Non-alcoholic fatty liver degree and long-term risk of incident inflammatory bowel disease:A large-scale prospective cohort study

Background:Non-alcoholic fatty liver disease(NAFLD)and inflammatory bowel disease(IBD)have shown similar worsening epidemic patterns globally and shared various overlapping pathophysiological mechanisms.However,evidence on the relationship between NAFLD and IBD risk is lacking.We aimed to investigate the associations between long-term risk of incident IBD and NAFLD in a large prospective cohort.Methods:Participants from the United Kingdom Biobank cohort(https://biobank.ndph.ox.ac.uk/)who were free of IBD and alcoholic liver disease at baseline were enrolled.Baseline non-alcoholic fatty liver degree was measured by the well-established fatty liver index(FLI).The outcomes of interest included incident IBD,ulcerative colitis(UC),and Crohn’s disease(CD).Multivariable Cox proportional hazard regression was used to calculate hazard ratios(HRs)and 95%confidence intervals(CIs).Results:Among 418,721 participants(mean FLI:48.11±30.11),160,807(38.40%)participants were diagnosed as NAFLD at baseline.During a median of 12.4 years’follow-up,2346 incident IBD cases(1545 UC,653 CD,and 148 IBD-unclassified)were identified.Due to limited events,those IBD-unclassified were combined in UC or CD when examining the associated risk of UC or CD,separately.Compared with the lowest quartile of FLI,the highest quartile showed a separately 36.00%,25.00%,and 58.00%higher risk of incident IBD(HR_(Q4 vs.Q1)=1.36,95%CI:1.19-1.55,P_(trend)<0.001),UC(HR_(Q4 vs.Q1)=1.25,95%CI:1.07-1.46,P_(trend)=0.047),and CD(HR_(Q4 vs.Q1)=1.58,95%CI:1.26-1.97,P_(trend)<0.001)after multivariable adjustment.Compared with non-NAFLD,NAFLD participants had a significantly higher risk of incident IBD(HR=1.13,95%CI:1.04-1.24)and CD(HR=1.36,95%CI:1.17-1.58).Conclusions:Higher degree of non-alcoholic fatty liver is associated with increased risk of incident IBD.Interventions aimed at improving NAFLD may be a potential targeted strategy for the detection and treatment of IBD.

Accountable attribute-based authentication with fine-grained access control and its application to crowdsourcing

We introduce a new notion called accountable attribute-based authentication with fine-grained access control (AccABA), which achieves (i) fine-grained access control that prevents ineligible users from authenticating;(ii) anonymity such that no one can recognize the identity of a user;(iii) public accountability, i.e., as long as a user authenticates two different messages, the corresponding authentications will be easily identified and linked, and anyone can reveal the user’s identity without any help from a trusted third party. Then, we formalize the security requirements in terms of unforgeability, anonymity, linkability and traceability, and give a generic construction to fulfill these requirements. Based on AccABA, we further present the first attribute-based, fair, anonymous and publicly traceable crowdsourcing scheme on blockchain, which is designed to filter qualified workers to participate in tasks, and ensures the fairness of the competition between workers, and finally balances the tension between anonymity and accountability.

Analysis of risk factors associated with endoscopic retrograde cholangiopancreatography for patients with liver cirrhosis: a multicenter, retrospective, clinical study

Background:Endoscopic retrograde cholangiopancreatography(ERCP)is the endoscopic modality of choice for the treatment of biliary and pancreatic diseases.However,patients with cirrhosis,particularly those with decompensated cirrhosis,are believed to be at increased risk for complications associated with ERCP.There is a paucity of literature describing the outcomes of ERCP for patients with cirrhosis.This study aimed to investigate the outcomes of ERCP for cirrhosis patients,especially adverse events,and evaluated its safety and efficacy.Methods:We performed a multicenter,retrospective study of all patients at Beijing Friendship Hospital affiliated to Capital Medical University,Xijing Hospital affiliated to Air Force Military Medical University,Beijing Youan Hospital affiliated to Capital Medical University,and the Fifth Medical Center of the People’s Liberation Army General Hospital from June 2003 to August 2019.The adverse events of inpatient ERCP for patients with(n=182)and without liver cirrhosis(controls;n=385)were compared.Results:A total of 567 patients underwent ERCP between January 2003 and December 2019 were enrolled in this study.Compared to patients without cirrhosis,patients with cirrhosis were at higher risk for postoperative complications(odds ratio[OR],4.172;95%confidence interval[CI],1.232–7.031;P<0.001)such as postoperative pancreatitis(OR,2.026;95%CI,1.002–4.378;P=0.001)and cholangitis(OR,3.903;95%CI,1.001–10.038;P=0.036).The main indications for ERCP for patients with cirrhosis in this study included choledocholithiasis(101 cases;55.5%),benign bile duct strictures(46 cases;25.3%),and malignant bile duct strictures(28 cases;15.4%).Among them,23 patients(12.6%)underwent balloon dilation and 79 patients(43.4%)underwent sphincterotomy.Of the patients with cirrhosis,delayed bleeding occurred in ten patients(5.5%),postoperative pancreatitis occurred in 80 patients(44.0%),and postoperative cholangitis occurred in 25 patients(13.7%).An additional multivariate analysis showed that the total bilirubin(TBIL)level(OR,4.58;95%CI,2.37–6.70)and Child-Pugh score of C(OR,3.11;95%CI,1.04–5.37)were risk factors for postoperative complications in patients with cirrhosis.Conclusions:Compared with the general population of patients undergoing ERCP,patients with cirrhosis were more prone to postoperative pancreatitis and cholangitis.TBIL levels and Child-Pugh scores were risk factors for postoperative complications in patients with cirrhosis.