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Currently, the most frequently studied, adapted and management concepts and tools adopted belong to the US management. and Japan, so the U.S. became the current world leader again Japan is quite developed. The reason lies in the fact that companies in Japan and the United States are characterized by the highest competitiveness. Next, we will try a review of a general characteristics of Japanese and American management and culture, including similarities and the differences between them.

Background: The diagnosis of NASH needs a liver biopsy, an invasive procedure that is not frequently accepted by patients. The aim of our study was to evaluate the efficacy of the 13C-Octanoate breath test (OBT) as a non-invasive surrogate marker to differentiate patients with NASH from patients with simple steatosis (NAFL). Methods: We performed a prospective study on patients with histologically established non-alcoholic steatohepatitis and no other hepatic disease. Each patient underwent a testing protocol, which included a clinical exam, laboratory blood tests, standard abdominal ultrasound, and a 13C-Octanoate breath test. Results: The study group included: 82 patients with steatohepatitis, 64 patients with simple steatosis, and 21 healthy volunteers. The univariate and bivariate analysis identified that significant values were the percent dose recovery (PDR) at 15 min—r = 0.65 (AUROC = 0.902) and cumulative percent dose recovery (cPDR) at 120 min—r = 0.69 (AUROC = 0.899). Discussion: Our study showed that 13C-OBT had good efficacy for identifying patients with NASH from those with NAFL (steatosis alone) but not those with NAFL from healthy subjects. Considering all these pathogenic steps in NASH we considered that OBT could have the clinical utility to identify patients at risk for NASH, especially “fast progressors”.