Activation of Rejected Fly Ash Using Flue Gas Desulphurization (FGD) Sludge

Low-grade fly ash (rejected fly ash,rFA),a significant portion of the pulverized fuel ash (PFA) produced from coal-fired power plants and rejected from the ash classifying process,remains unused due to its high carbon content and large particle size (>45μm).But it is thought that the rejected ash may have potential uses in chemical stabilization/solidification (S/S) processes which need relatively lower strengths and a lower chemical reactivity.Flue Gas Desulphurisation (FGD) sludge is a by-product of air pollution control equipment in coal fired power plants whose chemical composition is mainly gypsum.As there is no effective usage of both of these two materials,it is of interest to research on the possible activation of rFA using FGD.This paper presents experimental results of a study on the properties of rFA activated by the FGD in rFA-cement pastes.Different percentages of FGD were added into the mix to study the effects of the FGD on the reaction of the rFA blended cement pastes.The results show that FGD takes effect as an activator only at late curing ages.Adding Ca(OH) 2 enhances the effect of FGD on activating the hydration of rFA.Also,10% FGD by weight of rFA is the optimal addition in the rFA-cement pastes.The results of the compressive strength measurements correlate well with the porosity results.

Active tracking of rejected dried blood samples in a large program in Nigeria

AIM: To study the impact of rejection at different levels of health care by retrospectively reviewing records of dried blood spot samples received at the molecular laboratory for human immunodeficiency virus(HIV) early infant diagnosis(EID) between January 2008 and December 2012.METHODS: The specimen rejection rate, reasons for rejection and the impact of rejection at different levels of health care was examined. The extracted data were cleaned and checked for consistency and then deduplicated using the unique patient and clinic identifiers. The cleaned data were ciphered and exported to SPSS version 19(SPSS 2010 IBM Corp, New York, United States) for statistical analyses.RESULTS: Sample rejection rate of 2.4%(n = 786/32552) and repeat rate of 8.8%(n = 69/786) were established. The mean age of infants presenting for first HIV molecular test among accepted valid samples was 17.83 wk(95%CI: 17.65-18.01) vs 20.30 wk(95%CI: 16.53-24.06) for repeated samples. HIV infection rate was 9.8% vs 15.9% for accepted and repeated samples. Compared to tertiary healthcare clinics, secondary and primary clinics had twofold and three-fold higher likelihood of sample rejection, respectively(P < 0.05). We observed a significant increase in sample rejection rate with increasing number of EID clinics(r = 0.893, P = 0.041). The major reasons for rejection were improper sample collection(26.3%), improper labeling(16.4%) and insufficient blood(14.8%). CONCLUSION: Programs should monitor pre-analytical variables and incorporate continuous quality improvement interventions to reduce errors associated with sample rejection and improve patient retention.

Desulfurization of rejected electrolytic manganese metal by electroslag remelting furnace with a water-cooled electrode

Remelting rejected electrolytic manganese metal (EMM) scrap was investigated by electroslag remelting (ESR) process through industrial experiment. The results indicated that the ANF-6 slag (70 wt.% CaF_(2) + 30 wt.% Al_(2)O_(3)) and deoxidizer could promote the desulfurization of ESR manganese in an air atmosphere. Under an air atmosphere, the sulfur in the ingot decreased to 0.0534 wt.% with a desulfurization ratio of ESR manganese of 53.2% by using ANF-6 slag and water-cooled copper electrode electroslag remelting rejected EMM scrap, suggesting its efficient removal. The electroslag ingots exhibited uneven chemical composition in an air atmosphere and cooling condition of the ESR process. The metal manganese could be oxidized by electroslag remelting of rejected EMM scrap in an air atmosphere with MnO content in the final slag of 21.9 wt.%. Besides, the activity of MnO in slag increased with increasing remelting temperature, resulting in a reduction in the slag–manganese sulfur partition ratio and desulfurization ratio. Moreover, with the accumulation of sulfur in slag and the oxidation of metallic manganese liquid, the slag showed a lower cleanliness and more oxidation, leading to an increase in sulfur and oxygen content in the electroslag ingot with the increase in ingot height.

Hepatobiliary & Pancreatic Diseases International

Hepatobiliary&Pancreatic Diseases International is a journal published bimonthly in the English language by the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,China.We welcome original research articles,review articles,editorials,and others from any part of the world.Manuscripts are reviewed by members of the international editorial board and our expert peer reviewers,then either accepted for publication or rejected by the chief editor.Manuscripts should be submitted via https://mc03.manuscriptcentral.com/hbpdint.

Hepatobiliary&Pancreatic Diseases International

General information Hepatobiliary&Pancreatic Diseases International is a journal published bimonthly in the English language by the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,China.We welcome original research articles,review articles,editorials,and others from any part of the world.Manuscripts are reviewed by members of the international editorial board and our expert peer reviewers,then either accepted for publication or rejected by the chief editor.Manuscripts should be submitted via https://mc03.manuscriptcentral.com/hbpdint.

Seasonal increase in nest defense,but not egg rejection,in a cuckoo host

The interactions between avian brood parasites and their hosts provide an informative and easy-to-handle system for studying coevolution.Avian brood parasitism reduces the reproductive success of hosts,and thus,hosts have evolved anti-parasitic strategies,such as rejecting parasitic eggs and adopting aggressive nest defense strategies,to avoid the cost brought on by brood parasitism.To test whether host anti-parasitic strategies are adjusted with the risk of being parasitized when the breeding seasons of brood parasites and hosts are not synchronous,we conducted a field experiment assessing nest defense and egg recognition behaviors of the Isabelline Shrike(Lanius isabellinus),a host of the Common Cuckoo(Cuculus canorus).In the local area,the host Isabelline Shrike begins to breed in April,whereas the summer migratory Common Cuckoo migrates to the local area in May and begins to lay parasitic eggs.Results showed that nest defense behaviors of the Isabelline Shrike increases significantly after cuckoo arrival,showing higher aggressiveness to cuckoo dummies,with no significant difference in attack rates among cuckoo,sparrowhawk and dove dummies,but their egg rejection did not change significantly.These results imply that Isabelline Shrikes may adjust their nest defense behavior,but not egg rejection behavior,with seasonality.

Effects of slag composition and additive type on desulfurization of rejected electrolytic manganese metal scrap by Na2O-containing electroslag

The recycling rate of rejected electrolytic manganese metal(EMM)scrap can be increased by inhibiting the manganese metal(MM)vaporization during the remelting process with electroslag.However,if the latter is achieved by reducing the remelting temperature,the desulfurization behavior will deteriorate.Therefore,Na_(2)O-containing electroslag and metallic additive were used to increase the rejected EMM scrap recovery ratio.The respective high-temperature experiment was conducted in a MoSi_(2) electrical resistance furnace filled with fluid argon at 1673 K using five different types of electroslag with the Na_(2)O content ranging from 5.81%to 15.71%.High-purity metallic magnesium and magnesium calcium alloy additives were used as deoxidizers.The addition of Na_(2)O and metallic additives effectively promoted the desulfurization and deoxidization of MM.The removal of sulfur and oxygen by the interaction between Na_(2)O-containing electroslag melt and molten MM with metallic additive was analyzed from the thermodynamic and kinetic standpoints.The effect of Na_(2)O-containing electroslag volatilization on desulfurization and deoxidization was considered.With an increase in Na_(2)O content in the slag,the mass loss rates of Na_(2)O and electroslag rose,as well as the final sulfur partition ratio.If the Na_(2)O content volatilized in the slag melt did not exceed 10.44%,the sulfur removal ratio was increased by high sulfide capacity and CaO activity in all slags due to the addition of Na_(2)O.The rejected EMM scrap deoxidization ratio grew with the increased activity of CaO and reduced activity of Al_(2)O_(3) in the molten slag,caused by the increased Na_(2)O content in the molten slag.The addition of metallic Mg and Mg-Ca alloy indirectly promoted desulfurization and deoxidization by reducing the MnO content in the rejected EMM scrap and growing slag oxidability.The Mg-Ca alloy could also react with dissolved sulfur and oxygen,directly promoting desulfurization and deoxidization processes.The Na_(2)O content in slag should not exceed 10.44%to ensure the high desulfurization and deoxidization abilities,fluidity and low volatilization of slag.

Recognition and rejection of foreign eggs of different colors in Barn Swallows

Brood parasitic birds lay eggs in the nests of other birds,and the parasitized hosts can reduce the cost of raising unrelated offspring through the recognition of parasitic eggs.Hosts can adopt vision-based cognitive mechanisms to recognize foreign eggs by comparing the colors of foreign and host eggs.However,there is currently no uniform conclusion as to whether this comparison involves the single or multiple threshold decision rules.In this study,we tested both hypotheses by adding model eggs of different colors to the nests of Barn Swallows(Hirundo rustica)of two geographical populations breeding in Hainan and Heilongjiang Provinces in China.Results showed that Barn Swallows rejected more white model eggs(moderate mimetic to their own eggs)and blue model eggs(highly non-mimetic eggs with shorter reflectance spectrum)than red model eggs(highly nonmimetic eggs with longer reflectance spectrum).There was no difference in the rejection rate of model eggs between the two populations of Barn Swallows,and clutch size was not a factor affecting egg recognition.Our results are consistent with the single rejection threshold model.This study provides strong experimental evidence that the color of model eggs can has an important effect on egg recognition in Barn Swallows,opening up new avenues to uncover the evolution of cuckoo egg mimicry and explore the cognitive mechanisms underlying the visual recognition of foreign eggs by hosts.

Tree‑Inspired Structurally Graded Aerogel with Synergistic Water,Salt,and Thermal Transport for High‑Salinity Solar‑Powered Evaporation

Solar-powered interfacial evaporation is an energy-efficient solution for water scarcity.It requires solar absorbers to facilitate upward water transport and limit the heat to the surface for efficient evaporation.Furthermore,downward salt ion transport is also desired to prevent salt accumulation.However,achieving simultaneously fast water uptake,downward salt transport,and heat localization is challenging due to highly coupled water,mass,and thermal transport.Here,we develop a structurally graded aerogel inspired by tree transport systems to collectively optimize water,salt,and thermal transport.The arched aerogel features root-like,fan-shaped microchannels for rapid water uptake and downward salt diffusion,and horizontally aligned pores near the surface for heat localization through maximizing solar absorption and minimizing conductive heat loss.These structural characteristics gave rise to consistent evaporation rates of 2.09 kg m^(-2) h^(-1) under one-sun illumination in a 3.5 wt%NaCl solution for 7 days without degradation.Even in a high-salinity solution of 20 wt%NaCl,the evaporation rates maintained stable at 1.94 kg m^(-2) h^(-1) for 8 h without salt crystal formation.This work offers a novel microstructural design to address the complex interplay of water,salt,and thermal transport.

Uncertainty and disturbance estimator-based model predictive control for wet flue gas desulphurization system

Wet flue gas desulphurization technology is widely used in the industrial process for its capability of efficient pollution removal.The desulphurization control system,however,is subjected to complex reaction mechanisms and severe disturbances,which make for it difficult to achieve certain practically relevant control goals including emission and economic performances as well as system robustness.To address these challenges,a new robust control scheme based on uncertainty and disturbance estimator(UDE)and model predictive control(MPC)is proposed in this paper.The UDE is used to estimate and dynamically compensate acting disturbances,whereas MPC is deployed for optimal feedback regulation of the resultant dynamics.By viewing the system nonlinearities and unknown dynamics as disturbances,the proposed control framework allows to locally treat the considered nonlinear plant as a linear one.The obtained simulation results confirm that the utilization of UDE makes the tracking error negligibly small,even in the presence of unmodeled dynamics.In the conducted comparison study,the introduced control scheme outperforms both the standard MPC and PID(proportional-integral-derivative)control strategies in terms of transient performance and robustness.Furthermore,the results reveal that a lowpass-filter time constant has a significant effect on the robustness and the convergence range of the tracking error.

Fixed-Time Gradient Flows for Solving Constrained Optimization: A Unified Approach

The accelerated method in solving optimization problems has always been an absorbing topic.Based on the fixedtime(FxT)stability of nonlinear dynamical systems,we provide a unified approach for designing FxT gradient flows(FxTGFs).First,a general class of nonlinear functions in designing FxTGFs is provided.A unified method for designing first-order FxTGFs is shown under Polyak-Łjasiewicz inequality assumption,a weaker condition than strong convexity.When there exist both bounded and vanishing disturbances in the gradient flow,a specific class of nonsmooth robust FxTGFs with disturbance rejection is presented.Under the strict convexity assumption,Newton-based FxTGFs is given and further extended to solve time-varying optimization.Besides,the proposed FxTGFs are further used for solving equation-constrained optimization.Moreover,an FxT proximal gradient flow with a wide range of parameters is provided for solving nonsmooth composite optimization.To show the effectiveness of various FxTGFs,the static regret analyses for several typical FxTGFs are also provided in detail.Finally,the proposed FxTGFs are applied to solve two network problems,i.e.,the network consensus problem and solving a system linear equations,respectively,from the perspective of optimization.Particularly,by choosing component-wisely sign-preserving functions,these problems can be solved in a distributed way,which extends the existing results.The accelerated convergence and robustness of the proposed FxTGFs are validated in several numerical examples stemming from practical applications.

Human leukocyte antigen compatibility and incidence of donorspecific antibodies in pediatric liver transplant recipients

BACKGROUND Antibody-mediated rejection following liver transplantation(LT)has been increasingly recognized,particularly with respect to the emergence of de novo donor-specific antibodies(DSAs)and their impact on graft longevity.While substantial evidence for adult populations exists,research focusing on pediatric LT outcomes remains limited.AIM To investigate the prevalence of human leukocyte antigen(HLA)mismatches and DSA and evaluate their association with rejection episodes after pediatric LT.METHODS A cohort of pediatric LT recipients underwent HLA testing at Santa Casa de Porto Alegre,Brazil,between December 2013 and December 2023.Only patients who survived for>30 days after LT with at least one DSA analysis were included.DSA classes I and II and cross-matches were analyzed.The presence of de novo DSA(dnDSA)was evaluated at least 3 months after LT using the Luminex®single antigen bead method,with a positive reaction threshold set at 1000 MFI.Rejection episodes were confirmed by liver biopsy.RESULTS Overall,67 transplanted children were analyzed;61 received grafts from living donors,85%of whom were related to recipients.Pre-transplant DSA(class I or II)was detected in 28.3%of patients,and dnDSA was detected in 48.4%.The median time to DSA detection after LT was 19.7[interquartile range(IQR):4.3-35.6]months.Biopsyproven rejection occurred in 13 patients at follow-up,with C4d positivity observed in 5/13 Liver biopsies.The median time to rejection was 7.8(IQR:5.7-12.8)months.The presence of dnDSA was significantly associated with rejection(36%vs 3%,P<0.001).The rejection-free survival rates at 12 and 24 months were 76%vs 100%and 58%vs 95%for patients with dnDSA anti-DQ vs those without,respectively.CONCLUSION Our findings highlight the importance of incorporating DSA assessment into pre-and post-transplantation protocols for pediatric LT recipients.Future implications may include immunosuppression minimization strategies based on this analysis in pediatric LT recipients.

Polyethylene glycol has immunoprotective effects on sciatic allografts, but behavioral recovery and graft tolerance require neurorrhaphy and axonal fusion

Behavioral recovery using(viable)peripheral nerve allografts to repair ablation-type(segmental-loss)peripheral nerve injuries is delayed or poor due to slow and inaccurate axonal regeneration.Furthermore,such peripheral nerve allografts undergo immunological rejection by the host immune system.In contrast,peripheral nerve injuries repaired by polyethylene glycol fusion of peripheral nerve allografts exhibit excellent behavioral recovery within weeks,reduced immune responses,and many axons do not undergo Wallerian degeneration.The relative contribution of neurorrhaphy and polyethylene glycol-fusion of axons versus the effects of polyethylene glycol per se was unknown prior to this study.We hypothesized that polyethylene glycol might have some immune-protective effects,but polyethylene glycol-fusion was necessary to prevent Wallerian degeneration and functional/behavioral recovery.We examined how polyethylene glycol solutions per se affect functional and behavioral recovery and peripheral nerve allograft morphological and immunological responses in the absence of polyethylene glycol-induced axonal fusion.Ablation-type sciatic nerve injuries in outbred Sprague–Dawley rats were repaired according to a modified protocol using the same solutions as polyethylene glycol-fused peripheral nerve allografts,but peripheral nerve allografts were loose-sutured(loose-sutured polyethylene glycol)with an intentional gap of 1–2 mm to prevent fusion by polyethylene glycol of peripheral nerve allograft axons with host axons.Similar to negative control peripheral nerve allografts not treated by polyethylene glycol and in contrast to polyethylene glycol-fused peripheral nerve allografts,animals with loose-sutured polyethylene glycol peripheral nerve allografts exhibited Wallerian degeneration for all axons and myelin degeneration by 7 days postoperatively and did not recover sciatic-mediated behavioral functions by 42 days postoperatively.Other morphological signs of rejection,such as collapsed Schwann cell basal lamina tubes,were absent in polyethylene glycol-fused peripheral nerve allografts but commonly observed in negative control and loose-sutured polyethylene glycol peripheral nerve allografts at 21 days postoperatively.Loose-sutured polyethylene glycol peripheral nerve allografts had more pro-inflammatory and less anti-inflammatory macrophages than negative control peripheral nerve allografts.While T cell counts were similarly high in loose-sutured-polyethylene glycol and negative control peripheral nerve allografts,loose-sutured polyethylene glycol peripheral nerve allografts expressed some cytokines/chemokines important for T cell activation at much lower levels at 14 days postoperatively.MHCI expression was elevated in loose-sutured polyethylene glycol peripheral nerve allografts,but MHCII expression was modestly lower compared to negative control at 21 days postoperatively.We conclude that,while polyethylene glycol per se reduces some immune responses of peripheral nerve allografts,successful polyethylene glycol-fusion repair of some axons is necessary to prevent Wallerian degeneration of those axons and immune rejection of peripheral nerve allografts,and produce recovery of sensory/motor functions and voluntary behaviors.Translation of polyethylene glycol-fusion technologies would produce a paradigm shift from the current clinical practice of waiting days to months to repair ablation peripheral nerve injuries.

Elimination of GGTA1,CMAH,β4GalNT2 and CIITA genes in pigs compromises human versus pig xenogeneic immune reactions

Background:Pig organ xenotransplantation is a potential solution for the severe organ shortage in clinic,while immunogenic genes need to be eliminated to im-prove the immune compatibility between humans and pigs.Current knockout strat-egies are mainly aimed at the genes causing hyperacute immune rejection(HAR)that occurs in the first few hours while adaptive immune reactions orchestrated by CD4 T cell thereafter also cause graft failure,in which process the MHC II molecule plays critical roles.Methods:Thus,we generate a 4-gene(GGTA1,CMAH,β4GalNT2,and CIITA)knockout pig by CRISPR/Cas9 and somatic cell nuclear transfer to compromise HAR and CD4 T cell reactions simultaneously.Results:We successfully obtained 4KO piglets with deficiency in all alleles of genes,and at cellular and tissue levels.Additionally,the safety of our animals after gene editing was verified by using whole-genome sequencing and karyotyping.Piglets have survived for more than one year in the barrier,and also survived for more than 3 months in the conventional environment,suggesting that the piglets without MHC II can be raised in the barrier and then gradually mated in the conventional environment.Conclusions:4KO piglets have lower immunogenicity,are safe in genomic level,and are easier to breed than the model with both MHC I and II deletion.

Disturbances rejection optimization based on improved two-degree-of-freedom LADRC for permanent magnet synchronous motor systems

Permanent magnet synchronous motor(PMSM)speed control systems with conventional linear active disturbance rejection control(CLADRC)strategy encounter issues regarding the coupling between dynamic response and disturbance suppression and have poor performance in suppressing complex nonlinear disturbances.In order to address these issues,this paper proposes an improved two-degree-of-freedom LADRC(TDOF-LADRC)strategy,which can enhance the disturbance rejection performance of the system while decoupling entirely the system's dynamic and anti-disturbance performance to boost the system robustness and simplify controller parameter tuning.PMSM models that consider total disturbances are developed to design the TDOF-LADRC speed controller accurately.Moreover,to evaluate the control performance of the TDOF-LADRC strategy,its stability is proven,and the influence of each controller parameter on the system control performance is analyzed.Based on it,a comparison is made between the disturbance observation ability and anti-disturbance performance of TDOF-LADRC and CLADRC to prove the superiority of TDOF-LADRC in rejecting disturbances.Finally,experiments are performed on a 750 W PMSM experimental platform,and the results demonstrate that the proposed TDOF-LADRC exhibits the properties of two degrees of freedom and improves the disturbance rejection performance of the PMSM system.

Fractional Gradient Descent RBFNN for Active Fault-Tolerant Control of Plant Protection UAVs

With the increasing prevalence of high-order systems in engineering applications, these systems often exhibitsignificant disturbances and can be challenging to model accurately. As a result, the active disturbance rejectioncontroller (ADRC) has been widely applied in various fields. However, in controlling plant protection unmannedaerial vehicles (UAVs), which are typically large and subject to significant disturbances, load disturbances andthe possibility of multiple actuator faults during pesticide spraying pose significant challenges. To address theseissues, this paper proposes a novel fault-tolerant control method that combines a radial basis function neuralnetwork (RBFNN) with a second-order ADRC and leverages a fractional gradient descent (FGD) algorithm.We integrate the plant protection UAV model’s uncertain parameters, load disturbance parameters, and actuatorfault parameters and utilize the RBFNN for system parameter identification. The resulting ADRC exhibits loaddisturbance suppression and fault tolerance capabilities, and our proposed active fault-tolerant control law hasLyapunov stability implications. Experimental results obtained using a multi-rotor fault-tolerant test platformdemonstrate that the proposed method outperforms other control strategies regarding load disturbance suppressionand fault-tolerant performance.

To analyze the differentially expressed genes in chronic rejection after renal transplantation by bioinformatics

Objective: To use bioinformatics technology to analyse differentially expressed genes in chronic rejection after renal transplantation, we can screen out potential pathogenic targets associated with the development of this disease, providing a theoretical basis for finding new therapeutic targets. Methods: Gene microarray data were downloaded from the Gene Expression Profiling Integrated Database (GEO) and cross-calculated to identify differentially expressed genes (DEGs). Analysis of differentially expressed genes (DEGs) with gene ontology (GO) is a method used to study the differences in gene expression under different conditions as well as their functions and interrelationships, while Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis is a tool used to explore the functions and pathways of genes in specific biological processes. By calculating the distribution of immune cell infiltration, the result of immune infiltration in the rejection group can be analysed as a trait in Weighted Gene Co-Expression Network Analysis (WGCNA) for genes associated with rejection. Then, protein-protein interaction networks (PPI) were constructed using the STRING database and Cytoscape software to identify hub gene markers. Results: A total of 60 integrated DEGs were obtained from 3 datasets (GSE7392, GSE181757, GSE222889). By GO and KEGG analysis, the GEDs were mainly concentrated in the regulation of immune response, defence response, regulation of immune system processes, and stimulation response. The pathways were mainly enriched in antigen processing and presentation, EBV infection, graft-versus-host, allograft rejection, and natural killer cell-mediated cytotoxicity. After further screening using WGCNA and PPI networks, HLA-A, HLA-B, HLA-F, and TYROBP were identified as hub genes (Hub genes). The data GSE21374 with clinical information was selected to construct the diagnostic efficacy and risk prediction model plots of the four hub genes, and the results concluded that all four Hub genes had good diagnostic value (area under the curve in the range of 0.794-0.819). From the inference, it can be concluded that the four genes, HLA-A, HLA-B, HLA-F and TYROBP, may have an important role in the development and progression of chronic rejection after renal transplantation. Conclusion: DEGs play an important role in the study of the pathogenesis of chronic rejection after renal transplantation, and can provide theoretical support for further research on the pathogenesis of chronic rejection after renal transplantation and the discovery of new therapeutic targets through enrichment analysis and pivotal gene screening, as well as inferential analyses of related diagnostic efficacy and disease risk prediction.

Immunology demystified: A guide for transplant hepatologists

Liver transplantation has become standard practice for treating end-stage liver disease.The success of the procedure relies on effective immunosuppressive medications to control the host's immune response.Despite the liver's inherent capacity to foster tolerance,the early post-transplant period is marked by significant immune reactivity.To ensure favorable outcomes,it is imperative to identify and manage various rejection types,encompassing T-cell-mediated,antibody-mediated,and chronic rejection.However,the approach to prescribing immunosuppressants relies heavily on clinical judgment rather than evidencebased criteria.Given that the majority of patients will require lifelong immunosuppression as the mechanisms underlying operational tolerance are still being investigated,healthcare providers must possess an understanding of immune responses,rejection mechanisms,and the pathways targeted by immunosuppressive drugs.This knowledge enables customization of treatments and improved patient care,even though a consensus on an optimal immunosuppressive regimen remains elusive.

Predicting outcomes after kidney transplantation: Can Pareto’s rules help us to do so?

Kidney transplantation is the best option for kidney replacement therapy,even considering that most of the times the grafts do not survive as long as their recipients.In the Khalil et al's experience,published in this issue of the Journal,they analyze their second kidney graft survival and describe those significant predictors of early loss.This editorial comments on the results and put in perspective that most of the times,long-term graft survival could be inadvertently jeopardized if the immunosuppressive therapy is reduced or withdrawn for any reason,and that it could happen frequently if the transplant physician intends to innovate with the clinical care without proper evidence-based data.

Clinical use of donor-derived cell-free DNA in kidney transplantation

Traditional monitoring of kidney transplant recipients for allograft dysfunction caused by rejection involves serial checks of serum creatinine with biopsy of the renal allograft if dysfunction is suspected.This approach is labor-intensive,invasive and costly.In addition,because this approach relies on a rise in serum creatinine above historical baselines,injury to the allograft can be extensive before this rise occurs.In an effort to address this,donor-derived cell-free DNA(dd-cf DNA)is being used with increasing frequency in the clinical setting as a means of diagnosing a rejection of the renal allograft early in the course.This can poten-tially allow for early intervention to minimize not only injury,but the intensity of antirejection therapy needed and the avoidance of side effects.Here,we will review the available methodology for the determination and quantification of dd-cf DNA,the data supporting its use in clinical practice and the limitations of this technology.