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Vaishya R, Misra A, Vaish A, Ursino N, D'Ambrosi R. Hand grip strength as a proposed new vital sign of health: a narrative review of evidences. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:7. [PMID: 38195493 PMCID: PMC10777545 DOI: 10.1186/s41043-024-00500-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/05/2024] [Indexed: 01/11/2024]
Abstract
Hand grip strength (HGS) serves as a fundamental metric in assessing muscle function and overall physical capability and is particularly relevant to the ageing population. HGS holds an important connection to the concept of sarcopenia, which encompasses the age-related decline in muscle mass, strength, and function. It has also been reported to indicate the health of an individual. We reviewed the interplay between HGS and various health parameters, including morbidity and mortality, by carrying out a literature search on PubMed, Scopus and Google Scholar between 10 and 30 August 2023, to identify the relevant papers on the relationship between health and HGS. We used several keywords like 'hand grip strength', 'muscle strength, 'sarcopenia', 'osteosarcopenia', 'health biomarker', 'osteoporosis', and 'frailty', to derive the appropriate literature for this review. This review has shown that the HGS can be measured reliably with a hand-held dynamometer. The cut-off values are different in various populations. It is lower in Asians, women, less educated and privileged, and those involved in sedentary work. Several diseases have shown a correlation with low HGS, e.g., Type 2 diabetes, cardiovascular disease, stroke, chronic kidney and liver disease, some cancers, sarcopenia and fragility fractures. The low HSG is also associated with increased hospitalization, nutritional status, overall mortality and quality of life. We believe that there is adequate evidence to show that HGS stands as an important biomarker of health. Its utility extends to the identification of diverse health issues and its potential as a new vital sign throughout the lifespan.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 10076, India
| | - Anoop Misra
- Department of Endocrinology, C-DOC Fortis Hospital, Nehru Place, New Delhi, India
| | - Abhishek Vaish
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 10076, India
| | - Nicola Ursino
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy.
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Murata K, Namisaki T, Fujimoto Y, Takeda S, Enomoto M, Takaya H, Tsuji Y, Shibamoto A, Suzuki J, Kubo T, Iwai S, Tomooka F, Tanaka M, Kaneko M, Asada S, Koizumi A, Yorioka N, Matsuda T, Ozutsumi T, Ishida K, Ogawa H, Takagi H, Fujinaga Y, Furukawa M, Sawada Y, Nishimura N, Kitagawa K, Sato S, Kaji K, Inoue T, Asada K, Kawaratani H, Moriya K, Akahane T, Mitoro A, Yoshiji H. Clinical Significance of Serum Zinc Levels on the Development of Sarcopenia in Cirrhotic Patients. CANCER DIAGNOSIS & PROGNOSIS 2022; 2:184-193. [PMID: 35399181 PMCID: PMC8962814 DOI: 10.21873/cdp.10093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM Sarcopenia increases the mortality in patients with cirrhosis. Approximately 60% of zinc is accumulated in skeletal muscle. We aimed to determine the role of subclinical zinc deficiency on sarcopenia development in patients with cirrhosis. PATIENTS AND METHODS We enrolled 151 patients with cirrhosis and divided them into the group with normal serum zinc levels (Group N: 80-130 μg/dl; n=38) and group with subclinical zinc deficiency (Group D: <80 μg/dl; n=113). The risk factors for sarcopenia were then investigated. RESULTS Group D had more sarcopenia cases than Group N (31.0% vs. 13.2%). In group D, HGS exhibited a weakly positive but significant correlation with serum zinc levels (R=0.287, p=0.00212), serum zinc levels negatively correlated with both ammonia and myostatin levels (R=-0.254, p=0.0078; R=-0.33, p<0.01), and low zinc levels were independently associated with sarcopenia development. CONCLUSION Patients with cirrhosis showing subclinical zinc deficiency have a significantly higher risk of developing sarcopenia.
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Affiliation(s)
- Koji Murata
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Yuki Fujimoto
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Soichi Takeda
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Masahide Enomoto
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Yuki Tsuji
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Akihiko Shibamoto
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Junya Suzuki
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takahiro Kubo
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Satoshi Iwai
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Fumimasa Tomooka
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Misako Tanaka
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Miki Kaneko
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Shohei Asada
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Aritoshi Koizumi
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Nobuyuki Yorioka
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takuya Matsuda
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takahiro Ozutsumi
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Koji Ishida
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Hiroyuki Ogawa
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Hirotetsu Takagi
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Yukihisa Fujinaga
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Masanori Furukawa
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Yasuhiko Sawada
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Koh Kitagawa
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Shinya Sato
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Kosuke Kaji
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takashi Inoue
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara, Japan
| | - Kiyoshi Asada
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Kei Moriya
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takemi Akahane
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Akira Mitoro
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
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Nishikawa H, Yoh K, Enomoto H, Nishimura T, Nishiguchi S, Iijima H. Clinical impact of the finger-circle test in patients with liver diseases. Hepatol Res 2021; 51:603-613. [PMID: 33772972 DOI: 10.1111/hepr.13639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022]
Abstract
AIM To elucidate the relationship between the finger-circle test (Yubi-wakka [in Japanese] test; three levels of bigger, just-fits, and smaller) and sarcopenia-related factors and anthropometric parameters in patients with chronic liver disease (n = 202, 99 men, mean age 61 years). METHODS Patients with both grip strength decline (<26 kg for men and <18 kg for women) and skeletal muscle index (SMI) decline (<7.0 kg/m2 in men and <5.7 kg/m2 in female) were diagnosed as sarcopenia. RESULTS Liver cirrhosis was found in 56 patients (27.7%). The proportions of bigger, just-fits, and smaller in liver cirrhosis versus non-liver cirrhosis patients were 51.8%, 21.4%, and 26.8% versus 77.4%, 11.4%, and 8.2% (p < 0.01). The proportions of grip strength decline in patients with bigger, just-fits, and smaller were 12.0% (77/142), 21.2% (7/33), and 40.7% (11/27; overall p < 0.01). The proportions of SMI decline in patients with bigger, just-fits, and smaller were 9.9% (14/142), 45.5% (15/33), and 77.8% (21/27; overall p < 0.01). The proportions of sarcopenia in patients with bigger, just-fits, and smaller were 3.5% (5/142), 18.2% (6/33), and 33.3% (9/27; overall p < 0.01). In both sexes, arm circumference, triceps skinfold thickness, calf circumference, and waist circumference were significantly stratified according to the finger-circle test. In the multivariate analysis, smaller was an independent predictor for SMI decline (p < 0.01, risk ratio 8.188, bigger as a reference), and body mass index was an independent predictor for both SMI decline and sarcopenia. CONCLUSION The finger-circle test can be helpful for the screening of sarcopenia in chronic liver disease and is closely linked to body composition.
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Affiliation(s)
- Hiroki Nishikawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazunori Yoh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hirayuki Enomoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Nishimura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | | | - Hiroko Iijima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Nishikawa H, Yoh K, Enomoto H, Nishimura T, Nishiguchi S, Iijima H. Decrease in grip strength is associated with the progression of sleep disturbances in chronic liver diseases. WORLD ACADEMY OF SCIENCES JOURNAL 2021; 3:16. [DOI: 10.3892/wasj.2021.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2025]
Affiliation(s)
- Hiroki Nishikawa
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Kazunori Yoh
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Hirayuki Enomoto
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Takashi Nishimura
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Shuhei Nishiguchi
- Department of Internal Medicine, Kano General Hospital, Osaka, 531-0041, Japan
| | - Hiroko Iijima
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
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Tamaki N, Kurosaki M, Loomba R, Izumi N. Clinical Utility of Mac-2 Binding Protein Glycosylation Isomer in Chronic Liver Diseases. Ann Lab Med 2020; 41:16-24. [PMID: 32829576 PMCID: PMC7443525 DOI: 10.3343/alm.2021.41.1.16] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/15/2020] [Accepted: 07/29/2020] [Indexed: 12/15/2022] Open
Abstract
An accurate evaluation of liver fibrosis is clinically important in chronic liver diseases. Mac-2 binding protein glycosylation isomer (M2BPGi) is a novel serum marker for liver fibrosis. In this review, we discuss the role of M2BPGi in diagnosing liver fibrosis in chronic hepatitis B and C, chronic hepatitis C after sustained virologic response (SVR), and nonalcoholic fatty liver disease (NAFLD). M2BPGi predicts not only liver fibrosis but also the hepatocellular carcinoma (HCC) development and prognosis in patients with chronic hepatitis B and C, chronic hepatitis C after SVR, NAFLD, and other chronic liver diseases. M2BPGi can also be used to evaluate liver function and prognosis in patients with cirrhosis. M2BPGi levels vary depending on the etiology and the presence or absence of treatment. Therefore, the threshold of M2BPGi for diagnosing liver fibrosis and predicting HCC development has to be adjusted according to the background and treatment status.
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Affiliation(s)
- Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.,NAFLD Research Center, Division of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Rohit Loomba
- NAFLD Research Center, Division of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
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Nishikawa H, Enomoto H, Yoh K, Iwata Y, Sakai Y, Kishino K, Ikeda N, Takashima T, Aizawa N, Takata R, Hasegawa K, Ishii N, Yuri Y, Nishimura T, Iijima H, Nishiguchi S. Walking Speed: Japanese Data in Chronic Liver Diseases. J Clin Med 2020; 9:166. [PMID: 31936162 PMCID: PMC7019849 DOI: 10.3390/jcm9010166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 12/17/2022] Open
Abstract
We aim to clarify the impact of walking speed (WS) and analyze factors linked to WS decline in patients with chronic liver diseases (CLDs, 165 males and 191 females, 137 liver cirrhosis patients). The WS decline is defined as <0.8 m/second (m/s), referring to the guidelines. The median (range) WS was 1.3 m/s (0.2-2.02 m/s). There were 17 patients with WS <0.8 m/s (4.8%). The WS value was significantly correlated with the handgrip strength value both in males (r2 = 0.252, p < 0.0001) and females (r2 = 0.256, p < 0.0001). In the multivariate analysis of factors associated with WS decline, only the extracellular water (ECW) to total body water (TBW) ratio using bioimpedance analysis was an independent predictor (p = 0.0398). Extracellular fluid excess was categorized as follows: normal condition (ECW to TBW ratio <0.390), mild overhydrated condition (ECW to TBW ratio 0.390-0.399), and moderate to severe overhydrated condition (ECW to TBW ratio ≥0.400). The WS value was well stratified according to the ECW to TBW ratio (normal vs. mild, p = 0.0001; mild vs. moderate to severe, p < 0.0001; normal vs. moderate to severe, p < 0.0001; overall p-value <0.0001). In conclusion, the ECW to TBW ratio can be closely linked to WS decline in CLD patients.
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Affiliation(s)
- Hiroki Nishikawa
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
- Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Hirayuki Enomoto
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
| | - Kazunori Yoh
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
| | - Yoshinori Iwata
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
| | - Yoshiyuki Sakai
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
| | - Kyohei Kishino
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
| | - Naoto Ikeda
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
| | - Tomoyuki Takashima
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
| | - Nobuhiro Aizawa
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
| | - Ryo Takata
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
| | - Kunihiro Hasegawa
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
| | - Noriko Ishii
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
| | - Yukihisa Yuri
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
| | - Takashi Nishimura
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
| | - Hiroko Iijima
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
| | - Shuhei Nishiguchi
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan; (H.E.); (K.Y.); (Y.I.); (Y.S.); (K.K.); (N.I.); (T.T.); (N.A.); (R.T.); (K.H.); (N.I.); (Y.Y.); (T.N.); (H.I.); (S.N.)
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