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Background. Lung cancer is the leading cause of malignancy related mortality in the United States. Accurate staging of NSCLC influences therapeutic decisions. Transbronchial needle aspiration (TBNA) and endobronchial ultrasound-guided TBNA (EBUS-TBNA) has been accepted as a procedure for the diagnosis and staging of lung cancer. The aim of this study is to evaluate the efficacy and adequacy of TBNA and EBUS-TBNA for sampling of mediastinal adenopathy using the Wang’s eleven lymph node map stations. Methods. We retrospectively reviewed 99 consecutive cases diagnosed with malignancy by EBUS-TBNA and a series 74 patients evaluated for mediastinal adenopathy or a pulmonary lesion using conventional transbronchial needle aspiration. The IASLC lymph node map was correlated with Wang’s map. Results. A total of 182 lymph node stations were sampled using EBUS-TBNA. 96 were positive for nodal metastasis. A total of four cases of samples taken from station 2R showed malignant cells. From the 74 cases series using cTBNA 167 nodes were sampled in 222 passes. Lymphoid or malignant tissue was obtained in 67 (91.8%) cases; 55.1% of the nodes were 1 cm or less. Conclusions. The use of the eleven stations described in Wang’s map to guide TBNA of the mediastinal nodes allows sampling of radiologically considered nonpathological nodes. These data suggest that Wang’s map covers the most frequent IASLC nodal stations compromised with metastasis.

Criegee intermediates, which are the result of ozonolysis of alkenes, play a key role in many chemical and physical processes in the Earth’s atmosphere. Their reactions with various atmospheric compounds are responsible for formation of hydroxyl radicals, atomic oxygen and hydrogen, sulfuric and nitric acids, and other chemically active radicals and molecules. In this work we have considered collisional-induced chemical reactions between three simple Criegee intermediate molecules: CH 2 OO, CH 3 CHOO, and (CH 3 ) 2 COO with methane, which is a well-known active greenhouse gas. Methane concentration rapidly growths last decades that causes serious concern to the global scientific community. It was established that reactions between methane and Criegee Intermediates can follow through two main routes. One of them occurs over exchange of oxygen and hydrogen atoms upon collision and leads to the formation of methanol. Another one pass through the formation of an intermediate complex with a deep energy minimum, and produces OH radicals and a variety of other products, among which are acetone, acetaldehyde, formaldehyde, propaldehyde, methanol, water molecules, and others. In this work, the both kinds of the reactions have been studied, and the relative reaction rates of both pathways have been compared.

Pentalene and its chemically active isomers benzocyclobutadiene and phenylacetylene play an important role in processes of creation and destruction of polyaromatic hydrocarbons (PAHs), which are the main element of soot microparticles, abundantly arising due to burning of organic fuels in internal combustion engines, power plants, and natural fires. They are one of the most dangerous anthropogenic air pollutants, causing serious negative impacts on human health. The probable dissociation mechanisms of pentalene and its isomers, as far as their cations and dications are considered. It is shown that the loss of electrons during ionization changes the aromatic/antiaromatic properties of pentalene and its isomers to the opposite ones. At low values of internal energy the main dissociation pathway for neutral molecules and cations is the acetylene elimination. At high values of internal energy H atom loss becomes the major reaction.

Synopsis Spectral line profile of Ti XII 11.64 nm was measured using spatio-temporally resolved laser-produced plasma technique. The electron density of laser-produced Ti plasmas was calculated based on the spectral line Stark broadening of highly charged ions.

The present study aimed to investigate the expression of aldosterone synthase (CYP11B2), adrenocorticotropic hormone receptor (ACTH-R) and their regulating transcription factors in adrenal incidentalomas (AIs) from normotensive and hypertensive patients to distinguish subclinical or atypical primary aldosteronism (PA) from AIs. Total RNA was extracted from 8 normal adrenal cortices (NAs), 46 AIs, 15 aldosterone-producing adenomas (APAs) and 6 idiopathic hyperaldosteronisms (IHAs). Real-time quantitative polymerase chain reaction (PCR) and immunohistochemistry were performed to determine the mRNA and protein expression of CYP11B2, ACTH-R, steroidogenic factor-1 (SF1) and dosage-sensitive sex reversal, adrenal hypoplasia congenita, critical region on the X chromosome, gene-1 (DAX-1) in the different tissues. The AI hypertensive subgroup displayed increased plasma aldosterone concentration (PAC) and PAC/PRA ratio (ARR) and decreased plasma renin activity (PRA) compared to the normotensive group. CYP11B2, ACTH-R and SF1 mRNAs were significantly higher in the APA group compared to the other groups, and gradually increased in AI hypertensive samples. DAX-1 mRNA was expressed faintly in PA compared with NA. In normotensive-AI samples, DAX-1 mRNA was higher compared to PA and AI hypertensive samples. Significant differences in gene expression levels in AIs were observed between probable and improbable PA patients. Immunohistochemical results were consistent with those of real-time PCR. Plasma aldosterone levels were positively correlated with CYP11B2, ACTH-R and SF1 mRNA and inversely correlated with DAX-1 mRNA. In conclusion, a significant number of hypertensive-AI patients may have subclinical forms of PA. CYP11B2, ACTH-R and their regulating transcription factors may be noteworthy in distinguishing subclinical PA from AIs.

Medical school curriculum typically consists of didactical experiences with minimal patient interaction for junior students followed by clinical experiences with supplementary didactics for senior students. Due to the focus on understanding basic medical concepts and disease pathophysiology during the first few years of medical school, students have limited exposure to real-life clinical situations that involve complex, difficult concepts such as death and dying. This leaves students ill-prepared to contribute meaningfully to patients' end-of-life (EOL) care that they will inevitably encounter during their clerkship years. We believe that students would benefit from increased exposure to these difficult situations through structured educational environments, such as the No One Dies Alone Program. In this way, students can become more familiar with the difficult concepts of death and dying, learn how to make meaningful contributions in their patients' EOL care, and ultimately provide patients with the \"good death\" they deserve.

Background Ovarian follicles, which are the basic units of female reproduction, are composed of oocytes and surrounding somatic (pre) granulosa cells (GCs). A recent study revealed that signaling in somatic preGCs controlled the activation (initial recruitment) of follicles in the adult ovaries, but it is also known that there are two waves of follicle with age-related heterogeneity in their developmental dynamics in mammals. Although this heterogeneity was proposed to be crucial for female reproduction, our understanding of how it arises and its significance is still elusive. Results In the current study, by deleting the key secreted factor KIT ligand from preGCs and analyzing the follicle cell developmental dynamics, we revealed distinct patterns of activation and growth associated with the two waves of follicles in mouse ovary. Our results confirmed that activation of adult wave follicles is initiated by somatic preGCs and dependent on the KIT ligand. By contrast, activation of first wave follicles, which are awakened from germ cells before follicle formation, can occur in the absence of preGC-secreted KIT ligand in postnatal ovaries and appears to be oocyte-initiated. We also found that the asynchronous activity of phosphatidylinositol 3 kinases (PI3K) signaling and meiotic process in embryonic germ cells lead to the follicle heterogeneity in postnatal ovaries. In addition, we supplied evidence that the time sequence of embryonic germ cell development and its related first wave follicle growth are correlated to the time of puberty onset in females. Conclusion Taken together, our study provides evidence that asynchronous development of embryonic oocytes leads to the heterogeneity of postnatal ovarian follicle activation and development, and affects the timing of onset of puberty in females.

The efficiencies with which ice crystals at low-intermediate Reynolds numbers collide with supercooled cloud droplets are determined numerically. Three ice crystal habits are considered here: hexagonal ice plates, broad-branch crystals, and columnar ice crystals.

This study presents a new epistemological analysis of drought chronology through a well-defined methodology for reconstructing past drought series, as well as series of other associated ecological and societal impact variables. Instead of building a grading system based on mixed criteria, this method facilitates transparency in the reconstruction process and enables the statistical examination of all variables when building series. The data for the present study are derived mainly from the REACHES (Reconstructed East Asian Climate Historical Encoded Series) database; however, other archival documentary and index data from independent sources are also applied to understand drought narratives and to cross-check and validate the analysis derived from REACHES. From the time series analysis, six severe drought periods are identified in the Qing dynasty, and then a spatial analysis is performed to demonstrate the spatial distribution of drought and other variables in the six periods, as well as a social network analysis to reveal connections between drought and other ecological and societal variables. Research results clearly illustrate the role of human intervention in influencing the impacts of drought and their societal consequences. Particularly, the correlation between drought and socioeconomic turmoil is not strong; crop failure and famine are important intermediate factors, while ecological factors such as locust and disaster relief measures are all imperative to intervene between crop production and famine. Implications of the study on drought impact are provided, as well as the significance of drought on historical climate reconstruction studies.

To compare two different image registration methods for accurately displaying the position of a flexible bronchoscope on a previously acquired three-dimensional CT scan during bronchoscopy. Bronchoscopy suite of a university hospital. Fifteen adult patients scheduled for nonemergent bronchoscopy. A miniature electromagnetic position sensor was placed at the tip of a flexible bronchoscope. Previously acquired three-dimensional CT scans were registered with the patient in the bronchoscopy suite. Registration method 1 used multiple skin fiducial markers. Registration method 2 used the inner surface of the trachea itself for registration. Method 1 was objectively assessed by measuring the error distance between the real skin marker position and the computer display position. Methods 1 and 2 were subjectively assessed by the bronchoscopist correlating visual bronchoscopic anatomic location with the computer display position on the CT image. The error distance (+/- SD) from known points for registration method 1 was 5.6 +/- 2.7 mm. Objective error distances were not measured for method 2 because no accurate placement of the bronchoscope sensor could be correlated with CT position. Subjectively, method 2 was judged more accurate than method 1 when compared with the fiberoptic view of the airways through the bronchoscope. Additionally, method 2 had the advantage of not requiring placement of fiducial markers before the CT scan. Respiratory motion contributed an error of 3.6 +/- 2.6 mm, which was partially compensated for by a second tracking sensor placed on the patient's chest. Image registration method 2 of surface fitting the trachea rather than method 1 of fiducial markers was subjectively judged to be superior for registering the position of a flexible bronchoscope during bronchoscopy. Method 2 was also more practical inasmuch as no special CT scanning technique was required before bronchoscopy.