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Nodular fasciitis is a benign tumor of soft tissues originating from the proliferation of fibroblasts and myofibroblasts, generally developing between the subcutaneous tissue and the underlying muscular layer. Nodular fasciitis predominantly localizes in the upper extremities, trunk, head and neck. Biomolecular and immunohistochemical analyses result essential to demonstrate the benign origin of the process, also confirmed by very low recurrence rate after complete excision, which represents the gold standard for treatment. We report the case of a 36 years-old man who developed a nodular protuberance clinically evident in the upper-left side of the thorax. We further, highlight the main characteristics of this rare neoplasm trough a thorough review of the literature.

Background and Aims Pertussis is a common and potentially serious disease affecting mainly infants and young children. In its non-classic presentation, pertussis can be clinically indistinguishable from other respiratory illnesses. Pertussis today often remains underdiagnosed in adults. Our aims was to report a complicated cases of pertussis. Results A case of serologically confirmed pertussis occurred in an 18-year-old man presenting with pneumomediastinum, subcutaneous emphysema in the neck and chest, and persistent attacks of coughing with apnea that required treatment in the intensive care unit. Conclusion Pneumomediastinum and subcutaneous emphysema have never been described in adult patients with pertussis. Physicians should be aware that patients presenting with persistent cough and pneumomediastinum may have pertussis and include this in their differential diagnosis.

The aim of this study is to report our experience about the treatment of complex sternal and thoracic wounds following cardiothoracic surgery, using vacuum-assisted closure (VAC therapy. Twelve patients presenting with sternal (five cases) and thoracic (seven cases) wounds that were difficult to heal were treated through VAC therapy after the first surgical debridement. The duration of VAC application ranged from 12 to 36 days with an average hospital stay of 24⋅6 ± 11⋅4 days. During a mean follow-up of 12 months, we observed complete wound healing in seven cases (58⋅3%), in an average period of 25⋅5 ± 14⋅3 days; one patient died during follow-up, two patients were lost to follow-up and two patients required definitive surgical closure of the wound cavity. In conclusion, VAC therapy promotes faster wound healing, with shorter hospital stay and subsequent lesser in-hospital cost, reducing the mortality rate in the long run. It also promotes early rehabilitation and alleviates the need for a second procedure, thus improving patient satisfaction, with minimal discomfort or inconvenience.

The paper illustrates the methodology developed for unsupervised analysis to be conducted on high-definition, high sampling rate image sequences collected in experiments with a single spark ignition optically accessible spherical bomb. Images recorded along the line-of-sight were first processed to identify the reaction front, and then analyzed by means of a two-dimensional numerical estimation technique. The laminar flame front is detected by making use of the concept of “scalar dissipation rate” basing on flame luminosity data, i.e. the square of the gradient of flame luminosity. The new scalar field is then tracked to derive the time history of the flame radius. In order to extract the Region Of Interest from the images, masking techniques are employed, whereas signal-to-noise ratio is improved by means of data binning. The proposed automatic, non-intrusive method proves effective in providing a fast characterization of the flame propagation phenomenon in terms of apparent velocity.

Background and Aims: Pertussis is a common and potentially serious disease affecting mainly infants and young children. In its non-classic presentation, pertussis can be clinically indistinguishable from other respiratory illnesses. Pertussis today often remains underdiagnosed in adults. Our aims was to report a complicated cases of pertussis. Results: A case of serologically confirmed pertussis occurred in an 18-year-old man presenting with pneumomediastinum, subcutaneous emphysema in the neck and chest, and persistent attacks of coughing with apnea that required treatment in the intensive care unit. Conclusion: Pneumomediastinum and subcutaneous emphysema have never been described in adult patients with pertussis. Physicians should be aware that patients presenting with persistent cough and pneumomediastinum may have pertussis and include this in their differential diagnosis.

Low-grade inflammatory state causes the development of the principal chronic-degenerative pathologies related with ageing. Consequently, it is required a better comprehension of the physiologic origins and the consequences of the low-grade inflammatory state for the identification of 1) the basic mechanisms that lead to the chronic inflammatory state and, after that, to the progression toward the pathologies and 2) the parallel identification of the prognostic biomarkers typical of these passages. These biomarkers could bring to several improvements in the health quality, allowing an early diagnosis and more effective treatments for: a) the prevention strategies on the healthy population, to assure a healthy longevity and b) the identification of personalized treatment in patients, to assure the benefit of the therapy. For the identification of these biomarkers it is necessary to consider that the ageing processes produce alterations of the physiologic systems and that these modifications compromise the communications between these networks: this state constitutes an obstacle for an appropriate physiologic homeostasis, that plays a fundamental role for the safeguard of the health. It is also to be considered that immune senescence affects both men and women, but it does it in different ways: a sexual dimorphism of immune pathways in the setting of immune response homeostasis is normally present, as we previously underlined. Therefore we hypothesize that, in order to prevent the development of the chronic-degenerative pathologies related with ageing, it is important to identify "Biomarkers of Homeostasis " specific for each gender: these are biologic molecules that should be measurable in a practical and no-invasive way and whose variations can quantify the male and female risk of losing the physiologic system homeostatic capacity. This competence is not only critical in the control of inflammation, but it is also prognostic for the passages from low-grade inflammatory state to the chronic inflammation and to the progression toward the degenerative pathologies. Beginning from the actual results, our intent is 1) to discuss and underline the importance of these new research perspectives in the definition of ageing gender-specific clinical "Biomarkers of Homeostasis" and 2) to propose homeostasis biomarkers, already present in the research results.

We investigated the response of predatory spiders, carabids, staphylinids and heteropteran bugs to the age of wildflower areas at twenty 1- to 4-year-old wildflower sites and in wheat fields. Density, biomass and species richness of spiders, carabids and bugs increased with the age of wildflower sites, and were higher at older wildflower sites than in the wheat fields. In contrast, staphylinid density decreased significantly with the age of wildflower sites. Canonical correspondence analysis explained 42.4% and 46.7% of the total variance of spider and carabid assemblages, respectively. Spider and carabid assemblages were best explained by vegetation cover. Mean individual weights of spiders, carabids and staphylinids increased significantly with the age of wildflower sites. The positive response of these three groups of beneficials is of practical relevance because many farmers currently remove wildflower areas after two to three years of establishment. Thus, older stages of succession increase the numbe...

Spontaneous pneumomediastinum (SPM) is defined as the presence of air in the mediastinum, developing in the absence of traumatic, iatrogenic, or preceding pulmonary pathologies (emphysema, chronic bronchitis, and lung cancer). The aim of this study was to review our experiences with SPM, underlining its symptomatology, diagnosis, treatment, and followup, and defining a reasonable course of assessment and management. A retrospective case series was conducted to identify adult patients with SPM who were diagnosed and treated in our institution between 1998 and 2005. Eighteen patients (10 males) were identified (average age = 25 +/- 4.8 years). Acute onset of chest pain was the predominant symptom at presentation. All patients developed clinically evident subcutaneous emphysema and underwent chest computerized tomography. Fiber bronchoscopy and echocardiogram were used selectively (8 patients). The average hospital stay was 6 (+/-1.4) days. Sixteen patients were conservatively treated, and only two patients were treated with thoracic drainage due to a related pneumothorax. The disease followed a benign evolution in all patients and, as of today, no relapse has been reported. SPM is an uncommon pathology with a usually benign course. The authors discuss SPM. A diagnostic algorithmic approach is necessary to rule out severe secondary entities and consequences that need urgent treatment.

Plant infections by the soil bacterium Agrobacterium rhizogenes result in neoplastic disease with the formation of hairy roots at the site of infection. Expression of a set of oncogenes residing on the stably integrated T-DNA is responsible for the disease symptoms. Besides the rol (root locus) genes, which are essential for the formation of hairy roots, the open reading frame orf13 mediates cytokinin-like effects, suggesting an interaction with hormone signaling pathways. Here we show that ORF13 induced ectopic expression of KNOX (KNOTTED1-like homeobox) class transcription factors, as well as of several genes involved in cell cycle control in tomato (Lycopersicon esculentum). ORF13 has a retinoblastoma (RB)-binding motif and interacted with maize (Zea mays) RB in vitro, whereas ORF13, bearing a point mutation in the RB-binding motif (ORF13*), did not. Increased cell divisions in the vegetative shoot apical meristem and accelerated formation of leaf primordia were observed in plants expressing orf13, whereas the expression of orf13* had no influence on cell division rates in the shoot apical meristem, suggesting a role of RB in the regulation of the cell cycle in meristematic tissues. On the other hand, ectopic expression of LeT6 was not dependent on a functional RB-binding motif. Hormone homeostasis was only altered in explants of leaves, whereas in the root no effects were observed. We suggest that ORF13 confers meristematic competence to cells infected by A. rhizogenes by inducing the expression of KNOX genes and promotes the transition of infected cells from the G1 to the S phase by binding to RB.

The Bacillus subtilis ssuBACD gene cluster is required for the utilization of aliphatic sulphonates as sulphur sources. The regulation of expression of the ssu genes was studied in constructs carrying chromosomal transcriptional fusions of the ssu promoter region to lacZ. When sulphate or cystine served as sulphur sources, expression of the ssu genes was repressed. A putative terminator located between the promoter and the start of the ssuB gene partially overlaps a putative antiterminator. Removal of both the antiterminator and the terminator led to a decrease in the repression ratio of about 10-fold, but not to constitutive expression. Replacement of the ssu promoter by the Pspac promoter led to decreased expression of the ssu genes, but not to loss of repression by sulphate and cystine. Thus, the repression exerted by sulphate and cystine resulted from regulation at the level of both transcription initiation and transcription termination. O-acetyl-L-serine, a precursor of cysteine, served as effector molecule in both regulation systems.

Bronchioloalveolar carcinoma (BAC) is a subtype of lung adenocarcinoma whose incidence is raising. Bronchioloalveolar carcinoma has a tendency to involve diffusely the lung. No agreement exists about whether diffuse bronchioloalveolar carcinoma has a multicentric or unicentric origin. The purpose of this work is to evaluate the correlation between intrapulmonary spread of bronchioloalveolar carcinoma and its histologic and immunohistochemical characteristics.Surgical specimens of 20 bronchioloalveolar carcinomas with radiologically proved evolution from focal to diffuse disease were retrieved and reviewed. Patterns of pulmonary spread were defined on the basis of CT and MR imaging examinations. Immunohistochemical studies were performed to investigate the expression of gelatinase A and alpha2-integrin. Correlation between immunohistochemical results and patterns of pulmonary spread was evaluated. Statistical evaluation was performed by using Fisher Exact Test.Three histological subtypes of bronchioloalveolar carcinoma were found: mucinous (11 cases), non-mucinous (3 cases), and mixed adenocarcinoma with prominent bronchioloalveolar pattern (6 cases). Three patterns of pulmonary spread were depicted radiologically: parenchymal opacification (11 cases), multiple nodules (7 cases) and mixed pattern (2 cases). Eleven out of 12 mucin-producing versus none out of 8 non-mucin producing cancers developed parenchymal opacification. The difference was statistically significant (P0.028). A statistically significant difference was also found between the development of parenchymal opacification and the level of alpha2-integrin: 11 out of 13 tumors with negative alpha2-integrin versus none out of 7 with positive alpha2-integrin immunoreactivity (P0.033).Diffuse bronchioloalveolar carcinoma may develop from a prior focal cancer. Mucinous subtype is the most prone to develop diffuse disease with parenchymal opacification, probably representing aerogenous spread. Low levels of alpha2-integrin receptors were found in bronchioloalveolar carcinoma which developed parenchymal opacification.

We studied the nutritional and reproductive response of Poecilus cupreus (synonymous with Pterostichus cupreus), one of the most abundant carabid beetles in arable land, to the succession in sixteen 1- to 4-year-old wildflower areas. A total of 390 male and 373 female beetles was examined. Each female was dissected and the number of ripe eggs counted. The nutritional state was expressed by a condition factor, which was calculated for each individual based on the observed weight and elytra length of male and female P. cupreus. Carabids in the 1-year-old wildflower areas contained significantly less ripe eggs than those from the 4-year-old areas. The condition factor of female and male beetles was significantly lower in 1- than 2- to 4-year-old areas. We examined the influence of habitat parameters (vegetation cover, soil water content, coarse and fine sand, pore volume, habitat size and age, surrounding landscape structure) on the reproductive success and nutritional state of P. cupreus in the 16 wildflower areas. The number of eggs was best explained by habitat age, accounting for 53.4% of the variability. The variation in the condition factor of female and male beetles was best explained by habitat age, which accounted for 73% and 71% of the variation, respectively. Moreover, the beetles' reproductive potential and nutritional condition were significantly associated with vegetation cover, and occasionally also with soil water content. The potential of wildflower areas as a reservoir for the generalist predator P. cupreus was shown to increase with successional age.

We report the case of a 17-year-old boy with cystic fibrosis (CF) who presented with persistent cough; after starting intravenous antibiotics for Pseudomonas aeruginosa he underwent a computed tomography (CT) scan of the chest. CT revealed extensive consolidation in the right lower lobe with relative bronchus obstruction; the cause of bronchial obstruction was detected in the mediastinal window, corresponding to a bronchial tree-shaped, thick, tenacious mucous plug. This was extracted 48 h after unresponsive bronchial washing and endobronchial instillation of rhDNAse, using foreign-body forceps, with subsequent resolution of cough. This case, which is the second report of plastic bronchitis in CF, was resolved by mechanical removal of the mucous plug, suggesting that a careful observation of CT imaging may guide intervention aimed at resolution of atelectasis.

A 65-year-old man presented with a nonspecific thymic neoplasm following blunt thoracic trauma. The lesion increased in size over 12 years, to reach 47 mm in diameter. After thymectomy, the lesion was described as an epidermoid lining cyst composed of thickened stratified squamous epithelium. We assume that this rare pathological condition was caused by skin tissue islands and fat migrating into the mediastinum.

The function of the Bacillus subtilis cysK and cysJI (previously designated yvgQR) genes, expected to be involved in the assimilatory sulfate reduction pathway, was investigated. A B. subtilis mutant with a deletion in the cysJI genes was unable to use sulfate or sulfite as sulfur source, which confirmed that these genes encode sulfite reductase. A mutant with a transposon insertion in the cysK gene, whose deduced protein sequence showed similarity to cysteine synthases, grew poorly on sulfate and butanesulfonate. A strain in which cysK and yrhA, a cysK paralog, were inactivated was unable to grow with sulfate. Whereas expression of the cysJI genes was induced by sulfate, expression of cysK was repressed both by sulfate and by cysteine.

Study objective To determine the value of gadolinium-enhanced MRI in the assessment of disease activity in chronic infiltrative lung diseases (CILDs). Design Retrospective study. Setting University hospital. Materials and Methods Twenty-five consecutive patients with CILD were studied. The following diseases were diagnosed: sarcoidosis (n = 10), bronchiolitis obliterans organizing pneumonia (n = 3), usual interstitial pneumonia (n = 4), radiation pneumonia (n = 2), desquamative interstitial pneumonia (n = 1), rheumatoid lung (n = 1), vasculitis (n = 1), alveolar proteinosis (n = 1), bronchioloalveolar carcinoma (n = 1), and chronic eosinophilic pneumonia (n = 1). In each patient, the disease activity was assessed by one or more of the following studies: BAL (n = 18), gallium-radioisotope lung scanning (n = 6), serum angiotensin-converting enzyme assay (n = 10), and open lung biopsy (n = 4). T1-weighted breath-hold MRI studies were obtained before and after IV injection of gadolinium. The MRI examinations were analyzed to assess the presence or absence of lesional enhancement. Results The presence of enhanced pulmonary lesions was seen in 14 patients. All of these patients had active disease. Of the 17 patients with active disease, 14 had enhanced lesions, and 3 had unenhanced lesions. Pulmonary lesions were not enhanced in any patients with inactive disease. The difference was statistically significant (Fisher Exact Test, p Conclusion Gadolinium-enhanced MRI may prove to be a useful tool in assessing disease activity in CILDs.

Methanol extracts of the plants Geranium robertianum, Lepidium sativum, Origanum vulgare, Salvia officinalis, Salvia pratensis, Saponaria officinalis, Thymus vulgaris, Trifolium repens and Valerianella locusta were produced and applied to cotyledons of 6-8 clays old rape seedlings to investigate whether they can influence the feeding of the slug Arion lusitanicus on young rape. All plant extracts appeared to reduce slug feeding on rape to some extent, but only the extracts of Saponaria officinalis and V. locusta significantly deterred A. lusitanicus from feeding. The small effects of some extracts may be due to a poor extraction efficiency or an insufficient feeding inhibition capacity of these extracts.

Objective We retrospectively reviewed CT and pathologic examinations in resected nodular bronchioloalveolar carcinomas (BACs) to correlate the histology with the appearance of the nodules on preoperative thin section CT images. Materials and methods Thin section CT scans of 11 patients with nodular BAC were reviewed by two observers. In each case, size, tumor-lung interface, and internal characteristics of the nodule were recorded and correlated with histopathologic examinations. Results Computed tomography showed a large bronchus leading to or contained within the nodule in 36%; spiculated, lobulated, or irregular borders in 82%; pleural retraction in 36%; internal inhomogeneity in 45%; and a zone of intermediate attenuation surrounding a higher attenuation nodule and separating it from the surrounding lung parenchyma (the CT halo sign) in 18% of the 11 BACs. In two lesions internal serpentine radiolucencies could be seen. Histopathologic studies showed this correlated with the air-containing glandular spaces of the tumor. Conclusion The CT halo sign and serpentine radiolucencies should be added to the list of the CT findings of nodular BAC. However histologic examination is required to confirm the diagnosis of BAC.

a b s t r a c t Objective: To evaluate the role of MRI water-sensitive sequences in the differential diagnosis between pneumonia-like mucinous adenocarcinoma and infectious pneumonia. Subjects and methods: Twenty-three patients with pneumonia-like mucinous adenocarcinoma and 30 patients with infectious pneumonia underwent computed tomography (CT) and MRI. Two blinded and independent readers evaluated CT and MR images using a 3-level confidence scale in two separate sessions. Results were tested for statistical significance using the Fisher's exact test and the Cohen's k test. Results: On CT, the two readers respectively made correct diagnoses of mucinous adenocarcinoma in 17 out of 23 cases (73.9%), and in 15 out of 23 cases (65.2%). A correct diagnosis of infectious pneumonia was made in 22 out of 30 cases (73.3%), and in 24 out of 30 cases (80.0%). On MRI, both readers made correct diagnoses of mucinous adenocarcinoma in 23 out of 23 (100%) cases, and of infectious pneumonia in 30 out of 30 (100%) cases. Fisher's exact test showed a significant difference in the diagnosis of mucinous adenocarcinoma between MRI and CT for both readers, P = 0.01 for reader 1 and P = 0.002 for reader 2, respectively. A good agreement (k = 0.73) was found between the two readers on CT evaluation, whereas an almost perfect agreement (k = 1.00) was found for MRI. Conclusions: MRI with "water-sensitive" sequences should be added in the diagnostic protocol of every patient with pulmonary consolidation suspected to be mucinous adenocarcinoma. © 2011 Elsevier Ireland Ltd. All rights reserved.

The traditional approach for memory fail bitmap analysis is to identify the topological signatures and perform a Failure Analysis investigation on the most frequent signatures, based on the (x, y) coordinates of the fails. This approach is inappropriate when a large portion of the fails are single bits, because too many investigations are required to statistically identify the major repetitive failure mechanisms. This becomes a problem for fast product development and production yield ramp. This paper presents a methodology to classify single fail bits by their unique fault signature, based on the sequence of failing march element read operations from multiple data backgrounds, in a standard Memory BIST flow. These classifications allow investigations to focus on the most important failure mechanisms with greatest yield impact. The methodology is demonstrated in an industrial environment, with identification of critical yield detractors. Starting from a yield problem associated to MBIST failures at high operating temperature, the fault signatures were used to identify a static noise margin parametric problem and a dislocation fault physical problem.

This paper describes an optimized embedded memory diagnosis flow that exploits many levels of knowledge to produce accurate failure hypothesis. The proposed post-processing analysis flow is composed of many steps investigating failure shapes as well as cell fail syndromes, and includes advanced techniques to tackle incomplete data possibly due to tester noise and/or by faults showing intermittent effects. The effectiveness of the technique is demonstrated on an automotive-oriented System-on-Chip (SoC) manufactured in a 90nm technology by STMicroelectronics, which includes embedded SRAM memory cores tested using a programmable BIST. Scrambled BITMAPS gives a visual feedback leading to quick physical defect identification. Such research is relevant to aid on the manufacturing, material and process enhancements raising silicon yield.

Background The pulmonary inflammatory pseudotumor (PIP) is a rare disease. It is still debated whether it represents an inflammatory lesion characterized by uncontrolled cell growth or a true neoplasm. PIP is characterized by a cellular polymorphism. Methods We retrospectively analyzed 8 patients with PIP treated by surgery between 2001 and 2009. Preoperative thoracic computed tomography (CT) scan was performed in all cases. All patients underwent preoperative bronchoscopy with washing and brushing and/or transbronchial biopsy and preoperative cytology examination Results There were 5 men and 3 women, aged between 38 and 69 years (mean of 58 years). 3 patients (37%) were asymptomatic. The others had symptoms characterized by chest pain, shortness of breath and persistent cough or hemoptysis. 5 patients had neutrophilic leucocytosis. CT scan demonstrated solitary nodules (maximum diameter 3 cm) in 3 patients (37%). In 2 patients there were signs of pleural infiltration. Distant lesions were excluded in all cases. A preoperative histology examination failed to reach a definitive diagnosis in all patients. At surgery, we performed two lobectomies, one segmentectomy and five wedge resections, these being performed with videothoracoscopy (VATS), except for one patient where open surgery was used. Complete tumor resection was obtained in all patients. According to the Matsubara classification, there were 2 cases of organizing pneumonia, 5 cases of fibrous histiocytoma and one case of lymphoplasmacytoma. All patients were discharged alive from hospital between 4 and 7 days after surgery. At follow-up CT scan performed annually (range 11 to 112 months) (mean 58 months), there were no residual lesions, neither local nor distant recurrences. Conclusions PIP is a rare disease. Many synonyms have been used for this disease, usually in relation to the most represented cell type. The true incidence is unclear. Preoperative diagnosis is difficult to reach, despite performing a bronchoscopy or a transparietal needle aspiration. Different classifications have been proposed for PIP. Either medical, radiation or surgical therapy has been used for PIP. Whenever possible, surgery should be considered the standard treatment. Complete surgical resection is advocated to prevent recurrence.

Less than 1% of lung neoplasms are represented by benign tumors. Among these, hamartomas are the most common with an incidence between 0.025% and 0.32%. In relation to the localization, hamartomas are divided into intraparenchymal and endobronchial. Clinical manifestation of an endobronchial hamartoma (EH) results from tracheobronchial obstruction or bleeding. Usually, EH localizes in large diameter bronchus. Endoscopic removal is usually recommended. Bronchotomy or parenchimal resection through thoracotomy should be reserved only for cases where the hamatoma cannot be approached through endoscopy, or when irreversible lung functional impairment occurred after prolonged airflow obstruction. Generally, when endoscopic approach is used, this is through rigid bronchoscopy, laser photocoagulation or mechanical resection. Here we present a giant EH occasionally diagnosed and treated by fiberoptic bronchoscopy electrosurgical snaring.

Polycythemia vera is a myeloproliferative disorder characterized by thrombotic complications both in the arterial and venous systems. We report the case of a 55-year-old patient affected by polycythemia vera, presenting with acute superior vena cava syndrome due to thrombosis of the upper part of the superior vena cava. Diagnosis was done clinically and by computed tomography scan and showed an unusual finding: an air bubble trapped in the brachiocephalic venous trunk. The patient underwent emergency surgery. Diagnosis and treatment of the case are discussed.

Candida empyema thoracis can be a consequence of operation, gastropleural fistula, and esophageal perforation. Case report and review of the literature. A fatal case of a 45-year-old pregnant woman with Candida krusei empyema thoracis secondary to spontaneous esophagus perforation associated with candida esophagitis is reported. The case is contextualized among similar cases found through a PubMed search. A suspect of esophagus rupture should arise in the presence of a fungal empyema. Candida esophagitis should be always considered as a possible cause or con-cause of esophagus rupture. An empirical systemic antimycotic therapy should always be considered in an ideal multidisciplinary approach to the management of patients with esophagus rupture.

Chest trauma is frequently followed by pulmonary contusion and sepsis. High mobility group box-1 (HMGB-1) is a late mediator of severe sepsis that has been associated with mortality under experimental conditions. We studied HMGB-1 mRNA expression in patients with lung injury and its relationship with the severity of trauma and survival. A total of 24 consecutive patients with chest trauma referring to the Intensive Care Unit of Messina University Hospital, were enrolled. Lung trauma was established on the basis of chest X-ray and computed tomography. Injury Severity Score (ISS), Revised Trauma Score (RTS) and Glasgow Coma Scale (GCS) were also assessed. Accordingly to these results 6 patients were considered as controls because of no penetrating trauma and low ISS. Blood and broncho-alveolar lavage fluid (BALF) from chest trauma patients were withdrawn at admission and 24h after the beginning of the standard therapeutic protocol. HMGB-1 mRNA increased significantly in blood (r=0.84) and BALF (r=0.87) from patients with trauma and pulmonary contusion and positively correlated with the severity of trauma (based on ISS and RTS) and the final outcome. HMGB-1 protein levels were also elevated in BALF macrophages from severe trauma patients compared to control subjects, furthermore TNF-alpha and its receptor TNFR-1 mRNA levels were also markedly increased in patients with a poor outcome respect to other subjects. Our study suggests that HMGB-1 may be an early indicator of poor clinical outcome in patients with chest trauma.

Bronchogenic mediastinal cysts (BMC) represent 18% of primitive mediastinal tumors and the most frequent cystic lesions in this area. Nowadays, BMC are usually treated by VATS. However, the presence of major adhesions to vital structures is often considered as an unfavourable condition for thoracoscopic treatment. The authors report the thoracoscopic treatment of a BMC having dense adhesions to the aortic arch. Diagnosis and surgical treatment is described. Review of the literature and surgical options on this topic are discussed.

To evaluate the utility of the CT bronchus sign in making a choice between transbronchial biopsy (TBB) and transthoracic needle aspiration (TTNA) as the first diagnostic procedure in a patient with a solitary pulmonary nodule (SPN), we reviewed the results of TBB and TTNA in 26 patients who had a bronchogenic carcinoma less than 3 cm, studied with thin-section CT. The patients were divided into two groups. Group 1 included ten cases with a third- to fifth-order bronchus sign. Group 2 included two cases with a sixth-order bronchus sign and 14 cases with absence of a bronchus sign. TBB was performed in all the patients; conversely, TTNA was carried out in 22 patients. In group 1, TBB gave a diagnostic yield in eight (80 percent) of ten patients, while TTNA was positive in three (42 percent) of seven patients (p>0.05). Conversely, in group 2, results of TBB were normal in all the patients, while TTNA gave a diagnosis in 10 (66 percent) of 15 patients (p

Pericardial effusion may lead to cardiac tamponade sometimes requiring surgical treatment. The aim of the study was to retrospectively analyse a group of patients with cardiac tamponade treated with a modified video-assisted thoracoscopy technique. We treated 15 patients (8 males and 7 females; mean age 63 years; range 24-80 years) with cardiac tamponade. All patients were treated by a modified video-assisted thorascopic approach on the right hemithorax, with the use of two trocars: a 15-mm trocar on the 4th right intercostal space on the anterior axillary, and a 10-mm trocar on the 7th right intercostal space on the median axillary line. We used a 5-mm optic, the size of which permitted the simultaneous use of two instruments through a single trocar (both for the optic and the endoscopic forceps), leaving the second trocar for the dissecting scissors. In all patients we obtained a pericardial resection equivalent to the one obtainable in an anterolateral thoracotomy. There was no intraoperative mortality or perioperative morbidity. Drainage of the pericardial effusion was effective in all cases. The modified video-assisted thoracoscopic technique on the right chest using two trocars seems a feasible surgical technique for patients suffering from cardiac tamponade.

Dear Editor, We read with interest the recent article of Yavas on the tracheostomy in the intensive care unit.1 The authors treated 205 patients needing tracheostomy, 65.4% with surgical tracheostomy (ST) and 34.6% with percutaneous tracheostomy (PT). The authors, while performing PT, used two procedures: the Ciaglia percutaneous dilatational tracheostomy technique using multiple dilators and the Griggs percutaneous technique using guidewire-dilating forceps. We would like to address two points on the use of PT. First point: Since the first report,2 the technique has undergone an important modification: a single dilator has been substituted for multiple dilators. This is a bevelled and curved dilator for the Blue Rhino and the UltraPerc technique and a screwlike dilating device for the Percu-twist technique described by Frova and Quintel.3 The single-step dilator has the advantage of not requiring a change in dilator, thereby reducing tidal volume loss until the tracheostomy tube is inserted and reducing the bleeding during the changing of dilators. The Percutwist kit3 has a screw-type dilator with a hydrophilic coating activated by wetting; this dilator has a thin internal lumen and the guidewire slides into that. The dilator is advanced over the guidewire to the skin and is rotated clockwise into the soft tissue, avoiding pressure over the anterior tracheal wall. Second point: The procedure can be performed under bronchoscopic guidance to confirm the correct site for puncture that is spotted with tracheal transillumination. After the correct site of needle is confirmed by bronchoscopy, the metal needle is removed and a Seldinger guidewire is advanced into the trachea through the cannula.

Animal-mediated pollination is essential in plant reproductive biology and is often associated with pollination syndromes, sets of floral traits, such as color, scent, shape, or nectar content. Selection by pollinators is often considered a key factor in floral evolution and plant speciation. Our aim is the identification and characterization of the genetic changes that caused the evolution of divergent pollination syndromes in closely related plant species. We focus on ANTHOCYANIN2 (AN2), a well-defined myb-type transcription factor that is a major determinant of flower color variation between Petunia integrifolia and Petunia axillaris. Analysis of sequence variation in AN2 in wild P. axillaris accessions showed that loss-of-function alleles arose at least five times independently. DNA sequence analysis was complemented by functional assays for pollinator preference using genetic introgressions and transgenics. These results show that AN2 is a major determinant of pollinator attraction. Therefore, changes in a single gene cause a major shift in pollination biology and support the notion that the adaptation of a flowering plant to a new pollinator type may involve a limited number of genes of large effect. Gene identification and analysis of molecular evolution in combination with behavioral and ecological studies can ultimately unravel the evolutionary genetics of pollination syndromes.

Rapid pollen tube growth places unique demands on energy production and biosynthetic capacity. The aim of this work is to understand how primary metabolism meets the demands of such rapid growth. Aerobically grown pollen produce ethanol in large quantities. The ethanolic fermentation pathway consists of two committed enzymes: pyruvate decarboxylase (PDC) and alcohol dehydrogenase (ADH). Because adh mutations do not affect male gametophyte function, the obvious question is why pollen synthesize an abundant enzyme if they could do just as well without. Using transposon tagging in Petunia hybrida, we isolated a null mutant in pollen-specific Pdc2. Growth of the mutant pollen tubes through the style is reduced, and the mutant allele shows reduced transmission through the male, when in competition with wild-type pollen. We propose that not ADH but rather PDC is the critical enzyme in a novel, pollen-specific pathway. This pathway serves to bypass pyruvate dehydrogenase enzymes and thereby maintain biosynthetic capacity and energy production under the unique conditions prevailing during pollen–pistil interaction.

Francesco Monaco*, Mario Barone and Maurizio Monaco Thoracic Surgery Unit, ‘Policlinico G. Martino Hospital’ of University of Messina, Messina, Italy * Corresponding author. Thoracic Surgery Unit, ‘Policlinico G. Martino Hospital’ of University of Messina, Via C. Pompea 1, Messina, Italy. Tel: +39-090-353053; e-mail: fmonaco@unime.it (F. Monaco). Received 15 November 2013; received in revised form 17 December 2013; accepted 15 January 2014

We present an uncommon case of hepatic hydatidosis, complicated by transphrenic migration of the cyst, in which the use of magnetic resonance performed with ultrafast, breath-hold, heavily T2-weighted sequences (HASTE) demonstrated a bronchial fistula.

Purpose The purpose of our study was to assess the CT patterns and prognostic value of ground-glass attenuation in nodular bronchioloalveolar carcinoma (BAC). Method We retrospectively reviewed CT examinations of 22 patients with 24 nodular BACs who underwent surgery. CT and pathologic findings were analyzed and correlated with postoperative course of disease. Results We detected five patterns of ground-glass attenuation associated with nodular BAC: pure ground-glass nodule (n = 1), ground-glass nodule with superimposed lymphangitis (n = 1), nodule with mixed areas of ground-glass attenuation and consolidation (n = 2), ground-glass halo around nodule (halo sign) (n = 3), and nodule associated with a plurisegmental area of ground-glass attenuation (n = 1). Two patients with the halo sign and a third patient with a plurisegmental area of ground-glass attenuation rapidly developed diffuse pulmonary disease by bronchogenic spread and died a few months after surgery. Conclusion Our series demonstrates that focal BAC may progress to diffuse pulmonary involvement by bronchogenic spread. The presence of a large area of ground-glass attenuation associated with a nodular BAC might be the CT sign of an aggressive biologic behavior. In these cases there is a high likelihood for diffuse disease to develop from bronchogenic spread.

To investigate the value of computed tomography (CT) for depicting the relationship between carcinomatous solitary pulmonary nodules and the bronchial tree and predicting the results of various bronchoscopic biopsy techniques, the authors retrospectively reviewed CT scans from 27 consecutive patients with solitary pulmonary nodules associated with a positive bronchus sign. All patients underwent bronchoscopy and transbronchial biopsy. Macroscopic demonstration of the tumor-bronchi relationship was obtained in 18 patients. Five basic types of tumor-bronchus relationships were identified with CT: (a) bronchus cut off by the tumor, (b) bronchus contained within the tumor, (c) bronchus compressed by the tumor, (d) thickening and smooth narrowing of the bronchus leading to the tumor, and (e) thickening and irregular narrowing of the bronchus leading to the tumor. The diagnostic yield of transbronchial forceps biopsy and bronchial brushing was significantly higher in nodules characterized by a cut-off or contained bronchus. Transbronchial needle aspiration was performed in six patients, and results were positive in five, all of whom had a compressed or thickened bronchus. These results confirm that yield of transbronchial biopsy is determined by the type of tumor-bronchus relationship and the biopsy technique performed.

The bronchus sign on CT represents the presence of a bronchus leading directly to a peripheral pulmonary lesion. We investigated the value of this sign in predicting the results of transbronchial biopsy and brushing in 33 consecutive cases of proved peripheral bronchogenic carcinoma studied with thin-slice CT (2-mm-thick sections). The bronchus sign was seen on CT in 22 patients and was absent in 11. Transbronchial biopsy and brushing showed peripheral carcinoma in 13 (59%) of 22 patients in whom the bronchus sign was seen on CT and in only two (18%) of 11 patients in whom it was not seen. The difference is statistically significant (Fisher's exact test, p = .029). When analyzed by the order of involved bronchus, a 90% success rate of transbronchial biopsy and brushing was found in patients in whom the bronchus sign was seen at a fourth-order bronchus (p = .01). This compared with a success of 33% when the bronchus sign was seen at fifth-, sixth-, or seventh-order branches. Our results suggest that the bronchus sign at a fourth-order bronchus is valuable in predicting the success of transbronchial biopsy and brushing. The presence of the sign on CT may be useful in determining if the workup should include transbronchial biopsy and brushing or transthoracic needle aspiration in patients with peripheral lung lesions.