Rhizosheath drought responsiveness is variety-specific and a key component of belowground plant adaptation

Biophysicochemical rhizosheath properties play a vital role in plant drought adaptation. However, their integration into the framework of plant drought response is hampered by incomplete mechanistic understanding of their drought responsiveness and unknown linkage to intraspecific plant-soil drought reactions. Thirty-eight Zea mays varieties were grown under well-watered and drought conditions to assess the drought responsiveness of rhizosheath properties, such as soil aggregation, rhizosheath mass, net-rhizodeposition, and soil organic carbon distribution. Additionally, explanatory traits, including functional plant trait adaptations and changes in soil enzyme activities, were measured. Drought restricted soil structure formation in the rhizosheath and shifted plant-carbon from litter-derived organic matter in macroaggregates to microbially processed compounds in microaggregates. Variety-specific functional trait modifications determined variations in rhizosheath drought responsiveness. Drought responses of the plant-soil system ranged among varieties from maintaining plant-microbial interactions in the rhizosheath through accumulation of rhizodeposits, to preserving rhizosheath soil structure while increasing soil exploration through enhanced root elongation. Drought-induced alterations at the root-soil interface may hold crucial implications for ecosystem resilience in a changing climate. Our findings highlight that rhizosheath soil properties are an intrinsic component of plant drought response, emphasizing the need for a holistic concept of plant-soil systems in future research on plant drought adaptation.

Unraveling root and rhizosphere traits in temperate maize landraces and modern cultivars: Implications for soil resource acquisition and drought adaptation

A holistic understanding of plant strategies to acquire soil resources is pivotal in achieving sustainable food security. However, we lack knowledge about variety-specific root and rhizosphere traits for resource acquisition, their plasticity and adaptation to drought. We conducted a greenhouse experiment to phenotype root and rhizosphere traits (mean root diameter [Root D], specific root length [SRL], root tissue density, root nitrogen content, specific rhizosheath mass [SRM], arbuscular mycorrhizal fungi [AMF] colonization) of 16 landraces and 22 modern cultivars of temperate maize (Zea mays L.). Our results demonstrate that landraces and modern cultivars diverge in their root and rhizosphere traits. Although landraces follow a 'do-it-yourself' strategy with high SRLs, modern cultivars exhibit an 'outsourcing' strategy with increased mean Root Ds and a tendency towards increased root colonization by AMF. We further identified that SRM indicates an 'outsourcing' strategy. Additionally, landraces were more drought-responsive compared to modern cultivars based on multitrait response indices. We suggest that breeding leads to distinct resource acquisition strategies between temperate maize varieties. Future breeding efforts should increasingly target root and rhizosphere economics, with SRM serving as a valuable proxy for identifying varieties employing an outsourcing resource acquisition strategy.

Rhizosphere priming promotes plant nitrogen acquisition by microbial necromass recycling

Nitrogen availability in the rhizosphere relies on root-microorganism interactions, where root exudates trigger soil organic matter (SOM) decomposition through the rhizosphere priming effect (RPE). Though microbial necromass contribute significantly to organically bound soil nitrogen (N), the role of RPEs in regulating necromass recycling and plant nitrogen acquisition has received limited attention. We used 15 N natural abundance as a proxy for necromass-N since necromass is enriched in 15 N compared to other soil-N forms. We combined studies using the same experimental design for continuous 13 CO2 labelling of various plant species and the same soil type, but considering top- and subsoil. RPE were quantified as difference in SOM-decomposition between planted and unplanted soils. Results showed higher plant N uptake as RPEs increased. The positive relationship between 15 N-enrichment of shoots and roots and RPEs indicated an enhanced necromass-N turnover by RPE. Moreover, our data revealed that RPEs were saturated with increasing carbon (C) input via rhizodeposition in topsoil. In subsoil, RPEs increased linearly within a small range of C input indicating a strong effect of root-released C on decomposition rates in deeper soil horizons. Overall, this study confirmed the functional importance of rhizosphere C input for plant N acquisition through enhanced necromass turnover by RPEs.

Changes in arsenic mobility and speciation across a 2000-year-old paddy soil chronosequence

Rice accumulates arsenic (As) when cultivated under flooded conditions in paddy soils threatening rice yield or its safety for human consumption, depending on As speciation. During long-term paddy use, repeated redox cycles systematically alter soil biogeochemistry and microbiology. In the present study, incubation experiments from a 2000-year-old paddy soil chronosequence revealed that As mobilization and speciation also change with paddy soil age. Younger paddies (≤100 years) showed the highest total As mobilization, with speciation dominated by carcinogenic inorganic oxyarsenic species and highly mobile inorganic thioarsenates. Inorganic thioarsenates formed by a high availability of reduced sulfur (S) due to low concentrations of reducible iron (Fe) and soil organic carbon (SOC). Long-term paddy use (>100 years) resulted in higher microbial activity and SOC, increasing the share of phytotoxic methylated As. Methylated oxyarsenic species are precursors for cytotoxic methylated thioarsenates. Methylated thioarsenates formed in soils of all ages being limited either by the availability of methylated As in young soils or that of reduced-S in older ones. The present study shows that via a linkage of As to the biogeochemistry of Fe, S, and C, paddy soil age can influence the kind and the extent of threat that As poses for rice cultivation.

Novel insights into orchid mycorrhiza functioning from stable isotope signatures of fungal pelotons

Stable isotope signatures of fungal sporocarps have been instrumental in identifying carbon gains of chlorophyllous orchids from a fungal source. Yet, not all mycorrhizal fungi produce macroscopic sporocarps and frequently fungi of different taxa occur in parallel in orchid roots. To overcome this obstacle, we investigated stable isotope signatures of fungal pelotons extracted from orchid roots and compared these data to the respective orchid and reference plant tissues. Anoectochilus sandvicensis and Epipactis palustris represented specialized or unspecialized rhizoctonia-associated orchids. Epipactis atrorubens and Epipactis leptochila are orchids considered ectomycorrhiza-associated with different preferences for Basidio- and Ascomycota. ¹³ C enrichment of rhizoctonia pelotons was minor compared with plant tissues and significantly lower than enrichments of pelotons from ectomycorrhizal Epipactis species. ¹⁵ N values of pelotons from E. leptochila and E. atrorubens showed similar patterns as known for respective sporocarps of ectomycorrhizal Ascomycota and Basidiomycota, however, with an offset towards lower ¹⁵ N enrichments and nitrogen concentrations. Our results suggest an explicit fungal nutrition source of orchids associated with ectomycorrhizal fungi, whereas the low ¹³ C enrichment in rhizoctonia-associated orchids and fungal pelotons hamper the detection of carbon gains from fungal partners. ¹⁵ N isotopic pattern of orchids further suggests a selective transfer of ¹⁵ N-enriched protein-nitrogen into orchids.

Above and belowground traits impacting transpiration decline during soil drying in 48 maize (Zea mays) genotypes

BACKGROUND AND AIMS

Stomatal regulation allows plants to promptly respond to water stress. However, our understanding of the impact of above and belowground hydraulic traits on stomatal regulation remains incomplete. The objective of this study was to investigate how key plant hydraulic traits impact transpiration of maize during soil drying. We hypothesize that the stomatal response to soil drying is related to a loss in soil hydraulic conductivity at the root-soil interface, which in turn depends on plant hydraulic traits.

METHODS

We investigate the response of 48 contrasting maize (Zea mays) genotypes to soil drying, utilizing a novel phenotyping facility. In this context, we measure the relationship between leaf water potential, soil water potential, soil water content and transpiration, as well as root, rhizosphere and aboveground plant traits.

KEY RESULTS

Genotypes differed in their responsiveness to soil drying. The critical soil water potential at which plants started decreasing transpiration was related to a combination of above and belowground traits: genotypes with a higher maximum transpiration and plant hydraulic conductance as well as a smaller root and rhizosphere system closed stomata at less negative soil water potentials.

CONCLUSIONS

Our results demonstrate the importance of belowground hydraulics for stomatal regulation and hence drought responsiveness during soil drying. Furthermore, this finding supports the hypothesis that stomata start to close when soil hydraulic conductivity drops at the root-soil interface.

Ectomycorrhizal and non-mycorrhizal rhizosphere fungi increase root-derived C input to soil and modify enzyme activities: A 14 C pulse labelling of Picea abies seedlings

Consequences of interactions between ectomycorrhizal fungi (EcMF) and non-mycorrhizal rhizosphere fungi (NMRF) for plant carbon (C) allocation belowground and nutrient cycling in soil remain unknown. To address this topic, we performed a mesocosm study with Norway spruce seedlings [Picea abies (L.) H. Karst] inoculated with EcMF, NMRF, or a mixture of both (MIX). ¹⁴ CO₂ pulse labelling of spruce was applied to trace and visualize the ¹⁴ C incorporation into roots, rhizohyphosphere and hyphosphere. Activities and localization of enzymes involved in the C, nitrogen (N) and phosphorus (P) cycling were visualized using zymography. Spruce seedlings inoculated with EcMF and NMRF allocated more C to soils (EcMF: 10.7%; NMRF: 3.5% of total recovered C) compared to uninoculated control seedlings. The ¹⁴ C activity in the hyphosphere was highest for EcMF and lowest for NMRF. In the presence of both, NMRF and EcMF (MIX), the ¹⁴ C activity was 64% lower compared with EcMF inoculation alone. This suggests a suppressed C allocation via EcMF likely due to the competition between EcMF and NMRF for N and P. Furthermore, we observed 57% and 49% higher chitinase and leucine-aminopeptidase activities in the rhizohyphosphere of EcMF compared to the uninoculated control, respectively. In contrast, β-glucosidase activity (14.3 nmol cm^-2  h^-1 ) was highest in NMRF likely because NMRF consumed rhizodeposits efficiently. This was further supported by that enzyme stoichiometry in soil with EcMF shifted to a higher investment of nutrient acquisition enzymes (e.g., chitinase, leucine-aminopeptidase, acid phosphatase) compared to NMRF inoculation, where investment in β-glucosidase increased. In conclusion, the alleviation of EcMF from C limitation promotes higher activities of enzymes involved in the N and P cycle to cover the nutrient demand of EcMF and host seedlings. In contrast, C limitation of NMRF probably led to a shift in investment towards higher activities of enzymes involved in the C cycle.

Silica fertilization improved wheat performance and increased phosphorus concentrations during drought at the field scale

Drought and the availability of mineable phosphorus minerals used for fertilization are two of the important issues agriculture is facing in the future. High phosphorus availability in soils is necessary to maintain high agricultural yields. Drought is one of the major threats for terrestrial ecosystem performance and crop production in future. Among the measures proposed to cope with the upcoming challenges of intensifying drought stress and to decrease the need for phosphorus fertilizer application is the fertilization with silica (Si). Here we tested the importance of soil Si fertilization on wheat phosphorus concentration as well as wheat performance during drought at the field scale. Our data clearly showed a higher soil moisture for the Si fertilized plots. This higher soil moisture contributes to a better plant performance in terms of higher photosynthetic activity and later senescence as well as faster stomata responses ensuring higher productivity during drought periods. The plant phosphorus concentration was also higher in Si fertilized compared to control plots. Overall, Si fertilization or management of the soil Si pools seem to be a promising tool to maintain crop production under predicted longer and more serve droughts in the future and reduces phosphorus fertilizer requirements.

Effect on soil water availability, rather than silicon uptake by plants, explains the beneficial effect of silicon on rice during drought

Various studies showed a decrease of drought stress specific parameters of plants after silicon (Si) fertilization. But all studies differed in soil Si concentration between the control and Si treatments. As amorphous silica (ASi) was recently found to cause a strong increase of water holding capacity and plant available water in soils, a combined effect of soil moisture and plant response due to Si addition was assumed. In this study, the influence of the soil Si content was excluded by using the same Si enriched soil for treatments of two rice lines, lsi1 mutant defective in Si uptake and its wild-type rice. Most plant parameters, such as nutrient contents, biomass, specific leaf area, specific root length, leaf water content and C allocation did not differ significantly between the genotypes neither under flooded conditions, nor under drought conditions. Only photosynthesis and stomatal conductance were slightly higher for the wild type in both drought and flooded treatments. Overall, our data showed that Si accumulation within the plant tissues has only a minor effect on plant performance under drought stress. Hence, existing studies should be reinterpreted in light of the fact that Si additions may increase soil water availability.

Alternating Wet-Dry Cycles Rather than Sulfate Fertilization Control Pathways of Methanogenesis and Methane Turnover in Rice Straw-Amended Paddy Soil

Alternate wet-drying (AWD) and sulfate fertilization have been considered as effective methods for lowering CH₄ emissions from paddy soils. However, there is a clear knowledge gap between field studies that focus on the quantification of emissions and laboratory studies that investigate mechanisms. To elucidate mechanisms of CH₄ production and oxidation under field conditions, rice was planted in straw-amended mesocosms with or without sulfate fertilization under continuously flooded conditions (FL) or two wet-dry cycles. CO₂ and CH₄ concentrations in soil air and their natural C isotope compositions were measured at stem elongation, booting, and flowering stages. CH₄ concentration reached 51 mg C L^-1 at the flowering stage under FL, while it decreased to 0.04 mg C L^-1 under AWD. Relative ¹³C enrichment in CH₄ and depletion in CO₂ under AWD indicated CH₄ oxidation. Ample organic substrate supply may have reduced competition between sulfate-reducing bacteria and methanogenic archaea, and therefore, it explains the absence of a decrease in CH₄ concentrations in sulfate treatments. ¹³C enrichment in CO₂ over time (6 and 7‰ with and without sulfate fertilizers, respectively) under FL indicates continuous contribution of hydrogenotrophic methanogenesis to CH₄ production with ongoing rice growth. Overall, AWD could more efficiently reduce CH₄ production than sulfate fertilization in rice straw-amended paddy soils.

Plant intraspecific competition and growth stage alter carbon and nitrogen mineralization in the rhizosphere

Plant roots interact with rhizosphere microorganisms to accelerate soil organic matter (SOM) mineralization for nutrient acquisition. Root-mediated changes in SOM mineralization largely depend on root-derived carbon (root-C) input and soil nutrient status. Hence, intraspecific competition over plant development and spatiotemporal variability in the root-C input and nutrients uptake may modify SOM mineralization. To investigate the effect of intraspecific competition on SOM mineralization at three growth stages (heading, flowering, and ripening), we grew maize (C4 plant) under three planting densities on a C3 soil and determined in situ soil C- and N-mineralization by ¹³ C-natural abundance and ¹⁵ N-pool dilution approaches. From heading to ripening, soil C- and N-mineralization rates exhibit similar unimodal trends and were tightly coupled. The C-to-N-mineralization ratio (0.6 to 2.6) increased with N availability, indicating that an increase in N-mineralization with N depletion was driven by microorganisms mining N-rich SOM. With the intraspecific competition, plants increased specific root lengths as an efficient strategy to compete for resources. Root morphologic traits rather than root biomass per se were positively related to C- and N-mineralization. Overall, plant phenology and intraspecific competition controlled the intensity and mechanisms of soil C- and N- mineralization by the adaptation of root traits and nutrient mining.

Stable C and N isotope natural abundances of intraradical hyphae of arbuscular mycorrhizal fungi

Data for stable C and N isotope natural abundances of arbuscular mycorrhizal (AM) fungi are currently sparse, as fungal material is difficult to access for analysis. So far, isotope analyses have been limited to lipid compounds associated with fungal membranes or storage structures (biomarkers), fungal spores and soil hyphae. However, it remains unclear whether any of these components are an ideal substitute for intraradical AM hyphae as the functional nutrient trading organ. Thus, we isolated intraradical hyphae of the AM fungus Rhizophagus irregularis from roots of the grass Festuca ovina and the legume Medicago sativa via an enzymatic and a mechanical approach. In addition, extraradical hyphae were isolated from a sand-soil mix associated with each plant. All three approaches revealed comparable isotope signatures of R. irregularis hyphae. The hyphae were 13C- and 15N-enriched relative to leaves and roots irrespective of the plant partner, while they were enriched only in 15N compared with soil. The 13C enrichment of AM hyphae implies a plant carbohydrate source, whereby the enrichment was likely reduced by an additional plant lipid source. The 15N enrichment indicates the potential of AM fungi to gain nitrogen from an organic source. Our isotope signatures of the investigated AM fungus support recent findings for mycoheterotrophic plants which are suggested to mirror the associated AM fungi isotope composition. Stable isotope natural abundances of intraradical AM hyphae as the functional trading organ for bi-directional carbon-for-mineral nutrient exchanges complement data on spores and membrane biomarkers.

Effects of rain shortage on carbon allocation, pools and fluxes in a Mediterranean shrub ecosystem - a 13C labelling field study

Hydrological cycle is expected to become the primary cause of ecosystem's degradation in near future under changing climate. Rain manipulation experiments under field conditions provide accurate picture on the responses of biotic processes to changed water availability for plants. A field experiment, mimicking expected changes in rain patterns, was established in a Mediterranean shrub community at Porto Conte, Italy, in 2001. In November 2011 Cistus monspeliensis, one of the dominating shrub species in the Mediterranean basin, was ¹³C labelled on plots subjected to extended rain shortage period and on control non manipulated plots. Carbon (C) allocation was traced by ¹³C dynamics in shoots, shoot-respired CO₂, roots, microbial biomass, K₂SO₄-extractable C and CO₂ respired from soil. Most of the recovered ¹³C (60%) was respired by shoots within 2weeks in control plots. In rain shortage treatment, ¹³C remained incorporated in aboveground plant parts. Residence time of ¹³C in leaves was longer under the rain shortage because less ¹³C was lost by shoot respiration and because ¹³C was re-allocated to leaves from woody tissues. The belowground C sink was weak (3-4% of recovered ¹³C) and independent on rain manipulation. Extended rain shortage promoted C exudation into rhizosphere soil in expense of roots. Together with lowered photosynthesis, this "save" economy of new C metabolites reduces the growing season under rain shortage resulting in decrease of shrub cover and C losses from the system on the long-term.

First-order wedge wetting revisited

We consider a fluid adsorbed in a wedge made from walls that exhibit a first-order wetting transition and revisit the argument as to why and how the pre-filling and pre-wetting coexistence lines merge when the opening angle is increased approaching the planar geometry. We clarify the nature of the possible surface phase diagrams, pointing out the connection with complete pre-wetting, and show that the merging of the coexistence lines lead to new interfacial transitions. These occur along the side walls and are associated with the unbinding of the thin-thick interface, rather than the liquid-gas interface (meniscus), from the wedge apex. When fluctuation effects, together with the influence of dispersion forces are included, these transitions display strong non-universal critical singularities that depend on the opening angle itself. Similar phenomena are also shown to occur for adsorption near an apex tip.

Root hairs increase rhizosphere extension and carbon input to soil

BACKGROUND AND AIMS

Although it is commonly accepted that root exudation enhances plant-microbial interactions in the rhizosphere, experimental data on the spatial distribution of exudates are scarce. Our hypothesis was that root hairs exude organic substances to enlarge the rhizosphere farther from the root surface.

METHODS

Barley (Hordeum vulgare 'Pallas' - wild type) and its root-hairless mutant (brb) were grown in rhizoboxes and labelled with 14CO2. A filter paper was placed on the soil surface to capture, image and quantify root exudates.

KEY RESULTS

Plants with root hairs allocated more carbon (C) to roots (wild type: 13 %; brb: 8 % of assimilated 14C) and to rhizosheaths (wild type: 1.2 %; brb: 0.2 %), while hairless plants allocated more C to shoots (wild type: 65 %; brb: 75 %). Root hairs increased the radial rhizosphere extension three-fold, from 0.5 to 1.5 mm. Total exudation on filter paper was three times greater for wild type plants compared to the hairless mutant.

CONCLUSION

Root hairs increase exudation and spatial rhizosphere extension, which probably enhance rhizosphere interactions and nutrient cycling in larger soil volumes. Root hairs may therefore be beneficial to plants under nutrient-limiting conditions. The greater C allocation below ground in the presence of root hairs may additionally foster C sequestration.

Carbon input by roots into the soil: Quantification of rhizodeposition from root to ecosystem scale

Despite its fundamental role for carbon (C) and nutrient cycling, rhizodeposition remains 'the hidden half of the hidden half': it is highly dynamic and rhizodeposits are rapidly incorporated into microorganisms, soil organic matter, and decomposed to CO₂ . Therefore, rhizodeposition is rarely quantified and remains the most uncertain part of the soil C cycle and of C fluxes in terrestrial ecosystems. This review synthesizes and generalizes the literature on C inputs by rhizodeposition under crops and grasslands (281 data sets). The allocation dynamics of assimilated C (after ¹³ C-CO₂ or ¹⁴ C-CO₂ labeling of plants) were quantified within shoots, shoot respiration, roots, net rhizodeposition (i.e., C remaining in soil for longer periods), root-derived CO₂ , and microorganisms. Partitioning of C pools and fluxes were used to extrapolate belowground C inputs via rhizodeposition to ecosystem level. Allocation from shoots to roots reaches a maximum within the first day after C assimilation. Annual crops retained more C (45% of assimilated ¹³ C or ¹⁴ C) in shoots than grasses (34%), mainly perennials, and allocated 1.5 times less C belowground. For crops, belowground C allocation was maximal during the first 1-2 months of growth and decreased very fast thereafter. For grasses, it peaked after 2-4 months and remained very high within the second year causing much longer allocation periods. Despite higher belowground C allocation by grasses (33%) than crops (21%), its distribution between various belowground pools remains very similar. Hence, the total C allocated belowground depends on the plant species, but its further fate is species independent. This review demonstrates that C partitioning can be used in various approaches, e.g., root sampling, CO₂ flux measurements, to assess rhizodeposits' pools and fluxes at pot, plot, field and ecosystem scale and so, to close the most uncertain gap of the terrestrial C cycle.

Limited carbon and mineral nutrient gain from mycorrhizal fungi by adult Australian orchids

PREMISE OF THE STUDY

In addition to autotrophic and fully mycoheterotrophic representatives, the orchid family comprises species that at maturity obtain C and N partially from fungal sources. These partial mycoheterotrophs are often associated with fungi that simultaneously form ectomycorrhizas with trees. This study investigates mycorrhizal nutrition for orchids from the southwestern Australian biodiversity hotspot.

METHODS

The mycorrhizal fungi of 35 green and one achlorophyllous orchid species were analyzed using molecular methods. Nutritional mode was identified for 27 species by C and N isotope abundance analysis in comparison to non-orchids from the same habitat. As a complementary approach, (13)CO(2) pulse labeling was applied to a subset of six orchid species to measure photosynthetic capacity.

KEY RESULTS

Almost all orchids associated with rhizoctonia-forming fungi. Due to much higher than expected variation within the co-occurring nonorchid reference plants, the stable isotope approach proved challenging for assigning most orchids to a specialized nutritional mode; therefore, these orchids were classified as autotrophic at maturity. The (13)CO(2) pulse labeling confirmed full autotrophy for six selected species. Nonetheless, at least three orchid species (Gastrodia lacista, Prasophyllum elatum, Corybas recurvus) were identified as nutritionally distinctive from autotrophic orchids and reference plants.

CONCLUSIONS

Despite the orchid-rich flora in southwestern Australia, partial mycoheterotrophy among these orchids is less common than in other parts of the world, most likely because most associate with saprotrophic fungi rather than ectomycorrhizal fungi.

Palliativtherapie der malignen Ösophagusobstruktion mit selbstexpandierenden Metallendoprothesen

A total of 23 self-expanding metal stents were implanted in 17 patients (12 men, 5 women; mean age 66 [44-83] years) with inoperable malignant obstruction of the oesophagus or the oesophago-gastric junction. A primary success was achieved in all, a good functional result in 16 (94%). There were no complications. In the follow-up period (mean of 15.2 +/- 13 weeks) re-obstruction by the tumour process occurred in three patients. Twelve patients died after a mean survival time of 15.8 +/- 14 weeks. In ten of these the stent was still patent at death, while two had again developed dysphagia. The cumulative patency rate of the stents was 79%. These observations indicate that self-expanding metal stents can achieve satisfactory palliation in dysphagia due to a malignancy. The mortality and morbidity rates of the method seem to be less than those of other palliative measures.

[Treatment of cholestatic hepatic diseases: more than the substitution of fat soluble vitamins?]

The clinical-biochemical syndrome of cholestasis is characterized by an alteration in bile constituents. As a consequence, the concentrations of bilirubin, bile acids, phospholipids and cholesterol are elevated. The main clinical symptoms of cholestasis are icterus and pruritus, and in severe cases xanthelasma and xanthoma. Primary intrahepatic cholestasis, caused by impaired bile secretion in the liver, should be separated from the extrahepatic secondary cholestasis which is a consequence of a biliary obstruction. This paper evaluates the therapy of liver diseases which developed as consequence of a primary disturbance in bile secretion.

Randomized, controlled trial with IFN-alpha combined with ribavirin with and without amantadine sulphate in non-responders with chronic hepatitis C

BACKGROUND/AIMS

Efficacy and safety of interferon-alpha (IFN-alpha)/ribavirin retreatment with or without amantadine sulphate were evaluated in non-responders with chronic hepatitis C.

METHODS

Two hundred twenty five consecutive non-responders to previous antiviral treatment(s) with IFN-alpha alone or in combination with ribavirin or amantadine were treated with IFN-alpha 2b 5 MU daily for 4 weeks, 5 MU tiw for 20 weeks, followed by 3 MU tiw for additional 24 weeks combined with ribavirin 1000-1200 mg/d. One hundred fifteen of 225 patients were randomized to receive amantadine sulphate 100 mg bid for 48 weeks. Treatment was discontinued in patients with detectable serum hepatitis C virus (HCV)-RNA at treatment week 24.

RESULTS

An overall sustained virologic response with undectable serum HCV-RNA levels was observed in 49/225 patients (22%). Patients infected with HCV-genotype non-1 (P<0.001), low viremia (P=0.011) and only one previous antiviral treatment (P=0.032) were more likely to respond to antiviral retreatment. There was a trend towards higher sustained virologic response rates in patients receiving triple retreatment compared with those treated with IFN-alpha/ribavirin alone (25 versus 18%, P=0.172).

CONCLUSIONS

The addition of amantadine was well tolerated and led to an improvement of sustained virologic responses compared with retreatment with IFN-alpha/ribavirin alone, in particular in patients with low baseline viremia.

[Non-cardiac chest pain]

Non-cardiac chest pain is caused in 50% by esophageal disorders. About 30% of such esophageal chest pain is induced by gastroesophageal reflux. 2/3 of esophageal chest pain is related to various esophageal motility disorders, which can be differentiated by manometry. Diagnostic procedures for esophageal dysfunction (endoscopy, radiology, long-term pH-metry) have been evaluated. Therapy of gastroesophageal reflux disease has been proven effective; maintenance therapy should be evaluated in further controlled randomized trials. Treatment of esophageal motility disorders, unsatisfactory so far, needs to be improved and standardized.

[Refractory hydrothorax in primary biliary cirrhosis: successful treatment with transjugular intrahepatic portosystemic stent shunt]

HISTORY AND CLINICAL FINDINGS

A 55-year-old woman with known primary biliary cirrhosis (PBC) was hospitalized because of increasing dyspnoea. A year before she had for the first time experienced a right-sided pleural effusion which had to be drained every 4 weeks. Physical examination revealed dullness on percussion and greatly decreased breath sounds on auscultation over the entire right thorax. In addition there were signs of moderate ascites and leg oedema.

INVESTIGATIONS

Chest radiograph showed a homogeneous shadowing of the right thorax without mediastinal shift. Diagnostic thoracocentesis produced a serous effusion, a transudate on chemical analysis, comparable to the composition of the ascitic fluid. Bacteriological and cytological tests on both fluids were unremarkable.

TREATMENT AND COURSE

The right pleural effusion was presumed to be due to a hydrothorax from the ascites caused by portal hypertension associated with the PBC. Despite continuous diuretic treatment and thoracocentesis with albumin substitution every 3 days there was no improvement and implantation of a transjugular intrahepatic portosystemic stent shunt (TIPSS) was performed. This effectively lowered portal pressure and markedly improved the patient's condition so that further thoracocentesis were no longer necessary. 3 weeks after TIPSS implantation she was discharged in good condition. Radiography 3 weeks later demonstrated continued reduction in the hydrothorax.

CONCLUSION

Hydrothorax is a rare complication of liver cirrhosis. TIPSS implantation can provide lasting resolution and corresponding clinical improvement of a hydrothorax, especially in those conditions which are refractory to diuretic treatment and thoracocentesis.

[Comparison of psychodiagnostic methods for dementia and deterioration]

Several cognitive impairment/dementia diagnostic methods were examined concerning their results: (a) in the differentiation of accidental and pathological ability changes; (b) in the demonstration/exclusion of cognitive impairment; and (c) the degree of dementia. Sixty-five patients suffering from brain damage were examined with five accepted methods of diagnosing dementia (Syndrom-kurztest, KAI-MWT-Methode, Demenz-Test, Mini-Mental-Status-Test, Wurzer-Methode) and a comprehensive performance test battery as an external criterion for valid determination of the degree of dementia and definite differentiation of accidental and pathological performance changes. The five methods of diagnosing dementia differ appreciably in determining the degree of severity (r = 0.44). They are effective in registering accidental performance changes in comparison with the outer criterion, but pathological changes are inaccurately registered (hit rate 88%/53%); the results concerning the degree of cognitive impairment are identical: between 25 and 43% (r = 0.43). High rates (58%) of false-negative diagnoses are especially apparent in the range of slight and intermediate cognitive impairment. The methods examined are only useful for the demonstration and not for the exclusion of severe cognitive impairment (dementia) and in no circumstances for the registration of slight/intermediate cognitive impairment. Valid diagnosis of cognitive impairment/dementia necessitates the use of test batteries that differentiate functions including the premorbid performance level.

Antimitochondrial antibody profiles in primary biliary cirrhosis distinguish at early stages between a benign and a progressive course: a prospective study on 200 patients followed for 10 years

In recent retrospective studies, it was shown that subtypes of antimitochondrial antibodies (AMA) can help to discriminate between a benign [only anti-M9 and/or anti-M2 positive by enzyme-linked immunosorbent assay (ELISA)] and a rather progressive course (anti-M2, -M4 and/or -M8 positive). According to different constellations of these AMA subspecificities in ELISA and complement fixation test (CFT), four AMA profiles (A-D) were defined. In 1984 we started a prospective study based on 200 PBC patients with known AMA profiles in order to correlate the antibody pattern with the clinical outcome. Progression was defined primarily as the necessity of liver transplantation and death due to hepatic failure or variceal bleeding. At entry, 18 (9%) of the 200 patients had AMA profile A (only anti-M9), 57 (29%) profile B (only anti-M2 with or without anti-M9), 74 (37%) profile C (anti-M2 in association with anti-M4/-M8 by ELISA), and 51 (26%) profile D (anti-M2/-M4/-M8 by ELISA and CFT). At the beginning of the study, 177 patients had PBC stage I/II. During the observation period of ten years, ten patients died and in 18 orthotopic liver transplantation (OLT) was performed; all these patients belonged to profile C/D. Furthermore, 44% of the patients with profile C and 31% of the patients with profile D progressed to late stages, as defined by histology and clinical manifestations such as portal hypertension and increase of bilirubin, while only one of the patients with profile B and none of the profile A-patients developed late stage PBC. A significant increase of bilirubin was observed only in C/D-patients. AMA profiles did not change during the follow-up. In conclusion, AMA profiles discriminate between a benign and a progressive course of PBC already at early stages.

[The risk of liver biopsy]

Complications have been reported to occur in 0.14 through 0.29% of all patients undergoing liver biopsy. The total incidence of complications is lower in laparoscopically guided biopsy when compared with percutaneous liver biopsy. On the other hand fatal complications appear to be more frequent with laparoscopy (0.038%) than with percutaneous biopsy (0.009-0.017%). Nevertheless, laparoscopic biopsy should be preferred particularly in patients with suspected liver cirrhosis, since laparoscopy is more sensitive for this diagnosis. Until now, the significance of the type of biopsy needle used has not definitively been clarified. The results that are available however indicate, that biopsy with the Tru-cut needle is accompanied by a particularly high bleeding risk. Regarding the results of retrospective studies concerning needle diameter, less serious complications appear to occur after fine needle biopsy when compared with standard needles. Thus, fine needle biopsy should be preferred in patients with focal liver lesions, since the bleeding risk is assumed to be higher in these cases.

[Septic portal vein thrombosis. Its successful therapy by local fibrinolysis and a transjugular portasystemic stent-shunt (TIPS)]

HISTORY AND FINDINGS

A 68-year-old man, without any preceding hepatic or abdominal disease, suddenly developed a severe septic illness with consumptive coagulopathy and upper abdominal pain. B-mode and duplex ultrasonography revealed fresh portal vein thrombosis. Despite extensive conservative measures there was no significant improvement after one week and further thrombus extension with threatened acute mesenteric vein occlusion.

TREATMENT AND COURSE

Local fibrinolysis with recombinant plasminogen activator and urokinase via percutaneous transjugular intrahepatic catheterization of the portal vein achieved almost complete dissolution of the thrombus within 3 days. Subsequently the portal vein catheter was changed into a transjugular portosystemic stent shunt (TIPS).

CONCLUSIONS

While local or systemic fibrinolysis has been practised in previously reported cases of acute portal vein thrombosis, the described use of TIPS introduces a new element. The shunt between hepatic and portal veins assures therapeutic access to the portal venous bed. It lowers portal vein pressure and can diminish the danger of recurrent thrombosis by raising portal flow. This minimally invasive procedure may be a nearly ideal treatment even in the course of portal vein thrombosis which has a high complication rate.