Both RUT and W-S stain were positive was diagnosed as Helicobacter pylori infection.Contrast the diagnostic accuracy of atrophic gastritis among the three groups. Compare the differences of gastric mucosa features which suggest Helicobacter pylori infection among the three group. Results: Results: 85 cases of group I,88.3% were Hp positive,25.8% were atrophy,1.1% were intestinal metaplasia and 4.4% were heterogenesis.108 cases of group II,31.5% were Hp positive,49%

were atrophy,27.8% were intestinal metaplasia and 10.2% were heterogenesis; 15 cases of group III,26.7% were Hp positive,93.3%were atrophy,60% were intestinal metaplasia and 26% were heterogenesis.14 cases of the 15 cases in the III group, the region which got grey and thinner were atrophic selleck compound Pembrolizumab gastritis,the region which surrouding erythrophlogosis

gastric mucosa were chronic inflammation.Compared group I with group II, both of the cases of Hp infection and atrophic gastritis were differences (P < 0.05).Among the group comparison, the cases of atrophic gastritis were significantly differences(P < 0.05). Conclusion: Conclusion: Regions of gastric mucosa with a obvious boundary got thinner and blood vessel could be seen,the description above could be the specific manifestation of atrophic gastritis. Key Word(s): 1. Atrophic gastritis; 2. Helicobacter pylori; 3. endoscopy; Presenting selleck chemical Author: RAPAT PITTAYANON Additional Authors: WIRIYAPORN RIDTITID, NUTTAPHAT NAMJUD, RATHA-KORN VILAICHONE, VAROCHA MAHACHAI Corresponding Author: VAROCHA MAHACHAI Affiliations: Chulalongkorn University; Thammasart University Objective: Optimal H.pylori eradication therapy varies among different geographical locations depending mainly on antibiotic resistance. Recently, there has been suggestion that CYP2C19 genotype can have an effect on the efficacy of PPI due to the metabolizing activity and consequently affecting the eradicating

rate. This study was aimed to determine the efficacy of dual therapy as the first line H.pylori eradication therapy. Methods: Patients who had gastritis from gastroscopy with positive urease test were recruited. Additional gastric biopsy was taken for CYP2C19 genotypes. The dual therapy consisting of high dose Rabeprazole 20 mg qid and amoxicillin 1 gm tid was given for 10 days. We excluded those patients with penicillin allergy, receiving prior eradication therapy or antibiotic use within prior one month. All patients underwent 13C urea breath test (UBT) at least 6 weeks after eradication therapy. Results: A total of 72 patients with H.pylori associated gastritis were included. The regimen was well tolerated by all patients with no reported drop out. The eradication success rate as determined by negative UBT was achieved in 52/72 patients (72.2%).

Our modeling of uncomplicated TCP is significant, in our view, as it demonstrates the capacity of radiotherapy to sterilize or cure small HCC tumors with a relatively high probability. Radiotherapy has only rarely been considered as a curative treatment modality. Our findings are supported by recent clinical reports

which have demonstrated impressive complete radiological response rates (ranging 80–87.5%) for small HCC,28,29 although this end-point is not a reliable indicator of sterilization. While the potential for radiotherapy to cure smaller HCC exists, it is also clear from our modeling that large tumors are unlikely to be sterilized. Despite this, radiotherapy to large tumors will result in a large proportion CH5424802 concentration of clonogens being killed. This can be clinically useful in terms of tumor shrinkage or delay MK-2206 clinical trial of growth or recurrence. The clinical benefits of radiotherapy in the setting of large, incurable HCC have been widely reported in non-randomized clinical trials and recently reviewed by Hawkins et al.27 In general, radiotherapy, usually combined with transarterial chemoembolization (TACE), has been associated with partial (>50%) radiological responses in over 50% of patients and complete disappearance

of tumor thrombus in major veins has been reported in more than 30% of cases.30,31 The tumor control probability modeling also highlights the need for high radiation doses to sterilize HCC following other local therapy of HCC which may see more leave residual subclinical disease. This is an important consideration when radiotherapy is required to provide adjuvant therapy following initial treatment with other modalities such as TACE or radiofrequency ablation

(RFA). There are several important advantages of standard external beam radiotherapy techniques which warrant further discussion. First, radiotherapy is an established cancer therapy which is already widely accessible and the techniques required are routinely available. This differs from other therapies (liver transplantation and resection, RFA and TACE) which may be less accessible and the results more operator-dependent. We believe that current CT planning techniques combined with standard treatment are sufficient for most cases, although achieving greater accuracy, which is desirable for small tumors, may be possible using intensity modulation or stereotactic techniques if available. Even so, inaccuracies due to movement must be recognized. In HCC endemic areas of the developing world, 90Y microspheres are not generally available and heavy ion techniques are prohibitively expensive. An advantage of radiotherapy over chemotherapy is greater tumor cell kill. For typical cancers, radiotherapy may achieve approximately 10–12 or more log kill, compared with approximately up to 6 log kill associated with chemotherapy.

IL-22 has been shown to promote hepatoma cell proliferation and survival12; however, no tumor was observed in all organs, including the PLX-4720 in vivo liver, in IL-22TG mice up to 2 years of age (data not shown). Next, we examined whether IL-22TG mice were more susceptible to DEN-induced liver tumorigenesis. As illustrated in Fig. 5A,B, IL-22TG mice had a larger liver tumor size and a higher liver/body weight ratio than WT mice 9 months after DEN injection. Liver histology confirmed that the liver tumors from both WT and IL-22TG mice are hepatocarcinoma (Supporting Information Fig. 3a). The incidence of tumor development in IL-22TG

mice was 100%, whereas the WT littermate group only had 60% and 80% tumor incidence after injection of 10 μg/g and 20 μg/g, respectively (Supporting Information Fig. 3b). In addition, the maximum size of tumors and the number of tumors were greater in IL-22TG mice compared with WT mice after DEN injection (Fig. 5C,D). Western blot analysis demonstrated that pSTAT3 activation was detected

in both nontumor and tumor regions in IL-22TG mice, but was detected only in the tumor region in WT mice. In addition, cyclin D1 and Bcl-xL expression were higher in the tumors from IL-22TG mice than in those from WT mice (Fig. 5E). Real-time PCR analyses revealed that IL-22 was detected at low levels in nontumor and tumor tissues from DEN-treated WT mice, but was detected at very high levels in nontumor and tumor tissues from DEN-treated IL-22TG mice (Fig. Selleck Adriamycin 5F). The levels of IL-22 in tumor tissues were slightly lower compared with those in nontumor tissues from DEN-treated IL-22 mice (Fig. 5F). Furthermore, the number of Ki67-positive cells was higher in the tumor tissues from IL-22TG mice compared with WT mice (Supporting Information Fig. 3c). To rule out whether increased DEN-induced liver tumorigenesis in IL-22TG mice was due to an increase in DEN metabolism–associated liver injury and oxidative stress induced by a single dose of DEN injection at age 15 days, we measured serum ALT and AST, liver glutathione (an antioxidant), malondialdehyde (a marker of

lipid peroxidation), and 8-hydroxy-2′-deoxyguanosine (a major see more product of DNA oxidation). As illustrated in Fig. 6A, DEN injection induced elevation of serum ALT and AST in both WT and IL-22TG mice, with lower serum ALT in the latter group 12 hours after injection. A single dose of DEN injection induced elevation of malondialdehyde and 8-hydroxy-2′-deoxyguanosine but reduction of glutathione in WT mice. Similar changes were observed in IL-22TG mice. These findings indicate that a single injection of DEN induced similar levels of lipid peroxidation and DNA oxidation in the liver of WT and IL-22TG mice at age 15 days, suggesting the increased DEN-induced liver tumorigenesis in IL-22TG is not caused by an increase in DEN-metabolism.

Transplantation of cell sheets manipulated by hexachlorophene promotes liver regeneration by producing trophic factors including liver-specific serum proteins. Disclosures: The following people have nothing to disclose: Noriko Itaba, Yoshiaki Matsumi, Kaori Okinaka, Yohei Kono, Goshi Shiota Background and Aim: Hepatic steatosis is the main feature of non-alcoholic fatty liver disease (NAFLD). Severe steatosis and progression to non-alcoholic steatohepatitis (NASH) results in hepatocyte damage and liver dysfunction. Factors involved in progression of simple steatosis to NAFLD

and NASH are incompletely understood, but likely X-396 cost involve a ‘multiple hit’ mechanism. As the number of individuals with mild to moderate liver steatosis is increasing, the number of patients with steatosis that require a partial hepatectomy for malignant disease is increasing. We hypothesized that partial hepatectomy would affect the progression of steatotic

liver disease and have investigated the effect of partial hepatectomy on liver regeneration and the progression of the NAFLD status in mice with mild steatosis. Methods: C57BL/6JolaHsd mice were fed a choline deficient L-amino acid defined diet (CD-AA) for a maximum of 3 weeks. Mice fed a choline sufficient L-amino acid defined diet (CS-AA) were used as controls. Two weeks after the start of the diet, mice underwent partial hepatectomy or a sham operation. Mice were sacrificed at several time points after the operation and blood and R788 in vivo liver samples were taken for analysis. Results: The CD-AA diet induced mild hepatic steatosis by 3 weeks as demonstrated by histological examination and an elevated NAFLD activity score (1. 8 ± 0. 7) in the sham group.

Mice in the CD-AA sham group had significantly higher basal levels of aminotransferases in plasma compared to the CS-AA group by 3 weeks (P <0. 05). After partial hepatectomy, aminotransferase levels in plasma increased significantly (p <0. 05) in both CDAA and CS-AA groups over a 2-hour period but returned to basal levels over time. Liver mass restoration over time was not different between the CD-AA and CS-AA groups. Interestingly, selleck chemicals in the CD-AA group NAFLD activity scores were significantly higher at 7 days after partial hepatectomy compared to the sham operated mice (3. 7 ± 1. 3 vs. 1. 8 ± 0. 7; P<0. 05). In addition, malondialdehyde (MDA) levels in liver tissue of the CD-AA but not of the CS-AA group were significantly higher at day 1, 3 and 7 after partial hepatectomy compared to the sham mice (P <0. 05). Conclusion: Mild liver steatosis does not impair liver regeneration. However, partial hepatectomy does substantially accelerate the progression of NAFLD, which may have clinical consequences for humans with steatosis that require partial hepatectomy. Disclosures: The following people have nothing to disclose: Golnar Karimian, Marc Kirschbaum, Susanne Veldhuis, Robert J.

“
“Spontaneous intracranial hypotension (SIH) is typically characterized by orthostatic headache; however, various atypical manifestations of SIH have been

reported recently. We report here the case of a 46-year-old man with headache secondary to SIH, which was nonorthostatic, triggered only when the patient shook his head. We suggest that SIH should be suspected in patients with headache induced by head-shaking, even without orthostatic features, especially when the headache is accompanied by other symptoms commonly associated with SIH. “
“Background.— Studies using resources of a public family health program to estimate the prevalence of chronic STAT inhibitor daily headaches (CDH) are lacking. Objectives.— To estimate the 1-year prevalence of CDH, as well as the presence of associated psychiatric and temporomandibular disorders (TMD) comorbidities,

on the entire population of a city representative of the rural area of Brazil. Methods.— This was a cross-sectional, population-based, 2-phase study. In the first phase, health agents interviewed all individuals older than 10 years, in a rural area of Brazil. In the second stage, all individuals who reported headaches on 4 or more days per week were then evaluated by a multidisciplinary team. CDH were classified according to the second edition of the International Classification of Headache Disorders (ICHD-2). Medication overuse headache selleck chemicals llc was diagnosed, as per the ICHD-2, after detoxification trials. Psychiatric comorbidities JAK inhibitor review and TMD were diagnosed based on the DSM-IV and on the Research Diagnostic Criteria for Temporomandibular Disorders criteria, respectively. Results.— A total of 1631 subjects participated in the direct interviews. Of them, 57 (3.6%) had CDH. Chronic migraine was the most common of the CDH (21, 36.8%). Chronic tension-type headache (10, 17.5%), medication overuse headache (13, 22.8%) and probable medication overuse headache

(10, 17.5%) were also common. Psychiatric disorders were observed in 38 (67.3%) of the CDH subjects. TMD were seen in 33 (58.1)% of them. Conclusions.— The prevalence of CDH in the rural area of Brazil is similar to what has been reported in previous studies. A significant proportion of them have psychiatric comorbidities and/or TMD. In this sample, comorbidities were as frequent as reported in convenience samples from tertiary headache centers. (Headache 2010;50:1306-1312) “
“The primary aim of our study was to evaluate if a group of medication-overuse headache (MOH) patients present dysfunctions in the mesocorticolimbic dopamine circuit. The secondary aim was to disentangle the role of the medication overuse and of the acute/chronic headache in determining these alterations and to investigate their persistence. Several researches have suggested that MOH may belong to the spectrum of addictive behavior.

Methods: Using patient registration database of a university hospital of Iran University of Medical Scicnes, we extracted the data of diagnosed celiac patients. All demographic data, signs

and symptoms and laboratory data including celiac disease serologic tests were collected. All patients had been diagnosed based on Marsh classification following duodenal biopsy. The ethics committee of the Iran University of Medical Science approved the study and informed consents were obtained from all patients after explaining the study aims and protocol. Results: 133 celiac disease patients (80 men) with mean age of 42 were recruited. The most common chief complaint was diarrhea in 57 patients (43%). Constipation, weight loss, abdominal pain, chronic dyspepsia and Reflux were also main complaints in about 6% of patients, separately. 12 patients ABT-263 chemical structure were referred only by chronic fatigue and malaise, whom finally being diagnosed for CD. In 2 patients the diagnosis of CD was made following evaluation of recurrent abortion and in 1 for infertility. Anemia reported in 73% patients besides other symptoms, however it was the only chief complaint

of 22 patients. The main clue for diagnosis of CD in 5 patients was abnormal LFT. Conclusion: Celiac disease in Iran is presented with a wide range of signs and symptoms. The real challenge about celiac disease is to recognize atypical, asymptomatic or Caspase activity oligosymptomatic cases. We recommend thinking about celiac disease in all cases with suspicious signs and symptoms and checking celiac disease serologic tests to prevent late or misdiagnose. Key Word(s): 1. Celiac disease; 2. Iran; Presenting Author: CHEN HUANG Additional Authors: BIN LV, SHUO ZHANG, HONGYI FAN, LU

ZHANG, NING JIANG Corresponding Author: CHEN HUANG, BIN LV Affiliations: selleck screening library First Affiliated Hospital of Zhejiang Chinese Medical University Objective: Data indicate that NSAIDs-induced small bowel injury are less well recognized in the past. In a randomized, open-label, controlled clinical trial with video capsule endoscopy (VCE), we prospectively to evaluate the incidence of small bowel injury in healthy subjects treated with diclofenac and the effect of isinglass on preventing NSAIDs-induced small bowel injury. Methods: We randomly assigned 20 healthy subjects with normal baseline VCEs to A group (isinglass 3 g twice daily plus diclofenac slow-release 75 mg twice daily, n = 10), or B group (diclofenac slow-release 75 mg twice daily, n = 10), all of them with omeprazole 20 mg once daily for gastroprotection for a total of 14 days, then the VCE investigations were repeated. Results: After drug treatment, 18 subjects (7 males and 11 females; mean age 34.1 years; A group: n = 8, B group: n = 10) had increased repeat the VCE investigations above the upper limit of normal. Capsule enteroscopy showed new pathology in 11 subjects (A:4/8, 50%; B:7/10, 70%).

Levels of coagulation FVIII and FIX at certain time points can be predicted using PKs

and studies have shown correlation between PK parameters and clinical phenotype in haemophilia. Using PK-tailored prophylaxis means that levels can be controlled, predicted and monitored to improve medical and health economic outcomes. In the near future, with the introduction of long-acting products, the use of PKs will become even more imperative. Population PKs have been studied for both FVIII and FIX and documented the requirement of sparse sampling only. This, together with new IT solutions, will soon make it feasible for haemophilia centres to use PKs in daily routine. PKs Veliparib cost are an important and integrated part of haemophilia treatment and have been for decades, even if always not fully evident. Strategies for replacement therapy have evolved. When concentrates for replacement therapy became available PCI-32765 in vitro during the 1950s and 1960s, treatment on demand was the dominating way of replacement. Some pioneers realised that haemorrhages and the sequelae of haemorrhages, mainly joint disease, could be prevented by implementing prophylaxis [10, 11] and regimens were more and more fine-tuned over the years – with prophylaxis being

started earlier and dosing being more frequent [12]. Concomitantly with this evolution of regimens, the awareness of the role of PKs increased, as outlined in Fig. 1. Methods for PK evaluation have emerged and become more and more sophisticated. However, experiences from the 1970s clearly showed that if a specific number check details of units were infused three times per week, the

bleed prevention was much better than if infused once-weekly [13]. The use of PKs has since become more established for prophylaxis not least by the contributions of Björkman and colleagues who, during the 1990s, showed the benefit of PK modelling and implementation during haemophilia prophylaxis [14]. It stands clear from these early studies and several later studies that PKs introduce an understanding of how treatment is performed and how the concentrate behaves in the organism, all of benefit for the medical outcome and, not least, outcome in terms of cost efficacy. In other words, if PKs are not used, the patient is left to the discretion of opinion and not to evidence. The rationale for using PKs is that FVIII or FIX levels correlate with clinical phenotype. However, as always, there are exceptions from the rule, it has been clearly shown that levels do predict risk of bleeding. This was shown in a Swedish cohort where joints were not affected, that is, target joints did not impact the bleeding pattern [15], and later on by the studies of the large Advate® trials where Collins and colleagues clarified the role of factor levels for risk of bleeding in a well-controlled, large study [16] (Fig. 2).

Complementing these well-characterized clinical observations, recent molecular studies of HCV–host interactions in state-of-the-art cell culture and animal models have convincingly demonstrated that HCV exploits lipid biosynthesis pathways for its viral life cycle JQ1 price (for review, see Georgel et al.2 and Jones and McLauchlan3). Following

HCV entry and replication, the viral life cycle is completed by viral assembly and egress of infectious viral particles.2 Virus assembly and production require key factors of lipid biosynthesis, and circulating virions are associated with lipid proteins (for review, see Negro1 and Jones and McLauchlan3). A unique feature of HCV assembly in the infected hepatocyte is the interaction of the viral capsid protein core with a lipid-storing cell organelle—the lipid droplet (LDs).3, 4 LDs consist of neutral lipids, predominantly triacylglycerols (TGs) or cholesteryl

esters, that are surrounded by a monolayer of phospholipids and associated proteins.5 The neutral lipids that are stored in LDs are used for metabolism, membrane synthesis (phospholipids and cholesterol), and steroid synthesis. In addition, LDs have a crucial role in storing cholesterol in the form of LY294002 cell line cholesteryl esters. This function is part of the complex homeostatic mechanisms that are involved in regulating the level of intracellular free cholesterol. Interestingly, association of the viral core with LDs has been shown to be essential for infectious HCV production (for review, see Jones and McLauchlan3). It is assumed that nascent viral genomes are transported from the replication sites to core-associated LDs via the recruitment of nonstructural proteins selleck screening library NS3 and NS5A on the LD surface.4, 6, 7 Subsequently, following formation of the assembly complex and envelopment, maturation and secretion pathway (for review, see Jones and McLauchlan3), including

apolipoproteins as essential host factors for virus production.8 A recent report in Nature Medicine produced by Melanie Ott’s laboratory at the Gladstone Institute in San Francisco, CA, provides another important link between the HCV life cycle and lipid metabolism: In this study, the authors elegantly demonstrate that HCV particle formation requires a novel cellular factor: diacylglycerol acyltransferase-1 (DGAT1).9 DGAT1 is an enzyme required for TG biosynthesis specifically present in hepatocytes, adipocytes and enterocytes. The final step of TG biosynthesis is the covalent association between a fatty acyl-coenzyme A and diacylglycerol to form a TG. This reaction is catalyzed by DGAT1 or DGAT2.10 TGs are synthesized in the endoplasmic reticulum (ER), accumulate in the leaflet lipid bilayer, and are channeled into the cytosol.

A loss-of-function alteration

in chymotrypsinogen C (CTRC) gene has been shown to be associated with tropical calcific pancreatitis (TCP). Cathepsin B (CTSB) is also found to be associated with TCP. However mutations in cationic and anionic trypsinogen gene do not play an important role in causing CP in Asia Pacific region. Chronic pancreatitis (CP) is an inflammatory disease which is characterized by irreversible destruction and fibrosis of the parenchyma, leading to pancreatic exocrine insufficiency and progressive VX-770 cell line endocrine failure leading to diabetes.1 In most developed countries, alcohol abuse causes about 60% to 70% of CP in male patients, and about 25% are classified as idiopathic chronic pancreatitis (ICP). Tropical calcific pancreatitis (TCP, OMIM 608189) is a juvenile form of chronic calcific non-alcoholic pancreatitis, seen almost exclusively in developing countries of the tropical world.2 A recent study in southern India has shown the prevalence of TCP to be 0.02% in the general population.3 TCP has been described as a disease with “pain in childhood, diabetes in puberty and death at the prime of life.”4 TCP was earlier seen only Lumacaftor mouse in children, adolescents,

or sometimes young adults, who had common characteristics of malnutrition, deficiency signs, cyanotic hue of enlarged lips, bilateral enlargement of parotid glands, pot belly and pedal

edema in a few. However, the clinical features and presentation of tropical pancreatitis have changed over a period of time with an older age of onset and a milder form of disease.5–8 The clinical manifestations of TCP are recurrent abdominal pain in childhood, followed by onset of diabetes mellitus a few years later. Prevalence of pancreatic calculi in TCP is nearly 90%, check details compared with the 30% of alcoholic pancreatitis.9 Histopathological changes include intralobular fibrosis in the early stage and interacinar fibrosis in later stages of the disease.1 Genetic predisposition to CP due to heightened oxidative metabolism or depletion of antioxidant/conjugation capacity has been explored without consistent evidence of either.10–12 It was hypothesized that the primary step in the development of pancreatitis could be an inappropriate activation of trypsinogen in the pancreas.13,14 Three different trypsinogens—cationic, anionic and meso, representing 23.1%, 16% and 0.5% of total pancreatic secretory proteins, respectively—have been described in human pancreatic juice. Polymorphism in the respective genes could be the genetic basis of CP.15 It is postulated that 5% of trypsinogens are activated within the normal pancreas. There are safety mechanisms within the pancreas to protect it from premature activation of these enzymes which would otherwise cause autodigestion.

Some cases also show complications of epithelial tumors, as in the present case. When a liver tumor of unknown etiology is

accompanied by characteristic aging of the face, Werner syndrome should be suspected and a comprehensive search for other tumors and complications of metabolic disorders undertaken. “
“Background and Aim:  We intended Lumacaftor research buy to determine whether laparoscopic splenectomy (Lap-Sp) contributes to treatment with interferon therapy in hepatitis C virus (HCV)-cirrhotic patients with thrombocytopenia caused by hypersplenism. Methods:  From December 2004 to August 2008, 100 cirrhotic patients (54 men and 46 women) underwent Lap-Sp for a clinical application of interferon therapy. All the patients were Child–Pugh class A or B with thrombocytopenia (average platelet count, 56 × 103/mm3). The HCV genotype was type 1 in 80 patients and type 2 in 20 patients. Results:  Pure laparoscopic or hand-assisted laparoscopy was performed in 78 and 22 patients, respectively, without mortality. Conversion to open surgery was not required in any of the patients. The platelet counts improved (mean platelet count 172 × 103/mm3 1 month after surgery) PS-341 cost and interferon (IFN) therapy was started in 97 patients. In this study period, 36 patients obtained a sustained virologic

response. Eight patients discontinued IFN therapy because of depression, neutropenia or other reasons. Conclusions:  Lap-Sp permits most patients with HCV cirrhosis and hypersplenism to receive sufficient IFN therapy. Therefore, Lap-Sp can become a strong supportive surgery for cirrhotic patients who require antiviral therapy. “
“Background and Aims:  Transient elastography (TE) is useful for predicting the fibrosis stage, but it is unsatisfactory as a substitute for liver biopsy, especially in patients with chronic hepatitis B (CHB). This study was performed to establish a reliable model click here for predicting significant fibrosis (SF) in patients with CHB. Methods:  All CHB patients who were admitted to undergo liver biopsy were enrolled. They

were randomly classified into either a training set (n = 139) or a validation set (n = 69). A model for predicting SF was established in the training set and validated in the validation set. Low and high cutoff values (COVs) were chosen for sensitivity ≥ 99% and specificity ≥ 99%, respectively. Results:  A total of 208 patients were enrolled. Age was 39 ± 12 years and 149 (71.6%) were men. In the training set, liver stiffness values and serum haptoglobin, apolipoprotein A1, and α2-macroglobulin levels were independent predictors of SF on multivariate analysis. These variables were used to construct a novel model, called the HALF index. The area under the receiver operating characteristics curve of the HALF index for predicting SF was significantly higher than that of TE alone (0.915 vs 0.877, P = 0.010). Using low and high COVs of the HALF index, it appears that approximately half (47.