Programmed cell death ligand 1 (PD-L1) inhibitors are commonly used in treating advanced-stage urothelial carcinoma (UC). Therefore, this study evaluated the relationship between PD-L1 expression in circulating tumor cells (CTCs) and treatment response to PD-L1 inhibitors using blood samples collected from patients with UC (n = 23). Subsequently, PD-L1 expression and its clinical correlation were analyzed. All patients had CTCs before PD-L1 inhibitory treatment, of which 15 had PD-L1-positive CTCs. However, PD-L1-positive expression in CTCs was not correlated with PD-L1 expression in tumor biopsy samples. Patients with PD-L1-positive CTCs had better disease control (DC) rates than those without PD-L1-positive CTCs. Moreover, changes in the proportion of PD-L1-positive CTCs were associated with disease outcomes. Furthermore, the PD-L1-positive CTC count in 9 of 11 patients who achieved DC had significantly decreased (p = 0.01). In four patients with progressive disease, this was higher or did not change. PD-L1-positive CTCs at baseline could be used as a biomarker to identify patients suitable for PD-L1 blockade therapy. Dynamic changes in PD-L1-positive CTCs during the course of treatment are predictive factors of immunotherapy response and prognostic factors of disease control. Hence, PD-L1-positive CTCs could be employed as a real-time molecular biomarker for individualized immunotherapy.

Background and Objectives: Post-transplant anastomotic pseudoaneurysms are a rare but serious complication of renal transplantation, typically requiring graft sacrifice. This case report demonstrates a novel hybrid approach for managing a mycotic pseudoaneurysm while preserving graft function. Case report: A 56-year-old male developed a pseudoaneurysm at the anastomotic site after cadaveric kidney transplantation, presenting with recurrent infections and declining renal function. Imaging confirmed the pseudoaneurysm. A hybrid strategy combining femoral–femoral bypass with a polytetrafluoroethylene graft, percutaneous transluminal angioplasty with stenting, and coil embolization was performed. Results: The intervention successfully isolated the pseudoaneurysm and preserved graft function. Post-procedure, serum creatinine levels improved, stabilizing at 2.3 mg/dL during follow-up. Imaging confirmed no residual flow in the aneurysm, and vascular complications were absent. Conclusions: This report highlights a successful combined surgical and endovascular approach for treating mycotic pseudoaneurysms, preserving graft function and restoring limb blood flow. This strategy offers a promising alternative for managing complex post-transplant complications, though long-term outcomes require further evaluation.

Extracorporeal membrane oxygenation (ECMO) can deliver effective respiratory and circulatory maintenance to organ donors, improve organ function, and shorten warm ischemic time before harvesting. However, ECMO-supported brain-dead donors (DBDs) still have a high risk of acute kidney injury related to decreased renal oxygen delivery and inflammatory damage, which may cause early graft failure. Kidney transplantation from an ECMO-supported DBD. We found an extremely abnormal “very dark blue” appearance of the graft kidneys from an ECMO-supported DBD during kidney procurement. Rather than discarding the graft kidneys, we performed an on-table biopsy. Pretransplant biopsy results revealed minimal interstitial fibrosis in the section of these graft kidneys. Two candidates received graft kidneys, and the two grafts remained functional until the 8-month follow-up. Currently, there is no standard method for evaluating graft kidney function of ECMO-supported DBDs. Regardless of the donors’ preoperative serum creatinine (SCr) level, estimated glomerular filtration rate (eGFR), or gross appearance of the graft kidney, we believe that it is more reliable to include pretransplant biopsy as a criterion in clinical practice to safely accept kidneys from ECMO-supported DBDs.

Background: Homocysteine (Hcy) is a sulfur-containing amino acid crucial for various physiological processes, with elevated levels linked to cardiovascular and neurological adverse conditions. Various factors contribute to high Hcy, and past studies of impact factors relied on traditional statistical methods. Recently, machine learning (ML) techniques have greatly improved and are now widely applied in medical research. This study used four ML methods to identify key factors influencing Hcy in healthy elderly Taiwanese men, comparing their accuracy using multiple linear regression (MLR). The study seeks to improve Hcy prediction accuracy and provide insights into relevant impact factors. Methods: A total of 468 healthy elderly men were studied in terms of 33 parameters using four ML methods: random forest (RF), stochastic gradient boosting (SGB), eXtreme gradient boosting (XGBoost), and elastic net (EN). MLR served as a benchmark. Model performance was assessed using SMAPE, RAE, RRSE, and RMSE. Results: All ML methods demonstrated lower prediction errors than MLR, indicating higher accuracy. By averaging the importance scores from the four ML models, C-reactive protein (CRP) emerged as the leading impact factor for Hcy, followed by GPT, WBC, LDH, eGFR, and sport volume (SV). Conclusions: Machine learning methods outperformed MLR in predicting Hcy levels in healthy elderly Taiwanese men. CRP was identified as the most crucial factor, followed by GPT/ALT, WBC, LDH, and eGFR.