Chemotherapy-induced nausea and vomiting (CINV) in patients with advanced lung cancer during the first-line treatment: assessment by physicians, nurses, and patients from an Italian multicenter survey.

PURPOSE: Chemotherapy-induced nausea and vomiting (CINV) still represents a common side-effect of chemotherapy, and often, its perception differs between patients and healthcare professionals. The aim of this study was to evaluate the agreement on the perception of CINV and other items among clinicians, patients, and nurses. METHODS: This observational prospective study was part of an evaluation program promoted by the Women Against Lung Cancer in Europe (WALCE) Onlus. From August 2015 to February 2016, a survey was administered in 11 oncologic institutions to 188 stage IV lung cancer patients and to their oncologists and nurses during first-line chemotherapy. Our survey investigated 11 aspects: anxiety, mood, weakness, appetite, nausea, vomiting, pain, drowsiness, breath, general condition, and trust in treatments. These items were assessed through Numerical Rating Scale at four consecutive evaluations: at T0 (immediately prior to the first cycle), at T1 (immediately prior to the second cycle), at T2 (immediately prior to the third cycle), and at T3 (immediately prior to the fourth cycle). Clinician versus patient (CvP), nurse versus patient (NvP), and clinician versus nurse (CvN) agreements were estimated applying Weighted Cohen's kappa. A multivariate logistic model and generalized equation estimates were applied to evaluate factors possibly influencing CINV development. RESULTS: The incidence of patients reporting CINV varied from 40% at T0 to 71% at T3. Both CvP and NvP agreement on the investigated items were mainly moderate, slightly increasing over time, and becoming substantial for some items, in particular for NvP. Pre-chemotherapy anxiety in its mild, moderate, and severe manifestations, as well as mild, moderate, and severe anxiety experienced after chemotherapy start, exposed patients to a higher risk of anticipatory and acute/delayed CINV, respectively. CONCLUSIONS: Despite clinical staff awareness of patients' status and perceptions, CINV still represents a clinical problem. This study confirms that particular attention should be paid to anxiety due to its key role in CINV development.

First Report of Verticillium Wilt caused by Verticillium dahliae Kleb. on New Zealand Spinach (Tetragonia tetragonioides) in Italy.

Tetragonia tetragonioides (New Zealand spinach, Aizoaceae) is an Australasian annual species that occurs naturally in Italy, where it is cultivated for the edible young shoots and succulent leaves. In September 2011, a previously unknown wilt was observed in 10 private gardens, each 0.1 to 0.5 ha, near Castellaro, Northern Italy, on 7-month-old New Zealand spinach plants. Leaves wilted, starting from the collar and moving up the plant, and vascular tissues showed brown streaks in the roots, crowns, and stems. Diseased plants were stunted with small, chlorotic leaves. Infected stems and leaves then wilted, and plants often died. Of about 500 plants, 30% were affected. Stems of 10 diseased plants were disinfected with 1% NaOCl for 1 min. Sections of symptomatic vascular tissue were plated on potato dextrose agar. After 3 days at 23 ± 1°C, colonies developed that were white and turned a grey to dark green color. Irregular, black microsclerotia (32.0) 63.1 ± 16.8 µm (106.1) × (18.7) 39.1 ± 12.3 µm (65.8) developed in hyaline hyphae after 8 days. Hyaline, elliptical, single-celled conidia (2.7) 3.8 ± 0.6 µm (4.8) × (1.9) 2.6 ± 0.5 µm (3.5) developed on verticillate conidiophores with three phialides at each node. Based on these morphological characteristics, the fungus was identified as Verticillium dahliae (1). The internal transcribed spacer (ITS) region of rDNA was amplified for one isolate using the primers ITS1/ITS4 (3) and sequenced (GenBank Accession No. JX308315). BLASTn analysis of the 479-bp segment showed 100% homology with the ITS sequence of a V. dahliae isolate (AB551206). Pathogenicity tests were performed twice using 60-day-old plants of T. tetragonioides. Unwounded roots of eight plants were dipped for 1 min in a conidial suspension (5 × 107 conidia/ml) of one isolate of V. dahliae obtained from the original infected New Zealand spinach plants, and grown in potato dextrose broth. The inoculated plants were transplanted into 2-liter pots (1 plant/pot) containing steamed potting mix (sphagnum peat-perlite-pine bark-clay; 50:20:20:10) and maintained in a growth chamber at 20 to 24°C and 50 to 80% RH. Eight plants immersed in sterile water served as a control treatment. Wilt symptoms were observed 30 days after inoculation, with vascular discoloration in the roots, crowns and stems. V. dahliae was reisolated consistently from infected tissues, but not from the control plants that remained healthy. Pathogenicity was also tested using the same method on plants of four cultivars (five plants/cultivar) of Spinacia oleracea (Matador, Asti, Merlo Nero, and America). Wilt symptoms developed on all cultivars and V. dahliae was reisolated from each inoculated plant. No fungal colonies were reisolated from control plants, which remained healthy. To our knowledge, this is the first report of Verticillium wilt caused by V. dahliae on T. tetragonioides in Italy, as well in Europe. V. dahliae was reported on T. tetragonioides in Canada (2). At this time, the economic impact of Verticillium wilt on New Zealand Spinach in Italy is limited, although the use of this vegetable in Italy is increasing. References: (1) G. F. Pegg and B. L. Brady. Verticillium Wilts. CABI Publishing, Wallingford, UK, 2002. (2) M. J. Richardson. Page 387 in: An Annotated List of Seed-Borne Diseases, Fourth Edition. International Seed Testing Association, Zurich, Switzerland, 1990. (3) T. J. White et al. Page 315 in: PCR Protocols. A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.

First Report of Leaf Spot Caused by Corynespora cassiicola on Basil (Ocimum basilicum) in Italy.

Sweet basil (Ocimum basilicum) is an economically important herb in several Mediterranean countries. Approximately 80 ha are grown annually in Italy for fresh consumption and processing. In 2006, a damaging foliar disease of sweet basil cv. Genovese gigante was observed in several greenhouses located in the Liguria Region of northern Italy. A disease incidence of more than 50% was observed. Leaves of infected plants initially showed dark brown-to-black, 1 to 3 × 1.5 to 5.3 mm in diameter, circular spots surrounded by a chlorotic halo. Within 2 to 3 days, the spots coalesced, leading to extensive leaf necrosis with occasional shot holes. Stem lesions were brown, elongated, and irregularly dispersed. Although the distribution of the disease generally became uniform, it usually appeared originally in a patchy pattern at the central areas of the greenhouses, where temperatures and relative humidity were highest. Basal leaves were most severely affected by the disease when air circulation was apparently poor. Microscopic observations revealed light brown conidiophores, ending in sterigmata with conidia borne singly or in chains. Conidia were 31.9 to 212.2 µm (average 68.1 µm) long and 4.3 to 11.6 µm (average 7.8 µm) wide, with longitudinal cross walls. Such morphology is typical of Corynespora cassiicola (3). The fungus was consistently isolated from symptomatic leaves onto potato dextrose agar. The ITS region (internal transcribed spacer) of rDNA was amplified using primers ITS4/ITS6 and sequenced. BLASTn analysis (1) of the 215 bp obtained showed an E-value of 0.0 with C. cassiicola and the nucleotide sequence has been assigned GenBank Accession No. EF 545008. Pathogenicity tests were performed by spraying leaves of 10 healthy 30-day-old potted O. basilicum plants cv. Genovese gigante with a 105 conidia per ml aqueous suspension. Plants in 10 pots sprayed with water only served as controls. Plants were covered with plastic bags for 24 h after inoculation and maintained at 20 to 25°C. The first foliar lesions developed on leaves 3 to 4 days after inoculation, whereas control plants remained healthy. C. cassiicola was consistently reisolated from these lesions. The pathogenicity test was completed twice. To our knowledge, this is the first report of C. cassiicola on O. basilicum in Italy. Other previous records of this disease were from India (2) and Brunei (4). References: (1) S. F. Altschul et al. Nucleic Acids Res. 25:3389, 1997. (2) L. R. Devi et al. Indian Phytopathol. 32:150, 1979. (3) M. B. Ellis. CMI Mycol. Pap. No. 65, 1957. (4) W. T. H. Peregrine and K. B. Ahmad. Phytopathol. Pap. 27:1, 1982.