Tungsten Nitride (W5N6): An Ultraresilient 2D Semimetal

Two-dimensional transition metal nitrides offer intriguing possibilities for achieving novel electronic and mechanical functionality owing to their distinctive and tunable bonding characteristics compared to other 2D materials. We demonstrate here the enabling effects of strong bonding on the morphology and functionality of 2D tungsten nitrides. The employed bottom-up synthesis experienced a unique substrate stabilization effect beyond van-der-Waals epitaxy that favored W5N6 over lower metal nitrides. Comprehensive structural and electronic characterization reveals that monolayer W5N6 can be synthesized at large scale and shows semimetallic behavior with an intriguing indirect band structure. Moreover, the material exhibits exceptional resilience against mechanical damage and chemical reactions. Leveraging these electronic properties and robustness, we demonstrate the application of W5N6 as atomic-scale dry etch stops that allow the integration of high-performance 2D materials contacts. These findings highlight the potential of 2D transition metal nitrides for realizing advanced electronic devices and functional interfaces.

Nanoscale Gap-Plasmon-Enhanced Superconducting Photon Detectors at Single-Photon Level

With a growing demand for detecting light at the single-photon level in various fields, researchers are focused on optimizing the performance of superconducting single-photon detectors (SSPDs) by using multiple approaches. However, input light coupling for visible light has remained a challenge in the development of efficient SSPDs. To overcome these limitations, we developed a novel system that integrates NbN superconducting microwire photon detectors (SMPDs) with gap-plasmon resonators to improve the photon detection efficiency to 98% while preserving all detector performance features, such as polarization insensitivity. The plasmonic SMPDs exhibit a hot-belt effect that generates a nonlinear photoresponse in the visible range operated at 9 K (∼0.64Tc), resulting in a 233-fold increase in phonon-electron interaction factor (γ) compared to pristine SMPDs at resonance under CW illumination. These findings open up new opportunities for ultrasensitive single-photon detection in areas like quantum information processing, quantum optics, imaging, and sensing at visible wavelengths.

The interaction of serum testosterone levels and androgen receptor CAG repeat polymorphism on the risk of erectile dysfunction in aging Taiwanese men

Testosterone has been found to play important roles in men's sexual function. However, the effects of testosterone can be modulated by androgen receptor (AR) CAG repeat polymorphism. It could also contribute to the risk of erectile dysfunction (ED). The aim of this study is to evaluate the interaction of serum testosterone levels and AR CAG repeat polymorphism on the risk of ED in aging Taiwanese men. This cross-sectional data of Taiwanese men older than 40 years were collected from a free health screening held between August 2010 and August 2011 in Kaohsiung city, Taiwan. All participants completed a health questionnaires included five-item version of the International Index of Erectile Function (IIEF-5) and the International Prostate Symptoms Score, received a detailed physical examination and provided 20 cm3 whole blood samples for biochemical and genetic evaluation. The IIEF-5 was used to evaluate ED. Serum albumin, total testosterone (TT), and sex hormone-binding globulin levels were measured. Free testosterone level was calculated. AR gene CAG repeat polymorphism was determined by direct sequencing. Finally, 478 men with the mean age of 55.7 ± 4.8 years were included. When TT levels were above 330 ng/dL, the effect of testosterone level on erectile function seemed to reach a plateau and a significantly negative correlation between AR CAG repeat length and the score of IIEF-5 was found (r = -0.119, p = 0.034). After adjusting for other covariates, the longer AR CAG repeat length was still an independent risk factor for ED in subjects with TT above 330 ng/dL (p = 0.006), but not in TT of 330 ng/dL or below. In conclusion, both serum testosterone levels and AR CAG repeat polymorphism can influence erectile function concomitantly. In subjects with normal TT concentration, those with longer AR CAG repeat lengths have a higher risk of developing ED.

First Report of Chrysoporthe deuterocubensis Causing Canker on Syzygium samarangense in Taiwan

Wax apple (Syzygium samarangense Merr. & Perry, syn. Eugenia javanica Lam.) belongs to the Myrtaceae family is an important economical tree fruit in Taiwan. The total production acreage of wax apple was 5,266 ha in which more than 77% were located in Pingtung County, southern Taiwan, in 2012. Since the winter of 2010, symptoms of withering leaves and cracking branches on wax apple trees were observed in some orchards in Nanjhou and Linbian Townships, Pingtung County. Diseased trees declined gradually and resulted in reduced fruit production. On the bark of diseased twigs and branches, black conidiamata with yellowish orange conidia were usually observed. For diagnosis, tissues from symptomatic branches were excised, surface sterilized with 0.5% sodium hypochlorite, and placed on 2% water agar in petri dishes. A total of four identical fungal isolates were obtained and maintained on potato dextrose agar (PDA). To fulfill Koch's postulates, three twigs of a wax apple tree were wounded with scalpel and inoculated with each of the four isolates, one tree per isolate. A 7-day-old hyphal mat (about 7 × 18 mm) of each fungal isolate was attached on the wound, wrapped with a wet absorbent cotton and Parafilm, and then covered with a layer of aluminum foil. For the control, the twigs of a wax apple tree were inoculated with PDA plugs. The pathogenicity test was repeated once. After 30 days, withering leaves and cracking twigs were observed on inoculated twigs and the same pathogen was reisolated. Conversely, all of the non-inoculated plants remained healthy. Identification of the pathogen was conducted using its morphological, physiological, and molecular characteristics. On malt extract agar, the colony was floccose and white with hazel hues. The optimal temperature for the mycelial growth was 30°C. Conidia were hyaline, and oblong, with the average size of 4.7 ± 0.6 × 2.7 ± 0.2 μm (100 conidia). Ascostromata were semi-immersed in the bark with fusoid asci, eight ascospores per ascus. Ascospores were hyaline, 2-celled, and tapered in both ends, with the average length of 6.8 ± 0.7 × 2.4 ± 0.3 μm (100 ascospores). For molecular identification, the internal transcribed spacer (ITS) of ribosomal DNA and β-tubulin genes was amplified using the ITS1/ITS4 (3), Bt1a/Bt1b, and Bt2a/Bt2b (1) primer pairs. The gene sequences were deposited in GenBank (Accessions KC792616, KC792617, KC792618, and KC792619 for the ITS region; KC792620, KC792621, KC792622, and KC792623 for Bt1 region, and KC812732, KC812733, KC812734, and KC812735 for Bt2 region) and showed 99 to 100% identity to the Chrysoporthe deuterocubensis isolate CMW12745 (DQ368764 for ITS region; GQ290183 for Bt1 region, and DQ368781 for Bt2 region). In addition, the Bt1 region of the β-tubulin gene consisted of two restriction sites for AvaI and one restriction site for HindIII. This is identical to the description of C. deuterocubensis, a cryptic species in C. cubensis, by Van Der Merwe et al. (2). According to these results, the pathogen was identified as C. deuterocubensis Gryzenh. & M. J. Wingf. To the best of our knowledge, this is the first report of canker disease caused by C. deuterocubensis on S. samarangense in Taiwan. References: (1) N. L. Glass and G. C. Donaldson. Appl. Environ. Microbiol. 61:1323, 1995. (2) N. A. Van Der Merwe et al. Fungal Biol. 114:966, 2010. (3) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

First Report of Myrothecium roridum Causing Myrothecium Leaf Spot on Dieffenbachia picta 'Camilla' in Taiwan

Dumb cane (Dieffenbachia picta (Lodd.) Schott 'Camilla'), family Araceae, is a popular houseplant in Taiwan. During the winter of 2012, dumb canes with dark brown concentric spots on leaves and bright yellow borders were found in a protected ornamental nursery in Wandan township, Pingtung County, Taiwan. On diseased leaves, fungal fruiting bodies were sometimes observed in the concentric lesions and a fungal isolate was consistently isolated from the lesions. A single spore isolate, myr 2-2, was maintained on potato dextrose agar (PDA) for further tests. To fulfill Koch's postulates, the spores of myr 2-2 were suspended in sterilized distilled water containing 0.05% of Tween 20, 1 × 10⁵ conidia ml^-1, and then sprayed on leaves of D. picta 'Camilla' growing in polypropylene plant pots (about 7 cm in diameter), three plants per treatment. For the control, three plants were sprayed with sterilized distilled water containing 0.05% of Tween 20. Both inoculated and non-inoculated plants were covered with plastic bags and incubated in a growth chamber at 26 ± 1°C. Nine to 12 days after inoculation, symptoms described above were observed on inoculated plants whereas the plants in control remained healthy. The same fungus was reisolated from inoculated plants but not from the controls. Furthermore, the fungal pathogen was identified using its physiological, morphological, and molecular characteristics. In the mycelial growth test, the diameter of the fungal colony reaches 58.2 mm on PDA at 25°C after 14 days. The colonies were floccose, white to buff, and sporulate in concentric zones with olivaceous black to black sporodochia bearing viscid masses of conidia. Conidia were narrowly ellipsoid with rounded ends. The average size of 100 conidia was 6.25 ± 0.04 × 1.63 ± 0.02 μm. For molecular identification, the rDNA internal transcribed spacer (ITS) of isolate myr 2-2 was PCR amplified using ITS1 (5'-TCCGTAGGTGAACCTGCGG-3') and ITS4 (5'- TCCTCCGCTTATTGATATGC-3') primer pairs (3) and sequenced. The rDNA sequence was deposited in GenBank (KC469695) and showed 100% identity to the Myrothecium roridum isolates BBA 71015 (AJ302001) and BBA 67679 (AJ301995) (4). According to the physiological, morphological (1,2), and molecular characteristics, the fungal isolate was identified as M. roridum Tode ex Fr. To the best of our knowledge, this is the first report of Myrothecium leaf spot caused by M. roridum on D. picta 'Camilla' in Taiwan. References: (1) D. F. Farr and A. Y. Rossman. Fungal Databases, Systematic Mycology and Microbiology Laboratory, ARS, USDA. Retrieved from http://nt.ars-grin.gov/fungaldatabases/ , January 31, 2013. (2) M. Tulloch. Mycol. Pap. 130: 1-42, 1972. (3) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds. Academic Press, New York, 1990. (4) Y. X. Zhang et al. Plant Dis. 95:1030, 2011.

Potassium intake and risk of incident type 2 diabetes mellitus: the Coronary Artery Risk Development in Young Adults (CARDIA) Study

AIMS/HYPOTHESIS

Serum potassium has been found to be a significant predictor of diabetes risk, but the effect of dietary potassium on diabetes risk is not clear. We sought to determine if dietary potassium is associated with risk of incident type 2 diabetes in young adults.

METHODS

We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Potassium intake was measured by (1) an average of three 24 h urinary potassium collections at the 5-year study visit, and (2) the CARDIA dietary assessment instrument at baseline. Incident type 2 diabetes cases were ascertained on the basis of use of diabetes medication and laboratory measurements. Analyses were adjusted for relevant confounders including intake of fruit and vegetables and other dietary factors.

RESULTS

Of 1,066 participants with urinary potassium measurements, 99 (9.3%) developed diabetes over 15 years of follow-up. In multivariate models, adults in the lowest urinary potassium quintile were more than twice as likely to develop diabetes as their counterparts in the highest quintile (HR 2.45; 95% CI 1.08, 5.59). Of 4,754 participants with dietary history measurements, 373 (7.8%) developed diabetes over 20 years of follow-up. In multivariate models, African-Americans had a significantly increased risk of diabetes with lower potassium intake, which was not found in whites.

CONCLUSIONS/INTERPRETATION

Low dietary potassium is associated with increased risk of incident diabetes in African-Americans. Randomised clinical trials are needed to determine if potassium supplementation, from either dietary or pharmacological sources, could reduce the risk of diabetes, particularly in higher-risk populations.

Quantum dots in molecular detection of disease

The unique photophysical properties of semiconductor quantum dots (QDs) have made them ideal for use as spectral labels and luminescent probes. In this review, applications are presented in which QDs function as active participants in nanoscale biosensor assemblies, where replacing traditional molecular fluorophores results in improved assay performance. Specific focus is on disease detection with applications including multiplexed target detection, mutation detection by coincidence analysis and QD-based FRET reporters for miRNA detection and DNA methylation analysis.

Missed opportunities in diabetes management: a longitudinal assessment of factors associated with sub-optimal quality

BACKGROUND

In diabetic adults, tight control of risk factors reduces complications.

OBJECTIVE

To determine whether failure to make visits, monitor risk factors, or intensify therapy affects control of blood pressure, glucose, and lipids.

DESIGN

A non-concurrent, prospective study of data from electronic files and standardized abstraction of hard-copy medical records for the period 1/1/1999-12/31/2001.

PARTICIPANTS

Three hundred eighty-three adults with diabetes managed in an academically affiliated managed care program.

MEASUREMENTS

Main exposure variable: Intensification of therapy or failure to intensify, reckoned on a quarterly basis.

MAIN OUTCOME MEASURE

Hemoglobin A1c (A1c), systolic blood pressure (SBP), and LDL-cholesterol at the end of the interval.

RESULTS

In this visit-adherent cohort, control of glycemia and lipids showed improvement over 24 months, but many patients did not achieve targets. Only those with the worst blood pressure control (SBP >or=160 mmHg) showed any improvement over 2 years. Failure to intensify treatment in patients who kept visits was the single strongest predictor of sub-optimal control. Compared to their counterparts with no failures of intensification, patients with failures in >or=3 quarters showed markedly worse control of blood glucose (A1c 1.4% higher: 95% CI: 0.7, 2.1); hypertension (SBP 22.2 mmHg higher: 95% CI: 16.6, 27.9) and LDL cholesterol (LDL 43.7 mg/dl higher: 95% CI: 24.1, 63.3). These relationships were strong, graded, and independent of socio-demographic factors, baseline risk factor values, and co-morbidities.

CONCLUSIONS

Failure to intensify therapy leads to suboptimal control, even with adequate visits and monitoring. Interventions designed to promote appropriate intensification should enhance diabetes care in primary practice.

Coupling confocal fluorescence detection and recirculating microfluidic control for single particle analysis in discrete nanoliter volumes

The recent proliferation of platforms designed to handle arrays of nano- and picolitre volumes is in response to the need to perform biological assays on discrete entities, such as single cells. However, a critical challenge associated with this trend for in vitro compartmentalization is the need for highly sensitive, yet low-volume detection platforms. In this paper, we coupled confocal fluorescence detection with recirculating microfluidic control to perform single particle DNA assays within five nL chambers. The performance of this low-volume assay was shown to match that of traditional single molecule detection platforms. However, volume requirements per measurement were nearly 3 orders of magnitude less than conventional systems, enabling future integration with lab-on-a-chip systems that require discrete or digitalized sample processing.

Pilot study of a specific dietary supplement in tumor-bearing mice and in stage IIIB and IV non-small cell lung cancer patients

Previously, a specific dietary supplement, selected vegetables (SV), was found to be associated with prolonged survival of stage III and IV non-small cell lung cancer (NSCLC) patients. In this study, several anticancer components in SV were measured; the anticancer activity of SV was assessed using a lung tumor model, line 1 in BALB/c mice. SV was also used in conjunction with conventional therapies by stage IIIB and IV NSCLC patients whose survival and clinical responses were evaluated. A daily portion (283 g) of SV was found to contain 63 mg of inositol hexaphosphate, 4.4 mg of daidzein, 2.6 mg of genistein, and 16 mg of coumestrol. Mouse food containing 5% SV (wt/wt) was associated with a 53-74% inhibition of tumor growth rate. Fourteen of the 18 patients who ingested SV daily for 2-46 months were included in the analyses; none showed evidence of toxicity. The first lead case remained tumor free for > 133 months; the second case showed complete regression of multiple brain lesions after using SV and radiotherapy. The median survival time of the remaining 12 patients was 33.5 months, and one-year survival was > 70%. The median survival time of the 16 "intent-to-treat" patients (including ineligible patients) was 20 months, and one-year survival was 55%. The Karnofsky performance status of eligible patients was 55 +/- 13 at entry but improved to 92 +/- 9 after use of SV for five months or longer (p < 0.01). Five patients had stable lesions for 30, 30, 20, 12, and 2 months; two of them, whose primary tumor was resected, used SV alone and demonstrated an objective response of their metastatic tumors. In addition to the two lead cases, eight patients had no new metastases after using SV. Three patients had complete regression of brain metastases after using radiotherapy and SV. In this study, daily ingestion of SV was associated with objective responses, prolonged survival, and attenuation of the normal pattern of progression of stage IIIB and IV NSCLC. A large randomized phase III clinical trial is needed to confirm the results observed in this pilot study.

Cooperative and selective lithium complexation of 2,11,13,22-tetraaza-5,8,16,19- tetraoxa-1,12-dioxocyclodocosanes

[reaction: see text] Ureyleno crown ethers 2 and 3 bind with 2 equiv of Li(+) cooperatively and selectively over other alkali metal ions such as Na(+), K(+), and Cs(+). The binding constant for 3 was found to be 3.0 x 10(7) (L/mol)(2).

Microcystic features at US: a nonspecific sign for microcystic adenomas of the pancreas

Microcystic adenoma of the pancreas is a benign tumor with no malignant potential and may not require surgery if it is asymptomatic. In the past, a mass containing more than six small (<2-cm) cysts at ultrasonography (US) has been considered to be diagnostic for microcystic adenoma. However, a retrospective study of 36 patients with focal or diffuse pancreatic lesions containing over six small cysts demonstrated that this finding can occur in a wide variety of neoplastic and inflammatory lesions, most of which are malignant. These lesions included adenocarcinoma (n = 18), mucinous cystadenocarcinoma (n = 2), islet cell carcinoma (n = 1), lymphoma (n = 1), sarcoma (n = 1), metastases (n = 2), pancreatitis (n = 4), and adenoma (n = 7). Thus, a finding of multiple small cysts in a pancreatic mass is not specific for microcystic adenoma, and if diagnosis is based on US findings alone, many malignant tumors will be misdiagnosed as microcystic adenomas. Furthermore, computed tomography provides only limited assistance in this setting due to overlapping findings. Needle biopsy can be highly accurate in diagnosing both microcystic adenoma and other malignant lesions and should generally be performed for all lesions with the US features described earlier.

Compound spatial sonography of the thyroid gland: evaluation of freedom from artifacts and of nodule conspicuity

OBJECTIVE

The purpose of this study was to compare compound spatial sonography with conventional sonography of the thyroid gland with respect to freedom from sonographic artifacts and conspicuity of thyroid nodules.

SUBJECTS AND METHODS

A prospective study was performed on 50 thyroid nodules (in 43 patients). Each nodule was examined using compound spatial sonography and conventional sonography. The sonographic techniques were then compared with respect to freedom from sonographic artifacts and thyroid nodule conspicuity.

RESULTS

For freedom from artifacts, compound spatial sonography was superior in 45 cases (90%), and conventional sonography was superior in five cases (10%). Statistical analysis showed that compound spatial sonography was superior to conventional sonography for freedom from artifacts (p < 0.001). For thyroid nodule conspicuity, compound spatial sonography was superior in 37 cases (74%), and conventional sonography was superior in 13 cases (26%). Statistical analysis showed that compound spatial sonography was superior to conventional sonography for thyroid nodule conspicuity (p < 0.001).

CONCLUSION

Compound spatial sonography of the thyroid displays greater freedom from artifacts and better nodule conspicuity than does conventional sonography.

Stopped-flow kinetic study of the H2O2 oxidation of substrates catalyzed by microperoxidase-8

We have studied the oxidation of microperoxidase-8 (MP-8) by H2O2 and the subsequent reaction of the intermediates with substrate by stopped-flow experiments. Oxidation of MP-8 by H2O2 gives two intermediates, I and II. The observed rate constant for the formation of I is linearly dependent on [H2O2] and exhibits a bell-shaped dependence on pH with pKa values of 8.90 and 10.60, which are attributed to the deprotonation of MP-bound H2O2 and H2O, respectively. The observed rate constant for the conversion of I to II is independent of [H2O2], but increases sharply at pH>9.0. The predominant forms of the intermediate at pH 7.0 and 10.7 are I and II, respectively. Addition of substrate to the intermediates at pH 9.0 gives rise to three distinct stages, corresponding to the three steps (in decreasing order of rate): I-->II*, II-->MP, and II*-->MP. The rates of these steps are all linearly dependent on the substrate concentration and each individual rate constant has been determined. Substrate reactivity at pH 10.7 covers over two orders of magnitude, ranging from 1.36 x 10(7) M(-1) s(-1) for 1-naphthol to 4.03 x 10(4) M(-1) s(-1) for ferrocyanide. The substrate reactivity is linearly correlated with its reduction potential, indicating that an electron transfer process is involved in the rate-limiting step.

Some misconceptions and pitfalls in ultrasonography

There are many misconceptions in the field of ultrasonography. Some are because of poor understanding of anatomy and/or embryological or developmental features of certain organs, which have prevailed over the course of the centuries since the discovery of these entities (e.g., column of Bertin and hypertrophic column of Bertin). Some misconceptions derived from misinterpretation (e.g., double decidual sac sign) or inadequate observation of ultrasonographic findings. (e.g., hyperechoic stroma in polycystic ovarian syndrome).

Intratumoral adenovirus-mediated suicide gene transfer for hepatic metastases from colorectal adenocarcinoma: results of a phase I clinical trial

Animal studies have shown that direct injection of an adenoviral vector (Adv.RSV-tk) expressing the herpes thymidine kinase gene into established tumors in the liver, followed by systemic ganciclovir administration, was effective in inducing tumor necrosis. Toxicities were minimal at therapeutically effective vector doses, although severe hepatic necroinflammation was seen at much higher supratherapeutic doses. We conducted a clinical phase I trial in patients with metastatic colorectal adenocarcinoma in the liver to assess the safety of intratumoral Adv.RSV-tk injection (escalating doses) followed by intravenous ganciclovir (fixed dose). The vector was injected into a metastatic tumor in the liver under local anesthesia by percutaneous needle placement with concurrent ultrasonographic monitoring to prevent injection or leakage into adjacent normal liver structures. We treated 16 patients in five dose level cohorts of Adv.RSV-tk, from 1.0x10(10) to 1.0x10(13) virus particles per patient. Hepatic toxicities were low, with transient grade 1 elevations in serum aminotransferase levels in 3 of 16 patients. Other toxicities were also transient: grade 2-3 fevers in 5 of 16 patients, grade 3 thrombocytopenia in 1 of 16 patients, and grade 2 leucopenia in 3 of 16 patients. These results indicate that Adv.RSV-tk can be safely administered by percutaneous intratumoral injection in patients with hepatic metastases at doses up to 1.0x10(13) virus particles per patient, and can provide the basis for future clinical trials involving intratumoral adenoviral vector injection.

The prevalence and distribution of bone defects in patients with moderate to advanced periodontitis

BACKGROUND

Alveolar bone defect is one of the common features of periodontitis and may vary in its form, extent, and distribution among teeth and individuals. The purpose of this study was to analyze the prevalence and distribution of different forms of bone defects in Taiwanese patients with moderate to advanced periodontitis.

METHODS

One hundred and thirty-seven Taiwanese patients with moderate to advanced periodontitis comprising a total sample of 3542 teeth were studied. During periodontal surgery, osseous defects were explored and classified as interproximal crater, 1-wall, 2-wall, 3-wall, hemiseptal and circumferential defects. Among them, some were also recorded as complicated defects.

RESULTS

Among 3542 existing teeth, 1376 were examined surgically and 483 teeth had bone defects. There was an increase in bone defects from anterior to posterior. The frequencies of defects in anterior and posterior segments were significantly different. More defects were found on the right side than on the left side. Yet there was no difference between the maxillary and mandibular arch. Interproximal surfaces of the first and second molars had the highest prevalence of bone defects. Crater was the most common defect type (26.50%), followed by circumferential (23.40%) and 3-wall defect (20.08%). More than 40% also presented with complicated defects.

CONCLUSIONS

There was an increase in bone defects from anterior to posterior. Interproximal aspects were more frequently involved than buccal or lingual aspects. Crater, circumferential and 3-wall defects were more common than other defect types. The treatment of complicated defects, which comprise over 40% of all defects, presents a challenging task for periodontists.

Characterization of a microprocessor-controlled tubular multiple metered dose inhaler aerosol generator for inhalation exposures of pharmaceuticals

A microprocessor-controlled tubular multiple metered dose inhaler (MDI) aerosol generator was constructed for the delivery of pharmaceutical aerosols to inhalation chambers. The MDIs were mounted in four cassettes containing one to four MDIs on a stepped end plate. The MDIs in each cassette were pneumatically activated at intervals that were controlled by the microprocessor. The cassettes permitted easy replacement of each set of MDIs with a fresh set of MDIs whenever necessary. Aerosol concentration was controlled by varying the number of active MDIs in each cassette and the frequency of activations per minute of each row. Aerosol from the MDIs flowed along the long axis of the tube, which provided a path length sufficient to diminish impaction losses. Using a light-scattering device to monitor the aerosol concentration, the pulsatile output from the MDIs in the cassettes was demonstrated to be adequately damped out provided that the dilution/mixing/aging chamber exceeded 3 ft in length. The tube diameter selected was the minimum compatible with mounting the required number of MDIs so that the linear velocity of the aerosol was adequate to efficiently transport the aerosol out of the dilution chamber. Aerosol concentration and particle size data were recorded for a nose-only rodent exposure chamber. Reproducible aerosol concentrations ranging from 0.03 to 0.6 mg/L were generated. Particle sizes ranged from 2- to 3-microm mass median aerodynamic diameter. Thus, the aerosol generated was within the size range suitable for inhalation exposures.

Phase I/II study of stage III and IV non-small cell lung cancer patients taking a specific dietary supplement

This phase I/II study evaluates the influence of selected vegetables (SV) that contain known antitumor components on the survival of stage III-IV non-small cell lung cancer (NSCLC) patients. All patients were treated with conventional therapies. SV was added to the daily diet of 5 stage I patients in the toxicity study group (TG) and 6 stage III and IV patients in the treatment group (SVG), but not to the diet of 13 stage III and IV patients in the control group (CG). Age, Karnofsky performance status (KPS), and body mass index of SVG and CG patients were comparable at entry. KPS declined in the CG patients (79 +/- 8 to 55 +/- 11) but improved in the SVG patients (75 +/- 8 to 80 +/- 13) one to three months after entry. Weight change in the CG, SVG, and TG patients was -12 +/- 5%, -2 +/- 2%, and +4 +/- 4%, respectively. The median survival time and mean survival of the CG patients were 4 and 4.8 months, but in the SVG patients they were 15.5 and 15 months (p < 0.01). No clinical signs of toxicity were found in the TG patients in the 24-month study period. Adding SV to the daily diet of NSCLC patients was found to be nontoxic and associated with improved weight maintenance, KPS, and survival of stage III and IV NSCLC patients.

Tissue harmonic imaging sonography: evaluation of image quality compared with conventional sonography

OBJECTIVE

The purpose of this study was to determine if tissue harmonic imaging (THI) sonography produced higher quality images than did conventional sonography.

SUBJECTS AND METHODS

A prospective study was performed on 89 patients to compare the image quality of THI sonography with that of conventional sonography. Each examination was performed using THI sonography (transmitted frequency, 2.0 MHz; received frequency, 4.0 MHz) and conventional sonography at 2.5 and 4.0 MHz. The pancreatic area was studied in 60 patients, and other anatomic areas were studied in 68 patients. The images were then graded for penetration, detail, and total image quality. Graders were unaware of the sonographic technique.

RESULTS

Of the 60 pancreatic examinations, THI sonography was the best technique for penetration in 45, detail in 54, and total image quality in 50. For the pancreas, THI sonography was significantly better than 2.5-MHz conventional sonography for penetration (p = .0002), detail (p < .0001), and total image quality (p < .0001). THI sonography was significantly better than 4.0-MHz conventional sonography for penetration (p < .0001), detail (p < .0001), and total image quality (p < .0001). Of the 68 examinations of other anatomic areas, THI sonography was the best technique for penetration in 42, detail in 57, and total image quality in 58. For other anatomic areas, THI sonography was significantly better than 2.5-MHz conventional sonography for penetration (p = .05), detail (p < .0001), and total image quality (p < .0001). THI sonography was significantly better than 4.0-MHz conventional sonography for penetration (p < .0001), detail (p < .0001), and total image quality (p < .0001).

CONCLUSION

The THI technique improved sonographic image quality.

Torsion of the fallopian tube: progression of sonographic features

Isolated torsion of the fallopian tube is a rare gynecologic condition that is difficult to diagnose preoperatively. We present the sonographic and CT findings over a 48-hour period in a case of isolated torsion of the fallopian tube. The radiologic features of isolated torsion have been described previously; however, to our knowledge, the progressive findings have not been previously reported.

A comparative analysis of primate nasal airways using magnetic resonance imaging and nasal casts

The nasal cavity is an intricate part of the respiratory tract. It is not only the site of olfaction, but also serves as a filter to protect the lower respiratory tract from inhaled pollutants. A substantial fraction of inhaled particles deposit in this region and may pose potential health risks. To predict possible sites of inhaled aerosol deposition and better understand health risks associated with inhaled aerosols in this region, it is necessary to examine the morphometry of the nasal passage. Magnetic resonance imaging (MRI) of the nose was done from the anterior to the posterior, in 3-mm sections, on five anesthetized rhesus monkeys and on two nasal casts (one human and one rhesus monkey). The MRI images were analyzed for perimeter and cross-sectional areas of each section. Results indicated that the left and right nasal passages were very symmetric for the five monkeys but not for the human cast. The cross-sectional area and, consequently, the volume varied greatly among monkeys in vivo. Measurements from the monkey cast exhibited 1.4-fold differences normalized body weight in cross-sectional areas, but with smaller differences in perimeter when compared to the MRI in vivo images. The human cast exhibited a volume three times greater than that of the monkey cast, while the surface area was approximately doubled. Results from this comparison showed many similarities in the structure of the monkey and human nose suggesting that the rhesus monkey would be a good human surrogate in aerosol deposition studies.

Measurements of airway dimensions and calculation of mass transfer characteristics of the human oral passage

This paper presents measurements of the geometric shape, perimeter, and cross-sectional area of the human oral passage (from oral entrance to midtrachea) and relates them through dimensionless parameters to the depositional mass transfer of ultrafine particles. Studies were performed in two identical replicate oral passage models, one of which was cut orthogonal to the airflow direction into 3 mm elements for measurement, the other used intact for experimental measurements of ultrafine aerosol deposition. Dimensional data were combined with deposition measurements in two sections of the oral passage (the horizontal oral cavity and the vertical laryngeal-tracheal airway) to calculate the dimensionless mass transfer Sherwood number (Sh). Mass transfer theory suggests that Sh should be expressible as a function of the Reynolds number (Re) and the Schmidt number (Sc). For inhalation and exhalation through the oral cavity (O-C), an empirical relationship was obtained for flow rates from 7.5-30.0 1 min-1: Sh = 15.3 Re0.812 Sc-0.986 An empirical relationship was likewise obtained for the laryngeal-tracheal (L-T) region over the same range of flow rates: Sh = 25.9 Re0.861 Sc-1.37 These relationships were compared to heat transfer in the human upper airways through the well-known analogy between heat and mass transfer. The Reynolds number dependence for both the O-C and L-T relationships was in good agreement with that for heat transfer. The mass transfer coefficients were compared to extrathoracic uptake of gases and vapors and showed similar flow rate dependence. For gases and vapors that conform to the zero concentration boundary condition, the empirical relationships are applicable when diffusion coefficients are taken into consideration.

An experimental method for measuring aerosol deposition efficiency in the human oral airway

An experimental technique was developed to measure the oral deposition of aerosols by successively drawing them passively through (1) the nasal and oral passage in series, and (2) the nose and an oral bypass "extension tube" inserted into the oral cavity just anterior to the uvula. To test this technique, a replicate human upper airway cast was challenged with monodisperse aerosols ranging in diameter from 3.6 to 150.0 nm at constant flow rates ranging from 7.5 to 30 L/min. For the inhalation study, test aerosols were drawn into the nasal cavity and directed either through the laryngeal-tracheal (L-T) section or the oral passage with/without the oral extension tube. The flow was reversed for the exhalation study. Deposition fractions of aerosols in the main oral cavity were found approximately equal to those in the L-T section for both inhalation and exhalation. Following this phase of the study, experimental measurements of total particle deposition fraction for the oral inlet-tracheal outlet path were performed. The results of these measurements agreed well with the calculated oral deposition fractions based on the initial measurements. This technique has application for measuring oral deposition of larger particles encountered in occupational environments.

Micronodulation: ultrasonographic sign of Hashimoto thyroiditis

The purpose of this work is to assess the validity of an ultrasonographic sign, micronodulation, in the diagnosis of Hashimoto thyroiditis. Among 101 patients found to have ultrasonographic features of micronodulation, 57 patients had autoantibody test results available. Fifty-four patients were positive and three were negative for the autoantibodies. Therefore, the positive predictive value for micronodulation in diagnosing Hashimoto thyroitis is 94.7%. The micronodules were 0.1 to 0.65 cm in size, hypoechoic, and surrounded by an echogenic rim. This corresponds to accentuated lobulation on the pathologic specimen. Although micronodulation is highly diagnostic of Hashimoto thyroiditis, the ultrasonographic features of eight biopsy-proved masses caused by Hashimoto thyroiditis varied and were not specific for the disease.

A follow-up study of childhood nasopharyngeal radium irradiation in Washington County, Maryland

In 1978 an epidemiologic study exploring the health consequences of nasopharyngeal radium irradiation among individuals treated for adenoid enlargement in Washington County, Maryland, found an excess risk of brain tumors and a deficit of female breast cancers. The study population included all persons first seen at the Washington County Clinic for the Prevention of Deafness in Children from 1940 to January 1, 1960. We will continue the follow-up of irradiated and nonirradiated patients to (1) assess the risk of brain tumors and other neoplasms of the head and neck developing during a 40-year period, (2) assess hormone-related disorders resulting from irradiation of the pituitary gland, and (3) compare cancer incidence and mortality rates among exposed and nonexposed groups. Of the 2135 persons eligible for this study, 93.5% have been traced, and 90% have replied to a mailed questionnaire that elicits information on demographic characteristics, reproductive and medical history, infertility, and other sources of radiation exposure. Information on cancer incidence and mortality is being obtained from the Washington County Cancer Registry and death certificate files from Washington County and the Social Security Administration. Statistical methods to be used in the data analysis include standardized mortality ratios, standardized cancer incidence ratios, and Kaplan-Meier survival analysis.

Paraumbilical venous collateral circulations: color Doppler ultrasound features

Using Color Doppler ultrasonography to trace the dilated paraumbilical vein to its connection with systemic veins in 27 patients, we have found four major pathways: In type 1 (63%), the vein connected with the external iliac vein via the inferior epigastric vein. In type 2 (3.7%), the vein connected with the saphenous vein via the superficial epigastric vein. In type 3 (22.2%), the vein connected with the internal thoracic vein via the superior epigastric vein. Type 4 (11.1%) is a combination of types 1 and 2. A frank caput medusa was not seen, but occult caput medusa were seen in two patients. Turbulent flow was seen at the junction between inferior epigastric and external iliac veins, paraumbilical and superficial epigastric veins, and superficial epigastric and saphenous veins in some patients. Color Doppler ultrasonography is a convenient, noninvasive method for determining the course and associated hemodynamic changes in the paraumbilical collateral circulation.

Conformational change and inactivation of membrane phospholipid-related activity of cardiotoxin V from Taiwan cobra venom at acidic pH

The phospholipid binding activity of cardiotoxin V from Naja naja atra (CTX A5) was studied by use of Langmuir monolayers and found to exhibit pH-dependence in binding to phosphatidylcholine membrane with an apparent pKa around 6.0. Proton NMR investigation of the CTX A5 molecule in the presence of phosphatidylcholine micelles reveals a decrease in association of CTX A5 with membranes at low pH as a result of the protonation of His-4 near the membrane binding site of loop I region of CTX. The pH-dependent binding can be attributed mainly, but not solely, to the change in charge content of the CTX molecule upon His-4 protonation at the membrane/water interface. This is shown by analyzing the pH- and ionic strength dependence of binding of CTXs to phospholipid monolayers according to Gouy-Chapman theory. The protonation of the His-4 residue also results in a local conformational change in the loop I region since the chemical shifts of amide protons for the amino acid residues from Cys-3 to Thr-14 are all found to vary as a function of pH with an apparent pKa similar to that of His-4. Interestingly, the effect is relayed to other amino acid residues in the structural core of the protein such as those in C-terminal (Lys-60, Cys-61, and Asn-62) and triple-stranded antiparallel beta-sheet (Cys-22, Lys-24, Ala-25, Arg-38, and Ala-41) regions. An additional local conformational change in the molecule results around pH 5 as evidenced by circular dichroism spectroscopic studies, although this change does not affect the characteristic beta-sheet and three-finger loop structure of CTX molecule as revealed by two-dimensional NOESY 1H NMR study. The latter conformational change at acidic pH, however, completely inactivates CTX-induced aggregation/fusion activity of sphingomyelin vesicles. The results suggest that deciphering the functional sites of CTXs on the basis of structure and dynamics determined at low pH should be done with caution. Since 19 out of 44 CTX homologues with known amino acid sequence contain His-4, the effect of His-4 on the structure and function of CTX molecules is important and is discussed in terms of the diverse membrane targets of CTX subtypes. Also discussed is the pH-induced activation of snake venom proteins in the victim.

Transjugular intrahepatic portosystemic shunt: correlation of portal vein velocity measurements and portosystemic pressure gradients

To assess the relationship between portal vein velocity measurements and portosystemic gradients, color Doppler sonography was performed on 12 patients before and after transjugular intrahepatic portosystemic shunt placement. An additional patient was examined before and after shunt modification. The average maximum portal vein velocity increased from 15.7 cm s-1 before shunt placement to 43.5 cm s-1 after shunt placement, while the average portosystemic gradient decreased from 22.0 mm Hg before shunt placement to 7.9 mm Hg after shunt placement. Flow was observed within the shunt in 11 of the 12 cases. Shunt velocity was measurable in nine patients, with an average value of 115.7 cm s-1. Reversal of intrahepatic portal vein flow was observed in 10 cases following shunt placement. Color Doppler sonography is a useful non-invasive tool in the evaluation of intrahepatic portosystemic shunts, and changes in portal vein velocity correlate well with changes in the portosystemic gradient.

Junctional parenchyma: revised definition of hypertrophic column of Bertin

The so-called hypertrophic column of Bertin is a normal variation and simply represents unresorbed polar parenchyma of one or both of the two subkidneys that fuse to form a normal kidney. It contains renal cortex, pyramids, and columns (septa) of Bertin. (Since all elements of the tissue are normal, that is, neither hypertrophic nor a displaced or embryonic rest, it is referred to as "junctional parenchyma.") When a masslike lesion is suspected at sonography or excretory urography, diagnosis of junctional parenchyma can be made with a high degree of certainty when sonography shows that the structure (a) is located between the overlapping portion of two renal sinus systems, (b) is bordered by a junctional parenchymal line and defect, (c) contains renal cortex, pyramids, and columns of Bertin, and (d) contains renal cortex that is continuous with the adjacent renal cortex of the same subkidney.

Use of an acoustic transponder for US visualization of biopsy needles

A 20-gauge Chiba needle with a stylet embedded with polyvinyldifluoride (PVDF), a polymer that acts as an acoustic-electric transducer, facilitated a variety of diagnostic and therapeutic ultrasound (US)-guided interventions in nine patients. PVDF receives acoustic energy from the US scanner and transmits an electrical signal through the stylet and a shielded cable to the scanner, which results in appearance of a bright echo on the monitor at the location of the needle tip.

Anatomic variations and abnormalities in the diaphragm seen with US

The authors report their experience with diaphragmatic structures that simulate intrahepatic masses at abdominal ultrasonography (US). In a series of 74 patients, diaphragmatic slips were the most common finding (34 patients). The slips could be differentiated from masses by scanning along their long axis to demonstrate elongated structures with multiple linear echoes. Scalloping of the diaphragm, associated with multiple slips, was seen in 10 patients. Partial eventration was found in 23. Inversion of a hemidiaphragm, caused by a large pleural effusion or intrathoracic mass, was seen in 13 patients. Pleural masses affecting the diaphragm were seen in 13 patients; focal hypertrophy of a diaphragmatic crus simulated a mass in three. Real-time US allowed the differentiation of diaphragmatic abnormalities from lesions.

Deposition of ultrafine aerosols in rat nasal molds

To evaluate the health effects of air pollutants on the respiratory tract, it is critical to determine the regional deposition of inhaled aerosols. Information on deposition of larger particles (greater than 0.2 microns) in the nasal passages of laboratory animals is available; the deposition fraction increases with increasing particle size. However, little deposition information is available for ultrafine particles of less than 0.2 microns. Three clear, plastic molds (models) of the nasal passages of F344/N rats, prepared from metal replica casts were used in these studies. Total deposition of ultrafine aerosols in the casts was determined by using a unidirectional flow system. The pressure drops measured in the casts were a function of flow rate to the power of 1.4-1.6, indicating that flow through the nasal passages has nonlaminar components. Deposition data were obtained by using monodisperse sodium chloride aerosols with particle sizes ranging from 0.2 to 0.005 microns, at inspiratory and expiratory flow rates of 200 to 600 ml/min. Similar deposition data were obtained for two of the casts studied. Deposition efficiency was greatest for the smallest particles, and decreased with increasing particle size and flow rate. At an inspiratory flow rate of 400 ml/min, which is comparable to the mean respiratory flow of an adult male F344 rat with a respiratory minute volume of 200 ml, deposition efficiencies reached 40 and 70% for 0.01- and 0.005-microns particles, respectively. These studies demonstrated that turbulent diffusional deposition was the dominant mechanism for uptake of ultrafine particles by the nasal passages.

Sonographic evaluation of portal hypertension in children

Portal hypertension, an expected consequence of cirrhosis, often has an insidious course in children. A noninvasive technique using abdominal sonography has been previously employed by several investigators as a means of diagnosing this condition. Their technique involves sonographically measuring the diameter of the lesser omentum, which increases as a result of engorged collaterals. In this communication, the method is successfully employed in two children, an infant in whom cirrhosis developed who eventually died from acquired immunodeficiency syndrome, and one whose portal hypertension was relieved after orthotopic liver transplantation. Although successful in these two instances, the theoretical basis on which this technique is based is critically evaluated. Anatomical relationships are reviewed that would caution sonographers who attempt to duplicate these studies. Modifications of the technique that will minimize potential false positive results are also discussed.

Deposition of cigarette smoke particles in the rat

The fractional deposition of cigarette smoke particles in the respiratory tracts of rats was studied. Male and female rats were conditioned in nose-only exposure tubes 25 min/day for 2 days, exposed to cigarette smoke at mass concentrations of 95 or 341 mg/m3, 25 min/day for 3 days, and then exposed to smoke at mass concentrations of 212 and 657 mg/m3, 25 min/day for 5 days. Mainstream cigarette smoke was generated by a modified Walton smoking machine from two 1R3 research cigarettes burned sequentially for each exposure. Deposition studies were conducted by placing the rats in plethysmograph tubes to allow respiratory minute volume measurements during exposure, then exposing them to [14C]dotriacontane-labeled cigarette smoke at mass concentrations of 202 or 624 mg/m3 for 25 min, using the same smoking machine. Size distribution, real-time concentration, and 14C activity of the smoke particles were determined using a multijet Mercer impactor, a real-time aerosol monitor, and filter samples, respectively. Immediately after the exposure, the rats were terminated to determine the distribution of the 14C. Individual lung lobes, trachea and lobar bronchi, head, larynx, kidneys, liver, gastrointestinal (GI) tract, blood, and depleted carcass of each rat were analyzed for 14C content. Results showed that the GI tract contained 16-31% of the total activity, indicating significant clearance from the large airways and nose to the GI tract during the exposure and during the 10-15 min between the cessation of the exposure and the removal of the organs. Total deposition of the inhaled 14C activity was 20.1 +/- 1.6% for both exposure concentrations. The intrapulmonary deposition fractions (lung lobes plus airways below the lobar bronchi) were 12.4 +/- 0.9 and 15.9 +/- 1.4% for concentrations of 202 and 624 mg/m3, respectively, suggesting a slight enhancement in upper airway deposition for animals exposed to the higher smoke concentration.

Lung retention and binding of [14C]-1-nitropyrene when inhaled by F344 rats as a pure aerosol or adsorbed to carbon black particles

1-Nitropyrene (NP), as found in the environment, is more typically associated with carbonaceous particles than found as an aerosol of the pure compound. To determine whether (and why) an association with particles resulted in prolonged lung retention of NP, rats were exposed to 14C-NP as a pure aerosol or adsorbed on carbon black particles. Total 14C retained in the lung was greater at all times from 0.5 h to 30 d after exposure to 14C-NP adsorbed to carbon black particles than after exposure to pure 14C-NP (p less than .05). The fraction of total 14C in lung bound to carbon black particles decreased steadily with time after exposure, indicating in vivo removal of NP from the particles. At 0.5 h after exposure, the fraction of the estimated deposited 14C that was covalently bound to lung macromolecules was twofold greater for NP adsorbed on carbon black than for pure NP. Covalently bound 14C in lungs increased with time after exposure to 14C-NP adsorbed to carbon black, reaching levels of approximately 1% of the deposited radioactivity at 7-30 d after exposure, whereas levels of covalently bound 14C declined with time after exposure to pure NP. Thus, at 30 d after exposure, the amount of 14C covalently bound to lung macromolecules was approximately 10-fold greater (p less than .05) in rats that inhaled 14C-NP adsorbed on carbon black particles than in rats that inhaled pure 14C-NP aerosols. These results suggest that association of NP with carbon black particles augments the interaction of reactive metabolites of NP with target macromolecules. This phenomenon is thought to be related to the slow release of NP from carbon black particles, and may augment the biological effects of inhaled NP when adsorbed on carbon black or similar particles in the environment.

Adrenal gland and nonrenal retroperitoneum

Ultrasound, as the initial cross-sectional imaging technique, confirmed the value of axial records. Although computerized tomography and possibly magnetic resonance offers better resolution, ultrasonography has the advantage of being less expensive, convenient, and highly portable. With these specific indications and reservations, ultrasonography of the adrenal and retroperitoneum has an accepted role in imaging.

The prevalence of hyperandrogenism in 109 consecutive female patients with diffuse alopecia

Endocrine dysfunction was studied in 109 consecutive female patients with moderate to severe alopecia, mostly of a diffuse pattern. The study included an evaluation of associated hirsutism and/or menstrual dysfunction, plasma hormonal measurements, and ultrasonography of the ovaries. A control group of 24 ovulatory, nonhirsute, nonalopecia individuals was also studied. Of the 109 patients, 70 (64.2%) had no clinical evidence of hirsutism or menstrual dysfunction. Two of 44 patients tested with cosyntropin (Cortrosyn) had 21-hydroxylase deficiency, whereas two other patients had hyperprolactinemia caused by pituitary tumors. Hyperandrogenism was defined as an increase in any of the plasma androgens (testosterone, non-sex hormone-binding globulin bound testosterone, dehydroepiandrosterone sulfate, androstenedione, or dihydrotestosterone) and was noted in 42 of the 109 patients studied (38.5%). Of these 42 patients, 11 were ovulatory with no evidence of clinical hirsutism, 13 were ovulatory and hirsute, and 18 had oligomenorrhea or amenorrhea with or without hirsutism with confirmatory evidence of polycystic ovarian disease. Patients with diffuse alopecia may demonstrate hyperandrogenism, even in the absence of hirsutism, oligomenorrhea, or amenorrhea. The most common endocrine disorder in this series of patients with diffuse alopecia was polycystic ovarian disease.