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Background/Aims Pegylated interferon (PEG-IFN) treatment with a high rate of off-therapy host immune control is still an attractive treatment for chronic hepatitis B virus (HBV) infection. There remains uncertain about the prognosis of sustained responder after PEG-IFN treatment who do not need nucleos(t)ides (NAs). We investigated the long-term outcomes of PEG-IFN treatment focused on tolerant patients without NAs up to 13 years. Methods A consecutive 172 patients treated with PEG-IFN for chronic hepatitis B or compensated liver cirrhosis between 2005 and 2014 were enrolled and finally 122 patients who fully completed PEG-IFN treatment were analyzed. The definition of response for PEG-IFN treatment at 6months posttreatment were as follows: hepatitis B e antigen (HBeAg) positive patients, achieve both virologic response (VR; <2,000 IU/mL of HBV DNA) and serologic response (HBeAg loss or seroconversion); HBeAg negative patients, reach VR. During follow-up period, we analyzed the number of patients with HBsAg loss, starting NAs due to viral activation and disease progression including liver cirrhosis and hepatocellular carcinoma (HCC). Results The median follow-up period of 122 patients were 7.2 years (range, 1.1 to 13.2 years). Of 122 patients, 43 patients (35.2%) had a response at 6 months posttreatment. During follow-up, 69 patients (56.6%) started NAs and the patients who had a response for PEG-IFN significantly lower rate of starting NAs (14/43 vs 55/79, p<0.001). HBsAg loss occurred in nine patients (7.4%) and sustained responders without further NAs treatment had significantly high rate of HBsAg loss compared to the patients with starting NAs (13.2% vs 2.9%, p=0.01). Eight patients (6.6%) developed disease progression including HCC (n=3). All of them were nonsustained responders who started NAs after PEG-IFN therapy compared to sustained responders (p=0.03). Conclusions Sustained responders without further NAs treatment after PEG-IFN treatment had a favorable clinical outcome in HBsAg loss and no disease progression up to 13 years. [ABSTRACT FROM AUTHOR]

Background/Aims Transarterial radioembolization (TARE) is a form of radiation therapy performed by selective intra-arterial injection of microspheres loaded with Yttrium-90. TARE is known to be effective in the management of unresectable hepatocellular carcinoma (HCC). The aim of this study is to identify prognostic factors for overall survival (OS) and time to progression (TTP) in patients with HCC undergoing TARE. Methods This study included 73 consecutive HCC patients who underwent TARE from July 2009 to January 2018. The tumor responses to TARE were assessed according to modified Response Evaluation Criteria in Solid Tumors. Results The patients' baseline characteristics were as follows: median age was 66 years, 74% of male. The median tumor size was 9 cm and 41% of the patients had tumors larger than 10 cm. Multifocal HCCs identified in 58% and 26% of the patients showed infiltrative tumor. Sixty-three percent of the patients did not have portal vein tumor thrombus (PVTT), 10% had VP 1-2, and 27% had VP 3-4 of PVTT. Among 73 patients, five (7%) obtained complete response and 25 (34%) showed partial response at 3 months after TARE. Median OS was 27.6 months and TTP was 3.2 months. Multivariate analysis revealed that the absence of PVTT (hazard ratio [HR], 0.137; 95% confidence interval [CI], 0.057 to 0.331; p<0.001) was independent factor for OS. The absence of PVTT (HR, 0.330; 95% CI, 0.172 to 0.632; p=0.001) and tumor diameter ≤10 cm (HR, 0.287; 95% CI, 0.135 to 0.611, p=0.001) were independent prognostic factors for TTP. Conclusions TARE is an effective therapy for patients with advanced HCC. Absence of PVTT before TARE is an independent predictive factor for both OS and TTP. [ABSTRACT FROM AUTHOR]

Background/Aims Nonalcoholic fatty liver disease (NAFLD) is a metabolic-related disorder ranging from steatosis to steatohepatitis which may progress to fibrosis, cirrhosis and hepatocellular carcinoma. Micro RNAs (miRNAs) are important posttranscriptional regulators of gene expression, and the dysregulation of miRNAs is involved in various biological processes in the liver, including lipid homeostasis, inflammation, apoptosis, and cell proliferation. This study aimed at suggesting the miRNAs may be a biomarker of the fat accumulation and inflammation in NAFLD. Methods We use male mice of 6- to 8-week old had fed normal diet or 60% high fat diet for 3 months and 6 months. The accumulation of lipid in liver was examined by hematoxylin and eosin stain (H&E stain). We used human liver cell lines loaded with free fatty acids. And we performed quantitative real-time reverse transcriptase polymerase chain reaction and Western blotting for the validation of miRNAs and lipid droplets formation markers. Results miRNAs levels were identified in NAFLD in vivo and in vitro model. In the high fat diet group, liver index and body weigh were increased. H&E stain results show that high fat diet groups had accumulated lots of fat. And in the high fat diet group, lipid droplets formation markers and inflammation markers were increased. In NAFLD in vitro model, lipid droplets formation markers and inflammation markers were increased. miRNA level of miR-26a, miR-26b, let-7f and miR-22 was increased in the NAFLD in vivo and in vitro model. But, level of miR-101 was decreased in the NAFLD in vivo ad in vitro model. Conclusions In this study we evaluated the level of miRNAs on lipid metabolism using the in vitro and in vivo NAFLD model. Our results demonstrate that miRNAs may be a biomarker in NAFLD. [ABSTRACT FROM AUTHOR]

Background/Aims High fructose consumption leads to increased hepatic lipogenesis resulting in hepatic steatosis and the development of nonalcoholic fatty liver disease (NALFD). Naringin, a flavanone glycoside found in citrus fruit, has been reported to have antioxidant, anti-inflammatory and hypolipidemic properties. The aim of this study was to determine the effect and underlying mechanism of naringin treatment on hepatic steatosis in fructose-fed rats. Methods Male Sprague-Dawley rats were given 10% (w/v) fructose in drinking water for 12 weeks. Naringin (100 mg/kg/day)was administered orally to rats for the last 4 weeks of fructose overload. After 12 weeks, the contents of total cholesterol (TC) and triglyceride (TG) in liver homogenates were evaluated. Hepatic steatosis was evaluated using histological staining with hematoxylin and eosin (H&E) and Oil Red O staining. Hepatic expressions of lipogenesis-related proteins were detected by Western blotting. Results Results indicated that treatment of fructose-fed rats with naringin decreased TC and TG contents in liver. Naringin treatment also reduced high fructose-induced hepatic lipid accumulation, as indicated by H&E and Oil Red O staining. In addition naringin decreased the expression of lipogenesis-related proteins, including sterol regulatory element- binding protein 1c and fatty acid synthase in liver of fructose-fed rats. Conclusions The present study suggests that naringin treatment reduces high fructose- induced hepatic steatosis in rats by suppressing hepatic lipogenesis. [ABSTRACT FROM AUTHOR]

Background/Aims We aimed to validate the updated version of Korean stroop test for MHE screening. Methods Liver cirrhosis (LC) patients without history of overt HE were recruited prospectively from 13 centers. All participants completed Korean paper-pencil test (KPPT) and the Korean stroop test. Korean stroop test consisted of two stroop-off states (color and word) and two stroop-on states (inhibition and switching). Four types of "on time+off time"s were analyzed (color-plus-inhibition, color-plus-switching, word-plus-inhibition, and word-plus-switching). MHE was diagnosed when KPPT scores ≥2. Results A total of 119 LC patients and 792 healthy controls were enrolled. The most common etiology of LC was alcohol (62.8%). Mean Model for End Stage Liver Disease (MELD) score of LC patients was 11. Prevalence of MHE was 39.5% by KPPT. Four types of "on time+off time" significantly differed among healthy controls, cirrhosis patients without MHE, and cirrhosis patients with MHE. All types of "on time+off time" showed positive correlation with PHES scores (all p<0.01). The highest area under the curve (AUC) among "on time+off time"s, was for word-plus-inhibition (AUC, 0.699; 95% confidence interval, 0.603 to 0.795; p<0.001) in discrimination of MHE. Ln prothrombin time (international normalized ratio; odds ratio [OR), 197.33; p=0.008) and word-plus-inhibition (OR, 1.012; p=0.011) were significant in multivariate analysis for MHE diagnosis. The cutoff point for the highest Youden's index value was 155 seconds for word-plus-inhibition time with 78.8% of sensitivity and 60.6% of specificity. In the subgroup of patients with MELD score less than 11, on time+off time for word-plus-inhibition was the only prognostic factor in the diagnosis of MHE (OR, 1.008; p=0.037). Conclusions The Korean Stroop Test is simple and valid for screening of MHE. [ABSTRACT FROM AUTHOR]

Background/Aims In Mongolia, 95% of the patients with liver cancer have chronic viral hepatitis and its 53% of patients infected with hepatitis B, 38.9% infected with hepatitis C and 5.6% infected with hepatitis B, C viruses. This survey was conducted among a population of the Dornod province with an aim to evaluate knowledge of population on hepatitis B, C virus infections and to define their attitudes, behaviors and practices. Our aim to assess the knowledge, attitude and behaviors of the population of Dornod province on hepatitis B virus (HBV), hepatitis C virus (HCV) infections. Methods The survey recruited 600 people, which are randomly selected from 50,864 populations of the Dornod province, aged 15 to 64 years. The survey was carried out by analytical descriptive study design. Results In total 600 people were randomly selected for the survey in order to evaluate knowledge, attitude and behaviors of the population of Dornod province on HBV, HCV infections. In the total participants aged 15 to 64 years, 49.7% (298) were male and 50.3% (302) were women. Most of the participants (77.2%) have "meanly level" of knowledge and only 1.8% of the participants evaluated as they have "good" knowledge on HBV, HCV infections. We conclude that study population have relatively positive attitudes towards the HBV, HCV infections, such as 76.39% of the population worry on HBV, HCV infections and 92.1% of them prefer diagnostic tests for HBV, HCV and 27.8% of them involved for voluntary vaccinations and 55.0% of them examined for diagnostic tests. Young people are more likely to share of a razor blade or nail clipper with another people and damaging of skin by tattoo or piercing. Conclusions Knowledge level of the population of Dornod province on HBV, HCV infections is "average." There was only 1.8% of the population has good knowledge among the population of Dornod province. [ABSTRACT FROM AUTHOR]

Background/Aims There are many attempts to predict portal pressure and esophageal varices by noninvasive method. The spleen stiffness (SS) and liver stiffness are expected to be useful in noninvasive diagnosis. We evaluate the performance of SS measured by two-dimensional shear wave elastography (2D-SWE) for predicting portal hypertension and esophageal varices. Methods From January 2017 to August 2019, 130 patients who measured SS and hepatic venous wedge pressure (HVPG) and esophagogastroduodenoscopy simultaneously were enrolled. Thirty-four patients who showed invalid measurement (n=31) and combined hematologic malignancy (n=3) and concurrent hepatocellular carcinoma (n=2) were excluded. SS was measured by three examiner using 2D-SWE (LOGIQ E9, GE healthcare) from three tertiary medical center. Results Ninety-four patients were eligible for analysis. Most common etiology was alcoholic hepatitis (n=63, 67.0%) and followed by chronic hepatitis B (n=17, 18.1%). Patients were consisted of Child-Pugh class A (n=33), B (n=46), C (n=15). The mean value of HVPG was 14.6±5.1 mmHg and 83.0% and 58.5% of patients has esophageal varices and high-risk varices. The HVPG and SS did not showed significant correlation (r=0.197, p=0.057). The presence of varices appeared significant positive correlation with SS (r=0.212, p=0.043). High-risk varices showed stronger correlation with SS (r=0.324, p=0.002). The area under receiver operating characteristics showed 0.698 (confidence interval, 0.592 to 0.804; p=0.001) Conclusions Whether SS is associated with HVPG is unclear, SS could be useful for evaluating high-risk varices. Further studies are needed to clarify the clinical implication. [ABSTRACT FROM AUTHOR]

Background/Aims Chronic hepatitis B (CHB) infection burden in Taiwan is high. Treatments goals are to suppress viral replication and achieve early normalization of alanine aminotransferase levels to decrease the liver damage risk and liver-related complications (i.e., hepatocellular carcinoma [HCC]). Notably, certain CHB treatments and increasing CHB patients' age can increase risk of bone and renal adverse events. In this study, we simulated 10-year liver and safety outcomes for 100,000 non-cirrhotic Taiwanese CHB patients comparing tenofovir alafenamide (TAF) to tenofovir disoproxil fumarate (TDF) and entecavir (ETV) treatments. Methods A health outcomes model was developed using an individual patient simulation framework tracking treatment impact on liver complications, chronic kidney disease and major osteoporotic facture. The model assumed 90% of all patients were treatment- experienced, of which 10% had lamivudine experience. Patient demographics and other inputs were drawn from published randomized controlled trials, peer-reviewed Taiwanese literature, and Taiwanese hepatologists. The treatments considered were TAF, TDF and ETV. Patients received treatment in accordance with the latest Taiwanese National Health plan reimbursement criteria. Results Over a 10-year horizon, TAF-treated patients had fewer hepatic (i.e., compensated cirrhosis-CC, decompensated cirrhosis-DCC, and HCC) events as compared to TDF and ETV (Table 1). In addition, TAF-treated patients had lower or similar rates of bone- and renal-related safety events as compared to TDF and ETV (Table 1). Conclusions Utilizing clinical data from various first-line NA treatments, this model projects TAF-treated patients to have better liver outcomes and lower adverse events rates over a 10-year time horizon compared to TDF and ETV, driven by its improved efficacy and safety profile. As Taiwanese CHB patients are aging with increasing comorbidities, careful selection of treatment is warranted. Notably, a limitation of this analysis is that CC and HCC event risks are based on untreated population data given limited treated patient data to date. [ABSTRACT FROM AUTHOR]