Effective communication between healthcare providers and parents facing their child's end of life is critical yet complex. A comprehensive synthesis of how empathic communication influences clinical and bereavement outcomes in pediatric palliative care is lacking. To synthesize qualitative and quantitative evidence on parent-provider empathic communication in pediatric palliative care and to develop an integrative theoretical-conceptual model explaining its proposed mediating role in symptom management and family bereavement. A mixed-methods systematic review was conducted following Joanna Briggs Institute (JBI) methodology for convergent segregated synthesis. We searched PubMed/MEDLINE, Scopus, CINAHL, PsycINFO, and LILACS (June-July 2025, updated January 2026). Studies reporting parental experiences of empathic communication in pediatric palliative care were eligible. Methodological quality was assessed using JBI checklists. Qualitative findings were synthesized via JBI meta-aggregation; quantitative data were analyzed through narrative synthesis; findings were integrated configurationally. Fifty-four studies (28 qualitative, 15 quantitative, 11 mixed-methods) involving approximately 3,567 participants across 16 countries were included. Meta-aggregation yielded eight synthesized findings, including that empathic communication fosters relational trust (S1, S3), enhances prognostic understanding (S2), supports meaning-making (S7), and prevents communication failures that increase complicated grief risk (S5). Narrative synthesis showed that better communication (β = -9.08, p = 0.03) and continuity of care (β = -11.74, p = 0.01) were associated with lower parental grief, while late information about imminent death increased unresolved grief risk (OR = 2.73; 95% CI: 1.02-7.33). Perception of a non-peaceful death was the strongest factor associated with unresolved grief among siblings (OR = 9.86; 95% CI: 2.39-40.65). Integration of findings generated the "Relational Layered Care Model," which proposes that empathic communication activates four theoretical mechanisms - relational trust, prognostic understanding, meaning-making, and care alignment - that influence bereavement adaptation and symptom-related outcomes. Empathic communication in pediatric palliative care operates through specific psychosocial mechanisms rather than merely a communication style. The proposed theoretical model provides a framework for clinical practice, education, and future interventions. PROSPERO CRD420251083662.
We theoretically investigate optically controlled pattern formation in a Rydberg-dressed Bose-Einstein condensate by employing two-frequency modulation of the control laser field. This approach enables direct and periodic tuning of the long-range nonlocal interactions in time, thereby intrinsically modulating the system's nonlinearity. A Floquet analysis reveals parametric resonances that simultaneously excite roton and Faraday instabilities (RI and FI), identifying distinct regimes of pure RI, pure FI, and a joint RI-FI phase. Direct numerical simulations confirm the emergence of novel Faraday patterns, which are selected by the relative amplitude and frequency ratio of the modulation. Our results establish a theoretical framework for studying nonlinear dynamics in driven nonlocal quantum fluids, providing a phase diagram that may serve as a benchmark for future experiments in Rydberg-dressed systems.
Temporal reflection in nonlinear optical fibers provides a powerful framework for manipulating light. In this work, we theoretically and experimentally demonstrate a novel, to the best of our knowledge, mechanism for wave trapping induced by the dynamical evolution of a single high-order soliton pulse. Experimental measurements performed in a 5-km-long nonlinear dispersion-shifted fiber confirm the coexistence of reflected, transmitted, and trapped components, in excellent agreement with theoretical predictions. These results establish a simple and versatile route toward dynamic temporal waveguiding using a single optical pulse, opening new opportunities for all-optical control and manipulation of ultrafast signals.
Learning causal structures from discrete time series data presents significant challenges, particularly in the presence of unobserved variables, or latent confounders, which are frequently encountered in real-world scenarios. Such latent factors often lead existing algorithms to output incorrect causal structures. In this work, we consider a general setting in which certain observed variables are influenced by a discrete latent confounder. Under appropriate non-degeneracy conditions, we reveal a fundamental connection between the rank of probability tensors and d-separation patterns in discrete time series models, and we introduce a graphical criterion to characterize this relationship. Building on this insight, we develop an efficient constraint-based temporal causal discovery algorithm, Tensor Rank-based Temporal Causal Discovery (TRTCD), which first recovers the causal skeleton among observed variables and then infers causal relations involving latent variables. Theoretically, we show that TRTCD can recover the causal structure up to a Markov equivalence class, even in the presence of latent confounders. Empirical evaluations on both synthetic and real-world datasets demonstrate the effectiveness of the proposed approach.
Corticobasal syndrome (CBS) is a clinically defined phenotype with different underlying neuropathological substrates most commonly the 4-repeat tauopathy corticobasal degeneration (CBD). 2-[18F] fluoro-2-deoxy-D-glucose Positron Emission Tomography ([18F]FDG-PET) studies have described regional metabolic abnormalities but detailed subcortical and cerebellar structures involvement is less known and metabolic connectivity remains unexplored. This study combined voxel-based, region-of-interest (ROI) analyses and connectivity approaches to further characterize metabolic alterations and to provide a network-level framework in CBS. Thirty-nine CBS patients underwent [18F]FDG-PET at two sites, with images flipped to align the most affected hemisphere; 99 controls were drawn from a national normative database. Voxel-based SPM method and ROIs analysis were performed. Thirty-six bilateral cortical and subcortical regions of interest were processed to perform interregional correlation and network-based analyses within five functional networks. Pairwise Spearman correlations were computed from normalized regional signals. Group differences were assessed at regional and network levels using Fisher-transformed correlations, Cohen's q, permutation testing (10,000 iterations), and graph-theoretical metrics (node strength, clustering coefficient; threshold ρ > 0.25). CBS patients showed asymmetric hypometabolism predominantly in frontal, parietal, and temporal cortices, caudate and thalamus of the predominantly affected hemisphere, with additional contralateral involvement, notably in the cerebellum and caudate. Metabolic connectivity analyses revealed widespread intra- and inter-network disconnection, particularly involving frontal, parietal, and sensorimotor cortices, and thalamo-cortical pathways, with significant lateralization toward the affected hemisphere. Graph analysis showed decreased cortical node strength with relative increases in subcortical hubs and mixed changes in clustering coefficients, suggesting network reorganization. This first [18F]FDG-PET metabolic connectivity study in CBS demonstrates asymmetric and bilateral regional hypometabolism, widespread and lateralized network disconnection, and subcortical reorganization. These findings reflect both degenerative, functional and compensatory mechanisms and highlight metabolic connectivity as a sensitive marker of network-level alterations in neurodegenerative disease.
Uncertainty is inherent within medicine. Evidence-based medicine (EBM) teaching within medical curricula seeks to prepare doctors to make clinical decisions within conditions of uncertainty. The goals and scope of training for medical students and doctors are defined by published EBM competencies. We conducted a scoping review to identify the aspects of clinical uncertainty that are addressed by EBM competencies. A scoping review was conducted to identify and synthesise existing literature and models of clinical uncertainty, with help from an advisory group. Reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Five databases (MEDLINE, EMBASE, PsycINFO, ERIC and Web of Science Core Collection) and supplementary searches. The searches were performed on 7 March, 2023, repeated and updated on 19 February 2025. We included empirical research studies that described uncertainty related to clinical decision-making in medical students and doctors. Screening against the inclusion/exclusion criteria, first using titles/abstracts and then full text, was conducted independently by EJ and one other author. Disagreements were discussed and resolved by the full team. Data from included studies were used to create an overarching framework and typology of clinical uncertainty relevant to EBM, which was then mapped to published EBM competencies. 44 of 3048 papers met the inclusion criteria. The overarching framework and typology described types of uncertainty, properties and modifiers of the uncertainty, which led to responses and strategies that clinicians adopted within conditions of uncertainty. The mapping process revealed that EBM competencies focus on the theoretical, technical and cognitive aspects of clinical uncertainty, and tend to neglect real-world clinical decision-making, doctor-patient interaction and behavioural/emotional responses to uncertainty. The new framework and typology facilitate better conversations about uncertainty within everyday clinical practice. Findings from the mapping exercise can help medical educators to better align EBM teaching with clinical practice, helping them to better prepare doctors for clinical uncertainty. The findings enable different parts of medical curricula to forge stronger connections, for example, linking EBM teaching, communication skills teaching and clinical placements.
Concerns persist regarding the potential long-term effects of general anaesthesia on brain development in children. This narrative review summarises recent preclinical and clinical evidence (2019-25) and updates consensus messages. Preclinical studies show that commonly used anaesthetic agents can interfere with neurodevelopmental processes during vulnerable developmental periods. Clinical evidence is less clear. Randomised trials indicate that a single, short exposure in infancy is not associated with measurable impairment in cognitive outcomes, whereas observational studies report mixed findings. Several large population-based studies consistently identified a small, increased risk of attention-deficit hyperactivity disorder following early exposure to general anaesthesia. Emerging evidence also suggests modifications in visual development and processing, including preferential processing of global visual information, although these findings remain preliminary. Interpretation is limited by confounding related to surgery, comorbidity, and environmental factors. Communication with families should emphasise acknowledgment of parental concerns, individualised anaesthetic care, physiological stability, and that necessary procedures should not be delayed because of theoretical neurodevelopmental risks.
The UK NHS faces increasing pressure to diminish its carbon footprint, with fluorinated anaesthetic agents representing a significant source of direct greenhouse gas emissions. Several NHS trusts retain substantial quantities of unused stock and waste volatile anaesthetics (VAs), particularly desflurane, requiring appropriate disposal. However, a crucial unquantified aspect is the endpoint destruction routes and associated emissions for accumulated desflurane stock and waste anaesthetics. We developed a mathematical model accompanied by an open-source Python-based application programming interface (API) to estimate equivalent carbon emissions and their climate impacts across disposal pathways. Stochastic modelling also estimates uncertainties of input parameters and their effects on model predictions. User-defined input parameters in the API allow practitioners to model specific destruction pathways. We identified high-temperature incineration in clinical waste streams as the most likely route, which, compared with release, shows reductions of more than 70% in equivalent emissions. Model predictions suggest that plasma destruction has the highest potential for reducing equivalent carbon emissions, to less than 5% from all waste fluorinated VAs by reducing the formation of products of incomplete combustion, with an associated reduction in climate impact. Crucial work still needs to be done to validate theoretical estimates, accurately assess the formation of products of incomplete combustion from fluorinated VAs under varying destruction conditions, and evaluate the feasibility of implementing the assessed waste streams.
Reliable theoretical reaction cross sections require nuclear structure inputs that remain physically meaningful over different projectile types, mass regions and reaction mechanisms. In this work, the influence of collective nuclear motion on calculated cross sections was re-examined for four benchmark like reactions: 47Ti(d,2p)47Sc, 74Ge(γ,2n)72Ge, 111Cd(p,n)111In and 160Gd(n,γ)161Gd. Cross section curves obtained with the Collective Semi-Classical Fermi Gas Model (CSCFGM) were compared with EXFOR measurements, default TALYS calculations and TENDL-2025 evaluated residual production data. The analysis shows that the CSCFGM description reproduces the principal experimental features, including threshold behavior, peak location and post peak decrease or saturation, while the degree of improvement depends on the dominant reaction mechanism. The strongest peak agreement is obtained for the 74Ge(γ,2n)72Ge and 111Cd(p,n)111In reactions. The 47Ti(d,2p)47Sc and 160Gd(n,γ)161Gd cases indicate additional sensitivity to deuteron breakup, optical model parameters, gamma ray strength functions and resonance like neutron capture behavior. A dedicated gamma strength sensitivity test for 74Ge(γ,2n)72Ge further demonstrates that the photonuclear peak magnitude cannot be interpreted from the NLD input alone. The novelty of the study is the reaction by reaction evaluation of a common collective NLD framework against experimental data, default TALYS and TENDL, thereby identifying both the predictive value and the limitations of collective enhancement in model based nuclear data calculations.
The combined pollution of heavy metals and antibiotics continues to threaten the safety of water bodies. Adsorption is an effective approach for removing the combined pollution of metals and antibiotics. Low-cost grape stalk biochar (SBC) and grape leaf biochar (LBC) were prepared through direct pyrolysis of grape waste. In the binary system (20mg/L Cu2++10mg/L CTC), the adsorption capacities of SBC for Cu2+ and CTC were 57.46 and 23.54 mg/g, respectively, while those of LBC were 56.71 and 20.82 mg/g, respectively. Compared with single adsorption, the removal rate of Cu2+ increased by 16.49% and 25.36% for SBC and LBC, respectively, the removal rates of CTC increased 26.22% and 41.03% for SBC and LBC, respectively. The adsorption removal process of Cu2+ and CTC followed Pseudo-Second-Order kinetics (PSO), primarily involved chemical adsorption. The adsorption isotherms could be described using a multi-isotherm model, indicating that the removal of Cu2+ and CTC involved multiple mechanisms. In addition to pore filling and electrostatic attraction, the adsorption of Cu2+ was primarily attributed to ion exchange and complexation, whereas the adsorption of CTC was mainly due to hydrogen bonding and π-π electron donor-acceptor (EDA) interactions. Density functional theory (DFT) calculations indicated that after the adsorption of Cu2+, the electron cloud density on the surface of biochar decreased, and CTC transitions from an electron acceptor to an electron donor, confirming that Cu2+ was a bridging molecule in the reaction. The results from the adsorption energy and HOMO-LUMO energy gap indicated that coexistence enhanced the adsorption energy and reduced the energy gap, regulating electronic interactions and achieving a synergistic adsorption effect. These findings provided theoretical basis and data support for the synergistic adsorption and immobilization of heavy metals and antibiotics.
Temporal order perception (TOP), a fundamental cognitive function that enables decoding of event timing, is influenced by perceptual grouping and attention, yet the role of cue validity in the interactive modulation of these two factors remains unclear. The present study adopted C-shaped stimuli composed of three line segments as experimental materials. Drawing on the grouping principle of closure, two experiments were conducted to examine the interactive effects of perceptual grouping and peripheral cues with non-predictive validity (50%, Experiment 1) and counter-predictive validity (20%, Experiment 2) on TOP. The results demonstrated that perceptual grouping facilitates simultaneity perception but impairs sequential perception. Notably, this dual effect of perceptual grouping on TOP is independent of both the validity and predictability of peripheral cues. Furthermore, the prior entry effect was enhanced by non-predictive peripheral cues but attenuated by counter-predictive ones. Perceptual grouping significantly reduced the modulatory effect of attention on TOP. Overall, these findings confirm a hierarchical modulation mechanism of TOP, in which the effect of perceptual grouping takes precedence over that of spatial attention in regulating TOP, and thus provide novel empirical and theoretical insights into the cognitive mechanisms of temporal order processing.
The growing popularity of rooftop rainwater harvesting systems (RRWHS) requires a realistic assessment of their performance. Based on 11 years of monitoring of 40 properties, this article analyses the effectiveness of these systems using key hydrological indicators and compares the model water mass balance with actual outdoor water consumption. It was shown that local conditions (roof area, proportion and size of green areas) and user behaviour have a key impact on the efficiency of the systems, and that theoretical models systematically overestimate water consumption for garden irrigation. The results prove that the use of fixed, hypothetical irrigation schemes in modelling does not reflect actual and behaviourally determined water consumption patterns. Consequently, the need to implement a data-driven approach based on actual sub-meter data and user preferences into calculation algorithms has been emphasised in order to optimise the selection of tank capacity and make the assessment of the hydrological performance of RRWHS more realistic.
Mg alloys have become a new generation of biodegradable medical materials due to their good biocompatibility. However, their rapid corrosion rate in physiological environments and the mismatch between their degradation rate and tissue reconstruction pose challenges for clinical applications. To improve the corrosion resistance and biocompatibility of Mg alloys, drug-loaded corrosion resistant coating has gradually become a research hotspot. In this work, a uniform pH-responsive ZIF-14 coating was in situ synthesized on the surface of Mg alloy via a solvothermal method. Using rapamycin, an anti-restenosis drug, as a model compound, the drug release behavior and biocompatibility of the rapamycin-loaded ZIF-14 coating were evaluated under different pH conditions. ZIF-14 coating exhibited rapid drug release under both acidic and alkaline conditions. The rapamycin-loaded ZIF-14 coating effectively inhibited the excessive proliferation of smooth muscle cells, thereby preventing vascular restenosis after device implantation. Notably, theoretical calculations and experimental characterizations revealed that Zn2+ ions in ZIF-14 precursor solution can coordinate with both imidazole ligands and Mg from the substrate, leading to the formation of a stable ZIF precursor on Mg surface. In addition, ZIF-14 coating enhanced the corrosion resistance of Mg alloy, effectively prolonging its service life. This work provides a new strategy for the design of multifunctional smart coatings on Mg alloy surfaces and shows great potential for applications in biomedical Mg alloy implants. STATEMENT OF SIGNIFICANCE: This study presents a significant advancement in addressing the limitations of biodegradable Mg alloy stents by developing a uniform, and pH-responsive ZIF-14 coating via one-step in situ solvothermal synthesis. Integrating DFT calculations with experimental validation, this research elucidates the intricate coordination mechanism among Zn2+, imidazole ligands, and Mg, offering fundamental insights into MOFs growth on reactive metal surfaces. This coating exhibits dual-trigger pH-responsive drug release, accelerating drug release under both acidic (local inflammation) and alkaline (Mg corrosion) conditions, thus providing a smart solution for localized therapeutic intervention. Furthermore, this nanostructured coating enhances the corrosion resistance and biocompatibility of Mg alloy. This work proposes a strategy for designing multifunctional smart coatings on biodegradable implants, holding potential for biodegradable implants.
Reproductive injury is a core pathological process leading to gamete dysfunction, gonadal structural damage, and impaired reproductive capacity. Basic research has revealed that its pathogenesis involves a complex regulatory network of oxidative stress, inflammatory response, germ cell apoptosis, hypothalamic-pituitary-gonadal (HPG) axis disorder, mitochondrial dysfunction, and epigenetic dysregulation. Panax ginseng C. A. Meyer, a classic medicinal and edible herb, and its bioactive constituents have shown reproductive protective effects in numerous in vitro and in vivo basic studies. This review systematically summarizes the core pathological mechanisms of reproductive injury revealed by basic research, sorts out the main bioactive constituents of ginseng and their remarkable functional characteristics in reproductive protection, focuses on the potent molecular mechanisms and basic research progress of ginseng and its active ingredients against reproductive injury, and identifies the limitations of current basic research and future research directions. This review aims to provide a systematic theoretical basis for further basic research of ginseng in the field of reproductive protection, and to support the in-depth exploration of its intervention mechanism and active ingredient development.
To address low nitrogen removal efficiency in aquaculture tailwater with a low carbon-to-nitrogen ratio, this study constructed a multi-compartment aerobic denitrification reactor (MPBR) integrating nitrification, slow-release carbon, anoxic denitrification, and simultaneous nitrification-denitrification zones. The synergistic effects of temperature (15 °C, 25 °C), hydraulic retention time (HRT; 4 h, 8 h, 10 h), and influent NO₃⁻-N load (20 mg/L, 50 mg/L) on nitrogen removal were investigated, along with microbial community dynamics via high-throughput sequencing. The partitioned structure ensured robust nitrification, with ammonia removal exceeding 90% under all conditions. Denitrification was highly sensitive to multi-parameter interactions: low temperature (15 °C) reduced NO₃⁻-N removal from 89.4% (25 °C) to 38.1%; high load (50 mg/L) increased absolute removal when HRT was sufficient (≥8 h) but caused inhibition when HRT was insufficient; HRT exhibited a threshold (∼8 h), with limited benefit at low temperatures. The simultaneous nitrification-denitrification zone maintained effluent NO₂⁻-N below 0.2 mg/L across all conditions. Pseudomonadota dominated the microbial community (75% average abundance), correlating positively with denitrification efficiency. At the genus level, Pseudomonas thrived at room temperature, whereas Simplicispira enriched significantly in the slow-release carbon zone under low temperature (up to 47.5%), exhibiting complementary succession and sustaining denitrification potential. Spatial niche differentiation across functional zones and functional compensation under stress supported system stability. This study elucidates the multi-factor regulation of aerobic denitrification and microbial compensation mechanisms, providing a theoretical basis for applying partitioned reactors in aquaculture tailwater treatment.
The rational disposal of digestate is a prerequisite for the sustainable development of anaerobic digestion. This study evaluated the feasibility of digestate gasification with a biogas atmosphere to achieve the integration of anaerobic digestion and gasification. Besides, four atmospheres (N2, CO2, CH4 and biogas) were used to explore the effect of biogas atmosphere on digestate gasification performance. The results showed that a CO2 atmosphere could enhance the conversion efficiency of digestate through the Boudouard reaction, while a CH4 atmosphere was conducive to the generation of H2 through the reforming and cracking reactions. Moreover, the CO2 and CH4 in the biogas atmosphere exhibited significant promotional effects during gasification. The syngas yield of digestate gasification in the biogas atmosphere was 1.91 Nm3/kg, and the actual H2 + CO yield was 0.38 Nm3/kg, which was 131% higher than the theoretical value. This study provides a potential approach for the efficient disposal of digestate, and the concept of biorefinery is further strengthened through this innovative integration of anaerobic digestion and gasification.
In metabolic dysfunction-associated steatohepatitis (MASH), abnormalities in post-translational modification (PTM) are both a consequence of the pathological process and a driving force for disease progression. Therefore, this study intends to characterize the PTM features (acetylation, lactylation, and phosphorylation) of MASH, which will provide a crucial theoretical basis for the diagnosis and development of new targets for MASH. In this study, protein/modification profiles of clinical liver tissues from Normal and MASH were analyzed by LC-MS to identify differentially expressed proteins (DEPs) and differentially modified proteins (DMPs) with acetylation, lactylation, and phosphorylation. This study found that acetylation and lactylation occurred mainly in K, whose upstream and downstream amino acids consisted of A, G, K, R, and V. Phosphorylation occurred mainly in S and T, whose upstream and downstream ones consisted of D, E, P, R, and S. Proteomics with ordinary, acetylation, lactylation, and phosphorylation identified 468, 433, 434, and 1,471 DEPs/DMPs, respectively, which mainly regulate cytoskeleton, immunity, proliferation, oxidative stress, inflammatory cascades, various metabolisms (sugars, amino acids, lipids, and carbon). CMKLR1, CYP2E1, GLRX, and XRCC1 were identified as key regulators in the shared DEPs of ordinary proteomics and modification proteomics. Notably, the differences in expression of the four proteins in clinical liver tissues from Normal and MASH were consistent with the proteomics results. In conclusion, this study systematically reveals the global dysregulation of PTM, emphasizing CMKLR1, CYP2E1, GLRX, and XRCC1 as the key proteins/modification sites, and provides new perspectives for targeted intervention in MASH.
The oxygen evolution reaction (OER), a critical process in energy conversion and storage technologies, necessitates highly efficient electrocatalysts to address its inherently sluggish kinetics. In recent years, cobalt-iron (CoFe) composites have emerged as promising candidates for OER in alkaline due to their low cost, abundant reserves, and exceptional catalytic performance. These attributes have driven advancements in the design and development of sophisticated nanostructures such as nanoarrays and core-shell structures. This review focuses on the latest progress in CoFe-based electrocatalysts including alloys, oxides, hydroxides, nitrides, phosphides, and sulfides, with a particular focus on the modification strategies and synthetic methods of diverse CoFe-based electrocatalysts. In particular, the role and mechanisms of the external physical fields used to enhance the OER performance are discussed. At last, the current challenges and future research directions for efficient CoFe-based electrocatalysts are also presented. This review aims to provide theoretical foundations and technical insights for the rational design and broader applications of high-performance CoFe-based electrocatalysts.
Although the extraperitoneal approach is standard in renal transplant, intraperitoneal placement is utilized in pediatric recipients and select adult cases. Concerns exist regarding the safety of percutaneous allograft biopsy in intraperitoneally placed kidneys due to potential visceral injury. We aimed to compare biopsy-related complication rates between intraperitoneal and extraperitoneal kidney transplant recipients. This retrospective cohort study (2022-2024) compared biopsy-related complications in 100 transplant recipients (50 intraperitoneal, 50 extraperitoneal) at Labbafinezhad Hospital. Only 23 patients underwent ultrasonography-guided allograft biopsy (13 intraperitoneal, 10 extraperitoneal) for clinical indications. Demographic, clinical, and transplant-related variables and postbiopsy complications were evaluated. The intraperitoneal group (mean age 39 ±12 years, 69% male) and the extraperitoneal group (mean age 37 ± 13 years, 60% male) were demographically comparable (P > .05). All transplants were from living donors. No significant differences were observed in baseline characteristics, including cause of end-stage renal disease, dialysis vintage, or number of previous transplants. Postbiopsy complications were rare and of minor severity in both cohorts. One patient (7.7% ) in the intraperitoneal group developed a small hematoma (grade 3), and 1 patient (7.7% ) had a minor perinephric collection (40 mL). No such events occurred in the extraperitoneal group, but this difference was not significant (P = .565). No instances of gross hematuria, clinically significant hemoglobin drop, transfusion requirement, hypotension, fistula, or need for angioembolization were recorded in either group. Ultrasonography-guided renal allograft biopsy appears to be a safe procedure with a similarly low complication profile in both intraperitoneal and extraperitoneal transplant recipients. Despite theoretical risks associated with intraperitoneal organ placement, our study found no evidence of increased major or minor complications, supporting the safety of percutaneous biopsy in this population when performed with image guidance.
Liver fibrosis is a key pathological process in the progression of chronic liver disease to cirrhosis and hepatocellular carcinoma, with core features including hepatic stellate cells (HSCs) activation and extracellular matrix (ECM) deposition. Nonetheless, the precise spatiotemporal regulatory mechanisms of its gene expression have not been fully clarified. Interestingly, chromatin accessibility, as a core level of epigenetic regulation, directly determines the expression "switch" of fibrosis-related genes by dynamically altering the chromatin open state, which is closely related to key pathological processes such as HSCs activation, hepatocyte injury, and immune cell infiltration. Chromatin accessibility is coordinately modulated by histone modifications, ATP-dependent chromatin remodelers, CpG methylation, as well as enhancers, super-enhancers, and transcription factors, which together constitute a multilayered epigenetic network. Key regulatory mediators, including histone deacetylases (HDACs), histone acetyltransferase p300 (p300), bromodomain-containing protein 4 (BRD4), DNA methyltransferases (DNMTs), and methyl-CpG-binding protein 2 (MeCP2), have emerged as promising therapeutic candidates. Relevant inhibitors or interventions can inhibit HSCs activation and ECM deposition by reversing abnormal chromatin accessibility. An in-depth study of the regulatory network of chromatin accessibility may provide new perspectives on the pathogenesis of liver fibrosis and lay a theoretical foundation for the development of novel precision-targeted drugs.