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The use of volatile organic compounds (VOCs) in bile was recently studied and appeared promising for diagnosis of malignancy. Noninvasive diagnosis of malignant biliary strictures by using VOCs in urine has not been studied. To identify potential VOCs in urine to diagnose malignant biliary strictures. In this prospective cross-sectional study, urine was obtained immediately prior to ERCP from consecutive patients with biliary strictures. Selected-ion flow-tube mass spectrometry was used to analyze the concentration of VOCs in urine samples. Fifty-four patients with biliary strictures were enrolled. Fifteen patients had malignant stricture [six cholangiocarcinoma (CCA) and nine pancreatic cancer], and 39 patients had benign strictures [10 primary sclerosing cholangitis (PSC) and 29 with benign biliary conditions including chronic pancreatitis and papillary stenosis]. The concentration of several compounds (ethanol and 2-propanol) was significantly different in patients with malignant compared with benign biliary strictures (p

CXC-chemokine ligand 10 (CXCL10) inhibits angiogenesis and attracts activated T lymphocytes. Abnormal angiogenesis and lymphocytic infiltration participate in the pathobiology of pulmonary arterial hypertension (PAH). We hypothesized that serum CXCL10 is elevated in idiopathic PAH and that it is associated with clinical outcomes. This was a cohort study that included 40 idiopathic PAH patients (age = 44 +/- A 14 years, 37 females) and 22 healthy controls (age = 35 +/- A 6 years, 18 females). It took place at the Pulmonary Vascular Program at the Cleveland Clinic. Serum CXCL10 levels were measured by an enzyme-linked immunosorbent assay. A cutoff value of CXCL10 for best distinguishing alive and dead patients was obtained from a receiver operating characteristic curve (ROC). Survival and time to clinical worsening curves according to the appropriate CXCL10 level were derived by the Kaplan-Meier method and compared by means of the log-rank test. The prognostic value of CXCL10 and of other variables of interest was tested by Cox proportional hazards regression analysis. Serum CXCL10 levels were elevated in PAH subjects compared to controls [CXCL10 pg/ml (mean +/- A SEM) for PAH: 306 +/- A 73, and for controls: 92 +/- A 10; p < 0.0001]. CXCL10 levels higher than 111 pg/ml discriminated survivors from nonsurvivors with a sensitivity of 81% and a specificity of 75% (area under the ROC curve = 0.74). After a mean follow-up of 23.5 +/- A 13.5 months since the day of venous sampling, higher CXCL10 levels were associated with improved survival (hazard ratio for mortality = 0.10, 95% confidence interval = 0.01-0.97; p = 0.01). Serum CXCL10 is elevated in PAH and this is associated with improved survival.

Pleural effusion is defined as an abnormal amount of pleural fluid accumulation in the pleural space and is the result of an imbalance between excessive pleural fluid formation and pleural fluid absorption. Although the list of causes of pleural effusions is extensive, the great majority of the cases are caused by pneumonia, congestive heart failure, and malignancy. In this article, we provide an overview of the most common causes of pleural effusions likely to be encountered by the general practitioner, and a practical approach to the diagnosis and management of this common condition.

Pulmonary hypertension (PH) is a hemodynamic state characterized by elevation in the mean pulmonary arterial pressure and pulmonary vascular resistance leading to right ventricular failure and premature death. PH can be the result of a variety of diseases of different etiologies. Pulmonary arterial hypertension (PAH) should be distinctly differentiated from pulmonary venous hypertension (PVH) as a result of left heart disease. PAH is commonly caused by or associated with an underlying pulmonary, cardiac, or systemic disease (APAH). In the absence of an identifiable etiology or associated underlying disease, PAH is referred to as idiopathic (IPAH). IPAH, formerly known as primary pulmonary hypertension (PPH), is a rare disease most commonly seen in women of childbearing age. Presenting symptoms and signs are nonspecific and include dyspnea on exertion, fatigue, and a loud pulmonary component of the second heart sound. Transthoracic Doppler echocardiography is an excellent noninvasive test to detect the presence of pulmonary hypertension, although every patient should receive a right heart catheterization to confirm the diagnosis. A detailed work up, including laboratory tests and imaging studies, is also indicated to rule out known causes of pulmonary hypertension. Several targeted treatment options have become available in recent years and include parenteral and inhaled prostanoids, oral endothelin receptor antagonists, and oral phosphodiesterase type-5 inhibitors. As a result of their complex care, patients should be referred to centers with expertise in pulmonary hypertension.

Measurement of NO and/or its metabolites in the various body compartments has transformed our understanding of biology. The inability of the current NO measurement methods to account for naturally occurring and experimental NO isotopes, however, has prevented the scientific community from fully understating NO metabolism in vivo. Here we present a mid-IR Faraday rotation spectrometer (FRS) for detection of NO isotopes. The instrument utilizes a novel dual modulation/demodulation (DM) FRS method which exhibits noise performance at only 2 times the fundamental quantum shot-noise level and provides the record sensitivity in its class. This is achieved with a system that is fully autonomous, robust, transportable and does not require cryogenic cooling. The DM-FRS enables continuous monitoring of nitric oxide isotopes with the detection limits of 3.72 ppbv/Hz1/2 to14NO and 0.53 ppbv/Hz1/2 to15NO using only 45 cm active optical path. This DM-FRS measurement method can be used to improve the performance of conventional FRS sensors targeting other radical species. The feasibility of the instrument to perform measurements relevant to studies of NO metabolism in humans is demonstrated.