Efficacy of Caprini risk assessment model in predicting venous thromboembolism risks among Asian surgical patients.

INTRODUCTION: Caprini risk assessment model (RAM) has been validated in Caucasians but evidence of its suitability in Asian surgical patients is still unknown. This study aims to determine the efficacy of Caprini model in venous thromboembolism (VTE) risk assessment among Asian surgical patients. MATERIALS AND METHODS: Consecutive surgical patients with Asian ethnicities admitted to a tertiary public hospital between January 2013 and December 2014, were included. Their demographic details, VTE risk factors and scores based on Caprini RAM were recorded. Primary outcome of this study was symptomatic VTE within 90 days of hospitalisation. Fisher's exact test and Lasso regression were performed for statistical analysis. RESULTS: A total of 4206 patients were included in this study. Distribution of this study population by risk level was very low, 14.7%; low, 44.1%; moderate, 25.6% and high, 15.7%. The overall symptomatic VTE incidence within 90 days was 0.5%. The incidence of deep venous thrombosis (DVT), pulmonary embolism (PE) and both was 0.31%, 0.19% and 0.05% respectively. VTE incidence by risk category was very low, 0%; low, 0.16%; moderate, 0.37% and high, 2.12%. Obesity (BMI >25), history of prior major surgery, history of DVT/PE and high-risk category (scores ≥5) were significant VTE factors with odds ratio > 5.0. Following the Caprini RAM with ACCP preventive recommendations, an estimated 85% of surgical patients would need prophylaxis. CONCLUSION: The overall VTE incidence among Asian surgical patients is low. Prophylaxis using Caprini RAM may subject a low incidence patient population to over utilisation of thromboprophylaxis and therefore not cost-effective when applied to Asian patients.

Genomic sequence analysis of four new chrysanthemum virus B isolates: evidence of RNA recombination.

Chrysanthemums worldwide suffer from a high incidence of infection with chrysanthemum virus B (CVB), a member of the genus Carlavirus, family Betaflexiviridae. Three major lineages or strains of this virus have been found in India, but none have been characterized beyond the genetic variation they display in their coat protein genes. Here, we describe the analysis of four near-complete genome sequences (from the three lineages) representing the genetic diversity of these strains. Ranging in size from 8815 to 8855 nucleotides (excluding the polyA tail), these four isolates have a genome organization very similar to that of the recently reported Japanese isolate of CVB, with which they share between 70 and 73% genome-wide sequence identity. We present further evidence that recombination may feature quite prominently in the evolution of CVB.

Velvet bean severe mosaic virus: a distinct begomovirus species causing severe mosaic in Mucuna pruriens (L.) DC.

Velvet bean [Mucuna pruriens (L.) DC] is one of the most important medicinal plants. It is used to treat many ailments, but is widely used for the treatment especially for Parkinson's disease because of the presence of 3,4-dihydroxyphenylalanine (L-dopa) in it. It was noticed in last 5 years that the plants in the field showed severe mosaic, downward curling of the leaves, stunting, etc. This is consistently observed over the years in India. The disease was transmitted by whiteflies and by grafting and the causal agent was found to be a bipartite begomovirus. The whole genome was amplified by rolling circle amplification (RCA) using ϕ-29 DNA polymerase and characterized. DNA-A and DNA-B shared a 124-nucleotide (nt) long highly conserved (98%) common region (CR). Comparisons with other begomovirus showed that DNA-A sequence has highest identity (76%) with an isolate of Mungbean yellow mosaic India virus (MYMIV; AY937195) reported from India. This data suggested that the present isolate is a new species of genus Begomovirus for which the name "Velvet bean severe mosaic virus" (VbSMV) is proposed. DNA-B has a maximum sequence identity of 49% with an isolate of Horsegram yellow mosaic virus (HgYMV; AM932426) reported from India. Infectious clones consisting of a 1.7 mer partial tandem repeat of DNA-A and a dimer of DNB-B were constructed and agro-inoculated to Macuna pruriens (L.) DC plants, which showed field observed symptoms 24 days post-infiltration (dpi). In phylogenetic analysis, DNA-A and DNA-B of the present isolate grouped with DNA-A of different begomoviruses reported from fabaceous crops. The study presents first ever molecular evidence of any disease in velvet bean and whole genome analysis of the causative virus which is a distinct bipartite species of Begomovirus.

Complete nucleotide sequence of cherry virus A (CVA) infecting sweet cherry in India.

Cherry virus A (CVA) is a graft-transmissible member of the genus Capillovirus that infects different stone fruits. Sweet cherry (Prunus avium L; family Rosaceae) is an important deciduous temperate fruit crop in the Western Himalayan region of India. In order to determine the health status of cherry plantations and the incidence of the virus in India, cherry orchards in the states of Jammu and Kashmir (J&K) and Himachal Pradesh (H.P.) were surveyed during the months of May and September 2009. The incidence of CVA was found to be 28 and 13% from J&K and H.P., respectively, by RT-PCR. In order to characterize the virus at the molecular level, the complete genome was amplified by RT-PCR using specific primers. The amplicon of about 7.4 kb was sequenced and was found to be 7,379 bp long, with sequence specificity to CVA. The genome organization was similar to that of isolates characterized earlier, coding for two ORFs, in which ORF 2 is nested in ORF1. The complete sequence was 81 and 84% similar to that of the type isolate at the nucleotide and amino acid level, respectively, with 5' and 3' UTRs of 54 and 299 nucleotides, respectively. This is the first report of the complete nucleotide sequence of cherry virus A infecting sweet cherry in India.

Wild Himalayan Cherry (Prunus cerasoides) as a Natural Host of Prunus necrotic ringspot virus in India.

Prunus cerasoides, also known as wild Himalayan cherry, grows naturally in the Himalayas. A member of the Rosaceae family, the tree has medicinal (astringent) and other (beads, dye, wood) uses. During surveys in the northwestern Himalayan Region of India, necrotic spots were observed on leaves of P. cerasoides. Since the symptoms were typical of Prunus necrotic ringspot virus (PNRSV), preliminary detection was done by double-antibody sandwich (DAS)-ELISA (Agdia, Elkhart, IN). Positive results were obtained three times more than the negative control which is provided in the kit. To further confirm its presence, reverse transcription (RT)-PCR analysis was performed using a primer pair (upstream 5'-AACTGCAGATGGTTTGCCGAATTTGCAA-3'; downstream 5'-GCTCTAGACTAGATCTCAAGCAGGTC-3') specific for the coat protein gene (GenBank Accession Nos. AJ619984 and AJ619983). Amplification of the expected 675-bp fragment was obtained. The sequence of a cloned copy of the amplified product showed 99% similarity to the PNRSV coat protein gene (GenBank Accession No. AF170165), confirming the presence of PNRSV in P. cerasoides (sequence submitted as Accession No. AM493717). The cloned DNA has the potential for utilization as an additional tool, and an early PNRSV screening (both pollen and seed transmitted) will be highly useful to ensure healthy rootstocks are used for grafting purposes (1). PNRSV mainly infects members of the Rosaceae family, including stone fruits and ornamental plants such as peach, plum, cherry, apricot, nectarines, and roses, and was first reported in P. persica (1). Proper management of PNRSV at this level can prevent its transmission and disease development in grafted scions of commercial Prunus spp. Reference: (1) A. A. Brunt et al. Page 1047 in: Viruses of Plants. CAB International, Wallingford, UK. 1996.

Pneumatic retinopexy: success rate and complications.

AIM: To evaluate the success rate and complications of pneumatic retinopexy performed at a university hospital and to identify which patients are best suited for pneumatic retinopexy. METHODS: This was an interventional case series. Retrospective review of 61 patients who had pneumatic retinopexy performed by two retina surgeons at two University of California, San Francisco hospitals between 1998 and 2004. Patients who had been treated for rhegmatogenous retinal detachment (RRD) with pneumatic retinopexy were identified by reviewing operative reports and billing records. The primary outcome measure was anatomical reattachment of the retina with a single intervention. Secondary outcome measures included postoperative visual acuity and postoperative complications. RESULTS: 33 of 61 (54%) cases were successful with a single procedure. 40 of 61 (66%) cases were successful with repeat injection of gas or laser retinopexy alone. All cases had anatomical success at final follow up. Age, myopia, lens status, and number of breaks were not proved to be risk factors for failure. The average duration of follow up was 15 months. CONCLUSIONS: In this case series, pneumatic retinopexy was less effective for the repair of RRD than most large published reports. However, failure of pneumatic retinopexy followed by scleral buckle or pars plana vitrectomy did not negatively influence visual acuity at final follow up.

Coat protein sequence shows that Cucumber mosaic virus isolate from geraniums (Pelargonium spp.) belongs to subgroup II.

A viral disease was identified on geraniums (Pelargonium spp.) grown in a greenhouse at the Institute of Himalayan Bioresource Technology (IHBT), Palampur, exhibiting mild mottling and stunting. The causal virus (Cucumber mosaic virus, CMV) was identified and characterized on the basis of host range, aphid transmission, enzyme linked immunosorbent assay (ELISA), DNA-RNA hybridization and reverse transcription polymerase chain reaction (RT-PCR). A complete coat protein (CP) gene was amplified using degenerate primers and sequenced. The CP gene showed nucleotide and amino acid homology up to 97%-98% and 96%-99%, respectively with the sequences of CMV subgroup II. The CP gene also showed homologies of 75%-97% in nucleotide and 77%-96% in amino acid with the CMV Indian isolates infecting various crops. On the basis of sequence homology, it was concluded that CMV-infecting geraniums in India belong to subgroup II.

Plant parasitic and vector nematodes associated with Asiatic and Oriental hybrid lilies.

A survey for distribution and abundance of plant parasitic nematodes in fields grown to Lilium in Himachal Pradesh, India at four study sites viz. Nagrota (at 810 m a.s.l.), Palampur (at 1270 m a.s.l.), Sunder Nagar (at 1400 m a.s.l.) and Chail (at 2250 m a.s.l.) was carried out. Moderate (101-500/200 ml soil) to high (501-1000/200 ml soil) populations of phytonematodes including the vectors for plant viruses (Aphelenchoides avenae, Criconemoides spp., Hoplolaimus spp., Longidorus spp., Paratylenchus spp., Pratylenchus spp., Rhabditis spp., Trichodorus spp., Tylenchoryhnchus spp., Tylenchulus spp. and Xiphinema diversicaudatum) were recorded. Mean population of nematodes was positively correlated with pH in all the study sites, negatively correlated with electrical conductivity (EC), percent organic matter (OM%), available potassium (K) and positively correlated with percent carbon (C%), available nitrogen (N) and available phosphorus (P) in all but one study site. The highest incidence of virus-vector nematodes viz. X. diversicaudatum, Longidorus spp. and Trichodorus spp. was recorded at Palampur. Only Strawberry latent ringspot nepovirus (SLRSV) was detected in Lilium cvs. Star Gazer Max and Galeili by Enzyme Linked Immunosorbent Assay (ELISA) and reverse transcription polymerase chain reaction (RT-PCR) and in X. diversicaudatum associated with the cultivars by RT-PCR. Cucumis sativus used as bait plants showed SLRSV symptoms after 15 days of nematode inoculation and further SLRSV was again detected by ELISA and RT-PCR in C. sativus plants confirming the transmission of SLRSV by X. diversicaudatum in Lilium.

Blinded proficiency testing of FTA-ABS test.

In 1976 and 1977, 28 state laboratories participated in a blinded proficiency testing study of syphilis serologic tests. The test considered of a battery of 50 duplicate reagin-positive sera; 12 specimens were obtained from syphilitic patients. The median reproducibility scores for the VDRL and FTA-ABS tests were the same, 92%, and the scores for the two tests were correlated. Given the relatively low prevalence of untreated syphilis in the United States today, serologic results that are highly predictive of syphilis are obtainable only from the most proficient laboratories, if unselected sera are tested. Reactivity in the VDRL and FTA-ABS tests does not prove the diagnosis of syphilis. Physicians must use clinical judgment to preselect patients for serologic testing.

Natural Occurrence of a Potyvirus on Murraya koenigii in India.

Murraya koenigii (L.) Spreng., a small, strong-smelling umbrageous tree with subcampanulate white flowers belonging to the family Rutaceae, is native to India and southeastern Asia (2). It is distributed across the Indian subcontinent excluding the higher elevations of the Himalayas. In India, the leaves are mainly used for culinary purposes. The leaves are commonly known as curry leaves or 'sweet neem'. The whole plant including bark, root, leaves, fruits, and fruit pulp is used medicinally. This plant was reported to be a host of Citrus tristeza virus (1). In a survey of potyvirus incidence in the northwestern Himalaya foothills of the Kangra and Hamirpur districts in the state of Himachal Pradesh in 2004, M. koenigii plants showing mosaic symptoms on leaves, typical of a virus infection, were frequently observed. Symptomatic leaves were tested for the presence of several viruses using enzyme-linked immunosorbent assay with specific antibodies. Positive results were obtained with potyvirus group specific antibodies (Agdia, Elkhardt, IN) in triplicate analyses of 5 of 15 leaf samples tested. To further identify the infecting virus, RNA from plants was tested using universal potyvirus primer pair P9502 and CPUP (3) and reverse transcription-polymerase chain reaction to amplify a genome fragment encoding portions of the coat protein and the 3'UTR (3). An amplification product of the expected size (~800 bp) was obtained. The product was cloned into the pGem-T easy vector (Promega, Madison, WI), and three clones were sequenced. The sequence (GenBank Accession No. AJ852504) had 92% identity to Chili vein banding mottle virus, a potyvirus infecting pepper reported from Thailand (GenBank Accession No. U72193). To our knowledge, this is the first report of a potyvirus naturally occurring on a Murraya sp. References: (1) K. Balaram and K. Ramakrishnan. Curr. Sci. 48:453, 1979. (2) J. D. Hooker. Flora British India 1:502, 1875. (3) R. A. A. van der Vlugt et al. Phytopathology. 89:148, 1999.

A simplified strategy for studying the etiology of viral diseases: Apple stem grooving virus as a case study.

A simple method to amplify infective, complete genomes of single stranded RNA viruses by long distance PCR (LD PCR) from woody plant tissues is described in detail. The present protocol eliminates partial purification of viral particles and the amplification is achieved in three steps: (i) easy preparation of template RNA by incorporating a pre processing step before loading onto the column (ii) reverse transcription by AMV or Superscript reverse transcriptase and (iii) amplification of cDNA by LD PCR using LA or Protoscript Taq DNA polymerase. Incorporation of a preprocessing step helped to isolate consistent quality RNA from recalcitrant woody tissues such as apple, which was critical for efficient amplification of the complete genomes of Apple stem pitting virus (ASPV), Apple stem grooving virus (ASGV) and Apple chlorotic leaf spot virus (ACLSV). Complete genome of ASGV was cloned under T7 RNA polymerase promoter and was confirmed to be infectious through transcript inoculation producing symptoms similar to the wild type virus. This is the first report for the largest RNA virus genome amplified by PCR from total nucleic acid extracts of woody plant tissues.

Decreasing prevalence hides a high HIV incidence: Miami.

OBJECTIVE: Study methods of assessing HIV trends in sexually transmitted disease (STD) clinics where blinded seroprevalence has been among the highest in the United States. DESIGN: Cross-sectional and retrospective cohort. METHODS: Reviewed computerized records of the four Miami STD clinics for 1987-1992. RESULTS: A total of 53,403 persons had 70,793 tests. When testing began, 13% were HIV-positive. By 1992, 35% of all tests were performed on previously HIV-negative persons. This caused a faster decline in overall seroprevalence (to 7%) compared with seroprevalence among persons tested for the first time (to 9%). The percentage of tests performed for previously HIV-negative persons varied among age, race and sex subgroups, causing confounding if overall seroprevalence was used to compare groups. Seroconversion occurred in 514 patients. Black women were most likely to be positive on retesting (4.3%). Incidence rates did not change much over time, remaining at 2.5% per year. CONCLUSIONS: When using a routine HIV-testing data to analyze trends, separate analyses should be undertaken for patients who were (or were not) previously tested. In these patients, the prevalence decreased slightly but incidence remained high, particularly among black women.

High rate of HIV seroconversion among patients attending urban sexually transmitted disease clinics.

OBJECTIVE: To study rates of documented HIV seroconversion and syphilis as a cofactor for seroconversion in sexually transmitted disease (STD) clinics. In the main clinic the HIV seroprevalence rate was 12% and most infections had been shown to be acquired by heterosexual contact. METHODS: We analyzed computer records of patients who had at least two HIV-antibody tests between 1 December 1987 and 31 December 1990, at STD clinics in Dade County (Miami), Florida. RESULTS: Of 5164 individuals with two HIV tests, 208 (4.0%) seroconverted. The overall seroconversion rate was 3.1 per 100 person-years. Among blacks, who accounted for 77% of seroconversions, the rate was higher for women (4.8) than for men (2.7). The highest rate was in 15-19-year-old black women (7.1 per 100 person-years). The HIV seroconversion rate was 12.8 for patients with primary or secondary syphilis diagnosed between two HIV tests, 3.1 for patients who acquired syphilis before their first HIV test, and 2.3 for patients who had never had syphilis. Eighteen per cent of all HIV seroconversions were attributable to syphilis acquired in the interval between two HIV tests. CONCLUSIONS: We found high HIV seroconversion rates, especially among black teenagers and black women, in an STD clinic population in which the majority of HIV infections were shown previously to have been acquired heterosexually. Syphilis was a marker for HIV seroconversion and syphilitic ulcers may facilitate HIV transmission. Innovative prevention programs directed towards women and adolescents should be developed and evaluated.

Geography of AIDS-associated Kaposi's sarcoma in Europe.

BACKGROUND: Classical Kaposi's sarcoma (KS) is about four times more common in southern Europeans than in northern Europeans. OBJECTIVE: To describe the epidemiology of AIDS-associated KS (AIDS-KS) in Europe and to determine whether it occurs with increased frequency in southern Europe. METHODS: Analysis of the 'European non-aggregate AIDS data set', as of September 1995. Countries with a cumulative total of > or = 50 KS cases as the presenting manifestation of AIDS were included. Homosexual men were excluded from south versus non-south comparisons because of possible confounding effects due to their route of HIV transmission. RESULTS: KS was the presenting manifestation of AIDS for 13.3% (16,367 out of 122,679) of men and 2% (491 out of 24,826) of women. In all countries, the risk for KS was higher in individuals who acquired HIV infection via sexual rather than parenteral transmission. Among AIDS patients, there is little difference by sex in the risk of KS in injecting drug users (IDU) or transfusion recipients. The percentage with KS increased with age among homosexual and bisexual men, from 10% in the age group 15-19 years to 23% in the age group 30-39 years. In all countries, the percentage with KS declined over time. The risk of KS was not significantly higher in southern Europe. The percentage with KS in southern Europe was slightly lower than in northern Europe (P > 0.1) in male IDU (1.8% versus 2.1%), and only slightly higher (P > 0.1) in female IDU (1.5% versus 1.1%), in male transfusion recipients (3.5% versus 3.0%), in female transfusion recipients (2.4% versus 2.3%), and in both heterosexual men (7.5% versus 6.2%) and women (2.0% versus 1.6%) excluding those originating from countries where heterosexual HIV transmission is frequent. CONCLUSIONS: The strong geographic predilection described for classical KS in southern Europe was not seen for AIDS-KS. If KS is caused by a viral infection in an immunodeficient host, our findings suggest the geographical variations in classical KS are not due to variation in prevalence of the causative virus but may be due to geographical variations in the prevalence of a form of mild immunodeficiency.

Decline in sexually transmitted disease prevalence in female Bolivian sex workers: impact of an HIV prevention project.

OBJECTIVE: To implement an HIV prevention intervention among female commercial sex workers (CSW), and to monitor key outcomes using routinely collected clinical and laboratory data. DESIGN: Cross-sectional and longitudinal analysis of data from an open-enrollment cohort. SETTING: One public sexually transmitted disease (STD) clinic and about 25 brothels in La Paz, Bolivia. PARTICIPANTS: A total of 508 female CSW who work at brothels and attend a public STD clinic. INTERVENTION: Improved STD clinical care, supported by periodic laboratory testing, and behavioral interventions performed by a local non-governmental organization. MAIN OUTCOME MEASURES: Prevalence of gonorrhea, syphilis (reactive plasma reagin titer > or = 1 : 16), genital ulcer disease, chlamydial infection, and trichomoniasis; self-reported condom use in the previous month; and HIV seroprevalence. RESULTS: From 1992 through 1995, prevalence of gonorrhea among CSW declined from 25.8 to 9.9% (P < 0.001), syphilis from 14.9 to 8.7% (P = 0.02), and genital ulcer disease from 5.7 to 1.3% (P = 0.006); trends in prevalence of chlamydial infection and trichomoniasis were not significant. Self-reported condom use during vaginal sex in the past month increased from 36.3 to 72.5% (P < 0.001). In a multivariate analysis, condom use was inversely associated with gonorrhea [odds ratio (OR), 0.63; 95% confidence interval (Cl), 0.41-0.97], syphilis (OR, 0.39; 95% Cl, 0.23-0.64), and trichomoniasis (OR, 0.44; 95% Cl, 0.32-0.71). In 1995, HIV seroprevalence among CSW was 0.1%. CONCLUSION: Effective prevention interventions for female CSW can be implemented through public services and non-governmental organizations while HIV rates are still low, and key outcomes can be monitored using data obtained from periodic screening examinations.

Maternal hypertension and associated pregnancy complications among African-American and other women in the United States.

OBJECTIVE: To characterize maternal hypertension and related pregnancy complications among African-American and other women in the United States. METHODS: Using data from the National Hospital Discharge Survey, we analyzed the incidence and clinical spectrum of maternal hypertension among African-American women who delivered in hospital during 1988-1992. Maternal hypertension consisted of pregnancy-induced hypertension and chronic hypertension preceding pregnancy, including pregnancy-aggravated hypertension. Pregnancy-induced hypertension included preeclampsia, eclampsia, and transient hypertension. Incidence rates (per 1000 deliveries) and 95% confidence intervals (CI) were calculated by type of hypertension and demographic characteristics. Risk ratios and 95% CIs for adverse pregnancy outcomes among women with hypertension were also calculated. RESULTS: The overall incidence of all causes of maternal hypertension was 64.2, and of chronic hypertension preceding pregnancy it was 25.0 per 1000 deliveries among African-American women, an excess of 15.6 and 14.5 cases per 1000 deliveries, respectively, compared with rates for other women. The risks of preterm delivery and inadequate fetal growth were similarly increased for all hypertensive women, regardless of race. However, hypertensive African-American women were at a threefold greater risk of pregnancies complicated by antepartum hemorrhage, an association that was not observed, in other women. Development of preeclampsia and eclampsia irrespective of race was about four times higher among women with chronic hypertension preceding pregnancy than among those without chronic hypertension. CONCLUSION: The excess incidence of maternal hypertension, particularly chronic hypertension, may contribute to adverse maternal and fetal pregnancy outcomes and the disparity in outcomes observed between African-American and other women in the U.S. These findings provide a specific focus for further clinical outcomes research and assessment of prenatal management in African-American women.

Differences in hormonal patterns during the first postabortion menstrual cycle after two techniques of termination of pregnancy.

Fifteen patients underwent first-trimester abortion by one of two techniques. In group P, seven patients received prostaglandin vaginal suppositories during the 12 hours prior to vacuum aspiration, whereas eight patients in group V were aborted by aspiration alone. During the first postabortion menstrual cycle, daily peripheral blood levels of several hormones, including follicle-stimulating hormone (FSH), luteinizing hormone, human chorionic gonadotropin, estradiol, and progesterone, were determined. Patients in group P demonstrated a more rapid fall in progesterone levels following pregnancy termination (P less than 0.01). They also experienced a more physiologic first postabortion cycle as evidenced by a larger preovulatory estradiol peak (P less than 0.05) and a more normal luteal phase as judged by both the duration and elevation of progesterone levels. Certain endocrine changes common to both groups but different from those of normally menstruating women were also observed. These consisted of short-term spurts of progesterone secretion in many patients (10 of 15) prior to ovulation and exaggerated levels of FSH during the early follicular phase.

PIP: This study investigated hormonal patterns in 2 groups of women following termination of pregnancy, in order to determine whether the patterns conform to those in a normal cycle. 15 patients underwent first trimester abortion by either PG (Prostaglandin) vaginal suppositories (N=7) during the 12 hours prior to vacuum aspiration, or by vacuum aspiration alone (N=8). During the 1st postabortion menstrual cycle, daily peripheral blood levels of FSH (follicle stimulating hormone), LH (luteinizing hormone), hCG (human chorionic gonadotropin), estradiol, and progesterone were determimed. HCG disappearance did not vary among the 2 groups and the mean for its elimination was 30 days. All experienced a large increase in FSH between 1 and 2 weeks postabortion. Estradiol levels fell and LH levels peaked. Patients in Group P demonstrated a more rapid fall in progesterone levels following pregnancy termination (p 0.01). Also, they experienced a more physiologic 1st postabortion cycle as evidenced by a larger preovulatory estradiol peak (p 0.05), and a more normal luteal phase, as judged by both the duration and elevation of progesterone levels. Certain endocrine changes common to both groups but different from those of normally menstruating women were observed, such as short-term spurts of progesterone secretion in many patients (10 of 15) prior to ovulation, and exaggerated levels of FSH during the early follicular phase. From observed data, it would seem that those patients whose pregnancies were terminated by PGs had normal postabortion cycles whereas those aborted by vacuum aspiration did not.

Trabeculectomy: a review and 4-year follow-up.

Since the first attempt at glaucoma surgery in 1830 many surgical procedures have been devised and adopted depending on the understanding of the aetiology and pathogenesis of the disease. Trabeculectomy, the most recent drainage procedure for glaucoma, has become a widely used, effective, and safe method, particularly for chronic simple glaucoma. Up to 4 years' follow-up of 66 eyes (55 patients) is reported. The findings at 6 months, 1 year, 2 years, 3 years, and 4 years were in agreement with previous reports by other authors. The main postoperative complication was transient hyphaema. Of the total number of eyes, 7 needed miotic drops and 5 required further surgical procedures to control the intraocular pressure.

The influence of safety belt laws on self-reported safety belt use in the United States.

We assessed rates and trends in safety belt use by presence and type of safety belt law using data from states participating in the 1984-1989 Behavioral Risk Factor Surveillance System. State(s) with a safety belt law allowing law enforcement officers to stop vehicles for occupants' failure to use safety belts (primary enforcement law) had greater and more rapid increases in safety belt use rates than did states with laws requiring that vehicles must first be stopped for some other violation before a citation or fine for occupants' failure to use safety belts could be imposed (secondary enforcement law). Larger and sustained increases in safety belt use occurred when safety belt laws became effective or when fines were imposed for violations than when laws were first enacted. These data suggest that primary enforcement laws result in greater and more rapid increases in safety belt use than do secondary enforcement laws, and that initial increases in safety belt use following implementation of laws are sustained.

Rubus ellipticus, a Perennial Weed Host of Prunus Necrotic Ring Spot Virus in India.

Rubus ellipticus is a perennial shrub occurring in natural vegetation of the temperate and subtropical Himalayas. For several years, plants of R. ellipticus in and around the Institute of Himalayan Bioresource Technology in Palampur were seen with mild mosaic and chlorotic symptoms on leaves followed by necrotic ring spots. Infected plants often recovered from the symptoms. The causal agent was mechanically transmissible to several herbaceous hosts including Cucumis sativus, Chenopodium album, C. quinoa, Cucurbita maxima, C. pepo, Melilotus alba, Trifolium repens, and Zinnia elegans. The virus incited chlorotic local lesions followed by systemic necrotic lesions or ring spots and severe stunting on C. sativus. Several aphid species (Myzus persicae, Aphis gossypii, A.fabae-solanella, Brevicoryne brassicae, and Macrosiphoniella sanbornii) were tried as viral vectors, but all failed to transmit the virus. Virus has been detected in pollen and fruit of infected plants. Ilarvirus-like particles, 27 nm in diameter, were observed in partially purified extracts of symptomatic plants of R. ellipticus and in experimentally infected C. sativus plants, but not in healthy plants. The isolate was distantly serologically related to apple mosaic virus and unrelated to tobacco streak virus. Presence of Prunus necrotic ring spot virus (PNRSV) in symptomatic plants was also confirmed by enzyme-linked immunosorbent assay with antiserum from American Type Culture Collection and Agdia, Inc. (Elkhart, IN). This is the first report of a viral disease in R. ellipticus. The presence of PNRSV in a new weed host may become an important constraint to production of susceptible agronomic crops around Palampur.