Regulation of gambling in Sub-Saharan Africa: findings from a comparative policy analysis

OBJECTIVES

Commercial gambling markets have undergone unprecedented expansion and diversification in territories across Sub-Saharan Africa (SSA). This gambling boom has popularised the uptake of gambling products in existing circuits of popular culture, sport and leisure and raised concerns about the extent to which state legislation is equipped to regulate the differentiated impacts of gambling on public health.

STUDY DESIGN

Comparative policy analysis.

METHODS

This article provides a systematic mapping of the regulatory environment pertaining to gambling across SSA. The review was conducted by obtaining and triangulating data from a desk review of online materials, consultation with regulatory bodies in each territory and the VIXIO Gambling Compliance database.

RESULTS

Gambling is legally regulated in 41 of 49 (83.6%) SSA countries, prohibited in 7 (14.3%) and is not legislated for in 1 (2.0%). Of those countries that regulate gambling, 25 (61.0%) countries had dedicated regulators and 16 (39.0%) countries regulated via a government department. Only 2 of 41 (4.9%) countries have published annual reports continuously since the formation of regulatory bodies, and 3 (7.3%) countries have published an incomplete series of reports since the formation. In 36 (87.8%) countries, no reports were published. Enforcement activities were documented by all five regulators that published reports.

CONCLUSION

The review uncovered a lack of coherence in regulatory measures and the need for more transparent public reporting across SSA territories. There are also variations in regulating online products and marketing, with most countries lacking apt guidelines for the digital age. Our findings suggest an urgent need to address the regulatory void surrounding online forms of gambling and the promotion of gambling products. This underlines the importance of a public health approach to protect against an increase in gambling-related harms.

The growth of sports betting in Malawi: corporate strategies, public space and public health

OBJECTIVES

Gambling is increasingly positioned as a public health issue, with links to a wide range of harms for individuals, communities and societies. Malawi has experienced a rapid rise in the availability of high street and online sports betting services, situated in a context of extreme inequality and poverty. We aim to document the strategies through which a leading sports betting firm have established a market worth MK2.1bn, to inform future initiatives to mitigate gambling-related harm.

STUDY DESIGN

A case study of strategies deployed by a leading firm to grow a sports betting market in Malawi.

METHODS

We undertook a qualitative media analysis of articles from six major Malawian news outlets and combined this with photographic evidence relating to company advertising and presence in Malawian public space. Data were analysed thematically and triangulated to generate a typology of corporate strategies.

RESULTS

We collected 39 articles and 15 photographs. After we screened the articles, we analysed 27 and identified seven corporate strategies: adopt a mobile network franchise model; use media coverage; purchase high-visibility advertising; sponsor locally; build association with (European) football; appeal to aspects of hegemonic masculinity; construct narratives of individual and collective benefit.

CONCLUSION

Malawi has been exposed to a sophisticated set of corporate strategies aimed at growing a sports betting market. These strategies have been successful, and it is likely that a range of foreseeable gambling-related harms are affecting Malawi. We offer suggestions for how policy-makers and public health professionals might respond.

The intervention process in the European Fans in Training (EuroFIT) trial: a mixed method protocol for evaluation

BACKGROUND

EuroFIT is a gender-sensitised, health and lifestyle program targeting physical activity, sedentary time and dietary behaviours in men. The delivery of the program in football clubs, led by the clubs' community coaches, is designed to both attract and engage men in lifestyle change through an interest in football or loyalty to the club they support. The EuroFIT program will be evaluated in a multicentre pragmatic randomised controlled trial (RCT), for which ~1000 overweight men, aged 30-65 years, will be recruited in 15 top professional football clubs in the Netherlands, Norway, Portugal and the UK. The process evaluation is designed to investigate how implementation within the RCT is achieved in the various football clubs and countries and the processes through which EuroFIT affects outcomes.

METHODS

This mixed methods evaluation is guided by the Medical Research Council (MRC) guidance for conducting process evaluations of complex interventions. Data will be collected in the intervention arm of the EuroFIT trial through: participant questionnaires (n = 500); attendance sheets and coach logs (n = 360); observations of sessions (n = 30); coach questionnaires (n = 30); usage logs from a novel device for self-monitoring physical activity and non-sedentary behaviour (SitFIT); an app-based game to promote social support for physical activity outside program sessions (MatchFIT); interviews with coaches (n = 15); football club representatives (n = 15); and focus groups with participants (n = 30). Written standard operating procedures are used to ensure quality and consistency in data collection and analysis across the participating countries. Data will be analysed thematically within datasets and overall synthesis of findings will address the processes through which the program is implemented in various countries and clubs and through which it affects outcomes, with careful attention to the context of the football club.

DISCUSSION

The process evaluation will provide a comprehensive account of what was necessary to implement the EuroFIT program in professional football clubs within a trial setting and how outcomes were affected by the program. This will allow us to re-appraise the program's conceptual base, optimise the program for post-trial implementation and roll out, and offer suggestions for the development and implementation of future initiatives to promote health and wellbeing through professional sports clubs.

TRIAL REGISTRATION

ISRCTN81935608 . Registered on 16 June 2015.

Performance of a third-generation TSH-receptor antibody in a UK clinic

BACKGROUND

UK national guidelines recommend the measurement of TSH receptor antibodies (TRAb) in certain clinical scenarios. A commercial third-generation TRAb autoantibody M22-biotin ELISA assay was introduced in May 2008 in our centre.

OBJECTIVE

To evaluate the diagnostic performance of a TRAb assay in a retrospective and subsequently a prospective cohort in a UK centre.

DESIGN

A retrospective review of patients with thyroid disease followed by a prospective observational study in consecutive patients with newly found suppressed serum thyrotrophin (TSH).

PATIENTS AND MEASUREMENTS

Medical records of 200 consecutive patients with thyroid disorders who had TRAb measured since the introduction of the assay. In a prospective study 44 patients with newly identified hyperthyroidism (TSH < 0·02 mIU/l) had sera assayed for TRAb prior to their clinic appointment at which a final diagnosis was sought.

RESULTS

In the retrospective cohort, the manufacturer's cut-off point of TRAb ≥0·4 U/l resulted in a positive predictive value (PPV) of 95%, sensitivity 85%, specificity 94% and negative predictive value (NVP) 79% to diagnose Graves' disease using defined criteria. Receiver operating characteristic (ROC) analysis determined an optimal cut-off point of TRAb ≥3·5 U/l with a 100% specificity to exclude patients without Graves' disease at the cost though of a lower sensitivity (43%). In the prospective study, the sensitivity, PPV, specificity and NPV were all 96% using the ≥0·4 U/l cut-off. When combining hyperthyroid patients from both cohorts the assay sensitivity and specificity at ≥0·4 U/l cut-off were 95% and 92% respectively. A positive TRAb result increased the probability of Graves' disease for a particular patient by 25-35% and only six (2·5%) patients had a diagnosis of hyperthyroidism of uncertain aetiology after TRAb testing.

CONCLUSIONS

The assay studied specifically identifies patients with Graves' disease. It is a reliable tool in the initial clinical assessment to determine the aetiology of hyperthyroidism and has the potential for cost-savings.

Performance of a multiplex assay compared to enzyme and precipitation methods for anti-ENA testing in systemic lupus and systemic sclerosis

INTRODUCTION

Testing for autoantibodies to extractable nuclear antigens (ENA) is essential in the investigation of connective tissue disease. Counterimmunoelectrophoresis is an early described testing methodology for antibodies to ENAs, but is labour-intensive, only moderately sensitive, and reliant on high-quality reference sera. Enzyme-linked immunosorbent assay (ELISA) is automatable for relatively high sample throughput, but has issues with false positives. The addressable laser bead immunoassay (ALBIA) is a multiplex technology which can assess several antibody specificities simultaneously on a small serum sample. We report performance of an ALBIA system compared with CIE and ELISA.

METHODS

Samples from 100 systemic sclerosis patients attending Royal Free Hospital in 2007 and 99 SLE patients attending St Thomas's Hospital in 2007-2008 were studied. All samples were tested for antibodies to RNP, Sm, Ro, La, Scl-70, Jo-1 by in-house CIE, FIDIS™ ALBIA (BMD, France), and ELISAs (Phadia, Germany). Cohen's kappa coefficient was used to examine agreement of the different assay methods for the same antibody. McNemar's test was used to detect differences between methodologies.

RESULTS

One sample was positive for anti-Jo-1 by CIE, & confirmed by ALBIA & ELISA. All 198 remaining samples were anti-Jo-1 negative by all 3 methods. With respect to RNP, Ro, La, Scl-70 antibodies, there was good agreement in assay performance between CIE, ALBIA, and ELISA. For Sm, agreement was less good between CIE and ELISA (kappa 0.491), and ALBIA and ELISA (kappa 0.403). Using McNemar's test performance was no different between the 3 assays, with the following exceptions: between CIE and ELISA for Ro-60 (p<0.01) and RNP (p<0.05), and between ALBIA and ELISA for RNP (p<0.01).

CONCLUSIONS

The FIDIS™ ALBIA produced similar level of performance as CIE, but with advantages of automation, and less dependence on highly skilled operators. ALBIA represents a potential advancement applicable to routine Immunology diagnostics.

Clinical immunology review series: an approach to the use of the immunology laboratory in the diagnosis of clinical allergy

In the last 10 years UK immunology laboratories have seen a dramatic increase in the number and range of allergy tests performed. The reasons for this have been an increase in the incidence of immunoglobulin E (IgE)-mediated allergic disease set against a background of greater public awareness and more referrals for assessment. Laboratory testing forms an integral part of a comprehensive allergy service and physicians treating patients with allergic disease need to have an up-to-date knowledge of the range of tests available, their performance parameters and interpretation as well as the accreditation status of the laboratory to which tests are being sent. The aim of this review is to describe the role of the immunology laboratory in the assessment of patients with IgE-mediated allergic disease and provide an up-to-date summary of the tests currently available, their sensitivity, specificity, interpretation and areas of future development.

[Wildlife and emerging diseases]

This article reviews the conditions that allow an infectious or parasitic pathogen to migrate from a wild reservoir to domestic animals and/or humans, and examines the possibility of a new disease emerging as a result. The review presents epidemiological mechanisms grouped into three principal models, illustrating them with examples: the intentional or accidental release of the reservoir host or pathogen; the exceeding of a numerical, ecological or behavioural threshold in the host populations and/or increased exposure of humans and domestic animals due to changes in behaviour; and lastly, an "adaptive" leap that ensures that a new host species finally succumbs to the pathogen and that it spreads among the conquered population. The authors examine the lessons to be drawn from such occurrences in terms of surveillance, prophylaxis and prevention.

Intramuscular plasmid DNA injection can accelerate autoimmune responses

We have investigated if the administration of plasmid vectors engineered for gene delivery into mammalian muscle induced the production of anti-double stranded (ds) DNA and anti-nuclear autoantibodies in normal and autoimmunity-prone mouse models. In normal mice, repeated injection of plasmid DNA did not trigger an anti-DNA response. The presence of eukaryotic transcription factor binding sites in plasmid vectors did not increase autoantibody formation in these animals. In contrast, repeated injection of such plasmids in autoimmunity-prone MRL/MpJ mice caused a significant increase in both anti-dsDNA and anti-nuclear antibody levels. Thus the repeated administration of bacterial plasmids containing eukaryotic promoter elements may induce immune responses with generation of antibodies cross-reacting not only with the mammalian DNA, but also with nuclear antigens. The potential for iatrogenic autoimmunity in susceptible individuals should be considered.

The expression of plasminogen activator system in a rat model of periodontal wound healing

BACKGROUND

The plasminogen activator system has been proposed to play a role in proteolytic degradation of extracellular matrices in tissue remodeling, including wound healing. The aim of this study was to elucidate the presence of components of the plasminogen activator system during different stages of periodontal wound healing.

METHODS

Periodontal wounds were created around the molars of adult rats and healing was followed for 28 days. Immunohistochemical analyses of the healing tissues and an analysis of the periodontal wound healing fluid by ELISA were carried out for the detection of tissue-type plasminogen activator (t-PA), urokinase-type plasminogen activator (u-PA), and 2 plasminogen activator inhibitors (PAI-1 and PAI-2).

RESULTS

During the early stages (days 1 to 3) of periodontal wound healing, PAI-1 and PAI-2 were found to be closely associated with the deposition of a fibrin clot in the gingival sulcus. These components were strongly associated with the infiltrating inflammatory cells around the fibrin clot. During days 3 to 7, u-PA, PAI-1, and PAI-2 were associated with cells (particularly monocytes/macrophages, fibroblasts, and endothelial cells) in the newly formed granulation tissue. During days 7 to 14, a new attachment apparatus was formed during which PAI-1, PAI-2, and u-PA were localized in both periodontal ligament fibroblasts (PDL) and epithelial cells at sites where these cells were attaching to the root surface. In the periodontal wound healing fluid, the concentration for t-PA increased and peaked during the first week. PAI-2 had a similar expression to t-PA, but at a lower level over the entire wound-healing period.

CONCLUSIONS

These findings indicate that the plasminogen activator system is involved in the entire process of periodontal wound healing, in particular with the formation of fibrin matrix on the root surface and its replacement by granulation tissue, as well as the subsequent formation of the attachment of soft tissue to the root surface during the later stages of wound repair.

Class II HLA associations with autoantibodies in scleroderma: a highly significant role for HLA-DP

Scleroderma is a condition of variable phenotype characterised by fibrosis of the skin and internal organs. There is a range of disease-specific autoantibodies found in the sera of patients. The aims of this study were to: (1) investigate the role of the MHC and particularly HLA-DP in the production of autoantibodies; (2) investigate clinical associations with autoantibodies. We have performed HLA class II typing using PCR with sequence-specific primers on DNA samples from 202 scleroderma patients and 307 UK control subjects. All patients had well defined clinical phenotypes. Sera from patients were examined for the presence of disease specific autoantibodies in particular the anti-topoisomerase autoantibody (ATA), the anti-centromere autoantibody (ACA) and the anti-RNA polymerase autoantibody (ARA). There was a striking association between HLA-DPB1*1301 and ATA (Pcorr = 0.0001). In addition, ATA was associated with HLA-DRB1*11 and the anticentromere autoantibody (ACA) with HLA-DRB1*04, HLA-DRB1*08 (P = 0.001) and HLA-DQB1 alleles with a glycine residue at position 26. Very strong associations were detected between clinical phenotypes and autoantibodies. ATA was associated with pulmonary fibrosis (P = 0.00002), anti-RNA polymerase autoantibody (ARA) with renal involvement (P = 0.0000006) and diffuse skin disease (P = 0.00001), and ACA with limited skin involvement (P = 0.00002) and protection against pulmonary fibrosis (P = 0.0000003). We have identified a significant association between the ATA and HLA-DPB1*1301 which may provide an insight into how this autoantibody is formed. Patient clinical characteristics depend on the autoantibodies they carry.

Distribution of novel polymorphisms of the interleukin-8 and CXC receptor 1 and 2 genes in systemic sclerosis and cryptogenic fibrosing alveolitis

OBJECTIVE

To search for single-nucleotide polymorphisms in the interleukin-8 (IL-8) and IL-8 receptor CXCR-1 and CXCR-2 genes, and to compare their distribution among patients with systemic sclerosis (SSc) with fibrosing alveolitis (FASSc) or without fibrosing alveolitis (NFASSc), or patients with cryptogenic fibrosing alveolitis (CFA), and normal healthy subjects.

METHODS

Fifty control subjects were screened for potential polymorphisms by using polymerase chain reaction in association with sequence-specific primers incorporating mismatches at the 3' end. The novel polymorphisms were subsequently examined in British Caucasian subjects, including 194 healthy controls, 71 patients with CFA, and 128 patients with SSc who were further subdivided into 78 FASSc patients and 50 NFASSc patients.

RESULTS

Three novel biallelic polymorphisms were identified in the IL-8 gene (all in noncoding areas of the gene), 1 was found in the CXCR-1 gene (resulting in a conservative amino acid change), and 3 were observed in the CXCR-2 gene, of which the first resulted in a silent codon change and the others were in the 3' untranslated area of exon 3. Compared with controls, a significant increase in the frequency of the CXCR-2 +785 CC homozygote and of the CXCR-2 +1208 TT homozygote was found in the SSc patients (37% versus 22% [P = 0.01] and 33% versus 17% [P = 0.003], respectively). A subgroup analysis revealed this association to be significant both in the FASSc patients and in the NFASSc patients.

CONCLUSION

This report describes an association between SSc and 2 polymorphisms occurring close to each other in the CXCR-2 gene. This finding and its functional significance need to be confirmed and analyzed in future studies.

Distribution of novel polymorphisms of the interleukin-8 and CXC receptor 1 and 2 genes in systemic sclerosis and cryptogenic fibrosing alveolitis

OBJECTIVE

To search for single-nucleotide polymorphisms in the interleukin-8 (IL-8) and IL-8 receptor CXCR-1 and CXCR-2 genes, and to compare their distribution among patients with systemic sclerosis (SSc) with fibrosing alveolitis (FASSc) or without fibrosing alveolitis (NFASSc), or patients with cryptogenic fibrosing alveolitis (CFA), and normal healthy subjects.

METHODS

Fifty control subjects were screened for potential polymorphisms by using polymerase chain reaction in association with sequence-specific primers incorporating mismatches at the 3' end. The novel polymorphisms were subsequently examined in British Caucasian subjects, including 194 healthy controls, 71 patients with CFA, and 128 patients with SSc who were further subdivided into 78 FASSc patients and 50 NFASSc patients.

RESULTS

Three novel biallelic polymorphisms were identified in the IL-8 gene (all in noncoding areas of the gene), 1 was found in the CXCR-1 gene (resulting in a conservative amino acid change), and 3 were observed in the CXCR-2 gene, of which the first resulted in a silent codon change and the others were in the 3' untranslated area of exon 3. Compared with controls, a significant increase in the frequency of the CXCR-2 +785 CC homozygote and of the CXCR-2 +1208 TT homozygote was found in the SSc patients (37% versus 22% [P = 0.01] and 33% versus 17% [P = 0.003], respectively). A subgroup analysis revealed this association to be significant both in the FASSc patients and in the NFASSc patients.

CONCLUSION

This report describes an association between SSc and 2 polymorphisms occurring close to each other in the CXCR-2 gene. This finding and its functional significance need to be confirmed and analyzed in future studies.

Reliability and validity of the dieter's inventory of eating temptations (DIET) in overweight binge eating women

The aim of this study was to evaluate the validity of the Dieter's Inventory of Eating Temptations (DIET). TJye DIET, Tennessee Self-Concept Scale (TSCS), and Binge Eating Scale (BES) were completed by 219 obese, binge-eating women. A 5-factor solution was generated that accounted for 46.9% and 95.0% of the total and common variance, respectively. The DIET demonstrated high internal consistency (alpha=0.93), as did the 5 factors (alphas ranging from 0.71-0.89). The DIET was correlated positively with the TSCS (r=0.212; p=0.002) and negatively with the BES (r=-0.199: p=0.003) suggesting that women who report higher ability to manage problematic diet situations have higher self-esteem and lower binge-related emotional distress. The results of this study suggest that the DIET is a reliable and valid instrument, but the six subscales could probably be reduced to five distinct domains.

Atypical C-ANCA following high dose intravenous immunoglobulin

AIMS

(1) To assess a range of intravenous immunoglobulin products for atypical classical antineutrophil cytoplasmic antibody (C-ANCA) staining and to determine if this is present in patients treated with high dose intravenous immunoglobulin (2 g/kg/month) and replacement doses (200 mg/kg fortnightly); (2) using the United Kingdom national external quality assessment scheme (NEQAS), to determine if laboratories could differentiate this pattern from classical ANCA.

METHODS

ANCA testing was performed on 30 batches of intravenous immunoglobulin from several manufacturers. Six patients treated with high dose intravenous immunoglobulin and 11 receiving replacement doses of immunoglobulin for hypogammaglobulinaemia were tested for ANCA by indirect immunofluorescence on cytospin preparations of ethanol fixed neutrophils and by enzyme linked immunosorbent assay (ELISA). One of the positive immunoglobulin batches was tested blindly by 125 laboratories involved in NEQAS by indirect immunofluorescence and by ELISA in some laboratories.

RESULTS

16 of 31 batches of intravenous immunoglobulin from six different manufacturers were atypical C-ANCA positive. Three of six patients receiving high dose intravenous immunoglobulin and none of 11 patients on replacement doses were atypical C-ANCA positive. The results of the NEQAS assessment by indirect immunofluorescence were 68% C-ANCA positive, 17% negative, 9% atypical C-ANCA, and 6% P-ANCA.

CONCLUSIONS

Some but not all intravenous immunoglobulin products yield a positive atypical cANCA by indirect immunofluorescence. An identical pattern may be observed in patients receiving high dose intravenous immunoglobulin but not in those on replacement doses. Of laboratories participating in NEQAS, 68% reported this pattern as cANCA. This reinforces the importance of reporting only "classical ANCA," defined by international ANCA workshops, to maintain the specificity of ANCA immunofluorescence and its close disease associations.

HLA associations in three mutually exclusive autoantibody subgroups in UK systemic sclerosis patients

Systemic sclerosis (SSc) is characterized by the presence of autoantibodies, mostly IgG, which target a limited set of nuclear proteins. These antinuclear antibodies (ANA) associate with disease subgroups and specific organ involvement. Here we show that there is mutual exclusivity of individual ANA in 130 UK SSc patients, confirm clinical associations with antibody profile and extend the analysis to include genetic data. The ANA mutual exclusivity observed leads to the possibility that SSc, in these patients, is in fact three separate diseases. An alternative explanation for exclusivity relates to the fact that optimal production of IgG antibody requires T-cell help, a process restricted by the HLA class II presentation of antigen peptide. If each autoantibody has a different and tight MHC restriction, then there is a possibility that these groups arose from a common pathway and were modified by genetics into the mutually exclusive groups observed, making the separate disease theory less tenable. In order to answer this question, we have determined MHC class II restriction precisely using high-resolution HLA genotyping (SSP) coupled with an amino acid analysis program in our 130 UK SSc patients. DRB1*11 was associated with anti-topoisomerase-I antibody (ATA)-positive patients (P = 0.007) and when combined with ATA (RR = 15.82), dcSSc (RR = 11.45), or both (RR = 21.9), represented the strongest risk factor for pulmonary fibrosis. Patients with antibodies to RNA polymerases I, II and III were associated with DQB1*0201. At the amino acid level, 20 positions in DRB1 and 20 positions in DQB1 showed some significant correlation with an ANA group. Clearly, however, the linkages to MHC class II alleles are not nearly strong enough to explain the mutually exclusive nature of the autoantibody groups and our results support, but do not prove, the separate disease theory.

Measurement of antibody to poly (adenosine diphosphate-ribose): its diagnostic value in systemic lupus erythematosus

Poly (ADP-ribose) and dsDNA binding activity have been measured in sera from 61 patients with systemic lupus erythematosus (SLE) and 188 control sera from 20 normal individuals, 144 patients with clinically similar diseases and 24 patients with drug-induced anti-nuclear antibodies (ANA). Elevated poly (ADP-ribose) binding was not observed with normal sera. Five of 144 samples from diseases entering the differential diagnosis of SLE gave raised poly (ADP-ribose) binding compared with 12 in the 125I-dsDNA binding. Only two of these false positive samples gave elevated binding in the 14C-dsDNA assay. The apparent high specificity of the poly(ADP-ribose) assay was not observed with samples containing drug-induced ANA where 62% had elevated binding values. The frequency with which the poly(ADP-ribose) assay was positive with SLE sera (sensitivity) was lower than either of the dsDNA assays. This low sensitivity and the high rate of false positives in patients with drug-induced ANA limit the value of the poly(ADP-ribose) assay as a diagnostic test for SLE. However the restriction of poly(ADP-ribose) antibody to SLE and patients with drug-induced ANA together with the known role of poly(ADP-ribose) in DNA excision repair suggest that the antibody may be of fundamental significance.

Frequency and clinical significance of antibodies to ribonucleoprotein in SLE and other connective tissue disease subgroups

Antibodies to the ribonucleoprotein (RNP) component of extractable nuclear antigen were measured in patients with systemic lupus erythematosus (SLE) and other connective tissue subgroups by counterimmunoelectrophoresis. Antibodies to RNP were found in the sera of 32% of patients with a primary diagnosis of SLE, 29% of patients with features of SLE and erosive joint disease, none of 9 scleroderma patients, and in 75% of 8 patients with features of SLE and scleroderma. In the SLE patients overall there was an increased frequency of sclerodactyly and severe Raynaud's phenomenon in the patients with antibodies to RNP but no association of antibodies to RNP was found with the presence of erosive joint disease, Sjögren's syndrome, or the absence of renal disease in these patients.

Antiribonucleoprotein antibodies in connective tissue diseases: estimation by counterimmunoelectrophoresis

One hundred and seventy-two patients with various connective tissue diseases were investigated for the presence of serum antibodies to extractable nuclear antigen (ENA) and its major components, ribonucleo-protein (RNP) and Sm antigen. The counter-immunoelectrophoresis assay allowed independent detection and measurement of antibodies to the different components. All 13 patients with mixed connective tissue disease (MCTD) had anti-RNP antibody in high titres, 16% of patients with systemic lupus erythematosus (SLE) had low titres, and none of the patients with scleroderma had anti-RNP antibody. MCTD seems to be more benign than either SLE or scleroderma. The counterimmunoelectrophoresis assay is a simple and sensitive technique for confirming the diagnosis.

Prevalence of pseudorabies in sows in central Illinois

Of 1,224 serums from slaughtered sows from central Illinois, 52 (4.25%) were found to be positive for pseudorabies neutralizing antibody.