Application of 3D printing technology on the treatment of complex proximal humeral fractures (Neer3-part and 4-part) in old people

PURPOSE

This study was conducted to investigate the feasibility and clinical potential of using the 3D printing technology (3DPT) versus typical strategy (thin-layer CT scan) for the treatment of complicated proximal humeral fractures (PHFs) in old people.

METHODS

Sixty-six old patients age ranging from 61 to 76 years with persistent complicated PHFs were randomly assigned to two groups as per the controlled randomization table (34 cases in the test group and 32 cases in the control group). In the test group, 3DPT was applied to build the 3D facture model of a patient, according to the data acquired from the thin-layer CT scan and subsequently processed with Mimics software. This helped to confirm the diagnosis, design the individual operation plan, simulate the surgical procedures and perform the surgery as plan. In the control group, only thin-layer CT scan was applied for the design of the operation plan prior to the surgery. Here, parameters including surgery duration, blood loss volume during surgery, the number of fluoroscopy, time to union were statistically analyzed for two groups after the operation. The screw lengths designed before the surgery and measured during the surgery were compared.

RESULTS

The 3D PHF model generated using 3DPT was able to provide the visual display and omni-directional observation of the direction and severity of the fracture dislocation, which facilitated preoperative diagnosis, operation planning and design, data measurement, preselection of internal fixator and surgical outcome simulation. According to the follow-up ranging from 12∼28 months for the 66 patients, the results showed no significant difference in time to union between the two groups (P>0.05). Apart from that, less surgery duration, less blood loss during surgery, less number of fluoroscopy can be observed compared with the control group (P<0.05).

CONCLUSIONS

In this study, 3DPT showed great clinical feasibility of the treatment of complicated PHFs. The 3D-print PHF model had the ability to clearly display the fracture and thus was useful to determine the fracture classification and the magnitude of fracture injury. It benefited surgeons to gain a better understanding of complicated PHFs, design a most suitable operation plan prior to surgery and facilitate the doctor-patient communication. This therefore enabled the reduction of intraoperative injury and the optimization of surgical outcomes.

Delayed upper tract drainage on voiding cystourethrogram may not be associated with increased risk of urinary tract infection in children with vesicoureteral reflux

INTRODUCTION

Urinary stasis in the setting of obstruction provides an opportunistic environment for bacterial multiplication and is a well-established risk factor for UTI. Vesicoureteral reflux (VUR) with delayed upper tract drainage (UTD) on VCUG has been reported to correlate with increased UTI risk. We sought to determine whether delayed UTD can be reliably classified, and whether it correlates with UTI incidence, VCUG, or endoscopic findings.

METHODS

Children undergoing endoscopic surgery for primary VUR (2009-2012) were identified. VUR grade, timing, and laterality were abstracted. Demographics, hydrodistention (HD) grade, reported febrile and culture-proven UTI were assessed. UTD on VCUG was graded on post-void images as 1 = partial/complete UTD or 2 = no/increased UTD. Inter-observer agreement was calculated. Patients were excluded for incomplete imaging or inability to void during VCUG.

RESULTS

The cohort included 128 patients (10M, 118F), mean age 4.1 ± 2.1 years. Mean age at diagnosis was 2.8 ± 2.8 years. Mean maximum VUR grade was 3 ± 0.9: 1 (7.8%), 2 (20.3%), 3 (43%), 4 (25.8%), 5 (3.1%). UTD occurred in 45 (35%), and no drainage in 83 (65%) patients. Agreement coefficient between graders was 0.596 (p < 0.0001). Cultures were available in 100 patients (70 positive). Patients experienced a mean of 2 ± 1.2 parent-reported fUTIs and 1.2 ± 1.2 culture-proven UTIs from birth to surgery. UTI rate did not differ by UTD status for parent or culture-proven UTI (Table). On multivariate analysis, no patient characteristic was a significant predictor of UTI based on drainage status. Children diagnosed with VUR before 1 year of age had a higher verified UTI rate (p < 0.001). However, drainage was not a significant predictor of UTI rate and when testing the interaction of drainage and age.

CONCLUSION

We sought to determine whether UTD was an accurate predictor of UTI risk to maximize available prognostic information from a single VCUG. Delayed UTD was not a predictor of infection in our patients, nor was it associated with previously described UTI risk factors, such as VUR timing or grade, and voiding dysfunction. Limitations included the retrospective nature of the study in patients undergoing endoscopic VUR treatment, and possible inaccurate UTI reports from parents and pediatricians. UTD can be reliably scored using a binary system with high inter-observer correlation. Our data call into question the previous finding that children with poor UTD are at increased risk of recurrent UTI. Delayed UTD is also not associated with higher HD, or VUR grade compared with those with more prompt UTD.

[Clinical application of multi-electrode synchronous radiofrequency ablation via switching controller for treating large hepatocellular carcinoma]

Objective: To explore the preliminary clinical efficacy and safety of multi-electrode synchronous radiofrequency ablation via switching controller for treating large hepatocellular carcinoma. Methods: A total of 20 patients with large hepatocellular carcinoma from minimally invasive Interventional department of Sun Yat-sen University Cancer Center were enrolled in this retrospective study from December 2013 to December 2014.The procedures were conducted with multi-electrode synchronous radiofrequency ablation via switching controller under CT guidance.The necrosis rate of tumor was assessed by the following imaging examination.The single factor analysis of variance (ANOVA) was employed to compare the total bilirubin, albumin, renal function, blood coagulation function before and after ablation, to evaluate the safety of treatment. Result: Twenty patients with a total of 31 lesions accepted 23 times ablation procedures using multi-electrode synchronous radiofrequency ablation via switching controller.The recent evaluation after treatment was as followed: complete necrosis rate 51.6% (16/31), nearly complete necrosis rate 22.6% (7/31), partial necrosis rate 9.7% (3/31), treatment effectiveness rate (necrosis rate > 50%) 83.9%.The necrosis rate which was less than half volume of the tumor was only seen in 5 cases with huge hepatocellular carcinoma (16.1%). No dead cases appeared after ablation procedures.The patients' total bilirubin elevated moderately after ablation procedures and reversed to normal level after liver function protection treatment.There were no statistical differences of renal function and blood coagulation function before and after ablation.After ablation procedures, 5 cases (21.7%, 5/23) appeared fever, 6 cases (26.1%) with vomiting, only 3 cases (13.0%, 3/23) with moderately severe pain in 3 days after ablation and remitted after taking oral analgesics in one week. Conclusion: The clinical efficacy of multi-electrode synchronous radiofrequency ablation via switching controller for large hepatocellular carcinoma is satisfactory with guaranteed security, which can be a choice for treating large hepatocellular carcinoma.

[Finite element analysis of astigmatic keratotomy based on corneal biomechanical properties]

OBJECTIVE

To establish a finite-element biomechanical model of astigmatic keratotomy, and to investigate the impact of surgical parameters on corneal deformation, stress distribution and astigmatism correction.

METHODS

With Rhinoceros modeling and Abaqus finite element analysis software, a three-dimensional finite-element model of astigmatic cornea was developed, and surgical parameters such as incision optical zone, incision depth and length were varied. Postoperative corneal stress, apical deformation and astigmatism correction were assessed.

RESULTS

A significant increase of stress was noticed near corneal incisions, and maximum corneal stress decreased with the increase of incision depth. Both anterior and posterior corneal surface moved slightly forward postoperatively. Maximum corneal stress was 340 392, 361 022 and 214 187 Pa, and anterior and posterior apical deformation was 49.80, 51.64, 55.53 μm and 54.15, 55.91, 59.67 μm, with 45°, 60° and 90° in arc length of the incision, respectively. The refractive power decreased in steep meridian and increased in flat meridian, resulting in a total decrease of corneal astigmatism. The magnitude of astigmatism correction was 0.85, 1.59, 2.23 and 3.06 D with 30°, 45°, 60° and 90° in arc length of the incision, respectively.

CONCLUSIONS

The finite-element biomechanical model of astigmatic keratotomy could be used to predict the optical outcomes after surgery. The magnitude of astigmatism correction is positively correlated with the surgical incision arc length. (Chin J Ophthalmol, 2016, 52: 674-680).

Surgical Management of Primary Scrotal Cancer

Primary scrotal cancer is a rare urologic malignancy with various histologic subtypes. Management and outcomes are not designed optimally. Surgical excision is the recommended treatment for localized scrotal cancer, with assessment of the margins for disease. Closure of the defect can be performed with primary closure, skin grafts, flaps, or by secondary intention. Analysis of outcomes suggests that high-risk scrotal cancer may have a worse prognosis compared with penile cancer, and low-risk scrotal cancer may have a comparable prognosis. Understanding techniques for management and survival outcomes can help the urologist determine the appropriate course of treatment and improve patient care.

[Phenotypic characteristics of LAP(+) CD4(+) T lymphocytes in colorectal cancer tissues]

OBJECTIVE

To analyze the phenotypic characteristics of LAP(+) CD4(+) T lymphocytes and investigate their molecular mechanisms in colorectal cancer (CRC) microenvironment.

METHODS

Fifty colorectal cancer patients treated in our two hospitals from January 2014 to May 2014 were included in this study. Their tumor tissues and adjacent normal tissues, peripheral blood samples, and peripheral blood samples of 25 healthy donors (HD) were collected to isolate the lymphocytes. The different expressions of CCR7, CD45RA, Foxp3, CTLA-4, CCR4 and CCR5 in LAP(+) CD4(+) T and LAP(-)CD4(+) T lymphocytes were analyzed by flow cytometry (FCM).

RESULTS

The FCM assay detected that the percentage of LAP(+) CD4(+) T cells in peripheral blood of the CRC patients were significantly higher than that of HD [(9.44±3.18)% versus (1.49±1.00)%, P<0.001]. In addition, significantly more LAP(+) CD4(+) T cells were also recruited into tumor tissue than those in the tumor-adjacent normal tissue [(11.76±3.74)% versus (3.87±1.64)%, P<0.001]. LAP(+) CD4(+) T cells in the tumor-adjacent normal tissue and peripheral blood of both HDs and CRC patients mainly displayed a central memory phenotype. However, effector memory lymphocytes were predominant in the tumor tissue.In the tumor tissue, the expression of Foxp3 in the LAP(+) CD4(+) T cells was (3.87±1.12)%, significantly lower than that in the LAP(-)CD4(+) T cells (16.70±2.61)%, (P<0.001); the expression of CTLA-4 in the LAP(+) CD4(+) T cells was (36.36±19.14)%, significantly higher than the (19.60±8.91)% in the LAP(-)CD4(+) T cells (P<0.001); the expression of CCR4 in the LAP(+) CD4(+) T cells was (37.72±11.14)%, significantly higher than the (30.06±9.14)% in the LAP(-)CD4(+) T cells (P<0.001); and the expression of CCR5 in the LAP(+) CD4(+) T cells was (18.86±7.10)%, significantly higher than the (13.92±3.31)% in the LAP(-)CD4(+) T cells (P<0.001).

CONCLUSIONS

LAP(+) CD4(+) T cells with low expression of Foxp3 and high expressions of CTLA-4, CCR4 and CCR5 are tend to be enriched and accumulated in the tumor tissue. The unique phenotypic characteristics make these cells a distinct subset of lymphocytes, apparently different from the traditional CD4(+) CD25(+) Treg cells.

Pyrroloquinoline quinone enhances the resistance to oxidative stress and extends lifespan upon DAF-16 and SKN-1 activities in C. elegans

Pyrroloquinoline quinone (PQQ) is linked to fundamental biological processes such as mitochondrial biogenesis and lipid metabolism. PQQ may also function as an essential micronutrient during animal development. Recent studies have shown the therapeutic potential of PQQ for several age-related diseases due to its antioxidant capacity. However, whether PQQ can promote longevity is unknown. Here, we investigate the effects of PQQ on oxidative stress resistance as well as lifespan modulation in Caenorhabditis elegans. We find that PQQ enhances resistance to oxidative stress and extends the lifespan of C. elegans at optimal doses. The underlying molecular mechanism involves the increased activities of the primary lifespan extension transcriptional factors DAF-16/FOXO, the conserved oxidative stress-responsive transcription factor SKN-1/Nrf2, and upregulation of daf-16, skn-1 downstream targets including sod-3, hsp16.2, gst-1 and gst-10. Our findings uncover a novel role of PQQ in longevity, supporting PQQ as a possible dietary supplement for overall health improvement.

Note: Enhancing the sensitivity of roll-angle measurement with a novel interferometric configuration based on waveplates and folding mirror

A novel method for very high resolution measurement of roll angle on a transparent plate is developed theoretically and tested experimentally. The new optical configuration is based on the interferometric readout of phase shift accumulated on the double passage through half wave plate, together with a careful control of polarization state by means of quarter wave plate, and optimizing the tilt of the folding mirror. Sensitivity to roll angle is greatly enhanced and a gain coefficient exceeding 700 is found theoretically, based on Jones' matrix analysis, with a 6-fold increase respect to previous results. In the experimental setup, at the optimum 36° incidence to retroreflector, we measured a gain coefficient of 340. Correspondingly, with an interferometer phase meter resolving 0.01°, a roll-angle resolution 0.1-arc sec is attained.

Major histocompatibility complex I upregulation in clear cell renal cell carcinoma is associated with increased survival

Objective

To examine the prognostic value of tumor major histocompatibility complex I (MHCI) expression on survival and recurrence in patients with clear cell renal cell carcinoma (RCC).

Methods

Fifty-three patients that underwent nephrectomy at our institution for clear cell RCC (T1-T3) with ≥4 years of follow-up were queried from our nephrectomy database. Immunohistochemical staining for MHCI was performed on tumor specimens and MHCI expression was quantified with an automated image analysis technique. Patients were divided into high and low MHCI expression groups in order to study the relationship between MHCI expression and prognosis using the Kaplan-Meier method and log-rank test.

Results

Overall survival and recurrence free survival were increased in the high MHCI expression group compared to the low MHCI expression group (log-rank, p = 0.036 and p = 0.028, respectively). Patients alive at the end of the study had higher MHCI expression (mean positivity score 0.82) than those that died of disease (mean positivity score 0.76, t test, p = 0.030). Patients that did not develop recurrence during the study period had higher MHCI expression (mean positivity score 0.83) than those that did develop recurrence (mean positivity score 0.78), but this difference was not significant (t test, p = 0.079).

Conclusion

Our data demonstrate that high MHCI expression confers improved overall and recurrence free survival in patients with clear cell RCC and could serve as an important prognostic tool in identifying high-risk patients.

Elevated preoperative neutrophil-to-lymphocyte ratio may be associated with decreased overall survival in patients with metastatic clear cell renal cell carcinoma undergoing cytoreductive nephrectomy

OBJECTIVE

Inflammatory serum markers have proven to be a powerful predictive tool of patient prognosis in cancer treatment for a wide variety of solid organ malignancies, predominantly in the context of localized disease. In this study we evaluated the preoperative neutrophil-to-lymphocyte ratio (NLR) as a predictive tool in patients with metastatic clear cell renal cell carcinoma (RCC).

METHODS

Sixty-four patients with metastatic clear cell RCC undergoing nephrectomy were selected. Only patients with preoperative NLR were included for survival analysis. Patients were categorized into high and low NLR score determined by plotting the NLR ROC curve. Multivariable analysis was performed.

RESULTS

Median age was 60.8 years (38.2-81.2). Median follow-up time was 8.1 months (0.1-106.3). Fuhrman grade distribution was: 2 (3.1%) grade 1, 6 (9.4%) grade 2, 24 (37.5%) grade 3 and 32 (50.0%) grade 4. Median NLR score was 3.5 (1.4-31.0). NLR ≥ 4 was associated with decreased overall survival compared to NLR < 4 (p = 0.017). Multivariable survival analysis showed NLR ≥ 4 as an independent predictor of survival (Hazard ratio (HR) 2.41, 95%CI 1.05-5.50, p = 0.03).

CONCLUSION

Elevated preoperative NLR is associated with poor prognosis in patients with metastatic kidney cancer. Preoperative NLR is a useful tool, which can predict prognosis, stratify patients for postoperative surveillance, and help guide decisions for therapy.

Efficient diode-pumped acousto-optic Q-switched Er:Yb:GdAl(3)(BO(3))(4) pulse laser at 1522 nm

End-pumped by a continuous-wave 976 nm diode laser, efficient 1522 nm laser operation was demonstrated in an Er:Yb:GdAl(3)(BO(3))(4) crystal when a sapphire crystal was used as a heat diffuser. A continuous-wave 1522 nm laser with a maximum output power of 750 mW and slope efficiency of 36% was realized at an absorbed pump power of 4.1 W. The pulse performances of an acousto-optic Q-switched laser with various repetition frequencies were investigated in detail. In a repetition frequency range of 1-10 kHz, 1522 nm pulse lasers with a slope efficiency of about 10%, peak output power at the kilowatt level, and width of about 50 ns were first obtained in an Er:Yb:GdAl(3)(BO(3))(4) crystal pumped by a continuous-wave diode laser. The results indicate that the crystal is a promising gain medium for an actively Q-switched 1.5 μm laser.

Evaluation of major histocompatibility complex class I expression in clear cell renal cell carcinoma as a prognostic tool

469

Background: After nephrectomy for clear cell renal cell carcinoma (ccRCC) approximately one-third of patients develop metastases. Yet, with currently used prognostic tools such as the TNM staging and the Fuhrman nuclear grade (FNG) system, it is difficult to accurately assess prognosis for each patient. Here, we evaluated Major Histocompatibility Complex Class I (MHCI) expression as a potential prognostic immune marker in ccRCC. Methods: Fifty-five post-nephrectomy patients that presented with localized ccRCC were included. All patients had four or more years of follow up. MHCI was stained in the tumor sections via immunohistochemistry. Then, via an automated image analysis algorithm MHCI expression was quantitated with the Positivity score, the ratio of positively stained pixels over the total number of pixels. Results: Mean MHCI positivity score of the cohort was 0.75 (SE= ±0.20). At the end of the follow-up period, the patients who were alive had higher MHCI expression (0.80 positivity score; SE ±0.14) than those who died of disease (0.62 positivity score; SE= ±0.16; t test, p<0.0001). MHCI positivity scores above the mean were associated with increased cancer specific survival (Mantel-Cox, p=0.0021). MHCI expression was higher among patients with no recurrence (0.80; SE= ±0.16) compared to those that recurred during the study period (0.70; SE= ±0.22; t test, p=0.017); and time-to-recurrence was longer in patients with above mean MHCI positivity scores (Mantel-Cox, p=0.017). Patients who were alive with recurrence had increased MHCI expression (0.81; SE= ±0.10) compared to those who succumbed to disease recurrence (0.62; SE= ±0.25; t-test, p=0.0009). No correlation was detected between FNG and tumor expression of MHCI (ANOVA, p=0.655, F=0.423) or between stage at presentation and MHCI tumor expression (ANOVA, p=0.734, F=0.311). Conclusions: With an automated high-throughput image analysis, this cohort shows that increased MHCI expression in ccRCC is associated with improved prognosis after curative nephrectomy.

DNA hypermethylation of the forkhead box protein 3 (FOXP3) promoter in CD4+ T cells of patients with systemic sclerosis

BACKGROUND

Systemic sclerosis (SSc) is a complex autoimmune disease that involves dysregulation of immune homeostasis. The failure of impaired regulatory T cells (Tregs) to maintain immune homeostasis plays a major role in the development of SSc. Transcriptional silencing of the forkhead box protein 3 gene (FOXP3) via hypermethylation of regulatory regions has been identified as a hallmark of committed Tregs and several autoimmune disorders.

OBJECTIVES

To investigate whether aberrant expression and methylation of FOXP3 occurs in CD4+ T cells of patients with SSc and their roles in the pathogenesis of SSc.

METHODS

FOXP3 expression in CD4+ T cells was measured by real-time quantitative reverse-itranscriptase polymerase chain reaction and western blot. Bisulfite sequencing was performed to determine the methylation status of the FOXP3 proximal promoter sequence. The percentage of Treg cells was estimated by flow cytometry.

RESULTS

Decreased FOXP3 expression was observed in CD4+ T cells from patients with SSc. The methylation levels of the FOXP3 regulatory sequences were elevated and inversely correlated with FOXP3 mRNA expression in patients with SSc. The number of Tregs was significantly reduced in patients with SSc. Treatment of SSc CD4+ T cells with a DNA methylation inhibitor, 5-azacytidine, reduced the mean methylation levels, and enhanced FOXP3 expression and Treg generation. The promoter methylation status and expression level of FOXP3 are significantly associated with disease activity.

CONCLUSIONS

The contribution of the hypermethylation of the FOXP3 promoter to decreased FOXP3 expression and the subsequent quantitative defects of Tregs may mediate the immune dysfunction in SSc.

Thulium laser resection for bladder neck obstruction in women

AIM

The aim of this paper was to investigate the efficacy of thulium laser resection of bladder neck in women with bladder neck obstruction (BNO).

METHODS

Clinical information of 86 women with BNO who were treated in our hospital from Jan 2011 to Dec 2012 was retrospectively reviewed; 46 patients received thulium laser resection (group 1), and the remaining patients were treated with standard electric resection (group 2). Maximum urinary flow rate (MFR), residual urine volume (RV), overactive bladder symptom score (OABSS) and quality of life (QOL) were determined before and after surgery. These patients were followed up at 1 week, 3 months, and 12 months after surgery.

RESULTS

The RV levels after surgery in groups 1 were significantly lower than those before operation. MFR significantly increased after surgery when compared with preoperation, OABSS and QOL score markedly decreased at 3 months after surgery (P<0.05). Thulium laser resection had advantages in postoperative catheter retaining time (2.18±0.73 d vs. 4.24±1.01 d), postoperative hospitalization time (3.25±0.61 d vs. 4.73±1.41 d), Intraoperative blood loss (11.5±1.53 mL vs. 32.32±8.53 mL) and total cost ($1415±71 vs. $1148±59) over standard electric resection (P<0.05), but the operative time was comparable between two groups (18.36±5.45 min vs. 19.25±7.08 min) (P >0.05). In group 2, urethral stricture was seen in 1 patient, and two patients suffered from temporary incontinence, being back to normal in one month. However, urethral stricture and incontinence were not observed in group 1.

CONCLUSION

Thulium laser resection is a simple, safe and effective strategy for the treatment of bladder neck obstruction in women.

Right mini-parasternotomy may be a good minimally invasive alternative to full sternotomy for cardiac valve operations-a propensity-adjusted analysis

AIM

Limited realworld data existed for miniparasternotomy approach with good sample size in Asian cohorts and most previous studies were eclipsed by case heterogeneity. The goal of this study was to compare safety and quality outcomes of cardiac noncoronary valve operations by miniparasternotomy and full sternotomy approaches on riskadjusted basis.

METHODS

From our hospital database, we retrieved the cases of non-coronary valve operations from 1 January 2005 to 31 December 2012, including re-do, emergent, and combined procedures. Estimated EuroScore-II and propensity score for choosing mini-parasternotomy were adjusted for in the regression models on hospital mortality, complications (pneumonia, stroke, sepsis, etc.), and quality parameters (length of stay, ICU time, ventilator time, etc.). Non-complicated cases, defined as survival to discharge, ventilator use not over one week, and intensive care unit stay not over two weeks, were used for quality parameters.

RESULTS

There were 283 miniparasternotomy and 177 full sternotomy cases. EuroScore-II differed significantly (medians 2.1 vs. 4.7, p<0.001). Propensity scores for choosing miniparasternotomy were higher with lower EuroScore-II (OR=0.91 per 1%, p<0.001), aortic regurgitation (OR=2.3, p=0.005), and aortic non-mitral valve disease (OR=3.9, p<0.001). Adjusted for propensity score and EuroScore-II, mini-parasternotomy group had less pneumonia (OR=0.32, p=0.043), less sepsis (OR=0.31, p=0.045), and shorter non-complicated length of stay (coefficient=7.2 (day), p<0.001) than full sternotomy group, whereas Kaplan-Meier survival, non-complicated ICU time, non-complicated ventilator time, and 30-day mortality did not differ significantly.

CONCLUSION

The propensity-adjusted analysis demonstrated encouraging safety and quality outcomes for mini-parasternotomy valve operation in carefully selected patients.

First Report of Downy Mildew Caused by Plasmopara obducens on Impatiens in Taiwan

In February 2013, single and double flowered impatiens (Impatiens walleriana Hook. f.) affected by downy mildew were observed in nurseries (cv. Accent) and in the wild in central Taiwan. More than 90% of the plants were infected in areas where the disease broke out. Symptomatic leaves showed yellowing, with white, fungal-like structure covering the lower leaf surfaces, causing the plants to become wilted and defoliated. Under microscopic observation, hyaline, thin-walled sporangiophores branched monopodially and had slightly swollen bases. Three apical branchlets were at right angles to the main axis, measuring 4.3-15.0 μm (average 8.5 μm). Sporangia were hyaline, ovoid, with an average length and width of 14.2 (10.0 to 18.0) × 12.1 (9.3 to 15.0) μm. For molecular categorization, PCR amplification of the 5' end of the large ribosomal subunit gene was performed with primers NL1 and NL4 (2). The amplicons were cloned, sequenced, and deposited in GenBank (Accession Nos. KC905620 and KC905621). The sequence similarities were 99% compared with that of Plasmopara obducens (J. Schröt.) J. Schröt from Florida (JX217746) (3). Based on morphological and molecular characters, the pathogen was identified as P. obducens. Three voucher specimens (TNM Nos. F0026644, F0026645, and F0026646) were deposited in the herbarium of the National Museum of Natural Science, Taichung, Taiwan. Pathogenicity was confirmed by inoculation of five young, potted impatiens plants with a suspension containing 1 × 10⁵ sporangia/ml in 0.05% Tween 20 (approximately 8 ml/plant). An additional five plants sprayed with 0.05% Tween 20 served as negative controls. The plants were maintained in an outdoor ambient environment. After 2 weeks incubation at an average temperature of 20°C and approximately 80% relative humidity, the inoculated plants exhibited typical downy mildew symptoms, while the control plants remained healthy. The pathogenicity test was repeated in a dew chamber under 20°C with similar results. In the Asia-Pacific region, impatiens downy mildew was recently confirmed in Korea and Japan (1,4). To our knowledge, this is the first report of downy mildew on impatiens in Taiwan. Our further surveys indicated the disease has spread to other parts of the island and will become a potential problem requiring prevention. References: (1) Y. J. Choi et. al. Plant Pathol. J. 25:433, 2009. (2) K. O'Donnell. Curr. Genet. 22:213, 1992. (3) A. J. Palmateer et. al. Plant Dis. 97:687, 2013. (4) M. Satou et. al. J. Gen. Plant Pathol. 79:205, 2013.

Nonlocal optical effects on the Goos-Hänchen shift at an interface of a composite material of metallic nanoparticles

We present a theoretical study on the nonlocal optical effects on the Goos-Hänchen (GH) shift of reflected light from a composite material of metallic nanoparticles (MNPs). Using different nonlocal effective medium models, it is observed that such effects can be significant for small MNP of sizes down to a few nanometers. For small metallic volume fractions, the composite behaves like dielectric and the nonlocal effects lead to significant different Brewster angles, at which large negative GH shifts take place. For larger volume fractions or shorter wavelengths, the composite behaves more like metals and the nonlocal effects also lead to different Brewster angles but at values close to grazing incidence. These results will have significant implications in the application of different effective medium models for the characterization of these nanometallic composites when the MNPs are down to a few nanometers in size.

First Report of Leaf Spot on Tibouchina semidecandra Caused by Beltrania rhombica in China

Tibouchina semidecandra Cogn. is a popular ornamental plant in tropical and subtropical areas (1). In August 2011, a leaf spot was observed on approximately 70% of 5,000 potted plants of T. semidecandra in a nursery in Zhongshan, Guangdong Province, China. Each leaf spot was round with a brown center surrounded by a reddish brown border, and ranged from 8 to 10 mm in diameter. A fungus was isolated consistently from the lesions by surface-sterilizing symptomatic leaf sections (each 3 cm²) with 75% alcohol for 8 s, washing the sections with sterile water, soaking the sections in 3% NaOCl for 15 s, rinsing the sections with sterile water three times, and then placing the sections on potato dextrose agar (PDA) at 28°C. Each of three single-spore isolates on PDA produced gray, floccose colonies that reached 70 mm in diameter after 5 days at 28°C. Setae were dark brown, straight, erect, distantly and inconspicuously septate, and 125 to 193 × 3.0 to 4.5 μm. Conidiophores were light brown, cylindrical, simple or sometimes branched at the base, and 105 to 202 × 3 to 5 μm. Separating cells were hyaline, oval, and 12 to 13 × 4 to 5 μm. Conidia were unequally biconic, unicellular, dark brown with a pale brown or subhyaline band just above the widest part, and 26 to 31 × 8.5 to 12 μm (mean 27.3 × 10.6 μm) with a conspicuous appendage at the apex that was 6 to 14 × 1 to 1.8 μm. These characteristics were consistent with the description of Beltrania rhombica Penz. (3). The internal transcribed spacer (ITS) region of the ribosomal DNA (rDNA) of one isolate (GenBank Accession No. JN853777) was amplified using primers ITS4 and ITS5 (4) and sequenced. A BLAST search in GenBank revealed 97% similarity to the ITS sequence of an isolate of B. rhombica (GU797390.1). To confirm pathogenicity of the isolate, ten detached leaves from 3-month-old plants of T. semidecandra 'Purple Glorybush' were inoculated in vitro with 5-mm diameter, colonized mycelial plugs from the periphery of 5-day-old cultures of the isolated fungus. The agar plugs were put on the leaf surface and secured with sterile, moist cotton. Sterile PDA plugs were similarly used as the control treatment on ten detached leaves. Leaves were placed in petri dishes and incubated in a growth chamber with 12 h of light/day at 28°C. Necrotic lesions appeared on leaves after 2 to 3 days of incubation, whereas control leaves inoculated with sterile PDA plugs remained asymptomatic. B. rhombica was consistently reisolated from the lesions using the same method described above, but was not reisolated from the control leaves. Although there are approximately 77 reported hosts of B. rhombica (2), to our knowledge, this is the first report of B. rhombica causing a leaf spot on T. semidecandra. Because the disease caused foliar damage and reduced the ornamental value of the nursery plants, control measures may need to be implemented for this species in nurseries. References: (1) M. Faravani and B. H. Bakar. J. Food Agric. Env. Pap. 5:234, 2007. (4) D. F. Farr and A. Y. Rossman. Fungal Databases. Systematic Microbiology Laboratory, ARS, USDA. Retrieved from http://nt.ars-grin.gov/fungaldatabases/ , 30 Mar. 2012. (2) K. A. Pirozyski and S. D. Patil. Can. J. Bot. Pap. 48:567, 1970. (3) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds. Academic Press, San Diego, CA, 1990.

Computer aided diagnosis system for breast cancer based on color Doppler flow imaging

Color Doppler flow imaging takes a great value in diagnosing and classifying benign and malignant breast lesions. However, scanning of color Doppler sonography is operator-dependent and ineffective. In this paper, a novel breast classification system based on B-Mode ultrasound and color Doppler flow imaging is proposed. First, different feature extraction methods were used to obtain the texture and geometric features from B-Mode ultrasound images. In color Doppler feature extraction stage, several spectrum features are extracted by applying blood flow velocity analysis to Doppler signals. Moreover, a velocity coherent vector method is proposed based on color coherence vector, which is helpful for designing to the optimize detection of flow indices from different blood flow velocity fields automatically. Finally, a support vector machine classifier with selected feature vectors is used to classify breast tumors into benign and malignant. The experimental results demonstrate that the proposed computer-aided diagnosis system is useful for reducing the unnecessary biopsy and death rate.

First Report of Leaf Spot on Gerbera jamesonii Caused by Corynespora cassiicola in China

Gerbera (Gerbera jamesonii Bolus ex. Hook f.) is a popular cut flower and flowering potted plant. In August 2011, a new leaf spot disease was observed on double-type Gerbera growing in outdoor ground beds in Guangzhou, Guangdong Province, China. Approximately 30% of about 20,000 Gerbera plants in the Guangzhou ground beds were affected. Leaf spots were round or irregular with grayish centers surrounded by dark brown borders and ranged from 5 to 15 mm in diameter. Leaves with multiple lesions became blighted. A fungus was isolated from the lesions and single-spore isolates plated on potato dextrose agar (PDA) produced gray, floccose colonies, which reached 65 mm on PDA after 7 days at 28°C. Conidiophores were brown or olivaceous, cylindrical, straight and unbranched, two to seven septations, and 25 to 83 × 4 to 7 μm. Conidiogenous cells were olivaceous or brown, cylindrical, and 11 to 21 × 4 to 6 μm. Conidia were borne singly or in chains of two to five, brown, cylindrical, straight to slightly curved, two to eight pseudosepta, and 30 to 90 × 5.5 to 11.5 μm (mean 70.4 × 7.3 μm), with a conspicuous hilum. These characteristics were consistent with the description of Corynespora cassiicola (Berk. & M.A. Curtis.) C.T. Wei (1). The internal transcribed spacer region (ITS) of one isolate (GenBank Accession No. JN853778) was amplified using primers ITS4 and ITS5 (3) and sequenced. A BLAST search in GenBank revealed highest similarity (99%) to sequences of C. cassiicola (AY238606.1 and FJ852715.1). Pathogenicity tests were conducted on 10 potted double-type Gerbera plants. Five wounded and five unwounded leaves on each plant were inoculated with 5-mm mycelial plugs from the periphery of 5-day-old cultures of the isolated fungus. The plugs were put on the leaf surface and secured with sterile wet cotton. Sterile PDA plugs were used as the control treatment on different leaves of the same plants that were inoculated. Plants were covered with plastic bags and incubated in a growth chamber with 12 h of light at 28°C. Necrotic lesions appeared on wounded leaves after 2 to 3 days of incubation and on unwounded leaves 5 to 7 days after incubation. Symptoms on wounded and unwounded leaves were similar to those observed in the field, whereas control leaves inoculated with sterile PDA plugs remained symptomless. C. cassiicola was consistently reisolated from these lesions. Although there are approximately 644 reported hosts of C. cassiicola (2), to our knowledge, this is the first report of C. cassiicola leaf spot on G. jamesonii. Because the disease caused damage to the foliage and affected the flowering of the plants, control measures may need to be implemented for the production of Gerbera in cut flower nurseries. References: (1) M. B. Ellis. CMI Mycol. Pap. 65:15, 1957. (2) D. F. Farr and A. Y. Rossman. Fungal Databases, Systematic Mycology and Microbiology Laboratory, ARS, USDA. Retrieved from http://nt.ars-grin.gov/fungaldatabases/ , 21 November 2011. (3) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds. Academic Press, San Diego, 1990.

First Report of Anthracnose Caused by Colletotrichum gloeosporioides on Cymbidium sinense in China

Cymbidium sinense are among the most important commercial orchids cultivated in China for flower production. In April of 2010, a leaf spot was sporadically observed on C. sinense in fields located in Guangzhou, China. Symptoms first appeared as yellow to brown, irregular-shaped lesions on the leaf margin or tip. As the infection continued on the tissues, the spot expanded and became dark brown along the margins and developed gray brown centers. At later stages, numerous epidermal acervuli developed on the lesions and mucilaginous conidial masses appeared on the lesions under moist conditions. Ten samples from tissue along the margins of lesions were collected and surface sterilized by washing in 70% ethanol for 30 s, followed by washing in 1% sodium hypochlorite for 30 s, and rinsing in sterile distilled water. These samples were plated onto potato dextrose agar (PDA) and incubated at 25°C with a 12-h alternating light and dark cycle. After 5 days, fungal colonies that grew from the tissue were subcultured onto PDA and pure cultures were obtained using the single-spore method. The fungus was identified as Colletotrichum gloeosporioides based on typical cultural characteristics and conidial morphology (1). PDA cultures were white at first and subsequently became grayish white to gray and pink to reddish brown. Conidia were straight, one-celled, hyaline, oblong, or cylindrical, slightly curved with truncate base and rounded apex and measured 14.0 to 19.5 × 4.0 to 6.0 μm. Chlamydospores, sclerotia, and a teleomorph were not found. Genomic DNA was extracted from one isolate and the internal transcribed spacer (ITS) region of the ribosomal DNA (ITS1-5.8S-ITS2) was amplified using ITS1 (5'-TCCGTAGGTGAACCTGCGG-3') and ITS4 (5'-CCTCCGCTTATTGATATGC-3') primers. The ITS region was further cloned and sequenced and showed 100% homology with many GenBank sequences (e.g., HQ333546.1) of C. gloeosporioides as the closest match. Pathogenicity tests were done by transferring one 4-mm-diameter disk of PDA that was colonized by the test isolates to wounds (4 × 4 mm) made with a needle in the leaves of 1-year-old C. sinense plants. Control plants received a sterile agar plug in wound. Ten inoculated plants were covered with plastic bags to maintain a high relative humidity and maintained in a greenhouse at 25 ± 2°C for 72 h. Five days after inoculation, no symptoms developed on the control plants. Foliar lesions closely resembled those observed in the field. C. gloeosporioides was reisolated consistently from symptomatic tissue collected from greenhouse experiments. To our knowledge, this is the first report of C. gloeosporioides causing anthracnose on C. sinense in China. Reference: (1) B. C. Sutton. Colletotrichum Biology, Pathology and Control. CAB International, Wallingford, UK, 1992.