Performance of the GenoType MTBDRsl in a programmatic setting, South Africa.

BACKGROUND: The GenoType MTBDRsl v2 is a molecular test designed for the rapid detection of resistance to second-line anti-TB drugs in Mycobacterium tuberculosis complex (MTBC).OBJECTIVE: To assess the use of MTBDRsl in a programmatic setting and to describe the resistance patterns in a high HIV-TB-endemic area in South Africa.METHODS: We performed a retrospective data analysis of all MTBDRsl results in patients with newly diagnosed rifampicin-resistant TB (RR-TB). We compared its performance on direct testing of smear-positive and smear-negative specimens. Results were examined to observe the detected resistance-conferring mutations.RESULTS: Of 1873 RR-TB/multidrug-resistant TB (MDR-TB), 37.4% were smear-negative and 62.5% were smear-positive. Among smear-negative specimens, the MTBDRsl showed an inconclusive rate of 61.2%, while the inconclusive rate from smear-positive specimens was 6.6%. The most common mutation observed in case of fluoroquinolone resistance occurred at the gyrA gene, codon 90 (A90V) (61/158, 38.6%), and the most common mutation in injectable aminoglycoside resistance occurred in the rrs region, A1401G (71/108, 65.7%).CONCLUSION: In HIV-TB-prevalent settings, routine use of the MTBDRsl is more effective when performed directly on smear-positive specimens. In view of currently used injectable-free regimens, this test requires revision.

Hemostats in Spine Surgery: Literature Review and Expert Panel Recommendations.

Bleeding in spine surgery is a common occurrence but when bleeding is uncontrolled the consequences can be severe due to the potential for spinal cord compression and damage to the central nervous system. There are many factors that influence bleeding during spine surgery including patient factors and those related to the type of surgery and the surgical approach to bleeding. There are a range of methods that can be employed to both reduce the risk of bleeding and achieve hemostasis, one of which is the adjunct use of hemostatic agents. Hemostatic agents are available in a variety of forms and materials and with considerable variation in cost, but specific evidence to support their use in spine surgery is sparse. A literature review was conducted to identify the pre-, peri-, and postsurgical considerations around bleeding in spine surgery. The review generated a set of recommendations that were discussed and ratified by a wider expert group of spine surgeons. The results are intended to provide a practical guide to the selection of hemostats for specific bleeding situations that may be encountered in spine surgery.

Body mass index at diagnosis of a childhood brain tumor; a reflection of hypothalamic-pituitary dysfunction or lifestyle?

PURPOSE: Childhood brain tumor survivors (CBTS) are at risk of becoming overweight, which has been shown to be associated with hypothalamic-pituitary (HP) dysfunction during follow-up. Body mass index (BMI) at diagnosis is related to BMI at follow-up. It is uncertain, however, whether aberrant BMI at brain tumor diagnosis reflects early hypothalamic dysfunction or rather reflects genetic and sociodemographic characteristics. We aimed to examine whether BMI at childhood brain tumor diagnosis is associated with HP dysfunction at diagnosis or its development during follow-up. METHODS: The association of BMI at diagnosis of a childhood brain tumor to HP dysfunction at diagnosis or during follow-up was examined in a Dutch cohort of 685 CBTS, excluding children with craniopharyngioma or a pituitary tumor. Individual patient data were retrospectively extracted from patient charts. RESULTS: Of 685 CTBS, 4.7% were underweight, 14.2% were overweight, and 3.8% were obese at diagnosis. Being overweight or obese at diagnosis was not associated with anterior pituitary deficiency or diabetes insipidus at diagnosis or during follow-up. In children with suprasellar tumors, being obese at diagnosis was associated with central precocious puberty. CONCLUSION: Overweight or obesity at diagnosis of a childhood brain tumor seems not to be associated with pituitary deficiencies. These results suggest that genetics and lifestyle may be more important etiologic factors for higher BMI at diagnosis in these children than hypothalamic dysfunction. To improve the long-term outcome of CBTS with regards to overweight and obesity, more attention should be given to lifestyle already at the time of brain tumor treatment.

Prevalence and risk factors of hypothalamic-pituitary dysfunction in infant and toddler childhood brain tumor survivors.

OBJECTIVE: Childhood brain tumor survivors (CBTS) are at risk to develop hypothalamic-pituitary (HP) dysfunction (HPD). The risk for HPD may vary between different age groups due to maturation of the brain and differences in oncologic treatment protocols. Specific studies on HPD in infant brain tumor survivors (infant-BTS, 0-1 years at diagnosis) or toddler brain tumor survivors (toddler-BTS, ≥1-3 years) have not been performed. PATIENTS AND METHODS: A retrospective nationwide cohort study in CBTS was performed. Prevalence and risk factors for HPD were compared between infant-, toddler-, and older-BTS. Subgroup analysis was performed for all non-irradiated CBTS (n = 460). RESULTS: In total, 718 CBTS were included, with a median follow-up time of 7.9 years. Overall, despite the less frequent use of radiotherapy (RT) in infants, no differences in the prevalence of HPD were found between the three groups. RT (OR: 16.44; 95% CI: 8.93-30.27), suprasellar tumor location (OR: 44.76; 95% CI: 19.00-105.49), and younger age (OR: 1.11; 95% CI: 1.05-1.18) were associated with HP dysfunction. Infant-BTS and toddler-BTS showed more weight gain (P < 0.0001) and smaller height SDS (P = 0.001) during follow-up. In non-irradiated CBTS, infant-BTS and toddler-BTS were significantly more frequently diagnosed with TSH-, ACTH-, and ADH deficiency, compared to older-BTS. CONCLUSION: Infant and toddler brain tumor survivors seem to be more vulnerable to develop HP dysfunction than older children. These results emphasize the importance of special infant and toddler brain tumor treatment protocols and the need for endocrine surveillance in children treated for a brain tumor at a young age.

Management and consequences of postoperative fluctuations in plasma sodium concentration after pediatric brain tumor surgery in the sellar region: a national cohort analysis.

PURPOSE: Severe fluctuations in plasma sodium concentration and plasma osmolarity, including central diabetes insipidus (CDI), may have significant influence on postoperative morbidity and mortality after pediatric brain tumor surgery.The aim of this study was to describe the frequency, severity and neurological consequences of these fluctuations in pediatric brain tumor survivors. METHODS: A retrospective, multi-institutional chart review was conducted among all children who underwent brain tumor surgery in the sellar or suprasellar region in seven university hospitals in the Netherlands between January 2004 and December 2013. RESULTS: Postoperative CDI was observed in 67.5% of 120 included children. Fluctuations of plasma sodium concentration ≥ 10 mmol/L/24 h during the first ten postoperative days were seen in 75.3% of patients with CDI, with a maximum delta of 46 mmol/L/24 h. When compared to patients without CDI, altered mental status occurred more frequently in patients with postoperative CDI (5.1 vs. 23.5% respectively, p = 0.009). Low plasma sodium concentration was related to altered mental status and the occurrence of seizures. Frequency and severity of fluctuations in plasma sodium concentration during the first ten postoperative days were significantly higher in patients with permanent CDI at last follow-up than in patients with transient CDI or without CDI (p = 0.007). CONCLUSION: Postoperative CDI is a common complication after pediatric brain tumor surgery in the sellar or suprasellar region. Extreme plasma sodium concentrations and large intra-day fluctuations still occur and seem to influence the postoperative neurological course. These results illustrate the need for intensive monitoring in a highly experienced center.

Predictors of general discomfort, limitations in activities of daily living and intention of a second donation in unrelated hematopoietic stem cell donation.

We performed a retrospective study of 1868 consecutive unrelated donors to predict the risk factors related to general discomfort, limitations in activities of daily living (ADLs) and intention of a second donation in hematopoietic stem cell (HSC) donation. General discomfort and limitations in ADLs were assessed by numerical measurement (scores of 0-10) and donor's intention of a second donation by yes or no reply. The post-donation questionnaires were completed within 48 h after HSC collection and at 1 week, 4 weeks, and 4 months thereafter. Predictors of general discomfort included female sex (P<0.0001), bone marrow (BM) collection (P<0.0001) or PBSC collection through a central line (CL; P=0.0349), 2-day collection (P=0.0150) and negative or undetermined intention of a second donation on day 1 (P<0.0001). Predictors of limitations in ADLs included age group of 30-39 years (P=0.0046), female sex (P<0.0001), BM collection (P<0.0001) or PBSC collection through a CL (P<0.0001) and negative or undetermined intention of a second donation on day 1 (P<0.0001). The only predictor of positive intention of a second donation was male sex (P=0.0007). Age, sex and collection method and period should be considered risk factors when unrelated HSC donation is performed.

Rectal tube drainage reduces major anastomotic leakage after minimally invasive rectal cancer surgery.

AIM: Anastomotic leakage is the most serious complication following low anterior resection for rectal cancer and is a major cause of postoperative morbidity and mortality. The object of the present study was to investigate whether rectal tube drainage can reduce anastomotic leakage after minimally invasive rectal cancer surgery. METHOD: Three hundred and seventy-four patients who underwent laparoscopic or robotic LAR for tumours located ≤ 15 cm above the anal verge between 1 April 2012 and 31 October 2014 were assessed retrospectively. Of these, 107 with intermediate risk of anastomotic leakage received transanal rectal tube drainage. The rectal tube group was matched by propensity score analysis with patients not having rectal tube drainage, giving 204 patients in the study. Covariates for propensity score analysis included age, sex, body mass index, tumour height from the anal verge and preoperative chemoradiation. RESULTS: Patient demographics, tumour location, preoperative chemoradiation and operative results were similar between the two groups. The overall leakage rate was 10.8% (22/204), with no significant difference between the rectal tube group (9.8%) and the nonrectal tube group (11.8%, P = 0.652). Of the patients with anastomotic leakage, major leakage requiring reoperation developed in 11.8% of those without and 3.9% of those with a rectal tube. On multivariate analysis, age over 65 years and nonuse of a rectal tube were found to be independent risk factors for major anastomotic leakage. CONCLUSION: Rectal tube placement may be a safe and effective method of reducing the rate of major anastomotic leakage, alleviating the clinical course of leakage following minimally invasive rectal cancer surgery.

Long-term outcomes of locally or radically resected T1 colorectal cancer.

AIM: Little is known about the long-term outcome of T1 colorectal cancer (CRC) following curative resection. The present study addressed the long-term outcome of locally or radically resected T1 CRCs. METHOD: A total of 430 patients with T1 CRC who underwent local or radical resection were considered. Unfavourable histological factors were defined as positive resection margin, deep submucosal invasion, vascular invasion, Grade 3 and budding. The patients were classified as low-risk (unfavourable histological factor negative, n = 65) or high-risk (unfavourable histological factor positive, n = 365). RESULTS: Over a median follow-up of 78.4 months, disease recurred in 16 (3.7%) patients in the high-risk group, and no recurrence in the low-risk group. Resection type and vascular invasion were significantly associated with recurrence. In the vascular invasion (+) high-risk group, both 5-year disease-free survival rate and 5-year overall survival rate were significantly associated with resection type (radical 94.6%, local 43.8%, P < 0.001, and radical 99.1%, local 66.7%, P < 0.001). In the vascular invasion (-) high-risk group, 5-year disease-free survival rate was also significantly associated with resection type (radical 98.9%, local 84.7%, P = 0.001). However, 5-year overall survival rate was not associated with resection type (radical 98.9%, local 95.2%, P = 0.816). CONCLUSION: Local resection may be effective and oncologically safe in low-risk T1 CRC. Although additional surgery should be recommended for the locally resected high-risk T1 CRC cases, intensive surveillance without additional surgery and timely salvage operation may offer another treatment option, if vascular invasion is negative.

Treatment of neonatal progressive ventricular dilatation: a single-centre experience.

OBJECTIVE: To describe our experience with a cohort of 295 infants with progressive ventricular dilatation occurring in the antenatal or neonatal period. METHODS: A search was performed in our cranial ultrasound database. All records and images of infants in whom an imaging diagnosis of progressive ventricular dilatation had been made were retrieved. In addition, modes of treatment were analysed. RESULTS: Between February 1991 and March 2012, 295 neonates were admitted to our level 3 neonatal intensive care unit (NICU), and developed progressive ventricular dilatation for which they required intervention. In the majority of these infants, progressive ventricular dilatation developed following IVH grade III or IV (240/295; 81%) of whom 214/240 (89%) were preterms. Temporary treatment with lumbar punctures and punctures from ventricular reservoirs was sufficient for the majority of the preterms. A ventricular reservoir was inserted in 216/295 infants (73%). The overall infection rate was low (6%). A ventriculoperitoneal shunt (VP shunt) was inserted in 32% of the whole cohort, revision within 3 months was necessary in 20%, and shunt-related infection occurred in 12%. CONCLUSIONS: This large, single-centre cohort study reports the management of progressive ventricular dilatation in newborn infants. We have shown that with our approach, complications stay within acceptable limits.

First Report of Choanephora Rot Caused by Choanephora cucurbitarum on Hosta plantaginea in Korea.

Hosta plantaginea (Lam.) Asch. is an herbaceous perennial plant with ornamental value. In August 2013, water-soaked spots and wet rot were found on flowers of H. plantaginea in a garden bedded out for landscaping in Hongcheon County, Korea. Symptoms initially appeared as water-soaked spots at the tips of flowers. Dark gray spots on flower petals often coalesced and led to rotting of flowers, with abundant sporulation. However, no symptoms were found on the leaves. Approximately 30% of the flowers were affected in the landscape bed. A fungal isolate was obtained by plating surface-disinfested diseased flower tissue on potato dextrose agar (PDA). Fungal colonies covering the plate (diam. 90 mm) in 48 h were white at first, with abundant aerial mycelia, but later turned pale yellow with abundant sporangiola. Sporangiophores bearing sporangiola were aseptate, hyaline, and usually arose from infected tissue. Sporangiola were ellipsoid to ovoid, indehiscent, brown to dark brown, pediculate, 7 to 12 µm wide and 9 to 20 µm high, and showed longitudinal striations at high magnification. Sporangia were few-spored to multispored, pale brown to brown, and 50 to 150 µm. Sporangiospores from sporangia were broadly ellipsoid, brown to pale brown, with hyaline polar appendages, 8 to 10 µm wide and 15 to 22 µm high. Zygospores were not observed. The morphological and cultural characteristics, especially based on shape and striation of sporangiola, were identical with those of Choanephora cucurbitarum (Berk. & Ravenel) Thaxt. (2,3). A representative specimen was deposited in the Korea University Herbarium (KUS-F27540). Genomic DNA was extracted using a DNeasy Plant Mini Kit (Qiagen Inc., Valencia, CA). The primers ITS1/ITS4 and NL1/LR3 were used to amplify the internal transcribed spacer (ITS) region of rDNA and the D1/D2 region of the large subunit (LSU), respectively (4). The PCR products were purified and directly sequenced. The resulting 594-bp ITS and 680-bp D1/D2 sequences were submitted to GenBank (Accession Nos. KM200034 and KM200035). A GenBank BLAST search of the fungal database showed that the sequences of ITS and D1/D2 regions matched those of C. cucurbitrarum (JN943006 and JN939195) with 100% similarity. A pathogenicity test was conducted by spraying three healthy potted plants (2 months old) with a sporangiola suspension (2 × 104 conidia/ml). Another three potted plants of the same age were treated with sterile water and served as controls. The plants were kept in humid chambers for 2 days and placed in a greenhouse (28°C and 60 to 80% RH). After 4 to 5 days, water-soaked spots were evident on the flowers of inoculated plants. No symptoms were observed on control plants. A pathogenicity test was conducted twice with the same results, fulfilling Koch's postulates. C. cucurbitarum has a wide host range but has not been previously reported to cause disease on H. plantaginea (1). To our knowledge, this is the first report of C. cucurbitarum on H. plantaginea globally as well as in Korea. Choanephora rot of flowers is an issue under high-moisture conditions, so allowing for adequate airflow and a dry plant canopy should aid in disease suppression. References: (1) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab. Online publication, ARS, USDA, retrieved July 11, 2014. (2) P. M. Kirk. Mycol. Pap. 152:1, 1984. (3) A. Saroj et al. Plant Dis. 96:293, 2012. (4) G. Walther et al. Persoonia 30:11, 2013.

Stereolithographic skull models in the surgical planning of fronto-supraorbital bar advancement for non-syndromic trigonocephaly.

BACKGROUND: Fronto-supraorbital bar advancement in the treatment for trigonocephaly is associated with extensive intraoperative blood loss and compensatory erythrocyte transfusions. Since both are related to the length of surgery, efforts have been focused on optimizing preoperative preparations. The utilization of three-dimensional skull models in surgical planning allows for familiarization with the patient's anatomy, the optimization of osteotomies, the preparation of bone grafts and the selection of fixation plates. METHODS: Stereolithographic skull models were used in the surgical planning for five patients with non-syndromic trigonocephaly treated in Wilhelmina Children's Hospital in 2012. A comparison group was composed of six patients with non-syndromic trigonocephaly treated by the same surgical team. Once all patients had received surgery, a retrospective chart review was performed to identify the volumes of perioperative blood loss and erythrocyte transfusions and the length of the procedure. Furthermore, the educational value of the models was assessed in a round table discussion with the surgical team and residents. RESULTS: In the model group patients were transfused a mean 24 ml/kg (27% of Estimated Blood Volume [EBV]) compared to 16 ml/kg (18% of EBV) in the comparison group (P = 0.359) for a mean perioperative blood loss of 53 ml/kg (60% of EBV) in the model group against 40 ml/kg (41% of EBV) in the comparison group (P = 0.792). The mean length of surgery in the model groups was 256 min versus 252 min in the comparison group (P = 0.995). Evaluation of educational purposes demonstrated that the models had a role in the instruction of residents and communication to parents, but did not improve the insight of experienced surgeons. CONCLUSION: The usage of stereolithographic skull models in the treatment of non-syndromic trigonocephaly does not reduce the mean volume of perioperative erythrocyte transfusions, the mean volume of perioperative blood loss nor the mean length of the surgical procedure. Nonetheless, the models do facilitate the education of the patient's parents as well as support the training of residents.

First Report of Choanephora Blight Caused by Choanephora infundibulifera on Hibiscus rosa-sinensis in Korea.

Hibiscus rosa-sinensis L., commonly known as Chinese hibiscus, is an evergreen flowering shrub belonging to the Malvaceae and is widely cultivated throughout Asia including Korea. In August 2013, blight was observed on Chinese hibiscus in a commercial flower nursery in Seoul, Korea. Initial symptoms began as reddish purple spots at the tip of flowers and expanded to encompass entire flowers. Infected lesions appeared water-soaked, reddish brown, and were followed by rapid rotting of infected tissues. Approximately 50% of the plants surveyed were affected. Monosporous sporangiola formed on infected tissue were transferred to potato dextrose agar (PDA). Fungal colonies were obtained that were at first white with abundant aerial mycelium, and then became yellowish with the appearance of sporangiola. Sporangiophores bearing sporangiola were erect to slightly curved, unbranched, and hyaline. Funnel-shaped secondary vesicles formed on the primary vesicles. Sporangiola were indehiscent, ovoid to subglobose, smooth, non-striated, brown to dark brown, 10 to 27.5 × 8.5 to 17 µm, and sometimes germinated in culture. The fungus was identified as Choanephora infundibulifera (Curr.) D.D. Cunn. based on the morphological and cultural characteristics (2). Voucher specimens were housed in the Korea University Herbarium (KUS). An isolate obtained from KUS-F27535 was deposited in the Korean Agricultural Culture Collection (Accession No. KACC47643) and used for a pathogenicity test and molecular analyses. To confirm identity of the fungus, genomic DNA was extracted with DNeasy Plant Mini Kits (Qiagen Inc., Valencia, CA). The internal transcribed spacer (ITS) region of rDNA and the D1/D2 region of the large subunit (LSU) were amplified with the primers ITS1/ITS4 and NL1/LR3, respectively (3), and sequenced. The resulting 635-bp ITS and 680-bp D1/D2 sequences were deposited in GenBank (Accession Nos. KF486539 and KF486538). A GenBank BLAST search revealed that the ITS sequences showed 100% similarity with that of C. infundibulifera (JN943009) and D1/D2 sequences also showed 100% identity with that of C. infundibulifera (JN939193). A sporangiola suspension (2 × 104 cells/ml) was sprayed over three pots of the shrub, kept in a humid chamber for 2 days, and placed in greenhouse (28°C and 80 to 100% RH). Another three potted plants of the same age were sprayed with sterile water and served as controls. After 4 days, typical blossom blight symptoms, identical to the ones observed in the nursery, developed on the inoculated flowers. No symptoms were observed on controls. C. infundibulifera was re-isolated from inoculated plants. Pathogenicity test was conducted twice with the same results, fulfilling Koch's postulates. Choanephora blight caused by C. infundibulifera on H. rosa-sinenesis has been reported in Japan, Myanmar, Nepal, Guinea, and the United States (1). In Korea, there was one record of this fungus on H. syriacus (1). To our knowledge, this is the first report of C. infundibulifera on H. rosa-sinensis in Korea. This pathogen could be a potential threat to the production of this ornamental shrub over a prolonged period of hot and humid weather. References: (1) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, Retrieved February 28, 2014. (2) P. M. Kirk. Mycol. Pap. 152:1, 1984. (3) G. Walther et al. Persoonia 30:11, 2013.

First Report of Powdery Mildew Caused by Erysiphe heraclei on Chervil in Korea.

Chervil (Anthriscus cerefolium (L.) Hoffm.), belonging to the family Apiaceae, is an aromatic annual herb that is native to the Caucasus. It is widely used as a flavoring agent for culinary purposes. This herb was recently introduced in Korea. In April 2013, plants showing typical symptoms of powdery mildew disease were observed in a polyethylene film-covered greenhouse in Seoul, Korea. White mycelium bearing conidia formed irregular patches on leaves and stems. Mycelial growth was amphigenous. Severe infections caused leaf withering and premature senescence. Voucher specimens were deposited in the Korea University Herbarium (KUS). Hyphae were septate, branched, with moderately lobed appressoria. Conidiophores presented 3 to 4 cells and measured 85 to 148 × 7 to 9 µm. Foot-cells of conidiophores were 37 to 50 µm long. Conidia were produced singly, oblong-elliptical to oblong, measured 30 to 50 × 13 to 18 µm with a length/width ratio of 2.0 to 3.3, lacked conspicuous fibrosin bodies, and with angular/rectangular wrinkling of the outer walls. Germ tubes were produced in the subterminal position of conidia. Chasmothecia were not found. These structures are typical of the powdery mildew Pseudoidium anamorph of the genus Erysiphe. The specific measurements and morphological characteristics were consistent with those of E. heraclei DC. (1). To confirm identity of the causal fungus, the complete internal transcribed spacer (ITS) region of rDNA of KUS-F27279 was amplified with primers ITS5 and P3 (4) and sequenced directly. The resulting 561-bp sequence was deposited in GenBank (Accession No. KF111807). A GenBank BLAST search of this sequence showed >99% similarity with those of many E. heraclei isolates, e.g., Pimpinella affinis (AB104513), Anethum graveolens (JN603995), and Daucus carota (EU371725). Pathogenicity was confirmed through inoculation by gently pressing a diseased leaf onto leaves of five healthy potted chervil plants. Five non-inoculated plants served as a control treatment. Plants were maintained in a greenhouse at 22 ± 2°C. Inoculated plants developed signs and symptoms after 6 days, whereas the control plants remained healthy. The fungus present on the inoculated plants was identical morphologically to that originally observed on diseased plants. Chervil powdery mildews caused by E. heraclei have been reported in Europe (Bulgaria, France, Germany, Hungary, Italy, Romania, Switzerland, and the former Soviet Union) and the United States (2,3). To our knowledge, this is the first report of powdery mildew caused by E. heraclei on chervil in Asia as well as in Korea. The plant is cultivated in commercial farms for its edible leaves in Korea. Occurrence of powdery mildew is a threat to quality and marketability of this herb, especially those grown in organic farming where chemical control options are limited. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No. 11, CBS, Utrecht, 2012. (2) D. F. Farr and A. Y. Rossman. Fungal Databases, Syst. Mycol. Microbiol. Lab., Online publication. ARS, USDA. Retrieved July 29, 2013. (3) S. T. Koike and G. S. Saenz. Plant Dis. 88:1163, 2004. (4) S. Takamatsu et al. Mycol. Res. 113:117, 2009.

First Report of Anthracnose Caused by Colletotrichum lupini on Yellow Lupin in Korea.

Yellow lupin (Lupinus luteus L.) is native to the Mediterranean region of southern Europe. In Korea, yellow lupins are cultivated for ornamental purposes. In May 2013, hundreds of yellow lupins that were grown in pots for 7 weeks in polyethylene-film-covered greenhouses were observed severely damaged by a previously unknown disease with about 30% disease incidence in a flower farm in Yongin City, Korea. Voucher specimens were deposited in the Korea University Herbarium (KUS). Early symptoms on petioles and stems appeared as small, slightly sunken, water-soaked, and circular spots. Lesions increased in size (4 to 12 µm in diameter), became more depressed, with a darkened central portion. As the disease progressed, affected areas sometimes girdled the stem and killed the shoot. Leaves were partly blighted, but less damaged. The darkened areas contained blackish acervuli from which masses of pale salmon-colored conidia were released in moist weather. Acervuli were circular to ellipsoid, 80 to 400 µm in diameter. Acervular setae were not observed. Conidia (n = 30) were long obclavate to oblong-elliptical, aguttulate, hyaline, and 10 to 18 × 3.6 to 5.2 µm with a length/width ratio of 2.6 to 3.6. Appressoria were single or occasionally in small dense clusters, medium brown, elliptical to round in outline with a smooth to lobate margin, and 8 to 14 × 6 to 9 µm. These characters were consistent with the description of Colletotrichum lupini (Bondar) Damm, P.F. Cannon & Crous (1,3). An isolate was deposited in the Korean Agricultural Culture Collection (Accession No. KACC47254). Fungal DNA was extracted with DNeasy Plant Mini DNA Extraction Kits (Qiagen Inc., Valencia, CA). The complete internal transcribed spacer (ITS) region of rDNA was amplified with the primers ITS1/ITS4 and sequenced. The resulting 545-bp sequence was deposited in GenBank (Accession No. KJ447119). The sequence showed 100% identity with sequences of C. lupini (e.g., GenBank AJ301968, JN943480, JQ948162, and KF207599). To confirm pathogenicity, inoculum was prepared by harvesting conidia with sterile distilled water from 3-week-old cultures on potato dextrose agar. A conidial suspension (2 × 105 conidia/ml) was sprayed until runoff onto the aerial parts of five healthy plants. Control plants were sprayed with sterile water. The plants were covered with plastic bags to maintain a relative humidity of 100% for 48 h and then transferred to a greenhouse. Typical symptoms of necrotic spots appeared on the inoculated leaves 6 days after inoculation, and were identical to the ones observed in the field. C. lupini was re-isolated from symptomatic leaf tissues. No symptoms were observed on control plants. The pathogenicity test was repeated twice. Anthracnose associated with C. lupini on lupins has been known from Europe (Germany, Ukraine, Austria, and Netherlands), North America (Canada and the United States), South America (Bolivia and Brazil), and Oceania (Australia and New Zealand) (2,4). To our knowledge, this is the first report of C. lupini on yellow lupins in Asia as well as in Korea. The presence of C. lupini on lupins in Asia can be considered as a potentially new and serious threat to this ornamental plant. References: (1) U. Damm et al. Stud. Mycol. 73:37, 2012. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, Retrieved February 17, 2014. (3) H. I. Nirenberg et al. Mycologia 94:307, 2002. (4) E. Rosskopf et al. Plant Dis. 98:161, 2014.

First Report of White Blister Rust Caused by Albugo candida on Wasabi in Korea.

Wasabi (Wasabia japonica (Miq.) Matsum.), a member of the Brassicaceae family, is a commercially important crop in East Asian countries such as China, Japan, Korea, and Taiwan. In Korea, wasabi is under commercial development since it has become popular as a condiment due to its strong pungent constituents. In May 2013, wasabi plants showing typical symptoms of white blister rust disease were first observed in plastic greenhouses in Taebaek City, Korea. Leaves of infected plants had whitish sori on the lower surfaces and chlorotic blotches on the corresponding upper leaf surfaces. Later, sori changed to creamy to light tan with necrosis of leaf lesion. New infections might occur anytime during the growing season. A representative sample was deposited in the Korea University Herbarium (KUS-F27596). Microscopic examination of fresh materials was performed under a light microscope. The grouped sporangiophores were hyaline, clavate or cylindric, and measured 20 to 35 × 10 to 14 µm. The sporangia were arranged in basipetal chains, hyaline, globose to subglobose, with uniform wall thickness and measured 16 to 21 × 13 to 18 µm. The primary sporangia were morphologically similar to the secondary sporangia, although the former exhibited a slightly thicker wall than the latter. No resting organs were observed. Previously, the white blister rust pathogen on wasabi has been considered either Albugo candida or A. wasabiae, although the latter name is often considered a synonym of A. candida. Based on the morphological characteristics and the specific host plant, the causal agent of this disease was identified as A. candida (2). To confirm this morphological identification, genomic DNA was extracted from infected plant tissue, and the amplification and sequencing of the internal transcribed spacer (ITS) region of rDNA of the Korean specimen were performed using procedures outlined by Choi et al. (1), with oomycete-specific primer set, DC6 and LR0. The resulting 835-bp sequence of the region was deposited in GenBank (Accession No. KF887494). Since this was the first ITS sequence submitted for A. candida on wasabi, comparable data were not available. A comparison with the ITS sequences available in the GenBank database revealed that it is identical to A. candida found on Capsella bursa-pastoris (AF271231), and shows a high similarity of 99% with many A. candida sequences originating from other brassicaceous plants. Therefore, the pathogen found in Korea was confirmed to be A. candida. In Korea, it has been reported that A. candida attacks Brassica juncea, B. campestris subsp. penikensis, and B. napus (3), but to our knowledge this is the first record of A. candida on wasabi (4). The white blister rust caused by A. candida is one of the most devastating diseases of wasabi in Japan and Taiwan where the crop is widely cultivated. On the other hand, in the United States, Canada, and New Zealand, where wasabi is a new crop on a commercial scale, there is no record of this disease. These facts taken together suggest that wasabi white blister rust be not only currently spreading in East Asia, but it also poses a new and serious threat to production of this crop in countries in which it is currently absent. References: (1) Y. J. Choi et al. Mol. Phylogenet. Evol. 40:400, 2006. (2) Y. J. Choi et al. Fungal Divers. 27:11, 2007. (3) Y. J. Choi et al. Plant Pathol. J. 27: 192, 2011. (4) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, Retrieved November 15, 2013.

Recovery of intact IgG in the gastrointestinal tract of the growing rat following ingestion of an ovine serum immunoglobulin.

The aim of this study was to determine whether orally ingested ovine serum IgG partly resists digestion in the growing rat. Fifteen Sprague-Dawley male rats were allocated to one of three diets for a 3-week study: a control diet (CON) and two test diets containing either freeze-dried ovine serum immunoglobulin (FDOI) or inactivated ovine serum immunoglobulin (IOI). Samples of stomach chyme and intestinal digesta from the ad libitum-fed rats were subjected to ELISA and Western blot analysis. Amounts of intact ovine IgG for the FDOI diet were found to be 13.9, 20.0, 34.1, 13.0 and 36.9 µg in the total wet digesta from the stomach chyme, duodenal, jejunal, ileal and colonic digesta respectively. Qualitative detection by Western blot revealed the presence of intact ovine serum IgG with a ~150 kDa MW. This was detected in all of the gut segments (stomach chyme, duodenal, jejunal, ileal and colonic digesta) for growing rats fed the FDOI diet. No ovine IgG was detected in the chyme or digesta from rats fed the CON or the IOI diets. Ovine serum IgG partly resisted digestion in the growing rat fed the FDOI diet and was found throughout the digestive tract. These results provide a basis to explain the reported biological effects of orally administered immunoglobulin.

Orally administered ovine serum immunoglobulins modulate the intestinal levels of Lactobacillus and enterobacteria in the growing rat.

The aim was to determine whether orally administered ovine serum immunoglobulins modulate the gut microbiota in the growing rat. Thirty Sprague-Dawley male rats were used in a 21-d study and fed either a basal control diet (control; no immunoglobulin) or a similar diet containing freeze-dried ovine immunoglobulin (ovine Ig) with 15 individually fed rats per diet. Bacterial DNA isolated from ileal and colonic digesta were subjected to PCR-denaturing gradient gel electrophoresis (PCR-DGGE). In the ileum, the DGGE band number and diversity index were greater (P < 0.05) for rats fed the ovine Ig than those fed the control diet. The DNA sequencing of a selected DGGE band in the ovine Ig-fed rats revealed 99% similarity to the Lactobacillus strains. The quantitative PCR data revealed that supplementation of the diet with the ovine Ig fraction supported the growth of Lactobacillus and conversely decreased the number of enterobacteria in ileal and colonic digesta. Inclusion of the ovine Ig fraction led to a greater (P < 0.05) ratio for total Lactobacillus to total bacteria and total Lactobacillus to enterobacteria. The results from the present study show that dietary supplementation with ovine Ig may alter the intestinal environment by a specific enrichment of Lactobacillus strains and depletion of enterobacteria.

[A toddler with traumatic brain injury]. / Een peuter met schedel-hersenletsel.

A 14-month-old boy presented with a haematoma and an oedematous swelling in the left parieto-occipital region after sustaining a fall from 3 meters. CT images of the brain showed a multifragmentary fracture in the parietotemporal region. Because the swelling progressed during admission, an MRI of the brain was performed, which revealed extrusion of brain tissue through a skull defect into the subgaleal space. Resultantly, the diagnosis of 'cranial burst fracture' was established. After neurosurgical resection and dural repair, the boy was discharged from the hospital without neurological symptoms.