Background:The aspartate transaminase (AST)-to-alanine aminotransferase (ALT) ratio, which is used to measure liver injury, has been found to be associated with some chronic diseases and mortality. However, its relevance to cancer incidence resulting from population-based prospective studies has rarely been reported. In this study, we investigated the correlation of the AST/ALT ratio as a possible predictor of mortality and cancer incidence. Methods: A total of 9,946 participants fulfilled the inclusion criteria for a basic public health service project of the Health Checkup Program conducted by the BaiYun Community Health Service Center, Taizhou. Deceased participants and cancer incident cases were from The Taizhou Chronic Disease Information Management System.Odds ratios (ORs) and interval of quartile range (IQR) computed by logistic regression analysis and cumulative incidence rate were calculated by the Kaplan-Meier survival method and compared with log-rank test statistics.Results: Serum ALT and AST levels were both increased in patients with chronic diseases, but the ratio of AST/ALT was generally decreased. The cancer incident cases (488 new cases) had a greater baseline ratio (median =1.23, IQR: 0.96-1.54) than noncancer cases (median =1.15, IQR: 0.91-1.44). Compared to the first quartile of the AST/ALT ratio, the population in the top quartile had a higher cumulative cancer incidence rate (7.54% vs. 4.44%) during follow-up period. Furthermore, an elevated AST/ ALT ratio increased the risk of all-cause mortality. Conclusions:The ratio of AST/ALT is a potential biomarker to assess healthy conditions and long-term mortality. Especially for cancer, the AST/ALT ratio not only increases at baseline but also predicts the future development of cancer. The clinical value and potential mechanism deserve further research.

Dear editor,We are honored to read the high-level article by Nasim Nikbakhtan Esfahani et al. 1 , entitled "Effect of group hope therapy on self-efficacy of adolescents with type 1 diabetes". This study found that hope therapy had a significant impact on self-efficacy of adolescents with type 1 diabetes, but had no effect on academic self-efficacy and self-efficacy in blood glucose management. However, according to our opinion, there are some issues that are worth exploring.First, general self-efficacy did not change glycemic control in diabetic patients. The duration of the disease is the only variable that affects glycemic control in diabetic individuals. A sample of 46 patients was randomly allocated to the intervention group or the control group. Different patients have different diseases, different blood sugar levels, and different treatments, and this study did not establish the standard drug treatment regimen. These factors may bias the self-efficacy of diabetes management.Second, if the sample size is calculated haphazardly and the sample does not include a well-defined population, the results of the survey should not be extrapolated to the overall situation. How the authors assure that adolescent patients have never obtained the relevant section. In contrast, have sample size estimates been produced? Whether the inconsistency with previous research results is caused by the small sample size? All these concerns are not discussed in this study.The authors did not explain whether the missing demographic descriptions are associated with the missing values in the tables. Finally, the criteria for the p-value specified in the table are also not discussed.

LETTERS TO THE EDITORDear Editor, We have read with great interest the article by Fatih Aksoy 1 , entitled "Relationship between c-reactive protein/albumin ratio and new-onset atrial fibrillation after coronary artery bypass grafting." The authors find that the novel inflammatory marker C-reactive protein/albumin ratio (CAR) can be used as a reliable marker to predict the development of atrial fibrillation (AF) following coronary artery bypass grafting (CABG). The findings of this survey can bring new judgment indicators for the diagnosis and therapy of AF, to save the diagnosis cost of AF. Nevertheless, we believe that this article still has some issues worthy of further discussion.The purpose of this study was to compare the predictive value of CAR with other inflammatory markers such as neutrophil/lymphocyte (N/L) ratio and platelet/lymphocyte (P/L) ratio in determining new-onset AF after CABG. Only the prediction accuracy of CAR and CPB was compared in this study. However, the reliability of CAR with N/L and P/L was not explored 2 . Therefore, we recommend that the authors edit the summary objective or add data and statement that can prove the objective. The exclusion criteria of the study included hyperthyroidism, age <18 years, prior cardiac surgery, class III or IV heart failure, previous AF, left atrial diameter >55 mm, left ventricular ejection fraction <0.25, sepsis, heart rate <60 bpm, systolic blood pressure <90 mmHg, inflammatory disease, pericarditis, patients undergoing off-pump surgery, and having antiarrhythmic treatment. The CAR was changed with diabetes, dyslipidemia, and left ventricular ejection fraction 3 . Table 1 reveals that patients with postoperative atrial fibrillation (POAF) were significantly older and more males were affected when compared to patients without POAF (p<0.001 and p=0.003, respectively

LETTERS TO THE EDITOR Dear Editor,We were very pleased to read the article entitled "Diagnostic and prognostic significance of long noncoding RNA LINC00173 in patients with melanoma" by Wang et al. 1 in which they revealed that LINC00173 expression could serve as an unfavorable prognostic biomarker for melanoma patients. However, some views should be raised in my opinion.The main problem of the study was that the reliability of conclusions has been questioned in a study published recently. A study found that the LINC00173 was a potential target for the diagnosis, prognosis, and/or treatment of melanoma 2 .