VII Scandinavian Copd Research Symposium, Holmenkollen, Oslo 18th-19th November 2016

Peer reviewe

Lung transplantation after allogeneic stem cell transplantation : a pan-European experience

Late-onset noninfectious pulmonary complications (LONIPCs) affect 6% of allogeneic stem cell transplantation (SCT) recipients within 5 years, conferring subsequent 5-year survival of 50%. Lung transplantation is rarely performed in this setting due to concomitant extrapulmonary morbidity, excessive immunosuppression and concerns about recurring malignancy being considered contraindications. This study assesses survival in highly selected patients undergoing lung transplantation for LONIPCs after SCT. SCT patients undergoing lung transplantation at 20 European centres between 1996 and 2014 were included. Clinical data pre- and post-lung transplantation were reviewed. Propensity score-matched controls were generated from the Eurotransplant and Scandiatransplant registries. Kaplan-Meier survival analysis and Cox proportional hazard regression models evaluating predictors of graft loss were performed. Graft survival at 1, 3 and 5 years of 84%, 72% and 67%, respectively, among the 105 SCT patients proved comparable to controls (p=0.75). Sepsis accounted for 15 out of 37 deaths (41%), with prior mechanical ventilation (HR 6.9, 95% CI 1.0-46.7; p Lung transplantation outcomes following SCT were comparable to other end-stage diseases. Lung transplantation should be considered feasible in selected candidates. No SCT-specific factors influencing outcome were identified within this carefully selected patient cohort.Peer reviewe

Critical Exponents of the N-vector model

Recently the series for two RG functions (corresponding to the anomalous dimensions of the fields phi and phi^2) of the 3D phi^4 field theory have been extended to next order (seven loops) by Murray and Nickel. We examine here the influence of these additional terms on the estimates of critical exponents of the N-vector model, using some new ideas in the context of the Borel summation techniques. The estimates have slightly changed, but remain within errors of the previous evaluation. Exponents like eta (related to the field anomalous dimension), which were poorly determined in the previous evaluation of Le Guillou--Zinn-Justin, have seen their apparent errors significantly decrease. More importantly, perhaps, summation errors are better determined. The change in exponents affects the recently determined ratios of amplitudes and we report the corresponding new values. Finally, because an error has been discovered in the last order of the published epsilon=4-d expansions (order epsilon^5), we have also reanalyzed the determination of exponents from the epsilon-expansion. The conclusion is that the general agreement between epsilon-expansion and 3D series has improved with respect to Le Guillou--Zinn-Justin.Comment: TeX Files, 27 pages +2 figures; Some values are changed; references update

Gastrointestinal symptoms in invasive pneumococcal disease: a cohort study

Background The study aimed to assess whether gastrointestinal (GI) symptoms at admission are associated with increased short-term mortality in patients with invasive pneumococcal disease (IPD). Methods We included all patients with IPD at Aker University Hospital in Oslo, Norway, from 1993 to 2008. Clinical data were registered. Survival data were retrieved from official registries. We used Cox regression and Kaplan-Meier curve to compare mortality within 28 days of admission in patients with and without GI symptoms. Results Four hundred sixteen patients were included. Of these, 108 patients (26%) presented with GI symptoms, and 47 patients (11%) with GI symptoms only. Patients with GI symptoms were younger (p < 0.001) and had less cardiovascular disease (p < 0.001), pulmonary disease (p = 0.048), and cancer (p = 0.035) and received appropriate antibiotic treatment later. After adjusting for risk factors, we found an increased hazard ratio of 2.28 (95% CI 1.31–3.97) in patients presenting with GI symptoms. In patients with GI symptoms only there was an increased hazard ratio of 2.24 (95% CI 1.20–4.19) in univariate analysis, which increased to 4.20 (95% CI 2.11–8.39) after multivariate adjustment. Fewer patients with GI symptoms only received antibiotics upon admission. Conclusions A large proportion of IPD patients present with GI symptoms only or in combination with other symptoms. GI symptoms in IPD are associated with increased short-term mortality

Distinct symptom experiences in subgroups of patients with COPD.

BackgroundIn addition to their respiratory symptoms, patients with COPD experience multiple, co-occurring symptoms.ObjectivesThe aims of this study were to identify subgroups of COPD patients based on their distinct experiences with 14 symptoms and to determine how these subgroups differed in demographic and clinical characteristics and disease-specific quality of life.Patients and methodsPatients with moderate, severe, and very severe COPD (n=267) completed a number of self-report questionnaires. Latent class analysis was used to identify subgroups of patients with distinct symptom experiences based on the occurrence of self-reported symptoms using the Memorial Symptom Assessment Scale.ResultsBased on the probability of occurrence of a number of physical and psychological symptoms, three subgroups of patients (ie, latent classes) were identified and named "high", "intermediate", and "low". Across the three latent classes, the pairwise comparisons for the classification of airflow limitation in COPD were not significantly different, which suggests that measurements of respiratory function are not associated with COPD patients' symptom burden and their specific needs for symptom management. While patients in both the "high" and "intermediate" classes had high occurrence rates for respiratory symptoms, patients in the "high" class had the highest occurrence rates for psychological symptoms. Compared with the "intermediate" class, patients in the "high" class were younger, more likely to be women, had significantly more acute exacerbations in the past year, and reported significantly worse disease-specific quality of life scores.ConclusionThese findings suggest that subgroups of COPD patients with distinct symptom experiences can be identified. Patients with a higher symptom burden warrant more detailed assessments and may have therapeutic needs that would not be identified using current classifications based only on respiratory function

Distinct pain profiles in patients with chronic obstructive pulmonary disease.

BackgroundFew studies have examined changes in the pain experience of patients with COPD and predictors of pain in these patients.ObjectivesThe objectives of the study were to examine whether distinct groups of COPD patients could be identified based on changes in the occurrence and severity of pain over 12 months and to evaluate whether these groups differed on demographic, clinical, and pain characteristics, and health-related quality of life (HRQoL).Patients and methodsA longitudinal study of 267 COPD patients with very severe COPD was conducted. Their mean age was 63 years, and 53% were females. The patients completed questionnaires including demographic and clinical variables, the Brief Pain Inventory, and the St Georges Respiratory Questionnaire at enrollment, and 3, 6, 9, and 12 months follow-up. In addition, spirometry and the 6 Minute Walk Test were performed. Latent class analysis was used to identify subgroups of patients with distinct pain profiles based on pain occurrence and worst pain severity.ResultsMost of the patients (77%) reported pain occurrence over 12 months. Of these, 48% were in the "high probability of pain" group, while 29% were in the "moderate probability of pain" group. For the worst pain severity, 37% were in the "moderate pain" and 39% were in the "mild pain" groups. Females and those with higher body mass index, higher number of comorbidities, and less education were in the pain groups. Patients in the higher pain groups reported higher pain interference scores, higher number of pain locations, and more respiratory symptoms. Few differences in HRQoL were found between the groups except for the symptom subscale.ConclusionPatients with COPD warrant comprehensive pain management. Clinicians may use this information to identify those who are at higher risk for persistent pain

Meta-analysis of the effects of predation on animal prey abundance: evidence from UK vertebrates

Background: Controlling vertebrate predators is one of the most widespread forms of wildlife management and it continues to cause conflict between stakeholders worldwide. It is important for managers and policy-makers to make decisions on this issue that are based on the best available scientific evidence. Therefore, it is first important to understand if there is indeed an impact of vertebrate predators on prey, and then to quantify this impact. Methodology/Principal Findings: Using the UK as a case study, we use a meta-analytical approach to review the available evidence to assess the effect of vertebrate predation on animal prey abundance. We find a significant effect of predators on prey abundance across our studies. On average, there is a 1.6 fold increase in prey abundance in the absence of predation. However, we show significant heterogeneity in effect sizes, and discuss how the method of predator control, whether the predator is native or non-native, and aspects of study design, may be potential causes. Conclusions/Significance: Our results allow some cautious policy recommendations to be made regarding the management of predator and prey populations. Meta-analysis is an important tool for understanding general patterns in the effect of predators on prey abundance across studies. Such an approach is especially valuable where management decisions need to be made in the absence of site-specific information

Dichotomy in pulmonary graft-versus-host disease evident among allogeneic stem-cell transplant recipients undergoing lung transplantation

International audienceno abstrac

Long-term persistence of human donor alveolar macrophages in lung transplant recipients

Background Alveolar macrophages (AMFs) are critical regulators of lung function, and may participate in graft rejection following lung transplantation. Recent studies in experimental animals suggest that most AMFs are self-maintaining cells of embryonic origin, but knowledge about the ontogeny and life span of human AMFs is scarce. Methods To follow the origin and longevity of AMFs in patients with lung transplantation for more than 100 weeks, we obtained transbronchial biopsies from 10 gender-mismatched patients with lung transplantation. These were subjected to combined in situ hybridisation for X/Y chromosomes and immunofluorescence staining for macrophage markers. Moreover, development of AMFs in humanised mice reconstituted with CD34+ umbilical cord-derived cells was assessed. Results The number of donor-derived AMFs was unchanged during the 2 year post-transplantation period. A fraction of the AMFs proliferated locally, demonstrating that at least a subset of human AMFs have the capacity to self-renew. Lungs of humanised mice were found to abundantly contain populations of human AMFs expressing markers compatible with a monocyte origin. Moreover, in patients with lung transplantation we found that recipient monocytes seeded the alveoli early after transplantation, and showed subsequent phenotypical changes consistent with differentiation into proliferating mature AMFs. This resulted in a stable mixed chimerism between donor and recipient AMFs throughout the 2-year period. Conclusions The finding that human AMFs are maintained in the lung parenchyma for several years indicates that pulmonary macrophage transplantation can be a feasible therapeutic option for patients with diseases caused by dysfunctional AMFs. Moreover, in a lung transplantation setting, long-term persistence of donor AMFs may be important for the development of chronic graft rejection