Endosonographic features of esophageal granular cell tumors

BACKGROUND AND STUDY AIMS: Granular cell tumors of the esophagus are rare tumors. A definite diagnosis is achieved by endoscopic biopsies in only 50% of cases. Endoscopic ultrasonography (EUS) is the best procedure in the evaluation of upper gastrointestinal tract submucosal tumors. The aim of this study was to describe the endosonographic findings of esophageal granular cell tumors. METHODS: From January 1989 to March 1994, 15 patients with 21 granular cell tumors which had negative biopsies were examined by EUS (Olympus GF UM3 or GF UM20,7,5 and 12 MHz). In five cases, the tumor was also studied with a 20 MHz Olympus miniprobe. The final histological diagnoses were obtained by subsequent endoscopic snare resection in 20 cases and surgically in one case. RESULTS: The endosonographic features (with the GF UM3 or GF UM20) of esophageal granular cell tumors were: a) a tumor size of less than 2 cm in 95% of cases; b) an hypoechoic solid pattern in 100% of cases; c) a tumor arising in the inner layers in 95% (second echo-poor layer n=15; third echo-rich layer n=5). In one case, the endosonographic finding was transmural malignant infiltration of the esophageal wall (histologically confirmed). CONCLUSION: When a granular cell tumor of the esophagus is suspected, EUS can show the inner layer location of the tumor and thus contribute to planning the endoscopic resection or follow up. When the tumor also invades the outer layers, EUS can contribute to planning the surgical resection.     

Symposium: Italian Industrial Districts In The I99Os

This paper reviews the scholarship concerning the rise to economic prominence of the Italian industrial districts, and the causes of some of the difficulties in which some districts have found themselves since the mid-1980s. The paper develops the main lines of the economic advantages that districts enjoyed during a period of rapid growth, resulting from the operation of a market in common which blends competition and cooperation. The effects of globalisation are changing this somewhat ‘idyllic’ picture, as the structure of linkages between firms comes under pressure. Prospects for the Italian districts in these new circumstances are discussed.     

From hospital to municipal cogeneration systems: an Italian case study

A mixed integer linear programming model combined with a more traditional design by scenarios is proposed to optimize facilities size and operation mode of a municipal energy system involving significant civil centres and a hospital. Moving from the need of a new heat and power station for the local hospital due to the construction of new pavilions, the opportunity of involving other centres in the neighbourhood in a distributed cogeneration system is analysed, increasing system complexity step by step. Smaller cogeneration units tailored to hospital needs are rewarding ventures with relatively low risks but, in a country whose traditional power generation systems heavily rely on fossil fuels and where energy policy and market conditions can make it profitable to sell surplus power, district heating systems foster the installation of larger cogenerators and lead thereby to higher profits and to better performance as for primary energy savings and greenhouse gases emission reduction. Copyright © 2006 John Wiley & Sons, Ltd.     

On the Use of the Flickermeter to Limit Low-Frequency Interharmonic Voltages

The possibility of using the IEC flickermeter for the assessment of the limits of low frequency interharmonic voltages is critically analyzed. The response of flickermeters to interharmonic components is analytically investigated, obtaining approximation formulas for the calculation of Pst in the presence of couples of components at frequencies that are symmetric with reference to the fundamental and in the presence of one or more single components. The instrument characteristics and limitations are also highlighted, using the results obtained from a numerical implementation of the IEC flickermeter. Finally, the general problem of the limits of low frequency interharmonic voltages is discussed and practical solutions are proposed.     

Gluten-free diet induces regression of T-cell activation in the rectal mucosa of patients with celiac disease

OBJECTIVE: An increase in the number of intraepithelial lymphocytes (IEL) in the rectal epithelium of patients with active celiac disease has been described. No data are available about how they vary during a gluten-free diet. The aim of the study was to assess the effect of a gluten-free diet on T-cell activation in the rectal mucosa of adult patients with celiac disease. METHODS: Frozen duodenal and rectal biopsies were available in four celiac patients (one male, three female, mean age 39 yr) both before and after 7 to 24 months on a gluten-free diet. Biopsy samples were stained using monoclonal antibodies directed against CD3, betaF1, TcRdelta1, CD25, and HLADR. Numbers of IEL were estimated by counting the peroxidase-stained cells per 100 epithelial cells. Four patients without histological abnormalities were used as control subjects. RESULTS: In the four patients with active celiac disease but in none of the controls, CD25 was expressed by both duodenal and rectal lamina propria cells and HLADR was expressed by duodenal (4/4) and rectal (2/4) epithelial cells. In addition, two patients with active celiac disease had features of lymphocytic colitis, i.e., >20 IEL per 100 epithelial cells. After a gluten-free diet, the mean number of rectal CD3+ betaF1+ IEL decreased (9% vs 21%) and the expression of CD25 and HLADR was no longer present. These changes mirrored those found in the small intestinal biopsies. CONCLUSION: These results suggest that in celiac disease, gluten-driven T-cell activation is not restricted to the proximal part of the intestine but is present on the whole intestinal length. Assessment of the effectiveness of a gluten-free diet through rectal biopsies warrants investigation, as it could lessen discomfort for patients and prove more cost-effective.     

Confocal Blood Flow Videomicroscopy of Thrombus Formation over Human Arteries and Local Targeting of P2X7

Atherothrombosis exposes vascular components to blood. Currently, new antithrombotic therapies are emerging. Herein we investigated thrombogenesis of human arteries with/without atherosclerosis, and the interaction of coagulation and vascular components, we and explored the anti-thrombogenic efficacy of blockade of the P2X purinoceptor 7 (P2X7). A confocal blood flow videomicroscopy system was performed on cryosections of internal mammary artery (IMA) or carotid plaque (CPL) determining/localizing platelets and fibrin. Blood from healthy donors elicited thrombi over arterial layers. Confocal microscopy associated thrombus with tissue presence of collagen type I, laminin, fibrin(ogen) and tissue factor (TF). The addition of antibodies blocking TF (aTF) or factor XI (aFXI) to blood significantly reduced fibrin deposition, variable platelet aggregation and aTF + aFXI almost abolished thrombus formation, showing synergy between coagulation pathways. A scarce effect of aTF over sub-endothelial regions, more abundant in tissue TF and bundles of laminin and collagen type I than deep intima, may suggest tissue thrombogenicity as molecular structure-related. Consistently with TF-related vascular function and expression of P2X7, the sections from CPL but not IMA tissue cultures pre-treated with the P2X7 antagonist A740003 demonstrated poor thrombogenesis in flow experiments. These data hint to local targeting studies on P2X7 modulation for atherothrombosis prevention/therapy.     

Selective Complexation and Membrane Transport of Guanidinium Salts by Calix[6]arene Amides

The p-tert-butylcalix[6]arene hexamide 2 and syn-1,3,5–trimethoxy-2,4,6-triamide 4 were synthesized by reaction of α-chloro-N,N-diethylacetamide and the corresponding calix[6]arenes 1 and 3 , respectively. ¹H NMR spectroscopy shows that 2 is a mixture of different conformations whereas 4 is fixed in a cone conformation. Extraction experiments, (S-L) and (H₂O–CDCl₃) with picrate salts, indicate that 2 complexes both alkali metal (1:2 complex) and guanidinium salts (1:1 complex) but 4 complexes only guanidinium (1:1 complex). Incorporated in supported liquid membranes (Accurel^® / o-nitrophenyl n-octyl ether) the calixarenes 2 and 4 transport guanidinium salts. The hexamide 2 is a more efficient carrier of guanidinium but the syn-1,3,5-trimethoxy-2,4,6-triamide 4 is much more selective. Both 2 and 4 are sufficiently lipophilic to give membranes that are stable over longer periods (weeks).     

Nonlinear Versus Linear Learning Devices: A Procedural Perspective

We provide a discussion of bounded rationality learning behind traditional learning mechanisms, i.e., Recursive Ordinary Least Squares and Bayesian Learning . These mechanisms lack for many reasons a behavioral interpretation and, following the Simon criticism, they appear to be substantively rational. In this paper, analyzing the Cagan model, we explore two learning mechanisms which appear to be more plausible from a behavioral point of view and somehow procedurally rational: Least Mean Squares learning for linear models and Back Propagation for Artificial Neural Networks . The two algorithms look for a minimum of the variance of the error forecasting by means of a steepest descent gradient procedure. The analysis of the Cagan model shows an interesting result: non-convergence of learning to the Rational Expectations Equilibrium is not due to the restriction to linear learning devices; also Back Propagation learning for Artificial Neural Networks may fail to converge to the Rational Expectations Equilibrium of the model.