Comprehensive assessment of the association between tumorinfiltrating immune cells and the prognosis of renal cell carcinoma

BACKGROUND According to current statistics,renal cancer accounts for 3%of all cancers world-wide.Renal cell carcinoma(RCC)is the most common solid lesion in the kidney and accounts for approximately 90%of all renal malignancies.Increasing evi-dence has shown an association between immune infiltration in RCC and clinical outcomes.To discover possible targets for the immune system,we investigated the link between tumor-infiltrating immune cells(TIICs)and the prognosis of RCC.AIM To investigate the effects of 22 TIICs on the prognosis of RCC patients and iden-tify potential therapeutic targets for RCC immunotherapy.METHODS The CIBERSORT algorithm partitioned the 22 TIICs from the Cancer Genome Atlas cohort into proportions.Cox regression analysis was employed to evaluate the impact of 22 TIICs on the probability of developing RCC.A predictive model for immunological risk was developed by analyzing the statistical relationship between the subpopulations of TIICs and survival outcomes.Furthermore,multi-variate Cox regression analysis was used to investigate independent factors for the prognostic prediction of RCC.A value of P<0.05 was regarded as statistically significant.RESULTS Compared to normal tissues,RCC tissues exhibited a distinct infiltration of im-mune cells.An immune risk score model was established and univariate Cox regression analysis revealed a significant association between four immune cell types and the survival risk connected to RCC.High-risk individuals were correlated to poorer outcomes according to the Kaplan-Meier survival curve(P=1E-05).The immunological risk score model was demonstrated to be a dependable predictor of survival risk(area under the curve=0.747)via the receiver operating characteristic curve.According to multivariate Cox regression analysis,the immune risk score model independently predicted RCC patients'prognosis(hazard ratio=1.550,95%CI:1.342–1.791;P<0.001).Finally,we established a nomogram that accurately and comprehensively forecast the survival of patients with RCC.CONCLUSION TIICs play various roles in RCC prognosis.The immunological risk score is an independent predictor of poor survival in kidney cancer cases.

Nomograms and risk score models for predicting survival in rectal cancer patients with neoadjuvant therapy

BACKGROUND Colorectal cancer is a common digestive cancer worldwide.As a comprehensive treatment for locally advanced rectal cancer(LARC),neoadjuvant therapy(NT)has been increasingly used as the standard treatment for clinical stage II/III rectal cancer.However,few patients achieve a complete pathological response,and most patients require surgical resection and adjuvant therapy.Therefore,identifying risk factors and developing accurate models to predict the prognosis of LARC patients are of great clinical significance.AIM To establish effective prognostic nomograms and risk score prediction models to predict overall survival(OS)and disease-free survival(DFS)for LARC treated with NT.METHODS Nomograms and risk factor score prediction models were based on patients who received NT at the Cancer Hospital from 2015 to 2017.The least absolute shrinkage and selection operator regression model were utilized to screen for prognostic risk factors,which were validated by the Cox regression method.Assessment of the performance of the two prediction models was conducted using receiver operating characteristic curves,and that of the two nomograms was conducted by calculating the concordance index(C-index)and calibration curves.The results were validated in a cohort of 65 patients from 2015 to 2017.RESULTS Seven features were significantly associated with OS and were included in the OS prediction nomogram and prediction model:Vascular_tumors_bolt,cancer nodules,yN,body mass index,matchmouth distance from the edge,nerve aggression and postoperative carcinoembryonic antigen.The nomogram showed good predictive value for OS,with a C-index of 0.91(95%CI:0.85,0.97)and good calibration.In the validation cohort,the C-index was 0.69(95%CI:0.53,0.84).The risk factor prediction model showed good predictive value.The areas under the curve for 3-and 5-year survival were 0.811 and 0.782.The nomogram for predicting DFS included ypTNM and nerve aggression and showed good calibration and a C-index of 0.77(95%CI:0.69,0.85).In the validation cohort,the C-index was 0.71(95%CI:0.61,0.81).The prediction model for DFS also had good predictive value,with an AUC for 3-year survival of 0.784 and an AUC for 5-year survival of 0.754.CONCLUSION We established accurate nomograms and prediction models for predicting OS and DFS in patients with LARC after undergoing NT.

Comparison scoring model of severe viral hepatitis and model of end stage liver disease for the prognosis of patients with liver failure in China

AIM:To estimate the prognosis of patients with liver failure using a scoring model of severe viral hepatitis (SMSVH) and a model of end stage liver disease (MELD) to provide a scientific basis for clinical decision of treatment. METHODS:One hundred and twenty patients with liver failure due to severe viral hepatitis were investigated with SMSVH established. Patients with acute,subacute,and chronic liver failure were 40,46 and 34,respectively. The follow-up time was 6 mo. The survival rates of patients with liver failure in 2 wk,4 wk,3 mo and 6 mo were estimated with Kaplan-Meier method. Comparison between SMSVH and MELD was made using ROC statistic analysis. RESULTS:The survival curves of group A (at low risk,SMSVH score ≤ 4) and group B (at high risk,SMSVH score ≥ 5) were significantly different (The 4-wk,3-mo,6-mo survival rates were 94.59%,54.05%,43.24% in group A,and 51.81%,20.48%,12.05% in group B,respectively,P < 0.001). The survival curves of group C (SMSVH scores unchanged or increased),group D (SMSVH scores decreased by 1) and group E (SMSVH scores decreased by 2 or more) were significantly different .The survival rates of groups C,D and E were 66.15%,100%,100% in 2-wk; 40.0%,91.18%,100% in 4-wk; 0%,58.82%,80.95% in 3-mo and 0%,38.24%,61.90% in 6-mo,respectively,P < 0.001). The area under the ROC curve (AUC) of SMSVH scores at baseline and after 2 wk of therapy was significantly higher than that under the ROC curve of MELD scores (0.804 and 0.934 vs 0.689,P < 0.001). CONCLUSION:SMSVH is superior to MELD in theestimation of the prognosis of patients with severe viral hepatitis within 6 mo. SMSVH may be regarded as a criterion for estimation of the efficacy of medical treatment and the decision of clinical treatment.

Prognostic models for acute liver failure

BACKGROUND: Acute liver failure (ALF) remains a dramatic and unpredictable disease with high morbidity and mortality. Early and accurate prognostic assessment of patients with ALF is critically important for optimum clinical pathway. DATA SOURCES: Five English-language medical databases, MEDLINE, Science Direct, OVID, Springer Link and Wiley Interscience were searched for articles on 'acute liver failure', 'prognosis', and related topics. RESULTS: Multi-variable prognostic models including the King's College Hospital criteria and the model for end-stage liver disease score have been widely used in determination of the prognosis of ALF, but the results are far from satisfactory. Other prognostic indicators including serum Gc-globulin, arterial blood lactate, serum phosphate, arterial blood ammonia, and serum alpha-fetoprotein are promising but await further assessement. CONCLUSIONS: A reliable prognostic model to be developed in the future should not only have predictive value for poor outcome but also help to predict the survival of patients without a liver transplantation. Further studies are necessary to assess the prognostic accuracy of any new models. (Hepatobiliary Pancreat Dis Int 2010; 9: 122-128)

APPROXIMATE POWER OF HETEROSCEDASTICITY TEST IN NONLINEAR MODELS WITH ARIMA（0,1,0） ERRORS

This paper presents an approach for estimating power of the score test, based on an asymptotic approximation to the power of the score test under contiguous alternatives. The method is applied to the problem of power calculations for the score test of heteroscedasticity in European rabbit data （Ratkowsky, 1983）. Simulation studies are presented which indicate that the asymptotic approximation to the finite-sample situation is good over a wide range of parameter configurations.

A multicriteria credit scoring model for SMEs using hybrid BWM and TOPSIS

Small-and medium-sized enterprises(SMEs)have a crucial influence on the economic development of every nation,but access to formal finance remains a barrier.Similarly,financial institutions encounter challenges in the assessment of SMEs’creditworthiness for the provision of financing.Financial institutions employ credit scoring models to identify potential borrowers and to determine loan pricing and collateral requirements.SMEs are perceived as unorganized in terms of financial data management compared to large corporations,making the assessment of credit risk based on inadequate financial data a cause for financial institutions’concern.The majority of existing models are data-driven and have faced criticism for failing to meet their assumptions.To address the issue of limited financial record keeping,this study developed and validated a system to predict SMEs’credit risk by introducing a multicriteria credit scoring model.The model was constructed using a hybrid best–worst method(BWM)and the Technique for Order of Preference by Similarity to Ideal Solution(TOPSIS).Initially,the BWM determines the weight criteria,and TOPSIS is applied to score SMEs.A real-life case study was examined to demonstrate the effectiveness of the proposed model,and a sensitivity analysis varying the weight of the criteria was performed to assess robustness against unpredictable financial situations.The findings indicated that SMEs’credit history,cash liquidity,and repayment period are the most crucial factors in lending,followed by return on capital,financial flexibility,and integrity.The proposed credit scoring model outperformed the existing commercial model in terms of its accuracy in predicting defaults.This model could assist financial institutions,providing a simple means for identifying potential SMEs to grant credit,and advance further research using alternative approaches.

The Effect of Urban Agglomeration Expansion on PM_(2.5) Concentrations: Evidence from a Quasi-natural Experiment

This study constructs a quasi-natural experiment based on the expansion of the Yangtze River Delta urban agglomeration(YRDUA) of China in 2010 to investigate the impact and inner mechanism of urban agglomeration expansion on fine particulate matter(PM_(2.5)) concentrations through propensity scores in difference-in-differences models(PSM-DID) using panel data from 286 prefecturelevel cities in China from 2003 to 2016. The results show that 1) urban agglomeration expansion contributes to an overall decrease in PM_(2.5)concentration, which is mainly achieved from the original cities. For the new cities, on the other hand, the expansion significantly increases the local PM_(2.5)concentration. 2) In the long term, the significant influence of urban agglomeration expansion on PM_(2.5)concentration lasts for three years and gradually decreases. A series of robustness tests confirm the applicability of the PSM-DID model.3) Cities with weaker government regulation, a better educated population and higher per capita income present stronger PM_(2.5)reduction effects. 4) Urban agglomeration expansion affects the PM_(2.5)concentration mainly through industrial transfer and population migration, which cause a decrease in the PM_(2.5)concentration in the original cities and an increase in the PM_(2.5)concentration in the new cities.Corresponding policy suggestions are proposed based on the conclusions.

Corrected QT interval in cirrhosis:A systematic review and metaanalysis

BACKGROUND Corrected QT(QTc)interval is prolonged in patients with liver cirrhosis and has been proposed to correlate with the severity of the disease.However,the effects of sex,age,severity,and etiology of cirrhosis on QTc have not been elucidated.At the same time,the role of treatment,acute illness,and liver transplantation(Tx)remains largely unknown.AIM To determine the mean QTc in patients with cirrhosis,assess whether QTc is prolonged in patients with cirrhosis,and investigate whether QTc is affected by factors such as sex,age,severity,etiology,treatment,acute illness,and liver Tx.METHODS In the present systematic review and meta-analysis,the searching protocol“{[QTc]OR[QT interval]OR[QT-interval]OR[Q-T syndrome]}AND{[cirrhosis]OR[Child-Pugh]OR[MELD]}”was applied in PubMed,EMBASE,and Google Scholar databases to identify studies that reported QTc in patients with cirrhosis and published after 1998.Seventy-three studies were considered eligible.Data concerning first author,year of publication,type of study,method used,sample size,mean age,female ratio,alcoholic etiology of cirrhosis ratio,Child-Pugh A/B/C ratio,mean model for end-stage liver disease(MELD)score,treatment withβ-blockers,episode of acute gastrointestinal bleeding,formula for QT correction,mean pulse rate,QTc in patients with cirrhosis and controls,and QTc according to etiology of cirrhosis,sex,Child-Pugh stage,MELD score,and liver Tx status(pre-Tx/post-Tx)were retrieved.The Newcastle-Ottawa quality assessment scale appraised the quality of the eligible studies.Effect estimates,expressed as proportions or standardized mean differences,were combined using the randomeffects,generic inverse variance method of DerSimonian and Laird.Subgroup,sensitivity analysis,and meta-regressions were applied to assess heterogeneity.RESULTS QTc combined mean in patients with cirrhosis was 444.8 ms[95%confidence interval(CI):440.4-449.2;P<0.001 when compared with the upper normal limit of 440 ms],presenting high heterogeneity(I2=97.5%;95%CI:97.2%-97.8%);both Egger’s and Begg’s tests showed non-significance.QTc was elongated in patients with cirrhosis compared with controls(P<0.001).QTc was longer in patients with Child-Pugh C cirrhosis when compared with Child-Pugh B and A(P<0.001);Child-Pugh B patients presented longer QTc when compared with Child-Pugh A patients(P=0.003).The MELD score was higher in patients with cirrhosis with QTc>440 ms when compared with QTc≤440 ms(P<0.001).No correlation of QTc with age(P=0.693),sex(P=0.753),or etiology(P=0.418)was detected.β-blockers shortened QTc(P<0.001).QTc was prolonged during acute gastrointestinal bleeding(P=0.020).Tx tended to improve QTc(P<0.001).No other sources of QTc heterogeneity were revealed.CONCLUSION QTc is prolonged in cirrhosis independently of sex,age,and etiology but is correlated with severity and affected byβ-blockers and acute gastrointestinal bleeding.QTc is improved after liver Tx.

Investigation on the Long Term Operational Stability of Underground Energy Storage in Salt Rock

Underground energy storage is an important function of all energy supply systems,and especially concerning the seemingly eternal imbalance between production and demand.Salt rock underground energy storage,for one,is widely applied in both traditional and renewable energy fields;and this particular technique can be used to store natural gas,hydrogen,and compressed air.However,resource diversification and structural complexity make the supply system increasingly uncertain with the passing years,leading to great challenges for energy storage facilities in the present,and perhaps going into the future as well.Hence,it is necessary to research the operation stability of underground energy storage further.In this paper,a stability evaluation index system of Underground Gas Storage(UGS)is constructed with natural gas as the main medium,according to FLAC 3D cavity creep simulation software,along with fuzzy membership function to comprehensively determine the impact factor scoring model;the subjective weight is calculated based on the improved Analytic Hierarchy Process(AHP),the objective weight is calculated by the Entropy Weight Method(EWM),the combined constant weight is obtained by combining the variance maximization theory,and introducing the variable weight theory to obtain a more accurate combined variable weight.Finally,with this all being considered and accounted for,and with the four different conditions designed for UGS deployment case analysis and verification taken into consideration,the combined variable weight evaluation achieved excellent results;compared with the traditional constant weight method,in fact,the new evaluation results are more rigorous and objective.

Lymphocyte-to-white blood cell ratio is associated with outcome in patients with hepatitis B virus-related acute-on-chronic liver failure

BACKGROUND The lymphocyte-to-white blood cell ratio(LWR)is a blood marker of the systemic inflammatory response.The prognostic value of LWR in patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF)remains unclear.AIM To explore whether LWR could stratify the risk of poor outcomes in HBV-ACLF patients.METHODS This study was conducted by recruiting 330 patients with HBV-ACLF at the Department of Gastroenterology in a large tertiary hospital.Patients were divided into survivor and non-survivor groups according to their 28-d prognosis.The independent risk factors for 28-d mortality were calculated by univariate and multivariate Cox regression analyses.Patients were divided into low-and high-LWR groups according to the cutoff values.Kaplan-Meier analysis was performed according to the level of LWR.RESULTS During the 28-d follow-up time,135 patients died,and the mortality rate was 40.90%.The LWR level in non-surviving patients was significantly decreased compared to that in surviving patients.A lower LWR level was an independent risk factor for poor 28-d outcomes(hazard ratio=0.052,95%confidence interval:0.005-0.535).The LWR level was significantly negatively correlated with the Child-Turcotte-Pugh,model for end-stage liver disease,and Chinese Group on the Study of Severe Hepatitis B-ACLF II scores.In addition,the 28-d mortality was higher for patients with LWR<0.11 than for those with LWR≥0.11.CONCLUSION LWR may serve as a simple and useful tool for stratifying the risk of poor 28-d outcomes in HBVACLF patients.

Biomarkers for hepatocellular cancer

Hepatocellular carcinoma(HCC)is the third leading cause of cancer-related deaths worldwide.If diagnosed early,curative treatment options such as surgical resection,loco-regional therapies,and liver transplantation are available to patients,increasing their chances of survival and improving their quality of life.Unfortunately,most patients are diagnosed with late stage HCC where only palliative treatment is available.Therefore,biomarkers which could detect HCC early with a high degree of sensitivity and specificity,may play a crucial role in the diagnosis and management of the disease.This review will aim to provide an overview of the different biomarkers of HCC comprising those used in the diagnosis of HCC in at risk populations,as well as others with potential for prognosis,risk predisposition and prediction of response to therapeutic intervention.

Phase 1 human trial of autologous bone marrow-hematopoietic stem cell transplantation in patients with decompensated cirrhosis

AIM: To evaluate safety and feasibility of autologous bone marrow-enriched CD34+ hematopoietic stem cell Tx through the hepatic artery in patients with decompensated cirrhosis.METHODS: Four patients with decompensated cirrhosis were included. Approximately 200 mL of the bone marrow of the patients was aspirated, and CD34+ stem cells were selected. Between 3 to 10 million CD34+ cells were isolated. The cells were slowly infused through the hepatic artery of the patients.RESULTS: Patient 1 showed marginal improvement in serum albumin and no significant changes in other test results. In patient 2 prothrombin time was decreased; however, her total bilirubin, serum creatinine, and Model of End-Stage Liver Disease (MELD) score worsened at the end of follow up. In patient 3 there was improvement in serum albumin, porthrombin time (PT), and MELD score. Patient 4 developed radiocontrast nephropathy after the procedure, and progressed to type 1 hepatorenal syndrome and died of liver failure a few days later. Because of the major side effects seen in the last patient, the trial was prematurely stopped.CONCLUSION: Infusion of CD34+ stem cells through the hepatic artery is not safe in decompensated cirrhosis. Radiocontrast nephropathy and hepatorenal syndrome could be major side effects. However, this study doesnot preclude infusion of CD34+ stem cells through other routes.

Revalidation of a prognostic score model based on complete blood count for nasopharyngeal carcinoma through a prospective study

Objective： In our previous work, we incorporated complete blood count （CBC） into TNM stage to develop a new prognostic score model, which was validated to improve prediction efficiency of TNM stage for nasopharyngeal carcinoma （NPC）. The purpose of this study was to revalidate the accuracy of the model, and its superiority to TNM stage, through data from a prospective study.Methods： CBC of 249 eligible patients from the 863 Program No. 2006AA02Z4B4 was evaluated. Prognostic index （PI） of each patient was calculated according to the score model. Then they were divided by the PI into three categories： the low-, intermediate-and high-risk patients. The 5-year disease-specific survival （DSS） of the three categories was compared by a log-rank test. The model and TNM stage （Tth edition） were compared on efficiency for predicting the 5-year DSS, through comparison of the area under curve （AUC） of their receiver-operating characteristic curves.Results： The 5-year DSS of the low-, intermediate- and high-risk patients were 96.0%, 79.1% and 62.2%, respectively. The low- and intermediate-risk patients had better DSS than the high-risk patients （P〈0.001 and P〈0.005, respectively）. And there was a trend of better DSS in the low-risk patients, compared with the intermediate-risk patients （P=0.049）. The AUC of the model was larger than that of TNM stage （0.726 vs. 0.661, P：0.023）. Conclusions： A CBC-based prognostic score model was revalidated to be accurate and superior to TNM stage on predicting 5-year DSS of NPC.

MELD score can predict early mortality in patients with rebleeding after band ligation for variceal bleeding

AIM:To investigate the outcomes,as well as risk factors for 6-wk mortality,in patients with early rebleeding after endoscopic variceal band ligation (EVL) for esophageal variceal hemorrhage (EVH).METHODS:Among 817 EVL procedures performed for EVH between January 2007 and December 2008,128 patients with early rebleeding,defined as rebleeding within 6 wk after EVL,were enrolled for analysis.RESULT:The rate of early rebleeding after EVL for acute EVH was 15.6% (128/817).The 5-d,6-wk,3-mo,and 6-mo mortality rates were 7.8%,38.3%,55.5%,and 58.6%,respectively,in these early rebleeding patients.The use of beta-blockers,occurrence of hypovolemic shock,and higher model for end-stage liver disease (MELD) score at the time of rebleeding were independent predictors for 6-wk mortality.A cut-off value of 21.5 for the MELD score was found with an area under ROC curve of 0.862 (P < 0.001).The sensitivity,specificity,positive predictive value,and negative predictive value were 77.6%,81%,71.7%,and 85.3%,respectively.As for the 6-mo survival rate,patients with a MELD score ≥ 21.5 had a significantly lower survival rate than patients with a MELD score < 21.5 (P < 0.001).CONCLUSION:This study demonstrated that the MELD score is an easy and powerful predictor for 6-wk mortality and outcomes of patients with early rebleeding after EVL for EVH.

Pentoxifylline versus prednisolone for severe alcoholic hepatitis:A randomized controlled trial

AIM： To compare the efficacy of pentoxifylline and prednisolone in the treatment of severe alcoholic hepatitis, and to evaluate the role of different liver function scores in predicting prognosis.METHODS： Sixty-eight patients with severe alcoholic hepatitis （Maddrey score ≥ 32） received pentoxifylline （n = 34, group Ⅰ） or prednisolone （n = 34, group Ⅱ） for 28 d in a randomized double-blind controlled study, and subsequently in an open study （with a tapering dose of prednisolone） for a total of 3 mo, and were followed up over a period of 12 mo.RESULTS： Twelve patients in group Ⅱ died at the end of 3 mo in contrast to five patients in group Ⅰ. The probability of dying at the end of 3 mo was higher in group Ⅱ as compared to group Ⅰ （35.29% vs 14.71%, P = 0.04; log rank test）. Six patients in group I developed hepatorenal syndrome as compared to none in group Ⅰ. Pentoxifylline was associated with a significantly lower model for end-stage liver disease （MELD） score at the end of 28 d of therapy （15.53± 3.63 vs 17.78± 4.56, P=0.04）. Higher baseline Maddrey score was associated with increased mortality.CONCLUSION： Reduced mortality, improved risk-benefit profile and renoprotective effects of pentoxifylline compared with prednisolone suggest that pentoxifylline is superior to prednisolone for treatment of severe alcoholic hepatitis.

Modified model for end-stage liver disease improves shortterm prognosis of hepatitis B virus-related acute-on-chronic liver failure

AIM To investigate whether the short-term prognosis of hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF) could be improved by using a modified model for end-stage liver disease(MELD) including serum lactate.METHODS This clinical study was conducted at the First Affiliated Hospital, Fujian Medicine University, China. From 2009 to 2015, 236 patients diagnosed with HBV-related ACLF at our center were recruited for this 3-month followup study. Demographic data and serum lactate levels were collected from the patients. The MELD scores with or without serum lactate levels from survival and nonsurvival groups were recorded and compared.RESULTS Two hundred and thirty-six patients with HBV-ACLF were divided into two groups: survival group(S) andnon-survival group(NS). Compared with the NS group, the patients in survival the S group had a significantly lower level of serum lactate(3.11 ± 1.98 vs 4.67 ± 2.43, t = 5.43, P < 0.001) and MELD score(23.33 ± 5.42 vs 30.37 ± 6.58, t = 9.01, P = 0.023). Furthermore, serum lactate level was positively correlated with MELD score(r = 0.315, P < 0.001). Therefore, a modified MELD including serum lactate was developed by logistic regression analysis(0.314 × lactate + 0.172 × MELD-5.923). In predicting 3-month mortality using the MELD-LAC model, the patients from the S group had significantly lower baseline scores(-0.930 ± 1.34) when compared with those from the NS group(0.771 ± 1.32, t = 9.735, P < 0.001). The area under the receiver operating characteristic curve(AUROC) was 0.859 calculated by using the MELD-LAC model, which was significantly higher than that calculated by using the lactate level(0.790) or MELD alone(0.818). When the cutoff value was set at-0.4741, the sensitivity, specificity, positive predictive value and negative predictive value for predicting short-term mortality were 91.5%, 80.10%, 94.34% and 74.62%, respectively. When the MELD-LAC scores at baseline level were set at-0.5561 and 0.6879, the corresponding mortality rates within three months were 75% and 90%, respectively.CONCLUSION The short-term prognosis of HBV-related ACLF was improved by using a modified MELD including serum lactate from the present 6-year clinical study.

A risk prediction score model for predicting occurrence of post-PCI vasovagal reflex syndrome： a single center study in Chinese population

Background The vasovagal reflex syndrome （VVRS） is common in the patiems undergoing percutaneous coronary intervemion （PCI） However, prediction and prevention of the risk for the VVRS have not been completely fulfilled. This study was conducted to develop a Risk Prediction Score Model to identify the determinants of VVRS in a large Chinese population cohort receiving PCI. Methods From the hos- pital electronic medical database, we idemified 3550 patients who received PCI （78.0% males, mean age 60 years） in Chinese PLA General Hospital from January 1, 2000 to August 30, 2016. The multivariate analysis and receiver operating characteristic 01OC） analysis were performed. Results The adverse events of VVRS in the patients were significantly increased after PCI procedure than before the operation （all P 〈 0.001）. The rate of VVRS [95% confidence interval （CI）] in patients receiving PCI was 4.5% （4.1%-5.6%）. Compared to the patients suffering no VVRS, incidence of VVRS involved the following factors, namely female gender, primary PCI, hypertension, over two stems im- plantation in the left anterior descending （LAD）, and the femoral puncture site. The multivariate analysis suggested that they were independ- ent risk factors for predicting the incidence of VVRS （all P 〈 0.001）. We developed a risk prediction score model for VVRS. ROC analysis showed that the risk prediction score model was effectively predictive of the incidence of VVRS in patients receiving PCI （c-statistic 0.76, 95% CI： 0.72-0.79, P 〈 0.001）. There were decreased evems of VVRS in the patients receiving PCI whose diastolic blood pressure dropped by more than 30 mmHg and heart rate reduced by 10 times per minute （AUC： 0.84, 95% CI： 0.81-0.87, P 〈 0.001）. Conclusion The risk prediction score is quite efficient in predicting the incidence of VVRS in patients receiving PCI. In which, the following factors may be in- volved, the femoral puncture site, female gender, hypertension, primary PCI, and over 2 stents implanted in LAD.

Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients

AIMTo evaluate the reversibility of minimal hepatic encephalopathy (MHE) following liver transplantation (LT) in Egyptian cirrhotic patients. METHODSThis prospective study included twenty patients with biopsy-proven liver cirrhosis listed for LT and twenty age- and sex-matched healthy control subjects. All underwent neuro-psychiatric examination, laboratory investigations, radiological studies and psychometric tests including trail making test A (TMT A), TMT B, digit symbol test and serial dotting test. The psychometric hepatic encephalopathy score (PHES) was calculated for patients to diagnose MHE. Psychometric tests were repeated six months following LT in the cirrhotic patient group. RESULTSBefore LT, psychometric tests showed highly significant deficits in cirrhotic patients in comparison to controls (P P P P = 0.005). More patients in whom reversal of MHE was observed had a pre-transplant MELD score CONCLUSIONReversal of MHE in cirrhotic patients could be achieved by LT, especially in those with a MELD score

Predictors of the outcomes of acute-on-chronic hepatitis B liver failure

AIM： To identify the risk factors in predicting the out- come of acute-on-chronic hepatitis B liver failure pa- tients. METHODS： We retrospectively divided 113 patients with acute-on-chronic liver failure-hepatitis B virus （ACLF-HBV） and without concurrent hepatitis C or D virus infection and hepatocellular carcinoma into two groups according to their outcomes after anti-HBV therapy. Their demographic, clinical, and biochemical data on the day of diagnosis and after the first week of treatment were analyzed using the Mann-Whitney U test, Fisher＇s exact test, and a multiple logistic regres- sion analysis. RESULTS： The study included 113 patients （87 men and 26 women） with a mean age of 49.84 years. Fifty- two patients survived, and 61 patients died. Liver failure （85.2%）, sepsis （34.4%）, and multiple organ failure （39.3%） were the main causes of death. Mul- tivariate analyses showed that Acute Physiology and Chronic Health Evaluation （APACHE） Ⅱ scores ≥ 12 [odds ratio （OR） = 7.160, 95% CI： 2.834-18.092, P 〈 0.001] and positive blood culture （OR = 13.520, 95% CI： 2.740-66.721, P = 0.001） on the day of diagnosis and model for end-stage liver disease （MELD） scores 28 （OR = 8.182, 95% CI： 1.884-35.527, P = 0.005） after the first week of treatment were independent predictors of mortality. CONCLUSION： APACHE II scores on the day of diag- nosis and MELD scores after the first week of anti-HBV therapy are feasible predictors of outcome in ACLF- HBV patients.

Child-Pugh-Turcott versus Meld score for predicting survival in a retrospective cohort of black African cirrhotic patients

AIM: To compare the performance of the Child-Pugh-Turcott (CPT) score to that of the model for end-stage liver disease (MELD) score in predicting survival of a retrospective cohort of 172 Black African patients with cirrhosis on a short and mid-term basis.METHODS: Univariate and multivariate (Cox model) analyses were used to identify factors related to mortality. Relationship between the two scores was appreciated by calculating the correlation coefficient. The Kaplan Meier method and the log rank test were used to elaborate and compare survival respectively. The Areas Under the Curves were used to compare the performance between scores at 3, 6 and 12 mo.RESULTS: The study population comprised 172 patients, of which 68.9% were male. The mean age of the patient was 47.5 ± 13 years. Hepatitis B virus infection was the cause of cirrhosis in 70% of the cases. The overall mortality was 31.4% over 11 years of follow up. Independent factors significantly associated with mortality were: CPT score (HR = 3.3, 95% CI [1.7-6.2]) (P < 0.001) (stage C vs stage A-B); Serum creatine (HR = 2.5, 95% CI [1.4-4.3]) (P = 0.001) (Serum creatine > 1.5 mg/dL versus serum creatine < 1.5 mg/dL); MELD score (HR = 2.9, 95% CI [1.63-5.21]) (P < 0.001) (MELD > 21 vs MELD < 21). The area under the curves (AUC) that predict survival was 0.72 and 0.75 at 3 mo (P = 0.68), 0.64 and 0.62 at 6 mo (P = 0.67), 0.69 and 0.64 at 12 mo (P = 0.38) respectively for the CPT score and the MELD score.CONCLUSION: The CPT score displays the sameprognostic significance as does the MELD score in black African patients with cirrhosis. Moreover, its handling appears less cumbersome in clinical practice as compared to the latter.