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Producción Científica, This chapter analyses three strategies proposed to redefine current urban policies to deal with issues inherited from the contemporary city evolution. The case study analysis focuses on applying the concepts of 15-min City, Tactical Urbanism, and Superblock in global cities such as Barcelona, Shanghai, and Milan. Have these cities changed the urban environment and mobility patterns dealing with health, social, and economic inequities? Which have been the impacts of urban regeneration, governance, and inclusion towards achieving the Sustainable Development Goal 11, emphasizing the need for inclusivity and equitability in urban areas? These questions find the answer in three main aspects. First, the regeneration of the existing built environment; second, short-, medium-, and long-term governance issues; third, the concerns about the possible risk of gentrification. An introductive part explains the adopted methodology, follows an analysis of the three case studies, and, eventually, remarks on what we learned. Two are the primary outcomes: a comparison between different global cities and diverse ways to deal with the impacts of people-centered solutions for urban environments and an evaluation of 15-min City, Tactical Urbanism, and Superblocks feasible solutions for sustainable urban transition.

Metabolic syndrome (MetS) is a common condition closely associated with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH). Recent meta-analyses show that MetS can be prodromal to intrahepatic cholangiocarcinoma (iCCA) development, a liver tumor with features of biliary differentiation characterized by dense extracellular matrix (ECM) deposition. Since ECM remodeling is a key event in the vascular complications of MetS, we aimed at evaluating whether MetS patients with iCCA present qualitative and quantitative changes in the ECM able to incite biliary tumorigenesis. In 22 iCCAs with MetS undergoing surgical resection, we found a significantly increased deposition of osteopontin (OPN), tenascin C (TnC), and periostin (POSTN) compared to the matched peritumoral areas. Moreover, OPN deposition in MetS iCCAs was also significantly increased when compared to iCCA samples without MetS (non-MetS iCCAs, n = 44). OPN, TnC, and POSTN significantly stimulated cell motility and the cancer-stem-cell-like phenotype in HuCCT-1 (human iCCA cell line). In MetS iCCAs, fibrosis distribution and components differed quantitatively and qualitatively from non-MetS iCCAs. We therefore propose overexpression of OPN as a distinctive trait of MetS iCCA. Since OPN stimulates malignant properties of iCCA cells, it may provide an interesting predictive biomarker and a putative therapeutic target in MetS patients with iCCA.

Ecosystem service assessments play a crucial role in highlighting the importance of ecosystems in human life and guiding regional planning processes. This study examines the significance of rural ecosystems and their diverse ecological services, ranging from agricultural productivity to water purification and esthetic value. At present, the ecological restoration of rural riparian zones in China mainly relies on engineering standards as reference guidelines, lacking responses to surrounding land use patterns (including diverse ecological functional requirements) at the planning and design level. This paper proposes 17 assessment indicators for ecosystem services based on a case analysis of Shuiku Village in Shanghai. Through the evaluation of the supply-demand relationship of ecosystem services in the water network rural riparian zone, the paper suggests feasible restoration approaches based on a comprehensive evaluation of the ecological status to address the diverse needs of rural water ecosystems. The result indicated that using an ecosystem services evaluation framework can provide more precise analysis at a small scale.

Cholangiocarcinoma (CCA) is a rare malignancy that develops at any point along the biliary tree. CCA has a poor prognosis, its clinical management remains challenging, and effective treatments are lacking. Therefore, preclinical research is of pivotal importance and necessary to acquire a deeper understanding of CCA and improve therapeutic outcomes. Preclinical research involves developing and managing complementary experimental models, from in vitro assays using primary cells or cell lines cultured in 2D or 3D to in vivo models with engrafted material, chemically induced CCA or genetically engineered models. All are valuable tools with well-defined advantages and limitations. The choice of a preclinical model is guided by the question(s) to be addressed; ideally, results should be recapitulated in independent approaches. In this Consensus Statement, a task force of 45 experts in CCA molecular and cellular biology and clinicians, including pathologists, from ten countries provides recommendations on the minimal criteria for preclinical models to provide a uniform approach. These recommendations are based on two rounds of questionnaires completed by 35 (first round) and 45 (second round) experts to reach a consensus with 13 statements. An agreement was defined when at least 90% of the participants voting anonymously agreed with a statement. The ultimate goal was to transfer basic laboratory research to the clinics through increased disease understanding and to develop clinical biomarkers and innovative therapies for patients with CCA.

Background & Aims: Cholangiocarcinoma (CCA) is a rare and heterogeneous biliary cancer, whose incidence and related mortality is increasing. This study investigates the clinical course of CCA and subtypes (intrahepatic [iCCA], perihilar [pCCA], and distal [dCCA]) in a pan-European cohort. Methods: The ENSCCA Registry is a multicenter observational study. Patients were included if they had a histologically proven diagnosis of CCA between 2010-2019. Demographic, histomorphological, biochemical, and clinical studies were performed. Results: Overall, 2,234 patients were enrolled (male/female=1.29). iCCA (n = 1,243) was associated with overweight/ obesity and chronic liver diseases involving cirrhosis and/or viral hepatitis; pCCA (n = 592) with primary sclerosing cholangitis; and dCCA (n = 399) with choledocholithiasis. At diagnosis, 42.2% of patients had local disease, 29.4% locally advanced disease (LAD), and 28.4% metastatic disease (MD). Serum CEA and CA199 showed low diagnostic sensitivity, but their concomitant elevation was associated with increased risk of presenting with LAD (odds ratio 2.16; 95% CI 1.43-3.27) or MD (odds ratio 5.88; 95% CI 3.69-9.25). Patients undergoing resection (50.3%) had the best outcomes, particularly with negative-resection margin (R0) (median overall survival [mOS] = 45.1 months); however, margin involvement (R1) (hazard ratio 1.92; 95% CI 1.53-2.41; mOS = 24.7 months) and lymph node invasion (hazard ratio 2.13; 95% CI 1.55-2.94; mOS = 23.3 months) compromised prognosis. Among patients with unresectable disease (49.6%), the mOS was 10.6 months for those receiving active palliative therapies, mostly chemotherapy (26.2%), and 4.0 months for those receiving best supportive care (20.6%). iCCAs were associated with worse outcomes than p/dCCAs. ECOG performance status, MD and CA19-9 were independent prognostic factors. Conclusion: CCA is frequently diagnosed at an advanced stage, a proportion of patients fail to receive cancer-specific therap

[EN] BACKGROUND & AIMS: Cholangiocarcinoma (CCA) comprises a heterogeneous group of malignant tumors associated with dismal prognosis. Alterations in post-translational modifications (PTMs), including NEDDylation, result in abnormal protein dynamics, cell disturbances and disease. Herein, we investigate the role of NEDDylation in CCA development and progression. METHODS: Levels and functions of NEDDylation, together with response to pevonedistat (NEDDylation inhibitor) or CRISPR/Cas9 against NAE1 were evaluated invitro, invivo and/or in patients with CCA. The development of preneoplastic lesions in Nae1+/- mice was investigated using an oncogene-driven CCA model. The impact of NEDDylation in CCA cells on tumor-stroma crosstalk was assessed using CCA-derived cancer-associated fibroblasts (CAFs). Proteomic analyses were carried out by mass-spectrometry. RESULTS: The NEDDylation machinery was found overexpressed and overactivated in human CCA cells and tumors. Most NEDDylated proteins found upregulated in CCA cells, after NEDD8-immunoprecipitation and further proteomics, participate in the cell cycle, proliferation or survival. Genetic (CRISPR/Cas9-NAE1) and pharmacological (pevonedistat) inhibition of NEDDylation reduced CCA cell proliferation and impeded colony formation invitro. NEDDylation depletion (pevonedistat or Nae1+/- mice) halted tumorigenesis in subcutaneous, orthotopic, and oncogene-driven models of CCA invivo. Moreover, pevonedistat potentiated chemotherapy-induced cell death in CCA cells invitro. Mechanistically, impaired NEDDylation triggered the accumulation of both cullin RING ligase and NEDD8 substrates, inducing DNA damage and cell cycle arrest. Furthermore, impaired NEDDylation in CCA cells reduced the secretion of proteins involved in fibroblast activation, angiogenesis, and oncogenic pathways, ultimately hampering CAF proliferation and migration. CONCLUSION: Aberrant protein NEDDylation contributes to cholangiocarcinogenesis by promoting cell sur

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Background & Aims: Cholangiocarcinoma (CCA) is a rare and heterogeneous biliary cancer, whose incidence and related mortality is increasing. This study investigates the clinical course of CCA and subtypes (intrahepatic [iCCA], perihilar [pCCA], and distal [dCCA]) in a pan-European cohort. Methods: The ENSCCA Registry is a multicenter observational study. Patients were included if they had a histologically proven diagnosis of CCA between 2010-2019. Demographic, histomorphological, biochemical, and clinical studies were performed. Results: Overall, 2,234 patients were enrolled (male/female=1.29). iCCA (n = 1,243) was associated with overweight/obesity and chronic liver diseases involving cirrhosis and/or viral hepatitis; pCCA (n = 592) with primary sclerosing cholangitis; and dCCA (n = 399) with choledocholithiasis. At diagnosis, 42.2% of patients had local disease, 29.4% locally advanced disease (LAD), and 28.4% metastatic disease (MD). Serum CEA and CA19-9 showed low diagnostic sensitivity, but their concomitant elevation was associated with increased risk of presenting with LAD (odds ratio 2.16; 95% CI 1.43-3.27) or MD (odds ratio 5.88; 95% CI 3.69-9.25). Patients undergoing resection (50.3%) had the best outcomes, particularly with negative-resection margin (R0) (median overall survival [mOS] = 45.1 months); however, margin involvement (R1) (hazard ratio 1.92; 95% CI 1.53-2.41; mOS = 24.7 months) and lymph node invasion (hazard ratio 2.13; 95% CI 1.55-2.94; mOS = 23.3 months) compromised prognosis. Among patients with unresectable disease (49.6%), the mOS was 10.6 months for those receiving active palliative therapies, mostly chemotherapy (26.2%), and 4.0 months for those receiving best supportive care (20.6%). iCCAs were associated with worse outcomes than p/dCCAs. ECOG performance status, MD and CA19-9 were independent prognostic factors. Conclusion: CCA is frequently diagnosed at an advanced stage, a proportion of patients fai

BACKGROUND AND AIMS: cholangiocarcinoma (CCA) comprises a heterogeneous group of malignant tumors with dismal prognosis. Alterations in post-translational modifications (PTMs), including NEDDylation, result in abnormal protein dynamics, cell disturbances and disease. Here, we investigate the role of NEDDylation in CCA development and progression.METHODS: levels and function of NEDDylation, together with response to pevonedistat (NEDDylation inhibitor) or CRISPR/Cas9 against NAE1 were evaluated in vitro, in vivo and/or in patients with CCA. Development of preneoplastic lesions in Nae1 +/- mice was investigated using an oncogene-driven CCA model. The impact of NEDDylation in CCA cells on tumor-stroma crosstalk was assessed using CCA-derived cancer-associated fibroblasts (CAFs). Proteomic analyses were carried out by mass-spectrometry. RESULTS: NEDDylation machinery was found overexpressed and overactivated in human CCA cells and tumors. Most NEDDylated proteins found upregulated in CCA cells, after NEDD8-immunoprecipitation and further proteomics, participate in cell cycle, proliferation or survival. Genetic (CRISPR/Cas9-NAE1) and pharmacological (pevonedistat) inhibition of NEDDylation reduced CCA cell proliferation and impeded colony formation in vitro. NEDDylation depletion (pevonedistat or Nae1 +/- mice) halted tumorigenesis in subcutaneous, orthotopic, and oncogene-driven models of CCA in vivo. Moreover, pevonedistat potentiated chemotherapy-induced cell death in CCA cells in vitro. Mechanistically, impaired NEDDylation triggered the accumulation of both cullin RING ligase and NEDD8 substrates, inducing DNA damage and cell cycle arrest. Furthermore, NEDDylation impairment in CCA cells reduced the secretion of proteins involved in fibroblast activation, angiogenesis, and oncogenic pathways, ultimately hampering CAF proliferation and migration. CONCLUSION: aberrant protein NEDDylation contributes to cholangiocarcinogenesis by promoting cell

[EN] BACKGROUND AND AIMS: Intrahepatic cholangiocarcinoma (iCCA) with liver metastases is perceived to have a poor prognosis, but the American Joint Committee on Cancer (AJCC) classifies them as early stage in the absence of lymph nodes or extrahepatic spread. APP ROA CH AND RESULT S: Patients with iCCA from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) and Surveillance, Epidemiology, and End Results (SEER) registries with survival/staging (AJCC v.7) data were eligible. Modified staging was used (mAJCC v.7): group A: stages I-III (excluding T2bN0); group B: stage IVa (excluding T2bN1M0); group C: liver metastases (T2bN0/1); and group D: stage IVb (extrahepatic metastases). Survival analysis (Kaplan-Meier and Cox regression) was performed in an ENS-CCA training cohort (TC) and findings internally (ENS-CCA iVC) and externally (SEER) validated. The aim was to assess whether liver metastases (group C) had a shorter survival compared to other early stages (group A) to propose a modified version of AJCC v.8 (mAJCC v.8). A total of 574 and 4,171 patients from the ENS-CCA and SEER registries were included. Following the new classification, 19.86% and 17.31% of patients from the ENS-CCA and SEER registries were reclassified into group C, respectively. In the ENS-CCA TC, multivariable Cox regression was adjusted for obesity (p = 0.026) and performance status (P < 0.001); patients in group C (HR, 2.53; 95% CI, 1.18-5.42; P = 0.017) had a higher risk of death (vs. group A). Findings were validated in the ENS-CCA iVC (HR, 2.93; 95% CI, 2.04-4.19; P < 0.001) and in the SEER registry (HR, 1.88; 95% CI, 1.68-2.09; P < 0.001). CONCLUSIONS: iCCA with liver metastases has a worse outcome than other early stages of iCCA. Given that AJCC v.8 does not take this into consideration, a modification of AJCC v.8 (mAJCC v.8), including “liver metastases: multiple liver lesions, with or without vascular invasion” as an “M1a stage,” is suggested. (Hepatology 2021;73:2311-232

Landscape Architecture

[EN] Cholangiocarcinoma (CCA) includes a cluster of highly heterogeneous biliary malignant tumours that can arise at any point of the biliary tree. Their incidence is increasing globally, currently accounting for ~15% of all primary liver cancers and ~3% of gastrointestinal malignancies. The silent presentation of these tumours combined with their highly aggressive nature and refractoriness to chemotherapy contribute to their alarming mortality, representing ~2% of all cancer-related deaths worldwide yearly. The current diagnosis of CCA by non- invasive approaches is not accurate enough, and histological confirmation is necessary. Furthermore, the high heterogeneity of CCAs at the genomic, epigenetic and molecular levels severely compromises the efficacy of the available therapies. In the past decade, increasing efforts have been made to understand the complexity of these tumours and to develop new diagnostic tools and therapies that might help to improve patient outcomes. In this expert Consensus Statement, which is endorsed by the European Network for the Study of Cholangiocarcinoma, we aim to summarize and critically discuss the latest advances in CCA, mostly focusing on classification, cells of origin, genetic and epigenetic abnormalities, molecular alterations, biomarker discovery and treatments. Furthermore, the horizon of CCA for the next decade from 2020 onwards is highlighted

Producción Científica, El artículo aborda de forma crítica varias soluciones y estrategias para abordar las desigualdades urbanas con el fin de defender el reciente paradigma espacial del “derecho a la ciudad saludable”. El artículo reflexiona críticamente sobre la aplicación de los conceptos de “Supermanzana”, “Urbanismo Táctico” y “Ciudad de los 15 minutos”, ilustrando y comparando su aplicación en tres ciudades globales (respectivamente Barcelona, Pekín y Milán). El objetivo es demostrar que estas prácticas pueden ser aplicadas de forma eficaz para diferentes contextos, proponiendo estrategias exitosas para superar los problemas de salud, medio ambiente y movilidad en todas las ciudades globales contemporáneas, Proyecto UrbanHist, Programa de Investigación Horizon 2020 de la UE, Acuerdo de subvención Marie Skłodowska-Curie n. 721933

Cholangiocarcinoma (CCA) includes a cluster of highly heterogeneous biliary malignant tumours that can arise at any point of the biliary tree. Their incidence is increasing globally, currently accounting for ~15% of all primary liver cancers and ~3% of gastrointestinal malignancies. The silent presentation of these tumours combined with their highly aggressive nature and refractoriness to chemotherapy contribute to their alarming mortality, representing ~2% of all cancer-related deaths worldwide yearly. The current diagnosis of CCA by non-invasive approaches is not accurate enough, and histological confirmation is necessary. Furthermore, the high heterogeneity of CCAs at the genomic, epigenetic and molecular levels severely compromises the efficacy of the available therapies. In the past decade, increasing efforts have been made to understand the complexity of these tumours and to develop new diagnostic tools and therapies that might help to improve patient outcomes. In this expert Consensus Statement, which is endorsed by the European Network for the Study of Cholangiocarcinoma, we aim to summarize and critically discuss the latest advances in CCA, mostly focusing on classification, cells of origin, genetic and epigenetic abnormalities, molecular alterations, biomarker discovery and treatments. Furthermore, the horizon of CCA for the next decade from 2020 onwards is highlighted.

Tumour microenvironment is a complex, multicellular functional compartment that, particularly when assembled as an abundant desmoplastic reaction, may profoundly affect the proliferative and invasive abilities of epithelial cancer cells. Tumour microenvironment comprises not only stromal cells, mainly cancer-associated fibroblasts, but also immune cells of both the innate and adaptive system (tumour-associated macrophages, neutrophils, natural killer cells, and T and B lymphocytes), and endothelial cells. This results in an intricate web of mutual communications regulated by an extensively remodelled extracellular matrix, where the tumour cells are centrally engaged. In this regard, cholangiocarcinoma, in particular the intrahepatic variant, has become the focus of mounting interest in the last years, largely because of the lack of effective therapies despite its rising incidence and high mortality rates worldwide. On the other hand, recent studies in pancreatic cancer, which similarly to cholangiocarcinoma, is highly desmoplastic, have argued against a tumour-promoting function of the tumour microenvironment. In this review, we will discuss recent developments concerning the role of each cellular population and their multifaceted interplay with the malignant biliary epithelial counterpart. We ultimately hope to provide the working knowledge on how their manipulation may lead to a therapeutic gain in cholangiocarcinoma.

Producción Científica, Throughout the twentieth century, Friuli Venezia Giulia, the north-eastern region of Italy that borders Austria and Slovenia, played a strategic wartime role. From the Great War to the Cold War, the installation of defensive works including barracks, fortifications and infrastructure distinguished the territory. A significant rationalization in the territory and modification in the organizational structure of the Armed Forces took place from the end of the Cold War, through the EU expansion to the countries located on the north-eastern border of Italy, and up to the Army’s transformation from conscription to voluntary service. The town of Casarsa della Delizia represents a case of important significance due to the presence of the “Trieste” barracks, a settlement of extensive and significant environmental impact, a part of which has not been used for years, becoming over time a landscape-abandonment issue, on which action is needed. The paper focuses on the proposals to recover this former military area as a new integrated part of the city, merging the necessity of saving the past heritage and developing a new landscape vision, bringing together the historical and contemporary ways of living and promoting urban regeneration complex operations., European Joint Doctorate “urbanHIST”. European Union. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 721933.

Il colangiocarcinoma (CCA) è una neoplasia epiteliale che origina dai dotti biliari, ed è caratterizzata da una prognosi infausta, imputabile alla spiccata invasività e alla resistenza alla chemioterapia. L’aggressività delle cellule di CCA è esacerbata dallo stroma desmoplastico che si sviluppa contestualmente alla crescita tumorale, contenente fibroblasti cancro-associati (CAF), macrofagi tumore-associati e cellule endoteliali linfatiche (LEC). Durante il mio dottorato, ho analizzato la natura e la rilevanza biologica dei segnali paracrini intercorrenti tra cellule stromali e tumorali nel CCA, nel tentativo di chiarire i meccanismi molecolari che guidano la progressione tumorale. In un primo studio, abbiamo esaminato la citochina pleiotropica Leukemia Inhibitory Factor (LIF), che abbiamo scoperto essere secreta non solo dalle cellule di CCA, ma anche dalle cellule infiammatorie e dai CAF all’interno del microambiente tumorale. Abbiamo dimostrato che il LIF ostacolava l’induzione di apoptosi in cellule di CCA trattate con gemcitabina e cisplatino, tramite attivazione del pathway PI3K/Akt, e conseguente up-regolazione della proteina anti-apoptotica Myeloid Cell Leukemia (Mcl)-1. In un secondo studio, abbiamo considerato un tipico readout delle interazioni stroma-tumore, ovvero la transizione epitelio-mesenchimale (EMT) delle cellule carcinomatose, un fenomeno alla base dell’invasione tumorale. In precedenza, avevamo dimostrato che S100A4, un biomarcatore della EMT, promuove attivamente l’invasività del CCA quando espresso nel nucleo delle cellule tumorali. Abbiamo quindi osservato che la nuclearizzazione di S100A4 era dipendente dalla sua SUMOilazione, che poteva essere inibita trattando le cellule di CCA con dosi nanomolari di paclitaxel. La riduzione dei livelli nucleari di S100A4 si associava ad una diminuzione dell’attività di RhoA e Cdc42, della secrezione della metalloproteinasi della matrice (MMP)-9, e dell’espressione della MMP di membrana di tipo 1., Cholangiocarcinoma (CCA) is an epithelial cancer arising from the biliary tree. CCA carries a poor prognosis, owing to early and pronounced invasiveness, and resistance to chemotherapy. The aggressiveness of CCA cells is exacerbated by the desmoplastic stroma developing in conjunction with tumor outgrowth, which mainly consists of cancer-associated fibroblasts (CAFs), tumor-associated macrophages, and lymphatic endothelial cells (LECs). During my PhD studies, I sought to dissect the nature and the biological relevance of the dense paracrine communications between stromal and cancer cells in CCA, in an effort to unveil the molecular mechanisms driving tumor progression. In a first study, we focused on a pleiotropic cytokine named leukemia inhibitory factor (LIF), which we found to be released not only by CCA cells, but also by inflammatory cells and CAFs within the tumor microenvironment. We showed that LIF hindered the induction of apoptosis in CCA cells treated with gemcitabine plus cisplatin, an effect dependent on the up-regulation of the anti-apoptotic protein myeloid cell leukemia (Mcl)-1, occurring downstream of PI3K activation. Therefore, targeting the LIF/PI3K/Mcl-1 axis may represent a feasible strategy to increase CCA responsiveness to chemotherapy. In a second study, we considered a classic readout of tumor-stroma interactions, i.e., the epithelial-to-mesenchymal transition (EMT) of cancer cells, a process underlying carcinoma invasion and metastasis. Previously, we had shown that S100A4, an EMT biomarker, acts as a mechanistic determinant of CCA invasiveness when expressed in the nucleus of cancer cells. We then demonstrated that the nuclearization of S100A4 was dependent on its SUMOylation, which could be inhibited by treating CCA cells with paclitaxel at nanomolar doses. Down-modulation of nuclear S100A4 hampered the activity of RhoA and Cdc42, the secretion of matrix metalloproteinase (MMP)-9, and the expression of membrane-type (MT)1-MMP. Moreover, l

Background & aimsPrimary sclerosing cholangitis (PSC) is an orphan hepatobiliary disorder associated with inflammatory bowel disease (IBD). We aimed to estimate the risk of disease progression based on distinct clinical phenotypes in a large international cohort of patients with PSC.MethodsWe performed a retrospective outcome analysis of patients diagnosed with PSC from 1980 through 2010 at 37 centers in Europe, North America, and Australia. For each patient, we collected data on sex, clinician-reported age at and date of PSC and IBD diagnoses, phenotypes of IBD and PSC, and date and indication of IBD-related surgeries. The primary and secondary endpoints were liver transplantation or death (LTD) and hepatopancreatobiliary malignancy, respectively. Cox proportional hazards models were applied to determine the effects of individual covariates on rates of clinical events, with time-to-event analysis ascertained through Kaplan-Meier estimates.ResultsOf the 7121 patients in the cohort, 2616 met the primary endpoint (median time to event of 14.5 years) and 721 developed hepatopancreatobiliary malignancy. The most common malignancy was cholangiocarcinoma (n = 594); patients of advanced age at diagnosis had an increased incidence compared with younger patients (incidence rate: 1.2 per 100 patient-years for patients younger than 20 years old, 6.0 per 100 patient-years for patients 21-30 years old, 9.0 per 100 patient-years for patients 31-40 years old, 14.0 per 100 patient-years for patients 41-50 years old, 15.2 per 100 patient-years for patients 51-60 years old, and 21.0 per 100 patient-years for patients older than 60 years). Of all patients with PSC studied, 65.5% were men, 89.8% had classical or large-duct disease, and 70.0% developed IBD at some point. Assessing the development of IBD as a time-dependent covariate, Crohn's disease and no IBD (both vs ulcerative colitis) were associated with a lower risk of LTD (unadjusted hazard ratio [HR], 0.6

BACKGROUND amp; AIMS: Primary sclerosing cholangitis (PSC) is an orphan hepatobiliary disorder associated with inflammatory bowel disease (IBD). We aimed to estimate the risk of disease progression based on distinct clinical phenotypes in a large international cohort of patients with PSC. METHODS: We performed a retrospective outcome analysis of patients diagnosed with PSC from 1980 through 2010 at 37 centers in Europe, North America, and Australia. For each patient, we collected data on sex, clinician-reported age at and date of PSC and IBD diagnoses, phenotypes of IBD and PSC, and date and indication of IBD-related surgeries. The primary and secondary endpoints were liver transplantation or death (LTD) and hepatopancreatobiliary malignancy, respectively. Cox proportional hazards models were applied to determine the effects of individual covariates on rates of clinical events, with time-to-event analysis ascertained through Kaplan-Meier estimates. RESULTS: Of the 7121 patients in the cohort, 2616 met the primary endpoint (median time to event of 14.5 years) and 721 developed hepatopancreatobiliary malignancy. The most common malignancy was cholangiocarcinoma (n = 594); patients of advanced age at diagnosis had an increased incidence compared with younger patients (incidence rate: 1.2 per 100 patient-years for patients younger than 20 years old, 6.0 per 100 patient-years for patients 21-30 years old, 9.0 per 100 patient-years for patients 31-40 years old, 14.0 per 100 patient-years for patients 4150 years old, 15.2 per 100 patient-years for patients 51-60 years old, and 21.0 per 100 patient-years for patients older than 60 years). Of all patients with PSC studied, 65.5% were men, 89.8% had classical or large-duct disease, and 70.0% developed IBD at some point. Assessing the development of IBD as a time-dependent covariate, Crohns disease and no IBD (both vs ulcerative colitis) were associated with a lower risk of LTD (unadjusted hazard ratio [HR], 0.62; P amp;lt;.00, Funding Agencies|German Federal Ministry of Education and Research through the Integrated Research and Treatment Center Transplantation at Hannover Medical School [01EO0802]; Wellcome Trust; NIHR Birmingham Biomedical Research Centre (BRC); NIHR University College London Hospitals Biomedical Research Centre; NIH [R01 DK84960]; German Research Community [MU 2864/1-1, MU 2864/1-3]; German Research Community (DFG) [SFB 841]; YAEL-Foundation; Helmut and Hannelore Greve Foundation

Marco Massani,1 Paola Maccatrozzo,1 Giovanni Morana,2 Luca Fabris,3 Cesare Ruffolo,1 Luca Bonariol,1 Bruno Pauletti,1 Nicolò Bassi1 1IV Department of Surgery, Regional Center for HPB Surgery, 2Diagnostic and Interventional Radiology, Regional Hospital of Treviso, Treviso, 3Molecular Medicine Department, University Hospital, Padua, Italy Introduction: Accessory spleen has a worldwide prevalence of 10%–30% and is defined as intrapancreatic accessory spleen (IPAS) when it locates within the pancreas. This occasional finding can raise difficulties in differential diagnosis with hypervascular pancreatic lesions, such as pancreatic neuroendocrine tumor. Presentation of cases: We present five cases in which a mass of the pancreatic tail was found on radiologic investigations. The first case was a young female patient who underwent a distal pancreatectomy because of a mass of the pancreatic tail misdiagnosed as a pancreatic neuroendocrine tumor due to its radiologic features on computed tomography and magnetic resonance imaging (MRI) (small, ovoidal, and well defined). Misdiagnosis also occurred in the second case, in which an 82-year-old woman was referred to our hospital because of a pancreatic mass of uncertain diagnosis. She also underwent an operation, and pathologic examination showed splenic parenchyma. A correct diagnosis was achieved in the remaining three cases that are still under radiologic monitoring. Discussion: IPAS is a benign entity and therefore does not require surgical treatment. We discuss the best diagnostic options that have recently been experienced, focusing on diffusion-weighted and superparamagnetic iron oxide MRI, which in our experience seem to be the safest and most easily accessible diagnostic tools. Conclusion: We suggest that a multidisciplinary approach should guide the diagnosis. When a pancreatic mass with specific features (round, ovoid, and well defined) is detected by computed tomography or MRI, an IPAS should be s

Intrahepatic bile ducts maintain a dose anatomical relationship with hepatic arteries. During liver ontogenesis, the development of the hepatic artery appears to be modulated by unknown signals originating from the bile duct. Given the capability of cholangiocytes to produce angiogenic growth factors and influence peribiliary vascularization, we studied the immunohistochemical expression of vascular endothelial growth factor (VEGF), angiopoietin-1, angiopoietin-2, and their cognate receptors (VEGFR-1, VEGFR-2, Tie-2) in fetal human livers at different gestational ages and in mice characterized by defective biliary morphogenesis (Hnf6(-/-)). The results showed that throughout the different developmental stages, VEGF was expressed by developing bile ducts and angiopoietin-1 by hepatoblasts, whereas their cognate receptors were variably expressed by vascular cells according to the different maturational stages. Precursors of endothelial and mural cells expressed VEGFR-2 and Tie-2, respectively. In immature hepatic arteries, endothelial cells expressed VEGFR-1, whereas mural cells expressed both Tie-2 and Angiopoietin-2. In mature hepatic arteries, endothelial cells expressed Tie-2 along with VEGFR-1. In early postnatal Hnf6(-/-) mice, VEGF-expressing ductal plates failed to incorporate into the portal mesenchyma, resulting in severely altered arterial vasculogenesis. Conclusion: The reciprocal expression of angiogenic growth factors and receptors during development supports their involvement in the cross talk between liver epithelial cells and the portal vasculature. Cholangiocytes generate a VEGF gradient that is crucial during the migratory stage, when it determines arterial vasculogenesis in their vicinity, whereas angiopoietin-1 signaling from hepatoblasts contributes to the remodeling of the hepatic artery necessary to meet the demands of the developing epithelium.