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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]

Purpose : Non-selective beta blockers remain the pharmacotherapy of choice for prevention of the first episode of variceal bleeding (primary prevention) and for prevention of its recurrence after initial hemostasis (secondary prophylaxis). This review will update the current and emerging pharmacological therapies for portal hypertension. Recent Findings: Data have emerged on carvedilol in preventing hepatic decompensation and improving patient survival among patients with clinically significant portal hypertension. Because measurement of WHVP is invasive and not feasible in routine practice, non-invasive tests with liver stiffness measurement in combination with platelet count may be accurate in identifying clinically significant portal hypertension. Summary: Carvedilol is more effective in reducing portal pressure compared to nadolol or propranolol. Its use has expanded to reduce risk of hepatic decompensation among patients with CSPH, which can be identified non-invasively using liver stiffness and platelet count. Studies are needed on non-invasive biomarkers to guide and optimize pharmacological treatment of portal hypertension. [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]

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]