An immunohistochemical study of the diagnostic value of TREM-1 as marker for fatal sepsis cases

Triggering receptor expressed on myeloid cells-1 (TREM-1) is produced and up-regulated by exposure of myeloid cells to lipopolysaccharides or other components of either bacterial or fungal origin, which causes it to be strongly expressed on phagocytes that accumulate in inflamed areas. Because TREM-1 participates in septic shock and in amplifying the inflammatory response to bacterial and fungal infections, we believe it could be an immunohistochemical marker for postmortem diagnosis of sepsis. We tested the anti-TREM-1 antibody in 28 cases of death by septic shock and divided them into two groups. The diagnosis was made according to the criteria of the Surviving Sepsis Campaign. In all cases, blood cultures were positive. The first group was comprised subjects that presented high ante-mortem serum procalcitonin and the soluble form of TREM-1 (s-TREM-1) values. The second group comprised subjects in which s-TREM-1 was not measured ante-mortem. We used samples of brain, heart, lung, liver and kidney for each case to test the anti-TREM-1 antibody. A semiquantitative evaluation of the immunohistochemical findings was made. In lung samples, we found immunostaining in the cells of the monocyte line in 24 of 28 cases, which suggests that TREM-1 is produced principally by cells of the monocyte line. In liver tissue, we found low TREM-staining in the hepatocyte cytoplasm, duct epithelium, the portal-biliary space and blood vessel. In kidney tissue samples, we found the TREM-1 antibody immunostaining in glomeruli and renal tubules. We also found TREM-1 staining in the lumen of blood vessels. Immunohistochemical staining using the anti-TREM-1 antibody can be useful for postmortem diagnosis of sepsis

Boredom and Distraction in Multiple Unmanned Vehicle Supervisory Control

Operators currently controlling Unmanned Aerial Vehicles report significant boredom, and such systems will likely become more automated in the future. Similar problems are found in process control, commercial aviation, and medical settings. To examine the effect of boredom in such settings, a long duration low task load experiment was conducted. Three low task load levels requiring operator input every 10, 20, or 30 minutes were tested in a our-hour study using a multiple unmanned vehicle simulation environment that leverages decentralized algorithms for sometimes imperfect vehicle scheduling. Reaction times to system-generated events generally decreased across the four hours, as did participants’ ability to maintain directed attention. Overall, participants spent almost half of the time in a distracted state. The top performer spent the majority of time in directed and divided attention states. Unexpectedly, the second-best participant, only 1% worse than the top performer, was distracted almost one third of the experiment, but exhibited a periodic switching strategy, allowing him to pay just enough attention to assist the automation when needed. Indeed, four of the five top performers were distracted more than one-third of the time. These findings suggest that distraction due to boring, low task load environments can be effectively managed through efficient attention switching. Future work is needed to determine optimal frequency and duration of attention state switches given various exogenous attributes, as well as individual variability. These findings have implications for the design of and personnel selection for supervisory control systems where operators monitor highly automated systems for long durations with only occasional or rare input.This work was supported by Aurora Flight Sciences under the ONR Science of Autonomy program as well as the Office of Naval Research (ONR) under Code 34 and MURI [grant number N00014-08-C-070]

Evaluation with doppler sonography of mesenteric blood flow in celiac disease

OBJECTIVE. The aim of this study was to investigate with Doppler sonography the variations of resistance in the superior mesenteric artery, both at fasting and in the postprandial state, in patients with celiac disease. SUBJECTS AND METHODS. Twenty-five patients with celiac disease (20 women, five men; mean age, 30 ± 7 years) and 10 healthy volunteers (seven women, three men; mean age, 28 ± 6 years) were examined with Doppler sonography. Nineteen patients were untreated (no dietary restrictions) and six patients were treated with a gluten-free diet at the time of the examination. Imaging was performed at both fasting and 15 min after an 1890- kJ meal. We introduced a parameter called 'resistive difference,' defined as the mathematic difference between the resistive index measured at fasting (highest value) and that measured at 15 min after the meal (lowest value) as a way to express the postprandial resistive change in the superior mesenteric artery. RESULTS. Untreated patients with flat mucosa showed a resistive difference of 0.03 ± 0.05, followed by untreated patients with mucosal subatrophy (0.05 ± 0.04), treated patients (0.09 ± 0.02), and healthy volunteers (0.12 ± 0.04). A statistically significant difference was noticed between the resistive difference of healthy volunteers and both those of the untreated patients with subatrophy (p = .016) and of the patients with complete atrophy (p = .011), as well as between the resistive difference of the treated patients and both those of the untreated patients with subatrophy (p = .021) and of the patients with complete atrophy (p = .020). CONCLUSION. We believe that Doppler measurement of resistive difference in the superior mesenteric artery can be an effective way to express severity of celiac disease and to document its regression after diet therapy

Placental site trophoblastic tumor (PSTT): a case report to describe medical legal aspects.

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease with unpredictable malignant potential and highly variable clinical course. The etiology, epidemiology and risk factors of PSTT are poorly understood. Patients that present an abnormal uterine bleeding, uterine enlargement, and positive pregnancy test and are often misdiagnosed about an intrauterine pregnancy, a missed abortion, or an ectopic pregnancy. The majority of patients with PSTT are cured by hysterectomy and a large number of cases require aggressive treatment with chemotherapy and/or radiation. It is described a case of post-mortem diagnosis of PSTT in a 21 year old woman at 25 weeks of gestational age. Patient until admission in hospital refereed episodes of hyper-emesis and exaggerated lose weight. Ultrasonography examination showed a normal fetus growth but a placenta with a cystic formation large 52 for 12 mm. After twenty days of hospital admission patient presents an incoercible emesis with severe malnutrition, heavy anaemic state and subsequent a total alteration of the metabolism the patient deceased. The cause of death is to be charged to an acute cardiac failure. At the autopsy, macroscopic examination of the uterus described a thin wall approximately 2,51 centimetres and a microscopical large trophoblastic cells with abundant eosinophilic cytoplasm and nuclear pleomorphism are seen invading the myometrium. The immunoistochemical features of those cells correspond to those of intermediate trophoblast with focal immunoreactivity for hCG and keratin. Placenta had a small diameter of 15 centimetres and a weight of 154 gr. PSTT introduces like a challenge to the clinical management due to its rarity and with its variability of biological development, therefore, strategy of optimal treatment does not concur one. The diagnostic for image of the PSTT does not help in the clinical identification of the tumor. Some studies showed as ultrasonography (US) that the magnetic resonance (MR) is not specific tools for diagnosis of the existence of the PSTT. In this situation, when ultrasonography showed a fetus with a normal growth without anomalies or malformations it does not be considered the interruption of pregnancy. Despite, in the course of hospitalization had not been performed the dosage of the hormones (B-HCG and H.P.L.) on blood and urine and the literature confirm the concept that these hormones is not settling for the diagnosis of PSTT a cause of variability of the biological development and because the production of these hormones can result absent. Missing the diagnosis of a serious and rare pathology such PSTT and being the patient continuation assiduously and constantly, a lot of precipitation of the clinical picture happens nearly unexpectedly and without warning is a frequently conduction. In truth, has not been shown an interruption and in equal way discharge from professional responsibility the sanitary staff that had she in cure

Strain Induced by Ti Salicidation in Sub-quarter-micron CMOS Devices, as Measured by TEM/CBED

The use of TiSi2 layers as ohmic contacts in complementary MOS (CMOS) devices is expected to introduce large distortions in the underlying silicon which may degrade the device performances. In this work, the TEM technique known as convergent beam electron diffraction (CBED) has been employed to map the strain distributions across (1 1 0) cross-sectional specimens of sub-quarter-micron CMOS structures. Different experimental set-ups in terms of energy filtering, liquid nitrogen cooling and zone axis have been explored and compared to each other by using three differently equipped microscopes. The strain induced on silicon by TiSi2 layers has then been investigated. quantified and compared with that due to the presence of an oxide isolation trench. Also, the effects of depositing a TEN capping layer on TiSi2 have been analysed. Our results show that its presence results in a more tensile strain without altering the strain distribution trend. (C) 2002 Elsevier Science B.V. All rights reserved

Convergent beam electron diffraction investigation of strain induced by Ti self-aligned silicides in shallow trench Si isolation structures

The deformation induced onto silicon by the formation of Ti self-aligned silicides (salicides) in shallow trench isolation structures has been investigated by the convergent beam electron diffraction technique (CBED) in the transmission electron microscope (TEM). The splitting of the high order Laue zone (HOLZ) lines in the CBED patterns taken in TEM cross sections close to the salicide/silicon interface has been explained assuming that the salicide grains induce a local bending of the lattice planes of the underlying matrix. This bending, which affects in opposite sense the silicon areas below adjacent grains, decreases with the distance from the interface, eventually vanishing at a depth of 300-400 nm. The proposed strain field has been implemented into a fully dynamical simulation of the CBED patterns and has proved to be able to reproduce both the asymmetry of the HOLZ line splitting and the associated subsidiary fringes. This model is confirmed by the shift of a Bragg contour observed in large angle CBED patterns, taken in a cross section cut along a perpendicular direction. The whole experimental results cannot be explained by just a strain relaxation of the TEM cross section, induced by the salicide film onto the underlying silicon

Initial reactions in Ti-Si bilayers-new indications from in-situ measurements

The interactions occurring in a Ti–Si bilayer have been investigated by in situ resistance measurements and the reaction products have been analyzed by complementary techniques, such as x-ray diffraction, Auger electron spectroscopy, and MeV 4He+ Rutherford backscattering. The measurements were performed by heating the samples at a constant rate in the 5–425 °C/min range. The samples are 60 nm of titanium sputter deposited on 250 nm of a silicon film deposited by chemical vapor technique; the bilayers were placed on 650 nm of SiO2, thermally grown on p-type silicon wafers. Samples were also prepared by reactively depositing 25 nm of TiN on the Ti film. The TiN cap, deposited without breaking the vacuum, protects the metal films from contaminants, namely oxygen, during handling and heat treatments. It has been shown that, at temperatures around 400 °C and before any massive Ti–Si interaction, the resistance increases. This effect, attributed in the literature to the silicon diffusion in the metal film, is due to oxygen, generally contained in the annealing ambient, which diffuses in the Ti film. The Ti–Si reaction produces a decrease in the value of resistance; the first decrease, generally attributed to the formation of a C49–TiSi2 phase, is due to the growth of an amorphous compound having a graded in-depth composition between Ti5Si3 and TiSi. The activation energy for such formation is 2.8±0.1 eV. At higher temperatures C49–TiSi2 starts to form, more likely between the silicon and the amorphous layer. The formation of silicide induces a segregation of oxygen in the unreacted Ti film, thus slowing down the growth of silicide