Since April 2022, robot-assisted liver resection has been covered by insurance, and strict institutional standards and guidelines from the Japanese Society of Hepato-Biliary-Pancreatic Surgery and the Japanese Society of Endoscopic Surgery have been proposed for its safe introduction, setting forth the criteria for proctors certified by the societies. Robotic precision surgical techniques are expected to enable safer liver resection. However, several issues must be addressed for widespread use of robot-assisted liver resection, such as overcoming the learning curve of the robotic technique and establishing evidence through prospective case registries in terms of short- and long-term outcomes.

We conducted a prospective, noninterventional, observational study with a focus on individuals tested positive for hepatitis C cirus (HCV) antibodies (HCVAb). In this study, we also measured HCV core antigen levels in residual serum samples. When both samples showed positive results, we strongly encouraged these patients to seek medical care. Out of 8,805 cases, the HCVAb positivity rate was 4.4% (390 cases). The HCV core antigen positivity rate was notably higher at 8.2%, with 14 men and 17 women out of the 378 cases. Notably, this rate was significantly higher in patients with HCVAb levels ≥ 10 (n = 249) compared to those with levels < 10 COI (n = 129) (11.6% vs. 1.6%, P = 0.002). With the exception of 2 patients who did not attend their scheduled visits, the remaining 29 patients were strongly encouraged to undergo a more detailed examination. Among these patients, 9 (32.1%) were prescribed direct-acting antiviral (DAA) treatment. However, 13 individuals were deemed ineligible for DAA treatment due to complications such as hepatocellular carcinoma or malignancy, and 6 individuals expressed no interest in therapy. This study highlights the potential utility of measuring HCV core antigen in HCVAb-positive individuals for identifying HCV carriers and guiding them towards additional medical care and potential cure.

A woman in her thirties with alcoholic liver cirrhosis had been treated as outpatient with oral medications, including branched-chain amino acids, and advised to abstain from alcohol and to consult a psychiatrist. Her laboratory data revealed anemia, dehydration, and malnutrition progression two years after the initial consultation and a computed tomography scan revealed the presence of fatty liver and ascites, resulting in hospitalization. The registered dietitian who took the e-learning training course on alcoholism diagnosis and treatment provided by the Japan Society of Hepatology administered nutritional therapy and guidance in addition to medical treatments. Continuous nutritional management and guidance care during hospitalization and after discharge for her resulted in improved nutritional status, reduced alcohol consumption, and improved liver disease severity. The results indicated the effectiveness of the intervention by e-learning-trained, registered dietitians in the multidisciplinary treatments of patients with alcoholic liver cirrhosis.

A 49-year-old man with alcoholic liver cirrhosis was admitted to our hospital because of bilateral blindness. Head magnetic resonance imaging (MRI) revealed no abnormalities. He was treated with branched-chain amino acids for the suspicion of hepatic encephalopathy. However, his visual activity did not improve. Three days after admission, MRI revealed a high-intensity lesion in bilateral basal ganglia on diffusion-weighted imaging. He received high-dose vitamin B1 therapy, methylprednisolone (1000 mg/day for 3 days), and high-dose intravenous immunoglobulin therapy for the suspicion of metabolic encephalopathy. However, his visual activity showed no improvements. Given that he had previously taken methanol, his urine methanol level was measured. Subsequently, he was diagnosed with methanol intoxication due to high urine methanol levels. He was discharged from our hospital with no improvement in visual acuity.

The patient was a woman in her 70s who had a liver tumor after achieving sustained virologic response for hepatitis C infection. Contrast-enhanced computed tomography and ultrasonography revealed a mass measuring 27 mm with contrast effect in the early phase and washout in the late phase. However, as a draining vein was flowing into the middle hepatic vein, she was diagnosed with hepatic angiomyolipoma (HAML) and was followed up. Three months later, the tumor size increased to 47 mm, and the early draining vein disappeared; therefore, hepatocellular carcinoma was considered, and left hemihepatectomy was performed. Histopathological examination findings revealed a moderately differentiated hepatocellular carcinoma with fatty degeneration. An early draining vein is an important characteristic of HAML and is useful in the differential diagnosis of hepatocellular carcinoma with fatty degeneration. To tour knowledge, this is the first report of a case of hepatocellular carcinoma with early draining vein; thus, further studies are needed for improve the accuracy of its diagnosis.

We report the successful treatment of a patient with hepatocellular carcinoma undergoing hemodialysis using atezolizumab plus bevacizumab combination therapy. The patient was a 61-year-old man who was undergoing hemodialysis for 6 years due to diabetic nephropathy. He was diagnosed with chronic hepatitis C in his 30s and received interferon therapy; however, the infection remained unresolved. Since his 40s, he received repeated localized puncture and embolization therapies for hepatocellular carcinoma. However, his allergy to contrast media made embolization difficult. Therefore, atezolizumab plus bevacizumab combination therapy was initiated, and there is a lack of evidence regarding its efficacy and safety in patients undergoing hemodialysis. The patient developed hypothyroidism and cerebral hemorrhage after starting the treatment. However, the therapy duration was prolonged by administering levothyroxine sodium hydrate and discontinuing bevacizumab, suggesting that this combination can be used in patients with hepatocellular carcinoma on hemodialysis if adverse events are detected and treated early.

A man in his 50s with hepatitis B was left untreated. Medical checkup revealed a hepatic mass that was diagnosed as hepatocellular carcinoma (HCC). S8 demonstrated two lesions, which underwent open anterior segmental resection of the liver. Histopathological diagnosis confirmed portal vein invasion (vp2). A computed tomography scan performed 2 months postoperation revealed portal vein tumor thrombosis (PVTT) in the left branch of the portal vein. The recurrence was considered high despite the possible rehepatectomy. Therefore, lenvatinib (LEN) administration was initiated and stereotactic radiotherapy was performed for PVTT; however, micrometastasis developed. A repeat liver resection was performed because PVTT and micrometastasis did not worsen under LEN administration. Thereafter, CyberKnife was performed for micrometastasis, which resulted in complete remission. Herein, we report a case that revealed the efficacy of multidisciplinary treatment, including LEN and radiation therapy, for HCC with recurring PVTT.

This study was conducted in 2021, wherein we investigated in-hospital measures for patients positive for hepatitis virus in 288 hospitals specializing in liver diseases in 13 Japanese prefectures. Our results showed that even at specialty hospitals, the overall countermeasure implementation rate was low (56%). The rate was higher in hospitals that had a higher bed capacity (>400), more full-time hepatologists, and more hepatitis medical care coordinators. Of these three factors, implementation rate was most influenced by coordinator enrollment, with highest involvement by clinical laboratory technologists. Therefore, clinical laboratory technologists should be trained to improve countermeasure rates for both treatment of liver disease and safety management in hospitals. Furthermore, the improvement in the implementation rate of measures for patients positive for hepatitis virus will help in providing better treatment.

A Japanese woman in her 30s was diagnosed with hepatitis B surface antigen positivity during pregnancy with her first child. Her liver function was normal; however, high viral load was observed. In accordance with the guidelines, a nucleic acid analog was administered starting at 28 weeks' gestation. The baby was delivered nearly at term, and the nucleic acid analog was discontinued one day prior to the delivery. Liver dysfunction was observed two months after the analog was discontinued, and the patient was restarted on nucleic acid analog treatment. There are many issues to be resolved, including whether nucleic acid analogs should be discontinued immediately following delivery or continued for certain time or whether breastfeeding should continue during nucleic acid analog treatment.

We developed and reported a fully automated, high-sensitivity hepatitis B core-related antigen assay (iTACT-HBcrAg). This study aimed to evaluate the impact of carryover during the use of iTACT-HBcrAg by analyzing samples with high HBcrAg levels. A negative sample tested immediately after a sample with an HBcrAg of 8.7 LogU/mL showed an HBcrAg of 2.4 LogU/mL, thus confirming carryover. The sample with an HBcrAg of 8.8 LogU/mL and collection tubes containing the negative samples were continuously opened to check for the effects of sample splashing and aerosols. The results showed that sample splashing and aerosols did not account for the carryover. The iTACT-HBcrAg is a highly sensitive assay; therefore, carryover can occur when magnetic particle-antigen complexes are introduced into the next sample via the BF wash nozzle. Any sample determined to be positive for HBcrAg after the testing of a sample with an HBcrAg above the measurement range should be retested for confirmation.