Background and Aim Gastrointestinal endoscopy is resource-intensive, but no carbon footprint data have been reported from a Japanese facility, and published estimates differ widely in system boundary. We quantified the operational carbon footprint of an endoscopy unit at a Japanese regional hospital and identified which emission sources are amenable to unit-level intervention.Methods In this retrospective single-center study, we analyzed 794 consecutive procedures performed over 5 months at a 150-bed regional public hospital. Emissions from electricity, patient travel, medical waste, consumables, reprocessing chemicals, medical gas, and water were estimated according to the Greenhouse Gas Protocol using Japanese national emission factors and published life-cycle data. Patient travel was aggregated at the procedure level under two scenarios: procedure-day travel only (Scenario A) and visit-count-corrected travel (Scenario B). Sensitivity analyses addressed transport mode, air-conditioning load factor, and waste composition.Results The operational carbon footprint was 6537.5 kg CO2e (CO2e) (8.23 kg CO2e per procedure) in Scenario A and 8042.1 kg CO2e (10.13 kg CO2e per procedure) in Scenario B. In Scenario B, electricity was the largest source (38.8%), followed by patient travel (35.3%) and medical waste (13.5%). Air conditioning accounted for 69.3% of electricity use. Waste generation was 0.80 kg per procedure, of which suction fluid bags represented 36.7%.Conclusions Electricity, dominated by air conditioning, was the largest operational emission source and is directly modifiable by the unit. Patient travel was of comparable magnitude but reflects healthcare access geography rather than endoscopic practice.
Background Post-transplant lymphoproliferative disorders (PTLD) remain a major complication of solid organ transplants (SOT), occurring in 1%-10% of patients, but in greater proportions in children. About 50%-80% of cases are Epstein-Barr Virus (EBV) associated, through partially known and still unknown mechanisms. Even in EBV seronaive SOT recipients, transplant of an SOT from an EBV seropositive donor does not always lead to peripheral blood EBV replication. Longitudinal peripheral blood EBV DNA nucleic acid testing (NAT) after SOT has not improved the individual prediction of PTLD occurrence, likely due to variable SOT recipient immune responses.Methods This prospective study is designed to assess longitudinal and comprehensive T and NK cell phenotyping and responses to peripheral blood EBV replication via multispectral flow cytometry and other assays. We will also compare local to central EBV NAT values and test whether torquetenovirus NAT can act as a simpler assay to predict EBV clearance. We will collect 1390 blood samples across 5 time points in the first year after 347 enrolled (278 completed) SOTs (kidney, liver, heart, lung or intestine) from three major pediatric SOT centers in the U.S.A.Results As of June 30, 2025, our study has enrolled 133 participants, of whom 110 have received an organ transplant (27% Hispanic ethnicity, 16% black race, median age 8 years, across all 4 major SOT types).Conclusions By study end, we will know the global immune responses to EBV replication across a spectrum of clinical pediatric SOT situations. We expect to find key immune mechanisms that will predict poor or delayed EBV clearance despite clinical interventions. These findings may lead to new translational immunotherapy approaches to treat EBV DNaemia or prevent PTLD. We expect that our findings will also inform EBV oncogenesis in other immunocompromised or immunocompetent populations.
Background: The initiation of antiretroviral therapy in people co-infected with HIV and tuberculosis (TB) may trigger TB-associated immune reconstitution inflammatory syndrome (TB-IRIS), a condition associated with a significant morbidity and mortality. Methods: We conducted a retrospective study of patients co-infected with HIV and TB over 15 years, with the aim to describe the clinical characteristics of patients who developed TB-IRIS and to identify factors predictive of its occurrence. Results: Overall, 28 of the 123 patients (22.8%) developed TB-IRIS, including 18 cases of paradoxical TB-IRIS among 89 patients at risk (20.2%) and 10 cases of unmasking TB-IRIS among 34 patients at risk (29.4%). The most frequent TB sites were lymph nodes ( n = 17, 61%), the central nervous system (CNS) ( n = 5, 18%), and lungs ( n = 5, 18%). Corticosteroids were administered to 9 patients (32%). Eight deaths (29%) occurred in patients with TB-IRIS. In univariate analysis, factors associated with paradoxical TB-IRIS included CNS TB ( P = 0.032), higher white blood cell count ( P = 0.045), and negative Toxoplasma serology ( P = 0.032). Among patients at risk of unmasking TB-IRIS, factors associated with the occurrence of unmasking TB-IRIS included the absence of TB chemoprophylaxis ( P = 0.017), female sex ( P = 0.048), and hematopoietic-organ involvement of TB ( P = 0.020). Conclusion: TB-IRIS is a severe complication in people living with HIV and is becoming increasingly frequent. Early identification of risk factors is essential to prevent its occurrence and to reduce associated mortality. (c) 2026 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
