Native T1-Mapping as a Quantitative Biomarker of Renal Allograft Function and Its Relationship with Serum Cytokine Profiles after Paediatric Kidney Transplantation: A Comprehensive Narrative Review
https://doi.org/10.22034/thr.2025.564424.1032
Ahmad Deylami, Shahabaldin Bagheri, Zia Hejripour, Amirsaleh Abdollahi, Behkam Rezaiemehr, Mohammad Javad Bay, Mehdi Younesi Rostami, Hossein Meskar
Abstract Background: Pediatric kidney transplantation is the optimal therapy for end-stage kidney disease in children, yet long-term allograft survival remains inferior to adults due to heightened immunological reactivity, subclinical inflammation, and progressive fibrosis. Conventional monitoring with serum creatinine and protocol biopsies is limited by poor sensitivity and invasiveness.
Methods: This comprehensive narrative review synthesizes evidence on native T1-mapping MRI—a non-contrast technique quantifying renal parenchymal microstructure via elevated cortical T1 and reduced corticomedullary differentiation, reflecting inflammation, oedema, and interstitial fibrosis/tubular atrophy (IFTA)—and its mechanistic interplay with serum cytokine/chemokine profiles capturing alloimmune response phenotypes.
Results: Emerging data show strong pathophysiological/statistical correlations between pro-inflammatory cytokines (especially IL-6, TNF-α, CXCL10) and T1 prolongation, as cytokine-driven inflammation alters tissue relaxation properties detectable by MRI. Native T1-mapping demonstrates high diagnostic performance for IFTA (sensitivity 81-89%, specificity 78-85%), predicts graft dysfunction (HR 3.8 per 100 ms T1 increase), and tracks treatment response. Combined with cytokines, it identifies subclinical rejection with 94% specificity, outperforming eGFR/creatinine.
Conclusions: Native T1-mapping offers robust prognostic value in pediatric renal allografts. Integrated with targeted cytokine panels, it enables biopsy-sparing monitoring, early injury detection, and personalized strategies to improve outcomes. Multicenter trials with standardized protocols are needed.
A Narrative Review of Integrative Management for Upper Limb Spasticity After Stroke: The Synergistic Role of Acupuncture and Botulinum Toxin A Monitored Through Biomarkers
https://doi.org/10.22034/thr.2025.237475
Burhan Tahir Saeed
Abstract Post-stroke upper limb spasticity (PULS) is a disabling condition that severely limits motor function and quality of life. While botulinum toxin A (BTX-A) injection is a standard treatment, its benefits are often partial and temporary. Traditional Chinese acupuncture (TCA) is increasingly used as an adjunct therapy. Concurrently, there is growing interest in identifying objective biomarkers to monitor recovery and elucidate treatment mechanisms.Combining acupuncture with BTX-A is more effective than BTX-A monotherapy for PULS rehabilitation. The therapy induces favorable changes in biomarkers related to muscle repair, neural plasticity, and neuroendocrine adaptation, providing a molecular basis for the observed clinical synergy. This integrated, biomarker-informed approach offers a promising direction for personalized neurorehabilitation in stroke survivors.
The Influence of Low Molecular Weight Heparin and Early Enteral Nutrition on Immune, Coagulation, Inflammatory, and Nutritional Indicators in Hyperlipidemic Acute Pancreatitis: An In-Depth Analysis
https://doi.org/10.22034/thr.2025.236658
Mohammed Ibrahim Mohialdeen Gubari
Abstract Backgrounds: Hyperlipidemic acute pancreatitis (HLAP) is a growing and serious subtype of acute pancreatitis, involving a complicated interaction of metabolic imbalance, widespread inflammation, and clotting irregularities. The potential of low molecular weight heparin (LMWH) and early enteral nutrition (EEN) as supplementary treatments has attracted considerable attention for their ability to influence central disease mechanisms.
Methods: This detailed review integrates findings from clinical research, randomized controlled trials, and meta-analyses released between 2010 and 2024, gathered via systematic searches of PubMed, Embase, and Cochrane Library databases. Emphasis was placed on studies assessing how LMWH and EEN affect immune markers (IgA, IgG, IgM), clotting factors (PT, TT, APTT, FIB), inflammatory mediators (TNF-α, IL-6, IL-8, CRP), and nutritional indicators (TP, ALB, TRF) in HLAP patients.
Results: Current data suggest that using LMWH together with EEN produces better patient results than traditional care alone. Notable outcomes involve a marked decrease in inflammatory markers, better clotting function, higher antibody levels, and improved nutritional measures. This combined method is linked to reduced hospitalization time, quicker return of digestive function, and fewer complications like multiple organ failure.
Conclusion: The complementary actions of LMWH and EEN tackle the diverse causes of HLAP. LMWH enhances blood flow in the pancreas while lowering excessive clotting and inflammation, whereas EEN protects intestinal lining and helps regulate immunity. Subsequent studies should aim to establish consistent treatment guidelines and determine which patients would gain the most from this dual therapy.
Distinct Heritable Architectures in Esophageal Cancer Revealed by Two Decades of Genome-Wide Association Studies
https://doi.org/10.22034/thr.2025.560806.1027
Ruaa Emad Al-Khalidi
Abstract Objective To integrate the latest evidence regarding inherited genetic risk factors for esophageal cancer while emphasizing contrasting susceptibility profiles between esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC)/Barrett’s esophagus as this integration also allows assessment of how genome-wide association studies (GWAS) together with new trans-ancestry genomic methods have advanced the discovery of risk loci and their potential clinical application.
Results More than 30 reliable risk loci are now recognized for ESCC mostly identified in East Asian populations with major signals located in PLCE1 alcohol/aldehyde metabolism genes ADH/ALDH2 (showing strong interaction with alcohol consumption) CHEK2 and HLA-region immune pathways whereas recent trans-ancestry studies have validated shared loci such as PLCE1 while uncovering novel African-enriched variants that highlight population-specific genetic architecture. By comparison EAC and Barrett’s esophagus present a separate genetic profile shaped largely by European-ancestry consortia featuring risk loci near BARX1 FOXP1 CRTC1 (involved in mucosal development) as well as CFTR MSRA BLK (linked to barrier function and oxidative stress) and although fewer loci have been found overall EAC exhibits considerable shared heritability with Barrett’s esophagus which supports the value of genetically guided surveillance.
Conclusion ESCC and EAC display strikingly different inherited risk patterns that closely reflect their distinct environmental risk factors as this difference now permits the construction of polygenic risk scores that incorporate subtype-specific GWAS findings together with emerging rare-variant and functional genomic information thereby enabling personalized risk assessment and more targeted screening in high-risk families and populations.
The Role of Exercise in Cardiac Rehabilitation for Coronary Heart Disease: A Systematic Review
https://doi.org/10.22034/thr.2025.560885.1028
Mohammed Ibrahim Mohialdeen Gubari
Abstract Background: Physical inactivity is a key risk factor for coronary heart disease (CHD). This systematic review explores the role of exercise in cardiac rehabilitation for CHD patients, emphasizing the integration of nuclear stress tests and tumor imaging techniques to assess heart function.
Materials and Methods: A systematic review was conducted, analyzing randomized controlled trials (RCTs) indexed in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and EMBASE. Studies were selected based on criteria related to exercise-based cardiac rehabilitation, including outcomes such as cardiovascular mortality, hospitalization, and quality of life. Imaging methods, such as nuclear stress tests and tumor imaging, were also considered. The quality of the studies was assessed using the Cochrane Risk of Bias tool.
Results: Five RCTs were included in the final analysis. The reviewed literature consistently reported that exercise-based cardiac rehabilitation led to reductions in cardiovascular mortality and hospital admissions, alongside notable improvements in patient quality of life. The inclusion of nuclear stress tests was found to improve diagnostic accuracy for identifying myocardial ischemia and assessing heart function during exercise. Tumor imaging techniques were successfully used to identify cardiac tumors and monitor post-surgical heart function.
Conclusion: This systematic review supports the integration of exercise as a core component of cardiac rehabilitation programs for CHD patients. The findings indicate significant benefits in reducing cardiovascular mortality and improving quality of life. The use of nuclear stress tests and tumor imaging techniques enhances the precision of rehabilitation strategies, offering a more personalized approach to care.
The Role of Acupuncture in Obesity Management: A Review of Clinical Efficacy and Imaging Evidence on Fat Distribution
https://doi.org/10.22034/thr.2025.561197.1030
Ruaa Emad Al-Khalidi
Abstract Introduction: The global prevalence of obesity has spurred interest in alternative therapies beyond conventional diet, exercise, and pharmacotherapy. Acupuncture, a staple of Traditional Chinese Medicine, is one such intervention, though its efficacy and mechanisms of action, particularly on fat distribution, warrant further synthesis of existing evidence.
Objective: This review aims to critically appraise and summarize the current literature on the efficacy and safety of acupuncture for weight loss, with a special focus on insights provided by MRI and CT scan imaging regarding its impact on visceral and subcutaneous fat distribution.
Methods: A narrative review of scientific literature was conducted. Key databases, including PubMed, Google Scholar, and ISI Web of Science, were searched for relevant clinical trials, reviews, and meta-analyses published up to September 2024. The focus was on human studies involving acupuncture for obesity that reported on weight loss outcomes, safety, and/or imaging data.
Findings: The body of literature suggests that acupuncture may contribute to reductions in body weight and BMI. A notable finding across several studies is the objective evidence provided by medical imaging. MRI scans have demonstrated significant reductions in visceral adipose tissue, with one analysis reporting a 15% decrease in abdominal fat area. Similarly, CT scans have shown a 12% reduction in subcutaneous fat surrounding internal organs following acupuncture treatment. These imaging techniques have also highlighted the potential for incidental tumor detection, though no new tumors were reported in the reviewed studies. The therapy appears to be generally safe, with most adverse effects being mild and transient, such as minor bruising or dryness of mouth.
Conclusion: Current evidence, including objective data from medical imaging, suggests that acupuncture may be a beneficial and safe complementary approach for weight management, particularly through the modulation of fat distribution. However, methodological limitations in many existing studies, such as small sample sizes and lack of blinding, preclude definitive conclusions. More rigorous, large-scale, and long-term studies are recommended to confirm these findings and elucidate the underlying mechanisms.
