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Vincent's Super, Olympic Valentine's Sense

For the month of February 2014, we have what might be the most expensive television program in America, Super Bowl XLVIII; the 22nd Winter Olympics on the World's stage; Valentine's Day and President's Day, mostly commemorating George Washington and Abraham Lincoln. Because of this sports-filled February and in keeping with our focus on improving communication, the Editor's Corner will provide you some everyday language derived from the vocabulary of sports, but I will punt on this for now.

In this issue of the ISHLT Links for the month of February 2014, we focus on lung transplantation and infectious diseases. Keith Meyer from the University of Wisconsin School of Medicine refines and defines our classification of BOS. The unchanging outcomes over the years have kept lung transplant specialists whittling away at the various expressions of allograft dysfunction. With clearer definitions of what has been observed over the years by splitting the old lump of BOS into seemingly more meaningful parts may actually allow us to lump our findings into the split categories of phenotypic expressions of allograft injury leading to more suitable and future investigations. Nevertheless, most lung recipients will have architecturally distorted airways down to the bronchioles in their allografts rendering them all the more vulnerable to infection along with their chronic immunosuppression.

Dana Willner and Dan Chambers from the University of Queensland in Australia explore the respiratory mycobiome of lung recipients and shed potential bright, shining or twinkling concepts before our very eyes through these fungal communities. These concepts may be the diamonds in the rough that will lead us to the golden fleece of our understanding. Eileen Marziaz of Duke University provides a treatise on whether we should treat or not treat nontuberculous mycobacteria isolated from surveillance examinations of the airways of lung recipients. Of course, another means to perhaps maintain microbiota diversity of the respiratory tract and other systems of lung recipients is through prevention by vaccines. Deepali Kumar of University Health Network in Toronto summarizes the importance of pre-transplant vaccination for optimal patient care. Other prevention strategies include universal prophylaxis or pre-emptive therapy. Luciano Potena from the University of Bologna shares with us the equalities and inequalities of CMV prevention strategies. During this review he conjures up the "iron curtain" originally described by Winston Churchill that had descended across Europe dividing the Soviet Union and her satellites from the democratic nations of western Europe at the end of World War II in 1945. For more on CMV and Winston Churchill the ISHLT Links refers you to the Glen Westall's summary in the June 2011, volume 3, issue 1, page 6, CMV - The Gathering Storm.

If not prevented by vaccines or prophylactic strategies then infections occur, most frequently respiratory infections in lung recipients. Most assuredly antibiotics are prescribed and more than likely too long and too frequently. The result is a change in the microbiota not only in the respiratory tract but the gastrointestinal tract as well. Then waiting in the wings, not Cupid's wings, but is the nightmare of Clostridium difficile. Cameron Wolfe of Duke University summarizes the emerging success of fecal microbiota transplant for recurrent C diff infection and what lies ahead in the revolt of bringing back the homeostatic diversity of lower intestinal microbial communities. Revolting! Repulsive! Yet successful. But I leave you with this, for Valentine's Day, you've got to love a species who shares its species. And there are published reports that poop-throwing may be a sign of intelligence, at least in chimpanzees.

Don't forget those chocolates!

Vincent Valentine, MD
Editor-in-Chief, ISHLT Links Newsletter

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