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Dilated and dysfunctional gut lymphatic vessels (LVs) have been reported in experimental cirrhosis. Here, we studied LVs in duodenal (D2)-biopsies of liver cirrhosis patients and investigated the prognostic role of a LV marker, podoplanin (PDPN), in predicting the mortality of patients with cirrhosis. A prospective, single-center cohort study was performed in liver cirrhosis patients (n = 31) and matched healthy controls (n = 9). D2-biopsies were obtained during endoscopy procedure, immunostained with PDPN, and scored based on 1) intensity and 2) density of positively-stained LVs per high power field. Gut and systemic inflammation were estimated by quantifying duodenal CD3+ intraepithelial lymphocytes (IELs), CD68+ macrophages, and serum TNF-α and IL-6 levels, respectively. Gut permeability and inflammation as assessed by quantifying gene expression of TJP1, OCLN, TNF-α, and IL-6 in D2-biopsies. Gene expression of LV markers, PDPN (8-fold), and LYVE1 (3-fold) was enhanced in D2-biopsies of cirrhosis patients compared to control (p < 0.0001). The mean PDPN score in decompensated cirrhosis patients (6.91 ± 1.26, p < 0.0001) was significantly increased as compared to those with compensated (3.25 ± 1.60). PDPN score positively and significantly correlated with the number of IELs (r = 0.33), serum TNF-α (r = 0.35), and IL-6 (r = 0.48) levels, while inversely correlated with TJP1 expression (r = -0.46, p < 0.05 each). In Cox regression, the PDPN score was a significant and independent 3-month-mortality predictor in patients (HR: 5.61; 1.08-29.109; p = 0.04). The area under the curve for the PDPN score was 84.2, and cutoff value for predicting mortality was ≥6.5 with 100% sensitivity and 75% specificity. Collectively, dilated LVs with high PDPN expression in D2-biopsies is a characteristic feature of patients with decompensated cirrhosis. PDPN score correlates with enhanced gut and systemic inflammation and also associates with 3-month mortality in cirrhosis.

Background: Gastrointestinal bleeding is one of the emergencies that all therapeutic measures should be performed effectively and efficiently in a short time. This study aims to determine the effectiveness of an educational program on the improvement of nurses' knowledge, performance, and response time in the care of patients with upper gastrointestinal bleeding in the Emergency Department. Methods: This quasi-experimental study employed a single group pre-test and post-test design and was conducted at the Emergency Room of the Institute of Liver and Biliary Sciences (ILBS), New Delhi, India. A total of 20 nurses working in the Emergency Room were recruited through enumeration. Also, 35 events before and 35 events after the intervention were observed. The educational program was implemented through face-to-face lecture-cum discussion in six 30-minute sessions and groups of 3 to 4 nurses over three days. A researcher-made questionnaire was used to measure nurses’ knowledge regarding upper gastrointestinal bleeding, and their performance and response time were observed and calculated through a checklist. The data were described and analyzed using descriptive statistics, the paired t-test, the Kruskal-Wallis H test, and the Mann-Whitney U test in SPSS software, version 20. The significance level was set at P≤0.05. Results: A noticeable improvement in the scores of knowledge and performance and a significant decrease in the nurses’ response time were observed (P