Peripheral Blood Gene Expression Changes Associated With Primary Graft Dysfunction After Lung Transplantation.

Recipient responses to primary graft dysfunction (PGD) after lung transplantation may have important implications to the fate of the allograft. We therefore evaluated longitudinal differences in peripheral blood gene expression in subjects with PGD. RNA expression was measured throughout the first transplant year in 106 subjects enrolled in the Clinical Trials in Organ Transplantation-03 study using a panel of 100 hypothesis-driven genes. PGD was defined as grade 3 in the first 72 posttransplant hours. Eighteen genes were differentially expressed over the first year based on PGD development, with significant representation from innate and adaptive immunity genes, with most differences identified very early after transplant. Sixteen genes were overexpressed in the blood of patients with PGD compared to those without PGD within 7 days of allograft reperfusion, with most transcripts encoding innate immune/inflammasome-related proteins, including genes previously associated with PGD. Thirteen genes were underexpressed in patients with PGD compared to those without PGD within 7 days of transplant, highlighted by T cell and adaptive immune regulation genes. Differences in gene expression present within 2 h of reperfusion and persist for days after transplant. Future investigation will focus on the long-term implications of these gene expression differences on the outcome of the allograft.

Consolidated bioprocessing strategy for ethanol production from Jerusalem artichoke tubers by Kluyveromyces marxianus under high gravity conditions.

AIMS: Developing an innovative process for ethanol fermentation from Jerusalem artichoke tubers under very high gravity (VHG) conditions. METHODS AND RESULTS: A consolidated bioprocessing (CBP) strategy that integrated inulinase production, saccharification of inulin contained in Jerusalem artichoke tubers and ethanol production from sugars released from inulin by the enzyme was developed with the inulinase-producing yeast Kluyveromyces marxianus Y179 and fed-batch operation. The impact of inoculum age, aeration, the supplementation of pectinase and nutrients on the ethanol fermentation performance of the CBP system was studied. Although inulinase activities increased with the extension of the seed incubation time, its contribution to ethanol production was negligible because vigorously growing yeast cells harvested earlier carried out ethanol fermentation more efficiently. Thus, the overnight incubation that has been practised in ethanol production from starch-based feedstocks is recommended. Aeration facilitated the fermentation process, but compromised ethanol yield because of the negative Crabtree effect of the species, and increases the risk of contamination under industrial conditions. Therefore, nonaeration conditions are preferred for the CBP system. Pectinase supplementation reduced viscosity of the fermentation broth and improved ethanol production performance, particularly under high gravity conditions, but the enzyme cost should be carefully balanced. Medium optimization was performed, and ethanol concentration as high as 94·2 g l(-1) was achieved when 0·15 g l(-1) K(2) HPO(4) was supplemented, which presents a significant progress in ethanol production from Jerusalem artichoke tubers. CONCLUSIONS: A CBP system using K. marxianus is suitable for efficient ethanol production from Jerusalem artichoke tubers under VHG conditions. SIGNIFICANCE AND IMPACT OF THE STUDY: Jerusalem artichoke tubers are an alternative to grain-based feedstocks for ethanol production. The high ethanol concentration achieved using K. marxianus with the CBP system not only saves energy consumption for ethanol distillation, but also significantly reduces the amount of waste distillage discharged from the distillation system.

Comparative echocardiographic study of recovery of diastolic versus systolic function after brief periods of coronary occlusion: differential effects of intravenous nifedipine administered before and during occlusion.

The effect of intravenous nifedipine (5 micrograms/kg) on the recovery of myocardial function after occlusion of the left anterior descending coronary artery was studied in 18 closed chest dogs. Using computer-aided analysis of two-dimensional echocardiograms, systolic and diastolic function of ischemic segments in low papillary left ventricular cross sections were characterized, respectively, as holosystolic fractional area change and early diastolic velocity of luminal area change. The time required for systolic function to return to preocclusion values after a 1 minute untreated control occlusion (n = 12) was 5 to 10 minutes, and after a 2 minute occlusion (n = 6) it was 20 to 30 minutes. When nifedipine was administered during the occlusion, recovery after a 2 minute occlusion was accelerated slightly to 10 to 15 minutes. Recovery times of early diastolic function were substantially longer, and nifedipine effects were more pronounced. After a 1 or 2 minute control coronary occlusion, 60 to 75 minutes or 90 to 105 minutes were needed to return early diastolic function to normal levels. Nifedipine administered during a 1 or 2 minute coronary occlusion improved these recovery times to 10 to 15 minutes. When the dogs were treated with intravenous nifedipine before coronary occlusion, recovery after 1 or 2 minutes of acute ischemia was apparent as early as 2 minutes after reperfusion. Thus, intravenous nifedipine accelerates the recovery of myocardial function after brief periods of ischemia, and when administered before coronary occlusion, it assures very prompt recovery of function.

Enhanced myocardial washout and retrograde blood delivery with synchronized retroperfusion during acute myocardial ischemia.

The effects of synchronized coronary venous retroperfusion of arterial blood on myocardial washout were studied with digital subtraction angiography in 10 closed chest dogs during balloon occlusion of the proximal left anterior descending coronary artery. The center lumen of the intracoronary balloon catheter was used for sequential injections of 1 ml (meglumine diatrizoate) Renografin-76, and contrast washout rate was determined by videodensitometry in myocardial regions subserved by the left anterior descending coronary artery. Before coronary artery occlusion, washout rate was 22.4 +/- 2.7 min-1 (mean +/- SEM). Five minutes after occlusion, and immediately before synchronized retroperfusion, washout rate dropped sharply to 2.0 +/- 0.7 min-1. Twenty-five minutes after occlusion, with 50 ml/min synchronized retroperfusion treatment applied for 5 minutes, washout rate was 5.0 +/- 1.5 min-1. Thus, synchronized retroperfusion significantly (p less than 0.05) accelerated contrast disappearance over that during presynchronized retroperfusion ischemia. To determine the effects of synchronized retroperfusion on retrograde delivery to the ischemic myocardium, monastral blue dye was retroinfused through the system into the great cardiac vein before the dog was killed. Transverse heart slices were then studied by light microscopy, and regional intravascular dye content was scored from 0 to 3 (0 = no dye, 3 = maximal dye). After great cardiac vein synchronized retroperfusion, blue dye content in capillaries of ischemic anterior and nonischemic posterior aspects of the left ventricle was 2.3 +/- 0.5 versus 0.7 +/- 0.3, respectively (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Microbubble dynamics visualized in the intact capillary circulation.

The potential for the use of contrast echocardiography to study myocardial perfusion has generated efforts to develop standardized echo contrast agents. The two methods used in this laboratory to generate microbubbles in solutions serving as contrast agents included the widely used hand-agitation method and the newer ultrasonic microcavitation (sonication) method. The latter has been demonstrated to generate smaller and more uniform microbubbles in an in vitro system. The present study was designed to observe, by direct microscopic examination of a cat mesentery preparation, the behavior and fate of the microbubbles in an in vivo system. The in vivo mesentery observations confirm the critical role of microbubble size in its unhindered passage through the capillary vasculature. The smaller and more uniform sonicated microbubbles passed rapidly through the microcirculation along with the red blood cells, whereas the larger microbubbles were observed to coalesce and interrupt the flow of blood and subsequently collapse or shrink.

Red cell velocity and autoregulation in the cerebral cortex of the cat.

This report deals with a comparison of total and regional cerebral blood flow with red cell velocity in the microcirculation of the ecto- and suprasylvian areas of the cerebral cortex of the cat and their response to changes in systemic blood pressure. Total and regional blood flows were measured during a steady-state with radioactive microspheres; a newly devised method, based on transillumination was employed for direct visualization of the microcirculation in the cerebral cortex. Craniotomy failed to influence either autoregulation or red cell velocity under the skull opening or of the total cerebral flow. Autoregulation of total and regional cerebral flow was present. In contrast marked pressure-dependent variations in microcirculatory red cell velocity occurred. A fall in systemic pressure was accompanied by a decrease in red cell velocity; return of pressure resulted in increased red cell velocity and in some instances, in an overshoot. Considerable inhomogeneity of red cell velocity in different microcirculatory vessels was encountered. In some cases a fall in systemic pressure led to complete disappearance of red cells.

Holmium:YAG laser thermokeratoplasty for astigmatism in rabbits.

BACKGROUND: Holmium:YAG laser thermokeratoplasty has generated considerable interest as a technique for correcting hyperopia. In this study, the effect of holmium:YAG laser on inducing astigmatism according to application patterns was evaluated. METHODS: An experimental study based on the results of astigmatic holmium:YAG laser thermokeratoplasty using the Summit OmniMed laser system (Summit Technology Inc, Waltham, Mass) in 36 rabbit eyes is presented. We divided the rabbits into four groups: arcuate, reverse arcuate, linear, and control group according to application patterns. All rabbits were followed for 3 months and cycloplegic refractive measurements were carried out. RESULTS: The average surgically induced astigmatism was 1.86 diopters (D) for the arcuate group, 2.93 D for the reverse arcuate group, and 1.31 D for the linear group. No significant complications related to the operation were noted. CONCLUSION: The reverse arcuate pattern of holmium:YAG laser thermokeratoplasty is most effective in inducing astigmatism in rabbits.

Does what nurses do affect clinical outcomes for hospitalized patients? A review of the literature.

OBJECTIVE: Through a review of the literature, to identify and describe (1) empirical studies of inpatient nursing care quality that evaluate links between nursing care processes and health-related patient outcomes, (2) nursing care processes for which process-outcome links have been established, and (3) important nursing care processes that have not yet been evaluated. DATA SOURCES/STUDY SETTING: Published empirical studies of inpatient nursing care quality that evaluated links between processes of nursing care and health-related patient outcomes. STUDY DESIGN/DATA COLLECTION/EXTRACTION METHODS: This literature review used a five-step article search and review method. PRINCIPAL FINDINGS: Of 257 data-based studies of nursing care quality identified, 135 investigated a process-outcome link but only 17 met study inclusion criteria. The literature provides evidence that the quality of nursing care processes affects health-related patient outcomes during and after hospitalization. Gaps in the literature that evaluates nursing quality are identified. CONCLUSIONS: Although some nursing care processes affect health-related patient outcomes, the full extent of nursing process-outcome links is relatively understudied. Further evaluation of the interrelationships between nursing care processes and outcomes is critical.

Use of physical barriers for delayed adjustable strabismus surgery: the effect of interceed and polyglactin 910 mesh.

AIMS/BACKGROUND: In the course of adjustable strabismus surgery there is only a limited period after surgery before the formation of firm adhesions prevents successful adjustment. To determine if this period could be increased by the interposition of suitable physical barriers, the use of Interceed and polyglactin 910 mesh was investigated in an animal model. METHODS: A total of 39 rabbit eyes were divided into three groups. After recession of the superior rectus muscle (SRM), balanced salt solution was applied to the control group between the free muscle end and the sclera; in each of the two experimental groups, Interceed and polyglactin 910 mesh were applied. Delayed adjustment was performed once on each SRM at 1, 2, or 3 weeks postoperatively. The length and force of the adjustment, the degree of adhesions, and the degree of fibrous proliferation were recorded. RESULTS: Adjustment was not possible in any of the eyes in the control group. At 1 week postoperatively, adjustment was possible in four out of five eyes with Interceed and in three out of five eyes with polyglactin 910 mesh as a physical barrier. CONCLUSIONS: Interceed may be clinically useful in delaying the timing of adjustment up to 1 week. Further study of the use of other materials could be carried out to see if it was possible to delay the timing of adjustment for more than 1 week.

Combined effect of Interceed and 5-fluorouracil on delayed adjustable strabismus surgery.

AIMS/BACKGROUND: To discover a more reliable method of performing delayed suture adjustment as a basis to investigate whether delayed adjustment actually provides more stable results. In order to prevent the formation of postoperative adhesions and delay the time of adjustment, an animal study was performed to determine the combined effect of physical barriers, Viscoat and Interceed, and a pharmacological agent, 5-fluorouracil (5-FU). METHODS: 38 rabbit eyes were divided into three groups. After recession of the superior rectus muscle (SRM), 5-FU was applied beneath and over the SRM in group 5-FU. Group I-f had Interceed and 5-FU and group I-fv, Interceed, 5-FU, and Viscoat. Delayed adjustment was performed once on each SRM at 1, 2, and 3 weeks postoperatively. The possible length and the necessary force to adjust as well as the degree of adhesions were recorded. RESULTS: 5-FU delayed the adjustment for up to 1 week after surgery in three out of four eyes. Combined use of Interceed and 5-FU could delay the adjustment for up to 1 week after surgery in three out of five eyes. Addition of Viscoat could delay the adjustment for up to 1 week after surgery in four out of five eyes. Adjustment was possible on only one of four eyes thereafter. CONCLUSIONS: Combined use of Interceed, 5-FU, and Viscoat could delay the adjustment in rabbits until 1 week postoperatively.

Effect of ADCON-L on adjustable strabismus surgery in rabbits.

BACKGROUND/AIMS: In search of a way to prevent postoperative adhesion after strabismus surgery, an animal study was performed to assess the effect of a gel consisting of a polyglycan ester in a gelatin matrix (ADCON-L). METHODS: Bilateral recessions of superior rectus muscle (SR) were performed on 16 rabbits. ADCON-L was applied beneath and over the SR in the right eyes of all rabbits, while the operative fields in the left eyes were irrigated with a balanced salt solution (BSS). The adjustment was performed on each SR at 4 and 7 days postoperatively on the same eye. The length and force of the adjustment and the degree of adhesion were recorded. At 3 weeks postoperatively, disinsertional force was measured in several of the eyes, and the other eyes were enucleated. RESULTS: The length of the adjustment was longer and the force of the adjustment was less in the ADCON-L group than in the BSS treated group at 4 and 7 days postoperatively (p=0.00). A significant reduction (p=0.00) in the degree of adhesion was noted in eyes treated with ADCON-L. There was no significant difference in disinsertional force between the two groups. Histopathological evaluation of the muscle revealed decreased fibrosis of perimuscular connective tissue in eyes treated with ADCON-L at 3 weeks postoperatively. CONCLUSION: This study suggests that ADCON-L helps to prevent postoperative adhesion in rabbits and enables adjustment twice within 7 days postoperatively without complications.

Effect of diode laser trans-scleral cyclophotocoagulation in the management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments.

AIMS: To evaluate the effect of trans scleral cyclophotocoagulation (TSCPC) on intraocular pressure (IOP) in the eyes retaining intravitreal silicone oil with medically uncontrolled secondary glaucoma following intravitreal silicone oil injection. METHODS: Medical records of 11 eyes of 11 patients who underwent TSCPC for medically uncontrolled glaucoma without pupillary block following intravitreal silicone oil injection for complicated retinal detachment were reviewed retrospectively. In all cases, intravitreal silicone oil was not removed for fear of retinal redetachment. Diode laser contact TSCPC was performed at a power of 1.5-2.5 W, for a duration of 2 seconds, and with 20-27 applications. IOP, number of glaucoma medications, and success rate were evaluated. RESULTS: After a mean follow up period of 52.5 (SD 8.2) (range 42-68) weeks, the mean pretreatment level of IOP, 43.0 (14.4) (26-67) mmHg, had fallen to 14.5 (4.3) (7-20) mm Hg (p=0.003). The number of glaucoma medications was reduced from 2.6 (0.8) to 0.6 (1.0) (p= 0.005). Qualified success was achieved in nine eyes (81.8%) and complete success in six (54.5%). After TSCPC, patients' retinal status had not changed. CONCLUSION: Patients with medically uncontrolled glaucoma secondary to intravitreal silicone oil injection can be treated with TSCPC in spite of the retained intravitreal silicone oil.

Surgical management of congenital cataract associated with severe microphthalmos.

PURPOSE: To report the results of cataract surgery in children with severe microphthalmos and congenital cataract. SETTING: Seoul National University, Department of Ophthalmology, Seoul, Korea. METHODS: Retrospective studies were conducted by reviewing the charts of 20 eyes of 11 patients with severe microcornea and microphthalmos or severe microcornea with a corneal diameter smaller than 9.0 mm. The patient pool was divided according to surgical method, specifically by incision site: an anterior group that had corneal limbal incisions and a posterior group treated via pars plicata incisions. Preoperative examinations included bilaterality, corneal diameter, axial length, and eye and systemic abnormalities. Postoperative results and complications of the 2 operative methods were compared. RESULTS: All 11 patients had bilateral congenital cataract and microphthalmos. Except in 1 case, surgeries were done in patients ranging in age from 2 to 16 months. Mean follow-up was 2 years. Corneal diameter was smaller than 9.0 mm in all 20 eyes and smaller than 7.5 mm in 11 eyes. Ten eyes were categorized into the anterior group, and the other 10 eyes were placed in the posterior group. Postoperative complications included secondary membranes in 3 eyes in the posterior group and corneal opacity in 3 eyes in the anterior group. CONCLUSION: The surgical management of children with congenital cataract and severe microphthalmos is recommended as a way to improve vision but must be performed carefully to avoid complications.

Characterization of hydrogen bonding between selected barbiturates and polyethylene glycol 4000 by IR spectral analysis.

Several barbiturates and primidone were equilibrated with polyethylene glycol 4000 in pyridine. IR spectral properties of these samples indicate that seven disubstituted barbiturates complex with polyethylene glycol 4000 while five disubstituted barbiturates and two trisubstituted barbiturates as well as primidone do not. Forces responsible for complexation of barbiturates with polyethylene glycol 4000, as inferred from spectral data, consist of hydrogen bonds formed between N1 and N3 hydrogens of the barbiturate ring and two oxygen atoms of the --O--CH2CH2--O--moiety. Also, there appear to be three configurations of intermolecular hydrogen bonding sites between disubstituted barbiturates. Several factors affect the barbiturate-polyethylene glycol 4000 interaction, including the nature of the solvent, C5 substituents, the number of hydrogen bonds formed between reactants, and the 2-carbonyl group of the barbiturate ring. Complexes of polyethylene glycol 4000 with phenobarbital, butabarbital, and cyclobarbital are stable in water at 26 degrees or below, but complexes of polyethylene glycol 4000 with butethal, cyclopentenyl allylbarbituric acid, pentobarbital, and probarbital are not.

Effects of ibuprofen on pulmonary oedema in an animal smoke inhalation model.

The ability of ibuprofen to lower extravascular lung water significantly was examined in an animal smoke inhalation model. Adult New Zealand White rabbits weighing 3-5 kg were anaesthetized and intubated. They were then allowed to breathe cooled cotton smoke until the carboxyhaemoglobin (COHb) reached a level of 60 per cent or higher. Each ibuprofen-treated animal received a dose of 50 mg/kg either intraperitoneally or intravenously. Ibuprofen was administered to animals that received smoke inhalation alone and those that received smoke inhalation combined with a 10 per cent BSA partial skin thickness thermal injury. Control groups were established for both of the above-mentioned groups. Peak carboxyhaemoglobin levels as well as CO half-lives were not significantly different between ibuprofen-treated groups and the controls. Ibuprofen treatment resulted in significantly (P less than 0.05) decreased lung water in both smoke, and smoke plus thermal injury groups as compared to controls. These results suggest that ibuprofen promotes the reduction of early-onset lung water resulting from smoke inhalation injury alone or from smoke inhalation injury plus a thermal injury.

The effect of 5-hydroxytryptamine and arterial blood withdrawal on cerebral microcirculation in the cat, arterial permeability in the rabbit.

Studies dealing with the effect of 5-HT on cerebral cortical microcirculation of cats and on permeability of femoral arteries to RISA of rabbits are presented. The effect of 5-HT on cerebral cortical microcirculation was compared to that of arterial blood withdrawal and blood reinfusion. The effect of topical administration of 5-HT was also studied. Cortical microcirculation was observed by transillumination using a microtransilluminator. Motion pictures were taken at a speed of 400 frames/sec. and a magnification of 3000X. Permeability was investigated using arterial RISA uptake in vessels perfused in vitro, with continuous recording of perfusion pressure. Microcirculatory studies revealed that arterial blood withdrawal and injection of 5-HT diminished red cell velocity, although to a different degree. With blood withdrawal and reinjection, good correlation existed between blood pressure and red cell velocity. In contrast, no correlation between blood pressure and red cell velocity was found after intracarotid injection of 5-HT. Reactive hyperemia was noted during reinfusion of blood. Both arterial blood withdrawal and 5-HT injection resulted in disappearance of red cells in individual vessels (unperfused channels). Good correlation of blood pressure with capillary red cell velocity during arterial blood withdrawal suggests absence of autoregulation in this portion of the microcirculation. Topical administration of 5-HT caused general vasoconstriction. Permeability to 5-HT to RISA followed a parabolic curve. With slight arterial vasoconstriction, permeability declined, while it rose with severe vasoconstriction.

The validity of a nursing assessment and monitoring of signs and symptoms scale in ICU and non-ICU patients.

PURPOSE: This study examined the validity of medical-record-based nursing assessment and monitoring of signs and symptoms (nursing surveillance) in predicting patients who were admitted to ICUs and those admitted to non-ICUs. The association of this assessment and monitoring with differences in an intermediate patient outcome, instability at discharge, was also explored. Patients admitted to either setting with a diagnosis of acute myocardial infarction, cerebrovascular accident, congestive heart failure, or pneumonia, were included in the study. METHOD: A secondary analysis was carried out using a subset of data originally collected for a quality-of-care study. Data from the medical records of 11,246 patients (52% female, 48% male) with a mean age of 76.4 years were used in the present study. RESULTS: ICU patients (n = 3969) were found to have a longer length of stay and to be sicker on admission than non-ICU patients (n = 7277). Overall, patients in the ICU received significantly higher nursing assessment and monitoring of signs and symptoms scores than non-ICU patients. Nursing assessment and monitoring of signs and symptoms scores were lower for patients discharged with greater instability for three of the four diseases (cerebrovascular accidents, congestive heart failure, and pneumonia).

Sleep and depression in cancer caregivers.

A cross-sectional, correlational design was used to describe and explore the relation between caregiver sleep and depression. For the study, 51 caregivers were recruited from two sites in southern California. Caregivers were primarily white (84%), female (80%), spouses (61%), or adult children (29%), who had provided care for a mean of 16 hours per day for an average of 2 years. The Center for Epidemiological Studies-Depression (CES-D)and the Pittsburgh Sleep Quality Index (PSQI) were used to measure caregiver depression and sleep, respectively. Most of the caregivers (95%) expressed severe sleep problems, and more than half of them were experiencing depressive symptoms at a level that would suggest risk for clinical depression. Correlations were strongest between caregiver depression and the sleep subscales of overall quality (r = 0.70; p < 0.001), habitual sleep efficiency (r = 0.54; p < 0.001), and daytime dysfunction (r = 0.59; p < 0.001). The final regression model, which included these subscales, predicted 63.6% of the variance in depression scores (F = 27.32; p < 0.001). These findings, which are consistent with results from other studies, suggest that caregivers of persons with terminal illness are at risk for clinical depression. It is critical for nurses to be cognizant of the relation between sleep problems and depression, and to explore interventions that would allow the caregivers to obtain needed sleep without diminishing their ability to function in their role as caregiver.

Colon cancer screening among older women caregivers.

UNLABELLED: Colorectal cancers are common causes of morbidity and mortality among women in the United States. Many of these deaths are unnecessary because of the availability of effective early detection methods. The demands of caregiving may limit older women's participation in screening. The purposes of this exploratory study were to describe the participation in colorectal cancer screening of older women (n = 52; mean age 65 years) who were the primary caregivers for an ill spouse or parent, and to investigate the relationship of the caregiving burden and perceptions of health to participation in recommended colorectal cancer screening tests. RESULTS: Only 36% of the older women (n = 16) had been screened with both fecal occult blood testing (FOBT) and sigmoidoscopy. A number of women had never participated in colorectal cancer screening: 10 (21%) had never undergone FOBT and 22 (47%) had never undergone sigmoidoscopy. Only 20% (n = 9) had received all of the recommended cancer screening tests: mammogram, Papanicalaou smear, FOBT, and sigmoidoscopy. Those who did not participate in cancer screening with sigmoidoscopy had significantly worse health perceptions than those who did participate. Caregiver burden was not significantly associated with differences in cancer screening participation. Only 14 of these older women felt that they would have a good chance of survival if they received a diagnosis of colon cancer. Further research is needed to investigate strategies to increase participation of older women in colon cancer screening.

Allergy as a risk factor for nursing care problems in the elderly cancer patient.

The purpose of this secondary analysis was to determine (a) the nursing diagnoses in elderly patients with cancer and (b) whether elderly cancer patients with a current or past history of allergy were at risk for selected nursing problems. A retrospective clinical data base from 59 patients (32 male, 27 female) with a diagnosis of cancer and an age range of 55-85 years with a mean age of 65.6 years was examined. The most frequently occurring priority nursing diagnoses identified by Clinical Nurse Specialists (CNS) were Pain, Risk for Infection, and Impairment of Skin Integrity. When examining the comprehensive list of priority and nonpriority nursing diagnoses, identified for these patients with cancer, it was found that those with a history of allergy were significantly more likely to have a high risk for infection than those without a history of allergy. Two other diagnoses (knowledge deficit and potential fluid volume deficit) occurred in a significant number in the allergy group, but there was no occurrence of these two diagnoses in the nonallergy group. The limitations of assessing immunologic status as a part of regular nursing assessments were discussed. Recommendations were provided for future research in the area of immunology, aging, and nursing diagnoses.