For the histopathological classification of the severity of osteoarthritic lesions of cartilage, the Mankin score is frequently used. A necessary constraint on the validity of this scoring system is the consistency with which cartilage lesions are classified. The intra- and interobserver agreement of the Mankin score was determined. The intra- and interobserver agreement of the 14-point Mankin score was adequate. Between observers 95% of differences were less than approximately 7 points. By a more strict definition of the elements of the Mankin score, the intraobserver differences were reduced only for some observers. The interobserver differences were only slightly reduced: between observers 95% of differences were less than approximately 6 points. We found the Mankin score to be an adequate histopathological tool.

We performed a prospective, randomised trial on 106 patients to compare the effects of local corticosteroid injections with physiotherapy as advocated by Cyriax in the treatment of tennis elbow. The main outcome measures were the severity of pain, pain provoked by resisted dorsiflexion of the wrist, and patient satisfaction.At six weeks 22 of 53 patients in the injection group were free from pain compared with only three in the physiotherapy group. In the corticosteroid-treated group 26 patients had no pain on resisted dorsiflexion of the wrist compared with only three in the physiotherapy group. Thirty-five patients who had injections and 14 who had physiotherapy were satisfied with the outcome of treatment at six weeks. At the final assessment there were 18 excellent and 18 good results in the corticosteroid group and one excellent and 12 good results in the physiotherapy group. There was a significant increase in grip strength in both groups but those with injections had a significantly better result.After one year there were no significant differences between the two groups. Half of the patients, however, had received only the initial treatment, 20% had had combined therapy and 30% had had surgery.We conclude that at six weeks, treatment with corticosteroid injections was more effective than Cyriax physiotherapy and we recommend it because of its rapid action, reduction of pain and absence of side-effects. Cyriax (1936, 1982) claimed substantial success for using local friction in combination with Mills' manipulations. There have been no comparative studies of these forms of treatment.Our aim was to compare the outcome and side-effects of treatment with local corticosteroids with physiotherapy as described by Cyriax. PATIENTS AND METHODSFor one year all patients with tennis elbow referred to the University Hospital, Maastricht were included in our study. The criteria for entry were pain on the lateral side of the elbow, tenderness over the forearm extensor origin, and pain on the lateral epicondyle during resisted dorsiflexion of the wrist with the elbow in full extension. Patients were excluded if they had had a previous operation on the lateral side of the elbow, or had arthritis or allied conditions, neurological disorders of the painful extremity, more than three local corticosteroid injections during the six months before consultation, and if the same elbow had been treated before by Cyriax's methods.In those with bilateral symptoms only the most painful arm was included. The patients were randomised into two groups using sealed numbered envelopes without strata or blocks. For ethical reasons we did not continue the randomised treatment if the results were unsuccessful.There were 106 patients (59 men and 47 women) with a mean age of 43 years (SD 9). Physical examination consisted of inspection, measurement of range of movement of the elbow, and assessment of the pain provoked by resisted movement and palpation. The mean duration of the symp-

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We report the experimental evidence of the ac Josephson effect in a transition edge sensor (TES) operating in a frequency domain multiplexer and biased by ac voltage at MHz frequencies. The effect is observed by measuring the non-linear impedance of the sensor. The TES is treated as a weakly-linked superconducting system and within the resistively shunted junction model framework. We provide a full theoretical explanation of the results by finding the analytic solution of the non-inertial Langevian equation of the system and calculating the non-linear response of the detector to a large ac bias current in the presence of noise.Superconducting transition-edge sensors (TESs) are highly sensitive thermometers widely used as radiation detectors over an energy range from near infrared to gamma rays. In particular we are developing TESbased detectors for the infrared SAFARI/SPICA 1 and the X-ray XIFU/Athena 2 instruments. TESs are in most cases low impedance devices that operate in the voltage bias regime while the current is generally read-out by a SQUID current amplifier. Both a constant or an alternating bias voltage can be used 3,4 . In the latter case changes of the TES resistance induced by the thermal signal modulate the amplitude of the ac bias current. The small signal detector response is modelled in great details both under dc and ac bias 5,6 . Those models however do not fully explain all the physical phenomena recently observed in TESs. It has been recently demonstrated that TES-based devices behave as weak-links due to longitudinally induced superconductivity from the leads via the proximity effect 7 and a detailed experimental investigation of the weak-link effects in dc biased x-ray microcalorimeters has been reported 8 . Evidence of weaklink effects in ac biased TES microcalorimeters has been given 9 , but an adequate experimental and theoretical investigation is still missing. We previously proposed a theoretical framework 10 based on the resistively shunted junction model (RSJ) that can be used to describe the resistive state of a TES under dc bias. In this letter, we extend the model to calculate the stationary non-linear response of a TES to a large ac bias current in the presence of noise and we compare it to the experimental data obtained with a TES-based bolometer. We report a clear signature of the ac-Josephson effect in the TES biased at MHz frequencies.The general equation for the Frequency Domain Multiplexing (FDM) electrical circuit, simplified for a single a) Electronic mail: l.gottardi@sron.nl resonator is 6(1) where V (t) is the total voltage across the TES, L and C are respectively the inductance and the capacitance of the bias circuit, r s is the total stray resistance in the circuit and Z T ES is the TES impedance, which depends on temperature T and current I(t). As previously reported 8,11 , the superconducting leads proximitize the TES bilayer film over a distance defined by the coherence length ξ. As a result, the superconducting order parameter |Ψ| is spatially dependent over the ...

The usefulness of thionin for staining cartilage sections embedded in glycol methacrylate (GMA) and the effect of decalcification on cartilage sections embedded in paraffin and GMA were assessed. Short decalcification periods using 5% formic acid or 10% EDTA did not influence the staining properties or the morphology of cartilage matrix and chondrocytes. The standard stain safranin O-fast green for differential staining of cartilage was used as control in these experiments. Prolonged exposure of safranin O stained sections to fast green resulted in disappearance of the safranin O stained matrix, thereby hampering the quantitative measurement of negatively charged glycosaminoglycans (GAG). Thionin stained evenly throughout all cartilage layers, independent of the staining times. In contrast to safranin O, thionin did not show metachromasia in nondehydrated cartilage sections, which made it more suitable for assessing cartilage quality in GMA embedded cartilage. To evaluate the selectivity of thionin staining in cartilage, chondroitinase ABC and trypsin digestions were carried out. Thionin staining was prevented by these enzymes in the territorial matrix, representing the interlacunar network and the chondrocyte capsule. Staining with thionin of the interterritorial matrix was only slightly reduced, possibly representing keratan sulfate and hyaluronic acid in cartilage of elderly patients. Comparison of thionin stained GMA embedded cartilage with safranin O stained paraffin embedded sections showed significant similarity in optical densitometry, indicative of the specificity of thionin bound to negatively charged GAG in cartilage. In GMA embedded cartilage morphology was relatively intact compared to paraffin embedded sections due to less shrinkage of chondrocytes and the interlacunar network.

The recently developed fast microwave-assisted cationic ring-opening polymerization procedure for 2-oxazolines seems to be ideally suited for slower polymerizing cyclic imino ether monomers. In this study we report the effect of the cyclic imino ether structure on the polymerization rate under exactly the same microwave-assisted conditions revealing that indeed less reactive cyclic imino ethers, including 2-oxazines as well as 4- and 5-substituted 2-oxazolines, can be polymerized to at least 50% conversion for the slowest monomer, namely 5-methyl-2-butyl-2-oxazoline, within 10 h. In addition, the copolymerization behavior of 4-ethyl-2-butyl-2-oxazoline with 2-methyl-2-oxazoline and 2-phenyl-2-oxazoline unexpectedly revealed faster incorporation of the less reactive 4-ethyl-2-butyl-2-oxazoline monomer compared to 2-phenyl-2-oxazoline due to the increased bulk of the latter monomer amplifying the sterical hindrance for polymerization onto the 4-ethyl-2-butyl-2-oxazolinium propagating species.

We have investigated the use of a conically-shaped cement plug made of Polyactive (PA), a biodegradable copolymer. The flexibility and hydrogel properties were thought to facilitate occlusion of the femoral canal even when it was oval or irregular in shape. The function of the plug was first compared with that of the Thackray polyethylene model in 16 artificial plastic femora.The maximum intramedullary pressure achieved during cementing was ten times higher with the biodegradable model. Migration or leakage of cement did not occur when the diameter of the femoral canal was equal to or smaller than the diameter of the plug. We also showed that the biodegradable properties of this implant were such that it did not require removal during revision.The new plug was tested in a pilot clinical trial. At two years only two out of 21 patients had evidence of migration or leakage of cement, probably due to a mismatch in the size of plug and femoral canal. There were no local changes in the femur.

We are developing kilo-pixel arrays of transition-edge sensors (TESs) for the X-ray Integral Field Unit on ESA's Athena observatory. Previous measurements of ACbiased Mo/Au TESs have highlighted a frequency-dependent loss mechanism that results in broader transitions and worse spectral performance compared to the same devices measured under DC bias. In order to better understand the nature of this loss, we are now studying TES pixels in different geometric configurations. We present measurements on devices of different sizes and with different metal features used for noise mitigation and X-ray absorption. Our results show how the loss mechanism is strongly dependent upon the amount of metal in close proximity to the sensor and can be attributed to induced eddy current coupling to these features. We present a finite element model that successfully reproduces the magnitude and geometry dependence of the losses. Using this model, we present mitigation strategies that should reduce the losses to an acceptable level.