Digestive and Liver Disease最新文献

{"title":"Investigating Notch3 expression in hepatocellular carcinoma and its interplay with KDM2A","authors":"I. De Giorgi ,&nbsp;T. Caruso ,&nbsp;M.C. Scavuzzo ,&nbsp;S. Piaggi ,&nbsp;F. Scolari ,&nbsp;P. Faviana ,&nbsp;S. Pillozzi ,&nbsp;R. Del Frate ,&nbsp;G. Paties Montagner ,&nbsp;F. Bartoli ,&nbsp;A. Corti ,&nbsp;G. Cavallini ,&nbsp;V. Carloni ,&nbsp;L. Gragnani","doi":"10.1016/j.dld.2025.01.032","DOIUrl":"10.1016/j.dld.2025.01.032","url":null,"abstract":"<div><h3>Introduction</h3><div>Notch3 receptor is involved in different aspects of hepatocellular carcinoma (HCC). Nevertheless, to unlock Notch3 therapeutic/diagnostic/prognostic potential a deeper understanding of its role in HCC onset/progression is needed. KDM2A demethylase epigenetically regulates gene expression. Its levels increase with HCC grading.</div></div><div><h3>Aim</h3><div>To investigate the involvement of KDM2A in controlling Notch3 expression in HCC.</div></div><div><h3>Material and Methods</h3><div>An expression analysis of Notch3 and KDM2A was conducted by Real-Time PCR on mRNA from formalin-fixed paraffin-embedded (FFPE) HCCs and peritumoral tissue (PT). Huh7 cells were transiently silenced for KDM2A using siRNAs for a first evaluation of Notch3/KDM2A association. KDM2A and Notch3 levels after silencing were assessed by Real-Time PCR and Western-Blotting (WB). The stem-cell marker CD133, associated with Epithelial Mesenchymal Transition, was evaluated in Notch3-silenced cells. Immunohistochemistry (IHC) was conducted using anti-Notch3 and anti-KDM2A antibodies.</div></div><div><h3>Results</h3><div>Notch3 and KDM2A in FFPE samples were higher in HCCs compared to PT (p&lt;0.001 and p&lt;0.01, respectively) and increased from G1 to G3 HCC. In well differentiated HCC the staining was mainly localized in the vascular endothelium while in G3 HCC it involved clusters of tumoral hepatocytes, sometimes invading portal areas. CD34 staining showed that the Notch3 positive blood vessels were consequences of neo-angiogenesis. The transient KDM2A silencing resulted in Notch3 transcript downregulation (p≤0.001), confirmed by WB (p≤0.01). CD133 was downregulated in Notch3-silenced Huh7 (p≤0.0001).</div></div><div><h3>Conclusions</h3><div>An increasing Notch3 expression was observed during HCC progression. IHC revealed the involvement of Notch3 in neo-angiogenesis in early HCC and a role in invasiveness of stromal portal areas in G3 tumors. This latter, together with Notch3/CD133 association, suggests an involvement of Notch3 in local invasiveness. Furthermore, we found an association between Notch3 and KDM2A suggesting a possible mechanism of epigenetic regulation that could be responsible for the higher Notch3 expression in poorly differentiated HCC with high KDM2A levels.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S18"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unravelling MASLD heterogeneity at single cell level in the switching towards progressive disease","authors":"M. Meroni ,&nbsp;E. Paolini ,&nbsp;M. Longo ,&nbsp;M. Battistin ,&nbsp;E. Mosca ,&nbsp;P. Pelucchi ,&nbsp;A. Chiodi ,&nbsp;A. Sula ,&nbsp;S. Gatti ,&nbsp;P. Dongiovanni","doi":"10.1016/j.dld.2025.01.028","DOIUrl":"10.1016/j.dld.2025.01.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) embraces different conditions, including metabolic dysfunction-associated steatohepatitis (MASH), fibrosis/cirrhosis and hepatocarcinoma. The landscape of cellular abnormalities occurring in the different stages of MASLD and the processes which drive its evolution are not elucidated.</div></div><div><h3>Aim</h3><div>We aimed to investigate cell population heterogeneity involved in progressive MASLD at single cell resolution, to define the role of hepatic cell types in the disease transition.</div></div><div><h3>Materials and Methods Results</h3><div>C57Bl6 male mice were fed standard (SD) or high fat high fructose (AMLN) diets for 14 (steatosis), 22 (MASH) and 28 (MASH-fibrosis) weeks to resemble human MASLD. Single cell RNA-sequencing (scRNAseq) was applied to decipher cell populations, differentiation and genes/pathways guiding MASLD progression.</div><div>By considering the expression of canonical markers, we classified 32 clusters (Cls), including hepatocytes (HEPs), hepatic stellate cells (HSCs), endothelial cells (Endo), Kupffer cells (KCs), and immune cells. We observed changes in HEPs Cls across disease severity, with a mixed pericentral/periportal localization in steatosis and a periportal one in MASH and MASH-fibrosis, reflecting the advanced damage in this area. The latter conditions were featured by Endo Cls which induced the expression of vascular angiogenesis and ECM molecules whereas endothelial mesenchymal transition (EndMT) markers gradually appeared during the disease. Among KCs, we found Cls of resident cells and immune cells recruited from the circulation with a M1 phenotype which increased throughout diet exposure. Regarding HSCs, MASH-fibrosis was featured by Cls with mesenchymal markers. Among the 32 Cls, we identified 5 chimeric populations named HSCs/Endo (Cl 21), HEPs/Endo (Cl 15), KCs/Endo (Cl 26) and HEPs/KCs (Cl 10 and Cl 17). Evolutionary trajectory outlined the directions of cell differentiation, which was more pronounced in MASH-fibrosis.</div></div><div><h3>Conclusions</h3><div>We observed an evolution of cellular heterogeneity during MASLD and identified chimeric populations in the advanced stages thus suggesting their involvement in disease progression.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S16"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-based estimation of cardiovascular risk in MASLD patients using non-contrast CT imaging and clinical data","authors":"A. Cirella ,&nbsp;P. Bruno ,&nbsp;V. Caputo ,&nbsp;P. Palumbo ,&nbsp;SJ Santini ,&nbsp;A. Quarta ,&nbsp;F. Calimeri ,&nbsp;P. Palumbo ,&nbsp;E. Di Cesare ,&nbsp;C. Balsano","doi":"10.1016/j.dld.2025.01.080","DOIUrl":"10.1016/j.dld.2025.01.080","url":null,"abstract":"<div><h3>Introduction</h3><div>Accurate cardiovascular risk (CVR) assessment is crucial for apparently healthy individuals. Metabolic-dysfunction associated steatotic liver disease (MASLD), formerly NAFLD, affects 38% of the population worldwide and the cardiovascular diseases (CVD) represent the primary cause of death in these patients, suggesting that MASLD could be considered as an independent risk factor for a novel CVR assessment score.</div></div><div><h3>Aim</h3><div>our study aims at modelling non-contrast Cardio-CT scans and clinical data with artificial intelligence (AI) approaches to develop a predictive model for CVR assessment in MASLD.</div></div><div><h3>Materials and Methods, Results</h3><div>A retrospective study analyzed clinical and imaging data from 174 patients who underwent Cardio-CT in S.Salvatore Hospital in L'Aquila and S.Pertini Hospital in Rome. Based on Coronary Artery Calcium (CAC) scores and Hunsfield units (HU), 50% of patients were affected by MASLD and CVD, the rest of patients were healthy controls. 96 Patients were enlisted for training and 78 for the internal validation cohort to obtain performance metrics.</div><div>A U-Net convolutional neural network was used to segment liver parenchyma, and a Gray-Level Co-occurrence Matrix (GLCM) was applied to extract radiomic features and evaluate levels of steatosis. The relevant features were combined with clinical data and used as input into a multilayer perceptron neural network to perform binary classification of CAC.</div></div><div><h3>Results</h3><div>Our trained algorithm automatically defines the severity of CAC, based on liver steatosis and patient clinical data, thereby assessing the level of CVR. Notably, the related important features were represented by dyslipidemia, diabetes and age. By testing images and clinical data from both centers, the most performing model was the Stacking Model achieving an AUC of 80%.</div></div><div><h3>Conclusion</h3><div>Our AI model estimates CVR in MASLD patients undergoing abdominal CT, integrating radiomic and clinical data, it could be useful also for cirrhotic patients undergoing HCC screening or awaiting OLT.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S43"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features and factors related to intensive care unit admission of cirrhotic patients with Acute-on-Chronic Liver Failure: a single-center observational study","authors":"L. De Marco ,&nbsp;A. Dalbeni ,&nbsp;M. Bevilacqua ,&nbsp;R. Stupia ,&nbsp;F. Cattazzo ,&nbsp;K. Donadello ,&nbsp;D. Sacerdoti","doi":"10.1016/j.dld.2025.01.065","DOIUrl":"10.1016/j.dld.2025.01.065","url":null,"abstract":"<div><h3>Introduction and Aims</h3><div>Acute-on-chronic liver failure (ACLF) is a severe form of acutely decompensated cirrhosis. Infections play a crucial role in precipitating and complicating ACLF. This study aimed to evaluate the characteristics of a population of patients with ACLF admitted to our unit, with the goal of identifying factors predisposing to intensive care unit (ICU) admission and to death or liver transplantation (LT).</div></div><div><h3>Materials and Methods</h3><div>This is a single-center prospective study conducted from January 2018 to July 2024. Demographic, clinical, laboratory, and radiologic data of 94 consecutive cirrhotic patients diagnosed with ACLF and admitted to our department were collected and analyzed. ACLF-related ICU admission, mortality, or LT were recorded. Infections that triggered ACLF or occurred during hospitalization for ACLF, prior to potential ICU admission, were categorized.</div></div><div><h3>Results</h3><div>During hospitalization, 37% of patients were admitted to ICU. 80% of the patients either died or underwent LT. Infections, either triggering or complicating ACLF occurred in 87% of patients prior to potential admission to the ICU. In survival analysis, ACLF patients who had undergone tertiary hepatological follow-up for at least six months prior to hospitalization (49%) exhibited a significantly reduced risk of ICU admission following ACLF (HR 0.21, 95% CI 0.07–0.37, p&lt;0.001), and a reduced risk of ACLF-related death or need of LT (HR 0.12, 95% CI 0.07–0.24, p&lt;0.001). Fungal infections, on the other hand, were strongly associated with a higher likelihood of ICU admission (HR 2.93, 95% CI 1.31–6.54, p=0.009), and multidrug-resistant (MDR) infections markedly increased the risk of death or LT (HR 2.16, 95% CI 1.13–4.10, p=0.019).</div></div><div><h3>Conclusions</h3><div>Fungal infections have been identified as a risk factor for ICU admission in patients with ACLF. Moreover, MDR infections significantly increase the risk of ACLF-related death or LT. Therefore, strategies aimed at preventing and rapidly managing these infections are essential. Finally, outpatient tertiary hepatological follow-up appears to be protective in cirrhotic patients, reducing the risk of ICU admission, as well as of death or LT when developing ACLF.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S34"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of diagnostic performances of HDV RNA quantification assays used in clinical practice in Italy: data from the first national quality control multicenter study","authors":"L. Piermatteo ,&nbsp;R. Salpini ,&nbsp;GP Caviglia ,&nbsp;A. Bertoli ,&nbsp;MR. Brunetto ,&nbsp;B. Bruzzone ,&nbsp;A. Callegaro ,&nbsp;C. Caudai ,&nbsp;D. Cavallone ,&nbsp;L. Chessa ,&nbsp;F. Coghe ,&nbsp;N. Coppola ,&nbsp;N. Cuomo ,&nbsp;S. D'Anna ,&nbsp;M. Di Stefano ,&nbsp;F. Facchetti ,&nbsp;C. Farina ,&nbsp;D. Ferraro ,&nbsp;E. Franchin ,&nbsp;D. Francisci ,&nbsp;Valentina Svicher","doi":"10.1016/j.dld.2025.01.099","DOIUrl":"10.1016/j.dld.2025.01.099","url":null,"abstract":"<div><h3>Introduction</h3><div>A reliable quantification of serum hepatitis D virus (HDV) RNA is of paramount importance for a proper monitoring of patients under antiviral therapy.</div></div><div><h3>Aim</h3><div>This quality-control study compares the diagnostic performances of quantitative HDV-RNA assays, used in clinical-practice.</div></div><div><h3>Methods</h3><div>Two HDV-RNA sample panels were quantified at 30 laboratories by 6 commercial assays: RoboGene(N=9 laboratories), Eurobio/EliTech-platform(N=7), Altona(N=5), Anatolia(N=3), DiaPro(N=2), Nuclear-Laser-Medicine(N=1) and 3 in-house assays. Panel-A and -B comprised 8 serial dilutions of WHO/HDV standard(range:5-0.5logIU/ml) and 20 clinical samples(range:6-0.5logIU/ml), respectively. Laboratories quantified dilutions of Panel-A and -B 9 and 5 times, respectively, in order to define for each assay: i)sensitivity by 95%LOD(limit of detection), ii)precision by intra- and inter-run CV(coefficient of variation), iii)accuracy by the differences between expected-observed HDV-RNA loads, iv)linearity by linear-regression analysis.</div></div><div><h3>Results</h3><div>In Panel-A, 95%LOD varied across the assays underlining heterogeneous sensitivities: Altona had the lowest median 95%LOD (10[min-max:3-316]IU/ml), followed by Robogene (31[3-316] IU/ml), Nuclear-Laser-Medicine (31IU/ml) and EliTech (100[100-316]IU/ml). Moreover, 5 assays (Robogene/EliTech/Altona, Nuclear-Laser-Medicine/In-house) showed &lt;0.5logIU/ml differences between expected and observed HDV-RNA for all dilutions while the remaining assays had HDV-RNA underestimations&gt;1logIU/ml. In Panel-B, Altona and EliTech had the highest precision (mean intra-run CV&lt;20%), followed by Robogene and Nuclear-Laser-Medicine (&lt;30%). Inter-run CV was higher for all assays with only Altona, Nuclear-Laser-Medicine and EliTech maintaining this parameter&lt;25%. Five assays (Robogene/Altona/EliTech/Nuclear-Laser-Medicine/In-house) showed a good linearity(R²&gt;0.9) between LLOQ and 6.7logIU/ml. Conversely, a linearity drop emerged for HDV-RNA&lt;1000IU/ml, with only Altona and Robogene retaining R²&gt;0.85.</div></div><div><h3>Conclusions</h3><div>This study underlines heterogeneous sensitivities (inter- and intra-assays), that could hamper the proper HDV-RNA quantification, particularly at low viral-loads. This raises the need to improve the diagnostic performance of most assays for properly identifying virological response to anti-HDV drugs.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S53-S54"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NOSTRIN is an emerging positive regulator of decompensated cirrhotic patients with portal hypertension","authors":"Balasubramaniyan Vairappan ,&nbsp;Ravikumar TS ,&nbsp;Amit Kumar Ram ,&nbsp;Pazhanivel Mohan ,&nbsp;Biju Pottakkat","doi":"10.1016/j.dld.2024.08.050","DOIUrl":"10.1016/j.dld.2024.08.050","url":null,"abstract":"<div><h3>Background and aims</h3><div>Decreased nitric oxide (NO) bioavailability in a cirrhotic liver contributes to high intrahepatic vascular resistance (IHVR) and portal hypertension (PHT). Nostrin is an inhibitory protein of NO synthesising enzyme endothelial NO synthase (eNOS), shown to increase in cirrhosis with PHT, however, the precise molecular mechanism is poorly documented. This study aimed to elucidate the role of Nostrin and associated derangement in hepatic NO generation in cirrhotic liver. Further, we investigate whether Nostrin could be a biomarker in the progression of cirrhosis.</div></div><div><h3>Methods</h3><div>This study was conducted on sixty healthy subjects and 120 cirrhotic patients. In addition, liver tissue samples were collected from cirrhotic patients for the analysis of Nostrin, eNOS and inflammatory markers.</div></div><div><h3>Results</h3><div>When compared to healthy controls, systemic levels of Nostrin and cGMP were elevated in compensated cirrhosis. In decompensated cirrhosis, further robust increases in Nostrin and cGMP were noted. Furthermore, Nostrin expression was considerably higher whilst reduced eNOS activity and hepatic cGMP levels in cirrhotic liver compared to control liver.</div></div><div><h3>Conclusions</h3><div>In cirrhotic patients, a robust increase in hepatic Nostrin expression may reduce eNOS activity and associated local NO generation. Furthermore, Blood Nostrin concentration was higher and parallel to disease severity and could be a key diagnostic and prognostic biomarker in cirrhotic patients with PHT.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 427-435"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and risk factors for thromboembolic events in pediatric-onset inflammatory bowel disease: A French population-based study","authors":"Nicolas Richard ,&nbsp;Ariane Leroyer ,&nbsp;Delphine Ley ,&nbsp;Claire Dupont ,&nbsp;Valérie Bertrand ,&nbsp;Pauline Wils ,&nbsp;Corine Gower-Rousseau ,&nbsp;Dominique Turck ,&nbsp;Nathalie Guillon ,&nbsp;Hélène Sarter ,&nbsp;Guillaume Savoye ,&nbsp;Mathurin Fumery","doi":"10.1016/j.dld.2024.09.005","DOIUrl":"10.1016/j.dld.2024.09.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with inflammatory bowel disease (IBD) are at higher risk of thromboembolic events (TE). In pediatric-onset IBD, more data on incidence and risk factors of venous (VTE) and arterial events (ATE) at the population level are needed to guide thromboprophylaxis.</div></div><div><h3>Methods</h3><div>All patients aged ≤ 16 years diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) between 1988 and 2011 in the prospective EPIMAD population-based registry were followed until 2013. Every TE occurring during the follow-up period was included.</div></div><div><h3>Results</h3><div>A total of 1,344 patients were included: 1,007 with CD and 337 with UC, and a median diagnosis age of 14.3 years. After a median follow-up of 8.3 years, 2 (0.15 %) ATE and 15 (1.1 %) VTE occurred at median age of 20.4 years. The global incidence rate of thromboembolic events was 1.32 per 1000 person-years. Periods of active disease (HR=8.4, <em>p</em> = 0.0002), the 3-month-period following surgery (HR=16.4, <em>p</em> = 0.0002) and hospitalization (HR=21.7, <em>p</em> &lt; 0.0001) were found to be associated with an increased risk of VTE. A lower rate of VTE was found in patients treated with 5-aminosalicylates (HR=0.1, <em>p</em> = 0.002).</div></div><div><h3>Conclusion</h3><div>The risk of TE was low in this population. VTE were strongly associated with active disease, surgery and hospitalization.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 584-594"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of the PHM-CPA model to predict in-hospital mortality for cirrhotic patients with acute kidney injury","authors":"Luyan Zheng,&nbsp;Jing Yang,&nbsp;Lingzhu Zhao,&nbsp;Chen Li,&nbsp;Kailu Fang,&nbsp;Shuwen Li,&nbsp;Jie Wu ,&nbsp;Min Zheng","doi":"10.1016/j.dld.2024.09.012","DOIUrl":"10.1016/j.dld.2024.09.012","url":null,"abstract":"<div><h3>Background</h3><div>The presence of acute kidney injury (AKI) significantly increases in-hospital mortality risk for cirrhotic patients. Early prognosis prediction for these patients is crucial. We aimed to develop and validate a machine learning model for in-hospital mortality prediction for cirrhotic patients with AKI.</div></div><div><h3>Methods</h3><div>Data from cirrhotic patients with AKI hospitalized at the First Affiliated Hospital of Zhejiang University between January 1, 2013, and December 31, 2020 were used to train and validate an extreme Gradient Boosting model to predict in-hospital mortality risk. The Boruta algorithm was used for variable selection. The optimal model was selected and named as PHM-CPA (<strong>P</strong>rediction of in-<strong>H</strong>ospital <strong>M</strong>ortality for <strong>C</strong>irrhotic <strong>P</strong>atients with <strong>A</strong>KI). The PHM-CPA model was then externally validated in patients from eICU Collaborative Research Database (eICU-CRD) and Medical Information Mart for Intensive Care III dataset (MIMIC). The predictive performance of PHM-CPA model was compared with that of logistic regression (LR) model and 25 previously reported models.</div></div><div><h3>Results</h3><div>A total of 519 cirrhotic patients with AKI were enrolled in model training cohort, of whom 118 (23%) died during hospitalization. Fifteen variables from common laboratory tests were selected to develop the PHM-CPA model. The PHM-CPA model achieved an AUROC of 0.816 (95% CI, 0.763–0.861) in the internal validation cohort and 0.787 (95% CI, 0.745–0.830) in the external validation cohort. The PHM-CPA model consistently outperformed the LR model and 25 previously reported models.</div></div><div><h3>Conclusion</h3><div>We developed and validated the PHM-CPA model, comprising readily available clinical variables, which demonstrated superior performance and calibration in predicting in-hospital mortality for cirrhotic patients with AKI.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 485-493"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatic steatosis is a strong risk factor for post-ERCP pancreatitis: An emerging concept","authors":"Caroline Prouvot ,&nbsp;Myriam Boumaiza ,&nbsp;Khawla Maoui ,&nbsp;Anne Sophie Peaucelle ,&nbsp;Soiwafi Mohamed ,&nbsp;Hanae Boutallaka ,&nbsp;Claire Boutet ,&nbsp;Xavier Roblin ,&nbsp;Jean-Marc Phelip ,&nbsp;Rémi Grange ,&nbsp;Nicolas Williet","doi":"10.1016/j.dld.2024.10.005","DOIUrl":"10.1016/j.dld.2024.10.005","url":null,"abstract":"<div><h3>Objective</h3><div>The Endoscopic Retrograde Cholangiopancreatography (ERCP) is the treatment of choice for biliary obstruction but is associated with post-ERCP pancreatitis (PEP) in around 5 % of cases. No radiological criteria have been evaluated for predicting PEP risk.</div></div><div><h3>Design</h3><div>This retrospective study examined records of 1365 patients who underwent ERCP at our center between 2014–2023. Only sphincterotomy-naïve patients were included. CT scans within 30 days of ERCP were reviewed for radiological criteria. The optimal pancreatic density cut-off was determined using AUROC and Youden index. Logistic regression was used for analyses.</div></div><div><h3>Results</h3><div>PEP occurred in 75 patients (6.1 %). The CT scan was performed before ERCP for 565 of the total population. A fatty pancreas, defined as a spontaneous density less than -50HU, was statistically associated with PEP (OR: 7.35; 95 % CI: 1.56–26.5 <em>p</em> = 0.004), as well as with biliary obstruction due to stones (OR: 0.61; 95 % CI: 0.38–0.98; <em>P</em> = 0.04), the need for precut (OR: 2.19; 95 % CI: 1.35–3.51; <em>P</em> = 0.001), cannulation of the main pancreatic duct (OR: 2.23; 95 % CI: 1.36–3.59; <em>P</em> = 0.001), and the use of a pancreatic stent (OR: 2.48; 95 % CI: 1.29–4.47; <em>P</em> = 0.004). In multivariate analyses, only obstruction unrelated to gallstones (OR = 2.63; 95 % CI: 1.16–6.25; <em>P</em> = 0.024) and a low pancreatic density (&lt;-50HU) (OR=7.94, 95 %CI: 1.59–31.09; <em>P</em> = 0.005) remains significantly associated with the risk of PEP, including after adjustment for age and sex (<em>P</em> = 0.006).</div></div><div><h3>Conclusion</h3><div>A very low pancreatic fat density could be a significant risk factor for post-ERCP pancreatitis with potential clinical and research implications. Further validation is needed.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 542-548"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translating knowledge into policy: Organizational model and minimum requirements for the implementation of a regional pancreas unit network","authors":"Gianpaolo Balzano ,&nbsp;Michele Reni ,&nbsp;Maria Di Bartolomeo ,&nbsp;Marta Scorsetti ,&nbsp;Augusto Caraceni ,&nbsp;Piero Rivizzigno ,&nbsp;Alessandro Amorosi ,&nbsp;Alessandro Scardoni ,&nbsp;Mohammad Abu Hilal ,&nbsp;Giovanni Ferrari ,&nbsp;Roberto Labianca ,&nbsp;Massimo Venturini ,&nbsp;Claudio Doglioni ,&nbsp;Luca Riva ,&nbsp;Riccardo Caccialanza ,&nbsp;Silvia Carrara","doi":"10.1016/j.dld.2024.05.022","DOIUrl":"10.1016/j.dld.2024.05.022","url":null,"abstract":"<div><div><span>Pancreatic and periampullary cancers pose significant challenges in oncological care due to their complexity and diagnostic difficulties. Global experiences underscore the crucial role of multidisciplinary collaboration and centralized care in improving patient outcomes in this context. Recognizing these challenges, Lombardy, Italy's most populous region, embarked on establishing pancreas units across its territory to enhance clinical outcomes and organizational efficiency. This initiative, driven by a multistakeholder approach involving the Lombardy Welfare Directorate, clinicians, and a patient association, emphasizes the centralization of complex care in high-volume hospitals, adopting a hub-and-spoke model and a multidisciplinary approach. This article outlines the process and criteria set forth for pancreas unit implementation, aiming to provide a structured framework for enhancing </span>pancreatic cancer care. Central to this initiative is the establishment of structured criteria and minimal requirements, not only for surgery but also for other essential components of care, ensuring a comprehensive approach to pancreatic cancer management. The Lombardy model offers a structured framework for enhancing pancreatic cancer care, with potential applicability to other regions and countries seeking to improve their cancer care infrastructure</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 370-377"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}