Prior diabetes mellitus is associated with increased morbidity in cystic fibrosis patients undergoing bilateral lung transplantation: an ‘orphan’ area? A retrospective case–control study

Background: The aim of this study was to determine whether pre-existing diabetes mellitus increases the risk of rejection, infection and/or death in cystic fibrosis patients undergoing bilateral sequential single-lung transplantation.
Methods: A retrospective audit of 25 consecutive patients with cystic fibrosis who underwent bilateral sequential single-lung transplantation between 1 January 2003 and 31 December 2005 at a tertiary referral hospital was carried out.
Results: Although 32% patients had diabetes diagnosed before lung transplantation, 92% had random blood glucose levels ≥11.1 mmol/L requiring insulin during admission. Patients with pre-existing diabetes had increased infection-related (3.9 vs 1.2, P = 0.01) and putative rejection-related (1.4 vs 0.5, P = 0.04) hospital admissions post-transplantation compared with those without diabetes pre-transplant. During the period of observation, four of eight patients with a prior diagnosis of diabetes died compared with none of 17 patients without prior diabetes ( P = 0.0055).
Conclusion: Almost all cystic fibrosis patients develop hyperglycaemia after lung transplantation, but patients with prior diabetes have more complication-related admissions to hospital and a higher mortality rate.     

Exercise in claudicants is accompanied by excessive thrombin generation.

BACKGROUND: exercise in IC leads to ischaemia-reperfusion injury of leg muscles and a systemic inflammatory response, but the effect of on coagulation is unknown. OBJECTIVE: to compare the effect of exercise on thrombin formation and fibrin turnover in patients with IC (n = 10), and age and sex matched smokers ([S] n = 5) and non-smokers ([NS] n = 5) without peripheral vascular disease. METHODS: blood was taken from subjects 60 and 30 min before, and 1, 5, 20, 40, 60 and 120 min after, treadmill exercise. Markers of thrombin generation (thrombin-antithrombin complexes [TAT] and prothrombin fragments 1 + 2 [PF1 + 2]) and fibrin turnover (D-dimer and fibrin degradation products [FbDP]) were assayed at each time point. RESULTS: following exercise, thrombin generation was significantly greater in the claudicant group compared to the control groups (Area Under Curve [AUC] post exercise IC vs S vs NS; TAT 3960 vs 1623 vs 1476 vs = 0.007 Kruskal-Wallis [KW]; PF1 + 2 163 vs 107 vs 123 p = 0.024 KW). Pre and post-exercise, fibrin turnover in claudicants was similar to smoking controls, but higher than non-smoking controls. (AUC post exercise IC vs NS; D-dimer 6340 vs 2754 p = 0.055 Mann-Whitney U[MW]; FbDP 45113 vs 21511 p = 0.009 MW). CONCLUSION: when compared to non-claudicants, exercise in IC is associated with excessive production of thrombin. Despite this, claudicants have a similar level of fibrin turnover suggesting a possible defect in fibrinolysis. This prothrombotic state may contribute to the excess thrombotic morbidity and mortality suffered by claudicants.     

An altered calmodulin binding protein in cystic fibrosis--a clue to the biochemical defect

Cytosolic extracts prepared from submandibular tissues of CF patients showed a greater ability to activate calmodulin-deficient cyclic AMP phosphodiesterase than did control extracts. Thus, apparent calmodulin levels measured by cyclic AMP phosphodiesterase activation were significantly greater (p less than 0.001) in CF submandibular extracts than control; whereas calmodulin levels measured by radioimmunoassay were not different. In addition a calmodulin-binding protein of molecular weight 61,000 which showed a specific Ca2+-dependent interaction with calmodulin, was shown to be markedly altered in heat-treated extracts from CF submandibular glands. The results indicate that a specific protein which modulates selective biological action(s) of calmodulin is altered in CF. This would provide a biochemical link between disturbances in autonomic function and Ca2+ homeostasis seen in this disease and might therefore be closely related to the genetic defect.     

Modulation of the crayfish swimmeret rhythm by octopamine and the neuropeptide proctolin

1. The swimmeret system can be excited by perfusing the neuropeptide proctolin through the isolated ventral nerve cord of the crayfish. Previously silent preparations begin to generate a characteristic motor pattern, the swimmeret rhythm, in the nerves that innervate the swimmerets. The response to proctolin is dose dependent and reversible. The threshold concentration of proctolin perfused through the ventral artery is approximately 10(-8) M. The EC50 is 1.6 X 10(-6) M. 2. Proctolin-induced motor patterns have periods and phases similar to those of spontaneously generated motor patterns. The durations of the bursts of impulses in power-stroke motor neurons generated in the presence of proctolin are, however, significantly longer than those that occur during spontaneous activity. 3. DL-Octopamine inhibits the swimmeret system, both when the system is spontaneously active and when it has been excited by proctolin. The inhibition by octopamine is dose dependent and reversible. The threshold for inhibition is approximately 10(-6) M, and the EC50 is approximately 5 X 10(-5) M. 4. Octopamine's effect is mimicked by its agonists, synephrine and norepinephrine. Synephrine has a lower threshold concentration than does octopamine, but norepinephrine is much less effective than octopamine. 5. Octopamine's inhibition is partially blocked by an antagonist, phentolamine. 6. Phentolamine also blocks inhibition of the swimmeret system by inhibitory command interneurons. This block is dose dependent and can be partially overcome by stimulating the command interneurons at higher frequencies. 7. Perfusion with 11 other suspected crustacean neurotransmitters and transmitter analogues did not similarly excite or inhibit the swimmeret system, so we suggest that proctolin and octopamine are transmitters used by the neurons that normally control expression of the swimmeret rhythm.     

Effect of pituitary gonadotrophins on proliferation of primary cultures of human ovarian stroma

Proliferation of ovarian stromal cells is a common phenomenon in peri- and post-menopausal ovaries. It is generally assumed to be secondary to the rise in circulating gonadotrophins at the menopause, though the process by which it occurs is poorly understood. This study aimed to examine the effect of menopausal levels of pituitary gonadotrophins on the growth of primary cultures of ovarian stroma. A culture system was developed using primary explants of ovarian stroma on a collagen substrate. The effect of follicle stimulating hormone (FSH; 10(-5) g/l) and luteinizing hormone (LH; 10(-5) g/l) on the proliferation of cultures derived from the cortices and medullae of ten ovaries was evaluated using a dual radiothymidine labelling technique. FSH was stimulatory to cortical cultures from 9/10 ovaries and medullary cultures from 7/10 ovaries, while LH was stimulatory to cortical cultures from 6/9 ovaries and medullary cultures from 5/10 ovaries. The responsiveness of the cultures did not correlate with the degree of hyperplasia in vivo. This study demonstrates that pituitary gonadotrophins may modulate the growth of stromal cells in culture, and thus may play a role in the process whereby stromal proliferation occurs in peri- and post-menopausal ovaries.     

Investigations into the survival of Mycoplasma gallisepticum, Mycoplasma synoviae and Mycoplasma iowae on materials found in the poultry house environment

Following preliminary experiments to determine suitable methods for studying mycoplasma survival, suspensions of Mycoplasma gallisepticum (four strains), Mycoplasma synoviae (two strains) or Mycoplasma iowae (two strains) were seeded onto replicate samples of cotton, rubber, straw, shavings, timber, food, feathers and human hair. The organisms were also seeded onto human skin, ear and nasal mucosa. All samples were cultured for viability after 4, 8, 12 and 24 h, and then daily up to 6 days. The identity of recovered mycoplasmas was confirmed by indirect immunofluorescence. All three Mycoplasma species survived for the longest time on feathers with M. gallisepticum surviving between 2 and 4 days and M. synoviae 2 to 3 days. The type strain of M. iowae remained viable for 5 days on feathers, while the field strain was still viable at the end of the 6-day experiment. This strain also survived for at least 6 days on human hair and several other materials. M. gallisepticum survived on human hair up to 3 days and one recent field isolate also survived in the nose for 24 h. Survival times of the organisms were generally less on other materials although M. gallisepticum could be isolated from straw, cotton and rubber samples after 2 days.     

Late Niemann-Pick disease with neurovisceral storage: a classification problem.

A 51 year old man presented in 1969 with slowly progressive cerebellar ataxia of unknown origin. He was admitted to hospital aged 68 after a fall, and a ruptured spleen was removed at laparotomy. Histological analysis of the spleen suggested Niemann-Pick disease, which was subsequently confirmed. He deteriorated and died of bronchopneumonia shortly afterwards: subdural haemorrhage with storage material in neurones was found at necropsy. This late onset case of Niemann-Pick disease with neurovisceral storage is unusual and may represent a variant.     

Pathogenicity and cytadherence of Mycoplasma imitans in chicken and duck embryo tracheal organ cultures.

Two strains of the avian organism Mycoplasma imitans were examined for pathogenicity and cytadherence in chicken and duck embryo tracheal organ cultures, and a virulent strain of the related pathogen Mycoplasma gallisepticum was included for comparison. All consistently cause ciliostasis in tracheal explants from both hosts, and examination of infected tissues by immunofluorescence and transmission electron microscopy demonstrated that M. imitans proliferated on the epithelial surface and adhered to the respiratory epithelium by means of its terminal tip structure in the same manner as M. gallisepticum. These observations endorse the striking phenotypic similarities between M. imitans and M. gallisepticum and suggest that M. imitans may have pathogenic potential in vivo.