Stem Lesions Research Articles

Otic Langerhans Cell Histiocytosis in Adults: A Report of Two Cases

We presented two cases of Langerhans cell histiocytosis (LCH) in which the temporal bone and hearing center in the brain stem were affected. We discuss the diagnosis and management of this disease and how it presents if the temporal bone is involved. The first case involved a patient with destructive lesions in the temporal bone, who responded to medical management, while the second case involved a patient with brain stem lesions, who did not improve on chemotherapy. The findings from these two cases suggest that a differential diagnosis of LCH should be considered in patients with persistent ear discharge or hearing loss that does not respond to conventional antibiotic treatment, and that imaging studies are required for any atypical presentation. J Med Cases. 2018;9(3):106-108 doi: https://doi.org/10.14740/jmc2917w

First Report of Stem Rot on Potato Caused by Dickeya chrysanthemi in Minnesota

Bacterial soft rot and black leg diseases of potato occur sporadically in the Upper Midwestern United States. Multiple members of the soft rot Enterobacteriaceae (SRE) cause diseases in potato. The taxonomy of SREs has undergone extensive revision, resulting in the establishment of new genera and species to better reflect the phylogeny and diversity of strains formerly classified as Erwinia carotovora or E. chrysanthemi (Marrero et al. 2013). One such species, Dickeya dianthicola, has been associated with recent severe black leg outbreaks in the eastern United States. To identify the SREs in the Upper Midwest, a 2016 survey of commercial and seed potato fields in Minnesota and North Dakota was conducted. SREs (123) were isolated from 78 tissue samples exhibiting symptoms of black leg, stem rot, and soft rot. Small tissue samples from the margin of symptomatic and healthy tissues were suspended in 0.02 M potassium phosphate buffer, pH 7.2, for 30 min. Cell suspensions were serially diluted and spread onto crystal violet pectate (CVP) agar. Bacterial colonies producing pitting on CVP were subsequently reisolated on CVP and purified on nutrient broth yeast extract medium. Three isolates from one sample were obtained from a stem sample collected in Sherburne County, Minnesota. One isolate, SR64, was retained for phenotypic characterization and genetic identification. Symptoms associated with SR64 included dry, black-brown necrotic stem lesions with cracking and exposed vasculature. SR64 was determined to be gram negative based on reaction in 3% KOH. Growth on King’s B agar medium failed to produce fluorescence characteristic of Pseudomonas. SR64 also exhibited facultative anaerobic respiration in Hugh-Leifson medium and the ability to grow at 37°C on nutrient agar. Reinoculation of potato tuber slices with SR64 and incubation at 25°C for 2 days produced tissue maceration and dark ooze typical of SRE. DNA extracted from a pure culture of SR64 using DNeasy blood and tissue kits (Qiagen, Valencia, CA, U.S.A.) was used as template for genetic analysis. PCR was conducted using two primer sets: ADE1/ADE2 (Nassar et al. 1996) and Df/Dr (Laurila et al. 2010). SR64 template DNA produced 420 and 119 bp amplicons via ADE1/ADE2 and Df/Dr primers, respectively, as expected for Dickeya. The 16S rDNA was amplified using primer set F27/R1492 (Monciardini et al. 2002), and the ∼1.2 kb amplicon was sequenced and submitted for GenBank nucleotide BLAST analysis. SR64 shared 98% identity with that of the 16S rDNA sequence of type strain Dickeya chrysanthemi LMG 2804 (NZ_CM001974) (Samson et al. 2005). To confirm the species identification, additional housekeeping genes, dnaJ (DCH402_RS02710), dnaX (DCH402_RS15110), and gyrB (DCH402_RS00180) were amplified using primer sets reported by Marrero et al. (2013). Housekeeping gene sequences were concatenated creating a 1,955 bp fragment for analysis with CLC Main Workbench software (Qiagen). The pairwise percent identity between the concatenated sequences of SR64 and D. chrysanthemi LMG 2804ᵀ, D. zeae LMG 2505ᵀ, D. dianthicola LMG 2485ᵀ, D. dadantii subsp. dadantii LMG 25991ᵀ, and D. solani LMG 25993ᵀ was 99.13, 89.42, 90.85, 89.88, and 85.89%, respectively. The low incidence of Dickeya observed in this survey could be owing to limitations of the protocols used to isolate SREs. Alternatively, it could indicate that Dickeya is not currently prevalent in the region. This is the first report of D. chrysanthemi on potato in Minnesota.

Respiratory Dysfunction in Spinal Cord Injury: Physiologic Changes and Clinically Relevant Therapeutic Applications

Spinal cord injury (SCI) can result in serious respiratory compromise, impaired cough ability and respiratory failure. Complications include atelectasis and pneumonia. Respiratory failure is the primary cause of morbidity and mortality in high cervical cord injuries. Various methods have been used to assist coughing in SCI, including manual and mechanical techniques. Physical therapists can apply certain exercises and maneuvers to augment tidal breathing and expiratory effort, such as respiratory muscle training. For patients with vital capacities <10 to 15 mL/ kg, noninvasive methods such as abdominal binding, the pneumobelt, and face mask-applied ventilators are used to maintain adequate respiration. Phrenic nerve and diaphragmatic pacing provide increased patient mobility, comfort and lower health care costs; breathing pacemakers have increased survival and improved quality of life in individuals with upper cervical cord and brain stem lesions. Tracheostomy should be used only for those patients that have severe bulbar impairment and cannot successfully use airway clearance methods. Even patients with tracheostomyassisted ventilation can be eventually weaned off respirators, provided they meet criteria for spontaneous breathing. Peak expiratory flows should exceed 160 L/m to assure expulsion of airway secretions and the negative inspiratory pressure should exceed -20 cm H2O (variables measured with the tube cuff inflated) before the patient is decannulated. Appropriate vaccinations should be provided for any individual with compromised respiratory function, particularly with regularly scheduled influenza and pneumococcal pneumonia vaccines. Management of the physically impaired patient can be a major challenge for family, leading to adverse physical and psychological consequences. Long-term management requires a multidisciplinary approach that includes respiratory, physical and occupational therapists, nutritionists, social workers, psychologists, and home health agencies, all of whom contribute to key aspects of maintaining optimum respiratory function. Life satisfaction is a major consideration in this group of individuals, but it may have a more positive outlook than one would think in someone with significant physical and psychological challenges.

First Report of Fusarium acuminatum Wilt in the Broomrape Parasite of Processing Tomato in China

During July to August 2015, diaseased processing tomato broomrapes with spindle-shaped stem lesions were collected from fields of Changji Hui and Korla Bayingolin Mongol Autonomous Prefecture, Xinjiang. The causal agent was identified as Fusarium acuminatum based on morphological characters, pathogenicity tests and molecular methods. This is the first report of F. acuminatum infects broomrape on processing tomato in China. This study offers a potentially promising strategy for control of broomrape.

First Report of Southern Blight in Pitaya (Hylocereus undatus) Caused by Sclerotium rolfsii in China

Pitaya (Hylocereus undatus) is a tropical and subtropical fruit of the family Cactaceae. The enormous economic potential of this fruit has encouraged its cultivation in Hainan Province of China. In June 2016, a stem blight disease was observed affecting over 15% of the plant in the fruit nursery of Lingao (Hainan Province). Symptomatic plants initially had hygrophanous, dark brown to brown spots, developing into sunken lesions on the lower stem near the ground. White, silky mycelium developed on the stem lesions. Later, white, spherical, shiny and smooth sclerotia (1.0 to 1.5 mm in diameter) were observed, which gradually turned tan to dark brown. Finally only the middle of the pith was left in the stem lesions. Sclerotia were aseptically transferred to potato dextrose agar (PDA) and incubated at 28°C. Two days after incubation, fast-growing fungal colonies (70 to 75 mm in diameter) were observed. Subsequently, small round sclerotia developed in the culture. Abundant milky globoid sclerotia were observed ...

First Report of Alder Phytophthora Closely Related to P. uniformis on Alnus glutinosa Seedling in Finland

The allotriploid Phytophthora x alni (Brasier & S.A. Kirk) Husson, Ioos & Marcais and its progenitors, the diploid P. uniformis (Brasier & S.A. Kirk) Husson, Ioos & Aguayo and the allotetraploid P. x multiformis (Brasier & S.A. Kirk) Husson, Ioos & Frey are the causal agents of alder decline in Europe. In June 2015, a dark, ca. 40 mm stem lesion was found on one out of 100 inspected Alnus glutinosa (L.) Gaertn seedlings in Mantyharju, Finland. Surface wood pieces from the lesion edges were plated onto malt agar (MEA). Cultures on carrot piece agar (CPA) showed appressed colony with woolly aerial mycelium. Oogonia (O mean 44.8 µm, n = 50) and oospores (O mean 40.0 µm, n = 50) developed after 7 days at 20 °C in the dark. They were commonly smooth walled and 49 out of 50 of the amphigynous antheridia were single celled. Sporangia (21.7 µm x 18.1 µm, n = 50) were produced on pea broth, with 2-day flooding with soil extract, and they were commonly unpapillate and obpyriform-ellipsoidal. DNA was extracted and t...

A Destructive Leaf Spot and Blight Caused by Alternaria kareliniae sp. nov. on a Sand-Stabilizing Plant, Caspian Sea Karelinia.

Leaf spots and stem lesions causing widespread mortality of Caspian Sea karelinia (Karelinia caspia) were observed in desert regions of Xinjiang Uyghur Autonomous Region, China. Fifteen samples were collected from five widely distributed counties of Tarim and Junggar Basins in 2016. The pathogen was identified using morphological observations and phylogenetic analyses based on combined partial sequences from seven genes (Alt a 1, ATPase, calmodulin, glyceraldehyde 3-phosphate dehydrogenase, internal transcribed spacer, RNA polymerase II, and translation elongation factor 1), and placed as a new species: Alternaria kareliniae sp. nov. in section Dianthicola. The fungus has a small conidium (24.3 to) 29.1 to 64.8 (to 75.8) by (9.3 to) 12.4 to 16.5 (to 21.7) μm with a long beak (130 to) 183.9 to 350.4 (to 378.2) μm, as well as four to eight transverse septa, which differs significantly from other species of Alternaria section Dianthicola. On potato carrot agar, it grew significantly more slowly than others of this section. Pathogenicity tests showed that the fungus could infect leaves and stems of K. caspia and cause the same symptoms as those observed in the field. The fungus was reisolated from inoculated leaves and stems of the host. The disease in desert regions appears to be increasing, and it may have future negative implications for desert ecology in these areas. Future research should concentrate on elucidating the disease cycle and disease management alternatives.

First Report of Pythium myriotylum as a Causal Agent of Crown and Root Rot in Soilless Green Bean Cultivation in Italy

HomePlant DiseaseVol. 102, No. 3First Report of Pythium myriotylum as a Causal Agent of Crown and Root Rot in Soilless Green Bean Cultivation in Italy PreviousNext DISEASE NOTES OPENOpen Access licenseFirst Report of Pythium myriotylum as a Causal Agent of Crown and Root Rot in Soilless Green Bean Cultivation in ItalyS. Vitale, L. Luongo, E. Marinelli, and A. BelisarioS. VitaleSearch for more papers by this author, L. LuongoSearch for more papers by this author, E. MarinelliSearch for more papers by this author, and A. Belisario†Corresponding author: A. Belisario; E-mail: E-mail Address: [email protected]http://orcid.org/0000-0001-8912-7638Search for more papers by this authorAffiliationsAuthors and Affiliations S. Vitale L. Luongo E. Marinelli A. Belisario † , Consiglio per la Ricerca in Agricoltura e l’analisi dell’economia agraria, Centro di ricerca per la Difesa e la Certificazione (CREA-DC), 00156, Roma (Italy). Published Online:23 Jan 2018https://doi.org/10.1094/PDIS-07-17-0942-PDNAboutSectionsSupplemental ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InRedditEmailWechat Green beans are the unripe young fruit of common bean (Phaseolus vulgaris). Italy is one of the larger European producers, together with Spain, of green beans with 140,000 t of fresh vegetable (FAOSTAT 2014). To increase green bean production and quality, its cultivation includes soilless growing. In the summer 2016, during a survey in a commercial greenhouse farm in central Italy (Latium region), over 200 out of 1,000 green bean plants (P. vulgaris cv. Valdarno) showed symptoms of crown and root rot followed by wilting. Plants were cultivated in a pot with sterile perlite and coconut fiber with no recycled-water irrigation system. The infected crowns and roots appeared water soaked with a cinnamon brown color, and dead plants occurred in distinct and well-delimited areas. Microbial isolations were performed from 10 diseased plants previously abundantly washed under running tap water. Fragments cut from the margin of subepidermal stem lesions were plated on P5ARP (Jeffers and Martin 1986). A Pythium species was consistently isolated, and three single-hyphal cultures out of 25 colonies were transferred onto potato dextrose agar (PDA). Sporangia induced by soil filtrate were terminal or intercalary, filamentous, consisting of undifferentiated and inflated lobulate or digitate elements of variable length, mostly 7 to 17 µm in diameter. Oogonia mostly globose were terminal or intercalary from 20 to 35 µm in diameter (average 29 µm). Oospores were mostly aplerotic. On the basis of morphological features, the isolates were identified as Pythium myriotylum Drechsler (van der Plaats-Niterink 1981). The identity was confirmed by cytochrome oxidase subunit 1 (COI) and by internal transcribed spacer (ITS) sequence comparison with 100 and 99% homology with HQ708745 and HQ643701, respectively. Both sequences were from a P. myriotylum Israeli (CBS 25470) isolate obtained from peanuts. The sequences of the three isolates AB290, AB291, and AB292 were deposited in GenBank with numbers LT882483, LT882484, and LT882485 and numbers MF374745, MF374746, and MF374747 for ITS and COI, respectively. Pathogenicity tests were conducted in the greenhouse on P. vulgaris cv. Valdarno plants at the 4 to 5 leaf stage. Five plants for each isolate were inoculated with a 3-mm mycelial plug cut from the margins of actively growing 6-day-old PDA cultures. Plugs were inserted at the collar level and wrapped with Parafilm. Two plants for each isolate were used as controls and treated as described above except that sterile PDA plugs replaced the inoculum. Inoculated plants were kept for 2 weeks under controlled conditions in a greenhouse at 25 ± 2°C. After that period all inoculated plants showed stem necrotic streaks extended downward to the crown and roots. Most of the plants eventually died, developing symptoms similar to those observed on plants naturally infected, thus fulfilling Koch’s postulates. Control plants remained symptomless. Colonies isolated from the lesions morphologically resembled the inoculated isolates. Pythium myriotylum is the causal agent of root rot in numerous economically important crops including peanuts, tomato, wheat, oats, cucumber, soya bean, tobacco, and maize (Wang et al. 2003). However, only one report described this pathogen on green bean in Europe, namely, in Spain (Serrano et al. 2007). To our knowledge, this is the first report of P. myriotylum on green bean plants in Italy. A more careful water management in soilless potting mix would avoid the emergence of Pythium root rot in this crop’s production system.

Microbiome and infectivity studies reveal complex polyspecies tree disease in Acute Oak Decline

Decline-diseases are complex and becoming increasingly problematic to tree health globally. Acute Oak Decline (AOD) is characterized by necrotic stem lesions and galleries of the bark-boring beetle, Agrilus biguttatus, and represents a serious threat to oak. Although multiple novel bacterial species and Agrilus galleries are associated with AOD lesions, the causative agent(s) are unknown. The AOD pathosystem therefore provides an ideal model for a systems-based research approach to address our hypothesis that AOD lesions are caused by a polymicrobial complex. Here we show that three bacterial species, Brenneria goodwinii, Gibbsiella quercinecans and Rahnella victoriana, are consistently abundant in the lesion microbiome and possess virulence genes used by canonical phytopathogens that are expressed in AOD lesions. Individual and polyspecies inoculations on oak logs and trees demonstrated that B. goodwinii and G. quercinecans cause tissue necrosis and, in combination with A. biguttatus, produce the diagnostic symptoms of AOD. We have proved a polybacterial cause of AOD lesions, providing new insights into polymicrobial interactions and tree disease. This work presents a novel conceptual and methodological template for adapting Koch’s postulates to address the role of microbial communities in disease.

BACTERIAL SOFT ROT OF EGGPLANT CAUSED BY PECTOBACTERIUM CAROTOVORUM subsp. CAROTOVORUM IN CHINA

In December 2016, soft rot lesions on the stem and fruit of eggplants cv. Green Beauty were noted in greenhouses in Anshan, Liaoning Province, China. Disease incidence was estimated at 5-10% and resulted in a substantial yield reduction. Symptoms appeared as soft, dark green stem lesions that progressively turned brown with vascular bundle necrosis appearing. Fruits of infected plants initially had small water-soaked lesions that rapidly enlarged with a watery ooze. Infected tissues from stems and fruits of eggplant were macerated in sterile water, streaked onto nutrient agar (NA) and incubated at 28oC for 2 days. The resultant bacterial colonies were round, translucent, white, convex with smooth edges. All isolated bacteria were gram-negative rods, facultative anaerobes, non-fluorescent on King’s B media, produced a positive pectolytic response on crystal violet pectate agar and gave a positive hypersensitive response in tobacco plants. All were negative for sucrose reduction, sensitive to erythromycin (50 µg/ml), indole, oxidase and could grow at 37°C. PCR amplification of the pel gene using Y1/Y2 primers (Darrasse et al., 1994) produced a 430 bp fragment. Amplification of the 16S- 23SrRNA region by G1 and L1 primers (Toth et al., 2001) produced two main bands of 550 and 580 bp. 16S rRNA fragment of 1440 bp was amplified from bacterial isolates and the partial sequence deposited in GenBank (accession No. KY786125) showed 99% identity to the sequence of Pectobacterium carotovorum subsp. carotovorum strain Y57 (KP187518.1). No amplification products were produced for any isolate using P. atrosepticum and P. carotovorum subsp. brasiliensis specific primers (Eca1f/Eca2r and Br1f/L1r, respectively), whereas the P. carotovorum subsp. carotovorum primers EXPCCF/EXPCCR produced the expected 550 bp fragment (Kang et al., 2003). For pathogenicity testing, mature fruits and stems of Green Beauty were needle-stab inoculated with a 10 µl bacteria suspension (1×108 CFU/ml). Sterile water was used as a negative control. Inoculated plants were incubated at 28°C for 48 h, after which watersoaked and soft-rot symptoms were observed on all eggplant fruits and stems, but not on control plants. Bacteria with the same characteristics as those inoculated were reisolated from diseased tissues. To our knowledge, this is the first report of P. carotovorum subsp. carotovorum on eggplant in China.

P 84 Progressive ataxia as leading symptom of chronic neuroborreliosis

Case report A 58-year-old female presented with a slowly progressive ataxic gait disorder for about 6 months. She also reports a recent bladder emptying disorder. Moreover, her husband had observed short-term memory loss with his wife. Her past medical history was uneventful. In clinical examination, an atactic finger-nose test and knee-jaw test as well as stait unsteadiness and atactic gait were impressive. Biceps and brachioradial reflexes could not be attained. There also was a pallhypaesthesia of 3–4/8 at both ankles. Rest of neurological findings was correct, in particular, no paresis, pyramidal path signs, oculomotor or cerebellar signs were found. There was no history of pain. In a cranial MRI, subcortical changes in the white matter as well as laterally symmetrical lesions of the cerebral stem in the lemniscus medialis, along the spinothalamic fibers were observed (Fig. 1a). In an MRI of cervical and thoracic spine, a continuous circular intraspinal enrichment of contrast agent of the pia mater was visible. (Fig. 1b). For the differential diagnosis, an inflammatory DD metabolic genesis was considered. Results of motor evoked potentials indicated a left- and leg-emphasized lesion of central motor tracts to all four limbs. Cerebrospinal fluid (CSF) analysis showed a definite pleocytosis (131 leukocytes/ μ l). In cytological analysis of CSF activated lymphocytes and monocytes were apparent (Fig. 2). Moreover, CSF protein content (386 mg/ dl) was increased; a three-class reaction was found [IgG 77.3 mg/dl (44.9%), IgA 8.86 mg/dl (51.4%), IgM 3.87 mg/dl (74.3%) ]. Furthermore, CSF lactate was increased (4.6 mmol/l). Antibody titers for Borrelia burgdorferi were also clearly increased in CSF (IgG > 1700 U/ml, IgM 2.2 U/ml). Upon repeated questioning, the patient remembered a tick bite more than 12 months previously. Even in retrospect, she had not realized any discomfort (especially pain or cranial nerve dysfunction), except for progressive unsteadiness and gait disorder. In summary, the patient suffers from a neuroborreliosis stage III. Intravenous therapy with ceftriaxone 2 g was administered over 21 days. Discussion The differential diagnosis for ataxia in adults is long and includes, among others, Multiple sclerosis, cerebellar ataxias, neuropathies, vitamin deficiencies, and to the rare Creuzfeldt-Jakob disease ( Bassetti and Mumenthaler, 2012 ). Borreliosis is an infectious disease that passes through several stages and is caused by spirochetes of the species Borrelia. In addition to numerous other symptoms, the nervous system may also be involved. Here, a distinction is made between the acute and the chronic form. While the former primarily presents as meningoencephalitis, a typical manifestation of the chronic form is a spastic-atactic gait, accompanied by a bladder emptying disorder ( Deutsche Gesellschaft fur Neurologie (Hrsg), 2012 ). Chronic neuroborreliosis, with about 2%, is significantly less frequent than acute neuroborreliosis (98%) ( Dersch and Rauer, 2016 ), and thus not the first aspect considered in a differential diagnosis of ataxia. The additionally existing symptoms (bladder emptying disorder, short-term memory disorders) and the conspicuous imaging prompted further evaluation.

Detection, prevalence and severity of upper canopy infection on mature Brassica napus plants caused by Leptosphaeria maculans in Australia

Blackleg, caused by Leptosphaeria maculans, is the main disease constraint for canola production in Australia. The fungus infects all aboveground and belowground parts of the canola plant. Yield loss in Australia and worldwide is generally associated with cankers at the crown, which arise from leaf infections during the early stages of seedling growth. Infection of flowers, peduncles, siliques, main stems and branches, with resultant lesions and canker formation, are typically uncommon symptoms. We propose the term ‘upper canopy infection’ to encompass symptoms on all of these plant parts because they generally occur together on the same plant and appear after the plant has undergone elongation. Branch and stem lesions observed in a commercial crop in 2010 were confirmed as L. maculans. Since then, assessment of upper canopy symptoms at 25 sites across the canola-producing regions of Australia between 2011 and 2016 show that symptoms are more prevalent, although they differed between sites and seasons. In 2011, symptoms were present at a single site, and this increased to seven sites in 2013 and 23 sites in 2016. Preliminary data indicate that infection arises from both ascospore and pycnidiospore inoculum, and that earlier onset of flowering is a key risk factor for more severe upper canopy infection. Evidence suggests that host genetic resistance may be an effective control for upper canopy infection.

Single-centre experience of STENTYS Xposition S in treatment of left main stem lesions

ABSTRACTBackground: The second generation STENTYS Xposition S self-expanding stent with a novel balloon delivery system was launched in May 2015. The stents unique properties are well suited for the treatment of left main stem disease where large diameters, coverage of diameter differences and precise positioning are required. We report the first consecutive experience of using this device in the treatment of left main stem lesions.Methods: 20 consecutive patients with a mean age of 73.9±10.1 years were treated over a period of 8 months at our institution and were assessed on the parameters of technical, angiographic and procedural success.Results: Technical success was achieved in 95% of cases and angiographic success in 80% of cases. There was no incidence of geographical miss. Side branch access was straightforward, with no failure to recross stent struts, dilate or deploy a second stent if required. In this unselected clinical cohort, 2 critically ill patients with cardiogenic shock on presentation died despite successful revascularisation. There was no incidence of early stent related complications up to 30-day follow up.Conclusion: This first consecutive series of left main lesions treated with STENTYS Xposition S documents high acute technical and procedural success rates.

Evaluation of Pepper Root Rot Resistance in an Integrated Phytophthora Blight Management Program

Phytophthora crown and root rot, incited by Phytophthora capsici, is an important and limiting disease in bell pepper (Capsicum annuum) production in many vegetable-producing areas of the United States. Soilborne oospores initiate disease when conditions are favorable, and polycyclic production of sporangia and zoospores occurs on infected plant tissue during the production season. Raised-bed plant culture, resistant cultivars, and oomycete-specific fungicides are commonly used to manage P. capsici. The objective of this study was to evaluate four bell pepper cultivars and four experimental breeding entries (collectively termed entries) for resistance to P. capsici in Michigan (MI) and New Jersey (NJ) and to determine the effect of a fungicide program on plant health and yield. The pepper cultivars included Camelot X3R (susceptible), Aristotle (intermediately resistant), and Paladin and Archimedes (resistant) for comparison. Disease symptoms included plant wilting and sunken necrotic stem lesions. In NJ, blighting of stems and foliage was also observed. In MI, &gt;90% of the susceptible ‘Camelot X3R’ plants in the untreated plot wilted and died in both years of the study. All other entries had &lt;10% plant wilting and death in 2014. In 2015, ‘Archimedes’ and ‘Paladin’ had &lt;10% wilt and plant death; ‘Aristotle’, AP4835, 13SE12671, and AP4841 had 10% to 30% symptomatic plants. The fungicide program reduced disease to &lt;10% for all entries except ‘Camelot X3R’ in 2014 and ‘Aristotle’ and ‘Camelot X3R’ in 2015. In NJ, ‘Paladin’, ‘Aristotle’, and ‘Camelot X3R’ (2014) and ‘Archimedes’, ‘Aristotle’, and ‘Camelot X3R’ (2015) had &gt;30% plant wilting and death in the untreated plot. In the fungicide-treated plot, AP4841, AP4835, and AP4839 (2014), and AP4839 (2015) had &lt;10% of plants with disease symptoms; ‘Camelot X3R’ and ‘Aristotle’ had &gt;40% plant wilting and death in both years. In MI, marketable yield for ‘Paladin’ in fungicide-treated and untreated plots was significantly higher than the other entries in both years (P &lt; 0.05). AP4839 was the highest yielding entry in NJ in the untreated plot, and AP4839 and ‘Archimedes’ were highest yielding in the fungicide-treated plot in 2014 and 2015, respectively. Fruit size for 13SE12671 was the largest among entries in both locations. There was no entry × fungicide program interaction in MI.

Growth and physiological responses of Quercus brantii seedlings inoculated with Biscogniauxia mediterranea and Obolarina persica under drought stress

SummaryCharcoal canker of oak is a common disease in the western regions of Iran, which has widely spread due to climate change and increasing drought in recent years. Biscogniauxia mediterranea and Obolarina persica are known as two agents of oak charcoal canker in Zagros forests causing the dieback of oak trees. The effects of charcoal disease agent pathogens on the growth and physiological response of two‐year‐old seedlings of Quercus brantii were evaluated under drought stress in greenhouse over a period of nine months. Survival was 21.7% lower in seedlings inoculated with B. mediterranea subjected to drought stress compared with control treatment. The length of lesions on stems was 68% more under charcoal pathogens in drought stressed compared with the length of lesions caused by charcoal pathogens only. On the other hand, stem lesion length caused by B. mediterranea was 25% greater than those caused by O. persica. Some morphophysiological characteristics were affected by charcoal pathogens alone and/or in combination with drought. Diameter, height and biomass decreased the most in seedlings inoculated with charcoal pathogens under drought stress. Pathogenic agents alone and in combination with drought stress reduced photosynthetic rates, stomatal conductance, transpiration, the maximum Rubisco activity (Vcmax), maximum photochemical efficiency of photosystem II (Fv/Fm) and xylem water potential. In general, drought increased the aggressiveness of fungus and intensification of their destructive effects in Quercus brantii. Moreover, there was no significant difference between the effect of B. mediterranea and O. persica on the morphophysiological parameters studied.

Prolonged weaning during early neurological and neurosurgical rehabilitation : S2k guideline published by the Weaning Committee of the German Neurorehabilitation Society (DGNR)

Prolonged weaning of patients with neurological or neurosurgery disorders is associated with specific characteristics, which are taken into account by the German Society for Neurorehabilitation (DGNR) in its own guideline. The current S2k guideline of the German Society for Pneumology and Respiratory Medicine is referred to explicitly with regard to definitions (e.g., weaning and weaning failure), weaning categories, pathophysiology of weaning failure, and general weaning strategies. In early neurological and neurosurgery rehabilitation, patients with central of respiratory regulation disturbances (e.g., cerebral stem lesions), swallowing disturbances (neurogenic dysphagia), neuromuscular problems (e.g., critical illness polyneuropathy, Guillain-Barre syndrome, paraplegia, Myasthenia gravis) and/or cognitive disturbances (e.g., disturbed consciousness and vigilance disorders, severe communication disorders), whose care during the weaning of ventilation requires, in addition to intensive medical competence, neurological or neurosurgical and neurorehabilitation expertise. In Germany, this competence is present in centers of early neurological and neurosurgery rehabilitation, as a hospital treatment. The guideline is based on a systematic search of guideline databases and MEDLINE. Consensus was established by means of a nominal group process and Delphi procedure moderated by the Association of the Scientific Medical Societies in Germany (AWMF). In the present guideline of the DGNR, the special structural and substantive characteristics of early neurological and neurosurgery rehabilitation and existing studies on weaning in early rehabilitation facilities are examined.Addressees of the guideline are neurologists, neurosurgeons, anesthesiologists, palliative physicians, speech therapists, intensive care staff, ergotherapists, physiotherapists, and neuropsychologists. In addition, this guideline is intended to provide information to specialists for physical medicine and rehabilitation (PMR), pneumologists, internists, respiratory therapists, the German Medical Service of Health Insurance Funds (MDK) and the German Association of Health Insurance Funds (MDS). The main goal of this guideline is to convey the current knowledge on the subject of "Prolonged weaning in early neurological and neurosurgery rehabilitation".

A Sclerotinia disease assay for screening flowering canola plants in controlled environments

Sclerotinia sclerotiorum is an important fungal pathogen of canola, for which limited host resistance or tolerance has been identified. Several robust seedling-based S. sclerotiorum disease assays have been developed for germplasm screening, but there is no non-destructive, reliable and routine assay for screening mature, flowering canola plants at the developmental stage when disease symptoms are predominant under field conditions. Disease measurements from field trials are the most informative, but such trials are time consuming and require screening across multiple locations and years to take into account variable disease expression due to different pathogen inoculum levels and environmental factors. We developed a disease assay for screening mature canola plants under controlled environment conditions that ensures consistency in disease results between experiments. The method involves applying petals, dipped in a broth containing S. sclerotiorum mycelia, to the leaves of canola plants at the 10–30% bloom stage. The inoculated plants are then housed in a chamber wrapped in plastic sheeting until assessment, and kept well-watered to ensure high humidity (>70% relative humidity) and temperature conditions (>10 °C) which favour disease development. The method is an effective disease assay for measuring the foliar effects of S. sclerotiorum with leaf lesion formation developing in >94% of inoculated plants. Within 21 days, in 64–68% of cases these leaf lesions developed into stem lesions and associated sclerotia.

Circulating steroids negatively correlate with tinnitus

While not a disease entity in itself; symptoms of tinnitus (from Latin tinnio – clink) accompany a number of diseases. Tinnitus prevalence increases with age, deteriorates one’s quality of life, and may even result in suicidal behavior. Tinnitus develops in response to a variety of risk factors, otoxic substances, noise exposure, hearing disorders, and psychological alterations. Tinnitus is closely related to mood, depression, and psychological state. In the present study, we focused on alterations of the steroid metabolome and particularly neuroactive, neuroprotective, and immunomodulatory steroids in patients with tinnitus. The study group consisted of 28 patients without evidence of an organic cause of tinnitus as well as without associated diseases or the effect of ototoxic medications. All patients underwent a complete audiological assessment and laboratory tests including routine biochemical markers and quantification of circulating steroids using gas chromatography/mass spectrometry and immunoassays. To rule out a pathology in the cerebellopontine angle area, CT scan or MRI were performed. To diagnose stem lesions, evoked potentials were also measured. Pearson’s correlations and multivariate regression were used to assess any links between tinnitus intensity and frequency on the one hand, and steroid levels on the other. Results indicated a significant and consistent negative correlation between tinnitus indices and intensity of adrenal steroidogenesis. The circulating steroid metabolome including hormones and neuroactive, neuroprotective, and immunomodulatory steroids negatively correlates with the degree of tinnitus due to hypothalamo-pituitary-adrenal axis malfunction. Our results may help explain the pathophysiology of tinnitus and improve its diagnosis. However, further studies are needed to verify our postulation.

Cardiac surgery 2016 reviewed

For the year 2016, more than 20,000 published references can be found in Pubmed when entering the search term "cardiac surgery". Publications last year have helped to more clearly delineate the fields where classic surgery and modern interventional techniques overlap. The field of coronary bypass surgery (partially compared to percutaneous coronary intervention) was enriched by five large prospective randomized trials. The value of CABG for complex coronary disease was reconfirmed and for less complex main stem lesions, PCI was found potentially equal. For aortic valve treatment, more evidence was presented for the superiority of transcatheter aortic valve implantation for patients with intermediate risk. However, the 2016 evidence argued against the liberal expansion to the low-risk field, where conventional aortic valve replacement still appears superior. For the mitral valve, many publications emphasized the significant impact of mitral valve reconstruction on survival in structural mitral regurgitation. In addition, there were many relevant and other interesting contributions from the purely operative arena in the fields of coronary revascularization, surgical treatment of valve disease, terminal heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While this article attempts to summarize the most pertinent publications it does not have the expectation of being complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.

Detection of crossed cerebellar diaschisis in hyperacute ischemic stroke using arterial spin-labeled MR imaging.

Background and purposeArterial spin-labeling (ASL) was recently introduced as a noninvasive method to evaluate cerebral hemodynamics. The purposes of this study were to assess the ability of ASL imaging to detect crossed cerebellar diaschisis (CCD) in patients with their first unilateral supratentorial hyperacute stroke and to identify imaging or clinical factors significantly associated with CCD.Materials and methodsWe reviewed 204 consecutive patients who underwent MRI less than 8 hours after the onset of stroke symptoms. The inclusion criteria were supratentorial abnormality in diffusion-weighted images in the absence of a cerebellar or brain stem lesion, bilateral supratentorial infarction, subacute or chronic infarction, and MR angiography showing vertebrobasilar system disease. For qualitative analysis, asymmetric cerebellar hypoperfusion in ASL images was categorized into 3 grades. Quantitative analysis was performed to calculate the asymmetric index (AI). The patients’ demographic and clinical features and outcomes were recorded. Univariate and multivariate analyses were also performed.ResultsA total of 32 patients met the inclusion criteria, and 24 (75%) presented CCD. Univariate analyses revealed more frequent arterial occlusions, higher diffusion-weighted imaging (DWI) lesion volumes and higher initial NIHSS and mRS scores in the CCD-positive group compared with the CCD-negative group (all p < .05). The presence of arterial occlusion and the initial mRS scores were related with the AI (all p < .05). Multivariate analyses revealed that arterial occlusion and the initial mRS scores were significantly associated with CCD and AI.ConclusionASL imaging could detect CCD in 75% of patients with hyperacute infarction. We found that CCD was more prevalent in patients with arterial occlusion, larger ischemic brain volumes, and higher initial NIHSS and mRS scores. In particular, vessel occlusion and initial mRS score appeared to be significantly related with CCD pathophysiology in the hyperacute stage.