Dependence of murine obstructive airway disease on CD40 ligand.

BACKGROUND: Human lung transplantation carries a poor prognosis because of chronic rejection in the form of obliterative bronchiolitis syndrome (OBS). Using the mouse model of heterotopic tracheal transplantation, we examined the role of costimulation in the allograft rejection that characterizes obstructive airway disease (OAD). METHODS: C57BL/6 or BALB/c tracheae were implanted into wild-type control, CD28-/-, muMT (B-cell deficient), or CD40L-/- recipient mice. Grafts were explanted from 7 to 42 days posttransplantation and evaluated. RESULTS: Thickening of the basement membrane and a decrease in patent luminal area were first noted at 2 weeks in wild-type allogeneic trachea recipients and to a slightly lesser degree in CD28-/- recipients. In contrast, CD40L-/- recipient mice showed no evidence of cellular infiltrates or fibrosis in transplanted tracheae. To determine whether CD40L interacted with host or donor CD40, CD40-deficient tracheae were transplanted into CD40L+/+, CD40+/+ wild-type mice. Wild-type mice rejected CD40-/- tracheae. Tracheae were transplanted into B-cell-deficient mice to determine the role of B-cell CD40 in chronic pulmonary allograft rejection. The OAD reaction was identical in wild-type and B-cell-deficient mice. CONCLUSIONS: Development of OAD in the mouse trachea transplant model is primarily dependent on CD40L and is relatively CD28 independent. The ability of mice to reject CD40-/- tracheae demonstrated that host, not donor, CD40 is required for rejection. Furthermore, the ability of B-cell-deficient mice to reject allogeneic tracheae demonstrated that B-cell CD40-mediated responses are not required for the development of OAD.

An overview of intermittent inotropic therapy for severe congestive heart failure.

Congestive heart failure (CHF) is a major problem in the field of medicine in the U.S. Over 4 million people in the U.S. have CHF with 400,000 new cases per year. This diagnosis creates 6 million hospital days with a Medicare cost of billions of dollars. There are limited options for patients >65 years of age who have resistant heart failure on maximum medical therapy. There is considerable debate surrounding intermittent inotropic therapy. This paper is a review of the literature regarding this form of therapy; 20 studies are described. All but one of these studies disclose beneficial effects. The major criticism of these studies is that they are small and not randomized or placebo controlled. Larger well controlled studies are needed to determine the effect and safety of this treatment. Researchers must develop and evaluate all forms of therapy fairly to help decrease hospitalizations, decrease mortality, and improve quality of life.

Cardiac rehabilitation/exercise in patients with implantable cardioverter defibrillators.

There have been no specific exercise or daily activity guidelines determined for patients with automatic implantable cardioverter defibrillators. Two patients, one with a Ventritex Cadence Model V-100 defibrillator and one with a CPI Ventak Model 1550 defibrillator were enrolled in monitored cardiac rehabilitation. One patient had symptoms of syncope and cardiodefibrillation during a vigorous short walk prior to cardiac rehabilitation and became fearful of any activity. Stress testing on this patient was terminated early because his atrial fibrillation rate approached the defibrillization rate. A low dose of beta blockade was added to his regimen. He underwent repeat stress testing and was placed in cardiac rehabilitation. This patient had no further shocks, and it was assumed that his shock was due to high atrial fibrillation rates. The second patient experienced recurrent shocks on amiodarone, propafenone, and mexiletine with presyncope. However, stress testing did not disclose abnormalities. The patient was fearful of any activity and was placed in cardiac rehabilitation. During an average of 26 sessions of cardiac rehabilitation, no symptoms have been noted, and the patients have returned to a more normal lifestyle. Specific exercise and lifestyle criteria should be given to patients with cardioverter defibrillators. Stress testing with monitored exercise can develop such a program. Larger numbers of patients need to be studied.

Demographic characteristics and mean profiles of Learning Disability Index subsets of the standardization sample of the Wechsler Intelligence Scale for Children-Revised.

The Learning Disability Index (LDI) was validated by an examination of the mean profiles and demographic characteristics of high and low LDI subsets of the standardization sample of the Wechsler Intelligence Scale for Children-Revised. The LDI continuum, however, was found to measure Third Factor strengths/weaknesses as much as verbal-performance discrepancies.

Distribution of relative attention deficits on the WISC-R by age, sex, social class, and region.

We examined the demographic distribution of 102 subjects with attention deficits in the Wechsler Intelligence Scale for Children-Revised (WISC-R) (Wechsler, 1974) standardization sample. Neither age nor occupational status was significant; males were overrepresented (3:1); and the West was overrepresented by 50%, largely due to the relatively high proportion of females in the West who appeared within the attention deficit sample (41% in West vs. 19% in the rest of the nation). Replication is encouraged.

Arteriographic demonstration of coronary artery spasm during thrombolysis.

A 60-year-old man with an acute inferior-wall myocardial infarction was noted, on arteriography, to have an occluded distal right coronary artery. The vessel was reopened with intravenous tissue plasminogen activator; during resolution of the clot, spasm was observed arteriographically but was successfully treated with intracoronary nitroglycerin. Follow-up arteriography showed a normal right coronary artery. The significance of this case lies in the fact that we were able to document the occurrence of spasm during coronary thrombolysis; such documentation supports the hypothesis that spasm may be a factor in the initiation of coronary thrombosis.