Overexpression of MicroRNA-133a Inhibits Apoptosis and Autophagy in a Cell Model of Parkinson's Disease by Downregulating Ras-Related C3 Botulinum Toxin Substrate 1 (RAC1).

The manuscript is being retracted due to non-original and duplicated content in the figure images, which raise concerns regarding the credibility of the study. Reference: Wusheng Lu, Jinhuang Lin, Dequan Zheng, Chunyong Hong, Laishun Ke, Xinyu Wu, Peineng Chen. Overexpression of MicroRNA-133a Inhibits Apoptosis and Autophagy in a Cell Model of Parkinson's Disease by Downregulating Ras-Related C3 Botulinum Toxin Substrate 1 (RAC1). Med Sci Monit, 2020; 26: e922032. DOI: 10.12659/MSM.922032.

Overexpression of MicroRNA-133a Inhibits Apoptosis and Autophagy in a Cell Model of Parkinson's Disease by Downregulating Ras-Related C3 Botulinum Toxin Substrate 1 (RAC1).

BACKGROUND Parkinson's disease (PD) is a movement disorder. microRNA (miR)-133 expression is reduced in PD patients and in mice with a dopamine neuron deficiency. We aimed to identify the mechanism of miR-133a in apoptosis and autophagy in PD. MATERIAL AND METHODS The optimal concentration of MPP⁺ (1-methyl-4-phenylpyridinium ion) was initially determined to construct a PD cell model. Gain-of function experiments were carried out to evaluate the role of miR-133a in PD. The levels of miR-133a, RAC1 (Ras-related C3 botulinum toxin substrate 1), apoptosis-related factors, and autophagy-related factors were detected after detection of cell proliferation, cell cycle, and apoptosis. Transmission electron microscopy was applied to observe autophagosomes, and immunofluorescence staining was performed to detect LC3 and further analyze the effect of miR-133a on autophagy in a PD cell model. RESULTS Low miR-133a expression was detected in a cell model of MPP⁺-induced PD. After overexpressing miR-133a, cell proliferation increased, and apoptosis (cleaved caspase-3 and Bax levels decreased, while Bcl2 levels increased) and autophagy was inhibited (LC3II/I and Beclin-1 levels decreased, while p62 levels increased). MiR-133a targeted RAC1. RACY upregulation attenuated the inhibitory effects of miR-133a on PC12 cell apoptosis and autophagy. CONCLUSIONS Our data highlighted that miR-133a overexpression prevented apoptosis and autophagy in a cell model of MPP⁺-induced PD by inhibiting RAC1 expression.

A novel combined systemic inflammation-based score can predict survival of intermediate-to-advanced hepatocellular carcinoma patients undergoing transarterial chemoembolization.

BACKGROUND: There is currently limited information regarding the prognostic ability of the dNLR-PNI (the combination of the derived neutrophil-to-lymphocyte ratio [dNLR] and prognostic nutritional index [PNI]) for hepatocellular carcinoma (HCC). This study aimed to assess the predictive ability of the dNLR-PNI in patients with intermediate-to-advanced HCC after transarterial chemoembolization (TACE). METHODS: A total of 761 HCC patients were enrolled in the study. The dNLR-PNI was retrospectively calculated in these patients, as follows: patients with both an elevated dNLR and a decreased PNI, as determined using the cutoffs obtained from receiver operating characteristic curve analysis, were allocated a score of 2, while patients showing one or neither of these alterations were allocated a score of 1 or 0, respectively. RESULTS: During the follow-up period, 562 patients died. Multivariate analysis suggested that elevated total bilirubin, Barcelona Clinic Liver Cancer C stage, repeated TACE, and dNLR-PNI were independently associated with unsatisfactory overall survival. The median survival times of patients with a dNLR-PNI of 0, 1, and 2 were 31.0 (95% confidence interval [CI] 22.5-39.5), 16.0 (95% CI 12.2-19.7) and 6.0 (95% CI 4.8-7.2) months, respectively (P < 0.001). CONCLUSIONS: The dNLR-PNI can predict the survival outcomes of intermediate-to-advanced HCC patients undergoing TACE, and should be further evaluated as a prognostic marker for who are to undergo TACE treatment.

Liver resection versus liver resection plus TACE for patients with hepatocellular carcinoma beyond Milan criteria.

BACKGROUND: The recurrence of patients with hepatocellular carcinoma (HCC) beyond the Milan criteria after liver resection (LR) is common. This study aimed to clarify whether LR plus postoperative adjuvant transcatheter arterial chemoembolization (TACE) could improve the outcomes of patients with HCC beyond the Milan criteria after LR. METHODS: A total of 754 consecutive patients with HCC beyond the Milan criteria who received LR alone (n = 459) or LR + TACE (n = 295) were included. A propensity scoring matched model (PSM) was used to adjust for the baseline differences between the groups. RESULTS: The 1, 3, and 5-y recurrence-free survival (76.7%, 40.4%, and 30.8%, respectively, for the LR-alone group versus 78.3%, 50.5%, and 46.2%, respectively, for the LR + TACE group; P = 0.004) and overall survival (94.1%, 58.3%, and 36.3%, respectively, for the LR-alone group versus 95.3%, 71.3%, and 54.9%, respectively, for the LR + TACE group; P < 0.001) rates of patients who underwent LR alone were much lower than in the LR + TACE group. Multivariate Cox proportional hazards regression analysis showed that LR alone was an independent risk factor for postoperative recurrence and poor long-term survival. After one-to-one PSM, 284 patients who underwent LR alone and 284 patients who underwent LR + TACE were selected for further analyses. Similar results were observed in the PSM model. CONCLUSIONS: This study showed that LR + TACE may be beneficial for patients with HCC beyond the Milan criteria. Postoperative adjuvant TACE should be considered to patients with HCC beyond the Milan criteria.

Hepatic Arterial Buffer Response Maintains the Homeostasis of Graft Hemodynamics in Patient Receiving Living Donor Liver Transplantation.

BACKGROUND: In living donor liver transplantation (LDLT), the hepatic hemodynamics plays important roles in graft regeneration, and the hepatic blood inflows are associated with graft size. However, the data of interplay between the hepatic arterial buffer response (HABR) and graft-to-recipient weight ratio (GRWR) in clinical LDLT are lacking. AIMS: To identify the effect of the HABR on the hepatic hemodynamics and recovery of graft function and to evaluate the safe lower limit of the GRWR in carefully selected recipients. METHODS: Portal venous and hepatic arterial blood flow was measured in recipients with ultrasonography, and the graft functional recovery, various complications, and survive states after LDLT were compared. RESULTS: In total, 246 consecutive patients underwent LDLT with right lobe grafts. In total, 26 had a GRWR < 0.7 % (A), 29 had a GRWR between 0.7 and 0.8 % (B), and 181 had a GRWR > 0.8 % (C). For small-for-size syndrome, there was no significant difference (P = 0.176). Graft survival rates at 1, 3, and 5 year were not different (P = 0.710). The portal vein flow and portal vein flow per 100 g graft weight peaks were significantly higher in the A. Hepatic arterial velocity and hepatic arterial flow decreased in all the three groups on postoperative day 1; however, the hepatic arterial flow per 100 g graft weight was close to healthy controls. CONCLUSIONS: HABR played important roles not only in the homeostasis of hepatic afferent blood supply but also in maintaining enough hepatic perfusion to the graft.

The effect of postoperative TACE on prognosis of HCC: an update.

Hepatocellular carcinoma (HCC) is a common malignancy in the world and is mainly treated by surgery resection. It is believed that even after radical resection, the recurrence and metastasis rates remain at a high level. This threatens the health and safety of patients. Postoperative adjuvant transcatheter arterial chemoembolization (TACE) is regarded as a common strategy for HCC patients at a high recurrence risk. However, there is a debate on the effects of postoperative TACE and range of applications in the medical world. Here we review the effects of postoperative TACE on the prognosis of HCC.

Federated Learning for Data Trading Portfolio Allocation With Autonomous Economic Agents.

In the rapidly advancing ubiquitous intelligence society, the role of data as a valuable resource has become paramount. As a result, there is a growing need for the development of autonomous economic agents (AEAs) capable of intelligently and autonomously trading data. These AEAs are responsible for acquiring, processing, and selling data to entities such as software companies. To ensure optimal profitability, an intelligent AEA must carefully allocate its portfolio, relying on accurate return estimation and well-designed models. However, a significant challenge arises due to the sensitive and confidential nature of data trading. Each AEA possesses only limited local information, which may not be sufficient for training a robust and effective portfolio allocation model. To address this limitation, we propose a novel data trading market where AEAs exclusively possess local market information. To overcome the information constraint, AEAs employ federated learning (FL) that allows multiple AEAs to jointly train a model capable of generating promising portfolio allocations for multiple data products. To account for the dynamic and ever-changing revenue returns, we introduce an integration of the histogram of oriented gradients (HoGs) with the discrete wavelet transformation (DWT). This innovative combination serves to redefine the representation of local market information to effectively handle the inherent nonstationarity of revenue patterns associated with data products. Furthermore, we leverage the transform domain of local model drifts in the global model update process, effectively reducing the communication burden and significantly improving training efficiency. Through simulations, we provide compelling evidence that our proposed schemes deliver superior performance across multiple evaluation metrics, including test loss, cumulative return, portfolio risk, and Sharpe ratio.

[Perioperative outcomes after endovascular versus open repair of abdominal aortic aneurysms: a single center experience].

OBJECTIVE: To evaluate the outcomes of endovascular repair (EVAR) versus open repair (OR) in the patients with abdominal aortic aneurysm (AAA) and compare their perioperative rates of morbidity and mortality. METHODS: The clinical data of 371 AAA patients from January 2006 to January 2011 were collected and analyzed. Endovascular (n = 174) and open (n = 197) repairs were performed. The relevant parameters included preoperative status, intraoperative blood loss, procedure time, intensive care unit (ICU) stay length, ventilatory support time, postoperative fasting time and duration of postoperative hospital stay and anesthesia methods. The perioperative rates of morbidity and mortality were presented. RESULTS: The patients of EVAR group were elder than those of OR group [(72 ± 8) vs (60 ± 14) years old, P = 0.000]. The comorbidity rate of chronic obstructive pulmonary disease (COPD) in EVAR group was higher than that in OR group (31.0% vs 21.8%, P = 0.045). As compared with OR group, the EVAR group had less blood loss [(125 ± 43) vs (858 ± 602) ml, P = 0.000], a lower rate of blood transfusion (0 vs 71.1%, P = 0.000), shorter ICU stay length [(15 ± 5) vs (31 ± 11) h, P = 0.000], shorter postoperative fasting time [(7 ± 4) vs (90 ± 32) h, P = 0.000], shorter procedure time [(146 ± 39) vs (210 ± 24) min, P = 0.000] and shorter ventilatory support time [(90 ± 23) vs (220.0 ± 132.0) min, P = 0.000]. In EVAR group, general (88, 50.6%), epidural (52, 30.0%) and local (34, 19.4%) anesthesia were used. General anesthesia was used for all OR group patients. The duration of postoperative hospital stay was similar in two groups (9.1 ± 2.7) d vs (9.2 ± 2.6) d (P = 0.798). The perioperative complication rate was lower in EVAR group (12.6% vs 27.0%, P = 0.001). And the 30-day mortality rate was 1.15% in EVAR group and 2.0% in OR group. CONCLUSION: Endovascular repair is less-invasive in AAA patients and offers significant advantages over open surgery. Especially it is indicated for those patients non-suitable for open surgery. And a long-term survival rate is expected.

[Digital subtract arteriographic characteristics of carotid artery, vertebral artery, subclavian artery and renal artery in type 2 diabetic patients with lower extremities peripheral arterial disease].

OBJECTIVE: To investigate angiographical characteristics of carotid, vertebral, subclavian, and renal arteries in the type 2 diabetic patients with lower extremities peripheral arterial disease (LEPAD). METHODS: There were 104 type 2 diabetic patients with LEPAD recruited in this study, who received digital subtract arteriography (DSA). Ankle-brachial index (ABI) assessment was also performed in 50 participants. Dependent upon the stenosis degree of vertebral artery, subclavian artery and renal artery measured by DSA, the patients were divided into normal group (stenosis < or = 50%) or pathological group(stenosis > 50% or blocked lesions). The angiographic features of carotid, vertebral, subclavian, and renal arteries were analyzed and the relationship between arterial stenosis and ABI was explored. RESULTS: DSA results of 104 patients showed that the most common lesion in the arteries was plaque. The stenosis degrees of 51%-74% and 75%-99% were most commonly observed in renal artery, with incidence of 22.1% and 5.8%, respectively. Arterial occlusion was most commonly observed in vertebral artery, with incidence of 27.9%. The patients with stenosis or occlusion of arteries had lower ABI (P = 0.000), and the patients with stenosis or occlusion of vertebral and renal arteries also had lower ABI (P = 0.003 and 0.02, respectively), compared with those without stenosis. ABI < 0.9 indicated higher risk of stenosis or occlusion of vertebral and renal arteries (P = 0.008 and 0.047 respectively). Between the patients with subclavian arterial stenosis and those without this artery stenosis, there was no statistical significant difference observed in ABI level. CONCLUSION: Type 2 diabetic patients with LEPAD can affect multiple arteries, showing plaque formation, multi-segmental stenosis and occlusion of arteries. The patients with ABI < 0.9 have higher risk of multiple arterial stenosis or occlusion lesions.

[Surgical vascular by-pass operation of lower limb artery occlusion in patients with diabetic foot].

OBJECTIVE: To document the effectiveness and patient experience of surgical treatment for diabetic lower limb arterial occlusion. METHODS: Out of 290 diabetic patients with lower limb arterial occlusion, 69 received by-pass operation because of severe stenosis below the abdominal aorta and severe ulcers in feet from April 2004 to April 2011. We reviewed the experience and outcome of the 69 diabetic patients who underwent surgical operations on lower limb arterial occlusion. RESULTS: 100% initial surgical success was achieved. The morbidity (excluding death) was 12.3% +/- 4.1% and 15.7% +/- 5.1% at 1 year and 3 years after operations, respectively. Five (7.2%) death cases were recorded, which resulted in a survival rate of 94.2% +/- 2.8% and 92.0% +/- 3.5% at 1 year and 3 years after operations, respectively. About 90.6% +/- 3.6% and 87.2% +/- 4.9% of patients had graft patency 1 year and 3 years after operations, respectively; and 6. 5% + 3. 1% had amputations. Four (5. 8%) patients developed graft thrombosis, in which 2 (2.9%) had amputations because of recurrence of thrombosis after thrombectomy. Two (2.9%) patients had amputations because of graft infection accompanied with graft resection operations. One (1.4%) patient received repeated arterialized operation on great saphenous vein because of popliteal artery occlusion, and obtained a good outcome within two years. One (1.4%) patient developed stomas false aneurysm, but the excision of the false aneurysm resulted in a good outcome in four years. CONCLUSION: Detailed pre-operation assessment, optimal selection of surgical procedure and perioperative management can help improve the outcome of diabetes and decrease amputation rate in patients with diabetic lower limb arterial occlusion.

[Surgical treatment of sinus tract in diabetic foot with adjacent pedicle fascia flap and arthrodesis].

OBJECTIVE: To study the therapeutic effect of adjacent pedicle fascia flap filling and arthrodesis in the regional management of sinus tract in diabetic foot. METHODS: From February 2007 to August 2010, 6 patients suffering diabetic foot with sinus tract were included. There were 4 male and 2 female patients, aged 47 to 68 (averaging 58.3 +/- 6.7). One case had the entrance of sinus tract in the heel, and its base located deep in the calcaneus. Three cases had the sinus tract in the vola or dorsum of the foot, in which 1 with a perforating tract connecting the vola and the dorsum. Another 2 cases were in the toes, both located around joints. Under the effective treatments of anti-infection, anti-coagulation and control of blood sugar, blood pressure as well as blood lipid level, the patients were subjected to surgical treatments of sinus tract, the sinuses in the heel, sole and dorsum of the feet were filled up with facial flap, and those in the toes were eliminated using arthrodesis. RESULTS: All the 6 patients received rational debridement. Four patients were treated with adjacent fascia flap filling, the other two were treated with arthrodesis. The sinus tracts healed 14-20 d after surgery in all patients. One patient developed skin necrosis at the edge of the incision in the dorsum of the foot and another whose sinus located in the toe suffered inflammation and exudation. Both patients recovered after dressing replacement, antiseptic therapy and blood sugar regulation for a period of time. CONCLUSION: Appropriately designed pedicle fascia flap can provide satisfactory healing for sinus in the heel, vola and dorsum, and arthrodesis is a safe and effective way for that in the toes. Rational debridement is the key prerequisite for healing of sinus tract in diabetic foot.

131Iodine-DEM TACE vs. conventional TACE in cirrhotic patients with hepatocellular carcinoma: a single center experiment.

BACKGROUND: To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) with 131iodine-doxorubicin-eluting gelatin microspheres (131I-DEM TACE) compared with conventional TACE (cTACE) with polyvinyl alcohol foam (PVA) embolization microspheres. METHODS: A total of 22 patients diagnosed with hepatocellular carcinoma were equally divided into 2 groups. The patients who underwent TACE with 131I-DEM (25.7×107 Bq of 131iodine and 10 mg of doxorubicin) were compared to controls who received cTACE with PVA embolization microspheres. Therapeutic effects were evaluated by the tumor regression rates, levels of alpha-fetoprotein in serum, survival rates, and complications. RESULTS: The operative complications of the 2 groups were not significantly different (P=0.753). The radioactivity ratio of the tumor to the liver was approximately 4.1:1 for the 131I-DEM TACE group. In the 131I-DEM TACE group, 54.5% of patients achieved tumor regression of more than 50%, compared to 36.6% of patients in the cTACE group. AFP levels in serum declined in 100% of patients in the 131I-DEM TACE group and 50% of patients in the cTACE group. The median survival time of the patients was 12.0±3.3 months for the 131I-DEM TACE group and 10.0±3.3 months for the cTACE group. There were no significant differences in survival between the 2 groups (P=0.414). CONCLUSIONS: 131I-DEM may become a potential radiochemoembolization agent to treat patients with unresectable hepatocellular carcinoma through TACE.

[Digital subtract arteriographic (DSA) characteristics of lower extremities and ankle-brachial index in patients with diabetic feet].

OBJECTIVE: To evaluate the Digital Subtract Arteriography (DSA) characteristics of lower limb arterial diseases in patients with diabetic feet and to explore the correlation between DSA and Ankle-brachial index (ABI). METHODS: Fifty-two patients with diabetic feet were recruited in this study. ABI and DSA of bilateral lower extremities were examined to assess the severity of vasculopathy. The relationship between ABI and DSA was analyzed. RESULTS: ABI values for 91 lower extremities were obtained, with a mean of 0.73 +/- 10.43 (0.15-1.97), among which 19.8% ranged from 0.9 to 1.3, 69.2% were less than 0.9, and 11% were more than 1.3. Based on the integrated angiographic images, the arteries with < or = 50% degree of stenosis, 50%-99% degree of stenosis and occlusion comprised 49.5%, 22%, and 28.5% for femoral artery; 79.1%, 14.3%, and 6.6% for popliteal artery; 25.3%, 8.8%, and 65.9% for anterior tibial artery; 29.7%, 14.3%, and 56% for posterior tibial artery; 25.3%, 20.9%, and 53.8% for peroneal artery; and 54.9%, 14.3%, and 30.8% for dorsal pedis artery. Forty (50.5%) limbs had three or more above-mentioned arteries occluded simultaneously. The average vascular score was 8.5 +/- 4.3 with a range between 0 and 18. The spearman correlation analysis showed that ABI inversely correlated with artery stenosis score (r = -0. 588, P < 0.05). CONCLUSION: Arterial diseases of lower extremities in patients with diabetic feet are wide-spread, ranging from femoral artery to the dorsal pedis artery. Multiple segments of arteries are involved. Severe stenosis and occlusion are more common in anterior and posterial tibial arteries, and peroneal artery.

[Pharmacokinetics of injection of iodine-131 labelling MEI-TUO-XI monoclonal antibody in human body].

To study pharmacokinetics of injection of iodine-131 labelling MEI-TUO-XI monoclonal antibody (hepatoma monoclonal antibody HAb18 F(ab')2) in vivo. 24 cases of primary hepatocelluar carcinoma (PHC) were equally divided into the low dose group, middle dose group and high dose group. After the relevant injection was administrated into the hepatic artery of each case, intravenous blood and urine samples were separately collected at different time for determination of the radioactive count ratio (min(-1)). The proportion of 131I-HAb18 F(ab')2 in serum of each blood sample was determined, and the radioactive count ratio (min(-1)) of druggery for each blood sample was revised according to the proportion. The pharmacokinetic parameters were calculated using DAS ver 1.0 (Drug And Statistics for Windows) program. The component of urine radiomaterial was determined and the percentages of urine radioactivity in administration dosage were calculated. The catabolism of the injection with time accorded with dynamics two-compartment model. The catabolism product was mainly free-131I and was excreted via kidney; the urine radioactivity was 47.70%-51.16% of administration dosage during 120 h after administration of drug. Therefore, the pharmacokinetics of the injection can satisfy the clinical demands. The drug dose recommended for clinical use was 27.75 MBq of the injection for each kg of human body.

Localization algorithms for asynchronous time difference of arrival positioning systems.

An asynchronous time difference of arrival (ATDOA) positioning system requires no time synchronization among all the anchor and target nodes, which makes it highly practical and can be easily deployed. This paper first presents an ATDOA localization model, and then primarily focuses on two new localization algorithms for the system. The first algorithm is a two-step positioning algorithm that combines semidefinite programming (SDP) with a Taylor series method to achieve global convergence as well as superior estimation accuracy, and the second algorithm is a constrained least-squares method that has the advantage of low complexity and fast convergence while maintaining good performance. In addition, a novel receiver re-selection method is presented to significantly improve estimation accuracy. In this paper, we also derive the Cramer-Rao lower bound (CRLB) of the ATDOA positioning system using a distance-dependent noise variance model, which describes a realistic indoor propagation channel.

Changes of alpha-fetoprotein levels could predict recurrent hepatocellular carcinoma survival after trans-arterial chemoembolization.

BACKGROUND: There is paucity of information concerning whether AFP change is a predictor of prognosis for recurrent hepatocellular carcinoma (RHCC) patients after trans-arterial chemoembolization (TACE). METHODS: A total of 177 RHCC patients who received TACE as first-line therapy were retrospectively analyzed. The patients were classified into three groups according to their pre-TACE and post-TACE AFP levels (group A: AFP decreased, group B: AFP consistent normal, and group C: AFP increased). The recurrence to death survival (RTDS) and overall survival (OS) were estimated by the Kaplan-Meier method, and compared by the log-rank test. Multivariate analyses were performed to identify prognostic factors for OS and RTDS. RESULTS: There was no significant difference among the three groups concerning the baseline characteristics. The median overall survival (OS) was 74.5 months in group A (95% confidence interval (CI): 63.5, 85.6), 64.0 months in group B (95% CI: 52.3, 75.7) and 29.0 months in group C (95% CI: 24.1, 33.9; P<0.001). The median recurrence to death survival (RTDS) was 66.5 months (95% CI: 53.4, 79.6) in group A, 50.4 months (95% CI: 39.5, 61.4) in group B and 17.7 months (95% CI: 13.4, 22.1; P<0.001) in group C. Multivariate analysis revealed that tumor size at resection stage, tumor number at recurrent stage, cycles of TACE, mRECIST response and AFP change after TACE were significant independent risk factors for RTDS and OS. CONCLUSIONS: AFP change could predict the prognoses of patients with RHCC who received trans-arterial chemoembolization, which may help clinicians make subsequent treatment decision.

Neutrophil-to-lymphocyte and aspartate-to-alanine aminotransferase ratios predict hepatocellular carcinoma prognosis after transarterial embolization.

The neutrophil-to-lymphocyte ratio (NLR) reflects the systematic inflammatory status, and the aspartate aminotransferase-to-alanine aminotransferase ratio (AAR) is a biomarker of liver fibrosis and cirrhosis. These values can be conveniently obtained from routine blood tests; however, their combined clinical utility has not been extensively studied in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). This study aimed to investigate the prognostic value of NLR-AAR in patients with unresectable HCC undergoing TACE. Data for 760 patients with newly diagnosed HCC were retrospectively evaluated. The NLR-AAR was calculated as follows: patients in whom both the NLR and AAR were elevated according to the receiver operating characteristic (ROC) curve analysis were assigned a score of 2; patients showing an elevation in one or neither of these indicators were assigned a score of 1 or 0, respectively. Univariate and multivariate analyses were performed to identify the clinicopathological variables associated with overall survival. An ROC curve was also generated and the area under the curve (AUC) was calculated to evaluate the discriminatory ability of each index at 1, 3, and 5 years of follow-up, as well as overall. The NLR-AAR consistently had a greater AUC value at 1 year (0.669), 3 years (0.667), and 5 years (0.671) post-TACE compared with either NLR or AAR alone. The median survival times of patients with a NLR-AAR of 0, 1, and 2 were 31.0 (95% confidence interval [CI] 24.0-38.0), 15.0 (95% CI 11.2-18.8), and 5.0 (95% CI 4.0-5.9) months, respectively (P < .001). Multivariate analysis showed that the NLR-AAR, elevated total bilirubin level, and vascular invasion were independently associated with overall survival. NLR and AAR, when combined to produce an inflammation-based index and fibrosis score, is an independent marker of poor prognosis in patients with HCC receiving TACE.