Background/Purpose: The rates and outcomes of primary biliary cholangitis (PBC) in Taiwan remain unclear. Methods: A nationwide population-based cohort study (Taiwan National Health Insurance Research Database, 2002–2015) was conducted. Data from four PBC cohorts with various definitions were compared (cohort 1 (C1): ICD-9-CM (571.6); C2: alkaline phosphatase (Alk-P) and antimitochondrial antibody (AMA) measurements; C3: Alk-p and AMA measurements and ursodeoxycholic acid (UDCA) treatment; C4: ICD-9-CM (571.6), Alk-p and AMA measurements and UDCA treatment). Results: The average prevalence rate ranged from 9.419/105 (C4) to 307.658/105 (C2), and the female-to-male ratio ranged from 1.192 (C1) to 3.66 (C4). Prevalence rates increased over time in all cohorts. The average incidence rates ranged from 1.456/105 (C4) to 66.386/105 (C2). Incidence rates decreased over time in C1 (−9.09%, p < 0.0001) and C4 (−6.68%, p < 0.0001) and remained steady in the others. C4 had the lowest prevalence and incidence rates and highest female-to-male ratio. Cirrhosis rates ranged from 7.21% (C2) to 39.34% (C4), hepatoma rates ranged from 2.77%(C2) to 6.66%(C1), liver transplantation (LT) rates ranged from 1.07% (C2) to 6.77% (C4), and mortality rates ranged from 18.24% (C2) to 47.36% (C1). C4 had the highest LT (6.77%), osteoporosis (13.87%) and dyslipidemia rates (17.21%). Conclusions: Based on the reported ranges of reasonable rates, female predominance and characteristic outcomes, C4 was the most representative Taiwanese PBC cohort, with average prevalence and incidence rates of 9.419/105 and 1.456/105, respectively, and a female-to-male ratio of 3.66. In a 14-year period, cirrhosis, hepatoma, LT, and mortality were noted in 39.34%, 5.52%, 6.77%, and 34.22% of C4 patients, respectively.

Background Laparoscopic liver resections (LLR) have been shown a treatment approach comparable to open liver resections (OLR) in hepatocellular carcinoma (HCC). However, the influence of procedural type on body composition has not been investigated. The aim of the current study was to compare the degree of skeletal muscle loss between LLR and OLR for HCC. Methods By using propensity score matching (PSM) analysis, 64 pairs of patients were enrolled. The change of psoas muscle index (PMI) after the operation was compared between the matched patients in the LLR and OLR. Risk factors for significant muscle loss (defined as change in PMI > mean change minus one standard deviation) were further investigated by multivariate analysis. Results Among patients enrolled, there was no significant difference in baseline characteristics between the two groups. The PMI was significantly decreased in the OLR group (P = 0.003). There were also more patients in the OLR group who developed significant muscle loss after the operations (P = 0.008). Multivariate analysis revealed OLR (P = 0.023), type 2 diabetes mellitus, indocyanine green retention rate at 15 min (ICG-15) > 10%, and cancer stage ≧ 3 were independent risk factors for significant muscle loss. In addition, significant muscle loss was associated with early HCC recurrence (P = 0.006). Metabolomic analysis demonstrated that the urea cycle may be decreased in patients with significant muscle loss. Conclusion LLR for HCC was associated with less significant muscle loss than OLR. Since significant muscle loss was a predictive factor for early tumor recurrence and associated with impaired liver metabolism, LLR may subsequently result in a more favorable outcome.

Abstract. Background Hepatitis B is a major global health problem. According to the Global hepatitis report, 2017 of the World Health Organization report, it chronically infects approximately 240 million people worldwide. Patients with chronic hepatitis B virus (HBV) infection have increased risk of developing hepatic decompensation, liver cirrhosis and hepatocellular carcinoma. Oral antiviral agents are the main choice of chronic hepatitis B infection in the present days. Approved oral antiviral agents include entecavir, tenofovir, telbivudine, lamivudine, and adefovir. These nucleos(t)ide analogues are safe and effective for long-term suppression of hepatitis B virus replication if no drug resistance is developed.Telbivudine is one of the choices for treatment of chronic hepatitis B (1). Besides its antiviral effect, an increase of estimated glomerular filtration rate (eGFR) has been observed after long-term telbivudine treatment (2). Additionally, increased or decreased mRNA levels in a panel of genes have been found by peripheral blood mononuclear cell-derived cDNA microarray study (3). Of those, decreased serum levels of angiotensinconverting enzyme upon long-term telbivudine treatment have been verified (3). However, of the list of dysregulated genes, up-regulation of kallikrein-8 (KLK8) gene expression appeared to statistically, be the most significant change.KLK8 belongs to a group of serine proteases -kallikreins, carrying diverse physiological functions. Many kallikreins are implicated in the development or the regulation of cancers (4, 5). KLK8 is one of the 15 kallikrein subfamily members. Different isoforms of KLK8 mRNA have been reported in the GenBank. The greatest abundance of KLK8 is found in esophagus and skin. Elevated tissue or serum levels of KLK8 have been found in ovarian cancer (6-8), salivary gland tumors (9), endometrial carcinoma (10), and cervical cancer (11). Decreased KLK8 levels have been observed in breast cancer (12). KLK8 serves as a biomarker for poor prognosis in colorectal cancer (13), lung cancer (14), and oral squamous cell carcinoma (15). Conversely, it serves as a biomarker for favorable prognosis in non-small cell lung cancer (16) and ovarian cancer (17,18). Despite these clinical correlations, the actual molecular mechanisms remain unknown. 955This article is freely accessible online. Although increased KLK8 mRNA levels after long-term telbivudine treatment were discovered by cDNA microarray analysis, further verification has never been performed. The correlation between the changes in KLK8 levels and eGFR is also unknown. The goal of this study is to verify whether serum KLK8 protein levels indeed increase after telbivudine treatment and if this increase is associated with eGFR changes. Materials and MethodsPatients. This study was conducted under the approval of institutional review board, Chang Gung Memorial Hospital, Taiwan. A total of 83 chronic hepatitis B patients receiving long-term telbivudine were analyzed retrospectively. These patients were under regular out...