Anti-beta-2-glycoprotein I domain 1 identifies antiphospholipid antibodies-related injuries in patients with concomitant lupus nephritis.

BACKGROUND: In this study we aimed to evaluate the usefulness of domain profiling of Beta-2-glycoprotein I(ß2GPI)-Domain-1 (D1) antibodies in relation to antiphospholipid antibodies (aPL)-related nephropathy (aPL-N) in patients with biopsy-proven lupus nephritis (LN). METHODS: Of 124 consecutive patients (96 women, mean age 45.5 ± 12.3 years, mean disease duration 14.7 ± 9.6 years) fulfilling the 1982 criteria for systemic lupus erythematosus (SLE), we identified 39 patients (mean age 39.84 ± 8.6 years, mean disease duration 11.3 ± 7.7 years) with the following characteristics: (a) biopsy-proven LN; (b) no previous diagnosis of antiphospholipid syndrome (APS) according to the current classification criteria. RESULTS: Patients with both LN and aPL-N had higher median aß2GPI-D1 antibody titres (220.1 CU, 25-75th IQ 29.1-334.2) as compared those with LN alone (46.5 CU, 25-75th IQ 12.5-75.1) (p = 0.0087). Median aß2GPI-D1 antibody titres were higher in patients with acute thrombotic microangiopathy (aTMA) (N = 7) (250.1 CU, 25-75th IQ 61.2-334.2) vs. with LN alone (46.5 CU, 25-75th IQ 12.5-75.1 CU) (p = 0.0009). Having a Global Antiphospholipid Syndrome Score > 10 confers an increased probability of having acute features of aTMA (OR 6.25, 95%CI 1.2-31.8). As compared to other aPL, aß2GPI-D1 antibodies have the best diagnostic accuracy for aTMA as evaluated by performances in Area Under the Curves in a ROC analysis. CONCLUSIONS: aß2GPI-D1 antibodies detection might provide a second-line assay to be performed in aß2GPI positive patients with LN, allowing more accurate stratification of the renal vascular involvement risk, thus potentially leading to a more tailored management.

Merkel cell carcinoma of the forehead area: a literature review and case report.

BACKGROUND: Merkel cell carcinoma (MCC) is an uncommon, aggressive malignancy of the skin, mostly affecting head and neck area in elderly white patients. Between head/neck sites, face accounts for 61% and forehead accounts for 17% of all face MCCs. PURPOSE: We here present a literature review MCC cases arising in the forehead area, published in the English literature in the period 1987-2018, and report a personal observation with a late diagnosis and a treatment out of the current recommendations. The aims of this paper are to provide an up-to-date on MCC arising in the forehead area and to raise awareness about misdiagnosis of this type of lesion mimicking arteriovenous malformations (AVM). MATERIAL AND METHOD: Literature review was performed on PubMed and Medline database and "Merkel cell carcinoma (MCC)," "forehead" and "MCC forehead location" were the terms the authors searched for. Patients' data have been drawn from descriptions of single cases and of short case series reports. For each case, data were collected about clinical characteristics, treatment modalities and outcomes. The study has been limited to the clinical features of the disease, excluding etiologic/pathogenic aspects. RESULTS: Twenty-five patients with forehead MCC have been identified, coming from 20 sources. Nineteen presented a locoregional disease and 6 had an advanced pathology. TNM classification was reported in only two cases lacking for the other available data. Patients presented at mean age of 66 years with solitary or multiple nodules or dome-shaped/hemispherical mass, rarely ulcerated. Mean size of tumors was 1.13 cm of max diameter. Previous or concurrent malignancies or immune-hematologic disorders (AIDS) were often associated. At first investigation, lesion was often mistaken for other malignant or benign processes and, then, diagnosis was generally late. Some type of preoperative biopsy was performed in 3 patients, while the others had only a postoperative microscopic study of specimen. Initial treatment consisted in 6 cases (24%) in a not further specified about extent and width of margins local excision of the primary lesion, while a wide resection was reported in only 3 cases (12%). Surgical treatment of involved lymph-nodes was performed in 3 cases (12%). Six patients underwent radiotherapy for locoregional or distant recurrences. Mortality and overall survival rate at five years were 28% and 24%, respectively. Spontaneous regression was observed in 3 patients (12%). CASE REPORT: Personal observation concerned an 82-year-old woman presenting with a forehead periorbital 5 × 5 cm red-bluish mass. The erythematous lesion was erroneously diagnosed as hemangioma on the base of color, the absence of any signs of malignancy, an angio CT indicating a hypervascular tissue and a FNA cytology (FNAC) lacking of malignant cells. The mass was excised as a benign lesion with about 1 cm margins extent without searching larger edges. Postoperative radiotherapy was offered to the patient after histology report, but she refused. After 4 months from surgery, she had a parotid metastasis and died from the illness in spite of platinum-based chemotherapy. CONCLUSIONS: This study confirms the aggressiveness of forehead MCC, comparable with that of other face similar tumors. Personal case suggests that the deceitful benign feature of lesion may mimic an AVM and that FNAC may be misleading and diagnostic failure worsen prognosis. Our experience suggests that in the face smaller than 2-3 cm margins resection may increase the risk of locoregional recurrence. Therefore, postoperative wide-field irradiation should be ever delivered, after forehead MCC surgery, not only when clear margins are unattainable or involved with tumor, but also when negative microscopic edges are documented and residual cancer is thought not persist in the tumor bed. Orbit irradiation seems to be not dangerous for the eye.

The Peltier driven frequency domain approach in thermal analysis.

The merits of Frequency Domain analysis as a tool for thermal system characterization are discussed, and the complex thermal impedance approach is illustrated. Pure AC thermal flux generation with negligible DC component is possible with a Peltier device, differently from other existing methods in which a significant DC component is intrinsically attached to the generated AC flux. Such technique is named here Peltier Driven Frequency Domain (PDFD). As a necessary prerequisite, a novel one-dimensional analytical model for an asymmetrically loaded Peltier device is developed, which is general enough to be useful in most practical situations as a design tool for measurement systems and as a key for the interpretation of experimental results. Impedance analysis is possible with Peltier devices by the inbuilt Seebeck effect differential thermometer, and is used in the paper for an experimental validation of the analytical model. Suggestions are then given for possible applications of PDFD, including the determination of thermal properties of materials.

Frequency domain analysis of spreading-constriction thermal impedance.

Spreading-constriction effects are analyzed in the frequency domain. The existence of a half-pole altering the steady state solution at high frequencies is pointed out. Application to the case of thermoelectric devices allows direct comparison with experimental data because thermal quantities can be measured as electrical signals at the very spot where spreading takes place. Good agreement with theory is shown here for a thermoelectric device in which the particular constriction geometry enhances its effect, making easily observable the difference between frequency domain and the steady state approaches.

An accurate new method to measure the dimensionless figure of merit of thermoelectric devices based on the complex impedance porcupine diagram.

The heat diffusion related f(-1/2) slow decay in the frequency domain transfer function of thermoelectric devices introduces a bias in figure of merit measurement methods that do not take it into account. The bias can range from less than 1% to more than 20% depending on the device. Harman type methods are not immune. Neither is the simple single measurement procedure proposed here on the basis of a complex thermal impedance analysis of the device, but in this case the supporting theory allows evaluating and correcting for the bias with documented accuracy. To this aim, both a theoretical approach based on a priori knowledge of the device and an experimental one based on theory guided measurements are possible and are described in the paper. Typical residual Type B uncertainties after correction can be below 10% of the bias.

The elusive half-pole in the frequency domain transfer function of Peltier thermoelectric devices.

A half-pole can be expected in the transfer function of a Peltier device because proportionality between the diffusion length and the square root of the diffusion time is intrinsic in the diffusion equation. The resulting -1∕2 bilogarithmic slope (10 dB∕dec) is, however, easily masked by the thermal time constant of the load, which makes it elusive. The goal of this work is to identify the arrangements which can reveal and make usable the half-pole, because the latter can be instrumental in a servo control to increase the open-loop gain without risking instability. The diffusion equation was solved in a sine wave regime for a one-dimensional model of a Peltier device. The Laplace transform method was used, and the periodic solution was obtained using Cauchy's theorem and the method of residues. The -1∕2 slope of the half-pole appeared observable in a frequency range which can be several decades wide, depending on details of device configuration and considered position within. Amplitude and phase of temperature and heat flux in various spots are discussed with emphasis on the physical meaning, and a comparison is provided with solutions yielded by the lumped model, which cannot show the half-pole. An experimental check of the theoretical approach and analysis was made taking into account the deviations from one-dimensionality occurring in a real Peltier device. Given a constant amplitude sine wave injected current, the quadrature component of the Seebeck voltage across the whole series of junctions was identified as the most easily measurable quantity related to the thermal response of the device. Experimental results for the latter turned out in good agreement with analytical solutions.

Hospital costs of coronary artery bypass grafting on elective coronary patients.

OBJECTIVE: To assess hospital costs associated with coronary artery bypass grafting performed on elective coronary patients, and the relation of costs with the number of grafts. METHODS: Descriptive prospective study carried out at Instituto Dante Pazzanese de Cardiologia in April, May and June of 2005. Coronary patients of different ages and both genders were included. Emergency patients, patients with other associated heart conditions and reoperation cases were excluded. Appropriate forms for the operating room, early postoperative period and for the final period in the ward were developed for the initial hospitalization phase preoperatively. RESULTS: The procedure was performed on 103 patients, at an average cost of R$6,990.00 (US$2,784.98), at a minimum of R$5,438.69 (US$2,166.81), and maximum of R$11,778.96 (US$4,692.81); standard deviation was R$1,035.47 (US$412.54) and the confidence interval was 95%, ranging from R$6,790.33-R$7,190.27 (US$2,705.31-US$2,864.67). The total average cost for three to five bypass grafts was higher (R$7,148.05) than for one and two bypass grafts (R$6,659.29) and the difference was significant (p < 0.05). CONCLUSION: The highest average costs were in the operating room (R$4,627.97), and in the early postoperative period (R$1,221.39), followed by costs incurred in the ward after the early postoperative period (R$840.04) and by the initial preoperative period in the ward (R$300.90).