Omitting radiation therapy after lumpectomy for pure DCIS does not reduce the risk of salvage mastectomy.

PURPOSE: Radiation therapy (RT) after breast-conserving surgery (BCS) for Ductal Carcinoma in Situ (DCIS) halves the risk of local recurrence (LR). The omission of RT is often supported by the paradigm that patients who develop LR can be salvaged with further breast-conserving therapy leading to higher rates of breast preservation and improved quality of life. However, population-based, long-term rates of breast preservation in women treated by upfront BCS ± RT are unknown. METHODS AND MATERIALS: Women diagnosed with pure DCIS from 1994 to 2003 treated with BCS ± RT in Ontario were identified. Median follow-up is 12 years. The development and treatment of LR and contralateral breast cancers were determined by administrative databases with validation. The 10-year mastectomy-free survival was calculated using the Kaplan-Meier method. The impact of RT on breast preservation was determined by propensity-adjusted cox proportional hazards model. RESULTS: The cohort includes 3303 women with DCIS; 1649 (50%) underwent BCS alone, 1654 (50%) underwent BCS + RT. Women treated by BCS alone were more likely to develop a LR compared to those treated by upfront BCS + RT (20.8% versus 15.5%, p < 0.001). Mastectomy was used to treat LR in 57.4% (197/343) of women who recurred after BCS alone and 67.6% (174/257) of those who recurred after BCS + RT. Women treated with upfront BCS + RT had higher rates of bilateral breast preservation at 10 years compared to those treated by BCS alone (87.3% vs.82.7%, p = 0.0096). CONCLUSION: Local Recurrence after BCS alone does not favor breast preservation.

Multigene Expression Assay and Benefit of Radiotherapy After Breast Conservation in Ductal Carcinoma in Situ.

Background: Most women with ductal carcinoma in situ (DCIS) will receive breast-conserving surgery (BCS) and radiation (RT). RT can be omitted for women at low risk of local recurrence (LR). The Oncotype DX DCIS score (DS) predicts LR risk after BCS alone. This study assesses the impact of RT and DS on LR risk. Methods: Population-based cohort analysis of individuals with DCIS treated by BCS ± RT from 1994-2003. Treatment and outcomes were determined by linkage and chart review. We used a propensity score-adjusted multivariable model to examine associations between DS and LR and evaluate the impact of RT. All statistical tests were two-sided. Results: The cohort includes 571 individuals treated by BCS alone, 689 cases treated with BCS + RT. Median follow-up was 9.4 years. On multivariable analysis, factors associated with LR include RT, age at diagnosis, tumor size, and multifocality. Adjusting for these factors, the DS risk group was statistically significantly associated with LR risk (hazard ratio high/intermediate = 1.75, 95% confidence interval = 1.28 to 2.41, P < .001). Women with a low-risk DS treated by BCS alone had an LR risk of 10.6% at 10 years and a small benefit from RT, while those with a high DS had a higher risk of LR (25.4%) after BCS alone and greater benefit from RT. A subgroup of patients with favorable clinicopathological features had a high-risk DS; these patients had a higher than expected risk of LR after BCS alone and a greater benefit with RT. Conclusions: The DS molecular assay improves risk stratification and estimates of RT benefit in individuals with DCIS treated with breast-conserving therapy.

Peculiar orientational disorder in 4-bromo-4'-nitrobiphenyl (BNBP) and 4-bromo-4'-cyanobiphenyl (BCNBP) leading to bipolar crystals.

180° orientational disorder of molecular building blocks can lead to a peculiar spatial distribution of polar properties in molecular crystals. Here we present two examples [4-bromo-4'-nitrobiphenyl (BNBP) and 4-bromo-4'-cyanobiphenyl (BCNBP)] which develop into a bipolar final growth state. This means orientational disorder taking place at the crystal/nutrient interface produces domains of opposite average polarity for as-grown crystals. The spatial inhomogeneous distribution of polarity was investigated by scanning pyroelectric microscopy (SPEM), phase-sensitive second harmonic microscopy (PS-SHM) and selected volume X-ray diffraction (SVXD). As a result, the acceptor groups (NO2 or CN) are predominantly present at crystal surfaces. However, the stochastic process of polarity formation can be influenced by adding a symmetrical biphenyl to a growing system. For this case, Monte Carlo simulations predict an inverted net polarity compared with the growth of pure BNBP and BCNBP. SPEM results clearly demonstrate that 4,4'-dibromobiphenyl (DBBP) can invert the polarity for both crystals. Phenomena reported in this paper belong to the most striking processes seen for molecular crystals, demonstrated by a stochastic process giving rise to symmetry breaking. We encounter here further examples supporting the general thesis that monodomain polar molecular crystals for fundamental reasons cannot exist.

Close or positive resection margins are not associated with an increased risk of chest wall recurrence in women with DCIS treated by mastectomy: a population-based analysis.

Mastectomy is effective treatment for ductal carcinoma in situ (DCIS) but some women will develop chest wall recurrence. Most chest wall recurrences that develop after mastectomy are invasive cancer and are associated with poorer prognosis. Past studies have been unable to identify factors predictive of chest wall recurrence. Therefore, it remains unclear if a subset exists of women with DCIS treated by mastectomy experience a high rate of recurrence in whom more aggressive treatment may be of benefit. We report outcomes of all women in Ontario (N = 1,546) diagnosed with pure DCIS from 1994 to 2003 treated with mastectomy without radiotherapy and evaluate factors associated with the development of chest wall recurrence. Treatments and outcomes were validated by chart review. Proportional differences were compared using Chi square analyses. Survival analyses were used to study the development of chest wall recurrence in relation to patient and tumor characteristics. Median follow-up was 10.1 years. Median age was 57.1 years. 36 patients (2.3%) developed chest wall recurrence. The 10-year actuarial chest wall recurrence-free survival rates and invasive chest wall recurrence-free survival rates were 97.6 and 98.6%, respectively. There was no difference in cumulative 10 year rates of chest wall recurrence by age at diagnosis (<40 years = 5.2%, 40-44 years = 1.3%, 45-50 years = 2.9%, >50 years = 2.1%; p = 0.19), nuclear grade (high = 3.0%, intermediate = 1.4%, low = 1.0%, unreported = 2.5%; p = 0.41), or among women with close or positive resection margins (positive = 3.0%, 2 mm or less = 1.4%, >2 mm = 1.5%, unreported = 2.8%; p = 0.51). On univariate and multivariable analysis, none of the factors were significantly associated with the development of chest wall recurrence. In this population cohort, individuals treated by mastectomy experienced low rates of chest wall recurrence. We did not identify a subset of patients with a high rate of chest wall recurrence, including those with positive margins.

A population-based validation study of the DCIS Score predicting recurrence risk in individuals treated by breast-conserving surgery alone.

Validated biomarkers are needed to improve risk assessment and treatment decision-making for women with ductal carcinoma in situ (DCIS) of the breast. The Oncotype DX DCIS Score (DS) was shown to predict the risk of local recurrence (LR) in individuals with low-risk DCIS treated by breast-conserving surgery (BCS) alone. Our objective was to confirm these results in a larger population-based cohort of individuals. We used an established population-based cohort of individuals diagnosed with DCIS treated with BCS alone from 1994 to 2003 with validation of treatment and outcomes. Central pathology assessment excluded cases with invasive cancer, DCIS < 2 mm or positive margins. Cox model was used to determine the relationship between independent covariates, the DS (hazard ratio (HR)/50 Cp units (U)) and LR. Tumor blocks were collected for 828 patients. Final evaluable population includes 718 cases, of whom 571 had negative margins. Median follow-up was 9.6 years. 100 cases developed LR following BCS alone (DCIS, N = 44; invasive, N = 57). In the primary pre-specified analysis, the DS was associated with any LR (DCIS or invasive) in ER+ patients (HR 2.26; P < 0.001) and in all patients regardless of ER status (HR 2.15; P < 0.001). DCIS Score provided independent information on LR risk beyond clinical and pathologic variables including size, age, grade, necrosis, multifocality, and subtype (adjusted HR 1.68; P = 0.02). DCIS was associated with invasive LR (HR 1.78; P = 0.04) and DCIS LR (HR 2.43; P = 0.005). The DCIS Score independently predicts and quantifies individualized recurrence risk in a population of patients with pure DCIS treated by BCS alone.

Long-term outcomes of hypofractionation versus conventional radiation therapy after breast-conserving surgery for ductal carcinoma in situ of the breast.

PURPOSE: Whole-breast radiation therapy (XRT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) may decrease the risk of local recurrence, but the optimal dose regimen remains unclear. Past studies administered 50 Gy in 25 fractions (conventional); however, treatment pattern studies report that hypofractionated (HF) regimens (42.4 Gy in 16 fractions) are frequently used. We report the impact of HF (vs conventional) on the risk of local recurrence after BCS for DCIS. METHODS AND MATERIALS: All women with DCIS treated with BCS and XRT in Ontario, Canada from 1994 to 2003 were identified. Treatment and outcomes were assessed through administrative databases and validated by chart review. Survival analyses were performed. To account for systematic differences between women treated with alternate regimens, we used a propensity score adjustment approach. RESULTS: We identified 1609 women, of whom 971 (60%) received conventional regimens and 638 (40%) received HF. A total of 489 patients (30%) received a boost dose, of whom 143 (15%) received conventional radiation therapy and 346 (54%) received HF. The median follow-up time was 9.2 years. The median age at diagnosis was 56 years (interquartile range [IQR], 49-65 years). On univariate analyses, the 10-year actuarial local recurrence-free survival was 86% for conventional radiation therapy and 89% for HF (P=.03). On multivariable analyses, age <45 years (hazard ratio [HR] = 2.4; 95% CI: 1.6-3.4; P<.0001), high (HR=2.9; 95% CI: 1.2-7.3; P=.02) or intermediate nuclear grade (HR=2.7; 95% CI: 1.1-6.6; P=.04), and positive resection margins (HR=1.4; 95% CI: 1.0-2.1; P=.05) were associated with an increased risk of local recurrence. HF was not significantly associated with an increased risk of local recurrence compared with conventional radiation therapy on multivariate analysis (HR=0.8; 95% CI: 0.5-1.2; P=.34). CONCLUSIONS: The risk of local recurrence among individuals treated with HF regimens after BCS for DCIS was similar to that among individuals treated with conventional radiation therapy.

[Assessment of job stress after implementation of prevention measures in a pension fund]. / Evaluation du stress au travail après mesures de prévention dans une caisse de retraite.

AIM: Work stress and its impact on health have been widely studied. However, very few studies have examined the effect of implementing measures designed to reduce work stress, a risk factor for psychological health problems. The purpose of this study was to fill this gap. METHODS: Two surveys were conducted in October 2009 and October 2011. 150 employees participated in the first trial, while 108 took part in the second trial. Among them, 74 employees participated in both surveys and were matched. Participation in the two surveys was anonymous and the participants were asked to complete three questionnaires. RESULTS: The intervention was not effective in reducing perceived poor health, accidents, hospitalizations, sick leaves, medication use, musculoskeletal disorders, psychosocial distress and job stress. However, there wasa significant decrease in iso-strain and an increase in social support. Iso-strain decreased, especially among women (p < 0.002) and employees (p < 0.001). The increased support provided by supervisors and colleagues benefited women and employees, while improved emotional support from supervisors and colleagues mainly benefited employees. These trends were associated with psychological and musculoskeletal disorders. CONCLUSIONS: The significant decrease of iso-strain through improved social support suggests that efforts to prevent work-related stress need to be pursued.

Impact of boost radiation in the treatment of ductal carcinoma in situ: a population-based analysis.

PURPOSE: To report the outcomes of a population of women with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and radiation and to evaluate the independent effect of boost radiation on the development of local recurrence. METHODS AND MATERIALS: All women diagnosed with DCIS and treated with breast-conserving surgery and radiation therapy in Ontario from 1994 to 2003 were identified. Treatments and outcomes were identified through administrative databases and validated by chart review. The impact of boost radiation on the development of local recurrence was determined using survival analyses. RESULTS: We identified 1895 cases of DCIS that were treated by breast-conserving surgery and radiation therapy; 561 patients received boost radiation. The cumulative 10-year rate of local recurrence was 13% for women who received boost radiation and 12% for those who did not (P=.3). The 10-year local recurrence-free survival (LRFS) rate among women who did and who did not receive boost radiation was 88% and 87%, respectively (P=.27), 94% and 93% for invasive LRFS (P=.58), and was 95% and 93% for DCIS LRFS (P=.31). On multivariable analyses, boost radiation was not associated with a lower risk of local recurrence (hazard ratio = 0.82, 95% confidence interval 0.59-1.15) (P=.25). CONCLUSIONS: Among a population of women treated with breast-conserving surgery and radiation for DCIS, additional (boost) radiation was not associated with a lower risk of local or invasive recurrence.

Plasmacytoid variant of urothelial carcinoma: a report of a rare case.

Plasmacytoid variant of urothelial bladder carcinoma is rare. We report a case with a detailed discussion of features that help characterize this variant. A 50-year-old man originally presented with gross hematuria. Resections at that time revealed a grade I-II superficial urothelial carcinoma. He did not return for follow-up until recently, three years later, when he presented with recurrent gross hematuria. An extensive tumor was identified on cystoscopy. Resection revealed a high-grade non-invasive papillary urothelial carcinoma. CT scan revealed a large urinary bladder solid mass with bilateral hydronephrosis. Metastatic workup was negative. The patient underwent a radical cystectomy with creation of ileal conduit. Final pathology revealed plasmacytoid variant of urothelial carcinoma with extensive vascular invasion and extension to the perivesical adipose tissue. We present a rare variant of urothelial carcinoma with comprehensive analysis of the morphological and immunophenotypic clues that characterize this variant.

Heterocyclic amine directed synthesis of metal(II)-oxalates: investigating the magnetic properties of two complete series of chains with S = 5/2 to S = 1/2.

We report here two series of coordination polymer chains: the first being [M(II)(ox)(bnz)(2)](n) (M = Mn 1, Fe 2, Co 3, Ni 4, Cu 5 and Zn 6; ox = oxalate C(2)O(4)(2-); bnz = benzimidazole) and the second [M(II)(ox)(btz)(2)](n) (M = Mn 7, Fe 8, Co 9, Ni 10, Cu 11 and Zn 12; btz = benzotriazole). The first series displays an unusual homometallic [-M(i)-M(ii)-M(ii)-](n) chain topology and the second series is isostructural to [Fe(II)(ox)(btz)(2)](n), originally reported by Jia et al. (Collect. Czech. Chem. Commun., 2002, 67, 1609-1615). These two series allow us to make comparisons between the spin state of each metal and the magnetic coupling interaction within an isostructural series spanning the full range of spin states available in 3d metals and to investigate which models are the best to use in each case. Compound 8 is a single-chain magnet, the behaviour through spin-canting arising from a Dzyaloshinskii-Moriya interaction. Additionally, we have synthesised a two-dimensional coordination polymer {[Zn(II)(bnz)(4)][Zn(II)(2)(ox)(3)]}(n) (13), in which distorted hexagonal [Zn(II)(2)(ox)(3)](n)(2n-) layers are hydrogen bonded by [Zn(II)(bnz)(4)](2+) cations to give an interlayer separation of 12.001(2) Å.

The role of drinking motives in social anxiety and alcohol use.

Although social anxiety and problem drinking commonly co-occur, the relationship between social anxiety and drinking among college students is not well understood. The current study examined the relationship between drinking motives, or reasons for drinking, and social anxiety in 239 volunteers. Contrary to hypotheses, high (n=83), moderate (n=90), and low (n=66) social anxiety groups did not differ in endorsement of coping and conformity drinking motives. Further, social anxiety was negatively related to weekly alcohol use and unrelated to alcohol-related problems. Post hoc hierarchical multiple regression analyses conducted for each social anxiety group indicated that coping motives were related to greater alcohol use and problems for those in the high and moderate social anxiety groups, but not for the low social anxiety group. It appears that drinking motives, particularly coping motives, have promise in providing a greater understanding of the social anxiety-drinking relationship. Drinking motives could aid in identification of socially anxious students at risk for alcohol problems and inform intervention strategies.

Expression of RBM5-related factors in primary breast tissue.

The aim of this study was to examine the expression of the RBM5 tumor suppressor, in relation to RBM6 and RBM10, to obtain a better understanding of the potential role played by these RBM5-related factors in the regulation of RBM5 tumor-suppressor activity. Paired non-tumor and tumor samples were obtained from 73 breast cancer patients. RNA and protein expression were examined by semi-quantitative reverse transcription-polymerase chain reaction and immunoblot, respectively. Data were analyzed using various statistical methods to test for correlations amongst the RBM5-related factors, and between the factors and various pathological parameters. Most notably, RBM5, RBM10v1, and HER2 protein expression levels were elevated in tumor tissue (P < 0.0001). RBM5 and RBM10v1 protein expression were significantly positively correlated (P < 0.001), as were RBM5 and HER2 protein expression (P < 0.01), in both non-tumor and tumor tissue, whereas RBM10v1 and HER2 protein expression were only marginally correlated, in non-tumor tissue (P < 0.05). Interestingly, RBM5 and RBM10v1 protein expression were both deregulated in relation to RNA expression in tumor tissue. RBM10v2 and RBM6 RNA were highly significantly positively correlated in relation to various factors relating to poor prognosis (P < 0.0001). To our knowledge, this study is the first to examine RBM5 expression at both the RNA and protein level in primary breast tumor tissue, and the first to examine expression of all RBM5-related factors in a comprehensive manner. The results provide a graphic illustration that RBM5-related factors are significantly differentially expressed in breast cancer, and suggest complex inter-related regulatory networks involving alternative splicing, oncogenic expression, and tissue-specific function.

Electrochemically triggered open and closed Pacman bis-metalloporphyrins.

A new type of very compact Pacman bis-porphyrin scaffold has been obtained in which a calix[4]arene spacer provides both cofacial preorganization and flexibility. Changes in the distance between the two tetrapyrrolic macrocycles can be triggered by electrochemistry, where closed and open conformers can be interconverted in a handclapping motion.

NFATc3 deficiency may contribute to the development of mammary gland adenocarcinoma in aging female mice.

The nuclear transcription factor of activated T cells (NFAT) suggested to be a tumor suppressor. Here we report that two out of three NFATc3-/- and two in four NFATc3 +/- female mice developed aggressive mammary adenocarcinoma by 12.5 and 16 mo of age, respectively, with no occurrences in age-matched wild-type littermates (N-14). Thus, our data suggest that NFATc3 can suppress the development of mammary gland tumors in female mice.

Structural and binding features of cofacial bis-porphyrins with calixarene spacers: pac-man porphyrins that can chew.

Based on the efficient combination of calixarene spacers and acetylenic porphyrin derivatives, a new generation of cofacial bis-porphyrins has been synthesized. The first crystal structure of a cofacial bis-porphyrin-calixarene conjugate is reported. Their unique architectural features, analogous to those of pac-man-type bis-porphyrins, allow these calixarene-porphyrin conjugates to adapt their shape to the size of bidentate guests, such as diazabicyclo[2.2.2]octane (dabco) and 1,4-pyrazine. The predefined, cofacial arrangement of the porphyrin moieties observed in the solid state and in solution results in extremely high affinities (in the range of 10(9) M(-1)) for these guests. The 1,3-alternate calixarene conformations afford "open-mouth" pac-man structures whose ability to bite on nitrogen bidentates depends on their functionalization. A cone conformer provides a much more flexible structure that exhibits the highest affinity for dabco and pyrazine.

Cross-resistance studies of isogenic drug-resistant breast tumor cell lines support recent clinical evidence suggesting that sensitivity to paclitaxel may be strongly compromised by prior doxorubicin exposure.

Less than half of breast cancer patients respond to second-line chemotherapy with paclitaxel after failing treatment with anthracyclines such as doxorubicin. A recent clinical trial by Paridaens et al. [J. Clin. Oncol. 18 : 724-733, 2000] examined whether patients may derive a better clinical benefit if paclitaxel was administered before doxorubicin. While overall survival was similar regardless of the order of drug administration, a >4-fold reduction in the response rate to paclitaxel was observed after late crossover from doxorubicin, compared to the response rate to doxorubicin after late crossover from paclitaxel. This may be related to differences in the ability of the drugs to induce cross-resistance to each other. To test this hypothesis, we examined whether isogenic breast tumor cells selected for resistance to doxorubicin exhibit greater cross-resistance to paclitaxel and other drugs than identical cells selected for resistance to paclitaxel. We found that cells selected for resistance to paclitaxel showed strong resistance (>/=40-fold) to paclitaxel and docetaxel, with little cross-resistance (4-fold) to doxorubicin. In contrast, cells selected for resistance to doxorubicin exhibited 50-fold resistance to doxorubicin and a dramatic 4700-fold and 14,600-fold cross-resistance to paclitaxel and docetaxel, respectively. Doxorubicin-resistant cells exhibited higher P-glycoprotein and breast cancer resistance protein (BCRP) levels than paclitaxel-resistant cells. In addition, procaspase-9 was strongly downregulated in doxorubicin-resistant cells but not in paclitaxel-resistant cells. These differences may account for the contrasting cross-resistance profiles observed for the two cell lines and may help to explain why treatment of breast cancer patients with paclitaxel appears to be compromized by prior doxorubicin exposure.

Induced fit process in the selective distal binding of imidazoles in zinc(II) porphyrin receptors.

The respective affinities of various imidazole derivatives, imidazole (ImH), 2-methylimidazole (2-MeImH), 2-phenylimidazole (2-PhImH), N-methylimidazole (N-MeIm), 2-methylbenzimidazole (2-MeBzImH), and 4,5-dimethylbenzimidazole (4,5-Me(2)BzImH), for two phenanthroline (Phen) strapped zinc(II) porphyrin receptors porphen-Zn 1-Zn and 2-Zn have been studied. The formation of a supplementary H-bond considerably enhances the affinity of the zinc(II)-porphen receptor for imidazoles unsubstituted on the pyrrolic nitrogen (ImH) versus N-substituted imidazoles such as N-MeIm. The ImHs subset porphen-Zn complexes are formed with association constants up to 4 orders of magnitude superior to those measured either for N-MeIm as substrate or TPP-Zn as receptor. Distal or proximal binding of the substrates was determined by (1)H NMR measurements and titration. In two cases, the very high stability of the inclusion complex enabled the use of 2D NMR techniques. Excellent correlation between solution and solid-state structures has been obtained. A total of six X-ray structures are detailed in this article showing that the evolution of the shape of the zinc(II) receptor is mostly dependent on the steric constraints induced by the substitution on the imidazole. Hindered guests also progressively induce considerable mobility restrictions and severe distortions on the receptor, especially in the case of 2-MeBzImH and 2-PhImH.

Urotropin azelate: a rather unwilling co-crystal.

Urotropin (U) and azelaic acid (AA) form 1:1 co-crystals (UA) that give rise to a rather complex diffraction pattern, the main features of which are diffuse rods and bands in addition to the Bragg reflections. UA is characterized by solvent inclusions, parasite phases, and high vacancy and dislocation densities. These defects compounded with the pronounced tendency of U to escape from the crystal edifice lead to at least seven exotic phase transitions (many of which barely manifest themselves in a differential scanning calorimetry trace). These involve different incommensurate phases and a peritectoid reaction in the recrystallization regime (T(h) > 0.6). The system may be understood as an OD (order-disorder) structure based on a layer with layer group P(c)c2 and cell a(o) approximately 4.7, b approximately 26.1 and c approximately 14.4 A. At 338 K the layer stacking is random, but with decreasing temperature the build-up of an orthorhombic MDO (maximal degree of order) structure with cell a(1) = 2a(o), b(1) = b, c(1) = c and space group Pcc2 is begun (at approximately 301 K). The superposition structure of the OD system at T = 286 (1) K with space group Bmmb and cell â = 2a(o), b = b and c = c/2 owes its cohesion to van der Waals interactions between the AA chains and to three types of hydrogen bonds of varied strength between U-U and U-AA. Before reaching completion, this MDO structure is transformed, at 282 K, into a monoclinic one with cell a(m) = -a(o) + c/4, b(m) = b, c(m) = -2(a(o) + c/2), space group P2(1)/c, spontaneous deformation approximately 2 degrees, and ferroelastic domains. This transformation is achieved in two steps: first a furtive triggering transition, which is not yet fully understood, and second an improper ferroelastic transition. At approximately 233 K, the system reaches its ground state (cell a(M) = a(m), b(M) = b, c(M) = c(m) and space group P2(1)/c) via an irreversible transition. The phase transitions below 338 K are described by a model based on the interaction of two thermally activated slip systems. The OD structure is described in terms of a three-dimensional Monte Carlo model that involves first- and second-neighbour interactions along the a axis and first-neighbour interactions along the b and c axes. This model includes random shifts of the chains along their axes and satisfactorily accounts for most features that are seen in the observed diffraction pattern.