Prevalent Transmission of 'Candidatus Liberibacter asiaticus' over 'Ca. Liberibacter americanus' in a Long-Term Controlled Environment.

In Brazil, citrus huanglongbing (HLB) is associated with 'Candidatus Liberibacter americanus' (CLam) and 'Ca. Liberibacter asiaticus' (CLas). However, there are few studies about HLB epidemiology when both Liberibacter spp. and its insect vector, the Asian citrus psyllid (ACP, Diaphorina citri), are present. The objective of this work was to compare the transmission of HLB by ACP when both CLam and CLas are present as primary inoculum. Two experiments were performed under screenhouse conditions from April 2008 to January 2012 (experiment 1) and from February 2011 to December 2015 (experiment 2). The experiments were carried out with sweet orange plants infected with CLam or CLas as inoculum source surrounded by sweet orange healthy plants. One hundred Liberibacter-free adult psyllids were monthly confined to the source of inoculum plants for 7 days with subsequent free movement inside the screenhouse. Fortnightly, nymphs and adults of psyllids were monitored. Psyllid and leaf samples were collected periodically for Liberibacter detection by PCR or quantitative PCR. CLas was detected more frequently than CLam in both psyllid and leaf samples. No mixed infections were detected in the psyllids. A clear prevalence of CLas over CLam was observed in both experiments. The final HLB incidences were 16.7 and 14.5% of Liberibacter-positive test plants, and CLas was detected in 92.3 and 93.1% of these infected plants. Mixed infection was observed only in 3.8% of infected test plants in experiment 1. These results endorse the shift in the prevalence of CLam to CLas observed in citrus orchards of São Paulo, Brazil.

Molecular Characterization and Detection of 16SrIII Group Phytoplasma Associated with Huanglongbing Symptoms.

When huanglongbing (HLB) was found in Brazil in 2004, 'Candidatus Liberibacter americanus' was infecting most of the trees while 'Ca. L. asiaticus' was present in a minor proportion. Currently, 'Ca. L. asiaticus' is the predominant bacterium associated with HLB in citrus trees in São Paulo (SP) and Minas Gerais (MG) States, the major citrus-growing regions in Brazil. A phytoplasma from the 16SrIX group was associated with HLB symptoms in Brazil in 2007, in plants free of Liberibacter spp. In this report, HLB samples testing negative for 'Ca. L. asiaticus', 'Ca. L. americanus', and 16SrIX phytoplasma were infected with 16SrIII phytoplasmas. Coinfection with 'Ca. L. asiaticus' and 16SrIII was also found. The 16S ribosomal RNA (rRNA) gene sequences from 22 samples were obtained and sequenced, confirming that the 16SrIII group phytoplasma is associated with HLB symptoms in SP and MG States. Ten single-nucleotide polymorphisms (SNPs) were found in the 1,427-bp 16S rRNA gene sequences from 16SrIII phytoplasmas from citrus, whereas none was detected in 16S rRNA gene sequences among 16SrIX phytoplasma from citrus. Ribosomal protein (rp) rpsSrplVrpsC gene sequences were amplified with 16SrIII group-specific primers, sequenced from a subset of nine samples, and assembled into three groups based on eight SNPs. SNPs in 16S rRNA gene and rp gene sequences are common in 16SrIII phytoplasmas from other hosts and this phytoplasma group is widespread in South America. 16SrIII phytoplasmas highly related are commonly found in Melia azedarach, a widespread tree in Brazil and Argentina. The finding of a new phytoplasma associated with HLB symptoms belonging to the 16SrIII group reinforces the need to develop diagnostic tools to assess HLB-associated microbiomes.

Apple-peel intestinal atresia: enteroplasty for intestinal lengthening and primary anastomosis.

Apple-peel atresia (or Type-IIIb intestinal atresia) is an unusual type of jejunoileal atresia. They present with jejunal atresia near the ligament of Treitz and a foreshortened small bowel. Many surgical options have been used, but the optimal method of repair remains unclear. We present a case of a newborn with apple-peel intestinal atresia managed by enteroplasty for intestinal lengthening and primary anastomosis.

Clinical, manometric and profilometric evaluation after surgery for Hirschsprung's disease: comparison between the modified Duhamel and the transanal rectosigmoidectomy techniques.

PURPOSE: To evaluate fecal continence, anorectal manometry (AM) and profilometry (P), in patients operated for congenital megacolon, using either the modified Duhamel technique (MDT) or the modified transanal rectosigmoidectomy (MTR) technique. METHODS: 42 patients were evaluated clinically and via AM and P, for postoperative control. The resting, coughing, voluntary contraction, maintained voluntary contraction and perianal stimulation pressures were investigated. The rectosphincteric reflex was tested and the simple and enhanced pressure curves were evaluated. The three-dimensional profilometric outline was produced. Student's t, chi-squared and Fisher's exact tests were used for statistical analysis (p<0.05). RESULTS: AM showed mean resting pressures of 53.44 mmHg for MDT and 60.67 mmHg for MTR, and mean voluntary contraction pressures of 94.50 mmHg for MDT and 95.47 mmHg for MTR. There was no statistical difference between the groups. The shapes of the simple and enhanced pressure curves did not present any statistical difference, independent of the surgical technique used. CONCLUSION: The two surgical techniques were equivalent. MDT caused greater incidence of postoperative constipation that MTR did. AM and P were shown to be excellent tests for postoperative follow-up among these patients.

Clinical, manometric and profilometric evaluation after surgery for Hirschsprung's disease: comparison between the modified Duhamel and the transanal rectosigmoidectomy techniques / Avaliação clínica, manométrica e profilométrica após correção cirúrgica para doença de Hirschsprung: comparação entre as técnicas de Duhamel modificado e a retossigmoidectomia transanal modificada

PURPOSE: To evaluate fecal continence, anorectal manometry (AM) and profilometry (P), in patients operated for congenital megacolon, using either the modified Duhamel technique (MDT) or the modified transanal rectosigmoidectomy (MTR) technique. METHODS: 42 patients were evaluated clinically and via AM and P, for postoperative control. The resting, coughing, voluntary contraction, maintained voluntary contraction and perianal stimulation pressures were investigated. The rectosphincteric reflex was tested and the simple and enhanced pressure curves were evaluated. The three-dimensional profilometric outline was produced. Student's t, chi-squared and Fisher's exact tests were used for statistical analysis (p<0.05). RESULTS: AM showed mean resting pressures of 53.44 mmHg for MDT and 60.67 mmHg for MTR, and mean voluntary contraction pressures of 94.50 mmHg for MDT and 95.47 mmHg for MTR. There was no statistical difference between the groups. The shapes of the simple and enhanced pressure curves did not present any statistical difference, independent of the surgical technique used. CONCLUSION: The two surgical techniques were equivalent. MDT caused greater incidence of postoperative constipation that MTR did. AM and P were shown to be excellent tests for postoperative follow-up among these patients.

OBJETIVO: Avaliar a continência fecal, a manometria anorretal (MAR) e a profilometria (PFM), em pacientes submetidos a tratamento cirúrgico do megacolo congênito pelas técnicas de Duhamel modificado (DM) ou de retossigmoidectomia transanal modificada (RTM). MÉTODOS: 42 pacientes foram clinicamente avaliados e submetidos à MAR e PFM para controle pós-operatório. Foram pesquisadas as pressões no repouso (PR), à tosse (T), à contração voluntária (CV), à contração voluntária mantida (CVM) e à estimulação perianal (EPA). O reflexo reto-esficteriano (RRE) foi testado e as curvas pressóricas simples e potencializada foram avaliadas. Foi elaborado traçado tridimensional de PFM. Utilizamos os testes t de Student, Qui-Quadrado e exato de Fisher para análise estatística (p<0,05). RESULTADOS: A MAR mostrou médias de PR=53,44 mmHg para DM e 60,67 mmHg para RTM; CV média = 94,50 mmHg para o grupo DM e 95,47 mmHg para o grupo RTM. Não houve diferença estatística entre os grupos. A forma das CPS e CPP não apresentou diferença estatística, independentemente da técnica cirúrgica utilizada CONCLUSÃO: As duas técnicas operatórias foram manometricamente equivalentes. DM determinou maior incidência de constipação pós-operatória que RTM. A MAR e a PFM revelaram-se excelentes exames para acompanhamento destes pacientes após a cirurgia.

Anomalia anorretal associada a regressäo caudal / Retal and anal anomalies associate with caudal regression

Os autores apresentam um caso de sirenomelia (síndrome da sereia) em uma criança de dois anos de idade, branca, com múltiplas malformaçöes associadas, sem história materna de doenças , ingestäo de drogas ou medicamentos durante a gravidez. As malformaçöes associadas säo: anomalia anorretal alta sem fístula urinária; deformidades de várias vertebras, com arcos alongados e displásicos; deformidades vertebrais importantes, com cifoescoliose em S da coluna torácica, com convexidade para a direita; arcos posteriores em nível lombossacro com fusäo parcial e displásicos; dextrocardia; deformidades de costelas, ausência do membro inferior esquerdo; deformidade importante do membro superior esquerdo; assimetria das dimensöes renais, com hipoplasia direita; aumento do diâmetro cerebral, com alargamento significativo do sistema ventricular supratentorial, em especial em nível dos ventrículos laterais e dos espaço subdural, nas regiöes frontotemporais, bilateral; malformaçäo da coluna lombossacra, com agenesia e presença de hemipélvis direita; testículo direito localizado no canal inguinal e testículo esquerdo intra-abdominal. Discutem-se o tipo de cariótipo da criança, os exames pré-operatorios a que foi submetida e o tratamento cirúrgico. Os autores relatam os aspectos embriológicos da malformaçäo, bem como fazem um levantamento da literatura existente, revelando um número pequeno de casos de síndrome de regressäo caudal em seu grau extremo, que é a sirenomelia (síndrome da sereia).