Multiplex Polymerase Chain Reaction Reveals Unique Trends in Pathogen and Parasitoid Infestations of Alfalfa Leafcutting Brood Cells.

The alfalfa leafcutting bee Megachile rotundata Fabricius (HYMENOPTERA: Megachilidae) is an important pollinator for multiple agricultural seed commodities in the United States. M. rotundata is a solitary cavity nesting bee that forms brood nests where its larvae can develop. During the developmental stages of growth, brood can be preyed upon by multiple different fungal pathogens and insect predators and parasitoids, resulting in the loss of the developing larvae. Larval loss is a major concern for alfalfa (Medicago sativa L.) seed producers because they rely on pollination services provided by M. rotundata. Reduced pollination rates result in lower yields and increased production costs. In the present study, we examined the taxonomic composition of organisms found within M. rotundata brood cells using a multiplex PCR assay which was developed for the detection of bacterial, fungal, and invertebrate pests and pathogens of M. rotundata larvae. Known pests of M. rotundata were detected, including members of the fungal genus Ascosphaera, the causative agent of chalkbrood. The presence of multiple Ascosphaera species in a single brood cell was observed, with potential implications for chalkbrood disease management. The multiplex assay also identified DNA from more than 2,400 total species, including multiple predators and pathogenetic species not previously documented in association with M. rotundata brood cells.

A mixed methods study of emotional exhaustion: Energizing and depleting work within an innovative healthcare team.

This mixed methods study documents emotional exhaustion experiences among care team members during the development of an innovative team approach for caring for adults with serious illness. A mixed methods study design was employed to examine depleting work experiences that may produce emotional exhaustion, and energizing aspects of the work that may increase meaningfulness of work, thus reducing emotional exhaustion. The population studied included team members involved in care for adults with serious illness (n = 18). Team members were surveyed quarterly over an 18-month period using the Maslach Burnout Inventory (MBI). The MBI measures burnout, defined as the inability to continue work because of the interactional toll of the work. Analyses of MBI data show that although overall levels of burnout are low, 89% of team members reported moderate/high levels of emotional exhaustion during at least one survey period. In order to understand the kinds of work experiences that may produce or ameliorate emotional exhaustion, qualitative interviews were also conducted with team members at the end of the 18-month period. Major qualitative findings indicate that disputes within the team, environmental pressures, and standardisation of meaningful work leave team members feeling depleted. Having authentic relationships with patients, working as a team, believing in the care model, and practicing autonomy and creativity help team members to restore their emotional energy. Supports for team members' well-being are critical for continued innovation. We conclude with recommendations for improving team members' well-being.

Using targeted sequencing and TaqMan approaches to detect acaricide (bifenthrin, bifenazate, and etoxazole) resistance associated SNPs in Tetranychus urticae collected from peppermint fields and hop yards.

Tetranychus urticae (Koch) is an economically important pest of many agricultural commodities world-wide. Multiple acaricides, including bifenazate, bifenthrin, and extoxazole, are currently registered to control T. urticae. However, populations of T. urticae in many different growing regions have developed acaricide resistance through multiple mechanisms. Within T. urticae, single nucleotide polymorphisms (SNPs) have been documented in different genes which are associated with acaricide resistance phenotypes. The detection of these mutations through TaqMan qPCR has been suggested as a practical, quick, and reliable tool to inform agricultural producers of acaricide resistance phenotypes present within their fields and have potential utility for making appropriate acaricide application and integrated pest management decisions. Within this investigation we examined the use of a TaqMan qPCR-based approach to determine genotypes which have been previously associated with acaricide resistance in field-collected populations of T. urticae from peppermint fields and hop yards in the Pacific Northwest of the United States and confirmed the results with a multiplex targeted sequencing. The results suggest that a TaqMan qPCR approach accurately genotypes T. urticae populations for SNPs that have been linked to Bifenazate, Bifenthrin, and Etoxazole resistance. The results also demonstrated that different populations of mites in Washington and Idaho displayed varying frequencies of the examined SNPs. While we were able to detect the SNPs associated with the examined acaricides, the mutation G126S was not an appropriate or accurate indicator for bifenazate resistance.

Sine Qua Non: Oncocytoma.

Oncocytomas of the salivary gland are uncommon neoplasms that are characterized by polygonal cells with abundant granular eosinophilic cytoplasm and relatively uniform nuclei. They are benign in nature and have a low recurrence rate with complete surgical excision. Though uncommon, oncocytic and clear cell variants of malignant tumors may histologically mimic oncocytomas and identification of their distinguishing features is essential. A classic example of an oncocytoma is discussed.

Examining Historical Rates of Leafcutting Bee Brood Cell Pathogens, Parasitoids, and Predators to Establish Baseline Infectivity Rates for Alfalfa Seed Growers.

The alfalfa leafcutting bee Megachile rotundata (Fabricius) (Hymenoptera: Megachilidae) is the primary pollinator for the alfalfa seed industry. It is a solitary cavity nesting bee that utilizes leaf lined brood cells provisioned with pollen for larval development and pupation into the adult stage. During development, multiple pathogens, parasitoids, and predators can prey upon or use the larvae as a host, resulting in the loss of the future adult bee. As such, the presence of invertebrate pests and fungal pathogens presents a major concern for commercial alfalfa seed growers. In the present study, we used historic data from the Parma Cocoon Diagnostic Laboratory to determine baseline rates of pathogens, parasitoids, and predators of Megachile rotundata brood cells and used this analysis to determine cutoffs for management practices to inform growers when the purchase of new bee stocks should be considered. Additionally, we compared the presence of chalkbrood, predators, and parasitoids in samples collected from both grower-produced stocks and newly purchased Canadian bees. The results of the investigation provide historic averages of the presence of chalkbrood, predators, and parasitoids, show a significant increase in chalkbrood and predators in 2007-2011, and find a significant difference in rates of chalkbrood and predators between samples from Canadian suppliers and grower stocks. We speculate that these differences may have resulted from economic conditions that increased the cost of Canadian Megachile rotundata cells and likely resulted in increased reliance on 2nd-year U.S. grower stocks and subsequently increased infection rates during this time period.

Sine Qua Non: Dentigerous Cyst.

Dentigerous cysts, also known as follicular cysts, are among the most common developmental cysts of the gnathic bones. The majority of cases are clinically asymptomatic and discovered incidentally on panographic radiographs during routine dental care. The cyst appears as a radiolucency, classically unilocular, associated with the crown of an unerupted or impacted tooth. Usually diagnosed in the 2nd-3rd decade, third molars of the mandible are the most commonly affected teeth. Histologically, dentigerous cysts demonstrate a fibrous or fibromyxoid connective tissue wall lined by squamous epithelium, classically lacking rete ridges. Inflammation may introduce histologic changes, however. The differential diagnosis includes hyperplastic dental follicle, periapical or radicular cyst, unicystic ameloblastoma, odontogenic keratocyst, and other odontogenic cysts and tumors. While the findings are generally classic and pose no diagnostic dilemma, the diagnosis is best made in the context of the appropriate clinical and radiographic setting. Submitted tissue with a lack of history, to include a detailed relationship with the affected tooth, may result in misdiagnosis and subsequent confusion for the clinician. So, despite its simple features, dentigerous cysts are not uncommonly mischaracterized. Therefore a review of a classic case of dentigerous cyst is presented.

Sine Qua Non: Sinonasal Inverted Papilloma.

Inverted papilloma (IP) is a common proliferation of squamous epithelial cells of the sinonasal tract. Although considered benign, IP is known to cause local destruction, has a high rate of recurrence, and a low, but significant rate of malignant transformation. Differentiating an IP from its histologic mimickers is essential for appropriate risk stratification and long-term surveillance. A classic case of sinonasal inverted papilloma is discussed.

Carcinoma Ex-Pleomorphic Adenoma Diagnosis During Global Health Engagement Operations.

INTRODUCTION: In global health engagement settings, performance of oncologic surgery is evaluated by understanding the host nation healthcare capacity to include inpatient care support and the available postoperative adjunctive therapy to include chemotherapy and radiation therapy. MATERIALS AND METHODS: We present a case during Pacific Partnership 2018 of a patientwith a malignant facial mass diagnosed postoperatively. A literature review was conducted, searching specifically for cases related to pleomorphic adenoma (PA), carcinoma ex-PA, cases of misdiagnosis, and global health engagement operations. RESULTS: The patient presented without constitutional symptoms, clinical lymphadenopathy, or cranial nerve VII weakness with a preoperative host nation diagnosis of a benign salivary neoplasm (PA). Postoperatively, a gross total resection of the mass was diagnosed as high-grade adenocarcinoma-a carcinoma ex-PA of the parotid gland. Oncologic staging was noted to be advanced at T3N0, and the patient was referred back to the host nation surgeons for radiation oncology consultation and clinical surveillance to follow. DISCUSSION: Diagnosis of carcinoma ex-PA-a rare form of salivary gland malignancy-is not always straightforward because of its high degree of cellular heterogeneity, leading to inconsistencies in preoperative sampling results. This case addresses the preoperative diagnostic challenges associated with this type of malignancy, different types of possible treatment modalities aimed at reducing postoperative morbidity, and the preoperative and postoperative challenges that are critical to address during health engagement operations.

Reticular Oral Lichen Planus.

Reticular oral lichen planus is a common clinical finding, often found incidentally on routine oral examination. Patients rarely complain of symptoms and the condition does not require treatment, as a result, biopsies and ancillary laboratory evaluation are seldom performed. We present a case of reticular oral lichen planus with a classic clinical presentation and characteristic histologic findings.

Laryngeal Contact Ulcer.

A 47-year-old man presented to the otolaryngology service with complaint of 6 months of intermittent globus sensation. He reported constant throat clearing and subjective lowering of his voice. Flexible nasolaryngoscopy revealed a large pedunculated mass originating from the left vocal process of the arytenoid, lying superior to the vocal fold. The patient was treated conservatively with an anti-reflux regiment and speech language therapy for 2 months, however he noted marginal worsening in voice over the proceeding interval with an increasing raspy quality. He underwent suspension microlaryngoscopy with biopsy. Microscopic examination demonstrated mucosal epithelium with surface ulceration and considerable fibrinoid necrosis, a mixed inflammatory infiltrate, and abundant granulation tissue with reactive endothelial cells. The diagnosis of laryngeal contact ulcer was rendered. The patient was treated with KTP (potassium titanyl phosphate) laser ablation and corticosteroid microinjection; he tolerated the procedures well and on follow-up noted reduced cough, improving voice quality and no residual dysphagia.

Lymphangioma of the Dorsal Tongue.

Lymphangiomas are rare, congenital malformations of the lymphatic system which have a marked predilection for the head and neck. In this region, they most commonly occur on the dorsum of the tongue, followed by the lips, buccal mucosa, soft palate, and floor of the mouth. Lymphangiomas of the tongue are commonly present at birth; however, they may go unnoticed until after eruption of the dentition or even puberty. They may present as a defined mass or as macroglossia with impaired speech, difficulty in mastication, and, in extreme cases, airway obstruction. Clinically, lymphagiomas of the tongue are characterized by clusters of pebbly, vesicle-like nodules. A benign proliferation of lymphatic vessels is identified histologically. A classic case of a lymphangioma of the dorsal tongue is presented.

Benign Fibro-Osseous Lesions of the Head and Neck.

Benign fibro-osseous lesions (BFOLs) are a particularly challenging set of diagnoses for the pathologist. This diverse collection of diseases includes fibrous dysplasia, ossifying fibroma and cemento-osseous dysplasia. While all three conditions have similar microscopic presentations, their treatment and prognosis differ, demanding an accurate and definitive diagnosis. A practical and systematic approach considering the patient's history, demographics, intraoperative presentation, and gross appearance with an emphasis on radiology and histology will be discussed.

Squamous Cell Papillomatosis in the Setting of Recurrent Respiratory Papillomatosis.

A 23 year old male presented to the Otolaryngology clinic with 6 months of hoarseness and poor voice projection without improvement from speech therapy or medical anti-reflux medication. Upon examination he was found to have multiple polypoid lesions emanating from bilateral false vocal folds, left true vocal fold, and the anterior commissure. Biopsy and potassium titanyl phosphate (KTP) laser ablation with bevacizumab injection provided treatment and confirmed the clinical suspicion of squamous cell papilloma. Despite 3 years of treatment, the papillomatosis proved difficult to control, requiring a procedure approximately every 3 months. In an attempt to control the course of the disease the patient received a series of three bevacizumab and three cidofovir injections. Serial biopsies showed mild atypia within the squamous cell papillomas. Two separate biopsies confirmed presence of human papillomavirus (HPV) 6/11 via in situ hybridization with appropriate controls. There is promising research that the quadrivalent HPV (types 6, 11, 16, and 18) vaccine both reduces the disease burden in patients with active disease and reduces the incidence of recurrent respiratory papillomatosis (RRP). Other studies have shown that local immunologic dysregulation may play a role in RRP pathogenesis. Therefore new treatment options, to include PDL-1 blockade, offer hope in treating this benign condition with high morbidity and rare mortality.

Oral Histoplasmosis.

A 44-year-old female presented to her general dentist with the chief complaint of a painful mouth sore of 2 weeks duration. Clinical examination revealed an irregularly shaped ulcer of the buccal and lingual attached gingiva of the anterior mandible. A biopsy was performed and microscopic evaluation revealed histoplasmosis. Histoplasmosis, caused by Histoplasma capsulate, is the most common fungal infection in the United States. Oral lesions of histoplasmosis are generally associated with the disseminated form of histoplasmosis and may present as a fungating or ulcerative lesion of the oral mucosa. The histologic findings and differential diagnosis for oral histoplasmosis are discussed.

Embryonal Rhabdomyosarcoma of the Oral Cavity.

A 19 year old female presents to the emergency room with right facial enlargement. Clinical examination revealed a soft tissue mass of the right buccal mucosa. Treated initially as infection, the patient later turned to clinic with now rapidly enlarging and intermittently painful mass. Computed tomography with contrast showed a low attenuated buccal mass with mild enhancement lateral to the right caudal maxilla and superior mandible. Biopsy was performed and microscopic examination showed cells with moderate pleomorphism with numerous atypical mitotic figures and occasional elongated "strap" cells with eccentric nuclei. Fluorescence in situ hybridization analysis revealed no rearrangement of the FKHR gene. The diagnosis of embryonal rhabdomyosarcoma was rendered. The patient was referred to the local children's hospital for definitive treatment.

Oral Secondary Syphilis.

Secondary syphilis develops in approximately 25% of patients infected with the spirochete bacterium Treponema pallidum. It typically develops several weeks to several months after the primary infection, which is recognized by a painless chancre. Secondary syphilis is characterized by systemic symptoms, such as malaise and fever as well as a maculopapular rash involving the trunk and extremities including the palms and soles. Condyloma lata, which are raised, fleshy lesions, tend to develop at the site of the primary chancre. Diagnosis is achieved primarily through screening and confirmational serologic testing. Histologic findings seen in condyloma lata are largely non-specific. Therefore, a high index of suspicion should be maintained and immunohistochemical stains specific for T. pallidum should be utilized.

Juvenile Active Ossifying Fibroma.

A case of juvenile active ossifying fibroma affecting a 27 year-old man will be discussed. The characteristic radiologic and histologic features of the entity will be described.

Dermoid Cyst of the Floor of the Mouth.

A case of a dermoid cyst of the floor of mouth affecting a 19 years old male will be discussed. The macroscopic and histologic findings used for diagnosis will be covered. The typical features of this type of cyst will also be reviewed including radiographic and histologic findings. Discussion will include etiology and usual presentation, as well as treatment.