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Introduction Trastuzumab(T) is a humanized monoclonal antibody used in the treatment of HER2-positive breast cancer and is available as a subcutaneous(sc) formulation thereby allowing short and convenient administration. A lack of trained nurses to administer T at home and/or train patients at home to self-administer, together with challenges in maintaining cold-chain delivery have impeded uptake of home administration.1,2 In order to support patients’ ability to self-administer T at home, we have implemented an educational programme that includes nurse-led training, education material, support apps and follow-up telephone clinics. Home delivery of pre-filled syringes was enabled in collaboration with commercial providers for aseptics and logistic. Aim The aim of this service evaluation was to evaluate the utility of this programme from the patients’ perspective and to assess patient satisfaction and impact on quality of life (QOL). Methods A previously validated Self-Injection Assessment Questionnaire (SIAQ)3 was modified to assess patient satisfaction, perceptions and impact of the programme. Patients who had agreed to enrol on the ‘self-administration’ scheme, were asked to complete the questionnaire at baseline, at the third training session and at the second self-administered dose. Approval from a Research Ethics Committee is not required for this service evaluation. Results All 14 patients offered the questionnaire responded to all questions. The median age was 58 years old (age range 43-76), 11 patients were Caucasian, 2 were Asian and one was African/Caribbean. The average distance from their home address to hospital was 10.1 miles (range 4-19). Following completion of the one-to-one nurse training there was an improvement in patient confidence to self-administer sc. T. No differences in ‘feeling in control of their treatment’ or ‘satisfaction of attending hospital appointments’ were noted. Of the 11 patients who reached the self-administration stage, 10 reported that they felt ‘very confident’ and 8 reported that it was ‘very easy’ to give themselves the injection. All patients rated themselves ‘very satisfied’ with self-administration and reported that the nurse training programme helped them to be more confident. 10 patients reported that the App and written information was useful as well as the pre- and post- administration telephone clinics. All patients reported that the self-administration programme had a positive impact on their QOL by reducing the number of hospital visits. In the first 4 months of self-administration each patient reduced their hospital attendance by an average of 8 appointments (median=8) equating to 10 hours of time that would have been spent at hospital. Discussion/Conclusion The subcutaneous T self-administration programme was well received by patients. The nurse training sessions and supportive materials enabled patients to feel more confident about self-administration with no reported incidents or adverse events. This led to fewer hospital visits and improved QOL. This programme was critically dependent on the services of a commercial compounder and homecare provider, emphasizing the importance of joint working between the NHS and commercial sector. Evaluation of this programme will continue and will include other agents, including Phesgo® (sc trastuzumab and pertuzumab) which have more patients and will improve the reliability of the results. References 1. Tjalma, W., Huizing, M., Papadimitriou, K. The smooth and bumpy road of trastuzumab administration: from intravenous (IV) in a hospital to subcutaneous (SC) at home. Facts Views Vis Obgyn, 2017;9(1):51-55. 2. Grady, PA, Gough, LL. Self-management: a comprehensive approach to management of chronic conditions. American Journal of Public Health 2014; 104(8):e25-31. doi:10.2105/AJPH.2014.302041 3. Keininger D, Coteur G. Assessment of self-injection experience in patients with rheumatoid arthritis: psychometric validation of the Self-Injection Assessment Questionnaire (SIAQ). Health Qual Life Outcomes. 2011;9:2. doi:10.1186/1477-7525-9-2

Amid the search for efficient terahertz transmission and gas sensing, all‐polymer terahertz waveguides attract significant interest due to their compactness and capability for providing environmentally robust systems. The high loss within metals and dielectrics in the terahertz range makes it challenging to build a low loss, mechanically stable, and broadband terahertz waveguides. In this context, hollow waveguides made of Zeonex are promising for attaining low transmission loss in the terahertz range. Herein, a microstructured hollow hexagonal‐core fiber (HCF) is investigated, which exhibits low loss, near‐zero dispersion, wide operating bandwidth, and is suitable as a gas sensor. Notably, HCF fabrication is carried out by exploiting an efficient single‐step extrusion method—by a standard filament extruder and a puller; hence the production cost is low compared with conventional extrusion methods. This introduces a novel way of fabricating complex and low‐loss terahertz fibers. The experiments demonstrate that an HCF can achieve remarkably low attenuation and near‐zero flattened dispersion as compared with any other terahertz fibers. The resulting HCFs are easy to handle and have high thermal and chemical stability. These results bring significant advancements for terahertz fiber fabrication, low‐loss ultrafast short‐distance terahertz transmission, and sensing in the terahertz spectral domain.

To evaluate a newly developed noninvasive ambulatory, quantitative polymerase chain reaction (Q-PCR) Epstein-Barr virus (EBV) DNA detection and screening system (NP Screen™) for nasopharyngeal carcinoma (NPC).Correlation of the nasopharyngeal epithelial EBV-DNA levels and clinical findings by nasopharyngoscopy and final pathologic diagnosis of NPC with biopsy.Multicenter ENT/Oncology clinics in Hong Kong (Radiation Oncology Clinic at the Queen Elizabeth Hospital and Radiation Oncology Clinic and Head and Neck Clinic, Queen Mary Hospital, University of Hong Kong) and in Toronto, Canada (the Otolaryngology-Head and Neck Clinic at the Rouge Valley Health System and 2 large ENT practices in Toronto).A single-use trans-oral brush was used for rapid, nontraumatic nasopharyngeal (NP) epithelial cells DNA harvest in 600 Chinese patients, combined with a preservation and shipping kit for remote, real-time Q-PCR EBV DNA determinations.All 600 patients had NP brushings using NP Screen in an ambulatory environment, and no adverse events or complications were recorded. A final 578 patients were included with sufficient amount of DNA for completion of the Q-PCR assay. Of these 578 patients, 94 were confirmed positive for NPC histologically. The study yielded a sensitivity of 98.9%, specificity of 99.3%, positive predictive value (PPV) of 96.9%, and negative predictive value (NPP) of 99.7% for NP Screen in detecting NPC. Endoscopy had a sensitivity of 94%, specificity 97.1%, PPV 85%, and NPP 98.9%.The trans-oral brushing system fulfills the characteristics of a noninvasive, sensitive, specific detection method suitable for routine, large-scale ambulatory NPC risk assessment for high-risk NPC populations.

Loading of p53-binding protein 1 (53BP1) and receptor-associated protein 80 (RAP80) at DNA double-strand breaks (DSBs) drives cell cycle checkpoint activation but is counterproductive to high-fidelity DNA repair. ring finger protein 169 (RNF169) maintains the balance by limiting the deposition of DNA damage mediator proteins at the damaged chromatin. We report here that this attribute is accomplished, in part, by a predicted nuclear localization signal (NLS) that not only shuttles RNF169 into the nucleus but also promotes its stability by mediating a direct interaction with the ubiquitin-specific protease USP7. Guided by the crystal structure of USP7 in complex with the RNF169 NLS, we uncoupled USP7 binding from its nuclear import function and showed that perturbing the USP7–RNF169 complex destabilized RNF169, compromised high-fidelity DSB repair, and hypersensitized cells to poly (ADP-ribose) polymerase inhibition. Finally, expression of USP7 and RNF169 positively correlated in breast cancer specimens. Collectively, our findings uncover an NLS-mediated bipartite mechanism that supports the nuclear function of a DSB response protein.

Although research has been reported on pre and post processes for cold spraying, quantitative results are lacking. This study aims to quantify the effect of pre-coat grit blasting and post-spray stress relief and annealing treatments on cold-spray coating microhardness, bond strength, and microstructure. It was found that stress relief treatments reduce hardness, but have little effect on adhesion. Annealing also reduces hardness, but is shown to significantly improve adhesive bond strength. Grit blasting, on the other hand, was found to have a detrimental effect on tensile adhesion strength with little impact on coating microhardness.

This paper presents a comprehensive comparison study between the discrete singular convolution (DSC) and the well-known global method of generalized differential quadrature (GDQ) for vibration analysis so as to enhance the understanding of the DSC algorithm. The DSC method is implemented through Lagrange's delta sequence kernel (DSC-LK), which utilizes local Lagrange polynomials to calculate weighting coefficients, whereas, the GDQ requires global ones. Moreover, it is shown that the treatments of boundary conditions and the use of grid systems are different in the two methods. Comparison study is carried out on 21 rectangular plates of different combinations of simply supported (S), clamped (C) and transversely supported with nonuniform elastic rotational restraint (E) edges, and five rectangular plates of mixed supporting edges, some of which with a range of aspect ratios and rotational spring coefficients. All the results of the DSC-LK agree very well with both those in the literature and newly computed GDQ results. Furthermore, it is observed that the DSC-LK performs much better for plates vibrating at higher-order eigenfrequencies. Unlike the GDQ, the DSC-LK is numerically stable for problems which require a large number of grid points.

Objectives:Obstructive sleep apnea (OSA) is a common sleep disorder due primarily to upper airway obstruction. Certain ethnic groups, particularly Chinese, are more susceptible to a severe degree of OSA irrespective of body weight due in part to inherent narrow upper airway anatomy. In this study, we investigated the treatment outcome of combined upper airway surgeries: septoplasty (SP), turbinate reduction (TR), tonsillectomy, and uvulopalatoplasty (UVPP) on OSA in this ethnic group who have clinical identifiable upper airway anatomical obstruction and are unable to tolerate continuous positive airway pressure (CPAP) treatment.Methods:A retrospective study to analyze the effect of either: (1) SP and TR (inferior turbinectomy) only or (2) in combination with UVPP (partial uvulectomy and lateralization of palatal pillars) and standard tonsillectomy, on Chinese patients diagnosed with OSA. Outcome measures were obtained from pre- and postoperative polysomnographs (PSG) where sleep parameters, AHI, and oxyge...

The remaining life for a hypothetical pressure vessel containing a defect which is subject to thermal shock has been calculated. Twelve cases of thermal shock loads of different severity characterized by the dimensionless parameters, Biot (B) and Fourier (F) numbers, were analysed by finite element modelling (FEM). The estimation of remaining life for each case was carried out based on the PD6493 defect assessment procedure (1). The effect of thermal shock on the crack growth rate was quantified showing that more severe shocks accelerate crack growth while less severe shocks may lead to slow growth or eventual crack arrest.

Electric utility engineers have commented that extruded distribution cables frequently fail during or shortly after a thunder storm. These engineers also comment that failures often reoccur on cable circuits where previous failures were located with a thumper. Linemen at Georgia Power often make similar comments. To investigate this observation, crosslinked (XLPE) and tree retardant crosslinked (TRXLPE) power cable designs were subjected to accelerated water treeing tests. Samples were subjected to simulated lightning surges or simulated thumping surges. Crosslinked cables removed after 15 years of service operation were also subjected to these surges. The results show that, in some cases, lightning surges do reduce extruded distribution cable life. Also, high level thumping surges appear to reduce cable life once cables are well aged. >

Polo-like kinase 1 (Plk1) is a critical regulator of many stages of mitosis; increasing evidence indicates that Plk1 overexpression correlates with poor clinical outcome, yet its mechanism of regulation remains unknown. Hence, a detailed evaluation was undertaken of Plk1 expression in human nasopharyngeal cancer (NPC), the cellular effects of targeting Plk1 using siRNA in combination with ionizing radiation (RT) and potential upstream microRNAs (miRs) that might regulate Plk1 expression. Using immunohistochemistry, Plk1 was observed to be overexpressed in 28 of 40 (70%) primary NPC biopsies, which in turn was associated with a higher likelihood of recurrence (p = 0.018). SiPlk1 significantly inhibited Plk1 mRNA and protein expression, and decreased Cdc25c levels in NPC cell lines. This depletion resulted in cytotoxicity of C666-1 cells, enhanced by the addition of RT, mediated by G2/M arrest, increased DNA double-strand breaks, apoptosis, and caspase activation. Immunofluorescence demonstrated that the G2/M arrest was associated with aberrant spindle formation, leading to mitotic arrest. In vivo, transfection of C666-1 cells and systemic delivery of siPlk1 decreased tumour growth. MicroRNA-100 (miR-100) was predicted to target Plk1 mRNA, which was indeed underexpressed in C666-1 cells, inversely correlating with Plk1 expression. Using luciferase constructs containing the 3'-UTR of Plk1 sequence, we document that miR-100 can directly target Plk1. Hence, our data demonstrate for the first time that underexpressed miR-100 leads to Plk1 overexpression, which in turn contributes to NPC progression. Targeting Plk1 will cause mitotic catastrophe, with significant cytotoxicity both in vitro and in vivo, underscoring the important therapeutic opportunity of Plk1 in NPC.

Recently, there have been numerous food scares particularly with the production of milk powders for infants. This has been caused by the addition of excess melamine to increase the tested protein count of a powder. In this paper we investigate the potential of THz-TDS for use in food quality control and compare this technique to other established techniques. Refereed/Peer-reviewed

Objectives: To assess the association of diagnostic predictors available in the emergency department (ED) with the outcome diagnosis of severe acute respiratory syndrome (SARS). Methods: This retrospective cohort study describes all patients from the Amoy Garden complex who presented to an ED SARS screening clinic during a 2-month outbreak. Clinical and diagnostic predictors were recorded, along with ED diagnoses. Final diagnoses were established independently based on diagnostic tests performed after the ED visit. Associations of key predictors with the final diagnosis of SARS were described. Results: Of 821 patients, 205 had confirmed SARS, 35 undetermined SARS and 581 non-SARS. Multivariable logistic regression showed that the strongest predictors of SARS were abnormal chest x-ray (odds ratio [OR] = 17.4), subjective fever (OR = 9.7), temperature >38°C (OR = 6.4), myalgias (OR = 5.5), chills and rigors (OR = 4.0) and contact exposure (OR = 2.6). In a subset of 176 patients who had a complete blood cell count performed, the strongest predictors were temperature ≥38ºC (OR = 15.5), lymphocyte count Conclusions: Two components of the World Health Organization case definition — fever and contact exposure — are helpful for ED decision-making, but respiratory symptoms do not discriminate well between SARS and non-SARS. Emergency physicians should consider the presence of diarrhea, chest x-ray findings, the absolute lymphocyte count and the platelet count as significant modifiers of disease likelihood. Prospective validation of these findings in other clinical settings is desirable.

In human, the cervical spine region is very susceptible to impact injury. The complex structures of C1 and C2 serve to transmit the weight of the cranium to the greatly similar structural cervical spine from C3 caudally. Application of sudden disruption forces will detach the junction of the cervico-cranium with the pars interarticularis of the neural arch of C2 from the lower cervical spine by fracturing, as in a "hangman's fracture". Severe falls or blows to the head from heavy objects will cause the fracture of the odontoid process of C2. Many biomechanical studies were conducted based on full restraint of the inferior aspects of isolated C2 to produce odontoid fracture. In this study, two different restraining conditions of C2 were adopted experimentally to determine the absolute fracture load and the corresponding fracture patterns that are common to C2.Nine C2 vertebrae obtained from cadaver spines, ranging from 51 to 80 years, were used. Two specified restraint conditions were employed: (1) fully constrain the posterior element postero-anteriorly up to one-quarter of the inferior facet; and (2) fixing of C2 by a specially-designed rig whereby the body of C2 embedded in the pivoted cup and its inferior facets positioned on top of two lateral plates. Antero-posterior shear force was applied on the anterior articulating facet of the dens until failure.These specified restraint conditions had resulted in specific fracture of C2. Antero-posterior shear force ranges from 840 to 1220 N was required to cause fracture across the pars interarticularis under restraint condition 1. Failure load of between 900 and 1500 N was found to cause odontoid fracture under restraint condition 2. These values are in agreement with published data.The biomechanical response of C2 was specific to the mode of restraint conditions of C2. In reality, depending on the force vector applied to the head, precise posture at the time of trauma, spinal geometry, and physical properties, different types of C2 fracture patterns may happen. These findings are of potentials for the biomechanical correlation and validation study of C2 vertebra using analytical approaches, and in the surgical anterior screw fixation of odontoid fracture.

Fracture of the atlas was first described by Jefferson (1920). He theorised a bursting mechanism of fracture as the occipital condyles were driven into the atlas. Experimental studies by Hays and Alker (1988) and Panjabi et al (1991) were also conducted to explain the injury mechanisms. Injury mechanisms and fracture patterns are important in the clinical evaluation of spinal injuries. Recognition and interpretation of the fracture patterns help to determine the spinal instability and consequently the choice of treatment. Although the fracture mechanics of the atlas have received much attention, it has not been investigated using theoretical modelling.A high-definition digitiser was used to obtain the geometrical data for the finite element mesh generation. Contrary to the widely used method, such as computed tomography scan for geometric extraction, the direct digitising process of the dried specimen reliably preserves the accurate topography of up to 0.1-mm interval of the original structure. The finite element model was exercised under an axial compressive mode of pressure loading to investigate the sites of failure reported in vivo and in vitro.Using material properties from literature, the predicted results from the 7808-finite element model demonstrate high concentration of localised stress at the anterior and posterior arch of the atlas, which agrees well with those reported in the literature. Furthermore, our results are also in good agreement with the findings reported by Panjabi et al (1991), which show that the groove of the posterior arch is subjected to enormous bending moment under simulated hyperextension conditions.The close agreement of the failure location provided confidence to perform further analysis and in vitro experiments. The predicted results from finite element analysis may be potentially used to supplement experimental research in understanding the clinical biomechanics of the C1.

The short-term reproducibility in cardiac output (CO) and stroke volume (SV) measurements by transthoracic electrical bioimpedance (TEB) and thermodilution (TH) and their agreement were studied in 31 consecutive patients in the Intensive Care Unit (ICU). For comparison of changes in CO and SV, six patients were studied separately. TEB data were not obtainable in four patients due to interference with impedance signals or heart rate detection. Both methods were reproducible. For TEB, the mean difference of duplicate measurements was 0.03 (SD 0.3) l/min for CO and 0.3 (SD 3.2) ml for SV. For TH, it was -0.04 (SD 0.5) l/min for CO and 0.6 (SD 6.6) ml for SV. The coefficient of reproducibility for CO was thus 0.6 l/min for TEB and 1.0 l/min for TH and that for SV was 6.4 ml for TEB and 13.2 ml for TH. There was no agreement in absolute CO or SV between the methods; TEB giving lower absolute readings. The mean difference (TH-TEB) was 1.4 (SD 1.4) l/min for CO and 14 (SD 13.4) ml for SV. There was, however, good correlation between the two methods. For CO, the regression equation was TEB=0.623+0.739 (TH); (p less than 0.0005, r=0.87). For SV, the regression equation was TEB=-0.23+0.823 (TH); (p less than 0.0005, r=0.86). When only changes were considered, the mean difference (TH-TEB) was -0.5 (SD 0.9) l/min for CO and -4 (SD 8) ml for SV. There was significant correlation in the changes detected by each method.(ABSTRACT TRUNCATED AT 250 WORDS)

Combustion-aided suspension plasma spraying (SPS) was developed for the synthesis of Y2O3 nanoparticles. Numerical models for Ar, Ar∕O2, and combustion-aided plasma fields were built using FLUENT V6.3.2© to compare their different plasma thermophysical properties. Modeling and experimental results both indicate that the plasma field was substantially altered by combustion-aided SPS. The plasma exhibited an elevated volume average temperature and reduced velocity as well as a broadened plasma plume, which resulted in an enhanced vapor supersaturation degree and a faster quenching rate in the radial direction. These can be attributed to the dual effects of oxygen dissociation/recombination and acetone solvent combustion. Consequently, productivity of the obtained nanoparticles increased remarkably and the particles’ morphology was improved, with a smaller mean particle size and a narrower size distribution in comparison with those of powder feeding spraying. Furthermore, plasma-induced cubic→monoclinic phas...

Chronic Myelogenous Leukaemia (CML) is a clonogeneic disease with the Philadelphia (Ph') chromosome as a cytogenetic marker. Conventional therapy rarely leads to cure in CML. Treatment of CML by bone marrow transplantation (BMT) is thus a reasonable alternative. This study reports on nine patients in chronic phase CML who were given allogeneic bone marrow transplantation with bone marrow cells from HLA identical siblings. There were 5 males and 4 females. Median age was 25 years (range 15-33 years). Median time from diagnosis to BMT was 8 months (range 25 to 48 months). Conditioning regimens: (i) 4 patients received cyclophosphamide 60 mgm/kg x 2 days and Total Body Irradiation (TBI) 200 rads x 6 doses x 3 days. (ii) 5 patients received busulphan 4 mgm/kg per day x 4 days followed by cyclophosphamide 60 mgm/kg x 2 days. Cyclosporin A (CSA) and methotrexate (MTX) was administered for Graft-Versus-Host-Disease (GVHD) prophylaxis in 8 patients; one patient received CSA and prednisolone. Median time for engraftment and for peripheral blood granulocytes to reach more than 500/ul was 18 days (range 12-30 days). Median time for platelet count to reach more than 20,000/ul was 25.5 days (range 15-30 days). 33% of patients developed acute GVHD of Grade II and above. The acturial survival of the 9 patients is 46%. Eight of 9 patients transplanted had two or more risk factors which adversely affect prognosis in CML. Four patients are alive and in remission at 562, 386, 46 and 46 days post-BMT respectively.

Tables of normal values are available for the measurement of four sagittal diameters (Roof, FM, C1 and C2) and areas of the soft tissue of the nasopharynx as seen in the lateral neck radiograph. The lateral neck radiographs of 100 nasopharyngeal carcinoma (NPC) cases as well as 100 normal controls of corresponding sex and age distribution are measured to ascertain the usefulness of the above measurement in the detection of NPC. Depending on the method of calculation, figures for positive results (sensitivity) may rise to as high as 85% but the specificity (i.e. probability of a correct diagnosis in a person without NPC) is at the same time lowered to 92%. The detection of NPC from any lateral neck radiograph, however, presents a different problem compared to the situation when a person clinically suspected of having NPC is referred for radiography. Many factors are involved in the former situation and it is to this situation that the predictive value (PV) of the scores has to be employed.

Laboratory tests were performed to investigate the effects of lightning and thumping impulses on the performance of various 15 kV cable designs. The cable designs were aged in the laboratory using an accelerated water treeing test. Some samples were subjected to lightning impulses, some were subjected to thumping impulses, and some were aged without impulses applied. The impulse effects were evaluated using time to failure data, AC breakdown data, and impulse breakdown data. The results show that lightning or thumping impulses do not affect cable AC or impulse breakdown strength. There is also no visual difference between wafers taken from impulsed and control samples. However, there is a strong indication that lightning impulses can reduce cable life. Almost all the aging failures occurred while the cables were warm. No failures occurred during the impulse application. It is also shown that increased cable wall thickness extends cable life for the tree-resistant high-molecular-weight insulation material tested, but not for the crosslinked polyethylene insulation material tested. >

Fourteen patients with haematological malignancies received allogeneic bone marrow transplantation from Major Histocompatility Complex compatible siblings. Five (35.7%) patients developed mild and 4 (28.6%) severe graft-versus-host disease (GVHD). There were correlations between the age of recipient (p less than 0.05), the degree of haematological support (p less than 0.1) and GVHD. The effects of the Mixed Lymphocyte Culture reactivity, donor/recipient sex match, cyclosporin A levels and the use of Total Parenteral Nutrition were not apparent. Two patients had relapses of their initial diseases. One of them did not develop any GVHD and the other only mild GVHD post bone marrow transplantation.

A case study was made on 56 patients with chronic myeloid leukaemia in Singapore. The most common clinical presentations were abdominal discomfort with swelling and hepatosplenomegaly. The mean haemoglobin, white cell count, and platelet count at presentation were 9.23 g/dl, 217.9 X 10(9)/1 and 418 X 10(9)/1 respectively. Twenty-three of the 56 patients had gone into blast transformation at the time of analysis. The median duration of the chronic phase from the time of diagnosis to the time of blast transformation was 23 months. The median duration of survival after blast transformation was 3 months. The median duration of survival for all patients was 23 months. Busulphan remains the drug of choice for the chronic phase of chronic myeloid leukaemia.

The P blood-group system was discovered by Landsteiner and Levine in 1927. This study delineates: a) The ethnic group specific distribution patterns of the P1 blood group antigen in the population of Singapore. b) The occurrence rate of the anti-P1 antibody in the same population. In the blood donor population, the estimated incidence of the P1-negative phenotype was calculated to be 75%. Though the percentage of P1-negative individuals among the Chinese did not differ significantly from that for the Malays, it was significantly higher than that for the Indians (P less than 0.01). The weighted average incidence of anti-P1 in the blood-donor population over the period 1982-1987 was calculated to be 9.14 per 100,000. For the patients, the average incidence of the anti-P1 antibody was calculated to be about 13.9 per 100,000 patients. The Malays were noted to have the highest incidence of anti-P1 antibody despite the occurrence of a higher proportion of P1-negatives among the Chinese.

The purpose of this retrospective study is to delineate: a) The ethnic group specific distribution patterns of the various Lewis phenotypes in our population in Singapore. b) The occurrence rates of the various anti-Lewis antibodies in our population. The approximate frequencies of the Lewis A-B-, Lewis A-B+ and Lewis A + B- phenotypes in the blood-donor population were estimated to be about 10%, 48% and 42% respectively. It was evident that frequency of the Lewis A-B- phenotype was highest among the Malays, being almost 3 times more frequent than it was among the Chinese (P less than 0.01). The anti-Lewis antibodies were noted to be the commonest irregular antibodies seen in our blood donor population, with an occurrence rate of about 127 per 100,000. Likewise, from 1982 to 1987, the anti-Lewis antibodies were also noted to be the most frequently encountered antibodies in our patient population, accounting for nearly 60% of all cases. Although the Malays comprised only about 15% of the Singaporean population, they accounted for as much as 42.9% of all patients with anti-Lewis antibodies. Similarly, out of all 76 blood donors in 1987 with anti-Lewis antibodies, 50% were found to be Malays although they comprised only 14.28% of the donor population. It was also interesting to note that a sizeable proportion of all patients with anti-Lewis antibodies were pregnant women with or without obstetric complications.

Pre-operative blood requests are often greatly in excess of the number of units of blood actually transfused during elective surgical procedures. Such practices are costly in terms of laboratory manpower and leads to unnecessary wastage of blood due to outdating. Developing guidelines for the number of blood units to cross-match preoperatively for surgical procedures optimises the use of blood. This study reports on blood ordering patterns and offers guidelines on the maximum number of units of blood to order for some of the commoner surgical procedures. The use of a Type and Screen procedure is recommended for those operations where blood is regularly ordered but rarely used. Operative procedures listed under the Surgical Tables 1 and 2 and the Minor Surgical Procedure Table, Ministry of Health, Singapore, fall into this group.

Six new patients with acute lymphoblastic leukaemia (ALL) have been studied with a battery of cell surface marker assays. These included T cell enumeration, B cell enumeration, monoclonal antibody studies for T cell subsets, (T helper cells, T suppressor cells and mature peripheral total T cells), HLA--DR (Ia-like antigens) and common ALL antigen. Three patients were found to have common ALL, 2 had null cell ALL and one had T cell ALL. Cytochemical studies on these 6 patients demonstrated a positive correlation between E rosette positivity and focal paranuclear staining with acid phosphatase. There appeared to be no correlation between FAB morphology and immunological subtype in the 6 patients studied.

Seventy patients with Haemophilia A, B, von Willebrand's disease and Factor V deficiency had their liver functions studied. Twenty-five patients (36%) were found to have significant "transaminitis" (elevated SGPT/SGOT). Nine patients (13%) had positive Hepatitis B surface antigen (HBsAg). The incidence of Hepatitis B surface antibody (anti-HBs) in the study group was 74%. All patients were asymptomatic at the time of study. This asymptomatic liver dysfunction will require close monitoring for clinical significance.

The authors recommend measurement of four sagittal diameters of the soft tissue of the nasopharynx, namely, “Roof”, “FM”, “Cl” and “C2”. Values of these diameters are derived from a study of lateral neck radiographs of 640 Chinese in Singapore, and their means and standard deviations presented by age and sex. Significant age and sex differences of varying degrees are found in all parameters. Age and sex should therefore be taken into consideration when assessing individual observations. The value of the lateral neck radiograph in the detection of masses of the nasopharynx was recognized since the early 1930s. Thus, Groth (1931) described adenoid vegetations. Digby and Khoo (1934) stated that in nasopharyngeal carcinoma X rays could show up as an irregularity of the nasopharyngeal clear space. Ho (1961) suggested a method of measurement of the roof and upper posterior wall of nasopharynx. Oon (1964) supplied a table of normal diameters from a study of 150 adults of various races. Johannesson (1968...

1000 consecutive blood donors had their liver functions studied. 110 donors (11%) were found to have raised ALT of more than twice normal levels. 29 donors had liver biopsies done. Histologically 23 had fatty change, 5 had chronic persistent hepatitis and 1 had liver cirrhosis. Fourteen out of the 23 donors with fatty change also had hypercholesterolemia and hypertriglyceridemia. Viral serology of the 110 donors showed that 3 donors were HBsAg positive, 5 donors were Anti-HAV (IgM) positive and 20 donors were Anti-HBc (IgM) positive. Majority of donors with raised ALT had fatty liver on biopsy with only 6 donors having significant findings of chronic persistent hepatitis and cirrhosis. Serologically, most of the donors (74.5%) with raised ALT had no markers of Hepatitis A, Hepatitis B, CMV or EBV. An interesting finding is the high incidence (18%) of positive, Anti HBc (IgM) in donors with raised ALT.

The clinico-pathological features of 5 patients with malignant histiocytosis aged 18 years to 73 years seen over a three year period from 1980 to 1983 at the Department of Haematology Singapore General Hospital were studied. Haematological, cytological and histopathological findings of the disease are described. Diagnosis of malignant histiocytosis was established from biopsies of bone marrow, liver, spleen or lymph nodes. Three out of the 5 patients died rapidly after diagnosis despite cytotoxic chemotherapy. One patient was lost to follow up while another is alive surviving so far for 3 months since diagnosis. The differential diagnosis of malignant histiocytosis is also discussed.

A wide range of drug demand reduction programmes are being carried out in Hong Kong. These include community involvement projects; preventive drug education and publicity through the use of mass media in the form of television and radio announcements and posters; and the production of educational and publicity materials. Most of these programmes are intended to reach young people. The local district campaigns are held every year to arouse awareness of the dangers of drug abuse and to encourage public support in combating such abuse. A selected volunteer group encourages young people to participate in the planning, organization and implementation of drug-abuse prevention projects. A programme called "Youth against drugs scheme", which was launched in 1981, is open to all youth groups, providing an opportunity for young people to plan and implement anti-narcotics publicity projects in their own way with limited supervision. These programmes have proved successful in involving the young in the fight against drug abuse and associated problems.

Using the Haemonetic Model 30 intermittent continuous flow centrifuge, 142 procedures, including 64 granulocytes and platelets, 68 platelet collection, 8 therapeutic leukapheresis and 2 plasmapheresis were performed. Granulocyte transfusions (mean collection 1.39 x 10(10) granulocytes) were given to 27 neutropenic patients for febrile episodes which were unresponsive to systemic antibiotics. Thirty-eight thrombocytopenic patients received a mean of 4.2 x 10(11) platelets per collection. Bleeding was controlled in most of the patients who received transfusion with a mean rise in platelet count of 30.6 x 10(9)/L. Therapeutic leukapheresis were performed on 3 patients with chronic leukaemias. A mean of 2.53 x 10(11) cells were collected per run with a mean fall of 58.2 x 10(9)/L in the patients' white blood cell count. Plasmapheresis was used to treat 1 patient with multiple myeloma. The authors' experience demonstrates that cell separator support is essential for patients with bone marrow depression and that the therapeutic leukapheresis is effective therapy for selected patients with chronic leukaemias. Plasmapheresis is effective in patients with hyperviscosity syndrome.

A case of systemic lupus erythematosus is described in which for 10 years the only significant findings were erythema multiforme and vasculitis. Gross hepatosplenomegaly with persistent pancytopenia developed, and bone marrow examination revealed the presence of sideroblasts. The patient's condition deteriorated, and subsequently she developed a severe bleeding tendency, terminating in erythroleukaemia.

Underground power cables on electric utility systems are frequently subjected to lightning impulses during normal service. They can also be subjected to impulses from fault locating equipment (thumpers). The effects of these impulses on the power cable's life is not well defined. Various cable designs were aged in the laboratory using an accelerated water treeing test. Some samples were subjected to lightning impulses, some to thumping impulses and some were aged without impulses applied. The impulse effects were evaluated using time to failure data, ac breakdown data and impulse breakdown data. The results show that lightning or thumping impulses do not affect cable ac or impulse breakdown strength. There is also no visual difference between wafers taken from impulsed and control samples. However, there is a strong indication that lightning impulses can reduce cable life. Interestingly, almost all the aging failures occurred while the cable were warm. No failures occurred during the impulse application. Also, increased cable wall thickness extended cable life for one insulation but not for another. ..