Histopathological scoring systems mainly assess architectural abnormalities and need a minimum biopsy size (≥10 mm). Quantification of liver collagen has the potential to use small size biopsies and improve the prediction of clinical outcomes. Aim: To test the ability of collagen proportional area (CPA) to predict clinical outcomes for chronic hepatitis C (CHC) patients and compare it with Metavir stage. Methods: Clinical outcomes were determined using population based data-linkage methodology for chronic hepatitis C (CHC) patients from 1992–2012. Quantitative

digital image analysis was used to measure CPA. Results: 533 patients with CPA measurement area ≥5 mm2 were included. Median follow up was Sirolimus molecular weight 10.5 years and 26 developed hepatocellular carcinoma (HCC), 39 developed liver decompensation and 33 had a liver related death (LRD). 102 had Metavir F0, 244 had F1, 89

had F2, 48 had F3 and 50 had F4. CPA values ranged from 1.3%-44.6%. CPA was correlated with Metavir stage (r = 0.615, P < 0.001). Univariate analysis found CPA, Metavir stage and age were significantly associated with decompensation, HCC and LRD. Multivariate analysis found CPA and Metavir stage were independently associated with decompensation and LRD while p38 MAPK inhibitor Metavir stage and age were significantly associated with HCC. CPA stage (C1: 0%-5%, C2: 5%-10%, C3: 10%-20%, C4: >20%) was used to stratify risk. There was a significant difference in composite end point free survival (HCC, decompensation and LRD) between C1 and C2 (p = 0.010), C2 and C3 (p < 0.001), C3 and C4 (p < 0.001). The 15 year composite end point free survival probability was 97.1%

for C1, 88.7% for C2, 60.5% for C3, 7.3% for C4. A significant difference was also found in separate analyses for HCC development between C1 and C2 (p = 0.016), C2 and C3 (p < 0.001), C3 and C4 (p = 0.004) and for decompensation between C2 and C3 (p = 0.010), C3 and C4 (p < 0.001) and for LRD between C2 and medchemexpress C3 (p = 0.0002) and C3 and C4 (p < 0.001). The only significant difference between Metavir stages was between F3 and F4 for the composite end point and all three endpoints (p < 0.001). Among cirrhotic patients C4 had significantly worse LRD than C1-C3 (p = 0.026). For non-cirrhotic patients C1 had significantly better HCC free survival than C2-C4 (p = 0.006). Cox regression found no significant interaction between biopsy size and CPA predictive ability. Conclusions: Simple digital technologies allowed measurement of CPA in previously inadequate sized liver biopsy samples. CPA stage was superior to Metavir stage in its ability to stratify risk of LRD, HCC and liver decompensation for CHC patients.

apoptosis; 4. adenocarcinoma; Presenting Author: SHANGGUO YIN Corresponding Author: SHANGGUO YIN Affiliations: The First Affiliated Hospital of Harbin Medical University Objective: To study the apoptosis effect of Arsenic trioxideon on human gastric and colorectal adenocarcinoma cells and mechanisms and the relation between this apoptosis and expression of p53 and bcl -2. Methods: Intravenous

administration of Arsenic trioxideon at 10 mg/ day for 3 days were carried out preoperatively. The expression of p53, bcl-2 and apoptosis induced by arsenic trioxide were examined by immunohistochemistry method and TUNEL. Results: Arsenic trioxide induced decrease of the expression of bcl -2 and increase of the expression PARP inhibitor of apoptosis in gastric and colorectal cancer cells. The expression of p53 was not changed

by As2O3. Conclusion: Preoperatively intravenous chemotherapy with Arsenic trioxide can induce apoptosis and inhibite proliferation effectively in gastric and colorectal cancer. Arsenic trioxide induce the apoptosis of gastric and colorectal cancer cells through accommodating the expression of cancer associated genes. Key Word(s): 1. gastric cancer; 2. As2O3; 3. p53; 4. nm23; Presenting Author: ZHOUYI NAN Corresponding Author: ZHOUYI NAN Affiliations: The First Affiliated Hospital of Harbin Medical University Objective: To detect the effects of vascular endothelial growth factor (VEGF)-C and Smad4 上海皓元医药股份有限公司 in lymph node metastasis and prognosis, we observed the expression of VEGF-C and Smad4 in patients with colon carcinoma. Methods: Seventy-five

paraffin-embedded specimens from patients with colon carcinoma PLX-4720 ic50 were included in this study. Among all of 75 specimens, they were divided into lymph node metastatic group (n = 43) and nonmetastatic group(n = 32). The expressions of VEGF-C and Smad4 were detected by immunohistochemical stain in colon carcinoma. Survival curves were drawn according to the Kaplan-Meier method. Univariate and multivariate analysis of prognostic factors were based on the Cox hazard ratio model. Results: VEGF-C protein was observed predominantly in the cytoplasm of the tumor cells, the expression of VEGF-C in lymph node metastatic group was significantly higher than that in nonmetastatic group. Smad4 protein was observed in cytoplasm and nucleus of tumor cells, the expression of Smad4 in nonmetastatic group was significantly higher than that in lymph node metastatic group. Smad4 expression was negative correlated with VEGF-C expression in colon carcinoma(r = -0.625, P < 0.001). Patients with VEGF-C positive tumors were found to have significantly shorter survival times compared with those with VEGF-C negative tumors(χ2 = 8.790, P = 0.003). Patients with the negative expression of Smad4 showed poorer overall survival compared with those with positive expression of Smad4(χ2 = 9.945, P = 0.002).

There was no significant correlation between absolute or vigorous physical activity levels at baseline and age (Spearman’s

rho = 0.02 and 0.02, respectively, Fig. 2a and 2b), nor was there any correlation between incidence rate of bleeds and level of absolute or vigorous physical activity at baseline (Spearman’s rho = 0.05 and 0.07, respectively, Fig. 3a and 3b). The median level of physical activity for Australian children with haemophilia is 7.9 h/week including 3.8 h spent engaged in vigorous physical activity selleck products (>6 METS). The median small-screen time per day is 2.5 h. There was no correlation between age of the child and habitual physical activity nor was there any correlation between bleeding rate and level of physical activity at baseline. Only 43% of all children with haemophilia www.selleckchem.com/products/AC-220.html and 44% of those over the age of 10 years met the Australian government guidelines for physical activity compared with 57% (winter) to 67% (summer) of healthy peers [28]. Twenty-three per cent (10/43) of children with haemophilia over the age of 10 years and 27% of healthy peers met the Australian government guidelines for small-screen time in children [28]. Not surprisingly, for children with haemophilia, the proportion of time spent in high risk Category 3 activities is low. This study used two methods for assessing physical activity – an

activity questionnaire which was retrospective and a one-week physical activity diary which was prospective and occurred at a randomly generated time. The

habitual activity questionnaire has been validated for use in adolescents and details of involvement in physical activity, including type of activity, frequency and duration of sessions enable estimation of time spent in vigorous physical activity in addition to overall time spent in physical activity. It is, however, subject to recall bias as children or their parents are asked to recall patterns of physical activity over a 12 month period. The prospective activity diary is likely to have been subject to relatively little recall bias. One of the limitations of the prospective activity diary was the follow-up MCE公司 rate. Only 66/104 (63.5%) returned their activity diaries so it is possible that data from the prospective activity diaries are subject to selection bias. The timing of the prospective activity diaries was randomly generated to avoid possible bias created by the differing types and levels of physical activity during different seasons of the year. The target population for this study was similar to populations from other developed countries where the majority of children receive prophylactic clotting factor. Other studies that have examined levels of physical activity in children with haemophilia have returned different results to those reported here. In many instances this reflects the availability of clotting factor concentrates in the countries in which the studies were performed.

Percentage necrosis in explanted tumors was correlated with imaging findings. 100%, 50%-99% and <50% pathological necrosis was observed in 6 (67%), 1 (11%), and 2 (22%) tumors in Group A and 3 (42%), 2 (28%), and 2 (28%) in Group B, respectively (P = 0.81). While ADC (P = 0.46) did not change after treatment, WHO (P = 0.06) and RECIST (P = 0.08) response at 1 month failed to reach significance,

but significant responses by EASL (P < 0.01/0.03) and mRECIST (P < 0.01/0.03) Opaganib purchase at 1 and 3 months were observed. Response was equivalent by EASL or mRECIST. No difference in response rates was observed between groups A and B at 1 and 3 months by WHO, RECIST, EASL, mRECIST or ADC measurements. Despite failing to reach significance, smaller baseline size was associated with complete pathological necrosis (CPN) (RECIST: P = 0.07; WHO: P = 0.05). However, a cut-off size of 35 mm was predictive of CPN (P = 0.005). CPN could not be predicted by WHO (P = 0.25 and 0.62), RECIST (P = 0.35 and 0.54), EASL (P = 0.49 and 0.46), mRECIST (P = 0.49 and 0.60) or ADC (P = 0.86 and 0.93). Conclusion: The adjunct of Sorafenib did not augment radiological or pathological response to Y90 therapy for HCC. Equivalent significant reduction in enhancement at 1 and 3 months

by EASL/mRECIST was noted. Neither EASL nor mRECIST could reliably predict CPN. (HEPATOLOGY 2013;58:1655–1666) The development of surrogate markers for locoregional therapies (LRTs) in hepatocellular carcinoma (HCC) is PDGFR inhibitor desirable to improve treatment planning and accelerate design and endpoints in clinical trials. Before validation, early imaging surrogate markers face different challenges, including methodological considerations, reproducibility, accuracy to detect real treatment response, and, potentially most important, detection of a survival benefit. In comparison with survival, surrogate endpoints (time to progression [TTP] and progression-free survival) offer the advantage of potentially less-confounding effect by concomitant liver (i.e., cirrhosis, fibrosis) or systemic diseases as well as previous or subsequent locoregional or systemic

treatment.[1] The European Association for the Study of the Liver (EASL) guidelines (2011) advocate the use of enhancing tissue to assess imaging response of HCC.[2] Modified Response Evaluation Criteria in Solid Tumors (mRECIST) were MCE公司 devised with keeping this concept in mind and are currently being proposed as the standard methodology of radiological response in HCC.[3] However, few radiological-pathological studies support these criteria; our research group has previously highlighted the relevance of these important correlative concepts for both chemo- and radioembolization.[4-6] Uni- and bidimensional measurements of the entire treated tumor (Response Evaluation Criteria in Solid Tumors [RECIST] and World Health Organization [WHO] criteria) are often criticized, given their lack of correlation with viable tumor.

The average anhepatic time was 19.8 ± 1.7 minutes. The bile

duct was connected via ligation over the stent. BM cells were collected from the long bones of the extremities of wild-type (WT) or KO mice, and 2 × 107 unfractionated cells were injected intravenously into lethally irradiated (9.5 Gy) WT or KO mice via the tail vein. Animals were used as liver graft donors more than 2 months after BM transplantation. Additionally, the replacement of BMDCs selleck compound in the liver was confirmed in GFP radiation chimeras. Syngeneic LT was performed with KO, WT, or chimeric animals as donors and with WT B6 mice or B6.CD45.1 mice as recipients with 24 hours of cold storage. The recipient animals were euthanized 1, 3, 6, 12, or 24 hours after reperfusion so that we could obtain serum and liver graft samples. All procedures in this study were performed according to the guidelines of Guide for the Care and Use of Laboratory Animals (National Institutes of Health) and were approved by the institutional animal care and use committee of the University of Pittsburgh. Liver samples were fixed in 10% formalin, embedded in paraffin, sectioned (6 μm), and stained with hematoxylin and eosin. Grafts were also embedded in an optimal cutting temperature compound,

and 6-μm cryosections were stained with anti-CD3 and anti-CD11b monoclonal antibodies with nuclear Hoechst staining. Sections were visualized with 上海皓元 an Olympus BX51 epifluorescence microscope, and two-dimensional images were digitized with an Olympus/Optronics (Goleta, CA) charge-coupled device camera, c-Met inhibitor which was interfaced with MagnaFire image capture software. Messenger RNA (mRNA) expression was quantified by SYBR Green real-time RT-PCR

with an ABI-Prism 7000 sequence detection system (PE Applied Biosystems)20 and with primers for B7-H117 and other inflammatory and death-related molecules. The expression of each gene was normalized to the β-actin mRNA content and was calculated with respect to a normal liver. Hepatocytes and hepatic NPCs were isolated from the liver grafts by the collagenase digestion method22 with some modifications.21 Briefly, each liver was perfused in situ via the infrahepatic inferior vena cava (initially with 20 mL of Ca+Mg+-free HBSS containing 5 mM ethylene glycol tetraacetic acid and 10 mM HEPES and then with 100 mL of HBSS containing 0.025% collagenase B, 5 mM HEPES, 56 mg of calcium dichloride, and 0.005% trypsin inhibitor). NPCs and parenchymal cells were liberated from the removed liver grafts, and the initial cell suspension was filtered through a 70-μm nylon mesh. Hepatocytes and NPCs were separated by low-speed centrifugation (5 × 45g for 5 minutes) and washed by high-speed centrifugation (150g for 10 minutes).

“
“The development of impulse control disorders

(ICDs) in Parkinson’s SB203580 mw disease (PD) may arise from an interaction among cognitive impairment, impulsive responding and dopaminergic state. Dopaminergic state may be influenced by pharmacologic or genotypic (catechol-O-methyltransferase; COMT) factors. We sought to investigate this interaction further by comparing those with (n = 35) and without (n = 55) ICDs on delay-discounting in different pharmacologic conditions (ON or OFF dopaminergic medication) and on response inhibition as well as aspects of executive functioning in the ON state. We then undertook an exploratory sub-group analysis of these same tasks when the overall PD group was divided into different allelic variants of COMT (val/val vs. met/met). A healthy control group (HC; n = 20) was also included. We found that in those with PD and ICDs, ‘cognitive flexibility’ (set shifting, verbal fluency, and attention) in the ON medication state was not impaired compared with those without ICDs. In contrast, our working memory, or ‘cognitive focus’, task was impaired in PS-341 research buy both PD groups compared with the HC group when ON. During the delay-discounting task, the PD with ICDs group expressed greater impulsive choice compared with the PD group without ICDs, when in the ON, but not the OFF, medication state. However, no group difference on the response inhibition task was seen when ON. Finally,

the met homozygous group performed differently on tests of executive function compared with the val homozygous group. We concluded that the disparity in levels of impairment among different domains of executive function

and impulsive decision-making distinguishes those with ICD in PD from MCE公司 those without ICD, and may in part be affected by dopaminergic status. Both pharmacologic and genotypic influences on dopaminergic state may be important in ICD. “
“The double dissociation involving person-specific and general semantic knowledge is supported by numerous patient studies, though cases with preservation of the former are few. In this paper, we report longitudinal data from two cases. Their knowledge in both domains was preserved at the start of the investigation, but progressive deterioration was primarily observed on tests of general semantics. These data strengthen the evidence-base for preservation of person-specific knowledge in semantic memory disorder, and support its separate representation from object knowledge. “
“Lexical–gustatory synaesthesia is a rare phenomenon in which the individual experiences flavour sensations when they read, hear, or imagine words. In this study, we provide insight into the neural basis of this form of synaesthesia using functional neuroimaging. Words known to evoke pleasant, neutral, and unpleasant synaesthetic tastes and synaesthetically tasteless words were presented to two lexical–gustatory synaesthetes, during fMRI scanning.

5) ng, which is 3.9 (1.8) log10 ng lower than the controls. Moreover, in the presence of HepeX-B, HBsAg remained undetectable (< 0.1 ng) throughout the 48 hours of the experiment. Fitting of the full kinetics data with the in vitro model (Supporting Material, Equations 10 and 11) indicated that HBV-Ab17 or HBV-Ab19 give rise to a partial blocking of HBsAg release with effectiveness of 99.98% or 98.8%, respectively. A minimal estimate of the effectiveness in blocking release in the presence of HepeX-B is 99.998%. Similar results were obtained by estimation of HBsAg at 48 hours using the analytical solution (Supporting Material, Equations 12 and 13). In order to verify whether the

antibodies to HBsAg have a prolonged effect on HBsAg release from PLC/PRF/5 cells, we repeated the experiment, but after the first 24 hours, we replaced the supernatants with fresh medium and continued measuring the HBsAg levels in supernatants for an additional 24 hours (Fig. 5B). this website During the first 24 hours,

when either control medium or antibodies to HBsAg were present, the kinetics were similar to the first experiment. After we replaced the supernatants with fresh medium at 24 hours, the HBsAg levels in the new supernatants started from 0 and the kinetics of HBsAg secretion from control cells (treated with medium only) was slightly faster, probably due to a CP-673451 larger number of cells per well relative to the first 24 hours. In contrast, cells that were treated initially with HBV-Ab17 (undetectable HBsAg during first 24 hours) showed slower medchemexpress kinetics of HBsAg secretion (i.e., de novo increase in supernatants) also after the antibodies were removed from the medium. Fitting of the kinetics with the model indicated a delay of 2.6 hours in HBsAg

release from the cells and also a slow decline, with a half-life of 6.9 days, of the effectiveness in blocking release from an initial 99.99% at 24 hours. Similarly, a delay of 10.7 hours and a slow decline of the blocking release effectiveness with a half-life of 11.5 days were observed for the cells initially treated with HepeX-B. By modeling viral dynamics during in vivo and in vitro treatment with antibodies to HBsAg, this study reveals a novel antiviral mechanism of antibodies to HBV. Apart from the “conventional” antiviral activities against viral particles in the circulation, anti-HBs antibodies are internalized in liver cells and exert intracellular antiviral activities with prolonged blocking of viral particles release from infected cells. Both experimental approaches—in vivo infusions of HepeX-B and in vitro treatment of cells with the same antibodies—produced concordant results with a reduction of viremia and/or HBsAg titers, as well as a prolonged antiviral effect after anti-HBs administration. The combination of two human antibodies—HBV-Ab17, recognizing a conformational epitope, and HBV-Ab19, recognizing a linear epitope on HBsAg—had an additive effect.

Median age of haemophilic patients and healthy controls was

21 and 24 years respectively. In haemophilic patients 23% of knees Selisistat datasheet and 22% of ankles showed joint effusion. Healthy controls had significantly more positive scores for knee effusion (67%, P < 0.01) and a comparable scores for effusion in the ankle (17%). Joint effusion according to criteria of the IPSG MRI scale was observed significantly more often in knees of healthy controls, while findings in ankles were similar. These data suggest that joint effusion in knees and ankles is not haemophilia specific. Inclusion of joint effusion in the MRI scale is expected to reduce its specificity for haemophilic arthropathy. "
“Summary.  Increased or maintained health and quality of life (HRQoL) are essential goals in health care among patients with a chronic disease. To gain an understanding of HRQoL in patients with haemophilia at

the Haemophilia Treatment www.selleckchem.com/products/MG132.html Centre in Malmö, Sweden, patients seen from 2004–2008 were asked to complete the Short form Health Survey, SF-36, also answering to what extent haemophilia, physically and mentally, interferes with their daily life at their annual check-up. Data were extracted from the UMAS Haemophilia Database. Interference of haemophilia in daily life was estimated using a Visual Analogue Scale. A total of 105/144 haemophilia patients were included in the study (73%); 28 mildly, 21 moderately and 56 severely affected. The median age of patients at study entry was 44.0 years (range 18–84 years). The comparison of SF-36 data of Swedish haemophilia patients with the general Swedish male population yielded no significant differences in age groups 15–24, 25–34 and 65–74 years.

Patients in age groups 35–44 years, 45–54 years and 55–64 years were significantly impaired in some of their HRQoL domains. For severely affected patients who filled in SF-36 over a period of 5 years no statistical differences in HRQoL were found. For patients undergoing orthopaedic surgery HRQoL increased in most SF-36 domains. Patients reported in general on the VAS that they feel ‘somehow’ interfered in their daily life 上海皓元医药股份有限公司 due to haemophilia. The results indicate a need for continuous monitoring of HRQoL to identify an increased need of care in the ageing haemophilia population. “
“von Willebrand disease (VWD) is caused by a quantitative and/or qualitative deficiency of the von Willebrand factor (VWF). The laboratory diagnosis of VWD is dependent on the measurement of VWF antigen (VWF:Ag) and ristocetin cofactor activity (VWF:RCo). The aim of this study was to undertake a two-centre evaluation of two new automated VWF:Ag and VWF:RCo assays systems from Instrumentation Laboratory (Bedford, USA).

He had also noted anorexia, weight loss and upper abdominal discomfort. His liver was mildly enlarged, about 3 cm below the right costal margin. Liver enzymes were mildly abnormal while an abdominal CT scan showed a large hypodense mass, 7 cm in diameter, in the right lobe of the liver (Figure 2). A fine-needle www.selleckchem.com/products/LY294002.html biopsy under CT control again showed a neoplastic infiltration of intermediate and large lymphoid cells with histochemical stains that were positive for CD-20, CD-79 and CD-43. Other investigations including a bone marrow biopsy were unhelpful. He was diagnosed with a large B-cell non-Hodgkin’s lymphoma and was treated with

6 courses of combination chemotherapy. He remains in good health after follow-up for 3 years. Contributed by “
“A 66-year-old woman with no past medical history presented for further evaluation of chronic diarrhea. Five months previously, she had a sudden-onset of watery, large volume stools that occurred four to six times per day. After one month of persistent symptoms, she underwent an upper endoscopy which revealed the small bowel mucosa

to be diffusely abnormal with mucosal granularity, scalloping, and a fine mosaic mucosal pattern with cobblestoning and whitish villi (Figure 1). Small bowel biopsies showed villous atrophy and increased intraepithelial lymphocytes buy SCH772984 with a mixed population of lymphocytes, plasma cells, and eosinophils (Figure 2). Serologic testing for celiac disease with both IgA and IgG tissue transglutaminase antibodies was negative. Human leukocyte antigen MCE公司 (HLA) haplotype testing showed positivity for HLA DQ2 and HLA DQ8. A presumptive diagnosis of serologically negative celiac disease was made

and she was initiated on and compliant with a gluten-free diet for two months without any improvement in diarrhea. Because of persistent symptoms, she was referred for further evaluation. On further review of the small bowel biopsy, in addition to villous atrophy and increased intraepithelial lymphocytes, there was thickening (>10 micrometer) of the subepithelial collagen band (Figure 2, arrow); findings diagnostic of collagenous sprue. In most malabsorptive disorders, histopathologic examination of the small bowel biopsy is not diagnostic as there is a limited spectrum of mucosal response to injury. However, in some cases there may be specific histologic features present that may be diagnostic. The malabsorptive disorders with diagnostic histologic features include: Whipple’s disease, abetalipoproteinemia, intestinal lymphangiectasia, giardiasis, lymphoma, autoimmune enteropathy, and collagenous sprue. Collagenous sprue is a clinicopathological entity characterized by chronic diarrhea and malabsorption with the histological findings of subepithelial collagen deposition and villous atrophy of the small intestinal mucosa. The only histologic feature that differentiates it from celiac disease is the thickened subepithelial collagen band.

Histologically, he had a poorly-differentiated hepatocellular carcinoma with multinucleated giant cells, numerous mitoses and a Ki-67 labeling index of 15%. Hyaline inclusions were noted in the cytoplasm of malignant cells. Pedunculated hepatocellular carcinoma is defined as a carcinoma protruding from

the liver with or without a pedicle. These carcinomas are unusual and only account for a small minority of all hepatocellular carcinoma cases (0.2–3%). Histologically, most of these carcinomas are poorly differentiated and show features of rapid growth including numerous mitoses and a high Ki-67 labeling index. Although peritoneal metastases are common, vascular invasion is not a prominent feature and most of these patients do not have early distant metastases. However, LDE225 datasheet as in the above case, tumor rupture can occur with either major or minor bleeding into the peritoneal cavity. Occasionally, surgical resection of these tumors is curative and

this may include resection of small peritoneal metastases. Contributed by “
“We read with great interest the article by Mannaerts et al.,1 who demonstrated the inhibitory effect of valproic acid (VPA) on hepatic stellate cell activation and consequent liver fibrosis in a chronically injured mouse liver. The authors’ initial concept is rather surprising because VPA, one of the most widely prescribed anticonvulsants, has been considered a hepatotoxic agent.2 The successful results of this study may make

clinicians expect implications for therapeutic options for liver fibrosis. Although NVP-BGJ398 in vitro they have presented hopeful information, we as pathologists insist that one must carefully ponder the risk-benefit balance. There medchemexpress have been many reports warning of the hepatotoxicity of VPA, including microvesicular steatosis, steatohepatitis, hepatocellular carcinomas, and even fulminant hepatitis.3, 4 We have also experienced an autopsy case of severe steatohepatitis related to chronic VPA administration. The patient, a 22-year-old man with an approximately 14-year medical history of VPA administration under a diagnosis of Lennox-Gastaut syndrome, died of fatal aspiration pneumonia. Most autopsy findings were concordant with clinical diagnoses, except for a markedly fatty liver. The liver was tender and yellowish and weighed 955 g. A cut surface of the liver showed a peculiar nodular appearance (Fig. 1A). Histological examination revealed a hallmark of incomplete septal cirrhosis associated with steatohepatitis (Fig. 1B). Because he was a nonobese nondrinker and was negative for any hepatitis viruses, it was concluded that VPA was the most likely cause of steatohepatitis in this case. The liver disorder had been subclinical (serum aminotransferases had been almost normal until just before death); therefore, an accurate diagnosis could not have been made while he was alive.