Konan Medical Center

Autoimmune pancreatitis (AIP) could induce peripancreatic vascular involvement, such as portal system stenosis, through inflammatory extension, resulting in the development of collateral vessels. In severe cases, gastric varices may develop, leading to a life-threatening risk of variceal rupture. However, these complications remain underrecognized and are not explicitly addressed in the current clinical guidelines. This study aimed to evaluate the frequency of vascular involvement in AIP, assess therapeutic effects of glucocorticoids, and identify key vessels associated with gastric varices.

This multicenter retrospective study included 230 patients diagnosed with AIP at 17 institutions in Japan between 2010 and 2021. We analyzed clinical data, contrast-enhanced computed tomography images, and endoscopy findings. All images were evaluated individually by 3 professionals at a central facility. The primary outcome was the frequency of peripancreatic vascular involvement.

At diagnosis, 51.3% of the patients exhibited peripancreatic vascular involvement, primarily in the splenic vein (48.3%), superior mesenteric vein (23.9%), and portal vein (9.6%). Collateral vessel formation was observed in 40.0% of patients, with 24.3% being severe; 2 gastric variceal ruptures occurred prior to therapy. Glucocorticoid therapy significantly improved venous stenosis (response rates: 95.6%, 93.8%, and 93.1% in the splenic, portal, and superior mesenteric veins, respectively). Additionally, 80.9% of patients exhibited collateral vessel improvement. Among 55 patients who underwent upper endoscopy, 10.9% had gastric varices strongly associated with severe splenic vein stenosis.

Peripancreatic vascular involvement represents a common complication of AIP and significantly responds to glucocorticoid therapy, underscoring the importance of careful monitoring to prevent potentially fatal outcomes.

Psychotherapeutic interventions show promise for managing dyspnea in patients with cancer and other serious illnesses, but evidence synthesis has been limited by substantial heterogeneity. Additionally, the characteristics of interventional delivery remain poorly understood.

This systematic review examined the characteristics of psychotherapeutic techniques-mindful breathing, progressive muscle relaxation, meditation, and guided imagery-to inform standardization, clinical application, and digital development.

We searched PubMed, CINAHL, CENTRAL, and Scopus from inception through January 17, 2025 for quantitative interventional studies evaluating these techniques for dyspnea in adults. Two reviewers independently screened the studies and extracted data on the delivery methods, session structure, provider requirements, and self-practice components. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT).

Forty-two studies were included: mindful breathing (n = 5), progressive muscle relaxation (n = 11), meditation (n = 4), guided imagery (n = 2), and multicomponent interventions (n = 20). Substantial heterogeneity in intervention delivery was identified, even within the same technique, including session duration, frequency, provider training, and home practice components. Psychotherapeutic techniques were predominantly delivered through multicomponent interventions (20/42 studies), most frequently combined with education, breathing techniques (16 studies each), and exercise (11 studies). Most studies met only one to three of the five MMAT criteria, indicating early-stage evidence development.

Psychotherapeutic techniques for dyspnea demonstrate substantial delivery heterogeneity and are predominantly integrated into multicomponent programs. Future research should distinguish the core from adaptable components, integrate psychotherapeutic techniques with education and self-management strategies, and employ rigorous designs with standardized reporting to advance this clinically relevant field.

Metabolic dysfunction-associated steatotic liver disease (MASLD) coexists with type 2 diabetes and is rising in Japan. Liver fibrosis progression in MASLD causes adverse outcomes, highlighting the need for early risk stratification. The utility of the Metabolic Dysfunction–Associated Fibrosis 5 (MAF-5) score has not been assessed in Japanese populations, especially among individuals with type 2 diabetes. Herein, the clinical relevance of the MAF-5 score was assessed in Japanese patients with MASLD.

This prespecified secondary analysis used data from a study titled “A Study to Estimate the Severity of MAFLD Using Continuous Glucose Monitoring.” Sixty-six patients diagnosed with metabolic dysfunction–associated fatty liver disease (MAFLD) underwent vibration-controlled transient elastography. All participants were subsequently confirmed to meet the revised diagnostic criteria for MASLD. The MAF-5 score and FIB-4 index were calculated for each participant. Correlations between these scores and liver stiffness measurement (LSM) were assessed using Spearman’s rank correlation coefficient. Significant fibrosis was defined as LSM ≥ 8.0 kPa. The predictive performance of each score was evaluated using the area under the receiver operating characteristic curve (AUROC).

The final analysis included 57 participants (28 with type 2 diabetes). The MAF-5 score significantly correlated with LSM, whereas the FIB-4 index did not. These associations were consistent regardless of diabetes status. The AUROC for the MAF-5 score was higher than that for the FIB-4 index.

The MAF-5 score may serve as a useful noninvasive marker for predicting liver fibrosis in Japanese patients with MASLD, regardless of diabetes status.