Stable Function Research Articles

Acute Myeloid Leukemia as a Trigger for Hemolytic–Uremic Syndrome

Acute myeloid leukemia (AML) has not been identified as a cause of secondary hemolytic–uremic syndrome (HUS). This case report describes a woman who developed severe HUS at the time of AML diagnosis and responded favorably to initial treatment with eculizumab, which stabilized her condition and allowed for treatment of the AML. After one year, with stable renal function and genetic studies reported as normal, eculizumab was successfully discontinued. The prompt use of eculizumab was critical to the patient’s survival and improvement in renal function, highlighting the efficacy of early eculizumab treatment in secondary HUS.

Successful eculizumab treatment as an adjunctive therapy to desensitization in ABO-incompatible living donor kidney transplantation and its molecular phenotypes

IntroductionABO-incompatible (ABOi) kidney transplantation (KT) has become an important option to overcome organ shortage. Plasmapheresis/rituximab-based desensitization therapy has successfully reduced anti-ABO antibody levels and suppressed antibody-mediated rejection (AMR) in ABOi KT. However, high titers of anti-ABO antibodies in some patients are refractory to standard desensitization, leading to loss of KT opportunities or AMR.MethodsEculizumab treatment was used an adjunctive therapy to rescue high-titer ABOi KT patients refractory to plasmapheresis/rituximab-based desensitization. Molecular phenotypes of allograft biopsies and cellular phenotypes of peripheral blood mononuclear cells of eculizumab group were compared with those of control groups using the Banff Human Organ Transplant gene panel and flow-cytometric analysis, respectively.ResultsThe initial titers of anti-ABO antibodies in the two patients were 1:512 and >1:1024; the final pre-transplant titers after desensitization were 1:128 and 1:64. Both patients received eculizumab from KT day to two or four weeks post-KT and maintained stable renal function up to one-year post-transplantation without overt infection, despite early episodes of probable AMR or borderline T cell-mediated rejection. Molecular phenotype analysis revealed that gene expression patterns in the ABOi KT with eculizumab group overlapped with those in the ABOi KT with AMR group more than in the ABOi KT without AMR group, except for complement pathway-related gene expression. Anti-ABO antibody titers decreased to low levels 1–3 months post-transplant in the eculizumab group in parallel with decreasing anti-B-specific B cells.ConclusionsShort-term eculizumab therapy is promising for rescuing ABOi KT recipients with high anti-ABO antibody titers refractory to plasmapheresis-based desensitization therapy.

Clinical Remission Predictors in Non-Colonized Bronchiectasis and Severe Asthma with Type 2-Targeted Biologic Therapy: A Retrospective Real-Life Pilot Study

Background/Objective: Patients with severe asthma (SA) and non-cystic fibrosis bronchiectasis (BE) without microbiological colonization represent a unique and understudied population. Type 2-targeted biologic therapies have emerged as a promising treatment for these patients. However, predictive factors for achieving clinical remission remain unclear. This study aims to identify the predictive factors for achieving clinical remission in patients with severe asthma and non-colonized bronchiectasis undergoing type 2-targeted biologic therapies. Methods: A retrospective longitudinal analysis was conducted on 14 patients with severe asthma and non-cystic fibrosis bronchiectasis without microbiological colonization. Clinical remission was assessed at baseline (T0) and after 12 months (T1) of biologic therapy. Clinical remission was defined according to the Severe Asthma Network Italy (SANI) criteria, including the absence of oral corticosteroid use, no asthma-related symptoms, stable lung function, and no exacerbations. Logistic regression was performed to identify predictors of remission. ROC curves were constructed to evaluate the predictive accuracy of lung function parameters, specifically FEV1 and FVC. Results: After 12 months of biologic therapy, 28.6% of patients (n = 4) achieved clinical remission. The mean FEV1 percentage at baseline was significantly higher in the remission group (92.25 ± 15.64%) compared to the non-remission group (65.10 ± 23.36%, p = 0.034). Logistic regression analysis identified baseline FEV1 as a significant predictor of remission (OR = 1.008, p = 0.050). ROC curve analysis revealed that an FEV1 cutoff of 72.5% had a sensitivity of 100% and a specificity of 70% (AUC = 0.900, p = 0.024) for predicting clinical remission. Conclusions: FEV1 is a crucial predictor of clinical remission in patients with severe asthma and non-colonized bronchiectasis treated with type 2-targeted biologic therapies. An FEV1 threshold of 72.5% can guide clinicians in identifying patients most likely to achieve remission. These findings underline the importance of preserving lung function to optimize therapeutic outcomes in this complex population.

Successful prevention of BK-polyomavirus nephropathy using extracorporeal photopheresis for immunosuppression minimisation following severe BK polyomavirus replication after kidney transplantation in a double lung transplant recipient, a case report

BackgroundBK-polyomavirus (BKpyV) nephropathy (BKVN) is associated with end-stage kidney disease in kidney and non-kidney solid organ transplantation, with no curative treatment.Case presentationA 45-year-old woman with a past medical history of double lung transplantation subsequently developed end-stage kidney disease, of undetermined origin. One month after receiving a kidney transplant, a diagnosis of early BKVN was suspected, and in retrospect was a reasonable cause for the loss of her native kidneys. Minimisation of immunosuppression, achieved through extracorporeal photopheresis, allowed clearance of BKpyV and so prevented nephropathy. Both lung and kidney grafts had a satisfactory and stable function after one year of follow-up, with no rejection.ConclusionsExtracorporeal photopheresis may have facilitated minimisation of immunosuppression and BKpyV clearance without lung allograft rejection.

Ischemia‐Free Kidney Transplantation From Deceased Donor Kidneys: The First Retrospective Cohort Study

ABSTRACTBackgroundThe study aimed to evaluate the safety and effectiveness of ischemia‐free kidney transplantation (IFKT) in preventing ischemia‐reperfusion injury (IRI), a common complication associated with organ transplantation.MethodsTwelve kidneys were obtained from six donors and divided into two groups: the IFKT and the conventional kidney transplantation (CKT) group. The left kidneys underwent conventional cold perfusion and storage, while the right kidneys were procured using normothermic machine perfusion (NMP) to maintain uninterrupted blood supply. Perfusion parameters, metabolic and electrolyte parameters in the perfusate and urine, along with post‐transplant clinical data of the recipients, were collected for subsequent analysis.ResultsPerfusion flow rates varied from 100 to 300 mL/min under a pressure of 65 mmHg across different donor kidneys. Biochemical parameters such as the pH value, oxygen partial pressure, and electrolyte levels, including Na+ and K+ concentrations in the perfusate, remained stable within physiological ranges during NMP. Urine samples demonstrated significantly lower pH values, reduced Na+ concentrations, and elevated K+ concentrations compared to the perfusate, indicating effective kidney function in acid excretion, sodium retention, and potassium excretion during NMP. All patients survived, and the kidney grafts showed satisfactory function during the 12‐month follow‐up period. Clinical outcomes for recipients in the IFKT group were comparable to those in the CKT group, including similar rates of patient and graft survival at 1 year, as well as equivalent serum creatinine levels and eGFR at 1, 3, 6, and 12 post‐transplantation. Delayed graft function (DGF) occurred in one case (16.67%) from the same donor in both groups. One patient in the IFKT group experienced acute rejection, while no instances of primary graft nonfunction or other complications were observed in either group.ConclusionsOur findings indicate that the kidneys maintained in a physiological environment through NMP exhibit stable function, and post‐transplant allograft function is comparable between IFKT and CKT. The IFKT procedure demonstrates both feasibility and safety, presenting a promising approach to effectively mitigating IRI in kidney transplantation.

Posterior urethral valves: Clinical audits of presentation, diagnostic and therapeutic intervention in a nigerian teaching hospital.

We described our experience in the management of PUV at UNIOSUN Teaching Hospital, Osogbo, Osun State. This was a retrospective analysis of patients with diagnosis of PUV carried out over a 4year period (2019-2023). Demographic characteristics, clinical presentation, diagnosis and mode of therapeutic interventions were the variables analysed. A total of 17 patients with PUV were managed during the study period. Median age at presentation and surgery were 10months (range 3.0-48.0) and 13months (range 3.0-49.5), respectively. Most common presentation was poor urinary stream, 11 (64.7%). Mean PCV was 34.42%. Klebsiella aerogens was the predominant 9 (52.9%) organism isolated. A patient had prenatal USS diagnosis suggestive of PUV, majority (52.9%) had bilateral grade 1V hydronephrosis at presentation. Voiding cystogram was diagnostic in 14 patients, (82.4%) while urethrocystoscopy was done in 14 (82.4%) patients. Median creatinine level were 116, 76.5 and 51.0 (micromol/l) pre- and post-catheterization and 1month post-surgery, respectively. There was positive correlation between the age and post- surgery creatinine but a negative correlation between the PCV and grade of hydronephrosis. All patients had Mohans valvotomy. We had mortality in a patient from urosepsis. At 6months-1year follow-up, 15 patients had good urine stream with stable renal function. Early intervention assist in optimizing renal and bladder function and minimize risk of urosepsis. Where there is no facility for endoscopic valve ablation, Mohans valvotomy remains a viable treatment option.

Evaluation of Single Versus Two-Dose Basiliximab Induction Therapy in Live-Donor Liver Transplant.

Basiliximab is a high-cost induction agent typically given as two doses in liver transplant recipients. This study evaluated renal outcomes in live-donor liver transplant recipients (LDLTRs) with stable renal function at the time of transplant receiving one versus two doses of basiliximab. We retrospectively identified 231 adult LDLTR with a serum creatinine (SCr) <1.5mg/dL on post-transplant Day 5. The primary endpoint was a change in SCr from post-transplant Days 5 to 30 between the groups. Secondary endpoints included incidence of acute kidney injury (AKI), liver rejection, and culture-positive infections within 3 and 6 months of transplant. Basiliximab-related cost savings were also evaluated. Median change in SCr from post-transplant Days 5 to 30 was no different between the single-dose or two-dose groups (0.1 [IQR: -0.1-0.3] vs. 0.2 [IQR: -0.1-0.4], p = 0.08). Incidence of AKI was 56.9% in the two-dose group versus 39.0% in the single-dose group (p = 0.01). There was no difference in bacterial (p = 0.40), fungal (p = 0.59), or viral (p = 0.78) infections. Acute cellular rejection through 6 months post-transplant was noted in 9.7% of patients receiving two doses and 6.3% in the single-dose arm (p = 0.42). Basiliximab-related cost savings in the single-dose arm was ∼$697 863.72 over 159 transplants. Single-dose basiliximab appears to be safe and effective in place of two doses in LDLTR with stable renal function on post-transplant Day 5. Utilization of a single basiliximab dose significantly reduced medication-related costs.

Characteristics, treatment, and outcomes of spontaneous renal artery dissection: a 10-year retrospective single-center experience.

Spontaneous renal artery dissection (SRAD) is a rare cause of renal failure and renovascular hypertension, with the diagnosis often being delayed and treatment varying across different centers. The objective of this retrospective cohort study was to scrutinize the characteristics, treatment modalities, and outcomes of patients with SRAD at our center over the past ten years. Furthermore, the study sought to identify the most suitable treatment options for different categories of patients with SRAD. Data from 21 consecutive patients who presented with symptoms of SRAD from December 2013 to December 2023 were collected. Lesion characteristics, treatment options, blood pressure (BP) control, serum creatinine and estimated glomerular filtration rate (eGFR) were analyzed. A paired t-test was used for comparisons of BP, serum creatinine, and eGFR. An independent samples t-test was used to analyze baseline BP and BP change in different treatment groups. The mean age, weight, and height of patients with SRAD was 49.2±13.0 (range, 18-69) years, 69.0±9.7 (range, 50-80) kg, and 1.7±0.1 (range 1.6-1.8) m, respectively. New-onset hypertension was found in 8 (38.1%) patients. Renal artery dissecting aneurysm and renal artery stenosis were found in 1 (4.8%) and 4 (19.0%) patients, respectively. Supportive medical treatment alone, endovascular intervention, and nephrectomy were required in 15, 4 and 2 cases, respectively. Stable renal function and satisfactory hypertension control were obtained in all treatment groups, with a median follow-up of 18.1 (range, 12-32) months. Medical management is a reasonable choice in most patients with SRAD. Interventional management is an efficacious strategy for the management of renovascular hypertension and the preservation of renal function.

Long-term outcomes of mitral valve repair in children.

Mitral Valve Disease in children presents unique challenges due to the wide range of associated pathologies and the complexities of pediatric cardiac anatomy. Mitral valve repair in this demographic is preferred over replacement due to the drawbacks associated with prosthetic valves in young patients, such as the need for long-term anticoagulation and issues with prosthetic size and growth. This retrospective study reviewed pediatric patients under 18 years who underwent mitral valve repair between January 2002 and December 2023. Exclusion criteria included patients with atrioventricular septal defects or single-ventricle physiology. Surgical outcomes were assessed using preoperative and postoperative transthoracic echocardiography, with follow-up data analyzed via Kaplan-Meier survival estimates. The study included 47 patients with a median age of 4 years. Surgical techniques varied based on the specific mitral valve pathology. The overall early mortality was 6.3%, and the one and ten-year survival rates were 93.6 ± 3.6% and 91.4 ± 4.1%, respectively. Most patients showed improved or stable postoperative cardiac function during a median follow-up of 105 months. Notably, the rate of freedom from re-operation at ten years was 85.1 ± 6.9%, highlighting the durability of the surgical interventions. Mitral valve repair in children demonstrates favorable long-term outcomes with low mortality and reoperation rates, particularly when performed at an older age to accommodate growth and avoid the complexities of smaller, more delicate cardiac structures. These findings suggest that mitral valve repair should be considered a viable and effective option for managing pediatric MVD, with a personalized approach essential for optimizing outcomes.

Kidney transplant artery and vein stenting: 15-year follow-up

BackgroundWe would like to present an unusual case of simultaneous stenosis of renal graft artery and vein diagnosed four months after transplantation. both treated by stent placement. Our aim is to point at the fact that renal graft venous stenosis is very rarely reported in the literature and – as it is not easy to diagnose by routine US - it could be overlooked. If early detected it can be treated by stent placement.Case presentationWe present a case of 36-old-male with renal failure who received a kidney graft from deceased donor. The patient experienced delayed graft function. No rejection was found in the biopsy. Four months after transplantation the kidney function deteriorated to sCr 280 µmol/l. Graft artery stenosis together with graft vein stenosis was revealed. Both lesions were dilated with stent placement, the graft function returned to 230 µmol/l and became stable for 10 years. Ten years after stent placement graft function deteriorated to 300 µmol/l. An in stent restenosis of arterial stent was detected. It was successfully dilated by the balloon, the graft function returned to 230 µmol/l and stays stable for another 5 years.ConclusionsAn unusual simultaneous transplanted kidney artery and vein stenosis treated by stent placement is presented. The patient had stable graft function for 15 years after the procedure with one re-intervention on arterial stent.

The Incidence and Impact of Cardiac Function Decline after Lower Extremity Revascularization

The impact of cardiac function decline on major adverse limb events (MALE) following lower extremity revascularization (LER) in patients with peripheral arterial disease (PAD) has not been described. The electronic records of patients undergoing LER for PAD in a single center were reviewed. Two transthoracic echocardiograms were captured, the first within 6 months of LER and the second on later follow-up (most recent to date). Patients were then divided into 2 groups: cardiac function decline (decrease in left ventricular ejection fraction ΔEF ≥10%) or stable cardiac function (reduction in ΔEF <10%, no change or improved EF). Patient characteristics and outcomes, including MALE, were compared. Of the 926 patients who underwent LER, 222 (24.0%) experienced a cardiac function decline, with 704 (76.0%) patients having stable cardiac function. Patients with cardiac function decline were more likely to have diabetes mellitus and heart failure than patients with stable cardiac function. There were no differences in the mode of revascularization (open vs. endovascular) between both groups. Patients with cardiac function decline demonstrated higher rates of periprocedural bleeding after initial LER. After a mean follow-up of 3 years, patients with cardiac function decline had higher mortality. However, Kaplan-Meier analysis revealed no difference in freedom from MALE or reintervention rates between the 2 groups. Patients with cardiac function decline after LER for PAD have increased mortality but no significant difference in limb outcomes compared to patients with stable cardiac function.

Clinical response and on-treatment clinical remission with tezepelumab in a broad population of patients with severe, uncontrolled asthma: results over 2 years from the NAVIGATOR and DESTINATION studies.

In asthma, clinical response is characterized by disease improvement with treatment, whereas clinical remission is characterized by long-term disease stabilization with or without ongoing treatment. The proportion of patients receiving tezepelumab who responded to treatment and those who achieved on-treatment clinical remission was assessed in the NAVIGATOR (NCT03347279) and DESTINATION (NCT03706079) studies of severe, uncontrolled asthma. NAVIGATOR and DESTINATION were phase 3, randomized, double-blind, placebo-controlled studies; DESTINATION was an extension of NAVIGATOR. Complete clinical response was defined as achieving all of the following: ≥50% reduction in exacerbations versus the previous year, improvements in pre-bronchodilator (BD) forced expiratory volume in 1 s (FEV1) of ≥100 mL or ≥5%, improvements in Asthma Control Questionnaire (ACQ)-6 score of ≥0.5 and physicians' assessment of asthma improvement. On-treatment clinical remission was defined as an ACQ-6 total score ≤1.5, stable lung function (pre-BD FEV1 >95% of baseline) and no exacerbations or use of oral corticosteroids during the time periods assessed. Higher proportions of tezepelumab than placebo recipients achieved complete clinical response over weeks 0-52 (46% versus 24%; OR: 2.83 [95% CI: 2.10-3.82]), and on-treatment clinical remission over weeks 0-52 (28.5% versus 21.9%; OR: 1.44 [95% CI: 0.95-2.19]) and weeks >52-104 (33.5% versus 26.7%; OR: 1.44 [95% CI: 0.97-2.14]). Tezepelumab recipients who achieved on-treatment clinical remission versus complete clinical response at week 52 had better preserved lung function and lower inflammatory biomarkers at baseline, and fewer exacerbations in the 12 months before the study. Among patients with severe, uncontrolled asthma, tezepelumab treatment was associated with an increased likelihood of achieving complete clinical response and on-treatment clinical remission compared with placebo. Both are clinically important outcomes but may be driven by different patient characteristics.

Effects of switching from twice-daily tacrolimus to once-daily extended-release meltdose tacrolimus on cellular immune response.

LCP-Tacro [LCPT], a novel once-daily, extended-release formulation of tacrolimus, has a reduced Cmax with comparable AUC exposure, requiring a ∼30% dose reduction in contrast to immediate-release tacrolimus (IR-Tac). Once-daily LCPT in de novo kidney transplantation has a comparable efficacy and safety profile to that of IR-Tac with advantages in bioavailability and absorption. The present investigation intends to analyze the effects of conversion from IR-Tac to LCPT on phenotype and function of T-cells and B-cells. 16 kidney transplant patients treated by triple standard immunosuppression with a stable graft function undergoing a switch from IR-Tac to LCPT were included in this observational prospective study. We measured the main immune cell types and performed an in-depth characterization of B cell, dendritic cells and T cells including regulatory T cells of the patients before, 4 and 8 weeks after IR-Tac to LCPT conversion using multi-parameter fl ow cytometry. Additionally, we analyzed T cells by assessing third-party antigens (Tetanus Diphtheria, TD)-reactive T cells, which could be analyzed by restimulation with tetanus vaccine. Overall, we found no significant alterations following LCPT conversion for the most immune cell populations with a few cell populations showing transient quantitative increase. Thus, 4 weeks after conversion, more regulatory T cells could be measured in the patients with a significant shift from memory to naïve Tregs. Furthermore, we found a transient B cell expansion 4 weeks after conversion from IR-Tac to LCPT. There were no changes in the percentage of other basic immune cell types and the antigen-reactive T cells were also not altered after changing the medication to LCP-tacrolimus. Here, we demonstrate first insights into the immune system changes occurred under IR-Tac to LCPT conversion therapy in kidney transplant patients. While phenotypic and functional characteristics of the most immune cell populations did not change, we could observe an a transient expansion of regulatory T cells in peripheral blood following IR-Tac to LCTP conversion, which might additionally contribute to the overall immunosuppressive effect.

Dimensionality reduction of neuronal degeneracy reveals two interfering physiological mechanisms.

Neuronal systems maintain stable functions despite large variability in their physiological components. Ion channel expression, in particular, is highly variable in neurons exhibiting similar electrophysiological phenotypes, which raises questions regarding how specific ion channel subsets reliably shape intrinsic properties of neurons. Here, we use detailed conductance-based modeling to explore how stable neuronal function is achieved despite variability in channel composition among neurons. Using dimensionality reduction, we uncover two principal dimensions in the channel conductance space that capture most of the variance of the observed variability. These two dimensions correspond to two sources of variability that originate from distinct physiologically relevant mechanisms underlying the regulation of neuronal activity, providing quantitative insights into how channel composition is linked to the electrophysiological activity of neurons. These insights allow us to understand and design a model-independent, reliable neuromodulation rule for variable neuronal populations.

Clinical experience on switching trientine tetrahydrochloride to trientine dihydrochloride in Wilson disease patients

AbstractThis study evaluates the effectiveness and safety of trientine dihydrochloride (TETA 2‐HCl) in patients with Wilson disease (WD) following a switch from trientine tetrahydrochloride (TETA 4‐HCl). A total of 30 WD patients with stable copper metabolism were identified for treatment with TETA 2‐HCl (Cufence™) after prior use of TETA 4‐HCl (Cuprior™). Biochemical markers including urinary copper, non‐ceruloplasmin bound copper (NCC) and liver function were analyzed at baseline and followed up over 12 months. Safety was assessed based on reported adverse events (AEs). Urinary copper levels and NCC remained stable across all follow‐ups, indicating adequate copper metabolism control. Reported AEs during TETA 2‐HCl treatment were mostly gastrointestinal discomfort (n = 6). In two patients, progressive elevation of transaminases occurred (despite stable copper metabolism). AEs led to discontinuation of treatment in five cases. Median baseline dose per day was 10.2 mg TETA 4‐HCl/kg bodyweight, whereas median baseline dose after therapeutic switch to TETA 2‐HCl was 12.8 mg/kg bodyweight. Median daily dose at 12 months did not differ significantly from TETA 2‐HCl dose at switching timepoint, with stable biochemical markers and markers of copper metabolism in most (25/30) of the patients. Transitioning from TETA 4‐HCl to TETA 2‐HCl maintained stable copper parameters and liver function in most of analyzed patients. TETA 2‐HCl treatment was generally well tolerated, suggesting that switching medications is safe and effective. In our real‐life cohort, adjustment factor of ~1.25× for the switch of TETA 4‐HCl to TETA 2‐HCl resulted in adequate copper metabolism control.

Efficacy and safety of rituximab in patients with PLA2R associated membranous nephropathy and resolved HCV infection

Rituximab occasionally induces reactivation of hepatitis C virus (HCV) in patients with resolved HCV infection, sometimes with fatal consequences. As rituximab has become one of the first-line therapies for the treatment of phospholipase A2 receptor (PLA2R)-associated membranous nephropathy (MN) and is more widely used, there is a lack of studies reporting the effectiveness and safety of rituximab in patients with PLA2R-associated MN and resolved HCV infection. A single-center retrospective study was conducted on PLA2R-associated membranous nephropathy (MN) patients who were HCVAb positive but HCV-RNA negative and treated with rituximab. A total of 598 adult patients with PLA2R-associated MN who underwent rituximab therapy were screened. General clinical information, including gender, age, pathological data, and previous treatment plans, was collected from medical records. Routine blood tests, liver and kidney function assessments, blood lipid profiles, 24-h urine protein levels, anti-PLA2R antibody titers, circulating B-cell counts, and HCV viral loads were measured at the time of rituximab infusion and repeated at intervals of 1–3 months post-rituximab administration. A total of 8 patients were enrolled, with a median follow-up period of 19.00 (range: 16.00–25.25) months. Among the 8 patients, 5 were male, and the mean age was 50.13 ± 4.29 years. Histological findings indicated that tubuloreticular inclusions, mesangial deposits, intramembranous deposits, and subendothelial deposits were not observed in any of the 8 patients. The overall 1-year remission rate for these patients was 75%, accompanied by a significant reduction in proteinuria. Additionally, blood albumin levels increased significantly, and renal function remained stable. No increase in HCV viral load and stable liver function tests were observed throughout the entire follow-up period. This study suggested that on the basis of successful eradication of HCV virus with antiviral drugs, rituximab can effectively induce clinical remission of patients with PLA2R associated MN and resolved HCV infection, and does not lead to a significant increase in HCV virus load. However, this finding is based on a very small sample size and should be confirmed in larger clinical trials.

447.9: Porcine islet-after-kidney transplantation in with cure of diabetes and six months of stable graft function in life-supporting pig-to-baboon model.

447.9: Porcine islet-after-kidney transplantation in with cure of diabetes and six months of stable graft function in life-supporting pig-to-baboon model.

Memristive gas sensor (gasistor) based on Ag/ordered TiO2 nanorods/FTO sandwich structure for evaluation of ethanol concentration in mixed ambient

Herein, we designed a memoristor-type gas sensor (gasistor) with Ag/ordered TiO2 nanorods/FTO sandwich structure for recognizing ethanol concentration in ethanol-methanol mixtures. The gas adsorption characteristics of different TiO2 substrates were first investigated by first-principle calculations. The results showed that the TiO2 surface in the low resistance state exhibited better immunity to other interfering gas molecules. However, similar adsorption energies and charge transfers calculated for adsorption of methanol and ethanol mean that the interference of methanol to the response of ethanol cannot be completely ignored. In next experiments, the Ag/TiO2/FTO gasistor with well-aligned TiO2 nanorods as the resistive layer was constructed successfully and demonstrated the stable resistive switching function and excellent retention characteristic. Further device tests confirm the ability of the gasistor in the low resistance state to discriminate between ethanol and methanol, as well as better anti-interference for other organic vapors. Also, an ultra-short recovery time (∼1.8 s) was observed by applying a direct current scanning voltage to the gasistor. Finally, to improve the recognition rate of ethanol in ethanol-methanol mixed atmosphere, a neural network algorithm based on back-propagation was incorporated and good prediction accuracy was obtained at ethanol concentrations ≥ 5 ppm.

Preload responsiveness–guided fluid removal in mechanically ventilated patients with fluid overload: A comprehensive clinical–physiological study

This study investigated fluid removal strategies for critically ill patients with fluid overload on mechanical ventilation. Traditionally, a negative fluid balance (FB) is aimed for. However, this approach can have drawbacks. Here, we compared a new approach, namely removing fluids until patients become fluid responsive (FR) to the traditional empiric negative balance approach.Twelve patients were placed in each group (n = 24). FR assessment was performed using passive leg raising (PLR). Both groups maintained stable blood pressure and heart function during fluid management. Notably, the FR group weaned from the ventilator significantly faster than negative FB group (both for a spontaneous breathing trial (14 h vs. 36 h, p = 0.031) and extubation (26 h vs. 57 h, p = 0.007); the difference in total ventilator time wasn't statistically significant (49 h vs. 62 h, p = 0.065). Additionally, FR group avoided metabolic problems like secondary alkalosis and potential hypokalemia seen in the negative FB group.FR-guided fluid-removal in fluid overloaded mechanically ventilated patients was a feasible, safe, and maybe superior strategy in facilitating weaning and disconnection from mechanical ventilation than negative FB-driven fluid removal. FR is a safe endpoint for optimizing cardiac function and preventing adverse consequences during fluid removal.

Application value of ultrasonic contrast imaging and ultrasonic parameters in post-transplant renal surgery.

Utilize VUEBOX quantitative analysis software to perform quantitative analysis dynamic ultrasound contrast images of post-transplant renal patients were assessed quantitatively five parameters of ultrasonic contrast and two-dimensional ultrasound are examined to explore their six value in Diagnosing Renal Graft Dysfunction. A retrospective analysis was conducted on 73 post-transplant renal patients who underwent ultrasound contrast examinations at Yiyang Central Hospital from July 2022 to December 2023, They were diagnosed clinically and pathologically. Based on pathological and clinical diagnostic results, the patients were divided into three groups: 47 cases in the stable renal function group, 18 cases in the acute rejection (AR) group, and 8 cases in the delayed graft function (DGF) group. All patients underwent routine ultrasound and ultrasound contrast examinations post-transplantation. By comprehensively assessing renal function test results, clinical course, and pathological findings, differences in ultrasonic contrast quantitative parameters were analyzed. Additionally, ROC curves were constructed to evaluate the diagnostic efficacy of ultrasound contrast in discriminating between transplant renal rejection reactions and delayed renal function recovery. Statistically significant differences in characteristics, such as renal segmental artery resistance index, were observed among the stable renal function group, AR group, and DGF group (all P < 0.05), while peak systolic velocity showed no statistical significance (P > 0.05). Differences in cortical time to peak (TTP), medullary time to peak(TTP), main renal artery rise time (RT), main renal artery(TTP), and main renal artery fall time (FT) were statistically significant among the stable renal function group, AR group, and DGF group (P < 0.05). ROC curve analysis demonstrated that the accuracy of quantitative parameters for the DGF group and AR group was as follows: Renal artery TTP = Renal artery RT > Renal artery FT > Medulla TTP > Cortex TTP (with respective area under the curve values of 0.828, 0.828, 0.758, 0.742, 0.719). Among these, Renal artery TTP and Renal artery RT exhibited larger AUC values, with sensitivities of 87.5% each and specificities of 81.2 and 87.5%, respectively. There are discernible differences in VUEBOX quantitative parameters between post-transplant AR and DGF cases, thereby providing imaging references for diagnosing of acute rejection and functional impairment following renal transplantation.