The role of the immune system in lung transplantation: Towards improved long-term results

Over the past 35 years, lung transplantation has evolved from an experimental treatment to the treatment of choice for patients with end-stage lung disease. Beyond the immediate period after lung transplantation, rejection and infection are the leading causes of death. The risk of rejection after lung transplantation is generally higher than after other solid organ transplants, and this necessitates more intensive immunosuppression. However, this more intensive treatment does not reduce the risk of rejection sufficiently, and rejection is one of the most common complications after transplantation. There are multiple forms of rejection including acute cellular rejection, antibody-mediated rejection, and chronic lung allograft dysfunction. These have posed a vexing problem for clinicians, patients, and the field of lung transplantation. Confounding matters is the inherent effect of more intensive immunosuppression on the risk of infections. Indeed, infections pose a direct problem resulting in morbidity and mortality and increase the risk of chronic lung allograft dysfunction in the ensuing weeks and months. There are complex interactions between microbes and the immune response that are the subject of ongoing studies. This review focuses on the role of the immune system in lung transplantation and highlights different forms of rejection and the impact of infections on outcomes

Antibody-mediated rejection after lung transplantation

Antibody-mediated rejection (AMR) has been identified as a significant form of acute allograft dysfunction in lung transplantation. The development of consensus diagnostic criteria has created a uniform definition of AMR; however, significant limitations of these criteria have been identified. Treatment modalities for AMR have been adapted from other areas of medicine and data on the effectiveness of these therapies in AMR are limited. AMR is often refractory to these therapies, and graft failure and death are common. AMR is associated with increased rates of chronic lung allograft dysfunction (CLAD) and poor long-term survival. In this review, we discuss the history of AMR and describe known mechanisms, application of the consensus diagnostic criteria, data for current treatment strategies, and long-term outcomes. In addition, we highlight current gaps in knowledge, ongoing research, and future directions to address these gaps. Promising diagnostic techniques are actively being investigated that may allow for early detection and treatment of AMR. We conclude that further investigation is required to identify and define chronic and subclinical AMR, and head-to-head comparisons of currently used treatment protocols are necessary to identify an optimal treatment approach. Gaps in knowledge regarding the epidemiology, mechanisms, diagnosis, and treatment of AMR continue to exist and future research should focus on these aspects

Cystic Fibrosis Foundation consensus statements for the care of Cystic Fibrosis Lung Transplant Recipients

Cystic fibrosis (CF) is the indication for transplantation in approximately 15% of recipients worldwide, and Cystic Fibrosis Lung Transplant Recipients (CFLTRs) have excellent long-term outcomes. Yet, CFLTRs have unique comorbidities that require specialized care. The objective of this document is to provide recommendations to CF and lung transplant clinicians for the management of perioperative and underlying comorbidities of CFLTRs and the impact of transplantation on these comorbidities. The Cystic Fibrosis Foundation (CFF) organized a multidisciplinary committee to develop CF Lung Transplant Clinical Care Recommendations. Three workgroups were formed to develop focused questions. Following a literature search, consensus recommendations were developed by the committee members based on literature review, committee experience and iterative revisions, and in response to public comment. The committee formulated 32 recommendation statements in the topics related to infectious disease, endocrine, gastroenterology, pharmacology, mental health and family planning. Broadly, the committee recommends close coordination of care between the lung transplant team, the cystic fibrosis care center, and specialists in other disciplines with experience in the care of CF and lung transplant recipients. These consensus statements will help lung transplant providers care for CFLTRs in order to improve post-transplant outcomes in this population

Shock and Vibration Isolation System for Ambulatory and Litter Patients in Ground and Air Medical Transport

This project explored the effectiveness of seat and litter air bladder technologies in reducing patient exposure to whole body shock and vibration during ground borne and airborne medical transport. Several seat and litter air bladder configurations were examined during field tests in a U.S. Army RG-33 MRAP ambulance and a U.S. Army HH-60M Black Hawk helicopter. The MRAP field tests were conducted at Ft. Detrick, Maryland. The Black Hawk field tests were conducted at Ft. Rucker, Alabama. During the field tests, tri-axial vibration signals were recorded on a 16-channel CoCo90 Data Logger/Frequency Analyzer and then post processed in the laboratory to obtain three-axis 1/3 octave vibration spectra and vibration transmissibility values and low-pass, band-pass and ISO overall vibration values. Vibration reductions through the seat air bladder of up to 47 percent in the vertical direction were achieved. The vibration reducing characteristics of the litter air bladder were significantly affected by the flexibility of the litter webbing and were more difficult to evaluate. More testing is necessary on the litter air bladder to more accurately determine its effectiveness in reducing patient exposure to shock and vibration during medical transport

Early stage Design Workflow for high Energy Performance Multi-storey Residential Buildings

This paper presents a methodology to optimize building envelope energy performance for multi-storey residential buildings using a design performance model approach. Five analysis techniques, applied to a database of parametric simulation results, are proposed to derive information on various building performance features that can support early design decisions. Information may include optimal combination of design parameter values to achieve lowest energy consumption, or the relative impact of design parameters on a given design, such as a base case. A workflow template is established to provide support for the design process of energy efficient multi-storey residential buildings. This template can form a basis for the development of an interactive tool that integrates energy performance principles into early stage design decisions. The application of this methodology to a building in Vancouver (BC, Canada, 49°N) is presented as a case study. Results of this application demonstrates that adopting a specific combination of building envelope parameters, thermal load can be reduced by up to 85% as compared to a base case designed according to commonly built apartment buildings in the studied location. 

Study of the Fusion-Fission Process in the 35Cl+24Mg^{35}Cl+^{24}Mg Reaction

Fusion-fission and fully energy-damped binary processes of the $^{35}$Cl+$^{24}$Mg reaction were investigated using particle-particle coincidence techniques at a $^{35}$Cl bombarding energy of E$_{lab}$ $\approx$ 8 MeV/nucleon. Inclusive data were also taken in order to determine the partial wave distribution of the fusion process. The fragment-fragment correlation data show that the majority of events arises from a binary-decay process with a relatively large multiplicity of secondary light-charged particles emitted by the two primary excited fragments in the exit channel. No evidence is observed for ternary-breakup processes, as expected from the systematics recently established for incident energies below 15 MeV/nucleon and for a large number of reactions. The binary-process results are compared with predictions of statistical-model calculations. The calculations were performed using the Extended Hauser-Feshbach method, based on the available phase space at the scission point of the compound nucleus. This new method uses temperature-dependent level densities and its predictions are in good agreement with the presented experimental data, thus consistent with the fusion-fission origin of the binary fully-damped yields.Comment: 30 pages standard REVTeX file, 10 eps Figures; to be published at the European Physical Journal A - Hadrons and Nucle

A Study on U.S. Japanese Foreign Trade

This research presents an in depth discussion and analysis on U.S. Japanese foreign trade. It is divided into two parts. The first hypothesis states that the appreciation of the dollar in the early eighties is positively correlated with the U.S. trade deficit, especially with Japan. The second hypothesis states that Friedrich Von Hayek's Theory of Social Order applies to the development of capitalism in that country. This can also be divided into two parts, a) this generation of Japanese consumes, saves, and invests differently than previous generations, and b) Japanese consumption and investment patterns follow U.S. consumption and investment patterns with a lag

Arthroscopic Knotless Subscapularis Bridge Technique for Reverse Hill-Sachs Lesion With Posterior Shoulder Instability

Posterior shoulder dislocations are an uncommon cause of glenohumeral instability; they are frequently missed and are associated with humeral head defects and capsulolabral lesions. Despite surgical treatment often being mandatory, there is still no standardized treatment for anterior impaction fractures of the humeral head (reverse Hill-Sachs lesions). Arthroscopic surgery is typically indicated, with a tendency toward resorting to knotless techniques in recent years. We present a method for the treatment of posterior shoulder dislocations with engaging reverse Hill-Sachs lesions that achieves full defect coverage using an arthroscopic all-in-the-box knotless subscapularis bridge technique with 2 anchors-with one crossing the subscapularis tendon and the other embracing it-along with posterior capsulolabral complex restoration. This promising technique is a potentially superior alternative for the treatment of these lesions that can also be used in the presence of concomitant partial subscapularis tears