Potential functional and survival benefit of double over single lung transplantation for selected patients with idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a frequent indication for lung transplantation (LTX) with pulmonary hypertension (PH) negatively affecting outcome. The optimal procedure type remains a debated topic. The aim of this study was to evaluate the impact of pretransplant PH in IPF patients. Single LTX (SLTX, n = 46) was the standard procedure type. Double LTX (DLTX, n = 30) was only performed in cases of relevant PH or additional suppurative lung disease. There was no significant difference for pretransplant clinical parameters. Preoperative mean pulmonary arterial pressure was significantly higher in DLTX recipients (22.7 +/- 0.8 mmHg vs. 35.9 +/- 1.8 mmHg, P < 0.001). After transplantation, 6-min-walk distance and BEST-FEV(1) were significantly higher for DLTX patients (6-MWD: 410 +/- 25 m vs. 498 +/- 23 m, P = 0.02; BEST-FEV(1): 71.2 +/- 3.0 (% pred) vs. 86.2 +/- 4.2 (% pred), P = 0.004). Double LTX recipients demonstrated a significantly better 1-year-, overall- and Bronchiolitis obliterans Syndrome (BOS)-free survival (P < 0.05). Cox regression analysis confirmed SLTX to be a significant predictor for death and BOS. Single LTX offers acceptable survival rates for IPF patients. Double LTX provides a significant benefit in selected recipients. Our data warrant further trials of SLTX versus DLTX stratifying for potential confounders including PH.

Anaplasma phagocytophilum infection in a dog: identifying the causative agent using PCR

A diagnosis of Anaplasma phagocytophilum infection was confirmed in a two-year-old male golden retriever displaying few clinical and haematological abnormalities. This was achieved by demonstrating ehrlichial organisms in circulating neutrophils, by indirect immunofluorescence assay using A phagocytophilum as an antigen, and by detecting DNA specific for the 16S rRNA gene of granulocytic Anaplasma by PCR. After treatment with doxycycline for 10 days the dog showed improvement and the laboratory values returned to normal.

Tractor-trailer crashes in Indiana: a case-control study of the role of truck configuration

Studies of the crash experience of tractors pulling multiple trailers have reached different conclusions concerning the relationship of truck configuration to crash risk. A previous case-control study found a significant increase in crash risk for double-trailer trucks in the state of Washington. The present case-control study was done of tractor-trailers crashing on Indiana interstates during November 1989-March 1991. Controls were obtained for 25% of the crash sites and were all tractor-trailers passing the crash sites during a traffic observation session one to four weeks following a crash on the same day of the week for 30 minutes at the same time of day. Logistic regression identified day of week, time of day, urban/rural area, and specific highway as significant predictors of controls' truck configuration. This model was applied to the cases to estimate the expected number of double-trailer cases. For all crashes combined, no increased crash risk was observed for doubles (Standardized Crash Ratio (SCR) = 83). Doubles were significantly underinvolved in multiple-vehicle crashes (SCR = 74), crashes on dry roads (SCR = 61), and crashes on wet (other than snow, ice, or slush) roads (SCR = 54). Doubles were significantly overinvolved in crashes on roads with snow, ice, or slush (SCR = 153). Because truck configuration was highly associated with driver age and work operation attributes among trucks in crashes, the absence of control data on these potential confounders precluded definitive assessment of the intrinsic risk of multiple versus single-trailer vehicles.