Hepatocellular carcinoma (HCC) is a significant cause of mortality in patients with chronic liver disease around the world. Development of biomarkers for early HCC detection is a primary public health goal to decrease mortality. The ideal biomarkers should be highly sensitive and specific for surveillance of high-risk populations and early detection of HCC and also be able to predict therapeutic outcome and provide a prognosis on survival. Currently, the new biomarkers do not perform better than the conventional ones such as alpha-fetoprotein in such a way that they could be widely adopted in clinical practice. Another problem is the low sensitivity of these biomarkers in the detection of HCC. Further work on the development of novel biomarkers and on a combination of them is necessary. Advances in identifying unique molecular signatures including genomic, proteomic, metabolomic, and glycomic profiles have improved our understanding of many biological processes involved in HCC. This review focuses on the role of old and new biomarkers in surveillance, diagnosis, prognosis, and prediction of response to therapeutic targets for HCC and provides up-to-date data to health-care providers which would be applied in clinical practice.

Background and objectiveUnlike weight stigma, internalized weight stigma (IWS) may be a common but still underreported problem. With the recent emergence of studies investigating its various aspects in Arab-speaking countries, there is still scant data on its incidence and severity in the literature. In light of this, the aim of this study was to evaluate the prevalence of IWS and its association with psychiatric disorders and sociodemographic factors among overweight and obese individuals in a sample from a Saudi population. MethodsA cross-sectional study was conducted among a Saudi population using a convenience sample technique and 868 individuals were enrolled to participate in this study. They were asked to fill out an electronic questionnaire about IWS, demographics, and other parameters such as Patient Health Questionnaire (PHQ)-9 and General Anxiety Disorder (GAD)-7. The association was tested using an independent t-test and chisquare test. ResultsThe overall prevalence of internalized stigma in this study was 57%. Higher levels of internalization were more prevalent among younger respondents. We found that females were more prone to internalize weight stigma, at a slightly higher rate than males (59.26% vs. 53.66%), but this difference was not statistically significant. The other sociodemographic factors associated with higher internalization were as follows: being widowed, married, retired, or housewife. Those with higher IWS levels were individuals with higher BMI and with previous experiences of weight stigma. In addition, higher internalization was associated with the development of severe depression and anxiety (p<0.001). ConclusionThe prevalence of IWS among overweight and obese individuals was found to be high, and it is highly associated with the development of severe depression and anxiety. There is a need to raise awareness about obesity stigma to help tackle IWS in overweight and obese individuals and to promote their quality of life.

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