Search Results (34)

Background: Patient blood management (PBM) strategies have been shown to significantly reduce the use of blood products and enabled surgical procedures to be carried out safely without the need for transfusions. This evidence has raised questions about the possibilities of the “extreme” application of PBM strategies for complex surgical interventions, such as organ transplants, even in patients in whom it is not possible to proceed with transfusion. The aim of this scoping review was to identify and describe the current evidence available in the medical literature on the transplant of the four main solid organs: kidney, heart, liver, and lung in patients declining blood transfusions. Methods: A comprehensive literature search was conducted using PubMed from January 2000 to February 2025. Only articles reporting cases, case series, population samples, or comparative studies describing solid organ transplantation without the use of blood components were included. The results are presented separately for each solid organ. Results: Kidney: Nine studies were included, seven of which reported case reports or case series of kidney or kidney–pancreas transplants, and two articles were comparative studies. Liver: Nine studies reported bloodless liver transplants, eight were case reports or case series, and one was a comparative observational study. Heart: Five studies were included, four of which were case reports of heart transplants; in addition there was a comparative study describing eight heart transplants without the use of blood components to 16 transfusable transplant patients. Lung: Five studies reporting lung transplant without transfusion were reported, four of which were case reports performed in the absence of deaths, and two of which were bilateral. Furthermore, there was an article describing two single lung transplants without the use of blood components compared to ten transfusable transplant patients. Conclusions: The analysis performed demonstrates the possibility, depending on the organ, of performing solid organ transplant procedures without the use of blood components in selected and carefully prepared patients by experienced multidisciplinary teams. Full article

Mitochondria are currently of great interest to scientists. The role of mitochondrial DNA (mtDNA) mutations has been proven in the genesis of more than 200 pathologies, which are called mitochondrial disorders. Therefore, the study of mitochondria and mitochondrial DNA is of great interest not only for understanding cell biology but also for the treatment and prevention of many mitochondria-related pathologies. There are two main trends of mitochondrial therapy: mitochondrial replacement therapy (MRT) and mitochondrial transplantation therapy (MTT). Also, there are two main categories of MRT based on the source of mitochondria. The heterologous approach includes the following methods: pronuclear transfer technique (PNT), maternal spindle transfer (MST), Polar body genome transfer (PBT) and germinal vesicle transfer (GVT). An alternative approach is the autologous method. One promising autologous technique was the autologous germline mitochondrial energy transfer (AUGMENT), which involved isolating oogonial precursor cells from the patient, extracting their mitochondria, and then injecting them during ICSI. Transmission of defective mtDNA to the next generation can also be prevented by using these approaches. The development of a healthy child, free from genetic disorders, and the prevention of the occurrence of lethal mitochondrial disorders are the main tasks of this method. However, a number of moral, social, and cultural objections have restricted its exploration, since humanity first encountered the appearance of a three-parent baby. Therefore, this review summarizes the causes of mitochondrial diseases, the various methods involved in MRT and the results of their application. In addition, a new technology, mitochondrial transplantation therapy (MTT), is currently being actively studied. MTT is an innovative approach that involves the introduction of healthy mitochondria into damaged tissues, leading to the replacement of defective mitochondria and the restoration of their function. This technology is being actively studied in animals, but there are also reports of its use in humans. A bibliographic review in PubMed and Web of Science databases and a search for relevant clinical trials and news articles were performed. A total of 81 publications were selected for analysis. Methods of MRT procedures were reviewed, their risks described, and the results of their use presented. Results of animal studies of the MTT procedure and attempts to apply this therapy in humans were reviewed. MRT is an effective way to minimize the risk of transmission of mtDNA-related diseases, but it does not eliminate it completely. There is a need for global legal regulation of MRT. MTT is a new and promising method of treating damaged tissues by injecting the body’s own mitochondria. The considered methods are extremely good in theory, but their clinical application in humans and the success of such therapy remain a question for further study. Full article

Objectives: Microbial keratitis is a precursor to corneal scarring, the fifth-leading cause of blindness and visual impairment worldwide. Despite its significance, there is a paucity of data quantifying the recurrence rates of keratitis and the subsequent corneal damage. This study aims to address this gap by providing a comprehensive analysis of the frequency and origin of keratitis recurrences and its impact on visual deterioration. Methods: We retrospectively analyzed a cohort of 1303 patients diagnosed with microbial keratitis at the Independent Public University Eye Hospital in Warsaw, Poland, between January 2018 and December 2023. All adult patients with at least one documented episode of infectious keratitis were included in the study. Patients were divided into two cohorts: Group 1: patients with recurrent keratitis (n = 233) and Group 2: patients with the first episode of keratitis (n = 1070). Results: The recurrence rate of keratitis was 17.88% (233 of 1303 patients), regardless of etiology. Visual acuity on admission did not differ significantly between the recurrent and naïve groups. However, among patients with at least three episodes, visual acuity was worse (median logMAR for 1 vs. 2 vs. 3 recurrences were the following: 0.30 (0.08–0.67) vs. 0.60 (0.12–1.30) vs. 0.44 (0.20–0.92), accordingly, p = 0.049). Univariate logistic regression identified contact lens usage as a significant risk factor for recurrence (OR 2.37, 95% CI: 1.84–3.08, p < 0.001), also including its inappropriate use (OR 2.25, 95% CI: 1.42–3.66, p = 0.001). In terms of etiology, bacteria were the most common identified cause of keratitis in both the recurrent and naïve groups, accounting for 38.36% (90 cases) in Group 1 and 47% (503 cases) in Group 2. Viruses were the second most prevalent etiology, representing 31.33% (73 cases) in Group 1 and 19.91% (213 cases) in Group 2. Furthermore, a multivariate logistic regression model indicated that advanced age, delayed treatment, fungal etiology, and post-corneal transplant status were strongly associated with worse visual outcomes. Conclusions: Although each recurrence contributes to cumulative vision loss, the majority of patients with recurrent keratitis present with a useful visual acuity (0.3 to 0.60 logMAR). Our study identified older age, fungal etiology, delayed treatment, and post-keratoplasty keratitis as the most significant risk factors for visual deterioration. These findings underscore the need for targeted interventions in populations at higher risk of adverse visual outcomes. Full article

Background: Solid organ transplantation, which began as an experimental procedure over 100 years ago, has now become a viable therapeutic option for the vast majority of patients with end-stage organ failure. However, a major limiting factor remains the shortage of organs available for transplantation. To expand the donor pool, it is essential to increase awareness of transplantation, including its legal, cultural, and ethical aspects. Every year, numerous organizations, primarily non-governmental, organize hundreds of campaigns promoting transplantation worldwide. The majority of these initiatives are one-time events tied to observances such as World Transplant Day, World Kidney Day, and others. The growing role of social media in spreading information is also becoming a key factor in promoting organ donation and transplantation, as social factors play an important role in expanding the donor pool. Many organizations that support transplantation, along with healthcare providers, widely use platforms like Facebook and other social media to promote and increase organ donation. Objectives: The “Second Life” is a social campaign presentation to raise awarenes about transplantation. Project Description: The campaign has been running continuously for 17 years in Poland, promoting the concepts of organ donation and transplantation in collaboration with high school students. During this time, 950 high schools across the country participated in the project, with approximately 450,000 high school students actively engaging in the campaign. Outcomes: They organized a series of activities to promote organ donation and transplantation within their social circles, distributing nearly 1.5 million declarations of will. Additionally, they helped raise awareness about presumed consent and educated others on the concepts of organ donation and transplantation. Conclusions/Implications: This long-term initiative is crucial for raising awareness, educating the public, and promoting the idea of organ donation. It fosters a more positive attitude toward organ donation and transplantation, ultimately contributing to the expansion of the donor pool and an increase in transplantations in the near future. Full article

Purpose: To determine the incidence, risk factors (including systemic immunosuppression), and outcomes of microbial keratitis in corneal transplants over a 16-year observation period at a tertiary referral hospital in Poland. Methods: This retrospective cohort study included 125 episodes of infectious keratitis in 117 patients who underwent corneal transplantation between 2008 and 2023 at the Department of Ophthalmology, Medical University of Warsaw, Poland. The data collected included demographics, indications for transplantation, infection rates, risk factors, best-corrected visual acuity (BCVA) at presentation and discharge, changes in visual acuity, and treatments received prior to hospital admission. Clinical signs, symptoms, diagnostic tests, and management strategies were also reviewed. Additionally, the outcomes of surgical interventions, such as therapeutic corneal transplantation and evisceration, were examined. Results: Among the 2869 corneal transplants performed over the 16-year period, the incidence of post-keratoplasty microbial keratitis (PKMK) was 4.35%. The most common indication for transplantation in affected patients was an active infection unresponsive to medical therapy (n = 62, 52%). One-third of PKMK cases occurred in patients with repeat transplants. Median visual acuity prior to infection was 1.6 logMAR, worsening to 2.3 logMAR at presentation. Following treatment, visual acuity improved to a median of 1.9 logMAR at discharge, with no significant improvement by the one-year follow-up. At that time, 75.1% of patients remained legally blind (BCVA ≤ 20/200); 21% recovered to pre-infection visual levels, while 46% experienced additional visual loss due to PKMK. Multivariate regression identified corneal perforation and systemic immunosuppression as independent predictors of poorer visual outcomes (p < 0.001 and p = 0.03, respectively. Conclusions: Microbial keratitis in corneal grafts is associated with poor long-term visual outcomes. At one year post-infection, the median BCVA was 1.9 logMAR, with 75.1% of patients remaining legally blind. Nearly half of the cohort experienced additional visual loss compared to their pre-infection status, underscoring the severity of PKMK and the need for vigilant postoperative care. Full article

Purpose: To evaluate visual acuity improvement and identify contributing factors in patients with severe keratitis affecting both virgin and transplanted corneas, treated at a hospital. Methods: A retrospective analysis was conducted on 497 patients with unilateral corneal ulcers treated at a tertiary referral center between 2008 and 2023. Data included distance (BCVA) and near best-corrected visual acuity at initial presentation and at discharge, treatments before hospital admission, demographic details, risk factors, clinical signs and symptoms, ancillary test results, and management strategies. Patients were categorized into two groups: Group A (naïve corneal ulcers, 379 patients) and Group B (post-keratoplasty infectious keratitis, 118 patients). Additional analysis focused on patients with presenting visual acuity of at least 1.0 logMAR (≤5/50 Snellen charts = legal blindness) to predict final visual outcomes. Results: The median BCVA at presentation for the entire cohort was 1.9 logMAR, advancing to 1.5 logMAR at discharge (p < 0.001). At least one line improvement in BCVA was observed in 47% of patients (52% of naïve cornea and 33% of transplanted cornea patients). Significantly worse results were observed in Group B were observed for BCVA at presentation, BCVA improvement, and distance and near vision improvement. Among patients with legal blindness at presentation, vision status improved for 52/379 (14%) in Group A and 6/118 (5%) in Group B during hospital admission (p < 0.001), while 67% of the cohort was discharged with VA equal or worse than 5/50. The average hospital stay was 9 days. Near visual acuity got better in 23% of patients (27% in Group A vs. 9% in Group B). A multivariate regression model showed that older age and worse distance BCVA on admission were independent negative predictors of improvement (p < 0.001, p < 0.001, respectively) while midperiphery ulcers were associated with better visual outcomes. Conclusions: Hospital admission leads to BCVA improvement in 47% of the patients with severe corneal ulcer, though the prognosis is significantly worse for those with post-keratoplasty microbial keratitis. At discharge, 67% of patients remained at the legal blindness level. Older age and lower BCVA at first presentation are associated with worse prognosis, while ulcers located in the corneal midperiphery are linked to better visual outcomes. Full article

Kidney allograft rejection is one of the main limitations to long-term kidney transplant survival. The diagnostic gold standard for detecting rejection is a kidney biopsy, an invasive procedure that can often give imprecise results due to complex diagnostic criteria and high interobserver variability. In recent years, several additional diagnostic approaches to rejection have been investigated, some of them with the aid of machine learning (ML). In this review, we addressed studies that investigated the detection of kidney allograft rejection over the last decade using various ML algorithms. Various ML techniques were used in three main categories: (a) histopathologic assessment of kidney tissue with the aim to improve the diagnostic accuracy of a kidney biopsy, (b) assessment of gene expression in rejected kidney tissue or peripheral blood and the development of diagnostic classifiers based on these data, (c) radiologic assessment of kidney tissue using diffusion-weighted magnetic resonance imaging and the construction of a computer-aided diagnostic system. In histopathology, ML algorithms could serve as a support to the pathologist to avoid misclassifications and overcome interobserver variability. Diagnostic platforms based on biopsy-based transcripts serve as a supplement to a kidney biopsy, especially in cases where histopathologic diagnosis is inconclusive. ML models based on radiologic evaluation or gene signature in peripheral blood may be useful in cases where kidney biopsy is contraindicated in addition to other non-invasive biomarkers. The implementation of ML-based diagnostic methods is usually slow and undertaken with caution considering ethical and legal issues. In summary, the approach to the diagnosis of rejection should be individualized and based on all available diagnostic tools (including ML-based), leaving the responsibility for over- and under-treatment in the hands of the clinician. Full article

Background/Objectives: Data regarding the outcomes of liver transplantation in disabled, highly dependent, and legally incapacitated adults are scarce, likely due to the infrequency of these procedures in such populations. Multicenter studies in adult transplant centers have shown that patients with coexisting intellectual and developmental disabilities (IDDs) may be denied transplantation because of their expected low longevity and the complexities associated with managing post-transplant care. We examined the long-term patient and graft outcomes in highly dependent, incapacitated patients with IDDs who underwent elective transplantation for chronic liver disease. Methods: Six adult patients who underwent liver transplantation for primary biliary cholangitis (n = 2), hepatitis C cirrhosis (n = 2), Wilson’s disease (n = 1), and autoimmune hepatitis (n = 1) were included. The main causes of their disability were infantile cerebral palsy, myotonia, and Niemann–Pick disease. Results: Four of the six patients were women, with a median age of 26 (range: 23–36) years. Only one patient died during follow-up. Their 1- and 5-year survival rates were 100 and 75%, respectively, which were not statistically different from those of the general cohort of electively transplanted patients (95.8 and 90.1%, respectively) (p = 0.35). Conclusions: Adult patients who are highly dependent, disabled, or legally incapable should not be denied liver transplantation because of poor long-term survival rates. Physiological disorders and psychiatric comorbidities should not prevent patients from receiving life-saving surgeries due to poor postoperative compliance or low quality of life. Full article

Triadica sebifera is an important landscaping tree species because of its colorful autumn leaves. In recent years, some cultivars have been bred and licensed, but it can be difficult to identify them from their morphological traits due to their similar phenotypes. To explore the genetic relationships and construct a fingerprint of the cultivars, the licensed T. sebifera cultivars were analyzed using SSR markers. A total of 179 alleles were identified among the 21 cultivars at 16 SSR loci, and these alleles exhibited a high level of genetic diversity (He = 0.86). The genetic variations mainly occurred among cultivars based on an analysis of molecular variance (AMOVA). According to phylogenetic analysis, principal coordinate analysis (PCoA), and Bayesian clustering analysis, the genetic relationships were independent of geographic distances, which may be mainly due to transplantations between regions. Some cultivars with different leaf colors showed obvious genetic differentiation and may be preliminary candidates for cross-breeding. Finally, the fingerprint for the licensed cultivars was constructed with two SSR markers. The results of this study can provide technical support for the application and legal protection of licensed Triadica sebifera cultivars. Full article

Forensic microbiology is a relatively new discipline, born in part thanks to the development of advanced methodologies for the detection, identification and characterization of microorganisms, and also in relation to the growing impact of infectious diseases of iatrogenic origin. Indeed, the increased application of medical practices, such as transplants, which require immunosuppressive treatments, and the growing demand for prosthetic installations, associated with an increasing threat of antimicrobial resistance, have led to a rise in the number of infections of iatrogenic origin, which entails important medico-legal issues. On the other hand, the possibility of detecting minimal amounts of microorganisms, even in the form of residual traces (e.g., their nucleic acids), and of obtaining gene and genomic sequences at contained costs, has made it possible to ask new questions of whether cases of death or illness might have a microbiological origin, with the possibility of also tracing the origin of the microorganisms involved and reconstructing the chain of contagion. In addition to the more obvious applications, such as those mentioned above related to the origin of iatrogenic infections, or to possible cases of infections not properly diagnosed and treated, a less obvious application of forensic microbiology concerns its use in cases of violence or violent death, where the characterization of the microorganisms can contribute to the reconstruction of the case. Finally, paleomicrobiology, e.g., the reconstruction and characterization of microorganisms in historical or even archaeological remnants, can be considered as a sister discipline of forensic microbiology. In this article, we will review these different aspects and applications of forensic microbiology. Full article

Third molar extraction is the most common procedure in oral and maxillofacial surgery. Third molars are considered less functional than other teeth and are often extracted. Sometimes, they are also used for auto-transplantation for the benefit of oral rehabilitation. Since many biological factors are involved in this surgical approach, herein, we outline a review of the biological characteristics of medico-legal/forensic interest, in addition to presenting a successful clinical case. A scoping review of currently available research data (following the principles of PRISMA-ScR or the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) on third molar auto-transplantation was conducted by drawing upon the main databases (Scopus, PubMed, Google Scholar and LILACS) to evaluate biological and clinical characteristics possibly relatable to forensic issues. All the collected data were summarized and elaborated on for the purpose of this article. A patient underwent extraction of the right upper first molar and auto-transplantation of the unerupted ipsilateral third molar. Many biologic and clinical factors are involved in the success of this clinical procedure. Knowledge of third molar anatomy, of its development and viable surgical approaches are all essential elements; just as important are the treatment of the tooth before and after transplantation and the integrity of the periodontal ligament. Follow-up of the clinical case for 5 years made it possible to verify the stability of the procedure over time. Third molar auto-transplantation is feasible and cost-effective. However, the use of third molars as donor teeth in auto-transplantation may have medico-legal implications. The lack of official protocols and consistent evidence-based guidelines for operators still prevent such a procedure from becoming mainstream; therefore, it is viewed with suspicion by clinicians and patients, even though the biological factors herein detected point to a reasonably high degree of safety. The understanding of many specific biological and clinical factors involved in the stability of third molar auto-transplantation allows for a thorough understanding of the forensic implications relevant to clinical practice. Effective communication and information provision are therefore of utmost importance, in the interest of both patients and doctors. Full article

In Poland, teleconsultations (TCs) were not legally regulated or even conducted until the COVID-19 pandemic, which necessitated their abrupt implementation and posed a challenge to patients and doctors. The aim of this study was to assess the quality of TCs and the satisfaction with this mode of consultation among nephrology and kidney transplant outpatients with a high risk of severe courses of SARS-CoV-2 infection. A self-designed questionnaire regarding patients’ demographics; digital fluency; and participation in, satisfaction with, and attitude towards TCs was distributed among patients in the nephrology and posttransplant outpatient clinics at two hospitals in central Poland. The questionnaires were completed by 294 adult patients, of whom 72.1% (n = 212) had participated in TCs at one of the abovementioned clinics. Almost all (96.7%) of the TCs were conducted via phone, and in 94.8% of cases, they fulfilled the purpose of the consultation. The most commonly reported advantages were not having to leave home and the reduced risk of infection. Only a few patients felt that TCs offer no advantages. The patients’ profiles and demographic data had no significant effect on their assessments of teleconsultations. Despite the overall positive rating given to TCs, patients unhesitatingly indicated that a face-to-face visit would be a preferable way to contact a specialist. Full article

Three-dimensional bioprinting is a rapidly evolving technology that holds the promise of addressing the increasing demand for organs, tissues, and personalized medicine. By employing computer-aided design and manufacturing processes, 3D bioprinting allows for the precise deposition of living cells, biomaterials, and biochemicals to create functional human tissues and organs. The potential applications of this technology are vast, including drug testing and development, disease modeling, regenerative medicine, and ultimately, organ transplantation. However, as with any groundbreaking technology, 3D bioprinting presents several ethical, legal, and regulatory concerns that warrant careful consideration. As the technology progresses towards clinical applications, it is essential to address these challenges and establish appropriate frameworks to guide the responsible development of 3D bioprinting. This article, utilizing the Arksey and O’Malley scoping review model, is designed to scrutinize the bioethical implications, legal and regulatory challenges, and medico-legal issues that are intertwined with this rapidly evolving technology. Full article

This case report describes a new approach to segmental meniscal reconstruction using a peroneal longus autograft in a patient with recurrent traumatic medial meniscus tear and anterior cruciate ligament reconstruction (ACLR) failure. While allograft meniscal transplantation is the preferred method for treating meniscal deficiency, its high cost and various legal regulations have limited its widespread use. Autologous tendon grafts have been proposed as a substitute for allograft meniscus transplantation, but their initial results were poor, leading to little progress in this area. However, recent animal experiments and clinical studies have demonstrated promising results in using autologous tendon grafts for meniscal transplantation, including improvements in pain and quality of life for patients. Further research is needed to evaluate the effectiveness of segmental meniscal reconstruction using autologous tendon grafts, but it could potentially lead to more accessible and cost-effective treatment options for patients with meniscal deficiency. Full article

Auto-brewery syndrome (ABS), also called gut fermentation syndrome, is an extremely infrequent but also underrecognized disorder where ethanol is produced endogenously, similar to a typical bioreactor. The reliability of forensic alcohol analysis results is frequently challenged as the ethanol concentration in the breath, blood, and/or urine constitutes important evidence for prosecuting drivers under the influence of the alcohol. This further emphasizes the need to understand ABS, as in legal proceedings it is often presented as grounds for acquittal due to the concept that the findings could have corresponded to endogenously produced ethanol. However, this rare and underdiagnosed medical condition should not be considered as purely a lawyer’s favorite argument. Manifestations of ABS can have a severe impact on a patient’s life and pose social consequences as well. Unfortunately, barely anything has been unearthed, and aspects such as genetic susceptibility, gut-mucus-eating microorganisms, and fecal microbiome transplantation were reviewed for the first time in this context. The framework of this review was not limited to the gut microbiota exclusively; moreover, the overgrowth of microorganisms is linked to the use of antibiotics. Studies have indicated that carbohydrate fermentation occurs in locations other than in intra-intestinal flora. Accordingly, the literature was searched for cases of patients with ABS with yeast infections in their genitourinary or oral systems. Full article