The pH of Exhaled Breath Condensate of Patients with Allograft Rejection After Lung Transplantation

Endogenous airway acidification, as assessed by the condensate pH, has been implicated in the pathophysiology of inflammatory airway diseases such as cystic fibrosis and asthma. The aim of this study was to investigate the pH of condensate in patients after lung transplantation (LTX). From the cohort of transplanted patients at our center, 83 patients (9 heart-lung transplantation, 48 double-lung transplantation, 26 single-lung transplantation) were recruited and analyzed in a cross-sectional manner: 26 patients were diagnosed with chronic rejection or bronchiolitis obliterans syndrome (BOS), 7 patients were diagnosed with acute rejection (AR) while 50 patients had no evidence of rejection according to the International Society for Heart and Lung Transplantation criteria. The condensate pH was significantly reduced in patients with BOS and AR when compared to patients without rejection and control subjects (5.8 +/- 0.5 and 6.2 +/- 0.4 versus 6.6 +/- 0.4 and 6.5 +/- 0 .4, respectively; p < 0.05). Moreover, there was a significant correlation between condensate pH levels and the BOS grade (r =-0.62; p < 0.01), the FEV(1) (r = 0.39; p < 0.01) and the total cell and neutrophil count in bronchoalveolar lavage fluid (r =-0.39 and r =-0.56, respectively; p < 0.01). Airway acidification occurs in BOS and may directly or indirectly reflect airway inflammation in patients with allograft rejection after LTX. Measuring condensate pH might thus be a new tool for the evaluation of rejection in lung transplant patients.     

Bilateral Hematogenous Pseudomonas aeruginosa Endophthalmitis After Lung Transplantation

Pseudomonas aeruginosa commonly colonizes the airways of patients with cystic fibrosis (CF). However, the occurrence of bacteremia with metastatic infection to the eye causing endogenous endophthalmitis is very rare. In the setting of lung transplantation, the significance of P. aeruginosa bacteremia in patients with CF whose airways are colonized before transplantation is unknown. We report a case of bilateral P. aeruginosa endogenous endophthalmitis in a patient with CF after lung transplant without documented bacteremia. The patient presented with acute eye symptoms in the presence of a left atrial thrombus and the disease followed a rapidly progressive course requiring aggressive medical-surgical treatment. Typically P. aeruginosa endophthalmitis has been associated with a poor visual prognosis. However, with combined medical-surgical management this patient retained useful vision in one eye without having retinal detachment or requiring enucleation. Endogenous endophthalmitis should be considered in the differential diagnosis of ocular complaints in patients with CF after lung transplant.     

Neuropathological study 16 years after autologous adrenal medullary transplantation in a Parkinson's disease patient.

To date, there is no clinicopathological correlation of adrenal medullary transplant cases in patients with survival beyond a few years. Postmortem examination of a brain from a patient with Parkinson's disease (PD), 16 years after autologous adrenal medullary transplant, was performed using tyrosine hydroxylase (TH) and chromogranin A. The patient experienced a four-year initial improvement in motor function followed by resumption of the progressive nature of her disease that continued until her death. She expired 16 years following grafting. At autopsy, TH stain of the brain revealed severe loss of TH-immunoreactivity in the substantia nigra and Lewy bodies, confirming the diagnosis of PD. The transplant site was identified by the presence of scarring and there was complete absence of any TH staining cells at the site of the transplant. There were few surviving cells staining with chromogranin A. The absence of TH-staining cells in the transplant 16 years after surgery provides further evidence that adrenal medullary transplants do not survive in the long term.     

情绪波动对急性心肌梗死后心律失常和心力衰竭的影响

目的回顾性探讨情绪波动对急性心肌梗死后心律失常、休克和心力衰竭的影响 ,为针对性地护理提供理论依据。方法将 2 4 1例急性心肌梗死病人有情绪波动 15 6例为观察组 ,无情绪波动 85例为对照组 ,比较情绪波动与心律失常、休克和心力衰竭的关系。结果观察组心律失常的发病率比对照组明显增高 (P <0 .0 1) ,差异有显著性意义。并得出相对危险度 (RR) =1.6 3,归因危险度 (AR) =2 9.12 % ,归因危险比数 (ARP) =38.83% ;室性期前收缩发病率比对照组明显增高 (P <0 .0 1) ,差异有显著性意义 ,并得出RR =2 .2 9,AR =2 6 .5 0 % ,ARP =5 6 .37%。结论情绪波动可使急性心肌梗死后心律失常 ,特别是室性期前收缩的发病率增高。     

Assay of cytomegalovirus susceptibility to ganciclovir in renal and heart transplant recipients

Ganciclovir (GCV) prophylaxis or pre-emptive therapy significantly reduce the rate of cytomegalovirus (CMV) disease and viremia, but increase the potential for emergence of ganciclovir-resistant CMV strains. The inhibitor concentration at 50% (IC(50)) of GCV from 156 CMV isolates from 59 renal or heart transplant recipients was calculated by means of a rapid phenotypic susceptibility assay. Twenty-seven strains were from 14 patients undergoing GCV therapy. The IC(50) was higher in patients under the prophylaxis regimen. One CMV strain, from a heart transplant recipient, became GCV-resistant after 1 month of therapy (IC(50)=13.7 micromol/l). These data, together with clinical and virological markers, suggested that a switch to foscarnet was necessary, and good evolution was observed. Thus, assay of CMV susceptibility to GCV could be helpful in clinical management.     

Cell transplantation to improve ventricular function in the failing heart

Current therapies for congestive heart failure are limited in efficacy or in applicability. Cardiac cell transplantation offers a novel therapeutic approach to improve heart function. Although significant progress has been made over the past decade in the development of cell transplantation, only recently have investigators studied the changes in ventricular function following cell transplantation. This review article describes the latest research developments, evaluates recent studies of ventricular function after cell transplantation, and discusses the future directions of cell transplantation as a new therapy to ‘repair broken hearts’.     

Non-invasive estimation of the diastolic elastic and viscoelastic properties of the left ventricle

The present study applies a non-invasive method to the quantitative evaluation of left ventricular stiffness in normal subjects and in patients with ischaemic heart disease (IHD). We have studied 20 patients with IHD and 25 healthy subjects. The third heart sound (S3) was detectable in all patients. We have correlated the energy spectrum of S3, divided into 15 Hz bands, with a series of echocardiographic parameters. The existence of a significant correlation between the spectrum energy and the diameter and thickness of the left ventricle at the moment of S3 allowed us to explore the possibility of interpreting the origin of S3 based on a mathematical model. Our hypothesis has been that, once the left ventricle starts vibrating, it behaves as a simple physical model composed of a mass and an elastic element. To this purely elastic model one can add a factor accounting for viscosity, with a damping effect, to obtain a more complex viscoelastic model. The stiffness coefficient 'k' was computed in both models from the peak frequency of S3 and the left ventricular mass at the moment of S3. Furthermore, in the viscoelastic model, the damping element 'c' was also computed. Both parameters--k and c--were significantly increased in the group with IHD compared with the control group. Although a simplification of the vibrating system, these models make it possible to obtain non-invasively information on the characteristics of the left ventricle through the combined use of echocardiography and spectral analysis of S3.     

通心络胶囊对冠心病治疗效果的临床对照观察

目的观察通心络胶囊对冠心病（CHD）常见临床症状的改善效果。方法对照组维持原有药物治疗不变,治疗组在此基础上加服通心络胶囊4粒/次,3次/日,疗程4周。病人接受观察前进行常规化验检查,检测心率、血压、心功能等指标。疗程结束时对上述指标再进行检查,并观察病人的临床症状改善情况。结果两组病人的胸痛、胸闷、气憋、心悸、乏力等常见临床症状均有改善,且治疗组明显优于对照组（P〈0.05）;治疗组每搏量和心排血量的较对照组提高较为明显（P〈0.01）。结论加服通心络胶囊治疗CHD能增强西药的治疗效果,进一步改善CHD病人的常见临床症状。     

Effects of low-dose transdermal scopolamine on autonomic cardiovascular control in healthy young subjects

We studied how posture influences the effects of transdermal scopolamine on autonomic cardiovascular regulation in a randomized, double-blind, placebo-controlled crossover study of 10 healthy young volunteers. We recorded the electrocardiogram and auscultatory sphygmomanometric and continuous non-invasive finger arterial pressure (Finapres device) to obtain signals for the beat-by-beat R–R interval and systolic, mean and diastolic pressures. R–R interval and arterial pressure variabilities were characterized by power spectral analysis. Scopolamine increased the mean R–R intervals and reduced arterial pressure in both the supine and the standing positions, but did not affect blood pressure variability. Scopolamine increased the total variability of R–R interval and its mid- (0·07–0·15 Hz) and high- (0·15–0·40 Hz) frequency band power in the standing position during controlled breathing at 0·25 Hz. In the supine position, scopolamine did not affect R–R interval variability. In the deep breathing test, scopolamine increased the maximal expiratory–inspiratory R–R interval ratio. This study showed that low-dose scopolamine increases vagal cardiac inhibition in both supine and standing positions in healthy volunteers. However, scopolamine increases heart rate variability only in the standing position during partial vagal withdrawal. The study also demonstrates that transdermal scopolamine decreases blood pressure in healthy young subjects.     

Coronary stenting for coronary artery narrowing in a heart transplant recipient

Transplant atherosclerotic coronary disease remains the leading cause of death in heart transplant recipients. We report the first case of coronary stent implantation in a heart graft for epicardial focal stenosis. Due to the lower rate of restenosis after stenting in the native coronary artery, we suggest that coronary stenting be considered an acceptable, first intention therapeutic option instead of angioplasty alone whenever possible.