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The lumbar spine radiographs of 400 orthopaedic outpatients were reviewed to determine if the absence of the coned lateral lumbosacral junction radiograph would lead to a loss in diagnostic accuracy. In 84 (21%) patients the antero-posterior and lateral lumbar spine radiographs failed to visualize adequately the lumbosacral junction. In these patients the coned lateral lumbosacral junction radiograph resulted in 17 (4.5%) diagnoses which would otherwise have been missed. The diagnoses were spondylosis (11), spondylolisthesis (3), spondylolysis (1), Paget's disease (1) and infection (1). Absence of the coned lateral lumbosacral radiograph will result in inadequate demonstration of the lumbosacral junction and a loss in diagnostic accuracy.

We describe a patient with the typical features of Hajdu-Cheney Syndrome. The previously undescribed cranial computerised tomographic (C.T.) findings in this condition are discussed. In addition we describe a possible association with bowel malrotation.

An AlSiCu aluminium alloy reinforced with discontinuous amorphous Al2O3SiO2 fibres and particulates was produced in the semiliquid state using flow cast material. Two different compositions having 20 and 30 vol.% of reinforcement were tested. The material was then partially remelted and die forged to give defect-free components. Microstructural characterization was carried out on both as-produced and forged materials. Optical and scanning electron microscopy show that the reinforcements tend to distribute around the rounded dendrites typical of flow cast alloys. The effects of this trend influence also the structure of the shaped components. Finally, material testing was performed on the shaped materials.

A review of the world literature on streptokinase treatment of arterial thromboembolic disease is presented, followed by two cases of peripheral arterial thromboembolic disease successfully treated with streptokinase. The role of streptokinase in the treatment of arterial occlusive disease is discussed, and its emerging role as a primary mode of therapy in thromboembolic arterial disease is predicted. The successful management of venous embolic and occlusive disease by treatment with streptokinase is well-known, including its use in treating pul monary emboli, deep venous thromboses and clotted hemodialysis shunts. However, the role of streptokinase in the management of arterial thromboem bolic disease has not received much attention in the United States, although it has been used extensively in Europe. The purpose of this paper is to review the literature on the use of strep tokinase in treating thromboembolic arterial disease, to present two cases successfully treated with this technique, and to discuss the emerging role of streptokinase in arterial thromboembolic disease.

A sample of 95 coronary artery bypass surgery (CABS) patients was studied in order to examine the relationship between quality of life and CABS. Quality of life is studied through measures of social situation, physical limits, and work status. Findings indicate that quality of life improvement is a function of the patient's post-operative experience and perception of their physical limits, which, in turn, is likely to influence their desire to work. Retirement rates are high, particularly among patients over 55 years of age. Unemployment rates are high among those patients between 49–54 years of age. However, surprisingly few patients saw themselves as physically limited, a reflection of the high overall satisfaction with surgical outcome. The discussion focuses upon the use of productivity rather than work status measures as indicators of CABS success. The importance of the affiliative experience leads to specification of conditions under which life quality can be improved as a result of CABS. Surgery is discussed as a part of a complex interplay of physical and social experiences which influence individual and social benefits.

Mediastinal lymph node dissection in conjunction with pulmonary resection was performed in 232 patients with bronchogenic carcinoma at the University of Michigan Medical Center from 1959 to 1965. The mediastinum was irradiated postoperatively in those patients with mediastinal metastases. The absolute five-year survival rate of the patients undergoing resection was 29.2%. Of 110 patients with squamous cell carcinoma, 37.2% lived five years free of disease. The overall five-year survival of those patients undergoing resection who had no hilar lymph node metastases was 45.7%, and it was 45% in those with hilar metastases only. The absolute five-year survival rate of the patients with mediastinal metastases who received radiation therapy was 29.5%. Of 76 patients with adenocarcinoma, 19.7% lived five years free of disease. The overall five-year survival of those patients undergoing resection who had no lymph node metastases was 33%, whereas none of the patients with hilar metastases survived and only 1 of 17 patients with mediastinal metastases survived five years free of disease. The findings suggest that the histological cell type is an important factor in determining the prognosis in bronchogenic carcinoma, especially if there is evidence of lymph node involvement. In addition, this study also suggests that it is the presence, and not necessarily the extent, of lymph node metastases in patients with squamous cell carcinoma that determines the survival rate following pulmonary resection, provided those patients with mediastinal metastases undergo postoperative mediastinal irradiation.

Complete myocardial revascularization entails the grafting of all vessels of adequate size demonstrating occlusive arteriosclerotic vascular disease. Revascularization of the circumflex coronary artery in the atrioventricular groove has been a major surgical challenge because of the difficulty of exposing it. We discuss here our operative technique in 12 consecutive patients requiring revascularization of that segment of the circumflex coronary artery. Eleven grafts studied in the postoperative period were found to be patent, and the clinical course of the remaining patient and direct observations, including enzyme studies and periodic stress testing, have not shown any evidence of graft failure.

A 49-year-old Japanese man presented with chronic granulomatous uveitis in his left eye. Later he developed macular subretinal neovascularisation. The chest x-ray showed bilateral hilar lymphadenopathy. Bronchoscopy and gallium-67 scanning were positive, PPD skin test negative, and serum angiotensin converting enzyme (ACE) levels increased. Ophthalmoscopy and fluorescein angiography of the left eye showed perivasculitis, retinochoroidal exudates, snow banking, and vitreous opacity. On these findings, the diagnosis of sarcoidosis was made. Treatment was based on topical corticosteroids, mydriatics, beta blockers, and oral carbonic anhydrase inhibitors. After 15 months the visual acuity decreased in the left eye, and a neovascular membrane was observed in the macula. Fluorescein angiography confirmed subretinal neovascularisation. Almost two years later the patient still has the neovascular membrane in his left eye.

The preparation of a hybrid molecule obtained by chemical glycosilation of pertussis toxin (PT) is reported, with the purpose of obtaining a semi-synthetic glycoprotein antigen with bivalent antigenicity. The chemical glycosilation was performed using an oligosaccharide hapten derived from the purified capsular polysaccharide of Neisseria meningitidis group C. The semi-synthetic molecule was investigated by chemico-physical and immunochemical analysis. The oligosaccharide haptens appeared exposed on the surface of the carrier protein PT, since the glycoprotein inhibited the immunoprecipitate between a specific polyclonal antiserum and the native bacterial capsular polysaccharide. By contrast, the main antigenic regions recognized in the native protein PT by specific polyclonal antibodies appeared lost after the coupling procedure involving PT as the carrier protein.

Younger patients are surviving extensive damage to the heart and supporting structures, often associated with multiple systems injuries. A 23-year-old patient who sustained blunt trauma to the chest resulting in a pericardial laceration, injury to tricuspid and mitral valves, myocardial contusion, and paresis of the left phrenic nerve is reported. Porcine bioprosthetic valve replacement of both atrioventricular valves was necessary. Prompt diagnosis and aggressive intervention of such injuries can lead to successful repair of complex cardiac trauma.

The diagnosis and surgical management of non-penetrating high cervical internal carotid injuries continues to be a major problem. The increased incidence of these lesions is due to the escalation of motor vehicular trauma involving multi-system injuries as seen in our Trauma Unit. Carotid angiographic studies are necessary for diagnosis when there is an index of suspicion at time of injury. There have been varied opinions concerning the best treatment due to the difficulty of direct access to the para-mandibular, para-antantoxial segment of the internal carotid artery. Two cases of post-traumatic aneurysms have been discussed and an innovative surgical technique is demonstrated with excellent results. This technique can be utilized in other lesions of the high carotid artery such as intimal flaw and/or dissection of this vessel. The primary indications for surgical intervention are propagation of emboli originating in the aneurysmal sac and intolerance of head noise to the patients (not seen in our patients).

We reviewed 50 consecutive patients who had undergone complete myocardial revascularization combined with aortic valve replacement during a 5-year interval ending in June 1983. A cold blood cardioplegia technique, utilizing not only the native circulation but also the vein conduits, was used. All patients had greater than 70% stenoses of the major coronary arterial system. No patient had valve replacement alone, and no patient was refused operation. The mean number of arteries grafted was 2.3. There were two hospital deaths. One patient had evidence of perioperative myocardial infarction. There were two late deaths and one non-fatal myocardial infarction during the follow-up period, which averaged 16 months. The technique of hypothermic blood cardioplegia used provides a uniform distribution for myocardial protection, especially in the hypertrophied ventricle, and is superior to previously employed methods. This study indicates that myocardial revascularization combined with aortic valve replacement should be performed in patients with coexisting aortic valvular and coronary disease.

Blunt chest trauma may produce a variety of cardiac lesions, which may occur alone or in combination. A case with a ventricular septal defect, left ventricular aneurysm, and coronary arteriovenous fistula with an associated rupture of the thoracic aorta following blunt trauma is presented in order to demonstrate that multiple, life-threatening cardaic lesions may be managed successfully. Surgical repair 32 days postinjury with Teflon patch plus ligation of the fistula were followed by recovery in the patient presented. Language: en

In recent years, the indications for percutaneous transluminal coronary angioplasty have expanded to include multivessel disease, unstable angina pectoris, stenosis of coronary bypass grafts, and recent total coronary occlusion. To evaluate our experience in using percutaneous transluminal coronary angioplasty to treat unstable angina, we reviewed the records of the patients who underwent this procedure at our hospital between January 1983 and December 1986. Of the 689 patients who underwent balloon angioplasty during the study period, 454 had stable angina and 235 had unstable angina; of the latter group, 34 (14.5%) required emergency coronary artery bypass grafting after balloon angioplasty failed. This outcome was associated with 2 risk factors: previous myocardial infarction and triple-vessel disease. Our data suggest that, in cases of unstable angina pectoris, percutaneous transluminal coronary angioplasty should be reserved for patients with single-vessel disease and no evidence of previous myocardial infarction. They also lend credence to the conclusion that the disease process in unstable angina is different from that in stable angina, and that therapy should be directed towards reducing platelet aggregation and correcting global ischemia, rather than towards balloon angioplasty of "culprit lesions."

Aneurysms of the high internal carotid artery, though rare, present a therapeutic problem. Presented herein is a case report and a method of primary repair.

A patient with a tracheoesophageal fistula from blunt chest trauma is presented and the literature is reviewed. A common pathophysiologic factor is the involvement of a young male in a deceleration injury. Early surgical intervention with division of the fistula and repair of the tracheal and esophageal defects is recommended.

Errors in the childhood feeding administration are commonly met, particularly during the first and second year of life, according to the poor or vague knowledge among paediatricians. A first proof of this assumption is given when, as a consequence of digestive disturbance, caused by a wrong nourishment, the paediatrician suggests remedies that, substantially, make the same primitive mistakes. A second proof is given when a particular diet, due to the presence of intestinal disturbance and already seen to be inefficacious, is reproposed, even more than once, with industrial aliments which differ from the ones used in the name and the brand but not in the composition. Finally, another proof is given when in the exclusion therapy due to an intolerance towards gluten, towards cow's milk, towards disaccharides, the paediatrician inserts, in the diet, products containing, respectively, the above mentioned components. These and other mistakes are reported in the present casuistry (121 cases), the majority of which (75 cases) is accompanied by specific examples. Between the cases that mostly stand out we find the so called "precocious weaning" as cause of digestive disturbance and, frequently, as initial moment of a chain of errors responsible, in their turn for the protraction and the chronicization of the aforementioned intestinal pathology.

In over 3500 consecutive open heart procedures using Swan-Ganz catheterization at our institution, we have experienced three major pulmonary artery injuries secondary to this procedure. Pulmonary artery hemorrhage is a rare but frequently fatal complication and a mortality rate as high as fifty percent has been reported. In two of these cases, major retraction of the heart was needed for adequate exposure of the cardiac pathology. The Swan-Ganz catheter inadvertently was advanced into the wedge position for prolonged intervals of time, and periodic overdistention of the balloon occurred. The third case occurred in the cardiac catheterization laboratory. The need for aggressive surgical approach has been demonstrated. The authors have recommended steps to be taken when massive hemoptysis occurs and Swan-Ganz catheter perforation of the pulmonary artery is suspected. Re-evaluation of the "routine" use of the Swan-Ganz catheter may be necessary and overutilization may be a distinct possibility. When the use of this catheter is deemed appropriate, a more exact positioning of the distal portion of the catheter is mandatory if pulmonary artery perforation is to be avoided.

Blunt trauma to the chest may produce a spectrum of cardiac lesions extending from asymptomatic myocardial contusion to rapidly fatal cardiac rupture. A case is discussed in which a patient with signs of cardiac tamponade after blunt trauma was found to have a rupture of the atrium. During repair of the cardiac injury, an unusual tear of the right superior pulmonary vein was also discovered. Both injuries were successfully repaired and the patient recovered.

The terms "spondyloarthropathy" and "spondyloarthritis" have been recently introduced to indicate a group of syndromes associated in clinical and genetical peculiarities. The "ankylosing spondylitis with childhood onset", that is usually considered very rare, is, as a matter of fact, a disease difficult to diagnose because of the partial overlap with the "pauciarticular juvenile rheumatoid arthritis type II" for clinical and laboratory data. The Authors, after a recapitulation of the "pauciarticular juvenile rheumatoid arthritis type II" and of the "ankylosing spondylitis with childhood onset" diagnosis definition elements, propose a description of a clinical case that came to their observation. The clinical picture described, even though it presented some clinical peculiarities (particularly a primitive affection of the lumbosacral spine), some radiographic peculiarities (the precocious demineralization of the affected segments) and laboratory characteristics (positive F.A.N. to diffuse pattern) seemed a form of "ankylosing spondylitis with childhood onset", apparently primitive.

Sternal dehiscence and mediastinitis are two of the most severe complications of a median sternotomy. A technique of closure is described that appears to provide a more stable sternal approximation without any increase in overall complication rate. Using this technique in 978 consecutive patients, no cases of sternal dehiscence or mediastinitis have been seen.

Hamster tracheal epithelia consist of three cell types: ciliated, mucus and basal cells. Autoradiographic data from several studies suggest that either basal or non-ciliated columnar cells may serve as stem cells for regeneration of lost or damaged ciliated and mucus cells. The objective of the present study was to examine the role of basal cells in the formation of ciliated and mucus cells in hamster tracheal epithelial (HTE) cell cultures via tritiated thymidine ([3H]-TdR) autoradiography. When 3 day cultures were pulsed with [3H]-TdR for 6 hr and incubated for 2 additional days in non-radioactive media (5 day total) label was present in the nuclei of basal and columnar epithelial cells suggesting that the labeled columnar cells may be derived from basal cells. However, the morphological reorganization occurring during this 2 day interval may create difficulties in this interpretation. Since these morphological changes are minimal during the 6 day to 8 day in vitro period, 6 day HTE cultures were pulsed with [3H]-TdR for 6 hr and incubated for 2 additional days in non-radioactive media (8 day total), and examined to further study the fate of labeled basal cells during this period. Analysis of these 8 day cultures revealed that labeled nuclei were present in both basal cells and adjacent ciliated and mucus cells. These results do not exclude the possibility of non-basal cell origin of ciliated and mucus cells in other systems but suggest that, at least in HTE cultures, undifferentiated basal cells have the ability to develop into ciliated and mucus cells.

The diagnosis of superior sulcus tumor was established in 35 patients at the University of Michigan Medical Center over the sixteen-year period from 1955 through 1970. Twelve patients underwent preoperative irradiation with cobalt 60 followed by radical en bloc excision of the chest wall. None of these patients survived five years. Twenty-three patients received radiation therapy with cobalt 60 only. Three of these patients survived five years free of disease. The absolute five-year survival in the entire group of patients was 8.6%. This study raises the question of the role of radical chest wall excision in the treatment of superior sulcus tumor.

Resonant inelastic light scattering provides a venue for the study of spin transitions and interactions in quantum dots (QDs) with few electrons. Here we present the observation of inter‐shell excitations in GaAs/AlGaAs nanofabricated QDs containing four electrons. The ground state with four electrons dictated by Hund’s rule is a triplet with total spin S = 1 so that peculiar to this configuration there are two monopole inter‐shell spin modes with changes ΔS = ±1 that connect the triplet state to the excited states with S = 0 and S = 2, respectively. We present light scattering spectra that offer evidence of these excitations. The light scattering spectra are interpreted by numerical evaluations within a full configuration interaction approach.

Il presente lavoro si inserisce in uno studio pilota condotto nell’anno scolastico 2018-2019per valutare l’efficacia del Logical Intelligence Enhancement Programme (LIEP, Calvani, Peru,& Zanaboni, 2019), un programma composto da tavole di logica verbale e numerica volte asviluppare il ragionamento logico e le capacità metacognitive di studenti di quinta primaria.All’interno di questo studio è stato sviluppato il Logical Intelligence Enhancement test perstimare gli effetti del training sulle abilità logico-verbali. Il contributo presenta la costru-zione del test, le sue caratteristiche psicometriche e la validazione. A tal fine, lo strumentoè stato somministrato a un campione di 173 studenti di classe quinta primaria nell’area diPalermo e Firenze.Il LIEP Test si compone di 22 item e include otto dimensioni di esercizilogici come il completamento di tabelle o serie di numeri, la risoluzione di problemi nu-merici o geometrici e tavole di inferenza logica. This work is part of a pilot study conducted during 2018-2019 to evaluate the effectivenessof the Logical Intelligence Enhancement Programme (LIEP, Calvani, Peru & Zanaboni, 2019),a program which consists of logical-verbal and numeric exercises to enhance logical rea-soning and metacognitive skills of fifth grade students. During this study the Logical Intel-ligence Enhancement test was developed to measure the effects of the training on thelogical-verbal skills. This paper describes the development of the LIEP test, its psychometricfeatures and validation process. For the validation the measure was administered to a sam-ple of 173 fifth grade students in Palermo and Florence. The final version of the test consistsof 18 items and includes eight dimensions of logical exercises, such as tables to be com-pleted, numeric series, problem solving and logical inferences.

Background: Intracellular calcium is essential for muscle cells contrac- tion. Several drugs such as amines and levosimendan increase inotropism by acting directly or indirectly on intracellular calcium levels or sensitiv- ity. Serum calcium levels (SCL) are not directly correlated to intracellular calcium concentration, but a reduced gradient could influence intracellular concentrations. For this reason, we aimed to evaluate whether SCL could be related to in-hospital survival among patients affected by acute heart failure. Materials and Methods: 216 consecutive patients admitted to our Internal Medicine Department (IMD) for acute heart failure were retrospectively enrolled. In-hospital mortality and comorbidities (hypertension, diabetes, atrial fibrillation, chronic heart failure, acute coronary syndrome, COPD, sepsis, chronic kidney disease and cancer) were collected as binary vari- ables. Days of hospitalization were treated as continuous data. SCL were synthesized as an ordinal variable (25% low percentile, 50% middle percen- tile and 25% high percentile).Cox regression model was set up to evaluate the role of serum calcium levels on in-hospital mortality inserting in the model all the comorbidities, days of hospitalization, age and sex as covari- ates. Statistic was performed with SPSS 13.0 for Windows Systems. Results: Mean age was 80 years (±12,55 years), with M:F ratio of 1:1 (males 52.7%). Diabetes was present in 23,1%, hypertension in 34,3%, ac- tive cancer in 8,8%, atrial fibrillation in 30,1%, chronic ischemic cardiopa- thy in 28,2%, acute coronary syndrome in 12,5%, congestive heart failure in 42,6%, COPD in 18,1%, sepsis in 1,4%, chronic kidney disease in 18,5% of the sample. 13,4% of the sample died during the admission. Mean of the days of hospitalization was of 12,65 days (±8,28 days). In the Cox model, correcting for all the above-mentioned covariates, serum calcium levels taken at the admission behaved as an independent risk factor for in-hospital death (Figure 1). Lower or normal serum calcium levels were associated to a higher risk of in-hospital mortality (OR: 8,308; 95%CI:1,075-64,21; p

Spin resolved edge states are ideal candidates for the implementation of dual-rail quantum computation architectures by encoding the qubit in the spin degree of freedom of the co-propagating edge states. An important element for the realization of such architectures is a coherent beam splitter that controllably mixes the two co-propagating spin-resolved edge channels. Coupling of the spin resolved edge states is demonstrated recently by spin-flip scattering event that is induced by in-plane spatially-dependent periodic magnetic field of the nano-magnet array placed at the boundary of the mesa. In this paper we discuss the nanofabrication and our preliminary transport analysis of an electronic interferometer device made of two nano-magnetic arrays placed in close proximity. The impact of temperature in the coherent properties of the devices is addressed. Spin resolved edge states are ideal candidates for the implementation of dual-rail quantum computation architectures by encoding the qubit in the spin degree of freedom of the co-propagating edge states. An important element for the realization of such architectures is a coherent beam splitter that controllably mixes the two co-propagating spin-resolved edge channels. Coupling of the spin resolved edge states is demonstrated recently by spin-flip scattering event that is induced by in-plane spatially-dependent periodic magnetic field of the nano-magnet array placed at the boundary of the mesa. In this paper we discuss the nanofabrication and our preliminary transport analysis of an electronic interferometer device made of two nano-magnetic arrays placed in close proximity. The impact of temperature in the coherent properties of the devices is addressed.

Controllable point junctions between different quantum Hall phases are a necessary building block for the development of mesoscopic circuits based on fractionally-charged quasiparticles. We demonstrate how particle-hole duality can be exploited to realize such point-contact junctions. We show an implementation for the case filling factors $\nu=1$ and $\nu^*\le1$ in which both the fractional filling $\nu^*$ and the coupling strength can be finely and independently tuned. A peculiar crossover from insulating to conducting behavior as $\nu^*$ goes from 1/3 to 1 is observed. These results highlight the key role played on inter-edge tunneling by local charge depletion at the point contact., Comment: 4 pages, 3 figures, suppl.mat

Transport properties of high quality Nb/semiconductor/Nb long Josephson junctions based on metamorphic In_0.75Ga_0.25As epitaxial layers are reported. Different junction geometries and fabrication procedures are presented that allow a systematic comparison with quasiclassical theory predictions. The impact of junction transparency is highlighted and a procedure capable of yielding a high junction quality factor is identified., Comment: 11 pages, 3 figures

Monatomic layers of graphite are emerging as building blocks for novel optoelectronic devices. Experimental studies on a single graphite layer (graphene) are today possible since very thin graphite can be identified on a dielectric substrate using a normal optical microscope. We investigate the mechanism behind the strong visibility of graphite, and we discuss the importance of substrates and of the microscope objective used for the imaging.

The coherent dynamics of vibronic wave packets in the green fluorescent protein is reported. At room temperature the non-stationary dynamics following impulsive photoexcitation displays an oscillating optical transmissivity pattern with components at 67 fs (497 cm-1) and 59 fs (593 cm-1). Our results are complemented by ab initio calculations of the vibrational spectrum of the chromophore. This analysis shows the interplay between the dynamics of the aminoacidic structure and the electronic excitation in the primary optical events of green fluorescent proteins., Comment: accepted for publication in Physical Review Letters

The green fluorescent protein (GFP) has emerged, in recent years, as a powerful reporter molecule for monitoring gene expression, protein localization and protein-protein interaction. Several mutant variants are now available differing in absorption, emission spectra and quantum yield. Here we present a detailed study of the fluorescence properties of the Phe-64-->Leu, Ser-65-->Thr mutant down to the single molecule level in order to assess its use in quantitative fluorescence microscopy and single-protein trafficking. This enhanced GFP (EGFP) is being used extensively as it offers higher-intensity emission after blue-light excitation with respect to wild-type GFP. By means of fluorescence spectroscopy we demonstrate the absence of the neutral form of the chromophore and the lack of photobleaching recovery after ultraviolet light irradiation. Furthermore, we show that the EGFP spectral properties from isolated to densely packed molecules are highly conserved. From these experiments EGFP emerges as an ideal molecule for quantitative studies of intra and intercellular tagged-protein dynamics and fluorescence-activated cell sorting, but not for monitoring single-protein trafficking over extended periods of time.