For ECC, neither HCV nor HBV status was a significant risk factor

For ECC, neither HCV nor HBV status was a significant risk factor.53

A large, population-based, case-control study by Shaib et al. of Medicare-enrolled patients compared 625 cases of ICC with 90,834 controls. In a multivariate analysis, HCV was significantly associated with ICC. It was unclear whether patients with HCV also had a recorded diagnostic code for cirrhosis. However, nonspecific cirrhosis was strongly associated with ICC. The prevalence of HBV infection was similar in cases and controls.47 A similar population-based, case-control study by Welzel et al. of Medicare-enrolled patients examined risk factors for both ICC and ECC. There were 549 cases of ECC and 535 cases of ICC, compared with 102,782 controls. Significant risk factors for ICC included PI3K inhibitor HCV and nonspecific cirrhosis. Regarding ECC, nonspecific cirrhosis was

also a risk factor, but HCV infection was not significant.28 A large cohort study of U.S. veterans by El-Serag et al. examined the association between HCV and both ICC and ECC in a cohort of 146,394 HCV-infected veterans and 572,293 uninfected controls. The risk for ICC in the HCV-infected cohort, though low at 4 per 100,000 person-years, was more than double that in the controls. The risk of ECC did not differ between the HCV-infected and uninfected veterans.54 The association of these risk factors with CC is not entirely clear, as studies have differing conclusions, and there is a paucity of population-based C-X-C chemokine receptor type 7 (CXCR-7) or prospective cohort studies. In countries such as Korea and Thailand, where both HBV and CC are endemic, data show HBV, but not HCV, as a risk factor for ICC. On the other CFTR modulator hand, countries such as Japan and Western nations, including the United

States, where HCV is more prevalent, were more likely to show an association between HCV and ICC.27, 55 Diabetes and obesity have been examined as possible risk factors for CC. Most studies presented in this section were previously discussed in the section on viral hepatitis and cirrhosis (Table 6). The two SEER-Medicare studies showed a significant positive association between diabetes and CC.28, 47 Another large, population-based, case-control study from the United Kingdom by Grainge et al. found a significant association between diabetes and CC.56 Conversely, a population-based study by Welzel conducted in Denmark did not find a significant association between diabetes and ICC.48 Additionally, one hospital-based, case-control study showed a significant association between diabetes and ICC,27 whereas at least three others failed to show a signification association (Table 6).41, 51, 53 The data on diabetes as a risk factor for CC, especially ICC, are mostly indicative of a modest association, but are inconsistent. Data on obesity are limited (Table 6). Obesity was reported as a significant, but weak, risk factor for CC in two population-based, case-control studies. In the study by Grainge et al.

3) Their studies are designed and

orchestrated by academ

3). Their studies are designed and

orchestrated by academic centers, and the involvement of community physicians and/or their patients is encouraged. These studies are meant to answer questions never answered by other published reports and are designed to better serve our patients. Answers to a variety of clinical issues that pertain to a disease can be achieved by something as simple selleck screening library as recording daily coffee intake! In previous nonresponders to treatment for CHC, intake of three or more cups of coffee per day was associated with both enhanced viral clearance and a reduced rate of disease progression!15, 16 Ability to conduct ancillary studies allows for one study to provide multiple answers to several aspects of the one disease (e.g., sociocultural, immunologic, radiologic, and serologic), all of which are clinically relevant, but less likely to interest Selleckchem Y-27632 the “industry,” but nevertheless factors that may influence patient compliance and care and/or outcome. The studies emanating from the Hepatitis C Antiviral Long-term Treatment against Cirrhosis consortium alone have, to date, resulted in 64 clinically

relevant peer-reviewed publications! Both hard clinical findings and blood-test results were incorporated into one of the first combined measures of outcome, the Child-Turcotte-Pugh Score, first designed to predict postoperative outcome after surgical maneuvers for portal hypertension. More recently, another combined measure of liver function, the Model for End-Stage Farnesyltransferase Liver Diease (MELD) score, also specifically developed to predict the likelihood of postoperative survival after triangular intrahepatic portosystemic shunt (TIPS) insertion, is now employed universally to assess

the “optimal timing” for a transplant in patients with liver failure. A recent MELD remodel, which adds serum sodium, may be even more reliable.17 It is much harder to predict outcome in patients with presymptomatic disease—those we most often see in clinics in 2011. In the 1960s, most were diagnosed only once their liver disease was advanced. For example, of patients with AIH recruited to the trials of prednisone in the 1960s, nearly all had end-stage liver disease; hence, over a relatively short period, it was possible to appreciate that those randomized to placebo had a significantly higher mortality rate than those who received prednisolone.18 Fifty years later, patients with AIH rarely present with liver failure, though some are given this diagnosis even though they are asymptomatic! This begs the question whether AIH always shortens the person’s life. So, before we treat all AIH cases, we need to know if the survival of asymptomatic cases is as bad as for those with symptomatic disease.

However, due to small sample size and lack of randomization, resp

However, due to small sample size and lack of randomization, response to steroids could not be analyzed as a diagnostic marker for DZNeP purchase AI-ALF. Patients who survived ALF, either after spontaneous recovery or liver transplantation, were requested to return twice, at 12 and ≥24 months after the admission for ALF. Detailed medical history including laboratory analysis results and liver biopsy results were reviewed at each visit. Follow-up liver biopsies

were read locally for histological evidence of hepatitis and rejection (in transplant recipients) by study site pathologists and were not retrieved for central reanalysis. Samples of liver were evaluated in a blinded fashion on two occasions by an experienced hepatopathologist (J.H.L.). The first review was a survey to identify features of an acute autoimmune pathogenesis, as described.6-12 Particular attention was paid to the centrilobular region of the lobule.8, 9, 11, 12 The second review, performed blinded to the

APO866 in vivo first review, was undertaken to ensure reproducibility of the findings and to further subclassify the types of MHN. Concordance for finding in the first and second reviews was 100% (data not shown). During the first review, several variants of MHN were observed and were classified as MHN1 to MHN5 in the second review (Figs. 1 and 2). Three patterns (MHN1, MHN2, and MHN3) were considered relatively nonspecific. MHN1 was characterized by classical massive necrosis with

near-complete loss of hepatocytes throughout the lobules, residual intrasinusoidal inflammation, periportal neocholangiolar proliferation (ductular reaction), and portal/periportal inflammation. MHN2 was characterized by submassive necrosis, representing regions of MHN1 as well as regenerative nodules and areas of early fibrosis, and was considered to represent a more subacute clinical course than MHN1. MHN3 demonstrated necroinflammatory changes of acute hepatitis in portions of the specimen (spotty necrosis) as well as other regions Sitaxentan with more substantial confluent necrosis, including areas of bridging hepatic necrosis or multilobular necrosis with neocholangiolar proliferation. Two patterns of MHN (types 4 and 5) were considered more characteristic of an autoimmune pathogenesis. MHN4 showed the typical features of panlobular necrosis, but with prominence of centrilobular necroinflammation and hemorrhage, resembling the severe form of the centrilobular variant of AIH10-12 and the centrilobular variant of acute cellular rejection observed in transplant allografts.14, 16 MHN5 showed features of classical periportal AIH in conjunction with superimposed changes of massive necrosis and sometimes centrilobular necroinflammation.

Conclusions: SWE and HRI measurements are non-invasive methods th

Conclusions: SWE and HRI measurements are non-invasive methods that can assist in clinical decision making in the assessment of fibrosis and steatosis in both OLT and non-OLT patients although caution should be exercised over the interpretation of these measurements in patients with a BMI>40. Disclosures: this website Edward I. Bluth – Advisory Committees or Review Panels: PHILLIPS; Grant/ Research Support: PHILLIPS The following people have nothing to disclose: George Therapondos, Michael T. Perry, Neal Savjani, Adriana Dornelles Background: Psoriasis is a chronic inflammatory immune-mediated skin disease which is showed to be associated with metabolic syndrome. Nonalcoholic fatty liver disease (NAFLD), a hepatic manifestation

of metabolic syndrome, can progress to advanced fibrosis and cirrhosis. Liver biopsy is a gold standard method for assessing liver fibrosis; however it is invasive with possible risks. Liver stiffness measurement (LSM) by transient elastography (TE), a noninvasive liver fibrosis assessment tool, was evaluated in chronic liver diseases. We aimed to investigate the prevalence of significant liver fibrosis by LSM criteria and to identify the associate

factors of significant fibrosis in psoriatic patients. Rapamycin chemical structure Methods: A cross-sectional study was conducted at psoriasis clinic from January 2013 to December 2013. Psoriatic patients were invited to participate with the study. The subjects underwent laboratory tests for biochemistry, ultrasonography and TE (Fibroscan®) after overnight fasting. LSM ≥7.1 kPa was defined as a significant liver fibrosis. The prevalence of significant fibrosis was calculated. Univariate analysis was performed to identify factors associated with significant fibrosis. Factors with p-value less than 0.10 were analyzed with multivariate logistic regression analysis. A p-value <0.05 was taken as statistical significance. Results: One hundred and sixty-eight patients Isoconazole were enrolled. TE could not be performed in 3 patients due to obesity. Mean age was 49.22 (14.0) years. Ninety (54.5%) patients were female. Mean body mass index was 24.76 (4.7) kg/m2. Eighty-eight

(53.3%), 55 (33.3%) and 31 (18.8%) patients had hypertension, dyslipidemia and diabetes mellitus (DM). According to AHA/NHLBI criteria, metabolic syndrome was documented in 83 (50.3%) patients. Median duration of psoriasis was 13.00 (range: 0.4-68.0) years. Taking methotrexate over 1500 g in accumulating dosage was found in 39 (23.6%) patients. Mean LSM was 5.26 (2.9) kPa, and 18 (10.95%) patients had significant fibrosis. By multivariate analysis, DM (OR 17.65, 95%CI: 21.997-55.966; p=0.01), waist circumference (OR 1.24, 95%CI: 1.044-1.475; p=0.014) and AST level (OR 1.16, 95%CI: 1.052-1.288; p=0.003) were independently associated with significant fibrosis. Conclusions: Approximately 11% of psoriatic patients have significant liver fibrosis defined by transient elastography criteria.

this meta-analysis is to compare DBE versus SBE procedures in pat

this meta-analysis is to compare DBE versus SBE procedures in patients.

Methods: Meta-analysis was performed by retrieving Medline, Pubmed, Embase, Cochrane Library and Chinese CQVIP database (January 2008 to March 2013). Eligible studies were randomized controlled trials that compare SBE and DBE in adult patients. The quality of trials was assessed with the Jadad score. Results: Four randomized controlled Y-27632 mouse trials with 315 patients (327 procedures, 171 for DBE, 156 for SBE) met the inclusion criteria. The diagnostic yield for DBE was 48.3% (95% CI 37.9–58.6), and for SBE was 62.7% (95% CI 40.8–84.7), with a non-significant odds ratio for DBE compared with SBE of OR = 1.42 (95%CI = 0.9–2.25).

Considering different disease incidence and patterns in western and eastern country, subgroup was carried out, but also showed no significant Cabozantinib solubility dmso difference (OR = 1.24, 95%CI = 0.73–2.10 for the West and OR = 2.21, 95%CI = 0.85–5.74 for the East). Conclusion: This meta-analysis is the first systemic meta-analysis comparing SBE and DBE. Though the diagnostic yield is not significantly different between DBE and SBE, considering the time-consuming handling, SBE may be suitable for primary survey, while DBE may be better for identifying the extent and number of lesions. Key Word(s): 1. balloon enteroscopy; 2. meta-analysis; Presenting Author: YU MI LEE Additional Authors: KYUNG HO SONG, HOON SUP KOO, YONG SEOK KIM, TAE HEE LEE, KYU CHAN HUH, YOUNG WOO CHOI, YOUNG WOO KANG Corresponding Author: KYUNG HO SONG Affiliations: Department of Internal Medicine, Konyang University College of Medicine Objective: Narrow band imaging (NBI) and magnifying endoscopy provides more accurate diagnosis of colonic polyps. However these systems are not clinically used as standard endoscopic equipment in most institutions. The aim of this study was to determine if the white spots around colon polyp give additional information about colorectal polyps under conventional white light colonoscopic observation,

including histology and lymphovascular invasion and even differentiating neoplastic polyp from nonneoplastic one. Methods: We retrospectively Astemizole reviewed the clinical data and pathologic reports of 381 polyps (consecutive 143 patients who underwent endoscopic polypectomy) of the colon at a tertiary care hospital between January 1, 2011 and June30, 2011. Two endoscopist judge whitish spots. We analyze association between whitish spots of the colonic mucosa around polyps with histology. Results: The interobserver variability was moderate degree. (kappa 0.555, P < 0.01) Majority (95.7%) of whitish spots-positive polyps were neoplastic. (p = 0.001, sensitivity 15.2%, specificity 97.8%).

pylori infection, two studies tested the association between H  p

pylori infection, two studies tested the association between H. pylori infection and hyperemesis gravidarum characterized by intractable vomiting in pregnant women [92] and the occurrence see more of neural tube defects in newborns [93], but the low inclusion rate limited the conclusions to be drawn. The cross-reactivity between anti-H. pylori antibodies and other antigens is one of the hypotheses to explain the role of H. pylori infection in extradigestive disease. Based on this mechanism, Franceschi et al. [94] attempted to explain the epidemiologic association between CagA-positive H. pylori strains and previously reported pre-eclampsia [95-98].

They used placenta samples from healthy women and tested the ability of anti-CagA antibodies Trichostatin A mw to recognize trophoblast cells and invasive potential and pro-inflammatory properties of trophoblast cells in the presence or absence of anti-CagA antibodies. Results supported the hypothesis that anti-CagA antibodies recognize cytotrophoblast cells and reduce their invasiveness. Chen et al. [99] in a prospective

cohort analysis with 9895 participants (<41 year) followed for at least 12 years (the National Health and Nutrition examination Survey III) did not conclude that H. pylori infection was a major risk factor for all-cause mortality. In fact, In this cohort, H. pylori positivity (including CagA strains) was not associated with increased all-cause mortality. H. pylori infection was associated with an increased risk of death due to gastric cancer, but with reduced risks of death due to stroke and lung cancer. Over the last year, several diseases have been reported to be associated with H. pylori infection and/or CagA-positive strains. Their role, in some hematologic condition, such as ITP, idiopathic sideropenic anemia, and vitamin B12 deficiency, has been fully validated and included in the current guidelines. There is a positive trend in favor

of an association between H. pylori infection Interleukin-2 receptor and neurodegenerative disorders. Furthermore, there are new data concerning a reduced risk of death due to stroke and lung cancer in patients with H. pylori infection but an increased risk of pre-eclampsia in women infected by CagA-positive strains, which deserves further investigations. Competing interests: the authors have no competing interests. “
“Background:  Many micronutrients depend on a healthy stomach for absorption. Helicobacter pylori chronic gastritis may alter gastric physiology affecting homeostasis of vitamins and minerals. Objectives:  Systematic review to assess whether H. pylori infection is associated with reduced micronutrient levels (other than iron) in the plasma or gastric juice and whether low micronutrient levels are modified by eradication treatment. Method:  Medline was searched for relevant publications from inception to June 2010. Studies describing micronutrient levels in H. pylori-infected and not-infected adults and/or the effect of eradication treatment on micronutrient levels were included.

Results: After 21 days post-surgery

Results: After 21 days post-surgery Selleckchem BTK inhibitor of BM-GFP cells, the percentage of GFP+ cells (chimerism) was 69±2.3 %. Further, on CCl4 injury, liver tissue showed significant fibrosis with increased hepatic inflammation, necrosis and collagen deposition with bridge formation. Ishak scoring of 1-2 was observed on day 14 and 3-4 was observed on day 25. After one and two weeks of CCl4 injury, percentage of GFP+ cells increased from 69±2.3 % to 82±1.9 % and 94.35±3.1 % in the blood respectively. Flk-1 +/CD34+ cells in blood were also increased

from 0.02±0.01 % to 0.2±0.04 % and 0.24±0.01% after 1 and 2 weeks of injury. Immunofluroscence of the liver sections showed co-localization of CD-31+/GFP+ cells indicating the mobilization of CACs from BM to the liver. Conclusion: Our result shows the migration of CD-31+/GFP+ CACs from

bone marrow to liver during fibrosis. The CACs may contribute to vascular repair and are capable of accelerating the recovery of liver injury. Further studies are needed to define the CACs role in arresting or reverencing the fibrosis Disclosures: The following people have nothing to disclose: Arpita Banik, Savneet Kaur, Nirupma Trehanpati, Ashok Mukhopadhyay, Shiv K. Sarin Background: Inflammatory bowel disease (IBD) is found to be associated with several kinds of liver disease. The purpose of this study is to investigate the role of combination with dextran sodium sulfate (DSS) in hepatitis and fibrosis in mice treated by with CCl4. Methods: Male BYL719 manufacturer C57BL/6 mice were grouped as follows: Control group (n=1 0), DSS group (n=1 0), Olive oil group (n=10), CCl4 group (n=10) and CCl4+DSS group Unoprostone (n=10). Severity of colitis was evaluated by disease activity index (DAI), colon length, colon pathology score, myeloperoxidase (MPO) and histopathology. Haematoxylin and eosin (H&E) staining, Sirius

red staining and Masson’s trichrome (MT) staining were used to detect liver histopathological changes. Pro-inflammatory cytokines in both colon and liver tissues including TNF-α, IFN-γ and IL-17A were detected by immunohistochemical staining, western blot and real-time Q-PCR, respectively. The protein and mRNA expressions of TGF-β1, α-SMA, collagen I, collagen III, MMP-2 and TIMP-2 in liver tissues were observed by immunohistochemical staining, western blot and real-time Q-PCR, respectively. Results: DSS treatment led to increased BW loss, higher DAI score, shortened colon length, elevated MPO activity, and worsened histologic inflammation in colon. Moreover, TNF-α, IFN-γ and IL— 1 7A expressions in both colon and liver tissues were all enhanced in DSS group. Hepatitis was also found in DSS group as well as CCl4 group and CCl4+DSS group by histological analysis. However, comparing with CCl4 group, hepatitis in CCl4+DSS were more severe, reflected by histology and pro-inflammation cytokines expressions.

Treatment of HG involves supportive treatment with IV hydration,

Treatment of HG involves supportive treatment with IV hydration, anti-emetics and vitamin supplementation especially thiamine to prevent Wernicke’s encephalopathy. HG resolves by 18 weeks of gestation and ICP after delivery. However, ICP can lead to fetal prematurity and anoxia and therefore delivery should be considered after fetal maturity has

been achieved in refractory cases. “
“Hepatitis delta remains a therapeutic challenge. Interferon-alpha (IFN-α) is the sole therapeutic option for patients with chronic hepatitis delta, but results are suboptimal. Less than 30% of patients treated for 48 weeks with pegylated IFN-α (Peg-IFN-α) have a negative viremia 24 weeks after the end of treatment. Heidrich et al. report on the long-term outcome of patients treated in the HIDIT-1 trial. Their assessment is humbling. More than 50% of the patients Selleckchem BI 2536 NVP-LDE225 ic50 with a negative viremia 24 weeks

after treatment have late relapse, and Peg-IFN-α therapy was not associated with a reduction of hepatic events until year 5 of follow-up. On a positive note, none of the patients with a negative viremia at 24 weeks post-treatment experienced a clinical event. This article delivers two messages: (1) A negative viremia 24 weeks post-treatment should not be considered a sustained virological response (SVR) in hepatitis delta and (2) better treatments are required. (Hepatology 2014;60:87-97.) There is no doubt that the best way to avoid problems with hepatitis B virus (HBV) is to vaccinate at birth. Since the implementation of programs Clomifene aiming at vaccinating every newborn, the effect of HBV decreased substantially, especially in countries with high prevalence. But, how important is it to have the multiple shots that a complete vaccination against HBV implies? To answer this question, Chien et al. stratified 3.8 million Taiwanese subjects, according to their complete or incomplete vaccination status, and investigated whether an incomplete vaccination could be associated

with liver-related outcomes (i.e., chronic liver disease, hepatocellular carcinoma [HCC], or fulminant liver failure). All of these outcomes were significantly more frequent in individuals who did not receive a complete vaccination, in comparison with those who had a complete vaccination. To implement general vaccination against hepatitis B is excellent, but to be sure that the complete vaccination is performed is even better. (Hepatology 2014;60:125-132.) Patients with cirrhosis are prone to develop infections, and infections in these patients can lead to severe, potentially lethal complications, such as acute-on-chronic liver failure (ACLF). It is essential to identify patients at high risk as early as possible. Bajaj et al., for the North American Consortium for the Study of End-stage Liver Disease, studied 507 patients with cirrhosis hospitalized with an infection.

Voxels with an absolute value of t greater than 3 1 (P < 001, un

Voxels with an absolute value of t greater than 3.1 (P < .001, uncorrected for multiple comparisons) and within a spatially contiguous cluster size greater than 100 voxels were considered significant differences between blindness and sightedness. The regions with significant group differences are listed in Table 2. Compared with SC, the contracted regions are primarily located in the left early MS-275 cell line occipital lobe (Fig 1) in EB. By contrast, expanded regions are located in the left higher level visual association areas, posterior cingulated cortex, and cerebellum

(Fig 2) in EB. The statistical results were superimposed on the selected template image. Given that it was a single SC image, the Brodmann areas were checked by mapping the Torin 1 supplier Brodmann areas image template (provided in MRIcro software, http://www.cabiatl.com/mricro/) to our template. The result on a significant volume contraction occurring in the left lower visual areas (BA 17/18) of EB is consistent with previous findings.[7], [8], [12], [18], [19] The early visual cortex of EB is suggested to be structurally atrophic. However, the volume change in the right early visual cortex was not detected within a significant threshold (P < .001, uncorrected for multiple comparisons) in the statistic map. This result can possibly be attributed to the serious value of the

threshold. When the significance threshold value was adjusted to a higher value (P < .005, uncorrected for multiple comparisons), there was volume reduction at the local region in the right visual cortex (BA 17/18), thereby validating our supposition. This finding indicates that the volume reduction in the left-brain hemisphere is much more significant than that in the right. To some degree, this may be related to the right-handedness of all the participants. Compared with the results of Leporé and colleagues,[12] no significant differences were detected in the frontal and parietal lobes. On the contrary, regions in BA 19 showed significant

increases in volume in EB. Notably, the volumes of local regions in the posterior cingulated cortex (BA 23, BA 31) increased in EB. Consistent with previous studies, volume increase was also detected in the cerebellum in both sides. To evaluate whether the results were influenced by total brain size, the data were of reanalyzed by removing the global scaling factor derived from the initial affine transformation. No significant differences were detected in the unscaled data. Functional plasticity in the visual cortex of EB has been demonstrated in several previous studies.[20-24] However, aside from those that use VBM, there have been few reports to date on the structural plasticity in the visual cortex of EB. The main objective of the VBM method is to detect and analyze the differences in the entire brain, including the GM and WM between groups of people.[25], [26] In previous structural MRI studies, the VBM method was commonly used.

Percutaneous isolated hepatic perfusion chemotherapy following de

Percutaneous isolated hepatic perfusion chemotherapy following debulking

hepatectomy is reportedly useful in treating patients with severe advanced HCC with tumor thrombus of major vessels.14 LIVER TRANSPLANTATION IS the best treatment method for removing metastatic foci in the liver together with the cirrhotic liver from which the cancer develops. In Japan, living-donor liver transplantation has been covered by health insurance since January 2004. According to reports published up to the end of 2009, almost all liver transplantations for HCC see more in Japan involved living donors, with 1131 transplantations from living donors and seven from deceased donors.15 As liver transplantations are taken from living donors, indications for liver transplantation in Japan only cover those patients who meet the Milan criteria (≤3 tumors with tumor diameter ≤3 cm or a single tumor ≤5 cm in diameter), but whose hepatic reserve has deteriorated severely (Child–Pugh class C),1,2 meaning that liver transplantations are regarded very differently in comparison with other countries where the majority of transplantations are from deceased donors.15 However,

because most liver transplantations are from living donors, issues of the appropriate distribution of liver grafts and waiting times involved in transplantations from deceased donors are almost non-existent. Recently, tumor markers have also been included in the criteria, and attempts are being made to extend indications beyond those of Histamine H2 receptor the Milan criteria.16,17 In addition, donors are restricted to close relatives. this website As a result, blood groups are frequently mismatched, although in almost all cases this can be managed by the preoperative administration of anti-CD20 antibodies and plasmapheresis.18 According to a report by the Japanese Liver Transplantation Society, 1-, 3-, 5- and 10-year survival rates following liver transplantation from a living donor were 84.4%, 73.9%, 68.5% and 58.8%, respectively.15 The Act on Organ Transplantation was revised in July 2010 to enable organ donation with the family’s permission even if the donor’s own intentions had not been made clear, and

since then the number of liver transplants from deceased donors has gradually been increasing. LOCAL ABLATION THERAPY constitutes the main medical therapy for HCC in Japan. According to the report of the 18th follow-up survey, local ablation therapies were used in 30.6% of cases, administrated percutaneously in approximately 90% of those cases. RFA was used in 72.1% of cases (Fig. 2).9 Radiofrequency ablation has been covered by health insurance in Japan since April 2004, and its efficacy has been demonstrated in several subsequent randomized comparative trials,19–22 making this the first choice in percutaneous local therapy today.2 Percutaneous ethanol injection therapy, the therapy previously used, is still performed in rare cases for sites where insertion of an electrode for RFA is regarded as dangerous.