Alien flora are accumulating steadily in China over the last 80 years

New alien species are increasingly introduced and established outside their native range. The knowledge of the spatiotemporal dynamics of their accumulation and the factors determining their residence time in the introduced range is critical for proactive management, especially in emerging economies. Based on a comprehensive time series dataset of 721 alien angiosperms in China, we show that new alien flora has been accumulating steadily in China, particularly in the coastal regions, for the last 80 years without saturation. The ability to occupy a large number of habitats facilitates the early introduction of alien flora, whereas a large naturalized range, greater number of uses, and multiple introduction pathways directly contribute to their naturalization and invasion. The temporal pattern is predicted to remain consistent in the foreseeable future. We propose upgrading the country's biosecurity infrastructure based on a standardized risk assessment framework to safeguard the country from ongoing and future invasions.

Invasive alien plants are phylogenetically distinct from other alien species across spatial and taxonomic scales in China

Introduction

Phylogenetic relatedness is one of the important factors in the community assembly process. Here, we aimed to understand the large-scale phylogenetic relationship between alien plant species at different stages of the invasion process and how these relationships change in response to the environmental filtering process at multiple spatial scales and different phylogenetic extents.

Methods

We identified the alien species in three invasion stages, namely invasive, naturalized, and introduced, in China. The occurrence records of the species were used to quantify two abundance-based phylogenetic metrics [the net relatedness index (NRI) and the nearest taxon index (NTI)] from a highly resolved phylogenetic tree. The metrics were compared between the three categories of alien species. Generalized linear models were used to test the effect of climate on the phylogenetic pattern. All analyses were conducted at four spatial scales and for three major angiosperm families.

Results

We observed significantly higher NRI and NTI values at finer spatial scales, indicating the formation of more clustered assemblages of phylogenetically closely related species in response to the environmental filtering process. Positive NTI values for the invasive and naturalized aliens suggested that the presence of a close relative in the community may help the successful naturalization and invasion of the introduced alien species. In the two-dimensional phylogenetic space, the invasive species communities significantly differed from the naturalized and introduced species, indicating that established alien species need to be phylogenetically different to become invasive. Positive phylogenetic measures for the invasive aliens across the spatial scales suggested that the presence of invasive aliens could facilitate the establishment of other invasive species. Phylogenetic relatedness was more influenced by temperature than precipitation, especially at a finer spatial scale. With decreased temperature, the invasive species showed a more clustered assemblage, indicating conservatism of their phylogenetic niche. The phylogenetic pattern was different at the family level, although there was a consistent tendency across families to form more clustered assemblages.

Discussion

Overall, our study showed that the community assemblage became more clustered with the progression of the invasion process. The phylogenetic measures varied at spatial and taxonomic scales, thereby highlighting the importance of assessing phylogenetic patterns at different gradients of the community assembly process.

Implications for biological invasion of non-native plants for sale in the world's largest online market

Internet trade is increasingly recognized as a dispersal pathway of non-native plant species that is difficult to monitor. We sought to identify non-native flora present in the Chinese online market, the largest e-commerce market globally, and to decipher the effect of existing trade regulations, among other variables, on e-trading patterns and to inform policy. We used a comprehensive list of 811 non-native plant species in China present in 1 of the 3 phases of the invasion continuum (i.e., introduced, naturalized, and invasive). The price, propagule types, and quantities of the species offered for sale were retrieved from 9 online stores, including 2 of the largest platforms. Over 30% of the non-native species were offered for sale in the online marketplaces; invasive non-native species dominated the list (45.53%). No significant price difference was observed across the non-native species of the 3 invasion categories. Among the 5 propagule types, a significantly higher number of non-native species were offered for sale as seeds. The regression models and path analyses consistently revealed a direct positive effect of the number of uses and species' minimum residence time and an indirect effect of biogeography on the pattern of trade in non-native plant species when minimal phylogenetic signal was detected. A review of the existing phytosanitary regulations in China revealed their inadequacy in managing e-trading of non-native plant species. To address the problem, we propose integration of a standardized risk assessment framework that considers perceptions of stakeholders and is adaptable based on continuous surveillance of the trade network. If implemented successfully, the measures could provide a template for other countries to strengthen trading regulations for non-native plant species and take proactive management measures.

Interspecific variation and phylogenetic relationship between mangrove and non-mangrove species of a same family (Meliaceae)-insights from comparative analysis of complete chloroplast genome

The mahogany family, Meliaceae, contains 58 genera with only one mangrove genus: Xylocarpus. Two of the three species of the genus Xylocarpus are true mangroves (X. granatum and X. moluccensis), and one is a non-mangrove (X. rumphii). In order to resolve the phylogenetic relationship between the mangrove and non-mangrove species, we sequenced chloroplast genomes of these Xylocarpus species along with two non-mangrove species of the Meliaceae family (Carapa guianensis and Swietenia macrophylla) and compared the genome features and variations across the five species. The five Meliaceae species shared 130 genes (85 protein-coding genes, 37 tRNA, and eight rRNA) with identical direction and order, with a few variations in genes and intergenic spacers. The repetitive sequences identified in the rpl22 gene region only occurred in Xylocarpus, while the repetitive sequences in accD were found in X. moluccensis and X. rumphii. The TrnH-GUG and rpl32 gene regions and four non-coding gene regions showed high variabilities between X. granatum and the two non-mangrove species (S. macrophylla and C. guianensis). In addition, among the Xylocarpus species, only two genes (accD and clpP) showed positive selection. Carapa guianensis and S. macrophylla owned unique RNA editing sites. The above genes played an important role in acclimation to different stress factors like heat, low temperature, high UV light, and high salinity. Phylogenetic analysis with 22 species in the order Sapindales supported previous studies, which revealed that the non-mangrove species X. rumphii is closer to X. moluccensis than X. granatum. Overall, our results provided important insights into the variation of genetic structure and adaptation mechanism at interspecific (three Xylocarpus species) and intergeneric (mangrove and non-mangrove genera) levels.

Characterization of the complete chloroplast genome of Firmiana hainanensis (Malvaceae), an endemic and vulnerable tree species of China

Firmiana hainanensis Kosterm. is a commercially valuable endemic tree species in China and has long been considered a globally vulnerable species. We assembled and characterized the complete chloroplast genome of this species by using Illumina pair-end sequencing data. The total chloroplast genome size was 161,559 bp, including two inverted repeats (IRs) of 25,612 bp, separated by a large single copy (LSC) and a small single copy (SSC) regions of 90,057 and 20,277 bp, respectively. A total of 130 genes were identified, including 85 protein-coding genes, 37 tRNA, and eight rRNA genes. Phylogenetic analysis showed that F. hainanensis was the most basal species in the genus Firmiana. The chloroplast genome of this species will provide a theoretical basis to understand the taxa's evolution further and is expected to contribute to its conservation efforts.

An occurrence data set for invasive and naturalized alien plants in India

India has numerous invasive alien plant species (IAPS), which seriously impact biodiversity, ecosystem services, and economic development. Availability of reliable occurrence records of the IAPS is of great importance for their successful management, prediction of distribution across time and space, and other research and development efforts. Global databases of occurrence data, like the Global Biodiversity Information Facility (GBIF), are often not exhaustive, especially for India, and poorly represent the actual distribution of the IAPS in the country. Our objectives to create this data set were three folds: 1) to compile occurrence data for the invasive and naturalized alien plant species of India, 2) to have the spatial and temporal information associated with the occurrence records, and 3) to share the data in an accessible format, so every record is traceable to its sources, and allow users to submit data to increase the resolution of the data set. To achieve these objectives, we extracted data from 3137 literature records and 357 herbarium sheets. For each occurrence record, we curated information for 20 variables, which were arranged in a table with the Darwin Core (DwC) terms as column names. All data were undergone technical validation before including them in the database. A total of 12,347 occurrence records were obtained for 362 species (195 invasive aliens and 167 naturalized aliens). The number of collected occurrence records was much higher for the invasive aliens (73.7%) than for the naturalized alien species (26.3%). Our data set will supplement the GBIF data by 60.39%, and occurrence records will be added for 64 invasive and naturalized alien plant species. The data set, as a part of the larger database of the Indian Alien Flora Information (ILORA) database, is made available without any restriction of use, given this data paper is properly cited. We have also made provisions for users to submit occurrence-related data following a data standard. The users are encouraged to cite the original reference when using a specific data record. The data set is expected to assist a wide range of stakeholders involved in India's scientific research, policy formulation, and decision-making related to IAPS.

Glacial vicariance and oceanic circulation shape population structure of the coastal legume Derris trifoliata in the Indo-West Pacific

PREMISE

The phylogeography of coastal plant species is shaped by contemporary and historical biogeographic processes. In this study, we aim to decipher the phylogeography of Derris trifoliata, a woody legume of relatively recent origin and wide distribution, in coastal areas in the Indo-West Pacific (IWP) region.

METHODS

Genetic diversity and population structure were assessed by analyzing six nuclear and three chloroplast DNA sequences from 30 populations across the species' range. Phylogeography was inferred by estimating gene flow, divergence time, historical population size changes, and historical habitat suitability using paleoclimatic niche modeling.

RESULTS

High genetic diversity was observed at the species level. The populations of three oceanic regions included in this study (i.e., Indian Ocean, South China Sea, and Pacific Ocean) formed distinct clades and likely diverged during the late Pleistocene. Potential barriers to gene flow were identified, including the Sunda and Sahul shelves, geographic distance, and current patterns of oceanic circulation. Analysis of changes in population size supported the bottleneck model, which was strengthened by estimates of habitat suitability across paleoclimatic conditions.

CONCLUSIONS

The once widespread distribution of D. trifoliata was fragmented by changes in climatic suitability and biogeographic barriers that arose following sea-level changes during the Pleistocene. In addition, contemporary patterns of oceanic circulation and geographic distance between populations appear to maintain genetic differentiation across its distribution in the IWP.

Setting the priorities straight - Species distribution models assist to prioritize conservation targets for the mangroves

Mangrove forests provide a wide range of ecosystem services, yet they are declining rapidly due to climate change and human activities. Identification of conservation priority targets across spatial and temporal scales may assist in planning and decision making, especially in areas having rich mangrove diversity but with limited response capacity. In this study, we aimed to identify the species and areas which should be prioritized for conservation in the Indo-West Pacific (IWP) region, one of the two global hotspots of mangroves. We used an ensemble species distribution modelling framework to map the potential distribution of ten species, including true mangroves and mangrove associates, in current, past, and future environmental conditions. The priority targets were then identified through a weighted-scoring approach with the current distribution and the modelled outputs. Our study revealed that precipitation and surface elevation could influence the distribution of the true mangroves, while the temperature was the important variable for the mangrove associates. Although suitable habitat for the mangroves is predicted to increase in future, primarily due to the northward range expansion of six species, areas with high species richness would decrease. We found 7.09% and 4.16% areas of the IWP should be prioritized for conservation of the true mangroves and mangrove associates, respectively. The characteristics of these priority sites indicated that the inclusion of the anthropogenic component in the conservation framework and species-targeted management plans in the protected areas are required for the effective implementation of conservation actions. Five of the studied species, namely Acanthus ilicifolius, Dolichandrone spathacea, Heritiera littoralis, Pemphis acidula and Xylocarpus granatum, were found to have the highest priority score for conservation. The glacial refugia of the species, mostly distributed in the Philippines, New Guinea, southern India and Madagascar, should be explored further for species-specific conservation actions.

Phylogeographic pattern of a cryptoviviparous mangrove, Aegiceras corniculatum, in the Indo-West Pacific, provides insights for conservation actions

This study identified the historical geoclimatic factors which caused low genetic diversity and strong phylogeographic structure in a cryptoviviparous mangrove. The phylogeographic pattern was used to suggest conservation actions. Phylogeographic studies are used to understand the spatial distribution and evolution of genetic diversity, and have major conservation implications, especially for threatened taxa like the mangroves. This study aimed to assess the phylogeographic pattern of Aegiceras corniculatum, a cryptoviviparous mangrove, across its distribution range in the Indo-West Pacific (IWP) region. We genotyped 398 samples, collected from 37 populations, at four chloroplast DNA (cpDNA) loci, and identified the influence of historical processes on the contemporary population structure of the species. Low genetic diversity at the population level was observed. The evolutionary relationship between 12 cpDNA haplotypes suggested a strong phylogeographic structure, which was further validated by the clustering algorithms and proportioning of maximum variation among hierarchical population groups. The magnitude and direction of historical gene flow indicated that the species attained its wide distribution from its likely ancestral area of the Malay Archipelago. The divergence time estimates of the haplotypes indicated that the geoclimatic changes during the Pleistocene, especially the glacial sea-level changes and emergence of landmasses, hindered genetic exchange and created genetic differentiation between the phylogenetic groups. The species overwintered the last glacial maxima in multiple refugia in the IWP, as identified by the environmental niche modelling. Overall, our findings indicated that ancient glacial vicariance had influenced the present genetic composition of A. corniculatum, which was maintained by the current demographic features of this region. We discussed how these findings can be used to prioritize areas for conservation actions, restore disturbed habitats and prevent further genetic erosion.

Different factors influence naturalization and invasion processes - A case study of Indian alien flora provides management insights

Why do some alien plants become naturalized, and some naturalized become invasive? Do different factors determine successful naturalization and invasion? Most, if not all, studies addressing these questions have focused either on the part of the invasion continuum or a specific group of alien species. In this study, we aimed to answer these questions for alien plant invasion in India by considering 13 variables related to biogeography, introduction pathways, uses, functional traits, and distribution for 715 species belonging to three invasion categories. We deciphered the variables' influence on successful naturalization and invasion through a structural equation modeling framework implemented as path analyses and translated the findings to management implications. Our study revealed that the invasive aliens had significantly higher naturalized range size, a greater number of uses, and higher specific leaf area than the naturalized and casual aliens. Path analyses revealed that the native and naturalized range sizes, number of uses, and growth form had a direct influence on naturalization success, whereas longer minimum residence time (MRT) facilitated overcoming of the dispersal barrier for naturalized species. Invasion success was directly influenced by the MRT and number of uses, which were further influenced by the number of native congeners and the naturalized range size, respectively. Plant growth forms indirectly influenced invasion success, whereas the native range sizes had indirect effects on successful naturalization and invasion by strongly influencing the size of the naturalized range. Our findings suggested considering species biogeography in the formulation of quarantine measures, imposing policies to discourage the uses and spread of alien plants within the country, and implementing early control measures, especially for the naturalized aliens. The curated dataset used in this study would also provide a ready reference for future research and decision-making towards the management of alien plant invasion in the country.

Biological invasions in Singapore and Southeast Asia: data gaps fail to mask potentially massive economic costs

The impacts of invasive alien species are well-known and are categorised as a leading contributor to biodiversity loss globally. However, relatively little is known about the monetary costs incurred from invasions on national economies, hampering management responses. In this study, we used published data to describe the economic cost of invasions in Southeast Asia, with a focus on Singapore – a biodiversity-rich, tropical island city state with small size, high human density and high trade volume, three factors likely to increase invasions. In this country, as well as in others in Southeast Asia, cost data were scarce, with recorded costs available for only a small fraction of the species known to be invasive. Yet, the overall available economic costs to Singapore were estimated to be ~ US$ 1.72 billion in total since 1975 (after accounting for inflation), which is approximately one tenth of the total cost recorded in all of Southeast Asia (US$ 16.9 billion). These costs, in Singapore and Southeast Asia, were mostly linked to insects in the family Culicidae (principally Aedes spp.) and associated with damage, resource loss, healthcare and control-related spending. Projections for 11 additional species known to be invasive in Singapore, but with recorded costs only from abroad, amounted to an additional US$ 893.13 million, showing the potential huge gap between recorded and actual costs (cost records remain missing for over 90% of invasive species). No costs within the database for Singapore – or for other Southeast Asian countries – were exclusively associated with proactive management, highlighting that a shortage of reporting on the costs of invasions is mirrored by a lack of investment in management. Moreover, invasion cost entries in Singapore were under-reported relative to import levels, but total costs exceeded expectations, based on land area and population size, and to a greater extent than in other Southeast Asian countries. Therefore, the evaluation and reporting of economic costs of invasions need to be improved in this region to provide efficient data-based support for mitigation and management of their impacts.

Contrasting Phylogeographic Patterns in Lumnitzera Mangroves Across the Indo-West Pacific

Mangroves are ecologically important forest communities in tropical and subtropical coasts, the effective management of which requires understanding of their phylogeographic patterns. However, these patterns often vary among different species, even among ecologically similar taxa or congeneric species. Here, we investigated the levels and patterns of genetic variation within Lumnitzera consisting of two species (L. racemosa and L. littorea) with nearly sympatric ranges across the Indo-West Pacific (IWP) region by sequencing three chloroplast DNA regions (for both species) and genotyping 11 nuclear microsatellite loci (for L. littorea). Consistent with findings in studies on other mangrove species, we found that both L. racemosa and L. littorea showed relatively high genetic variation among populations but low genetic variation within populations. Haplotype network and genetic clustering analyses indicated two well-differentiated clades in both L. racemosa and L. littorea. The relationship between geographic and genetic distances and divergence time estimates of the haplotypes indicated that limited dispersal ability of the propagules, emergence of land barriers during ancient sea-level changes, and contemporary oceanic circulation pattern in the IWP influenced the current population structure of the two species. However, the position of genetic break was found to vary between the two species: in L. racemosa, strong divergence was observed between populations from the Indian Ocean and the Pacific Ocean possibly due to land barrier effect of the Malay Peninsula; in L. littorea, the phylogeographic pattern was created by a more eastward genetic break along the biogeographic barrier identified as the Huxley's line. Overall, our findings strongly supported previous hypothesis of mangrove species divergence and revealed that the two Lumnitzera species have different phylogeographic patterns despite their close genetic relationship and similar current geographic distribution. The findings also provided references for the management of Lumnitzera mangroves, especially for the threatened L. littorea.

Land masses and oceanic currents drive population structure of Heritiera littoralis, a widespread mangrove in the Indo-West Pacific

Phylogeographic forces driving evolution of sea-dispersed plants are often influenced by regional and species characteristics, although not yet deciphered at a large spatial scale for many taxa like the mangrove species Heritiera littoralis. This study aimed to assess geographic distribution of genetic variation of this widespread mangrove in the Indo-West Pacific region and identify the phylogeographic factors influencing its present-day distribution. Analysis of five chloroplast DNA fragments' sequences from 37 populations revealed low genetic diversity at the population level and strong genetic structure of H. littoralis in this region. The estimated divergence times between the major genetic lineages indicated that glacial level changes during the Pleistocene epoch induced strong genetic differentiation across the Indian and Pacific Oceans. In comparison to the strong genetic break imposed by the Sunda Shelf toward splitting the lineages of the Indian and Pacific Oceans, the genetic differentiation between Indo-Malesia and Australasia was not so prominent. Long-distance dispersal ability of H. littoralis propagules helped the species to attain transoceanic distribution not only across South East Asia and Australia, but also across the Indian Ocean to East Africa. However, oceanic circulation pattern in the South China Sea was found to act as a barrier creating further intraoceanic genetic differentiation. Overall, phylogeographic analysis in this study revealed that glacial vicariance had profound influence on population differentiation in H. littoralis and caused low genetic diversity except for the refugia populations near the equator which might have persisted through glacial maxima. With increasing loss of suitable habitats due to anthropogenic activities, these findings therefore emphasize the urgent need for conservation actions for all populations throughout the distribution range of H. littoralis.

Going with the flow: analysis of population structure reveals high gene flow shaping invasion pattern and inducing range expansion of Mikania micrantha in Asia

BACKGROUND AND AIMS

Mikania micrantha, a climbing perennial weed of the family Asteraceae, is native to Latin America and is highly invasive in the tropical belt of Asia, Oceania and Australia. This study was framed to investigate the population structure of M. micrantha at a large spatial scale in Asia and to identify how introduction history, evolutionary forces and landscape features influenced the genetic pattern of the species in this region.

METHODS

We assessed the genetic diversity and structure of 1052 individuals from 46 populations for 12 microsatellite loci. The spatial pattern of genetic variation was investigated by estimating the relationship between genetic distance and geographical, climatic and landscape resistances hypothesized to influence gene flow between populations.

KEY RESULTS

We found high genetic diversity of M. micrantha in this region, as compared with the genetic diversity parameters of other invasive species. Spatial and non-spatial clustering algorithms identified the presence of multiple genetic clusters and admixture between populations. Most of the populations showed heterozygote deficiency, primarily due to inbreeding, and the founder populations showed evidence of a genetic bottleneck. Persistent gene flow throughout the invasive range caused low genetic differentiation among populations and provided beneficial genetic variation to the marginal populations in a heterogeneous environment. Environmental suitability was found to buffer the detrimental effects of inbreeding at the leading edge of range expansion. Both linear and non-linear regression models demonstrated a weak relationship between genetic distance and geographical distance, as well as bioclimatic variables and environmental resistance surfaces.

CONCLUSIONS

These findings provide evidence that extensive gene flow and admixture between populations have influenced the current genetic pattern of M. micrantha in this region. High gene flow across the invaded landscape may facilitate adaptation, establishment and long-term persistence of the population, thereby indicating the range expansion ability of the species.

Genetic and epigenetic regulation of phenotypic variation in invasive plants – linking research trends towards a unified framework

Phenotypic variation in the introduced range of an invasive species can be modified by genetic variation, environmental conditions and their interaction, as well as stochastic events like genetic drift. Recent studies found that epigenetic modifications may also contribute to phenotypic variation being independent of genetic changes. Despite gaining profound ecological insights from empirical studies, understanding the relative contributions of these molecular mechanisms behind phenotypic variation has received little attention for invasive plant species in particular.

This review therefore aimed at summarizing and synthesizing information on the genetic and epigenetic basis of phenotypic variation of alien invasive plants in the introduced range and their evolutionary consequences. Transgenerational inheritance of epigenetic modifications was highlighted focusing on its influence on microevolution of the invasive plant species. We presented a comprehensive account of epigenetic regulation of phenotypic variation and its role in plant invasion in the presence of reduced standing genetic variation, inbreeding depression and associated genomic events which have often been observed during introduction and range expansion of an invasive alien species. Finally, taking clues from the studies conducted so far, we proposed a unified framework of future experimental approaches to understand ecological and evolutionary aspects of phenotypic variation. This holistic approach, being aligned to the invasion process in particular (introduction-establishment-spread), was intended to understand the molecular mechanisms of phenotypic variation of an invasive species in its introduced range and to disentangle the effects of standing genetic variation and epigenetic regulation of phenotypic variation.

A Six Year Prospective Study of Fibrinogen and Other Risk Factors Associated with Mortality in Stable Claudicants

A total of 333 patients with stable intermittent claudication at recruitment were followed up for 6 years to determine risk factors associated with subsequent mortality. Cardiovascular diseases were the underlying cause of death in 78% of the 114 patients who died. The strongest independent predictor of death during the follow-up period was the plasma fibrinogen level, an increase of 1 g/l being associated with a nearly two-fold increase in the probability of death within the next 6 years. Age, low ankle/brachial pressure index and a past history of myocardial infarction also increased the probability of death during the study period. The plasma fibrinogen level is a valuable index of those patients with stable intermittent claudication at high risk of early mortality. The results also provide further evidence for the involvement of fibrinogen in the pathogenesis of arterial disease.

Characterization of the complete chloroplast genome of Camellia granthamiana (Theaceae), a Vulnerable species endemic to China

Camellia granthamiana is a wild camellia resource endemic to China and is listed as a Vulnerable species globally. Here, we reported and characterized its complete chloroplast (cp) genome by using Illumina pair-end sequencing data. The total chloroplast genome size was 157,001 bp, including inverted repeats (IRs) of 26,042 bp, separated by a large single copy (LSC) and a small single copy (SSC) of 86,622 and 18,295 bp, respectively. A total of 131 genes, including 36 tRNA, 8 Rrna, and 87 protein-coding genes were identified. Phylogenetic analysis showed that C. granthamiana is sister to C. sinensis with 100% value support.

Wire-Guided Balloon Coloplasty – a New Treatment for Colorectal Strictures?

A new technique for dilatation of colorectal anastomotic strictures – wire-guided balloon coloplasty – is described. It is suitable for high strictures, may be performed without general anaesthetic and is repeatable. It does not require endoscopy and may be used to relieve obstructive symptoms in both benign and malignant strictures so avoiding the need for a defunctioning colostomy.

Management protocols for chronic heart failure in India

Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient's quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management.

Intra-arterial methylene blue injection into ex vivo colorectal cancer specimens improves lymph node staging accuracy: a randomized controlled trial

AIM

A randomized controlled trial was carried out to study the effect of a recently proposed technique of ex vivo intra-arterial methylene blue injection of the surgical specimen removed for colorectal cancer on lymph node harvest and staging.

METHOD

Between May 2012 and February 2013, 100 consecutive colorectal cancer resection specimens in a single institution were randomly assigned to intervention (methylene blue injection) and control (standard manual palpation technique) groups before formalin fixation. The specimen was then examined by the histopathologist for lymph nodes.

RESULTS

Both groups were similar for age, sex, site of tumour, operation and tumour stage. In the intervention group, a higher number of nodes was found [median 23 (5-92) vs. 15 (5-37), P < 0.001], with only one specimen not achieving the recommended minimum standard of 12 nodes [1/50 (2%) vs. 8/50 (16%), P = 0.014]. However, there was no upstaging effect in the intervention group [23/50 (46.0%) vs. 20/50 (40.0%); P = 0.686]. With a significantly lower number of nodes harvested in rectal cancer, the positive effect of the intervention was particularly observed in the patients who underwent preoperative neoadjuvant radiotherapy [median 30 nodes (12-57) vs. 11 (7-15); P = 0.011; proportion of cases with < 12 nodes 0/5 vs. 5/8 (62.5%), P = 0.024].

CONCLUSION

Ex vivo intra-arterial methylene blue injection increases lymph node yield and can help to reduce the number of cases with a lower-than-recommended number of nodes, particularly in patients with rectal cancer having neoadjuvant treatment. The technique is easy to perform, cheap and saves time.

The association between serum progesterone and outcome of medical management of early fetal demise: a pilot study

The study objective was to determine the relationship between serum progesterone level and the outcome of mifepristone-misoprostol regimen for medical management of missed miscarriage up to 12 weeks. A blood sample was collected just before mifepristone administration for serum progesterone assay. After 48 h, misoprostol 800 μg was administered vaginally; further 400 μg was administered 4 h later if necessary. Treatment was classed as a success if retained tissues were expelled within 72 h (Group 1), and a failure if this did not occur (Group 2). Of 52 analysed cases, complete medical evacuation occurred within 72 h in 40 (76.9%) women (serum progesterone ranged 13-90 nmol/l). Serum progesterone between the two groups were statistically significant (p < 0.001), by Mann-Whitney test. Of the 12 patients who did not respond, nine (75%) women had serum progesterone < 10 nmol/l. We found mifepristone-misoprostol regimen is less effective in missed miscarriage when serum progesterone is < 10 nmol/l.

Targeting tuberculosis: a glimpse of promising drug targets

Tuberculosis caused by Mycobacterium tuberculosis has emerged as the biggest curse of our time causing significant morbidity and mortality. Increasing resistance in mycobacterium to existing drugs calls for exploration of metabolic pathways for finding novel drug targets and also for prioritization of known drug targets. Recent advances in molecular biology, bioinformatics and structural biology coupled with availability of M. tuberculosis genome sequence have provided much needed boost to drug discovery process. This review provides a glimpse of attractive drug targets for development of anti-mycobacterial drug development.

Targeting strategies for Human immunodeficiency virus: a combinatorial approach

The battle between human and the Human immunodeficiency virus (HIV) is on, with both of them rapidly improving their attacking and defense strategies. Many therapeutic agents for HIV infection have been designed and developed, However there are various aspects, like novel targets against HIV, which are yet to be unfolded with a goal of designing and developing novel drug molecules against HIV. This article reviews the current status and innovative new options for antiretroviral therapy for HIV and also discusses the various mechanisms of action for each class of drugs, and the problems yet to be solved with respect to HIV as a target for improvised treatment against AIDS.

New targets, new hope: novel drug targets for curbing malaria

Malaria continues to plague the tropical and subtropical regions causing high morbidity and mortality. Every year, millions die due to lack of affordable and effective anti-malarial drugs. Malaria poses significant threat to half of the world's population and our arsenal to combat this disease is nearly empty. Pharmaceutical companies shy away from investing in research and development for anti-malarial drugs and have shunned it as non-profitable venture. In wake of emergence and spread of drug resistant malaria to newer territories, there is imperative need to develop new drugs for curbing malaria. This underscores the need of exploring new drug targets and reevaluation of existing drug targets. Availability of genome sequence of both parasite and human host has greatly facilitated the search for novel drug targets. This endeavor is complemented well by advances in functional genomics, structure - based drug design and high throughput screening methods and raises much optimism about winning this battle against malaria. This review discusses potential drug targets in the malarial parasite for designing intervention strategies and suitable chemotherapeutic agents.

Limbic encephalitis secondary to HIV seroconversion

We present a case of acute limbic encephalitis secondary to HIV seroconversion. The patient made a gradual neurological recovery following treatment with antiretroviral therapy, steroids and intravenous immunoglobulin.

Dyselectrolytemia in chronic obstructive pulmonary diseases with acute exacerbation

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of mortality and morbidity world wide. Due to lack of awareness about the precipitating factors and predictors of prognosis, cases of acute exacerbation of COPD often suffer the fatal outcomes. In our study we assessed the levels of serum sodium and potassium in subjects with acute episodes of COPD and their healthy controls. We found a significantly low level of serum sodium (133± 6.86 meq/lit) and potassium (3.39 ± 0.96 meq/L)) in subjects with acute exacerbation of COPD than their healthy counterparts [sodium-142 ± 2.28 meq/L and potassium- 4.52 ± 0.02 meq/L (p <0.05)]. Therefore, our study findings suggest that, serum sodium and potassium levels may get deranged in subjects with acute exacerbations of COPD which should be routinely checked for to avoid fatal outcomes.

Parasitic infections of the lung: a guide for the respiratory physician

Parasitic infections of the lung occur worldwide among both immunocompetent and immunocompromised patients and may affect the respiratory system in a variety of ways. This review provides an update on the presenting symptoms, signs, investigation and management of diseases affecting the lung caused by protozoa, nematodes and trematodes. The clinical presentations and radiographic findings of several of these diseases may mimic tuberculosis and malignancy. It is important to consider parasitic infections in the differential diagnosis of such lung diseases. If identified early, most parasitic diseases that affect the lung are curable with medical or surgical treatments.

Chest radiography findings in adults with pandemic H1N1 2009 influenza

The current pandemic of a novel influenza A (H1N1) virus, commonly referred to as "swine flu", began in Mexico in March 2009 and reached the UK in April 2009. By 21 July 2009, more than 850 suspected cases of influenza had been seen at Birmingham Heartlands Hospital (BHH), including 52 adults with laboratory-confirmed pandemic H1N1 influenza who were admitted. Of seven patients (13%) requiring intensive care, six needed mechanical ventilation, two needed extra-corporeal membrane oxygenation (ECMO) and one died. Of the 52 admitted adults, 42 (81%) had respiratory symptoms or signs and positive PCR tests for novel Influenza A (H1N1) virus. These patients also had chest radiographs (CXR) taken, which were abnormal for 12 patients (29%). Of these, six patients had bilateral consolidation, which was bibasal in three and widespread in three; all six had pleural effusions. A further six patients had unilateral consolidation with predominantly basal changes; one of these patients had a pleural effusion. The odds ratio for requiring intubation and ventilation with H1N1 influenza and an abnormal CXR was 29.0 (95% confidence interval 2.93-287.0). CXR changes were not common in swine flu, but a significant minority of those requiring admission had consolidation on their CXR. Those who required admission and had CXR changes are more likely to require intubation and ventilation than those without abnormalities on CXR.

MRI total sagittal abdominal diameter as a predictor of metabolic syndrome compared to visceral fat at L4-L5 level

OBJECTIVE

To compare associations between anteroposterior (AP) diameter or sagittal abdominal diameter - a measure of total central fat, and visceral fat alone with the metabolic syndrome as defined by ATPIII criteria.

RESEARCH DESIGN AND METHODS

Twenty-four Caucasian male with type 2 diabetes and 24 non-diabetic Caucasian male subjects [body mass index (BMI) (+/-SD): 32.23 +/- 7.52 kg/m(2), age (+/-SD): 51.35 +/- 13.80 years] were studied by magnetic resonance imaging (MRI) scan to measure central fat at L4-L5 level. The visceral and total central adipose tissue was calculated in cm(2) and total sagittal MRI diameter and visceral sagittal MRI diameters in cm. Components of the ATPIII definition of the metabolic syndrome and circulating adipocytokine concentrations were also measured.

RESULTS

MRI total sagittal abdominal diameter was positively associated with waist circumference in controls (r=0.62, p=0.007) and in diabetic subjects (r=0.81, p<0.001). Binary logistic regression analysis showed that MRI-calculated total sagittal diameter (r=0.61, p=0.002) was a more significant predictor of the adverse metabolic profile of the metabolic syndrome than MRI-assessed visceral fat. Receiver operating characteristic curves revealed that MRI-calculated total sagittal diameter most effectively identified subjects with the metabolic syndrome.

CONCLUSIONS

MRI-calculated total sagittal abdominal diameter is a non-validated MRI method that predicts the adverse metabolic profile of the ATPIII definition of the metabolic syndrome. Antero-posterior fat is a dimension of central fat that seems to be more closely associated with cardiovascular risk compared to visceral fat.

Validity of 20 meter multi stage shuttle run test for prediction of maximum oxygen uptake in Indian female university students

BACKGROUND

The 20-meter multi stage shuttle run test (20-m MST) has not yet been used by Indian scientists and validity of the test has not been studied for use with any of the Indian population.

AIMS

The purpose of this study was to validate the applicability of the 20-m MST in Indian adult female.

MATERIALS AND METHODS

For application of direct method cross over design was followed. For validity of the results repeatability was used.

METHODS AND MATERIAL

32 female university students (age range 20.4 approximately 24.8 years) from three different universities of West Bengal, India were recruited for the study. Direct estimation of VO2 max comprised treadmill exercise followed by expired gas analysis by scholander micro-gas analyzer whereas VO2 max was indirectly predicted by the 20-m MST.

STATISTICAL ANALYSIS

Paired t-test, Pearson's product moment correlation, linear regression statistics and Bland and Altman approach for limit of agreement were adopted for statistical analysis of the data.

RESULTS

The difference between the mean (SD) VO2 max values of direct measurement (VO2 max = 32.84 +/- 2.92 ml/kg/min) and the 20-m MST (SPVO2 max = 32.60 +/- 3.40 ml/kg/min) was statistically insignificant (p>0.10). Limits of agreement analysis also suggest that the 20-m MST can be applied for use with the studied population.

CONCLUSIONS

The results suggest that the application of the present form of the 20-m MST be justified in the studied population. For better prediction of VO2 max a new equation has been computed based on present data for use with Indian female university students.

Clonal divergence in lung cancer development is associated with allelic loss on chromosome 4

Patients who receive curative treatment for lung cancer can develop additional lung tumors that may or may not be related to the original tumor and thus require different clinical management. If a subsequent tumor has a pattern of allele loss, revealed by allelotype analysis, overlapping that of the first tumor, it is believed to be a local recurrence or metastasis. In this case history, we present loss of heterozygosity analyses of the original primary tumor, and two second primary tumors occurring in the ipsilateral and the contra-lateral lungs. The allelotyping suggests that these tumors are all clonally related but concordance is not complete. Our interpretation is that the original primary tumor and the two new primary tumors have developed to full malignancy independently, but are clonally related, possibly via a clone of motile progenitor cells. Deletion mapping of DNA from biopsies of this patient delineated a region in 4p16 that we had previously shown to be lost in the transition from carcinoma in situ to invasive tumor. We identified a minimally deleted region encompassing six genes including two candidate tumor suppressor genes, CRMP1 a lung cancer metastasis-suppressing gene and PPP2R2C a gene for a regulatory subunit of the PP2 complex known to suppress tumorigenesis, particularly viral induced transformation.

Current knowledge on the distribution of arsenic in groundwater in five states of India

Testing of groundwater used for drinking for arsenic has been undertaken more widely by state governments in several states of India in recent years with the support of UNICEF. Available data for five states are collated in this paper and this provides the most up-to-date picture of areas known to be affected by arsenic in groundwater in the Indian portion of the Ganges-Brahmaputra river basin. In West Bengal, water from 132,262 government installed handpumps in 8 districts has been tested and overall 25.5% of samples were found to contain arsenic at concentrations greater than 50 microgL(-1) and 57.9% at concentrations greater than 10 microgL(-1). On the banks of the Brahmaputra in Assam, to date, samples from 5,729 government handpump sources in 22 districts have been tested for arsenic. Overall, samples from 6.3% of sources were found to contain arsenic at concentrations greater than 50 microgL(-1) and 26.1% at concentrations greater than 10 microgL(-1). In Bihar, on the River Ganges upstream of West Bengal, 66,623 sources from 11 districts have been tested and water samples from 10.8% of sources were found to contain arsenic at concentrations greater than 50 microgL(-1) and 28.9% at concentrations greater than 10 microgL(-1). Upstream of Bihar in Uttar Pradesh, home of the Taj Mahal, to date water samples from 20,126 government-installed handpump sources have been tested. As a result 2.4% of the samples tested were found to contain arsenic at concentrations greater than 50 microgL(-1) and 21.5% at concentrations greater than 10 microgL(-1). Finally in one district of Jharkhand, lying on the Ganges alluvial plain between Bihar and West Bengal, 9,007 sources have been tested and water samples from 3.7% of sources were found to contain arsenic at concentrations greater than 50 microgL(-1) and 7.5% at concentrations greater than 10 microgL(-1). State governments have adopted different sampling strategies and these are described in this paper. Testing is ongoing in several states and the complete picture is yet to emerge in some areas.