Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver pathology worldwide. Meanwhile, liver cancer represents the sixth most common malignancy, with hepatocellular carcinoma (HCC) as the primary, most prevalent subtype. Due to the rising incidence of metabolic disorders, NAFLD has become one of the main contributing factors to HCC development. However, although NAFLD might account for about a fourth of HCC cases, there is currently a significant gap in HCC surveillance protocols regarding noncirrhotic NAFLD patients, so the majority of NAFLD-related HCC cases were diagnosed in late stages when survival chances are minimal. However, in the past decade, the focus in cancer genomics has shifted towards the noncoding part of the genome, especially on the microRNAs (miRNAs) and long noncoding RNAs (lncRNAs), which have proved to be involved in the regulation of several malignant processes. This review aims to summarize the current knowledge regarding some of the main dysregulated, noncoding RNAs (ncRNAs) and their implications for NAFLD and HCC development. A central focus of the review is on miRNA and lncRNAs that can influence the progression of NAFLD towards HCC and how they can be used as potential screening tools and future therapeutic targets.

Background and Aims: Non-alcoholic fatty liver disease (NAFLD) is a common hepatic condition that can progress to hepatocellular carcinoma (HCC) in non-cirrhotic livers. To better understand the development of NAFLD-associated HCC, we performed an integrated morphological and molecular analysis to identify new insights that can improve the follow-up of NAFLD patients. Methods: Our study included a cohort of 14 NAFLD-associated HCC and 41 NAFLD patients. We analyzed clinical parameters, a four-microRNA (miRNA) panel (miR-21-5p, miR-34a-5p, miR-130a-3p, and miR-155-3p) panel and their relationship with p53 and β-catenin expression. Results: In the study cohort, the NAFLD-associated HCC patients were predominantly male, older, had significantly altered hepatic function, and a higher incidence of hypertension, type 2 diabetes, and dyslipidemia. Morphologically, the NAFLD-HCC group had substantially higher steatosis, ballooning, and fibrosis grades than the NAFLD group. The β-catenin expression was higher in both adjacent non-tumoral liver tissue (ANT) from NAFLD-associated HCC patients and in HCC tissue com-pared with NAFLD samples. The 4 miRNAs panel showed a dysregulated expression profile between NAFLD, ANT and HCC samples. Conclusions: This study provides important insights regarding the molecular mechanisms underlying HCC progression in NAFLD patients, allowing for the development of better screening strategies for the early detection of NAFLD-associated HCC.

The ability of texture analysis (TA) features to discriminate between different types of infected fluid collections, as seen on computed tomography (CT) images, has never been investigated. The study comprised forty patients who had pathological post-operative fluid collections following gastric cancer surgery and underwent CT scans. Patients were separated into six groups based on advanced microbiological analysis of the fluid: mono bacterial (n = 16)/multiple-bacterial (n = 24)/fungal (n = 14)/non-fungal (n = 26) infection and drug susceptibility tests into: multiple drug-resistance bacteria (n = 23) and non-resistant bacteria (n = 17). Dedicated software was used to extract the collections’ TA parameters. The parameters obtained were used to compare fungal and non-fungal infections, mono-bacterial and multiple-bacterial infections, and multiresistant and non-resistant infections. Univariate and receiver operating characteristic analyses and the calculation of sensitivity (Se) and specificity (Sp) were used to identify the best-suited parameters for distinguishing between the selected groups. TA parameters were able to differentiate between fungal and non-fungal collections (ATeta3, p = 0.02; 55% Se, 100% Sp), mono and multiple-bacterial (CN2D6AngScMom, p = 0.03); 80% Se, 64.29% Sp) and between multiresistant and non-multiresistant collections (CN2D6Contrast, p = 0.04; 100% Se, 50% Sp). CT-based TA can statistically differentiate between different types of infected fluid collections. However, it is unclear which of the fluids’ micro or macroscopic features are reflected by the texture parameters. In addition, this cohort is used as a training cohort for the imaging algorithm, with further validation cohorts being required to confirm the changes detected by the algorithm.

Pancreatico-duodenal artery aneurysm (PDAA) associated with stenosis or occlusion of the celiac trunk is a rare condition. Furthermore, PDAAs associated with stenosis of the superior mesenteric artery (SMA) are even more uncommon, with only six cases reported in the literature. We report a case of a 61-year old male patient who presented with hematemesis, haematochezia and haemorrhagic shock. The upper gastrointestinal endoscopy revealed an ulcerous lesion at the third portion of the duodenum, without achieving the haemostasis. The emergency laparotomy (suture of the lesion and gastro-entero-anastomosis) permitted temporary haemostasis. Computed tomography angiography identified the PDAA ruptured into the third portion of the duodenum and the SMA stenosis at its origin; a dense network of collateral vessels was present. The patient was successfully managed with coil embolization. Short and mid-term follow-up were without incidents.

Background: Gastric cancer remains a leading global health challenge, despite advances in surgical techniques and perioperative care. Patients with gastric cancer present with a degree of postoperative complications, most notably anastomotic fistulas, which can lead to a high level of morbidity and mortality. Although significant advances have been made in their management by implementing less invasive methods, issues and debate remain regarding their early detection and treatment decisions. The purpose of this study was to emphasize the particularities of the treatment of postoperative fistulas in gastric cancer surgery, focusing on risk factors as well as management strategies. Methods: This retrospective study analyzed risk factors, diagnostic methods, and treatment strategies for anastomotic fistulas in 527 patients undergoing curative gastric cancer surgery over the span of five years, highlighting postoperative complication rates, the management of postoperative complications, and the primary risk factors for developing fistulas. Results: Conservative treatment combined with minimally invasive interventions achieved a primary success rate of over 65%, with surgical intervention being reserved for severe cases. The primary risk factors identified were an advanced tumor stage, total gastrectomy, type II diabetes mellitus, and a high number of transfusions required, as well as hypoalbuminemia. Conclusions: Although further research is required to standardize treatment protocols and reduce the morbidity and mortality associated with postoperative fistulas, understanding the primary elements of its causation can prove helpful in choosing the correct treatment.

Background and Aims: Several computed tomographic (CT) imaging features have been proposed to describe the infection of postoperative abdominal fluid collections; however, these features are vague, and there is a significant overlap between infected and non-infected collections. We assessed the role of textural parameters as additional diagnostic tools for distinguishing between infected and non-infected peritoneal collections in patients operated for gastric cancer. Methods: From 527 patients operated for gastric cancer, we retrospectively selected 82 cases with intraperitoneal collections who underwent CT exams. The fluid component was analyzed through a novel method (texture analysis); different patterns of pixel intensity and distribution were extracted and processed through a dedicated software (MaZda). A univariate analysis comparing the parameters of texture analysis between the two groups was performed. Afterwards, a multivariate analysis was performed for the univariate statistically significant parameters. Results: The study included 82 patients with bacteriologically verified infected (n=40) and noninfected (n=42) intraperitoneal effusions. The univariate analysis evidenced statistically significant differences between all the parameters involved. The multivariate analysis highlighted 10 parameters as being statistically significant, adjusted to Bonferroni correction. Conclusions: Our evidence supports the fact that textural analysis can be used as a complementary diagnostic tool for the detection of infected fluid collections after gastric cancer surgery. Further studies are required to validate the accuracy of this method.