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The real-world efficacy of sofosbuvir/velpatasvir treatment for patients with hepatitis C virus-related decompensated cirrhosis is unclear. We aimed to identify factors that improve liver functional reserve after treatment.This was a multicenter retrospective study of 12-week sofosbuvir/velpatasvir treatment. A total of 48 patients with Child-Pugh (CP) class B or C were enrolled at 11 institutions. We evaluated changes in liver functional reserve at 24 weeks post-treatment.At baseline, 40 and eight patients were CP class B and C, respectively. The overall rate of sustained virologic response 12 weeks post-treatment was 95.8% (46/48). Serum albumin, alanine aminotransferase and α-fetoprotein levels, and the FIB-4 index were significantly improved post-treatment (P 0.05). Among patients who achieved sustained virologic response 12 weeks post-treatment, those with CP class A increased from 0 to 24 patients (56%) at 24 weeks post-treatment. In multivariate analysis, body mass index (BMI) ≥25 was an independent factor that inhibited CP class improvement (P 0.05). In decision tree analysis, after treatment, the initial divergent variable for CP class improvement was hepatic encephalopathy, followed by serum sodium level and BMI.Sofosbuvir/velpatasvir treatment improved the liver functional reserve in patients with hepatitis C virus-related decompensated cirrhosis at 24 weeks post-treatment. However, BMI ≥25 inhibited improvement in CP class. Additionally, decision tree analysis revealed that a combination of hepatic encephalopathy, serum sodium levels, and BMI were diversity profiles associated with no improvement in liver functional reserve after the treatment.

Sodium glucose cotransporter‐2 inhibitors (SGLT2is) are now widely used to treat diabetes, but their effects on nonalcoholic fatty liver disease (NAFLD) remain to be determined. We aimed to evaluate the effects of SGLT2is on the pathogenesis of NAFLD. A multicenter, randomized, controlled trial was conducted in patients with type 2 diabetes with NAFLD. The changes in glycemic control, obesity, and liver pathology were compared between participants taking ipragliflozin (50 mg/day for 72 weeks; IPR group) and participants being managed without SGLT2is, pioglitazone, glucagon‐like peptide‐1 analogs, or insulin (CTR group). In the IPR group (n = 25), there were significant decreases in hemoglobin A1c (HbA1c) and body mass index (BMI) during the study (HbA1c, −0.41%, P, In the randomized controlled trial, long‐term ipragliflozin treatment ameliorates hepatic outcomes, including fibrosis, in patients with type 2 diabetes with NAFLD. Ipragliflozin also ameliorates obesity and glycemic control in patients with type 2 diabetes with NAFLD.

This study examines the effect of gender on marketing efficiency among maize producing households using data collected in the Dawuro zone, southern Ethiopia. Results indicate that the amount of maize assigned to the first ranked (most efficient) channel for male, female and joint decision-making households is significantly larger than that of the second, third, and fourth ranked channels, respectively. Significant results vary across gender categories at the same stage of marketing channel. Female decision-making households receive a lower producer price, as well as cover higher marketing costs and margins of middlemen, as compared to male and joint decision-makers at the same stage of the marketing channel. This study also found a limited financial ability for local institutions to establish maize storages in the study area. There is a need for an integrated agricultural marketing information system that would help female decision-making maize producers to better engage in available market opportunities.

Inspired by the use of rift-sawn softwood board for covering curved surfaces in Kokerabuki, a traditional Japanese roofing method, we investigated the flexural anisotropy of wood caused by its end-grain orientation. We measured the flexural displacement of softwood species, Chamaecyparis obtusa and Cryptomeria japonica, and hardwood species, Populus suaveolens and Cerasus serrulata. For the softwood species, this was approximately five times longer for the rift-sawn specimens than for the other grain patterns. Using the replica method to measure the softwood tracheid deformation with different flexural displacements, we confirmed the different deformation mechanisms of the tracheid in the flat- and quarter-sawn specimens, and rift-sawn specimens. In the flat- and quarter-sawn woods, on-axis loading was generated, in which the stress was concentrated on the radial and tangential cell walls parallel to the direction of tension or compression. By contrast, in the rift-sawn wood, off-axis loading was generated, in which the stress was evenly distributed throughout the corner cell walls without the wall directly resisting the tensile and compressive forces. We also concluded that the tapered shape of the tracheid walls contributes to the excellent flexibility of rift-sawn softwood.

Using primary data collected from 560 farm households in Dawuro zone, southern Ethiopia, this study analyzes the gender gaps in food security among male, female, and joint decision-making farm households. It examines the factors inducing gender gaps among the households of those three categories. The results show that female decision-making households have a lower probability of ensuring food-security and a higher probability of being transitionally and chronically food-insecure. Joint decision-making households showed a higher probability of falling into the chronically food-insecure category. The decomposition results show significant gender gaps between male and female decision-making households in terms of food-secure, transitory food-insecure, and chronically food-insecure categories. Overall, both the endowment and return effects account for the gaps; however, the magnitude of the effect from the return is higher than from the endowment on significant gaps in the food-secure, transitory, and chronically food-insecure categories. Hence, there is a need for policies that not only ensure equal levels of productive resources but also help households build their capacity in order to improve both transitory and chronically food insecure situations.

This paper examines the land grab processes dominated by a domestic state-owned enterprise in Vietnam. We examine the case of a rubber plantation in an ethnic minority area in the Northwest of the country. In doing so, the paper seeks to address how the Vietnamese socialist State – often considered a ‘strong state’ because it has pursued egalitarian land distribution policies over the past three decades – proceeds with domestic land grabbing in a context where the local people follow customary land use practices. The field research revealed the following. First, the Vietnamese government, while maintaining land distribution policies for its rural farming population, has increasingly sought to bring these policies more in line with the global trend of large-scale land acquisition at the expense of the traditional interests and livelihoods of the local population. By seeking to justify their essentially non-egalitarian land grab processes through the policy of post-land grab ‘egalitarian land re-distributions’ in areas with disembedded customary control, the domestic state actors deployed a cunning duplicity in their persistent adherence to agrarian egalitarianism. Second, with the supports from the local and central governments, a state-owned enterprise named Vietnam Rubber Group, carved out its land grab processes with more freedom, leverage, and power than similar firms investing abroad through land concessions. Last, the post-land grab redistribution of land rights materializes state formation through re-territorialization of and re-legalization within the frontier zone.

Liver fibrosis is associated with lifestyle-related diseases, including diabetes. The identification of diabetic patients with severe liver fibrosis is important, but a simple and reliable diagnostic procedure remains to be determined. We conducted an observational study to evaluate the performance of a FIB-4 index-based screening strategy for the diagnosis of advanced liver fibrosis in patients with diabetes or prediabetes. Two hundred and forty-two patients underwent abdominal imaging in our Study. According to the abdominal imaging findings, fatty liver, liver cirrhosis, and hepatocellular carcinoma were defined, and their association with FIB-4 index evaluated. The prevalences of liver cirrhosis and hepatocellular carcinoma in patients with a high (≥ 2.67; liver cirrhosis: 42.9%, hepatocellular carcinoma: 14.3%) FIB-4 index were significantly higher than in those with an intermediate (1.3 ≤ FIB-4

This paper analyzes market participation gaps among male, female, and joint decision-making households, and the factors influencing that gap, using data collected from 560 maize farm households in the Dawuro zone, southern Ethiopia. The results from the ordered probit analysis reveal that female and joint decision-making households were negatively associated with the probability of being a net seller, while being positively associated with being autarchic and net buyers. The decomposition results indicate clear market participation gaps in the net seller and net buyer positions between male and female decision-makers. The mean quantity gaps between males and females are more apparent in the net seller and net buyer positions. Between male and joint decision-makers, the mean quantity gaps are significant in the net seller and autarchic positions, while between female and joint decision-makers, it is significant in the net seller positions. In each market position, the quantity of gaps is unevenly distributed across the quantities of distribution, but the values increase as we approach higher levels of distribution. The gaps in the net seller and autarchic positions indicate that males are better positioned than females and that females are better positioned than joint decision-makers. Both endowment and return effects account for the quantity gaps. Thus, there is a need for policies to secure more equal access to productive resources for female and joint decision-making households and build their capacity to increase their resource returns.

The prevalence of glucose intolerance in chronic liver disease patients is high, but glucose intolerance may be overlooked in a single blood test. The purpose of this study is to evaluate blood glucose variability in patients with chronic liver disease by a continuous glucose monitoring system (CGMS) and to examine the discrepancy between hemoglobin A1c (HbA1c) levels estimated from average blood glucose levels and HbA1c.This study included 335 patients with chronic liver disease associated with glucose intolerance. A fasting blood test and 72-h CGMS were performed. The estimated HbA1c was calculated from the average blood glucose level, and the correlation between hepatic functional reserve and blood glucose-related parameters was analyzed. From the obtained data, we created a new formula to calculate HbA1c without using CGMS.As hepatic functional reserve decreased, average blood glucose and insulin resistance increased while HbA1c decreased (P 0.0001). The discrepancy between the estimated HbA1c calculated from the mean blood glucose level and the serum HbA1c (ΔHbA1c) increased as the liver reserve decreased. Using multiple regression analysis, a formula based on fasting blood glucose, HbA1c, body mass index, albumin, and liver function was constructed, and its validity was demonstrated in a study using a different control group.Hemoglobin A1c may be underestimated because of decreased hepatic functional reserve. CGMS was useful in assessing accurate glycemic control of blood glucose and in detecting postprandial hyperglycemia and nocturnal hypoglycemia. Patients with chronic hepatic impairment should be corrected for hepatic functional reserve before glycemic control.

The design procedure considered in the Japanese code for low-rise timber houses (two or fewer stories), is through a wall volume method. The wall volume method entails calculating the shear...

Objective Despite recent advances in hepatitis C virus (HCV) treatment, some HCV-positive individuals are unaware of their infection. The present study aimed to assess the rate and age distribution in Saga Prefecture regarding i) HCV infection and HCV screening and ii) direct acting anti-viral (DAA) treatment. Methods HCV screening data collected at a medical institution or in the workplace were obtained from the administrative database in Saga Prefecture between April 1, 2008 and March 31, 2014. DAA treatment data from Saga Prefecture were obtained from the DAA treatment reimbursement recipient database between October 2014 and March 2017. Results There were 35,625 individuals who underwent HCV screening, and the HCV positive rate was 1.18% (421 individuals), which increased in an age-related manner. The screening rate in the screened populations peaked at 45-74 years of age (approximately 6%) and decreased in the younger and older generations. The estimated percentage of DAA treatment peaked at 65-74 years old (65.8%) and significantly decreased inversely with age in the younger generations; only 9.4% of HCV carriers received DAA treatment in the 20- to 34-year age group. The proportion of subjects who received a complete physical examination for DAA treatment was higher in the subjects who were screened at a medical institution than in those screened at the workplace. Conclusion The rate of subjects who underwent HCV screening and DAA treatment was not high, especially in the younger generation, in Saga Prefecture. This group should be targeted for HCV screening and treatment.

Chronic liver disease, especially viral hepatitis, is an urgent issue in Japan. Human resource management is important to promote appropriate care for patients with chronic liver disease in medical institutions and in the community. In 2011 the Ministry of Health, Labour and Welfare in Japan started training hepatitis medical care coordinators (HMCCs). Various medical professionals (such as public health nurses, general nurses, and clinical technicians), patients, and ordinary citizens are certified as HMCCs by the prefectural government after learning about liver diseases in a training program. The training program can be optimized in accordance with the regional circumstances and basic knowledge and skills of the applicants. HMCCs encourage residents and patients to undergo a hepatitis screening test, after which positive patients undergo detailed examination, treatment, and follow-up. HMCCs contribute to the expansion of knowledge about hepatitis in their workplace and community. By 2018, there were HMCCs in all 47 prefectures of Japan. There were 20,049 HMCCs in 2019. The most common professions of HMCCs were public health nurses, followed by general nurses, hospital pharmacists, laboratory technicians, and medical social workers. After certification, the activities of HMCCs vary; to ensure that HMCCs are adequately used in medical institutions, the supervisor and physicians must recognize the importance of HMCCs and generate opportunities for HMCC activity. The training and effective utilization of HMCCs is a promising way to decrease the prevalence and mortality of chronic liver diseases in Japan.

The effect of the skin–capsular distance (SCD) on the controlled attenuation parameter (CAP) for diagnosis of liver steatosis in patients with nonalcoholic fatty liver disease (NAFLD) remains unclear. The SCD was measured using B-mode ultrasound, and the CAP was measured using the M probe of FibroScan®. According to the indications of the M probe, 113 patients with an SCD of ≤ 25 mm were included in the present study. The association between the SCD and CAP was investigated, and the diagnostic performance of the SCD-adjusted CAP was tested. The SCD showed the most significant positive correlation with the CAP (ρ = 0.329, p

There is an association between nonalcoholic fatty liver disease (NAFLD) and atherosclerosis, but the genetic risk of atherosclerosis in NAFLD remains unclear. Here, a single-nucleotide polymorphism (SNP) of the heat shock 70 kDa protein 8 (HSPA8) gene was analyzed in 123 NAFLD patients who had been diagnosed using a liver biopsy, and the NAFLD phenotype including the maximum intima–media thickness (Max-IMT) of the carotid artery was investigated. Patients with the minor allele (A/G or G/G) of rs2236659 showed a lower serum heat shock cognate 71 kDa protein concentration than those with the major A/A allele. Compared with the patients with the major allele, those with the minor allele showed a higher prevalence of hypertension and higher Max-IMT in men. No significant associations between the HSPA8 genotype and hepatic pathological findings were identified. In decision-tree analysis, age, sex, liver fibrosis, and HSPA8 genotype were individually associated with severe carotid artery atherosclerosis (Max-IMT ≥ 1.5 mm). Noncirrhotic men aged ≥ 65 years were most significantly affected by the minor allele of HSPA8. To predict the risk of atherosclerosis and cardiovascular disease, HSPA8 SNP genotyping might be useful, particularly for older male NAFLD patients.

To promote the development of cross-laminated timber (CLT) structures, the Japanese Government Notifications on Structural Design of CLT Buildings (GN 611) was issued in 2016. In GN 611, th...

From our investigation of the experimental seismic response of post-and-beam wooden buildings with different column joints, we developed a nonlinear three-dimensional distinct element model...

Background: Ipragliflozin (IPR) is a sodium-glucose cotransporter 2 inhibitor (SGLT2i) used to treat diabetes. Given the global increase in diabetes and nonalcoholic fatty liver disease (NAFLD), the effects of SGLT2i on hepatic outcomes and glycemic control are of interest. Methods: The current study was a multicenter randomized controlled trial, and all patients included were diabetics with liver biopsy-proven NAFLD. They were divided into an IPR group (n = 24) administered IPR orally (50 mg/day), and a control group (CTR; n = 26) who undertook enhanced lifestyle modifications including diet and exercise therapy and/or antidiabetic drugs other than SGLT2i, pioglitazone, or GLP-1 analogs. After 72 weeks, a second liver biopsy was performed and clinical parameters including pathological indicators were compared in the two groups. All liver biopsies were evaluated by two expert pathologists. Results: There were no significant differences in basal bodyweight, hemoglobin A1c, or pathological NAFLD findings between the groups. Mean bodyweight reduction from baseline at 72 weeks was significantly greater in the IPR group (-3.2 vs. -0.4, p < 0.01). Compared to the CTR group, hemoglobin A1c was significantly lower at 48 weeks (-0.46 vs. -0.09, p < 0.05). The mean decrease in visceral fat area determined with CT scan was significantly greater in the IPR group. Neither AST nor ALT differed significantly between the groups. Liver fibrosis improved in 57.1% of patients in the IPR group and 16% in the CTR group (p < 0.01). Liver steatosis improved in 19.0% of patients in the IPR group and 28% in the CTR group (p > 0.05; not significant). Low-grade adverse events were observed in both groups. Conclusion: IPR reduces bodyweight and hemoglobin A1c in diabetics with NAFLD, and ameliorates liver fibrosis. Long-term IPR administration improves hepatic outcomes of NAFLD, and obesity and glycemic control. Disclosure H. Takahashi: Research Support; Self; Astellas Pharma Inc. T. Kessoku: None. M. Kawanaka: None. M. Nonaka: None. H. Hyogo: None. H. Fujii: None. T. Nakajima: None. K. Imajo: None. K. Tanaka: None. Y. Kubotsu: None. H. Isoda: None. S. Oeda: None. O. Kurai: None. M. Yoneda: None. M. Ono: None. A. Takamori: None. R. Tajiri: None. A. Kawaguchi: None. S. Aishima: None. M. Kage: None. A. Nakajima: Consultant; Self; Kowa Company, Ltd. Speaker’s Bureau; Self; Astellas Pharma Inc., Mylan. Y. Eguchi: None. K. Anzai: Research Support; Self; Astellas Pharma Inc., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Inc. Speaker’s Bureau; Self; Daiichi Sankyo, Kyowa Hakko Kirin Co., Ltd., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. Funding Astellas Pharma Inc.

A national research project to investigate proper structural design methods for cross-laminated timber (CLT) buildings has been initiated by a subsidiary of the Ministry of Land, Infrastructure, Transport and Tourism of Japan since 2011. In the final stage of the project, shaking table tests were conducted for CLT buildings designed according to a proposed structural design procedure which confirmed damage limit state, safety limit state, allowable stress, and ductile factors, etc. This paper presents results of shaking table testing for full-scaled CLT building and a design procedure. The three different systems examined are buildings composed of narrow panels, wide panels with an edge tensile connection, and wide panels with an edge tensile connection for each no-window shear part. The focus of this paper is the building of narrow panels. This building system is suitable for midrise CLT building with high ductility produced through rocking. The structure was shown to behave well during severe strong motion as specified in the Japanese building standard law and to have survived the 1995 Kobe earthquake despite the occurrence of a compressive rupture in shear walls which are support elements against the vertical load. Story shear capacity calculated from a numerical model and element tests (such as connections) were safely evaluated; but to evaluate the capacity correctly, further research is required in the element and system levels. Though a variety of undetermined issues and challenges remains, the Building Standard Law and Notification for three different CLT construction systems was enforced in April 2016 to ensure the construction of safe CLT buildings.

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and one of the leading causes of hepatocellular carcinoma and liver transplantation. Moreover, patients with NAFLD frequently complain of non-specific symptoms including fatigue, abdominal discomfort, as well as anxiety, and NAFLD is reported to affect patient-reported outcomes (PROs). Thus, for clarifying the total burden of NAFLD, it is crucial to assess all associated outcomes, including not only clinical and economic outcomes but also PROs. PROs are thought to reflect what is happening in one's daily life and is an important way patients and health-care professionals communicate. There are various instruments for the assessment of PROs. Recently, a NAFLD/non-alcoholic steatohepatitis (NASH)-specific instrument called "Chronic Liver Disease Questionnaire (CLDQ)-NAFLD/NASH" has been developed. CLDQ-NAFLD/NASH comprises six domains: (i) abdominal symptoms, (ii) activity/energy, (iii) emotional health, (iv) fatigue, (v) systemic symptoms, and (vi) worry. CLDQ-NAFLD/NASH has demonstrated excellent internal consistency, face validity, content validity, and test-retest reliability. It has been sufficiently validated in two international phase 3 clinical trials. In this review, we summarize features of various instruments for assessing PROs by focusing on CLDQ-NAFLD/NASH. We also examine the validity of CLDQ-NAFLD/NASH in Japanese patients and alterations in CLDQ-NAFLD/NASH score in Japanese patients with significant hepatic fibrosis. Moreover, we discuss the utility of CLDQ-NAFLD/NASH in phase 3 clinical trials and in a real-world clinical setting.

The increasing interest in cross-laminated timber (CLT) construction has resulted in multiple international research projects and publications covering the manufacturing and performance of CLT. Multiple regions and countries have adopted provisions for CLT into their engineering design standards and building regulations. Designing and building CLT structures, also in earthquake-prone regions is no longer a domain for early adopters, but is becoming a part of regular timber engineering practice. The increasing interest in CLT construction has resulted in multiple regions and countries adopting provisions for CLT into their engineering design standards. However, given the economic and legal differences between each region, some fundamental issues are treated differently, particularly with respect to seismic design. This article reflects the state-of-the-art on seismic design of CLT buildings including both, the global perspective and regional differences comparing the seismic design practice in Europe, Canada, the United States, New Zealand, Japan, China, and Chile.