Invited Article: miniTimeCube

We present the development of the miniTimeCube (mTC), a novel compact neutrino detector. The mTC is a multipurpose detector, aiming to detect not only neutrinos but also fast/thermal neutrons. Potential applications include the counterproliferation of nuclear materials and the investigation of antineutrino short-baseline effects. The mTC is a plastic 0.2% (10)B-doped scintillator (13 cm)(3) cube surrounded by 24 Micro-Channel Plate (MCP) photon detectors, each with an 8 × 8 anode totaling 1536 individual channels/pixels viewing the scintillator. It uses custom-made electronics modules which mount on top of the MCPs, making our detector compact and able to both distinguish different types of events and reject noise in real time. The detector is currently deployed and being tested at the National Institute of Standards and Technology Center for Neutron Research nuclear reactor (20 MWth) in Gaithersburg MD. A shield for further tests is being constructed, and calibration and upgrades are ongoing. The mTC's improved spatiotemporal resolution will allow for determination of incident particle directions beyond previous capabilities.

Prognostic factors in the diagnostic work-up of cancer patients in an internal medicine department: does age matter?

INTRODUCTION

Increasing life expectancy in the general population has led to a rise in the incidence of cancer and new challenges with regard to the diagnosis, therapy and prognosis of this disease.

AIM

To assess prognostic factors in the initial work-up of patients ultimately diagnosed with cancer in an Internal Medicine Service, particularly those related with age.

PATIENTS AND METHODS

A prospective study was undertaken with 224 patients ultimately diagnosed with cancer, as confirmed by histological or cytological study. The neoplasms included respiratory, gastrointestinal, genitourinary, metastatic adenocarcinoma of unknown origin, gynaecological, hepatobiliary and others. Before reaching the diagnosis, the following factors were investigated in all patients: functional status [Karnofsky Performance Status (KPS)], comorbidity (Charlson scale), body mass index (BMI), serum cholesterol and albumin concentrations, cognitive level (Mini-mental test), quality of life (Short Form 36 questionnaire), and extension of the disease according to established criteria. Survival at 1 year was analysed. Statistical analyses were done with spss 11.0 for Windows, using a forward stepwise (likelihood ratio) method to construct the model and a Cox multivariate model for the survival analysis.

RESULTS

A total of 224 patients, 167 men (74.5%) and 57 women (25.5%), with a mean age of 66.1 +/- 12.3 years were studied. KPS was >or= 70 in 84% and comorbidity was zero or one in 74%. BMI was 24.25 +/- 4.3, cholesterol 180.7 +/- 4.3, albumin 3.32 +/- 0.5 and Mini-mental score 25.4 +/- 3.7. Metastasis was seen in 131 patients (58.5%) and local disease in 93 cases (41.5%). One-year survival was 38.8% (87 patients) with a mean of 203.8 +/- 143 days. In the Cox analysis, the independent predictive factors for survival were KPS [hazard ratio (HR) = 0.951; 95% CI = 0.930-0.974; p < 0.01], metastatic dissemination (HR = 2.422; 95% CI = 1.643-3.571; p < 0.01), physical quality of life (HR = 0.978; 95% CI = 0.962-0.995; p < 0.01) and albumin (HR = 0.653; 95% CI = 0.455-0.936; p < 0.01).

CONCLUSIONS

In the initial work-up of patients ultimately diagnosed with cancer in an Internal Medicine Service, functional status, dissemination, the physical component in the quality of life scale and serum albumin levels were independent prognostic factors for survival. Age was not an independent prognostic factor and should not be used as a basis for adopting diagnostic or therapeutic decisions in these patients.

62-kb plasmids harboring rulAB homologues confer UV-tolerance and epiphytic fitness to Pseudomonas syringae pv. syringae mango isolates

The presence of genetic determinants homologous to rulAB genes for ultraviolet (UV) radiation resistance was determined in a collection of Pseudomonas syringae pv. syringae strains isolated from mango. The potential role of these plasmids in UV tolerance and ecological fitness in the mango phyllosphere was also evaluated. Nearly all of the 62-kb plasmids present in the P. syringae pv. syringae strains hybridized with a rulAB probe, but these 62-kb plasmids showed differences in restriction patterns. In vitro assays of tolerance to UV radiation of P. syringae pv. syringae strains showed a higher survival of the strains harboring the 62-kb plasmids compared to strains lacking plasmids when exposed to UVC or UVA+B fractions. Similar results were observed when transconjugants harboring the 62-kb plasmid were tested. Survival assays were carried out under field conditions, and a higher survival of P. syringae pv. syringae strains harboring 62-kb plasmids under direct solar radiation on the adaxial surface of leaves was also observed. When the assays were carried out in shady areas or on the abaxial surface of leaves, survival time was comparable for all the assayed strains, whether or not they contained a 62-kb plasmid hybridizing to rulAB. Our results indicate that P. syringae pv. syringae strains harboring 62-kb plasmids show an increase in ecological fitness when colonizing the mango phyllosphere.

Patterns of the circumflex femoral arteries revisited

Knowledge of variations of the circumflex femoral arteries is important when undertaking clinical procedures within the femoral region and in hip joint replacement. Since the 19th century, many different patterns have been proposed to classify their origins. This work studied a statistically reliable sample, the lower limbs of 221 embalmed human cadavers (equal right-left and approximately equal sex distributions), and reviewed the previous literature to propose a unified and simple classification that will be useful to clinicians. Statistical comparisons were made using the chi(2) test. The medial and lateral circumflex femoral arteries have been classified into three different patterns based on the levels of their origin. Distribution related to sex and side was also studied. Pattern I: Both arteries arose from the deep femoral artery (346 cases, 78.8%). This pattern was more frequent in females, P = 0.01. There was no significant difference between sides. Type Ia, medial circumflex femoral artery origin was proximal to the lateral circumflex femoral artery origin (53.2%); Type Ib, lateral circumflex femoral artery origin was proximal to medial circumflex femoral artery origin (23.4%); Type Ic, both arteries arose from a common trunk (23.4%). Pattern II: One of the arteries arose from the femoral artery and the other from the deep femoral artery (90 cases, 20.5%). Type IIa, the medial circumflex femoral artery arose from the femoral artery (77.8%) and Type IIb, the lateral circumflex femoral artery arose from the femoral artery (22.2%). There were no significant differences between sexes or sides. Pattern III: Both arteries arose from the femoral artery (2 cases, 0.5%). In every disposition there was a significantly higher prevalence of unilateral rather than bilateral occurrence. In one dissection the medial circumflex femoral artery was absent. Awareness of these variations could avoid unexpected injuries.

Femoral nerve entrapment: A new insight

Compression of the femoral nerve in the iliac fossa has been reported as a consequence of several pathologies, but never as a result of muscular compression. Aberrant slips of iliacus, however, have occasionally been reported to cover or split the femoral nerve. This study aimed to assess such variations as potential factors in femoral nerve compression. A large and homogeneous sample of 121 embalmed cadavers (242 specimens) was studied. Statistical comparisons were made using the chi-squared test. Muscular slips from iliacus and psoas, piercing or covering the femoral nerve, were found in 19 specimens (7.9%). No significant differences by sex or side were found. The more frequent variation was piercing of the femoral nerve by a muscular slip (17 specimens, 7.0%). The nerve then entered the thigh as one or more branches. The less frequent variation found was a muscular slip or sheet covering the femoral nerve as it lay on iliacus (2 specimens, 0.8%). Each disposition may be a potential risk for nerve entrapment.

[Expert opinion on the basic surgical technique for laparoscopic ventral hernia repair]

Laparoscopic ventral hernia repair is currently the subject of intense debate, even though it provides a series of advantages over open surgery and is feasible and safe. Various studies have shown this technique to be as effective as open repair with a lower recurrence rate. Despite the excellent results of laparoscopic repair of ventral hernias, there are numerous controversies associated with this procedure. These controversies concern the indications and contraindications of the procedure, and technical aspects such as how to create the pneumoperitoneum, perform adhesiolysis, manage the hernia sac, and insert and fix the mesh to the anterior abdominal wall. Also controversial are outcome, complications related to postoperative seroma, and which type and size of mesh should be used. The present article aims primarily to address many of these issues, based on the experience of distinct surgeons with expertise in this approach, in order to provide data to establish a consensus on how laparoscopic ventral hernia repair should be performed.

Six Races of Venturia inaequalis are Found Causing Apple Scab in Spain

Apple scab, caused by the ascomycete Venturia inaequalis, is an important disease of apple (Malus domestica) worldwide and is generally managed with intensive applications of fungicides or, for specific markets, by planting of resistant cultivars. Currently, eight races of the pathogen have been defined on the basis of their ability to overcome sources of resistance used by plant breeders (2). We undertook the identification of apple scab races present in Spain as a necessary step for the deployment of resistant cultivars. Spore suspensions (2.5 × 10⁵ spores per ml) were prepared from fresh lesions of apple scab collected from apple trees in commercial or domestic orchards located in the northeastern Spanish provinces of Gerona, Guipúzcoa, and Navarra. To identify races 1 to 7, the suspensions were used to inoculate cv. Gala and six differential apple clones with five replicates. Cultivar Gala was used as a universal susceptible control. The differential apple clones included X2250, X2253 (Geneva), X2249, X2225, X2596 (Prima), and X6518 (M. floribunda 821) (1,4). All leaves were assessed on each inoculated shoot 17 days after inoculation, and the type of symptoms were scored using the scale of Chevalier et al. (3). Sporulation was evaluated on seven replicate leaf discs (1 cm in diameter) for each combination of inoculum and plant host (4). All the inocula tested produced typical apple scab symptoms and sporulation (>10⁶ conidia per cm²) on cv. Gala. Races 2, 3, 5, and 6 were identified on the basis of the elicitation of typical disease symptoms with abundant sporulation (>3 × 10⁶ conidia per cm²) on clones X2250, X2253, X2225, and X2596, respectively. Races 2 and 6 were present in inocula from Gerona, Guipúzcoa, and Navarra, whereas races 3 and 5 were identified only in an inoculum from Tudela, Navarra. An inoculum from La Tallada, Gerona, was assigned to race 1 because it produced typical disease symptoms and sporulation only on cv. Gala, while the differential clones were scored as resistant. In Santesteban, Navarra, a monosporic isolate of V. inaequalis, designated VIP28, was obtained in the field from a single lesion in a 2-year-old tree of clone 2.1.1, which is resistant to race 1. VIP28 produced lesions typical of weak virulence in clone X6518 and produced a significant degree of sporulation (0.8 × 10⁶ conidia per cm²), whereas the differential clones for races 2 to 6 were scored as resistant, indicating that this isolate can be classified as race 7 (1). To our knowledge, this is the first report of races of V. inaequalis present in Spain. References: (1) G. Bénaouf and L. Parisi. Phytopathology 90:236, 2000. (2) V. G. M. Bus et al. New Phytol. doi:10.1111/j.1469-8137.2005.01395.x, 2005. (3) M. Chevalier et al. Plant Pathol. 40:249, 1991. (4) L. Parisi et al. Phytopathology 83:533, 1993.

Avascular jaw osteonecrosis in association with cancer chemotherapy: series of 10 cases

BACKGROUND

We present a series of 10 patients with osteonecrosis of the jaws (ONJ) that appeared following cancer chemotherapy.

MATERIAL AND METHODS

Of the 10 cases with ONJ, six had bone metastases from breast cancers and the other four had multiple myeloma. We analysed the location of bone metastases, as well as the characteristics of the ONJ, and the drugs with which they had been treated for their bone metastases.

RESULTS

Of the 10 patients, all had ONJ in the mandible; 50% also had maxillary involvement. The average number of areas of painful exposed was 2.1 per patient (range 1-5). In seven patients a tooth extraction preceded the onset of ONJ. Two patients developed oroantral communications and another a cutaneous fistula to the neck with suppuration. In all the 10 patients the histopatholological diagnosis was of chronic osteomyelitis without evidence of metastatic disease to the jaws. All the patients had received treatment for their malignant bone disease with bisphosphonates. These were the only drugs that all patients had received.

CONCLUSION

ONJ appears to have a relationship with the use of bisphosphonates.

Genetic characterization of Erwinia amylovora strains by amplified fragment length polymorphism

AIMS

Erwinia amylovora is one of the most important pathogens of pear and apple and is subject to strict quarantine regulations worldwide, although its patterns of dispersal are largely unknown. Previous attempts to fingerprint E. amylovora strains by molecular techniques have detected very little polymorphism because of the high genetic homogeneity of this bacterium. Our aim was to establish and test a typing method to quantify genetic diversity among strains of this plant pathogen.

METHODS AND RESULTS

Twenty-two strains from different hosts and geographical locations were examined by PCR fingerprinting with four primers and by amplified fragment length polymorphism (AFLP) with four selected combinations of primers with a single base extension. PCR fingerprinting revealed little polymorphism producing the same amplification patterns for 17 strains, while the combined AFLP patterns yielded 78 polymorphic bands (34% of total bands) and allowed the differentiation of all but two strains. Clustering of strains in the resulting dendrogram was not correlated with host, year or country of isolation, and questions previous genealogies based on PFGE patterns.

CONCLUSIONS

The AFLP technique allowed the detection of an unprecedented number of genetic markers in E. amylovora and proved to be the most useful tool so far for discriminating among strains of this pathogen. The results obtained in this study strongly suggest the occurrence of multiple introductions of the pathogen in Spain and other European countries.

SIGNIFICANCE AND IMPACT OF THE STUDY

A major limitation in understanding the ecology of fire blight is the lack of typing techniques with a high power of discrimination. This study demonstrates the high resolution and the usefulness of the AFLP technique to differentiate among E. amylovora strains.

[Surgical treatment of haemangiomas]

The therapeutic approach to haemangiomas has changed slightly in recent years, moving from a generally conservative attitude to a more aggressive one in some cases. Chronic unaesthetic alterations that might be caused by haemangiomas, psychosocial traumas that can be caused during childhood, together with a better understanding of the behaviour of this type of lesions and advances in safer and more efficient surgical techniques are the basic factors behind this change of attitude. The present paper concentrates on the surgical treatment of haemangiomas, explaining their indications according to the stage of evolution at which they are found, and the surgical techniques employed to resect the lesion with the least morbidity. Similarly, a detailed treatment is given to those lesions that, because of their specific facial anatomical localization, require a special surgical treatment.