A Retrospective Study of Ultrasound Characteristics and Macroscopic Findings in Confirmed Malignant Pleural Effusion.

BACKGROUND: A definitive diagnosis of malignant pleural effusion (MPE) is reached by cytological or histological assessment, but thorough analysis of the ultrasound features of the effusion as well as pleural thickening or nodularity can also be of significant diagnostic help. OBJECTIVE: To assess the relationship of specific ultrasound characterisctics and macroscopic features of confirmed malignant pleural effusion, thus increasing the diagnostic potential of thoracic ultrasound. METHODS: The findings of thoracic ultrasonography performed prior to initial thoracentesis in 104 patients with subsequently confirmed malignant pleural effusion were analyzed with regard to the macroscopic features of the pleural effusion. RESULTS: Distribution in terms of frequency of hemorrhagic/sanguinolent (n=64) in relation to nonhemorrhagic transparent/opaque (n=40) MPE, regardless of their ultrasound characteristics, did not yield a statistically significant correlation (p=0.159). Conversely, the frequency distribution of hemorrhagic pleural effusions (n=8) in relation to nonhemorrhagic effusions (n=1), in the group of septated MPE, showed a statistically significant difference (p<0.001). The least number of patients (0.96%) had a complex septated MPE combined with the macroscopic appearance of a serous/transparent nonhemorrhagic effusion, which suggests that this combination is a sporadic occurrence and may have a diagnostic significance for this patient group. CONCLUSION: The incidence of specific combinations of the ultrasound characteristics and macroscopic appearance of MPEs showed different frequency distributions, which may improve the diagnostic value of thoracic ultrasound in this patient population.

Validity of Treadmill-Derived Critical Speed on Predicting 5000-Meter Track-Running Performance.

Nimmerichter, A, Novak, N, Triska, C, Prinz, B, and Breese, BC. Validity of treadmill-derived critical speed on predicting 5,000-meter track-running performance. J Strength Cond Res 31(3): 706-714, 2017-To evaluate 3 models of critical speed (CS) for the prediction of 5,000-m running performance, 16 trained athletes completed an incremental test on a treadmill to determine maximal aerobic speed (MAS) and 3 randomly ordered runs to exhaustion at the [INCREMENT]70% intensity, at 110% and 98% of MAS. Critical speed and the distance covered above CS (D') were calculated using the hyperbolic speed-time (HYP), the linear distance-time (LIN), and the linear speed inverse-time model (INV). Five thousand meter performance was determined on a 400-m running track. Individual predictions of 5,000-m running time (t = [5,000-D']/CS) and speed (s = D'/t + CS) were calculated across the 3 models in addition to multiple regression analyses. Prediction accuracy was assessed with the standard error of estimate (SEE) from linear regression analysis and the mean difference expressed in units of measurement and coefficient of variation (%). Five thousand meter running performance (speed: 4.29 ± 0.39 m·s; time: 1,176 ± 117 seconds) was significantly better than the predictions from all 3 models (p < 0.0001). The mean difference was 65-105 seconds (5.7-9.4%) for time and -0.22 to -0.34 m·s (-5.0 to -7.5%) for speed. Predictions from multiple regression analyses with CS and D' as predictor variables were not significantly different from actual running performance (-1.0 to 1.1%). The SEE across all models and predictions was approximately 65 seconds or 0.20 m·s and is therefore considered as moderate. The results of this study have shown the importance of aerobic and anaerobic energy system contribution to predict 5,000-m running performance. Using estimates of CS and D' is valuable for predicting performance over race distances of 5,000 m.

Gross efficiency during flat and uphill cycling in field conditions.

PURPOSE: While a number of studies have investigated gross efficiency (GE) in laboratory conditions, few studies have analyzed it in field conditions. Therefore, the aim of this study was to analyze the effect of gradient and cadence on GE in field conditions. METHODS: Thirteen trained cyclists (mean ± SD age 23.3 ± 4.1 y, stature 177.0 ± 5.5 cm, body mass 69.0 ± 7.2 kg, maximal oxygen uptake [VO2max] 68.4 ± 5.1 mL · min-1 ·kg-1) completed an incremental graded exercise test to determine ventilatory threshold (VT) and 4 field trials of 6 min duration at 90% of VT on flat (1.1%) and uphill terrain (5.1%) with 2 different cadences (60 and 90 rpm). VO2 was measured with a portable gas analyzer and power output was controlled with a mobile power crank that was mounted on a 26-in mountain bike. RESULTS: GE was significantly affected by cadence (20.6% ± 1.7% vs 18.1% ± 1.3% at 60 and 90 rpm, respectively; P < .001) and terrain (20.0% ± 1.5% vs 18.7% ± 1.7% at flat and uphill cycling, respectively; P = .029). The end-exercise VO2 was 2536 ± 352 and 2594 ± 329 mL/min for flat and uphill cycling, respectively (P = .489). There was a significant difference in end-exercise VO2 between 60 (2352 ± 193 mL/min) and 90 rpm (2778 ± 431 mL/min) (P < .001). CONCLUSION: These findings support previous laboratory-based studies demonstrating reductions in GE with increasing cadence and gradient that might be attributed to changes in muscle-activity pattern.

Flow cytometric analysis of deep-seated lymph nodes.

Flow cytometry (FC) immunophenotyping is an important tool in the evaluation of lymphadenopathy and is widely used in the diagnosis of non-Hodgkin's lymphomas (NHLs) on fine-needle aspirates of lymph nodes and extranodal sites. Because at least 80% of NHLs are of B-cell type, detection of immunoglobulin (Ig) light-chain-restriction is the most commonly used method for confirmation of monoclonality. The aim of our study was to evaluate usefulness of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for FC analysis from deep-seated lymph nodes and to compare results of FC clonality analysis to cytomorphologic diagnosis of sampled lymph nodes. For cytological diagnosis direct smears were made, selected slide was stained for rapid-on site evaluation procedure. Sixteen patients with suspected NHL of deep-seated lymph nodes obtained by EUS-FNA were submitted for FC clonality analysis using four-color multiparameter flow cytometry stained with kappa/lambda/CD19/CD45. Clonality analysis was performed on 11 samples. Monoclonality was demonstrated in seven of 11 cases cytologically diagnosed as NHL and four of 11 cases cytologically diagnosed as benign were polyclonal. Our results show that EUS-FNAC with FC is a sensitive and specific tool in the diagnosis of deep-seated B-NHL. Cytologic diagnosis combined with FC clonality analysis can be performed in majority of cases and may eliminate need for open biopsy in some cases.

Fine-needle aspiration cytology of apocrine hidradenoma.

An apocrine hidradenoma is a benign adnexal neoplasm, usually covered by intact skin, but may show superficial ulceration and serous discharge. This feature is raising the possibility of malignancy as it was in our case of macroscopically suspicious tumour. We described cytomorphologic features of cutaneous nodule that might be a lead to the cytologic diagnosis of hidradenoma, but primary or secondary malignant tumour has been ruled out first.

Fine needle aspiration cytology of chondroid syringoma.

Chondroid syringoma (CS) is a rare, benign, appendageal tumor with diagnostic feature of myxochondroid stroma supporting eccrine and apocrine epithelial structures. The usual presentation is a painless, slowly growing mass, typically located in the head and neck region. It usually affects middle-aged and older male patients. Because of its unremarkable clinical presentation it is often overlooked. It should be included in the differential diagnosis of cutaneous head and neck tumors, especially in middle-aged men. Optimal treatment of CS is total surgical excision. We present a 63 year-old man with a small nodule on the neck with 5 years of duration. The diagnosis was made initially on fine needle aspiration cytology that was performed by ultrasound guidance and confirmed subsequently by histology. FNA cytology may be very useful to determine diagnosis before excision.

Targeting multifunctional proteins by virtual screening: structurally diverse cytohesin inhibitors with differentiated biological functions.

Virtual screening (VS) of chemical libraries formatted in silico provides an alternative to experimental high-throughput screening (HTS) for the identification of small molecule modulators of protein function. We have tailored a VS approach combining fingerprint similarity searching and support vector machine modeling toward the identification of small molecular probes for the study of cytohesins, a family of cytoplasmic regulator proteins with multiple cellular functions. A total of 40 new structurally diverse inhibitors were identified, and 26 of these compounds were more active than the primary VS template, a single known inhibitory chemotype, in at least one of three different assays (guanine nucleotide exchange, Drosophila insulin signaling, and human leukocyte cell adhesion). Moreover, these inhibitors displayed differential inhibitory profiles. Our findings demonstrate that, at least for the cytohesins, computational extrapolation from known active compounds was capable of identifying small molecular probes with highly diversified functional profiles.

The importance of urgent cytological examination of synovial fluids in differentiation inflammatory and non-inflammatory joint diseases.

The aim of this study was to imply the possibilities of the urgent cytological examination of synovial fluids in differential diagnosis of arthropathies and to motivate the clinicians to use this method. It gave valuable information particularly with respect to differentiate the inflammatory and non-inflammatory joint diseases. This study included 115 synovial fluids obtained by fine needle aspiration (FNA) of the swollen knee from the patients in the period between 2003 and 2008. At our department the urgent cytological examination of the synovial fluids consisted of macroscopic analysis that includes volume, colour, clarity, viscosity and mucin clot test, native microscopic analysis for crystals and tissue fragments, counting the total nucleated cell count and semiquantitative microscopic analysis for neutrophil granulocyte percentage on the slides stained with Hemacolor rapid staining. All cytological analyses were done within one hour since FNA. According to our results the clarity, viscosity, mucin clot test, the total nucleated cell count and the neutrophil granulocyte percentage enabled distinction between inflammatory and non-inflammatory diseases with statistically significant difference at the 0.01 level but we could not differentiate these two groups of illnesses according to volume and colour. In inflammation the total nucleated cell count and the neutrophil granulocyte percentage was greater than in non-inflammation, the clarity was only translucent and opaque, the viscosity was low and the mucin clot test was negative. In non-inflammatory diseases the clarity varied from transparent to opaque, the total nucleated cell count and the neutrophil granulocyte percentage was smaller than in inflammatory diseases, the viscosity was high and consequently the mucin test was highly positive in all samples. Crystals were detected in only 12 samples of synovial fluids, mostly in inflammation and they were all monosodium urate (MUS) so we could diagnose gout. We could conclude that the urgent cytological analysis of the synovial fluid is a very useful, simple and reliable basic diagnostic screening test in differentiation inflammatory and non-inflammatory joint diseases and we recommended using it as the initial test in the diagnostic procedure of these illnesses using our protocol.

Requirement of CCL17 for CCR7- and CXCR4-dependent migration of cutaneous dendritic cells.

Chemokines are known to regulate the steady-state and inflammatory migration of cutaneous dendritic cells (DCs). The beta-chemokine CCL17, a ligand of CCR4, is inducibly expressed in a subset of DCs and is strongly up-regulated in atopic diseases. Using an atopic dermatitis model, we show that CCL17-deficient mice develop acanthosis as WT mice, whereas dermal inflammation, T helper 2-type cytokine production, and the allergen-specific humoral immune response are significantly decreased. Notably, CCL17-deficient mice retained Langerhans cells (LCs) in the lesional skin after chronic allergen exposure, whereas most LCs emigrated from the epidermis of allergen-treated WT controls into draining lymph nodes (LNs). Moreover, CCL17-deficient LCs showed impaired emigration from the skin after exposure to a contact sensitizer. In contrast, the absence of CCR4 had no effect on cutaneous DC migration and development of atopic dermatitis symptoms. As an explanation for the major migratory defect of CCL17-deficient DCs in vivo, we demonstrate impaired mobility of CCL17-deficient DCs to CCL19/21 in 3D in vitro migration assays and a blockade of intracellular calcium release in response to CCR7 ligands. In addition, responsiveness of CCL17-deficient DCs to CXCL12 was impaired as well. We demonstrate that the inducible chemokine CCL17 sensitizes DCs for CCR7- and CXCR4-dependent migration to LN-associated homeostatic chemokines under inflammatory conditions and thus plays an important role in cutaneous DC migration.