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Non‐alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and one of the leading causes of hepatocellular carcinoma and liver transplantation. Moreover, patients with NAFLD frequently complain of non‐specific symptoms including fatigue, abdominal discomfort, as well as anxiety, and NAFLD is reported to affect patient‐reported outcomes (PROs). Thus, for clarifying the total burden of NAFLD, it is crucial to assess all associated outcomes, including not only clinical and economic outcomes but also PROs. PROs are thought to reflect what is happening in one's daily life and is an important way patients and health‐care professionals communicate. There are various instruments for the assessment of PROs. Recently, a NAFLD/non‐alcoholic steatohepatitis (NASH)‐specific instrument called "Chronic Liver Disease Questionnaire (CLDQ)‐NAFLD/NASH" has been developed. CLDQ‐NAFLD/NASH comprises six domains: (i) abdominal symptoms, (ii) activity/energy, (iii) emotional health, (iv) fatigue, (v) systemic symptoms, and (vi) worry. CLDQ‐NAFLD/NASH has demonstrated excellent internal consistency, face validity, content validity, and test–retest reliability. It has been sufficiently validated in two international phase 3 clinical trials. In this review, we summarize features of various instruments for assessing PROs by focusing on CLDQ‐NAFLD/NASH. We also examine the validity of CLDQ‐NAFLD/NASH in Japanese patients and alterations in CLDQ‐NAFLD/NASH score in Japanese patients with significant hepatic fibrosis. Moreover, we discuss the utility of CLDQ‐NAFLD/NASH in phase 3 clinical trials and in a real‐world clinical setting. [ABSTRACT FROM AUTHOR]

Aim: Muscle atrophy is a prognostic factor for patients with chronic liver disease (CLD) and hepatocellular carcinoma (HCC). The Liver Frailty Index (LFI) is a simple physical function test; however, an association between LFI and muscle mass remains unclear. We aimed to investigate the utility of LFI for predicting muscle atrophy in CLD patients with HCC. Methods: We enrolled 138 CLD patients with HCC (aged 77 years, female/male 34.8%/65.2%). Muscle mass was assessed by skeletal muscle index, and patients were classified into the muscle atrophy group (n = 109) or the non‐muscle atrophy group (n = 29). Physical frailty was assessed by LFI. The optimal cut‐off value of LFI for predicting muscle atrophy was identified by receiver operating characteristic analysis. Results: In the muscle atrophy group, the prevalence of pre‐frail/frail was significantly higher than the non‐muscle atrophy group (87.2% vs. 58.6%, P = 0.0005). In the logistic regression analysis, being female and pre‐frail/frail were identified as independent factors associated with muscle atrophy (pre‐frail/frail; OR 3.601, 95% CI 1.381–9.400, P = 0.0088). In patients with normal grip strength, 71.1% of patients were pre‐frail/frail, in which 82.8% of patients showed muscle atrophy. Receiver operating characteristic statistics provided an area under the curve of 0.74, and an LFI cut‐off value of 2.94 for predicting muscle atrophy (sensitivity 88.06%, specificity 52.17%, accuracy 77.91%). Conclusions: We showed that pre‐frail/frail was an independent factor for muscle atrophy in CLD patients with HCC. Furthermore, LFI predicted muscle atrophy with high sensitivity, even in patients with normal grip strength. Thus, LFI might be a useful screening tool for muscle atrophy in CLD patients with HCC. [ABSTRACT FROM AUTHOR]

Background and Aim: Sarcopenia is a prognostic factor in hepatocellular carcinoma (HCC) patients. HCC patients who underwent transcatheter arterial chemoembolization (TACE) are at a risk of muscle atrophy. We aimed to investigate the effects of in‐hospital exercise on muscle mass and factors associated with muscle hypertrophy in HCC patients who underwent TACE. Methods: We enrolled 209 HCC patients who underwent TACE. Patients were classified into either an exercise (n = 102) or control (n = 107) group. In the exercise group, patients were treated with in‐hospital exercise (median 2.5 metabolic equivalents/20–40 min/day). The effects of exercise on muscle mass were evaluated by changes in skeletal muscle index (ΔSMI) between before and after TACE. Factors associated with an increase in SMI were analyzed by logistic regression and decision‐tree analyses. Results: There was no significant difference in serum albumin and bilirubin levels between the two groups. ΔSMI was significantly higher in the exercise group than in the control group (0.28 cm2/m2vs −1.11 cm2/m2, P = 0.0029). In the logistic regression analysis, exercise was an independent factor for an increase in SMI (hazard ratio 2.13; 95% confidence interval 1.215–3.846; P = 0.0085). Moreover, the decision‐tree analysis showed that exercise was the initial divergence variable for an increase in SMI (the ratio of increased SMI: 53% in the exercise group vs 36% in the control group). Conclusions: In‐hospital exercises increased muscle mass in HCC patients who underwent TACE. In addition, exercise was an independent factor for muscle hypertrophy. Thus, in‐hospital exercise may prevent sarcopenia in HCC patients who underwent TACE. [ABSTRACT FROM AUTHOR]

Neuromuscular electrical stimulation (NMES) is widely used for improving muscle strength, preventing muscle atrophy, and decreasing pain. Recently, NMES has become a substitute for exercise therapy for metabolism improvement and functional capacity improvement. However, NMES has several disadvantages. First, slow-twitch muscle contractions are insufficient because the recruitment pattern of NMES does not obey Henneman's size principle. Second, when using surface electrodes, it is difficult to contract deep skeletal muscles at the application site. Third, electrical stimulation causes discomfort. Therefore, we devised a simultaneous combination of NMES and voluntary muscle contractions to overcome the weak points of NMES. A hybrid training system (HTS) that resists the motion of a volitionally contracting agonist muscle with force generated by its electrically stimulated antagonist was developed as a technique to combine the application of NMES and volitional contractions. This motion sensor makes it possible to simultaneously combine voluntary movements with NMES. Our HTS synchronizes with voluntary movements, enhancing safety and reducing discomfort. This HTS enhances the exercise effect of even simple exercise. So far, our HTS has been reported to be effective for muscle strength enhancement, prevention of muscle atrophy, improvement of physical function, pain relief, enhancement of physical fitness, and improvement of metabolic function. HTS are expected to be useful methods in environments where sufficient exercise load is not available or for individuals with low exercise tolerance.

Increased liver stiffness and insulin resistance are important therapeutic targets in patients with nonalcoholic fatty liver disease (NAFLD). A hybrid training system (HTS) has been developed which combines application of electrical stimulation and volitional contractions. We compared the effect of walking exercise (5.6 km/h) both with and without simultaneous HTS on liver stiffness and insulin resistance. In a single-blind, controlled trial, 32 subjects with NAFLD were randomized to 12 weeks of triweekly 30 minute walking exercise with either HTS (HTS group) or without HTS (control group). Transient elastography for the assessment of liver stiffness, body weight, visceral fat, the homeostasis model assessment of insulin resistance, fasting blood glucose, serum aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transpeptidase were evaluated. Data were evaluated using the linear model after adjusting the baseline value. In the subjects with BMI of 27 kg/m 2 or more, the decrement of transient elastography in the HTS group was significantly larger than in the control group (mean ± standard error: Δ2.13 ± 0.64 kPa vs. Δ-0.67 ± 0.42 kPa, p=0.0009). There were no significant differences between groups in other endpoints. These results showed that simultaneously combining electrical stimulation with walking exercise could potentially improve liver stiffness in people who have NAFLD. In fact, because the exercise effect was increased by HTS without increasing the walking speed, this HTS could be especially useful for obese or overweight subjects, in whom NAFLD and joint problems often coexist. However, its effects on insulin resistance and body composition were not clear.

Background: Patients with hip fracture are limited as to physical activity. It is difficult to evaluate the physical function of the legs at admission; however, it is easy to measure grip strength, which has been reported to be correlated with systemic muscular strength and physical function. The objective of this study was to investigate the utility of grip strength in predicting functional outcome after hip fracture., Methods: Fifty-seven patients who underwent surgery for hip fracture were evaluated for height, weight, Body Mass Index (BMI), grip strength, bone density (femoral neck), hemoglobin, Hemoglobin A1c (HbA1c), Hasegawa's Dementia Scale-Revised (HDS-R), and albumin at admission and Functional Independence Measure (FIM) at discharge. Spearman's rank correlation coefficient was used to evaluate the relation between grip strength and the above variables. Furthermore, factors of walking acquisition were analyzed by logistic regression analysis and decision-tree analysis., Results: Correlation analysis showed that grip strength was positively correlated with bone density at admission and FIM at discharge and negatively correlated with age. In the logistic regression analysis, the independent factor associated with walking acquisition was grip strength (OR 1.26; 95%CI 1.018-1.566; p=0.0339). In the decisiontree analysis, grip strength was the initial divergence variable for walking acquisition (the percentage with walking acquisition was 80.0% of the patients with grip strength ≧13.2 kg VS. 18.7% of the patients with grip strength < 13.2 kg)., Conclusions: Grip strength at admission was definitive in predicting the functional outcome of patients with hip fracture who underwent surgery.

Neuromuscular electrical stimulation (NMES) is used to increase not only muscle strength but also whole-body metabolism. A hybrid training system (HTS) in which NMES is synchronized to voluntary exercise by an articular motion sensor may increase exercise load during aerobic walking exercise. We assessed the metabolic cost during walking exercise (5 minutes at 4 km/h and 5.6 km/h) on a treadmill simultaneously combined with HTS (HTSW) or without HTS (CON). We evaluated oxygen uptake ( VO · 2 ) and heart rate (HR) during HTSW or CON on different days in fifteen subjects. The values ofVO · 2 during HTSW at 4 km/h and 5.6 km/h were signifi cantly greater than those during CON (16.6 ± 1.85 ml/min/kg vs 15.3 ± 1.48 ml/min/kg; p < 0.05, 21.0 ± 2.17 ml/min/kg vs 19.4 ± 2.13 ml/min/kg; p < 0.01, respectively). The values of HR during HTSW at 4 km/h, 5.6 km/h were significantly greater than those during CON (106.7 ± 8.1 bpm vs 101.7 ± 10.3 bpm; p < 0.05, 126.5 ± 11.1 bpm vs 121.5 ± 12.5 bpm; p < 0.05, respectively). HTS added significantly to the exercise load by 8.3 ± 12.0% or 9.1 ± 9.9% during aerobic walking exercise at 4 km/h or 5.6 km/h, respectively. HTS might be useful for health promotion by increasing metabolic cost during aerobic walking exercise without increasing the perceived difficulty.

Objective: Muscle atrophy is associated with autologous stem cell transplantation (ASCT)-related outcomes in patients with malignant lymphoma (ML). However, the impact of ASCT on muscle mass remains unclear in patients with ML. The aims of this study were to investigate changes in muscle mass and risk profiles for muscle atrophy after ASCT., Method: We enrolled 40 patients with refractory ML (age 58 [20-74] years, female/male 16/24, body mass index (BMI) 21.1 kg/m 2 [17.1-29.6]). Psoas muscle mass was assessed using the psoas muscle index (PMI) before and after ASCT., Statistical Analysis Used: Independent factors associated with a severe decrease rate of change in PMI were evaluated by decision-tree analysis, respectively., Results: PMI was significantly decreased after ASCT (4.61 vs. 4.55 cm 2 /m 2 ; P=0.0425). According to the decision-tree analysis, the regimen was selected as the initial split. The rates of change in PMI were -5.57% and -3.97% for patients administered MCEC and LEED, respectively. In patients who were administered LEED, the second branching factor was BMI. In patients with BMI < 20.3 kg/m 2 , the rate of change in PMI was -7.16%. On the other hand, the rate of change in PMI was 4.05% for patients with BMI ≥ 20.3 kg/m 2 ., Conclusion: We demonstrated that muscle mass decreased after ASCT in patients with ML. Patients who received MCEC and patients with low BMI were at risk for a decrease in muscle mass., Competing Interests: There is no conflict of interest to disclose., (2021, JAPANESE PHYSICAL THERAPY ASSOCIATION.)

The SEM Glove developed by Bioservo Technologies AB is a new device that increases grip and pinch force. The purpose of this study was to evaluate the effectiveness of the device on the grip and pinch strength of patients with functional disorders of the fingers., Materials and Method: 30 hospitalized patients with upper limb functional disorder were enrolled. The assistance of the device for the grip and pinch strength of each subject were assessed by the difference between the measured values with and without the SEM Glove. The 95% confidence interval of the difference was calculated across the subjects, and statistical significance was defined as when the lower limit was a positive value (corresponding with a paired t-test at a significance level of 0.05). The odds ratio was calculated in the study of subject adaptation, with statistical significance set using Fisher's exact test at a significance level of 0.05., Results: Grip strength significantly decreased (worn-not worn difference (kg): mean = -3.7, CI95 (-5.4, -2.1)). Pinch strength (thumb - middle finger) significantly increased (worn-not worn difference (N): mean = -4.1, CI95 (1.6, 6.6)). Analysis of factors related to improvement in hand function when wearing the SEM Glove extracted manual muscle tests (MMTs) of the upper extremity 4 or higher. The odds ratio was 6.11., Conclusions: Use of the SEM Glove improved the pinch strength of patients with functional disorders of the hands.