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.

Insufficient physical function is strongly associated with decreased activity of daily living and health-related quality of life in middle-aged and older women. YOSAKOI Soran is one of the traditional Japanese dances to have naruko (wooden hand clappers) in their hands as they dance and incorporate the phrase from the Soran Bushi in their song. YOSAKOI Soran festivals can be seen being held in various places across the country, proving its growing popularity with residents as a celebration regardless of age or occupation. The purpose of this study was to examine the cross-sectional associations between YOSAKOI Soran and the physical functions of middle-aged and older women. A total of 30 middle-aged and older women practicing YOSAKOI Soran (YOSAKOI group) and 163 middle-aged and older women who had not practiced YOSAKOI Soran (control group) participated in this cross-sectional study. Handgrip strength, 30-second chair stand performance, and flexibility were used to measure physical functions. Handgrip strength was not significantly differed between the YOSAKOI group and the control group (P = 0.79). 30-second chair stand performance and flexibility were significantly higher in the YOSAKOI group than in the control group (both P < 0.05). These results remained significant after adjusting for age and body mass index (both P < 0.05). The present results suggest that practicing YOSAKOI Soran may increase lower extremity function and flexibility in middle-aged and older women.

Objective: Owing to the potential benefits of minimally invasive hysterectomy for endometrial cancer, the practice pattern has recently shifted in Japan. This study examined the trends in minimally invasive surgery (MIS) in patients with endometrial cancer in Japan. Methods: This retrospective observational study examined the Japan Society of Obstetrics and Gynecology Tumor Registry database between 2015–2019. This study examined the time-specific proportion change and predictors of MIS use in initial endometrial cancer treatment in Japan, and compared it with the use of abdominal surgery. Additionally, the association between hospital surgical treatment volume and MIS use was examined. Results: A total of 14,059 patients (26.5%) underwent minimally invasive hysterectomy, and 39,070 patients (73.5%) underwent abdominal hysterectomy in the study period. Patients who underwent MIS were more likely to be treated at high-volume centers, younger, central, or western Japan residents, registered in recent years, and had a tumor with stage I disease, type 1 histology, and less myometrial invasion (all adjusted p<0.05). The proportion of MIS treatments increased from 19.1% in 2015 to 34.3% in 2019 (p<0.001). On multivariable analysis, treatment at high-volume centers was a contributing factor for MIS (adjusted odds ratio=3.85; 95% confidence interval=3.44–4.30). MIS at high-volume centers increased significantly from 24.8% to 41.0% (p<0.001) during the study period, whereas MIS at low-volume centers remained at median 8.8%. Conclusion MIS has increased significantly in recent years, accounting for nearly 34% of surgical management of endometrial cancer in Japan. High-volume treatment centers take the lead in performing MIS.

In Mongolian gerbils, bilateral common carotid artery occlusion (BCCAO) for several minutes induces ischemia, due to an incomplete circle of Willis, resulting in delayed neuronal cell death in the Cornet d'Ammon 1 (CA1) region of the hippocampus. Neuronal cell death in the hippocampus and changes in behavior were examined after BCCAO was performed for 5 min in the gerbils. One day after BCCAO, the pyramidal neurons of the CA1 region of the hippocampus showed degenerative changes (clumped chromatin in nuclei). At 5 and 10 days after BCCAO, extensive neuronal cell death was observed in the hippocampal CA1 region. Cognitive performance was evaluated by using the radial maze and passive avoidance tests. In the radial maze test, which examines win-stay performance, the number of errors was significantly higher in ischemic gerbils than in sham-operated gerbils on days 1 and 2 post-operation. In the passive avoidance test, the latency and freezing times were significantly shorter in ischemic gerbils than in sham-operated gerbils on the days 1, 2, and 4–6 post-operation. These results indicate that transient forebrain ischemia impairs cognitive performance, even immediately after the ischemic insult when there are only subtle signs of neuronal cell death.
CA1 Region, Hippocampal ; Carotid Artery, Common ; Cell Death ; Chromatin ; Circle of Willis ; Freezing ; Gerbillinae ; Hippocampus ; Ischemia ; Neurons ; Prosencephalon ; Pyramidal Cells

Early detection and treatment decrease the mortality rate associated with gastric cancer (GC). However, the natural history of GC remains unclear. An 85-year-old woman was referred to our hospital for evaluation of a gastric tumor. Esophagogastroduodenoscopy identified a 6 mm, flat-elevated lesion at the lesser curvature of the antrum. A biopsy specimen showed a well-differentiated tubular adenocarcinoma. The depth of the lesion was estimated to be intramucosal. Although the lesion met the indications for endoscopic resection, periodic endoscopic follow-up was performed due to the patient's advanced age and comorbidities. The mucosal GC invaded into the submucosa 3 years later, and finally progressed to advanced cancer 5 years after the initial examination. The patient died of tumor hemorrhage 6.4 years after the initial examination. In this case, mucosal GC progressed to advanced GC, eventually leading to the patient's death from GC. Early and appropriate treatment is required to prevent GC-related death.
Adenocarcinoma ; Aged, 80 and over ; Biopsy ; Comorbidity ; Endoscopy, Digestive System ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Mortality ; Natural History* ; Stomach Neoplasms*

History of Mongolian medicine could be traced back to 2000 years ago. Mongolian traditional medicine has been built over many years. We traveled Mongolia to visit a hospital and a private clinic where traditional Mongolian medicine is in practice, and visited National University of Medical Sciences. In this paper, we report the current status of traditional medicine in Mongolia. We visited Mongolian National University of Medical Sciences and conversed with the president, vicepresident, and director of the traditional medical department. We visited a clinic where Mongolian traditional medicine is performed and a hospital where mainly traditional therapies and practical development are carried out. In the hospital, they mainly provide acupuncture and moxibustion treatment, cupping therapy, herbal therapy, and thermotherapy. It cannot be denied that moxibustion treatment came from Mongolia, because it is also said that ‘the north' in “Huangdi Neijing Suwen” chapter 12 means Mongolia. However, as there is a background once traditional medicine has been kept away from the national health care system, it is difficult to find a specific medical practice for Mongolian medicine as far as we have viewed the present status of medical practice in Mongolia. Considering that the cultural exchange with Japan is being carried out in many other fields, we expect that a number of new facts will come to light in the near future.

STUDY DESIGN: A retrospective study. PURPOSE: To examine the effectiveness of using an electrodiagnostic technique as a new approach in the clinical diagnosis of extraforaminal stenosis at L5-S1. OVERVIEW OF LITERATURE: We introduced a new effective approach to the diagnosis of extraforaminal stenosis at the lumbosacral junction using the existing electrophysiological evaluation technique. METHODS: A consecutive series of 124 patients with fifth lumbar radiculopathy were enrolled, comprising a group of 74 patients with spinal canal stenosis and a second group of 50 patients with extraforaminal stenosis at L5-S1. The technique involved inserting a pair of needle electrodes into the foraminal exit zone of the fifth lumbar spinal nerves, which were used to provide electrical stimulation. The compound muscle action potentials from each of the tibialis anterior muscles were recorded. RESULTS: The distal motor latency (DML) of the potentials ranged from 11.2 to 24.6 milliseconds in patients with extraforaminal stenosis. In contrast, the DML in patients with spinal canal stenosis ranged from 10.0 to 17.2 milliseconds. After comparing the DML of each of the 2 groups and at the same time comparing the differences in DML between the affected and unaffected side of each patient, we concluded there were statistically significant differences (p<0.01) between the 2 groups. Using receiver operating characteristic curve analysis, the cutoff values were calculated to be 15.2 milliseconds and 1.1 milliseconds, respectively. CONCLUSIONS: This approach using a means of DML measurement enables us to identify and localize lesions, which offers an advantage in diagnosing extraforaminal stenosis at L5-S1.
Action Potentials ; Constriction, Pathologic* ; Diagnosis* ; Diagnostic Techniques and Procedures ; Electric Stimulation ; Electrodes ; Humans ; Muscles ; Needles ; Radiculopathy ; Retrospective Studies ; ROC Curve ; Spinal Canal ; Spinal Nerves ; Spinal Stenosis

BACKGROUND/AIMS: Infliximab (IFX), an antibody to tumor necrosis factor, (TNF)-alpha has efficacy in treating Crohn's disease (CD). However, knowledge of the potential effects of IFX on patients' immune profiles is lacking. The purpose of this study was to reveal the immunological effects of IFX. METHODS: Twenty-two patients with a CD activity index (CDAI) of 194.2+/-92.9 and an average duration of disease of 3.26 months and 21 healthy controls were included. Patients were to have their first IFX remission induction therapy with 3 infusions (5 mg/kg) at weeks 0, 2, and 6. Oral 5-aminosalicylic acid was the only ongoing medication in the patient population. Blood samples at baseline, 12 hours after the first infusion and at week 14 were labeled with anti-CD4/CD25 antibodies for immunohistochemical measurement of regulatory T-cells (Treg). Serum cytokines and chemokines were measured by suspension array and ELISA. RESULTS: CDAI significantly decreased prior to the second IFX infusion (p<0.001). Clinical remission rates were 77.3% and 91% by the second and third infusions, respectively. At baseline, interleukin (IL)-6 (p<0.03), IL-8 (p<0.03), IL-10 (p=0.050), IL-13 (p<0.01), transforming growth factor-beta1 (p<0.01), and 'regulated on activation, normal T cell expressed and secreted' (RANTES) (p<0.01) were elevated in patients. After the initial IFX infusion, TNF-alpha (p<0.04), IL-6 (p<0.03), interferon (IFN)-gamma (p<0.04), IFN-gamma-inducible protein-10 (p<0.01), monocyte chemoattractant protein-1 (p<0.01), macrophage inflammatory protein-1beta (p<0.01), and RANTES (p<0.01) were decreased. IFX infusion was associated with an increase in Treg (p<0.01) and a decrease in the Th1 (IFN-gamma)/Th2 (IL-4) ratio (p<0.03). CONCLUSIONS: IFX use was associated with restoration of the Th1/Th2 balance after a single infusion and seemed to promote induction of naive Th0 lymphocytes to Treg. This knowledge should have clinical relevance.
Antibodies ; Antibodies, Monoclonal ; Chemokine CCL2 ; Chemokine CCL5 ; Chemokines ; Crohn Disease ; Cytokines ; Humans ; Immune System ; Interferons ; Interleukin-10 ; Interleukin-13 ; Interleukin-6 ; Interleukin-8 ; Interleukins ; Lymphocytes ; Macrophages ; Mesalamine ; Remission Induction ; T-Lymphocytes, Regulatory ; Tumor Necrosis Factor-alpha ; Infliximab

We experienced a clinical case of a patient with psychotic depression who ingested the residual saponated cresol solution from a 500ml bottle of cresol, a disinfectant, with the intention of committing suicide. Through this experience, we felt it neccessary to investigate the present commercial situation of cresol for domestic use, and to come up with some safty measares.All the 128 drugstores and pharmacies in four cities located in the Tohno area of Gifu Pref. (Mizunami, Toki, Tajimi and Ena) were queried by telephone about the sale and stock of cresol.Almost 80% of the drugstores in these four cities, excluding pharmacies, were found to deal in saponated cresol solutions. They carried a little more than two 500ml bottles of cresol on average. This volume exceeds an estimated adult lethal dose of 250ml.Although it is unlikely that an ordinary household will use the whole of 500ml bottle of the disinfectant at a time, the residual saponated cresol solution could increase the risk of accidental cresol poisoning at home.So, it would be desirable not to sell 500ml bottles in ordinary drugstores. Furthermore, before selling a bottle of cresol, the pharmacists, who have a specialized knowledge about it, should kindly explain to the user about its toxicity and usage.
cresol ; Solutions ; Area ; Disinfectants ; Cancer patients and suicide and depression

The purpose of this study was to examine how S-R compatibility affected P 300, the stimulusevaluation process and response process. The P 300 component is thought to reflect information processing of stimuli. Previous studies used visual stimuli. In this study, we measured S-R compatibility effects on EMG-RT and P 300 using electrical somatosensory stimuli. Subjects performed the oddball task (Task 1) and the four-choice stimuli response task (Task 2) . They were presented electrical stimuli through ring electrodes on the index and little fingers of both hands and instructed to respond quickly to stimuli. S-R compatibility was decided by position of the stimuli. EMG-RT and P 300 latency for compatible and incompatible conditions were analyzed.
For ERP analysis, data of subjects who reacted faster to compatibility ware used. Neither P 300 latency nor amplitude differed significantly between compatibility and incompatibility in Tasks 1 and 2, but for Task 2, latency tended to be prolonged by incompatibility. Therefore, it is thought that S-R compatibility mainly has an effect on response processing. However, judging from the tendency of P 300 latency to be prolonged by incompatibility for Task 2, it was considered that there is the possibility that S-R compatibility influenced P 300 latency, even if using a somatosensory stimulus.