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 investigate the impact of two different surgical methods, orthotopic kidney transplantation and abdominal heterotopic kidney transplantation, on the surgical outcomes of pig-to-pig kidney transplantation and the short-term survival of recipient pigs after surgery. Methods Twenty-four Bama miniature pigs were divided into two groups, with 12 pigs in each group, and underwent orthotopic kidney transplantation and abdominal heterotopic kidney transplantation, respectively. The perioperative indicators of the recipient pigs, renal blood perfusion, the overall incidence rate of complications and survival rate were compared between the two surgical methods. Results The total surgical time, renal artery anastomosis time, renal vein anastomosis time, cold ischemia time and total ischemia time were all shorter in the abdominal heterotopic kidney transplantation group than in the orthotopic kidney transplantation group, with statistically significant differences (all P<0.05). The number of satisfactory renal perfusion cases was higher in the abdominal heterotopic kidney transplantation group than in the orthotopic kidney transplantation group (83% vs. 75%), but the difference was not statistically significant (P>0.05). The total incidence of postoperative complications was 33% in the heterotopic kidney transplantation group, with a survival rate of 92%, and the cause of death was rupture of the vascular anastomosis. The total incidence of postoperative complications was 50% in the orthotopic kidney transplantation group, with a survival rate of 83%, and the causes of death were renal vein thrombosis and renal artery thrombosis. There were no statistically significant differences in the total incidence of postoperative complications and survival rates between the two groups (all P>0.05). Conclusions Compared with orthotopic kidney transplantation, abdominal heterotopic kidney transplantation showes better surgical outcomes in pig-to-pig kidney transplantation and is more beneficial for the short-term survival of recipient pigs after surgery. This provides experience for improving the stability of pig-to-non-human primate kidney xenotransplantation models in the future.

[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.

Objective To investigate the clinical features,treatment and prognosis of primary testicular lymphoma(PTL),so as to provide reference for the standardized diagnosis and treatment of this disease.Methods Clinical data of 13 PTL cases treated in Xijing Hospital during Jan.2014 and Dec.2024 were retrospectively collected.The patients' diagnosis,treatment methods and prognosis were summarized.Results All 13 patients underwent orchiectomy of the affected side.According to the postoperative pathological results,11 cases were diagnosed as diffuse large B-cell lymphoma and 2 as NK/T-cell lymphoma.Among the 11 cases with diffuse large B-cell lymphoma,10 received immunotherapy and chemotherapy according to the international standardized treatment plan,and 5 received preventive myeloablative injection therapy.Recurrence in the contralateral testis occurred in 3 cases,1 complicated with central nervous system infiltration died,and another 1 refusing chemotherapy had contralateral testicular metastasis.Of the 2 cases with NK/T-cell lymphoma,1 received systemic chemotherapy and died after central nervous system recurrence,and another 1 died 1 month after surgery whithout undergoing chemotherapy.Conclusion Primary testicular lymphoma is highly invasive with poor prognosis.Patients with NK/T-cell lymphoma have extremely poor prognosis,while those with diffuse large B-cell lymphoma have relatively better prognosis.However,even after comprehensive treatment,it is still prone to recurrence in the testis and the central nervous system.

Objective:To investigate the clinicopathological characteristics and prognostic factors of patients with giant cell carcinoma of the lung (GCCL).Methods:A retrospective case series study was conducted. The clinical data and the survival related information of patients with GCCL in Surveillance, Epidemiology and End Results (SEER) database from the establishment of the databank to April 2019 were collected, and the clinicopathological characteristics of patients were summarized. Cox proportional hazards model was used for univariate and multivariate analysis of the overall survival (OS) and the independent influencing factors for poor OS were screened. Kaplan-Meier method was used to analyze the OS and cancer-specific survival (CSS) of the entire group and the patients stratified by the independent influencing factors. The log-rank test was used for inter-group comparisons.Results:A total of 248 GCCL cases were included. Among them, 64.9% (161 cases) were aged ≤70 years, 60.1% (149 cases) were male, and 57.7% (143 cases) were married. GCCL was more commonly found in the right lung [58.5% (145 cases)], and 64.1% (159 cases) were classified as TNM stage Ⅲ-Ⅳ. No high differentiation cases were observed, and there was only 1 case (0.4%) of moderate differentiation, while the remaining cases were poorly differentiated [56.0% (139 cases)] or undifferentiated [43.5% (108 cases)]. Lymph node metastasis was observed in 55.6% (138 cases), and distant metastasis occurred in 35.5% (88 cases). Regarding treatment, 50.4% (125 cases) underwent surgery, 18.5% (46 cases) received radiotherapy, and 39.1% (97 cases) underwent chemotherapy. Kaplan-Meier analysis showed that the 1-year and 5-year OS rates for all 248 cases were 38.8% and 21.3%, respectively, while the 1-year and 5-year CSS rates were 47.7% and 32.3%, respectively. Univariate and multivariate Cox regression analyses revealed that age (≥71 years vs. <70 years, HR = 1.526, 95% CI: 1.145-2.033, P = 0.004), marital status (married vs. others, HR = 0.755, 95% CI: 0.569-1.000, P = 0.049), N stage (all compared to N 0 stage; N 1 stage: HR = 1.876, 95% CI: 1.212-2.903, P = 0.005; N 2 stage: HR = 1.560, 95% CI: 1.074-2.265, P = 0.020; N 3 stage: HR = 1.902, 95% CI: 1.089-3.323, P = 0.024), M stage (M 1vs. M 0, HR = 2.122, 95% CI: 1.488-3.026, P < 0.001), and surgical treatment (surgery vs. no surgery, HR = 0.542, 95% CI: 0.361-0.813, P = 0.003) were independent risk factors for poor OS. Kaplan-Meier analysis demonstrated that patients aged >70 years, married, without lymph node metastasis, without distant metastasis, and those who underwent surgery had better OS, and the differences were statistically significant (all P < 0.05). Conclusions:GCCL is more common in elderly men and is more frequently found in the right lung. Most patients have lymph node metastasis and the patients with the distant metastasis are relatively common. The majority of cancer patients have an undifferentiated or poorly differentiated degree. Age, marital status, N stage, M stage, and whether surgery was performed are independent prognostic factors for GCCL.

Objective To investigate the clinical features,treatment and prognosis of primary testicular lymphoma(PTL),so as to provide reference for the standardized diagnosis and treatment of this disease.Methods Clinical data of 13 PTL cases treated in Xijing Hospital during Jan.2014 and Dec.2024 were retrospectively collected.The patients' diagnosis,treatment methods and prognosis were summarized.Results All 13 patients underwent orchiectomy of the affected side.According to the postoperative pathological results,11 cases were diagnosed as diffuse large B-cell lymphoma and 2 as NK/T-cell lymphoma.Among the 11 cases with diffuse large B-cell lymphoma,10 received immunotherapy and chemotherapy according to the international standardized treatment plan,and 5 received preventive myeloablative injection therapy.Recurrence in the contralateral testis occurred in 3 cases,1 complicated with central nervous system infiltration died,and another 1 refusing chemotherapy had contralateral testicular metastasis.Of the 2 cases with NK/T-cell lymphoma,1 received systemic chemotherapy and died after central nervous system recurrence,and another 1 died 1 month after surgery whithout undergoing chemotherapy.Conclusion Primary testicular lymphoma is highly invasive with poor prognosis.Patients with NK/T-cell lymphoma have extremely poor prognosis,while those with diffuse large B-cell lymphoma have relatively better prognosis.However,even after comprehensive treatment,it is still prone to recurrence in the testis and the central nervous system.

Objective:To investigate the clinicopathological characteristics and prognostic factors of patients with giant cell carcinoma of the lung (GCCL).Methods:A retrospective case series study was conducted. The clinical data and the survival related information of patients with GCCL in Surveillance, Epidemiology and End Results (SEER) database from the establishment of the databank to April 2019 were collected, and the clinicopathological characteristics of patients were summarized. Cox proportional hazards model was used for univariate and multivariate analysis of the overall survival (OS) and the independent influencing factors for poor OS were screened. Kaplan-Meier method was used to analyze the OS and cancer-specific survival (CSS) of the entire group and the patients stratified by the independent influencing factors. The log-rank test was used for inter-group comparisons.Results:A total of 248 GCCL cases were included. Among them, 64.9% (161 cases) were aged ≤70 years, 60.1% (149 cases) were male, and 57.7% (143 cases) were married. GCCL was more commonly found in the right lung [58.5% (145 cases)], and 64.1% (159 cases) were classified as TNM stage Ⅲ-Ⅳ. No high differentiation cases were observed, and there was only 1 case (0.4%) of moderate differentiation, while the remaining cases were poorly differentiated [56.0% (139 cases)] or undifferentiated [43.5% (108 cases)]. Lymph node metastasis was observed in 55.6% (138 cases), and distant metastasis occurred in 35.5% (88 cases). Regarding treatment, 50.4% (125 cases) underwent surgery, 18.5% (46 cases) received radiotherapy, and 39.1% (97 cases) underwent chemotherapy. Kaplan-Meier analysis showed that the 1-year and 5-year OS rates for all 248 cases were 38.8% and 21.3%, respectively, while the 1-year and 5-year CSS rates were 47.7% and 32.3%, respectively. Univariate and multivariate Cox regression analyses revealed that age (≥71 years vs. <70 years, HR = 1.526, 95% CI: 1.145-2.033, P = 0.004), marital status (married vs. others, HR = 0.755, 95% CI: 0.569-1.000, P = 0.049), N stage (all compared to N 0 stage; N 1 stage: HR = 1.876, 95% CI: 1.212-2.903, P = 0.005; N 2 stage: HR = 1.560, 95% CI: 1.074-2.265, P = 0.020; N 3 stage: HR = 1.902, 95% CI: 1.089-3.323, P = 0.024), M stage (M 1vs. M 0, HR = 2.122, 95% CI: 1.488-3.026, P < 0.001), and surgical treatment (surgery vs. no surgery, HR = 0.542, 95% CI: 0.361-0.813, P = 0.003) were independent risk factors for poor OS. Kaplan-Meier analysis demonstrated that patients aged >70 years, married, without lymph node metastasis, without distant metastasis, and those who underwent surgery had better OS, and the differences were statistically significant (all P < 0.05). Conclusions:GCCL is more common in elderly men and is more frequently found in the right lung. Most patients have lymph node metastasis and the patients with the distant metastasis are relatively common. The majority of cancer patients have an undifferentiated or poorly differentiated degree. Age, marital status, N stage, M stage, and whether surgery was performed are independent prognostic factors for GCCL.

Organ shortage has become one of the major challenges hindering the development of organ transplantation. Xenotransplantation is one of the most valuable methods to resolve global organ shortage. In recent years, the development of genetic engineering technique and research and development of new immunosuppressant have provided novel theoretical basis for xenotransplantation. International scholars have successively carried out researches on xenotransplantation in genetically modified pigs to non-human primates or brain death recipients, making certain substantial progresses. However, most of the researches are still in the preclinical stage, far from clinical application. Therefore, according to the latest preclinical experimental research progress at home and abroad, the history of xenotransplantation, the development of gene modification technology, xenotransplantation rejection and immunosuppression regimens were reviewed, aiming to provide reference for subsequent research of xenotransplantation, promote clinical application of xenotransplantation and bring benefits to more patients with end-stage diseases.

Knee osteoarthritis (KOA) is a common chronic degenerative disease of cartilage, which often occurs in middle-aged and elderly patients. It can cause joint swelling, pain and limited movement. With the aging population gradually increasing in China, the prevalence of KOA is also increasing, imposing burdens on patients, families and society. At present, the clinical treatment methods for KOA mainly include physical exercise therapy, non-steroidal analgesic drug therapy, intra-articular hormone injection therapy and surgical treatment, which can improve symptoms and reduce pain but cannot effectively cure KOA. With the development of medicine, platelet-rich plasma (PRP) therapy, as a new treatment method, has the effects of nerve repair and pain relief, and has become a new choice for the treatment of KOA. This article reviews the application of PRP in KOA, so as to provide a new perspective for clinical treatment of knee osteoarthritis KOA.

ObjectiveTo understand the current status and development of research on the subject of domestic violence， and to grasp the main research hotspots in the field. MethodsThe literature in the core database of Web of Science were retrieved， and 20 417 literature related to domestic violence from January 1966 to September 2021 were sorted by using the CiteSpace software， and the number of literature， authors， research institutions and keywords were analyzed. Results①The volume of literature on domestic violence grown rapidly since 2015. ②Among the authors， Kelsey Hegarty， Gene Feder and others had large number of publications on domestic violence， moreover， the authors' cooperation formed some small collaborative groups and research groups of a certain scale. ③The research institutions were closely collaborating， among which University of North Carolina was the institution of highest number of publications， and Boston University was the institution with the strongest research centrality. ④Hot keywords kept developing and changing， and the current hot keywords were mainly dating violence， sexual violence and the perception and perpetration of domestic violence. ConclusionThe field of domestic violence has been studied by a large number of researchers and has given rise to many research hotspots.