TROG 15.03/ANZUP International Multicenter Phase II Trial of Focal Ablative STereotactic RAdiotherapy for Cancers of the Kidney (FASTRACK II)

PURPOSE/OBJECTIVE(S)

Stereotactic body radiotherapy (SBRT) is an emerging non-invasive alternative for primary renal cell cancer (RCC) in patients unsuitable for surgery. The objective of the FASTRACK II clinical trial was to investigate the efficacy of SBRT for primary RCC.

MATERIALS/METHODS

This non-randomized, intergroup multi-institutional phase II study was activated in 7 Australian centers and 1 Dutch center, through the Trans Tasman Radiation Oncology Group (TROG) and the Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP). Eligible patients had biopsy confirmed diagnosis of primary RCC with a single lesion within a kidney, ECOG performance ≤2 and were medically inoperable, high risk or declined surgery. For tumors ≤4 cm a single fraction of 26 Gy was prescribed, for tumors > 4 cm, 42 Gy in three fractions was prescribed. The primary outcome of the study was to estimate the efficacy of SBRT for primary RCC, defined as local control based on RECIST criteria. The study was powered assuming that 1-year local control would be 90%, with the null hypothesis of ≤80% considered undesirable and not worthy of proceeding to a future randomized controlled trial.

RESULTS

Between July 2016 and February 2020, 70 patients were enrolled with a median follow-up of 42 months. Median age was 77 years. Forty-nine patients were male (70%), median BMI was 32 and median Charlson comorbidity score was 7. The median [IQR] RENAL complexity score was 8 [7-10]. Biopsy confirmation was 100%. Twenty-three patients (33%) had T1a disease. The median (interquartile range [IQR]) tumor size was 4.6cm [3.7-5.5]; it was 3.3cm [3.0-3.6] in those receiving single fraction (n = 23), and 5.3cm [4.6-6.0] in those receiving 3-fraction SBRT (n = 47). During real-time pre-treatment quality assurance review, 10 cases (14.3%) required resubmission for protocol deviation, 2119 variables were assessed at final review, and final protocol compliance was 99.3%. Seven (10%) patients experienced grade 3 treatment-related adverse events, with no grade 4 or 5 events observed. Eleven (16%) patients reported no adverse events. Local control was 100% throughout the lifetime of the trial (p<0.001). Cancer-specific survival was also 100% throughout the lifetime of the trial. Freedom from distant failure (95% CIs) at 1 and 3 years was 99% (90-100%). Overall survival (95% CIs) at 1 and 3 years was 99% (90-100%) and 82% (70-89%), respectively. Baseline mean eGFR (95% CI) was 61.1 mLs/min (56.6; 65.6) and reduced by -10.8 mLs/min (-13.0; -8.6) by 1-year, by -14.6 mLs/min (-17.0; -12.2) by 2-years and plateaued thereafter.

CONCLUSION

In the first multicenter prospective trial of a non-surgical primary RCC cohort, enrolling mostly T1b+ disease, SBRT was an effective treatment strategy with no observed local failures. We observed an acceptable side effect profile and renal function after SBRT. These outcomes support the design of a future randomized clinical trial of SBRT versus surgery for primary RCC. The trial was registered with ID: NCT02613819.

New hominin dental remains from the ∼2.04-1.95 Ma Drimolen Main Quarry, South Africa

BACKGROUND

The Drimolen Palaeocave site is situated within the UNESCO Fossil Hominid Sites of South Africa World Heritage Area and has yielded numerous hominin fossils since its discovery in 1992. Most of these fossils are represented by isolated dental elements, which have been attributed to either of two distinct hominin genera, Paranthropus and Homo.

AIM

This paper provides morphological descriptions for a further 19 specimens that have been recovered from the ∼2.04-1.95 Ma Drimolen Main Quarry (DMQ) deposits since 2008. This paper also discusses the two primary hypotheses used to explain Paranthropus robustus variation: sexual dimorphism, and micro-evolution within a lineage.

SUBJECTS AND METHODS

These 19 fossils are represented by 47 dental elements and expand the sample of DMQ early Homo from 13 to 15, and the sample of Paranthropus robustus from 69 to 84.

RESULTS

The evidence presented in this paper was found to be inconsistent with the sexual dimorphism hypothesis.

CONCLUSION

Some support was found for the micro-evolution hypothesis.

Cardiotoxicity of Radiation Therapy: Mechanisms, Management, and Mitigation

OPINION STATEMENT

Radiation therapy is a key component of modern-day cancer therapy and can reduce the rates of recurrence and death from cancer. However, it can increase risk of cardiovascular (CV) events, and our understanding of the timeline associated with that risk is shorter than previously thought. Risk mitigation strategies, such as different positioning techniques, and breath hold acquisitions as well as baseline cardiovascular risk stratification that can be undertaken at the time of radiotherapy planning should be implemented, particularly for patients receiving chest radiation therapy. Primary and secondary prevention of cardiovascular disease (CVD), as appropriate, should be used before, during, and after radiation treatment in order to minimize the risks. Opportunistic screening for subclinical coronary disease provides an attractive possibility for primary/secondary CVD prevention and thus mitigation of long-term CV risk. More data on long-term clinical usefulness of this strategy and development of appropriate management pathways would further strengthen the evidence for the implementation of such screening. Clear guidelines in initial cardiovascular screening and cardiac aftercare following radiotherapy need to be formulated in order to integrate these measures into everyday clinical practice and policy and subsequently improve post-treatment morbidity and mortality for these patients.

Testicular Dislocation After Pelvic Ring Injury: A Report of 2 Cases

CASES

We present 2 cases of traumatic testicular dislocation associated with a pelvic ring injury after a motorcycle collision. Case 1 describes bilateral testicular dislocation discovered intraoperatively. Urology was consulted, and the testicles were manually reduced under general anesthesia. Case 2 describes unilateral testicular dislocation discovered at the 1-month follow-up after pelvic ring fixation. Concern for infarction prompted urology to take the patient for surgical reduction. Both cases resolved uneventfully without genitourinary complaints at the follow-up.

CONCLUSIONS

Testicular dislocation is rare but should be considered in the setting of pelvic injury due to a motorcycle collision. Detection warrants urgent urologic consultation.

Correction to: Genetic characterization and expression analysis of wheat (Triticum aestivum) line 07OR1074 exhibiting very low polyphenol oxidase (PPO) activity

The above-mentioned article was published in 2015 with an error in the reverse primer sequence for the PPOA2d1074 marker, which made amplification difficult. The reverse primer was missing a thymine nucleotide at the thirteenth position (GCGGTGCTTCACTTGGT).

Fish on steroids: Temperature-dependent effects of 17β-trenbolone on predator escape, boldness, and exploratory behaviors

Hormonal growth promoters (HGPs), widely used in beef cattle production globally, make their way into the environment as agricultural effluent-with potential impacts on aquatic ecosystems. One HPG of particular concern is 17β-trenbolone, which is persistent in freshwater habitats and can affect the development, morphology and reproductive behaviors of aquatic organisms. Despite this, few studies have investigated impacts of 17β-trenbolone on non-reproductive behaviors linked to growth and survival, like boldness and predator avoidance. None consider the interaction between 17β-trenbolone and other environmental stressors, such as temperature, although environmental challenges confronting animals in the wild seldom, if ever, occur in isolation. Accordingly, this study aimed to test the interactive effects of trenbolone and temperature on organismal behavior. To do this, eastern mosquitofish (Gambusia holbrooki) were subjected to an environmentally-relevant concentration of 17β-trenbolone (average measured concentration 3.0 ± 0.2 ng/L) or freshwater (i.e. control) for 21 days under one of two temperatures (20 and 30 °C), after which the predator escape, boldness and exploration behavior of fish were tested. Predator escape behavior was assayed by subjecting fish to a simulated predator strike, while boldness and exploration were assessed in a separate maze experiment. We found that trenbolone exposure increased boldness behavior. Interestingly, some behavioral effects of trenbolone depended on temperature, sex, or both. Specifically, significant effects of trenbolone on male predator escape behavior were only noted at 30 °C, with males becoming less reactive to the simulated threat. Further, in the maze experiment, trenbolone-exposed fish explored the maze faster than control fish, but only at 20 °C. We conclude that field detected concentrations of 17β-trenbolone can impact ecologically important behaviors of fish, and such effects can be temperature dependent. Such findings underscore the importance of considering the potentially interactive effects of other environmental stressors when investigating behavioral effects of environmental contaminants.

How to Organize the Medical Data of Chronically Ill Patients in the Computer

The problems of aiding in the medical decision-making process are very important today, especially through the use of artificial intelligence methods. Before studying these problems, it is necessary to have an excellent availability of relevant medical patient health data as well as medical knowledge.

The computer is well adapted for the task of satisfying this essential condition; but in order to accomplish this goal, it is necessary to develop an efficient system of data organization. The current system of sequential organization of medical histories is most likely not the best possible method of data filing. Furthermore, at the present time there are only a small number of relations (in the mathematical sense) between these health data. This situation is not favorable to the development of a relational data base.

This article proposes an organization of health data which is relative to the patient. The organization is based on the notion of a medical entity and on the three-dimensionality of health data.

The Notion of Time in Medical Records — Structure of Chronology, Validation and Calculation of a Time Interval

The reasons for and requirements of collecting chronological information in a chronic progressive disease are considered. The authors discuss the rules for writing the chronology together with the algorithms permitting full validation. They show from examples the kinds of studies made possible by the chronology. Taking the progressive nature of the disease into consideration, its chronicity and numerous degenerations necessitate the structuration of different occurrences of the same notion. Hence, there results the development of chronological axes relative to each notion. Our procedures used operationally for several years are only limited in their efficacy by the time the doctor can spare to use them.

Structural, Syntactical and Semantic Data Validation in the Computer Processing of a Medical File

Validation of all data in the medical file is indispensable before storage in the computer in order to eliminate errors which may have occurred during data collection and transmission. Formal internal validation checks the observance of spelling and syntax rules governing conversion of medical observations into a form usable by the computer. Internal semantic validation checks the credibility of data by reference to standards. External validation cheeks conformity of the file, printed in clear language, with medical reality.

From Medical Data to Health Knowledge

The problems of assisting in the medical decision-making process are attracting more and more attention.

Actually a certain number of computer systems have considerably improved the availability of medical data. However, we encounter some difficulties when extending these systems. In order to surmount these problems, it is necessary to proceed further in the analysis and comprehension of medical information and processes.

To accomplish this goal, it is necessary to have a better understanding of the way in which a group of medical data is derived from one piece of medical knowledge and also how a chunk of medical knowledge is related to its corresponding medical data.

This article is a beginning in the study of the transition from medical data to health knowledge, and this transition represents only part of the global entity, the nature, the representation, and use of medical information.

Long Range Medical Follow-up and Updating of Computerized Records

In order to follow the clinical course of patients with chronic diseases, it is necessary to have a system for updating their computerized record.

To achieve this objective, it is necessary to minimize the length of time devoted to information collecting and to feed the data into the computer in a manner which satisfies two essential criteria:

— easy filing process,

— easy access to the data for searches.

In this article we will consider five aspects of the updating process of a computerized record : a file of records, any record, any elementary item, the lexicon of notions, the results of questioning before and after updating.

With such a tool in hand, one can perform longitudinal studies using the data contained in the records. The approach of the authors is not only a formal one. They set up some basic formal principles from an existing experience of processing the data of several thousands of patients with diabetes and give a condensed description of the existing system.

Occupational Risks: A Follow-up Method Based on Individual Work History Records Including the Environmental Aspects of the Workplace

This article analyzes the Curriculum Laboris or career reconstruction as a means of studying the occupational risks of employees. A type of Curriculum Laboris which makes the established record easier to use has been suggested. The authors point out some advantages to be expected from the proposed computerized method. The usefulness of the proposed Curriculum Laboris is largely conditioned by lack of standards for guiding data collection by physicians. Finally, the Curriculum Laboris has been considered as an element of a larger information system.

Surveillance of Occupational Risks Using Job-Exposure Matrices

This article deals with the problem of surveillance of occupational risks of workers. Computer-assisted elaboration of the job history (JH) for each worker was achieved by means of a job-exposure matrix (JEM) for each company. The final aim of the project is to find correlations between the exposure data of JHs and the health data of corresponding medical records.

As a first experiment, some JEMs were computed using rectangular arrays even though it was realized that this simple structure was not really adequate. Later on, the structure of the computerized JEM included the following questions: (1) what types of information are involved; (2) how can the job-exposure correspondence be represented in the computer; (3) what characteristics of a company should be used for the elaboration of a JEM; (4) who is to construct each JEM, and how? This article shows the inadequacy of some occupational names for evoking the appropriate risks, a drawback which can be surmounted if the company organization is included in the JEM. Based on our analysis, several specifications useful for JEM computerization have been suggested.

Identification of Candidate Genes Responsible for Stem Pith Production Using Expression Analysis in Solid-Stemmed Wheat

The wheat stem sawfly (WSS) is an economically important pest of wheat in the Northern Great Plains. The primary means of WSS control is resistance associated with the single quantitative trait locus (QTL) , which controls most stem solidness variation. The goal of this study was to identify stem solidness candidate genes via RNA-seq. This study made use of 28 single nucleotide polymorphism (SNP) makers derived from expressed sequence tags (ESTs) linked to contained within a 5.13 cM region. Allele specific expression of EST markers was examined in stem tissue for solid and hollow-stemmed pairs of two spring wheat near isogenic lines (NILs) differing for the QTL. Of the 28 ESTs, 13 were located within annotated genes and 10 had detectable stem expression. Annotated genes corresponding to four of the ESTs were differentially expressed between solid and hollow-stemmed NILs and represent possible stem solidness gene candidates. Further examination of the 5.13 cM region containing the 28 EST markers identified 260 annotated genes. Twenty of the 260 linked genes were up-regulated in hollow NIL stems, while only seven genes were up-regulated in solid NIL stems. An -methyltransferase within the region of interest was identified as a candidate based on differential expression between solid and hollow-stemmed NILs and putative function. Further study of these candidate genes may lead to the identification of the gene(s) controlling stem solidness and an increased ability to select for wheat stem solidness and manage WSS.

Phenotypic and Haplotype Diversity among Tetraploid and Hexaploid Wheat Accessions with Potentially Novel Insect Resistance Genes for Wheat Stem Sawfly

Genetic diversity in breeding programs can be impaired by fixation of alleles derived from a limited number of founder lines. This is demonstrated with the use of a solid-stem trait derived from the Portuguese landrace 'S-615' over 70 yrs ago that is widely used to resist the wheat stem sawfly ( Norton, WSS) in North America. The objective of this study was to evaluate haplotype diversity underlying the quantitative trait locus (QTL) that controls the majority of the S-615 derived solid-stem genetic variation using single-nucleotide polymorphism (SNP) assays in a diverse set of 228 solid-stem tetraploid and hexaploid wheat accessions originating from areas of the world infested with various species of WSS. Haplotype analysis showed all WSS-resistant hexaploid wheat varieties in North America, except 'Conan', evaluated in this study contain a haplotype associated with the S-615 solid-stem allele. In total, 26 haplotypes were identified among the hexaploid and tetraploid accessions at . Prevalence of most haplotypes were skewed toward either the hexaploid or tetraploid wheat accessions. The haplotype found in the S-615- hexaploid wheat landrace was not found in the solid-stem tetraploid landrace accessions evaluated in this study. Haplotype analysis revealed several new haplotypes that have potential to contain novel alleles for solid-stems at , which may form the basis for introducing genetic diversity into breeding programs aimed at WSS resistance.

Efficacy of Chlorine Dioxide as a Gas and in Solution in the Inactivation of Two Trichothecene Mycotoxins

The efficacy of chlorine dioxide (ClO2) in detoxifying two potential bioterrorism agents, the trichothecene mycotoxins verrucarin A and roridin A, was evaluated. In the first experiment, verrucarin A (1, 5, or 10 μg) and roridin A (5 or 10 μg) were each inoculated onto square-inch sections of glass, paper, and cloth and exposed to 1000 ppm of ClO2 for either 24 or 72 h at room temperature. In the second experiment, verrucarin A and roridin A (1 or 2 ppm in water) were treated with 200, 500, or 1000 ppm ClO2 for up to 116 h at room temperature in light and dark conditions ( N = 9 per treatment for test and control). A yeast assay using Kluyveromyces marxianus was used to quantify the toxicity of verrucarin A and roridin A. Additionally, high-performance liquid chromatography was performed on selected samples. Results for the first experiment showed that ClO2 treatment had no detectable effect on either toxin. For the second experiment, both toxins were completely inactivated at all tested concentrations in as little as 2 h after treatment with 1000 ppm ClO2. For verrucarin A, an effect was seen at the 500 ppm level, but this effect was not as strong as that observed at the 1000 ppm level. Roridin A toxicity was decreased after treatment with 200 and 500 ppm ClO2, but this was not significant until the 24-h exposure time was reached. These data show that ClO2 (in solution) can be effective for detoxification of roridin A or verrucarin A at selected concentrations and exposure times.

A comparative study on the functionality of S- and P-based lubricant additives by combined first principles and experimental analysis

Sulfur reduces the adhesion and shear strength of iron more effectively than phosphorus. The surface chemistry, well described by first principles calculations, impacts macroscale tribological properties.

Impact of the D genome and quantitative trait loci on quantitative traits in a spring durum by spring bread wheat cross

The impact of the D genome and QTL in the A and B genomes on agronomic performance of hexaploid wheat and tetraploid durum was determined using novel recombinant inbred line populations derived from interploid crosses. Genetic differences between common hexaploid (6X) bread wheat (Triticum aestivum, 2n = 6x = 42, genome, AABBDD) and tetraploid (4X) durum wheat (T. turgidum subsp. durum, 2n = 4x = 28, genome, AABB) may exist due to effects of the D genome and allelic differences at loci in the A and B genomes. Previous work allowed identification of a 6X by 4X cross combination that resulted in a large number of fertile recombinant progeny at both ploidy levels. In this study, interspecific recombinant inbred line populations at both 4X and 6X ploidy with 88 and 117 individuals, respectively, were developed from a cross between Choteau spring wheat (6X) and Mountrail durum wheat (4X). The presence of the D genome in the 6X population resulted in increased yield, tiller number, kernel weight, and kernel size, as well as a decrease in stem solidness, test weight and seed per spike. Similar results were found with a second RIL population containing 152 lines from 18 additional 6X by 4X crosses. Several QTL for agronomic and quality traits were identified in both the 4X and 6X populations. Although negatively impacted by the lack of the D genome, kernel weight in Mountrail (4X) was higher than Choteau (6X) due to positive alleles from Mountrail on chromosomes 3B and 7A. These and other favorable alleles may be useful for introgression between ploidy levels.

Genetic characterization and expression analysis of wheat (Triticum aestivum) line 07OR1074 exhibiting very low polyphenol oxidase (PPO) activity

Characterized novel mutations present at Ppo loci account for the substantial reduction of the total kernel PPO activity present in a putative null Ppo - A1 genetic background. Wheat (Triticum aestivum) polyphenol oxidase (PPO) contributes to the time-dependent discoloration of Asian noodles. Wheat contains multiple paralogous and orthologous Ppo genes, Ppo-A1, Ppo-D1, Ppo-A2, Ppo-D2, and Ppo-B2, expressed in wheat kernels. To date, wheat noodle color improvement efforts have focused on breeding cultivars containing Ppo-D1 and Ppo-A1 alleles conferring reduced PPO activity. A major impediment to wheat quality improvement is a lack of additional Ppo alleles conferring reduced kernel PPO. In this study, a previously reported very low PPO line, 07OR1074, was found to contain a novel allele at Ppo-A2 and null alleles at the Ppo-A1 and Ppo-D1 loci. To examine the impact of each mutation upon kernel PPO, populations were generated from crosses between 07OR1074 and the hard white spring wheat cultivars Choteau and Vida. Expression analysis using RNA-seq demonstrated no detectable Ppo-A1 transcripts in 07OR1074 while Ppo-D1 transcripts were present at less than 10% of that seen in Choteau and Vida. Novel markers specific for the Ppo-D1 and Ppo-A2 mutations discovered in 07OR1074, along with the Ppo-A1 STS marker, were used to screen segregating populations. Evaluation of lines indicated a substantial genotypic effect on PPO with Ppo-A1 and Ppo-D1 alleles contributing significantly to total PPO in both populations. These results show that the novel mutations in Ppo-A1 and Ppo-D1 present in 07OR1074 are both important to lowering overall wheat seed PPO activity and may be useful to produce more desirable and marketable wheat-based products.

Tribochemistry of phosphorus additives: experiments and first-principles calculations

The work of separation and shear strength of iron dramatically decrease by increasing the phosphorus concentration at the interface.

Trimethyl-phosphite dissociative adsorption on iron by combined first-principle calculations and XPS experiments

The reaction of trimethyl-phosphite, TMPi, with a clean Fe(110) surface has been investigated by ab initio calculations.

MoDTC friction modifier additive degradation: Correlation between tribological performance and chemical changes

To get a better understanding of how the MoDTC additive works at the molecular level, correlation between its chemical behaviour in a bulk oil during thermo-oxidative degradation and its ability to reduce friction has been investigated.

Evaluation of a capacity building clinical educational model for oral health clinicians treating very young children

OBJECTIVE

There are significant levels of dental caries in Australian school-aged children, with children aged five years having a mean dmft of 1.3. It has also been identified that, in general, oral health clinicians lack confidence to treat very young children and this study aimed to increase capacity of public sector oral health clinicians to treat preschool children.

BASIC RESEARCH DESIGN

An educational program was developed, implemented and evaluated for its capability to increase the confidence and knowledge of oral health clinicians and dental assistants in providing oral care for children aged 12 months to 5 years.

RESULTS

In 2011 and 2012, the course was delivered to 36 clinicians (22 dentists, 12 dental therapists, and two oral health therapists) and showed increases in their confidence and knowledge for participants when providing dental procedures to preschool children.

CONCLUSIONS

The educational program that was developed and implemented has met its objective of increasing the knowledge and confidence of practicing oral health clinicians and dental assistants in the management of preschool children. Strategies to further enhance the outcomes of this educational program have been proposed.

Thermal stability of kudzu root (Pueraria Radix) isoflavones as additives to beef patties

Kudzu root, Pueraria radix, extracts are a rich source of isoflavones. This study investigates the thermal stability of Pueraria radix extracts as a natural nutraceutical supplement in beef patties. The extract contained puerarin, diadzin, genistin, ononin, daidzein, glycitein, calycosin, genistein, formononetin and biochanin A; however, puerarin, daidzein and glycitein were the main components. The isoflavones concentrations in the spiked beef patties with kudzu root extracts were unaffected by cooking.

Feasibility of cochlear implantation in Mucopolysaccharidosis

Mucopolysaccharidoses (MPS) are a group of rare inherited metabolic disorders resulting from deficiencies of particular enzymes involved in the breakdown of glycosaminoglycans. Amongst the manifestations of MPS within the head and neck patients may develop conductive, mixed or sensorineural hearing loss.

OBJECTIVE

The main objective of this paper is to describe the management of profound sensorineural hearing loss in children with Mucopolysaccaridosis. The primary outcome measures for this case series were improvement in auditory performance and speech perception scores following cochlear implantation. Secondary outcome measures included surgical complications.

METHODS

We carried out a casenote review of the first two cases of cochlear implantation (CI) to rehabilitate profound sensory neural hearing loss in Mucopolysaccharidoses. Improvement in auditory performance was measured by categories of auditory performance (CAP) score, speech reception score (SRS) and the IHR McCormick toy discrimination test.

RESULTS

Both patients with MPS had demonstrable benefit from CI in terms of auditory performance and speech perception. The first patient improved from pre-operatively only managing to recognise environmental sounds to understanding conversation without lip-reading with a familiar talker. Following CI, the second patient can discriminate speech in noisy environments to a degree, without lip-reading. No peri-operative complications were noted in either patient.

CONCLUSION

As the medical management of the MPS has progressed there is likely to be a corresponding increase in survival. This increased life-expectancy will likely lead to greater numbers of patients with MPS surviving long enough to develop profound hearing loss. Likewise, when considering the risks and benefits of quality of life interventions such as CI in patients with MPS, it is more likely that the risks of surgery and general anaesthesia will be considered acceptable. Clinicians managing such patients will need to be aware of these developments.

Should we continue temozolomide beyond six cycles in the adjuvant treatment of glioblastoma without an evidence of clinical benefit? A cost analysis based on prescribing patterns in Spain

PURPOSE

The standard adjuvant treatment for glioblastoma is temozolomide concomitant with radiotherapy, followed by a further six cycles of temozolomide. However, due to the lack of empirical evidence and international consensus regarding the optimal duration of temozolomide treatment, it is often extended to 12 or more cycles, even in the absence of residual disease. No clinical trial has shown clear evidence of clinical benefit of this extended treatment. We have explored the economic impact of this practice in Spain.

MATERIALS AND METHODS

Spanish neuro-oncologists completed a questionnaire on the clinical management of glioblastomas in their centers. Based on their responses and on available clinical and demographic data, we estimated the number of patients who receive more than six cycles of temozolomide and calculated the cost of this extended treatment.

RESULTS

Temozolomide treatment is continued for more than six cycles by 80.5 % of neuro-oncologists: 44.4 % only if there is residual disease; 27.8 % for 12 cycles even in the absence of residual disease; and 8.3 % until progression. Thus, 292 patients annually will continue treatment beyond six cycles in spite of a lack of clear evidence of clinical benefit. Temozolomide is covered by the National Health Insurance System, and the additional economic burden to society of this extended treatment is nearly 1.5 million euros a year.

CONCLUSIONS

The optimal duration of adjuvant temozolomide treatment merits investigation in a clinical trial due to the economic consequences of prolonged treatment without evidence of greater patient benefit.

Lubrication mechanisms of hollow-core inorganic fullerene-like nanoparticles: coupling experimental and computational works

Inorganic fullerene-like (IF) nanoparticles made of metal dichalcogenides have previously been recognized to be good friction modifiers and anti-wear additives under boundary lubrication conditions. The tribological performance of these particles appears to be a result of their size, structure and morphology, along with the test conditions. However, the very small scale of the IF nanoparticles makes distinguishing the properties which affect the lubrication mechanism exceedingly difficult. In this work, a high resolution transmission electron microscope equipped with a nanoindentation holder is used to manipulate individual hollow IF-WS(2) nanoparticles and to investigate their responses to compression. Additional atomistic molecular dynamics (MD) simulations of similarly structured, individual hollow IF-MoS(2) nanoparticles are performed for compression studies between molybdenum surfaces on their major and minor axis diameters. MD simulations of these structures allows for characterization of the influence of structural orientation on the mechanical behavior and nano-sheet exfoliation of hollow-core IF nanoparticles. The experimental and theoretical results for these similar nanoparticles are qualitatively compared.

Identification of quantitative trait loci for productive tiller number and its relationship to agronomic traits in spring wheat

Productive tiller number (PTN), defined as the number of tillers that produce spikes and seeds, is a key component of grain yield in wheat. Spring wheat cultivars in the northern Great Plains of North America differ in PTN. The objectives of this study were (1) to determine the relationship of PTN to agronomic traits using recombinant inbred line (RIL) populations derived from crosses Reeder/Conan, McNeal/Thatcher and Reeder/McNeal grown under a range of environments, and (2) to identify and validate quantitative trait loci (QTL) associated with high PTN. Correlation between PTN and plot weight ranged from r = 0.4-0.6 among the populations based on combined means over years, and was positive in every environment for all crosses (P < 0.05). A genetic map generated for the Reeder/Conan RIL allowed identification of a QTL for PTN consistent over environments, located on chromosome 6B. The QTL on chromosome 6B (QTn.mst-6B) explained 9-17% of the variation of PTN and co-segregated with a QTL for yield in the Reeder/Conan RIL. QTn.mst-6B was validated by single marker analysis in the McNeal/Thatcher RIL, McNeal/Reeder RIL, and a set of near isogenic line (NIL) developed for QTn.mst-6B. The allele for high PTN significantly increased PTN by 8.7, 4, and 13% in the McNeal/Reeder RIL, McNeal/Thatcher RIL and Choteau/Reeder NIL, respectively. The allele for high PTN also had a significant positive effect on plot weight in the McNeal/Reeder RIL. Our results suggest that high PTN, controlled to a significant extent by QTn.mst-6B, contributed to increased yield potential over a range of environmental conditions. QTn.mst-6B may be useful for improving spring wheat in the northern Great Plains of North America and similar environments.

Clinician's guide to prostate IMRT plan assessment and optimisation

Intensity-modulated radiotherapy (IMRT) offers dosimetric benefit for irregularly shaped treatment volumes compared to three-dimensional conformal approaches. Some groups advocate IMRT as the standard of care for prostate radiotherapy. For clinicians, assessment of an IMRT plan can introduce new opportunities and challenges. Although a standard IMRT plan may be deemed acceptable by meeting pre-set dose constraints, further optimisation may yield a superior treatment plan by further reducing dose to critical structures or improving target volume homogeneity. The aim of this article is to present aspects of IMRT planning relevant to clinicians to aid in plan critiquing.

A unique snapshot of intensive care resources in Australia and New Zealand

The objective of this study was to analyse and report on the distribution and attributes of intensive care services in Australia and New Zealand for the 2005/2006 financial year A survey was mailed to 155 Australian and 26 New Zealand intensive care units (ICU) listed on the database of the Australian and New Zealand Intensive Care Society. A descriptive analytical approach was used. Of the 181 ICUs, 177 provided data. In Australia there were 100 public sector and 51 private sector ICUs and in New Zealand, 24 public sector and two private sector ICUs. These units contain 1485 available beds in the public sector and 538 available beds in the private sector Calculations to determine beds per 100,000 population, medical specialists per 1000 patient days and registered nurses per 1000 patient days showed wide variation. International comparisons are limited by lack of data; however it does appear that intensive care patients in Australia and New Zealand have very good outcomes.

Malignant round cell neoplasia in llamas and alpacas

Malignant round cell neoplasia was identified in 12 llamas and 12 alpacas aged 0-23 years. Mean age of affected alpacas (3.1 years) was significantly less than that of affected llamas (8.0 years). Tumor cell morphology varied from large and often pleomorphic (11 tumors) to small and often homogeneous (13 tumors). Neoplastic lesions were multicentric in 12 cases. Other sites were gastric (5 cases), intra-abdominal (perirenal; 4 cases), intrathoracic (2 cases), and cervical (1 case). Immunohistochemistry with antibodies to CD79alpha, BLA36, and CD3 identified B-cell lymphoma (12 cases) and T-cell lymphoma (6 cases). Six tumors did not express any lymphoid marker and were further immunostained for neuron-specific enolase (NSE), synaptophysin, S-100, glial fibrillary acidic protein (GFAP), and chromogranin A. All 6 of these tumors were negative for GFAP and chromogranin A but expressed 1 or more of the neural markers NSE, synaptophysin, and S-100 and were classified as primitive malignant round cell tumors (PMRCT). Tumor types could not be distinguished on the basis of animal age, gross pathologic appearance, tumor morphology, or tumor location. All animals with lymphoma and 5 with PMRCT died or were euthanatized. One alpaca with a focal cervical PMRCT lived for at least 20 months after diagnosis. Results of this study indicate that malignant round cell tumors in llamas and alpacas are a heterogeneous group that cannot be distinguished on the basis of signalment, postmortem findings, or routine light microscopic findings. Immunohistochemistry is a valuable diagnostic procedure when evaluating malignant round cell neoplasia in llamas and alpacas.

Creation and functional analysis of new Puroindoline alleles in Triticum aestivum

The Hardness (Ha) locus controls grain texture and affects many end-use properties of wheat (Triticum aestivum L.). The Ha locus is functionally comprised of the Puroindoline a and b genes, Pina and Pinb, respectively. The lack of Pin allelic diversity is a major factor limiting Ha functional analyses and wheat quality improvement. In order to create new Ha alleles, a 630 member M(2) population was produced in the soft white spring cultivar Alpowa using ethylmethane sulfonate mutagenesis. The M(2) population was screened to identify new alleles of Pina and Pinb. Eighteen new Pin alleles, including eight missense alleles, were identified. F(2) populations for four of the new Pin alleles were developed after crossing each back to non-mutant Alpowa. Grain hardness was then measured on F(2:3) seeds and the impact of each allele on grain hardness was quantified. The tested mutations were responsible for between 28 and 94% of the grain hardness variation and seed weight and vigor of all mutation lines was restored among the F(2) populations. Selection of new Pin alleles following direct phenotyping or direct sequencing is a successful approach to identify new Ha alleles useful in improving wheat product quality and understanding Ha locus function.

Energy spectrum of cosmic-ray electrons at TeV energies

The very large collection area of ground-based gamma-ray telescopes gives them a substantial advantage over balloon or satellite based instruments in the detection of very-high-energy (>600 GeV) cosmic-ray electrons. Here we present the electron spectrum derived from data taken with the High Energy Stereoscopic System (H.E.S.S.) of imaging atmospheric Cherenkov telescopes. In this measurement, the first of this type, we are able to extend the measurement of the electron spectrum beyond the range accessible to direct measurements. We find evidence for a substantial steepening in the energy spectrum above 600 GeV compared to lower energies.

Limits on an energy dependence of the speed of light from a flare of the active galaxy PKS 2155-304

In the past few decades, several models have predicted an energy dependence of the speed of light in the context of quantum gravity. For cosmological sources such as active galaxies, this minuscule effect can add up to measurable photon-energy dependent time lags. In this Letter a search for such time lags during the High Energy Stereoscopic System observations of the exceptional very high energy flare of the active galaxy PKS 2155-304 on 28 July 2006 is presented. Since no significant time lag is found, lower limits on the energy scale of speed of light modifications are derived.