Background: For patients with hepatitis C virus (HCV)-related decompensated cirrhosis, poor prognosis was documented due to the development of portal hypertension-related complications and hepatocellular carcinoma. Sofosbuvir-based direct-acting antiviral agents (DAAs) has revolutionized the treatment landscape of HCV, particularly in this subpopulation. To date, real-world efficacy, tolerability, and safety profiles for Taiwanese HCV-related decompensated cirrhosis treated by DAAs have not been reported. Methods: Between December 2015 and June 2020, 50 consecutive HCV-related Child-Turcotte-Pugh (CTP) classes B or C cirrhotics treated by sofosbuvir-based DAAs (with daclatasvir: 7, with ledipasvir: 32, with velpatasvir: 10, with ledipasvir then shifted to velpatasvir: 1) were enrolled. Forty-seven (94%) patients used DAAs in combination with low-dose ribavirin. SVR 12 was defined by undetectable HCV RNA (<15 IU/mL) at treatment end and 12 weeks after the completion of therapy. Results: The mean age of the enrolled patients was 68.1 ± 11.2 years, 18% of the patients were CTP class C, and the baseline HCV RNA level was 5.42 ± 1.2 log 10 IU/mL. The genotype distribution was as follows: 1a: 3; 1b: 34; 2: 9; 6: 3; and one patient with an unclassified HCV genotype. After DAAs treatment, the rates of undetectable HCV RNA at week 4 and at the end of the treatment were 88.9% and 98.0%, respectively. Subjective adverse events were reported by 42.0% of the patients, but they were generally mild and could be relieved by medications. One patient did not finish therapy due to sepsis with multiple organ dysfunction. The overall SVR 12 rate was 96.0% (CTP class B: 97.6%, CTP class C: 88.9%). A significant improvement in hepatic functional reserve was noted after successful antiviral therapy. Conclusion: For patients with HCV-related decompensated cirrhosis, which has been considered a contraindication for interferon-based therapy, sofosbuvir-based all-oral DAAs provided high treatment efficacy, acceptable safety, and good tolerability.

Background: The treatment of chronic hepatitis C (CHC) infection underwent a significant transformation with the introduction of all-oral direct-acting anti-virals (DAAs). These medications offered a high success rate in treatment, shorter duration, good tolerability, and expanded treatment options. However, a residual risk of hepatocellular carcinoma (HCC) development remained for a few patients even after achieving sustained virological response (SVR). To date, there is a lack of real-world data on evaluating risk factors associated with de novo HCC in CHC patients post-SVR, particularly in Taiwan. Methods: Between January 2017 and December 2019, a total of 671 consecutive CHC patients who achieved SVR after receiving DAAs were included for analysis. Patients with a history of HCC or liver transplantation prior to DAAs, a short follow-up period (< 1 year), or treatment failure with DAAs were excluded. The primary outcome was the development of HCC following the initiation of DAAs. Variables associated with the primary outcome were assessed using multivariate Cox proportional hazards models. Results: The mean age of the enrolled patients was 65.1 ± 12.8 years, with 39.6% of them being male. Among the patients, 30.6% had advanced (F3-4) fibrosis, and the median follow-up period was 2.90 years. The cumulative incidence of HCC in CHC patients post-SVR12 was 1.6% at 1 year, 4.4% at 2 years, 4.8% at 3 years, 5.3% at 4 years, and 6.1% at 4.8 years, respectively. Variables independently associated with de novo HCC were advanced liver fibrosis (HR = 6.745; 95% CI, 1.960–23.218; p = 0.002), end-of-treatment 12 weeks (EOT12) AFP > 7 ng/ml (HR = 3.059; 95% CI, 1.215–7.669; p = 0.018), EOT12 ALBI grade ≥ 2 (HR = 2.664; 95% CI, 1.158–6.128; p = 0.021), and body mass index (BMI) ≥ 25 kg/m 2 (HR = 2.214; 95% CI, 1.011–4.852; p = 0.047). Conclusion: Despite achieving viral clearance with DAAs, CHC patients still face a residual risk of de novo HCC. Establishing a risk stratification model based on independent variables could facilitate the prediction of future HCC development and enhance screening strategies.

Dear Colleagues:Everyone working in the field of focused ultrasound has been intrigued and inspired by the therapeutic potential and promise of this exciting technology. While still at an early stage, our push to develop focused ultrasound applications is increasing in scope and intensity. To me, the best gauge of our progress is the 3rd International Symposium on Focused Ultrasound.What makes this year's symposium different from its predecessors is the inclusion of more presentations, more indications and more advances in R&D and commercialization. All signal that the pace of progress in our field is escalating.I hope that clinicians attending this year's symposium gain meaningful insight into the full range of applications that focused ultrasound can provide to them and, therefore, to their patients. After all, having patients live longer, healthier lives is the driving force in all of our work. From the Foundation ChairmanDear Colleagues:Welcome to the 3rd International Symposium on Focused Ultrasound. You are participating in the most extensive program we have hosted to date featuring more than 170 oral and poster presentations spotlighting the latest developments in our field. This represents more than a 50% increase compared to the 2010 symposium and reflects the accelerating progress being achieved by the focused ultrasound community.In keeping with the Foundation's intense patient-centric orientation, the program emphasizes the translational and clinical research that is moving focused ultrasound into the realm of patient care.The potential focused ultrasound to improve the quality of life and longevity for millions of people around the world with serious medical disorders has never been more apparent. Effective therapies to decrease death, disability and suffering are now on the horizon, no longer beyond it. But we still need to shorten the distance. We will do that through capitalfinancial and, more importantly, human capital.The number of focused ultrasound investigators is continuing to grow as evidenced by the applications received for the Young Investigator Travel Awards. In 2010, there were 11 applications; this year, there were 44. But in order to move focused ultrasound forward more rapidly, we need more human capital. The most expeditious way to achieve this is to leverage the people who are currently engaged.The symposium is an important vehicle for disseminating knowledge and sharing ideas, the most important role is to serve as an incubator to foster collaboration -collaboration being the ultimate force multiplier for human capital. Please take advantage of the opportunities to establish new partnerships and collaborations, particularly during the Tuesday evening poster session.Several special events are planned during the symposium, including keynote talks by Dean Kamen, one of the international leaders in medical device innovation and inventor of the Segway, at Sunday's opening reception and by John Grisham, best-selling author and Foundation board member, on Tuesday morning.The Focused U...