The first lung retransplantation with “ECMO bridge” in the Czech Republic - case report.

During the last 23 years of the National Lung Transplant Program in the Czech Republic, more than 500 lung transplantations, 4 retransplantations and one lobar retransplantation have been performed. We present the case report of a female patient with cystic fibrosis who underwent her first bilateral lung transplantation in January 2020. Due to a chronic lung allograft dysfunction, the patient required ECMO support and retransplantation. For the first time in the Czech Republic, a lung retransplantation with “ECMO bridge to (re)transplantation” preoperative support was performed in April 2021. The patient was discharged 39 days after retransplantation in a stable condition. At the day 90 follow-up visit, the patient was in a generally good condition with satisfying spirometric functions.

Malignancy after lung transplantation.

INTRODUCTION: Lung transplantation has become a successful life-saving treatment for patients with end-stage pulmonary disorders. Long-term survival outcomes after lung transplantation have been improving with increasing experience. Malignancies occupy the third position among the causes of death, particularly between years 5 to 10 from lung transplantation. The risk factors include predominantly high doses of immunosuppressive therapy, older age, infections caused by oncogenic viruses and smoking history. METHODS: We retrospectively evaluated all patients undergoing lung transplantation between 2010 and 2019. The aim of this study was to analyze the incidence, type and location of tumors, time from detection, survival time and cause of death in patients with malignant tumors after lung transplantation. RESULTS: In total, 308 lung transplantations were performed at the 3rd Department of Surgery of the 1st Faculty of Medicine, Charles University and University Faculty Hospital in Motol between 2010 and 2019. Posttransplant malignancy was diagnosed in 32 patients; a tumor was detected in the explanted lung in 5 patients. Lung cancer was the most frequent tumor in our study and was found in 13 patients (37%); 6 patients (17%) had a nonmelanoma skin cancer; and posttransplant proliferative disease developed in 4 patients (12.5%). The incidence rate of other types of malignancy was low. Mean of survival after diagnosis was 152 days. CONCLUSION: Life time administration of immunosuppressive therapy in lung transplanted patients plays a key role in the prevention of rejection but on the other hand it represents a risk factor for cancer development. Oncological management of posttransplant cancer is based on reduction of immunosuppressive therapy, combined with surgical resection of solid organ tumors and other types of cancer therapy. Oncology screening tests should be done regularly as a method of prevention, and for an early detection of any tumor.

Impacts of dietary fat level and saturation when feeding distillers grains to high producing dairy cows.

This experiment was conducted to determine whether increasing the net energy (NEL ) of a total mixed ration (TMR) with mainly unsaturated fat from corn distillers dried grains with solubles (DDGS) vs. rumen inert (RI)-saturated fat has similar impacts on animal performance. The experiment was an incomplete Youden square with three treatments and four 28-days periods, completed on a large commercial dairy using three early lactation pens each with approximately 380 multiparity cows. The TMR for all treatments was the same, except for 150 g/kg dry matter (DM) of each TMR which contained 90 g/kg high-protein DDGS (HPDDGS) and 60 g/kg beet pulp (i.e. low-fat control diet; LFC); 150 g/kg DDGS (i.e. high-fat diet with unsaturated fat; HFU); or 111 g/kg HPDDGS, 20 g/kg beet pulp and 19 g/kg RI fat (i.e. high-fat diet with saturated fat; HFS). The DM intake was highest (p < 0.05) for HFU-fed cows. Milk, fat and true protein yields, as well as milk energy output, were higher (p < 0.01) when cows were fed HFS vs. HFU and LFC diets. Milk true protein concentration was lowest (p < 0.01) for HFS-fed cows, but milk fat % was lowest (p < 0.01) for HFU and highest (p < 0.01) for HFS-fed cows. There were numerous differences (p < 0.01) in milk fatty acid levels amongst diets. The increase in body condition score was lowest (p < 0.01) for LFC. Whole tract digestibility of acid detergent fibre was lower (p < 0.01) for LFC vs. HFS cows, and fat digestion was lowest (p < 0.01) for LFC-fed cows. This DDGS, high in unsaturated fatty acids, was fed at high levels (i.e. 152 g/kg DM) with little impact on animal performance vs. a lower fat control diet, although addition of an RI-saturated fat to create a diet with a similarly higher fat level resulted in higher animal productivity.

[Pathophysiology of metabolic acidosis in patients with reduced glomerular filtration rate according to Stewart-Fencl theory]. / Patofyziologie vzniku metabolické acidózy u pacientu se snízenou glomerulární filtrací z hlediska Stewartovy-Fenclovy teorie.

AIM: Metabolic acidosis is a regular sign of renal insufficiency. Conventional assessment of acid-base balance using Henderson-Hasselbalch equation does not make identification of the cause of metabolic disorders possible as the serum HCO3- concentration might only reflect changes to the overall plasma ion spectrum. Therefore, we used the Stewart-Fencl approach that is based on a more detailed physical and chemical analysis and that showed that changes to serum HCO3- concentration are closely related to parameters not usually monitored in connection to acid-base balance. PATIENT GROUP AND METHODOLOGY: We performed a single measurement of arterial or capillary blood pH and pCO2 in 69 non-dialysed patients with glomerular filtration rate ranging from 0.04 to 0.88 ml/s/1.73 m2 according to MDRD, standard calculation of serum HCO3- concentration using Henderson-Hasselbalch equation was carried out, and serum albumin and ion concentrations (Na+, K+, Cl, Pi) plus creatinine and urea concentrations were determined from venous blood. RESULTS: Metabolic acidosis was present in 47 patients ([S-HCO3-] < 22 mmol/l) with the mean [S-HCO3-] value of 19.6 mmol/l for the entire group. We proved a statistically significant correlation between [S-HCO3-] and [SID] (p < 0.001), and between [S-HCO3-] and the individual [SID] determining factors: [Na+-Cl-], [UA- ], [Pi-], [K+] (p < 0.01). CONCLUSION: Reduction in [S-HCO3-] in non-dialysed patients with reduced glomerular filtration is predominantly associated with a decrease in [Na+-Cl-] difference, the quantitative contribution of which to metabolic acidosis is more significant than the strong acids retention. In addition to [S-Cl-] increase, [S-Na+] reduction too has a major role in reducing the [Na+-Cl-] difference.

Change in soluble phosphorus in soils following fertilization is dependent on initial Mehlich-3 phosphorus.

There is a lack of information on how fertilization and initial Mehlich-3 phosphorus (M3P) interact to affect water soluble P (WSP) in soils. Our objectives were to (i) quantify the relationship between WSP and M3P for four textural diverse benchmark soils of North Carolina (NC) and (ii) quantify the change in WSP concentrations following P additions to soils over a wide range of initial M3P. Soils known to represent a wide range in M3P were collected from an Autryville loamy sand (loamy, siliceous, subactive, thermic Arenic Paleudults), Wasda muck (fine-loamy, mixed, semiactive, acid, thermic Histic Humaquepts), Georgeville silt loam (fine, kaolinitic, thermic Typic Kanhapludults), and Pacolet sandy clay loam (fine, kaolinitic, thermic Typic Kanhapludults) and analyzed for M3P, Fe, Al, and WSP. An incubation study was also conducted where four samples representing a range in M3P from each series were fertilized at rates of 150 and 300 kg P ha(-1), and WSP was measured at 1, 7, and 21 d after fertilization. The Wasda muck exhibited a change point at 115 mg P kg(-1) across a broad range of M3P concentrations (60-238 mg kg(-1)) while Autryville, Georgeville, and Pacolet series (with ranges in M3P of 32-328, 119-524, 0-1034 mg P kg(-1), respectively) maintained linear relationships between WSP and M3P. For the fertilized soils, significant increases in WSP occurred regardless of P rate. Yet, WSP concentrations were greater in soils with greater initial M3P. Thus, these data suggest that shifting animal waste applications to fields of relatively lower M3P concentrations would have an immediate impact on reducing risk for P losses, if all other factors are equal.

Technical basis for quantifying phosphorus transport to surface and groundwaters.

Decreasing the potential delivery of phosphorus in fertilizers or animal waste to surface and groundwater requires a knowledge of phosphorus's fate and transport mechanisms. The USDA Natural Resources Conservation Service has recently mandated each state to develop an assessment tool to estimate P transport to water bodies. The objective of this paper is to describe the processes involved with P transport to surface and groundwaters that must be accounted for in practical methods used to quantify the potential for P loss. Mechanistic models to assess P loss should account for: 1) P adsorbed to eroding sediments, 2) soluble P in runoff water, 3) soluble P in leaching water, and 4) P losses related to specific P sources. With sediment-bound P, the adsorbed P content in the eroded soil mass at the field edge must be quantified, whereas runoff volume and P concentration are needed to estimate soluble P loss in runoff water. Estimating P leaching potential requires calculation of drainage water volume and P concentration. When P is applied in animal waste, the specific source influences both soluble and particulate P loss because of differences in P solubility between waste types. In addition, the effects of conservation practices and other technologies on decreasing sediment, soluble, and leached P need to be included. Using these methods, a practical, quantitative P loss assessment tool can be developed that will enable technical service providers and other practitioners to estimate potential P loss and design best-management practices for land-applied waste management systems in order to minimize P transport to surface and groundwater.