Metabolic dysfunction-associated steatohepatitis (MASH) is increasingly recognized as a leading cause of hepatocellular carcinoma (HCC), the third-leading cause of cancer mortality worldwide, driven by the global obesity epidemic. Projected to become the primary cause of HCC by 2030, MASH-HCC presents unique clinical challenges. This review examines its clinical management, including surveillance strategies and treatment advances, and discusses prospects to overcome existing challenges. MASH-HCC accounts for 10%–20% of HCC cases, particularly in Western countries, with a rising incidence due to obesity. Risk factors include cirrhosis, diabetes, obesity, alcohol, smoking, genetic polymorphisms (e.g., PNPLA3), and microbiome alterations. The pathogenesis involves fibrosis, immune dysfunction (e.g., T-cell impairment), and molecular changes. Prevention focuses on lifestyle modifications. Surveillance in patients with MASH cirrhosis is crucial but is hindered by poor ultrasound sensitivity in obese patients, necessitating alternative methods. Treatment mirrors that of other HCC types, but comorbidities and potentially reduced efficacy of immunotherapy necessitate tailored approaches. MASH is becoming the leading cause of HCC, necessitating lifestyle interventions for prevention. Improved surveillance and early detection are critical but challenging due to obesity-related factors. Treatments align with those for other HCC types, but comorbidities and potential differences in immunotherapy efficacy due to T-cell dysfunction require careful consideration. Key needs include identifying molecular drivers in non-cirrhotic metabolic dysfunction-associated steatotic liver disease, developing preventive therapies, refining surveillance methods, and tailoring treatments. Trials should specifically report MASH-HCC outcomes to enable personalized therapies. Further research is needed to understand T-cell dysfunction, optimize immunotherapies, and identify predictive biomarkers.
, Won Kim Understanding the effects of sex and sex differences on liver health and disease is crucial for individualized healthcare and informed decision-making for patients with liver disease. The impact of sex on liver disease varies according to its etiology. Women have a lower prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) than men. However, postmenopausal women face a higher risk of advanced liver fibrosis due to hormonal influences. Sex differences affect the pathogenesis of MASLD, which involves a complex process involving several factors such as hormones, obesity, and the gut microbiome. Furthermore, sex-related differences in the development of MASLDrelated hepatocellular carcinoma have been observed. The sex-specific characteristics of MASLD necessitate an individualized management approach based on scientific evidence. However, research in this area has been lacking. This article reviews the current understanding of sex differences in MASLD.
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, Tae Hun Kim, Kwon Yoo, Ye Ji Han, Jeong Eun Choi, Ji Yoon Kim, Min-Sun Cho Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease that may progress to end stage liver cirrhosis. Benefits of ursodeoxycholic acid (UDCA) treatment has been investigated through large clinical studies. However, most of the studies were done in western countries and recent increase in prevalence of this relatively uncommon chronic liver disease draws attention in Korea. As early UDCA treatment effectively prevent the grave consequences of PBC progression, early diagnosis and lifelong management with UDCA is important. This study was designed to investigate the clinical features of PBC and response rates of UDCA treatments in Ewha Womans University Medical Center.
Clinical data of PBC patients diagnosed between 2001 and 2014 at Ewha Womans University Medical Center were analyzed retrospectively.
A total of 35 patients with mean follow-up duration of 42 months were enrolled. At the diagnosis, 72.7% of the patients were asymptomatic, 5.7% had decompensated liver cirrhosis. The mean serum alkaline phosphate (ALP) level was 2.65 times upper limit of normal. UDCA was prescribed in 91.4% of the patients (n=32), among which 77.4% exhibited biochemical responses defined as serum ALP less than 2 upper limit of normal at 6 months (Mayo criteria).
Most PBC patients were asymptomatic at the time of diagnosis and the average biochemical responses rate to UDCA treatment were ranged from 60.0% to 78.9% according to various response criteria. To elucidate the clinical features and courses of Korean PBC patients in detail, larger scale investigations and longer clinical follow up studies are warranted.
Since he liver is the central organ of uric acid metabolism, I investigated the utility of serum uric acid level as an indicator of the residual liver function and prediction of survival in patients with liver cirrhosis.
I measured the liver function test including uric acid level in the patients with chronic liver disease(41 patients with chronic hepatitis and 66 patients with liver cirrhosis). The serum uric acid level was analyzed for prognostic value.
The serum uric acid level was significant decreased in patients with Child-Pugh class B and C group(group III) compared with Child-Pugh class A(group II) or chronic hepatitis(group I)(p<0.001). There was no difference of the level of uric acid between alcoholic and nonalcoholic cirrhotic patients(p=0.09). The serum uric acid level was correlated inversely with serum bilirubin level in patients with cirrhosis. The sensitivity and specificity of hypouricemia in detecting liver function status in patients with liver cirrhosis were 62.5% and 100%, respectively.
The hypouricemia is one of sensitive factors to assess liver function and predictive value of survival in liver cirrhosis.
, Ah-Young Ji, Jung-Hee Lee, Sooyun Chang, In-Soo Kim, Young Ju Kim, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Sang Hoon Ahn, Kwang-Hyub Han, Do Young Kim Citations
, Jae Jung Park, Jung Yoon Yoon, Jung Youn Jo, Eun Kyung Baek, Eun Jin Shim, Kwon Yu, Hee Jung Choi Rhodotorula species are emergent opportunistic pathogens, Particularly m mmunocompromised patients. Rhodotorula mucilaginosa was the species most frequently recovered, followed by Rhodotorula glutinis. They have been associated with endocarditis, peritonitis, meningitis and catheter-associated fungemia. We experienced a case of catheter-related blood stream infection by rhodotorula glutinis. He was 46-year old man with decompensated liver cirrhosis. He was admitted for esophageal variceal bleeding. Rhodotorula glutinis was identified on blood culture, and amphotericin B was administered for fungemia treatment.
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