Performance of the Enhanced Liver Fibrosis Score,Comparison with Vibration-controlled Transient Elastography Data,and Development of a Simple Algorithm to Predict Significant Liver Fibrosis in a Community-based Liver Service:A Retrospective Evaluation

Background and Aims:Liver fibrosis is a key risk factor for cirrhosis,hepatocellular carcinoma and end stage liver failure.The National Institute for Health and Care Excellence guidelines for assessment for advanced(≥F3)liver fibrosis in people with nonalcoholic fatty liver disease recommend the use of enhanced liver fibrosis(ELF)test,followed by vibration-controlled transient elastography(VCTE).Performance of ELF at predicting significant(≥F2)fibrosis in real-world practice is uncertain.To assess the accuracy of ELF using VCTE;investigate the optimum ELF cutoff value to identify≥F2and≥F3;and develop a simple algorithm,with and without ELF score,for detecting≥F2.Methods:Retrospective evaluation of patients referred to a Community Liver Service for VCTE,Jan-Dec 2020.Assessment included:body mass index(BMI),diabetes status,alanine aminotransferase(ALT)levels,ELF score and biopsy-validated fibrosis stages according to VCTE.Results:Data from 273 patients were available.n=110 patients had diabetes.ELF showed fair performance for≥F2 and≥F3,area under the curve(AUC)=0.70,95%confidence interval(CI)0.64-0.76 and AUC=0.72,95%CI:0.65-0.79 respectively.For≥F2 Youden's index for ELF=9.85 and for≥F3,ELF=9.95.Combining ALT,BMI,and HbA1c(ALBA algorithm)to predict≥F2 showed good performance(AUC=0.80,95%CI:0.69-0.92),adding ALBA to ELF improved performance(AUC=0.82,95%CI:0.77-0.88).Results were independently validated.Conclusions:Optimal ELF cutoff for≥F2 is 9.85 and 9.95 for≥F3.ALT,BMI,and HbA1c(ALBA algorithm)can stratify patients at risk of≥F2.ELFperformance is improved by adding ALBA.

The audit expectation gap： A review of the contributing factors

The audit expectation gap is critical to the auditing profession because the greater the unfulfilled expectations from the public, the lower is the credibility, earning potential and prestige associated with the work of auditors. The aim of this paper is to uncover the causes of an audit expectation gap. It is revealed that the existence of an audit expectation gap is due to complicated nature of an audit function; conflicting role of auditors; retrospective evaluation of auditors＇ performance; time lag in responding to changing expectation; and self-regulation process of the auditing profession.

Deuterium Depletion May Delay the Progression of Prostate Cancer

Deuterium-depleted water (DDW) is a new promising agent in cancer therapy. The efficiency of the method is based on the discovery, that cancer cells are extremely sensitive to depletion of deuterium (D) and might cause necrosis of the tumour. The purpose of this study was to show the efficacy of D-depletion in prostate cancer (PC) patients. In the double blind, four-month-long, randomized Phase II clinical trial the daily water intake was replaced with DDW in 22 PC patients. Other 22 PC patients took normal water while both groups received the same forms of conventional treatment. In the retrospective study, 91 DDW-treated PC patients were evaluated and median survival time (MST) in the subgroups was calculated. The time course of changes in DDW dose and PSA is presented in two cases. In the prospective trial seven patients in the treated group and one patient in the placebo group achieved partial response (p = 0.046). In the treated group, the net decrease in the prostate volume was three times higher (160.3 cm3 vs. 54.0 cm3;p = 0.0019), urination complaints ceased at a higher rate (8 vs. 0 patients, p = 0.0041), and the one-year survival rate was also higher (2 vs. 9 deaths;p = 0.034). The 91 retrospectively evaluated patients achieved an MST of 11.02 years, despite the fact that 46 of them suffered from distant metastasis. In the two monitored patients, drop of PSA level correlated with the DDW intake. In summary, D-depletion prolonged MST in patients with PC. The method proved to be safe thus its integration in the PC cure as an adjuvant or complementary therapy would be considered.

Levels of Serum Procalcitonin and C-Reactive Protein for Evaluating Pulmonary Bacterial Infection in Patients with Lupus Erythematosus

The severity of systemic lupus erythematosus（SLE） patients with pulmonary bacterial infection varies widely. We investigated the significance of procalcitonin（PCT） and C-reactive protein（CRP） in evaluating the severity of pulmonary infection in SLE patients. This retrospective study contained a total of 117 patients（107 women and 10 men） with SLE from January 2010 to June 2011. Serum levels of PCT and CRP were measured by enzyme-linked immunosorbent assay. The severity of pulmonary bacterial infection（PBI） was evaluated using the pneumonia severity index（PSI）. SLE patients with PBI, particularly those with bacterial isolates, had significantly higher levels of serum PCT and CRP than those without PBI. Serum PCT and CRP were not associated with SLE disease activity, but positively with the values of PSI in active SLE patients with PBI. Serum levels of PCT and CRP may be additional biomarkers in evaluating the severity of PBI in lupus patients.