Typical Symptoms Research Articles

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 >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<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.

#1723 Genetic landscape of polycystic kidney disease in a Chinese cohort – experience using whole genome sequencing in a tertiary renal unit

Abstract Background and Aims Genetic testing has increasingly been employed to provide definitive diagnoses and prognostic information in patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD). We aim to explore the genetic landscape of ADPKD in a Chinese cohort utilizing whole genome sequencing and study its real-world clinical utility. Method From 1st January 2022 to 31st March 2023, we recruited 50 adult Chinese patients who had the clinical diagnosis of ADPKD followed up at Queen Mary Hospital and consented to the study protocol. The study was approved by the University Institution Review Board and local ethics committees. Genomic DNA was isolated from samples obtained from patients per standard protocol. Whole-genome sequencing was performed and analysed through the germline analysis pipeline. Diagnostic analysis was performed per American College of Medical Genetics (ACMG) guidelines and ClinGen variant curation expert panel specifications. Diagnostic variants were defined as those classified as ‘pathogenic’ or ‘likely pathogenic’. Potential clinical utility of genetic findings were studied case-by-case based on the Kidney Disease Improving Global Outcomes (KDIGO) 2023 Clinical Practice Guideline for the Evaluation, Management and Treatment of ADPKD. Results Among the 50 unrelated probands with ADPKD, half were males and the mean age at presentation was 38. 38% patients had incidental finding of kidney cysts on abdominal imaging performed for unrelated symptoms or health screening, 32% presented for screening due to positive family history and only 30% presented with typical symptoms of ADPKD. Cystic complications were present in 30%, with cyst haemorrhage being the most common, followed by kidney stones, cyst rupture and infection. 80% patients also had liver cysts and none had a history of cerebral aneurysms. The majority of our cohort (72%) had a family history of ADPKD. We identified diagnostic variants in 35 individuals, reaching a diagnostic yield of 70%. Diagnostic variants were identified in PKD1 (20/35), PKD2 (11/35), IFT140 (3/35) and ALG9 (1/35). The majority of diagnostic variants were protein-truncating (32/35), while non-truncating variants consisted of 1 in-frame deletion and 2 missense variants in PKD1. We identified 3 copy number variation:NC_000016.10:g.2110587_2111851del,NC_000016.10:g.2132339_2137621del,NC_000016.10:g.2036427_2101117del. The genetic findings allowed physicians to make definitive diagnosis in 9 patients with negative family history of ADPKD. The genetic findings provided important prognostic information as protein-truncating variants in PKD1 or PKD2 were associated with more severe disease compared to non-truncating variants. For the 3 patients harbouring heterozygous pathogenic variants in IFT140 (NM_014714.4:c.2659G>T, NM_014714.4:c.3780del, NM_014714.4:c.1035_1036del), they demonstrated a milder PKD phenotype with stable kidney function, normal kidneys size and absence of liver cysts 10 years after the diagnosis. The patient with heterozygous likely pathogenic ALG9 variant (NM_024740.2:c.1225del) also had milder PKD phenotype with normal kidney function and normal sized kidneys on USG 5 years after the diagnosis. In another male patient with young hypertension who was classified as Mayo Class 1C according to kidney imaging, identifying the pathogenic protein-truncating variant in PKD1 (NM_001009944.3:c.7288C>T) would render him eligible to tolvaptan treatment in view of the high PROPKD score (7). Furthermore, the genetic findings enabled an earlier diagnosis in a number of family members by cascade testing and genetic results were important to identify suitable living-related kidney donors. Conclusion Genetic testing utilizing whole genome sequencing has multiple clinical utility in ADPKD patients. It could provide a definitive diagnosis in those with atypical presentation or without family history, inform prognosis, guide treatment, determine living-related donor suitability and allow earlier diagnosis in other family members.

Patterns of care at the end of life: a retrospective study of Italian patients with advanced breast cancer.

To better understand the type of care offered to Italian patients with advanced breast cancer at the End-of-Life (EoL), we conducted a retrospective observational study. EoL was defined as the period of six months before death. One hundred and twenty-one patients with advanced breast cancer (ABC) treated at IRCCS San Martino Policlinic Hospital who died between 2017 and 2021 were included. Data about patient, disease, and treatment characteristics from breast cancer diagnosis to death, along with information about comorbidities, medications, imaging, specialist evaluations, hospitalization, palliative care and home care, hospice admissions, and site of death were collected. 98.3% of the patients received at least one line of active treatment at EoL; 52.8% were hospitalized during the selected period. Palliative (13.9%), psychological (7.4%), and nutritional evaluations (8.2%) were underutilized. Palliative home care was provided to 52% of the patients. Most of the patients died at home (66.1%) and fewer than one out of five (18.2%) died at the hospital. Among the patients who died at home, 27.3% had no palliative support. Our findings indicate that palliative care in EoL breast cancer patients is still inadequate. Only a minority of patients had psychological and nutritional support While low nutritional support may be explained by the fact that typical symptoms of ABC do not involve the gastrointestinal tract, the lack of psychological support suggests that significant barriers still exist. Data on the site of death are encouraging, indicating that EoL management is increasingly home centered in Italy.

Symptom clusters and unplanned hospital readmission in Chinese patients with acute myocardial infarction on admission.

Acute myocardial infarction (AMI) has a high morbidity rate, high mortality rate, high readmission rate, high health care costs, and a high symptomatic, psychological, and economic burden on patients. Patients with AMI usually present with multiple symptoms simultaneously, which are manifested as symptom clusters. Symptom clusters have a profound impact on the quality of survival and clinical outcomes of AMI patients. The purpose of this study was to analyze unplanned hospital readmissions among cluster groups within a 1-year follow-up period, as well as to identify clusters of acute symptoms and the characteristics associated with them that appeared in patients with AMI. Between October 2021 and October 2022, 261 AMI patients in China were individually questioned for symptoms using a structured questionnaire. Mplus 8.3 software was used to conduct latent class analysis in order to find symptom clusters. Univariate analysis is used to examine characteristics associated with each cluster, and multinomial logistic regression is used to analyze a cluster membership as an independent predictor of hospital readmission after 1-year. Three unique clusters were found among the 11 acute symptoms: the typical chest symptom cluster (64.4%), the multiple symptom cluster (29.5%), and the atypical symptom cluster (6.1%). The cluster of atypical symptoms was more likely to have anemia and the worse values of Killip class compared with other clusters. The results of multiple logistic regression indicated that, in comparison to the typical chest cluster, the atypical symptom cluster substantially predicted a greater probability of 1-year hospital readmission (odd ratio 8.303, 95% confidence interval 2.550-27.031, P < 0.001). Out of the 11 acute symptoms, we have found three clusters: the typical chest symptom, multiple symptom, and atypical symptom clusters. Compared to patients in the other two clusters, those in the atypical symptom cluster-which included anemia and a large percentage of Killip class patients-had worse clinical indicators at hospital readmission during the duration of the 1-year follow-up. Both anemia and high Killip classification suggest that the patient's clinical presentation is poor and therefore the prognosis is worse. Intensive treatment should be considered for anemia and high level of Killip class patients with atypical presentation. Clinicians should focus on patients with atypical symptom clusters, enhance early recognition of symptoms, and develop targeted symptom management strategies to alleviate their discomfort in order to improve symptomatic outcomes.

Hydrogen sulfide alleviates the chilling-induced lignification in loquat fruit by regulating shikimate, phenylpropanoid and cell wall metabolisms

Lignification is a typical symptom of chilling injury (CI) in loquat fruit under chilling stress. This study investigated the impact of hydrogen sulfide (H2S) on endogenous H2S, shikimate, phenylpropanoid, and cell wall metabolisms of loquat fruit during refrigeration. The findings suggested that H2S treatment hindered the rise in the CI index and firmness while delaying the reduction in extractable juice, soluble sugar, and titratable acid content of loquat fruit. Besides, H2S treatment promoted the endogenous H2S content, which was correlated with the increase in activities of related H2S synthase enzymes. Furthermore, H2S suppressed enzymes involved in shikimate and phenylpropanoid metabolisms, thereby decreasing phenylalanine and lignin accumulation. Simultaneously, H2S treatment retarded the increases in insoluble pectin, hemicellulose, and cellulose by orchestrating cell wall-modifying enzymes. This work indicates that H2S treatment may alleviate chilling-induced lignification by inhibiting lignin accumulation and enhancing the depolymerization and solubilization of cell wall polysaccharides.

Alteration of gut microbiome in goslings infected with goose astrovirus

Goose astrovirus (GoAstV) is an emerging avian pathogen that induces gout in goslings with a mortality of up to 50%. Organ damage caused by GoAstV infection was considered the cause of gout, but it is still unclear whether other factors are involved. Human and murine studies have linked the gut microbiome-derived urate and gout, thus we hypothesized that gut microbiome may also play an important role in gout induced by GoAstV infection. This study tested the pathogenicity of our isolated GoAstV genotype 2 strain on goslings, while the appearance of clinical signs, histopathological changes, viral distribution and the blood level of cytokines were monitored for 18 days post-infection (dpi). The dynamics in the gut microbiome were profiled by 16S sequencing and then correlated with GoAstV infection. Results showed that this study successfully developed an experimental infection model for studying the pathogenicity of the GoAstV infection which induces typical symptoms of gout. GoAstV infection significantly altered the gut microbiome of goslings with the enrichment of potential pro-inflammatory bacteria and depletion of beneficial bacteria that can produce short-chain fatty acids. More importantly, the microbial pathway involved in urate production was significantly increased in goslings infected with GoAstV, suggesting that gut microbiome-derived urate may also contribute to the gout symptoms. Overall, this study demonstrated the role of gut microbiome in the pathogenesis of GoAstV infection, highlighting the potential of gut microbiome-based therapeutics against gout symptoms.

Evaluation of Endophytic Microorganisms (Trichoderma hazianum and Bacillus subtilus) as Biofungicides against Bayoud Disease (Fusarium oxysporum f. sp. albedinis) on Date Palm (Phoenix dactylifera L.)

Backgraound: Date palm disease named Bayoud, is the major constraint caused by the soil fungus Fusarium oxysporum f. sp. albedinis (Foa) in Algeria. This work has the objective to in vivo biocontrol on bayoud disease incidence on three date palm varieties (Deglet-Nour, Feggous and H-mira), using two antagonistic microorganisms, one fungus (Trichoderma harzianum) and one bacterium (Bacillus subtilus). Methods: Foa strains obtained from isolation of the spines carrying the typical symptoms of Bayoud disease. Two strains used T. harzianum and B. subtilus, are isolated from rhizosphere soils of the date palm. Using the greenhouse screening test, the in vivo biocontrol test is carried out on 3-4 month-old date palm seedlings at the rate of 5 ml of inoculum suspension. Result: A significant (P less than 0.01), difference of date palm seedlings reactions against Foa isolate and antagonistic microorganisms was observed. All three date palm varieties present a high susceptibility against Foa until the total mortality of date palm seedlings. The biocontrol test showed that two antagonists showed different reaction, with the complete resistance of three varieties treated by T. harzianum, while, the antagonist B. subtilus protect just two varieties (Deglet-Nour and H-mira) and can’t protect Feggous variety when showed the susceptibility reaction by presentation of typical symptoms of bayoud disease. We can apply of these antagonistic microorganisms to protect our groves contaminated by Bayoud disease and contain just susceptible commercial cultivars of date palm.

Case Report of Multiple Rectosigmoid Adenomatous Polyps and Its Management i.e. Transanal Endoscopic Microsurgery

Adenomatous polyps in the colorectal region are prevalent. On account of its rarity and effective excision using Transanal Endoscopic Microsurgery (TEM) with assistance from a Covidien Small Incision Laparoscopic System (SILS) Port, we present this case of an adenomatous polyp wherein the patient complaints of per rectal bleed. Most frequently asymptomatic, adenomatous polyps are the most prevalent. In the present case, five to six polyps were found in the rectosigmoid area during colonoscopy. Rectal bleeding, stomach pain, and changes in bowel function that have a high malignant potential are the most typical symptoms associated with polyps. Large rectal adenomas should only be treated with TEM at this time, and traditional Trans Endoscopic (EMR/ESD) should be stopped. Despite the availability of newer procedures like endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), TEM is still the method of choice. TEM is not recorded in our country up till now. This is the first time it is performed in our country. Keywords: Adenomatous Polyp; Transanal Endoscopic Microsurgery; Small Incision Laparoscopic System; Endoscopic Mucosal Resection; Endoscopic Submucosal Dissection

Nail growth disorder in multiple fingers following harvesting of radial forearm free flap for phalloplasty in gender-affirming surgery: a case report

Nail growth disturbance commonly takes place after trauma or relevant diseases, such as infections and tumors. However, abnormal growth of the nail plate sometimes occurs without an obvious causative factor. This report presents the case of a patient who underwent male genital reconstruction with a radial forearm free flap for gender affirmation. Although the entire process was smooth, with no accidental events, the second, third, and fourth phalangeal nail plates of the hand from which the flap was harvested showed no evident growth of the fingernail 2 months postoperatively. Nail production was preserved in the remaining fingernails. Typical symptoms, such as redness, swelling, and tenderness, were noted upon clinical observation. Eventually, nail production restarted 5 months after surgery. Steroid and antibiotic treatment was attempted to reduce periungual inflammation. Additionally, close observation with psychological support was conducted.

Virulent Fusarium isolates with diverse morphologies show similar invasion and colonization strategies in alfalfa.

Root rot is a major disease that causes decline of alfalfa production, and Fusarium is a major pathogen associated with root rot. In this study, 13 Fusarium isolates were obtained from alfalfa with root rot in Gansu Province, the major alfalfa production region in China. The isolates were characterized by molecular genotyping (ITS, TEF 1-α and RPB2 fragments) and identified as six species, which included the F. acuminatum, F. incarnatum, F. oxysporum, F. proliferatum, F. redolens, and F. solani. We found that their morphology varied significantly at both the macro- and micro-levels, even for those from the same species. We developed a low cost and fast pathogenicity test and revealed that all isolates were pathogenic to alfalfa with typical root rot symptoms such as leaf yellowing and brown lesions on the root and stem. However, the virulence of the isolates differed. We also found that the conidia of all isolates germinated as early as 24 hours post inoculation (hpi), while hyphae colonized the root extensively and invaded the xylem vessel by 48 hpi. Together our results reveal that different virulent Fusarium isolates use a similar invasion strategy in alfalfa. This natural plant-fungus pathosystem is intriguing and warrants further examination, particularly with regard to efforts aimed at mitigating the impact of multiple similar vascular pathogens on infected alfalfa plants.

Ultrasound-Guided Lidocaine Injection as a Novel Predictor of Response to Botulinum for Patients With Myofascial Pain Syndrome: A Case Report.

Botulinum injection is a well-known non-surgical intervention utilized in the management of myofascial pain syndrome (MPS). However, sparse evidence exists regarding the utility of ultrasound guidance of injectate or lidocaine as a predictive marker of patient response to botulinum toxin A (BTX-A). A 39-year-old male active duty service member demonstrated typical signs and symptoms of MPS. He reported a 10-year history of neck and back spasms that were triggered by exertion but also could occur spontaneously. Based on the characteristic regional motor-sensory defects, treatment options were discussed. With shared decision-making, the patient opted to try ultrasound-guided injection of lidocaine followed by xenomin brand BotoxA. Immediately following lidocaine injection, the patient reported complete relief of symptoms. Both injections were uncomplicated, and the patient reported great reduction in symptoms during the subsequent visit 2 months later. Relief of pain following ultrasound-guided injection of lidocaine may serve as an indicator of successful patient response to BTX-A in patients with MPS.

Complete Genome Sequence and Construction of an Infectious Bacterial Artificial Chromosome Clone of a Virulent Duck Enteritis Virus Strain XJ

In 2021, a highly virulent strain of duck enteritis virus (DEV), designated as DEV XJ, was isolated from Zhejiang, China, and its complete genome, spanning 162,234 bp with 78 predicted open reading frames (ORFs), was sequenced. While showing relative homology to the DEV CV strain, DEV XJ exhibited distinctions in 38 ORFs, including various immunogenic and virulence-related genes. Amino acid variation analysis, focusing on UL6 and LORF3, indicated a high degree of homology between DEV XJ and the 2085 strain from Europe, as well as the DEV DP-AS-Km-19 strain from India. Subsequently, a full-length infectious bacterial artificial chromosome clone (BAC) of DEV XJ was successfully constructed to delve into the pathogenic mechanisms of this virulent strain. XJ BAC demonstrated substantial similarity to the parental DEV XJ in both in vitro growth properties and the induction of typical pathogenic symptoms in sheldrakes. Furthermore, the US3, LORF3, UL21, and UL36 genes were individually deleted using a two-step RED recombination approach based on the infectious BAC clone. Our findings revealed that the UL21 and UL36 genes play crucial roles in viral proliferation. Although the US3 and LORF3 genes were dispensable for viral replication and cell-to-cell transmission in vitro, they attenuated the replication and transmission efficiency of DEV compared to the WT. In summary, this study accomplished the whole-genome sequencing of a clinically virulent DEV strain and the successful construction of an infectious DEV XJ clone. Moreover, the functional roles of the above-mentioned mutant genes were preliminarily explored through the analysis of their in vitro biological characteristics.

Complete genome sequence of a novel mitovirus identified in the phytopathogenic fungus Fusarium oxysporum f. sp. melonis strain T-SD3.

A novel mitovirus was identified in Fusarium oxysporum f. sp. melonis strain T-SD3 and designated as "Fusarium oxysporum mitovirus 3" (FoMV3). The virus was isolated from diseased muskmelon plants with the typical symptom of fusarium wilt. The complete genome of FoMV3 is 2269 nt in length with a predicted AU content of 61.40% and contains a single open reading frame (ORF) using the fungal mitochondrial genetic code. The ORF was predicted to encode a polypeptide of 679 amino acids (aa) containing a conserved RNA-dependent RNA polymerase (RdRp) domain with a molecular mass of 77.39 kDa, which contains six conserved motifs with the highly conserved GDD tripeptide in motif IV. The 5'-untranslated region (UTR) and 3'-UTR of FoMV3 were predicted to fold into stem-loop structures. BLASTp analysis revealed that the RdRp of FoMV3 shared the highest aa sequence identity (83.85%) with that of Fusarium asiaticum mitovirus 5 (FaMV5, a member of the family Mitoviridae) infecting F. asiaticum, the causal agent of wheat fusarium head blight. Phylogenetic analysis further suggested that FoMV3 is a new member of the genus Unuamitovirus within the family Mitoviridae. This is the first report of a new mitovirus associated with F. oxysporum f. sp. melonis.

Cystic fibrosis primarily presenting with pseudo-Bartter syndrome: a report of three cases and literature review

To summarize the clinical characteristics and genetic variations in children with cystic fibrosis (CF) primarily presenting with pseudo-Bartter syndrome (CF-PBS), with the aim to enhance understanding of this disorder. A retrospective analysis was performed on the clinical data of three children who were diagnosed with CF-PBS in Hunan Children's Hospital from January 2018 to August 2023, and a literature review was performed. All three children had the onset of the disease in infancy. Tests after admission showed hyponatremia, hypokalemia, hypochloremia, and metabolic alkalosis, and genetic testing showed the presence of compound heterozygous mutation in the CFTR gene. All three children were diagnosed with CF. Literature review obtained 33 Chinese children with CF-PBS, with an age of onset of 1-36 months and an age of diagnosis of 3-144 months. Among these children, there were 29 children with recurrent respiratory infection or persistent pneumonia (88%), 26 with malnutrition (79%), 23 with developmental retardation (70%), and 18 with pancreatitis or extrapancreatic insufficiency (55%). Genetic testing showed that c.2909G>A was the most common mutation site of the CFTR gene, with a frequency of allelic variation of 23% (15/66). CF may have no typical respiratory symptoms in the early stage. The possibility of CF-PBS should be considered for infants with recurrent hyponatremia, hypokalemia, hypochloremia, and metabolic alkalosis, especially those with malnutrition and developmental retardation. CFTR genetic testing should be performed as soon as possible to help with the diagnosis of CF.