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The potential benefits of adopting Metabolic dysfunction-associated steatotic liver disease (MASLD) rather than Metabolic dysfunction-associated fatty liver disease (MAFLD) diagnostic criteria in defining the disease progression risk of steatotic (SLD) patients have never been prospectively evaluated. To compare MASLD and MAFLD criteria in estimating the 5-year risk of advanced chronic liver disease (ACLD) progression and hepatocellular carcinoma (HCC) occurrence in lean (L) and not-lean (NL) SLD patients. Between January 2014 and June 2019, 931 ultrasonographic-defined-SLD patients were recruited, excluding individuals with ACLD, alcoholism, and other causes of steatosis. Baseline biochemical and clinical data were collected, including Liver Stiffness (LSM) (>9.7 kPa= advanced fibrosis-AF; >15 kPa=ACLD) and Controlled-Attenuation-Parameter (CAP) (>293-db/m=Severe-steatosis-S3). Patients were observed annually or semiannually (AF) over 5 years, reassessing LSM, CAP, and HCC occurrence. In July 2024, based on baseline features, patients were a posteriori subdivided into "L" (Body-Mass-Index<25 kg/m2) (n.134) and "NL" (n.797) and, subsequently, by separately applying MAFLD and MASLD criteria, in L-MASLD (n.18), L-MASLD/MAFLD (n.82), L-MAFLD (n.34) and NL-MASLD (n.60), NL-MASLD/MAFLD (n.581), NL-MAFLD (n.156). At baseline, no differences in S3 (L, p :0.163; NL, p :0.103) and AF (L, p :0.718; NL, p :0.277) prevalences emerged. A higher 5-year ACLD progression (RR: 1.83, C.I.95%:1.357-2.431, p :0.0002) and HCC occurrence (RR:1.32, C.I.95%:1.032-1.451, p :0.03) risk was reported in NL-MASLD. Contrariwise, L-MAFLD presented a higher risk of ACLD progression (RR:2.11, C.I.95%: 1.171-2.250, p :0.01) and, even not significant, HCC occurrence (RR:1.588, C.I.95%:0.747-2.781, p :0.371). ACLD progression occurred in 33.34% L-MASLD vs 70.59% L-MAFLD (median: 43 vs 45.50 months; p: 0.0091).Logistic regression (adjusted for sex, age, diabetes, steatosis, and fibrosis severity) revealed high-sensitivity-C-reactive protein (aOR: 1.21; C.I. 95%: 1.052-2.183; p :0.02) and Homeostatic-model-assessment-for-insulin-resistance(aOR: 1.38; C.I. 95%: 1.151-2.275; p :0.01) as variables significantly associated with ACLD-progression in L-MAFLD. MASLD criteria better estimate the liver disease progression risk limitedly to SLD-NL patients. [ABSTRACT FROM AUTHOR]

Lifestyle modifications represent the main therapeutic intervention for Metabolic dysfunction-associated Steatotic Liver disease (MASLD). Unfortunately, the dietary-behavioral prescription is constantly limited by poor compliance. In this context, the benefits of motivational support remain unexplored. To evaluate the effectiveness of a multidisciplinary (hepatologist-nutritionist-psychologist) management in improving clinical outcomes in MASLD, via ameliorating adherence to specialistic tailored-indications. MASLD patients (n.286) were consecutively enrolled and randomized in three cohorts: 72 followed generic hepatologist-provided dietary advice ("H"), 71 also received a nutritionists-prescribed individualized intervention ("HN") (H+N= "standard of care"), and 143 were treated with an approach additionally involving cognitive/behavioral-based psychological support ("HNP") ("experimental-group"). At baseline, anthropometric, biochemical, clinical, liver stiffness (LSM), controlled attenuation parameter (CAP), lifestyle habits, and body composition values were recorded. Along 18 months, semestral hepatological (for all), nutritional (H and HN), and psychological (HNP) follow-ups reassessed parameters and evaluated compliance. After 18 months, the prevalence of patients achieving a ≥ 10% decrease in body weight was significantly higher in HNP (HNP:62.09%; HN:44.9%; H:35.8%; HNP vs HN, p :0.01; HNP vs H, p :0.0002). In HNP, a significant improvement in Homeostatic-model-assessment-for-insulin-resistance (p :0.001), HDL (p <0.0001), LSM (p :0.007), CAP (p :0.002), and Fat-Mass (p < 0.0001) was observed. Loss of compliance rate was significantly lower in HNP (HNP:12.08%; HN:34.7%; H:45.8%; HNP vs HN, HNP vs H, p :0.001). Relevantly, HNP patients presented a significantly lower risk of acute cardiovascular events (ACEs) during the observation period [HR: 0.497, IC (0.236-0.751) 95%, p :0.04)] (Figure). Logistic regression analysis (adjusted for sex, age, and cardiovascular risk factors) revealed HNP adherence as significantly associated with lower ACEs occurrence (aOR: 0.81; C.I. 95%: 0.55-0.97; p:0.02). Dynamic work, city life, and large family emerged as social factors influencing compliance (OR: 2.11, 1.78, 1.12) (all p <0.05). Integrating standard hepatological-nutritional with psychological support significantly improves the outcomes of MASLD patients. [ABSTRACT FROM AUTHOR]

The platelet (PLT) count is paramount in almost all the available non-invasive tools (NITs) predicting the first hepatic decompensation (FHD) in advanced chronic liver disease (ACLD). However, a non-negligible proportion of Metabolic dysfunction-associated Steatotic Liver Disease (MASLD)-related ACLD individuals presenting clinically significant portal hypertension (CSPH) do not show splenomegaly and hypersplenism-related thrombocytopenia. To evaluate the performance of NITs in predicting the 3-year FHD in CSPH-MASLD-cACLD, stratifying the study population according to the splenomegaly. Between 2018 and 2021, 148 splenic and 27 asplenic (25-splenectomized; 2-agenesis) nonselective-beta-blockers-(NSBB)-naïve MASLD-cACLD patients with endoscopic CSPH were enrolled. Patients subsequently received NSBBs and the response was surrogately evaluated following the available guidelines. Ultrasound AI-supported dedicated tools automatically defined spleen diameter and spleen area (SA), discriminating "Splenomegaly +" (91) and "Splenomegaly -" (57) patients. Patients were semiannually observed and the liver-related events were recorded. Albumin-bilirubin (ALBI) score and PLT count-incorporating NITs (PINs) [FIB-4, ALBI-FIB-4, red-cell-distribution-width/PLT-ratio, Liver-Stiffness-Measurement/PLT-ratio, and ANTICIPATE±NASH] were determined at baseline and during the follow-up. FHD occurred in 18.68% of "Splenomegaly+", 19.29% of "Splenomegaly-", and 22.22% of "Asplenic" individuals. The multivariate competing risk analysis (adjusted for sex, age, BMI, diabetes, MELD, and NSBB-response) revealed the PINs as modest predictors of FHD, highlighting SA as the variable more significantly associated with this outcome [aSHR: 0.870 (95% C.I.: 0.833-1.108), p <0.0001] in "Splenomegaly -", and ALBI [aSHR:1.273 (95% C.I.:1.199-1.305, p :0.002] as the only significantly predicting factors in the "Asplenic" group. Consistently, contrariwise to "Splenomegaly +", in "Splenomegaly -" and "Asplenic" individuals, ROC and time-dependent ROC analysis evidenced the poor performance of PINs in predicting HD at baseline, 1,1.5, and 2 years, evidencing only ALBI preserved a good accuracy (baseline AUC 0.651, p :0.04 and baseline AUC:0.625, p :0.03 respectively) (Figure). The spleen area dramatically affects the predictive performance of the PINs in CSPH-MASLD-cACLD patients. [ABSTRACT FROM AUTHOR]

Progressive disease (PD) occurred in 67 cases in the Ven-Obi arm with 39 second-line treatments, and in 141 cases in the Clb-Obi arm (with 103 second-line treatments). B Background: b One-year fixed-duration venetoclax-obinutuzumab (Ven-Obi) is a standard-of-care for patients (pts) with previously untreated chronic lymphocytic leukemia (CLL). Overall, 48 deaths were reported in the Ven-Obi arm (9 PD related) and 70 in the Clb-Obi arm (26 PD related); 6-year-OS rate was 78.7% in the Ven-Obi and 69.2% in the Clb-Obi arm (HR 0.69 [0.48-1.01], I p i = 0.052). [Extracted from the article]

Human gut microbiome is related to different clinical conditions and diseases. Recently several hypotheses have been theorized about a link between gut microbiota and genitourinary disease including urinary tract infections, and benign prostatic hyperplasia. Despite several data, underlying mechanisms still remain unclear. The aim of this review is to report the current state of knowledge in relation to urinary tract infections, benign prostatic hyperplasia and intestinal microbiota with a focus on its role in the development of disease and the underlying pathophysiologic mechanisms. [ABSTRACT FROM AUTHOR]

After 6 months from discharge, 10/89 (11.24%) patients showed dermatological symptoms: 5/89 (5.61%) showed persistence of telogen effluvium, 1 of which was associated with pruritus, 1/89 (1.12%) presented guttate psoriasis, 1/89 (1.12%) presented purpuric capillaritis resolved in 15 days, 1/89 (1.12%) presented intertrigo. After 6 months from discharge, 6/30 (20.00%) patients showed dermatological symptoms: 5/30 (16.60%) showed persistence of telogen effluvium, 1 of which was associated with pruritus, 1/30 (3.33%) presented guttate psoriasis. Analysis of dermatological symptoms 1 month after hospital discharge (T1) showed that 4/30 (13.33%) patients had presented the following symptoms: 4/30 (13.33%) had telogen effluvium and 1/30 (3.33%) also had skin xerosis. [Extracted from the article]