We showed previously that vitamin A deficiency per se causes emphysema. Benzo(a)pyrene, a constituent in cigarette smoke, induces vitamin A depletion when administered to rats; therefore, we tested the hypothesis that cigarette smoke induces vitamin A depletion, which is associated with the development of emphysema. Male weanling rats were fed a purified AIN-93G diet and divided into two groups. The experimental group was exposed to cigarette smoke from 20 nonfiltered commercial cigarettes/d for 5 d/wk, whereas the control group was exposed to air. After 6 wk, tissues were collected for histological and biochemical analyses. Retinol levels were measured in serum, lung and liver. The trachea, lung and liver were examined for histological changes. Vitamin A levels decreased significantly in serum, lung and liver of smoke-treated rats. Histological examination revealed the presence of interstitial pneumonitis along with severe emphysema. There was a significant inverse relationship between vitamin A concentration in the lung and the severity of emphysema (r = -0.69 and P < 0.03). Detachment or hyperplasia (and metaplasia) of the tracheal epithelium and liver vacuole formation also were evident in the smoke-treated rats. The results of this research indicate that exposure to cigarette smoke induces vitamin A depletion in rats, which is associated with the development of emphysema.
Toxoplasmosis is an important disease in immunocompromised hosts, particularly in patients with AIDS and in heart transplant recipients. Infection with Toxoplasma is less commonly seen in recipients of other solid organ transplants. We report a case of fulminant disseminated infection with Toxoplasma after liver transplantation. Despite numerous diagnostic studies including open lung biopsy, toxoplasmosis was diagnosed only at the time of autopsy and involved the brain, spinal cord, pituitary gland, lungs, and heart. Toxoplasmosis should be considered in the differential diagnosis of multiorgan failure in the early period after liver transplantation. If mismatched serologies could be identified then clinical suspicion might be higher and prophylactic or empirical therapy could be instituted. The United Network for Organ Sharing (Richmond, VA) should consider including serology for Toxoplasma in the testing of donors.
Background:Computerized physician order entry (CPOE) systems are quickly becoming ubiquitous, and groups of orders (“order sets”) to allow for easy order input are a common feature. This provides a streamlined mechanism to view, modify, and place groups of related orders. This often serves as an electronic equivalent of a specialty requisition. A characteristic, of these order sets is that specific orders can be predetermined to be “preselected” or “defaulted-on” whenever the order set is used while others are “optional” or “defaulted-off” (though there is typically the option is to “deselect” defaulted-on tests in a given situation). While it seems intuitive that the defaults in an order set are often accepted, additional study is required to understand the impact of these “default” settings in an order set on ordering habits. This study set out to quantify the effect of changing the default settings of an order set.Methods:For quality improvement purposes, order sets dealing with transfusions were recently reviewed and modified to improve monitoring of outcome. Initially, the order for posttransfusion hematocrits and platelet count had the default setting changed from “optional” to “preselected.” The default settings for platelet count was later changed back to “optional,” allowing for a natural experiment to study the effect of the default selections of an order set on clinician ordering habits.Results:Posttransfusion hematocrit values were ordered for 8.3% of red cell transfusions when the default order set selection was “off” and for 57.4% of transfusions when the default selection was “preselected” (P < 0.0001). Posttransfusion platelet counts were ordered for 7.0% of platelet transfusions when the initial default order set selection was “optional,” increased to 59.4% when the default was changed to “preselected” (P < 0.0001), and then decreased to 7.5% when the default selection was returned to “optional.” The posttransfusion platelet count rates during the two “optional” periods: 7.0% versus 7.5% – were not statistically different (P = 0.620).Discussion:Default settings in CPOE order sets can significantly influence physician selection of laboratory tests. Careful consideration by all stakeholders, including clinicians and pathologists, should be obtained when establishing default settings in order sets.
Acute cardiac rejection involves myocyte necrosis. Hence, markers of myocyte death may be useful in diagnosing rejection. Creatine kinase MB, MB isoforms, and troponins I and T were measured in 186 patients undergoing 365 endomyocardial biopsies. No differences were noted with rejection (rejectors vs. nonrejectors: CK=63.8 U/L and 86.6 U/L, P=0.0881; CK MB=2.04 ng/ml and 2.06 ng/ml, P=0.949; troponin T=0.134 ng/ml and 0.0881 ng/ml, P=0.374; troponin I=0.216 ng/ml and 0.707 ng/ml, P=0.357). The time course of troponins T and I levels in rejectors and nonrejectors do not differ with both groups having early elevations. Markers of myocyte death are inadequate predictors of acute rejection in cardiac allografts. The time course of troponins T and I suggests a possible role as prognostic indicators of outcome.
The prevalence of SGD and the presence of fibrosis and collagen I in Cameroonians with HIV is significantly higher than in HIV-positive American patients, and is similar to US patients with primary SS. The impact of patient selection, anti-retroviral therapy, and pathogenic mechanisms on salivary gland pathology is discussed.
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