A placebo-controlled, crossover trial to investigate the efficacy of tiotropium bromide or placebo added to usual care in stable symptomatic post-hematopoietic stem cell transplantation (HSCT) bronchiolitis obliterans syndrome (BOS).

BACKGROUND: Despite the fundamental progress in hematopoietic stem cell transplant, this treatment is also associated with complications. Graft-versus-host disease is a possible complication of HSCT. Bronchiolitis obliterans syndrome (BOS) is the pulmonary form of this syndrome. Due to the high morbidity and mortality rate of BOS, various studies have been conducted in the field of drug therapy for this syndrome, although no standard treatment has yet been proposed. According to the hypotheses about the similarities between BOS and chronic obstructive pulmonary disease, the idea of using tiotropium bromide as a bronchodilator has been proposed. METHOD/DESIGN: A randomized, double-blind, placebo-controlled, and crossover clinical trial is being conducted to evaluate the efficacy of tiotropium in patients with BOS. A total of 20 patients with BOS were randomly assigned (1:1) to receive a once-daily inhaled capsule of either tiotropium bromide (KP-Tiova Rotacaps 18 mcg, Cipla, India) or placebo for 1 month. Patients will receive tiotropium bromide or placebo Revolizer added to usual standard care. Measurements will include spirometry and a 6-min walking test. ETHICS/DISSEMINATION: This study was approved by the Research Ethics Committees of Imam Khomeini Hospital Complex, Tehran University of Medical Science. Recruitment started in September 2022, with 20 patients randomized. The treatment follow-up of participants with tiotropium is currently ongoing and is due to finish in April 2024. The authors will disseminate the findings in peer-reviewed publications, conferences, and seminar presentations. TRIAL REGISTRATION: Iranian Registry of Clinical Trial (IRCT) IRCT20200415047080N3. Registered on 2022-07-12, 1401/04/21.

Comparison of the Effects of Plasmapheresis, Hemoperfusion, and Convalescent Plasma Therapy on Inflammatory Factors in COVID-19 Patients.

Background: Since the emergence of coronavirus disease 2019 (COVID-19), the treatment protocols are continuously updated, based on the evidence gathered all around the world and reported to the World Health Organization. Like many other emerging infectious diseases, using convalescent plasma from those recovered from the disease was a preliminary treatment approach that showed partial effectiveness for severe COVID-19 patients. Besides, blood filtration strategies, such as hemoperfusion and plasmapheresis, are employed to lessen the load of inflammatory molecules. However, few studies compared their effects to conclude which treatment might be more efficacious for COVID-19 patients. We compared the effects of plasmapheresis or plasma exchange, convalescent plasma therapy, and hemoperfusion on O2 saturation and inflammatory factors in COVID-19 patients. Methods: In this retrospective study, 50 COVID-19 patients received standard treatments based the international guidelines. Patients were divided into 4 groups: hemoperfusion, plasmapheresis, plasma therapy, and control. The control group received only the standard treatments. The mortality rate, O2 saturation, and laboratory factors were compared between the 4 groups. Results: We found a significant decrease in the C-reactive protein level following hemoperfusion (32.75 ± 23.76 vs 13 ± 7.54 mg/dL; p = 0.032) but not plasmapheresis and plasma therapy. Besides, serum levels of lactate dehydrogenase (p = 0.327, 0.136, 0.550, for hemoperfusion, plasmapheresis, and plasma therapy, respectively) and other inflammatory molecules did not significantly change following treatments. There is also no significant difference in the mortality rate between the treatment groups (p = 0.353). Conclusion: It seems that hemoperfusion, plasmapheresis, and plasma therapy did not have considerable effects on decreasing the inflammation and mortality rate compared with standard treatment.

The Reality of Inadequate Patient Care and the Need for a Global Action Framework in Organ Donation and Transplantation.

BACKGROUND: Transplant therapy is considered the best and often the only available treatment for thousands of patients with organ failure that results from communicable and noncommunicable diseases. The number of annual organ transplants is insufficient for the worldwide need. METHODS: We elaborate the proceedings of the workshop entitled "The Role of Science in the Development of International Standards of Organ Donation and Transplantation," organized by the Pontifical Academy of Sciences and cosponsored by the World Health Organization in June 2021. RESULTS: We detail the urgency and importance of achieving national self-sufficiency in organ transplantation as a public health priority and an important contributor to reaching relevant targets of the United Nations Agenda for Sustainable Development. It details the elements of a global action framework intended for countries at every level of economic development to facilitate either the establishment or enhancement of transplant activity. It sets forth a proposed plan, by addressing the technical considerations for developing and optimizing organ transplantation from both deceased and living organ donors and the regulatory oversight of practices. CONCLUSIONS: This document can be used in governmental and policy circles as a call to action and as a checklist for actions needed to enable organ transplantation as treatment for organ failure.

Impact of Recruitment Maneuvers to Cover Adverse Effects of Donor Transfer.

OBJECTIVES: Our aim was to investigate the negative effects of transferring brain-dead donors to the intensive care unit on the ratio of PaO2 to inspired oxygen fraction and the benefits of recruitment maneuvers on its reversal. MATERIALS AND METHODS: In this randomized trial, we assigned 30 brain-dead donors to an intervention group and a control group. After transfer to the intensive care unit, donors in the intervention group received a lung recruitment maneuver according to protocol for 1 hour, whereas the control group did not receive this intervention. Arterial blood gas was drawn before transfer, immediately aftertransfer, and 3 hours after transfer. RESULTS: Before transfer to immediately after transfer, the PaO2-to-inspired oxygen fraction ratio decreased from 281.30 ± 100.33 to 225.03 ± 95.72 mm Hg (P < .01). At 3 hours aftertransfer,the PaO2-to-inspired oxygen fraction ratio in the intervention and control groups was 280.4 ± 120.4 and 213.4 ± 75.5 mm Hg (P = .017), respectively. The absolute difference in PaO2-to-inspired oxygen fraction ratio from before to 3 hours after transfer was -16.9 ± 44.1 and 51.8 ± 61.4 mm Hg (P < .001), in the intervention and control groups,respectively. Increasing central venous pressure and/or transfer time further potentiated the decrease ofthe PaO2-to-inspired oxygen fraction ratio. CONCLUSIONS: The PaO2-to-inspired oxygen fraction ratio decreased after transfer of brain-dead donors to the intensive care unit. This was partially reversible by standardized recruitment maneuvers.

Diagnostic values of bronchodilator response versus 9-question questionnaire for asthma.

INTRODUCTION: Several studies have investigated different tools for asthma diagnosis in order to reduce the cost and improve its early recognition. The goal of this study is to establish ashort questionnaire to be used in practice for asthma screening and compare diagnostic values between this method and spirometric response to bronchodilators. MATERIAL AND METHOD: 208 patients presenting with chronic stable dyspnea (> 6 months) and definite clinical diagnosis of chronic obstructive pulmonary disease, bronchiectasis, pulmonary fibrosis or asthma, were enrolled. 9 questions out of 43 based on the literature search were selected by regression analysis. Patients were asked to complete the questionnaire and then their spirometric responses to bronchodilators were evaluated. RESULTS: Of all, 53.8% of cases were diagnosed clinically to have asthma. For establishing diagnosis of asthma, the bronchodilator test had 48.2% sensitivity, 78.1% specificity, 72% positive, 56.4% negative predictive values, 2.2 positive, 0.66 negative likeli-hood ratios, and false positive, false negative and accuracy of 21.9%, 51.8% and 62.01%, respectively. The revised 9 questions from the questionnaire had 97.3% sensitivity, 77.1% specificity, 83.2% positive, 96.1% negative predictive values, 4.24 positive, 0.03 negative likelihood ratios, 22.9% false positive, 2.7% false negative and 87.98% accuracy. CONCLUSIONS: The 9-question questionnaire had better diagnostic values in defining asthma in patients with chronic dyspnea than reversibility of airway obstruction to salbutamol and can be used as auseful screening test for diagnosis of asthma in clinical practice and for investigational purposes.

Effects of Sirolimus on Lung function in patients with Lymphangioleiomyomatosis.

BACKGROUND: Lymphangioleiomyomatosis (LAM) is a progressive lungs disease that affects women at reproductive years. Sirolimus inhibits mammalian target of rapamycin (mTOR) and its administration in past studies was hopeful in treatment of patients with LAM. The aim of this study was to evaluate sirolimus therapy on lung function in LAM patients. METHODS: We conducted a trial to evaluate the effect of sirolimus on six patients with LAM who had severe or very severe obstructive lung disease, and one-year follow up. Maintenance level of Sirolimus was 10-15 ng/ml. Serial visits (including physical examination, evaluation of signs and symptoms of disease and adverse events due to treatment), spirometry, 6MWT done at baseline 3, 6, 9 and 12 months after. Spirometric parameters walk distance and O2 saturationbefore and after exercise at first and the end of treatment were measured. RESULTS: Four patients had TSC-LAM while the other 2 patients had S-LAM. The mean level of sirolimus was 13 ng/ml after one-year treatment. Mean FEV1 at enrollment and end of study was 1000cc (33% predict) and 1228cc (42% predict) respectively (P=0.674). The mean FVC at baseline and end of study was 1648cc (49% predict) and 1866cc (55% predict) (P=0.996). The mean FEV1/FVC at enrollment and the end of treatment was 58% and 62% respectively (P=0.753). The mean FEF25-75 at first and at the end of treatment was 16% and 26%, respectively (P=0.028). The mean walk distance in 6MWT at first and at the end of study was 315 meters (P=0.9). The mean percentage of O2 saturation at rest was 84% and 92% at first and at the end of study (P=0.104). CONCLUSION: In LAM patients, sirolimus has been shown stabilizeto or improve lung function, rest and exertional O2 saturation. Sirolimus was effective in LAM patients who had severe or very severe physiological disorders.

Determinants of medical students for intention to organ donation: Application of theory of planned behavior.

Organ donation and transplantation save thousands of lives in the world. The aim of this study was identifying determinants of organ donation intention based on the Theory of Planned Behavior (TPB) among Iranian Medical Students. This cross-sectional study was performed during 2017 in Shahid Beheshti University of Medical Sciences. A sample of 438 students of Shahid Beheshti University of Medical Sciences was selected using multi-stage sampling method including stratified and random sampling. Data were collected by using a reliable and valid TPB-based questionnaire. All the participants filled the questionnaires and the data were extracted according to the previously described method. Data were analyzed by using the Statistical Package for the Social Sciences version 16.0 software. Descriptive statistic and Spearman correlation and Logistic regression were used for analyzing the data. Mean age of the participants was 20.92 ± 1.98 years. There was a significant linear positive correlation between behavioral intention and attitude, subjective norms, and perceived behavior control. Logistic regression analysis for assessing relation of TPB variables with behavioral intention showed that perceived behavioral control was more correlate with students' intention for getting organ donation card (odds ratio: 1.049, confidence interval: 1.062, P <0.000) perceived behavioral control, explain student's willingness to register as an organ donor. We must provide facilities so that students could register for organ donation easily.

Ex Vivo Lung Perfusion: Establishment and Operationalization in Iran.

OBJECTIVES: Although the number of lung transplants is limited because of general shortage of organ donors, ex vivo lung perfusion is a novel method with 2 main benefits, including better evaluation of lung potential and recovery of injured lungs. The main aim of this study was to establish and operationalize ex vivo lung perfusion as the first experience in Iran. MATERIALS AND METHODS: This was a prospective operational research study on 5 cases, including 1 pig from Vienna Medical University and 4 patients from Masih Daneshvari Hospital. All organ donations from brain dead donors were evaluated according to lung transplant or ex vivo lung perfusion criteria from May 2013 to July 2015 in Tehran, Iran. If a donor did not have any sign of severe chest trauma or pneumonia but had poor oxygenation due to possible atelectasis or neurogenic pulmonary edema, their lungs were included for ex vivo lung perfusion. RESULTS: A successful trend in the difference between the pulmonary arterial Po2 and the left atrial Po2 was observed, as well as an increasing pattern in other functional parameters, including dynamic lung compliance and a decreasing trend in pulmonary vascular resistance. CONCLUSIONS: These initial trials indicate that ex vivo lung perfusion can lead to remarkable progress in lung transplant in Iran. They also provide several important pieces of guidance for successful ex vivo lung perfusion, including the necessity of following standard lung retrieval procedures and monitoring temperature and pressure precisely. The development of novel methods can provide opportunities for further research studies on lungs of deceased donors and lead to undiscovered findings. By keeping this science up to date in Iran and developing such new and creative methods, we can reveal effective strategies to promote the quality of donor lungs to support patients on transplant wait lists.

Normothermic Ex Vivo Lung Perfusion in Brain-dead Donors Reduces Inflammatory Cytokines and Toll-like Receptor Expression.

Inflammatory responses and innate immunologic reactions play an important role in the respiratory system. Ex vivo lung perfusion (EVLP) is considered a novel method in the evaluation and reconditioning of donor lungs prior to transplantation. However, EVLP's effect on inflammatory and metabolic markers of human lung tissue is unknown.  This study investigated how the performance of EVLP on brain-dead (BD) donor lungs affects the production and release of inflammatory cytokines (IL-6, IL-8, and TNF-a), inflammatory cells and toll-like receptors (TLR) -2, 4. This study was conducted with an animal subject for qualification of EVLP team and then EVLP was performed on 4 human cases referred to Masih Daneshvari Hospital (Tehran,Iran), from May 2013 to July 2015. Two of these cases, who had acceptable lung function parameters, were enrolled in this study for immunologic investigations. Bronchoalveolar lavages (BAL) were taken before and after EVLP. Cytokines were quantitatively measured before lung retrieval, at the end of the lung removal, at the start of EVLP, and at the end of the each hour of EVLP. TLR expression was measured on the cells obtained by flow cytometry. TNF-a, IL-6 and IL-8 decreased in each stage of washing perfusate in both cases, and the level of cytokines in serum was in the normal range. Flow cytometry analysis revealed a decreasing expression of CD3, CD4/8, CD19, and CD16+56, as well as TLR-2 and TLR-4 in both cases. Intra-capillary pools of pro-inflammatory cytokines (IL-6, IL-8, and TNF-a) were determined to contribute to the lung injury during prolonged lung perfusion. This raises the possibility that EVLP donor lungs could be less immunogenic than standard lungs. However, to assess EVLP's effects on lung grafts and optimize recipient outcomes, further studies with a sufficient number of lungs are required.

Bronchiolitis Obliterans Syndrome and Death in Iranian Lung Transplant Recipients: A Bayesian Competing Risks Analysis.

BACKGROUND: Bronchiolitis obliterans syndrome (BOS) is delayed allograft deterioration after lung transplant (LTX) that is clinically characterized by ≥ 20% decline from the baseline value of forced expiratory volume during the first second (FEV1). BOS is still a major obstacle limiting long-term survival post-LTX. The main aim of this study was to determine the predictors of BOS and death in Iranian LTX recipients. MATERIALS AND METHODS: This retrospective cohort study included 44 LTX recipients who survived ≥ 3 months post-LTX at the Masih Daneshvari Hospital, Tehran, Iran from 2000 to 2014. The outcome was time from lung transplantation to BOS and/or death (due to all causes except BOS). We used competing risks analysis to assess the effect of other factors on the cumulative incidence function of BOS and death. We applied a Fine and Gray model with Bayesian approach. RESULTS: The recipients' age (Mean ± SD) was 36.7 ± 14.5 yr. 11 (25%) recipients developed BOS as the first event within the first five years post-LTX and 13 (30%) died due to all causes except for BOS. Our results showed that CMV infection was associated with a significant increase in risk of developing BOS [hazard ratio (HR) 1.22 (95% credible set: (1.01, 3.2)] controlling for other variables. Bilateral transplantation [HR (95% credible set): 2.4(1.51, 4.05)] and CMV infection [HR (95% credible set): 2.02 (1.67, 2.55)] were predictors of the mortality risk. CONCLUSION: CMV infection was a predictor of BOS risk in the studied patients. Moreover, bilateral transplantation and CMV infection were significant predictors of mortality in the present sample. Multi-center studies with larger sample sizes are required to better study the other risk factors, and the pathophysiologic mechanisms of BOS.

Role of Transcranial Doppler Sonography in Diagnosis of Brain Death: A Single Center Study.

BACKGROUND: Diagnosis of brain death relies on clinical and electroencephalographic (EEG) criteria. Waiting for 24 hours is mandatory to make definitive diagnosis of the condition in the Iranian protocol. Although it has been previously shown that oscillatory or spiked systolic or reversed diastolic flow patterns in transcranial Doppler sonography (TCD) are associated with faster brain death confirmation, it has not yet been approved in our protocol. Thus, the aim of this study was to assess the applicability of this method to our organ donation system. MATERIALS AND METHODS: This study was performed in Masih Daneshvari Organ Procurement Unit from July to December 2009. TCD from the middle cerebral and basilar arteries was attempted in 35 patients who fulfilled the clinical and EEG criteria for brain death. Extensive skull defects and hypotension (blood pressure < 80 mmHg) were the exclusion criteria. Examinations were made for about 30 minutes via temporal and occipital windows as soon as possible after diagnosis of brain death. RESULTS: The mean age of cases was 31.9±14.78 years and 18 (51.4%) were males. The most prevalent cause of brain death was trauma (in 19 or 54.2% of cases). We were unable to detect any intracranial artery in 2 (5.7%) cases. There were no false negative or false positive results in the remaining ones. Detected ultrasonic patterns of cerebral vascular flow were systolic spike and oscillating signal in 29 (87.9%) and 4 (12.1%) donors, respectively. CONCLUSION: Our study showed that TCD results in brain dead cases were concordant with clinical and EEG criteria. Therefore, TCD, as a confirmatory test, can be applied for rapid diagnosis of brain death.

Home spirometry: Assessment of patient compliance and satisfaction and its impact on early diagnosis of pulmonary symptoms in post-lung transplantation patients.

Telemedicine is useful in monitoring patients, and in particular those, such as lung transplant recipients, suffering from chronic illnesses. This prospective cohort study was conducted on 15 lung transplant recipients. The patients provided physicians with data from spirometry as well as their clinical respiratory symptoms via SMS messages. In cases where spirometry results or clinical symptoms required follow-up, the monitoring physician contacted the patient according to guidelines and gave appropriate instructions. Qualitative assessment of satisfaction showed that the sense of increased support from medical staff was rated highest (92.9%). Telespirometry is an efficient method of monitoring lung transplant recipients which leads to patient satisfaction, compliance, adherence to study and sense of security. Nevertheless, for optimal implementation of this method, thorough training of both medical staff and patients is required.

Factors Affecting the Occurrence of Spinal Reflexes in Brain Dead Cases.

OBJECTIVES: Brain death is defined as the permanent absence of all cortical and brain stem reflexes. A wide range of spontaneous or reflex movements that are considered medullary reflexes are observed in heart beating cases that appear brain dead, which may create uncertainty about the diagnosis of brain death and cause delays in deceased-donor organ donation process. We determined the frequency and type of medullary reflexes and factors affecting their occurrence in brain dead cases. MATERIALS AND METHODS: During 1 year, 122 cases who fulfilled the criteria for brain death were admitted to the special intensive care unit for organ procurement of Masih Daneshvari Hospital. Presence of spinal reflexes was evaluated by trained coordinators and was recorded in a form in addition to other information including demographic characteristics, cause of brain death, time from detection of brain death, history of craniotomy, vital signs, serum electrolyte levels, and parameters of arterial blood gas determination. RESULTS: Most cases (63%) included in this study were male, and mean age was 33 ± 15 y. There was > 1 spinal reflex observed in 40 cases (33%). The most frequent reflex was plantar response (17%) following by myoclonus (10%), triple flexion reflex (9%), pronator extension reflex (8%), and undulating toe reflex (7%). Mean systolic blood pressure was significantly higher in cases who exhibited medullary reflexes than other cases (126 ± 19 mm Hg vs 116 ± 17 mm Hg; P = .007). CONCLUSIONS: Spinal reflexes occur frequently in brain dead cases, especially when they become hemodynamically stable after treatment in the organ procurement unit. Observing these movements by caregivers and family members has a negative effect on obtaining family consent and organ donation. Increasing awareness about spinal reflexes is necessary to avoid suspicion about the brain death diagnosis and delays in organ donation.

Diagnóstico por la imagen de la antracofibrosis bronquial aislada: un análisis de tomografía computarizada de pacientes con confirmación broncoscópica e histológica / Imaging Findings of Isolated Bronchial Anthracofibrosis: A Computed Tomography Analysis of Patients With Bronchoscopic and Histologic Confirmation

Antecedentes: Evaluar los resultados de la tomografía computarizada (TC) de tórax en pacientes con antracofibrosis bronquial aislada demostrada broncoscópica y anatomopatológicamente. Metodología: Se incluyó en el estudio a un total de 58 pacientes con antracofibrosis bronquial aislada (29 mujeres; media de edad, 70 años). El diagnóstico de antracofibrosis bronquial se estableció en función de las observaciones broncoscópicas y anatomopatológicas en todos los pacientes. Los diversos aspectos observados en la TC torácica fueron revisados retrospectivamente por 2 radiólogos torácicos, que tomaron las decisiones por consenso. Resultados; Resaltamos el engrosamiento del tejido blando peribronquial central (n = 37, 63,8%) como un hallazgo importante en las exploraciones de imagen, que causa estenosis (n = 37, 63,8%) u obstrucción bronquial (n = 11, 19%). Se observaron múltiples estenosis bronquiales con afectación simultánea de 2, 3 y 5 bronquios en 12 (21%), 9 (15%) y 2 (3,4%) pacientes, respectivamente. Se detectaron atelectasias segmentarias y colapsos lobulares y multilobulares. Estas observaciones se realizaron sobre todo en el pulmón derecho, con un predominio del lóbulo medio derecho. Se observaron también patrones de atenuación en mosaico, nódulos parenquimatosos diseminados, patrones nodulares y ganglios linfáticos calcificados o no calcificados. Conclusiones: En la TC de tórax, la antracofibrosis bronquial aislada se observa en forma de engrosamiento de tejido blando peribronquial, estenosis u obstrucción bronquiales, atelectasia segmentaria o colapso lobular o multilobular. Estas observaciones fueron más frecuentes en el lado derecho, con múltiples bronquios afectados de manera simultánea en algunos pacientes

Background: To evaluate the chest computed tomography (CT) findings of patients with isolated bronchial anthracofibrosis confirmed by bronchoscopy and histopathology. Methodology: Fifty-eight patients with isolated bronchial anthracofibrosis (29 females; mean age, 70 years) were enrolled in this study. The diagnosis of bronchial anthracofibrosis was made based on both bronchoscopy and pathology findings in all patients. The various chest CT images were retrospectively reviewed by two chest radiologists who reached decisions in consensus. Results: Central peribronchial soft tissue thickening (n = 37, 63.8%) causing bronchial narrowing (n = 37, 63.8%) or obstruction (n = 11, 19%) was identified as an important finding on imaging. Multiple bronchial stenoses with concurrentinvolvement of 2, 3, and 5 bronchi were seen in 12 (21%), 9 (15%), and 2 (3.4%) patients, respectively. Segmental atelectasis and lobar or multilobar collapse were detected. These findings mostly occurred in the right lung, predominantly in the right middle lobe. Mosaic attenuation patterns, scattered parenchymal nodules, nodular patterns, and calcified or non-calcified lymph nodes were also observed. Conclusions: On chest CT, isolated bronchial anthracofibrosis appeared as peribronchial soft tissue thickening, bronchial narrowing or obstruction, segmental atelectasis, and lobar or multilobar collapse. The findings were more common in the right side, with simultaneous involvement of multiple bronchi in some patients

Evaluation of the Effect of Ascorbic Acid Administration on Gene Expression Level of IL-6 and TNF-α Cytokines in Deceased Donors.

Brain death is associated with increased inflammatory cytokines levels and poor graft quality to transplant. We aimed to evaluate the impact of Ascorbic Acid (AA) on the inflammatory status of Brain-Dead Donors (BDDs). Forty BDDs were randomly divided into two groups. Donor treatment (n=20) consisted of 100 mg/kg AA infusion 6 hours before donor operation and subsequent infusion of 100 mg/kg/p6h until organ removal. Blood samples were taken at three times, 6 hours before donor surgery (TP(1)), immediately after laparotomy (TP(2)), and before organ removal (TP(3)). Gene expression level and serum concentration of IL-6 and TNF-α cytokines were assessed by real-time PCR and ELISA methods. To investigate transplanted liver function, serum values of Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), and Billirubin-Total were evaluated on the 1(st), 3(rd), and 10(th) postoperative days. We found a significant reduction in IL-6 mRNA expression ratio of TP(3) to TP(1) following AA application among BDDs. Despite the considerable decrease in treated donors regarding IL-6 mRNA expression ratio of TP(2) to TP(1), TP(3) to TP(2), and also TNF-α variations in these periods, the results were not significant. Regarding serum concentration of these cytokines, particularly IL-6, there was a decrease between TP(2) and TP(3) following AA application in the treated donors. Furthermore, a significant reduction was found in serum AST and ALT levels in the recipients of treated group on the 3(rd) day compared to the 1(st) day after transplantation. It seems that AA beneficially affects the inflammatory status of BDDs, resulting in improved primary allograft function.

Imaging Findings of Isolated Bronchial Anthracofibrosis: A Computed Tomography Analysis of Patients With Bronchoscopic and Histologic Confirmation.

BACKGROUND: To evaluate the chest computed tomography (CT) findings of patients with isolated bronchial anthracofibrosis confirmed by bronchoscopy and histopathology. METHODOLOGY: Fifty-eight patients with isolated bronchial anthracofibrosis (29 females; mean age, 70 years) were enrolled in this study. The diagnosis of bronchial anthracofibrosis was made based on both bronchoscopy and pathology findings in all patients. The various chest CT images were retrospectively reviewed by two chest radiologists who reached decisions in consensus. RESULTS: Central peribronchial soft tissue thickening (n=37, 63.8%) causing bronchial narrowing (n=37, 63.8%) or obstruction (n=11, 19%) was identified as an important finding on imaging. Multiple bronchial stenoses with concurrent involvement of 2, 3, and 5 bronchi were seen in 12 (21%), 9 (15%), and 2 (3.4%) patients, respectively. Segmental atelectasis and lobar or multilobar collapse were detected. These findings mostly occurred in the right lung, predominantly in the right middle lobe. Mosaic attenuation patterns, scattered parenchymal nodules, nodular patterns, and calcified or non-calcified lymph nodes were also observed. CONCLUSIONS: On chest CT, isolated bronchial anthracofibrosis appeared as peribronchial soft tissue thickening, bronchial narrowing or obstruction, segmental atelectasis, and lobar or multilobar collapse. The findings were more common in the right side, with simultaneous involvement of multiple bronchi in some patients.

Performance of QuantiFERON TB Gold test in detecting latent tuberculosis infection in brain-dead organ donors in Iran: a brief report.

With regard to the significant morbidity and mortality due to tuberculosis in lung transplant recipients, the identification of brain-dead organ donors with latent tuberculosis by use of the QuantiFERON TB Gold (QFT-G) test may be of help to reduce the risk of TB reactivation and mortality in lung recipients. This study was conducted in the National Research Institute of Tuber-culosis and Lung Diseases (NRITLD) in Iran, from January to March 2013. A total of 38 conse-cutive brain-dead donors, not currently infected with active tuberculosis, were recruited. The medi-cal records of all the study enrollees were reviewed. A whole-blood IFN- release assay (IGRA) in reaction to early secreted antigenic target 6 (ESAT-6), culture filtrate protein 10 (CFP-10), and TB7.7 antigens, was performed and the released Interferon- was measured via enzyme-linked immunosorbent assay (ELISA). The data was analyzed with QFT-G software which was provided by the company. The demographic, characteristics and other variables were entered into SPSS version 11.5. The QFT-G test results of three donors (7.9%) turned out to be positive, negative for 24 donors (63.1%), and indeterminate for 11 cases (28.9%). Our study revealed the potential advantages of QFT-G in lowering the incidence of donor-derived post-transplant tuberculosis among lung recipients. However, a high rate of indeterminate results restricted the performance of QFT-G in this study.

Risk factors associated with survival after lung transplant in iran.

OBJECTIVES: Limited information is available about risk factors associated with survival after lung transplant in Iranian recipients. This study evaluated the effect of recipient and donor characteristics on survival after lung transplant. MATERIALS AND METHODS: This retrospective study included 69 lung transplants (single, 31 patients [45%]; bilateral, 38 patients [55%]), from 2000 to 2013, at the National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. The Kaplan-Meier method was used to calculate survival, and variables were evaluated with multivariate analysis. RESULTS: There were 54 male recipients (78%), and the most frequent indications for transplant included pulmonary fibrosis in 31 patients (45%) and bronchiectasis in 23 patients (33%). Recipient mean age was 36 ± 13 years and body mass index was 20 ± 4 kg/m2. Mean half-life (all recipients) was 2 ± 1 years and survival was 73% at 1 month, 67% at 1 year, and 40% at 5 years after transplant. For recipients who survived > 2 weeks after transplant half-life and survival were similar to previously international reported results. Recipient age, sex, type of transplant, body mass index, and pulmonary artery pressure were not associated with survival. Survival was significantly higher with recipient bronchiectasis, younger donors, and female donors. CONCLUSIONS: Survival after lung transplant was better with recipients who had bronchiectasis and donors that were younger or female. Patient selection, invasive monitoring, and supportive techniques such as extracorporeal membrane oxygenation for unstable patients during surgery may be helpful.

Heart-lung transplantation in Iran: a case report.

We report our initial experience with a heart-lung transplant operation performed on a 12- year- old girl with Eisenmenger syndrome at Masih Daneshvari Teaching Hospital in Tehran, in 2009. We also outline the operative indications, anesthetic management, and postoperative complications of heart-lung transplantation. We hope that this issue on transplantation may provide an encouraging prospect for patients with end-stage cardiopulmonary disorders in Iran.

Using Home Spirometry for Follow up of Lung Transplant Recipients: "A Pilot Study".

BACKGROUND: Lung transplantation is considered the ultimate treatment for some patients, but due to the specific condition of patients undergoing it, follow up is a major concern. The aim of this study was to evaluate the role of home spirometry in follow up of lung transplant recipients and early detection of complications in these patients. MATERIALS AND METHODS: A PC-based portable spirometry set was used to evaluate the well being of two lung transplant recipients on a regular daily basis for a 6-month period. Patient satisfaction and compliance, and device sensitivity in detecting complications were evaluated. Results of follow up were compared with 2 matched control patients. RESULTS: Patient adherence to home spirometry was 80% in one and 61% in the other patient and both patients were satisfied with the method, although this satisfaction declined towards the end of the study period. The main reason for low adherence was insufficient internet access. This method succeeded in early detection of infectious complications. CONCLUSION: Home spirometry seems to be a reliable method for follow up of lung transplant recipients, but further studies in a larger group of patients is recommended.