Abstract. High levels of genetic diversity in Plasmodium falciparum populations are an obstacle to malaria control. Here, we investigate the relationship between local variation in malaria epidemiology and parasite genetic diversity in Papua New Guinea (PNG). Cross-sectional malaria surveys were performed in 14 villages spanning four distinct malariaendemic areas on the north coast, including one area that was sampled during the dry season. High-resolution msp2 genotyping of 2,147 blood samples identified 761 P. falciparum infections containing a total of 1,392 clones whose genotypes were used to measure genetic diversity. Considerable variability in infection prevalence and mean multiplicity of infection was observed at all of the study sites, with the area sampled during the dry season showing particularly striking local variability. Genetic diversity was strongly associated with multiplicity of infection but not with infection prevalence. In highly endemic areas, differences in infection prevalence may not translate into a decrease in parasite population diversity.

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Continued from page 165.) Wounds of the Pancreas.Of all abdominal organs the pancreas is most exempt from injury, both from direct and indirect violence, a circumstance which is entirely due to its remote location, and the ample protection furnished by the vertebral column and the bony walls of the chest. The anatomical rela¬ tions of the pancreas to numerous and important organs are such that when this organ is injured the same violence which has produced the injury has also wounded an adjacent and perhaps more important viscus.The frequency with which such grave complications attend wounds of the pancreas, and the profuse hemorrhage which usually attends such injury, are elements of danger which impart to wounds of the pancreas more than an ordinary degree of gravity. Contusion.Case I.-Cooper [Lancet, Dec. 31,1839, vol. i. P. 486) reports the case of a man, aged thirty-three years, run over by a light cart, moving with great speed. No marks of external injury were visible, but the lower left ribs were fractured, and the pancreas was literally smashed, and embedded in semicoagulated blood. The spleen and left kidney were also ruptured. He died a few days after the accident.Case il.-Travers [Lancet, 1827, vol. xii. p. 384) observed a case of lacera¬ tion of the pancreas at St. Thomas's Hospital. An intoxicated woman was knocked down by the wheel of a stage-coach, which, however, did not pass over her. She lived only a few hours. Several ribs were fractured; the pan¬ creas was found completely torn through transversely, the liver was lacerated, and much blood was effused. Case in.->Storck {Annus Medicus, 1836, p. 244) mentions the case of a woman who was run over by a coach, and who died within a few hours. The pancreas was found completely torn in two, and embedded in a large massof semifluid blood. Several ribs were fractured, and the liver was also ruptured.Case IV.-M. Le Gros Clark [Led. on Princ. Surg. Diag., 1870, p. 298) observed an instance of subcutaneous laceration of the pancreas, which occurred in a lad who was also the subject of other severe injuries that speedily proved fatal.Penetrating Wound of Abdomen, with Protrusion of Pancreas. Case V.-Laborderie {Gazette des HCpitaux, 1856, No. 2) reports the case of a girl, aged ten years, wlio had fallen, while running, upon an open pocketknife, which inflicted a wound two centimetres below the lower border of the

Objective. To investigate the potential structural and metabolic role of skeletal muscle in systemic lupus erythematosus (SLE)-related fatigue.Methods. A case-control, multimodal magnetic resonance imaging (MRI) study was conducted. Cases were patients with inactive SLE who reported chronic fatigue. Controls were age-and sex-matched healthy members of the general population. Patients were clinically characterized and then underwent a 3T whole-body MRI scan. Resting and dynamic 31 P MRI spectroscopy of the calf muscles was applied, from which phosphocreatine (PCr) recovery halftime, a marker of mitochondrial dysfunction, was computed. In addition, microstructural sequences (T1-weighted anatomic images, T2 mapping, and diffusion tensor imaging) were acquired. Descriptive statistics evaluated group differences and within-case physical fatigue correlations were explored.Results. Of the 37 recruits (mean age 43.8 years, 89.2% female), cases (n = 19) reported higher levels of physical fatigue, pain, depression, and sleep disturbance compared to the control group (P < 0.0001). PCr was greater (P = 0.045) among cases (mean ± SD 33.0 ± 9.0 seconds) compared to controls (mean ± SD 27.1 ± 6.6 seconds). No microstructural group differences were observed. Within cases, physical fatigue did not correlate with PCr (r = -0.28, P = 0.25).Conclusion. We report preliminary data demonstrating greater skeletal muscle mitochondrial dysfunction among fatigued patients with SLE compared to healthy controls.

Background Response guided treatment in breast cancer is highly desirable, but the effectiveness is only established based on residual cellularity from histopathological analysis after surgery. Tubule formation, a key component of grading score, is directly associated with cellularity, with significant implications on prognosis. Peri-tumoural lipid composition, a potential marker, can be rapidly mapped across the entire breast using novel method of chemical shift-encoded imaging, enabling the quantification of spatial distribution. We hypothesise that peri-tumoural spatial distribution of lipid composition is sensitive to tumour cellular differentiation and proliferative activity. Methods Twenty whole tumour specimens freshly excised from patients with invasive ductal carcinoma (9 Score 2 and 11 Score 3 in tubule formation) were scanned on a 3 T clinical scanner (Achieva TX, Philips Healthcare). Quantitative lipid composition maps were acquired for polyunsaturated, monounsaturated, and saturated fatty acids (PUFA, MUFA, SFA). The peri-tumoural spatial distribution (mean, skewness, entropy and kurtosis) of each lipid constituent were then computed. The proliferative activity marker Ki-67 and tumour-infiltrating lymphocytes (TILs) were assessed histologically. Results For MUFA, there were significant differences between groups in mean (p = 0.0119), skewness (p = 0.0116), entropy (p = 0.0223), kurtosis (p = 0.0381), and correlations against Ki-67 in mean (ρ = -0.5414), skewness (ρ = 0.6045) and entropy (ρ = 0.6677), and TILs in mean (ρ = -0.4621). For SFA, there were significant differences between groups in mean (p = 0.0329) and skewness (p = 0.0111), and correlation against Ki-67 in mean (ρ = 0.5910). For PUFA, there was no significant difference in mean, skewness, entropy or kurtosis between the groups. Conclusions There was an association between peri-tumoural spatial distribution of lipid composition with tumour cellular differentiation and proliferation. Peri-tumoural lipid composition imaging might have potential in non-invasive quantitative assessment of patients with breast cancer for treatment planning and monitoring.