Although sarcopenia is characterized by a loss of muscle strength and skeletal muscle mass, few studies have evaluated the effect of muscle strength on hepatocellular carcinoma (HCC) patients. We evaluated the impact of sarcopenia-related factors (grip strength (GS) and the skeletal muscle index (SMI)) on the survival among lenvatinib-treated unresectable HCC (u-HCC) patients. This single-center cohort study was conducted at a university hospital. The study population included 63 lenvatinib-treated u-HCC patients managed between April 2018 and April 2020. A decreased GS and decreased SMI were found in 21 (33.3%) and 22 (34.9%) patients, respectively. The overall survival (OS) of the normal GS group was significantly higher than that of the decreased GS group, while that of the normal and decreased SMI groups did not differ markedly. There were no significant differences in the progression-free survival between the normal GS and decreased GS groups or the normal SMI and decreased SMI groups. A multivariate Cox proportional hazards model showed that modified albumin-bilirubin-grade (mALBI) 2b (hazard ratio (HR) 4.39) and a decreased GS (HR 3.55) were independently associated with an increased risk of poor prognosis. In addition to the hepatic functional reserve, a decreased GS was a poor prognostic factor in lenvatinib-treated u-HCC patients.
Aim To prevent the progression of sarcopenia, early identification is important. We investigated the usefulness of sarcopenia screening tests using the arm and calf circumferences in patients with chronic liver disease. Methods This was a single‐center cross‐sectional study based on data collected from a university hospital. We analyzed simple anthropometric data and sarcopenia‐related chemical data or imaging data between April and December 2019. Sarcopenia was defined according to the Japan Society of Hepatology guidelines. Results In total, 661 patients participated. Low muscle mass and low muscle strength were found in 245 (37.1%) and 153 (23.1%) patients, respectively. Ultimately, 90 (13.6%) patients were diagnosed with sarcopenia. The sarcopenia group was significantly older and had a higher cirrhosis ratio and poorer liver function than the non‐sarcopenia group. The sarcopenia group had a significantly lower body mass index, arm circumferences and calf circumferences than the non‐sarcopenia group. A receiver operating characteristics analysis for diagnosing sarcopenia by arm and calf circumferences showed respective areas under the curve of 0.89 and 0.91 for men and 0.84 and 0.89 for women. The optimal cut‐off values of arm and calf circumferences were respectively determined to be 25.0 and 32.6 cm for men (sensitivity 88.4% and 83.7%; specificity 74.0% and 84.7%) and 22.7 and 32.1 cm for women (sensitivity 66.0% and 85.1%; specificity 90.0% and 81.3%). Conclusions The arm and calf circumferences seem useful as simple surrogate markers for screening sarcopenia in patients with chronic liver disease.
The relation between dopaminergic cells (and centrifugal fibers), the electroretinogram (ERG) c-wave, and the light peak were electrophysiologically investigated by observing the effects of a retrobulbar conduction block and intravitreal injection of either dopamine or haloperidol on these retinal responses. The retrobulbar conduction block (1% lidocaine) caused a decrease in the amplitude of the c-wave and the light peak in newly hatched chicks. Injections (2-20 microliters) containing dopamine (0.1-10 mM) or haloperidol (1.3-13 mM) were given intravitreously while the responses were recorded. Although intravitreous injection of saline for control resulted in no observable change in the responses, dopamine selectively augmented the c-wave of ERGs and the light peak, but not the a-, b-, and d-waves. Haloperidol decreased first the light peak and later the c-wave. The augmentation of the retinal responses by dopamine and their reduction by haloperidol was statistically significant. The estimated threshold concentration of dopamine in the vitreous cavity was 1-3.5 microM. Since in many species the interplexiform cells have been found to contain dopamine, we hypothesize that the modulatory effects on the c-wave and the light peak in this preparation may be due to a centrifugal feed-back loop which includes the interplexiform cells to the horizontal and bipolar cells and the horizontal cells to the cones.
Background and Aim: Although chronic liver disease is associated with secondary sarcopenia, the effect of primary disease treatment (hepatitis C virus elimination) on the skeletal muscle is unclear. This study aimed to determine the effect of a sustained virologic response at 24 weeks following direct-acting antiviral therapy on the skeletal muscle in hepatitis C virus-infected patients. Methods: Hepatitis C virus-infected patients treated with direct-acting antivirals between 2014 and 2017 in our hospital were included. We evaluated the skeletal muscle index and intramuscular adipose tissue content at the third lumbar vertebra on abdominal computed tomography and compared the rate of change in the skeletal muscle index per year and intramuscular adipose tissue content per year before and after direct-acting antiviral treatment. Results: Ninety-two patients participated. At sustained virologic response at 24 weeks, liver test results, including fibrosis marker levels, were significantly improved compared to those before direct-acting antiviral treatment. Skeletal muscle index measured before direct-acting antiviral treatment initiation was significantly lower than that at the first computed tomography scan. However, no significant change was found between the skeletal muscle index at the second computed tomography scan and final follow up. The rate of change in skeletal muscle index measured after direct-acting antiviral treatment was significantly higher than that before direct-acting antiviral treatment (À0.07 vs À0.99% per year). There was no significant difference between the change in intramuscular adipose tissue content before and after direct-acting antiviral treatment. Conclusions: Viral eradication by direct-acting antiviral treatment improved the liver function and suppressed skeletal muscle loss in hepatitis C virus-infected patients.
Background and AimUstekinumab is a human monoclonal antibody targeting the p40 subunit of both interleukin‐12 and interleukin‐23 with reported efficacy to treat Crohn's disease. However, few studies have reported the use of ustekinumab for pediatric inflammatory bowel disease. This study aimed to assess the clinical efficacy and safety of ustekinumab in children and adolescents with inflammatory bowel disease.MethodsMedical records of patients aged under 20 years with Crohn's disease or Crohn's disease‐like inflammatory bowel disease who had received ustekinumab at a Japanese pediatric inflammatory bowel disease center were retrospectively reviewed for efficacy and safety. The primary outcome was the steroid‐free clinical remission rate at weeks 26 and 52. The steroid‐free remission rate beyond week 52 was also evaluated. Weighted pediatric Crohn's disease activity index and simple endoscopic score for Crohn's disease were used to assess disease activity.ResultsSeventeen patients were included (male : female = 8:9, A1a [diagnosed < 10 years old]:A1b [diagnosed ≥ 10 years old] = 8:9). All patients were on ustekinumab at week 26, and 9/10 continued treatment over 1 year. The steroid‐free clinical remission rates were 59% at week 26, 50% at week 52, and 70% over 1 year. Three of eight children who underwent endoscopy after ustekinumab introduction achieved endoscopic remission. No serious adverse events were recorded during the study period.ConclusionsUstekinumab may be an effective and safe treatment option for pediatric and adolescent Crohn's disease and Crohn's disease‐like inflammatory bowel disease patients having nonresponse or adverse reactions to anti‐tumor necrosis factor agents.
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