Kobe Asahi Hospital

The audio-visual media is a type of media that contains sound elements as well as images that can be seen, such as video recordings, various sizes of films, slides, sounds, and so on. This type of media is considered more attractive because it contains elements of both the first and second types of media. This study aims to describe how audio-visual media is used in teaching the Hijaiyah alphabet to children in Group B at Assalam Kindergarten. This research uses a descriptive method with a qualitative approach. The results show that a) in planning activities using audio-visual media in teaching the Hijaiyah alphabet to Group B at Assalam Kindergarten in Pagerbumi, teachers are accustomed to preparing lesson plans, learning media, learning methods, and the tools and materials used in learning activities. In addition to preparing lesson plans and learning media, teachers also stimulate children regarding what they should do in accordance with the theme being discussed; b) the implementation of learning with the use of audio-visual media in introducing Hijaiyah letters to Group B at Assalam Kindergarten Pagerbumi with the implementation of learning using audio media can improve children's ability to recognize Hijaiyah letters; c) The results of the learning evaluation using audio-visual media in introducing Hijaiyah letters in Katakana developed very well (BSB). In this case, children were able to recognize Hijaiyah letters and were able to name them.

Objective To compare the effect of the FIB4 index on skeletal muscle mass (SMM) loss (i.e., pre-sarcopenia) with that of three other liver fibrosis markers [FIB3 index, aminotransferase to platelet ratio index (APRI), and platelet count] or sarcopenia-related factors such as age and body mass index (BMI) in patients with metabolic dysfunction associated with steatotic liver disease (MASLD, 2,093 men and 1,280 women; median age, 55 years). Methods An SMM decrease was defined as a fat-free index, as tested by a bioelectrical impedance analysis, <18 kg/m2 in men and <15 kg/m2 in women. We compared the diagnostic ability of the above-mentioned six markers to induce an SMM decrease. Results The median BMI was 25.0 kg/m2. The median FIB4 index, FIB3 index, APRI, and platelet count were 0.99, -0.40, 2.93 and 25.2 × 104/μL. The prevalence of SMM decrease in men and women was 21.7% (455/2,093) and 16.7% (214/1,280), respectively. For all cases, the percentage of a decreased SMM was 15.0% (372/2,479) in cases with FIB4 index <1.3, 32.1% (268/834) in cases with 1.3< FIB4 index <2.67 and 48.3% (29/60) in cases with FIB4 index >2.67 (overall p<0.0001). In almost all subgroup analyses, the cases were well-stratified according to the FIB4 index. In all cases, the area under the receiver operating characteristic curve (AUC) for SMM decrease was highest for BMI (AUC=0.94), followed by the FIB4 index (AUC=0.67). In all subgroup analyses, except for BMI ≥25 kg/m2, the FIB4 index had the second highest AUC for SMM decrease after BMI. Conclusion The FIB4 index may be useful for predicting pre-sarcopenia in patients with MASLD.

Clones harboring cancer driver mutations can expand in normal tissues, known as somatic mosaicism, and can be influenced by age and environmental and germline factors. Somatic mosaicism in the blood predicts the risk of hematological malignancies; however, the relevance of somatic mosaicism to solid tumors remains unclear, in part because of limited sample availability. Lifestyle habits, including alcohol consumption and tobacco smoking, and pathogenic germline variants increase the risk of developing esophageal squamous cell carcinoma (ESCC). Because somatic mosaicism in the esophagus is known to be associated with aging and lifestyle habits and considering the contiguity of squamous epithelium from the esophagus to the oral cavity, we noninvasively collected buccal mucosa samples from patients with and without ESCC using swabs of different sizes and conducted deep error-corrected sequencing of 26 cancer driver genes to obtain comprehensive landscapes of tissue remodeling by driver-mutant clones. We found that the number of mutations increased with drinking, but only in individuals with germline risks. Moreover, across positively selected genes in the buccal mucosa, mutations increased with age and smoking regardless of germline risks, whereas drinking affected only those with germline risks. The buccal mucosa of patients with ESCC was extensively remodeled, and models predicting the presence of ESCC demonstrated high accuracy with smaller swab sizes, possibly because of their higher sensitivity in detecting small mutant clones. In conclusion, we showed that buccal mucosal remodeling reflects lifestyle and germline risks, as well as age, which might be exploited for noninvasive risk assessment of ESCC.

Tremelimumab plus durvalumab (Dur/Tre) combination therapy is now a first-line systemic therapy for advanced hepatocellular carcinoma (HCC). Because systemic therapy is not effective in some patients, it is clinically important to identify factors that could predict the response to treatment at an early stage. We investigated the factors associated with the response to Dur/Tre for advanced HCC in a clinical setting. Seventy patients (median age 74 years; 61 men) who received Dur/Tre between March 2023 and September 2024 were analyzed. We examined the factors associated with the treatment response, including pretreatment factors and factors early in treatment. The median treatment duration was 77.5 (interquartile range [IQR] 28-187) days. The overall response and disease control rates were 25.8% and 58.1%, respectively. The median (IQR) progression-free survival (PFS) and overall survival (OS) were 82 (61-133) and 415 (337-NA) days, respectively. Multivariable analysis revealed that higher absolute lymphocyte count (ALC) and lower des-γ-carboxyprothrombin (DCP) levels were significantly associated with PFS. Receiver operating characteristic curve analysis showed that the cutoff value for ALC after 4 weeks of treatment in relation to clinical efficacy was 1125/mm3. A log-rank test using the Kaplan-Meier method showed that OS was significantly longer in patients with ALC above the cutoff and in patients whose DCP levels decreased after starting treatment. Higher ALC and lower DCP levels after treatment initiation were associated with the clinical efficacy of Dur/Tre for advanced HCC.

A 20-year-old Japanese woman moved to Manchuria and worked as a sheep farmer for 5 years. Subsequently, she returned to Japan. In her 80s, abdominal ultrasound and computed tomography revealed a large tumor that had spread to both lobes of the liver. The tumor was encapsulated, and partial calcification and multiple cysts within a large cyst (honeycomb pattern) were observed. Serological tests for echinococcosis showed that the Echinococcus-specific antigen was positive, but the antigen characteristic of E. multilocularis was negative. We herein report a case of E. granulosus infection diagnosed more than 60 years after the initial infection.

症例は90歳代女性．腰椎圧迫骨折にて入院後に鎮痛目的でアセトアミノフェン（APAP）1.8 g/日を7日間，0.6 g/日を19日間投与された．投与後17日目より肝胆道系酵素上昇が出現し，好酸球増多をともなっていた．抗核抗体（ANA）陰性，抗ミトコンドリア-M2抗体（AMA-M2）陰性，HBs抗原陰性，HCV抗体陰性であった．

Pityriasis Rubra Pilaris is a rare, chronic inflammatory dermatosis of unknown etiology, presenting with erythema and papular eruptions. Treatment is difficult due to the lack of causal therapy, guidelines and requires an individualized approach. The most common treatments are systemic retinoids, immunosuppressants, phototherapy and biological therapy. This article presents the case of a 73-year-old man suffering from type 1 pityriasis rubra pilaris. The patient was initially treated with acitretin, which was discontinued due to hypogammaglobulinemia. This rare side effect of acitretin has not been previously published. As a second-line treatment, the patient received methotrexate, but with no clinical improvement after 3 months and an increase in skin pruritus. Finally, the use of isotretinoin resulted in significant clinical improvement and was well tolerated.

There is a strong association between the distribution of Hepatitis B virus (HBV) carriers and the incidence of hepatocellular carcinoma (HCC). About 60% of HCC in Japan is caused by viral hepatitis. Ten to 15 percent of hepatitis virus-related HCCs derive from HBV. Recently, antiviral therapy against HBV has developed, and interferon therapy and nucleos(t)ide analogues (NAs) are currently the standard of care. NAs exhibit antiviral activity by inhibiting DNA polymerase and suppressing HBV replication. NAs are highly effective in suppressing HBV-DNA and improving alanine aminotransferase. The long-term treatment goal for chronic hepatitis B is HB surface antigen (HBsAg) loss. However, the number of patients who achieve HBsAg loss by NA (i.e., functional cure) is low and there have been cases of HCC incidence during (or after) NA therapy. In this article, we review the efficacy of NA therapy in suppressing HBV-derived carcinogenesis.