Demonstrating Agreement between Radio and Fluorescence Measurements of the Depth of Maximum of Extensive Air Showers at the Pierre Auger Observatory.

We show, for the first time, radio measurements of the depth of shower maximum (X_{max}) of air showers induced by cosmic rays that are compared to measurements of the established fluorescence method at the same location. Using measurements at the Pierre Auger Observatory we show full compatibility between our radio and the previously published fluorescence dataset, and between a subset of air showers observed simultaneously with both radio and fluorescence techniques, a measurement setup unique to the Pierre Auger Observatory. Furthermore, we show radio X_{max} resolution as a function of energy and demonstrate the ability to make competitive high-resolution X_{max} measurements with even a sparse radio array. With this, we show that the radio technique is capable of cosmic-ray mass composition studies, both at Auger and at other experiments.

Measurement of the Fluctuations in the Number of Muons in Extensive Air Showers with the Pierre Auger Observatory.

We present the first measurement of the fluctuations in the number of muons in extensive air showers produced by ultrahigh energy cosmic rays. We find that the measured fluctuations are in good agreement with predictions from air shower simulations. This observation provides new insights into the origin of the previously reported deficit of muons in air shower simulations and constrains models of hadronic interactions at ultrahigh energies. Our measurement is compatible with the muon deficit originating from small deviations in the predictions from hadronic interaction models of particle production that accumulate as the showers develop.

Features of the Energy Spectrum of Cosmic Rays above 2.5×10

We report a measurement of the energy spectrum of cosmic rays above 2.5×10^{18} eV based on 215 030 events. New results are presented: at about 1.3×10^{19} eV, the spectral index changes from 2.51±0.03(stat)±0.05(syst) to 3.05±0.05(stat)±0.10(syst), evolving to 5.1±0.3(stat)±0.1(syst) beyond 5×10^{19} eV, while no significant dependence of spectral features on the declination is seen in the accessible range. These features of the spectrum can be reproduced in models with energy-dependent mass composition. The energy density in cosmic rays above 5×10^{18} eV is [5.66±0.03(stat)±1.40(syst)]×10^{53} erg Mpc^{-3}.

Use of a comprehensive diagnostic algorithm for Anisakis allergy in a high seroprevalence Mediterranean setting.

Summary: Background.Diagnosis of anisakis allergy (AA) is based on the skin prick test (SPT) and specific IgE (sIgE) determination. Anyway, false positivity cases are due to cross reactivity with numerous allergens. The aim of the study was to evaluate the reliability of a comprehensive diagnostic algorithm for the AA. Methods.An observational study was conducted on a sample of consecutive subjects accessing the allergology outpatient ambulatories of two hospitals located in Western Sicily. All the recruited outpatients were tested by Skin Prick Test performed using anisakis extracts by ALK-Abellò (Madrid, Spain). Specific IgE dosage for anisakis extracts was then performed by using ImmunoCAP250 (Immunodiagnostics Uppsala, Sweden). Consequently, outpatients who tested positive to first line tests underwent sIgE testing for ascaris and tropomyosin. Lastly, outpatients positive to the first line were invited to be further tested by basophil activation test (BAT) by using Flow CAST kit and anisakis commercial extract (Bühlmann Laboratories AG, Schönenbuch, Switzerland), as confirmatory analysis. Results.One hundred and eleven outpatients with an anamnesis suggestive of sensitization to anisakis (AS) and 466 subjects with chronic urticaria (CU) were recruited in the study. Of these, 22 with AS and 41 with CU showed a sensitization to anisakis allergens. The diagnostic algorithm revealed that 8.8% of outpatients who tested positive to sIgE determination were affected by CU, while 82.5% of all the sIgE positivity was related to cross-reactivity. Overall, a genuine anisakis seroprevalence of 2.3% was documented. Within a sub-sample of 15 subjects with clinical symptoms related to AA, n. 8 showed a real positivity after BAT. A greater response to A. pegreffii allergens as compared to A. simplex was reported. Conclusions.Our preliminary findings support the high clinical specificity of BAT for AA diagnosis, suggesting implementing this method in a comprehensive diagnostic algorithm.

Anisakis spp. larvae in three mesopelagic and bathypelagic fish species of the central Mediterranean Sea.

In this work 437 fish samples of species belonging to the families Myctophidae (Electrona risso and Diaphus metopoclampus) and Phosichthyidae (Vinciguerria attenuata) were examined for the presence of Anisakidae larvae. The study was performed with fishes in the central Mediterranean Sea, particularly in the Strait of Sicily and in the Strait of Messina. The visual inspection and chloro-peptic analysis revealed the presence of nematode parasites with prevalence values between 2.9% in Electrona risso samples and 5.4% in Vinciguerria attenuata samples. A positive correlation was found between standard length (SL) and prevalence of infestation in D. metopoclampus samples (p<0.05). The larvae examined were morphologically ascribed, at genus level, to Anisakis morphotypes I and II and molecularly identified as Anisakis pegreffii, Anisakis ziphidarum and Anisakis physeteris, in 67%, 9% and 24% of the fish samples examined. Overall, A. pegreffii and A. ziphidarum larvae were isolated in 14 and 2 specimens of D. metopoclampus respectively, A. physeteris larvae were found in 3 E. risso and 2 V. attenuata. A positive correlation was found between standard length and prevalence of infestation in D. metopoclampus samples (p<0.05). First information is provided on the presence of Anisakis spp. larvae of the myctophid fish species E. risso, D. metopoclampus and V. attenuata from the Central Mediterranean. It is also confirmed the role of lanternfishes (Myctophidae) as paratenic hosts for Anisakis spp.

Expression of gelatinases (MMP-2, MMP-9) and cyclooxygenases (COX-1, COX-2) in some benign salivary gland tumors.

Salivary gland tumors, most of which are rare benign tumors, represent a histologically heterogenous group with the greatest diversity of morphological and cellular features. The aim of this study is to analyse the expression and possible interactions between gelatinases (MMP-2, MMP-9) and cyclooxygenases (COX-1, COX-2) in some benign salivary gland tumors. We investigated the expression of gelatinases and cyclooxigenases in control salivary gland, Pleomorphic adenoma and Warthin's tumor through immunohistochemistry and Reverse Transcription - Polymerase Chain Reaction (PCR). We identified the expression of both classes of enzyme in normal samples and in the two types of pathological samples without any quantitative differences. From the present data no significant differences emerge in the expression of these enzymes among the different pathologies examined. Nevertheless, due to the small number of samples included in this study, general statements regarding correlation between the degree of severity of the tumoral pathology and the quantitative expression of these potential tumoral markers can not be made.

Immunohistochemical and transcriptional expression of the matrix metalloproteinases MMP-2 and MMP-9 in normal and pathological human oral mucosa.

The oral cavity is exposed to chronic or recurrent, physical and chemical trauma that could lead to mucosal reactions (e.g. hyperplasia, dysplasia and tumors). The objective of this study is to investigate the expression and the possible changes of the two matrix metalloproteinases MMP-2 and MMP-9 in normal and pathological human oral mucosa samples. Normal oral mucosa samples and three different types of pathological conditions (hyperplasia, dysplasia and carcinoma) were used for this study. Immunohistochemical analysis was used to evaluate protein expression for the two enzymes, while Reverse Transcription ? Polymerase Chain Reaction (RT-PCR) was used to investigate gene expression. Image analysis was used to give a quantitative evaluation of the immunohistochemical data. In control samples we identified a weak expression of both MMP-2 and MMP-9 in the epithelial layers. In hyperplasia samples MMPs expression is limited to epithelial layers but the immunoreactivity is more intense than in the control. In dysplasia and carcinoma samples the two matrix metalloproteases are expressed not only in epithelium but also in some cells of the connective tissue and in the vessel walls. Qualitative RT-PCR and image analysis confirmed the immunohistochemical data. The results obtained in this study suggest the existence of a possible relationship between the entity of morphological disorganization of the oral mucosa in different pathologies and the increase of MMP-2 and MMP-9 expression.

Immunohistochemical and biomolecular identification of orphanin FQ, eNOS, atrial natriuretic factor and oxytocin in rat seminal vesicles.

In previous studies performed on rodents, we detected the presence of adreno-cholinergic and peptidergic innervation in seminal vesicles and other organs of the male genital system, such as prostate and deferent duct, in which we also investigated the expression of NOS and NADPH-diaphorase. During this project, we focused our attention on the expression of some peptides involved in local control of smooth muscle relaxation, contractility, vasodilatation and control of blood flow in rat seminal vesicles. We investigated, through immunohistochemistry and RT-PCR, the presence of four peptides: orphanin, eNOS, ANF and oxytocin. Immunohistochemistry was used to detect the presence of the proteins, whereas RT-PCR analysis confirmed gene expression of orphanin, eNOS and ANF, but not oxytocin. In our opinion, orphanin, eNOS and ANF could have paracrine effects regulating the function of seminal vesicles, whereas oxytocin, which may reach this anatomical district through the blood flow, may have a hormonal action. This is a pilot study that, with further investigation, may allow to better clarify the role of these molecules in the control of seminal vesicle tissues' homeostasis.

Matrix metalloproteinase-2 matrix metalloproteinase-9 and inducible nitric oxide synthase in oral leukoplakia: immunohistochemistry and RT-PCR analysis.

Oral leukoplakia is the most common and potentially malignant disorder of the oral mucosa. The definition of leukoplakia given by the World Health Organization is ?a white plaque that cannot be characterized either from a clinical or from a histopathological point of view?, thus the diagnosis of leukoplakia is based on the exclusion of other lesions of the oral mucosa. We believe it is necessary to identify molecular and immunohistochemical parameters that can contribute to discriminating between the different leukoplakia clinical subtypes coded by the epidemiology. In the present work we show the preliminary results of this research project. We investigated the expression of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9) and inducible nitric oxide synthase (iNOS) in a verrucous proliferative leukoplakia sample. By immunohistochemistry we detected the presence of all the three proteins both in the leukoplakia samples and in healthy oral mucosa, while the reverse transcription-polymerase chain reaction (RT-PCR) analysis revealed in both samples only the expression of MMP-2 and MMP-9 but not iNOS.

Expression and modification of NO synthase in human dental pulps during orthodontic treatment.

In the last few years our histology laboratory has worked in collaboration with Winchmore Hill Dental Practice in London in studying nitric oxide synthase (NOS) protein expression by the use of immunohistochemistry in dental pulps following orthodontic treatment (A. Gerbino et al. 2000; A. Gerbino et al 2001; A. Gerbino et al 2001.) The study has been carried out on samples taken from orthodontically treated and non-orthodontically treated teeth. The results suggest a close correlation between the duration of the orthodontic traction and the expression of the above-mentioned neurotransmitter (NO).

Absence of oligoclonally restricted immunoglobulins in tears from multiple sclerosis patients.

To study the extent of systemic immunodysregulation in multiple sclerosis (MS) we measured immunoglobulin (Ig)G, A, and M levels and studied their migrational properties after agarose isoelectric focusing in serum, cerebrospinal fluid (CSF) and tear samples from 18 MS patients, 17 patients with other neurological diseases (OND), and tears and serum samples from ten normal controls (NC). A slight elevation of total IgG, IgM and IgA levels was detected in tears from patients with MS and OND compared to NC. Of the five patients (two MS, three OND) that showed IgG oligoclonal bands (OCB) in tears, only one MS patient showed unique bands in tears not seen in the paired CSF and serum. We never found IgA, and IgM OCB in serum, CSF or tear samples. Our results suggest that polyclonal Igs are systemically elevated during chronic neurological inflammatory diseases. Oligoclonal Ig in MS, although occasionally detectable in tears, is mainly confined to the central nervous system and appears restricted to class G.

Noncontact tonometry in children.

A hand-held noncontact tonometer (Pulsair, Keeler Ltd., UK) was tested in 42 children, from 5 months to 12 years of age. At least 1 intraocular pressure (IOP) reading was obtained in all of the 84 eyes studied, whereas with a Goldman applanation tonometer measurements could be obtained in only 26 eyes (14 subjects). Time required for examination with the Pulsair was quite variable and related to age (p less than 0.0001). Compliance in children was reported as "good" in the majority of cases; it was also age-related (p less than 0.005). Although its reliability could not be definitely evaluated, the results of this study indicate that this instrument may be a valuable choice for screening and follow-up purposes in childhood.

Unilateral versus bilateral simultaneous arthroplasties of the lower extremities.

We reviewed retrospectively 26 replacement arthroplasties performed as bilateral simultaneous procedures in 12 patients at an osteopathic community hospital during a 52-month period. One patient had two bilateral operations. Surgical time, estimated blood loss, units of blood transfused, perioperative morbidity, number of days hospitalized, and hospital costs were compared with data from randomly selected patients who underwent unilateral procedures during the same time period. The bilateral group had an average length of stay of 12 days (vs 10.3 days), an average surgical time of 2 hours 37 minutes (vs 1 hour 55 minutes), an average blood loss of 419 mL (vs 277 mL), and average hospital costs of $12,315 (vs $10,272) in comparison with the unilateral group. Perioperative morbidity was similar for both groups. Our findings indicate that bilateral simultaneous procedures offer a reasonable approach and a savings of time and money for selected patients who require multiple joint replacements for improved functional status.

Clinical detection of early glaucomatous foveal involvement.

The aim of our study was to verify whether threshold testing of the central area with a common automated perimeter could detect early glaucomatous damage. We selected 9 eyes of 9 patients with suspected primary open angle glaucoma and normal visual fields and 18 eyes of 18 age-matched normal subjects. They underwent the Macula Threshold Test of the Humphrey Field Analyzer using white and blue targets. We found no significant difference in retinal sensitivity to white targets between the two groups. Sensitivity to blue targets was significantly lower among glaucoma suspects (18.43 +/- 1.14 dB) than in the control group (22.37 +/- 0.94 dB) p less than 0.001). Blue thresholds related significantly to age only in normals (p = 0.028) while in glaucoma suspects they were strongly related to vertical cup/disc ratios (p less than 0.001). These results suggest that it is possible to detect early central visual disturbances from glaucoma using an automated perimeter and its built-in color filters.

[Threshold testing of the macular area in glaucoma]. / Etude du seuil de sensibilité maculaire dans le glaucome.

The purpose of this study has been to verify whether threshold testing of the central area with a common automated perimeter could detect glaucomatous damage. We selected 31 eyes of 31 patients with primary open angle glaucoma free from defects within the central 5 degrees of the field and 32 eyes of 32 age-matched normal subjects. They underwent the Macula Threshold Test of the Humphrey Field Analyzer using white and blue targets. Statistical analysis of the results obtained showed that threshold sensitivities to both white and blue targets were significantly depressed in glaucomatous eyes (t = 2.44, p = 0.018 and t = 12.59, p less than 0.001 respectively), but only blue thresholds distributed really differently in glaucomatous and normals. Sensitivities to blue stimuli related to age only in normals (r = 0.58; p = 0.0005), while in glaucomatous they were related to cup/disc ratios (r = 0.70, p less than 0.0001 for horizontal C/D; r = 0.52, p = 0.0027 for vertical C/D). These results suggest that it is possible to detect early central functional disturbances from glaucoma using an automated perimeter and its built-in color filters.

Flexor digitorum profundus avulsions with associated distal phalanx fractures. A report of four cases and review of the literature.

A review of the current literature reveals that avulsions of the flexor digitorum profundus tendon, with a separate and concomitant intraarticular fracture of the distal phalanx, is an uncommon and easily misdiagnosed injury that has been infrequently described. This report encompasses a review of four patients with such an injury, and includes treatment recommendations for this complex injurious pattern. A classification system for flexor digitorum profundus avulsions is reviewed and it is proposed that the avulsion of the flexor digitorum profundus tendon with concomitant and separate intraarticular fracture of the distal phalanx, be added to the classification as a Type IV injury.

Transcuneiform fracture--cuboid dislocation of the midfoot.

Complete dislocation of the tarsal cuboid is presented along with regional anatomic considerations. Thorough literature search revealed only three other reported cases of dislocation of the tarsal cuboid. The operative procedure described encompasses an interesting method of reduction of this dislocation. It should be emphasized that A-P, lateral, and oblique X-rays should be obtained for injuries of the mid and forefoot. The rarity of such a dislocation is attributed to the structural integrity of the supporting ligamentous elements.

Dominantly inherited ureteropelvic junction obstruction.

We report on siblings from two families with unilateral ureteropelvic junction obstruction. HLA studies were undertaken and found to be a useful marker between affected members. We believe that incomplete penetrance with variable expression is the most probable mode of transmission of this disorder.