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Measles is a highly contagious febrile exanthematous disease caused by the measles virus. The measles virus spreads via airborne and droplet transmission and can cause severe complications, such as pneumonia, [...]

We investigated clinically suspected measles cases that had discrepant real-time reverse transcription PCR (rRT-PCR) and measles-specific IgM test results to determine diagnoses. We performed rRT-PCR and measles-specific IgM testing on samples from 541 suspected measles cases. Of the 24 IgM-positive and rRT-PCR­–negative cases, 20 were among children who received a measles-containing vaccine within the previous 6 months; most had low IgG relative avidity indexes (RAIs). The other 4 cases were among adults who had an unknown previous measles history, unknown vaccination status, and high RAIs. We detected viral nucleic acid for viruses other than measles in 15 (62.5%) of the 24 cases with discrepant rRT-PCR and IgM test results. Measles vaccination, measles history, and contact history should be considered in suspected measles cases with discrepant rRT-PCR and IgM test results. If in doubt, measles IgG avidity and PCR testing for other febrile exanthematous viruses can help confirm or refute the diagnosis.

Background/Aims Metabolic dysfunction-associated steatotic liver disease (MASLD) was recently proposed as an alternative disease concept to nonalcoholic fatty liver disease (NAFLD). We aimed to investigate the prognosis of patients with biopsy-confirmed MASLD using data from a multicenter study. Methods This was a sub-analysis of the Clinical Outcome Nonalcoholic Fatty Liver Disease (CLIONE) study that included 1,398 patients with NAFLD. Liver biopsy specimens were pathologically diagnosed and histologically scored using the NASH Clinical Research Network system, the FLIP algorithm, and the SAF score. Patients who met at least one cardiometabolic criterion were diagnosed with MASLD. Results Approximately 99% of cases (n=1,381) were classified as MASLD. Patients with no cardiometabolic risk (n=17) had a significantly lower BMI than patients with MASLD (20.9 kg/m2 vs. 28.0 kg/m2, P

Abstract Background Atezolizumab plus bevacizumab therapy was recently introduced as the first line for unresectable advanced hepatocellular carcinoma (HCC), but immune-related adverse events (IrAEs) due to atezolizumab are a great concern. Here, we report the case of a patient who developed fatal acquired coagulation factor deficiency after hepatectomy for HCC, treated with atezolizumab and bevacizumab before surgery. Case presentation A 70-year-old man received right trisegmentectomy of the liver with hepaticojejunostomy for advanced HCC with bile duct invasion, after atezolizumab and bevacizumab therapy. The patient suffered the sudden onset of severe multiple coagulation factor deficiency (II, V, VII, VIII, IX, X, XI and XII) immediately following reoperation for anastomotic leakage of hepaticojejunostomy, 7 days after hepatectomy. The coagulation factor deficiency did not reverse even with intensive treatment, and the patient died of uncontrollable bleeding 32 days after hepatectomy. An IrAE due to atezolizumab was suspected because the patient had developed the possible IrAE of enthesitis of the right gastrocnemius muscle before surgery, and specific inhibitors against factor V and anti-factor V autoantibodies were detected, leading to an ultimate diagnosis of autoimmune FV/5 deficiency (AiF5D). Conclusion Severe acquired coagulopathy should be recognized as a possible life-threatening IrAE when using atezolizumab and bevacizumab for HCC.

Background and Aims: Nonalcoholic fatty liver diseases (NAFLD) and nonalcoholic steatohepatitis (NASH) can cause hepatocellular carcinoma (HCC). We examined histological features and reported noninvasive markers/models for stratifying the risk of HCC development in patients with biopsy-proven NAFLD or NASH. Methods: A total of 1389 patients who had a histological diagnosis of NAFLD or NASH based on liver biopsy and underwent regular surveillance for HCC were included. The ability to predict HCC development was compared between histological features including liver fibrosis and NAFLD activity score, and noninvasive markers/models including aMAP (age, male, albumin–bilirubin, and platelet) score, FIB-4 (Fibrosis-4) index, and ALBI (albumin-bilirubin) score calculated at the time of biopsy. Results: The C index of aMAP score was 0.887, which was consistent with the original report, comparable to FIB-4 index (0.878), and higher than those of ALBI score (0.789), histological liver fibrosis (0.723), and NAFLD activity score (0.589). The hazard ratios for HCC development in the aMAP intermediate and high-risk groups were 21.0 (95% confidence interval [CI], 3.6–402.0) and 110.3 (95% CI, 16.3–2251.4), respectively, in comparison to the aMAP score low-risk group. Those in the FIB-4 index moderate- and high-fibrosis groups were 10.3 (95% CI, 1.7–199.8) and 93.1 (95% CI, 16.3–1773.8), respectively, in comparison to the FIB-4 index mild-fibrosis group. No patients in the aMAP score low-risk group developed HCC during the study period. Conclusion: For stratifying the risk of HCC development in patients with biopsy-proven NAFLD or NASH, both aMAP score and FIB-4 index showed high discriminative ability as noninvasive markers, which were superior histological features.

Abstract Flexible p–n thermoelectric generator (TEG) technology has rapidly advanced with power enhancement and size reduction. To achieve a stable power supply and highly efficient energy conversion, absolute chemical stability of n‐type materials is essential to ensuring large temperature differences between device terminals and ambient stability. With the aim of improving the long‐term stability of the n‐type operation of carbon nanotubes (CNTs) in air and water, this study uses cationic surfactants, such as octylene‐1,8‐bis(dimethyldodecylammonium bromide) (12–8–12), a gemini surfactant, to stabilize the nanotubes in a coating, which retains the n‐doped state for more than 28 days after exposure to air and water in experiments. TEGs with 10 p–n units of 12–8–12/CNT (n‐type) and sodium dodecylbenzene sulfonate/CNT (p‐type) layers are manufactured, and their water stability is evaluated. The initial maximum output of 16.1 µW (75 K temperature difference) is retained after water immersion for 40 days without using a sealant to prevent TEG module degradation. The excellent stability of these CNT‐based TEGs makes them suitable for underwater applications, such as battery‐free health monitoring and information gathering systems, and facilitates the development of soft electronics.

Background and Aims: Because the accuracy of the Fibrosis‐4 (FIB‐4) index for predicting liver fibrosis changes with age, the need for different cut‐offs in various age groups has frequently been discussed. We developed the age‐independent score, the Fibrosis‐3 (FIB‐3) index, and have shown its usefulness in patients with metabolic dysfunction‐associated steatotic liver disease (MASLD). This study aimed to validate the diagnostic ability of the FIB‐3 index to predict fibrosis progression using a large new patient cohort. Methods: The ability of the FIB‐3 index to predict liver fibrosis was analyzed by comparing it with that of the FIB‐4 index using data from 1398 patients with MASLD enrolled in the Asia‐based clinical outcome NAFLD study. Results: The areas under the receiver operating characteristic curves for predicting fibrosis stage F3 or higher were not different between the FIB‐3 and FIB‐4 indices in the entire cohort. Using the single ideal cut‐offs of the indices (3.41 for FIB‐3 index and 2.01 for FIB‐4 index), the predictive accuracy of the FIB‐3 index was not significantly different from that of the FIB‐4 index among patients aged <60 years; however, the accuracy of the FIB‐3 index was significantly higher than that of the FIB‐4 index in those aged ≥60 years (0.645 and 0.529, respectively; p < 0.0001). Conclusion: The high ability of the FIB‐3 index with a single cut‐off to predict liver fibrosis in patients with MASLD was confirmed. The FIB‐3 index could serve as a useful tool for assessing liver fibrosis regardless of age. [ABSTRACT FROM AUTHOR]

Abstract We examined the epidemiological trends, including the distribution of sex, age, and disease etiology, in HCC incident cases, over 24 years. Data of 20,547 HCC patients (1996–2019) were analyzed in this prospective study. We divided the study period into four 6-yearly quarters. HCC etiology was categorized as hepatitis B virus (HBV) infection, HBV + hepatitis C virus (HCV) infection, HCV infection, and both negative (non-BC). The incident cases of HCC per quarter of the study period were 4311 (21.0%), 5505 (26.8%), 5776 (28.1%), and 4955 (24.1%), sequentially. Overall, 14,020 (68.2%) patients were male. The number of HCC cases in patients

A true aneurysm is a dilation of the arterial wall that preserves vessel continuity, retains three layers (intima, media, and adventitia), and commonly occurs in the aorta, including the thoracic and abdominal aorta. In contrast, true aneurysms of the external carotid artery and its branches are rare. Among several therapeutic options for true aneurysms, catheter-based embolization is the traditional treatment method. However, parent artery occlusion may not always result in permanent exclusion of the aneurysm from the systemic circulation. Dilation of the vasa vasorum is one of the mechanisms of occlusion recanalization. Herein, we present a rare case of a true aneurysm of the facial artery aneurysm. The patient underwent coil embolization as the initial treatment. Subsequently, surgical resection was performed due to aneurysm regrowth caused by vasa vasorum dilation. Although embolization is a useful and safe treatment option for facial aneurysms, careful follow-up radiological examinations are required because of the possibility of regrowth. [ABSTRACT FROM AUTHOR]

Abstract Once disseminated tumor cells (DTCs) arrive at a metastatic organ, they remain there, latent, and become seeds of metastasis. However, the clonal composition of DTCs in a latent state remains unclear. Here, we applied high-resolution DNA barcode tracking to a mouse model that recapitulated the metastatic dormancy of head and neck squamous cell carcinoma (HNSCC). We found that clones abundantly circulated peripheral blood dominated DTCs. Through analyses of multiple barcoded clonal lines, we identified specific subclonal population that preferentially generated homotypic circulating tumor cell (CTC) clusters and dominated DTCs. Despite no notable features under static conditions, this population significantly generated stable cell aggregates that were resistant to anoikis under fluid shear stress (FSS) conditions in an E-cadherin-dependent manner. Our data from various cancer cell lines indicated that the ability of aggregate-constituting cells to regulate cortical actin-myosin dynamics governed the aggregates’ stability in FSS. The CTC cluster-originating cells were characterized by the expression of a subset of E-cadherin binding factors enriched with actin cytoskeleton regulators. Furthermore, this expression signature was associated with locoregional and metastatic recurrence in HNSCC patients. These results reveal a biological selection of tumor cells capable of generating FSS-adaptive CTC clusters, which leads to distant colonization.

The relationship between baseline serum albumin level and long-term prognosis of patients with nonalcoholic fatty liver disease (NAFLD) remains unknown. This is a sub-analysis of the CLIONE (Clinical Outcome Nonalcoholic Fatty Liver Disease) study. The main outcomes were: death or orthotopic liver transplantation (OLT), liver-related death, and liver-related events (hepatocellular carcinoma [HCC], decompensated cirrhosis, and gastroesophageal varices/bleeding). 1383 Japanese patients with biopsy-confirmed NAFLD were analyzed. They were divided into 3 groups based on serum albumin: high (>4.0 g/dL), intermediate (3.5–4.0 g/dL), and low (p < 0.001; low vs. high albumin group: HR 22.9, 95% CI 8.21–63.9, p < 0.001). Among biopsy-confirmed NAFLD patients, those with intermediate or low serum albumin had a significantly higher risk of death or OLT than those with high serum albumin.

Summary: Aims: A multi‐stakeholder consensus has proposed MASLD (metabolic dysfunction‐associated steatotic liver disease). We aimed to investigate the pathological findings related to the mid‐term mortality of patients with biopsy‐proven MASLD in Japan. Methods: We enrolled 1349 patients with biopsy‐proven MASLD. The observational period was 8010 person years. We evaluated independent factors associated with mortality in patients with MASLD by Cox regression analysis. We also investigated pathological profiles related to mortality in patients with MASLD using data‐mining analysis. Results: The prevalence of MASH and stage 3/4 fibrosis was observed in 65.6% and 17.4%, respectively. Forty‐five patients with MASLD died. Of these, liver‐related events were the most common cause at 40% (n = 18), followed by extrahepatic malignancies at 26.7% (n = 12). Grade 2/3 lobular inflammation and stage 3/4 fibrosis had a 1.9‐fold and 1.8‐fold risk of mortality, respectively. In the decision‐tree analysis, the profiles with the worst prognosis were characterised by Grade 2/3 hepatic inflammation, along with advanced ballooning (grade 1/2) and fibrosis (stage 3/4). This profile showed a mortality at 8.3%. Furthermore, the random forest analysis identified that hepatic fibrosis and inflammation were the first and second responsible factors for the mid‐term prognosis of patients with MASLD. Conclusions: In patients with biopsy‐proven MASLD, the prevalence of MASH and advanced fibrosis was approximately 65% and 20%, respectively. The leading cause of mortality was liver‐related events. Hepatic inflammation and fibrosis were significant factors influencing mid‐term mortality. These findings highlight the importance of targeting inflammation and fibrosis in the management of patients with MASLD. [ABSTRACT FROM AUTHOR]

Abstract Despite advancements in treatments, oral squamous cell carcinoma (OSCC) has not significantly improved in prognosis or survival rate primarily due to the presence of treatment‐resistant OSCC. The intercellular communication between tumour cells is a molecular mechanism involved in acquiring OSCC treatment resistance. Extracellular vesicles (EVs) and encapsulated miRNAs are important mediators of intercellular communication. Here, we focused on EVs released from clinically relevant radioresistant (CRR) OSCC cells. Additionally, we evaluated the correlation between miRNA expression in the serum samples of patients who showed resistance to radiotherapy and in EVs released from CRR OSCC cells. We found that EVs released from CRR OSCC cells conferred radioresistance to radiosensitive OSCC cells via miR‐503‐3p contained in EVs. This miR‐503‐3p inhibited BAK and impaired the caspase cascade to suppress radiation‐induced apoptosis. Furthermore, OSCC cells with BAK knockdown had increased radioresistance. Additionally, the expression of circulating miR‐503‐3p in patients with OSCC was correlated with a poor treatment response and prognosis of radiotherapy. Our results provide new insights into the relationship between EVs and the radioresistance of OSCC and suggest that the miR‐503‐3p–BAK axis may be a therapeutic target and that circulating miR‐503‐3p is a useful prognostic biomarker in the radiotherapy of OSCC.

This study aimed to reveal the prevalence of heat‐labile enterotoxin (LT) gene‐positive Escherichia fergusonii in retail chicken meat and genetically characterize these strains. E. fergusonii harboring LT gene was isolated from 6 out of 60 (10%) retail chicken samples in Okinawa, Japan. Whole‐genome sequencing analysis revealed that LT gene‐positive E. fergusonii from chicken meat and feces contain an IncFII plasmid harboring elt1AB, and suggested to spread clonally to retail chicken through fecal contamination. Additionally, it was found that these strains harbor multidrug‐resistant genes on their plasmids. Their pathogenicity and continuous monitoring are required for confirmation. [ABSTRACT FROM AUTHOR]

We analyzed a mechanism to alleviate aggressions on computer mediated communications. A title that supposedly reflects the user's behavior or status, such as calm, expert, optimist, or aggressive is displayed on the screen. Two types of title generation, title reflecting and not reflecting exact aggression level, are compared to the case without title using laboratory experiments, where participants select comments to be posted after reading the topics of discussion and other participants' comments. The results indicate that displaying a title that is unrelated to the aggressiveness of comments posted by the user is equivalent to displaying a title based on accurately calculated aggression level of comments. Therefore, simply displaying their titles to users is effective to reduce aggressiveness of their comments in pseudonym type computer mediated communications.

Abstract Background Essential thrombocythemia (ET) is a myeloproliferative disorder characterized by thrombocytosis and a propensity for both thrombotic and hemorrhagic events. ET rarely occurs simultaneously with colorectal cancer. Here, we report a case of colorectal cancer in an ET patient treated using laparoscopic ileocecal resection. Case presentation A 40-year-old woman was admitted to our hospital after presenting with liver dysfunction. She had been previously diagnosed with ET; aspirin and anagrelide had been prescribed. Subsequent examination at our hospital revealed cecal cancer. Distant metastasis was absent; laparoscopic ileocecal resection was performed. Anagrelide was discontinued only on the surgery day. She was discharged on the seventh postoperative day without thrombosis or hemorrhage. However, when capecitabine and oxaliplatin were administered as adjuvant chemotherapy with continued anagrelide administration, she experienced hepatic dysfunction and thrombocytopenia; thus, anagrelide was discontinued. Five days later, her platelet count recovered. Subsequently, anagrelide and aspirin administration was resumed, without any adjuvant chemotherapy. Her liver function normalized gradually in 4 months. One-year post operation, she is well without tumor recurrence or new metastasis. Conclusions To our knowledge, this is the first report of laparoscopic colectomy performed on an ET patient receiving anagrelide. Our report shows that complications such as bleeding or thrombosis can be avoided by anagrelide administration. Contrastingly, thrombocytopenia due to anagrelide intake should be considered when chemotherapy that could cause bone marrow suppression is administered.

Abstract Background Previous studies have suggested an association between the use of direct‐acting antiviral agents (DAAs) for treating hepatitis C virus (HCV) infection and the resulting decrease in the incidence of hepatocellular carcinoma (HCC); however, it is unclear whether DAAs prevent the recurrence of HCC after curative treatment for HCC. This study aimed to prospectively investigate HCC recurrence and its predictors after curative treatment for HCC. Methods A total of 3012 patients with chronic HCV infection, with or without cirrhosis, who were treated with DAAs were enrolled between January 1, 2015 and January 31, 2017 as per the institutional review board approved study protocol at 15 institutions, including 10 university hospitals and five high‐volume centers in the Kyusyu area of Japan. Of the 3012 patients, 459 patients who had HCC but were cured with surgery or ablation therapy (curative treatment) before the use of DAAs were included in the analysis. Results During a mean follow‐up period of 29.4 months, 217 (47.2%) patients developed HCC recurrence. The median time to recurrence was 34.0 months, and the 1‐, 2‐, and 3‐year cumulative HCC recurrence rates were 27.1%, 43.4%, and 50.8%, respectively. The risk factors for HCC recurrence were the α‐fetoprotein (AFP) level before DAA therapy (P = 0.0047) and the number of curative treatments for HCC before DAA therapy (P

The case is presented of a 29-year-old primiparous woman who was COVID-19-positive at 34 weeks of gestation and who developed severe acute respiratory distress syndrome. After a four-day history of fever and mild dyspnea, she was referred to hospital. Ciclesonide, dexamethasone, heparin sodium, and sulbactam/ampicillin were initiated, followed by remdesivir and tocilizumab. On the fourth day after admission (at 34 weeks 5 days of gestation), respiratory failure required ventilator management. An emergency cesarean section was performed and a 2565-g male infant was delivered with an Apgar score of 8/8 and negative COVID-19 status. However, on the following day the patient's respiratory condition deteriorated and mechanical ventilation was initiated. Subsequently, her respiratory condition quickly improved and mechanical ventilation was terminated 4 days after intubation. She was discharged 12 days after cesarean delivery. Our case provides additional evidence that raises concerns regarding the unfavorable maternal consequences of COVID-19 infection during pregnancy.

Describing phenomena of interest as a system is valuable because system science methodologies are applicable for the analysis. This paper presents a model to describe and analyze phenomena which present (1) no definable boundaries, (2) multiple hierarchical levels, and (3) necessity of diverse viewpoints to understand the phenomena. The proposed framework, the hypernetwork model, is applied to describe the lifestyle disease and the music composition process. The hypernetwork model homogenizes boundaries, hierarchical levels, and different viewpoints to be treated as instances of relationship.

Hepatitis C virus (HCV) infection is frequently associated with various extrahepatic manifestations, such as autoimmune features and immune complex deposit diseases. Oral lichen planus (OLP) is one such extrahepatic manifestation of HCV infection. Recently, direct-acting antivirals (DAA) have proved to be highly effective and safe for the eradication of HCV. Herein, we report a case of OLP accompanied by HCV-related hepatocellular carcinoma (HCC) that disappeared after liver transplantation and achievement of sustained virological response following interferon (IFN)-free treatment with ledipasvir (LDV) and sofosbuvir (SOF). The 50-year-old patient developed erosive OLP during IFN therapy, with hyperthyroidism at 53 years of age and HCC at 55 years. He received immunosuppressive drugs and IFN-free DAA treatment after liver transplantation at 60 years of age, which led to disappearance of the symptoms of OLP. The patient was treated safely and effectively with LDV/SOF, although it is not known whether the disappearance of OLP resulted from the eradication of HCV or the immunosuppressive therapy.

Aim: The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing worldwide. The aim of this study was to determine the recent prevalence and clinical characteristics of NAFLD in Japan. Methods: This study initially included 410 061 retrospectively enrolled adults from the medical health checkup registry for metabolic syndrome, chronic kidney disease, and fatty liver in Japan (MIRACLE‐J; UMIN‐CTR no. UMIN000049419), who were evaluated between 2014 and 2018 at 13 health centers in Japan. Individuals consuming >20 g of alcohol/day or with chronic liver disease were excluded. Fatty liver was diagnosed by ultrasonography. The probability of NAFLD with advanced fibrosis was estimated based on the fibrosis‐4 index and NAFLD fibrosis score. Results: A total of 71 254 participants were included in the final analysis. The overall prevalence of NAFLD was 25.8%. There was a significant, twofold difference in NAFLD prevalence between men (37.4%) and women (18.1%). Nonalcoholic fatty liver disease prevalence increased linearly with body mass index, triglycerides, and low‐density lipoprotein cholesterol regardless of threshold values, even in the absence of obesity. Among patients with NAFLD, 14% had diabetes mellitus, 31% had hypertension, and 48% had dyslipidemia. The estimated prevalence of NAFLD with advanced fibrosis was 1.7% and 1.0% according to the fibrosis‐4 index and NAFLD fibrosis score, respectively. Conclusions: The prevalence of NAFLD was approximately one‐quarter of the general population in Japan. There was a linear relationship between NAFLD prevalence and various metabolic parameters, even in nonobese participants. The prevalence of NAFLD with advanced fibrosis was estimated to be 1%–2%. [ABSTRACT FROM AUTHOR]

In this study, we evaluated the performance of low Global Warming Potential (GWP) refrigerant R1234yf on the activated carbon (MSC-30) for adsorption heating applications. The adsorption isotherms of MSC-30/R1234yf were measured using a constant-volume–variable-pressure (CVVP) method from very low relative pressure to the practical operating ranges. The data were fitted with several isotherm models using non-linear curve fitting. An improved equilibrium model was employed to investigate the influence of dead thermal masses, i.e., the heat exchanger assembly and the non-adsorbing part of the adsorbent. The model employed the model for the isosteric heat of adsorption where the adsorbed phase volume was accounted for. The performance of the heat pump was compared with MSC-30/R134a pair using the data from the literature. The analysis covered the desorption temperature ranging from 60 °C to 90 °C, with the evaporation temperature at 5 °C and the adsorption temperature and condensation temperature set to 30 °C. It was observed that the adsorption isotherms of R1234yf on MSC-30 were relatively lower than those of R134a by approximately 12%. The coefficient of performance (COP) of the selected pair was found to vary from 0.03 to 0.35 depending on the heat source temperature. We demonstrated that due to lower latent heat, MSC-30/R1234yf pair exhibits slightly lower cycle performance compared to the MSC-30/R134a pair. However, the widespread adaptation of environmentally friendly R1234yf in automobile heat pump systems may call for the implementation of adsorption systems such as the direct hybridization using a single refrigerant. The isotherm and performance data presented in this work will be essential for such applications.

This paper reports the results of a survey that investigated the practice and experience of task management of university students. A total of 202 tasks identified by 24 university students were analyzed. The results suggest that participants had a reasonable sense of priority of tasks, that they tend to perceive a task as a big chunk, not a series of small chunks, that estimated time can be a good indicator of task completion, that time management and loss of coordination are the major factors for uncompleted or non-started tasks, and finally that their notion of task grouping was dominated by task themes or topics.

Background and Aims: Both fibrosis status and body weight are important for assessing prognosis in nonalcoholic fatty liver disease (NAFLD). The aim of this study was to identify population clusters for specific clinical outcomes based on fibrosis‐4 (FIB‐4) index and body mass index (BMI) using an unsupervised machine learning method. Methods: We conducted a multicenter study of 1335 biopsy‐proven NAFLD patients from Japan. Using the Gaussian mixture model to divide the cohort into clusters based on FIB‐4 index and BMI, we investigated prognosis for these clusters. Results: The cohort consisted of 223 cases (16.0%) with advanced fibrosis (F3–4) as assessed from liver biopsy. Median values of BMI and FIB‐4 index were 27.3 kg/m2 and 1.67. The patients were divided into four clusters by Bayesian information criterion, and all‐cause mortality was highest in cluster d, followed by cluster b (P = 0.001). Regarding the characteristics of each cluster, clusters d and b presented a high FIB‐4 index (median 5.23 and 2.23), cluster a presented the lowest FIB‐4 index (median 0.78), and cluster c was associated with moderate FIB‐4 level (median 1.30) and highest BMI (median 34.3 kg/m2). Clusters a and c had lower mortality rates than clusters b and d. However, all‐cause of death in clusters a and c was unrelated to liver disease. Conclusions: Our clustering approach found that the FIB‐4 index is an important predictor of mortality in NAFLD patients regardless of BMI. Additionally, non‐liver‐related diseases were identified as the causes of death in NAFLD patients with low FIB‐4 index. [ABSTRACT FROM AUTHOR]

The components of children's trust in same-gender peers (trust beliefs, ascribed trustworthiness, and dyadic reciprocal trust) were examined in samples of 8-11-year-olds from the UK, Italy, and Japan. Trust was assessed by children's ratings of the extent to which same-gender classmates kept promises and kept secrets. Social relations analyses confirmed that children from each country showed significant: (a) actor variance demonstrating reliable individual differences in trust beliefs, (b) partner variance demonstrating reliable individual differences in ascribed trustworthiness, and (c) relationship variance demonstrating unique relationships between interaction partners. Cultural differences in trust beliefs and ascribed trustworthiness also emerged and these differences were attributed to the tendency for children from cultures that value societal goals to share personal information with the peer group.

Background and Aims: Noninvasive tests (NITs) have prognostic potential, but whether NITs are comparable with liver biopsy is unclear. This study aimed to examine the prognostic accuracy of NITs for liver‐related mortality (LRM) and events (LREs) in patients with biopsy‐proven nonalcoholic fatty liver disease (NAFLD). Methods: We investigated 1313 patients with NAFLD. Patients were assigned to low‐risk, indeterminate‐risk, and high‐risk groups using conventional cutoff values of each FIB‐4 and NAFLD fibrosis score (NFS) and to stage 0–2 and stage 3–4 groups using the fibrosis stage. Survival and Cox regression analyses of the prognostic potential of NITs for LRM/LREs were conducted. Results: During a median follow‐up of 4.5 years, regarding to FIB‐4, the incidence rate (/1000 person‐years) in the low risk was zero for LRM and 0.5 for LREs. In contrast, the rate in stage 0–2 was 1.3 for LRM and 2.8 for LRE. The adjusted hazard ratios (aHRs) for LREs in the high risk compared with the low risk were 32.85 (P < 0.01). The aHRs in stage 3–4 compared with stage 0–2 were 2.68 (P = 0.02) for LREs and 2.26 (P = 0.582) for LRM. In the same fibrosis stage, the incidence of LRM/LREs was more frequent with a higher risk stratification. The same trend was observed for NFS. Conclusions: NITs accurately predict LRM and LREs as well as a liver biopsy in Japanese patients with NAFLD. Patients in the low risk may not require close follow‐up for at least 5 years. The simple NITs could be an acceptable alternative method to performing a liver biopsy for the prognosis of NAFLD. [ABSTRACT FROM AUTHOR]

The relationship between baseline serum albumin level and long-term prognosis of patients with nonalcoholic fatty liver disease (NAFLD) remains unknown. This is a sub-analysis of the CLIONE (Clinical Outcome Nonalcoholic Fatty Liver Disease) study. The main outcomes were: death or orthotopic liver transplantation (OLT), liver-related death, and liver-related events (hepatocellular carcinoma [HCC], decompensated cirrhosis, and gastroesophageal varices/bleeding). 1383 Japanese patients with biopsy-confirmed NAFLD were analyzed. They were divided into 3 groups based on serum albumin: high (>4.0 g/dL), intermediate (3.5–4.0 g/dL), and low (<3.5 g/dL). Unadjusted hazard ratio [HR] of the intermediate albumin group, compared with the high albumin group, were 3.6 for death or OLT, 11.2 for liver-related death, 4.6 for HCC, 8.2 for decompensated cirrhosis, and 6.2 for gastroesophageal varices (all risks were statistically significant). After adjusting confounding factors, albumin remained significantly associated with death or OLT (intermediate vs. high albumin group: HR 3.06, 95% confidence interval [CI] 1.59–5.91, p < 0.001; low vs. high albumin group: HR 22.9, 95% CI 8.21–63.9, p < 0.001). Among biopsy-confirmed NAFLD patients, those with intermediate or low serum albumin had a significantly higher risk of death or OLT than those with high serum albumin. [ABSTRACT FROM AUTHOR]