Xenogeneic kidney transplantation is an important approach to alleviate the shortage of donor kidneys, but acute rejection remains the main obstacle in its clinical application. Xenogeneic acute rejection shows a clear temporal sequence: in the early stage, it is mainly mediated by antibodies and occurs through humoral rejection, with pre-existing antibodies targeting α-Gal and non-Gal antigens, activating complement and inducing thrombotic microangiopathy; in the later stage, it gradually transforms into a cellular rejection driven by infiltration of T cells and macrophages. In terms of diagnosis, donor-derived cell-free DNA can serve as an early non-invasive warning indicator, and histopathological biopsy remains the gold standard. In 2024, the Banff Working Group on Transplant Pathology of xenogeneic kidney transplantation released the first consensus on the pathological assessment of pig-human kidney/heart xenogeneic transplantation. However, this is currently only a reporting framework, and an independent grading system still awaits more clinical data. The treatment mainly focuses on multi-gene-modified donors combined with intensified immunosuppression, but it still faces challenges such as immature immunization regimens, the absence of monitoring systems and prominent infection risks. This article reviews the mechanisms, diagnostic monitoring, treatment strategies and clinical dilemmas of acute rejection, providing a reference for subsequent research.

Objective:To analyze the research trends and hotspots of bupivacaine liposomes from 1994 to 2023 using bibliometrics.Methods:A comprehensive search was conducted for the literature related to bupivacaine liposomes in the Web of Science Core Collection from 1994 to 2023. The CiteSpace software was used to conduct an in-depth analysis of the included literature data, including publication year, country, institution, author, journal, cited references, keywords, etc.Results:A total of 875 papers related to bupivacaine liposomes were included. The research and development of bupivacaine liposomes were divided into 3 stages: slow development (1994-2011), a sharp rise (2011-2021), and stabilization (2021-2023). The United States was in a leading position in terms of the number of publications, centrality, and author cooperation, and Harvard University had the largest number of publications. de Paula E had the most publications, Bramlett K had the highest number of citations, and Boogaerts J had the highest centrality of publications. Journals such as Anesthesia and Analgesia made significant contributions to this field. The most cited references focused on the infiltration of wounds and the periprosthetic injection of bupivacaine liposomes. The keyword analysis showed that local anesthetics, postoperative pain, etc. were commonly used keywords, and enhanced recovery after surgery was an emerging hotspot. Conclusions:Bupivacaine liposomes show good application prospects in the field of peripheral nerve block due to their unique pharmacological properties and safety characteristics and are expected to prolong the duration of postoperative analgesia. However, there is a difference between the actual effect and the expectation, and more clinical trials are needed to evaluate the curative effect, providing a more solid and reliable theoretical basis and practical guidance for clinical practice.

Hereditary angioedema (HAE) is a rare autosomal dominant genetic disorder characterized by recurrent and unpredictable episodes of edema. Currently, there is no effective cure available, which seriously affects patients′ quality of life. Gene therapy intervenes in the disease at the genetic level, offering new perspectives for the treatment of HAE. This article summarizes the current research progress in gene therapy for HAE, including gene editing, transgenic therapy, and RNA therapy. It aims to draw the attention of researchers in this field, and provide references and insights for clinicians.

Objective:To analyze the research trends and hotspots of bupivacaine liposomes from 1994 to 2023 using bibliometrics.Methods:A comprehensive search was conducted for the literature related to bupivacaine liposomes in the Web of Science Core Collection from 1994 to 2023. The CiteSpace software was used to conduct an in-depth analysis of the included literature data, including publication year, country, institution, author, journal, cited references, keywords, etc.Results:A total of 875 papers related to bupivacaine liposomes were included. The research and development of bupivacaine liposomes were divided into 3 stages: slow development (1994-2011), a sharp rise (2011-2021), and stabilization (2021-2023). The United States was in a leading position in terms of the number of publications, centrality, and author cooperation, and Harvard University had the largest number of publications. de Paula E had the most publications, Bramlett K had the highest number of citations, and Boogaerts J had the highest centrality of publications. Journals such as Anesthesia and Analgesia made significant contributions to this field. The most cited references focused on the infiltration of wounds and the periprosthetic injection of bupivacaine liposomes. The keyword analysis showed that local anesthetics, postoperative pain, etc. were commonly used keywords, and enhanced recovery after surgery was an emerging hotspot. Conclusions:Bupivacaine liposomes show good application prospects in the field of peripheral nerve block due to their unique pharmacological properties and safety characteristics and are expected to prolong the duration of postoperative analgesia. However, there is a difference between the actual effect and the expectation, and more clinical trials are needed to evaluate the curative effect, providing a more solid and reliable theoretical basis and practical guidance for clinical practice.

Kidney transplantation is an effective treatment for end-stage renal disease.However,post transplantation diabetes mellitus(PTDM)is a common complication after kidney transplantation,affecting 10%to 40%of recipients and increasing the risk of cardiovascular disease,infections,sepsis and other conditions.The pathogenesis of PTDM is complex,including pancreatic β-cell dysfunction and insulin resistance.Tacrolimus,a commonly used immunosuppressive drug,is an independent risk factor for PTDM.Its mechanisms include damaging pancreatic β-cells,mediating impaired mitochondrial autophagy,etc.In addition,tacrolimus also raises blood glucose levels through various pathways,such as affecting gut microbiota metabolism and activating bile acid signaling pathways.In recent years,some new anti-diabetic drugs have shown certain application prospects in kidney transplant recipients,but the evidence-based medical evidence for their combined use still needs further exploration.In the future,it is necessary to conduct in-depth research on the multiple sites of action of tacrolimus to reduce the occurrence of PTDM and improve the prognosis of kidney transplant recipients.

Talaromyces marneffei is a rare opportunistic pathogen.Talaromyces marneffei infection is characterized by insidious onset,atypical clinical manifestations,low early diagnosis rate,and high misdiagnosis and fatality,and has received widespread attention in recent years.Organ transplant recipients become a high-risk group for Talaromyces marneffei infection due to postoperative immunosuppressive therapy.Metagenomic next-generation sequencing,targeted antifungal therapy,and immunosuppression regimen adjustment are key to improving the prognosis of Talaromyces marneffei infection patients.This article reviews the epidemiology,pathogenesis,diagnosis and treatment of Talaromyces marneffei infection in organ transplant recipients,explores current challenges and future research directions,and aims to inform the diagnosis and treatment of Talaromyces marneffeiinfection.

Kidney transplantation is an effective treatment for end-stage renal disease.However,post transplantation diabetes mellitus(PTDM)is a common complication after kidney transplantation,affecting 10%to 40%of recipients and increasing the risk of cardiovascular disease,infections,sepsis and other conditions.The pathogenesis of PTDM is complex,including pancreatic β-cell dysfunction and insulin resistance.Tacrolimus,a commonly used immunosuppressive drug,is an independent risk factor for PTDM.Its mechanisms include damaging pancreatic β-cells,mediating impaired mitochondrial autophagy,etc.In addition,tacrolimus also raises blood glucose levels through various pathways,such as affecting gut microbiota metabolism and activating bile acid signaling pathways.In recent years,some new anti-diabetic drugs have shown certain application prospects in kidney transplant recipients,but the evidence-based medical evidence for their combined use still needs further exploration.In the future,it is necessary to conduct in-depth research on the multiple sites of action of tacrolimus to reduce the occurrence of PTDM and improve the prognosis of kidney transplant recipients.

Talaromyces marneffei is a rare opportunistic pathogen.Talaromyces marneffei infection is characterized by insidious onset,atypical clinical manifestations,low early diagnosis rate,and high misdiagnosis and fatality,and has received widespread attention in recent years.Organ transplant recipients become a high-risk group for Talaromyces marneffei infection due to postoperative immunosuppressive therapy.Metagenomic next-generation sequencing,targeted antifungal therapy,and immunosuppression regimen adjustment are key to improving the prognosis of Talaromyces marneffei infection patients.This article reviews the epidemiology,pathogenesis,diagnosis and treatment of Talaromyces marneffei infection in organ transplant recipients,explores current challenges and future research directions,and aims to inform the diagnosis and treatment of Talaromyces marneffeiinfection.

Objective:To describe the clinical characteristics and diagnosis and treatment process of one patient with primary thyroid mucosa-associated lymphoid tissue(MALT)lymphoma,in order to broaden the diagnostic and therapeutic strategies for this disease. Methods:The clinical features,diagnosis and treatment of one patient with primary thyroid MALT lymphoma were reported,and the relevant literatures were reviewed. Results:The patient complained of"bilateral thyroid enlargement for over 3 months",and the preoperative thyroid B-ultrasound and neck CT examination showed significant enlargement of thyroid.The patient underwent thyroidectomy on the right lobe behind the sternum,and postoperative pathological diagnosis confirmed primary thyroid MALT lymphoma.After a definitive diagnosis,the radiotherapy was performed on the thyroid lesion and cervical lymph node drainage area at a dose of 30 Gy/15 sessions.There was no disease progression 7 months after radiotherapy. Conclusion:Primary thyroid MALT lymphoma is a subtype of primary thyroid lymphoma(PTL)that commonly occurs in elderly female patients(＞60 years)accompanied by Hashimotos's thyroiditis(HT),and presents progressive enlargement of neck masses or lymph nodes in a short period.The clinical diagnosis of PTL relies on pathological biopsy,and there are significant differences in the clinical manifestations,treatment approaches,and prognosis among different subtypes of PTL.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.