Current and future genomic applications for surgeons

Genomics is a crucial part of managing surgical disease. This review focuses on some of the genomic advances that are available now and looks to the future of their application in surgical practice. Whole-genome sequencing enables unbiased coverage across the entire human genome of approximately three billion base pairs. Newer technologies, such as those that permit long-read sequence analysis, provide additional information in longer phased fragment and base pair epigenomic (methylomic) data. Whole-genome sequencing is currently available in England for cancers in children, teenagers and young adults, central nervous system tumours, sarcoma and haematological malignancies. Circulating tumour DNA (ctDNA), immunotherapy and pharmacogenomics have emerged as groundbreaking approaches in the field of cancer treatment. These are now revolutionising the way oncologists and surgeons approach curative cancer surgery. Cancer vaccines offer an innovative approach to reducing recurrence after surgery by priming the immune system to trigger an immune response. The Cancer Vaccine Launch Pad project facilitates cancer vaccine studies in England. The BNT122-01 trial is recruiting patients with ctDNA-positive high-risk colorectal cancer after surgery to assess the impact of cancer vaccines. The evolving landscape of cancer treatment demands a dynamic and integrated approach from the surgical multidisciplinary team. Immunotherapy, ctDNA, pharmacogenomics, vaccines, mainstreaming and whole-genome sequencing are just some of the innovations that have the potential to redefine the standards of care. The continued exploration of these innovative diagnostics and therapies, the genomic pathway evolution and their application in diverse cancer types highlights the transformative impact of precision medicine in surgery.

Predation by introduced cats Felis catus on Australian frogs: compilation of species records and estimation of numbers killed

Abstract ContextWe recently estimated the numbers of reptiles, birds and mammals killed by cats (Felis catus) in Australia, with these assessments providing further evidence that cats have significant impacts on Australian wildlife. No previous studies have estimated the numbers of frogs killed by cats in Australia and there is limited comparable information from elsewhere in the world. AimsWe sought to (1) estimate the numbers of frogs killed by cats in Australia and (2) compile a list of Australian frog species known to be killed by cats. MethodsFor feral cats, we estimated the number of frogs killed from information on their frequency of occurrence in 53 cat dietary studies (that examined stomach contents), the mean number of frogs in dietary samples that contained frogs, and the numbers of cats in Australia. We collated comparable information for take of frogs by pet cats, but the information base was far sparser. Key resultsFrogs were far more likely to be reported in studies that sampled cat stomachs than cat scats. The mean frequency of occurrence of frogs in cat stomachs was 1.5%. The estimated annual per capita consumption by feral cats in Australia’s natural environments is 44 frogs, and, hence, the annual total take is estimated at 92 million frogs. The estimated annual per capita consumption by pet cats is 0.26 frogs, for a total annual kill of one million frogs by pet cats. Thirty native frog species (13% of the Australian frog fauna) are known to be killed by cats: this tally does not include any of the 51 threatened frog species, but this may simply be because no cat dietary studies have occurred within the small ranges typical of threatened frog species. ConclusionsThe present study indicated that cats in Australia kill nearly 100 million frogs annually, but further research is required to understand the conservation significance of such predation rates. ImplicationsThe present study completed a set of reviews of the impacts of cats on Australian terrestrial vertebrates. Cat predation on Australian frogs is substantial, but is likely to be markedly less than that on Australian reptiles, birds and mammals.

The maternal health behaviours of non-Irish nationals during pregnancy and the effect of time living in Ireland

OBJECTIVES

Maternal health behaviours (MHBs) can influence pregnancy outcomes. Despite efforts internationally to encourage positive MHBs, women often fail to comply with pregnancy guidelines. International studies show differences in MHBs between nationalities and an effect of time spent in the host country. There is limited Irish data in this area, with no previous research relating to the effect of time in Ireland.

STUDY DESIGN

This study is a cross-sectional analysis of the Growing Up in Ireland infant cohort, a nationally representative longitudinal study.

METHODS

Examination of the MHBs of non-Irish nationals during pregnancy and the effect of time in Ireland on the said behaviours.

RESULTS

An association was found between time spent in Ireland and increased alcohol consumption prevalence. Those living in Ireland for ≤5 years were 60.8% less likely to consume alcohol during pregnancy (0.000) and 29.3% less likely to take folic acid before conception (0.021). Those who smoked during pregnancy were 98.6% more likely to consume alcohol (0.000) and those who consumed alcohol were 95.2% more likely to smoke during pregnancy (0.000).

CONCLUSIONS

The results demonstrate differences in MHBs and the influence of time living in Ireland. These findings are of relevance for policy and intervention planning to optimise pregnancy outcomes among non-nationals.

How many reptiles are killed by cats in Australia?

Context Feral cats (Felis catus) are a threat to biodiversity globally, but their impacts upon continental reptile faunas have been poorly resolved. Aims To estimate the number of reptiles killed annually in Australia by cats and to list Australian reptile species known to be killed by cats. Methods We used (1) data from >80 Australian studies of cat diet (collectively >10 000 samples), and (2) estimates of the feral cat population size, to model and map the number of reptiles killed by feral cats. Key results Feral cats in Australia’s natural environments kill 466 million reptiles yr–1 (95% CI; 271–1006 million). The tally varies substantially among years, depending on changes in the cat population driven by rainfall in inland Australia. The number of reptiles killed by cats is highest in arid regions. On average, feral cats kill 61 reptiles km–2 year–1, and an individual feral cat kills 225 reptiles year–1. The take of reptiles per cat is higher than reported for other continents. Reptiles occur at a higher incidence in cat diet than in the diet of Australia’s other main introduced predator, the European red fox (Vulpes vulpes). Based on a smaller sample size, we estimate 130 million reptiles year–1 are killed by feral cats in highly modified landscapes, and 53 million reptiles year–1 by pet cats, summing to 649 million reptiles year–1 killed by all cats. Predation by cats is reported for 258 Australian reptile species (about one-quarter of described species), including 11 threatened species. Conclusions Cat predation exerts a considerable ongoing toll on Australian reptiles. However, it remains challenging to interpret the impact of this predation in terms of population viability or conservation concern for Australian reptiles, because population size is unknown for most Australian reptile species, mortality rates due to cats will vary across reptile species and because there is likely to be marked variation among reptile species in their capability to sustain any particular predation rate. Implications This study provides a well grounded estimate of the numbers of reptiles killed by cats, but intensive studies of individual reptile species are required to contextualise the conservation consequences of such predation.

Integrated optical frequency shifter in silicon-organic hybrid (SOH) technology

We demonstrate for the first time a waveguide-based frequency shifter on the silicon photonic platform using single-sideband modulation. The device is based on silicon-organic hybrid (SOH) electro-optic modulators, which combine conventional silicon-on-insulator waveguides with highly efficient electro-optic cladding materials. Using small-signal modulation, we demonstrate frequency shifts of up to 10 GHz. We further show large-signal modulation with optimized waveforms, enabling a conversion efficiency of -5.8 dB while suppressing spurious side-modes by more than 23 dB. In contrast to conventional acousto-optic frequency shifters, our devices lend themselves to large-scale integration on silicon substrates, while enabling frequency shifts that are several orders of magnitude larger than those demonstrated with all-silicon serrodyne devices.

Generation of 64 GBd 4ASK signals using a silicon-organic hybrid modulator at 80°C

We demonstrate a silicon-organic hybrid (SOH) Mach-Zehnder modulator (MZM) generating four-level amplitude shift keying (4ASK) signals at symbol rates of up to 64 GBd both at room temperature and at an elevated temperature of 80°C. The measured line rate of 128 Gbit/s corresponds to the highest value demonstrated for silicon-based MZM so far. We report bit error ratios of 10^-10 (64 GBd BPSK), 10^-5 (36 GBd 4ASK), and 4 × 10^-3 (64 GBd 4ASK) at room temperature. At 80 °C, the respective bit error ratios are 10^-10, 10^-4, and 1.3 × 10^-2. The high-temperature experiments were performed in regular oxygen-rich ambient atmosphere.

Plasmonic-organic hybrid (POH) modulators for OOK and BPSK signaling at 40 Gbit/s

We report on high-speed plasmonic-organic hybrid Mach-Zehnder modulators comprising ultra-compact phase shifters with lengths as small as 19 µm. Choosing an optimum phase shifter length of 29 µm, we demonstrate 40 Gbit/s on-off keying (OOK) modulation with direct detection and a BER < 6 × 10(-4). Furthermore, we report on a 29 µm long binary-phase shift keying (BPSK) modulator and show that it operates error-free (BER < 1 × 10(-10)) at data rates up to 40 Gbit/s and with an energy consumption of 70 fJ/bit.

Low-power silicon-organic hybrid (SOH) modulators for advanced modulation formats

We demonstrate silicon-organic hybrid (SOH) electro-optic modulators that enable quadrature phase-shift keying (QPSK) and 16-state quadrature amplitude modulation (16QAM) with high signal quality and record-low energy consumption. SOH integration combines highly efficient electro-optic organic materials with conventional silicon-on-insulator (SOI) slot waveguides, and allows to overcome the intrinsic limitations of silicon as an optical integration platform. We demonstrate QPSK and 16QAM signaling at symbol rates of 28 GBd with peak-to-peak drive voltages of 0.6 V(pp). For the 16QAM experiment at 112 Gbit/s, we measure a bit-error ratio of 5.1 × 10⁻⁵ and a record-low energy consumption of only 19 fJ/bit.

Zoonotic protozoa in the marine environment: a threat to aquatic mammals and public health

This collection of abstracts provides an account of four presentations at the 19th International Conference of the World Association for the Advancement of Veterinary Parasitology (WAAVP)(held in New Orleans, LA, USA from 10–14 August 2003) in a symposium session on zoonotic protozoan parasites found in the marine environment and chaired by Ronald Fayer and David Lindsay.The focus was on three genera of parasites of veterinary and public health concern—Toxoplasma,Giardia, and Cryptosporidium with emphasis on their epidemiology in the marine environment.

Silicon-organic hybrid (SOH) frequency comb sources for terabit/s data transmission

We demonstrate frequency comb sources based on silicon-organic hybrid (SOH) electro-optic modulators. Frequency combs with line spacings of 25 GHz and 40 GHz are generated, featuring flat-top spectra with less than 2 dB power variations over up to 7 lines. The combs are used for WDM data transmission at terabit/s data rates and distances of up to 300 km.

The impact of new national HIV testing guidelines at a district general hospital in an area of high HIV seroprevalence

The latest UK national human immunodeficiency virus (HIV) testing guidelines, released in September 2008, state that HIV testing should be offered to all patients with indicator conditions and considered in all general medical admissions in high-prevalence areas. We audited testing rates at Blackpool Victoria Hospital, a high-prevalence area, one year before and one year after the publication of the new guidelines. In the year after publication the rate of HIV testing in patients with indicator diseases was as follows: hepatitis B 6%, hepatitis C 28%, tuberculosis 9% and lymphoma 14%. The overall rate of HIV testing in acute medical admissions was 0.5%. Our results demonstrate that traditional methods of guideline dissemination did not lead to implementation. We are now assessing alternative methods such as marking all positive laboratory results for indicator diseases with the phrase 'HIV testing should be considered' and implementing universal opt-out screening in our Clinical Decisions Unit.

Reduced propagation loss in silicon strip and slot waveguides coated by atomic layer deposition

When silicon strip and slot waveguides are coated with a 50 nm amorphous titanium dioxide (TiO2) film, measured losses at a wavelength of 1.55 μm can be as low as (2 ± 1)dB/cm and (7 ± 2)dB/cm, respectively. We use atomic layer deposition (ALD), estimate the effect of ALD growth on the surface roughness, and discuss the effect on the scattering losses. Because the gap between the rails of a slot waveguide narrows by the TiO2 deposition, the effective slot width can be back-end controlled. This is useful for precise adjustment if the slot is to be filled with, e. g., a nonlinear organic material or with a sensitizer for sensors applications.

42.7 Gbit/s electro-optic modulator in silicon technology

CMOS-compatible optical modulators are key components for future silicon-based photonic transceivers. However, achieving low modulation voltage and high speed operation still remains a challenge. As a possible solution, the silicon-organic hybrid (SOH) platform has been proposed. In the SOH approach the optical signal is guided by a silicon waveguide while the electro-optic effect is provided by an organic cladding with a high χ(2)-nonlinearity. In these modulators the optical nonlinear region needs to be connected to the modulating electrical source. This requires electrodes, which are both optically transparent and electrically highly conductive. To this end we introduce a highly conductive electron accumulation layer which is induced by an external DC "gate" voltage. As opposed to doping, the electron mobility is not impaired by impurity scattering. This way we demonstrate for the first time data encoding with an SOH electro-optic modulator. Using a first-generation device at a data-rate of 42.7 Gbit/s, widely open eye diagrams were recorded. The measured frequency response suggests that significantly larger data rates are feasible.

The persistence of fibres on skin in an outdoor deposition crime scene scenario

Textile fibres were transferred to a pig skin carcass and their persistence determined at daily intervals for up to a 12 day period during which time the carcass was left outdoors exposed to the prevailing weather conditions and animal activity. In the absence of strong winds and precipitation, the loss of fibres was found to be exponential. Stronger winds and heavier precipitation caused an increase in the rate of loss of fibres. The results of this study showed that the majority of fibres transferred to a body deposited outdoors, can be expected to be lost after the first 2 days, however, none of the experiments performed resulted in a complete loss of fibres, even after 12 days exposure. These persistence characteristics differed from those observed in a similar study using small sections of skin, rather than carcasses. The implications of the results of the present study in relation to the examination of fibre evidence in cases of homicide are discussed.

A microdeletion at 12q24.31 can mimic beckwith-wiedemann syndrome neonatally

We report on a patient who was initially suspected to have Beckwith-Wiedemann syndrome because of recurrent neonatal hypoglycaemias, macroglossia and overgrowth, but in whom no 11p15 abnormality could be found. Follow-up showed continued overgrowth and disturbed glucose homeostasis, a marked developmental delay, and severe behavioural problems especially caused by anxieties. Array comparative genomic hybridization analysis showed a de novo 12q24.31 interstitial deletion, which was confirmed by fluorescence in situ hybridization. The deleted region contains amongst others: HNF1 homeobox A (HNF1A) which is important for the regulation of gene expression in the liver and involved in maturity-onset diabetes of the young type 3 and insulin resistance; acyl-CoA dehydrogenase short chain (ACADS) which encodes an enzyme important in mitochondrial fatty acid beta-oxidation and can cause short-chain acyl-CoA dehydrogenese (SCAD) deficiency, and purinergic receptor P2X7 (P2RX7) which encodes a ligand-gated ion channel, and of which polymorphisms are found with increased frequency in patients with psychiatric disorders, especially anxieties. We conclude the present patient has a hitherto undescribed contiguous gene syndrome, which can initially resemble Beckwith-Wiedemann syndrome.

Clinical trial: efficacy and safety of dexlansoprazole MR 60 and 90 mg in healed erosive oesophagitis - maintenance of healing and symptom relief

BACKGROUND

Dexlansoprazole MR, a modified-release formulation of dexlansoprazole, an enantiomer of lansoprazole, effectively heals erosive oesophagitis.

AIM

To assess dexlansoprazole MR in maintaining healed erosive oesophagitis.

METHODS

Patients (n = 451) with erosive oesophagitis healed in either of two dexlansoprazole MR healing trials randomly received dexlansoprazole MR 60 or 90 mg or placebo once daily in this double-blind trial. The percentage of patients who maintained healing at month 6 was analysed using life table and crude rate methods. Secondary endpoints were percentages of nights and of 24-h days without heartburn based on daily diaries.

RESULTS

Dexlansoprazole MR 60 and 90 mg were superior to placebo for maintaining healing (P < 0.0025). Maintenance rates were 87% and 82% for the 60 and 90 mg doses, respectively, vs. 26% for placebo (life table), and 66% and 65% vs. 14%, respectively (crude rate). Both doses were superior to placebo for the percentage of 24-h heartburn-free days (60 mg, 96%; 90 mg, 94%; placebo, 19%) and nights (98%, 97%, and 50%, respectively). Diarrhoea, flatulence, gastritis (symptoms) and abdominal pain occurred more frequently with dexlansoprazole MR than placebo, but were not dose-related.

CONCLUSION

Dexlansoprazole MR effectively maintained healed erosive oesophagitis and symptom relief compared with placebo, and was well tolerated.

Organizing and managing personal electronic files

This article deals with the organization and management of the computer files handled by mechanical engineers on their personal computers. In engineering organizations, a wide variety of electronic files (documents) are necessary to support both business processes and the activities of design and manufacture. Whilst a large number of files and hence information is formally archived, a significant amount of additional information and knowledge resides in electronic files on personal computers. The widespread use of these personal information stores means that all information is retained. However, its reuse is problematic for all but the individual as a result of the naming and organization of the files. To begin to address this issue, a study of the use and current practices for managing personal electronic files is described. The study considers the fundamental classes of files handled by engineers and analyses the organization of these files across the personal computers of 40 participants. The study involves a questionnaire and an electronic audit. The results of these qualitative and quantitative elements are used to elicit an understanding of the practices and requirements of engineers for managing personal electronic files. A potential scheme for naming and organizing personal electronic files is discussed as one possible way to satisfy these requirements. The aim of the scheme is to balance the personal nature of data storage with the need for personal records to be shared with others to support knowledge reuse in engineering organizations. Although this article is concerned with mechanical engineers, the issues dealt with are relevant to knowledge-based industries and, in particular, teams of knowledge workers.

A double-blind, placebo-controlled trial of montelukast in adult atopic eczema

BACKGROUND

Montelukast is an antagonist of cys-leukotriene receptors used mainly in the treatment of asthma- and seasonal-allergic rhinitis. Initial reports concerning the use of montelukast in atopic dermatitis (AD) have been encouraging, although not consistent.

OBJECTIVES

We have undertaken a randomized, double-blind, parallel-group, placebo-controlled trial to investigate further the efficacy of montelukast in the treatment of atopic eczema.

METHODS

Following a screening visit, subjects received placebo treatment for 2 weeks in a single-blind phase, followed after visit 2 by an 8-week, double-blind period of treatment with montelukast 10 mg daily or placebo. Subjects were patients aged 16-60 years under our care for treatment of AD of moderate severity, defined by a six-area, six-sign atopic dermatitis (SASSAD) score in the range 12-50. Response to treatment was assessed by investigators and by subjects using a seven-point scale, with response defined as marked improvement or better. In addition, the SASSAD score was used to monitor the severity of clinical signs. The proportion of skin involved was estimated and visual analogue scales were used to record the severity of pruritus and sleep disturbance. Topical corticosteroid usage was recorded using a five-point scale. Adverse events were recorded.

RESULTS

Sixty subjects were recruited and 54 completed the study. The treatment groups were well matched for disease severity at baseline (SASSAD scores were 25 and 29 in the montelukast and placebo groups, respectively). There were no significant differences between the treatment groups in any of the parameters used to assess treatment response. The improvement in mean SASSAD score from baseline (visit 2) to the end of treatment was marginally superior in the placebo group, 1.41 points on montelukast vs. 1.76 on placebo, a difference of 0.35 (95% confidence interval -6.1 to 6.8). Adverse events were generally of a mild nature except for a brief septicaemic illness in one subject receiving montelukast.

CONCLUSIONS

The data do not support previous reports of efficacy of montelukast in treatment of AD.

Profile of neurocognitive impairments associated with female in-patients with anorexia nervosa

BACKGROUND

Although many studies have reported impairments of neurocognitive performance in patients with anorexia nervosa (AN), these have involved a wide range of assessment methods and some findings are inconsistent.

METHOD

Twenty-five female in-patients with a DSM-IV diagnosis of AN, identified from three units specializing in the treatment of eating disorders, volunteered for the study. Twenty-five non-clinical control subjects were recruited, matched for age, gender and estimated IQ. Subjects were assessed with a range of computer-administered neurocognitive tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB), which has been validated in many studies of neuropsychiatric disorders.

RESULTS

The patient group showed significant but moderate impairments (i.e. less than one standard deviation below the mean performance of the control group) on tests of spatial recognition memory, a planning task and rapid visual information processing, while a subgroup of patients (n = 14) showed greater degrees of impairments on at least one of these tests. The degrees of impairments did not correlate with body mass index (BMI). No impairments were observed on tests of spatial span, pattern recognition memory, spatial working memory, matching-to-sample, paired associates learning and set-shifting.

CONCLUSIONS

The findings, in relation to a mean BMI of 15.3, are compatible with, in general, subtle impairments in neurocognition in AN. However, in those patients with relatively severe degrees of impairments, these may have adverse effects on complex tasks of social and occupational functioning. Further research is needed on the nature of relevant causal mechanisms, including the effects of potentially confounding variables.

The immune responses to human and microbial heat shock proteins in periodontal disease with and without coronary heart disease

The human 60 kDa and microbial 65 kDa heat shock proteins (HSP) have been implicated in the pathogenesis of chronic periodontitis (P) and coronary heart disease (CHD). We have studied four male non-smoking cohorts of 81 subjects, matched for age. Group (a) consisted of a healthy group with minimal gingivitis (n = 18), group (b) were patients with P (n = 23), group (c) patients with CHD and minimal gingivitis (n = 20) and group (d) patients with CHD and P (n = 20). T cells separated from peripheral blood were found to be primed to both microbial HSP65 and human HSP60 but significant CD4, human leucocyte antigen (HLA) class II-restricted proliferative responses were found only with the human HSP60 in patients with P (P < 0.001) and CHD without (P < 0.001) or with (P < 0.00001) periodontitis. Dose-dependent inhibition of T cell proliferative responses was carried out to determine the receptors involved in recognition of HSP60 and HSP65. Monoclonal antibodies to CD14 showed inhibition of T cell proliferation stimulated by both HSP60 and HSP65, consistent with the role of CD14 as a receptor for these HSPs in P and CHD. The toll-like receptor 2 (TLR-) and TLR-4 were then studied and these showed that TLR-4 was recognized by microbial HSP65, whereas TLR-2 was recognised by human HSP60 in both P and CHD. However, a dissociation was found in the HSP60 and TLR4 interaction, as TLR4 appeared to have been recognized by HSP60 in P but not in CHD. The results suggest an autoimmune or cross-reactive CD4(+) class II-restricted T cell response to the human HSP60 in P and CHD. Further studies are required to determine if there is a common epitope within HSP60 that stimulates T cell proliferation in P and CHD.

The secondary transfer of fibres from head hair

In this study, the effects of fibre type, hair style, time and fibre persistence on the secondary transfer of mask fibres to pillowcases via head hair were studied. Volunteers with a range of hair styles, and masks consisting of different fibre compositions were used in the study. Fibres from the masks were found to transfer from donor subjects to the pillowcases up to 14 nights after the mask had been worn. On average, the number of secondarily transferred fibres found decreased with time; however, this decrease appeared to be more 'linear' in nature, rather than an exponential decay. The greatest degree of secondary transfer occurred with cotton, then acrylic, then wool. In a primary transfer/persistence experiment with a 50% acrylic/50% wool mask, wool was found to persist in the hair more readily than acrylic. The results also showed that the greatest degree of secondary transfer occurred via short straight and long straight hair, with no clear pattern emerging between medium length hair (both straight and curly) and with long curly hair. The implications of these findings for the assessment and interpretation of casework are considered along with data obtained from related studies.

Variations in health status within and between socioeconomic strata

OBJECTIVES

To analyse the variability in health status within as well as between socioeconomic groups. What is the range of individual variability in the health effects of socioeconomic status? Is the adverse effect of lower socioeconomic status uniform across the entire distribution of health status?

DESIGN

Nationally representative telephone survey of the US population in 1996.

SETTING

60 US metropolitan and rural areas.

PARTICIPANTS

47 076 adult respondents to the community tracking study.

MAIN OUTCOME MEASURES

Self rated physical and mental health status, measured by the Short Form-12 instrument.

RESULTS

There is considerable variability in self rated health within socioeconomic strata and that variability increases in a step-wise fashion at each lower stratum of income. Most of the increased variability is accounted for by changes in the middle and lower (10th, 25th, and 50th centiles) rather than the upper (75th and 90th) portions of the distribution. A resilient subgroup of lower socioeconomic status people seems to maintain excellent self rated health throughout life, while a more vulnerable lower socioeconomic status group experiences rapid deterioration in health status as people reach middle age.

CONCLUSIONS

Within the population level social structuring of health there are differences in individual resilience and vulnerability that are amenable to further exploration and potential modification.

A randomised placebo controlled 12 week trial of budesonide and prednisolone in rheumatoid arthritis

OBJECTIVES

To compare budesonide, a locally acting glucocorticoid with minimal systemic exposure, with conventional glucocorticoid treatment and placebo in rheumatoid arthritis.

METHODS

A double blind, randomised, controlled trial over 12 weeks in 143 patients with active rheumatoid arthritis, comparing budesonide 3 mg daily, budesonide 9 mg daily, prednisolone 7.5 mg daily, and placebo. Particular attention was paid to the pattern of clinical response and to changes in the four week period following discontinuation of treatment.

RESULTS

There were improvements in tender joint count and swollen joint count on budesonide 9 mg compared with placebo (28% for tender and 34% for swollen joint counts, p<0.05). Prednisolone 7.5 mg gave similar results, while budesonide 3 mg was less effective. ACR20 response criteria were met by 25% of patients on placebo, 22% on budesonide 3 mg, 42% on budesonide 9 mg, and 56% on prednisolone 7.5 mg. A rapid and significant reduction in symptoms and signs in response to budesonide 9 mg and prednisolone 7.5 mg was evident by two weeks and maximal at eight weeks. There was no evidence that budesonide provided a different pattern of symptom control from prednisolone, or that symptoms became worse than placebo treatment levels after discontinuation of glucocorticoid treatment. Adverse effects attributable to glucocorticoids were equally common in all groups.

CONCLUSIONS

The symptomatic benefits of budesonide 9 mg and prednisolone 7.5 mg are achieved within a short time of initiating treatment, are maintained for three months, and are not associated with any rebound in symptoms after stopping treatment.

The population of coloured fibres in human head hair

In 2002 a population study of textile fibres in human hair was carried out using 26 volunteers in Cambridgeshire, UK. Over 12,000 fibres were recovered from a variety of hair lengths using low adhesive tape and classified according to colour, generic type and fibre length. The results of the study showed that the most common fibre colours were black/grey (48%), blue (29.1%) and red (12.7%), the least common being green, orange/brown and yellow which each accounted for less than 5% of the total. Natural fibres (mainly cotton) were predominant (72.3%) and man-made fibres were considerably less frequent. When colour and generic type were classified together, the most common combinations were black and blue cottons. The least common were the man-made fibre/colour combinations with the most frequent of these accounting for less than 7% of the sample. Fibre loads carried by long hair were found to be significantly less than that carried by short hair. The results of this study are in accordance with previous fibre population studies using other types of recipient surfaces and are likely to be influenced by factors such as seasonal and geographical variation.