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Introduction: Steatotic liver disease (SLD) is a new overarching term proposed to replace nonalcoholic fatty liver disease and metabolic dysfunction-associated fatty liver disease. Subclassification includes metabolic dysfunction-associated SLD (MASLD), MASLD with increased alcohol intake (MetALD), and cryptogenic SLD. This study aimed to investigate whether SLD and its subclassification could stratify hepatocellular carcinoma (HCC) risk. Methods: A cohort of 85,119 adults without viral hepatitis or heavy alcohol intake was analyzed for the risk of HCC according to SLD and its subclassification. The fibrosis-4 (FIB-4) index was used to estimate the degree of liver fibrosis. Results: During a median follow-up of 11.9 years, HCC was diagnosed in 123 individuals. The incidence rate of HCC per 1,000 person-years was higher in individuals with SLD than in those without SLD (0.197 vs. 0.071, p < 0.001), with an adjusted hazard ratio of 2.02 (95% confidence interval: 1.40–2.92). The HCC incidence rate per 1,000 person-years was 0, 0.180, and 0.648 for cryptogenic SLD, MASLD, and MetALD, respectively. When participants with SLD was further stratified by the FIB-4 index, the HCC incidence rate per 1,000 person-years was 0.074 for SLD with FIB-4 < 1.3 and 0.673 for SLD with FIB-4 ≥ 1.3. Of note, HCC risk was substantially high (HCC incidence rate: 1.847 per 1,000 person-years) for MetALD with FIB-4 ≥ 1.3. Conclusions: HCC risk was different by SLD and its subclassification. The utilization of SLD and its subclassification can aid in stratifying HCC risk and facilitate the identification of individuals requiring interventions to mitigate the risk of HCC. [ABSTRACT FROM AUTHOR]

Simple Summary: Early-stage hepatocellular carcinoma (HCC) is notorious for its high recurrence rate even after curative treatment. Several studies have suggested the association between diabetes mellitus (DM) and the risk of HCC. However, current evidence regarding the impact of glycemic burden on the outcomes of HCC is still limited. The present study provides an important insight into the relationship between glycemic burden and outcomes of early-stage HCC. Lower glycemic burden was an independent factor associated with better overall survival as well as lower recurrence in early-stage HCC. Moreover, there was a dose–response relationship between recurrence/overall survival and glycemic burden. Good glycemic control should be considered as a significant part of HCC management. Early-stage hepatocellular carcinoma (HCC) is still difficult to cure for its high recurrence rate. This study aimed to examine whether glycemic burden management could be one way to improve outcomes of early-stage HCC. A total of 137 very early or early-stage HCC patients who underwent resection or ablation at Samsung Medical Center and had glycemic burden assessment were analyzed. Glycemic burden was assessed using hemoglobin A1c (HbA1c) level. Outcomes were recurrence and overall survival. Risks of recurrence and overall survival were compared according to glycemic burden using a cut-off point of 6.5% or two cut-off points of 6.0% and 7.5%. Overall, 51 (37.2%) patients experienced HCC recurrence. The adjusted hazard ratio (aHR) for recurrence comparing patients with HbA1c > 6.5% to those with HbA1c ≤ 6.5% was 2.66 (95% CI: 1.26–5.78). The risk of recurrence increased in a dose-dependent manner by glycemic burden; aHR for 6.0 < HbA1c ≤ 7.5%: 2.00 (95% CI: 0.78–5.55); aHR for HbA1c > 7.5%: 6.05 (95% CI: 2.31–17.5). Mortality was observed in 16 (11.7%) patients. The risk of mortality was higher for HbA1c > 6.5% than for HbA1c ≤ 6.5% (aHR: 2.33; 95% CI: 1.10–5.08). There was also a dose–response relationship between overall survival and glycemic burden. Glycemic burden assessed using HbA1c level was significantly associated with outcomes of early-stage HCC patients. Good glycemic control could be a therapeutic goal to improve clinical outcomes in these populations. [ABSTRACT FROM AUTHOR]

Central bank independence (CBI) has been widely advocated as a means to address the time‐inconsistency problem of controlling inflation. Consequently, many countries have embraced central bank reforms since the 1990s. While extant research in political science has sought to unveil the consequences of CBI, there remains an unexplained variation in the response of countries with regard to capital account openness. Notably, a positive association exists between CBI and capital account openness due to the constraints CBI places on leaders' discretionary monetary and fiscal policies, thereby fostering reliance on financial policy to boost their economies. However, this relationship is contingent on the domestic political contexts of countries. CBI leads to capital account liberalization only when the rule of law is guaranteed, given that CBI is often stipulated by laws. Therefore, in countries where political leaders can easily override formal rules, CBI shows no discernible impact on capital account openness. Employing two‐way fixed‐effects and error‐correction models, the study reveals that CBI increases capital account openness only in democracies, in the presence of multiple veto players, and a high level of transparency. The findings underscore the pivotal role of the domestic political environment in analyzing how CBI constrains political leaders. [ABSTRACT FROM AUTHOR]

Introduction: Hepatocellular carcinoma (HCC) is the sixth most commonly diagnosed cancer and the third leading cause of cancer death worldwide. While there has been rapid evolution in the treatment paradigm of HCC across the past decade, the extent to which these newly approved therapies are utilized in clinical practice in the real world is, however, unknown. The INSIGHT study was an investigator-initiated, multi-site longitudinal cohort study conducted to reflect real-world epidemiology and clinical practice in Asia-Pacific in the immediate 7-year period after the conclusion of the BRIDGE study. Methods: Data were collected both retrospectively (planned 30% of the total cohort size) and prospectively (planned 70%) from January 2013 to December 2019 from eligible patients newly diagnosed with HCC from 33 participating sites across 9 Asia-Pacific countries. Results: A total of 2,533 newly diagnosed HCC patients (1,052 in retrospective cohort and 1,481 in prospective cohort) were enrolled. The most common risk factor was hepatitis B in all countries except Japan, Australia, and New Zealand, where the prevalence of hepatitis C and diabetes were more common. The top three comorbidities reported in the INSIGHT study include cirrhosis, hypertension, and diabetes. We observe high heterogeneity in the first-line treatment recorded across countries and across disease stages, which significantly affects survival outcomes. Stratification by factors such as etiologies, tumor characteristics, the presence of extrahepatic metastases or macrovascular invasion, and the use of subsequent lines of treatment were performed. Conclusion: The INSIGHT study describes a wide spectrum of clinical management practices in HCC, where patient demographics, differential costs, and patient access to therapies may lead to wide geographical variations through the patient's treatment cycle, from diagnosis to clinical outcome. The high heterogeneity in patient outcomes demonstrates the need for more robust and clinical management strategies to be designed and adopted to bring about better patient outcomes. [ABSTRACT FROM AUTHOR]

Despite the frequent use of economic sanctions by states, there are insufficient analyses of the collateral effects of these measures on target states. Under the sanctions, targeted leaders who pursue the longevity of their regimes adjust domestic policies to mitigate the costs associated with sanctions. Specifically, this article analyzes the effects of sanctions on capital account liberalization in target states. Economic sanctions trigger changes in the capital account openness of target states. However, the direction of the reform is dependent on the political institutions in target states, which characterize the behavioral incentive structure of the leaders. Specifically, economic sanctions lower capital account openness, albeit only in autocracies. Democracies, which are sensitive to the benefits of capital account openness, are less likely to tighten the restrictions. Instead, they are likely to open their markets. I employ the two-way fixed approach to test my argument, using time-series cross-sectional data spanning 145 countries for the period 1965–2005. In this regard, I find evidence in favor of my argument, with the findings suggesting the indirect impact of economic sanctions on target states' financial policies on which the decisions are primarily driven by the political incentives of the targeted leaders. A pesar del uso frecuente de las sanciones económicas por parte de los Estados, no existen suficientes análisis acerca de los efectos colaterales que tienen estas medidas en los Estados de destino. En virtud de las sanciones, los líderes de los Estados de destino de estas sanciones, que tienen como objetivo la longevidad de sus regímenes, ajustan sus políticas nacionales con el fin de mitigar los costes asociados a las sanciones. En concreto, en este artículo se analizan los efectos que tienen las sanciones sobre la liberalización de la cuenta de capital en los Estados de destino. Las sanciones económicas provocan cambios en la transparencia de la cuenta de capital de los Estados de destino. Sin embargo, la dirección de las reformas depende de las instituciones políticas de los Estados de destino, las cuales caracterizan la estructura de incentivos conductuales de los líderes. De manera más concreta, las sanciones económicas reducen la transparencia de la cuenta de capital, aunque solo en las autocracias. Las democracias, que son sensibles a los beneficios de la transparencia de la cuenta de capital, son menos propensas a endurecer las restricciones. En cambio, es probable que abran sus mercados. Utilizamos el enfoque fijo bidireccional con el fin de demostrar nuestro razonamiento, mediante el uso de datos transversales de series temporales que abarcan 145 países durante el período entre 1965 y 2005. A este respecto, encontramos evidencias que apoyan nuestro razonamiento, ya que las conclusiones sugieren el impacto indirecto que tienen las sanciones económicas sobre las políticas financieras de los Estados de destino, cuyas decisiones están impulsadas principalmente por los incentivos políticos de los líderes del Estado de destino. Malgré la fréquence de l'utilisation des sanctions économiques par les États, les analyses des effets collatéraux de ces mesures sur les États cibles restent insuffisantes. Les dirigeants ciblés qui souhaitent assurer la longévité de leur régime ajustent les politiques nationales pour atténuer les coûts associés aux sanctions auxquelles ils sont soumis. Plus précisément, cet article analyse les effets des sanctions sur la libéralisation du compte de capital dans les États cibles. Les sanctions économiques déclenchent des modifications dans l'ouverture de celui-ci. Cependant, l'orientation de la réforme dépend des institutions politiques des États cibles, qui caractérisent la structure d'incitations comportementales des dirigeants. Plus précisément, les sanctions économiques réduisent l'ouverture du compte de capital, quoique seulement dans les autocraties. Les démocraties, plus sensibles aux avantages de l'ouverture du compte de capital, accentueront moins souvent les restrictions. Elles auront plutôt tendance à ouvrir leur marché. J'utilise une approche d'effets fixes bilatéraux pour évaluer mon argument, à l'aide de données chronologiques transversales couvrant 145 pays entre 1965 et 2005. À cet égard, je trouve des éléments pour étayer mon argument : les conclusions indiquent la présence de conséquences indirectes des sanctions économiques sur les politiques financières des États cibles. Les décisions concernant ces dernières se fondent principalement sur des incitations politiques des dirigeants ciblés. [ABSTRACT FROM AUTHOR]

Background and Aims: Baveno VII consensus introduced the non‐invasive criteria of clinically significant portal hypertension (CSPH) using liver stiffness measurement (LSM). We evaluated the usefulness of the Baveno VII criteria to predict the risk of decompensation in patients with compensated advanced chronic liver disease (cACLD). Methods: We conducted a retrospective cohort study of 1966 patients with cACLD. Patients were categorized into four groups (CSPH excluded (n = 619), grey zone (low risk of CSPH (n = 699), high risk of CSPH (n = 207)), and CSPH included (n = 441)) according to Baveno VII consensus. The risk of events was estimated using a Fine and Gray competing risk regression analysis, with liver transplantation and death as competing events. We calculated standardized hazard ratios (sHR) to assess the relative risk of decompensation. Results: Among 1966 patients, 178 developed decompensations over a median follow‐up of 3.06 (IQR: 1.03–6.00) years. Patients with CSPH had the highest decompensation risk, followed by the grey zone high‐risk group, grey zone low‐risk group, and those without CSPH with 3‐year cumulative risks of 22%, 12%, 3.3%, and 1.4% respectively (p <.001). Compared to CSPH excluded group, CSPH included group (sHR: 8.00, 95% CI: 4.00–16.0), grey zone high‐risk group (sHR: 6.57, 95% CI: 3.16–13.6), grey zone low‐risk group (sHR: 2.15, 95% CI: 1.04–4.41) had significantly higher risk of decompensation (Gray's test p <.01). Conclusion: Non‐invasive diagnosis of CSPH according to the Baveno VII criteria can stratify the risk of decompensation. [ABSTRACT FROM AUTHOR]

Normalization of serum alanine aminotransferase (ALT) levels is one of the goals of hepatitis B treatment. However, ALT levels in cirrhosis patients might be normal or mildly elevated regardless of ongoing inflammation. Therefore, we examined whether on-treatment ALT and other potential on-treatment indicators could be clinical surrogates of antiviral therapy in HBV-related cirrhosis. A total of 911 patients with HBV-related liver cirrhosis who started treatment with entecavir or tenofovir were analyzed. At 1 year of antiviral therapy, we evaluated 'ALT normalization', 'undetectable serum HBV DNA', 'fibrosis-4 (FIB-4) index improvement', and 'serum HBeAg loss' as potential biomarkers for HCC development. During 6.6 (3.8–10.2) years of follow-up, 222 patients (24.3%) newly developed HCC. Undetectable HBV DNA levels at 1 year were observed in 667 patients (73.2%), and the HCC incidence was significantly lower in this population (adjusted hazard ratio (HR) 0.66, 95% CI 0.50–0.87). Improvement of the FIB-4 index (< 3.25) was associated with a lower risk of HCC in 478 patients with an elevated FIB-4 index (adjusted HR 0.59, 95% CI 0.55–0.82). However, there was no significant difference in HCC risk between those with and without normalization of ALT levels (p = 0.39) among those with elevated ALT levels or between those with and without HBeAg seroconversion (p = 0.55) among HBeAg-positive patients. Therefore, on-treatment FIB-4 levels at 1 year are clinically useful surrogates of antiviral therapy for HBV-related cirrhosis patients. [ABSTRACT FROM AUTHOR]