The international journal of medical robotics + computer assisted surgery : MRCASManal Mohamed Elhassan Taha, Siddig Ibrahim Abdelwahab
BACKGROUND: Robotic organ transplantation research remains fragmented and largely kidney-focused, lacking cross-organ synthesis. This study mapped global productivity, thematic evolution, collaboration and intellectual structure through 2025. METHODS: A Scopus-based dataset of 475 original English-language articles (2002-2025) was analysed using Bibliometrix/Biblioshiny and VOSviewer, integrating performance, collaboration, Bradford's law, thematic evolution and source co-citation analyses. RESULTS: The field showed rapid growth (15.94% annual growth rate) with peak productivity in 2025. The United States, Italy, and Japan were leading contributors, whereas Alberto Breda was the most prolific scholar. A 10-journal core accounted for 35.6% of publications. Themes evolved from kidney transplantation and robotic surgery towards broader multiorgan applications, particularly liver and donor surgery, with strong co-citation integration across transplantation, hepatobiliary and robotic surgery domains. CONCLUSION: The field has matured into a multiorgan, outcomes-oriented and transdisciplinary robotic transplantation ecosystem.
Biomedical chromatography : BMCRuigeng Yang, Lei Wang, Nannan Li, Shufeng Li, Jiancheng Fang, Wenli Sun, Chunfei Jiang, Meng Li, Xiaofei Luo, Yang Xue, Jing Long, Hongxing Liu
This study utilized LC-MS/MS-based metabolomics to characterize the dynamic metabolic changes associated with the onset and progression of acute graft-versus-host disease (aGVHD), aiming to identify potential noninvasive biomarkers for diagnosis and prognostic assessment. A total of 110 patients with AML who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) were enrolled in the study. Plasma samples from these patients were analyzed using an untargeted metabolomics platform. Differential metabolites and their clinical relevance were investigated using multiple statistical approaches, including pathway enrichment, hierarchical clustering, and ROC curve analysis. The results showed that compared with patients without aGVHD, 36 plasma metabolites were significantly dysregulated in those with aGVHD (VIP > 1, p < 0.05). Among these, six glycerophospholipids-PC(P-16:0/18:1), PC(20:4/20:4), PC(16:0/16:0), PC(18:0/20:3), PE(P-18:0/20:5), and PC(o-16:1/18:0)-exhibited regular alterations across different stages of aGVHD. The combined AUC under the six metabolites was 0.960, highlighting their strong diagnostic potential. Multivariate analysis further indicated that this six-metabolite signature was predictive of 4-year overall survival, with several metabolites serving as independent prognostic factors. In conclusion, these six glycerophospholipid metabolites display dynamic changes during aGVHD progression and hold promise as noninvasive biomarkers for both diagnosis and prognostic stratification. Validation in larger patient cohorts is warranted to confirm these findings.
Liver international : official journal of the International Association for the Study of the LiverJarell Jie-Rae Tan, Joo Wei Ethan Quek, Sean Shao Wei Lam, Ming-Hua Zheng, Christophe Corpechot, Aldo J Montano-Loza, Yu Jun Wong
INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized in patients with primary biliary cholangitis (PBC). While metabolic comorbidities are expected to worsen outcomes, the clinical impact of MASLD in PBC remains uncertain. We investigated whether concomitant MASLD modifies hepatic and cardiovascular outcomes in patients with PBC. METHODS: We conducted a retrospective international cohort study using de-identified electronic health records from the TriNetX global research network, including 172 healthcare organizations between 2010 and 2025. Adult patients with PBC with and without MASLD were matched using propensity score matching (1:1) to balance baseline characteristics. The primary outcomes were all-cause mortality. Major adverse cardiovascular events (MACE) and hepatic decompensation were evaluated as secondary outcomes. Additional outcomes included hepatocellular carcinoma, liver transplantation, and one-year biochemical response (ALP normalization). RESULTS: Among 30 934 patients with PBC (78.9% female; mean age 68 years), 5955 (19.2%) had concomitant MASLD. After matching, 10 856 patients (5428 per group) were included. Over a mean follow-up of 4 years, patients with PBC-MASLD had a lower risk of all-cause mortality (HR 0.60; 95% CI 0.54-0.67) and hepatic decompensation (HR 0.82; 95% CI 0.71-0.93), but higher risk of MACE (hazard ratio [HR] 1.30; 95% CI 1.14-1.48). One-year biochemical response rates were comparable between groups. Findings remained consistent across multiple sensitivity analyses. CONCLUSION: MASLD identifies a distinct metabolic phenotype of PBC characterized by increased cardiovascular risk but paradoxically lower mortality and hepatic decompensation. These findings highlight the need to integrate cardiovascular risk assessment into the management of patients with PBC.
Clinical and experimental dental researchNga Thi Nguyen, Hanh Thi-My Tran, Nga Minh Truong
OBJECTIVES: This case report describes orthodontics-assisted autogenous tooth transplantation for a maxillary incisor injury in a pediatric patient with crowding and Class II malocclusion. MATERIAL AND METHODS: A 10-year-old boy presented with a compromised maxillary left central incisor with a periapical lesion after failed endodontic treatment, together with bimaxillary crowding and Class II malocclusion. The mandibular right second premolar was transplanted to replace the maxillary incisor and was integrated with comprehensive orthodontic treatment. RESULTS: After transplantation, endodontic treatment was completed when pulp vitality could not be maintained. During long-term follow-up, the transplanted tooth remained clinically stable, with healthy periodontal tissues and no progressive root resorption or bone loss. Orthodontic treatment achieved stable occlusion, improved function, and satisfactory smile esthetics. CONCLUSIONS: Orthodontics-assisted autogenous tooth transplantation may be a biologically favorable option for replacing a traumatized maxillary incisor in growing patients with crowding and malocclusion. Careful donor selection, coordinated orthodontic timing, and long-term follow-up are essential for stable functional and esthetic outcomes.
Recurrence of focal segmental glomerulosclerosis (FSGS) following kidney transplantation remains a significant cause of allograft loss. Much remains unknown about the efficacy of apheresis treatments and the factors that determine favorable treatment outcomes. This retrospective cohort study involved adult patients with pre-transplant diagnosis of FSGS, who developed recurrent FSGS in the post-transplant period over 6 years, from January 1, 2017, to December 31, 2022. Twenty patients with biopsy-confirmed FSGS who received therapeutic plasma exchange (TPE) as part of their treatment regimen were included. Demographic data, transplant characteristics, procedure details, urine protein levels, and other relevant variables were retrieved. Data was compiled in a Microsoft Excel spreadsheet and analyzed using the Statistical Package for the Social Sciences (SPSS, IBM NY, 2023, version 29). A p-value of less than 0.05 was considered statistically significant. Data from 20 patients encompassing 169 TPE sessions were analyzed. Of these, 15 patients (75%) achieved remission of proteinuria, while 5 (25%) did not. The median time to remission was 6 months, and the median number of TPE was 7 (interquartile range [IQR] = 2-13). There was no significant difference in time to remission between patients with complete and partial remission. Receiving more than five TPE sessions (adjusted odds ratio [AOR] = 1.6 (1.01-2.46); p = 0.02) and having lower baseline proteinuria at treatment initiation (AOR = 1.9 (1.03-8.94); p = 0.01) were independent predictors of remission. The complication rate was 10.7%, with hypocalcemia being the most common, occurring in 5.9% of cases. One mortality was recorded during apheresis, yielding a procedure mortality rate of 0.6%. Initiating treatment at lower levels of proteinuria (i.e., earlier in the course of disease recurrence) appear to enhance the likelihood of remission. Our result suggests that a trial of therapy extending beyond the initial induction phase may be necessary to capture late-responding patients. The procedure was generally well tolerated, with few reversible adverse events. However, vigilant monitoring remains essential for optimal management.
Renal failureKim Solez, Habba Mahal, Wisit Cheungpasitporn, Giuseppe Orlando
The purpose of this review is to summarize the most influential and conceptually significant publications from the past 2 years, including substantial 2026 publications, and to identify emerging directions likely to shape xenotransplantation and regenerative medicine in the near future. Advances in artificial intelligence (AI) now support more structured anticipation of future developments by integrating patterns across experimental, computational, and translational research. The field is approaching a potential inflection point in which increasingly capable AI systems, potentially approaching artificial general intelligence, may accelerate the design of stem-cell-derived tissues and progressively more complex organ constructs. In addition, scientific communication is evolving toward formats that support machine-assisted analysis and AI-driven knowledge synthesis. Multiple developments signal significant expansion across xenotransplantation and regenerative medicine, driven by innovations in gene editing, multimodal data integration, and AI-enabled prediction and decision-support systems. These advances will help to broaden access to transplantable organs and increase the scale and impact of the field across clinical practice, research, and workforce domains. Together, these trends suggest that AI-enabled regenerative and xenogeneic strategies may meaningfully reduce the organ shortage and support future progress toward precision-engineered organ replacement.
Hepatology communicationsSharad I Wadhwani, Bethany Reyna, Andrea Huerta, John C Bucuvalas, Laura M Gottlieb, Catherine Lee, Courtney R Lyles, Sue J Rhee, Amy M Shui, Jennifer C Lai
BACKGROUND: Children undergoing liver transplantation experience socioeconomic disparities in long-term outcomes, partly due to unaddressed material economic hardships such as food insecurity and housing instability. Health Advocates-trained lay health workers who assist families in navigating social and medical systems-may mitigate these disparities. We pilot-tested a Health Advocate intervention (NCT05700799) to assess feasibility, acceptability, and preliminary effects on caregiver experience and clinical outcomes in pediatric liver transplant recipients. METHODS: In this single-center study, 18 caregivers/child dyads participated in a 90-day Health Advocate program; they were provided weekly support from trained navigators. Navigators helped to identify and connect participants with community-based resources and communicated reported social risks to the transplant team. RESULTS: The patients' median age at transplant was 1.1 (0.7, 4.6) and the median age at study enrollment was 8.6 (4.3, 13.1) years; 83% remained in the intervention until their needs were met or the end of the 12-week intervention. Caregivers reported improvement in comfort discussing social risks with the transplant team and improved overall care experience (both median 1-point change). Clinical parameters, including the Medication Level Variability Index, trended toward improvements. Qualitative analysis demonstrated high enthusiasm for the intervention, with themes of enhanced communication, reduced stress, and practical assistance addressing diverse social needs. CONCLUSIONS: A Health Advocate intervention for pediatric liver transplant families was feasible, acceptable, and associated with improved caregiver experiences. These preliminary findings support testing this intervention in a multi-center effectiveness and implementation trial to evaluate its impact on improving longer-term transplant outcomes.
Renal failureElvan Onur Kırımker, Deniz Kütük, Kıvanç Kılınç, Mehmet Ali Koç, Acar Tüzüner, Akın Fırat Kocaay
BACKGROUND: Urological complications remain a significant source of morbidity following kidney transplantation, often leading to re-intervention and graft dysfunction. Although advances in surgical technique and perioperative care have reduced incidence rates, controversy persists regarding risk predictors and the prophylactic role of double-J ureteral stenting. METHODS: We retrospectively analyzed 425 adult kidney transplant recipients at a single tertiary center between January 2008 and December 2023. Patient demographics, donor characteristics, surgical variables, and postoperative outcomes were reviewed. Complications were defined as urinary leak, ureteral stricture, or anastomotic obstruction requiring intervention within 12 months. Data were compared across three eras (2008-2012, 2013-2017, 2018-2023). Multivariable logistic regression identified independent risk factors. RESULTS: Overall, 11.1% (n = 47) of patients developed urological complications. Ureteral stricture was the most frequent (57%), followed by urinary leak (28%) and anastomotic obstruction (15%). Older recipient age (OR 1.04, 95% CI 1.01-1.07, p = 0.012), re-transplantation (OR 2.95, 95% CI 1.12-7.77, p = 0.028), and deceased donor grafts (OR 2.17, 95% CI 1.12-4.19, p = 0.021) were independent predictors. Prophylactic double-J ureteral stenting demonstrated a non-significant protective trend (OR 0.71, 95% CI 0.44-1.15, p = 0.091). Routine stenting in Era 3 coincided with a non-significant reduction in leak and stricture rates. CONCLUSION: Older age, re-transplantation, and deceased donor grafts independently predicted complications, while prophylactic stenting showed a non-significant protective effect. Further multicenter studies are needed to validate these findings and optimize stent protocols.
Annals of medicineZhenshuan Zhao, Xiaoguang Yu, Feng Zhao, Jun Li
BACKGROUND: Hepple Type V osteochondral lesions of the talus (OLT) are challenging. This study compared the clinical efficacy and inflammatory response of allogeneic osteochondral mosaicplasty (AOM) combined with high tibial osteotomy (HTO) versus AOM alone for OLT and identified prognostic factors. METHODS: This retrospective cohort study compared perioperative inflammatory markers [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6)], clinical outcomes [Visual Analogue Scale (VAS) pain score, ankle range of motion (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) score, Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, tibiotalar tilt angle (TTA), joint line convergence angle (JLCA)], complications and prognostic factors between AOM alone (n = 263) and AOM+HTO (n = 176) groups. RESULTS: The combined group showed lower day 7 VAS, better 12-month ROM, and higher AOFAS and MOCART scores at 3 and 12 months (all p < 0.05). Postoperative CRP, ESR, and IL-6 were transiently higher in the combined group (p < 0.05). At 12 months, the combined group demonstrated greater improvements in TTA and JLCA (both p < 0.001). Complication rates were similar between groups. Multivariate analysis identified older age, higher BMI, diabetes, longer procedure time, delayed full weight-bearing, elevated preoperative IL-6, larger cyst diameter/depth, and central lesion location as factors associated with poor prognosis, while combined treatment was associated with lower odds of poor prognosis. CONCLUSION: In this retrospective cohort, AOM combined with HTO was associated with better short-term outcomes than AOM alone, with an acceptable inflammatory response. However, prospective studies are required to confirm these associations.
OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of myeloablative allogeneic peripheral blood stem cell transplantation (allo-PBSCT) in patients with relapsed/refractory T-cell acute lymphoblastic leukemia/lymphoma (R/R T-ALL/LBL), focusing on immune interventions' impact on long-term prognosis. METHODS: 16 adult patients (≥18 years; 11 male, 5 female; median age 28 years [range 18-50]) with R/R T-ALL/LBL undergoing salvage allo-PBSCT at the Chinese PLA General Hospital between 2013 and 2022 were retrospectively analyzed. All patients were in partial remission (PR) or disease progression (PD) pre-transplant. Primary endpoints were overall survival (OS), progression-free survival (PFS), and relapse rate (RR); secondary endpoints included GVHD incidence and immune intervention efficacy. Median follow-up was 15.5 months (range 2-69). RESULTS: 5 patients (31.3%) survived at last follow-up. At 3-month post-transplantation assessment, 9 patients achieved CR and 5 maintained PR, while 2 patients died of PD within 2 months post-transplant. Among the 14 evaluable patients, CR patients (n = 9) received immunosuppressant tapering without additional intervention: 4 sustained CR, 2 died of relapse, 3 of transplant-related mortality. PR patients (n = 5) underwent initial immunosuppression withdrawal followed by: donor lymphocyte infusions (DLI, n = 3), chemotherapy (n = 1), or DLI + radiotherapy (n = 1). 4 patients ultimately died of relapse, and 1 attained CR. The 1-year OS and PFS were both 56.3%, 1-year RR was 22.1%, and non-relapse mortality rate (NRM) was 27.1%. CONCLUSION: Myeloablative allo-PBSCT is a feasible salvage therapeutic option for R/R T-ALL/LBL patients. Furthermore, immune interventions, such as DLI, may improve outcomes, particularly in patients with PR.
American journal of physiology. Renal physiologyTiago Pinto Coelho, Jihad Abdelmalki, Margaux Navez, Morgan Vandermeulen, Pauline Erpicum, Olivier Detry, Francois Jouret
Brain death (BD) induces a robust inflammatory response that impairs kidney quality before transplantation. Given that TNFα is a central upstream mediator of BD-related injury, we investigated whether selective TNFα inhibition using etanercept could mitigate renal damage in a rat model of BD. BD was maintained for 6 h in anesthetized rats (n = 6 controls; n = 12 etanercept-treated; balanced for sex), after which animals were randomized to receive either etanercept (ETNCPT) or vehicle (CTL). We evaluated serum biomarkers, histological kidney injury, immune cell infiltration, and whole-kidney transcriptomic profiles. Etanercept significantly reduced circulating TNFα levels (15.25 [12.30-21.05] vs. 34.23 [26.03-50.19] pg/mL; P < 0.001), whereas other cytokines remained unchanged. Kidney function parameters [serum creatinine and blood urea nitrogen (BUN)], electrolytes, and hemodynamics were similar across groups. In contrast, etanercept markedly attenuated renal injury, reducing acute tubular necrosis (30.0 [15.0-35.0]% vs. 42.5 [40.0-51.3]%; P < 0.001), CD11b+ myeloid infiltration (0.13 [0.11-0.15]% vs. 0.21 [0.19-0.27]%; P < 0.001), tubular kidney injury molecule-1 expression (0.04 [0.01-0.08]% vs. 0.17 [0.13-0.18]%; P < 0.001), and apoptosis (-69%; P = 0.036). Transcriptomic analysis identified 281 differentially expressed genes after TNFα blockade, with strong inhibition of inflammatory and apoptotic pathways including TNF signaling, TNFR1/TNFR2 activation, death receptor signaling, and cytokine storm signaling. Predicted downstream effects included reduced kidney cell death and inflammation. Sex-stratified analyses showed similar directional effects in males and females. In summary, early TNFα blockade after BD selectively neutralizes TNFα, limits immune recruitment, and suppresses injury and inflammatory signaling at cellular and transcriptomic levels. Targeting TNFα during kidney donor management may offer a promising strategy to improve kidney quality before transplantation.NEW & NOTEWORTHY Brain death (BD) remains a major contributor to kidney injury in deceased donors. In this study, we demonstrate that selective TNFα blockade with etanercept during donor management markedly reduces BD-induced renal damage. Using a rat model of 6-h BD, we show that etanercept selectively neutralizes circulating TNFα without altering hemodynamics or kidney function markers yet significantly decreases tubular injury, myeloid infiltration, KIM-1 expression, and apoptosis. Whole-kidney transcriptomics confirmed broad suppression of TNF-dependent inflammatory and apoptotic pathways. These findings confirm TNFα as a central mediator of BD-associated renal injury and support TNFα-targeted interventions as a promising strategy to improve the quality of BD donor kidney before transplantation.
Human fertility (Cambridge, England)Haowen Zou, Kelli Peirce, Vincent Chapple, Jay Natalwala, Rui Wang, Yanhe Liu
The objective was to investigate whether there are differences in cumulative live birth rate, cumulative clinical pregnancy rate, or perinatal outcomes after delaying ICSI timing. The design was a retrospective cohort study at Fertility North in Australia using 1,969 ICSI cycles with different ICSI timings among 1,078 patients from 2017 to 2022. Cumulative outcomes included cumulative live birth and cumulative clinical pregnancy rates per oocyte retrieval cycle. Perinatal outcomes included preterm birth, low/high birthweight, and small/large for gestational age. Binomial logistic regression and multinomial logistic regression were used. Generalised estimating equation (GEE) was incorporated into the logistic regression analyses to account for the cluster effect from patients undergoing multiple retrieval cycles. ICSI timing was grouped into quartiles: Q1(37.1-41.1h, n = 498), Q2(41.2-42.4h, n = 510), Q3(42.5-43.3h, n = 483), and Q4(43.4-46.8h, n = 478). No significant difference was found in cumulative live birth in Q2 (aOR: 0.79, 95%CI: 0.55-1.14), Q3 (0.87, 0.61-1.25), and Q4 (0.86, 0.58-1.27), compared with Q1, respectively. Similarly, there was no significant difference in cumulative clinical pregnancy rate between the four groups. Furthermore, no significant differences were found in preterm birth, low birth weight, high birth weight, small for gestational age, and large for gestational age in Q4, compared to Q1. Delaying ICSI until 46.8 hours post-trigger does not compromise cumulative clinical pregnancy or live birth rates, or increase adverse perinatal risks.
International immunopharmacologyMustafa T Ardah, Waleed K Abdulsahib, Hasanain Amer Naji, M M Rekha, Pradeepta Sekhar Patro, Anima Nanda, Vipasha Sharma, Ashish Singh Chauhan, Zebiniso Alimov…
Osteoporosis (OP) is a gradual metabolic bone disease characterized by decreased bone mass and degradation of bone microarchitecture. It affects hundreds of millions of people globally and places considerable pressure on healthcare systems. Current pharmacological treatments, such as bisphosphonates, selective estrogen receptor modulators, and anabolic agents, can reduce fracture risk; however, their prolonged use is limited by significant adverse effects, elevated treatment costs, and a lack of sustained disease remission. Their constraints have intensified interest in restorative approaches utilizing mesenchymal stem cells (MSCs). In the past 20 years, MSCs have emerged as attractive treatment options for OP due to their capacity to differentiate into osteoblasts, modulate immune responses, and exert paracrine effects. Bone marrow-MSCs are the best characterized; nevertheless, MSCs obtained from adipose tissue, umbilical cord, and dental pulp have distinct benefits. Preclinical data demonstrate that direct MSC transplantation enhances bone mineral density, promotes osteoblast production, and reestablishes the equilibrium of bone remodeling in many OP models, including Ovariectomy, glucocorticoid-induced OP, and diabetic OP. Nonetheless, significant obstacles persist: insufficient targeting of osteoporotic bone surfaces, suboptimal cell viability and integration, donor heterogeneity, and unresolved safety concerns. The discovery that the secretome and exosomes (EXOs) produced from MSCs recapitulate several therapeutic advantages of the original cells has initiated a transition toward cell-free methodologies. EXOs produced from MSCs include osteogenic microRNAs (including miR-150-3p and miR-21), inhibit NLRP3 inflammasome activation in osteoclasts, promote macrophage polarization toward an M2 phenotype via TRIM25/TREM1 signaling, and facilitate angiogenesis through the activation of the PI3K/Akt pathway. Furthermore, nanoparticle engineering and combinatorial medicines are advancing to enhance targeting and therapeutic efficacy.
European journal of obstetrics, gynecology, and reproductive biologyLena Ottou, S Mebroukine, L Ferretti, L Chansel-Debordeaux, M Lambert, V Bernard, C Hocke, G Robert, C Depuydt, A Buffeteau, E Begon, A Boulenger de Hauteclocq…
This retrospective observational cohort study was designed to evaluate the cumulative live birth rates achieved through testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (ICSI) in couples affected by isolated non-obstructive male infertility, to better estimate their chances of achieving biological fatherhood. We also aimed to estimate their time to live birth, and identify predictive factors of successful TESE. We included all couples undergoing a first TESE procedure for isolated non-obstructive male infertility at a tertiary university hospital between January 2014 and December 2024. Our main outcomes were : Sperm retrieval rate, live birth rate per ICSI cycle, cumulative live birth rate, and time to live birth. Among 168 included couples, sperm retrieval was successful for 99 patients (58.9 %). Forty men (23.8 % of the couples included) achieved biological fatherhood. The mean live birth rate per ICSI cycle was 32.8 %, with a cumulative live birth rate of 45 % after four ICSI cycles. Median time to live birth was 19.5 months from the first TESE and 10 months from the first ICSI attempt. Thirty-eight men achieved fatherhood through sperm donation (22.6 % of the cohort). Median time to live birth was 3 years from the first consultation, irrespective of TESE or sperm donation. TESE-ICSI provides a substantial probability of achieving biological fatherhood in couples with non-obstructive male infertility, with clinically relevant cumulative live birth rates and time to live birth, supporting informed counseling and decision-making.
Facial plastic surgery clinics of North AmericaJaffer Khan, Zara Yousufzai
This article reviews the clinical application of direct injection of stem cells and differentiated cells, comparing established European experience with the rapidly evolving regenerative medicine landscape in Dubai. It highlights the strongest evidence in orthopedic applications, outlines current limitations in standardization and long-term outcomes, and examines emerging technologies such as exosomes and engineered cellular therapies. Differences in regulatory frameworks and clinical adoption are discussed, emphasizing the need for continued evidence-based integration and ethical oversight in the expansion of regenerative medicine.
Facial plastic surgery clinics of North AmericaJeffrey Segal
Stem cell clinics and stem cell use are arguably subject to regulatory oversight at multiple levels including the US Food and Drug Administration (FDA), offices of attorney generals, and state medical licensing boards. Such regulatory oversight has been enforced unevenly. Two high profile appellate court cases propelled by the FDA, Department of Justice criminal prosecutions, and a US Supreme Court decision have reshuffled the deck, auguring over the next several years paradoxically for both more stringent enforcement and less enforcement.
Facial plastic surgery clinics of North AmericaChim Yang, James Newman
Autologous fat transfer has progressed from a volumetric filler to a regenerative cornerstone in modern facial plastic and reconstructive surgery. This article reviews the biological basis, technical refinements, and current processing systems that underpin facial fat grafting. Adipose tissue functions as both a biocompatible filler and a regenerative organ enriched with adipose-derived stem cells and stromal vascular fraction, driving angiogenesis, collagen remodeling, and skin rejuvenation. Commercial systems Puregraft, REVOLVE, Lipocube, and Tulip Nanofat are compared in terms of purification mechanisms, benefits, and clinical use. These closed sterile systems enhance safety, standardization, and predictability, bridging aesthetic artistry with regenerative science.
Cardiology clinicsAmy L Friedman, Marissa W Mery, Christina A Jelly, Bret D Alvis
Heart transplantation is the definitive treatment for end-stage heart failure. Post-transplant care is dynamic and complex, requiring a thoughtful multidisciplinary approach. Invasive hemodynamic monitoring is central to guiding inotrope and vasopressor titration to optimize allograft function and end-organ perfusion. Vigilant assessment for primary graft dysfunction is essential and informs escalation to mechanical circulatory support when needed. As hemodynamics and graft function stabilize, patients are liberated from mechanical ventilation, volume status is optimized, nutrition and mobility are prioritized, and pharmacologic and mechanical supports are weaned. Concurrently, immunosuppression is titrated and patients are monitored closely for infection.
Replantation is generally recommended for thumb amputations, multiple-digit amputations, and single-digit amputations distal to the flexor digitorum superficialis insertion, because it offers superior functional outcomes compared with revision amputation. Replantation of distal forearm amputations is also considered beneficial, as it results in better postoperative function than prostheses and offers a high likelihood of successful return to work. Elective amputation with bionic reconstruction may be a viable alternative when hand function remains poor, particularly when combined with diminished sensibility following replantation of major upper limb amputations.
Bionic prostheses and vascularized composite allotransplantation represent transformative strategies for upper extremity reconstruction. While both approaches aim to restore function and improve quality of life, they differ significantly in technique, risk profile, resource requirements, and long-term outcomes. This review synthesizes current evidence and expert perspectives on the role of hand allotransplantation in the modern era, particularly considering the expanding capabilities of advanced bionic reconstruction. We explore clinical indications, contraindications, functional and psychosocial outcomes, economic considerations, and ethical implications to support patient-centered decision-making in upper limb reconstruction.