Observation of two-neutrino double-beta decay in 136Xe with the EXO-200 detector

We report the observation of two-neutrino double-beta decay in (136)Xe with T(1/2) = 2.11 ± 0.04(stat) ± 0.21(syst) × 10(21) yr. This second-order process, predicted by the standard model, has been observed for several nuclei but not for (136)Xe. The observed decay rate provides new input to matrix element calculations and to the search for the more interesting neutrinoless double-beta decay, the most sensitive probe for the existence of Majorana particles and the measurement of the neutrino mass scale.

Gas Chromatographic Determination of Bifenthrin in Technical and Selected Formulated Products: Collaborative Study

A GC method for the analysis of technical and formulated bifenthrin samples was evaluated in a collaborative study. Bifenthrin is determined by using a 50 (trifluoropropyl)-methylpolysiloxane wide-bore capillary column and flame ionization detector. Ten samples, consisting of four formulations and a technical material were analyzed by 12 collaborators using Youden pairs. The four formulation types included in this study were microemulsion (ME), wettable powder (WP), suspension concentrate (SC), and emulsifiable concentrate (EC). Variability in the analysis of two of the formulation types, SC and EC, was later found to be due to the noncommercial containers used to hold the test samples. Because of this, valid data could not be obtained for the EC and SC. For the two formulations for which valid data could be obtained, ME and WP, and the technical chemical, accuracy and variability results are typical of large data sets. For the technical chemical and the two formulations for which valid data were obtained, Official First Action is recommended.

Predictors of oral bisphosphonate prescriptions in post-menopausal women with osteoporosis in a real-world setting in the USA

SUMMARY

We identified factors associated with oral bisphosphonate treatment in 50+-year-old female patients with a first fracture, osteoporosis diagnosis, or BMD < or =-2.5 in the Geisinger Health System electronic health record database. Treatment was positively associated with age, oral corticosteroids, and smoking, and negatively associated with body mass index and bone mineral density scores.

INTRODUCTION

To identify factors associated with oral bisphosphonate treatment in patients with an indicator for post-menopausal osteoporosis.

METHODS

Females age 50+ years with a first fracture, osteoporosis diagnosis, or bone mineral density (BMD) < or =-2.5 (index date) were identified in the Geisinger Health System electronic health record database. Treatment was defined as an oral bisphosphonate prescription order (risedronate sodium, ibandronate sodium, or alendronate) < or =90 days post-index date. Treatment rates were assessed and a multivariate logistic model was used to identify predictors of treatment separately for patients with fracture (FRAC) and with diagnosis or low BMD (ICD-9-BMD).

RESULTS

The FRAC group had 2,003 female patients with a mean (SD) age of 69.0 (+/-11.3) years and the ICD-9-BMD group had 12,976 female patients with a mean (SD) age of 66.9 (+/-10.0) years. Within 90 days of the index date of fracture, diagnosis, or low BMD score, 188 (9.4%) patients in the FRAC group and 5,395 (41.6%) in the ICD-9-BMD group received treatment. Treatment was positively associated with age and oral corticosteroids and negatively associated with body mass index and subsequent BMD in both groups. Smoking currently was positively associated with treatment in the ICD-9-BMD group.

CONCLUSION

Certain patient characteristics are predictors of physicians prescribing oral bisphosphonates. However, many patients remain untreated.

Analysis of glycaemic control and weight change in patients initiated with human or analog insulin in an US ambulatory care setting

BACKGROUND

Insulin is a mainstay in the treatment of type 1 diabetes and is a recommended option in patients with type 2 diabetes who fail to maintain glycaemic control on other non-insulin therapies. The purpose of this study was to describe patient characteristics and evaluate changes in glycaemic control and weight in patients treated with insulin in an ambulatory care setting.

METHODS

Patients with diabetes were identified from the General Electric electronic medical record (EMR) database (1 September 2004 to 30 April 2008). Patients were > or =18 years, insulin naive, newly treated with monoinsulin therapy (index date). Baseline characteristics were identified overall and stratified by insulin type (basal, mixed, and rapid). Basal insulins were described by human versus analog and for insulin detemir and insulin glargine. Change in haemoglobin A1C (HbA1C) and weight from baseline (45 days pre- to 15 days postindex date) to 6 months (+/-90 days) were compared. Regression analyses were used to evaluate HbA1C outcomes across insulins and for the likelihood of gaining 0.9 kg (2 lbs) for detemir versus glargine controlling for baseline characteristics.

RESULTS

A total of 12 136 patients were included. A majority were initiated on a basal insulin (64.7%) followed by mixed (20.8%) and rapid (14.4%). Basal users had significantly higher mean body weight and lower mean baseline HbA1C than mixed users (p < 0.001 for all), and were significantly older, had higher baseline HbA1C and higher baseline body mass index (BMI) than rapid insulin users (p < 0.001 for all). Glargine patients had a significantly higher mean baseline HbA1C (p = 0.003) than detemir patients. The adjusted reduction in HbA1C was greater for rapid insulin than for mixed or basal insulin (p < or = 0.05). The adjusted differences in HbA1C between basal human and basal analog insulins and between detemir and glargine were not statistically significant (p > 0.05). Patients using detemir were 30% less likely to gain 0.9 kg or more than glargine users (p < 0.05).

CONCLUSIONS

HbA1C outcomes in the ambulatory care setting were generally not different between insulin classes. The likelihood of weight gain was less with insulin detemir than with insulin glargine. Thus, real-world weight outcomes for basal analog insulin may differ by specific product.

Clinical experience with porous tantalum cervical interbody implants in a prospective randomized controlled trial

A prospective randomized study was undertaken to evaluate the radiological appearance and clinical effectiveness of two porous tantalum (Hedrocel) implants in achieving a stable cervical interbody fusion. A prerandomization protocol was used to allocate patients to the three arms of the study: a ring implant containing autologous cancellous bone graft, a solid block implant or autologous tricortical iliac crest bone graft. Patients were followed for 2 years with plain radiological studies, SF-36, and Neck Disability Index questionnaires and neurological assessment. Early in the study the postoperative radiographs of four patients receiving Hedrocel implants showed inferior end-plate lucency raising concerns about delayed or non-fusion. Recruitment to the study was halted by the investigators to allow longer-term follow-up of the implanted patients when only 24 patients had been recruited to the study. Although fusion was subsequently noted in all patients at 12 months there was no further enrolment to the study. At 2 years the radiological and clinical outcomes of the three groups appeared comparable, but the study numbers were too small for any statistical analysis. This study highlights the difficulties that can arise when clinical caution takes precedence over objective measures of clinical progress during a study. In the absence of an independent safety monitoring committee, the investigators were under an ethical obligation to suspend recruitment to this study, until it was clear that the radiological features were not associated with poor clinical outcomes. The use of safety monitoring committees and the clarification of stopping criteria in relation to outcome measures should be considered in open randomized trials of spinal surgical techniques and implants.

Is there a survival benefit with adjuvant chemotherapy for patients with stage I (T1N0) triple negative breast cancer?

e11547

Background: Chemotherapy is the only systemic modality for patients with breast cancer lacking expression of estrogen, progesterone, and HER2 receptors (triple negative), a group comprising 15% of all breast cancers. The majority of such patients present with nodal metastases. The median time to distant recurrence is short: at 2.6 years, and median time to death is 4.2 years. (Dent R, et al. Triple-Negative Breast Cancer: Clinical Features and Patterns of Recurrence, Clin Cancer Res 2007; 13(15) August, 2007). The benefit from proceeding with adjuvant chemotherapy for ≤2cm, node negative triple negative breast cancer remains undefined. Patients and Methods: A retrospective chart review was conducted to assess the benefit of adjuvant chemotherapy for overall survival for stage I (T1N0) triple-negative breast cancer treated from 1996 to 2006 at City of Hope and USC. ER, PR, and HER2 status (as assessed by fluorescent in-situ hybridization (FISH) or immunohistochemistry) were reviewed and confirmed. Overall survival was defined as time from date of diagnosis to date of death. All patients received standard surgery ± radiation. Results: A total of 100 stage I triple-negative breast cancer patients were identified. The median age at diagnosis was 56 (range 27–91). Of the 100 patients, 59 received adjuvant chemotherapy: 38 received anthracycline-based, 17 received non-anthracycline-based regimens and 4 were unknown. Median length of follow-up was 4.0 years. No difference in overall survival was found in patients who received adjuvant chemotherapy (p-value = 0.94). Similarly, there was no difference between patients who received non-anthracycline-based chemotherapy versus those given anthracycline-based chemotherapy (p-value=0.17). The group of patients who received adjuvant chemotherapy were younger (51.8 y.o versus 61.5 y.o (p=0.0004)) and had larger tumor size (13.6mm versus 10.2mm (p=0.0002)). Lack of statistical significance may be related to the limited sample size. Conclusion: We did not find a statistically survival benefit of adjuvant chemotherapy in 100 triple negative stage I breast cancer patients. Further studies are needed to clarify the role of adjuvant chemotherapy in this group of patients.

No significant financial relationships to disclose.

Survival, Dispersal, and Primary Infection Site for Cercospora beticola in Sugar Beet

Cercospora beticola survives as stromata in infected crop residue. Spores produced on these survival structures serve as primary inoculum during the next cropping season. This study was conducted to determine how long C. beticola can survive at different soil depths, the mechanism of inoculum dispersal, and the primary infection site in sugar beet. Longevity of C. beticola was studied over a 3-year period under field conditions at Fargo, ND. C. beticola-infected leaves were placed at depths of 0, 10, and 20 cm and retrieved after 10, 22, and 34 months. Survival of C. beticola inoculum declined with time and soil depth. Inoculum left on the soil surface, 0 cm in depth, survived the longest (22 months) compared with that buried at 10 cm (10 months) and 20 cm (10 months). C. beticola dispersal from the primary source of inoculum was studied in the field for three growing seasons. Sugar beet plants were surrounded with plastic cages with and without ground cover, or exposed with and without ground cover. Significantly higher disease severity was observed on exposed plants than caged plants with or without ground cover, suggesting that wind was the major dispersal factor for C. beticola inoculum. The primary infection site by C. beticola was determined in a greenhouse study. Leaves, roots, and stems of healthy sugar beet plants were inoculated with C. beticola. Cercospora leaf spot symptoms were observed only on plants that were leaf inoculated, suggesting that the leaf was the primary infection site for C. beticola.

Probiotics for treatment of Clostridium difficile-associated colitis in adults

BACKGROUND

Probiotics are live microorganisms consisting of non-pathogenic yeast and bacteria that are believed to restore the microbial balance of the gastrointestinal tract altered by infection with Clostridium difficile (C. difficile).

OBJECTIVES

To assess the efficacy of probiotics in the treatment of antibiotic associated C. difficile colitis.

SEARCH STRATEGY

The databases MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and Cochrane IBD/FBD Specialized Trials register were searched to locate all published reports from 1966 to 2007.

SELECTION CRITERIA

Randomized, prospective studies using probiotics alone or in conjunction with conventional antibiotics for the treatment of documented C. difficile colitis were eligible for inclusion.

DATA COLLECTION AND ANALYSIS

Data extraction and analysis was done independently by two authors.

MAIN RESULTS

Four studies met the inclusion criteria and were included in the review. The four studies examined the use of probiotics in conjunction with conventional antibiotics (vancomycin or metronidazole) for the treatment of recurrence or an initial episode of C. difficile colitis in adults. The studies were small in size and had methodological problems. A statistically significant benefit for probiotics combined with antibiotics was found in one study. McFarland 1994 found that patients receiving S. boulardii were significantly less likely than patients receiving placebo to experience recurrence of C. difficile diarrhea (RR 0.59; 95% CI 0.35 to 0.98). No benefit of probiotics treatment was found in the other studies.

AUTHORS' CONCLUSIONS

There is insufficient evidence to recommend probiotic therapy as an adjunct to antibiotic therapy for C. difficile colitis. There is no evidence to support the use of probiotics alone in the treatment of C. difficile colitis.

Probiotics for treatment of Clostridium difficile-associated colitis in adults

BACKGROUND

Probiotics are live microorganisms consisting of non-pathogenic yeast and bacteria that are believed to restore the microbial balance of the gastrointestinal tract altered by infection with Clostridium difficile (C. difficile).

OBJECTIVES

To assess the efficacy of probiotics in the treatment of antibiotic associated C. difficile colitis.

SEARCH STRATEGY

The databases MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and Cochrane IBD/FBD Specialized Trials register were searched to locate all published reports from 1966 to 2007.

SELECTION CRITERIA

Randomized, prospective studies using probiotics alone or in conjunction with conventional antibiotics for the treatment of documented C. difficile colitis were eligible for inclusion.

DATA COLLECTION AND ANALYSIS

Data extraction and analysis was done independently by two authors.

MAIN RESULTS

Four studies met the inclusion criteria and were included in the review. The four studies examined the use of probiotics in conjunction with conventional antibiotics (vancomycin or metronidazole) for the treatment of recurrence or an initial episode of C. difficile colitis in adults. The studies were small in size and had methodological problems. A statistically significant benefit for probiotics combined with antibiotics was found in one study. McFarland 1994 found that patients receiving S. boulardii were significantly less likely than patients receiving placebo to experience recurrence of C. difficile diarrhea (RR 0.59; 95% CI 0.35 to 0.98). No benefit of probiotics treatment was found in the other studies.

AUTHORS' CONCLUSIONS

There is insufficient evidence to recommend probiotic therapy as an adjunct to antibiotic therapy for C. difficile colitis. There is no evidence to support the use of probiotics alone in the treatment of C. difficile colitis.

Space flight alters bacterial gene expression and virulence and reveals a role for global regulator Hfq

A comprehensive analysis of both the molecular genetic and phenotypic responses of any organism to the space flight environment has never been accomplished because of significant technological and logistical hurdles. Moreover, the effects of space flight on microbial pathogenicity and associated infectious disease risks have not been studied. The bacterial pathogen Salmonella typhimurium was grown aboard Space Shuttle mission STS-115 and compared with identical ground control cultures. Global microarray and proteomic analyses revealed that 167 transcripts and 73 proteins changed expression with the conserved RNA-binding protein Hfq identified as a likely global regulator involved in the response to this environment. Hfq involvement was confirmed with a ground-based microgravity culture model. Space flight samples exhibited enhanced virulence in a murine infection model and extracellular matrix accumulation consistent with a biofilm. Strategies to target Hfq and related regulators could potentially decrease infectious disease risks during space flight missions and provide novel therapeutic options on Earth.

Improving the Cercospora Leaf Spot Management Model for Sugar Beet in Minnesota and North Dakota

Management of Cercospora leaf spot, caused by Cercospora beticola, is necessary for the economic production of sugar beet (Beta vulgaris). The objectives of this study were to evaluate the impact of two relative humidity thresholds (87 and 90%) on the daily infection values (DIVs) used to determine when fungicide applications were required, to determine whether current Cercospora management recommendations for northern areas of Minnesota and North Dakota could be used by growers in the southern areas of these states, and to compare the utility of calendar-based fungicide applications with the Cercospora management model. Research was conducted in Breckenridge, MN and St. Thomas, ND in 2003 and 2004. Fungicide applications significantly (P = 0.05) reduced maximum disease severity (y_max) and area under the disease progress curve (AUDPC) when compared with the nontreated control at both locations during 2003 and 2004. Fungicides applied according to DIVs calculated at RH ≥ 87% or RH > 90% gave similar results. The mandatory second fungicide application 14 days after the first application for southern areas did not significantly decrease disease severity or AUDPC, or improve root yield or recoverable sucrose compared with treatments without the mandatory application. This research illustrates that a DIV calculated at RH ≥ 87% would result in similar timing of fungicide applications compared with DIVs calculated at RH > 90%. The results further show that the recommendation of fungicide applications at initial symptom and subsequent applications based on DIV and disease severity should be used for both northern and southern growers. Finally, this research showed that fungicide applications based on the Cercospora management model provided similar, effective disease control with fewer fungicide applications compared with calendar-based applications.