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BACKGROUND\ud The West African outbreak of Ebola virus disease that peaked in 2014 has caused more than 11,000 deaths. The development of an effective Ebola vaccine is a priority for control of a future outbreak.\ud \ud METHODS\ud In this phase 1 study, we administered a single dose of the chimpanzee adenovirus 3 (ChAd3) vaccine encoding the surface glycoprotein of Zaire ebolavirus (ZEBOV) to 60 healthy adult volunteers in Oxford, United Kingdom. The vaccine was administered in three dose levels — 1×1010 viral particles, 2.5×1010 viral particles, and 5×1010 viral particles — with 20 participants in each group. We then assessed the effect of adding a booster dose of a modified vaccinia Ankara (MVA) strain, encoding the same Ebola virus glycoprotein, in 30 of the 60 participants and evaluated a reduced prime–boost interval in another 16 participants. We also compared antibody responses to inactivated whole Ebola virus virions and neutralizing antibody activity with those observed in phase 1 studies of a recombinant vesicular stomatitis virus–based vaccine expressing a ZEBOV glycoprotein (rVSV-ZEBOV) to determine relative potency and assess durability.\ud \ud RESULTS\ud No safety concerns were identified at any of the dose levels studied. Four weeks after immunization with the ChAd3 vaccine, ZEBOV-specific antibody responses were similar to those induced by rVSV-ZEBOV vaccination, with a geometric mean titer of 752 and 921, respectively. ZEBOV neutralization activity was also similar with the two vaccines (geometric mean titer, 14.9 and 22.2, respectively). Boosting with the MVA vector increased virus-specific antibodies by a factor of 12 (geometric mean titer, 9007) and increased glycoprotein-specific CD8+ T cells by a factor of 5. Significant increases in neutralizing antibodies were seen after boosting in all 30 participants (geometric mean titer, 139; P

UNLABELLED A new patellofemoral arthroplasty is described, based on a previous design of total knee arthroplasty. The indications are for patients with specific isolated patellofemoral disease with advanced chondral or arthritic damage. The design and technique of insertion is detailed. Three hundred six patellofemoral arthroplasties have been done in 240 patients. The initial results show a high level of pain relief and improvement in function. Two-year followup is available for treatment of 124 knees and 5-year followup is available for treatment of 33 knees. There has been no deterioration in pain or function with followup to 5 years, and there were no late complications attributable to the arthroplasty. Disease progression in the tibiofemoral joint has occurred in 14 patients (16 knees, 5%) requiring revision in 10 of these patients (11 knees, 3.6%). Persistent anterior knee pain was recorded in 14 knees (4%). The short-term results using this new design were better than those of the prosthesis that we used previously, especially concerning malalignment and wear. It offers a reasonable alternative to total knee replacement in the small group of patients with isolated patellofemoral disease. LEVEL OF EVIDENCE Therapeutic study, Level II (prospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.

A double-blind, parallel-group clinical trial was carried out in 25 patients with post-herpetic neuralgia to determine the efficacy and tolerability of a mixture of gangliosides ('Cronassial') compared with placebo. Patients were allocated at random to receive treatment with either 'Cronassial' (100 mg in 2 ml buffered solution) or placebo given by 11 subcutaneous injections over a period of 27 days, and their symptoms assessed on entry and after 2, 4 and 8 weeks. The four aspects of pain considered (overall pain, hyperaesthesia, stabbing pain and constant ache) all showed maintained reductions in severity with 'Cronassial' treatment, but not with placebo. In the case of hyperaesthesia, this difference between treatments was statistically significant (both during and after the course of injections), even with the relatively small number of patients in this study. Sleep patterns showed significant sustained improvements with 'Cronassial', but not with placebo treatment. Other psychological assessments (general psychological state, appetite and mood) showed little difference between 'Cronassial' and placebo treatment. Although 'Cronassial' was well tolerated systemically, 1 of the 12 patients was withdrawn because of general malaise, and 5 patients had local pain at the injection sites. Two of these 5 patients were withdrawn from the study. There were no withdrawals in the placebo group. It is suggested that further studies employing greater numbers of patients should be carried out to confirm the efficacy of gangliosides in improving symptoms of patients with post-herpetic neuralgia.

1. Furberg CD, Adams HPJ, Applegate WB, Byington RP, Espeland MA, Hartwell T, Hunninghake DB, Lefkowitz DS, Probstfield J, Riley WA: Effect of lovastatin on early carotid atherosclerosis and cardiovascular events. Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group. Circulation 1994;90:1679–1687 2. Hedblad B, Wikstrand J, Janzon L, Wedel H, Berglund G: Low-dose metoprolol CR/XL and fluvastatin slow progression of carotid intima-media thickness: Main results from the Beta-Blocker Cholesterol-Lowering Asymptomatic Plaque Study (BCAPS). Circulation 2001;103:1721–1726 3. Crouse JR III, Byington RP, Bond MG, Espeland MA, Craven TE, Sprinkle JW, McGovern ME, Furberg CD: Pravastatin, Lipids, and Atherosclerosis in the Carotid Arteries (PLAC-II). Am J Cardiol 1995;75:455–459 4. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). J Am Med Assoc 2001;285:2486–2497 5. Sacks FM, Moye LA, Davis BR, Cole TG, Rouleau JL, Nash DT, Pfeffer MA, Braunwald E: Relationship between plasma LDL concentrations during treatment with pravastatin and recurrent coronary events in the Cholesterol and Recurrent Events trial. Circulation 1998;97:1446–1452 6. Markwood TT, Kent SM, Coyle LC, Flaherty PJ, O’Malley PG, Taylor AJ: Design and rationale of the ARBITER trial (Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol)—a randomized trial comparing the effects of atorvastatin and pravastatin on carotid artery intima-media thickness. Am Heart J 2001;141:342–347

The use of pectoralis major flaps for reconstruction after oral and oropharyngeal resection in a series of seventeen patients is reported. The applications and complications are described. A post-operative assessment of speech, chewing and swallowing in ten of the patients is reported. The functional aspects of such surgery are discussed.

The results of the treatment of 89 consecutive cases of Pott's paraplegia admitted to care in Korea are reported. Eighty-five patients were treated conservatively. Four patients underwent costo-transversectomy, three of them in the later stages of treatment without apparent benefit. All patients were followed-up for more than one year, 22 (25%) of them for five years or more. 75 patients (84%) recovered sufficiently to walk unaided. 74 patients (83%) returned to normal life and full activity. 64 of these (72%) were neurologically and functionally completely normal and, at the end of follow-up, the other ten (11%) had minimal persistent neurological signs not affecting life and activity. 54 patients (61%) spent less than six months in hospital and 56 (63%) returned to normal activity within one year of the start of treatment. There were two deaths. 41 patients (46%) deteriorated neurologically during the first two months of treatment, but 37 of these recovered completely. The place of chemotherapy as the basis of the treatment of Pott's disease is emphasised. A comparison is made with the published results of other series. The place of operative intervention is discussed and it is argued that the case for urgent early surgical intervention in the treatment of Pott's paraplegia may have been overstated.

SUMMARY The developing hard tissues of the teeth of Echinus esculentus are described and figured, and it is noted that calcification occurs in two forms. Attention is drawn to a structural analogy which appears to exist between these two calcified tissues and the primary tissues of vertebrate teeth, despite certain differences in the chemical analysis. This is considered noteworthy in view of the fact that true teeth are generally associated only with the vertebrates.

In discussing comparative abortion incidence care must be taken in defining abortion and expression and interpreting statistical data. prevalent in urban than rural areas. gal and illegal abortions and between use of abortion and contraception are very complex and not easily analyzed. Japan Hungary and Britain show that a decline in birthrate is due to pre- and post-conceptive control of fertility. computer analysis of a model population using reversible contraception has shown that at least 25% of couples will have one unplanned pregnancy. ion. sterilized after attaining desired family size. es of legal abortion increases with the duration of pregnancy. Morality rates of illegal or clandestine abortion are difficult to establish. le that the death rate for illegal abortion is approaching 1% whereas in developed countries the rate may be 1 in 1000 or less.

Epidermoid inclusion cysts are a relatively common finding following superficial trauma. Inclusion cysts have previously been reported following rhinoplasty, but these have been mucosal cysts and one case of a paraffinoma. A case of multiple recurrent epidermoid inclusion cysts, developing in relation to rhinoplasty, is presented.

A double-blind, parallel group, 7-centre trial was carried out to compare the clinical efficacy and patient acceptability of two formulations of sodium cromoglycate for inhalation in patients suffering from asthma. Each single-dose capsule for use in a breath-actuated inhaler contained either a blend of sodium cromoglycate (20 mg) plus lactose (20 mg) or a lactose-free pelletized formulation of sodium cromoglycate (20 mg). Data were summarized from 529 asthmatic patients who had been using the blend formulation for at least 3 months previously. Two hundred and sixty-five patients then received pelletized sodium cromoglycate and 264 patients remained on sodium cromoglycate plus lactose for at least 3 months. Regular assessments were made by patients and clinicians during the trial period of treatment effectiveness. No clinically significant differences were observed between the two formulations after 3 months on test treatment. After a treatment period of 6 months, the pelletized formulation was shown to have some advantages over the blend formulation which were not observed at 3 months, with a significantly higher proportion of 'very effective' assessments being recorded by both patients and clinicians. The capsules of pelletized sodium cromoglycate required significantly less inhalations to empty compared to the capsules of the blend. No differences were observed between the two formulations with regard to the incidence of transient cough and throat irritation after inhalation.

Fibrous dysplasia is an uncommon bone condition with characteristic radiologic features. It is well known that there is increased uptake of Tc-99m hydroxymethylene diphosphonate (HMDP) and methylene diphosphonate (MDP) in fibrous dysplasia. There are no reports of uptake of Ga-67 citrate by fibrous dysplasia. A case is reported in which positive Ga-67 uptake was seen in a patient with polyostotic fibrous dysplasia.

Otosporin and Gentisone HC ear drops were inserted twice daily for 3 weeks into the external auditory meatuses of guinea pigs. An intraperitoneal injection of vincristine (1 mg/kg.) was given to each animal three hours before it was killed. Temporal bones and attached external auditory meatuses were dissected, tissues were fixed in 10 per cent buffered formalin, decalcified in EDTA, and embedded in JB4 plastic for sectioning at 4 μm. The proliferative activity in the epidermis of the bony meatus and in the lateral surface of the tympanic membrane was obtained by deriving the mitotic indices. After both types of ear drops there was a statistically significant reduction in mitotic indices, the values being about half the control values. The proliferative activity in the tympanic membrane was too low to permit statistical analysis, but no differences were apparent between the groups. The thicknesses of the epidermis and dermis of the bony canal, and of the tympanic membrane, were measured using a Kontron MOP-AM03 analyser. Although the dermis was thinner as a result of the administration of ear drops, both the epidermis of the bony meatus and that of the tympanic membrane were thicker, all these changes being statistically significant.

We report two cases of rhinocerebral mucormycosis due toAbsidia corymbifera, an extremely uncommon causal agent. Both occurred in patients with haematological disorders and both had a fatal outcome, despite antemortem diagnosis and aggressive treatment. We discuss the factors which generally contribute to the poor prognosis in this group of patients and suggest another possible mechanism which may contribute to the high mortality.

An 18-month-old boy treated for congenital dislocation of the hip, developed osteochondritis dissecans of the femoral head. Serial roentgenograms demonstrated that the lesion had healed by the time he was 15 years of age. There have been no previous reports of healing of osteochondritis dissecans complicating congenital dislocation of the hip, or Legg-Calve-Perthes disease, although healing in idiopathic cases has been described.

Although osteoarthritis (OA) generally is considered a disorder of mechanical origin, the common occurrence of chronic mononuclear cell infiltrates in the synovium in conjunction with immunofluorescent evidence for immune-reactant products in cartilage of surgical case specimens (knees, hips, and peripheral joints) has suggested the local involvement of immune processes in the arthritis. Further, the findings of polyarthropathy in the majority of these cases have indicated the propensity for a systemic disorder. Wide variations were noted in both synovial and cartilage immune changes, quite different to those found in rheumatoid arthritis, along with the frequent asymptomatology of the many joints involved. These features, with and without other causative factors, suggest that immune reactions of local and/or systemic origin occur at times in a population at risk for joint degradation.

A comparison of the services provided for the elderly in Great Britain and the United States shows the impact that organized medical care has on day-to-day clinical activities. The British...

An electronic system for automatically testing the human visual field is described in the context of mass screening for visual disorders, such as glaucoma. Present methods of field testing are briefly reviewed. The new system is patient operated and uses a television monitor as the means for presenting the test stimuli and displaying the results. A multilevel map of a patient's retinal sensitivity is produced in a form which is readily interpreted by an ophthalmologist. A data-transfer unit enables the local storage of results and allows direct access to a computer. Preliminary clinical trials show good agreement with conventional field-testing methods, and yield more detailed information than has hitherto been feasible on a routine basis.