Prospects of microalgae in nutraceuticals production with nanotechnology applications

Nutraceutical supplements provide health benefits, such as fulfilling the lack of nutrients in the human body or being utilized to treat or cure certain diseases. As the world population is growing, certain countries are experiencing food crisis challenges, causing natural foods are not sustainable to be used for nutraceutical production because it will require large-scale of food supply to produce enriched nutraceutics. The high demand for abundant nutritional compounds has made microalgae a reliable source as they can synthesize high-value molecules through photosynthetic activities. However, some microalgae species are limited in growth and unable to accumulate a significant amount of biomass due to several factors related to environmental conditions. Therefore, adding nanoparticles (NPs) as a photocatalyst is considered to enhance the yield rate of microalgae in an energy-saving and economical way. This review focuses on the composition of microalgal biomass for nutraceutical production, the health perspectives of nutritional compounds on humans, and the application of nanotechnology on microalgae for improved production and harvesting. The results obtained show that microalgal-based compounds indeed have better nutrients content than natural foods. However, nanotechnology must be further comprehended to make them non-hazardous and sustainable.

Coherent spin control of s-, p-, d- and f-electrons in a silicon quantum dot

Once the periodic properties of elements were unveiled, chemical behaviour could be understood in terms of the valence of atoms. Ideally, this rationale would extend to quantum dots, and quantum computation could be performed by merely controlling the outer-shell electrons of dot-based qubits. Imperfections in semiconductor materials disrupt this analogy, so real devices seldom display a systematic many-electron arrangement. We demonstrate here an electrostatically confined quantum dot that reveals a well defined shell structure. We observe four shells (31 electrons) with multiplicities given by spin and valley degrees of freedom. Various fillings containing a single valence electron-namely 1, 5, 13 and 25 electrons-are found to be potential qubits. An integrated micromagnet allows us to perform electrically-driven spin resonance (EDSR), leading to faster Rabi rotations and higher fidelity single qubit gates at higher shell states. We investigate the impact of orbital excitations on single qubits as a function of the dot deformation and exploit it for faster qubit control.

Single-spin qubits in isotopically enriched silicon at low magnetic field

Single-electron spin qubits employ magnetic fields on the order of 1 Tesla or above to enable quantum state readout via spin-dependent-tunnelling. This requires demanding microwave engineering for coherent spin resonance control, which limits the prospects for large scale multi-qubit systems. Alternatively, singlet-triplet readout enables high-fidelity spin-state measurements in much lower magnetic fields, without the need for reservoirs. Here, we demonstrate low-field operation of metal-oxide-silicon quantum dot qubits by combining coherent single-spin control with high-fidelity, single-shot, Pauli-spin-blockade-based ST readout. We discover that the qubits decohere faster at low magnetic fields with [Formula: see text] μs and [Formula: see text] μs at 150 mT. Their coherence is limited by spin flips of residual 29Si nuclei in the isotopically enriched 28Si host material, which occur more frequently at lower fields. Our finding indicates that new trade-offs will be required to ensure the frequency stabilization of spin qubits, and highlights the importance of isotopic enrichment of device substrates for the realization of a scalable silicon-based quantum processor.

Seroma prevention strategies in laparoscopic ventral hernia repair: a systematic review

BACKGROUND

Laparoscopic ventral hernia repair (LVHR) has been increasing in popularity over the years. Seroma formation is a common complication of LVHR. The aim of this study is to review the current evidence on seroma prevention strategies following LVHR.

METHODS

A systematic search of PubMed, Embase (1946-13 February 2019) and Medline (1946-13 February 2019) databases was conducted using terms which include "seroma", "hernia, ventral" and "laparoscopy". All studies are comparative retrospective or prospective human adult studies in peer-reviewed journals describing at least one intra-operative intervention designed to decrease the rate of seroma formation in laparoscopic ventral hernia repair.

RESULTS

The database searches identified 3762 citations, and 21 studies were included for final analysis. Five studies compared the different methods of mesh fixation, nine studies compared primary defect closure (PFC) and bridged repair, two studies compared the effect of different types of meshes, two studies looked into the use of electrical cauterization, one study compared single- site laparoscopy with conventional laparoscopy, one study looked into the use of fibrin sealant and one study compared transabdominal preperitoneal placement of mesh with conventional repair. PFC appears to be the most promising with large studies showing a low rate of seroma formation with additional benefits of decreasing wound infection and recurrence rate. Cauterisation of hernia sac and injection of fibrin sealant also show promising results but are mainly derived from small studies. Other strategies did not demonstrate benefit.

CONCLUSION

Currently, primary fascial closure appears to be the most promising strategy available to decrease seroma formation after LVHR based on the results of large studies. Other promising strategies that decrease dead space such as cauterisation of the sac and fibrin sealant injection will require further multicentre trials to confirm benefit before an increase in operative time and cost can be justified for their routine use.

Flux-tunable heat sink for quantum electric circuits

Superconducting microwave circuits show great potential for practical quantum technological applications such as quantum information processing. However, fast and on-demand initialization of the quantum degrees of freedom in these devices remains a challenge. Here, we experimentally implement a tunable heat sink that is potentially suitable for the initialization of superconducting qubits. Our device consists of two coupled resonators. The first resonator has a high quality factor and a fixed frequency whereas the second resonator is designed to have a low quality factor and a tunable resonance frequency. We engineer the low quality factor using an on-chip resistor and the frequency tunability using a superconducting quantum interference device. When the two resonators are in resonance, the photons in the high-quality resonator can be efficiently dissipated. We show that the corresponding loaded quality factor can be tuned from above 10⁵ down to a few thousand at 10 GHz in good quantitative agreement with our theoretical model.

Perfluoroalkyl substances in waters along the Grand Canal, China

The Grand Canal, also known as the Beijing-Hangzhou Grand Canal, is a UNESCO World Heritage Site and the longest canal in the world. It is an important trunk line of the South-to-North Water Diversion Project in China. The contamination status and spatial distributions of perfluoroalky substances (PFASs) in waters of the Grand Canal were investigated. The total concentrations of PFASs (∑PFASs) range from 7.8 ng/L to 218.0 ng/L, with high ∑PFASs occurring in the southern part of the Grand Canal which is located in a highly urbanized and economically developed region. The dominance of PFOA showed a decreasing trend toward north while shorter chain homologue proportions increased in the northern part of the Canal which mainly traverses underdeveloped and rural areas in Eastern China. Positive correlations were observed between ∑PFASs and the population density as well as GDP per capita. Intersection with large rivers may affect the contamination levels and composition of PFASs in the water of the Grand Canal near the intersection sites.

Detection of Zeptojoule Microwave Pulses Using Electrothermal Feedback in Proximity-Induced Josephson Junctions

We experimentally investigate and utilize electrothermal feedback in a microwave nanobolometer based on a normal-metal (Au_{x}Pd_{1-x}) nanowire with proximity-induced superconductivity. The feedback couples the temperature and the electrical degrees of freedom in the nanowire, which both absorbs the incoming microwave radiation, and transduces the temperature change into a radio-frequency electrical signal. We tune the feedback in situ and access both positive and negative feedback regimes with rich nonlinear dynamics. In particular, strong positive feedback leads to the emergence of two metastable electron temperature states in the millikelvin range. We use these states for efficient threshold detection of coherent 8.4 GHz microwave pulses containing approximately 200 photons on average, corresponding to 1.1×10^{-21}  J≈7.0  meV of energy.

'Start to finish trans-institutional transdisciplinary care': a novel approach improves colorectal surgical results in frail elderly patients

AIM

The frail elderly surgical patient is at increased risk of morbidity after major surgery. A transdisciplinary Geriatric Surgery Service (GSS) has been shown to produce consistently positive results in our institution. A trans-institutional transdisciplinary Start to Finish (STF) programme was initiated incorporating seamless prehabilitation and rehabilitation to enhance the outcome further.

METHOD

Patients who underwent major colorectal resection in Khoo Teck Puat Hospital and were managed under the GSS from January 2007 to December 2014 were included in this prospective study. The STF programme was initiated from January 2012. The surgical outcome of patients managed under the GSS before the initiation of STF was compared with that after its implementation.

RESULTS

There were 57 patients after the initiation of the STF programme compared with 60 patients managed before STF. There were 26.4% and 25% of frail patients in the STF group compared with the non-STF group (P = 0.874). The mean length of hospital stay was significantly shorter in the STF group (8.4 days vs 11.0 days, P = 0.029). Functional recovery in patients available for follow-up at 6 weeks showed 100% (46/46) recovery in the elective STF group who received prehabilitation and 95.7% (45/47) in the elective non-STF group who did not (P = 0.157). There were no significant differences in a Clavien-Dindo complication score of Grade 3 or more and 30-day mortality between the two groups.

CONCLUSION

Through a trans-institutional transdisciplinary approach, we managed to achieve a significantly shorter hospital stay in frail patients having colorectal surgery. All elective patients who received prehabilitation achieved full functional recovery.

Latitudinal distributions of activities in atmospheric aerosols, deposition fluxes, and soil inventories of ⁷Be in the East Asian monsoon zone

Activities of atmospheric aerosols, bulk deposition fluxes, and undisturbed soil inventories of (7)Be were investigated in China's East Asian monsoon zone at various latitudes ranging from 23.8°N to 43.5°N. The annual latitudinal distributions of (7)Be concentrations in aerosols follow a distribution pattern which looks similar to a normal distribution with the maxima occurring in the mid-latitude region. Simultaneous measurements of (7)Be at various latitudes suggest that atmospheric circulation may play an important role in the latitudinal distributions of (7)Be in surface air. Latitude and wet precipitation are the main factors controlling the bulk (7)Be depositional fluxes. Significant seasonal variations in (7)Be depositional fluxes in Beijing, a mid-latitude city, were observed with the highest flux in summer and the lowest in winter, whereas less seasonality were found in the high- and the low-latitude cities. The highest (7)Be inventory in undisturbed soils in summer also occurred at a mid-latitudinal area in the East Asian monsoon zone. Precipitation is the main factor controlling the (7)Be soil inventory in Qingdao with the highest values occurring in autumn followed by summer.

Tunable electromagnetic environment for superconducting quantum bits

We introduce a setup which realises a tunable engineered environment for experiments in circuit quantum electrodynamics. We illustrate this concept with the specific example of a quantum bit, qubit, in a high-quality-factor cavity which is capacitively coupled to another cavity including a resistor. The temperature of the resistor, which acts as the dissipative environment, can be controlled in a well defined manner in order to provide a hot or cold environment for the qubit, as desired. Furthermore, introducing superconducting quantum interference devices (SQUIDs) into the cavity containing the resistor, provides control of the coupling strength between this artificial environment and the qubit. We demonstrate that our scheme allows us to couple strongly to the environment enabling rapid initialization of the system, and by subsequent tuning of the magnetic flux of the SQUIDs we may greatly reduce the resistor-qubit coupling, allowing the qubit to evolve unhindered.

Nanoscale broadband transmission lines for spin qubit control

The intense interest in spin-based quantum information processing has caused an increasing overlap between the two traditionally distinct disciplines of magnetic resonance and nanotechnology. In this work we discuss rigorous design guidelines to integrate microwave circuits with charge-sensitive nanostructures, and describe how to simulate such structures accurately and efficiently. We present a new design for an on-chip, broadband, nanoscale microwave line that optimizes the magnetic field used to drive a spin-based quantum bit (or qubit) while minimizing the disturbance to a nearby charge sensor. This new structure was successfully employed in a single-spin qubit experiment, and shows that the simulations accurately predict the magnetic field values even at frequencies as high as 30 GHz.

Pneumothorax following endoscopic submucosal dissection of a rectal tumor

Endoscopic submucosal dissection is a useful alternative to endoscopic mucosal resection and surgery for en bloc resection of colorectal tumors. However, the technique is considered to be difficult, and potential complications include perforation and postoperative bleeding. In this case report, we present a case of a 63-year-old woman who developed pneumothorax after endoscopic submucosal dissection of a rectal tumor.

Reproducibility and diagnostic value of E100 event recorder for patients with complains on heart arrhythmias and no changes on multiple routine ECGs and 24-hour holter monitoring

Aim of the study was to assess reproducibility and diagnostic value of E100 event recorder for patients with complains on heart arrhythmias and no abnormalities on multiple routine ECGs and/or 24-hour Holter ECG monitoring and the second one, an assessment of adherence and attitude of patients to the E100 event recorder, dependent on the results of self- assessment questionnaires. 24 patients with complains on heart arrhythmias were included in the study. All the patients were provided with the REKA E100 event monitors for 5 ± 2 days and self-assessment questionnaires to assess level of adherence and attitude of patients to the E100 event recorder. E100 event recorders revealed junctional rhythm (n=2), AV nodal reentrant tachycardia (n=2), extrasystolic arrhythmias (n=10), atrial fibrillation (n=2), WPW syndrome (n=4), ventricular tachycardia (n=1), sinus tachycardia (n=7) and complete AV block (n=1). Majority of patients consider device as easy to use, comfortable and safe. In comparison with multiple routine ECGs and 24-hour Holter ECG monitoring, E100 event recorders showed higher reproducibility and efficacy for detecting and interpreting heart arrhythmias.

Transanal radical endoscopic resection of the rectum on a swine model: a surviving model

INTRODUCTION

This multimedia video is the second part of our study on transanal endoscopic radical resection of the rectum, which we have previously described (http://links.lww.com/DCR/A4). In this present study, we hypothesized that this procedure is not only technically feasible but also safe.

MATERIALS AND SURGICAL TECHNIQUE

This procedure was performed on two swine as a surviving model. After radical resection of the rectum and primary anastomosis, the two swine were monitored in an animal holding area for a period of 1 week, and the anastomoses were inspected after that period. The lower rectum was transected, and retroperitoneal dissection was performed transanally using flexible endoscopic equipment to achieve high ligation of the caudal mesenteric vessels. After rectal resection, hand-sewn coloanal anastomosis was performed.

DISCUSSION

Both swine had good postoperative outcomes, and the postoperative period was captured on video. Transanal radical endoscopic resection of the rectum is not only technically feasible, but it can can be safely performed on swine.

Prospective study to validate HpOne in the diagnosis of Helicobacter pylori infection

INTRODUCTION

The HpOne test is a new five-minute rapid urease test developed for the rapid detection of Helicobacter pylori infection during gastroscopy. However, evidence in the literature supporting its use clinically is scarce. The most commonly used rapid urease test remains the Campylobacter-like organism (CLO) test, which generates accurate readings only after 24 hours. The aim of this study was to evaluate the efficacy of the HpOne test in our local population.

METHODS

From August 2007 to May 2008, consecutive patients undergoing gastroscopy for various indications were recruited into this prospective study. Patients who were pregnant, lactating, on proton pump inhibitors, antibiotics, immunosuppressants or had previous gastric surgery were excluded. During gastroscopy, six gastric mucosal biopsies were taken; three from the body and three from the antrum. One body and one antral biopsy were used for each of the HpOne test, CLO test and histology. Results of the HpOne and CLO tests were then compared against the gold standard of histology.

RESULTS

Of the 149 patients recruited, 82 (55 percent) were men and 67 (45 percent) were women. The prevalence of Helicobacter pylori infection was 38.9 percent (n is 58). The sensitivity and specificity of the HpOne test were 65.5 percent and 85.7 percent, respectively, while those for the CLO test were 63.8 percent and 84.6 percent, respectively.

CONCLUSION

The HpOne test is as efficacious as the CLO test, with the added advantage of yielding results faster. It is thus a superior alternative and should be considered for clinical use.

A randomized phase II study comparing two schedules of the 21-day regimen of gemcitabine and carboplatin in advanced non-small cell lung cancer

PURPOSE

Carboplatin area under the curve (AUC) 5 ml/min on day 1 with gemcitabine 1,250 mg/m(2) on day 1 and day 8 is a widely used regimen in advanced non-small cell lung cancer. Grade 3-4 thrombocytopenia and neutropenia are frequent. The aim of this study is to investigate whether toxicity of gemcitabine/carboplatin could be reduced by administering carboplatin on day 8 instead of day 1 without a decrease in response rate (RR).

METHODS

Patients received gemcitabine 1,250 mg/m(2) on days 1 and 8, carboplatin AUC 5 on day 1 (arm A) or day 8 (arm B). Drugs were administered over a 21-day cycle. Toxicity and RR were evaluated weekly and every second cycle, respectively.

RESULTS

71 patients were enrolled into the study. We found 79% (95% CI 61-91%) grade 3-4 toxicity (neutropenia and thrombocytopenia) in arm A and 50% (95% CI 32-68%) in arm B; 66% grade 3-4 thrombocytopenia in arm A and 26% in arm B. We observed 30% grade 4 hematological toxicity in arm A and 3% in arm B. In arm A an overall RR of 20% (95% CI 7.7-38.6%) was seen, and 18.2% (95% CI 7-35.5%) in arm B.

CONCLUSIONS

Although the study was prematurely closed, the current data are of interest. The schedule with carboplatin on day 8 is associated with substantially lower grade 3-4 neutropenia and thrombocytopenia with comparable dose intensity and RR.

Distribution of the first metastatic lymph node in colon cancer and its clinical significance

INTRODUCTION

The pattern of distribution of lymph node metastasis in resected specimens of colon cancer has been rarely reported in the English literature. The aim of this study was to determine the location of the first metastatic lymph node, giving insight into the drainage pattern of colon cancer lymphatics.

METHOD

All lymph nodes in the mesentery of the resected specimen were carefully harvested and their precise locations documented. Patients with a single metastatic node in the resected specimen were included in the study.

RESULTS

Ninety-three patients with only one metastatic lymph node found on histology were studied. The mean number of lymph nodes per specimen was 22.3 (range: 8-72). The patients' first metastatic node was not directly below the tumour in 48% of cases. The first metastatic node was found in the region either along the feeding vessels (skipping the pericolic nodes) or in the pericolic area outside 5 cm on either side of the tumour edge in 18% of cases. No factors were found to be predictive for lymph node metastasis occurring elsewhere other than in the pericolic region just below the tumour.

CONCLUSION

Although there has been recent resurgence of interest in using sentinel node biopsy to limit surgical dissection to facilitate minimally access and natural orifice surgery, the present study is a warning that this may compromise oncological clearance. Radical surgery should remain standard practice for colorectal cancer.

Life-threatening perineal sepsis after rubber band ligation of haemorrhoids

Rubber band ligation is a widely performed procedure in the outpatient setting for symptomatic haemorrhoids. This method is generally considered to be safe and easily performed. However, there have been reports of severe sepsis following interventions for haemorrhoids and the majority of patients had undergone rubber band ligation. We present a patient who had undergone elective rubber band ligation of haemorrhoids who presented with severe anal pain with difficulty in micturition. She deteriorated rapidly over a period of 3 days and succumbed to fulminant perineal sepsis.

The role of traditional Chinese medicine in colorectal cancer treatment

Surgery, chemotherapy and radiotherapy have been the mainstay of colorectal cancer treatment. There is however current intense research on traditional Chinese medicine (TCM) as novel or additional treatment methods for colorectal cancer. This article reviews the current use of TCM in colorectal cancer so as to increase the awareness of colorectal surgeons. The pathogenesis of colorectal cancer according to TCM is discussed. TCM has been used successfully during the perioperative period to relieve intestinal obstruction, reduce postoperative ileus and reduce urinary retention after rectal surgery. Good results have been reported in the treatment of the complications of chemotherapy and radiation enterocolitis. Favourable results have also been shown in the use of TCM either alone or in combination with chemotherapy to treat advanced colorectal cancer. Molecular studies have shown some TCM compounds to reduce tumour cell proliferation and induce apoptosis. Although the reported results of TCM have been exciting thus far, problems of lack of consensus on treatment regimes and questions on the reliability, validity and applicability of published studies prevent its widespread use. There is now an urgent need for colorectal surgeons to work with TCM physicians in the continuing research on this 6,000-year-old art so as to realize its full potential for our patients.

Application of biochemical products as a bioremediation technique for domestic sewage treatment plants

Biochemical products have been widely used for treatment of various types of wastewater. The treatment processes with the addition of biochemical products are quite attractive because of their simplicity, minimal use of equipment, they are environmentally friendly and are suitable for the removal of organic pollutants. The purpose of these products is to enhance the activities of beneficial microbes in order to improve treatment performance. This study was carried out to determine the potential of applying biochemical products in assisting and improving the performance of sewage treatment plants. In this study, four biochemical products, namely: Zeolite, Bio-C, Eco-B and Was-D, were applied to the sewage treatment plant. Analyses were carried out on several water quality parameters such as biochemical oxygen demand (BOD), chemical oxygen demand (COD), suspended solids (SS), oil & grease (O&G), phosphorus (P), ammoniacal nitrogen (AN) and sludge thickness (ST). From the results obtained, it can be seen that the overall performance of the treatment plant improved with most of the parameters studied were found to fulfill the DOE Standard B requirements. The performance of Bio-C was found to give better results than other products.

Finding hepatic portal venous gas in an adult patient: its significance

Portal venous gas is a well-established radiological finding in neonates. With the advancement in diagnostic imaging, more cases are being reported in adults. We present a 55-year-old man with radiological findings of both portal venous gas and pneumatosis intestinalis secondary to ischaemic necrotising enterocolitis, with subsequent fatality. The significance of finding portal venous gas and its possible aetiology is discussed.

A phase II study of induction therapy with carboplatin and gemcitabine among patients with locally advanced non-small cell lung cancer

INTRODUCTION

The objectives of this trial were to evaluate the activity and safety of gemcitabine carboplatin as induction therapy in patients with locally advanced non-small cell lung cancer

METHODS

Patients received two cycles of gemcitabine (1250 mg/m on day 1 and 8), plus carboplatin (area under the curve = 5 on day 1), after which response was established. Patients received a third course only in the case of an objective response (OR). Non-responding patients were directly irradiated. Toxicity was assessed according to the NCI-CTC version 2, radiation toxicity was assessed according to RTOG criteria. Response evaluation was performed according to RECIST criteria.

RESULTS

We identified 42 patients, of whom 37 were eligible. Of these, 51% (95% CI, 34%-68%) achieved an OR, all partial responses. No disease progression on therapy was established. Toxicity was mostly hematological: 35% trombocytopenia grade 3 and 4, and 40% neutropenia grade 3 and 4. No severe bleeding or hospitalization because of febrile neutropenia occurred.

CONCLUSIONS

Gemcitabine and carboplatin administered according to a 3-week schedule is an active and safe induction regimen. Pending the results of a phase III study, we believe that it is a reasonable alternative among patients for whom cisplatin-based chemotherapy is contraindicated.

A pilot project on hospital-based universal newborn hearing screening: lessons learned

OBJECTIVE

This paper reports the performance of a newly implemented hospital-based universal newborn hearing screening programme and the challenges to the effective implementation.

METHODS

Data of 4437 babies screened from April 2003 to February 2004 at Hospital Universiti Kebangsaan Malaysia was analyzed to measure the performance of the newborn hearing screening programme. Quality indicators, which include the coverage rate, initial refer rate, return for follow-up rate, ages of diagnosis and intervention were calculated. Factors contributing to poor compliance for follow-up were examined through questionnaire survey of 341 parents who did not bring their babies for the initial screening follow-up.

RESULTS

The findings of this study revealed unsatisfactory performance of the hearing screening programme compared to the Joint committee of Infant Hearing recommendation [Joint Committee on Infant Hearing Year 2000 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs, Pediatrics 106 (4) (2000) 798-817]. The coverage rate, initial refer rate, and return for follow-up rate were 84.64, 11.97 and 56.97%, respectively. The average age of diagnosis was 3.56 months (S.D. 1.33). Only 1 of the 16 babies identified as having hearing loss through the screening programme has been fitted with hearing aids. Delay in coming to audiological certainty was one of the reasons hampering early intervention of these children. The commonly cited reasons for not returning for screening follow-up reflect the need to create public awareness of the importance of early diagnosis and intervention of hearing loss.

CONCLUSIONS

The implementation of the present screening programme needs to be reviewed. Factors contributing to its unsatisfactory performance must be identified and steps must be taken to resolve them so that early identification and intervention of permanent congenital hearing loss can become a reality.

[Problematic cases of mesothelioma reported to the Dutch Institute for Asbestos Victims: evaluation by the Mesothelioma Working Group of the Netherlands Association of Pulmonologists and Specialists in Tuberculosis]

OBJECTIVE

To analyse the assessments of problematic cases reported to the Dutch Institute for Asbestos Victims (IAS) by the Mesothelioma Working Party of the Netherlands Association of Pulmonologists and Specialists in Tuberculosis (NVALT).

DESIGN

Descriptive.

METHOD

The pathological confirmation of a malignant pleural mesothelioma of occupational origin is difficult in about 10% of the cases. The IAS has requested the Mesothelioma Working Party of the NVALT to review these cases. When no definitive diagnosis can be made on histological or cytological grounds, three pulmonologists reach a conclusion on the basis of correspondence, X-ray examination and other information.

RESULTS

In the period January 2000--March 2004 the Working Party evaluated 132 cases, two-thirds of whom (n = 89) were assessed to be compatible with 'malignant pleural mesothelioma' and one-third of whom (n = 43) were felt to be non-compatible. In 69% of the cases (91/132) the conclusions of the three independent specialists were unanimous. The median time from request to report was 25 days (range: 1-185).

CONCLUSION

This approach was effective and rapid.

Which colorectal cancers are missed by double contrast barium enema?

BACKGROUND

The relative merits of either barium enema or colonoscopy for investigating lower gastrointestinal tract symptoms is still unclear. We studied the value of double contrast barium enema (DCBE) as the initial evaluation modality. We reviewed our 10-year experience of double contrast enemas as read by consultant radiologists. The study also aimed to identify which lesions are usually missed.

PATIENTS AND METHODS

We reviewed clinical data for all patients who underwent DCBE within the 6 months prior to surgical resection of colorectal cancer between April 1989 and April 1999. Patient demographics and tumour characteristics were analysed for their effects on the likelihood of the lesions being missed at DCBE.

RESULTS

There were 706 patients included in the study, 54.2% were male and the mean age was 63.7 years (SEM=0.5 years). The site along the colon and rectum of tumours missed by DCBE corresponded with the frequency of tumour occurrence at each site. The overall rate of missed lesions was 4.1% (29 of 706 patients); these patients were found on subsequent endoscopy to harbour cancer. Tumours less than 3 cm in length and with lesser extent of circumferential involvement were more likely missed at DCBE (p=0.05 and p=0.01, respectively). Age, sex, and tumour grade and stage were not significant predictors of the likelihood of missed lesions. Of the 29 patients with missed lesions, 77.2% had a serum concentration of carcinoembryonic antigen (CEA) above the normal range (3.5 microg/l). The mean follow-up was 65.3 months (SEM=1.8 months). The overall survival for this series was 60.1%. The inaccuracy of the initial DCBE was not found to cause statistically significant differences in the stage of the tumour at diagnosis nor the overall survival of the patients in our series.

CONCLUSIONS

Smaller cancers without circumferential involvement may be missed when DCBE is performed to evaluate lower gastrointestinal symptoms. Further evaluation by colonoscopy must be recommended when symptoms persist, especially in the context of a raised CEA level.

Open reduction and internal fixation of fractures of the acetabulum--local experience

INTRODUCTION

It is now widely accepted that open reduction and internal fixation of displaced acetabular fractures should be the standard of care. This paper reports a case series of acetabular fracture fixation performed at the Changi General Hospital by a single trauma surgeon.

PATIENTS AND METHODS

A retrospective study was conducted of 15 consecutive cases of displaced acetabular fracture fixation between February 1996 and September 1999. Outcome was assessed radiologically and functionally with the use of a hip scoring system used by Matta.

RESULTS

The patients' age had a mean of 34.9 years. All fractures were a result of high energy trauma. The median duration to operation upon admission was eight days. The mean hospital stay was 24.9 days and the mean medical hospitalisation leave was 159 days. Bony union was achieved in all patients. Two patients (13.3%) had a residual displacement of 1 mm. Four patients (26.6%) had a residual displacement of 2 mm. Of these four patients with 2 mm displacement, two eventually developed osteoarthritis. Subsequently, one of the two with OA required revision to a total hip arthroplasty two years post fracture. Other complications include 1 (6%) wound infection and 2 (13%) deep vein thrombosis. There were no complications of heterotopic ossification or sciatic nerve injury. Functional scores with a minimum follow up of one year and a mean of 22.6 months follow-up were excellent in 13.3%, good in 66.7%, fair in 13.3% and poor in 6.7%.

CONCLUSION

The number of cases in this paper is insufficient to produce any statisticallly significant outcome predictors but accuracy of reduction is an important factor. A good to excellent result was attained in 80% of the patients which confirms that open reduction and internal fixation is the treatment of choice for displaced and acetabular fractures.

[Severe respiratory symptoms following the use of waterproofing sprays]

Five patients became short of breath following the use of a waterproofing spray in an unventilated room: one 40-year-old woman and 4 men aged 40, 18, 21 and 39 years, respectively. After treatment the complaints diminished within the course of a few weeks. Waterproofing sprays are commonly used to make clothing and shoes water-repellent. Several hours after inhalation of such sprays symptoms of dyspnoea can occur. Without therapy this can lead to pulmonary fibrosis. Corticosteroid therapy seems to shorten the duration of complaints in the acute phase and preclude fibrosis. It is therefore advisable to present patients with respiratory complaints following inhalation of waterproofing sprays at an emergency department. A chest X-ray and blood gas analysis should be performed. In case of abnormalities, patients should be hospitalised.

Toxicity assays to determine the start-up strategy for an anaerobic sequencing batch reactor (anSBR)

Addition of glucose as the co-substrate and the use of a water-based polymer to enhance granulation were studied with the aim of shortening the start-up period of an anSBR (anerobic sequencing batch reactor) for high-strength industrial wastewater treatment. An initial start-up feed composition consisting of 70% sucrose and 30% industrial wastewater was favorable to reduce the start-up time. Increase in the average particle size and reduction in settled supernatant turbidity was observed with increased water-based polymer addition up to a concentration of 0.1 m/L. Polymer dosages above 0.1 ml/L were undesirable as big and "flaky" flocs were formed which prevented the flocs from settling quickly. Addition of 0.005 ml/L to 0.1 ml/L polymer to the mixed liquor had no observable adverse effects on the anaerobic biomass metabolism. Instead, the addition of the polymer appeared to improve biogas production and had an overall positive effect on anSBR performance treating the industrial wastewater.

Clinics in diagnostic imaging (50). Leiomyosarcoma of bladder

A 39-year-old man presented with intermittent painless macroscopic haematuria. He was subsequently diagnosed to have a high grade leiomyosarcoma of the bladder. He underwent total cystoprostatectomy and radiotherapy but died of metastatic disease five months after the initial diagnosis. Aspects of the imaging and diagnostic pathway of painless haematuria are discussed. The management of leiomyosarcomas in the urinary system is highlighted.

Normal human immunoglobulin G4 is bispecific: it has two different antigen-combining sites

Unlike other immunoglobulin G (IgG) subclasses, IgG4 antibodies in plasma have been reported to be functionally monovalent. In this paper we show that the apparent monovalency of circulating IgG4 is caused by asymmetry of plasma IgG4. A large fraction of plasma IgG4 molecules have two different antigen-binding sites, resulting in bispecificity. Sera from patients with IgG4 antibodies to both house dust mite and grass pollen induced cross-linking of Sepharose-bound grass pollen antigen to radiolabelled house dust mite allergen Der p I. This bispecific binding activity was not observed in sera with IgG4 antibodies to either grass pollen or house dust mite exclusively. Depletion of IgG4 antibodies resulted in disappearance of the bispecific activity. By size exclusion chromatography we excluded the possibility that bispecific activity was caused by aggregation of IgG4 antibodies. These results indicate that circulating (polyclonal) IgG4 antibodies have two different antigen-binding sites and therefore are functionally monovalent antibodies.

[Pleural amyloidosis as a cause of excessive pleural effusions]

A 83-year-old woman known with a stable disease multiple myeloma was hospitalized frequently with dyspnoea caused by copious bilateral pleural effusions. Thoracentesis was performed repeatedly but pleural effusions returned. Extensive laboratory and radiological examinations failed to reveal the cause of the pleural effusions. Finally, after pleural biopsy the diagnosis of amyloidosis of the pleura could be made. The patient died in hospital from a stroke. Pleural amyloidosis is rarely reported and is accompanied by large uni- or bilateral pleural effusions even without amyloidosis of the heart.

[Chickenpox: varicella pneumonia in adults]

Two patients, a man aged 33 years and a woman aged 30, suffered from a varicella zoster induced pneumonia. In adults a varicella zoster infection may be accompanied by a very severe pneumonia. In one patient mechanical ventilation was necessary. A chest X-ray and blood gas analysis must be made in adults suffering from a varicella zoster virus infection who have pulmonary complaints. In case of abnormalities in one of these two examinations the patient must be observed in a clinical setting. The pneumonia can be treated with aciclovir.

Measurement of IgE antibodies against purified grass pollen allergens (Lol p 1, 2, 3 and 5) during immunotherapy

BACKGROUND

IgE titres tend to rise early after the start of immunotherapy, followed by a decline to pre-immunotherapy levels or lower.

OBJECTIVES

We were interested to know whether the early increase in IgE antibodies includes new specificities of IgE, and whether these responses persist.

METHODS

Sera of 64 patients undergoing grass pollen immunotherapy were tested for IgE against four purified grass pollen allergens: Lol p 1, 2, 3, and 5. At least two serum samples were taken, one before the start of therapy and one between 5 and 18 months after the first immunization (mean: 10 months).

RESULTS

The mean IgE responses to Lol p 1, 2 and 3 showed a moderate but not significant increase. In contrast, the mean IgE response to Lol p 5 showed a significant decrease of > 30%. IgE against total Lohum perenne pollen extract moderately increased (> 20%), showing that a RAST for total pollen is not always indicative for the development of IgE against its major allergens. For > 40% of the patients it was found that IgE against one or more of the four allergens increased, while IgE against the remaining allergen(s) decreased. For 10 sera the ratio of IgE titres against at least two allergens changed by at least a factor of 5. The changes in specific IgE also included conversions from negative (< 0.1 RU) to positive (0.6 to 5.0 RU) for five patients. For two patients, the induction of these 'new' IgE antibodies against major allergens was shown to result in a response that was persistent over several years.

CONCLUSION

Although active induction of new IgE specificities by immunotherapy was not really proven, the observations in this study indicate that monitoring of IgE against purified (major) allergens is necessary to evaluate changes in specific IgE in a reliable way.

Once daily mometasone furoate aqueous nasal spray is as effective as twice daily beclomethasone dipropionate for treating perennial allergic rhinitis patients

BACKGROUND

Perennial allergic rhinitis is chronic and persistent, may lead to a constellation of secondary complaints including sinusitis, mouth-breathing, and some symptoms resembling a permanent cold, and often requires constant medical intervention. Well-tolerated nasal corticosteroids, alone or in combination with antihistamines, have been found to be very effective in treating this condition.

OBJECTIVE

To compare the effectiveness and tolerability of mometasone furoate aqueous suspension, a new once daily nasal spray, to placebo vehicle and to beclomethasone dipropionate, administered twice daily, in patients with perennial allergic rhinitis.

METHODS

This was a randomized, double-blind, placebo-controlled, double-dummy, parallel group study, in 427 patients age 12 years and older at 24 centers in Canada and Europe. Patients allergic to at least one perennial allergen, confirmed by medical history, skin testing, and adequate symptomatology were eligible to receive one of the following regimens for 3 months: mometasone furoate, 200 micrograms only daily; beclomethasone dipropionate, 200 micrograms twice daily (400 micrograms total dose); or placebo vehicle control. The primary efficacy variable was the change from baseline in total AM plus PM diary nasal symptom score over the first 15 days of treatment.

RESULTS

Three hundred eighty-seven patients were valid for efficacy. For the primary efficacy variable, mometasone furoate was significantly (P < or = .01) more effective than placebo and was indistinguishable from beclomethasone dipropionate. Similar trends were seen among individual symptoms, physician symptom evaluations, and therapeutic response. There was no evidence of tachyphylaxis. All treatments were well tolerated.

CONCLUSIONS

Mometasone furoate nasal spray adequately controls symptoms of perennial allergic rhinitis, offers the advantage of once daily treatment, and is well tolerated.

Grass pollen immunotherapy induces highly cross-reactive IgG antibodies to group V allergen from different grass species

Sera from two groups of patients receiving grass pollen immunotherapy were tested on IgG reactivity with group V allergen from six different grass species. One group of patients was treated with a mixture of 10 grass species, and the other with a mixture of five. Only Lolium perenne, Dactylis glomerata, and Phleum pratense were present in both mixtures. Although Anthoxanthum odoratum and Secale cereale were absent from the mixture of five, IgG responses to Ant o V and Sec c V were comparable in both patient groups. This reactivity was inhibited for 92-99% with L. perenne extract, illustrating the cross-reactive nature of the IgG antibodies. The presence of A. odoratum and S. cereale in the mixture resulted in only minor amounts of species-specific anti-group V IgG. These results indicate that application of just one grass species in immunotherapy might be sufficient to induce an IgG response that covers other relevant Gramineae species as well.

Use of trapped atoms to measure absolute photoionization cross sections

We describe a new technique for accurate measurement of absolute photoionization cross sections. By measuring the loss rateof atoms from a laser trap in the presence of ionizing light, we directly measure the photoionization rate. The only quantities requiring absolute calibration are the ionizing laser intensity and the fractional population in the relevant state. Our technique is capable of detecting extremely small ionization rates, which means that low-power cw sources can be used. We have applied this method to photoionization from the 5P(3/2) state of rubidium at wavelengths of 413 and 407 nm.The cross sections are 1.36(12) x 10(-17) and 1.25(11) x 10(-17) cm(2) , respectively.

Miliary tuberculosis presenting with thyrotoxicosis

A male patient is described who presented with thyrotoxicosis, and a large painful neck mass. From the excised mass and stomach aspiration Mycobacterium tuberculosis was cultured and a diagnosis of miliary tuberculosis was made. The thyrotoxicosis was attributed to tuberculous thyroiditis.