Diagnostic role of internal mammary lymph node involvement in tuberculous pleurisy: a multicenter study.

BACKGROUND AND OBJECTIVES: Diagnosis of tuberculous pleurisy (TP) may be challenging and it often requires pleural biopsy. A tool able to increase pre-test probability of TP may be helpful to guide diagnostic work-up and enlargement of internal mammary lymph node (IMLN) has been suggested to play a potential role. The aim of the present investigation was to assess role of IMLN involvement in TP in a multi-centric case-control study, by comparing its prevalence and test performance to those observed in patients with infectious, non-tuberculous pleurisy (NTIP), and in controls free from respiratory diseases (CP). METHODS: A total of 419 patients, from 14 Pulmonology Units across Italy were enrolled (127 patients affected by TP, 163 affected by NTIP and 129 CP). Prevalence, accuracy and predictive values of ipsilateral IMLN involvement between cases and control groups were assessed, as well as concordance between chest computed tomography (CT scan) and thoracic ultrasound (TUS) measurements. RESULTS: The prevalence of ipsilateral IMLN involvement in TP was significantly higher than that observed in NTIP and CP groups (respectively 77.2%, 39.3% and 14.7%). Results on test performance, stratified by age, revealed a high positive predictive value in patients aged ≤50 years, while a high negative predictive value in patients aged >50 years. The comparison between CT scan and ultrasound showed moderate agreement (Kappa=0.502). CONCLUSIONS: Evaluation of IMLN involvement plays a relevant role in assessing the pre-test probability of TP. Considering the increasing global prevalence of mycobacterial infections, a tool able to guide diagnostic work-up of suspected TP is crucial, especially where local sources are limited.

Can a weight loss of one pound a week be achieved with a 3500-kcal deficit? Commentary on a commonly accepted rule.

Despite theoretical evidence that the model commonly referred to as the 3500-kcal rule grossly overestimates actual weight loss, widespread application of the 3500-kcal formula continues to appear in textbooks, on respected government- and health-related websites, and scientific research publications. Here we demonstrate the risk of applying the 3500-kcal rule even as a convenient estimate by comparing predicted against actual weight loss in seven weight loss experiments conducted in confinement under total supervision or objectively measured energy intake. We offer three newly developed, downloadable applications housed in Microsoft Excel and Java, which simulates a rigorously validated, dynamic model of weight change. The first two tools available at http://www.pbrc.edu/sswcp, provide a convenient alternative method for providing patients with projected weight loss/gain estimates in response to changes in dietary intake. The second tool, which can be downloaded from the URL http://www.pbrc.edu/mswcp, projects estimated weight loss simultaneously for multiple subjects. This tool was developed to inform weight change experimental design and analysis. While complex dynamic models may not be directly tractable, the newly developed tools offer the opportunity to deliver dynamic model predictions as a convenient and significantly more accurate alternative to the 3500-kcal rule.

Recombination dynamics of deep defect states in zinc oxide nanowires.

The recombination dynamics of defect states in zinc oxide nanowires has been studied by developing a general expression for time-resolved photoluminescence intensity based on a second-order approximation for the radiative and non-radiative recombination rates. The model allows us to determine the parameters that characterize the recombination from deep defect states (defect concentration, unimolecular lifetime and bimolecular coefficient) through multi-fitting analysis of time-resolved photoluminescence measurements. Analyses conducted on zinc oxide nanowires gave deep state concentrations of the order of 10(18) cm(-3) and unimolecular lifetimes and bimolecular recombination coefficient comparable to those typical of interband recombination in direct gap semiconductors. The consistency of a 'two-channel decay' model (double exponential decay) has been tested by means of a similar analysis procedure. The results suggest that double exponential fitting of time-resolved photoluminescence data of zinc oxide nanowires may be just a mere phenomenological tool which does not reflect the real recombination dynamics of the visible emission band.

Ion specific effects on phase transitions in protein solutions.

A recent Monte Carlo simulation determined the potential of mean force between two lysozyme molecules in various aqueous solutions [M. Lund, Phys. Rev. Lett. 100, 258105 (2008)]. The study involved a combination of explicit solvent and continuum model simulations and showed that there are significant ion-specific protein-protein interactions due to hydrophobic patches on the protein surfaces. In this paper we use the results of their study to determine the phase diagram for lysozyme for aqueous solutions of NaCl and NaI. Two of the three phase diagrams have a stable fluid-fluid critical point, while the third has a slightly metastable critical point. This results from a secondary extremum in the potential associated with a repulsive interaction. This repulsive interaction reduces the effective range of the attractive interaction and produces a metastable critical point. We compare the results of one of these phase diagrams with that for a model that includes ion-dispersion forces, but does not contain solvent structural effects.

Marine diatoms as optical biosensors.

We have chemically modified the frustules of the marine diatom Coscinodiscus concinnus Wm. Smith to properly bind a highly selective bioprobe such as an antibody. By measuring the changes in the photoluminescence emission of diatoms frustules, we have monitored the molecular recognition event between the antibody and its ligand: the dissociation constant estimated is of the same order of that measured by standard Biacore. The nanostructured silica frustules, a low-cost and natural available material, have shown high sensitivity, equal to 1.2+/-0.2 nm microM(-1), and a detection limit of 100 nM, and thus are quite ideal candidates for lab-on-particle applications.

Phase diagram of a model of nanoparticles in electrolyte solutions.

We obtain accurate fluid-fluid coexistence curves for a recent simple model of interacting nanoparticles that includes the effects of ion-dispersion forces. It has been proposed that these ion-dispersion forces provide at least a partial explanation for the Hofmeister effect [M. Bostrom et al. Phys. Rev. Lett. 87, 168103 (2001)]. We study a model of aluminum oxide nanoparticle [Deniz et al., Colloids Surf. A 319, 98 (2008)] for three different electrolyte solutions with added salt type being sodium chloride, sodium iodide, and a nonpolarizable salt. We observe that the fluid-fluid coexistence curves depend substantially on the identity of added salt; this provides an efficient way of tuning the phase behavior of nanoparticles. The methods we employ include finite-size scaling (FSS), multicanonical histogram reweighting, and Gibbs ensemble methods. We show that, as expected, all three cases belong to the Ising universality class. The scaling fields and critical point parameters are obtained in the thermodynamic limit of infinite system size by extrapolation of our FSS results.

Hofmeister effect and the phase diagram of lysozyme.

The phase diagrams for lysozyme are calculated for two different precipitant salts, NaCl and NaSCN, using a potential of mean force that takes into account contributions from ion-dispersion forces [M. Boström, J. Phys. Chem. B 110, 24757 (2006)]. Our results are consistent with a recent perturbation theory calculation (referenced above) in that the phase diagram for lysozyme with NaCl is quite different than for lysozyme with NaSCN for the same molar concentration (0.2M) . However, in contrast to the perturbation theory calculation, we find that the lysozyme phase diagram with NaCl has a metastable fluid-fluid coexistence curve and that the metastability gap in the case of NaSCN is much larger than predicted by perturbation theory.

Direct role of surface oxygen vacancies in visible light emission of tin dioxide nanowires.

Tin dioxide (SnO(2)) nanowires exhibit a strong visible photoluminescence that is not observed in bulk crystalline SnO(2). To explain such effect, oxygen vacancies are often invoked without clarifying if they represent the direct origin of luminescence or if their presence triggers other radiative processes. Here we report an investigation of the nature of the visible light emission in SnO(2) nanowires, showing that both experimental and theoretical ab initio analyses support the first hypothesis. On the basis of photoluminescence quenching analysis and of first-principles calculations we show that surface bridging oxygen vacancies in SnO(2) lead to formation of occupied and empty surface bands whose transition energies are in strong agreement with luminescence features and whose luminescence activity can be switched off by surface adsorption of oxidizing molecules. Finally, we discuss how such findings may explain the decoupling between "electrical-active" and "optical-active" states in SnO(2) gas nanosensors [G. Faglia et al., Appl. Phys. Lett. 86, 011923 (2005)].

Field localization and enhanced Second-Harmonic Generation in silicon-based microcavities.

High-quality amorphous Silicon Nitride (a-Si(1-x)N(x):H) Fabry-Pérot microcavities can show resonant surface Second Harmonic Generation (SHG) effect. We consider two different layouts of planar microcavities with almost identical linear reflectance and show how the structure geometry can strongly affect SHG yield. In particular, a difference of more than one order of magnitude in the SHG intensity is observed when the fundamental beam is tuned at the cavity resonance frequency. We explain this finding on the basis of a theoretical model taking into account the spatial distribution of the electric fields of the pump and harmonic frequencies inside the structure. A satisfactory matching of experimental data with the theoretical model is obtained by considering the source of second-order nonlinearity as limited to surface contributions.

A new device for abrasive cytology sampling during upper gastrointestinal endoscopy: experience in infectious and neoplastic diseases.

BACKGROUND AND STUDY AIMS: The increase in infectious diseases of the gastrointestinal tract related to immunosuppression is becoming an important topic for the endoscopist. To improve the diagnostic efficacy of tissue acquisition while at the same time restricting costs, we have developed a new device for obtaining material from the upper gastrointestinal tract that can also be used in the diagnosis of neoplastic disease. PATIENTS AND METHODS: A total of 90 patients were examined and assigned to two groups according to indications. Group A consisted of 53 symptomatic patients with positive human immunodeficiency virus (HIV) serology with a suspicion of gastrointestinal infection. Group B included 37 patients in whom there was an endoscopic suspicion of neoplasia in the upper gastrointestinal tract. Cell fragments for cytological study were obtained using a device introduced through the endoscopic instrumentation channel (abrasive cytology). Different staining methods were used to isolate bacteria or diagnose tumors from cell fragments. The findings were compared with those obtained from conventional bioptic histology. RESULTS: Potentially responsible pathogens were isolated in 48 of the 53 patients in Group A, while bioptic histology provided a diagnosis in only 32 patients. In the 37 patients in group B, the cytological diagnosis matched the histological results. The costs of this new technique are similar to those for conventional cytological staining, and the time from sampling to obtaining a final diagnosis is less than one hour. CONCLUSIONS: This new device provides a fast and low-cost method of isolating pathogens and obtaining cell fragments from the gastrointestinal mucosa during routine upper gastrointestinal endoscopy.

Cost-effective analysis of surgical palliation versus endoscopic stenting in the management of unresectable pancreatic cancer.

BACKGROUND: Ductal carcinoma of the pancreas is unresectable for cure in the majority of patients. We reviewed our results and cost effectiveness of surgical and endoscopic biliary bypass for unresectable pancreatic cancer to evaluate the comparable outcomes. METHODS: Between 1990 and 1992, 136 patients were managed operatively or endoscopically for pancreatic carcinoma. Excluding potentially curative resections and patients without follow-up, 34 patients endoscopically stented and 32 patients surgically bypassed were evaluated. RESULTS: Mean patient age was older (72.1 vs. 69.3 years) but average performance status was comparable (0.8 vs. 0.9 Eastern Cooperative Oncology Group grading) in the medical treatment group. The initial hospital stay was significantly longer for surgical patients (mean 14 vs. 7 days, p < 0.001), with higher average charges ($18,325 vs. $9,663). Twelve stented patients required rehospitalization (average charge of $4,029), and eight surgical patients were readmitted (average charge of $6,776). An average of 1.7 stent changes (average charge $1,190) were required. Mean survival was longer for the stented group (9.7 vs. 7.3 months, p = 0.13). CONCLUSIONS: Endoscopic stenting for unresectable pancreatic cancer provides equivalent duration of survival at reduced cost and shorter hospital stay, although subsequent stent changes are necessary. When curative resection is not possible, endoscopic biliary drainage should be considered a good first choice for palliative management.

Further observations on the extramacular chromatic mechanisms.

Monochromatic targets presented at 30 degrees excentricity on orange, magenta and blue backgrouds are used. A small monochromatic light, 476 nm on orange, 551 nm on magenta and 621 nm on blue, is flashed at 3 cps-1 on the centre of the targets. The size of the targets is varied and their luminance adjusted using neutral filters until the flashing light is just not visible. This method allows the study of chromatic mechanism sensitivity and of retinal interactions (summation and inhibition). Some observations in normal as well as in pathological conditions are presented.