Infections in patients with cystic fibrosis following lung transplantation

BACKGROUND: There is controversy over whether colonization with drug-resistant organisms is a contraindication to lung transplantation. METHODS: We undertook a retrospective review of the results of lung transplantation for patients with cystic fibrosis (CF) at Duke University Medical Center. RESULTS: As of May 1996, 21 patients with CF underwent bilateral lung transplantation. The first patient died within 24 h of transplantation from sepsis due to Stenotrophomonas maltophilia. Of the remaining 20 patients, 17 (85%) are alive and in stable condition. The three deaths were related primarily to bronchiolitis obliterans at 4 and 18 months in two patients and to cytomegalovirus pneumonitis at 5 months in the other patient. The 17 surviving patients have been followed up for a mean of 13 months (range, 0.5 to 34 months). Most of them were colonized and infected with multidrug-resistant organisms before transplantation. Following transplantation, 11 patients had complications from infections. One patient had bacteremia due to a panresistant Burkholderia cepacia and was treated successfully. Two patients had bacteremia and wound infection due to Burkholderia gladioli, previously thought to be pathogenic only in plants. Both patients were treated successfully. Of the six patients with Aspergillus fumigatus isolated from cultures before transplantation, only one had invasive disease following transplantation and responded to treatment. CONCLUSION: The organisms present before transplantation were not the primary cause of mortality in our patient population. Our findings suggest that lung transplantation should be considered in CF patients infected with multidrug-resistant organisms.     

Influence of age and health on immune functions and trace elements

Apparently healthy elderly donors were screened according to a simple protocol that included clinical examination and the determination of hematological and biochemical values. This screening was performed to detect subclinical alterations which might interfere with immune responses and trace element status. The elderly were divided into two groups. The first group consisted of 22 (age 76 +/- 1 years) positively selected elderly (PSE), i.e. healthy subjects with no hematological and laboratory alterations, the second one comprised 13 (age 75 +/- 1 years) negatively selected elderly (NSE). Data were then compared with those obtained from 40 (age 35 +/- 2 years) healthy young controls. In both groups of elderly donors, plasma zinc levels were normal, while plasma copper concentrations were increased. Intracellular values of zinc and copper in mono- and polymorphonuclear cells from both groups of elderly were within reference limits. After in vitro activation, granulocyte chemiluminescence activity was impaired only in NSE. A decrement in the number of circulating CD3 lymphocytes and an increase in CD8d, CD57 cells were found in PSE, while NSE showed an increased number of CD3,DR cells and CD8d, CD57, CD8b,CD57 and CD16,CD56 positive cells. Our results indicate that only plasma copper levels were affected by age, whereas subclinical alterations in hematological or biochemical values appear to impair immune responses in the elderly.     

The human homologue of yeast CRM1 is in a dynamic subcomplex with CAN/Nup214 and a novel nuclear pore component Nup88

The oncogenic nucleoporin CAN/Nup214 is essential in vertebrate cells. Its depletion results in defective nuclear protein import, inhibition of messenger RNA export and cell cycle arrest. We recently found that CAN associates with proteins of 88 and 112 kDa, which we have now cloned and characterized. The 88 kDa protein is a novel nuclear pore complex (NPC) component, which we have named Nup88. Depletion of CAN from the NPC results in concomitant loss of Nup88, indicating that the localization of Nup88 to the NPC is dependent on CAN binding. The 112 kDa protein is the human homologue of yeast CRM1, a protein known to be required for maintenance of correct chromosome structure. This human CRM1 (hCRM1) localized to the NPC as well as to the nucleoplasm. Nuclear overexpression of the FG-repeat region of CAN, containing its hCRM1-interaction domain, resulted in depletion of hCRM1 from the NPC. In CAN-/- mouse embryos lacking CAN, hCRM1 remained in the nuclear envelope, suggesting that this protein can also bind to other repeat-containing nucleoporins. Lastly, hCRM1 shares a domain of significant homology with importin-beta, a cytoplasmic transport factor that interacts with nucleoporin repeat regions. We propose that hCRM1 is a soluble nuclear transport factor that interacts with the NPC.     

Fracture mechanics of oilseed rape pods

The basic theory of linear elastic fracture mechanics was applied to the fracture of pods from six genetic lines of oilseed rape (Brassica napus). An experiment was designed to allow the energetics of the fracture process to be accurately determined. The work of fracture, toughness and fracture toughness of five experimental varieties and one common commercial variety (Apex) were measured. The values for the toughness (0.006–0.271 kJ m-2) and fracture toughness (0.026–0.233 MN m-3/2) obtained from each line were distinct from each other but broadly similar to those of other brittle materials. The toughness and fracture toughness of Apex were approximately midway between the lowest and highest values measured. This result indicates that there is scope for improving the fracture resistance of oilseed rape crops so as to reduce seed loss before and during harvest. The approach described would be useful in selecting fracture-resistant genetic lines to help to develop such crops. This revised version was published online in November 2006 with corrections to the Cover Date.     

Serial cytological assay of micronucleus induction: a new tool to predict human cancer radiosensitivity

The role of the propeptide sequence and a disulfide bridge between sites 1 and 122 in chymotrypsin has been examined by comparing enzyme activities of wild-type and mutant enzymes. The kinetic constants of mutants devoid of the Cys1-Cys122 disulfide-linked propeptide show that this linkage is not important either for activity or substrate specificity. However this linkage appears to be the major factor in keeping the zymogen stable against non-specific activation. A comparison of zymogen stabilities showed that the trypsinogen propeptide is ten times more effective than the chymotrypsinogen propeptide in preventing non-specific zymogen activation during heterologous expression and secretion from yeast. This feature can also be transferred in trans to chymotrypsinogen; i.e. the chymotrypsin trypsin propeptide chimera forms a stable zymogen.     

Coliphage prevalence in high school septic effluent and associated ground water

At the present time, somatic and male-specific coliphage and human enterovirus groups are being considered as indicators of possible pathogenic human enteric virus contamination from fecal contamination. A primary attribute for any indicator of fecal contamination is its prevalence at the source and in associated ground water. It must be consistently found in the source material at concentrations that are measurable with available techniques. Over a period of ten months, male-specific and somatic coliphage ranged from 7000 to 4,000,000 PFU/L in the effluent from a multi-user septic-tank. Unlike the values determined for septic-tank effluent, coliphage concentrations measured in ground water over this same period only varied by five-fold. Coliphage concentration in ground water under the down-gradient edge of the drainfield contained 1000 PFU/L. This concentration decreased at −1 log₁₀/5 m during 17.4 m of ground-water transport. From these data, coliphage concentrations in septic-tank effluent seem sufficient to allow their use as indicators of fecal contamination in ground water.     

Toward successful compliance with JCAHO standard NC.1

Recommendations resulting from a JCAHO survey can be a true blessing as they force nursing departments to assess critically their professional practice and documentation systems. Systematic preparation, begun at least two years prior to the survey, includes Nursing Administration, a Nursing Documentation Task Force and all staff nurses. Educational consultants assigned to each unit bring nurses up-to-date on nursing process and nursing diagnosis. Mock surveys and cross-training in chart review prepare staff nurses for confident participation in the accreditation process.     

DIDS: rapidly prototyping configuration design systems

The domain independent design system (DIDS) provides a set of tools for rapidly constructing new configuration design systems from a library of reusable software elements called mechanisms. A DIDS user begins by creating a model of the problem domain and the task to be automated. This includes describing a library of parts from which new artifacts could be configured, optimization and preference criteria, and functionality constraints. DIDS analyzes this input and automatically builds an operational prototype system by selecting and combining mechanisms. DIDS' ability to automate this process is derived from its model of configuration design, which enables reusable mechanisms to be identified and automatically selected based on a problem's characteristics. The use of DIDS is illustrated by showing how DIDS solved an elevator-configuration problem.