Tacrolimus/methotrexate vs tacrolimus/reduced-dose methotrexate/mycophenolate for graft-versus-host disease prevention

Tacrolimus (Tac)/methotrexate (MTX) is standard graft-versus-host disease (GVHD) prophylaxis; however, is associated with several toxicities. Tac, reduced-dose MTX (mini-MTX), and mycophenolate mofetil (MMF) have been used but never compared with standard MTX. We performed a randomized trial comparing Tac/MTX (full-MTX) with Tac/mini-MTX/MMF (mini-MTX/MMF) for GVHD prevention after allogeneic hematopoietic cell transplantation (HCT). Patients (pts) receiving first myeloablative HCT using an 8/8 HLA-matched donor were eligible. Primary end points were incidence of acute GVHD (aGVHD), mucositis, and engraftment. Secondary end points included chronic GVHD (cGVHD), organ toxicity, infection, relapse, nonrelapse mortality (NRM), and overall survival (OS). Ninety-six pts were randomly assigned to full-MTX (N = 49) or mini-MTX (N = 47). The majority (86%) used bone marrow grafts. There was no significant difference in grade 2-4 aGVHD (28% mini-MTX/MMF vs 27% full-MTX; P = .41); however higher incidence of grade 3-4 aGVHD (13% vs 4%; P = .07) with mini-MTX/MMF. Pts receiving mini-MTX/MMF had lower grade 3 or 4 mucositis and faster engraftment. There were no differences in moderate-to-severe cGVHD at 1 year or infections. Pts receiving mini-MTX/MMF experienced less nephrotoxicity and respiratory failure. There was no difference in the 1-year relapse (19% vs 21%; P = .89) and OS (72% vs 71%; P = .08), and mini-MTX/MMF was associated with lower but nonsignificant NRM (11% vs 22%; P = .06). Compared with full-MTX, mini-MTX/MMF was associated with no difference in grade 2-4 aGVHD and a more favorable toxicity profile. The higher severe aGVHD warrants further study to optimize this regimen. The trial was registered at www.clinicaltrials.gov as #NCT01951885.

Survival following relapse after allogeneic hematopoietic cell transplantation for acute leukemia and myelodysplastic syndromes in the contemporary era

OBJECTIVE/BACKGROUND

Relapse is the most common cause of treatment failure after allogeneic hematopoietic cell transplantation (alloHCT). No standard of care exists, and a wide range of treatments are used for post-alloHCT relapse. In the recent era, several novel therapies including targeted agents are available for acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), and myelodysplastic syndrome (MDS).

METHODS

We reviewed outcomes after alloHCT relapse, with or without use of these newer agents for ALL, AML, and MDS. In total, 115 adults with relapsed or refractory ALL (n = 17), AML (n = 67), and MDS (n = 31) at median 5 (range, 1-64) months after their first alloHCT in 2010-2018 were included.

RESULTS

Median follow-up was 19 (range, 6-80) months after relapse from alloHCT. Targeted agents were given to 29 (25%) patients. In multivariable analysis, use of targeted agent at any time point after relapse was not associated with survival. Matched unrelated (vs. matched sibling; hazard ratio [HR] 1.70; p = .027) or haploidentical donor grafts (vs. matched sibling; HR 2.69; p = .003), presence of grade II-IV acute graft-versus-host disease before relapse (HR 2.46; p < .001), and less than 12 months from HCT to relapse (<6 vs. > 12 months; HR 6.34; p < .001; 6-12 vs. > 12 months; HR 3.16; p = .005) were adverse prognostic factors for post-relapse survival.

CONCLUSION

Outcomes after alloHCT relapse remain poor regardless of the novel agent use. Innovative treatment strategies are needed to improve outcomes after relapse post-alloHCT.

A Phase II Trial of Imatinib Mesylate as Maintenance Therapy for Patients With Newly Diagnosed C-kit-positive Acute Myeloid Leukemia

INTRODUCTION

Adults with acute myeloid leukemia (AML) have a high rate of remission; however, more than 50% relapse. C-kit is expressed in approximately 60% of patients with de novo AML and represents a potential therapeutic target.

MATERIALS AND METHODS

Patients with newly diagnosed AML received 12 months of imatinib mesylate as maintenance therapy after the completion of post-remission therapy. The primary objective was to determine whether this approach improved progression-free survival (defined as no relapse and no death) compared with historical controls.

RESULTS

The median progression-free survival of patients < 60 years of age was 52.1 months (historical control, 13 months) and for patients ≥ 60 years of age was 10.7 months (historical control, 8 months). The median level of AF1q expression was high (9.59), and 84% of patients had moderate or high levels of drug-resistance factors.

CONCLUSIONS

Imatinib maintenance therapy may improve the outcome of newly diagnosed patients with AML who are < 60 years of age.

Breath analysis in gastrointestinal graft-versus-host disease after allogeneic hematopoietic cell transplantation

Volatile organic compounds (VOCs) are generated during pathologic processes, and their assessment can be used to diagnose and monitor a variety of diseases. Given the role of the microbiome in graft-versus-host disease (GVHD), we hypothesized that microorganisms producing volatile metabolites may alter VOCs expelled in breath in patients with gastrointestinal (GI) GVHD. In this pilot study, exhaled breath samples were obtained from 19 patients with grade 2 to 4 acute GI GVHD, 10 patients with no GVHD at day 100, and 10 healthy control subjects; the samples were analyzed by using mass spectrometry. Overall, nine (47%) patients had grade 2 GVHD, eight (42%) patients had grade 3 GVHD, and two (11%) patients had grade 4 GVHD; 26% had upper GI, 21% had lower GI, and 53% had both upper and lower GI manifestations. Stepwise canonical discriminant analysis identified 5 VOCs distinguishing patients with and without GI GVHD: 2-propanol, acetaldehyde, dimethyl sulfide, isoprene, and 1-decene (Wilks' Λ, 0.43; F statistic, 6.08; P = .001). The model correctly classified 89% (17 of 19) and 90% (9 of 10) of patients with and without GI GVHD, respectively. Breath analysis is a feasible and promising noninvasive method to detect acute GI GVHD. Further study of serial breath analysis and the gut microbiome in a larger cohort are ongoing to validate these findings.

Psychosocial Assessment of Candidates for Transplant (PACT) as a tool for psychological and social evaluation of allogeneic hematopoietic cell transplantation recipients

Psychosocial Assessment of Candidates for Transplant (PACT) is a tool originally developed to address psychosocial risks in solid organ transplant recipients and has the potential for application to hematopoietic cell transplantation (HCT) recipients. In a retrospective cohort study, we reviewed 404 adult allogeneic HCT cases from 2003 to 2014 to identify predictors of adverse psychosocial status as determined by PACT. Final PACT rating was poor/borderline (score 0-1) in 5%, acceptable (score 2) in 22%, good (score 3) in 44%, and excellent (score 4) in 29% recipients. In multivariable regression, higher PACT score was associated with White race (odds ratio [OR] 2.95, P < 0.001), having a related donor (OR 1.61, P = 0.015), and a higher quality of life score (OR 1.22/ 10-point increase in FACT-BMT total score, P < 0.001). PACT score correlated with all quality of life subscales. The final PACT score was associated with non-relapse mortality (HR 0.82/ 1-point increase, p = 0.03) in multivariable analysis that considered patient and disease factors, but not in models that also included transplant-related factors and performance status. PACT score was not associated with overall survival. PACT can be considered as part of a comprehensive psychosocial assessment for identifying patients who may require additional resources around allogeneic HCT.

Prognostic Factors for Mortality among Day +100 Survivors after Allogeneic Hematopoietic Cell Transplantation

Although day +100 survival among allogeneic hematopoietic cell transplantation (HCT) recipients has improved over time, longer-term survival remains a challenge. The aim of this study was to identify prognostic factors for survival among patients surviving longer than 100 days using baseline characteristics and factors identified within the first 100 days after transplantation. Of 413 patients undergoing a first allogeneic HCT between 2006 and 2014, 335 survived >100 days post-transplantation. The majority underwent a myeloablative transplantation (75%) with a bone marrow (BM) (52%) graft source. One-year all-cause mortality (ACM) was 29%, with 16% relapse mortality (RM) and 12% nonrelapse mortality. In multivariable analysis, high-risk disease (hazard ratio [HR], 1.55; P = .003), non-cytomegalovirus infection (HR, 1.79; P = .003), more days hospitalized (HR, 1.16; P < .001), and relapse (HR, 4.38; P < .001) within the first 100 days were associated with increased risk of ACM. Patients with higher income (HR, .89; P = .024) and those who received BM (HR, .52; P < .001) or umbilical cord blood (HR, .40; P = .002) relative to peripheral blood stem cells had lower risk of ACM. Our study identifies risk factors for adverse long-term survival in 100-day survivors, a time point when patients frequently are discharged from transplantation centers. In addition to disease- and transplantation-related factors, low socioeconomic status was associated with worse long-term survival, highlighting the need for focused efforts to improve outcomes in vulnerable patient populations.

Community Risk Score for Evaluating Health Care Disparities in Hematopoietic Cell Transplantation

There is a critical need for tools to comprehensively describe disparities in hematopoietic cell transplant (HCT) recipients. We conducted a retrospective cohort study to evaluate a Community Risk Score (CRS) tool for this purpose. CRS included 10 community health indicators based on county or state of residence obtained from several secondary data sources and a composite score was assigned to each county (range 0 to 40), that was further categorized into six tiers (I to VI) with higher tiers indicating poor community health. CRS was assessed for 509 allogeneic and 1033 autologous HCT recipients from 2003 to 2013. Our cohort represented allogeneic and autologous HCT recipients from 300 and 431 unique ZIP codes from 99 and 125 counties in 15 and 16 states, although 86% and 90% patients were from Ohio, respectively. A greater proportion of patients had adverse individual community risk indicators in higher-risk tiers (P < .001 for trend for all). In multivariable analysis, clear trends toward association of CRS with outcomes were not observed. For autologous HCTs, Tier III has higher risks of relapse mortality (hazard ratio [HR] 2.2, P = .02) and all-cause mortality (HR 1.8, P = 0.03). In conclusion, CRS was able to categorize patients into groups representing greater levels of health care disparities. We did not see a clear association between CRS and transplant outcomes, although our cohort was limited to a relatively small group of counties. Community-based risk score model may serve as a tool for evaluating disparities in HCT recipients, but its validation in a nationally representative cohort of patients is needed.

A retrospective analysis of longitudinal changes in bone mineral content in cystic fibrosis

BACKGROUND

We aimed to describe the longitudinal changes in bone mineral content and influencing factors, in children with cystic fibrosis (CF).

METHODS

One hundred children (50 females) had dual X-ray absorptiometry (DXA) performed. Of these, 48 and 24 children had two to three scans, respectively over 10 years of follow-up. DXA data were expressed as lumbar spine bone mineral content standard deviation score (LSBMCSDS) adjusted for age, gender, ethnicity and bone area. Markers of disease, anthropometry and bone biochemistry were collected retrospectively.

RESULTS

Baseline LSBMCSDS was >0.5 SDS in 13% children, between -0.5; 0.5 SDS, in 50% and ≤-0.5 in the remainder. Seventy-eight percent of the children who had baseline LSBMCSDS >-0.5, and 35% of the children with poor baseline (LSBMCSDS<-0.5), showed decreasing values in subsequent assessments. However, mean LS BMC SDS did not show a significant decline in subsequent assessments (-0.51; -0.64; -0.56; p=0.178). Lower forced expiratory volume in 1 s percent (FEV1%) low body mass index standard deviation scores (BMI SDS) and vitamin D were associated with reduction in BMC.

CONCLUSIONS

Bone mineral content as assessed by DXA is sub-optimal and decreases with time in most children with CF and this study has highlighted parameters that can be addressed to improve bone health.

Relationship between knee extension force and stand-up performance in community-dwelling elderly women

OBJECTIVE

To describe the relationship between knee extension force and stand-up performance.

DESIGN

Prospective, cross-sectional, descriptive, and correlational.

SETTING

Community.

PARTICIPANTS

Fifty-five community-dwelling women 60 or more years old.

INTERVENTIONS

Information pertaining to stand-up performance was gathered via structured questions. The time to complete 1 sit-to-stand from a bench of known height (16in) was obtained in conjunction with subjects' ratings of perceived exertion (RPEs) relative to the task. Bilateral lower extremity knee extension strength was measured with a hand-held dynamometer and normalized against body weight.

MAIN OUTCOME MEASURES

Total knee extension forces (raw and body-weight normalized values) generated by each subject were correlated with 3 measures of stand-up performance.

RESULTS

Low to moderate correlations (r = -.323 to -.526) were found between knee extension forces and the stand-up performance measures of bench stand time and stand-up difficulties. Normalized knee extension force had a higher correlation than raw knee extension force with stand-up difficulties and RPE. Correlations were higher when the curvilinear nature of the relationship was taken into account. The highest correlation was between normalized knee extension force and the RPE associated with the bench stand task (r = -.767).

CONCLUSION

Knee extension force offers an important but incomplete explanation of stand-up performance from low surfaces by elderly women. Interventions leading to increased knee extension force may improve stand-up performance.

Development of a bioassay for phytochemicals using Daphnia pulex

The freshwater cladoceran Daphnia pulex was explored as an alternative to Artemia salina for the biological screening of phytochemicals. This paper reports on the results of screening 27 compounds, and comparisons are made with screens using Artemia salina. The effect of miniaturisation of the assay system was investigated. Petri-dish based tests were performed for the 27 compounds using 10 daphnids at each of 5 concentrations (1 - 1000 mg l(-1)). Potassium dichromate was used as a control and the number immobile after 24 hours were counted. Results were expressed as EC(50) values. The active compounds (EC(50) < 25 mg l(-1)) comprised mainly adrenoceptor agonist alkaloids, while the cytotoxins vincristine and colchicine, and several antibiotics were relatively non-toxic towards Daphnia. The method was validated by comparative bioassay of A. belladonna fractions. Overall, this screen compared favourably with those based on Artemia. Daphnia were sensitive to a wide range of biologically active molecules including CNS-stimulants, anti-malarials, narcotics and anti-spasmodics, and the sensitivity was broader than previously seen with Artemia. The screen is perhaps limited by the lack of sensitivity to cytotoxins, but this might be overcome by altering the test criteria.

Phenylalkylamine abuse among opiate addicts attending a methadone treatment programme in the Republic of Ireland

Since the early 1990s ring-substituted derivatives of amphetamine have been abused widely in the Republic of Ireland. The main ring-substituted amphetamines being abused include methylenedioxyamphetamine (MDA), methylenedioxymethamphetamine (MDMA) and methylenedioxyethamphetamine (MDEA). A newer illicit synthetic analogue, which has been seized to a lesser extent by Irish police, is N-methyl-1-(3,4-methylenedioxyphenyl)-2-butanamine (MBDB). The work presented here involved the determination of the type of ring-substituted amphetamines being abused by a group of recovering opiate abusers participating in a methadone maintenance programme in a Dublin Drug Rehabilitation Centre. Urine samples which tested positive for amphetamines and ring-substituted amphetamines via EMIT immunoassay were subjected to further analysis using GC-MS with MBTFA flash derivatization. It was found that the methylenedioxypropanamines were being abused, as was amphetamine itself. However, no abuse of methylenedioxybutanamines or thioamphetamines was observed.

A broad range of forces is encompassed by the maximum manual muscle test grade of five

This retrospective study summarizes the range of knee extension forces associated with the manual muscle test grade of 5. The range of the forces (>560 Newtons) was large and encompassing of more than 86% of measurable forces. These findings help to explain the insensitivity of manual muscle testing and why it has such a profound ceiling effect.

Impact of pasture type on methane production by lactating beef cows

In order to determine the quantity of methane (CH4) produced by lactating beef cows on pasture, 16 Hereford–Simmental first-calf heifers with a mean weight of 511.2 ± 5.8 kg were randomly selected from a larger group of cows (n = 60) on a grazing management experiment and used to evaluate the effects of pasture type on ruminal CH4 production using the sulfur hexafluoride (SF6) tracer-gas technique. Pasture treatments consisted of two pasture types, alfalfa-grass [78% alfalfa (Medicago sativa L.) – 22% meadow bromegrass (Bromus biebersteinii Roem and Schult.)] or 100% meadow bromegrass at each of two fertility levels (either unfertilized or soil test recommended fertilizer levels) with two replications of each pasture treatment (8 pastures). Cows were managed using a "put and take" stocking system to leave equal residual herbage mass on all treatments following the grazing period in each paddock. During the 69-d grazing season, two cows from each pasture were sampled to determine daily forage intake and CH4 production on four occasions. The chemical composition of diets differed between pasture types and sampling periods. Dry matter intake was greater for cows grazing alfalfa–grass pastures than for cows grazing grass-only pastures (11.4 vs. 9.7 kg DM d−1. P < 0.018). However, methane production was greater for cows grazing alfalfa–grass pastures than for cows grazing grass-only pastures (373.8 vs. 411.0 L CH4 d−1. P < 0.008). Consequently, energy lost through eructation of CH4 was less for cows grazing alfalfa–grass pastures than it was for cows grazing grass-only pastures (7.1 vs. 9.5% of GEI; P < 0.001). Key words: Methane, cattle, environment, digestion efficiency, pasture, forage

Hepatic enzyme abnormalities in children on triple therapy for tuberculosis

Standard chemotherapy for tuberculosis (TB) in children uses hepatotoxic drugs. Published data and guidelines on monitoring of liver function during TB treatment are often contradictory and not directly relevant to the pediatric population. We carefully monitored 43 children (age 6.6 years, 0.7-15.1 [median, range]; 49% male; 72% Caucasian) being treated for TB infection (n = 8) or disease (n = 35) with triple therapy, using pyrazinamide, rifampicin, and isoniazid in standard recommended doses. Children on other hepatotoxic drugs were excluded. Measurements of liver function tests (LFT) included aspartate transaminase (AST), alanine transaminase (ALT), and bilirubin, and they were checked before and a median of 5 times (1-23) during treatment. Only one child had mildly abnormal LFTs pretreatment. Thirteen children (n = 13, [30%]; age 7.6 years, 1.8-10.9; 54% male; 77% Caucasian) developed abnormal LFTs (> mean + 2 SD) and of these 10 had TB disease. Eight of the 13 had mildly elevated enzymes (< twice upper limit of normal) while in five, all with disease, the enzymes were more markedly raised. In the group with normal LFTs (n = 30, [70%]; age 6.6 years 0.7-15.1; 47% male; 70% Caucasian) 25 had disease (83%). Liver enzyme elevation occurred early (1.65 weeks, 0.6-16.6). Only two children had symptoms (one jaundice, one pruritus) with treatment being stopped temporarily only in the jaundiced child. Otherwise, LFTs normalized without interrupting treatment. We conclude that elevated liver enzymes are not uncommon in children receiving triple therapy for TB, generally occurring early in treatment. Symptoms are rare. Current British Thoracic Society and American Thoracic Society guidelines (that if LFTs are normal prior to treatment then further monitoring should only be performed if clinically indicated) seem adequate for children.

Methane production by steers on pasture

In order to determine the quantity of methane (CH4) produced by steers on pasture, 16 steers with a mean weight of 356 ± 25 kg were randomly selected from a larger group of cattle (n = 48) to evaluate the effects of grazing management and monensin controlled release capsule (CRC) administration on ruminal CH4 production using the sulphur hexafluoride (SF6) tracer-gas technique. Pasture management treatments consisted of two grazing systems (continuous stocking or 10-paddock rotational stocking) at each of two stocking rates (low, 1.1 steer ha−1 or high, 2.2 steers ha−1) with two replications of each pasture treatment. Half of the animals on each pasture treatment were administered a monensin CRC delivering 270 mg d−1, and untreated animals served as controls. During the 140-d grazing season, one steer from each treatment-replicate combination was sampled to determine daily intake and CH4 production on four occasions. The chemical composition of diets differed between grazing management treatments and sampling periods. Voluntary intake and CH4 production, adjusted for differences in body weight, were unaffected by grazing management, sampling period or by monensin CRC administration and averaged 0.69 ± 0.1 L kg BW−1 d−1 across all grazing management treatments. The energy lost through eructation of CH4 averaged 4.5 ± 1.4% of gross energy intake. Key words: Methane, cattle, environment, digestion efficiency, pasture, forage

Comparison of resistance of fungal spores to gamma and electron beam radiation

The irradiation sensitivity of fungal spores to either gamma or electron beam irradiation was evaluated in distilled water. The D10 (the dose required to reduce the initial population by 90%) gamma values ranged from 0.236 to 0.416 kGy and from 0.209 to 0.319 kGy for Penicillium and Aspergillus species, respectively. The D10 electron beam values ranged from 0.194 to 0.341 and from 0.198 to 0.243 kGy for Penicillium and Aspergillus species, respectively. Of the aspergilli species evaluated, only half exhibited significantly (P < 0.05) greater sensitivity to the electron beam treatment compared to gamma irradiation. Four of the six penicillia species evaluated also exhibited significantly (P < 0.05) higher sensitivities to electron beam treatment.

The effects of aerobic and anaerobic exercise conditioning on resting metabolic rate and the thermic effect of a meal

This study examined resting metabolic rate (RMR) and thermic effect of a meal (TEM) among athletes who had participated in long-term anaerobic or aerobic exercise. Nine collegiate wrestlers were matched for age, weight, and fat-free weight with 9 collegiate swimmers. Preliminary testing included maximal oxygen consumption, maximal anaerobic capacity (MAnC) for both the arms and the legs, and percent body fat. On two separate occasions, RMR and TEM were measured using indirect calorimetry. VO2max was significantly higher in the swimmers while MAnC was significantly higher in the wrestlers for both the arms and the legs. RMR adjusted for fat-free weight was not significantly different between groups. The differences in total and percentage of TEM between the groups were not statistically significant, and there were no differences in baseline thyroid hormones. These data suggest that despite significant differences in VO2max and WAnT values following long-term aerobic and anaerobic exercise training, resting energy expenditure does not differ between these college athletes.

Two seasons of weight cycling does not lower resting metabolic rate in college wrestlers

Over the course of 2 yr, we prospectively studied the effect on resting metabolic rate (RMR) of multiple cycles of weight loss followed by regain in six weight cycling collegiate wrestlers (WC) (mean age = 19.0 yr) compared with 12 weight stable, physically active, nonwrestling controls (C) (mean age = 20.9 yr), whose body composition was similar to the wrestlers. Furthermore, during the second year of the investigation, a group of six nonweight cycling collegiate wrestlers (NWC) (mean age = 18.8 yr) were included in the analyses. The WC had previously undergone at least three seasons of weight cycling and continued this pattern during each year of the study. For the WC, RMR was determined by indirect calorimetry before and after a 6-month season of weight cycling for each of two consecutive years. A similar time frame was followed for measurement of RMR in the C, while for the NWC, pre- and postseason RMRs were measured only during the second year. During the 2 yr, the WC had significantly higher (P < 0.05) pre- and postseason measures of RMR compared with the C. A separate analysis comparing all three groups during the second year showed that RMR was not different for WC and NWC, and that RMR was higher for both wrestling groups compared with C. In this prospective study, weight cycling did not increase the thermogenic efficiency of collegiate wrestlers compared with either nonweight cycling wrestlers or weight stable controls, who were not wrestlers.

Resting metabolic rate in weight-cycling collegiate wrestlers compared with physically active, noncycling control subjects

To determine the effect of multiple cycles of weight loss and regain on resting metabolic rate (RMR), we compared RMR between 12 weight-cycling collegiate wrestlers (means age 19.4 y) with a minimum of three previous seasons of weight cycling and 13 weight-stable nonwrestlers of similar weight and body composition (means age 20.6 y). RMR was measured before, during, and after a 6-mo wrestling season. Wrestlers exhibited a significantly higher baseline RMR compared with the control subjects (p less than 0.05). During the season when wrestlers had lost weight for competition, RMR was reduced (p less than 0.05) but was not significantly lower than that of the weight-stable control subjects. After a season of weight cycling and the final weight regain, the wrestler's postseason RMR was similar to preseason values and higher than the postseason RMR of the control subjects (p less than 0.05). Participation in numerous cycles of weight loss and regain did not lower RMR in these competitive athletes, as has been previously suggested.

The thebaine content of ornamental poppies belonging to the papaver section oxytona

Encouraging yields of thebaine have been obtained from Papaver bracteatum grown in Ireland. However climatic conditions adversely affect flower (and subsequent capsule production). Twelve vigorously flowering ornamental cultivars labelled P. orientale or "oriental poppy" were screened for the presence of thebaine. Five of the cultivars had no detectable thebaine. The thebaine content of the remaining 7 cultivars was determined. The capsules of the cultivar "Goliath" had a thebaine content of 3.0%. The identity of the thebaine was confirmed by isolation and examination of spectral evidence. In addition the two known N-oxides of thebaine were isolated and characterised from cv. Goliath. The combination of this chemical evidence and stomatal pore length measurements indicate that the plant labelled P. orientale cv. Goliath is closely related to P. bracteatum Lindl . This cultivar shows promise as a source of thebaine and has a potential in the hybridisation of genuine P. bracteatum to improve its flowering characteristics in mild climates.

The identification of drugs of abuse in the Republic of Ireland during the years 1968-1978

A survey of the composition of 4,933 exhibits submitted for laboratory analysis by the Drug Squad of the Irish police during the years 1968-1978 indicated an increase in the level of non-medical drug consumption in the Republic of Ireland. Cannabis was the most widely encountered drug. Barbiturates constituted a considerable proportion. Amphetamines were rarely found; this was attributed to the unique legislation controlling the storage and sale of amphetamines. Various substances were sold as drugs of abuse. For example, Datura was sold as cannabis which caused a considerable concern because of its toxicity. The recognition of a drug-related problem of some significance in Ireland during 1968 led to the formation of a drug squad in the Irish police. Since that time a total of 4,933 exhibits arising from arrests and drug seizures have been submitted for laboratory analyses. These exhibits ranged from "normal" pharmaceutical formulations (tablets, ampoules, etc.) to unknown powders and a large number of more unusual items (table 1). The drugs were identified using an appropriate combination of microscopic, chromatographic and spectroscopic techniques (1, 2).