Allogeneic Hematopoietic Stem Cell Transplantation After Prior Lung Transplantation for Hereditary Pulmonary Alveolar Proteinosis: A Case Report

Pulmonary alveolar proteinosis (PAP) is a rare, diffuse lung disorder characterized by surfactant accumulation in the small airways due to defective clearance by alveolar macrophages, resulting in impaired gas exchange. Whole lung lavage is the current standard of care treatment for PAP. Lung transplantation is an accepted treatment option when whole lung lavage or other experimental treatment options are ineffective, or in case of extensive pulmonary fibrosis secondary to PAP. A disadvantage of lung transplantation is recurrence of PAP in the transplanted lungs, especially in hereditary PAP. The hereditary form of PAP is an ultra-rare condition caused by genetic mutations in genes encoding for the granulocyte macrophage-colony stimulating factor (GM-CSF) receptor, and intrinsically affects bone marrow derived-monocytes, which differentiate into macrophages in the lung. Consequently, these macrophages typically display disrupted GM-CSF receptor-signaling, causing defective surfactant clearance. Bone marrow/hematopoietic stem cell transplantation may potentially reverse the lung disease in hereditary PAP. In patients with hereditary PAP undergoing lung transplantation, post-lung transplant recurrence of PAP may theoretically be averted by subsequent hematopoietic stem cell transplantation, which results in a graft-versus-disease (PAP) effect, and thus could improve long-term outcome. We describe the successful long-term post-transplant outcome of a unique case of end-stage respiratory failure due to hereditary PAP-induced pulmonary fibrosis, successfully treated by bilateral lung transplantation and subsequent allogeneic hematopoietic stem cell transplantation. Our report supports treatment with serial lung and hematopoietic stem cell transplantation to improve quality of life and prolong survival, without PAP recurrence, in selected patients with end-stage hereditary PAP

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Whose games? The costs of being 'Olympic citizens' in Beijing

Mega-events such as the Olympic Games tend to be accompanied by copious media coverage of the negative social impacts of these events, and people in the affected areas are often thought to share similar experiences. The research in this paper, which focused on the Beijing Summer Olympic Games of 2008, unpacks the heterogeneous groups in a particular sector of the housing market to gain a better understanding of how the Games affected different resident groups. The paper critically examines the experience of migrant tenants and Beijing citizens (landlords in particular) in “villages-in-the-city” (known as cheongzhongcun), drawing on their first-hand accounts of the citywide preparations for the Games and the pervasive demolition threats to their neighbourhoods. The paper argues that the Beijing Summer Olympiad produced an uneven, often exclusionary, Games experience for a certain segment of the urban population

Peri-Urban Dynamics: Case studies in Chennai, Hyderabad and Mumbai

Selected case studies of peri-urban dynamics are detailed, drawing from the experiences of Chennai (Pushpa Arabindoo), Hyderabad (Eric Leclerc and Camille Bourguignon) and Mumbai (Himanshu Burte and Malini Krishnankutty). The broader context of metropolitan growth and the case studies are further introduced by N. Sridharan [Occassional Paper N 17/2006].peri-urban, dynamics, Chennai, Hyderabad, Mumbai, metropolitan

Recipient selection process and listing for lung transplantation

Lung transplantation remains the ultimate treatment option for selected patients with end-stage (cardio) pulmonary disease. Given the current organ shortage, it is without any doubt that careful selection of potential transplant candidates is essential as this may greatly influence survival after the procedure. In this paper, we will review the current guidelines for referral and listing of lung transplant candidates in general, and in more depth for the specific underlying diseases. Needless to state that these are not absolute guidelines, and that decisions depend upon center's activity, waiting list, etc. Therefore, every patient should be discussed with the transplant center before any definite decision is made to accept or decline a patient for lung transplantation.status: publishe

Virus mediated trophic interactions between aphids and their natural enemies

post-printInternational audienceMicrobial endosymbiontsalter the phenotype of their host which may have cascading effects at both population and community levels. However, we currently lack information on whether the effects of viruses on both host phenotypic traits and host population demography can modify interactions with upper trophic levels. To fill this gap, we investigated whether a prevalent densovirus infecting the aphid Myzus persicae(i.e. MpDNV) can modify trophic interactions between host aphids and their natural enemies (i.e. predators and parasitoids) by influencing aphid phenotypic traits (i.e. body mass and defensive behaviours), population demography (i.e. density and age-structure) and susceptibility towards both predation and parasitism. We found that the virus decreased aphid body mass but did not influence their behavioural defences. At the population level,the virus had a minor effect on aphid adult mortality whereas it strongly reduced the density of nymphs and influenced the stage structure of aphid populations. In addition, the virusenhanced the susceptibility of aphids to parasitism regardless of the parasitoid species. Predation rate on adult aphids was not influenced by the virus but ladybeetle predators strongly decreased the number of aphid nymphs, especially for uninfected ones compared to infected ones. As a result, the virus decreased predator effect on aphid populations. By reducing both aphid quality and availability, increasing their susceptibility to parasitism, and modulating predator effect on aphid populations, we highlighted that viral endosymbionts can be prevalent drivers of their host ecology as they modify their phenotypes and interspecific interactions. These virus-mediated ecological effects may have consequences on enemies foraging strategies as well as trophic webs dynamics and structure

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Magnetostratigraphy of the Neogene Siwalik Group in the far eastern Himalaya: Kameng section, Arunachal Pradesh, India

International audienceThe Siwalik Group was deposited from the Mid-Miocene to the Pliocene in the foreland of the Himalaya and records the unroofing history of the mountain belt. In this study we provide the first magnetostratigraphic data for the eastern Himalayan foreland basin. We analyzed two sections of the lower to upper Siwalik Group along the Kameng River in Arunachal Pradesh, India. Magnetostratigraphic data were acquired from 395 sites within a 5.8 km-thick molassic series. Thermal demagnetization and magnetic rock-property analyses indicate a relatively low temperature (150-340 °C) Characteristic Remanent Magnetization (ChRM) yielding reliable primary directions carried by iron sulfides such as greigite. The results show local counter-clockwise rotation of the thrust sheets, which is consistent with partitioning of arc-normal and left-lateral strain along the Himalaya. Nineteen polarity zones have been identified in the two sections. Detrital fission-track data from the top and bottom of the sections are used to constrain correlations with the geomagnetic polarity time scale (GPTS) from chron C5Ar.1n to chron C2An.2n. From these results, we propose that the Siwalik Formation in Arunachal Pradesh was deposited between 13 and 2.5 Ma. The transition between the lower and middle Siwaliks is dated at about 10.5 Ma and the middle to upper Siwaliks transition is dated at 2.6 Ma. These results, coupled with sedimentological observations, suggest that the eastern Himalayan chrono-stratigraphic record is nearly synchronous with that analyzed in other parts of the Neogene Himalayan foreland basin. Nevertheless, some differences in the evolution of the sedimentation rate and in the thickness of the middle Siwaliks suggest that Indian plate flexure in the East is different from that observed in other parts of the Indian foreland basin, and could be affected by the presence of the Shillong Plateau to the south