Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the most prevalent chronic liver disease worldwide, with an increasing number of patients progressing to cirrhosis and hepatocellular carcinoma (HCC). Early identification of individuals at high risk for advanced fibrosis is essential for preventing liver-related events and improving long-term outcomes. This guideline summarizes current evidence and provides practical recommendations for the diagnosis, risk stratification, and management of MASLD in clinical practice. These recommendations were developed through systematic evaluation of the literature and expert consensus. Diagnostic approaches, including noninvasive fibrosis assessment tools, imaging, biochemical testing, and indications for referral to gastroenterology/hepatology specialists, were reviewed. Advanced fibrosis is the major determinant of liver-related morbidity and mortality in MASLD. The Fibrosis-4 (FIB-4) index is a widely accessible and reliable first-line noninvasive tool for fibrosis risk stratification. Patients with elevated FIB-4 values or clinical features suggestive of progressive liver injury should undergo secondary assessment with elastography and be referred to a specialist when appropriate. Liver biopsy is not routinely required for the diagnosis of MASLD but remains essential for establishing a definitive diagnosis of at-risk metabolic dysfunction-associated steatohepatitis (MASH), assessing inflammatory activity, resolving discrepancies between noninvasive tests, and differentiating MASLD from other chronic liver diseases. Lifestyle modification remains the foundation of management, with pharmacological therapy considered for patients with a high likelihood of at-risk MASH. MASLD represents a heterogeneous disease spectrum in which advanced fibrosis is the key prognostic factor. These guideline recommendations aim to standardize clinical practice and support evidence-based management of MASLD in Japan.
This study examined changes in practice patterns and outcomes of allogeneic hematopoietic cell transplantation (HCT) over the past 20 years. Data were analyzed from a Japanese nationwide registry of consecutive adult patients with acute myeloid leukemia who underwent allogeneic HCT between 2001 and 2020. The study population included 17,553 patients, of whom 6653 underwent allogeneic HCT in 2001–2010 and 10,900 in 2011–2020. Patients in the later period were older, were more likely to be in first complete remission, and more frequently received umbilical cord blood transplantation. After adjusting for major covariates, the 2011–2020 cohort had lower risks of overall mortality (hazard ratio [HR], 0.84; 95
A 67-year-old woman with a 25-year history of type 1 diabetes mellitus and comorbid Crohn’s disease developed rapidly progressive proteinuria, hypoalbuminemia, edema, and kidney dysfunction. Minimal change disease (MCD) was diagnosed on kidney biopsy. Mesalazine was discontinued, and prednisolone (PSL) at 50 mg/day (0.9 mg/kg) induced remission of MCD. During treatment, glycemic management markedly worsened, and multiple daily insulin injections failed to achieve adequate control. After edema improved and PSL was tapered to 35 mg/day, continuous subcutaneous insulin infusion was resumed, and advanced hybrid closed-loop (AHCL) therapy was initiated using the MiniMed™ 780G system. Consequently, time in range markedly increased, accompanied by a significant decrease in time above range without a clinically significant increase in time below range. During PSL tapering, hypoglycemia was successfully prevented through automated basal rate adjustment by the AHCL system, optimization of the carbohydrate-to-insulin ratio, extension of active insulin time, setting of temporary glucose targets, and supplemental carbohydrate intake. This case suggests that MCD should be considered in the differential diagnosis of patients with Crohn’s disease or diabetes presenting with rapidly progressive proteinuria and kidney impairment. To prevent hypoglycemia and mitigate the limitations of automated delivery, device settings should be dynamically adjusted during steroid tapering to account for changes in insulin sensitivity. With this clinical management strategy, AHCL therapy may be an effective treatment option for steroid-induced hyperglycemia.
Allogeneic hematopoietic stem-cell transplantation (allo-HSCT) is one of the standard treatments for relapsed/refractory (r/r) non-Hodgkin lymphoma, but benefits across large B-cell lymphoma (LBCL) and nodal peripheral T-cell lymphoma (PTCL) subtypes remain unclear. This single-center retrospective study evaluated outcomes after the first allo-HSCT in 92 adults with r/r aggressive lymphoma (59 and 33 patients with LBCLs and PTCLs, respectively) treated during 2011–2023. The patients’ median age was 51 years; 58.7
Primary hepatic liposarcoma is extremely rare. Pleomorphic liposarcoma is a rare subtype of liposarcoma, accounting for approximately 7
