Inter-fractional monitoring of [Formula: see text]C ions treatments: results from a clinical trial at the CNAO facility

The high dose conformity and healthy tissue sparing achievable in Particle Therapy when using C ions calls for safety factors in treatment planning, to prevent the tumor under-dosage related to the possible occurrence of inter-fractional morphological changes during a treatment. This limitation could be overcome by a range monitor, still missing in clinical routine, capable of providing on-line feedback. The Dose Profiler (DP) is a detector developed within the INnovative Solution for In-beam Dosimetry in hadronthErapy (INSIDE) collaboration for the monitoring of carbon ion treatments at the CNAO facility (Centro Nazionale di Adroterapia Oncologica) exploiting the detection of charged secondary fragments that escape from the patient. The DP capability to detect inter-fractional changes is demonstrated by comparing the obtained fragment emission maps in different fractions of the treatments enrolled in the first ever clinical trial of such a monitoring system, performed at CNAO. The case of a CNAO patient that underwent a significant morphological change is presented in detail, focusing on the implications that can be drawn for the achievable inter-fractional monitoring DP sensitivity in real clinical conditions. The results have been cross-checked against a simulation study.

New trends in adjunctive treatment and diagnosis in medication-related osteonecrosis of the jaw: A 10-year review

Medication-related osteonecrosis of the jaw (MRONJ) is a major disease under study for over the last twenty years. Different classifications have been proposed and many therapies for the different stages have been applied. The evolution of treatments lead to an increasingly conservative approach. Numerous adjuvant treatments have been proposed in the last decade. All these complementary treatments have been proposed mainly to resolve or reduce the painful stress, predominantly caused by bacterial infection, simplifying the wound healing process and improving patients' compliance. Nowadays "secondary" treatments, such as autologous platelet concentrates (APCs, more specifically PRP, PRGF or PRF), hyperbaric oxygen (HBO), Auto/tetracycline fluorescence-guided bone surgery (AF-GBS/TF-GBS), medical drugs like teriparatide or the combination between pentoxifylline and tocopherol, fluorodeoxyglucose positron emission tomography (FDG-PET), laser and/or low-laser therapy and ozone therapy are more or less well documented and known considering their clinical effectiveness. The aim of the present review is the evaluation of the quantity and quality of scientific studies concerning this specific topic.

Review and performance of the Dose Profiler, a particle therapy treatments online monitor

Particle therapy (PT) can exploit heavy ions (such as He, C or O) to enhance the treatment efficacy, profiting from the increased Relative Biological Effectiveness and Oxygen Enhancement Ratio of these projectiles with respect to proton beams. To maximise the gain in tumor control probability a precise online monitoring of the dose release is needed, avoiding unnecessary large safety margins surroundings the tumor volume accounting for possible patient mispositioning or morphological changes with respect to the initial CT scan. The Dose Profiler (DP) detector, presented in this manuscript, is a scintillating fibres tracker of charged secondary particles (mainly protons) that will be operating during the treatment, allowing for an online range monitoring. Such monitoring technique is particularly promising in the context of heavy ions PT, in which the precision achievable by other techniques based on secondary photons detection is limited by the environmental background during the beam delivery. Developed and built at the SBAI department of "La Sapienza", within the INSIDE collaboration and as part of a Centro Fermi flagship project, the DP is a tracker detector specifically designed and planned for clinical applications inside a PT treatment room. The DP operation in clinical like conditions has been tested with the proton and carbon ions beams of Trento proton-therapy center and of the CNAO facility. In this contribution the detector performances are presented, in the context of the carbon ions monitoring clinical trial that is about to start at the CNAO centre.

Cardiorespiratory and gastrointestinal parasites of dogs in north-west Italy

The present study was conducted to evaluate the prevalence of gastrointestinal and cardio-respiratory parasites in dogs in Liguria (northwest Italy) which is a region that has scarcely been studied. A total of 450 dogs (260 males and 190 females) were enrolled in the study from 2009 and 2013. All dogs lived in a rural or semi-rural environment in the provinces of Imperia (n = 352) or Savona (n = 98), Liguria. Coprological examinations showed that 197 dogs (43.8 %, CI 38.7-48.9 %) were infected by parasites. Specifically, 3.3 % of the dogs presented only cardio-respiratory species, 32.4 % only intestinal species, and 8.0 % presented a mixed infection.

The most frequent intestinal parasites were Toxocara canis (20 %), Trichuris vulpis (17.8 %), Ancylostomatidae (12 %), Coccidia (2.7 %), Aonchotheca putorii (1.8 %) and Toxascaris leonina (1.8 %). The cardio-respiratory species found were Eucoleus aerophilus (9.6 %), Eucoleus boehmi (1.6 %), Angiostrongylus vasorum (0.7 %), and Crenosoma vulpis (0.2 %). A total of 116 dogs (25.8 %) were parasitized by a single species, multiple infections were observed in 81 dogs (18.0 %) up to a six-order infection.

This preliminary study highlighted that the prevalence of intestinal parasites in investigated area is high. Cardio respiratory parasites were detected in an area that has not been investigated before. The creation of a more extensive sampling programme of the area, on a provincial basis in order to build a more detailed map of prevalences for different species of dog parasites throughout Liguria, a more extensive sampling programme of the area needs to be created - ideally for each province.

Intestinal helminths of red foxes (Vulpes vulpes) in north-west Italy

A total of 180 foxes (Vulpes vulpes) from an area scarcely investigated of north-west Italy, were examined for intestinal helminths using sedimentation and counting technique (SCT). Faecal samples were submitted to centrifugation with 50 % zinc sulphate used as flotation solution.

No fox was found completely negative for intestinal helminths. The most frequently identified nematodes were Uncinaria stenocephala (70.0 %), Molineus legerae (27.2 %), Toxocara canis (26.7 %), Toxascaris leonina (25.6 %), Trichuris vulpis (21.1 %), Aonchotheca putorii (8.9 %), Pterygodermatites affinis (5.6 %). Genus Mesocestoides (81.7 %), family Dilepididae (29.4 %) and Taenia spp. (8.3 %) were the most prevalent cestodes. All foxes were negative for E. multilocularis and E. granulosus. In two foxes trematodes belonging to the family Plagiorchidae were found.

The study highlighted that foxes are hosts of intestinal helminths of veterinary and medical importance which may be transmitted to dogs and humans.

First report of Eucoleus boehmi (syn. Capillaria boehmi) in dogs in north-western Italy, with scanning electron microscopy of the eggs

Dogs can be infected by several nematodes of the Trichuridae family. Trichuridae eggs are all similar, barrel shaped with polar plugs, and misdiagnosis among different species can occur. The most common species is Trichuris vulpis, while the respiratory parasites Eucoleus boehmi (syn. Capillaria boehmi) and Eucoleus aerophilus (syn. Capillaria aerophila) are rarely observed in pets. E. boehmi is reported for the first time in this study in north-western Italy with other Trichuridae. Dog faecal samples (270) were examined by flotation. E. boehmi (2.2%), E. aerophilus (4.4%) and T. vulpis (12.2%) were found; identification was done with measurements and through observation of morphological characters already known. The specific identification of E. boehmi was confirmed using scanning electron microscopy: its egg shell shows a dense network with a fine mesh, surrounding small pits, on the contrary E. aerophilus eggs present a thick mesh with wide depressions, while T. vulpis eggs surface is smooth.

Care manager to control cardiovascular risk factors in primary care: the Raffaello cluster randomized trial

BACKGROUND AND AIM

This cluster randomized trial evaluated the efficacy of a disease and care management (D&CM) model in cardiovascular (CVD) prevention in primary care.

METHODS AND RESULTS

Eligible subjects had ≥ 1 among: blood pressure ≥ 140/90 mmHg; glycated hemoglobin ≥ 7%; LDL-cholesterol ≥ 160 or ≥ 100 mg/dL (primary or secondary prevention, respectively); BMI ≥ 30; current smoking. The D&CM intervention included a teamwork including nurses as care managers for the implementation of tailored care plans. Control group was allocated to usual-care. The main outcome was the proportion of subjects achieving recommended clinical targets for ≥ 1 of uncontrolled CVD risk factors at 12-month. During 2008-2009 we enrolled 920 subjects in the Abruzzo/Marche regions, Italy. Following the exclusion of L'Aquila due to 2009 earthquake, final analyses included 762 subjects. The primary outcome was achieved by 39.1% (95%CI: 34.2-44.2) and 25.2% (95%CI: 20.9-29.9) of subjects in the intervention and usual-care group, respectively (p < 0.001). The D&CM intervention significantly increased the proportion of subjects who achieved clinical targets for both diabetes and hypertension, with no differences in hypercholesterolemia, smoking status and obesity.

CONCLUSIONS

The D&CM intervention was effective in controlling cardiovascular risk factors, in particular hypertension and diabetes. Numbers needed to treat were small. Such intervention may deserve further consideration in clinical practice.

REGISTRATION NUMBER

ACTRN12611000813987.

In vivo and in vitro immunomodulation of Der p 1 allergen-specific response by Lactobacillus plantarum bacteria

BACKGROUND

Lactic acid bacteria (LAB) were reported to reduce some allergic manifestations in mice and humans but their impact on the aeroallergen-dependent immune mechanisms is still debated.

OBJECTIVE

The potential capacities of Lactobacillus plantarum NCIMB8826 to reduce the allergic response induced by Der p 1, the major house dust mite allergen of Dermatophagoides pteronyssinus, were evaluated in vivo and in vitro. Methods First, the effect of the intranasal co-administration of LAB and purified Der p 1 allergen before a sensitization protocol was evaluated. The allergen-specific antibody and cellular responses as well as airway inflammation were measured. Second, the impact of LAB on the cytokine profile of spleens cells from Der p 1-sensitized mice was assessed. Third, upon stimulation with LAB, the levels of cytokine produced by dendritic cells derived from the bone marrow (BMDCs) of wild-type, Toll-like receptor 2 (TLR2)-, TLR4- and MyD88-KO mice were compared. Results The co-application of L. plantarum and Der p 1 induced a T-helper type 1 (Th1)-biased allergen-specific IgG response, the absence of specific IgE response and favoured the production of INF-gamma upon allergen re-stimulation. Moreover, the previous LAB administration reduced the development of bronchoalveolar lavage eosinophilia usually induced by aerosol exposure. Additionally, the studied LAB strain was shown to modify in vitro the cytokine level produced by Der p 1-sensitized spleen cells mainly towards a Th1 profile. Finally, L. plantarum stimulated high IL-12 and moderate IL-10 production in mouse BMDCs notably through the TLR2-, MyD88-dependent and TLR4-independent pathway.

CONCLUSION

In vivo co-administration of probiotic LAB with Der p 1 might prevent the development of the mite allergic response. The probiotic L. plantarum was shown to display in vitro therapeutic potentials for the treatment of allergy and to trigger the immune system by a TLR2- and MyD88-dependent signalling pathway.

Feline leukaemia virus (FeLV) and feline immunodeficiency virus infections in cats in the Pisa district of Tuscany, and attempts to control FeLV infection in a colony of domestic cats by vaccination

The seroprevalence of feline immunodeficiency virus (FIV) in 203 apparently healthy domestic cats living in the district of Pisa, central Italy, was 11.3 per cent, and the prevalence of feline leukaemia virus (FeLV) was 8.4 per cent. The prevalence of FIV depended significantly on the lifestyle and age of the cats; cats living outdoors were more likely to be FIV-positive than cats living indoors, and the proportion of FIV-positive cats increased with age. In contrast, there was no significant relationship between these variables and the prevalence of FeLV. There was no significant relationship between the cats' seropositivity for FIV and FeLV. The results of a five-year field study to control FeLV infection by vaccination in a colony of 30 domestic adult cats naturally exposed to the infection suggest that the vaccination was effective in FIV-negative cats, but failed to protect FIV-positive cats against FeLV.

Natural vectors of dirofilariasis in rural and urban areas of the Tuscan region, central Italy

Entomological investigations by means of dog- and human-baited traps were carried out in summers 2000-2002 in urban and rural areas of the Tuscan region in central Italy. The aim of the study was to define the mosquito species involved in the transmission of Dirofilaria nematodes and to assess the risk that their presence might represent for animal and human health. Nocturnal fieldwork on host-seeking activity and feeding preferences was followed by microscopic identification of the mosquito species attracted and by molecular identification of Dirofilaria parasites in mosquitoes. In total, 3,611 mosquito females belonging to 12 species, largely represented by Culex pipiens L. and Aedes caspius (Pallas), were caught. Some females of each species collected fed on the dogs, indicating their possible role as an intermediate host, but filarial DNA was found only in Cx. pipiens, Anopheles maculipennis s.l. (Meigen), and Coquillettidia richiardii (Ficalbi). In rural environments, the DNA evidence indicated the presence of infective larvae of Dirofilaria immitis, whereas in urban areas, infective larvae of Dirofilaria repens were present. The role of Cx. pipiens as a vector for heartworm disease and subcutaneous infections in natural and artificial environments was confirmed, whereas Ae. caspius seemed refractory to the infection. The different role of the collected species is discussed. The vector competence of An. maculipennis and Cq. richiardii needs further investigation, because the importance of these species poorly represented, and the role of species such as Aedes albopictus (Skuse), characterized by a dominant diurnal activity pattern, has to be evaluated.

Phoretic association of mites and mallophaga with the pigeon flyPseudolynchia canariensis

Myialges anchora Trouessart, 1906 and M. lophortyx (Furman & Tarshis, 1953) gravid females, surrounded by clusters of eggs, were found strongly inserted into the cuticle of head, thorax, abdomen, femurs and wings of Pseudolynchia canariensis (Macquart, 1840), a hippoboscid fly parasite of the pigeon. This lousefly results obligatory host for ovigerous females of Myialges and for the development of their eggs, and phoretic host because the dispersal of hatching larvae to new hosts may then occur with dispersal of fly carriers. Together with the Myiolges species, not ovigerous females of Ornithocheyletia hallae Smiley, 1970 and Columbicola columbae (Linnaeus, 1758) were found on the pigeon fly.

Necropsy and coprology in wild boar (Sus scrofa) in Livorno Mountain Park (Tuscany, Central Italy)

The present research analyses the reliability of coprological tests, both quantitative and qualitative, as indicators of the parasite burden of hosts, using data from wild boars (Sus scrofa) living in Livorno Mountain Park (Tuscany, Central Italy). In the case of intestinal strongyles, which turned out to be the dominant helminths of wild boars, the qualitative coprological test appears as a bad predictor of the real parasite situation of the herds, due to the high number of false negative results (34 animals out of 68). On the other hand, the positive predictive value of the test is high (90%). The quantitative test is significantly correlated with the individual parasite burden of wild boars.

Absence of immunoglobulin E synthesis and airway eosinophilia by vaccination with plasmid DNA encoding ProDer p 1

BACKGROUND

Various studies have shown that immunization with naked DNA encoding allergens induces T helper 1(Th1)-biased non-allergic responses.

OBJECTIVE

To evaluate the polarization of the immune responses induced by vaccinations with plasmid DNA encoding the major mite allergen precursor ProDer p 1.

METHODS

A DNA vaccine was constructed on the basis of a synthetic cDNA encoding ProDer p 1 with optimized codon usage. The immunogenicity of ProDer p 1 DNA in CBA/J mice was compared with that of purified natural Der p 1 or recombinant ProDer p 1 adjuvanted with alum. Vaccinated mice were subsequently exposed to aerosolized house dust mite extracts to provoke airway inflammation. The presence of inflammatory cells was examined in bronchoalveolar lavage (BAL) fluids and allergen-specific T cell reactivity was measured.

RESULTS

Naive mice immunized with ProDer p 1 DNA developed Th1 immune responses characterized by high titres of specific IgG2a antibodies, low titres of specific IgG1 and, remarkably, the absence of anti-ProDer p 1 IgE. No specific responses were observed in animals vaccinated with the blank DNA vector. By contrast, natural Der p 1 or recombinant ProDer p 1 adsorbed to alum induced pronounced Th2 allergic responses with strong specific IgG1 and IgE titres. Spleen cells from DNA ProDer p 1-vaccinated mice secreted high levels of IFN-gamma and low production of IL-5. Conversely, both adjuvanted allergens stimulated typical Th2-type cytokine profile characterized by high and low levels of IL-5 and IFN-gamma, respectively. Whereas BAL eosinophilia was clearly observed in Der p 1-immunized animals, ProDer p 1 DNA as well as ProDer p 1 vaccinations prevented airway eosinophil infiltrations.

CONCLUSIONS

These results suggest that vaccination with DNA encoding ProDer p 1 effectively fails to induce the allergen-induced IgE synthesis and airway cell infiltration. Plasmid DNA encoding ProDer p 1 may provide a novel approach for the treatment of house dust mite allergy.

Epidemiological study of the intestinal helminths of wild boar (Sus scrofa) and mouflon (Ovis gmelini musimon) in central Italy

Since 1995 the population of wild ungulates increased significantly in the "Parco provinciale dei Monti Livornesi" (Livorno, Tuscany, Central Italy). We studied the intestinal macroparasites of two hosts, the wild boar (Sus scrofa) and the mouflon (Ovis gmelini musimon). In the case of wild boars we found a dominant parasite species, Globocephalus urosubulatus. For this parasite the frequency distribution of the number of parasites per host agrees with a negative binomial distribution. There is not a significant correlation between the age of the animals and the parasitosis. Furthermore the mean parasite burden of male and female wild boars does not differ significantly. In the case of mouflons we found a dominant parasite species Nematodirus filicollis with Trichuris ovis as codominant species.

High-level expression of recombinant house dust mite allergen Der p 1 in Pichia pastoris

BACKGROUND

The major house dust mite Der p 1 allergen is associated with allergic disease. Heterologous over-expression of biologically active Der p 1 was previously attempted but with limited success.

OBJECTIVE

The aim of this study was to establish an efficient system for the production of recombinant Der p 1.

METHODS

The proform of Der p 1 was expressed in Pichia pastoris as a fusion with the alpha mating factor signal sequence. The recombinant product was purified from culture medium and compared to Der p 1 isolated from mite culture, in terms of enzymatic activity as well as IgE binding capacity.

RESULTS

ProDer p 1 was efficiently secreted into culture medium as a hyperglycosylated protein of 40-60 kDa. Postpurification dialysis in acidic buffer was required for the autocatalytic processing of Der p 1. During this treatment, the prosequence was efficiently removed to give highly glycosylated recombinant mature Der p 1. Competition ELISA experiments as well as cysteine proteinase activity assays indicated that recombinant processed Der p 1 was similar to natural Der p 1 isolated from mite cultures in terms of IgE binding and enzymatic activities. However, the histamine releasing activity of recombinant Der p 1 was slightly weaker than that of natural Der p 1.

CONCLUSION

This efficient system for recombinant Der p 1 expression leads the way for the design of new diagnostics for house dust mite allergy, epitope mapping, allergen engineering, structural and immunological studies and new immunotherapeutic treatments.

High-level expression in mammalian cells of recombinant house dust mite allergen ProDer p 1 with optimized codon usage

BACKGROUND

The major house dust mite allergen Der p 1 is associated with allergic diseases such as asthma. Production of recombinant Der p 1 was previously attempted, but with limited success. The present study describes the expression of recombinant (rec) ProDer p 1, a recombinant precursor form of Der p 1, in CHO cells.

METHODS

As optimization of the codon usage may allow successful overexpression of protein in mammalian cells, a synthetic gene encoding ProDer p 1 was designed on the basis of the codon usage frequently found in highly expressed human genes. Gene synthesis was accomplished from a set of 14 mutually priming overlapping oligonucleotides and after two runs of polymerase chain reaction.

RESULTS

COS cells transiently transfected with the synthetic ProDer p 1 gene produced up to 5--10 times as much ProDer p 1 compared with the expression level obtained after transfection with the authentic gene. To stably express the recombinant allergen, CHO-K1 cells were transfected with the ProDer p 1 synthetic gene, and one amplified recombinant clone produced up to 30 mg of recProDer p 1 per liter in the culture medium before purification. recProDer p 1 was secreted as an enzymatically inactive single-chain molecule presenting three glycosylated immunoreactive forms of 41, 38 and 36 kD. When examined with respect to direct binding, recProDer p 1 and natural Der p 1 displayed very similar IgE reactivities. However, IgE inhibition and histamine release assays showed a much higher reactivity to natural Der p 1 compared to recProDer p 1.

CONCLUSIONS

These data indicated that codon optimization represents an attractive strategy for high-level production of allergen in mammalian cells.

5 S ribosomal spacer sequences of some filarial parasites: comparative analysis and diagnostic applications

We have amplified by PCR the sequences of the 5 S ribosomal spacer of Setaria labiatopapillosa and Foleyella furcata. After sequencing, these sequences have been compared with those of Dirofilaria immitis and Dirofilaria repens. Two major goals have been achieved: (i) the establishment of a multiplex PCR-based diagnostic assay, applicable to identify the four species in vertebrate and invertebrate hosts; (ii) the identification, in S. labiatopapillosa and F. furcata, of a canonical spliced leader 1 (SL1) sequence, so confirming that only D. repens, of the filarial parasites so far studied, shows a peculiar SL1 sequence. The PCR assay here developed and the analysis of the 5 S ribosomal spacer, can further improve both epidemiological and molecular analysis of these filarial species.

The parasites of the badger (Meles meles) in the north of Mugello (Florence, Italy)

During the period January 1993-June 1994, a parasitological survey was carried out on 19 badgers (Meles meles) road killed in Northern Mugello (Florence). The following helminths (together with their prevalence) were isolated and classified: Uncinaria criniformis (84.2%); Capillaria sp. (31.6%); Molineus patens (21.1%); Mesocestoides melesi (21.1%); Aelurostrongylus falciformis (52.6%); Crenosoma melesi (21.1%). According to results, only sex related differences in prevalence were studied. The parasite biocenosis is composed exclusively by dominant and codominant species. Mesocestoides melesi represents the first record for Italy. All the species found fitted a negative binomial distribution.

Light and scan electron microscopic analysis of cyclops syndrome: etiopathogenic hypothesis and technical solutions

The loss of range of motion after anterior cruciate ligament (ACL) reconstruction is one of the most common and most challenging complications of this kind of surgery. Recently, an intercondylar notch fibrous proliferation, called cyclops syndrome because of its arthroscopic appearance, has been identified as one of the specific causes of loss of extension. The incidence of cyclops syndrome is 2%-4% [17, 18], but there is still no understanding of its etiology. We speculate on the etiology and suggest some technical solutions to reduce this complication. In 180 patients submitted to arthroscopic ACL reconstruction with patellar tendon, we observed in 4 cases a fibrous nodule adherent to the neoligament that caused a loss of extension between 12 degrees and 17 degrees. In all cases, arthroscopic removal of this nodule solved completely the loss of articular motion. The nodules were subjected to light and scanning electron microscope evaluation. We observed numerous, newly formed vessels in all 4 nodules. These vessels were made up of hyperplastic and hypertrophic cells and were surrounded by bundles of disorganized fibrous tissue. No inflammatory cells or bone or cartilaginous tissue was observed. We hypothesize a microtraumatic genesis for cyclops syndrome. Repeated microtraumas expose the graft collagen fibers, which can lead to productive inflammatory process and thence to the formation of the cyclops nodule. We suggest some technical solutions to avoid graft impingement with the notch and with the tibial bone tunnel.

[Efficacy of ivermectin in preventing Dirofilaria repens infestation in dogs naturally exposed to contagion]

The ability of ivermectin to control canine dirofilariosis in naturally infected dogs was tested. Two studies were carried out in the coast line of Grosseto district (Italy), where D. repens infection is endemic. A sample of 384 dogs from the area was examined as background controls and we found D. repens in 21.1%, D. immitis in 7.8% and both species in 6.5%. In the first study we used 72 privately-owned dogs, of varying sex, breed and age; all animals were negative to Knott's modified test for microfilariae and to CITE test for the adult antigens. All the dogs were treated monthly per os with tablets of ivermectin (> or = 6 mcg/kg) seven times from May 1991. All dogs were found negative for microfilariae 6-8 months after the last treatment. The second experiment was carried out on 16 Beagles aged 5.5-7 months (8 control dogs and 8 treated dogs). The dogs lived in a semi-open kennel in the selected area. We treated 8 dogs--8 times at monthly intervals, starting in June--with ivermectin tablets per os (> or = 6 mcg/kg). The monthly examination for circulating microfilariae (Knott's modified test) showed D. repens in two control dogs 7 months after the beginning of the experiment, one month later in 6 control and in another control animal also positive for D. immitis between the 10th and 11th month. Treated dogs were always negative. At the necropsy of all the dogs, about 11 months after the beginning of the experiment, we found adults or pre-adults of filariae in all the control dogs. Four animals had a double infection, 3 with D. repens and one with D. immitis. We never found adults or pre-adults of filariae in treated dogs.

Hoffa disease

Among the causes of anterior knee pain, impingement of portions of the infrapatellar fat pad between the femoropatellar and femorotibial articular surfaces plays an important role. This disease, first described by Hoffa in 1904, has always been fairly obscure. This review of 63 cases delineates the clinical features, distinguishing two phases, acute and chronic, and analyzing the pathologic changes in the fat pad and the other joint structures involved. Treatment of both the chronic and acute phases is described, emphasizing the importance of arthroscopy in the chronic phase. The arthroscopic techniques are thoroughly described and commented on. Analysis of the results confirms the validity of arthroscopic surgery in the treatment of this disease.

Rheumatic disorders in the Swedish population and health care system

Rheumatological diagnosis encountered at 3 levels of the health care system primary care, district hospital and specialized centers, were registered. The prevalence of rheumatic disorders was calculated from a population survey. Back complaints were the predominant diagnosis of primary care physicians, while inflammatory diseases were the major diagnostic group seen in specialized rheumatology centers. Among in-patients at the district hospital level, back disorders and inflammatory diseases each constituted 1/2 of cases. The utilization of primary care for patients over 65 yr of age decreased for back disorders but was higher for all other types of rheumatic disorders. Young and middle aged patients were seen more frequently by specialists than older patients. Awareness of the high frequency of noninflammatory rheumatic disorders in the population and at all levels of care is important in the planning of health services for the rheumatic disorders.

Rheological analysis of soft collagenous tissue

As a direct continuation of Part I, where the theoretical background for the rheological model was discussed, possible operations on the model are discussed and performed on anterior cruciate ligament preparations from rabbits. Different methods of evaluating model constants are compared and other mathematical expressions than those of the model proposed are tried and discussed. Model parts are verified and numerical values are given for certain constants.