First Report of Grapevine fleck virus in Idaho Grapevines.

Idaho has a growing viticulture industry, with nearly 1,600 acres of wine grapes (Vitis vinifera L.). Production is largely concentrated in two locations, the Snake River valley, which includes Canyon County in the southwest, and the Clearwater River valley, primarily Nez Perce County in the northwest. Grapevine fleck virus (GFkV) belongs to the genus Maculavirus, family Tymoviridae, comprising positive-sense, single-stranded RNA viruses with ca. 7.6-kb genome (3). It is one of five non-mechanically transmitted viruses associated with the fleck disease complex and has been previously documented to occur in the neighboring state of Washington (2). Main sources of wine grape nursery material imported to Idaho reside in Washington or in California, and it is important to monitor virus status of the planting material brought to the state. However, no information was available on the occurrence and prevalence of GFkV in wine grapes in Idaho. During three growing seasons in 2009 through 2011, random grapevine samples were collected in 14 vineyards in Canyon, Elmore, Ada, and Nez Perce counties. A total of 434 samples were tested by one step RT-PCR using GFkV-specific primers, GFkVf: 5'-TGACCAGCCTGCTGTCTCTA-3' and GFkVr: 5'-TGGACAGGGAGGTGTAGGAG-3' designed to amplify a fragment of the GFkV capsid protein gene (1). Twenty-four samples tested positive for GFkV by RT-PCR and produced the expected 179-bp DNA fragment. These samples came from five vineyards sampled across all surveyed counties, and represented seven wine grape cultivars, including Pinot Noir, Cabernet Sauvignon, Syrah, Lemberger, Riesling, Chardonnay, Pinot Gris, and one unknown table grape cultivar. Twelve PCR products were cloned into the pGEM-T Easy plasmid vector (Promega), sequenced (numbered ID1 to 12, available upon request), and confirmed to represent fragments of the GFkV CP gene between positions 6,453 and 6,631 in the genome of GFkV isolate MT48 (GenBank Accession No. AJ309022.1). Eight of the Idaho GFkV sequences (ID2, ID3, ID7 to 11, and ID12) matched closely with other GFkV sequences from Washington State, Italy, India, and South America, showing 97 to 99% identity at the nucleotide level in pair-wise comparisons. Four GFkV sequences from Idaho (ID1 and ID4 to 6) showed only modest (90 to 92%) identity in pair-wise comparisons with GFkV sequences available in GenBank. Consequently, in phylogenetic reconstructions eight Idaho GFkV sequences clustered in the same lineage with the six GFkV sequences deposited in GenBank, and four other GFkV sequences were placed outside of this main clade. It is possible that this phylogeny of the Idaho GFkV reflects different sources of the virus-infected planting material brought to the state. In the absence of symptoms expressed in wine grape cultivars infected with GFkV, laboratory methods remain the only tool to detect the virus. To our knowledge, this is the first report of GFkV found in wine grapes in Idaho demonstrating its substantial presence in production areas. References: (1) G. Gambino and I. Gribaudo. Phytopathology 96:1223, 2006. (2) R. A. Naidu et al. Plant Dis. 94:784, 2010. (3) S. Sabanadzovic et al. J. Gen. Virol. 82:2009, 2001.

Chemotherapy with the modified Bagshawe protocol for poor prognosis metastatic trophoblastic disease.

The Southeastern Regional trophoblastic Disease Center has treated 126 patients with metastatic gestational trophoblastic disease from 1966 through 1979. Sixty-three cases were categorized as having a poor prognosis on the basis of criteria published previously. Since 1976, 18 patients have been treated with a modification of Bagshawe's multiagent chemotherapy protocol. Ten of 18 patients (56%) have achieved sustained remission. Seventy-eight percent of these patients encountered serious myelosuppression (white blood count 1000 cells or fewer) and 39% suffered severe thrombocytopenia (platelet count 50,000 or fewer). There were no deaths related to drug toxicity. The courses of therapy and complications of modified Bagshawe chemotherapy are reviewed.

An American health dilemma: a history of blacks in the health system.

The present black health crisis is a continuum. After 346 years of neglect, flawed efforts were made to admit black Americans to the "mainstream" health system. Gains were significant from 1965 to 1975; however, since then black health status has eroded. Since colonial times, the racial dilemma that affected America's liberal democratic system also distorted medical relationships and institutions. There are clear connections between campaigns to defeat bills that would improve the health of blacks and other disadvantaged groups and acquiescence with the present reassignment of them to the underfunded, overcrowded, inferior, public health-care sector. Physician leadership helped to establish the slaveocracy, create the racial inferiority myths, and build the segregated health subsystem for blacks and the poor. Clearly, if the history-based health disparities are to be resolved, black physician leadership will be necessary. Without justice and equity in health care, the dream of Martin Luther King will never become a reality for African Americans.

Race, medicine, and health care in the United States: a historical survey.

Racism in medicine, a problem with roots over 2,500 years old, is a historical continuum that continuously affects African-American health and the way they receive healthcare. Racism is, at least in part, responsible for the fact African Americans, since arriving as slaves, have had the worst health care, the worst health status, and the worst health outcome of any racial or ethnic group in the U.S. Many famous doctors, philosophers, and scientists of each historical era were involved in creating and perpetuating racial inferiority mythology and stereotypes. Such theories were routinely taught in U.S. medical schools in the 18th, 19th, and first half of the 20th centuries. The conceptualization of race moved from the biological to the sociological sphere with the march of science. The atmosphere created by racial inferiority theories and stereotypes, 246 years of black chattel slavery, along with biased educational processes, almost inevitably led to medical and scientific abuse, unethical experimentation, and overutilization of African-Americans as subjects for teaching and training purposes.

Race: a major health status and outcome variable 1980-1999.

Based on the latest available data, African Americans are faced with persistent, or worsening, wide and deep, race-based health disparities compared to the white or general population as we enter the new millennium. These disparities are a 382-year continuum. There have been two periods of health reform specifically addressing the correction of race-based health disparities. The first period (1865-1872) was linked to Freedmen's Bureau legislation and the second (1965-1975) was a part of the Black Civil Rights Movement. Both had dramatic and positive effects on black health status and outcome, but were discontinued too soon to correct the "slave health deficit." Although African-American health status and outcome is slowly improving, black health has generally stagnated or deteriorated compared to whites since 1980. There is a compelling need for a third period of health reform accompanied by a cultural competence movement to address and correct persistent, often worsening, race-based health disparities.

Endocrine aspects of trophoblastic neoplasia.

The trophoblastic cells in both benign and malignant trophoblastic disease secrete a variety of steroid, polypeptide and hormonal agents. Those substances that are known to be elaborated by the neoplastic trophoblastic tissue include hCG, a substance with TSH-like activity, estrogens, progestogens and placental lactogen. The most well characterized of these is hCG, which can be assayed easily. The level of hCG plays an important role in the diagnosis, management and follow-up of patients with trophoblastic disease. Because of this, a sensitive assay that does not cross-react with LH would be ideal. It appears that some of the clinical signs and symptoms seen in these patients (including toxemia, theca lutein cyst, hyperthyroidism and thyrotoxicosis, and galactorrhea) are a direct manifestation or reflection of the level of hCG. There is very little information available at this time on the pathophysiologic role that hCG plays at the cellular level in causing these signs and symptoms. Many questions remain to be answered regarding the role of the other hormones in trophoblastic disease and how they affect the patient. Additionally, very little is known about the potential use of the other hormones in diagnosis, management and follow-up of patients with trophoblastic disease.

African-American physicians' views on health reform: results of a survey.

Little is known about African-American physicians' health system experience or their opinions on health reform. In an attempt to obtain socioculturally relevant data quantifying these experiences and opinions, the National Medical Association administered a 38-question, 80-item survey instrument in August 1993. The questionnaire was completed by 236 physicians. The results indicate that African-American physicians feel health care is a right and that the health system needs fundamental change. Although there was no consensus on the type of health reform needed, approximately 35% cited availability and access to care to be the greatest problem facing the system with high costs of care (18.2%) ranking second. Unique findings in the survey indicated respondents felt that the needs and concerns of most African Americans will not be fairly addressed in the reform of the health-care system, that African-African physicians are not included in the formation of health-care policies, and that African-American physicians are facing high levels of professional and healthcare system racial discrimination. More than 99% of African-American physicians reported some degree of racial discrimination in the practice of medicine including peer review, obtaining practice privileges at hospitals, hospital staff promotions, Medicaid and Medicare reimbursements, malpractice suits, private insurance oversight and reimbursements, and referral practices of white colleagues. These findings have profound health policy, health financing, and health service delivery implications and should be included in debates and deliberations on health reform.

The African-American cancer crisis, Part II: A prescription.

To appreciate the causes of the African-American cancer crisis, contemporary myths and perceptual gaps regarding cancer in blacks must be analyzed and placed in historical context. Since ancient times, racism has permeated western scientific, medical, and social cultures. Yet contemporary analysts typically frame a 370-year-old African-American health deficit in nonracial terms, and ignore both the metamorphosis of racism and the impact of racism on the prevention, diagnosis, and treatment of cancer; exposure to cancer-causing industrial pollutants; educational opportunities for black health professionals and policymakers, and other factors. If the African-American cancer crisis is to be halted, the growing divergence between urgent needs and meager resources devoted to preventing, detecting, and treating cancer in blacks must be sharply reversed.

The African-American cancer crisis, Part I: The problem.

Over the past 40 years, increasing numbers of Americans have benefited from cancer prevention, early detection, and improved treatment. But a review of site-specific cancer data from 1950 to the present shows that contemporary African-Americans have the highest age-adjusted rates of cancer incidence and mortality of any racial or ethnic group in the United States. Compared to whites, blacks have significantly higher incidence rates for cancers of the lung, prostate, breast (under age 40), colon, pancreas, esophagus, cervix, larynx, stomach, and multiple myeloma. Blacks have significantly higher mortality rates for cancers of the lung, prostate, breast (all ages), colon, pancreas, esophagus, cervix, uterine corpus, larynx, stomach, and multiple myeloma. Moreover, the gap between whites and blacks is widening dramatically. These startling statistics suggest that cancer researchers and policymakers, and the institutions they represent, may not fully appreciate the black cancer experience.

Neurologic conditions causing lameness in companion animals.

Animals presented with non-weight-bearing lameness are a diagnostic challenge for the veterinarian. It is extremely important to distinguish between orthopedic and neurologic causes of lameness, because the diagnostic and therapeutic plans can be quite different. Myopathies can be confused with orthopedic disease because of gait abnormalities and associated muscle pain. Common myopathies seen in companion animal medicine include polymyositis, muscular dystrophy, endocrine and infectious myopathies, and myasthenia gravis. Lameness caused by disease of the nerve root or nerve is confused with orthopedic disease because of the disturbances of a nerve's sensory distribution (nerve-root signature) or disruption of the motor innervation. The diseases of the nerve root or nerve discussed are lateralized intervertebral disk disease, spinal cord neoplasia, malignant peripheral nerve sheath tumors, and traumatic neuropathies. The diagnosis of these diseases requires careful attention to the signalment, a complete history, and a thorough physical examination focusing on the neurologic and orthopedic components. Ancillary testing should be selected based on these results and a minimum database. Electrodiagnostic testing, radiography, and advanced imaging may help to localize the lesion more precisely and sometimes to confirm the diagnosis. Surgical exploration and histopathology often provide the definitive diagnosis. These cases of non-weight-bearing lameness are a diagnostic challenge, but when successful resolution can be reached, it is gratifying to the clinician, client, and patient.

Combination chemotherapy of ovarian carcinoma with cisplatinum and treosulfan--a phase II study.

Twenty-one patients with advanced ovarian carcinoma were treated with a combination of cisplatinum and treosulfan. The overall response rate by clinical and ultrasound assessment was 86%, but ultrasound was less optimistic in assessing 'completeness' of response (48% compared with 67% clinically). The median actuarial survival was 21 months. There was a 54.9% probability of survival at 43 months in those patients with a complete response and a median survival of 15 months in patients with a partial response. The data suggest that while short-term survival may depend upon the extent of residual disease, longer-term survival is determined by response to chemotherapy. The only toxicity of note was haematological.

Endometrial cancer: stage at diagnosis and associated factors in black and white patients.

OBJECTIVE: This study examined the relationship of clinicopathologic, health status, medical system, and socioeconomic factors to differences in stage at diagnosis of endometrial cancer in black and white patients. STUDY DESIGN: A population-based study of 130 black and 329 white patients with invasive endometrial cancer was conducted as part of the National Cancer Institute's Black/White Cancer Survival Study. Logistic regression was used to determine the relative importance of factors thought to be related to stage at diagnosis after age and geographic location were adjusted for. RESULTS: High-grade (poorly differentiated) lesions increased the risk for stage III or IV disease (odds ratio 8.3, 95% confidence interval 3.4 to 20.3), as did serous histologic subtype (odds ratio 3.5, 95% confidence interval 1.4 to 8.8) and no usual source of care (odds ratio 5.5, 95% confidence interval 1.4 to 20.9). In the final statistical model these three factors also accounted for the majority of the excess risk of advanced stage for blacks. CONCLUSIONS: Black-white racial disparities in stage at diagnosis appear to be related to higher-grade lesions and more aggressive histologic subtypes occurring more frequently in black patients with endometrial cancer.