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Non-invasive tests to assess the probability of clinically significant portal hypertension (CSPH) – including the ANTICIPATE±NASH models based on liver stiffness measurement and platelet count±BMI, and the von Willebrand factor antigen to platelet count ratio (VITRO) – have fundamentally changed the management of compensated advanced chronic liver disease (cACLD). However, their prognostic utility has not been compared head-to-head to the gold standard for prognostication in cACLD, i.e. the hepatic venous pressure gradient (HVPG). Patients with cACLD (liver stiffness measurement ≥10 kPa) who underwent advanced characterization via same-day HVPG/non-invasive test assessment from 2007-2022 were retrospectively included. Long-term follow-up data on hepatic decompensation was recorded. Four hundred and twenty patients with cACLD of varying etiologies, with a CSPH prevalence of 67.6%, were included. The cumulative incidence of hepatic decompensation at 1 and 2 years was 4.7% and 8.0%, respectively. HVPG, VITRO, and ANTICIPATE±NASH-CSPH-probability showed similar time-dependent prognostic value (AUROCs 0.683-0.811 at 1 year and 0.699-0.801 at 2 years). In competing risk analyses adjusted for MELD score and albumin, HVPG (adjusted subdistribution hazard ratio [aSHR] 1.099 [95% CI 1.054–1.150] per mmHg; p < 0.001), or VITRO (aSHR 1.134 [95% CI 1.062–1.211] per unit; p < 0.001), or ANTICIPATE±NASH-CSPH-probability (aSHR 1.232 [95% CI 1.094–1.387] per 10%; p < 0.001) all predicted first decompensation during follow-up. Previously proposed cut-offs (HVPG ≥10 mmHg vs. <10 mmHg, VITRO ≥2.5 vs. < 2.5, and ANTICIPATE-CSPH probability ≥60% vs. < 60%) all accurately discriminated between patients at negligible risk and those at substantial risk of hepatic decompensation. The prognostic performance of ANTICIPATE±NASH-CSPH-probability and VITRO is comparable to that of HVPG, supporting their utility for identifying patients who may benefit from medical therapies to prevent first hepatic decompensation. Non-invasive tests have revolutionized the diagnosis and management of clinically significant portal hypertension in patients with compensated advanced chronic liver disease (cACLD). However, limited data exists regarding the prognostic utility of non-invasive tests in direct comparison to the gold standard for prognostication in cACLD, i.e. the hepatic venous pressure gradient. In our study including 420 patients with cACLD, the ANTICIPATE±NASH model and VITRO yielded similar AUROCs to hepatic venous pressure gradient for hepatic decompensation within 1 to 2 years. Thus, non-invasive tests should be applied and updated in yearly intervals in clinical routine to identify patients at short-term risk, thereby identifying patients who may benefit from treatment aimed at preventing hepatic decompensation. [Display omitted] • Non-invasive tests have similar prognostic utility to the hepatic venous pressure gradient in patients with cACLD. • ANTICIPATE±NASH and VITRO identify patients at short-term risk of decompensation. • Non-invasive tests may be applied to individualize prognosis and treatment decisions in cACLD. [ABSTRACT FROM AUTHOR]

Background: Spleen stiffness measurement (SSM) correlates with the severity of portal hypertension. Aims: We investigated the utility of SSM in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) for detecting cirrhosis, esophageal varices (EV), and high-risk EV. Methods: 154 study participants with MASLD underwent simultaneous liver stiffness measurement (LSM) and SSM. 96 (62%) participants had an upper endoscopy (73 participants, i.e., 47% undergoing within a year). The diagnostic performance of SSM, as well as the BAVENO VII proposed SSM cutoffs (≥ 21 kPa, > 40 kPa, and > 50 kPa), was examined. Results: The failure rate for SSM was 19% compared to 5% for LSM. An invalid SSM was statistically significantly associated with a higher body mass index, a larger waist circumference, and a lower fibrosis stage. The area under the receiver operating characteristics for SSM to diagnose cirrhosis, EV, and high-risk EV was 0.78 (95% CI 0.70–0.85), 0.74 (95% CI 0.61–0.84), and 0.82 (95% CI 0.75–0.98), respectively. SSM ≥ 21 kPa cutoff had a sensitivity > 96% for all three outcomes, with a positive predictive value (PPV) of 88% for cirrhosis. In contrast, SSM > 40 kPa and SSM > 50 kPa cutoffs had better diagnostic abilities for identifying EV, particularly high-risk EV (sensitivity of 100% and 93% with NPV of 100% and 96%, respectively). Conclusion: SSM has a higher failure rate in individuals who are non-cirrhotic or have a higher BMI, or larger waist circumference. Although useful for diagnosing NASH cirrhosis, SSM is most reliable in excluding EV and high-risk EV. [ABSTRACT FROM AUTHOR]

Sc-rich babingtonite from Heftetjern, Norway and Baveno, Italy were examined using electron microprobe analysis and X-ray single-crystal refinement in order to re-examine the behavior of Sc3+ and analyze its effect on the crystal structure of babingtonite. The Sc2O3 content is 13.78 wt.% in the Heftetjern specimen, and 8.44 wt.% in the Baveno one. In contrast, the latter has higher Fe content (11.13 wt.% as FeO) rather than the former one (8.63 wt.% as FeO). Characteristically, both specimens contain sodium. Although the oxidation state of octahedral cations in babingtonites is in general Me2+:Me3+ = 1:1, trivalent cations in the Heftetjern specimen attain 1.14 apfu. This excess of trivalent cations must be counterbalanced by monovalent Na substituted for Ca. The unit-cell parameters are a = 7.5272(1), b = 11.7175(1), c = 6.7613(1) Å, α = 91.710(1), β = 93.637(1), γ = 104.522(1)°, and V = 575.49(2) Å3 for the Heftetjern specimen, and a = 7.5199(2), b = 11.7145(3), c = 6.7408(2) Å, α = 91.756(2), β = 93.786(2), γ = 104.549(2)°, and V = 573.83(3) Å3 for the Baveno one. The structural formulae are A1Ca1.00A2(Ca0.879Na0.121)M1(Sc3+0.42Fe2+0.37Mn2+0.21)M2(Sc3+0.68Fe2+0.27Mg0.03Fe3+0.02)Si5O14(OH) for Heftetjern, and A1Ca1.00A2(Ca0.819Na0.181)M1(Sc3+0.43Mn2+0.36Fe2+0.21)M2(Fe3+0.36Fe2+0.30Sc3+0.26Sn4+0.05Al0.03)Si5O14(OH) for Baveno. Due to Sc3+ substitution, the distance, 2.09–2.11 Å, is longer than that of Sc-free babingtonite, 2.03–2.05 Å. The M2O6 expansion leads to the lengthened O4–O10 edge shared between the M1O6 and M2O6 octahedra, and causes the stronger angular distortion of M2O6. This can be explained by the increase of the O4–M1–O10 angle and decrease of the O4–M1–O8 angle with lengthening of the O4–O10 edge. [ABSTRACT FROM AUTHOR]

Background: Direct-acting antivirals (DAAs) show high efficacy and safety in HCV-cirrhotic patients, but most maintain clinically significant portal hypertension after sustained virological response (SVR). Non-invasive Baveno and expanded-Baveno criteria can identify patients without high-risk gastroesophageal varices (GEV) who have no need for endoscopic surveillance. However, data after SVR are scarce. We performed a multicenter study to evaluate SVR effects over GEV and diagnostic accuracy of non-invasive criteria after SVR.Methods: HCV-cirrhotic patients receiving DAAs and baseline endoscopic evaluation were included (November 2014-October 2015). GEV were classified as low risk (LR-GEV) (< 5 mm) or high risk (HR-GEV) (≥ 5 mm or with risk signs). Transient elastography (TE) and endoscopy were performed during follow-up.Results: SVR was achieved in 230 (93.1%) of 247 included patients, 151 (65.7%) with endoscopic follow-up. Among 64/151 (42.4%) patients without baseline GEV, 8 (12.5%) developed GEV after SVR. Among 50/151 (33.1%) with baseline LR-GEV, 12 (24%) developed HR-GEV. Patients with GEV progression showed TE ≥ 25 kPa before treatment (64.7%) or ≥ 20 kPa after SVR (66.7%). Only 6% of patients without GEV and LSM < 25 kPa before treatment, and 10% of those with baseline LSM < 25 kPa and LSM < 20 kPa after SVR showed GEV progression after 36 months. The negative predictive value of Baveno and expanded-Baveno criteria to exclude HR-GEV was maintained after SVR (100% and 90.7%, respectively).Conclusions: HCV-cirrhotic patients can develop HR-GEV after SVR. Surveillance is especially recommended in those with GEV before antiviral treatment. Baveno and expanded-Baveno criteria can be safely applied after SVR. https://clinicaltrials.gov: NCT02758509. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Expanded Baveno VI works better than Baveno VI criteria for ruling out the presence of VNT in NAFLD-cirrhosis. • New NAFLD-cirrhosis criteria based on LSM and platelet values and optimized for M and XL FibroScan probes are optimal. • The accuracy of noninvasive scores for VNT is lower in non-obese patients. Background & Aims Baveno VI and expanded Baveno VI criteria can avoid the need for esophagogastroduodenoscopy (EGD) to screen for varices needing treatment (VNT) in a substantial proportion of compensated patients with viral and/or alcoholic cirrhosis. This multicenter, cross-sectional study aims to validate these criteria in patients with compensated cirrhosis due to non-alcoholic fatty liver disease (NAFLD), accounting for possible differences in liver stiffness measurement (LSM) values between M and XL probes. Methods We assessed 790 patients with NAFLD-related compensated cirrhosis who had EGD within six months of a reliable LSM, measured by FibroScan® using M and/or XL probe. Baveno VI and expanded Baveno VI criteria were tested. The main variable used to optimize criteria was the percentage of endoscopies spared, keeping the risk of missing large VNT below a 5% threshold. Results LSM was measured by both M and XL probes (training set) in 314 patients, while only M or XL probe (validation sets) were used to measure LSM in 338 and 138 patients, respectively. In the training set, use of Baveno VI and expanded Baveno VI criteria reduced the number of EGD by 33.3% and by 58%, with 0.9% and 3.8% of large esophageal varices missed, respectively. The best thresholds to rule-out VNT were identified as platelet count >110,000/mm3 and LSM <30 kPa for M probe, and platelet count >110,000/mm3 and LSM <25 kPa for XL probe (NAFLD cirrhosis criteria). Thus, usage of NAFLD cirrhosis criteria would have led to an absolute reduction in the number of EGD screened patients of 34.7% and 10.5% with respect to Baveno VI and expanded Baveno VI criteria, respectively. Conclusion The new NAFLD cirrhosis criteria, established for the FibroScan probe, can reduce the use of EGD for screening of VNT in NAFLD cirrhosis by more than half, with a chance of missing VNT below 5%. Lay summary In non-alcoholic fatty liver disease-related compensated cirrhosis, the expanded Baveno VI criteria work better than the Baveno VI criteria for ruling out the presence of varices needing treatment, sparing unnecessary and invasive screening procedures. New diagnostic criteria for this patient group, based on liver stiffness measurement and platelet count, and optimized for the specific FibroScan® probe used, work better than both Baveno VI and expanded Baveno VI criteria. The accuracy of all non-invasive scoring criteria was lower in non-obese patients. [ABSTRACT FROM AUTHOR]

CaCeAl(Fe □)[SiO][SiO]O(OH), allanite-(Ce) and rare earth element (REE)-bearing epidote occur as globular aggregates and platy prismatic crystals in miarolitic cavities in a niobium, yttrium, fluorine (NYF) granitic pegmatite at Baveno, Verbania, Southern Alps, Italy. These samples were investigated by means of an electron probe micro-analyser (EPMA) and single-crystal X-ray diffraction. Our EPMA results show that the globular aggregates have the highest REE content in the core portion and decreases to REE-bearing epidote towards the rim whereas the prismatic crystals are characterized by marked oscillatory zoning that have the highest REE contents at the rim of the crystal. The unit-cell parameters of 'allanites' have an intermediate unit-cell between CaCeAl(Fe □)[SiO][SiO]O(OH), allanite-(Ce) and REE-free epidote, because reflect the strong chemical heterogeneity of the samples which form complete solid solutions. Hydrothermal fluids control the activity and precipitation of incompatible elements like high field strength elements (HFSE), Sc and REE by hydrous F-rich fluids below the critical temperature which allow to deposit accessory minerals in the cavities with decreasing temperature. The source of REE and Y are the sheet and REE-silicates like siderophyllite-annite, and gadolinite-(Y) which underwent partial to complete decomposition by the activity of aggressive F-rich hydrothermal fluids. [ABSTRACT FROM AUTHOR]