Background/Aim: Sorafenib is standard treatment for advanced hepatocellular carcinoma (HCC). Hand-foot skin reaction (HFSR) is a notorious side-effect of this therapy. This study evaluated prophylactic benefits of an oral nutritional supplement (ONS) on sorafenib-associated HFSR in advanced HCC. Patients and Methods: This was a prospective, singlecenter, open-label trial arm using combined ONS and sorafenib in patients

A 60-year-old man presented with postoperative recurrence of intrahepatic cholangiocarcinoma with right portal vein tumor thrombosis (PVTT). After failure of standard chemotherapy, a liver biopsy showed that his microsatellite instability (MSI) status was high. Treatment with the immune checkpoint inhibitor (ICI) pembrolizumab was commenced, which resulted in a partial response and resolution of the PVTT. There were no significant immune-related adverse events. According to recently published reports, the frequency of MSI-high biliary tract cancer (BTC) is about 0-2.1%, which is extremely rare. However, ICIs may be effective in patients with MSI-high BTC, such as the present patient.

The patient (case 1) was a 72 year old female with multiinfarct dementia. Four months before our examination she had been started on a regimen of calcium hopantenate therapy (37 mg/kg/&). One day before the examination, with no prodromal symptoms, she developed severe nausea and vomiting, and then became stuporous. On examination her vital signs were as follows: temperature 35 6°C; pulse, 96 beats/min, respiration, 36/min, and BP, 160/70mmHg. She was deeply comatose and unresponsive to noxious stimuli. Pupils were small and reactive to light. Her upper limbs were flaccid and her lower limbs were spastic in flexion, a condition present since the age of 70 years. Deep tendon reflexes were brisk in all four extremities. Hepatosplenomegaly was not observed.Laboratory values at the time of coma included: arterial pH, 704; PaCO2, 12 mmHg; PaO2, 152 mmHg; HC03 , 5 mmol/l; base excess, -22 mmol/l; blood glucose,

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