Remote Cardiac Rehabilitation With Wearable Devices.

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients' busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as cost-effectiveness and insurance coverage still persist.

[Evaluation of the "Health management guideline on occupational allergy in nursing occupations and its primary prevention" by nursing managers].

OBJECTIVE: Individuals in nursing occupations are often exposed to various materials such as rubber products and drugs, and they comprise a population at high risk of developing occupational allergies. We therefore created a "Health management guideline on occupational allergy in nursing occupations and its primary prevention" (hereinafter referred to as "HMG") and conducted a questionnaire survey to elucidate its potential use and the challenges of implementing it in clinical practice. SUBJECTS AND METHODS: The HMG includes the following content: A. Basic knowledge of occupational allergies; B. Common occupational allergies in nursing occupations; C. Occupational allergies triggered by specific antigens in nursing occupations; D. Eczema and skincare for hands; and E. Health management for occupational allergies. A questionnaire survey was conducted on one nursing manager each from 80 hospitals, with at least 400 beds. The survey included questions to gauge the level of understanding the content described in the HMG and opinions on incorporating the management method. The ethics committee of the researcher's institution approved the study. RESULTS: Responses were obtained from 30 nursing managers. Over 70% responded that they understood the instructions for [occupational allergies], [common occupational allergies in nursing occupations], and [eczema and skincare for hands] presented in the HMG, and 100% said they either understood or mostly understood them. For [work management], 57% said they understood the content and 90% wanted to incorporate it. Furthermore, 10% responded that they wanted to incorporate the guidelines but did not believe it was feasible, given that "achieving general awareness and efforts involving other occupations are difficult." For [work environment management], 53% said they understood the content and 83% wanted to incorporate it. Additionally, 17% responded that they wanted to incorporate it but did not believe it was feasible, amid concerns that "allergen monitoring is difficult in reality" and "installation of local ventilation systems seems difficult." DISCUSSION AND CONCLUSIONS: The HMG was postulated to be useful in providing knowledge on occupational allergy and health management methods, and for employing in clinical practice. The study recommended that in order to specifically incorporate the management methods, it is imperative that the entire hospital, including staff from other occupations, understand the guidelines and make adjustments accordingly.

Vitamin C Maintenance against Cell Growth Arrest and Reactive Oxygen Species Accumulation in the Presence of Redox Molecular Chaperone hslO Gene.

Chromosome damage combined with defective recombinase activity renders cells inviable, owing to deficient double-strand break repair. Despite this, recA polA cells grow well under either DNA damage response (SOS) conditions or catalase medium supplementation. Catalase treatments reduce intracellular reactive oxygen species (ROS) levels, suggesting that recA polA cells are susceptible to not only chronic chromosome damage but also ROS. In this study, we used a reducing agent, vitamin C, to confirm whether cell growth could be improved. Vitamin C reduced ROS levels and rescued colony formation in recAts polA cells under restrictive temperatures in the presence of hslO, the gene encoding a redox molecular chaperone. Subsequently, we investigated the role of hslO in the cell growth failure of recAts polA cells. The effects of vitamin C were observed in hslO+ cells; simultaneously, cells converged along several ploidies likely through a completion of replication, with the addition of vitamin C at restrictive temperatures. These results suggest that HslO could manage oxidative stress to an acceptable level, allowing for cell division as well as rescuing cell growth. Overall, ROS may regulate several processes, from damage response to cell division. Our results provide a basis for understanding the unsolved regulatory interplay of cellular processes.

Reactive oxygen species accumulation is synchronised with growth inhibition of temperature-sensitive recAts polA Escherichia coli.

When combined with recombinase defects, chromosome breakage and double-strand break repair deficiencies render cells inviable. However, cells are viable when an SOS response occurs in recAts polA cells in Escherichia coli. Here, we aimed to elucidate the underlying mechanisms of this process. Transposon mutagenesis revealed that the hslO gene, a redox chaperone Hsp33 involved in reactive oxidative species (ROS) metabolism, was required for the suppression of recAts polA lethality at a restricted temperature. Recently, it has been reported that lethal treatments trigger ROS accumulation. We also found that recAts polA cells accumulated ROS at the restricted temperature. A catalase addition to the medium alleviates the temperature sensitivity of recAts polA cells and decreases ROS accumulation. These results suggest that the SOS response and hslO manage oxidative insult to an acceptable level in cells with oxidative damage and rescue cell growth. Overall, ROS might regulate several cellular processes.

Possible Relevance of PNPLA3 and TLL1 Gene Polymorphisms to the Efficacy of PEG-IFN Therapy for HBV-Infected Patients.

Lifestyle changes have led to an increase in the number of patients with nonalcoholic fatty liver disease (NAFLD). However, the effects of NAFLD-associated single-nucleotide gene polymorphisms (SNPs) in HBV-infected patients have not been adequately investigated. Methods: We investigated the association of the NAFLD-related SNPs patatin-like phospholipase domain-containing protein 3 (PNPLA3; rs738409), transmembrane 6 superfamily member 2 (TM6SF2; rs58542926), 17-beta hydroxysteroid dehydrogenase 13 (HSD17B13; rs72613567, rs6834314 and rs62305723), membrane-bound O-acyltransferase domain containing 7 (MBOAT7; rs641738) and glucokinase regulatory protein (GCKR; rs1260326) with the presence of histologically proven hepatic steatosis (HS) in HBV-infected patients (n = 224). We also investigated tolloid-like 1 (TLL1) SNP (rs17047200), which has been reported to be involved in the disease progression in Japanese NAFLD patients, and evaluated the association of HS and various SNPs with the treatment efficacy of pegylated-interferon (PEG-IFN) monotherapy following nucleotide/nucleoside (NA) treatment (NA/PEG-IFN sequential therapy; n = 64). Among NAFLD-associated SNPs evaluated, only the PNPLA3 SNP was significantly associated with the presence of hepatic steatosis in a total of 224 HBV-infected patients (P = 1.0×10-4). Regarding the sequential therapy, PNPLA3 SNP and TLL1 SNP were related to the treatment efficacy, and patients without minor alleles of these SNPs showed favorable results with a high virologic response and significant reduction in their HBsAg titer. A multivariate analysis showed that HBeAg positivity (odds ratio 5.810, p = 0.016) and the absence of a risk allele in PNPLA3 and TLL1 SNPs (odds ratio 8.664, p = 0.0042) were significantly associated with treatment efficacy. The PNPLA3 SNP might be associated with the presence of HS, and the combination of the PNPLA3 and TLL1 SNPs might be related to the efficacy of PEG-IFN monotherapy following NA treatment.

Serum Zinc Level Grading System: A Useful Model for Composite Hepatic Events in Hepatitis C Virus-Associated Liver Cirrhosis.

We aimed to clarify the impact of the serum zinc (Zn) level grading system proposed by the Japanese society of clinical nutrition (JSCN: 80 µg/dL < serum Zn level <130 µg/dL (type A), 60 µg/dL < serum Zn level <80 µg/dL (type B), and serum Zn level <60 µg/dL (type C)) in patients with hepatitis C virus (HCV)-related liver cirrhosis (LC) on the incidence of composite hepatic events (Com-HEs) compared with Child-Pugh (C-P) classification or albumin-bilirubin (ALBI) grade. (n = 275, median age = 67 years). The Akaike information criterion (AIC) was compared among three prognostic models. Factors associated with the incidence of Com-HEs were also studied. The first incidence of any HE was confirmed in 112 patients (40.7%). The AIC value for Com-HEs by the Zn level grading system was the lowest among the three prognostic models (AIC: 301.788 in Zn level grading system, 303.372 in ALBI grade, and 333.953 in C-P classification). In the multivariate analysis, male (p = 0.0031), ALBI grade 3 (p = 0.0041), type B (p = 0.0238), type C (p = 0.0004), and persistent viremia (p < 0.0001) were significant factors associated with the incidence of Com-HEs. In conclusion, the serum Zn level grading system proposed by JSCN can be helpful for estimating the incidence of Com-HEs in HCV-related LC patients.

Proposal of predictive model on survival in unresectable pancreatic cancer receiving systemic chemotherapy.

Aims: To construct a predictive model for overall survival (OS) in unresectable pancreatic cancer (PaC) undergoing systemic chemotherapy and to confirm its accuracy in an independent cohort. Patients and methods: The training set (Ts) and the validation set (Vs) included 93 patients (median age=71 years) and 75 patients (median age=76 years). In the Ts, we examined variables linked to OS by uni- and multivariate analyses and constructed a predictive model for OS. Next, we evaluated the reproducibility of the proposed model in the Vs. Results: In the multivariate analysis for the Ts, PaC stage IV (P=0.0020) and carbohydrate antigen (CA) 19-9 ≥437.5 IU/l (P=0.0237) were identified to be significant factors associated with OS. Patients with PaC stage IV or not were given a score of 1 or 0, whereas patients with CA19-9 ≥437.5 IU/l or <437.5 IU/l were given a score of 1 or 0. Sum of the point of PaC stage (0 or 1) and CA19-9 (0 or 1) was defined as "PaC-CA score". In the Ts, there were 16 patients with score 0, 40 with score 1 and 37 with score 2, while in the Vs, there were 9 patients with score 0, 32 with score 1 and 34 with score 2. Overall P values reached significance in the Ts (P=0.0002), the Vs (P=0.0029) and the combined Ts and Vs (P<0.0001) among patients with PaC score 0, 1 and 2. Conclusion: PaC-CA score can be helpful for risk stratification in PaC patients undergoing systemic chemotherapy.

Serum Zinc Level and non-Protein Respiratory Quotient in Patients with Chronic Liver Diseases.

We sought to clarify the correlation between non-protein respiratory quotient (npRQ) in indirect calorimetry and serum zinc (Zn) level in chronic liver diseases (CLDs, n = 586, 309 liver cirrhosis (LC) patients, median age = 63 years). Clinical parameters potentially linked to npRQ <0.85 (best cutoff point for the prognosis in LC patients) were also examined in receiver operating characteristic curve (ROC) analyses. The median npRQ was 0.86. The median serum Zn level was 64 µg/dL. The median npRQ in patients with non-LC, Child-Pugh A, Child-Pugh B and Child-Pugh C were 0.89, 0.85, 0.83 and 0.82 (overall p < 0.0001)). The median serum Zn level in patients with npRQ <0.85 (58 µg/dL) was significantly lower than that in patients with npRQ ≥ 0.85 (68 µg/dL) (p < 0.0001). The correlation coefficient (r) between npRQ level and serum Zn level for all cases was 0.40 (p < 0.0001). Similar tendencies were observed in all subgroup analyses. The highest correlation coefficient between serum Zn level and npRQ was found in patients with Child-Pugh C (n = 22, r = 0.69). In ROC analyses for npRQ <0.85, serum Zn level had the highest area under the ROC (AUC) among baseline laboratory parameters (AUC = 0.69). In conclusion, serum Zn level can be helpful for npRQ in patients with CLDs.

Walking Speed: Japanese Data in Chronic Liver Diseases.

We aim to clarify the impact of walking speed (WS) and analyze factors linked to WS decline in patients with chronic liver diseases (CLDs, 165 males and 191 females, 137 liver cirrhosis patients). The WS decline is defined as <0.8 m/second (m/s), referring to the guidelines. The median (range) WS was 1.3 m/s (0.2-2.02 m/s). There were 17 patients with WS <0.8 m/s (4.8%). The WS value was significantly correlated with the handgrip strength value both in males (r2 = 0.252, p < 0.0001) and females (r2 = 0.256, p < 0.0001). In the multivariate analysis of factors associated with WS decline, only the extracellular water (ECW) to total body water (TBW) ratio using bioimpedance analysis was an independent predictor (p = 0.0398). Extracellular fluid excess was categorized as follows: normal condition (ECW to TBW ratio <0.390), mild overhydrated condition (ECW to TBW ratio 0.390-0.399), and moderate to severe overhydrated condition (ECW to TBW ratio ≥0.400). The WS value was well stratified according to the ECW to TBW ratio (normal vs. mild, p = 0.0001; mild vs. moderate to severe, p < 0.0001; normal vs. moderate to severe, p < 0.0001; overall p-value <0.0001). In conclusion, the ECW to TBW ratio can be closely linked to WS decline in CLD patients.

Serum zinc concentration and quality of life in chronic liver diseases.

Health related quality of life (HRQOL) in chronic liver disease (CLD) patients has been attracting much attention these days because it is closely associated with clinical outcomes in CLD patients. HRQOL has become established as an important concept and target for research and practice in the fields of medicine. A critique of HRQOL research is the lack of conceptual clarity and a common definition of HRQOL. Using a clear definition of HRQOL may increase the conceptual understanding. In this study, we aimed to elucidate the association between serum zinc (Zn) level and HRQOL as assessed by the Beck Depression Inventory-2nd edition (BDI-II), Pittsburgh Sleep Quality Index Japanese version (PSQI-J) and the 36-Item Short Form Health Survey (SF-36) in CLD patients (n = 322, median age = 65 years, 121 liver cirrhosis (LC) patients (37.6%)). The median serum Zn level for all cases was 73.2 µg/dl. The median BDI-II score and PSQI-J score were 6 and 5, respectively. Patients with higher BDI-II score tended to have lower serum Zn level compared with those with lower BDI-II score. Similar tendencies were observed in patients with higher PSQI-J score. In the SF-36, physical functioning, role physical and physical component summary score significantly correlated with serum Zn level regardless of age, liver disease etiology and the LC status. While mental health and mental component summary score did not significantly correlate with serum Zn level regardless of age, liver disease etiology and the LC status. In conclusion, serum Zn level can be a useful marker for decreased HRQOL in patients with CLDs, especially for physical components.

Combined albumin-bilirubin grade and Mac-2 binding protein glycosylation isomer as a useful predictor in compensated liver cirrhosis.

We aimed to compare the impact on survival among albumin-bilirubin (ALBI) grade, modified ALBI (mALBI) and our proposed combined ALBI grade and Mac-2 binding protein glycosylation isomer (M2BPGi) or FIB4 index grading system in chronic hepatitis C (CHC) related compensated liver cirrhosis (n = 165, 93 men and 72 women, median age = 67 years). Patients with ALBI grade 1, 2, and 3 were allocated a score of 1, 2, and 3 points, respectively. Patients with mALBI grade 1, 2A, and 2B were allocated a score of 1, 2, and 3 points, respectively. Patients with a high or low M2BPGi were allocated a score of 1 and 0 point. Patients with a high or low FIB4 index were allocated a score of 1 and 0 point. Sum of the point of ALBI (1, 2, or 3) and M2BPGi (0 or 1) or FIB4 index (0 or 1) was defined as ALBI-M2BPGi grade or ALBI-FIB4 grade. Prognostic accuracy was compared using the Akaike information criterion (AIC) value and time dependent receiver operating characteristics (ROC) curve analysis. The median follow-up duration was 5.422 years. AIC value for survival by ALBI-M2BPGi grade was the lowest among 4 prognostic models (AIC: 205.731 in ALBI grade, 200.913 in mALBI grade, 189.816 in ALBI-M2BPGi grade, and 204.671 in ALBI-FIB4 grade). All area under the ROC curves of ALBI-M2BPGi grade in each time point were higher than those of ALBI grade, mALBI grade, and ALBI-FIB4 grade. In conclusion, our proposed ALBI-M2BPGi grading system seems to be helpful for estimating prognosis in patients with CHC related compensated LC.

Serum Zinc Level Classification System: Usefulness in Patients with Liver Cirrhosis.

Currently, the Japanese society of clinical nutrition (JSCN) defines serum zinc (Zn) level < 60 µg/dL as Zn deficiency and 60 µg/dL ≤ serum Zn level < 80 µg/dL as subclinical Zn deficiency, and 80 µg/dL ≤ serum Zn level < 130 µg/dL as normal Zn range. We aimed to elucidate the prognostic impact of this Zn classification system in patients with liver cirrhosis (LC) compared to the Child-Pugh classification and the albumin-bilirubin (ALBI) grading system (n = 441, median age = 66 years). The Akaike information criterion (AIC) with each evaluation method was tested in order to compare the overall survival (OS). The median serum Zn level was 65 µg/dL. There were 56 patients with normal Zn level, 227 with subclinical Zn deficiency and 158 with Zn deficiency. OS was well stratified among three groups of serum Zn level (p < 0.0001). The AIC value for survival by the Zn classification system was the lowest among three prognostic models (AIC: 518.99 in the Child-Pugh classification, 502.411 in ALBI grade and 482.762 in the Zn classification system). Multivariate analyses of factors associated with OS revealed that serum Zn classification by JSCN was an independent factor. In conclusion, the serum Zn classification proposed by JSCN appears to be helpful for estimating prognosis in LC patients.

Association between Albumin-Bilirubin Grade and Non-Protein Respiratory Quotient in Patients with Chronic Liver Diseases.

We sought to elucidate the relationship between albumin-bilirubin (ALBI) grade and non-protein respiratory quotient (npRQ) calculated by indirect calorimetry in chronic liver disease (CLD) patients (n = 601, median age = 63 years). Factors linked to npRQ < 0.85, which is reported to be an optimal cutoff point for the prognosis in liver cirrhosis (LC) patients, were also investigated using univariate and multivariate analyses. The median npRQ for all cases was 0.86. In total, 253 patients (42.1%) had npRQ < 0.85. The proportions of patients with npRQ < 0.85 in LC and non-LC patients were 51.9% (166/320) in LC patients and 31.0% (87/281) in non-LC patients (p < 0.0001). The median npRQ in ALBI grades 1, 2, and 3 for all cases were: 0.89, 0.85, and 0.82 (overall p < 0.0001). The proportions of patients with npRQ < 0.85 were 31.0% (71/229) in ALBI grade 1, 46.34% (152/328) in ALBI grade 2, and 68.18% (30/44) in ALBI grade 3 (overall p < 0.0001). In multivariate analyses of factors linked to npRQ < 0.85, ALBI grade 3 (p = 0.0095, hazard ratio = 3.242, ALBI grade 1 as a reference) was an independent predictor along with prothrombin time (p = 0.0139). In conclusion, ALBI grade can be a useful marker for npRQ in patients with CLDs.

Significant Correlation Between Grip Strength and m2bpgi in Patients with Chronic Liver Diseases.

: We sought to compare the impact upon grip strength (GS) between the Mac-2 binding protein glycosylation isomer (M2BPGi) and the Fibrosis-4 (FIB4) index in chronic liver disease (CLD) patients (n = 376: 171 males and 205 females, and 137 liver cirrhosis (LC) cases (36.4%)). Factors linked to the low GS (<26 kg in male and <18 kg in female) were also investigated using univariate and multivariate analyses. The median GS in males was 35.5 kg, while that in females was 21.1 kg. The median M2BPGi was 1.11 cutoff index, whereas the median FIB4 index was 2.069. In both male (P < 0.0001) and female (P = 0.0001), GS in LC patients was significantly lower than that in non-LC patients. In males, M2BPGi (r = -0.4611, P < 0.0001) and the FIB4 index (r = -0.4556, P < 0.0001) significantly correlated with GS. Similarly, in females, M2BPGi (r = -0.33326, P < 0.0001) and our FIB4 index (r = -0.26388, P = 0.0001) also significantly correlated with GS. In the multivariate analyses of factors linked to the low GS, independent factors were: M2BPGi (P = 0.0003) and skeletal muscle index (P = 0.0007) in males, and age (P < 0.0001) and serum albumin level (P = 0.0484) in females. In conclusion, liver fibrosis markers were well-correlated with GS in CLD patients. In particular, M2BPGi can be helpful for predicting the low GS in male patients.

Usefulness of Attenuation Imaging with an Ultrasound Scanner for the Evaluation of Hepatic Steatosis.

We investigated the diagnostic capability of the proprietary attenuation imaging (ATI) modality found on some Canon Medical Systems Corp. ultrasound scanners to detect histologically diagnosed steatosis in 148 patients. ATI values increased significantly with increasing steatosis grade (p < 0.001). The diagnostic values (area under the receiver operating characteristic curve) of ATI for steatosis grades ≥ 1 (5%-33% of hepatocytes), ≥ 2 (33%-66% of hepatocytes) and 3 (> 66% of hepatocytes) were 0.85, 0.91 and 0.91. In addition, ATI values increased significantly with increasing steatosis grades (p = 0.002) even in obese patients (n = 41). The diagnostic values of ATI for steatosis grades ≥ 1, ≥ 2 and 3 in obese patients were 0.72, 0.72 and 0.78. Furthermore, ATI values increased significantly with increasing steatosis grade (p < 0.001) in patients with non-alcoholic fatty liver disease (NAFLD) (n = 38). The diagnostic values of ATI for steatosis grades ≥ 1, ≥ 2 and 3 in NAFLD patients were 0.77, 0.88 and 0.86. In conclusion, the ATI method showed good diagnostic capability for the detection of hepatic steatosis.

Combined Albumin-Bilirubin Grade and Skeletal Muscle Mass as a Predictor in Liver Cirrhosis.

We aimed to compare the prognostic impact among albumin-bilirubin (ALBI) grade, the Child-Pugh classification and our proposed combined ALBI grade and skeletal muscle mass (SMM) grading system in patients with liver cirrhosis (LC) (n = 468, 254 males and 214 females) using the Akaike information criterion (AIC) and time-dependent receiver operating characteristics (ROC) curve analysis. SMM was tested using bioimpedance analysis. Male subjects with skeletal muscle mass index (SMI) <7.0 cm2/m2 and female subjects with SMI <5.7 cm2/m2 were defined as having low SMM. Patients with ALBI grade 1, 2 and 3 were given 1, 2 and 3 points. Patients with and without low SMM were given 1 and 0 point, respectively. The sum of the point of ALBI (1, 2, or 3) and SMM (0 or 1) was defined as the ALBI-SMM grade. The value obtained with the AIC for survival by the ALBI-SMM grade was the lowest among three assessment methods (AIC: 513.418 in ALBI grade, 533.584 in Child-Pugh classification and 493.72 in ALBI-SMM grade). In time-dependent ROC analysis, all area under the ROCs of the ALBI-SMM grade in each time point were the highest among three assessment methods. In conclusion, the ALBI-SMM grading system can be helpful for LC patients.

Association between Sarcopenia and Depression in Patients with Chronic Liver Diseases.

Association between sarcopenia, as evaluated by grip strength (GS) and skeletal muscle mass (SMM), and depression, as evaluated by Beck Depression Inventory-2nd edition (BDI-II) in chronic liver diseases (CLDs, n = 414, average age = 61.5 years), was investigated. Study subjects were classified into four groups: Group A (n = 60), lower GS and lower SMM (sarcopenia); group B (n = 44), lower GS and higher SMM; group C (n = 100), higher GS and lower SMM; group D (n = 210), higher GS and higher SMM. Factors associated with BDI-II score ≥11 were examined. BDI-II score 0-10 (normal) was found in 284 (68.6%), 11-16 (minimal) in 76 (18.4%), 17-20 (mild) in 24 (5.8%), 21-30 (moderate) in 15 (3.6%), and ≥31 (severe) in 15 (3.6%). The average ± standard deviation BDI-II score in liver cirrhosis (LC) patients (10.2 ± 9.6, n = 152) was significantly higher than that in non-LC patients (7.4 ± 7.2, n = 262) (p = 0.0058). Univariate analysis identified three factors to be significantly associated with BDI-I score ≥11: Our classification (groups of A, B, C, and D) (p = 0.0259), serum albumin (p = 0.0445), and the presence of LC (p = 0.0157). Multivariate analysis revealed that only group A (p = 0.0074, group D as a reference) was significant. In conclusion, sarcopenia can be an independent predictor for depression in CLDs.

Serum Zinc Concentration and Sarcopenia: A Close Linkage in Chronic Liver Diseases.

We sought to investigate the influence of serum zinc (Zn) concentration on sarcopenia in chronic liver diseases (CLDs, n = 372, median age = 65 years, 147 liver cirrhosis (LC) cases (39.5%)). Sarcopenia was defined by low grip strength and low skeletal muscle mass. Study subjects were divided into the following three groups (High-, Intermediate-, and Low-Zn groups) based on the baseline serum Zn level. The impacts of serum Zn concentration on sarcopenia were examined. The median (interquartile range) serum Zn concentration for all cases was 72.85 (63.7, 81.45) µg/dL. The proportions of sarcopenia in the High-Zn, Intermediate-Zn, and Low-Zn groups were 10.75% (10/93), 11.23% (21/187), and 27.17% (25/92), respectively (P = 0.9046 (High vs. Intermediate), P = 0.0007 (Intermediate vs. Low), P = 0.0044 (High vs. Low), overall P value = 0.0009). The median serum Zn concentrations in patients with sarcopenia, pre-sarcopenia, and control were 66.35, 73.1 and 73.8 µg/dL, respectively (P = 0.0234 (sarcopenia vs. pre-sarcopenia), P = 0.2116 (pre-sarcopenia vs. control), P = 0.0002 (sarcopenia vs. control), overall P value = 0.0016). In the multivariate analyses of factors linked to the presence of sarcopenia, Low-Zn was an independent predictor for all cases (P = 0.0236) and LC cases (P = 0.0082). In conclusion, Zn deficiency can be an independent predictor for sarcopenia in patients with CLDs.

Liver fibrosis markers as assessed by ultrasound elastography and serum samples: A large comparative study in hepatitis virus B and C liver diseases.

AIM: We aimed to compare the well-established liver fibrosis (LF) markers in Japanese patients with chronic hepatitis B (CHB, n = 331) and chronic hepatitis C (CHC, n = 886) and to discuss possible causes of differences in results between CHB patients and CHC patients. METHODS: Virtual touch quantification (VTQ) in acoustic radiation force impulse, Fibrosis-4 (Fib-4) index, aspartate aminotransferase to platelet ratio index (APRI), and hyaluronic acid (HA) were compared between the two cohorts. As an additional investigation, total collagen proportional area (TCPA, %) was tested using liver pathological samples (n = 83). RESULTS: Significant LF (F2 or greater) and advanced LF (F3 or greater) were identified in 153 (46.2%) and 76 (23.0%) patients in the CHB cohort and 579 (65.3%) and 396 (44.7%) patients in the CHC cohort. The median VTQ, Fib-4 index, APRI, and HA values in the CHB cohort were 1.20 m/s, 1.36, 0.44, and 25 ng/mL; those in the CHC cohort were 1.32 m/s, 2.60, 0.74, and 65.5 ng/mL (P-values, all <0.0001). Similar tendencies were noted by F stage-based stratification. The median TCPA in the CHB cohort and the CHC cohort were 8.5% and 12.7% (P < 0.0006). The TCPA values in the CHC cohort were higher than those in the CHB cohort regardless of LF stage. CONCLUSION: Values of LF markers in CHB patients can differ from those in CHC patients even in the same LF stage. Difference in total amount of collagen fiber in CHB and CHC appears to be linked to the difference.

Impact of Sustained Virological Response for Gastroesophageal Varices in Hepatitis-C-Virus-Related Liver Cirrhosis.

We aimed to clarify the relationship between sustained virological response (SVR) and gastroesophageal varices (GEVs) progression among hepatitis C virus (HCV)-related liver cirrhosis (LC) patients treated with interferon (IFN)-based therapies (n = 18) and direct-acting antiviral (DAA)-based therapies (n = 37), and LC patients with no SVR (n = 71) who had already developed GEVs. Factors influencing GEVs progression were also examined. During the follow-up period, GEVs progression was observed in 50 patients (39.7%). The 3-year cumulative GEVs progression rates in the DAA-SVR group, the IFN-SVR group, and the non-SVR group were 32.27%, 5.88%, and 33.76%, respectively (overall p value = 0.0108). Multivariate analysis revealed that sex (p = 0.0430), esophageal varices (EVs) F2 or more (p < 0.0001), and DAA-SVR (p = 0.0126, IFN-SVR as a reference) and non-SVR (p = 0.0012, IFN-SVR as a reference) were independent predictors for GEVs progression. The proportion of GEVs progression in patients with no or F1 EVs was significantly lower than that in patients with F2 or F3 EVs (33.9% (38/112) vs. 85.7% (12/14), p = 0.0003). In conclusion, IFN-based therapies can have a favorable impact for preventing GEVs progression in HCV-related LC patients with GEVs. Clinicians should be aware of a point of no return where SVR is no longer capable of avoiding GEVs progression.