First report of Irpex rosettiformis causing white root rot in avocado trees in Michoacán, México.

In México, avocado production is an important economic source. In the last season it generated $ 3. 27 billion USD of foreign currency in the country. Irpex spp. are wood decay fungi. In the period 2019-2022, in the state of Michoacán (19°13' N; 101°55' W), México, basidiomes of Irpex sp. were observed on the base of trunks and crowns of 5-years-old and older avocado (Persea americana) trees. The trees exhibited disease symptoms that included white root rot, leaf yellowing, small leaves, branch diebacks, generalized defoliation, apical flaccidity, abundant but small sun burnt fruits due to the lack of foliage, and after 2-4 years of first disease appearance, the infected trees died. In the place where fungus was established, abundant white and cottony mycelium was formed, which caused trees decay. The incidence of the disease in the sampled orchards was estimated to be 30% per ha with 350 - 400 trees, which was determined through a simple sampling design focused on trees with signs and symptoms of the disease due to the phytopathogen. Samples of infected tissue (roots and stems) and fungal basidiomes were collected from 90 trees (5-6 per orchard). The symptomatic avocado trees studied were randomly selected from 17 orchards. For the fungal macroscopic characterization, the synoptic keys described by Gilbertson and Ryvarden (1986) and by Largent (1973) were used. The samples showed typical structures corresponding to Irpex sp., including rosettes, annual basidiomes, a system of monomitic hyphae, and subglobose basidiospores. In vitro fungal isolation from basidiomes and infected tree tissues was done according to the protocol of Agrios (2004). The fungal strains were maintained on PDA at 28 °C. At 16 days of incubation the colonies were opaque, whitish with fluffy and corky mycelium. Microscopic analysis of the fungus showed typical yellowish spores, with an ellipsoid shape of 3-4 x 4-5.5 µm (50 accounted structures per isolate [N=19]) and basidia of 20-25 x 4.5-5.5 µm (n=20 basidiomes). For molecular characterization, two molecular markers were used, the internal transcribed spacer rDNA-ITS1 5.8 rDNA-ITS2 (ITS; White et al. 1990) and the large ribosomal subunit (LSU; Vilgalys and Hester 1990). The PCR reaction was performed as described by Martínez-González et al. (2017). The consensus sequences were compared with those deposited in the NCBI-GenBank, using the BLASTN 2.2.19 tool (Zhang et al. 2000), the samples showed 99% match with the species, Irpex rosettiformis. GenBank accession numbers of the submitted isolates are summarized in supplementary Table 4. To test Koch's postulates, 3-months old avocado plants grown in greenhouse conditions were inoculated (n = 10 per each isolate [N= 19]) on the roots with 3 g of I. rosettiformis mycelium. The experiment was done twice with 20 non-inoculated plants as control. After 67 days, basidiomes (50 x 70 x 1.5 mm in average) were observed where the disease incidence was >77%, with subsequent tree decline. The pathogen was re-isolated in vitro in PDA and its identity was confirmed by morphological characteristics of mycelium. This work shows that I. rosettiformis is not only a wood decay fungus, but also a phytopathogen, the causative agent of white root rot disease in P. americana var. drymifolia, cultivar 'Hass', which establishes a precedent for monitoring and preventing its proliferation to other regions in the American continent and the world where nursery avocado seedlings are exported.

Magnetic Quincke rollers with tunable single-particle dynamics and collective states.

Electrohydrodynamically driven active particles based on Quincke rotation have quickly become an important model system for emergent collective behavior in nonequilibrium colloidal systems. Like most active particles, Quincke rollers are intrinsically nonmagnetic, preventing the use of magnetic fields to control their complex dynamics on the fly. Here, we report on magnetic Quincke rollers based on silica particles doped with superparamagnetic iron oxide nanoparticles. We show that their magnetic nature enables the application of both externally controllable forces and torques at high spatial and temporal precision, leading to several versatile control mechanisms for their single-particle dynamics and collective states. These include tunable interparticle interactions, potential energy landscapes, and advanced programmable and teleoperated behaviors, allowing us to discover and probe active chaining, anisotropic active sedimentation-diffusion equilibria, and collective states in various geometries and dimensionalities.

BREAST-Q and Donor Site Comparison in Bilateral Stacked Autologous Breast Reconstruction.

Background: Patients undergoing bilateral autologous breast reconstruction may benefit from increased flap volume using bilateral stacked deep inferior epigastric perforator (DIEP) and profunda artery perforator (PAP) flaps. Our aim was to characterize the donor site morbidity and patient-reported outcomes in four-flap breast reconstruction. Methods: Retrospective review was performed for all patients undergoing four-flap breast reconstruction by two surgeons between January 2010 and September 2021. Outcome measures including the BREAST-Q reconstructive module, the lower extremity functional scale (LEFS), inpatient surgical site pain scores by numeric pain rating scale (NPRS), and a postoperative subjective survey comparing donor sites were obtained. Four-flap BREAST-Q scores were compared with bilateral DIEP and bilateral PAP patients. Results: A total of 79 patients undergoing four-flap breast reconstruction were identified. Four-flap BREAST-Q scores (n = 56) were similar to bilateral DIEP and bilateral PAP reconstruction patients. Long-term survey outcomes from the LEFS demonstrated improved score trend after 6 months. Mean instances of donor site pain location recorded at the abdomen were significantly higher than the thigh during the postoperative admission. Subjective survey data revealed more long-term donor site pain at the PAP site, a patient preference for the DIEP donor site, and easier postoperative care for the DIEP donor site. Conclusions: This is the largest consecutive series of four-flap breast reconstruction outcomes reported to date. BREAST-Q scores in four-flap patients demonstrate overall patient satisfaction that is similar to both bilateral DIEP and bilateral PAP reconstruction patients. The DIEP donor site appears to be preferred by patients over the PAP donor site.

Utility of ERAS Pathway in Nonabdominal-Based Microsurgical Breast Reconstruction: Efficacy in PAP Flap Reconstruction?

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols are effective in decreasing hospital length of stay and inpatient opioid consumption. Implementation of these protocols in abdominally based breast reconstruction has been successful. When a patient is a poor candidate for abdominally based flaps a popular secondary option is the profunda artery perforator (PAP) flap. We present our experience with implementation of our ERAS protocol in patients treated with PAP flaps for breast reconstruction. METHODS: Retrospective review of patients treated with autologous breast reconstruction using PAP flaps before and after ERAS implementation were performed. Patient characteristics, postoperative oral morphine equivalents (OMEs), and flap data were collected. RESULTS: A total of 87 patients were included in this study (58 patients in pre-ERAS and 29 patients in ERAS group). There was no statistical difference in patient age, comorbidities, smoking, and radiation between two groups. The ERAS group had statistically lower hospital length of stay (2.6 vs. 3.8 days), procedure time (315 vs. 433 minutes), postoperative day 0 (54.8 vs. 96.3), postoperative day 1 (29.9 vs. 57.7), and total opioid consumption (103.7 vs. 192.1). There was no statistical difference in average pain scores between two groups. Multivariate analysis revealed that procedure time significantly increased the amount of opioid consumption while ERAS implementation significantly reduced LOS and opioid consumption. CONCLUSION: Use of an ERAS protocol in PAP flap breast reconstruction has not been previously studied. Our work shows that ERAS implementation in PAP flap breast reconstruction significantly reduces inpatient opioid use and length of hospital stay.

Observations from Implementation of the ERAS Protocol after DIEP Flap Breast Reconstruction.

BACKGROUND: The Enhanced Recovery After Surgery (ERAS) protocol is a multivariate intervention requiring the help of several departments, including anesthesia, nursing, and surgery. This study seeks to observe ERAS compliance rates and obstacles for its implementation at a single academic institution. METHODS: This is a retrospective study looking at patients who underwent deep inferior epigastric perforator (DIEP) flap breast reconstruction from January 2016 to September 2019. The ERAS protocol was implemented on select patients early 2017, with patients from 2016 acting as a control. Thirteen points from the protocol were identified and gathered from the patient's electronic medical record (EMR) to evaluate compliance. RESULTS: Two hundred and six patients were eligible for the study, with 67 on the control group. An average of 6.97 components were met in the pre-ERAS group. This number rose to 8.33 by the end of 2017. Compliance peaked with 10.53 components met at the beginning of 2019. The interventions most responsible for this increase were administration of preoperative medications, goal-oriented intraoperative fluid management, and administration of scheduled gabapentin postoperatively. The least met criterion was intraoperative ketamine goal of >0.2 mg/kg/h, with a maximum compliance rate of 8.69% of the time. CONCLUSION: The introduction of new protocols can take over a year for full implementation. This is especially true for protocols as complex as an ERAS pathway. Even after years of consistent use, compliance gaps remain. Staff-, patient-, or resource-related issues are responsible for these discrepancies. It is important to identify these issues to address them and optimize patient outcomes.

Defining Enhanced Recovery Pathway with or without Liposomal Bupivacaine in DIEP Flap Breast Reconstruction.

BACKGROUND: Enhanced recovery after surgery (ERAS) includes multiple interventions that have yielded positive outcomes in a number of surgical fields. The authors evaluated whether an ERAS protocol and the subsequent addition of liposomal bupivacaine affect patient outcomes specifically in deep inferior epigastric perforator (DIEP) flap breast reconstruction. METHODS: All patients treated with DIEP flaps from January of 2016 to December of 2019 were reviewed retrospectively. The ERAS protocol was implemented midway through 2017; halfway through 2018, intraoperative transversus abdominis plane blocks with liposomal bupivacaine were added to the protocol. Such interventions allowed for comparison of three patient groups: before ERAS, during ERAS, and after ERAS plus liposomal bupivacaine. Primary outcomes observed were postoperative opioid consumption and length of stay. The p values were obtained using the Wilcoxon test for pairwise comparisons. RESULTS: After adjusting for ERAS group compliance, 216 patients were analyzed. The pre-ERAS group was composed of 67 patients, the ERAS group was composed of 69 patients, and the ERAS plus liposomal bupivacaine group was composed of 80 patients. Postoperative opioid consumption was reduced when comparing the pre-ERAS and ERAS groups (from 275.7 oral morphine equivalents to 146.7 oral morphine equivalents; p < 0.0001), and also reduced with the addition of liposomal bupivacaine (115.3 oral morphine equivalents; p = 0.016). Furthermore, hospital length of stay was decreased from 3.6 days in the pre-ERAS group to 3.2 days (p = 0.0029) in the ERAS group, and to 2.6 days (p < 0.0001) in the ERAS group plus liposomal bupivacaine groups. CONCLUSIONS: Enhanced recovery after surgery protocols decrease postoperative opioid consumption and hospital length of stay in DIEP flap breast reconstruction. The addition of liposomal bupivacaine further strengthens the impact of the protocol. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Implications of Instituting an Enhanced Recovery after Surgery Pathway in Patients Receiving Chemotherapy in Microsurgical Breast Reconstruction.

BACKGROUND: Neuropathy is a common side effect of chemotherapeutic agents. Manifestations of chemotherapy-induced neuropathy can present in a myriad of fashions, ranging from numbness, tingling, and pain to motor weakness and autonomic dysfunction.1 Given the nature of breast reconstruction, a significant portion of the patients have a history of chemotherapy exposure; its effect on postoperative pain management has not been previously explored. METHODS: This study is a retrospective review of patients who underwent deep inferior epigastric perforator flap breast reconstruction performed by the two senior authors from January of 2016 to September of 2019. The patients were separated into two groups, before and after enhanced recovery after surgery. The primary outcome observed was postoperative opioid consumption, measured as oral morphine equivalents; p values were obtained through univariate linear regression. RESULTS: In total, 256 patients were analyzed, of which 113 had chemotherapy exposure. The difference between opioid consumption in patients in the pre-enhanced recovery after surgery group without and with chemotherapy exposure was statistically significant (211.5 mg versus 278.5 mg; p = 0.0279). There was no difference between opioid consumption with regard to chemotherapy history in the enhanced recovery after surgery group (137.4 mg versus 133.0 mg; p = 0.7251). CONCLUSIONS: Patients with chemotherapy exposure required more opioids to be comfortable. It is unknown whether this difference is secondary to increased pain or less effectiveness of opioids. Further research is necessary to assess whether there are better ways to address pain postoperatively in patients with chemotherapy exposure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Intususcepción como complicación de bypass en Y de Roux en pacientes embarazadas, una complicación infrecuente. Reporte de caso y revisión de la literatura.

La obesidad es actualmente un problema de salud pública de ámbito internacional. Es considerada como la segunda causa de muerte prevenible en México, después del tabaquismo, según la Organización Mundial de la Salud. Actualmente, las opciones quirúrgicas son la gastrectomía en manga, el bypass gástrico o derivación gástrica, la banda gástrica y el bypass gástrico en omega, cada una con sus indicaciones. Se presenta el caso clínico de una paciente con intususcepción yeyuno-yeyunal secundaria a bypass gástrico en el embarazo.Obesity is currently an international public health problem. It is considered the second preventable cause of death in Mexico, after smoking, according to the World Health Organization. Currently, surgical options are sleeve gastrectomy, gastric bypass or gastric derivation, gastric banding, and omega gastric bypass, each with specific indications. The objective of the article is to present the clinical case of a patient with jejuno-jejunal intussusception secondary to gastric bypass in pregnancy.

A Management Strategy for Idiopathic Bone Cavities of the Jaws.

PURPOSE: Idiopathic bone cavities (IBCs) are benign osseous pseudocysts of unclear etiology. Their clinical course and response to treatment are poorly understood. The purpose of this study was to present a case series of patients with IBC with long-term follow-up. PATIENTS AND METHODS: A retrospective case series of patients with IBC of the jaw was implemented. Medical records were reviewed for data on presentation and imaging. All patients underwent surgical exploration to confirm the diagnosis. Follow-up radiographs were evaluated for resolution or persistence after the procedure. Descriptive data were summarized. RESULTS: The sample included 45 patients (60% girls) with 47 IBCs who presented at a mean age of 13.5 ± 0.35 years (range, 9 to 17 yr). All lesions were asymptomatic and discovered as incidental findings; the average size was 2.0 cm (range, 0.8 to 7 cm). Most (n = 44) were solitary lesions of the mandible presenting within the body (n = 27), symphysis (n = 15), or ramus (n = 2). One patient had synchronous bilateral mandibular and maxillary IBCs. Common radiographic features included scalloping without root resorption or displacement and cortical thinning without expansion or perforation. Intraoperative findings showed an empty bone cavity often filled with blood-tinged serous fluid or blood. The histopathology of scrapings from the bony wall showed benign mixed fibrous tissue and no epithelial lining. Average radiographic follow-up was 32.7 ± 6.7 months (range, 0 to 9 yr). After exploration and curettage, 43% of patients had complete bone fill within 2 to 5 years. The other 57% had no change in lesion size at an average of 2.25 years (range, 2 to 9 yr). No patients developed symptoms, had enlargement of the lesion, or had pathologic fracture. CONCLUSION: Many IBCs persist for years despite exploration and curettage. Nonetheless, unresolved lesions did not enlarge or cause harm. A single procedure to confirm the diagnosis is sufficient for management.

Obesity-related non-alcoholic steatohepatitis and TGF-beta1 serum levels in relation to morbid obesity.

Non-alcoholic steatohepatitis (NASH) can vary from mild hepatic inflammation and steatosis to cirrhosis, and is most frequently associated with obesity, Type 2 diabetes mellitus, hypertension, and the female gender. The prevalence of fatty liver and NASH in the general population is 20% and 3%, respectively. In Western countries, 15-20% of the population is obese and 74-90% of them exhibit fatty changes in liver biopsies. We assessed the prevalence of NASH in morbidly obese patients and evaluated serum TGF-beta1 concentrations in different stages of liver fibrosis. Thirty-five obese patients were evaluated, nine male and 26 female. Their mean body mass index (BMI) was 43.62 +/- 7.92 kg/m2. Liver biopsies were evaluated by light microscopy; graded and staged according to Brunt's system. Serum obtained from patients was used to detect TGF-beta1 concentrations by an ELISA method. Serum alanine transaminase (ALT) levels were elevated in four of the patients and the mean level was 49.98 +/- 94.7 (8-65 IU/L). NASH was diagnosed in 32 (91%) of the biopsies, and the most common pattern seen was mixed, predominantly macrovesicular steatosis. Some degree of fibrosis was seen in 34 (97%) of the biopsies and 22 (63%) were at stage 2 (range 1-3). Serum concentrations of TGF-beta1 had no relationship with the stages of fibrosis. In conclusion, NASH and fibrosis are common in our obese patients, as observed in other studies. TGF-beta1 may play a key role in liver fibrogenesis.

Fractura de Colles: correlación anatomo-funcional mediante el esquema de Green y O'Brian / Colles's fracture: anatomo-functional correlationship based upon the Green and O'Brian scale

Objetivo. Comparar los resultados anatómicos con los clínicos en pacientes tratados por fractura de Colles unilateral, según los criterios de Green y O'Brian. Material y métodos. De 30 pacientes con fractura de Colles unilateral tratados de marzo a julio de 1998, se presenta una serie de 19 por llenar criterios de inclusión al no tratarse de fracturas con antecedentes patológicos. Se comparó su estudio clínico y radiográfico inicial y final y los pacientes llenaron un cuestionario de evaluación personal de su resultado. Resultados. Independientemente del tratamiento, que fue cerrado en 17 de los 19 casos, los resultados fueron excelentes en 31 por ciento, buenos en 15 por ciento, regulares en 26 por ciento y malos en 26 por ciento. Asimismo, la correlación se pudo establecer en 52 por ciento (10 casos) y no así en los restantes nueve, ya fuera por un mal resultado radiológico y buen curso clínico o viceversa. Conclusión. No existe regla absoluta entre resultado anatómico y funcional. El mejor resultado funcional se obtiene en los casos que se apegaron estrictamente al programa domiciliario de rehabilitación.