Vision characteristics of Special Olympics athletes seen at the United States National Games 2010-2018

BACKGROUND

Special Olympics International (SOI) has provided eye assessments at no cost to athletes participating in competitions through the Special Olympics Lions Clubs International Foundation Opening Eyes (OE) programme. Access to vision services is crucial given the high rates of eye abnormalities found in studies collected at OE programmes in other countries. As of 2022, no studies covering vision data have been published on SOI athletes specifically from the USA. Therefore, this multiple cross-sectional study hopes to investigate the vision profile of US athletes over three national games, detecting any changes in vision and ocular health outcomes over an 8-year period.

METHODS

Vision assessments were conducted in the US national games of 2010, 2014 and 2018. Demographic and clinical data from 1427 vision assessments were used in this study. Prevalence of vision and ocular health abnormalities were compared across national games.

RESULTS

In our cohort of 1427 assessments with athletes' mean age ± SD of 29.8 ± 11.5 years, 85.3% (n = 1170) had an abnormal vision result with at least one of the following findings: decreased visual acuity of 20/40 or worse (31.0%, n = 442), refractive error including myopia (52.8%, n = 754), hypermetropia (15.7%, n = 224), and astigmatism (35.0%, n = 499), ocular misalignment distant (16.2%, n = 224) or near (17.2%, n = 239), or ocular abnormality (19.1%, n = 273).

CONCLUSIONS

This study demonstrates the burden of vision defects and ocular disease in US SOI athletes over the past decade. While continued effort must be made to train eye providers in caring for patients with ID to increase eyecare accessibility outside of SOI, vision assessments at national games can continue providing opportunities for improved ocular health in children and adults with ID.

Brainstem cavernous malformations - no longer a forbidden territory? A systemic review of recent literature

BACKGROUND

Due to its eloquent location and potentially devastating neurological consequences, the management of brainstem cavernous malformations (CCMs) attracts considerable debate. There is currently a paucity of Level 1 evidence for their management. The aim of this literature review is to explore the current evidence on the risk-benefit profile of different management options.

METHODS

A systemic literature search, following the PRISMA algorithm was performed on publications between 2010 and 2018 using the Pubmed database, with the relevant keywords. Only English articles were included. Articles focusing on spinal CCMs and studies with less than 30 participants were excluded.

RESULTS

A total of 222 search results were reviewed and after removal of duplicates and screening of abstracts, 28 clinical papers comprising 30 or more brainstem CCM cases were included in the study. The heterogeneity of the publications precluded a formal meta-analysis of results. The general consensus is that for CCMs presenting with severe symptoms and/or multiple haemorrhages that reach an accessible pial surface, surgery is considered to be the gold-standard treatment, with some authors suggesting the optimal timing to be within two to six weeks of ictus. For those patients with multiple, deep-seated CCM related haemorrhages that do not reach the pial surface, stereotactic radiosurgery (SRS) can be considered. Conservative treatment is generally considered in incidental cases. Management of brainstem cavernomas of other categories still remains controversial.

CONCLUSIONS

Due to their highly eloquent location, brainstem CCMs are challenging lesions to manage. Management must be balanced by the risk-benefit profile and tailored to the individual patients and their treating clinicians. This review provides a comprehensive reference considering all treatment options and provides a basis for evidence-based patient counselling.

Complication rates of external ventricular drain insertion by surgeons of different experience

Introduction Insertion of external ventricular drain (EVD) is a widely accepted, routinely performed procedure for treatment of hydrocephalus and raised intracranial pressure. The purpose of this study was to investigate whether a surgeon's experience affects the associated complication rate. Methods This retrospective study included all adult patients undergoing EVD insertion at a single centre between July 2013 and June 2015. Medical records were retrieved to obtain details on patient demographics, surgical indication, risk factors for infection and use of anticoagulants or antiplatelets. Surgeon experience, operative time, intraoperative antibiotic prophylaxis, need for revision surgery and EVD associated infection were examined. Information on catheter tip position and radiological evidence of intracranial haemorrhage was obtained from postoperative imaging. Results A total of 89 patients were included in the study. The overall infection, haemorrhage and revision rates were 4.8%, 7.8% and 13.0% respectively, with no significant difference among surgeons of different experience. The mean operating time for patients who developed an infection was 22 minutes while for those without an infection, it was 33 minutes (p=0.474). Anticoagulation/antiplatelet use did not appear to increase the rate of haemorrhage. The infection rate did not correlate with known risk factors (eg diabetes and steroids), operation start time (daytime vs out of hours) or duration of surgery although intraoperative (single dose) antibiotic prophylaxis seemed to reduce the infection rate. There was also a correlation between longer duration of catheterisation and increased risk of infection. Conclusions This is the first study demonstrating there is no significant difference in complication rates between surgeons of different experience. EVD insertion is a core neurosurgical skill and junior trainees should be trained to perform it.

Randomized clinical trial of hepatic resection versus radiofrequency ablation for early-stage hepatocellular carcinoma

Background

Hepatic resection and radiofrequency ablation (RFA) are treatment options for early-stage hepatocellular carcinoma (HCC). Whether tumour recurrence and long-term survival favour either treatment has not been established. This randomized trial aimed to test the hypothesis that RFA is superior to hepatic resection in terms of lower tumour recurrence rate and better long-term survival.

Methods

Patients with early-stage HCC (solitary tumour no larger than 5 cm; or no more than 3 tumours, each 3 cm or smaller) were randomized into hepatic resection and RFA groups. Demographic and clinical characteristics, and short- and long-term outcome measures were compared between groups. Primary and secondary outcome measures were overall tumour recurrence and survival respectively.

Results

Clinicopathological data were similar in the two groups, which each contained 109 patients. The RFA group had a shorter treatment duration, less blood loss and shorter hospital stay than the resection group. Mortality and morbidity rates were similar in the two groups. The overall tumour recurrence rate was similar in the resection and RFA groups (71·3 versus 81·7 per cent respectively). The 1-, 3-, 5- and 10-year overall survival rates were 94·5, 80·6, 66·5 and 47·6 per cent respectively in the resection group, compared with 95·4, 82·3, 66·4 and 41·8 per cent in the RFA group (P = 0·531). Corresponding disease-free survival rates were 74·1, 50·9, 41·5 and 31·9 per cent in the resection group, and 70·6, 46·6, 33·6 and 18·6 per cent in the RFA group (P = 0·072).

Conclusion

RFA for early-stage HCC is not superior to hepatic resection, in terms of tumour recurrence, overall survival and disease-free survival. Registration number: HKUCTR-10 (http://www.hkuctr.com).

A Risk Assessment Framework for Seed Degeneration: Informing an Integrated Seed Health Strategy for Vegetatively Propagated Crops

Pathogen buildup in vegetative planting material, termed seed degeneration, is a major problem in many low-income countries. When smallholder farmers use seed produced on-farm or acquired outside certified programs, it is often infected. We introduce a risk assessment framework for seed degeneration, evaluating the relative performance of individual and combined components of an integrated seed health strategy. The frequency distribution of management performance outcomes was evaluated for models incorporating biological and environmental heterogeneity, with the following results. (1) On-farm seed selection can perform as well as certified seed, if the rate of success in selecting healthy plants for seed production is high; (2) when choosing among within-season management strategies, external inoculum can determine the relative usefulness of 'incidence-altering management' (affecting the proportion of diseased plants/seeds) and 'rate-altering management' (affecting the rate of disease transmission in the field); (3) under severe disease scenarios, where it is difficult to implement management components at high levels of effectiveness, combining management components can be synergistic and keep seed degeneration below a threshold; (4) combining management components can also close the yield gap between average and worst-case scenarios. We also illustrate the potential for expert elicitation to provide parameter estimates when empirical data are unavailable. [Formula: see text] Copyright © 2017 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .

Epidemiology: Past, Present, and Future Impacts on Understanding Disease Dynamics and Improving Plant Disease Management-A Summary of Focus Issue Articles

Epidemiology has made significant contributions to plant pathology by elucidating the general principles underlying the development of disease epidemics. This has resulted in a greatly improved theoretical and empirical understanding of the dynamics of disease epidemics in time and space, predictions of disease outbreaks or the need for disease control in real-time basis, and tactical and strategic solutions to disease problems. Availability of high-resolution experimental data at multiple temporal and spatial scales has now provided a platform to test and validate theories on the spread of diseases at a wide range of spatial scales ranging from the local to the landscape level. Relatively new approaches in plant disease epidemiology, ranging from network to information theory, coupled with the availability of large-scale datasets and the rapid development of computer technology, are leading to revolutionary thinking about epidemics that can result in considerable improvement of strategic and tactical decision making in the control and management of plant diseases. Methods that were previously restricted to topics such as population biology or evolution are now being employed in epidemiology to enable a better understanding of the forces that drive the development of plant disease epidemics in space and time. This Focus Issue of Phytopathology features research articles that address broad themes in epidemiology including social and political consequences of disease epidemics, decision theory and support, pathogen dispersal and disease spread, disease assessment and pathogen biology and disease resistance. It is important to emphasize that these articles are just a sample of the types of research projects that are relevant to epidemiology. Below, we provide a succinct summary of the articles that are published in this Focus Issue .

A rare case of multiple subungual glomus tumours in a neurofibromatosis type 1 patient

Glomus tumours are uncommon lesions of the digit. They tend to be solitary. Only a small number of multifocal cases have been published, most of which are linked to an underlying genetic disorder. Here we report an unusual case of multifocal glomus tumours in the same hand in a patient suffering from neurofibromatosis type 1.

Sleep duration, C-reactive protein and risk of incident coronary heart disease--results from the Framingham Offspring Study

BACKGROUND

Both sleep-duration and C-reactive protein (CRP) are useful predictors of coronary heart disease (CHD). The increased CRP level is associated with the unusual sleep-duration. However, it is unclear whether CRP impacts the CHD risk prediction of sleep-duration.

METHODS AND RESULTS

A total of 3381 individuals from the Framingham Offspring Study, aged 30+, CHD-free, and without missing measurement of CRP and sleep-duration and being followed to the end of 2007 were included in this analysis. Hazards ratio (HR) from the Cox regression models was used to evaluate the strength of association between the sleep-duration, CRP levels, and risk of incident CHD. Compared to sleep-duration 7-8 h (n = 2512) after adjusting for age and gender, the HR (95% CL) of incident CHD were 1.42 (1.15, 1.76, p < 0.005) for sleep-duration ≤6 h (n = 588) and 1.23 (0.90, 1.70, p < 0.2) for sleep-duration ≥9 h (n = 281), respectively. A further adjustment for other covariates including CRP did not change the CHD risk association. When subjects were categorized into 9 groups by sleep-duration (≤6, 7-8, and ≥9 h) and CRP levels (<1, 1-3, and ≥3 mg/L), and compared to those whose sleep-duration was 7-8 h and CRP levels were <1 mg/L, the HRs of CHD were similar for sleep-duration in ≤6 h or ≥9 h categories regardless of their CRP levels. The increased CRP levels, however, did show an increased risk for CHD when sleep-duration was 7-8 h

CONCLUSION

The levels of CRP do not significantly attenuate the association between sleep duration and incident CHD.

Rust Fungi Forming Aecia on Berberis spp. in Sweden

Barberry (Berberis spp.) hosts the aecial stage of several rust species, including Puccinia graminis, which causes stem rust on grasses and cereals. The aecial stage of this pathogen has received less attention because it is not as economically important compared with the uredinial and telial stages. The main objective of this study was to identify and describe the rust species that were found on Berberis spp. collected in different parts of Sweden. A morphological study, including spore measurements and aecia descriptions, was conducted, as well as DNA sequence analyses (using the internal transcribed spacer region and the EF1-α gene). Based on spore and aecia morphology as well as the genetic analyses, three different taxa could be distinguished on barberry: P. graminis f. sp. avenae, P. graminis f. sp. tritci/secalis, and P. arrhenatheri. The genetic analysis revealed little or no differentiation between P. graminis f. sp. tritici and P. graminis f. sp. secalis and, thus, this group of samples was denominated P. graminis f. sp. tritici/secalis. Aecial morphology may be used to differentiate between different taxa. In particular, examination of aecial cross-sections may be used to distinguish between P. graminis f. sp. avenae and P. graminis f. sp. tritici/secalis. A clear differentiation in the mode of growth on barberry was also found; P. arrhenatheri always appeared systemic whereas P. graminis always appeared localized.

Can weed hosts increase aggressiveness of Phytophthora infestans on potato?

Potato late blight, caused by Phytophthora infestans, is a major disease in potato production throughout the world. In southern Sweden, hairy nightshade (Solanum physalifolium), an alternative non-crop host to the pathogen, is an increasing weed problem. Single-lesion leaves infected by P. infestans were collected from potato and hairy nightshade to determine phenotypic and genotypic population differentiation of P. infestans between the two hosts. Genotypic variation was estimated using microsatellites as markers. The results showed no genotypic differentiation in the samples between the two hosts. Aggressiveness tests were performed using the sampled isolates to cross-inoculate potato and hairy nightshade. The proportion of infected leaves, latency period, lesion growth rate, and sporulation capacity were measured. For isolates from hairy nightshade, the odds of infection were higher on both hosts combined. When tested on potato leaves, isolates from hairy nightshade showed a significantly shorter latency period and higher sporulation capacity compared with isolates from potato. This indicates that an alternative host can filter populations of P. infestans toward a higher aggressiveness, which could lead to increasing problems in controlling potato late blight.

Molecular Mapping of a Leaf Rust Resistance Gene on the Short Arm of Chromosome 6B of Durum Wheat

Leaf rust, caused by Puccinia triticina, is an important disease of durum wheat (Triticum turgidum subsp. durum) worldwide, and the most effective way to control it is through the use of resistant cultivars. A partially dominant leaf rust resistance gene present in the International Maize and Wheat Improvement Center-derived Chilean cv. Guayacan INIA and its sister line Guayacan 2 was mapped to chromosome arm 6BS by identifying linked amplified fragment length polymorphisms (AFLPs) and mapping two of the molecular markers in common wheat (T. aestivum) linkage maps of the International Triticeae Mapping Initiative and Oligoculm × Fukuho-komugi populations. Comparison of infection type responses of the two resistant durums with common wheat testers carrying the previously mapped resistance genes Lr36 and Lr53 on 6BS, and their chromosomal positions, indicated that the resistance gene in durum wheat Guayacan INIA is a new leaf rust resistance gene, which was designated as Lr61. Gene Lr61 is effective against the P. triticina race BBG/BN predominant in northwestern Mexico and other races infecting durum wheat in various countries.

Identification and Molecular Characterization of Leaf Rust Resistance Gene Lr14a in Durum Wheat

Leaf rust, caused by Puccinia triticina, is an important disease of durum wheat (Triticum turgidum subsp. durum) and only a few designated resistance genes are known to occur in this crop. A dominant leaf rust resistance gene in the Chilean durum cv. Llareta INIA was mapped to chromosome arm 7BL through bulked segregant analysis using the amplified fragment length polymorphism (AFLP) technique, and by mapping three polymorphic markers in the common wheat (T. aestivum) International Triticeae Mapping Initiative population. Several simple sequence repeat (SSR) markers, including Xgwm344-7B and Xgwm146-7B, were associated with the leaf rust resistance gene. Resistance response and chromosomal position indicated that this gene is likely to be Lr14a. The SSR markers Xgwm344-7B and Xgwm146-7B and one AFLP marker also differentiated common wheat cv. Thatcher from the near-isogenic line with Lr14a, as well as durum 'Altar C84' from durum wheat with Lr14a. This is the first report of the presence of Lr14a in durum wheat, although the gene originally was transferred from emmer wheat 'Yaroslav' to common wheat. Lr14a is also present in CIMMYT-derived durum 'Somateria' and effective against Mexican and other P. triticina races of durum origin. Lr14a should be deployed in combination with other effective leaf rust resistance genes to prolong its effectiveness in durum wheat.

Financial benefit of using crop protection decision rules over systematic spraying strategies

ABSTRACT Decision rule models are considered to be one of the main cornerstones of the implementation of integrated pest management (IPM) programs. Even if the need for such programs to offer cost advantages over conventional strategies is a major incentive for IPM adoption, few studies focus on this financial dimension. In this article, a modeling approach of the response of a pathosystem to a disease control method and of the predictive performance of decision rules is used to explore how some basic factors act on the likelihood of adoption of decision rule models strategies (such as using an IPM system) over systematic strategies (such as systematic-spraying and never-spraying strategies). Even if the average cost of using the decision rule strategies is always lower than the average cost of systematic strategies in several different scenarios, the models developed here showed strong effects of different pathosystems and decision rules on financial benefits. The number of production situations where decision rules are of interest is highly correlated with their accuracy. However, because of the inescapable trade-offs between decision rule accuracy and limiting factors such as its user-friendly characteristics, the use of decision rules is unlikely to reduce costs to <70% of the costs of systemic strategies. In more general terms, this study provides quantitative guidelines on the financial advantage that decision rules can offer in plant protection as well as a better understanding of their potential usefulness.

Preparing Public Health Nurses for Pandemic Influenza Through Distance Learning

As a global influenza pandemic appears imminent with the spread of avian influenza, the California Department of Health Services (CDHS) and the California Distance Learning Health Network (CDLHN) presented a live 90-min satellite broadcast and subsequent 2-hr small group problem-solving tabletop exercise to practice interventions needed to minimize the consequences of a pandemic event. Public health nurses (PHNs), managers, and other staff in laboratories, clinical care, veterinary medicine, environmental health, public information and safety, emergency management, and transportation down linked the program, broadcast by satellite from the CDHS Richmond Laboratory Campus, to view on-site locally. PHNs represented the professional category with the highest number of participants for those conducting the program outside of California. For those in California, PHNs represented the professional category with the second highest number of participants. Participants and distance-learning facilitators completed a training evaluation survey. Continuing education credits were provided by the Centers for Disease Control and Prevention to participants who completed the satellite broadcast evaluation. This distance-learning-by-satellite method of education paired with an activities-based tabletop exercise, and a focus on local rather than State-based responsibility, marks an innovative method of training PHNs and other staff in emergency preparedness response.

Risk perceptions and behavioral intentions for Hepatitis B: how do young adults fare?

Young adults are at risk for Hepatitis B infection. Little is known about their attitudes and beliefs concerning Hepatitis B, which are determinants of getting immunized. This investigation examined risk perceptions and behavioral intentions concerning Hepatitis B among a convenience sample of 1070 young adults, 18-24 years old who participated in a Hepatitis B campaign that aired a prevention-based advertisement in movies. The campaign did not produce any significant effects. Therefore, analyses presented in this paper explored whether risk perceptions and intentions vary by sociodemographic characteristics. Most young adults do not perceive themselves to be at risk for Hepatitis B, but perceive other people to be at risk. Gender and ethnic differences in behavioral intentions to seek out Hepatitis B information were also observed. This study offers insight about important factors to consider when designing Hepatitis B prevention interventions for young adults and suggests that increasing health-promotion efforts for this group, while accounting for differences in age, culture and gender, are warranted.

Effect of Leaf Rust on Grain Yield and Yield Traits of Durum Wheats with Race-Specific and Slow-Rusting Resistance to Leaf Rust

Leaf rust, caused by Puccinia triticina, is an important disease of durum wheat (Triticum turgidum) in many countries. We compared the effectiveness of different types of resistance in International Maize and Wheat Improvement Center-derived durum wheat germ plasm for protecting grain yield and yield traits. In all, 10 durum wheat lines with race-specific resistance, 18 with slow-rusting resistance, and 2 susceptible were included in two yield loss trials sown on different planting dates in Mexico with and without fungicide protection under high disease pressure. Eight genotypes with race-specific resistance were immune to leaf rust. Durum wheat lines with slow-rusting resistance displayed a range of severity responses indicating phenotypic diversity. Mean yield losses for susceptible, race-specific, and slow-rusting genotypes were 51, 5, and 26%, respectively, in the normal sowing date trial and 71, 11, and 44% when sown late. Yield losses were associated mainly with a reduction in biomass, harvest index, and kernels per square meter. Slow-rusting durum wheat lines with low disease levels and low yield losses, as well as genotypes with low yield losses despite moderate disease levels, were identified. Such genotypes can be used for breeding durum wheat genotypes with higher levels of resistance and negligible yield losses by using strategies that previously have been shown to be successful in bread wheat.

Efficacy and safety of radiofrequency ablation for perivascular hepatocellular carcinoma without hepatic inflow occlusion

BACKGROUND

The role of radiofrequency ablation (RFA) for perivascular (up to 5 mm from the major intrahepatic portal vein or hepatic vein branches) hepatocellular carcinoma (HCC) is unclear because of possible incomplete tumour ablation and potential vascular damage. This study aimed to evaluate the safety and efficacy of RFA for perivascular HCC without hepatic inflow occlusion.

METHODS

Between May 2001 and November 2003, RFA using an internally cooled electrode was performed on 52 patients with perivascular HCC (group 1) through open (n = 39), percutaneous (n = 9), laparoscopic (n = 2) and thoracoscopic (n = 2) approaches. Hepatic inflow occlusion was not applied during the ablation procedure. The perioperative and postoperative outcomes were compared with those of 90 patients with non-perivascular HCC (group 2) treated by RFA during the same period.

RESULTS

The morbidity rate was similar between groups 1 and 2 (25 versus 28 per cent; P = 0.844). One patient in group 1 (2 per cent) and two in group 2 (2 per cent) had developed thrombosis of major intrahepatic blood vessels on follow-up computed tomography scan. There were no significant differences between groups 1 and 2 in mortality rate (2 versus 0 per cent; P = 0.366), complete ablation rate for small HCC (92 versus 98 per cent; P = 0.197), local recurrence rate (11 versus 9 per cent; P = 0.762) and overall survival (1-year: 86 versus 87 per cent; 2-year: 75 versus 75 per cent; P = 0.741).

CONCLUSION

RFA without hepatic inflow occlusion is a safe and effective treatment for perivascular HCC.

A meta-analysis of two randomised trials of early chemotherapy in asymptomatic metastatic colorectal cancer

This report constitutes a prospectively planned meta-analysis combining two almost identical trials undertaken in Australasia and Canada to study the effect of starting chemotherapy immediately in asymptomatic patients with metastatic colorectal cancer. Patients (n=168) were randomised to receive either immediate or delayed treatment (at onset of predefined symptoms). Australasian patients received either weekly 5-fluorouracil and leucovorin (500 and 20 mg m(-2), respectively) (n=59) or the daily x 5 Mayo Clinic schedule (425 and 20 mg m(-2), respectively) (n=42). Canadian patients were treated with the Mayo schedule (n=67). Otherwise, the two studies were almost identical in design and each used the European Organisation for the Research and Treatment of Cancer (EORTC) QLQ-C30 instrument for measuring quality of life (QoL). Treatment was continued until 6 months had elapsed or disease progression occurred. Low accrual led to trial suspension before the predetermined sample size for either study was reached. Median survival was not significantly better with immediate treatment (median 13.0 vs 11.0 months; hazard ratio, 1.15; 95% confidence interval (CI) 0.79-1.72; P=0.49). There was no statistically significant difference in progression-free survival (time from randomisation until first evidence of progression after chemotherapy, 10.2 vs 10.8 months; hazard ratio, 1.08; 95% CI 0.71-1.64; P=0.73). There was no difference in overall QoL or its individual domains between the two treatment strategies at baseline or at any subsequent time point. Early treatment of asymptomatic patients with metastatic colorectal cancer did not provide a survival benefit or improved QoL compared to withholding treatment until symptoms occurred.

Breast and other cancers in 1445 blood relatives of 75 Nordic patients with ataxia telangiectasia

Epidemiological studies have consistently shown elevated rates of breast cancer among female blood relatives of patients with ataxia telangiectasia (AT), a rare autosomal recessive disease. A large proportion of the members of AT families are carriers of AT-causing gene mutations in ATM (Ataxia Telangiectasia Mutated), and it has been hypothesised that these otherwise healthy carriers are predisposed to breast cancer. This is an extended and enlarged follow-up study of cancer incidence in blood relatives of 75 patients with verified AT in 66 Nordic families. Blood relatives were identified through population registry linkages, and the occurrence of cancer was determined from cancer registry files in each country and compared with national incidence rates. The ATM mutation carrier probabilities of relatives were assigned from the combined information on location in family, consanguinity, if any, and supplementary carrier screening in some families. Among the 1445 blood relatives of AT patients, 225 cancers were observed, with 170.4 expected, yielding a standardised incidence ratio (SIR) of 1.3 (95% confidence interval (CI), 1.1-1.4). Invasive breast cancer occurred in 34 female relatives (SIR, 1.7; 95% CI, 1.2-2.4) and was diagnosed in 21 women before the age of 55 years (SIR, 2.9; 95% CI, 1.8-4.5), including seven mothers of probands (SIR, 8.1; 95% CI, 3.3-17). When the group of mothers was excluded, no clear relationship was observed between the allocated mutation carrier probability of each family member and the extent of breast cancer risk. We concluded that the increased risk for female breast cancer seen in 66 Nordic AT families appeared to be restricted to women under the age of 55 years and was due mainly to a very high risk in the group of mothers. The findings of breast cancer risk in mothers, but not other likely mutation carriers, in this and other studies raises questions about the hypothesis of a simple causal relationship with ATM heterozygosity.

New Genes for Leaf Rust Resistance in CIMMYT Durum Wheats

Leaf rust, caused by Puccinia triticina, has become an important disease of durum wheat (Triticum turgidum) in Mexico since the detection in 2001 of BBG/BN, a new race virulent on all common cultivars and on more than 80% of CIMMYT's durum wheat collection. We investigated the genetic basis and diversity of resistance in nine durum genotypes that are highly resistant to the new race. These resistant durums were crossed with the susceptible cv. Atil C2000 and intercrossed in a half diallel arrangement. Five diverse sources of resistance were identified by evaluating parents, F₁, F₂, and F₃ populations in greenhouse and/or field trials under artificial epidemics of race BBG/BN. The same pair of partially dominant complementary genes determined resistance in Jupare C2001, Hualita, and Pohowera. Somateria and Llareta INIA shared the same dominant resistance gene, whereas a partially dominant gene conferred resistance in two sister lines, Guayacan 2 and Guayacan INIA. A different partially dominant gene present in Storlom was linked in repulsion to another partially dominant gene in Camayo. These diverse resistance genes can be used effectively to control leaf rust, preferably by deploying them in combinations.

Impact of radiofrequency ablation on the management of patients with hepatocellular carcinoma in a specialized centre

Background

Radiofrequency ablation (RFA) has been used increasingly in the treatment of hepatocellular carcinoma (HCC). The aim of this study was to investigate changes in the treatment pattern of primary HCC following the implementation of RFA in a specialized surgical centre.

Methods

This was a retrospective analysis of all 894 patients admitted for treatment of primary HCC over 36 months.

Results

There was no difference in the age, sex ratio, liver function according to Child–Pugh grade, serum α-fetoprotein concentration, hepatitis B surface antigen status and tumour size among patients before and after the introduction of RFA therapy. Fifty-one patients (10·6 per cent) with primary HCC received RFA treatment after its implementation. There was a 6·8 per cent reduction in the number of patients who had supportive treatment (P = 0·041) and a 3·2 per cent reduction in surgical treatment. The hospital mortality rates for RFA and surgery were 2·0 and 4·9 per cent respectively. The overall survival rates at 6, 12 and 18 months for patients treated with RFA were 92·2, 73·4 and 61·2 per cent respectively. The corresponding survival rates for the 213 patients who had surgery were 88·0, 77·0 and 71·5 per cent. These values were no different from those in patients who had RFA (P = 0·718). Patients treated with RFA or surgery survived longer than those who had other treatments.

Conclusion

RFA had a significant impact on the management of primary HCC, increasing the number of patients suitable for liver-directed therapy and leading to survival benefit. RFA may become the treatment of choice for patients with irresectable HCC.

Cancer risk among patients with IgA deficiency or common variable immunodeficiency and their relatives: a combined Danish and Swedish study

The extremely high risk reported for some types of cancer among patients with common variable immunodeficiency (CVID) is based on a limited number of investigations. Therefore, we examined the risks for cancer among 562 Danish and Swedish patients with CVID or IgA deficiency and 2071 relatives in 1958-96. The patients were identified through an Immunodeficiency Register and hospital records, while the relatives were traced through population registers. Cancer incidence was assessed by linkage to the Cancer Registries and compared with that in the general population. Among 386 patients with IgA deficiency, the incidence of cancer was not increased (standardized incidence ratio (SI) = 1.0); but two cases of stomach cancer were found, resulting in a non-significant increase in risk (SIR = 5.4; 95% CI = 0.7-19.5). Among 176 patients with common variable immunodeficiency (CVID), the incidence of cancer at all sites combined was increased (SIR = 1.8; 95% CI = 1.0-2.9), which was due mainly to significant excesses of malignant lymphoma (obs = 4; SIR = 12.1; 95% CI = 3.3-31.0) and of stomach cancer (obs = 3; SIR = 10.3; 95% CI = 2.1-30.2). Among the 626 relatives of patients with CVID, no increase in risk was found for these types of cancer or for cancer overall (obs = 53; SIR = 1.0; 95% CI = 0.8-1.3). Our data show that the risks for malignant lymphoma and stomach cancer among patients with CVID may be lower than reported previously. The absence of an increased risk among relatives suggests that the increased cancer morbidity in patients with CVID is related to the immunodeficiency per se rather than to specific genetic traits shared with their relatives.

Improved detection rate of prostate cancer using the 10-core biopsy strategy in Singapore

OBJECTIVES

To evaluate if changing the biopsy regime to 10 cores might improve the positive predictive value (PPV) of elevated prostate-specific antigen [PSA, elevated range, 4 to 20 ng per ml, normal range, < 4 ng per ml] for the diagnosis of prostate carcinoma.

METHODS

From February 2000 to April 2001, 191 patients, mean age 64 years [range, 38 to 85 yr], underwent transrectal ultrasound [TRUS] for either elevated PSA [elevated range, 4 to 20 ng per ml] and/or abnormal digital rectal examination [DRE]. A 10-core TRUS-guided biopsy of the prostate was performed. This included the standard sextant biopsy and two additional cores for each far lateral zone.

RESULTS

Using this technique, 47 out of 191 patients [24.6%] had prostate cancer. The PPV for PSA levels of 4.1 to 10.0 ng per ml and 10.1 to 20.0 ng per ml were 19.3% and 35.4%, respectively. The lateral cores contributed 21.3% of the cancer cases, which would have been missed if only sextant biopsies were performed.

CONCLUSIONS

With the 10-core biopsy method, the PPV for prostate cancer for patients with a PSA in the range of 4 to 20 ng per ml was in the range of 25%. This is significantly different from previous reports. The reason for this may be due to the adoption of a better, more uniform and systematic biopsy strategy for patients with elevated PSA, or it may be a true reflection of the current population incidence. Hence, this biopsy strategy is highly recommended.

Single nucleotide polymorphisms of the fukutin gene

Mutations in the LMNA gene, which encodes nuclear lamins A and C, underlie both Emery-Dreifuss muscular dystrophy (EMD2) and Dunnigan-type familial partial lipodystrophy (FPLD). This indicates that one gene can cause different phenotypes characterized by tissue degeneration. The gene for one form of Berardinelli-Seip-type congenital total lipodystrophy (BSCL) has been mapped to chromosome 9q34. Based on the observation that one gene caused both FPLD and EMD2, we considered that a known gene for muscular dystrophy at or near the BSCL locus on chromosome 9q would be an appropriate candidate for BSCL. The gene encoding fukutin, which is mutated in Fukuyama congenital muscular dystrophy has been mapped to 9q31. We thus developed amplification primers for the coding regions of the fukutin gene. We found no putative disease mutations, but through screening of diseased and normal subjects, we identified three novel single nucleotide polymorphisms (SNPs). We conclude that mutations in fukutin are not present in subjects with BSCL. However, the identification of SNPs provides tools to investigate this protein for association with other phenotypes.

Cancer incidence and work place exposure among Swedish biomedical research personnel

OBJECTIVE

This cohort study aimed to elucidate cancer occurrence in relation to occupational exposure to specific chemical, biological and physical agents among biomedical research laboratory personnel in Sweden.

METHODS

Standardized incidence ratios (SIRs) for the period 1970-1994 were calculated for specific exposures in the laboratory group (n = 3,277) and for personnel working in non-laboratory departments (n = 2,011), as an internal reference group. Expected numbers were based on national cancer rates.

RESULTS

The total number of cancer cases was lower than expected in both laboratory and non-laboratory personnel. Elevated SIRs were noted for malignant melanoma among female laboratory employees for whom use was reported of solvents (SIR 2.73; CI 1.10-5.63) and of selected carcinogenic (International Agency for Research on Cancer (IARC) group 2B) agents (SIR 3.15; CI 1.16-6.85). A light increase of the risk estimate for breast cancer was also observed.

CONCLUSIONS

In general, there were few cases of cancer in this comparatively young cohort, but the findings give some indication of increased risks for malignant melanoma in female laboratory personnel after exposure to organic solvents or substances classified by IARC as being possibly carcinogenic.

A pilot study of pentoxifylline in the treatment of radiation-induced trismus

Radiation-induced trismus has a significant impact on the quality of life of patients receiving radiotherapy for head and neck cancers. Pentoxifylline has immunomodulatory activities that downregulate certain cytokines that have been implicated as mediators of fibrogenic reactions after radiation. A pilot study was therefore conducted to evaluate the efficacy of pentoxifylline in the treatment of radiation-induced trismus. Twenty patients with severe trismus (dental gap < or = 25 mm) after receiving radiotherapy for nasopharyngeal carcinoma were enrolled onto the study. Four patients were excluded from analysis because of poor drug compliance. The remaining 16 evaluable patients completed an 8-week course of pentoxifylline at a dose of 400 mg two to three times daily. Changes in dental gap were recorded by measuring the distance between left upper and lower incisor before and after treatment. At the end of treatment, 10 patients had a measured increase in dental gap ranging from 2 to 25 mm. Six patients had an increment of 5 mm or more. The mean dental gap before treatment was 12.5 mm compared with 16.5 mm at the end of treatment (p = 0.023). The mean difference in dental gap was 4 mm, with a 95% confidence interval of 0.6 to 7.4 mm. The drug pentoxifylline appears to exert a modest therapeutic effect in patients with radiation-induced trismus, although our findings need to be confirmed by a randomized placebo-controlled study. While awaiting more evidence from clinical studies, a therapeutic trial of pentoxifylline is worth considering in patients experiencing radiation-induced trismus.