Search Results (428)

Lung transplantation remains the standard of care for end-stage lung disease, yet a persistent gap exists between donor lung availability and growing clinical demand. Expanding the donor pool and optimising donor lung management are therefore critical priorities. However, no universally accepted management protocols are currently in place. This narrative review examines evidence-based strategies to improve lung utilisation across three donor categories: donors after brain death (DBD), controlled donors after circulatory death (cDCD), and uncontrolled donors after circulatory death (uDCD). A systematic literature search was conducted to identify interventions targeting lung preservation and function, including protective ventilation, recruitment manoeuvres, fluid and hormonal management, and ex vivo lung perfusion (EVLP). Distinct pathophysiological mechanisms—sympathetic storm and systemic inflammation in DBD, ischaemia–reperfusion injury in cDCD, and prolonged warm ischaemia in uDCD—necessitate tailored approaches to lung preservation. In DBD donors, early application of protective ventilation, bronchoscopy, and infection surveillance is essential. cDCD donors benefit from optimised pre- and post-withdrawal management to mitigate lung injury. uDCD donor lungs, uniquely vulnerable to ischaemia, require meticulous post-mortem evaluation and preservation using EVLP. Implementing structured, evidence-based lung management strategies can significantly enhance donor lung utilisation and expand the transplantable organ pool. The integration of such practices into clinical protocols is vital to addressing the global shortage of suitable lungs for transplantation. Full article

The objective of this study was to evaluate the physiological, biochemical, and productive effects of the foliar application of bioregulators, based on auxin, cytokinin, and gibberellic acid, on yellow melon, cultivar DALI^®, plants subjected to different salinity levels in a protected environment to simulate Brazil’s semi-arid conditions. The experiment was conducted using a completely randomized block design, in a 4 × 3 factorial scheme, with four salinity levels (0, 2, 4, and 6 dS m⁻¹) and three doses of the bioregulator, Stimulate^® (0%, 100%, and 150% of the recommended dose), with six weekly applications. The physiological variables (chlorophyll a fluorescence and gas exchange) and biochemical parameters (antioxidant enzyme activity and lipid peroxidation) were evaluated at 28 and 42 days after transplanting, and the agronomic traits (fresh fruit mass, physical attributes, and post-harvest quality) were evaluated at the end of the experiment. The results indicated that salinity impaired the physiological and productive performance of the plants, especially at higher levels (4 and 6 dS m⁻¹), causing oxidative stress, reduced photosynthesis, and decreased yield. However, the application of the bioregulator at the 100% dose mitigated the effects of salt stress under moderate salinity (2 dS m⁻¹), promoting higher CO₂ assimilation rates of up to 31.5%, better water-use efficiency, and reduced lipid peroxidation. In addition, the fruits showed a greater mass of up to 66%, thicker pulp, and higher soluble solids (> 10 °Brix) content, making them suitable for sale in the market. The 150% dose did not provide additional benefits and, in some cases, resulted in inhibitory effects. It is concluded that the application of Stimulate^® at the recommended dose is effective in mitigating the effects of moderate salinity, up to ~3 dS m⁻¹, in yellow melon crops; however, its effectiveness is limited under high salinity conditions, requiring the use of complementary strategies. Full article

Health professionals and institutions, as users and influencers, use social networks to disseminate information and knowledge about health issues, in the case of organ donation and transplantation (ODT) to spread the social benefits of the process and increase the positive attitude towards ODT. The aim of this work was to analyse the perception and use of social networks by university students of health sciences to determine whether, in their opinion, social platforms are suitable for the promotion of ODT after participating in an educational programme specialising in ODT and communication. The students indicated that social networks are a good medium for disseminating messages about ODT, with WhatsApp standing out as the most appropriate after the programme. Eighty-six per cent say that social media can positively influence the attitude towards ODT and 65% have started to follow ODT institutional accounts on social media. Addressing communication in specialisation programmes in the field of health and ODT raises awareness of the responsible use of social media among university health students and strengthens their capacity as prescribers of the social benefits of ODT. Full article

The need for organs suitable for transplantation has continued to rise as need outweighs availability. Increased demand has driven innovation in the field. Over the past ten years, donation after circulatory death (DCD) donors have become a greater portion of the donor pool. This method of donation includes a period of warm ischemia time to the organs. Thus, its use is dependent on recovery methods. Historically, extracorporeal membrane oxygenation (ECMO) was one of the first pumping technologies to enhance organ preservation in the potential donor. Subsequently, the adoption of normothermic regional perfusion (NRP) technology has also shown promise in organ transplantation. These technologies have increased utilization of organs and enhanced the pool of donor organs. This review seeks to summarize the literature supporting in situ technologies (ECMO and NRP) utilized in procurement of solid organs from DCD donors. The benefit of in situ perfusion in DCD organ recovery is that these technologies increase the number of organs available for transplantation by reducing ischemic injury. The disadvantages include the added technical aspect, added operating room time, and the increased ethical concerns surrounding these technologies compared to conventional methods of organ recovery. Full article

Background: To overcome the limitations of conventional CRC (colorectal cancer) mouse models in replicating metastasis and enabling efficient therapeutic evaluation, we developed a novel implantation method using tissue adhesive to establish reproducible orthotopic and metastatic tumors. Conventional models using injection or suturing techniques often suffer from technical complexity, inconsistent tumor establishment, and limited metastatic reliability. Methods: We developed and validated a novel orthotopic and metastatic CRC model utilizing tissue adhesive for tumor transplantation. Uniform tumor fragments derived from bioluminescent HCT116/Luc xenografts were affixed to the cecum of nude mice. Tumor growth and metastasis were monitored through bioluminescence imaging and confirmed by the results of histological analysis of metastatic lesions. The model’s utility for therapeutic testing was evaluated using MK801, an NMDA receptor antagonist. Results: The biological-based model demonstrated rapid and reproducible tumor implantation (<5 min), consistent primary tumor growth, and robust metastasis to the liver and lungs. The biological-based approach achieved 80% tumor engraftment (4/5), with consistent metastasis to the liver and lungs in all mice, compared with lower and variable metastasis rates in injection (0%, 0/5) and suturing (20%, 1/5) methods. MK801 treatment significantly suppressed both primary tumor growth and metastasis, validating the model’s suitability for preclinical drug evaluation. Conclusions: By enabling rapid, reproducible, and spontaneous formation of metastatic lesions using a minimally invasive tissue adhesive technique, our model represents a significant methodological advancement that supports high-throughput therapeutic screening and bridges the gap between experimental modeling and clinical relevance in colorectal cancer research. Full article

Background: Colorectal liver metastases (CRLM) occur in up to 50% of colorectal cancer with a significant impact on patient survival, of whom only 20–30% will be considered suitable for surgical treatment. Despite the progress in systemic therapies, palliative chemotherapy alone results in a 5-year overall survival (OS) < 10%. Recently, liver transplantation (LT) has been reconsidered as an option and demonstrates improved survival in highly selected patients. This study assessed the impact of implementing a standardised patient selection protocol (LITORALE) on post-transplant outcomes for unresectable CRLM (uCRLM) at a high-volume single centre. Methods: This is a prospective observational study including all consecutive patients transplanted for uCRLM at our institution between July 2015 and September 2024. This prospective observational study evaluated the impact of the LITORALE protocol on post-transplant outcomes in uCRLM patients at a single centre. Patients who underwent LT between July 2015 and September 2024 were grouped into pre-LITORALE (2015–2021) and LITORALE (post-2021) cohorts. Recipient profiles, transplant variables, and post-transplant outcomes were compared. Results: Twenty-one patients were included (eight pre-LITORALE, thirteen LITORALE). The LITORALE group had a lower median number of lesions (4 vs. 17.5, p = 0.004), a smaller major lesion size (3 cm vs. 5.5 cm, p = 0.082), and a significantly lower tumour burden score (6.32 vs. 18.02, p = 0.002). Similar to recent major clinical trials, one- and three-years OS were 100% and 83%, respectively, after protocol introduction; recurrence patterns were significantly different, with reduced multi-site recurrences (7.7% vs. 50%, p = 0.048) and a higher incidence of lung-only recurrences in the LITORALE group (50% vs. 0%, p = 0.033). Conclusions: The introduction of the LITORALE protocol significantly influenced patient selection and recurrence patterns in LT for uCRLM. Although the limited number of patients and the short study timespan highlight the need for future validation, these preliminary results support the adoption of structured, multidisciplinary criteria to optimise oncologic outcomes. Full article

Invasive alien species are one of the main threats to global biodiversity, and pose significant management challenges in several areas outside their natural range. In southern Mediterranean Europe, the invasion of Acacia species is particularly severe and its control requires costly and often ineffective actions. The use of vermicompost derived from these species to replace peat-based substrates in horticulture offers a promising alternative to mitigate their economic and environmental impacts while enhancing the sustainability of their control. This study explored the potential of vermicompost produced from the fresh aboveground waste biomass (leaves + stems + flowers) of Acacia dealbata and Acacia melanoxylon (75:25 w/w), two of the most aggressive Acacia species in the Mediterranean, using Eisenia fetida over twelve weeks. In essence, this study aimed to evaluate the quality of the produced vermicompost and its suitability as a partial substitute for potting substrate in the production of cucumber (Cucumis sativus) seedlings for transplant. Four substrate mixtures containing 0%, 10%, 30%, and 50% of Acacia vermicompost (w/w), combined with commercial peat-based potting substrate and perlite (20%) were tested in polystyrene seedling trays. Seedling emergence, growth, and leaf biochemical parameters (photosynthetic pigments, phenolics, soluble sugars and starch, and total thiobarbituric acid-reactive substances—TBARSs) were evaluated. The results showed that the addition of Acacia vermicompost to the commercial substrate did not affect its germination but significantly enhanced seedling growth, particularly in mixtures containing 30% and 50% Acacia vermicompost. In addition, the absence of accumulation of TBARSs also reflected the superiority of these two treatments. These findings suggest that vermicompost derived from A. dealbata and A. melanoxylon biomass can be a viable peat-based substrate alternative for horticultural production, with the dual benefit of promoting sustainable agricultural practices and contributing to invasive species management. Full article

Background/Objectives: Renal transplantation (RT) remains the gold standard for end-stage renal disease, offering superior outcomes versus dialysis. Despite advances, ureteric complications (leaks/strictures) persist, primarily from ischemic injury, posing substantial graft risks. We review etiology, incidence, and management strategies for post-RT ureteric complications, focusing on surgical reconstruction techniques. Methods: Literature assessment examined ischemic-related ureteric complications. Primary outcomes: incidence, success, complication rates, operative times, and long-term patency. Secondary outcomes: graft/patient survival and reoperation rates. Techniques evaluated included extravesical Lich–Gregoir (L-G) and transvesical Leadbetter–Politano (L-P) ureteroneocystostomy (UNC), Boari flap with psoas hitch, pyelo/ureteroureterostomy, pyelovesicostomy, and ureteroenterostomy. Surgical indications, procedural details, advantages, disadvantages, and quantitative outcomes were systematically analyzed. Results: Ureteric complication incidence ranged from 1 to 15%, with ischemic injury as the primary cause. L-G UNC demonstrated lower complication rates than L-P (6.15% vs. 8.33%) with reduced operative times. Pyelo/ureteroureterostomy achieved excellent salvage outcomes (>90% success, 3.9% reintervention rate). Boari flap provides a suitable option for extensive ureteric defects, consistently preserving graft function without stricture recurrences. Pyelovesicostomy showed 80% long-term success in complex cases. Ureteroenterostomy achieved comparable 5-year graft survival (63%) to standard drainage, despite higher infection rates (65%). Pyelovesicostomy and ureteroenterostomy remain important solutions for specific challenging scenarios. Conclusions: Urinary reconstruction technique selection should be individualized based on anatomical considerations, pathology, and surgical expertise. Comprehensive understanding of reconstruction techniques enables effective management of ureteric complications, preserving graft function and improving outcomes. Full article

Critical-sized bone defects or CSDs result from bone loss due to trauma, tumor removal, congenital defects, or degenerative diseases. Though autologous bone transplantation is the current gold standard in treating CSDs, its limitations include donor-site morbidity, unavailability of donor bone tissues, risk of infection, and mismatch between the bone geometry and the defect site. Customized scaffolds fabricated using 3D printing and biocompatible materials can provide mechanical integrity and facilitate osseointegration. Ti-6Al-4V (Ti64) is one of the most widely used commercial alloys in orthopedics. To avoid elastic modulus mismatch between bones and Ti64, it is imperative to use porous lattice structures. Ti64 scaffolds with diamond, cubic, and triply periodic minimal surface (TPMS) gyroid lattice architectures were fabricated using selective laser melting (SLM)with pore sizes ranging from 300 to 900 μm using selective laser melting and evaluated for mechanical and biological performance. Increasing pore size led to higher porosity (up to 90.54%) and reduced mechanical properties. Young’s modulus ranged from 13.18 GPa to 1.01 GPa, while yield stress decreased from 478.16 MPa to 14.86 MPa. Diamond and cubic scaffolds with 300–600 μm pores exhibited stiffness within the cortical bone range, while the 900 μm diamond scaffold approached trabecular stiffness. Gyroid scaffolds (600–900 μm) also showed modulus and yield strength within the cortical bone range but were not suitable for trabecular applications due to their higher stiffness. Cytocompatibility was confirmed through leachate analysis and DAPI-stained osteoblast nuclei. The biological evaluation reported maximum cell adherence in lower pore sizes, with gyroid scaffolds showing a statistically significant (p < 0.01) increase in cell proliferation. These findings suggest that 300–600 μm lattice scaffolds offer an optimal balance between mechanical integrity and biological response for load-bearing bone repair. Full article

Background/Objectives: Liver transplantation is a life-saving procedure for patients with end-stage liver disease. In recent years, the demand for liver transplantation has surpassed the supply of available donor organs. Utilizing extended-criteria donors (ECDs) alleviates the scarcity of suitable donor livers for transplantation. One of the ECD was donors with a history of alcohol abuse. Liver grafts from donors with a history of chronic and active alcohol abuse are typically promptly excluded, diminishing the available organ pool. This highlights the need to re-evaluate the donor exclusion criteria and expand the organ pool to address the ongoing shortage. Methods: We examined adult (>18 years) liver transplant recipients who received deceased donor livers and had a documented history of alcohol abuse between 2011 and 2024. Liver transplant indications were conventional and included hepatitis C virus (HCV), non-alcoholic steatohepatitis, alcoholic liver disease, alcoholic liver disease coexisting with HCV, cryptogenic cirrhosis, chronic cholestatic liver disease, primary biliary cholangitis, primary sclerosing cholangitis, metabolic liver disease, hepatocellular carcinoma, and alcoholic hepatitis. We compared the 1-year, 5-year, and 9-year survival rates with those of liver recipients from non-alcohol-consuming donors. Results: In total, 370 liver recipients from deceased donors with a documented history of alcohol abuse were included. At 1 year post-transplant, survival was comparable between the two groups. Conclusions: Liver transplantation from deceased donors with a history of alcohol abuse yielded survival rates and liver function outcomes comparable to those from non-alcohol-using donors. By expanding the criteria to include carefully screened alcohol-using donors, transplant programs can improve access to life-saving transplantations. Full article

Background: With the COVID-19 pandemic, a rapid adoption of telemedicine became necessary. Data regarding its implementation in specialized hepatology/IBD care remain limited. This study evaluated telemedicine’s effectiveness and safety during the pandemic at a German tertiary center and explored its integration into future hybrid care models. Methods: In a retrospective study, we analyzed 3147 patient encounters at the outpatient clinic of the Department for Gastroenterology and Hepatology at the University Hospital Frankfurt between March and June 2020. We assessed patient characteristics, appointment adherence, and outcomes across the three specialized clinics: hepatology (n = 1963), liver transplant (n = 594), and IBD (n = 590). Multivariate regression analysis identified predictors of successful telemedicine utilization. Results: Out of all appointments, 1112 (35.3%) were conducted via telemedicine, with significantly different adoption rates across clinics (hepatology, 40.4%; liver transplant, 32.8%; IBD, 21.0%, p < 0.01). Adherence rates were comparable between telemedicine (91.3%) and in-person visits (90.5%). Multivariate analysis identified age (OR 1.009, 95%CI 1.004–1.014, p < 0.001), metabolic-associated steatotic liver disease (OR 1.737, 95%CI 1.400–2.155, p < 0.001), and post-liver transplant status (OR 1.281, 95%CI 1.001–1.641, p = 0.049) as independent predictors of successful telemedicine utilization. HBV/HDV coinfection (OR 0.370, 95%CI 0.192–0.711, p = 0.003) and required endoscopy (OR 0.464, 95%CI 0.342–0.630, p < 0.001) were associated with in-person care. Hospitalization rates were low and comparable across modalities, confirming telemedicine’s safety. Conclusions: This study demonstrates that telemedicine can be successfully implemented in specialized gastroenterology and hepatology care, with high compliance rates comparable to in-person visits. Patient characteristics and disease-specific factors influence the suitability for telemedicine, supporting a stratified approach to hybrid care models, which can optimize resource utilization while maintaining quality of care. Particularly stable MASLD patients, well-controlled post-transplant recipients beyond one year, and IBD patients in sustained remission can be properly managed through telemedicine with annual in-person assessments. Full article

Chronic liver disease (CLD) in children poses significant challenges, necessitating timely management to mitigate morbidity and mortality. Liver transplantation (LT) has emerged as a transformative intervention, offering improved long-term survival for paediatric patients with CLD. This review explores the evolving landscape of liver transplantation, focusing on indications and timing considerations. The aetiology of CLD is diverse, encompassing intrahepatic, extrahepatic cholestatic conditions, metabolic diseases, malignancy, and drug-induced liver injury. LT is indicated when children exhibit signs of hepatic decompensation, necessitating a comprehensive evaluation to assess transplant suitability. Indications for LT include biliary atresia, inborn errors of metabolism, hepatocellular carcinoma, and emerging indications such as mitochondrial hepatopathies and acute on chronic liver failure. The timing of transplantation is critical, emphasizing the need for early recognition of decompensation signs to optimise outcomes. Advancements in LT techniques and immunosuppressive therapies have enhanced patient and graft survival rates. Various transplant modalities, including reduced-size LT and living-related LT, offer tailored solutions to address the unique needs of paediatric patients. While LT represents a cornerstone in the management of paediatric CLD, careful patient selection, multidisciplinary collaboration, and ongoing refinements in transplant protocols are imperative for optimizing outcomes and addressing the evolving landscape of paediatric liver disease management. Full article

Background: The suitability of the Kidney Donor Risk Index (KDRI) has not been fully validated in the European population. The aim of this study was to evaluate the value of the KDRI in predicting kidney graft function and cardiovascular events (CVEs) in a Polish cohort of kidney transplant recipients (KTRs). Methods: In this retrospective study kidney graft function and CVEs were analyzed among 1420 patients transplanted between 1999 and 2017 and followed until 2021. The KDRI was calculated according to the formula proposed by Rao. Patients were assigned into quartiles (Qs) of KDRI values. Results: Patients in Q4 were older, with higher BMI, longer cold ischemia time (CIT), and a greater rate of ischemic heart disease at the transplantation. The KDRI value determined both early and long-term graft function. During a median follow-up period of 91 months, at least one cardiovascular event was noted in 227 (16.0%) kidney transplant recipients. There was a significant increasing trend for the occurrence of post-transplant CV complications along the consecutive KDRI quartiles (χ² = 7.3; p < 0.01) among kidney transplant patients younger than 50 years at the time of transplantation. Conclusions: The KDRI is an adequate prognostic tool also for the European population. Despite the KDRI not being used for allocation in Poland we found that kidneys with a higher KDRI are allocated to recipients with worse survival prognosis. The quality of kidneys from a deceased donor may be related to the occurrence of post-transplant cardiovascular complications in recipients younger than 50 years at the transplantation, including those without history of comorbidities such as diabetes or cardiovascular disease. Full article

Transplant oncology integrates a wide variety of fields, such as surgery, oncology, and transplant medicine, intending to increase the range of studies and treatments for hepatobiliary cancers and other liver-related malignant lesions. Liver transplantation (LT) has proven to be an effective treatment for hepatocellular carcinoma. While the Milan criteria are still the gold standard, several new, more inclusive criteria have been proposed, and hepatocellular carcinoma has become a major indication for liver transplantation. The continuous evolution of diagnostic technologies supported this with higher image quality and more accurate staging. This review describes the current applications of transplant oncology in hepatocellular carcinoma, cholangiocarcinoma, neuroendocrine tumors, and liver metastatic disease from colorectal cancer and discusses the path that led to the development of transplant oncology as an organized approach to managing gastrointestinal malignancies through transplantation. More importantly, the significance of a multidisciplinary approach and criteria in the selection of suitable candidates are discussed. In addition, newer aspects of transplant oncology, such as immunotherapy, circulating tumor DNA (ctDNA), novel surgical techniques, and the utilization of artificial intelligence, are presented. Finally, the opportunities and challenges involved in the field’s future, as well as the evolution of the criteria used over the years and insightful thoughts for the future of the criteria, are discussed. Full article

Agrivoltaics have emerged as a promising solution to mitigate climate change effects as well as competition for land use between food and energy production. While previous studies have demonstrated the potential of agrivoltaic systems to enhance land productivity, limited research has focused on their impact on specific crops, particularly in organic processing tomatoes. In the present study, a two-year experiment was conducted in northwest Italy to assess the suitability of the agrivoltaic system on processing tomato yield and quality in the organic farming system. In the first growing season, the transplanting of tomato was carried out under the following light conditions: internal control (A1)—inside the tracker rows obtained by removing PV panels; extended agrivoltaic panels—shaded condition with an increased ground coverage ratio (GCR) of 41% (A2); and external control (FL)—full-light conditions outside the tracker rows. The second year of experimentation involved the transplanting of tomato under the following light conditions: internal control (B1); dynamic shading conditions that consist of solar panels in a vertical position until full fruit set (B2); standard agrivoltaic trackers (GCR = 13%, shaded conditions) (B3); and external control (FL). In 2023, the results showed that A2 achieved a total yield of only 24.5% lower than FL, with a marketable yield reduction of just 6.5%, indicating its potential to maintain productivity under shaded conditions. In 2024, B2 management increased marketable yield by 80.6% compared to FL, although it also led to a 46.2% increase in fruit affected by blossom end rot. Moreover, B2 improved nitrogen agronomic efficiency and fruit water productivity by 6.4% while also reducing the incidence of rotten fruit. Our findings highlight that moderate coverage (A2 and B2) can sustain high marketable yields and improve nitrogen use efficiency in different growing seasons. Full article