BACKGROUND The Karnofsky Performance Status(KPS)scale has been widely validated for clinical practice for over 60 years.AIM To examine the extent to which poor pre-transplant functional status,assessed using the KPS s...BACKGROUND The Karnofsky Performance Status(KPS)scale has been widely validated for clinical practice for over 60 years.AIM To examine the extent to which poor pre-transplant functional status,assessed using the KPS scale,is associated with increased risk of mortality and/or graft failure at 1-year post-transplantation.METHODS This study included 38278 United States adults who underwent first,non-urgent,liver-only transplantation from 2005 to 2014(Scientific Registry of Transplant Recipients).Functional impairment/disability was categorized as severe,moderate,or none/normal.Analyses were conducted using multivariableadjusted Cox survival regression models.RESULTS The median age was 56 years,31%were women,median pre-transplant Model for End-Stage for Liver Disease score was 18.Functional impairment was present in 70%;one-quarter of the sample was severely disabled.After controlling for key recipient and donor factors,moderately and severely disabled patients had a 1-year mortality rate of 1.32[confidence interval(CI):1.21-1.44]and 1.73(95%CI:1.56-1.91)compared to patients with no impairment,respectively.Subjects with moderate and severe disability also had a multivariable-adjusted 1-year graft failure rate of 1.13(CI:1.02-1.24)and 1.16(CI:1.02-1.31),respectively.CONCLUSION Pre-transplant functional status is a useful prognostic indicator for 1-year posttransplant patient and graft survival.展开更多
Background Schistosomiasis japonica,caused by Schistosoma japonicum,remains a significant public health concern in the Philippines,where 12.4 million people are at risk due to persistent transmission in endemic region...Background Schistosomiasis japonica,caused by Schistosoma japonicum,remains a significant public health concern in the Philippines,where 12.4 million people are at risk due to persistent transmission in endemic regions.The distribution of schistosomiasis is closely linked to the distribution of its snail intermediate host.This study aims to assess the potential of using soil samples to detect the environmental presence of Oncomelania hupensis quadrasi and Schistosoma japonicum.Methods This cross-sectional observational study utilized a soil-based environmental DNA(eDNA)detection system for simultaneous detection of O.h.quadrasi,and S.japonicum mitochondrially encoded cytochrome c oxidase subunit 1 gene in multiplex quantitative real-time PCR and digital PCR platforms.A two-phase sample collection and testing were carried out in December 2023(Phase 1)and March 2024(Phase 2)across 30 selected sampling sites in Ekiran village,Leyte,Philippines.Wilcoxon two-sample/Mann-Whitney U test was used to determine whether there was a significant difference in eDNA presence and edaphic factors,while percent agreement was used to assess the concordance among methods.Results This study reveals that S.japonicum eDNA can be detected in soil samples and confirms the strong applicability of soil-based eDNA for detecting O.h.quadrasi snails and even in sites without visible snail presence.Furthermore,it demonstrates the superiority of soil-eDNA system compared to classical malacological surveys in detecting O.h.quadrasi and S.japonicum microhabitats:in Phase 1,eDNA detected O.h.quadrasi and S.japonicum in 50%(3/6)and 66.67%(4/6)of sites,respectively,while malacological surveys detected them in only 50%and 16.67%(1/6)of sites.In Phase 2,eDNA detected O.h.quadrasi in 20%(6/30)of sites compared to only 10%(3/30)by malacological survey,and S.japonicum was detected only by eDNA in 10%(3/30)of sites.Among the measured soil parameters,only pH showed a statistically significant difference between eDNA-positive and eDNA-negative sites(P=0.04).Conclusions Soil-based eDNA sensitively detected O.h.quadrasi and S.japonicum,enabling scalable,non-invasive transmission site identification and outperforming traditional surveys without visible snails.Its ability to detect S.japonicum highlights its value for comprehensive schistosomiasis monitoring.展开更多
文摘BACKGROUND The Karnofsky Performance Status(KPS)scale has been widely validated for clinical practice for over 60 years.AIM To examine the extent to which poor pre-transplant functional status,assessed using the KPS scale,is associated with increased risk of mortality and/or graft failure at 1-year post-transplantation.METHODS This study included 38278 United States adults who underwent first,non-urgent,liver-only transplantation from 2005 to 2014(Scientific Registry of Transplant Recipients).Functional impairment/disability was categorized as severe,moderate,or none/normal.Analyses were conducted using multivariableadjusted Cox survival regression models.RESULTS The median age was 56 years,31%were women,median pre-transplant Model for End-Stage for Liver Disease score was 18.Functional impairment was present in 70%;one-quarter of the sample was severely disabled.After controlling for key recipient and donor factors,moderately and severely disabled patients had a 1-year mortality rate of 1.32[confidence interval(CI):1.21-1.44]and 1.73(95%CI:1.56-1.91)compared to patients with no impairment,respectively.Subjects with moderate and severe disability also had a multivariable-adjusted 1-year graft failure rate of 1.13(CI:1.02-1.24)and 1.16(CI:1.02-1.31),respectively.CONCLUSION Pre-transplant functional status is a useful prognostic indicator for 1-year posttransplant patient and graft survival.
基金funded by the e-ASIA Joint Research Program(e-ASIA JRP)Grant No.23jm0210091h0003.
文摘Background Schistosomiasis japonica,caused by Schistosoma japonicum,remains a significant public health concern in the Philippines,where 12.4 million people are at risk due to persistent transmission in endemic regions.The distribution of schistosomiasis is closely linked to the distribution of its snail intermediate host.This study aims to assess the potential of using soil samples to detect the environmental presence of Oncomelania hupensis quadrasi and Schistosoma japonicum.Methods This cross-sectional observational study utilized a soil-based environmental DNA(eDNA)detection system for simultaneous detection of O.h.quadrasi,and S.japonicum mitochondrially encoded cytochrome c oxidase subunit 1 gene in multiplex quantitative real-time PCR and digital PCR platforms.A two-phase sample collection and testing were carried out in December 2023(Phase 1)and March 2024(Phase 2)across 30 selected sampling sites in Ekiran village,Leyte,Philippines.Wilcoxon two-sample/Mann-Whitney U test was used to determine whether there was a significant difference in eDNA presence and edaphic factors,while percent agreement was used to assess the concordance among methods.Results This study reveals that S.japonicum eDNA can be detected in soil samples and confirms the strong applicability of soil-based eDNA for detecting O.h.quadrasi snails and even in sites without visible snail presence.Furthermore,it demonstrates the superiority of soil-eDNA system compared to classical malacological surveys in detecting O.h.quadrasi and S.japonicum microhabitats:in Phase 1,eDNA detected O.h.quadrasi and S.japonicum in 50%(3/6)and 66.67%(4/6)of sites,respectively,while malacological surveys detected them in only 50%and 16.67%(1/6)of sites.In Phase 2,eDNA detected O.h.quadrasi in 20%(6/30)of sites compared to only 10%(3/30)by malacological survey,and S.japonicum was detected only by eDNA in 10%(3/30)of sites.Among the measured soil parameters,only pH showed a statistically significant difference between eDNA-positive and eDNA-negative sites(P=0.04).Conclusions Soil-based eDNA sensitively detected O.h.quadrasi and S.japonicum,enabling scalable,non-invasive transmission site identification and outperforming traditional surveys without visible snails.Its ability to detect S.japonicum highlights its value for comprehensive schistosomiasis monitoring.
