The effect of hand-arm vibration syndrome on quality of life

BACKGROUND

It is important to determine how hand-arm vibration syndrome (HAVS), a common occupational condition, affects quality of life (QOL).

AIMS

To measure the physical (SF12-P) and mental (SF12-M) components of QOL in workers with HAVS, using the SF12 questionnaire, and to determine the effect of the vascular, sensorineural and musculoskeletal components of HAVS on QOL.

METHODS

Subjects were recruited consecutively from workers with HAVS attending an occupational medicine clinic. They were assessed to determine the Stockholm vascular and sensorineural scale stages as well as an upper extremity pain score, measured by the Borg scale, as an indication of musculoskeletal problems associated with the use of vibrating tools. The SF12-P and SF12-M were both compared with Canadian population normal values after adjusting for age and sex. Multiple linear regression was used to determine the effect of the various HAVS components on SF12-P and SF12-M as well as the effects of age and carpal tunnel syndrome.

RESULTS

One hundred and forty-one subjects were recruited and 139 (99%) agreed to participate, including 134 men and 5 women. The SF12-P and SF12-M scores were significantly below the Canadian population mean values (P < 0.001), indicating lower QOL. In the multiple regression analysis, the predictor with the largest partial R (2) value for both the SF12-P and SF12-M was the upper extremity pain score.

CONCLUSIONS

Both the physical and the mental QOL in workers with HAVS were below Canadian population normal values and subjects' upper extremity pain score had the greatest effect on their QOL.

Factors influencing the pharmacological management of osteoporosis after fragility fracture: results from the Ontario Osteoporosis Strategy's fracture clinic screening program

Potential mediating factors in the pathway to initiation of osteoporosis treatment following a fragility fracture were evaluated. Patients' perceived need for treatment, mediated by their perception of bone density test results, was central to treatment initiation. Interventions focusing on patients' perceptions of need and test results may improve treatment rates.

INTRODUCTION

We tested a hypothesized pathway to osteoporosis (OP) pharmacotherapy initiation in fragility fracture patients. We hypothesized that bone mineral density (BMD) testing is strongly associated with treatment initiation and perception of BMD test results would inform patients' perceived need for treatment, which would mediate the effect between BMD testing and treatment initiation.

METHODS

A longitudinal cohort study followed patients, ≥50 years of age, screened for fragility fracture in 31 fracture clinics in Ontario, Canada who had no prior diagnosis of or treatment for OP. At screening, OP risk factors, baseline-patient perception of OP risk, OP knowledge, and perceived benefits of medication were reported by patients. Patients were followed up within 6 months of fracture to determine BMD testing and prescription of and adherence to first-line OP pharmacotherapy. Structural equation modeling tested the hypothesized pathway. Significance and magnitude of the coefficients and indicators of overall model fit were used to test our model.

RESULTS

The direct path from BMD testing to OP treatment initiation was non-significant. The pathway to treatment initiation was mediated by patients' perception of their need, which was influenced by their self-reported BMD results. Baseline fracture risk factors, knowledge of OP, and perceived benefits of treatment-predicted patient-perceived need for treatment at follow-up and initiation of OP treatment.

CONCLUSIONS

Patient perceptions were central factors in the path to initiation of OP pharmacotherapy. Interventions to facilitate accurate patient perceptions of BMD test results and OP risk status could prove helpful in improving OP treatment initiation.

A one-step multiplex RT-PCR assay for simultaneous detection of four viruses that infect peach

A multiplex reverse transcription polymerase chain reaction (mRT-PCR) assay was developed to enable the simultaneous detection and differentiation of four viruses that infect peach, namely Apple chlorotic leaf spot virus (ACLSV), Cherry green ring mottle virus (CGRMV), Prunus necrotic ringspot virus (PNRSV) and Apricot pseudo-chlorotic leaf spot virus (APCLSV). In this study, four pairs of primers, one specific for each virus, were designed; the corresponding PCR products were 632, 439, 346 and 282 bp in length for ACLSV, CGRMV, PNRSV and APCLSV, respectively, and the fragments could be distinguished clearly by agarose gel electrophoresis. The sensitivity and specificity of the method were tested using individual RT-PCR and enzyme-linked immunosorbent assay (ELISA), and the identity of the RT-PCR amplification products was also confirmed by DNA sequencing. The results of RT-PCR and ELISA, along with batch detection using samples collected from peach orchards, revealed that this rapid and simple technique is an effective way to identify the four viruses simultaneously.

SIGNIFICANCE AND IMPACT OF THE STUDY

The mRT-PCR assay described in this study was developed for the simultaneous detection of four peach viruses from infected peach samples is reliable and sensitive. In contrast to conventional uniplex RT-PCR, mRT-PCR is more efficient, reducing costs, time and handling when testing large numbers of samples. This rapid and simple method is useful for large-scale surveys of viruses that infect peach.

Extreme ultraviolet interferometer using high-order harmonic generation from successive sources

We present a new interferometer technique whereby multiple extreme ultraviolet light pulses are generated at different positions within a single laser focus (i.e., from successive sources) with a highly controllable time delay. The interferometer technique is tested with two generating media to create two extreme ultraviolet light pulses with a time delay between them. The delay is found to be a consequence of the Gouy phase shift. Ultimately the apparatus is capable of accessing unprecedented time scales by allowing stable and repeatable delays as small as 100 zs.

A new strategy employed for identification of sweet orange cultivars with RAPD markers

We optimized RAPD techniques by increasing the length of RAPD primers and performing a strict screening of PCR annealing temperature to distinguish 60 sweet orange cultivars from the Research Institute of Pomology at the Chinese Academy of Agricultural Sciences. A new approach called cultivar identification diagram (CID) was used to improve the efficiency of RAPD markers for cultivar identification. Thirteen effective primers were first screened from 54 RAPD arbitrary 11-mer primers based on their amplification products and amplified polymorphic bands; they were then used for PCR amplification of all 60 cultivars. All cultivars were manually and completely separated by the polymorphic bands appearing in DNA fingerprints from 13 primers; a CID of the 60 sweet orange cultivars was then constructed. This CID separated all the cultivars from each other, based on the polymorphic bands; the corresponding primers were marked in the correct positions on the sweet orange CID. The CID strategy facilitates the identification of fruit cultivars with DNA markers. This CID of sweet orange cultivars will be very useful for the protection of cultivar rights and for early identification of seedlings in the nursery industry.

DASH work module in workers with hand-arm vibration syndrome

BACKGROUND

The Disabilities of the Arm, Shoulder and Hand work module (DASH-W) questionnaire has not previously been described in relation to hand-arm vibration syndrome (HAVS).

AIMS

To measure work-related disability in workers with HAVS using the DASH-W questionnaire and to determine how the various components of HAVS affect the DASH-W score.

METHODS

Workers with HAVS from a variety of industries were assessed over a 2-year period at the occupational health clinic, St Michael's Hospital, Toronto. Subjects completed the DASH-W questionnaire and were assessed by an occupational physician to determine their Stockholm sensorineural and vascular stages and upper extremity pain score measured by the Borg scale, as an indication of musculoskeletal problems associated with HAVS. The average DASH-W score was compared with the average value for the US population. Multiple linear regression was used to determine the contribution of the various components of HAVS to the DASH-W score.

RESULTS

There were 139 (134 men and 5 women) participants. The subjects with HAVS had a mean DASH-W score of 54.7 (95% CI: 50.3-59.1), which was considerably higher than the average for the US population (P < 0.001). Statistically significant HAVS variables in the multiple linear regression included the Stockholm sensorineural stage (P < 0.05) and the upper extremity pain score (P < 0.001) with the pain score having the highest partial R (2) value.

CONCLUSIONS

Workers with HAVS reported significant upper extremity work-related disability as measured by the DASH-W questionnaire, and the upper extremity pain score made the largest contribution to the DASH-W scores in these subjects.

A patient survey of sleep quality in the Intensive Care Unit

BACKGROUND

Patients in the Intensive Care Unit (ICU) experience qualitative and quantitative sleep disruption leading to sleep deprivation and adverse sequelae. Patient-related factors, environmental factors, and health-support techniques contribute to sleep disruption. This quality improvement study examines potential factors contributing to poor sleep in the ICU.

METHODS

Medical and surgical patients who spent at least one night in one of two academic Canadian ICUs were asked to complete a questionnaire that explored quality and quantity of sleep, factors contributing to poor sleep, and suggested modifications to improve sleep in the ICU. Patient demographics as well as admission data were recorded.

RESULTS

Study population was 116 patients (63 M:53 F). Mean age was 55.5 ± 18.1 years and APACHE II score 16.0 ± 7.9. 45.7% were mechanically ventilated, and 68.9% received intravenous sedatives and/or analgesics. Sleep quality in the ICU was rated as poor/very poor by 59% of patients compared to 24% at home; the 5 most frequently cited reasons for this were noise, pain, light, loud talking, and intravenous catheters. Patients suggested the following nocturnal modifications: closing doors/blinds, no unnecessary interruptions, sleeping pills, and dimmed lights. No significant correlations were found between perceived sleep quality and illness severity or mechanical ventilation. Patients who received intravenous sedatives reported better sleep quality (P<0.01).

CONCLUSION

Patients commonly report poor sleep in the ICU related to environmental factors that are potentially modifiable.

IL28B genetic variants and gender are associated with spontaneous clearance of hepatitis C virus infection

Single nucleotide polymorphisms (SNPs) near the IL28B gene have been shown to be associated with response to treatment for chronic hepatitis C and also with spontaneous clearance of hepatitis C virus (HCV) infection. We analysed the association between IL28B genetic variants and spontaneous clearance of HCV infection in 376 HCV-infected Chinese paid plasma donors. Genotyping of eight SNPs near the IL28B region was performed by the iPLEX system (MassARRAY(®) SNP Genotyping; Sequenom) in all donors, and sequencing was performed on all 80 donors who cleared HCV and on 160 of 296 donors who did not clear HCV to validate the genotypes. Eighty (21.3%) donors spontaneously cleared HCV. Four SNPs were significantly associated with spontaneous HCV clearance: rs8099917 TT (vs GT), rs8105790 TT (vs CT), rs12980275 AA (vs AG) and rs10853728 CC (vs CG or GG) with OR (95% CI) 15.27 (2.07-112.50), 14.88 (2.02-109.72), 7.92 (1.88-33.32) and 2.32 (1.22-4.42) respectively. No association between the other four IL28B SNPs including rs12979860 and spontaneous HCV clearance was found. Women had a higher rate of spontaneous HCV clearance than men [56/213 (26.3%) vs 24/163 (14.6%), P = 0.007], and this was true even after stratification for IL28B genotypes with OR of 1.9-2.2 among those with favourable genotypes. Our results confirmed that IL28B polymorphism is associated with spontaneous clearance of HCV in Chinese subjects, but the SNPs that predict HCV clearance in Chinese subjects were different from those reported in Caucasians. Women were more likely to clear HCV infection regardless of IL28B genotypes.

Electric acoustic stimulation of the auditory system: experience and results of ten patients using MED-EL's M and FlexEAS electrodes

OBJECTIVE

To evaluate the hearing preservation rate and speech perception scores in patients with profound high frequency hearing loss and acoustically aidable low frequency hearing, managed with the MED-EL electric acoustic stimulation system referenced to the insertion depth of the electrode array.

STUDY DESIGN

Retrospective data analysis.

PARTICIPANTS AND SETTING

Ten patients implanted at the Auditory Implant Centre, Guy's and St Thomas's Hospital, London, UK.

MAIN OUTCOME MEASURES

Pure tone audiometry, speech perception tests and electrode insertion depth angle.

RESULTS

Postoperatively, functional hearing preservation allowing electric acoustic stimulation was achieved in eight patients and total preservation of residual hearing in five patients with follow-up periods of more than 12 months. Three of four (75%) patients with an insertion depth of >360 degrees had a threshold shift of >25 dB, and all four patients had a threshold shift of >10 dB. All patients with total hearing preservation had the electrode inserted up to 360 degrees at maximum. Overall, speech perception outcomes increased significantly and hearing impairment was significantly reduced after electric acoustic stimulation or electric stimulation alone as compared with the preoperative scores.

CONCLUSION

Electric acoustic stimulation provides significant benefit to individuals with profound high frequency hearing loss. Studies with larger number of patients are needed to establish the optimal electrode insertion angle as well as to further analyse the benefit of electric acoustic stimulation.

Thymectomy resulted in complete remission of pure red cell aplasia when associated with thymoma

Patients with thymoma associated with pure red cell aplasia (PRCA) are rare and the relevant literature is limited. Prognostic evaluations into the appropriate surgical management of this rare coincidence of diseases are controversial, with some authors believing that none of their cases experienced remission of anemia after thymectomy. Despite the extreme rare concomitance of thymoma and PRCA, we report three consecutive cases, who experienced long-term complete remission of PRCA after extended thymectomy as their only therapy over a 6-year period. Possible features leading to the favorable outcome are discussed.

Characterization of some culture factors affecting oxalate degradation by the mycoparasite Coniothyrium minitans

AIMS

To find possible approaches to utilize the mechanism of oxalate degradation by Coniothyrium minitans (Cm) in controlling the plant pathogen Sclerotinia sclerotiorum (Ss).

METHODS AND RESULTS

Differences in oxalate degradation by different Cm strains and effects of the initial oxalate concentration, ambient pH and nutrient factors on mycelial growth and oxalate degradation by Cm were studied in shaken cultures. Results showed that two wild-type Cm strains, Chy-1 and ZS-1, did not differ in oxalate degradation in modified potato dextrose broth (mPDB) amended with oxalic acid (OA). Cm could grow in mPDB amended with sodium oxalate (SO-mPDB) at pH 6.5 or with ammonium oxalate (AO-PDB) at pH 6.2, but oxalate degradation was very low; oxalate degradation was greatly enhanced in SO- or AO-mPDB with pH being lowered to 2.8-2.9. Similarly, oxalate degradation was higher than 90% in OA-amended mPDB at pH 4.4 but was reduced to be <22% at pH 7.0. Five carbon sources and three nitrogen sources investigated and nutrients from mycelia and sclerotia of Ss were favorable for the growth of Cm and OA degradation by Cm.

CONCLUSIONS

Cm can degrade oxalate under acidic pH. Exudates from mycelia or sclerotia of Ss may serve as nutrients for Cm mycelial growth and degradation of oxalate secreted by Ss.

SIGNIFICANCE AND IMPACT OF THE STUDY

The finding of oxalate degradation laid a foundation for mining-related genes in Cm for engineering plant resistance against Ss. Elucidation of the importance of acidic pH and nutrients from Ss in oxalate degradation by Cm will help to understand the interaction between Cm and Ss.

The experimental study of cardiac allograft vasculopathy and myocardial fibrosis in rats

We sought to analyze the development of myocardial fibrosis and cardiac allograft vasculopathy (CAV) as a theoretical basis for the prevention and treatment of rejection. Heterotopic cardiac transplantation was performed from Wistar rats to Sprague-Dawley rats. The recipients pretreated with donor splenocyte (SPC) infusion followed by cyclophosphamide (CP) were divided into 3 groups: Control animals without immunosuppression (Group 1; n = 10); Group 2, CsA treatment (n = 10) with euthanasia 2-3 months posttransplantation; and Group 3 (n = 20), CP plus SPC treatment with 10 recipients euthanized at 2 weeks posttransplantation and 10 animals monitored for at least 1 year posttransplantation. Histological studies were performed to evaluate myocardial fibrosis and CAV; 2-3 days after transplantation, there was abundant infiltration of collagenous fibers in the adventitia and intima of the coronary arteries in Group 1 allografts. Group 2 allografts demonstrated abundant infiltration of collagenous fibers in the adventitia and intima of arteries and arterioles resulting in significant luminal stenosis. In contrast, pretreatment of animals with SPC and CP induced long-term allograft survival; myocardial fibrosis and CAV were dramatically reduced in Group 3 compared with Groups 1 and 2. The infiltration of collagenous fibers in coronary arteries was one of the major causes of CAV. Preconditioning of recipients with SPC followed by CP not only induced immune tolerance but also alleviated myocardial fibrosis and CAV in allografts.

High rate of maternal vitamin B12 deficiency nearly a decade after Canadian folic acid flour fortification

Vitamin B12 deficiency may be an independent risk factor for neural tube defects (NTD). We determined the prevalence of biochemical B12 deficiency (<125 pmol/l) among 10 622 Ontarian women aged 15-46 years who underwent concomitant testing of serum bhCG and B12 9 years after the implementation of Canadian folic acid flour fortification. The overall prevalence of biochemical B12 deficiency was 7.4%. Relative to non-pregnant women, the adjusted odds ratio (95% confidence interval) of biochemical B12 deficiency was 0.78 (0.60-1.0) among women pregnant 28 days gestation or less and was 1.4 (1.1-1.8) after 28 days gestation. About 1 in 20 women may be deficient in B12 in early pregnancy. The impact on maternal and fetal well-being, including preventable NTD, should be considered.

On-line learning of dynamical systems in the presence of model mismatch and disturbances

This paper is concerned with the on-line learning of unknown dynamical systems using a recurrent neural network. The unknown dynamic systems to be learned are subject to disturbances and possibly unstable. The neural-network model used has a simple architecture with one layer of adaptive connection weights. Four learning rules are proposed for the cases where the system state is measurable in continuous or discrete time. Some of these learning rules extend the sigma-modification of the standard gradient learning rule. Convergence properties are given to show that the weight parameters of the recurrent neural network are bounded and the state estimation error converges exponentially to a bounded set, which depends on the modeling error and the disturbance bound. The effectiveness of the proposed learning rules for the recurrent neural network is demonstrated using an illustrative example of tracking a Brownian motion.

Adsorption of Pseudomonas putida on clay minerals and iron oxide

Adsorption of Pseudomonas putida on minerals including montmorillonite, kaolinite and goethite was studied. The adsorption isotherms of P. putida on the examined minerals conformed to the Langmuir equation. The amount of P. putida adsorbed followed the order: goethite > kaolinite > montmorillonite. A greater extent of P. putida adsorption on minerals was observed in the range of temperature from 15 to 35 degrees C. The adsorption of P. putida on minerals decreased with the increase of pH from 3.0 to 10.0. Magnesium ion was more efficient than sodium ion in promoting P. putida adsorption on minerals. The results suggest that electrostatic interactions play a vital role in P. putida adsorption by soil colloidal factions. The information obtained in this study is of fundamental significance for the understanding of the survival and transport of bacteria in soil systems.

Raman spectrum of graphene and graphene layers

Graphene is the two-dimensional building block for carbon allotropes of every other dimensionality. We show that its electronic structure is captured in its Raman spectrum that clearly evolves with the number of layers. The D peak second order changes in shape, width, and position for an increasing number of layers, reflecting the change in the electron bands via a double resonant Raman process. The G peak slightly down-shifts. This allows unambiguous, high-throughput, nondestructive identification of graphene layers, which is critically lacking in this emerging research area.

The role of hyaluronan degradation products as innate alloimmune agonists

Dendritic cells (DCs) play a key role in initiating alloimmunity yet the substances that activate them during the host response to transplantation remain elusive. In this study we examined the potential roles of endogenous innate immune agonists in activating dendritic cell-dependent alloimmunity. Using a murine in vitro culture system, we show that 135 KDa fragments of the extracellular matrix glycosaminoglycan hyaluronan induce dendritic cell maturation and initiate alloimmunity. Priming of alloimmunity by hyaluronan-activated DCs was dependent on signaling via TIR-associated protein, a Toll-like receptor (TLR) adaptor downstream of TLRs 2 and 4. However, this effect was independent of alternate TLR adaptors, MyD88 or Trif. Using an in vivo murine transplant model, we show that hyaluronan accumulated during skin transplant rejection. Examination of human lung transplant recipients demonstrated that increased levels of intragraft hyaluronan were associated with bronchiolitis obliterans syndrome. In conclusion, our study suggests that fragments of hyaluronan can act as innate immune agonists that activate alloimmunity.

Hematopoietic stem cell mobilization after rat partial orthotopic liver transplantation

BACKGROUND

On the basis of the recently recognized potential of hematopoietic stem cells (HSC) to give rise to hepatocytes, we investigated the possibility that HSC could be mobilized and home to the injured liver promoting tissue repair after 50% partial orthotopic liver transplantation (PLTx) in the rat.

METHODS

Using sex-mismatched (female to male) syngeneic SD rats, we performed 50% PLTx or whole orthotopic liver transplantation (WLTx) versus 50% partial hepatectomy (PHx) and sham operation (O). Elements with stem cell markers were detected in peripheral blood (PB) and in the liver. Liver injury and regeneration were estimated. The sex-determining region for Y chromosome gene (SRY) was used to define cell origin by in situ hybridization in liver sections.

RESULTS

Comparison of WLTx and PHx groups showed a lower survival rate (50%), in the PLTx group were (P<.05). Further, the liver injury was more serious and the levels of serum biochemical parameters were higher. Compared with PHx groups, on days 3 and 5 postoperatively, the mitosis index and the expression of PCNA were lower among the PLTx groups. Compared with WLTx and sham operation groups, beta2m-/Thy-1.1+, CD34+ cells in PB in PLTx groups and PHx were increased on day 1 postoperatively and decreased on the following days. Compared with PHx groups, beta2m-/Thy-1.1+, CD34+ cells were higher in PLTx. The CD34-, c-kit-, and Thy-1.1-positive cells detected in portal tract areas peaked during 3 to 5 days postoperatively in PLTx. Few SRY+ cells were detected in PLTx liver grafts.

CONCLUSIONS

beta2m-/Thy-1.1+ and CD34+ stem cells mobilized after PLTx and PHx may be related to the reduced-size liver. Few HSC are involved in liver regeneration in PLTx.

Strong suppression of weak localization in graphene

Low-field magnetoresistance is ubiquitous in low-dimensional metallic systems with high resistivity and well understood as arising due to quantum interference on self-intersecting diffusive trajectories. We have found that in graphene this weak-localization magnetoresistance is strongly suppressed and, in some cases, completely absent. The unexpected observation is attributed to mesoscopic corrugations of graphene sheets which can cause a dephasing effect similar to that of a random magnetic field.

Acute presentation of a fibroepithelial pharyngeal polyp

We report the case of a 60-year-old Caucasian man who presented with choking and airway compromise due to a large pharyngeal polyp. It was resected as an emergency procedure and subjected to macroscopic and microscopic examination. The fibroepithelial polyp arose from the right pharyngeal wall and consisted of adipose tissue covered by squamous epithelium without evidence of malignancy. This is a particularly rare lesion in adults and there are few references in the medical literature. To our knowledge this is the first English case report of an acute presentation of adult fibroepithelial pharyngeal polyp. This case report also discusses the issues raised in the management of a potentially fatal lesion that may have resulted in complete airway obstruction.

Interpretation of deformation fabrics of infrastructure zone rocks in the context of channel flow and other tectonic models

Infrastructure zones are essentially horizontal to shallowly dipping crustal-scale zones of non-coaxial flow, with two possible interpretations: (a) a crustal-scale shear zone, transporting upper crust over lower crust and/or mantle (transport flow); or (b) a zone of channel flow in which there is a flux of weak crust between relatively strong upper and lower crust and/or mantle, away from the centre of the orogen. Transport flow has a constant shear sense across the zone, whereas in channel flow the sense of shear reverses across the zone. Channel flow may be driven by extrusion (extrusive channel flow), due to the two channel walls approaching one another, or by a pressure gradient along the channel (normal channel flow), with no convergence of the walls necessary. Arguments based on strain compatibility and mechanics suggest that extrusive channel flow is unlikely. Kinematic vorticity numbers have been used to show that infrastructure and other shear zones have undergone flattening strains, but we show that the numbers are incompatible with extrusion. We also show that in addition to the problems inherent in determining kinematic vorticity numbers from fabric, the numbers cannot be related to bulk flow in mechanically heterogeneous zones, because of flow partitioning. Drag folds are a better indication, albeit qualitative, of whether a zone is thinning or not. They also give a conservative estimate of the minimum accumulated shear strains, and may inhibit strain localization. Like snowball garnets, they indicate shear strains that are so large that the pure-shear-thinning component for a steady-shear zone has to be small.

Two-dimensional gas of massless Dirac fermions in graphene

Quantum electrodynamics (resulting from the merger of quantum mechanics and relativity theory) has provided a clear understanding of phenomena ranging from particle physics to cosmology and from astrophysics to quantum chemistry. The ideas underlying quantum electrodynamics also influence the theory of condensed matter, but quantum relativistic effects are usually minute in the known experimental systems that can be described accurately by the non-relativistic Schrödinger equation. Here we report an experimental study of a condensed-matter system (graphene, a single atomic layer of carbon) in which electron transport is essentially governed by Dirac's (relativistic) equation. The charge carriers in graphene mimic relativistic particles with zero rest mass and have an effective 'speed of light' c* approximately 10(6) m s(-1). Our study reveals a variety of unusual phenomena that are characteristic of two-dimensional Dirac fermions. In particular we have observed the following: first, graphene's conductivity never falls below a minimum value corresponding to the quantum unit of conductance, even when concentrations of charge carriers tend to zero; second, the integer quantum Hall effect in graphene is anomalous in that it occurs at half-integer filling factors; and third, the cyclotron mass m(c) of massless carriers in graphene is described by E = m(c)c*2. This two-dimensional system is not only interesting in itself but also allows access to the subtle and rich physics of quantum electrodynamics in a bench-top experiment.

Two-dimensional atomic crystals

We report free-standing atomic crystals that are strictly 2D and can be viewed as individual atomic planes pulled out of bulk crystals or as unrolled single-wall nanotubes. By using micromechanical cleavage, we have prepared and studied a variety of 2D crystals including single layers of boron nitride, graphite, several dichalcogenides, and complex oxides. These atomically thin sheets (essentially gigantic 2D molecules unprotected from the immediate environment) are stable under ambient conditions, exhibit high crystal quality, and are continuous on a macroscopic scale.

Identification of a novel HLA-DRB1 allele (HLA-DRB1*111902*)

In this paper, we report a new HLA-DRB1 allele identified in a male acute myeloid leukaemia Chinese patient. This sample was initially typed as DRB1*11XX using commercial polymerase chain reaction-sequence-specific primers kit. When it was typed using a chip-based sequence-specific oligonucleotide technique, a novel hybridization pattern that does not match any known alleles was observed. Through sequencing, we have identified this allele as a new HLA-DRB1 allele, which was later named HLA-DRB1*111902 by the WHO Nomenclature Committee. The sequence of this new allele differs from DRB1*111901 by one nucleotide (from G to C) at 203nt of exon 2 but does not cause any amino acid substitution.

The Effects of Mass Loading the Ossicles with a Floating Mass Transducer on Middle Ear Transfer Function

HYPOTHESIS

The aim of this study was to measure the mass loading effect of an active middle-ear implant (the Vibrant Soundbridge) in cadaver temporal bones.

BACKGROUND

Implantable middle ear hearing devices such as Vibrant Soundbridge have been used as an alternative to conventional hearing aids for the rehabilitation of sensorineural hearing loss. Other than the obvious disadvantage of requiring implantation middle ear surgery, it also applies a direct weight on the ossicular chain which, in turn, may have an impact on residual hearing. Previous studies have shown that applying a mass directly on the ossicular chain has a damping effect on its response to sound. However, little has been done to investigate the magnitude and the frequency characteristics of the mass loading effect in devices such as the Vibrant Soundbridge.

METHODS

Five fresh cadaver temporal bones were used. The stapes displacement was measured using laser Doppler vibrometry before and after the placement of a Vibrant Soundbridge floating mass transducer. The effects of mass and attachment site were compared with the unloaded response. Measurements were obtained at frequencies between 0.1 and 10 kHz and at acoustic input levels of 100 dB sound pressure level. Each temporal bone acted as its own control.

RESULTS

Placement of the floating mass transducer caused a reduction of the stapes displacement. There were variations between the bones. The change of the stapes displacement varied from 0 dB to 28 dB. The effect was more prominent at frequencies above 1,000 Hz. Placing the floating mass transducer close to the incudostapedial joint reduced the mass loading effect.

CONCLUSION

The floating mass transducer produces a measurable reduction of the stapes displacement in the temporal bone model. The effect is more prominent at high frequencies.

Minimally invasive approach and fixation of cochlear and middle ear implants

One of the conventional surgical approaches for cochlear implantation is a retro-auricular incision with a posterior-inferiorly based skin and subcutaneous tissue flap and a superiorly based periosteal flap. The obvious advantage is an open operating field but the disadvantages are a large wound and a lengthy operating time. It may also result in more wound-related complications. To overcome these disadvantages, we have developed a minimally invasive technique that includes a small retro-auricular single layer incision. We have used a metal bridge beneath the posterior flap to increase accessibility when creating a recess for the implant. A novel technique is used to place the securing suture deep to the flap. This technique has been used in 49 paediatric and adult patients, and there have been no wound-related complications. Although this technique was initially designed for the CLARION CII implant, it has been used to place and secure the new CLARION HiRes 90 K, the Nucleus device, the MEDEL device and the Vibrant Soundbridge.

Electric Field Effect in Atomically Thin Carbon Films

We describe monocrystalline graphitic films, which are a few atoms thick but are nonetheless stable under ambient conditions, metallic, and of remarkably high quality. The films are found to be a two-dimensional semimetal with a tiny overlap between valence and conductance bands, and they exhibit a strong ambipolar electric field effect such that electrons and holes in concentrations up to 10 13 per square centimeter and with room-temperature mobilities of ∼10,000 square centimeters per volt-second can be induced by applying gate voltage.

Diffusion of single cardiac ryanodine receptors in lipid bilayers is decreased by annexin 12

Diffusion of cardiac ryanodine receptors (RyR2) in lipid bilayers was characterized. RyR2 location was monitored by imaging fluo-3 fluorescence due to Ca2+ flux through RyR2 channels or fluorescence from RyR2 conjugated with Alexa 488 or containing green fluorescent protein. Single channel currents were recorded to ensure that functional channels were studied. RyR2 exhibited an apparent diffusion coefficient (DRyR) of 1.2 x 10(-8) cm2 s(-1) and a mean path length of 5.0 microm. Optimal use of optical methods for analysis of RyR2 channel function requires that RyR2 diffusion be limited. Therefore, we tested the effect of annexin 12, which interacts with anionic phospholipids in a Ca2+-dependent manner. Addition of annexin 12 (0.25-4.0 microM) to the trans side of bilayers containing an 80:20 ratio of phosphatidylethanolamine/phosphatidylserine decreased RyR2 diffusion in a concentration-dependent manner. Annexin 12 (2 microM) decreased the apparent DRyR 683-fold from 1.2-10(-8) to 1.8 x 10(-11) cm2 s(-1) and the mean path length 10-fold from 5.0 to 0.5 micro m without obvious changes in the conductance of the native bilayer or in activation of RyR2 channels by Ca2+ or suramin. Thus, annexin 12 may provide a useful tool for optimizing optical analysis of RyR2 channels in lipid bilayers.

The influence of long-term tracheostomy on speech and language development in children

BACKGROUND

Individuals diagnosed as having primary neurological disorders have a high incidence of abnormal speech and language development. However, results in cohorts where this group are excluded are controversial. With no coexisting neurological impairment, some suggested that tracheostomy has little influence on speech development, whilst others showed a clear pattern of language disability. The aim of this study is to evaluate the influence of tracheostomy on speech and language development.

METHOD

Retrospective study using standardised outcome measures.

RESULTS

A series of 39 paediatric tracheostomies was studied. In the group where children had neurological disorders, 94% showed no language or delayed language development. In contrast, of the group of children without a neurological impairment, 60.9% had normal speech and language development. The median age at the decannulation in those children with delayed speech was 23 months, whilst in those children with normal speech it was 14.5 months.

CONCLUSION

Tracheostomy affects speech and language development in those with and without neurological disorders. Crucial factors affecting speech and language development within the neurologically normal group are age at the tracheostomy, and the duration of the tracheostomy until decannulation. Achieving earliest decannulation improves the chance of a normal speech and language development.

Carbon monoxide concentrations in paediatric sepsis syndrome

Plasma carbon monoxide (CO) concentrations were measured in 12 patients with sepsis syndrome. CO concentrations were found to be significantly increased in patients compared with those in 30 normal controls. Patients with septic shock had significantly higher plasma CO concentrations than those without shock. Results suggest that CO might play an important role in paediatric sepsis syndrome.

Anti-endothelial cell antibodies in Behçet's disease

OBJECTIVE

Circulating antibodies that bind to human endothelial cells cultured in vitro have been detected in a variety of diseases, including Behçet's disease. In this disorder the reported prevalence of AECA has varied widely. One likely source of variability is the ELISA assay itself, in which differing conditions and reagents have been used in different reports.

METHODS

We have re-examined the frequency of AECA in 132 Turkish Behçet's patients and 50 healthy Turkish controls, comparing several different methods of preparing the target endothelial cells. Human umbilical vein endothelial cells (HUVEC) were used either: 1) fresh and non-treated, 2) fixed, or 3) TNF alpha-stimulated. All stages of the procedures were performed at room temperature.

RESULTS

In Behçet's patients, using fresh, non-treated HUVEC, 17 of 130 (13.1%) and 9 of 132 (6.8%) sera were positive for IgG- and IgM-AECA, respectively. However, among 50 normal controls, 2 (4.0%) had IgG-positive and 4 (8.0%) had IgM-positive ELISAs under the same conditions. The difference in the frequency of positives between patients and controls was not statistically significant. Fixed HUVEC and TNF alpha-treated HUVEC gave similar results as well. When group means were examined, only the mean for IgG-AECA determined with TNF alpha-stimulated HUVEC reached statistical significance.

CONCLUSION

The discrepancy between our data and earlier reports in the literature probably reflects the methodological differences alluded to, and highlights the difficulties in interpreting ELISA assays for AECA.