Efficiency of the traditional practice of traps to stimulate black truffle production, and its ecological mechanisms.

The black truffle Tuber melanosporum was disseminated all over the world, propelled by the development of a wide variety of empirical practices. A widespread practice, called 'truffle trap', consists of placing pieces of truffles into excavations dug under host trees, and of collecting truffle in these traps in the next years. This research aims at (1) evaluating the effect of this practice on fruitbody production based on the analysis of 9924 truffle traps installed in 11 orchards across T. melanosporum native area in France and (2) exploring the mechanisms involved in fruitbody emergence using traps where the genotypes of introduced truffles were compared with those of fruitbodies collected in the same traps. We confirmed that truffle traps provide a major and highly variable part of truffle ground production, representing up to 89% of the collected fruitbodies. We evidenced a genetic link between introduced spores and collected fruitbodies, and then demonstrated that truffle growers provide paternal partners for mating with local maternal mycelia. We also highlighted that soil disturbance stimulate the vegetative development of established maternal mycelia. This research supports that a widely used traditional practice enhances fruitbody production by shaping favorable conditions and providing sexual partners required for fruiting.

The genus Elaphomyces (Ascomycota, Eurotiales): a ribosomal DNA-based phylogeny and revised systematics of European 'deer truffles'.

Elaphomyces ('deer truffles') is one of the most important ectomycorrhizal fungal genera in temperate and subarctic forest ecosystems, but also one of the least documented in public databases. The current systematics are mainly based on macromorphology, and is not significantly different from that proposed by Vittadini (1831). Within the 49 species recognised worldwide, 23 were originally described from Europe and 17 of these were described before the 20th century. Moreover, very recent phylogenetic treatments of the genus are mainly based on a few extra-European species and most common European species are still poorly documented. Based on an extensive taxonomic sampling mainly made in the biogeographically rich Cantabrian area (Spain), complemented with collections from France, Greece, Italy, Norway, Portugal and Sweden, all currently recognized species in Europe have been sequenced at the ITS and 28S of the rDNA. Combined phylogenetic analyses yielded molecular support to sections Elaphomyces and Ceratogaster (here emended), while a third, basal lineage encompasses the sections Malacodermei and Ascoscleroderma as well as the tropical genus Pseudotulostoma. Species limits are discussed and some taxa formerly proposed as genuine species based on morphology and biogeography are re-evaluated as varieties or forms. Spore size and ornamentation, features of the peridial surface, structure of the peridium, and the presence of mycelium patches attached to the peridial surface emerge as the most significant systematic characters. Four new species: E. barrioi, E. quercicola, E. roseolus and E. violaceoniger, one new variety: E. papillatus var. sulphureopallidus, and two new forms: E. granulatus forma pallidosporus and E. anthracinus forma talosporus are introduced, as well as four new combinations in the genus: E. muricatus var. reticulatus, E. muricatus var. variegatus, E. papillatus var. striatosporus and E. morettii var. cantabricus. Lectotypes and epitypes are designated for most recognised species. For systematic purposes, new infrageneric taxa are introduced: E. sect. Ascoscleroderma stat. nov., E. subsect. Sclerodermei stat. nov., E. subsect. Maculati subsect. nov., E. subsect. Muricati subsect. nov., and E. subsect. Papillati subsect. nov. Lastly, E.laevigatus, E. sapidus, E. sulphureopallidus and E. trappei are excluded from the genus and referred to Rhizopogon roseolus, Astraeus sapidus comb. nov., Astraeus hygrometricus and Terfezia trappei comb. nov. (syn.: Terfezia cistophila), respectively.

How the truffle got its mate: insights from genetic structure in spontaneous and planted Mediterranean populations of Tuber melanosporum.

The life cycles and dispersal of edible fungi are still poorly known, thus limiting our understanding of their evolution and domestication. The prized Tuber melanosporum produces fruitbodies (fleshy organs where meiospores mature) gathered in natural, spontaneously inoculated forests or harvested in plantations of nursery-inoculated trees. Yet, how fruitbodies are formed remains unclear, thus limiting yields, and how current domestication attempts affect population genetic structure is overlooked. Fruitbodies result from mating between two haploid individuals: the maternal parent forms the flesh and the meiospores, while the paternal parent only contributes to the meiospores. We analyzed the genetic diversity of T. melanosporum comparatively in spontaneous forests vs. plantations, using SSR polymorphism of 950 samples from South-East France. All populations displayed strong genetic isolation by distance at the metric scale, possibly due to animal dispersal, meiospore persistence in soil, and/or exclusion of unrelated individuals by vegetative incompatibility. High inbreeding was consistently found, suggesting that parents often develop from meiospores produced by the same fruitbody. Unlike maternal genotypes, paternal mycelia contributed to few fruitbodies each, did not persist over years, and were undetectable on tree mycorrhizae. Thus, we postulate that germlings from the soil spore bank act as paternal partners. Paternal genetic diversity and outbreeding were higher in plantations than in spontaneous truffle-grounds, perhaps because truffle growers disperse fruitbodies to maintain inoculation in plantations. However, planted and spontaneous populations were not genetically isolated, so that T. melanosporum illustrates an early step of domestication where genetic structure remains little affected.

Permanent genetic resources added to Molecular Ecology Resources Database 1 December 2011-31 January 2012.

This article documents the addition of 473 microsatellite marker loci and 71 pairs of single-nucleotide polymorphism (SNP) sequencing primers to the Molecular Ecology Resources Database. Loci were developed for the following species: Barteria fistulosa, Bombus morio, Galaxias platei, Hematodinium perezi, Macrocentrus cingulum Brischke (a.k.a. M. abdominalis Fab., M. grandii Goidanich or M. gifuensis Ashmead), Micropogonias furnieri, Nerita melanotragus, Nilaparvata lugens Stål, Sciaenops ocellatus, Scomber scombrus, Spodoptera frugiperda and Turdus lherminieri. These loci were cross-tested on the following species: Barteria dewevrei, Barteria nigritana, Barteria solida, Cynoscion acoupa, Cynoscion jamaicensis, Cynoscion leiarchus, Cynoscion nebulosus, Cynoscion striatus, Cynoscion virescens, Macrodon ancylodon, Menticirrhus americanus, Nilaparvata muiri and Umbrina canosai. This article also documents the addition of 116 sequencing primer pairs for Dicentrarchus labrax.

Mild hypoxia disrupts recollection, not familiarity.

Yonelinas et al. (2002) found that hypoxic patients exhibited deficits in recollection that left familiarity relatively unaffected. In contrast, Manns, Hopkins, Reed, Kitchener, and Squire (2003) studied a group of hypoxic patients who suffered severe and equivalent deficits in recollection and familiarity. We reexamine those studies and argue that the discrepancy in results is likely due to differences in the hypoxic groups that were tested (i.e., differences in amnestic severity, subject sampling methods, and patient etiology). Yonelinas et al. examined memory in 56 cardiac arrest patients who suffered a brief hypoxic event, whereas Manns et al. examined a group of severely amnesic patients that consisted of 2 cardiac arrest patients, 2 heroin overdose patients, 1 carbon monoxide poisoning patient, and 2 patients with unknown etiologies. We also consider an alternative explanation proposed by Wixted and Squire (2004), who argued that the two patient groups suffered similar deficits, but that statistical or methodological artifacts distorted the results of each of Yonelinas et al.'s experiments. A consideration of those results, however, indicates that such an explanation does not account for the existing data. All of the existing evidence indicates that recollection, but not familiarity, is disrupted in mild hypoxic patients. In more severe cases of hypoxia, or those with more complex etiologies such as heroin overdose, more profound deficits may be observed.

[Iodine-125 transperineal prostate brachytherapy with preplanning technique: pre and post-implant dosimetry results analysis]. / Curiethérapie prostatique transpérinéale par iode 125 avec dosimétrie prévisionnelle: analyse des résultats dosimétriques pré- et post-implantation.

PURPOSE: Post-implant CT-based dosimetry is the only method of assessing the quality of permanent prostate brachytherapy. As a consequence of our permanent feedback with the preplanned technique, geometric and dosimetric criteria for optimal seed implantation are proposed and pre and post-implantation dosimetric results are presented. PATIENTS AND METHODS: In 2000 and 2001, one hundred and twenty patients with early stage prostate cancer were treated with transperineal I-125 preplanned brachytherapy (RAPID Strand, Amersham Health). The prescription dose was 145 Gy to the planning target volume. For the pre-planning and post-implant dosimetry the Variseed 6.7 version software was used (Varian Medical Systems). The D90, V100 and V150 values, the position of the dose peak [Dose] peak) and the full width at half maximum (FWHM) on differential dose volume histogram from both planned and post-implant dosimetry were compared for all patients. RESULTS: For preplanned dosimetry, the mean values for D90, V100, V150, [Dose] peak, FWMH were respectively of 199Gy, 100%, 70%, 220Gy, 113Gy. For post-implantation, these values became respectively of 157Gy, 90%, 62%, 220Gy, 194Gy. CONCLUSION: In our practice, differences are noted between preplanned and post-implant dosimetry parameters that should be anticipated to assure optimal definitive result. A working methodology both for performing the preplanned dosimetry and for evaluating the post-implantation dosimetric results is proposed.

A simple, inexpensive, life-saving way to perform iterative laparotomy in patients with severe intra-abdominal sepsis.

Between 1 June 1993 and 31 December 1998, 17 patients underwent temporary abdominal closure with 3L urological irrigation bags, because in most cases, there was massive sepsis leading to the conclusion that primary closure was not advisable. Indicative of the seriousness of these conditions, Apache score averaged 19 (range 10-30). The technique consisted of suturing a double thickness of irrigation bags to each side of the wound, and joining the two bags in the midline with running sutures. Abdominal lavage with large quantities of fluid was performed every other day. This type of closure was used for a mean duration of 15 days. Mean length of hospitalization was 60 days. There were only three deaths (17.6%). No incisional hernia occurred after the iterative laparotomies. Deleting patients with acute pancreatitis would have reduced the death rate to only 7%. A 3L urological irrigation bag costs pound 11.60 (24.40 dollars CAN) while a Marlex mesh costs pound 81.40 (171.00 dollars CAN). We conclude that the usage of 3L urological plastic bags is a simple, safe and efficient method for temporary closure of the abdomen.

Dose escalation with 3D-CRT in prostate cancer: French study of dose escalation with conformal 3D radiotherapy in prostate cancer-preliminary results.

PURPOSE: To evaluate the feasibility of dose escalation in a multi-institutional study in prostate cancer patients. METHODS AND MATERIALS: Between October 1995 and October 1998, 164 patients with localized adenocarcinoma of the prostate were treated with 3-dimensional conformal radiotherapy at one of five French institutions. The dose of radiation was escalated from 66 to 80 Gy (ICRU point). The maximum dose to the rectal wall was limited to 75 Gy. RESULTS: Results were compared in two groups, one (group 1) receiving the standard dose (n = 46 patients; 66 to 70 Gy) and the other (group 2) receiving the escalated dose (n = 118 patients; 74 to 80 Gy). There was no difference in the characteristics of patients between the two groups. The mean follow-up time was 32 months in group 1 and 17.5 months in group 2. No statistical difference between the two groups was observed in the incidence of late gastrointestinal and urinary toxicities. The probability of achieving a posttreatment prostate-specific antigen nadir of

[Evaluation tests of computer systems concerning tri-dimensional dose calculations]. / Tests d'évaluation des systèmes informatiques concernant le calcul de la dose en trois dimensions.

The development of irradiation techniques in radiotherapy shows a clear tendency towards the systematic use of three-dimensional (3D) information. Great efforts are being made to set up 3D conformal radiotherapy. Consequently, in the aim of greater coherence and accuracy, "the dosimetric tool" must also meet the requirements of 3D radiotherapy, as it plays a role in the treatment chain. To know if the treatment planning system is a "3D", "2D" or even "1D" system, one should not be satisfied with reading the technical documentation and the program algorithm description nor entirely trust the constructor's assertions. It is essential to clearly and precisely evaluate the possibilities of the treatment planning system. Even if it is proved not to satisfy perfectly all the tests which would qualify it as a real 3D calculation system, the study of the test results helps to give clear explanations of the dosimetric results. Two series of test cases are proposed. The first series allows us to understand in which conditions the treatment planning system takes into account the scatter influence in a volume. The second series is designed to inform us about the capability of the dose calculation algorithm when the medium encloses non-homogeneities. These test cases do not constitute an exhaustive "check-list" able to tackle completely the question of 3D calculation. They are submitted as examples and should be considered as an evaluation methodology for the software implanted in the treatment planning system.

Patterns of cognitive recovery in sudden cardiac arrest survivors: the pilot study.

OBJECTIVE: To determine the prevalence, type, severity, and natural evolution of cognitive impairments in survivors of sudden cardiac arrest over time and to assess the relation of selected clinical and psychologic variables to those outcomes. DESIGN: Longitudinal with repeated measures. Twenty-five consecutive patients underwent extensive neuropsychologic testing during hospitalization within 3 weeks of their initial cardiac arrest. Of these, 17 completed additional testing at 6 to 9 weeks, 12 to 15 weeks, and 22 to 25 weeks after the event. SETTING: Cardiac electrophysiologic services at a university teaching hospital, a community hospital, and home. OUTCOME VARIABLES: Orientation, attention, concentration, immediate recall, early retention, delayed recall, reasoning, motor speed, and motor regularity were measured. RESULTS: During hospitalization, 72% of the patients had mild to severe impairments in one or more cognitive areas. Memory, particularly delayed recall, was the most common deficit. At 6 months after the arrest event, 29% (5 of 17) of the patients continued to be impaired, and all had deficits in delayed recall. Depression was significantly related to deficits in attention and delayed recall at 6 months only. Time to postarrest awakening was the most reliable predictor of long-term cognitive functioning in this patient sample. CONCLUSION: A significant minority of sudden death survivors incur long-term cognitive impairments, particularly in delayed recall or short-term memory. The occurrence of long-term cognitive deficits in these patients can be estimated from the duration of unconsciousness after resuscitation (time-to-awakening).

Factors associated with cognitive recovery after cardiopulmonary resuscitation.

BACKGROUND: A range of neuro-cognitive sequelae, from mild intellectual impairments to brain death, have been reported in survivors of aborted sudden cardiac death. PURPOSE: To determine to what extent, if any, factors associated with cardiopulmonary resuscitation, left ventricular function, and mood state are related to outcomes in five cognitive areas, namely orientation, attention, memory, reasoning, and motor performance. METHODS: Repeated measures were used to assess cognitive outcomes in 45 sudden cardiac arrest survivors over the 6 months following cardiopulmonary resuscitation. A battery of neuro-psychological tests was used to assess cognitive outcomes and psychological status over time. The relationship of the cardiopulmonary resuscitation, left ventricular function, and psychological variables to cognitive outcomes were assessed at each data point. The independent variables included time to cardiopulmonary resuscitation, time to defibrillation, duration of cardiopulmonary resuscitation, time to awakening, ejection fraction, New York Heart Association Class I to IV, tension, anger, and depression. RESULTS: During hospitalization 38 of the 45 survivors (84%) had mild to severe deficits in one or more cognitive areas; 19 of 38 survivors (50%) continued to be impaired in one or more cognitive areas at 6 months. Of these, all had mild to severe deficits in at least one aspect of memory, with delayed recall the most frequent impairment. Time to awakening accounted for a unique portion of the variance in orientation and memory outcomes over time. The left ventricular function variables accounted for a significant portion of the variance in motor speed. CONCLUSIONS: Our results suggest that half of the long-term survivors of aborted sudden cardiac death are cognitively intact 6 months after resuscitation but that 25% have moderate to severe impairment in memory, which could hamper and/or preclude the resumption of prearrest roles.

Reassessing the number and mix of system physicians needed.

As the fee-for-service reimbursement environment gives way to managed care in many parts of the country, healthcare executives are facing the need to reassess the number and specialty mix of their systems' physician populations. By using two sets of guidelines--one developed for fee-for-service environments (the Graduate Medical Education National Advisory Committee guidelines) and the other developed for managed care environments (the Kaiser Permanente guidelines)--healthcare executives can calculate the appropriate number and specialty mix of physicians their systems need to serve their communities.

Impact of aborted sudden cardiac death on survivors and their spouses: the phenomenon of different reference points.

BACKGROUND: Although anecdotal data suggest that spouses of aborted sudden cardiac death survivors become enmeshed in the physical and emotional recovery of their mates, few longitudinal studies address the personal struggle of aborted sudden cardiac death survivors and their spouses during recovery. OBJECTIVE: To identify and explore phenomena experienced by aborted sudden cardiac death survivors and their spouses, and to determine implications for care. METHODS: This was a phenomenological study; qualitative interviews were conducted within 3 weeks of aborted sudden cardiac death and continued through 24 weeks after arrest at 6- to 8-week intervals. A total of 180 interviews were conducted with 40 survivors and 30 spouses. Interviews were tape-recorded, transcribed, and analyzed for recurrent themes. RESULTS: For the spouses the point of focus, or reference point, for future decision making was the arrest; for the survivors the reference point was prearrest life. These different reference points led to different concerns between spouses and survivors, from which spousal protectiveness and entrapment emerged. CONCLUSIONS: Acknowledgment of different reference points is essential in planning interventions for aborted sudden cardiac death survivors and their spouses. This population must be encouraged to express their questions, concerns, and fears early. Differences in perspectives should be identified to avoid troubled communication and conflicts.

Long-term physical functioning and psychosocial adjustment in survivors of sudden cardiac death.

OBJECTIVE: To identify and describe a range of functional health outcomes in a sample of sudden cardiac death survivors. DESIGN: Cross-sectional survey. SETTING: Northern California tertiary medical center. SUBJECTS: Sixty-one sudden cardiac death survivors at least 6 months but not more than 4 years after cardiac arrest. Subjects were excluded if they had uncontrolled congestive heart failure, unstable angina, other debilitating cardiac or concomitant illness, or evident cognitive deficits. METHODS: Chart reviews, patient interviews, and a standardized questionnaire. RESULTS: Survivors reported significantly poorer physical functioning than normal subjects (p < 0.001), although none were limited in self-care. Mental Health Index Scores and subscale scores for psychologic well-being were within established norms. However, mean scores for the psychologic distress subscale were elevated (p < 0.001). Initial work return was 72%. Of the 37 (61%) survivors who were sexually active before their arrests, 78% resumed coitus. Twenty-five survivors reported mild to moderately severe impairments in memory or other cognitive skills. Poor physical functioning was associated with illness severity, change in work status, and increased anxiety. Psychologic distress was associated with change in work status and poor physical functioning, but not illness severity. CONCLUSIONS: Despite significant decreases in physical functioning and reports of mild to moderately severe cognitive impairments, only a minority of sudden cardiac death survivors are severely psychologically distressed. Illness severity is a strong predictor of physical functioning, but its contribution to psychologic distress is indirect, acting largely through the aegis of poor physical functioning and loss of prearrest work status.

Analysis of published studies on the detection of extrathoracic metastases in patients presumed to have operable non-small cell lung cancer.

BACKGROUND: A study was undertaken to determine the proportion of patients with potentially operable non-small cell lung cancer that could be spared thoracotomy by a systematic search for extrathoracic metastases. METHODS: An English language literature search was carried out using MEDLINE (1966-91) and bibliographic reviews of textbooks, review articles, and key articles. Studies were included in which at least 90% of the patients had histologically proven non-small cell cancer of the lung, were presumed otherwise operable, and for which the results of computed tomography of the head or abdomen, ultrasonography of the abdomen, or radionuclide imaging (scan) of bone or liver were available. Study quality and specific descriptive information concerning population, intervention, and outcome measurements were assessed. RESULTS: Of approximately 1500 citations which were screened, 100 were reviewed in detail and data abstracted from 16. The number of patients (total number, followed in square brackets by number of asymptomatic patients) shown to be inoperable directly as a result of the investigation and thus spared unnecessary thoracotomy was: computed tomography of the head: 26/785 (3.3%), 95% confidence interval (CI) 2.1% to 4.4% [14/353 (4.0%), 95% CI 2% to 6%], computed tomography of the adrenal glands: 30/632 (4.7%), 95% CI 3.0% to 6.4% [number asymptomatic indeterminate], bone scan: 45/480 (9.3%), 95% CI 6.7% to 12% [9/301 (3.0%), 95% CI 1.1% to 4.9%], liver imaging: 12/529 (2.3%), 95% CI 0.9% to 3.3% [4/268 (1.5%), 95% CI 0.1% to 3%]. CONCLUSIONS: A study with a large sample size and preferably incorporating thoracic computed tomography is required to narrow the confidence intervals around each test. All tests may play an important part in the preoperative evaluation of patients with non-small cell carcinoma of the lung who are presumed to be operable, including asymptomatic patients. Limitations of present data preclude definitive recommendations for asymptomatic patients.

Survival after implantation of the cardioverter defibrillator.

The actuarial survival of 60 consecutive recipients of the implanted cardioverter defibrillator (ICD) were compared with 120 matched concurrent medically treated patients using a case-control design. All ICD patients and controls presented with either sustained ventricular tachycardia or ventricular fibrillation. Controls were matched to ICD recipients according to 5 variables: age, left ventricular ejection fraction, arrhythmia at presentation, underlying heart disease and drug therapy status. Mean ages were 58 and 59 years in ICD patients and controls, and the average ejection fractions were 36 and 35%. Coronary artery disease was present in 75 and 79% of ICD patients and controls, respectively. During follow-up, sudden deaths were fewer in ICD recipients than in controls (5 vs 10%, p less than 0.01). At 1 and 3 years, actuarial survival was 0.89 vs 0.72 and 0.65 vs 0.49 for ICD recipients and controls. The 5-year actuarial survival curves were significantly different by the Cox proportional hazards model (p less than 0.05). It is concluded that in this retrospective case-control study, the use of the ICD in the management of patients at risk for sudden death results in improved probability of survival.

Long-term results of amiodarone therapy in patients with recurrent sustained ventricular tachycardia or ventricular fibrillation.

Four hundred sixty-two patients, all with either documented spontaneous sustained ventricular tachycardia or cardiac arrest unresponsive to other antiarrhythmic drugs (2.6/patient), were treated with amiodarone. Thirty-five patients (7.6%) failed to respond or died during the initial oral or intravenous loading phase. The remaining 427 patients were discharged on treatment with oral amiodarone and followed up for up to 98 months. Recurrence of ventricular tachycardia or sudden cardiac death at 1, 3 and 5 years by life-table analysis was 19%, 33% and 43%, respectively, for patients discharged on amiodarone therapy. The sudden cardiac death rate was 9%, 15% and 21%, respectively, at 1, 3 and 5 years. Side effects were reported by 45% of patients after 1 year, by 61% after 2 years and by 86% after 5 years. Amiodarone was discontinued because of side effects in 14%, 26% and 37% of patients after 1, 3 and 5 years, respectively. Incidence rates of recurrence of arrhythmia, sudden cardiac death and side effects were highest in the early months and then decreased. By multivariate analysis, advanced age, low ejection fraction and a history of cardiac arrest were independent risk factors for sudden cardiac death during amiodarone therapy.

Usefulness of sotalol for drug-refractory malignant ventricular arrhythmias.

Fifty patients with recurrent sustained symptomatic ventricular tachycardia (43 patients) or ventricular fibrillation (7 patients) resistant to a mean of 2.8 + 1.4 antiarrhythmic drugs were treated with sotalol, a beta-adrenergic receptor antagonist, and 45 underwent invasive electrophysiologic testing before and after sotalol therapy. The arrhythmia became noninducible in 10, was slower and hemodynamically well tolerated in 12 and was poorly tolerated in 23. Four patients were empirically treated with long-term administration of oral sotalol as were 21 patients who either had noninducible arrhythmia (10 patients) or had hemodynamically stable ventricular tachycardia (11 patients). In these 25 patients treated with long-term administration of sotalol, there was no recurrence of ventricular tachycardia in the group with noninducible arrhythmia, whereas 37% of patients with inducible ventricular tachycardia had new ventricular tachycardia or sudden death. Programmed ventricular stimulation with up to three extrastimuli proved to be an excellent predictor of drug efficacy and a good predictor of inefficacy. A positive prior response to amiodarone was not a reliable indicator of a positive response to sotalol. Side effects included those attributed to both beta-adrenergic blockade as well as proarrhythmic effects. The latter were observed in two of four patients with a QT interval greater than 600 ms. Sotalol was found to be effective therapy for a subset of patients with ventricular tachycardia unresponsive to type IA drugs.