Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have signi...Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.展开更多
Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is importan...Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced EUS.Clinical studies have reported varying diagnostic and adverse event rates with these modalities.In addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations.In this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.展开更多
When kidney function declines to a point where it can no longer maintain life and requires renal replacement therapy(i.e.renal transplant or dialysis),it is called end-stage renal disease(ESRD).Patients with ESRD ofte...When kidney function declines to a point where it can no longer maintain life and requires renal replacement therapy(i.e.renal transplant or dialysis),it is called end-stage renal disease(ESRD).Patients with ESRD often experience a range of gastrointestinal(GI)symptoms,with prevalence rates reported as high as 77%-79%.These symptoms and pathologies arise from various factors,including electrolyte imbalance,fluid imbalance,toxin buildup,uremia,medications,dietary and lifestyle restrictions,and the effects of dialysis.GI diseases in patients with renal failure can be further categorized into upper GI,small bowel,and lower GI issues.Common conditions include gastroesophageal reflux disease,nausea and vomiting,dysmotility within the esophagus and stomach,upper GI bleeding,peptic ulcer bleeding,angioectasia,irritable bowel syndrome,mesen-teric ischemia,angiodysplasia,diverticular disease,constipation,pancreatitis,and diseases associated with peritoneal dialysis peritonitis and peritoneal stenosis.This review assesses the existing literature on the different GI diseases among individuals with ESRD,shedding light on their pathophysiology and prevalence.展开更多
Liver transplantation(LT)is the definitive treatment for end-stage liver disease,acute liver failure,and liver cancer.Although advancements in surgical techniques,postoperative care,and immunosuppressive therapies hav...Liver transplantation(LT)is the definitive treatment for end-stage liver disease,acute liver failure,and liver cancer.Although advancements in surgical techniques,postoperative care,and immunosuppressive therapies have significantly improved outcomes,the long-term use of immunosuppression has increased the risk of complications,including infections,cardiovascular disease,and cancer.Among these,de novo malignancies(DNMs)are a major concern,accounting for 20%-25%of deaths in LT recipients surviving beyond the early post-transplant period.Non-melanoma skin cancers,particularly squamous cell carcinoma are the most prevalent DNMs.Other significant malignancies include Kaposi's sarcoma,post-transplant lymphoproliferative disorders,and various solid organ cancers,including head and neck cancers.Compared to the general population,LT patients face a twofold increase in solid organ malignancies and a 30-fold increase in lymphoproliferative disorders.Risk factors for DNM include chronic immunosuppression,alcohol or tobacco use,viral infections,and underlying liver disease.Emerging evidence emphasizes the importance of tailored cancer screening and prevention strategies,including regular dermatological examinations,targeted screenings for high-risk cancers,and patient education on lifestyle modifications.Early detection through enhanced surveillance protocols has been shown to improve outcomes.Management of DNMs involves a combination of standard oncological therapies and adjustments to immunosuppressive regimens,with promising results from the use of mTOR inhibitors in select patients.The review highlights the critical need for ongoing research to refine risk stratification,optimize screening protocols,and improve treatment approaches to mitigate the burden of DNMs in LT recipients.By implementing personalized preventive and therapeutic strategies,we can enhance long-term outcomes and quality of life for this vulnerable population.展开更多
Human immunodeficiency virus(HIV)modifies CD4-positive cells,resulting in immunodeficiency and a wide range of gastrointestinal(GI)manifestations.The burden of HIV-related GI illnesses has significantly evolved with t...Human immunodeficiency virus(HIV)modifies CD4-positive cells,resulting in immunodeficiency and a wide range of gastrointestinal(GI)manifestations.The burden of HIV-related GI illnesses has significantly evolved with the widespread use of antiretroviral therapy(ART).While ART has effectively reduced the occurrence of opportunistic infections,it has led to an increase in therapy-related GI illnesses.Common esophageal conditions in HIV patients include gastroesophageal reflux disease,idiopathic esophageal ulcers,herpes simplex virus,cytomegalovirus(CMV),and candidal esophagitis.Kaposi’s sarcoma,a hallmark of acquired immunodeficiency syndrome,may affect the entire GI system.Gastritis and peptic ulcer disease are also frequently seen in patients with HIV.Diarrhea,often linked to both opportunistic infections and ART,requires careful evaluation.Bloody diarrhea,often a sign of colitis caused by bacterial infections such as Shigella or Clostridium difficile,is prevalent.Small bowel lymphoma,although rare,is increasing in prevalence.Anorectal disorders,including proctitis,fissures,and anal squamous cell carcinoma,are particularly relevant in homosexual men,underlining the importance of timely diagnosis.This review comprehensively explores the epidemiology,pathogenesis,and treatment considerations for the various GI disorders associated with HIV,highlighting the importance of accurate diagnosis and effective treatment to improve outcomes for HIV-infected patients.展开更多
Critically ill patients have a variety of complex pathologies and are in a multifarious state of catabolism supplanted by external and internal factors.Early enteral nutrition(EEN)is defined as the initiation of enter...Critically ill patients have a variety of complex pathologies and are in a multifarious state of catabolism supplanted by external and internal factors.Early enteral nutrition(EEN)is defined as the initiation of enteral feeding within 24-48 hours of hospitalization.Previous studies show the benefits of EEN include supporting the healing process through preservation of the gut mucosa,modulation of the immune response,and suppression of inflammation.However,recent studies suggest the advantages of EEN may not be as robust as previously believed.This review aims to discuss the outcomes of EEN when used in different critical care settings while managing complex disease states such as burns,sepsis,pancreatitis,and upper gastrointestinal bleeding.Evidence indicates that EEN has a positive impact on patient outcomes,hospital costs,length of intensive care unit stay,and preventing complications.展开更多
BACKGROUND Esophageal cancer is a significant global health concern,characterized by high mortality rates and diverse histological types,primarily adenocarcinoma and squamous cell carcinoma.AIM To analyze trends in es...BACKGROUND Esophageal cancer is a significant global health concern,characterized by high mortality rates and diverse histological types,primarily adenocarcinoma and squamous cell carcinoma.AIM To analyze trends in esophageal cancer using Surveillance,Epidemiology,and End Results(SEER)data,focusing on patient characteristics,stage at diagnosis,treatment modalities,and survival outcomes,to provide insights that may guide clinical practice and public health initiatives.METHODS Age-adjusted incidence and mortality rates for esophageal cancer,2004-2021,were obtained from SEER rate sessions using SEER*Stat version 8.4.4.Average percent changes(APC)over time in age-adjusted incidence and mortality rates relative to gender,race/ethnicity,and stage at diagnosis were assessed using Joinpoint’s loglinear regression.Finally,Poisson regression was used to ascertain incidence and mortality rate ratios to ascertain associations between age,gender,race/ethnicity,and staging with incidence and mortality rates.All analyses were further stratified by gender to assess interactions between gender and the other demographic and clinical characteristics.RESULTS Overall,the data reveals significant trends in both the incidence and mortality rates of esophageal cancer,with notable variations across gender,race,and stage at diagnosis.Age-adjusted incidence and mortality rates were higher in males compared to females(incidence:4.1 per 100000 vs 0.9 per 100000,mortality:3.4 per 100000 vs 0.7 per 100000),P<0.001.Furthermore,the APC among males decreased more significantly over time[APC(95%CI):-1.14(-1.52 to-0.78);P<0.001].Both non-Hispanic(NH)Blacks and NH Whites showed significant decreases in cancer incidence,with NH Blacks observing a 3.27%decline and NH Whites a 0.51%decline.Patients with distant staging had a 5%APC increase in mortality rates over time(P=0.003).Additionally,mortality rates increased with age,and all minority groups showed declines in incidence and mortality compared to NH Whites.Cancer diagnosed at a distant stage had a mortality rate 4.16 times higher than in situ cases.CONCLUSION The analysis reveals clear disparities in both the incidence and mortality of esophageal cancer,with males,particularly NH Whites,experiencing significantly higher rates than females.Despite a general decline in incidence rates over time,the upward trend in mortality for certain subgroups warrants further investigation into potential contributing factors such as healthcare access,treatment efficacy,and underlying socio-economic disparities.展开更多
BACKGROUND Viral hepatitis is characterized by a group of hepatotropic viruses that contribute to high rates of liver disease and mortality.It is well-documented that viral hepatitis is the leading cause of liver canc...BACKGROUND Viral hepatitis is characterized by a group of hepatotropic viruses that contribute to high rates of liver disease and mortality.It is well-documented that viral hepatitis is the leading cause of liver cancer and liver failure,with Hepatitis B and Hepatitis C being the most common viruses associated with these outcomes.AIM To study viral hepatitis-related mortality trends from 1999 to 2022,focusing on gender,race/ethnicity,age,region,and urban/rural classifications.METHODS We used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database to identify viral hepatitis-related deaths in the United States from 1999 to 2022.Data on demographic and regional information were analyzed and stratified by gender,race/ethnicity,age,regional,and urban rural classifications.Using the Joinpoint Regression Program(version 4.9.0.0 used,available from the National Cancer Institute,Bethesda,Maryland)the annual percentage change(APC)and average APC(AAPC)were calculated with 95%CI for extracted Age Adjusted Mortality Rates(AAMR).RESULTS From 1999 to 2022,there were 389916 viral hepatitis-related deaths in the United States.The overall AAMR increased from 1999 to 2013(APC:3.20%;95%CI:2.54-3.99;P<0.001),then declined through 2022(APC:-5.54%;95%CI:-6.75 to-4.47;P<0.001).Males accounted for 70.4%of deaths,with steeper declines in females(AAPC:-0.48%;95%CI:-0.87 to-0.12;P<0.05).The American Indian/Alaska Native population had the highest AAMR(AAPC:2.90%;95%CI:2.30 to 3.68;P<0.001).The population of 65-74 years had the largest increase in overall crude mortality rate(AAPC:3.20%;95%CI:2.77 to 3.85;P<0.001).Mortality was highest in the West(AAPC:-0.78%;95%CI-1.28 to-0.29;P<0.05).Rural AAMR exceeded urban rates after 2015.CONCLUSION This study found significant racial,ethnic,and geographical disparities in viral hepatitis AAMR.Key factors for mortality reduction include patient education,screening,and access to hepatitis vaccination and treatment.展开更多
Integrins are heterodimeric transmembrane receptors that mediate bidirectional interactions between the intracellular cytoskeletal array and the extracellularmatrix.These interactions are critical in tissue developmen...Integrins are heterodimeric transmembrane receptors that mediate bidirectional interactions between the intracellular cytoskeletal array and the extracellularmatrix.These interactions are critical in tissue development and function by regulating gene expression and sustaining tissue architecture.In humans,the integrin family is composed of 18 alpha(α)and 8 beta(β)subunits,constituting 24 distinctαβcombinations.Based on their structure and ligandbinding properties,only a subset of integrins,8 out of 24,recognizes the arginine-glycine-aspartate(RGD)tripeptide motif in the native ligand.One of the major RGD binding integrins is integrin alpha 8 beta 1(α8β1),a central Ras homolog gene familymemberA(RHOA)-dependentmodulator highly expressed in cells with contractile function.This review focuses on the recent advances regardingα8β1 function during organ development,with a particular interest in kidney and inner ear development.We alsodiscussα8β1’s role ininjury anddisease and its importance formesenchymal to epithelial transition during cancer development.Finally,we highlightα8β1’s importance for hearing function and its future use as a potential diagnostic and therapeutic tool for disease elimination.展开更多
BACKGROUND Hepatitis C virus(HCV)affects millions of individuals globally and is linked to dilated cardiomyopathy and hypertrophic cardiomyopathy via complex direct viral,immune,and metabolic mechanisms,often exacerba...BACKGROUND Hepatitis C virus(HCV)affects millions of individuals globally and is linked to dilated cardiomyopathy and hypertrophic cardiomyopathy via complex direct viral,immune,and metabolic mechanisms,often exacerbated by cirrhosis,increasing cardiovascular morbidity.AIM To review the pathogenesis of cardiomyopathy in patients infected with HCV and investigate its clinical implications.METHODS A narrative literature review(PubMed,Scopus,Google Scholar;1990–2024)focused on English-language studies examining the HCV–cardiomyopathy link,pathophysiology,and treatment.The findings were qualitatively synthesized.RESULTS HCV drives cardiomyopathy through direct viral toxicity,immune damage,genetic factors,and apoptosis.The associated cirrhosis contributes via cirrhotic cardiomyopathy mechanisms.Clinically,HCV increases cardiovascular events.Direct-acting antivirals(DAAs)generally improve cardiovascular outcomes by reducing adverse events and enhancing cardiac function.CONCLUSION HCV is a significant cardiomyopathy risk factor involving diverse pathways,including cirrhosis.DAA therapy offers cardiovascular benefits.Further research on the underlying mechanisms,biomarkers(e.g.,M2BPGi,Ang-2),and global DAA access is warranted.展开更多
Atrial fibrillation(AF)is a growing global health burden,with a prevalence of over 52.55 million cases.Rising disability-adjusted life-years,increasing age,and disparities in care have contributed to the worsening sev...Atrial fibrillation(AF)is a growing global health burden,with a prevalence of over 52.55 million cases.Rising disability-adjusted life-years,increasing age,and disparities in care have contributed to the worsening severity and mortality of AF.Modifiable risk factors,such as hypertension,obesity,and diabetes mellitus,are associated with alterations in gut microbiota,making the gut-heart axis a potential therapeutic target.Gut dysbiosis influences AF pathogenesis through inflam-mation,metabolic disruption,and autonomic dysfunction.Key mechanisms include gut barrier dysfunction,short-chain fatty acid(SCFA)depletion,lipopoly-saccharides(LPS)-induced inflammation,and ferroptosis-mediated atrial remodeling.Trimethylamine N-oxide,bile acids,and tryptophan metabolites contribute to arrhythmogenic remodeling.Emerging evidence suggests that dietary interventions,including prebiotics and probiotics,as well as gut surveillance,may help mitigate AF progression.Clinical implications of gut modulation in AF include person-alized dietary strategies,microbiome assessment through metagenomic sequencing,and targeted interventions such as SCFA-based therapies and ferroptosis inhibition.Metabolite surveillance,including LPS and indoxyl sulfate monitoring,may influence the effectiveness of anticoagulant and antiarrhythmic therapy.Despite growing mechanistic evidence linking gut dysbiosis to AF,clinical applications remain unexplored.This review summarizes the current understanding of the gut microbiome's role in AF.展开更多
Metabolic dysfunction-associated steatotic liver disease(MASLD)is the most common chronic liver disease with a continually rising global prevalence and significant mortality rates.Emerging evidence suggests a strong a...Metabolic dysfunction-associated steatotic liver disease(MASLD)is the most common chronic liver disease with a continually rising global prevalence and significant mortality rates.Emerging evidence suggests a strong association between MASLD and mental health disorders such as depression and anxiety.In addition to the shared risk factors such as obesity,type 2 diabetes and insulin resistance which contribute to this relationship through mechanisms involving systemic inflammation and oxidative stress;other pathophysiological mechanisms such as dysregulation of hypothalamic-pituitary-adrenal axis,neurotransmitter imbalances and gut dysbiosis have also been proposed to play a significant role.The current paper aims to review the pathophysiological mechanisms underlying the association between MASLD and mood disorders such as depression and anxiety.We note a bidirectional relationship between these two disorders,and the dual burden of both these disease processes can be alleviated by early detection and encouraging a more proactive and holistic approach through diet and lifestyle changes.This review summarizes the existing literature on association between MASLD and depression.展开更多
This review explores the emerging connection between psoriasis and atrial fibrillation(AF),focusing on shared inflammatory mechanisms,clinical implications,and research gaps.Psoriasis,characterized by chronic systemic...This review explores the emerging connection between psoriasis and atrial fibrillation(AF),focusing on shared inflammatory mechanisms,clinical implications,and research gaps.Psoriasis,characterized by chronic systemic inflammation,has been associated with increased AF risk,driven by elevated pro-inflammatory cytokines such as interleukin(IL)-6,IL-17,and tumor necrosis factor-alpha.These inflammatory mediators contribute to atrial remodeling,fibrosis,and conduction abnormalities,evidenced by prolonged P-wave dispersion and atrial electromechanical delay in psoriasis patients.Severe psoriasis further exacerbates atrial dysfunction,increasing susceptibility to AF.This review synthesizes existing epidemiological and biological data,highlighting the need for interdisciplinary management of psoriasis patients to mitigate cardiovascular risks.However,the reliance on observational studies limits definitive conclusions about causality.We emphasize the necessity for large-scale,multicenter research to validate these findings,investigate genetic predispositions,and evaluate lifestyle factors and AF burden.Future research should aim to delineate the pathophysiological link between psoriasis and AF.By examining the interplay of systemic inflammation,electrophysiological changes,and clinical outcomes,this review aims to advance understanding of the psoriasis-AF link and guide strategies for early detection,prevention,and management of AF in psoriasis patients.Comprehensive care integrating dermatology and cardiology is essential for improving patient outcomes.展开更多
Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous ma...Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous manifestations that may hold diagnostic and prognostic significance. Patients with BMES have reported localized erythema, dermal thickening, and induration overlying the affected joints, which are hypothesized to reflect microvascular compromise and inflammatory processes within the bone and adjacent soft tissues. Dermatologic signs are likely linked to regional hyperemia, venous stasis, and cytokine-mediated inflammation, paralleling the pathophysiological mechanisms underlying intraosseous edema. Elevated intraosseous pressure in BMES may disrupt local perfusion, resulting in ischemia-reperfusion injury and subsequent vascular leakage, which manifests in visible cutaneous changes. Pro-inflammatory mediators, such as interleukin-1β and vascular endothelial growth factor (VEGF), central to BMES pathogenesis, may exacerbate endothelial activation, and dermal involvement. Histopathologic studies of affected skin have revealed perivascular lymphocytic infiltration and increased dermal vascularity, further supporting the theory of a shared ischemic and inflammatory pathway between bone and skin. Although MRI remains the gold standard for BMES diagnosis, recognition of these cutaneous manifestations could expedite orthopedic referral and intervention, especially in cases where imaging is delayed or symptoms are ambiguous. Current treatment options, including bisphosphonates, prostacyclin analogs, and offloading of weight bearing, may benefit from integration with dermatologic strategies to alleviate localized cutaneous symptoms and improve patient comfort. Evaluating the molecular and vascular links between BMES and its cutaneous manifestations provides an opportunity to refine diagnostic protocols and therapeutic approaches, offering a comprehensive understanding of the systemic interplay between dermal and skeletal pathophysiology, and optimizing clinical outcomes for patients affected by BMES.展开更多
BACKGROUND Proton pump inhibitors(PPIs)are among the most commonly prescribed medications globally.While concerns exist regarding their association with adverse infection-related outcomes,their impact on coronavirus d...BACKGROUND Proton pump inhibitors(PPIs)are among the most commonly prescribed medications globally.While concerns exist regarding their association with adverse infection-related outcomes,their impact on coronavirus disease 2019(COVID-19)severity remains uncertain.Emerging preclinical data suggest immunomodulatory and antiviral properties of PPIs,yet clinical evidence is conflicting.AIM To investigate whether chronic pre-hospital PPI use is associated with improved outcomes in patients hospitalized with COVID-19.METHODS We conducted a retrospective case-control study of adult inpatients with severe acute respiratory syndrome coronavirus 2 infection admitted to a racially and ethnically diverse communityhospital in Massachusetts from July 2021 to March 2022. Patients were stratified by documented pre-hospital PPIuse. The primary outcomes were intensive care unit (ICU) admission, need for invasive mechanical ventilation, andin-hospital mortality. Multivariable logistic regression was used to adjust for demographics, comorbidities, andtreatment variables. Significance was set at P < 0.05.RESULTSAmong 248 patients, 83 (33.4%) were on PPIs prior to hospitalization. Compared to non-users, PPI users hadsignificantly lower rates of ICU admission (13.3% vs 24.8%, P = 0.034), mechanical ventilation (13.3% vs 25.5%, P =0.027), and in-hospital mortality (6.0% vs 17.6%, P = 0.013). Multivariable analysis confirmed these associations:ICU admission [adjusted odds ratios (aOR): 0.462, 95%CI: 0.223–0.955], mechanical ventilation (aOR: 0.447, 95%CI:0.216–0.923), and mortality (aOR: 0.144, 95%CI: 0.031–0.677). Findings were consistent across demographic andcomorbidity strata.CONCLUSIONIn this diverse, real-world United States cohort, chronic pre-hospital PPI use was independently associated withlower odds of intensive care unit admission, mechanical ventilation, and mortality among COVID-19 inpatients.These findings highlight a potentially protective role of PPIs and support continued therapy in eligible patients.展开更多
Metabolic dysfunction-associated steatotic liver disease(MASLD)significantly contributes to cardiovascular morbidity,with cardiovascular disease being the leading cause of mortality among affected individuals.Atrial f...Metabolic dysfunction-associated steatotic liver disease(MASLD)significantly contributes to cardiovascular morbidity,with cardiovascular disease being the leading cause of mortality among affected individuals.Atrial fibrillation(AF),the most common cardiac arrhythmia,is frequently observed in patients with MASLD.While shared metabolic risk factors such as obesity,diabetes,dyslipidemia,and hypertension are implicated,underlying pathophysiological mechanisms that include systemic inflammation,oxidative stress,insulin resistance,endothelial dysfunction,and activation of the renin-angiotensin-aldosterone system(RAAS)are proposed to play significant part in the increased risk of AF in MASLD.The aim is to review the pathogenesis linking MASLD and AF.A comprehensive literature review was conducted,focusing on studies that explore the epidemiology,pathogenesis,and clinical implications of MASLD and AF.Databases searched included PubMed,Scopus,and Web of Science,with keywords such as"metabolic associated steatotic liver disease","non fibrotic metabolic associated steatohepatitis","Nonalcoholic fatty liver disease","metabolic syndrome","atrial fibrillation","antifibrotic therapies","pathogenesis",and"cardiovascular risk".Chronic low-grade inflammation and oxidative stress in MASLD contribute to atrial structural and electrical remodeling,fostering an arrhythmogenic substrate.Insulin resistance,a hallmark of MASLD,exacerbates metabolic dysfunction and promotes atrial fibrosis.Dysregulated lipid metabolism and gut microbiota alterations further compound cardiovascular risk.Aldosterone dysregulation and systemic inflammation stemming from RAAS activation contributes to the shared pathophysiology.The severity of MASLD does not seem to directly influence the risk of AF,suggesting that even early stages of liver disease can increase susceptibility to this arrhythmia.Effective management of MASLD requires targeted risk-factor modification strategies,including weight management,glycemic control,and pharmacological interventions.A multidisciplinary approach is essential for comprehensive assessment and management of MASLD patients,with a focus on cardiovascular risk assessment and arrhythmia prevention.Future research should explore the impact of emerging MASLD therapeutic agents on the incidence and recurrence of cardiac arrhythmias.Early detection and comprehensive management of MASLD and AF are crucial to mitigate the dual burden of these conditions.展开更多
Objective:To determine the effect of management before and during transplantation on the quality of donated organs.Improvement of preservation methods in cases involving brain death will lead to more effective organ p...Objective:To determine the effect of management before and during transplantation on the quality of donated organs.Improvement of preservation methods in cases involving brain death will lead to more effective organ procurement.Methods:Data were collected from the 226 brain death cases enrolled in the 12-month study period.All cases,patients with a Glasgow Coma Scale(GCS)score of 3 points,appropriate age,and having medical indications for organ donation,were considered to confirm the criteria of brain death.Transplant outcome data were obtained from the transplant centers.Results:The age of the deceased ranged between 1 year and 68 years,with a mean±SD of 39.54±17.28 years.There was no significant difference between the quality of organs regarding blood group and cause of brain death(P>0.05).However,there was a significant difference in the quality of organs regarding age,body mass index(BMI),and gender.There was a significant difference between the level of urea at admission time and procurement time(P<0.001),as well as between creatinine level at admission time and procurement time(P<0.001).There was also a significant difference between aspartate aminotransferase(AST)at admission time and procurement time(P<0.001),and between alanine aminotransferase(ALT)at admission time and procurement time(P<0.001).Conclusions:Transplant outcomes using older donor livers and kidneys were comparable to those using younger or male donors.These findings provide further evidence that decision-making about organ quality is influenced by age and gender and emphasize the importance of transparency in organ acceptance practices.展开更多
文摘Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.
文摘Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced EUS.Clinical studies have reported varying diagnostic and adverse event rates with these modalities.In addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations.In this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.
文摘When kidney function declines to a point where it can no longer maintain life and requires renal replacement therapy(i.e.renal transplant or dialysis),it is called end-stage renal disease(ESRD).Patients with ESRD often experience a range of gastrointestinal(GI)symptoms,with prevalence rates reported as high as 77%-79%.These symptoms and pathologies arise from various factors,including electrolyte imbalance,fluid imbalance,toxin buildup,uremia,medications,dietary and lifestyle restrictions,and the effects of dialysis.GI diseases in patients with renal failure can be further categorized into upper GI,small bowel,and lower GI issues.Common conditions include gastroesophageal reflux disease,nausea and vomiting,dysmotility within the esophagus and stomach,upper GI bleeding,peptic ulcer bleeding,angioectasia,irritable bowel syndrome,mesen-teric ischemia,angiodysplasia,diverticular disease,constipation,pancreatitis,and diseases associated with peritoneal dialysis peritonitis and peritoneal stenosis.This review assesses the existing literature on the different GI diseases among individuals with ESRD,shedding light on their pathophysiology and prevalence.
文摘Liver transplantation(LT)is the definitive treatment for end-stage liver disease,acute liver failure,and liver cancer.Although advancements in surgical techniques,postoperative care,and immunosuppressive therapies have significantly improved outcomes,the long-term use of immunosuppression has increased the risk of complications,including infections,cardiovascular disease,and cancer.Among these,de novo malignancies(DNMs)are a major concern,accounting for 20%-25%of deaths in LT recipients surviving beyond the early post-transplant period.Non-melanoma skin cancers,particularly squamous cell carcinoma are the most prevalent DNMs.Other significant malignancies include Kaposi's sarcoma,post-transplant lymphoproliferative disorders,and various solid organ cancers,including head and neck cancers.Compared to the general population,LT patients face a twofold increase in solid organ malignancies and a 30-fold increase in lymphoproliferative disorders.Risk factors for DNM include chronic immunosuppression,alcohol or tobacco use,viral infections,and underlying liver disease.Emerging evidence emphasizes the importance of tailored cancer screening and prevention strategies,including regular dermatological examinations,targeted screenings for high-risk cancers,and patient education on lifestyle modifications.Early detection through enhanced surveillance protocols has been shown to improve outcomes.Management of DNMs involves a combination of standard oncological therapies and adjustments to immunosuppressive regimens,with promising results from the use of mTOR inhibitors in select patients.The review highlights the critical need for ongoing research to refine risk stratification,optimize screening protocols,and improve treatment approaches to mitigate the burden of DNMs in LT recipients.By implementing personalized preventive and therapeutic strategies,we can enhance long-term outcomes and quality of life for this vulnerable population.
文摘Human immunodeficiency virus(HIV)modifies CD4-positive cells,resulting in immunodeficiency and a wide range of gastrointestinal(GI)manifestations.The burden of HIV-related GI illnesses has significantly evolved with the widespread use of antiretroviral therapy(ART).While ART has effectively reduced the occurrence of opportunistic infections,it has led to an increase in therapy-related GI illnesses.Common esophageal conditions in HIV patients include gastroesophageal reflux disease,idiopathic esophageal ulcers,herpes simplex virus,cytomegalovirus(CMV),and candidal esophagitis.Kaposi’s sarcoma,a hallmark of acquired immunodeficiency syndrome,may affect the entire GI system.Gastritis and peptic ulcer disease are also frequently seen in patients with HIV.Diarrhea,often linked to both opportunistic infections and ART,requires careful evaluation.Bloody diarrhea,often a sign of colitis caused by bacterial infections such as Shigella or Clostridium difficile,is prevalent.Small bowel lymphoma,although rare,is increasing in prevalence.Anorectal disorders,including proctitis,fissures,and anal squamous cell carcinoma,are particularly relevant in homosexual men,underlining the importance of timely diagnosis.This review comprehensively explores the epidemiology,pathogenesis,and treatment considerations for the various GI disorders associated with HIV,highlighting the importance of accurate diagnosis and effective treatment to improve outcomes for HIV-infected patients.
文摘Critically ill patients have a variety of complex pathologies and are in a multifarious state of catabolism supplanted by external and internal factors.Early enteral nutrition(EEN)is defined as the initiation of enteral feeding within 24-48 hours of hospitalization.Previous studies show the benefits of EEN include supporting the healing process through preservation of the gut mucosa,modulation of the immune response,and suppression of inflammation.However,recent studies suggest the advantages of EEN may not be as robust as previously believed.This review aims to discuss the outcomes of EEN when used in different critical care settings while managing complex disease states such as burns,sepsis,pancreatitis,and upper gastrointestinal bleeding.Evidence indicates that EEN has a positive impact on patient outcomes,hospital costs,length of intensive care unit stay,and preventing complications.
文摘BACKGROUND Esophageal cancer is a significant global health concern,characterized by high mortality rates and diverse histological types,primarily adenocarcinoma and squamous cell carcinoma.AIM To analyze trends in esophageal cancer using Surveillance,Epidemiology,and End Results(SEER)data,focusing on patient characteristics,stage at diagnosis,treatment modalities,and survival outcomes,to provide insights that may guide clinical practice and public health initiatives.METHODS Age-adjusted incidence and mortality rates for esophageal cancer,2004-2021,were obtained from SEER rate sessions using SEER*Stat version 8.4.4.Average percent changes(APC)over time in age-adjusted incidence and mortality rates relative to gender,race/ethnicity,and stage at diagnosis were assessed using Joinpoint’s loglinear regression.Finally,Poisson regression was used to ascertain incidence and mortality rate ratios to ascertain associations between age,gender,race/ethnicity,and staging with incidence and mortality rates.All analyses were further stratified by gender to assess interactions between gender and the other demographic and clinical characteristics.RESULTS Overall,the data reveals significant trends in both the incidence and mortality rates of esophageal cancer,with notable variations across gender,race,and stage at diagnosis.Age-adjusted incidence and mortality rates were higher in males compared to females(incidence:4.1 per 100000 vs 0.9 per 100000,mortality:3.4 per 100000 vs 0.7 per 100000),P<0.001.Furthermore,the APC among males decreased more significantly over time[APC(95%CI):-1.14(-1.52 to-0.78);P<0.001].Both non-Hispanic(NH)Blacks and NH Whites showed significant decreases in cancer incidence,with NH Blacks observing a 3.27%decline and NH Whites a 0.51%decline.Patients with distant staging had a 5%APC increase in mortality rates over time(P=0.003).Additionally,mortality rates increased with age,and all minority groups showed declines in incidence and mortality compared to NH Whites.Cancer diagnosed at a distant stage had a mortality rate 4.16 times higher than in situ cases.CONCLUSION The analysis reveals clear disparities in both the incidence and mortality of esophageal cancer,with males,particularly NH Whites,experiencing significantly higher rates than females.Despite a general decline in incidence rates over time,the upward trend in mortality for certain subgroups warrants further investigation into potential contributing factors such as healthcare access,treatment efficacy,and underlying socio-economic disparities.
文摘BACKGROUND Viral hepatitis is characterized by a group of hepatotropic viruses that contribute to high rates of liver disease and mortality.It is well-documented that viral hepatitis is the leading cause of liver cancer and liver failure,with Hepatitis B and Hepatitis C being the most common viruses associated with these outcomes.AIM To study viral hepatitis-related mortality trends from 1999 to 2022,focusing on gender,race/ethnicity,age,region,and urban/rural classifications.METHODS We used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database to identify viral hepatitis-related deaths in the United States from 1999 to 2022.Data on demographic and regional information were analyzed and stratified by gender,race/ethnicity,age,regional,and urban rural classifications.Using the Joinpoint Regression Program(version 4.9.0.0 used,available from the National Cancer Institute,Bethesda,Maryland)the annual percentage change(APC)and average APC(AAPC)were calculated with 95%CI for extracted Age Adjusted Mortality Rates(AAMR).RESULTS From 1999 to 2022,there were 389916 viral hepatitis-related deaths in the United States.The overall AAMR increased from 1999 to 2013(APC:3.20%;95%CI:2.54-3.99;P<0.001),then declined through 2022(APC:-5.54%;95%CI:-6.75 to-4.47;P<0.001).Males accounted for 70.4%of deaths,with steeper declines in females(AAPC:-0.48%;95%CI:-0.87 to-0.12;P<0.05).The American Indian/Alaska Native population had the highest AAMR(AAPC:2.90%;95%CI:2.30 to 3.68;P<0.001).The population of 65-74 years had the largest increase in overall crude mortality rate(AAPC:3.20%;95%CI:2.77 to 3.85;P<0.001).Mortality was highest in the West(AAPC:-0.78%;95%CI-1.28 to-0.29;P<0.05).Rural AAMR exceeded urban rates after 2015.CONCLUSION This study found significant racial,ethnic,and geographical disparities in viral hepatitis AAMR.Key factors for mortality reduction include patient education,screening,and access to hepatitis vaccination and treatment.
基金supported by NIH-NIDCD,5R01DC21070-0,and Creighton University’s Start-up funds to MZMs.Iman Ezzat was supported by the Department of Biomedical Sciences at Creighton University and the Bellucci Foundation pre-doctoral award.
文摘Integrins are heterodimeric transmembrane receptors that mediate bidirectional interactions between the intracellular cytoskeletal array and the extracellularmatrix.These interactions are critical in tissue development and function by regulating gene expression and sustaining tissue architecture.In humans,the integrin family is composed of 18 alpha(α)and 8 beta(β)subunits,constituting 24 distinctαβcombinations.Based on their structure and ligandbinding properties,only a subset of integrins,8 out of 24,recognizes the arginine-glycine-aspartate(RGD)tripeptide motif in the native ligand.One of the major RGD binding integrins is integrin alpha 8 beta 1(α8β1),a central Ras homolog gene familymemberA(RHOA)-dependentmodulator highly expressed in cells with contractile function.This review focuses on the recent advances regardingα8β1 function during organ development,with a particular interest in kidney and inner ear development.We alsodiscussα8β1’s role ininjury anddisease and its importance formesenchymal to epithelial transition during cancer development.Finally,we highlightα8β1’s importance for hearing function and its future use as a potential diagnostic and therapeutic tool for disease elimination.
文摘BACKGROUND Hepatitis C virus(HCV)affects millions of individuals globally and is linked to dilated cardiomyopathy and hypertrophic cardiomyopathy via complex direct viral,immune,and metabolic mechanisms,often exacerbated by cirrhosis,increasing cardiovascular morbidity.AIM To review the pathogenesis of cardiomyopathy in patients infected with HCV and investigate its clinical implications.METHODS A narrative literature review(PubMed,Scopus,Google Scholar;1990–2024)focused on English-language studies examining the HCV–cardiomyopathy link,pathophysiology,and treatment.The findings were qualitatively synthesized.RESULTS HCV drives cardiomyopathy through direct viral toxicity,immune damage,genetic factors,and apoptosis.The associated cirrhosis contributes via cirrhotic cardiomyopathy mechanisms.Clinically,HCV increases cardiovascular events.Direct-acting antivirals(DAAs)generally improve cardiovascular outcomes by reducing adverse events and enhancing cardiac function.CONCLUSION HCV is a significant cardiomyopathy risk factor involving diverse pathways,including cirrhosis.DAA therapy offers cardiovascular benefits.Further research on the underlying mechanisms,biomarkers(e.g.,M2BPGi,Ang-2),and global DAA access is warranted.
文摘Atrial fibrillation(AF)is a growing global health burden,with a prevalence of over 52.55 million cases.Rising disability-adjusted life-years,increasing age,and disparities in care have contributed to the worsening severity and mortality of AF.Modifiable risk factors,such as hypertension,obesity,and diabetes mellitus,are associated with alterations in gut microbiota,making the gut-heart axis a potential therapeutic target.Gut dysbiosis influences AF pathogenesis through inflam-mation,metabolic disruption,and autonomic dysfunction.Key mechanisms include gut barrier dysfunction,short-chain fatty acid(SCFA)depletion,lipopoly-saccharides(LPS)-induced inflammation,and ferroptosis-mediated atrial remodeling.Trimethylamine N-oxide,bile acids,and tryptophan metabolites contribute to arrhythmogenic remodeling.Emerging evidence suggests that dietary interventions,including prebiotics and probiotics,as well as gut surveillance,may help mitigate AF progression.Clinical implications of gut modulation in AF include person-alized dietary strategies,microbiome assessment through metagenomic sequencing,and targeted interventions such as SCFA-based therapies and ferroptosis inhibition.Metabolite surveillance,including LPS and indoxyl sulfate monitoring,may influence the effectiveness of anticoagulant and antiarrhythmic therapy.Despite growing mechanistic evidence linking gut dysbiosis to AF,clinical applications remain unexplored.This review summarizes the current understanding of the gut microbiome's role in AF.
文摘Metabolic dysfunction-associated steatotic liver disease(MASLD)is the most common chronic liver disease with a continually rising global prevalence and significant mortality rates.Emerging evidence suggests a strong association between MASLD and mental health disorders such as depression and anxiety.In addition to the shared risk factors such as obesity,type 2 diabetes and insulin resistance which contribute to this relationship through mechanisms involving systemic inflammation and oxidative stress;other pathophysiological mechanisms such as dysregulation of hypothalamic-pituitary-adrenal axis,neurotransmitter imbalances and gut dysbiosis have also been proposed to play a significant role.The current paper aims to review the pathophysiological mechanisms underlying the association between MASLD and mood disorders such as depression and anxiety.We note a bidirectional relationship between these two disorders,and the dual burden of both these disease processes can be alleviated by early detection and encouraging a more proactive and holistic approach through diet and lifestyle changes.This review summarizes the existing literature on association between MASLD and depression.
文摘This review explores the emerging connection between psoriasis and atrial fibrillation(AF),focusing on shared inflammatory mechanisms,clinical implications,and research gaps.Psoriasis,characterized by chronic systemic inflammation,has been associated with increased AF risk,driven by elevated pro-inflammatory cytokines such as interleukin(IL)-6,IL-17,and tumor necrosis factor-alpha.These inflammatory mediators contribute to atrial remodeling,fibrosis,and conduction abnormalities,evidenced by prolonged P-wave dispersion and atrial electromechanical delay in psoriasis patients.Severe psoriasis further exacerbates atrial dysfunction,increasing susceptibility to AF.This review synthesizes existing epidemiological and biological data,highlighting the need for interdisciplinary management of psoriasis patients to mitigate cardiovascular risks.However,the reliance on observational studies limits definitive conclusions about causality.We emphasize the necessity for large-scale,multicenter research to validate these findings,investigate genetic predispositions,and evaluate lifestyle factors and AF burden.Future research should aim to delineate the pathophysiological link between psoriasis and AF.By examining the interplay of systemic inflammation,electrophysiological changes,and clinical outcomes,this review aims to advance understanding of the psoriasis-AF link and guide strategies for early detection,prevention,and management of AF in psoriasis patients.Comprehensive care integrating dermatology and cardiology is essential for improving patient outcomes.
文摘Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous manifestations that may hold diagnostic and prognostic significance. Patients with BMES have reported localized erythema, dermal thickening, and induration overlying the affected joints, which are hypothesized to reflect microvascular compromise and inflammatory processes within the bone and adjacent soft tissues. Dermatologic signs are likely linked to regional hyperemia, venous stasis, and cytokine-mediated inflammation, paralleling the pathophysiological mechanisms underlying intraosseous edema. Elevated intraosseous pressure in BMES may disrupt local perfusion, resulting in ischemia-reperfusion injury and subsequent vascular leakage, which manifests in visible cutaneous changes. Pro-inflammatory mediators, such as interleukin-1β and vascular endothelial growth factor (VEGF), central to BMES pathogenesis, may exacerbate endothelial activation, and dermal involvement. Histopathologic studies of affected skin have revealed perivascular lymphocytic infiltration and increased dermal vascularity, further supporting the theory of a shared ischemic and inflammatory pathway between bone and skin. Although MRI remains the gold standard for BMES diagnosis, recognition of these cutaneous manifestations could expedite orthopedic referral and intervention, especially in cases where imaging is delayed or symptoms are ambiguous. Current treatment options, including bisphosphonates, prostacyclin analogs, and offloading of weight bearing, may benefit from integration with dermatologic strategies to alleviate localized cutaneous symptoms and improve patient comfort. Evaluating the molecular and vascular links between BMES and its cutaneous manifestations provides an opportunity to refine diagnostic protocols and therapeutic approaches, offering a comprehensive understanding of the systemic interplay between dermal and skeletal pathophysiology, and optimizing clinical outcomes for patients affected by BMES.
文摘BACKGROUND Proton pump inhibitors(PPIs)are among the most commonly prescribed medications globally.While concerns exist regarding their association with adverse infection-related outcomes,their impact on coronavirus disease 2019(COVID-19)severity remains uncertain.Emerging preclinical data suggest immunomodulatory and antiviral properties of PPIs,yet clinical evidence is conflicting.AIM To investigate whether chronic pre-hospital PPI use is associated with improved outcomes in patients hospitalized with COVID-19.METHODS We conducted a retrospective case-control study of adult inpatients with severe acute respiratory syndrome coronavirus 2 infection admitted to a racially and ethnically diverse communityhospital in Massachusetts from July 2021 to March 2022. Patients were stratified by documented pre-hospital PPIuse. The primary outcomes were intensive care unit (ICU) admission, need for invasive mechanical ventilation, andin-hospital mortality. Multivariable logistic regression was used to adjust for demographics, comorbidities, andtreatment variables. Significance was set at P < 0.05.RESULTSAmong 248 patients, 83 (33.4%) were on PPIs prior to hospitalization. Compared to non-users, PPI users hadsignificantly lower rates of ICU admission (13.3% vs 24.8%, P = 0.034), mechanical ventilation (13.3% vs 25.5%, P =0.027), and in-hospital mortality (6.0% vs 17.6%, P = 0.013). Multivariable analysis confirmed these associations:ICU admission [adjusted odds ratios (aOR): 0.462, 95%CI: 0.223–0.955], mechanical ventilation (aOR: 0.447, 95%CI:0.216–0.923), and mortality (aOR: 0.144, 95%CI: 0.031–0.677). Findings were consistent across demographic andcomorbidity strata.CONCLUSIONIn this diverse, real-world United States cohort, chronic pre-hospital PPI use was independently associated withlower odds of intensive care unit admission, mechanical ventilation, and mortality among COVID-19 inpatients.These findings highlight a potentially protective role of PPIs and support continued therapy in eligible patients.
文摘Metabolic dysfunction-associated steatotic liver disease(MASLD)significantly contributes to cardiovascular morbidity,with cardiovascular disease being the leading cause of mortality among affected individuals.Atrial fibrillation(AF),the most common cardiac arrhythmia,is frequently observed in patients with MASLD.While shared metabolic risk factors such as obesity,diabetes,dyslipidemia,and hypertension are implicated,underlying pathophysiological mechanisms that include systemic inflammation,oxidative stress,insulin resistance,endothelial dysfunction,and activation of the renin-angiotensin-aldosterone system(RAAS)are proposed to play significant part in the increased risk of AF in MASLD.The aim is to review the pathogenesis linking MASLD and AF.A comprehensive literature review was conducted,focusing on studies that explore the epidemiology,pathogenesis,and clinical implications of MASLD and AF.Databases searched included PubMed,Scopus,and Web of Science,with keywords such as"metabolic associated steatotic liver disease","non fibrotic metabolic associated steatohepatitis","Nonalcoholic fatty liver disease","metabolic syndrome","atrial fibrillation","antifibrotic therapies","pathogenesis",and"cardiovascular risk".Chronic low-grade inflammation and oxidative stress in MASLD contribute to atrial structural and electrical remodeling,fostering an arrhythmogenic substrate.Insulin resistance,a hallmark of MASLD,exacerbates metabolic dysfunction and promotes atrial fibrosis.Dysregulated lipid metabolism and gut microbiota alterations further compound cardiovascular risk.Aldosterone dysregulation and systemic inflammation stemming from RAAS activation contributes to the shared pathophysiology.The severity of MASLD does not seem to directly influence the risk of AF,suggesting that even early stages of liver disease can increase susceptibility to this arrhythmia.Effective management of MASLD requires targeted risk-factor modification strategies,including weight management,glycemic control,and pharmacological interventions.A multidisciplinary approach is essential for comprehensive assessment and management of MASLD patients,with a focus on cardiovascular risk assessment and arrhythmia prevention.Future research should explore the impact of emerging MASLD therapeutic agents on the incidence and recurrence of cardiac arrhythmias.Early detection and comprehensive management of MASLD and AF are crucial to mitigate the dual burden of these conditions.
文摘Objective:To determine the effect of management before and during transplantation on the quality of donated organs.Improvement of preservation methods in cases involving brain death will lead to more effective organ procurement.Methods:Data were collected from the 226 brain death cases enrolled in the 12-month study period.All cases,patients with a Glasgow Coma Scale(GCS)score of 3 points,appropriate age,and having medical indications for organ donation,were considered to confirm the criteria of brain death.Transplant outcome data were obtained from the transplant centers.Results:The age of the deceased ranged between 1 year and 68 years,with a mean±SD of 39.54±17.28 years.There was no significant difference between the quality of organs regarding blood group and cause of brain death(P>0.05).However,there was a significant difference in the quality of organs regarding age,body mass index(BMI),and gender.There was a significant difference between the level of urea at admission time and procurement time(P<0.001),as well as between creatinine level at admission time and procurement time(P<0.001).There was also a significant difference between aspartate aminotransferase(AST)at admission time and procurement time(P<0.001),and between alanine aminotransferase(ALT)at admission time and procurement time(P<0.001).Conclusions:Transplant outcomes using older donor livers and kidneys were comparable to those using younger or male donors.These findings provide further evidence that decision-making about organ quality is influenced by age and gender and emphasize the importance of transparency in organ acceptance practices.
