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Summary This study aims to examine and compare the effectiveness of dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) and Digital Subtraction Angiography (DSA) in evaluating hypervascular spinal metastases. A comprehensive literature review was conducted, utilizing top‐tier databases such as PubMed, Scopus and Google Scholar, to compile an authoritative and up‐to‐date overview of the current advancements in the field. We synthesized key studies focusing on the advantages, limitations and efficacy of both imaging techniques. DCE‐MRI provides a non‐invasive method for evaluating tissue morphology, perfusion and vascularity, offering valuable information for cancer diagnosis and treatment monitoring. In contrast, DSA is an invasive procedure primarily used for embolization and diagnosing cerebrovascular events. Both modalities have distinct features regarding image acquisition, contrast agents, resolution and accessibility. DCE‐MRI shows promise for cancer‐related applications, offering advantages over conventional MRI by incorporating anatomical and hemodynamic parameters. While DSA remains important for cases requiring critical vascular information, further research is necessary to explore its potential therapeutic benefits in assessing vessel patency. Continued investigations are crucial to uncover additional insights and therapeutic applications for both DCE‐MRI and DSA in medical imaging. [ABSTRACT FROM AUTHOR]

Background and objectives: This study aimed to employ machine learning techniques to predict the clinical efficacy of acupuncture as an intervention for patients with upper limb motor dysfunction following ischemic stroke, as well as to assess its potential utility in clinical practice. Methods: Medical records and digital subtraction angiography (DSA) imaging data were collected from 735 ischemic stroke patients with upper limb motor dysfunction who were treated with standardized acupuncture at two hospitals. Following the initial screening, 314 patient datasets that met the inclusion criteria were selected. We applied three deep-learning algorithms (YOLOX, FasterRCNN, and TOOD) to develop the object detection model. Object detection results pertaining to the cerebral vessels were integrated into a clinical efficacy prediction model (random forest). This model aimed to classify patient responses to acupuncture treatment. Finally, the accuracies and discriminative capabilities of the prediction models were assessed. Results: The object detection model achieved an optimal recognition rate, The mean average precisions of YOLOX, TOOD, and FasterRCNN were 0.61, 0.7, and 0.68, respectively. The prediction accuracy of the clinical efficacy model reached 93.6%, with all three-treatment response classification area under the curves (AUCs) exceeding 0.95. Feature extraction using the prediction model highlighted the significant influence of various cerebral vascular stenosis sites within the internal carotid artery (ICA) on prediction outcomes. Specifically, the initial and C1 segments of the ICA had the highest predictive weights among all stenosis sites. Additionally, stenosis of the middle cerebral, anterior cerebral, and posterior cerebral arteries exerted a notable influence on the predictions. In contrast, the stenosis sites within the vertebral artery exhibited minimal impact on the model's predictive abilities. Conclusions: Results underscore the substantial predictive influence of each cerebral vascular stenosis site within the ICA, with the initial and C1 segments being pivotal predictors. [ABSTRACT FROM AUTHOR]

Purpose. Arterial supply of thalamus is complex and highly variable. In particular, the distribution pattern of thalamoperforating arteries received more attention some decades ago than in recent years. Methods. We are presenting the case of a 46-year-old patient with wake-up drowsiness, complex oculomotor disorder and dysarthria. He was investigated in the acute phase using non-contrast brain Computed Tomography (NCCT), CT Angiography (CTA), and in the following days Digital Subtraction Angiography (DSA) was performed Results. The NCCT showed a subacute ischemic stroke in the right anterior thalamus and rostral midbrain with normal findings on CTA. DSA imaged a variant of thalamic supply (Percheron type III), constituted by perforating branches arising from an artery bridging the P1 segments of both Posterior Cerebral Arteries (PCAs). Results. The thalamus has a complex and variable arterial supply, mainly in the pattern of paramedian thalamic-mesencephalic perforating arteries. The most reported variant is Percheron type IIb and supplies the paramedian thalami and the rostral midbrain. Type IIb occlusion usually causes a bilateral paramedian thalamic stroke, but rostral midbrain and anterior thalamus are involved in 57% and 19% cases. The rarer Type III variant probably prevented the bilateral extension of infarction and involved the territory of tuberothalamic and paramedian perforating arteries. Conclusions. Currently, DSA allows directly imaging variants in thalamic vascularization and better understanding the stroke mechanisms. In particular, in the presented case, a medium-sized vessel occlusion rather than a small vessel occlusion mechanism might be raised, leading to a different diagnostic pathway. [ABSTRACT FROM AUTHOR]

The clinical value of magnetic resonance angiography (MRA), transcranial Doppler ultrasound (TCD) and electroencephalogram (EEG) in the diagnosis of intracranial artery stenosis in ischemic cerebrovascular disease (ICVD) was explored. The clinical data of TCD, MRA and EEG in 98 patients with ICVD were retrospectively analyzed. The clinical value of TCD, MRA combined with EEG in the diagnosis of intracranial artery stenosis in ICVD was analyzed based on the results of digital subtraction angiography (DSA) as the gold standard. A total of 98 patients were diagnosed with 27 cases of normal intracranial artery, 32 cases of mild stenosis, 25 cases of moderate stenosis, and 14 cases of severe stenosis DSA examination. TCD was detected in 23 cases of normal, 25 cases of mild stenosis, 23 cases of moderate stenosis and 13 cases of severe stenosis. MRA showed 24 cases of normal, 28 cases of mild stenosis, 21 cases of moderate stenosis and 12 cases of severe stenosis. EEG examination detected that there were 25 cases of normal, 24 cases of mild stenosis, 22 cases of moderate stenosis, and 14 cases of severe stenosis. Sensitivity, accuracy and negative predictive value had significant differences between combined diagnosis and single diagnosis. The combined detection of TCD, MRA and EEG is consistent with DSA detection in the diagnosis of ICVD intracranial artery stenosis. [ABSTRACT FROM AUTHOR]

Background: a relatively little amount of studies that discuss the optimal imaging method for subarachnoid haemorrhage caused by aneurysmal bleeding. In these individuals, a variety of imaging modalities are used despite the fact that they are seen as invasive, not always accessible, and possibly hazardous to the patient. Consequently, there has been a significant need for non-invasive alternatives. We aim To achieve an accurate diagnosis of aneurysmal subarachnoid hemorrhage. Methods: This comparative cross-sectional study was conducted at the Radiology Department, Zagazig University Hospital on 18 male and female patients with aneurysmal subarachnoid hemorrhage, their ages ranged from 30 to 60 years. Digital subtraction angiography and three-dimensional computed tomography were performed for all cases. Results: The sensitivity and specificity of digital subtraction angiography in comparison to 3D CT angiography were 98% and 87.5% respectively with statistically significant value (p= 0.035). The true positive was 16 and the true negative was 1.Conclusion: Recent advances in CT angiography technique, being non-invasive with no procedural neurological complications, add to the advantages of CTA. [ABSTRACT FROM AUTHOR]

The article discusses the life and legacy of Jorge Semprún, highlighting his remarkable experiences from fighting in the French Resistance to surviving the Buchenwald concentration camp and later becoming a Communist leader and cultural figure in Spain. Topics discussed include Semprún's reflections on the importance of memory in both personal and political contexts, the tragic fate of fellow militant Julián Grimau and the broader implications of memory manipulation within Communist politics, and the relationship between historical remembrance and the forward-looking aspirations of socialism, emphasizing the necessity of acknowledging past struggles to foster future successes.

Dimensional Stable Anode (DSA) is a promising candidate for the electrodeposition of nonferrous metals. However, the industrial applications of DSA are limited due to the propensity of Ti substrate to easily undergo passivation. Theoretically analyses shows that TiMn2 has better corrosion resistance in highly acidic and strongly polarized environments, making it an ideal middle‐layer for DSA anodes. To investigate the corrosion resistance of TiMn2, N‐doped TiMn2 (N‐TiMn2) is prepared by the high‐temperature nitriding method. The high charge transfer resistance (Rpo) of N‐TiMn2 reduces the electron transfer ability of its surface and improves the chemical stability. Scanning electron microscopy, X‐ray diffraction, and Raman spectroscopy show that Ti/N‐TiMn2 can better inhibit the oxidation of Ti during electrochemical corrosion while forming a more stable α‐MnO2 film. The Ti/N‐TiMn2/MnO2 anode is prepared, and the theoretical lifetime reaches 541.5 days in zinc electrodeposition simulation experiments. This middle layer provides a new idea for developing the oxygen evolution anode in the electrowinning of nonferrous metals. [ABSTRACT FROM AUTHOR]

Copyright of Orientamenti Pedagogici is the property of Pontificio Ateneo Salesiano (Facoltà di Scienze dell'Educazione dell'Università Pontificia Salesian) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The diagnosis of liver antibody-mediated rejection (AMR) is challenging and likely underrecognized. The association of AMR with donor-specific antibodies (DSA), and its clinical course in relation to pathologic findings and treatment are ill defined. We identified cases of liver AMR by following the criteria outlined by the 2016 Banff Working Group. Patient demographics, native liver disease, histopathologic findings, treatment type, clinical outcome, and transaminase levels during AMR diagnosis, treatment, and resolution were determined. Patients (n = 8) with AMR average age was 55.2 years (range: 19-68). Seven of eight cases met the Banff criteria for AMR. Personalized treatment regimens consisted of optimization of immunosuppression, intravenous pulse steroids, plasmapheresis, IVIG, rituximab, and bortezomib. Five patients experienced complete resolution of AMR, return of transaminases to baseline, and decreased DSA at long-term follow-up. One patient developed chronic AMR and two patients required retransplantation. Follow-up after AMR diagnosis ranged from one to 11 years. Because AMR can present at any time, crossmatch, early biopsy, and routine monitoring of DSA levels should be implemented following transaminase elevation to recognize AMR. Furthermore, treatment should be immediately implemented to reverse AMR and prevent graft failure, chronic damage, re-transplantation, and possibly mortality. [ABSTRACT FROM AUTHOR]

Computed tomography angiography (CTA) is a well-established diagnostic modality for carotid stenosis. However, false-positive CTA results may expose patients to unnecessary procedural complications in cases where surgical intervention is not warranted. We aim to assess the correlation of CTA to digital subtraction angiography (DSA) in carotid stenosis and characterize patients who were referred for intervention based on CTA and did not require it based on DSA. We retrospectively reviewed 186 patients who underwent carotid angioplasty and stenting following preprocedural CTA at our institution from April 2017 to December 2022. Twenty-one of 186 patients (11.2%) were found to have <50% carotid stenosis on DSA (discordant group). Severe plaque calcification on CTA was associated with a discordant degree of stenosis on DSA (LR+ = 7.4). Among 186 patients, agreement between the percentage of stenosis from CTA and DSA was weak-moderate (r2 = 0.27, P < 0.01). Among concordant pairs, we found moderate-strong agreement between CTA and DSA (adj r2 = 0.37) (P < 0.0001). Of 186 patients, 127 patients had CTA stenosis of ≥70%, and 59 had CTA of 50%–69%. Correlation between CTA and DSA in severe CTA stenosis was weak (r2 = 0.11, P < 0.01). In patients with stenosis found on CTA, over 88% also had stenosis on DSA, with this positive predictive value in line with previous studies. The percent-stenosis value from CTA and DSA was weakly correlated but does not affect the overall clinical judgement of stenosis. Severe calcification found on CTA may potentially indicate nonstenosis on DSA. [ABSTRACT FROM AUTHOR]

Lateralization Shoulder Angle (LSA) and Distalization Shoulder Angle (DSA) have been proposed to estimate the appropriateness of reverse shoulder arthroplasty (RSA) positioning. The purpose of this study was to evaluate the predictive value of DSA and LSA over clinical outcomes in a group of patients treated by the same surgeon with the same clinical and radiographic follow-up. A retrospective analysis of a consecutive series of RSAs performed between 2017 and 2021 was carried out. Inclusion criteria were primary RSA as a treatment for Cuff Tear Arthropathy, Massive Irreparable rotator cuff tear, Osteoarthritis or Rheumatoid arthritis, a true anteroposterior radiograph of the affected shoulder in neutral rotation at final follow-up, a minimum follow-up of 12 months, radiograph used to measure the angles, and clinical evaluation with the same follow-up. Outcome measures were shoulder range of motion (ROM), visual analog scale (VAS) for pain and Constant-Murley score (CS). A total of 83 patients were included in the study. Patients achieved on average, 130 ± 14.14° of flexion, 97.5 ± 17.67° of abduction, 62.5 ± 3.53° and 72.5 ± 10.60° of external rotation, respectively, at 0° and 90° of abduction, and 5.13° of internal rotation. The mean VAS and CS were, respectively, 2.5 ± 3.5 mm and 69 ± 2.82 points at last follow-up. The mean DSA and LSA were 45 ± 2.72 and 92.99 ± 9.17, respectively. Neither the linear nor the quadratic regression fit for DSA or LSA revealed relevant associations with any of individual ROM measures, except for the quadratic fit correlating LSA and forward flexion (beta = 0.029, P =.027). Linear fit showed a low reverse, but significant, association between DSA and VAS (beta = −0.56, P =.036) and an association of LSA with both CS (beta = −0.344, P =.009) and VAS (beta = 0.091, P =.01). Quadratic models showed higher R squared for all associations, but correlation was significant only between VAS and LSA (beta = 0.006, P =.011) We present the first evaluation of the predictive value of both DSA and LSA in a group of patients treated by the same surgeon with the same clinical and radiographic follow-up. DSA and LSA play only a marginal to no role in the prediction of RSA postoperative ROM and might have a role in predicting VAS and CS. [ABSTRACT FROM AUTHOR]

Abstract Background and objectives This study aimed to employ machine learning techniques to predict the clinical efficacy of acupuncture as an intervention for patients with upper limb motor dysfunction following ischemic stroke, as well as to assess its potential utility in clinical practice. Methods Medical records and digital subtraction angiography (DSA) imaging data were collected from 735 ischemic stroke patients with upper limb motor dysfunction who were treated with standardized acupuncture at two hospitals. Following the initial screening, 314 patient datasets that met the inclusion criteria were selected. We applied three deep-learning algorithms (YOLOX, FasterRCNN, and TOOD) to develop the object detection model. Object detection results pertaining to the cerebral vessels were integrated into a clinical efficacy prediction model (random forest). This model aimed to classify patient responses to acupuncture treatment. Finally, the accuracies and discriminative capabilities of the prediction models were assessed. Results The object detection model achieved an optimal recognition rate, The mean average precisions of YOLOX, TOOD, and FasterRCNN were 0.61, 0.7, and 0.68, respectively. The prediction accuracy of the clinical efficacy model reached 93.6%, with all three-treatment response classification area under the curves (AUCs) exceeding 0.95. Feature extraction using the prediction model highlighted the significant influence of various cerebral vascular stenosis sites within the internal carotid artery (ICA) on prediction outcomes. Specifically, the initial and C1 segments of the ICA had the highest predictive weights among all stenosis sites. Additionally, stenosis of the middle cerebral, anterior cerebral, and posterior cerebral arteries exerted a notable influence on the predictions. In contrast, the stenosis sites within the vertebral artery exhibited minimal impact on the model's predictive abilities. Conclusions Results underscore the substantial predictive influence of each cerebral vascular stenosis site within the ICA, with the initial and C1 segments being pivotal predictors.

Objective: While the long-term durability of completely clipped intracranial aneurysms (IA) is excellent, IA with remnants poses a significant risk for future re-growth with subsequent need for long-term follow-up or requirement for retreatment. We aim at reviewing the detection rate of IA remnants after clip ligation in the imaging modalities used to date. Methods: A systematic review was performed according to the PRISMA guidelines using the PubMed/Medline database. The search terms included “intracranial aneurysm” AND “remnant” either in combination with “digital subtraction angiography” OR “computed tomography angiography” OR “indocyanine green video angiography”. Results: The overall observed prevalence of IA remnants after clipping was 5.9 %, 10.9 %, 12.5 %, 14.1 % and 28.3 %, using ICG-VA, intraoperative 2D-DSA, CTA, and 3D-DSA, respectively. In studies comparing all imaging modalities altogether, 3D-DSA performed significantly better (p

The purpose of this study was to evaluate the relationship between multiple radiographic measures of lateralization and distalization and clinical outcome scores after a reverse total shoulder arthroplasty (RTSA). We retrospectively evaluated all RTSAs performed by the senior author between January 1, 2007, and November 1, 2017. We then evaluated the visual analog scale for pain (VAS pain), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) scores and complication and reoperation rates at a minimum of 2-year follow-up. We measured preoperative and postoperative (2-week) radiographs for the lateralization shoulder angle (LSA), the distalization shoulder angle (DSA), lateral humeral offset, and the distance from the glenoid to the lateral aspect of the greater tuberosity. A multivariable analysis was performed to evaluate the effect of the postoperative radiographic measurements on final patient-reported outcomes (ASES scores, SST, and VAS pain). The cohort included 216 shoulders from unique patients who had patient-reported outcome scores available at a minimum of 2-year follow-up (average, 4.0 ± 1.9 years) for a total follow-up rate of 70%. In the multivariable models, more lateralization (LSA) was associated with worse final ASES scores −0.52 (95% confidence interval [CI]: −0.88, −0.17; P =.004), and more distalization (DSA) was associated with better final ASES scores 0.40 (95% CI: 0.11, 0.69; P =.007). More lateralization (LSA) was associated with worse final SST scores −0.06 (95% CI: −0.11, −0.003; P =.039). Finally, greater distalization (DSA) was associated with lower final VAS pain scores, ratio = 0.98 (95% CI: 0.96, 1.00; P =.021). Greater distalization and less lateralization are associated with better function and less pain after a Grammont-style RTSA. When using a Grammont-style implant, remaining consistent with Grammont's principles of implant placement will afford better final clinical outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Donor-specific antibodies (DSAs) are common following lung transplantation (LuTx), yet their role in graft damage is inconclusive. Mean fluorescent intensity (MFI) is the main read-out of DSA diagnostics; however its value is often disregarded when analyzing unwanted post-transplant outcomes such as graft loss or chronic lung allograft dysfunction (CLAD). Here we aim to evaluate an MFI stratification method in these outcomes. Methods A cohort of 87 LuTx recipients has been analyzed, in which a cutoff of 8000 MFI has been determined for high MFI based on clinically relevant data. Accordingly, recipients were divided into DSA-negative, DSA-low and DSA-high subgroups. Both graft survival and CLAD-free survival were evaluated. Among factors that may contribute to DSA development we analyzed Pseudomonas aeruginosa (P. aeruginosa) infection in bronchoalveolar lavage (BAL) specimens. Results High MFI DSAs contributed to clinical antibody-mediated rejection (AMR) and were associated with significantly worse graft (HR: 5.77, p

Background: The lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) are used to reproducibly measure lateralization and distalization after reverse shoulder arthroplasty (RSA). However, LSA and DSA may not offer a precise measurement of humeral lateralization and distalization and this relationship has not been explored. The aim of this study was to evaluate the validity of these measurements and to propose new measurement methods to estimate implant lateralization and distalization. Methods: 3D models were constructed from computed tomography (CT) scans of 30 patients using a software platform. For each patient 24 different RSA modifications were created, resulting in 720 different RSA configurations. For each configuration LSA and DSA angles as well as lateralization and distalization distances were measured. Moreover, for each configuration two new measurements were done: the lateralization index (LI) and distalization index (DI). Correlations of the lateralization and distalization parameters were evaluated between measurements. Results: Weak correlations were founded between LSA and lateralization (r = 0.36, p < 0.01), whereas moderate correlations were observed between LI and lateralization (r = 0.72, p < 0.01). No significant correlations were found between DSA and distalization (r = 0.17, p = 0.113). In contrast, moderate correlations were identified between DI and distalization (r = 0.69, p < 0.01). Conclusion: LI and DI are more reliable methods to estimate implant lateralization and distalization compared to angular radiographic measurements. However, the prognostic significance in predicting clinical outcomes after RSA remains unknown. [ABSTRACT FROM AUTHOR]

Spontaneous renal hemorrhage (SRH) is a diagnostic challenge and a significant cause of morbidity, and sometimes mortality. Early identification is essential to institute lifesaving and reno-protective interventions. In this review, we classify spontaneous renal hemorrhage by location, presentation and etiology. We also discuss the diagnostic approach to renal hemorrhage and optimum imaging modalities to arrive at the diagnosis. Finally, we review strategies to avoid missing a diagnosis of SRH and discuss the pitfalls of imaging in the presence of renal hemorrhage. [ABSTRACT FROM AUTHOR]

Introduction: Calcified arterial cerebral embolism is a rare occurrence among large and medium vessel occlusions causing ischemic stroke and its diagnosis and treatment is a challenge. The sources of calcified embolism might be a calcific atheroma from the aortic arch and carotid artery, but also heart valve disease has been reported in the literature. Calcified embolism is frequently simultaneous on multiple vascular territories. The prognosis of patients is usually poor, including patients treated by using endovascular thrombectomy (EVT) and this diagnosis could be easily missed in the acute phase. In addition, the optimal secondary prevention has not been yet fully stated. Methods: We are presenting two cases of acute stroke due to calcified embolism in the middle cerebral artery (MCA) coming from a complicated carotid atheroma, non-stenosing in the first case (a 49 years old man) and stenosing in the second case (a 71 years old man) without clinical indications to intravenous thrombolysis and/or EVT, extensively investigated in the acute phase and followed-up for over 12 months with a favorable clinical course and the persisting steno-occlusion in the involved MCA. In both cases, antiplatelet treatment and targeting of vascular risk factors were done without recurrences in the follow-up period. Discussion: Cerebral calcified embolism has been reported in 5.9% of cases of acute ischemic stroke in a single center series and only in 1.2% of a large retrospective cohort of EVT-treated patients. In both series the prognosis was poor and only one third of EVT-treated patients had functional independence at 3-months follow-up. The natural history of these subtype of ischemic stroke is relatively poorly understood and both etiological diagnosis and treatment have not yet defined. It is possible that some cases might be underdiagnosed and underreported. Conclusions: Calcified cerebral embolism is a rare cause of stroke, but it is largely underreported and both acute phase and secondary preventive treatment have to be defined. [ABSTRACT FROM AUTHOR]

Acute limb ischemia due to limb-graft occlusion (LGO) after fenestrated endovascular aneurysm repair (FEVAR) and acute bypass graft occlusion with an ePTFE graft pose critical challenges, necessitating prompt intervention to prevent limb loss. This paper discusses two cases of acute limb ischemia treated with a hybrid approach using the AngioJet™ Ultra Thrombectomy System as an adjunct to Fogarty thrombectomy. Case I involved a 69-year-old male post-FEVAR with contralateral iliac limb graft occlusion of the fenestrated Anaconda™, while Case II featured a 70-year-old male (ASA IV) post-bypass surgery (iliopopliteal arterial bypass with ePTFE Graft) with acute bypass graft occlusion. Both cases underwent successful recanalization using the AngioJet™ Ultra Thrombectomy System (ZelanteDVT™ 8F catheter, Solent™ Proxi 6F catheter) (Boston Scientific, Marlborough, MA, USA), combined with adjunctive techniques including Fogarty thrombectomy, balloon angioplasty, stenting, and local lysis. Immediate postoperative and follow-up assessments after 6 months revealed restored limb perfusion and improved clinical outcomes, with palpable pulses and improved ulcer healing. The aim of this treatment strategy is not only to alleviate limb ischemia but also to preserve future options in the event of graft failure. The use of the AngioJet™ Thrombectomy System in cases of LGO aims not only to clear the thrombus load but also to avoid the need for graft relining. In the case of acute arterial bypass graft occlusion in a patient with ASA IV, the goal of using the thrombectomy device is to preserve the native vessels for future procedures, such as long infragenual bypass, in addition to limb salvage. These cases demonstrate the efficacy of a hybrid surgical approach in managing acute limb ischemia following graft occlusion following FEVAR and bypass surgery. Long-term follow-up will further elucidate the durability of these interventions and their impact on limb salvage and overall patient outcomes. By combining mechanical thrombectomy with adjunctive techniques, such as balloon angioplasty and stenting, this hybrid approach offers a comprehensive solution to acute limb ischemia, addressing both the underlying occlusive pathology and ensuring optimal limb perfusion. Furthermore, the utilization of the AngioJet™ Ultra Thrombectomy System provides a minimally invasive yet effective method for thrombus removal, reducing procedural time and potential complications associated with open surgical techniques. As such, this approach represents a valuable addition to the armamentarium of treatments for acute limb ischemia, particularly in cases of graft occlusion following complex endovascular and bypass procedures. [ABSTRACT FROM AUTHOR]

AbstractHaploidentical hematopoietic cell transplants (haplo-HCT) with donor-specific anti-HLA antibodies (DSAs) are associated with high rates of primary graft failure and poor overall survival (OS). Limited data exists regarding the effect of desensitization. Our institution began routine desensitization for patients with DSAs in 2014. Adult patients undergoing haplo-HCT at Washington University from 2009–2021 were identified and divided into three cohorts: no DSA, untreated DSA (2009–2014) or treated DSA (2014–2021). Desensitization therapy using plasmapheresis and IVIg was performed. Retrospectively, 304 patients were identified. 14 of 30 patients with DSAs underwent desensitization. By day +2, 57% of patients cleared all DSAs. After multivariable analysis, OS was similar between treated DSA and no DSA (HR: 0.69, p = 0.37). Untreated DSA had significantly lower OS compared to no DSA group (HR 1.80, p = 0.046). Desensitization with a backbone of plasmapheresis and IVIg before haplo-HCT may produce similar outcomes to patients without DSAs. [ABSTRACT FROM AUTHOR]

The Digital Services Act (DSA) creates a system of general risk management that is composed of two main obligations: risk assessment (Article 34), and risk mitigation (Article 35). The obligations are mandatory for very large online platforms and search engines (VLOPs/VLOSEs). The adoption of the risk-based approach to digital services make the law more future-proof. But inevitably it also makes the law very vague. This vagueness of the statutory language causes some to suggest that the European Commission will inevitably become the proverbial Ministry of Truth when tackling disinformation. This article argues that upon closer reading of the DSA, and its constitutional context, the worries that the Commission inevitably becomes a Ministry of Truth are misplaced. Suppressing incorrect or misleading lawful information is not the goal of the DSA. That is not to say that the DSA cannot be abused. But the law is not pre-programmed to do so. [ABSTRACT FROM AUTHOR]

Since the coronavirus pandemic and the war in Ukraine, the EU has been concerned about the dissemination of disinformation in times of crisis. A mandatory Crisis Response Mechanism in the Digital Services Act is intended to counteract its dissemination via very large providers. However, the mechanism's weaknesses could trigger a far greater crisis for the free opinion-forming process. [ABSTRACT FROM AUTHOR]

Background: Donor-specific antibodies (DSAs) are common following lung transplantation (LuTx), yet their role in graft damage is inconclusive. Mean fluorescent intensity (MFI) is the main read-out of DSA diagnostics; however its value is often disregarded when analyzing unwanted post-transplant outcomes such as graft loss or chronic lung allograft dysfunction (CLAD). Here we aim to evaluate an MFI stratification method in these outcomes. Methods: A cohort of 87 LuTx recipients has been analyzed, in which a cutoff of 8000 MFI has been determined for high MFI based on clinically relevant data. Accordingly, recipients were divided into DSA-negative, DSA-low and DSA-high subgroups. Both graft survival and CLAD-free survival were evaluated. Among factors that may contribute to DSA development we analyzed Pseudomonas aeruginosa (P. aeruginosa) infection in bronchoalveolar lavage (BAL) specimens. Results: High MFI DSAs contributed to clinical antibody-mediated rejection (AMR) and were associated with significantly worse graft (HR: 5.77, p < 0.0001) and CLAD-free survival (HR: 6.47, p = 0.019) compared to low or negative MFI DSA levels. Analysis of BAL specimens revealed a strong correlation between DSA status, P. aeruginosa infection and BAL neutrophilia. DSA-high status and clinical AMR were both independent prognosticators for decreased graft and CLAD-free survival in our multivariate Cox-regression models, whereas BAL neutrophilia was associated with worse graft survival. Conclusions: P. aeruginosa infection rates are elevated in recipients with a strong DSA response. Our results indicate that the simultaneous interpretation of MFI values and BAL neutrophilia is a feasible approach for risk evaluation and may help clinicians when to initiate DSA desensitization therapy, as early intervention could improve prognosis. [ABSTRACT FROM AUTHOR]

Optimization of individual immunosuppression, which reduces the risks of both graft loss and patients' death, is considered the best approach to improve long‐term outcomes of renal transplantation. Torque Teno Virus (TTV) DNAemia has emerged as a potential biomarker reflecting the depth of therapeutic immunosuppression during the initial year post‐transplantation. However, its efficacy in long‐term monitoring remains uncertain. In a cohort study involving 34 stable kidney transplant recipients and 124 healthy volunteers, we established lower and upper TTV DNAemia thresholds (3.75–5.1 log10 cp/mL) correlating with T‐cell activatability, antibody response against flu vaccine, and risk for subsequent serious infections or cancer over 50 months. Validation in an independent cohort of 92 recipients confirmed that maintaining TTV DNAemia within this range in >50% of follow‐up time points was associated with reduced risks of complications due to inadequate immunosuppression, including de novo DSA, biopsy‐proven antibody‐mediated rejection, graft loss, infections, or cancer. Multivariate analysis highlighted "in‐target" TTV DNAemia as the sole independent variable significantly linked to decreased risk for long‐term complications due to inadequate immunosuppression (odds ratio [OR]: 0.27 [0.09–0.77]; p = 0.019). Our data suggest that the longitudinal monitoring of TTV DNAemia in kidney transplant recipients could help preventing the long‐term complications due to inadequate immunosuppression. [ABSTRACT FROM AUTHOR]

This article provides an overview of the litigation that has emerged in the European Union (EU) following the implementation of the Digital Markets Act (DMA) and the Digital Services Act (DSA). The DMA aims to create a fairer and more competitive digital sector, while the DSA regulates the content of online intermediaries and platforms. Litigation has already begun at both the European and national levels, involving gatekeepers, consumers, and competitors. The article also discusses the challenges faced by gatekeepers, such as Meta, Apple, and Alphabet, in complying with the regulations, as well as potential areas of contention and non-compliance that may lead to litigation. It suggests that long-term regulatory dialogue, third-party engagement, and the development of guidelines could be potential solutions to minimize litigation. [Extracted from the article]

The article discusses the case of Meta v Bundeskartellamt, where the German competition agency found Facebook's data collection policy to be in violation of German competition law. The agency argued that Facebook abused its dominant position by imposing unfair terms on users, and that the terms also violated the GDPR and infringed on users' right to informational self-determination. The European Court of Justice ruled that competition agencies can consider whether an undertaking's data collection terms comply with the GDPR when assessing conduct under competition law. The ruling establishes that data protection laws are relevant in determining if conduct qualifies as fair competition, and may extend to other regulatory tools in the future. However, there are still unanswered questions about the interpretation of Article 102 TFEU in cases involving data-based conduct. [Extracted from the article]

Hannah Ruschemeier hat hier in einem Beitrag vom 4.11.2024 ein positives Bild der sogenannten Trusted Flagger gezeichnet. Über die eigentlichen rechtsstaatlichen und grundrechtlichen Probleme geht der Beitrag hingegen großzügig hinweg. In der konkreten Umsetzung des Digital Services Act (DSA) verbergen sich aber nicht akzeptable Gefahren für Meinungsfreiheit und Demokratie.

Background: In clinical practice, digital subtraction angiography (DSA) is widely used to diagnose cerebrovascular disease based on detailed information about blood vessel structure. Challenges remain on accurately find blood vessel abnormalities in a time-limited manner. In this perspective, computer-aided analysis of DSA can assist clinicians in interpreting the images. Purpose: Provide a method for extracting cerebral blood vessels from DSA images. Materials and methods: In this work, we presented a new method for segmenting digital subtraction angiography (DSA) by incorporating both global and local information about an image to adaptively classify each pixel to the foreground and background. The method utilizes the global mean and standard deviation of an angiography and local mean and standard deviation within a sliding window to build two criteria. The two criteria contains both global and local characteristics about an image and individual pixels. The two criteria work together to reduce noise in segmentation and preserve valid details about the foreground. We tested the method on angiography and compared it with several widely used algorithms. Results: In total, there were 72 DSA images in our dataset. Compared to Otsu, Niblack, iNiblack, Sauvola, Wolf, and CNW, our method achieved the best overall performance. The accuracy, Dice coefficient (Dice), and intersection over union (IoU) are 0.9777, 0.8500, and 0.7440, respectively. Conclusion: The results demonstrated that our method can obtain good outcomes, especially in achieving a balance between extracting the correct foreground and reducing incorrect classifications, and had the best performance among the methods being compared with.

BackgroundAntibody-mediated rejection is a significant cause of kidney transplant failure. Recent studies have shown that the MHC class I MICA gene influences the transplantation outcome. However, the role of the primary MICA receptor, NKG2D, has yet to be explored.AimWe aimed to investigate the correlation between recipient/donor MICA allele matching and NKG2D genotype with the risk of antibody-mediated rejection and their potential clinical effects and implications for organ maintenance therapy.MethodsOf the 524 patients who underwent transplantation, 387 were eligible for the study. Complete MICA allele and two functional polymorphisms of NKG2D (rs1049174C>G and rs2255336G>A) were analyzed in 148 transplanted patients and 146 controls.ResultsIncreased recipient/donor MICA allele mismatches correlate with an elevated risk of antibody-mediated rejection (X2 = 6.95; Log-rank=0.031). Notably, the rs1049174[GG] genotype contributes to a significantly increased risk of antibody-mediated rejection (X2 = 13.44; Log-rank=0.001 and X2 = 0.34; Log-rank=0.84). The combined effect of two MICA allele mismatches and rs1049174[GG] genotype shows the highest risk (X2 = 23.21; Log-rank

Nachdem die Bundesnetzagentur den ersten vertrauenswürdigen Hinweisgeber (Trusted Flagger) benannt hat, werden Vorwürfe der Zensur, übermäßigen Einschränkung der Meinungsfreiheit und fehlenden Erforderlichkeit solcher Stellen laut. Dabei ist das Konzept der Trusted Flagger keinesfalls neu oder eine Idee das DSA und das Vorgehen gegen illegale Inhalte im Netz weiterhin eine große Herausforderung in demokratischen Gesellschaften. Der DSA schafft klare Vorgaben für Trusted Flagger und transparente Verfahren.

Background: Gastroesophageal reflux disease (GERD) is highly prevalent after lung transplantation (LTx) and is suspected to favor the development of chronic lung allograft dysfunction (CLAD), almost of bronchiolitis obliterans syndrome (BOS) phenotype. The preventive effect of antireflux surgery (ARS) on BOS/CLAD onset in patients with GERD still remains debated. We compared the outcome (freedom from CLAD and graft survival) of patients with GERD with or without performed ARS (GERD-ARS and GERD-noARS groups) and those without GERD (noGERD group) in our LTx cohort. Methods: Data from 284 LTx recipients with available post-LTx pHmetry findings were reviewed (2001-2014). We focused on the outcome of 244 patients without CLAD at the date of pHmetry. Results: Among 244 stable patients at the date of pHmetry, 78 patients did not have GERD and 166 patients had GERD [41 with and 125 without ARS performed]). The mean DeMeester score was higher in the GERD-ARS group than GERD-noARS group (p = 0.03). An increase in donor-specific antibodies' mean fluorescence intensity values was observed only in GERD after LTx (M6 vs day 0, p

Articles 45-47 of the Digital Services Act provide for codes of conduct to ‘contribute to the proper application’ of the Act. Codes could therefore significantly shape the DSA’s implementation and its effectiveness. This article provides the most detailed analysis to date of the role of codes in the DSA, making three key contributions. First, it maps the functions and legal status of DSA codes, showing that they create de facto legal obligations for the largest platforms. This underlines the need to consider how they will shape the DSA’s interpretation. Second, the article argues that codes could significantly strengthen platform companies’ accountability by providing more detailed standards, mandating risk mitigation measures in under-addressed areas, and broadening stakeholder participation. Third, however, it identifies potential disadvantages such as capacity limitations, corporate capture, and legitimacy and accountability issues.

The regulation of the digital ecosystem is one of the priorities of the European Union, and the Digital Markets Act [hereinafter the DMA] and the Digital Services Act [hereinafter the DSA] are two of the main instruments used in this area. They aim at ensuring contestability, fairness, safety, and transparency in the digital single market by altering the power imbalances that characterised the relations between online platforms and individual and/or business users. In this context, the role of individuals will be paramount to the fulfillment of the obligations of both Regulations and private enforcement will be a crucial tool in this regard. Against this framework, this paper aims at connecting the well-settled principles of EU law, namely, the principle of effective judicial protection and the Rewe principles, with the new developments in the digital atmosphere, specifically in terms of the private means of redress. To that end, this article will first give an overview of the DMA and the DSA, as well as the question of private enforcement under EU law. Second, the possibilities and conditions for individuals to enforce their rights correlative to the obligations laid down in the DMA and the DSA privately will be studied. Finally, this paper will compare the situation regarding private enforcement in both Regulations with the previous rules in this matter through a series of examples that will facilitate an understanding of the rationale behind the introduction of the new legal framework.

Abstract Background Renal arteriovenous fistula (RAVF) is a rare vascular malformation, which can be asymptomatic or may cause hemorrhage, hypokalaemic hypertension, heart failure and hematuria. Endovascular embolization is a minimally invasive method which can preserve renal parenchyma. In our case, balloon assisted coil embolization with simultaneous transvenous and transarterial approach was used. A remodelling balloon, which is routinely used in neurovascular procedures, was chosen in order to eliminate the risk of coil migration and preserve feeding artery and renal parenchyma. Case presentation We present a case of successful balloon – assisted coil embolization of a high flow renal arteriovenous fistula in a 25-year-old male patient via simultaneous transarterial and transvenous approach with preservation of the feeding artery. Conclusion Endovascular embolisation is a safe and effective treatment of RAVFs with low risk of complications. Simultaneous transarterial and transvenous coil deployment with the use of a flow control balloon catheter can eliminate the risk of coil migration and coil protrusion into the parent artery with permanent RAVF occlusion and renal parenchyma preservation.

This paper takes an interdisciplinary approach, combining legal studies, ethics and technical insights to shed light on the complex issues surrounding the regulation of predictive analytics. We argue that the individualised concept of regulation, shaped by the dogma of fundamental rights, is unable to adequately capture the implications of predictive analytics. We show that predictive analytics is a problem of collective privacy and informational power asymmetries, and conceptualise the form of data power at work in predictive analytics as 'prediction power'. The unregulated prediction power of certain actors poses societal risks, especially if this form of informational power asymmetry is not normatively represented. The article analyses this legal lacuna in the light of recent case law of the European Court of Justice and new legislation at the EU level. To address these challenges, we develop the concept of 'predictive privacy' as a protected good based on collective interests. [ABSTRACT FROM AUTHOR]

Lateralization and distalization in reverse shoulder arthroplasty (RSA) can be measured on anteroposterior (AP) radiographs using 2 previously described angles: lateralization shoulder angle (LSA) and distalization shoulder angle (DSA). However, these 2 angles measure global lateralization and distalization but do not allow to differentiate how much lateralization or distalization are attributable to the glenoid and the humerus. We hypothesized that new angles could allow us to separately measure glenoid vs. humeral lateralization and distalization. A more precise understanding of independent glenoid and humeral contributions to lateralization and distalization may be beneficial in subsequent clinical research. Retrospective analysis of postoperative AP radiographs of 100 patients who underwent primary RSA for cuff-tear arthropathy, massive cuff tear, or glenohumeral osteoarthritis were analyzed. The new angles that we proposed use well-known bony landmarks (the acromion, glenoid, and humerus) and the most lateral point of the glenosphere, which we termed the "glenoid pivot point" (GPP). For lateralization, we used the GPP to split LSA into 2 new angles: glenoid lateralization angle (GLA) and humeral lateralization angle (HLA). For distalization, we introduced the modified distalization shoulder angle (mDSA) that can also be split into 2 new angles: glenoid distalization angle (GDA) and humeral distalization angle (HDA). Three orthopedic surgeons measured the new angles, using the online tool Tyche. Mean values with overall and individual standard deviations as well as intraclass correlation coefficients (ICCs) were calculated. Because the angles form a triangle, the following equations can be made: LSA = GLA + HLA, and mDSA = GDA + HDA. All angles showed excellent inter- and intraobserver reliability (ICC = 0.92-0.97) with low means of individual standard deviations that indicate a precision of 2° for each angle. Use of the most lateral part of the glenosphere (termed glenoid pivot point) allows us to separately measure glenoid vs. humeral lateralization and distalization. The 4 new angles (HLA, GLA, GDA, HDA) described in the present study can be used on true AP radiographs, routinely obtained after shoulder replacement, and the measured angles may be used with all types of reverse prostheses available. [ABSTRACT FROM AUTHOR]

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Copyright of Revista de Derecho Politico is the property of Editorial UNED and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Renal arteriovenous fistula (RAVF) is a rare vascular malformation, which can be asymptomatic or may cause hemorrhage, hypokalaemic hypertension, heart failure and hematuria. Endovascular embolization is a minimally invasive method which can preserve renal parenchyma. In our case, balloon assisted coil embolization with simultaneous transvenous and transarterial approach was used. A remodelling balloon, which is routinely used in neurovascular procedures, was chosen in order to eliminate the risk of coil migration and preserve feeding artery and renal parenchyma. Case presentation: We present a case of successful balloon – assisted coil embolization of a high flow renal arteriovenous fistula in a 25-year-old male patient via simultaneous transarterial and transvenous approach with preservation of the feeding artery. Conclusion: Endovascular embolisation is a safe and effective treatment of RAVFs with low risk of complications. Simultaneous transarterial and transvenous coil deployment with the use of a flow control balloon catheter can eliminate the risk of coil migration and coil protrusion into the parent artery with permanent RAVF occlusion and renal parenchyma preservation. [ABSTRACT FROM AUTHOR]

Background: Repeated exposure to sensitizing events can activate HLA-specific memory B cells, leading to the production of donor-specific memory B cell antibodies (DSAm) that pose a risk for antibody-mediated rejection (ABMR) in kidney transplant recipients (KTRs). This single-center retrospective study aimed to identify DSAm and assess their association with outcomes in a cohort of KTRs with pretransplant serum donor-specific antibodies (DSA). Methods: We polyclonally activated pretransplant peripheral blood mononuclear cells (PBMCs) from 60 KTRs in vitro, isolated and quantified IgG from the culture supernatant using ELISA, and analyzed the HLA antibodies of eluates with single antigen bead (SAB) assays, comparing them to the donor HLA typing for potential DSAm. Biopsies from 41 KTRs were evaluated for rejection based on BANFF 2019 criteria. Results: At transplantation, a total of 37 DSAm were detected in 26 of 60 patients (43%), of which 13 (35%) were found to be undetectable in serum. No significant association was found between pretransplant DSAm and ABMR (P=0.53). Similar results were observed in a Kaplan-Meier analysis for ABMR within the first year posttransplant (P=0.29). Additionally, MFI levels of DSAm showed no significant association with ABMR (P=0.28). Conclusion: This study suggests no significant association between DSAm and biopsy-proven clinical ABMR. Further prospective research is needed to determine whether assessing DSAm could enhance existing immunological risk assessment methods for monitoring KTRs, particularly in non-sensitized KTRs. [ABSTRACT FROM AUTHOR]

Although there are different data supporting benefits of HLA matching in kidney transplantation, its role in heart transplantation is still unclear. HLA mismatch (MM) between donor and recipient can lead to the development of donor-specific antibodies (DSA) which produces negative events on the outcome of heart transplantation. Moreover, DSAs are involved in the development of antibody-mediated rejection (AMR) and are associated with an increase in cardiac allograft vasculopathy (CAV). In this study it is analyzed retrospectively the influence of HLA matching and anti-HLA antibodies on overall survival, AMR and CAV in heart transplantation. For this retrospective study are recruited heart transplanted patients at the Cardiac Transplantation Centre of Naples between 2000 and 2019. Among the 155 heart transplant patients, the mean number of HLA-A, –B, -DR MM (0 to 6) between donor and recipient was 4.5 ± 1.1. The results show a negative association between MM HLA-DR and survival (p = 0.01). Comparison of patients with 0–1 MM at each locus to all others with 2 MM, for both HLA class I and class II, has not showed significant differences in the development of CAV. Our analysis detected DSA in 38.1% of patients. The production of de novo DSA reveals that there is not an influence on survival (p = 0.72) and/or AMR (p = 0.39). Instead, there is an association between the production of DSA class II and the probability of CAV development (p = 0.03). Mean fluorescence intensity (MFI) values were significantly higher in CAV-positive patients that CAV-negative patients (p = 0.02). Prospective studies are needed to evaluate HLA class II matching as an additional parameter for heart allocation, especially considering the increment of waiting list time. [ABSTRACT FROM AUTHOR]

Background: The main treatment of intermediate-stage hepatocellular carcinoma (HCC) is considered to be transcatheter arterial chemoembolization (TACE). Objective: To compare the accuracy of 3D reformatted computed tomography (CT) angiography and digital subtraction angiography (DSA) during TACE for the identification of feeding arteries of hepatocellular carcinoma. Patients and Methods: This prospective study was performed on 50 cases already diagnosed with HCC. Arterial phase multidetector-row CT (MDCT) images were retrospectively reformatted and analyzed to determine the anatomical variants of hepatic arterial supply and tumor-feeding vessel using maximum intensity projection (MIP), multi-planar reconstruction (MPR), and volume-rendering (VR) technique and compared to results of DSA done during TACE. Results: The whole number of HCC lesions was 68 lesions. The accuracy of CT angiography using MIP and VR techniques for assessing hepatic artery variations was (100%) in MIP and (94%) in VR technique compared to DSA done during TACE. The total number of feeding arteries was 96 feeder arteries; 93 feeders were from hepatic artery branches and only 3 feeders were extra-hepatic. The accuracy of assessing the feeding arteries of HCC was (87.5%) in MIP and (24%) in VR techniques compared to DSA results. Conclusions: For evaluating HCC feeding arteries, CT angiography with MIP demonstrated more accuracy and superior image quality than the VR technique compared with DSA done during TACE. [ABSTRACT FROM AUTHOR]

Twig-like middle cerebral artery (MCA) is a rare anomaly where the M1 MCA is partially or completely replaced by a plexiform network. It has been described in angiographic series from Asian and South-American cohorts, but has not yet been reported in a European population. The digital subtraction angiograms (DSAs) of adult patients referred to a single neurovascular center for a diagnostic hypothesis of moyamoya arteriopathy (MMA) from 2018 to 2023 were prospectively and retrospectively checked by experienced neuroradiologists for identifying patients with twig-like MCA. The angioarchitecture of twig-like MCA was systematically evaluated and described. Five of 30 (16.7%) male patients (mean age 55.8 + 14.7 years) of European ancestry were identified as having twig-like MCA. The clinical presentations were ischemic stroke (2 of 5), hemorrhagic stroke (1 of 5), and headache (2 of 5). All patients showed a unilateral involvement on DSA and in 1 of 5 (20%) an intracranial aneurysm was found. DSA was used to confirm the diagnosis of twig-like MCA and define the angioarchitecture and associated anomalies. An accessory MCA and recurrent artery of Heubner were found in 3 of 5 (60%) cases, feeding the network together with the anterior choroidal artery (4 of 5, 80%). Twig-like MCA is a rare vascular anomaly, but it seems to be less rare than expected among adult European patients with suspected MMA on noninvasive neuroimaging studies. DSA is fundamental for a reliable differential diagnosis and should not be omitted in these patients. [Display omitted] [ABSTRACT FROM AUTHOR]

The diagnosis of liver antibody-mediated rejection (AMR) is challenging and likely under-recognized. The association of AMR with donor-specific antibodies (DSA), and its clinical course in relation to pathologic findings and treatment are ill defined. We identified cases of liver AMR by following the criteria outlined by the 2016 Banff Working Group. Patient demographics, native liver disease, histopathologic findings, treatment type, clinical outcome, and transaminase levels during AMR diagnosis, treatment, and resolution were determined. Patients (n = 8) with AMR average age was 55.2 years (range: 19–68). Seven of eight cases met the Banff criteria for AMR. Personalized treatment regimens consisted of optimization of immunosuppression, intravenous pulse steroids, plasmapheresis, IVIG, rituximab, and bortezomib. Five patients experienced complete resolution of AMR, return of transaminases to baseline, and decreased DSA at long-term follow-up. One patient developed chronic AMR and two patients required re-transplantation. Follow-up after AMR diagnosis ranged from one to 11 years. Because AMR can present at any time, crossmatch, early biopsy, and routine monitoring of DSA levels should be implemented following transaminase elevation to recognize AMR. Furthermore, treatment should be immediately implemented to reverse AMR and prevent graft failure, chronic damage, re-transplantation, and possibly mortality.