Factors associated with hepatocellular carcinoma occurrence after HCV eradication in patients without cirrhosis or with compensated cirrhosis.

The present study aimed to investigate the incidence of hepatocellular carcinoma (HCC) and factors related to HCC occurrence after direct-acting antiviral (DAA) treatment in the Fukushima Liver Academic Group (FLAG). We conducted a multicenter retrospective cohort study of 1068 patients without cirrhosis (NC) or with compensated liver cirrhosis (LC) who achieved a sustained virologic response (SVR). First, we compared the cumulative HCC incidence and survival rates in NC (n = 880) and LC (n = 188) patients without a history of HCC treatment. Second, we performed multivariate analysis of factors related to HCC occurrence after DAA treatment. Overall, the average age was 65 years, and the male/female ratio was 511/557. Thirty-nine (4%) patients developed HCC. The cumulative 4-year HCC incidence and survival rates were 3.0% and 99.8% in NC patients and 11.5% and 98.5% in LC patients, respectively. The independent factors affecting HCC occurrence identified by multivariate analysis were the serum albumin (ALB) level before SVR for NC patients and the ALBI score, platelet count, and diabetes before SVR for LC patients. The factors related to HCC occurrence differed between NC and LC patients. Careful surveillance of post-SVR patients with these risk factors is needed.

Quantitative evaluation of subjective posture recognition by physiotherapists using a 3D motion capture.

[Purpose] This study evaluated subjective posture recognition by physiotherapists with expertise in posture, examined the quantification of posture using a three-dimensional (3D) motion capture, and described posture-based characteristics. [Participants and Methods] We photographed good, normal, and bad postures in 12 participants using an infrared camera, and the resultant data were analyzed. [Results] We observed the largest displacement from a good to a bad posture in the tenth thoracic vertebra on the X-axis in the anterior-posterior direction in comparison with other index points. Further, we observed considerable differences between good and bad postures compared with other index points. Moreover, we noted significant differences between the amount of displacement between good to a normal posture and from a good to a bad posture. The vertical displacement of the Z-axis was smaller than other index points. [Conclusion] Th10 captured features from the three postures. The X-axis was displaced most between good and bad postures. Further, the amount of displacement on the Z-axis was less between good and bad posture, rendering it difficult to capture features. Therefore, the findings reported herein can be used to compare the front and rear directions of the X-axis for capturing postural changes.

A case of gastric pseudoaneurysm following endoscopic submucosal dissection of early gastric cancer.

A woman in her 80s underwent endoscopic submucosal dissection (ESD) for a 20-mm-sized early gastric cancer lesion in the posterior wall of the upper gastric body. The lesion was resected en bloc with no adverse events. However, bleeding was observed in a post-ESD mucosal defect the day after ESD, so endoscopic hemostasis was performed. Moreover, hematemesis occurred 4 days after ESD, when the bleeding site showed a sign of pulsatile aneurysm. Therefore, endoscopic hemostasis was considered difficult, and angiographic treatment was chosen. Since angiography revealed a pseudoaneurysm in a portion of a branch of the left gastric artery, embolization with microcoils was performed. Thereafter, no bleeding occurred. To the best of our knowledge, there is no case report about the formation of a pseudoaneurysm in a post-gastric ESD mucosal defect. Thus, this case is being reported to document valuable information.

BCG-induced pneumonitis with lymphocytic pleurisy in the absence of elevated KL-6.

BACKGROUND: Pneumonitis is a rare complication of bacillus Calmette-Guerin (BCG) immunotherapy seen in patients with urothelial cancer following the repeated administration of BCG. However, no case of BCG-induced pleurisy has been reported. CASE PRESENTATION: We here report the first case of pneumonitis with lymphocytic pleurisy following bacillus Calmette-Guerin (BCG) immunotherapy. Although marked T helper cell alveolitis was found by bronchoalveolar lavage and transbronchial biopsies, no acid-fast bacillus could be identified in recovered BALF or pleural effusion. The lymphocyte stimulation test of BCG was strongly positive. However, levels of serum and bronchoalveolar lavage fluid KL-6, a useful marker for hypersensitivity pneumonitis (HP), were within normal ranges. CONCLUSION: We speculate that the pathogenesis of our case may be a hypersensitive reaction to the proteic component of BCG entering the lung and pleural space, which is different from the etiology of the common type of HP.

[Nutritional environment in utero and development of obesity].

Obesity and metabolic syndrome have been acutely increasing worldwide with far-reaching health care and economic implications. The steep increase of these diseases' patients suggests us that environmental and life-style influences, rather than genetic causes, are fueling the epidemic. The developmental origins of health and disease (DOHaD) hypothesis has highlighted the relation between the poor nutritional state of the periconceptional, embryonic, fetal, and early infant phases and the subsequent metabolic disorders in later life. Especially newly constructed epigenetic modification has persisted for long time and induces metabolic disruption. Some experimental animal studies are disclosing developmental programming for diseases are reversible by nutritional or targeted therapeutic interventions during the time of developmental plasticity.

A case of hepatic angiosarcoma supplied by both hepatic artery and portal vein.

Liver neoplasms, whether they are benign or malignant, are usually fed by the hepatic artery. We experienced a case of hepatic angiosarcoma supplied by both hepatic artery and portal vein. Since there are currently no specific laboratory tests to diagnose hepatic angiosarcoma, it is important to detect suspect cases from imaging features. This unique hemodynamic property was detected on computed tomography (CT) during hepatic arteriography and CT during hepatic arterioportography. If any imaging examinations indicate the liver tumor to be fed by the portal vein, hepatic angiosarcoma should be suspected.

Clinicolaboratory characteristics of patients with primary biliary cirrhosis associated with CREST symptoms.

Aims: Patients with primary biliary cirrhosis (PBC) occasionally suffer complications from other autoimmune diseases. When PBC was associated with calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly and telangiectasias (CREST) symptoms, it has been proposed that it is a distinct clinical entity. This study aimed to investigate whether PBC associated with CREST symptoms is a distinct disease complex. Method: Clinicolaboratory data, HLA type of leukocytes and disease prognosis were compared between 31 patients with PBC associated with CREST symptoms and 68 patients with PBC alone. Results: The characteristic findings and significant differences observed in patients with PBC associated with CREST symptoms compared with PBC alone are as follows: all women with older age with milder clinical features of both PBC (asymptomatic PBC in 84%) and CREST syndrome (incomplete CREST in 81%), more frequent occurrence of esophageal varices (28.6 vs. 9.3%), better prognosis (87.5 vs. 45.5% in 10 years survival), lower serum levels of AST (39.8 vs. 63.6 IU/l) and IgM (460 vs. 676 mg/dl), higher prevalence of discrete speckled pattern of antinuclear antibodies (93.5 vs. 12.3%), higher median titers of anti-CENP-B antibodies (1.22 vs. 0.31), lower median titers of antimitochondrial antibody (1:80 vs. 1:160), and a higher prevalence of HLA-DR9 (54.5 vs. 24.3%). Conclusion: These findings support the presence of a subgroup in PBC as PBC associated with CREST symptoms.