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.

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.

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.

Objectives:To investigate the incidence and related risk factors of mid-term postoperative cognitive impairment by a single cognitive function test among heart transplant recipients.Methods:The heart transplant recipients who visited our heart transplant outpatient department from May to October of 2019 were recruited and received cognitive function test.Their heart transplantation,anesthesia,cardiopulmonary bypass and immunosuppressive therapy were performed by the same heart transplant team.Mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)were used to test the study population and diagnose cognitive impairment.The patients were divided into cognitive impairment group and non-cognitive impairment group,and the clinical characteristics,perioperative characteristics of heart transplantation,hospital outcomes and donor characteristics were compared between the two groups.After excluding those with missing data(n=34),48 patients in the cognitive impairment group and 50 patients in the non-cognitive impairment group were analyzed.Univariate and multivariate logistic regression were used to analyze the potential influencing factors of cognitive impairment diagnosed by a single assessment after heart transplantation.Results:The median time of cognitive test after surgery was 2(1,4)years.The incidence of mid-term postoperative cognitive impairment by a single test among heart transplant recipients was 50.0%(66/132).Compared with the non-cognitive impairment group,patients in the cognitive impairment group were older at heart transplant([40.2±13.4]years vs.[46.4±11.0]years)and at cognitive test([42.3±13.0]years vs.[49.2±11.2]years),with a higher proportion of males(68.0%vs.87.5%),a higher proportion of those with lower education(less than high school)(31.9%vs.63.8%),and a longer postoperative hospital stay(32.0[26.0,38.8]d vs.38.0[20.3,50.0]d),and the differences between groups were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that older age at cognitive test(OR=1.067,95%CI:1.019-1.117,P=0.005),longer postoperative in-hospital stay(OR=1.051,95%CI:1.006-1.097,P=0.025)were associated with higher risk of mid-term postoperative cognitive impairment by a single test,while the education level higher than high school was an independent protective factor(OR=0.132,95%CI:0.029-0.607,P=0.009)of mid-term postoperative cognitive impairment.Conclusions:The incidence of mid-term postoperative cognitive impairment by a single test among heart transplant recipients is high.Patients with an older age,low education level,long postoperative in-hospital stay face increased risk of mid-term postoperative cognitive impairment,these patients need to be monitored for cognitive function during follow up to achieve early recognition and treatment of cognitive decline.

Objectives:To investigate the incidence and related risk factors of mid-term postoperative cognitive impairment by a single cognitive function test among heart transplant recipients.Methods:The heart transplant recipients who visited our heart transplant outpatient department from May to October of 2019 were recruited and received cognitive function test.Their heart transplantation,anesthesia,cardiopulmonary bypass and immunosuppressive therapy were performed by the same heart transplant team.Mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)were used to test the study population and diagnose cognitive impairment.The patients were divided into cognitive impairment group and non-cognitive impairment group,and the clinical characteristics,perioperative characteristics of heart transplantation,hospital outcomes and donor characteristics were compared between the two groups.After excluding those with missing data(n=34),48 patients in the cognitive impairment group and 50 patients in the non-cognitive impairment group were analyzed.Univariate and multivariate logistic regression were used to analyze the potential influencing factors of cognitive impairment diagnosed by a single assessment after heart transplantation.Results:The median time of cognitive test after surgery was 2(1,4)years.The incidence of mid-term postoperative cognitive impairment by a single test among heart transplant recipients was 50.0%(66/132).Compared with the non-cognitive impairment group,patients in the cognitive impairment group were older at heart transplant([40.2±13.4]years vs.[46.4±11.0]years)and at cognitive test([42.3±13.0]years vs.[49.2±11.2]years),with a higher proportion of males(68.0%vs.87.5%),a higher proportion of those with lower education(less than high school)(31.9%vs.63.8%),and a longer postoperative hospital stay(32.0[26.0,38.8]d vs.38.0[20.3,50.0]d),and the differences between groups were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that older age at cognitive test(OR=1.067,95%CI:1.019-1.117,P=0.005),longer postoperative in-hospital stay(OR=1.051,95%CI:1.006-1.097,P=0.025)were associated with higher risk of mid-term postoperative cognitive impairment by a single test,while the education level higher than high school was an independent protective factor(OR=0.132,95%CI:0.029-0.607,P=0.009)of mid-term postoperative cognitive impairment.Conclusions:The incidence of mid-term postoperative cognitive impairment by a single test among heart transplant recipients is high.Patients with an older age,low education level,long postoperative in-hospital stay face increased risk of mid-term postoperative cognitive impairment,these patients need to be monitored for cognitive function during follow up to achieve early recognition and treatment of cognitive decline.

In the 2023 series, we summarized the major clinical research advances in gynecologic oncology based on communications at the conference of Asian Society of Gynecologic Oncology Review Course. The review consisted of 1) Endometrial cancer: immune checkpoint inhibitor, antibody drug conjugates (ADCs), selective inhibitor of nuclear export, CDK4/6 inhibitors WEE1 inhibitor, poly (ADP-ribose) polymerase (PARP) inhibitors. 2) Cervical cancer: surgery in low-risk early-stage cervical cancer, therapy for locally advanced stage and advanced, metastatic, or recurrent setting; and 3) Ovarian cancer: immunotherapy, triplet therapies using immune checkpoint inhibitors along with antiangiogenic agents and PARP inhibitors, and ADCs. In 2023, the field of endometrial cancer treatment witnessed a landmark year, marked by several practice-changing outcomes with immune checkpoint inhibitors and the reliable efficacy of PARP inhibitors and ADCs.

In the 2023 series, we summarized the major clinical research advances in gynecologic oncology based on communications at the conference of Asian Society of Gynecologic Oncology Review Course. The review consisted of 1) Endometrial cancer: immune checkpoint inhibitor, antibody drug conjugates (ADCs), selective inhibitor of nuclear export, CDK4/6 inhibitors WEE1 inhibitor, poly (ADP-ribose) polymerase (PARP) inhibitors. 2) Cervical cancer: surgery in low-risk early-stage cervical cancer, therapy for locally advanced stage and advanced, metastatic, or recurrent setting; and 3) Ovarian cancer: immunotherapy, triplet therapies using immune checkpoint inhibitors along with antiangiogenic agents and PARP inhibitors, and ADCs. In 2023, the field of endometrial cancer treatment witnessed a landmark year, marked by several practice-changing outcomes with immune checkpoint inhibitors and the reliable efficacy of PARP inhibitors and ADCs.

Background/Aims: Quick sequential organ failure assessment (qSOFA) is believed to identify patients at risk of poor outcomes in those with suspected infection. We aimed to evaluate the ability of modified qSOFA (m-qSOFA) to identify high-risk patients among those with acutely deteriorated chronic liver disease (CLD), especially those with acute-onchronic liver failure (ACLF). Methods: We used data from both the Korean Acute-on-Chronic Liver Failure (KACLiF) and the Asian Pacific Association for the Study of the Liver ACLF Research Consortium (AARC) cohorts. qSOFA was modified by replacing the Glasgow Coma Scale with hepatic encephalopathy, and an m-qSOFA ≥2 was considered high. Results: Patients with high m-qSOFA had a significantly lower 1-month transplant-free survival (TFS) in both cohorts and higher organ failure development in KACLiF than those with low m-qSOFA (Ps<0.05). Subgroup analysis by ACLF showed that patients with high m-qSOFA had lower TFS than those with low m-qSOFA. m-qSOFA was an independent prognostic factor (hazard ratios, HR=2.604, 95% confidence interval, CI 1.353–5.013, P=0.004 in KACLiF and HR=1.904, 95% CI 1.484– 2.442, P<0.001 in AARC). The patients with low m-qSOFA at baseline but high m-qSOFA on day 7 had a significantly lower 1-month TFS than those with high m-qSOFA at baseline but low m-qSOFA on day 7 (52.6% vs. 89.4%, P<0.001 in KACLiF and 26.9% vs. 61.5%, P<0.001 in AARC). Conclusions Baseline and dynamic changes in m-qSOFA may identify patients with a high risk of developing organ failure and short-term mortality among CLD patients with acute deterioration.

Background: Considering the interactions between heavy metals, a comprehensive evaluation of the effects of exposure to various types of co-interacting heavy metals on health is required.This study assessed the association between dyslipidemia markers and blood mercury, lead, cadmium, iron, zinc, and nickel levels in residents of an abandoned refinery plant. Methods: A total of 972 individuals (exposed group: 567, control group: 405) living near the Janghang refinery plant in the Republic of Korea were included. Blood mercury, lead, cadmium, iron, zinc, nickel, cholesterol, and triglyceride levels were measured. The combined effect of the six heavy metals on dyslipidemia markers was evaluated using a Bayesian kernel machine regression (BKMR) model and compared with the results of a linear regression analysis. The BKMR model results were compared using a stratified analysis of the exposed and control groups. Results: In the BKMR model, the combined effect of the six heavy metals was significantly associated with total cholesterol (TC) levels both below the 45th percentile and above the 55th percentile in the total population. The combined effect range between the 25th and 75th percentiles of the six metals on TC levels was larger in the exposed group than that in the total population. In the control group, the combined effects of the changes in concentration of the six heavy metals on the TC concentration were not statistically significant. Conclusion These results suggest that the cholesterol levels of residents around the Janghang refinery plant may be elevated owing to exposure to multiple heavy metals.