Serum Adipokine Levels in Patients Considered for Lung Transplantation.

The aim of the study was to investigate serum concentration of visfatin, irisin, and omentin in patients diagnosed as having end-stage lung diseases who qualified for lung transplantation (LTx) and to find the relationship between adipokine levels and clinical status. MATERIAL AND METHODS: The study population consisted of 23 consecutive patients (10 patients diagnosed as having cystic fibrosis, 6 patients diagnosed as having chronic obstructive pulmonary disease, and 7 patients diagnosed as having idiopathic pulmonary fibrosis) who qualified for LTx. Patients performed pulmonary function tests; visfatin, irisin, and omentin serum levels were assessed using commercially available enzyme-linked immunosorbent assay kits. RESULTS: Mean visfatin serum level was 4.99 ± 3.83 pg/mL; mean irisin serum level was 2.82 ± 0.24 ng/mL; mean omentin serum level was 389.99 ± 320.85 ng/mL. Mean distance in 6-minute walk test (6MWT) was 310.62 ± 147.09 m. Average partial pressure of oxygen (pO2) was 55.79 ± 10.33 mm Hg, forced expiratory volume (FEV1) was 26.25 ± 22.38%, and forced vital capacity (FVC) was 56.95 ± 21.91% of a due value. There was no statistically significant correlation between adipokine levels and 6MWT, pO2, FEV1, and FVC in patients waiting for LTx, regardless of underlying lung disease. Significant difference between patients was noted only in 6MWT, FEV1, and pO2 in connection to lung disease. CONCLUSION: Our findings indicate that adipokines may not have a statistically significant effect on parameters of pulmonary function. Results require further investigation on a larger study group, especially comparison of adipokine serum levels between groups of overweight patients, obese patients, and patients with normal weight who qualify for LTx.

Prognostic Value of Mean, Diastolic, and Systolic Pulmonary Artery Pressure in Patients With End-stage Lung Disease Referred for Lung Transplantation.

BACKGROUND: Pulmonary hypertension (PH) is a common complication in end-stage lung disease (esLD). The aim of this study was to establish the best threshold values for mean, systolic, and diastolic artery pressure (mPAP, dPAP, and sPAP, respectively) to identify patients with esLD referred for lung transplantation and to predict 1-year prognosis. METHODS: Sixty-five patients were enrolled in the study (75% men) with a mean age of 53.3 ± 9.5 years; 31% had chronic obstructive pulmonary disease (COPD), 57% had idiopathic pulmonary fibrosis (IPF), and 12% had interstitial lung diseases (ILDs). The mean period of observation was 14.4 ± 5 months. We assessed invasively mPAP, dPAP, and sPAP, as well as pulmonary capillary wedge pressure (PCWP), using a Swan-Ganz catheter. Receiver-operating characteristic (ROC) curves were constructed to identify the best cutoff points for mPAP, dPAP, and sPAP to predict survival. The study endpoint was defined as 1-year mortality before transplantation. Survival analysis was completed according to the Kaplan-Meier method. RESULTS: During follow-up, 30 (46.1%) patients died and 19 (29%) underwent lung transplantation. Based on ROC curve analysis, we estimated mPAP ≥30 mm Hg, dPAP ≥20 mm Hg, and sPAP ≥44 mm Hg as the best threshold values with the highest sensitivity (70%, 70%, and 73%, respectively) and specificity (76%, 69%, and 72%, respectively) and the acceptable area under curve (0.67, 0.68, and 0.72, respectively). The negative predictive values for mPAP, dPAP, and sPAP were higher than the positive predictive values (79%, 77%, and 81% vs 67%, 61%, and 64%, respectively). We also constructed Kaplan-Meier curves for mPAP, dPAP, and sPAP threshold values. There were significant differences in 1-year survival between patients with and without PH for mPAP, dPAP, and sPAP threshold values (P = .005, P = .035, and P < .001; respectively). CONCLUSION: Elevated mPAP, dPAP, and sPAP are related to worse prognosis in patients with esLD referred for lung transplantation.

Immunosuppressive Treatment and Its Effect on the Occurrence of Pneumocystis jiroveci, Mycoplasma pneumoniae, Chlamydophila pnemoniae, and Legionella pneumophila Infections/Colonizations Among Lung Transplant Recipients.

BACKGROUND: The aim of the study was to assess the frequency of infections caused by Pneumocystis jiroveci, Chlamydophila pneumoniae, Legionella pneumophila, and Mycoplasma pneumoniae among lung transplant recipients in the context of immunosuppression. METHODS: The study group consisted of 94 patients (37 women and 57 men; mean age 42.03 years) transplanted between 2009 and 2016 at the Silesia Center for Heart Diseases (SCCS). Immunosuppressive treatment (induction and maintenance therapy) was assessed. The immunofluorescence methods were used to detect the P. jiroveci, L. pneumophila, C. pneumoniae, and M. pneumoniae antigens in samples obtained from the respiratory tract. RESULTS: Thirty-two of 94 graft recipients developed atypical or opportunistic infection. The median time of its occurrence was 178 days after transplantation. P. jiroveci was responsible for 84.38% of first infections. Five patients developed infection with P. jiroveci and C. pneumoniae. None of the infections occurred during induction of immunosuppression. An opportunistic or atypical infection developed in 19.35% of the patients treated with a tacrolimus-based regimen, and in 43.33% of patients on a cyclosporine-based regimen. CONCLUSION: Infection with P. jiroveci is a recognized problem after lung transplantation and should be monitored. The percentage of infected patients is higher in patients treated with a cyclosporine-based regimen in comparison to those treated with tacrolimus.

Nordic Walking in Pulmonary Rehabilitation of Patients Referred for Lung Transplantation.

BACKGROUND: Although the effectiveness of pulmonary rehabilitation in patients with chronic obstructive lung disease, cystic fibrosis, and interstitial lung disease is well documented, little is known about pulmonary rehabilitation in patients who are referred for lung transplantation. Nordic walking is a low-cost and accessible form of physical exercise with proven benefits. The purpose of this prospective study was to examine the effects of Nordic walking on lung function, perception of dyspnea, and health-related quality of life in patients referred for lung transplantation. METHODS: Twenty-two of 40 patients who was qualified for lung transplantation at the Department of Lung Diseases in Zabrze, Poland, completed a rehabilitation program consisting of 12 weeks of Nordic walking. Lung function tests, exercise tolerance, and perception of dyspnea and quality of life were assessed before and after completion of the program. RESULTS: No adverse events were observed during the rehabilitation program. After 12 weeks, there was a significant increase in mean 6-minute walk distance (374 meters vs 288 meters, P < .034) and a significant reduction in perception of dyspnea after completion of the rehabilitation program. Assessment of general health and quality of life showed significant improvement (P < .05). No significant changes in lung function tests were noted. CONCLUSION: Nordic walking is a safe and feasible physical activity for pulmonary rehabilitation in patients with end-stage lung disease who are referred for lung transplantation. This rehabilitation technique results in significant improvements in patient mobility and quality of life.

Bacterial Infections During Hospital Stay and Their Impact on Mortality After Lung Transplantation: A Single-Center Study.

INTRODUCTION: The aim of the study was to assess the impact of bacterial infection during hospital stay on long-term follow-up. MATERIALS AND METHODS: This was a retrospective single-center study of 97 recipients of lung transplantations performed between December 2004 and June 2016 at a single center. Information about age, sex, underlying lung disease, and date and type of procedure was gathered from patients' charts. Immunosuppressive treatment has been analyzed individually among the cohort. Microbiological evaluation included the presence of infection, bacterial species in recipients and donors, as well as type of biological material. RESULTS: During a mean hospitalization time of 57 days (range 4-398 days), 67 patients (69%) were diagnosed with bacterial infection. There were 120 episodes of infection caused by 32 species of bacteria. The most common were Pseudomonas aeruginosa (27%), Acinetobacter baumanii (21%), Klebsiella pneumoniae (10%) and Stenotrophomonas maltophilia (11%). Analysis revealed that 39 patients developed bronchiolitis obliterans syndrome (43%). Patients with A baumanii had a lower probability of survival than the rest of the population (P < .05). Patients treated with mammalian target of rapamycin inhibitors had a higher probability of survival. CONCLUSIONS: Infection with A baumanii affects lung transplant recipients' survival. Incorporating sirolimus could be beneficial for the lung transplant recipients' survival.

Usefulness of the Impulse Oscillometry System in Graft Function Monitoring in Lung Transplant Recipients.

BACKGROUND: After successful lung transplantation, patients are monitored for chronic lung allograft dysfunction. Pulmonary function tests and 6-minute-walk tests are commonly used for functional graft monitoring. As these methods require substantial effort, however, many patients are unable to complete testing fully. The impulse oscillometry system is a noninvasive method that requires minimal patient cooperation and is suitable for use for patients incapable of strenuous activity. We compared impulse oscillometry system with pulmonary function tests and 6-minute-walk tests to determine if impulse oscillometry system could serve as a substitute measure. METHODS: This prospective, observational study evaluated 25 consecutive patients (19 men, median age 54.5 years) admitted to a single institution from January to October 2016 (double-lung = 13, single-lung = 13). Patients were assessed using pulmonary function tests, impulse oscillometry system, and 6-minute-walk tests. RESULTS: Eighty-eight percent of patients reached high-resonance frequency (Fres) and, in 84% of patients, the value of Ax (area of reactance) increased above the norm (N < 0.33 kPa/L) indicating peripheral airways obstruction. High resistance of small airways, measured with an R5 - R20 difference, followed higher Ax values. The increase of resistance at 5 Hz in 31% of patients (R5 >150% predicted value) also indicated small airway obstruction. Airway obturation in patients with elevated Ax and R5 was confirmed by decreased FEV1 (<75% predictive value) and FEV1/FVC ratio in 38% of patients. CONCLUSIONS: Study results confirm the impulse oscillometry system method could be a substitute for pulmonary function tests in determining the occurrence of chronic lung allograft dysfunction. 6-minute-walk tests showed neither strong correlations regarding impulse oscillometry system and pulmonary function tests nor any base for differentiation of results regarding main factor codes.

Pulmonary rehabilitation in patients referred for lung transplantation.

Effectiveness of pulmonary rehabilitation in patients with chronic obstructive lung diseases, cystic fibrosis, and interstitial lung disease is well documented but little is known about the results of pulmonary rehabilitation in patients referred for lung transplantation. The purpose of this study is to prospectively examine the efficacy of Nordic walking, a low cost, accessible, and proven beneficial form of physical exercise, as a form of pulmonary rehabilitation in patients referred for lung transplantation. Twenty-two male patients referred for lung transplantation at the Department of Lung Diseases and Tuberculosis in Zabrze, Poland, were invited to take part in the study. The rehabilitation program, which was conducted for 12 weeks, was based on Nordic walking exercise training with ski poles. Lung function tests (FVC, FEV1), mobility (6 min walking test (6MWT)), rating of dyspnea (Oxygen Cost Index, MRC and Baseline Dyspnea Index), and quality of life assessments (SF-36) were performed before and after the completion of the exercise program. No adverse events were observed after completing the pulmonary rehabilitation program in patients referred for lung transplantation. After 12 weeks of pulmonary rehabilitation with Nordic walking we observed a significant increase in the mean distance walked in the 6MWT (310.2 m vs. 372.1 m, p < 0.05). The results of lung function tests also showed improvement in FVC. There were no significant differences in the perception of dyspnea before and after completing the rehabilitation program. General health and quality of life questionnaire (SF-36) showed improvement in the domain of social functioning (p < 0.05). In conclusion, pulmonary rehabilitation with a Nordic walking program is a safe and feasible physical activity in end-stage lung disease patients referred for lung transplantation and results in improvements in patients' mobility and quality of life.

Lymphocyte subtypes CD3+, CD19+, CD16+CD56+, CD4+, CD8+, and CD3+HLA-DR+ in peripheral blood obtained from patients after thoracic organ transplantation.

INTRODUCTION: The aim of this study was to assess peripheral blood lymphocyte subtypes (CD3+, CD19+, CD16+CD56+, CD4+, CD8+, and CD3+HLA-DR+) obtained from thoracic organ recipients at various periods after transplantation. MATERIAL AND METHODS: Seventeen patients after lung transplantation (LT) and 5 patients after heart transplantation (HT) included 13 males (76.5%) and 4 females (23.5%) of overall mean age at the time of transplantation of 46.7±11.55 years and mean body mass index of 21.1±4. Lymphocyte phenotypes were estimated using Simultest IMK Plus. RESULTS: A significant decrease in lymphocytes of the majority of subtypes was observed at 1 year posttransplantation compared with normal ranges: CD19+ B lymphocytes in 56% of patients, CD8+ T cells among 48% and CD16+CD56+ natural killer elements, 56%. In contrast, there were increased numbers of activated lymphocytes (CD3+HLA-DR+). Beyond the 1-year observation, we observed a trend to normalize parameters among the majority of subjects. CONCLUSION: A clear tendency to a decrease number of peripheral blood lymphocytes of various subtypes was observed among thoracic organ recipients in the first year posttransplantation with the exception of activated HLA-DR+ cells. After the first year, there was slow restoration of lymphocytes.

Procalcitonin serum concentration in lung transplant recipients during mold colonization or infection.

BACKGROUND: This publication attempted to evaluate the frequency of mold colonization and infection and the procalcitonin serum concentrations (PCT) among lung transplant recipients. METHODS AND MATERIALS: We included 49 patients (36 males and 13 females) of mean age at transplantation of 47.1±13.6 years. Molds were isolated using routine microbiologic methods. PCT (ng/mL) was measured using an immunoluminescence assay with values below 0.5 showing no probability of infection, 0.5 to 2.0, a moderate infection risk; 2.0 to 10, a high infection risk; and above 10 high sepsis risk. RESULTS: Twenty-four (49%) patients revealed the presence of molds in material from the lower respiratory tract (sputum, tracheal, or tracheobronchial aspirate), mini-bronchoalveolar lavage. Aspergillus species was isolated in 14 (28.6%) patients, Penicillium in 7 (14.3%) patients, and Zygomycetes fungi in 9 (18.4%) patients. The average PCT value from 61 examinations of PCT during fungal isolation was 0.5±0.7 ng/mL. However, when the studied group was categorized according to the PCT range, the rates for the groups were no infection (n=30; 49.2%), moderate (n=20; 32.8%), high (n=9; 14.8%) and high sepsis risk (n=2; 3.3%). CONCLUSIONS: The mold colonization of transplanted lung is a frequent complication and should be considered even in the case of proper prophylaxis. Procalcitonin might be the marker helpful in mold infection diagnosis.

Osteoporosis in patients referred for lung transplantation.

OBJECTIVE: Osteoporosis may significantly impair the final result of lung transplantation. The purpose of study is to determine the prevalence of osteoporosis with the regard to risk factors for osteoporosis in patients awaiting lung transplantation. MATERIAL AND METHODS: We determined bone mineral density (BMD) in 48 patients (12 with idiopathic pulmonary fibrosis (IPF), 15 with other form idiopathic interstitial pneumonia (IIP), 5 with sarcoidosis and 16 with COPD) referred for lung transplantation (LT). BMD was performed on lumbar spine (LS), total hip (TH), and femoral neck (FN). Osteoporosis risk factors were analyzed with the consideration to principal diagnosis, lung function tests (FVC, FEV1) and mobility (6 MWT; six minute walking test). RESULTS: In osteoporosis group (50% of study population) the most affected was LS (mean T-score -3 ±1), with higher steroid consumption (cumulative steroid dose 40 ±28), lower FVC, FEV1 and mobility (6 MWT: 285 m) than in patients without osteoporosis. COPD patients presented the lowest BMD with the highest cumulative steroid dose (csd/kg: 0.6 ±0.6), lowest FEV1 (21 ±15% pred.) and 6 MWT (279 m). In patients with the lowest steroid consumption (IPF) the best results of BMD and FVC, FEV1 and 6 MWT were observed. No relation was found between BMD and sex and age in study group. CONCLUSIONS: Osteoporosis is very common in patients referred for lung transplantation, especially among COPD candidates. Steroid consumption is the mean risk factor. Therefore, early diagnosis and prevention of osteoporosis in lung transplant candidates should receive high priority.

Dyspnea and quality of life in patients referred for lung transplantation.

BACKGROUND: In the years 2007-2010 in the Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 86 patients fulfilling ISHLT criteria qualified for lung transplantation. OBJECTIVES: The aim of the study was to assess the correlation between dyspnea and quality of life, and how it is related to clinical data in the examined group. MATERIAL AND METHODS: MRC, OCD, BDI and Borg scale were used for dyspnea evaluation, whereas quality of life was evaluated with SF-36 and SGRQ. A reference group consisted of 18 females and 68 males of the mean age 52 ±10 years and BMI 24 ±6. Thirty patients were diagnosed with IPF, 22 with COPD, and 34 with IIP. RESULTS: In the reference group, there was a significant correlation between dyspnea and quality of life: between MRC and Pf (SF-36 domain) r = -0.53; OCD and activity (SGRQ) r = 0.56; OCD and Pf r = -0.55; BDI and impact (SGRQ) r = 0.51; Borg scale and impact r = 0.47. In patients after lung transplantation, correlation between MRC and SF was r = -0.92; OCD and Pf, Bp, MH, PCS r = -0.97; OCD and RE r = -0.89; BDI and Pf r = -0.89; BDI and activity r=0.9; BDI and PCS r = -0.84. Depending on the diagnosis, the strongest correlation in IIP patients was found between OCD and activity (r = 0.62), in COPD patients - between BDI and impact (r = 0.79), and in IPF patients r = - 0.62 for OCD and Pf. Summing up the results, we can state that there is a significant correlation between dyspnea and quality of life. This correlation seems the strongest in patients after lung transplantation. CONCLUSIONS: The correlation found between the level of dyspnea and quality of life domains in lung transplant patients suggests that it would be worthwhile to add questions regarding dyspnea to assess the severity of the disease, clinical symptoms, and functional impairment during referring the patients for lung transplantation.

Screening of aquatic and wetland plant species for phytoremediation of explosives-contaminated groundwater from the Iowa Army Ammunition Plant.

The results of this study indicate that the presence of plants did enhance TNT and TNB removal from IAAP groundwater. Most effective at 25 degrees C were reed canary grass, coontail and pondweed. Groundwater and plant tissue analyses indicate that in presence of the plants tested TNT is degraded to reduced by-products and to other metabolites that were not analyzed. TNT removal was best modeled using first order kinetics, with rate constants at 25 degrees C incubations ranging from 0.038 microgram L-1 h-1 for reed canary grass to 0.012 microgram L-1 h-1 for parrot-feather. These kinetics predict hydraulic retention times (HRTs) ranging from 4.9 days to 19.8 days to reach a TNT concentration of 2 micrograms L-1. Decreasing incubation temperature to 10 degrees C affected reed canary grass more than parrot-feather, increasing estimated HRTs by factors of four and two, respectively. The plant species tested showed a far lower potential for RDX removal from the IAAP groundwater. Most effective at 25 degrees C were reed canary grass and fox sedge. Analyses of plant material indicated the presence of RDX in under-water plant portions and in aerial plant portions, and RDX accumulation in the latter. RDX removal was best modeled using zero order kinetics, with rate constants for the 25 degrees C incubation ranging from 13.45 micrograms L-1 h-1 for reed canary grass to no removal in four species. Based on these kinetics, estimated HRTs to reach 2 micrograms L-1 RDX increased from 39 days. Decreasing the temperature to 10 degrees C increased HRT 24-fold for reed canary grass. By using the biomass-normalized K value, submersed plants are identified as having the highest explosives-removing activity (microgram explosive L-1 h-1 g DW-1). However, biomass production of submersed plants is normally five to ten times less than that of emergent plants per unit area, and, thus, in plant selection for wetland construction, both, explosives removal potential and biomass production are important determinants.

Mineralization of S from dibenzothiophene, dibenzothiophene sulphone, and benzene sulphonic acid by soil isolates.

The presence of substantial levels of organic S in coal is a major source of air pollution, and considerable efforts are being made to devise a cost-effective way of removing this form of sulphur. One method is to develop naturally occurring bacteria capable of heterocyclic organic S degradation and S mineralization. In this study, fourteen isolates capable of dibenzothiophene (DBT), dibenzothiophene sulphone (DBTS) or benzene sulphonic acid (BSA) decomposition were obtained from samples collected from an abandoned strip mine. The degradation of DBT varied from 4.4 to 91% and the mineralization of S as sulphate was less than or equal to 1.5%. Higher rates of DBTS decomposition were determined (94.9 to 97.7%) and S mineralization varied from 21.8 to 30.8%. The extent of BSA degradation could not be determined, but 57.8 to 71.1% of the S was mineralized as sulphate. All of the soil isolates possessed a single plasmid 20 to 23 kb in size.

Purification of inorganic pyrophosphatase from rat salivary glands.

Inorganic pyrophosphatase [EC 3.6.1.1] isolated from rat sublingual and submandibular glands was purified 2300-fold and 2600-fold, respectively. The purified enzymatic preparations separated on electrophoresis into two protein bands, of which only one showed the pyrophosphatase activity. Inorganic pyrophosphatase from rat salivary glands is a monomeric anionic protein, its isoelectric point is 5.42 and 4.90 for the sublingual and submandibular glands, respectively.