What is the evidence that advertising policies could have an impact on gambling-related harms? A systematic umbrella review of the literature

OBJECTIVE

To summarise the evidence on the impacts of gambling-related advertising that could lead to gambling-related harm, including impacts on vulnerable individuals and inequalities in the distribution of harms.

STUDY DESIGN

An umbrella review of studies investigating the impact of gambling advertising.

METHODS

A review was undertaken of systematic reviews of qualitative, quantitative and mixed method studies reporting outcomes associated with gambling advertising and marketing. The search strategy included database searches (Web of Science, PsycInfo) and website searches. The quality of the included reviews was determined using A MeaSurement Tool to Assess systematic Reviews 2.

RESULTS

1024 papers were identified by database searches. Eight systematic reviews, including 74 unique studies, met inclusion criteria. Included studies, using quantitative and qualitative methods, consistently support the existence of a causal relationship between exposure to advertising of gambling products/brands and more positive attitudes to gambling, greater intentions to gamble and increased gambling activity at both individual and population level. There is evidence of a 'dose-response' effect; greater advertising exposure increases participation which leads to a greater risk of harm. There was more evidence for the impact on children and young people and for those already at risk from current gambling activity with those most vulnerable more likely to be influenced.

CONCLUSION

Gambling advertising restrictions could reduce overall harm and mitigate the impact of advertising on gambling-related inequalities. Public health harm prevention strategies should include policies which limit exposure to advertising, particularly among children and vulnerable groups.

AB1260 SIGNIFICANCE OF WHOLE-BODY MRI IN CHILDREN WITH RHEUMATIC DISEASES

Background

Whole-body MRI (WB-MRI) has the potential to detect early or hidden signs of inflammation and seems to be more informative test than X-ray and ultrasound methods for bone and joints diseases. WB-MRI is important for identification of asymptomatic inflammation areas that are not available for clinical examination methods (sacroiliitis, TMJ). WB-MRI can become a tool for monitoring the progression of the disease and the efficacy of therapy. There is not enough data of knowledge about the role of WB-MRI in children with JIA.

Objectives

To evaluate the results of WB-MRI in children with rheumatic diseases (RD) in a single-center retrospective study.

Methods

57 WB-MRI studies performed in children with RD in our center as a part of real-life diagnostic procedures.

Results

Among 57 children there are 22 boys and 35 girls, the average age is 13 years [11; 16]. 33 patients were examined once, 20 children twice after the initial course of therapy, two children underwent WB-MRI three times to evaluate the dynamics. It was most important to detect inflammatory lesions in multifocal non-bacterial osteomyelitis (mf-NBO). The structure of diagnosis and therapy before and after WB-MRI is present in Table 1.

Table 1.

The effect of MRI on changes in the structure of diagnoses and approaches to therapy

Before WB-MRIAfter WB-MRIDiagnosis:Juvenile idiopathic arthritis (JIA)2212JIA+ mf-NBO2230JIA+ mf-NBO +Psoriasis58JIA+ mf-NBO +FMF11JIA+ Psoriasis20JIA+IBD11 (JIA+IBD+ mf-NBO)Fibrodisplasia ossificans progressive (FOP) +JIA11Systemic JIA11Juvenile dermatomyositis (JDM)11Systemic lupus erythematosus (SLE)11SLE+ mf-NBO01Therapy:NSAIDs mono1712DMARDs2629Biologics: / bDMARDs: anti-TNFα Tofacitinib Abatacept121011272151Bisphosphonates45No current therapy30

11 patients have multimorbidity (in addition to RD, one girl has Down syndrome). 5 pts had severe hypermobility syndrome patients making it difficult to identify inflammation due to the discrepancy between objective signs and the absence of limitation of joint mobility. 2 patients had multiple ankylosis. 7 patients underwent surgical interventions: 5 because of vertebral fracture, 2 because of osteomyelitis.

The WB-MRI revealed: 48 polyarthritis signs, 33 osteitis, 3 osteonecrosis, 11 sacroiliitis, 1 sequestration, 1 epiphyseolysis, 1 initial signs of myositis. Surgical intervention was recommended to two patients after the diagnosis of WB-MRI (sequestration of the osteomyelitis focus and vertebral fracture).

Figure 1.

WB-MRI 10-yrs old girl with JIA+ mf-NBO +Psoriasis. Than WB-MRI picture 4 months after the Etanercept administration. Positive dynamics in the sacroiliac joints, but the persistence of osteitis in the right radius, calcaneus, femur with the forming lytic destruction.

The principal significance and purpose of the performance of WB-MRI were disease control (continuation of therapy) - 22 (39%), the onset of DMARDs/bDMARDs – 17 (30%), the change of bDMARDs - 2 (3%), differential diagnosis – 16 (28%).

Conclusion

WB-MRI is useful for detecting asymptomatic and radiologically hidden lesions in JIA. Early diagnosis leading to appropriate treatment can prevent long-term structural damage to the joint. WB-MRI is a important tool for the diagnosis and diseases control in children with RD.

Disclosure of Interests

None declared

AB1042 ASSESSMENT OF BONE MINERAL DENSITY AND FREQUENCY FRACTURES PERIPHERAL SKELETON BONES IN PATIENTS WITH ALKAPTONURIA

Background:

Objectives:

To assess the bone mineral density (BMD) of the skeleton using the Hologic Discovery A DXA, determine the frequency of low-energy skeletal bone fractures among adult patients with alkaptonuria (AKU), and identibjectivefy factors that affect the occurrence of fractures.

Methods:

AKU is a rare genetic disease (1 case per 250,000) which occur to severe damage to the spine and large joints. Serious problem in this category of patients is a decrease in BMD. The study included 40 patients with a reliable diagnosis of AKU (23 men and 17 women) aged from 33 to 78 years (mean 60.32±9.1). Densitometry of the lumbar spine was performed in 40 patients; of the forearm bones in 34 patients; of the proximal femur in 32 patients (8 patients were not examined due to bilateral hip joint replacement).

Results:

Normal values of spinal BMD were found in 26 patients (65%), osteopenia – in 12 (30%) and osteoporosis – in 2 (5%) patients. In the proximal parts of the femur, osteoporosis was detected in 12 patients (30%), osteopenia in 13 (32.5%), and normal in 7 (17.5%) patients. In the bones of the forearm, osteoporosis was found in 22 patients (55%), osteopenia – in 8 (20%), and norm – in 4 (10%) patients. The BMD values (g / cm2) in the group were as follows:

Table 2.

Disease and treatment characteristics of 2 discrete phenotypes (Systemic and Chronic articular)

Systemic formChronic articular formTotalPatients (n)10616Duration of follow-up (years), median (range)13 (3-24)14 (1-14)14 (1-24)Duration of disease prior to bDMARDs (months)7.5 (2-120)21 (3-36)10.5 (2-120)Number of cDMARDs prior to bDMARDs2 (1-2)1 (1-4)2 (1-4)Patients on concomittant cDMARDs, n (n/N%)10 (100%)6 (100%)16 (100%)Type of 1stbDMARD (n)3 TCZ, 2 anti-TNFa, 4 Anakinra, 1 Canakinumab4 anti-TNFa, 2 TCZPatients on bDMARD at the end of follow-up (n/N%)6 (60%)6 (100%)12 (75%)Time to steroids discontinuation after bDMARD initiation (months)7.5 (2-22)4.5 (3-36)6.5 (2-36)NMeanPercentiles25th75thBMD L1-L4401,060,881,25BMD Prox.Femur320,560,610,81BMD Forearm340,480,430,54

Peripheral bone fractures were diagnosed in 15 (32.6%) patients – 9 men and 6 women; 25 (62.5%) patients had no fractures. For the first time, fractures were reported in patients aged from 33 to 69 years (mean 55.9±9.5). The localization of fractures was as follows: femur – in 8 patients (20%), forearm – in 6 (15%), shin bones – in 1 (2.5%) patients. Despite lower BMD rates in women, there were no significant differences in the frequency of fractures depending on sex. Correlation analysis (for Spearman) showed the relationship of fractures with age (r= -0.31, p<0.05), femur BMD in general (r= -0.53, p<0.01) and forearm BMD (r= -0.44, p<0.01).

Conclusion:

There is a high incidence of osteoporosis, mainly in the proximal femur and forearm in patients of the older age group with AKU. In the lumbar spine (due to the development of calcification of the intervertebral discs and ligamentous apparatus), osteoporosis is rarely detected, but the frequency of osteopenia is quite high. 32.6% patients had a history of skeletal bone fractures, and the sex of the patients did not affect the risk of fractures. The occurrence of fractures in patients with AKU is associated with low BMD values of the proximal femur.

Disclosure of Interests:

None declared

Variables Associated with Severity of Bacterial Canker and Wilt Caused by Clavibacter michiganensis subsp. michiganensis in Tomato Greenhouses

Clavibacter michiganensis subsp. michiganensis, the causal agent of bacterial canker and wilt of tomato, is considered to be one of the most important bacterial pathogens worldwide. In the year 2000 there was an increase in the number of infected greenhouses and in the severity of the disease in Israel. As part of the effort to cope with the disease, a comprehensive survey was conducted. Scouts recorded disease severity monthly in 681 production units. At the end of the season the scouts met with the growers and together recorded relevant details about the crop and cultural practices employed. The results suggested an absence of anisotropy pattern in the study region. Global Moran's I analysis showed that disease severity had significant spatial autocorrelation. The strongest spatial autocorrelation occurred within a 1,500 m neighborhood, which is comparable to the distance between production units maintained by one grower (Farm). Next, we tested three groups of variables including or excluding the Farm as a variable. When the Farm was included the explained variation increased in all the studied models. Overall, results of this study demonstrate that the most influential factor on bacterial canker severity was the Farm. This variable probably encompasses variation in experience, differences in agricultural practices between growers, and the quality of implementation of management practices.

Promoting and maintaining physical activity in the transition to retirement: a systematic review of interventions for adults around retirement age

It has been argued that transition points in life, such as the approach towards, and early years of retirement present key opportunities for interventions to improve the health of the population. Research has also highlighted inequalities in health status in the retired population and in response to interventions which should be addressed. We aimed to conduct a systematic review to synthesise international evidence on the types and effectiveness of interventions to increase physical activity among people around the time of retirement. A systematic review of literature was carried out between February 2014 and April 2015. Searches were not limited by language or location, but were restricted by date to studies published from 1990 onwards. Methods for identification of relevant studies included electronic database searching, reference list checking, and citation searching. Systematic search of the literature identified 104 papers which described study populations as being older adults. However, we found only one paper which specifically referred to their participants as being around the time of retirement. The intervention approaches for older adults encompassed: training of health care professionals; counselling and advice giving; group sessions; individual training sessions; in-home exercise programmes; in-home computer-delivered programmes; in-home telephone support; in-home diet and exercise programmes; and community-wide initiatives. The majority of papers reported some intervention effect, with evidence of positive outcomes for all types of programmes. A wide range of different measures were used to evaluate effectiveness, many were self-reported and few studies included evaluation of sedentary time. While the retirement transition is considered a significant point of life change, little research has been conducted to assess whether physical activity interventions at this time may be effective in promoting or maintaining activity, or reducing health inequalities. We were unable to find any evidence that the transition to retirement period was, or was not a significant point for intervention. Studies in older adults more generally indicated that a range of interventions might be effective for people around retirement age.

Microbiological quality of raw milk produced in Estonia

AIMS

The microbial quality of farm bulk-tank raw milk produced in Estonia during years 2004-2007 was investigated.

METHODS AND RESULTS

Bulk-tank milk samples were analysed for lactic acid bacteria count (LABC), psychrotrophic bacteria count (PBC), aerobic spore-forming bacteria count (ASFBC), total bacterial counts using BactoScan and somatic cell count (SCC) using Fossomatic. Randomly selected psychrotrophic isolates were subjected to 16S-23S PCR-ribotyping. LABC remained below 10(4) CFU ml(-1) in most samples, while psychrotrophic micro-organisms dominated in 60% of farms. PBC ranged from 4.2 × 10(2) to 6.4 × 10(4) CFU ml(-1), and ASFBC varied from 5 to 836 CFU ml(-1).

CONCLUSIONS

In general, the microbiological quality of the farm bulk-tank milk was good - more than 91% of samples contained <50,000 CFU ml(-1), and SCC in the majority of samples did not exceed the internationally recommended limits. Genus Pseudomonas spp. was the dominating spoilage flora with Pseudomonas fluorescens as the prevailing species.

SIGNIFICANCE AND IMPACT OF THE STUDY

Specific bacterial groups (LABC, PBC and ASFBC), not analysed routinely by dairies, were determined in bulk-tank raw milk of numerous dairy farms during 4-year period. Based on the survey, dairy plants can better control their supply chains and select farms (milk) for the production of specific products, i.e. milk with low PBC and high LABC for cheesemaking.

How do parents' child-feeding behaviours influence child weight? Implications for childhood obesity policy

BACKGROUND

Parents have some responsibility for children's dietary habits and they are often the focus of public health interventions designed to improve children's diets and thereby reduce the prevalence of childhood obesity. The current UK interventions promote awareness of healthy food choices, but offer little guidance for parents on child-feeding behaviours.

METHODS

A review of recent literature regarding child-feeding behaviours and child weight.

RESULTS

Parents report using a wide range of child-feeding behaviours, including monitoring, pressure to eat and restriction. Restriction of children's eating has most frequently and consistently been associated with child weight gain. Furthermore, there is substantial evidence for a causal relationship between parental restriction and childhood overweight.

CONCLUSIONS

Parents may inadvertently promote excess weight gain in childhood by using inappropriate child-feeding behaviours. We recommend the development of interventions to increase awareness of the possible consequences of inappropriate child-feeding behaviours. Parents who are concerned about their child's weight will also require guidance and support in order to adopt more appropriate child-feeding behaviours.

Physical activity and health: evidence from a study of deprived communities in England

This study aims to explore the relationship between physical activity levels and the self-reported health status of residents living in deprived communities in England. A cross-sectional interview survey was conducted in communities in receipt of funding from the New Deal for Communities (NDC) regeneration programme. A sample of 848 addresses was selected by random sampling from within each of the 39 NDC areas, and one adult from each household was selected for interview. A total of 19 574 residents were interviewed between July and October 2002. The main outcome measures were physical activity level and health status assessed using four self-reported health measures: health in the last 12 months, health change in the last 12 months, long-standing illness or disability and a mental health-related quality-of-life score. There are large regional and demographic variations in respect of NDC residents' physical activity levels. The areas with the lowest levels of physical activity are mainly located in northern industrial towns. Residents who did little or no physical activity were more than twice as likely to feel that their health was not good (adjusted OR 2.54, 95% CI 2.35-2.75).

Reducing inequalities in access to health care: developing a toolkit through action research

PROBLEM

Healthcare organisations are expected both to monitor inequalities in access to health services and also to act to improve access and increase equity in service provision.

DESIGN

Locally developed action research projects with an explicit objective of reducing inequalities in access.

SETTING

Eight different health care services in the Yorkshire and Humber region, including community based palliative care, general practice asthma care, hospital based cardiology clinics, and termination of pregnancy services.

KEY MEASURES FOR IMPROVEMENT

Changes in service provision, increasing attendance rates in targeted groups.

STRATEGIES FOR CHANGE

Local teams identified the population concerned and appropriate interventions using both published and grey literature. Where change to service provision was achieved, local data were collected to monitor the impact of service change.

EFFECTS OF CHANGE

A number of evidence based changes to service provision were proposed and implemented with variable success. Service uptake increased in some of the targeted populations.

LESSONS LEARNT

Interventions to improve access must be sensitive to local settings and need both practical and managerial support to succeed. It is particularly difficult to improve access effectively if services are already struggling to meet current demand. Key elements for successful interventions included effective local leadership, identification of an intervention which is both evidence based and locally practicable, and identification of additional resources to support increased activity. A "toolkit" has been developed to support the identification and implementation of appropriate changes.

Regional differences in the provision of adult renal dialysis services in the UK

BACKGROUND

Provision of renal dialysis varies between UK regions.

AIM

To analyse these differences in provision and investigate their causes.

DESIGN

Questionnaire-based survey.

METHODS

A questionnaire was posted to all renal provider units and renal commissioning groups in the UK. Questions covered issues such as dialysis modalities and patient choice. Data were collected by telephone interview (or post in some cases) and analysed using SPSS.

RESULTS

All renal provider units in the UK responded. A full range of modalities was provided by the majority of units. Clear variations in the level and quality of dialysis provision were seen between the UK regions. These included variation in choice of dialysis modality, provision of high-cost drugs, vascular access waiting times, number of support staff and availability of spare dialysis slots.

DISCUSSION

The considerable variation between UK regions in the provision of adult renal dialysis services cannot be entirely explained by age or ethnic variation, and is in part due to limited bed space, dialysis machines and support staff, as well as changes in commissioning arrangements. To meet the requirements of the renal national service framework in most regions, changes to policy and funding will be required, such that the relatively new commissioning groups implement more appropriate funding structures in closer dialogue with their provider units.

Acute toxicity of conventional radiation therapy for high-risk prostate cancer in EORTC trial 22863

OBJECTIVES

We analysed the acute toxicity observed in the European Organisation for Research and Treatment of Cancer (EORTC) randomised trial 22863 comparing conventional external irradiation with or without an agonist analogue of gonadotropin-releasing hormone in high-risk prostate cancer patients.

METHODS

Four hundred five patients that received a dose of at least 30 Gy were considered evaluable for acute toxicity assessment. Toxicity was grouped in a few categories: general, genito-urinary, and lower gastro-intestinal. Univariate and multivariate analyses were performed using the World Health Organisation (WHO) toxicity score and grouping together toxicity scores in different bimodal and trimodal groups.

RESULTS

Overall, our data show that age, previous surgery and irradiation dose are important predictive factors for acute toxicity, but not the use of combined hormone therapy. Fifteen percent of patients suffered of moderate to severe acute toxicity (WHO G3-G4). Life threatening toxicity was observed in six cases (1.5%).

CONCLUSIONS

The assessment of toxicity combining in different groups the original five scores scale produced conflicting results similar to those commonly reported in literature. Interpretation of the role of pre-treatment factors with uneven distribution in the study requires careful evaluation. These data obtained with conventional curative irradiation of high-risk prostate cancer patients are proposed for comparison with results achieved using modern state-of-the-art irradiation techniques.

Fermentation characterization and flux analysis of recombinant strains of Clostridium acetobutylicum with an inactivated solR gene

The effect of solR inactivation on the metabolism of Clostridium acetobutylicum was examined using fermentation characterization and metabolic flux analysis. The solR-inactivated strain (SolRH) of this study had a higher rate of glucose utilization and produced higher solvent concentrations (by 25%, 14%, and 81%, respectively, for butanol, acetone, and ethanol) compared to the wild type. Strain SolRH(pTAAD), carrying a plasmid-encoded copy of the bifunctional alcohol/aldehyde dehydrogenase gene (aad) used in butanol production, produced even higher concentrations of solvents (by 21%, 45%, and 62%, respectively, for butanol, acetone, and ethanol) than strain SolRH. Clarithromycin used for strain SolRH maintenance during SolRH(pTAAD) fermentations did not alter product formation; however, tetracycline used for pTAAD maintenance resulted in 90% lower solvent production.

Recommendations for incorporating palliative care education into the acute care hospital setting

This article presents recommendations for improving the education of physicians about end-of-life care in the acute care hospital setting. The authors, who have a variety of backgrounds and represent several types of institutions, formulated and reached consensus on these recommendations as members of the Acute Care Hospital Working Group, one of eight working groups convened at the National Consensus Conference on Medical Education for Care Near the End of Life in May 1997. A recently published literature review on the status of palliative care education, a summary of recent research on education about end-of-life care, and expert opinion were helpful in developing the recommendations. The authors emphasize that the acute care setting offers many opportunities for education about care at the end of life. Faculty should support learners' appreciation of the importance of end-of-life care, and convey the meaning and privilege of attending to patients and families at this difficult time. Faculty should teach students and residents to provide care that embodies attention to the control of distressing physical, physiologic, and spiritual symptoms, appropriate awareness of patients' differing cultural backgrounds and their impact upon the experience of dying, excellent communication skills, the application of bioethical principles, timely referral and smooth transition to other care settings that meet patient and family goals, and the role of the interdisciplinary team in meeting the diverse needs of dying patients and their families.

Involvement of Pex13p in Pex14p localization and peroxisomal targeting signal 2-dependent protein import into peroxisomes

Pex13p is the putative docking protein for peroxisomal targeting signal 1 (PTS1)-dependent protein import into peroxisomes. Pex14p interacts with both the PTS1- and PTS2-receptor and may represent the point of convergence of the PTS1- and PTS2-dependent protein import pathways. We report the involvement of Pex13p in peroxisomal import of PTS2-containing proteins. Like Pex14p, Pex13p not only interacts with the PTS1-receptor Pex5p, but also with the PTS2-receptor Pex7p; however, this association may be direct or indirect. In support of distinct peroxisomal binding sites for Pex7p, the Pex7p/Pex13p and Pex7p/ Pex14p complexes can form independently. Genetic evidence for the interaction of Pex7p and Pex13p is provided by the observation that overexpression of Pex13p suppresses a loss of function mutant of Pex7p. Accordingly, we conclude that Pex7p and Pex13p functionally interact during PTS2-dependent protein import into peroxisomes. NH2-terminal regions of Pex13p are required for its interaction with the PTS2-receptor while the COOH-terminal SH3 domain alone is sufficient to mediate its interaction with the PTS1-receptor. Reinvestigation of the topology revealed both termini of Pex13p to be oriented towards the cytosol. We also found Pex13p to be required for peroxisomal association of Pex14p, yet the SH3 domain of Pex13p may not provide the only binding site for Pex14p at the peroxisomal membrane.

ZntR is a Zn(II)-responsive MerR-like transcriptional regulator of zntA in Escherichia coli

We have identified the promoter/operator region of the zntA gene of Escherichia coli and shown that Zn(II) is the primary inducer of expression of this Zn(II)/Cd(II) export gene. The promoter PzntA shows sequence similarities to the promoters of mercury resistance (mer) operons, including a long spacer region containing an inverted repeat sequence. The gene encoding the transcriptional regulator of PzntA, designated zntR, has been identified from genome sequence data, by expression of the gene product and by insertional inactivation/complementation. The ZntR product is a member of the MerR family of transcriptional regulators and appears to act as a hypersensitive transcriptional switch. A hybrid MerR/ZntR protein has been constructed and indicates that the C-terminal region of ZntR recognizes Zn(II).

Connected and separate selves: development of an inventory and initial validation

We describe the development and validation of the Relationship Self Inventory (RSI), which assesses 2 general self-orientations, (a) the Separate Self (SS) and (b) the Connected Self (CS), as well as two manifestations of connection, (a) Primacy of Other Care and (b) Self and Other Care. The CS reflects the importance of interconnectedness with others and a "voice of caring," whereas the SS reflects autonomy, independence, and a "voice of justice." Adequate reliability was demonstrated for the RSI on samples consisting of 927 women and 218 men ranging in age from 26 to 78. Construct validity of the RSI was also explored in a subsample (n = 604) by comparing its scales with measures of personality, temperament, and psychological adjustment. Although mean scores of men and women differed minimally on the CS and SS scales, gender differences in patterns of correlation with validity measures suggested that the meanings of the scales differed for men and women. The RSI appears to be an adequate survey tool for assessing these self-orientations.

Pex17p of Saccharomyces cerevisiae is a novel peroxin and component of the peroxisomal protein translocation machinery

The Saccharomyces cerevisiae pex17-1 mutant was isolated from a screen to identify mutants defective in peroxisome biogenesis. pex17-1 and pex17 null mutants fail to import matrix proteins into peroxisomes via both PTS1- and PTS2-dependent pathways. The PEX17 gene (formerly PAS9; Albertini, M., P. Rehling, R. Erdmann, W. Girzalsky, J.A.K.W. Kiel, M. Veenhuis, and W.-H Kunau. 1997. Cell. 89:83-92) encodes a polypeptide of 199 amino acids with one predicted membrane spanning region and two putative coiled-coil structures. However, localization studies demonstrate that Pex17p is a peripheral membrane protein located at the surface of peroxisomes. Particulate structures containing the peroxisomal integral membrane proteins Pex3p and Pex11p are evident in pex17 mutant cells, indicating the existence of peroxisomal remnants ("ghosts"). This finding suggests that pex17 null mutant cells are not impaired in peroxisomal membrane biogenesis. Two-hybrid studies showed that Pex17p directly binds to Pex14p, the recently proposed point of convergence for the two peroxisomal targeting signal (PTS)-dependent import pathways, and indirectly to Pex5p, the PTS1 receptor. The latter interaction requires Pex14p, indicating the potential of these three peroxins to form a trimeric complex. This conclusion is supported by immunoprecipitation experiments showing that Pex14p and Pex17p coprecipitate with both PTS receptors in the absence of Pex13p. From these and other studies we conclude that Pex17p, in addition to Pex13p and Pex14p, is the third identified component of the peroxisomal translocation machinery.

Randomized double-blind trial of prednisone versus radiotherapy in Graves' ophthalmopathy

Corticosteroids are usually given for management of Graves' ophthalmopathy, but they have many and serious side-effects. By comparison, retrobulbar irradiation is well tolerated, although its efficacy has been evaluated only in uncontrolled studies. Therefore, we did a double-blind randomised trial, in which 28 patients with moderately severe Graves' ophthalmopathy were treated with a 3-month course of oral prednisone and sham irradiation, and 28 received retrobulbar irradiation (20 Gy) and placebo capsules. Therapeutic outcome, assessed twenty-four weeks after the start of treatment, was determined by the change in the highest NOSPECS class. A successful outcome was observed in 14 prednisone-treated and in 13 irradiated patients. Responders to treatment (but not nonresponders) in both groups showed improvements in total and subjective eye score and a decrease in eye-muscle volume. Response to either treatment was due largely to changes in soft-tissue involvement and eye-muscle motility. Mean elevation in responders to radiotherapy increased from 18.5 degrees (95% CI 14.8-22.2) at baseline to 21.8 degrees (18.6-25.0) at week twenty-four (p = 0.003), but did not change in prednisone responders. Side-effects were more frequent and severe during prednisone than during radiotherapy. Radiotherapy and oral prednisone appear to be equally effective as initial treatment in patients with moderately severe Graves' ophthalmopathy. In view of its better tolerability, radiotherapy should be considered the treatment of first choice.

Fructose prevents 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced ATP depletion and toxicity in isolated hepatocytes

The loss of viability of isolated rat hepatocytes exposed to either 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) or its toxic metabolite 1-methyl-4-phenylpyridinium ion (MPP+) was prevented by addition of fructose to the incubation medium. This protection was dependent on fructose concentration, being complete at 10 mM. Addition of fructose dramatically delayed MPTP- and MPP+-induced depletion of ATP and was accompanied by a significant accumulation of lactate, indicating the occurrence of enhanced glycolytic production of ATP. Glucose was much less effective against MPTP and MPP+ toxicity, probably because it is a relatively poor substrate for glycolysis in liver cells. We conclude that depletion of ATP is a critical event in MPTP cytotoxicity in our in vitro model system, and that the use of alternative sources of ATP production may represent an important protective device against the effects of this toxic agent.

Carcinoma of the stomach disguised as a benign gastric ulcer

All gastric ulcerations must be suspected of being gastric carcinoma. Two of the more reliable signs of benignancy have been demonstration of a Hampton's line on upper gastrointestinal barium study and either roentgenographic or endoscopic evidence of ulcer healing. We have reported a case of gastric ulcer with both a Hampton's line and complete healing, which ultimately proved to be malignant.

Body concern, body image and nudity

100 nudists and 60 controls were compared on several aspects of figure drawings and the Secord-Jourard inventories of body- and self-cathexis. The results showed important effects of sex differences and testing milieu on test responses and tended to support findings of an earlier study indicating that nudists present more body-image distortion and signs of body-image disturbance than controls. However, nudists claim to be more gratified with the appearance, if not function, of their bodies. It is suggested that bodily conflict leads to somatic emphasis, that nudist behavior is not necessarily psychopathological and may serve adaptive purposes for certain individuals.

Voyeurism and exhibitionism

To investigate the topics of looking and showing as they are expressed in conventional, unconventional, and deviant behaviors, nudists, college females, suburban husbands and wives, and male engineering students were administered the MMPI and DAP, Particularly when more subtle comparisons were made, nudists manifested more deviant features: sexual preoccupation, conflicts, inhibitions, and body-image distortion. Essentially, the nudist's concern with his body or the bodies of others seems to present a readiness for nudist behavior, but this readiness appears not to be uncommon in many people. Willingness to be nonconforming may be a critical aspect in determining nudism. The implications of the findings for voyeuristic and exhibitionistic behavior were considered.