BACKGROUND: The primary limitation to kidney transplantation is organ shortage. Recent progress in gene editing and immunosuppressive regimens has made xenotransplantation with porcine organs a possibility. However, evidence in pig-to-human xenotransplantation remains scarce, and antibody-mediated rejection (AMR) is a major obstacle to clinical applications of xenotransplantation. METHODS: We conducted a kidney xenotransplantation in a brain-dead human recipient using a porcine kidney with five gene edits (5GE) on March 25, 2024 at Xijing Hospital, China. Clinical-grade immunosuppressive regimens were employed, and the observation period lasted 22 days. We collected and analyzed the xenograft function, ultrasound findings, sequential protocol biopsies, and immune surveillance of the recipient during the observation. RESULTS: The combination of 5GE in the porcine kidney and clinical-grade immunosuppressive regimens prevented hyperacute rejection. The xenograft kidney underwent delayed graft function in the first week, but urine output increased later and the single xenograft kidney maintained electrolyte and pH homeostasis from postoperative day (POD) 12 to 19. We observed AMR at 24 h post-transplantation, due to the presence of pre-existing anti-porcine antibodies and cytotoxicity before transplantation; this AMR persisted throughout the observation period. Plasma exchange and intravenous immunoglobulin treatment mitigated the AMR. We observed activation of latent porcine cytomegalovirus toward the end of the study, which might have contributed to coagulation disorder in the recipient. CONCLUSIONS 5GE and clinical-grade immunosuppressive regimens were sufficient to prevent hyperacute rejection during pig-to-human kidney xenotransplantation. Pre-existing anti-porcine antibodies predisposed the xenograft to AMR. Plasma exchange and intravenous immunoglobulin were safe and effective in the treatment of AMR after kidney xenotransplantation.
Transplantation, Heterologous/methods* ; Kidney Transplantation/methods* ; Heterografts/pathology* ; Immunoglobulins, Intravenous/administration & dosage* ; Graft Survival/immunology* ; Humans ; Animals ; Sus scrofa ; Graft Rejection/prevention & control* ; Kidney/pathology* ; Gene Editing ; Species Specificity ; Immunosuppression Therapy/methods* ; Plasma Exchange ; Brain Death ; Biopsy ; Male ; Aged

Objective:To construct a dispatching system based on ultra wide band(UWB)positioning technique,so as to enhance dynamic management capabilities for equipment and clinical response efficiency.Methods:The dispatching system based on UWB positioning technique for emergency equipment included internet of things(IoTs)perception layer of network,network layer,data service layer,and business application layer of intelligently medical equipment,which integrated the positioning technique with UWB centimeter level and the deep Q-network(DQN)algorithm,and it can realize real-time localization and intelligent dispatching decisions for equipment.The used thirty-five emergency equipment in the intensive care unit(ICU)ward of Eastern Branch of Ningbo Medical Center Li Huili Hospital from January 2023 to December 2024 were selected.Based on different management modes,25 equipment using conventional manual dispatching during January and June 2023 were divided into control group,while 25 equipment using the UWB dispatching technique-based dispatching system during July and December 2023(included 15 equipment of the original control group and 10 new equipment at later stage)were used as observation group.The dispatching efficiency,utilization rate,positioning precision,and maintenance efficiency of equipment between two groups were compared.Results:The dispatching time for equipment in the observation group was(7.2±0.8)min,which significantly shorter than(12.2±1.5)min in the control group,and the difference was significant(t=18.34,P<0.05).The distance of movement,and response time for fault in the observation group were significantly lower than those in the control group,and the utilization rate of equipment was significantly higher than that in the control group,and the differences were significant(t=15.67,14.28,6.92,P<0.05).The repair rate for fault in the observation group was significantly higher than that in the control group,and the difference was significant(x2=7.80,P<0.05).The positioning error of the system is(35±10)cm.Conclusion:The UWB-based dispatching system can significantly optimize the dispatching process for resource of emergency equipment,which can improve utilization and management efficiency for equipment.It can provide reliably technical support for rapid response in clinical emergency.

Lung cancer is one of the malignant tumours with the highest morbidity and mortality rates worldwide today, posing a major threat to human health. Accurate diagnosis and standardised treatment play a crucial role in improving the survival rate of lung cancer patients. In recent years, the rapid rise of artificial intelligence (AI) has brought about significant changes in the medical field, providing a new diagnostic and treatment model for lung cancer, and making a series of breakthroughs in lung cancer diagnostic imaging, pathological diagnosis, surgical oncology, radiotherapy, and drug development and treatment. This article introduces the current status of AI application in the field of lung cancer diagnosis and treatment, and extensively discusses the current challenges and future prospects, hoping to provide references and suggestions for future clinical practice.

[Objective] To explore the clinical features of IgG4-related urinary diseases so as to provide reference for the diagnosis and treatment of such diseases. [Methods] The clinical data of 4 cases of IgG4-related urinary system diseases diagnosed and treated in Xijing Hospital of Air Force Medical University during Aug.2019 and Dec.2023 were retrospectively collected.Here, we report on the diagnosis and treatment of these patients, analysing their symptoms, serology, imaging and pathology as well as their treatment and outcomes. [Results] The patients included 2 male and 2 female.The lesions were involved with the retroperitoneum and urinary system.Three patients had symptoms of lumbar pain.The imaging manifestations were complex, including retroperitoneal mass involving urinary system organs in 2 cases, tabdense shadow of the right kidney in 1 case, and simple cystic mass of kidney in 1 case.Serum IgG4 value was not detected before surgery.All patients underwent radical surgical treatment.Postoperative pathology showed fibrous tissue hyperplasia with a large number of plasma cells, lymphocytes, a few neutrophil infiltrates, and lymphoid follicles and obliterated vasculitis in some specimens.The number of IgG4⁺ plasma cells was more than 10 in all tissues under high power microscope.After surgery, 3 patients had symptoms improved, and serum IgG4 value was within the normal range; 1 patient (patem 3) had elevated IgG4 value during follow-up, received subsequent hormone therapy, and the serum IgG 4 level remained stable. [Conclusion] The symptoms of IgG4-related diseases involving the urinary system are non-specific, and the imaging findings are various, easily confused with other diseases.Early detection of serum IgG4 and biopsy pathology can help clinicians make correct diagnosis in the early stage.

Lung cancer is one of the malignant tumours with the highest morbidity and mortality rates worldwide today, posing a major threat to human health. Accurate diagnosis and standardised treatment play a crucial role in improving the survival rate of lung cancer patients. In recent years, the rapid rise of artificial intelligence (AI) has brought about significant changes in the medical field, providing a new diagnostic and treatment model for lung cancer, and making a series of breakthroughs in lung cancer diagnostic imaging, pathological diagnosis, surgical oncology, radiotherapy, and drug development and treatment. This article introduces the current status of AI application in the field of lung cancer diagnosis and treatment, and extensively discusses the current challenges and future prospects, hoping to provide references and suggestions for future clinical practice.

Objective To observe the value of dynamic attention aggregation network(DAANet)for automatic segmentation of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA)in CT angiography(CTA).Methods CTA data in 30 patients with ALCAPA syndrome were retrospectively enrolled.ALCAPA were segmented in CTA with DAANet based on residual edge feature(REF),pyramid dynamic attention(PDA)and dynamic global feature aggregation(DGFA)modules.Taken physician manual segmentation results as references,the results were compared with those of other networks.Results Compared with other networks,DAANet had better value for automatic segmentation of ALCAPA in CTA,which could show the details of irregular margins of left coronary artery with good continuity and high clarity,and the performance parameters were overall better.Conclusion DAANet had better performance for automatic segmentation of ALCAPA in CTA.

Objective To observe the value of dynamic attention aggregation network(DAANet)for automatic segmentation of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA)in CT angiography(CTA).Methods CTA data in 30 patients with ALCAPA syndrome were retrospectively enrolled.ALCAPA were segmented in CTA with DAANet based on residual edge feature(REF),pyramid dynamic attention(PDA)and dynamic global feature aggregation(DGFA)modules.Taken physician manual segmentation results as references,the results were compared with those of other networks.Results Compared with other networks,DAANet had better value for automatic segmentation of ALCAPA in CTA,which could show the details of irregular margins of left coronary artery with good continuity and high clarity,and the performance parameters were overall better.Conclusion DAANet had better performance for automatic segmentation of ALCAPA in CTA.

Objective:To construct a dispatching system based on ultra wide band(UWB)positioning technique,so as to enhance dynamic management capabilities for equipment and clinical response efficiency.Methods:The dispatching system based on UWB positioning technique for emergency equipment included internet of things(IoTs)perception layer of network,network layer,data service layer,and business application layer of intelligently medical equipment,which integrated the positioning technique with UWB centimeter level and the deep Q-network(DQN)algorithm,and it can realize real-time localization and intelligent dispatching decisions for equipment.The used thirty-five emergency equipment in the intensive care unit(ICU)ward of Eastern Branch of Ningbo Medical Center Li Huili Hospital from January 2023 to December 2024 were selected.Based on different management modes,25 equipment using conventional manual dispatching during January and June 2023 were divided into control group,while 25 equipment using the UWB dispatching technique-based dispatching system during July and December 2023(included 15 equipment of the original control group and 10 new equipment at later stage)were used as observation group.The dispatching efficiency,utilization rate,positioning precision,and maintenance efficiency of equipment between two groups were compared.Results:The dispatching time for equipment in the observation group was(7.2±0.8)min,which significantly shorter than(12.2±1.5)min in the control group,and the difference was significant(t=18.34,P<0.05).The distance of movement,and response time for fault in the observation group were significantly lower than those in the control group,and the utilization rate of equipment was significantly higher than that in the control group,and the differences were significant(t=15.67,14.28,6.92,P<0.05).The repair rate for fault in the observation group was significantly higher than that in the control group,and the difference was significant(x2=7.80,P<0.05).The positioning error of the system is(35±10)cm.Conclusion:The UWB-based dispatching system can significantly optimize the dispatching process for resource of emergency equipment,which can improve utilization and management efficiency for equipment.It can provide reliably technical support for rapid response in clinical emergency.

Objective:To investigate the alterations of resting-state functional connectivity (RSFC) in ventral tegmental area (VTA) and substantia nigra (SN) among male smokers, and its correlation with clinical characteristics of smoking.Methods:The resting-state functional magnetic resonance data of 131 subjects recruited from January 2014 to December 2018 were analyzed retrospectively, including 76 smokers (smoking group) and 55 non-smokers (control group). VTA/SN was selected as regions of interest (ROI), and then calculated RSFC between VTA/SN and the whole brain.Based on SPM12 software, independent sample t-test was conducted to compare the differences in RSFC between smoking group and control group.Based on SPSS 22.0 software, Pearson correlation analysis was used to investigate the relationships between the RSFC of brain regions with significant differences and Fagerstr?m test for nicotine dependence (FTND) score, pack-year of smokers. Results:Compared with control group, the results showed decreased RSFC between VTA and the brain regions related default mode network (DMN)(including posterior cingulate cortex, right anterior cuneiform lobe, bilateral superior temporal gyrus, right middle temporal gyrus and right inferior parietal lobule), and regions of limbic system(including right marginal lobe and right angular gyrus), right calcarine (MNI: x, y, z=24, -55, -14) and left insula(MNI: x, y, z=-35, -11, 9) in smoking group(GRF corrected, voxel level P<0.005, cluster level P<0.05). Taking SN as the seed, there was no significant difference between smoking group and control group ( P>0.05). RSFC of VTA-left superior temporal gyrus was positively correlated with pack-year( r=0.243, P=0.034) and FTND ( r=0.282, P=0.014). VTA-left insula RSFC was positively correlated with FTND ( r=0.316, P=0.006). Conclusion:The RSFC in the mesolimbic system and the VTA-DMN circuit exist abnormal changes in smokers.To some extent, it may explain the reward deficits and dysfunction of emotion regulation in smokers, which may provide clues for further understanding the mechanism of tobacco addiction.

Objective:To explore the practical value of general anesthesia with non-intubated spontaneous breathing in uniportal thoracoscopic surgery in elderly patients.Methods:Clinical data of 86 elderly patients undergone uniportal thoracoscopy surgery during hospitalization at our hospital between March 2020 and December 2021 were retrospectively reviewed and analyzed.Based on the anesthesia intubation method, they were divided into a non-intubated spontaneous breathing video-assisted thoracic surgery group(NI-VATS group)and a one-lung ventilation video-assisted thoracic surgery group(OLV-VATS group), with 43 cases in each group.Data were compared on the inflammatory indexes, preparation time for anesthesia, time to awakening after anesthesia, intraoperative lung collapse score, mediastinal flutter score, time to postoperative feeding, digestive tract complications, sore throat, postoperative pulmonary atelectasis, and hospitalization time.Results:Compared with the OLV-VATS group, the NI-VATS group had a shorter anesthesia preparation time [(19.8±2.6)min vs.(32.3±4.5)min, t=-15.77, P<0.001]and a shorter time to awakening [(6.8±2.1)min vs.(11.9±2.9)min, t=-9.485, P<0.001], slightly poorer operating field during surgery, an unfavorable lung collapse score [(2.5±0.7) vs.(1.8±0.7) t=4.704, P<0.001], worse mediastinal flutter [(2.1±0.6) vs.(1.3±0.5), t=6.514, P<0.001]. Lower procalcitonin(PCT)[(0.189±0.130)μg/L vs.(0.264±0.123)μg/L, t=-2.744, P=0.007), a shorter time to postoperative feeding [(3.4±1.0)h vs.(5.5±1.0)h, t=-9.55, P<0.001], and lower rates of digestive tract reactions(4.7% vs.20.9%, χ2=5.108, P=0.024)and throat pain(4.7% vs.23.3%, χ2=6.198, P=0.013), and a shorter length of hospital stay [(3.8±0.3)d vs.(4.9±0.8)d, t=-7.266, P<0.001]. Conclusions:For the elderly patients undergoing uniportal thoracoscopic surgery, non-intubated spontaneous breathing may somewhat obstruct the operating field, but it can shorten the time of anesthesia and the time to awakening, does not increase complications from anesthesia and surgery, favors rapid postoperative recovery for patients and therefore should be promoted.