Liver resection associated with mini porto-caval shunt as salvage treatment in patients with progression of hepatocellular carcinoma before liver transplantation: a case report

Tumor progression before orthotopic liver transplantation (OLT) is the main cause of dropouts from waiting lists among patients with hepatocellular carcinoma (HCC). Performing a porto-caval shunt (PCS) before parenchymal liver transection has the potential to allow an extended hepatectomy in patients with decompensated liver cirrhosis, reducing portal hyperflow and therefore the sinusoidal shear-stress on the remnant liver. We report the case of a 59-year-old man affected by hepatitis C virus (HCV)-related decompensated liver cirrhosis (Child Pugh score presentation, C-10; Model for End Stage Liver Disease score, 18) and HCC (2 lesions of 2 and 2.8 cm). The patient began the evaluation to join the OLT waiting list, but, in the 3 months required to complete the evaluation, he developed tumor progression: 3 HCC lesions, the largest 1 with a diameter of about 4.4 cm. These findings excluded transplantation criteria and the patient was referred to our center. After appropriate preoperative studies, the patient underwent a major liver resection (trisegmentectomy) after side-to-side PCS by interposition of an iliac vein graft from a cadaveric donor. The patient overcame the worsened severity of cirrhosis. After 6 months of follow-up, he developed 2 other HCC nodules. He was then included on the waiting list at our center, undergoing OLT from a cadaveric donor at 8 months after salvage treatment. At 36 months after OLT, he is alive and free from HCC recurrence. Associating a partial side-to-side PCS with hepatic resection may represent a potential salvage therapy for patients with decompensated cirrhosis and HCC progression beyond listing criteria for OLT.

Expression of alpha-dystroglycan correlates with tumour grade and predicts survival in oral squamous cell carcinoma

AIMS

Dystroglycan (DG) is a non-integrin adhesion molecule connecting the extracellular matrix to the actin cytoskeleton. Decreased expression of DG has been reported in several human cancers and related to tumour aggressiveness.

METHODS

Expression of the alpha-DG subunit was evaluated by immunostaining in a series of oral squamous cell carcinoma (OSCC) and its relation with traditional prognostic indicators and with the clinical outcome of the patients was evaluated.

RESULTS

Alpha-DG expression was easily detected in normal epithelium with a mean percentage of positive cells >80% but was undetectable in a significant fraction (59%) of OSCC. Loss of alpha-DG staining correlated with higher tumour grade (p = 0.04) and stage (p = 0.01), with nodal involvement (p = 0.001) and with an increased risk of recurrence (p = 0.002) and death (p = 0.004) in a univariate analysis, but it was not confirmed as an independent predictor of clinical outcome in a multivariate analysis.

CONCLUSIONS

Loss of alpha-DG expression, which corresponds to loss of a functional DG complex, is a frequent event in human OSCC. Further studies are warranted on the role of this molecule in the entire multistep process of oral squamous tumorigenesis.

First Report of Crown Rot and Stem Rot Caused by Rhizoctonia solani AG-4 on Marmalade Bush in Italy

Marmalade bush (Streptosolen jamesonii (Benth.) Miers), also known as fire bush, is an evergreen, perennial shrub in the family Solanaceae, which is native to South America (Colombia, Ecuador, and Peru). In Italy, this species is cultivated as an ornamental creeper or bush. During September 2009, a new disease was observed in a stock of ~10,000 pot-grown, 2-month-old plants of marmalade bush in a nursery in eastern Sicily, Italy. More than 50% of the plants exhibited symptoms of disease. Disease symptoms consisted of extensive water-soaked, dark brown lesions at the crown level that girdled entire stems and an internal brown discoloration of cortical tissue. Infected plants died within a few days. Diseased tissue was disinfested for 10 s in 1% NaOCl, rinsed with sterile water, and plated on potato dextrose agar (PDA) amended with streptomycin sulfate at 100 mg/liter. Fungal colonies were initially white, turned brown after 2 to 3 days, and produced irregularly shaped, brown sclerotia. Microscopic examination showed mycelium consistent with Rhizoctonia solani Kühn that branched at right angles, constricted at the base of the branch originating from primary hyphae, and septate near the constriction. The number of nuclei per hyphal cell was determined on cultures grown at 25°C on 2% water agar in petri plates by staining with 1% safranin O and 3% KOH solution (1) and examined at ×400. The hyphal cells were all multinucleate. Anastomosis group was determined by pairing isolates on 2% water agar in petri plates (2). Pairings were made with tester strains AG-1 IA, AG-2-2-1, AG-2-2IIIB, AG-2-2IV, AG-3, AG-4, AG-5, AG-6, and AG-11. Anastomosis was observed only with tester isolates of AG-4. Pathogenicity tests were performed by placing 1-cm² plugs of PDA from 5-day-old mycelial cultures near the base of the stem on 25 potted, healthy, 2-month-old rooted cuttings of marmalade bush. The same number of plants treated with 1-cm² PDA plugs served as controls. Following inoculation, all plants were maintained for 20 days at 25°C and 95% relative humidity under a 12-h fluorescent light/dark regimen. Crown and stem symptoms, identical to those observed in the nursery, developed 5 days after inoculation on all inoculated plants. Control plants remained symptomless. R. solani was consistently reisolated from symptomatic tissues and identified as previously described. To our knowledge, this is the first report of R. solani causing disease on marmalade bush. References: (1) R. J. Bandoni. Mycologia 71:873, 1979. (2) C. C. Tu and J. W. Kimbrough. Mycologia 65:941, 1973.

First Report of Fusarium Wilt of Paper Flower (Bougainvillea glabra) Caused by Fusarium oxysporum in Italy

Paper flower (Bougainvillea glabra Choisy), native to Brazil, is the most widely and intensively cultivated species of bougainvillea as a potted plant in Sicily (Italy). During 2008 and 2009, a wilting of vegetatively produced B. glabra cv. Sanderiana was observed in several nurseries in eastern Sicily (Catania and Messina provinces). Disease incidence was higher (~10 to 30%) in the tree-shaped potted plants (standards). Occasionally, wilting was detected on plants that were not tree shaped. Internally, symptomatic plants showed conspicuous vascular orange discoloration from the crown to the canopy. Diseased crown and stem tissues were surface disinfested for 30 s in 1% NaOCl, rinsed in sterile water, plated on potato dextrose agar (PDA) amended with 100 mg/liter of streptomycin sulfate, and incubated at 25°C. A Fusarium sp. was consistently isolated from affected plant tissue. Colonies with light purple or purple mycelia and violet reverse colony colors developed after 10 days. On carnation leaf agar, single-spore isolates produced microconidia in false heads on short monophialides, macroconidia that were 3-septate with a pedicellate base, and solitary and double-celled or aggregate chlamydospores. A PCR assay was conducted on two representative strains (DISTEF-BGS1 and DISTEF-BGS2) by analyzing sequences of the parzial translation elongation factor alpha gene (TEF-1α) and CaM gene (coding calmodulin protein). The primers used are previously used by O'Donnell et al. (1,2). Calmodulin sequences of BGS1 and BGS2 strains (GenBank Nos. FN645740 and FN645741, respectively) exhibited 99% homology with Fusarium oxysporum strain ITEM 2367 (GenBank No. AJ560774), and have homology of 99.6% between them. TEF-1 gene sequences of BGS1 (GenBank No. FN645739) exhibited an identity of 100% to F. oxysporum f. sp. lycopersici MUCL 22544 GenBank No. EF056785.1) and TEF-1α gene sequences of BGS2 (GenBank No. FN655742) exhibited an identity of 100% to F. oxysporum strain NRRL 45954 (GenBank No. FJ985431.1), whereas the homology between the two strains is 98.5%. Both PCR approaches established the identity of the isolates to the F. oxysporum Schlechtend:Fr (1,2). Pathogenicity tests were performed by placing 1-cm² plugs of PDA from 10-day-old mycelial cultures near the crown on 40 potted, healthy, 6-month-old cuttings of paper flower. Twenty plants for each isolate were used. The same number of plants served as noninoculated controls. All plants were enclosed for 5 days in plastic bags and placed in a growth chamber at 24 ± 1°C. Plants were then moved to a greenhouse where temperatures ranged from 24 to 26°C. Symptoms identical to those observed in nurseries developed 1 month after inoculation with both strains. Crown and stem orange discoloration was detected in all inoculated plants after 2 months. Control plants remained symptomless. F. oxysporum was consistently reisolated from symptomatic tissues and identified as previously described. To our knowledge, F. oxysporum was previously reported on paper flower in Ghana (3). However, this is the first demonstration of the pathogenicity of F. oxysporum on paper flower and it is the first report in Europe of the disease. The presence of Fusarium wilt in Sicily is a potential threat to paper flower production in nurseries. References: (1) K. O'Donnell et al. Proc. Natl. Acad. Sci. USA 95:2044, 1998. (2) K. O'Donnell et al. Mycoscience 41:61, 2000. (3) P. Spaulding. USDA Agric. Handb. 197:1, 1961.

Harm and benefits of primary liver resection and salvage transplantation for hepatocellular carcinoma

Primary transplantation offers longer life-expectancy in comparison to hepatic resection (HR) for hepatocellular carcinoma (HCC) followed by salvage transplantation; however, livers not used for primary transplantation can be reallocated to the remaining waiting-list patients, thus, the harm caused to resected patients could be balanced, or outweighed, by the benefit obtained from reallocation of livers originating from HCC patients first being resected. A Markov model was developed to investigate this issue based on literature data or estimated from the United Network for Organ Sharing database. Markov model shows that primary transplantation offers longer life-expectancy in comparison to HR and salvage transplantation if 5-year posttransplant survival remains higher than 60%. The balance between the harm for resected patients and the benefit for the remaining waiting list depends on (a) the proportion of HCC candidates, (b) the percentage shifted to HR and (c) the median expected time-to-transplant. Faced with a low proportion of HCC candidates, the harm caused to resected patients was higher than the benefit that could be obtained for the waiting-list population from re-allocation of extra livers. An increased proportion of HCC candidates and/or an increased median time-to-transplant could lead to a benefit for waiting-list patients that outweighs this harm.

First Report of Crown and Root Rot Caused by Binucleate Rhizoctonia AG-A on Thryptomene saxicola in Italy

Thryptomene saxicola (Hook.) Schauer is an evergreen shrub native to Western Australia and a member of the Myrtaceae. In Italy, this species was recently introduced as an ornamental plant from abroad. From July of 2008 to September 2009, a new crown and root rot of T. saxicola was observed on several stocks of approximately 20,000 1- to 3-year-old potted plants. Diseased plants were obtained from a commercial nursery in eastern Sicily, Italy. They were propagated from cuttings and grown under drip irrigation. More than 30% of the plants showed disease symptoms. Infected plants were characterized by a lack of vigor. Roots and crowns were partially or completely destroyed, and as a consequence, infected plants were chlorotic and often wilted. Early in the disease development, roots and crowns showed brown lesions. Successively, mature crown lesions turned dark brown. Longitudinal sections of crown tissues revealed a discoloration of the basal stem. Diseased tissues were surface disinfested for 1 min in 1% NaOCl, rinsed in sterile water, plated on potato dextrose agar (PDA) amended with 100 mg/liter of streptomycin sulfate, and then incubated at 25°C. A binucleate Rhizoctonia (BNR) species was consistently isolated from affected tissues of plants. Phytophthora isolates were not recovered from symptomatic tissues plated on BNPRAH (benomyl, nystatin, pentachloronitrobenzene, rifampicin, ampicillin, and hymexazol) selective medium. Fungal colonies were white with floccose, aerial hyphae. Hyphal cells were determined to be binucleate when stained with 1% safranin O and 3% KOH solution (1) and examined at ×400. Anastomosis groups were determined by pairing isolates with five different tester isolates of BNR AG-A on 2% water agar in petri plates (3). Anastomosis was observed with all tester isolates. The rDNA-ITS of one isolate of BNR (DISTEF-TS1) was sequenced (GenBank Accession No. AB514570) (2). The sequence from this isolate exhibited 99% homology with BNR AG-A (GenBank Accession No. AY738628). Pathogenicity tests were conducted on potted, healthy, 1-year-old plants of T. saxicola. Forty plants were inoculated by placing 1/cm² plugs of PDA from 5-day-old mycelial cultures near the base of the stem. The same number of plants was treated with 1/cm² PDA plugs as controls. Plants were kept at 25°C and 95% relative humidity on a 12-h fluorescent light/dark regimen. Root and crown rots, identical to those observed in the nursery, appeared 45 days after inoculation, and 80% of the inoculated plants died within 4 months. Control plants remained healthy. Binucleate Rhizoctonia was reisolated from symptomatic tissues, completing Koch's postulates. To our knowledge, this is the first report in the world of BNR causing disease on T. saxicola. References: (1) R. J. Bandoni. Mycologia 71:873, 1979. (2) M. Hyakumachi et al. Phytopathology 95:784, 2005. (3) C. C. Tu and J. W. Kimbrough. Mycologia 65:941, 1973.

First Report of Leaf Spot Caused by Cylindrocladium pauciramosum on Dwarf Willow Myrtle in Italy

Dwarf willow myrtle (Agonis flexuosa (Willd.) Sweet) cv. Nana, an evergreen ornamental shrub belonging to the Myrtaceae, is grown in Italy as an ornamental potted plant. In November 2008, a widespread new leaf spot disease was noticed on ~80% of 5,000 6-month-old potted plants. Plants were obtained from cuttings and produced by a commercial nursery in Catania Province. Symptomatic leaves showed minute, reddish brown spots that enlarged (3 to 5 mm in diameter) and then darkened, presenting a necrotic center defined by a dark purple halo. Leaf spots were surface disinfested with 0.8% NaOCl and plated on potato dextrose agar. Twenty isolates of the fungus that was consistently isolated from the spots were selected and cultured for 8 days at 25°C on carnation leaf agar (CLA). Macroconidiophores consisted of a stipe, a penicillate arrangement of fertile branches, and stipe extension terminating in an obpyriform to ellipsoidal vesicle (6 to 10 μm in diameter). Cylindrical conidia were rounded at both ends, straight, one-septate, and ranged from 44 to 60 × 4 to 5 μm. The fungus was tentatively identified as Cylindrocladium pauciramosum based on these morphological characteristics (2). All single-conidium isolates were mated with tester strains of Calonectria pauciramosa C. L. Schoch & Crous, telomorph of C. pauciramosum, on CLA and produced fertile perithecia (4). Perithecia were solitary or in groups, orange to red-brown, subglobose to ovoid, and ranged from 280 to 400 μm long × 180 to 290 μm in diameter. Further confirmation of species was obtained by amplification and sequencing of the intergenic spacer (IGS) region of rDNA, using M13 Forward (-20) and M13 Reverse primers. On the basis of the complete IGS sequence, two primer sets (218F/218R and 106F/106R) were designed and successfully used in a nested-PCR protocol for the detection of C. pauciramosum from tissues of infected plants (3). On the basis of the combination of morphological characters, mating type, and molecular data, the isolates were identified as C. pauciramosum C.L. Schoch & Crous. One representative isolate (DISTEF-Af1) was deposited at Centraalbureau voor Schimmelcultures open fungi collection (Fungal Biodiversity Centre, Utrecht, the Netherlands; CBS 124659). Pathogenicity tests were performed by adding sterile water to CLA cultures of C. pauciramosum from a single-conidium isolate (DISTEF-Af1) and spraying the resulting spore suspension (10⁵ conidia per ml) on the leaf surface of 20 6-month-old A. flexuosa cv. Nana potted plants. The same number of plants served as noninoculated controls. Following inoculation, plants were kept in plastic bags in a growth chamber at 25 ± 1°C. All inoculated plants developed circular, brown leaf spots identical to those observed in the nursery 5 to 7 days after inoculation. Control plants remained symptomless. C. pauciramosum was always reisolated from the infected plants and identified as previously described. Leaf spotting in seedlings of A. flexuosa was previously associated with infections by C. scoparium in Australia (1). To our knowledge, this is the first record in the world of leaf spots caused by C. pauciramosum on A. flexuosa. References: (1) A. L. Bertus. Agric. Gaz. N. S. W. 87:22, 1976. (2) P. W. Crous. Taxonomy and Pathology of Cylindrocladium (Calonectria) and Allied Genera. The American Phytopathological Society, St. Paul MN, 2002. (3) F. Nigro et al. J. Plant Pathol. 88:S22, 2006. (4) G. Polizzi and P. W. Crous. Eur. J. Plant Pathol. 105:407, 1999.

Harm and benefits of primary liver resection and salvage transplantation for hepatocellular carcinoma

Primary transplantation offers longer life-expectancy in comparison to hepatic resection (HR) for hepatocellular carcinoma (HCC) followed by salvage transplantation; however, livers not used for primary transplantation can be reallocated to the remaining waiting-list patients, thus, the harm caused to resected patients could be balanced, or outweighed, by the benefit obtained from reallocation of livers originating from HCC patients first being resected. A Markov model was developed to investigate this issue based on literature data or estimated from the United Network for Organ Sharing database. Markov model shows that primary transplantation offers longer life-expectancy in comparison to HR and salvage transplantation if 5-year posttransplant survival remains higher than 60%. The balance between the harm for resected patients and the benefit for the remaining waiting list depends on (a) the proportion of HCC candidates, (b) the percentage shifted to HR and (c) the median expected time-to-transplant. Faced with a low proportion of HCC candidates, the harm caused to resected patients was higher than the benefit that could be obtained for the waiting-list population from re-allocation of extra livers. An increased proportion of HCC candidates and/or an increased median time-to-transplant could lead to a benefit for waiting-list patients that outweighs this harm.

First Report of Southern Blight on Silverbush (Convolvulus cneorum) Caused by Sclerotium rolfsii in Italy

The genus Convolvulus has more than 200 species that are encountered in temperate to tropical climates all around the world. Convolvulus cneorum L., also known as silverbush, is a perennial shrub native to southern Europe (Sicily and Croatia) with dense, silver foliage and masses of large, circular, white flowers. During July of 2009, a widespread blight was observed on approximately 10% of 12,000 4-month-old potted silverbush plants. The plants were obtained from cuttings and produced by a commercial nursery in eastern Sicily, Italy. Symptomatic plants initially had sunken, tan lesions at the ground level that developed into typical southern blight. Circular and crescent-shaped patches were observed on the masses of weeds on the surface of the containers where silverbush were grown. At the soil line, white mycelia and small (1 to 2 mm in diameter), brown, spherical sclerotia with internally differentiated rind, cortex, and medulla characteristic of Sclerotium rolfsii Sacc. were observed. Crown and stem lesions were surface disinfested (1% NaOCl) for 1 min, rinsed in sterile water, and placed on potato dextrose agar. Isolation consistently yielded colonies of Sclerotium rolfsii (teleomorph Athelia rolfsii (Curzi) Tu & Kimbrough) with typical sclerotia produced within 6 to 7 days (2). Pathogenicity tests were performed on 20 plants by placing 10 sclerotia obtained from 10-days-old cultures in the soil below the crown portion on each of 5-month-old healthy cuttings of silverbush. The same number of plants served as noninoculated controls. All plants were maintained in a growth chamber at 25 ± 1°C and enclosed for 7 days in polyethylene bags. Plants were then moved to a greenhouse where temperatures ranged from 24 to 28°C. Symptoms of southern blight developed after 7 to 20 days on all inoculated plants. Control plants remained symptomless. S. rolfsii was reisolated from symptomatic plants. S. rolfsii was reported for the first time in Sicily in 2004 in an ornamental nursery (1). To our knowledge, this is the first report in the world of S. rolfsii on silverbush and it is the first outbreak of southern blight on Convolvulus species. The high susceptibility of silverbush to the pathogen could be a limiting factor for the cultivation in nursery of this indigenous wildflower plant. References: (1) G. Polizzi et al. Plant Dis. 88:310, 2004. (2) Z. K. Punja and A. Damiani. Mycologia 88:694, 1996.

First Report of Damping-Off Caused by Rhizoctonia solani AG-4 on Mediterranean Fan Palm in Italy

Mediterranean fan palm (Chamaerops humilis L.), one of just two autochthonous European palms, is native to the western Mediterranean Region in southwestern Europe and northwestern Africa. It can be found growing wild in the Mediterranean area. In Europe, this species is very popular as an ornamental plant. In March 2009, a widespread damping-off was observed in a stock of approximately 30,000 potted 1-month-old plants of C. humilis cv. Vulcano in a nursery in eastern Sicily. Disease incidence was approximately 20%. Disease symptoms consisted of lesions at the seedling shoot (plumule). Stem lesions were initially orange, turned brown, and followed by death of the entire plumule or eophyll. A fungus with mycelial and morphological characteristics of Rhizoctonia solani Kühn was consistently isolated from lesions when plated on potato dextrose agar (PDA) amended with streptomycin sulfate at 100 μg/ml. Fungal colonies were initially white, turned brown with age, and produced irregularly shaped, brown sclerotia. Mycelium was branched at right angles with a septum near the branch and a slight constriction at the branch base. Hyphal cells removed from cultures grown at 25°C on 2% water agar were determined to be multinucleate when stained with 1% safranin O and 3% KOH solution (1) and examined at ×400. Anastomosis groups were determined by pairing isolates with tester strains AG-1 IA, AG-2-2-1, AG-2-2IIIB, AG-2-2IV, AG-3, AG-4, AG-5, AG-6, and AG-11 on 2% water agar in petri plates (3). Anastomosis was observed only with tester isolates of AG-4, giving both C2 and C3 reactions (2). One representative isolate obtained from symptomatic tissues was deposited at the Fungal Biodiversity Centre, Centraalbureau voor Schimmelcultures (CBS No. 125095). Pathogenicity tests were performed on container-grown, healthy, 1-month-old seedlings. Twenty plants of C. humilis cv. Vulcano were inoculated near the base of the stem with two 1-cm² PDA plugs from 5-day-old mycelial cultures. The same number of plants served as uninoculated controls. Plants were incubated in a growth chamber and maintained at 25°C and 95% relative humidity on a 12-h fluorescent light/dark regimen. Symptoms identical to those observed in the nursery appeared 5 days after inoculation and all plants died within 20 days. No disease was observed on control plants. A fungus identical in culture morphology to R. solani AG-4 was consistently reisolated from symptomatic tissues, confirming its pathogenicity. To our knowledge, this is the first report in the world of R. solani causing damping-off on Mediterranean fan palm. References: (1) R. J. Bandoni. Mycologia 71:873, 1979. (2) D. E. Carling. Page 37 in: Grouping in Rhizoctonia solani by Hyphal Anastomosis Reactions. Kluwer Academic Publishers, the Netherlands, 1996. (3) C. C. Tu and J. W. Kimbrough. Mycologia 65:941, 1973.

First Report of Crown and Root Rot Caused by Binucleate Rhizoctonia AG-A on Dodonaea viscosa in Italy

Florida hopbush (Dodonaea viscosa (L.) Jacq.) is an evergreen bush or small tree native to Australia and a member of the Sapindaceae. During September of 2008, a crown and root rot of D. viscosa was observed on 1-year-old potted plants in a commercial nursery in eastern Sicily, Italy. More than 15% of the plants showed disease symptoms. Infected plants were characterized by a lack of vigor. Roots and crowns were partially or completely destroyed, and as a consequence, infected plants were often wilted. Early in the disease development, roots and crowns showed brown lesions. Successively, mature crown lesions turned dark brown. Diseased tissues were surface disinfested for 1 min in 1% NaOCl, rinsed in sterile water, plated on potato dextrose agar (PDA) amended with 100 mg/liter of streptomycin sulfate, and then incubated at 25°C. A binucleate Rhizoctonia (BNR) species was consistently isolated from affected tissue of plants. Fungal colonies were white with floccose, aerial hyphae. Hyphal cells were determined to be binucleate when stained with 1% safranin O and 3% KOH solution (1) and examined at ×400. Anastomosis groups were determined by pairing isolates with five different tester isolates of BNR AG-A on 2% water agar in petri plates (3). Anastomosis was observed with all tester isolates. The rDNA-ITS of one isolate of BNR (DISTEF-DV2) was sequenced (GenBank Accession No. AB514569) (2). The sequence from this isolate exhibited 99% homology with BNR AG-A (GenBank Accession No. AY738628). Pathogenicity tests were conducted on potted, healthy, 8-month-old plants of D. viscosa. Twenty plants were inoculated by placing 1/cm² plugs of PDA from 5-day-old mycelial cultures near the base of the stem. The same number of plants was treated with 1/cm² PDA plugs as controls. Plants were kept at 25°C and 95% relative humidity on a 12-h fluorescent light/dark regimen. Root and crown rots, identical to those observed in the nursery, appeared 30 days after inoculation, and all the inoculated plants died within 2 months. Control plants remained healthy. Binucleate Rhizoctonia was reisolated from symptomatic tissues, completing Koch's postulates. To our knowledge, this is the first report in the world of BNR AG-A causing disease on Florida hopbush. References: (1) R. J. Bandoni. Mycologia 71:873, 1979. (2) M. Hyakumachi et al. Phytopathology 95:784, 2005. (3) C. C. Tu and J. W. Kimbrough. Mycologia 65:941, 1973.

First Report of Crown Rot Caused by Cylindrocladium pauciramosum on Scarlet Honey Myrtle in Italy

Scarlet honey myrtle (Melaleuca fulgens R. Br.), native to Australia, is an evergreen colorful shrub (Myrtaceae) and grown in Italy as an ornamental plant. During November 2008, a widespread disease was noticed on ~90% of 3,000 6-month-old M. fulgens cv. Red potted plants. Plants were obtained from cuttings and produced by a commercial nursery in Catania Province. Symptomatic plants showed a crown rot and longitudinal sections of tissues revealed a brown discoloration of the basal stem. As a consequence, leaves gradually became necrotic and abscised, followed by death of the entire plant. Root rots and leaf spots were not observed. M. gibbosa, M. ericifolia, M. thymifolia, and M. elliptica, cultivated in the same nursery, did not show disease symptoms. A Cylindrocladium sp. was consistently isolated from the crown and basal stem of symptomatic plants on potato dextrose agar (1). Ten Cylindrocladium isolates obtained from infected basal stems and crowns were selected and cultured for 8 days at 25°C on carnation leaf agar (CLA). Macroconidiophores consisted of a stipe, a penicillate arrangement, and a stipe extension terminating in an obpyriform to ellipsoidal vesicle (6 to 10 μm in diameter). Cylindrical conidia were rounded at both ends, straight, 1-septate, and 42 to 60 × 4 to 5 μm. All single-conidial isolates were mated with opposite tester strains of C. pauciramosum on CLA and produced fertile perithecia (3). Perithecia were solitary or in groups, orange to red-brown, subglobose to ovoid, and 270 to 400 μm high × 180 to 290 μm in diameter. Further confirmation of species was obtained by amplification and sequencing of the intergenic spacer (IGS) region of rDNA with the M13 forward (-20) and M13 reverse primers. On the basis of the complete IGS sequence, two primer sets (218F/218R and 106F/106R) were designed and successfully used in a nested-PCR protocol for the detection of C. pauciramosum from tissues of infected plants (2). On the basis of morphological characters, mating type, and molecular data, the isolates were identified as C. pauciramosum C.L. Schoch & Crous. One representative isolate (DISTEF-MFR2; CBS 124657) was deposited at Centraalbureau voor Schimmelcultures open fungi collection (Fungal Biodiversity Centre, Utrecht, the Netherlands). Pathogenicity tests were performed by adding sterile water to CLA cultures of C. pauciramosum from a single-conidial isolate and incorporating the resulting spore suspension (10⁵ conidia per ml) on the soil surface of 20 3-month-old M. fulgens cv. Red potted plants. The same number of plants served as uninoculated controls. Following inoculation, plants were well irrigated and maintained in a growth chamber at 25 ± 1°C and 90 to 95% relative humidity. All inoculated plants developed crown rot symptoms identical to those observed in the nursery 2 months after inoculation. Control plants remained symptomless. C. pauciramosum was always reisolated from the infected plants and identified as previously described. C. pauciramosum was previously detected in Italy as being responsible for a leaf spot on M. hypericifolia (3). To our knowledge, this is the first record in the world of crown rot of scarlet honey myrtle caused by C. pauciramosum. References: (1) P. W. Crous. Taxonomy and Pathology of Cylindrocladium (Calonectria) and Allied Genera. The American Phytopathological Society, St. Paul MN, 2002. (2) F. Nigro et al. J. Plant Pathol. 88:S22, 2006. (3) G. Polizzi and P. W. Crous. Eur. J. Plant Pathol. 105:407, 1999.

First Report of Shoot Blight, Canker, and Gummosis Caused by Neoscytalidium dimidiatum on Citrus in Italy

In September 2008, a new disease was noticed in eastern Sicily, Italy in a 2-year-old regrafted citrus orchard with approximately 1,500 plants of sweet orange (Citrus sinensis (L.) Osbeck cv. Tarocco Scirè) on sour orange rootstock. Symptoms on the sweet orange scion consisted of blight of vigorously growing shoots and a sooty canker on shoots and rootstock trunks, resulting in shoot dieback to the cankered area. Masses of black fungal spores appeared under the bark and on the canker surface. Abundant gummosis was frequently associated with the affected tissues. Of the 1,500 plants surveyed, 12% were infected. A Scytalidium-like fungus was isolated consistently from symptomatic tissues on 2% potato dextrose agar (PDA). Conidia were ellipsoid to ovoid, hyaline, with an acutely rounded apex, truncate base, initially aseptate, becoming brown and two-septate at maturity, (10-) 12 to 13 (-14) × (4-) 5 (-6) μm. Mycelium was branched with septate, brown hyphae that disarticulated into 0- to 1-septate phragmospores (toruloid state). Genomic DNA was extracted from mycelia of single-conidial isolates cultivated on malt extract agar. Primers V9G and ITS4 were used to amplify the nuclear rRNA operon spanning the 3' end of 18S rRNA gene, the internal transcribed spacers, the 5.8S rRNA gene, and a part of the 5' end of the 28S rRNA gene (1,2). Both PCR primers were used to sequence directly the entire amplicon. DNA sequences of two isolates (CBS 124887 and 124888) were deposited in GenBank (Accession Nos. GQ330902 and GQ330903, respectively). These sequences were 100% identical in more than 545 nt to GenBank Accession Nos. AY213688 and FJ648577. On the basis of morphological characters and molecular data, the fungal isolates were identified as Neoscytalidium dimidiatum (Penz.) Crous & Slippers (2,3). Pathogenicity tests were conducted on five 2-year-old potted plants of sweet orange cv. Tarocco Scirè and lemon cv. Femminello Zagara Bianca, both grafted on sour orange. Eight 5-cm mycelial plugs of a single-conidial isolate were placed in wounds made with a sterile blade in the inner bark of plant stems and branches. Inoculation wounds were wrapped with Parafilm. The same number of plants inoculated with sterile PDA plugs served as controls. Inoculated plants were maintained in a growth chamber at 25 ± 1°C and 90 to 95% relative humidity. After 2 weeks, all inoculated plants developed gummosis originating from the inoculation point. Shoot blight and death of the entire plant were observed within 6 months on all inoculated plants. No differences were observed among the two citrus species. Control plants remained healthy. N. dimidiatum was reisolated from the infected plants and identified as described. To our knowledge, this is the first record of a disease caused by N. dimidiatum on citrus in Italy. The pathogen has been previously observed to infect freeze-damaged limbs of citrus in California, inducing a disease named Hendersonula branch wilt (4). This pathogen on citrus is important mainly as a wound-invading pathogen, therefore posing a serious threat to regrafted citrus orchards. References: (1) R. Cheewangkoon et al. Persoonia 21:77, 2008. (2) P. W. Crous et al. Stud. Mycol. 55:235, 2006. (3) E. Punithalingam and J. M. Waterston. No 274 in: Descriptions of Pathogenic Fungi and Bacteria. CMI, Kew, Surrey, UK, 1970. (4) J. O. Whiteside. Page 29 in: Compendium of Citrus Diseases. The American Phytopathological Society, St. Paul, MN, 1988.

First Report of Leaf Spot and Shoot Blight Caused by Cylindrocladium scoparium on Mallee Honeymyrtle in Italy

In December of 2008, a widespread disease was observed on several blocks of approximately 15,000 plants (6-month to 2-year-old) of mallee honeymyrtle (Melaleuca acuminata F. Muell.). The plants were grown in two nurseries in eastern Sicily where high diffusion of diseases caused by Cylindrocladium pauciramosum and C. scoparium was previously detected. The plants exhibited leaf spots, defoliation, and apical blight of shoots. Crown rot and root rot were not present. Leaf spots were detected on all plants, whereas shoot blight was observed on approximately 3% of the plants. A Cylindrocladium sp. was consistently isolated from the diseased portions of plants onto potato dextrose agar. To determine the species, 20 single-conidia isolates of the fungus obtained from symptomatic tissues from different blocks and nurseries were cultured on carnation leaf agar (CLA) for 7 days at 25°C under 12-h light/dark conditions. Mycelia and spores growing on the carnation leaves were examined with a light microscope and the isolates were identified as C scoparium Morgan (teleomorph Calonectria morganii Crous, Alfenas & M.J. Wingf.) on the basis of their pyriform to broadly ellipsoidal terminal vesicles, conidiophore branching pattern, and conidia (1). In addition, the ability of the isolates to mate with South African and Italian opposite tester strains of C. scoparium (2,4) confirmed the identification of all the isolates. Koch's postulates were fulfilled by inoculating 30 6-month-old plants of mallee honeymyrtle with a spore suspension (10⁵ conidia per ml) of one isolate of the pathogen (DISTEF-MA1) obtained from 14-day-old single-spore colonies grown on CLA at 24°C under fluorescent cool white lights on a 12-h light/dark regimen. Following inoculation, all plants were maintained in plastic bags in a growth chamber at 25 ± 1°C and 90 to 95% relative humidity. The same number of mallee honeymyrtle plants was used as uninoculated controls. Leaf spots, defoliation, and apical shoot blight identical to those observed in the nurseries appeared within 4 to 25 days. No symptoms were detected on the control plants. C. scoparium was reisolated from the artificially infected tissues and was identified as previously described. The isolate used in the pathogenicity proof was deposited at the Fungal Biodiversity Centre, Centraalbureau voor Schimmelcultures (Accession No. CBS 124658). In Italy, C. scoparium was detected for the first time on Pistacia lentiscus in 2005 (3). Another report confirmed the spread of the pathogen in Sicilian ornamental nurseries (4). To our knowledge, this is the first record in the world of C. scoparium causing disease on mallee honeymyrtle. The data demonstrate the high susceptibility of this species to the C. scoparium leaf spot and twig blight especially when environmental conditions (heavy rains and mild temperatures) are conductive to the infections. References: (1) P. W. Crous. Taxonomy and Pathology of Cylindrocladium (Calonectria) and Allied Genera. The American Phytopathological Society, St. Paul MN, 2002. (2) P. W. Crous and M. J. Wingfield. Mycotaxon 51:341, 1994. (3) G. Polizzi et al. Plant Dis. 90:1110, 2006. (4) G. Polizzi et al. Plant Dis. 91:769, 2007.

First Report of Crown and Root Rot Caused by Rhizoctonia solani AG-4 on Coprosma repens and C. lucida in Italy

Coprosma (J.R. Forster & G. Forster), a genus containing approximately 90 species, occurs principally in New Zealand, Hawaii, Australia, New Guinea, and islands of the Pacific. In Italy, some of these species, including many variegated varieties and hybrids, are grown as ornamental evergreen shrubs or small trees. In June 2008, a crown and root rot was observed in a stock of approximately 12,000 potted 3-year-old plants of Coprosma repens cv. Yvonne and C. lucida in a nursery in eastern Sicily. Disease incidence was approximately 30%. Disease symptoms consisted of water-soaked lesions at the crown of the trunk and a root rot. Successively, older stem lesions turned orange to brown. As a consequence, leaves initially became chlorotic, gradually became necrotic, and death of the plant followed. A fungus with mycelial and morphological characteristics of Rhizoctonia solani Kühn was consistently isolated from crown and root lesions when plated on potato dextrose agar (PDA) amended with streptomycin sulfate at 100 μg/ml. Fungal colonies were initially white, turned brown with age, and produced irregularly shaped, brown sclerotia. Mycelium was branched at right angles with a septum near the branch and a slight constriction at the branch base. Hyphal cells removed from cultures grown at 25°C on 2% water agar were determined to be multinucleate when stained with 1% safranin O and 3% KOH solution (1) and examined at ×400. Anastomosis groups were determined by pairing isolates on 2% water agar in petri plates (3). Pairings were made with tester strains of AG-1 IA, AG-2-2-1, AG-2-2IIIB, AG-2-2IV, AG-3, AG-4, AG-5, AG-6, and AG-11. Anastomosis was observed only with tester isolates of AG-4, giving C2 and C3 reactions (2). Two representative isolates obtained from symptomatic tissues of C. lucida and C. repens cv. Yvonne were deposited at the Fungal Biodiversity Centre, Centraalbureau voor Schimmelcultures (DISTEF CL1 = CBS-124593 and DISTEF CR1 = CBS-124594, respectively). Pathogenicity tests were performed on container-grown, healthy, 3-month-old cuttings. Ten plants of C. lucida and ten plants of C. repens cv. Yvonne were inoculated near the base of the stem with five 1-cm² PDA plugs from 5-day-old mycelial cultures. The same number of plants served as uninoculated controls. Plants were maintained at 25°C and 95% relative humidity on a 12-h fluorescent light/dark regimen. Symptoms identical to ones observed in the nursery appeared 5 days after inoculation and all plants died within 15 days. No disease was observed on control plants. A fungus identical in culture morphology to R. solani AG-4 was consistently reisolated from symptomatic tissues, confirming its pathogenicity. To our knowledge, this is the first report of R. solani causing crown and root rot on the genus Coprosma. References: (1) R. J. Bandoni. Mycologia 71:873, 1979. (2) D. E. Carling. Page 37 in: Grouping in Rhizoctonia solani by Hyphal Anastomosis Reactions. Kluwer Academic Publishers, the Netherlands, 1996. (3) C. C. Tu and J. W. Kimbrough. Mycologia 65:941, 1973.

Severe Outbreak of Crown Rot and Root Rot Caused by Cylindrocladium pauciramosum on Strawberry Tree in Italy

From 2006 to 2009, a new disease was noticed in several commercial nurseries in Sicily (Italy) on ~13,000 potted plants of strawberry tree (Arbutus unedo L.) ranging from 3 months to 4 years old. Symptomatic plants showed a crown and root rot and internal brown discoloration of the basal stem. No leaf spots were detected. The percentage of symptomatic plants was variable in the different stocks (1 to 28%). A Cylindrocladium sp. was isolated consistently from symptomatic tissues on potato dextrose agar (PDA). Although many crown rots are caused by Phytophthora or Rhizoctonia spp., plating small pieces of diseased tissue from rotten roots and crowns onto corn meal agar or PDA yielded these pathogens sporadically. Twenty Cylindrocladium isolates obtained from infected basal stems, crowns, and roots were selected and subsequently cultured on carnation leaf agar (CLA). Macroconidiophores consisted of a stipe, a penicillate arrangement of fertile branches, and stipe extension terminating in an obpyriform-to-ellipsoidal vesicle (6 to 10 μm in diameter). Conidia cylindrical, straight, and 1-septate ranged from 40 to 60 × 4 to 5 μm. All single-conidial isolates were mated with tester strains DISTEF-G87 (MAT1-1) and DISTEF-G128 (MAT1-2) of Cylindrocladium pauciramosum (3) on CLA and produced fertile perithecia after 2 months. Perithecia were solitary or in groups, orange to red-brown, subglobose to ovoid, and ranged from 260 to 400 × 180 to 290 μm in diameter. On the basis of the combination of morphological and perithecial characters and mating type the isolates were identified as C. pauciramosum C.L. Schoch & Crous, teleomorph Calonectria pauciramosa C.L. Schoch & Crous (1,4). One representative isolate was deposited at Centraalbureau voor Schimmelcultures (CBS; No. 123918) open fungi collection. Pathogenicity tests were performed by adding sterile water to CLA cultures of C. pauciramosum from a single-conidial isolate and incorporating the resulting spore suspension (10⁵ conidia per ml) on the soil surface of 20 3-month-old strawberry tree potted plants. The same number of plants served as a control. After inoculation, plants were maintained in a growth chamber at 25 ± 1°C and 90 to 95% relative humidity. All inoculated plants developed crown and root rot identical to one observed in the nursery 2 months after inoculation. Control plants remained symptomless. C. pauciramosum was always reisolated from infected plants. This fungus represents a serious threat for ornamental nurseries in Europe. Diseases related to infection of C. pauciramosum are different in relationship to the host tissues and the affected species. On strawberry tree, C. pauciramosum was previously detected in Italy as causal agent of leaf spots (2). To our knowledge, this is the first record of crown and root rot of strawberry tree caused by C. pauciramosum. In contrast with leaf spots, this report could indicate an important limiting factor for cultivation of strawberry tree potted plants in nurseries. The knowledge of the susceptibility of this host to crown and root rot caused by C. pauciramosum can help growers apply specific control strategies in nurseries. References: (1) P. W. Crous. Taxonomy and Pathology of Cylindrocladium (Calonectria) and Allied Genera. The American Phytopathological Society, St. Paul, MN, 2002. (2) G. Polizzi and V. Catara. Plant Dis. 85:803, 2001. (3) G. Polizzi and P. W. Crous. Eur. J. Plant Pathol. 105:407, 1999. (4) C. L. Schoch et al. Plant Dis. 85:941, 2001.

First Record of Crown and Root Rot Caused by Cylindrocladium pauciramosum on Brush Cherry in Italy

Brush cherry (Eugenia myrtifolia Sims; synonym Syzygium paniculatum Gaertn.) is a woody evergreen ornamental plant belonging to the Myrtaceae family. This plant is a very common species in Sicilian landscapes. In June of 2008, a new blight disease was detected in a commercial nursery located in Sicily (Italy) in a stock of 10,000 2-year-old E. myrtifolia cv. Newport potted plants obtained from cuttings. The disease was randomly distributed, affecting approximately 2% of the plants. Twig dieback, followed in some cases by plant death, was associated with crown and root rot. Roots were necrotic and crown tissue was brown. A Cylindrocladium sp. was consistently isolated from symptomatic roots, crowns, and lower stems of affected plants on potato dextrose agar petri dishes. Phytophthora isolates were not found associated with symptomatic tissues with BNPRAH (benomyl, nystatin, pentachloronitrobenzene, rifampicin, ampicillin, and hymexazol) selective medium. Five Cylindrocladium isolates were selected and subsequently identified as single-conidial colonies on carnation leaf agar. Isolates were incubated at 25°C under near-UV light with a 12-h_light/dark regimen and examined after 7 days (1). Isolates were characterized by having conidiophores terminating in obpyriform to broadly ellipsoidal vesicles and conidia hyaline, one septate, and straight with rounded ends, (50-) 54 to 55 (-59) × (3.5-) 4 to 6 μm. These characteristics, as well as their ability to produce perithecia when mated with Italian tester strains of Cylindrocladium pauciramosum, allowed their identification as C. pauciramosum C.L. Schoch & Crous (1,4). One mating type (MAT1-1) was found to be present on this host and a representative fungal isolate (DISTEF-Em3) was deposited at the Centraalbureau voor Schimmelcultures (CBS) open fungi collection (Fungal Biodiversity Centre, Utrecht, NL) with Accession No. 123917. Pathogenicity of the isolate DISTEF-Em3 was confirmed by applying 10 ml of a spore suspension (10⁵ conidia per ml) to the crowns of 20 potted 4-month-old E. myrtifolia cv. Newport cuttings that were subsequently maintained in a greenhouse (23 to 25°C and 80 to 90% relative humidity). The same number of untreated plants was used as control. After 4 weeks, only four treated plants developed symptoms identical to those observed in the nursery. Control plants remained symptomless. C. pauciramosum was always reisolated from the infected plants and the identification of the isolate was made as previously described. Pathogenicity tests were repeated twice. In Italy, C. pauciramosum is a widespread pathogen in nurseries that causes extensive losses on young ornamental plants belonging to several genera (2,3). On the basis of the limited spread of the disease in the nursery and the pathogenicity tests, we consider Cylindrocladium crown and root rot of brush berry as a minor disease. However, this work demonstrated the susceptibility of brush cherry to C. pauciramosum that could lead to more extensive losses in association with other biotic or abiotic stresses. To our knowledge, this is the first record of crown and root rot caused by C. pauciramosum on brush cherry. References: (1) P. W. Crous. Taxonomy and Pathology of Cylindrocladium (Calonectria) and Allied Genera. The American Phytopathological Society, St. Paul, MN, 2002. (2) G. Polizzi et al. Plant Dis. 85:803, 2001. (3) G. Polizzi et al. Plant Dis. 90:1459, 2006. (4) C. L. Schoch et al. Plant Dis. 85:941, 2001.

Serum hepatocyte growth factor is increased in Hashimoto's thyroiditis whether or not it is associated with nodular goiter as compared with healthy non-goitrous individuals

BACKGROUND

Some growth factors and cytokines are known to cooperate with TSH in thyroid nodular growth, but few data are available on their circulating levels in Hashimoto's thyroiditis (HT).

AIM

To evaluate in HT patients whether thyroid nodules are associated with variations in serum levels of hepatocyte growth factor (HGF) and interleukin-6 (IL-6).

SUBJECTS AND METHODS

Serum levels of HGF and IL-6 were measured by enzyme-linked immunosorbent assay in 176 euthyroid subjects, subdivided into 4 groups: A) HT patients with nodular goiter (no.=42); B) non-goitrous HT patients (no.=36); C) non-HT patients with nodular goiter (no.=48), and D) healthy subjects without thyroid disease (no.=50).

RESULTS

The highest concentrations of serumHGF were found in patients with nodular goiter, irrespective of the presence of associated HT (groups A and C). Nevertheless, in group A serum HGF levels were significantly higher than in group C (860.8+/-333.6 pg/ml vs 691.5+/-156 pg/ml, p<0.01). Moreover, though serum HGF levels in group B (578.3+/-217 pg/ml) were lower than in group A, they were significantly higher than in healthy controls (group D, 512.7+/-170.4 pg/ml, p<0.001). Serum IL-6 levels were similar in the two HT groups (A and B), and increased with respect to groups C and D.

CONCLUSIONS

Serum HGF is increased in HT, especially associated to thyroid nodules, as compared with healthy non-goitrous individuals.

Therapy of essential thrombocythemia with alpha-interferon: results and prospects

Conventional treatment of symptomatic essential thrombocythemia (ET) consists of long-term administration of myelosuppressive cytotoxic agents which, although efficacious in most cases, are associated with leukemogenic potential. Alpha-interferon (IFN) exerts a dose-dependent inhibitory influence on thrombopoiesis through a direct antiproliferative effect on megakaryocytic precursors. Therefore, it may provide a biologic, potentially non-mutagenic alternative to conventional cytotoxic treatments. At daily doses ranging from 1 to 5 M.U., alpha-IFN is efficacious in inducing a hematologic response in most patients with ET. Response to IFN is a gradual process. The median time to hematologic response varies from 1 to 3 months and a significant proportion of patients reach and maintain normal platelet counts with low doses (1-3 M.U./d). Normalization of marrow megakaryocytosis requires longer treatment (9-12 months). Also patients resistant to cytotoxic drugs may respond to alpha-IFN, suggesting a lack of cross-resistance between the two treatment modalities. Side-effects, although not severe, represents a limit to the administration of adequate doses of IFN in about 25% of cases. Once hematologic response has been obtained, both low-dose IFN and cytotoxic drugs are effective as maintenance. The full potentialities of alpha-IFN in ET in combination with cytotoxic drugs or with other cytokines need to be further investigated.