Introduction

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a disease that complements Nonalcoholic Fatty Liver Disease (NAFLD) and is newly defined in 2020. It is defined based on metabolic abnormalities, regardless of the presence of liver disease caused by other causes such as alcohol consumption. Regarding the newly defined MAFLD, there has not been many studies related to the prevalence and risk factors in Korea, and no studies were found targeting soldiers, especially pilots.

Aims & Methods

The purpose of this study is to identify prevalence and risk factors for MAFLD in Korean air force army inclusive of pilots. The subjects are 1044 soldiers who underwent health checkups in Korean Air Force Aerospace medical center from January 2020 to December 2022. The data was retrospectively collected including age, height, weight, body mass index, waist circumference, blood pressure, smoking, drinking, exercise intensity, various blood test results, presence of fatty liver, and degree of fatty liver. Risk factors were analyzed using logistic regression.

Results

There were 667 pilots (64%) in our study, of whom 477 (72%) were high-performing pilots. The prevalence of MAFLD was 316 (30%) in all soldier. There was difference in the prevalence of MAFLD between pilot and non-pilot group (pilot group: 185 (28%), non-pilot group: 131 (35%) p-value=0.018). According to the multivariate analysis, body mass index (BMI), diabetes, systolic blood pressure, triglycerides (TG), uric acid (UA), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), alanine aminotransferase (ALT) were a risk factor associated with MAFLD among the entire soldiers. When categorized into pilot and non-pilot group, risk factors were associated with BMI, diabetes, alcohol consumption, and ALT in the non-pilot group. In the pilot group, they were statistically associated with age, BMI, dyslipidemia, TG, UA, HDL and ALT. Among them, UA showed the largest difference between the non-pilot group and the test group (non-pilot group: 1.14 (95% CI: 0.80-1.62), pilot group: 1.80 (95% CI: 1.38-2.36)).

Conclusion

There was a difference in the prevalence of MAFLD between pilot and non-pilot group. In particular, UA could be used to predict MAFLD as a specific risk factor in pilots comparing with non-pilots.

Introduction

According to Baveno VII, non-invasive-based criteria is useful to rule in or out for clinically significant portal hypertension (CSPH) in advanced chronic liver disease (ACLD). Liver stiffness measurement (LSM) and platelet count (PLT) are the two parameters considered in this field, particularly LSM≥25 kPa is highly predictive for CPSH, while LSM ≤15 kPa plus PLT ≥150 G/L exclude CSPH. Spleen Stiffness Measurement (SSM) can be used in ACLD patients, identifying patients with a low probability (SSM<40 kPa) of having high-risk varices.

Aims & Methods

The aim of our study is to explore the utility of SSM in predicting endoscopic signs of portal hypertension and its added value compared to LSM and platelet count. This retrospective study was conducted at the University of Naples “Federico II”. All patients with ACLD (for any etiologies) with at least LSM≥10 who underwent esophagogastroduodenoscopy (EGD) for portal hypertension assessment within one year before Spleen Stiffness measurement were enrolled. Exclusion criteria were patients < 18 yrs, PLT>150*10³/cc, liver transplantation, HCC patients, portal vein thrombosis and incomplete data. The study population was divided in three groups: the first includes patients with LSM≥25, the second patients with LSM≥15 and <25 and the third patients with LSM≥10 and <15.

Results

Sixty-nine patients (41 male, mean age 62.7±14.8 years old) were recruited. The main etiology was virus-related (30 patients, 43.4%) followed by metabolic (13 patients, 18.8%), alcohol (12 patients, 17.4%), autoimmune (7 patients, 10.1%) and other (7 patients, 10.1%). Fifty-five patients were Child A and 14 patients were Child B. Overall, mean LSM was 24.7±12.9 kPa, mean SSM was 59.8±23.5 kPa and mean PLT count was 102±50*10³/cc. The groups were composed by 25, 27 and 17 patients, respectively. Eighteen out of 25 patients (69.2%) belonging to the first group had endoscopic sign of PH and almost all of them (17/18, 94.4%) had SSM≥40kPa. In the second group a lower rate of endoscopic sign of PH was found (14/27, 51.8%), although SSM had a high diagnostic performance (100%). Finally, in the third group, in which according to Baveno VII the pre-test probability of CSPH is low, 5 out of 17 (29.4%) had endoscopic sign of PH and, among them, 60% of patients (3/5) had SSM>40kPa. Indeed, SSM demonstrated a better positive correlation with the presence of endoscopic sign of PH (Pearson coefficient r=0.4) then LSM (r=0.3).

Conclusion

SSM enhances the diagnostic performance of LSM and PLT assessment proposed by Baveno VII in predicting portal hypertension in patients with ACLD.

Introduction

Direct-acting antivirals (DAA) have revolutionized the treatment landscape for chronic hepatitis C (CHC), yielding notably high sustained virological response (SVR) rates. While SVR is associated with reduced hepatocellular carcinoma (HCC) risk, recent studies emphasize the importance of ongoing surveillance, particularly in patients with advanced fibrosis (F3-F4), mainly within the initial three years post-SVR.

Aims & Methods

The aim of this study was to assess the risk of hepatocellular carcinoma over a five-year period following DAA-induced SVR in a real-life cohort of F3-F4 patients.
Data were retrospectively collected from CHC F3-F4 patients initiating DAA treatment between February 2015 and January 2017 at a tertiary center. Statistical analysis was performed with SPSS 29.0 (significance level ≤0.05).

Results

Out of 239 patients included (69.5% male; median age: 58 years), a SVR at 12 weeks rate of 96.6% was achieved. Among those with SVR and continued follow-up (n=229), 5.2% (n=12) developed HCC over the five-year period, with 50% occurring more than three years post-SVR.
The annual HCC incidence rate was 1.1 cases/100 person-years (33.3% HCC-related mortality rate). Most HCC cases occurred in males (75%) and cirrhotic patients (75%, Child-Pugh A: 77.8%). The mean alpha-fetoprotein level at HCC diagnosis was 156.1 ng/mL. Additionally, 75% of patients who developed HCC had other co-factors for liver disease, mainly metabolic. Comparing the presence of other liver disease co-factors, no statistically significant difference was found between those who developed HCC and those who did not during the five-year follow-up period (p-value 0.267).

Conclusion

The incidence rate of HCC post- SVR has been reported to be 0.9-2.96/100 person-years for DAA therapy, consistent with the findings of this investigation. Nevertheless, our study underscores that the risk of HCC persists for at least five years following SVR, warranting long-term surveillance. Contrary to previous research, there is insufficient evidence to support the involvement of other co-factors in HCC development.

Disclosure

Hsu CC, Gopalakrishna H, Mironova M, Lee MH, Chen CJ, Yang HI, Wiese M, Chang KM, Wright EC, Abijo T, Feld JJ, Kaplan DE. Risk of Hepatocellular Carcinoma After Spontaneous Clearance of Hepatitis C Virus and in Noncirrhosis Chronic Hepatitis C Patients With Sustained Virological Response: A Systematic Review. Clin Infect Dis. 2023 Aug 14;77(Suppl 3):S245-S256. doi: 10.1093/cid/ciad380. PMID: 37579210; PMCID: PMC10425144.
Li M, Li Y, Zhang Y, Wang X, Lin C. Five-year follow-up of sustained virological response with hepatitis C infection after direct-acting antiviral therapy: A single-center retrospective study. Medicine (Baltimore). 2024 Feb 16;103(7):e37212. doi: 10.1097/MD.0000000000037212. PMID: 38363923; PMCID: PMC10869073.

Introduction

Colonoscopy is a critical diagnostic and therapeutic procedure in gastroenterology. However, it carries risks, including hypoxemia, which can impact patient safety. Understanding the factors that contribute to the incidence of severe hypoxemia, specifically the role of procedure duration, is essential for improving patient outcomes.

Aims & Methods

This study aims to elucidate the relationship between the length of colonoscopy procedures and the occurrence of severe hypoxemia. We conducted a retrospective cohort study at Sheba Medical Center, Israel, including 21,524 adult patients who underwent colonoscopy from January 2020 to January 2024. The study focused on the incidence of severe hypoxemia, defined as a drop in oxygen saturation below 90%. Sedation protocols, involving a combination of Fentanyl, Midazolam, and Propofol, were personalized based on the endoscopist's discretion. Data were collected from electronic health records, covering patient demographics, clinical scores, sedation and procedure details, and outcomes. Statistical analyses, including logistic regression, were used to examine the association between procedure duration and hypoxemia, adjusting for various patient and procedural factors.

Results

The study found a significant correlation between colonoscopy duration and the risk of hypoxemia. Short procedures (under 20 minutes) had a 17.3% incidence of hypoxemia, which increased to 36.1% for procedures lasting over 60 minutes. Age and procedure duration were significant predictors of hypoxemia, with older patients and longer procedures associated with higher risks. The analysis highlighted the need for careful sedation management, especially in longer procedures.
Table 1- patient characteristics and outcomes based on the colonoscopy duration

Conclusion

The duration of colonoscopy procedures significantly impacts the risk of severe hypoxemia, with longer durations associated with higher risks. This study underscores the importance of optimizing procedural efficiency and tailoring sedation protocols to individual patient risk profiles to enhance the safety of colonoscopy. Further research is needed to develop strategies that minimize procedure duration without compromising the quality of care, thereby reducing the risk of hypoxemia and improving patient safety.