Critical analysis of the utility of initial pleural aspiration in the diagnosis and management of suspected malignant pleural effusion

INTRODUCTION:Current guidelines recommend an initial pleural aspiration in the investigation and management of suspected malignant pleural effusions (MPEs) with the aim of establishing a diagnosis, identifying non-expansile lung (NEL) and, at times, providing a therapeutic procedure. A wealth of research has been published since the guidelines suggesting that results and outcomes from an aspiration may not always provide sufficient information to guide management. It is important to establish the validity of these findings in a 'real world' population. METHODS:A retrospective analysis was conducted of all patients who underwent pleural fluid (PF) sampling, in a single centre, over 3 years to determine the utility of the initial aspiration. RESULTS:A diagnosis of MPE was confirmed in 230/998 (23%) cases, a further 95/998 (9.5%) were presumed to represent MPE. Transudative biochemistry was found in 3% of cases of confirmed MPE. Positive PF cytology was only sufficient to guide management in 45/140 (32%) cases. Evidence of pleural thickening on CT was associated with both negative cytology (χ2 1df=26.27, p<0.001) and insufficient samples (χ2 1df=10.39, p=0.001). In NEL 44.4% of patients did not require further procedures after pleurodesis compared with 72.7% of those with expansile lung (χ2 1df=5.49, p=0.019). In patients who required a combined diagnostic and therapeutic aspiration 106/113 (93.8%) required further pleural procedures. CONCLUSIONS:An initial pleural aspiration does not achieve either definitive diagnosis or therapy in the majority of patients. A new pathway prioritising symptom management while reducing procedures should be considered

Carbon-Nanotube-Based Monolithic CMOS Platform for Electrochemical Detection of Neurotransmitter Glutamate

We present a monolithic biosensor platform, based on carbon-nanotube field-effect transistors (CNTFETs), for the detection of the neurotransmitter glutamate. We used an array of 9′216 CNTFET devices with 96 integrated readout and amplification channels that was realized in complementary metal-oxide semiconductor technology (CMOS). The detection principle is based on amperometry, where electrochemically active hydrogen peroxide, a product of the enzymatic reaction of the target analyte and an enzyme that was covalently bonded to the CNTFET, modulated the conductance of the CNTFET-based sensors. We assessed the performance of the CNTs as enzymatic sensors by evaluating the minimal resolvable concentration change of glutamate in aqueous solutions. The minimal resolvable concentration change amounted to 10 µM of glutamate, which was one of the best values reported for CMOS-based systems so far

Carbon-nanotube-based monolithic CMOS platform for electrochemical detection of neurotransmitter glutamate

We present a monolithic biosensor platform, based on carbon-nanotube field-effect transistors (CNTFETs), for the detection of the neurotransmitter glutamate. We used an array of 9′216 CNTFET devices with 96 integrated readout and amplification channels that was realized in complementary metal-oxide semiconductor technology (CMOS). The detection principle is based on amperometry, where electrochemically active hydrogen peroxide, a product of the enzymatic reaction of the target analyte and an enzyme that was covalently bonded to the CNTFET, modulated the conductance of the CNTFET-based sensors. We assessed the performance of the CNTs as enzymatic sensors by evaluating the minimal resolvable concentration change of glutamate in aqueous solutions. The minimal resolvable concentration change amounted to 10 µM of glutamate, which was one of the best values reported for CMOS-based systems so far.ISSN:1424-822

CMOS-integrated high-density arrays of carbon nanotube sensors

We report on the integration of single and small bundles of carbon nanotube (CNT) biosensors on a CMOS-integrated array featuring 1024 devices. The system has been designed to allow for direct and versatile readout of each nanosensor. A parallel integration of the CNT nanosensors has been achieved by using semi-sacrificial electrodes and dielectrophoresis (DEP). The developed sensing platform will be used for high-resolution chemical monitoring of complex biological systems. Here, we present the onchip CNT integration process and statistical analysis of the fabricated devices

Switch-matrix-based Monolithic CMOS Platform Featuring a Large Array of Carbon Nanotube Sensor Elements and a 96-channel Readout Circuitry

We present a monolithic CMOS biosensor system comprised of a switch-matrix-based array of carbon nanotube field-effect transistors (CNT-FETs) and an associated readout circuitry. The switch-matrix allows for flexible selection and simultaneous routing of 96 sensor elements to the readout channels. The resistances of the CNT-FETs were measured by applying a constant voltage and measuring the resulting current. Variation of the first-stage-amplifier gain and bandwidth allows for measuring resistances in the range between 50 kΩ and 20 MΩ at a bandwidth of up to 20 kHz. A parallel integration of the CNT-FETs has been achieved by using a floating electrode dielectrophoresis (DEP) manipulation technique

Monolithic CMOS sensor platform featuring an array of 9'216 carbon-nanotube-sensor elements and low-noise, wide-bandwidth and wide-dynamic-range readout circuitry

ISSN:0925-400

Determinants of risk factor control in subjects with coronary heart disease: a report from the EuroAspire III investigators

The EUROASPIRE audits of risk factor control have indicated that, even in those with established coronary heart disease, risk factor control remains poor. We therefore analysed the EUROASPRE III data set to establish the factors associated with success or failure in risk factor control in order to inform future risk factor management strategies. University education, attendance at a specialist cardiology clinic, and participation in a cardiac rehabilitation programme were associated with improved risk factor control. Risk factor control was poorer in women, those with diabetes, and those undergoing coronary artery bypass surgery as opposed to medical therapy or percutaneous coronary intervention. Increasing age, depression, and anxiety were not associated with poorer risk factor control

Cardiovascular risk age: concepts and practicalities

Objectives : A young person with many risk factors may have the same level of risk as an older person with no risk factors. Thus a high-risk 40-year-old may have a risk age of 60 years or more. The aim of the study was to derive a generic equation for risk age, construct risk age charts, and explore the hypothesis that risk age is similar regardless of the cardiovascular disease (CVD) end point used. Methods : The equation was generated by equating the generic formula for 10-year CVD risk (with unknown risk factor levels) to the generic formula for 10-year CVD risk in a person with age = x and ideal risk factor levels (total cholesterol 4 mmol/l, systolic blood pressure 120 mm Hg, and non-smoker) and solving for x. To examine the consistency between risk ages for different end points, a risk age based on risk of CVD fatal events and based on risk of fatal and non-fatal CVD events was derived for each of the participants in the FINRISK population study. The correlation between these risk ages was examined. Results : A generic equation for risk age was derived. The generic equation could not be used for SCORE (Systematic COronary Risk Evaluation), because the age is included in the baseline. Therefore a table of SCORE risk ages was developed by looking up the risk age corresponding to each combination of risk factors in the chart. Risk age remains similar regardless of the cardiovascular end point used, which bypasses the dilemma of whether to use a risk-estimation system based on CVD mortality or on the more attractive but less reliable end point of total CVD events. On the basis of the equation, risk age is not dependent on baseline survival and therefore recalibration is not required. Conclusions : Risk age is an intuitive and easily understood method for communicating about risk, particularly in younger patients, and may facilitate lifestyle change in younger patients. However, treatment decisions should be based on absolute risk, as recommended by guidelines on CVD prevention