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A novel supramolecular assembly built from Keggin-type polyoxometalates and [18]crown-6 ether building blocks was first applied as sulfur host in lithium–sulfur batteries to resolve remaining critical challenge of polysulfide shuttle effect.

Sustainability of 3D printing can be reflected in three main aspects: deployment of renewable inks, recycling of printed products, and applications for energy- and materials- savings. In this work, we demonstrated sustainable vat-photopolymerization (VPP)-based 3D printing in a whole life-cycle process by developing a renewable ink made of soybean oil and natural polyphenols and recycling the ink for reprinting or converting printed biocomposite to flash graphene (FG) as reinforcing nanofillers in the biocomposite. We also realized its applications in fabricating lightweight, materials-saving 3D structures, acoustic metamaterials, and disposable microreactors for time-saving and efficiency-improving synthesis of metal-organic framework nanostructures. In addition to enhancing the tensile strength and Young's modulus of the biopolymers by 42% and 232% with only 0.6 wt % FG nanofillers, respectively, FG improved the printability of the ink in forming 3D tubular structures, which are usually very hard to be achieved in transparent resin. Success of this work will inspire further development for sustainability in 3D printing.

Mother-to-child transmission (MTCT) of the hepatitis B virus (HBV) is a serious public health challenge. Estimating HBV MTCT incidence by region under different prophylaxis regimens is critical to understanding the regional disease burden and prioritizing interventions. This study aimed to calculate HBV MTCT incidence under different prophylaxis regimens globally and regionally and identify the HBV DNA threshold for maternal peripartum antiviral prophylaxis.This review was registered in advance in PROSPERO (CRD 42019120567). We searched PubMed, Embase, China National Knowledge Infrastructure, ClinicalTrials.gov, and Cochrane Library databases for studies on MTCT in pregnant women with chronic HBV infection from their inception until June 13, 2022. MTCT was defined as hepatitis B surface antigen (HBsAg) or HBV DNA seropositivity in infants aged 6-12 months. We calculated the pooled HBV MTCT incidence using the DerSimonian-Laird random-effects model.Among 300 studies, 3402 of 63 293 infants had HBV due to MTCT. Without prophylaxis regimens, the pooled HBV MTCT incidence was 31.3%, ranging from 0.0% (95% confidence interval [CI] 0.0%-6.0%; European Region) to 46.1% (95% CI 29.7%-63.0%; Western Pacific Region). Following the introduction of the hepatitis B vaccine, the HBV MTCT incidence decreased from 82.9% to 15.9% in HBeAg-positive women and from 10.3% to 2.3% in HBeAg-negative women. Maternal peripartum antiviral treatment alongside infant immunoprophylaxis further decreased MTCT incidence to 0.3% (95% CI 0.1%-0.5%). Despite infant immunoprophylaxis, the incidences of MTCT at maternal HBV DNA levels of2.30, 2.00-3.29, 3.00-4.29, 4.00-5.29, 5.00-6.29, 6.00-7.29 and ≥7.00 logHBV MTCT incidence varies across regions. The Western Pacific Region bears the heaviest burden. Peripartum antiviral prophylaxis plus infant immunoprophylaxis is promising for interrupting HBV MTCT. Regarding the HBV DNA threshold for peripartum antiviral prophylaxis, maternal HBV DNA of 4.00 log

Plant fiber-reinforced composites have the advantages of environmental friendliness, sustainability, and high specific strength and modulus. They are widely used as low-carbon emission materials in automobiles, construction, and buildings. The prediction of their mechanical performance is critical for material optimal design and application. However, the variation in the physical structure of plant fibers, the randomness of meso-structures, and the multiple material parameters of composites limit the optimal design of the composite mechanical properties. Based on tensile experiments on bamboo fiber-reinforced, palm oil-based resin composites, finite element simulations were carried out and the effect of material parameters on the tensile performances of the composites was investigated. In addition, machine learning methods were used to predict the tensile properties of the composites. The numerical results showed that the resin type, contact interface, fiber volume fraction, and multi-factor coupling significantly influenced the tensile performance of the composites. The results of the machine learning analysis showed that the gradient boosting decision tree method had the best prediction performance for the tensile strength of the composites (R2 was 0.786) based on numerical simulation data from a small sample size. Furthermore, the machine learning analysis demonstrated that the resin performance and fiber volume fraction were critical parameters for the tensile strength of composites. This study provides an insightful understanding and effective route for investigating the tensile performance of complex bio-composites.

Seagrasses are rapidly declining worldwide. To safeguard and restore their natural populations, it is fundamental to understand first the biological properties that influence seagrass ecological and demographic trends. Such characteristics are typically linked to the reproductive success of these flowering plants, modulating the genetic diversity and the adaptive potential of seagrass populations. Aiming to inform future restoration efforts, we investigated the reproductive phenology and fruit set of the dioecious tropical seagrass Enhalus acoroides in Li’an lagoon, Hainan Island, China. Although E. acoroides flowered year-round, the flowering intensity varied across seasons (highest in the summer and lowest in the winter), most likely mediated by sea surface temperatures and tides. Mature fruits occurred predominantly in fall and winter, but the frequency was low probably due to the influence of disturbance and algal blooms. Despite the high reproductive investment in terms of flower formation observed throughout the year in E. acoroides, there was limited sexual reproductive success evidenced by the low fruit formation. This study provides insight into the reproductive ecology of E. acoroides, which will be useful for the future conservation and restoration of this threatened seagrass.

To determine whether the monocyte-to-lymphocyte ratio (MLR), as a systemic inflammation index, predicts malnutrition risk during the early stages of cirrhosis.We conducted a single-center prospective cohort study, enrolling patients from June 2016 to September 2020. The patients underwent malnutrition risk assessments upon admission. The patients were classified into five clinical stages according to portal hypertension. The malnutrition risk was scored using the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) and validated by the Nutritional Risk Screening 2002 (NRS-2002) or Liver Disease Undernutrition Screening Tool (LDUST). Routine clinical laboratory measurements were performed to calculate the MLR, Child-Turcotte-Pugh (CTP) class, and model for end-stage liver disease (MELD) score. The patients were followed up for 2 years.Among the 154 patients with cirrhosis, 60 had compensated cirrhosis and 94 had decompensated cirrhosis. The optimal cutoff value of the MLR,0.4, was effective in predicting malnutrition related to death or liver transplantation. Those with a high malnutrition risk defined by the NRS-2002 or RFH-NPT had a higher MLR than those with a low malnutrition risk. For patients with class A CTP cirrhosis or a MELD score of10, an MLR cutoff of0.4 significantly distinguished more patients with a low malnutrition risk than those with a high malnutrition risk. Both the RFH-NPT score and MLR increased significantly across the decompensated cirrhosis substages. Interestingly, the MLR exhibited a positive correlation with the RFH-NPT score until varices appeared, but the correlation was the highest at the substage of a history of variceal bleeding (r = 0.714, P = 0.009). Multivariable analysis demonstrated that an MLR of0.4 was an independent factor for malnutrition risk by screening with the RFH-NPT, and this was confirmed using the LDUST and NRS-2002.Immune-related inflammatory dysfunction predicts malnutrition risk during the early stages of cirrhosis.

Glioma is a primary brain tumor with high incidence rate. High-grade gliomas (HGG) are those with the highest degree of malignancy and the lowest degree of survival. Surgical resection and postoperative adjuvant chemoradiotherapy are often used in clinical treatment, so accurate segmentation of tumor-related areas is of great significance for the treatment of patients. In order to improve the segmentation accuracy of HGG, this paper proposes a multi-modal glioma semantic segmentation network with multi-scale feature extraction and multi-attention fusion mechanism. The main contributions are, (1) Multi-scale residual structures were used to extract features from multi-modal gliomas magnetic resonance imaging (MRI); (2) Two types of attention modules were used for features aggregating in channel and spatial; (3) In order to improve the segmentation performance of the whole network, the branch classifier was constructed using ensemble learning strategy to adjust and correct the classification results of the backbone classifier. The experimental results showed that the Dice coefficient values of the proposed segmentation method in this article were 0.909 7, 0.877 3 and 0.839 6 for whole tumor, tumor core and enhanced tumor respectively, and the segmentation results had good boundary continuity in the three-dimensional direction. Therefore, the proposed semantic segmentation network has good segmentation performance for high-grade gliomas lesions.脑胶质瘤是一种发病率较高的原发性脑部肿瘤，其中高等级胶质瘤恶性程度高，患者生存率低。临床常采用手术切除和术后辅助放化疗的方式进行治疗，因此准确分割肿瘤相关区域对患者的治疗具有重要意义。为改善高等级胶质瘤的分割精度，本文提出一种基于多尺度特征提取、多路注意力融合机制的多模态脑胶质瘤分割方法，主要贡献在于：① 使用多尺度残差结构对多模态脑胶质瘤磁共振图像进行特征提取；② 使用两类注意力模块结构对通道维度和空间维度下的特征信息进行注意力汇聚；③ 使用集成学习策略构建支路分类器对主干分类器的分类结果进行调整修正，提升整体网络的分割性能。实验结果表明本文提出的二维网络分割方法分割全肿瘤区、肿瘤核心区和增强肿瘤区三类目标物的Dice系数值分别为0.909 7、0.877 3和0.839 6，并且分割结果在三维方向上具有良好的边界连续性。因此，本文提出的语义分割网络对高等级脑胶质瘤病灶区具有良好的分割性能。.

Ir-based heterogeneous catalysts for photocatalytic CO2 reduction have rarely been reported and are worthy of investigation. In this work, TiO2 nanosheets with a higher specific surface area and more oxygen vacancies were employed to support Ir metal by impregnation (Imp) and ethylene glycol (EG) reduction methods. In comparison with Ir/TiO2 (Imp) and TiO2, Ir/TiO2 (EG) exhibited excellent photocatalytic performance toward CO2 reduction, especially for CH4 production on account of the oxygen defect of TiO2 and rich surface hydroxyl groups produced from the interaction between TiO2 nanosheets and metallic Ir. In situ ESR suggested that the oxygen defect was significant for CO2 adsorption/activation. Furthermore, metallic Ir was beneficial for photogenerated electron transfer, surface hydroxyl generation, and adsorption of the CO intermediate, generating more available electrons and reducing agents for CH4 production. In situ CO2 DRIFTS confirmed the key synergistic interaction between the oxygen defect and metallic Ir in the photoreduction from CO2 to CH4.

What is already known about this topic? Though coronavirus disease 2019 (COVID-19) has largely been controlled in China, several outbreaks of COVID-19 have occurred from importation of cases or of suspected virus-contaminated products. Though several outbreaks have been traced to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) isolated on the outer packaging of cold chain products, live virus has not been obtained. What is added by this report? In September 2020, two dock workers were detected as having asymptomatic SARS-CoV-2 infection using throat swabs during routine screening in Qingdao, China. Epidemiological information showed that the two dock workers were infected after contact with contaminated outer packaging, which was confirmed by genomic sequencing. Compared to the Wuhan reference strain, the sequences from the dock workers and the package materials differed by 12–14 nucleotides. Furthermore, infectious virus from the cold chain products was isolated by cell culture, and typical SARS-CoV-2 particles were observed under electron microscopy. What are the implications for public health practice? The international community should pay close attention to SARS-CoV-2 transmission mode through cold chain, build international cooperative efforts in response, share relevant data, and call on all countries to take effective prevention and control measures to prevent virus contamination in cold-chain food production, marine fishing and processing, transportation, and other operations.

Alanine aminotransferase (ALT) flare remains one of the determinants of initiating antiviral therapy in children with chronic hepatitis B (CHB). Insufficient data exist regarding children with CHB attributed to mother-to-child transmission. This study aimed to assess the occurrence of spontaneous ALT flares and identify factors affecting therapy-induced hepatitis B surface antigen (HBsAg) loss in the flare cohort. We retrospectively included untreated children with mother-to-child transmitted CHB. The primary outcomes were spontaneous ALT flares and therapy-induced HBsAg loss. Among 83 untreated children, 73.5% (61/83) experienced spontaneous ALT flares during the median follow-up of 14.6 months (range, 0.1-177.1 months), with 54.1% of the first ALT flares and 44.3% of ALT peaks occurring within 6 years of age. Thirty-six of 61 children with ALT flares received antiviral therapy, nine (25.0%) of whom achieved therapy-induced HBsAg loss with a median duration of 19.3 months (range, 6.5-56.2 months). The age of initiation of antiviral therapy was the sole predictor of therapy-induced HBsAg loss (HR = 0.544, 95% CI 0.353-0.838, p = 0.006). The restricted cubic spline showed a negative relationship between the age of initiation of antiviral therapy and HBsAg loss and identified that 6.2 years of age discriminated children with therapy-induced HBsAg loss. Kaplan-Meier estimations suggested a higher probability of HBsAg loss in children who started antiviral therapy before 6.2 years old (p = 0.03). In conclusion, asymptomatic ALT flares were frequent in preschool-aged children with mother-to-child transmitted CHB, and early initiation of antiviral therapy showed promising effects in those children with ALT flares.

Nano-silica was modified with triazine derivative and characterized using FTIR and TGA techniques. Then the hybrid nano-silica was blended with polypropylene and intumescent flame retardant to prepare a novel intumescent flame-retardant polypropylene. Nitrogen and phosphorus elemental mapping micrographs and SEM micrographs elucidated that the hybrid nano-silica could facilitate intumescent flame retardant to disperse more uniformly in polypropylene. TGA results showed that hybrid nano-silica could improve the thermal stability of polypropylene. With 18% intumescent flame retardant and 2% hybrid nano-silica, the novel intumescent flame-retardant polypropylene got a limiting oxygen index of 29.7% and passed the vertical burning (UL-94) V-0 rating. Cone calorimeter test showed that the peak heat release rate and total heat release clearly decreased.

Background Several antiviral agents licenced for blocking mother-to-child transmission (MTCT) of HBV, but their relative efficacy beginning from different trimesters has scarce been evaluated. We aimed to conduct a network meta-analysis to statistically differ the efficacy and safety of each antiviral agents initiating on different timings in preventing mother-to-infant transmission of HBV. Methods Studies were included from PubMed, EMBASE, Web of Science, and Cochrane databases through July 1, 2019. Eligible studies recruited randomized controlled trials and nonrandomized studies reporting about infant or/and maternal efficacy and safety outcomes and were screened by two investigators independently. Extracted data were analyzed by pair-wised and network meta-analysis, respectively. Results 3 Randomized and 32 nonrandomized studies enrolling 6738 pregnant female were included. Using network analysis, any antiviral agent interrupted HBV vertical transmission much more effectively than placebo. No agent showed significant efficacy different from others, but a strong trend toward significance was found in telbivudine and tenofovir, of which had the highest probability of being ranked the first- or second-best treatment for reducing MTCT of HBV. The treatment applied in the first and second trimester had a similar efficacy in preventing MTCT. Compared with the initiation during the third trimester, lower rate of MTCT was revealed when antiviral therapy was administrated before third trimester, (RR = 0.045, 95% CI 0.0053 to 0.20); a similar effect at delivery on suppressing maternal HBV DNA level and converting serum HBeAg were achieved if the timing of antiviral treatment started prior, but an obvious improvement of normalizing ALT flare was calculated out; no statistically differences among maternal and fetal safety outcomes were found if mothers received antiviral agents before pregnant 28 weeks. Conclusion This network meta-analysis recommended the earlier use of telbivudine or tenofovir, tends to be better to prevent MTCT of HBV in pregnancy with no increased adverse maternal or fetal outcomes.

Defect-rich carbon nanotubes (CNTs) for cyclohexane oxidation were systematically investigated. Abundant defects on the CNT surface generated by annealing treatment show an exceptional capability to generate electrophilic oxygen in air. These electrophilic species were verified as the ‘promoters’ for the oxidation of cyclohexane, significantly enhancing the reaction conversion.

Background Fewer than 50% of patients with acute-on-chronic liver failure (ACLF) recover spontaneously, and ACLF has high mortality without liver transplantation. Oxidative stress has been shown to mediate hepatic inflammation during acute liver failure (ALF). We wanted to see if a biomarker for oxidative stress might be used to measure the severity and prognosis of ACLF patients. Methods A retrospective cohort of 124 ACLF patients, as well as healthy individuals, liver cirrhosis and ALF patients, was studied between January 2015 and September 2018. The levels of plasma superoxide dismutase (SOD) were detected using an ELISA commercial kit, and the Kaplan–Meier method was used for survival analysis. Results Patients with ACLF had statistically higher plasma SOD levels than the controls did (healthy controls and liver cirrhosis patients); however, the levels did not differ from those in patients with ALF. The plasma SOD level may be an inexpensive, easily accessible, and significant independent prognostic index for mortality on multivariate analysis (HR = 1.201, 95% CI 1.001–1.403, P 428 U/mL was linked to a statistically significant increase in the likelihood of death or liver transplantation in ACLF patients. Combination of plasma SOD levels and MELD scores improved performance in measuring the severity and prognosis of ACLF patients. Conclusion Patients with ACLF can be classified into high-risk and low-risk groups based on their plasma SOD levels at the time of admission to the hospital. The patient outcome is more closely connected with the combination of SOD level and MELD score than either value alone. This approach might be used to predict patient prognoses and prioritize liver transplant candidates.

Designing highly efficient and low-cost electrocatalysts is of great importance in the fields of energy conversion and storage. We report on the facile synthesis of a single atom (SA) iron catalyst via the pyrolysis of a functionalized mesophase pitch. Monomers of naphthalene and indole underwent polymerization in the presence of iron chloride, which afterwards served as the pore-forming agent and iron source for the resulting catalyst. The SA-Fe@NC catalyst has a well-defined atomic dispersion of iron atoms coordinated by N-ligands in the porous carbon matrix, exhibiting excellent oxygen reduction reaction (ORR) activity (E1/2 = 0.89 V) that outperforms the commercial Pt/C catalyst (E1/2 = 0.84 V). Moreover, it shows better long-term stability than the Pt/C catalyst in alkaline media. This facile strategy could be employed in versatile fossil feedstock and develop promising non-platinum group metal ORR catalysts for fuel cell technologies.

Hippocampus is one of the first affected brain regions in Alzheimer's disease (AD). To help AD diagnosis, hippocampal atrophy have been studied extensively, but accurate segmentation of hippocampus has always been a difficult problem. In this study, we propose a 3D multi-scale multi-attention UNet with the use of multi-scale inception module, residual connections and attention modules for automatic hippocampal segmentation. Experimental results on the HarP dataset show that our proposed method can achieve average Dice coefficient of 0.827 for hippocampal segmentation, which outperform classic 3D UNet. The efficiency and accuracy of the proposed methods suggests that it may facilitate the study of the hippocampus for large-scale studies.

Background Viral hepatitis E clinically ranges from self-limiting hepatitis to lethal liver failure. Oxidative stress has been shown to mediate hepatic inflammation during HBV-induced liver failure. We investigated whether a biomarker of oxidative stress may be helpful in assessing severity and disease outcomes of patients with HEV-induced liver failure. Methods Clinical data were obtained from patients with HEV-induced acute viral hepatitis (AVH, n = 30), acute liver failure (ALF, n = 17), and acute-on-chronic liver failure (ACLF, n = 36), as well as from healthy controls (HC, n = 30). The SOD and HMGB1 levels were measured in serum by ELISA. HL-7702 cells were cultured and stimulated by serum from HEV-infected patients or by HMGB1; oxidative status was investigated by CellROX and apoptosis was investigated by flow cytometry. Results Patients with HEV-induced liver failure (including ALF and ACLF) showed increased SOD levels compared with HEV-AVH patients and healthy controls. SOD levels > 400 U/mL were associated with a significantly higher risk of mortality in HEV-ALF and HEV-ACLF patients. Serum from HEV-infected patients led to ROS accumulation, HMGB1 secretion, and apoptosis in HL-7702 cells. Antioxidant treatment successfully inhibited HEV-induced HMGB1 secretion, and HMGB1 promoted apoptosis in HL-7702 cells. Conclusion HEV increased oxidative stress in the pathogenesis of HEV-induced hepatic diseases. Early testing of serum SOD may serve as a predictor of both HEV-ALF and HEV-ACLF outcomes. Moreover, development of strategies for modulating oxidative stress might be a potential target for treating HEV-induced liver failure patients.

The development of sustainable fiber-polymer composites using renewable or recycled feedstocks has received considerable attention from both academia and industry. In this study, a soybean oil base...

Background Physical exercises have been shown to be a surprisingly effective strategy to take advantage of the brain's natural capacity for plasticity, and prevent brain degeneration in mouse histological studies. In vivo magnetic resonance microscopy (MRM) provides highly resolved anatomical images and allows quantitative assessment of brain atrophy in the aged mouse model. Objective The aim of the present study was to investigate, through the effects of 10 weeks voluntary wheel running, the mouse's brain atrophy. Methods Sixteen C57BL/6J mice, aged 21 months, were randomized to the exercise or sedentary group. Each mouse was scanned in a 7.0-T MRM scanner at two time points: 22 months old baseline and a follow-up three months later. Multi-atlas based brain segmentation approach was used to obtain volumes of 39 brain regions. Results The results showed that mice in the exercise group had less brain atrophy compared with the mice in the sedentary group. Conclusions The results provide new insights into exercise induced brain plasticity in aged animals.

The advent of 3D printing has led to a new era of highly customized products. Printing reprocessable thermoplastic polymers is limited to slow printing techniques such as fused deposition modeling. Photocuring 3D printing is a high-speed 3D printing technique suitable for photocurable thermosetting resins because the cross-linked 3D network could achieve rapid solid-liquid separation during printing. However, thermoplastics usually cannot be printed via photocuring 3D printers because rapid solid-liquid separation is hard to be achieved due to the diffusion/dissolution of linear molecular chains in their liquid precursor. Herein, we hypothesize that hydrogen bonds (H-bonds) between monomers may accelerate polymerization and reduce solubility of the polymer in liquid precursors to achieve rapid solid-liquid separation. Using this strategy, a series of UV-curable methacrylic and acrylic monomers was selected as inks to demonstrate the role of H-bonds in photocuring 3D printing. The hypothesis was further verified by using blended inks of N-vinyl-2-pyrrolidinone (NVP) and acrylic acid (AA) via experimental and molecular dynamic simulation. Oil palm occupies the top position of plantation species in southeastern Asian forests. Palm oil (PO) has the lowest price compared with other plant oils. Thus, a PO-based vinyl monomer was selected as the raw material for 3D printing thermoplastic polymers. Various biobased thermoplastics were successfully printed from the PO-based monomer and commercial monomers. The amide structure in the PO monomer formed H-bonds with polar monomers, including NVP and AA, resulting in printed 3D objects with surprising functionalities such as high stretchability and self-healing ability.

Inflammation plays a critical role in disease pathogenesis of acute-on-chronic liver failure (ACLF). Atg13 is a vital regulatory component of ULK1 complex, which plays an essential role in initiation of autophagy, and autophagy has been connected to hepatic inflammation. The aim of this study is to evaluate how autophagy regulates hepatic stellate cells (HSCs) inflammatory responses via Atg13 during ACLF. Clinical data were collected from ACLF patients, and surgical resected paraffin embedded human ACLF liver tissues specimens were collected. Inflammation and autophagy were investigated by immunoblot analysis in HSCs treated with lipopolysaccharide (LPS). Co-immunoprecipitation were used to investigate interaction of Atg13 and ULK1. Our data exhibit that serum LPS is positively associated with disease severity in ACLF patients, and p38 MAPK is overexpressed in ACLF liver tissues. Inflammatory factors are up-regulated via the activation of p38 MAPK and the inhibition of the autophagy in LX-2 cells. Furthermore, we illuminate in the vitro study that LPS triggers p38 MAPK activity, resulting in phosphorylation of Atg13, inhibition of Atg13-ULK1 interaction and autophagy. This study highlights a molecular mechanism that LPS promotes inflammation through inhibition of autophagy in HSCs via Atg13, and provides a new understanding into the mechanistic of inflammatory process of severe hepatitis and a novel strategy for ACLF treatment.

Ir-based heterogeneous catalysts for photocatalytic CO

OBJECTIVES To evaluate the performance and cost-effectiveness of existing diabetes risk scores (DRSs) to screen for undiagnosed diabetes mellitus (UDM) and prediabetes (PD) in a community-based southwestern Chinese population. METHODS Participants in TIDE-Chengdu survey with requisite data and without known diabetes were included. Five Chinese-derived DRSs and six non-Chinese-derived DRSs were included for evaluation. Their performance in detecting UDM and UMD or PD (UDM/PD) was assessed using the C-statistic. The cost-effectiveness of the optimal DRS was compared with that of capillary fasting blood glucose (CFBG). RESULTS Of the 1,692 TIDE-Chengdu survey participants included, 177 (10.5%) had UDM and 339 (20.0%) had PD. The rural participants (N = 737) were more likely to have UDM (13.4% vs. 8.2%) and PD (24.8% vs. 16.3%) than their urban counterparts (N = 955) (P

The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) to identify malnutrition risk in patients with liver disease. However, little is known about the application of the RFH-NPT to screen for the risk of malnutrition in China, where patients primarily suffer from hepatitis virus-related cirrhosis. A total of 155 cirrhosis patients without liver cancer or uncontrolled co-morbid illness were enrolled in this prospective study. We administered the Nutritional Risk Screening 2002 (NRS-2002), RFH-NPT, Malnutrition Universal Screening Tool (MUST) and Liver Disease Undernutrition Screening Tool (LDUST) to the patients within 24 h after admission and performed follow-up observations for 1·5 years. The RFH-NPT and NRS-2002 had higher sensitivities (64·8 and 52·4 %) and specificities (60 and 70 %) than the other tools with regard to screening for malnutrition risk in cirrhotic patients. The prevalence of nutritional risk was higher under the use of the RFH-NPT against the NRS-2002 (63 v. 51 %). The RFH-NPT tended more easily to detect malnutrition risk in patients with advanced Child–Pugh classes (B and C) and lower Model for End-stage Liver Disease scores (