A multi-year field study to evaluate the environmental fate and agronomic effects of insecticide mixtures.

A mixture of insecticides used in corn production was monitored over a three-year period in a field study to determine how long each persists in the environment, where each insecticide travels within the corn field, and the efficacy of using soil-applied insecticides with genetically modified corn. The genetically modified corn contained the insecticidal Cry1Ab and Cry3Bb1 proteins (Bt corn) and the Cry1Ab protein was found to persist only during the corn growing season in soil, runoff water, and runoff sediment with highest concentrations measured during pollination. Very low concentrations of Cry1Ab proteins were measured in soil collected in the non-Bt corn field, and no Cry1Ab proteins were detected in shallow groundwater or soil pore water. Clothianidin, a neonicotinoid insecticide used as a seed coating, was detected in all matrices and remained persistent throughout the year in soil pore water. Tefluthrin, a pyrethroid insecticide applied at planting to control corn rootworm larvae (Diabrotica spp., Coleoptera: Chrysomelidae) populations, was consistently detected in soil, runoff water, and runoff sediment during the corn growing season, but was not detected in groundwater or soil pore water. Tefluthrin did not have an effect on root damage from corn rootworm larvae feeding to Bt corn, but did prevent damage to non-Bt corn. A slight reduction in grain yield was observed in the non-Bt, no tefluthrin treatment when compared to all other treatments, but no significant difference in grain yield was observed among Bt corn treatments regardless of soil insecticide application. In the current study, the use of tefluthrin on Bt corn did not significantly affect crop damage or yield, and tefluthrin may travel off-site in runoff water and sediment.

Electroconvulsive therapy in patients with skull defects or metallic implants: a review of the literature and case report.

CONTEXT: Head injury is often associated with psychiatric morbidity. While it is well understood that the loss of critical areas of the brain may play a role in cognitive dysfunction and change in personality, head injury can also have profound effects on mood and cognition. The role of medications in the treatment of mood disorders associated with brain injury is well documented, and there is also evidence favoring the use of electroconvulsive therapy (ECT) in this context. However, data are limited on the use of ECT in patients with skull defects or metallic head implants. EVIDENCE ACQUISITION: First, a review of the literature on use of ECT in patients with metallic head implants is provided. Electronic databases and online sites, including PubMed, Cochrane Library of Systematic Reviews, and UpToDate, were used to search for relevant articles and case reports on the use of ECT in patients with and without metallic implants in the head (1964 to 2009). The search terms electroconvulsive, electroconvulsive therapy, ECT, electroshock therapy, EST, head injury, brain injury, metallic plates, metallic implants, skull prosthesis, and depression were used interchangeably. The search produced 7 articles discussing exclusively the use of ECT in patients with a metallic skull plate. Second, the case of the successful and safe use of ECT in an individual with a previous history of brain trauma and metallic plate implantation is described. RESULTS: Most cases of head injury are managed by neurologists and rehabilitation consultants; the more severe cases of depression and other mood disorders tend to be referred for specialist psychiatric care. With greater degrees of deficit following head injury, management becomes more complicated. Our patient showed positive results with ECT, including improvement in depressive features and resolution of suicidal ideas/plans. CONCLUSION: ECT is an effective and safe alternative in patients with a history of brain trauma and metallic plate implantation who subsequently develop treatment-resistant depression and associated suicidal ideas or plans refractory to management with medications.

Phase II randomized comparison of topotecan plus cyclophosphamide versus topotecan alone in children with recurrent or refractory neuroblastoma: a Children's Oncology Group study.

PURPOSE: Single-agent topotecan (TOPO) and combination topotecan and cyclophosphamide (TOPO/CTX) were compared in a phase II randomized trial in relapsed/refractory neuroblastoma. Because responders often underwent further therapies, novel statistical methods were required to compare the long-term outcome of the two treatments. PATIENTS AND METHODS: Children with refractory/recurrent neuroblastoma (only one prior aggressive chemotherapy regimen) were randomly assigned to daily 5-day topotecan (2 mg/m(2)) or combination topotecan (0.75 mg/m(2)) and cyclophosphamide (250 mg/m(2)). A randomized two-stage group sequential design enrolled 119 eligible patients. Toxicity and response were estimated. Long-term outcome of protocol therapy was assessed using novel methods-causal inference-which allowed adjustment for the confounding effect of off-study therapies. RESULTS: Seven more responses were observed for TOPO/CTX (complete response [CR] plus partial response [PR], 18 [32%] of 57) than TOPO (CR+PR, 11 [19%] of 59;P = .081); toxicity was similar. At 3 years, progression-free survival (PFS) and overall survival (OS) were 4% +/- 2% and 15% +/- 4%, respectively. PFS was significantly better for TOPO/CTX (P = .029); there was no difference in OS. Older age at diagnosis and lack of MYCN amplification predicted increased OS (P < .05). Adjusting for randomized treatment effect and subsequent autologous stem-cell transplantation, there was no difference between TOPO and TOPO/CTX in terms of the proportion alive at 2 years. CONCLUSION: TOPO/CTX was superior to TOPO in terms of PFS, but there was no OS difference. After adjustment for subsequent therapies, no difference was detected in the proportion alive at 2 years. Causal inference methods for assessing long-term outcomes of phase II therapies after subsequent treatment can elucidate effects of initial therapies.