Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease worldwide. Although it has become one of the leading causes of cirrhosis and hepatocellular carcinoma in the Western world, the proportion of NAFLD patients developing these complications is rather small. Therefore, current guidelines recommend noninvasive tests for the initial assessment of NAFLD. Among the available non-invasive tests, transient elastography by FibroScan® (Echosens, Paris, France) is commonly used by hepatologists in Europe and Asia, and the machine has been introduced to the United States in 2013 with rapid adoption. Transient elastography measures liver stiffness and the controlled attenuation parameter simultaneously and can serve as a one-stop examination for both liver steatosis and fibrosis. Liver stiffness measurement also correlates with clinical outcomes and can be used to select patients for varices screening. Although obesity is a common reason for measurement failures, the development of the XL probe allows successful measurements in the majority of obese patients. This article reviews the performance and limitations of transient elastography in NAFLD and highlights its clinical applications. We also discuss the reliability criteria for transient elastography examination and factors associated with false-positive liver stiffness measurements.

Identifi cation of unknown suspect through bite marks has always been challenging. Narrowing list of suspects through sex and race markers is always recommend but rarely utilized due to limited publication in this area. Thus, this preliminary research was aimed to study the difference of bite mark made on dental wax between sex and race. A sample size of 40 UKM undergraduates comprising of Malay (male = 10, female = 10) and Chinese (male = 10, female = 10) were used in this study. Bite mark of subject was obtained through dental wax, digitally scanned and analyzed using Image-J software. Parameters measured were anterior teeth size, intercanine width and anterior teeth relative rotation. Result indicated that mandible left canine tooth size had signifi cant sexual dimorphism (p < 0.05) in differentiating sex. The means for male and female measured were 4.63 ± 1.05 mm and 5.35 ± 0.87 mm respectively. In addition to the result, tooth size of maxillary left canine and mandible left lateral incisor were signifi cantly different (p < 0.05) between races. Means for mandible left canine Malay and Chinese were 5.27 ± 1.01 mm and 4.50 ± 1.22 mm respectively. Furthermore, left lateral incisor mandible had means of 5.15 ± 0.87 mm and 4.60 ± 0.74 mm for Malay and Chinese respectively. Unfortunately, there were no signifi cant differences for intercanine width and anterior teeth relative rotation between the two major races in Malaysia. In conclusion, this research has demonstrated the possibility of using tooth size of mandible left canine, maxillary left canine and mandible left lateral discriminate sex and race.
Tooth

Owing to the high prevalence of various chronic liver diseases, cirrhosis is one of the leading causes of morbidity and mortality worldwide. In recent years, the development of non-invasive tests of fibrosis allows accurate diagnosis of cirrhosis and reduces the need for liver biopsy. In this review, we discuss the application of these non-invasive tests beyond the diagnosis of cirrhosis. In particular, their role in the selection of patients for hepatocellular carcinoma surveillance and varices screening is highlighted.
Biomarkers/blood ; Carcinoma, Hepatocellular/diagnosis ; *Elasticity Imaging Techniques ; Endoscopy, Digestive System ; Humans ; Hypertension, Portal/complications ; Liver Cirrhosis/complications/*diagnosis ; Liver Neoplasms/diagnosis ; Risk Factors

The natural history of chronic hepatitis B (CHB) is complex and may run through different immune phases that may overlap. In particulars, the immune-tolerant phase is the most interesting and not as well understood as we thought. The concept of true immune tolerance have been under challenged from immunology points of view. The major international guidelines have not yet reached a consensus on the definition of the immune-tolerant phase. While positive hepatitis B e antigen (HBeAg), high serum hepatitis B virus (HBV) DNA and normal serum alanine aminotransferase (ALT) levels are the three key features of this phase, some guidelines also put age into consideration. A new nomenclature, Phase 1 or HBeAg-positive chronic HBV infection, is given by the latest European Association for the Study of the Liver (EASL) published in April 2017. While current guidelines advise against starting antiviral treatment for immune-tolerant CHB patients, some new data suggest treating such patients may reduce the risk of liver fibrosis progression and hepatocellular carcinoma.
Alanine Transaminase ; Allergy and Immunology ; Carcinoma, Hepatocellular ; Consensus ; DNA ; Hepatitis B ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Immune Tolerance ; Liver ; Liver Cirrhosis ; Natural History