Effects of bicycle exercise duration (i. e., 20, 40 and 60 min) on post-exercise glucose metabolism was studied in four healthy untrained men (19.8±0.4 yr), who were previously considered normal on a resting oral glucose tolerance test (OGTT) . These three exercises were performed on different days. The intensity of exercise corresponded to approximately 60% of VO₂max. A glucose sample of 100-g/300 ml was orally administered on 20 min after the completion of each exercise. Blood samples were obtained from a forearm vein before exercise, immediately after and on 20 min after the cessation of exercise, and on 30, 60, 90, 120 and 180 min after glucose ingestion. The following results were obtained. 1) Blood glucose concentrations observed on 60, 90, 120 and 180 min after glucose ingestion following 60 min exercise appeared to be higher than OGTT levels, indicating the time delay to return to the resting level. 2) Serum insulin concentrations after glucose ingestion following 20 and 40 min exercise were lower than OGTT levels. Changes in serum insulin concentrations following 60 min exercise were similar to those on OGTT levels with the exception of the level on 30 min after glucose ingestion. Serum C-peptide response curves were similar to serum insulin response curves after each exercise. 3) Serum free fatty acids (FFA) increased during each exercise as compared to a resting level and increased further after each exercise. The degree of changes in FFA was most significant during a recovery period following 60 min exercise, however, it decreased abruptly after glucose ingestion as a case after 20 and 40 min exercise. 4) Plasma cyclic-AMP concentrations increased most profoundly during 60 min exercise. Plasma cyclic-AMP level before glucose ingestion was also higher following 60 min exercise. These results suggested that postexercise glucose metabolism after glucose ingestion tended to be decreased with elevated rates of serum FFA during a recovery period following 60 min exercise.

We conducted an outpatient escort program as a part of our early exposure curriculum for first-year medical students. Each student escorted one patient at the University of Tsukuba Hospital throughout his or her first visit. This program enabled the students to experience and think about the system of a university hospital from a patient's point of view. We believe that this program is useful to motivate first-year medical students in their future studies.

Students in their 5th and 6th year of University of Tsukuba, School of Medicine, enter into a clinical clerkship. They record medical charts and flow sheets and they present at clinical rounds.
1) From 2000 to 2005, a questionnaire survey was conducted to evaluate the clinical clerkship in the rheumatology division. We also evaluated the influence of the introduction of infliximab therapy (October 2003) on the students' experience.
2) Evaluation of the clinical clerkship by the students was improved by attending the infliximab ward. Students felt more involved in the treatment of the patients by preparing drip infusion sets, disssolving infliximab, assisting with the drawing of blood and drip infusions, checking of the vital signs every 30 minutes, and recording charts.
3) Students realized the improvement of rheumatoid arthritis with therapy and the changes in the patients' emotional status after the introduction of infliximab.

We conduct an outpatient escort program as a part of our early exposure curriculum for first-year medical students. Each student escorts one patient at the University of Tsukuba Hospital throughout his or her first visit. We evaluated this program from the points of view of both students and patients.
1) A questionnaire was distributed to all participating patients and students in 2006.
2) In their questionnaires, many students commented on the long waiting time, the structural problems of the hospital, and the attitudes of physicians.
3) Results of the questionnaire showed that both students and patients rated this program highly.
4) No significant differences were noted between the comments of the students and those of the patients. The patients tended to rate this program more highly than did the students. One patient, however, commented that being constantly accompanied by a stranger was somewhat stressful.
5) We conclude that this program can be efficiently carried out without being too much of a burden to patients and is a valuable part of an early exposure program for first-year medical students.

Background/Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) was recently proposed as an alternative disease concept to nonalcoholic fatty liver disease (NAFLD). We aimed to investigate the prognosis of patients with biopsy-confirmed MASLD using data from a multicenter study. Methods: This was a sub-analysis of the Clinical Outcome Nonalcoholic Fatty Liver Disease (CLIONE) study that included 1,398 patients with NAFLD. Liver biopsy specimens were pathologically diagnosed and histologically scored using the NASH Clinical Research Network system, the FLIP algorithm, and the SAF score. Patients who met at least one cardiometabolic criterion were diagnosed with MASLD. Results: Approximately 99% of cases (n=1,381) were classified as MASLD. Patients with no cardiometabolic risk (n=17) had a significantly lower BMI than patients with MASLD (20.9 kg/m2 vs. 28.0 kg/m2, P<0.001), in addition to significantly lower levels of inflammation, ballooning, NAFLD activity score, and fibrosis stage based on liver histology. These 17 patients had a median follow-up of 5.9 years, equivalent to 115 person-years, with no deaths, liver-related events, cardiovascular events, or extrahepatic cancers. The results showed that the prognosis for pure MASLD was similar to that for the original CLIONE cohort, with 47 deaths and one patient who underwent orthotopic liver transplantation. The leading cause of death was extrahepatic cancer (n=10), while the leading causes of liver-related death were liver failure (n=9), hepatocellular carcinoma (n=8), and cholangiocarcinoma (n=4). Conclusions Approximately 99% of NAFLD cases were considered MASLD based on the 2023 liver disease nomenclature. The NAFLD-only group, which is not encompassed by MASLD, had a relatively mild histopathologic severity and a favorable prognosis. Consequently, the prognosis of MASLD is similar to that previously reported for NAFLD.