Survival and quality of life benefit after endoscopic management of malignant central airway obstruction

Although interventional management of malignant central airway obstruction (mCAO) is well established, its impact on survival and quality of life (QoL) has not been extensively studied.We prospectively assessed survival, QoL and dyspnea (using validated EORTC questionnaire) in patients with mCAO 1 day before interventional bronchoscopy, 1 week after and every following month, in comparison to patients who declined this approach. Material/Patients/Methods: 36 patients underwent extensive interventional bronchoscopic management as indicated, whereas 12 declined. All patients received full chemotherapy and radiotherapy as indicated. Patients of the 2 groups were matched for age, comorbidities, type of malignancy and level of obstruction. Follow up time was 8.0±8.7 (range 1-38) months.Mean survival for intervention and control group was 10±9 and 4±3 months respectively (p=0.04). QoL improved significantly in intervention group patients up to the 6(th) month (p<0.05) not deteriorating for those surviving up to 12 months. Dyspnea decreased in patients of the intervention group 1 month post procedure remaining reduced for survivors over the 12th month. Patients of the control group had worse QoL and dyspnea in all time points.Interventional management of patients with mCAO, may achieve prolonged survival with sustained significant improvement of QoL and dyspnea

Spin-polarized oxygen hole states in cation deficient La(1-x)CaxMnO(3+delta)

When holes are doped into a Mott-Hubbard type insulator, like lightly doped manganites of the La(1-x)CaxMnO3 family, the cooperative Jahn-Teller distortions and the appearance of orbital ordering require an arrangement of Mn(3+)/Mn(4+) for the establishment of the insulating canted antiferromagnetic (for x<=0.1), or of the insulating ferromagnetic (for 0.1<x<= 0.2) ground state. In the present work we provide NMR evidence about a novel and at the same time puzzling effect in La(1-x)CaxMnO(3+delta) systems with cation deficience. We show that in the low Ca-doping regime, these systems exhibit a very strong hyperfine field at certain La nuclear sites, which is not present in the stoichiometric compounds. Comparison of our NMR results with recent x-ray absorption data at the Mn K edge, suggests the formation of a spin-polarized hole arrangement on the 2p oxygen orbitals as the origin of this effect.Comment: 10 pages, 4 Figures, submitted to PR

Structural efficiency of percolation landscapes in flow networks

Complex networks characterized by global transport processes rely on the presence of directed paths from input to output nodes and edges, which organize in characteristic linked components. The analysis of such network-spanning structures in the framework of percolation theory, and in particular the key role of edge interfaces bridging the communication between core and periphery, allow us to shed light on the structural properties of real and theoretical flow networks, and to define criteria and quantities to characterize their efficiency at the interplay between structure and functionality. In particular, it is possible to assess that an optimal flow network should look like a "hairy ball", so to minimize bottleneck effects and the sensitivity to failures. Moreover, the thorough analysis of two real networks, the Internet customer-provider set of relationships at the autonomous system level and the nervous system of the worm Caenorhabditis elegans --that have been shaped by very different dynamics and in very different time-scales--, reveals that whereas biological evolution has selected a structure close to the optimal layout, market competition does not necessarily tend toward the most customer efficient architecture.Comment: 8 pages, 5 figure

On the observational determination of squeezing in relic gravitational waves and primordial density perturbations

We develop a theory in which relic gravitational waves and primordial density perturbations are generated by strong variable gravitational field of the early Universe. The generating mechanism is the superadiabatic (parametric) amplification of the zero-point quantum oscillations. The generated fields have specific statistical properties of squeezed vacuum quantum states. Macroscopically, squeezing manifests itself in a non-stationary character of variances and correlation functions of the fields, the periodic structures of the metric power spectra, and, as a consequence, in oscillatory behavior of the higher order multipoles C_l of the cosmic microwave background anisotropy. We start with the gravitational wave background and then apply the theory to primordial density perturbations. We derive an analytical formula for the positions of peaks and dips in the angular power spectrum l(l+1)C_l as a function of l. This formula shows that the values of l at the peak positions are ordered in the proportion 1:3:5:..., whereas at the dips they are ordered as 1:2:3:.... We compare the derived positions with the actually observed features, and find them to be in reasonably good agreement. It appears that the observed structure is better described by our analytical formula based on the (squeezed) metric perturbations associated with the primordial density perturbations, rather than by the acoustic peaks reflecting the existence of plasma sound waves at the last scattering surface. We formulate a forecast for other features in the angular power spectrum, that may be detected by the advanced observational missions, such as MAP and PLANCK. We tentatively conclude that the observed structure is a macroscopic manifestation of squeezing in the primordial metric perturbations.Comment: 34 pages, 3 figures; to appear in Phys. Rev. D66, 0435XX (2002); includes Note Added in Proofs: "The latest CBI observations (T.J.Pearson et al., astro-ph/0205388) have detected four peaks, at l ~ 550, 800, 1150, 1500, and four dips, at l ~ 400, 700, 1050, 1400. These positions are in a very good agreement with the theoretical formula (6.35) of the present paper. We interpret this data as confirmation of our conclusion that it is gravity, and not acoustics, that is responsible for the observed structure.

Bilateral spontaneous hemotympanum: Case report

BACKGROUND: The most common causes of hemotympanum are therapeutic nasal packing, epistaxis, blood disorders and blunt trauma to the head. Hemotympanum is characterized as idiopathic, when it is detected in the presence of chronic otitis media. A rare case of spontaneous bilateral hemotympanum in a patient treated with anticoagulants is presented herein. CASE PRESENTATION: A 72-year-old male presented with acute deterioration of hearing. In the patient's medical history aortic valve replacement 1 year before presentation was reported. Since then he had been administered regularly coumarinic anticoagulants, with INR levels maintained between 3.4 and 4.0. Otoscopy revealed the presence of bilateral hemotympanum. The audiogram showed symmetrical moderately severe mixed hearing loss bilaterally, with the conductive component predominating. Tympanograms were flat bilaterally with absent acoustic reflexes. A computerized tomography scan showed the presence of fluid in the mastoid and middle ear bilaterally. Treatment was conservative and consisted of a 10-day course of antibiotics, anticongestants and temporary interruption of the anticoagulant therapy. After 3 weeks, normal tympanic membranes were found and hearing had returned to previous levels. CONCLUSION: Anticoagulant intake should be included in the differential diagnosis of hemotympanum, because its detection and appropriate treatment may lead to resolution of the disorder

Quintessence and Gravitational Waves

We investigate some aspects of quintessence models with a non-minimally coupled scalar field and in particular we show that it can behave as a component of matter with $-3 \lesssim P/\rho \lesssim 0$. We study the properties of gravitational waves in this class of models and discuss their energy spectrum and the cosmic microwave background anisotropies they induce. We also show that gravitational waves are damped by the anisotropic stress of the radiation and that their energy spectrum may help to distinguish between inverse power law potential and supergravity motivated potential. We finish by a discussion on the constraints arising from their density parameter \Omega_\GW.Comment: 21 pages, 18 figures, fianl version, accepted for publication in PR

Surgical and minimally invasive treatment of ischaemic and non-ischaemic priapism : A systematic review by the EAU Sexual and Reproductive Health Guidelines panel

Peer reviewedPostprin

Interaction of consumer preferences and climate policies in the global transition to low-carbon vehicles

Burgeoning demands for mobility and private vehicle ownership undermine global efforts to reduce energy-related greenhouse gas emissions. Advanced vehicles powered by low-carbon sources of electricity or hydrogen offer an alternative to conventional fossil-fuelled technologies. Yet, despite ambitious pledges and investments by governments and automakers, it is by no means clear that these vehicles will ultimately reach mass-market consumers. Here, we develop state-of-the-art representations of consumer preferences in multiple, global energy- economy models, specifically focusing on the non-financial preferences of individuals. We employ these enhanced model formulations to analyse the potential for a low-carbon vehicle revolution up to mid-century. Our analysis shows that a diverse set of measures targeting vehicle buyers is necessary for driving widespread adoption of clean technologies. Carbon pricing alone is insufficient for bringing low-carbon vehicles to mass market, though it can certainly play a supporting role in ensuring a decarbonised energy supply