Liver cirrhosis is associated with impaired liver function due to various metabolic disorders, causing poor prognosis and several complications, such as hepatic encephalopathy. Although a number of studies have reported the favorable effects of branched-chain amino acid (BCAA) administration on hepatic encephalopathy, liver function, and prognosis, several studies have shown that BCAA administration might be associated with the following adverse effects: activated glutamine catabolism to ammonia and drainage of alpha-ketoglutarate from the TCA cycle. This review presents the mechanism and management of the favorable and harmful effects of BCAA administration in patients with liver cirrhosis.

A health fair conducted by our hospital in 2019 provided participants the opportunity to undergo a hepatitis screening test and obtain the result on site. Of 70 participants who visited the fair's hepatitis test booth, 40 underwent the test on site, and 28 were aged <60 years. In 2018, a health fair informed participants of similar testing opportunities provided at our outpatient clinic at a later date; 15 people visited the clinic for the test, and 11 underwent the test. Eight (73%) tested individuals were aged >60 years. The ratio of test participants to fair visitors aged <60 years in 2019 (2.8%) was 18.7 times higher than those in 2018 (0.2%). Similarly, a threefold increase in the number of test participants was shown in those aged >60 years in 2019 compared with those in 2018. An on-site hepatitis virus screening test can be an efficient strategy for identifying middle-aged individuals with latent hepatitis.

The patient was a man in his 70s. He had been a carrier of hepatitis B virus. However, he had not undergone clinical treatment regularly. He visited a physician due to fever and fatigue and was diagnosed with hepatocellular carcinoma (HCC). Computed tomography (CT) did not show bone metastasis, but fluorodeoxyglucose-positron emission tomography (FDG-PET) showed abnormal uptake of the bone marrow without destruction of the bone cortex. Bone marrow biopsy showed metastasis of HCC. The patient was diagnosed with HCC cStage IVB. He was treated with lenvatinib for 9 months, but it was discontinued due to stomatitis, diarrhea, and severe fatigue. The patient died 10 months after initiation of treatment.

A high PIVKA-II level increases the risk of extrahepatic metastasis. Therefore, we suggest checking the FDG-PET even if it does not show extrahepatic metastasis by CT.

A 40-year-old woman received interferon and entecavir treatment for hepatitis B since October 20XX. The HBV DNA level was negative.

In 20XX, contrast-enhanced magnetic resonance imaging (MRI) showed a tumor, approximately 10 mm in size, in the liver S6, with a low signal in the hepatocellular contrast phase but no contrast effect in the arterial predominant phase.

The patient was followed with contrast-enhanced MRI every 6 months, but there was no change in imaging findings or elevation of tumor marker levels for approximately 9 years.

In 20XX+9 years, faint staining appeared in the arterial predominant phase of the contrast-enhanced MRI, but there was no increase in the tumor marker levels.

Because hypervascularized hepatocellular carcinoma was suspected, hepatic subsegmentectomy was performed in 20XX+10 years. The patient was diagnosed with moderately differentiated hepatocellular carcinoma.

We present a case of a patient in whom a hypovascular tumor was unchanged for a long time, but hypervascularity was noted after 9 years.

We encountered 13 cases of hepatitis E in Gifu, Japan. All cases occurred sporadically, and 13 different hepatitis E virus (HEV) strains were detected. For 11 strains detected, similar strains were found in DNA databases. Eight strains were similar to those detected in patients with hepatitis E, wild animals, or pig liver within the economic zone, including Gifu. Two other strains were closely related to the strains found in a patient or blood donor living far from Gifu. The other strain from a patient with no travel history abroad had high homologies with strains circulating in France and Spain. Consumption of domestically and internationally distributed pork may be a possible cause for the three patterns of HEV diffusion identified in this study.