Objective To evaluate the treatment results and side-reactions of esophageal carcinoma treated with late course accelerated hyperfration radiotherapy plus concurrent chemotherapy(LCAHR+C). Methods A prospective randomized trial was carried out on 173 esophagus squamous carcinoma patients whom were randomized into two groups:1. LCAHR group—89 patients treated by conventional fractionated radiotherapy during the first two-thirds of the whole course with 40Gy in 20-22 fractions, then followed by LCAHR with 20-30Gy in 14-20 fractions, 1.5Gy per fraction, 2 times per day, to a total dose of 60-70Gy in 34-42 fractions over 37-42 days; 2.LCAHR+C group—94 patients were received the same radiotherapy as LCAHR, supplement with concurrent chemotherapy from the first day of radiotherapy. The chemotherapy regimen was LFP: intravenous infusion of cisplatin 20mg/d, calcium folinate 100mg/d and 5-fluorouracil 500mg/d for five consecutive days, every 28d as one cycle to totally 4 cycles. Results The short-term effective rate was 85% and 95% in LCAHR and LCAHR+C group,respectively(?~2=4.45,P=0.035).The 1-,2-and 3-year local control rate was 73%,55%,49% and 83%,73%,65% in LCAHR and LCAHR+C group, respectively(?~2=5.32,P=0.021).The 1-,2- and 3-year survival rate was 74%,53%,41% and 84%,65%,52% in LCAHR and LCAHR+C group,respectively(?~2= 2.85 , P= 0.091 ).The leucocytopenia and gastrointestinal tract side-reactions in LCAHR+C group were more severe than those of LCAHR group(?~2=7.85,15.06;P=0.005,0.000). Conclusions Late course accelerated hyperfractionated radiotherapy plus concurrent chemotherapy can be taken as a effective treatment for esophageal carcinoma. It can improve short-term curative effect and local control rate, in spite of increase in leucocytopenia and gastrointestinal tract side-reactions.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.