The Changing Face of Heart Transplantation

It has been 40 years since the first human-to-human heart transplant performed in South Africa by Christiaan Barnard in December 1967. This achievement did not come as a surprise to the medical community but was the result of many years of early pioneering experimental work by Alexis Carrel, Frank Mann, Norman Shumway, and Richard Lower. Since then, refinement of donor and recipient selection methods, better donor heart management, and advances in immunosuppression have significantly improved survival. In this article, we hope to give a perspective on the changing face of heart transplantation. Topics that will be covered in this review include the changing patient population as well as recent advances in transplantation immunology, organ preservation, allograft vasculopathy, and immune tolerance

Reactively Deposited Aluminum Oxide and Fluoropolymer Filled Aluminum Oxide Protective Coatings for Polymers

Reactive ion beam sputter deposition of aluminum simultaneous with low energy arrival of oxygen ions at the deposition surface enables the formation of highly transparent aluminum oxide films. Thick (12 200 A), adherent, low stress, reactively deposited aluminum oxide films were found to provide some abrasion resistance to polycarbonate substrates. The reactively deposited aluminum oxide films are also slightly more hydrophobic and more transmitting in the UV than aluminum oxide deposited from an aluminum oxide target. Simultaneous reactive sputter deposition of aluminum along with polytetrafluoroethylene (PTFE Teflon) produces fluoropolymer-filled aluminum oxide films which are lower in stress, about the same in transmittance, but more wetting than reactively deposited aluminum oxide films. Deposition properties, processes and potential applications for these coatings will be discussed

Accelerated coronary vascular disease in the heart transplant patient: Coronary arteriographic findings

AbstractAnnual coronary arteriograms have been obtained from all heart transplant recipients at Stanford University Medical Center since 1969. Angiographic lesions in 81 transplant patients exhibiting coronary vascular disease were classified into three categories: type A, discrete or tubular stenoses; type B, diffuse concentric narrowing; and type C, narrowed irregular vessels with occluded branches. The 81 arteriograms showing transplant coronary vascular disease were contrasted with 32 from nontransplant patients with coronary artery disease analyzed in a similar fashion.The nontransplant angiograms showed 178 lesions, all of type A (discrete or tubular) morphology, 75% of which were located in primary epicardial coronary vessels and 25% in secondary branch vessels. In the patients with transplant coronary vascular disease, 349 (76%) of 461 lesions were type A: 57% in primary vessels, 42% in secondary branches and 1.4% in tertiary branches. Of the 112 type B and C lesions (diffuse narrowing, tapering and obliteration), 25% were in primary vessels, 44% in secondary vessels and 31% in tertiary branches (p < 0.05 for patients with transplant coronary vascular disease versus patients with nontransplant coronary artery disease). Total vessel occlusion was found in proximal or middle vessel segments in 96% and distally in 4% of patients with “ordinary” coronary artery disease versus 49% distally in patients with transplant coronary disease (p < 0.002). In the presence of total vessel occlusion, collateral vessels were poor or absent in 92% of transplant versus 7% of nontransplant patients with coronary disease (p < 0.002).Therefore, coronary artery disease in transplant patients represents a mixture of typical atheromatous lesions and unique transplant-related progressive distal obliterative disease that occurs without collateral vessel development

Comparison of bacterial genome assembly software for MinION data and their applicability to medical microbiology.

Translating the Oxford Nanopore MinION sequencing technology into medical microbiology requires on-going analysis that keeps pace with technological improvements to the instrument and release of associated analysis software. Here, we use a multidrug-resistant Enterobacter kobei isolate as a model organism to compare open source software for the assembly of genome data, and relate this to the time taken to generate actionable information. Three software tools (PBcR, Canu and miniasm) were used to assemble MinION data and a fourth (SPAdes) was used to combine MinION and Illumina data to produce a hybrid assembly. All four had a similar number of contigs and were more contiguous than the assembly using Illumina data alone, with SPAdes producing a single chromosomal contig. Evaluation of the four assemblies to represent the genome structure revealed a single large inversion in the SPAdes assembly, which also incorrectly integrated a plasmid into the chromosomal contig. Almost 50 %, 80 % and 90 % of MinION pass reads were generated in the first 6, 9 and 12 h, respectively. Using data from the first 6 h alone led to a less accurate, fragmented assembly, but data from the first 9 or 12 h generated similar assemblies to that from 48 h sequencing. Assemblies were generated in 2 h using Canu, indicating that going from isolate to assembled data is possible in less than 48 h. MinION data identified that genes responsible for resistance were carried by two plasmids encoding resistance to carbapenem and to sulphonamides, rifampicin and aminoglycosides, respectively.Health Innovation Challenge Fund (WT098600, HICF-T5-342) (Department of Health, Wellcome Trust)This is the final version of the article. It first appeared from the Microbiology Society via http://dx.doi.org/10.1099/mgen.0.00008

Early development of accelerated graft coronary artery disease: Risk factors and course

AbstractObjectives. This study assessed the time of first appearance of angiographic graft coronary artery disease in relation to clinical and laboratory variables and clinical events in heart transplant recipients.Background. Graft coronary artery disease is the main factor limiting long-term survival after heart transplantation, and it is important to understand its natural history.Methods. One hundred thirty-nine consecutive patients who developed angiographic coronary artery disease after heart transplantation were classified according to early (≤2 years) versus late (>2 years) posttransplantation initial detection of coronary artery disease. These subgroups were analyzed for differences in clinical and laboratory demographics, incidence of progression to ischemic events and incidence of antecedent cytomegalovirus infection.Results. The early-onset group (64 patients) had more rapid progression to ischemic events than the late-onset group (75 patients), with 59% of the late group and only 35% of the early group free from ischemic events by 5 years after initial detection (p = 0.02), but there were no significantly correlated clinical or laboratory predictors of ischemic events. The early group had a significantly higher incidence of antecedent cytomegalovirus infection.Conclusions. We conclude that 1) accelerated graft coronary artery disease develops at variable times after heart transplantation; 2) the early appearance of graft coronary artery disease may be a marker of intrinsically more aggressive disease; 3) cytomegalovirus infection is associated with earlier onset of graft coronary artery disease. Patients with early development of graft coronary artery disease should potentially be given priority for interventional strategies as they are developed

Atomic Oxygen Textured Polymers

Atomic oxygen can be used to microscopically alter the surface morphology of polymeric materials in space or in ground laboratory facilities. For polymeric materials whose sole oxidation products are volatile species, directed atomic oxygen reactions produce surfaces of microscopic cones. However, isotropic atomic oxygen exposure results in polymer surfaces covered with lower aspect ratio sharp-edged craters. Isotropic atomic oxygen plasma exposure of polymers typically causes a significant decrease in water contact angle as well as altered coefficient of static friction. Such surface alterations may be of benefit for industrial and biomedical applications. The results of atomic oxygen plasma exposure of thirty-three (33) different polymers are presented, including typical morphology changes, effects on water contact angle, and coefficient of static friction

Drugs-related death soon after hospital discharge among drug treatment clients in Scotland:record linkage, validation and investigation of risk factors.

We validate that the 28 days after hospital-discharge are high-risk for drugs-related death (DRD) among drug users in Scotland and investigate key risk-factors for DRDs soon after hospital-discharge. Using data from an anonymous linkage of hospitalisation and death records to the Scottish Drugs Misuse Database (SDMD), including over 98,000 individuals registered for drug treatment during 1 April 1996 to 31 March 2010 with 705,538 person-years, 173,107 hospital-stays, and 2,523 DRDs. Time-at-risk of DRD was categorised as: during hospitalization, within 28 days, 29-90 days, 91 days-1 year, >1 year since most recent hospital discharge versus 'never admitted'. Factors of interest were: having ever injected, misuse of alcohol, length of hospital-stay (0-1 versus 2+ days), and main discharge-diagnosis. We confirm SDMD clients' high DRD-rate soon after hospital-discharge in 2006-2010. DRD-rate in the 28 days after hospital-discharge did not vary by length of hospital-stay but was significantly higher for clients who had ever-injected versus otherwise. Three leading discharge-diagnoses accounted for only 150/290 DRDs in the 28 days after hospital-discharge, but ever-injectors for 222/290. Hospital-discharge remains a period of increased DRD-vulnerability in 2006-2010, as in 1996-2006, especially for those with a history of injecting

A New Approach for Checking and Complementing CALIPSO Lidar Calibration

We have been studying the backscatter ratio of the two CALIPSO wavelengths for 3 different targets. We are showing the ratio of integrate attenuated backscatter coefficient for cirrus clouds, ocean surface and liquid. Water clouds for one month of nightime data (left:July,right:December), Only opaque cirrus classified as randomly oriented ice[1] are used. For ocean and water clouds, only the clearest shots, determined by a threshold on integrated attenuated backscatter are used. Two things can be immediately observed: 1. A similar trend (black dotted line) is visible using all targets, the color ratio shows a tendency to be higher north and lower south for those two months. 2. The water clouds average value is around 15% lower than ocean surface and cirrus clouds. This is due to the different multiple scattering at 532 nm and 1064 nm [2] which strongly impact the water cloud retrieval. Conclusion: Different targets can be used to improve CALIPSO 1064 nm calibration accuracy. All of them show the signature of an instrumental calibration shift. Multiple scattering introduce a bias in liquid water cloud signal but it still compares very well with all other methods and should not be overlooked. The effect of multiple scattering in liquid and ice clouds will be the subject of future research. If there really is a sampling issue. Combining all methods to increase the sampling, mapping the calibration coefficient or trying to reach an orbit per orbit calibration seems an appropriate way

Student Satisfaction and Performance in an Online Teacher Certification Program

The article presents a study which demonstrates the effectiveness of an online post baccalaureate teacher certification program developed by a Wisconsin university. The case method approach employing multiple methods and multiple data sources were used to investigate the degree to which pre-service teachers were prepared to teach. It was concluded that the study supports online delivery as an effective means of teacher preparation, but it was limited in the number of students followed into their first year of teaching