Angle class Ⅱ malocclusion is often characterized by mandibular retraction and lip incompetence,which affects the patient's lateral appearance and may even lead to upper airway stenosis.It can be classified into dental and skeletal types.For skeletal class Ⅱ malocclusion patients with mandibular retraction during the peak growth period,mandibular anterior guidance with a functional orthodontic appliance is generally considered as the optimal clinical treatment approach.At present,there remains a paucity of clinical reports on the clinical application of bracket-free clear aligners in mandibular anterior guidance,both domestically and internationally.This article presented a case of an adolescent patient with skeletal class Ⅱ malocclusion accompanied with deep overbite treated with bracket-free clear aligner for mandibular anterior guidance in combination with intermaxillary class Ⅱ traction.During the treatment,vertical correction involved anterior intrusion of the anterior teeth to improve the deep overbite,while horizontal correction included maxillary and mandibular expansion to coordinate the width of the dental arches,and asymmetric anterior guidance was used to correct the midline deviation.After 35 months of treatment,the patient's convex facial profile and mandibular retrusion were significantly improved.The subspinale-nasion-supramentale angle(ANB)was decreased from 6.8° to 3.9°,the overbite and overjet were normalized,and the bilateral canine and molar reached a neutral relationship.The mentolabial sulcus depth(Si-LiPg′)and the soft tissue thickness of pogonion to pogonion(Pm-Pm′)were decreased,resulting in a shallower mentolabial sulcus and a more harmonized lateral facial soft tissue profile.The mandibular incisor to mandibular plane angle(IMPA)was decreased from 116.6° to 110.7°,indicating retraction of the lower incisors during mandibular anterior guidance.In conclusion,the orthodontic strategy of mandibular advancement with clear aligners in skeletal class Ⅱ malocclusion patients can avoid excessive overcompensation of the upper and lower anterior teeth and shorten the orthodontic treatment cycle.

Objective To explore the effects of different grinding amounts of articular processes on the biomechanical stability and inflammatory response of lumbar spine during percutaneous foraminoscopic surgery(PTED).Methods A total of 195 patients with lumbar disc herniation(LDH)in our hospital were selected for prospective study from January 2018 to October 2020,and they were divided into three groups by randomized numerical table method,each with 65 cases,and all of them were implemented PTED.Patients with intraoperative upper joint process grinding＜33％were treated as a small group,patients with intraoperative grinding＜33％～50％were treated as a medium group,and patients with＞50％were treated as a large group.The surgery-related indexes of the three groups of patients were observed,as well as the inflammatory indexes[interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α)],biomechanical stability,and joint functional recovery scores at different time points before and after surgery.Results The operation time and intraoperative bleeding were(61.32±7.86)min and(11.85±1.10)ml in the small group,(70.06±8.53)min and(14.32±2.21)ml in the medium group,and(74.47±10.00)min and(19.86±3.00)ml in the large group,and the differences among the three groups were statistically significant(P＜0.05).Serum IL-6 and TNF-α were(6.10±1.12)pg/ml and(8.21±1.87)ng/L in the small group 3d postoperatively,and(3.27±0.58)pg/ml and(4.32±1.00)ng/L in the discharge group,and in the medium group 3d postoperatively,they were(6.68±1.35)pg/ml and(9.00±1.20)ng/L at discharge and(4.10±0.63)pg/ml and(6.85±1.28)ng/L at discharge,respectively,and(7.32±1.00)pg/ml and(10.57±1.28)ng/L in the massive group at 3d postoperatively and(4.57±0.49)pg/ml and(8.14±1.35)ng/L at discharge,and the difference between the three groups was statistically significant(P＜0.05);the serum lumbar lordosis angle,lumbar flexion,and lumbar stability scores were(42.28±2.12)°,(1.86±0.36)cm,and(10.52±2.01)° at 1 month postoperatively,and(42.11±1.97)°,(1.87±0.52)cm,and(10.63±1.96)° at 1 year postoperatively,respectively,for the small group,and(40.86±1.89)°,(1.72±0.28)cm,(10.63±2.15)scores,(39.15±2.11)°,(1.60±0.42)cm,(12.11±1.63)scores for the medium group,respectively,1 month postoperatively in the large volume group,(39.01±2.35)°,(1.61±0.29)cm,(11.20±2.75)scores,and(38.11±2.32)°,(1.43±0.33)cm,(13.24±1.52)scores at 1 year postoperatively,respectively,and the difference between the three groups were statistically significant(P＜0.05).Conclusion PTED treatment of LDH can reduce the amount of grinding of the superior articular process during surgery,reduce operative time and intraoperative bleeding,alleviate inflammatory response,and achieve good short-and medium-term lumbar function and joint stability.

Objective To explore the effects of different grinding amounts of articular processes on the biomechanical stability and inflammatory response of lumbar spine during percutaneous foraminoscopic surgery(PTED).Methods A total of 195 patients with lumbar disc herniation(LDH)in our hospital were selected for prospective study from January 2018 to October 2020,and they were divided into three groups by randomized numerical table method,each with 65 cases,and all of them were implemented PTED.Patients with intraoperative upper joint process grinding＜33％were treated as a small group,patients with intraoperative grinding＜33％～50％were treated as a medium group,and patients with＞50％were treated as a large group.The surgery-related indexes of the three groups of patients were observed,as well as the inflammatory indexes[interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α)],biomechanical stability,and joint functional recovery scores at different time points before and after surgery.Results The operation time and intraoperative bleeding were(61.32±7.86)min and(11.85±1.10)ml in the small group,(70.06±8.53)min and(14.32±2.21)ml in the medium group,and(74.47±10.00)min and(19.86±3.00)ml in the large group,and the differences among the three groups were statistically significant(P＜0.05).Serum IL-6 and TNF-α were(6.10±1.12)pg/ml and(8.21±1.87)ng/L in the small group 3d postoperatively,and(3.27±0.58)pg/ml and(4.32±1.00)ng/L in the discharge group,and in the medium group 3d postoperatively,they were(6.68±1.35)pg/ml and(9.00±1.20)ng/L at discharge and(4.10±0.63)pg/ml and(6.85±1.28)ng/L at discharge,respectively,and(7.32±1.00)pg/ml and(10.57±1.28)ng/L in the massive group at 3d postoperatively and(4.57±0.49)pg/ml and(8.14±1.35)ng/L at discharge,and the difference between the three groups was statistically significant(P＜0.05);the serum lumbar lordosis angle,lumbar flexion,and lumbar stability scores were(42.28±2.12)°,(1.86±0.36)cm,and(10.52±2.01)° at 1 month postoperatively,and(42.11±1.97)°,(1.87±0.52)cm,and(10.63±1.96)° at 1 year postoperatively,respectively,for the small group,and(40.86±1.89)°,(1.72±0.28)cm,(10.63±2.15)scores,(39.15±2.11)°,(1.60±0.42)cm,(12.11±1.63)scores for the medium group,respectively,1 month postoperatively in the large volume group,(39.01±2.35)°,(1.61±0.29)cm,(11.20±2.75)scores,and(38.11±2.32)°,(1.43±0.33)cm,(13.24±1.52)scores at 1 year postoperatively,respectively,and the difference between the three groups were statistically significant(P＜0.05).Conclusion PTED treatment of LDH can reduce the amount of grinding of the superior articular process during surgery,reduce operative time and intraoperative bleeding,alleviate inflammatory response,and achieve good short-and medium-term lumbar function and joint stability.

Objective To evaluate the differences in chemical composition and pharmacological effects between Angelica-Astragalus medicine pair decoction(DGD)and traditional decotion,and to provide a reference for the rational clinical application of Danggui Buxue decoction.Methods With the two comparison methods of unified and non-uniform raw material source batches,we set up different sample groups,established characteristic maps by HPLC,and evaluated the chemical components based on the similarity of characteristic maps,component types,index component content,common peak area,and other factors.The efficacy of the drug was evaluated in the hemorrhagic blood deficiency model mice.Results ①The similarity of the feature map between the DGD and TD was high(similarity was greater than 0.87).②The number of chromatographic peaks was inconsistent.Traditional decoction from self-purchased decoction pieces,or traditional decoction-Factory A decoction pieces had a total of 12 chromatographic peaks each.The DGD of Factory A had a total of 15 chromatographic peaks.There were 10 chromatographic peaks in the DGD of Factory B.③The contents of ferulic acid and calycosin 7-O-glucoside(CG)in DGD of Factory A were higher than those in traditional decoction(P<0.05,n=3).There was no significant difference between DGD and TD ferulic acid content in Factory B,but the content of CG was lower than that in traditional decoction(P<0.05).④The total area of common peaks in DGD was different from that in TD.The relative total ratios of the contents of the components in the self-purchased traditional decoction pieces,the traditional decoction pieces of Factory A,the formula granules of Factory A,and the formula granules of Factory B were 1.00,0.96,2.14,0.60,respectively.⑤Both DGD and traditional decoction could significantly promote the recovery of hemoglobin and red blood cells in hemorrhagic anemia model mice(P<0.01);Compared with the model control group,there was a significantly difference(P<0.05)except for the DGD group of Plant B.There was no significant difference between DGD and TD of Plant A,but there was a very significant difference between DGD and TD of Plant B(P<0.01).Conclusion Whether the raw material source batch is consistent or not,DGD and TD have certain differences in chemical composition.In terms of pharmacological effect,DGD,prepared from a unified batch of decoction pieces,has similar efficacy to traditional decoction in alleviating hemorrhagic anemia.There are certain differences in the pharmacological effects between DGD prepared from different batches of decoction pieces and traditional decoctions.The differences caused by the different preparation processes of the same source batch of prepared slices were compared,and the quality differences of the formula granules from different manufacturers were caused by the different source batches of prepared slices and different preparation processes,indicating the necessity and urgency of the country to formulate a unified quality standard for formula granules and related process specifications.

OBJECTIVE To analyze the narrow-band imaging(NBI)endoscopic characteristics of recurrent early glottic carcinoma patients after undergoing CO2 laser surgery with a suspend laryngoscopy.METHODS A retrospective study was conducted on patients with early-stage glottic carcinoma(Ⅰ-Ⅱ stage)who received CO2 laser surgery under supportive laryngoscopy at the Department of Otolaryngology Head and Neck Surgery,the Second Affiliated Hospital of Xi'an Jiao Tong University from January 2017 to December 2023.The medical history,treatment methods,laryngoscopy(including common white light endoscopy and NBI endoscopy),imaging examinations,and pathological results of patients with recurrent glottic carcinoma were collected at different time points including preoperation,postoperative 1 month,postoperative 3 months,and postoperative 6 months.The endoscopic characteristics of NBI in patients with recurrent glottic carcinoma were summarized.RESULTS First,among 18 patients with early-stage glottic cancer recurrence after CO2 laser,the diagnostic rate of NBI endoscopy for laryngeal cancer recurrence(88.89％,16/18)was significantly higher than that of common white light endoscopy(55.56％,10/18)(χ2=4.985,P=0.026).The intraepithelial papillary capillary loop(IPCL)was classified as a vertical vessel according to ELS in all relapsed patients.However,according to Ni classification,the IPCL of the 72.22％(13/18)were classified as type V,while the IPCL of 27.78％(5/18)showed suspicious abnormal neovascularization(punctate or dilated and curved).The proportion of patients with abnormal IPCL on the surgical surface at 1 month,3 months,and 6 months postoperatively was 0.00％,27.78％(5/18),and 61.11％(11/18),respectively,with statistically significant differences(χ2=16.164,P<0.001),which indicated that the longer the follow-up time for recurrent laryngeal cancer patients,the higher the proportion of patients with abnormal IPCL on the surface of the surgical area under NBI endoscopy.CONCLUSION For early glottic carcinoma after CO2 laser surgery with a suspend laryngoscopy,the appearance of suspicious new blood vessels with type Ⅴ IPCL and punctate or dilated curvature under NBI endoscopy may indicate early recurrence of laryngeal cancer.

AIM:The aim of this study was to investigate the effects and mechanism of high fat on autolyso-somes in hepatoma cells before and after serum deprivation.METHODS:HepG2 cells were intervened with 1 mmol/L so-dium oleate to create a cell high-fat model.The gene expression of transcription factor EB(TFEB)in HepG2 cells was knocked down using TFEB small interfering RNA(TFEB-siRNA)transfection reagent.AMP-activated protein kinase(AMPK)inhibitor compound C(CC)was used to inhibit AMPK phosphorylation expression in HepG2 cells.The expres-sion of nuclear and cytoplasmic TFEB,lysosome-associated membrane protein 1(LAMP1),microtubule-associated pro-tein light chain 3(LC3),autophagy adaptor protein(p62),AMPK,and p-AMPK proteins in each group was analyzed through Western blot experiments.Lipid metabolism and liver function damage in each group were analyzed using total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)assay kits.The accumulation of lipid droplets in each group of cells was analyzed through oil red O staining.RESULTS:(1)Sodium oleate intervention resulted in a concentration-dependent decrease in the protein expression levels of LAMP1,LC3-Ⅱ/LC3-Ⅰ,and nuclear TFEB,while increasing the protein expression level of p62(P＜0.01).(2)Compared to the NC group,the sodium oleate group showed decreased expression of LAMP1,LC3-Ⅱ/LC3-Ⅰ,nuclear TFEB,and AMPK phosphorylation levels,with an increase in p62 expression.Compared to the sodium oleate group,the sodium oleate+serum deprivation combined intervention group showed increased nuclear TFEB,LAMP1,LC3-Ⅱ/LC3-Ⅰ,AMPK phosphorylation levels,and decreased p62 expression levels(P＜0.05).(3)The levels of TC,TG,LDL-C,ALT,and AST were increased in the sodium oleate group compared to the NC group.Serum deprivation reduced the number of lipid droplets induced by sodium oleate in HepG2 cells and decreased the levels of TC,TG,LDL-C,ALT,and AST compared to the sodium oleate group(P＜0.05).(4)Knockdown of TFEB did not result in significant changes in the levels of nuclear TFEB,LAMP1,LC3-Ⅱ/LC3-Ⅰ,p62,TC,TG,LDL-C,ALT and AST compared to the so-dium oleate group.(5)Inhibition of AMPK phosphorylation did not result in significant changes in the levels of nuclear TFEB,LAMP1,LC3-Ⅱ/LC3-Ⅰ,p62,and AMPK phosphorylation in the sodium oleate+serum deprivation group com-pared to the sodium oleate group.CONCLUSION:Serum deprivation improves sodium oleate-induced lipid metabolism damage in HepG2 cells through the autophagolysosome pathway mediated by AMPK-TFEB.

AIM:The aim of this study was to investigate the effects and mechanism of high fat on autolyso-somes in hepatoma cells before and after serum deprivation.METHODS:HepG2 cells were intervened with 1 mmol/L so-dium oleate to create a cell high-fat model.The gene expression of transcription factor EB(TFEB)in HepG2 cells was knocked down using TFEB small interfering RNA(TFEB-siRNA)transfection reagent.AMP-activated protein kinase(AMPK)inhibitor compound C(CC)was used to inhibit AMPK phosphorylation expression in HepG2 cells.The expres-sion of nuclear and cytoplasmic TFEB,lysosome-associated membrane protein 1(LAMP1),microtubule-associated pro-tein light chain 3(LC3),autophagy adaptor protein(p62),AMPK,and p-AMPK proteins in each group was analyzed through Western blot experiments.Lipid metabolism and liver function damage in each group were analyzed using total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)assay kits.The accumulation of lipid droplets in each group of cells was analyzed through oil red O staining.RESULTS:(1)Sodium oleate intervention resulted in a concentration-dependent decrease in the protein expression levels of LAMP1,LC3-Ⅱ/LC3-Ⅰ,and nuclear TFEB,while increasing the protein expression level of p62(P＜0.01).(2)Compared to the NC group,the sodium oleate group showed decreased expression of LAMP1,LC3-Ⅱ/LC3-Ⅰ,nuclear TFEB,and AMPK phosphorylation levels,with an increase in p62 expression.Compared to the sodium oleate group,the sodium oleate+serum deprivation combined intervention group showed increased nuclear TFEB,LAMP1,LC3-Ⅱ/LC3-Ⅰ,AMPK phosphorylation levels,and decreased p62 expression levels(P＜0.05).(3)The levels of TC,TG,LDL-C,ALT,and AST were increased in the sodium oleate group compared to the NC group.Serum deprivation reduced the number of lipid droplets induced by sodium oleate in HepG2 cells and decreased the levels of TC,TG,LDL-C,ALT,and AST compared to the sodium oleate group(P＜0.05).(4)Knockdown of TFEB did not result in significant changes in the levels of nuclear TFEB,LAMP1,LC3-Ⅱ/LC3-Ⅰ,p62,TC,TG,LDL-C,ALT and AST compared to the so-dium oleate group.(5)Inhibition of AMPK phosphorylation did not result in significant changes in the levels of nuclear TFEB,LAMP1,LC3-Ⅱ/LC3-Ⅰ,p62,and AMPK phosphorylation in the sodium oleate+serum deprivation group com-pared to the sodium oleate group.CONCLUSION:Serum deprivation improves sodium oleate-induced lipid metabolism damage in HepG2 cells through the autophagolysosome pathway mediated by AMPK-TFEB.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

OBJECTIVES: To investigate the effect of different soft-tissue morphologies on the treatment of skeletal class Ⅰ malocclusion patients by analyzing measurement data before and after treatment. METHODS: Pre- and post-treatment lateral cephalograms of 55 adult female Angle class Ⅰ patients were collected in the Department of Orthodontics, Hospital of Stomatology, Jilin University from January 2012 to December 2020. Chin soft-tissue morphologies in the lateral cranial radiographs were used to divide the patients into an abnormal chin morphology group (flat and retracted chins, n=27) and a normal chin morphology group (rounded and prominent chins, n=28). Relevant soft- and hard-tissue indexes were selected to study in-group varieties and intergroup differences in the varying chin morphologies before and after treatment. RESULTS: The chin-lip angle, mandibular chin angle, mandibular chin vertex angle, PP-MP, LL-E, UL-E, Po-Pos, and B-B' thickness in the abnormal chin morphology group were significantly higher than those in the normal chin morphology group (P<0.05). Furthermore, m∶BMe and n∶B'Mes in the abnormal chin morphology group were signi-ficantly lower than those in the normal chin morphology group (P<0.05). After treatment, the mandibular chin angle, mandibular chin vertex angle, U1-SN, L1-MP, LL-E, UL-E, SNA, SNB, and B-B' thickness of the abnormal chin morphology group significantly decreased (P<0.05), whereas the nasolabial angle, m∶BMe, n∶B' Mes, and Po-Pos significantly increased (P<0.05). In the normal chin morphology group, the U1-SN, L1-MP, LL-E, UL-E, and B-B' thicknesses decreased significantly (P<0.05), whereas the nasolabial angle significantly increased (P<0.05). Among them, m∶BMe and n∶B' Mes were positively correlated. CONCLUSIONS Chin morphology affects the formulation of treatment plans. Compared with the normal chin morphology group, the abnormal chin morphology group required a larger retraction of incisors. Although the chin of soft-tissue morphology is related to the morphology of bones, the changes in soft tissue chin after treatment cannot be directly predicted according to the bone changes. Soft-tissue chin morphology affects the aesthetic assessment of the soft-tissue lateral profile and the change in soft tissue before and after treatment. The method of predicting the change in soft-tissue chin after treatment should consider the morphology of the soft-tissue chin.
Adult ; Humans ; Female ; Chin ; Lip ; Cephalometry/methods* ; Esthetics, Dental ; Mandible

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.