We evaluated regional differences of muscle O₂ dynamics between distal and proximal sites in the vastus lateralis (VL) muscle using near infrared spatial resolved spectroscopy (NIR_SRS). forty-one male subjects performed a 30 W ramp incremental bicycle exercise test until exhaustion. The NIR_SRS probes were attached on each distal and proximal site in the VL. The pulmonary O₂ uptake and heart rate were monitored continuously during the experiment. The TOI at rest was significantly higher in proximal than distal sites (65.0±5.2 vs. 69.7±4.6%, p<0.001). The TOI at exhaustion was also significantly higher in proximal than distal sites (39.5±6.7 vs. 47.5±7.6%, p<0.001). Moreover, a significant correlation was found between VO₂max and the TOI at exhaustion in each proximal and distal site in the VL. Half time reoxygenation, the time to reach a value of half-maximal recovery, was significantly slower in distal sites than proximal sites (27.1±5.6 vs. 25.0±6.1 sec, p<0.01). In conclusion, lower muscle oxygenation at exhaustion in higher VO₂max may be due to enhanced O₂ extraction in high oxidative capacity muscle. In addition, slower reoxygenation and lower muscle deoxygenation at the distal site in the VL may be explained by differences in O₂ supply and/or muscle fiber composition between distal and proximal sites.

We reported four cases of agricultural chemicals poisoning treated in our hospital during the past two years. These comprised two Paraquat poisoning and two Sumition poisoning cases. One Paraquat poisoned patient and one Sumition poisoned patient died of respiratory failure. The survivor of Paraquat poisoning had drank more Paraquat solutions than the dead case. However, the patient vomitted many times, and received medical treatment promptly, including gastric lavage, hemodialysis, and hemoperfusion.
While on the other hand, it took a long time before starting of hemodialysis and hemoper-fusion on the dead case of Sumition poisoning. Because the poison was unknown when the patient was sent to our hospital. Our experience suggesuted that every time we examine a case of agricultural chemical poisoning, we have to treat a patient intensively from the beginning.

Liposarcoma is one of the most common types of soft tissue sarcomas and can develop at any site, although omental liposarcoma is extremely rare. Omental liposarcoma has a poor prognosis because the diagnosis is difficult, until it presents as a large tumor causing severe noticeable clinical symptoms. A 51-year-old male with lower abdominal pain was referred to our clinic. Abdominal ultrasonography revealed an ill-defined, solid, heterogeneous, and hypoechoic tumor deep in the lower abdomen. Generally, liposarcomas are hyperechoic, though 20% of liposarcomas present as hypoechoic tumors. This variation might occur depending on the pathological classification. We should consider the possibility of a dedifferentiated component if ultrasonography reveals typical features of soft tissue sarcoma with hypoechoic lesion.

Objective: Lenvatinib is an oral multitarget tyrosine kinase inhibitor (mTKI) and is recommended for patients with advanced hepatocellular carcinoma (HCC) with Child-Pugh A liver function, who are not amenable to surgical resection, locoregional treatment, or transcatheter arterial chemoembolization. Hepatogastric fistula is a rare complication with a poor prognosis in patients with HCC. Previous reports on fistula formation during mTKI therapy for HCC were all associated with sorafenib. Here, we report the first case of recurrent hepatogastric fistula during lenvatinib therapy for advanced HCC managed using an over-the-scope clip (OTSC).Patient: We present the case of a 73-year-old man with alcoholic liver cirrhosis who was treated for multiple HCC for 7 years. HCC was treated using repetitive transcatheter arterial chemoembolization, radiofrequency ablation, and sorafenib. Owing to disease progression, lenvatinib treatment was started. During lenvatinib treatment, recurrent hepatogastric fistulas developed. An OTSC was useful for fistula closure and prevention of recurrence.Results: The major cause of fistula formation is considered to be the direct invasion of HCC; however, HCC treatment might also be a contributing factor in our case. In addition, OTSC was useful for fistula closure.Conclusion: Clinicians should be aware of the fatal complications during HCC treatment.