A Fatal Case of Isolated Renal Mucormycosis in an Immunocompetent Male.

Mucormycosis (MM) is an angio-invasive fungal infection that often presents in immunocompromised patients. Isolated renal MM is an uncommon presentation that has been documented as a life-threatening condition in immunocompetent patients due to its poor prognosis. Here, we present a rare case of isolated renal MM in a 27-year-old male who presented with left flank pain, nausea, and vomiting. Upon further investigation, a renal infarct was discovered, and he underwent a subsequent nephrectomy. A renal biopsy revealed MM. The patient's infection spread, and he ultimately succumbed to his illness. Isolated renal involvement of this pathogen is extremely rare in healthy individuals and has poor outcomes. The ubiquitous nature of MM increases the risk of exposure to humans. Comorbidities such as coronavirus disease 2019 and immunosuppressive states are risk factors for the deleterious outcomes of MM. It is unusual for an immunocompetent patient with no underlying conditions to die despite early diagnosis and prompt treatment. This example calls attention to the unpredictable clinical presentation of isolated renal MM. Our case highlights MM as a differential diagnosis in patients with unilateral flank pain and identifies the importance of a prompt clinical diagnosis and treatment due to the rapid progression and poor health outcomes associated with MM infection.

Individual and interactive effects of white-tailed deer and an exotic shrub on artificial and natural regeneration in mixed hardwood forests.

Underplanting tree seedlings in areas where natural regeneration is limited may offer a tool by which desired overstory composition can be maintained or restored in forests. However, invasive plant species and ungulate browsing may limit the effectiveness of underplanting, and in-turn, the successful restoration of forest ecosystems. Individually, the invasive shrub Lonicera maackii and browsing by white-tailed deer (Odocoileus virginianus) have been found to negatively affect the regeneration of native tree species in the Midwestern United States, but few studies have examined their interactive or cumulative effects. Using exclosures and shrub removal at five sites, we examined the effects of white-tailed deer and L. maackii both on underplanted seedlings of Castanea dentata and Quercus rubra and on the composition, species richness and diversity of naturally regenerated native tree seedlings. Individually, both deer and L. maackii had negative effects on the survival of underplanted seedlings, but we identified no interactive effects. The presence of L. maackii or deer alone resulted in similar declines in the survivorship of Q. rubra seedlings, but the presence of deer alone resulted in lower survival of C. dentata seedlings than the presence of L. maackii alone. Lonicera maackii reduced light levels, increased seedling moisture stress and decreased relative basal diameter growth for Q. rubra seedlings. Deer reduced the relative growth in height of underplanted C. dentata and Q. rubra seedlings and increased moisture stress of C. dentata seedlings. No effects of L. maackii or deer were found on soil or foliar nitrogen or the overall abundance, species richness and diversity of naturally regenerated seedlings. However, L. maackii and white-tailed deer did affect the abundance of individual tree species, shifting composition of the regeneration layer towards shade tolerant and unpalatable and/or browse tolerant species.

Functional diversity response to hardwood forest management varies across taxa and spatial scales.

Contemporary forest management offers a trade-off between the potential positive effects of habitat heterogeneity on biodiversity, and the potential harm to mature forest communities caused by habitat loss and perforation of the forest canopy. While the response of taxonomic diversity to forest management has received a great deal of scrutiny, the response of functional diversity is largely unexplored. However, functional diversity may represent a more direct link between biodiversity and ecosystem function. To examine how forest management affects diversity at multiple spatial scales, we analyzed a long-term data set that captured changes in taxonomic and functional diversity of moths (Lepidoptera), longhorned beetles (Coleoptera: Cerambycidae), and breeding birds in response to contemporary silvicultural systems in oak-hickory hardwood forests. We used these data sets to address the following questions: how do even- and uneven-aged silvicultural systems affect taxonomic and functional diversity at the scale of managed landscapes compared to the individual harvested and unharvested forest patches that comprise the landscapes, and how do these silvicultural systems affect the functional similarity of assemblages at the scale of managed landscapes and patches? Due to increased heterogeneity within landscapes, we expected even-aged silviculture to increase and uneven-aged silviculture to decrease functional diversity at the landscape level regardless of impacts at the patch level. Functional diversity responses were taxon-specific with respect to the direction of change and time since harvest. Responses were also consistent across patch and landscape levels within each taxon. Moth assemblage species richness, functional richness, and functional divergence were negatively affected by harvesting, with stronger effects resulting from uneven-aged than even-aged management. Longhorned beetle assemblages exhibited a peak in species richness two years after harvesting, while functional diversity metrics did not differ between harvested and unharvested patches and managed landscapes. The species and functional richness of breeding bird assemblages increased in response to harvesting with more persistent effects in uneven- than in even-aged managed landscapes. For moth and bird assemblages, species turnover was driven by species with more extreme trait combinations. Our study highlights the variability of multi-taxon functional diversity in response to forest management across multiple spatial scales.

Combining community resurvey data to advance global change research.

More and more ecologists have started to resurvey communities sampled in earlier decades to determine long-term shifts in community composition and infer the likely drivers of the ecological changes observed. However, to assess the relative importance of, and interactions among, multiple drivers joint analyses of resurvey data from many regions spanning large environmental gradients are needed. In this paper we illustrate how combining resurvey data from multiple regions can increase the likelihood of driver-orthogonality within the design and show that repeatedly surveying across multiple regions provides higher representativeness and comprehensiveness, allowing us to answer more completely a broader range of questions. We provide general guidelines to aid implementation of multi-region resurvey databases. In so doing, we aim to encourage resurvey database development across other community types and biomes to advance global environmental change research.

Spatial patterning and floral synchrony among trillium populations with contrasting histories of herbivory.

We investigated the spatial patterning and floral synchrony within and among populations of a non-clonal, forest understory herb, Trillium catesbaei. Two populations of T. catesbaei within Great Smoky Mountains National Park were monitored for five years: Cades Cove (high deer abundance) and Whiteoak Sink (low deer abundance). All individuals within each population were mapped during year one and five. Only flowering and single-leaf juveniles were mapped during intervening years. Greater distances between flowering plants (plants currently in flower) and substantially lower population densities and smaller patch sizes were observed at Cades Cove versus Whiteoak Sink. However, with the exception of flowering plants, contrasting histories of herbivory did not appear to fundamentally alter the spatial patterning of the T. catesbaei population at Cades Cove, an area with a long and well-documented history of deer overabundance. Regardless of browse history, non-flowering life stages were significantly clustered at all spatial scales examined. Flowering plants were clustered in all years at Whiteoak Sink, but more often randomly distributed at Cades Cove, possibly as a result of their lower abundance. Between years, however, there was a positive spatial association between the locations of flowering plants at both sites. Flowering rate was synchronous between sites, but lagged a year behind favorable spring growing conditions, which likely allowed plants to allocate photosynthate from a favorable year towards flowering the subsequent year. Collectively, our results suggest that chronically high levels of herbivory may be associated with spatial patterning of flowering within populations of a non-clonal plant. They also highlight the persistence of underlying spatial patterns, as evidenced by high levels of spatial clustering among non-flowering individuals, and the pervasive, although muted in a population subjected to chronic herbivory, influence of precipitation and temperature on flowering in long-lived forest herbs.

Accumulation and connectivity of coarse woody debris in partial harvest and unmanaged relict forests.

When a tree dies, it continues to play an important ecological role within forests. Coarse woody debris (CWD), including standing deadwood (SDW) and downed deadwood (DDW), is an important functional component of forest ecosystems, particularly for many dispersal-limited saproxylic taxa and for metapopulation dynamics across landscapes. Processes, such as natural disturbance or management, modify forest composition and structure, thereby influencing CWD abundance and distribution. Many studies have compared older forests to forests managed with even-aged silvicultural systems and observed a prolonged period of low CWD occurrence after harvesting. With fine-scale spatial data, our study compares the long-term impacts of light partial harvesting on the CWD structure of eastern deciduous hardwood forests. We mapped and inventoried DDW and SDW using variable radius plots based on a 10 m × 10 m grid throughout an unmanaged, structurally-complex relict forest and two nearby forests that were partially harvested over 46 years ago. The relict stand had significantly larger individual pieces and higher accumulations of DDW and SDW than both of the partially harvested stands. Connectivity of CWD was much higher in the relict stand, which had fewer, larger patches. Larger pieces and higher proportion of decay-resistant species (e.g. Quercus spp.) in the relict forest resulted in slower decomposition, greater accumulation and increased connectivity of CWD. Partial harvests, such that occur with selection forestry, are generally considered less disruptive of ecosystem services, but this study highlights the long-term impacts of even light partial harvests on CWD stocks and distribution. When planning harvesting events, forest managers should also consider alternative methods to ensure the sustainability of deadwood resources and function.

Microclimate moderates plant responses to macroclimate warming.

Recent global warming is acting across marine, freshwater, and terrestrial ecosystems to favor species adapted to warmer conditions and/or reduce the abundance of cold-adapted organisms (i.e., "thermophilization" of communities). Lack of community responses to increased temperature, however, has also been reported for several taxa and regions, suggesting that "climatic lags" may be frequent. Here we show that microclimatic effects brought about by forest canopy closure can buffer biotic responses to macroclimate warming, thus explaining an apparent climatic lag. Using data from 1,409 vegetation plots in European and North American temperate forests, each surveyed at least twice over an interval of 12-67 y, we document significant thermophilization of ground-layer plant communities. These changes reflect concurrent declines in species adapted to cooler conditions and increases in species adapted to warmer conditions. However, thermophilization, particularly the increase of warm-adapted species, is attenuated in forests whose canopies have become denser, probably reflecting cooler growing-season ground temperatures via increased shading. As standing stocks of trees have increased in many temperate forests in recent decades, local microclimatic effects may commonly be moderating the impacts of macroclimate warming on forest understories. Conversely, increases in harvesting woody biomass--e.g., for bioenergy--may open forest canopies and accelerate thermophilization of temperate forest biodiversity.

Drought-herbivory interaction disrupts competitive displacement of native plants by Microstegium vimineum, 10-year results.

Biological invasions are often exacerbated by disturbance or deviations from historic disturbance regimes. Dense understory layers of invasive exotic plants can alter successional trajectories, resulting in consequences that cascade through the biota. However, it is unclear if such layers are self-sustaining or maintained by chronic disturbances that asymmetrically depress native competitors. We examined the role of white-tailed deer (Odocoileus virginianus Zimm.) herbivory and drought on the permeability of recalcitrant understory layers dominated by the invasive exotic Microstegium vimineum (Trin.) A. Camus in 15 exclosures and 15 control plots from 1997 to 2006. This study was conducted in Cades Cove, Great Smoky Mountains National Park, Tennessee, USA. M. vimineum cover exhibited high inter- and intra-annual variation in both exclosures and controls, but displayed a significant correspondence to drought severity. Native species richness and the abundance of woody plants increased within exclosures, but not controls, following a drought-induced nadir in M. vimineum cover that occurred in 2000. By 2003, all height classes of native tree seedlings were present in exclosures and seedlings were advancing into the sapling layer (>or=50 cm tall). After 10 years, no tree seedling on a control plot had been able to attain and maintain a height >or=20 cm. Our results suggest that chronic herbivory inhibits state transitions that could occur in response to intermittent disturbances, which reduce the abundance of the invader. Consequently, recalcitrance is likely reinforced by chronic herbivory.

The relationship between fire history and an exotic fungal disease in a deciduous forest.

Exotic diseases have fundamentally altered the structure and function of forest ecosystems. Controlling exotic diseases across large expanses of forest has proven difficult, but fire may reduce the levels of diseases that are sensitive to environmental conditions. We examined Cornus florida populations in burned and unburned Quercus-Carya stands to determine if burning prior to anthracnose infection has reduced the impacts of an exotic fungal disease, dogwood anthracnose, caused by Discula destructiva. We hypothesized that fire has altered stand structure and created open conditions less conducive to dogwood anthracnose. We compared C. florida density, C. florida health, and species composition and density among four sampling categories: unburned stands, and stands that had burned once, twice, and 3 times over a 20-year period (late 1960s to late 1980s). Double burn stands contained the greatest density of C. florida stems (770 stems ha(-1)) followed by triple burn stands (233 stems ha(-1)), single burn stands (225 stems ha(-1)) and unburned stands (70 stems ha(-1); P < 0.01). We observed less crown dieback in small C. florida trees (<5 cm diameter at breast height) in burned stands than in unburned stands (P < 0.05). Indicator species analysis showed that burning favored species historically associated with Quercus-Carya forests and excluded species associated with secondary succession following nearly a century of fire suppression. Our results suggest that fire may mitigate the decline of C. florida populations under attack by an exotic pathogen by altering forest structure and composition. Further, our results suggest that the burns we sampled have had an overall restorative effect on forest communities and were within the fire return interval of the historic fire regime. Consequently, prescribed fire may offer a management tool to reduce the impacts of fungal disease in forest ecosystems that developed under historic burning regimes.

Impacts of an exotic disease and vegetation change on foliar calcium cycling in Appalachian forests.

Because of the high calcium content of its foliage, Cornus florida (flowering dogwood) has been described as a calcium "pump" that draws calcium from deeper mineral soil and enriches surface soil horizons. However, over the last two decades an exotic fungal disease (dogwood anthracnose, Discula destructiva) has decimated populations of this once-common understory species. Its loss, combined with forest stand development, could alter intra-stand calcium cycling. We used data from long-term vegetation monitoring plots to examine the ecological role of C. florida in calcium cycling and to identify changes in annual foliar calcium cycling over a 20-year period between two sampling intervals, 1977-1979 (preanthracnose) and 1995-2000 (post-anthracnose). Published equations were used to estimate foliar biomass per species for five forest types: alluvial, typic cove, acid cove, oak-hickory, and oak-pine. Calcium concentrations derived from foliage samples were used to estimate annual foliar calcium production per species for understory woody stems (<20 cm dbh) and total foliar calcium production for overstory stems (> or =20 cm dbh). At a given level of soil calcium availability, C. florida foliage contained greater concentrations of calcium than three other dominant understory species (Tsuga canadensis, Acer rubrum, and Rhododendron maximum). Between 1977-1979 and 1995-2000, the annual calcium contributions of understory woody vegetation declined across all forest types, ranging from 26% in oak-pine stands to 49% in acid coves. Loss of C. florida was responsible for only 13% of this decline in oak-pine stands, but accounted for 96% of the decline in typic coves. In oak-hickory and oak-pine stands, we observed large increases in the foliar biomass of T. canadensis, a species whose calcium-poor foliage increases soil acidity. Increases in overstory foliar biomass and calcium offset understory losses in three forest types (alluvial, typic coves, and oak-pine) but not in oak-hickory and acid cove stands. Overall, calcium cycling in oak-hickory stands was more negatively affected by the loss of C. florida than the other forest types. Oak-hickory forests comprise over a third of the total forest cover in the eastern United States, and decreases in annual calcium cycling could have cascading effects on forest biota.

Mini-laparoscopy-assisted placement of Tenckhoff catheters: an improved technique to facilitate peritoneal dialysis.

BACKGROUND AND PURPOSE: Despite its overall efficacy and patient satisfaction with it, peritoneal dialysis has a history of significant complications, which has contributed to the evolution in the technique from open laparotomy to minimally invasive placement of the catheters. Our goal was twofold: (1) to review our early experience with a technique of mini-laparoscopy-assisted (MLA) placement of dialysis catheters compared with open placement and (2) to demonstrate that urologists are able to provide a satisfactory procedure while concurrently developing and maintaining laparoscopic skills within a residency training program. PATIENTS AND METHODS: The charts of the first 14 consecutive patients who underwent MLA placement of Tenckhoff dialysis catheters by a single surgeon (LCM) from January 1, 2000, through March 31, 2001, were reviewed. Postoperative narcotic analgesia, length of hospital stay, operative times, days until cycling, and rates of leakage, infection, and malfunction necessitating removal of catheters were compared with the corresponding data from 12 consecutive patients who underwent traditional open placement during the same time period. A telephone survey was performed to corroborate and supplement the findings from the chart review. RESULTS: Differences in complications necessitating catheter removal were not significant. The difference in the mean operative times of 41.7 minutes in the MLA group and 55.7 minutes for open placement was statistically significant. Postoperatively, the MLA group used less narcotic analgesia, had shorter hospital stays, and returned earlier to usual activities. The incidence of leakage after catheter placement was greater in the open group, although this difference was not statistically significant. CONCLUSIONS: The MLA technique of dialysis catheter placement appears to have similar or greater efficacy than the open technique. It is a viable teaching procedure, and with reusable 3-mm ports and shorter operative times, it is cost efficient as well.

Laparoscopic excision of a solitary renal cell carcinoma metastasis to the contralateral perirenal adipose tissue.

Metastasis of renal cell carcinoma to the contralateral perirenal fat is a very rare occurrence. We report a case of a synchronous, solitary perirenal metastasis excised laparoscopically 2 years after initial, open radical nephrectomy.

Bilateral hand-assisted laparoscopic nephrectomy for autosomal dominant polycystic kidney disease using a single midline HandPort incision.

OBJECTIVES: To present one of the first known series of bilateral, transperitoneal laparoscopic nephrectomy for autosomal dominant polycystic kidney disease using a hand-assisted technique by way of a single, midline HandPort incision. Synchronous, bilateral nephrectomy for autosomal dominant polycystic kidney disease is an infrequently performed procedure, with only a few reports using laparoscopy. METHODS: We retrospectively reviewed the charts of 4 patients undergoing bilateral hand-assisted laparoscopic nephrectomy for symptomatic autosomal dominant polycystic kidney disease between June 2000 and January 2001. Follow-up consisted of chart review and telephone survey. RESULTS: All 4 patients underwent successful bilateral hand-assisted laparoscopic nephrectomy, with a mean operative time of 286 minutes. This included 1 patient who underwent simultaneous laparoscopic marsupialization of symptomatic hepatic cysts. The average size of the polycystic kidneys removed was 1582 g. Complications included acute tubular necrosis of a renal allograft in 1 patient that resolved spontaneously and retained retroperitoneal cystic fluid that required percutaneous drainage in another patient. All patients did well postoperatively, with complete resolution of their presenting symptoms. Those with renal allografts had stable function at the last follow-up visit. CONCLUSIONS: Bilateral hand-assisted laparoscopic nephrectomy using a single HandPort incision is a feasible alternative for the removal of symptomatic polycystic kidneys. It offers the advantage of easier identification and control of hilar structures that are often obscured by the distorted renal anatomy. In addition, it allows the simultaneous performance of other intra-abdominal procedures.