ICARUS at the Fermilab Short-Baseline Neutrino program: initial operation

The ICARUS collaboration employed the 760-ton T600 detector in a successful 3-year physics run at the underground LNGS laboratory, performing a sensitive search for LSND-like anomalous ν e appearance in the CERN Neutrino to Gran Sasso beam, which contributed to the constraints on the allowed neutrino oscillation parameters to a narrow region around 1 eV2 . After a significant overhaul at CERN, the T600 detector has been installed at Fermilab. In 2020 the cryogenic commissioning began with detector cool down, liquid argon filling and recirculation. ICARUS then started its operations collecting the first neutrino events from the booster neutrino beam (BNB) and the Neutrinos at the Main Injector (NuMI) beam off-axis, which were used to test the ICARUS event selection, reconstruction and analysis algorithms. ICARUS successfully completed its commissioning phase in June 2022. The first goal of the ICARUS data taking will be a study to either confirm or refute the claim by Neutrino-4 short-baseline reactor experiment. ICARUS will also perform measurement of neutrino cross sections with the NuMI beam and several Beyond Standard Model searches. After the first year of operations, ICARUS will search for evidence of sterile neutrinos jointly with the Short-Baseline Near Detector, within the Short-Baseline Neutrino program. In this paper, the main activities carried out during the overhauling and installation phases are highlighted. Preliminary technical results from the ICARUS commissioning data with the BNB and NuMI beams are presented both in terms of performance of all ICARUS subsystems and of capability to select and reconstruct neutrino events.

The benefits of index telephone consultations in patients referred on the two-week wait colorectal cancer pathway

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic led to hospitals in the UK substituting face-to-face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the use of virtual two-week wait (2-ww) lower gastrointestinal (LGI) clinic appointments, conducted using telephone calls at a district general hospital in England.

METHODS

Patients undergoing index outpatient 2-ww LGI clinic assessment between 1 June 2019 and 31 October 2019 (FtF group) and 1 June 2020 and 31 October 2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets was assessed. Environmental and financial impact analyses were performed.

RESULTS

In total, 1,531 patients were analysed (median age=70, male=852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone; the remainder were seen FtF (n=774, 50.6%). Ninety-two (6%, VC=44, FtF=48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC); of these, 46 (71.9%, VC=26, FtF=20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p<0.001). The cancer detection rates (p=0.749), treatments received (p=0.785) and median time to index treatment for CRC patients (p=0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p<0.001). VC appointments saved patients a total of 9,288 miles, 0.7 metric tonnes of CO2 emissions and £7,482.97. Taxpayers saved £80,242.00 from VCs. No formal complaints were received from patients or staff in the VC group.

CONCLUSION

Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits.

Effects of a Football Simulated Exercise on Injury Risk Factors for Anterior Cruciate Ligament (ACL) Injury in Amateur Female Players

Females are more at risk of Anterior Cruciate Ligament (ACL) injuries than males; however, there is limited literature on neuromuscular risk factors such as angle-specific hamstring/quadriceps functional strength ratios (H_ecc/Q_con) and rate of torque development (RTD) in female footballers. The aim of this study was to investigate the effects of fatigue on these neuromuscular risk factors. Thirty-three amateur players (20.3 ± 2.0 years old, 1.67 ± 9.31 m, 63.4 ±8.1 kg, 23.6 ± 5.7% body fat) performed strength assessments of the quadriceps (concentrically, Q_con) and hamstrings (eccentrically, H_ecc) on both legs on an isokinetic dynamometer, before and immediately after a football-specific exercise. Results showed significantly lower peak H_ecc (-15.1 to -15.5%), peak H_ecc/Q_con (-8.8 to -12.9%) and RTD (-14.0 to -17.0%) for hamstring eccentric contractions after fatigue in the dominant and non-dominant legs. Furthermore, significant decreases in H_ecc/Q_con were observed at 10° only in the dominant leg (-15.5%), and at 10°, 20° and 30° in the non-dominant leg (-15.1 to -21.8%). These results suggest a reduced capacity of the hamstrings to stabilise the knee joint with fatigue. Unlike results previously shown on men, the non-dominant leg seemed more affected, highlighting the need to consider specific prevention measures in females.

997 Audit Examining the Treatment of Patients Who Developed Post Operative Complications Following Appendicectomy

Aim

To identify trends in management of patients with post operative complications following appendicectomy in a district general hospital.

Method

The coding department identified patients who were admitted with appendicitis in the previous year and those who developed post operative complications. Data was gathered retrospectively from these patients using their online records.

Results

Coding identified 270 patients that were admitted between 22/10/20–29/10/21 with appendicitis. 19 patients had post operative complications. 9 had intra-abdominal collections, 5 had wound infections/collections, 3 had an ileus.

15/19 patients with complications underwent imaging, 8 had CT scans and 7 had US scans. Patients waited a mean of 0.4 days between presentation and imaging. Patients waited a mean of 2.2 and median of 0 days between imaging and appendicectomy.

12 patients had complicated appendicitis, 6 had simple appendicitis and 1 had a normal appendix. 16 patients had antibiotics pre and post operatively, 3 did not. The mean length of stay was 5.6 days for patients with complications, compared to a mean length of stay of 3.9 days for all patients with appendicitis.

Conclusions

Early identification and management of appendicitis reduces morbidity, and our centre appears to have lower than average complication rates. The patients who did develop complications, were generally imaged and operated on efficiently

An area of improvement is ensuring all patients undergoing appendicectomies are given at least one preoperative dose of antibiotics and up to 3–5 days post operatively if complicated as per WSES guidelines. We aim to re-audit this after an education drive within our department.

Oxidative stress from DGAT1 oncoprotein inhibition in melanoma suppresses tumor growth when ROS defenses are also breached

Dysregulated cellular metabolism is a cancer hallmark for which few druggable oncoprotein targets have been identified. Increased fatty acid (FA) acquisition allows cancer cells to meet their heightened membrane biogenesis, bioenergy, and signaling needs. Excess FAs are toxic to non-transformed cells but surprisingly not to cancer cells. Molecules underlying this cancer adaptation may provide alternative drug targets. Here, we demonstrate that diacylglycerol O-acyltransferase 1 (DGAT1), an enzyme integral to triacylglyceride synthesis and lipid droplet formation, is frequently up-regulated in melanoma, allowing melanoma cells to tolerate excess FA. DGAT1 over-expression alone transforms p53-mutant zebrafish melanocytes and co-operates with oncogenic BRAF or NRAS for more rapid melanoma formation. Antagonism of DGAT1 induces oxidative stress in melanoma cells, which adapt by up-regulating cellular reactive oxygen species defenses. We show that inhibiting both DGAT1 and superoxide dismutase 1 profoundly suppress tumor growth through eliciting intolerable oxidative stress.

Tricuspid valve leaflet strains in the beating ovine heart

The tricuspid leaflets coapt during systole to facilitate proper valve function and, thus, ensure efficient transport of deoxygenated blood to the lungs. Between their open state and closed state, the leaflets undergo large deformations. Quantification of these deformations is important for our basic scientific understanding of tricuspid valve function and for diagnostic or prognostic purposes. To date, tricuspid valve leaflet strains have never been directly quantified in vivo. To fill this gap in our knowledge, we implanted four sonomicrometry crystals per tricuspid leaflet and six crystals along the tricuspid annulus in a total of five sheep. In the beating ovine hearts, we recorded crystal coordinates alongside hemodynamic data. Once recorded, we used a finite strain kinematic framework to compute the temporal evolutions of area strain, radial strain, and circumferential strain for each leaflet. We found that leaflet strains were larger in the anterior leaflet than the posterior and septal leaflets. Additionally, we found that radial strains were larger than circumferential strains. Area strains were as large as 97% in the anterior leaflet, 31% in the posterior leaflet, and 31% in the septal leaflet. These data suggest that tricuspid valve leaflet strains are significantly larger than those in the mitral valve. Should our findings be confirmed they could suggest either that the mechanobiological equilibrium of tricuspid valve resident cells is different than that of mitral valve resident cells or that the mechanotransductive apparatus between the two varies. Either phenomenon may have important implications for the development of tricuspid valve-specific surgical techniques and medical devices.

Prospective cohort study of surgical trainee experience of access to gastrointestinal endoscopy training in the UK and Ireland

INTRODUCTION

Surgical trainees are reporting barriers to training in gastrointestinal (GI) endoscopy. This snapshot survey aimed to gather data on variation in access to quality GI endoscopy training for Colorectal and Upper Gastrointestinal (GI) surgical trainees across the UK and Ireland.

MATERIALS AND METHODS

An online 20-point survey was designed and distributed nationally to surgical trainee members of the Association of Surgeons in Training (ASiT), Dukes and The Roux Group (formerly Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland Trainees). The survey was designed in collaboration with The Roux Group for Upper GI trainees and the Dukes' Club for Colorectal trainees.

RESULTS

218 responses were received, most with a Colorectal or Upper GI sub-specialty interest (colorectal 56.0%; upper GI surgery 25.7%). Only 28.6% of trainees attended a dedicated training endoscopy list at least once a week with 28.1% not attending any at all. Less than half of trainees reported having endoscopy formally timetabled on rotas (36.9%). Most trainees (88.0%) encountered difficulties in gaining endoscopy training including lack of available lists (77.2%), conflicting operative commitments (59.4%), preferential allocation of lists to gastroenterology trainees (57.9%) and resistance from endoscopy departmental leads (38.6%). Regarding JAG accreditation, 77.1% respondents felt it should be mandatory prior to CCT with 80.3% believing this would lead to better access to dedicated endoscopy training equivalent to gastroenterology trainees. 93.1% trainees felt that attaining JAG accreditation by surgical trainees was important to patient care.

DISCUSSION

This study demonstrates significant barriers in accessing GI endoscopy training for general surgical trainees which urgently needs to be improved. In order to meet JAG training requirements for surgical trainees, a multifaceted collaborative approach from surgical and gastroenterology training bodies, local JAG trainers and the General Surgery SAC and JCST is required. This is to ensure that endoscopy is promoted and a robust model of training is successfully designed and delivered to general surgery trainees.

Defining our destiny: trainee working group consensus statement on the future of emergency surgery training in the United Kingdom

The United Kingdom National Health Service treats both elective and emergency patients and seeks to provide high quality care, free at the point of delivery. Equal numbers of emergency and elective general surgical procedures are performed, yet surgical training prioritisation and organisation of NHS institutions is predicated upon elective care. The increasing ratio of emergency general surgery consultant posts compared to traditional sub-specialities has yet to be addressed. How should the capability gap be bridged to equip motivated, skilled surgeons of the future to deliver a high standard of emergency surgical care? The aim was to address both training requirements for the acquisition of necessary emergency general surgery skills, and the formation of job plans for trainee and consultant posts to meet the current and future requirements of the NHS.

Twenty nine trainees and a consultant emergency general surgeon convened as a Working Group at The Association of Surgeons in Training Conference, 2015, to generate a united consensus statement to the training requirement and delivery of emergency general surgery provision by future general surgeons. Unscheduled general surgical care provision, emergency general surgery, trauma competence, training to meet NHS requirements, consultant job planning and future training challenges arose as key themes. Recommendations have been made from these themes in light of published evidence. Careful workforce planning, education, training and fellowship opportunities will provide well-trained enthusiastic individuals to meet public and societal need.

Just-in-Time Compound Pooling Increases Primary Screening Capacity without Compromising Screening Quality

Compound pooling, or multiplexing more than one compound per well during primary high-throughput screening (HTS), is a controversial approach with a long history of limited success. Many issues with this approach likely arise from long-term storage of library plates containing complex mixtures of compounds at high concentrations. Due to the historical difficulties with using multiplexed library plates, primary HTS often uses a one-compound–one-well approach. However, as compound collections grow, innovative strategies are required to increase the capacity of primary screening campaigns. Toward this goal, we have developed a novel compound pooling method that increases screening capacity without compromising data quality. This method circumvents issues related to the long-term storage of complex compound mixtures by using acoustic dispensing to enable “just-in-time” compound pooling directly in the assay well immediately prior to assay. Using this method, we can pool two compounds per well, effectively doubling the capacity of a primary screen. Here, we present data from pilot studies using just-in-time pooling, as well as data from a large >2-million-compound screen using this approach. These data suggest that, for many targets, this method can be used to vastly increase screening capacity without significant reduction in the ability to detect screening hits.

Toward parametric amplification in plasmonic systems: second harmonic generation enhanced by surface plasmon polaritons

Having in mind parametric amplification of surface plasmon polaritons (SPPs) as the final goal, we took the first step and studied in the Kretschmann geometry a simpler nonlinear optical process - second harmonic generation (SHG) enhanced by SPPs propagating at the interface between gold film and 2-methyl-4-nitroaniline (MNA). The experimentally demonstrated SHG efficiency was nearly 10(6) times larger than the one reported previously in the SPP system with different nonlinear optical material. The experimentally measured nonlinear conversion efficiency is estimated to be sufficient for parametric amplification of surface plasmon polaritons at ultra-short laser pumping.

Hand-arm vibration syndrome: a common occupational hazard in industrialized countries

Regular exposure to hand-transmitted vibration can result in symptoms and signs of peripheral vascular, neurological and other disorders collectively known as the hand-arm vibration syndrome (HAVS). A significant proportion of workers can suffer from HAVS after using vibrating power tools. HAVS is a chronic and progressive disorder. Early recognition and prevention is the key to managing vibrating tool exposures and health effects. This article gives a broad overview of the condition with a detailed account of its pathogenesis, identification and management.

A comparative molecular study of the presence of "Candidatus arthromitus" in the digestive system of rainbow trout, Oncorhynchus mykiss (Walbaum), healthy and affected with rainbow trout gastroenteritis

Observations were made using histopathological techniques in conjunction with a nested polymerase chain reaction (PCR) protocol for the specific detection of "Candidatus arthromitus" on DNA extracted from wax-embedded tissues and fresh digestive contents of rainbow trout. Samples positive for "Candidatus arthromitus" DNA included fish with rainbow trout gastroenteritis (RTGE), clinically normal cohabiting fish, and apparently healthy controls from RTGE positive and RTGE negative sites. The results obtained from the PCR were confirmed by nucleotide sequencing. "Candidatus arthromitus" DNA was found in distal intestine as well as in sections of pyloric caeca, suggesting that both these locations are appropriate for molecular detection of "Candidatus arthromitus" DNA in trout. Furthermore, rainbow trout fry distal intestinal samples from two different hatcheries where RTGE had not been reported were also positive. Differences in "Candidatus arthromitus" DNA detection between paraffin wax-embedded and fresh digestive content samples from the same fish suggested that it may be predominantly epithelium-associated in healthy trout. Parallel histopathological observations indicated that pyloric caeca are the preferred site for visualizing segmented filamentous bacteria (SFB) in trout with RTGE. The results of this study showed that the presence of SFB was not invariably associated with clinical disease and that more information is required to understand the role of these organisms.

PTPN11 analysis for the prenatal diagnosis of Noonan syndrome in fetuses with abnormal ultrasound findings

Noonan syndrome (NS) is an autosomal dominant disorder characterized by short stature, congenital heart defects and distinctive facies. The disorder is genetically heterogeneous with approximately 50% of patients having PTPN11 mutations. Prenatally, the diagnosis of NS has been suspected following certain ultrasound findings, such as cystic hygroma, increased nuchal translucency (NT) and hydrops fetalis. Studies of fetuses with cystic hygroma have suggested an NS prevalence of 1-3%. A retrospective review was performed to assess the utility of PTPN11 testing based on prenatal sonographic findings (n = 134). The most commonly reported indications for testing were increased NT and cystic hygroma. Analysis showed heterozygous missense mutations in 12 fetuses, corresponding to a positive test rate of 9%. PTPN11 mutations were identified in 16% and 2% of fetuses with cystic hygroma and increased NT, respectively. Among fetuses with isolated cystic hygroma, PTPN11 mutation prevalence was 11%. The mutations observed in the three fetuses with hydrops fetalis had previously been reported as somatic cancer mutations. Prenatal PTPN11 testing has diagnostic and possible prognostic properties that can aid in risk assessment and genetic counseling. As NS is genetically heterogeneous, negative PTPN11 testing cannot exclude the diagnosis and further study is warranted regarding the other NS genes.

Cycle control, quality of life and acne with two low-dose oral contraceptives containing 20 microg ethinylestradiol

OBJECTIVES

Poor cycle control and tolerability can be reasons for irregular pill intake. This study compared the tolerability of two low-dose oral contraceptives and their effect on cycle control.

METHODS

In this open, group-comparative, randomized multicenter trial in Germany and the Netherlands, women received either 20 microg ethinylestradiol plus 150 microg desogestrel (20EE/DSG; n = 500) or 20 microg ethinylestradiol plus 100 microg levonorgestrel (20EE/LNG; n = 498) for six treatment cycles. Cycle control, dysmenorrhea and premenstrual syndrome (PMS) were assessed using diary cards. Tolerability was assessed using the self-administered questionnaires Psychological General Well-Being Index (PGWBI) and the Profile of Mood States (POMS). Acne was assessed by objective (acne counts) and subjective (no, moderate, mild, severe) acne scoring of the facial area at baseline and treatment cycles 1, 3 and 6.

RESULTS

A total of 404 (78.1%) and 384 (75.3%) women in the 20EE/DSG and 20EE/LNG groups, respectively, completed the trial. The occurrence rate of irregular bleeding and spotting was statistically significantly higher with 20EE/LNG than with 20EE/DSG (0.18 vs. 0.13; p < 0.05). The mean number of bleeding-spotting days per cycle was statistically significantly higher with 20EE/LNG than with 20EE/DSG (0.63 vs. 0.48; p < 0.05). Early withdrawal bleeding was more frequent with 20EE/LNG (0.15 vs. 0.08; p < 0.005), whereas continued withdrawal bleeding was more frequent with 20EE/DSG (0.32 vs. 0.45; p < 0.001); absence of withdrawal bleeding was comparable (0.06 vs. 0.04, respectively). Thirteen subjects in the 20EE/LNG group and three in the 20EE/DSG group discontinued due to unacceptable bleeding (p < 0.05). Dysmenorrhea and PMS decreased comparably in both groups. There were no differences between groups for the mean total scores of PGWBI or POMS at all time-points. Fewer acne lesions were counted with 20EE/DSG vs. 20EE/LNG after six cycles (p < 0.05). The subjective acne scores supported this finding.

CONCLUSIONS

20EE/DSG provided better cycle control than 20EE/LNG with less treatment discontinuation due to unacceptable bleeding. There were no apparent differences between the two groups regarding tolerability and quality of life. There was less acne with 20EE/DSG.

Oxidation and Ignition Behaviour of Saturated Hydrocarbon Samples With Crude Oils Using TG/DTG and DTA Thermal Analysis Techniques

Abstract

This research is aimed at providing a better understanding of the oxidation behaviour of fractions of crude oil, and to then develop an approach to improve ignition for air injection processes.

In this research, Thermogravimetric and Differential Thermal Analysis (TG/DTA) techniques were used to investigate oxidation behaviour using thermal fingerprinting effects on pure paraffin samples and mixtures of pure components with crude oil. The results demonstrated that each paraffin sample shows different oxidation behaviours at low temperatures and high temperatures. The fractions lighter than C16 distill before they reach a temperature where oxidation reactions are significant. Only low temperature exothermic activities are apparent for the fractions between C16 and C26. The heavier fractions show both low and high temperature exothermic activities. The lower molecular weight samples show lower onset temperatures for oxidation reactions. With increasing molecular weight, the exothermic peak temperatures both in the low and high temperature regions shift to higher temperatures and increased energy release.

When low activity Oil B and the more reactive Oil C were mixed with a small amount of paraffin sample heavier than C26, both crude oils showed intensified low temperature oxidation behaviour, with a greater magnitude of heat evolution. The addition of heavier paraffins offers the potential to accelerate reactions and improve ignition.

Introduction

High Pressure Air Injection (HPAI) has been proven as a potential and viable process for improving oil recovery from several light oil reservoirs. When air is injected into an oil reservoir, the oxygen contained in the air can potentially react with the oil in place by various oxidation reaction schemes. Success of such a process depends mainly on the crude oil properties and rock properties, as well as operating conditions. The oxidation behaviour and the conditions typically favouring auto-ignition of crude oils are of the utmost importance for light oil air injection. However, because of the low initial temperature of many of the formations, and the poor reactivity of some crude oils, the magnitude of timedelay is often so great that spontaneous ignition is not economically attractive. Chemical ignition is one of the options to improve ignition(1, 2). Unfortunately, little research has been documented.

The potential for using thermal analysis techniques to investigate oxidation behaviour of crude oils during combustion has been realized. Thermal analysis techniques include Thermogravimetric (TG) and Differential Thermal Analysis techniques (DTA) or Differential Scanning Calorimetry (DSC). In TG, a small amount of a sample of crude oil, with or without sand, is heated in the presence of flowing air and the change in weight of the sample is recorded as a function of temperature. In DTA or DSC, the difference in temperature or energy input/output during hemical or physical transitions based on the differences between the sample and a reference material is recorded as a function oftemperature or time.

Screening of Three Light-Oil Reservoirs for Application of Air Injection Process by Accelerating Rate Calorimetric and TG/PDSC Tests

Abstract

A series of Accelerating Rate Calorimeter (ARC) and Thermo Gravimetric Pressurized Differential Scanning Calorimeter (TG/PDSC) tests was conducted on oil-rock systems from three light-oil reservoirs (Oils A, B and C) to screen and evaluate the potential of the air injection process. ARC tests helped determine, a priori, whether the test oils would autoignite under reservoir conditions of pressure and temperature. Also, the limits of the low temperature range were established and Arrhenius oxidation kinetics parameters were estimated. The goals of the TG/PDSC tests were to identify temperature ranges over which the oil reacted with oxygen in the injected air, and to determine the fraction of the sample responsible for the reactivity.

ARC and TG/PDSC tests demonstrate that Oils A and C offer favourable exothermic behaviour in the low temperature range with lower activation energies and low orders of reactions?the conditions typically favouring autoignition. The presence of rock material lowered the ignition temperature, confirming its impact on O2 uptake. Oil A had a lower energy generation (ignition) temperature, and a stronger and smoother transition to the higher temperature region. Both oils responded favourably during isothermal aging with air as manifested by a drop in the initial self-heating temperature (a 15 °C drop for Oil A and a 10 °C drop for Oil C). The third oil, Oil B, showed unusual characteristics, with almost no impact of the core material on the starting temperature of the exotherm; rather, the core material appeared to have acted as a heat sink. Overall, Oil B needed a much higher activation energy to ignite, and its order of reactions was very high. Furthermore, it showed no response to isothermal aging, and hence, it is less likely to autoignite in the reservoir.

esults revealed that ARC and TG/PDSC tests could be an effective tool to rank and study the oxidation characteristics in the low temperature range of the candidate oils. Also, it was observed that the oil composition and rock mineralogy are important factors affecting the type and rate of the oxidation reactions occurring in the low temperature range.

Introduction

The air injection process is now a proven and viable process in improving oil recovery from several light-oil reservoirs. As a result, it has generated much interest in recent years(1–5). Cheap and abundant, air is also touted as a possible alternative to highcost hydrocarbon and CO2 gases in certain circumstances or locations where water is scarce(6–10).

Moore et al(11) suggest that in an air injection process in lightoil reservoirs, both oxygen addition and bond scission reactions take place. Oxygen addition reactions are believed to occur at temperatures between 100 °C and 150 °C. These reactions are characterized by heavier oxygenated hydrocarbon products. Bond scission reactions for light oils typically occur at temperatures in the 150 to 300 °C and the 350 to 700 °C range. These reactions produce carbon oxides, water (steam) and heat, which contribute significantly towards mobilizing oil.

Rolling circle amplification: a new approach to increase sensitivity for immunohistochemistry and flow cytometry

Immunohistochemistry is a method that can provide complementary diagnostic and prognostic information to morphological observations and soluble assays. Sensitivity, specificity, or requirements for arduous sample preparation or signal amplification procedures often limit the application of this approach to routine clinical specimens. Rolling circle amplification (RCA) generates a localized signal via an isothermal amplification of an oligonucleotide circle. The application of this approach to immunohistochemistry could extend the utility of these methods to include a more complete set of immunological and molecular probes. RCA-mediated signal amplification was successfully applied to the sensitive and specific detection of a variety of cell surface antigens (CD3, CD20, and epithelial membrane antigen) and intracellular molecules (vimentin and prostate-specific antigen) within a variety of routinely fixed specimens, as well as samples prepared for flow cytometry. RCA technology, which has an intrinsically wide dynamic range, is a robust and simple procedure that can provide a universal platform for the localization of a wide variety of molecules as a function of either antigenicity or nucleic acid sequence. The use of RCA in this way could enhance the use of markers of current interest as well as permit the integration of emerging information from genomics and proteomics into cell- and tissue-based analyses.

Multicenter study of the efficacy, cycle control and tolerability of a phasic desogestrel-containing oral contraceptive

OBJECTIVE

To investigate the efficacy, cycle control and tolerability of a phasic oral contraceptive containing ethinylestradiol 35/30/30 microg and desogestrel 50/100/150 microg.

METHODS

A multicenter study was conducted involving 2070 healthy, fertile women, who received study treatment for six treatment cycles.

RESULTS

Most of the participants (79%) had previously been using an alternative oral contraceptive. In 10,408 treatment cycles, two women became pregnant while on treatment (Pearl index, 0.25). The incidence of irregular bleeding was 10% before treatment, rising to 27% at cycle 1, and decreasing to 11% by cycle 6. Irregular bleeding was mainly due to spotting rather than breakthrough bleeding and the incidence of breakthrough bleeding remained below 2.2% for most of the study period. Only 1.8% of women withdrew due to bleeding irregularities. First-time oral contraceptive users initially experienced more irregular bleeding than switchers but these differences lessened over time. The most common adverse events during treatment were headache, breast tenderness and nausea. The incidence of these adverse events fell to below pretreatment levels with continued use.

CONCLUSION

The phasic preparation was effective and well tolerated.

Update and rationale for the inverted functional foot orthosis

The inverted orthotic technique, also known as the Blake functional foot orthosis, is a prescription variable that allows for greater control of abnormal foot function. This article describes the indications for this prescription and the specific stability changes this technique produces. The authors conclude that it is crucial for laboratories to be brought into the process of orthosis development so that new techniques can be incorporated easily into therapy.

Posterior tibial tendinitis. A literature review with case reports

Overuse posterior tibial tendinitis is caused by the increased stress placed on the tendon as it tries to compensate for the increased subtalar joint pronatory movement and velocity during physical activity. The stress can cause microtrauma and rupture of some of the fibers of the tendon. This leads to an inflammatory process and the classical clinical signs and symptoms. Therapy is directed at reducing the inflammation, minimizing the fibrosis buildup, re-strengthening the weakened tissue, and controlling the pronatory force. The two case reports illustrate typical clinical signs, symptoms, and treatment for this injury.

The effect of salbutamol controlled release on airways responsiveness to inhaled methacholine in mild asthmatic subjects

Single doses of inhaled bronchodilating agents have been shown to reduce airways responsiveness (AR) in both normal and asthmatic individuals. The longer term effects of these treatments on airways responsiveness are less clear. We have studied the effects of 4 weeks of treatment with oral salbutamol controlled release (SCR) (8 mg b.d.) on airways responsiveness in mild asthmatics in a double-blind, placebo-controlled study. Airways responsiveness to inhaled methacholine, baseline FEV1 and plasma salbutamol levels was assessed 6 h, 48 h and 4 weeks after commencing treatment and again 24 h and 72 h after cessation of medication. When compared to placebo, SCR significantly attenuated AR at the 48-h time point only. There were no increases in AR recorded at any of the post-treatment time points. In addition, there were no significant differences in baseline FEV1 at any of the time-points studied, when compared to placebo. The change in AR at 48 h after starting treatment was probably due to functional antagonism of smooth muscle contraction. Importantly, there were no increases in AR recorded at either of the post-treatment time points.

Synovial osteochondromatosis. A brief review

An unusual clinical finding is presented with a brief review of the literature. Synovial osteochondromatosis is typically a benign process involving metaplasia of the synovial intima and the formation of cartilaginous nodules that may eventually become ossified. Synovial osteochondromatosis should always be considered as a differential diagnosis whenever a patient presents with pain, swelling, and loss of function at or around a joint. Chondrosarcoma has been misdiagnosed, leading to radical and unnecessary amputation, because synovial osteochondromatosis has not been considered. Alternatively, synovial osteochondromatosis may degenerate to or be associated with a malignant process. When radiographs or more sophisticated investigative procedures, such as magnetic resonance imaging, fail to provide a conclusive answer, histologic findings provide the definitive diagnosis.

The effect of intranasal azelastine, Rhinolast, on nasal airways obstruction and sneezing following provocation testing with histamine and allergen

The effect of single dose topical nasal therapy with azelastine hydrochloride (azelastine) on the response of nasal airways resistance (NAR) to provocation testing was studied in 36 patients with seasonal allergic rhinitis. Nasal provocation testing (NPT) with histamine or grass pollen was performed after a single dose of azelastine, 0.28 mg to each nostril, or placebo. NAR was assessed by rhinomanometry for 10 hr following NPT. Compared to placebo the NAR response to histamine was inhibited at both 1 and 2 hr following azelastine administration, significant at 1 hr (P less than 0.02) and 2 hr (P less than 0.0001). No such effect was observed in relation to allergen-induced changes in NAR. Azelastine also inhibited numbers of sneezes for up to 10 hr following both histamine NPT (P less than 0.02) and allergen NPT (P less than 0.05), when compared to placebo. Forty-seven per cent of participants experienced bitter or unpleasant taste sensations after azelastine administration but no other unwanted effects were clearly related to azelastine therapy.

Extrinsic rearfoot posts

The addition of an extrinsic rearfoot post to an orthotic device allows the podiatric practitioner to modify the function of the device. Specifically, rearfoot posts are used to allow for a more inverted heel position at contact, to provide greater resistance to abnormal frontal plane motion of the calcaneus and to provide for motion for shock absorption. The authors present nine prescription variables that each provide for a specific functional change to be incorporated into the orthotic device.

The os trigonum syndrome. A literature review

The os trigonum syndrome, a musculoskeletal ankle disorder causing posterior ankle pain, is an entity that may present as numerous disorders. To accurately diagnose and treat the syndrome, its anatomy, origin, nomenclature, and biomechanics must be thoroughly understood. For this purpose, a review of recent literature is presented.

Limb length discrepancies

Examining for a possible limb length discrepancy is an important part of the podiatric biomechanical examination. The authors present a review of the literature pertaining to the definition of and examination for a limb length discrepancy. They present a typical rationale for lift therapy in the treatment of this pathology.

Foot orthosis for the severe flatfoot in sports

The control of excessively pronating feet in athletes can be a prolonged and frustrating experience for both the doctor and the patient. The inverted orthotic technique has previously been described for making a device that has two basic applications: to control excessive subtalar joint pronation, especially where a Root or modified Root device cannot, and to invert the entire lower limb for such problems as medial knee pain. The authors present two case histories that highlight the indications of this orthotic device for the athletic population.

TL-61 versus Rohadur orthoses in heel spur syndrome

The authors present the subjective responses of 40 patients with heel spur syndrome or plantar fascitis to orthotic treatment. Twenty patients had Rohadur orthoses and 20 patients had TL-61 orthoses. These data show no difference in the response to or problems created by either TL-61 or Rohadur orthoses. The authors recommend TL-61 as one alternative to Rohadur, now that that latter is unavailable.

Expression of immunoreactive glutathione S-transferases in hepatic neoplasms induced by aflatoxin B1 or 1,2-dimethylbenzanthracene in rainbow trout (Oncorhynchus mykiss)

The expression of immunoreactive glutathione S-transferase (GST) was examined in hepatic neoplasms induced in rainbow trout by aflatoxin B1 (AFB) or 1,2-dimethylbenzanthracene (DMBA). Tumors were induced in adult trout by continuous dietary exposure to 8 p.p.b. AFB1 for 12 months or embryo bath exposure to DMBA (5 p.p.m. for 24 h, 3 times with 12 h intervals between exposures). Polyclonal antiserum specific for the two major trout hepatic GST subunits in trout liver was produced by immunizing rabbits with affinity-purified trout GST. Hepatocellular, cholangiolar and mixed neoplasms as well as foci of hepatocellular alteration were examined for GST immunoreactivity by the PAP technique. The majority of lesions were GST-deficient (AFB treated, 67%; DMBA treated, 54%), whereas GST expression was induced in 21% (AFB treated) and 31% (DMBA treated) of altered hepatic foci. The GST-induced foci were consistently small (AFB treated, 0.07 +/- 0.05 mm2; DMBA treated, 0.02 +/- 0.01 mm2) and none had progressed beyond the altered focus stage. The majority of larger advanced lesions (adenomas and carcinomas) were GST deficient (AFB treated, 2.33 +/- 0.35 mm2; DMBA treated, 2.95 +/- 0.59 mm2). These studies demonstrate that induced GST expression occurs in some small populations of hepatocytes, but not in larger advanced stages of malignant progression of aflatoxin- or PAH-induced hepatic neoplasms in rainbow trout.

Bronchial provocation testing of sodium iso-nonanoyl oxybenzene sulphonate

1. Asthmatic symptoms have been reported in workers following occupational exposure to certain low molecular ratio chemicals. 2. A small number of workers involved in the initial manufacture of a new low temperature bleach activating chemical, sodium iso-nonanoyl oxybenzene sulphonate (SINOS) developed rashes, rhinitis and conjunctivitis following exposure to the compound. One worker also developed asthma. An investigative study was undertaken to examine the possible asthmatic effects of inhaling SINOS in naive non-asthmatic and asthmatic subjects handling the material in the laboratory setting. 3. Since SINOS has a similar chemical structure to aspirin, it was hypothesized that SINOS-associated asthma might be elicited by a mechanism similar to the mechanism associated with aspirin asthma. Therefore aspirin-sensitive asthmatics were also included in the study. 4. No adverse respiratory reactions were observed in the non-asthmatic subjects or in the aspirin and non-aspirin-sensitive patient volunteers following exposure to SINOS dust at atmospheric concentrations of up to 36.3 micrograms m-3. 5. Skin prick tests to increasing concentrations of SINOS were carried out in all subjects. No positive reactions were observed on any occasion. 6. This study indicates that SINOS does not elicit asthma via a mechanism similar to aspirin. Additionally, the study suggests that the addition of SINOS to washing powder will not cause significant respiratory reactions in consumers even if they are asthmatic or intolerant to aspirin.

Morphological integrity of the bronchial epithelium in mild asthma

In severe asthma bronchial epithelial cells are damaged and detached, and it has been proposed that such damage might lead to the bronchial hyperresponsiveness that characterises asthma. To investigate the relation between airway hyperresponsiveness and epithelial damage, biopsy specimens of the bronchial mucus membrane were obtained at fibreoptic bronchoscopy from 11 patients with mild atopic asthma and airway hyperresponsiveness (provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) less than 1.0 mg/ml), and from 17 healthy non-atopic subjects who did not have airway hyperresponsiveness (PC20 methacholine greater than 8.0 mg/ml). Observers who were blind to the presence or absence of asthma examined the biopsy specimens by light and electron microscopy. Epithelial cells, intercellular spaces, and goblet cells were counted. Intercellular junctional complexes were examined, and a semiquantitative assessment was made of ciliary loss, non-parallel central ciliary filaments, and vacuoles in ciliated cells. There were no differences between the asthmatic and healthy groups in any of these measurements. These findings indicate that airway hyperresponsiveness may be present when there is no apparent change in the structure of the bronchial epithelium.

Nuclear Level Densities in Intermediate and Heavy Nuclei

The level densities of intermediate and heavy nuclei have been fitted to the free gas model formula with some improvement over previous fits. The predictions of tho model regarding cross section behaviour have been tested and found to lead to anomalous behaviour of the partial widths for incident neutron energies above 1�5 MeV.