Search Results (271)

The lung–kidney axis forms an important physiologically integrated system which controls multiple essential functions of the body. An important observation of this interaction is tissue oxygenation and erythropoiesis, a vital process that involves erythropoietin (EPO) release by the kidney to bring red cell production into the bone, while pulmonary gas exchange ensures adequate oxygen delivery to the cells. Subsequently, the lung–kidney activation of the renin angiotensin system (RAS) influences vascular tone, blood pressure, and tissue perfusion, influencing the delivery of oxygen and the body’s requirement for erythropoietin. Additionally, beyond oxygen sensing, studies have evidenced the role of hypoxia-inducible factors (HIFs), inflammatory mediators, endothelial signaling pathways and iron availability. These modulate erythropoietin production, which enhances the process of erythropoiesis and arterial oxygen balance. Localized variations in renal oxygen levels together with hemodynamic control mechanisms enable the body to produce erythropoietin independently from systemic hypoxia conditions. This concept emerged to include the renal oxygen extraction fraction (OFE) and intrarenal microvascular shunting with perfusion oxygen coupling in governing EPO production. The present review refines the traditional knowledge to further expand our understanding of the lung–kidney axis regulating the process of erythropoiesis and arterial oxygen content. The integrative framework demonstrates that pulmonary arterial oxygenation and renal oxygen sensing together with bone hematopoietic responses operate as a unified system which maintains both oxygen equilibrium and hematopoietic balance throughout the body. Full article

Upper-tract urothelial carcinoma (UTUC) represents a biologically distinct and clinically challenging subset of urothelial malignancies, accounting for only 5–10% of urothelial cancers but carrying a disproportionately high risk of advanced disease and recurrence. Historically, management strategies for UTUC have been extrapolated from bladder cancer data, with limited prospective evidence specific to the upper urinary tract. However, recent years have witnessed an expanding number of UTUC-focused clinical trials that are reshaping treatment paradigms across localized, locally advanced, and metastatic disease states. This review examines the evolving landscape of clinical trials in UTUC, highlighting pivotal and ongoing studies that will inform contemporary management. We summarize evidence supporting perioperative systemic therapy, including neoadjuvant and adjuvant chemotherapy, and discuss the expanding role of immune checkpoint inhibitors in both perioperative and metastatic settings. Additionally, we review trials evaluating kidney-sparing approaches, intraluminal therapies, and novel drug-delivery platforms aimed at preserving renal function while maintaining oncologic control. Emerging trial designs incorporating molecular profiling, fibroblast growth factor receptor (FGFR)-targeted therapies, and biomarker-driven patient selection are also explored. Despite meaningful progress, significant gaps remain, including the underrepresentation of UTUC patients in large urothelial cancer trials, heterogeneity in risk stratification, and challenges in trial accrual for this rare disease. We conclude by outlining future directions for UTUC-specific clinical research, emphasizing the need for collaborative, multicenter trials, innovative endpoints, and integrated translational studies to further refine personalized treatment strategies. As the clinical trial ecosystem for UTUC continues to mature, these efforts hold promises for improving outcomes while balancing oncologic efficacy with renal preservation. Full article

In October 2025, an outbreak occurred among farmed Chinese rice-field eels (Monopterus albus) in Jiangxi, China. A Nocardia seriolae strain designated JXMa251025, which has not been previously documented in Chinese rice-field eels, was isolated from moribund fish exhibiting multiple white nodules of various sizes in visceral tissues. Histopathological examination revealed multi-organ damage, including necrosis of liver cells, granulomatous inflammation with hemorrhage in visceral organs, and necrosis of renal glomeruli and tubules accompanied by vascular congestion. Artificial infection trials confirmed that strain JXMa251025 reproduced clinical signs consistent with those observed in the natural outbreak. Infection experiments resulted in 100% mortality in high-concentration challenge groups, with a median lethal dose (LD₅₀) of 9.76 × 10⁵ CFU/mL, indicating high virulence. Whole-genome sequencing revealed a circular chromosome of 8,295,032 bp with a GC content of 68.10%. The genome contains 66 tRNA genes and four copies each of the 23S, 16S, and 5S rRNA genes. Phylogenomic analysis placed strain JXMa251025 within a clade of Nocardia seriolae strains with approximately 99% bootstrap support, confirming its identification as Nocardia seriolae. Further genomic screening identified 253 potential virulence genes associated with nutrient metabolism, regulatory systems, immune modulation, effector delivery, and exotoxin production. Antibiotic susceptibility testing showed that strain JXMa251025 was sensitive to seven antibiotics: ciprofloxacin, neomycin, enrofloxacin, florfenicol, gentamicin, amikacin, and doxycycline. This study represents the first report of Nocardia seriolae infecting Chinesse rice-field eels, providing useful descriptive information for disease diagnosis and reference. Full article

siRNA, as a precise, specific, and highly effective gene-silencing therapy, has been extensively studied. Before reaching tumor cell targets, siRNA formulations must overcome multiple extracellular barriers, including clearance from the bloodstream, membrane impermeability, capture by the mononuclear phagocyte system (MPS), rapid renal excretion, endosomal escape, and precise recognition of target cells. These challenges limit siRNA’s clinical application. Consequently, various modifications have been applied to siRNA to enhance transfection efficiency, while researchers continue to pursue improved siRNA-targeting delivery systems. Nanotechnology offers a rational technical approach to address siRNA delivery. Nanoparticles can increase transfection efficiency while exhibiting lower cytotoxicity and reduced off-target effects. Various matrices have been employed to construct nanoparticles for targeted therapeutic delivery. This review briefly discusses siRNA nanoparticle delivery strategies, illustrates examples of various siRNA nanodelivery systems, such as lipid nanoparticles, polymeric siRNA nanoparticles, inorganic nanoparticles, hybrid nanoparticles, and conjugate-siRNA delivery systems, and introduces clinical trials of siRNA-loaded nanoparticles for cancer treatment, which can provide valuable references for further research and clinical application of siRNA nanoparticle delivery systems. Full article

Chronic kidney disease (CKD) involves uremic toxin-driven tubular injury and systemic vascular dysfunction, in which mitochondrial impairment and apoptotic cell loss contribute to progressive tissue deterioration. Accordingly, a targeted EV platform is required to enable efficient miRNA delivery to the toxin-stressed tubular–endothelial compartment. Based on our previous study showing that melatonin restores miR-4516 levels under CKD-related stress, we directly loaded miR-4516 into engineered extracellular vesicles (EVs) to evaluate its effects on mitochondrial function and cell survival. Here, we engineered EVs with a G3-C12/RGD surface modification and established a miR-4516 loading strategy to enhance delivery to kidney proximal tubule cells and vascular endothelial cells. miR-4516 loading increased EV-associated miR-4516 levels without major changes in particle size distribution, and EV identity was supported by CD9 and CD81 expression. Confocal microscopy and flow cytometry demonstrated increased cellular uptake of miR-4516-loaded G3-C12/RGD-EVs compared with control EVs in TH1 proximal tubule cells and HUVECs. Under indoxyl sulfate stress, engineered EV treatment restored intracellular miR-4516 and improved mitochondrial function, as indicated by recovery of respiratory Complex I and Complex IV activities and improved Seahorse bioenergetic parameters (OCR/ECAR, basal and maximal respiration, ATP-linked respiration, and spare respiratory capacity). Annexin V staining further indicated reduced toxin-induced apoptosis. In an adenine diet-induced CKD mouse model, intravenous administration of miR-4516-loaded G3-C12/RGD-EVs improved urinary albumin-to-creatinine ratio (UACR), blood urea nitrogen (BUN), and serum creatinine. These findings indicate that miR-4516-loaded, targeting-engineered EVs may mitigate uremic toxin-associated mitochondrial dysfunction and renal impairment in CKD. Full article

Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE), characterized by immune system disorders and multiple organ damage. Current clinical treatment of LN requires a complex multi-drug combination, which is often associated with severe side effects and low patient compliance. The aim of this study was to design a self-nanoemulsifying drug delivery system (SNEDDS) co-loading total glucosides of Paeonia (TGP) and dihydroartemisinin (DHA) to increase the solubility of the drug as well as achieve synergistic anti-inflammatory and immunomodulatory effects for LN therapy. Network pharmacology, molecular docking and molecular dynamics simulations were employed to predict the core therapeutic targets and related signaling pathways. The SNEDDS co-loaded with TGP and DHA was optimized via central composite design response surface methodology (CCD-RSM). Its physicochemical properties, particle size and the polydispersity index (PDI) of the optimized formulation were characterized. In vivo therapeutic efficacy was evaluated in MRL/lpr mice by measuring disease-related indicators (urinary protein, serum ANA, and anti-ds-DNA) and inflammatory cytokines (TNF-α, IL-6, and IL-1β). Renal tissue pathology was also examined. All data were analyzed by one-way analysis of variance (ANOVA) with p < 0.05 considered statistically significant. The core therapeutic targets predicted with high relevance were AKT1, MAPK1, MAPK3, and RELA. The optimized SNEDDS achieved a high loading capacity of 16.11 ± 0.43 mg/g for TGP and 12.79 ± 1.33 mg/g for DHA, with a particle size of (25.84 ± 0.30) nm and PDI of (0.07 ± 0.02). In MRL/lpr mice, SNEDDS treatment significantly reduced urinary protein levels (p < 0.01), serum ANA (p < 0.01) and anti-ds-DNA titers (p < 0.01) compared with the model group. Additionally, the levels of pro-inflammatory cytokines (TNF-α, IL-6, and IL-1β) were markedly decreased (p < 0.05), and renal tissue damage was alleviated. Conclusions: The SNEDDS co-loaded TGP and DHA is a promising oral nanotherapeutic strategy for LN, offering synergistic anti-inflammatory and immunomodulatory effects. Full article

Percutaneous computed tomography (CT) -guided cryoablation is an effective curative treatment for renal cell carcinoma. Improvements in treatment efficacy reflect not only the learning curve but also the integration of multiple adjunctive techniques that can be implemented at different stages of the procedure. Tumour targeting can be enhanced by intravenous contrast administration, or by intra-arterial delivery of contrast medium or iodized oil. Fusion imaging is another option to improve tumour delineation by registering intraprocedural CT with prior cross-sectional imaging. Probe placement for difficult-to-access lesions may be facilitated by alternative access routes, while electromagnetic navigation and robotic systems are being developed as alternatives to manual advancement. To mitigate the cold-sink effect and reduce bleeding risk, transarterial techniques such as embolization or temporary arterial occlusion can be added. Finally, thermoprotective manoeuvres are increasingly used to displace adjacent organs, thereby improving the feasibility, safety, and efficacy of renal cryoablation. Full article

Background: Online hemodiafiltration (HDF) represents the most advanced form of kidney replacement therapy, combining diffusive and convective transport to enhance the removal of uremic toxins across a wide molecular spectrum. Achieving high convective volumes is a key determinant of treatment efficacy and has been associated with improved survival. Beyond small solutes, HDF targets middle molecules and protein-bound uremic toxins (PBUTs), including β₂-microglobulin, inflammatory cytokines, and other large uremic compounds implicated in cardiovascular and systemic complications. Aims: This narrative review examines advances in dialysis membrane materials, dialyzer design, and monitoring technologies that optimize mass transfer in HDF. It focuses on the interplay between membrane permeability, hemocompatibility, and convective dose delivery, and discusses how these engineering developments translate into clinical performance. Key mechanisms: Recent progress in synthetic polymer membranes, particularly polysulfone- and polyethersulfone-based systems, and hollow-fiber manufacturing has enabled improved control of pore size distribution, hydraulic permeability, and sieving characteristics. These developments enhance the clearance of middle molecules and selected PBUTs while preserving essential proteins such as albumin. Mechanistic insights into internal filtration, protein polarization, and Donnan effects highlight the complex transport processes occurring within the dialyzer and their interaction with automated HDF systems. Expanded hemodialysis and high-volume HDF approaches further increase the removal of larger solutes but require careful management to limit albumin loss and maintain hemocompatibility. Clinical implications: Optimized membrane design, combined with advanced HDF machine algorithms, allows delivery of high convective volumes under safe and stable conditions, improving removal of β₂-microglobulin, cytokines, and other clinically relevant toxins associated with inflammation and cardiovascular risk. However, treatment must remain individualized, considering electrolyte balance, albumin preservation, and patient-specific factors such as inflammation and nutritional status. Mechanistic modeling supports understanding of transport phenomena but must be interpreted cautiously when translated into clinical practice. Conclusions: Advances in membrane science, dialyzer engineering, and monitoring technologies have strengthened the role of HDF as a precision-based renal replacement therapy. Continued innovation aimed at optimizing middle-molecule and PBUT clearance while preserving albumin and treatment stability is essential to improve patient outcomes and support the broader implementation of HDF as a mainstream dialysis modality. Full article

Diabetic kidney disease (DKD) remains a leading cause of end-stage renal disease worldwide, with current therapies often failing to halt its progression due to an incomplete understanding of intrinsic renal molecular mechanisms. This review highlights the pivotal role of non-coding RNAs (ncRNAs)—including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs)—as central regulators in the pathogenesis and progression of DKD. We systematically examine how the diabetic milieu dysregulates specific ncRNA profiles in renal cells, driving core pathological processes such as metabolic dysfunction, inflammation, fibrosis, and podocyte injury. Furthermore, we explore the emerging roles of exosomal ncRNAs in intercellular communication and their potential as non-invasive liquid biopsy biomarkers for early diagnosis and disease monitoring. Finally, we discuss the translational prospects of targeting ncRNAs through innovative therapeutic strategies, such as antisense oligonucleotides and miRNA mimics, while addressing the challenges of tissue-specific delivery and clinical implementation. Understanding ncRNA networks offers a refined, systems-level perspective on DKD and opens new avenues for precision diagnostics and targeted interventions aimed at modifying the disease course. Full article

Background: Diabetes mellitus is a global health challenge associated with chronic complications like diabetic nephropathy and diabetic foot infections. Diabetic nephropathy, mediated by hyperglycemia-induced activation of the polyol pathway, represents a primary cause of end-stage renal disease. Additionally, infections caused by multidrug-resistant bacteria like Enterococcus faecalis lead to amputations and contribute to morbidity in diabetic patients. Methods: In this study, we synthetized nitrogen-doped carbon dots (N-CDs) using succinic acid with either hexamethylenediamine (N-HCD) or ethylenediamine (N-ECD) and evaluated their potential therapeutic applications. Results: Both N-HCD and N-ECD demonstrated a significant reduction in aldose reductase (AR) and sorbitol dehydrogenase (SDH) in vitro, with a substantial reduction in polyol pathway enzymatic activity. Furthermore, these N-CDs exhibited antibacterial activity against E. faecalis in vitro. Conclusions: Taken together, our findings suggest that N-HCD and N-ECD represent promising candidates for addressing diabetes-related complications and warrant further investigation for potential drug delivery applications. Full article

Background: Prostate cancer is a leading malignancy among males, and conventional chemotherapy is often limited by insufficient tumor selectivity and systemic toxicity. Prostate-specific membrane antigen (PSMA), which is highly expressed on prostate cancer cells, represents a promising target for precision drug delivery. In this study, we developed a folate-modified, PSMA-targeting nanoliposome loaded with docetaxel (DFL) to enhance tumor specificity and therapeutic efficacy. Methods: DFL was prepared using a thin-film hydration–sonication method and characterized through physicochemical analyses. Cellular uptake and cytotoxicity were evaluated in PSMA-high LNCaP cells, with PSMA knockdown used to assess target-dependent internalization. Antitumor efficacy was examined with a microfluidic system and LNCaP xenograft nude mice, and safety was evaluated by measuring hepatic and renal biomarkers and performing histopathological analysis of major organs. Results: DFL demonstrated favorable physicochemical properties and significantly enhanced cellular uptake and cytotoxicity in LNCaP cells relative to control formulations. PSMA knockdown markedly attenuated cellular sensitivity to DFL, confirming PSMA-dependent internalization. A 3D microfluidic perfusion platform further corroborated robust and selective DFL uptake under dynamic flow conditions, thereby strengthening the translational relevance of the targeting effect beyond static cultures. In vivo, DFL substantially inhibited tumor progression in LNCaP xenograft models, reducing both tumor volume and weight by more than 50%. TUNEL assays showed increased apoptosis, and immunohistochemistry revealed reduced Ki-67 expression with concomitant upregulation of Caspase-3. No significant alterations in hepatic or renal biomarkers were observed, and histopathological evaluation demonstrated no treatment-associated lesions in major organs. Conclusions: A folate-modified, PSMA-targeting docetaxel nanoliposome was successfully developed, demonstrating enhanced tumor-specific drug delivery and improved antitumor activity with favorable biocompatibility in preclinical models. DFL represents a promising nanomedicine strategy for the precision chemotherapy of prostate cancer. Full article

Obstetric critical care encompasses the management of pregnant and postpartum women with life-threatening conditions, requiring integration of intensive care principles with pregnancy-specific physiological, ethical, and organizational considerations. Although pregnancy is a physiological state, profound maternal adaptations may mask early signs of clinical deterioration, allowing rapid progression to a critical illness condition. This review provides a comprehensive overview of the foundations of obstetric intensive care, addressing maternal–fetal physiology, recognition of severity, organ support strategies, and contemporary models of care. Key aspects discussed include cardiovascular, respiratory, renal, and hematological adaptations of pregnancy; principles of airway management and mechanical ventilation; hemodynamic support; transfusion strategies guided by viscoelastic testing; renal replacement therapy; extracorporeal support, including extracorporeal membrane oxygenation and cardiopulmonary bypass; and the safe use of diagnostic imaging involving ionizing radiation. The role of point-of-care ultrasonography, structured early warning systems, and advanced monitoring in early detection and management of clinical deterioration is emphasized. Special attention is given to maternal–fetal interactions, fetal monitoring in the intensive care unit (ICU), and complex decision-making regarding timing and mode of delivery. The review also highlights the importance of multidisciplinary and multiprofessional collaboration, ethical challenges inherent to dual-patient care, and emerging strategies to expand access to specialized care, including tele–ICU models and artificial intelligence–assisted surveillance. Across all scenarios, maternal stabilization remains the primary determinant of fetal outcome. A structured approach grounded in maternal–fetal physiology and ethical principles is essential to reduce preventable maternal and perinatal morbidity and mortality in high-complexity settings. Full article

This study aims to establish diagnostic reference levels (DRLs) for common pediatric nuclear medicine (NM) procedures performed within the Dubai Health sector. The established DRLs will serve as a benchmark for pediatric NM practice, supporting standardized healthcare delivery and guiding ongoing quality improvement and internal audit activities. Patient dose survey data were collected from the solo NM center within the Dubai Health sector. The study included common scintigraphy procedures using gamma cameras and the hybrid positron emission tomography with computed tomography (PET/CT) procedures. Scintigraphy procedures include the dynamic and static renal scans, and ocular eye scans. The hybrid PET/CT procedures entail tumor/infection and neuroendocrine scans. Patient demographics, administered activities, CT doses, and study description were recorded. Both weight bands of <5, 5–<15, 15–<30, 30–<50, and 50–<80 kg, and age bands of <1, 1–<5, 5–<10, and 10–<15 years were considered. Statistical analysis was performed to determine the 25th percentile, median and 75th percentile of the dose distribution. The median value was used to establish the DRLs for the Dubai Health sector. The analyses revealed significant variation in the administered activities across the different pediatric NM procedures. The proposed DRLs for various pediatric NM procedures for the weight band 15–<30 kg are as follows: renal dynamic 98.4 MBq, renal static 96.2 MBq, ocular eyes 18.5 MBq, tumor/infection 155 MBq, and neuroendocrine 80 MBq. This work provides the first pediatric NM DRLs for the Dubai Health sector, offering a key reference for developing the local DRLs for the Emirate of Dubai. The findings indicate that achieving meaningful dose optimization will require systematic revision of existing imaging protocols, with targeted parameter adjustments informed by continuous dose monitoring and benchmarking to enhance patient safety and overall diagnostic quality. Full article

Background: Combination chemotherapy using nanotechnology-based delivery is a promising approach to improve cancer treatment, but the added value of co-loaded polymeric nanocarriers has not been comprehensively appraised. This review synthesizes preclinical evidence on polymeric systems co-encapsulating antitumor agents. Methods: A narrative literature review identified 33 preclinical studies (2015–2025) employing polymer-based nanocarriers to co-load at least two antitumor drugs. Study characteristics and in vitro and in vivo outcomes were qualitatively analyzed. Results: Most studies addressed breast, lung, or ovarian cancer and used micelles or nanospheres. Co-loaded formulations consistently enhanced in vitro cytotoxicity and, in vivo, produced marked tumor growth inhibition relative to free drugs or single-loaded systems; in several reports, near-complete or complete tumor regression was achieved. Synergy was frequently suggested but not consistently quantified, more than half of the studies did not report a combination index. Most formulations showed favorable tolerability, with few reports including mild hepatic toxicity, renal, or weight-related effects. Beyond conventional drug pairs, examples of co-delivering chemotherapeutics with resistance modulators, gene therapy agents, or targeted ligands illustrated how tailored release profiles and active targeting can potentiate efficacy. Nevertheless, heterogeneity in models, dosing schedules, endpoints, and limited long-term safety data hamper cross-study comparison and translation. Conclusions: Co-loaded polymeric nanocarriers constitute a promising platform to optimize combination chemotherapy, improving preclinical antitumor efficacy with generally limited toxicity, but more standardized and mechanistically driven studies are required to support clinical development. Full article

Background/Objectives: The emergence of immune-evasive SARS-CoV-2 variants highlights the need for adaptable vaccine strategies. Trimeric receptor-binding domain (tRBD) antigens offer structural and immunological advantages over monomeric RBDs, but DNA vaccine efficacy has been limited by inefficient antigen expression, particularly in non-dividing antigen-presenting cells. Although cytoplasmic transcription–based DNA platforms have been developed to overcome nuclear entry barriers, their utility for antigen structure–function optimization remains underexplored. This study evaluated whether integrating a rationally designed trimeric RBD with a T7-driven cytoplasmic transcription system could enhance immunogenic performance. Methods: A DNA vaccine encoding a tandem trimeric SARS-CoV-2 RBD was delivered using a T7 RNA polymerase-driven cytoplasmic transcription system. In vitro antigen expression was assessed following Lipofectamine 3000-mediated transfection. In vivo, mice were immunized with the SM-102-based Rpol/tRBD/LNP formulation, and immunogenicity was assessed by antigen-specific antibody titers, serum neutralizing activity, and T-cell response profiling, together with basic safety/tolerability evaluations. Results: The T7-driven cytoplasmic transcription system markedly increased antigen mRNA and protein expression compared with conventional plasmid delivery. Rpol/tRBD vaccination induced higher anti-RBD IgG titers, enhanced neutralizing antibody activity, and robust CD8⁺ T cell responses relative to monomeric RBD and plasmid-based trimeric RBD vaccines. Immune responses were Th1-skewed and accompanied by germinal center activation without excessive inflammatory cytokine induction, body-weight loss, or hepatic and renal toxicity. Conclusions: This study demonstrates that integrating rational trimeric antigen engineering with direct cytoplasmic transcription enables balanced and well-tolerated immune activation in a DNA vaccine context. The T7 autogene-based platform provides a flexible framework for antigen structure–function optimization and supports the development of next-generation DNA vaccines targeting rapidly evolving viral pathogens. Full article