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Blazars are active galactic nuclei, which are powerful sources of radiation whose central engine is located in the core of the host galaxy. Blazar emission is dominated by non-thermal radiation from a jet that moves relativistically towards us, and therefore undergoes Doppler beaming. This beaming causes flux enhancement and contraction of the variability timescales, so that most blazars appear as luminous sources characterized by noticeable and fast changes in brightness at all frequencies. The mechanism that produces this unpredictable variability is under debate, but proposed mechanisms include injection, acceleration and cooling of particles, with possible intervention of shock waves or turbulence. Changes in the viewing angle of the observed emitting knots or jet regions have also been suggested as an explanation of flaring events and can also explain specific properties of blazar emission, such as intra-day variability, quasi-periodicity and the delay of radio flux variations relative to optical changes. Such a geometric interpretation, however, is not universally accepted because alternative explanations based on changes in physical conditions—such as the size and speed of the emitting zone, the magnetic field, the number of emitting particles and their energy distribution—can explain snapshots of the spectral behaviour of blazars in many cases. Here we report the results of optical-to-radio-wavelength monitoring of the blazar CTA 102 and show that the observed long-term trends of the flux and spectral variability are best explained by an inhomogeneous, curved jet that undergoes changes in orientation over time. We propose that magnetohydrodynamic instabilities or rotation of the twisted jet cause different jet regions to change their orientation and hence their relative Doppler factors. In particular, the extreme optical outburst of 2016–2017 (brightness increase of six magnitudes) occurred when the corresponding emitting region had a small viewing angle. The agreement between observations and theoretical predictions can be seen as further validation of the relativistic beaming theory.

ABSTRACTAnalytical and clinical performance validation is essential before introduction of a new human papillomavirus (HPV) assay into clinical practice. This study compares the new BD Onclarity HPV assay, which detects E6/E7 DNA from 14 high-risk HPV types, to the Hybrid Capture II (HC2) HPV DNA test, to concurrent cytology and histology results, in order to evaluate its performance in detecting high-grade cervical lesions. A population of 567 women, including 325 with =ASCUS (where ASCUS stands for atypical cells of undetermined significance) and any HC2 result and 242 with both negative cytology and negative HC2 results, were prospectively enrolled for the study. The overall agreement between Onclarity and HC2 was 94.6% (95% confidence intervals [CI], 92.3% to 96.2%). In this population with a high prevalence of disease, the relative sensitivities (versus adjudicated cervical intraepithelial neoplasia grades 2 and 3 [CIN2+] histology endpoints) of the Onclarity and HC2 tests were 95.2% (95% CI, 90.7% to 97.5%) and 96.9% (95% CI, 92.9% to 98.7%), respectively, and the relative specificities were 50.3% (95% CI, 43.2% to 57.4%) for BD and 40.8% (95% CI, 33.9%, 48.1%) for HC2. These results indicate that the BD Onclarity HPV assay has sensitivity comparable to that of the HC2 assay, with a trend to an increased specificity. Moreover, as Onclarity gives the chance to discriminate between the different genotypes, we calculated the genotype prevalence and the absolute risk of CIN2+: HPV 16 was the most prevalent genotype (19.8%) with an absolute risk of CIN2+ of 77.1%.

Malignant pleural mesothelioma (MPM) is a rare aggressive tumor associated with asbestos exposure. The possible role of genetic factors has also been suggested and MPM has been associated with single nucleotide polymorphisms (SNPs) of xenobiotic and oxidative metabolism enzymes. We have identified an association of the DNA repair gene XRCC1with MPM in the population of Casale Monferrato, a town exposed to high asbestos pollution. To extend this observation we examined 35 SNPs in 15 genes that could be involved in MPM carcinogenicity in 220 MPM patients and 296 controls from two case–control studies conducted in Casale (151 patients, 252 controls) and Turin (69 patients, 44 controls), respectively. Unconditional multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Two DNA repair genes were associated with MPM, i.e. XRCC1and ERCC1. Considering asbestos-exposed only, the risk increased with the increasing number of XRCC1-399Q alleles (Casale: OR=1.44, 95%CI 1.02–2.03; Casale+Turin: OR=1.34, 95%CI 0.98–1.84) or XRCC1−77T alleles (Casale+Turin: OR=1.33, 95%CI 0.97–1.81). The XRCC1-TGGGGGAACAGA haplotype was significantly associated with MPM (Casale: OR=1.76, 95%CI 1.04–2.96). Patients heterozygotes for ERCC1N118N showed an increased OR in all subjects (OR=1.66, 95%CI 1.06–2.60) and in asbestos-exposed only (OR=1.59, 95%CI 1.01–2.50). When the dominant model was considered (i.e. ERCC1heterozygotes CT plus homozygotes CC versus homozygotes TT) the risk was statistically significant both in all subjects (OR=1.61, 95%CI 1.06–2.47) and in asbestos-exposed only (OR=1.56, 95%CI 1.02–2.40). The combination of ERCC1N118N and XRCC1R399Q was statistically significant (Casale: OR=2.02, 95%CI 1.01–4.05; Casale+Turin: OR=2.39, 95%CI 1.29–4.43). The association of MPM with DNA repair genes support the hypothesis that an increased susceptibility to DNA damage may favour asbestos carcinogenicity.

Two hundred consecutive patients undergoing resection surgery of the lung during 1999 were retrospectively reviewed to define prevalence, type, clinical course and risk factors for postoperative supraventricular arrhythmias (SVA) with particular reference to atrial fibrillation or flutter (AF).

Descending necrotizing mediastinitis (DNM) is a primary complication of cervical or odontogenical infections that can spread to the mediastinum through the anatomic cervical spaces.

We reviewed our experience with trimodality management of malignant pleural mesothelioma (MPM).

Squamous-cell carcinoma into an extrapleural pneumothorax for active tuberculosis was incorrectly diagnosed as late tubercular empyema. Right axillary thoracostomy was carried out to drain large dense effusion decompressing the brachial plexus and the sympathetic chain with symptomatic release. Surgical biopsy of the extrapleural sac allowed to identify two different tissues: normal epithelium similar to epidermis and nodular fragments composed of well-differentiated squamous carcinoma. The cause of this tumour is not clear: probably the carcinoma arose from normal epidermis carried in the extrapleural cavity during multiple air-refills to maintain the therapeutic pneumothorax.

Interstitial lung diseases (ILD) require lung biopsy for the diagnosis in more than 30% of patients. Open lung biopsy (OLB) was generally considered the most reliable method of biopsy and tissue diagnosis. This study tests the diagnostic accuracy and safety of the videothoracoscopic lung biopsy (VTLB) in the diagnosis of ILD.

Twenty infants under one yr of age undergoing minor surgery were divided in two groups according to the type of anesthesia (epidural, Group 1, n = 10; general, Group 2, n = 10) which was randomly performed. Blood samples for Cortisol (F), growth hormone (GH), and prolactin (PRL) determination were taken from each infant in baseline conditions, before surgery, and at the end of surgery. Mean plasma F levels in infants of group 2 rose significantly (p< 0.01) before surgery to attend a maximum at the end of surgery (p< 0.005). In infants of Group 1 a significant increase was also observed before surgery (p< 0.05) but at the end of surgery mean plasma cortisol returned to levels comparable to baseline. Mean GH plasma levels were not significantly affected by both types of anesthesia, however an increase (not statistically significant) was observed at the end of surgery in both groups. Mean plasma PRL levels showed a significant increase before surgery (p< 0.05 and p< 0.01 in group 1 and 2, respectively) and a further increase at the end of surgery in both groups of infants (p< 0.005). These results suggest that in infants under one yr of age both types of anesthetic procedures preceding surgery have no significant effect on plasma GH, but produce a significant increase of cortisol and prolactin mean plasma levels. The cortisol response to surgery and general or epidural anesthesia was similar to that reported in adults and prepubertal boys. At difference with adult subjects the PRL response to surgery and general anesthesia was not prevented by epidural anesthesia and the GH increase observed after surgery and general anesthesia was not statistically significant.

Thymocytes express multiple different surface antigens according to their stage of maturation. We studied lymphocyte surface differentiation antigens using direct immunofluorescence technique in the thymus of 20 patients with myasthenia gravis (MG) and 10 controls undergoing cardiac surgery. Fluorescein isothiocyanateconjugated monoclonal antibodies were used to stain thymic cell surface antigens. We found a decrease in the percent expression of CD1, CD5, and CD7 surface antigens and a significant increase of CD20+ cells in myasthenic thymus compared with the controls. The changes in the percent expression of CD3, CD4, and CD8 antigens were not significant. These data suggest both the decrease in the imunophenotypes corresponding to cortical thymocytes (probably reflecting the cortical atrophy of the MG thymus) and the increase of mature B Cells (CD20+), which may participate in an active immune response.

Objective and methods: This study reports clinicopathologic features, treatment, and outcome of 30 recurrent thymomas out of 266 totally resected thymomas. Results: The mean disease-free interval to recurrence was 86 months. Recurrence occurred less frequently and after a longer disease-free interval after resection of encapsulated versus invasive thymomas. The presence of associated myasthenia gravis did not affect recurrence proportion, disease-free interval, or survival after recurrence. A local recurrence occurred in 11 patients, 17 patients had a distant recurrence, and the extent of the recurrence could not be determined in 2 cases. Surgical treatment of the recurrent tumor was attempted in 16 cases, and a total resection was possible in 10 cases; exclusive radiotherapy was done in 11 cases. Overall 5- and 10-year survivals were 48% and 24%, respectively. In a univariate analysis, survival was significantly better in the presence of a local recurrence and in case of a total resection of the recurrent tumor. The use of adjuvant therapy after the resection of the initial thymoma had no effect on reducing the incidence of recurrence, in prolonging the disease-free interval, or in improving survival after the development of the recurrence. In a multivariate survival analysis, significant prognostic factors were the presence of a local recurrence and total resection of the recurrent tumor. Conclusions: Surgical resection is recommended in patients with recurrent thymoma. Local recurrence and total resection of the recurrent tumor are associated with excellent prognosis. A poor prognosis may be anticipated in the presence of distant recurrence and when radical surgical treatment is not done. (J Thorac Cardiovasc Surg 1997;113:55-63)

Hepatocyte growth factor/scatter factor (HGF/SF) stimulates the invasive growth of epithelial cells via the c-MET oncogene-encoded receptor. In normal lung, both the receptor and the ligand are detected, and the latter is known to be a mitogenic and a motogenic factor for both cultured bronchial epithelial cells and non-small-cell carcinoma lines. Here, ligand and receptor expression was examined in 42 samples of primary human non-small-cell lung carcinoma of different histotype. Each carcinoma sample was compared with adjacent normal lung tissue. The Met/HGF receptor was found to be 2 to 10-fold increased in 25% of carcinoma samples (P = 0.0113). The ligand, HGF/SF, was found to be 10 to 100-fold overexpressed in carcinoma samples (P < 0.0001). Notably, while HGF/SF was occasionally detectable and found exclusively as a single-chain inactive precursor in normal tissues, it was constantly in the biologically-active heterodimeric form in carcinomas. Immunohistochemical staining showed homogeneous expression of both the receptor and the ligand in carcinoma samples, whereas staining was barely detectable in their normal counterparts. These data show that HGF/SF is overexpressed and consistently activated in non-small-cell lung carcinomas and may contribute to the invasive growth of lung cancer.

— The Authors analyse the success of surgical treatment for pulmonary metastasis on the basis of survival rate. The case histories of 127 patients are analysed and compared to those in literature.

Objective: This study was aimed at analyzing the degree of intercostal nerve impairment in posterolateral and muscle-sparing thoracotomy and at correlating the nerve damage to the severity of long-lasting postthoracotomy pain. Methods: Neurophysiologic recordings were performed 1 month after either posterolateral or muscle-sparing thoracotomy to assess the presence of the superficial abdominal reflexes (mediated in part by the intercostal nerves), the somatosensory-evoked responses after electrical stimulation of the surgical scar, and the electrical thresholds for tactile and pain sensations of the surgical incision. Results: The patients who underwent a posterolateral thoracotomy showed a higher degree of intercostal nerve impairment than the muscle-sparing thoracotomy patients as revealed by the disappearance of the abdominal reflexes, a larger reduction in amplitude of the somatosensory-evoked potentials, and a larger increase of the sensory thresholds to electrical stimulation for both tactile perception and pain. In addition, these neurophysiologic parameters were highly correlated to the postthoracotomy pain experienced by the patients 1 month after surgery, indicating a causal role for nerve impairment in the long-lasting postoperative pain. Conclusions: This study shows for the first time the pathophysiologic differences between posterolateral and muscle-sparing thoracotomy and suggests that the minor long-lasting postthoracotomy pain in muscle-sparing thoracotomy patients is partly due to a minor nerve damage. In addition, because nerve impairment is responsible for the long-lasting neuropathic component of postoperative pain, it is necessary to match specific treatments to the neuropathic pain-generating mechanisms. (J Thorac Cardiovasc Surg 1998;115:841-7)

Coral records of surface‐ocean conditions extend our knowledge of interannual El Niño–Southern Oscillation (ENSO) variability into the preinstrumental period. That said, the wide range of natural variability within the climate system as well as multiple sources of uncertainties inherent to the coral archive produce challenges for the paleoclimate community to detect forced changes in ENSO using coral geochemical records. We present a new coral proxy system model (PSM) of intermediate complexity, geared toward the evaluation of changes in interannual variance. Our coral PSM adds additional layers of complexity to previously published transfer functions of sensor models that describe how the archive responds to sea surface temperature (SST) and salinity. We use SST and salinity output from the Community Earth System Model Last Millennium Ensemble 850 control to model coral oxygen isotopic ratios and SST derived from Sr/Ca. We present a detailed analysis of our PSM using climate model output for sites in the central and southwest Pacific before extending the analyses to span the broader tropical Pacific. We demonstrate how variable growth rates, analytical and calibration errors, and age model assumptions systematically impact estimates of interannual variance and show that the relative magnitude of the change in interannual variance is location dependent. Importantly, however, we find that even with the added uncertainties in our PSM, corals from many circum‐Pacific locations are broadly able to capture decadal and longer (decadal+) changes in ENSO variability. Our code is publicly available on GitHub to facilitate future comparisons between model output and coral proxy data. Climate scientists use the chemistry of coral skeletons to study past tropical climate conditions. The elemental ratio of strontium to calcium (Sr/Ca) and the oxygen isotopic composition (δ18O) in the coral skeleton are used to reconstruct past sea surface temperature and salinity. Coral Sr/Ca varies in response to changes in sea surface temperature, whereas coral δ18O records both changes in temperature and salinity. Individual corals provide tens to hundreds of years of climate information from the tropical oceans. They are well‐suited for studying variability related to the El Niño–Southern Oscillation (ENSO), a climate phenomenon that impacts global temperature and rainfall patterns every few years. We rely on both climate proxy data and simulations from global climate models to study changes in ENSO variability in the past. Nevertheless, it is difficult to directly compare proxy data with climate model output due to the imperfect nature of how the climate signal is recorded in the coral skeleton. Proxy system models are a tool designed to help bridge the gap between climate information recorded in corals and climate model output. In this study, we develop a coral proxy system model to demonstrate how different processes impact a coral's ability to record changes in ENSO variability. We present a new coral proxy system model to facilitate comparison between proxy observations and climate model outputAnalytical and calibration errors, variable growth rates, and age modeling uncertainties all have measurable impacts on interannual varianceThe relative importance of different uncertainties on interannual variance are site dependent

Chest-wall is a rare localization of Castleman's disease. The tumour is often diagnosed after onset of non-specific thoracic symptoms but can be occasionally detected in asymptomatic patients. Surgical removal is curative and should be conservative with no recurrences. We report a new case and we review the international literature.