摘要
Non-alcoholic fatty liver disease (NAFLD) is accepted as a counterpart to alcohol-related liver disease because it is defined as hepatic steatosis without excessive use of alcohol. However, the definition of moderate alcohol consumption, as well as whether moderate alcohol consumption is beneficial or detrimental, remains controversial. In this review, the findings of clinical studies to date with high-quality evidence regarding the effects of moderate alcohol consumption in NAFLD patients were compared and summarized.
摘要
Objective@#A deep learning-based classification system (DLCS) which uses structural brain magnetic resonance imaging (MRI) to diagnose Alzheimer’s disease (AD) was developed in a previous recent study. Here, we evaluate its performance by conducting a single-center, case-control clinical trial. @*Methods@#We retrospectively collected T1-weighted brain MRI scans of subjects who had an accompanying measure of amyloid-beta (Aβ) positivity based on a 18F-florbetaben positron emission tomography scan. The dataset included 188 Aβ-positive patients with mild cognitive impairment or dementia due to AD, and 162 Aβ-negative controls with normal cognition. We calculated the sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) of the DLCS in the classification of Aβ-positive AD patients from Aβ-negative controls. @*Results@#The DLCS showed excellent performance, with sensitivity, specificity, positive predictive value, negative predictive value, and AUC of 85.6% (95% confidence interval [CI], 79.8–90.0), 90.1% (95% CI, 84.5–94.2), 91.0% (95% CI, 86.3–94.1), 84.4% (95% CI, 79.2–88.5), and 0.937 (95% CI, 0.911–0.963), respectively. @*Conclusion@#The DLCS shows promise in clinical settings where it could be routinely applied to MRI scans regardless of original scan purpose to improve the early detection of AD.
摘要
Background/Aims@#Several treatment options are currently available for patients with hepatocellular carcinoma (HCC) failing previous sorafenib treatment. We aimed to compare the effectiveness of regorafenib and nivolumab in these patients. @*Methods@#Consecutive HCC patients who received regorafenib or nivolumab after failure of sorafenib treatment were included. Primary endpoint was overall survival (OS) and secondary endpoints were time to progression, tumor response rate, and adverse events. Inverse probability of treatment weighting (IPTW) using the propensity score was conducted to reduce treatment selection bias. @*Results@#Among 150 study patients, 102 patients received regorafenib and 48 patients received nivolumab. Median OS was 6.9 (95% confidence interval [CI], 3.0–10.8) months for regorafenib and 5.9 (95% CI, 3.7–8.1) months for nivolumab (P=0.77 by log-rank test). In multivariable analysis, nivolumab was associated with prolonged OS (vs. regorafenib: adjusted hazard ratio [aHR], 0.54; 95% CI, 0.30–0.96; P=0.04). Time to progression was not significantly different between groups (nivolumab vs. regorafenib: aHR, 0.82; 95% CI, 0.51–1.30; P=0.48). HRs were maintained after IPTW. Objective response rates were 5.9% and 16.7% in patients treated with regorafenib and nivolumab, respectively (P=0.04). @*Conclusions@#After sorafenib failure, the use of nivolumab may be associated with improved OS and better objective response rate as compared to using regorafenib.
摘要
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.
摘要
Reducing caloric intake is important for weight loss and obesity; a reduction of ~500-700 kcal/day has been recommended previously. However, only a minority of individuals can successfully sustain such a reduced caloric intake. Therefore, many specialized diet programs have been proposed. Until now, many experts have recommended low-fat diets in various countries, but very-low-carbohydrate diets have recently garnered attention in Korea. The various effects of changing the dietary compositions of macro- and micronutrients have been debated. The majority of large-scale studies have demonstrated that total caloric intake, rather than the composition of macronutrients or the consumption of a specialized diet, is important for successful weight loss. While many cross-sectional studies have investigated specialized diet programs for patients with non-alcoholic liver disease, no randomized controlled studies have been performed, except for some that investigated the effect of high consumption of unsaturated fatty acids as part of the Mediterranean diet.
Subject(s)
Humans , Cross-Sectional Studies , Diet , Diet, Fat-Restricted , Diet, Mediterranean , Energy Intake , Fatty Acids, Unsaturated , Korea , Liver Diseases , Micronutrients , Non-alcoholic Fatty Liver Disease , Obesity , Weight Loss摘要
Hepatocellular carcinoma (HCC) is one of the most common life-threatening cancers worldwide. Recently, many patients with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) have progressed to HCC even in the absence of cirrhosis. As the morbidity of metabolic syndrome increases, the proportion of HCC associated with NAFLD is expected to increase gradually. A new mechanism for the development of HCC in NAFLD has been identified; Diabetes mellitus, insulin resistance, obesity, lipotoxicity, gut dysbiosis are risk factors. Inflammatory cytokines such as adipokines, leptin, tumor necrosis factor-α, interlukin-8, nuclear factor-κB constitute dysplasia-carcinoma sequence. At the time of diagnosis, NAFLD/NASH related HCC tend to progress to larger and in advanced tumor-node-metastasis stages compared to viral hepatitis related HCC. But there are no guidelines for early detection of NAFLD-related HCC. So, it is essential to study the screening program for the early detection of NAFLD-related HCC and precise methods for NAFLD.
Subject(s)
Humans , Adipokines , Carcinoma, Hepatocellular , Cytokines , Diabetes Mellitus , Diagnosis , Dysbiosis , Fatty Liver , Fibrosis , Hepatitis , Insulin Resistance , Leptin , Mass Screening , Metabolic Syndrome , Necrosis , Non-alcoholic Fatty Liver Disease , Obesity , Risk Factors摘要
Emphysematous gastritis is a rare disorder characterized by emphysematous change of the gastric wall due to infection with a gas-forming organism. Acute necrotizing esophagitis is a rare disorder with an unknown pathogenesis. Above two disorders rarely occur together, only three global cases have been reported to date. Such a case has never been reported in Korea, we report a novel case of severe emphysematous gastritis with concomitant portal venous air and acute necrotizing esophagitis in type 1 diabetes presenting with diabetic ketoacidosis. A 24-year-old man known to have type 1 diabetes and pulmonary tuberculosis was brought to the emergency room for epigastric pain with vomiting. His body mass index was 14.7, and the laboratory findings demonstrated leukocytosis and acidosis, as well as elevated serum glucose, ketone, and C-reactive protein levels. Enhanced computed tomography showed portal vein gas and edematous wall thickening without enhancement in the stomach wall, with air density along the stomach and esophageal wall. The patient required surgical intervention of total gastrectomy and cervical esophagostomy followed by esophagocolostomy and esophageal reconstruction. Early radiologic diagnosis and clinical suspicion of this disease and prompt intervention including antibiotics, decompression, and surgery are important for a good prognosis.
Subject(s)
Humans , Young Adult , Acidosis , Anti-Bacterial Agents , Blood Glucose , Body Mass Index , C-Reactive Protein , Decompression , Diabetic Ketoacidosis , Diagnosis , Emergency Service, Hospital , Esophagitis , Esophagostomy , Gastrectomy , Gastritis , Korea , Leukocytosis , Portal Vein , Prognosis , Stomach , Tuberculosis, Pulmonary , Vomiting摘要
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.
Subject(s)
Cardiovascular Diseases , Diet , Insulin Resistance , Insulin , Sodium摘要
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.
Subject(s)
Humans , Biomarkers/analysis , Chenodeoxycholic Acid/analogs & derivatives , Clinical Trials as Topic , Fatty Liver/diagnosis , Fibrosis , Liver/diagnostic imaging , Magnetic Resonance Imaging , Non-alcoholic Fatty Liver Disease/diagnosis , Tomography, X-Ray Computed , Ultrasonography , Vitamin E/therapeutic use摘要
Development of transfusion-related acute lung injury (TRALI), a non-cardiogenic pulmonary edema, after blood transfusion, is a rare but potentially leading cause of mortality from blood transfusion. We report on a case of TRALI in a 51-year male with acute calculous cholecystitis and liver cirrhosis. As preoperative treatment, he was given ten units of fresh frozen plasma (FFP) for 3 days before the operation. During the transfusion of the 10th unit of FFP, he experienced a sudden onset of hemoptysis, tachypnea, tachycardia, and cyanosis. Bilateral pulmonary infiltration not observed on the chest X-ray at the visit was newly developed. There was no evidence of volume overload but severe hypoxemia. Blood transfusion was stopped and he recovered fully after 8 days of oxygen therapy through a nasal cannula. Although HLA and HNA antibodies were not detected in the donor's blood, HLA antibodies (A2, B57, B58) were detected in the patient's blood. We reported this meaningful case of TRALI that occurred after transfusion of only fresh frozen plasma which did not contain human leukocyte antibody in a patient with HLA antibody.
Subject(s)
Humans , Male , Acute Lung Injury , Hypoxia , Antibodies , Blood Transfusion , Catheters , Cholecystitis , Cyanosis , Hemoptysis , Leukocytes , Liver Cirrhosis , Mortality , Oxygen , Plasma , Pulmonary Edema , Tachycardia , Tachypnea , Thorax摘要
Papular mucinosis (PM, scleromyxoedema) is a rare dermatologic disease. It is histologically characterized by a focal dermal deposit of mucin within the skin. Although PM is accepted as an idiopathic disease in most cases, some authors argued that it may be a cutaneous manifestation of a systemic disease. Here, we describe a 68-year-old male kidney transplantation recipient with a complaint of intractable itching sensation on the forehead. We diagnosed the skin lesions as PM, which were improved after cyclosporine dose reduction.