Two novel endophytic Tolypocladium species identified from native pines in south Florida.

This study investigated the incidence and diversity of Tolypocladium within trunks of south Florida slash pines (Pinus densa). Thirty-five isolates were recovered from trunk tissue including living phloem, cambium, and sapwood. Two novel species of Tolypocladium (T. subtropicale and T. trecense) are described here based on morphological and molecular analysis of concatenated LSU, ITS, tef-1, tub, and RPB1 sequences. Our findings expand our understanding of the distribution, diversity, and ecology of this genus and confirm that it is widely spread as an endophyte across ecosystems and hosts. Strains collected in this survey will be used in future bioassays to determine their potential ecological roles as mycoparasites or entomopathogens. Citation: Soares JM, Karlsen-Ayala E, Salvador-Montoya CA, Gazis R (2023). Two novel endophytic Tolypocladium species identified from native pines in south Florida. Fungal Systematics and Evolution 11: 51-61. doi: 10.3114/fuse.2023.11.04.

Asperosporus subterraneus, a new genus and species of sequestrate Agaricaceae found in Florida nursery production.

We describe a novel sequestrate genus and species, Asperosporus subterraneus gen. et sp. nov., found associated with nursery production of ferns in south Florida. This truffle species has a unique combination of morphological characters among described Agaricaceae in that it lacks a stipe or columella, has large, ornamented spores, the fresh sporocarps rapidly stain pink-red when cut or bruised, and they have a rancid smell. Although this fungus does not appear to be a direct plant pathogen, the hyphae of A. subterraneus produce a thick hydrophobic mycelial mat that binds the organic matter and therefore prevents water and fertilizer from being absorbed by plants, consequently causing wilting and chlorosis. Using morphological characteristics and phylogenetic reconstruction based on the internal transcribed spacer (ITS), partial large subunit nuclear ribosomal DNA (LSU), second largest subunit of RNA polymerase II (rpb2) and translation elongation factor 1-alpha (tef1) regions, we describe this taxon as a new genus and species in Agaricaceae.

Urología en tiempos de pandemia / Urology in times of pandemic

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Relationship of endoscopic lesions of the renal papilla with type of renal stone and 24 h urine analysis.

BACKGROUND: Our purpose was to study the relationship of the 3 different types of endoscopic calcifications of the renal papilla (Randall's plaque, intratubular calcification, papillary crater) with the type of stone and urine analysis. METHODS: This prospective study examined 41 patients (age range: 18 to 80 years) who received retrograde intrarenal surgery (RIRS) for renal lithiasis (mean stone size: 15.3 ± 7.2 mm). The renal papilla injuries were endoscopically classified as Randall's plaque, intratubular calcification, or papillary crater. Calculi were classified as uric acid, calcium oxalate monohydrate (COM; papillary and cavity), calcium oxalate dihydrate (COD), or calcium phosphate (CP). A 24 h urine analysis of calcium, oxalate, citrate, phosphate, and pH was performed in all patients. The relationship of each type of papillary injury with type of stone and urine chemistry was determined. Fisher's exact test and Student's t-test were used to determine the significance of relationships, and a p value below 0.05 was considered significant. RESULTS: The most common injury was tubular calcification (78%), followed by Randall's plaque (58%), and papillary crater (39%). There was no significant relationship of Randall's plaque with type of stone. However, endoscopic intratubular calcification (p = 0.025) and papillary crater (p = 0.041) were more common in patients with COD and CP stones. There were also significant relationships of papillary crater with hypercalciuria (p = 0.036) and hyperoxaluria (p = 0.024), and of Randall's plaque with hypocitraturia (p = 0.005). CONCLUSIONS: There are certain specific relationships between the different types of papillary calcifications that were endoscopically detected with stone chemistry and urine analysis. COD and CP stones were associated with endoscopic tubular calcifications and papillary craters. Hypercalciuria was associated with tubular calcification, and hypocitraturia was associated with Randall's plaque.

The prognostic value of the neutrophil-to-lymphocyte ratio in patients with testicular cancer.

OBJECTIVES: To evaluate the potential prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in testicular cancer. MATERIALS AND METHODS: 80 patients with testicular cancer treated at our institution from 2005 to 2018 were retrospectively reviewed. Age, tumor markers, stage and histotype at final pathology, eventual medical treatment, tumor recurrence and follow-up data were extracted. The NLR was retrospectively calculated from blood tests. Data were analyzed by medians comparison, linear correlation, univariate and multivariate Cox regression and survival curve analysis. RESULTS: Population's median age was 33 years and median follow-up was 40.5 months. Overall, the median NLR was significantly reduced after orchiectomy (2.2 [1.55-3.09] vs. 1.77 [1.34-2.46], M-W P<0.001). Post-orchiectomy NLR was higher in patients who had disease recurrence (2.51;IQ 1.84-3.74 vs 1.59; IQ 1.10-2.24; M-W P=0.001), regardless of disease's stage: HR=1,85 (95%CI 0,99-3,46) and HR=1,91 (95%CI 0,96-3,78) for stage disease I or stage II, respectively. After stratification of patients by post-orchiectomy NLR (optimal cut-off: 2.255), patients with lower NLR had significantly longer recurrence-free survival (107.7 months [95%CI 97,7-119,2] vs. 57.65 months [95%CI 48,2-81,1], P<0.001). Univariable and multivariable Cox proportional hazard analyses, showed post-orchiectomy NLR, histotype at final pathology and disseminated disease at diagnosis as predictors of recurrence. CONCLUSION: NLR is a simple and wildly available biomarker. Higher post-orchiectomy NLR was found independently correlated to higher risk of recurrence, regardless of disease stage, which could potentially lead to a worse prognosis.

Administración previa de antibiótico como factor asociado con infección urinaria por E. coli productora de BLEE de origen comunitario en pacientes diabéticos / Previous administration of antibiotic as factor related to urinary infection due to E. coli producers of ESBL of community origin in diabetic patients

Resumen ANTECEDENTES: las infecciones urinarias causadas por bacilos gramnegativos productores de betalactamasas de espectro extendido (BLEE) constituyen un problema mundial de salud pública. OBJETIVO: determinar si existe relación entre el tratamiento antibiótico previo y el desarrollo de E. coli BLEE al ingreso en pacientes con diabetes mellitus tipo 2. MATERIAL Y MÉTODO: estudio piloto de tipo transversal, analítico, en el que se revisaron los casos de infección de vías urinarias en pacientes diabéticos atendidos en el Nuevo Sanatorio Durango. Se compararon dos grupos según el resultado del urocultivo de ingreso. Se recolectaron datos tomando en cuenta el antecedente de tratamiento antibiótico, cifra de hemoglobina glucosilada (Hb1Ac), antecedente de hospitalización, si había antecedente de catéter urinario (sonda Foley) y diagnóstico de enfermedad renal crónica. RESULTADOS: se incluyeron 103 pacientes: 49 con E. coli y 54 con E. coli BLEE. Se encontró mayor asociación con infecciones urinarias productoras de BLEE en individuos de 68 ± 14.04 años en comparación con la edad de 49 ± 12 años en los sujetos con infecciones urinarias no productoras de BLEE. Se calculó razón de momios para cada uno de los rubros, se encontró asociación estadísticamente significativa por medio de X2 (p<0.05) calculando una razón de momios de 10.2 para el antecedente de administración de antibiótico y de 2.97 para el diagnóstico de enfermedad renal crónica y para el aislamiento de E. coli productora de BLEE. CONCLUSIÓN: existe asociación de la administración previa de tratamiento antibiótico y la existencia de enfermedad renal crónica con el aislamiento E. coli BLEE en infecciones adquiridas en la comunidad en pacientes diabéticos.

Abstract BACKGROUND: Urinary tract infections caused by gram-negative bacilli producers of extended-spectrum beta-lactamases (ESBL) are a global public health problem. MATERIAL AND METHOD: An analytical, cross-sectional, pilot study was carried out in Nuevo Sanatorio Durango, Mexico City, in which the cases of urinary tract infection in diabetic patients were reviewed. Two groups were compared depending on the result of the urinary culture. Data were collected taking into account the antecedent of antibiotic treatment, glycosylated hemoglobin (Hb1Ac), history of hospitalization, history of urinary catheter (Foley catheter) and diagnosis of chronic kidney disease. RESULTS: There were included 103 patients, divided according to the result of the urinary culture: E. coli (n = 49) and E. coli ESBL (n = 54). We found a greater association with ESBL-producing urinary tract infections in individuals aged 68 ± 14.04 years. We calculated odds ratios for each of the items, finding a statistically significant association by means of X2 test (p < 0.05), calculating an OR of 10.2 with the antecedent of antibiotic use and a OR of 2.97 with the diagnosis of chronic kidney disease, when there was isolation of E. coli producing ESBL. CONCLUSION: There is an association between the use of antibiotic treatment and the presence of chronic kidney disease with E. coli ESBL isolation in community-acquired infections in diabetic patients.

Effect of sexual steroids on boar kinematic sperm subpopulations.

Here, we show the effects of sexual steroids, progesterone, testosterone, or estradiol on motility parameters of boar sperm. Sixteen commercial seminal doses, four each of four adult boars, were analyzed using computer assisted sperm analysis (CASA). Mean values of motility parameters were analyzed by bivariate and multivariate statistics. Principal component analysis (PCA), followed by hierarchical clustering, was applied on data of motility parameters, provided automatically as intervals by the CASA system. Effects of sexual steroids were described in the kinematic subpopulations identified from multivariate statistics. Mean values of motility parameters were not significantly changed after addition of sexual steroids. Multivariate graphics showed that sperm subpopulations were not sensitive to the addition of either testosterone or estradiol, but sperm subpopulations responsive to progesterone were found. Distribution of motility parameters were wide in controls but sharpened at distinct concentrations of progesterone. We conclude that kinematic sperm subpopulations responsive to progesterone are present in boar semen, and these subpopulations are masked in evaluations of mean values of motility parameters. © 2017 International Society for Advancement of Cytometry.

Is myeloablative dose intensity necessary in allogeneic hematopoietic cell transplantation for lymphomas?

The advent of novel immunotherapy and tyrosine kinase inhibitors has ushered a new era in the treatment of Hodgkin and non-Hodgkin lymphomas. Allogeneic hematopoietic cell transplantation remains, however, a vital component in the management and potential cure of lymphomas, especially in the relapsed setting. Considering the biological and clinical heterogeneity of various subtypes of lymphomas, the optimal intensity of conditioning regimens remains controversial. Reduced intensity conditioning regimens have broadened applicability of the procedure to older and frail patients. Observational studies suggest that although reduced intensity allografting is associated with higher risk of relapse, overall survival is comparable and in some cases even better, than observed with myeloablative regimens. Here, we review the available published data pertaining to allogeneic hematopoietic cell transplantation using reduced intensity or myeloablative conditioning for various lymphoma histologies. Owing to the lack of randomized prospective trials, recommendations are mainly based on registry and single-institution studies. Special emphasis must be given to implementing strategies to prevent relapse when using reduced intensity regimens. Identifying particular patients who may benefit from myeloablative regimens in lymphomas remains to be better defined.

Predictors of overall survival among patients treated with sirolimus/tacrolimus vs methotrexate/tacrolimus for GvHD prevention.

Sirolimus (SIR)/tacrolimus (TAC) is an alternative to methotrexate (MTX)/TAC. However, rational selection among these GvHD prophylaxis approaches to optimize survival of individual patients is not possible based on current evidence. We compared SIR/TAC (n=293) to MTX/TAC (n=414). The primary objective was to identify unique predictors of overall survival (OS). Secondary objective was to compare acute and chronic GvHD, relapse, non-relapse mortality, thrombotic microangiopathy (TMA), hepatic veno-occlusive disease (VOD/SOS), and acute kidney injury. Day 100 grades II-IV acute GvHD was significantly reduced in SIR/TAC vs MTX/TAC group (63 vs 73%, P=0.02). An interaction between GvHD prophylaxis groups and comorbidity index (hematopoietic cell transplantation (HCT)-CI) significantly impacted OS. Patients with HCT-CI⩾4 had significantly worse OS with MTX/TAC (HR 1.86, 95% CI 1.14-3.04, P=0.01) while no such effect was seen for SIR/TAC (HR 0.78, 95% CI 0.48-1.26, P=0.31). Other end points did not significantly differ between groups except TMA and VOD/SOS were increased in the SIR/TAC group, but excess death from these complications was not observed. We conclude, GvHD prophylaxis approach of SIR/TAC is associated with reduced grades II-IV acute GvHD, comparable toxicity profile to MTX/TAC, and improved OS among patients with HCT-CI⩾4.

Síndrome de Wilkie / Wilkie's syndrome

Resumen El síndrome de Wilkie es una variante poco frecuente de obstrucción del intestino delgado en la tercera porción del duodeno por la arteria mesentérica superior. Es más frecuente en mujeres, adolescentes y adultos jóvenes; la mayoría de los casos ocurre después de pérdida ponderal importante. Los síntomas pueden incluir: intolerancia a la alimentación, con náuseas y vómitos, pérdida de peso, saciedad temprana, distensión abdominal y dolor epigástrico. Se requieren estudios de imagen específicos, como serie gastroduodenal con bario, ultrasonido Doppler y angiotomografía. El tratamiento consiste en dieta fraccionada o alimentación enteral y descompresión nasogástrica, si es necesario. En caso de mala respuesta, se recomienda tratamiento quirúrgico.

Abstract Wilkie's syndrome is a rare presentation of small bowel obstruction in the third portion of the duodenum by the superior mesenteric artery. It is more common in women, teenagers and young adults. Most cases presented after a major weight loss. Symptoms may include: food intolerance, nausea and vomiting, weight loss, early satiety, bloating and epigastric pain. Barium meal, Doppler ultrasound and angiotomography are required for diagnostic evaluation. Treatment consists of enteral or split diet and nasogastric decompression if necessary. In case of poor response, surgical treatment is required.

Abordaje perineal de fístulas rectouretrales tras prostatectomía radical laparoscópica / Perineal approach for rectourethral fistulae after radical laparoscopic prostatectomy

Objetivo: Describir nuestra experiencia con el abordaje perineal para el tratamiento de las fístulas rectouretrales (FRU) tras prostatectomía radical laparoscópica. Materiales y métodos: Realizamos un estudio retrospectivo desde el año 2012 al 2015 presentando 5 casos de FRU tras prostatectomía radical laparoscópica. Todos los casos requirieron cirugías abdominales mayores entre la prostatectomía radical laparoscópica y el tratamiento de la FRU a causa de complicaciones varias. En ningún caso se indicó radioterapia previa o posterior a la reparación. Se realizó abordaje perineal en los 5 casos como primera opción. Un caso requirió una segunda intervención con abordaje combinado (abdominal y perineal) por persistencia de la fístula. Resultados: Tras un mínimo de 12 meses de seguimiento en los 5 casos se ha resuelto la FRU. 2 pacientes presentaron incontinencia urinaria y uno estenosis de la anastomosis que requirió uretrotomía interna. El resto no ha mostrado complicaciones a largo plazo. Conclusión: El abordaje perineal permite un campo quirúrgico sano en pacientes multioperados, obteniendo altas tasas de resolución de la fístula

Objective: To describe our experience with the perineal approach to treat rectourethral fistulae (RUF) after radical laparoscopic prostatectomy. Materials and methods: We performed a retrospective study from 2012 to 2015 presenting 5 cases of RUF after radical laparoscopic prostatectomy. All cases required major abdominal surgery between the radical laparoscopic prostatectomy and the RUF treatment due to various complications. In no case was radiation therapy indicated prior to or after the repair. A perineal approach was performed in the 5 cases as the first option. One case required a second operation with a combined approach (abdominal and perineal) due to persistent fistulae. Results: After a minimum of 12 months of follow-up, 5 cases had resolved the RUF. Two patients presented urinary incontinence, and one patient had an anastomotic stricture that required internal urethrotomy. The other patients had no long-term complications. Conclusion: The perineal approach provides a healthy surgical field in patients who undergo multiple operations, achieving high rates of resolution of the fistulae

El epitelio seminal en biopsia prostática puede semejar lesiones prostáticas malignas y premalignas / Seminal epithelium in prostate biopsy can mimic malignant and premalignant prostatic lesions

Objetivos: En la mayoría de las biopsias prostáticas el epitelio seminal se reconoce fácilmente, ya que muestra criterios histológicos característicos. Sin embargo, algunas biopsias pueden semejar lesiones prostáticas malignas o premalignas. Los propósitos de este estudio son analizar el aspecto histológico de las biopsias que simularon adenocarcinomas o lesiones prostáticas preneoplásicas; comentar su diagnóstico diferencial y conocer la frecuencia de epitelio seminal en biopsias prostáticas. Métodos: Revisamos 500 biopsias prostáticas consecutivas por punción obtenidas por el método de sextantes, y seleccionamos aquellos casos en los que observamos epitelio seminal de vesículas seminales o conductos eyaculatorios. En las biopsias en las que el epitelio seminal semejó lesiones malignas o premalignas se emplearon estudios inmunohistoquímicos que incluyeron antígeno prostático específico y MUC6. Se anotaron los datos clínicos de mayor importancia. Resultados: Treinta y seis (7,2%) biopsias mostraron epitelio seminal y 7 de ellas (1,4%) semejaron diversas lesiones prostáticas, incluyendo neoplasia intraepitelial prostática de alto grado, proliferaciones acinares atípicas, adenocarcinomas con patrón papilar y carcinoma poco diferenciado. El epitelio seminal semejó lesiones prostáticas cuando el depósito de lipofuscina, las vacuolas perinucleares o las pseudoinclusiones nucleares fueron poco aparentes o estuvieron ausentes. Cinco de las 7 biopsias mostraron atipia celular leve o moderada con núcleos pequeños e hipercromáticos y solos 2 pleomorfismo celular. Los pacientes se encontraban vivos y asintomáticos después de 6 años de evolución en promedio. Conclusiones: El epitelio seminal semeja neoplasia intraepitelial prostática, proliferaciones acinares atípicas y diversos tipos de adenocarcinomas prostáticos en aproximadamente el 1,4% de las biopsias prostáticas

Objectives: In most prostate biopsies, the seminal epithelium is easily recognised because it meets characteristic histological criteria. However, some biopsies can mimic malignant or premalignant prostatic lesions. The aims of this study were to analyse the histological appearance of the biopsies that mimic adenocarcinomas or preneoplastic prostatic lesions, discuss the differential diagnosis and determine the frequency of seminal epithelia in prostate biopsies. Methods: We consecutively reviewed 500 prostate puncture biopsies obtained using the sextant method and selected those cases in which we observed seminal vesicle or ejaculatory duct epithelium. In the biopsies in which the seminal epithelium resembled malignant or premalignant lesions, immunohistochemical studies were conducted that included prostate-specific antigen and MUC6. The most important clinical data were recorded. Results: Thirty-six (7.2%) biopsies showed seminal epithelium, and 7 of them (1.4%) resembled various prostate lesions, including high-grade prostatic intraepithelial neoplasia, atypical acinar proliferations, adenocarcinomas with papillary patterns and poorly differentiated carcinoma. The seminal epithelium resembled prostate lesions when the lipofuscin deposit, the perinuclear vacuoles or the nuclear pseudoinclusions were inconspicuous or missing. Five of the 7 biopsies showed mild to moderate cellular atypia with small and hyperchromatic nuclei, and only 2 showed cellular pleomorphism. The patients were alive and asymptomatic after an average of 6 years of progression. Conclusions: The seminal epithelium resembles prostatic intraepithelial neoplasia, atypical acinar proliferations and various types of prostatic adenocarcinomas in approximately 1.4% of prostate biopsies

Long-term survival outcomes of reduced-intensity allogeneic or autologous transplantation in relapsed grade 3 follicular lymphoma.

Grade 3 follicular lymphoma (FL) has aggressive clinical behavior. To evaluate the optimal first transplantation approach in relapsed/refractory grade 3 FL patients, we compared the long-term outcomes after allogeneic (allo-) vs autologous hematopoietic cell transplantation (auto-HCT) in the rituximab era. A total of 197 patients undergoing first reduced-intensity conditioning (RIC) allo-HCT or first auto-HCT during 2000-2012 were included. Rituximab-naive patients were excluded. Allo-HCT recipients were younger, more heavily pretreated and had a longer interval between diagnosis and HCT. The 5-year probabilities of non-relapse mortality (NRM), relapse/progression, PFS and overall survival (OS) for auto-HCT vs allo-HCT groups were 4% vs 27% (P<0.001), 61% vs 20% (P<0.001), 36% vs 51% (P=0.07) and 59% vs 54% (P=0.7), respectively. On multivariate analysis, auto-HCT was associated with reduced risk of NRM (relative risk (RR)=0.20; P=0.001). Within the first 11 months post HCT, auto- and allo-HCT had similar risks of relapse/progression and PFS. Beyond 11 months, auto-HCT was associated with higher risk of relapse/progression (RR=21.3; P=0.003) and inferior PFS (RR=3.2; P=0.005). In the first 24 months post HCT, auto-HCT was associated with improved OS (RR=0.42; P=0.005), but in long-time survivors (beyond 24 months) it was associated with inferior OS (RR=3.6; P=0.04). RIC allo-HCT as the first transplant approach can provide improved PFS and OS, in long-term survivors.

Seminal epithelium in prostate biopsy can mimic malignant and premalignant prostatic lesions.

OBJECTIVES: In most prostate biopsies, the seminal epithelium is easily recognised because it meets characteristic histological criteria. However, some biopsies can mimic malignant or premalignant prostatic lesions. The aims of this study were to analyse the histological appearance of the biopsies that mimic adenocarcinomas or preneoplastic prostatic lesions, discuss the differential diagnosis and determine the frequency of seminal epithelia in prostate biopsies. METHODS: We consecutively reviewed 500 prostate puncture biopsies obtained using the sextant method and selected those cases in which we observed seminal vesicle or ejaculatory duct epithelium. In the biopsies in which the seminal epithelium resembled malignant or premalignant lesions, immunohistochemical studies were conducted that included prostate-specific antigen and MUC6. The most important clinical data were recorded. RESULTS: Thirty-six (7.2%) biopsies showed seminal epithelium, and 7 of them (1.4%) resembled various prostate lesions, including high-grade prostatic intraepithelial neoplasia, atypical acinar proliferations, adenocarcinomas with papillary patterns and poorly differentiated carcinoma. The seminal epithelium resembled prostate lesions when the lipofuscin deposit, the perinuclear vacuoles or the nuclear pseudoinclusions were inconspicuous or missing. Five of the 7 biopsies showed mild to moderate cellular atypia with small and hyperchromatic nuclei, and only 2 showed cellular pleomorphism. The patients were alive and asymptomatic after an average of 6 years of progression. CONCLUSIONS: The seminal epithelium resembles prostatic intraepithelial neoplasia, atypical acinar proliferations and various types of prostatic adenocarcinomas in approximately 1.4% of prostate biopsies.