.
BACKGROUND Frailty has been associated with mortality among patients referred for liver transplantation (LT), yet the impact on other clinical outcomes is less well defined.AIM To investigate the effect of physical frailty, measured by the liver frailty index (LFI), on the likelihood of LT, pre- and early post-LT outcomes, in an Australian cohort. METHODS Data were collected on adults with cirrhosis referred for LT and had their baseline LFI assessment. Outcomes of interest included: Receiving a LT, pre-LT unplanned hospitalizations, LT surgical complications, intensive care unit (ICU) and hospital length of stay. Cox proportional hazards modelling determined associations between LFI and outcomes, adjusting for age, sex, hepatocellular carcinoma, and model for end-stage liver disease score. Competing risk analysis explored reasons for not being transplanted including waitlist mortality [sub-hazards ratio (HR)]. RESULTS Among 266 patients [median model for end-stage liver disease 16 (interquartile range 11-19)], the median LFI was 3.7 (3.3-4.1); 19% were robust, 68% pre-frail, and 14% frail. After adjustment, each 1-point increase in the LFI was associated with a 29% lower likelihood of receiving a LT [HR = 0.71, 95% confidence interval (CI): 0.54-0.94, P = 0.020]. Competing-risk analysis showed higher LFI increased waitlist mortality (sub-HR = 1.90, 95%CI: 1.33-2.70). Each 1-point rise also conferred a 69% higher risk of unplanned pre-LT hospitalization (HR = 1.69, 95%CI: 1.09-2.62, P = 0.020). Among transplanted patients, higher LFI predicted prolonged ICU stay (> 4 days; odds ratio = 3.24, 95%CI: 1.06-9.85). Frailty was not associated with surgical complications or hospital length of stay. CONCLUSION Physical frailty independently predicts reduced LT likelihood, higher waitlist mortality, greater pre-LT unplanned hospitalizations, and prolonged ICU stay. This study provides the first Australian validation, extending LFI evidence beyond United States cohorts.
Interdigitating dendritic cell sarcoma (IDCS) is a rare malignancy with a poor prognosis, and currently, there lacks a standardized treatment protocol. IDCS can be challenging diagnostically given its immunophenotypic overlap with other malignancies such as melanoma. We describe a 52-year-old woman presenting with a left cervical mass. Following workup and MDT discussion, she underwent a unilateral modified radical neck dissection and superficial parotidectomy. On histopathological examination, despite some morphological and immunohistochemical overlap with melanoma, IDCS was confidently diagnosed. There have been few cases of IDCS in the head and neck published since the most recent pooled analysis. This case adds to the current literature, highlights unique diagnostic findings, and explores its overlap with melanoma. More data are required regarding treatment outcomes and follow-up for cases of IDCS. Increased reporting such as this case will facilitate future analyses to guide management of this rare malignancy.
Novoglan is a device that provides a non-surgical treatment of phimosis. It consists of a balloon placed under the foreskin, which the patient inflates in a controlled manner to stretch the foreskin and promote the generation of new skin cells. The balloon inflation had been originally controlled by an air plunger, which was later replaced by a bulb and a stop cock, while the balloon was changed from latex to medical-grade silicone. We conducted a post-marketing survey to assess patient-reported efficacy, usability, tolerability and safety of the Novoglan treatment and compare two generations of the device. Specifically designed questionnaires were emailed to 9700 Novoglan customers. Complete responses from 811 customers were de-identified and included in the analysis. The use of Novoglan with a bulb and a stop cock instead of an air plunger and a change of the balloon material produced an improvement in patient-reported efficacy from 85.0% to 93.5%. Usability has also improved, with the number of patients reporting difficulty in Novoglan use dropping from 13.8% to 6.7%. Similarly, the number of patients willing to recommend Novoglan treatment to other men increased from 92.2% to 98.1%. Neither group reported side effects that required cessation of the treatment or medical intervention, and 96.3% of all patients were able to tolerate the treatment. Of note, 97.7% reported that phimosis negatively impacts their mental well-being, and 88.8% reported that Novoglan had improved their mental health. The Novoglan post-marketing study revealed improvement in patient-reported efficacy, usability, tolerability and overall satisfaction with the introduction of the bulb and stop cock into the Novoglan device. It demonstrated the exceptional safety of the Novoglan treatment with no significant side effects reported and an improvement in the mental well-being of almost 90% of patients. These findings highlight the role of Novoglan treatment as an effective and safe non-surgical management of phimosis.
INTRODUCTION:Artificial intelligence (AI) and digital pathology have the potential to augment liver biopsy interpretation in MAFLD in clinical practice and trials assessment. However, attitudes and barriers to its implementation have not been systematically explored. METHODS:A survey focusing on conventional liver histology, digital pathology and its AI applications in MAFLD/MASH was conducted among hepatologists and liver pathologists in the Asia Pacific region. RESULTS:AI-assisted digital pathology is perceived to be a valuable addition to existing histological reporting in MAFLD/MASH. Defined standards for application and validation of AI models are important priorities for their implementation. CONCLUSION:There is consensus among clinical experts in the Asia Pacific that AI-assisted histological assessment is useful in MAFLD/MASH interpretation. However, there remain important challenges to the adoption of these technologies into routine clinical workflows.
This international, multidisciplinary consensus report represents the first effort to systematically define and characterize fatty pancreas. A key outcome of this endeavor was the recommendation to adopt "fatty pancreas" as the standardized and inclusive term to describe all forms of fat accumulation in the pancreas. This terminological consensus provides a critical foundation for unified reporting and clinical communication. Another major contribution of the report is the consensus on diagnostic imaging findings, which was based on radiological and endoscopic modalities. The proposed criteria aim to enhance consistency in clinical assessment and support the development of standardized research protocols. In addition to establishing terminology and diagnostic frameworks, the report also synthesizes current knowledge across a wide range of relevant domains. These include the etiology and epidemiology of fatty pancreas, as well as its associations with alcohol consumption, smoking, acute and chronic pancreatitis, pancreatic exocrine insufficiency, type 2 diabetes mellitus, and surgical outcomes. The potential links between fatty pancreas and neoplastic conditions such as intraductal papillary mucinous neoplasms and pancreatic cancer are also addressed, alongside the current understanding of its metabolic implications (beta-cell function and glucose homeostasis) and treatment strategies. Throughout the consensus process, a consistent theme emerged: the limited availability of high-quality, prospective clinical data. Therefore, many of the recommendations in this report are based on expert consensus rather than strong empirical evidence. As such, the statements require rigorous prospective validation before they can be adopted into routine clinical practice. This underscores a critical need for further research, particularly studies aimed at clarifying causal relationships, validating diagnostic tools, and determining the clinical relevance of fatty pancreas across diverse patient populations. This report serves as both a summary of our current understanding and a roadmap for future investigations, aiming to close existing knowledge gaps and guide evidence-based clinical practice in this emerging field.
