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.

Epithelial ovarian cancer remains the lethal gynecological malignancy in women. The representative histotype is high-grade serous carcinoma (HGSC), and most patients with HGSC present at advanced stages with peritoneal dissemination. Since the peritoneal dissemination is the most important factor for poor prognosis of the patients, complete exploration for its molecular mechanisms is mandatory. In this narrative review, being based on the clinical, pathologic, and genomic findings of HGSC, chromosomal instability and epigenetic dynamics have been discussed as the potential drivers for cancer development in the fallopian tube, acquisition of cancer stem cell (CSC)-like properties, and peritoneal metastasis of HGSC. The natural history of carcinogenesis with clonal evolution, and adaptation to microenvironment of peritoneal dissemination of HGSC should be targeted in the novel development of strategies for prevention, early detection, and precision treatment for patients with HGSC.

Tumor lysis syndrome (TLS) is a metabolic disorder that is caused by acute lysis of massive tumor cells. We report a case with opioids-related severe respiratory depression induced by TLS. A 39-year-old man received chemotherapy for mycosis fungoides. Two hours after administration of chemotherapeutic agents, his renal function worsened, and he was diagnosed with TLS by laboratory and clinical findings. Moreover, he showed severe respiratory depression and pinpoint pupils, and become drowsy. These symptoms were attributed to oxycodone that had been administered to treat his tumor-related cutaneous pain, and were improved by injection of anti-opioids agent naloxone. In this case, we consider that the clearance of oxycodone was disrupted by renal dysfunction caused by TLS, leading to enhancement of the effects of oxycodone.

Neoadjuvant chemotherapyeoadjuvant chemoradiotherapy (NAC/NACRT) can be performed in patients with pancreatic cancer to improve survival. We aimed to clarify the clinical outcomes of biliary drainage with a metal stent (MS) or a plastic stent (PS) during NAC/NACRT. Between October 2013 and April 2016, 96 patients with pancreatic cancer were registered for NAC/NACRT. Of these, 29 patients who underwent biliary drainage with MS or PS before NAC/NACRT and a subsequent pancreatoduodenectomy were retrospectively analyzed with regard to patient characteristics, preoperative recurrent biliary obstruction rate, NAC/NACRT delay or discontinuation rate, and operative characteristics. The median age of the patients was 67 years. NAC and NACRT were performed in 14 and 15 patients, respectively, and MS and PS were used in 17 and 12 patients, respectively. Recurrent biliary obstruction occurred in 6% and 83% of the patients in the MS and PS groups, respectively (p<0.001). NAC/NACRT delay was observed in 35% and 50% of the patients in the MS and PS groups, respectively (p=0.680). NAC/NACRT discontinuation was observed in 12% and 17% of the patients in the MS and PS groups, respectively (p=1.000). The operative time in the MS group tended to be longer than that in the PS group (625 minutes vs 497 minutes, p=0.051), and the operative blood loss volumes and postoperative adverse event rates were not different between the two groups. MS was better than PS from the viewpoint of preventing recurrent biliary obstruction, although MS was similar to PS with regards to perioperative outcomes.

Movement control and muscle function for pelvic movement in the frontal plane (pelvic elevation) are important for various single-leg sports activities. We aimed to clarify mechanical characteristics of pelvic squat (P-Sq: single-leg squat exercise with emphasis on pelvic elevation, developed by our research group) compared with the double-leg squat (D-Sq) and single-leg squat (S-Sq). Twelve male track and field athletes performed D-Sq, S-Sq, and P-Sq exercises at various loads (90%, 75%, and 60% of 1-repetition maximum [1RM]), using maximum effort. Kinematic and kinetic data were calculated using data recorded with a motion capture system and force platforms. We observed the highest values with P-Sq, followed by S-Sq and D-Sq under all load conditions as follows: peak vertical ground reaction force and rate of force development (RFD), range of pelvic elevation, peak pelvic elevation velocity, peak powers associated with hip abduction torque and trunk lateral flexion torque. In P-Sq, RFD at 90% 1RM was smaller than under the other load conditions, whereas peak vertical ground reaction force at 90% 1RM was larger than under the other load conditions. There were no differences among load conditions with regard to hip abduction and trunk lateral flexion torques and powers. Therefore, characteristics of P-Sq compared to those of D-Sq and S-Sq are 1) larger and faster pelvic elevation, using related muscles (hip abductors and trunk lateral flexors) under all load conditions, 2) larger peak ground reaction force with pelvic elevation under large load conditions, and larger RFD in pelvic elevation under low load conditions.

The purpose of this study was to identify the ground reaction force and lower extremity joint kinetics during clean exercises performed with light and heavy loads. Thirteen male track and field athletes performed the clean exercises from 20 kg to one repetition maximum (1RM). Kinetic data were collected from recorded data using a Vicon motion system (250 Hz) and force platforms (1,000 Hz). The results of the analyses were as follows: (1) Ground reaction force and joint kinetics of hip and ankle were increased by increasing loads in clean exercises. (2) From light to heavy loads, we found relationships between ground reaction force and joint torque of hip in clean exercises. (3) In progressing from light to heavy loads, some subjects continued to involve the muscle group controlling the hip joint as the main power source, while others did not. The results indicate that clean exercises yield different individual characteristics for training. These results suggest that the clean exercise is effective for selectively the hip extensor in all loads.

This study aimed to assess the effect of short-interval intracortical inhibition (SICI) before a jump off a platform (pre-set) on drop jump (DJ); the purpose was to investigate the relationship between this activity and performance, and the different effects of SICI on agonist and antagonist muscles during pre-set for jump athletes. Jump athletes (Jumper group, n=13) and Other athletes (Other group, n=9) performed DJ from drop heights of 0.30, 0.45, and 0.60 m). DJ performance was evaluated with DJ-index which was calculated from contact time and jump height. SICI was calculated from motor evoked potentials (MEP) recorded using paired-pulse transcranial magnetic stimulation for the medial gastrocnemius (MG) and tibialis anterior (TA) muscles in 7 jump athletes. Significantly higher DJ performance was observed for the Jumper group at all drop heights, and the Jumper group exhibited greater performance for the highest drop height than the Other groups. Significant decreases in SICI for MG were observed for the Jumper groups, and this decrease in inhibition was more prominent for the highest drop height during pre-set. Furthermore, the correlation between SICI for MG and DJ-index was stronger for increased drop heights, and a significantly positive correlation between these variables was observed at a height of 0.60 m. However, the SICI during the pre-set for TA exhibited no significant change under any of the conditions. The results of the present study suggest the importance of selective disinhibition of brain areas associated with the agonistic muscles during pre-set for higher DJ performance.

The aim of this study was to demonstrate a time-series relationship in drop jump (DJ) from a pre-set state with improved performance. Twelve male college athletes performed a DJ from a height of 0.60 m. DJ performance was assessed with a DJ-index (jump height/contact time). Short-interval intracortical inhibition (SICI) was assessed as intracortical inhibitory circuit excitability in a pre-set state, calculated by using paired-pulse transcranial magnetic stimulation for the medial gastrocnemius muscle (MG). The H-reflex of the left MG and the ankle joint torque were calculated in the early phase of take-off. A significant correlation was shown between ⊿SICI during the pre-set state and the DJ index. Thus, we examined the relationships between phases, focusing on time-series relationships throughout the jump period. The results showed a significant correlation between ⊿SICI during the pre-set state and %H-reflex during the early phase of take-off, and peak ankle joint torque during take-off was also significantly correlated with %H-reflex during the early phase of take-off. A significant correlation was also demonstrated between ankle joint torque during take-off and the DJ-index. In conclusion, we observed a time-series relationship between DJ from a pre-set state and improved performance. A decrease of intracortical inhibitory circuit excitability in the pre-set state affects stretch-reflex facilitation during the early phase of take-off; stretch-reflex facilitation results in the development of a large force in the ankle joint during take-off, and this force develops ankle joint torque. These findings may be used to improve jump performance.

　　This study is designed to clarify the effects of increases in a rehabilitation session on the functional outcome of hip fractures in the subacute phase.　　Of 95 patients with hip fractures admitted to our subacute care ward between November 2010 and March 2012, five patients transferred to another ward due to complications were excluded, and 90 patients were taken up. The 90 patients were divided into two groups: 22 patients who underwent rehabilitation before an increase in the frequency of rehabilitation sessions (early-phase group) and 68 who underwent rehabilitation after an increase in the frequency (later-phase group). Outcomes, such as the number of rehabilitation sessions, length of hospital stay, FIM at the time of discharge, FIM efficiency and destination after hospital discharge, were compared between the two groups.　　In a comparison of all patients, the number of rehabilitation sessions significantly increased (p<0.001), but there was no significant difference in FIM at the time of discharge from hospital, FIM efficiency and post-discharge destination. Group “Rank A” stood out in a comparison of the degree of independence enjoyed by the disabled elderly in their daily life before they suffered injuries (p<0.05). Group “Rank I” stood out in a comparison of the degree of independence in the daily life by the elderly with dementia, while they were in hospital (p⁢0.05). The FIM efficiency of the later-phase group was significantly higher than that of the early-phase group.　　It is presumably effective to begin intensive rehabilitation for patients whose ADL ability is somewhat reduced and those who have cognitive impairments. It has been thought that cognitive impairment was one of the factors that inhibit rehabilitation for hip fractures. However, it has been suggested that improvements in ADL are possible with increases in rehabilitation sessions for cases with mild cognitive impairment.

　　The purpose of this study was to clarify the effectiveness the score of the family’s ability to care to determine the discharge destination in patients with hip fractures.　　The subjects were 73 patients with hip fractures, who were admitted to the subacute care ward. They were classified into two groups: 48 patients who were discharged to home and 25, who were transferred to some other hospital or nursing home. 　　The following parameters were compared between the two groups: sex, age, preinjury level of independence in daily living for the disabled elderly, level of independence in daily living for the demented elderly during hospitalization, FIM (Functional Independence Measure) at the time of discharge from hospital, number of family caregivers, familial care ability score, and length of hospitalization. The parameters presenting significant differences were used as independent variables in multiple logistic regression analysis, with discharge outcome as the dependent variable.　　The parameters presenting significant differences between the two groups were “FIM at hospital discharge” and “familial care ability score”. In addition, multiple logistic regression analysis revealed that “FIM at hospital discharge” and “familial care ability score” were significantly related to discharge outcome. Results of receiver operating characteristic analysis (area under the curve) for &ldqup;FIM at hospital discharge,” “familial care ability score,” and “FIM at hospital discharge＋familial care ability score” were 0.763, 0.681, and 0.786, respectively. Furthermore, the area under the curve for “FIM at discharge＋familial care ability score” was higher compared with those for the other parameters.　　Thus, we demonstrated that familial care ability score was effective in determining the discharge destination in patients with hip fractures.