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Background: Gastroparesis is common after lung transplantation and is associated with worse transplant outcomes, including the development of chronic lung allograft dysfunction (CLAD). This study sought to identify the prevalence, risk factors, and outcomes associated with a new diagnosis of gastroparesis after lung transplantation.Methods: This was a single-center retrospective study of patients who underwent lung transplantation in 2008-2018. The primary outcome was a new diagnosis of gastroparesis within 3 years of transplant. Secondary outcomes included a new diagnosis of gastroesophageal reflux and the association between gastroparesis and both post-transplant survival and CLAD-free survival. Multivariable logistic regression was used to compare diagnosis of gastroparesis and gastroesophageal reflux, while multivariable Cox proportional hazards models were used to analyze gastroparesis and post-transplant outcomes.Results: Of 616 patients with no prior history of gastroparesis, 107 (17.4%) were diagnosed with delayed gastric emptying within 3 years of transplant. On multivariable logistic regression, black race (OR 2.16, 95% CI 1.18-3.98, p = 0.013) was significantly associated with a new diagnosis of gastroparesis. Age, sex, history of diabetes, connective tissue disease, type of transplant, diagnosis group, renal function, and body mass index were not predictive of gastroparesis post-transplant. Gastroparesis was significantly associated with CLAD (HR 1.76, 95% CI 1.20-2.59, p = 0.004), but not with overall mortality (HR 1.16, p = 0.43).Conclusion: While gastroparesis is common after lung transplantation, it remains difficult to predict which patients will develop these complications post-transplant. Black patients were more likely to be diagnosed with gastroparesis after adjusting for relevant confounders. Gastroparesis is associated with increased risk of CLAD, and further studies are needed to assess whether early detection and treatment can reduce the incidence of CLAD. [ABSTRACT FROM AUTHOR]

Background: There are currently three Food and Drug Administration approved endothelin receptor antagonists (ERAs): bosentan, ambrisentan, and macitentan. There is a growing body of evidence that demonstrates the beneficial effects of ERAs in patients with pulmonary arterial hypertension (PAH). Objectives: To compare the available evidence from randomized clinical trials for specific outcomes of different endothelin antagonists for the treatment of PAH. Methods: A multi-database search of randomized controlled trials up to March 15, 2016 was conducted for those that would measure functional parameters of patients with PAH treated with ERA monotherapy versus placebo. Studies that analyzed 6-min walking distance, pulmonary vascular resistance, pulmonary arterial pressure, or WHO functional status were incorporated for analysis. A total of 15 trials and 2 subanalyses were compiled and quality and abovementioned outcomes were compared among studies. Results: A constant decrease in pulmonary vascular resistance and pulmonary arterial pressure was globally reported among the different studies, resulting in increased 6-min walking distance and functional status compared to placebo. Conclusions: Although this evidence clearly shows the benefit of ERAs, studies, which compare ERAs against one another and with other therapies for progressive PAH, have been lacking. Larger and longer studies are necessary to define the role of ERAs as standalone agents and in combination therapies. [ABSTRACT FROM AUTHOR]

The Melon yellows virus (MYV), a whitefly-transmitted closterovirus, is one of the major pathogens causing crop losses in protected melons in southeastern Spain. An accession of the wild Asiatic Cucumis melo ssp. agrestis (Cma) shows resistance to MYV infection. Results indicate the participation of two resistance mechanisms in this source: firstly, an antixenotic reaction against Trialeurodes vaporariorum, the disease vector, and secondly, resistance to the virus. The combined effect of these two mechanisms confers Cma a higher level of resistance, expressed as a delayed and milder infection. The genetics of resistance to the Melon yellows closterovirus have been studied in two families derived from Cma. As under natural infection conditions, the effect of antixenosis and virus resistance cannot be distinguished, a biometrical model that permits separation of the two resistance mechanisms operating in the same resistant source, has been proposed to determine genetic control of MYV resistance. The genetic analysis has been conducted by fitting the disease progress curves of each generation to the biometrical model instead of fitting the final disease ratios. The scoring of disease incidence over time allows for the comparison of data from assays conducted in different conditions (2 years/4 transplanting dates), thus reinforcing the analysis. The results agree with a simple control of the resistance to MYV derived from Cma, with incomplete penetrance of the gene and partial dominance of resistance. The effect of antixenosis on the spread of this plant virus is highly significant in Cma, but not in segregant generations. Since there do not exist crossability barriers between this accession and the cultivated melon, Cma could be readily used in breeding programmes to obtain melon varieties resistant to MYV. [ABSTRACT FROM AUTHOR]