BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparosc...BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.展开更多
BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA...BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA)as an independent predictor of the prognosis of patients admitted to the coronary care unit(CCU).AIM To use the RDW and albumin level to predict the prognosis of patients in the CCU.METHODS Data were obtained from the Medical Information Mart Intensive Care III database.The primary outcome was 365-day all-cause mortality,whereas the secondary outcomes were 30-and 90-day all-cause mortality,hospital length of stay(LOS),and CCU LOS.Cox proportional hazards regression model,propen-sity score matching,and receiver operating characteristic curve analyses were used.RESULTS The hazard ratio(95%confidence interval)of the upper tertile(RA>4.66)was 1.62(1.29 to 2.03)when compared with the reference(RA<3.84)in 365-day all-cause mortality.This trend persisted after adjusting for demographic and clinical variables in the propensity score-matching analysis.Similar trends were observed for the secondary outcomes of hospital and CCU LOS.Receiver operating characteristic curve analysis was performed by combining the RA and sequential organ failure assessment(SOFA)scores,and the C-statistic was higher than that of the SOFA scores(0.733 vs 0.702,P<0.001).CONCLUSION RA is an independent prognostic factor in patients admitted to the CCU.RA combined with the SOFA score can improve the predictive ability of the SOFA score.However,our results should be verified in future prospective studies.展开更多
BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outc...BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.展开更多
The second edition of the United Arab Emirates inflammatory bowel disease(IBD)consensus guidance provides updated recommendations for diagnosing,treating,and monitoring IBD.Significant therapeutic advances and evolvin...The second edition of the United Arab Emirates inflammatory bowel disease(IBD)consensus guidance provides updated recommendations for diagnosing,treating,and monitoring IBD.Significant therapeutic advances and evolving treatment paradigms since 2020(including risk stratification and treat-to-target approaches)necessitated this comprehensive update to standardize care across the United Arab Emirates.Developed via Delphi consensus methodology,this guidance incorporates a systematic literature review and key international gui-delines.It presents 188 summary statements covering the full spectrum of IBD care,including complex scenarios like perianal disease and pregnancy.Key updates feature guidance on newer pharmacologic therapies-interleukin-23,Janus kinase,and sphingosine-1-phosphate receptor inhibitors-with refined therapeutic positioning informed by recent head-to-head trials.The consensus emphasizes early,effective treatment to prevent irreversible bowel damage,optimization strategies like therapeutic drug monitoring,and achieving objective treat-to-target goals to improve long-term outcomes.Recognizing local healthcare system challenges,it offers practical recommendations on reducing variability and enhancing equitable access to IBD care.By integrating current clinical evidence with United Arab Emirates-specific considerations,the second edition United Arab Emirates IBD consensus guidance aims to standardize care across sectors,provide a benchmark for payers and policymakers,optimize treatment outcomes,and improve IBD outcomes,aligning national practice with international standards.展开更多
BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely ...BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely studied.AIM To determine the short-term mortality outcome and identify the potential prognostic factors of CRC cancer patients admitted to the ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at the ICU departments of 37 cancer specialized hospitals in China,and included patients aged≥14 years with ICU duration≥24 hours.Clinical records of patients with a primary CRC diagnosis were reviewed.Patients were separated into groups according to 90-day survival.Characteristics between groups were compared.Univariate and multivariate regression tests were used to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS In total,189 CRC patients were included in the study.The 90-day mortality was 12.2%.Patients who died showed differences compared to patients who survived mostly in terms of disease severity and ICU complications.It appears that patients admitted to the ICU from a clinical ward due to emergencies may have a higher risk of mortality while surgical management was associated with better survival.In multivariate analysis,only chemotherapy,elective surgery and conventional oxygen therapy were identified as independently correlated with 90-day mortality.Sequential organ failure assessment and acute physiology and chronic health evaluation II scores had moderate accuracy in predicting short-term mortality.CONCLUSION ICU admitted CRC patients appear to have low short-term mortality which requires further confirmation in prospective studies.The prognostic tools for these patients need further optimization.展开更多
Knowledge graphs (KGs) offer a structured, machine-readable format for organizing complex information. In heterogeneous catalysis, where data on catalytic materials, reaction conditions, mechanisms, and synthesis rout...Knowledge graphs (KGs) offer a structured, machine-readable format for organizing complex information. In heterogeneous catalysis, where data on catalytic materials, reaction conditions, mechanisms, and synthesis routes are dispersed across diverse sources, KGs provide a semantic framework that supports data integration under the FAIR (Findable, Accessible, Interoperable, and Reusable) principles. This review aims to survey recent developments in catalysis KGs, describe the main techniques for graph construction, and highlight how artificial intelligence, particularly large language models (LLMs), enhances graph generation and query. We conducted a systematic analysis of the literature, focusing on ontology-guided text mining pipelines, graph population methods, and maintenance strategies. Our review identifies key trends: ontology-based approaches enable the automated extraction of domain knowledge, LLM-driven retrieval-augmented generation supports natural-language queries, and scalable graph architectures range from a few thousand to over a million triples. We discuss state-of-the-art applications, such as catalyst recommendation systems and reaction mechanism discovery tools, and examine the major challenges, including data heterogeneity, ontology alignment, and long-term graph curation. We conclude that KGs, when combined with AI methods, hold significant promise for accelerating catalyst discovery and knowledge management, but progress depends on establishing community standards for ontology development and maintenance. This review provides a roadmap for researchers seeking to leverage KGs to advance heterogeneous catalysis research.展开更多
BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,whil...BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,while non-cardiac/nonthoracic surgery has a reported incidence between 0.4% to 15%,with new onset POAF occurring at a rate of 0.4% to 3%.While AF has been extensively studied,it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting(ICU).AIM To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.METHODS This retrospective study included patients≥18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU.Data of interest included occurrence of POAF,demographic characteristics,comorbidities,laboratory values,administered fluids,medications,and postoperative outcomes.Statistical analyses consisted of identifying predic-tors of POAF and associations of POAF with outcomes of interest.RESULTS A total of 347 ICU patients were included,16.4% had a history of AF,13.0% developed POAF,and 7.9%developed new-onset POAF.Patients with new-onset POAF were older(79.6±9.1 vs 68.1±14.8 years,<0.001),of white race(47.8%vs 28.8,P<0.001),hypertensive(87.0%vs 71.2%,P=0.011),had longer ICU length of stay(ICU-LOS)(13.4 vs 6.7 days,P=0.042),higher mortality(43.5%vs 17.6%,P=0.016)and higher rate of cardiac arrest(34.8%vs 14.6%,P=0.005)compared to patients without new-onset POAF.Multivariable analysis revealed increased POAF risk with advanced age(OR=1.06;95%CI:1.02-1.10,P=0.005),white race(OR=2.85;95%CI:1.26-6.76,P=0.014),high intraoperative fluid(OR>1;95%CI:1.00-1.00,P=0.018),and longer ICU-LOS(OR=1.04;95%CI:1.00-1.08,P=0.023).After adjusting for demographics,new onset POAF significantly predicted mortality(OR=3.07;95%CI:1.14-8.01,P=0.022).CONCLUSION POAF was associated with prolonged ICU-LOS,white race,and high intraoperative fluid.New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.展开更多
BACKGROUND Normothermic liver machine perfusion(NMP)is a novel technology used to preserve and evaluate the function of liver allografts.AIM To assess NMP utilization in liver transplant(LT)practices.METHODS All adult...BACKGROUND Normothermic liver machine perfusion(NMP)is a novel technology used to preserve and evaluate the function of liver allografts.AIM To assess NMP utilization in liver transplant(LT)practices.METHODS All adult deceased-donor LT recipients between January 2021 and September 2023 in the United States were analyzed.Outcomes including discard rates,survival,preservation time and timing of surgery were compared between two groups:NMP vs non-NMP.RESULTS Between 2021 and 2023,NMP was utilized in 1493(6.3%)of all LTs in the United States.Compared to non-NMP group,NMP group had lower allograft discard rate(6.5%vs 10%,P<0.001),older recipients’age(median:47 vs 42 years,P<0.001),and higher utilization of donors from donation after circulatory death(DCD)(55%vs 11%,P<0.001).NMP group also had longer distances between recipient and donor hospitals(median:156 vs 138 miles,P<0.001),longer preser-vation time(median:12.2 vs 5.8 hours,P<0.001),and more daytime reperfusion(74%vs 55%,P<0.001).Post-transplant survival outcomes were comparable between the two groups.In a subgroup analysis of NMP,recipients in the long preservation time(≥8 hours)group had higher daytime reperfusion(78%vs 55%,P<0.001)and similar post-transplant survival when compared to the short preservation time(<8 hours)group.CONCLUSION The utilization of NMP is associated with lower discard rates and increased DCD organs for LT.NMP allows for prolonging the preservation time and increased occurrence of daytime LT,without any impact on the survival outcomes.展开更多
BACKGROUND In the intensive care unit(ICU)setting,patients with end-stage gastrointestinal cancer(GIC)frequently bear a heavier symptom burden,see faster functional regression,and struggle with eating impairments.Thes...BACKGROUND In the intensive care unit(ICU)setting,patients with end-stage gastrointestinal cancer(GIC)frequently bear a heavier symptom burden,see faster functional regression,and struggle with eating impairments.These further increase the demands and complexities of nursing care.AIM To discuss the development of Kano model-driven ICU end-of-life care(ICUEOLC)strategies for patients with GIC and its implications for quality of death(QoD).METHODS This study enrolled 115 patients with end-stage GIC admitted to the ICU from June 2021 to June 2024.A Kano model-driven ICU-EOLC protocol was applied to the observation group(n=65),contrasting with routine care in the control group(n=50).Pre-intervention and post-intervention comparisons were made in terms of psychological well-being[Hospital Anxiety and Depression Scale(HADS)],quality of life(QoL)[European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care Version(EORTC QLQ-C15-PAL)],QoD(Chinese version of the Quality of Dying and Death in the ICU Scale),death-related attitudes[Revised Death Attitude Profile(DAP-R)],and nursing care satisfaction.RESULTS Compared with controls,patients in the observation group scored markedly lower on HADS(all domains),EORTC QLQ-C15-PAL(symptom domain),and DAP-R(escape acceptance,fear of death,and death avoidance),while achieving statistically higher scores on EORTC QLQ-C15-PAL(physical function and overall QoL dimensions),C-QDD-ICU,DAP-R(natural and approaching acceptance),and nursing care satisfaction measures.CONCLUSION Kano model-driven ICU-EOLC interventions significantly reduced anxiety and depression in patients with endstage GIC,and patients’quality of life,QoD,death-related attitudes,and nursing satisfaction were improved.展开更多
Interventional pulmonology(IP)represents a rapidly growing and developing subspecialty within pulmonary medicine.To the intensivist,given the elaborate undertakings with respect to airway,lung and pleural disease mana...Interventional pulmonology(IP)represents a rapidly growing and developing subspecialty within pulmonary medicine.To the intensivist,given the elaborate undertakings with respect to airway,lung and pleural disease management-IP has shown an increasing presence and remain a major ally in the care of these pa-tients.Thus,an understanding of the different roles that IP could offer to the intensivist is of prime importance in the multi-disciplinary care of the complex patients within the intensive care units,particularly in relation to lung,airway and pleural diseases.This review article will explore the different intersections of IP in critical care and discuss the applications of this discipline within the highly complex critical care environment.展开更多
Breast cancer is the leading cause of cancer-related mortality in women globally,with its incidence continuing to rise,particularly in low-and middle-income countries,presenting a significant public health challenge w...Breast cancer is the leading cause of cancer-related mortality in women globally,with its incidence continuing to rise,particularly in low-and middle-income countries,presenting a significant public health challenge worldwide[1].According to data from the Institute for Health Metrics and Evaluation(IHME)and the World Health Organization(WHO),the gap in access to healthcare services between high-and low-income countries contributes to delayed detection,increased incidence of advanced-stage disease,and,consequently,higher mortality rates(up to 50%higher compared to high-income countries)[1,2].This translates into inequalities in access to screening and early diagnosis methods,which exacerbate the burden of this disease in low-resource settings where infrastructure,funding,and access to trained professionals are limited[3].展开更多
BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar k...BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar kinematics and function to a native knee.AIM To evaluate the clinical results and patient-reported outcomes after CR TKA procedures utilizing a kinematically designed medial dish system.METHODS A multicenter,retrospective cohort review of 139 primary elective TKAs utilizing a kinematically designed CR Knee System(JOURNEY™II CR MD;Smith and Nephew,Memphis,TN,United States)at three different institutions with a minimum of two years of follow-up.Demographic information,clinical outcomes,and patient-reported outcome measures were collected and analyzed.RESULTS With up to 3.7 years from surgery,overall implant survivorship was 98.6%.There were significant postoperative increases in the average Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores(17.4 at 6 months,26.1 points at two years or more,P<0.001).CONCLUSION The combination of high implant survivorship and substantial improvements in patient-reported outcome measures suggests that the medial dish tibial insert represents a safe and effective option within TKA.Additional investigation is necessary to evaluate the long-term survivorship of this design.展开更多
Myasthenia gravis is a chronic autoimmune disorder that affects the neuromuscular junction leading to fluctuating skeletal muscle fatigability. The majority of myasthenia gravis patients have detectable antibodies in ...Myasthenia gravis is a chronic autoimmune disorder that affects the neuromuscular junction leading to fluctuating skeletal muscle fatigability. The majority of myasthenia gravis patients have detectable antibodies in their serum, targeting acetylcholine receptor, muscle-specific kinase, or related proteins. Current treatment for myasthenia gravis involves symptomatic therapy, immunosuppressive drugs such as corticosteroids, azathioprine, and mycophenolate mofetil, and thymectomy, which is primarily indicated in patients with thymoma or thymic hyperplasia. However, this condition continues to pose significant challenges including an unpredictable and variable disease progression, differing response to individual therapies, and substantial longterm side effects associated with standard treatments(including an increased risk of infections, osteoporosis, and diabetes), underscoring the necessity for a more personalized approach to treatment. Furthermore, about fifteen percent of patients, called “refractory myasthenia gravis patients”, do not respond adequately to standard therapies. In this context, the introduction of molecular therapies has marked a significant advance in myasthenia gravis management. Advances in understanding myasthenia gravis pathogenesis, especially the role of pathogenic antibodies, have driven the development of these biological drugs, which offer more selective, rapid, and safer alternatives to traditional immunosuppressants. This review aims to provide a comprehensive overview of emerging therapeutic strategies targeting specific immune pathways in myasthenia gravis, with a particular focus on preclinical evidence, therapeutic rationale, and clinical translation of B-cell depletion therapies, neonatal Fc receptor inhibitors, and complement inhibitors.展开更多
BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant rec...BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant recipients receiving alemtuzumab vs basiliximab induction,focusing on graft function,acute rejection,infection,malignancy,post-transplant glomerulonephritis,and survival,using a propensity score matched cohort design.METHODS Kidney transplant recipients who received alemtuzumab or basiliximab induction from 2014 to 2019 across two nephrology centres in Northwest England were evaluated.Propensity score matching at a 1:1.5 ratio ensured comparability between cohorts.Baseline characteristics,immunosuppression regimens,and outcomes were analyzed.Linear,binary logistic and Cox proportional hazard regression models.RESULTS A total of 436 recipients were included,with a median follow-up of 5.2 years.The matched cohort(n=262)had a mean age of 51.1±13.5 years;39%were female and 92%were white.There was no significant difference in the cumulative incidence of acute rejection[odds ratio(OR)=2.10;95%CI:0.9-4.9;P=0.110].Compared with basiliximab,alemtuzumab was associated with lower estimated glomerular filtration rate at 12 months(-6.6 mL/minute/1.73 m2;95%CI:-10.5 to-2.7;P<0.001)and higher risks of cytomegalovirus viremia(OR=3.2;95%CI:1.6-6.5;P<0.001),BK viremia(OR=2.4;95%CI:1.1-5.5;P=0.02),post-transplant malignancy(OR=6.2;95%CI:1.6-29.9;P=0.013),and death-censored graft loss(hazard ratio=3.6;95%CI:1.2-11.4;P=0.03).No significant differences were observed in post-transplant glomerulonephritis or recipient mortality.CONCLUSION In this propensity score-matched analysis,alemtuzumab induction was associated with lower graft function at 12 months and higher risks of viral infection,post-transplant malignancy,and graft loss compared with basiliximab.These findings highlight the need for further studies to confirm the long-term safety and effectiveness of alemtuzumab in kidney transplantation.展开更多
Nail changes following upper extremity transplantation(UET)cannot be overlooked as they possess diagnostic and prognostic relevance in allotransplantation of upper limbs.This comprehensive review explores nail and nai...Nail changes following upper extremity transplantation(UET)cannot be overlooked as they possess diagnostic and prognostic relevance in allotransplantation of upper limbs.This comprehensive review explores nail and nail bed related changes encountered in UET recipients in the literature.The differential diagnosis of nail abnormalities in UET includes a wide range of systemic,local and iatrogenic conditions other than immune responses to the allograft.It requires interdisciplinary evaluation by primary transplant surgeons,pathologists,dermatologists and immunologists.The possible underlying mechanisms of nail pathology in UET and the management are discussed.It also underscores the importance of onychodystrophy and need for timely intervention and to improve outcomes in UET recipients.展开更多
Continuous cropping leads to high incidence of soilborne diseases such as bacterial wilt caused by Ralstonia solanacearum,which poses a risk to agricultural production.Anaerobic soil disinfestation(ASD)and plant growt...Continuous cropping leads to high incidence of soilborne diseases such as bacterial wilt caused by Ralstonia solanacearum,which poses a risk to agricultural production.Anaerobic soil disinfestation(ASD)and plant growthpromoting rhizobacteria(PGPR)are considered environmentally friendly methods to control bacterial wilt.However,the underlying mechanism of the improvement of soil health and the inhibition of bacterial wilt after ASD treatment and PGPR inoculation needs further exploration.This study evaluated the effect of ASD treatment on soil improvement at pre-planting of tomato,and the effect of ASD treatment combined with the application of Bacillus velezensis Y6(BV)on soil quality,R.solanacearum abundance,and bacterial communities at 90 days before harvesting of tomato.The results showed that ASD treatment reduced R.solanacearum abundance in soil by17.6%at pre-planting and 18.7%at 90 days before harvesting,but BV inoculation did not influence R.solanacearum abundance.ASD and ASD+BV treatments effectively reduced the occurrence of bacterial wilt,improved soil nutrient status and increased soil microbial activity at 90 days before harvesting.Principal co-ordinate analysis showed that the soil bacterial community was significantly influenced by ASD treatment both at pre-planting and at 90 days before harvesting.Further investigation found that ASD contributed to the enrichment of beneficial flora(Bacillus and Streptomyces).Moreover,pH was an important environmental factor affecting the abundance of R.solanacearum in soil.Co-occurrence network analysis showed that ASD treatment significantly increased network connection of bacterial communities and the proportion of beneficial microorganisms(Proteobacteria and Firmicutes),leading to complex soil bacterial co-occurrence networks both at pre-planting and at 90 days before harvesting.Collectively,these results indicate that ASD treatment,but not microbial inoculation can enhance tomato plant resistance to bacterial wilt by improving soil quality and modulating the soil bacterial community.展开更多
Fibrolamellar hepatocellular carcinoma is a rare and unique subtype of primary liver cancer that predominantly affects adolescents and young adults who do not have underlying liver disease or cirrhosis.Representing le...Fibrolamellar hepatocellular carcinoma is a rare and unique subtype of primary liver cancer that predominantly affects adolescents and young adults who do not have underlying liver disease or cirrhosis.Representing less than five percent of all liver tumors,it poses significant diagnostic and therapeutic challenges due to its uncommon occurrence,vague clinical symptoms,and absence of standardized treatment protocols.This review summarizes the current understanding of the disease,covering its epidemiology,clinical presentation,imaging characteristics,histopathologic features,molecular biology,and treatment approaches.Patients often present with nonspecific abdominal symptoms,and typical tumor markers,such as alpha-fetoprotein,are usually absent.Imaging may show a central scar and calcifications,while histology reveals large eosinophilic tumor cells separated by fibrous bands.A defining molecular hallmark is the DNAJB1-PRKACA fusion gene,found in the majority of cases.Surgical resection remains the primary curative treatment for localized disease,although recurrence rates are high.Liver transplantation may be an option for selected patients with non-resectable,liverconfined tumors.Treatment options for advanced disease are limited,with some benefit observed from chemotherapy and targeted agents.Recent developments in molecular therapies and immunotherapy offer promise,but further research and clinical trial participation are essential to improve outcomes in this challenging malignancy.展开更多
Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have signi...Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.展开更多
Green transplant refers to the realization of the importance of understanding and improving the environmental footprint of transplantation through sustainable practices.This involves assessing the entire transplantati...Green transplant refers to the realization of the importance of understanding and improving the environmental footprint of transplantation through sustainable practices.This involves assessing the entire transplantation process including preoperative evaluation,donation,organ and patient transportation,surgery,postoperative recovery,and follow-up.This is a topic that has not been fully addressed yet,but its importance is being increasingly appreciated in surgery.The aim of this study was to investigate the carbon footprint associated with transplantation and propose sustainable mitigating solutions.A comprehensive review of the existing literature on transplantation was conducted and supplemented with findings from the broader fields of surgical and perioperative care,given the scarcity of available data.The analysis identified the most involved environmental factors and attempted to offer practical solutions based on current sustainability practices.Notably,no study has yet examined the carbon footprint associated with the entire transplantation procedure.Only five studies have attempted to assess the environmental impact of kidney or liver transplants,but they focused,almost explicitly,on specific steps of the process.By employing an extrapolative methodology from the broader surgical field,we determined that the primary contributors to the environmental impact of transplantation are energy,consumables and materials,anesthesia and pharmaceuticals,transportation,and water.This review offers practical solutions utilizing the 5R framework,emphasizing sustainability to ensure transplantation remains clinically and environmentally relevant.展开更多
The global burden of bacterial infections,exacerbated by antimicrobial resistance(AMR),necessitates innovative strategies.Bacterial protein vaccines offer promise by eliciting targeted immunity while circumventing AMR...The global burden of bacterial infections,exacerbated by antimicrobial resistance(AMR),necessitates innovative strategies.Bacterial protein vaccines offer promise by eliciting targeted immunity while circumventing AMR.However,their clinical translation is hindered by their inherently low immunogenicity,often requiring potent adjuvants and advanced delivery systems.Biomembrane nanostructures(e.g.,liposomes,exosomes,and cell membrane-derived nanostructures),characterized by superior biocompatibility,intrinsic targeting ability,and immune-modulating properties,could serve as versatile platforms that potentiate vaccine efficacy by increasing antigen stability,enabling codelivery of immunostimulants,and facilitating targeted delivery to lymphoid tissues/antigen-presenting cells.This intrinsic immunomodulation promotes robust humoral and cellular immune responses to combat bacteria.This review critically reviews(1)key biomembrane nanostructure classes for bacterial protein antigens,(2)design strategies leveraging biomembrane nanostructures to enhance humoral and cellular immune responses,(3)preclinical efficacy against diverse pathogens,and(4)translational challenges and prospects.Biomembrane nanostructure-driven approaches represent a paradigm shift in the development of next-generation bacterial protein vaccines against resistant infections.展开更多
文摘BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.
文摘BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA)as an independent predictor of the prognosis of patients admitted to the coronary care unit(CCU).AIM To use the RDW and albumin level to predict the prognosis of patients in the CCU.METHODS Data were obtained from the Medical Information Mart Intensive Care III database.The primary outcome was 365-day all-cause mortality,whereas the secondary outcomes were 30-and 90-day all-cause mortality,hospital length of stay(LOS),and CCU LOS.Cox proportional hazards regression model,propen-sity score matching,and receiver operating characteristic curve analyses were used.RESULTS The hazard ratio(95%confidence interval)of the upper tertile(RA>4.66)was 1.62(1.29 to 2.03)when compared with the reference(RA<3.84)in 365-day all-cause mortality.This trend persisted after adjusting for demographic and clinical variables in the propensity score-matching analysis.Similar trends were observed for the secondary outcomes of hospital and CCU LOS.Receiver operating characteristic curve analysis was performed by combining the RA and sequential organ failure assessment(SOFA)scores,and the C-statistic was higher than that of the SOFA scores(0.733 vs 0.702,P<0.001).CONCLUSION RA is an independent prognostic factor in patients admitted to the CCU.RA combined with the SOFA score can improve the predictive ability of the SOFA score.However,our results should be verified in future prospective studies.
文摘BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.
文摘The second edition of the United Arab Emirates inflammatory bowel disease(IBD)consensus guidance provides updated recommendations for diagnosing,treating,and monitoring IBD.Significant therapeutic advances and evolving treatment paradigms since 2020(including risk stratification and treat-to-target approaches)necessitated this comprehensive update to standardize care across the United Arab Emirates.Developed via Delphi consensus methodology,this guidance incorporates a systematic literature review and key international gui-delines.It presents 188 summary statements covering the full spectrum of IBD care,including complex scenarios like perianal disease and pregnancy.Key updates feature guidance on newer pharmacologic therapies-interleukin-23,Janus kinase,and sphingosine-1-phosphate receptor inhibitors-with refined therapeutic positioning informed by recent head-to-head trials.The consensus emphasizes early,effective treatment to prevent irreversible bowel damage,optimization strategies like therapeutic drug monitoring,and achieving objective treat-to-target goals to improve long-term outcomes.Recognizing local healthcare system challenges,it offers practical recommendations on reducing variability and enhancing equitable access to IBD care.By integrating current clinical evidence with United Arab Emirates-specific considerations,the second edition United Arab Emirates IBD consensus guidance aims to standardize care across sectors,provide a benchmark for payers and policymakers,optimize treatment outcomes,and improve IBD outcomes,aligning national practice with international standards.
文摘BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely studied.AIM To determine the short-term mortality outcome and identify the potential prognostic factors of CRC cancer patients admitted to the ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at the ICU departments of 37 cancer specialized hospitals in China,and included patients aged≥14 years with ICU duration≥24 hours.Clinical records of patients with a primary CRC diagnosis were reviewed.Patients were separated into groups according to 90-day survival.Characteristics between groups were compared.Univariate and multivariate regression tests were used to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS In total,189 CRC patients were included in the study.The 90-day mortality was 12.2%.Patients who died showed differences compared to patients who survived mostly in terms of disease severity and ICU complications.It appears that patients admitted to the ICU from a clinical ward due to emergencies may have a higher risk of mortality while surgical management was associated with better survival.In multivariate analysis,only chemotherapy,elective surgery and conventional oxygen therapy were identified as independently correlated with 90-day mortality.Sequential organ failure assessment and acute physiology and chronic health evaluation II scores had moderate accuracy in predicting short-term mortality.CONCLUSION ICU admitted CRC patients appear to have low short-term mortality which requires further confirmation in prospective studies.The prognostic tools for these patients need further optimization.
基金support from the Full Bridge Fellowship for enabling the research stay at Virginia Tech.H.Xin acknowledge the financial support from the US Department of Energy,Office of Basic Energy Sciences under contract no.DE-SC0023323from the National Science Foundation through the grant 2245402 from CBET Catalysis and CDS&E programs.
文摘Knowledge graphs (KGs) offer a structured, machine-readable format for organizing complex information. In heterogeneous catalysis, where data on catalytic materials, reaction conditions, mechanisms, and synthesis routes are dispersed across diverse sources, KGs provide a semantic framework that supports data integration under the FAIR (Findable, Accessible, Interoperable, and Reusable) principles. This review aims to survey recent developments in catalysis KGs, describe the main techniques for graph construction, and highlight how artificial intelligence, particularly large language models (LLMs), enhances graph generation and query. We conducted a systematic analysis of the literature, focusing on ontology-guided text mining pipelines, graph population methods, and maintenance strategies. Our review identifies key trends: ontology-based approaches enable the automated extraction of domain knowledge, LLM-driven retrieval-augmented generation supports natural-language queries, and scalable graph architectures range from a few thousand to over a million triples. We discuss state-of-the-art applications, such as catalyst recommendation systems and reaction mechanism discovery tools, and examine the major challenges, including data heterogeneity, ontology alignment, and long-term graph curation. We conclude that KGs, when combined with AI methods, hold significant promise for accelerating catalyst discovery and knowledge management, but progress depends on establishing community standards for ontology development and maintenance. This review provides a roadmap for researchers seeking to leverage KGs to advance heterogeneous catalysis research.
文摘BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,while non-cardiac/nonthoracic surgery has a reported incidence between 0.4% to 15%,with new onset POAF occurring at a rate of 0.4% to 3%.While AF has been extensively studied,it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting(ICU).AIM To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.METHODS This retrospective study included patients≥18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU.Data of interest included occurrence of POAF,demographic characteristics,comorbidities,laboratory values,administered fluids,medications,and postoperative outcomes.Statistical analyses consisted of identifying predic-tors of POAF and associations of POAF with outcomes of interest.RESULTS A total of 347 ICU patients were included,16.4% had a history of AF,13.0% developed POAF,and 7.9%developed new-onset POAF.Patients with new-onset POAF were older(79.6±9.1 vs 68.1±14.8 years,<0.001),of white race(47.8%vs 28.8,P<0.001),hypertensive(87.0%vs 71.2%,P=0.011),had longer ICU length of stay(ICU-LOS)(13.4 vs 6.7 days,P=0.042),higher mortality(43.5%vs 17.6%,P=0.016)and higher rate of cardiac arrest(34.8%vs 14.6%,P=0.005)compared to patients without new-onset POAF.Multivariable analysis revealed increased POAF risk with advanced age(OR=1.06;95%CI:1.02-1.10,P=0.005),white race(OR=2.85;95%CI:1.26-6.76,P=0.014),high intraoperative fluid(OR>1;95%CI:1.00-1.00,P=0.018),and longer ICU-LOS(OR=1.04;95%CI:1.00-1.08,P=0.023).After adjusting for demographics,new onset POAF significantly predicted mortality(OR=3.07;95%CI:1.14-8.01,P=0.022).CONCLUSION POAF was associated with prolonged ICU-LOS,white race,and high intraoperative fluid.New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.
文摘BACKGROUND Normothermic liver machine perfusion(NMP)is a novel technology used to preserve and evaluate the function of liver allografts.AIM To assess NMP utilization in liver transplant(LT)practices.METHODS All adult deceased-donor LT recipients between January 2021 and September 2023 in the United States were analyzed.Outcomes including discard rates,survival,preservation time and timing of surgery were compared between two groups:NMP vs non-NMP.RESULTS Between 2021 and 2023,NMP was utilized in 1493(6.3%)of all LTs in the United States.Compared to non-NMP group,NMP group had lower allograft discard rate(6.5%vs 10%,P<0.001),older recipients’age(median:47 vs 42 years,P<0.001),and higher utilization of donors from donation after circulatory death(DCD)(55%vs 11%,P<0.001).NMP group also had longer distances between recipient and donor hospitals(median:156 vs 138 miles,P<0.001),longer preser-vation time(median:12.2 vs 5.8 hours,P<0.001),and more daytime reperfusion(74%vs 55%,P<0.001).Post-transplant survival outcomes were comparable between the two groups.In a subgroup analysis of NMP,recipients in the long preservation time(≥8 hours)group had higher daytime reperfusion(78%vs 55%,P<0.001)and similar post-transplant survival when compared to the short preservation time(<8 hours)group.CONCLUSION The utilization of NMP is associated with lower discard rates and increased DCD organs for LT.NMP allows for prolonging the preservation time and increased occurrence of daytime LT,without any impact on the survival outcomes.
文摘BACKGROUND In the intensive care unit(ICU)setting,patients with end-stage gastrointestinal cancer(GIC)frequently bear a heavier symptom burden,see faster functional regression,and struggle with eating impairments.These further increase the demands and complexities of nursing care.AIM To discuss the development of Kano model-driven ICU end-of-life care(ICUEOLC)strategies for patients with GIC and its implications for quality of death(QoD).METHODS This study enrolled 115 patients with end-stage GIC admitted to the ICU from June 2021 to June 2024.A Kano model-driven ICU-EOLC protocol was applied to the observation group(n=65),contrasting with routine care in the control group(n=50).Pre-intervention and post-intervention comparisons were made in terms of psychological well-being[Hospital Anxiety and Depression Scale(HADS)],quality of life(QoL)[European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care Version(EORTC QLQ-C15-PAL)],QoD(Chinese version of the Quality of Dying and Death in the ICU Scale),death-related attitudes[Revised Death Attitude Profile(DAP-R)],and nursing care satisfaction.RESULTS Compared with controls,patients in the observation group scored markedly lower on HADS(all domains),EORTC QLQ-C15-PAL(symptom domain),and DAP-R(escape acceptance,fear of death,and death avoidance),while achieving statistically higher scores on EORTC QLQ-C15-PAL(physical function and overall QoL dimensions),C-QDD-ICU,DAP-R(natural and approaching acceptance),and nursing care satisfaction measures.CONCLUSION Kano model-driven ICU-EOLC interventions significantly reduced anxiety and depression in patients with endstage GIC,and patients’quality of life,QoD,death-related attitudes,and nursing satisfaction were improved.
文摘Interventional pulmonology(IP)represents a rapidly growing and developing subspecialty within pulmonary medicine.To the intensivist,given the elaborate undertakings with respect to airway,lung and pleural disease management-IP has shown an increasing presence and remain a major ally in the care of these pa-tients.Thus,an understanding of the different roles that IP could offer to the intensivist is of prime importance in the multi-disciplinary care of the complex patients within the intensive care units,particularly in relation to lung,airway and pleural diseases.This review article will explore the different intersections of IP in critical care and discuss the applications of this discipline within the highly complex critical care environment.
文摘Breast cancer is the leading cause of cancer-related mortality in women globally,with its incidence continuing to rise,particularly in low-and middle-income countries,presenting a significant public health challenge worldwide[1].According to data from the Institute for Health Metrics and Evaluation(IHME)and the World Health Organization(WHO),the gap in access to healthcare services between high-and low-income countries contributes to delayed detection,increased incidence of advanced-stage disease,and,consequently,higher mortality rates(up to 50%higher compared to high-income countries)[1,2].This translates into inequalities in access to screening and early diagnosis methods,which exacerbate the burden of this disease in low-resource settings where infrastructure,funding,and access to trained professionals are limited[3].
文摘BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar kinematics and function to a native knee.AIM To evaluate the clinical results and patient-reported outcomes after CR TKA procedures utilizing a kinematically designed medial dish system.METHODS A multicenter,retrospective cohort review of 139 primary elective TKAs utilizing a kinematically designed CR Knee System(JOURNEY™II CR MD;Smith and Nephew,Memphis,TN,United States)at three different institutions with a minimum of two years of follow-up.Demographic information,clinical outcomes,and patient-reported outcome measures were collected and analyzed.RESULTS With up to 3.7 years from surgery,overall implant survivorship was 98.6%.There were significant postoperative increases in the average Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores(17.4 at 6 months,26.1 points at two years or more,P<0.001).CONCLUSION The combination of high implant survivorship and substantial improvements in patient-reported outcome measures suggests that the medial dish tibial insert represents a safe and effective option within TKA.Additional investigation is necessary to evaluate the long-term survivorship of this design.
文摘Myasthenia gravis is a chronic autoimmune disorder that affects the neuromuscular junction leading to fluctuating skeletal muscle fatigability. The majority of myasthenia gravis patients have detectable antibodies in their serum, targeting acetylcholine receptor, muscle-specific kinase, or related proteins. Current treatment for myasthenia gravis involves symptomatic therapy, immunosuppressive drugs such as corticosteroids, azathioprine, and mycophenolate mofetil, and thymectomy, which is primarily indicated in patients with thymoma or thymic hyperplasia. However, this condition continues to pose significant challenges including an unpredictable and variable disease progression, differing response to individual therapies, and substantial longterm side effects associated with standard treatments(including an increased risk of infections, osteoporosis, and diabetes), underscoring the necessity for a more personalized approach to treatment. Furthermore, about fifteen percent of patients, called “refractory myasthenia gravis patients”, do not respond adequately to standard therapies. In this context, the introduction of molecular therapies has marked a significant advance in myasthenia gravis management. Advances in understanding myasthenia gravis pathogenesis, especially the role of pathogenic antibodies, have driven the development of these biological drugs, which offer more selective, rapid, and safer alternatives to traditional immunosuppressants. This review aims to provide a comprehensive overview of emerging therapeutic strategies targeting specific immune pathways in myasthenia gravis, with a particular focus on preclinical evidence, therapeutic rationale, and clinical translation of B-cell depletion therapies, neonatal Fc receptor inhibitors, and complement inhibitors.
文摘BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant recipients receiving alemtuzumab vs basiliximab induction,focusing on graft function,acute rejection,infection,malignancy,post-transplant glomerulonephritis,and survival,using a propensity score matched cohort design.METHODS Kidney transplant recipients who received alemtuzumab or basiliximab induction from 2014 to 2019 across two nephrology centres in Northwest England were evaluated.Propensity score matching at a 1:1.5 ratio ensured comparability between cohorts.Baseline characteristics,immunosuppression regimens,and outcomes were analyzed.Linear,binary logistic and Cox proportional hazard regression models.RESULTS A total of 436 recipients were included,with a median follow-up of 5.2 years.The matched cohort(n=262)had a mean age of 51.1±13.5 years;39%were female and 92%were white.There was no significant difference in the cumulative incidence of acute rejection[odds ratio(OR)=2.10;95%CI:0.9-4.9;P=0.110].Compared with basiliximab,alemtuzumab was associated with lower estimated glomerular filtration rate at 12 months(-6.6 mL/minute/1.73 m2;95%CI:-10.5 to-2.7;P<0.001)and higher risks of cytomegalovirus viremia(OR=3.2;95%CI:1.6-6.5;P<0.001),BK viremia(OR=2.4;95%CI:1.1-5.5;P=0.02),post-transplant malignancy(OR=6.2;95%CI:1.6-29.9;P=0.013),and death-censored graft loss(hazard ratio=3.6;95%CI:1.2-11.4;P=0.03).No significant differences were observed in post-transplant glomerulonephritis or recipient mortality.CONCLUSION In this propensity score-matched analysis,alemtuzumab induction was associated with lower graft function at 12 months and higher risks of viral infection,post-transplant malignancy,and graft loss compared with basiliximab.These findings highlight the need for further studies to confirm the long-term safety and effectiveness of alemtuzumab in kidney transplantation.
文摘Nail changes following upper extremity transplantation(UET)cannot be overlooked as they possess diagnostic and prognostic relevance in allotransplantation of upper limbs.This comprehensive review explores nail and nail bed related changes encountered in UET recipients in the literature.The differential diagnosis of nail abnormalities in UET includes a wide range of systemic,local and iatrogenic conditions other than immune responses to the allograft.It requires interdisciplinary evaluation by primary transplant surgeons,pathologists,dermatologists and immunologists.The possible underlying mechanisms of nail pathology in UET and the management are discussed.It also underscores the importance of onychodystrophy and need for timely intervention and to improve outcomes in UET recipients.
基金the National Natural Science Foundation of China(31870420)the Science and Technology Program of Guangdong Province,China(2121A0505030057)。
文摘Continuous cropping leads to high incidence of soilborne diseases such as bacterial wilt caused by Ralstonia solanacearum,which poses a risk to agricultural production.Anaerobic soil disinfestation(ASD)and plant growthpromoting rhizobacteria(PGPR)are considered environmentally friendly methods to control bacterial wilt.However,the underlying mechanism of the improvement of soil health and the inhibition of bacterial wilt after ASD treatment and PGPR inoculation needs further exploration.This study evaluated the effect of ASD treatment on soil improvement at pre-planting of tomato,and the effect of ASD treatment combined with the application of Bacillus velezensis Y6(BV)on soil quality,R.solanacearum abundance,and bacterial communities at 90 days before harvesting of tomato.The results showed that ASD treatment reduced R.solanacearum abundance in soil by17.6%at pre-planting and 18.7%at 90 days before harvesting,but BV inoculation did not influence R.solanacearum abundance.ASD and ASD+BV treatments effectively reduced the occurrence of bacterial wilt,improved soil nutrient status and increased soil microbial activity at 90 days before harvesting.Principal co-ordinate analysis showed that the soil bacterial community was significantly influenced by ASD treatment both at pre-planting and at 90 days before harvesting.Further investigation found that ASD contributed to the enrichment of beneficial flora(Bacillus and Streptomyces).Moreover,pH was an important environmental factor affecting the abundance of R.solanacearum in soil.Co-occurrence network analysis showed that ASD treatment significantly increased network connection of bacterial communities and the proportion of beneficial microorganisms(Proteobacteria and Firmicutes),leading to complex soil bacterial co-occurrence networks both at pre-planting and at 90 days before harvesting.Collectively,these results indicate that ASD treatment,but not microbial inoculation can enhance tomato plant resistance to bacterial wilt by improving soil quality and modulating the soil bacterial community.
文摘Fibrolamellar hepatocellular carcinoma is a rare and unique subtype of primary liver cancer that predominantly affects adolescents and young adults who do not have underlying liver disease or cirrhosis.Representing less than five percent of all liver tumors,it poses significant diagnostic and therapeutic challenges due to its uncommon occurrence,vague clinical symptoms,and absence of standardized treatment protocols.This review summarizes the current understanding of the disease,covering its epidemiology,clinical presentation,imaging characteristics,histopathologic features,molecular biology,and treatment approaches.Patients often present with nonspecific abdominal symptoms,and typical tumor markers,such as alpha-fetoprotein,are usually absent.Imaging may show a central scar and calcifications,while histology reveals large eosinophilic tumor cells separated by fibrous bands.A defining molecular hallmark is the DNAJB1-PRKACA fusion gene,found in the majority of cases.Surgical resection remains the primary curative treatment for localized disease,although recurrence rates are high.Liver transplantation may be an option for selected patients with non-resectable,liverconfined tumors.Treatment options for advanced disease are limited,with some benefit observed from chemotherapy and targeted agents.Recent developments in molecular therapies and immunotherapy offer promise,but further research and clinical trial participation are essential to improve outcomes in this challenging malignancy.
文摘Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.
文摘Green transplant refers to the realization of the importance of understanding and improving the environmental footprint of transplantation through sustainable practices.This involves assessing the entire transplantation process including preoperative evaluation,donation,organ and patient transportation,surgery,postoperative recovery,and follow-up.This is a topic that has not been fully addressed yet,but its importance is being increasingly appreciated in surgery.The aim of this study was to investigate the carbon footprint associated with transplantation and propose sustainable mitigating solutions.A comprehensive review of the existing literature on transplantation was conducted and supplemented with findings from the broader fields of surgical and perioperative care,given the scarcity of available data.The analysis identified the most involved environmental factors and attempted to offer practical solutions based on current sustainability practices.Notably,no study has yet examined the carbon footprint associated with the entire transplantation procedure.Only five studies have attempted to assess the environmental impact of kidney or liver transplants,but they focused,almost explicitly,on specific steps of the process.By employing an extrapolative methodology from the broader surgical field,we determined that the primary contributors to the environmental impact of transplantation are energy,consumables and materials,anesthesia and pharmaceuticals,transportation,and water.This review offers practical solutions utilizing the 5R framework,emphasizing sustainability to ensure transplantation remains clinically and environmentally relevant.
基金the National Natural Science Foundation of China(82573571)the Shanghai 2025 Basic Research Plan Natural Science Foundation(25ZR1401393)the First Batch of Open Topics of the Shanghai Key Laboratory of Nautical Medicine and Translation of Drugs and Medical Devices(2025QN13)。
文摘The global burden of bacterial infections,exacerbated by antimicrobial resistance(AMR),necessitates innovative strategies.Bacterial protein vaccines offer promise by eliciting targeted immunity while circumventing AMR.However,their clinical translation is hindered by their inherently low immunogenicity,often requiring potent adjuvants and advanced delivery systems.Biomembrane nanostructures(e.g.,liposomes,exosomes,and cell membrane-derived nanostructures),characterized by superior biocompatibility,intrinsic targeting ability,and immune-modulating properties,could serve as versatile platforms that potentiate vaccine efficacy by increasing antigen stability,enabling codelivery of immunostimulants,and facilitating targeted delivery to lymphoid tissues/antigen-presenting cells.This intrinsic immunomodulation promotes robust humoral and cellular immune responses to combat bacteria.This review critically reviews(1)key biomembrane nanostructure classes for bacterial protein antigens,(2)design strategies leveraging biomembrane nanostructures to enhance humoral and cellular immune responses,(3)preclinical efficacy against diverse pathogens,and(4)translational challenges and prospects.Biomembrane nanostructure-driven approaches represent a paradigm shift in the development of next-generation bacterial protein vaccines against resistant infections.
