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In vitro studies indicate that hepatic resident macrophages detect elevated free fatty acids and respond by increasing TNF- secretion that, in turn, promotes the progression of steatosis in hepatocytes ( Metabolic burden in hepatocytes activates multiple cell death pathways, including apoptosis, necroptosis, pyroptosis, and ferroptosis, which can further amplify the inflammatory and fibrogenic response ( Figure 1B )

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Mozzanica N, Tadini G, Radaelli A, Negri M, Pigatto P, Morelli M,

Response: We remain committed to the Excessive Radiation eCQM as a patient safety issue and affirm, as we did in the CY 2024 OPPS/ASC final rule (88 FR 81987), that the measure's data elements are scientifically and practically valid