Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4) were female. Most patients (n = 3685 84.7%) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 62.8%), followed by strabismus (n = 429 10.2%) and proptosis (n = 309 7.4%). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 95% CI, 12.94-24.80, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 95% CI, 4.30-7.68). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs. © 2020 American Medical Association. All rights reserved

The export behaviour and assistance requirements of U.K. SMEs The effect of ethnicity

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Veillonella as a cause of chronic anaerobic pneumonitis

SummaryAnaerobes are not well recognized as a cause of chronic respiratory infections. A 44-year-old man was referred for evaluation of a progressive pulmonary disease of 7-month duration characterized by hemoptysis and fever. For these complaints, based on the radiological picture, he had already received antituberculous therapy without any relief. He was also subjected to bronchial artery embolization prior to referral. Evaluation of the patient led to a diagnosis of chronic anaerobic pneumonitis. Anaerobic culture of the computed tomography-guided transthoracic aspirate grew Fusobacterium and Veillonella species. Within 2 weeks of therapy with oral clindamycin, there was a dramatic relief in hemoptysis. This was accompanied by remarkable radiological clearance. This report underscores the importance of Veillonella species as a potential respiratory pathogen. A high index of suspicion is required to diagnose chronic anaerobic pneumonitis, which can mimic pulmonary tuberculosis, especially in tuberculosis endemic regions

Development of AFLP-derived, functionally specific markers for environmental persistence studies of fungal strains

The ability to rapidly identify and quantify a microbial strain in a complex environmental sample has widespread applications in ecology, epidemiology, and industry. In this study, we describe a rapid method to obtain functionally specific genetic markers that can be used in conjunction with standard or real-time polymerase chain reaction (PCR) to determine the abundance of target fungal strains in selected environmental samples. The method involves sequencing of randomly cloned AFLP (amplified fragment length polymorphism) products from the target organism and the design of PCR primers internal to the AFLP fragments. The strain-specific markers were used to determine the fate of three industrially relevant fungi, Aspergillus niger, Aspergillus oryzae, and Chaetomium globosum, during a 4 month soil microcosm experiment. The persistence of each of the three fungal strains inoculated separately into intact soil microcosms was determined by PCR analyses of DNA directly extracted from soil. Presence and absence data based on standard PCR and quantification of the target DNA by real-time PCR showed that all three strains declined after inoculation (-14-, 32-, and 4-fold for A. niger, A. oryzae, and C. globosum, respectively) but remained detectable at the end of the experiment, suggesting that these strains would survive for extended periods if released into nature

Morfologia e desenvolvimento do núcleo vitelínico do lambari Astyanax bimaculatus (Linnaeus, 1758) (Osteichthyes, Characidae)

<abstract language="eng">A morphological study of the yolk nucleus in previtellogenic oocytes from A. bimacularus has been carried out. Six phases of development were described from its formation closed to the oocyte nucleus to its dispersion in the periferic ooplasm. Histochemical techniques indicate proteins, lipids and RNA in the yolk nucleus of A. bimaculatus, but there are no carbohydrate in this structure. The origin and functional activity of the teleost yolk nucleus are discussed