Non-invasive tests for predicting liver outcomes in chronic hepatitis C patients: A systematic review and meta-analysis

BACKGROUND Liver fibrosis leads to liver-related events in patients with chronic hepatitis C(CHC)infection.Although non-invasive tests(NITs)are critical to early detection of the development of liver fibrosis,the prognostic role of NITs remains unclear due to the limited types of NITs and liver outcomes explored in previous studies.AIM To determine the prognostic value of NITs for risk stratification in CHC patients.METHODS The protocol was registered in PROSPERO(International Prospective Register of Systematic Reviews;no.CRD42019128176).The systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Search was performed using MEDLINE and EMBASE databases under a timeframe from the inception of the databases through February 25,2020.We restricted our search to CHC cohort studies reporting an association between liver fibrosis assessed by NITs and the development of hepatocellular carcinoma,decompensation,or mortality.Pooled hazard ratios(HR)and area under the receiver operating characteristic(AUROC)for each NIT were estimated using a random effects model.Subgroup analyses were performed for NITs assessed at pre-treatment or post-treatment with sustained virologic response(SVR),treatment with either pegylated interferon and ribavirin or direct acting antiviral,Eastern or Western countries,and different cutoff points.RESULTS The present meta-analysis included 29 cohort studies,enrolling 69339 CHC patients.Fibrosis-4(FIB-4)index,aspartate aminotransferase to platelet ratio(APRI)score,and liver stiffness measurement(LSM)were found to have hepatocellular carcinoma predictive potential with pooled adjusted HRs of 2.48[95%confidence interval(CI):1.91-3.23,I2=96%],4.24(95%CI:2.15-8.38,I2=20%)and 7.90(95%CI:3.98-15.68,I2=52%)and AUROCs of 0.81(95%CI:0.73-0.89,I2=77%),0.81(95%CI:0.75-0.87,I2=68%),and 0.79(95%CI:0.63-0.96,I2=90%),respectively.Pooled adjusted HR with a pre-treatment FIB-4 cutoff of 3.25 was 3.22(95%CI:2.32-4.47,I2=80%).Pooled adjusted HRs for post-treatment with SVR FIB-4,APRI,and LSM were 3.01(95%CI:0.32-28.61,I2=89%),9.88(95%CI:2.21-44.17,I2=24%),and 6.33(95%CI:2.57-15.59,I2=17%),respectively.Pooled adjusted HRs for LSM in patients with SVR following direct acting antiviral therapy was 5.55(95%CI:1.47-21.02,I2=36%).Pooled AUROCs for post-treatment with SVR FIB-4 and LSM were 0.75(95%CI:0.55-0.95,I2=88%)and 0.84(95%CI:0.66-1.03,I2=88%),respectively.Additionally,FIB-4 and LSM were associated with overall mortality,with pooled adjusted HRs of 2.07(95%CI:1.49-2.88,I2=27%)and 4.04(95%CI:2.40-6.80,I2=63%),respectively.CONCLUSION FIB-4,APRI,and LSM showed potential for risk stratification in CHC patients.Cutoff levels need further validation.

Non-invasive tests for the prediction of primary hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is one of the most common malignancies in the world and it is one of the main complications of cirrhosis and portal hypertension.Even in the presence of a well-established follow-up protocol for cirrhotic patients,to date poor data are available on predictive markers for primary HCC occurrence in the setting of compensated advanced chronic liver disease patients(cACLD).The gold standard method to evaluate the prognosis of patients with cACLD,beyond liver fibrosis assessed with histology,is the measurement of the hepatic venous pressure gradient(HVPG).An HVPG≥10 mmHg has been related to an increased risk of HCC in cACLD patients.However,these methods are burdened by additional costs and risks for patients and are mostly available only in referral centers.In the last decade increasing research has focused on the evaluation of several,simple,non-invasive tests(NITs)as predictors of HCC development.We reviewed the currently available literature on biochemical and ultrasound-based scores developed for the noninvasive evaluation of liver fibrosis and portal hypertension in predicting primary HCC.We found that the most reliable methods to assess HCC risk were the liver stiffness measurement,the aspartate aminotransferase to platelet ratio index score and the fibrosis-4 index.Other promising NITs need further investigations and validation for different liver disease aetiologies.

A Retrospective Analysis of Three Non-Invasive Tests for Initial Diagnosis of <i>Helicobacter pylori</i>Infection in Children

Proper diagnosis in the pediatric population is required to eradicate Helicobacter pylori (H. pylori) and prevent gastric cancer. Our aim was to assess the performance of non-invasive tests to diagnose H. pylori infection in pediatric patients. A retrospective analysis was performed on 141 pediatric patients requiring endoscopic evaluation and diagnostic tests for H. pylori infection to define the cause of abdominal symptoms. Non-invasive tests included the 13C-urea breath test (UBT), a monoclonal stool antigen test using enzyme-linked immuno-sorbent assay (mSAT), and a serum immunoglobulin G antibody test using antigens derived from Japanese individuals (S-Ab). This study investigated sensitivity, specificity, likelihood ratios for a positive and a negative test (LR+ and LR-), and accuracy of non-invasive tests, in comparison with invasive tests. Eighty two of 141 patients (58%) were recognized as H. pylori positive by invasive methods. When UBT, mSAT or S-Ab were analyzed, all were found to be effective over 94% accurate. Specificity ranged between 86.7% and 95.8%, and sensitivity ranged between 93.8% and 97.1%. When subjects were stratified into three distinct age groups, the best performance was achieved for 1-6 years old with mSAT at 100% for sensitivity, specificity, and accuracy. S-Ab yielded the best results for children 7-12 years old and the UBT test performed best for 13-18 years old. These results demonstrate the utility of UBT, mSAT, and S-Ab non-invasive tests in diagnosing H. pylori but suggest that certain tests may be optimal for children of distinct ages. Three non-invasive tests, UBT, mSAT and S-Ab showed sufficient sensitivity, specificity and accuracy for the initial diagnosis of H. pylori infection among pediatric patients. Non-invasive tests may contribute to achieving minimum invasive diagnosis with combining with a histological test and a culture test in children.

Clinical utility of non-invasive tests to predict clinical outcomes in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD)is the leading cause of chronic liver disease,and the fastest-growing cause of hepatocellular carcinoma(HCC)worldwide(1,2).As the number of people with NAFLD is too great to perform surveillance in all,risk-stratification strategies are increasingly important to identify those at the highest risk of decompensation and HCC(3,4).

Relationship Between Gene-Phenotype and Clinical Manifestations of Chromosomal Copy Number Variations Indicated by Non-Invasive Prenatal Testing

Objective:To analyze the clinical value of non-invasive prenatal testing(NIPT)in detecting chromosomal copy number variations(CNVs)and to explore the relationship between gene expression and clinical manifestations of chromosomal copy number variations.Methods:3551 naturally conceived singleton pregnant women who underwent NIPT were included in this study.The NIPT revealed abnormalities other than sex chromosome abnormalities and trisomy 13,18,and 21.Pregnant women with chromosome copy number variations underwent genetic counseling and prenatal ultrasound examination.Interventional prenatal diagnosis and chromosome microarray analysis(CMA)were performed.The clinical phenotypes and pregnancy outcomes of different prenatal diagnoses were analyzed.Additionally,a follow-up was conducted by telephone to track fetal development after birth,at six months,and one year post-birth.Results:A total of 53 cases among 3551 cases showed chromosomal copy number variation.Interventional prenatal diagnosis was performed in 36 cases:27 cases were negative and 8 were consistent with the NIPT test results.This indicates that NIPT’s positive predictive value(PPV)in CNVs is 22.22%.Conclusion:NIPT has certain clinical significance in screening chromosome copy number variations and is expected to become a routine screening for chromosomal microdeletions and microduplications.However,further interventional prenatal diagnosis is still needed to identify fetal CNVs.

Functional near-infrared spectroscopy in non-invasive neuromodulation

Non-invasive cerebral neuromodulation technologies are essential for the reorganization of cerebral neural networks,which have been widely applied in the field of central neurological diseases,such as stroke,Parkinson’s disease,and mental disorders.Although significant advances have been made in neuromodulation technologies,the identification of optimal neurostimulation paramete rs including the co rtical target,duration,and inhibition or excitation pattern is still limited due to the lack of guidance for neural circuits.Moreove r,the neural mechanism unde rlying neuromodulation for improved behavioral performance remains poorly understood.Recently,advancements in neuroimaging have provided insight into neuromodulation techniques.Functional near-infrared spectroscopy,as a novel non-invasive optical brain imaging method,can detect brain activity by measuring cerebral hemodynamics with the advantages of portability,high motion tole rance,and anti-electromagnetic interference.Coupling functional near-infra red spectroscopy with neuromodulation technologies offe rs an opportunity to monitor the cortical response,provide realtime feedbac k,and establish a closed-loop strategy integrating evaluation,feedbac k,and intervention for neurostimulation,which provides a theoretical basis for development of individualized precise neuro rehabilitation.We aimed to summarize the advantages of functional near-infra red spectroscopy and provide an ove rview of the current research on functional near-infrared spectroscopy in transcranial magnetic stimulation,transcranial electrical stimulation,neurofeedback,and braincomputer interfaces.Furthermore,the future perspectives and directions for the application of functional near-infrared spectroscopy in neuromodulation are summarized.In conclusion,functional near-infrared spectroscopy combined with neuromodulation may promote the optimization of central pellral reorganization to achieve better functional recovery form central nervous system diseases.

Research on aiming methods for small sample size shooting tests of two-dimensional trajectory correction fuse

The longitudinal dispersion of the projectile in shooting tests of two-dimensional trajectory corrections fused with fixed canards is extremely large that it sometimes exceeds the correction ability of the correction fuse actuator.The impact point easily deviates from the target,and thus the correction result cannot be readily evaluated.However,the cost of shooting tests is considerably high to conduct many tests for data collection.To address this issue,this study proposes an aiming method for shooting tests based on small sample size.The proposed method uses the Bootstrap method to expand the test data;repeatedly iterates and corrects the position of the simulated theoretical impact points through an improved compatibility test method;and dynamically adjusts the weight of the prior distribution of simulation results based on Kullback-Leibler divergence,which to some extent avoids the real data being"submerged"by the simulation data and achieves the fusion Bayesian estimation of the dispersion center.The experimental results show that when the simulation accuracy is sufficiently high,the proposed method yields a smaller mean-square deviation in estimating the dispersion center and higher shooting accuracy than those of the three comparison methods,which is more conducive to reflecting the effect of the control algorithm and facilitating test personnel to iterate their proposed structures and algorithms.;in addition,this study provides a knowledge base for further comprehensive studies in the future.

FibroScan-aspartate transaminase:A superior non-invasive model for diagnosing high-risk metabolic dysfunction-associated steatohepatitis

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)with hepatic histological NAFLD activity score≥4 and fibrosis stage F≥2 is regarded as“at risk”non-alcoholic steatohepatitis(NASH).Based on an international consensus,NAFLD and NASH were renamed as metabolic dysfunction-associated steatotic liver disease(MASLD)and metabolic dysfunction-associated steatohepatitis(MASH),respectively;hence,we introduced the term“high-risk MASH”.Diagnostic values of seven non-invasive models,including FibroScan-aspartate transaminase(FAST),fibrosis-4(FIB-4),aspartate transaminase to platelet ratio index(APRI),etc.for high-risk MASH have rarely been studied and compared in MASLD.AIM To assess the clinical value of seven non-invasive models as alternatives to liver biopsy for diagnosing high-risk MASH.METHODS A retrospective analysis was conducted on 309 patients diagnosed with NAFLD via liver biopsy at Beijing Ditan Hospital,between January 2012 and December 2020.After screening for MASLD and the exclusion criteria,279 patients wereincluded and categorized into high-risk and non-high-risk MASH groups.Utilizing threshold values of each model,sensitivity,specificity,positive predictive value(PPV),and negative predictive values(NPV),were calculated.Receiver operating characteristic curves were constructed to evaluate their diagnostic efficacy based on the area under the curve(AUROC).RESULTS MASLD diagnostic criteria were met by 99.4%patients with NAFLD.The MASLD population was analyzed in two cohorts:Overall population(279 patients)and the subgroup(117 patients)who underwent liver transient elastography(FibroScan).In the overall population,FIB-4 showed better diagnostic efficacy and higher PPV,with sensitivity,specificity,PPV,NPV,and AUROC of 26.9%,95.2%,73.5%,72.2%,and 0.75.APRI,Forns index,and aspartate transaminase to alanine transaminase ratio(ARR)showed moderate diagnostic efficacy,whereas S index and gamma-glutamyl transpeptidase to platelet ratio(GPR)were relatively weaker.In the subgroup,FAST had the highest diagnostic efficacy,its sensitivity,specificity,PPV,NPV,and AUROC were 44.2%,92.3%,82.1%,67.4%,and 0.82.The FIB-4 AUROC was 0.76.S index and GPR exhibited almost no diagnostic value for high-risk MASH.CONCLUSION FAST and FIB-4 could replace liver biopsy as more effectively diagnostic methods for high-risk MASH compared to APRI,Forns index,ARR,S index,and GPR;FAST is superior to FIB-4.

Retrospective analysis of discordant results between histology and other clinical diagnostic tests on helicobacter pylori infection

BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histologic examination is a test that clinicians heavily rely on,especially when complemented with immunohistochemistry(IHC).Additionally,other diagnostic tests for H.pylori,such as the rapid urease test(CLO test)and stool antigen test(SA),are also highly sensitive and specific.Typically,the results of histology and other tests align with each other.However,on rare occasions,discrepancy between histopathology and other H.pylori diagnostic tests occurs.AIM To investigate the discordance between histology and other H.pylori tests,the underlying causes,and the impact on clinical management.METHODS Pathology reports of gastric biopsies were retrieved spanning August 2013 and July 2018.Reports were included in the study only if there were other H.pylori tests within seven days of the biopsy.These additional tests include CLO test,SA,and H.pylori culture.Concordance between histopathology and other tests was determined based on the consistency of results.In instances where histology results were negative while other tests were positive,the slides were retrieved for re-assessment,and the clinical chart was reviewed.RESULTS Of 1396 pathology reports were identified,each accompanied by one additional H.pylori test.The concordance rates in detecting H.pylori infection between biopsy and other tests did not exhibit significant differences based on the number of biopsy fragments.117 discrepant cases were identified.Only 20 cases(9 with CLO test and 11 with SA)had negative biopsy but positive results in other tests.Four cases initially stained with Warthin-Starry turned out to be positive for H.pylori with subsequent IHC staining.Among the remaining 16 true discrepant cases,10 patients were on proton pump inhibitors before the biopsy and/or other tests.Most patients underwent treatment,except for two who were untreated,and two patients who were lost to follow-up.CONCLUSION There are rare discrepant cases with negative biopsy but positive in SA or CLO test.Various factors may contribute to this inconsistency.Most patients in such cases had undergone treatment.

Dynamic response of mountain tunnel,bridge,and embankment along the Sichuan-Tibet transportation corridor to active fault based on model tests

The Sichuan-Tibet transportation corridor is prone to numerous active faults and frequent strong earthquakes.While extensive studies have individually explored the effect of active faults and strong earthquakes on different engineering structures,their combined effect remains unclear.This research employed multiple physical model tests to investigate the dynamic response of various engineering structures,including tunnels,bridges,and embankments,under the simultaneous influence of cumulative earthquakes and stick-slip misalignment of an active fault.The prototype selected for this study was the Kanding No.2 tunnel,which crosses the Yunongxi fault zone within the Sichuan-Tibet transportation corridor.The results demonstrated that the tunnel,bridge,and embankment exhibited amplification in response to the input seismic wave,with the amplification effect gradually decreasing as the input peak ground acceleration(PGA)increased.The PGAs of different engineering structures were weakened by the fault rupture zone.Nevertheless,the misalignment of the active fault may decrease the overall stiffness of the engineering structure,leading to more severe damage,with a small contribution from seismic vibration.Additionally,the seismic vibration effect might be enlarged with the height of the engineering structure,and the tunnel is supposed to have a smaller PGA and lower dynamic earth pressure compared to bridges and embankments in strong earthquake zones crossing active faults.The findings contribute valuable insights for evaluating the dynamic response of various engineering structures crossing an active fault and provide an experimental reference for secure engineering design in the challenging conditions of the Sichuan-Tibet transportation corridor.

Stress tensor determination by modified hydraulic tests on pre-existing fractures:Method and stress constraints

The hydraulic testing of pre-existing fractures(HTPF)is one of the most promising in situ stress measurement methods,particularly for three-dimensional stress tensor determination.However,the stress tensor determination based on the HTPF method requires at least six tests or a minimum of 14-15 tests(under different conditions)for reliable results.In this study,we modified the HTPF method by considering the shear stress on each pre-existing fracture,which increased the number of equations for the stress tensor determination and decreased the number of tests required.Different shear stresses were attributed to different fractures by random sampling;therefore,the stress tensors were obtained by searching for the optimal solution using the least squares criterion based on the Monte Carlo method.Thereafter,we constrained the stress tensor based on the tensile strength criterion,compressive strength criterion,and vertical stress constraints.The inverted stress tensors were presented and analyzed based on the tensorial nature of the stress using the Euclidean mean stress tensor.Two stress-measurement campaigns in Weifang(Shandong Province,China)and Mercantour road tunnel(France)were implemented to highlight the validity and efficiency of the modified HTPF(M-HTPF)method.The results showed that the M-HTPF method can be applied for stress tensor inversion using only three to four tests on pre-existing fractures,neglecting the stress gradient.The inversion results were confined to relatively small distribution dispersions and were significantly reliable and stable due to the shear stresses on the fractures and the stress constraints employed.The M-HTPF method is highly feasible and efficient for complete stress tensor determination in a single borehole.

Novel Method for Evaluating the Aging of Aviation Turbine Engine Oils via High-Temperature Bearing Deposit Tests

Aviation turbine engine oils require excellent thermal-oxidative stability because of their high-temperature environments.High-temperature bearing deposit testing is a mandatory method for measuring the thermal-oxidative performance of aviation lubricant oils,and the relevant apparatus was improved in the present study.Two different commercial aviation turbine engine oils were tested,one with standard performance(known as the SL oil)and the other with high thermal stability,and their thermal-oxidative stability characteristics were evaluated.After 100 h of high-temperature bearing testing,the SL oil was analyzed by using various analytical techniques to investigate its thermal-oxidative process in the bearing test,with its thermal-oxidative degradation mechanism also being discussed.The results indicate that the developed high-temperature bearing apparatus easily meets the test requirements of method 3410.1 in standard FED-STD-791D.The viscosity and total acid number(TAN)of the SL oil increased with the bearing test time,and various deposits were produced in the bearing test,with the micro-particles of the carbon deposits being sphere-like,rod-like,and sheet-like in appearance.The antioxidant additives in the oil were consumed very rapidly in the first 30 h of the bearing test,with N-phenyl-1-naphthylamine being consumed faster than dioctyldiphenylamine.Overall,the oil thermal-oxidative process involves very complex physical and chemical mechanisms.

Significance of oxidative stress and antioxidant capacity tests as biomarkers of premature ovarian insufficiency: A case control study

BACKGROUND Premature ovarian insufficiency(POI)is a condition that causes secondary amenorrhea owing to ovarian hypofunction at an early stage.Early follicular depletion results in intractable infertility,thereby considerably reducing the quality of life of females.Given the continuum in weakened ovarian function,progressing from incipient ovarian failure(IOF)to transitional ovarian failure and further to POI,it is necessary to develop biomarkers for predicting POI.The oxidative stress states in IOF and POI were comprehensively evaluated via oxidative stress[diacron-reactive oxygen metabolites(d-ROMs)]test and anti-oxidant capacity[biological antioxidant potential(BAP)].METHODS Females presenting with secondary amenorrhea over 4 mo and a follicle stimulating hormone level of>40 mIU/mL were categorized into the POI group.Females presenting with a normal menstrual cycle and a follicle stimulating hormone level of>10.2 mIU/mL were categorized into the IOF group.Healthy females without ovarian hypofunction were categorized into the control group.Among females aged<40 years who visited our hospital from January 2021 to June 2022,we recruited 11 patients into both POI and IOF groups.For the potential antioxidant capacity,the relative oxidative stress index(BAP/d-ROMs×100)was calculated,and the oxidative stress defense system was comprehensively evaluated.RESULTS d-ROMs were significantly higher in the POI and IOF groups than in the control group,(478.2±58.7 U.CARR,434.5±60.6 U.CARR,and 341.1±35.1 U.CARR,respectively)(U.CARR is equivalent to 0.08 mg/dL of hydrogen peroxide).However,no significant difference was found between the POI and IOF groups.Regarding BAP,no significant difference was found between the control,IOF,and POI groups(2078.5±157.4μmol/L,2116.2±240.2μmol/L,and 2029.0±186.4μmol/L,respectively).The oxidative stress index was significantly higher in the POI and IOF groups than in the control group(23.7±3.3,20.7±3.6,and 16.5±2.1,respectively).However,no significant difference was found between the POI and IOF groups.CONCLUSION High levels of oxidative stress suggest that evaluating the oxidative stress state may be a useful indicator for the early detection of POI.

A Study on Near-Infrared Non-Invasive Blood Glucose Concentration Regression Prediction Based on PSO-MKL-SVR

To improve the accuracy of predicting non-invasive blood glucose concentration in the near-infrared spectrum, we utilized the Particle Swarm Optimization (PSO) algorithm to optimize hyperparameters for the Multi-Kernel Learning Support Vector Machine (MKL-SVR). With these optimized hyperparameters, we established a non-invasive blood glucose regression model, referred to as the PSO-MKL-SVR model. Subsequently, we conducted a comparative analysis between the PSO-MKL-SVR model and the PSO-SVR model. In a dataset comprising ten volunteers, the PSO-MKL-SVR model exhibited significant precision improvements, including a 16.03% reduction in Mean Square Error and a 0.29% increase in the Squared Correlation Coefficient. Moreover, there was a 0.14% higher probability of the Clark’s Error Grid Analysis falling within Zone A. Additionally, the PSO-MKL-SVR model demonstrated a faster operational speed compared to the PSO-SVR model.

Observation on the Effect of Non-Invasive Ventilator Combined with Conventional Therapy in the Treatment of Chronic Obstructive Pulmonary Disease Complicated with Respiratory Failure

Objective:To explore the clinical effect of a non-invasive ventilator combined with conventional therapy in the treatment of patients with chronic obstructive pulmonary disease(COPD)combined with respiratory failure.Methods:68 patients with COPD combined with respiratory failure treated in our hospital from September 2021 to October 2023 were selected as the research subjects.Using the random number table method,they were divided into a control group and an experimental group of 34 cases each.The control group received conventional symptomatic treatment,and the experimental group received non-invasive ventilator treatment based on the control group.The clinical effects,blood gas indicators(partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),arterial oxygen saturation(SaO_(2))),lung function(forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),6 min walking distance),complications,and inflammatory factor levels(c-reactive protein(CRP),interleukin-6(IL-6),neutrophil-to-lymphocyte ratio(NLR))of the two groups of patients were observed.Results:(1)The clinical efficacy of the patients in the experimental group(33/97.06%)was more significant as compared with the control group(25/73.53%)(P<0.05);(2)After treatment,the clinical efficacy of the two groups of patients in terms of FEV1,FEV1/FVC,6-minute walking distance,PaO_(2)and SaO_(2)all increased in the experimental group as compared to that of the control group(P<0.05);(3)After treatment,the PaCO_(2),CRP,IL-6,and NLR of the two groups of patients decreased,and the decrease in the experimental group was higher than that of the control group(P<0.05);(4)The patients’complication rate in the experimental group(2/5.88%)was lower as compared to that of the control group(9/26.46%)(P<0.05).Conclusion:Non-invasive ventilators combined with conventional therapy achieved good clinical results in treating patients with COPD and respiratory failure.

Entangled relationship:Chinese parents’involvement in young learners’English tests

Young learners’English(YLE)tests have become increasingly prevalent among and important to Chinese English learners and their parents.In China,parents are actively involved in their children’s education and test-taking decisions,and their participation has given rise to a series of social impacts.Although parent involvement has received increasing public and academic attention in newspaper and scholarly articles,there exists no thorough analysis of current research on parents’roles in young learners’test-taking.To address this gap,we systemically analyzed Chinese newspaper articles and academic articles between 2011 and 2021 to elicit Chinese parents’roles in YLE test-taking.Our thematic analysis of the literature identifies the ways in which parents influence their children’s test-taking experiences,and how the tests affect this influence.Specifically,our results elicit 1)parents’engagement in YLE testing;2)parents’understanding of the intended uses of YLE tests;3)parents’perception and consequences of their involvement in YLE testing;and 4)parents’backgrounds.This analysis reveals the popularity of YLE tests among young learners and their parents in China and public concern over test-related issues.It also broadens our understanding of YLE testing impact and suggests future potential research directions.

Declining diagnostic accuracy of non-invasive fibrosis tests is associated with elevated alanine aminotransferase in chronic hepatitis B

AIM To explore the effect of alanine aminotransferase(ALT) on the performance of non-invasive fibrosis tests in chronic hepatitis B(CHB) patients. METHODS A total of 599 treatment-naive and biopsy-proven CHB patients were included in the study. The cohort was divided into the following three groups: Normal ALT(ALT ≤ 40), slightly elevated ALT(40 < ALT ≤ 80) and elevated ALT(ALT > 80). The diagnostic performance of five common non-invasive fibrosis tests for liver fibrosis(stages S2-4), including the aspartate aminotransferase(AST)-to-platelet(PLT) ratio index(APRI), fibrosis index based on 4 factors(FIB-4), King's score, Forns index and gamma-glutamyl transpeptidase(GGT)-to-PLT ratio(GPR), were evaluated for each group. RESULTS Higher ALT levels were associated with higher non-invasive fibrosis test scores. Patients with the same fibrosis stage but higher ALT levels showed higher noninvasive test scores. The areas under the receiver operating characteristics curves(AUROCs) of the noninvasive tests for prediction of ≥ S2 were higher for patients with ALT ≤ 40 U/L(range 0.705-0.755) and 40 < ALT ≤ 80 U/L(range 0.726-0.79) than for patients with ALT > 80 U/L(range 0.604-0.701). The AUROCs for predicting ≥ S3 and S4 were higher in patients with ALT ≤ 40 U/L(range 0.736-0.814 for ≥ S3, 0.79-0.833 for S4) than in patients with 40 < ALT ≤ 80 U/L(range 0.732-0.754 for ≥ S3, range 0.626-0.723 for S4) and ALT > 80 U/L(range 0.7-0.784 for ≥ S3, range 0.662-0.719 for S4). The diagnostic accuracy of the non-invasive tests decreased in a stepwise manner with the increase in ALT.CONCLUSION ALT has a significant effect on the diagnostic performance of non-invasive fibrosis tests. The ALT level should be considered before performing these noninvasive tests.

Non-invasive panel tests for gastrointestinal motility monitoring within the MARS-500 Project

AIM:To develop an integrated approach for monitoring gastrointestinal motility and inflammation state suitable for application in long-term spaceflights.METHODS:Breath tests based on the oral administration of 13 C-labeled or hydrogen-producing substrates followed by the detection of their metabolites(13 CO 2 or H 2) in breath were used to measure gastrointestinal motility parameters during the 520-d spaceflight ground simulation within the MARS-500 Project.In particular,the gastric emptying rates of solid and liquid contents were evaluated by 13 C-octanoic acid and 13 Cacetate breath tests,respectively,whereas the orocecal transit time was assessed by an inulin H 2-breath test,which was performed simultaneously with the 13 C-octanoic acid breath test.A ready-to-eat,standardized pre-packaged muffin containing 100 mg of 13 C-octanoic acid was used in the 13 C-octanoic acid breath test to avoid the extemporaneous preparation of solid meals.In addition,a cassette-type lateral flow immunoassay was employed to detect fecal calprotectin,a biomarker of intestinal inflammation.Because no items could be introduced into the simulator during the experiment,all materials and instrumentation required for test performance during the entire mission simulation had to be provided at the beginning of the experiment.RESULTS:The experiments planned during the simulation of a manned flight to Mars could be successfully performed by the crewmembers without any external assistance.No evident alterations(i.e.,increasing or decreasing trends) in the gastric emptying rates were detected using the 13 C-breath tests during the mission simulation,as the gastric emptying half-times were in the range of those reported for healthy subjects.In contrast to the 13 C-breath tests,the results of the inulin H 2-breath test were difficult to interpret because of the high variability of the H 2 concentration in the breath samples,even within the same subject.This variability suggested that the H 2-breath test was strongly affected by external factors,which may have been related to the diet of the crewmembers or to environmental conditions(e.g.,the accumulation of hydrogen in the simulator microenvironment).At least in closed microenvironments such as the MARS-500 simulator,13 C-breath tests should therefore be preferred to H 2-breath tests.Finally,the fecal calprotectin test showed significant alterations during the mission simulation:all of the crewmembers were negative for the test at the beginning of the simulation but showed various degrees of positivity in at least one of the subsequent tests,thus indicating the onset of an intestinal inflammation.CONCLUSION:Breath tests,especially those 13 Cbased,proved suitable for monitoring gastrointestinal motility in the 520-d isolation experiment withinMARS-500 project and can be applied in long-term spaceflights.

Non-invasive tests for the prediction of post-hepatectomy liver failure in the elderly

Post-hepatectomy liver failure(PHLF)is associated with great morbidity and mortality after resection of hepatocellular carcinoma.Previous studies have underlined that advanced age could be a potential factor influencing post-operative complications and long-term survival.In the past,candidates for resection were based on the Child-Pugh classification,the predictive value of which was rather low.The selection of patients undergoing resection in Western countries is based on the assessment of portal hypertension(PH),which is clinically assessed by measurement of the hepatic venous pressure gradient,an invasive and costly process.Thus,there have been several attempts to identify the best non-invasive test(NIT)to accurately predict PHLF.Most biochemical NITs for the prediction of PHLF are focused on evaluation of underlying liver cirrhosis and PH.Amongst them,FIB-4,which also includes the patient's age,seems to have more robust supporting results.In Europe and the USA.,the most tested and reliable NIT for predicting PHLF is the evaluation of liver stiffness measurement,which is also influenced by age.Imaging parameters are promising tools which are used only in specialized centers however,and when available.Liver volume parameters,as well as contrast-enhanced data,demonstrate good accuracy in predicting PHLF.In this scenario,the evaluation of sarcopenia and bone mineral density through contextual imaging allows the delineation of PHLF in at-risk elderly patients.Further studies focused on parameters for the evaluation of PHLF in elderly patients are needed.

Evaluation of Non-Invasive Markers of Liver Fibrosis in Chronic Hepatitis B Patients in a Sub-Saharan African Setting: Transient Elastography versus APRI, FIB4, GTT/Platelet Scores

Background: Non-invasive markers which use routine laboratory tests are less expensive and highly needed to assess and stage liver fibrosis in chronic hepatitis B patients in Sub-Saharan Africa. We aimed at evaluating liver fibrosis, using the Aspartate aminotransferase to Platelet Ratio Index (APRI), Fibrosis Index Based on 4 factors (FIB4), and Gamma-glutamyl transpeptidase to Platelet Ratio (GPR) in chronic hepatitis B patients with transient elastography as the reference so as to choose an alternative to transient elastography. Method: We carried out a cross-sectional study using the records of patients who attended the Douala General Hospital and Marie O Polyclinic Douala from 2012 to 2017. Non-invasive tests were compared with Transient Elastography. The Spearman coefficient was used to determine correlation. The sensitivity, specificity, positive predictive values and negative predictive values were used to get the optimal cut-off values. The diagnostic accuracy was estimated by calculating the area under the Receiver Operating Characteristic Curve (ROC). P Results: Of the 243 patient records studied, the median age or interquartile range (IQR) was 35 (29 - 42) years with a male predominance of 73.7%. More than 60% of the study population had normal transaminases. Significant fibrosis was found in 88 (36.2%) patients and 32 (13.7%) patients had cirrhosis. APRI had the best cut-off values and highest area under the ROC Curve, for significant fibrosis and cirrhosis with 0.55 (0.823 95% CI [0.769 - 0.869], P Conclusion: APRI, had the best diagnostic properties to detect liver fibrosis and cirrhosis in patients with Chronic Hepatitis B in Douala. The cut-off values are 0.55 and 0.65 for significant fibrosis and cirrhosis respectively.