Stem Lesions Research Articles

A dark side of subcortical diffusion-weighted lesions? Characteristics, cause, and outcome in large subcortical infarction: the Bergen Norwegian stroke cooperation study.

Diffusion-weighted imaging (DWI) is highly accurate in identifying and locating ischemic stroke injury. Few studies using DWI have investigated large subcortical infarctions (LSIs). We aimed to study clinical characteristics, cause, and outcome in patients with ischemic stroke with LSI diagnosed on DWI and compare these with those who had lacunar DWI lesions or DWI lesions located elsewhere. Patients with stroke admitted between February 2006 and July 2013 were prospectively registered in a stroke database and examined with DWI. Patients with DWI lesions classified as LSI (subcortical, ≥15 mm) were compared with those with lacunar lesions (subcortical, <15 mm, lacunar infarction [LI]), cortical lesions (cortical infarction [CI]), or no LSI, which included LI, CI, mixed cortical-subcortical, cerebellar, brain stem, and combined lesion locations. A total of 1886 patients with ischemic stroke were included, of which 128 patients (6.8%) had LSI, 317 (16.8%) LI, and 544 (28.8%) CI. The no LSI group included 1758 patients. Occlusive pathology in the proximal middle cerebral artery was more frequent in patients with acute stroke with LSI. Lacunar syndrome was associated with LSI when compared with CI and no LSI. Unknown cause was frequent in the LSI group (60.4%) and independently associated with LSI in the LSI versus LI (P<0.001), LSI versus CI (P=0.002), and LSI versus no LSI population (P<0.001). LSI was independently associated with unfavorable outcome, whether compared with LI (P=0.002), CI (P<0.001), or no LSI (P=0.002). LSI is associated with distinct clinical characteristics, unknown cause, and unfavorable outcome, which separates this stroke entity from patients with lacunar subcortical DWI lesions or DWI lesions located elsewhere.

Chlorophyll fluorescence for visualizing the spatial and temporal spread of Phytophthora alni subsp. alni in alder bark tissue

The impact of alder Phytophthora (Phytophthora alni subsp. alni) on corticular photosynthetic metabolism was explored via measurements of chlorophyll fluorescence. Stem inoculation induced a sharp reduction of maximum (Fv/Fm) and effective quantum yield of PSII (). Observations of the axial and radial spread of the pathogen revealed that near to the point of inoculation and in the whole centre of the stem lesion Fv/Fm and of the cortex chlorenchyma decreased to almost zero, indicating tissue necrosis. Low values of Fv/Fm and were also found in some presymptomatic regions beyond the visible stem lesion. In contrast, substantial photosynthetic activity was found in uninvaded parts of the inoculated trees and in the control. These stem parts showed a marked light‐adapted quantum efficiency of PSII as well as marked electron transport rates in their bark tissues. Thus, corticular photosynthesis stayed unaffected in these stem parts supporting stem carbon balance. Chlorophyll fluorescence measurements in the field illustrated that stem infection with P. alni subsp. alni and the effect on the bark tissues is not only highly heterogeneous but also underlies very quick temporal changes, due to a rapid destruction of the photosynthetic apparatus. The results show that chlorophyll fluorescence measurements and fluorescence imaging are useful indicators of tissue infection caused by Phytophthora infection of bark tissues. Chlorophyll fluorescence measurements can be used to map and visualize the spatial as well as temporal spread of bark pathogens and can give a first indication of invasion of the host tissue beyond the visible lesion.

Corynespora spot of hot pepper caused by Corynespora cassiicola in China

Leaf and fruit spots and stem lesions were observed on hot pepper (Capsicum annuum L.) plants in Hainan province, China during 2010–2011. A fungus was isolated from dark brown spots on leaves and fruits and black stem lesions. The pathogenicity of the isolated fungus was confirmed from inoculation experiments. On the basis of morphological features and ITS-5.8S rDNA sequences, the pathogen was identified as Corynespora cassiicola (Berk. & Curt.) Wei. This is the first report of corynespora spot caused by C. cassiicola on hot pepper in China.

First Report of Rubber Tree Stem Rot Caused by Fusarium oxysporum in China.

Rubber tree (Hevea brasiliensis) is an important crop in tropical regions of China. In October 2013, a new stem rot disease was found on cv. Yunyan77-4 at a rubber tree plantation in Hekou, Yunnan Province. There were about 100 plants, and diseased rubber trees accounted for 30% or less. Initially, brown-punctuate secretion appeared on the stem, which was 5 to 6 cm above the ground. Eventually, the secretion became black and no latex produced from the rubber tree bark. After removing the secretion, the diseased bark was brown putrescence, but the circumambient bark was normal. Upon peeling the surface bark, the inner bark and xylem had brown rot and was musty. The junction between health and disease was undulate. On the two most serious plants, parts of leaves on the crown were yellow, and the root near the diseased stem was dry and puce. The pathogen was isolated and designated HbFO01; the pathogenicity was established by following Koch's postulates. The pathogen was cultivated on a potato dextrose agar (PDA) plate at 28°C for 4 days. Ten plants of rubber tree cv. Yunyan77-4 were selected from a disease-free plantation in Haikou, Hainan Province, and the stem diameter was about 7 cm. The bark of five plants was peeled, and one mycelium disk with a diameter of 1 cm was inserted into the cut and covered again with the bark. The other five plants were treated with agar disks as controls. The inoculation site was kept moist for 2 days, and then the mycelium and agar disk were removed. On eighth day, symptoms similar to the original stem lesions were observed on stems of inoculated plants, while only scars formed on stems of control plants. The pathogen was re-isolated from the lesions of inoculated plants. On PDA plates, the pathogen colony was circular and white with tidy edges and rich aerial hyphae. Microscopic examination showed microconidia and chlamydospores were produced abundantly on PDA medium. The falciform macroconidia were only produced on lesions and were slightly curved, with a curved apical cell and foot shaped to pointed basal cell, usually 3-septate, 16.2 to 24.2 × 3.2 to 4.0 μm. Microconidia were produced in false heads, oval, 0-septate, 6.2 to 8.2 × 3.3 to 3.8 μm, and the phialide was cylindrical. Chlamydospores were oval, 6.4 to 7.2 × 3.1 to 3.8 μm, alone produced in hypha. Morphological characteristics of the specimen were similar to the descriptions for Fusarium oxysporum (2). Genomic DNA of this isolate was extracted with a CTAB protocol (4) from mycelium and used as a template for amplification of the internal transcribed spacer (ITS) region of rDNA with primer pair ITS1/ITS4 (1). The full length of this sequence is 503 nt (GenBank Accession No. KJ009335), which exactly matched several sequences (e.g., JF807394.1, JX897002.1, and HQ451888.1) of F. oxysporum. Williams and Liu had listed F. oxysporum as the economically important pathogen of Hevea in Asia (3), while this is, to our knowledge, the first report of stem rot caused by F. oxysporum on rubber tree in China.

Traumatic axonal injury: the prognostic value of lesion load in corpus callosum, brain stem, and thalamus in different magnetic resonance imaging sequences.

The aim of this study was to explore the prognostic value of visible traumatic axonal injury (TAI) loads in different MRI sequences from the early phase after adjusting for established prognostic factors. Likewise, we sought to explore the prognostic role of early apparent diffusion coefficient (ADC) values in normal-appearing corpus callosum. In this prospective study, 128 patients (mean age, 33.9 years; range, 11-69) with moderate (n = 64) and severe traumatic brain injury (TBI) were examined with MRI at a median of 8 days (range, 0-28) postinjury. TAI lesions in fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), and T2*-weighted gradient echo (T2*GRE) sequences were counted and FLAIR lesion volumes estimated. In patients and 47 healthy controls, mean ADC values were computed in 10 regions of interests in the normal-appearing corpus callosum. Outcome measure was the Glasgow Outcome Scale-Extended (GOS-E) at 12 months. In patients with severe TBI, number of DWI lesions and volume of FLAIR lesions in the corpus callosum, brain stem, and thalamus predicted outcome in analyses with adjustment for age, Glasgow Coma Scale score, and pupillary dilation (odds ratio, 1.3-6.9; p = <0.001-0.017). The addition of Rotterdam CT score and DWI lesions in the corpus callosum yielded the highest R2 (0.24), compared to all other MRI variables, including brain stem lesions. For patients with moderate TBI only the number of cortical contusions (p = 0.089) and Rotterdam CT score (p = 0.065) tended to predict outcome. Numbers of T2*GRE lesions did not affect outcome. Mean ADC values in the normal-appearing corpus callosum did not differ from controls. In conclusion, the loads of visible TAI lesions in the corpus callosum, brain stem, and thalamus in DWI and FLAIR were independent prognostic factors in patients with severe TBI. DWI lesions in the corpus callosum were the most important predictive MRI variable. Interestingly, number of cortical contusions in MRI and CT findings seemed more important for patients with moderate TBI.

First Report of Anthracnose Disease on Young Stems of Bawanghua (Hylocereus undatus) Caused by Colletotrichum gloeosporioides in China.

Hylocereus undatus widely grows in southern China. Some varieties are planted for their fruits, known as dragon fruits or Pitaya, while some varieties for their flowers known as Bawanghua. Fresh or dried flowers of Bawanghua are used as routine Chinese medicinal food. Since 2008, a serious anthracnose disease has led to great losses on Bawanghua flower production farms in the Baiyun district of Guangzhou city in China. Anthracnose symptoms on young stems of Bawanghua are reddish-brown, sunken lesions with pink masses of spores in the center. The lesions expand rapidly in the field or in storage, and may coalesce in the warm and wet environment in spring and summer in Guangzhou. Fewer flowers develop on infected stems than on healthy ones. The fungus overwinters in infected debris in the soil. The disease caused a loss of up to 50% on Bawanghua. Putative pathogenic fungi with whitish-orange colonies were isolated from a small piece of tissue (3 × 3 mm) cut from a lesion margin and cultured on potato dextrose agar in a growth chamber at 25°C, 80% RH. Dark colonies with acervuli bearing pinkish conidial masses formed 14 days later. Single celled conidia were 11 to 18 × 4 to 6 μm. Based on these morphological characteristics, the fungi were identified as Colletotrichum gloeosporioides (Penz.) Penz. & Sacc (2). To confirm this, DNA was extracted from isolate BWH1 and multilocus analyses were completed with DNA sequence data generated from partial ITS region of nrDNA, actin (ACT) and glutamine synthetase (GS) nucleotide sequences by PCR, with C. gloeosporioides specific primers as ITS4 (5'-TCCTCCGCTTATTGATATGC-3') / CgInt (5'-GGCCTCCCGCCTCCGGGCGG-3'), GS-F (5'-ATGGCCGAGTACATCTGG-3') / GS-R (5'-GAACCGTCGAAGTTCCAC-3') and actin-R (5'-ATGTGCAAGGCCGGTTTCGC-3') / actin-F (5'-TACGAGTCCTTCTGGCCCAT-3'). The sequence alignment results indicated that the obtained partial ITS sequence of 468 bp (GenBank Accession No. KF051997), actin sequence of 282 bp (KF712382), and GS sequence of 1,021 bp (KF719176) are 99%, 96%, and 95% identical to JQ676185.1 for partial ITS, FJ907430 for ACT, and FJ972589 for GS of C. gloeosporioides previously deposited, respectively. For testing its pathogenicity, 20 μl of conidia suspension (1 × 106 conidia/ml) using sterile distilled water (SDW) was inoculated into artificial wounds on six healthy young stems of Bawanghua using sterile fine-syringe needle. Meanwhile, 20 μl of SDW was inoculated on six healthy stems as a control. The inoculated stems were kept at 25°C, about 90% relative humidity. Three independent experiments were carried out. Reddish-brown lesions formed after 10 days, on 100% stems (18 in total) inoculated by C. gloeosporioides, while no lesion formed on any control. The pathogen was successfully re-isolated from the inoculated stem lesions on Bawanghua. Thus, Koch's postulates were fulfilled. Colletotrichum anthracnose has been reported on Pitaya in Japan (3), Malaysia (1) and in Brazil (4). To our knowledge, this is the first report of anthracnose disease caused by C. gloeosporioides on young stems of Bawanghua (H. undatus) in China.

A severity score for acute necrotizing encephalopathy.

To develop a score that predicts the prognosis of children with acute necrotizing encephalopathy (ANE). We retrospectively evaluated clinical variables and neurological outcome in two cohorts of children with ANE. Firstly, we developed the ANE severity score (ANE-SS) according to the clinical variables that correlated with neurological outcome in 41 children who were included in our previous reports in 2009. We then applied the scoring system to a second cohort of 32 patients who were newly collected in 2011. We investigated the correlation between the ANE-SS and neurological outcome in all 73 patients. In the first cohort, brain stem lesions on MRI and state of shock at onset were significantly correlated with outcome. Age over 48 months, elevated CSF protein, and low platelet counts tended to be correlated with outcome. No types of treatment were correlated with outcome. The developed ANE-SS ranged from 0 to 9 points, with 3 points for existence of shock, 2 points for brain stem lesions, 2 points for age over 48 months, 1 point for platelet count below 100,000/μL, and 1 point for CSF protein above 60 mg/dl. Patients were classed as low risk (ANE-SS 0-1 points), medium risk (ANE-SS 2-4 points), or high risk (ANE-SS 5-9 points). ANE-SS was significantly correlated with outcome in the group of 73 patients. ANE-SS can be used to predict outcome in patients with ANE. More effective treatments need to be developed for high-risk patients.

Sexual disorders in women with MS: Assessment and management

ObjectivesSummarize the data on sexual disorders in women with multiple sclerosis (MS). MethodReview of 99 Pubmed articles covering sexual dysfunction in women with MS. ResultsPrevalence of dysfunction in women with MS varies from 34% to 85%. They include poor vaginal lubrication, poor clitoral erection, and anorgasmia, which correlate with level of disability. Specific brain stem and pyramidal lesions appear to correlate with anorgasmia. Age and duration of the disease correlate with sexual disorders, but not age at onset. Secondary consequences of MS, including bladder and bowel dysfunction, spasticity, pain, fatigue, depression, anxiety, and side effects of medication contribute to sexual dysfunction. Treatments can involve alpha-blockers or phosphodiesterase-5 inhibitors to increase smooth muscle relaxation, while lubricants and oestrogen therapy can help vaginal dryness, burning and dyspareunia. Antidepressants can delay (or abolish) orgasm, suggesting reducing dosage or combining them with PDE5 inhibitors. Counselling should emphasize planning sexual activities, reducing fatigue, managing positions, preventing incontinence, promoting sexual aids, extra-genital and other sexual options to achieve pleasurable and intimacy. Psychosocial interventions should include couples’ relationship and communication skills to increase satisfaction. ConclusionSexual dysfunctions in women with MS are amenable to treatments covering primary, secondary and tertiary consequences of the disease.

First Report on Resistance to Pyraclostrobin, Thiophanate-methyl, Fenhexamid and Boscalid in Botrytis cinerea from Eucalyptus Seedlings in Florida Greenhouses

Botryotinia fuckeliana de Bary (anamorph Botrytis cinerea Pers.) is an ubiquitous plant pathogen causing gray mold disease on more than 200 crops grown in the field or in greenhouses. Eucalyptus seedlings originating from three different greenhouses showing stem lesions were submitted to the Gulf Coast Research and Education Center Disease Clinic in June 2012. Ten single spore isolates of B. cinerea were obtained and tested for sensitivity using spore germination and germ tube elongation assays described previously (4). Fungicides tested were pyraclostrobin at 100 μg/ml (Cabrio, BASF, Research Triangle Park, NC), thiophanate-methyl at 100 μg/ml (Topsin-M, UPI, King of Prussia, PA), fenhexamid at 1 and 50 μg/ml (Elevate, Arysta Life Sciences, Cary, NC), fludioxonil at 0.1 and 10 μg/ml (Medallion, Syngenta Crop Protection, Research Triangle Park, NC), and iprodione at 5 and 50 μg/ml (Rovral, Bayer CropScience, Greensboro, NC) on 1% malt extract agar (MEA, 10 g malt extract and 15 g agar), and to cyprodinil at 1 and 25 μg/ml (Vanguard, Syngenta Crop Protection) on 0.5% sucrose agar (4). Sensitivity to the succinate dehydrogenase inhibitors (SDHIs) boscalid at 5 μg/ml (Endura, BASF), penthiopyrad at 1 and 3 μg/ml (Fontelis, DuPont Crop Protection, Willington, DE), and fluopyram at 3 μg/ml (Luna Privilege, Bayer CropScience) was evaluated on yeast bacto acetate agar (YBA) (3). The discriminatory dose for boscalid was adapted from (2) whereas those used for penthiopyrad and fluopyram were developed in this study. Isolates were grown on malt yeast extract agar for 7 to 10 days and spore suspensions were prepared in sterile distilled water and diluted to 106 conidia/ml. Respective media in 9-cm petri dishes were seeded with 7-μl droplets from each isolate allowing testing for all isolates on one plate. Two plates were used for each fungicide and sensitivity tests were repeated twice. Germination and germ tube growth were assessed microscopically after 16 to 24 h incubation at 22°C. The frequency of isolates resistant to two, three, and four fungicides was 90, 60, and 10%, respectively. Nine isolates (90%) were resistant to thiophanate-methyl and pyraclostrobin, simultaneously, whereas six (60%) and two isolates (20%) were resistant to boscalid and fenhexamid, respectively. All boscalid-resistant isolates were also resistant to pyraclostrobin and thiophanate-methyl, but one fenhexamid-resistant isolate was sensitive to the other three fungicides. Eight isolates that germinated at 5 μg/ml iprodione but not at 50 μg/ml were considered sensitive. All isolates were sensitive to the SDHIs penthiopyrad and fluopyram as well as to cyprodinil and fludioxonil. To our knowledge, this is the first report of resistance to pyraclostrobin, thiophanate-methyl, fenhexamid, and boscalid in B. cinerea from eucalyptus seedlings in Florida. The absence of resistance to fludioxonil and iprodione is likely because these fungicides are not registered in nurseries as well as fluopyram and penthiopyrad which were developed only recently. Management practices should be developed to limit the selection and spread of additional resistant populations in eucalyptus nurseries as has occurred in Florida strawberries where multi-fungicide resistance is widespread (1).

Cobalt chromium stents versus stainless steel stents in diabetic patients

The clinical outcome in diabetic patients undergoing percutaneous coronary intervention (PCI) is inferior to that in non-diabetic patients. Several aspects of diabetic coronary artery disease appear to be responsible for this observation. In comparison with stainless steel stent, cobalt chromium stent has a higher radial strength and radio-opacity for similar electronegativity, this allow for the production of thinner struts with a similar radiological visibility. Therefore we studied and compared six-months prognosis of cobalt chromium stent versus stainless steel Bare metal stents in diabetic patients undergoing PCI. Our study included seventy diabetic patients with Ischemic heart disease amendable to percutaneous stenting with stents ⩾3 mm in diameter and ⩽25 mm length. They were randomly assigned to cobalt chromium stents (Group I) or stainless steel stents (Group II). PCI was done with initial success and we excluded patients with unsuccessful PCI or complications during intervention, using stainless steel stent and chromium stent in the same lesion, left main stem lesions, osteal and bifurcational lesions. Our primary end point was Major adverse cardiac events (death, Myocardial infarction, unstable angina, emergency CABG or target lesion revascularization); over period of 6 months and our secondary end point was in-stent restenosis assessed by coronary angiography at 6 months in the follow up period. Total MACE in group (I) was 9 patients, coronary angiography was done for those patients after the cardiac event, that showed 7 patients with ISR and 2 of them showed patent stents. Patients without MACE whom undergone follow up coronary angiography after 6 months, revealed 6 patients suffered ISR out of 23 patients. While total MACE in group (II) was 5 patients, coronary angiography for those patients showed 4 patients with ISR and 1 of them showed patent stent. Patients without MACE whom undergone follow up coronary angiography after 6 months revealed 10 patients suffered ISR out of 28 patients. So as a result for all patients included in our study, 13 patients from group (I) suffered ISR in the period of 6 months follow up period, they represented 40% of the group, while 14 patients in group (II) with a percentage of 42.4% of the group suffered ISR at 6 months. There was no statistically significant difference between the two groups as regard the incidence of ISR at follow up. ( P > 0.05). We concluded that no significant statistical difference was found between the two stents (cobalt-chromium alloy bare metal stent versus conventional bare metal stainless steel stent) in diabetic patients regarding (initial procedural success, in-hospital complications, the incidence of ISR at follow up, event-free survival at follow up).

Characteristics of coronary artery involvement and probability of appropriate discharges of cardioverter-defibrillator implanted for primary prevention of sudden cardiac death

To assess characteristics of involvement of coronary vascular bed in patients with ischemic heart disease and cardioverter defibrillator (CD) implanted for primary prevention of sudden cardiac death (SCD) with and without history of appropriate implantable (I) CD therapies. We examined 64 survivors of myocardial infarction (MI) (60 men, 4 women) with CD implanted for primary prevention of SCD. Mean duration of follow up after CD implantation was 19.0 +/- 2.0 months. Patients were divided into 2 groups: with (n = 26, group 1) and without (n = 38, group 2) appropriate ICD therapies during follow-up. Coronary angiography data (on presence of hemodynamically significant lesions in main stem [MS], anterior interventricular, circumflex branches [CB] of left coronary artery [LCA], and in right coronary artery [RCA]) and data of transthoracic echocardiography (on localization of akinesia and dyskinesia zones) obtained in these groups were compared. Lesions in anterior interventricular branch were found in 25 (96%) and 28 (74%) patients in groups 1 and 2, respectively. Frequencies of involvement of other coronary arteries were not significantly different: MS LCA--7 (27%) vs 5 (13%), p = 0.14; CB--17(65%) vs. 18 (47%), p = 0.24; RCA--16 (62%) vs. 17 (45%), p = 0.29) in groups 1 and 2, respectively. There were no significant differences between groups in frequencies of various localizations of MI as detected by echocardiography. Hemodynamically significant involvement of anterior intraventricular branch of LCA is a predictor of any appropriate ICD therapy.

Effectiveness of 14 Fungicides for Suppressing Lesions Caused by Phytophthora capsici on Inoculated Stems of Chile Pepper Seedlings

Phytophthora blight, caused by the oomycete pathogen Phytophthora capsici, is an economically important disease in bell and chile pepper. Fourteen different fungicides were evaluated with respect to inhibition of stem lesion growth on chile pepper seedlings inoculated with mycelium or with zoospores of P. capsici 1 or 3 weeks after treatment of plant foliage and stems or roots. Fungicides containing ametoctradin + dimethomorph and fluopicolide were the most effective among tested products in both experiments across eight trial parameters (inoculum type, inoculation time after treatment, and fungicide application site). Other active ingredients, including acibenzolar-S-methyl, dimethomorph, fenamidone, ethaboxam, mandipropamid, mefenoxam, and oxathiapiprolin, were most effective in reducing stem lesion growth in three to seven of the eight trial parameters evaluated. Compared to nontreated plants, stem lesion inhibition ranged from 84.1 to 100%. Data from these trials demonstrate the comparative effectiveness of tested products under controlled environmental conditions favorable for disease development; however, confirmation of these findings is required in field trials, where plant and environmental conditions will be variable. Accepted for publication 18 September 2014. Published 1 November 2014.

Reversible lesions in the brain parenchyma in Wilson's disease confirmed by magnetic resonance imaging: earlier administration of chelating therapy can reduce the damage to the brain.

The aim of this study was to evaluate the resolution of brain lesions in patients with Wilson's disease during the long-term chelating therapy using magnetic resonance imaging and a possible significance of the time latency between the initial symptoms of the disease and the introduction of this therapy. Initial magnetic resonance examination was performed in 37 patients with proven neurological form of Wilson's disease with cerebellar, parkinsonian and dystonic presentation. Magnetic resonance reexamination was done 5.7 ± 1.3 years later in 14 patients. Patients were divided into: group A, where chelating therapy was initiated < 24 months from the first symptoms and group B, where the therapy started ≥ 24 months after the initial symptoms. Symmetry of the lesions was seen in 100% of patients. There was a significant difference between groups A and B regarding complete resolution of brain stem and putaminal lesions (P = 0.005 and P = 0.024, respectively). If the correct diagnosis and adequate treatment are not established less than 24 months after onset of the symptoms, irreversible lesions in the brain parenchyma could be expected. Signal abnormalities on magnetic resonance imaging might therefore, at least in the early stages, represent reversible myelinolisis or cytotoxic edema associated with copper toxicity.

“Kurdistan” Technique for the Treatment of Unprotected Trifurcation Left Main Stem Coronary Artery Lesion: Case Report

The left main coronary artery (LMCA) is responsible for supplying about 75% to 100% of the left ventricular cardiac mass. Left main stem coronary artery (LMCA) disease reduces flow to a large portion of the myocardium, placing the patient at high risk for life-threatening events such as left ventricular dysfunction and arrhythmias with a high mortality approaching 50% in those treated medically. For several decades, coronary artery bypass grafting (CABG) has been considered as a gold standard treatment of unprotected left main coronary artery (ULMCA). However, successful percutaneous coronary interventions (PCI) have been increasingly reported recently due to improved stent technology and better operator expertise. In spite of these factors, management can be challenging especially in LMCA bifurcational & trifurcational lesions, and therefore an integrated approach combining special techniques, physiological evaluation and adjunctive pharmacological agents should be combined for better clinical outcome. Herein, we describe a new promising technique named (Kurdistan technique) for the treatment of trifurcation unprotected left main stem lesion. In the last 18 months, 21 patients with significant trifurcational LMS had underwent PCI using this technique in our hospital (Sulaimany Heart Hospital/Kurdistan). The procedural success rate was 100%, follow up coronary angiography done between 6 - 12 months after the procedure for all the patients with no significant in-stent restenosis in any patient. One case is presented here demonstrating the technique.

Motor Symptoms in Brain Stem Lesion

Palatal tremor and Kernohan-Woltman notch phenomenon are rare motor symptoms that can show up in patients with lesion in brain stem or cerebellum. Patients with palatal tremor accompany ataxia, internuclear ophthalmoplegia, dysphagia, dysarthria and Kernohan-Woltman notch phenomenon causes ipsilateral motor deficits. Although its rarity, these conditions exhibit unexpected symptoms as well as considerable disability, which can raise etiologic and prognostic concerns for rehabilitation team. These two motor symptoms are discussed in this review. (Brain & NeuroRehabilitation 2014; 7: 101-104)

Fungicide Efficacy Against Calonectria pseudonaviculata, Causal Agent of Boxwood Blight.

Calonectria pseudonaviculata causes leaf spot and stem lesions resulting in defoliation and dieback of boxwood. Fungicides representing 20 different active ingredients from 13 different Fungicide Resistance Action Committee groups were evaluated for their effects on conidial germination and mycelial growth using in vitro assays, and the concentration that suppressed fungal growth to 15% of that on unamended media (EC85) values were determined. A number of fungicides strongly inhibited mycelial growth of C. pseudonaviculata. Four demethylation inhibitor fungicides had EC85 values of 1.2 μg a.i./ml or less. Thiophanate-methyl, fludioxonil, pyraclostrobin, trifloxystrobin, kresoxim-methyl, mancozeb, and chlorothalonil also had activity against mycelial growth. Fludioxonil + cyprodinil had a lower EC85 than the same rate of fludioxonil alone, suggesting that cyprodinil had activity against mycelial growth. Fungicides that inhibited C. pseudonaviculata conidial germination include pyraclostrobin, trifloxystrobin, and kresoxim-methyl as well as fludioxonil, mancozeb, chlorothalonil, and boscalid. Quinoxyfen, etridiazole, fenhexamid, hymexazol, famoxadone, and cymoxanil did not inhibit either C. pseudonaviculata conidial germination or mycelial growth. In comparison with values found in the literature, EC50 values for kresoxim-methyl were up to 10 times higher than reported previously, suggesting that fungicide insensitivity may have developed. Protectant fungicides with activity against conidial germination and systemic fungicides with activity against mycelial growth, such as those identified here, may be complementary to achieve the high levels of pathogen management required for control of this disease. In addition, multiple fungicide active ingredients from different mode-of-action groups used in mixtures or over time may also act to slow selection for fungicide insensitivity.

Association between Location of Brain Lesion and Clinical Factors and Findings of Videofluoroscopic Swallowing Study in Subacute Stroke Patients

Objective: To investigate whether patterns of dysphagia were associated with the location of the brain lesion and clinical factors in subacute stroke patients. Method: One hundred and seventy-eight first-ever subacute stroke patients who underwent videofluoroscopic swallowing study (VFSS) from January 2006 to April 2012 were enrolled in the present study. Swallowing-related parameters were assessed by VFSS. The location of brain lesions were classified into the cortical, subcortical, and brain stem. The degree of cognitive impairment and the independency of activities of daily living were assessed by the Korean version of mini-mental status examination and Korean version of modified Barthel index (K-MBI). Aphasia and hemineglect were assessed by Korean version of Western aphasia battery and line bisection test. These data were collected via retrospective chart review. Results: A reduced laryngeal elevation and prolonged pharyngeal delay time were associated with brain stem lesion. Other swallowing parameters were not associated with lesion topology. Pyriform sinus residue was associated with the presence of aphasia and low K-MBI scores. Prolonged pharyngeal delay time was associated with the patient's age, type of stroke and brain stem lesion. Conclusion: Pyriform sinus residue was associated with clinical factors such as aphasia and K-MBI scores rather than with the location of brain lesion. However, reduced laryngeal elevation and prolonged pharyngeal delay time were predominant in brain stem lesions. (Brain & NeuroRehabilitation 2014; 7: 54-60)

A selective medium for Xanthomonas axonopodis pv. Betlicola, bacterial pathogen of betelvine

Xanthomonas axonopodis pv. betlicola (Patel et al.) Vauterin et al. causes severe damage of betelvine (Piper betle L.) in West Bengal by producing different types of leaf spots (small to large, circular to irregular, angular), marginal leaf blight, stem lesion and wilting of vines. A selective medium was developed for isolation of this bacterium from diseased tissues and detection of this bacterium from the leaf surface, in soil and water. This bacterium grew best in Potato Sucrose Peptone Agar (PSPA) medium (Peeled potato 200 g, Sucrose 20 g, Peptone 5 g, Agar agar 20 g, and Water 1000 ml) and this medium was used as basal medium. Some fungicides and antibiotics (Carbendazim 25 mg, Copper oxychloride 25 mg, Metalaxyl 21 mg, Cycloheximide 50 mg, Pentid-200 100 mg, Nitrofurantoin 100 mg) were incorporated into the basal medium before use. Bavistin was used as source of Carbendazim, Blitox 50 as Copper oxychloride, Krilaxyl 35 WS as Metalaxyl, Furadantin capsule (human drug) as Nitrofurantoin. Pentid-200 is a human drug and it contains Penicillin-G potassium 2,00,000 units. The above fungicides and antibiotics were taken in a 25 ml sterilized conical flask plugged with cotton and 2 ml absolute alcohol was added to it. The flask was kept as such for 24 h to allow alcohol to evaporate. Then 20 ml of sterile water was added to the flask and shaken. The solution was kept in refrigerator for future use (30 days). The solution was mixed with the sterilized and melted PSPA medium prepared earlier at 4 ml/200 ml medium before use. Using this medium X. a. pv. betlicola was isolated successfully from the diseased tissue without surface sterilization. Key words: Bacterial disease, betelvine, selective medium, Xanthomonas axonopodis pv. Betlicola.

A new species of Calonectria causing leaf blight and cutting rot of three forest tree species in Brazil

Several species of Calonectria cause diseases on a wide range of forest tree species that are propagated either via seedlings or rooted cuttings. In nurseries these fungi cause damping-off, cutting and root rots, stem lesions, and leaf blights. Recently a Calonectria sp. was isolated from rooted cuttings of Anadenanthera peregrina (Fabaceae), Piptadenia gonoacantha (Fabaceae), and Azadirachta indica (Meliaceae) exhibiting leaf blight and cutting rot in a forest nursery at the Universidade Federal de Vicosa, Brazil. Morphological comparisons and DNA sequences of three loci containing partial gene sequences of β-tubulin (TUB2), calmodulin (CAL), and elongation factor (TEF-1α) indicated that these isolates represent an unnamed species of Calonectria, described here as C. hodgesii sp. nov. Sprayinoculated plants of all three hosts with a suspension at 1x104 conidia mL-1 induced leaf lesions, cutting rot, and intense defoliation as observed under natural conditions. Calonectria hodgesii was re-isolated from infected tissue, which fulfilled Koch's postulates and confirmed its status as a pathogen with a wide host range.

Multiple sclerosis associated fatigue and sleep disturbances

Fatigue is the most frequent symptom in multiple sclerosis (MS) patients and often is profoundly debilitating. It is poorly understood and difficult to treat. Patients with MS do not often distinguish between fatigue and sleepiness. Excessive somnolence, inappropriate daytime sleep and sleep disorders (restless legs syndrome, REM-sleep behavioral disorders, obstructive sleep apnea and others) are common in patients with MS. In one study there was a significant correlation between fatigue and disrupted sleep in patients with MS. The goal of this study was to determine sleep disturbances associated with fatigue in patients with MS and look for a correlation with the location of demyelinating lesions seen on magnetic resonance imaging (MRI). Ten consecutive patients with relapsing-remitting (RR) MS (Mc Donald diagnostic criteria) who had fatigue based on fatigue questionnaire (Modified Fatigue Impact Scale – MFIS) undergo nocturnal polysomnography, utilizing standard technique with additional arm electromyography leads and time-synchronized digital video recording. There were 3 men and 7 women aged between 20 and 32 with Expanded Disability Status Scale (EDSS) ranging between 2.0 and 4.5. Eight patients reported sleep-related problems. These included difficulties initiating sleep and/or frequent awakenings due to spasms in the legs (7), difficulties in initiating or maintaining sleep (4), snoring (2) and nocturia (3). All patients were screened for depression with Beck Depression Inventory (BDI) and no one had a score of more then 14. MRI scans were performed on all patients on the day of polysomnography. Of the 10 fatigued patients with MS all had REM-sleep without atonia, 2 had REM-sleep associated motor activity in legs, 7 had frequent awakenings and significantly reduced sleep efficiency, 5 had hypopnea. One of the patients with sleep apnoea and fatigue was especially prominent in this case. 2 had snoring. All patients had MRI brain stem lesions and two of them had demyelinating lesions in pons. We have noted a relationship between fatigue-associated sleep abnormalities in MS patients and MRI brain stem lesions. These abnormalities may play a role in the pathophysiology of poorly understood MS fatigue. Large-scale studies are needed to confirm our findings. P. Sarajishvili Institute of Neurology.