In 2012, the Saga Prefecture and Liver Center in Saga University Hospital embarked on the viral hepatitis elimination project. The ecosystem named "Saga methods" consisted of five steps, i.e., "prevention," "screening," "detail examination," "treatment," and "follow-up," which is widely used in many hepatitis elimination program in Japan. Finally, the worst liver cancer mortality rate in Japan decreased since 1999 in Saga prefecture by constructing and operating the Saga methods that supports patients at each stage in collaboration with related organizations. Saga methods, based on many surveys for hepatitis virus test questionnaires, detailed test result reports, effect measurement of TV commercials and leaflets, and interview surveys of doctors, patients, and hepatitis medical coordinators, consisted of various kinds of jobs including all medical staffs. Several useful suggestions were obtained for future liver cancer elimination programs, regardless of the region.

Oxaliplatin is an anticancer agent commonly used to treat gastric, colorectal, and pancreatic cancer, which sometimes induces sinusoidal obstructive syndrome (SOS), resulting in unfavorable outcomes relating to portal hypertension. There have been few reports about the association between clinical manifestation and pathological findings in patients with oxaliplatin-induced SOS. Here we retrospectively reviewed medical records of 88 patients who underwent liver biopsy or liver resection after receiving oxaliplatin and investigated their clinicopathological findings. Clinical findings of portal hypertension were observed in eight patients (9.1%), of which splenomegaly accompanied with thrombocytopenia was the most common. Pathological findings of SOS were found in nine patients (10.2%), and only two of them had clinical manifestation of portal hypertension simultaneously. Our study showed that pathological findings of SOS could be absent in clinically diagnosed SOS, and vice versa. Liver biopsy may be unnecessary when clinical manifestations strongly suggest SOS diagnosis. Longitudinal changes of spleen size and platelet counts appeared to be informative in clinical diagnosis of SOS.

A woman in her 70s had complained of appetite loss and general fatigue. An abdominal computed tomography (CT) scan showed a liver mass; hence, the patient was referred to our hospital for further examination. Her blood tests indicated mild liver damage, and hepatitis B virus and hepatitis C virus were both seronegative. Contrast-enhanced CT revealed a large low-density mass occupying the right lobe of the liver, and the lesions were localized within the liver. We performed ultrasound-guided liver biopsy with the diagnosis of diffuse large B cell lymphoma. Thus, she was diagnosed with primary hepatic lymphoma. The subtype was germinal center B-cell-like type due to the results of immunostaining[CD10 (−), Bcl-6 (+), and MUM-1 (−) ]. She received R-CHOP therapy and had a favorable clinical course. Herein, we reported a rare case of primary hepatic lymphoma diagnosed with diffuse large B cell lymphoma originating from a germinal center B cell.

We investigated whether the humanoid robot, Pepper, could help patients in taking hepatitis virus tests at an oral dental clinic. Ninety-five patients interacted with Pepper, followed by visiting the physician and answering a questionnaire. One asymptomatic patient was diagnosed as HBs-Ag positive. Most patients who operated Pepper were female and older than 50 years of age. Only a few patients (16%) knew a hepatitis subsidy system. Results of the questionnaire revealed that Pepper's promotion was beneficial and useful for understanding the severity of hepatitis. These findings suggest that the application of a humanoid robot may encourage hepatitis examinations in an oral dental clinic.

Ursodeoxycholic acid (UDCA) and bezafibrate combination therapy has been reported to improve biochemical parameters in primary biliary cholangitis (PBC) patients refractory to UDCA. However, bezafibrate has side effects such as renal dysfunction. In five patients who had to reduce to half doses of bezafibrate due to chronic kidney disease stage 3, we switched bezafibrate to the new selective peroxisome proliferator-activated receptor α modulator, pemafibrate, and investigated the long-term effect of biochemical response. In all five cases that switched from bezafibrate to pemafibrate, renal dysfunction was improved significantly. Four patients sustained good biochemical response over two years. However, in a patient with cirrhosis, treatment with pemafibrate was discontinued due to increase of ascites. In conclusion, pemafibrate with UDCA therapy might be a useful option to PBC patients with renal dysfunction.