What are the origins,historical development,and lineages of the reincarnation system of Living Buddhas in Tibetan Buddhism?What kind of academic framework is"Han-Tibetan Buddhist Studies"?In an interview wit...What are the origins,historical development,and lineages of the reincarnation system of Living Buddhas in Tibetan Buddhism?What kind of academic framework is"Han-Tibetan Buddhist Studies"?In an interview with this journal,Professor Shen Weirong ofTsinghua University discusses these issues on the basis of his research.展开更多
By leveraging the unique qualities of microorganisms,engineered living materials(ELMs)offer functional and economic advantages in everyday applications along with notable ecological benefits.This study contributes to ...By leveraging the unique qualities of microorganisms,engineered living materials(ELMs)offer functional and economic advantages in everyday applications along with notable ecological benefits.This study contributes to the growing field of biodesign by examining the potential of Flavobacteria for thermochromic ELMs.Many Flavobacteria,commonly found in marine environments,produce iridescent structural colorations as their colonies expand on semi-solid surfaces through gliding motility.In this study,we analyzed the effects of temperature variations on flavobacterium Cellulophaga lytica PLY A 2,characterizing distinct changes in colony growth and iridescent colorations at a macroscopic and microscopic scale.Using scanning electron microscopy,we investigated the relationship between iridescent color and the underlying cell-based optical structures.By providing insights into the temperature-responsive behavior of Flavobacteria,our findings highlight their potential for future thermochromic ELMs-with applications ranging from sustainable food packaging to smart textiles-while encouraging further characterization studies within biodesign research.展开更多
Editor's Note:As a unique system of succession in Tibetan Buddhism,the reincarnation of Living Buddhas is governed by standardized religious rituals,historical conventions,and established principles.Since the Karm...Editor's Note:As a unique system of succession in Tibetan Buddhism,the reincarnation of Living Buddhas is governed by standardized religious rituals,historical conventions,and established principles.Since the Karma Kagyu sect pioneered the reincarnation system of Living Buddhas in the 13th century,this tradition has continued for more than 700 years.Since the Gelug sect adopted the reincarnation practice in the 16th century,resulting in major lineages such as the Dalai Lama and Panchen Erdeni reincarnations,the system has now held a history of over 400 years.Since the Yuan Dynasty(1271-1368),successive central governments of China have,without exception,strengthened administration over reincarnation matters.In the 57th year of the reign of Emperor Qianlong(1792)of the Qing Dynasty,the Golden Urn Lot-Drawing System was formally established.This system has remained in place up to the present day.Demonstrating national sovereignty,governmental authority,as well as the sacredness and impartiality of Buddhism,it has effectively prevented corruption and malpractice during the reincarnation process.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
Objective:Robotic-assisted living donor nephrectomy(RALDN)has been shown to be a safe and feasible option,offering enhanced visualization and improved surgical dexterity,allowing for a potential increase in the living...Objective:Robotic-assisted living donor nephrectomy(RALDN)has been shown to be a safe and feasible option,offering enhanced visualization and improved surgical dexterity,allowing for a potential increase in the living donor pool to perform pediatric and adult kidney transplants,even in cases of grafts with anatomical variants.We report our recent experience in using RALDN for open kidney transplantation(OKT).Methods:Between August 2021 and July 2025,122 kidney transplant recipients underwent OKT using RALDN grafts obtained at the Miami Transplant Institute.Clinical outcomes,during the first12 months post-transplant,including the incidence of delayed graft function(DGF),surgical complications,estimated glomerular filtrationrate(eGFR),and graft loss,were evaluated.Results:Sixteen pediatric and 106 adult recipients were included.The median recipient and donor ages were 42.2 yr and 39.5 yr,respectively.Male recipients comprised 63.1%(77/122);female donors comprised 56.6%(69/122).Among the donors,no conversion to open surgery was needed,and no postoperative complications attributed to the RALDN procedure were observed.Thirty-one kidney grafts required back table reconstruction.The median cold and warm ischemia times were 55.5 min and 27.0 min,respectively.One case(0.8%)of DGF was observed.One recipient(0.8%)developed a postoperative vascular complication;five(4.1%)developed a urologic complication.The median eGFRs at 1 mo,3 mo,6 mo,and 12 mo post-transplant were 71.9,77.1,75.1,and 72.1 mL/min/1.73 m2,respectively.No cases of graft failure during the first12 months post-transplant were observed,and one patient died with a functioning graft.Conclusion:RALDN is a safe and effective technique that provides favorable outcomes among both donors and recipients.This minimally invasive approach should be offered as a safe alternative to living donor patients.展开更多
Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria....Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria. Liver resection (LR) is often the initial treatment for patients with solitary tumors and preserved liver function. The high recurrence rates associated with LR has prompted the exploration of sequential living donor liver transplantation (seq LDLT) after LR as a strategy for HCC patients with high-risk of recurrence.Methods:We analyzed data from 27 adult patients who underwent seq LDLT after LR for HCC at Kaohsiung Chang Gung Memorial Hospital (KCGMH) between June 1994 and December 2023. Patients were selected based on high-risk histopathological features post-LR or as part of downstaging strategy. Outcomes measured included overall survival (OS) and disease-free survival (DFS).Results:Among 765 HCC patients who underwent LDLT, 204 received LR before LDLT, and 27 underwent seqL DLT. Five patients (19%) underwent living donor liver transplantation (LDLT) following LR as a downstaging strategy while the rest received seqL DLT as a preemptive strategy. The median age was 53.5 years with 85%males. Chronic hepatitis B was the predominant underlying disease (74%). The 1-, 3-, and 5-year OS and DFS rates were 100%, 96.0%, 96.0%and 100%, 96.2%, 96.2%, respectively, with two patients experiencing HCC recurrence. One patient died from HCC recurrence. High-risk histopathological features included microvascular invasion (52%), satellite nodules (15%), multiple tumors (26%), tumors> 5 cm(19%), and a total tumor diameter> 10 cm (7%).Conclusions:Seq LDLT offers a promising, tailored approach for managing HCC with adverse histopathologic features. Combining seq LDLT, downstaging strategies, and multidisciplinary treatments can achieve satisfactory OS and DFS in carefully selected patients, highlighting the need for refined criteria to identify the best candidates.展开更多
BACKGROUND Pediatric liver transplantation(LT)is the definitive treatment for end-stage liver disease and acute liver failure in children.However,graft size mismatch poses significant challenges,particularly in infant...BACKGROUND Pediatric liver transplantation(LT)is the definitive treatment for end-stage liver disease and acute liver failure in children.However,graft size mismatch poses significant challenges,particularly in infants weighing less than 10 kg.Large-forsize grafts can lead to severe complications,including vascular thrombosis and impaired graft perfusion.Surgical innovations,such as hyper-reduced left lateral segment(HRLLS)grafts and monosegmental grafts(MSG),offer viable solutions by tailoring graft size without compromising vascular or biliary integrity.AIM To analyze the techniques and outcomes of HRLLS and MSG grafts in pediatric liver trabsplantation.METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,a comprehensive literature search was conducted across PubMed,Scopus,and Google Scholar,including studies up to February 2025.Eligible studies included case-control,observational,and randomized controlled trials reporting clinical outcomes of HRLLS,MSG,or reduced left lateral segment grafts(RLLS)in pediatric LT.The Joanna Briggs Institute Critical Appraisal Checklist was used for quality assessment.Meta-analysis was performed using MetaXL software to pool survival outcomes and assess complication profiles.RESULTS Eighteen studies involving various graft reduction techniques were included.Both HRLLS and MSG demonstrated comparable one-year survival rates exceeding 80%,with some studies reporting rates above 95%.Complications such as hepatic artery thrombosis,portal vein thrombosis,and sepsis were slightly more frequent in HRLLS/RLLS recipients but remained within acceptable limits.Meta-analysis revealed no significant differences in survivability between graft types.CONCLUSION HRLLS and MSG techniques enable successful liver transplantation in small pediatric recipients,achieving longterm outcomes comparable to standard approaches.These graft modification strategies expand donor pool utilization and optimize patient survival while mitigating large-for-size complications.展开更多
Rarer dementias are associated with atypical symptoms and younger onset,which result in a higher burden of care.We provide a review of the global literature on longitudinal decline in activities of daily living(ADLs)i...Rarer dementias are associated with atypical symptoms and younger onset,which result in a higher burden of care.We provide a review of the global literature on longitudinal decline in activities of daily living(ADLs)in dementias that account for less than 10%of dementia diagnoses.Published studies were identified through searches conducted in Medical Literature Analysis and Retrieval System Online(MEDLINE),Excerpta Medica Database(Embase),Excerpta Medica Care(Emcare),PsycINFO,and Cumulative Index in Nursing and Allied Health Literature(CINAHL).The search criteria included terms related to‘rarer dementias’,‘activities of daily living’and‘longitudinal or cross-sectional studies’following a predefined protocol registered.Studies were screened,and those that met the criteria were citation searched.Quality assessments were performed,and relevant data were extracted.20 articles were selected,of which 19 focused on dementias within the frontotemporal dementia/primary progressive aphasia spectrum,while one addressed posterior cortical atrophy.Four studies were cross-sectional and 16 studies were longitudinal,with a median duration of 2.2 years.The Disability Assessment for Dementia was used to measure decline in 8 of the 20 studies.The varied sequences of ADL decline reported in the literature reflect variation in diagnostic specificity between studies and within-syndrome heterogeneity.Most studies used Alzheimer’s disease staging scales to measure decline,which cannot capture variant-specific symptoms.To enhance care provision in dementia,ADL scales could be deployed postdiagnosis to aid treatment and planning.This necessitates staging scales that are variant-specific and span the disease course from diagnosis to end of life.展开更多
The prognosis of drug-induced acute liver failure(ALF)is poor,with a survival rate of 27.1%without liver transplantation.Liver transplantation significantly improved survival rates to 66.2%.[1]The shortage of availabl...The prognosis of drug-induced acute liver failure(ALF)is poor,with a survival rate of 27.1%without liver transplantation.Liver transplantation significantly improved survival rates to 66.2%.[1]The shortage of available grafts can be addressed by living donor liver transplantation(LDLT),an effective and safe method that expands the donor pool,enhances timely transplantation,and improves patient survival.展开更多
BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft ...BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft loss or graft dysfunction.Nevertheless,circumstances may arise where selecting the RK over the left kidney(LK)is unavoidable.Consequently,it is crucial to thoroughly examine the implications of such a choice on the overall transplant outcome.AIM To compare transplant outcomes between recipients of RK and LK while examining the factors that influence these outcomes.METHODS We retrospectively analyzed data from adult patients who received LD kidney transplants involving meticulous patient selection and surgical techniques at our center from January 2020 to December 2023.We included all kidney donors who were over 18,fit to donate,and had undergone diethylenetriamine pentaacetic acid split function and/or computed tomography based volumetry.The variables examined comprised donor and recipient demographics,and outcome measures included technical graft loss(TGL),delayed or slow graft function(SGF),and post-transplant serum creatinine(SC)trends.We used a logistic regression model to assess the likelihood of adverse outcomes considering the donor kidney side.RESULTS Of the 250 transplants performed during the period,56(22%)were RKs.The recipient demographics and transplant factors were comparable for the right and LKs,except that the donor warm and cold ischemia time were shorter for RKs.TGL and SGF each occurred in 2%(n=1)of RKs and 0.5%(n=1)of LKs,the difference being insignificant.These complications,however,were not related to the venous anastomosis.One RK(2%)developed delayed graft function after 48 hours,which was attributable to postoperative hypoxia rather than the surgical technique.The post-transplant SC trend and mean SC at the last follow-up were similar across both kidney sides.CONCLUSION The donor kidney side has little impact on post-transplant adverse events and graft function in LD transplants,provided that careful patient selection and precise surgical techniques are employed.展开更多
Impairments on body function,activities of daily living(ADL)and cognition are common after stroke.Eccentric resistance training(ERT)may be implemented to improve them.The primary objectives were to evaluate whether ER...Impairments on body function,activities of daily living(ADL)and cognition are common after stroke.Eccentric resistance training(ERT)may be implemented to improve them.The primary objectives were to evaluate whether ERT improves body function,ADL and cognition after stroke.The secondary objectives were to evaluate whether ERT improves strength,gait,quality of life,and self-perceived health.Seven electronic databases were searched:Cochrane Central Register of Controlled Trials,Cochrane Stroke Group Trials Register,PubMed,Epistemonikos,Embase,SPORTDiscus,and WHO International Clinical Trials Registry Platform.Last search was run in December 2023,including studies since 2012.Selection criteria were studies with stroke participants of both sexes,aged 18 or more,with an intervention based on ERT.Accepted languages were English,Spanish or French.First search was done in pairs.Authors removed duplicate studies and those which did not meet inclusion criteria through title and abstracts.Finally,all authors,independently,screened the final search results and extracted data.Of 68 records identified,15 were eligible and 6 were finally included(with moderate risk of bias),analyzing 159 participants.Body function(4 interventions,n=84),gait(4 interventions,n=115)and strength(3 interventions,n?78)showed significantly better results when ERT was performed.Meta-analysis could not be done because of the few studies and their heterogeneity.This review provided low-moderate quality evidence suggesting that ERT might be effective at improving body function,strength,and gait after stroke.Besides,no harm was documented,and it was well-accepted.展开更多
BACKGROUND Opioids are commonly used for management of post-operative pain in living kidney donors.Reducing exposure to opioids is desirable to minimize risk of dependence and potential side effects such as nausea,vom...BACKGROUND Opioids are commonly used for management of post-operative pain in living kidney donors.Reducing exposure to opioids is desirable to minimize risk of dependence and potential side effects such as nausea,vomiting,and constipation which may delay discharge.Liposomal bupivacaine,ketorolac,and scheduled acetaminophen have all demonstrated efficacy for management of post-operative pain in this population.AIM To assess the efficacy and safety of an opioid-sparing protocol utilizing a multimodal pain management approach in living kidney donors post-nephrectomy.METHODS Single-center,retrospective chart review study examining 52 living kidney donors(26 pre-protocol implementation,26 post-protocol implementation)from May 24th,2019 to September 27th,2023.Patients in the post-protocol group received intraoperative liposomal bupivacaine,hydromorphone PCA(until able to tolerate oral medications),15 mg of intravenous ketorolac every 6 hours for 3 doses,and scheduled oral acetaminophen,in addition to oxycodone as needed for moderate to severe pain.The primary endpoint was oral morphine equivalent(OME)use within 48 hours post-surgery.Secondary endpoints include average daily pain scale within 48 hours post-surgery,length of stay(LOS)(days),and incidence of new acute kidney injury(AKI)or gastrointestinal(GI)bleed during admission per provider.Differences between the pre-and post-protocol implementation groups were compared utilizing the exact Wilcoxon test for continuous variables and either the Fisher’s Exact orχ^(2) test for categorical variables.RESULTS Patients in the pre-protocol implementation group received more OME(mg)within 48 hours post-surgery when compared to the post-protocol group(median:84.5 vs 69.0).The median of total OME over the course of admission was numerically greater the pre-protocol group(105.0 vs 69.0),and was significantly more per LOS(41.3 vs 25.7,P=0.02).Average daily pain score was not statistically significantly different between the two groups on postoperative day 1(median:5.3 vs 4.4;P=0.43)and post-operative day 2(median:4.7 vs 5.2;P=0.96).No significant differences were found in provider-identified incidences of AKI or GI bleeding during admission.There was no difference in serum creatinine at the time of discharge between the two groups.CONCLUSION A multimodal,opioid-sparing pain management protocol was as effective for pain control and resulted in significantly less opioid daily exposure over LOS.No adverse events were found related to use of ketorolac in patients undergoing donor nephrectomy.Our findings suggest that an opioid-sparing protocol is both safe and effective at minimizing opioid exposure and managing post-operative pain within the first 48 hours post-surgery.展开更多
BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammator...BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammatory and immunomodulatory properties.AIM To compare the safety and efficacy of allogenic MSCs(^(Allo)MSCs)vs autologous MSCs(^(Auto)MSCs)in treating KOA in clinical settings.METHODS We conducted a systematic review and network meta-analysis to compare the safety and efficacy of^(Allo)MSCs vs^(Auto)MSCs in treating KOA.Our systematic search of four databases,including PubMed,Cochrane,Embase,and ClinicalTrials.gov,identified relevant randomized controlled trials(RCTs)reporting MSC-based treatment for KOA and reporting visual analog scale,Western Ontario and McMaster Universities Osteoarthritis scores,and adverse events.We assessed the methodological quality of the studies using the Cochrane Collaboration tool and calculated risk ratios(RRs)and weighted mean differences[with 95%confidence intervals(CIs)].Our statistical analyses used the R-Studio network meta-packages(version 2023.12.0).The study protocol was pre-registered on the International Prospective Register of Systematic Reviews(ID:CRD42024590866).RESULTS Nineteen RCTs involving 1216 patients with KOA met the inclusion criteria of the study.The network metaanalysis showed that^(Allo)MSCs gave a significant re-duction in visual analog scale scores by 14.91 points(95%CI:-24.52 to-5.30)vs 12.95 points with^(Auto)MSCs(95%CI:-24.42 to-1.48).For Western Ontario and McMaster Universities Osteoarthritis score,^(Allo)MSCs led to a significant reduction of 23.12 points(95%CI:-31.15 to-15.10)compared with 12.45 points using^(Auto)MSCs(95%CI:-19.31 to-5.59),thus revealing a significant improvement with^(Allo)MSCs(weighted mean difference:-10.62,95%CI:-21.23 to-0.11).Additionally,^(Auto)MSCs treatment showed a higher risk of joint-related adverse events(RR=1.39,95%CI:1.07-1.79)compared with^(Allo)MSCs(RR=1.13,95%CI:1.01-1.25).CONCLUSION^(Allo)MSCs may offer superior clinical outcomes with a lower risk of adverse events compared with^(Auto)MSCs in the treatment of KOA.However,the need for further RCTs directly comparing the two MSC types is crucial to validate this data,underscoring the importance of our findings in this field.展开更多
Background:Given the suboptimal quality of end‐of‐life care among patients with cancer in China,promoting living wills is critical in this population.Living wills ensure that individuals can receive the medical care...Background:Given the suboptimal quality of end‐of‐life care among patients with cancer in China,promoting living wills is critical in this population.Living wills ensure that individuals can receive the medical care they desire during the terminal phase of an illness,maintain their dignity,and ultimately achieve a good death.However,current awareness and attitudes about living wills among Chinese patients with cancer remain unclear.We administered a questionnaire survey on living wills to patients with malignant tumors to assess their most important needs and increase understanding about living wills.Methods:In this cross‐sectional study using convenience sampling,inpatients with malignant tumors in Wuhan completed our questionnaire between July 2020 and June 2021.We collected patients'sociodemographic characteristics and details regarding their knowledge and attitudes about living wills.Results:Among 213 patients with malignant tumors,114(53.52%)had heard of living wills;125(58.69%)expressed their willingness to sign the“Five Wishes”living will document after learning about it through the questionnaire.Patients with malignant tumors had a high level of desire for the following living will items:the lives of family and friends return to normal as soon as possible after their death,maintaining personal hygiene and dignity,and remaining pain‐free.The knowledge level of patients with malignant tumors was related to their educational level(p<0.05)and self‐care ability(p<0.05).Conclusions:Patients with malignant tumors have a high need for comfort,cleanliness,and pain relief in the terminal stages.Patients with a higher level of education and those with poorer self‐care ability had greater knowledge and acceptance of living wills.Promotion can first be targeted toward more highly educated patients and can then be gradually expanded to other groups.展开更多
Living donor kidney transplantation(LDKT)has evolved into a globally adopted clinical practice,driven by improvements in donor selection,immunological compatibility,and perioperative care.These advances have contribut...Living donor kidney transplantation(LDKT)has evolved into a globally adopted clinical practice,driven by improvements in donor selection,immunological compatibility,and perioperative care.These advances have contributed to enhanced donor safety and improved early graft outcomes.Still,its uptake remains limited worldwide,influenced by differences in clinical infrastructure,surgical expertise,and programmatic priorities.A central procedural consideration in LDKT is the choice of kidney for procurement,right or left.Left donor nephrectomy is generally preferred due to favorable vascular anatomy,yet right-sided procurement is often necessary in the presence of anatomical variations.While some studies report higher rates of early complications with right-sided nephrectomy,including delayed graft function and early graft loss,long-term outcomes appear comparable.The evaluation of laterality,however,varies significantly across centers and is often shaped more by institutional practice than by comparative evidence.In this editorial,we review key clinical and technical advances that have improved the safety and outcomes of LDKT,including immunological matching,donor selection,perioperative strategies,and early graft performance.We then critically examine the role of kidney laterality in donor nephrectomy,highlighting how anatomical complexity and procedural risk continue to shape clinical decision-making.展开更多
Khan et al’single-centre,retrospective study on the use of right or left kidneys in living-donor renal transplantation,offers the opportunity to further discuss a complex and debated topic in clinical transplantation...Khan et al’single-centre,retrospective study on the use of right or left kidneys in living-donor renal transplantation,offers the opportunity to further discuss a complex and debated topic in clinical transplantation.In brief,the authors confirm that,despite the historical preference for left kidneys,attributed to their anatomical advantages during donor nephrectomy and recipient transplantation,right kidneys can provide excellent outcomes when donors and recipients are carefully selected,and a meticulous surgical technique is applied in every step of the process.Usefully,the article includes some practical tips to help less experienced surgeons address the technical challenges of right kidney transplantation,such as extended renal vein dissection or full mobilization of the iliac vein of the recipient to minimize tension during anastomosis.Although limited by the selective use of minimally invasive(MI)nephrectomy for left kidneys,this work underscores the importance of expanding the living-donor pool,challenging the traditional taboos,and facilitating access to transplantation for a wider population of patients around the globe.Properly designed studies with larger sample size,comparable MI surgical techniques,prospective data collection,and long-term donor and recipient outcomes are warranted.展开更多
BACKGROUNDLiving donor kidney transplantation(LDKT)is considered the gold standard fortreating end-stage kidney disease.Previous studies have highlighted the impact ofdonor and recipient demographics in influencing po...BACKGROUNDLiving donor kidney transplantation(LDKT)is considered the gold standard fortreating end-stage kidney disease.Previous studies have highlighted the impact ofdonor and recipient demographics in influencing post-transplant outcomes.Webelieve that patient and graft outcomes in a tertiary university hospital setting willhave no difference between pairs of standard criteria vs pairs of extended criteria(EC)donors and recipients in LDKT.AIMTo investigate the outcomes of allocating EC donation(ECD)kidneys to ECrecipients(ECR)in LDKT and compare them to standard and mixed standard andEC pair counterparts.METHODSWe collected data from adult LDKTs conducted between April 2017 and April2022.Donor-recipient pairs were grouped based on criteria as follows:(1)Group1:Standard criteria donor(SCD)to standard criteria recipient(SCR);(2)Group 2:SCD to ECR;(3)Group 3:ECD to SCR;and(4)Group 4:ECD to ECR.RESULTSA total of 149 living donor transplants were analysed over a 5-year period.Graftsurvival,patient survival,and graft function were similar across all four groups.The incidence of common postoperative complications was as follows:(1)Perioperative bleeding(5.6%);(2)Surgical site infection(6.8%);and(3)Incisional hernia(7.4%).No statistically significantdifferences were found in patient or graft outcomes amongst the four groups.Multivariate analysis showed thatgroup 4 recipients might experience inferior 5-year graft function(β=-11.8,P=0.037)when compared with group1.CONCLUSIONIn LDKT,long-term patient and graft outcomes are comparable amongst different combinations of standard vs ECdonors and recipients.These findings show the primary potential of living donor ECD to ECR kidney transplantationwith satisfying outcomes.展开更多
Acupuncture,an ancient Chinese medical practice,has been a living heritage for thousands of years.It has helped countless patients,playing a significant role in the field of medicine long before modern medicine emerge...Acupuncture,an ancient Chinese medical practice,has been a living heritage for thousands of years.It has helped countless patients,playing a significant role in the field of medicine long before modern medicine emerged.The origin of acupuncture can be traced back to ancient times when people used stone tools to relieve pain.Over time,this simple method gradually developed into a profound and comprehensive medical system.Its therapeutic principles are in line with traditional Chinese medicine,focusing on holistic treatment,meridian(经脉)adjustment and the balance of bodily functions.展开更多
BACKGROUND Mesenchymal stem cells(MSCs),as a living bio-drug,are being considered as a potential treatment for coronavirus disease 2019(COVID-19)-induced acute res-piratory distress syndrome(ARDS)due to their immunomo...BACKGROUND Mesenchymal stem cells(MSCs),as a living bio-drug,are being considered as a potential treatment for coronavirus disease 2019(COVID-19)-induced acute res-piratory distress syndrome(ARDS)due to their immunomodulatory and repa-rative properties.AIM To synthesize the existing evidence on MSCs and their derivative exosomes for treating COVID-19-induced ARDS,with a focus on the key outcomes of safety and efficacy.METHODS Four databases were systematically searched for randomized controlled trials assessing MSCs and their derived exosomes for COVID-19-induced ARDS trea-tment.Their safety and efficacy were evaluated based on the duration of mecha-nical ventilation,hospital and intensive care unit stay,6-minute walk distance,mortality rates,and adverse events.Weighted mean differences and odds ratios with 95%confidence intervals(CIs)were calculated to estimate treatment out-comes:A network meta-analysis(NMA)evaluated mortality,adverse events,and the number of ventilation-free days.RESULTS Sixteen randomized controlled trials involving 1027 ARDS patients were in-cluded,with 574 receiving MSCs or MSC-derived exosomes.MSC-based therapy did not significantly improve mechanical ventilation duration,ventilation-free days,hospital or intensive care unit stay,or 6-minute walk distance.Sensitivity analysis revealed a significant reduction in mechanical ventilation duration when excluding an outlier(weighted mean difference:-4.84 days;95%CI:-8.21 to-1.47;I2=20%).In contrast,no significant differences were observed in the other outcomes.Mortality and adverse events were comparable between the groups(odds ratio for mortality:0.77;95%CI:0.56-1.06).An NMA of ventilation-free days,mortality,and adverse events revealed no significant difference among MSCs,exosomes,and controls.Exosomes ranked highest in terms of probability of benefit,although without statistical significance.CONCLUSION MSC and exosome-based therapies were found to be safe and associated with a reduced duration of mechanical ventilation in patients with ARDS.NMA showed that exosome-based therapy matched the benefits of its parent cells,but with practical and logistical advantages.展开更多
F-actin microstructures dominate cellular viscoelasticity and have been used to identify the migration and malignance of living cancer cells.Diabetic cancer patients suffer from increased metastasis and tumor recurren...F-actin microstructures dominate cellular viscoelasticity and have been used to identify the migration and malignance of living cancer cells.Diabetic cancer patients suffer from increased metastasis and tumor recurrence.However,the long-term evolution and correlation of F-actin microstructures and viscoelasticity distribution are still poorly understood in living cancer cells under varying glucose environment.Herein,by using atomic force microscopy with amplitude modulation-frequency modulation and nanoindentation mode,we characterized the hierarchical F-actin microstructures and the multi-passage viscoelasticity evolution in living Huh-7 cancer cells transferred from high to low glucose level.The highly oriented stress fibers connected by thinner fiber networks were observed in high glucose environment.The circumferential actin networks composed by straight segment-like fibers and the randomly distributed actin fragments connected by ultrathin crosslinking fibers were observed in low glucose environment.The viscoelasticity within the nucleus and the cytoplasm of living Huh-7 cancer cells showed longterm fluctuations over tens of passages after switching glucose environments.The viscoelasticity of cytoplasm was more responsive to the change of glucose environments than nucleus,which was due to the reorganization of F-actin microstructures.Our work provides the microstructural and nanomechanical understanding on the migration and proliferation of living cancer cells under varying glucose environment.展开更多
文摘What are the origins,historical development,and lineages of the reincarnation system of Living Buddhas in Tibetan Buddhism?What kind of academic framework is"Han-Tibetan Buddhist Studies"?In an interview with this journal,Professor Shen Weirong ofTsinghua University discusses these issues on the basis of his research.
基金partial support from the Living Circular Labels project,funded by the Taskforce for Applied Research SIA’s KIEM programme(No.CIE.06.007)in the Netherlands。
文摘By leveraging the unique qualities of microorganisms,engineered living materials(ELMs)offer functional and economic advantages in everyday applications along with notable ecological benefits.This study contributes to the growing field of biodesign by examining the potential of Flavobacteria for thermochromic ELMs.Many Flavobacteria,commonly found in marine environments,produce iridescent structural colorations as their colonies expand on semi-solid surfaces through gliding motility.In this study,we analyzed the effects of temperature variations on flavobacterium Cellulophaga lytica PLY A 2,characterizing distinct changes in colony growth and iridescent colorations at a macroscopic and microscopic scale.Using scanning electron microscopy,we investigated the relationship between iridescent color and the underlying cell-based optical structures.By providing insights into the temperature-responsive behavior of Flavobacteria,our findings highlight their potential for future thermochromic ELMs-with applications ranging from sustainable food packaging to smart textiles-while encouraging further characterization studies within biodesign research.
文摘Editor's Note:As a unique system of succession in Tibetan Buddhism,the reincarnation of Living Buddhas is governed by standardized religious rituals,historical conventions,and established principles.Since the Karma Kagyu sect pioneered the reincarnation system of Living Buddhas in the 13th century,this tradition has continued for more than 700 years.Since the Gelug sect adopted the reincarnation practice in the 16th century,resulting in major lineages such as the Dalai Lama and Panchen Erdeni reincarnations,the system has now held a history of over 400 years.Since the Yuan Dynasty(1271-1368),successive central governments of China have,without exception,strengthened administration over reincarnation matters.In the 57th year of the reign of Emperor Qianlong(1792)of the Qing Dynasty,the Golden Urn Lot-Drawing System was formally established.This system has remained in place up to the present day.Demonstrating national sovereignty,governmental authority,as well as the sacredness and impartiality of Buddhism,it has effectively prevented corruption and malpractice during the reincarnation process.
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Objective:Robotic-assisted living donor nephrectomy(RALDN)has been shown to be a safe and feasible option,offering enhanced visualization and improved surgical dexterity,allowing for a potential increase in the living donor pool to perform pediatric and adult kidney transplants,even in cases of grafts with anatomical variants.We report our recent experience in using RALDN for open kidney transplantation(OKT).Methods:Between August 2021 and July 2025,122 kidney transplant recipients underwent OKT using RALDN grafts obtained at the Miami Transplant Institute.Clinical outcomes,during the first12 months post-transplant,including the incidence of delayed graft function(DGF),surgical complications,estimated glomerular filtrationrate(eGFR),and graft loss,were evaluated.Results:Sixteen pediatric and 106 adult recipients were included.The median recipient and donor ages were 42.2 yr and 39.5 yr,respectively.Male recipients comprised 63.1%(77/122);female donors comprised 56.6%(69/122).Among the donors,no conversion to open surgery was needed,and no postoperative complications attributed to the RALDN procedure were observed.Thirty-one kidney grafts required back table reconstruction.The median cold and warm ischemia times were 55.5 min and 27.0 min,respectively.One case(0.8%)of DGF was observed.One recipient(0.8%)developed a postoperative vascular complication;five(4.1%)developed a urologic complication.The median eGFRs at 1 mo,3 mo,6 mo,and 12 mo post-transplant were 71.9,77.1,75.1,and 72.1 mL/min/1.73 m2,respectively.No cases of graft failure during the first12 months post-transplant were observed,and one patient died with a functioning graft.Conclusion:RALDN is a safe and effective technique that provides favorable outcomes among both donors and recipients.This minimally invasive approach should be offered as a safe alternative to living donor patients.
文摘Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria. Liver resection (LR) is often the initial treatment for patients with solitary tumors and preserved liver function. The high recurrence rates associated with LR has prompted the exploration of sequential living donor liver transplantation (seq LDLT) after LR as a strategy for HCC patients with high-risk of recurrence.Methods:We analyzed data from 27 adult patients who underwent seq LDLT after LR for HCC at Kaohsiung Chang Gung Memorial Hospital (KCGMH) between June 1994 and December 2023. Patients were selected based on high-risk histopathological features post-LR or as part of downstaging strategy. Outcomes measured included overall survival (OS) and disease-free survival (DFS).Results:Among 765 HCC patients who underwent LDLT, 204 received LR before LDLT, and 27 underwent seqL DLT. Five patients (19%) underwent living donor liver transplantation (LDLT) following LR as a downstaging strategy while the rest received seqL DLT as a preemptive strategy. The median age was 53.5 years with 85%males. Chronic hepatitis B was the predominant underlying disease (74%). The 1-, 3-, and 5-year OS and DFS rates were 100%, 96.0%, 96.0%and 100%, 96.2%, 96.2%, respectively, with two patients experiencing HCC recurrence. One patient died from HCC recurrence. High-risk histopathological features included microvascular invasion (52%), satellite nodules (15%), multiple tumors (26%), tumors> 5 cm(19%), and a total tumor diameter> 10 cm (7%).Conclusions:Seq LDLT offers a promising, tailored approach for managing HCC with adverse histopathologic features. Combining seq LDLT, downstaging strategies, and multidisciplinary treatments can achieve satisfactory OS and DFS in carefully selected patients, highlighting the need for refined criteria to identify the best candidates.
文摘BACKGROUND Pediatric liver transplantation(LT)is the definitive treatment for end-stage liver disease and acute liver failure in children.However,graft size mismatch poses significant challenges,particularly in infants weighing less than 10 kg.Large-forsize grafts can lead to severe complications,including vascular thrombosis and impaired graft perfusion.Surgical innovations,such as hyper-reduced left lateral segment(HRLLS)grafts and monosegmental grafts(MSG),offer viable solutions by tailoring graft size without compromising vascular or biliary integrity.AIM To analyze the techniques and outcomes of HRLLS and MSG grafts in pediatric liver trabsplantation.METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,a comprehensive literature search was conducted across PubMed,Scopus,and Google Scholar,including studies up to February 2025.Eligible studies included case-control,observational,and randomized controlled trials reporting clinical outcomes of HRLLS,MSG,or reduced left lateral segment grafts(RLLS)in pediatric LT.The Joanna Briggs Institute Critical Appraisal Checklist was used for quality assessment.Meta-analysis was performed using MetaXL software to pool survival outcomes and assess complication profiles.RESULTS Eighteen studies involving various graft reduction techniques were included.Both HRLLS and MSG demonstrated comparable one-year survival rates exceeding 80%,with some studies reporting rates above 95%.Complications such as hepatic artery thrombosis,portal vein thrombosis,and sepsis were slightly more frequent in HRLLS/RLLS recipients but remained within acceptable limits.Meta-analysis revealed no significant differences in survivability between graft types.CONCLUSION HRLLS and MSG techniques enable successful liver transplantation in small pediatric recipients,achieving longterm outcomes comparable to standard approaches.These graft modification strategies expand donor pool utilization and optimize patient survival while mitigating large-for-size complications.
基金supported by UKResearch and Innovation(MR/S03546X/1)National BrainAppeal,Economic and Social ResearchCouncil(ES/S010467/1)+4 种基金Wellcome Trust(221915/Z/20/Z),ESRC(ES/W006014/1)Royal National Institute for Deaf People-Dunhill Medical Trust Pauline Ashley(204841/Z/16/Z,PA23)London Hospitals Biomedical Research Centre(221915/Z/20/Z)Bloomsbury and East London Doctoral Training Partnership(ES/P000592/1)National Institute for Health Research.
文摘Rarer dementias are associated with atypical symptoms and younger onset,which result in a higher burden of care.We provide a review of the global literature on longitudinal decline in activities of daily living(ADLs)in dementias that account for less than 10%of dementia diagnoses.Published studies were identified through searches conducted in Medical Literature Analysis and Retrieval System Online(MEDLINE),Excerpta Medica Database(Embase),Excerpta Medica Care(Emcare),PsycINFO,and Cumulative Index in Nursing and Allied Health Literature(CINAHL).The search criteria included terms related to‘rarer dementias’,‘activities of daily living’and‘longitudinal or cross-sectional studies’following a predefined protocol registered.Studies were screened,and those that met the criteria were citation searched.Quality assessments were performed,and relevant data were extracted.20 articles were selected,of which 19 focused on dementias within the frontotemporal dementia/primary progressive aphasia spectrum,while one addressed posterior cortical atrophy.Four studies were cross-sectional and 16 studies were longitudinal,with a median duration of 2.2 years.The Disability Assessment for Dementia was used to measure decline in 8 of the 20 studies.The varied sequences of ADL decline reported in the literature reflect variation in diagnostic specificity between studies and within-syndrome heterogeneity.Most studies used Alzheimer’s disease staging scales to measure decline,which cannot capture variant-specific symptoms.To enhance care provision in dementia,ADL scales could be deployed postdiagnosis to aid treatment and planning.This necessitates staging scales that are variant-specific and span the disease course from diagnosis to end of life.
基金approved by the Ethics Committee of the Second Affiliated Hospital,Zhejiang University School of Medicine(2024-0690).
文摘The prognosis of drug-induced acute liver failure(ALF)is poor,with a survival rate of 27.1%without liver transplantation.Liver transplantation significantly improved survival rates to 66.2%.[1]The shortage of available grafts can be addressed by living donor liver transplantation(LDLT),an effective and safe method that expands the donor pool,enhances timely transplantation,and improves patient survival.
文摘BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft loss or graft dysfunction.Nevertheless,circumstances may arise where selecting the RK over the left kidney(LK)is unavoidable.Consequently,it is crucial to thoroughly examine the implications of such a choice on the overall transplant outcome.AIM To compare transplant outcomes between recipients of RK and LK while examining the factors that influence these outcomes.METHODS We retrospectively analyzed data from adult patients who received LD kidney transplants involving meticulous patient selection and surgical techniques at our center from January 2020 to December 2023.We included all kidney donors who were over 18,fit to donate,and had undergone diethylenetriamine pentaacetic acid split function and/or computed tomography based volumetry.The variables examined comprised donor and recipient demographics,and outcome measures included technical graft loss(TGL),delayed or slow graft function(SGF),and post-transplant serum creatinine(SC)trends.We used a logistic regression model to assess the likelihood of adverse outcomes considering the donor kidney side.RESULTS Of the 250 transplants performed during the period,56(22%)were RKs.The recipient demographics and transplant factors were comparable for the right and LKs,except that the donor warm and cold ischemia time were shorter for RKs.TGL and SGF each occurred in 2%(n=1)of RKs and 0.5%(n=1)of LKs,the difference being insignificant.These complications,however,were not related to the venous anastomosis.One RK(2%)developed delayed graft function after 48 hours,which was attributable to postoperative hypoxia rather than the surgical technique.The post-transplant SC trend and mean SC at the last follow-up were similar across both kidney sides.CONCLUSION The donor kidney side has little impact on post-transplant adverse events and graft function in LD transplants,provided that careful patient selection and precise surgical techniques are employed.
文摘Impairments on body function,activities of daily living(ADL)and cognition are common after stroke.Eccentric resistance training(ERT)may be implemented to improve them.The primary objectives were to evaluate whether ERT improves body function,ADL and cognition after stroke.The secondary objectives were to evaluate whether ERT improves strength,gait,quality of life,and self-perceived health.Seven electronic databases were searched:Cochrane Central Register of Controlled Trials,Cochrane Stroke Group Trials Register,PubMed,Epistemonikos,Embase,SPORTDiscus,and WHO International Clinical Trials Registry Platform.Last search was run in December 2023,including studies since 2012.Selection criteria were studies with stroke participants of both sexes,aged 18 or more,with an intervention based on ERT.Accepted languages were English,Spanish or French.First search was done in pairs.Authors removed duplicate studies and those which did not meet inclusion criteria through title and abstracts.Finally,all authors,independently,screened the final search results and extracted data.Of 68 records identified,15 were eligible and 6 were finally included(with moderate risk of bias),analyzing 159 participants.Body function(4 interventions,n=84),gait(4 interventions,n=115)and strength(3 interventions,n?78)showed significantly better results when ERT was performed.Meta-analysis could not be done because of the few studies and their heterogeneity.This review provided low-moderate quality evidence suggesting that ERT might be effective at improving body function,strength,and gait after stroke.Besides,no harm was documented,and it was well-accepted.
文摘BACKGROUND Opioids are commonly used for management of post-operative pain in living kidney donors.Reducing exposure to opioids is desirable to minimize risk of dependence and potential side effects such as nausea,vomiting,and constipation which may delay discharge.Liposomal bupivacaine,ketorolac,and scheduled acetaminophen have all demonstrated efficacy for management of post-operative pain in this population.AIM To assess the efficacy and safety of an opioid-sparing protocol utilizing a multimodal pain management approach in living kidney donors post-nephrectomy.METHODS Single-center,retrospective chart review study examining 52 living kidney donors(26 pre-protocol implementation,26 post-protocol implementation)from May 24th,2019 to September 27th,2023.Patients in the post-protocol group received intraoperative liposomal bupivacaine,hydromorphone PCA(until able to tolerate oral medications),15 mg of intravenous ketorolac every 6 hours for 3 doses,and scheduled oral acetaminophen,in addition to oxycodone as needed for moderate to severe pain.The primary endpoint was oral morphine equivalent(OME)use within 48 hours post-surgery.Secondary endpoints include average daily pain scale within 48 hours post-surgery,length of stay(LOS)(days),and incidence of new acute kidney injury(AKI)or gastrointestinal(GI)bleed during admission per provider.Differences between the pre-and post-protocol implementation groups were compared utilizing the exact Wilcoxon test for continuous variables and either the Fisher’s Exact orχ^(2) test for categorical variables.RESULTS Patients in the pre-protocol implementation group received more OME(mg)within 48 hours post-surgery when compared to the post-protocol group(median:84.5 vs 69.0).The median of total OME over the course of admission was numerically greater the pre-protocol group(105.0 vs 69.0),and was significantly more per LOS(41.3 vs 25.7,P=0.02).Average daily pain score was not statistically significantly different between the two groups on postoperative day 1(median:5.3 vs 4.4;P=0.43)and post-operative day 2(median:4.7 vs 5.2;P=0.96).No significant differences were found in provider-identified incidences of AKI or GI bleeding during admission.There was no difference in serum creatinine at the time of discharge between the two groups.CONCLUSION A multimodal,opioid-sparing pain management protocol was as effective for pain control and resulted in significantly less opioid daily exposure over LOS.No adverse events were found related to use of ketorolac in patients undergoing donor nephrectomy.Our findings suggest that an opioid-sparing protocol is both safe and effective at minimizing opioid exposure and managing post-operative pain within the first 48 hours post-surgery.
文摘BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammatory and immunomodulatory properties.AIM To compare the safety and efficacy of allogenic MSCs(^(Allo)MSCs)vs autologous MSCs(^(Auto)MSCs)in treating KOA in clinical settings.METHODS We conducted a systematic review and network meta-analysis to compare the safety and efficacy of^(Allo)MSCs vs^(Auto)MSCs in treating KOA.Our systematic search of four databases,including PubMed,Cochrane,Embase,and ClinicalTrials.gov,identified relevant randomized controlled trials(RCTs)reporting MSC-based treatment for KOA and reporting visual analog scale,Western Ontario and McMaster Universities Osteoarthritis scores,and adverse events.We assessed the methodological quality of the studies using the Cochrane Collaboration tool and calculated risk ratios(RRs)and weighted mean differences[with 95%confidence intervals(CIs)].Our statistical analyses used the R-Studio network meta-packages(version 2023.12.0).The study protocol was pre-registered on the International Prospective Register of Systematic Reviews(ID:CRD42024590866).RESULTS Nineteen RCTs involving 1216 patients with KOA met the inclusion criteria of the study.The network metaanalysis showed that^(Allo)MSCs gave a significant re-duction in visual analog scale scores by 14.91 points(95%CI:-24.52 to-5.30)vs 12.95 points with^(Auto)MSCs(95%CI:-24.42 to-1.48).For Western Ontario and McMaster Universities Osteoarthritis score,^(Allo)MSCs led to a significant reduction of 23.12 points(95%CI:-31.15 to-15.10)compared with 12.45 points using^(Auto)MSCs(95%CI:-19.31 to-5.59),thus revealing a significant improvement with^(Allo)MSCs(weighted mean difference:-10.62,95%CI:-21.23 to-0.11).Additionally,^(Auto)MSCs treatment showed a higher risk of joint-related adverse events(RR=1.39,95%CI:1.07-1.79)compared with^(Allo)MSCs(RR=1.13,95%CI:1.01-1.25).CONCLUSION^(Allo)MSCs may offer superior clinical outcomes with a lower risk of adverse events compared with^(Auto)MSCs in the treatment of KOA.However,the need for further RCTs directly comparing the two MSC types is crucial to validate this data,underscoring the importance of our findings in this field.
文摘Background:Given the suboptimal quality of end‐of‐life care among patients with cancer in China,promoting living wills is critical in this population.Living wills ensure that individuals can receive the medical care they desire during the terminal phase of an illness,maintain their dignity,and ultimately achieve a good death.However,current awareness and attitudes about living wills among Chinese patients with cancer remain unclear.We administered a questionnaire survey on living wills to patients with malignant tumors to assess their most important needs and increase understanding about living wills.Methods:In this cross‐sectional study using convenience sampling,inpatients with malignant tumors in Wuhan completed our questionnaire between July 2020 and June 2021.We collected patients'sociodemographic characteristics and details regarding their knowledge and attitudes about living wills.Results:Among 213 patients with malignant tumors,114(53.52%)had heard of living wills;125(58.69%)expressed their willingness to sign the“Five Wishes”living will document after learning about it through the questionnaire.Patients with malignant tumors had a high level of desire for the following living will items:the lives of family and friends return to normal as soon as possible after their death,maintaining personal hygiene and dignity,and remaining pain‐free.The knowledge level of patients with malignant tumors was related to their educational level(p<0.05)and self‐care ability(p<0.05).Conclusions:Patients with malignant tumors have a high need for comfort,cleanliness,and pain relief in the terminal stages.Patients with a higher level of education and those with poorer self‐care ability had greater knowledge and acceptance of living wills.Promotion can first be targeted toward more highly educated patients and can then be gradually expanded to other groups.
文摘Living donor kidney transplantation(LDKT)has evolved into a globally adopted clinical practice,driven by improvements in donor selection,immunological compatibility,and perioperative care.These advances have contributed to enhanced donor safety and improved early graft outcomes.Still,its uptake remains limited worldwide,influenced by differences in clinical infrastructure,surgical expertise,and programmatic priorities.A central procedural consideration in LDKT is the choice of kidney for procurement,right or left.Left donor nephrectomy is generally preferred due to favorable vascular anatomy,yet right-sided procurement is often necessary in the presence of anatomical variations.While some studies report higher rates of early complications with right-sided nephrectomy,including delayed graft function and early graft loss,long-term outcomes appear comparable.The evaluation of laterality,however,varies significantly across centers and is often shaped more by institutional practice than by comparative evidence.In this editorial,we review key clinical and technical advances that have improved the safety and outcomes of LDKT,including immunological matching,donor selection,perioperative strategies,and early graft performance.We then critically examine the role of kidney laterality in donor nephrectomy,highlighting how anatomical complexity and procedural risk continue to shape clinical decision-making.
文摘Khan et al’single-centre,retrospective study on the use of right or left kidneys in living-donor renal transplantation,offers the opportunity to further discuss a complex and debated topic in clinical transplantation.In brief,the authors confirm that,despite the historical preference for left kidneys,attributed to their anatomical advantages during donor nephrectomy and recipient transplantation,right kidneys can provide excellent outcomes when donors and recipients are carefully selected,and a meticulous surgical technique is applied in every step of the process.Usefully,the article includes some practical tips to help less experienced surgeons address the technical challenges of right kidney transplantation,such as extended renal vein dissection or full mobilization of the iliac vein of the recipient to minimize tension during anastomosis.Although limited by the selective use of minimally invasive(MI)nephrectomy for left kidneys,this work underscores the importance of expanding the living-donor pool,challenging the traditional taboos,and facilitating access to transplantation for a wider population of patients around the globe.Properly designed studies with larger sample size,comparable MI surgical techniques,prospective data collection,and long-term donor and recipient outcomes are warranted.
文摘BACKGROUNDLiving donor kidney transplantation(LDKT)is considered the gold standard fortreating end-stage kidney disease.Previous studies have highlighted the impact ofdonor and recipient demographics in influencing post-transplant outcomes.Webelieve that patient and graft outcomes in a tertiary university hospital setting willhave no difference between pairs of standard criteria vs pairs of extended criteria(EC)donors and recipients in LDKT.AIMTo investigate the outcomes of allocating EC donation(ECD)kidneys to ECrecipients(ECR)in LDKT and compare them to standard and mixed standard andEC pair counterparts.METHODSWe collected data from adult LDKTs conducted between April 2017 and April2022.Donor-recipient pairs were grouped based on criteria as follows:(1)Group1:Standard criteria donor(SCD)to standard criteria recipient(SCR);(2)Group 2:SCD to ECR;(3)Group 3:ECD to SCR;and(4)Group 4:ECD to ECR.RESULTSA total of 149 living donor transplants were analysed over a 5-year period.Graftsurvival,patient survival,and graft function were similar across all four groups.The incidence of common postoperative complications was as follows:(1)Perioperative bleeding(5.6%);(2)Surgical site infection(6.8%);and(3)Incisional hernia(7.4%).No statistically significantdifferences were found in patient or graft outcomes amongst the four groups.Multivariate analysis showed thatgroup 4 recipients might experience inferior 5-year graft function(β=-11.8,P=0.037)when compared with group1.CONCLUSIONIn LDKT,long-term patient and graft outcomes are comparable amongst different combinations of standard vs ECdonors and recipients.These findings show the primary potential of living donor ECD to ECR kidney transplantationwith satisfying outcomes.
文摘Acupuncture,an ancient Chinese medical practice,has been a living heritage for thousands of years.It has helped countless patients,playing a significant role in the field of medicine long before modern medicine emerged.The origin of acupuncture can be traced back to ancient times when people used stone tools to relieve pain.Over time,this simple method gradually developed into a profound and comprehensive medical system.Its therapeutic principles are in line with traditional Chinese medicine,focusing on holistic treatment,meridian(经脉)adjustment and the balance of bodily functions.
文摘BACKGROUND Mesenchymal stem cells(MSCs),as a living bio-drug,are being considered as a potential treatment for coronavirus disease 2019(COVID-19)-induced acute res-piratory distress syndrome(ARDS)due to their immunomodulatory and repa-rative properties.AIM To synthesize the existing evidence on MSCs and their derivative exosomes for treating COVID-19-induced ARDS,with a focus on the key outcomes of safety and efficacy.METHODS Four databases were systematically searched for randomized controlled trials assessing MSCs and their derived exosomes for COVID-19-induced ARDS trea-tment.Their safety and efficacy were evaluated based on the duration of mecha-nical ventilation,hospital and intensive care unit stay,6-minute walk distance,mortality rates,and adverse events.Weighted mean differences and odds ratios with 95%confidence intervals(CIs)were calculated to estimate treatment out-comes:A network meta-analysis(NMA)evaluated mortality,adverse events,and the number of ventilation-free days.RESULTS Sixteen randomized controlled trials involving 1027 ARDS patients were in-cluded,with 574 receiving MSCs or MSC-derived exosomes.MSC-based therapy did not significantly improve mechanical ventilation duration,ventilation-free days,hospital or intensive care unit stay,or 6-minute walk distance.Sensitivity analysis revealed a significant reduction in mechanical ventilation duration when excluding an outlier(weighted mean difference:-4.84 days;95%CI:-8.21 to-1.47;I2=20%).In contrast,no significant differences were observed in the other outcomes.Mortality and adverse events were comparable between the groups(odds ratio for mortality:0.77;95%CI:0.56-1.06).An NMA of ventilation-free days,mortality,and adverse events revealed no significant difference among MSCs,exosomes,and controls.Exosomes ranked highest in terms of probability of benefit,although without statistical significance.CONCLUSION MSC and exosome-based therapies were found to be safe and associated with a reduced duration of mechanical ventilation in patients with ARDS.NMA showed that exosome-based therapy matched the benefits of its parent cells,but with practical and logistical advantages.
基金supported by the National Natural Science Foundation of China(Grant No.11972383)to Wenpeng Zhuby the National Natural Science Foundation of China(Grant No.12132020)to Yue Zhengby the Guangdong Provincial Key Laboratory of Magnetoelectric Physics and Devices(Grant No.2022B1212010008).
文摘F-actin microstructures dominate cellular viscoelasticity and have been used to identify the migration and malignance of living cancer cells.Diabetic cancer patients suffer from increased metastasis and tumor recurrence.However,the long-term evolution and correlation of F-actin microstructures and viscoelasticity distribution are still poorly understood in living cancer cells under varying glucose environment.Herein,by using atomic force microscopy with amplitude modulation-frequency modulation and nanoindentation mode,we characterized the hierarchical F-actin microstructures and the multi-passage viscoelasticity evolution in living Huh-7 cancer cells transferred from high to low glucose level.The highly oriented stress fibers connected by thinner fiber networks were observed in high glucose environment.The circumferential actin networks composed by straight segment-like fibers and the randomly distributed actin fragments connected by ultrathin crosslinking fibers were observed in low glucose environment.The viscoelasticity within the nucleus and the cytoplasm of living Huh-7 cancer cells showed longterm fluctuations over tens of passages after switching glucose environments.The viscoelasticity of cytoplasm was more responsive to the change of glucose environments than nucleus,which was due to the reorganization of F-actin microstructures.Our work provides the microstructural and nanomechanical understanding on the migration and proliferation of living cancer cells under varying glucose environment.
