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Background: Magnetic resonance cholangiopancreatography (MRCP) is the gold standard for diagnosis of patients with primary sclerosing cholangitis (PSC). The semi-quantitative MRCP-derived Anali scores proposed for risk stratification, have poor-to-moderate inter-reader agreement. Aims: To evaluate the prognostic performance of quantitative MRCP metrics in PSC. Methods: This is a retrospective study of PSC patients undergoing MRCP. Images were processed using MRCP+ software (Perspectum Ltd, Oxford) that provides quantitative biliary features, semi-automatically extracted by artificial intelligence-driven analysis of MRCP-3D images. The prognostic value of biliary features has been assessed for all hepato-biliary complications. Results: 87 PSC patients have been included in the analysis. Median follow-up from MRCP to event/censoring of 30.9 months (Q1-Q3=13.6–46.6). An adverse outcome occurred in 27 (31.0%) patients. The number of biliary strictures (HR=1.05 per unit, 95%CI 1.02–1.08, p < 0.0001), spleen length (HR=1.16 per cm, 95%CI 1.01–1.34, p = 0.039), adjusted for height, age at MRCP, and time from diagnosis to MRCP predicted higher risk of hepatobiliary complications. These were incorporated into a the quantitative MRCP-derived PSC (qMRCP-PSC) score (C-statistic=0.80). After 3-fold cross-validation, qMRCP-PSC outperformed the Anali score in our cohort (C-statistic of 0.78 vs 0.64) and enabled the discrimination of survival of PSC patients (log-rank p < 0.0001). Conclusions: The qMRCP-PSC score identified patients at higher risk of hepatobiliary complications and outperformed the available radiological scores. It represents a novel quantitative biomarker for disease monitoring and a potential surrogate endpoint for clinical trials.

La pandemia del coronavirus 2019 (COVID-19) e le necessarie misure di controllo di diffusione, attuate dai governi, hanno indotto cambiamenti drastici nella vita quotidiana. La riduzione della mobilità e le severe limitazioni dei contatti sociali pongono una grande sfida, in particolare per gli adolescenti. Lo scopo di questo studio è di analizzare l’impatto psicologico del lockdown e l’eventuale correlazione con la resilienza, sugli adolescenti e sui giovani adulti in attesa di trapianto di fegato o nei riceventi. Sono state raccolte le variabili socio-demografiche dei partecipanti (n=66) come sesso, età, scolarità. Inoltre sono stati somministrati due questionari self-report: Depression Anxiety and Stress Scales (DASS-21) e la Connor-Davidson Resilience Scale (CD-RISC 25). Questi strumenti indagando le seguenti aree: stati emotivi di depressione, ansia e stress e fattori di resilienza. La correlazione tra depressione/ansia e resilienza è stata valutata mediante l’Indice di correlazione di Pearson e i modelli di regressione lineare. I risultati hanno mostrato una correlazione significativa tra le sottoscale: DASS depressione/ansia (r2=0,62) depressione/stress (r2=0,65) CD-RISC impegno/ottimismo (r2=0,71). Il punteggio totale delle scale DAAS depressione/ansia/stress è diminuito significativamente all’aumentare del punteggio totale CD-RISC. La correlazione inversa tra CD-RISC e DAAS sembra riferirsi alla scala secondaria della relazione tra DAAS depressione e CD-RISC (β= –0,33, P=0,006). I risultati del nostro studio suggeriscono che la resilienza può rappresentare un fattore protettivo per gli adolescenti sottoposti a trapianto di fegato e per i candidati a trapianto di fegato nel mitigare l’insorgenza di sintomi psicologici negativi correlati con la pandemia. The coronavirus disease 2019 (COVID-19) pandemic and the necessary spreading control measures implemented by the governments have induced drastic changes in daily life. The reduction in mobility and strict social contact limitations are posing a great challenge, particularly for the adolescents. The purpose of this study is to investigate the psychological and emotional impact of lockdown and their relationship with resilience, on adolescents and young adults listed for liver transplant or liver trans-plant recipient. Social and demographic variables of subjects (n=66) were collected and the analyses were based on the Depression Anxiety and Stress Scales (DASS-21), and Connor-Davidson Resilience Scale (CD-RISC 25), exploring the following areas: emotional states of depression, anxiety and stress; and resilience factors. A correlation between the measured degrees of depression/anxiety and resilience was evaluated by Pearson’s correlation coefficient and linear regression models. The results showed a significant correlation between subscales: DASS depression/anxiety (r2=0.62) depression/stress (r2=0.65) CD-RISC commitment/optimism (r2=0.71). The total score of DAAS depression/anxiety/stress scales significantly diminished at the increasing of CD-RISC total score. The inverse correlation between CD-RISC and DAAS seems to refer to the subscale of the relationship between DAAS depression and CD-RISC (β= –0.33, P=0.006). Our findings suggest that resilience can be a protective factor for adolescent liver transplant recipients and liver transplant candidates in mitigating the onset of negative psychological symptoms correlated with the pandemic.

BACKGROUND: Sars-Cov-2 pneumonia is a pandemic disease with high morbidity and mortality. In literature transaminases, CRP and LDH were frequently found abnormal but their role has not been clarified. OBJECTIVES: Aim of this retrospective study is to explore the role of transaminases, CRP and LDH on short-term prognosis of hospitalized COVID-19 patients. METHODS: patients admitted in hospital for COVID-19 were consecutively recruited. Primary endpoint: evaluate role of transaminases, CRP and LDH on disease progression (DP). Secondary endpoints: find possible risk factors for (1) mortality and (2) CPAP ventilation at day 7. We also analyzed patients without respiratory failure at admission, also a subgroup of patients with liver disease. RESULTS: 342 patients were included. Median age of patients was 64 years (IQR 55-74), and 35.1% (n=120) was female. At multivariate analysis moderate ALT elevation at Day 1 (p=0.001, OR 2,42, CI95% 1.23-4,73) and CRP at Day 7 (p=0.001, OR 1, CI95% 1-1,1) were predictors of DP; LDH at admission (p=0.05, OR 1, CI95% 1.23-1,1) and moderate AST elevation at day 7 (p=0.04, OR 4,5, CI95% 1.05-19,4) were predictors of CPAP at day 7. At multivariate analysis age (p

The liver plays a crucial role in coagulation cascade. Global hemostatic process is profoundly influenced by the presence of liver disease and its complications. Patients with cirrhosis have impaired synthesis of most of the factors involved in coagulation and fibrinolysis process due to a reduced liver function and altered platelet count secondary to portal hypertension. Altered routine tests and thrombocytopenia were considered in the past as associated with increased risk of bleeding. These concepts explain both the routine use of plasma and/or platelets transfusion in patients with liver cirrhosis, especially before invasive procedures, and why these patients were considered "auto-anticoagulated". New recent evidences show that patients with liver cirrhosis have a more complex hemostatic alteration. Despite the presence of altered levels of factors involved in primary hemostasis, coagulation and fibrinolysis, patients with stable cirrhosis have a rebalanced hemostatic, which however can easily be altered by decompensation or infection, both in hemorrhagic or thrombotic direction. Patients with cirrhosis have an increased risk of venous thrombotic events (namely portal vein thrombosis) while bleeding seems to be related to the grade of portal hypertension rather than to a hemostatic imbalance. The use of anticoagulants both as treatment or prophylaxis is safe, reduces the rate of portal vein thrombosis and decompensation, and improves survival. Standard laboratory coagulation tests are unable to predict bleeding and are inadequate for the assessment of hemostatic status in these patients, hence more comprehensive tests are required to guide the management of thrombotic and bleeding complications.

We formulate a fully discrete finite difference numerical method to approximate the incompressible Euler equations and prove that the sequence generated by the scheme converges to an admissible measure valued solution. The scheme combines an energy conservative flux with a velocity-projection temporal splitting in order to efficiently decouple the advection from the pressure gradient. With the use of robust Monte Carlo approximations, statistical quantities of the approximate solution can be computed. We present numerical results that agree with the theoretical findings obtained for the scheme.