Heart failure with preserved ejection fraction (HFpEF) is associated with multiple cardiovascular and noncardiovascular comorbidities and risk factors which increase the risk of thrombotic complications, such as atrial fibrillation, chronic kidney disease, arterial hypertension and type 2 diabetes mellitus. Subsequently, thromboembolic risk stratification in this population poses a great challenge. Since date from the large randomized clinical trials mostly include both patients with truly preserved EF, and those with heart failure with mildly reduced ejection fraction, there is an unmet need to characterize the patients with truly preserved EF. Considering the significant evidence gap in this area, we sought to describe the coagulation disorders and thrombotic complications in patients with HFpEF and discuss the specific thromboembolic risk factors in patients with HFpEF, with the goal to tailor risk stratification to an individual patient.

Transarterial chemoembolization (TACE) is used as a bridging treatment in liver transplant candidates with hepatocellular carcinoma (HCC). Alpha-fetoprotein (AFP) is the main tumor marker used for HCC surveillance. The aim of this study was to assess the potential of using the AFP change after the first TACE in the prediction of complete tumor necrosis. The study comprised 101 patients with HCC who underwent liver transplantation (LT) after TACE in the period between January 2011 and December 2020. The ΔAFP was defined as the difference between the AFP value before the first TACE and AFP either before the second TACE or the LT. The receiver operator characteristics (ROC) curves were used to identify an optimal cut-off value. Complete tumor necrosis was found in 26.1% (18 of 69) and 6.3% (2 of 32) of patients with an initial AFP level under and over 100 ng/mL, respectively (p = 0.020). The optimal cut-off value of ΔAFP for the prediction of complete necrosis was a decline of ≥10.2 ng/mL and ≥340.5 ng/mL in the corresponding subgroups. Complete tumor necrosis rates were: 62.5% (5 of 8) in patients with an initial AFP < 100 ng/mL and decline of ≥10.2 ng/mL; 21.3% (13 of 61) in patients with an initial AFP < 100 ng/mL and decline of 100 ng/mL and decline of ≥340.5 ng/mL; and null in 20 patients with an initial AFP > 100 ng/mL and decline of <340.5 ng/mL, respectively (p = 0.003). The simple scoring system, based on the initial AFP and AFP decline after the first treatment, distinguished between a high, intermediate and low probability of complete necrosis, with an area under the ROC curve of 0.699 (95% confidence intervals 0.577 to 0.821, p = 0.001). Combining the initial AFP with its change after the first treatment enables early identification of the efficacy of TACE.

Background: Malignant and benign neuroendocrine tumors (NET) share many histopathological features. Liver transplantation (LT) is one of the liver-directed therapies for neuroendocrine liver metastases (NELM). The aim of this study was to determine the outcomes of patients undergoing LT for NELM. Material/Methods: This was a retrospective study that included 19 patients who underwent LT for unresectable NELM between December 1989 and December 2022 in the Department of General, Transplant, and Liver Surgery of the Medical University of Warsaw. Kaplan-Meier estimator and Cox proportional hazards regression were used for statistical analyses.Results: The primary tumor was located most frequently in the pancreas. The median follow-up was 72.5 months. The overall survival (OS) was 94.7%, 88.0%, 88.0%, 70.4%, and 49.3% after 1, 3, 5, 10, and 15 years, respectively. Accordingly, the recurrence-free survival (RFS) rates were 93.8%, 72.9%, 64.8%, 27.8%, and 27.8% after 1, 3, 5, 10, and 15 years, respectively. Ki-67 index >= 5% was found as a risk factor for both worse OS (hazard ratio (HR) 7.13, 95% confidence intervals (95% CI) 1.32-38.63, P=0.023) and RFS (HR 13.68, 95% CI 1.54-121.52, P=0.019). Recipient age >= 55 years was a risk factor for worse RFS (P=0.046, HR 5.47, 95% CI 1.03-29.08). Multivariable analysis revealed Ki-67 >= 5% as the sole independent factor for worse OS (HR 13.78, 95% CI 1.48-128.56, P=0.021).Conclusions: Patients with unresectable NELM achieve great OS and satisfying RFS after LT. The risk factors associated with worse outcomes are attributed to primary tumor aggressiveness.

Mitral valve prolapse (MVP) and mitral annular disjunction (MAD) are common comorbidities that can lead to serious cardiac arrhythmias and sudden cardiac death (SCD). Arrhythmic MVP is characterized by the presence of MVP with frequent (over 5% ventricular extra beats) and/or complex ventricular arrhythmias, such as ventricular tachycardia (VT), non-sustained VT, or ventricular fibrillation in the absence of other causes of arrhythmia, e.g., post-infarction scar, recent ischemia, channelopathy, or cardiomyopathy. The mechanisms of the development of serious cardiac arrhythmias in patients with MVP and MAD are not fully understood. Arrhythmic MVP may be an indication for cardioverter defibrillator implantation. Considering the increased risk of SCD in this group of patients, the pathophysiology of this valvular dysfunction and characteristic deviations in diagnostic tests that indicate a higher risk of SCD are presented. The issue of tailored risk stratification in individual patients is crucial.

Liver transplantation is an effective method for treating end-stage liver failure and certain liver cancers. Survival after this procedure is associated with the development of comorbidities, including before diagnosed diabetes mellitus and new diagnosed post-transplant diabetes mellitus (PTDM). Its pathophysiology differs from that of type 2 diabetes in the general population and reflects a complex interplay between pre-existing metabolic vulnerability (e.g. obesity, insulin resistance, impaired fasting glucose), perioperative stressors, and chronic immunosuppression. Commonly used immunosuppressive drugs, such as calcineurin inhibitors (particularly tacrolimus), mTOR inhibitors, and glucocorticosteroids, affect not only pancreatic function but also contribute to weight gain and chronic inflammation. Therapeutic goals should therefore be individualized according to time since transplantation, comorbidity burden, risk of hypoglycemia, and liver graft and renal function. Aim of the study: The objective of this study is to summarize recent literature on the diagnosis and treatment of PTDM and type 2 diabetes mellitus after liver transplantation. Materials and methods: In this narrative review, we searched the PubMed database to analyze the latest evidence on the treatment and diagnosis of PTDM, and type 2 diabetes mellitus diagnosed before liver transplantation. Results: We discuss diagnostic approaches as well as pharmacological and non-pharmacological treatment strategies for these metabolic disorders in patients receiving long-term immunosuppression. Conclusions: Interdisciplinary care and integration of lifestyle interventions are essential to optimize metabolic and cardiovascular risk management in liver transplant recipients. There remains a strong need for further clinical trials evaluating the safety and efficacy of oral antidiabetic agents in this specific patient population.

Background: Endometriosis is a chronic inflammatory disease associated with pain, infertility, and impaired quality of life. Numerous systematic reviews and meta-analyses have evaluated available treatments but overlapping evidence and methodological heterogeneity limit interpretability. Objective: To synthesize secondary evidence on endometriosis management using an umbrella review with explicit assessment of evidence overlap. Methods: Systematic reviews with quantitative meta-analyses published between 2019 and 2026 were identified through PubMed. Methodological quality was assessed using AMSTAR 2. Evidence was synthesized narratively across therapeutic domains and overlap of primary studies was quantified using the Corrected Covered Area (CCA). Results: Forty-nine systematic reviews were included. Overall, methodological quality was moderate to high. Evidence overlap was generally low but high in selected domains, particularly hormonal pretreatment before assisted reproductive technologies. Progestins and gonadotropin-releasing hormone modulators consistently reduce endometriosis-related pain. Surgical excision of ovarian endometriomas reduced recurrence but impaired ovarian reserve, while postoperative hormonal suppression reduced recurrence risk. Conclusions: This umbrella review supports selected hormonal and surgical strategies for endometriosis management while highlighting evidence redundancy and key knowledge gaps.