In April 2023, the Japan Society of Hepatology published its official guidelines on liver rehabilitation for chronic liver disease. In this article, we summarize the current evidence on the role of liver rehabilitation in slowing the progression of chronic liver disease, particularly metabolic dysfunction-associated steatotic liver disease (MASLD), liver cirrhosis, and hepatocellular carcinoma (HCC). Specifically, we outline the following: (1) the definition of liver rehabilitation and its target population; (2) exercise therapy in liver rehabilitation according to disease state; (3) considerations for patients with complications; (4) nutritional therapy in liver rehabilitation; and (5) potential economic benefits. Liver rehabilitation represents a novel therapeutic approach for patients with chronic liver disease, and this guidance aims to promote high-quality clinical research and strengthen the evidence base for its application.
In skull-base surgery, excessive brain retraction may cause brain retraction injury (BRI), yet the brain retraction distance (BRD) that contributes to BRI and the potential of skull-base approaches to reduce BRD remain unclear. This study used a virtual reality (VR)–based method to quantify BRD related to BRI and to assess the impact of skull-base approaches on reducing BRD. We retrospectively analyzed 18 patients who underwent frontotemporal craniotomy for anterior skull-base tumors. Three-dimensional models were generated from perioperative imaging, and the frontal lobe was virtually elevated on the 3D model to reproduce the surgical exposure. BRD was estimated by comparing pre- and post-retraction configurations, and its association with BRI was assessed. Additionally, a virtual orbitotomy was performed to evaluate how much BRD could be reduced with this approach. Four patients developed BRI. The median BRD was 6.2 mm in the non-BRI group, whereas it was 12.2 mm in the BRI group, demonstrating a significant difference. Receiver operating characteristic curve analysis identified 10.1 mm as the optimal cutoff value for predicting BRI, yielding a sensitivity of 100
OBJECTIVE:To investigate the long-term safety and efficacy of tocilizumab, an IL-6 receptor inhibitor, in patients with adult-onset Still's disease. METHODS:Patients who completed the precedent phase III trial of tocilizumab for adult-onset Still's disease were enrolled in a long-term extension (LTE) study. Patients received i.v. tocilizumab (8 mg/kg every 2 weeks) until its approval in Japan. The primary end point was safety and tolerability, and secondary endpoints included the ACR coreset response, glucocorticoid doses, tocilizumab dosing interval, remission defined as achieving ACR50 without fever and other laboratory parameters. Efficacy was assessed every 12 weeks. RESULTS:All 22 patients who had completed the precedent phase III trial participated in the LTE study. Sixteen (72.7%) completed the LTE study, with the mean observation period of 168.9 ± 10.8 weeks. Whereas three (13.6%) patients experienced serious adverse events, resulting in two patients withdrawn from the trial, no new safety signal was detected. Treatment efficacy was maintained through the LTE study, with the ACR70 response rate of 68.2% and 95.2% reduction in glucocorticoid doses from the start of the phase III trial and glucocorticoid-free remission of 40.9% at the last visit. Laboratory markers such as CRP and ferritin remained well controlled. The dosing interval was successfully extended in 63.6% of patients, with the overall mean tocilizumab interval at the final visit of 3.4 weeks. CONCLUSIONS:During the observation period, no new safety findings were observed with the long-term use of tocilizumab. Response to tocilizumab was sustained even with an extended dosing interval, with substantial glucocorticoid dose reduction or discontinuation. CLINICAL TRIAL REGISTRATION:UMIN000018414.
Surgical outcomes have improved remarkably through specialist experience and certification; however, regional physicians have limited opportunities to publish because of the lack of accessible databases. The aim of this study was to examine whether establishing a large-scale database in regional areas could enhance academic output and thus support specialist certification. The databases of a university hospital and several regional general hospitals were unified in 2016. The period before database unification was termed the early period (E period) and that after unification was termed the late period (L period). The number of specialist certifications acquired was compared between the periods. The numbers of the following increased from the E period to the L period: academic presentations (86 vs. 186), publication of original articles (3 vs. 64), cases analyzed (5 vs. 20), papers written by new authors (2 vs. 20), Endoscopic Surgical Skill Qualification System-certified surgeons (2 vs. 12), and Board-certified Surgeons in Gastroenterology (2 vs. 12). Moreover, the mean number of years of clinical experience that it took for specialist qualifications to be obtained decreased from 14 years in the E period to 9 years in the L period. Establishing a database across regional areas promoted the presentation and publication of research by early-career clinicians, thereby supporting the development of medical specialists.
