Alpha-1-antitrypsin (alpha 1AT) deficiency is a hereditary disorder characterized in adults by a high risk for the development of severe destructive lung disease at an early age. The present study was designed to draw conclusions concerning the characteristics of a referral population of 124 patients with alpha 1AT deficiency and symptomatic emphysema. Typically, the alpha 1AT level was 30 mg/dl, and the alpha 1AT phenotype was almost always PiZZ. The individuals in this population were most often male, caucasian, and ex-smokers, and they had become dyspneic between 25 and 40 yr of age. Most routine blood tests were normal. The chest radiographs and ventilation-perfusion studies typically showed abnormalities with a lower zone distribution, and about one third of the study population had evidence suggestive of pulmonary hypertension. Lung function tests were typical for emphysema; the FEV1 and DLCO were the parameters most dramatically reduced, and the annual rate of decline of those parameters was greater than that of the general population. The cumulative probability of survival of this population indicated a significantly shortened lifespan with a mean survival of 16% at 60 yr of age compared with 85% for normal persons.

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The opportunities for human immunodeficiency virus (HIV) care and treatment created by new treatment initiatives promoting universal access are also creating unprecedented opportunities for persons with HIV-associated immunosuppression to be exposed to patients with infectious tuberculosis (TB) within health care facilities, with the attendant risks of acquiring TB infection and developing TB disease. Infection control measures can reduce the risk of Mycobacterium tuberculosis transmission even in settings with limited resources, on the basis of a 3-level hierarchy of controls, including administrative or work practice, environmental controls, and respiratory protection. Further research is needed to define the most efficient interventions. The importance of preventing transmission of M. tuberculosis in the era of expanding HIV care and treatment in resource-limited settings must be recognized and addressed.

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Inducible nitric oxide synthase (iNOS) is a cytoplasmic protein responsible for the generation of nitric oxide (NO ⅐ ) in macrophages. In this work, we hypothesized that the intracellular localization of iNOS is significant for effective delivery of NO ⅐ to phagosomes containing ingested microorganisms. Using immunofluorescence microscopy and Western blot analysis, iNOS was shown to localize in the vicinity of phagosomes containing latex beads in stimulated macrophages. iNOS also localized to phagosomes containing Escherichia coli. The colocalization of iNOS with ingested latex beads was an actin-dependent process, since treatment with the actin microfilament disrupter cytochalasin D prevented iNOS recruitment to latex bead phagosomes. In contrast to E. coli and inert particle phagosomes, mycobacterial phagosomes did not colocalize with iNOS. This study demonstrates that (i) iNOS can be recruited to phagosomes; (ii) this recruitment is dependent on a functional actin cytoskeleton; (iii) certain microorganisms have the ability to prevent or reduce colocalization with iNOS; and (iv) spatial exclusion of iNOS may play a role in Mycobacterium tuberculosis pathogenesis.

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When immediate bonding to bleached enamel is to be implemented, organic-solvent based adhesives are not capable of eliminating or reducing the adverse effect of bleaching systems on bond strength. AK Nour El-din • BH MillerJA Griggs • C Wakefield SUMMARYThis research sought to determine the shear bond strength, degree of resin infiltration and failure mode when organic solvent-based adhesives (acetone or ethanol) were used in immediate bonding to enamel bleached with 10% carbamide peroxide or 38% hydrogen peroxide systems. Seventy-two non-carious bovine incisors were randomly assigned to three groups of 24 specimens each-control group (deionized water), 38% hydrogen peroxide bleach group and 10% carbamide peroxide bleach group. Each group was further subdivided into two subgroups of 12 specimens each according to the adhesive system used to bond the resin composite to enamel surfaces. The two adhesive systems used were Single Bond, an ethanol-based adhesive, and OneStep, an acetone-based adhesive. The shear bond strengths of 38% hydrogen peroxide and 10% carbamide peroxide were significantly lower compared to the non-bleached controls. Fractography revealed an adhesive failure mode in all specimens. Qualitative comparisons of resin tags present in the bleached and unbleached specimens using scanning electron microscopy (SEM) revealed few, thin and fragmented resin tags when 38% hydrogen peroxide and 10% carbamide peroxide were used.