Intra-dialytic blood oxygen saturation (SO2): association with dialysis hypotension (the SOGLIA Study).

BACKGROUND: Intradialytic hypotension (IDH) has a dramatic impact on the main outcomes of dialysis patients. Early warning of hemodynamic worsening during dialysis would enable preventive measures to be taken. Blood oxygen saturation (SO2) is used for hemodynamic monitoring in the critical care setting and may provide useful information about IDH onset. AIM: To evaluate whether short- and medium-term variations in the SO2 signal (ST-SO2var, MT-SO2var,) during dialysis are a predictor of IDH. METHODS: In this 3-month observational cohort study, 51 hypotension-prone chronic hemodialysis (HD) patients, with vascular access by arteriovenous fistula (AVF) or central venous catheter (CVC), were enrolled. Continuous non-invasive blood SO2 was monitored (fc = 0.2 Hz) by an optical sensor on the arterial line of the extracorporeal circulation; blood pressure (every 30 min), symptoms and their time of appearance were noted. Predictive power of IDH was expressed by the area under curve (AUC) sensitivity and specificity based on intradialytic variations in SO2. RESULTS: A total of 1290 HD sessions were analyzed. Overall, off-line ST-SO2var analysis proved able to correctly predict IDH in 67 % of the sessions where IDH occurred. The best predictive performance was found in the presence of highly arterialized AVF (SO2 > 95 %) (75 % sensitivity; AUC 0.825; p < 0.05). On the contrary, in sessions with CVC, IDH prediction proved more efficient by MT-SO2var (AUC 0.575; p = 0.01). CONCLUSIONS: Intradialytic SO2 variability could be a valid parameter to detect in advance the hemodynamic worsening that precedes IDH. Appropriate timely intervention could help prevent IDH onset.

[HFR-AEQUILIBRIUM and intradialytic cardiovascular stability: results of the first multicenter study in Lazio]. / HFR-AEQUILIBRIUM e stabilità cardiovascolare intradialitica: risultati del primo studio multi-centrico laziale.

Intradialytic hypotension (IDH) is a still-frequent and poorly-understood complication of haemodialysis. Haemofiltration has recently been shown to reduce the phenomenon of IDH. HFR-Aequilibrium adds to traditional HFR and is, in practice, a variant comprising endogenous re-infusion of haemodiafiltration with dialysate sodium concentration and ultrafiltration rate profiles elaborated by the 'Profiler' plasma sodium biofeedback system, and measurement of plasma sodium via the on-line Natrium sodium sensor.

Preliminary classification criteria for the cryoglobulinaemic vasculitis.

BACKGROUND: To develop preliminary classification criteria for the cryoglobulinaemic syndrome or cryoglobulinaemic vasculitis (CV). METHODS: Study part I developed a questionnaire for CV to be included in the formal, second part (study part II). Positivity of serum cryoglobulins was defined by experts as an essential condition for CV classification. In study part II, a core set of classification items (questionnaire, clinical and laboratory items, as agreed) was tested in three groups of patients and controls-that is, group A (new patients with the CV), group B (controls with serum cryoglobulins but lacking CV) and group C (controls without serum cryoglobulins but with features which can be observed in CV). RESULTS: In study part I (188 cases, 284 controls), a positive response to at least two of three selected questions showed a sensitivity of 81.9% and a specificity of 83.5% for CV. This questionnaire was employed and validated in study part II, which included 272 patients in group A and 228 controls in group B. The final classification criteria for CV, by pooling data from group A and group B, required the positivity of questionnaire plus clinical, questionnaire plus laboratory, or clinical plus laboratory items, or all the three, providing a sensitivity of 88.5% and a specificity of 93.6% for CV. By comparing data in group A versus group C (425 controls), the same classification criteria showed a sensitivity 88.5% and a specificity 97.0% for CV. CONCLUSION: Classification criteria for CV were developed, and now need validation.

Hemodiafiltration with endogenous reinfusion with and without acetate-free dialysis solutions: effect on ESA requirement.

BACKGROUND: Hemofiltrate reinfusion (HFR) is a form of hemodiafiltration (HDF) in which replacement fluid is constituted by ultrafiltrate from the patient 'regenerated' through a cartridge containing hydrophobic styrene resin. Bicarbonate-based dialysis solutions (DS) used in routine hemodialysis and HDF contain small quantities of acetate (3-5 mM) as a stabilizing agent, one of the major causes of intradialytic hypotension. Acetate-free (AF) DS have recently been made available, substituting acetate with hydrochloric acid. The impact of AF DS during HFR on Hb levels and erythropoietic-stimulating agent (ESA) requirement in chronic dialysis patients was assessed. PATIENTS AND METHODS: After obtaining informed consent, 30 uremic patients treated by standard bicarbonate dialysis (BHD, DS with acetate) were randomized to treatment in 3-month cycles: first AF HFR, followed by HFR with acetate, and again AF HFR. At the beginning and end of each period, Hb and ESA requirements were evaluated. RESULTS: A significant increase in the Hb level was observed throughout all periods of HFR versus BHD (from 11.1 to 11.86 g/dl; p = 0.04), with a significant decrease of ESA requirements from 29,500 to 25,033 IU/month (p = 0.04). CONCLUSION: Regardless of the presence or absence of acetate in DS, HFR per se allows a significant lowering of ESA dosage versus BHD, while at the same time increasing Hb levels. Taking for granted the clinical impact produced, HFR seems to provide a relevant decrease in end-stage renal disease patient costs.

First Report of Alternaria Species Groups Involved in Disease Complexes of Hazelnut and Walnut Fruit.

During the last 5 years, two new diseases, brown apical necrosis (BAN) and gray necrosis (GN), were observed on English walnut (Juglans regia) and hazelnut (Corylus avellana), respectively (2,3). Both diseases caused severe fruit drop resulting in yield loss often exceeding 30%. Previous work demonstrated that BAN and GN are disease complexes caused by several fungi (Alternaria spp., Fusarium spp., and a Phomopsis sp.) (2,3). In both diseases, preliminary identification of Alternaria spp. revealed they were a complex of small-spored catenulate taxa related to A. alternata. To further characterize these taxa, additional pathogenicity tests and morphological examinations were conducted with isolates obtained from each host. Single-spored isolates were prescreened for pathogenicity by inoculating detached, surface-disinfested hazelnut leaves or walnut leaflets (1). Only isolates that produced foliar lesions after 5 days were used in subsequent fruit inoculations. From this screening, 35 isolates were selected (19 from walnut and 16 from hazelnut). For each isolate, attached fruit of respective hosts were inoculated at bloom by placing 10 µl of a conidial suspension (1 × 106 conidia per ml of H2O + 0.26% agar) onto the stigmas (150 fruit per isolate). Controls (150 fruit) were treated with agar solution only. After 15 days, fruit were examined for development of disease symptoms, and examination continued until fruit maturation (late July). Approximately 20 to 50% of the inoculated fruit displayed discoloration or necrosis of internal tissue, particularly the pericarp and the embryo, although symptoms were more limited than those typically seen in fully expressed BAN and GN. No differences in symptoms were evident among the isolates tested. The controls showed no symptom development initially, although 5% began to develop discoloration at fruit maturity. Fungal isolates used as inoculum were reisolated from all symptomatic fruit by surface disinfesting tissue from the margins of necrotic lesions. For each isolate, the conidial characteristics were described from cultures grown under defined conditions (4). Three distinct groups of isolates were identified. Alternata sp. group isolates produced conidial chains (8 to 20 spores) with numerous secondary and occasionally tertiary chains branching from apical and median cells. Conidia were typically ovate and often possessed a one-celled apical extension. Tenuissima sp. group isolates developed conidial chains (10 to 22 spores) with occasional branching forming secondary chains from apical and median cells. Conidia were ovate to obclavate, often with long apical extensions (10 to 35 µm). Arborescens sp. group isolates developed conidial chains (5 to 12 spores) with numerous secondary, tertiary, and quaternary short chains branching from apical cells. Conidia were typically ovate with minimal apical extensions. Of the walnut isolates, 12, 4, and 3 were from the arborescens, alternata, and tenuissima sp. groups, respectively. Of the hazelnut isolates, 7, 6, and 3 were from the arborescens, alternata, and tenuissima sp. groups, respectively. The finding that Alternaria from several distinct sp. groups can cause similar disease on a single host is consistent with previous work on pistachio, almond, and pear (4). References: (1) A. Belisario et al. Plant Dis. 83:696, 1999. (2) A. Belisario et al. Plant Dis. 86:599, 2002. (3) A. Belisario et al. Inf. Agrario 59:71, 2003. (4) B. M. Pryor et al. Phytopathology 92:406, 2002.

First Report of Wilt and Dieback on Pokeweed (Phytolacca decandra) Caused by Phytophthora nicotianae.

Pokeweed (Phytolacca decandra, synonym Phytolacca americana) is a root perennial plant that produces a succulent annual stem. In late June 2001, a severe dieback occurred on a group of pokeweed plants being grown as ornamentals in a garden in Rome. Disease symptoms consisted of leaf wilting followed by collapse of the plant. Stem collars and roots had dark brown-to-black water-soaked lesions. A wet rot was observed on plants with advanced disease symptoms. Isolations, from sections of roots and stems previously washed in running tap water, were made on PARBhy selective medium (10 mg of pimaricin, 250 mg of ampicillin [sodium salt], 10 mg of rifampicin, 50 mg of hymexazol, 15 mg of benomyl, 15 g of malt extract, and 20 g of agar in 1,000 ml of H2O) (2), followed by incubation at 20°C. A species of Phytophthora identified based on morphological and cultural characteristics (1) was isolated consistently from rotted roots and collars of diseased plants. All isolates produced papillate, spherical, ovoid to obturbinate, noncaducous sporangia and terminal and intercalary chlamydospores. Hyphal swellings with hyphal outgrowths were present. Observed characteristics were similar to those described for P. nicotianae. Isolates were mating type A2 with amphigynous antheridia in paired cultures with the A1 tester isolate of P. nicotianae. Identification was confirmed by comparing restriction fragment length polymorphism patterns of the internal transcribed spacer region of ribosomal DNA with those obtained from previously identified Phytophthora species. Pathogenicity tests were conducted on 10 2-month-old potted pokeweed plants. Inoculum was prepared by inoculating sterilized millet seeds moistened with V8 broth with plugs of mycelium and growing for 4 weeks. The inoculum was added to potting soil at 3% (wt/vol), and sporulation was induced by flooding the soil for 48 h. Five uninoculated plants were used as controls. Plants were maintained outdoors and assessed for symptoms within 2 months after inoculation. Wilting, root rot, and dark brown lesions on the collar developed on inoculated plants. The pathogen was reisolated from the inoculated plants and morphologically identical to the original isolates, which confirmed P. nicotianae as the causal agent of the disease. Few diseases have been reported on Phytolacca decandra. This species is not only an invasive weed, but is also cultivated as an ornamental and medicinal plant. In addition, antiviral (PAP) and antifungal (Pa-AFP) proteins that are used as a remedy for several human and plant infections have been extracted from the plant. To our knowledge, this is the first report of P. nicotianae on pokeweed. References: (1) D. C. Erwin and O. K. Ribeiro. Phytophthora Diseases Worldwide. The American Phytopathological Society, St. Paul, MN, 1996. (2) A. M.Vettraino et al. Plant Pathol. 50:90, 2001.

Resistance to Fusarium oxysporum f. sp. melonis Race 1,2 in Muskmelon Lines Nad-1 and Nad-2.

Of seven doubled-haploid melon lines parthenogenetically originated using irradiated pollen, two lines, Nad-1 and Nad-2, were selected for resistance to Fusarium wilt after successive inoculations with F. oxysporum f. sp. melonis race 1,2w virulent isolate. Nad-1 and Nad-2 were compared with the commercial hybrids and with the parent cvs. Isabelle and Giallo di Paceco. Evaluation of germplasm extended over a 2-year period showed a higher resistance of Nad-1 and Nad-2 plants to Fusarium oxysporum f. sp. melonis race 1,2 than other genotypes tested in this study. The resistance expressed in the two doubled-haploid lines could be due to their homozygous state that maximizes the expression of the genes for resistance already present in the parental line Isabelle. The use of this source of resistance may be exploited commercially either in rootstocks or to facilitate breeding for F1 hybrids. Future research will concentrate on the identification of genetic markers associated with resistance to race 1,2 using these doubledhaploid lines.

Occurrence of Pink Patch of Perennial Ryegrass Caused by Limonomyces roseipellis in Italy.

In March 1999, an unusual pink gelatinous mycelium was observed on several cultivars of perennial ryegrass (Lolium perenne L.) turf grown in experimental plots in Saint Andrea d'Agliano, Perugia (central Italy). Approximately 50% of the turf area showed symptoms on susceptible varieties. The same symptoms, although with lower severity, were observed during the following year in two experimental fields in northern Italy. The presence of mycelium on infected leaf blades was extensive during periods of high relative humidity and high temperature. The disease decreased progressively when weather conditions became dry and cold. A fungus, characterized by pink colonies, was consistently isolated from leaves of affected plants on potato dextrose agar (pH 5.5). On the basis of the presence of clamp connections and binucleate hyphal cells, the fungus was identified as Limonomyces roseipellis Stalpers & Loerakker, the causal agent of pink patch of turfgrass (1,3). For the pathogenicity test, one isolate of L. roseipellis was grown on maize flour and sand medium (2) at 22 ± 2°C for 14 days. Inoculum (20 g) was added to a sterile mixture of sand and peat moss (1:1; 640 g). Two hundred seeds of L. perenne (cv. Amadeus) were sown in boxes containing infested or noninfested soil as a control. Boxes were kept in a greenhouse at 22 ± 2°C, 80% relative humidity, and 14 h of sunlight per day. Four to five weeks after sowing, typical lesions resembling natural symptoms were observed only on plants grown in inoculum-infested soil, and L. roseipellis was consistently reisolated from diseased plants. Pink patch is probably underestimated in turf since the symptoms are less severe compared with red thread caused by Laetisaria fuciformis (McAlpine) Burdsall, and the development of mycelium of Limonomyces roseipellis is slower. References: (1) J. D. Kaplan and N. Jackson. Plant Dis. 67:159, 1983. (2) Y. L. Nene et al. ICRISAT Inf. Bull. 10:1, 1981. (3) J. A. Stalpers and W. M. Loerakker. Can. J. Bot. 60:529, 1982.

Occurrence and Etiology of Brown Apical Necrosis on Persian (English) Walnut Fruit.

In 1998, a severe fruit drop was observed in Italy, principally on cv. Lara Persian (English) walnut (Juglans regia). Dropped fruit showed a brown patch at the blossom end and blackening and rot of inner tissues. The disease, called brown apical necrosis (BAN), was investigated on fruit collected in Italy and France in 1999. In 2000, studies were carried out in three walnut orchards located in Italy and in France to substantiate the etiology of BAN. Isolations performed from inner diseased fruit tissues yielded several fungi, in decreasing frequency of isolation: species of Fusarium and Alternaria, and one species each of Cladosporium, Colletotrichum, and Phomopsis. However, only Fusarium spp. were recovered from stigmas of BAN-affected fruit. The fungi associated with BAN-diseased fruit and species composition differed among locations and over time, confirming results obtained in previous investigations. The species of Fusarium used in pathogenicity tests reproduced BAN-disease symptoms when inoculated on fruit, whereas an Alternaria alternata isolate caused only limited necrosis of the style. However, the role of the other fungi commonly isolated from BAN-diseased fruit remains to be defined. The walnut blight pathogen, Xanthomonas arboricola pv. juglandis, occasionally was isolated from BAN-diseased fruit. No correlation was found between the extent of external brown patches and the size of inner lesions. Repeated isolations from and inoculations of fruit demonstrated that BAN can be considered a complex disease, and the inner infections originate from the style of the fruit.

First Report of Leaf Spot Caused by Alternaria alternata on Kiwifruit in Italy.

A leaf spot of kiwifruit (Actinidia deliciosa (A. Chev.) C. F. Liang & A. R. Ferg.) leaves was recently observed on plants of the cultivar Hayward in an orchard near Salerno, in southern Italy. The affected plants showed early severe defoliation. The fungus isolated from the infected leaves was identified as Alternaria alternata (Fr.:Fr.) Keissl., based on conidial morphological characteristics. Pathogenicity tests were made by inoculating detached leaves of male pollinator cultivar Tomuri and the female cultivars Hayward and Bruno with a 7-mm disk taken from actively growing cultures of the fungus on potato dextrose agar (PDA). After 14 days, necrotic leaf spots developed and A. alternata was consistently isolated from the inoculated leaves. A. alternata has been observed as a pathogen on leaves and fruits in New Zealand. In the Mediterranean, it has been reported in Israel (2) and in the island of Crete (1). This is the first report of Alternaria leaf spot on kiwifruit in Italy. References: (1) V. A. Bourbos and M. T. Skoudridakis. Petria 7:111, 1997. (2) A. Sive and D. Resnizky. Alon Hanotea 41:409, 1987.

First Report of Root and Collar Rot by Sclerotium rolfsii on Apple Trees in Italy.

Sclerotium rolfsii Sacc. (teleomorph Athelia rolfsii (Curzi) Tu & Kimbrough) is a polyphagous, soilborne plant pathogen. In summer 1998, a sudden death of 2-year-old apple trees (Malus domestica Borkh.) cv. Royal Gala grafted on M9 rootstock was observed in an orchard near Rome, Italy. Symptoms were stunted vegetation, leaf chlorosis, and root and collar rot. A fungus identified as S. rolfsii was observed producing sclerotia and whitish mycelial strands on root and collar bark. Isolations from roots and at the margin of subcortical necrosis on the collar consistently yielded S. rolfsii colonies on potato dextrose agar (PDA); sclerotia developed within 7 days. Koch's postulates were fulfilled by inoculating 10 1-year-old apple tree cv. M9 rootstocks, grown in 3.5-liter pots, with an S. rolfsii isolate grown for 1 week on PDA at 25°C. One ground plate per plant was used, placed around collar and main roots. Five control plants were treated with PDA only. Rootstocks were kept in the greenhouse at 26 ± 2°C. Within 2 months, 70% of inoculated plants died, with marked necrosis girdling the collar. The other inoculated plants showed a general decline, with widespread necrosis on collars and main roots. Control plants remained healthy. S. rolfsii was reisolated from collars and roots of symptomatic plants. S. rolfsii has been recorded on apple trees in the U.S., India, China, and Israel. In Italy, it is destructive on several crops, and was recently recorded on walnut (1). This first outbreak of S. rolfsii on apple in Italy may have been favored by exceptionally warm late spring and summer temperatures. Reference: (1) A. Belisario and L. Corazza. Plant Dis. 80:824, 1996.

First Report of Alternaria alternata Causing Leaf Spot on English Walnut.

A foliar disease of English walnut (Juglans regia L.) was observed in 1998 in an orchard in northern Italy. Symptoms consisted of circular, necrotic spots bordered with concentric zones of darker tissue. Average lesion diameter was 20 mm, although lesions could extend to half of the leaflet lamina. A fungus identified as Alternaria alternata (Fr.:Fr.) Keissl. (1) was observed on the necrotic tissue and was consistently isolated from the margins of the necrosis. Conidia from leaves were brown, ellipsoid to ovoid (primary conidia 28 to 60 × 8 to 15 µm; secondary conidia 10 to 30 × 7 to 13 µm), with walls often ornamented, 1 to 6 transversely septate and 0 to 3 longitudinally septate. For pathogenicity tests, three isolates were grown on potato dextrose agar for 2 weeks. Inoculations were performed on detached, surface-sterilized, healthy J. regia leaflets. Four drops (5 µl each) of a sterile water suspension of 1 × 105 conidia per ml were placed on each leaflet; three leaves per isolate were used. Leaves were incubated in a moist chamber. After 10 days, leaf spots similar to the original symptoms developed on all the inoculated points for all three isolates, and the pathogen was reisolated. Control leaflets inoculated with sterile, distilled water remained symptomless. The experiment was performed three times and the results were similar. Alternaria alternata is a well-known pathogen on many crops but a few records report this fungus as a causal agent of leaf spot on deciduous trees. This is the first report of A. alternata on English walnut. Reference: (1) E. G. Simmons. Mycotaxon 37:79, 1990.

First Report of Myrothecium verrucaria from Muskmelon Seeds.

Myrothecium verrucaria (Albertini & Schwein.) Ditmar:Fr. was isolated from muskmelon (Cucumis melo L.) seeds of Charentais-T, a culti var used as a differential host with no resistance to Fusarium oxysporum f. sp. melonis races. A white floccose mycelial mat developed on melon seeds during incubation on moist blotters. Mycelia were mass transferred from melon seeds onto potato dextrose agar (PDA) medium. At 25°C in the dark, a mycelial mat with characteristic annelations of greenish-black sporodochia, without setae, was produced. Conidia (2 to 3 × 6 to 10 µm) were lemon shaped, with a typical conical mucous appendage at one end, which was visible with Loeffer's flagella stain (1). Based on these characteristics, the fungus was identified as M. verrucaria. For pathogenicity studies, surface sterilized seeds of C. melo cv. Charentais-T were coated with M. verrucaria conidia by gently rubbing the seeds on sporodochia produced on 15-day-old cultures on PDA. Once coated, seeds were plated onto water agar and on sterile moist blotters in 9-cm-diameter petri dishes. Plates were incubated at 28°C in the dark. Five seeds per plate and three plates per experiment were used. Experiments were replicated three times. Control seeds were plated without coating. After 7 days, on water agar, 90% of melon seeds failed to germinate while the remaining 10% produced young seedlings that died from root rot and necrotic lesions on the hypocotyl. After 12 days on moist blotters, 100% of the melon seedlings died, showing necrotic lesions on the hypocotyl and on the main root. The pathogen was reisolated from symptomatic melon seedlings. All control seeds germinated and grew into healthy seedlings. M. verrucaria, known to be a seed-borne pathogen, has been isolated from soil and plants worldwide (2). This is the first report of M. verrucaria pathogen on muskmelon. This fungus is not a serious concern when seeds are dressed with fungicides. References: (1) K. V. A. Thompson and S. C. Simmens. Nature. 193:196, 1962. (2) S.-M. Yang and S. C. Jong. Plant Dis. 79:994, 1995.