ObjectiveTo investigate whether visceral fat area （VFA） is an independent risk factor for significant liver fibrosis in patients with nonalcoholic fatty liver disease （NAFLD） based on clinical data， and to establish an effective diagnostic model. MethodsA total of 222 NAFLD patients who attended Department of Hepatology， Guangdong Provincial Hospital of Traditional Chinese Medicine， from January 2021 to April 2025 were enrolled， and according to liver stiffness measurement （≥8 kPa or not）， they were divided into significant fibrosis group and non-significant fibrosis group. Propensity score matching （PSM） was performed at a ratio of 1∶1 to balance the baseline data between the two groups. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups； the chi-square test was used for comparison of categorical data between groups. A Spearman correlation analysis was used to determine the correlation of VFA and other indicators with significant liver fibrosis； univariate and multivariate logistic regression analyses were used to identify whether VFA was an independent risk factor for significant liver fibrosis in NAFLD patients， and the receiver operating characteristic （ROC） curve was plotted to assess the predictive performance of related indicators. ResultsA total of 45 patients with significant liver fibrosis and 177 patients without significant liver fibrosis were enrolled， and after PSM， 90 patients （45 pairs） were finally included in analysis. Compared with the non-significant fibrosis group， the significant fibrosis group had significantly higher levels of body mass index （BMI）， fasting blood glucose （FBG）， glycated hemoglobin （HbA1c）， uric acid （UA）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， gamma-glutamyl transpeptidase （GGT）， controlled attenuation parameter （CAP）， and VFA， as well as a significantly higher proportion of patients with visceral fat obesity or three or more metabolic risk factors （all P<0.05）. VFA， BMI， AST， and HbA1c were strongly correlated with significant liver fibrosis （all r>0.5， all P <0.05）， and ALT， GGT， UA， FBG， and CAP were significantly positively correlated with significant liver fibrosis （r=0.3　—　0.5， all P<0.05）. VFA （odds ratio ［OR］=1.040， 95% confidence interval ［CI］： 1.018　—　1.062， P<0.05）， FBG （OR=2.372， 95%CI： 1.199　—　4.691， P<0.05）， and AST （OR=1.032， 95%CI： 1.003　—　1.058， P<0.05） were independent risk factors for significant liver fibrosis in NAFLD patients. The new diagnostic model based on VFA， FBG， and AST （with an area under the ROC curve ［AUC］ of 0.907） had a significantly better performance than aspartate aminotransferase-to-platelet ratio index （AUC=0.834）， fibrosis-4 （AUC=0.660）， triglyceride-glucose index （AUC=0.656）， and NAFLD fibrosis score （AUC=0.768） in predicting significant liver fibrosis in NAFLD patients （all P<0.05）. ConclusionVFA is an independent risk factor for significant liver fibrosis in NAFLD patients， and the noninvasive diagnostic model based on VFA， FBG， and AST can effectively predict the onset of significant liver fibrosis in NAFLD patients.

OBJECTIVE To establish a pharmaceutical management system for externally dispensed medicines in medical institutions， so as to improve medication safety and regulatory efficiency. METHODS Based on policy analysis and hospital practice， a pharmaceutical management system for externally dispensed medicines was constructed by integrating institutional frameworks， an information‑based platform and management procedures， and the management effectiveness was evaluated. RESULTS Our hospital formulated the Regulations on the Management of Externally Dispensed Medicines ， which standardized catalogue selection， prescription issuance， acceptance and use， supervision and evaluation. An information‑based management platform for externally dispensed medicines was built relying on the hospital information system， enabling electronic prescription circulation， intelligent prescription review and whole‑process traceability. Institutional requirements and platform functions were embedded into three core management procedures， namely catalogue selection， prescription issuance， and medicine acceptance and use， forming a closed‑loop working mechanism. After the implementation of the management system， compared with pre‑implementation， the qualified rate of externally dispensed prescriptions increased from 85.2% to 99.3% （ P ＜0.001）， the automatic prescription review pass rate exceeded 95%， the prescription review duration shortened from 7.2 min to 1.8 min （ P ＜0.001）. All dimensional satisfaction scores of patients and medical staff were significantly improved， the standardization awareness of medical staff reached 100%. CONCLUSIONS The construction of a pharmaceutical management system for externally dispensed medicines with standardized institutional frameworks， informatized platforms and standardized procedures effectively enhances the rationality and management efficiency of externally dispensed prescription medicines， and provides a replicable practical pathway for the management of externally dispensed medicines in medical institutions.

Objective To evaluate answers to typical clinical questions related to neuro-ophthalmology generated by Artificial Intelligence(AI)Large Language Models(LLM)and to explore the performance of neuro-ophthalmology-related questions on LLM in a multidimensional manner using objective and expert assessment.Methods Multicenter,random-ized,cross-sectional pilot study.Thirty typical questions related to neuro-ophthalmology were selected based on four per-spectives:definition,etiology,clinical manifestations and signs,and treatment and prognosis,and were analyzed quantita-tively using Deepseek,Wenxin Yiyin 4.0,Doubao,and Kimi 1.5,which are four open-source LLMs in China,and quantita-tively analyzed with objective assessment;and quantitatively rated by three ophthalmologists using expert assessment for 120 answer texts.Three ophthalmology experts quantitatively scored the 120 answer texts.Three ophthalmologists quantita-tively scored the 120 answer texts.Level 3,5,and 4 Likert scales were developed according to the completeness,accura-cy,professionalism,relevance,and criticality of the question texts,respectively.The best-performing LLM was selected,and its performance was observed across the four types of questions.Additionally,three other experts assessed whether the best-performing one could be evaluated as a substitute for real-world doctor-patient communication.Results In the objective Chinese text reading difficulty analysis,the differences in total word count among the four LLMs were statistically significant(all P＜0.001).Of the four LLMs,Kimi 1.5 performed the best,with frequencies of 61％,29％,and 41％for the highest scores in completeness(3),accuracy and professionalism(5),and relevance and usefulness(4),respective-ly.Kimi 1.5 performed more consistently on the questions on the four areas of neuro-ophthalmologic disorders:definition,etiology,clinical manifestations and signs,treatment,and prognosis,with no between-group differences(P＞0.05).Con-clusion Chinese language LLMs have great potential in the clinical application of neuro-ophthalmology.Kimi 1.5 outper-forms other LLMs in terms of completeness,accuracy,professionalism,relevance,and usefulness,but it still cannot re-place real-world doctor-patient communication.There is a need to explore new diagnostic and therapeutic model of AI+physician in the future.

Objective To explore TCM syndrome distribution law in patients with overlapping non-erosive reflux disease(NERD)and epigastric pain syndrome(EPS)gastrointestinal symptoms.Methods A multi-center,cross-sectional study was conducted to investigate the general information of 800 patients with overlapping NERD and EPS gastrointestinal symptoms in four hospitals,such as gender,age,body mass index(BMI)and four diagnostic information of TCM.Descriptive frequency analysis,factor analysis and clustering analysis were used to summarize the TCM syndrome types and distribution characteristics.Results The average age of 800 patients with overlapping NERD and EPS gastrointestinal symptoms was(44.50±14.43)years old,the average BMI was(23.17±4.80)kg/m2,and the male to female ratio was 3:5.Frequency of 95 TCM symptoms/signs≥20%.18 common factor variables were obtained based on factor analysis,and the cumulative contribution rate was 67.11%.The first three syndrome elements of disease location were liver,stomach and spleen,and the disease nature syndrome elements were qi stagnation,qi deficiency and yin deficiency.Based on the clustering analysis of 18 common factor variables,combined with expert discussion,four main TCM syndrome types were obtained,which were liver-stomach stagnation heat syndrome(213 cases,26.63%),spleen-stomach damp heat syndrome(209 cases,26.13%),spleen-stomach deficiency and cold qi stagnation syndrome(190 cases,23.75%)and qi-phlegm stagnation syndrome(188 cases,23.50%).There was no significant difference in the distribution of TCM syndrome types among patients with different genders,ages and BMI values(P>0.05).Patients with a course of disease≥2 years and those residing long-term north of the Qinling-Huaihe Line showed a significantly higher prevalence of spleen-stomach dampness-heat syndrome(P<0.05).Conclusion The syndrome elements of disease location of overlapping NERD and EPS gastrointestinal symptoms are mainly liver,stomach and spleen.The TCM syndrome types are liver-stomach stagnation heat syndrome,spleen-stomach damp heat syndrome,spleen-stomach deficiency cold qi stagnation syndrome and qi-phlegm stagnation syndrome.The course of disease and the regional differences between north and south may be the influencing factors of the distribution of syndrome types.

Objective To evaluate answers to typical clinical questions related to neuro-ophthalmology generated by Artificial Intelligence(AI)Large Language Models(LLM)and to explore the performance of neuro-ophthalmology-related questions on LLM in a multidimensional manner using objective and expert assessment.Methods Multicenter,random-ized,cross-sectional pilot study.Thirty typical questions related to neuro-ophthalmology were selected based on four per-spectives:definition,etiology,clinical manifestations and signs,and treatment and prognosis,and were analyzed quantita-tively using Deepseek,Wenxin Yiyin 4.0,Doubao,and Kimi 1.5,which are four open-source LLMs in China,and quantita-tively analyzed with objective assessment;and quantitatively rated by three ophthalmologists using expert assessment for 120 answer texts.Three ophthalmology experts quantitatively scored the 120 answer texts.Three ophthalmologists quantita-tively scored the 120 answer texts.Level 3,5,and 4 Likert scales were developed according to the completeness,accura-cy,professionalism,relevance,and criticality of the question texts,respectively.The best-performing LLM was selected,and its performance was observed across the four types of questions.Additionally,three other experts assessed whether the best-performing one could be evaluated as a substitute for real-world doctor-patient communication.Results In the objective Chinese text reading difficulty analysis,the differences in total word count among the four LLMs were statistically significant(all P＜0.001).Of the four LLMs,Kimi 1.5 performed the best,with frequencies of 61％,29％,and 41％for the highest scores in completeness(3),accuracy and professionalism(5),and relevance and usefulness(4),respective-ly.Kimi 1.5 performed more consistently on the questions on the four areas of neuro-ophthalmologic disorders:definition,etiology,clinical manifestations and signs,treatment,and prognosis,with no between-group differences(P＞0.05).Con-clusion Chinese language LLMs have great potential in the clinical application of neuro-ophthalmology.Kimi 1.5 outper-forms other LLMs in terms of completeness,accuracy,professionalism,relevance,and usefulness,but it still cannot re-place real-world doctor-patient communication.There is a need to explore new diagnostic and therapeutic model of AI+physician in the future.

Objective:To study the effects of fluoride and aluminum exposure alone and in combination on pyroptosis and the NOD-like receptor protein 3 (NLRP3)/cysteinyl aspartate specific proteinase-1 (Caspase-1)/gasdermin D (GSDMD) signaling pathway in NG108-15 cells.Methods:Using a factorial design method, NG108-15 cells cultured in vitro were divided into control group [0 mg/L sodium fluoride (NaF) + 0 mg/L aluminium trichloride (AlCl 3)], fluoride group (40 mg/L NaF + 0 mg/L AlCl 3), aluminum group (0 mg/L NaF + 160 mg/L AlCl 3), and fluoride + aluminum group (40 mg/L NaF + 160 mg/L AlCl 3) according to the concentrations of NaF and AlCl 3. After 24 hours of cultivation, the cells were collected for subsequent experiments. The fluorescence intensity of pyroptosis index GSDMD in each group was detected by immunofluorescence method. The mRNA expression levels of NLRP3, apoptosis associated speck-like protein (ASC), Caspase-1, and GSDMD in each group were detected by real-time fluorescence quantitative PCR (qRT-PCR). The protein expression levels of NLRP3, ASC, Caspase-1, GSDMD, gasdermin D N-terminus (GSDMD-N) and interleukin-1β (IL-1β) in each group were detected by Western blotting. Results:The immunofluorescence results showed that compared with the control group (1.00 ± 0.02), the fluorescence intensity of GSDMD in the fluoride, aluminum, and fluoride + aluminum groups (1.49 ± 0.02, 1.22 ± 0.04, 1.25 ± 0.03) were higher ( P < 0.05). The results of qRT-PCR showed that compared with the control group (1.00 ± 0.02, 1.00 ± 0.01, 1.00 ± 0.08, 1.00 ± 0.06), the mRNA expression levels of NLRP3 (1.21 ± 0.06, 1.60 ± 0.07, 1.42 ± 0.02), ASC (2.61 ± 0.07, 1.53 ± 0.01, 2.12 ± 0.03), Caspase-1 (1.32 ± 0.05, 1.53 ± 0.04, 2.07 ± 0.05), and GSDMD (1.60 ± 0.03, 1.65 ± 0.04, 2.23 ± 0.05) were higher in the fluoride, aluminum, and fluoride + aluminum groups ( P < 0.05). Western blotting results showed that compared with the control group (1.00 ± 0.04, 1.00 ± 0.08, 1.00 ± 0.05, 1.00 ± 0.02, 1.00 ± 0.03, 1.00 ± 0.06), the protein expression levels of NLRP3 (1.55 ± 0.06, 1.40 ± 0.07, 1.24 ± 0.05), ASC (1.66 ± 0.05, 1.48 ± 0.06, 1.32 ± 0.06), Caspase-1 (1.51 ± 0.02, 1.40 ± 0.01, 1.28 ± 0.03), GSDMD (1.24 ± 0.03, 1.31 ± 0.06, 1.18 ± 0.03), GSDMD-N (1.18 ± 0.04, 1.27 ± 0.03, 1.27 ± 0.03), and IL-1β (1.81 ± 0.03, 1.70 ± 0.08, 1.52 ± 0.05) were higher in the fluoride, aluminum, and fluoride + aluminum groups ( P < 0.05). Conclusion:Exposure to fluoride and aluminum alone and in combination can induce pyroptosis in NG108-15 cells, and the mechanism may be related to up-regulation of molecules related to the NLRP3/Caspase-1/GSDMD signaling pathway.

ObjectiveTo investigate the value of different noninvasive diagnostic models in the diagnosis of esophageal and gastric varices since there is a high risk of esophageal and gastric varices in patients with compensated hepatitis B cirrhosis and significant portal hypertension， and to provide a basis for the early diagnosis of esophageal and gastric varices. MethodsA total of 108 patients with significant portal hypertension due to compensated hepatitis B cirrhosis who attended Guangdong Provincial Hospital of Traditional Chinese Medicine from November 2017 to November 2023 were enrolled， and according to the presence or absence of esophageal and gastric varices under gastroscopy， they were divided into esophageal and gastric varices group （GOV group） and non-esophageal and gastric varices group （NGOV group）. Related data were collected， including age， sex， imaging findings， and laboratory markers. The chi-square test was used for comparison of categorical data between groups； the least significant difference t-test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The receiver operating characteristic （ROC） curve was plotted to evaluate the diagnostic value of five scoring models， i.e.， fibrosis-4 （FIB-4）， LOK index， LPRI， aspartate aminotransferase-to-platelet ratio index （APRI）， and aspartate aminotransferase/alanine aminotransferase ratio （AAR）. The binary logistic regression method was used to establish a combined model， and the area under the ROC curve （AUC） was compared between the combined model and each scoring model used alone. The Delong test was used to compare the AUC value between any two noninvasive diagnostic models. ResultsThere were 55 patients in the GOV group and 53 patients in the NGOV group. Compared with the NGOV group， the GOV group had a significantly higher age （52.64±1.44 years vs 47.96±1.68 years， t=0.453， P<0.05） and significantly lower levels of alanine aminotransferase ［42.00 （24.00 — 17.00） U/L vs 82.00 （46.00 — 271.00） U/L， Z=-3.065， P<0.05］， aspartate aminotransferase ［44.00 （32.00 — 96.00） U/L vs 62.00 （42.50 — 154.50） U/L，Z=-2.351， P<0.05］， and platelet count ［100.00 （69.00 — 120.00）×10⁹/L vs 119.00 （108.50 — 140.50）×10⁹/L， Z=-3.667， P<0.05］. The ROC curve analysis showed that FIB-4， LOK index， LPRI， and AAR used alone had an accuracy of 0.667， 0.681， 0.730， and 0.639， respectively， in the diagnosis of esophageal and gastric varices （all P<0.05）， and the positive diagnostic rates of GOV were 69.97%， 65.28%， 67.33%， and 58.86%， respectively， with no significant differences in AUC values （all P>0.05）， while APRI used alone had no diagnostic value （P>0.05）. A combined model （LAF） was established based on the binary logistic regression analysis and had an AUC of 0.805 and a positive diagnostic rate of GOV of 75.80%， with a significantly higher AUC than FIB-4， LOK index， LPRI， and AAR used alone （Z=-2.773，-2.479，-2.206， and-2.672， all P<0.05）. ConclusionFIB-4， LOK index， LPRI， and AAR have a similar diagnostic value for esophageal and gastric varices in patients with compensated hepatitis B cirrhosis and significant portal hypertension， and APRI alone has no diagnostic value. The combined model LAF had the best diagnostic efficacy， which provides a certain reference for clinical promotion and application.

Objective To investigate the role of exosomal microRNA(miRNA)miR-210-3p in chemoresistance and stem cell property formation in cervical cancer,and to elucidate its underlying mechanism through targeting of F-box protein 31(FBXO31).Methods Exosomes were isolated from cisplatin-sensitive HeLa cells and cisplatin-resistant HeLa/DDP cells via ultracentrifugation,and their uptake by HeLa/DDP cells was verified using the PKH26 red fluorescent labeling method.HeLa cells were transfected with NC inhibitor,miR-210-3p inhibitor alone,or in combination with si-NC and si-FBXO31.After 24 hours of transfection,exosomes were extracted and co-cultured with HeLa/DDP cells for 48 hours.Consequently,HeLa/DDP cells were divided into five groups:the Ctrl group(PBS blank control),the NC inhibitor group,the miR-210-3p inhibitor group,the miR-210-3p inhibitor+si-NC group and the miR-210-3p inhibitor+si-FBXO31 group.RT-qPCR was used to measure miR-210-3p and FBXO31 expression levels.The half-maximal inhibitory concentration(IC50)of cisplatin was determined using the MTT assay.Stem cell properties were assessed via tumor sphere formation assays.Western blot analysis was performed to detect the protein expression of FBXO31 and stem cell markers(e.g.,SOX2,OCT4,NANOG).The targeting relationship between miR-210-3p and FBXO31 was validated using dual-luciferase reporter assays.The effect of exosomal miR-210-3p on the metastasis of cervical cancer in vivo was evaluated by nude mice xenograft tumor.Resuts Compared with human normal cervical epithelial cells(HCeEpiC),miR-210-3p expression was significantly upregulated in cervical cancer cell lines(HeLa,HT3,C33A,and CaSki),while FBXO31 expression was significantly downregulated(P<0.05).HeLa/DDP cells(cisplatin-resistant)exhibited significantly higher miR-210-3p expression levels and IC50 values for cisplatin compared with parental HeLa cells(P<0.05),and HeLa exosomes were efficiently taken up by HeLa/DDP cells.Compared with the NC inhibitor groupThe miR-210-3p inhibitor group showed significantly reduced expression levels of miR-210-3p,OCT4,SOX2,and NANOG,as well as a significantly lower IC50(P<0.05),while FBXO31 expression was significantly increased(P<0.05).Compared with the miR-210-3p inhibitor+si-NC group,the miR-210-3p inhibitor+si-FBXO31 group exhibited significantly decreased FBXO31 expression(P<0.05)and increased IC50,Oct-4,SOX2,and NANOG expression(P<0.05).Compared with the control group and the empty vector group,the tumor weight and volume were significantly lower in the miR-210-3p than in the control and empty vector groups(P<0.05).Conclusion Exosomal miR-210-3p promotes chemoresistance to DDP and enhances stem cell-like properties in CC cells by directly targeting and inhibiting FBXO31.

Objective:To study the effects of fluoride and aluminum exposure alone and in combination on pyroptosis and the NOD-like receptor protein 3 (NLRP3)/cysteinyl aspartate specific proteinase-1 (Caspase-1)/gasdermin D (GSDMD) signaling pathway in NG108-15 cells.Methods:Using a factorial design method, NG108-15 cells cultured in vitro were divided into control group [0 mg/L sodium fluoride (NaF) + 0 mg/L aluminium trichloride (AlCl 3)], fluoride group (40 mg/L NaF + 0 mg/L AlCl 3), aluminum group (0 mg/L NaF + 160 mg/L AlCl 3), and fluoride + aluminum group (40 mg/L NaF + 160 mg/L AlCl 3) according to the concentrations of NaF and AlCl 3. After 24 hours of cultivation, the cells were collected for subsequent experiments. The fluorescence intensity of pyroptosis index GSDMD in each group was detected by immunofluorescence method. The mRNA expression levels of NLRP3, apoptosis associated speck-like protein (ASC), Caspase-1, and GSDMD in each group were detected by real-time fluorescence quantitative PCR (qRT-PCR). The protein expression levels of NLRP3, ASC, Caspase-1, GSDMD, gasdermin D N-terminus (GSDMD-N) and interleukin-1β (IL-1β) in each group were detected by Western blotting. Results:The immunofluorescence results showed that compared with the control group (1.00 ± 0.02), the fluorescence intensity of GSDMD in the fluoride, aluminum, and fluoride + aluminum groups (1.49 ± 0.02, 1.22 ± 0.04, 1.25 ± 0.03) were higher ( P < 0.05). The results of qRT-PCR showed that compared with the control group (1.00 ± 0.02, 1.00 ± 0.01, 1.00 ± 0.08, 1.00 ± 0.06), the mRNA expression levels of NLRP3 (1.21 ± 0.06, 1.60 ± 0.07, 1.42 ± 0.02), ASC (2.61 ± 0.07, 1.53 ± 0.01, 2.12 ± 0.03), Caspase-1 (1.32 ± 0.05, 1.53 ± 0.04, 2.07 ± 0.05), and GSDMD (1.60 ± 0.03, 1.65 ± 0.04, 2.23 ± 0.05) were higher in the fluoride, aluminum, and fluoride + aluminum groups ( P < 0.05). Western blotting results showed that compared with the control group (1.00 ± 0.04, 1.00 ± 0.08, 1.00 ± 0.05, 1.00 ± 0.02, 1.00 ± 0.03, 1.00 ± 0.06), the protein expression levels of NLRP3 (1.55 ± 0.06, 1.40 ± 0.07, 1.24 ± 0.05), ASC (1.66 ± 0.05, 1.48 ± 0.06, 1.32 ± 0.06), Caspase-1 (1.51 ± 0.02, 1.40 ± 0.01, 1.28 ± 0.03), GSDMD (1.24 ± 0.03, 1.31 ± 0.06, 1.18 ± 0.03), GSDMD-N (1.18 ± 0.04, 1.27 ± 0.03, 1.27 ± 0.03), and IL-1β (1.81 ± 0.03, 1.70 ± 0.08, 1.52 ± 0.05) were higher in the fluoride, aluminum, and fluoride + aluminum groups ( P < 0.05). Conclusion:Exposure to fluoride and aluminum alone and in combination can induce pyroptosis in NG108-15 cells, and the mechanism may be related to up-regulation of molecules related to the NLRP3/Caspase-1/GSDMD signaling pathway.

Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.