Chronological Course and Clinical Features after Denver Peritoneovenous Shunt Placement in Decompensated Liver Cirrhosis.

BACKGROUND: Refractory ascites affects the prognosis and quality of life in patients with liver cirrhosis. Peritoneovenous shunt (PVS) is a treatment procedure of palliative interventional radiology for refractory ascites. Although it is reportedly associated with serious complications (e.g., heart failure, thrombotic disease), the clinical course of PVS has not been thoroughly evaluated. OBJECTIVES: To evaluate the relationship between chronological course and complications after PVS for refractory ascites in liver cirrhosis patients. MATERIALS AND METHODS: This was a retrospective study of 14 patients with refractory ascites associated with decompensated cirrhosis who underwent PVS placement between June 2011 and June 2023. The clinical characteristics, changes in cardiothoracic ratio (CTR), and laboratory data (i.e., brain natriuretic peptide (BNP), D-dimer, platelet) were evaluated. Follow-up CT images in eight patients were also evaluated for ascites and complications. RESULTS: No serious complication associated with the procedure occurred in any case. Transient increases in BNP and D-dimer levels, decreased platelet counts, and the worsening of CTR were observed in the 2 days after PVS; however, they were improved in 7 days in all cases except one. In the follow-up CT, the amount of ascites decreased in all patients, but one patient with a continuous increase in D-dimer 2 and 7 days after PVS had thrombotic disease (renal and splenic infarction). The mean PVS patency was 345.4 days, and the median survival after PVS placement was 474.4 days. CONCLUSIONS: PVS placement for refractory ascites is a technically feasible palliative therapy. The combined evaluation of chronological changes in BNP, D-dimer, platelet count and CTR, and follow-up CT images may be useful for the early prediction of the efficacy and complications of PVS.

When stimulus variability accelerates the learning of task knowledge in adults and school-aged children.

Experience with instances that vary in their surface features helps individuals to form abstract task knowledge, leading to transfer of that knowledge to novel contexts. The current study sought to examine the role of this variability effect in how adults and school-aged children learn to engage cognitive control. We focused on the engagement of cognitive control in advance (proactive control) and in response to conflicts (reactive control) in a cued task-switching paradigm, and conducted four preregistered online experiments with adults (Experiment 1A: N = 100, Experiment 1B: N = 105) and 9- to 10-year-olds (Experiment 2A: N = 98, Experiment 2B: N = 97). It was shown that prior task experience of engaging reactive control makes both adults and 9- to 10-year-olds respond more slowly in a subsequent similar-structured condition with different stimuli in which proactive control could have been engaged. 9- to 10-year-olds (Experiment 2B) exhibited more negative transfer of a reactive control mode when uninformative cue and pre-target stimuli, which do not convey task-relevant information, were changed in each block, compared with when they were fixed. Furthermore, adults showed suggestive evidence of the variability effect both when cue and target stimuli were varied (Experiment 1A) and when uninformative cue and pre-target stimuli were varied (Experiment 1B). The collective findings of these experiments provide important insights into the contribution of stimulus variability to the engagement of cognitive control.

Emerging drugs for the treatment of hepatic fibrosis on nonalcoholic steatohepatitis.

INTRODUCTION: Approved drug therapies for nonalcoholic steatohepatitis (NASH) are lacking, for which various agents are currently being tested in clinical trials. Effective drugs for liver fibrosis, the factor most associated with prognosis in NASH, are important. AREAS COVERED: This study reviewed the treatment of NASH with a focus on the effects of existing drugs and new drugs on liver fibrosis. EXPERT OPINION: Considering the complex pathophysiology of fibrosis in NASH, drug therapy may target multiple pathways. The method of assessing fibrosis is important when considering treatment for liver fibrosis in NASH. The Food and Drug Administration considers an important fibrosis endpoint to be histological improvement in at least one fibrosis stage while preventing worsening of fatty hepatitis. To obtain approval as a drug for NASH, efficacy needs to be demonstrated on endpoints such as liver-related events and myocardial infarction. Among the current therapeutic agents for NASH, thiazolidinedione, sodium-glucose co-transporter 2, and selective peroxisome proliferator-activated receptors α modulator have been reported to be effective against fibrosis, although further evidence is required. The effects of pan-peroxisome proliferator-activated receptors, obeticholic acid, and fibroblast growth factor-21 analogs on liver fibrosis in the development stage therapeutics for NASH are of particular interest.

Identification of differentially methylated regions associated with both liver fibrosis and hepatocellular carcinoma.

BACKGROUND: Liver fibrosis is a major risk factor for hepatocellular carcinoma (HCC). We have previously reported that differentially methylated regions (DMRs) are correlated with the fibrosis stages of metabolic dysfunction-associated steatotic liver disease (MASLD). In this study, the methylation levels of those DMRs in liver fibrosis and subsequent HCC were examined. METHODS: The methylation levels of DMRs were investigated using alcoholic cirrhosis and HCC (GSE60753). The data of hepatitis C virus-infected cirrhosis and HCC (GSE60753), and two datasets (GSE56588 and GSE89852) were used for replication analyses. The transcriptional analyses were performed using GSE114564, GSE94660, and GSE142530. RESULTS: Hypomethylated DMR and increased transcriptional level of zinc finger and BTB domain containing 38 (ZBTB38) were observed in HCC. Hypermethylated DMRs, and increased transcriptional levels of forkhead box K1 (FOXK1) and zinc finger CCCH-type containing 3 (ZC3H3) were observed in HCC. The methylation levels of DMR of kazrin, periplakin interacting protein (KAZN) and its expression levels were gradually decreased as cirrhosis progressed to HCC. CONCLUSIONS: Changes in the methylation and transcriptional levels of ZBTB38, ZC3H3, FOXK1, and KAZN are important for the development of fibrosis and HCC; and are therefore potential therapeutic targets and diagnostic tools for cirrhosis and HCC.

The Semantic Similarity Effect on Short-Term Memory: Null Effects of Affectively Defined Semantic Similarity.

Studies on short-term memory have repeatedly demonstrated the beneficial effect of semantic similarity. Although the effect seems robust, the aspects of semantics targeted by these studies (e.g., categorical structure, associative relationship, or dimension of meaning) should be clarified. A recent meta-regression study inspired by Osgood's view, which highlights affective dimensions in semantics, introduced a novel index for quantifying semantic similarity using affective values. Building on the results of the meta-regression of past studies' data with that index, this study predicts that semantic similarity is deleterious to short-term memory if it is manipulated by affective dimensions, after controlling for other confounding factors. This prediction was directly tested. The experimental results of the immediate serial recall task (Study 1) and immediate serial reconstruction of order task (Study 2) indicated null effects of semantic similarity by affective dimensions and thus falsified the prediction. These results suggest that semantic similarity based on affective dimensions is negligible.

Prediction of outcomes in patients with metabolic dysfunction-associated steatotic liver disease based on initial measurements and subsequent changes in magnetic resonance elastography.

BACKGROUND: The prognosis of metabolic dysfunction-associated steatotic liver disease (MASLD) is strongly associated with liver fibrosis. We aimed to investigate whether liver stiffness measurement (LSM) and changes in LSM (ΔLSM) on magnetic resonance elastography (MRE) can predict clinical events in patients with MASLD. METHODS: We included 405 patients with MASLD who underwent at least two MREs. The patients were divided into five groups corresponding to fibrosis stages (0-4) based on initial LSM and classified as progressors (ΔLSM ≥ 19%) or non-progressors (ΔLSM < 19%) based on the difference between the first and last LSM. RESULTS: The mean follow-up period was 72.6 months, and the mean interval between MREs was 23.5 months. There were 52 (12.8%) progressors and 353 (87.2%) non-progressors. The initial LSM was significantly associated with the cumulative probabilities of decompensated cirrhosis, hepatocellular carcinoma (HCC), liver-related events, extrahepatic malignancies, and overall mortality but not with cardiovascular disease. Progressors had significantly higher hazard ratios (HRs) for decompensated cirrhosis, HCC, and liver-related events but not for extrahepatic malignancies, cardiovascular disease, or overall mortality. Among patients without cirrhosis, the HR for developing cirrhosis among progressors was 60.15. Progressors had a significantly higher risk of liver-related events, even in the low initial LSM (fibrosis stage 0-2) subgroups. CONCLUSIONS: Both initial LSM and ΔLSM can predict liver-related events in patients with MASLD, even for low initial LSM. This integrated assessment can allow more detailed risk stratification compared with single LSM assessments and identify high-risk patients with MASLD among those previously considered as low risk.

Hebb repetition effects in complex and simple span tasks are based on the same learning mechanism.

The Hebb repetition effect shows improvement in serial recall of repeated lists compared to random nonrepeated lists. Previous research using simple span tasks found that the Hebb repetition effect is limited to constant uninterrupted lists, suggesting chunking as the mechanism of list learning. However, the Hebb repetition effect has been found in complex span tasks, which challenges the chunking explanation, as successive list items are separated by distractor processing, possibly interfering with the unified representations. We tested the possibility that Hebb repetition learning arises from chunking in simple span, but from position-item associations in complex span. In a series of five experiments, we found evidence that contradicts that hypothesis. Results show that (a) Hebb repetition learning in a complex span task can be transferred to a simple span task; (b) Hebb repetition learning from a complex span task cannot be transferred to a partially repeated simple span task; (c) partial repetition in a complex span task does not lead to learning; (d) Hebb repetition learning from a simple span task can be transferred to a complex span task; and (e) repeating the distractors in complex span has no impact on the Hebb repetition effect. These results suggest that the mechanism underlying the Hebb repetition effect in simple and complex span tasks is the same and points at the creation of chunks while excluding the distractors from the long-term memory representation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evidence for positive and negative transfer of abstract task knowledge in adults and school-aged children.

Engaging cognitive control is essential to flexibly adapt to constantly changing environments. However, relatively little is known about how prior task experience impacts on the engagement of cognitive control in novel task environments. We aimed to clarify how individuals learn and transfer the engagement of cognitive control with a focus on the hierarchical and temporal aspects of task knowledge. Highlighting two distinct cognitive control processes, the engagement of cognitive control in advance (proactive control) and in response to conflicts (reactive control), we conducted six preregistered online experiments with both adults (Experiment 1, 3, and 5: N = 71, N = 108, and N = 70) and 9- to 10-year-olds (Experiment 2, 4, 6: N = 69, N = 108, and N = 70). Using two different experimental paradigms, we demonstrated that prior task experience of engaging reactive control makes adults and 9-to 10-year-olds respond in a reactive way in a subsequent similar-structured condition with different stimuli in which proactive control could have been engaged. This indicates that individuals do learn knowledge about the temporal structure of task goal activation and, on occasion, negatively transfer this knowledge. Furthermore, individuals exhibited these negative transfer effects in a similar-structured condition with different task goals and stimuli, indicating that they learn hierarchically-structured task knowledge. The collective findings suggest a new way of understanding how hierarchical and temporal task knowledge influences the engagement of cognitive control and highlight potential mechanisms underlying the near transfer effects observed in cognitive control training.

Frontiers of Collaboration between Primary Care and Specialists in the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is the most common liver disease. It has a rapidly growing patient population owing to the increasing prevalence of obesity and type 2 diabetes. Patients with MASLD are primarily treated by family physicians when fibrosis is absent or mild and by gastroenterologists/hepatologists when fibrosis is more advanced. It is imperative that a system for the appropriate treatment and surveillance of hepatocellular carcinoma be established in order to ensure that highly fibrotic cases are not overlooked among the large number of MASLD patients. Family physicians should check for viral hepatitis, autoimmune hepatitis, alcoholic liver disease, and drug-induced liver disease, and should evaluate fibrosis using NIT; gastroenterologists/hepatologists should perform liver biopsy, ultrasound elastography (260 units in Japan as of October 2023), and MR elastography (35 units in Japan as of October 2023). This review presents the latest findings in MASLD and the role, accuracy, and clinical use of NIT. It also describes the collaboration between Japanese primary care and gastroenterologists/hepatologists in Japan in the treatment of liver diseases, including MASLD.

Combined, elobixibat, and colestyramine reduced cholesterol toxicity in a mouse model of metabolic dysfunction-associated steatotic liver disease.

BACKGROUND: Cholesterol levels and bile acid metabolism are important drivers of metabolic dysfunction-associated steatohepatitis (MASH) progression. Using a mouse model, we investigated the mechanism by which cholesterol exacerbates MASH and the effect of colestyramine (a bile acid adsorption resin) and elobixibat (an apical sodium-dependent bile acid transporter inhibitor) concomitant administration on bile acid adsorption and MASH status. METHODS: Mice were fed a high-fat high-fructose diet with varying concentrations of cholesterol to determine changes in fatty liver according to liver status, water intake, defecation status, insulin resistance, bile acid levels, intestinal permeability, atherosclerosis (in apolipoprotein E knockout mice), and carcinogenesis (in diethylnitrosamine mice). Using small interfering ribonucleic acid (siRNA), we evaluated the effect of sterol regulatory element binding protein 1c (SREBP1c) knockdown on triglyceride synthesis and fatty liver status following the administration of elobixibat (group E), colestyramine (group C), or both (group EC). RESULTS: We found greater reductions in serum alanine aminotransferase levels, serum lipid parameters, serum primary bile acid concentrations, hepatic lipid levels, and fibrosis area in EC group than in the monotherapy groups. Increased intestinal permeability and watery diarrhea caused by elobixibat were completely ameliorated in group EC. Group EC showed reduced plaque formation rates in the entire aorta and aortic valve of the atherosclerosis model, and reduced tumor counts and tumor burden in the carcinogenesis model. CONCLUSIONS: Excessive free cholesterol in the liver can promote fatty liver disease. Herein, combination therapy with EC effectively reduced free cholesterol levels in MASH model mice. Our study provides strong evidence for combination therapy as an effective treatment for MASH.

Nonalcoholic Fatty Liver Disease as a Systemic Disease and the Need for Multidisciplinary Care.

Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease, and there has been a rapid increase in cases worldwide. NAFLD is rapidly becoming the leading cause of hepatocellular carcinoma and is also associated with an increased risk of cardiovascular disease or exacerbation of other organ diseases, thus posing a significant health problem from both a medical and a socioeconomic perspective. NAFLD is a systemic disease and requires the involvement of numerous medical professionals. Multidisciplinary collaboration, in which different professionals within different specialties come together and work together toward a common goal, supports better patient care by integrating perspectives of multiple experts and facilitating the exchange of opinions. Due to the large number of potential patients, gastroenterologists and hepatologists cannot manage the patients alone, and collaboration between specialists in various fields, including family doctors, dentists, nutritionists, and pharmacists is required for treatment of NAFLD. This review will discuss NAFLD from the perspective of various specialties and introduce multidisciplinary collaboration.

Prior appendectomy and cerebral infarction as potential risk factors for recurrent ischemic colitis: A retrospective observational study.

Background and Aim: Ischemic colitis (IC) is a benign disease associated with acute lower gastrointestinal bleeding and frequent recurrence. While several studies have investigated risk factors for IC onset, few have assessed the risk factors for recurrent IC. This study aimed to identify risk factors for recurrent IC. Methods: Potential risk factors for recurrence were assessed by examining medical records and laboratory findings in this single-center retrospective study. We extracted the following data from the patients' medical records: patient characteristics, clinical signs and symptoms, laboratory findings, method of treatment, length of hospital stay, disease course, and the frequency of IC morbidities. Patients with IC were selected from a total of 439 312 patients over an 11-year period. Patients were divided into recurrent and nonrecurrent IC groups. Results: In total, 225 patients met the diagnostic criteria for IC during the specified study period; of these, 204 patients (90.7%) and 21 patients (9.3%) were included in the nonrecurrent and recurrent IC groups, respectively. Univariate and multivariate analyses showed a significant association between IC recurrence and both cerebral infarction (P = 0.008, odds ratio [OR] = 6.3) and history of appendectomy (P = 0.0005, OR = 6.2). The median (interquartile range [IQR]) follow-up time for all patients was 1556 (353-2768) days; this was much longer than the median (IQR) time to recurrence of 291 (64-907) days in the recurrent IC group. Conclusion: The results of this study suggest that prior cerebral infarction and appendicectomy may be risk factors for IC recurrence.

Time sharing in working memory processing.

Although working memory (WM) is usually defined as a cognitive system coordinating processing and storage in the short term, in most WM models, memory aspects have been developed more fully than processing systems, and many studies of WM tasks have tended to focus on memory performance. The present study investigated WM functioning without focusing exclusively on short-term memory performance by presenting participants with an n-back task on letters, n varying from 0 to 2, each letter being followed by a tone discrimination task involving from one to three tones. Predictions regarding the reciprocal effects of these tasks on each other were motivated by the time-based resource-sharing (TBRS) theoretical framework for WM that assumes the temporal sharing of attention between processing and memory. Although, as predicted, increasing the n value had a detrimental effect on tone discrimination in terms of accuracy and response times, and increasing the number of tones disrupted speed and accuracy on n-back performance, the overall pattern of results did not perfectly fit the TBRS predictions. Nonetheless, the main alternative models of WM do not seem to offer a complete account. The present findings point toward the need to use a larger range of tasks and situations in designing and testing models of WM. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sequential processing facilitates Hebb repetition learning in visuospatial domains.

Exposure to the same information improves auditory/verbal short-term memory performance, but such improvement is not always observed in visual short-term memory. In this study, we demonstrate that sequential processing makes visuospatial repetition learning efficient in a paradigm that employs a similar design previously used for an auditory/verbal domain. When we presented sets of color patches simultaneously in Experiments 1-4, recall accuracy did not increase with repetition; however, once color patches were presented sequentially in Experiment 5, accuracy did increase rapidly with repetition, even when participants engaged in articulatory suppression. Moreover, these learning dynamics matched those in Experiment 6, which used verbal materials. These findings suggest that (a) sequential focus on each item facilitates a repetition learning effect, indicating a temporal bottleneck is involved early in this process and (b) repetition learning is mechanistically similar across sensory modalities even though these modalities differently specialize in processing spatial or temporal information. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

M-PAST score is better than MAST score for the diagnosis of active fibrotic nonalcoholic steatohepatitis.

BACKGROUND: Clinical trials enroll patients with active fibrotic nonalcoholic steatohepatitis (NASH) (nonalcoholic fatty liver disease [NAFLD] activity score ≥ 4) and significant fibrosis (F ≥ 2); however, screening failure rates are high following biopsy. We developed new scores to identify active fibrotic NASH using FibroScan and magnetic resonance imaging (MRI). METHODS: We undertook prospective primary (n = 176), retrospective validation (n = 169), and University of California San Diego (UCSD; n = 234) studies of liver biopsy-proven NAFLD. Liver stiffness measurement (LSM) using FibroScan or magnetic resonance elastography (MRE), controlled attenuation parameter (CAP), or proton density fat fraction (PDFF), and aspartate aminotransferase (AST) were combined to develop a two-step strategy-FibroScan-based LSM followed by CAP with AST (F-CAST) and MRE-based LSM followed by PDFF with AST (M-PAST)-and compared with FibroScan-AST (FAST) and MRI-AST (MAST) for diagnosing active fibrotic NASH. Each model was categorized using rule-in and rule-out criteria. RESULTS: Areas under receiver operating characteristic curves (AUROCs) of F-CAST (0.826) and M-PAST (0.832) were significantly higher than those of FAST (0.744, p = 0.004) and MAST (0.710, p < 0.001). Following the rule-in criteria, positive predictive values of F-CAST (81.8%) and M-PAST (81.8%) were higher than those of FAST (73.5%) and MAST (70.0%). Following the rule-out criteria, negative predictive values of F-CAST (90.5%) and M-PAST (90.9%) were higher than those of FAST (84.0%) and MAST (73.9%). In the validation and UCSD cohorts, AUROCs did not differ significantly between F-CAST and FAST, but M-PAST had a higher diagnostic performance than MAST. CONCLUSIONS: The two-step strategy, especially M-PAST, showed reliability of rule-in/-out for active fibrotic NASH, with better predictive performance compared with MAST. This study is registered with ClinicalTrials.gov (number, UMIN000012757).

Asymmetric negative transfer effects of working memory training.

Gathercole et al. (Journal of Memory and Language, 105, 19-42, 2019) presented a cognitive routine framework for explaining the underlying mechanisms of working memory (WM) training and transfer. This framework conceptualizes training-induced changes as the acquisition of novel cognitive routines similar to learning a new skill. We further infer that WM training might not always generate positive outcomes because previously acquired routines may affect subsequent task performance in various ways. Thus, the present study aimed to demonstrate the negative effects of WM training via two experiments. We conducted Experiment 1 online using a two-phase training paradigm with only three training sessions per phase and replicated the key findings of Gathercole and Norris (in prep.) that training on a backward circle span task (a spatial task) transferred negatively to subsequent training on a backward letter span task (a verbal task). We conducted Experiment 2 using a reversed task order design corresponding to Experiment 1. The results indicated that the transfer from backward letter training to backward circle training was not negative, but rather weakly positive, suggesting that the direction of the negative transfer effect is asymmetric. The present study therefore found that a negative transfer effect can indeed occur under certain WM training designs. The presence of this asymmetric effect indicates that backward circle and backward letter tasks require different optimal routines and that the locus of negative transfer might be the acquisition process of such optimal routines. Hence, the routines already established for backward circle might hinder the development of optimal routines for backward letter, but not vice versa.

Involvement of Periodontal Disease in the Pathogenesis and Exacerbation of Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis: A Review.

The increasing incidence of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), along with global lifestyle changes, requires further in-depth research to elucidate the mechanisms and develop new treatment strategies. In addition, the number of patients with periodontal disease has increased recently, suggesting that periodontal disease is sometimes associated with systemic conditions. In this review, we summarize recent studies linking periodontal disease and NAFLD, the concept of the mouth-gut-liver axis, oral and intestinal microbiota, and liver disease. We suggest new research directions toward a detailed mechanistic understanding and novel targets for treatment and prevention. Forty years have passed since the concepts of NAFLD and NASH were first proposed. however, no effective prevention or treatment has been established. We also found that the pathogenesis of NAFLD/NASH is not limited to liver-related diseases but has been reported to be associated with various systemic diseases and an increasing number of causes of death. In addition, changes in the intestinal microbiota have been shown to be a risk factor for periodontal diseases, such as atherosclerosis, diabetes, rheumatoid arthritis, nonalcoholic fatty liver disease, and obesity.

Impact of Sarcopenia on Non-Alcoholic Fatty Liver Disease.

With the increasing incidence of non-alcoholic fatty liver disease (NAFLD) and the aging of the population, sarcopenia is attracting attention as one of the pathological conditions involved in the development and progression of NAFLD. In NAFLD, sarcopenia is closely associated with insulin resistance and results from the atrophy of skeletal muscle, an insulin target organ. In addition, inflammatory cytokines that promote skeletal muscle protein breakdown, low adiponectin levels leading to decreased insulin sensitivity, and hyperleptinemia are also involved in NAFLD pathogenesis. The presence of sarcopenia is a prognostic factor and increases the risk of mortality in patients with cirrhosis and post-treatment liver cancer. Sarcopenia, the presence of which mainly occurs due to decreased muscle mass, combined with increased visceral fat, can lead to sarcopenia-associated obesity, which increases the risk of NASH, liver fibrosis, and cardiovascular disease. In order to treat sarcopenia, it is necessary to properly evaluate sarcopenia status. Patients with high BMI, as in sarcopenic obesity, may improve with caloric restriction. However, inadequate oral intake may lead to further loss of muscle mass. Aerobic and resistance exercise should also be used appropriately.

Non-invasive imaging biomarkers for liver steatosis in non-alcoholic fatty liver disease: present and future.

Non-alcoholic fatty liver disease is currently the most common chronic liver disease, affecting up to 25% of the global population. Simple fatty liver, in which fat is deposited in the liver without fibrosis, has been regarded as a benign disease in the past, but it is now known to be prognostic. In the future, more emphasis should be placed on the quantification of liver fat. Traditionally, fatty liver has been assessed by histological evaluation, which requires an invasive examination; however, technological innovations have made it possible to evaluate fatty liver by non-invasive imaging methods, such as ultrasonography, computed tomography, and magnetic resonance imaging. In addition, quantitative as well as qualitative measurements for the detection of fatty liver have become available. In this review, we summarize the currently used qualitative evaluations of fatty liver and discuss quantitative evaluations that are expected to further develop in the future.

Real-world assessment of SmartExam, a novel FibroScan computational method: A retrospective single-center cohort study.

BACKGROUND AND AIM: SmartExam is a novel computational method compatible with FibroScan that uses a software called SmartDepth and continuous controlled attenuation parameter measurements to evaluate liver fibrosis and steatosis. This retrospective study compared the diagnostic accuracy of conventional and SmartExam-equipped FibroScan for liver stiffness measurement (LSM). METHODS: The liver stiffness and the associated controlled attenuation parameters of 167 patients were measured using conventional and SmartExam-Equipped FibroScan as well as reference methods like magnetic resonance elastography (MRE) and magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) measurements to assess its diagnostic performance. M or XL probes were selected based on the probe-to-liver capsule distance for all FibroScan examinations. RESULTS: The liver stiffness and controlled attenuation parameter (CAP) correlation coefficients calculated from conventional and SmartExam-equipped FibroScan were 0.97 and 0.82, respectively. Using MRE/MRI-PDFF as a reference and the DeLong test for analysis, LSM and the area under the receiver operating characteristic curve for CAP measured by conventional and SmartExam-equipped FibroScan showed no significant difference. However, the SmartExam-equipped FibroScan measurement (33.6 s) took 1.4 times longer than conventional FibroScan (23.2 s). CONCLUSIONS: SmartExam has a high diagnostic performance comparable with that of conventional FibroScan. Because the results of the conventional and SmartExam-equipped FibroScan were strongly correlated, it can be considered useful for assessing the fibrosis stage and steatosis grade of the liver in clinical practice, with less variability but little longer measurement time compared with the conventional FibroScan.