BACKGROUND For compensated advanced chronic liver disease(cACLD)patients,the first decompensation represents a dramatically worsening prognostic event.Based on the first decompensation event(DE),the transition to deco...BACKGROUND For compensated advanced chronic liver disease(cACLD)patients,the first decompensation represents a dramatically worsening prognostic event.Based on the first decompensation event(DE),the transition to decompensated advanced chronic liver disease(dACLD)can occur through two modalities referred to as acute decompensation(AD)and non-AD(NAD),respectively.Clinically Significant Portal Hypertension(CSPH)is considered the strongest predictor of decompensation in these patients.However,due to its invasiveness and costs,CSPH is almost never evaluated in clinical practice.Therefore,recognizing noninvasively predicting tools still have more appeal across healthcare systems.The red cell distribution width to platelet ratio(RPR)has been reported to be an indicator of hepatic fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease(MASLD).However,its predictive role for the decompensation has never been explored.AIM In this observational study,we investigated the clinical usage of RPR in predicting DEs in MASLD-related cACLD patients.METHODS Fourty controls and 150 MASLD-cACLD patients were consecutively enrolled and followed up(FUP)semiannually for 3 years.At baseline,biochemical,clinical,and Liver Stiffness Measurement(LSM),Child-Pugh(CP),Model for End-Stage Liver Disease(MELD),aspartate aminotransferase/platelet count ratio index(APRI),Fibrosis-4(FIB-4),Albumin-Bilirubin(ALBI),ALBI-FIB-4,and RPR were collected.During FUP,DEs(timing and modaities)were recorded.CSPH was assessed at the baseline and on DE occurrence according to the available Clinical Practice Guidelines.RESULTS Of 150 MASLD-related cACLD patients,43(28.6%)progressed to dACLD at a median time of 28.9 months(29 NAD and 14 AD).Baseline RPR values were significantly higher in cACLD in comparison to controls,as well as MELD,CP,APRI,FIB-4,ALBI,ALBI-FIB-4,and LSM in dACLD-progressing compared to cACLD individuals[all P<0.0001,except for FIB-4(P:0.007)and ALBI(P:0.011)].Receiving operator curve analysis revealed RPR>0.472 and>0.894 as the best cut-offs in the prediction respectively of 3-year first DE,as well as its superiority compared to the other non-invasive tools examined.RPR(P:0.02)and the presence of baseline-CSPH(P:0.04)were significantly and independently associated with the DE.Patients presenting baseline-CSPH and RPR>0.472 showed higher risk of decompensation(P:0.0023).CONCLUSION Altogether these findings suggest the RPR as a valid and potentially applicable non-invasive tool in the prediction of timing and modalities of decompensation in MASLD-related cACLD patients.展开更多
BACKGROUND Von Meyenburg complex(VMC)(i.e.,biliary hamartoma)is a rare congenital disorder characterized by multiple dilated cystic bile ducts,without clear trends in sex or age predominance.Due to the low number of p...BACKGROUND Von Meyenburg complex(VMC)(i.e.,biliary hamartoma)is a rare congenital disorder characterized by multiple dilated cystic bile ducts,without clear trends in sex or age predominance.Due to the low number of published cases and the lack of recognized guidelines,the management of such patients remains a clinical challenge.CASE SUMMARY We present a case of symptomatic VMC that was diagnosed after imaging and histopathological examinations.Considering the patient’s condition,a conservative treatment strategy was chosen.Instrumental,laboratory,and clinical follow-up demonstrated the stable condition of the patient receiving conservative treatment.CONCLUSION VMC is a potentially non-life threatening condition,but its recognition is crucial for the management of patients.展开更多
BACKGROUND Portal vein aneurysm(PVA)is an uncommon vascular dilatation,showing no clear trend in sex or age predominance.Due to the low number of published cases and the lack of management guidelines,treatment of this...BACKGROUND Portal vein aneurysm(PVA)is an uncommon vascular dilatation,showing no clear trend in sex or age predominance.Due to the low number of published cases and the lack of management guidelines,treatment of this condition remains a clinical challenge.CASE SUMMARY We present three cases of asymptomatic PVA;the first and second involve an extrahepatic manifestation,of 48 mm and 42.3 mm diameter respectively,and the third involves an intrahepatic PVA of 27 mm.All were diagnosed incidentally during routine check-up,upon ultrasonography scan.Since all patients were asymptomatic,a conservative treatment strategy was chosen.Follow-up imaging demonstrated no progression in the aneurysm dimension for any case.CONCLUSION As PVA remains asymptomatic in many cases,recognition of its imaging features is key to favourable outcomes.展开更多
文摘BACKGROUND For compensated advanced chronic liver disease(cACLD)patients,the first decompensation represents a dramatically worsening prognostic event.Based on the first decompensation event(DE),the transition to decompensated advanced chronic liver disease(dACLD)can occur through two modalities referred to as acute decompensation(AD)and non-AD(NAD),respectively.Clinically Significant Portal Hypertension(CSPH)is considered the strongest predictor of decompensation in these patients.However,due to its invasiveness and costs,CSPH is almost never evaluated in clinical practice.Therefore,recognizing noninvasively predicting tools still have more appeal across healthcare systems.The red cell distribution width to platelet ratio(RPR)has been reported to be an indicator of hepatic fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease(MASLD).However,its predictive role for the decompensation has never been explored.AIM In this observational study,we investigated the clinical usage of RPR in predicting DEs in MASLD-related cACLD patients.METHODS Fourty controls and 150 MASLD-cACLD patients were consecutively enrolled and followed up(FUP)semiannually for 3 years.At baseline,biochemical,clinical,and Liver Stiffness Measurement(LSM),Child-Pugh(CP),Model for End-Stage Liver Disease(MELD),aspartate aminotransferase/platelet count ratio index(APRI),Fibrosis-4(FIB-4),Albumin-Bilirubin(ALBI),ALBI-FIB-4,and RPR were collected.During FUP,DEs(timing and modaities)were recorded.CSPH was assessed at the baseline and on DE occurrence according to the available Clinical Practice Guidelines.RESULTS Of 150 MASLD-related cACLD patients,43(28.6%)progressed to dACLD at a median time of 28.9 months(29 NAD and 14 AD).Baseline RPR values were significantly higher in cACLD in comparison to controls,as well as MELD,CP,APRI,FIB-4,ALBI,ALBI-FIB-4,and LSM in dACLD-progressing compared to cACLD individuals[all P<0.0001,except for FIB-4(P:0.007)and ALBI(P:0.011)].Receiving operator curve analysis revealed RPR>0.472 and>0.894 as the best cut-offs in the prediction respectively of 3-year first DE,as well as its superiority compared to the other non-invasive tools examined.RPR(P:0.02)and the presence of baseline-CSPH(P:0.04)were significantly and independently associated with the DE.Patients presenting baseline-CSPH and RPR>0.472 showed higher risk of decompensation(P:0.0023).CONCLUSION Altogether these findings suggest the RPR as a valid and potentially applicable non-invasive tool in the prediction of timing and modalities of decompensation in MASLD-related cACLD patients.
文摘BACKGROUND Von Meyenburg complex(VMC)(i.e.,biliary hamartoma)is a rare congenital disorder characterized by multiple dilated cystic bile ducts,without clear trends in sex or age predominance.Due to the low number of published cases and the lack of recognized guidelines,the management of such patients remains a clinical challenge.CASE SUMMARY We present a case of symptomatic VMC that was diagnosed after imaging and histopathological examinations.Considering the patient’s condition,a conservative treatment strategy was chosen.Instrumental,laboratory,and clinical follow-up demonstrated the stable condition of the patient receiving conservative treatment.CONCLUSION VMC is a potentially non-life threatening condition,but its recognition is crucial for the management of patients.
文摘BACKGROUND Portal vein aneurysm(PVA)is an uncommon vascular dilatation,showing no clear trend in sex or age predominance.Due to the low number of published cases and the lack of management guidelines,treatment of this condition remains a clinical challenge.CASE SUMMARY We present three cases of asymptomatic PVA;the first and second involve an extrahepatic manifestation,of 48 mm and 42.3 mm diameter respectively,and the third involves an intrahepatic PVA of 27 mm.All were diagnosed incidentally during routine check-up,upon ultrasonography scan.Since all patients were asymptomatic,a conservative treatment strategy was chosen.Follow-up imaging demonstrated no progression in the aneurysm dimension for any case.CONCLUSION As PVA remains asymptomatic in many cases,recognition of its imaging features is key to favourable outcomes.
