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

Comparative Performance of Strategies for Conjunctive Use of Fresh and Saline Water to Grow Wheat Crop

In arid lI!ld semi-arid regions, ground water is mainly saline in nature. It is open to question, whether such waters could be exploited to meet the crop water requirement. The experimental evidences generated world over reveal that it could be achieved through conjunctive use. Recently, some conflicting reports have appeared on the relative merits of different modes of conjunctive use i.e. cyclic, switching and mixing modes. A field experiment was conducted during 2001-02 and 2002-03 using low (3.6 dS m-1)  and highly saline water (15 dS m-1)  to show that with appropriate conjunctive mode even highly saline waters could be used to grow wheat crop. It has been shown that substitution of a part of the irrigation water requirement with highly saline water affected the wheat crop less adversely than when all irrigations were given with high salinity water. Yield, as high as 95% of the yield with low saline water could be obtained with cyclic mode (low saline-high saline water cycle) or switching mode (first 2 or 3 irrigations with low saline followed by all irrigations with highly saline water). Both the strategies were equally effective provided low saline water is applied at pre-sowing and/or initial growth stages of the wheat crop. At the same salt load, the mixing mode tried in this study could also give more than 90 % of the yield obtained with low saline water. The yield differences under the three best treatments (one each under the three strategies) with equal salt load were non-significant. The yield in the case of cyclic mode (highly saline-low saline) or switching mode (highly saline followed by low saline) was less than their counterparts (low-high saline cycle or switching) as well as the mixing mode. Apparently, salt stress at germination and initial establishment stages affected the crop performance. If it is so, the yield under mixing mode could be improved provided mixing ratio is varied with stage of growth although total salt load could be the same. Therefore, the conclusion regarding miling mode drawn from th.is study should be treated as temporary till more results are obtained in future studies. It emerges that one can manage the matric and osmotic stresses with conjunctive use to get high yields and ensure sustainability of irrigated agriculture. For developing an effective strategy crop characteristics, water qualities in hand and the past experiences should play an important role

Water production functions of wheat (Triticum aestivum L.) irrigated with saline and alkali waters using double-line source sprinkler system

Expected yield losses as a function of quality and quantity of water applied for irrigation are required to formulate guidelines for the effective utilisation of marginal quality waters. In an experiment conducted during 2004-2006, double-line source sprinklers were used to determine the separate and interactive effects of saline and alkali irrigation waters on wheat (Triticum aestivum L.). The study included three water qualities: groundwater (GW; electrical conductivity of water, ECw 3.5dSm-1; sodium adsorption ratio, SAR 9.8mmolL-1; residual sodium carbonate, RSC, nil) available at the site, and two synthesized waters, saline (SW; ECw 9.4dSm-1, SAR 10.3mmolL-1; RSC nil) and alkali (AW; ECw 3.7dSm-1, SAR 15.1mmolL-1; RSC 9.6meq.L-1). The depths of applied SW, AW, and GW per irrigation ranged from 0.7 to 3.5cm; the depths of applied mixtures of GW with either SW (MSW) or AW (MAW) ranged from 3.2 to 5cm. Thereby, the water applied for post-plant irrigations using either of GW, SW or AW ranged between 15.2 and 34.6cm and 17.1 and 48.1cm during 2004-2005 and 2005-2006, respectively and the range was 32.1-37.0 and 53.1-60.0cm for MSW or MAW. Grain yields, when averaged for two years, ranged between 3.08 and 4.36Mgha-1, 2.57 and 3.70Mgha-1 and 2.73 and 3.74Mgha-1 with various quantities of water applied using GW, SW and AW, respectively, and between 3.47 and 3.75Mgha-1 and 3.63 and 3.77Mgha-1 for MSW and MAW, respectively. The water production functions developed for the two sets of water quality treatments could be represented as: RY=0.528+0.843(WA/OPE)-0.359(WA/OPE)2-0.027ECw+0.44× 10-2(WA/OPE)× ECw for SW (R2=0.63); RY=0.446+0.816(OPE/WA)-0.326(WA/OPE)2-0.0124RSC-0.55× 10-4(WA/OPE)× RSC for AW (R2=0.56). Here, RY, WA and OPE are the relative yields in reference to the maximum yield obtained with GW, water applied for pre- and post-plant irrigations (cm), and open pan evaporation, respectively. Crop yield increased with increasing amount of applied water for all of the irrigation waters but the maximum yields as obtained with GW, could not be attained even with increased quantities of SW and AW. Increased frequency of irrigation with sprinklers reduced the rate of yield decline with increasing salinity in irrigation water. The sodium contents of plants increased with salinity/alkalinity of sprinkled waters as also with their quantities. Simultaneous decrease in potassium contents resulted in remarkable increase in Na:K ratio.Alkali water Double-line sprinkler source Na:K ratio Saline water Triticum aestivum L. Water-yield relations

Supplemental irrigation of wheat with saline water

In arid and semi-arid regions, both rainfall and surface irrigation water supplies are unreliable and inadequate to meet crop water requirement. Groundwater in these regions is mainly marginally saline (2-6 dS/m) to saline (>6 dS/m) and could be exploited to meet crop water requirement if no adverse effects on crops and land resource occur. The fear of adverse effects has often restricted the exploitation of naturally occurring saline water. The results reveal that substituting a part or all except pre-sowing irrigation with saline water having an electrical conductivity (ECiw) of 8 dS/m is possible for cultivation of wheat. Similarly, saline water with ECiw ranging between 8 and 12 dS/m could be used to supplement at least two irrigations to obtain 90% or more of the optimum yield. In low rainfall years, the use of such waters for all irrigations, except pre-sowing, produced more yield than skipping irrigations. Apparently, even at this level of osmotic salt stress, matric stress is more harmful. Thus, it would be interesting to use such waters for wheat production in monsoon climatic regions.

Eficiência de utilização de água e nutrientes em plantas de feijão-de-corda irrigadas com água salina em diferentes estádios de desenvolvimento Water and nutrient use efficiency in cowpea irrigated with saline water at different growth stages

O objetivo deste trabalho foi investigar os efeitos do uso de água salina em diferentes estádios de desenvolvimento de plantas de feijão-de-corda sobre a eficiência de utilização de água e de nutrientes. O experimento foi conduzido no campo e obedeceu ao delineamento em blocos ao acaso, com cinco tratamentos e cinco repetições. Os tratamentos empregados foram: T1 - água de poço com condutividade elétrica (CEa) de 0,8 dS m-1 durante todo o ciclo; T2 - água salina (CEa de 5,0 dS m-1) durante todo o ciclo; T3, T4 e T5 - água salina de 0 a 22 dias após o plantio (DAP), de 23 a 42 DAP e de 43 a 62 DAP, respectivamente. As plantas dos tratamentos T3, T4 e T5 foram irrigadas com água de poço nas demais fases do ciclo. Aos 8; 23; 43 e 63 DAP, as plantas foram colhidas e determinaram-se a matéria seca total e de grãos, a eficiência no uso da água, considerando a produção de matéria seca total (EUA P) e a produção de grãos (EUA GR), e a eficiência de utilização de nutrientes (K, Ca, N, P, Fe, Cu, Zn e Mn). A aplicação de água salina durante todo o ciclo (T2) reduziu a EUA P e a EUA GR, enquanto a aplicação de água na fase inicial do ciclo (T3) reduziu a EUA GR e a eficiência de utilização da maioria dos nutrientes. Por outro lado, a irrigação com água salina dos 23 aos 42 DAP (T4) e dos 43 aos 62 DAP (T5) não afetou as eficiências nos usos de água e de nutrientes.<br>The objective of this paper was to evaluate the effect of the saline water applied at different development stages of cowpea plants, on water and nutrient use efficiency. The experiment was set up in the field, during the dry season. A completely randomized block design, with five treatments and five repetitions was adopted. The treatments studied were: T1 - (groundwater with electrical conductivity (ECw) of 0.8 dS m-1) during the whole crop cycle; T2 - saline water (ECw = 5.0 dS m-1) during the whole crop cycle; T3, T4 and T5 - saline water from 0 to 22 days after sowing (DAS), from 23 to 42 DAS and from 43 to 62 DAS, respectively. The plants of T3, T4 and T5 were irrigated with groundwater in the remaining stages of the crop cycle. At 8, 23, 43 and 63 DAS the plants were harvested and the total dry mass and grain yield were measured. The water use efficiency was estimated by using total dry mass production (WUE P) and grain yield (WUE GR), as well as the nutrients use efficiency - NUE, (K, Ca, N, P, Fe, Cu, Zn and Mn). The application of saline water during whole the crop cycle (T2) reduced WUE P and WUE GR, while the use of saline water during the germination and initial plant development (T3) caused reduction in WUE GR and in the NUE for most of the analyzed nutrients. Irrigation with saline water from 23 to 42 DAS (T4) and from 43 to 62 DAS (T5) did not affect water and nutrient use efficiencies

Global Retinoblastoma Presentation and Analysis by National Income Level

This cross-sectional analysis reports the retinoblastoma stage at diagnosis across the world during a single year, investigates associations between clinical variables and national income level, and investigates risk factors for advanced disease at diagnosis. Key PointsQuestionIs the income level of a country of residence associated with the clinical stage of presentation of patients with retinoblastoma? FindingsIn this cross-sectional analysis that included 4351 patients with newly diagnosed retinoblastoma, approximately half of all new retinoblastoma cases worldwide in 2017, 49.1\% of patients from low-income countries had extraocular tumor at time of diagnosis compared with 1.5\% of patients from high-income countries. MeaningThe clinical stage of presentation of retinoblastoma, which has a major influence on survival, significantly differs among patients from low-income and high-income countries, which may warrant intervention on national and international levels. ImportanceEarly 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. ObjectivesTo 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 ParticipantsA 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 MeasuresAge at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. ResultsThe 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 RelevanceThis 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