Environmental and Edaphic Factors that Influence Spring Dead Spot Epidemics

Spring dead spot (SDS) (Ophiosphaerella spp.) is a soilborne disease of warm-season turfgrasses grown where winter dormancy occurs. The edaphic factors that influence where SDS epidemics occur are not well defined. A study was conducted during the spring of 2020 and repeated in the spring of 2021 on four 'TifSport' hybrid bermudagrass (Cynodon dactylon × transvaalensis) golf course fairways expressing SDS symptoms in Cape Charles, VA, U.S.A. SDS within each fairway was mapped from aerial imagery collected in the spring of 2019 with a 20 MP CMOS 4k true color sensor mounted on a DJI Phantom 4 Pro drone. Three disease intensity zones were designated from the maps (low, moderate, high) based on the density of SDS patches in an area. Disease incidence and severity, soil samples, surface firmness, thatch depth, and organic matter measurements were taken from 10 plots within each disease intensity zone from each of the four fairways (n = 120). Multivariate pairwise correlation analyses (P < 0.1) and best subset stepwise regression analyses were conducted to determine which edaphic factors most influenced the SDS epidemic within each fairway and each year. Edaphic factors that correlated with an increase in SDS or were selected for the best fitting model varied across holes and years. However, in certain cases, soil pH and thatch depth were predictors for an increase in SDS. No factors were consistently associated with SDS occurrence, but results from this foundational study of SDS epidemics can guide future research to relate edaphic factors to SDS disease development.

Interventions for visual field defects in people with stroke

BACKGROUND

Visual field defects are estimated to affect 20% to 57% of people who have had a stroke. Visual field defects can affect functional ability in activities of daily living (commonly affecting mobility, reading and driving), quality of life, ability to participate in rehabilitation, and depression and anxiety following stroke. There are many interventions for visual field defects, which are proposed to work by restoring the visual field (restitution); compensating for the visual field defect by changing behaviour or activity (compensation); substituting for the visual field defect by using a device or extraneous modification (substitution); or ensuring appropriate diagnosis, referral and treatment prescription through standardised assessment or screening, or both.

OBJECTIVES

To determine the effects of interventions for people with visual field defects after stroke.

SEARCH METHODS

We searched the Cochrane Stroke Group Trials Register, the Cochrane Eyes and Vision Group Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, AMED, PsycINFO, and PDQT Databse, and clinical trials databases, including ClinicalTrials.gov and WHO Clinical Trials Registry, to May 2018. We also searched reference lists and trials registers, handsearched journals and conference proceedings, and contacted experts.

SELECTION CRITERIA

Randomised trials in adults after stroke, where the intervention was specifically targeted at improving the visual field defect or improving the ability of the participant to cope with the visual field loss. The primary outcome was functional ability in activities of daily living and secondary outcomes included functional ability in extended activities of daily living, reading ability, visual field measures, balance, falls, depression and anxiety, discharge destination or residence after stroke, quality of life and social isolation, visual scanning, adverse events, and death.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened abstracts, extracted data and appraised trials. We undertook an assessment of methodological quality for allocation concealment, blinding of outcome assessors, method of dealing with missing data, and other potential sources of bias. We assessed the quality of evidence for each outcome using the GRADE approach.

MAIN RESULTS

Twenty studies (732 randomised participants, with data for 547 participants with stroke) met the inclusion criteria for this review. However, only 10 of these studies compared the effect of an intervention with a placebo, control, or no treatment group, and eight had data which could be included in meta-analyses. Only two of these eight studies presented data relating to our primary outcome of functional abilities in activities of daily living. One study reported evidence relating to adverse events.Three studies (88 participants) compared a restitutive intervention with a control, but data were only available for one study (19 participants). There was very low-quality evidence that visual restitution therapy had no effect on visual field outcomes, and a statistically significant effect on quality of life, but limitations with these data mean that there is insufficient evidence to draw any conclusions about the effectiveness of restitutive interventions as compared to control.Four studies (193 participants) compared the effect of scanning (compensatory) training with a control or placebo intervention. There was low-quality evidence that scanning training was more beneficial than control or placebo on quality of life, measured using the Visual Function Questionnaire (VFQ-25) (two studies, 96 participants, mean difference (MD) 9.36, 95% confidence interval (CI) 3.10 to 15.62). However, there was low or very-low quality evidence of no effect on measures of visual field, extended activities of daily living, reading, and scanning ability. There was low-quality evidence of no significant increase in adverse events in people doing scanning training, as compared to no treatment.Three studies (166 participants) compared a substitutive intervention (a type of prism) with a control. There was low or very-low quality evidence that prisms did not have an effect on measures of activities of daily living, extended activities of daily living, reading, falls, or quality of life, and very low-quality evidence that they may have an effect on scanning ability (one study, 39 participants, MD 9.80, 95% CI 1.91 to 17.69). There was low-quality evidence of an increased odds of an adverse event (primarily headache) in people wearing prisms, as compared to no treatment.One study (39 participants) compared the effect of assessment by an orthoptist to standard care (no assessment) and found very low-quality evidence that there was no effect on measures of activities of daily living.Due to the quality and quantity of evidence, we remain uncertain about the benefits of assessment interventions.

AUTHORS' CONCLUSIONS

There is a lack of evidence relating to the effect of interventions on our primary outcome of functional ability in activities of daily living. There is limited low-quality evidence that compensatory scanning training may be more beneficial than placebo or control at improving quality of life, but not other outcomes. There is insufficient evidence to reach any generalised conclusions about the effect of restitutive interventions or substitutive interventions (prisms) as compared to placebo, control, or no treatment. There is low-quality evidence that prisms may cause minor adverse events.

Interventions for age-related visual problems in patients with stroke

BACKGROUND

The prevalence of eye problems increases with age and, consequently, so does the level of visual impairment. As the incidence of stroke also increases with age, a significant proportion of stroke patients will have age-related visual problems. It is possible that the effect of interventions for age-related visual problems may differ in the population of stroke patients compared to the wider population of older people. The interaction between the problems arising directly from stroke and those arising directly from age-related visual problems will be complex. Interventions for age-related visual problems may also be affected by the presence of other stroke-related co-morbidities. Consequently, the nature and outcome of interventions for age-related visual problems may be different in patients with stroke.

OBJECTIVES

The aim of this review is to determine if interventions for age-related visual problems improve functional ability following stroke.

SEARCH METHODS

We searched the Cochrane Stroke Group Trials Register (March 2011), the Cochrane Eyes and Vision Group Trials Register (December 2009) and nine electronic bibliographic databases including: the Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE (1950 to February 2011), EMBASE (1980 to February 2011), CINAHL (1982 to February 2011), AMED (1985 to February 2011) and PsycINFO (1967 to February 2011). We also searched reference lists and trials registers, handsearched journals and conference proceedings, and contacted experts.

SELECTION CRITERIA

Randomised trials in adults after stroke, where the intervention is specifically targeted at assessing, treating or correcting age-related visual problems, or improving the ability of the patient to cope with visual impairment. Primary outcome was functional ability in activities of daily living and secondary outcomes included functional ability in extended activities of daily living, visual acuity, visual field, visual function, balance, falls, depression and anxiety, discharge destination/residence after stroke, quality of life and social isolation, adverse events and death.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened abstracts and planned to extract data and appraise trials. We planned that assessment of methodological quality would be undertaken for allocation concealment, blinding of outcome assessor, method of dealing with missing data and other potential sources of bias.

MAIN RESULTS

We considered 7357 titles, 460 abstracts and 85 full papers. We identified no studies for inclusion in this review.

AUTHORS' CONCLUSIONS

There are no implications for practice arising from this review. Evidence relating to the management of patients (from the general population) with age-related visual problems is available from other Cochrane reviews and is likely to be the best evidence available for making treatment decisions about individual patients. Subgroup analyses within these reviews to explore the effect of interventions for age-related visual problems in patients with stroke are recommended. We recommend that the objectives and selection criteria for this Cochrane review are amended and clarified prior to any future updates.

Interventions for visual field defects in patients with stroke

BACKGROUND

Visual field defects are estimated to affect 20% to 57% of people who have had a stroke. Visual field defects can affect functional ability in activities of daily living (commonly affecting mobility, reading and driving), quality of life, ability to participate in rehabilitation, and depression, anxiety and social isolation following stroke. There are many interventions for visual field defects, which are proposed to work by restoring the visual field (restitution); compensating for the visual field defect by changing behaviour or activity (compensation); substituting for the visual field defect by using a device or extraneous modification (substitution); or ensuring appropriate diagnosis, referral and treatment prescription through standardised assessment or screening, or both.

OBJECTIVES

To determine the effects of interventions for people with visual field defects after stroke.

SEARCH STRATEGY

We searched the Cochrane Stroke Group Trials Register (February 2011), the Cochrane Eyes and Vision Group Trials Register (December 2009) and nine electronic bibliographic databases including CENTRAL (The Cochrane Library 2009, Issue 4), MEDLINE (1950 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), AMED (1985 to December 2009), and PsycINFO (1967 to December 2009). We also searched reference lists and trials registers, handsearched journals and conference proceedings and contacted experts.

SELECTION CRITERIA

Randomised trials in adults after stroke, where the intervention was specifically targeted at improving the visual field defect or improving the ability of the participant to cope with the visual field loss. The primary outcome was functional ability in activities of daily living and secondary outcomes included functional ability in extended activities of daily living, reading ability, visual field measures, balance, falls, depression and anxiety, discharge destination or residence after stroke, quality of life and social isolation, visual scanning, adverse events and death.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened abstracts, extracted data and appraised trials. We undertook an assessment of methodological quality for allocation concealment, blinding of outcome assessors, method of dealing with missing data, and other potential sources of bias.

MAIN RESULTS

Thirteen studies (344 randomised participants, 285 of whom were participants with stroke) met the inclusion criteria for this review. However, only six of these studies compared the effect of an intervention with a placebo, control or no treatment group and were included in comparisons within this review. Four studies compared the effect of scanning (compensatory) training with a control or placebo intervention. Meta-analysis demonstrated that scanning training is more effective than control or placebo at improving reading ability (three studies, 129 participants; mean difference (MD) 3.24, 95% confidence interval (CI) 0.84 to 5.59) and visual scanning (three studies, 129 participants; MD 18.84, 95% CI 12.01 to 25.66) but that scanning may not improve visual field outcomes (two studies, 110 participants; MD -0.70, 95% CI -2.28 to 0.88). There were insufficient data to enable generalised conclusions to be made about the effectiveness of scanning training relative to control or placebo for the primary outcome of activities of daily living (one study, 33 participants). Only one study (19 participants) compared the effect of a restitutive intervention with a control or placebo intervention and only one study (39 participants) compared the effect of a substitutive intervention with a control or placebo intervention.

AUTHORS' CONCLUSIONS

There is limited evidence which supports the use of compensatory scanning training for patients with visual field defects (and possibly co-existing visual neglect) to improve scanning and reading outcomes. There is insufficient evidence to reach a conclusion about the impact of compensatory scanning training on functional activities of daily living. There is insufficient evidence to reach generalised conclusions about the benefits of visual restitution training (VRT) (restitutive intervention) or prisms (substitutive intervention) for patients with visual field defects after stroke.

Interventions for disorders of eye movement in patients with stroke

BACKGROUND

Eye movement disorders may affect over 70% of stroke patients. These eye movement disorders can result in difficulty maintaining the normal ocular position and difficulty moving the eyes appropriately. The resulting functional disabilities include a loss of depth perception, reduced hand-to-eye co-ordination, marked difficulties with near tasks and reading and reduced ability to scan the visual environment. They can also impact on the effectiveness of rehabilitation therapy. There are a wide variety of different treatment interventions proposed for eye movement disorders after stroke. However, in the past, there has been a lack of evidence specific to the impact of interventions on the functional outcome of patients with stroke.

OBJECTIVES

To determine the effects of interventions for eye movement disorders on functional ability following stroke.

SEARCH STRATEGY

We searched the Cochrane Stroke Group Trials Register (February 2011), the Cochrane Eyes and Vision Group Trials Register (December 2009) and nine electronic bibliographic databases including CENTRAL (The Cochrane Library 2009, Issue 4), MEDLINE (1950 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), AMED (1985 to December 2009), and PsycINFO (1967 to December 2009). We also searched reference lists and trials registers, handsearched journals and conference proceedings, and contacted experts.

SELECTION CRITERIA

Randomised trials in adults after stroke where the intervention was specifically targeted at improving the eye movement disorder or improving the ability of the participant to cope with the eye movement disorder. The primary outcome was functional ability in activities of daily living. Secondary outcomes included functional ability in extended activities of daily living, eye movement measures, balance, falls, depression or anxiety, discharge destination or residence after stroke, quality of life and social isolation, adverse events, and death.

DATA COLLECTION AND ANALYSIS

Two authors independently screened abstracts, extracted data and appraised trials. We undertook assessment of methodological quality for allocation concealment, blinding of outcome assessor, method of dealing with missing data, and other potential sources of bias.

MAIN RESULTS

Two studies (28 participants but only five were people with stroke) met the inclusion criteria and were included in this review. Both studies investigated pharmacological interventions for disorders of eye movement in patients with stroke. It was not appropriate to pool data and we were not able to draw conclusions from these studies. We found no other randomised studies which investigated interventions for disorders of eye movement in patients with stroke.

AUTHORS' CONCLUSIONS

There is insufficient evidence to reach conclusions about the effectiveness of interventions for patients with eye movement disorders after stroke. High quality research in the form of well-designed randomised trials are urgently required.

The association between gastro-oesophageal reflux disease and asthma: a systematic review

BACKGROUND AND AIMS

Gastro-oesophageal reflux disease (GORD) has been linked to a number of extra-esophageal symptoms and disorders, primarily in the respiratory tract. This systematic review aimed to provide an estimate of the strength and direction of the association between GORD and asthma.

METHODS

Studies that assessed the prevalence or incidence of GORD in individuals with asthma, or of asthma in individuals with GORD, were identified in Medline and EMBASE via a systematic search strategy.

RESULTS

Twenty-eight studies met the selection criteria. The sample size weighted average prevalence of GORD symptoms in asthma patients was 59.2%, whereas in controls it was 38.1%. In patients with asthma, the average prevalence of abnormal oesophageal pH, oesophagitis and hiatal hernia was 50.9%, 37.3% and 51.2%, respectively. The average prevalence of asthma in individuals with GORD was 4.6%, whereas in controls it was 3.9%. Pooling the odds ratios gave an overall ratio of 5.5 (95% CI 1.9-15.8) for studies reporting the prevalence of GORD symptoms in individuals with asthma, and 2.3 (95% CI 1.8-2.8) for those studies measuring the prevalence of asthma in GORD. One longitudinal study showed a significant association between a diagnosis of asthma and a subsequent diagnosis of GORD (relative risk 1.5; 95% CI 1.2-1.8), whereas the two studies that assessed whether GORD precedes asthma gave inconsistent results. The severity-response relationship was examined in only nine studies, with inconsistent findings.

CONCLUSIONS

This systematic review indicates that there is a significant association between GORD and asthma, but a paucity of data on the direction of causality.

Papuloerythroderma of Ofuji responding to treatment with cyclosporin

We describe a patient with papuloerythroderma of Ofuji (PE) of unknown cause, in whom no underlying malignancy was found. Topical steroids and systemic antihistamines did not resolve the rash. Systemic steroids induced a remission of the PE, which was not maintained on reduction of the dose. Therefore, cyclosporin was added which did lead to rapid clearing of the skin. Remission was maintained after discontinuation of treatment.

Sebum excretion rates in mothers and neonates

As neonates have a high sebum production compared with 6-month-old babies, we wished to investigate the relationship of sebum production in mother and neonate. The sebum excretion rate (SER) was therefore measured in 10 mothers prenatally, and in each mother and baby as soon after birth as possible, and again 5-12 weeks postnatally. There was a significant correlation between the maternal and neonatal SER perinatally. The perinatal SER in the babies was markedly higher than the postnatal sample. These observations suggest an important role for the maternal hormonal environment on the infant sebaceous glands. There is animal evidence which suggests that the endocrine environment of the neonate influences the sebaceous gland development in puberty, but it is not known whether babies with a high SER are more prone to seborrhoea and acne in later life.

The role of dispositional and situational factors in cognitive interference

Two studies investigated the cross-temporal stability and cross-situational consistency of cognitive interference. In Study 1, 70 college students reported on the intrusive thoughts they experienced during 2 course examinations and a self-reflective task. In Study 2, 55 college athletes reported on intrusive thoughts following 2 course examinations and 2 regular season football games. Major findings were (a) cognitive interference showed both cross-temporal stability and cross-situational consistency, (b) it was predicted by a measure of dispositional intrusive thinking, (c) the link between cognitive interference and dispositional intrusive thinking was not accounted for by indices of depressive symptomatology and trait anxiety, and (d) the degree of cross-situational consistency of cognitive interference and the content of these intrusive thoughts were influenced by situational factors.

Therapeutic options for the treatment of colorectal cancer following 5-fluorouracil failure

Therapeutic options after failure of 5-fluorouracil (5-FU) for the treatment of colorectal cancer include regional treatments, different 5-FU-based regimens, and different chemotherapy regimens. Of the regional treatments, resection of hepatic metastases is the most satisfactory because of the potential for long-term survival; however, the number of candidates for this option is limited. Responses are possible if 5-FU is administered by prolonged infusion, but the addition of other chemotherapeutic agents (eg, nitrosoureas, mitomycin C, or cisplatin) is less likely to induce objective responses. The new topoisomerase I inhibitor irinotecan has promising activity in patients with metastatic colorectal cancer. Depending on the status of the patient population, objective response rates of 15% to 30% have been reported in patients with colorectal cancer that has progressed or rapidly recurred following 5-FU-based treatment.

The role of dispositional and situational factors in cognitive interference

Two studies investigated the cross-temporal stability and cross-situational consistency of cognitive interference. In Study 1, 70 college students reported on the intrusive thoughts they experienced during 2 course examinations and a self-reflective task. In Study 2, 55 college athletes reported on intrusive thoughts following 2 course examinations and 2 regular season football games. Major findings were (a) cognitive interference showed both cross-temporal stability and cross-situational consistency, (b) it was predicted by a measure of dispositional intrusive thinking, (c) the link between cognitive interference and dispositional intrusive thinking was not accounted for by indices of depressive symptomatology and trait anxiety, and (d) the degree of cross-situational consistency of cognitive interference and the content of these intrusive thoughts were influenced by situational factors.

Flexible sigmoidoscopy screening: patient acceptance

Although compelling evidence is available that screening can reduce the risk of death from colon cancer, patient compliance with screening in the United States is poor. The objective of this study is to describe a program that uses patient education to improve patient acceptance of flexible sigmoidoscopy screening. Our program provides multiple opportunities for patients to ask questions and to receive information. Preliminary data show that this approach has resulted in a procedure acceptance rate of 81% of those referred in the first year of the program. Future research needs to focus on evaluating factors associated with noncompliance in colorectal cancer screening programs.

Multiple leiomyomata presenting in a child

We report a 2-year-old boy with a plaque on the upper arm composed of multiple 2- to 3-mm leiomyomata which developed at the age of 3 months and have been unchanged since. Immunohistologically there was positive staining for the muscle intermediate filament desmin. We discuss the unusual clinical presentation and possible prognosis.

Treatment of psoriasis with intermittent short course cyclosporin (Neoral). A multicentre study

A 1 year, prospective multicentre study was performed to investigate the efficacy and safety of intermittent treatment with cyclosporin in psoriasis vulgaris. Subjects received cyclosporin (Neoral) 5 mg/kg per day until achieving 90% reduction in area affected, or for a maximum of 12 weeks. Those failing to demonstrate a satisfactory response were withdrawn. When further treatment was required, cyclosporin was recommenced. This cycle was repeated up to three times. Psoriasis activity was recorded using the area affected and sign scores for erythema, scaling and infiltration. Overall assessments of response and tolerability were recorded. Forty-one subjects, mean age 36, mean PASI 12.8, entered the first treatment period. Thirty-three received a second period of treatment and 16 a third. Eighteen failed to complete the study as planned: five were withdrawn due to adverse events, four due to treatment failure and nine due to protocol violations. At the end of each treatment period, significant improvements were seen in all efficacy parameters. Overall response was graded as 'considerable improvement' or 'minimal or no symptoms', by over 80% of subjects and investigators. Median intervals to relapse for subjects remaining in the study were 72 days (range 28-329) and 53 days (range 14-141) after periods 1 and 2, respectively. There were significant increases in mean serum creatinine and blood pressure during each treatment period. However, there were no significant differences in either parameter between baseline and the final follow-up visit. At the end of each treatment period, overall tolerability of the treatment was considered 'good' or 'very good' by over 80% of subjects and investigators.

Multiple myeloma with hairy cell-like features

Hairy cell leukemia (HCL) and multiple myeloma (MM) are well-described disease entities with characteristic clinical and pathologic features. We describe two patients initially treated for MM in whom atypical clinical and morphologic features subsequently developed that raised the possibility of HCL. Although the cytologic appearance and immunophenotype were not diagnostic of HCL, these cases challenge the criteria used to diagnose MM, HCL, and other recently described villous neoplasms.

Skin disease in rural Tanzania

BACKGROUND

Skin disease is a common problem, accounting for significant morbidity in developing countries. Knowledge about the prevalence of different skin conditions allows appropriate planning for provision for these health needs. There are currently few data about the needs in rural areas; therefore, this study was set up to investigate skin abnormalities found in a village population in Tanzania.

MATERIALS AND METHODS

A village with a population of 2,876 was chosen and one-third of the population was examined for cutaneous abnormalities.

RESULTS

During the survey, 97.7% of the target population was examined. Signs of nutritional deficiency were common with koilonychia affecting 18.1% of the population examined and signs of hypoproteinemia being present in 3.4% of them. Infections and infestations were also frequently seen. Scabies was observed in 6.0% and pediculosis capitis in 5.3%. Dermatophyte infection was present in 5.1%. These were all most common in prepubertal children. Leg sores were seen in 5.1% and leg ulcers in 3.0% of the population.

CONCLUSIONS

The survey reveals that easily treatable skin infections and infestations are common in a rural Tanzian population. Signs of nutritional deficiency are also frequently seen.

Erythropoietic protoporphyria presenting in an adult

Erythropoietic protoporphyria is an inherited disorder of porphyrin metabolism, in which reduced activity of the enzyme ferrochelatase leads to accumulation of protoporphyrins in erythrocytes. Protoporphyrins are photoactivated by ultra-violet light causing tissue damage by release of free oxygen radicals, which manifests as photosensitivity. The majority of cases of erythropoietic protoporphyria present in childhood although sometimes symptoms are delayed until the second decade. We report here a case presenting in adulthood and discuss the risk of liver disease in the condition.

Arterial hypertension causing leg ulcers

We report clinical and histological features of 16 consecutive patients with hypertensive leg ulcers. The lumen/wall ratio in arterioles at the edges of these hypertensive leg ulcers was compared with that in other types of chronic leg ulcers and was found to be significantly reduced (P < 0.001). Additional conditions such as venous hypertension or main vessel arterial disease contributed. Nineteen of 22 ulcers were completely healed after a mean of 4.9 months. Recognition of this condition enables correct treatment choice, which usually involves excision and grafting, and early healing.

Urticaria associated with thyrotoxicosis

We report a patient with chronic urticaria which was closely associated with elevated levels of thyroxine. The urticaria responded poorly to antihistamines and only partially to systemic steroids, but resolved consistently when the thyroxine level was reduced to normal. The mechanism for the association may involve modulation of the cyclic AMP levels within mast cells.

Apert's syndrome and androgen receptor staining of the basal cells of sebaceous glands

We report two cases of Apert's syndrome, each of whom developed the severe acne in adolescence which is a feature of this disorder. Both responded to isotretinoin therapy. Immunohistochemical techniques, using a mouse monoclonal antibody, were employed to stain sebocyte androgen receptors in the two patients, and in five controls. This showed no difference in the number of cells with androgen receptor expression between the patients with Apert's syndrome and controls. These results support the concept that the underlying problem in Apert's syndrome is an abnormal sensitivity to normal circulating levels of androgens, and not an excess number of androgen receptors.

Laryngeal and cutaneous sarcoidosis treated with methotrexate

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A clinical evaluation of acne scarring and its incidence

Despite scarring being a recognized sequel of acne, the actual extent and incidence of residual scarring remains unknown. One hundred and eighty-five acne patients were included in this study (101 females, 84 males). Patients were selected from acne clinics and their acne scarring was examined. The scarring was quantified according to a lesion count and allocated a score. The type and extent of scarring was correlated to the age and sex of the patient, the site of the acne, the previous acne grade according to the Leeds Technique, acne type (noted in clinic at the original referral time) and duration of acne, before adequate therapeutic measures had been instituted. Results indicate that facial scarring affects both sexes equally and occurs to some degree in 95% of cases. Total scarring on the trunk was significantly greater in males, as was hypertrophic and keloid scarring in these sites (P < 0.05). There were significant correlations between the initial acne grade and the overall severity of scarring in all sites and in both sexes (P < 0.01). Superficial inflamed papular acne lesions as well as nodular lesions were capable of producing scars. A time delay up to 3 years between acne onset and adequate treatment related to the ultimate degree of scarring in both sexes and in all three sites. This emphasizes the need for earlier adequate therapy in an attempt to minimize the subsequent scarring caused by acne.

Treatment of scabies in rural east Africa--a comparative study of two regimens

Scabies is endemic in Africa where living conditions make synchronous treatment of every member of the large extended family impossible. An open study was designed to investigate the optimum treatment of school children in rural Tanzania. In one school where 34 children (7%) were infested, treatment with benzyl benzoate was distributed to the affected child and those sleeping in close proximity. In another school where 29 pupils (6.4%) were affected, the above treatment was given along with soap and some scabicidal ointment (6% sulphur) to be used on residually affected areas. Again, the treatment was given to those sleeping in proximity. One month later 46% were clear at the first school and a significantly higher proportion (69%) at the second. I conclude that inefficient application of scabicidal treatment and lack of washing contribute to scabies treatment failures. Synchronous treatment of small groups within the extended family can be effective.

Comparative study of calcipotriol (MC 903) ointment and betamethasone 17-valerate ointment in patients with psoriasis vulgaris

BACKGROUND

Topical vitamin D analogues have been reported to be an effective treatment in patients with psoriasis. Comparative studies with existing treatments are required.

OBJECTIVE

Our purpose was to compare the effectiveness of calcipotriol (50 micrograms/gm) and betamethasone 17-valerate (1 mg/gm) ointments twice daily in the treatment of stable plaque psoriasis.

METHODS

This study was a randomized, double-blind comparison over 6 weeks in 409 patients. Efficacy, as measured by the Psoriasis Area and Severity Index (PASI), and safety were assessed at 2, 4, and 6 weeks.

RESULTS

Reduction of PASI was statistically significant at all time points for both treatments but there were no significant between-treatment differences. At the completion of 6 weeks of treatment, the mean PASI reduction was 5.50 for calcipotriol and 5.32 for betamethasone (95% confidence interval [CI] -0.40 to 0.78). Analysis of patient assessment at 6 weeks showed clearance or marked improvement in 61.2% of the calcipotriol patients and 50.5% with betamethasone (95% CI 1.4 to 20.8). Calcipotriol produced significantly more local side effects (19.5% compared with 3.9%, p less than 0.001); however, these were minimal leading to withdrawal in only 3 of 205 patients.

CONCLUSION

Calcipotriol ointment was as effective as betamethasone 17-valerate ointment as measured by the PASI and superior as measured by self-assessment in patients with stable plaque psoriasis. Both treatments were well tolerated.

The use of haploidy to develop plants that express several recessive traits using light-seeded canola (Brassica napus) as an example

The use of haploidy to introgress recessive traits into Brassica napus canola is illustrated by describing the properties of doubled haploids obtained by microspore culture from crosses between a yellow-seeded rapeseed line (low erucic acid, high glucosinolate) and black-seeded canola. Of the 99 doubled haploid lines that were produced, 3 were yellow-seeded canola lines. This result was not significantly different than the predicted frequency of 1 in 64 for the homozygous recessive phenotype in a doubled haploid population segregating for six recessive genes. Thus, the study supports previous models of inheritance determined for yellow seededness and glucosinolate content in Brassica napus. Also, since the chances of obtaining a plant with the same characteristics in a F2 population are 1 in 4,096, the underscore results the advantages of using haploidy to introgress recessive traits into Brassica napus canola.

Atenolol-induced pseudolymphoma

The pseudolymphoma syndrome is a reversible reactive condition consisting of fever, lymphadenopathy and generalized rash. Initial cases were associated with anticonvulsants, although other drugs have now been implicated. We report on a case associated with atenolol.

A double-blind, placebo-controlled trial of topical I,25-dihydroxycholecalciferol in psoriasis

In a double-blind trial of topical I,25-dihydroxycholecalciferol in 47 patients with psoriasis no benefit was shown compared with placebo.

Acute psoriasis associated with Lancefield Group C and Group G cutaneous streptococcal infections

Involvement of Streptococcus pyogenes (beta haemolytic streptococcus, Lancefield Group A) infection, usually of the throat, in acute exacerbations of psoriasis is well known. We report here two cases of an acute psoriatic eruption associated in one patient with Group C streptococcal cellulitis and in another with Group G streptococcal intertrigo.

Perception of implicit relationships between personality traits by schizotypic college subjects: a pilot study

The perception of trait relationships was measured in both schizotypic and control college subjects (N = 46) by use of a similarity rating method. Schizotypic and control subjects were selected on the basis of their scores on four scales of schizotypy: Physical Anhedonia, Perceptual Aberration, Intense Ambivalence, and Somatic Symptoms. Schizotypes as a group were more variable in their ratings of trait relationships than were controls. When each scale was considered separately, only perceptual aberrators as a group were as consistent in their ratings of trait relationships as control subjects. These findings support the hypothesis that schizotypes fail to share the semantic trait structure accepted by most normal subjects and may be a possible explanation for previous findings of social deficits in schizotypes.

Effect of dietary salt, arsenic and copper additions and waste management systems on selected microbial organisms in swine wastes

Selected microbial organisms were counted in swine wastes during three studies in which the primary objective was to investigate the effects of feed additives and waste management systems on swine waste composition. Dietary salt (NaCl) levels (.2, .5%), dietary arsanilic acid levels (0, 100, 200 ppm), supplemental copper levels (0, 125, 250 ppm) and waste management systems (oxidation ditch, anaerobic deep pit, anaerobic lagoon) were compared in this series of studies. Dietary salt level did not affect total coliform and fecal streptococci concentrations in swine waste. Supplemental copper and arsanilic acid increased total coliform counts (dry matter basis) in anaerobic pit wastes over counts observed with the control. Salmonella spp concentrations were increased in the anaerobic pit waste at the end of the 104-day feeding trial, especially with the 250-ppm copper diet. Staphylococci spp organisms were not affected by supplemental copper. In all studies, concentrations of the microorganisms cultured were higher in freshly excreted waste than in waste stored and partially treated in the waste systems studies. Temperature, diultion and waste handling systems had some effects on microbial populations.

Adriamycin and daunomycin generate reactive oxygen compounds in erythrocytes

Adriamycin and daunomycin produce dose-related cardiac toxicity that may be related to oxygen radicals. Addition of these compounds to human erythrocyte suspensions resulted in stimulation of hexose monophosphate shunt activity that was markedly impaired in the absence of oxyhemoglobin. Evidence for generation of hydrogen peroxide by these compounds was provided by oxidation of reduced glutathione, by 14C-formate oxidation, and by the catalase-aminotriazole trapping technique. These experiments indicate that Adriamycin and daunomycin interact with oxyhemoglobin to generate reactive oxygen metabolites. A similar interaction with oxymyoglobin may occur in the heart and produce oxygen radicals that injure cardiac myocytes.

Characterization of anti-lymphocyte antibodies in inflammatory bowel disease

Sera from patients with inflammatory bowel disease (IBD) showing broad lymphocytotoxic or lymphocyte-binding activity were subjected to additional analysis to further characterize their properties. Lymphocytotoxins appear to be antibodies predominantly of IgM class as determined by [1] 2-mercaptoethanol sensitivity, [2] serum fractionation by sucrose density gradient sedimentation, Sephadex G-200 filtration, and DEAE ion exchange chromatography, and [3] absorption by anti-Ig immunoadsorbent columns. Lymphocyte-binding antibody was found to be IgG, IgA, and IgM, as determined by indirect immunofluorescent staining of acetone-fixed lymphocytes. Individual IBD sera showed marked variability in occurrence of cytotoxic and binding antibodies when tested against the same donor panel of lymphocytes. These studies emphasize the marked heterogeneity of anti-lymphocyte antibodies occurring in IBD.

Serum lymphocytotoxins in inflammatory bowel disease. Studies of frequency and specificity for lymphocyte subpopulations

Serum cold-reactive lymphocytotoxin (LCT) was detected in twenty-two of fifty-six (40%) patients with inflammatory bowel disease (IBD). The frequency of LCT detection was similar in Crohn's disease and ulcerative colitis. Cytotoxicity testing against T or B cell-enriched peripheral blood lymphocytes from normal donors, together with absorption experiments, indicated that LCT in IBD was reactive against determinants on both cell subpopulations. Reactivity against T cells from patients with common variable immunodeficiency was significantly less than with normal donor T cells. LCT in IBD could not be related to prior allogeneic sensitization and its presence appeared to be unrelated to disease activity or drug therapy. No correlation was found between LCT and peripheral blood T- or B-cell numbers. The present findings suggest the need for further investigation of the role of infectious agents in the pathogenesis of IBD.