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Cook KA, Hawke JP, Groman DB, Pretto T, Toffan A, Hanson LA, Nguyen D, Ford L, Baumgartner WA. Betanodavirus meningoencephalitis in an Atlantic blue marlin. J Vet Diagn Invest 2024; 36:389-392. [PMID: 38331725 PMCID: PMC11110777 DOI: 10.1177/10406387231218223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Viral nervous necrosis (viral encephalopathy and retinopathy) is caused by piscine nodavirus (Nodaviridae, Betanodavirus). Since 1986, this highly infectious virus has caused mass mortalities of up to 100% in farmed saltwater and freshwater fish around the world (with the exception of South America and Antarctica), affecting >60 species across 10 orders. The Atlantic blue marlin (Makaira nigricans Lacépède, 1802) is a top-level predator found throughout the tropical waters of the Atlantic and Indo-Pacific oceans. Despite their popularity as a sportfish, relatively little is known about the Atlantic blue marlin and other billfish. We describe here chronic betanodavirus infection in a juvenile Atlantic blue marlin, which is, to our knowledge, the first report of disease in M. nigricans.
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Affiliation(s)
- Kirstin A. Cook
- College of Veterinary Medicine, University of Illinois, Champaign, IL, USA
- Current address: University of Wisconsin–Madison, School of Veterinary Medicine, Madison WI, USA
| | - John P. Hawke
- School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - David B. Groman
- Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Tobia Pretto
- Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Anna Toffan
- Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Larry A. Hanson
- College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - D. Nguyen
- Research Institute for Aquaculture No 2, Ho Chi Minh City, Vietnam
| | - Lorelei Ford
- College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - Wes A. Baumgartner
- College of Veterinary Medicine, University of Illinois, Champaign, IL, USA
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LaFrentz BR, Khoo LH, Lawrence ML, Petrie-Hanson L, Hanson LA, Baumgartner WA, Hemstreet WG, Kelly AM, García JC, Shelley JP, Johnston AE, Bruce TJ, Griffin MJ. Flavobacterium covae is the predominant species of columnaris-causing bacteria impacting the Channel Catfish industry in the southeastern United States. J Aquat Anim Health 2024; 36:3-15. [PMID: 37859458 DOI: 10.1002/aah.10207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Columnaris disease is a leading cause of disease-related losses in the catfish industry of the southeastern United States. The term "columnaris-causing bacteria" (CCB) has been coined in reference to the four described species that cause columnaris disease: Flavobacterium columnare, F. covae, F. davisii, and F. oreochromis. Historically, F. columnare, F. covae, and F. davisii have been isolated from columnaris disease cases in the catfish industry; however, there is a lack of knowledge of which CCB species are most prevalent in farm-raised catfish. The current research objectives were to (1) sample columnaris disease cases from the U.S. catfish industry and identify the species of CCB involved and (2) determine the virulence of the four CCB species in Channel Catfish Ictalurus punctatus in controlled laboratory challenges. METHODS Bacterial isolates or swabs of external lesions from catfish were collected from 259 columnaris disease cases in Mississippi and Alabama during 2015-2019. The DNA extracted from the samples was analyzed using a CCB-specific multiplex polymerase chain reaction to identify the CCB present in each diagnostic case. Channel Catfish were challenged by immersion with isolates belonging to each CCB species to determine virulence at ~28°C and 20°C. RESULT Flavobacterium covae was identified as the predominant CCB species impacting the U.S. catfish industry, as it was present in 94.2% (n = 244) of diagnostic case submissions. Challenge experiments demonstrated that F. covae and F. oreochromis were highly virulent to Channel Catfish, with most isolates resulting in near 100% mortality. In contrast, F. columnare and F. davisii were less virulent, with most isolates resulting in less than 40% mortality. CONCLUSION Collectively, these results demonstrate that F. covae is the predominant CCB in the U.S. catfish industry, and research aimed at developing new control and prevention strategies should target this bacterial species. The methods described herein can be used to continue monitoring the prevalence of CCB in the catfish industry and can be easily applied to other industries to identify which Flavobacterium species have the greatest impact.
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Affiliation(s)
- Benjamin R LaFrentz
- U.S. Department of Agriculture, Agricultural Research Service, Aquatic Animal Health Research Unit, Auburn, Alabama, USA
| | - Lester H Khoo
- Thad Cochran National Warmwater Aquaculture Center, Aquatic Research and Diagnostic Laboratory, Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Stoneville, Mississippi, USA
| | - Mark L Lawrence
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi, USA
| | - Lora Petrie-Hanson
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi, USA
| | - Larry A Hanson
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi, USA
| | - Wes A Baumgartner
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi, USA
| | - William G Hemstreet
- School of Fisheries, Aquaculture, and Aquatic Sciences, College of Agriculture, Auburn University, Auburn, Alabama, USA
| | - Anita M Kelly
- School of Fisheries, Aquaculture, and Aquatic Sciences, College of Agriculture, Auburn University, Auburn, Alabama, USA
| | - Julio C García
- U.S. Department of Agriculture, Agricultural Research Service, Aquatic Animal Health Research Unit, Auburn, Alabama, USA
| | - John P Shelley
- U.S. Department of Agriculture, Agricultural Research Service, Aquatic Animal Health Research Unit, Auburn, Alabama, USA
| | - Amber E Johnston
- U.S. Department of Agriculture, Agricultural Research Service, Aquatic Animal Health Research Unit, Auburn, Alabama, USA
| | - Timothy J Bruce
- School of Fisheries, Aquaculture, and Aquatic Sciences, College of Agriculture, Auburn University, Auburn, Alabama, USA
| | - Matt J Griffin
- Thad Cochran National Warmwater Aquaculture Center, Aquatic Research and Diagnostic Laboratory, Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Stoneville, Mississippi, USA
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Athey JM, Vieson MD, Bailey K, Rudmann D, Baumgartner WA, Selting KA. Canine thyroid carcinomas: A review with emphasis on comparing the compact subtype of follicular thyroid carcinomas and medullary thyroid carcinomas. Vet Pathol 2024; 61:7-19. [PMID: 37306003 DOI: 10.1177/03009858231177225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Canine thyroid carcinomas are relatively common malignant endocrine neoplasms in dogs derived from either thyroid follicular cells (forming follicular thyroid carcinomas) or medullary cells (parafollicular, C-cells; forming medullary thyroid carcinomas). Older and recent clinical studies often fail to discriminate between compact cellular (solid) follicular thyroid carcinomas and medullary thyroid carcinomas, which may skew conclusions. The compact subtype of follicular thyroid carcinomas appears to be the least differentiated subtype of follicular thyroid carcinomas and needs to be differentiated from medullary thyroid carcinomas. This review includes information on the signalment, presentation, etiopathogenesis, classification, histologic and immunohistochemical diagnosis, clinical management, and biochemical and genetic derangements of canine follicular and medullary carcinomas, and their correlates with human medicine.
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Yang TS, LaDouceur EEB, Baumgartner WA, Marr HS, Karounos M, Robertson J, Whitehurst N, Miller LS, Birkenheuer AJ. A practical protocol to prepare paraffin-embedded whole tick histology sections. Ticks Tick Borne Dis 2023; 14:102162. [PMID: 36965259 PMCID: PMC10652274 DOI: 10.1016/j.ttbdis.2023.102162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/05/2023] [Accepted: 02/26/2023] [Indexed: 03/27/2023]
Abstract
Ticks are important ectoparasites that are capable of transmitting multiple classes of pathogens and are currently linked with many emerging tick-borne diseases worldwide. With increasing occurrences of tick-borne diseases in both humans and veterinary species, there is a continuous need to further our understanding of ticks and the pathogens they transmit. Whole tick histology provides a full scope of the tick internal anatomy, allowing researchers to examine multiple organs of interest in a single section. This is in contrast to other techniques that are more commonly utilized in tick-borne disease research, such as electron microscopy and light microscopy of individual organs. There is a lack of literature describing a practical technique to process whole tick histologic sections. Therefore, the current study aims to provide researchers with a workable protocol to prepare high quality paraffin-embedded whole tick histology sections. Amblyomma americanum adults were used as an example species for this study. After a series of pilot experiments using a combination of various fixatives, softening agents and processing techniques, we elected to compare two common fixatives, 10% neutral-buffered formalin (NBF) and Bouin's solution for whole ticks. Equal numbers of A. americanum unfed adults (n = 10/fixative) were processed identically and their whole tick histology coronal sections were individually scored. Higher scores were assigned to whole tick sections that contained more internal organs that are crucial for tick-borne disease research (e.g. salivary glands and midgut), high integrity of tissues and exoskeleton on the section, and good fixation and staining quality of the tissues. The mean total scores for Bouin's-fixed ticks were significantly higher compared to NBF-fixed ticks (p = 0.001). To further assess our preferred technique, we also demonstrated the feasibility of producing high quality whole tick sections for three other common tick species of medical importance (Rhipicephalus sanguineus, Ixodes scapularis, and Dermacentor variabilis) using Bouin's solution. While this technique may require further optimization for other tick species, we described a feasible protocol that uses commonly available tools, reagents and standard histologic equipment. This should allow any investigator to easily make adjustments to this protocol as needed based on their experimental goals.
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Affiliation(s)
- Tzushan S Yang
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Elise E B LaDouceur
- Joint Pathology Center, Veterinary Pathology Services, Silver Spring, Maryland, USA
| | - Wes A Baumgartner
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802, USA
| | - Henry S Marr
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Michael Karounos
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - James Robertson
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA; Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Nathan Whitehurst
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Laura S Miller
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Adam J Birkenheuer
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA.
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Alberson NR, Rosser TG, King DT, Woodyard ET, Khoo LH, Baumgartner WA, Wise DJ, Pote LM, Cunningham FL, Griffin MJ. EXPERIMENTAL ELUCIDATION OF THE LIFE CYCLE OF DREPANOCEPHALUS SPATHANS (DIGENEA: ECHINOSTOMATIDAE) WITH NOTES ON THE MORPHOLOGICAL PLASTICITY OF D. SPATHANS IN THE UNITED STATES. J Parasitol 2022; 108:141-158. [PMID: 35353188 DOI: 10.1645/19-157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The echinostomatid Drepanocephalus spathans (syn. Drepanocephalus auritus) parasitizes the double-crested cormorant Phalacrocorax auritus. In North America, the marsh rams-horn snail Planorbella trivolvis and ghost rams-horn snail Biomphalaria havanensis serve as snail intermediate hosts, both of which inhabit catfish aquaculture ponds in the southeastern United States. Studies have demonstrated D. spathans exposure can be lethal to juvenile channel catfish Ictalurus punctatus. Two studies were undertaken to elucidate the life cycle of D. spathans to establish a developmental time line. In both studies, D. spathans cercariae collected from naturally infected P. trivolvis individuals were used to infect channel catfish fingerlings, which were then fed to double-crested cormorants (DCCOs) that had been pharmaceutically dewormed. In study 1, laboratory-reared P. trivolvis and B. havanensis individuals were placed in aviary ponds with experimentally infected DCCO and examined bi-weekly for release of cercariae. Trematode eggs were observed in the feces of exposed birds 3 days post-infection. Birds were sacrificed 18 days post-exposure (dpe), and gravid adults morphologically and molecularly consistent with D. spathans were recovered. Snails from the aviary pond were observed shedding D. spathans cercariae 18-54 dpe. In study 2, trematode eggs were observed in the feces of exposed DCCOs beginning 8 dpe. Once eggs were observed, birds were allowed to defecate into clean tanks containing naïve laboratory-reared P. trivolvis individuals. Additionally, eggs from experimental DCCO feces were recovered by sedimentation and placed in an aquarium housing laboratory-reared P. trivolvis individuals. Birds in study 2 were sacrificed after 60 days, and gravid D. spathans specimens were recovered. Snails from the experimental DCCO tanks shed D. spathans cercariae 89-97 dpe. Lastly, trematode eggs were isolated and observed for the hatching of miracidia, which emerged on average after 16 days at ambient temperatures. No D. spathans adults were observed in control birds fed non-parasitized fish. This is the first experimental confirmation of the D. spathans life cycle, resolving previously unknown developmental time lines. In addition, the effects of fixation on adult trematode morphology were assessed, clarifying reports of pronounced morphological plasticity for D. spathans.
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Affiliation(s)
- Neely R Alberson
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, 240 Wise Center Drive, Mississippi State, Mississippi 39762
| | - Thomas G Rosser
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, 240 Wise Center Drive, Mississippi State, Mississippi 39762
| | - D Tommy King
- Mississippi Field Station, National Wildlife Research Center, Wildlife Services, U.S. Department of Agriculture, Mississippi State, Mississippi 39762
| | - Ethan T Woodyard
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, 240 Wise Center Drive, Mississippi State, Mississippi 39762
| | - Lester H Khoo
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, 240 Wise Center Drive, Mississippi State, Mississippi 39762.,Thad Cochran National Warmwater Aquaculture Center, Delta Research and Extension Center, Mississippi State University, Stoneville, Mississippi 38776
| | - Wes A Baumgartner
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, 240 Wise Center Drive, Mississippi State, Mississippi 39762
| | - David J Wise
- Thad Cochran National Warmwater Aquaculture Center, Delta Research and Extension Center, Mississippi State University, Stoneville, Mississippi 38776
| | - Linda M Pote
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, 240 Wise Center Drive, Mississippi State, Mississippi 39762
| | - Fred L Cunningham
- Mississippi Field Station, National Wildlife Research Center, Wildlife Services, U.S. Department of Agriculture, Mississippi State, Mississippi 39762
| | - Matt J Griffin
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, 240 Wise Center Drive, Mississippi State, Mississippi 39762.,Thad Cochran National Warmwater Aquaculture Center, Delta Research and Extension Center, Mississippi State University, Stoneville, Mississippi 38776
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Yossa R, Greiling AM, Basiita RK, Sakala ME, Baumgartner WA, Taylor A, Gatlin DM. Replacing fishmeal with a single cell protein feedstuff in Nile tilapia Oreochromis niloticus diets. Anim Feed Sci Technol 2021. [DOI: 10.1016/j.anifeedsci.2021.115089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yang TS, Rivers OS, Baumgartner WA. Mineralizing Pulmonary Elastosis in a Cat. J Comp Pathol 2021; 187:11-16. [PMID: 34503649 DOI: 10.1016/j.jcpa.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/27/2021] [Accepted: 06/20/2021] [Indexed: 11/17/2022]
Abstract
Mineralizing pulmonary elastosis (MPE) is a rare and unique phenomenon that has been reported in humans, typically secondary to recurrent pulmonary haemorrhage. MPE has a complex histopathological appearance, often containing iron-calcium deposits that can be mistaken as fungal organisms or other inorganic material. This report documents the first case of MPE in an animal species. A 10-year-old female domestic cat with respiratory failure was submitted for necropsy. The lungs were consolidated with severe pulmonary haemosiderosis, and widely disseminated granulomas surrounded large aggregates of hyphae-like structures. The pulmonary vasculature and airway smooth muscle were partially mineralized and fragmented. Histochemical stains revealed that the fungus-like material stained strongly with Prussian blue and alizarin red but only sparingly with von Kossa and negative with Gomori's methenamine silver stain. These findings are similar to those of MPE in humans. As most veterinary pathologists may not be familiar with MPE, it is important to avoid possible misinterpretation by recognizing its distinct features and the ancillary testing that may be required.
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Affiliation(s)
- Tzushan S Yang
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA; Department of Pathobiology and Population Medicine, Mississippi State University, Starkville, Mississippi, USA.
| | - Orion S Rivers
- Institute for Imaging and Analytical Technologies, Mississippi State University, Mississippi, USA
| | - Wes A Baumgartner
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA; Department of Pathobiology and Population Medicine, Mississippi State University, Starkville, Mississippi, USA
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Tollefson CR, Yates JL, Cade JC, Baumgartner WA, Lee AM. What Is Your Diagnosis? J Am Vet Med Assoc 2021; 259:137-140. [PMID: 34227856 DOI: 10.2460/javma.259.2.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rosser TG, Loch TP, Faisal M, Baumgartner WA, Griffin MJ. Henneguya michiganensis n. sp. (Cnidaria: Myxosporea) from the gills of muskellunge Esox masquinongy Mitchill(Esociformes: Esocidae). Syst Parasitol 2021; 98:119-130. [PMID: 33687653 DOI: 10.1007/s11230-021-09965-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/15/2020] [Indexed: 11/29/2022]
Abstract
Henneguya Thélohan, 1892 is the second most species rich genus of myxozoans, with reports from freshwater and marine fish worldwide. In the Great Lakes region of North America, muskellunge Esox masquinongy is an important game fish species that serves as an apex predator in the ecosystems of many inland lakes. The myxozoan fauna of esocid fish, especially muskellunge, remains largely understudied. During fish health assessments, muskellunge were examined for parasitic infections and myxozoan pseudocysts were observed on gill clip wet mounts. When ruptured under pressure, the intralamellar pseudocysts released thousands of myxospores consistent with those of the genus Henneguya. The myxospores were 67.3-96.6 (79.1 ± 5.9) µm in total length. The spore body was 18.6-22.6 (20.9 ± 1.0) µm × 5.4-6.9 (6.3 ± 0.4) µm in valvular view and 3.5-4.0 (3.8 ± 0.3) µm wide in sutural view. The two pyriform polar capsules positioned at the anterior of the spore body were 6.4-7.7 (7.0 ± 0.4) µm × 1.8-2.1 (2.0 ± 0.1) µm and each contained a tightly coiled polar filament with 9-10 turns. Two tapering caudal processes extended from the posterior of the spore body and were 47.3-75.6 (58.3 ± 5.8) µm in length. Histologically, large intralamellar polysporic plasmodia were surrounded by plump pillar cells and a distinct layer of plasma. Mild inflammation was present peripherally, with small numbers of necrotic germinative cells and intraplasmodial phagocytes internally. Ribosomal 18S rRNA gene sequence data were obtained from three gill pseudocysts. The three ~2000-bp sequences were identical, but shared no significant similarity with any publicly available sequence data. Phylogenetic analyses demonstrated sequence data from this Henneguya fell within a well-supported clade of Henneguya spp. reported from northern pike Esox lucius in Europe. Based on the distinct morphological, histological and molecular data, this species is designated as Henneguya michiganensis n. sp. from muskellunge in Michigan, USA.
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Affiliation(s)
- Thomas G Rosser
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi, MS, 39762, USA
| | - Thomas P Loch
- Department of Fisheries and Wildlife, College of Agriculture and Natural Resources, Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, 48824, USA.
| | - Mohamed Faisal
- Department of Fisheries and Wildlife, College of Agriculture and Natural Resources, Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - Wes A Baumgartner
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, University of Illinois, Urbana, IL, 61802, USA
| | - Matt J Griffin
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Stoneville, MS, 38776, USA
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Leis EM, Rosser TG, Baumgartner WA, Griffin MJ. Two Novel Myxozoans from Pirate Perch Aphredoderus sayanus (Gilliams, 1824) in the Upper Mississippi River, Including the First North American Species of Hennegoides Lom, Tonguthai, & Dyková, 1991. J Parasitol 2019. [PMID: 31829908 DOI: 10.1645/19-43] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The pirate perch Aphredoderus sayanus is a relatively small fish species found in rivers throughout much of the eastern United States. Due to their cryptic nature, relatively little is known regarding their parasite fauna. A survey of pirate perch from the upper Mississippi River revealed 2 novel myxozoans. Hennegoides flockae n. sp. was observed in heavily infected gills where the lamellae featured irregular expansion by bulbous myxozoan polysporic plasmodia, typically affecting the middle to distal half of the filaments. When severe, infection of sequential filaments was such that the filaments were fused, forming what appeared as multicystic/lobular parasitic aggregates subdivided by fine epithelial cords. The total myxospore length of Hennegoides flockae was 35.4-46.4 (41.3 ± 3.3) and the spore body, asymmetrically ovoid in valvular view, was 15.4-18.7 (17.0 ± 0.7) × 7.1-8.7 (7.9 ± 0.4). Henneguya marcquenskiae n. sp. was observed in the liver with plasmodia present randomly and infrequently in the hepatocellular parenchyma. The total myxospore length for Henneguya marcquenskiae was 39.5-55.9 (48.4 ± 4.2), with the spore body being lanceolate, 13.9-16.5 (15.4 ± 0.7) × 7.1-9.0 (8.3 ± 0.5). Phylogenetic analysis of the SSU rRNA gene placed both Hennegoides flockae and Henneguya marcquenskiae as sisters to each other in a clade containing other Myxozoans known to infect the gills of esocids, percids, and centrarchids. These parasites represent the first reports of Henneguya and Hennegoides from pirate perch, with the latter being the first report of this genus outside of the Asian continent.
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Affiliation(s)
- Eric M Leis
- La Crosse Fish Health Center - Midwest Fisheries Center, United States Fish and Wildlife Service, Onalaska, Wisconsin 54650
| | - Thomas G Rosser
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi 39762
| | - Wes A Baumgartner
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, MIssissippi State, Mississippi 39762
| | - Matt J Griffin
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Stoneville, Mississippi 38776
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Woodyard ET, Baumgartner WA, Rosser TG, Bodin EN, Ferrara AM, Noto TW, Ford LM, Rush SA. Morphological, Molecular, and Histopathological Data for Sebekia mississippiensis Overstreet, Self, and Vliet, 1985 (Pentastomida: Sebekidae) in the American Alligator, Alligator mississippiensis Daudin, and the Spotted Gar, Lepisosteus oculatus Winchell. J Parasitol 2019. [PMID: 30950763 DOI: 10.1645/18-122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Novel molecular data from both mitochondrial ( cytochrome c oxidase subunit 1) and ribosomal regions ( 18S, ITS1-5.8S, ITS2, and 28S) are provided for Sebekia mississippiensis Overstreet, Self, & Vliet, 1985 , a pentastome infecting the American alligator, Alligator mississippiensis Daudin, 1801, and the spotted gar, Lepisosteus oculatus Winchell, 1864. Adult and nymphal pentastomes are described from the lungs and liver of the type host, A. mississippiensis, collected from Mississippi, while additional nymphs are described from the esophageal lining of L. oculatus specimens collected from Louisiana. This sequencing data will facilitate more accurate identification of various life cycle stages of S. mississippiensis, enabling future work to resolve many ambiguities in the literature regarding this species. Additionally, histopathological data are provided from both the definitive and intermediate hosts.
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Affiliation(s)
- Ethan T Woodyard
- 1 Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi 39762
| | - Wes A Baumgartner
- 2 Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi 39762
| | - Thomas Graham Rosser
- 1 Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi 39762
| | - Emily N Bodin
- 3 Department of Biological Sciences, Nicholls State University, Thibodaux, Louisiana 70301
| | - Allyse M Ferrara
- 3 Department of Biological Sciences, Nicholls State University, Thibodaux, Louisiana 70301
| | - Travis W Noto
- 1 Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi 39762
| | - Lorelei M Ford
- 1 Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi 39762
| | - Scott A Rush
- 4 Department of Wildlife, Fisheries, and Aquaculture, College of Forest Resources, Mississippi State University, Mississippi State, Mississippi 39762
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Rosser TG, Baumgartner WA, Alberson NR, Noto TW, Woodyard ET, Tommy King D, Wise DJ, Griffin MJ. Clinostomum poteae n. sp. (Digenea: Clinostomidae), in the trachea of a double-crested cormorant Phalacrocorax auritus Lesson, 1831 and molecular data linking the life-cycle stages of Clinostomum album Rosser, Alberson, Woodyard, Cunningham, Pote & Griffin, 2017 in Mississippi, USA. Syst Parasitol 2018; 95:543-566. [PMID: 29855982 DOI: 10.1007/s11230-018-9801-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/13/2018] [Indexed: 11/30/2022]
Abstract
Clinostomum spp. (Digenea: Clinostomidae) are a group of trematodes commonly found in the buccal cavity and oesophagus of a variety of piscivorous birds. The metacercariae, colloquially known as "yellow grubs," have been reported from a diverse group of freshwater fishes worldwide. In the catfish farming region of the southeastern USA, piscivorous birds present a continuous challenge for aquaculturists in the form of fish depredation and the introduction of trematodes into these static, earthen pond systems. Clinostomum spp. are commonly encountered in farm-raised catfish. While generally considered pests of minimal importance, heavy infections can result in unmarketable fillets. Of the piscivorous birds that frequent catfish aquaculture operations in the southeastern US, the double-crested cormorant (Phalacrocorax auritus Lesson) is one of the most damaging, although reports of Clinostomum spp. from P. auritus are limited. In this study, adult trematodes morphologically consistent with Clinostomum sp. were found in the trachea of a double-crested cormorant captured in Lowndes Co., Mississippi, USA. These specimens differed from other recognised Clinostomum spp. in several key morphological characters. Moreover, sequence data of mitochondrial cytochrome c oxidase subunit 1 gene (cox1), nicotinamide adenine dinucleotide dehydrogenase subunit 1 gene (nad1) and ribosomal internal transcribed spacer (ITS) regions did not match any known Clinostomum sp. for which sequence data are available. While genetically similar to C. marginatum and C. album Rosser, Alberson, Woodyard, Cunningham, Pote & Griffin, 2017 reported from the great egret Ardea alba L. in Mississippi, these adult clinostomids were larger in size and limited to the trachea, whereas both C. marginatum Rudolphi, 1819 and C. album are found in the oral cavity and esophagus. Given these distinct morphological and molecular characters we propose a new member of the genus, known hereafter as Clinostomum poteae n. sp. Additionally, larval stages in the life-cycle of C. album are morphologically and molecularly identified for the first time from ramshorn snails Planorbella trivolvis Say and fathead minnows Pimephales promelas Rafinesque.
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Affiliation(s)
- Thomas G Rosser
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA.
| | - Wes A Baumgartner
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Neely R Alberson
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Travis W Noto
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Ethan T Woodyard
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - D Tommy King
- Mississippi Field Station, National Wildlife Research Center, Wildlife Services, United States Department of Agriculture, Mississippi State, MS, 39762, USA
| | - David J Wise
- Thad Cochran National Warmwater Aquaculture Center, Delta Research and Extension Center, Mississippi State University, Stoneville, MS, 38776, USA
| | - Matt J Griffin
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA.,Thad Cochran National Warmwater Aquaculture Center, Delta Research and Extension Center, Mississippi State University, Stoneville, MS, 38776, USA
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Loch TP, Rosser TG, Baumgartner WA, Boontai T, Faisal M, Griffin MJ. New host record and molecular characterization of Dicauda atherinoidi Hoffman & Walker (Bivalvulida: Myxobolidae): a parasite of the emerald shiner Notropis atherinoides Rafinesque, 1818 and mimic shiner Notropis vollucellus Cope, 1865. J Fish Dis 2017; 40:1405-1415. [PMID: 28422305 DOI: 10.1111/jfd.12616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 06/07/2023]
Abstract
Updated morphological and histopathological descriptions for Dicauda atherinoidi (Bivalvulida:Myxobolidae) and an expanded host range are supplemented with the first molecular data and phylogenetic analyses of the genus. Plasmodia were located on the head, ventrum/body and fins of infected emerald shiner Notropis atherinoides Rafinesque, 1818 and mimic shiner Notropis vollucellus Cope, 1865, a new host species. Myxospores were spherical, ranging 9.3-11.4 μm (10.5 ± 0.4) in length, 9.0-11.0 μm (9.7 ± 0.4) in width and 6.6-7.0 μm (6.8 ± 0.2) thick in sutural view, and possessed 2-3 caudal processes (5.3-68.3 μm, 31.1 ± 13.6) connected to the spore body at the sutural groove, all of which are consistent with the genus Dicauda. In the absence of available Dicauda sequence data, the 18S rDNA sequences from Michigan isolates were most similar to Myxobolus spp. Phylogenetic analyses clustered these isolates with myxobolid species from cyprinid fish, suggesting these parasites may represent an underpopulated group of cyprinid-infecting myxozoans. Histopathology revealed thin-walled plasmodial pseudocysts in the dermis and associated connective tissue, where granulomatous inflammation and focal scale atrophy were also present. Further sampling/sequencing of myxobolids from Notropis spp. should expand these underrepresented myxozoans and offer further insight into Myxobolidae host family tropisms.
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Affiliation(s)
- T P Loch
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - T G Rosser
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - W A Baumgartner
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - T Boontai
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - M Faisal
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
- Department of Fisheries and Wildlife, College of Agriculture and Natural Resources, Michigan State University, East Lansing, MI, USA
| | - M J Griffin
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Stoneville, MS, USA
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Baumgartner WA, Ford L, Hanson L. Lesions caused by virulent Aeromonas hydrophila in farmed catfish (Ictalurus punctatus and I. punctatus × I. furcatus) in Mississippi. J Vet Diagn Invest 2017; 29:747-751. [DOI: 10.1177/1040638717708584] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In 2009, a virulent strain of Aeromonas hydrophila caused severe disease and high mortalities (motile aeromonad septicemia variant [MASv]) in farmed channel catfish ( Ictalurus punctatus) and hybrid catfish ( I. punctatus × I. furcatus) in eastern Mississippi and Alabama. As is common in MAS, there is severe hemorrhagic dermatitis with ulceration, as well as abdominal hyperemia, petechiation, and mild ascites. Additional findings in MASv cases include panophthalmitis and orbital cellulitis, leading to ocular rupture, and brains are often hyperemic with mild random acute hemorrhage. In MASv infections, there is consistently also marked hemorrhage and edema in the submucosa and muscularis of the stomach, with lymphangitis and a few bacteria, plus splenomegaly with infarcts. Microscopically, spleens have necrosis of ellipsoids with macrophage infiltration and small numbers of bacteria; however, large infarcts are filled with bacteria. Other organs, such as liver, kidneys, and intestine, which are typically associated with MAS caused by various aeromonad species, are less affected. The findings in the stomach have not been reported in MAS in farmed catfish, to our knowledge, and the splenic changes are highly characteristic of MAS compared to infection with other gram-negative bacteria, including Edwardsiella ictaluri and other aeromonad species and strains.
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Affiliation(s)
- Wes A. Baumgartner
- Departments of Pathobiology and Population Medicine (Baumgartner), College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
- Basic Sciences (Ford, Hanson), College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Lorelei Ford
- Departments of Pathobiology and Population Medicine (Baumgartner), College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
- Basic Sciences (Ford, Hanson), College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Larry Hanson
- Departments of Pathobiology and Population Medicine (Baumgartner), College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
- Basic Sciences (Ford, Hanson), College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
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Rosser TG, Baumgartner WA, Barger MA, Griffin MJ. Myxobolus lepomis n. sp. (Cnidaria: Myxobolidae), a gill myxozoan infecting Lepomis marginatus Holbrook and Lepomis miniatus Jordan (Perciformes: Centrarchidae), in the Big Thicket National Preserve, Texas, USA. Syst Parasitol 2017; 94:535-545. [DOI: 10.1007/s11230-017-9719-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/26/2017] [Indexed: 10/19/2022]
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Leis EM, Rosser TG, Baumgartner WA, Griffin MJ. Henneguya laseeae n. sp. from flathead catfish (Pylodictis olivaris) in the upper Mississippi River. Parasitol Res 2016; 116:81-89. [PMID: 27704217 DOI: 10.1007/s00436-016-5264-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
A novel species of Henneguya was isolated from flathead catfish (Pylodictis olivaris) captured in the upper Mississippi River near Lansing (Allamakee County), IA, and La Crosse (La Crosse County), WI. Designated Henneguya laseeae n. sp., this novel species is described using critical morphological features, histology, and 18S ribosomal RNA gene sequence. Ovoid cysts, ranging from 1200 to 1800 μm in width, tended to be at filament tips or in the distal third, often directly on the filament midline, but occasionally paramedian. Lanceolate-shaped myxospores were consistent with those of the genus Henneguya. The spore body was 16.2 ± 0.5 μm (mean ± standard deviation; range = 15.1-17.0 μm) in length, 6.0 ± 0.4 μm (5.1-6.6 μm) in width, and 4.7 ± 0.2 μm (4.4-4.9 μm) thick. The two polar capsules at the anterior of the spore body were 5.9 ± 0.3 μm (5.3-6.3 μm) in length and 1.8 ± 0.1 μm (1.6-2.1 μm) in width and contained six to seven turns in the polar filament. The caudal processes tapered to fine points and were 54.3 ± 2.9 μm (49.1-61.7 μm) in length. Total spore length was 70.4 ± 3.3 μm (64.5-79.4 μm). The spores and plasmodium of this species are of similar size and morphology to other species of Henneguya from ictalurid fishes. Additionally, the 18S rRNA gene sequences placed this isolate within a clade populated by Henneguya spp. from North American ictalurids. This is the first reported species of Henneguya from flathead catfish.
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Affiliation(s)
- Eric M Leis
- La Crosse Fish Health Center, United States Fish and Wildlife Service, Onalaska, WI, 54650, USA.
| | - Thomas G Rosser
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, MS, 39762, USA
| | - Wes A Baumgartner
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Starkville, MS, 39762, USA
| | - Matt J Griffin
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Stoneville, MS, 38776, USA
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Rosser TG, Baumgartner WA, Alberson NR, Woodyard ET, Reichley SR, Wise DJ, Pote LM, Griffin MJ. Austrodiplostomum sp., Bolbophorus sp. (Digenea: Diplostomidae), and Clinostomum marginatum (Digenea: Clinostomidae) metacercariae in inland silverside Menidia beryllina from catfish aquaculture ponds, with notes on the infectivity of Austrodiplostomum sp. cercariae in channel catfish Ictalurus punctatus. Parasitol Res 2016; 115:4365-4378. [DOI: 10.1007/s00436-016-5222-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
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Baumgartner WA, Baumgartner AM. Accounting for disagreements on average cone loss rates in retinitis pigmentosa with a new kinetic model: Its relevance for clinical trials. Med Hypotheses 2016; 89:107-14. [PMID: 26968922 DOI: 10.1016/j.mehy.2016.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 02/08/2016] [Accepted: 02/18/2016] [Indexed: 01/06/2023]
Abstract
Since 1985, at least nine studies of the average rate of cone loss in retinitis pigmentosa (RP) populations have yielded conflicting average rate constant values (-k), differing by 90-160%. This is surprising, since, except for the first two investigations, the Harvard or Johns Hopkins' protocols used in these studies were identical with respect to: use of the same exponential decline model, calculation of average -k from individual patient k values, monitoring patients over similarly large time frames, and excluding data exhibiting floor and ceiling effects. A detailed analysis of Harvard's and Hopkins' protocols and data revealed two subtle differences: (i) Hopkins' use of half-life t0.5 (or t(1/e)) for expressing patient cone-loss rates rather than k as used by Harvard; (ii) Harvard obtaining substantially more +k from improving fields due to dormant-cone recovery effects and "small -k" values than Hopkins' ("small -k" is defined as less than -0.040 year(-1)), e.g., 16% +k, 31% small -k, vs. Hopkins' 3% and 6% respectively. Since t0.5=0.693/k, it follows that when k=0, or is very small, t0.5 (or t(1/e)) is respectively infinity or a very large number. This unfortunate mathematical property (which also prevents t0.5 (t(1/e)) histogram construction corresponding to -k to +k) caused Hopkins' to delete all "small -k" and all +k due to "strong leverage". Naturally this contributed to Hopkins' larger average -k. Difference (ii) led us to re-evaluate the Harvard/Hopkins' exponential unchanging -k model. In its place we propose a model of increasing biochemical stresses from dying rods on cones during RP progression: increasing oxidative stresses and trophic factor deficiencies (e.g., RdCVF), and RPE malfunction. Our kinetic analysis showed rod loss to follow exponential kinetics with unchanging -k due to constant genetic stresses, thereby providing a theoretical basis for Clarke et al.'s empirical observation of such kinetics with eleven animal models of RP. In contrast to this, we show that cone loss occurs in patients with increasing -k values during RP progression. And as the Hopkins' protocol selects more advanced RP cases than Harvard's to assure avoidance of ceiling effects (Harvard does this by kinetic monitoring), we show increasing -k kinetics to be the reason Harvard obtains more +k and small -k values. Thus the combined effects of (i) and (ii) produce Harvard's smaller average -k value. The relevance of the increasing biochemical stress model for optimizing clinical trials is discussed.
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Affiliation(s)
- W A Baumgartner
- Ianus Foundation, 1001 Cooper Point Rd SW #140, PMB 171, Olympia, WA 98502, United States.
| | - A M Baumgartner
- Ianus Foundation, 1001 Cooper Point Rd SW #140, PMB 171, Olympia, WA 98502, United States
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Rosser TG, Alberson NR, Baumgartner WA, Mauel MJ, Pote LM, Griffin MJ. Morphological, Histological, and Molecular Description ofUnicauda fimbrethilaen. sp. (Cnidaria: Myxosporea: Myxobolidae) from the Intestinal Tract of Channel CatfishIctalurus punctatus. J Parasitol 2016; 102:105-13. [DOI: 10.1645/15-810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wolf JC, Baumgartner WA, Blazer VS, Camus AC, Engelhardt JA, Fournie JW, Frasca S, Groman DB, Kent ML, Khoo LH, Law JM, Lombardini ED, Ruehl-Fehlert C, Segner HE, Smith SA, Spitsbergen JM, Weber K, Wolfe MJ. Nonlesions, Misdiagnoses, Missed Diagnoses, and Other Interpretive Challenges in Fish Histopathology Studies. Toxicol Pathol 2014; 43:297-325. [DOI: 10.1177/0192623314540229] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Differentiating salient histopathologic changes from normal anatomic features or tissue artifacts can be decidedly challenging, especially for the novice fish pathologist. As a consequence, findings of questionable accuracy may be reported inadvertently, and the potential negative impacts of publishing inaccurate histopathologic interpretations are not always fully appreciated. The objectives of this article are to illustrate a number of specific morphologic findings in commonly examined fish tissues (e.g., gills, liver, kidney, and gonads) that are frequently either misdiagnosed or underdiagnosed, and to address related issues involving the interpretation of histopathologic data. To enhance the utility of this article as a guide, photomicrographs of normal and abnormal specimens are presented. General recommendations for generating and publishing results from histopathology studies are additionally provided. It is hoped that the furnished information will be a useful resource for manuscript generation, by helping authors, reviewers, and readers to critically assess fish histopathologic data.
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Affiliation(s)
- Jeffrey C. Wolf
- Experimental Pathology Laboratories, Inc., Sterling, Virginia, USA
| | - Wes A. Baumgartner
- Department of Pathobiology/Population Medicine, College of Veterinary Medicine, Mississippi, USA
| | | | - Alvin C. Camus
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | | | - John W. Fournie
- U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Gulf Ecology Division, Gulf Breeze, Florida, USA
| | - Salvatore Frasca
- Connecticut Veterinary Medical Diagnostic Laboratory, Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, Connecticut, USA
| | - David B. Groman
- Aquatic Diagnostic Services, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Michael L. Kent
- Departments Microbiology & Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Lester H. Khoo
- Mississippi State University, College of Veterinary Medicine, Stoneville, Mississippi, USA
| | - Jerry M. Law
- Aquatic Ecotoxicology, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Eric D. Lombardini
- Divisions of Comparative Pathology and Veterinary Medical Research Department of Veterinary Medicine, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | | | - Helmut E. Segner
- Centre for Fish and Wildlife Health, University of Bern, Bern, Switzerland
| | - Stephen A. Smith
- Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
| | - Jan M. Spitsbergen
- Fish Disease Research Group, Department of Microbiology, Oregon State University, Corvallis, Oregon, USA
| | | | - Marilyn J. Wolfe
- Experimental Pathology Laboratories, Inc., Sterling, Virginia, USA
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Koenig MA, Grega MA, Bailey MM, Pham LD, Zeger SL, Baumgartner WA, McKhann GM. Statin use and neurologic morbidity after coronary artery bypass grafting: A cohort study. Neurology 2009; 73:2099-106. [PMID: 19907012 DOI: 10.1212/wnl.0b013e3181c677f6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Statin use before surgery has been associated with reduced morbidity and mortality after vascular surgery. The effect of preoperative statin use on stroke and encephalopathy after coronary artery bypass grafting (CABG) is unclear. METHODS A post hoc analysis was undertaken of a prospectively collected cohort of isolated CABG patients over a 10-year period at a single institution. Primary outcomes were stroke and encephalopathy. Univariable analyses identified risk factors for statin use, which were applied to a propensity score model using logistic regression and patients were divided into quintiles of propensity for statin use. Controlling for propensity score quintile, the odds ratio (OR) of combined stroke and encephalopathy (primary endpoint), cardiovascular mortality, myocardial infarction, and length of stay were compared between statin users and nonusers. RESULTS There were 5,121 CABG patients, of whom 2,788 (54%) were taking statin medications preoperatively. Stroke occurred in 166 (3.2%) and encephalopathy in 438 (8.6%), contributing to 604 patients (11.8%) who met the primary endpoint. The unadjusted OR of stroke/encephalopathy in statin users was 1.053 (95% confidence interval [CI] 0.888-1.248, p = 0.582). Adjustment based on propensity score resulted in balance of stroke risk factors among quintiles. The propensity score-adjusted OR of stroke/encephalopathy in statin users was 0.958 (95% CI 0.784-1.170, p = 0.674). There were no significant differences in cardiovascular mortality, myocardial infarction, or length of stay between statin users and otherwise similar nonusers. CONCLUSIONS In this large data cohort study, preoperative statin use was not associated with a decreased incidence of stroke and encephalopathy after coronary artery bypass grafting.
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Affiliation(s)
- M A Koenig
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Baumgartner WA, Hawke JP, Bowles K, Varner PW, Hasson KW. Primary diagnosis and surveillance of white spot syndrome virus in wild and farmed crawfish (Procambarus clarkii, P. zonangulus) in Louisiana, USA. Dis Aquat Organ 2009; 85:15-22. [PMID: 19593929 DOI: 10.3354/dao02051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This is the first report of natural white spot syndrome virus (WSSV) infection in wild and large-scale farmed crawfish. In the spring of 2007, 3 crawfish farms experienced heavy mortality in ponds populated by Procambarus clarkii and P. zonangulus. Histological examination revealed findings consistent with severe viral infection characterized by numerous intranuclear inclusions in ectodermal and mesodermal tissues. Samples tested by in situ hybridization, injection bioassay in Litopenaeus vannamei, and PCR (nested and real time) were all positive for WSSV. Samples were sent to the National Veterinary Services Laboratory in Ames, Iowa, USA, where WSSV was verified. Subsequently, a multi-parish survey of 184 sites in Louisiana (including farm and wild basin samples) using real-time PCR determined that >60% of sites sampled were positive for WSSV, including wild basin samples.
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Affiliation(s)
- W A Baumgartner
- Louisiana State University School of Veterinary Medicine, Department of Pathobiological Sciences, Skip Bertman Drive, LSU, Baton Rouge, Louisiana 70803, USA.
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Abstract
Intraocular choristomas are rare anomalies in domestic animals and are often associated with multiple ocular malformations. A Thoroughbred foal presented for ocular abnormalities and was diagnosed with microphthalmia, corneal dermoids, severe anterior segment dysgenesis (including glandular choristomas), aphakia, retinal dysplasia, and optic nerve hypoplasia. Morphological, histochemical, and immunohistochemical comparisons were made between ocular choristomatous tissues from this foal and lacrimal gland, third eyelid gland, nasopharynx, trachea, and lacrimal sac/nasolacrimal duct from normal horses. Morphologically the choristomatous tissues (glands and epithelium lining the anterior segment) were most similar to the lacrimal sac. Histochemistry of glandular components found the glands associated with the lacrimal sac/nasolacrimal duct to be serous, as was the glandular intraocular choristomas. Our findings suggest that the origin of intraocular glandular choristomas in this case is from the lacrimal sac.
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Affiliation(s)
- Wes A Baumgartner
- Louisiana State University School of Veterinary Medicine, Department of Pathobiological Sciences, Skip Bertman Dr., Baton Rouge, LA 70803, USA.
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Baumgartner WA, Guzman DSM, Hollibush S, Gaschen L, Hodgin EC, Mitchell MA. Bronchogenic adenocarcinoma in a hyacinth macaw (Anodorhynchus hyacinthinus). J Avian Med Surg 2008; 22:218-25. [PMID: 19014095 DOI: 10.1647/2007-052.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An adult female hyacinth macaw (Anodorhynchus hyacinthinus) was presented for sudden onset of severe weakness in the legs. Neurologic examination revealed bilateral paresis of the pelvic limbs and decreased proprioception. Results of radiographs and computed tomography (CT) revealed variably sized soft tissue nodules throughout the lungs and invading into the spine and vertebral canal. Soon after the CT scan, the bird went into cardiorespiratory arrest and died. At necropsy, several yellow, coalescing nodules that were firm with a caseous component were present in the lungs, and a focus of similar tissue was attached to the vertebrae and invaded the spinal canal. On histologic examination, the diagnosis was primary pulmonary bronchial adenocarcinoma with spinal invasion.
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Affiliation(s)
- Wes A Baumgartner
- Department of Pathobiological Sciences, Louisiana State University School of Veterinary Medicine, Skip Bertman Dr, Baton Rouge, LA 70803, USA
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McKhann GM, Grega MA, Borowicz LM, Bailey MM, Barry SJE, Zeger SL, Baumgartner WA, Selnes OA. Is there cognitive decline 1 year after CABG? Comparison with surgical and nonsurgical controls. Neurology 2005; 65:991-9. [PMID: 16107605 DOI: 10.1212/01.wnl.0000175220.78475.99] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is widely assumed that decline in cognition after coronary artery bypass grafting (CABG) is related to use of the cardiopulmonary bypass pump. Because most studies have not included comparable control groups, it remains unclear whether postoperative cognitive changes are specific to cardiopulmonary bypass, general aspects of surgery, or vascular pathologies of the aging brain. METHODS This nonrandomized study included four groups: CABG patients (n = 140); off-pump coronary surgery (n = 72); nonsurgical cardiac controls (NSCC) with diagnosed coronary artery disease but no surgery (n = 99); and heart healthy controls (HHC) with no cardiac risk factors (n = 69). Subjects were evaluated at baseline (preoperatively), 3 months, and 12 months. Eight cognitive domains and a global cognitive score, as well as depressive and subjective symptoms were analyzed. RESULTS At baseline, patients with coronary artery disease (CABG, off-pump, and NSCC) had lower performance than the HHC group in several cognitive domains. By 3 months, all groups had improved. From 3 to 12 months, there were minimal intrasubject changes for all groups. No consistent differences between the CABG and off-pump patients were observed. CONCLUSIONS Compared with heart healthy controls (HHC), the groups with coronary artery disease had lower cognitive test scores at baseline. There was no evidence that the cognitive test performance of coronary artery bypass grafting (CABG) patients differed from that of control groups with coronary artery disease over a 1-year period. This study emphasizes the need for appropriate control groups for interpreting longitudinal changes in cognitive performance after CABG.
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Affiliation(s)
- G M McKhann
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Shake JG, Peck EA, Marban E, Gott VL, Johnston MV, Troncoso JC, Redmond JM, Baumgartner WA. Pharmacologically induced preconditioning with diazoxide: a novel approach to brain protection. Ann Thorac Surg 2001; 72:1849-54. [PMID: 11789759 DOI: 10.1016/s0003-4975(01)03192-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Ischemic preconditioning is an endogenous mechanism whereby brief periods of ischemia render neurons resistant to subsequent lethal insults. This protection appears to alter cellular apoptosis and can be induced by potassium channel openers acting on the inner membrane of the mitochondria (mitoK(ATP)). To test the hypothesis that pharmacologic preconditioning could provide neuroprotection, the mitoK(ATP) opener diazoxide was used in a canine model of brain injury induced by hypothermic circulatory arrest (HCA). METHODS Seventeen dogs were placed on cardiopulmonary bypass (CPB) and cooled to 18 degrees C. After 2 hours of HCA, animals were rewarmed and weaned from CPB. Six dogs received intravenous diazoxide (2.5 mg/kg bolus 15 minutes prior to CPB, then 0.5 mg/min until circulatory arrest, then restarted for the first hour of rewarming). Six animals received vehicle only. Five received diazoxide and the mitoK(ATP) blocker 5-hydroxydecanoate (5-HD). Using a modified Pittsburgh Canine Neurological Scoring System (0 = normal, 500 = brain death), animals were evaluated every 24 hours for 3 days. The brains were removed and histologic sections of four regions characteristically injured in this model were scored (0 = no injury, 4 = infarction) by a neuropathologist in a blinded fashion. RESULTS Clinical scoring showed marked improvement in the diazoxide group at 48 hours (101 +/- 10.5 vs 165 +/- 14.8, p < 0.01) and 72 hours (54 +/- 9.3 vs 137 +/- 12.1, p < 0.01). This neuroprotection was attenuated when 5-HD was concomitantly administered. Three of four brain regions typically injured in this model (cortex, hippocampus, and entorhinal cortex) had significant neuron preservation in the diazoxide group. Likewise, combined region scores were significantly improved in the treatment group (1.18 +/- 0.2 vs 2.46 +/- 0.2, p < 0.01). CONCLUSIONS Pretreatment with diazoxide resulted in significant improvement in both clinical neurologic scores and histopathology in our model of HCA. This suggests that pharmacologic preconditioning with the mitoK(ATP) channel opener diazoxide may offer effective neuroprotection during HCA.
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Affiliation(s)
- J G Shake
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, and Kennedy-Krieger Research Institute, Baltimore, Maryland, USA
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Abstract
BACKGROUND Stroke remains a devastating complication of cardiac surgery, but stroke prevention remains elusive. Evaluation of early and long-term clinical outcomes and brain-imaging findings may provide insight into stroke prognosis, etiology, and prevention. METHODS Five thousand nine hundred seventy-one cardiac surgery patients were prospectively studied for clinical evidence of stroke. Stroke and nonstroke patients were compared by early outcomes. Data collected for stroke patients included brain imaging results, long-term functional status, and survival. Outcome predictors were then determined. RESULTS Stroke was diagnosed in 214 (3.6%) patients. Brain imaging demonstrated acute infarction in 72%; embolic in 83%, and watershed in 24%. Survival for stroke patients was 67% at 1 year and 47% at 5 years. Independent predictors of survival were cerebral infarct type, creatinine elevation, cardiopulmonary bypass time, preoperative intensive care days, postoperative awakening time, and postoperative intensive care days. Long-term disability was moderate to severe in 69%. CONCLUSIONS Stroke after cardiac surgery has profound repercussions that are independently related to infarct type and clinical factors. These data are essential for clinical decision making and prognosis determination.
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Affiliation(s)
- J D Salazar
- Department of Neurology, The Johns Hopkins University, Baltimore, Maryland, USA
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Abstract
BACKGROUND Expansion of traditional donor criteria has become standard in most centers. To determine how this has affected donor profiles, at our institution, we reviewed all adult (age > or = 16) cardiac donors of the past 15 years. METHODS We separated 261 cardiac donors into 2 groups based on time periods: Group I, 1983 to 1991 (n = 131), and Group II, 1991 to 1998 (n = 130). RESULTS The groups differed significantly in mean donor age (26.2 years vs 30.9; p < 0.001), percent older than 40 years (6% vs 27%; p < 0.001), percent female (23% vs 35%; p = 0.04), percent distant procurement (54% vs 22%; p < 0.001), and percent minority donors (14% vs 29%; p < 0.001). We found an increase in non-traumatic deaths (24% vs 40%; p = 0.008). Older donors had significantly more non-traumatic deaths than younger donors (79% vs 13%; p < 0.001). Overall 5-year survival of recipients was 64% and was not significantly different between our early and late experiences (60% vs 68%; p = not significant [NS]). Recipients with hearts from older donors had a 5-year survival similar to recipients with younger donor hearts (61% vs 64%; p = NS). Traumatic and non-traumatic donors had similar 5-year survivals (64% vs 63%, p = NS). A stepwise multivariate analysis of the entire cohort identified donor age, donor weight, recipient United Network for Organ Sharing status, and cardiopulmonary bypass time as significant independent risk factors for recipient survival. Recipients of hearts from donors < 90 kg had significantly better 5-year survivals than recipients from donors > or = 90 kg (66% vs 48%; p = 0.01). CONCLUSIONS Our evolving cardiac donor pool now has more minorities, women, and older donors whose deaths are often non-traumatic. At our institution, donor pool expansion has had no adverse effect on the long-term survival of recipients.
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Affiliation(s)
- M V Brock
- Johns Hopkins Medical Institutions, Divisions of Cardiac and Thoracic Surgery, Baltimore, Maryland 21287, USA.
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Abstract
The objective of this study was to examine cerebral hemodynamics changes during hypothermic circulatory arrest (HCA) with and without retrograde cerebral perfusion (RCP). Thirteen colony-bred hound dogs were placed on cardiopulmonary bypass (CPB) and cooled to 18 degrees C. Five dogs underwent 2 hours of HCA without RCP and 8 with RCP. The animals were then rewarmed on CPB until normothermic and weaned. Cerebral blood flow velocity (CBFV) and Gosling Pulsatility Index (PI) in the middle cerebral artery (MCA) were studied using trans-cranial Doppler ultrasound (TCD). At baseline and during pre- and postarrest CPB, there was anterograde direction of blood flow in the MCA. During HCA with RCP, there was retrograde direction of blood flow in the MCA. There was no difference in CBFV between pre-, during, and postarrest CPB in the group with RCP; however, there was significantly increased CBFV during postarrest CPB in the group without RCP compared to the dogs with RCP. Later, at 3 hours after postarrest CPB, there was decreased CBFV in all animals accompanied by increased PI (2.4 +/- 0.4 and 2.2 +/- 0.6 for animals with RCP and without RCP, respectively) and abnormal TCD waveform changes including decreased diastolic compartment and sharp systolic peak. During hypothermic circulatory arrest, RCP provides CBFV in the MCA comparable to MCA CBFV during CPB. HCA dogs without RCP showed immediate hyperemia on reperfusion. The decreased CBFV and increased PI at 1 hour after postarrest CPB could be an indicator of progressive ischemic injury due to the increased intracranial pressure despite the implementation of RCP.
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Affiliation(s)
- A Y Razumovsky
- Department of Anesthesiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Baumgartner WA, Stuart RS. Building a clinical program in a single institution. J Thorac Cardiovasc Surg 2001; 121:S12-6. [PMID: 11279439 DOI: 10.1067/mtc.2001.114134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A successful clinical program within either a single institution or a multi-institution complex requires the recruitment and retention of excellent faculty, a strong residency program, a successful, recognized research program, and leaders with administrative, organizational, and leadership skills.
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Affiliation(s)
- W A Baumgartner
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Elman I, Krause S, Breiter HC, Gollub RL, Heintges J, Baumgartner WA, Rosen BR, Gastfriend DR. The validity of self-reported drug use in non-treatment seeking individuals with cocaine dependence: correlation with biochemical assays. Am J Addict 2001; 9:216-21. [PMID: 11000917 DOI: 10.1080/10550490050148044] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Accurate estimate of drug exposure plays an important role in studies of the neurobiology of drug dependence. The validity of self-reported drug use by subjects participating in such studies has not been well established. This study examined the relationship between self-reported drug use and biological markers in 18 non-treatment-seeking cocaine-dependent individuals participating in research on the effects of cocaine on the brain. A significant relationship was found between self-reported frequency of cocaine use and hair cocaine concentration. Frequency of alcohol use correlated significantly with plasma carbohydrate-deficient transferrin and aspartate aminotransferase levels. These results suggest that self-reported substance use in non-treatment seeking research subjects is generally valid.
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Affiliation(s)
- I Elman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
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Abstract
The responsibility for those of us involved in residency training programs is to foster the development of future leaders in thoracic surgery. Although the actual training of female surgeons is no different than training male surgeons, academic advancement after training can be more difficult for women due to a variety of reasons. The education and training of female surgeons has its origin in admission to medical school followed by recruitment into a residency program. Following completion of a residency program, the retainment of women and men faculty should be the goal of departments and divisions of thoracic surgery. Specific recommendations are made for retainment of faculty. In addition to academic promotion and financial reward, creating the proper environment is an important consideration to allow women the chance to succeed in medicine. This report addresses the training aspects involved in the thoracic residency program and the state of professional academic advancement at the Johns Hopkins University School of Medicine.
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Zehr KJ, Wong CY, Chin B, Ravert HT, Dannals RF, Hruban RH, Wong DF, Baumgartner WA. Comparison of myocardial oxygen consumption using 11C acetate positron emission tomography scanning in a working and non-working heart transplant model. Eur J Cardiothorac Surg 2001; 19:74-81. [PMID: 11163564 DOI: 10.1016/s1010-7940(00)00611-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE In acute cardiac rejection, changes in myocardial oxygen consumption occur; non-invasive detection of these metabolic changes would have obvious clinical utility. In the classic cervical, heterotopic, canine, transplant model, the heart is non-working. It has a low myocardial oxygen consumption. Creation of a working model with normal myocardial oxygen consumption would enhance validity of non-human studies. METHODS Clearance of 11C acetate was determined by positron emission tomography (PET) scanning and compared with myocardial oxygen consumption in normal and transplanted canine hearts. Donor hearts from mongrel dogs (2.5-3 kg; n=4) were transplanted into the neck of adult beagles (12-15 kg; n=4), no immunosuppression was given. Two non-working hearts were modified to eject only coronary flow via the right ventricle. In two hearts, a novel working model was created with aortic regurgitation to load the left ventricle. Working and non-working hearts underwent PET scanning on post-operative days 2 and 4. Normal dog hearts (n=2) and native hearts of transplanted dogs (n=3) were used to validate the scanning technique. Coronary sinus and aortic oxygen saturation data along with myocardial blood flow (radiolabeled microspheres) confirmed that clearance of 11C acetate in normal and transplanted hearts followed a bi-exponential model. RESULTS Myocardial oxygen consumption was correlated with the rate constant of 11C acetate rapid phase clearance (r=0.91) in normal and transplanted hearts. The working hearts had increased myocardial oxygen consumption compared to non-working hearts. CONCLUSIONS This study (1) introduces a model of a working heterotopic cardiac transplantation with near-normal oxygen consumption; and (2) demonstrates that regional myocardial oxygen consumption in transplanted hearts can be detected by 11C acetate PET.
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Affiliation(s)
- K J Zehr
- Department of Cardiac Surgery, Johns Hopkins Medical Institution, MD 21287, Baltimore, USA.
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Jaryszak EM, Baumgartner WA, Peterson AJ, Presson RG, Glenny RW, Wagner WW. Selected contribution: measuring the response time of pulmonary capillary recruitment to sudden flow changes. J Appl Physiol (1985) 2000; 89:1233-8. [PMID: 10956374 DOI: 10.1152/jappl.2000.89.3.1233] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To determine how rapidly pulmonary capillaries recruit after sudden changes in blood flow, we used an isolated canine lung lobe perfused by two pumps running in parallel. When one pump was turned off, flow was rapidly halved; when it was turned on again, flow immediately doubled. We recorded pulmonary capillary recruitment in subpleural alveoli using videomicroscopy to measure how rapidly the capillaries reached a new steady state after these step changes in blood flow. When flow was doubled, capillary recruitment reached steady state in <4 s. When flow was halved, steady state was reached in approximately 8 s. We conclude that the pulmonary microcirculation responds rapidly to step changes in flow, even in the capillaries that are most distant from the hilum.
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Affiliation(s)
- E M Jaryszak
- Department of Physiology/Biophysics, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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Abstract
The paper provides an interdisciplinary evaluation of the etiology, pathogenesis, and experimental treatments of retinitis pigmentosa (RP). It addresses a 10-year controversy concerning the rate of progression of RP. One laboratory has estimated remaining visual field to be lost at a rate of 4.6% per year, whereas another laboratory estimates loss at 16-18%. This large discrepancy and lack of consensus needs resolution, since they pose serious statistical and operational problems for evaluating experimental treatment approaches to RP. The resolution of the controversy offered in the paper is based on a model of RP in which the initial rate of loss of visual field (the induction phase) is much slower than the subsequent logarithmic first-order rate of loss. The rationale for this kinetic model is that loss of mitochondrial function, possibly due to RP-genetically-related radical processes, has to reach a critical threshold value before the mitochondrial trigger of programmed cell death or apoptosis (i.e., the release of mitochondrial cytochrome c by the opening of the permeability transition pore, PTP) can be activated by an encounter with a second, but kinetically constant causative stress factor - most likely a light-stress-related factor. In its essential (two-causal) aspects, this kinetic model for RP is identical to the kinetic theories that have been proposed for the Gombertz human mortality plot. The described kinetic model for RP provides a solution to the visual field-loss controversy, since the first study was performed with a population containing a greater number of patients in the slow stage of RP than the second. Another objective of the investigation was to identify possible mechanisms of how the numerous genetic mutations in the rods of RP patients could give rise to damaging free-radical reactions capable of triggering apoptosis through their adverse effects on mitochondrial function. Another reason for focusing on radical reactions in RP was to provide a rationale for the proposed use of an extensive array of antioxidants and nutritional supplements for stemming progression of RP. In particular, the investigation focuses on saving cone-dependent central vision, i.e. on saving cells not affected by the genetic problems of the rods, but cells which can become lethally damaged by a spill-over of radicals and related harmful chemical reactions occurring in the rods.The third objective deals with the development of a rationale for a new strategy for retarding RP. This involves the use of desmethyldeprenyl, a metabolite of the anti-Parkinson's drug, deprenyl. The rationale is, in part, based on an observation that desmethyldeprenyl exerts antiapoptotic activities in a variety of neurodegenerative disorders. The protective mechanism involves the overexpression of the anti-apoptotic bcl-2 gene, leading to higher concentrations of bcl-2 proteins, which by binding to mitochondria inhibits the trigger mechanism of apoptosis - the opening of PTP and release of cytochrome C. At the same time, desmethyldeprenyl causes the underexpression of the pro-apoptotic bax gene, which via bax proteins facilitates the opening of the PTP. Both the anti-apoptotic and pro-apoptotic mechanisms appear to be mediated by the binding of desmethyldeprenyl to glyceraldehyde-3-phosphate dehydrogenase. Antiapoptotic effects can also be generated by the parent compound, deprenyl, when this is used daily in low concentrations of 1-2 mg/100 kg body weight. Under these conditions, it appears that the anti-apoptotic metabolite, desmethyldeprenyl, predominates over the pro-apoptotic metabolites of deprenyl, l -methamphetamine and l -amphetamine. Methamphetamine is not formed if desmethyldeprenyl is administered directly and thus could give desmethyldeprenyl a pharmacokinetic advantage over deprenyl. (ABSTRACT TRUNCATED)
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Abstract
Teaching surgery can be a very gratifying experience for those of us involved in academic thoracic surgery. Fundamentals of a good residency program require that patients should always be placed in the highest priority. However, the residency program should also be committed to teaching as a priority. Creating the proper operating room environment is essential for optimal conduct of the operation. This environment is similar to that of the airline industry, which is known as crew or cockpit resource management. The design of a teaching program needs to have evaluation as one of its key elements. In addition to resident evaluation, it is also important to have faculty evaluation by the residents. The goal of any residency program should be to foster the development of the future leaders in our specialty. The information contained within this article represents the art and science of teaching thoracic surgery as applied by the faculty in the Division of Cardiac Surgery at The Johns Hopkins Hospital.
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Abstract
BACKGROUND The proportion of patients in their ninth decade of life undergoing complex cardiovascular procedures has increased over the past decade. The purpose of this study is to quantify the potential for stroke and mortality associated with deep hypothermic circulatory arrest (DHCA) in this age group. METHODS At our institution, 251 adult patients had cardiovascular procedures that required DHCA since 1989. This included 20 patients 80 years of age or older (group I) and 231 patients less than 80 years (group II). Additionally, we analyzed 632 patients 80 years of age or older who underwent a variety of cardiovascular procedures since 1989 that required cardiopulmonary bypass but not DHCA (group III). Neurologic outcomes have been maintained in our database prospectively since 1991. RESULTS The 30-day mortality in group I was 5%, in group II 15.2%, and in group III 8.2%. The stroke rate was 20% in group I, 8.8% in group II, and 6.5% in group III. CONCLUSIONS DHCA can be performed with acceptable early mortality in patients in their ninth decade of life, but they are at an increased risk of stroke. Follow-up shows satisfactory late survival.
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Affiliation(s)
- J R Liddicoat
- Division of Cardiac Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Abstract
Heart and lung transplantation have become standard therapy for many patients with end-stage heart and lung disease. Successful transplantation requires preservation of allografts until they can be implanted and reperfused. In the decades since the transplantation of thoracic organs became a clinical reality, many advances have been made in preoperative donor management, procurement, and preservation techniques. This article summarizes the state of the art in heart and lung preservation and review some of the areas of current research that may lead to improvements in preservation techniques in the future.
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Affiliation(s)
- J V Conte
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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Affiliation(s)
- W A Baumgartner
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21287-4618, USA.
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Achuff SC, Baumgartner WA. Aortic-valve sclerosis. N Engl J Med 1999; 341:1856-7. [PMID: 10610470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Abstract
BACKGROUND S-100B is a protein mainly found in astroglial cells and only detected to a low level in blood. Serum levels of S-100B increase in patients with acute brain injuries. The aim of this study was to establish feasibility of a new Optical ImmunoAssay ([OIA], Bio-Star, Inc, Boulder, CO) test for determination of S-100B in blood. METHODS We have developed a new, rapid, and sensitive OIA test to identify elevated levels of S-100B in whole blood. The OIA test for S-100B combines monoclonal antibodies specific for the B-subunit of S-100 with OIA thin film technology. Each sample was tested for S-100B by the OIA method and a commercially available immunoluminometric assay. Blood samples were drawn serially from 9 patients undergoing coronary artery bypass graft surgery and during the early postoperative period. RESULTS The OIA test determination of S-100B protein correlated with immunoluminometric assay data (r = 0.8) with a detection limit of 0.25 ng/mL. CONCLUSIONS The sensitivity and feasibility of this rapid assay may be suitable for rapid evaluation of S-100B in urgent care settings (surgery, intensive care units, or emergency room).
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Affiliation(s)
- A Ettinger
- BioStar, Inc, Boulder, Colorado 80301, USA.
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Elman I, Breiter HC, Gollub RL, Krause S, Kantor HL, Baumgartner WA, Gastfriend DR, Rosen BR. Depressive symptomatology and cocaine-induced pituitary-adrenal axis activation in individuals with cocaine dependence. Drug Alcohol Depend 1999; 56:39-45. [PMID: 10462091 DOI: 10.1016/s0376-8716(99)00009-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The hypothalamic-pituitary-adrenal (HPA) axis plays a role in cocaine dependence and major depressive disorder. The authors examined the correlation between baseline depressive symptomatology and pituitary-adrenal axis activation induced by acute cocaine challenge. Twelve patients with cocaine dependence were administered an iv bolus of cocaine (0.6 mg/kg) and their plasma was assayed for levels of adrenocorticotropic hormone (ACTH) and cortisol. Depressive symptomatology was assessed with total Hamilton rating scale for depression (HRSD) scores and its vegetative and cognitive superfactors. Cocaine produced a mean increase from baseline of 261% for ACTH and 73% for cortisol plasma levels. Changes in ACTH (r=0.69) and cortisol (r=0.59) were positively and significantly correlated with total HRSD scores and its vegetative, but not cognitive, factor symptom cluster. These results suggest that the HPA axis may be involved in affective disturbances associated with the use of cocaine. Implications of these data for the pathophysiology of cocaine dependence are discussed.
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Affiliation(s)
- I Elman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Abstract
Apoptosis or programmed cell death is a feature of normal brain development and a response to brain injury. Cells undergoing apoptosis have a characteristic morphology that normally can only be appreciated at high magnification. Using dark-field transmitted light microscopy to examine Nissl-stained material, we detected groups of apoptotic cells at much lower magnifications than often were required in the two injury models we tested. This method was useful for screening entire brain sections to assess regional and global patterns of injury. We predict that this technique in which we detect the clumped chromatin associated with apoptosis can be applied to other types of tissue.
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Affiliation(s)
- M S Lange
- Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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Abstract
BACKGROUND Doctor Antoine Marfan described the first case of Marfan syndrome in 1896. It was over 50 years later that the development of aortic aneurysms and subsequent rupture was appreciated as the most life-threatening component of the syndrome. METHODS Doctor Vincent Gott, at our institution, performed the first Bentall procedure for an aneurysm of the ascending aorta in 1976. Since that time, the aortic root has been replaced in 231 Marfan patients. Of this group, 218 patients had a composite graft repair, 11 had an aortic root replacement with a homograft, and 2 patients had valve sparing procedures. There were 168 males and 63 females. Of the total 231 patients, 150 were operated on by Dr Gott. The remaining 81 patients were operated on by 10 other Hopkins surgeons. The average diameter of the ascending aorta was 6.8 cm, with a range from 4.5 to 10. The average aortic diameter of 43 patients who had an ascending aortic dissection was 7.3 cm. Fourteen of these patients had dissection with an aortic diameter of 6.5 cm or less. RESULTS Among the 198 patients who underwent elective repair, there was no 30-day mortality. Thirty-three patients underwent urgent repair with 2 deaths, yielding a 30-day mortality of 6.1%. The mortality for the entire group of patients was 0.9%. Complications associated with this series of patients included 8 with endocarditis, 7 with thromboembolism, and 4 late coronary dehiscences. Actuarial survival was 88% at 5 years, 81% at 10 years, and 75% at 20 years. Multivariate analysis revealed New York Heart Association classification, male gender and urgent surgery as independent risk factors for mortality. CONCLUSION Marfan patients with aortic aneurysms can undergo elective surgery with a low operative risk and excellent long-term survival with low morbidity. We feel that elective resection of an aneurysm in a Marfan patient should occur when it approaches a diameter of 5.5 cm. It is essential that a timely diagnosis be made in this group of young patients.
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Affiliation(s)
- W A Baumgartner
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland 21287-4618, USA.
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Baumgartner WA, Walinsky PL, Salazar JD, Tseng EE, Brock MV, Doty JR, Redmond JM, Blue ME, Goldsborough MA, Troncoso JC, Johnston MV. Assessing the impact of cerebral injury after cardiac surgery: will determining the mechanism reduce this injury? Ann Thorac Surg 1999; 67:1871-3; discussion 1891-4. [PMID: 10391329 DOI: 10.1016/s0003-4975(99)00445-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Central nervous system dysfunction continues to produce significant morbidity and associated mortality in patients undergoing cardiac surgery. Using a closed-chest canine cardiopulmonary bypass model, dogs underwent 2 h of hypothermic circulatory arrest (HCA) at 18 degrees C, followed by resuscitation and recovery for 3 days. Animals were assessed functionally by a species-specific behavioral scale, histologically for patterns of selective neuronal necrosis, biochemically by analysis of microdialysis effluent, and by receptor autoradiography for N-methyl-D-aspartate (NMDA) glutamate receptor subtype expression. RESULTS Using a selective NMDA (glutamate) receptor antagonist (MK801) and an AMPA antagonist (NBQX), glutamate excitotoxicity in the development of HCA-induced brain injury was documented and validated. A microdialysis technique was employed to evaluate the role of nitric oxide (NO) in neuronal cell death. Arginine plus oxygen is converted to NO plus citrulline (CIT) by the action of NO synthase (nNOS). CIT recovery in the cerebrospinal fluid and from canine cortical homogenates increased during HCA and reperfusion. These studies demonstrated that neurotoxicity after HCA involves a significant and early induction of nNOS expression, and neuronal processes leading to widespread augmentation of NO production in the brain. To further investigate the production of excitatory amino acids in the brain, we hypothesized the following scenario: HCA--> increased glutamate, increased aspartate, increased glycine--> increased intracellular Ca2+--> increased NO + CIT. Using the same animal preparation, we demonstrated that HCA caused increased intracerebral glutamate and aspartate that persists up to 20 h post-HCA. HCA also resulted in CIT (NO) production, causing a continued and delayed neurologic injury. Confirmatory evidence of the role of NO was demonstrated by a further experiment using a specific nNOS inhibitor, 7-nitroindazole. Animals underwent 2 h of HCA, and then were evaluated both physiologically and for NO production. 7-Nitroindazole reduced CIT (NO) production by 58.4 +/- 28.3%. In addition, dogs treated with this drug had superior neurologic function compared with untreated HCA controls. CONCLUSIONS These experiments have documented the role of glutamate excitotoxicity in neurologic injury and have implicated NO as a significant neurotoxin causing necrosis and apoptosis. Continued research into the pathophysiologic mechanisms involved in cerebral injury will eventually yield a safe and reliable neuroprotectant strategy. Specific interventional agents will include glutamate receptor antagonists and specific neuronal NO synthase inhibitors.
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Affiliation(s)
- W A Baumgartner
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21287-4618, USA.
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Tseng EE, Brock MV, Kwon CC, Annanata M, Lange MS, Troncoso JC, Johnston MV, Baumgartner WA. Increased intracerebral excitatory amino acids and nitric oxide after hypothermic circulatory arrest. Ann Thorac Surg 1999; 67:371-6. [PMID: 10197655 DOI: 10.1016/s0003-4975(99)00033-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Prolonged hypothermic circulatory arrest (HCA) results in neurologic injury, but the mechanism of this injury is unknown. This study was undertaken to measure quantitatively intracerebral excitatory amino acids and citrulline, an equal coproduct of nitric oxide, during HCA. We hypothesized that HCA resulted in higher levels of glutamate, aspartate, glycine, causing increased intracellular calcium, and therefore, nitric oxide and citrulline. METHODS Ten dogs underwent intracerebral microdialysis and 2 hours of HCA at 18 degrees C. Effluent was analyzed by high performance liquid chromatography with electrochemical detection. Five dogs each were sacrificed at 8 and 20 hours after HCA. Neuronal apoptosis was scored from 0 (no injury) to 100 (severe injury). RESULTS Time course of HCA was divided into six periods. Peak levels of amino acids in each period were compared with those at baseline. Glutamate, coagonist glycine, and citrulline, an equal coproduct of nitric oxide, increased significantly over baseline during HCA, cardiopulmonary bypass, and 2 to 8 hours after HCA. Aspartate increased significantly during HCA and 8 to 20 hours after HCA. Apoptosis score was 65.56 +/- 5.67 at 8 hours and 30.63 +/- 14.96 at 20 hours after HCA. CONCLUSIONS Our results provide direct evidence that HCA causes increased intracerebral glutamate and aspartate, along with coagonist glycine. We conclude that HCA causes glutamate excitotoxicity with subsequent nitric oxide production resulting in neurologic injury, which begins during arrest and continues until 20 hours after hypothermic circulation arrest. To provide effective cerebral protection, pharmacologic strategies to reduce glutamate excitotoxicity require intervention beyond the initial ischemic insult.
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Affiliation(s)
- E E Tseng
- Division of Cardiac Surgery, Johns Hopkins Medical Institutions and Kennedy-Krieger Research Institute, Baltimore, Maryland, USA
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Tseng EE, Brock MV, Lange MS, Troncoso JC, Lowenstein CJ, Blue ME, Johnston MV, Baumgartner WA. Nitric oxide mediates neurologic injury after hypothermic circulatory arrest. Ann Thorac Surg 1999; 67:65-71. [PMID: 10086526 DOI: 10.1016/s0003-4975(98)01363-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Prolonged hypothermic circulatory arrest (HCA) causes neurologic injury. However, the mechanism of this injury is unknown. We hypothesized that HCA causes nitric oxide production to result in neuronal necrosis. This study was undertaken to determine whether the neuronal nitric oxide synthase inhibitor 17477AR reduces necrosis after HCA. METHODS Thirty-two dogs underwent 2 hours of HCA at 18 degrees C. Nitric oxide synthase catalytic assay and intracerebral microdialysis for nitric oxide production were performed in acute nonsurvival experiments (n = 16). Sixteen animals survived for 72 hours after HCA: Group 1 (n = 9) was treated with 17477AR (Astra Arcus), and group 2 (n = 7) received vehicle only. Animals were scored from 0 (normal) to 500 (coma) for neurologic function and from 0 (normal) to 100 (severe) for neuronal necrosis. RESULTS Administration of 17477AR reduced nitric oxide production in the striatum by 94% (HCA alone), 3.65+/-2.42 micromol/L; HCA and 17477AR, 0.20+/-0.14 micromol/L citrulline). Dogs treated with 17477AR after HCA had superior neurologic function (62.22+/-29.82 for group 1 versus 141.86+/-61.53 for group 2, p = 0.019) and significantly reduced neuronal necrosis (9.33+/-4.67 for group 1 versus 38.14+/-2.23 for group 2, p<0.00001) compared with untreated HCA dogs. CONCLUSIONS Our results provide evidence that neuronal nitric oxide synthase mediates neuronal necrosis after HCA and plays a significant role in HCA-induced neurotoxicity. Pharmacologic strategies to inhibit neuronal nitric oxide synthase after the ischemic period of HCA may be clinically beneficial.
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Affiliation(s)
- E E Tseng
- Division of Cardiac Surgery, Johns Hopkins Medical Institutions and Kennedy-Krieger Research Institute, Baltimore, Maryland, USA
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Abstract
Successful strategies for avoiding obesity and hypercholesterolemia are difficult to validate because of imprecise problem identification. The purpose of this study was to describe the incidence, severity, and onset of obesity and hypercholesterolemia among heart transplant recipients and identify relationships between demographic variables and weight or cholesterol levels during the first year following transplantation. Data were collected from retrospective chart review. Forty-two patients were randomly selected from 224 patients who were undergoing heart transplantation at the Johns Hopkins Hospital between July 1983 and December 1995. Significant differences were found in weight and cholesterol level during the first 12 months. Patients with ideal body weight less than 110%, compared with greater than 110%, survived longer. Relationships were identified between prednisone dose and weight, cumulative prednisone dose and weight, and weight change and change in total cholesterol level 1 year following transplantation. Multivariate analysis showed cumulative prednisone as an independent predictor of weight. Obesity and hypercholesterolemia were significant problems within 3 months of transplantation. Although prednisone dosage should be adjusted to the lowest possible dose, dietary and lifestyle changes remain the foundation of effective management of these posttransplant complications.
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Affiliation(s)
- S M Augustine
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Md. 21286, USA
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Doty JR, Walinsky PL, Salazar JD, Alejo DE, Greene PS, Baumgartner WA. Conservative management of late rejection after heart transplantation: a 10-year analysis. Ann Surg 1998; 228:395-401. [PMID: 9742922 PMCID: PMC1191499 DOI: 10.1097/00000658-199809000-00012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Immunosuppressive regimens for rejection after heart transplantation have been modified to reduce infectious complications without diminishing rejection treatment efficacy. A review of a single institutional series was performed to evaluate the influence of conservative management of grade 2 rejection on long-term outcomes after heart transplantation. METHODS Before 1990, patients with late (>3 months after transplant) grade 2 rejection were treated with supplemental immunosuppressive drugs. Beginning in 1990, patients with late grade 2 rejection were treated conservatively by maintaining the current immunosuppressive regimen without additional therapy. The groups were compared for survival, incidence of subsequent rejection, and incidence of subsequent infection. RESULTS One hundred twelve patients had one or more episodes of isolated, late grade 2 rejection; 39 (35%) were treated with supplemental immunosuppression (treated group) and 73 (65%) received no additional therapy (nontreated group). The mean time from transplantation to the first episode of isolated grade 2 rejection was 15.6 months in the treated group and 17.8 months in the nontreated group. Graft survival at 5 and 10 years was 69% and 51 %, respectively, in the treated group and 67% and 41 %, respectively, in the nontreated group (p = 0.77). The rates for overall subsequent rejection were 0.031 episodes/patient-month in the treated group and 0.029 episodes/patient-month in the nontreated group (p = 0.64). The rates for early rejection within 6 months of initial grade 2 rejection were 0.044 episodes/patient-month in the treated group and 0.035 episodes/patient-month in the nontreated group (p = 0.56). The rates for overall subsequent infection were 0.018 episodes/patient-month in the treated group and 0.012 episodes/patient-month in the nontreated group (p = 0.05). The rates for early infection within 6 months of initial grade 2 rejection were 0.070 episodes/patient-month in the treated group and 0.032 episodes/patient-month in the nontreated group (p = 0.04). Group comparisons demonstrated a significantly lower incidence of infection in the nontreated group. CONCLUSIONS Conservative management of late grade 2 rejection neither adversely affects survival nor increases the incidence of subsequent short-term or long-term rejection. This approach lowers the early and late incidence of infection after rejection and may reduce other complications from aggressive supplemental immunosuppression.
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Affiliation(s)
- J R Doty
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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