No abstract

The prevalence of non-alcoholic fatty liver disease (NAFLD) is estimated to be 25-30% of the population, and is the most common cause of elevated liver enzymes in Korea. NAFLD is a “hot potato” for pharmaceutical companies. Many clinical trials are underway to develop a first-in-class drug to treat NAFLD. However, there are several challenging issues regarding the diagnosis of NAFLD. Currently, liver biopsy is the gold standard method for the diagnosis of NAFLD and steatohepatitis. Ideally, globally recognized standards for histological diagnosis and methods to optimize observer agreement on biopsy interpretation should be developed. Liver biopsy is the best method rather than a perfect one. Recently, multi-parametric magnetic resonance imagery can estimate the amount of intrahepatic fat successfully and is widely used in clinical trials. But no diagnostic method can discriminate between steatohepatitis and simple steatosis. The other unresolved issue in regard to NAFLD is the absence of satisfactory treatment options. Vitamin E and obeticholic acid have shown protective effects in randomized controlled trials, but this drug has not been approved for use in Korea. This study will provide a description of diagnostic methods and treatments that are currently recommended for NAFLD.

BACKGROUND & AIMS:Studies to evaluate risks of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection treated with the nucelos(t)ide analogues entecavir or tenofovir have produced contradictory results. These differences are likely to be the result of censored data, insufficient observation periods, and different observation periods for patients treated with different drugs. We aimed to compare the incidence of HCC development between patients treated with oral entecavir or tenofovir and followed up for the same time periods. METHODS:We performed a retrospective study, collecting data from 1560 treatment-naive patients with chronic HBV infection who were first treated with entecavir (n [ 753) or tenofovir (n [ 807) from 2011 through 2015 at 9 academic hospitals in Korea. Clinical outcomes were recorded over a mean time period of 4.7 -1.0 years, from 92.4% of patients treated with tenofovir and 92.7% of patients treated with entecavir. RESULTS:Thirty-four patients in the entecavir group (4.5%) and 45 patients in the tenofovir group (5.6%) developed HCC during the follow-up period. The incidence of HCC did not differ significantly between groups, even in a 516-pair propensity score-matched population. CONCLUSIONS:In a retrospective study of 1560 treatment-naive patients with chronic HBV infection, the incidence of HCC did not differ significantly between patients treated with entecavir vs tenofovir over the same observation period. Clinical trial: KCT0003487.

SummaryBackgroundIt is controversial whether chronic hepatitis B (CHB) patients have more non‐liver comorbidities than non‐CHB subjects.AimTo characterise the demographics, comorbidity and health utilisation of CHB patients in South Korea and compare them to matched controls.MethodsUsing the Health Insurance Review & Assessment Service (HIRA) 2007‐2016 database, adult patients with claims for CHB analysed. CHB cases and non‐CHB controls matched in a 1:4 ratio using propensity score matching method.ResultsThe age of CHB patients significantly increased from a mean 46.9 years in 2007 to 52.3 years in 2016. The proportions of persons having both liver‐related and non‐liver related comorbidities were higher in CHB patients compared to matched controls (dyslipidaemia [37.23% vs 23.77%, P < 0.0001], hypertension [29.39% vs 25.27%, P < 0.0001] chronic kidney disease (CKD) [3.02% vs 1.14%, P < 0.0001] and osteoporosis/fracture [OF] [4.09% vs 3.23%, P < 0.0001]). Approximately 50% of CHB patients had more than one comorbidity among CKD, diabetes, DLP, and OF. The odds of CKD in CHB patients were 1.42 times higher, and the odds of OF in CHB patients were 1.09 times higher than matched controls after adjustment for confounders (P < 0.0001).ConclusionPrevalence of liver as well as non‐liver comorbidities in patients with CHB was higher than matched controls and increased over time.

It is well known that high sodium intake is closely associated with the risk of cardiovascular disease, but the effect of low sodium intake on insulin resistance is not clear. In this article, we summarize findings from previous studies focusing on the association between low sodium intake and insulin resistance. While many investigations on this topic have been conducted actively, their major findings are inconsistent, partly due to different study designs. Thus, additional randomized controlled trials with an adequate study period and reasonable levels of low sodium intake are needed.

Background & Aims Gamma‐glutamyl transferase (GGT) has been predictive of chronic hepatitis C‐related hepatocellular carcinoma (HCC) development. Its role in the risk of HCC in chronic hepatitis B (CHB) patients treated with nucleotide/nucleoside analogues (NAs) is elusive. Methods A total of 2172 CHB patients from East Asia were randomized into development and validation groups in a 1:2 ratio. Serum GGT levels before and 6 months (M6) after initiating NAs and the potential risk factors were measured. The primary endpoint was HCC development 12 months after NA initiation. Results The annual incidence of HCC was 1.4/100 person‐years in a follow‐up period of 11 370.7 person‐years. The strongest factor associated with HCC development was high M6‐GGT levels (>25 U/L; hazard ratio [HR]/95% confidence interval [CI]: 3.31/2.02‐5.42, P < .001), followed by cirrhosis (HR/CI: 2.06/1.39‐3.06, P < .001), male sex (HR/CI: 2.01/1.29‐3.13, P = .002) and age (HR/CI: 1.05/1.03‐1.17, P < .001). Among cirrhotic patients, the incidence of HCC did not differ between those with high or low M6‐GGT levels (P = .09). In contrast, among non‐cirrhotic patients, the incidence of HCC was significantly higher for those with M6‐GGT level >25 U/L than for their counterparts (P < .001). Cox regression analysis revealed that the strongest factor associated with HCC development in non‐cirrhotic patients was high M6‐GGT levels (HR/CI: 5.05/2.52‐10.16, P < .001), followed by age (HR/CI: 1.07/1.04‐1.09, P < .001). Non‐cirrhotic elderly patients with high M6‐GGT levels had a similarly high HCC risk as cirrhotic patients did (P = .29). Conclusions On‐treatment serum GGT levels strongly predicted HCC development in CHB patients, particularly non‐cirrhotic patients, treated with NAs.

Abstract:Estimating the compressive strength of high strength concrete (HSC) is an essential investigation for the maintenance of nuclear power plant (NPP) structures. This study intends to evaluate the compressive strength of HSC using two approaches: non-destructive tests and concrete core strength. For non-destructive tests, samples of HSC were mixed to a specified design strength of 40, 60 and 100 MPa. Based on a dual regression relation between ultrasonic pulse velocity (UPV) and rebound hammer (RH) measurements, an estimation expression is developed. In comparison to previously published estimation equations, the equation proposed in this study shows the highest accuracy and the lowest root mean square error (RMSE). For the estimation of compressive strength using concrete core specimens, three different concrete core diameters were examined: 30, 50, and 100 mm. Based on 61 measured compressive strengths of core specimens, a simple strength correction factor is investigated. The compressive strength of a concrete core specimen decreases as the core diameter reduces. Such a relation is associated with the internal damage of concrete cores and the degree of coarse aggregate within the core diameter from the extracting process of the cores. The strength estimation expressions was formulated using the non-destructive technique and the core strength estimation can be updated with further test results and utilized for the maintenance of NPP.

Background/Aims A number of clinical trials reported varying effects of cholesterol lowering agents in nonalcoholic fatty liver disease (NAFLD) patients. We, therefore, assessed the changes in hepatic steatosis and NAFLD activity score (NAS) after treatment with cholesterol lowering agents in NAFLD patients by metaanalysis. Methods The Cochrane Library, the MEDLINE, and the Embase databases were searched until May 2015, without any language restrictions, for randomized controlled trials (RCTs) and nonrandomized studies (NRSs). Additional references were obtained from review of bibliography of relevant articles. The quality of evidence was assessed using the grading of recommendations assessment, development and evaluation guidelines. Results Three RCTs (n = 98) and two NRSs (n = 101) met our study inclusion criteria (adult, NAFLD, liver biopsy). Liver biopsy was performed in all five studies, but only the three studies reported NAS. Ezetimibe significantly decreased NAS (standardized mean difference [SMD], –0.30; 95% confidence interval [CI], –0.57 to –0.03) but not hepatic steatosis in RCT (SMD, –0.1; 95% CI, –0.53 to 0.32), while the effect was significant for both NAS and intrahepatic content in NRSs (SMD, –3.0; 95% CI, –6.9 to 0.91). Conclusions Ezetimibe decreased NAS without improving hepatic steatosis.