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
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
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
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
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
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...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
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
BACKGROUND Pediatric living-donor liver transplantation is considered a safe alternative for the treatment of children with end-stage liver disease.Experienced tertiary centers and specialized medical staff are necess...BACKGROUND Pediatric living-donor liver transplantation is considered a safe alternative for the treatment of children with end-stage liver disease.Experienced tertiary centers and specialized medical staff are necessary to ensure compatible long-term survival rates and quality-of-life for these children.AIM To report the results and the 10-year learning curve of a pediatric living-donor liver transplantation program.METHODS We conducted a retrospective cohort study of pediatric recipients from 2013 to 2023.Post-transplant outcomes and patient survival rates were compared between two 5-year periods of the program.RESULTS A total of 25 and 48 patients underwent transplantation in the first(2013-2017)and second period(2018-2023),respectively.Portal vein and hepatic artery thrombosis occurred in 11(15.1%)and seven(9.6%)patients,respectively.Biliary complications were observed in 39 of 73 patients(53.4%).A lower warm ischemia time was observed in the second period compared to the first(32.6±8.6 minutes vs 38.4±9.8 minutes,P=0.018,respectively).Patient survival rates at 1 and 5 years were 84%in the first period and 91.7%in the second period,with no significant difference(P=0.32).CONCLUSION The reported indications and outcomes align with the current literature.Our findings provide crucial evidence regarding the feasibility of establishing a living donor program with consistent results over time.展开更多
BACKGROUND Kidney transplantation is increasingly more common due to the ongoing shortage of deceased donors.However,anatomical challenges,such as a short renal artery,can complicate surgical procedures and increase c...BACKGROUND Kidney transplantation is increasingly more common due to the ongoing shortage of deceased donors.However,anatomical challenges,such as a short renal artery,can complicate surgical procedures and increase complication risk,including thrombosis and anastomotic stenosis.To address these issues and optimize graft outcomes,innovative surgical techniques are essential.CASE SUMMARY We present a case of kidney transplantation complicated by a short donor renal artery.To address the discrepancy between arterial length and diameter mismatch,the recipient’s inferior epigastric artery was used as a cuff interposition for arterial reconstruction.Following standard laparoscopic donor nephrectomy,vascular reconstruction was performed on the back table.The use of the inferior epigastric artery as a cuff allowed for successful elongation and size matching of the donor renal artery,enabling a tension-free anastomosis to the recipient’s external iliac artery.Postoperative Doppler ultrasound and angiography confirmed excellent graft perfusion.The patient experienced an uneventful recovery with immediate graft function and maintained stable renal function at 6 months post-transplant.To our knowledge,this is the first reported use of the inferior epigastric artery as a cuff interposition in renal artery reconstruction,offering a novel and effective technique for managing short renal arteries in kidney transplantation.CONCLUSION Interposition of the epigastric artery offers an innovative technique for managing short donor renal arteries,reducing the risk of early thrombosis and long-term complications as size mismatch and intimal hyperplasia.展开更多
BACKGROUND Post-transplant diabetes mellitus(PTDM)is a common metabolic adverse event following kidney transplantation,negatively impacting graft function and patient outcomes.AIM To evaluate the frequency of PTDM and...BACKGROUND Post-transplant diabetes mellitus(PTDM)is a common metabolic adverse event following kidney transplantation,negatively impacting graft function and patient outcomes.AIM To evaluate the frequency of PTDM and to determine predictive factors in living donor individuals who have undergone kidney transplantation.METHODS A retrospective analysis was conducted on 1200 living donor kidney transplant recipients treated between 2016 and 2023.Demographic,clinical,and treatment data were collected,and PTDM was identified based on American Diabetes Association criteria.Statistical analysis included logistic regression analysis to determine independent predictors of PTDM.RESULTS PTDM was diagnosed in 162 patients(13.5%).Risk factors included older age[odds ratio(OR)1.03,P=0.03],increased body mass index(OR 1.08,P=0.02),a genetic predisposition to diabetes(OR 1.95,P=0.001),and corticosteroid use(OR 1.30,P=0.04).Most PTDM cases(61.7%)occurred during the initial 6 months after transplant.Tacrolimus-based regimens were more commonly associated with PTDM compared to other protocols.Renal function at 12 months was com-parable between PTDM and non-PTDM groups.CONCLUSION PTDM remains a significant concern in kidney transplantation,particularly among patients with modifiable risk factors.Optimizing immunosuppressive regimens,implementing early metabolic monitoring,and addressing modifiable risks such as BMI may help reduce PTDM incidence.Additional research is required to evaluate extended-term results and refine preventive strategies.展开更多
Objective:To analyze the value of continuous care for patients with hypertensive intracerebral hemorrhage(HICH).Methods:A total of 80 patients with HICH who visited our hospital from January 2024 to December 2024 were...Objective:To analyze the value of continuous care for patients with hypertensive intracerebral hemorrhage(HICH).Methods:A total of 80 patients with HICH who visited our hospital from January 2024 to December 2024 were selected as samples and randomly divided into two groups.The observation group received continuous care,while the control group received routine care.The Functional Independence Measure(FIM),Symptom Checklist-90(SCL-90),and complications were compared between the two groups.Results:The FIM score of the observation group was higher than that of the control group(P<0.05).The SCL-90 score of the observation group was lower than that of the control group(P<0.05).The incidence of HICH complications in the observation group was lower than that in the control group(P<0.05).Conclusion:The application of continuous care in HICH nursing can enhance patients’independent living skills outside the hospital,optimize their psychosocial adaptation,and is safe and efficient.展开更多
Living cationic polymerization of 4-acetoxystyrene(STO)was conducted in CH_(2)Cl_(2) at-15℃ using a dicumyl chloride(DCC)/SnCl_(4)/nBu_(4)NBr initiating system.Impurity moisture initiation was inhibited by adding pro...Living cationic polymerization of 4-acetoxystyrene(STO)was conducted in CH_(2)Cl_(2) at-15℃ using a dicumyl chloride(DCC)/SnCl_(4)/nBu_(4)NBr initiating system.Impurity moisture initiation was inhibited by adding proton trap 2,6-di-tert-butylpyridine(DTBP),and the controlled initiation of DCC was confirmed by ^(1)H nuclear magnetic resonance(^(1)H-NMR)spectroscopy and matrix-assisted laser desorption ionization time-offlight mass(MALDI-TOF-MS)spectrometry.The polymerization kinetics were analyzed to for optimizing the polymerization rate.Allyl-telechelic PSTOs(allyl-PSTO-allyl)with molecular weight(Mn)range of 3540–7800 g/mol and narrow molecular weight dispersity(Mw/Mn)about 1.25 were prepared through nucleophilic substitution with allyltrimethylsilane(ATMS)at approximately 40%monomer conversion.The experimental results indicate that the substitution efficiency of ATMS increased with higher ATMS concentration,temperature,and extended reaction time.Nearly unity ally-functionality for allyl-PSTO-allyl was achieved by adding sufficient SnCl_(4) prior to the substitution.展开更多
About 44%of the world’s cocoa is produced in one single country,Côte d’Ivoire.Providing this important raw material,most Ivorian cocoa farmers live in severe poverty,which,despite a multitude of sector interven...About 44%of the world’s cocoa is produced in one single country,Côte d’Ivoire.Providing this important raw material,most Ivorian cocoa farmers live in severe poverty,which,despite a multitude of sector interventions,is still widespread,affecting social and environmental sustainability in cocoa production.In this context,cocoa farmers are still often treated as a homogeneous group of small-scale producers(mainly males),resulting in interventions being conceptualized as one-size-fits-all approaches and failing to deliver support schemes that take farmers’specific conditions appropriately into account.Applying a broader typology approach that combines farm characteristics with farmers’characteristics,this study aims to delineate Ivorian cocoa farmers and their farms into specific types in order to improve advice for targeted sustainability interventions and living income(LI)potentials.Principal component analysis and hierarchical clustering analysis of a household dataset collected in 2022 in five cocoa-growing regions of Côte d’Ivoire were chosen to identify types of male-headed farms.To assure gender sensitive analysis,a female-headed farm type was created artificially.The specific characteristics of the identified types were captured using descriptive analysis.Descriptive statistics and non-parametric tests were then applied to examine the relationships between these farm types and various outcomes.Additionally,a binary logistic model was used to estimate the probability of these links in relation to variables relevant for achieving a LI.Finally,Spearman non-parametric correlation was used to identify eventual differences in the strength of relationships between key variables per farm type.Three different types of male-headed farms are identified:type 1(the most productive and diversified farms with larger size),type 2(middle-sized farms with strong focus on cash crops),and type 3(small-sized farms with a good level of diversification for self-consumption).The artificially created type 4 represents female-headed farms with the smallest size.On average,none of these farm types achieves a LI.However,type 1 shows the smallest LI gap,while type 4 is by far the worst.Our analyses reveal underlying socio-economic factors systematically disadvantaging female-headed cocoa farms,most notably limited access to land and other material assets.The key contribution of this study lies in the empirical identification of the different characteristics of farms in a given farming system,thereby identifying the need for targeted support interventions.Type-specific recommendations are made,showing pathways to provide tailored programs to farmers of different types in order to reduce their LI gaps.展开更多
Objective:The objective of this study is to investigate the effect of empowerment strategies on quality of life(QOL),sleep quality,level of perceived stress,and activity of daily living(ADL)among perimenopausal women....Objective:The objective of this study is to investigate the effect of empowerment strategies on quality of life(QOL),sleep quality,level of perceived stress,and activity of daily living(ADL)among perimenopausal women.Materials and Methods:A single-blinded randomized,controlled community trial was adapted.The sample consisted of 70(35 in each group)perimenopausal women in Tapoban community,Bhubaneswar.A purposive sampling technique was used.Tools used were structured sociodemographic questions,the Menopause-Specific Quality of Life Questionnaire tool,ADL scale,the Pittsburgh Sleep Quality Index(PSQI)scale,and the Perceived Stress scale.The perimenopausal empowerment strategy was introduced to the intervention arm,and the control arm received standard care provided by the government.Descriptive statistics and analytical statistics(paired t-test,Chi-square)were employed to compare groups and examine relationships.Statistical analysis was likely conducted using SPSS version 21 software.The significance level was set at<0.05.Results:The study found a significant improvement in the QOL among perimenopausal women in the experimental group after intervention(t=16.764,P<0.00001).However,there were no significant differences between the experimental and control groups in terms of IADL scores(P=0.323)and PSQI scores(P=0.323)after intervention.The control group had significantly higher perceived stress scores compared to the experimental group(P=0.003).Age and employment status showed significant association with sociodemographic factors associated with QOL.Working women had a poorer QOL compared to homemakers,which was statistically significant(P=0.023).Conclusion:Empowerment strategies,such as training on improving sleep patterns,QOL,self-care activities and reducing perceived stress,were found to be effective interventions for perimenopausal women.展开更多
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.
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.
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.
文摘BACKGROUND Pediatric living-donor liver transplantation is considered a safe alternative for the treatment of children with end-stage liver disease.Experienced tertiary centers and specialized medical staff are necessary to ensure compatible long-term survival rates and quality-of-life for these children.AIM To report the results and the 10-year learning curve of a pediatric living-donor liver transplantation program.METHODS We conducted a retrospective cohort study of pediatric recipients from 2013 to 2023.Post-transplant outcomes and patient survival rates were compared between two 5-year periods of the program.RESULTS A total of 25 and 48 patients underwent transplantation in the first(2013-2017)and second period(2018-2023),respectively.Portal vein and hepatic artery thrombosis occurred in 11(15.1%)and seven(9.6%)patients,respectively.Biliary complications were observed in 39 of 73 patients(53.4%).A lower warm ischemia time was observed in the second period compared to the first(32.6±8.6 minutes vs 38.4±9.8 minutes,P=0.018,respectively).Patient survival rates at 1 and 5 years were 84%in the first period and 91.7%in the second period,with no significant difference(P=0.32).CONCLUSION The reported indications and outcomes align with the current literature.Our findings provide crucial evidence regarding the feasibility of establishing a living donor program with consistent results over time.
文摘BACKGROUND Kidney transplantation is increasingly more common due to the ongoing shortage of deceased donors.However,anatomical challenges,such as a short renal artery,can complicate surgical procedures and increase complication risk,including thrombosis and anastomotic stenosis.To address these issues and optimize graft outcomes,innovative surgical techniques are essential.CASE SUMMARY We present a case of kidney transplantation complicated by a short donor renal artery.To address the discrepancy between arterial length and diameter mismatch,the recipient’s inferior epigastric artery was used as a cuff interposition for arterial reconstruction.Following standard laparoscopic donor nephrectomy,vascular reconstruction was performed on the back table.The use of the inferior epigastric artery as a cuff allowed for successful elongation and size matching of the donor renal artery,enabling a tension-free anastomosis to the recipient’s external iliac artery.Postoperative Doppler ultrasound and angiography confirmed excellent graft perfusion.The patient experienced an uneventful recovery with immediate graft function and maintained stable renal function at 6 months post-transplant.To our knowledge,this is the first reported use of the inferior epigastric artery as a cuff interposition in renal artery reconstruction,offering a novel and effective technique for managing short renal arteries in kidney transplantation.CONCLUSION Interposition of the epigastric artery offers an innovative technique for managing short donor renal arteries,reducing the risk of early thrombosis and long-term complications as size mismatch and intimal hyperplasia.
文摘BACKGROUND Post-transplant diabetes mellitus(PTDM)is a common metabolic adverse event following kidney transplantation,negatively impacting graft function and patient outcomes.AIM To evaluate the frequency of PTDM and to determine predictive factors in living donor individuals who have undergone kidney transplantation.METHODS A retrospective analysis was conducted on 1200 living donor kidney transplant recipients treated between 2016 and 2023.Demographic,clinical,and treatment data were collected,and PTDM was identified based on American Diabetes Association criteria.Statistical analysis included logistic regression analysis to determine independent predictors of PTDM.RESULTS PTDM was diagnosed in 162 patients(13.5%).Risk factors included older age[odds ratio(OR)1.03,P=0.03],increased body mass index(OR 1.08,P=0.02),a genetic predisposition to diabetes(OR 1.95,P=0.001),and corticosteroid use(OR 1.30,P=0.04).Most PTDM cases(61.7%)occurred during the initial 6 months after transplant.Tacrolimus-based regimens were more commonly associated with PTDM compared to other protocols.Renal function at 12 months was com-parable between PTDM and non-PTDM groups.CONCLUSION PTDM remains a significant concern in kidney transplantation,particularly among patients with modifiable risk factors.Optimizing immunosuppressive regimens,implementing early metabolic monitoring,and addressing modifiable risks such as BMI may help reduce PTDM incidence.Additional research is required to evaluate extended-term results and refine preventive strategies.
文摘Objective:To analyze the value of continuous care for patients with hypertensive intracerebral hemorrhage(HICH).Methods:A total of 80 patients with HICH who visited our hospital from January 2024 to December 2024 were selected as samples and randomly divided into two groups.The observation group received continuous care,while the control group received routine care.The Functional Independence Measure(FIM),Symptom Checklist-90(SCL-90),and complications were compared between the two groups.Results:The FIM score of the observation group was higher than that of the control group(P<0.05).The SCL-90 score of the observation group was lower than that of the control group(P<0.05).The incidence of HICH complications in the observation group was lower than that in the control group(P<0.05).Conclusion:The application of continuous care in HICH nursing can enhance patients’independent living skills outside the hospital,optimize their psychosocial adaptation,and is safe and efficient.
基金financially supported by the National Natural Science Foundation of China(No.52373011)。
文摘Living cationic polymerization of 4-acetoxystyrene(STO)was conducted in CH_(2)Cl_(2) at-15℃ using a dicumyl chloride(DCC)/SnCl_(4)/nBu_(4)NBr initiating system.Impurity moisture initiation was inhibited by adding proton trap 2,6-di-tert-butylpyridine(DTBP),and the controlled initiation of DCC was confirmed by ^(1)H nuclear magnetic resonance(^(1)H-NMR)spectroscopy and matrix-assisted laser desorption ionization time-offlight mass(MALDI-TOF-MS)spectrometry.The polymerization kinetics were analyzed to for optimizing the polymerization rate.Allyl-telechelic PSTOs(allyl-PSTO-allyl)with molecular weight(Mn)range of 3540–7800 g/mol and narrow molecular weight dispersity(Mw/Mn)about 1.25 were prepared through nucleophilic substitution with allyltrimethylsilane(ATMS)at approximately 40%monomer conversion.The experimental results indicate that the substitution efficiency of ATMS increased with higher ATMS concentration,temperature,and extended reaction time.Nearly unity ally-functionality for allyl-PSTO-allyl was achieved by adding sufficient SnCl_(4) prior to the substitution.
基金This work was conducted in the frame of the accompanying research on strategies for improving farmer families’incomes and sustainable cocoa production funded by the German Federal Ministry for Economic Cooperation and Development(BMZ).
文摘About 44%of the world’s cocoa is produced in one single country,Côte d’Ivoire.Providing this important raw material,most Ivorian cocoa farmers live in severe poverty,which,despite a multitude of sector interventions,is still widespread,affecting social and environmental sustainability in cocoa production.In this context,cocoa farmers are still often treated as a homogeneous group of small-scale producers(mainly males),resulting in interventions being conceptualized as one-size-fits-all approaches and failing to deliver support schemes that take farmers’specific conditions appropriately into account.Applying a broader typology approach that combines farm characteristics with farmers’characteristics,this study aims to delineate Ivorian cocoa farmers and their farms into specific types in order to improve advice for targeted sustainability interventions and living income(LI)potentials.Principal component analysis and hierarchical clustering analysis of a household dataset collected in 2022 in five cocoa-growing regions of Côte d’Ivoire were chosen to identify types of male-headed farms.To assure gender sensitive analysis,a female-headed farm type was created artificially.The specific characteristics of the identified types were captured using descriptive analysis.Descriptive statistics and non-parametric tests were then applied to examine the relationships between these farm types and various outcomes.Additionally,a binary logistic model was used to estimate the probability of these links in relation to variables relevant for achieving a LI.Finally,Spearman non-parametric correlation was used to identify eventual differences in the strength of relationships between key variables per farm type.Three different types of male-headed farms are identified:type 1(the most productive and diversified farms with larger size),type 2(middle-sized farms with strong focus on cash crops),and type 3(small-sized farms with a good level of diversification for self-consumption).The artificially created type 4 represents female-headed farms with the smallest size.On average,none of these farm types achieves a LI.However,type 1 shows the smallest LI gap,while type 4 is by far the worst.Our analyses reveal underlying socio-economic factors systematically disadvantaging female-headed cocoa farms,most notably limited access to land and other material assets.The key contribution of this study lies in the empirical identification of the different characteristics of farms in a given farming system,thereby identifying the need for targeted support interventions.Type-specific recommendations are made,showing pathways to provide tailored programs to farmers of different types in order to reduce their LI gaps.
文摘Objective:The objective of this study is to investigate the effect of empowerment strategies on quality of life(QOL),sleep quality,level of perceived stress,and activity of daily living(ADL)among perimenopausal women.Materials and Methods:A single-blinded randomized,controlled community trial was adapted.The sample consisted of 70(35 in each group)perimenopausal women in Tapoban community,Bhubaneswar.A purposive sampling technique was used.Tools used were structured sociodemographic questions,the Menopause-Specific Quality of Life Questionnaire tool,ADL scale,the Pittsburgh Sleep Quality Index(PSQI)scale,and the Perceived Stress scale.The perimenopausal empowerment strategy was introduced to the intervention arm,and the control arm received standard care provided by the government.Descriptive statistics and analytical statistics(paired t-test,Chi-square)were employed to compare groups and examine relationships.Statistical analysis was likely conducted using SPSS version 21 software.The significance level was set at<0.05.Results:The study found a significant improvement in the QOL among perimenopausal women in the experimental group after intervention(t=16.764,P<0.00001).However,there were no significant differences between the experimental and control groups in terms of IADL scores(P=0.323)and PSQI scores(P=0.323)after intervention.The control group had significantly higher perceived stress scores compared to the experimental group(P=0.003).Age and employment status showed significant association with sociodemographic factors associated with QOL.Working women had a poorer QOL compared to homemakers,which was statistically significant(P=0.023).Conclusion:Empowerment strategies,such as training on improving sleep patterns,QOL,self-care activities and reducing perceived stress,were found to be effective interventions for perimenopausal women.
