Successful Management of Ileorectal Anastomotic Disruption With Off-Label Use of Endoscopic Covered Metallic Stent.

Colorectal surgery poses significant risks, with anastomotic disruption being a severe complication. Traditional management involves surgical intervention, contributing to postoperative morbidity and mortality. In this brief report, we present a 54-year-old woman with a history of diverticulitis, multiple surgeries, and anastomotic leak following ileorectal anastomosis. Attempts at managing anastomotic leaks with more minimally invasive approaches have been successful in esophageal surgery with the use of covered metallic stents. However, this approach has been rarely attempted for the management of colorectal anastomotic leaks. Instead of conventional surgical approaches, we employed an off-label use of an endoscopic covered metallic stent, WallFlex™, to successfully manage the anastomotic disruption. The patient's recovery was uneventful, highlighting the potential role of stents in select cases.

Beyond guesswork: how accurate are surgeons at determining the degree of glenoid bone loss in instability surgery?

Background: Accurate measurement of glenoid bone loss (GBL) is critical to preoperative planning in cases of recurrent shoulder instability. The concept of critical bone loss has been established with a value of GBL >13.5% being associated with higher failure rate following arthroscopic Bankart Repair. Advanced imaging, such as magnetic resonance imaging (MRI) scans, can be used to quantify GBL prior to surgery using the best-fit circle technique. Surgeons have traditionally relied on visual inspection of the MRI scan preoperatively or on visual inspection of the glenoid at the time of arthroscopy to determine whether GBL is present. The purpose of this study is to determine if 3 fellowship-trained shoulder surgeons could adequately quantify GBL without using best-fit circle measurements on MRI. Methods: A retrospective review was performed which included 122 patients over an 8-year period that had an arthroscopic Bankart repair performed by 3 fellowship-trained surgeons. In all patients, preoperative MRI scans were retrospectively measured using best-fit circle technique to determine true GBL and compare that to the surgeons' preoperative and intraoperative estimation of GBL. Results: GBL was correctly identified in only 36% (18/50) of patients when the preoperative best-fit circle measurements were not made. Critical bone loss was missed in 9.8% (12/122) of patients in the study group. The estimated mean bone loss in that group by visual inspection was 11.3% compared to 16% true bone loss measured on MRI. Even in the 18 patients with some identified bone loss prior to surgery, critical bone loss was missed in 6 patients when using visual inspection of the MRI or intraoperative inspection alone. Conclusion: Simple visual inspection of glenoid images on MRI scan and visual inspection of the glenoid at the time of surgery are inaccurate in determining the true extent of GBL especially in cases of subtle bone deficiency. Preoperative planning is dependent on the exact degree of bone deficiency and measurement on the MRI scan using the best-fit circle technique is recommended in all cases of instability surgery.

A new North American species of Etainia (Lepidoptera, Nepticulidae), feeding on Arbutus and Arctostaphylos species (Ericaceae).

Etainiathoraceleuca van Nieukerken, Epstein & Davis, sp. nov. is the second native American species of Etainia Beirne, 1945, and the second known Etainia species feeding on Ericaceae. The species is known from light-collected adults in the USA (California, Arizona) and Canada (Ontario). These were linked via DNA barcodes to larvae that make short leafmines on Arbutus and Arctostaphylos species, then continue feeding in stems and branches, causing damage in nurseries and planted trees in Sonoma and Marin Counties, California. The holotype was accidentally reared from Arbutusarizonica, without observing the damage. Life history and damage are described in detail. Damage in Arctostaphylosuva-ursi found in Washington State probably belongs to E.thoraceleuca, which is a sister species to the European E.albibimaculella (Larsen, 1927).

First report of Puccinia recondita rust on native jewelweed (Impatiens capensis) in Pennsylvania.

Jewelweed (Impatiens spp., Balsaminaceae) is a common native annual plant within Pennsylvania wetland ecosystems, many of which are under threat from invasive non-native plants, and is an important wetland indicator plant (code FACW; facultative wetland). In May 2014, rust disease symptoms on native jewelweed (Impatiens capensis Meerb.) were observed within a small (0.1 ha) wet area in York County, southeastern Pennsylvania (39.9080648oN, -77.2472024oW). Rust symptoms were noted on most jewelweed plants within the wet area. Foliar symptoms included chlorosis and premature defoliation; infected stems were distorted. Infected leaves and stems contained orange, erumpent aecia with white fragmented peridia (Fig. 1). Symptomatic leaves and stem sections were collected from five infected plants within one small (5 X 5 m) plot in the center of the wet area and taken to the laboratory for microscopic observations and morphological measurements. Mean aecia diameter was 299.2 ± 55.0 µm (n = 60). Aeciospores were single-celled, orange, and generally globose (Fig. 2) with a mean diameter of 24.4 ± 1.4 µm, (n = 60). Disease symptomology and aecia morphology were consistent with Puccinia recondita Dietel & Holw. DNA extraction (from infected stem material), polymerase chain reactions, and DNA sequencing of the 28S region of the nuclear ribosomal DNA repeat was conducted following protocols in Aime (2006) and Aime et al. (2018). The sequence shares 99.34% identity (903 / 909 bp) with P. recondita (BPI 910319) collected in California (KY798399). A voucher specimen has been deposited in the Arthur Fungarium at Purdue University (PUR N24229) with corresponding 28S sequence (GenBank accession OR648406). P. recondita has been reported on native I. capensis in Indiana (Koslow and Clay 2010) and North Carolina (Grand 1985), but not in Pennsylvania to the best of our knowledge (Farr and Rossman 2022). If this rust disease becomes severe on native jewelweeds in Pennsylvania, it may adversely affect our ability to accurately classify native wetlands in the state. In addition, P. recondita is a heteroecious rust that is a major pathogen of grain crops of economic importance (i.e., wheat, barley, oats), which are grown in southeastern Pennsylvania near the infested area. Further research is warranted to understand if native, annual jewelweed can serve as a secondary or alternate host to cause rust disease in major cereal crops.

Envisioning Better Healthcare Systems: A Unique and Innovative Journey From Community Hospital to Academic Medical Center.

The transformation from a community hospital to an academic medical center (AMC) presents a unique set of challenges and opportunities. This editorial provides an in-depth analysis of the barriers encountered and solutions developed within a large community hospital in Florida as it embarked on this transition, with a focus on the global relevance of issues experienced such as competition with major markets, the ongoing COVID-19 pandemic, the development of multiple Accreditation Council for Graduate Medical Education (ACGME) programs and balancing the complexities of the United States healthcare system. In alignment with the call for submissions, this editorial highlights the personal experiences of healthcare providers, researchers, and policymakers involved in this transition and explores how the lessons learned can inform the development of better healthcare systems worldwide.

Endometrioma Within the Anterior Abdominal Wall Causing Cyclic Abdominal Pain.

Lesions from endometriosis contain endometrial glands and stroma outside the uterine cavity. The lesions occur in the pelvis but are also found in the bowel, diaphragm, and pleural cavity. Endometriosis within the extraperitoneal abdominal wall is rare, though, and usually within c-section scars (incidence is .03%-.5%). The typical triad includes: mass in the abdominal wall, cyclical pain, and history of previous abdominal surgery. We present the case of a 28-year-old female with a past history of cesarean section and obesity (BMI = 31) who presented with approximately 3 years of abdominal pain which was "waxing and waning" in severity depending on her menstrual cycle. Multiple doctors and US imaging did not reveal a diagnosis. During consultation, she had a palpable 3 cm mass several centimeters above and right of her abdominal incision. She underwent a CT showing an inflamed subcutaneous mass abutting her anterior rectus sheath. She underwent wide excision which confirmed the diagnosis of endometrioma. This case demonstrates the need for good history and physical exam skills, as well as proficiency in reviewing radiographic imaging. Due to habitus and pain, the physical exam was difficult. However, there was a firm mass upon deep palpation. Her initial imaging was "negative," but review of the images revealed only intraperitoneal views and further imaging revealed the mass. There must be high clinical suspicion for this disease because failure to remove all tissue (including the surrounding fibrosis and desmoplastic tissue) or biopsy can lead to spread of residual endometrial cells and recurrence.

First Report of Puccinia lagenophorae on Senecio vulgaris in Pennsylvania.

Common groundsel (Senecio vulgaris L.), is an aster native to Eurasia and is now a common weed in gardens, roadsides and vacant lots worldwide. In 2001, Scholler and Toike were first to report that common groundsel was a host for the rust fungus Puccinia lagenophorae Cooke in North America (Scholler and Toike 2001). This report from California was followed by reports of P. lagenophorae infections on common groundsel in New York, Oklahoma, and Oregon (Little-field et al. 2005). In 2007, Bruckart et al. published the first report of this host-pathogen combi-nation in Canada (Bruckart et al. 2007). To our knowledge, there are no published reports of P. lagenophorae on common groundsel in Pennsylvania (Farr and Rossman 2022). In May 2022, symptomatic common groundsel plants were observed in Biglerville, Adams Co., southern Penn-sylvania (N 39.9268047, E 77.2473878). Host plants exhibited conspicuous aecia on deformed stems (Fig. 1). Disease symptomology and morphology were consistent with P. langenophorae (Scholler and Toike 2001). P. lagenophorae is an autoecious rust that forms aecia and telia, but only aecia are typically formed on Senecio spp.; telia were not noted during our observations. Aecia were orange, cup-shaped, bordered by fragmented recurved peridia (Fig. 1), and they had mean diameters 262.9 ± 20.9 X 175.2 ± 22.2 µm (n = 20). Aeciospores were orange, oval, with mean diameters of 16.5 ± 0.97 X 11.5 ± 1.08 µm (n = 20). Fungal DNA was extracted from symptomatic stems. Polymerase chain reaction and sequencing of the 28S region of the nuclear ribosomal DNA repeat were conducted with primers Rust2inv and LR6 following protocols in Aime (2006). The sequence shared 100% identity (909 / 909 bp) with 8 sequences of P. la-genphorae in GenBank, including one on Ozothamnus cordatus from Perth, Western Australia, Australia (KF690699), vouchered in the Queensland Plant Pathology Herbarium (BRIP 57770), Brisbane, Queensland, Australia. A voucher specimen has been preserved in the Arthur Fungari-um at Purdue University (PUR N24039) with corresponding 28S sequence (GenBank accession OP718536).

Growth Performance, Survival, Blood Chemistry, and Immune Gene Expression of Channel Catfish (Ictalurus punctatus) Fed Probiotic-Supplemented Diets.

The channel catfish (Ictalurus punctatus) farming industry is the largest and one of the oldest aquaculture industries in the United States. Despite being an established industry, production issues stemming from disease outbreaks remain problematic for producers. Supplementing fish diets with probiotics to enhance the immune system and growth potential is one approach to mitigating disease. Although considerable laboratory data demonstrate efficacy, these results do not always translate to natural modes of disease transmission. Hence, the present work was conducted in the laboratory but incorporated flow-through water from large catfish pond production systems, allowing for natural exposure to pathogens. Two feeding trials were conducted in an 18-tank aquaria system housing two different sizes, 34.8 ± 12.5 g and 0.36 ± 0.03 g, of channel catfish. Channel catfish in the first trial were fed three experimental diets over six weeks. Commercial diets were top-coated with two selected spore-forming Bacillus spp. probiotics, Bacillus velezensis AP193 (1 × 106 CFU g−1) and BiOWiSH (3.6 × 104 CFU g−1), or a basal diet that contained no dietary additive. In the second eight-week trial, diets were top-coated with BiOWiSH at three concentrations (1.8, 3.6, and 7.3 × 104 CFU g−1), along with one basal diet (no probiotic). At the completion of these studies, growth performance, survival, hematocrit, blood chemistry, and immune expression of interleukin 1ß (il1ß), tumor necrosis factor-alpha (tnf-α), interleukin-8 (il8), transforming-growth factor ß1 (tgf-ß1), and toll-like receptor 9 (tlr9) were evaluated using qPCR. Trial results revealed no differences (p > 0.05) among treatments concerning growth, survival, or hematological parameters. For immune gene expression, interesting trends were discerned, with substantial downregulation observed in B. velezensis AP193-fed fish for il1ß, tnf-α, and tlr9 expression within splenic tissue, compared to that of the basal and BiOWiSH diets (p < 0.05). However, the results were not statistically significant for anterior kidney tissue in the first trial. In the second trial, varied levels of probiotic inclusion revealed no significant impact of BiOWiSH's products on the expression of il1ß, tnf-α, il8, and tgf-ß1 in both spleen and kidney tissue at any rate of probiotic inclusion (p > 0.05). Based on these findings, more research on utilizing probiotics in flow-through systems with natural infection conditions is crucial to ensure consistency from a controlled laboratory scale to real-world practices.

Phragmidium rosae-multiflorae on Rosa multiflora reported from Pennsylvania, USA.

Rosa multiflora Thunb. is a perennial shrub native to eastern Asia. It is commonly found on habitat margins, such as forest edges, streams, and roadsides (CABI n.d.). Due to its aromatic flowers, its usefulness in erosion control, and as a living livestock fence, R. multiflora was introduced to North America as an ornamental in the early 1800's (Hindal and Wong 1988). However, R. multifora, grows rapidly and frequently outcompetes native species, and is therefore considered invasive in North America (Hindal and Wong 1988). In May 2020 Phragmidium rosae-multiflorae Dietel, or rose rust, was collected from R. multiflora in Patton Woods Park, a small residential park in Patton Township, Centre Co., PA, USA (40° 47' 28.40" N; 77° 55' 33.37" W). P. rosae-multiflorae is an autoecious macrocyclic rust fungus known to occur on R. multiflora in the plant's native range. To our knowledge, there are no previously published records of P. rosae-multiflorae in North America. The host exhibited conspicuous aecia on the stems and petioles. Aecia were caeoma form, orange, irregular, erumpant, and pulverulent. Aeciospores were one-celled, verrucose, hyaline to pale yellow, variable in shape, ranging from ellipsoidal to globose (Fig.1), measuring 22.5 ± 3 × 15.5 ± 5 µm (n = 30). Disease symptomology and aecia are consistent with P. rosae-multiflorae Dietel (Wei 1988; Liu et. al 2020). Fungal DNA was extracted from infected petioles. Polymerase chain reaction and sequencing of the 28S region of the nuclear ribosomal DNA repeat was conducted with primers Rust2inv and LR6 following protocols in Aime (2006). The sequence shares 98.77% identity (900 / 487 bp) with P. Rosae-multiflorae from China (MN264739). A voucher specimen has been preserved in the Arthur Fungarium at Purdue University (PUR N23123) with corresponding 28S sequence (GenBank accession #MZ323415). The recorded occurrence of P. rosae-multiflorae on R. multiflora in North America is significant, given the ecological impact of the host plant as an invasive species and need for biocontrol. While no formally published records of this fungus in North America exist, there are putative occurrences across the northeastern United States reported on Global Biodiversity Information Facility (GBIF) and the Maryland Biodiversity Project websites.

Phylogeny of gracillariid leaf-mining moths: evolution of larval behaviour inferred from phylogenomic and Sanger data.

Gracillariidae is the most taxonomically diverse cosmopolitan leaf-mining moth family, consisting of nearly 2000 named species in 105 described genera, classified into eight extant subfamilies. The majority of gracillariid species are internal plant feeders as larvae, creating mines and galls in plant tissue. Despite their diversity and ecological adaptations, their phylogenetic relationships, especially among subfamilies, remain uncertain. Genomic data (83 taxa, 589 loci) were integrated with Sanger data (130 taxa, 22 loci), to reconstruct a phylogeny of Gracillariidae. Based on analyses of both datasets combined and analyzed separately, monophyly of Gracillariidae and all its subfamilies, monophyly of the clade "LAMPO" (subfamilies: Lithocolletinae, Acrocercopinae, Marmarinae, Phyllocnistinae, and Oecophyllembiinae) and relationships of its subclade "AMO" (subfamilies: Acrocercopinae, Marmarinae, and Oecophyllembiinae) were strongly supported. A sister-group relationship of Ornixolinae to the remainder of the family, and a monophyletic leaf roller lineage (Callicercops Vári + Parornichinae) + Gracillariinae, as sister to the "LAMPO" clade were supported by the most likely tree. Dating analyses indicate a mid-Cretaceous (105.3 Ma) origin of the family, followed by a rapid diversification into the nine subfamilies predating the Cretaceous-Palaeogene extinction. We hypothesize that advanced larval behaviours, such as making keeled or tentiform blotch mines, rolling leaves and galling, allowed gracillariids to better avoid larval parasitoids allowing them to further diversify. Finally, we stabilize the classification by formally re-establishing the subfamily ranks of Marmarinae stat.rev., Oecophyllembiinae stat.rev. and Parornichinae stat.rev., and erect a new subfamily, Callicercopinae Li, Ohshima and Kawahara to accommodate the enigmatic genus Callicercops.

Predicting neurosurgical clearance in the polytrauma patient with concomitant traumatic brain injury.

The goal of this study is to develop a model based on previously used prognostic predictors in traumatic brain injury (TBI) patients with polytrauma, which will facilitate the decision-making of whether to clear these patients for non-cranial surgery. Data of eligible patients was obtained from a trauma database at a Level I trauma and academic tertiary referral center in the United States. The number of days seen by the neurosurgical service prior to clearance, injury severity score (ISS), post-trauma day 0 (PTD 0) of Glasgow Coma Score (GCS), intracranial pressure (ICP) score and computed tomography (CT) score, as well as the changes in GCS, ICP score and CT score between PTD 0 and day of clearance were the variables used in developing the model. The Neurosurgical Clearance Model (NCM) was developed using data from 50 patients included in the study. Patients were cleared by neurosurgeons 1.6 days later than it would appear possible based on a retrospective review of the patients' clinical conditions. A single model equation was developed, the ultimate result of which is a clearance probability value. The best cutoff clearance probability value was found to be 0.584 (or 58.4%) using Receiver Operator Characteristic curve analysis. Our data suggests that neurosurgeons are risk-averse in clearing polytrauma patients for non-cranial surgery. This pilot NCM, if reproduced and validated by other groups and in larger prospective studies, may become a useful tool to assist clinicians in this often-difficult decision-making process.

The dietary risk index system: a tool to track pesticide dietary risks.

BACKGROUND: For years the United States Department of Agriculture's Pesticide Data Program and the United Kingdom's Food Standards Agency have published annual or quarterly data on pesticide residues in foods. Both programs report residues in conventionally grown, organic, and imported foods. The US program has tested about 288,000 food samples since 1992, primarily fruits and vegetables consumed by children. Since 1999 the UK has tested about 72,000 samples of a wider range of foods. These data are vital inputs in tracking trends in pesticide dietary risks. METHODS: The Dietary Risk Index (DRI) system facilitates detailed analyses of US and UK pesticide residue data, trends, and chronic risk distributions. The DRI value for a pesticide is the dietary intake of that pesticide from a single serving of food divided by the pesticide's acceptable daily intake as set by the US Environmental Protection Agency. It can be calculated based on average annual residue concentrations, and on residue levels in individual samples of food. DRI values can be aggregated over multiple pesticides in single foods, and over individual pesticides in multiple foods. RESULTS: The DRI system provides insights into the levels, trends, and distribution of pesticide dietary risk across most widely consumed foods. By drawing on both US Pesticide Data Program and UK-Food Standards Agency residue data, the DRI is capable of assessing pesticide risks in a significant portion of the global food supply. Substantial reductions in pesticide dietary risks occurred in the early 2000s, primarily from replacement of organophosphate insecticides with seemingly lower-risk neonicotinoids. However, there remain several areas of concern and opportunities to reduce risks. Both herbicide and fungicide dietary risks are rising. Organically grown produce poses risks far lower than corresponding, conventionally grown produce. Risk differences are inconsistent between domestic and imported foods. CONCLUSIONS: The surest ways to markedly reduce pesticide dietary risks are to shift relatively high-risk fruits and vegetables to organic production. For other foods, reducing reliance on pesticides overall, and especially high-risk pesticides, will incrementally lower risks. The DRI system can help focus such efforts and track progress in reducing pesticide dietary risk.

Wrong side of the leaf: assigning some Lithocolletinae species (Lepidoptera: Gracillariidae) to their proper genera.

Cameraria Chapman and Phyllonorycter Hübner (Gracillariidae: Lithocolletinae) are two speciose genera of leaf-mining moths that were once treated as belonging to a single genus, Lithocolletis Hübner. Typically, species of Cameraria form flat mines on the upper leaf surface, whereas most Phyllonorycter species form underside tentiform mines. We reviewed North American literature records and found 15 exceptions to this generalization, with two Cameraria species reported to form underside mines and 13 Phyllonorycter species reported to form upper-surface mines. For each of these species we summarize the published data on larval biology, hostplants, and distribution, which we supplement with internet records and our own observations. Both purported Cameraria species making underside mines were misplaced in this genus by Davis (1983); we affirm the combinations Phyllonorycter affinis (Frey Boll) and P. leucothorax (Walsingham), each of which has been published once before but not formally proposed as a new combination, and thus has been ignored by subsequent authors. We have further determined P. affinis to be a junior synonym of P. mariaeella (Chambers). Three of the purported Phyllonorycter species making upper-surface mines were similarly misplaced. One of these, Anarsioses aberrans (Braun), has recently been transferred to a new genus, and we propose the new combinations Cameraria arizonella (Braun) and C. cretaceella (Braun) for the other two. Genitalia and forewing patterns are illustrated for all species whose generic placement is corrected in this paper.

A simple method for rapid calibration of faraday and ion-counting detectors on movable multicollector mass spectrometers.

Methods are presented for rapid determination of relative efficiencies of Faraday cups in a multicollector array with movable cups and of Daly or electron multiplier detector dead time and gain values. The Faraday calibration approach is based on measuring the same isotopic ratio in two sequences with different collector configurations having one collector in common. Changes in thermal fractionation during the two measurement sequences are monitored using the same two collectors. Since the relative efficiencies are determined by measuring the same ratio in different cups corrected for time-dependent changes in fractionation, it is unnecessary to use a standard of known composition and calculations are simple, not requiring the solution of multiple equations. Determination of dead time and gain values for a Daly detector are shown based on multidynamic measurements of masses 207, 206, and 208 from Pb standard SRM982 in two sequences consisting of L1-Daly-H1 and Daly-H1-H2. This provides two equations that can be solved for Daly dead time and gain. This method uses static measurements and is therefore insensitive to signal instability. It also does not require use of a standard of known isotopic composition. The potential of using known cup efficiencies to help determine absolute isotopic abundances is discussed.

The fall, recovery, classification, and initial characterization of the Hamburg, Michigan H4 chondrite.

The Hamburg meteorite fell on January 16, 2018, near Hamburg, Michigan, after a fireball event widely observed in the U.S. Midwest and in Ontario, Canada. Several fragments fell onto frozen surfaces of lakes and, thanks to weather radar data, were recovered days after the fall. The studied rock fragments show no or little signs of terrestrial weathering. Here, we present the initial results from an international consortium study to describe the fall, characterize the meteorite, and probe the collision history of Hamburg. About 1 kg of recovered meteorites was initially reported. Petrology, mineral chemistry, trace element and organic chemistry, and O and Cr isotopic compositions are characteristic of H4 chondrites. Cosmic ray exposure ages based on cosmogenic 3He, 21Ne, and 38Ar are ~12 Ma, and roughly agree with each other. Noble gas data as well as the cosmogenic 10Be concentration point to a small 40-60 cm diameter meteoroid. An 40Ar-39Ar age of 4532 ± 24 Ma indicates no major impact event occurring later in its evolutionary history, consistent with data of other H4 chondrites. Microanalyses of phosphates with LA-ICPMS give an average Pb-Pb age of 4549 ± 36 Ma. This is in good agreement with the average SIMS Pb-Pb phosphate age of 4535.3 ± 9.5 Ma and U-Pb Concordia age of 4535 ± 10 Ma. The weighted average age of 4541.6 ± 9.5 Ma reflects the metamorphic phosphate crystallization age after parent body formation in the early solar system.

An illustrated catalogue of the Neotropical Gracillariidae (Lepidoptera) with new data on primary types.

Gracillariidae leaf miners include 1987 species of poorly studied micromoths for which the majority of the diversity has been described from temperate regions. The Neotropics harbors one of the richest faunas of Gracillariidae, but the rate of taxon descriptions has been slow because of limited sampling and taxonomic activity. In this illustrated catalogue, we provide, for the first time, 476 high resolution illustrations for the 201 species of named gracillariids occurring in the region and revise their classification, newly considering the family-group names Oecophyllembiini stat. nov., Marmarini stat. nov., and Parornichini stat. nov. as tribes of Phyllocnistinae, in the first two cases and Gracillariinae in the last case respectively. Two species, Sauterina hexameris (Meyrick, 1921) comb. nov. and S. phiaropis (Meyrick, 1921) comb. nov., are transferred to Sauterina from Gracillaria. By making taxonomic, distributional, molecular and biological data available in a concise form, we aim to facilitate taxonomic work on Neotropical gracillariids, and in turn to enhance studies in general on poorly studied organisms such as parasitoids from this biogeographical region.

Should Hypotensive Trauma Patients Ever Be Transferred to a Trauma Center?

Many trauma patients present to nontrauma centers with emergency conditions. The Emergency Medical Treatment and Active Labor Act dictates that nontrauma centers attempt stabilization and provide appropriate transfer. Our goal was to determine whether there was a survival benefit in transferring hypotensive patients. The Tampa General Hospital trauma registry database was queried for adult trauma transfers from January 2012 to April 2018 including the first recorded systolic blood pressure (SBP) and other pertinent data. A manual chart review in hypotensive (SBP < 90) patients determined blood pressure at the time of transfer. Of the 3038 patients, 40 patients were hypotensive on arrival, with 40% (16) mortality. Eight of nine (88%) patients with SBP <70 on arrival, 3 of 11 (27%) with SBP 70 to 79, and 5 of 20 (25%) with SBP 80 to 89 died. The only survivor in the <70 group was normotensive at transport. Patients in these groups who were hypotensive at the time of transport died (4/4, 100%). Our data show no benefit in transferring patients with refractory hypotension at the time of transport; although the numbers are small, an SBP <70 should be considered prohibitive to transfer.

Genome Sequence of a Lethal Vascular Wilt Fungus, Verticillium nonalfalfae, a Biological Control Used Against the Invasive Ailanthus altissima.

Verticillium nonalfalfae, a cosmopolitan soil-borne phytopathogen, causes vascular wilt in agricultural crops and perennial woody plants. Select strains of V. nonalfalfae can cause lethal disease in the invasive tree Ailanthus altissima and several have since been utilized as a biological control (biocontrol) against this widespread invader. Here, we report the genome sequence and annotation of V. nonalfalfae strain VnAa140/NRRL 66861.

Anarsioses, a new generic name for Phyllonorycter aberrans (Braun) (Lepidoptera: Gracillariidae).

Annette Braun (1930) described the leafmining moth Phyllonorycter aberrans in the genus Lithocolletis Hübner, 1825. The species was later transferred to Phyllonorycter by Davis (1983). Recent morphological studies on North American Gracillariidae by the author have shown that P. aberrans requires a new generic placement. Generic distinction was also recognized by the molecular studies of Kawahara et al. (2017: fig. 2). Anarsioses is very similar to Phyllonorycter in general head morphology and wing venation, but differs in the unusual asymmetry of the male genitalia and in larval biology.