Typical Symptoms Research Articles

Efficacy and Safety of Ensitrelvir for Asymptomatic or Mild COVID-19: An Exploratory Analysis of a Multicenter, Randomized, Phase 2b/3 Clinical Trial.

This phase 2b/3, randomized, placebo-controlled trial explored the efficacy and evaluated the safety of ensitrelvir. This trial involved individuals with asymptomatic infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and patients with mild symptoms of coronavirus disease 2019 (COVID-19). The trial was conducted at 57 medical institutions in Japan, South Korea, and Vietnam (study period: January 6-August 14, 2022). Eligible participants were randomized (1:1:1) to the ensitrelvir 125-mg, ensitrelvir 250-mg, or placebo group, received the allocated intervention orally, and were followed up until Day 28. Participants self-rated the severity of 14 typical COVID-19 symptoms and recorded the data in an electronic diary. In total, 572 participants (194, 189, and 189 in the ensitrelvir 125-mg, ensitrelvir 250-mg, and placebo groups, respectively) were included in the intention-to-treat population. Ensitrelvir 125-mg group observed a 77% reduction in the risk of developing any of the 14 COVID-19 symptoms or fever and a 29% reduction in the risk of worsening of such symptoms or fever versus placebo (statistically nonsignificant). The viral RNA, viral titer, and time to infectious viral clearance observed a statistically significant decrease versus placebo. Most treatment-related adverse events (TEAEs) were mild to moderate in severity, and the most common TEAE observed across groups was a decrease in high-density lipoprotein. Our exploratory results suggest a potential reduction in the risk of development or worsening of COVID-19 symptoms with ensitrelvir. Ensitrelvir showed antiviral efficacy and was well tolerated. Japan Registry of Clinical Trials identifier: jRCT2031210350.

Study on blood pressure rhythm in hypertensive patients withdeficiency syndrome and a random forest model for predicting hypertension withdeficiency syndrome.

To investigate blood pressure rhythm (BPR) in Yin deficiency syndrome of hypertension (YDSH) patients and develop a random forest model for predicting YDSH. Our study was consistent with technical processes and specification for developing guidelines of Evidence-based Chinese medicine clinical practice (T/CACM 1032-2017). We enrolled 234 patients who had been diagnosed with primary hypertension without antihypertensive medications prior to the enrollment. All participants were divided into Yin deficiency group (YX, n = 74) and non-Yin deficiency group (NYX, n = 160). Participants were professionally grouped by three experienced chief Traditional Chinese Medicine (TCM) physicians according to four examinations (i.e., inspection, listening and smelling, inquiry and palpation). We collected data on 24 h ambulatory blood pressure monitoring (ABPM) and YDSH rating scale. We divided 24 h of a day into 12 two-hour periods [Chen-Shi (7:00-9:00), Si-Shi (9:00-11:00), Wu-Shi (11:00-13:00), Wei-Shi (13:00-15:00), Shen-Shi (15:00-17:00), You-Shi (17:00-19:00), Xu-Shi (19:00-21:00), Hai-Shi (21:00-23:00), Zi-Shi (23:00-1:00), Chou-Shi (1:00-3:00), Yin-Shi (3:00-5:00), Mao-Shi (5:00-7:00)] according to the theory of "midnight-midday ebb flow". We used random forest to build the diagnostic model of YDSH, with whether it was Yin deficiency syndrome as the outcome. Compared with NYX group, YX group had more female participants with older age, lower waist circumference, body mass index (BMI), diastolic blood pressure (DBP), and smoking and drinking rate (all P ＜ 0.05). The YDSH rating scores of YX group [28.5 (21.0-36.0)] were significantly higher than NYX group [13.0 (8.0-22.0)] (P < 0.001), and the typical symptoms of YX group included vexing heat in the chest, palms and soles, dizziness, dry eyes, string-like and fine pulse, soreness and weakness of lumbus and knees, palpitations, reddened cheeks, and tinnitus (all P < 0.05). The ratio of non-dipper hypertension in YX group was higher than in NYX group (56.9% vs 44.4%, P = 0.004). Compared with NYX group, 24 h DBP standard deviation (SD), nighttime DBP SD, Si-Shi DBP, Si-Shi mean arterial pressure (MAP), Hi-Shi systolic blood pressure (SBP), Hi-Shi DBP, Hi-Shi MAP, Zi-Shi SBP, Zi-Shi DBP, Zi-Shi MAP, Chou-Shi SBP SD, Chou-Shi DBP SD, Chou-Shi SBP coefficient of variation (CV) were lower in YX group (all P ＜ 0.05). Binary Logistic Regression analysis showed that the diagnosis of YDSH was positively correlated with age, heart rate, YDSH rating scores, and four TCM symptoms including vexing heat in the chest, palms and soles, string-like and fine pulse, soreness and weakness of lumbus and knees, and reddened cheeks (all P ＜ 0.05), but was negatively correlated with smoking (P﹥0.05). In addition, the diagnosis of YDSH was positively correlated with daytime SBP SD, nighttime SBP SD, nighttime SBP CV, and Hi-Shi SBP CV, but was negatively correlated with 24 h SBP CV, daytime DBP SD, nighttime DBP SD, and Hi-Shi DBP (all P ＜ 0.05). Hi-Shi SBP CV had independent and positive correlation with the diagnosis of YDSH after adjusting the variables of age, gender, course of hypertension, BMI, waist circumference, SBP, DBP, heart rate, smoking and drinking (P = 0.029). Diagnostic model of YDSH was established and verified based on the random forest. The results showed that the calculation accuracy, specificity and sensitivity were 77.3%, 77.8% and 76.9%, respectively. The BPR was significantly attenuated in YDSH patients, including lower 24 h DBP SD and nighttime DBP SD, and Hi-Shi SBP CV is independently correlated with the diagnosis of YDSH. The prediction accuracy of diagnosis model of YDSH based on the random forest was good, which could be valuable for clinicians to differentiate YDSH and non-Yin deficiency patients for more effective hypertensive treatment of TCM.

Điều tra bệnh hại sau thu hoạch trên giống chuối Tiêu hồng (Musa acuminata) và chuối Nam Mỹ (Musa paradisiaca) ở Việt Nam

The survey implemented in the 2021 winter season on the Tieu hong banana cultivar (Musa acuminata) grown in Phu Tho and Hung Yen provinces showed that the most severe diseases were fruit rot and fruit spot with infection rates of 79.1% and 75.5%, respectively. Peel cracking and end rot (cigar rot) were also recorded at less than 5.0%. Fruit spot was the main disease that affected the South-American banana cultivar (Musa paradisiaca) during the 2022 spring-summer season in Gia Lai province. Of the 24 fungal and 37 bacterial strains isolated from the disease samples collected during the investigation and tested for their pathogenicity via artificial infection on healthy bananas, only 17 fungal strains showed the ability of lesion formation of which 4 strains caused typical symptoms of the fruit rot disease. There was not a single bacterial strain ascertained as phytopathogen indicating that fungi were the primary agents of post-harvest diseases on bananas. These four fungal strains were taxonomically characterized based on their morphology (colony and spore), comparative analysis of the ITS sequences of the 18S rDNA gene, and were then identified as Corynespora torulosa B2B, Microdochium colombiense B6, Fusarium circinatum B13F, and Aspergillus niger GL2.1. The ITS sequences of these strains were deposited to GenBank under the accession numbers OP855524, OP855525, OP855526, and OP855527, respectively.

Identification of effector candidates in Bipolaris sorokiniana and their expression profile analysis during pathogen-wheat interactions

Spot blotch disease, caused by the fungal pathogen Bipolaris sorokiniana, poses a significant threat to global production particularly wheat, and barley due to substantial yield losses. Similar to many fungal pathogens, the infection of host plants heavily depends on the pathogen's ability to secrete effector proteins, which manipulate host defenses and aid disease progression. However, a critical knowledge gap exists in the comprehensive identification and characterization of effector candidates (ECs) in B. sorokiniana, requiring further research efforts. Therefore, study aimed to systematically identify and characterize ECs in B. sorokiniana by conducting pathogenicity tests to confirm disease symptoms on wheat leaves, utilizing a rigorous bioinformatics approach to predict ECs through sequence analysis and structural similarities, and validating effector expression profiles during infection using RNA sequencing (RNA-Seq) and quantitative real-time polymerase chain reaction (qRT-PCR). Pathogenicity testing confirmed the typical symptoms of spot blotch disease upon inoculation with B. sorokiniana. Through bioinformatics analysis, 81 ECs were identified, showing dynamic expression patterns during infection stages. Among these ECs, genes such as Cocsa1|129517, Cocsa1|141231, and Cocsa1|193443 stood out due to their different expression patterns and structural similarities, indicating their potential roles as effectors. This study offers new novel insights into the effector repertoire of B. sorokiniana and its implications for spot blotch disease management. The identified ECs present promising targets for further investigation to clarify their specific roles in fungal virulence and host immune modulation.

Twindemic Threats of Weeds Coinfected with Tomato Yellow Leaf Curl Virus and Tomato Spotted Wilt Virus as Viral Reservoirs in Tomato Greenhouses.

Tomato yellow leaf curl virus (TYLCV) and tomato spotted wilt virus (TSWV) are well-known examples of the begomovirus and orthotospovirus genera, respectively. These viruses cause significant economic damage to tomato crops worldwide. Weeds play an important role in the ongoing presence and spread of several plant viruses, such as TYLCV and TSWV, and are recognized as reservoirs for these infections. This work applies a comprehensive approach, encompassing field surveys and molecular techniques, to acquire an in-depth understanding of the interactions between viruses and their weed hosts. A total of 60 tomato samples exhibiting typical symptoms of TYLCV and TSWV were collected from a tomato greenhouse farm in Nonsan, South Korea. In addition, 130 samples of 16 different weed species in the immediate surroundings of the greenhouse were collected for viral detection. PCR and reverse transcription-PCR methodologies and specific primers for TYLCV and TSWV were used, which showed that 15 tomato samples were coinfected by both viruses. Interestingly, both viruses were also detected in perennial weeds, such as Rumex crispus, which highlights their function as viral reservoirs. Our study provides significant insights into the co-occurrence of TYLCV and TSWV in weed reservoirs, and their subsequent transmission under tomato greenhouse conditions. This project builds long-term strategies for integrated pest management to prevent and manage simultaneous virus outbreaks, known as twindemics, in agricultural systems.

Cholelithiasis Diagnosis and Management in Thalassemia

Background: Cholelithiasis, while infrequently found in children, carries a significant risk for those with underlying conditions like thalassemia compared to the general population. This study aimed to described the manifestations of cholelithiasis in thalassemic children. Case: A 12-year-old girl with beta-thalassemia major presented with recurrent right upper quadrant abdominal pain and vomiting. Imaging revealed cholelithiasis and choledocholithiasis. Due to complications related to her thalassemia, she underwent endoscopic retrograde cholangiopancreatography (ERCP) for gallstone removal followed by laparoscopic cholecystectomy. Post-operative management addressed post-ERCP pancreatitis and bleeding concerns. The patient recovered well and is scheduled for follow-up. Discussion: Increased bilirubin production, iron overload, and altered bile properties in beta-thalassemia contribute to cholelithiasis risk. The patient presented with typical symptoms and underwent successful laparoscopic cholecystectomy after initial management with ERCP, which led to post-ERCP pancreatitis. Conclusion: This case underscores the elevated risk of cholelithiasis in thalassemic children and the importance of early diagnosis and intervention for optimal outcomes.

Clinical, subclinical characteristics and treatment outcomes of patients with community - acquired pneumonia at risk of pes infection

This study aims to describe the clinical and subclinical characteristics and evaluate treatment outcomes of community-acquired pneumonia (CAP) patients at risk of Pseudomonas aeruginosa, extended-spectrum beta-lactamases-producing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus (PES) infection. A cross-sectional descriptive study was conducted on 90 CAP patients with potential PES infection admitted to the Respiratory Department of Can Tho Central General Hospital in 2023. Most cases presented with symptoms, including moist rales (91.1%), increased cough (90%), dyspnea (86%), purulent sputum production (77.8%), and consolidation syndrome (71.1%). More than half of the cases exhibited fever (54.4%). A white blood cell count increase was typical (13.31 x 109 cells/L) and predominantly neutrophilic (81.3 ± 19.7%). Chest radiography predominantly showed bilateral infiltration (58.9%). PES pathogens were isolated in 30 patients (33.3%). The majority of cases did not respond to initial antibiotics (56.6%), most of the cases were stable and cured (accounting for 91.1%) with an average hospital stay of 8 days. Patients with CAP at risk of PES infection exhibit typical acute symptoms and laboratory features of conventional CAP. Most responded poorly to initial treatment, but the final treatment resulted in a very high rate of stability and cure.

Colletotrichum species associated with atemoya anthracnose in northeast Brazil

Anthracnose, caused by Colletotrichum spp., is an important disease of atemoya that can infect and cause damage to different plant organs. The symptoms include foliar anthracnose, flower abortion, branch tip bleaching, and necrotic lesions on fruits. Knowing the etiology of this disease is essential for properly developing management strategies. Therefore, this study aimed to identify Colletotrichum species associated with atemoya in the Northeast region of Brazil, based on multi-locus phylogeny and morphological analyses, to better understand the etiology of anthracnose in this plant species. The Colletotrichum isolates were obtained from symptomatic leaves and branches of atemoya collected in commercial fields in Vitória da Conquista (Bahia), Palmeira dos Índios and Rio Largo (Alagoas), located in northeast Brazil. The initial analysis of the partial sequences of the GAPDH gene was performed with nineteen Colletotrichum isolates obtained from leaves and branches of atemoya trees with typical anthracnose symptoms. Seventeen isolates were grouped in the gloeosporioides complex and two in the boninense complex. Therefore, eleven isolates were submitted to concatenated phylogenetic analyses with the genes GAPDH, TUB2, and ITS region of the rDNA to confirm the identity of the isolates at the species level. The species C. theobromicola, C. siamense, C. fructicola and C. karstii were identified and are associated with atemoya anthracnose in the Northeast region of Brazil.

기능의학 증례 보고: 롱코비드와 부신 피로 동반 환자 1례

Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection or post-acute COVID-19 syndrome, refers to a range of symptoms and complications that persist more than four weeks after diagnosis. Typical symptoms include fatigue, headache, anosmia, ageusia, chronic cough, shortness of breath, impaired concentration and memory (brain fog), sleep disturbances, depression, anxiety, and hair loss. The incidence of long COVID varies according to the data, but it has been reported in approximately 20-60% of acute COVID-19 patients. However, despite its high incidence and significant medical and societal burden, there is currently no clear definition or objective diagnostic criteria for long COVID. Its diagnosis and treatment options are also limited and not established due to insufficient evidence. Nevertheless, a functional medicine approach, especially focused on adrenal functional and adrenal fatigue, can help long COVID patients. Relevant blood tests and urinary organic acid profile can be utilized, and lifestyle modification, oral or intravenous nutrition therapies can be implemented. In this article, we report a clinical case of long COVID with adrenal fatigue, demonstrating significant improvement after functional medical approach and management.

Identification of the biological functions and chemo-therapeutic responses of ITGB superfamily in ovarian cancer

BackgroundPatients with ovarian cancer (OC) tend to face a poor prognosis due to a lack of typical symptoms and a high rate of recurrence and chemo-resistance. Therefore, identifying representative and reliable biomarkers for early diagnosis and prediction of chemo-therapeutic responses is vital for improving the prognosis of OC.MethodsExpression levels, IHC staining, and subcellular distribution of eight ITGBs were analyzed using The Cancer Genome Atlas (TCGA)-Ovarian Serous Cystadenocarcinoma (OV) database, GEO DataSets, and the HPA website. PrognoScan and Univariate Cox were used for prognostic analysis. TIDE database, TIMER database, and GSCA database were used to analyze the correlation between immune functions and ITGBs. Consensus clustering analysis was performed to subtype OC patients in the TCGA database. LASSO regression was used to construct the predictive model. The Cytoscape software was used for identifying hub genes. The ‘pRRophetic’ R package was applied to predict chemo-therapeutic responses of ITGBs.ResultsITGBs were upregulated in OC tissues except ITGB1 and ITGB3. High expression of ITGBs correlated with an unfavorable prognosis of OC except ITGB2. In OC, there was a strong correlation between immune responses and ITGB2, 6, and 7. In addition, the expression matrix of eight ITGBs divided the TCGA-OV database into two subgroups. Subgroup A showed upregulation of eight ITGBs. The predictive model distinguishes OC patients from favorable prognosis to poor prognosis. Chemo-therapeutic responses showed that ITGBs were able to predict responses of common chemo-therapeutic drugs for patients with OC.ConclusionsThis article provides evidence for predicting prognosis, immuno-, and chemo-therapeutic responses of ITGBs in OC and reveals related biological functions of ITGBs in OC.

First report of Boeremia exigua causing spot blight on cowpea in China.

Cowpea or black-eyed pea [Vigna unguiculata (L.) Walp.] is a dual-purpose leguminous crop grown for food and fodder. In September 2022, cowpea plants exhibiting symptoms of a leaf spot and blight were observed in Renda Town located in Jingning County of Gansu Province, China, with the disease incidence in individual cowpea fields as high as 100%. Diseased leaves showed variable-sized, nearly circular brown blotches, large blotches with dark brown margins, and the adaxial surfaces of blotches had small black dots and whorls (Fig. 1). Multiple isolates with consistent colony characteristics were obtained from cowpea leaves with typical symptoms. The isolates were transferred to fresh potato dextrose agar medium (PDA) and then purified by transferring hyphal tips to PDA. Three isolates, JNJD-1, JNJD-2, and JNJD-3, were selected for subsequent identification and pathogenicity determination. After eight days at 25℃ on PDA, the colonies appeared irregular, aerial mycelium dense, cottony, atrovirens to olive brown, with white hyphae on the undulate margin (Fig. 2A and B). The pycnidia were globose to sub-globose, brown to dark brown, with 70-110 μm diameters. Single celled hyaline conidia were ellipsoidal to oblong with obtuse ends, and measured 6.6-9.3 × 2.8-4.1 μm (x̄ = 7.8 × 3.5 μm, n = 50) (Fig. 2C). Morphological characteristics are similar to the description of the genus Boeremia (Aveskamp et al, 2010). Primer pairs ITS1/ITS4, LR0R/LR5, fRPB2-5F2/fRPB2-7cR, and TUB2FD/TUB4RD were used to amplify portions of the ITS, LSU, RPB2, and TUB genes, respectively (Chen et al, 2015). The obtained sequences (Accession numbers: PP033662 to PP033664 for ITS, PP033667 to PP033669 for LSU, PP035531 to PP035533 for RPB2, and PP035534 to PP035536 for TUB) were 97% identical to that of a B. exigua strain CBS 431.74 (accession no. FJ427001, EU754183, GU371780, and FJ427112) (Table 1). The constructed maximum likelihood tree indicated close relationships between three isolates and B. exigua, which clustered together (Fig. 3). Cowpea plants (cultivar Junlintianxia) at the three-leaf stage were inoculated by spraying a spore suspension (1×106 conidia/ml) of JNJD-1, JNJD-2, and JNJD-3 until run off and incubated at greenhouse conditions (25°C and 12 h light). Inoculations with sterile water were used as a control and each treatment was repeated 3 times with five plants per replicate. Small brown spots appeared on the infected leaves at 2 dpi, followed by the appearance of large blotches, with dark brown at the margin and grayish-white in the center at 5 dpi (Fig. 4A). These lesions gradually increase and coalesce, causing leaf chlorosis and finally defoliation in serious cases. Disease incidence in inoculated cowpea plants treated with the isolates JNJD-1, JNJD-2, and JNJD-3 reached almost 100%. In contrast, control plants developed no symptoms (Fig. 4B). The pathogens were re-isolated from the inoculated leaves and identified as B. exigua using morphological and molecular analysis, whereas no fungus was isolated from control leaves. The experiment was repeated once under the same conditions, yielding similar results. B. exigua has a broad host range, infecting 19 families and 31 genera of plant species, and causing leaf spots, leaf blight, and tuber rot (Lan and Duan 2022). To our knowledge, this is the first report of the pathogen B. exigua causing spot blight on cowpeas. It has been reported that B. exigua infects leguminous crops from multiple genera, such as field pea, soybean, white clover, and Dumasia villosa (Liu et al, 2023). This study further enriches the host range of this pathogen and the pathogen species of cowpea leaf diseases.

Influence of Organisational-Level Factors on Delayed Door-to-Balloon Time among Patients with ST-Elevation Myocardial Infarction.

This study aimed to estimate the door-to-balloon (DTB) time and determine the organisational-level factors that influence delayed DTB times among patients with ST-elevation myocardial infarction in Oman. A cross-sectional retrospective study was conducted on all patients who presented to the emergency department at Sultan Qaboos University Hospital and Royal Hospital, Muscat, Oman, and underwent primary percutaneous coronary interventions during 2018-2019. The sample included 426 patients and the median DTB time was 142 minutes. The result of the bivariate logistic regression showed that patients who presented to the emergency department with atypical symptoms were 3 times more likely to have a delayed DTB time, when compared to patients who presented with typical symptoms (odds ratio [OR] = 3.003, 95% confidence interval [CI]: 1.409-6.400; P = 0.004). In addition, patients who presented during off-hours were 2 times more likely to have a delayed DTB time, when compared to patients who presented during regular working hours (OR = 2.291, 95% CI: 1.284-4.087; P = 0.005). To meet the DTB time recommendation, it is important to ensure adequate staffing during both regular and irregular working hours. Results from this study can be used as a baseline for future studies and inform strategies for improving the quality of care.

First report of leaf spot disease caused by Neopestalotiopsis rosae on Lonicera caerulea L. in Heilongjiang Province, China.

Recently, interest in cultivating blue honeysuckle (Lonicera caerulea L.) for horticulture and medicinal uses has grown (Sharma and Lee 2021). Between September 2022 and September 2023, a leaf spot disease (Fig. S1) was observed on approximately 20% of 'Lanjingling' blue honeysuckles grown in a 0.18 ha field in Qiqihar city (123.43°E, 47.92°N), Heilongjiang Province, China. Infected plants displayed black leaf spots that expanded to cover the entire leaf. Small, 3 to 4 mm segments of infected tissue were surface sterilized with 75% ethanol for 30 s and 5% sodium hypochlorite (NaOCl) for 3 min, rinsed three times with sterile distilled water, dried on paper towels, and plated in 9 cm Petri dishes containing potato dextrose agar (PDA) (Ma et al. 2023). To induce sporulation, nine purified cultures (Fig. S2) with similar culture characteristics were finally obtained from ten infected plants and they displayed a conidia morphology consistent with Neopestalotiopsis spp., no other fungi were isolated, and the isolation frequency was 90%. Conidiomata (Fig. S3) were brown to black and distributed in concentric rings with an average size of 261.98 (60.30-451.80) μm (n = 50). The conidia (Fig. S3) were fusoid and had four septa, straight to slightly curved, with an average size of 23.48 (13.50-30.30) × 5.42 (4.50-9.30) μm(n = 50), while basal and apical cells were hyaline and the three middle cells were brown with darker septa. PCR amplification was performed with ITS1/ITS4 (White et al. 1990), EFl-728F/EF1-986R (Carbone and Kohn 1999), and Btub2Fd/Btub4Rd (Glass and Donaldson 1995) primers from the genomic DNA of the LD-330. Sequences of ITS (PP033584), TEF (PP048757), and TUB (PP048758) revealed 99 to 100% (499/500, 255/255, and 481/486) shared identity with Neopestalotiopsis rosae sequences (NR145243, KM199524, and KM199430) (Rebollar-Alviter et al. 2020). Therefore, based on morphological characteristics and molecular phylogeny, LD-330 was identified as N. rosae. Six two-year-old healthy plants of the 'Lanjingling' cultivar were selected for a pathogenicity test (Yan et al. 2023). The leaves were surface disinfected with 75% alcohol and then wiped with sterilized water three times. Three plants were inoculated with 10 ml of LD-330 conidial suspension (1 × 106 spores/ml) or with sterile water as an experimental control, respectively. All plants were in closed plastic bag, incubated in a greenhouse at 28 ℃ and 75% relative humidity (RH) under a 12-h light/dark cycle, and each experiment was performed three times (Rebollar-Alviter et al. 2020). Typical leaf spot symptoms were observed on inoculated leaves after 14 days (Fig. S4), whereas no symptoms were detected on water-treated leaves. The same pathogen was reisolated from infected leaves, displayed the same morphological and molecular traits, and was again identified as N. rosae, confirming Koch's postulate. Neopestalotiopsis rosae was previously reported on pecan (Gao et al. 2022), causing black leaf spot disease in China. To our knowledge, this is the first report of a blue honeysuckle leaf spot caused by N. rosae in China and specifically in the Heilongjiang province which has the largest blue honeysuckle cultivation area in the country. Future research should be directed toward developing comprehensive management measures.

Safety and efficacy outcomes in 100 consecutive cases of pulsed field ablation

Abstract Background Pulsed field ablation (PFA) an emerging technology for ablation of atrial fibrillation (AF). This non-thermal ablation modality uses ultrarapid electrical pulses to destabilise cell membranes and can selectively ablate myocardial tissue. Successful pulmonary vein isolation (PVI) and reductions in procedure times compared to other modalities have been observed in initial studies. Aim To report initial outcomes and fluoroscopic times in the first 100 consecutive cases using PFA in AF ablation. Methods The first 100 consecutive PFA cases carried out by a single operator in a single centre were examined. All cases were performed under general anaesthesia, using ultrasound-guided vascular access and TOE-guided transseptal puncture. Outcomes were recorded from the first case in June 2022 to the present day. Electroanatomic mapping (EAM) was carried out using two proprietary systems. Results Procedural information and follow-up was achieved in all 100 patients (see table). The majority (77) were male. Mean age 61. Cardiovascular comorbidities included: hypertension (41), heart failure (12), ischaemic heart disease (10), stroke (4), diabetes mellitus (3). Antiarrhythmic drugs were used by 45 patients (Amiodarone in 22, Dronedarone in 18, Flecainide in 10, Sotalol in 8, Mexiletine in 1) with 55 taking beta blockers only or no rhythm control drugs. Persistent AF accounted for 57 cases, and 91 patients had no prior ablation procedure. Median CHA2DS2VASC 1. Warfarin was used on 1 patient, the other 99 patients underwent ablation on uninterrupted DOAC, most commonly Apixaban. EAM was conducted in 59 patients. Stand-alone PVI was carried out in 68, while 30 underwent an additional posterior wall box isolation, and a mitral isthmus line was added in a further 2 who had atrial flutter (AFl) during the procedure following successful PVI. There were no serious peri-procedural complications. (vascular access complications, pericardial effusion, stroke or death). All 100 patients were discharged following a one-night stay. Clinical pericarditis without effusion occurred in 1 patient on day 2, and resolved with a short course of Colchicine. Mean fluoroscopy time was 9minutes, 12seconds, and reductions in fluoroscopy times correlated significantly with case number (see figure). Mean fluoroscopy time was 2mins, 30secs higher where EAM was used. Sinus rhythm was achieved in 100%. Atrial arrhythmia recurred in 12 patients, 7 with AF and 3 atrial flutter, 2 with typical symptoms which could not be documented. Two of the recurrences were within 24 hours of the procedure. Conclusions This registry data shows that PFA was used to achieve PVI safely, with effective additional substrate ablation also demonstrated. There were no serious peri-procedural complications, and procedural improvements in fluoroscopic times were observed throughout the 100 cases. Long term follow-up data is required to validate the safety and efficacy of this new technology.

Assessment of Puccinia polliniicola as a potential biological control agent for Microstegium vimineum.

Microstegium vimineum (Trin.) A. Camus, commonly called stiltgrass, is a dominant weed in the United States and China. Although a lot of control approaches have been attempted, an economic, effective and practical measure has not been available to control the weed so far. A serious rust disease of Microstegium vimineum was observed in three regions of Wenzhou city in China, from 2019 to 2021, with a disease incidence ranging from 82% to 97%. Typical rust disease symptoms on Microstegium vimineum were prominently visible during the early monsoon season (June-July), with chlorotic spots on the leaf surfaces. The morphological characterization of the strain WZ-1 which was isolated from the diseased leaves was consistent with Puccinia polliniicola. The virulence tests showed that the average disease index of Microstegium vimineum plants could reach 35% at 10 days post-inoculation. The host specificity of Puccinia polliniicola was tested on 64 plant species from 12 families and it did not cause any diseased symptoms on 24 major crops and 36 weeds, but slightly infected four gramineous weeds, Arthraxon hispidus, Polypogon fugax, Cynodon dactylon, and Microstegium ciliatum. However, newly-produced urediniospores were not observed on the slightly infected plants. The urediniospores of strain WZ-1 infected the Microstegium vimineum leaves by two main approaches: mycelium or appressorium invaded the stoma; and mycelium or appressorium directly invaded intercellular spaces. Field experiments showed that the rust disease naturally prevailed among Microstegium vimineum populations, causing severe rust disease symptoms on the leaf surface. The rust epidemic effectively controlled all of the target plants in the closed plot where the rust was released. Puccinia polliniicola strain WZ-1 has great potential to be used as a classical biological control agent against Microstegium vimineum. © 2024 Society of Chemical Industry.

E.4 Machine learning based patient classification to predict neurological deterioration in mild Degenerative Cervical Myelopathy

Background: Degenerative Cervical Myelopathy (DCM) is the functional derangement of the spinal cord because of compression from degenerate tissues. Typical neurological symptoms of DCM include gait imbalance and upper extremity paresthesia. While it is thought that greater spinal cord compression leads to increased neurological deterioration, our clinical experience suggests a more complex mechanism involving spinal canal diameter (SCD). Methods: 124 MRI scans from 59 non-operative DCM patients underwent manual scoring of cord compression and SCD measurements. Unsupervised machine learning dimensionality reduction techniques and k-means clustering were used to establish patient groups. These patient groups underwent manual inspection of common compression patterns and SCD similarities to define their unique risk criteria. Results: We found that compression pattern is unimportant at SCD extremes (≤14.5 mm or &gt;15.75 mm). Otherwise, stenosis with clear signs of cord compression at two disc levels and stenosis without clear signs of cord compression at two disc levels result in a relatively higher and lower likelihood of deterioration, respectively. We elucidated five patient groups with unique associated risks for neurological deterioration, according to both SCD range and their cord compression pattern. Conclusions: The specific combination of narrow SCD with focal cord compression increases the likelihood of neurological deterioration in non-operative patients with DCM.

#2724 Renal amyloidosis cohort registry in our health area

Abstract Background and Aims Renal amyloidosis is the pathological phenomenon of amyloid deposition in the kidney with marked differences in renal function impairment, proteinuria, need for renal replacement therapy (RRT) and exitus, depending on the protein involved. Light chain amyloidosis (AL) and serum protein A (AA) amyloidosis are the most common. Typical symptoms are severe proteinuria, nephrotic syndrome, and end-stage chronic kidney disease (ESRD). Method Retrospective study of a cohort of patients with renal amyloidosis. Data extracted from the biopsy registry of the HUVM Nephrology Service (2013-2022). We collected demographic, clinical, analytical, histological and clinical outcome variables (RTT, Exitus). Results are analyzed using Mayo Clinic staging criteria. Results 19 patients with a mean age of 63.4a; 57.9% male. Mean laboratory values at diagnosis: creatinine (Cr) 1.56 mg/dl and proteinuria 3.9 g/24 h. Abdominal fat biopsy in 13 cases; 3 (23%) tested positive. Comparative analysis of AL vs non-AL forms, Cr values (1.14 vs 2.27 mg/dl respectively) (p=0.57) differed. Proteinuria according to the histological location of the amyloid: 4.6 g/24 h in glomerular involvement vs. 0.3 g/24 h in those who did not present it (p&amp;lt;0.05). 31.6% required RTT with a mean onset time of 250.6 d from biopsy. Exitus of 21.1%: average time of 426.5 d. (See analysis in attached table). Conclusion We did not observe significant deterioration of renal function, which is greater in non-AL forms of amyloidosis. Fat biopsy was less cost-effective than reported in the literature. Significantly lower levels of proteinuria were found in the amyloidosis group without glomerular involvement. In our series, the prognostic capacity associated with the MAYO staging was confirmed.

Cross-Inoculation of Commercial Forestry, Amenity, and Horticulture Tree Species with Ceratocystis Isolates Collected from Different Host Species.

Ceratocystis manginecans has caused significant losses in forestry productivity in Indonesia and neighboring nations. It also infects horticultural trees, but the host range of individual isolates of C. manginecans is poorly studied. So, this study aimed to better understand the potential host range and evaluate aggressiveness against forestry and fruit tree species of C. manginecans isolated from various tree species in Indonesia. Five C. manginecans isolates, four from different tree species and one from the shot-hole borer Euwallacea perbrevis, were used to inoculate seven fruit and six forest tree species, including E. pellita and Acacia mangium. Many of the inoculated trees produced typical canker disease symptoms, such as rough, swollen, and cracked lesions on the bark, but some trees did not have any external symptoms. Mortality in the most susceptible clone of A. mangium was 40% within 8 weeks. Forest tree species were more susceptible than fruit trees, with the length of xylem discoloration ranging from 0.4 to 101 cm. In fruit trees, the average extent of xylem discoloration was lower, ranging from 0.4 to 20.5 cm; however, mortalities were recorded in two fruit tree species, Citrus microcarpa and Durio zibethinus. Host-isolate interaction was evident; isolate Ep106C from Eucalyptus pellita caused the greatest xylem discoloration in Citrus sp., whereas Hy163C from Hymenaea courbaril was the most damaging in D. zibethinus, Artocarpus heterophyllus, and Mangifera indica. Increasingly globalized food and fiber systems increase risk of disease spread, and the serious threat of C. manginecans incursions into countries where it is not present must be evaluated more thoroughly.

Characterization of Colletotrichum fructicola causing anthracnose on Schima superba in China

AbstractLeaves of Schima superba with typical anthracnose symptoms were collected in July 2023 in Zhejiang Province, China. The fungi isolates were conducted from the margins of the lesions, and three isolates CA13, CA18 and CA27, were selected for identification and pathogenicity test. Based on morphological characteristics and phylogenetic analyses of the partial regions of internal transcribed spacer (ITS), actin (ACT), calmodulin (CAL), beta‐tubulin (TUB2), and glyceraldehyde‐3‐phosphate‐dehydrogenase sequences (GAPDH), the fungi were identified as Colletotrichum fructicola. Inoculation of the fungi on healthy S. superba leaves showed symptoms similar to those observed in the field, and the fungi were re‐isolated from the lesions. To the best of our knowledge, this represents the first report of C. fructicola causing anthracnose on S. superba worldwide.

Salmonella pathogenicity island-14 is a critical virulence factor responsible for systemic infection in chickens caused by Salmonella gallinarum

Salmonella enterica serovar Gallinarum (S. gallinarum) is an important host-specific pathogen that causes fowl typhoid, a severe systemic, septicemic, and fatal infection, in chickens. S. gallinarum causes high morbidity and mortality in chickens and poses a significant burden and economic losses to the poultry industry in many developing countries. However, the virulence factors and mechanisms of S. gallinarum-induced systemic infection in chickens remain poorly understood. In this study, we constructed a Salmonella pathogenicity island-14 (SPI-14) mutant strain (mSPI-14) of S. gallinarum and evaluated the pathogenicity of mSPI-14 in the chicken systemic infection model. The mSPI-14 exhibited the same level of bacterial growth and morphological characteristics but significantly reduced resistance to bile acids compared with the wild-type (WT) strain in vitro. The virulence of mSPI-14 was significantly attenuated in the chicken oral infection model in vivo. Chickens infected with WT showed typical clinical symptoms of fowl typhoid, with all birds succumbing to the infection within 6 to 9 days post-inoculation, and substantial increases in bacterial counts and significant pathological changes in the liver and spleen were observed. In contrast, all mSPI-14-infected chickens survived, the bacterial counts in the organs were significantly lower, and no significant pathological changes were observed in the liver and spleen. The expression of interleukin (IL)-1β, IL-12, CXCLi1, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ in the liver of mSPI-14-infected chickens were significantly lower than those in the WT-infected chickens. These results indicate that SPI-14 is a crucial virulence factor in systemic infection of chickens, and avirulent mSPI-14 could be used to develop a new attenuated live vaccine to prevent S. gallinarum infection in chickens.