Background: Spontaneous rupture is rare complication of hepatocellular carcinoma (HCC) with high mortality rate in cirrhotic cases. The aim of this study was to determine the factors influencing prognosis in cases of spontaneously ruptured HCC and to investigate the outcomes of the treatments employed, especially transcatheter arterial embolization (TAE).

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Background and study aims  Colorectal cancer (CRC) is one of the most common neoplasms and endoscopic submucosal dissection (ESD) is an effective treatment for early-stage CRC. However, it has been observed that patients undergoing ESD often complain of pain, even if ESD has been successfully performed. Risk factors for such pain still remain unknown. The aim of this study was to explore the risk factors for post-colorectal ESD coagulation syndrome (PECS). Patients and methods  This was a prospective multicenter observational trial (UMIN000016781) conducted in 106 of 223 patients who underwent ESD between March 2015 and April 2016. We investigated age, sex, tumor location, ESD operation time, lesion size, duration of hospitalization, and frequency of PECS. We defined PECS as local abdominal pain (evaluated on a visual analogue scale) in the region corresponding to the site of the ESD that occurred within 4 days of the procedure. Results  PECS occurred in 15/106 (14.2 %), and 10 were women ( P  = 0.01, OR: 7.74 [1.6 – 36.4]), 7 had lesions in the cecum ( P  < 0.001, OR: 20.6 [3.7 – 115.2]), and 9 in whom ESD operation time was > 90 min ( P  = 0.002, OR: 10.3 [2.4 – 44.6]). Frequency of deviation from the prescribed clinical path was significantly higher (47 % [7/15] vs. 2 % [2/91], P  < 0.001, OR: 38.9 [6.9 – 219.6]), and hospital stay was significantly longer in the PECS group.  Conclusions  Female gender, location of lesion in the cecum, and ESD operation time > 90 minutes were significant risk factors independent of PECS. These findings are important to management of PECS.

Stereotactic radiotherapy for HCC with or without transarterial chemoembolization is feasible therapy and provides good local control with a short treatment period. Stereotactic radiotherapy may be of clinical benefit in patients who are inoperable or for whom there are difficulties in other ablation therapies.

A highly sensitive second-generation hepatitis C virus (HCV) core antigen assay has recently been developed. We compared viral disappearance and first-phase kinetics between commercially available core antigen (Ag) assays, Lumipulse Ortho HCV Ag (Lumipulse-Ag), and a quantitative HCV RNA PCR assay, Cobas Amplicor HCV Monitor test, version 2 (Amplicor M), to estimate the predictive benefit of a sustained viral response (SVR) and non-SVR in 44 genotype 1b patients treated with interferon (IFN) and ribavirin. HCV core Ag negativity could predict SVR on day 1 (sensitivity ‫؍‬ 100%, specificity ‫؍‬ 85.0%, accuracy ‫؍‬ 86.4%), whereas RNA negativity could predict SVR on day 7 (sensitivity ‫؍‬ 100%, specificity ‫؍‬ 87.2%, accuracy ‫؍‬ 88.6%). None of the patients who had detectable serum core Ag or RNA on day 14 achieved SVR (specificity ‫؍‬ 100%). The predictive accuracy on day 14 was higher by RNA negativity (93.2%) than that by core Ag negativity (75.0%). The combined predictive criterion of both viral load decline during the first 24 h and basal viral load was also predictive for SVR; the sensitivities of Lumipulse-Ag and Amplicor-M were 45.5 and 47.6%, respectively, and the specificity was 100%. Amplicor-M had better predictive accuracy than Lumipulse-Ag in 2-week disappearance tests because it had better sensitivity. On the other hand, estimates of kinetic parameters were similar regardless of the detection method. Although the correlations between Lumipulse-Ag and Amplicor-M were good both before and 24 h after IFN administration, HCV core Ag seemed to be relatively lower 24 h after IFN administration than before administration. Lumipulse-Ag seems to be useful for detecting the HCV concentration during IFN therapy; however, we still need to understand the characteristics of the assay.Hepatitis C virus (HCV) infection causes a slowly progressive disease which can lead to chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (28, 30). Successful interferon (IFN) therapy for HCV leads to persistently undetectable serum viral levels and histological improvement (9, 11) and improves the survival of chronic hepatitis C patients by preventing liver-related deaths (36). A meta-analysis study including data from randomized trials showed that retreatment of nonresponders with a combination of IFN-␣2b and ribavirin (RBV) for 24 weeks was associated with only 14% sustained virological response (SVR) in genotype 1-infected patients (4). When a combination of pegylated interferon (IFN) and RBV was used as retreatment for 48 weeks, a 46% SVR rate was reached; however, patients infected with genotype 1 still had a limited chance of achieving SVR (12).Studies aimed at understanding the predictive value of SVR and non-SVR in the absence or presence of serum RNA during IFN therapy within 2 days (32), 1 week (18), 2 weeks (17), 1 month (3,6,13,15,29,39), or 3 months (23) have been reported. The biphasic or triphasic initial decline in the level of serum HCV RNA after IFN therapy has also been characterized and analyzed m...