THIS MONTH'S FOCUS:
INFECTIOUS DISEASES &
Many thanks to Fernanda Silveira and Janet Scheel for coordinating the content for this month's issue.
VINCENT'S HOT SUMMER SENSE:
The Heat is On (Beverly Hills Cop, 1984, oh and George Orwell comes to mind), for the summer is here in the Northern hemisphere. It is Aric Gregson from near Beverly Hills who explains the role on how the immune system polices the lung allograft milieu with every breath they take. Oveimar De La Cruz worries us more as we age and undergo immunosenescence. From bench to bedside, Pranava Sinha gives us insights on Fontan physiology from animal VAD models. Angela Lorts informs us that MCS in Pediatric Heart Failure is gaining momentum, and Janet Scheel provides an update from the PumpKIN patch. While Joanna Schaenman tears out a page not from the football or soccer playbook on how to tackle ESBL related infection, the world cup captivates us with many nations traveling afar. Kevin Carney recaps his travel to down under in Melbourne thanks to the Traveling Scholarship from the ISHLT. From the Editor's Corner, we plant the seeds of the pediatric years of France's most notable champion of reason who erupted on the scene in a France which by today's standards was brutal in the extreme with oppressive religious intolerance. Voltaire will enlighten France by pulling her out of ignorance, myth and superstition while summarizing the scientific method with one mere example on inoculation. Finally, a welcome relief to the heat of a huge work load has been delivered to the ISHLT with the addition of Megan Barrett native of Santa Ana, CA (yes the origin of the famous Santa Ana winds). She was blown in and hired on with the rest of the Administration of the ISHLT. She spent most of her life in McKinney, TX and recently graduated with honors with a degree in Liberal Studies from Oklahoma State University. Let's give Megan a warm ISHLT welcome as she assists us with communications in the ISHLT Headquarter Office as her first article debuts In the Spotlight asking the question with a breath of fresh air, "Is it nice in Nice?"
Vincent Valentine, MD
2014 Historical Interviews
Watch video interviews of transplant greats filmed at the 2014 Annual Meeting in San Diego! Read more →
IN THE SPOTLIGHT:
Is it nice in Nice?
by Megan Barnett
Is it nice in Nice? This particular question can be answered with a resounding YES!! With sunny skies and gorgeous ocean views, it's no wonder that this particular stretch of French coastline has become one of the top five vacation spots for the rich and famous. While I personally find the April highs of around 65°F to be a little chilly for beach-going and water sports, don't let that discourage you! The mild temperatures make the weather perfect for most outdoor activities and the seaside city has much more to offer than the mere opportunity to soak up the sunshine. Read more →
How to Tackle ESBL-related Infections: A Page from the Infectious Diseases Playbook
by Joanna Schaenman
Your patient, Mr. E., is a 68-year-old man with ischemic cardiomyopathy who underwent mechanical circulatory support device (MCSD) implantation and was doing well until fever and leukocytosis developed on post-op day 3. Prior to surgery he had been hospitalized for several weeks in an attempt at medical stabilization, complicated by a catheter-associated urinary tract infection requiring antibiotic treatment. After obtaining blood cultures, you begin to administer empiric vancomycin and piperacillin-tazobactam. On post-op day 5 the nurse notifies you that the microbiology lab called to report identification of an "ESBL-producing organism." What should you do now, and could you have predicted this development? Read more →
Lung Allograft Injury: Need for Different Police for Every Breath They Take
by Aric Gregson
Because the lung allograft is continually exposed to the external environment, it is uniquely susceptible to insults that do not plague most other solid organ transplants. The upper respiratory and gastrointestinal tracts provide a conduit by which both environmental and commensal microbes can enter the lung allograft. Under non-transplant settings such incursions rarely result in significant sequelae, like pneumonia. Read more →
Immunosenescence and Lung Transplantation - What Does It Mean to Be Old?
by Oveimar De La Cruz
Functional changes in the immune system associated with aging are collectively referred to as immunosenescence ... Ultimately, immunosenescence tells about a dysregulation of the intracellular pathway transduction and interaction among different cell lines (neutrophils, mononuclear cells, dendritic cells, macrophages, NKs). As the nature of the immune system is to dynamically "learn" and defend against different noxious challenges, its senescence equates to the inability to keep up with the plasticity of younger times. Read more →
News from the PumpKIN Patch
by Janet Scheel
In February 2010 NHLBI funded the Pumps for Kids, Infants, and Neonates (PumpKIN) Pre-clinical Program for preclinical testing of mechanical circulatory support devices for infants and children with heart failure. The goal was to support the continued development and necessary FDA testing of promising devices at that time, including some of those from the 2004 NHLBI funded Pediatric Circulatory Support Program. For us in the pediatric community, this was great news. Read more →
MCS in Pediatric Heart Failure Continues to Gain Momentum
by Angela Lorts
The pediatric heart failure community continues to build momentum with robust data collection and clinical trials. Pedimacs is gaining acceptance and over 30 centers are now enrolling their patients in the national database. With these heightened levels of enrollment, the database has collected data on more than 125 children. This data is similar to that of INTERMACS and will be formatted the same, with the new version of INTERMACS/PEDIMACS 4.0. The online data entry is currently under revision but will be back up for online data entry soon. Read more →
Insights into Fontan Physiology from Animal VAD Models
by Pranava Sinha
While the focus of most research on mechanical assistance of failing Fontan circulation is based on providing a subpulmonary pump (artificial RV) to push blood through the passive Fontan circuit, researchers at Children's National Medical Center have proposed this novel concept of pulling blood through the Fontan circuit by using a standard left (systemic) ventricular assist device. Read more →
OF SPECIAL INTEREST:
International Traveling Scholarship Report from Down Under
by Kevin Carney
The impetus for my trip to The Alfred started in 2007 while researching the clinical management of a potential lung donor. During my literature search, three names kept on repeating; Snell, Levvey and Oto, from The Alfred Hospital. At the 2008 ISHLT meeting in Boston, I attended a symposium on donor management that was chaired by Greg Snell. At the conclusion, I introduced myself to Greg, and was subsequently introduced to Bronwyn Levvey. Both Greg and Bronwyn took the time to answer my questions and offered their clinical expertise, both on donor management and on recipient selection. Read more →
ISHLT NEWS AND ANNOUNCEMENTS:
Monograph Volume 8: ISHLT Guidelines for the Management of Pediatric Heart Failure
Unsure of how to manage your patient given the recent advances in heart failure medicine? Then look no further than this monograph which provides an up to date reference for the diagnosis and management of heart failure in the pediatric age group. Edited by Richard Kirk, Anne Dipchand and David Rosenthal and written by experts throughout the world, this is the reference book to go to. The monograph is packed with sensible guidance on investigation and treatment and provides answers to questions such as why and how does the myocyte fail? There are chapters ranging from epidemiology, etiology, diagnostic approach, treatment including mechanical support and many more-with over 1700 up to date references.
CLICK HERE for the full table of contents. Suitable for cardiologists, pediatricians and allied health professionals - be they trainees or experienced staff, it provides the evidence base and expert guidance for management in this challenging area. The Monograph is available now for purchase online at www.ishlt.org with free shipping throughout the world.
2014 Annual Meeting and Academy Content Now Available!
The ISHLT 34th Annual Meeting and Scientific Sessions was conducted April 10-13, 2014 in San Diego, CA, USA before 3200 attendees, our largest ever audience. The content of the meeting covered a broad, multidisciplinary range of topics of interest for our members and professionals who manage and treat patients with end stage heart and lung disease, including those engaged in transplantation, pulmonary hypertension, mechanical circulatory support, heart failure, infectious disease, pathology, pharmacy, basic science, nursing and social science. Read more →
Voltaire, Jesuit Education, Philosophe, and Innoculation
by Vincent Valentine
The most widely quoted statement misattributed to Voltaire, "Although I disapprove of what you say, I will defend to the death your right to say it," (on the principle of freedom of speech) written by English biographer, Evelyn Beatrice Hall who wrote under the pseudonym S.G. Tallentyre in her book, The Friends of Voltaire, 1906. A witty description of the salonnières (to WIT, see Salonnières (fl. 17th and 18th c.) and the mind of France can be found in her other book, The Women of the Salons, and Other French Portraits, 1901. With this and the last issue she describes how women shaped the life and afterlife of Voltaire. In this issue we will turn to Voltaire's pediatric years. Read more →
"Judge a man by his questions rather than his answers.."
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Disclaimer: Any opinion, conclusion or recommendation published by the Links is the sole expression of the writer(s) and does not necessarily reflect the views of the ISHLT.