Tracking global invasion pathways of the spongy moth (Lepidoptera: Erebidae) to the United States using stable isotopes as endogenous biomarkers.

The spread of invasive insect species causes enormous ecological damage and economic losses worldwide. A reliable method that tracks back an invaded insect's origin would be of great use to entomologists, phytopathologists, and pest managers. The spongy moth (Lymantria dispar, Linnaeus 1758) is a persistent invasive pest in the Northeastern United States and periodically causes major defoliations in temperate forests. We analyzed field-captured (Europe, Asia, United States) and laboratory-reared L. dispar specimens for their natal isotopic hydrogen and nitrogen signatures imprinted in their biological tissues (δ2H and δ15N) and compared these values to the long-term mean δ2H of regional precipitation (Global Network of Isotopes in Precipitation) and δ15N of regional plants at the capture site. We established the percentage of hydrogen-deuterium exchange for L. dispar tissue (Pex = 8.2%) using the comparative equilibration method and two-source mixing models, which allowed the extraction of the moth's natal δ2H value. We confirmed that the natal δ2H and δ15N values of our specimens are related to the environmental signatures at their geographic origins. With our regression models, we were able to isolate potentially invasive individuals and give estimations of their geographic origin. To enable the application of these methods on eggs, we established an egg-to-adult fraction factor for L. dispar (Δegg-adult = 16.3 ± 4.3‰). Our models suggested that around 25% of the field-captured spongy moths worldwide were not native in the investigated capture sites. East Asia was the most frequently identified location of probable origin. Furthermore, our data suggested that eggs found on cargo ships in the United States harbors in Alaska, California, and Louisiana most probably originated from Asian L. dispar in East Russia. These findings show that stable isotope biomarkers give a unique insight into invasive insect species pathways, and thus, can be an effective tool to monitor the spread of insect pest epidemics.

Identifying barriers for nature-based solutions in flood risk management: An interdisciplinary overview using expert community approach.

The major event that hit Europe in summer 2021 reminds society that floods are recurrent and among the costliest and deadliest natural hazards. The long-term flood risk management (FRM) efforts preferring sole technical measures to prevent and mitigate floods have shown to be not sufficiently effective and sensitive to the environment. Nature-Based Solutions (NBS) mark a recent paradigm shift of FRM towards solutions that use nature-derived features, processes and management options to improve water retention and mitigate floods. Yet, the empirical evidence on the effects of NBS across various settings remains fragmented and their implementation faces a series of institutional barriers. In this paper, we adopt a community expert perspective drawing upon LAND4FLOOD Natural flood retention on private land network (https://www.land4flood.eu) in order to identify a set of barriers and their cascading and compound interactions relevant to individual NBS. The experts identified a comprehensive set of 17 barriers affecting the implementation of 12 groups of NBS in both urban and rural settings in five European regional environmental domains (i.e., Boreal, Atlantic, Continental, Alpine-Carpathian, and Mediterranean). Based on the results, we define avenues for further research, connecting hydrology and soil science, on the one hand, and land use planning, social geography and economics, on the other. Our suggestions ultimately call for a transdisciplinary turn in the research of NBS in FRM.

The superior effect of nature based solutions in land management for enhancing ecosystem services.

The rehabilitation and restoration of land is a key strategy to recover services -goods and resources- ecosystems offer to the humankind. This paper reviews key examples to understand the superior effect of nature based solutions to enhance the sustainability of catchment systems by promoting desirable soil and landscape functions. The use of concepts such as connectivity and the theory of system thinking framework allowed to review coastal and river management as a guide to evaluate other strategies to achieve sustainability. In land management NBSs are not mainstream management. Through a set of case studies: organic farming in Spain; rewilding in Slovenia; land restoration in Iceland, sediment trapping in Ethiopia and wetland construction in Sweden, we show the potential of Nature based solutions (NBSs) as a cost-effective long term solution for hydrological risks and land degradation. NBSs can be divided into two main groups of strategies: soil solutions and landscape solutions. Soil solutions aim to enhance the soil health and soil functions through which local eco-system services will be maintained or restored. Landscape solutions mainly focus on the concept of connectivity. Making the landscape less connected, facilitating less rainfall to be transformed into runoff and therefore reducing flood risk, increasing soil moisture and reducing droughts and soil erosion we can achieve the sustainability. The enhanced eco-system services directly feed into the realization of the Sustainable Development Goals of the United Nations.

Adult-Onset Still's Disease Masquerading as Sepsis in an Asplenic Active Duty Soldier.

This is a case of a 26-year-old active duty male with a history of idiopathic thrombocytopenic purpura (ITP) and surgical asplenia who presented with a one-week history of fevers, myalgias, arthralgias, and rigors. His evaluation upon presentation was significant for a temperature of 103 degrees F, white blood cell count of 36 K with a granulocytic predominance, and elevated transaminases. He was treated empirically with broad-spectrum antibiotics with concern for a systemic infection with an encapsulated organism. During his stay, he developed four SIRS criteria and was transferred to the progressive care unit for suspected sepsis. He continued to have twice-daily fevers and a faint, salmon-colored centripetal rash was eventually observed during his febrile episodes. After a nondiagnostic microbiologic and serologic workup, he was diagnosed with adult-onset Still's Disease and started on intravenous methylprednisolone with brisk response. He was discharged on oral prednisone and was started on anakinra. Adult-onset Still's disease is a rare condition that presents with varying severity, and this is the first reported case, to our knowledge, of its diagnosis in an asplenic patient. Its management in the setting of asplenia is complicated by the need for antibiotic therapy with each episode of fever.

Evaluation of two commercial immunoassays used to screen patients for systemic lupus erythematosus.

Diagnosing systemic lupus erythematosus (SLE) can be challenging as laboratory screening methods, although sensitive, lack specificity. The poor specificity of autoimmune testing produces more false positive results than true positive results. False positive results can cause stress to patients without autoimmune disease and require unnecessary rheumatology consultation to rule out disease. Our objective was to evaluate two screening assays to reduce the number of false positives while maintaining high sensitivity. In this study, we evaluated two immunoassays, the AtheNA Multi-Lyte II ANA System and QUANTA Lite ANA ELISA, to screen patients for SLE. All positive screening results were compared to immunoflourescent ANA testing using theHEp-2000 ANA System. A chart review was performed on all patients tested to determine clinical diagnosis of SLE. The QuantaLite ANA ELISA produced significantly more false positive results than the AtheNA Multi-Lyte II Test System when screening for SLE in our patient population.

A case of Salmonella gastroenteritis following ingestion of raw venison sashimi.

An interesting case of gastroenteritis due to Salmonella Birkenhead following ingestion of raw venison sashimi is described. A 65-year-old man presented with diarrhea, vomiting, and fever. On exam he was hypotensive, tachycardic, with evidence of severe dehydration following ingestion of raw venison sashimi produced with game meat hunted on the Hawaiian island of Lana'i. He responded rapidly to vigorous volume resuscitation, and stool cultures later were positive for Salmonella Birkenhead. Non-typhoidal Salmonella is the most frequently identified cause of foodborne illness in the United States. Clinicians in the state of Hawai'i should be alert and aware of the potential for the local deer population to be an unusual source of foodborne illness, especially given the prevalence of consumption of raw foods in the local cuisine.

Serial sonographic evaluation of Achilles tendons in patients taking fluoroquinolone antibiotics.

We performed a prospective study to determine if subclinical tendinopathy occurs in asymptomatic adults treated with fluoroquinolone antibiotics. Thirty-eight adults were enrolled. Serial ultrasounds of the Achilles tendons were performed. A board certified musculoskeletal radiologist interpreted the images in a blinded fashion. No changes were identified. Subclinical tendinopathy does not appear to exist in asymptomatic adults treated with fluoroquinolone antibiotics.

Falsely elevated cardiac troponin-I in patients with seropositive rheumatoid arthritis.

OBJECTIVE: To determine if patients with seropositive rheumatoid arthritis (RA) have abnormally elevated concentrations of cardiac troponin-I (cTnI). Reports suggest the presence of serum rheumatoid factor (RF) may interfere with the cTnI assay, leading to falsely elevated cTnI levels. One study reported a falsely elevated cTnI in 15 out of 100 serum samples with elevated RF using the Abbott assay, but no elevated level using the Bayer assay. It is unclear how many of these samples came from patients with RA. METHODS: Serum samples were drawn from 60 patients with seropositive RA. We measured RF and cTnI levels using both the Abbott AxSYM assay and the Bayer ADVIA Centaur assay. RESULTS: Of 60 RA patients with RF ranging from 15 to 2724 IU/ml, none was found to have an elevated cTnI on either assay. CONCLUSION: Using 2 commercial assays for cTnI, we found that patients with seropositive RA do not have falsely elevated serum cTnI levels.

Beaver fever arthritis.

Giardia lamblia, a flagellated protozoan and common cause of gastroenteritis, is a rare but previously reported cause of reactive arthritis (ReA). We report a case of inflammatory oligoarthritis in a young woman after infection with Giardia. Two weeks after being treated, she developed an inflammatory arthritis of her left knee and right elbow that was refractory to nonsteroidal antiinflammatory medication. Antinuclear antibody, rheumatoid factor, and HLA-B27 tests were negative. She had almost immediate relief with intraarticular injection of corticosteroids. We review the previously reported cases of ReA following giardiasis and discuss possible pathogenic mechanisms. Although ReA most commonly occurs after chlamydial urethritis or gastroenteritis associated with typical enteropathic bacteria, important historical clues could point to less common pathogens such as Giardia. Physicians should be aware of these less common causes of ReA, because this could have important diagnostic and therapeutic implications.

Spontaneous pneumothorax in scleroderma.

We present an illustrative case of a patient with advanced scleroderma who presented with a spontaneous pneumothorax, a condition that has only rarely been reported previously in association with scleroderma. Our patient and those previously reported had advanced pulmonary fibrosis with honeycombing and subpleural cysts, with spontaneous pneumothorax occurring secondary to cyst rupture. Our patient was treated with chest tube thoracostomy, but her spontaneous pneumothorax later recurred. She was then treated with talc pleurodesis and has not had a recurrence in 18 months of follow-up.Spontaneous pneumothorax remains a rare pulmonary manifestation of scleroderma, occurring only in patients with advanced pulmonary fibrosis associated with cyst formation and rupture. Initial management consists of chest tube insertion, but recurrence is high and may require pleurodesis or partial lobectomy. Physicians managing patients with scleroderma should be aware of spontaneous pneumothorax, especially in those with advanced pulmonary fibrosis and subpleural cysts.

Catastrophic antiphospholipid syndrome; a "CATASTROPHIC" case of systemic lupus erythematosus.

Less than 1% of patients with the antiphospholipid antibody syndrome (APS) can develop multiple, simultaneous organ-system thromboembolic disease, which is referred to as the catastrophic antiphospholipid antibody syndrome (CAPS). Roughly one-half of these patients have systemic lupus erythematosus (SLE). Factors known to precipitate CAPS include infection, surgery, trauma, neoplasia, anticoagulation withdrawal, obstetric complications, and SLE flares. Optimal treatment includes anticoagulation and high-dose corticosteroids, although IVIG and plasma exchange may also have a role. The overall mortality of CAPS is roughly 50%, but prompt clinical recognition of this rare but devastating syndrome may lead to improved outcomes.

Disseminated Histoplasmosis Mimicking Felty's Syndrome.

The successful treatment of rheumatoid arthritis often requires the use of immunosuppressive medications. Although these agents have different potential toxicities, they share in common the potential for permitting the development of opportunistic infections. We describe 2 patients with chronic rheumatoid arthritis treated with immunosuppressive agents who developed progressive neutropenia with documented splenomegaly. The differential diagnosis included Felty's syndrome versus bone marrow suppression from their immunosuppressive medication. Although both patients had the triad of Felty's syndrome, high titer seropositive rheumatoid arthritis with splenomegaly and neutropenia, the diagnosis of this syndrome relies on excluding other potential causative factors. Further investigation revealed that both patients had disseminated histoplasmosis with bone marrow involvement, which most likely represented reactivation from prior exposure to Histoplasma capsulatum. Opportunistic infections such as disseminated histoplasmosis can mimic other disease processes, including Felty's syndrome, and are important to consider when there is a change in the clinical status of patients with rheumatic disease who are immunocompromised.