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BackgroundBaricitinib and dexamethasone have randomised trials supporting their use for the treatment of patients with COVID-19. We assessed the combination of baricitinib plus remdesivir versus dexamethasone plus remdesivir in preventing progression to mechanical ventilation or death in hospitalised patients with COVID-19.MethodsIn this randomised, double-blind, double placebo-controlled trial, patients were enrolled at 67 trial sites in the USA (60 sites), South Korea (two sites), Mexico (two sites), Singapore (two sites), and Japan (one site). Hospitalised adults (≥18 years) with COVID-19 who required supplemental oxygen administered by low-flow (≤15 L/min), high-flow (>15 L/min), or non-invasive mechanical ventilation modalities who met the study eligibility criteria (male or non-pregnant female adults ≥18 years old with laboratory-confirmed SARS-CoV-2 infection) were enrolled in the study. Patients were randomly assigned (1:1) to receive either baricitinib, remdesivir, and placebo, or dexamethasone, remdesivir, and placebo using a permuted block design. Randomisation was stratified by study site and baseline ordinal score at enrolment. All patients received remdesivir (≤10 days) and either baricitinib (or matching oral placebo) for a maximum of 14 days or dexamethasone (or matching intravenous placebo) for a maximum of 10 days. The primary outcome was the difference in mechanical ventilation-free survival by day 29 between the two treatment groups in the modified intention-to-treat population. Safety analyses were done in the as-treated population, comprising all participants who received one dose of the study drug. The trial is registered with ClinicalTrials.gov, NCT04640168.FindingsBetween Dec 1, 2020, and April 13, 2021, 1047 patients were assessed for eligibility. 1010 patients were enrolled and randomly assigned, 516 (51%) to baricitinib plus remdesivir plus placebo and 494 (49%) to dexamethasone plus remdesivir plus placebo. The mean age of the patients was 58·3 years (SD 14·0) and 590 (58%) of 1010 patients were male. 588 (58%) of 1010 patients were White, 188 (19%) were Black, 70 (7%) were Asian, and 18 (2%) were American Indian or Alaska Native. 347 (34%) of 1010 patients were Hispanic or Latino. Mechanical ventilation-free survival by day 29 was similar between the study groups (Kaplan-Meier estimates of 87·0% [95% CI 83·7 to 89·6] in the baricitinib plus remdesivir plus placebo group and 87·6% [84·2 to 90·3] in the dexamethasone plus remdesivir plus placebo group; risk difference 0·6 [95% CI -3·6 to 4·8]; p=0·91). The odds ratio for improved status in the dexamethasone plus remdesivir plus placebo group compared with the baricitinib plus remdesivir plus placebo group was 1·01 (95% CI 0·80 to 1·27). At least one adverse event occurred in 149 (30%) of 503 patients in the baricitinib plus remdesivir plus placebo group and 179 (37%) of 482 patients in the dexamethasone plus remdesivir plus placebo group (risk difference 7·5% [1·6 to 13·3]; p=0·014). 21 (4%) of 503 patients in the baricitinib plus remdesivir plus placebo group had at least one treatment-related adverse event versus 49 (10%) of 482 patients in the dexamethasone plus remdesivir plus placebo group (risk difference 6·0% [2·8 to 9·3]; p=0·00041). Severe or life-threatening grade 3 or 4 adverse events occurred in 143 (28%) of 503 patients in the baricitinib plus remdesivir plus placebo group and 174 (36%) of 482 patients in the dexamethasone plus remdesivir plus placebo group (risk difference 7·7% [1·8 to 13·4]; p=0·012).InterpretationIn hospitalised patients with COVID-19 requiring supplemental oxygen by low-flow, high-flow, or non-invasive ventilation, baricitinib plus remdesivir and dexamethasone plus remdesivir resulted in similar mechanical ventilation-free survival by day 29, but dexamethasone was associated with significantly more adverse events, treatment-related adverse events, and severe or life-threatening adverse events. A more individually tailored choice of immunomodulation now appears possible, where side-effect profile, ease of administration, cost, and patient comorbidities can all be considered.FundingNational Institute of Allergy and Infectious Diseases.

Failure to identify anatomical variations may contribute to surgical errors or perioperative complications during abdominal and oncological surgery. We report the case of an anatomical variation of the inferior vena cava revealed during para-aortic lymphadenectomy for advanced ovarian cancer. Due to renal insufficiency, preoperative CT-scan was performed without contrast injection and the variation was not clearly detected. Our clinical case underlines the importance of the preoperative diagnosis of anatomical variations and highlights the need to provide young surgeons with adequate technical training in para-aortic lymphadenectomy.

Aim To assess the value of post-mastectomy radiation therapy (PMRT) to breast cancer (BC) patients with no or minimal lymph node (LN) involvement. Materials and methods We retrospectively analysed a French multi-centric cohort of 4283 patients treated by mastectomy and axillary dissection, with or without PMRT, between 1980 and 2013. Practices were analysed for three treatment periods (1980–1999, 2000–2005 and 2006–2013). The impact of PMRT on loco-regional recurrence (LRR), disease-free survival (DFS), BC-specific survival and overall survival was assessed in pN0-1mi patients using multivariate analyses (logistic regression and Cox model). It was subsequently assessed based on the number of clinicopathological recurrence-risk factors, generating a prognostic index (French-PMRT index), to isolate a pN0-1mi patients subgroup that might derive a benefit from PMRT. We tested the accuracy of the Cambridge-PMRT (c-PMRT) index to discriminate between patients with significantly different outcomes and the value of PMRT in each c-PMRT prognostic group. Results More than half of the pN0-1mi patients of our cohort underwent PMRT, which almost significantly improved LRR-free survival and DFS. Matching pN0-1mi patients based on the number of clinicopathologic recurrence-risk factors identified a higher risk subpopulation (≥3 recurrence-risk factors), but PMRT did not improve patient outcomes. Although the c-PMRT index had the potential to predict patient outcomes, its use did not help in making the decision of whether or not to use PMRT. Conclusion We failed to isolate a subgroup of early BC patients without LN involvement suitable for PMRT, despite studying a large cohort.

Introduction The aim of this study was to examine changes in therapeutic practices for early breast cancer T0-2 N0 managed by upfront surgery and SLNB. Population Between 1999 and 2012, 15.508 patients were treated. Four periods were determined: 1999–2003, 2004–2006, 2007–2009 and > 2009. Five tumor subtypes were defined according to hormonal receptors (HR) and Her2: Luminal A (HR + Her2- Grade 1–2), Her2 (Her2+ HR-), Triple-negative (HR- Her2-), Luminal B Her2- (HR + Her2- Grade 3), Luminal B Her2+ (HR + HER2+). Methods Rates of axillary lymph node dissection (ALND), adjuvant chemotherapy ± trastuzumab, endocrine treatment, mastectomy and post mastectomy radiotherapy (PMRT) were analyzed according to treatment periods with univariate and multivariate analysis. Overall and disease-free survivals were analyzed according to treatment periods adjusted for HR and then for tumor subtypes. Results Rates of ALND, adjuvant chemotherapy and endocrine treatment varied significantly according to treatment periods, for HR positive and negative tumors. ALND rate decreased for all tumor subtypes with a decrease of adjuvant chemotherapy rate for Luminal A tumors and an increase for Luminal B Her2+ and Her2-tumors. Endocrine treatment rate decreased for Luminal A and increased for Luminal B Her2+ tumors. In multivariate analysis, these modifications with time remained significant. Mastectomy and PMRT rates increased. In multivariate analysis, overall and disease-free survivals increased during successive periods. Conclusion A global therapeutic de-escalation in ALND and adjuvant systemic treatment, combined with an actual escalation in some specific subsets was demonstrated, but without negative impact on survival.

La proctectomia tramite assistenza robotica e una tecnica minimamente invasiva del futuro per la chirurgia del cancro del retto. Essa mira a facilitare questo intervento chirurgico per i pazienti difficili, ad alto rischio operatorio. Viene descritta, qui, la tecnica che utilizza il robot con un singolo attracco ( full robot -single docking ). Le diverse fasi chirurgiche sono dettagliate per facilitare la standardizzazione dell’intervento e diminuire il tempo operatorio. I primi risultati delle serie pubblicate mostrano una diminuzione del tasso di conversione rispetto alla laparoscopia e, per alcuni autori, meno margini positivi senza un aumento del tempo operatorio.

La proctectomia con asistencia robotica es una tecnica minimamente invasiva de futuro para la cirugia del cancer de recto. Su proposito es facilitar esta cirugia en los pacientes dificiles, con alto riesgo quirurgico. En este articulo, se describe la tecnica en la que se usa el robot con un unico acoplamiento (full robot-single docking). Se detallan las distintas etapas quirurgicas para facilitar la estandarizacion del procedimiento y disminuir la duracion de la intervencion. Los primeros resultados de las series publicadas muestran una disminucion de la tasa de conversion comparable a la de la laparoscopia y, segun algunos autores, menos margenes positivos sin aumento de la duracion de la intervencion.

Il retto e la porzione terminale del tratto digerente. E diviso, in anatomia chirurgica, in tre parti. Un terzo superiore, avvolto dal peritoneo, che fa seguito al colon sigmoideo, un terzo medio sottoperitoneale, che presenta rapporti importanti in particolare con l’innervazione autonomica genitourinaria, e un terzo inferiore, corrispondente al canale anale, a livello dell’apparato sfinterico. Inoltre, le specificita del drenaggio linfatico del cancro rettale spiegano il ruolo chiave della chirurgia nel trattamento di questa malattia e nella prevenzione delle recidive locali. Il chirurgo si trova, quindi, di fronte a due problematiche opposte, che sono la realizzazione di una chirurgia quanto piu completa possibile e la prevenzione delle sequele funzionali negative a volte molto invalidanti. E questa caratteristica che spiega la specificita della chirurgia rettale, come la necessita, per il chirurgo, di avere una perfetta conoscenza di questa anatomia.

El recto es la parte terminal del tubo digestivo. En anatomia quirurgica, se divide en tres tercios: un tercio superior peritonizado, que continua al colon sigmoide; un tercio medio infraperitoneal, que presenta relaciones importantes en particular con la inervacion autonoma genitourinaria, y un tercio inferior, que corresponde al conducto anal, al aparato esfinteriano. Por otra parte, las particularidades del drenaje linfatico de los canceres del recto explican la funcion clave de la cirugia en el tratamiento de esta patologia y en la prevencion de las recidivas locales. Asi, el cirujano se enfrenta a dos problematicas opuestas, que son la realizacion de una cirugia tan completa como sea posible y la prevencion de las secuelas funcionales, que en ocasiones pueden ser muy invalidantes. Es esta particularidad la que explica la especificidad de la cirugia rectal asi como la necesidad de que el cirujano tenga un perfecto conocimiento de esta anatomia.

Background Hepatitis C virus (HCV) infection and bacteremia are common comorbidities in hemodialysis patients. A specific relationship between HCV infection and bacteremia has not been defined; however, there is evidence of immune compromise in both HCV-infected and uremic patients, suggesting that this group may be at higher risk for infection. Methods We investigated risk factors and mortality associated with bacteremia in HCV-infected hemodialysis patients from the United states Renal Data system. Results During the 4-year study period, HCV was present in 2.1% of 355,084 patients initiating hemodialysis. When compared with the total population, the rate of bacteremia was significantly higher in patients with HCV (38.3% versus 21.8%). The adjusted relative risk (RR) for bacteremia was higher in HCV versus all patients (relative risk, 95% confidence interval [CI]) in the presence of methicillin-resistant Staphylococcus aureus infection (2.64, CI: 2.58-2.70 versus 2.32, CI: 2.27-2.38), HIV (1.93, CI: 1.85-2.02 versus 1.86, CI: 1.77-1.95) urinary tract infection (1.79, CI: 1.77, 1.82 versus 1.64, CI: 1.61-1.67) and cirrhosis (1.49, CI: 1.451.54 versus 1.29, CI: 1.25-1.34). The hazard ratio (95% CI) for death was higher in HCV versus all patients at 1.69 (CI: 1.58-1.81) versus 1.54 (CI: 1.53-1.56). Conclusions These data indicate that several clinical covariates increase the risk of bacteremia in hemodialysis patients, with the magnitude of that risk being further increased by HCV infection. Improving outcomes in HCV-infected hemodialysis patients will likely be dependent on aggressive diagnosis and treatment of both HCV and bacteremia.

This paper examines the impact of fiscal decentralization on both public investment in innovation (measured as the share of research and development - R&D - spending in total government budget) and on the intensity of basic research within the public R&D bundle. We present a theoretical model where a ‘benevolent government’ invests in R&D aiming at maximizing net income available in the country (central government) or in the respective region (subnational government), where states compete to attract capital investment, and where R&D results are subject to interregional knowledge spillovers. The model predicts that decentralization leads to a lower level of public spending on innovation, and to a lower share of basic research in government R&D budget. The implications of the model are empirically tested utilizing country aggregate data. We find evidence that expenditure decentralization leads to lower intensity of basic research within public R&D, and that both revenue and expenditure decentralization negatively affect the size of innovation spending. The findings suggest that fiscal decentralization policy, expected to be beneficial in many other dimensions, should be accompanied by measures to compensate for the otherwise decrease in innovation spending, and that the assignment of expenditure responsibilities should have central government play a greater role in financing and carrying out basic research.

The aim of this study was to determine the suspension level for the sensitivity of an intraoperative scintillation gamma probe in the detection of the sentinel lymph node (SLN) in melanoma patients. Thirty-eight consecutive patients with melanoma were enrolled in the study during a 12-month period and underwent lymphatic scintigraphy after the peritumoral intradermal administration of about 14 MBq of 99m Tc-nanocolloids. The SLNs were successfully removed during the surgical intervention about 4 h later. To identify and localize the SLN, a scintillation NaI(Tl) collimated probe was used. Predictably, the probe sensitivity decreased as the photopeak energy window was progressively narrowed, from 6.9 ± 0.7 counts per second (cps)/kBq (designated as the ‘optimum,’ or ‘OPT,’ sensitivity) to 2.5 ± 0.3 cps/kBq (LOW sensitivity) and to 1.4 ± 0.2 cps/kBq (VLOW sensitivity). Maximum lymph node count rates (cps) were determined for the foregoing energy windows prior to skin incision (PRE OPT , PRE LOW , PRE VLOW , respectively) and in vivo after incision (INV OPT , INV LOW , INV VLOW ). Forty-three SLNs were removed with a mean source-to-detector distance of 46 ± 24 mm (min 12 mm, max 92 mm). Four SLNs could not have been detected using PRE LOW. This figure would have decreased to 34, with nine undetectable lymph nodes, with PRE VLOW. One SLN could not have been identified using INV LOW and four could not have be identified using INV VLOW. In the clinical scenario of SLN detection in melanoma patients, a system sensitivity of 2.5 cps/kBq represents a suspension level, that is, a level under which the equipment must be suspended from clinical use and the poor performance must be investigated.

Surgery has still a key role in curative treatment of digestive carcinomas, and for almost all localisations, lymph node status is a major prognostic factor. As far as oesophageal and gastric cancer are concerned, there is not yet any internationally standardized approach. Occidental guidelines recommend more limited lymph node dissections than Asiatic ones. Lymph node numbers requested during surgery of such cancers remain high, at least 23 lymph nodes for oesophageal cancer, and 25 for a D2 or D1.5 lymphadenectomy for gastric cancer. Generalisation of neo-adjuvant and adjuvant treatments has not yet modified these standards. On the other hand, rectal cancer surgery is well standardized since the global adoption of Total Mesorectal Excision (TME) for the late eighties. Development of mini-invasive techniques (laparoscopy and robot-assisted surgery) enabled an important decrease of surgery related morbidity as well as an enhanced post-operative recovery. However, rectal cancer surgery still has an important morbidity. Development of neo-adjuvant chemo-radiotherapy as well as in-depth knowledge of risk factor of lymph node invasion opened up the path for transanal full thickness resection without lymphadenectomy. The goal of such an approach is to avoid TME's morbidity without risking local recurrence rate increase. As a consequence, this technique might need to be completed with a TME case histological factors are not favorable.

Las recidivas locales (RL) y locorregionales (RLR) de los canceres de la mama se caracterizan por su heterogeneidad. Las situaciones clinicas de presentacion, evolucion y pronostico son muy distintas. En este articulo se detallan los diversos factores asociados al riesgo de RLR despues del tratamiento de un cancer de mama (CM). Tambien considerara el efecto de los tratamientos sistemicos iniciales sobre el control locorregional de la enfermedad. A continuacion, se expondran los elementos que permiten determinar el pronostico en presencia de una RLR y orientar las estrategias principales del tratamiento.

Resume Les auteurs rapportent un cas de faux-positif d’une biopsie transrectale sous echographie endorectale lors de l’evaluation initiale d’un cancer du rectum. Il s’agissait d’un patient de 46 ans, porteur d’une tumeur du moyen rectum evaluee T2-T3 N+ par l’IRM et l’echographie endorectale. La biopsie transrectale echoguidee ramenait des cellules carcinomateuses. Une proctectomie subtotale etait realisee sans traitement neoadjuvant. Les resultats anatomopathologiques etaient en faveur d’un adenocarcinome bien differencie pT2pN0 (42 ganglions N0 examines). Les differentes hypotheses permettant d’expliquer la discordance entre les examens preoperatoires et le resultat histologique definitif sont discutees.

Resume Les complications biliaires au decours de la cholecystectomie sous cœlioscopie sont rares mais graves. Leur taux de mortalite peut atteindre 9 %. But de l’etude decrire les modalites de prise en charge des complications biliaires apres cholecystectomie dans notre centre. Patients nous avons analyse la prise en charge de 27 patients (13 femmes, 14 hommes) d’un âge moyen de 53 ans (18 a 92 ans), hospitalises entre janvier 1995 et juin 2005. Les complications que nous avons traitees etaient des plaies de la voie biliaire principale (VBP) (n = 16, 60 %), des stenoses de la VBP (n = 5, 18,5 %), des fistules par lâchage du moignon cystique (n = 4, 15 %) et des fistules sur canal aberrant (n = 2, 7,5 %). Resultats une cholecystite aigue etait presente dans 40 % des cas (n = 11). Une cholangiographie peroperatoire a ete realisee chez 12 patients (44 %). Le taux de mortalite a ete de 0. Les plaies de la VBP ont ete diagnostiquees en peroperatoire dans 43 % des cas (n = 7) ou dans un delai moyen de 11,2 jours dans 57 % des cas (n = 9). Les stenoses secondaires de la VBP ont ete diagnostiquees dans un delai moyen de 95 jours. Les traumatismes de la VBP ont ete traites par 16 anastomoses bilio-digestives et 5 drains de Kehr. Les fistules par lâchage du moignon cystique ont ete diagnostiquees dans un delai de 14,8 jours. Les fistules sur canal aberrant ont ete diagnostiquees en peroperatoire (n = 1) et a J2 (n = 1). Les fistules ont ete traitees par la mise en place d’un clip sur le canal cystique (n = 2), par un drain de Pedinelli (n = 1), par une endoprothese biliaire (n = 1) et par la fermeture d’un canal aberrant (n = 2). Conclusion les traumatismes de la VBP (plaies ou stenose) post cholecystectomie sont graves car elles necessitent trois fois sur quatre une derivation bilio-digestive a la difference des autres complications biliaires.

Paragangliomas (PG) are rare and often diagnosed in the young adult. One case of retroperitoneal preaortic paraganglioma localised between the celiac trunk and the superior mesenteric artery is reported. The management of paraganglioma involves endocrinologists, geneticists and surgeons but the only potentially curative treatment remains surgical resection. Pathology reports can not always discriminate between benign or malignant tumors. Hereditary in paraganglioma occurs in approximately 25% of cases. Genetic investigation is therefore mandatory in all patients with PG. Since the type of genetic mutation is correlated with tumoral aggressiveness, genetic investigation results should be taken into account when a surgical procedure is planned.

A rapid and effective procedure for the extraction and determination of 4-allylanisole (estragole), 4-allyl-1,3-benzodioxole (safrole) and 4-allyl-1,2-dimetoxybenzene (eugenol methyl ether) in food products was developed. These compounds were isolated from food matrices by employing a simultaneous distillation–extraction (SDE) technique with a Likens and Nickerson apparatus and using dichloromethane as extraction solvent. The method was validated by conducting recovery studies on fortified food products at several concentrations. Recoveries ranged between 94 and 105%. The analyses were performed by capillary gas-chromatography, the compounds identified by retention times and confirmed by GC/MS. The detection limits, determined both in standard solutions and in foods, were 10, 5 and 8 ng/ml for estragole, safrole and eugenol methyl ether, respectively and the calibration curves showed a good linearity for all the three compounds in the concentration range 0.5–25 ppm, with correlation coefficients ranging between 0.996 and 1.000. In a number of successive analyses, the estragole peak area repeatability (RSD) was 0.20 ng/ml, whereas for safrole resulted 0.33 ng/ml and for eugenol methyl ether 0.45 ng/ml. The estragole, safrole and eugenol methyl ether levels were measured in 42 samples, for a total of six product types, including “Pesto” sauce, tomato sauce containing basil, “Cola tasting” beverages, Bologna sausage (polony), Vienna sausage (wurstel) and fresh basil. The levels ranged from below the detection limit up to 19.30 mg/kg for estragole in “Pesto” sauce.

We have observed the cataclysmic variable AE Aqr for a total of 68.7 hours over the epoch 1991–1995 using the Whipple Observatory 10 m gamma-ray telescope. An analysis of these data has revealed no evidence for any steady, pulsed or episodic TeV emission. We have calculated an upper limit for steady emission of 4.0 × 10−12 photons cm−2s−1 at an energy threshold of 900 GeV. This is three orders of magnitude less than the flux reported by others during burst activity. Our upper limits coherent pulsed emission at the first and second harmonics of the white dwarf frequency are 1.5 × 10−12 photons cm−2s−1 in each case.

Extensive contact between blood and artificial surfaces causes platelet activation and depletion. The aim of the study was to test the efficacy of Ro 44-9883, a new nonpeptide, reversible, glycoprotein IIb/IIIa antagonist in preventing platelet count drop in dogs undergoing cardiopulmonary bypass during 2 hours. Twenty-two heparinized dogs were divided into three groups, one control group (n = 9) not treated, one group treated with a low dose of Ro 44-9883 (145 micrograms/kg intravenously, n = 6), and one group treated with a high dose of Ro 44-9883 (870 micrograms/kg intravenously, n = 7). In the control group, platelet counts declined to 53% +/- 15% of initial levels at the start of cardiopulmonary bypass and remained lower than 80% of initial levels during follow-up. Platelet count drop was completely prevented in the Ro 44-9883 high-dose group, whereas it was only partially prevented in the low-dose group. Blood loss was similar in the three groups despite the fact that bleeding times were longer in the Ro 44-9883 high-dose group than in the control group. We conclude that Ro 44-9883, together with heparin as a standard anticoagulant, is highly effective in preventing platelet count drop during cardiopulmonary bypass without causing excessive bleeding.

Pathologic hoof changes in horses and swine can be normalized by administration of biotin. This vitamin has been given orally to women with brittle fingernails or onychoschizia. The aim of the study was to test whether the favorable clinical results could be corroborated by scanning electron microscopy. We investigated the distal ends of the fingernails from 32 persons. They were placed into three groups: group A consisted of 10 control subjects with normal nails, group B comprised eight patients with brittle nails studied before and after biotin treatment, and group C was 14 patients with brittle nails in whom the administration of biotin did not coincide exactly with the initial and terminal clipping of the nails. The thickness of the nails in group B increased significantly by 25%. In group C, the increase was 7%. Splitting of the nails were reduced in groups B and C and the irregular cellular arrangement of the dorsal surface of brittle nails became more regular in all nails of group B and in 8 of 11 nails of group C.

Both neural and humoral systems participate in the control of blood flow to various organs. Exercise places the greatest demands on the circulation. At rest, in humans, skeletal muscle receives somewhere between 15% and 20% of cardiac output, while during maximal exercise, this percentage reaches a value of 80% to 90%. The active human muscles have a high-flow capacity that exceeds the capacity of the heart to pump blood. Measurements in single human muscle have indicated that blood flow may be inhomogeneous, that is, probably depending on variations of the vasomotor tone of the muscle mediated by humoral and neural factors. Exercise raises cardiac output and coronary blood flow, which rise linearly with increases in heart rate. In normal young men, coronary blood flow averages 280 ml/min/100 g of the left ventricle and reaches as high as 390 ml/min during moderately severe exercise, requiring about 85% of maximal heart rate. In nonexercising organs, the blood flow decreases at about 20% to 40% of the resting values, being the net result of competing vasoconstrictor and vasodilator drives.

Although anatomical abnormalities of the upper airway have been recorded in some patients with obstructive sleep apnoea (OSA), a muscle tone dysregulation also seems to have an important role in this disorder. Since habitual snoring is the initial stage of OSA, the structural characteristics of upper airway muscles (medium pharyngeal constrictor muscle [MPCM]) from 13 men (9 non-snorers and 4 habitual snorers) were studied. MPCM fibre structure in non-snorers was broadly similar to that in normal limb muscles, with the exception that fibre diameters were smaller for all fibre types. Compared with limb muscles, MPCM had a smaller proportion of type IIb fibres and a higher proportion of types I and IIa fibres. MPCM in habitual snorers had an abnormal distribution of fibre types (low percentage of type I and type IIb fibres and high percentage of type IIa fibres) compared with non-snorers (p less than 0.001) and the type IIa fibres were hypertrophic. No myopathic or neurogenic changes were seen. Two possible hypotheses explain the abnormal distribution of fibre types in snorers. First, a constitutionally determined reduction of slow alpha-motor neurons induces an adaptive transformation of type IIb to type IIa fibres and a hypertrophy of type IIa fibres; or, second, motor neurons change their patterns of discharge and, hence, of activation, and modify fibre-type distribution of MPCM as an adaptation to the anatomical characteristic of upper airway and habitual snoring.

The rotation of the static magnetization was measured by Mossbauer spectroscopy as 2.5 monolayers of resonating 57 Fe were moved from inside the Fe films to the Fe/Ni interfaces in Fe/Ni (17/200 A) multilayers produced by thermal evaporation. The results indicate a remarkable dependence of the tilt angle as a function of distance from the surface.

Polycrystalline multilayers of Fe-Ni produced by thermal evaporation are studied; some results obtained by a vibrating sample magnetometer, Mossbauer spectrometer and X-ray diffractometer are reported and discussed. Fe seems to grown on Ni with fcc structure. Fe atoms at the Ni/Fe interface seem to have localizated magnetic moments depending on the crystallographic orientations of the grains of the substrate; the remaining Fe atoms between the two interfaces appear as highly susceptible metal.

Supraependymal, varicose nerve fibres were observed in human post-mortem brain when ventricle surfaces were examined by transmission and scanning electron microscopy. Transmission electron microscopy revealed the presence of numerous profiles of nerve terminals, containing small electron-lucent vesicles and large dense-cored vesicles, and axons with their characteristic neurotubules. Occasionally, desmosome-like junctions were found between the nerve terminals and the adjacent ependymal cells. Scanning electron microscopy demonstrated the topographical distribution of varicose nerve fibres traversing among clusters of cilia and numerous microvilli on the ventricle surface. These nerve fibres, which were most frequently observed in the interventricular foramen, often coursed in bundles. In one of the five cases examined, a discrete formaldehyde-induced fluorescence typical of 5-hydroxytryptamine (yellow colour and rapid fading upon violet-blue irradiation) was observed on the floor of the fourth ventricle. It is concluded that supraependymal nerve fibres in human brain are probably identical to similar nerves previously characterized as serotoninergic in rat brain and occurring in several other mammalian brains.

Thin films grown in 10 -6 Torr on polycrystalline substrates of Ni, Cu, Ni/Cu, and Cu/Ni are investigated by transmission Mossbauer spectroscopy at 300 K. The effect of the substrate on the structure of the Fe films is discussed. Fe films grown on Ni seem to assume fcc structure while those on Cu are bcc.