Usefulness of health checkup-based indices in identifying metabolic dysfunction-associated steatotic liver disease.

Aims: The application of indices in the context of metabolic dysfunction-associated steatotic liver disease (MASLD) remains unexplored. We aimed to validate the ability of alanine aminotransferase (ALT), fatty liver index (FLI), and hepatic steatosis index (HSI) to identify MASLD during health checkups. Methods: We recruited 627 participants and utilized their health checkup data and ultrasound to assess the potential of using ALT, FLI, and HSI as indices for MASLD; this was indicated by the area under the curve (AUC) and restricted cubic spline (RCS) model. The optimal, rule-out (sensitivity ≥90%), and rule-in (specificity ≥90%) cutoff values of each index for identifying MASLD were reported. Results: Among participants with a median age of 46 years, the prevalence of MASLD was 28% in total (38% in males and 18% in females). RCS models confirmed a linear association between indices and MASLD. ROC analyses indicated that the AUC of ALT in identifying MASLD was 0.79 for the total cohort, 0.81 for males, and 0.69 for females. The optimal, rule-out, and rule-in cutoff values for ALT were 21, 13, and 29, respectively. Similarly, the AUC of FLI/HSI in identifying MASLD was 0.90/0.88 for the total cohort, 0.86/0.85 for males, and 0.93/0.90 for females. Considering the reference cutoff values, distinct cutoff values were observed between the sexes for FLI, while HSI had similar cutoff values. Conclusion: This study demonstrated that ALT > 30 IU/L is a reasonable cutoff value to rule-in MASLD. ALT, FLI, and HSI are reliable indices for identifying MASLD during health checkups.

Changes in Mental Health among Japanese University Students during the COVID-19 Era: Differences by College Department, Graduate Level, Sex, and Academic Year.

This study compared the effects of academic year, college department, and undergraduate or graduate status on Japanese students' mental health during the COVID-19 pandemic. From 2021-2023, an online survey was conducted using the Counseling Center Assessment of Psychological Systems-Japanese (CCAPS-Japanese) to evaluate students' mental health; 9395 undergraduate students (4623 female, 4772 male) and 1169 graduate students (380 female, 789 male) responded. Undergraduate students in medicine had lower levels of depression, generalized anxiety, and social anxiety than those in other departments. Engineering students exhibited the highest level of academic distress. First-year students had the highest levels of generalized and social anxiety but the lowest level of academic distress. Second-year students had the lowest level of depression, and third-year students had the highest level of academic distress. Among graduate students, first-year students had higher levels of depression, generalized anxiety, social anxiety, academic distress, and hostility than second-year students. Undergraduates had poorer mental health than graduate students. Females had higher levels of eating concerns than males among undergraduate students. This study revealed that the mental health of university students was affected by various factors. These findings demonstrate the characteristics of university students requiring early support.

Prevalence of Steatotic Liver Disease Based on a New Nomenclature in the Japanese Population: A Health Checkup-Based Cross-Sectional Study.

This cross-sectional study examined the prevalence and characteristics of steatotic liver disease (SLD) based on a recently introduced nomenclature in the Japanese health checkup population. SLD was evaluated using liver ultrasonography, and participants were categorized into metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol associated steatotic liver disease (MetALD), alcohol-associated/related liver disease (ALD), and cryptogenic SLD groups. The prevalence and characteristics of the SLD subclasses were assessed, and subgroup analyses were conducted for the non-obese (body mass index [BMI] ≤ 25 kg/m2) and lean (BMI ≤ 23 kg/m2) populations. Among the 694 participants, with a median age of 47 years and comprising 54% males, the prevalence of MASLD, MetALD, ALD, and cryptogenic SLD was 26%, 2%, 1%, and 2%, respectively. A remarkable difference was observed in the prevalence of SLD subclasses according to age, sex, and BMI. Subgroup analyses revealed heterogeneous demographic, clinical, and biochemical parameters between the SLD categories. Individuals with MetALD had higher gamma-glutamyl transferase levels, lower platelet counts, and higher fibrosis-4 index than did those with MASLD. Furthermore, the prevalence of non-obese and lean MASLD was 13% and 6%, respectively. This study provides preliminary information on the prevalence of SLD based on a new nomenclature in the Japanese population.

Usefulness of a questionnaire for assessing the relationship between eating behavior and steatotic liver disease among Japanese male young adults.

This study aimed to reveal the relationship between eating behavior and nonalcoholic fatty liver disease (NAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) in young adults and suggest a questionnaire for eating behavior assessment. We included 322 male graduate students at Gifu University. Diagnoses of NAFLD and MASLD were based on the presence of hepatic steatosis on ultrasonography. Eating behavior was assessed using the eating behavior questionnaire (EBQ) recommended by the Japan Society for the Study of Obesity. We assessed the eating behaviors associated with NAFLD and MASLD using logistic regression, decision tree, and random forest analyses. The median age of the participants was 22 years, and 16% and 11% had NAFLD and MASLD, respectively. The EBQ total score was significantly higher in participants with MASLD than in those without MASLD (102 vs. 90 points, P = 0.006) and in those with NAFLD than in those without NAFLD (97 vs. 90 points, P = 0.007). Among eating behavior categories, the decision tree and random forest analyses revealed that "perception of constitution and weight" was the strongest contributor for NAFLD/MASLD. Our study revealed that eating behavior assessed with the EBQ is robustly associated with NAFLD and MASLD in young male adults.

Nutritional intake and metabolic parameters of Japanese university students with and without obesity: Sex-specific differences.

OBJECTIVE: To establish effective methods of obesity prevention among young adults, we analyzed the relationship between obesity-related food intake and metabolic factors in Japanese university students. METHODS: We performed a cross-sectional analysis of nutrient intake information and metabolic parameters among 1,206 Gifu University students categorized by body mass index. RESULTS: The overweight/obesity rate was significantly higher in males. Additionally, among males, the intake of protein, potassium, magnesium, phosphorus, iron, zinc, all lipids/fats, and all metabolic parameters including blood sugar, hemoglobin A1c, uric acid, alanine aminotransferase, aspartate aminotransferase, low-density lipoprotein, high-density lipoprotein, triglycerides, and blood pressure significantly differed between the obese and non-obese groups. However, the same comparison among females revealed no significant differences in nutrient intake and significant differences in only half of the parameters. Among males, energy intake from protein and fat was significantly higher in the obese group, while the percentage of total energy intake from carbohydrates and fat was lower and higher, respectively, among females in the obese group. CONCLUSIONS: Overeating of protein and fat in males and unbalanced nutrition in females are sex-specific characteristics of Japanese university students with obesity, and metabolic abnormalities in students with obesity are more remarkable in males than in females.

Impact of COVID-19 on the mental health of Japanese university students (years II-IV).

This study aimed to investigate the differences in mental health during COVID-19, specifically among second-, third-, and fourth-year Japanese university students (n = 2,157; n = 2,000; and n = 2,284; respectively). A one-way MANOVA was conducted to assess the association between year of enrollment (academic years 2020, 2021, and 2022) and each of the eight subscales of the counseling Center Assessment Psychological Symptoms-Japanese. For second-year students, depression and generalized anxiety mean scores were higher in 2021 than those in 2020 and 2022. Alcohol use mean scores got smaller each year. For third-year students, depression, generalized anxiety, social anxiety, hostility, and alcohol use were significantly higher in 2021 than those in 2020 and 2022. Among fourth-year students, means for all eight subscale categories were significantly higher in 2021 than those in 2020 and 2022. The findings found worsened mental health profiles during 2021, which recovered to approximate pre-pandemic levels in 2022. This study demonstrates that university students' mental health has been negatively impacted by the COVID-19 pandemic, an effect which is more salient among fourth-year students. Further, it offers insights into mental health trends among Japanese university students and a possible foundation for learning about changes among university students worldwide.

Usefulness of health checkup for screening metabolic dysfunction-associated fatty liver disease and alcohol-related liver disease in Japanese male young adults.

We aimed to assess metabolic dysfunction-associated fatty liver disease (MAFLD) and alcohol-related liver disease (ALD) prevalence in young male adults and the role of health checkups in disease screening. We recruited 313 male graduate students at Gifu University in April 2022. With hepatic steatosis diagnosed by ultrasonography, MAFLD and nonalcoholic fatty liver disease (NAFLD) were diagnosed based on health checkup data, and ALD was diagnosed with alcohol consumption > 30 g/day. The ability of each variable to identify MAFLD, NAFLD, and ALD was assessed using logistic regression and receiver-operating characteristic curve analyses. Participants' mean age was 23 (± 4) years, and MAFLD, NAFLD, and ALD prevalence was 11%, 17%, and 1%, respectively. Among Japanese male young adults, alanine aminotransferase (ALT) (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01-1.07; P = 0.008) and body mass index (BMI) (OR 2.02; 95% CI 1.58-2.58; P < 0.001) were independently associated with MAFLD. Furthermore, only the alcohol use disorders identification test (AUDIT) was able to identify ALD (OR 1.49; 95% CI, 1.28-1.74; P = 0.001). Our study revealed that health checkups, including measurement of ALT, BMI, and AUDIT, are important for screening MAFLD and ALD in younger generations.

Impact of body fat accumulation on metabolic dysfunction-associated fatty liver disease and nonalcoholic fatty liver disease in Japanese male young adults.

AIM: Nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) are global concerns. The aim of this study was to reveal the relationship between body composition and NAFLD and MAFLD in male young adults. METHODS: We recruited 335 male graduate students from Gifu University who underwent a health checkup in April 2022. The diagnosis of NAFLD and MAFLD was based on health checkup data and ultrasonography. Muscle and fat mass were measured using bioelectrical impedance analysis and demonstrated as skeletal muscle mass index and fat mass index (FMI), respectively. We assessed factors associated with NAFLD and MAFLD using the logistic regression, decision tree, and random forest analyses. RESULTS: The median age of the participants was 22 years, and 9% were overweight or obese (body mass index ≥25 kg/m2 ), 8% had MAFLD, and 16% had NAFLD. In the multivariate logistic regression analysis, FMI was independently associated with NAFLD (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.26-1.75; p < 0.001) and MAFLD (OR, 1.93; 95% CI, 1.51-2.46; p < 0.001). The decision tree and random forest analyses revealed that the strongest classifier for NAFLD and MAFLD was FMI. Additional analyses among nonobese individuals also showed the strong relationship between FMI, NAFLD, and MAFLD. CONCLUSION: Our study revealed that fat accumulation plays a key role in the development of NAFLD and MAFLD in male young adults, even in nonobese individuals. The results could shed new light on the pathophysiology of NAFLD and MAFLD in young adults.

Subintimal Tracking and Re-entry Technique for Stent-Jailed Side-Branch Occlusion.

OBJECTIVES: This study aimed to evaluate the clinical effectiveness and outcomes of treatment with the subintimal tracking and re-entry technique for stent-jailed side branch (SB-STAR). SB occlusion is a serious complication of percutaneous coronary intervention (PCI). However, conventional strategies may fail to recanalize the stent-jailed SB. METHODS: We retrospectively analyzed consecutive patients who underwent elective PCI and were treated with SB-STAR at the Sapporo Cardiovascular Clinic in Japan. SB was treated for severe stenosis, reduced thrombolysis in myocardial infarction flow grade, or ischemic signs after main vessel stenting. Technical success during the procedure and clinical and angiographic follow-up findings at 6 months were analyzed. RESULTS: Of the 13,431 PCI procedures performed between January 2016 and June 2021, SB-STAR was performed in 10 patients. The angiographic success rate was 100%. At the 6-month follow-up, no deaths or target-vessel revascularizations had occurred. All patients underwent angiographic follow-up, and 8 of the 10 patients (80%) who underwent SB-STAR had confirmed patency. CONCLUSIONS: SB-STAR can be a bailout strategy to improve the critical situation of stent-jailed SB occlusion. At 6-month follow-up, the SB-STAR had good patency as well as good clinical outcomes.

Lingering effects of COVID-19 on the mental health of first-year university students in Japan.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is continuing unabated in Japan, as of October 2021. We aimed to compare first-year university students' psychological distress before the pandemic in 2019, during the pandemic in 2020, and one year after the onset of the pandemic, in 2021. METHODS: The study conducted online surveys over three years from April to May each year. Participants were 400 first-year students in 2019, 766 in 2020, and 738 in 2021. We examined differences in scores on the Counseling Center Assessment of Psychological Symptoms-Japanese version (CCAPS-Japanese) between the three years using a one-way analysis of variance, and differences in the CCAPS-Japanese critical items using chi-squared test and residual analysis. RESULTS: The average scores on the Depression and Generalized Anxiety subscale in 2021 were significantly higher than those in 2020, but remained the same as in 2019. The Academic Distress subscale score in 2020 was the worst compared to 2019 and 2021. Meanwhile, the number of students who experienced severe suicidal ideation increased year by year from 2019 to 2021. CONCLUSION: The mean mental health of first-year university students worsened after the onset of the COVID-19 pandemic, and recovered to the pre-pandemic level over the next two years. However, the number of high-risk students with suicidal ideation continued to increase. A system is required for early detection and support for students at high risk of mental health issues.

Coil Embolization for Coronary Artery Perforation: A Retrospective Analysis of 110 Patients.

OBJECTIVE: Coil embolization (CE) for coronary artery perforation (CAP) has not been thoroughly evaluated. This study aimed to evaluate the extent of myocardial damage and impact on cardiac function after CE for CAP. METHODS: A total of 110 consecutive patients treated with CE for CAP were retrospectively identified. The degree of myocardial damage and impact on cardiac function were evaluated. RESULTS: Forty-nine (44.5%) cases involved chronic total occlusions. A guidewire was the cause of perforation in 97 (88.2%) patients. The success rate of CE was 98.2%. Almost all patients were prescribed either antiplatelet drugs or anticoagulant medication or both. Patients with perforation types III and IV were found to be prone to creatinine kinase (CK) elevation and epicardial main vessel perforation, thereby causing myocardial damage. No changes were noted in the ejection fraction (EF) in patients with type V distal perforation and collateral channel perforation, while patients with perforation of the epicardial main vessel may show impaired cardiac function afterward. CONCLUSIONS: CE is safe and effective for treating CAP, especially when collateral channels and distal vessels are involved. Meanwhile, efforts should be taken to prevent CAP in epicardial main vessels since it may be difficult to treat with CS and cause myocardial damage when bailed out with CE leading to vessel sacrifice. We found that it was not necessary to change the anticoagulant regimen after CE owing to its ability to achieve robust hemostasis.

Three-dimensional dose-distribution measurement of therapeutic carbon-ion beams using a ZnS scintillator sheet.

The accurate measurement of the 3D dose distribution of carbon-ion beams is essential for safe carbon-ion therapy. Although ionization chambers scanned in a water tank or air are conventionally used for this purpose, these measurement methods are time-consuming. We thus developed a rapid 3D dose-measurement tool that employs a silver-activated zinc sulfide (ZnS) scintillator with lower linear energy transfer (LET) dependence than gadolinium-based (Gd) scintillators; this tool enables the measurement of carbon-ion beams with small corrections. A ZnS scintillator sheet was placed vertical to the beam axis and installed in a shaded box. Scintillation images produced by incident carbon-ions were reflected with a mirror and captured with a charge-coupled device (CCD) camera. A 290 MeV/nucleon mono-energetic beam and spread-out Bragg peak (SOBP) carbon-ion passive beams were delivered at the Gunma University Heavy Ion Medical Center. A water tank was installed above the scintillator with the water level remotely adjusted to the measurement depth. Images were recorded at various water depths and stacked in the depth direction to create 3D scintillation images. Depth and lateral profiles were analyzed from the images. The ZnS-scintillator-measured depth profile agreed with the depth dose measured using an ionization chamber, outperforming the conventional Gd-based scintillator. Measurements were realized with smaller corrections for a carbon-ion beam with a higher LET than a proton. Lateral profiles at the entrance and the Bragg peak depths could be measured with this tool. The proposed method would make it possible to rapidly perform 3D dose-distribution measurements of carbon-ion beams with smaller quenching corrections.

The effect of remote learning on the mental health of first year university students in Japan.

We examined the effects of the coronavirus disease 2019 (COVID-19) pandemic on first-year Japanese university students' mental health by comparing current year's survey results with previous year's results. Accordingly, an online survey was conducted on first-year Gifu University students from April 20 to May 31, 2020. Study results revealed that, despite the emergence of the COVID-19 pandemic, the number of "high-risk" students and the depression level were lower among the 2020 first-year students compared to previous year's students. However, the 2020 first-year students experienced high academic distress since they had to adapt to an unfamiliar e-learning environment.

Non-communicable Disease among Homeless Men in Nagoya, Japan: Relationship between Metabolic Abnormalities and Sociodemographic Backgrounds.

Objective To examine the degree of metabolic abnormalities and their association with the sociodemographic background or mental illness/cognitive disability among homeless men in Nagoya, Japan. Methods We interviewed 106 homeless men (aged 54.2±12.7 years) and measured their metabolic parameters. Mental illness and cognitive disability were diagnosed using the Mini-International Neuropsychiatric Interview and Wechsler Adult Intelligence Scale-III test, respectively. Associations between metabolic abnormalities and the sociodemographic background or mental illness/cognitive disability were analyzed. Results There were significant correlations of liver dysfunction (AST≥35 IU, ALT≥35 IU, γ-GTP≥75 IU), hypertension [systolic/diastolic blood pressure (BP) ≥140/90 mmHg], and dyslipidemia (HDL <40 mg/dL) with the history/duration of homelessness (over 2 times/year) and residence status (living on the streets). Although the mean body mass index (BMI), BP, HbA1c, and LDL in participants living in temporary residences were similar to those obtained from the general population data from National Health Nutrition Survey (NHNS) 2016, the systolic/diastolic BP in those living on the street was significantly higher than in the general population, and the HDL in those living in temporary residences was significantly lower than in those reported in the NHNS 2016 data. In the group with cognitive disability, the ALT, TG, and BMI values were significantly higher and the HDL level significantly lower in those living in temporary residences than in those living on the streets. Conclusion Stressful conditions while living on the streets may exacerbate hypertension and liver dysfunction, and unhealthy food habits when living in a temporary residence may exacerbate low HDL levels. In addition, an inability to self-manage due to cognitive disability may increase the ALT, TG, and BMI values. The provision of homeless people with the skills to sustain independent living conditions and ensure a healthy diet is required.