(Purpose) The factors related to changes in the skeletal muscle mass, strength, physical activity, and skeletal muscle quality (MQ) were examined longitudinally before and after sleeve gastrectomy (SG). (Methods) Body composition, muscle strength, upper and lower limb MQ (muscle strength/upper and lower limb muscle mass) assessments, and International Standardized Physical Activity Questionnaire results were compared before and after SG in 57 women who underwent SG for severe obesity. A multiple regression analysis was conducted to examine the relationship between the change in each independent variable (at 6 months post-SG value-the preoperative value ⊿) and ⊿lower limb MQ. (Results) At 6 months post-SG, body weight, body mass index (BMI), upper and lower limb skeletal muscle mass, body fat mass, and sitting time were significantly lower than the preoperative values. However, relative muscle strength, upper and lower limb MQ, and total physical activity showed significant increases. Multiple regression analyses adjusted for age and other measures revealed a significant association between ⊿lower limb MQ and ⊿sitting time (β=-0.28) and ⊿BMI (β=-0.22). (Conclusions) At 6 months post-SG, a lower BMI and shorter sitting time were associated with an increase in greater lower limb MQ.

A 64-year-old man with a history of kidney transplantation for glomerulonephritis developed posttransplant ureteral cancer and underwent radical ureterectomy. Maintenance hemodialysis and pembrolizumab were initiated. The patient visited our hospital because of fatigue and thirst. Despite the laboratory data showing severe hyperglycemia (1159 mg/dL) and metabolic acidosis, his consciousness was alarming, but there were no life-threatening vital sign abnormalities. His blood glucose level was reduced to 330 mg/dL by hemodialysis, and insulin therapy was initiated after restarting oral intake. Although C-peptide was detectable at the initial presentation, it was undetectable before discharge. Pancreatic islet autoantibody tests were negative. Based on the clinical course, he was diagnosed with fulminant type 1 diabetes mellitus (F-T1DM). The diagnosis and initial management of F-T1DM with immune checkpoint inhibitors (ICIs) in hemodialysis patients can be challenging because of the lack of severe symptoms and indolent clinical course compared to typical F-T1DM without ICIs.