Surgery:

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Cellular senescence has been identified as a potential driver of age-associated loss of organ function and as a mediator of age-related disease. Novel strategies in targeting senescent cells have shown promise in several organ systems to counteract functional decline, chronic inflammation, and age-dependent loss of repair capacity. Transgenic models have provided proof of principle that senolysis, the elimination of senescent cells, is an attractive strategy to overcome many age-related pathologies. The translation into clinical application is now possible with the emergence of drug-based senotherapies. In this review, we will discuss different senotherapeutic approaches and their modes of action. Senolytics eliminate senescent cells preferentially through the induction of apoptosis in senescent but not in normal cells, whereas senomorphics rather interact with the proinflammatory profile present in senescent cells. In the context of transplantation, the natural clearance of senescent cells might be reduced because of dysfunctional immune surveillance under immunosuppression. The transplantation setting allows for different applications of senotherapies. Conditioning donor organs before and during the ex situ phase offers the opportunity to interfere with accumulating senescence, ultimately reducing the burden of life-limiting comorbidities in chronically ill recipients.

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Adhesive capsulitis is characterized by limited range of motion (ROM) due to adhesions within the glenohumeral joint capsule. The pathophysiology is suspected to involve an inflammatory reaction progressing to fibrotic contracture. Active fibroblastic proliferation can be found on histologic analysis, with some transformation to myofibroblasts, ultimately creating collagen in the form of a thick band. Clinically, adhesive capsulitis is classified into phases: freezing, frozen, and thawing. Risk factors include diabetes, hyperthyroidism, prior fractures, shoulder and cervical spine surgery, and radiation therapy. The condition affects 2% to 5% of individuals, with higher rates in women. While plain radiographs are often unremarkable, magnetic resonance imaging may reveal a thickened capsule, synovial hypertrophy, and joint capsule edema. Nonsurgical treatment focuses on pain relief and restoring ROM and includes physical therapy (PT), oral anti-inflammatory medications, corticosteroid injections, extracorporeal shock wave therapy, and ultrasonography-guided hydrodistention. Early corticosteroid injections are associated with shortened symptom duration and improved functional scores. Both a rotator interval approach, compared with a posterior approach, and lower dosages (10 mg vs 40 mg) of corticosteroid may lead to better pain relief and functional improvement. Ultrasound-guided hydrodilatation with hyaluronic acid combined with PT has also shown superior outcomes compared with PT alone. For patients with diabetes, extracorporeal shock wave therapy avoids potential metabolic complications from steroids. Adhesive capsulitis is self-limiting, with most patients achieving symptom resolution without surgery. Surgical intervention, typically considered after 9 to 12 months of failed nonsurgical management, includes arthroscopic capsular release, manipulation under anesthesia (MUA), or both. Both approaches are efficacious, with improved pain, ROM, and functional scores. Although MUA may be more cost-effective, arthroscopy allows direct visualization and treatment of pathology while reducing the risk of complications from MUA, such as fracture, dislocation, or nerve injury. Postoperative protocols emphasize early PT supplemented by multimodal pain management to maintain and improve ROM.

This is a perspective of what it was like going through the diagnosis of advanced heart failure and subsequent heart transplant surgery in 2019.

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The 2024 Annual Congress of the International Liver Transplantation Society (ILTS) was from May 1-4 in Houston, Texas, USA, under the theme "Liver Disease and Transplantation: Breaking Barriers and Exploring New Frontiers." In addition to a robust scientific program, the congress also hosted a hands-on cadaveric robotic liver surgery course, a machine perfusion workshop, and a transesophageal echocardiography course. In this report, the ILTS Vanguard and Basic Sciences Committees present a summary of the congress proceedings.

Tissue-resident lymphocytes (TRLs) provide a front-line immunological defense mechanism uniquely placed to detect perturbations in tissue homeostasis. The heterogeneous TRL population spans the innate to adaptive immune continuum, with roles during normal physiology in homeostatic maintenance, tissue repair, pathogen detection, and rapid mounting of immune responses. TRLs are especially enriched in the liver, with every TRL subset represented, including liver-resident natural killer cells; tissue-resident memory B cells; conventional tissue-resident memory CD8, CD4, and regulatory T cells; and unconventional gamma-delta, natural killer, and mucosal-associated invariant T cells. The importance of donor- and recipient-derived TRLs after transplantation is becoming increasingly recognized, although it has not been examined in detail after liver transplantation. This review summarizes the evidence for the roles of TRLs in liver transplant immunology, focusing on their features, functions, and potential for their harnessing to improve transplant outcomes.

CONCLUSIONS: Proteomic analysis reveals unique biomarkers and biological pathway expression in ACR and AMR. Cardiac injury-associated biomarkers were more pronounced in AMR, whereas inflammatory biomarkers were more pronounced in ACR. Proteomic analysis may provide insights into rejection pathophysiology, detection, and therapy.

Heart and lung transplantation remain the primary treatments for end-stage organ failure; yet organ shortages and ischemia-reperfusion injury (IRI) limit their success. Extended criteria donors (ECDs) have expanded the donor pool; however, prolonged cold ischemia times increase the risk of primary graft dysfunction (PGD). Static cold storage (SCS), the standard organ preservation method, is suboptimal, leading to mitochondrial dysfunction, ATP depletion, and oxidative stress. Recent advancements in organ storage show promise in maintaining graft viability. Mitochondria are key regulators of cellular homeostasis, and their dysfunction exacerbates IRI, contributing to inflammation and graft failure. Mitochondrial transplantation (MTx) has emerged as a novel therapeutic strategy to restore cellular bioenergetics, reduce oxidative stress, and improve graft function. Further research is needed to optimize MTx protocols and integrate them into current preservation techniques to enhance transplant success and long-term graft survival.

In solid organ transplantation, the alloimmune response is traditionally attributed to the action of alloreactive T cells that recognize mismatched human leukocyte antigens (HLA), and by antibody formation and antibody-mediated rejection. However, recent evidence indicates that these paradigms of involvement of the adaptive immune system in organ transplant rejection don't explain all cases of graft inflammation, and that innate cell allorecognition plays a role. This review, conducted by the innate team of the Sensitization in Transplantation Assessment of Risk (STAR) workgroup, summarizes the concepts and empirical evidence supporting innate allorecognition. The focus is on NK cell activation via missing self and monocyte activation through SIRPα-CD47 pathway and SIRPα gene polymorphisms. A consensus definition of genetic missing self is proposed, necessitating both donor and recipient HLA class I genotyping, and evaluation of recipient inhibitory killer-cell immunoglobulin-like receptor (KIR) genotype. While in vitro studies and preclinical validations corroborate the potential of innate allorecognition concepts, further research is required to establish clinical utility. This article delineates future research directions to bridge the gap between theoretical promise and practical application in clinical transplantation.

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Simultaneous heart liver transplantation (SHLT) has expanded in recent years, bolstered by increases in congenital heart disease (CHD) indications and improvements in organ preservation. We performed a contemporary analysis of patients undergoing SHLT for CHD vs non-CHD, further exploring the impact of machine perfusion (MP). Patients undergoing SHLT between 2010-2024 were retrospectively identified using the UNOS database, assessing a primary outcome of patient survival and secondary outcome of MP utilization. 535 patients underwent SHLT, 224(41.9%) with CHD indication and 311(58.1%) non-CHD. CHD recipients had significantly lower one-(72.9% vs. 89.4%,p<0.01) and five-year survival (66.1% vs. 81.4%,p<0.01) compared to non-CHD recipients. CHD indication was independently associated with a two-fold increased mortality risk, compared to a non-CHD diagnosis (HR:2.31, 95%CI:[1.53,3.47]). Decision tree boosting demonstrated a 2.9% higher relative mortality likelihood after SHLT for recipients with CHD. From 2022-2024, SHLT MP utilization for CHD increased; among 111 patients, 18.0% received a MP liver, 8.1% a MP heart, and 10.8% MP heart and MP liver. In this analysis of modern SHLT cases, patients with CHD had suboptimal outcomes; several donor and recipient factors also impacted mortality. Awareness of these factors can guide pre-transplant optimization, donor/recipient matching, and strategic MP use to improve survival.

Congratulations to James H. Lubowitz, M.D., outgoing Editor-in-Chief (EIC) and now EIC Emeritus for successfully leading the Arthroscopy journal. He has been an integral part of the Journal's history, contributing to its success, forwarding its impact, and representing the interests of readers, researchers, and authors to improve patient care, which has set the stage for our vision. The insight of our EIC Emeriti ultimately yielded the 3 sister Arthroscopy journals (Arthroscopy; Arthroscopy, Sports Medicine, and Rehabilitation; and Arthroscopy Techniques) combined with Visual Abstracts, Infographics, and Podcasts, that provide a full family of resources for arthroscopic and related researchers with which to avail themselves in their education and care of patients. Our EIC Emeriti have provided the momentum to achieve our vision: Arthroscopy and its family of journals aspire to be the premier international, peer-reviewed platform showcasing high-impact research, innovative clinical practice, and cutting-edge technologies in arthroscopic surgery, sports medicine, rehabilitation, and related fields to advance high-quality patient care. As readers, authors, researchers, clinicians and editors, we provide our family of journals as a "platform" at your disposal to advance your knowledge and care of patients.

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Hamstring pathology is both a common, and commonly missed, source of pain. Acute traumatic tears can be missed or underappreciated, and hamstring tendinopathy and partial-thickness tears are often atraumatic with insidious onset. Partial-thickness hamstring tears or tendinopathy can be underappreciated on magnetic resonance imaging or missed in conjunction with concomitant pathology. Ultrasound-guided diagnostic injections are invaluable tools when sorting through concomitant pathologic processes. If noninvasive treatment options are unsuccessful, injections and surgery are options. Corticosteroid injections have limited utility; platelet-rich plasma injections have shown promise. When surgical treatment is warranted, both endoscopic and open techniques allow for improvement. Although technically demanding, endoscopic hamstring repair allows minimally invasive access to the entirety of the ischial tuberosity, magnified viewing of the tendon structure, and the ability to visualize both the sciatic nerve as well as the posterior femoral cutaneous nerve. These latter 2 structures are most at risk. Maintaining orientation with fluoroscopy enhances arthroscopic understanding of the deep gluteal space, with the posterior aspect of the ischium acting as a safe zone from which careful surgical dissection can begin.

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Islet transplantation in mice serves as a crucial preclinical model for understanding alloimmune and autoimmune mechanisms, optimizing immunosuppressive strategies, and developing novel therapies for diabetes. This review provides a comprehensive overview of best practices in murine islet transplantation, including diabetes induction models, technical aspects of islet transplantation, and criteria for transplant graft and rejection. We discuss the immunological challenges posed by major histocompatibility complex disparities, the impact of various transplantation sites, and the limitations of murine models in translating findings to clinical settings. Special emphasis is placed on emerging strategies such as stem cell-derived insulin-producing cells, immune tolerance induction, and alternative transplantation sites. Although mouse models have significantly advanced our understanding of diabetes and β-cell replacement, their inherent differences from human physiology necessitate careful interpretation of findings. The review also highlights novel imaging modalities, immunosuppressive protocols, and biomarkers for graft monitoring, underscoring the need for further refinement of these models to bridge the gap between experimental research and clinical application. By standardizing methodologies and addressing translational limitations, murine islet transplantation studies remain a key model in transplantation and can continue to shape the future of β-cell replacement therapies for insulin-dependent diabetes.

AIMS: There is increasing emphasis on applying AI techniques to enhance healthcare delivery and decision-making. However, despite much interest and early promise, a major challenge is translation into clinical practice. To address the challenges of AI deployment, optimize implementation, and establish strategies for effective utilization of AI technology in healthcare, we aimed to answer the question: what are the key determinants influencing effective deployment of AI technology in healthcare?