Chemical Bonding, 10Dq Parameter and Superexchange in the Model Compound KNiF3.

The cubic field splitting parameter, 10Dq, plays a central role in the ligand field theory on insulating transition metal compounds. Experimental data obtained in the last 50 years prove that 10Dq is highly dependent on changes of the metal-ligand distance, R, induced by chemical or applied pressures. Despite this fact has important consequences on optical and magnetic properties of such compounds, its actual origin is still controversial. Seeking to clarify that crucial issue, this work is focused on KNiF3, a reference system among insulating transition metal compounds. By means of first principles calculations we show that, contrary to what is usually thought, the R-dependence of 10Dq arises neither from the crystal field contribution nor from the covalent admixture of 3d(Ni) with valence 2p(F) orbitals. Indeed, we prove that it is mainly due to the residual covalency with deep 2s(F) orbitals, highly sensitive to R variations. As a salient feature the present calculations show that the 3d-2pσ and 3d-2pπ admixtures raise practically equal the energy of antibonding eg and t2g orbitals of NiF6 4- units in KNiF3 thus leading to a null contribution to 10Dq. This conclusion is not significantly altered when considering the change of covalency on passing from the ground state 3A2(t2g 6eg 2) to the excited state 3T2(t2g 5eg 3). The different influence of chemical bonding on the superexchange constant, J, and 10Dq is also discussed in a second step. It is pointed out that the strong dependence of J upon R can hardly be explained through the behavior of the 3d-2pσ covalency derived for a single NiF6 4- unit. For the sake of clarity, the meaning of 10Dq is also briefly analyzed.

Red Shift in Optical Excitations on Layered Copper Perovskites under Pressure: Role of the Orthorhombic Instability.

The red shift under pressure in optical transitions of layered compounds with CuCl6 4- units is explored through first-principles calculations and the analysis of available experimental data. The results on Cu2+ -doped (C2 H5 NH3 )2 CdCl4 , that is taken as a guide, show the existence of a highly anisotropic response to pressure related to a structural instability, driven by a negative force constant, that leads to an orthorhombic geometry of CuCl6 4- units but with a hole displaying a dominant 3z2 -r2 character (z being the direction perpendicular to the layer plane). As a result of such an instability, a pressure of only 3 GPa reduces by 0.21 Šthe longest Cu2+ -Cl- distance, lying in the layer plane, while leaving unmodified the two other metal-ligand distances. Owing to this fact, it is shown that the lowest d-d transition would experience a red shift of 0.34 eV while the first allowed charge transfer transition is also found to be red shifted but only by 0.11 eV that reasonably concurs with the experimental value. The parallel study on Jahn-Teller systems CdCl2 :Cu2+ and NaCl:Cu2+ involving tetragonal elongated CuCl6 4- units shows that the reduction of the long axis by a pressure of 3 GPa is three times smaller than that for the layered (C2 H5 NH3 )2 CdCl4 :Cu2+ compound. Accordingly, the optical transitions of such systems, which involve a positive force constant, are much less sensitive to pressure than in layered compounds. The origin of the red shift under pressure undergone by the lowest d-d and charge transfer transitions of (C2 H5 NH3 )2 CdCl4 :Cu2+ is discussed in detail.

New Ideas for Understanding the Structure and Magnetism in AgF2 : Prediction of Ferroelasticity.

In the search for new high-temperature superconductors, it has been proposed that there are strong similarities between the fluoroargentate AgF2 and the cuprate La2 CuO4 . We explored the origin of the possible layered structure of AgF2 by studying its parent high-symmetry phase and comparing these results with those of a seemingly analogous cuprate, CuF2 . Our findings first stress the large differences between CuF2 and AgF2 . Indeed, the parent structure of AgF2 is found to be cubic, naturally devoid of any layering, even though Ag2+ ions occupy trigonal sites that, nevertheless, allow the existence of a Jahn-Teller effect. The observed Pbca orthorhombic phase is found when the system is cooperatively distorted by a local E⊗e trigonal Jahn-Teller effect around the silver sites that creates both geometrical and magnetic layering. While the distortion implies that two Ag2+ -F- bonds increase their distance by 15 % and become softer, our simulations indicate that covalent bonding and interlayer electron hopping is strong, unlike the situation in cuprate superconductors, and that, in fact, exfoliation of individual planes might be a harder task than previously suggested. As a salient feature, these results prove that the actual magnetic structure in AgF2 is a direct consequence of vibronic contributions involved in the Jahn-Teller effect. Finally, our findings show that, due to the multiple minima intrinsic to the Jahn-Teller energy surface, the system is ferroelastic, a property that is strongly coupled to magnetism in this argentate.

Ground State and Optical Excitations in Compounds with Tetragonal CuF64- Units: Insight into KAlCuF6 and CuFAsF6.

It has been argued that AAlCuF6 (A = K, Cs) and CuFAsF6 are the only known crystals that exhibit compressed CuF64- units due to the Jahn-Teller effect. However, no grounds for this singular behavior have yet been reported. By means of first-principles calculations on such compounds and the isomorphous compounds involving Zn2+ ions instead of Cu2+, we prove that neither the ground state nor the equilibrium geometry of CuF64- complexes in KAlCuF6 and CuFAsF6 is the result of a Jahn-Teller effect. In contrast, it is shown that the internal electric field, ER(r), created by the rest of the lattice ions upon the localized electrons in the complex, plays an important role in understanding this matter as well as the d-d transitions of these two compounds. The energy of an optical transition is shown to involve two contributions: the intrinsic contribution derived for the isolated CuF64- unit at equilibrium and the extrinsic contribution coming from the ER(r) field. Aside from reproduction of the experimental d-d transitions observed for KAlCuF6, it is found that in CuFAsF6 the b1g(x2 - y2) → a1g(3z2 - r2) transition is not the lowest one due to the stronger effects from the internal field. Interestingly, the intrinsic contribution corresponding to that transition can simply be written as ß(Req - Rax) where Req and Rax are the equatorial and axial Cu2+-F- distances and ß = 2.7 eV/Å is the same for all systems involving tetragonal CuF64- units and an average metal-ligand distance close to 2.03 Å. This shows the existence of a common point shared by the Jahn-Teller system KZnF3:Cu2+ and other non-Jahn-Teller systems such as KAlCuF6, CuFAsF6, K2ZnF4:Cu2+, and Ba2ZnF6:Cu2+. Although most Jahn-Teller systems display an elongated geometry, there are however many Cu2+ compounds with a compressed geometry but hidden by an additional orthorhombic instability. The lack of that instability in KAlCuF6 and CuFAsF6 is also discussed.

Understanding the Structure and Ground State of the Prototype CuF2 Compound Not Due to the Jahn-Teller Effect.

Insulating CuF2 is considered a prototype compound displaying a Jahn-Teller effect (JTE) which gives rise to elongated CuF64- units. By means of first-principles calculations together with an analysis of experimental data of both CuF2 and Cu2+-doped ZnF2, we demonstrate that such an idea is not correct. For ZnF2:Cu2+, we find that CuF64- units are compressed always along the Z local axis with a hole essentially in a 3 z2- r2 antibonding orbital, in agreement with experimental EPR data that already underline the absence of a JTE. The structure of the monoclinic CuF2 crystal also comes from compressed CuF64- complexes, although hidden by an additional orthorhombic instability due to a negative force constant of b2g and b3g local modes. The associated distortion, similar to that involved in K2CuF4 and other layered Cu2+ compounds, is also shown to be developed for ZnF2:Cu2+ upon increasing the copper concentration. The origin of this cooperative effect is discussed together with the differences between non-Jahn-Teller systems like ZnF2:Cu2+ and CuF2 and true Jahn-Teller systems like KZnF3:Cu2+. From present results and those on layered compounds, the usual assumption of a JTE for explaining the properties of d9 ions in low-symmetry lattices can hardly be right.

Necrolisis epidérmica tóxica: un paradigma de enfermedad crítica / Toxic epidermal necrolysis: a paradigm of critical illness

RESUMEN La necrolisis epidérmica tóxica es una reacción cutánea adversa de tipo inmunológico secundaria en la mayor parte de los casos a la administración de un fármaco. La necrolisis epidérmica tóxica, el síndrome de Steven Johnson y el eritema exudativo multiforme forman parte del mismo espectro de enfermedad. La mortalidad de la necrolisis epidérmica tóxica es alrededor del 30%. La fisiopatología de la necrolisis epidérmica tóxica es semejante en muchos aspectos a la de las quemaduras dérmicas superficiales. La afectación mucosa del epitelio ocular y genital se asocia con secuelas graves si no se trata de forma temprana. Se acepta en general que los pacientes con necrolisis epidérmica tóxica son tratados mejor en unidades de grandes quemados, donde existe experiencia en el manejo de enfermos con pérdida cutánea extensa. El tratamiento es de soporte, eliminación y cobertura con derivados biosintéticos de la piel de las zonas afectadas, tratamiento de la afectación mucosa, y tratamiento inmunosupresor específico. De los tratamientos ensayados sólo se usa actualmente en la mayor parte de los centros la inmunoglobulina G y la ciclosporina A, aun cuando no existe evidencia sólida para recomendar ningún tratamiento específico. Entre los aspectos particulares del tratamiento de esta enfermedad se encuentra la prevención de secuelas relacionadas con la formación de sinequias, los cuidados oculares para prevenir secuelas graves que pueden conducir a la ceguera, y el tratamiento específico inmunosupresor. Un mejor conocimiento de los principios del manejo de la necrolisis epidérmica tóxica llevará a un mejor manejo de la enfermedad, a una mayor supervivencia y una menor prevalencia de las secuelas.

ABSTRACT Toxic epidermal necrolysis is an adverse immunological skin reaction secondary in most cases to the administration of a drug. Toxic epidermal necrolysis, Stevens-Johnson syndrome, and multiform exudative erythema are part of the same disease spectrum. The mortality rate from toxic epidermal necrolysis is approximately 30%. The pathophysiology of toxic epidermal necrolysis is similar in many respects to that of superficial skin burns. Mucosal involvement of the ocular and genital epithelium is associated with serious sequelae if the condition is not treated early. It is generally accepted that patients with toxic epidermal necrolysis are better treated in burn units, which are experienced in the management of patients with extensive skin loss. Treatment includes support, elimination, and coverage with biosynthetic derivatives of the skin in affected areas, treatment of mucosal involvement, and specific immunosuppressive treatment. Of the treatments tested, only immunoglobulin G and cyclosporin A are currently used in most centers, even though there is no solid evidence to recommend any specific treatment. The particular aspects of the treatment of this disease include the prevention of sequelae related to the formation of synechiae, eye care to prevent serious sequelae that can lead to blindness, and specific immunosuppressive treatment. Better knowledge of the management principles of toxic epidermal necrolysis will lead to better disease management, higher survival rates, and lower prevalence of sequelae.

Predictors of diffuse alveolar damage in patients with acute respiratory distress syndrome: a retrospective analysis of clinical autopsies.

BACKGROUND: Although diffuse alveolar damage (DAD) is considered the typical histological pattern of acute respiratory distress syndrome (ARDS), only half of patients exhibit this morphological hallmark. Patients with DAD may have higher mortality than those without DAD. Therefore, we aimed to identify the factors associated with DAD in patients with ARDS. METHODS: We analyzed autopsy samples of 356 patients who had ARDS at the time of death. DAD was assessed by two pathologists, and ARDS criteria were evaluated by two intensivists. Criteria for severe ARDS included the degree of hypoxemia and the ancillary variables of the current Berlin definition assessed within 48 h before death: radiographic severity, high positive end-expiratory pressure (PEEP) level, and physiological variables (i.e., altered respiratory system compliance and large anatomic dead space). RESULTS: After multivariable analysis, high PEEP levels, physiological variables, and opacities involving only three quadrants on chest radiographs were not associated with DAD. The four markers independently associated with DAD were (1) duration of evolution (OR 3.29 [1.95-5.55] for patients with ARDS ≥ 3 days, p < 0.001), (2) degree of hypoxemia (OR 3.92 [1.48-10.3] for moderate ARDS and 6.18 [2.34-16.3] for severe ARDS, p < 0.01 for both), (3) increased dynamic driving pressure (OR 1.06 [1.04-1.09], p = 0.007), and (4) radiographic severity (OR 2.91 [1.47-5.75] for patients with diffuse opacities involving the four quadrants, p = 0.002). DAD was found in two-thirds of patients with a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen ≤ 100 mmHg and opacities involving the four quadrants. CONCLUSIONS: In addition to severe hypoxemia, diffuse opacities involving the four quadrants were a strong marker of DAD.

Cervical cancer screening cotesting with cytology and MRNA HPV E6/E7 yields high rates of CIN2+ lesions in young women.

BACKGROUND: European guidelines recommend primary HPV testing for cervical cancer screening. However, the starting age remains to be defined, with an undecided window between 30 and 35 years. This pilot study compares the effectiveness of primary HPV testing to that of cytology for the detection of high-grade (CIN2+) lesions stratified by age. METHODS: Cotesting with LBC cytology and APTIMA® HPV (AHPV) was performed in 5053 women aged 25-65 in an opportunistic screening program in Madrid. AHPV-positive cases were referred to colposcopy and genotyped for HPV16 and 18/45 (AHPV-GT). Results were analyzed stratified in four age groups. RESULTS: 454 cases (9.0%) were AHPV-positive. Women under 35 had a 30.2% CIN2+ rate, compared to 21.9% and 20.4% for women aged 35-44 or 45-54. There was a significant increase (P < .05) in the rate of CIN2+ in AHPV-GT-positive women when compared to that for other HPV types (AHPV-other), being 43.3% versus 15.7%. AHPV-GT-positive women under 35 had significantly higher rates of CIN2+ lesions than any other age-group. The sensitivity of cytology for cervical CIN2+ in APHV-positive women was 60.6%. All 4 carcinomas, including one AHPV-negative endometrial adenocarcinoma, had abnormal cytology. All cervical CIN2+ lesions biopsied were AHPV-positive. CONCLUSIONS: Aptima HPV shows a significantly higher sensitivity for cervical CIN2+ lesions than cytology alone. Unexpectedly, AHPV-positive women under 35 had the highest incidence of CIN2+ lesions, particularly when they are HPV16/18/45-positive. Reconsidering HPV primary screening before the recommended age of 35 is warranted.

Large Differences in the Optical Spectrum Associated with the Same Complex: The Effect of the Anisotropy of the Embedding Lattice.

Transition-metal complexes with a well-defined geometry are usually considered to display almost the same properties independently of the system where they are embedded. Here we show that the above statement is not true depending on the anisotropy of the host lattice, which is revealed in the form of the electric field created by the rest of lattice ions over the complex. To illustrate this concept we analyze the origin of the surprisingly large differences in the d-d optical transitions of two systems containing square-planar CuF42- complexes, CaCuF4, and center II in Cu2+-doped Ba2ZnF6, even though the Cu2+-F-distance difference is just found to be 1%. Using a minimalist first-principles model we show that the different morphology of the host lattices creates an anisotropic field that red-shifts the in vacuo complex transitions to the 1.25-1.70 eV range in CaCuF4, while it blue-shifts them to the 1.70-3.0 eV region in Ba2ZnF6:Cu2+. This particular example shows how the lattice anisotropy strongly alters the optical properties of a given transition-metal complex. This knowledge opens a new path to tune the spectra of this large family of systems.

Toxic epidermal necrolysis: a paradigm of critical illness. / Necrolisis epidérmica tóxica: un paradigma de enfermedad crítica.

Toxic epidermal necrolysis is an adverse immunological skin reaction secondary in most cases to the administration of a drug. Toxic epidermal necrolysis, Stevens-Johnson syndrome, and multiform exudative erythema are part of the same disease spectrum. The mortality rate from toxic epidermal necrolysis is approximately 30%. The pathophysiology of toxic epidermal necrolysis is similar in many respects to that of superficial skin burns. Mucosal involvement of the ocular and genital epithelium is associated with serious sequelae if the condition is not treated early. It is generally accepted that patients with toxic epidermal necrolysis are better treated in burn units, which are experienced in the management of patients with extensive skin loss. Treatment includes support, elimination, and coverage with biosynthetic derivatives of the skin in affected areas, treatment of mucosal involvement, and specific immunosuppressive treatment. Of the treatments tested, only immunoglobulin G and cyclosporin A are currently used in most centers, even though there is no solid evidence to recommend any specific treatment. The particular aspects of the treatment of this disease include the prevention of sequelae related to the formation of synechiae, eye care to prevent serious sequelae that can lead to blindness, and specific immunosuppressive treatment. Better knowledge of the management principles of toxic epidermal necrolysis will lead to better disease management, higher survival rates, and lower prevalence of sequelae.

La necrolisis epidérmica tóxica es una reacción cutánea adversa de tipo inmunológico secundaria en la mayor parte de los casos a la administración de un fármaco. La necrolisis epidérmica tóxica, el síndrome de Steven Johnson y el eritema exudativo multiforme forman parte del mismo espectro de enfermedad. La mortalidad de la necrolisis epidérmica tóxica es alrededor del 30%. La fisiopatología de la necrolisis epidérmica tóxica es semejante en muchos aspectos a la de las quemaduras dérmicas superficiales. La afectación mucosa del epitelio ocular y genital se asocia con secuelas graves si no se trata de forma temprana. Se acepta en general que los pacientes con necrolisis epidérmica tóxica son tratados mejor en unidades de grandes quemados, donde existe experiencia en el manejo de enfermos con pérdida cutánea extensa. El tratamiento es de soporte, eliminación y cobertura con derivados biosintéticos de la piel de las zonas afectadas, tratamiento de la afectación mucosa, y tratamiento inmunosupresor específico. De los tratamientos ensayados sólo se usa actualmente en la mayor parte de los centros la inmunoglobulina G y la ciclosporina A, aun cuando no existe evidencia sólida para recomendar ningún tratamiento específico. Entre los aspectos particulares del tratamiento de esta enfermedad se encuentra la prevención de secuelas relacionadas con la formación de sinequias, los cuidados oculares para prevenir secuelas graves que pueden conducir a la ceguera, y el tratamiento específico inmunosupresor. Un mejor conocimiento de los principios del manejo de la necrolisis epidérmica tóxica llevará a un mejor manejo de la enfermedad, a una mayor supervivencia y una menor prevalencia de las secuelas.

Increased risk of malignancy for non-atypical urothelial cell groups compared to negative cytology in voided urine. Morphological changes with LBC.

Liquid-based cytology (LBC) has recently become the preferred method for urine cytology analysis, but differences with conventional cytology (CC) have been observed. The purpose of this study is to analyze these differences and the clinical relevance of non-atypical urothelial cell groups (UCG) in voided urine specimens. Reporting terminology is discussed. Initially, diagnostic categories from 619 LBC and 474 CC samples, reviewed by five different pathologists, were compared (phase 1). Five years after LBC was implemented and applying strict cytologic criteria for UCG diagnosis, 760 samples were analyzed (phase 2) and compared to previous LBC specimens. Diagnostic differences, interobserver variability and clinicopathological correlation with a 6-month follow-up, were analyzed. UCG increased from 6.5% with CC to 20.7% (218%, 3.2 fold, P < 0.0001) with LBC. This difference was not related to interobserver variability. Five years later, the rate of UCG had decreased to 13 2%. While 6% of cases with a negative cytology had urothelial carcinoma (UC) within 6 months of diagnosis, this percentage increased to 15.7% with UCG. The sensitivity of the UCG category for UC was low (30.4%), but the specificity and the negative predictive value (NPV) were high (87.1% and 94%, respectively). LBC increases UCG when compared to CC. This can be corrected with observers experience and using set cytological criteria. Due to its association with carcinoma, the presence of UCG in voided urine should be framed in a diagnostic category other than "negative for malignancy." Diagn. Cytopathol. 2016;44:582-590. © 2016 Wiley Periodicals, Inc.

A Genuine Jahn-Teller System with Compressed Geometry and Quantum Effects Originating from Zero-Point Motion.

First-principle calculations together with analysis of the experimental data found for 3d(9) and 3d(7) ions in cubic oxides proved that the center found in irradiated CaO:Ni(2+) corresponds to Ni(+) under a static Jahn-Teller effect displaying a compressed equilibrium geometry. It was also shown that the anomalous positive g∥ shift (g∥ -g0 =0.065) measured at T=20 K obeys the superposition of the |3 z(2) -r(2) ⟩ and |x(2) -y(2) ⟩ states driven by quantum effects associated with the zero-point motion, a mechanism first put forward by O'Brien for static Jahn-Teller systems and later extended by Ham to the dynamic Jahn-Teller case. To our knowledge, this is the first genuine Jahn-Teller system (i.e. in which exact degeneracy exists at the high-symmetry configuration) exhibiting a compressed equilibrium geometry for which large quantum effects allow experimental observation of the effect predicted by O'Brien. Analysis of the calculated energy barriers for different Jahn-Teller systems allowed us to explain the origin of the compressed geometry observed for CaO:Ni(+) .

Clear Cell Atypical Fibroxanthoma: Clinicopathological Study of 6 Cases and Review of the Literature With Special Emphasis on the Differential Diagnosis.

Atypical fibroxanthoma (AFX) is an uncommon dermal-based neoplasm arising on the sun-damaged skin of elderly people. Clear cell AFX is a rare variant with only 12 cases reported until the present date, all of them as case reports, except for 1 small series of 3 cases. The authors report 6 new cases and review the literature with special emphasis on the differential diagnosis. The clear cell variant represents 5% of AFX from their files. Histopathologically, it consists of sheets of epithelioid, pleomorphic cells, intermixed with a varying number of giant multinucleated and spindle cells, the latter arranged in a fascicular pattern. All cell types predominantly exhibit a clear, microvacuolated cytoplasm with well-demarcated cell borders. The clinical and immunohistochemical features of this variant are similar to those of the classic type. Clear cell AFX must be differentiated from other cutaneous clear cell neoplasms, some of them with an aggressive clinical behavior, including clear cell melanoma, primary cutaneous and metastatic clear cell carcinomas, clear cell sarcoma, pleomorphic liposarcoma, tumor of perivascular epithelioid cells, and distinctive dermal clear cell mesenchymal neoplasm. The clinical presentation and immunohistochemical profile play a key role in the differential diagnosis.

Origin of the exotic blue color of copper-containing historical pigments.

The study of chemical factors that influence pigment coloring is a field of fundamental interest that is still dominated by many uncertainties. In this Article, we investigate, by means of ab initio calculations, the origin of the unusual bright blue color displayed by historical Egyptian Blue (CaCuSi4O10) and Han Blue (BaCuSi4O10) pigments that is surprisingly not found in other compounds like BaCuSi2O6 or CaCuO2 containing the same CuO4(6-) chromophore. We show that the differences in hue between these systems are controlled by a large red-shift (up to 7100 cm(-1)) produced by an electrostatic field created by a lattice over the CuO4(6-) chromophore from the energy of the 3z(2)-r(2) → x(2)-y(2) transition, a nonlocal phenomenon widely ignored in the realm of transition metal chemistry and strongly dependent upon the crystal structure. Along this line, we demonstrate that, although SiO4(4-) units are not involved in the chromophore itself, the introduction of sand to create CaCuSi4O10 plays a key role in obtaining the characteristic hue of the Egyptian Blue pigment. The results presented here demonstrate the opportunity for tuning the properties of a given chromophore by modifying the structure of the insulating lattice where it is located.

A Practical Computational Approach to Study Molecular Instability Using the Pseudo-Jahn-Teller Effect.

Vibronic coupling theory shows that the cause for spontaneous instability in systems presenting a nondegenerate ground state is the so-called pseudo-Jahn-Teller effect, and thus its study can be extremely helpful to understand the structure of many molecules. While this theory, based on the mixing of the ground and excited states with a distortion, has been long studied, there are two obscure points that we try to clarify in the present work. First, the operators involved in both the vibronic and nonvibronic parts of the force constant take only into account electron-nuclear and nuclear-nuclear interactions, apparently leaving electron-electron repulsions and the electron's kinetic energy out of the chemical picture. Second, a fully quantitative computational appraisal of this effect has been up to now problematic. Here, we present a reformulation of the pseudo-Jahn-Teller theory that explicitly shows the contributions of all operators in the molecular Hamiltonian and allows connecting the results obtained with this model to other chemical theories relating electron distribution and geometry. Moreover, we develop a practical approach based on Hartree-Fock and density functional theory that allows quantification of the pseudo-Jahn-Teller effect. We demonstrate the usefulness of our method studying the pyramidal distortion in ammonia and its absence in borane, revealing the strong importance of the kinetic energy of the electrons in the lowest a2″ orbital to trigger this instability. The present tool opens a window for exploring in detail the actual microscopic origin of structural instabilities in molecules and solids.

Comparison of the Berlin definition for acute respiratory distress syndrome with autopsy.

RATIONALE: A revised definition of clinical criteria for acute respiratory distress syndrome (ARDS), the Berlin definition, was recently established to classify patients according to their severity. OBJECTIVE: To evaluate the accuracy of these clinical criteria using diffuse alveolar damage (DAD) at autopsy as the reference standard. METHODS: All patients who died and had a clinical autopsy in our intensive care unit over a 20-year period (1991-2010) were included. Patients with clinical criteria for ARDS were identified from the medical charts and were classified as mild, moderate, or severe according to the Berlin definition using PaO2/FiO2 oxygenation criteria. Microscopic analysis from each pulmonary lobe was performed by two pathologists. MEASUREMENTS AND MAIN RESULTS: Among 712 autopsies analyzed, 356 patients had clinical criteria for ARDS at time of death, classified as mild (n = 49, 14%), moderate (n = 141, 40%), and severe (n = 166, 46%). Sensitivity was 89% and specificity 63% to identify ARDS using the Berlin definition. DAD was found in 159 of 356 (45%) patients with clinical criteria for ARDS (in 12, 40, and 58% of patients with mild, moderate, and severe ARDS, respectively). DAD was more frequent in patients who met clinical criteria for ARDS during more than 72 hours and was found in 69% of those with severe ARDS for 72 hours or longer. CONCLUSIONS: Histopathological findings were correlated to severity and duration of ARDS. Using clinical criteria the revised Berlin definition for ARDS allowed the identification of severe ARDS of more than 72 hours as a homogeneous group of patients characterized by a high proportion of DAD.

Chronology of histological lesions in acute respiratory distress syndrome with diffuse alveolar damage: a prospective cohort study of clinical autopsies.

BACKGROUND: Diffuse alveolar damage is the histological hallmark of acute respiratory distress syndrome (ARDS). However, the chronology of histological lesions is not well established. We aimed to determine the time to onset of exudative or proliferative changes and end-stage fibrosis in ARDS. METHODS: We analysed all patients who died between Jan 1, 1991, and Dec 31, 2010, in the intensive-care unit at the Hospital Universitario de Getafe, Madrid, Spain, and who had a clinical autopsy. Patients had to have clinical criteria for ARDS at time of death and histological features of diffuse alveolar damage at autopsy examination. Capillary congestion and intra-alveolar oedema characterised the exudative phase whereas proliferation of alveolar cell type 2 or fibroblasts, or fibrosis characterised the proliferative phase. FINDINGS: We analysed 159 patients. The prevalence of exudative changes decreased over time, being reported in 74 (90%) of 82 patients with ARDS of less than 1 week duration, 40 (74%) of 54 patients with disease of 1-3 week duration, and only four (17%) of 23 patients with disease of longer than 3 weeks' duration (p<0·0001). The incidence of proliferative changes increased over time, and was reported in 44 (54%) of 82 patients with ARDS of less than 1-week duration, 42 (78%) of 54 patients with disease duration of 1-3 weeks, and 23 (100%) of 23 patients with disease duration longer than 3 weeks (p<0·0001). Fibrosis was noted in three (4%) of 82 patients with disease of less than 1 week duration, 13 (24%) of 54 patients with disease of 1-3-weeks' duration, and 14 (61%) of 23 patients with disease longer than 3-week duration (p<0·0001). Fibrosis was more frequent in ARDS of pulmonary origin than in that of extrapulmonary origin. INTERPRETATION: Histological features of the lungs were related to duration of ARDS. Within the first week of evolution, exudative changes were predominant and fibrosis was rarely noted. Beyond the third week of evolution, proliferative changes were noted in all patients and fibrosis in two-thirds of them. Treatments with a potential effect on inflammation or fibrosis, or both, should probably focus on the first week after the onset of ARDS. FUNDING: None.

The giant magnetic anisotropy energy of Fe+ ions in SrCl2.

We show that values of the magnetic anisotropy energy (MAE), which are about two orders of magnitude larger than the usual ones for transition metal cations in insulators (approximately 0.01-1 cm(-1)), can be found for the less common ion Fe+. In SrCl2:Fe+, the MAE is 93 cm(-1) when calculated using second-order perturbation multi-configurational calculations (CASPT2) while a similar value is found using multi-reference density functional theory (MR-DFT). This result is even larger than other recently reported giant MAEs for atoms on surfaces or magnetic clusters. The microscopic origin of this giant MAE is discussed in detail.

Cytopathology of a primary follicular dendritic cell sarcoma of the liver of the inflammatory pseudotumor-like type.

Follicular dendritic cell (FDC) sarcoma is an exceedingly uncommon tumor of lymph nodes and extranodal tissues. The inflammatory pseudotumor (IPT)-like variant of FDC sarcoma of intraabdominal location is considered a separate entity, with different clinical and pathological features than those of the classic FDC tumor. There have been only 12 cytological reports of FDC sarcomas in the literature. Two of them were metastases to the liver and, like our case, had features of IPT. Fine-needle aspiration biopsy (FNAB) and imprint and scrape cytology from the surgically excised tumor here reported revealed spindle tumor cells with moderate pleomorphism, nuclear grooves, prominent nucleoli, and cytoplasmic processes, admixed with inflammatory cells. To the best of our knowledge, this is the first cytology report of a primary hepatic FDC tumor. The cytological findings permit the recognition of this tumor. However, confirmation by inmunohistochemistry (IHQ) is mandatory for a definitive diagnosis.