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.

Objective:To investigate the incidence of sarcopenia in maintenance hemodialysis (MHD) patients and analyze its influencing factors.Methods:Totally 441 non-hospitalized MHD patients in stable condition were selected,by bioelectrical impedance analysis (BIA) to test appendicular skeletal muscle mass(ASM), by testing grip strength of MHD patients, to assess Muscle strength, by gait speed test to measure the 4-m usual walking speed, to assess physical performance of MHD patients.Risk factors of sarcopenia were identified by Logistic regression analysis.Results:The total incidence of sarcopenia in 441 MHD patients was 16.55% (73/441) and the incidence of sarcopenia in patients over 60 years old was 28.91% (61/211).The results showed older age ( OR=0.213, 95% CI 0.099-0.458, P<0.01), Karnofsky ( OR=9.661, 95% CI 3.850-24.244, P<0.01), subjective global assessment ( OR=0.491, 95% CI 0.250-0.965, P=0.039), serum phosphorus ( OR=0.422, 95% CI 0.204-0.875, P=0.020) and body mass index ( OR=0.754, 95% CI 0.609-0.935, P=0.010) were risk factors of sacopenia. Conclusions:The incidence of sarcopenia in elder, performed less physical activity, malnutrition predisposed MHD patients was high, so to those patients we should be paid more attention and gave active interventions to reduce sarcopenia.

Objective: To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) from different donors as first-line treatment for children and adolescents with severe aplastic anemia (SAA) . Methods: The clinical data of 79 children and adolescents with SAA diagnosed from January 2013 to December 2016 in Henan Province were retrospectively analyzed. There were 50 males and 29 females, with a median age of 14(4-18) years. 40 cases received matched sibling transplantation (MSD-HSCT), 17 with unrelated donor transplantation (UD-HSCT), and 22 with haploidentical transplantation (haplo-HSCT). Results: The comparison of MSD-HSCT, UD-HSCT, haplo-HSCT groups was conducted and the median times of neutrophils engraftment were statistically significant [12(9-25) d, 14(10-22) d, 16(11-26) d, respectively (χ²=13.302, P=0.001)], but no difference in+30 d engraftment rate [97.3%(36/37), 100%(15/15), 100%(20/20), χ²=0.959, P=0.619]. The median times of PLT engraftment were not statistically significant [14(6-34)d, 16(7-32)d, 19(10-34)d, respectively, χ²=5.892, P=0.053], and the +30 d engraftment rate had no difference [97.3%(36/37), 100%(15/15), 100%(20/20), χ²=0.959, P=0.619]. The post-transplant infection rate showed no statistically significance [35.0% (14/40), 29.4% (5/17), 45.5% (10/22), χ²=1.158, P=0.560], as well as the incidences of aGVHD, grade III/IV aGVHD and cGVHD(χ²=0.230, P=0.891; χ²=2.628, P=0.269; χ²=3.187, P=0.203). The two-years OS rate was not statistically significant respectively [(77.1±6.7)%, (70.6±11.1)%, (77.3±8.9)%, χ²=0.330, P=0.845]. Severe post-transplant infection (RR=4.617, P=0.009), grade Ⅲ/Ⅳ aGVHD (RR=2.707, P=0.048) were independent risk factors for OS. Conclusion The overall efficacy of MSD-HSCT, UD-HSCT and haplo-HSCT as first-line therapy for children and adolescents with SAA/VSAA is comparable.

Objective To investigate the effhect of ultrasound-guided nerve block on the prognosis of patients undergoing laparoscopic cholecystectomy.Methods A total of 150 cases undergoing elective laparoscopic cholecystectomy in our hospital was used as the research object,and randomly divided into control (n =75) and observation (n =75) groups.The control group used punctured local infiltration analgesia,and observation group used the transversus abdominis plane block (TAP) combined with local infiltration analgesia hole.The postoperative awake time,hemodynamic changes,pain score,and analgesic use were compared between two groups.Results The recovery time was significantly reduced in the observation group (9.7 ± 2) minutes compared to the control group (23.9 ± 2.4) minutes.The additional total dose of analgesics and average additional times were significantly lower in the observation group compared to the control group (P ＜0.05).The pain score were 0.99 ±0.22 after waking,1.05 ±0.14 at the postoperative 6 h,1.13 ±0.23 at the postoperative 24 h,and 1.40 ±0.38 at the postoperative 48 h in the observation group,which was significantly lower than the corresponding 3.99 ± 0.36,3.67 ± 0.43,3.39 ± 0.38,and 3.93 ± 0.20 in the control group (P ＜ 0.05).With the postoperative time,postoperative 48 h in two groups of visual pain scores were significantly higher than that of 24 h after the operation (P ＜ 0.05).The incidence of adverse reactions was no significant difference between observation group (36％) and control group (32％) (P ＞ 0.05).Conclusions Ultrasound-guided nerve block can obviously reduce postoperative pain,reduce drug use frequency and dosage,significantly improve postoperative outcomes,and does not increase the incidence of adverse drug reactions.It is worthy of clinical reference.