Penicillium digitatum, First Clinical Report in Chile: Fungal Co-Infection in COVID-19 Patient.

Penicillium digitatum is one of the most important phytopathogens. It causes deterioration and rotting of citrus fruits, generating significant economic losses worldwide. As a human pathogen, it is extremely rare. We present a case of pulmonary co-infection in a patient diagnosed with pneumonia due to SARS-CoV-2. A 20-year-old female patient, primigravid, 36 weeks of gestation, without comorbidities, and diagnosed with severe pneumonia due to the SARS-CoV-2, showed rapid lung deterioration for which their pregnancy was interrupted by surgery. The patient was hospitalized in the Intensive Care Unit (ICU), connected to mechanical ventilation and receiving corticosteroids and antibiotics. The diagnosis of pulmonary fungal infection was made through bronchoalveolar lavage (BAL) culture, and the species identification was performed by sequencing of ß-tubulin. Phylogenetic analysis with related species was performed for the confirmation of species identification. Antifungal susceptibility tests were performed for itraconazole (4 µg/mL), voriconazole (2 µg/mL), and amphotericin B (2 µg/mL). The patient was successfully treated with itraconazole. This is the second worldwide report of pulmonary infection by P. digitatum and the first in Chile. Although it is a fungus that rarely infects humans, it could represent an emerging opportunistic fungal pathogen, with associated risk factors that should be considered in the differential diagnosis of Penicillium species isolated from infections in humans.

Membrana de circulación extracorpórea veno-arterial para ablación de tormenta eléctrica en shock cardiogénico: caso clínico / Veno-arterial extracorporeal membrane oxygenation (ECMO) used for support during ablation of ventricular electrical storm: case report

RESUMEN: Se presenta el caso clínico de un paciente que presenta un infarto del miocardio con trombolisis no exitosa y posterior implantación de 2 stents coronarios quien desarrolla, algunos días después, una tormenta eléctrica ventricular. Una ablación de la taquicardia se realizó bajo ECMO, con buen resultado. Se detalla la descripción del caso, revisa y discute el tema.

ABSTRAC: A patient with a myocardial infarction whom, following a failed thrombolisis and implantion of 2 stents developed a ventricular electrical storm and hemodynamic instability. A successful ablation of the tachycardia with the use of ECMO was performed. A full description is included, along with a discussion of the subject.

Extracorporeal Membrane Oxygenation for COVID-19-associated Severe Acute Respiratory Distress Syndrome in Chile: A Nationwide Incidence and Cohort Study.

Rationale: The role of and needs for extracorporeal membrane oxygenation (ECMO) at a population level during the coronavirus disease (COVID-19) pandemic have not been completely established. Objectives: To identify the cumulative incidence of ECMO use in the first pandemic wave and to describe the Nationwide Chilean cohort of ECMO-supported patients with COVID-19. Methods: We conducted a population-based study from March 3 to August 31, 2020, using linked data from national agencies. The cumulative incidence of ECMO use and mortality risk of ECMO-supported patients were calculated and age standardized. In addition, a retrospective cohort analysis was performed. Outcomes were 90-day mortality after ECMO initiation, ECMO-associated complications, and hospital length of stay. Cox regression models were used to explore risk factors for mortality in a time-to-event analysis. Measurements and Main Results: Ninety-four patients with COVID-19 were supported with ECMO (0.42 per population of 100,000, 14.89 per 100,000 positive cases, and 1.2% of intubated patients with COVID-19); 85 were included in the cohort analysis, and the median age was 48 (interquartile range [IQR], 41-55) years, 83.5% were men, and 42.4% had obesity. The median number of pre-ECMO intubation days was 4 (IQR, 2-7), the median PaO2/FiO2 ratio was 86.8 (IQR, 64-99) mm Hg, 91.8% of patients were prone positioned, and 14 patients had refractory respiratory acidosis. Main complications were infections (70.6%), bleeding (38.8%), and thromboembolism (22.4%); 52 patients were discharged home, and 33 died. The hospital length of stay was a median of 50 (IQR, 24-69) days. Lower respiratory system compliance and higher driving pressure before ECMO initiation were associated with increased mortality. A duration of pre-ECMO intubation ≥10 days was not associated with mortality. Conclusions: Documenting nationwide ECMO needs may help in planning ECMO provision for future COVID-19 pandemic waves. The 90-day mortality of the Chilean cohort of ECMO-supported patients with COVID-19 (38.8%) is comparable to that of previous reports.

Salinity induced anatomical and morphological changes in Chloris gayana Kunth roots.

Chloris gayana Kunth is a grass species valuable as forage which was introduced into Argentina to be used as pasture in saline soils of subtropical and warm-temperate zones, given its good adaptability to drought, salinity and mild freezing. However, its tolerance varies according to the cultivar. In tetraploid cultivars, important reductions in yield have been observed. Here, a study of the variations produced on the root and stem system by salinity at different NaCl concentrations (0, 150 and 250 mM) was performed in the Boma cultivar, with the aim of determining the anatomical and morphological alterations produced by the salt excess. Plants cultivated with the highest level of salinity showed, in the whole, significant differences in the measured variables. A diminution in absolute values of the variables and a major reduction in vascular tissue dimensions were observed, which suggests that the lack of tolerance to salt stress could be related to a deficient adaptation to absorb and transport water and nutrients from the roots.

Salinity induced anatomical and morphological changes in Chloris gayana Kunth roots

Chloris gayana Kunth is a grass species valuable as forage which was introduced into Argentina to be used as pasture in saline soils of subtropical and warm-temperate zones, given its good adaptability to drought, salinity and mild freezing. However, its tolerance varies according to the cultivar. In tetraploid cultivars, important reductions in yield have been observed. Here, a study of the variations produced on the root and stem system by salinity at different NaCl concentrations (0, 150 and 250 mM) was performed in the Boma cultivar, with the aim of determining the anatomical and morphological alterations produced by the salt excess. Plants cultivated with the highest level of salinity showed, in the whole, significant differences in the measured variables. A diminution in absolute values of the variables and a major reduction in vascular tissue dimensions were observed, which suggests that the lack of tolerance to salt stress could be related to a deficient adaptation to absorb and transport water and nutrients from the roots.

Involvement of nitrate reductase (NR) in osmotic stress-induced NO generation of Arabidopsis thaliana L. roots.

Nitric oxide (NO) is undoubtedly a potential signal molecule in diverse developmental processes and stress responses. Despite our extensive knowledge about the role of NO in physiological and stress responses, the source of this gaseous molecule is still unresolved. The aim of this study was to investigate the potential role of nitrate reductase (NR) as the source of NO accumulation in the root system of wild-type and NR-deficient nia1, nia2 mutant Arabidopsis plants under osmotic stress conditions induced by a polyethylene glycol (PEG 6000) treatment. Reduction of primary root (PR) length was detected as the effect of osmotic stress in wild-type and NR-deficient plants. We found that osmotic stress-induced lateral root (LR) initiation in wild-type, but not in NR-mutant plants. High levels of NO formation occurred in roots of Col-1 plants as the effect of PEG treatment. The mammalian nitric oxide synthase (NOS) inhibitor N(G)-monomethyl-L-arginine (L-NMMA) had no effect on LR initiation or NO generation, while tungstate, an NR inhibitor, inhibited the later phase of osmotic stress-induced NO accumulation and slightly decreased the LR development. In nia1, nia2 roots, the PEG treatment induced the first phase of NO production, but later NO production was inhibited. We conclude that the first phase of PEG-induced NO generation is not dependent on NOS-like or NR activity. It is also suggested that the activity of NR in roots is required for the later phase of osmotic stress-induced NO formation.

Retinoids and cancer chemoprevention

The concept of chemoprevention is based on the identification of biological events that occur early in the epithelium and marked events for preventing the progression of malignancy. Retinoids are all the natural or synthetic structural analogues of vitamin A. These substances regulate several important cell functions such as modification of cell growth and differentiation. Several retinoids have been effective in the chemoprevention and treatment of various human cancers, especially epithelial cancer

Leaf expansion in grasses under salt stress.

Restriction of leaf growth is among the earliest visible effects of many stress conditions, including salinity. Because leaves determine radiation interception and are the main photosynthetic organs, salinity effects on leaf expansion and function are directly related to yield constraints under saline conditions. The expanding zone of leaf blades spans from the meristem to the region in which cells reach their final length. Kinematic methods are used to describe cell division and cell expansion activities. Analyses of this type have indicated that the reduction in leaf expansion by salinity may be exerted through effects on both cell division and expansion. In turn, the components of vacuole-driven cell expansion may be differentially affected by salinity, and examination of salinity effects on osmotic and mechanical constraints to cell expansion have gradually led to the identification of the gene products involved in such control. The study of how reactive oxygen species affect cell expansion is an emerging topic in the study of salinity's regulation of leaf growth.

Why are Chloris gayana leaves shorter in salt-affected plants? Analyses in the elongation zone.

Reduced hydraulic conductance calculated from growth data was suggested to be the main reason for reduced leaf expansion in salt-stressed Chloris gayana (Rhodes grass). In this work, xylem vessel cross-sections and wall enzyme activities were analysed to re-examine the effects of salinity on leaf growth in this species. Maximal segmental growth rates were 20% lower and the growth zone was 23% shorter in leaves from salinized plants than in controls; however, growth rates between 0 mm and 15 mm from the ligule were similar in both types of leaves. Xylem cross-sectional areas in this region were about 65% smaller in leaves of salinized plants, suggesting that hydraulic restrictions in the leaves of salinized plants were much higher than overall growth reductions. Extractable xyloglucan endotransglucosylase activity in this zone was twice as high in leaves of salinized plants as in leaves of controls. Nevertheless, the activity of the extracted enzyme was not affected by up to 1 M NaCl added to the reaction medium. Therefore, increased xyloglucan endotransglucosylase activity under salinity may be due to a promotion of transcription of XTH (xyloglucan endotransglucosylase/hydrolases) genes and/or translation of preformed transcripts. These results suggest that, as in drought stress, increased activity of cell wall enzymes associated with wall loosening may contribute to the maintenance of growth under saline conditions despite hydraulic restrictions.

Decreased reactive oxygen species concentration in the elongation zone contributes to the reduction in maize leaf growth under salinity.

Reactive oxygen species (ROS) in the apoplast of cells in the growing zone of grass leaves are required for elongation growth. This work evaluates whether salinity-induced reductions in leaf elongation are related to altered ROS production. Studies were performed in actively growing segments (SEZ) obtained from leaf three of 14-d-old maize (Zea mays L.) seedlings gradually salinized to 150 mM NaCl. Salinity reduced elongation rates and the length of the leaf growth zone. When SEZ obtained from the elongation zone of salinized plants (SEZs) were incubated in 100 mM NaCl, the concentration where growth inhibition was approximately 50%, O2*- production, measured as NBT formazan staining, was lower in these than in similar segments obtained from control plants. The NaCl effect was salt-specific, and not osmotic, as incubation in 200 mM sorbitol did not reduce formazan staining intensity. SEZs elongation rates were higher in 200 mM sorbitol than in 100 mM NaCl, but the difference could be cancelled by scavenging or inhibiting O2*- production with 10 mM MgCl2 or 200 microM diphenylene iodonium, respectively. The actual ROS believed to stimulate growth is *OH, a product of O2*- metabolism in the apoplast. SEZ(s) elongation in 100 mM NaCl was stimulated by a *OH-generating medium. Fusicoccin, an ATPase stimulant, and acetate buffer pH 4, could also enhance elongation in these segments, although both failed to increase ROS activity. These results show that decreased ROS production contributes to the salinity-associated reduction in grass leaf elongation, acting through a mechanism not associated with pH changes.

Elongation growth in leaf blades of Chloris gayana under saline conditions.

In Chloris gayana, salinity-associated yield decreases are due mainly to leaf area reductions. To understand the physiological basis for such reduction, the effects of salinity were studied on the spatial and temporal distribution of extension in the intercalary meristem at the leaf base, and on hydraulic conductance in that zone. C. gayana plants were grown on sand irrigated with Hoagland solution with the addition of 0 or 200 mmol/L NaCl, and all measurements were performed on tiller leaf four. In salinised plants, that leaf was 20% shorter than in controls. Extension in the blade expansion zone was studied by pricking through the leaf sheaths and analysing the displacement of the pricks. In salt-treated plants, maximum growth rates were depressed by 53% and the growth zone was shorter by approximately 10 mm, nevertheless, extension proceeded for a longer period than in control plants. The analysis of specific leaf areas in the expansion zone suggests the rate of dry matter deposition was lowered by salinity and estimations of tissue displacement time within that zone suggest cell wall maturity was delayed. Hydraulic conductance was reduced by salinity and this may be the main cause for reduced growth under salinity in Chloris gayana.