Skeletal muscle has a characteristic differentiation process involving cell fusion. The molecular mechanisms that regulate this differentiation remain to be elucidated. Muscle differentiation starting from satellite cells is hierarchically regulated by a network of myogenic transcription factors（TFs）depending on the stage of differentiation. The function of these TFs has been found to be highly dependent on chromatin structure（i.e., chromatin remodeling），which is altered various epigenetic regulatory mechanisms. Furthermore, novel mechanisms that regulate the chromatin remodeling, such as pioneer TFs, DNA strand breaks, and non-coding RNAs, are being elucidated to operate at each stage of muscle differentiation. The accumulation of such basic knowledge has contributed greatly to an integrated understanding of the regulatory mechanisms of differentiation in skeletal muscle. The pathological deterioration of skeletal muscles, represented by sarcopenia, is a risk factor for death and need for nursing care in the elderly, but currently only symptomatic treatment is available. The establishment of a molecular basis underlying the muscle differentiation will accelerate the development of fundamental therapeutic and preventive measures based on such molecular pathogenesis.

Several systemic therapeutic options have been developed for treatment of advanced hepatocellular carcinoma（HCC）in recent years. The sequential use of adequate key drugs is recommended to prolong survival. As there has been no established predictive biomarker of individual drug efficacy, a simple biomarker to predict drug efficacy and prognosis is required. In this study, we investigated the impact of body composition, i.e., skeletal muscle and visceral fat content, on the prognosis of advanced HCC patients treated with sorafenib. We identified ‘no muscle depletion with high visceral fat area’as a novel predictive biomarker. In contrast, the body composition was not found to be a prognostic factor in patients treated with hepatic arterial infusion chemotherapy（HAIC），which is also treatment option for advanced HCC, but could be a useful biomarker when selecting between sorafenib and HAIC. Furthermore, in a multicenter study, we demonstrated that skeletal muscle volume was an independent predictor of survival after sorafenib treatment failure in HCC patients. In conclusion, skeletal muscle volume may prove to be one of the crucial factors in selecting sequential therapies in advanced HCC patients.

This study aimed to clarify the nursing competency of fourth-year students in 2020 prior to their graduation, who had fewer opportunities for practical training due to the spread of the new coronavirus and the characteristics of their nursing competency in comparison with that of the graduates, who had received normal nursing education before the COVID-19 pandemic.

The items with the highest average scores among the nursing competency in the fourth-year students were "Able to support decision making" and "Able to respect individual values, beliefs and circumstances".

In comparison with the graduates, the mean scores of fourth-year students were significantly higher in 62 out of 66 items.

The rank order of average score of each item in the fourth-year students were compared with the graduates. The items that dropped significantly in ranking were individualize the explanation of the rationale and methods of providing nursing care.

The fourth-year students in the pandemic self-evaluated that they obtained a certain level of nursing competency at the graduation, however, they might have been unable to carry out the evaluation from a realistic perspectives because of a few clinical training opportunities they could have.

We report the case of a 48-year-old woman with relapsed B-lineage acute lymphoblastic leukemia（B-ALL）following cord blood transplantation, in which leukemic cell CD22 antigens became negative after a single administration of inotuzumab ozogamicin（InO）．At relapse, a major part of leukemic cells expressed CD19 and CD22 antigens, however some leukemic cells were negative for CD22. As treatment with blinatumomab proved ineffective, InO therapy was subsequently initiated；however, severe melena developed 5 days after the initial administration. The patient died 14 days after InO administration, owing to the rapid proliferation of CD22? leukemic cells. Autopsy revealed mucosal hemorrhage throughout the small intestine and marked infiltration of CD22? leukemic cells into the intestinal mucosa and other systemic organs. An expression pattern of surface antigens of a major clone of leukemic cells may be changed during a clinical course. Therefore, when we plan to use the novel antibody drugs, the surface antigens of leukemic cells should be re-examined.

We report a case of Monomorphic epitheliotropic intestinal T-cell lymphoma（MEITL），a rare malignant lymphoma that is prone to perforation and intestinal obstruction and has a poor prognosis. A 76-year-old man was referred to our hospital from the clinic because of continuing fever, vomiting, and diarrhea diagnosed as enteritis. At our hospital, he was diagnosed as enteritis again from the abdominal CT scan that has showed localized thickening of the small intestinal wall. About one month later of conservative treatment, he had severe abdominal pain and bowel obstruction, and admitted to our hospital urgently. PET-CT scan showed accumulation of FDG in the thickened intestinal wall, suggesting malignant lymphoma. After the further examination, the planned surgery was performed under the laparotomy. The tumor was extremely fragile, and the tumor perforated very easily just by grasping it. The tumor and its mesentery were resected. Postoperative course was good, and he was discharged 11 days after surgery. The tumor was finally diagnosed as MEITL by the pathological examination of surgical specimen. Although the chemotherapy was sequentially performed, the peritonitis carcinomatosa was developed 6 months after the operation. From the cytology of ascites, the MEITL recurrence was diagnosed. He died 7 months after the operation.