ACG Clinical Guideline: Perioperative Risk Assessment and Management in Patients With Cirrhosis.

This guideline presents a comprehensive approach to perioperative risk assessment and management in patients with cirrhosis. Recognizing the unique surgical risks in this population, the guideline emphasizes a multidisciplinary approach to preoperative evaluation, perioperative care, and postoperative follow-up. Key considerations include the severity of liver disease, nonhepatic comorbidities, and surgery-specific factors, with an emphasis on the use of validated cirrhosis-specific risk calculators, such as the VOCAL-Penn Score, for individualized risk stratification.

The Effect of Bariatric Surgery on Hypertension Outcomes: A Retrospective Cohort Study.

Metabolic and bariatric surgery (MBS) is an effective treatment for obesity and metabolic syndrome. Evidence regarding the impact of MBS on hypertension outcomes is limited by short-term follow-up. Thus, this retrospective cohort study was designed to compare blood pressure (BP) control, number of antihypertensive medications (AHMs), development of apparent treatment resistant hypertension (ATRH), and remission of hypertension between patients treated with and without MBS.

Long-Term Effectiveness and Safety of Tofacitinib in a Nationwide Veterans Affairs Cohort of Ulcerative Colitis Patients.

Background: There is limited real-world data on the long-term effectiveness and safety of tofacitinib among ulcerative colitis (UC) patients, especially among the elderly. Our aim was to evaluate these parameters among UC patients who had remained on the drug 1 year after initiation of therapy.

Methods: We conducted a retrospective cohort study, utilizing the US National Veterans Affairs Healthcare System, including patients with UC who received tofacitinib.

Intensified conditioning with high-dose total marrow irradiation and myeloablative chemotherapy reduces risk of relapse without increasing toxicity in allogeneic hematopoietic stem cell transplant for high-risk myeloid malignancies: a phase II study.

The intensity of the conditioning regimen in hematopoietic stem cell transplantation (HSCT) correlates with the risk of relapse, however its potential benefit may be outweighed by the associated risk of toxicity. The addition of total marrow irradiation (TMI) to myeloablative conditioning provides an opportunity to increase intensity with minimal additional toxicity. In this phase 2 clinical trial, 30 patients with high-risk myeloid malignancies received an allogeneic HSCT using myeloablative TMI at 9Gy in combination with standard myeloablative fludarabine/intravenous busulfan (FluBu4) chemotherapy.

Pre-Operative Assessment of Patients with Cirrhosis for Extrahepatic Surgery.

Purpose Of Review: Patients with cirrhosis are at increased risk of peri-operative morbidity and mortality compared to those without cirrhosis, requiring careful pre-operative assessment of their liver disease, extra-hepatic comorbidities, and surgery-specific risk factors.

Recent Findings: Adverse surgical outcomes in this population are often related to complications of advanced liver disease, including portal hypertension, impaired hemostasis, malnutrition/sarcopenia, and infection. Risk prediction tools, including the Child-Turcotte-Pugh score, Model for End-Stage Liver Disease score, Mayo Risk Score, and VOCAL-Penn Score, can be used to estimate post-operative mortality and support clinical decision-making when assessing surgical candidacy.

Safety of subconjunctival injection of mesenchymal stromal cells in persistent corneal epithelial disease - A phase 1b clinical trial.

Purpose: To investigate the safety and tolerability of subconjunctival injection of three escalating doses of allogeneic bone marrow-derived mesenchymal stromal cells (MSCs) in patients with persistent corneal epithelial defect/disease (PCED).

Design: Prospective single-center open label phase 1b clinical trial.

Participants: Patients with PCED in the setting of neurotrophic keratitis and/or limbal stem cell deficiency.

Shaping the future of cell and gene therapy workforce development: training of cell therapy processing personnel - perspectives from the International Society for Cell & Gene Therapy Lab Practices Committee.

Background: The field of cell and gene therapy (CGT) is expanding at a rapid rate. CGT workforce shortage is a growing concern, and high-quality training programs are essential to keep up with the increasing demand for qualified CGT technologists.

Methods: A working group within the International Society for Cell & Gene Therapy (ISCT) Laboratory Practices Committee developed an ISCT Lab Practices Committee Survey on Cell and Gene Therapy Technologist Training to gather information on CGT laboratory technologist training practices.

A Greener and More Scalable Synthesis of Biogenic Polydisulfides from Lipoic Acid.

Ring-opening polymerization (ROP) of 1,2-dithiolanes form polydisulfides, an emergent class of dynamic covalent polymers. However, both monomer and polymer syntheses typically require anaerobic and moisture-free conditions, often employing hazardous reagents and solvents that limit scalability. Herein, efficient, scalable syntheses for poly(ethyl lipoate) and ethyl lipoate that incorporate Green Chemistry principles are disclosed.

Carbohydrate consumption drives adaptive mutations in associated with increased risk for systemic infection.

Dissemination of organisms from the gut microbiota is a major contributor to sepsis and critical illness. Patients with cirrhosis are prone to systemic infections and are commonly prescribed the carbohydrate lactulose to manage hepatic encephalopathy (HE) . Commensal metabolism of lactulose is believed to reduce pathobiont colonization through short-chain fatty acid production, but its direct effects on gut pathobionts remain unexplored .

Functionalized Cyclic Poly(α-Hydroxy Acids) via Controlled Ring-Opening Polymerization of O-Carboxyanhydrides.

Linear poly(α-hydroxy acids) are important degradable polymers, and they can be efficiently prepared by ring-opening polymerization of O-carboxyanhydrides with pendant functional groups. However, attempts to prepare cyclic poly(α-hydroxy acids) have been plagued by side reactions, including epimerization and uncontrolled intramolecular chain transfers or termination, that prevent the synthesis of high-molecular-weight stereoregular cyclic polyesters. Herein, we report a scalable method for the synthesis of high-molecular-weight (>100 kDa) stereoregular functionalized cyclic poly(α-hydroxy acids) by means of controlled polymerization of O-carboxyanhydrides using a catalytic system consisting of a lanthanum complex with a sterically bulky ligand and a manganese silylamide.

Survival and Cost-Effectiveness of Bariatric Surgery Among Patients With Obesity and Cirrhosis.

Importance: Obesity and steatotic liver disease are associated with excess morbidity and mortality from cardiovascular, pulmonary, metabolic, and hepatic causes. Bariatric surgery has demonstrated long-term benefits in terms of weight loss and mortality rates, but barriers to its utilization persist.

Objective: To evaluate the impact of bariatric surgery on outcomes and cost-effectiveness among patients with obesity, focusing on those with cirrhosis.

A systematic review of noninvasive laboratory indices and elastography to predict hepatic decompensation.

Background: Hepatic decompensation carries profound implications for patient quality of life and risk of mortality. We lack comparative data on how noninvasive tools perform in risk stratification for those with compensated cirrhosis. We performed a systematic review to assess the performance of laboratory and transient elastography-based models for predicting hepatic decompensation in patients with compensated cirrhosis.

Acute-on-chronic liver failure (ACLF): the 'Kyoto Consensus'-steps from Asia.

Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the "APASL ACLF Research Consortium (AARC)" was formed in 2012.

Identifying Metabolic Dysfunction-Associated Steatotic Liver Disease Using Natural Language Processing in a US National Cohort.

Introduction: Although metabolic dysfunction-associated steatotic liver disease (MASLD) and MASLD with increased alcohol intake (MetALD) are identified as clinical entities; tools to identify patients from electronic health records (EHRs) to perform large outcome studies are lacking.

Methods: In this retrospective study of participants from the Veterans Analysis of Liver Disease cohort assembled from 1/1/2013 to 12/31/2022, a rule-based natural language processing (NLP) algorithm searched EHRs for imaging evidence of hepatic steatosis. This was combined with identification of cardiometabolic risk factors and harmful alcohol use.

Clinical outcomes and care for spontaneous bacterial peritonitis: A national cohort study.

Background And Aims: Spontaneous bacterial peritonitis (SBP) leads to high rates of acute kidney injury (AKI), hepatorenal syndrome, and mortality. Population-based studies on contemporary SBP epidemiology are needed to inform care. In a large, national cohort of patients diagnosed with SBP and confirmed by ascitic fluid criteria, we characterized ascitic fluid characteristics, in-hospital and 12-month mortality, AKI, and recurrent SBP.

High Cirrhosis Surgical Volume Centers Have Reduced Postoperative Mortality in Patients With Cirrhosis Undergoing Major Surgery.

Patients with cirrhosis have increased surgical risk and require care team expertise. We explored the association between center cirrhosis surgical volume and postoperative mortality in a large VA data set. In this retrospective cohort study of 14,500 major surgeries in patients with cirrhosis, we found in adjusted analysis that high-volume centers (>16 surgeries in past year) had a 36% reduced hazard of postoperative mortality through 90 days vs low-volume centers (<9 surgeries in past year; hazard ratio 0.

Endoscopy and anesthesia outcomes associated with glucagon-like peptide-1 receptor agonist use in patients undergoing outpatient upper endoscopy.

Background And Aims: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) can cause delayed gastric emptying, raising concern for retained gastric contents (RGC) during endoscopy and adverse anesthesia events. The aim of this study was to determine associations between GLP-1RA and endoscopy and anesthesia outcomes.

Methods: This single-center, retrospective cohort study examined patients prescribed GLP-1RAs who underwent outpatient endoscopy stratified according to exposure at the time of endoscopy.

Mortality, Hepatic Decompensation, and Cardiovascular Outcomes in Lean vs. Non-lean MASLD Cirrhosis: A Veterans Affairs Cohort Study.

Background And Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) has a global prevalence of 25%. Studies on incident liver and cardiovascular outcomes in lean (Body mass index: BMI < 25 kg/m, or < 23 kg/m for Asians) vs. non-lean individuals with MASLD have reported mixed results.

Representation of Women Among Cardiology Grand Rounds Speakers in the United States.

Importance: Women are underrepresented in leadership positions in cardiology. Institutional grand rounds (GR) are platforms through which faculty can gain professional exposure and access to career development opportunities. The gender diversity of invited cardiology GR speakers has not been investigated.

Validation and Epidemiologic Definition of the Novel Steatotic Liver Disease Nomenclature in a National United States Cohort With Cirrhosis.

Background & Aims: Novel steatotic liver disease (SLD) definitions were introduced in 2023. Accurate and meaningful classifications using clinical data are needed to study interventions and outcomes.

Methods: In a national cohort of Veterans with cirrhosis and imaging-confirmed steatosis, 7 algorithms differentially emphasizing cardiometabolic risk factors (CMRFs) and alcohol exposure were developed to define alcohol-associated liver disease (ALD), metabolic dysfunction associated SLD (MASLD), and MASLD with increased alcohol intake (MetALD).

Real-world impact of the platinum chemotherapy shortage on US patients with advanced cancer.

The recent cisplatin and carboplatin ("platinum") chemotherapy shortage, first announced on February 10, 2023, has impacted cancer patients nationwide. Here, we quantify the extent to which the shortage affected platinum chemotherapy prescribing and short-term mortality. This cohort study included 11 797 adults with advanced solid cancers who initiated first-line therapy during the 1-year period before (February 1, 2022-February 9, 2023) or during (February 10, 2023-January 31, 2024) the platinum shortage.