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CASE: A 62-year-old woman receiving romosozumab for 3 months underwent extreme lateral interbody fusion (XLIF) for lumbar degenerative spondylolisthesis. From 1 week after surgery, she experienced gradually increasing pain from the right groin to the front of the thigh. Examination revealed ossifying myositis in bilateral psoas major muscles. Etidronate treatment was initiated, improving pain after 4 days. Computed tomography showed lesion disappearance by 3 months after surgery. CONCLUSION: We report a rare case of myositis ossificans in bilateral psoas major muscles following XLIF surgery, possibly influenced by intraoperative manipulation and romosozumab treatment. Etidronate administration may be effective, as with heterotopic ossification.
Subject(s)
Myositis Ossificans , Psoas Muscles , Spinal Fusion , Humans , Female , Middle Aged , Myositis Ossificans/diagnostic imaging , Myositis Ossificans/surgery , Myositis Ossificans/drug therapy , Psoas Muscles/diagnostic imaging , Spondylolisthesis/surgery , Spondylolisthesis/diagnostic imaging , Antibodies, Monoclonal/administration & dosage , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/surgeryABSTRACT
Arterio-ureteral fistulas (AUFs), which are relatively rare but potentially life-threatening, require prompt diagnosis and treatment. We reported a case of AUFs following robot-assisted laparoscopic radical cystectomy (RARC) with extended pelvic lymph node dissection and ileal conduit urinary diversion for muscle-invasive bladder cancer, which resulted in massive hemorrhage. Urine leaked from the anastomosis between the ureter, and the end of the ileal conduit was infected, which resulted in an AUF between the pseudoaneurysm of the right common iliac artery and the ureter. The AUF was managed successfully by vascular intervention with an arterial stent graft.
Subject(s)
Aneurysm, False , Cystectomy , Iliac Artery , Laparoscopy , Robotic Surgical Procedures , Ureteral Diseases , Urinary Fistula , Vascular Fistula , Humans , Cystectomy/adverse effects , Aneurysm, False/etiology , Aneurysm, False/surgery , Urinary Fistula/etiology , Urinary Fistula/surgery , Ureteral Diseases/etiology , Ureteral Diseases/surgery , Iliac Artery/surgery , Vascular Fistula/etiology , Vascular Fistula/surgery , Male , Postoperative Complications/surgery , Postoperative Complications/etiology , Urinary Bladder Neoplasms/surgery , Aged , Middle AgedABSTRACT
Brain degenerations in sporadic Alzheimer's disease (AD) are observed earliest in the locus coeruleus (LC), a population of noradrenergic neurons, in which hyperphosphorylated tau protein expression and ß-amyloid (Aß) accumulation begin. Along with this, similar changes occur in the basal forebrain cholinergic neurons, such as the nucleus basalis of Meynert. Neuronal degeneration of the two neuronal nuclei leads to a decrease in neurotrophic factors such as brain-derived neurotrophic factor (BDNF) in the hippocampus and cerebral cortex, which results in the accumulation of Aß and hyperphosphorylated tau protein and ultimately causes neuronal cell death in those cortices. On the other hand, a large number of epidemiological studies have shown that tooth loss or masticatory dysfunction is a risk factor for dementia including AD, and numerous studies using experimental animals have also shown that masticatory dysfunction causes brain degeneration in the basal forebrain, hippocampus, and cerebral cortex similar to those observed in human AD, and that learning and memory functions are impaired accordingly. However, it remains unclear how masticatory dysfunction can induce such brain degeneration similar to AD, and the neural mechanism linking the trigeminal nervous system responsible for mastication and the cognitive and memory brain system remains unknown. In this review paper, we provide clues to the search for such "missing link" by discussing the embryological, anatomical, and physiological relationship between LC and its laterally adjoining mesencephalic trigeminal nucleus which plays a central role in the masticatory functions.
ABSTRACT
Trans-sacral canal plasty (TSCP) is a minimally invasive lumbar spine surgery under local anaesthesia. TSCP is expected to be effective regardless of whether the patient has had previous surgery. However, there are cases in which open revision surgery is required after TSCP. This study aimed to identify risk factors for open revision surgery after TSCP in order to determine surgical indications and limitations. A retrospective case-control study was conducted in patients who underwent TSCP for lumbar spine disease. Data of 112 patients were analysed. During an observation period of 7-23 months, 34 patients (30.4%) required open revision surgery and 78 (69.6%) did not. The following patient background characteristics were investigated: age, sex, body mass index (BMI), diagnosis, history of spine surgery and the institution where the surgery was performed. Comorbidities were scored using the Elixhauser Comorbidity Index. Preoperative imaging parameters were investigated, including the lesion level (L4/5, L5/S1, other), presence of intervertebral instability, dural sac area, presence of bony stenosis and presence of epidural lipoma. Multivariate analysis revealed that intervertebral instability (odds ratio 2.56, confidence interval 1.00-6.51, p = 0.046) and a narrow dural sac area (odds ratio 0.98, confidence interval 0.97-0.99, p = 0.002) were significant risk factors for open revision surgery after TSCP.
ABSTRACT
Background: We encountered a case of infected soft tissue defect of the fingertip treated using negative pressure wound therapy (NPWT). The development of NPWT was started in the early 1990s, and it is a relatively new treatment method included in insurance coverage in Japan in 2010. NPWT is used for intractable wounds; some reports have examined its use on infected wounds. However, to the best of our knowledge, no study has examined its use on infected fingertip wounds. Methods: A patient with an infected soft tissue defect in the fingertip whose epithelialization period was prolonged despite continued antibiotic therapy was treated using NPWT in combination. Results: After NPWT was started, signs of infection and wound granulation were good. Additionally, completion of epithelialization was confirmed 7 weeks after NPWT started. Conclusions: Conventionally, skin flap or graft by hand surgeons have been performed on fingertip soft tissue defects with infection. NPWT does not require specialized and advanced surgical techniques; treatment for infected soft tissue defects can be administered by anyone if they have the required skills. In conclusion, NPWT may be considered a suitable alternative when treatment options such as flaps and skin grafts are not feasible.
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BACKGROUND: Nivolumab plus ipilimumab (NIVO + IPI) is the first-line treatment for patients with metastatic renal cell carcinoma (mRCC). While approximately 40% of patients treated with NIVO + IPI achieve a durable response, 20% develop primary resistance with severe consequences. Therefore, there is a clinical need for criteria to select patients suitable for NIVO + IPI therapy to optimize its therapeutic efficacy. Accordingly, our aim was to evaluate the association between candidate biomarkers measured before treatment initiation and survival. METHODS: This was a multi-institutional, retrospective, cohort study of 183 patients with mRCC treated with systematic therapies between August 2015 and July 2023. Of these, 112 received NIVO + IPI as first-line therapy: mean age, 68 years; men, 83.0% (n = 93), and clear cell histology, 80.4% (n = 90). Univariable and multivariable analyses were used to evaluate associations between biomarkers and survival. RESULTS: On univariate analysis, high C-reactive protein and systemic index, a high neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio, and a low lymphocyte-to-monocyte ratio (LMR) were associated with shorter overall survival (OS). On multivariable analysis, a LMR ≤ 3 was retained as an independent factor associated to shorter OS with the highest accuracy (C-index, 0.656; hazard ratio, 7.042; 95% confidence interval, 2.0-25.0; p = 0.002). CONCLUSION: A low LMR may identify patients who would be candidate for NIVO + IPI therapy for mRCC.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Carcinoma, Renal Cell , Ipilimumab , Kidney Neoplasms , Lymphocytes , Monocytes , Nivolumab , Humans , Carcinoma, Renal Cell/drug therapy , Carcinoma, Renal Cell/mortality , Carcinoma, Renal Cell/secondary , Ipilimumab/administration & dosage , Ipilimumab/therapeutic use , Nivolumab/administration & dosage , Nivolumab/therapeutic use , Male , Aged , Female , Retrospective Studies , Kidney Neoplasms/drug therapy , Kidney Neoplasms/pathology , Kidney Neoplasms/mortality , Kidney Neoplasms/blood , Middle Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Lymphocytes/pathology , Biomarkers, Tumor/blood , Aged, 80 and overABSTRACT
The muscle contraction during voluntary movement is controlled by activities of alpha- and gamma-motoneurons (αMNs and γMNs, respectively). In spite of the recent advances in research on molecular markers that can distinguish between αMNs and γMNs, electrophysiological membrane properties and firing patterns of γMNs have remained unknown, while those of αMNs have been clarified in detail. Because of the larger size of αMNs compared to γMNs, blindly or even visually recorded MNs were mostly αMNs, as demonstrated with molecular markers recently. Subsequently, the research on αMNs has made great progress in classifying their subtypes based on the molecular markers and electrophysiological membrane properties, whereas only a few studies demonstrated the electrophysiological membrane properties of γMNs. In this review article, we provide an overview of the recent advances in research on the classification of αMNs and γMNs based on molecular markers and electrophysiological membrane properties, and discuss their functional implication and significance in motor control.
Subject(s)
Motor Neurons , Animals , Motor Neurons/physiology , Motor Neurons/metabolism , Rats , Trigeminal Nuclei/physiology , Trigeminal Nuclei/metabolism , Electrophysiological PhenomenaABSTRACT
Blood flow to the active muscles and arterial blood pressure (ABP) increase during dynamic exercise, whereas blood flow to inactive organs (e.g., splanchnic organs and inactive limbs) declines. Aging leads to exaggerated ABP responses to exercise in females, but whether this is related to greater splanchnic vasoconstriction is unknown. This study sought to clarify the effect of aging in females on celiac artery blood flow during dynamic light-intensity exercise. Twelve healthy young females (YF: 20 ± 2 yr, mean ± SD) and 12 healthy older females (OF: 71 ± 4 yr) performed dynamic knee-extension and knee-flexion exercises at 30% of heart rate reserve for 4 min. The absolute changes from baseline (Δ) for mean arterial blood pressure (MAP), celiac artery mean blood flow (celMBF), and celiac vascular conductance (celVC) during exercise were calculated. ABP was measured using an automated sphygmomanometer, and celMBF was recorded by Doppler ultrasonography. The increase in MAP during exercise was greater in OF than in YF (YF: +14 ± 7 mmHg, OF: +24 ± 13 mmHg, P = 0.028). The celMBF decreased during exercise in both groups, but there was no significant difference in the response between YF and OF (YF: -93.0 ± 66.1 mL/min, OF: -89.6 ± 64.0 mL/min, P = 0.951). The celVC also decreased during exercise and remained lower than baseline during exercise. However, the response was not different between YF and OF (YF: -1.8 ± 1.0 mL/min/mmHg, OF: -1.5 ± 0.6 mL/min/mmHg, P = 0.517). These results demonstrate that aging in females has minimal influence on splanchnic artery hemodynamic responses during dynamic light-intensity exercise, suggesting that exaggerated ABP responses during exercise in OF are not due to greater splanchnic vasoconstriction.NEW & NOTEWORTHY During exercise, the splanchnic arteries vasoconstrict, contributing to blood flow redistribution and the blood pressure response. Blood pressure responses to exercise are exaggerated with aging in females; however, the physiological mechanism responsible has not been clarified. We show that celiac artery blood flow changes during light-intensity dynamic exercise do not differ with age in females. This indicates the exaggerated blood pressure to exercise with aging is likely not due to a difference in splanchnic vasoconstriction.
Subject(s)
Aging , Celiac Artery , Exercise , Humans , Female , Exercise/physiology , Aging/physiology , Young Adult , Aged , Regional Blood Flow , Splanchnic Circulation , Blood Flow Velocity , Arterial Pressure , Vasoconstriction , Blood Pressure/physiology , Adult , Age FactorsABSTRACT
Robot-assisted partial nephrectomy (RAPN) has been shown to be a safe and effective method for treatment of small renal tumors, including clinical T1b renal cell carcinoma (RCC); however, the impact of RAPN for cT1b renal tumors on renal function is not well understood. In this retrospective study, 50 patients who underwent RAPN for cT1b renal tumors were evaluated for pre- and post-operative renal function and perioperative clinical factors. Renal function was assessed using the estimated glomerular filtration rate (eGFR) at baseline and on postoperative days (POD) 1, 7, 30, and 180.A significant renal functional decline was defined as ≥ 15% reduction in eGFR at POD180 compared with eGFR at baseline. Logistic regression analyses were used to identify risk factors for renal function decline, including age, sex, RENAL nephrometry score, operative time, and estimated blood loss. The median patient age was 62 years, and the median tumor diameter and RENAL nephrometry score were 44 mm (IQR 43-50) and 8 (IQR 7-9), respectively. Of these patients, 16 (36%) showed a significant renal functional decline at POD 180. In the multivariate analysis, the L component of the RENAL nephrometry score and an estimated blood loss of 200 mL or more were identified as significant risk factors for renal functional decline. These findings suggest that the preoperatively definable L component of the RENAL nephrometry score and intraoperative blood loss, which may be modifiable factors, play significant roles in post-RAPN renal function decline.
Subject(s)
Carcinoma, Renal Cell , Kidney Neoplasms , Robotic Surgical Procedures , Robotics , Humans , Middle Aged , Retrospective Studies , Robotic Surgical Procedures/methods , Nephrectomy/adverse effects , Kidney/surgery , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgeryABSTRACT
BACKGROUND: Hallux valgus and hallux rigidus are disorders affecting the first ray and are associated with hypermobility of this structure. This study aimed to investigate the three-dimensional mobility of each joint of the first ray between feet with hallux valgus or hallux rigidus and healthy feet using weightbearing and nonweightbearing computed tomography (CT). METHODS: This case-control study analyzed 17 feet of 11 healthy volunteers (control group), 16 feet of 16 patients with hallux valgus (HV group), and 16 feet of 11 patients with hallux rigidus (HR group). First, nonweightbearing foot CT imaging was performed in the supine position on a loading device with no load applied, with the legs extended and the ankle in the neutral position. Next, a load equivalent to body weight was applied for weightbearing CT imaging. Distal bone displacement relative to the proximal bone was quantified three-dimensionally under both conditions. RESULTS: In the HV group, the talonavicular joint showed significantly greater eversion (P = 00.011) compared with the control group and significantly greater dorsiflexion (P = 00.027) and eversion (P < 00.01) compared with the HR group. In the medial cuneiform joint, the HV group showed significantly greater eversion (P < 00.01) and abduction (P = 00.011) than the control group. For the first tarsometatarsal joint, the HV group showed significantly greater dorsiflexion (P = 00.014), inversion (P = 00.028), and adduction (P < 00.01) than the control group, and greater inversion (P < 00.01) and adduction (P < 00.01) than the HR group. Dorsiflexion of the first tarsometatarsal joint was significantly greater in the HR group compared with the control group (P = 00.026). CONCLUSION: Hypermobility of the first ray appears to be three-dimensional: in hallux valgus, it is centered at the first tarsometatarsal joint, while in hallux rigidus it is mainly in the sagittal plane at the first tarsometatarsal joint only. This difference may explain the different deformities ultimately observed in each condition.
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CASE: This report describes a 25-year-old female professional triathlete with right external iliac artery endofibrosis (EIAE) that was definitively diagnosed on contrast-enhanced magnetic resonance images obtained immediately after treadmill running. The EIAE was treated by percutaneous transluminal angioplasty. By 8 weeks after surgery, she had no symptoms of claudication or pain in the right thigh after a 1-hour running session. There has been no recurrence in 1 year postoperatively. CONCLUSION: EIAE is a rare condition and difficult to diagnose in a timely manner because symptoms and radiographic imaging features appear only during intense exercise. Our patient was successfully treated with percutaneous transluminal angioplasty.
Subject(s)
Iliac Artery , Vascular Diseases , Female , Humans , Adult , Iliac Artery/diagnostic imaging , Exercise , Pain , Lower ExtremityABSTRACT
CASE: The patient was an 18-year-old man who had sustained diaphyseal fractures of the left femur and tibia in a traffic accident and underwent surgery at another hospital. A severe left foot equinovarus deformity developed in the early after surgery. The patient's left foot deformity was addressed using unconstrained gradual external fixator correction (the Matsushita method) in combination with soft-tissue contracture through Achilles tendon lengthening and was maintained after removing the external fixation. CONCLUSION: The Matsushita method can be effective in the correction of post-traumatic equinovarus foot deformities.
Subject(s)
Achilles Tendon , Equinus Deformity , Ilizarov Technique , Humans , Male , Adolescent , Achilles Tendon/surgery , Ilizarov Technique/instrumentation , Equinus Deformity/surgery , Equinus Deformity/etiology , Tibial Fractures/surgery , Tibial Fractures/diagnostic imaging , Femoral Fractures/surgery , Clubfoot/surgeryABSTRACT
STUDY DESIGN: Cross-Sectional Study. OBJECTIVES: To investigate the changes in the characteristics of cervical spinal cord injuries (CSCI) before and after the coronavirus disease 2019 (COVID-19) pandemic among patients transported to our hospital in Japan. SETTING: Hospital with an emergency center in Chiba, Japan. METHODS: Patients eligible for the study were those transported within 24 h of injury and diagnosed with cervical spinal cord injury between January 2018 and December 2021 at our hospital. Medical records were retrospectively examined to investigate the number and characteristics of patients with CSCI. The clinical variables of patients with CSCI were compared according to the time of admission as related to the COVID-19 pandemic: 2018-19 (before) or 2020-21 (after). RESULTS: The total number of patients with CSCI from 2018 to 2021 was 108, with 57 before the COVID-19 pandemic and 51 after the COVID-19 pandemic. The number of severe cases with an injury severity score (ISS) of >16 decreased after COVID-19 (p < 0.05). Falls on level surfaces were the most common cause of injury both before and after COVID-19. Although the ranking of traffic accidents decreased after COVID-19, among those, the number of bicycle injuries tended to increase. CONCLUSIONS: The number of serious cases with an ISS > 16 decreased, presumably because of the decline in high-energy trauma due to the background decrease in the number of traffic accidents.
Subject(s)
COVID-19 , Cervical Cord , Neck Injuries , Spinal Cord Injuries , Humans , Pandemics , Retrospective Studies , Cervical Cord/injuries , Cross-Sectional Studies , Cervical Vertebrae/injuries , COVID-19/epidemiology , COVID-19/complications , Spinal Cord Injuries/diagnosis , Neck Injuries/complicationsABSTRACT
We developed a new model for predicting bone mineral density on chest radiographs and externally validated it using images captured at facilities other than the development environment. The model performed well and showed potential for clinical use. PURPOSE: In this study, we performed external validation (EV) of a developed deep learning model for predicting bone mineral density (BMD) of femoral neck on chest radiographs to verify the usefulness of this model in clinical practice. METHODS: This study included patients who visited any of the collaborating facilities from 2010 to 2020 and underwent chest radiography and dual-energy X-ray absorptiometry (DXA) at the femoral neck in the year before and after their visit. A total of 50,114 chest radiographs were obtained, and BMD was measured using DXA. We developed the model with 47,150 images from 17 facilities and performed EV with 2914 images from three other facilities (EV dataset). We trained the deep learning model via ensemble learning based on chest radiographs, age, and sex to predict BMD using regression. The outcomes were the correlation of the predicted BMD and measured BMD with diagnoses of osteoporosis and osteopenia using the T-score estimated from the predicted BMD. RESULTS: The mean BMD was 0.64±0.14 g/cm2 in the EV dataset. The BMD predicted by the model averaged 0.61±0.08 g/cm2, with a correlation coefficient of 0.68 (p<0.01) when compared with the BMD measured using DXA. The accuracy, sensitivity, and specificity of the model were 79.0%, 96.6%, and 34.1% for T-score < -1 and 79.7%, 77.1%, and 80.4% for T-score ≤ -2.5, respectively. CONCLUSION: Our model, which was externally validated using data obtained at facilities other than the development environment, predicted BMD of femoral neck on chest radiographs. The model performed well and showed potential for clinical use.
Subject(s)
Deep Learning , Osteoporosis , Humans , Bone Density , Osteoporosis/diagnostic imaging , Absorptiometry, Photon/methods , RadiographyABSTRACT
The purpose of this study was to clarify sex differences in the inhibition of sympathetic vasomotor outflow which is caused by the loading of cardiopulmonary baroreceptors. Ten young males and ten age-matched females participated. The participants underwent a passive leg raising (PLR) test wherein they were positioned supine (baseline, 0º), and their lower limbs were lifted passively at 10º, 20º, 30º, and 40º. Each angle lasted for 3 min. Muscle sympathetic nerve activity (MSNA) was recorded via microneurography of the left radial nerve. Baseline MSNA was lower in females compared to males. MSNA burst frequency was decreased during the PLR in both males (- 6.2 ± 0.4 bursts/min at 40º) and females (- 6.5 ± 0.4 bursts/min at 40º), but no significant difference was detected between the two groups (P = 0.61). These results suggest that sex has minimal influence on the inhibition of sympathetic vasomotor outflow during the loading of cardiopulmonary baroreceptors in young individuals.
Subject(s)
Leg , Muscle, Skeletal , Humans , Male , Female , Muscle, Skeletal/physiology , Sympathetic Nervous System/physiology , Pressoreceptors , Lower Extremity , Blood Pressure/physiology , Baroreflex/physiology , Heart RateABSTRACT
We experienced two cases of intractable hallux ganglion. Case 1 was a 70-year-old woman with a recurrent ganglion and severe pain on the plantar aspect of the hallux. The continuity between the mass and the distal flexor hallucis longus (FHL) tendon sheath was confirmed. The ganglion was resected along with part of the tendon sheath, and the tendon sheath was incised as proximally as possible. Case 2 was a 69-year-old woman with a ganglion on the dorsal aspect of the interphalangeal joint that repeatedly ruptured due to thinning of the skin. The ganglion was contiguous with the joint capsule but not with the FHL tendon sheath, and the entire capsule was resected. There was no recurrence one year after surgery in either case. The risk of recurrence of an intractable hallux ganglion can be reduced by blocking the synovial supply route and lowering the pressure inside the joint or tendon sheath.
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OBJECTIVE: Axitinib is an oral multi-target tyrosine kinase inhibitor used for the treatment of renal cell carcinoma (RCC). Because of the severe adverse events (AEs) associated with axitinib, patients often need dose reductions or discontinue its use, highlighting the need for effective biomarkers to assess efficacy and/or AEs. The aim of this study was to investigate the relationship between single nucleotide polymorphisms (SNPs) in genes involved in the pharmacodynamic action of axitinib and clinical prognosis and AEs in metastatic RCC (mRCC) patients. METHODS: This study included 80 mRCC patients treated with first-, second-, or third-line axitinib (5 mg orally twice daily). Clinical parameters and genetic polymorphisms were examined in 75 cases (53 males and 22 females). We assessed three SNPs in each of three candidate genes namely, angiotensin-converting enzyme (ACE), nitric oxide synthase 3 (NOS3), and angiotensin II receptor type 1 (AT1R), all of which are involved in axitinib effects on vascular endothelial function. RESULTS: Axitinib-treated patients carrying the ACE deletion allele suffered more frequently from hand-foot syndrome and a deterioration in kidney function (p = .045 and p = 0.005, respectively) whereas those carrying the NOS3 G allele suffered more frequently from proteinuria and multiple AEs (p = .025 and p = 0.036, respectively). CONCLUSIONS: Our study found that the ACE deletion allele and the NOS3 G allele are associated with increased AEs.
Subject(s)
Antineoplastic Agents , Carcinoma, Renal Cell , Kidney Neoplasms , Humans , Male , Female , Axitinib/adverse effects , Carcinoma, Renal Cell/drug therapy , Carcinoma, Renal Cell/genetics , Kidney Neoplasms/drug therapy , Kidney Neoplasms/genetics , Kidney Neoplasms/pathology , Indazoles/adverse effects , Polymorphism, Single Nucleotide , Antineoplastic Agents/therapeutic useABSTRACT
A 17-year-old girl sprained her left ankle and was diagnosed with a lateral malleolar fracture. She was treated conservatively for six months but had medial ankle pain with activity. Imaging revealed an oblique lateral malleolar fracture, with posterolateral displacement and partial fusion of the bone fragments, and bone marrow edema on the medial articular surface of the talus and medial malleolus. We diagnosed ankle instability due to delayed union with a displacement of the lateral malleolus, which caused an osteochondral lesion. We performed arthroscopic and open surgery eight months after the injury, reducted the lateral malleolus anatomically, and fixed it with a plate. Postoperatively, the pain improved rapidly, and the bone marrow edema had almost disappeared on an MRI. In this case, we think rotational instability of the ankle mortise caused abnormal pressure and continuous stress on the medial malleolus after injury, which may have contributed to persistent medial ankle pain.
ABSTRACT
The liver is a vital organ involved in nutrient metabolism, hormone regulation, immunity, cytokine production, and gut homeostasis. Impairment in liver function can result in malnutrition, chronic inflammation, decreased anabolic hormone levels, and dysbiosis. These conditions eventually cause an imbalance in osteoblast and osteoclast activities, resulting in bone loss. Osteoporosis is a frequent complication of chronic liver disease (CLD) that adversely affects quality of life and increases early mortality. Sarcopenia is another common complication of CLD characterized by progressive loss of skeletal muscle mass and function. Assessment criteria for sarcopenia specific to liver disease have been established, and sarcopenia has been reported to be associated with an increase in the risk of liver disease-related events and mortality in patients with CLD. Owing to their similar risk factors and underlying pathophysiological mechanisms, osteoporosis and sarcopenia often coexist (termed osteosarcopenia), progress in parallel, and further exacerbate the conditions mentioned above. Therefore, comprehensive management of these musculoskeletal disorders is imperative. This review summarizes the clinical implications and characteristics of osteoporosis, extending to sarcopenia and osteosarcopenia, in patients with CLD caused by different etiologies.