【Backgrounds】Insulin has an intensive anabolic action on skeletal muscle, even under severe surgical insult. Nutrients that stimulate insulin secretion, i.e., show insulinotropic action, thus show protein anabolism of skeletal muscle. The present study examined the insulinotropic action of L‐carnitine and branched‐chain amino acids after energy intake using healthy human volunteers.
【Methods】A total of 39 young healthy human volunteers （mean 20.8 years old） were assigned to orally receive either L‐carnitine alone （L group, n＝10） or L‐carnitine combined with single or long‐term continuous dose of branched‐chain amino acids . The control group （C group, n＝16） received none of these nutrients. L‐carnitine, 1000 mg/day, was administered orally for 14 days, and BCAA was administered orally either once just before exercise （L＋SB group, n＝6）, or every day for 14 days （L＋CB group, n＝7） until 2 days before the experiment. After overnight fasting, 200 kcal of glucose and oral nutritional supplement was administered to prevent discomfort due to hypoglycemia during and after exercise. The blood glucose, free fatty acid concentration, and serum insulin levels were measured to examine the insulinotropic action after energy intake as well as before and after exercise.
【Results】The blood glucose and serum insulin levels in the L group were significantly lower than those in the C group. While the serum insulin levels were higher after energy administration than those in the fasting state in all groups, these were significantly higher in the L＋SB group and in the L＋CB group compared with that in the L group. The insulinotropic action after energy intake remained even after the repeated administration of BCAA was discontinued 2 days before the experiment even after the serum BCAA levels remained the same.
【Conclusion】While the insulinotropic action appeared after a single dose of BCAA, it was also potentiated by the long‐term repeated oral administration of BCAA.

Although nutritional assessment should be carried out by combining multiple indicators, there is no clear standard for judging the nutritional status. During NST rounds at our hospital, opinions are sometimes divided on whether the nutritional status has improved. We examined factors that significantly affect the judgment.
Ninety‐eight patients who completed the intervention after two or more rounds between April and June 2019 were divided into three groups （improved, unchanged, and deteriorated） based on the changes in the judgment of nutritional status at the time of intervention completion and in the nutritional route at the end of the study.
At the time of intervention, there were no significant differences in any of the items, but at the end of the study, there were significant differences in gastrointestinal symptoms, PS, CONUT value, and sufficiency rate in the improvement group, and there was a significant shift in the nutritional route from infusion to oral management. However, the mean CONUT value of 5.04 in the improvement group corresponded to a moderately poor nutritional status, which was not consistent with the judgment of nutritional status. The judgment of whether the nutritional status improved was often influenced by the independence of the patients and objective indicators were undervalued.

Introduction：The aim of this study was to assess the effects of age on the outcome of liver resection in hepatocellular carcinoma （HCC）.
Methods：Three hundred and forty‐four HCC patients who underwent liver resection were analysed. The short‐term and long‐term results in the younger group （＜75 years old） and the elderly group （≥75 years old） were compared.
;Results：In the elderly group, albumin levels were significantly lower than those in the younger group, and the preoperative total liver volume was significantly smaller. There were no significant differences in the surgical results, postoperative complication rate, or in‐hospital mortality between the groups. There were also no significant differences between groups in overall or disease‐free survival after hepatic resection.
Conclusion：This study suggested that surgical resection for HCC in the elderly can be performed safely after sufficient assessment.