BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM ...BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM To explore the correlations among life satisfaction,pleasure levels,and negative emotions in patients with CRF.METHODS One hundred patients with CRF who received therapy at the First Affiliated Hospital of Jinzhou Medical University between December 2022 and February 2025 were included.The Depression,Anxiety,and Stress Scale(DASS-21),Satisfaction with Life Scale(SWLS),and Temporal Experience of Pleasure Scale(TEPS)were used to evaluate negative emotions,life satisfaction,and pleasure level,respectively.Pearson’s correlation coefficient analyzed the correlation between life satisfaction,pleasure level,and negative emotions.Linear regression analysis identified the factors affecting negative emotions.RESULTS The average DASS-21 score among patients with CRF was 51.90±2.30,with subscale scores of 17.90±1.50 for depression,18.53±1.18 for anxiety,and 15.47±2.36 for stress,all significantly higher than the domestic norm(P<0.05).The average SWLS score was 22.17±4.90.Correlation analysis revealed a negative correlation between the SWLS and total DASS-21 scores(P<0.05),but not with the individual depression,anxiety,or stress dimensions.The average TEPS score was 67.80±8.34.TEPS scores were negatively correlated with the DASS-21 score and the stress dimension(P<0.05),but not with depression or anxiety.Linear regression analysis showed that TEPS scores significantly influenced DASS-21 scores(P<0.05).CONCLUSION Patients with CRF experience high levels of negative emotions,which are negatively correlated with life satisfaction and pleasure.Furthermore,pleasure level had an impact on negative emotions.展开更多
Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenv...Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenvatinib and everolimus represents a viable option,and the present review aimed to summarize its activity,effectiveness,and safety.Methods:A systematic review of the literature was conducted using PubMed,targeting studies published between 2018 and 2025.Eligible studies included English-language prospective and retrospective trials reporting survival outcomes in mRCC patients treated with lenvatinib and everolimus after at least one ICI-containing regimen.Results:Nine studies met the inclusion criteria,encompassing a total of 441 patients.The lenvatinib and everolimus combination was primarily used in the third and subsequent lines of therapy.Median overall survival ranged from 7.5 to 24.5 months,while median progression-free survival was more consistent,between 6.1 and 6.7 months,except for one study reporting 12.9 months.Objective response rates varied widely(14.0%–55.7%).Adverse events of grade≥3 did not exceed the expected rate,with diarrhoea and proteinuria as the most reported events.Dose reductions and treatment discontinuations due to toxicity occurred but were generally lower than in prior pivotal trials.Conclusions:Real-world evidence suggests that lenvatinib and everolimus represent an effective and safe option after ICI failure in mRCC patients.Nevertheless,the lack of randomized phase III trials and the heterogeneity of existing studies highlight the need for more robust prospective research to guide post-ICI therapeutic strategies.展开更多
Glyphosate(GLY),a widely used herbicide,has been extensively applied in both the agricultural and non-agricultural sectors worldwide.The rate of GLY use varies considerably depending on the crop type and local farming...Glyphosate(GLY),a widely used herbicide,has been extensively applied in both the agricultural and non-agricultural sectors worldwide.The rate of GLY use varies considerably depending on the crop type and local farming practices,which can be up to approximately 53.5%of agricultural land in certain regions.展开更多
Elaidic acid(EA)is a typical trans fatty acid(TFA)that emerges during the processing of various fatty foods.In this study,we found that EA induced renal injury with necroptosis.Pretreatment with a reactive oxygen spec...Elaidic acid(EA)is a typical trans fatty acid(TFA)that emerges during the processing of various fatty foods.In this study,we found that EA induced renal injury with necroptosis.Pretreatment with a reactive oxygen species(ROS)inhibitor and a RIPK3 inhibitor alleviated EA-induced necroptosis.The data indicated that EA induced renal necroptosis through ROS/RIPK3/MLKL pathway.In mechanistic studies,we explored how EA induced ROS production.Results indicated that EA caused mitochondrial damage by testing MMP,MFN1,VDAC,and FIS1.Further,EA suppressed mitophagy by testing the levels of LC3,p62,PINK1,Parkin,colocalization of LC3 and Mito-Tracker Red.Mitophagy is a process of selective degradation of damaged mitochondria.A large number of damaged mitochondria couldn't be cleared by mitophagy in time,which increased ROS levels in renal cells.Pretreatment with a mitophagy activator decreased EA-induced ROS levels and mitochondrial damage.Taken together,our data identified that EA induced renal necroptosis by destroying mitochondria and inhibiting mitophagy,thereby activating the ROS/RIPK3/MLKL pathway.展开更多
BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular ana...BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.展开更多
BACKGROUND Complement-mediated thrombotic microangiopathy(TMA)is a rare endothelial injury syndrome caused by dysregulated activation of the alternative complement pathway,often linked to genetic abnormalities in comp...BACKGROUND Complement-mediated thrombotic microangiopathy(TMA)is a rare endothelial injury syndrome caused by dysregulated activation of the alternative complement pathway,often linked to genetic abnormalities in complement factor H(CFH),complement factor I,or complement factor H-related(CFHR)proteins.Both renal transplantation and pregnancy are independent triggers for recurrence.This case highlights a genetically high-risk patient who achieved a successful term pregnancy after renal transplantation without complement inhibition,emphasizing individualized risk stratification,close surveillance,and multidisciplinary management for favourable maternal and graft outcomes.CASE SUMMARY A 32-year-old woman with end-stage renal disease secondary to genetically confirmed complement-mediated TMA—homozygous CFH exon 17 deletion and CFHR3-CFHR1 duplication—was maintained on dialysis for 2.5 years before undergoing a successful live-donor kidney transplant from her mother.Post-transplant immunosuppression included tacrolimus,mycophenolate mofetil,and prednisolone,later modified to azathioprine during pregnancy planning.One-year post-transplant,she conceived spontaneously.Pregnancy was complicated by transient gestational hypertension,controlled with nifedipine,labetalol,and amlodipine.Proteinuria remained<150 mg/day;white blood cell counts 5.8-7.2×109/L without cytopenia.Serum creatinine ranged 0.9-1.1 mg/dL,and tacrolimus trough levels 5-7 ng/mL.At 36 weeks,she delivered a healthy 3 kg infant by elective caesarean section.Postpartum follow-up at three months confirmed stable maternal and graft function.CONCLUSION High-risk complement-mediated TMA patients can achieve successful pregnancy post-transplant through individualized care without mandatory complement blockade.展开更多
BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdia...BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdiagnosis and missed diagnosis.Additionally,this disease is difficult to treat,often requiring months or even years of antibacterial therapy,and can be fatal in patients with underlying conditions.CASE SUMMARY A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb.As a result of an initial misdiagnosis and inadequate treatment,the infection progressed,resulting in multiple rashes on his right upper limb.Local incision and drainage of pus,combined with oral antibiotics administered at a different hospital,yielded no significant improvement.Upon hospitalization,the patient’s immune function was assessed,and further local incision and drainage were performed.Cultures of the pus identified Nocardia brasiliensis.Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim,leading to the patient’s recovery.After discharge,the patient continued to take sulfamethoxazole tablets for 6 months,with complete healing of the skin lesions and no recurrence.CONCLUSION Nocardiosis should be considered in patients with underlying conditions and compromised immunity.Prompt and accurate diagnosis is crucial.展开更多
BACKGROUND Research examining the relationships among anxiety,depression,self-perceived burden(SPB),and psychological resilience(PR),along with the determinants of PR,in patients with chronic renal failure(CRF)receivi...BACKGROUND Research examining the relationships among anxiety,depression,self-perceived burden(SPB),and psychological resilience(PR),along with the determinants of PR,in patients with chronic renal failure(CRF)receiving maintenance hemodia-lysis(MHD)is limited.AIM To investigate the correlation between anxiety,depression,SPB,and PR in pati-ents with CRF on MHD.METHODS This study included 225 patients with CRF on MHD who were admitted between June 2021 and June 2024.The anxiety level was evaluated using the Self-Rating Anxiety Scale(SAS);the depression status was assessed using the Self-Rating Depression Scale(SDS);the SPB was measured using the SPB Scale(SPBS);and the PR was determined using the Connor–Davidson Resilience Scale(CD-RISC).The correlations among the SAS,SDS,SPB,and CD-RISC were analyzed using Pearson’s correlation coefficients.Univariate and multivariate analyses were performed to identify the factors that influence the PR of patients with CRF on MHD.RESULTS The SAS,SDS,SPB,and CD-RISC scores of the 225 patients were 45.25±15.36,54.81±14.68,32.31±11.52,and 66.48±9.18,respectively.Significant negative correlations were observed between SAS,SDS,SPB,and CD-RISC.Furthermore,longer dialysis vintage(P=0.015),the absence of religious beliefs(P=0.020),lower monthly income(P=0.008),higher SAS score(P=0.013),and higher SDS score(P=0.006)were all independent factors that adversely affected the PR of patients with CRF on MHD.CONCLUSION Patients with CRF on MHD present with varying degrees of anxiety,depression,and SPB,all of which exhibit a significant negative correlation with their PR.Moreover,longer dialysis vintage,the absence of religious beliefs,lower monthly income,higher SAS score,and higher SDS score were factors that negatively affected the PR of patients with CRF on MHD.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
Renal cell carcinoma is a heterogeneous group of renal tumors characterized by several histological subtypes.Herein,we discuss an unusual case of a 55-year-old male who presented as a consultation to our urology clini...Renal cell carcinoma is a heterogeneous group of renal tumors characterized by several histological subtypes.Herein,we discuss an unusual case of a 55-year-old male who presented as a consultation to our urology clinic with an incidentally found renal mass.After shared decision making patient proceeded with a Robotic Assisted Laparoscopy(RAL)left sided partial nephrectomy.Final pathology confirmed the presence of high nuclear grade mixed clear cell and papillary renal cell carcinoma(RCC)of the left kidney(pT3aN0M0).This case elucidates a very rare incidence of a patient seen to have a collision tumor,and furthermore demonstrates guideline-based treatment.展开更多
BACKGROUND Metastasis of renal cell carcinoma(RCC)to the skeletal muscle and small bowel is an exceedingly rare occurrence.Both of these sites are unusual sites for RCC to metastasize to and to occur simultaneously is...BACKGROUND Metastasis of renal cell carcinoma(RCC)to the skeletal muscle and small bowel is an exceedingly rare occurrence.Both of these sites are unusual sites for RCC to metastasize to and to occur simultaneously is even less common.CASE SUMMARY A 58-year-old male with known history of RCC presented with a recurrence that was diagnosed through imaging and biopsies.Mucosa abnormalities of small bowel noted during endoscopy were biopsied as well as lesion in the psoas muscle that was noted.CONCLUSION This case report emphasizes that RCC can not only recur but can do so even decades later and present as metastatic foci at atypical sites.展开更多
BACKGROUND Calciphylaxis,also called calcific uremic arteriolopathy,is characterized by microvascular calcification and occlusion,which is commonly seen in patients with end-stage renal disease(ESRD).Although several ...BACKGROUND Calciphylaxis,also called calcific uremic arteriolopathy,is characterized by microvascular calcification and occlusion,which is commonly seen in patients with end-stage renal disease(ESRD).Although several studies have demonstrated an association of calciphylaxis with ESRD,reports linking calciphylaxis to LT(LT)are scarce.This report presents a rare case of calciphylaxis in a patient who underwent LT,leading to microvascular occlusion and hyperbilirubinemia.A 34-year-old man presented with a 7-day history of jaundice and severe bilateral leg pain.The patient had undergone LT and was put on hemodialysis for one year due to calcineurin inhibitor-induced ESRD.Physical examination revealed jaundice,leathery skin changes,severe muscle pain in both legs,and penile induration.Laboratory tests identified elevated bilirubin levels,gamma-glutamyl-transferase,and alkaline phosphatase,while alanine aminotransferase and aspartate aminotransferase concentrations were within normal limits.Computed tomography(CT)revealed extensive calcifications in the subcutaneous tissue.Three-dimensional CT reconstruc-tion indicated significantly reduced blood flow in the hepatic artery,primarily in the small to medium-sized branches.Contrast-enhanced ultrasonography confirmed hepatic ischemia,with no enhancement seen in hepatic artery branches.Liver biopsy specimen revealed no signs of rejection.The patient decided to receive conservative treatment and succumbed to the illness after six months.CONCLUSION This case indicates that calciphylaxis should be suspected in patients who have undergone LT with ESRD presenting with hyperbilirubinemia and skin lesions.展开更多
Objective:Stage Ⅳ renal cell carcinoma(RCC)is associated with a significant decrease in survival rates.Cytoreductive nephrectomy(CN)is one of the treatments for stage Ⅳ RCC.However,there are studies showing that del...Objective:Stage Ⅳ renal cell carcinoma(RCC)is associated with a significant decrease in survival rates.Cytoreductive nephrectomy(CN)is one of the treatments for stage Ⅳ RCC.However,there are studies showing that delayed CN might have benefits for the survival of the patients.We aimed to examine the impact of deferred CN on the survival of patients with advanced RCC in relation to sequential management with targeted therapy(TT).Methods:A literature search was conducted in PubMed,EMBASE,EBSCOhost,MedRxiv,and Scopus.We included the randomized clinical trial and non-randomized study of intervention comparing the overall survival(OS)of upfront CN with deferred CN in patients with advanced RCC undergoing TT.Meta-analysis was carried out using Review Manager v5.4 software.The fixed-effect and random-effects models were used to obtain pooled estimates using the hazard ratio and standard error,presented using the forest plot with 95%confidence interval.Results:Four studies were analyzed quantitatively.Our analysis revealed that patients with upfront TT followed by deferred CN had significantly improved OS compared to those who underwent upfront CN followed by TT(hazard ratio 0.50,95%confidence interval 0.40–0.64,p<0.001).Conclusion:The findings of the study suggest that considering upfront TT followed by deferred CN may lead to improved OS in patients with advanced RCC.However,more research is needed to fully understand the role,optimal timing,and sequencing of TT and CN in the treatment of advanced RCC.展开更多
BACKGROUND Pancreatic carcinoma is recognized as one of the most prothrombotic malig-nancies,carrying a high risk of thrombotic events,which may even precede the diagnosis of the underlying occult tumor.Acute renal in...BACKGROUND Pancreatic carcinoma is recognized as one of the most prothrombotic malig-nancies,carrying a high risk of thrombotic events,which may even precede the diagnosis of the underlying occult tumor.Acute renal infarction(ARI)as the initial presenting feature in patients with pancreatic cancer is a rare occurrence,and misdiagnosis is common during early evaluation.CASE SUMMARY We report a patient who presented with ARI as the initial manifestation prior to the diagnosis of pancreatic cancer.The 50-year-old male was admitted to our emergency department with sharp,left-sided abdominal pain and was subse-quently transferred to our department following the detection of a pancreatic space-occupying lesion on computed tomography(CT).CT angiography prom-ptly identified the cause of his pain,confirming right renal infarction.Urgent interventional treatment was initiated to alleviate symptoms and restore renal perfusion.Despite aggressive thrombolytic and anticoagulant therapy,the thrombotic event rapidly worsened,leading to multiple cerebral infarctions.The patient’s condition ultimately deteriorated under palliative care.CONCLUSION This case illustrates that arterial thromboembolism,when diagnosed at an ad-vanced stage of pancreatic cancer,appears to be a terminal event that portends a poor prognosis.Establishing an arterial thrombosis prediction model will po-tentially identify the profile of high-risk patients with thrombotic consequences for primary prevention.展开更多
Introduction:In recent years,significant advancements in the treatment of metastatic renal cell carcinoma(mRCC)have notably extended overall survival(OS)times,particularly with the introduction of tyrosine kinase inhi...Introduction:In recent years,significant advancements in the treatment of metastatic renal cell carcinoma(mRCC)have notably extended overall survival(OS)times,particularly with the introduction of tyrosine kinase inhibitors(TKIs)and combination immunotherapy.However,survival outcomes in mRCC remain highly variable.Materials and Methods:This study retrospectively analyzed clinical and demographic factors at diagnosis in patients treated for mRCC to identify predictors of long-term survival(defined as OS≥48 months).Patients were categorized into long-term survivors(LTS)and non-long-term survivors(nLTS).Results:The analysis revealed that factors such as better Karnofsky Performance Status(KPS),normal baseline laboratory values(e.g.,hemoglobin,calcium),and the presence of lung-only metastases were significantly associated with longer survival.Conversely,comorbid conditions like hypertension and dyslipidemia,poorer KPS,and certain adverse laboratory findings were more common in the nLTS group.Conclusion:These findings underscore the importance of baseline prognostic factors in predicting survival outcomes and emphasize the need for personalized treatment strategies in mRCC.展开更多
BACKGROUND Exercise plays a key role in managing chronic conditions such as diabetes mellitus(DM),a major contributor to end-stage renal disease(ESRD),a serious public health issue.AIM To investigate the relationship ...BACKGROUND Exercise plays a key role in managing chronic conditions such as diabetes mellitus(DM),a major contributor to end-stage renal disease(ESRD),a serious public health issue.AIM To investigate the relationship between exercise intensity,DM duration,and ESRD incidence.METHODS This retrospective cohort study analyzed data from 2495031 individuals with DM who underwent the Korean National Health Screening between 2015 and 2016,with follow-up through 2022.The Cox proportional hazards model was adjusted for confounders,including age,sex,income,smoking,and baseline comorbidities.RESULTS Longer DM duration was associated with a significantly higher risk of ESRD,with durations≥10 years showing the highest risk[hazard ratio(HR):2.624,95%confidence interval(CI):2.486-2.770].Increased exercise intensity reduced the risk of developing ESRD across all diabetes duration groups,with the highest exercise category(≥1500 metabolic equivalents of task-min/week)demonstrating a protective effect compared to that of no exercise(HR:0.837,95%CI:0.791-0.886).Exercise benefits were more pronounced in patients without hypertension,non-smokers,and those with lower alcohol consumption.Additionally,ESRD risk reduction was significant among patients with a body mass index≥25 and those without proteinuria or chronic kidney disease.CONCLUSION Longer diabetes duration is associated with increased ESRD risk,while high-intensity exercise may mitigate this risk.These findings suggest promoting exercise is important for managing diabetes to reduce renal complications.展开更多
This letter discusses the critical yet underrecognized intersection of chronic renal insufficiency and Nocardia brasiliensis skin infection in the case reported by Zhang et al,emphasizing the diagnostic challenges and...This letter discusses the critical yet underrecognized intersection of chronic renal insufficiency and Nocardia brasiliensis skin infection in the case reported by Zhang et al,emphasizing the diagnostic challenges and therapeutic complexities in the context of advanced age,comorbidities,and immunocompromised populations.The study’s strengths included its integration of immunological profiling and precision medicine,demonstrating that a tailored low-dose trimethoprimsulfamethoxazole regimen with pharmacokinetic monitoring can improve outcomes in geriatric patients with chronic renal insufficiency while mitigating nephrotoxicity risks.However,its limitations included a single-case design,reliance on phenotypic diagnostics,and the lack of information regarding comorbidity interactions.The findings support the use of advanced molecular tools for rapid pathogen identification and identification of co-infection.Future studies should prioritize elucidating the synergistic effects of chronic kidney disease-uremia and immunosuppression on Nocardia colonization,developing biomarkers for early detection,and conducting global epidemiological studies in endemic regions.This case underscores the importance of interdisciplinary collaboration and innovative diagnostics to optimize management of nocardiosis in vulnerable populations.展开更多
BACKGROUND Patients with multiple injuries endure not just physical trauma and suffering but are also at risk of psychological conditions such as posttraumatic stress disorder(PTSD),anxiety,and depression.The co-occur...BACKGROUND Patients with multiple injuries endure not just physical trauma and suffering but are also at risk of psychological conditions such as posttraumatic stress disorder(PTSD),anxiety,and depression.The co-occurrence of PTSD in these patients may cause prolonged physical and mental health complications,thereby further increasing their healthcare expenses.AIM To determine the association between the high-risk factors of PTSD and anxiety as well as depression among patients with multiple injuries.METHODS This study selected 110 patients with multiple injuries who were admitted to our hospital from November 2022 to November 2024.The number and percentage of patients developing PTSD were tallied.Univariate and multivariate analyses were conducted to investigate the high-risk factors of PTSD in these patients.Subse-quently,the associations between these factors and the anxiety and depression levels of patients were analyzed.RESULTS Of the 110 patients,33 suffered from PTSD,representing an incidence rate of 30.0%.The univariate analysis identified age,personality,Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),economic status,negative life events,and smoking history to be significantly associated with PTSD in patients with multiple injuries.Further,the multivariate analysis revealed age,HAMA,HAMD,monthly income,and negative life events as prominent high-risk factors for PTSD in such patients.Regarding the relationships between these factors and HAMA and HAMD,age exhibited a significant positive correlation(r=0.398,P<0.001;r=0.387,P<0.001),monthly income showed a significant negative correlation(r=-0.437,P<0.001;r=-0.319,P<0.001),and negative life events demonstrated a significant positive correlation(r=0.505,P<0.001;r=0.365,P<0.001).CONCLUSION These results indicate age,HAMA,HAMD,monthly income,negative life events,etc.as high-risk factors for PTSD in patients with multiple injuries,among which age,monthly income,and negative life events are closely associated with anxiety and depression.展开更多
BACKGROUND Incisional hernia is one of the known complications of renal transplant surgery,with a reported incidence between 1.1%to 3.8%.Depending on the site and extent of incisional hernia,it may require surgery par...BACKGROUND Incisional hernia is one of the known complications of renal transplant surgery,with a reported incidence between 1.1%to 3.8%.Depending on the site and extent of incisional hernia,it may require surgery particularly if it contains the trans-planted kidney either partially or completely.The current common clinical prac-tice is to repair incisional hernias using polypropylene meshes,which have their own risks and benefits.Biological meshes,which are made from human or animal-derived connective tissue,are also in use and have a less inflammatory response.Recently,hybrid meshes have been developed.These are composed of both biological and synthetic products.One such example is OviTex 1S perma-nent,which is a sterile reinforced tissue matrix composed of ovine(sheep)derived extracellular matrix and monofilament polypropylene.In this case report,we are sharing our experience with the use of OviTex 1S in the repair of post-renal transplant incisional hernias.CASE SUMMARY We report four cases of post-renal transplant incisional hernia with a median time of 27 months post-surgery.The median size of the defect was 15 cm long.There was no post-operative complication.One patient required renal transplant biopsy after mesh repair,which was easily performed compared with polypropylene meshes repaired hernias in the past.CONCLUSION The OviTex 1S mesh provides benefits in hernial repairs pKTx,but cost is an issue,and their long-term viability is unclear.Continued use and reporting will help build a more informed picture.展开更多
Nocardiosis remains a rare and often underdiagnosed bacterial infection,particularly in immunocompromised individuals.The case report by Zhang et al highlights the diagnostic and therapeutic challenges in managing Noc...Nocardiosis remains a rare and often underdiagnosed bacterial infection,particularly in immunocompromised individuals.The case report by Zhang et al highlights the diagnostic and therapeutic challenges in managing Nocardia brasiliensis skin infection in a 93-year-old patient with chronic renal insufficiency.This editorial explores the importance of timely diagnosis,microbiological confirmation,and tailored antibiotic therapy.Emphasis is placed on the role of immune status evaluation,drug concentration monitoring,and the necessity of long-term antimicrobial therapy.Improved clinician awareness and adherence to evidencebased management protocols are essential to achieving better outcomes in nocardiosis cases.展开更多
文摘BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM To explore the correlations among life satisfaction,pleasure levels,and negative emotions in patients with CRF.METHODS One hundred patients with CRF who received therapy at the First Affiliated Hospital of Jinzhou Medical University between December 2022 and February 2025 were included.The Depression,Anxiety,and Stress Scale(DASS-21),Satisfaction with Life Scale(SWLS),and Temporal Experience of Pleasure Scale(TEPS)were used to evaluate negative emotions,life satisfaction,and pleasure level,respectively.Pearson’s correlation coefficient analyzed the correlation between life satisfaction,pleasure level,and negative emotions.Linear regression analysis identified the factors affecting negative emotions.RESULTS The average DASS-21 score among patients with CRF was 51.90±2.30,with subscale scores of 17.90±1.50 for depression,18.53±1.18 for anxiety,and 15.47±2.36 for stress,all significantly higher than the domestic norm(P<0.05).The average SWLS score was 22.17±4.90.Correlation analysis revealed a negative correlation between the SWLS and total DASS-21 scores(P<0.05),but not with the individual depression,anxiety,or stress dimensions.The average TEPS score was 67.80±8.34.TEPS scores were negatively correlated with the DASS-21 score and the stress dimension(P<0.05),but not with depression or anxiety.Linear regression analysis showed that TEPS scores significantly influenced DASS-21 scores(P<0.05).CONCLUSION Patients with CRF experience high levels of negative emotions,which are negatively correlated with life satisfaction and pleasure.Furthermore,pleasure level had an impact on negative emotions.
文摘Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenvatinib and everolimus represents a viable option,and the present review aimed to summarize its activity,effectiveness,and safety.Methods:A systematic review of the literature was conducted using PubMed,targeting studies published between 2018 and 2025.Eligible studies included English-language prospective and retrospective trials reporting survival outcomes in mRCC patients treated with lenvatinib and everolimus after at least one ICI-containing regimen.Results:Nine studies met the inclusion criteria,encompassing a total of 441 patients.The lenvatinib and everolimus combination was primarily used in the third and subsequent lines of therapy.Median overall survival ranged from 7.5 to 24.5 months,while median progression-free survival was more consistent,between 6.1 and 6.7 months,except for one study reporting 12.9 months.Objective response rates varied widely(14.0%–55.7%).Adverse events of grade≥3 did not exceed the expected rate,with diarrhoea and proteinuria as the most reported events.Dose reductions and treatment discontinuations due to toxicity occurred but were generally lower than in prior pivotal trials.Conclusions:Real-world evidence suggests that lenvatinib and everolimus represent an effective and safe option after ICI failure in mRCC patients.Nevertheless,the lack of randomized phase III trials and the heterogeneity of existing studies highlight the need for more robust prospective research to guide post-ICI therapeutic strategies.
基金supported by grants from the National Key Research and Development Program of China(2023YFC3603100 and 2023YFC3603105)“Leading Goose”R&D Program of Zhejiang(2022C03076-4),China.
文摘Glyphosate(GLY),a widely used herbicide,has been extensively applied in both the agricultural and non-agricultural sectors worldwide.The rate of GLY use varies considerably depending on the crop type and local farming practices,which can be up to approximately 53.5%of agricultural land in certain regions.
基金supported by National Key Research and Development Program of China(2023YFD1800902).
文摘Elaidic acid(EA)is a typical trans fatty acid(TFA)that emerges during the processing of various fatty foods.In this study,we found that EA induced renal injury with necroptosis.Pretreatment with a reactive oxygen species(ROS)inhibitor and a RIPK3 inhibitor alleviated EA-induced necroptosis.The data indicated that EA induced renal necroptosis through ROS/RIPK3/MLKL pathway.In mechanistic studies,we explored how EA induced ROS production.Results indicated that EA caused mitochondrial damage by testing MMP,MFN1,VDAC,and FIS1.Further,EA suppressed mitophagy by testing the levels of LC3,p62,PINK1,Parkin,colocalization of LC3 and Mito-Tracker Red.Mitophagy is a process of selective degradation of damaged mitochondria.A large number of damaged mitochondria couldn't be cleared by mitophagy in time,which increased ROS levels in renal cells.Pretreatment with a mitophagy activator decreased EA-induced ROS levels and mitochondrial damage.Taken together,our data identified that EA induced renal necroptosis by destroying mitochondria and inhibiting mitophagy,thereby activating the ROS/RIPK3/MLKL pathway.
文摘BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.
文摘BACKGROUND Complement-mediated thrombotic microangiopathy(TMA)is a rare endothelial injury syndrome caused by dysregulated activation of the alternative complement pathway,often linked to genetic abnormalities in complement factor H(CFH),complement factor I,or complement factor H-related(CFHR)proteins.Both renal transplantation and pregnancy are independent triggers for recurrence.This case highlights a genetically high-risk patient who achieved a successful term pregnancy after renal transplantation without complement inhibition,emphasizing individualized risk stratification,close surveillance,and multidisciplinary management for favourable maternal and graft outcomes.CASE SUMMARY A 32-year-old woman with end-stage renal disease secondary to genetically confirmed complement-mediated TMA—homozygous CFH exon 17 deletion and CFHR3-CFHR1 duplication—was maintained on dialysis for 2.5 years before undergoing a successful live-donor kidney transplant from her mother.Post-transplant immunosuppression included tacrolimus,mycophenolate mofetil,and prednisolone,later modified to azathioprine during pregnancy planning.One-year post-transplant,she conceived spontaneously.Pregnancy was complicated by transient gestational hypertension,controlled with nifedipine,labetalol,and amlodipine.Proteinuria remained<150 mg/day;white blood cell counts 5.8-7.2×109/L without cytopenia.Serum creatinine ranged 0.9-1.1 mg/dL,and tacrolimus trough levels 5-7 ng/mL.At 36 weeks,she delivered a healthy 3 kg infant by elective caesarean section.Postpartum follow-up at three months confirmed stable maternal and graft function.CONCLUSION High-risk complement-mediated TMA patients can achieve successful pregnancy post-transplant through individualized care without mandatory complement blockade.
基金Supported by Zhejiang Provincial Traditional Chinese Medicine Science and Technology Program,No.2023ZF075.
文摘BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdiagnosis and missed diagnosis.Additionally,this disease is difficult to treat,often requiring months or even years of antibacterial therapy,and can be fatal in patients with underlying conditions.CASE SUMMARY A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb.As a result of an initial misdiagnosis and inadequate treatment,the infection progressed,resulting in multiple rashes on his right upper limb.Local incision and drainage of pus,combined with oral antibiotics administered at a different hospital,yielded no significant improvement.Upon hospitalization,the patient’s immune function was assessed,and further local incision and drainage were performed.Cultures of the pus identified Nocardia brasiliensis.Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim,leading to the patient’s recovery.After discharge,the patient continued to take sulfamethoxazole tablets for 6 months,with complete healing of the skin lesions and no recurrence.CONCLUSION Nocardiosis should be considered in patients with underlying conditions and compromised immunity.Prompt and accurate diagnosis is crucial.
基金Supported by Key Research Fund of Wannan Medical College,No.WK2021ZF15Research Foundation for Advanced Talents of Wannan Medical College,No.YR202213+3 种基金Foundation of Anhui Educational Committee,No.2023AH051759Excellent Youth Research Project of Anhui UniversitiesNo.2023AH030107Horizontal Project of Wannan Medical College,No.622202504003 and No.662202404013.
文摘BACKGROUND Research examining the relationships among anxiety,depression,self-perceived burden(SPB),and psychological resilience(PR),along with the determinants of PR,in patients with chronic renal failure(CRF)receiving maintenance hemodia-lysis(MHD)is limited.AIM To investigate the correlation between anxiety,depression,SPB,and PR in pati-ents with CRF on MHD.METHODS This study included 225 patients with CRF on MHD who were admitted between June 2021 and June 2024.The anxiety level was evaluated using the Self-Rating Anxiety Scale(SAS);the depression status was assessed using the Self-Rating Depression Scale(SDS);the SPB was measured using the SPB Scale(SPBS);and the PR was determined using the Connor–Davidson Resilience Scale(CD-RISC).The correlations among the SAS,SDS,SPB,and CD-RISC were analyzed using Pearson’s correlation coefficients.Univariate and multivariate analyses were performed to identify the factors that influence the PR of patients with CRF on MHD.RESULTS The SAS,SDS,SPB,and CD-RISC scores of the 225 patients were 45.25±15.36,54.81±14.68,32.31±11.52,and 66.48±9.18,respectively.Significant negative correlations were observed between SAS,SDS,SPB,and CD-RISC.Furthermore,longer dialysis vintage(P=0.015),the absence of religious beliefs(P=0.020),lower monthly income(P=0.008),higher SAS score(P=0.013),and higher SDS score(P=0.006)were all independent factors that adversely affected the PR of patients with CRF on MHD.CONCLUSION Patients with CRF on MHD present with varying degrees of anxiety,depression,and SPB,all of which exhibit a significant negative correlation with their PR.Moreover,longer dialysis vintage,the absence of religious beliefs,lower monthly income,higher SAS score,and higher SDS score were factors that negatively affected the PR of patients with CRF on MHD.
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Renal cell carcinoma is a heterogeneous group of renal tumors characterized by several histological subtypes.Herein,we discuss an unusual case of a 55-year-old male who presented as a consultation to our urology clinic with an incidentally found renal mass.After shared decision making patient proceeded with a Robotic Assisted Laparoscopy(RAL)left sided partial nephrectomy.Final pathology confirmed the presence of high nuclear grade mixed clear cell and papillary renal cell carcinoma(RCC)of the left kidney(pT3aN0M0).This case elucidates a very rare incidence of a patient seen to have a collision tumor,and furthermore demonstrates guideline-based treatment.
文摘BACKGROUND Metastasis of renal cell carcinoma(RCC)to the skeletal muscle and small bowel is an exceedingly rare occurrence.Both of these sites are unusual sites for RCC to metastasize to and to occur simultaneously is even less common.CASE SUMMARY A 58-year-old male with known history of RCC presented with a recurrence that was diagnosed through imaging and biopsies.Mucosa abnormalities of small bowel noted during endoscopy were biopsied as well as lesion in the psoas muscle that was noted.CONCLUSION This case report emphasizes that RCC can not only recur but can do so even decades later and present as metastatic foci at atypical sites.
基金Supported by the Guangzhou Basic and Applied Basic Research Foundation,No.2025A04J4730National Natural Science Foundation of China,No.82470635 and No.82300751+2 种基金Guangdong Basic and Applied Basic Research Foundation,No.2024A1515011723Medical Scientific Research Foundation of Guangdong Province of China,No.A2023033Jiangxi Provincial Natural Science Foundation,No.20244BAB28028.
文摘BACKGROUND Calciphylaxis,also called calcific uremic arteriolopathy,is characterized by microvascular calcification and occlusion,which is commonly seen in patients with end-stage renal disease(ESRD).Although several studies have demonstrated an association of calciphylaxis with ESRD,reports linking calciphylaxis to LT(LT)are scarce.This report presents a rare case of calciphylaxis in a patient who underwent LT,leading to microvascular occlusion and hyperbilirubinemia.A 34-year-old man presented with a 7-day history of jaundice and severe bilateral leg pain.The patient had undergone LT and was put on hemodialysis for one year due to calcineurin inhibitor-induced ESRD.Physical examination revealed jaundice,leathery skin changes,severe muscle pain in both legs,and penile induration.Laboratory tests identified elevated bilirubin levels,gamma-glutamyl-transferase,and alkaline phosphatase,while alanine aminotransferase and aspartate aminotransferase concentrations were within normal limits.Computed tomography(CT)revealed extensive calcifications in the subcutaneous tissue.Three-dimensional CT reconstruc-tion indicated significantly reduced blood flow in the hepatic artery,primarily in the small to medium-sized branches.Contrast-enhanced ultrasonography confirmed hepatic ischemia,with no enhancement seen in hepatic artery branches.Liver biopsy specimen revealed no signs of rejection.The patient decided to receive conservative treatment and succumbed to the illness after six months.CONCLUSION This case indicates that calciphylaxis should be suspected in patients who have undergone LT with ESRD presenting with hyperbilirubinemia and skin lesions.
文摘Objective:Stage Ⅳ renal cell carcinoma(RCC)is associated with a significant decrease in survival rates.Cytoreductive nephrectomy(CN)is one of the treatments for stage Ⅳ RCC.However,there are studies showing that delayed CN might have benefits for the survival of the patients.We aimed to examine the impact of deferred CN on the survival of patients with advanced RCC in relation to sequential management with targeted therapy(TT).Methods:A literature search was conducted in PubMed,EMBASE,EBSCOhost,MedRxiv,and Scopus.We included the randomized clinical trial and non-randomized study of intervention comparing the overall survival(OS)of upfront CN with deferred CN in patients with advanced RCC undergoing TT.Meta-analysis was carried out using Review Manager v5.4 software.The fixed-effect and random-effects models were used to obtain pooled estimates using the hazard ratio and standard error,presented using the forest plot with 95%confidence interval.Results:Four studies were analyzed quantitatively.Our analysis revealed that patients with upfront TT followed by deferred CN had significantly improved OS compared to those who underwent upfront CN followed by TT(hazard ratio 0.50,95%confidence interval 0.40–0.64,p<0.001).Conclusion:The findings of the study suggest that considering upfront TT followed by deferred CN may lead to improved OS in patients with advanced RCC.However,more research is needed to fully understand the role,optimal timing,and sequencing of TT and CN in the treatment of advanced RCC.
文摘BACKGROUND Pancreatic carcinoma is recognized as one of the most prothrombotic malig-nancies,carrying a high risk of thrombotic events,which may even precede the diagnosis of the underlying occult tumor.Acute renal infarction(ARI)as the initial presenting feature in patients with pancreatic cancer is a rare occurrence,and misdiagnosis is common during early evaluation.CASE SUMMARY We report a patient who presented with ARI as the initial manifestation prior to the diagnosis of pancreatic cancer.The 50-year-old male was admitted to our emergency department with sharp,left-sided abdominal pain and was subse-quently transferred to our department following the detection of a pancreatic space-occupying lesion on computed tomography(CT).CT angiography prom-ptly identified the cause of his pain,confirming right renal infarction.Urgent interventional treatment was initiated to alleviate symptoms and restore renal perfusion.Despite aggressive thrombolytic and anticoagulant therapy,the thrombotic event rapidly worsened,leading to multiple cerebral infarctions.The patient’s condition ultimately deteriorated under palliative care.CONCLUSION This case illustrates that arterial thromboembolism,when diagnosed at an ad-vanced stage of pancreatic cancer,appears to be a terminal event that portends a poor prognosis.Establishing an arterial thrombosis prediction model will po-tentially identify the profile of high-risk patients with thrombotic consequences for primary prevention.
文摘Introduction:In recent years,significant advancements in the treatment of metastatic renal cell carcinoma(mRCC)have notably extended overall survival(OS)times,particularly with the introduction of tyrosine kinase inhibitors(TKIs)and combination immunotherapy.However,survival outcomes in mRCC remain highly variable.Materials and Methods:This study retrospectively analyzed clinical and demographic factors at diagnosis in patients treated for mRCC to identify predictors of long-term survival(defined as OS≥48 months).Patients were categorized into long-term survivors(LTS)and non-long-term survivors(nLTS).Results:The analysis revealed that factors such as better Karnofsky Performance Status(KPS),normal baseline laboratory values(e.g.,hemoglobin,calcium),and the presence of lung-only metastases were significantly associated with longer survival.Conversely,comorbid conditions like hypertension and dyslipidemia,poorer KPS,and certain adverse laboratory findings were more common in the nLTS group.Conclusion:These findings underscore the importance of baseline prognostic factors in predicting survival outcomes and emphasize the need for personalized treatment strategies in mRCC.
基金Supported by National Research Foundation of Korea(NRF)grant funded by the Korean Government(MSIT),No.RS-2023-00217317Chonnam National University Grant,No.2024-0444-01and Chonnam National University Hospital Institute for Biomedical Science,No.BCRI24032.
文摘BACKGROUND Exercise plays a key role in managing chronic conditions such as diabetes mellitus(DM),a major contributor to end-stage renal disease(ESRD),a serious public health issue.AIM To investigate the relationship between exercise intensity,DM duration,and ESRD incidence.METHODS This retrospective cohort study analyzed data from 2495031 individuals with DM who underwent the Korean National Health Screening between 2015 and 2016,with follow-up through 2022.The Cox proportional hazards model was adjusted for confounders,including age,sex,income,smoking,and baseline comorbidities.RESULTS Longer DM duration was associated with a significantly higher risk of ESRD,with durations≥10 years showing the highest risk[hazard ratio(HR):2.624,95%confidence interval(CI):2.486-2.770].Increased exercise intensity reduced the risk of developing ESRD across all diabetes duration groups,with the highest exercise category(≥1500 metabolic equivalents of task-min/week)demonstrating a protective effect compared to that of no exercise(HR:0.837,95%CI:0.791-0.886).Exercise benefits were more pronounced in patients without hypertension,non-smokers,and those with lower alcohol consumption.Additionally,ESRD risk reduction was significant among patients with a body mass index≥25 and those without proteinuria or chronic kidney disease.CONCLUSION Longer diabetes duration is associated with increased ESRD risk,while high-intensity exercise may mitigate this risk.These findings suggest promoting exercise is important for managing diabetes to reduce renal complications.
文摘This letter discusses the critical yet underrecognized intersection of chronic renal insufficiency and Nocardia brasiliensis skin infection in the case reported by Zhang et al,emphasizing the diagnostic challenges and therapeutic complexities in the context of advanced age,comorbidities,and immunocompromised populations.The study’s strengths included its integration of immunological profiling and precision medicine,demonstrating that a tailored low-dose trimethoprimsulfamethoxazole regimen with pharmacokinetic monitoring can improve outcomes in geriatric patients with chronic renal insufficiency while mitigating nephrotoxicity risks.However,its limitations included a single-case design,reliance on phenotypic diagnostics,and the lack of information regarding comorbidity interactions.The findings support the use of advanced molecular tools for rapid pathogen identification and identification of co-infection.Future studies should prioritize elucidating the synergistic effects of chronic kidney disease-uremia and immunosuppression on Nocardia colonization,developing biomarkers for early detection,and conducting global epidemiological studies in endemic regions.This case underscores the importance of interdisciplinary collaboration and innovative diagnostics to optimize management of nocardiosis in vulnerable populations.
基金Supported by Nanjing Municipal Special Fund for Health Science and Technology Development Support Project,No.GBX21333.
文摘BACKGROUND Patients with multiple injuries endure not just physical trauma and suffering but are also at risk of psychological conditions such as posttraumatic stress disorder(PTSD),anxiety,and depression.The co-occurrence of PTSD in these patients may cause prolonged physical and mental health complications,thereby further increasing their healthcare expenses.AIM To determine the association between the high-risk factors of PTSD and anxiety as well as depression among patients with multiple injuries.METHODS This study selected 110 patients with multiple injuries who were admitted to our hospital from November 2022 to November 2024.The number and percentage of patients developing PTSD were tallied.Univariate and multivariate analyses were conducted to investigate the high-risk factors of PTSD in these patients.Subse-quently,the associations between these factors and the anxiety and depression levels of patients were analyzed.RESULTS Of the 110 patients,33 suffered from PTSD,representing an incidence rate of 30.0%.The univariate analysis identified age,personality,Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),economic status,negative life events,and smoking history to be significantly associated with PTSD in patients with multiple injuries.Further,the multivariate analysis revealed age,HAMA,HAMD,monthly income,and negative life events as prominent high-risk factors for PTSD in such patients.Regarding the relationships between these factors and HAMA and HAMD,age exhibited a significant positive correlation(r=0.398,P<0.001;r=0.387,P<0.001),monthly income showed a significant negative correlation(r=-0.437,P<0.001;r=-0.319,P<0.001),and negative life events demonstrated a significant positive correlation(r=0.505,P<0.001;r=0.365,P<0.001).CONCLUSION These results indicate age,HAMA,HAMD,monthly income,negative life events,etc.as high-risk factors for PTSD in patients with multiple injuries,among which age,monthly income,and negative life events are closely associated with anxiety and depression.
文摘BACKGROUND Incisional hernia is one of the known complications of renal transplant surgery,with a reported incidence between 1.1%to 3.8%.Depending on the site and extent of incisional hernia,it may require surgery particularly if it contains the trans-planted kidney either partially or completely.The current common clinical prac-tice is to repair incisional hernias using polypropylene meshes,which have their own risks and benefits.Biological meshes,which are made from human or animal-derived connective tissue,are also in use and have a less inflammatory response.Recently,hybrid meshes have been developed.These are composed of both biological and synthetic products.One such example is OviTex 1S perma-nent,which is a sterile reinforced tissue matrix composed of ovine(sheep)derived extracellular matrix and monofilament polypropylene.In this case report,we are sharing our experience with the use of OviTex 1S in the repair of post-renal transplant incisional hernias.CASE SUMMARY We report four cases of post-renal transplant incisional hernia with a median time of 27 months post-surgery.The median size of the defect was 15 cm long.There was no post-operative complication.One patient required renal transplant biopsy after mesh repair,which was easily performed compared with polypropylene meshes repaired hernias in the past.CONCLUSION The OviTex 1S mesh provides benefits in hernial repairs pKTx,but cost is an issue,and their long-term viability is unclear.Continued use and reporting will help build a more informed picture.
文摘Nocardiosis remains a rare and often underdiagnosed bacterial infection,particularly in immunocompromised individuals.The case report by Zhang et al highlights the diagnostic and therapeutic challenges in managing Nocardia brasiliensis skin infection in a 93-year-old patient with chronic renal insufficiency.This editorial explores the importance of timely diagnosis,microbiological confirmation,and tailored antibiotic therapy.Emphasis is placed on the role of immune status evaluation,drug concentration monitoring,and the necessity of long-term antimicrobial therapy.Improved clinician awareness and adherence to evidencebased management protocols are essential to achieving better outcomes in nocardiosis cases.
