Airway complications after lung transplantation: risk factors, prevention and outcome

PURPOSE: Anastomotic complications following lung transplantation (LuTx) have been described in up to 15% of patients. Challenging to treat, they are associated with high morbidity and a mortality rate of 2-5%. The aim of this study was to analyze the incidence of complications in a consecutive series of bronchial anastomosis after LuTx at our center and to delineate the potential risk factors. METHODS: Between 1992 and 2007, 441 bronchial anastomoses were performed in 235 patients. Indications for transplantation were cystic fibrosis (35.7%) emphysema (28.1%) pulmonary fibrosis (12.8%) and pulmonary hypertension (7.7%). There were 206 sequential bilateral and 28 single transplants including lobar engraftments in 20 cases. The donor bronchus was shortened to the plane of the lobar carina including the medial wall of the intermediate bronchus. Peribronchial tissue was left untouched. Anastomosis was carried out using a continuous absorbable running suture (PDS 4/0) at the membranous and interrupted sutures at the cartilaginous part. Six elective surveillance bronchoscopies were done monthly during the first half-year post-LuTx, with detailed assessment of the pre- and post-anastomotic airways. RESULTS: One-year survival since 2000 was 90.5%. In all 441 anastomoses performed, no significant dehiscence was observed. In one patient, a small fistula was detected and closed surgically on postoperative day five. Fungal membranes were found in 50% of the anastomoses at 1 month and in 14% at 6 months. Discrete narrowing of the anastomotic lumen without need for intervention was found in 4.9% of patients at 1 month and in 2.4% at 6 months. Age, cytomegalovirus status, induction therapy, immunosuppressive regimen, ischemic time, and ventilation time had no influence on bronchial healing. CONCLUSIONS: Clinically relevant bronchial anastomotic complications after LuTx can be avoided by use of a simple standardized surgical technique. Aggressive antibiotic and antifungal therapy might play an important supportive rol

A tuberkulózis előfordulása egy XVIII. századi váci családban

Two individuals of the Nigrovits family from the Vác Mummy Collection of the Hungarian Natural History Museum were the subjects of multidisciplinary, anthropological, paleopathological, radiological, paleomicrobiological and paleoproteomic studies. The father, József Nigrovits (No 29), died at the age of 55 on the 11th of November 1793; his son, Antal Nigrovits (No 54), died on the 16th of July 1803, at the age of 22. They lived in the 18th century in a small town of northern Hungary. The macroscopic examination of body No 54 showed a severely deformed neck and back region; body No 29 had no characteristic marks of any illnesses. The CT scan data of the bodies and their 3D reconstructions showed no skeletal evidence of tuberculosis, despite the positive results of their paleomicrobiological studies. The deformity of body No 54 turned to be a developmental abnormality of unknown origin, but no Pott’s gibbus was present

Potencijalna upotreba izotopa važnih za okoliš u ispitivanju migracije onečišćujućih tvari

This article presents the use of natural abundance stable isotope (hydrogen, carbon, nitrogen, oxygen, chlorine) analysis data as a tool for providing important information about the origin of contaminants, the contribution of different sources to a multi-source plume, characterisation of their complex transport (rate and mechanisms) and for evaluating the success of contaminated site remediation. Isotopic signatures of contaminants are useful tracers of their sources, while isotopic fractionation can be used to quantitatively assess the progress of an environmental process such as biodegradation. This new isotopic approach is reliable and can offer more information than traditional techniques in pollutant migration studies, particularly after waste disposal. During biological degradation of any organic compound, molecules containing lighter isotopes are degraded, and the portion of heavier isotopes in the substrate is increased, identifying specific microbial roles in biogeochemical cycling. Since isotopic fractionation is proportional to degradation, depending on the type of contamination, a microbial degradation of 50 % to 99 % of the initial concentration can be quantified using isotope ratio measurements.Cilj ovog rada je da se prikaže korištenje podataka analize prirodne obilnosti stabilnih izotopa (vodika, ugljika, dušika, kisika i klora) kao alata za dobivanje važnih informacija o porijeklu onečišćujućih tvari, doprinosu različitih multikomponentnih onečišćivača, karakterizaciji njihova kompleksnog transporta (brzine i mehanizma) i praćenja uspjeha remedijacije onečišćenih mjesta. Izotopski sadržaji onečišćujućih tvari koriste se kao traseri za određivanje njihovih izvora, dok se izotopsko frakcioniranje može iskoristiti za kvantitativnu procjenu toka procesa kao što je biodegradacija. Takav nov izotopski pristup je pouzdan i nudi više informacija od tradicionalnih tehnika kontrole putovanja onečišćivala, napose nakon odlaganja opasnog otpada na zemljištu. Za vrijeme biodegradacije nekog organskog spoje molekule koje sadržavaju lake izotope lakše se degradiraju, a dio težih izotopa u supstratu se povećava, što upućuje na mikrobiološku ulogu u biokemijskom ciklusu. Kako je izotopsko frakcioniranje proporcionalno degradaciji zavisno od tipa onečišćenja, korištenjem podataka mjerenja izotopskih odnosa može se procijeniti mikrobiološka degradacija od 50 % do 99 % od početne koncentracije

Distribution of macrophages and T cells in syngrafts and allografts after experimental rat lung transplantation

Macrophages and T cells have a pivotal role in orchestrating the acute lung allograft rejection response. We investigated the spatial and temporal distribution of these immune cells and the synthesis patterns of the T(h)1- and T(h)2-cytokine IL-12 and IL-10 during the early course after transplantation (Tx). Orthotopic single-lung Tx was performed in Lewis to Lewis (syngrafts) and Brown Norway/Lewis F(1) hybrid to Lewis (allografts). Naïve lungs, syngrafts after 5 days and allografts after 3 and 5 days were analyzed for CD68(+), CD163(+) and CD3(+) cells by immunohistochemistry and IL-12 and IL-10 were detected by immunofluorescence. CD68(+) macrophages increased in number after allogeneic Tx compared to syngeneic Tx on day 5 (P<.001), CD163(+) macrophages sequestrated early around veins (day 3) compared to the accumulation around arteries and bronchioles (P<.001) while CD3(+) T cells were scarce. There was a predominance of IL-12 over IL-10 on day 5 after allogeneic Tx (P<.001). CD68(+) macrophages were the most abundant cells during acute pulmonary rejection and CD163(+) macrophages showed a characteristic distribution pattern over time around vessels and bronchioles. The up-regulation of IL-12 reflects an early response after allo-antigen exposure, indicating a strong impact of the initiation of the T(h)1 pathway at an early phase during acute lung rejection

The effect of low-dose continuous erythropoietin receptor activator in an experimental model of acute Cyclosporine A induced renal injury

The use of Cyclosporine A (CsA) as rejection prophylaxis following organ transplantation is limited by its nephrotoxicity. CsA induces renal damage that is associated with tubulo-interstitial injury and parenchymal sequestration of macrophages, perpetuating pro-inflammatory processes. Furthermore, CsA exerts a diabetogenic effect by damaging pancreatic islet cell integrity. Continuous Erythropoietin Receptor Activator (CERA) was shown to mediate tissue-protective and anti-inflammatory effects in various settings of organ injury. Here, we investigated the effect of low dose CERA in a model of CsA-induced renal and pancreatic injury. Rats were exposed to medium-dose CsA for 28 days. Low-dose CERA was given to the treatment group (CERA) (n=6) once per week vs. a CsA-treated control group (CONTROL) (n=6). The effect of CERA on renal and pancreatic injuries was analyzed by organ function, histology, immunohistochemistry (CD68(+)-macrophages, insulin), ELISA (TGF-β1) and RT-PCR (TGF-β1, Osteopontin, IL-10). CsA induced functional kidney damage. Low dose CERA did not lead to improved kidney function in the treatment group. However, low dose CERA showed a trend toward upregulation of osteopontin accompanied by increased renal macrophage-infiltration and enhanced parenchymal TGF-β1 and IL-10 when compared to controls. Moreover, CERA treated animals showed amelioration of pancreatic islet cell injury. In this model of acute CsA-mediated renal injury, low dose CERA administration was associated with anti-inflammatory effects and preservation of pancreatic islet cell viability

The influence of the rapamycin-derivate SDZ RAD on the healing of airway anastomoses

Objective: Among the many immunosuppressive effects of SDZ RAD (40-0(2-hydroxyethyl)-rapamycin), a rapamycin derivative, is the inhibition of fibroblast proliferation. Since the long-term success of lung transplantation is limited by the development of bronchiolitis obliterans, a fibroblast-associated progressive luminal obstruction of the terminal bronchioli, the use of SDZ RAD as immunosuppressive in pulmonary graft recipients may counteract this process. However, reduction of fibroblast activity, posttransplant, may impair the healing of the bronchial anastomoses. Materials and methods: The cervical trachea in pigs was denuded, divided and re-anastomosed with Prolene 4-0 single stitches. Control animals (group 1, n=4) were without, and study animals (group 2, n=6) were with SDZ RAD therapy (1.25 mg/kg/day, p.o., 14 days). After 14 days, the pigs were sacrificed. The anastomoses were examined histologically, and breaking strength of tracheal strips of 5-mm width was measured. Results: All animals survived without complications. Serum levels of SDZ RAD were 30.9±8.7 ng/ml (recommended level 20-40 ng/ml). All anastomoses healed macroscopically without difference between the two groups. Breaking strength was significantly lower in the treated animals (group 1 vs. group 2: 11.75±0.35 vs. 7.69±1.39 N, P=0.01). Histology did not show a significant change in histoarchitecture between the groups. Conclusions: Although SDZ RAD significantly reduced the breaking strength of the tracheal anastomosis, no obvious histological differences between treated and untreated animals could be detected. Since this model does not reflect the clinical situation, further investigations are necessary to reveal the effect of SDZ RAD on airway wound healing in concert with a contemporary clinically used multidrug immunosuppressive regimen in allograft recipient

Selective in situ protein expression profiles correlate with distinct phenotypes of basal cell carcinoma and squamous cell carcinoma of the skin

Non-melanoma skin cancer is the most common malignancy that shows increasing incidence due to our cumulative exposure to ultraviolet irradiation. Its major subtypes, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) differ in pathobiology, phenotype and clinical behavior, which must be reflected at the molecular level. In this study, protein expression profiles of BCC and SCC were tested in tissue microarrays and correlated with that of actinic keratosis, Bowen’s disease, seborrheic keratosis and normal epidermis by detecting 22 proteins involved in cell interactions, growth, cell cycle regulation or apoptosis. The significantly more reduced collagen XVII, CD44v6, pan-Desmoglein levels and more evident E-Cadherin delocalization in BCC compared to SCC correlated with the de novo dermal invasion of BCC against the progressive invasion from in situ lesions in SCC development. EGFR was also expressed at a significantly higher level in SCC than in BCC. The upregulated cell communication protein connexin43 in BCC could contribute to the protection of BCC from metastatic invasion. Elevated cell replication in BCC was underlined by the increased topoisomerase IIa and reduced p21waf1 and p27kip1 positive cells fractions compared to SCC. Compared to differentiated keratinocytes, caspase-8 and -9 were equally upregulated in skin carcinoma subtypes for either mediating apoptosis induction or immune escape of tumor cells. Hierarchical cluster analysis grouped SCC and actinic keratosis cases exclusively together in support of their common origin and malignant phenotype. BCC cases were also clustered fully together. Differentially expressed proteins reflect the distinct pathobiology of skin carcinoma subtypes and can serve as surrogate markers in doubtful cases

Inhibition of CD26/DPP IV attenuates ischemia/reperfusion injury in orthotopic mouse lung transplants: The pivotal role of vasoactive intestinal peptide

The T cell activation Ag CD26/dipeptidylpeptidase IV (DPP IV) combines co-stimulatory and enzymatic properties. Catalytically, it functions as an exopeptidase, modulating biological activity of key chemokines and peptides. Here we investigated the effect of organ-specific inhibition of DPP IV catalytic activity on ischemia/reperfusion injury after extended ischemia in the mouse model of orthotopic single lung transplantation. C57BL/6 mice were syngeneically, transplanted, grafts were perfused and stored in Perfadex with (treated) or without (control) a DPP IV enzymatic activity inhibitor (AB192). Transplantation was performed after 18h cold ischemia time; following 2-h reperfusion, grafts were analyzed for oxygenation, thiobarbituric acid-reactive substances, histomorphology, and immunohistochemistry was performed for leukocyte Ag 6, myeloperoxidase, hemoxygenase 1, vasoactive intestinal protein (VIP), and real-time PCR for VIP. Treatment with the DPP IV inhibitor AB192 resulted in significant improvement of gas exchange, less lipid oxidation, preservation of parenchymal ultrastructure, reduced neutrophil infiltration, reduced myeloperoxidase expression, increased hemoxygenase 1 expression, pronounced expression of VIP in alveolar macrophages and increased mRNA expression of VIP. Inhibition of intragraft DPP IV catalytic activity with AB192 strikingly ameliorates ischemia/reperfusion injury after extended ischemia. Furthermore, preservation of endogenous intragraft VIP levels correlate with maintaining lung function and structural integrity