First Report of Fusarium Yellows and Rhizome Rot Caused by Fusarium oxysporum f. sp. zingiberi on Ginger in the Continental United States.

Ginger (Zingiber officinale Roscoe) is one of the most widely consumed medicinal herb in the world, and the U.S. imports of ginger have risen in recent years because of its health benefits. Seed rhizome and soilborne diseases are serious concerns of ginger worldwide (Stirling 2004; Moreira et al. 2013), including the recent observations of Fusarium yellows and rhizome rot in the Commonwealth of Virginia. In October 2018 and 2019, ginger plants with yellowing of leaf margins and stunted growth were uprooted from a 9.1 m × 14.6 m high tunnel (HT) and from an outdoor raised bed at Virginia State University's Randolph farm. Disease incidence in the HT and the raised bed was estimated between 5-70%. Small pieces (2-5 mm) of symptomatic rhizomes were disinfected with 0.6% sodium hypochlorite solution and placed on potato dextrose agar (PDA) Petri plates to recover fungal isolates. Hyphal tips from these isolates were transferred to fresh PDA to obtain pure cultures. The fungal colonies were pinkish-white initially, and turned purplish-pink after 5-7 days of incubation at 25 °C. The microconidia were aseptate, oval or elliptical, hyaline, and measured 5 to 12 × 4 to 6 µm in size. Macroconidia were with 3 to 5 septations, curved like a sickle towards the ventral side, hyaline, smooth and thin-walled, and 15 to 40 × 3 to 6 µm in size. Fungal genomic DNA of one isolate (Gf-VA-3) was extracted from a 7-days old culture using PrepMan®Ultra (Thermo Fischer Scientific, Cheshire UK). Four conserved regions of the isolated pathogen, internal transcribed spacer (ITS), translation elongation factor (EF), ß-tubulin (Bt), and calmodulin (cal) gene regions were amplified using ITS1 and ITS4 (White et al. 1990), ef1α and ef2α (O'Donnell et al. 1998), Bt2a and Bt2b (Glass and Donaldson 1995), and calA1 and calQ1 (Carbone and Kohn 1999), respectively. PCR products were sequenced, and amplicons deposited in GenBank with accession numbers MT337417 for ITS, MT436712 for Bt, MT802441 for cal and MW816632 for EF. A 99-100% identity with Fusarium oxysporum was matched with accession nos. MW776326 for ITS, MN646766 for the ß-tubulin, MT010904 for the calmodulin and MN258350 for the translation elongation factor genes. For pathogenicity test, six 6-week-old healthy ginger plants grown on sterilized potting mix in the greenhouse were inoculated by injecting 3-ml of a 1 × 108 micro- and macro-conidia suspension per ml at the crown area transcending to the rhizome. Another set of six plants were injected with distilled and autoclaved water in the same way. After four weeks, leaves withered, plants exhibited yellowing and wilt followed by stunted growth and eventually complete collapse of the six inoculated plants, however control plants showed none of the symptoms. The same pathogen was re-isolated from the inoculated plants. The pathogenicity test was repeated, and the same results were observed. Fusarium yellows and rhizome rot has been reported from Hawaii in the U.S. (Trujillo 1963), Brazil (Moreira et al. 2013), Australia (Stirling 2004), China (Li et al. 2014), and India (Shanmugam et al. 2013). To our knowledge, this is the first report of Fusarium yellows and rhizome rot on ginger in the Continental U.S. The disease is seed rhizome and soilborne leading to poor establishment and hence economic loss in ginger production.

Discordant left and right ventricular optimal atrioventricular and interventricular delays during biventricular pacemaker optimization.

Echocardiography-guided optimization of atrioventricular (AV) delay (AVD) improves left ventricular (LV) filling, and optimized interventricular delay (VVD) leads to further improvement in cardiac output in patients with biventricular (Biv) pacing. Investigators use LV filling and ejection to optimize AV and VV delay in patients with Biv pacing. Effect of such optimization on right-sided hemodynamics remains unknown. In our experience, few patients experience worsening of right ventricle (RV) hemodynamics when LV parameters are optimized. We present a series of cases where we observed suboptimal RV filling or ejection at optimal AVD and VVD for LV. This RV-LV discordance may contribute to nonresponder rate to cardiac resynchronization therapy (CRT) and should be evaluated in a consecutive series of CRT nonresponder patients to help improve CRT response.

Extraction Solvents Affect Anthocyanin Yield, Color, and Profile of Strawberries.

Anthocyanins are a major group of plant pigments that have antioxidant activities. Pigments play a major role in human health and have attracted a lot of attention globally. Many factors affect anthocyanin yields, such as solvent type, incubation time, solvent-to-sample ratio, sample type, and temperature. The first parameter was tested, and the rest were considered constant in this experiment. A total of nine organic and water-based solvents (methanol and chloroform: methanol, acetone, ethanol, water) and their combinations were compared to extract anthocyanins from freshly-pureed strawberries. Solvents changed anthocyanin yield, color parameters, and profile. The color parameters of a* values lower than 30, L* values higher than 85, hue angle more than 40, and chroma less than 30 indicated some color degradation in strawberry anthocyanins. Therefore, the best solvents for anthocyanin assessment were methanol and methanol: water. The second-best solvent was the pH differential buffers. Other solvents such as ethanol, chloroform: methanol, water, and water-based solvents extracted considerable amounts of anthocyanins; however, they showed some degree of color degradation, evidenced by the color parameters. Acetone did not yield a stable extract which degraded over 48 h of storage at 4 °C. The extraction solvent determined the main anthocyanin of the anthocyanins profile. Pelargonidin was the major anthocyanin in chloroform: methanol solvent, while delphinidin was dominant in all other solvents.

Shortening of atrioventricular delay at increased atrial paced heart rates improves diastolic filling and functional class in patients with biventricular pacing.

BACKGROUND: Use of rate adaptive atrioventricular (AV) delay remains controversial in patients with biventricular (Biv) pacing. We hypothesized that a shortened AV delay would provide optimal diastolic filling by allowing separation of early and late diastolic filling at increased heart rate (HR) in these patients. METHODS: 34 patients (75 ± 11 yrs, 24 M, LVEF 34 ± 12%) with Biv and atrial pacing had optimal AV delay determined at baseline HR by Doppler echocardiography. Atrial pacing rate was then increased in 10 bpm increments to a maximum of 90 bpm. At each atrial pacing HR, optimal AV delay was determined by changing AV delay until best E and A wave separation was seen on mitral inflow pulsed wave (PW) Doppler (defined as increased atrial duration from baseline or prior pacemaker setting with minimal atrial truncation). Left ventricular (LV) systolic ejection time and velocity time integral (VTI) at fixed and optimal AV delay was also tested in 13 patients. Rate adaptive AV delay was then programmed according to the optimal AV delay at the highest HR tested and patients were followed for 1 month to assess change in NYHA class and Quality of Life Score as assessed by Minnesota Living with Heart Failure Questionnaire. RESULTS: 81 AV delays were evaluated at different atrial pacing rates. Optimal AV delay decreased as atrial paced HR increased (201 ms at 60 bpm, 187 ms at 70 bpm, 146 ms at 80 bpm and 123 ms at 90 bpm (ANOVA F-statistic = 15, p = 0.0010). Diastolic filling time (P < 0.001 vs. fixed AV delay), mitral inflow VTI (p < 0.05 vs fixed AV delay) and systolic ejection time (p < 0.02 vs. fixed AV delay) improved by 14%, 5% and 4% respectively at optimal versus fixed AV delay at the same HR. NYHA improved from 2.6 ± 0.7 at baseline to 1.7 ± 0.8 (p < 0.01) 1 month post optimization. Physical component of Quality of Life Score improved from 32 ± 17 at baseline to 25 ± 12 (p < 0.05) at follow up. CONCLUSIONS: Increased heart rate by atrial pacing in patients with Biv pacing causes compromise in diastolic filling time which can be improved by AV delay shortening. Aggressive AV delay shortening was required at heart rates in physiologic range to achieve optimal diastolic filling and was associated with an increase in LV ejection time during optimization. Functional class improved at 1 month post optimization using aggressive AV delay shortening algorithm derived from echo-guidance at the time of Biv pacemaker optimization.

Comparing pH differential and methanol-based methods for anthocyanin assessments of strawberries.

Anthocyanins are a group of water-soluble polyphenolic pigments found primarily in flowers, vegetables, and fruits. These pigments play critical roles in plant and human health. Spectrophotometric methods are a simple and inexpensive way to quantify anthocyanins in plant tissues. Two main spectrophotometric methods have been developed, organic solvent-based, and pH differential methods. Both of these methods are subject to interference from light-absorbing impurities and need to be optimized for different matrixes of different plant materials. Eight methods have been tested in this experiment to quantify anthocyanins in strawberry fruits. Six organic solvent-based methods tested methanol, chloroform-methanol, and MgO in different ratios. The other two methods were pH differential method and a combination of organic solvent-based and pH differential method. Two methods used organic solvents (methanol and chloroform-methanol) were the best in extracting anthocyanin from strawberry fruits. Adding MgO increased the pH of the extract and was less efficient in anthocyanin extraction. All other methods had lower anthocyanin yield compared with methanol and chloroform-methanol methods and are not recommended for strawberry fruit anthocyanin extraction.

Phytochemical profile and anti-oxidation activity changes during ginger (Zingiber officinale) harvest: Baby ginger attenuates lipid accumulation and ameliorates glucose uptake in HepG2 cells.

We determined the phenolic content and anti-oxidation properties of ginger at different harvesting time and tested its effects on lipid droplet formation and glucose uptake in HepG2 cells. Ginger samples at different stages of maturity were harvested every two weeks starting from mid-October for 16 weeks. Our data indicate that ginger has the highest phenolic contents and superior anti-oxidation activity when harvested early (immature baby ginger); however, the concentration of phenolic contents and its anti-oxidation activity were progressively reduced up to 50% as ginger matures. Furthermore, the data indicate that baby ginger extract inhibits lipid accumulation and triglyceride content in oleic acid-induced HepG2 cells up to 20% in a dose-dependent manner. Baby ginger exhibited significant inhibition of α-amylase enzyme activity by 29.5% and ameliorated glucose uptake in HepG2 cell at similar level. Our results suggest that harvesting ginger at an appropriate (early) time may be beneficial for optimizing its biological active contents and qualitative properties. The data also suggest that a regular use of ginger can potentially lower incidences of obesity and diabetes.

Pre-ejection period by radial artery tonometry supplements echo Doppler findings during biventricular pacemaker optimization.

BACKGROUND: Biventricular (Biv) pacemaker echo optimization has been shown to improve cardiac output however is not routinely used due to its complexity. We investigated the role of a simple method involving computerized pre-ejection time (PEP) assessment by radial artery tonometry in guiding Biv pacemaker optimization. METHODS: Blinded echo and radial artery tonometry were performed simultaneously in 37 patients, age 69.1 ± 12.8 years, left ventricular (LV) ejection fraction (EF) 33 ± 10%, during Biv pacemaker optimization. Effect of optimization on echo derived velocity time integral (VTI), ejection time (ET), myocardial performance index (MPI), radial artery tonometry derived PEP and echo-radial artery tonometry derived PEP/VTI and PEP/ET indices was evaluated. RESULTS: Significant improvement post optimization was achieved in LV ET (286.9 ± 37.3 to 299 ± 34.6 ms, p < 0.001), LV VTI (15.9 ± 4.8 cm to 18.4 ± 5.1 cm, p < 0.001) and MPI (0.57 ± 0.2 to 0.45 ± 0.13, p < 0.001) and in PEP (246.7 ± 36.1 ms to 234.7 ± 35.5 ms, p = 0.003), PEP/ET (0.88 ± 0.21 to 0.79 ± 0.17, p < 0.001), and PEP/VTI (17.3 ± 7 to 13.78 ± 4.7, p < 0.001). The correlation between comprehensive echo Doppler and radial artery tonometry-PEP guided optimal atrioventricular delay (AVD) and optimal interventricular delay (VVD) was 0.75 (p < 0.001) and 0.69 (p < 0.001) respectively. In 29 patients with follow up assessment, New York Heart Association (NYHA) class reduced from 2.5 ± 0.8 to 2.0 ± 0.9 (p = 0.004) at 1.8 ± 1.4 months. CONCLUSION: An acute shortening of PEP by radial artery tonometry occurs post Biv pacemaker optimization and correlates with improvement in hemodynamics by echo Doppler and may provide a cost-efficient approach to assist with Biv pacemaker echo optimization.

Original Investigations. Potential faces of patent foramen ovale (PFO PFO).

BACKGROUND: Patent foramen ovale (PFO) is diagnosed on echocardiography by saline contrast study with or without color Doppler evidence of shunting. PFO is benign except when it causes embolic events. METHODS AND RESULTS: In this report, we describe unique additional manifestations related to the diagnosis and presentation of PFO. These include demonstration of PFO during the release phase of "sigh" on the ventilator in the operating room, use of a separate venipuncture to allow preparation of blood-saline-air mixture after multiple failed saline bubble injections, resting and stress hypoxemia related to left to right shunting across a PFO in the absence of pulmonary hypertension, presentation of quadriperesis secondary to an embolic event from a PFO and development of a thrombus on the left atrial aspect of PFO in a patient with atrial fibrillation, and on the right atrial aspect of PFO in a patient who had undergone repair of a flail mitral valve. Finally, in one patient with end-stage renal disease, aortic valve endocarditis and periaortic abscess, PFO acted as a vent valve relieving right atrial pressure following development of aortoatrial fistula. CONCLUSION: PFO diagnosis can be elusive if appropriate techniques are not used during saline contrast administration. PFO can present as hypoxemia in the absence of pulmonary hypertension, can be a rare cause of quadriperesis, and can be associated with thrombus formation on either side of interatrial septum. Finally, PFO presence can be lifesaving in those with sudden increase in right atrial pressure such as with aortoatrial fistula.

SHOX2 overexpression favors differentiation of embryonic stem cells into cardiac pacemaker cells, improving biological pacing ability.

When pluripotency factors are removed, embryonic stem cells (ESCs) undergo spontaneous differentiation, which, among other lineages, also gives rise to cardiac sublineages, including chamber cardiomyocytes and pacemaker cells. Such heterogeneity complicates the use of ESC-derived heart cells in therapeutic and diagnostic applications. We sought to direct ESCs to differentiate specifically into cardiac pacemaker cells by overexpressing a transcription factor critical for embryonic patterning of the native cardiac pacemaker (the sinoatrial node). Overexpression of SHOX2 during ESC differentiation upregulated the pacemaker gene program, resulting in enhanced automaticity in vitro and induced biological pacing upon transplantation in vivo. The accentuated automaticity is accompanied by temporally evolving changes in the effectors and regulators of Wnt signaling. Our findings provide a strategy for enriching the cardiac pacemaker cell population from ESCs.

Echocardiography-guided biventricular pacemaker optimization: role of echo Doppler in hemodynamic assessment and improvement.

In spite of improvements in heart failure management and increasing utilization of cardiac resynchronization therapy (CRT), approximately 30-40% of CRT patients remain nonresponders and 50% or more are echocardiographic nonresponders (defined as less than 15% reduction in left ventricular end systolic volume post-CRT). Optimization guided by echocardiography has been studied as one of the methods to improve the nonresponder rate to CRT. Echo-guided biventricular (Biv) pacemaker optimization has been associated with improvement in acute cardiac hemodynamics and improvement in functional class. In this review, the authors discuss various methods to optimize Biv pacemaker by echocardiography, recent advances in pacemaker optimization and the limitations of echocardiography. The authors also demonstrate complex hemodynamic derangements in heart failure via multiple case examples highlighting the role of comprehensive echo Doppler in elucidating cardiac hemodynamics encountered in CRT nonresponders, as well as tailoring of Biv pacemaker optimization to the underlying physiologic derangement.

Electrical dissociation within the left atrium and left atrial appendage diagnosed with transesophageal echocardiography.

The authors describe the case of a 79-year-old man with prior mitral valve repair and a maze procedure who developed recurrent atrial fibrillation, in whom transesophageal echocardiography revealed an accessory lobe of the left atrial appendage in sinus rhythm when the remaining body of the left atrial appendage was in atrial fibrillation or flutter. Electrophysiology confirmed dissociated rhythm within the left atrium. This case emphasizes the need for careful Doppler interrogation of the left atrial appendage and its lobes to look for dissociated atrial rhythm.