Impact of Asian and Black Donor and Recipient Ethnicity on the Outcomes After Deceased Donor Kidney Transplantation in the United Kingdom.

Patients of Asian and black ethnicity face disadvantage on the renal transplant waiting list in the UK, because of lack of human leucocyte antigen and blood group matched donors from an overwhelmingly white deceased donor pool. This study evaluates outcomes of renal allografts from Asian and black donors. The UK Transplant Registry was analysed for adult deceased donor kidney only transplants performed between 2001 and 2015. Asian and black ethnicity patients constituted 12.4% and 6.7% of all deceased donor recipients but only 1.6% and 1.2% of all deceased donors, respectively. Unadjusted survival analysis demonstrated significantly inferior long-term allograft outcomes associated with Asian and black donors, compared to white donors. On Cox-regression analysis, Asian donor and black recipient ethnicities were associated with poorer outcomes than white counterparts, and on ethnicity matching, compared with the white donor-white recipient baseline group and adjusting for other donor and recipient factors, 5-year graft outcomes were significantly poorer for black donor-black recipient, Asian donor-white recipient, and white donor-black recipient combinations in decreasing order of worse unadjusted 5-year graft survival. Increased deceased donation among ethnic minorities could benefit the recipient pool by increasing available organs. However, it may require a refined approach to enhance outcomes.

Constructing Nano-Interlayer Inhibiting Interfacial Degradation toward High-Voltage PEO-Based All-Solid-State Lithium Batteries.

The interfacial instability between PEO-based solid electrolyte (SPE) and high-voltage cathode materials inhibits the longevity of high-energy-density all-solid-state polymer lithium metal batteries (ASSPLBs). Herein, for the first time it is demonstrated, that contact loss caused by gas generation from interfacial side reactions between the high-voltage cathode and solid polymer electrolyte (SPE) can also arise in ASSPLBs. To alleviate the interfacial side reactions, a LiNb0.6Ti0.5O3 (LNTO) layer is well coated on LiNi0.83Co0.07Mn0.1O2 (NCM83), denoted as (CNCM83). The LNTO layer with low electronic conductivity reduces the decomposition drive force of SPE. Furthermore, Ti and Nb in the LNTO layer spontaneously migrate inside the NCM83 surface to form a strong Ti/Nb─O bond, stalling oxygen evolution in high-voltage cathodes. The interfacial degradation phenomena, including SPE decomposition, detrimental phase transition and intragranular cracks of NCM83, and void formation between cathode and SPE, are effectively mitigated by the LNTO layer. Therefore, the growth rate of interfacial resistance (RCEI) decreases from 37.6 Ω h-0.5 for bare NCM83 to 2.4 Ω h-0.5 for CNCM83 at 4.2 V. Moreover, 4.2 V PEO-based ASSPLBs achieve impressive cyclability with high capacity retention of 135 mAh g-1 (75%) even after 300 cycles at 0.5 C.

A Functional Air-Stable Li9.8GeP1.7Sb0.3S11.8I0.2 Superionic Conductor for High-Performance All-Solid-State Lithium Batteries.

Solid-state electrolytes (SSEs) based on sulfides have become a subject of great interest due to their superior Li-ion conductivity, low grain boundary resistance, and adequate mechanical strength. However, they grapple with chemical instability toward moisture hypersensitivity, which decreases their ionic conductivity, leading to more processing requirements. Herein, a Li9.8GeP1.7Sb0.3S11.8I0.2 (LGPSSI) superionic conductor is designed with a Li+ conductivity of 6.6 mS cm-1 and superior air stability based on hard and soft acids and bases (HSAB) theory. The introduction of optimal antimony (Sb) and iodine (I) into the Li10GeP2S12 (LGPS) structure facilitates fast Li-ion migration with low activation energy (Ea) of 20.33 kJ mol-1. The higher air stability of LGPSSI is credited to the strategic substitution of soft acid Sb into (Ge/P)S4 tetrahedral sites, examined by Raman and X-ray photoelectron spectroscopy techniques. Relatively lower acidity of Sb compared to phosphorus (P) realizes a stronger Sb-S bond, minimizing the evolution of toxic H2S (0.1728 cm3 g-1), which is ∼3 times lower than pristine LGPS when LGPSSI is exposed to moist air for 120 min. The NCA//Li-In full cell with a LGPSSI superionic conductor delivered the first discharge capacity of 209.1 mAh g-1 with 86.94% Coulombic efficiency at 0.1 mA cm-2. Furthermore, operating at a current density of 0.3 mA cm-2, LiNbO3@NCA/LGPSSI/Li-In cell demonstrated an exceptional reversible capacity of 117.70 mAh g-1, retaining 92.64% of its original capacity over 100 cycles.

Genome Editing in Brassica juncea Using CRISPR/Cas9 Technology.

Modern genome editing tools particularly CRISPR/Cas9 have revolutionized plant genome manipulation for engineering resilience against changing climatic conditions, disease infestation, as well as functional genomic studies. CRISPR-mediated genome editing allows for editing at a single as well as multiple locations in the genome simultaneously, making it an effective tool for polyploid species too. However, still, its applications are limited to the model crops only. Extending it to crop plants will help improve field crops against the changing climates more rapidly and precisely. Here we describe the protocol for editing the genome of a field crop Brassica juncea (mustard), an allotetraploid and important oilseed crop of the Indo-Pak Subcontinent region. This protocol is based on the Agrobacterium-mediated transformation for the delivery of CRISPR components into the plant genome using cotyledon as explants. We elaborate on steps for recovering genome-edited knockouts, for validation of the edits, as well as recovering the transgene-free edited plants through a commonly used segregating approach.

Studying Salt-Induced Shifts in Gene Expression Patterns of Glucosinolate Transporters and Glucosinolate Accumulation in Two Contrasting Brassica Species.

Brassica crops are well known for the accumulation of glucosinolates-secondary metabolites crucial for plants' adaptation to various stresses. Glucosinolates also functioning as defence compounds pose challenges to food quality due to their goitrogenic properties. Their disruption leaves plants susceptible to insect pests and diseases. Hence, a targeted reduction in seed glucosinolate content is of paramount importance to increase food acceptance. GLUCOSINOLATE TRANSPORTERS (GTRs) present a promising avenue for selectively reducing glucosinolate concentrations in seeds while preserving biosynthesis elsewhere. In this study, 54 putative GTR protein sequences found in Brassica were retrieved, employing Arabidopsis GTR1 and GTR2 templates. Comprehensive bioinformatics analyses, encompassing gene structure organization, domain analysis, motif assessments, promoter analysis, and cis-regulatory elements, affirmed the existence of transporter domains and stress-related regulatory elements. Phylogenetic analysis revealed patterns of conservation and divergence across species. Glucosinolates have been shown to increase under stress conditions, indicating a potential role in stress response. To elucidate the role of GTRs in glucosinolate transportation under NaCl stress in two distinct Brassica species, B. juncea and B. napus, plants were subjected to 0, 100, or 200 mM NaCl. Based on the literature, key GTR genes were chosen and their expression across various plant parts was assessed. Both species displayed divergent trends in their biochemical profiles as well as glucosinolate contents under elevated salt stress conditions. Statistical modelling identified significant contributors to glucosinolate variations, guiding the development of targeted breeding strategies for low-glucosinolate varieties. Notably, GTR2A2 exhibited pronounced expressions in stems, contributing approximately 52% to glucosinolate content variance, while GTR2B1/C2 displayed significant expression in flowers. Additionally, GTR2A1 and GTR1A2/B1 demonstrated noteworthy expression in roots. This study enhances our understanding of glucosinolate regulation under stress conditions, offering avenues to improve Brassica crop quality and resilience.

Halophilic Plant-Associated Bacteria with Plant-Growth-Promoting Potential.

The salinization of soils is a growing agricultural concern worldwide. Irrigation practices, drought, and climate change are leading to elevated salinity levels in many regions, resulting in reduced crop yields. However, there is potential for a solution in the microbiome of halophytes, which are naturally salt-tolerant plants. These plants harbor a salt-tolerant microbiome in their rhizosphere (around roots) and endosphere (within plant tissue). These bacteria may play a significant role in conferring salt tolerance to the host plants. This leads to the possibility of transferring these beneficial bacteria, known as salt-tolerant plant-growth-promoting bacteria (ST-PGPB), to salt-sensitive plants, enabling them to grow in salt-affected areas to improve crop productivity. In this review, the background of salt-tolerant microbiomes is discussed and their potential use as ST-PGPB inocula is explored. We focus on two Gram-negative bacterial genera, Halomonas and Kushneria, which are commonly found in highly saline environments. These genera have been found to be associated with some halophytes, suggesting their potential for facilitating ST-PGPB activity. The study of salt-tolerant microbiomes and their use as PGPB holds promise for addressing the challenges posed by soil salinity in the context of efforts to improve crop growth in salt-affected areas.

Salt-Induced Modulation of Ion Transport and PSII Photoprotection Determine the Salinity Tolerance of Amphidiploid Brassicas.

Brassica species show varying levels of resistance to salt stress. To understand the genetics underlying these differential stress tolerance patterns in Brassicas, we exposed two widely cultivated amphidiploid Brassica species having different genomes, Brassica juncea (AABB, n = 18) and Brassica napus (AACC, n = 19), to elevated levels of NaCl concentration (300 mM, half the salinity of seawater). B. juncea produced more biomass, an increased chlorophyll content, and fewer accumulated sodium (Na+) and chloride (Cl-) ions in its photosynthesizing tissues. Chlorophyll fluorescence assays revealed that the reaction centers of PSII of B. juncea were more photoprotected and hence more active than those of B. napus under NaCl stress, which, in turn, resulted in a better PSII quantum efficiency, better utilization of photochemical energy with significantly reduced energy loss, and higher electron transport rates, even under stressful conditions. The expression of key genes responsible for salt tolerance (NHX1 and AVP1, which are nuclear-encoded) and photosynthesis (psbA, psaA, petB, and rbcL, which are chloroplast-encoded) were monitored for their genetic differences underlying stress tolerance. Under NaCl stress, the expression of NHX1, D1, and Rubisco increased several folds in B. juncea plants compared to B. napus, highlighting differences in genetics between these two Brassicas. The higher photosynthetic potential under stress suggests that B. juncea is a promising candidate for genetic modifications and its cultivation on marginal lands.

Targeted genome editing in polyploids: lessons from Brassica.

CRISPR-mediated genome editing has emerged as a powerful tool for creating targeted mutations in the genome for various applications, including studying gene functions, engineering resilience against biotic and abiotic stresses, and increasing yield and quality. However, its utilization is limited to model crops for which well-annotated genome sequences are available. Many crops of dietary and economic importance, such as wheat, cotton, rapeseed-mustard, and potato, are polyploids with complex genomes. Therefore, progress in these crops has been hampered due to genome complexity. Excellent work has been conducted on some species of Brassica for its improvement through genome editing. Although excellent work has been conducted on some species of Brassica for genome improvement through editing, work on polyploid crops, including U's triangle species, holds numerous implications for improving other polyploid crops. In this review, we summarize key examples from genome editing work done on Brassica and discuss important considerations for deploying CRISPR-mediated genome editing more efficiently in other polyploid crops for improvement.

Percutaneous Management of Hepatic Duct Injury Using Extra-Anatomic Biliary Catheters.

Iatrogenic bile duct injury during laparoscopic cholecystectomy is a known complication of low incidence. The outcome can be devastating if not recognized and managed timely and properly. In cases of iatrogenic biliary injury due to cholecystectomy, the management depends on the level of injury, the timing of discovery (intraoperative or postoperative), and the patient's condition. If discovered intraoperatively, the injury should be managed immediately. In case expertise is lacking, a surgical drain with external biliary drainage can provide a temporary alternative solution to allow for referral to a tertiary care center. If the patient is septic or not fit for surgery, a percutaneous internal-external biliary drainage (PTBD) catheter can be placed until the patient's condition improves. We report a case of complete transection of the common hepatic duct during laparoscopic cholecystectomy managed by extra-anatomic PTBD.

Colloid Electrolyte with Changed Li+ Solvation Structure for High-Power, Low-Temperature Lithium-Ion Batteries.

Lithium-ion batteries currently suffer from low capacity and fast degradation under fast charging and/or low temperatures. In this work, a colloid liquid electrolyte (CLE) is designed, where the trace amount of lithium thiocarbonate (LTC) colloids in commercial carbonate electrolyte (1 m LiPF6 in ethylene carbonate/dimethyl carbonate) not only boosts up σLi+ but also improves the Li+ transfer kinetics at LiNi0.8 Co0.15 Al0.05 O2 (NCA) cathode/electrolyte interface. The competitive coordination of LTCs with anions and solvents facilitates the dissociation of lithium salts and Li+ decoupling, dramatically enhancing the σLi+ (15 to 4.5 mS cm-1 at 30 and -20 °C, respectively); meanwhile, the desolvation process is accelerated. It demonstrates that LTC colloids induce an ≈5 nm ultrathin Li2 CO3 -rich cathode electrolyte interface and infuse the grain boundary of NCA particles, enhancing interfacial Li+ transfer and inhibiting the particle cracks during cycling. Consequently, the Li||CLE||NCA battery delivers a maximum capacity of 135 mAh g-1 at a 10 C rate with 80% retention after 2000 cycles. Moreover, the fast-charging capability under a sub-zero environment is proved (122 mAh g-1 with 90% retention after 400 cycles at 2 C and -10 °C). This strategy for tailoring the interfacial charge transfer appears generalizable and can practically be extended to next-generation energy-storage systems.

Successful production of human epidermal growth factor in tobacco chloroplasts in a biologically active conformation.

Human epidermal growth factor (hEGF) is an important therapeutic compound with multiple applications particularly in pharmaceutical industry. Human EGF has already been expressed in different expression systems, however, the production of hEGF with bioactivity in chloroplasts has not been successful so far. In this study, we expressed a 6 × His-tagged hEGF in tobacco chloroplasts in its native conformation for the potential of large-scale production of hEGF for industrial applications. Several transplastomic plant lines were obtained, which were screened by PCR (polymerase chain reaction) using primers specific to selectable gene aadA, hEGF- and GFP-coding sequences that were included in the chloroplast expression vector. The selected lines were confirmed to be homoplasmic by PCR verification and Southern blot analysis. Immunoblotting assays of homoplasmic lines using antibodies raised against hEGF confirmed the accumulation of hEGF in transplastomic plants and the ELISA results demonstrated the expression levels of hEGF were between 0.124% and 0.165% of the total soluble proteins (TSP), namely, 23.16-25.77 ng/g of the fresh weight. In terms of activity, the data from cell proliferation and elongation assays showed that the tobacco-derived recombinant hEGF was as bioactive as its commercial counterpart. To our knowledge, this is the first report of recombinant production of hEGF with native bioactivity form in the chloroplast stroma. Overall, our results demonstrate the potential of higher plant chloroplasts for the production of a human therapeutic, hEGF, in an active conformation.

Improving editing efficiency of prime editor in plants.

Prime editing creates targeted insertions or deletions in the genome without double-stranded breaks (DSBs). However, prime-editing efficiency in plants is low, thereby limiting its utilization. A recent study by Zong et al. used a simple strategy that led to substantially improvements in the editing efficiency in both protoplasts and transgenic plants.

Engineering Abiotic Stress Tolerance in Crop Plants through CRISPR Genome Editing.

Environmental abiotic stresses challenge food security by depressing crop yields often exceeding 50% of their annual production. Different methods, including conventional as well as genomic-assisted breeding, mutagenesis, and genetic engineering have been utilized to enhance stress resilience in several crop species. Plant breeding has been partly successful in developing crop varieties against abiotic stresses owning to the complex genetics of the traits as well as the narrow genetic base in the germplasm. Irrespective of the fact that genetic engineering can transfer gene(s) from any organism(s), transgenic crops have become controversial mainly due to the potential risk of transgene-outcrossing. Consequently, the cultivation of transgenic crops is banned in certain countries, particularly in European countries. In this scenario, the discovery of the CRISPR tool provides a platform for producing transgene-free genetically edited plants-similar to the mutagenized crops that are not extensively regulated such as genetically modified organisms (GMOs). Thus, the genome-edited plants without a transgene would likely go into the field without any restriction. Here, we focused on the deployment of CRISPR for the successful development of abiotic stress-tolerant crop plants for sustaining crop productivity under changing environments.

Zinc oxide nanoparticles improved chlorophyll contents, physical parameters, and wheat yield under salt stress.

Nanotechnology has a wide range of applications. Nanotechnology refers to the particle in nanoscale used to improve agricultural productivity and to encounter the unsolved problems conventionally. Nanostructured formulation through mechanisms, such as targeted delivery or slow/controlled release mechanisms as well as conditional release, could release their active ingredients in response to the environmental conditions and biological demands more precisely. Nanotechnology has a great potential for achieving sustainable agriculture, especially in developing countries. Salinity is among the major abiotic stresses which limits the yield and quality of global crops. Zinc (Zn) is a vital micronutrient that is mandatory for the ideal growth of plants and has proved to reduce the hazardous effects of salt stress. To counter the salinity problem, a pot experiment was conducted at wire house of the Institute of Soil and Environmental Sciences (ISES), University of Agriculture, Faisalabad, Pakistan, to observe the effects of zinc oxide (ZnO) nanoparticles (NPs) on wheat variety "Gemmieza" imported from Egypt under salt stress. Notably, 10 dS m-1 salinity was developed artificially, and different doses of Zn conventional fertilizer and ZnO NPs were applied to potted wheat. ZnO NPs (0.12 g pot-1) significantly increased the physical parameters of wheat compared to control under salt stress. Application of ZnO NPs (0.12 g pot-1) significantly increased chlorophyll A and B contents by 24.6 and 10%, plant height at vegetative and maturity stages by 34.6 and 37.4%, shoot and spike lengths by 30.7 and 27.6%, root fresh and dry weights by 74.5 and 63.1%, and wheat grain yield by 42.2%, respectively. ZnO NPs performed better compared to Zn conventional fertilizer under salt stress and could be used in place of Zn conventional fertilizer in salt-affected soils for attaining better crop production.

Enhanced Air and Electrochemical Stability of Li7P2.9Ge0.05S10.75O0.1 Electrolytes with High Ionic Conductivity for Thiophosphate-Based All-Solid-State Batteries.

Sulfide solid electrolytes (SSEs) show tremendous potential to realize high-energy-density secondary batteries and offer distinguishing safety features over the traditional liquid-electrolyte-based system. However, their installation is hindered by the air sensitivity and substandard interfacial compatibility with Li-metal anodes. Herein, an aliovalent P5+/Ge4+ and isovalent S2-/O2- cosubstitution strategy increases the σLi+ to 4.77 mS cm-1, which is associated with the lowest activation energy (18.66 kJ mol-1). Impressively, with limited substitution of P/Ge and S/O in Li7P3S11, the derived electrolytes largely suppressed the structural hydrolysis in the air. Furthermore, the Li//Li cell with novel Li7P2.9Ge0.05S10.75O0.1 SSEs realized Li plating/stripping over 100 h at 0.1 mA cm-2/0.1 mAh cm-2 @ RT, with the lowest overpotential at ∼5 mV. Next, ex situ X-ray photoelectron spectroscopy (XPS) quantified the electrochemical decomposition of the Li7P3S11/LiNbO3@NCA interface during cell operation. XPS results confirmed better thermodynamic stability between LiNbO3@NCA and L7P3S11 after GeO2 substitution. Accordingly, the LiNbO3@NCA/Li7P2.9Ge0.05S10.75O0.1/Li-In cell performed remarkably; first discharge capacity, 158.9 mAh g-1; capacity retention, 89%; and Coulombic efficiency, ∼100% after 50 cycles @ 0.064 mA cm-2 and even at 0.3 mA cm-2 versus the first discharge capacity and retention (129.4 mAh g-1 and 75.73%) after 70 cycles @ RT. These remarkable results could be attributable to the excellent σLi+, chemical/electrochemical stability toward LiNbO3@NCA, and meager interfacial resistance, essential for the practical application of sulfide-based batteries.

Exploring biocontrol and growth-promoting potential of multifaceted PGPR isolated from natural suppressive soil against the causal agent of chickpea wilt.

Chickpea is an important nutritive food crop both for humans and animals. Chickpea wilt caused by Fusarium oxysporum f.sp. ciceris (Foc) results in huge yield losses every year. Chickpea being a food crop requires the development of an eco-friendly bio-pesticide to effectively control the chickpea wilt disease. In this study, more than 50 bacterial stains isolated from the rhizosphere of healthy plants growing in wilt sick soil were examined for their Foc antagonist activities. Out of these, 17 strains showing > 90% growth inhibition of Foc were then characterized for their plant growth-promoting (PGP) and biocontrol traits. The biocontrol and PGP traits identified include amylase, hydrogen cyanide, protease, cellulase, chitinase activities, p-solubilization, nitrogen-fixing, and indole-3-acetic acid production. Two bacterial strains, IR-27 and IR-57, exhibiting the highest Foc proliferation inhibition and the PGP potential along with a consortium of four different strains (Serratia sp. IN-1, Serratia sp. IS-1, Enterobacter sp. IN-2, Enterobacter sp. IN-6) were used for controlling the chickpea wilt disease and growth promotion of the chickpea plants. Confocal laser scanning microscopy revealed their root colonization ability with partial or complete elimination of broken Foc mycelia and hyphae from roots. The bacterial inoculations particularly the consortium significantly suppressed the disease and improved the overall root morphology traits (root length, root surface area, root volume, forks, tips, and crossings), resulting in enhanced growth of the chickpea plants. Significant changes in growth (107% increase in root length, 23% increase in shoot length, and 54% increase in branches) in Foc-challenged plants were observed when inoculated with the consortium. Further investigations revealed that the chickpea plants inoculated with bacterial strains induced the expression of a number of key defence enzymes, including the phenylalanine ammonia lyase, peroxidase, polyphenol peroxidase, ß-1,3 glucanase, which might have helped the plants to thwart the pathogen attack. These findings indicate the potential of our identified bacterial strains to be used as a natural biopesticide for controlling the chickpea wilt disease.

Prospects of algae-based green synthesis of nanoparticles for environmental applications.

Green synthesis of nanoparticles (NPs) has emerged as an eco-friendly alternative to produce nanomaterials with diverse physical, chemical, and biological characteristics. Previously used, physical and chemical methods involve the production of toxic byproducts, costly instrumentation, and energy-intensive experimental processes thereby, limiting their applicability. Biogenic synthesis of nanoparticles has come forward as a potential alternative, providing an eco-friendly, cost-effective, and energy-efficient approach for the synthesis of a diverse range of NPs. Several biological entities are employed in the biosynthesis of NPs including bacteria, fungi, and algae. However, the distinguishing characteristics of microalgae and cyanobacteria make them promising candidates for NPs synthesis because of their higher growth rate, substantially higher rate of sequestering CO2, hyperaccumulation of heavy metals, absence of toxic byproducts, minimum energy input, and employment of biomolecules (pigments and enzymes) as reducing and capping agents. Algal extract, being a natural reducing and capping agent, serves as a living cell factory for the efficient green synthesis of nanoparticles. Physiological and biological methods allow algal cells to uptake heavy metals and utilize them as nutrient source to generate biomass by regulating their metabolic processes. Despite their enormous potential, studies on the microalgae-based synthesis of nanoparticles for the removal of toxic pollutants from wastewater remained an unexplored research area in the literature. This review was aimed to summarize the recent advancements and prospects in the algae-based synthesis of nanoparticles for environmental applications particularly treating the wastewater.

Portal vein aneurysm, a pathological entity or an innocent bystander? A review of six cases.

Portal venous aneurysms (PVAs) are a rare venous aneurysms. The mean diameter of a healthy portal vein varies considerably, with maximum diameter of 15 mm in healthy subjects and 19 mm in cirrhotic patients. The presentation varies; they could come with abdominal pain or more often as an incident imaging finding. Although risk factors like portal hypertension and liver cirrhosis have been highlighted, the aetiology remains to be clarified. PVA may be associated with various complications: thrombosis, aneurysmal rupture, inferior vena cava obstruction or duodenal compression. A conservative treatment showed satisfying clinical and radiological response, however, surgical and endovascular options can be considered. The aetiology and the mechanism of formation of PVA remain ill-defined. We aimed to use the small cohort of cases to define the distribution and radiological features of PVA and not for determining its prevalence or details of management. We retrospectively reviewed six cases from our institution (King Faisal Specialist Hospital and Research Centre, Jeddah) with variable presentations, complications and outcomes. Our review revealed that portal venous system aneurysms were mostly incidental, single, not gender- or age-specific and were frequently (66%) intrahepatic. Main portal vein was involved in three cases and splenic vein in only one case. Most of the portal venous system aneurysms were fusiform in configuration. Although PVAs are rare, more cases are detected through imaging. Hepatobiliary surgeons, gastroenterologists and radiologists should be aware of this entity, as it can have a wide variety of clinical spectrum. Our review and the limited evidence in published literature suggest that an individualised multidisciplinary team approach should be adopted to decide the best management and outcomes for each patient.