Airwaves Thorax: first published as 10.1136/thoraxjnl-2018-212867 on 13 December 2018. Downloaded from Highlights from this issue

doi:10.1136/thoraxjnl-2018-212867 The Triumvirate

Standing on the shoulders of after her discovery of CF, researchers in the patients with blood group O had the highest giants… USA and ‘other lands’ continue to improve waiting list mortality. The authors hope that In this month’s airwaves, we salute those the duration and quality of life for people the restructuring donor allocation in the titans of medicine who have made present with CF. UK will help reduce these discrepancies, day advances in medicine possible. however, as the father of transplantation What have the worms ever done reminds us ‘the intensity of the conviction Back to Black for us? that a hypothesis is true has no bearing on Almost 40 years ago, the Black Report In the 1970’s Sydney Brenner, John Sulston whether it is true or not’, which we would demonstrated that health inequalities were and Robert Horovitz discovered the role propose is sound advice to all scientists, so widespread, despite the fact that healthcare of genes that promoted cell death in the we need to wait and see what the data tell us. was (and is) free at the point of delivery Caenorhabditis elegans nematode, the nuc- in the UK. Sir Douglas Black provided 1, ced-3 and ced-4 genes. This system of Sir Bedevere the Wise evidence that the root cause of these health programmed cell death was called apoptosis It was only recently in 2012 that Sir John inequalities was economic: wealthier means and lead to the joint award of the Nobel Gurdon and Shinya Yamanaka shared the healthier. Fast forward to 2019 and this Prize to Brenner, Sulston and Horovitz in Nobel Prize for their pioneering work on month’s issue of Thorax (see page 51), where 2002. In 1989, Trauth et al first described stem cells and stem cell therapy remains Belot et al explore why some patients with the possibility of manipulating the first apop- the Holy Grail of medicine. It is therefore early stage lung cancer have surgery and tosis signal (Fas) receptor to promote apop- a little surprising to discover that the first some do not. They found that comorbidities tosis. Since then over 11 000 publications reports of stem cells biology emanate from (congestive heart failure, cerebrovascular have manipulated this receptor in various the mid-19th century when Goujon in 1869, disease and COPD) may explain why some experimental and therapeutic settings. then MacEwen in 1881, described the osteo- patients do not have surgery. Age and sex Herrero et al (see page 69) show that Fas genic potential of transplanted bone marrow also play a role. However, even when these activation of epithelial cells in the lung leads giving rise to the first example of mesen- factors are taken into account, individuals to increased alveolar permeability through chymal stem cells (MSCs). In this issue of who suffer greater levels of deprivation had effects on tight junctions both in vitro and Thorax, Park et al (see page 43) describe the less chance of receiving surgery for early in vivo and this occurs before apoptosis. development of microvesicles (MVs) secreted stage lung cancer. The ‘Inverse Care Law’ Inhibiting caspase-3 was able to prevent this as by MSCs as a potential therapy for ALI. (1971) proposed by the late Julian Tudor- permeability and could offer a new thera- Administration of MSC MV to human ex Hart still applies. peutic option in acute lung injury (ALI). So vivo model of bacterial pneumonia increased apart from helping us develop strategies to alveolar fluid clearance and reduced protein Eighty years of cystic fibrosis treat cancer and now ALI, what have the permeability and bacterial load in the injured research worms ever done for us? alveolus. So maybe the answer to the Holy http://thorax.bmj.com/ Dorothy Andersen, an American patholo- Grail is to use stem cells as Trojan Rabbit? gist and paediatrician, first described ‘cystic The father of transplantation fibrosis of the pancreas’ in 1938. A decade In 1912, Alexis Carrel, a French Surgeon, Mind games later, she published one of the first reports was awarded the Nobel Prize for Physiology In 1979, following training under Buddhist of the natural history of the disease and the and Medicine for pioneering surgical tech- teacher Thich Nhat Hanh, Jon Kabat-Zinn response to treatment (Pediatr 1949; 3 (4): niques. He also performed the first experi- founded the mindfulness-based stress reduc- 406–17). In this paper, she describes the mental transplants, which due to a lack of tion programme at the University of Massa- microbiological basis of early lung infection, immunological understanding at the time, chusetts to treat the chronically ill. He used on September 27, 2021 by guest. Protected copyright. ‘Cultures taken early in the course of the did not have great results. In 1960, Sir Peter this ancient meditation practice to alleviate disease grow Staph. aureus hemolyticus in Medawar was awarded the Nobel Prize, with the suffering of his patients. The same nearly every case…’. One possible source of Sir Mac Burnett, for discovery of acquired approach has been adopted by Cox et al (see such infections with Staphylococcus aureus immunological tolerance, which opened the page 33) with a focus of combining the old is explored in Thorax this month (see page door for organ transplantation. Only 23 with the new. The investigators performed a 87). Wood et al describe how S. aureus is years later, Joel Cooper performed the first feasibility study of the impact of mindfulness aerosolised during coughing. They studied lung transplantation in Toronto General training programmes, delivered by a mobile 30 people with CF, in a validated cough Hospital on 7 November 1983 and now we app, by telephone or a face-to-face education protocol, using a cascade impactor. They regard lung transplants as ‘curative’ proce- programme for survivors of critical illness. found that cough aerosols can travel 4 m dures for life-limiting diseases. However, In a 3-month trial, the mobile mindfulness and organisms remain viable within droplet there are many more people in need of app was shown to be feasible, acceptable and nuclei for up to 45 min. This provides some transplants than available organs. Kour- usable and indeed had a similar impact on underpinning evidence for person-to-person liouros et al (see page 60) address the factors psychological distress and physical symptoms spread of infection. In 1949, Dorothy that affect waiting list mortality. Patients with as a therapist-led programme. It sounds like Andersen described progress during the first COPD were more likely to receive a trans- we all need a bit of mindfulness training and decade of CF research: ‘…a considerable plant within 3 years, whereas patients with now it can be delivered by your smartphone! body of knowledge in regard to the disease IPF were more likely to die on the transplant has been accumulated by the efforts of many waiting list. Similarly, taller patients were © Author(s) (or their employer(s)) 2019. No commercial workers in this and other lands.’ Eighty years more likely to receive a transplant, whereas re-use. See rights and permissions. Published by BMJ.

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