Diagnostic and Prognostic Utility of Procalcitonin in Patients Presenting to the Emergency Department with Dyspnea

Background Among patients in the emergency department, dyspnea is a common complaint and can pose a diagnostic challenge. Biomarkers are used increasingly to improve diagnostic accuracy and aid with prognostication in dyspneic patients. The purpose of this study was to examine the clinical utility of serum procalcitonin (PCT) for the diagnosis of pneumonia in patients presenting to the emergency department with dyspnea. A secondary objective was to evaluate the prognostic value of PCT for death to 1 year. Methods This study pooled the patient populations of 2 prospective cohorts that previously enrolled patients presenting to 2 urban emergency departments with dyspnea. A total of 453 patients had serum samples available for biomarker analysis. Clinician certainty for the diagnosis of acutely decompensated heart failure was reviewed. Discrimination, calibration, and net reclassification improvement for the diagnosis of pneumonia as well as fatal outcomes were considered. The main outcome was accuracy of PCT for diagnostic categorization of pneumonia. The prognostic value of PCT for survival to 1 year was a secondary outcome. Results Pneumonia alone was diagnosed in 30 patients (6.6%), heart failure without pneumonia in 212 patients (47%), and both diagnoses in 30 patients (6.6%). Procalcitonin concentrations were higher in subjects with pneumonia (0.38 vs 0.06 ng/mL; P < .001). Area under the receiver operating characteristic curve for the diagnosis of pneumonia based on PCT was 0.84 (95% confidence interval [CI], 0.77-0.91; P < .001). Across all levels of clinician-based estimates of heart failure, PCT was sensitive and specific; notably, in patients judged with diagnostic uncertainty (n = 70), a PCT value of 0.10 ng/mL had the optimal balance of sensitivity and specificity (80% and 77%, respectively) for pneumonia. Adding PCT results to variables predictive of pneumonia resulted in a net reclassification improvement of 0.54 (95% CI, 0.24-0.83; P < .001) for both up- and down-reclassifying events. In adjusted analyses, elevated PCT was a predictor of 1-year mortality (hazard ratio 1.8; 95% CI, 1.4-2.3; P < .001) and was additive when elevated in conjunction with natriuretic peptides for this application. Conclusion In emergency department patients with acute dyspnea, PCT is an accurate diagnostic marker for pneumonia and adds independent prognostic information for 1-year mortality

Frequency response characterization of ironless inductive position sensors with long cables

The two linear position sensors used to determine the position of the European Organization for Nuclear Research; Large Hadron Collider collimator's jaws with respect to the beam are the linear variable differential transformer and the ironless inductive position sensor. The latter was designed as an alternative to the former since the linear variable differential transformer exhibits a position error in magnetic environments. The ironless inductive position sensor is an air cored, high-precision linear position sensor, which is by design immune to external DC or slowly varying magnetic fields. Since the ironless inductive position sensor is required to have no on-board electronics, the raw signal has to be carried through long cable lengths and this may lead to performance degradation. This paper focuses on a set of experimental measurements conducted to assess the ironless inductive position sensor's sensitivity at different frequencies with long cable lengths. This is critical for the sensor's correct operation in the Large Hadron Collider's collimators. Furthermore, to gain a better understanding, the ironless inductive position sensor's frequency response is compared with a commercial off-the-shelf linear variable differential transformer.peer-reviewe

Micropropagation of Quercus pubescens from buds

Some plants present challenging obstacles when grown by in vitro culture, they may be recalcitrant, hampering the development of reliable regeneration techniques. This ‘recalcitrant behaviour’ is genetically driven, so it is difficult to control by environmental and nutritional manipulation in microculture. Plants which are difficult to work with are usually perennials with complex seasonal life cycles. Quercus species show short growth spurts per season, when they stop growing until the next season. Such species may be called episodic and are not always successfully used in microculture and biotechnology. Micropropagation has the advantage of genetic homogeneity and avoids difficulties related to obtaining sterile plant material.peer-reviewe

Safety profile of drugs used in the treatment of osteoporosis: a systematical review of the literature.

The range of osteoporosis treatments is increasingly large and, like any disease, the pharmacological management of patients should involve a risk/benefit evaluation to attain the greatest reduction in risk of fracture with the lowest incidence of adverse events. The aim of this review is to critically appraise the literature about the safety issues of the main pharmacological treatments of osteoporosis. This document is the result of a consensus of experts based on a systematic review of regulatory documents, randomized controlled trials, metaanalyses, pharmacovigilance surveys and case series related to possible adverse drug reactions to osteoporosis treatment with calcium and vitamin D supplements, bisphosphonates, strontium ranelate, selective estrogen receptor modulators, denosumab, and teriparatide. As expected, randomized controlled trials showed only the most common adverse events due to the samples size and the short observation time. Case series and observational studies are able to provide data about uncommon side effects, but in some cases a sure cause-effect relationship needs still to be confirmed. Consistently with methodological limitations, the newer drugs have a tolerance profile that has not been fully explored yet. Osteoporosis treatments showed an overall good tolerance profile with rare serious adverse events that, however, must be well known by the clinician who prescribes these drugs. The concern about possible adverse events should be weighed against the reduction of morbidity and mortality associated with a significant fracture risk reduction

The Biobank of the ‘Istituto Zooprofilattico Sperimentale’ of Sicily: an important resource in medical research for safe and quality storage of biological specimens

The Mediterraean Biobank has been recently launched at the ‘Istituto Zooprofilattico Sperimentale’ (IZS) of Sicily in Palermo. The main aim of the Biobank is to collect and store, under standardised conditions and in a centralised system, several types of certified animal and zoonotic biological resources such as bacterial and viral strains, parasites, nucleic acids, positive/negative sera, cell cultures and tissues, in accordance to quality System procedures as regulated by UNI CEI EN ISO/IEC 17025:2005.peer-reviewe

Consensus communication strategies to improve doctor-patient relationship in paediatric severe asthma

Background: Asthma is a chronic inflammatory disease that is very common among youth worldwide. The burden of this illness is very high not only considering financial costs but also on emotional and social functioning. Guidelines and many researches recommend to develop a good communication between physicians and children/caregiver and their parents. Nevertheless, a previous Italian project showed some criticalities in paediatric severe asthma management. The consensus gathered together experts in paediatric asthma management, experts in narrative medicine and patient associations with the aim of identify simple recommendation to improve communication strategies. Methods: Participants to the consensus received the results of the project and a selection of narratives two weeks before the meeting. The meeting was structured in plenary session and in three working groups discussing respectively about communication strategies with children, adolescents and parents. The task of each working group was to identify the most effective (DO) and least effective practices (DON' T) for 5 phases of the visit: welcome, comprehension of the context, emotions management, duration and end of the visit and endurance of the relationship. Results: Participants agreed that good relationships translate into positive outcomes and reached consensus on communication strategies to implement in the different phase of relationships. Conclusions: The future challenges identified by the participants are the dissemination of this Consensus document and the implementation of effective communication strategies to improve the management of pediatric asthma

Growth and Self-Ejection of Single Condensate Droplet on Nanostructured Microcones

In the last decade, the phenomenon of coalescence-induced droplet jumping has been studied in depth because of the advantages it brings in applications such as anti-frosting, anti-icing, condensation heat transfer, water harvesting, thermal diodes for electronics cooling and self-cleaning [1]. In this work we theoretically and experimentally show that surfaces structured with micro truncated cones covered with highly hydrophobic nanostructures exhibit a recurrent self-ejection of single condensate droplets in addition to the common coalescence-induced jumps. We analytically modelled the external forces acting both on a droplet of condensate slowly growing in conical pores (a simplification of the growth between truncated cones) and during the following rapid transient for two possible cases of self-ejection: 1) rapid swelling out of the structures and 2) detachment from a pinning site (a less hydrophobic defect or the nucleation site). Viscous and adhesion dissipations were included in the modelling. We described the shape of the growing droplet as a function of the tapering (B) and of dynamic contact angles (vadv and vrec ). For both cases, the minimum requirement for self-ejection is that the receding angle of the walls (vrec ) and any pinning site (vpinningrec ) are greater than 90°+B. In the first case, as the volume increases, the upper meniscus moves towards the apex of the cones and the lower one follows it as soon as it reaches vrec; when the droplet reaches the apex of the structures it self-ejects because the superior meniscus expands rapidly and a Laplace pressure gradient is generated between the menisci. In the second case, the superior meniscus grows towards the apex and when the lower one recedes from the pinning site, the droplet self-ejects due to the Laplace pressure gradient generated by the abrupt change in wettability, as recently reported for relatively large droplets (radius > 50 μm) in diverging grooves [2]. Describing growth and self-ejection with a system of forces requires a careful distinction between external and internal forces. The modelling with forces, unlike the energetic one [2], allowed us to describe the ejection transient dynamics and to derive the ejection velocity while maintaining the dependence on the dynamic contact angles of the superhydrophobic walls and of an eventual pinning site, fundamental quantities for the design of real surfaces. The analytical results relative to the case of the pinning site foresee that, at a fixed contact angle hysteresis of the superhydrophobic walls and vpinningrec, the ejection velocity increases with B (until the limit B = vpinningrec − 90°, beyond which there cannot be ejection); in addition, the velocity is greater as the droplet size decreases if viscous dissipations are not considered while a peak trend is observed with the dissipations included. We fabricated silicon truncated micro cones arranged in square and hexagonal patterns and covered with nanostructures. Through condensation experiments in a controlled environmental chamber we observed for the first time the self-ejection of the drops that nucleate and grow between the cones (in the case in question the droplet diameter ≈ 11 um). By fabricating cones of different sizes, we have also studied the self-ejection rate per unit area as a function of the droplet size. Furthermore, we performed preliminary condensation frosting experiments. Future investigations of this new class of jumping droplet surfaces may show important advantages in the mentioned applications