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The oxygen K edge X-ray absorption spectra of aqueous HCl and NaCl solutions reveal distinct perturbations of the local water molecules by the respective solutes. While the addition of NaCl leads to large spectral changes, the effect of HCl on the observed X-ray absorption spectrum is surprisingly small. Density functional theory calculations suggest that this difference primarily reflects a strong blue shift of the hydrated proton (in either the Eigen (H9O4+) or Zundel (H2O5+) forms) spectrum relative to that of H2O, indicating the tighter binding of electrons in H3O+. This spectral shift counteracts the spectral changes that arise from direct electrostatic perturbation of water molecules in the first solvation shell of Cl-. Consequently, the observed spectral changes effected by HCl addition are minimal compared to those engendered by NaCl. Additionally, these results indicate that the effect of monovalent cations on the nature of the unoccupied orbitals of water molecules in the first solvation shell is negligible, in contrast to the large effects of monovalent anions.

STEOARTHRITIS OF THE hand is a common degenerative musculoskeletal condition affecting the health-related quality of life of many adults. Despite the high prevalence of symptomatic hand osteoarthritis, the therapeutic options are limited, and the mainstay of pharmacological treatment includes short-term use of oral analgesic and antiinflammatory medications. 1 However, the well-recognized systemic toxicities with these medications limit their use. 2 Recent public interest in alternative treatments for osteoarthritis has resulted from the limitations of conventional medications and the desire to decelerate the degenerative process. 3 Glucosamine and chondroitin sulfate (CS) are among the most popular nonprescription nutriceutical products in the United States and are widely promoted by manufacturers to have remarkable chondroprotective benefits. This article aims to review the best available evidence to facilitate an evidence-based discussion with patients regarding the efficacy and safety of these products in patients with osteoarthritis of the hand. BACKGROUND Glucosamine is an amino monosaccharide and a substrate for the biosynthesis of glycosaminoglycans (GAGs), important structural components of articular cartilage. 1 CS is a sulfated GAG macromolecule that is linked to proteins as part of a proteoglycan aggrecan. The highly charged sulfate groups of GAGs generate a strong affinity for water within the extracellular collagen matrix, contributing to the important compression resistance and viscoelastic properties of cartilage. 1 Os

Die Strahlentherapie des Prostatakarzinoms hat in den letzten Jahren bedeutende Fortschritte erzielt: Sowohl die Planung der Bestrahlung als auch die Bestrahlungstechniken sind heute besser und effizienter. In Abhangigkeit des jeweiligen Tumorstadiums stehen mit der perkutanen Strahlentherapie und der Brachytherapie verschiedene Optionen zur Verfugung, die in der Langzeitbeobachtung ahnlich gute Ergebnisse erreichen wie die radikale Operation. Die Verwendung dreidimensionaler Planungssysteme erlaubt eine immer grosere Dosiseskalation am Tumor, wobei gleichzeitig die Akut- und die Spattoxizitat vermieden bzw. zumindest reduziert werden konnen. Weisen die Patienten bereits ein fortgeschrittenes Prostatakarzinom auf bzw. haben sie ein hohes Risiko fur eine mogliche Lymphknotenmetastasierung, kann uber die Kombination beider Verfahren eine gute lokale Kontrolle erzielt werden. Auch eine zusatzliche antiandrogene Therapie kann bei diesen Patienten das krankheitsspezifische Uberleben verbessern. Ein Rezidiv nach radikaler Operation oder definitiver Strahlentherapie kann nach Ausschluss einer moglichen Metastasierung erneut in kurativer Intension strahlentherapeutisch behandelt werden. In der interdisziplinaren Behandlung hat die Strahlentherapie demnach heute ihren festen Platz, sie setzt jedoch einen uneingeschrankten Dialog zwischen Urologen und Strahlentherapeuten voraus. Radiotherapy of prostate cancer has gained great progress during the last years - 3 d planning and irradiation techniques are more efficient today. Depending on tumour stage external beam irradiation (EBRT) and brachytherapy offer different options for primary treatment achieving equal results in long term follow up compared to surgery. The use of 3d treatment planning systems allows a progressive dose escalation at the tumour site omitting or reducing acute and late toxicity. In patients with advanced carcinoma or at high risk of lymph node metastasis a combination of EBRT and brachytherapy is able to achieve good local control. An additional antiandrogen therapy can improve disease specific survival. Even tumour relapse after radical prostatectomy or definitive irradiation can be treated with irradiation in curative intension after exclusion of distant metastases. Today radiotherapy is well established in interdisciplinary treatment of prostate cancer but requires an unrestricted dialogue between urologists and radiotherapists.

An overview of the strangeness measurements made by the STAR collaboration at RHIC for Au-Au collisions at √s NN = 130 and 200 GeV plus p-p collisions at √s NN = 200 GeV is presented. A wealth of information has been generated on the kinematics and scale of strange particle production by this experiment. When viewed in combination a picture emerges of particles demonstrating a surprisingly high degree of collective motion, suggestive of strong internal pressure within the source which builds up rapidly. The non-resonance yields are consistent with statistical hadron formation. Although there appears to be a rapid decoupling of the source, resonance particle measurements show signs of rescattering during the hadronic phase. Meanwhile the observed suppression of high momentum probes and their large azimuthal asymmetry indicate that this hot dense matter has significant interactions with particles moving through it.

Values of the ratios in the mid-rapidity yields of Λ / Λ =0.71±0.01( stat. )±0.04( sys. ) , Ξ + / Ξ − =0.83±0.04( stat. )±0.05( sys. ) , Ω + / Ω − =0.95±0.15( stat. )±0.05( sys. ) and K + /K − =1.092±0.023(combined) were obtained in central s NN =130 GeV Au+Au collisions using the STAR detector. The ratios indicate that a fraction of the net-baryon number from the initial system is present in the excess of hyperons over antihyperons at mid-rapidity. The trend in the progression of the baryon ratios, with increasing strange quark content, is similar to that observed in heavy-ion collisions at lower energies. The value of these ratios may be related to the charged kaon ratio in the framework of simple quark-counting and thermal models.

Data handling in PHENIX is carried out by the On-Line Computing System (ONCS) and Off-Line Computing System (Off-Line). ONCS provides the overall control and monitoring of the front-end electronics, trigger and data acquisition system and detector ancillary systems. It configures and initializes the on-line system, monitors and controls the data flow, coordinates calibration processes, interlocks the data acquisition process with the slow control subsystems and performs a number of other functions. ONCS uses CORBA software to monitor and control the hardware. Off-Line provides all aspects of data handling not directly connected to the collection of data and monitoring, such as event simulation and reconstruction, data analysis and information management. The impact of the unprecedented data volumes on the design is presented, along with a detailed discussion of the tasks and methods of simulating, obtaining and monitoring the data.

On the basis of literature review and own experience we presented the method of treatment of Wilson's disease. Causative treatment has been impossible so far, although gene therapy could be real in the future. Nowadays the principle of treatment is the elimination of the excess of easily mobilized copper by chelating agents or blocking the intestinal absorption of copper. Chelation therapy, aimed at mobilizing copper from the affected organs and promoting its excretion in the urine or stool is the most important. The major chelating agent is d-penicillamine, which is quite effective but not without some side effects. Alternative chelating agents such as trientine and tetrathiomolybdate have also been successfully employed. Zinc salts are also of therapeutic value. They promote copper excretion by inducing the synthesis of metallothionein in the intestine, thereby blocking copper absorption from the gut. Zinc salts have almost no side effects. They cannot be used as an initial treatment, but are very effective for maintenance therapy. The chelation therapy is ineffective in patients with acute liver failure with encephalopathy and hemolysis. In these cases, liver transplantation is the only hope for survival. Liver transplantations in patients with dominating psychoneurological symptoms are open to discussion.

Ziel: In einer Pilotstudie untersuchten wir, ob sich zwi-schen [ 11 C]Azetat- und [11 C]Cholin-Positronenemissions-tomographie (PET) wesentliche Unterschiede in der Darstellung des Prostatakarzinoms (PCA) ergeben. Methode: Zwolf Patienten wurden mit beiden Radiotracern untersucht. Die Ganzkorper-PET ohne Schwachungskorrektur wurde nach Injektion von 0,95 ± 0,15 GBq [11 C]Azetat bzw. 0,84 ± 0,13 GBq [11C]Cholin von 5 bis 60 min p. i. durch-gefuhrt. Fokal erhohte Traceraufnahme im Knochen, kaudal der Harnblase oder in Lymphknotenregionen wurden als Tumorbefall betrachtet. Bei den Patienten waren Primartumor (n = 2), Lymphknotenbefall (n = 4), Knochenmetastasen (n = 2), Lokalrezidiv (n = 2) und kein Anhalt fur Tumorgewebe (n = 2) bekannt. Ergebnisse: [11 C]Azetat wurde am starksten in Milz und Pankreas aufgenommen, wahrend der [11 C]Cholin-Uptake in Leber und Nierenparenchym am hochsten war. Jedoch variierte der Uptake inter-individuell stark. Beide Radiotracer waren identisch im Nachweis von Skelettlasionen, Lymphknotenmetastasen und Primartumor. Sie versagten beide beim Nachweis eines kleinen Lokalrezidivs bei zwei Patienten sowie bei der Detektion eines histologisch verifizierten Lymph-knotenbefalls bei einem weiteren Patienten. Schlussfolgerung: In dieser Pilotstudie war der Uptake der Radiotracer [11C]Azetat und [11C]Cholin beim Prostatakarzinom und seinen Metastasen so weit iden-tisch, dass keine der beiden Substanz favorisiert werden kann. Derzeit konnen beide Radiotracer die Therapie-planung durch den Nachweis von Lokalrezidiv, Lymph-knoten- oder Skelettmetastasen beeinflussen.

Der Verein Freiburger Tierarzte wurde am 24. April 1852 in Freiburg gegrundet. Zu Beginn beschaftigte sich der Verein vor allem mit der Seuchen situation, die auch zur Grundung gefuhrt hatte. An den Versammlungen wurden aber auch Probleme zwischen praktisch ausgebildeten und wissenschaftlich tatigen Kollegen diskutiert. Interessant die Tatsache, dass zu jener Zeit die jungen Tierarzte im Kanton Freiburg eine kantonale Prufung absolvieren mussten. Seit der Grundung wurde der Verein in der Person von Martin Strebel stark gepragt, der von 1874 bis 1902 auch Prasident des Vereins Freiburger Tierarzte war. Martin Strebel war ein guter Praktiker, beschaftigte sich aber auch mit wissenschaftlichen Fragestellungen sowohl auf Kantons- wie auf Bundesebene. Rasch wurde er uber die Landesgrenzen bekannt und seine Publikationen sind noch heute in den Nachbarlandern zu finden. Der Verein Freiburger Tierarzte kann auf eine Personlichkeit wie Martin Strebel als Grundungsmitglied mit Recht stolz sein.

The STAR detector has made a variety of measurements of strange and other hadronic species in Au+Au collisions at s N N = 130 GeV. A comparison of kaon and pion production enables an examination of the systematics of strangeness production with energy by comparing them to lower energy collisions. Anti-baryon to baryon ratios indicate a much reduced net-baryon density and transverse momentum spectra show that a picture of transverse expansion seems appropriate.

Die Brachytherapie des Prostatakarzinoms mittels permanent implantierter Strahlenquellen hat in der letzten Zeit eine erhebliche Verbreitung gefunden. Insbesondere in den USA wird diese Methode zunehmend angewendet, sodass mittlerweile grosere Kollektive mit Nachbeobachtungszeiten von 10 Jahren zur Verfugung stehen [16, 29].

Health literacy is a relatively recent concept in Europe. First international investigations indicate that a substantial part of the population has significantly impaired subjective health literacy. In Germany there is a lack of meaningful data. Therefore, 2 comprehensive studies have been started that will provide population representative results, as well as take the health literacy level of vulnerable groups such as older people and migrants into consideration.

We present results for the charged-particle multiplicity distribution at midrapidity in Au-Au collisions at square root of [s(NN)] = 130 GeV measured with the PHENIX detector at RHIC. For the 5% most central collisions we find dN(ch)/d eta(vertical line eta = 0) = 622+/-1(stat)+/-41(syst). The results, analyzed as a function of centrality, show a steady rise of the particle density per participating nucleon with centrality.

Adult snails synthesize in their albumen glands a polysaccharide which is composed exclusively of D- or D- and L-galactose (Gal) residues which are interglycosidically linked by 1 --3 and 1 --6 bonds. It is the only carbohydrate source for embryos and freshly hatched snails. Two galactosyltransferases are described in this study which are most likely involved in the biosynthesis of this polysaccharide. One identified in Helix pomatia acts on oligosaccharides and could be used to synthesize a tetrasaccharide when the branched trisaccharide D-Gal-beta-(1 --3)-[D-Galbeta-(1 --6)]-D-Galbeta-1 --OMe was offered as acceptor. This enzyme, requiring Mg++-and Mn++-ions for activity, introduced a linear beta-(1 --6) linkage at the terminal non-reducing ends and was not detected in Biomphalaria glabrata. The other enzyme, which introduced beta-(1 --6) linkages at subterminal D-Gal residues, thus forming branching points in the polysaccharide, was found in H. pomatia, Arianta arbustorum and B. glabrata with comparable activities. With the enzyme preparation of H. pomatia, up to four D-Gal residues were introduced into vicinal positions, forming single-membered side chains, if a hexasaccharide with five linearly beta-(1 --3)-linked D-Gal residues was offered as a acceptor. The multiple-branched structure formed is typical for snail galactans, making this enzyme a prime candidate for the branching enzyme in galactan synthesis. The enzyme activity could be solubilized and purified by affinity chromatography. In SDS-polyacrylamide electrophoresis, the Helix-derived eluate displayed two bands (68, 37 kDa) and that of Biomphalaria five bands (68, 63, 17.5; 15; 13 kDa). The purified material showed only 8% of the total activity of the crude extracts, but it could be shown that a phosphatase present in the crude extract can degrade UDP formed in the transfer reaction and thus drive the reaction to completion.

The modified Broström procedure is an anatomic reconstruction of the lateral ankle ligaments. The present study evaluated twenty-two patients (mean age = 27.2 years) with chronic lateral ankle instability who underwent surgical repair of their lateral ankle ligaments using suture anchors as part of the modified Broström procedure. All surgeries were performed by the senior author (AK) on an outpatient basis. At a mean follow-up of 34.5 months (minimum of 18 months), twenty patients (91%) reported a good or excellent functional outcome as assessed by the Karlsson and Peterson ankle function scoring scale.21One patient developed a superficial wound infection post-operatively that was eradicated with a course of oral antibiotics. Sixteen of the twentytwo patients were available for follow-up physical examination and stress radiographs. Fourteen of the sixteen patients had no evidence of instability on physical examination or on stress radiographs. One patient had diminished sensation in the superficial peroneal nerve distribution. Five of the sixteen patients had generalized ligamentous laxity; none of these patients had an excellent result, and they had lower “Overall Satisfaction” scores (P = 0.013). We conclude that the use of suture anchors is a simple and effective adaptation of the modified Broström procedure, which results in a good or excellent outcome in the majority of patients with few complications.

The CERES/NA45 experiment at the CERN SPS was upgraded in 1998 by the addition of a cylindrical Time Projection Chamber. The aim is to improve the mass resolution of e+e− pairs in the ρ/ω/φ region to Δm/m < 2%. A progress report is given on the TPC performance during the 1998 commissioning runs (laser rays, beam halo muons, and particles produced by proton/π and lead beams hitting Pb and Au targets).

During the 1996 lead run time, CERES has accumulated 42 million events, corresponding to a factor of 5 more statistics than in 1995 and 2.5 million events of a special photon-run. We report on the results of the low-mass e$^+$e$^-$-pair analysis. Since the most critical item is the poor signal-to-background ratio we also discuss the understanding of this background, in absolute terms, with the help of a detailed Monte Carlo simulation. We show preliminary results of the photon analysis and summarize the results of the hadron analysis preliminarily reported on already at QM'97, 10 pages, 9 figures, Proceedings of the XIV Int. Conf. on Nucleus-Nucleus Collisions,Quark Matter 99, Torino, Italy, May 10 - 15, 1999

The CERES/NA45 experiment at the CERN-SPS is dedicated to study the production of e + e − -pairs in ultrarelativistic heavy ion collisions. Compared to extrapolations from results obtained in proton-induced reactions, it has previously observed an enhanced production in S-Au [1] and Pb-Au [2] collisions. To verify this enhancement and to study its properties, higher statistics were accumulated during a runtime in 1996. We report here, for the first time, on the results of this analysis (for details see ref. [3]).

Hadronic spectra from interactions of Pb on Au at 158 AGeV/c have been measured by the CERES experiment at the CERN SPS. We report on preliminary results on transverse mass spectra of identified pions and negative hadrons as well as spectra of the positive charge excess obtained by subtracting the negative particle distribution from that of positive tracks. We have also performed a study of the event azimuthal anisotropies which give evidence for directed and elliptic flow in non-central collisions.

The CERES/NA45 collaboration measured, at the CERN SPS, low-mass electron pair production in Pb Au collisions at 158 A GeV/c incident momentum. In this paper we present an analysis of the data taken during the SPS Pb-beam period in the fall of 1995. The results confirm previous findings of CERES showing that the pair production in the mass range 0.2 ee 2 , when scaled to the ion case with the event multiplicity, is enhanced over the expected yield from the known hadronic sources in pp collisions. A comparison of the results for different multiplicity bins indicates that the excess increases faster than linearly with charged-particle multiplicity. We also present the transverse-momentum distributions of the observed pairs.

A lysozyme isolated from the milk of a monotreme, the echidna, Tachyglossus aculeatus multiaculeatus, has been crystallized (space group P2(1), with unit-cell dimensions a = 37.1, b = 42.0, c = 38.1 A, beta = 91 degrees and Z = 2) and the structure refined to an R value of 0.167 for all measured data in the resolution range 7.0-1.9 A. It had previously been inferred from sequence homology with alpha-lactalbumins that echidna milk lysozyme (EML) would bind one calcium ion per molecule. This has been confirmed in the present study in which the largest peak in a difference Fourier synthesis is associated with a calcium ion. The calcium binding site of EML is very similar to that observed in baboon and human alpha-lactalbumins, and in a human lysozyme engineered to contain a calcium-binding site. The overall fold of the protein is similar to that of chick-type lysozymes. EML, like pigeon lysozyme, has only 125 residues terminating at a cysteine but in EML this forms a disulfide with a cysteine at residue 9 whereas the equivalent cysteine residue in all other lysozymes of known sequence occurs at position 6. These changes cause some minor structural rearrangements. The binding of calcium appears to have had little effect on the polypeptide backbone conformation and caused only small changes in the conformation of side chains coordinating the calcium ion. A homology modelling study [Acharya, Stuart, Phillips, McKenzieTeahan (1994). J. Protein Chem. 13(6), 569-584] correctly predicted the overall structure of EML and the nature of its calcium binding site but generally failed to model some more subtle differences observed in the EML structure as evidenced by the fact that the homology model more closely resembles the starting structure from which the model was derived than it does the crystal structure.

Sports are an integral part of American society. Millions of dollars are spent every year on professional, collegiate, and youth athletics, and participation in and viewing of these sports both alter and reflect how one perceives the world. Beamon and Messer deftly explore sports as a social construction, and more significantly, the large role race and ethnicity play in sports and consequently sports’ influence on modern race relations. This text is ideal for courses on Sport and Society as well as Race and Ethnicity.

We report preliminary results of the first measurement of low-mass electron pairs in 160 GeV/nucleon PbAu collisions at central rapidities in a wide multiplicity range. This work is the continuation of our systematic studies on pair production in p-Be, p-Au and SAu interactions. The motivation for this effort derives from a new source of lowmass dileptons recently observed in SAu and S-W collisions by CERES and HELIOS/3, respectively. The results obtained in the analysis of the PbAu data confirm our previous finding that pair production in the mass range 0.2 < mee < 1.5 GeV/c2 is enhanced over the contributions from hadron decays while no significant excess could be observed for mee ≲ 2mπ. A comparison of the results for different multiplicity bins favours a non-linear dependence of the e+e−-yield on the accompanying charged particle densities.

CERES is an experiment dedicated to measure e+ e−-pairs in nucleus-nucleus collisions at the CERN SPS. Following the experiences gained with proton and sulfur beams the CERES spectrometer was upgraded to cope with the much larger charged particle densities produced in PbPb collisions. Major parts of the upgrade were completed in time for a 10 days test with a lead beam in November 1994. The results clearly demonstrate the feasibility of the experiment in the environment of central PbPb collisions.

Hintergrund: Expertenstandards (ES) bieten systematisch entwickelte Empfehlungen fur die Pflegepraxis und ahneln damit klinischen Leitlinien. Ihre Anwendung in der ambulanten und stationaren Pflege ist relevant fur verpflichtende, externe Qualitatsprufungen, die veroffentlicht werden. Aus der Forschung mit Arzten ist bekannt das Leitlinien, neben ihren hilfreichen Eigenschaften, auch einen Befolgungsdruck ausuben konnen, der einer gemeinsamen Entscheidungsfindung mit dem Patienten entgegensteht. Bisher gibt es keine Erkenntnisse, wie sich die ES in der praktischen Umsetzung auf die Involvierung von Patienten in die pflegerische Entscheidungsfindung auswirken. Das Ziel der Studie ist die Untersuchung der Wahrnehmungen und Vorstellungen von Stakeholdern in der ambulanten und stationaren Langzeitpflege zur Teilhabe von Patienten an der Entscheidungsfindung bei Anwendung der ES: Wie handeln Pflegekrafte? Was sind fordernde und hemmende Faktoren? Material und Methoden: Um den internationalen Stand der Forschung einzubeziehen, wird ein Review durchgefuhrt. Zudem ist ein qualitativer Forschungsansatz geplant, um zu evaluieren wie Pflegekrafte im deutschen Kontext agieren: mittels leitfadengestutzter Experteninterviews werden die handlungsleitenden Muster in der ambulanten und stationaren Pflege analysiert. Erwartete Ergebnisse: Das Forschungsprojekt soll einen Beitrag dazu leisten, erste Hinweise bezuglich der Wirkung von ES auf die Patientenpartizipation in pflegerischen Entscheidungssituationen zu generieren. Die Erkenntnisse sollen eine fokussierte Weiterentwicklung der ES-methodik zur Forderung der Einbeziehung von Patienten in Entscheidungssituationen in Deutschland unterstutzen. Schlussfolgerung: ES sind derzeit ein verbreitetes Instrument der pflegerischen Qualitatsentwicklung. Eine Evaluation der Anwendungsfolgen fur die Teilhabe der Patienten an Versorgungsentscheidungen ist daher dringend angezeigt.

A technique for metacarpophalangeal joint arthrodesis of the thumb using the 3.0-mm AO cannulated screw is described. Advantages of this technique include its relative simplicity and accuracy, solid fixation, and high union rate.

Mammalian milk/colostrum contains from trace to ∼13% of carbohydrate, of which lactose (Gal(β1-4)Glc) usually constitutes more than 80%. Milk/colostrum of most mammals also contains a variety of oligosaccharides, many of which have N-acetylglucosamine, galactose, fucose, and/or sialic acid residues attached to lactose, which is always located at the reducing end. The ratio of milk oligosaccharides to free lactose in milk/colostrum varies, depending on the mammalian species. Most human milk oligosaccharides (HMOs) cannot be digested within the small intestine, and reach the colon where they stimulate the growth of bifidobacteria and act as possible antiadhesion factors against pathogenic microorganisms in the human infant. The biological functions of milk oligosaccharides have recently been an active field of research. In this article, we describe the chemical structures and methods for the structural analysis of milk oligosaccharides, quantitative aspects and methods for their quantification, their gastrointestinal digestion and biosynthesis, and their biological significance as prebiotics, anti-infection factors, receptor analogues, and immunomodulators, with special reference to the oligosaccharides of human milk. We also describe the milk oligosaccharides of domestic farm animals and discuss comparative aspects of milk oligosaccharides among mammalian species, as well as future trends and the industrial utilization of milk oligosaccharides.

Treatment-resistant depression often leads to increased morbidity and disability. The authors report the use of ketamine, a selective N-methyl-D-aspartate (NMDA) receptor antagonist, in two patients with treatment-resistant depression. Multiple ketamine treatments may provide an effective rapid antidepressant effect with prolonged benefit.

Volar locking plate fixation via open reduction and internal fixation is an increasingly accepted method for managing displaced distal radius fractures. Volar plating offers biomechanically stable fixation, allows early rehabilitation, and enables fixation of comminuted or osteopenic bone. The literature reporting complications of volar plate fixation is limited primarily to case reports and small case series. The surgeon must be mindful of potential soft-tissue, neurovascular, and osseous complications, such as extensor tendon and flexor tendon injury, flexor pollicis rupture, carpal tunnel syndrome, complex regional pain syndrome, and loss of reduction, as well as hardware failure. Increased awareness of potential complications may lead to more prompt recognition and treatment when they do arise.

We present a 3 day old girl born at term presenting with an interlabial, cystic mass. Pregnancy, delivery and routine antenatal screening were unremarkable. The smooth lesion was located in the anterior half of the vulva, covered with thin vessels. The medially displaced urethra and the medio-posteriorly displaced hymen were identified. Voiding was not impaired. We discuss the differential diagnosis of vulvar masses in the newborn girl. A thorough clinical examination must be the standard of care of pediatric examinations in infants.

The in vitro activity of LY264826, a novel glycopeptide antibiotic produced by Amycolatopsis orientalis, was compared with those of vancomycin, teicoplanin, and oxacillin against 311 gram-positive clinical isolates from patients with cancer, LY264826 had lower MICs for 90% of isolates (MIC90) than vancomycin for all species tested. It was active against oxacillin-resistant isolates including Staphylococcus aureus (MIC90, 0.5 micrograms/ml), Staphylococcus haemolyticus (MIC90, 2.0 micrograms/ml), Enterococcus spp. (MIC90, 0.5 micrograms/ml), Bacillus cereus (MIC90, 0.25 micrograms/ml), and Corynebacterium jeikeium (MIC90, 0.12 micrograms/ml). For S. aureus, including oxacillin-resistant isolates, the MICs of LY264826 were similar to those of teicoplanin. For coagulase-negative staphylococci, however, LY264826 had MICs that were 4- to 32-fold lower than those of teicoplanin. Against most streptococcal species the activities of LY264826 and teicoplanin were similar. Bactericidal activity against Staphylococcus spp. and most Streptococcus pyogenes isolates was less than or equal to 1 dilution of the MIC. One isolate of S. pyogenes and all Enterococcus faecalis strains tested were tolerant of LY264826, with MBCs greater than or equal to 32-fold greater than the MICs. The addition of 50% human serum resulted in a significant increase in activity only against Staphylococcus epidermidis. Variations in pH from 6.4 to 8.4 and in inoculum from 10(3) to 10(7) CFU/ml did not significantly affect the activity of LY264826.

The purpose of this research is to investigate the frequency of endodontic flare-ups using a visual analogue scale. Definitions of flare-ups vary widely as does their reported frequency. A flare-up was defined as an increase of 20 or more points on the visual analogue scale for a given tooth, within the periods of 4 h and 24 h after the initial treatment appointment. The data from a previous study were used to determine the incidence of flare-ups after using three modalities (Ledermix, calcium hydroxide and no medication) to manage patients presenting for relief of pain of endodontic origin. A statistical analysis showed that there were no significant differences in flare-up rates at both the 4-h and 24-h periods between the three modalities. Further research is required using the above definition of a flare-up and standardising treatment protocols.

Purpose In cases of digital nerve injury in which nerve ends cannot be approximated without tension, autologous nerve grafts represent the most commonly used method for reconstruction. Recently, interest in synthetic nerve guides as an alternative to grafting has increased. Although several basic science studies have shown promise for collagen tubes, clinical studies of their success in humans are limited. The purpose of this study was to review our early clinical experience with collagen nerve tubes. Methods The authors identified and followed all cases involving digital nerve repair at our institution over a 2-year period. Twelve patients had repair of a digital nerve with a collagen nerve tube during the study period. Two patients were lost to follow-up, and 1 patient had amputation of the grafted finger secondary to complications of other injuries. The primary outcome data points for the remaining 9 patients were the static 2-point discrimination (2PD), Semmes-Weinstein monofilament testing, and a Quick Disabilities of the Arm, Shoulder, and Hand (DASH) outcome survey at final follow-up. Results Nine patients had follow-up of at least 1 year, with an average follow-up time of 15 months (range 12–22 months). There were no intraoperative or postoperative complications related to the nerve tubes. Using modified American Society for Surgery of the Hand guidelines, 2PD results were good or excellent in 8 out of 9 of patients. Semmes-Weinstein testing results were full in 5 patients, diminished light touch in 2, diminished protective sensation in 1, and loss of protective sensation in 1. Average Quick DASH scores for the group were 10.86 overall, 4.86 for the work module, and 23.21 for the sports/performing arts module. Conclusions Although the patients in this study are still within the early follow-up period, our initial results compare favorably with those reported in the existing literature for various types of nerve repair and reconstruction, suggesting that collagen nerve tubes might offer a clinically effective option for restoration of sensory function. Type of study/level of evidence Therapeutic IV.

It was recently suggested that liquid water primarily comprises hydrogen-bonded rings and chains, as opposed to the traditionally accepted locally tetrahedral structure (Wernet et al. Science 2004, 304, 995). This controversial conclusion was primarily based on comparison between experimental and calculated X-ray absorption spectra (XAS) using computer-generated ice-like 11-molecule clusters. Here we present calculations which conclusively show that when hydrogen-bonding configurations are chosen randomly, the calculated XAS does not reproduce the experimental XAS regardless of the bonding model employed (i.e., rings and chains vs tetrahedral). Furthermore, we also present an analysis of a recently introduced asymmetric water potential (Soper, A. K. J. Phys.: Condens. Matter 2005, 17, S3273), which is representative of the rings and chains structure, and make comparisons with the standard SPC/E potential, which represents the locally tetrahedral structure. We find that the calculated XAS from both potentials is inconsistent with the experimental XAS. However, we also show the calculated electric field distribution from the rings and chains structure is strongly bimodal and highly inconsistent with the experimental Raman spectrum, thus casting serious doubt on the validity of the rings and chains model for liquid water.

Measurements of the oxygen K-edge X-ray absorption spectrum (XAS) of aqueous sodium halide solutions demonstrate that ions significantly perturb the electronic structure of adjacent water molecules. The addition of halide salts to water engenders an increase in the preedge intensity and a decrease in the postedge intensity of the XAS, analogous to those observed when increasing the temperature of pure water. The main-edge feature exhibits unique behavior and becomes more intense when salt is added. Density functional theory calculations of the XAS indicate that the observed red shift of the water transitions as a function of salt concentration arises from a strong, direct perturbation of the unoccupied molecular orbitals on water by anions, and does not require significant distortion of the hydrogen bond network beyond the first solvation shell. This contrasts the temperature-dependent spectral variations, which result primarily from intensity changes of specific transitions due to geometric rearrangement of the hydrogen bond network.

The goals of flexor tendon repair are to promote intrinsic tendon healing and minimize extrinsic scarring in order to optimize tendon gliding and range of motion. Despite advances in the materials and methods used in surgical repair and postoperative rehabilitation, complications following flexor tendon injuries continue to occur, even in patients treated by experienced surgeons and therapists. The most common complication is adhesion formation, which limits active range of motion. Other complications include joint contracture, tendon rupture, triggering, and pulley failure with tendon bowstringing. Less common problems include quadriga, swan-neck deformity, and lumbrical plus deformity. Meticulous surgical technique and early postoperative tendon mobilization in a well-supervised therapy program can minimize the frequency and severity of these complications. Prompt recognition of problems and treatment with hand therapy, splinting, and/or surgery may help minimize recovery time and improve function. In the future, the use of novel biologic modulators of healing may nearly eliminate complications associated with flexor tendon injuries.

The present paper presents critical reviews of studies that have explored models of adolescent self-mutilation. Current definitional problems were addressed, as well as a proposal for a classification system of self-mutilation. Seven historically significant explanatory models were included, the sexual/sadomachistic model, the depersonalization model, the interpersonal/systemic model, the suicide model, the physiological/biological model, the affect regulation model, and the behavioral/environmental model. Each model was briefly described, and studies were critiqued according to methodology, research design, and basis upon which authors provided support or rejection of a model. Suggestions for improvement in the literature were made throughout the paper. Studies often overlapped within the models, and the strongest empirical support was shown for the behavioral/environmental model, which included components of the affect regulation model, interpersonal/systemic model, and depersonalization model. Explaining adolescent self-mutilation is a complex task, and evidence provided in this paper suggests that aspects of several models, or an integration of models, likely contribute to the understanding of this phenomenon.