8, 9 The real cause is not clear; it is postulated that there exists a selection pressure between the HCV viral genotype and host immune responses during evolution that might determine HCV genotype–specific treatment responses.10 Whether the driving force of selection applies to viral replication as well as the preference of the viral genotype distribution in terms of host genetic diversities warrants further molecular-based studies in the future. Chung-Feng Huang M.D* †, Chia-Yen Dai M.D., Ph.D* § ¶, Jee-Fu Huang M.D.* ¶ **, Wan-Long Chuang M.D., Ph.D.* ¶, Ming-Lung Yu M.D., Ph.D.* ‡ ¶,

* Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, learn more Kaohsiung, Taiwan, † Departments of Occupational Medicine, ‡ Internal Medicine, Kaohsiung Municipal Ta- Tung Hospital, Kaohsiung, Taiwan, § Caspase inhibitor Graduate Institute of Medicine, ¶ Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ** Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan. “
“Patients with underlying acute and chronic liver disease are at risk of morbidity and mortality after surgery. The magnitude of the risk is related to the severity of liver disease, the type of surgery

and the urgency of the surgery. The severity of liver disease as measured by the model for end-stage liver disease (MELD) score and the Child-Turcotte-Pugh (CTP) score can be used to risk stratify patients with liver disease undergoing surgery. Even in patients with well-preserved liver synthetic function, the presence of significant portal hypertension can lead to adverse outcomes after surgery, particularly

if it involves hepatic resection. Cardiac and abdominal surgery carry the greatest risk, particularly in emergent situations, and acute liver failure and acute alcoholic hepatitis are generally contraindications for any type of surgery. “
“We read with interest the recent analysis by Remien et al.1 of the prognostic accuracy of the Model for Acetaminophen-induced Liver Damage (MALD). By combining serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, N-acetylglucosamine-1-phosphate transferase and international normalized ratio INR, the authors demonstrate a negative predictive value (NPV) of 100% for predicting death when applied to a mixed cohort of 53 acetaminophen overdoses. This complex model has several limitations to its use at present, including the difficulty in calculating the formula at the patients’ bedside, and in the use of serum AST, which may not always be routinely available in some centers. However, the study does highlight the importance of accurate triage when considering the potential need for liver transplantation following acetaminophen overdose. We similarly demonstrated an extremely high NPV following acetaminophen overdose by utilizing the Sequential Organ Failure Assessment (SOFA) score, where a SOFA score <7 by 96 hours following single timepoint overdose had a NPV of 98.2%.