Risky Business: Taking the Stigma Out of High-Risk Donation in Lung Transplantation.

BACKGROUND: Outcomes data for high-risk donors (HRD) for transplantation are limited. We sought to elucidate the outcomes of lung transplant (LTx) recipients who received HRDs. METHODS: We retrospectively reviewed the United Network for Organ Sharing (UNOS) registry from January 2005 to June 2013 to identify patients undergoing LTx. The Student t test and χ(2) test were used to identify differences in outcomes. A Cox proportional hazard model was developed to identify independent predictors of outcomes for HRD recipients. RESULTS: We identified 12,737 patients who underwent LTx. A total of 999 (7.8%) recipients received allografts from HRDs. Recipients in both the HRD and the non-HRD (NHRD) groups were similar. The HRDs had significantly higher rates of negative social behaviors and were likely to be thin young males who had died traumatically. Survival analysis demonstrated no survival benefit for patients receiving allografts from NHRDs (p = 0.63). Interestingly, HRDs did not have significantly higher viral loads, including hepatitis C virus (HCV) antibody, hepatitis B core antibody (HBcV), or hepatitis B surface antigen. When controlling for age, sex, and lung allocation score of the recipient, HRD status was not significantly detrimental to survival. CONCLUSIONS: Recipients receiving allografts from HRDs had at least equivalent survival to NHRD recipients. Our study supports the use of high-risk donation given limited resources. Centers interested in using these donors should educate prospective recipients willing to consider this option.

Assessment of dental prosthetic status and needs among prisoners of haryana, India.

This cross-sectional study was planned to evaluate the prosthetic status and treatment needs using WHO (1997) format among prisoners of Haryana state, India. 1,393 subjects with age range of 35.26 ± 12.29 years were examined. Of the study subjects, 11 (0.8 %) were completely while 606 (43.5 %) were partially edentulous. Of these 617 subjects, 305 (49.4 %) were edentulous only in posterior region. Dental caries accounted for loss of teeth in 325 (52.7 %) subjects. 44 (7.1 %) subjects were wearing some prosthesis. Regarding dental arch wise prosthetic need, 335 (54.3 %) subjects needed prosthesis in maxillary arch while 482 (78.1 %) needed prosthesis in mandibular arch. With advancing age there was an increase in the number of complete dental prosthesis required. There was no statistically significant difference between length of imprisonment and prosthetic need, except for need of a combination of prosthesis. Only one-fourth of the prisons had a dentist. The prisoners were taken to a hospital outside the prison in case of health needs. Prosthetic needs of prisoners were high. The lack of dental infrastructure in prisons makes the provision for multi-visit conservative dental treatments very difficult leading to higher tooth mortality. People who migrate back and forth across the prisons and communities represent a public health opportunity that should be addressed.

Giant asymptomatic primary esophageal schwannoma.

Primary esophageal schwannomas are uncommon. We describe a case of a large asymptomatic primary esophageal schwannoma in a 65-year-old patient. Computed tomography and positron emission tomography revealed an (18)F-fluorodeoxyglucose-avid 11-cm mass arising from the esophagus. A preoperative diagnosis was made via endoscopic ultrasound. The patient underwent a three-field esophagogastrectomy with cervical esophagogastric anastomosis. He remains well and free of recurrence 10 months after treatment.

Challenges and opportunities in implementing pharmacogenomics testing in the clinics.

The field of pharmacogenomics aims to incorporate individual patient genomic information into treatment selection. This is a rapidly evolving field with significant clinical promise. Implementation into clinical practice has several challenges that must be overcome. Genomics-based information encompasses large databases and requires expert knowledge for interpretation. Existing research suggests there are already several areas where pharmacogenomics-based decision-making is ripe for adoption into clinical practice. Impediments exist that must be overcome prior to large-scale implementation of existing pharmacogenomics-based therapies. There are several institutions and corporations at the forefront of implementation that are leading the development; however, larger systems-based approaches will be necessary. This article will discuss some of the present successes and future challenges that are necessary to overcome in order to implement a more patient-centered healthcare system.

Dentition status and treatment needs of prisoners of Haryana state, India.

PURPOSE: This paper aims to explore prisoner dental health in Haryana, India. DESIGN/METHODOLOGY/APPROACH: The authors assessed the prevalence of dental caries and the treatment needs of prisoners in all 19 prisons in Haryana. The results were compared with the prison populations of other countries and the general population of Haryana. FINDINGS: The mean age of 1,393 subjects examined was 35.26±12.29 years. A large number of the subjects reported to be in need of dental treatment. The number of decayed teeth was found to be similar to the general population of Haryana but the number of filled teeth was quite low. The number of teeth missing and the need for tooth extraction was high. Social implications - Long-standing prisoner dental problems indicated a need for dental treatment in prisons. ORIGINALITY/VALUE: This is the first study of its kind covering all 19 prisons in Haryana, India. The results indicate that the government needs to further consider and address the oral health needs of prisoners.

Nonhematopoietic NADPH oxidase regulation of lung eosinophilia and airway hyperresponsiveness in experimentally induced asthma.

Pulmonary eosinophilia is one of the most consistent hallmarks of asthma. Infiltration of eosinophils into the lung in experimental asthma is dependent on the adhesion molecule vascular cell adhesion molecule-1 (VCAM-1) on endothelial cells. Ligation of VCAM-1 activates endothelial cell NADPH oxidase, which is required for VCAM-1-dependent leukocyte migration in vitro. To examine whether endothelial-derived NADPH oxidase modulates eosinophil recruitment in vivo, mice deficient in NADPH oxidase (CYBB mice) were irradiated and received wild-type hematopoietic cells to generate chimeric CYBB mice. In response to ovalbumin (OVA) challenge, the chimeric CYBB mice had increased numbers of eosinophils bound to the endothelium as well as reduced eosinophilia in the lung tissue and bronchoalveolar lavage. This occurred independent of changes in VCAM-1 expression, cytokine/chemokine levels (IL-5, IL-10, IL-13, IFNgamma, or eotaxin), or numbers of T cells, neutrophils, or mononuclear cells in the lavage fluids or lung tissue of OVA-challenged mice. Importantly, the OVA-challenged chimeric CYBB mice had reduced airway hyperresponsiveness (AHR). The AHR in OVA-challenged chimeric CYBB mice was restored by bypassing the endothelium with intratracheal administration of eosinophils. These data suggest that VCAM-1 induction of NADPH oxidase in the endothelium is necessary for the eosinophil recruitment during allergic inflammation. Moreover, these studies provide a basis for targeting VCAM-1-dependent signaling pathways in asthma therapies.