Prolonged phloem feeding by the spotted lanternfly, an invasive planthopper, alters resource allocation and inhibits gas exchange in grapevines.

Spotted lanternfly (Lycorma delicatula White; SLF) is a phloem-feeding planthopper invasive to the Eastern United States that can feed on a range of wild and cultivated plant species. Since its 2014 introduction in the United States, large infestations and subsequent economic damage have been reported in cultivated grapevines, but no studies have detailed grapevine physiological responses to SLF phloem feeding. This study investigated grapevine-SLF interactions, detailing how different infestation densities affect leaf gas exchange and end-season concentrations of nonstructural carbohydrates and nitrogen in vegetative and perennial tissues of two Vitis species. Effects on fruit ripeness parameters and dormant bud freeze tolerance were examined, in addition to other year-after effects. Phloem feeding by low densities (≤4 SLF shoot-1) had minimal effects, whereas greater densities (5-15 SLF shoot-1) increasingly affected carbohydrate and nitrogen dynamics in both Vitis species. Phloem feeding substantially affected starch and, to a lesser extent, total nitrogen concentrations of woody roots. Prolonged exposure strongly reduced leaf gas exchange. We conclude that intensive late-season phloem feeding by large adult SLF population densities (≥8 SLF shoot-1) can induce carbon limitation, with the potential for negative year-after effects in cases of severe belowground carbon depletion. This work presents novel insights into SLF-grapevine interactions, identifies avenues of future SLF-plant research, and assists the development of action thresholds for SLF management in vineyards.

Large Primary Neuroendocrine Tumor of the Liver in a 57-year-Old Female Presenting With MSSA Bacteremia.

Primary neuroendocrine tumors (NETs) are rare forms of malignancy, representing just .5% of known cancers and having an overall incidence of 0.2/100,000. The most common sites of origin are bronchopulmonary and gastrointestinal, most commonly the appendix, pancreas, and ileum. We report the case of a 57-year-old female who was admitted for refractory MSSA bacteremia and several weeks of abdominal pain. CT imaging done on presentation demonstrated a 12.5 x 19.4 x 17.3 cm heterogeneous right liver mass with associated mass effect. The patient was taken to the operating room and a right hepatectomy and cholecystectomy were performed without complication. Histological examination revealed necrotic tumor in sheets and nests with marked nuclear pleomorphism. Immunohistochemistry demonstrated positive staining for pancytokeratin, synaptophysin, chromogranin, and TTF-1, consistent with undifferentiated NET. While rare, NETs can originate from a variety of organs outside the gastrointestinal and bronchopulmonary tract, including the liver.

Influence of Region on Sensory and Chemical Profiles of Pennsylvania Grüner Veltliner Wines.

The influence of cultural and environmental factors on the sensory and chemical profiles of wines has been the subject of research investigation for many years, and an examination of these relationships can help determine whether wine regional trends exist. The present study investigated the chemical and sensory factors that drive regional differences in Pennsylvania Grüner Veltliner wines through a controlled winemaking study across two vintages in 2018 and 2019. Descriptive analysis was used to identify key sensory attributes of Pennsylvania Grüner Veltliner. Intensities of these attributes were evaluated in wines vinified under identical conditions from grapes harvested across nine Pennsylvania vineyards. Chemical profiles of finished wines were examined through volatile, phenolic, and color analyses. Significant sensory differences were found between wine regions, with some trends consistent across both vintages; however, regionality based on compositional analyses was less clear. As the first study to examine Pennsylvania Grüner Veltliner wines sensorially, results revealed sensory characteristics that can be useful for wineries and their tasting room staff in marketing these lesser-known white wines to wine consumers as the variety grows in popularity in the state.

Risk Factors Associated With Invasive Fungal Infections in Kidney Transplant Patients.

BACKGROUND: Kidney transplant recipients are at increased risk for developing invasive fungal infections (IFI). We queried the United States Renal Data System (USRDS) for risk factors for IFI in these patients. METHODS: Patients who underwent a kidney transplant between 2005 and 2008 were queried for an IFI diagnosis using ICD-9 codes. An IFI was defined as at least one documented diagnosis from one of the following: (1) Candida (candidemia); (2) Histoplasmosis; (3) Aspergillosis; (4) Cryptococcosis; (5) "Other" mycoses. Potential risk factors included demographics, certain comorbidities and immunosuppressive medications. To examine the relative risk (RR), simple bivariate models were used, followed by a comprehensive full model to estimate the adjusted RR (aRR). RESULTS: Of 57,188 kidney transplant patients, 1,218 had 1,343 IFI diagnoses, with a median time to infection of 495 days. "Other" mycoses accounted for the most IFI diagnoses (37%), followed by aspergillosis (22%). The risk for any IFI was increased with age ≥65 years. Diabetes (aRR = 1.71), bacterial pneumonia (aRR = 1.62) and UTI (aRR = 1.34) were the top 3 clinical risk factors for infection. Each of the IFI groups was also associated with individual risk factors. Therapy with mycophenolate mofetil was associated with a decreased risk of candidemia. CONCLUSIONS: Risk factors for IFI in renal transplant patients include demographic, medication-associated and clinical data, as well as organism-specific factors. These results offer an extensive clinical profile of risk for IFI, and may thus help inform the diagnosis and presumptive therapy of invasive fungal infections in renal transplant recipients.

Modeling the Impacts of Weather and Cultural Factors on Rotundone Concentration in Cool-Climate Noiret Wine Grapes.

The sesquiterpenoid rotundone is the compound responsible for the "black pepper" aroma of many plant species, including several economically important wine grape varieties. Since its identification in wine in 2008, there has been an increased interest in understanding how individual climatic or cultural factors affect the accumulation of rotundone in grapes and subsequently the level of wine "pepperiness." However, no study has assessed climatic and viticultural factors together to identify which variables have the strongest influence on rotundone accumulation. Our study aimed to fill this knowledge gap by developing a predictive model that identified factors that explain rotundone concentrations in Noiret (Vitis sp.) grapes at harvest. Over the 2016 and 2017 seasons, we measured 21 viticultural, meso- and microclimatic variables and concentrations of rotundone in Noiret wine grapes at seven vineyards in the northeastern U.S. Vineyard growing degree days (GDD v ) and the amount of solar radiation (cumulative solar exposure; CSEv) accumulated from the beginning of fruit ripening to harvest were the variables best correlated (r = 0.70 and r = 0.74, respectively) with rotundone concentrations. Linear correlations between microclimatic parameters and rotundone concentrations were weaker, but overall rotundone was negatively correlated with low (<15°C) and high (>30°C) berry temperatures. Using the 2-year data set we were able to develop a four-variable model which explained more than 80% of the variation in rotundone concentration at harvest. The model included weather [growing degree days during fruit ripening (GDD v )] and plant-related variables (concentrations of phosphorus and calcium in the leaf petiole, and crop load). The model we developed could be used by wine producers to identify sites or cultural practices that favor rotundone accumulation in Noiret grapes after performing a model validation with an additional, external data set. More broadly, the statistical approach used here could be applied to other studies that also seek to assess the effects of multiple factors on a variable of interest under varying environmental conditions.

Differential Expression of Prostaglandin E2 Receptors in Porcine Kidney Transplants.

BACKGROUND: Acute rejection of a kidney allograft results from adaptive immune responses and marked inflammation. The eicosanoid prostaglandin E2 (PGE2) modulates the inflammatory response, is generated by cyclooxygenase 2 (COX-2), and binds to 1 of the 4 G protein-coupled E prostanoid cell surface receptors (EP1-4). Receptor activation results in in proinflammatory (EP1 and EP3) or anti-inflammatory (EP2 and EP4) responses. We theorized that expression of the components of the COX-PGE2-EP signaling pathway correlates with acute rejection in a porcine model of allogeneic renal transplantation. METHOD: COX-2 enzyme and EP receptor protein expression were quantitated with western blotting and immunohistochemistry from allotransplants (n = 18) and autotransplants (n = 5). Linear regression analysis was used to correlate EP receptor expression with the Banff category of rejection. RESULTS: Pigs with advanced rejection demonstrated significant increases in serum PGE2 metabolites, while pigs with less rejection demonstrated higher tissue concentrations of PGE2 metabolites. A significant negative correlation between COX-2 expression and Banff category of rejection (R = -0.877) was shown. Rejection decreased expression of EP2 and EP4. For both receptors, there was a significant negative correlation with the extent of rejection (R = -0.760 and R = -0.891 for EP2 and EP4, respectively). Rejection had no effect on the proinflammatory receptors EP1 and EP3. CONCLUSION: Downregulation of COX-2 and the anti-inflammatory EP2 and EP4 receptors is associated with acute rejection in unmatched pig kidney transplants, suggesting that the COX-2-PGE2-EP pathway may modulate inflammation in this model. Enhancing EP2 and/or EP4 activity may offer novel therapeutic approaches to controlling the inflammation of acute allograft rejection.

Efficacy, cost effectiveness, and sustainability of a pediatric high risk asthma clinic.

AIM: At our institution, a pediatric High Risk Asthma clinic has been in operation for over 15 years, targeting children with poorly controlled, and difficult to treat asthma. This study evaluates the outcomes and cost-effectiveness of the High Risk Asthma clinic from 2000 through 2014. METHODS: A retrospective chart review was performed on all patients entering High Risk Asthma clinic from 2000-2014, and total hospitalizations and Emergency Department visits were tallied for the year prior to entering clinic and the year after. Costs incurred, and reimbursements obtained from payors were tallied to determine cost-effectiveness and sustainability. RESULTS: Consistent decreases in hospitalizations (51.2% decrease, P < 0.001) and Emergency Department visits (23.0% decrease, P = 0.048) were seen for patients entering High Risk Asthma clinic, with commensurate significant decreases in related costs. Reimbursements received for outpatient services were sufficient to offset operational costs of the High Risk Asthma clinic, when both clinic visit, and pulmonary function testing charges were included. CONCLUSIONS: A pediatric High Risk Asthma clinic model is efficacious in decreasing hospitalizations and Emergency Department visits for a difficult to treat population, and such a model can be cost-effective and sustainable.