Long-term Favorable Efficacy of Regular and Repeated Hospitalizations with a Personalized Diet and Exercise Treatment for Steatotic Liver Disease.

Objective The long-term impact of personalized diet and exercise programs for steatotic liver disease (SLD) remains unclear. Materials The subjects of this retrospective cohort study included 104 consecutive Japanese patients with SLD. The long-term treatment efficacy of personalized diet and exercise treatment was evaluated two years after the start of observation. Regular and repeated hospitalizations every 6 months (RRH group, n=23) indicated the 4 times of the number of hospitalizations, and irregular hospitalizations (IH group, n=56) showed the 1 to three times. The group without hospitalization was defined as the no hospitalization group (NH group, n=25). To balance confounding biases, the difference in treatment efficacy between the RRH and IH groups was evaluated using propensity score (PS)-matched analysis. A diet of 25 to 30 kcal/kg multiplied by ideal body weight (BW) daily, and aerobic and resistance exercise (exercise intensity of 4 to 5 metabolic equivalents daily, respectively) was performed for 6 days. Results At 2 years compared to baseline, the decrease rates of liver function tests, HbA1c, and physical findings in the RRH group were significantly higher than those in the NH or IH groups by multiple comparisons. According to the liver function tests and physical findings, the rate of decrease in the RRH group (17 cases) was significantly higher than that in the IH group (17 cases) using a PS-matched analysis. Conclusion The present study indicated the long-term favorable efficacy of personalized diet and exercise programs for SLD. In particular, this RRH program was effective in improving the findings of liver function tests and might help to sustain diet and exercise.

Impact of genetic polymorphism on personalized diet and exercise program for steatotic liver disease.

AIMS: The effects of genetic polymorphism on a personalized diet and exercise program for steatotic liver disease (SLD) are still unclear. METHODS: Participants of this retrospective cohort study were 203 Japanese patients with SLD diagnosed by abdominal ultrasonography. All of them were introduced the personalized diet and exercise treatment. A diet of 25-30 kcal/kg multiplied by ideal body weight (BW) daily and aerobic and resistance exercise (exercise intensity of 4-5 metabolic equivalents daily, respectively) were performed for 6 days. Treatment efficacy was evaluated in terms of the rate of decrease of liver function tests, glycolipid metabolism markers, physical findings, image findings, and cardiovascular disease (CVD) risk score at 6 months compared with baseline. Furthermore, the impact of genetic polymorphism was also investigated. RESULTS: At 6 months compared with baseline, liver function tests (AST, ALT, γGTP), glycolipid metabolism markers (hemoglobin A1c, triglycerides [TG], low-density lipoprotein cholesterol), physical findings (BW, body mass index), image finding (liver stiffness measurement), and CVD risk score (Suita score) improved significantly. There was no significant difference in treatment efficacy, except for the rates of decrease of TG, according to genotype PNPLA3 rs738409, TM6SF2 rs58542926, and HSD17B13 rs6834314. The rates of decrease of TG with TM6SF2 CT were significantly higher than those with CC or TT, and the rates of TG with HSD17B13 AA were significantly higher than those with AG by multiple comparisons. CONCLUSION: Personalized diet and exercise program for SLD improved liver function tests, physical findings, glycolipid metabolism markers, and CVD risk score. Genetic polymorphism might partially affect treatment efficacy. Further studies should be performed to develop an individualized program for SLD, considering genetic polymorphism.

Treatment efficacy of diet and exercise program for fatty liver and pretreatment predictors.

AIMS: Both diet and exercise counseling are recommended for patients with fatty liver, including nonalcoholic fatty liver disease (NAFLD), to achieve weight loss goals. However, data evaluating treatment efficacy are limited. METHODS: The subjects of this retrospective cohort study were 186 consecutive Japanese cases with fatty liver diagnosed by abdominal ultrasonography. Treatment efficacy and predictive factors of "Hospitalization Program for Improvement Purpose for Fatty Liver" as a combined diet and aerobic and resistance exercise program were evaluated according to the hospitalization group (153 cases) or the no hospitalization group (33 cases). To balance the confounding biases, treatment efficacy was evaluated using propensity score-matched analysis. In the hospitalization group, a diet of 25-30 kcal/kg multiplied by ideal body weight (BW) daily and aerobic and resistance exercise (exercise intensity of 4-5 metabolic equivalents daily, respectively) were performed for 6 days. RESULTS: In liver function tests and BW at 6 months compared with baseline, the rates of decrease of the hospitalization group (24 cases) were significantly higher than those of the no hospitalization group (24 cases), using propensity score-matched analysis. In markers of glycolipid metabolism and ferritin levels, the rates of the hospitalization group were not different from those of the no hospitalization group. In the hospitalization group (153 cases), multivariate regression analysis identified the etiology of non-NAFLD, the presence of diabetes mellitus, and large waist circumference as independent predictors of decreased rates of hemoglobin A1c levels. CONCLUSION: The diet and exercise program for fatty liver improved liver function tests and BW. Further study should be performed to develop a feasible and suitable program.

[Ultrasonography for carpal tunnel syndrome].

Ultrasonography in cases of carpal tunnel syndrome is described with respect to the following aspects: (1) imaging technique; (2) image characteristics; (3) detection of pathophysiology; (4) diagnosis of idiopathic cases; (5) screening of local pathologies (space-occupying lesions, tenosynovitis, and bone and joint abnormalities), incomplete release, and anatomic variations; and (6) role in facilitating minimally-invasive surgery.

[Ultrasonography for the management of carpal tunnel syndrome].

Ultrasonography is useful for the management of carpal tunnel syndrome. It aids in the diagnosis of idiopathic cases, screening of local pathologies(space-occupying lesions, tenosynovitis, and bone and joint abnormalities), incomplete release, and anatomic variations, and performance of low-invasive surgery.

Percutaneous carpal tunnel release compared with mini-open release using ultrasonographic guidance for both techniques.

PURPOSE: To compare the outcomes of percutaneous carpal tunnel release (PCTR) and mini-open carpal tunnel release (mini-OCTR) using ultrasonographic guidance for both techniques. METHODS: We included 74 hands of 65 women with idiopathic carpal tunnel syndrome (age, 52-71 y; mean, 58 y). Thirty-five hands of 29 women had the PCTR (release with a device consisting of an angled blade, guide, and holder, along a line midway between the median nerve and ulnar artery (safe line) under ultrasonography (incision, 4 mm), and 39 hands of 36 women had the mini-OCTR (release along the safe line, distally under direct vision (incision, 1-1.5 cm) and proximally under ultrasonography, using a device consisting of a basket punch and outer tube. RESULTS: Assessments at 3, 6, 13, 26, 52, and 104 weeks showed no significant differences in neurologic recovery between the groups (p > .05). The PCTR group had significantly less pain, greater grip and key-pinch strengths, and better satisfaction scores at 3 and 6 weeks (p < .05), and less scar sensitivity at 3, 6, and 13 weeks (p < .05). There were no complications. CONCLUSIONS: The PCTR provides the same neurologic recovery as does the mini-OCTR. The former leads to less postoperative morbidity and earlier functional return and achievement of satisfaction. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Patient education for the treatment of ulnar neuropathy at the elbow.

OBJECTIVE: To assess the effect of patient education, the simplest conservative treatment of ulnar neuropathy at the elbow, and establish its indication. DESIGN: Patients with ulnar neuropathy at the elbow were treated by education. Its effects and factors affecting outcome were investigated. The length of the treatment was at least 3 months. If the symptoms were improving, the follow-up was lengthened. All of the improved patients were followed up at least for 1 year after they reached a plateau of improvement to check recurrence. SETTING: Patients were selected from an outpatient clinic of a general hospital. PARTICIPANTS: Patients (N=77; 80 nerves) with ulnar neuropathy at the elbow diagnosed clinically and electrophysiologically. INTERVENTIONS: Patient education on the pathophysiology and activity modification to unload the ulnar nerve from mechanical stress. MAIN OUTCOME MEASURES: Outcomes were graded as excellent, good, fair, or poor with use of the modified Akahori's classification system. Patient satisfaction was graded as 1 (low) to 5 (high). Repeat nerve conduction studies were performed in those who gave consent, and results were graded as excellent, good, fair, or poor. RESULTS: Fifty-three nerves (66%) had excellent or good outcomes. Multivariate logistic regression analysis revealed that degenerative change (graded as normal, mild, moderate, or severe) was associated with the outcome, while age, sex, side, duration and severity of the disease, diabetes, dislocation of the nerve, and smoking were not. Excellent or good outcomes were obtained in 43 (80%) of 54 nerves with no or mild degeneration and 10 (38%) of 26 nerves with moderate or severe degeneration. Recurrence was less frequent in the former (2 of 43 nerves, 5%) than the latter (4 of 10, 40%). The outcomes strongly correlated with the satisfaction scores and repeat nerve conduction study results. CONCLUSIONS: Patient education is effective for a considerable number of patients with ulnar neuropathy at the elbow. Whether this is indicated depends on the grade of elbow degeneration. Those who have no or mild degeneration respond better to this treatment with a lower rate of recurrence than those with more severe degeneration regardless of age, sex, side, duration and severity of the disease, presence or absence of diabetes and dislocation of the nerve, and smoking status.

Hypercholesterolemia as a risk factor for idiopathic carpal tunnel syndrome.

In idiopathic carpal tunnel syndrome (CTS), the median nerve is enlarged within the carpal tunnel due to intraneural connective tissue proliferation. Because hypercholesterolemia, especially increase in low-density lipoprotein (LDL), has been associated with fibrogenesis, we investigated the association of median nerve cross-sectional area and prevalence of idiopathic CTS with serum lipid measurements in middle-aged patients and controls. We found that nerve area and prevalence of CTS were correlated with serum LDL levels. Thus, high LDL levels in middle age are a risk factor for idiopathic CTS, suggesting that the LDL-correlated median nerve enlargement increases the volume of the carpal tunnel contents.

Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: Diagnostic accuracy.

Severity-correlated enlargement of the median nerve occurs in idiopathic carpal tunnel syndrome (CTS). We determined whether measurement of the nerve cross-sectional area was useful in making the diagnosis of CTS. In 414 wrists of 275 patients with clinically diagnosed idiopathic CTS and 408 wrists of 408 controls, we made ultrasonographic measurements of the nerve area at the distal (distal edge of the flexor retinaculum), mid (hook of the hamate), and proximal carpal tunnel (wrist crease). Criteria based on the area at a single level yielded sensitivities of 43-57% and specificities of 96-97%. Use of the mean carpal nerve area (average of the areas at the three levels) improved the results (sensitivity, 67%; specificity, 97%), which was as sensitive as the nerve conduction studies (NCS). In the NCS, we obtained sensitivities of 66% for the distal motor nerve latency and 67% for the distal sensory nerve latency, with specificities of 97% for each. A combination of the mean carpal nerve area and NCS criteria yielded a sensitivity of 84% and a specificity of 94%. The clinical implications of these findings for the diagnosis of CTS are discussed.