Retrospective analysis of autoimmune hepatitis-primary biliary cirrhosis overlap syndrome in Korea: characteristics, treatments, and outcomes

Background/AimsOverlap syndrome of autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) (AIH-PBC overlap syndrome) is a rare disease that has not been clearly characterized in Korean patients. This study investigated the clinical features of AIH-PBC overlap syndrome compared with those of AIH and PBC alone.MethodsThis retrospective cohort study included 158 consecutive patients who were diagnosed as AIH (n=61), PBC (n=81), or AIH-PBC overlap syndrome (n=9) based on the Paris and the International Autoimmune Hepatitis Group (IAIHG) criteria from 2001 to 2011 in Korea. We compared the clinical features of these three groups retrospectively, including their biochemical characteristics, treatments, responses, and clinical outcomes.ResultsThe AIH-PBC overlap syndrome patients exhibited biochemical characteristics of both AIH and PBC, and showed a similar response to ursodeoxycholic acid (UDCA) monotherapy as for the PBC patients. However, the response of AIH-PBC overlap syndrome patients to UDCA and steroid combination therapy was worse than the response of AIH patients to steroid-based therapy (P=0.024). Liver cirrhosis developed more rapidly in AIH-PBC overlap syndrome patients than in AIH patients group (P=0.013), but there was no difference between AIH-PBC overlap syndrome patients and PBC patients. The rates of developing hepatic decompensation did not differ significantly between the groups.ConclusionsThe AIH-PBC overlap syndrome patients exhibited a worse response to UDCA and steroid combination therapy and a faster cirrhotic progression compared with AIH patients

Overview of Asian clinical practice guidelines for the management of hepatocellular carcinoma: An Asian perspective comparison

Hepatocellular carcinoma (HCC) is highly prevalent and the third most common cause of cancer-related death in Asia. In contrast to the West, the main etiology of HCC in many Asian countries except Japan is chronic hepatitis B virus infection. Differences in the major causes of HCC lead to significant clinical and treatment differences. This review summarizes and compares guidelines on managing HCC from China, Hong Kong, Taiwan, Japan, and South Korea. From oncology and socio-economic perspectives, factors such as underlying diseases, staging methods, government policies, insurance coverage, and medical resources contribute to varying treatment strategies among countries. Furthermore, the differences in each guideline are fundamentally caused by the lack of incontrovertible medical evidence, and even existing results of clinical trials can be interpreted differently. This review will provide a complete overview of the current Asian guidelines for HCC in recommendations and in practice

Nonlinear Effects in Three-minute Oscillations of the Solar Chromosphere. II. Measurement of Nonlinearity Parameters at Different Atmospheric Levels

Recent theoretical studies suggest that the nonlinearity of three-minute velocity oscillations at each atmospheric level can be quantified by the two independent parameters—the steepening parameter and the velocity amplitude parameter. For the first time, we measured these two parameters at different atmospheric levels by analyzing a set of spectral lines formed at different heights of sunspots ranging from the temperature minimum to the transition region. The spectral data were taken by the Fast Imaging Solar Spectrograph of the Goode Solar Telescope, and by the Interface Region Imaging Spectrograph. As a result, from the wavelet power spectra of the velocity oscillations at different heights, we clearly identified the growth of the second harmonic oscillations associated with the steepening of the velocity oscillation, indicating that higher-frequency oscillations of periods of 1.2 to 1.5 minutes originate from the nonlinearity of the three-minute oscillations in the upper chromosphere. We also found that the variation of the measured nonlinearity parameters is consistent with the theoretical expectation that the nonlinearity of the three-minute oscillations increases with height, and shock waves form in the upper chromosphere. There are, however, discrepancies as well between theory and observations, suggesting the need to improve both theory and the measurement technique

Nonlinear guided waves and spatial solitons in a periodic layered medium

We overview the properties of nonlinear guided waves and (bright and dark) spatial optical solitons in a periodic medium created by a sequence of linear and nonlinear layers. First, we consider a single layer with a cubic nonlinear response (a nonlinear waveguide) embedded into a periodic layered linear medium, and describe nonlinear localized modes (guided waves and Bragg-like localized gap modes) and their stability. Then, we study modulational instability as well as the existence and stability of discrete spatial solitons in a periodic array of identical nonlinear layers, a one-dimensional nonlinear photonic crystal. Both similarities and differences with the models described by the discrete nonlinear Schrodinger equation (derived in the tight-binding approximation) and coupled-mode theory (valid for the shallow periodic modulations) are emphasized.Comment: 10 pages, 14 figure

Digital atmosphere of fashion retail stores

This study sheds light on a prominent issue in retailing: how the digital atmosphere can affect the consumer decision-making process in a fashion retail store. Digital devices and services such as digital screens and digital signage are widely employed in fashion retail stores, transforming the way consumers make decisions about purchasing fashion products. This research investigates how the digital atmosphere affects consumers purchase behavior patterns based on the attention-interest-desire-search-action-share (AIDSAS) model. The findings show that attention is a key antecedent to interest, desire, and behavioral responses (search, action, and share) triggered by the digital atmosphere. The findings further suggest that attention has significantly positive effects on consumers purchasing patterns of utilizing the digital atmosphere in two types of fashion retail stores: sports and luxury stores. However, we find that these positive effects are more pronounced for sports retail stores than luxury retail stores. This research contributes to understanding consumer behavior related to the digital atmosphere of fashion retail stores by applying the AIDSAS model and helps uncover the stepwise relationships between attention to the store atmosphere-interest/desire and the products-behavior response. These findings have practical implications that can be applied in the fashion industry.This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (NRF-2016S1A2A2912526)

Sofosbuvir-based therapy for patients with chronic hepatitis C: Early experience of its efficacy and safety in Korea

Background/AimsThe previous standard treatment for chronic hepatitis C (CHC) patients, comprising a combination of pegylated interferon (IFN) and ribavirin, was associated with suboptimal efficacy and severe adverse reactions. A new era of direct-acting antivirals is now dawning in Korea. Early experience of applying sofosbuvir-based therapy to CHC patients in Korea is reported herein.MethodsData on efficacy and safety were collected for CHC patients treated with a combination of sofosbuvir plus ribavirin or sofosbuvir/ledipasvir with or without ribavirin.ResultsThis retrospective study included 25 consecutive patients who received sofosbuvir-based therapy (19 with genotype 1b and 6 with genotype 2) at Seoul National University Hospital from May 2014 to April 2015. A virologic response was achieved at week 4 by 85.7% and 80% of the patients with genotypes 1b and 2, respectively. The HCV-RNA level decreased more slowly in IFN-experienced than in treatment-naïve patients with genotype 1b. However, the sustained virologic response at week 12 (SVR12) rate did not differ among these patients, and was as high as 100%. The presence of cirrhosis significantly increased the risk of a virologic response failure at week 4 (OR, 11.0; P=0.011) among patients with HCV genotype 1b. Only five patients (20%) experienced minor adverse events, including grade 1 fatigue and headache. The hemoglobin level decreased slightly after sofosbuvir-based therapy, but there was no case of premature discontinuation of this therapy.ConclusionsIn a real clinical practice, sofosbuvir-based therapy for CHC patients in Korea achieved optimal antiviral efficacy with insignificant adverse events. Long-term follow-up data are warranted to ensure the sustained antiviral efficacy and long-term safety of sofosbuvir-based IFN-free therapy

A case of successful surgical treatment for peritoneal seeding of hepatocellular carcinoma after radiotherapy and atezolizumab plus bevacizumab combination treatment

Peritoneal seeding of hepatocellular carcinoma (HCC) is incurable and has poor prognosis. A 68-year-old man underwent surgical resection for a 3.5 cm single nodular HCC at the tip of segment 3 and transarterial chemoembolization for a 1.5 cm-sized recurrent HCC at the tip of segment 6. 3 months later, an increasing 1 cm pelvic nodule on the rectovesical pouch warranted radiotherapy. Although it stabilized, a new 2.7 cm-sized peritoneal nodule in the right upper quadrant (RUQ) omentum appeared 3.5 years after radiotherapy. Hence, omental mass and small bowel mesentery mass excision were performed. 3 years later, recurrent peritoneal metastases in the RUQ omentum and rectovesical pouch progressed. 33 cycles of atezolizumab and bevacizumab treatment elicited stable disease response. Finally, laparoscopic left pelvic peritonectomy was performed without tumor recurrence. Herein, we present a case of HCC with peritoneal seeding that was successfully treated with surgery after radiotherapy and systemic therapy, leading to complete remission

Lean or diabetic subtypes predict increased all-cause and disease-specific mortality in metabolic-associated fatty liver disease

Background Metabolic-associated fatty liver disease (MAFLD) encompasses diverse disease groups with potentially heterogeneous clinical outcomes. We investigated the risk of all-cause and disease-specific mortality in MAFLD subgroups. Methods Using the Korean National Health Insurance Service database, participants were divided into four subgroups: no MAFLD, MAFLD-diabetes, MAFLD-overweight/obese, and MAFLD-lean. Hazard ratios (HRs) and 95% confidence interval (CI) values for all-cause and disease-specific mortality according to MAFLD subgroups were analyzed using Cox proportional hazards models. Results Among 9,935,314 participants, those with MAFLD-diabetes showed the highest risk of all-cause and disease-specific mortality. The HRs (95% CI) for all-cause mortality were 1.61 (1.59–1.63), 1.36 (1.34–1.38), and 1.19 (1.18–1.20) in the MAFLD-diabetes, MAFLD-lean, and MAFLD-overweight/obese groups, respectively. The magnitude of cardiovascular disease and cancer-related risk showed the same pattern. The risk of liver-related mortality in the MAFLD-lean group (HR: 2.84, 95% CI: 2.72–2.97) was comparable with that in the MAFLD-diabetes group (HR: 2.85, 95% CI: 2.75–2.95). When stratified by body mass index, liver-related mortality was the highest in MAFLD-lean individuals in the underweight group (HR, 5.03, 95% CI: 4.23–5.97). Conclusions The MAFLD-lean and MAFLD-diabetes groups had a higher risk of all-cause and disease-specific mortality than did the MAFLD-overweight/obese group. Classifying MAFLD subgroups based on metabolic phenotypes might help risk stratification of patients with MAFLD.This work was supported in part by grants from the Seoul National University Hospital (04–2022-3140 and 30–2022-0340) and the Liver Research Foundation of Korea (Bio Future Strategies Research Project)