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.

No abstract available.
Rupture ; Transcatheter Aortic Valve Replacement

A 51-year-old man was emergently admitted for acute renal failure. Blood tests showed a high serum creatinine level and metabolic alkalosis. He had a history of recurrent vomiting starting one month prior to admission to our hospital, and had circumferential thickening of the cardia on upper gastrointestinal endoscopy and CT. He underwent total gastrectomy and was given a diagnosis of scirrhous gastric carcinoma at the pylorus. After total gastrectomy, acute renal failure and metabolic alkalosis showed amelioration. We report this very rare case with metabolic alkalosis and acute renal failure resulting from pyloric stenosis caused by scirrhous gastric carcinoma.

The aim of this study was to examine a weight reduction program and residual effects, through confirming the relationship between changes in the morphological and psychological indices including personality and self-efficacy (SE) of the participants. Twenty-five middle-aged women were divided into two groups based on type of weight reduction program intervention. Thirteen women participated in a 3-month diet-only weight reduction program (DO group, 53.3±7.4 yr), and 12 women took part in a 3-month diet and aerobic exercise program (DE group, 48.3±9.6 yr). After the programs, the compatibility score of personality in the DO group was negatively correlated to SE that is indicated as confidence in ability to maintain decreased body weight at 2, 3, and 4 years after the program (r=-0.69, -0.58, and -0.60). It can be seen that personality has an effect on the results of the DO group weight reduction program. Additionally, despite a significant decrease in body-weight and %fat in both groups, only the change of %fat significantly correlated with SE. On the basis of these correlations, the changes of %fat that related to the movability perception of body movements has a greater effect on SE after the program than the information only of weight loss. The results of this study suggest that personality and SE accounted for weight maintenance, and were associated with the results of the weight reduction program.

Approximately 100 kinds of Foods for Specified Health Use (FOSHU) are used to “control postprandial elevated blood glucose level”. In this review, we describe their safety and effectiveness.

Primary Sjögren's syndrome is an autoimmune disorder characterized by lymphocytic infiltrates and destruction of the salivary and lacrimal glands, and systemic production of autoantibodies to the ribonucleoprotein (RNP) particles SS-A/Ro and SS-B/La, leading to clinical symptoms of dryness of the mouth and eyes (sicca syndrome). Autoreactive T cells bearing the CD4 molecule may recognize an unknown self antigen, triggering autoimmunity in the salivary and lacrimal glands. Although several candidate autoantigens including α-fodrin have been reported in Sjögren's syndrome, the pathogenic roles of the autoantigens in initiation and progression of SS are still unclear. It is possible that individual T cells activated by an appropriate self antigen can proliferate and form a restricted clone. Recent evidence suggests that the apoptotic pathway plays a central role in making T cells tolerant to tissue-specific self antigen, and may drive the autoimmune phenomenon. We recently reported that tissue-specific apoptosis in estrogen-deficient mice may contribute to autoantigen cleavage, leading to the development of autoimmune exocrinopathy. The studies reviewed imply that tissue-specific apoptosis and caspase-mediated α-fodrin proteolysis are involved in the progression of autoimmune lesions in Sjögren's syndrome. Moreover, Fas ligand (FasL) and its receptor Fas are essential in the homeostasis of the peripheral immune system. It is considered that a defect in activation-induced cell death (AICD) of effector T cells may result in the development of autoimmune exocrinopathy in Sjögren's syndrome.

Side to side difference in tennis players' mid-radius and cross-sectional study on mid-tibia of jumpers and sedentary controls suggest that the improvement of mechanical properties of cortical bone in response to long-term exercise is related to geometric adaptation and not to volumetric bone mineral density. In the present study, geometric and mechanical properties of right tibia were estimated along 64 directions centering center of gravity of the bone on cross-sectional peripheral quantitative computed tomography (pQCT) images. The tibias of 17 jumpers (7 females, 10 males) and 15 controls (8 females, 7males), aged 18-23, were scanned at mid site using pQCT. Periosteal and endocortical radius were larger, cortical thickness was thicker, and mechanical properties (moment of inertia of area and strength strain index) were greater in jumpers compared to those of controls. The differences in cortical thickness between the two groups were dependent on direction of measurement. Defined a direction from tibia's center of gravity to fibula's as 0°, difference in the cortical thickness between jumpers and controls was the greatest at around 240°. Along this direction, differences in mechanical properties were also the most significant, suggesting that the site-specific adaptation of bone to long-term exercise is due to geographical relation of bone to muscle.

We analyzed the scores of objective structured clinical examinations (OSCEs) and written examinations administered to fourth-year medical students after practical training in clinical skills and to fifth-year medical students after clinical training and scores of graduation examinations taken by sixth-year medical students. Correlations were analyzed among the scores of 96 students who had taken all 3 examinations during a 3-year period. Mean scores on examinations in the fourth, fifth, and sixth years were compared between sixth-year students who did or did not graduate and between graduating students who did or did not pass the national examination for medical practitioners in Japan. Significant correlations in the scores were found between 1) OSCEs and written examinations for fourth-year students versus those for the fifth-year students; 2) OSCE and written examinations for fourth-year students versus graduation examination scores for the sixth-year students; and 3) OSCE and written examinations for fifth-year students versus graduation examination scores for sixth-year students. In addition, the mean scores in the fourth and fifth years were significantly higher for sixth-year students who graduated and passed the national examination than for students who did not graduate or who graduated but failed the national examination. These results suggest that the practical training in clinical skills given to fourth-year students and the clinical training given to fifth-year students strongly affect the overall evaluation of the ability of sixth-year students and success on the national examination.

Purposes: We performed a white coat ceremony for medical students, because there had not been a definite passage ceremony to create the desire to serve and the awareness of being physician. Opinions about the ceremony were with a questionnaire survey. Methods: The ceremony of white coat conferment was performed for the first time for 112 fourth-year medical students on January 11, 2001, just before the start of clinical training. A white coat and an identification badge with photograph were presented to the medical students, who were taking the first step to becoming a physician. A questionnaire survey was performed the next day to evaluate students' feelings. The questionnaire asked about student's 1) sense of responsibility to be engaged in medical practice, 2) feelings of kindness to patient, 3) love for of their school, 4) attachment to the white robe, 5) consciousness of being a professional, 6) sense of mission as a physician, 7) motivation to learn, 8) feelings of seriousness, and 9) desire to live ethically. A listening survey for the school staff and students was also included. Results: Clear improvements in consciousness were recognized in all items of the questionnaire (P>.0001). Approximately 80% of students approved of the ceremony being performed annually from the following year. The ceremony had had no established form, but many people acknowledged its significance. However, some students who did not realize the significance of the ceremony because it was performed in the middle of the semester. Conclusions: Although this was the first experience for us, many students and teaching staff were understanding and responded favorably to this passage ceremony. The ceremony to instill medical professionalism in student doctors will be improved with further efforts and experiences.