Relapses in Wegener's granulomatosis: the role of infection.

Out of 20 relapses that occurred in patients with Wegener''s granulomatosis, nine were provoked by bacterial or viral infection. Seven of these occurred during maintenance treatment in response to infection with common pathogens, and treatment of the infection alone was insufficient to produce remission. Circulating immune complexes were seen only in relapses due to infection and rarely in infections that occurred without relapse. A possible mechanism for infection-provoked relapses is that infection-derived complexes reactivate disease; alternatively, the acute-phase or cellular response to infection may enhance quiescent disease. Infection may exacerbate Wegener''s granulomatosis and other autoallergic diseases, but whether it does so by a common mechanism is not known and further study is required.     

Second malignancies in Hodgkin's disease: a complication of certain forms of treatment.

A total of 764 patients with Hodgkin''s disease treated with radiotherapy (RT) or chemotherapy or both were reviewed 3-186 months (median 43 months) after initial treatment to assess the incidence of second malignancies. Incidence of solid tumours and acute non-lymphoblastic leukaemia (ANLL) were calculated by a life-table method and percentages of patients affected derived from life-table plots. Within 10 years after initial treatment the overall incidence of second solid tumours was 7.3%, and over a comparable period 2.4% of patients developed ANLL. Solid tumours occurred only in patients given RT with or without adjuvant chemotherapy, and ANLL occurred only after treatment with MOPP (mustine, vincristine, procarbazine, and prednisolone) or modified MOPP regimens. Neither solid tumours nor ANLL occurred in patients given ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine). The highest incidence of leukaemia (5.4%) occurred after treatment with extensive RT plus (5.4%) occurred after treatment with extensive RT plus MOPP; hence the benefits of this approach in Hodgkin''s disease must be weighed against its carcinogenic potential.     

Nematode parasites from the skin of the platypus Ornithorhynchus anatinus (Monotremata)

The morphology of three nematode taxa found in the skin of the platypus Ornithorhynchus anatinus (Monotremata) in southeastern New South Wales, Australia, is described and illustrated. Fourth-stage larvae belonging to the Rhabditoidea, ?Cylindrocorporidae, occurred primarily in superficial keratin and epidermal layers of the skin and in hair follicles. A nematode recognised by its conspicuous synlophe as a fourth-stage larva of the Trichostrongyloidea, of unknown genus and species but probably belonging to the molineid evolutionary line, was observed in histological section in the hypodermis. A gravid female nematode belonging to the Filarioidea, ?Lemdaninae, occurred in a lymphoid nodule in the hypodermis. O. anatinus is a protected species and these data are presented to draw the attention of parasitologists to skin as an important habitat for nematodes of the platypus.     

Vectoring gypsy moth nuclear polyhedrosis virus byApanteles melanoscelus [Hym.: Braconidae]

Gypsy mothLymantria dispar L. larvae were exposed toApanteles melanoscelus (Ratzeburg) females contaminated with nuclear polyhedrosis virus. Three methods of contamination (ovipositor, total body surface, and exposure to infected hosts) and two exposure periods (2 and 24 hours) were tested. A significantly greater incidence of larval mortality caused by virus occurred among larvae exposed to contaminated than among larvae exposed to uncontaminated parasites for 2 and 24 hours. No significant differences occurred in larval mortality caused by virus for the 3 methods of contamination for the 2- and 24-hour tests or in parasite emergence from larvae parasitized by contaminated or uncontaminated parasites.     

Properties of Statistical Tests of Neutrality for DNA Polymorphism Data

A class of statistical tests based on molecular polymorphism data is studied to determine size and power properties. The class includes TAJIMA''s D statistic as well as the D* and F* tests proposed by FU and LI. A new method of constructing critical values for these tests is described. Simulations indicate that TAJIMA''s test is generally most powerful against the alternative hypotheses of selective sweep, population bottleneck, and population subdivision, among tests within this class. However, even TAJIMA''s test can detect a selective sweep or bottleneck only if it has occurred within a specific interval of time in the recent past or population subdivision only when it has persisted for a very long time. For greatest power against the particular alternatives studied here, it is better to sequence more alleles than more sites.     

Successful pregnancy in patient on regular dialysis.

A pregnancy in a patient undergoing regular dialysis treatment was successfully managed. Premature labour occurred at 32 weeks. Fetal nutrition was satisfactory and the infant developed normally and showed no congenital abnormality during 12 months'' observation.     

A Comparison of Preparation Techniques in Taxonomic Studies of Longidorus africanus Merny

A comparison was made of ten different techniques for killing, fixing, and mounting Longidorus africanus Merny for microscopic study. The most satisfactory specimens were those killed by Seinhorst''s method, fixed in FAA and mounted in glycerin by the slow method. Specimens killed by "gentle heat," fixed in FAA and mounted in glycerin were also acceptable as were those killed by hot formalin and mounted in glycerin or processed by Baker''s method. Less satisfactory were: nematodes killed by "gentle heat," fixed in formalin and mounted in glycerin and specimens killed by vapor phase perfusion or by Hopper''s lethal stain, both latter groups were mounted in glycerin after fixation in formalin. Killing with cold formalin, gradual heat (60 C for 15 min), or by storage in distilled water produced poorly defined specimens. Nematodes killed by hot formalin, and processed to glycerin by the slow method, maintained their live dimensions. Reduction in length occurred in specimens killed by cold formalin, by storage, or treated with solutions containing acetic or propionic acids. Nematodes processed by Baker''s method increased in size. Other minor modifications occurred in specimens processed by the different methods. Esophageal definition was best in nematodes killed with formalin, hot or cold. There is no correlation between position of the posterior part of the esophagus and position of the onchiostyle.     

Effect on prescribing of the limited list in a computerised group practice.

The prescribing of drugs in the therapeutic classes that are affected by the government''s limited list was investigated in a computerised group practice of just over 3,000 patients. Prescribable drugs in categories that are affected by the list were identified for two consecutive six month periods before and one six month period after the introduction of the list. A significant decrease in the prescribing of cough and cold remedies, vitamins, and antacids occurred after the list was introduced, whereas no change occurred in the prescribing of laxatives, benzodiazepines, or analgesics. The prescribing of iron and penicillin increased significantly after the list was introduced, whereas the use of H2 antagonists and non-steroidal anti-inflammatory drugs showed no significant change.     

Trends of Acute Hepatitis B Notification Rates in Eastern China from 2005 to 2013

Zhejiang Province was a high endemicity for hepatitis B disease in the 1990''s. A number of measures implemented since then have begun to control and prevent hepatitis B. In 1992, hepatitis B vaccine came on the market. In 2002, hepatitis B vaccine was included in the national Expanded Programme on Immunization (EPI). Between 2007 and 2010, catch-up vaccination was implemented for children under 15. Since 2010, vaccination guidelines for high-risk groups have also been adopted. This study evaluated the impact of these control and prevention strategies on acute hepatitis B notification rates from 2005 through 2013. Data from the National Notifiable Disease Reporting System (NNDRS) revealed a steady downward trend in notification rates of acute hepatitis B. The most dramatic decline occurred among pre-adults, highlighting the benefits of EPI''s policy of universal vaccination for children. However, the highest notification rates occurred among young adults of lower socio-economic status. These findings indicate the strong need to vaccinate young adults at risk for HBV infection as well as to collect risk-factor information in the NNDRS for monitoring and following up persons with acute hepatitis B.     

Retroperitoneal fibrosis associated with Riedel's struma

A case of retroperitoneal fibrosis with bilateral ureteral obstruction in association with Riedel''s struma of the thyroid is reported. There has been a definite increase in incidence of retroperitoneal fibrosis, but with prompt recognition and adequate treatment the mortality rate has been decreased from the original 14%. The association of Riedel''s struma with retroperitoneal fibrosis has been noted in the past and its association with sclerosing cholangitis has also been mentioned. It is not known whether Riedel''s thyroiditis originates in the thyroid gland and spreads or whether true thyroiditis is part of a generalized process. The temporal relationship of thyroiditis and retroperitoneal fibrosis suggests an extension of fibrosis from the thyroid, but one cannot be sure which condition occurred first. Whatever the cause, the treatment remains the same as for retroperitoneal fibrosis from other causes.     

Artificial Feeding Systems for Plant-Parasitic Nematodes

Feeding of an "obligate" plant-parasitic nematode (nonfungal feeder), Pratylenchus scribneri, in the absence of plant tissue was demonstrated in an artificial system consisting of liquid media and indicator dyes including amaranth and various nontoxic food colors. Among the compounds tested, sucrose, dextrose, Gamborg''s B5 medium, and DL-methionine stimulated a small percentage of feeding (12-36%). A high percentage of feeding (90-100%) occurred in a filtrate from excised corn roots cultured in Gamborg''s B5 medium. This feeding system has the potential to develop an artificial medium for plant-parasitic nematodes and to screen novel nematicides that are stomach poisons.     

Dissolved organic carbon and UV-absorption in a polluted lowland brook-pond system

A natural water (brook-pond system), polluted with organic waste, was aerated by the Phallus technique. The evolution of the organic carbon concentration and the UV-absorption was followed. Aeration resulted in an abrupt decrease of the organic carbon concentration in the immediate vicinity of the experimental station, while in the downstream sampling sites a slower decrease occurred. A relationship between UV-absorption and total organic carbon was demonstrated. The use of UV-absorption measurements as a measure of organic matter content is discussed.     

Progesterone and the premenstrual syndrome: a double blind crossover trial.

A double blind, randomised, crossover trial of oral micronised progesterone (two months) and placebo (two months) was conducted to determine whether progesterone alleviated premenstrual complaints. Twenty three women were interviewed premenstrually before treatment and in each month of treatment. They completed Moos''s menstrual distress questionnaire, Beck et al''s depression inventory, Spielberger et al''s state anxiety inventory, the mood adjective checklist, and a daily symptom record. Analyses of data found an overall beneficial effect of being treated for all variables except restlessness, positive moods, and interest in sex. Maximum improvement occurred in the first month of treatment with progesterone. Nevertheless, an appreciably beneficial effect of progesterone over placebo for mood and some physical symptoms was identifiable after both one and two months of treatment. Further studies are needed to determine the optimum duration of treatment.     

Malignant Disease in Children whose Mothers had Chickenpox,Mumps, or Rubella in Pregnancy

To test the hypothesis that leukaemia may follow virus infection in pregnancy an analysis was made of deaths which occurred in a cohort of children born in 1951 and 1952 after pregnancies in which the mothers suffered virus infections—chickenpox or mumps at any stage of gestation or rubella in the first 18 weeks. All deaths which occurred between the children''s second birthday and the end of 1971 were studied.Two deaths from leukaemia occurred among the children whose mothers suffered from chickenpox, a significant excess. There were no deaths from leukaemia among the other children, but the causes of the two deaths after maternal mumps—Ewing''s tumour and Still''s disease—are noted because of their rarity.     

Effects of Cultivars,Subsoiling, and Fumigation on Soybean Yields and Meloidogyne incognita Populations

Application of 1,2-dibromo-3-chloropropane (DBCP) and subsoiling under the row in Tifton sandy loam heavily infested with Meloidogyne incognita increased yields of four soybean cultivars. These cultivars have levels of resistance to M. incognita as follows: ''Hutton'', high; ''Essex'', intermediate; and ''Davis'' and ''Ransom'', low. After growing these four cultivars, sub-soiling, and applying DBCP for 2 years in the same plots, the residual effects of these practices on yield of Davis cultivar and populations of M. incognita were studied. Greatest yields of Davis were obtained on plots previously planted to Hunon and Essex and on plots previously treated with DBCP for 2 years. Residual effects of subsoiling on yield were not significant. Data on nematode populations indicated that some residual effects occurred because of cultivars and nematicides. However, root-knot was suppressed only where DBCP was applied the 2 previous years. Although beneficial residual effects occurred, they were not sufficient for maximum soybean production.     

Is there a familial link between Down's syndrome and neural tube defects? Population and familial survey

Objective To verify whether Down''s syndrome and neural tube defects arise more often in the same family than expected by chance.Design Population and familial survey.Setting Network of maternity hospitals in the Latin American collaborative study of congenital malformations (ECLAMC) in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Uruguay, and Venezuela between 1982 and 2000.Probands 2421 cases of neural tube defects, 952 of hydrocephalus, and 3095 of Down''s syndrome registered from a total of 1 583 838 live births and stillbirths.Main outcome measures Observed number of cases of Down''s syndrome among siblings of probands with a neural tube defect or hydrocephalus and number expected on the basis of maternal age; observed number of cases of neural tube defects or hydrocephalus among siblings of probands with Down''s syndrome and number expected according to the prevalence in the same population.Results Five cases of Down''s syndrome occurred among 5404 pregnancies previous to a case of neural tube defect or hydrocephalus, compared with 5.13 expected after adjustment by maternal age. Twelve cases of neural tube defect or hydrocephalus occurred among 8066 pregnancies previous to a case of Down''s syndrome, compared with 17.18 expected on the basis of the birth prevalence for neural tube defects plus hydrocephalus in the same population.Conclusion No association occurred between families at risk of neural tube defects and those at risk of Down''s syndrome.     

Predicting the epidemic sizes of influenza A/H1N1, A/H3N2, and B: a statistical method

Background

The epidemic sizes of influenza A/H3N2, A/H1N1, and B infections vary from year to year in the United States. We use publicly available US Centers for Disease Control (CDC) influenza surveillance data between 1997 and 2009 to study the temporal dynamics of influenza over this period.

Methods and Findings

Regional outpatient surveillance data on influenza-like illness (ILI) and virologic surveillance data were combined to define a weekly proxy for the incidence of each strain in the United States. All strains exhibited a negative association between their cumulative incidence proxy (CIP) for the whole season (from calendar week 40 of each year to calendar week 20 of the next year) and the CIP of the other two strains (the complementary CIP) from the start of the season up to calendar week 2 (or 3, 4, or 5) of the next year. We introduce a method to predict a particular strain''s CIP for the whole season by following the incidence of each strain from the start of the season until either the CIP of the chosen strain or its complementary CIP exceed certain thresholds. The method yielded accurate predictions, which generally occurred within a few weeks of the peak of incidence of the chosen strain, sometimes after that peak. For the largest seasons in the data, which were dominated by A/H3N2, prediction of A/H3N2 incidence always occurred at least several weeks in advance of the peak.

Conclusion

Early circulation of one influenza strain is associated with a reduced total incidence of the other strains, consistent with the presence of interference between subtypes. Routine ILI and virologic surveillance data can be combined using this new method to predict the relative size of each influenza strain''s epidemic by following the change in incidence of a given strain in the context of the incidence of cocirculating strains. Please see later in the article for the Editors'' Summary     

Domiciliary immunisation for preschool child defaulters.

A selective domiciliary immunisation service has been introduced for preschool children living in the Central Manchester Health District. The service is provided for the children of parents who have given written consent for immunisation but have subsequently failed to bring their children to the clinic or their general practitioner''s surgery to start or complete the basic course of immunisation against diphtheria, tetanus, whooping cough, poliomyelitis, and measles. This failure has occurred despite at least two written invitations for each injection and several reminders from the health visitor. Many additional children have been protected by this scheme.     

Visceral and skin granuloma annulare,diabetes, and polyendocrine disease.

A middle aged man suffered with insulin dependent diabetes, autoimmune Addison''s disease, myxoedema, and severe ulcerative colitis, for which he had undergone subtotal colectomy with formation of an ileostomy. Granuloma annulare confined to the anterior abdominal wall was diagnosed in 1981. In 1983 an episode of severe colicky pain and excessive working of the ileostomy occurred associated with severe hyperglycaemia and increased irritation of the granuloma annulare. Laparotomy disclosed adhesions and numerous white nodules over bowel, mesentery, and peritoneum histologically identical with the skin lesions. Two further episodes of subacute small bowel obstruction occurred, and a repeat laparotomy showed widespread intra-abdominal granuloma annulare. Visceral granuloma annulare appears not to have been reported before, and in this patient exacerbation of the skin lesion was associated with poor diabetic control.