A First Generation Heterobasidion Hybrid Discovered in Larix lyalli in Montana.

On September 25, 2010, a wood sample was collected from an entirely decayed root ball of an alpine larch (Larix lyallii Parl.), 10 cm in diameter at breast height, recently downed, but still green. No attempts were made to determine whether the decay progressed into the stem. The discovery occurred in a stand in the Bitterroot Mountains, south of Darby, Montana (elev. 2,530 m; 45.893528° N, 114.278322° W). Several adjacent alpine larches were either dead or displayed thin crowns, and an old Heterobasidion basidiocarp was found on the decayed root ball of a neighboring dead tree, suggesting the presence of a root disease pocket. The stand is mature and composed of alpine larch, whitebark pine (Pinus albicaulis Engelm.), and a few subalpine firs (Abies lasiocarpa (Hooker) Nuttall), but only larches were symptomatic. No stumps were visible, and the site is in a designated wilderness area characterized by minimal forest management. Wood chips displaying a white rot with bleached speckles were plated on 2% malt agar, and cultures displaying the typical Heterobasidion anamorph (Spiniger meineckellus) were visible after 7 days. DNA was extracted from two distinct cultures, and the sequences of three nuclear loci, namely the internal transcribed spacer, the elongation factor 1-alpha, and the glyceraldehyde 3-phosphate dehydrogenase, were analyzed. The sequence of the mitochondrial ATPase was also sequenced. All loci were amplified using the primers indicated in Linzer et al. (2). Sequences of all three nuclear loci (GenBank Accession Nos. KF811480 to 82) unequivocally indicated both isolates to be first generation hybrids between H. irregulare (Underw.) Garbel. & Otrosina and H. occidentale Otrosina & Garbel. Cumulatively, sequences were heterozygous at over 40 positions in all three loci, and for the presence of two indels (one in ITS, one in EF 1-alpha). Polymorphisms and indels indicated alleles from both species were present in these heterokaryotic (ploidy n+n) isolates. The mitochondrial ATPase (KF811483 to 84) indicated instead the cytoplasm belonged to H. occidentale, suggesting that species was the first to be established in the infected tree and was either dikaryotized by a basidiopsore of the other species, or subject to nuclear re-assortment through di-mon mating with a genotype of H. irregulare. This is the first report of a Heterobasidion sp. in L. lyalli, and it is the second report of a natural Heterobasidion hybrid in North America (1). This finding indicates Alpine larch may be a host for both Heterobasidion species, as described for pine stumps in California (1). Thus, this conifer may have provided a substrate for the hybridization and interspecific gene introgression documented to have occurred before stumps were generated in high frequency by modern forestry practices (2). References: (1) M. Garbelotto et al. Phytopathology 86:543, 1996. (2) R. Linzer et al. Mol. Phylogenet. Evol. 46:844, 2008.

Central nervous system crystal-storing histiocytosis: neuroimaging, neuropathology, and literature review.

CSH is a very uncommon lesion and is distinctly unusual in the brain. We report a case of CSH within the brain parenchyma in a 27-year-old woman with Crohn disease. Advanced radiologic imaging and anatomic pathology correlation allow this report to serve as a reference for future similar cases.

Serpentine and non-serpentine ecotypes of Collinsia sparsiflora associate with distinct arbuscular mycorrhizal fungal assemblages.

Although plant adaptation to serpentine soils has been studied for several decades, the mechanisms of plant adaptation to edaphic extremes are still poorly understood. Arbuscular mycorrhizal fungi (AMF) are common root symbionts that can increase the plant hosts' establishment and growth in stressful environments. However, little is known about the role plant-AMF interactions play in plant adaptation to serpentine. As a first step towards understanding this role, we examined the AMF assemblages associated with field populations of serpentine and non-serpentine ecotypes of California native plant Collinsia sparsiflora. We sampled roots of C. sparsiflora from three serpentine and three non-serpentine sites in close proximity (110 m to 1.94 km between sites) and analysed the small subunit ribosomal DNA gene amplified from root DNA extracts using AMF-specific primers. A total of 1952 clones from 24 root samples (four from each site) were sequenced. We used sequence similarity and phylogenetic analysis to determine operational taxonomic units (OTU) resulting in 19 OTUs representing taxa from six AMF genera, including one serpentine-specific OTU. We used Bray-Curtis similarity, multidimensional scaling and analysis of similarity to compare root sample AMF assemblages. These analyses clearly showed that plant ecotypes associated with distinct AMF assemblages; an Acaulospora OTU-dominated serpentine, and a Glomus OTU-dominated non-serpentine assemblages. Species diversity and evenness were significantly higher in serpentine assemblages. Finally, relate analysis showed a relationship between ecotype AMF assemblages and soil nutrients. This study reveals a strong relationship between AMF associates and plant adaptation to edaphic extremes.

Measuring our nation's diversity: developing a common language for data on race/ethnicity.

During the 4-year period 1993 through 1997, the Office of Management and Budget (OMB) undertook a comprehensive review of the statistical standards that are used throughout the federal government to gather and publish data on race and ethnicity. The primary objective of this review was to ensure that our standards provide a common language that reflects the increasing diversity of the US population and maintains our ability to monitor compliance with civil rights laws. The review culminated with the October 1997 issuance of OMB's "Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity." In this article, we describe key aspects of the process that was undertaken to review and revise the 1977 standards. We also attempt to dispel some myths and misunderstandings that have been associated with these standards.

Integrating qualified nurses and non-nurses in midwifery education: the two-year experience of an ACNM DOA Accredited Program.

In 1996, the Division of Accreditation (DOA) of the American College of Nurse-Midwives (ACNM) preaccredited the first direct entry program of midwifery education for candidates who already possess undergraduate degrees in non-nursing disciplines. Inaugurated through the partnership of the State University of New York Health Science Center at Brooklyn and the North Central Bronx Hospital, this 1-year, postbaccalaureate, certificate program of studies graduated two integrated classes of 22 registered nurse (RN) and nine direct entry (DE) students between 1997 and 1998. This article presents the experience of the first 2 years of this innovative program, focusing on the profiles of the DE students, their achievements, and their experiences entering the workforce. All of the data comparing nurse and non-nurse student progress through the program of studies strongly support the conclusion that, within an ACNM DOA preaccredited/accredited midwifery education program, DE students can achieve standards of academic excellence and clinical competency that are at least equivalent to those demonstrated by their RN peers.

Management of uncomplicated acute diverticulitis: results of a survey.

PURPOSE: A survey was conducted to document current medical treatment of patients with uncomplicated acute diverticulitis. METHODS: A survey was mailed to 667 fellows of The American Society of Colon and Rectal Surgeons certified by the American Board of Colon and Rectal Surgery. Queries were based on a clinical scenario of a patient with uncomplicated diverticulitis. RESULTS: Three hundred seventy-three surveys (56 percent) were returned completed. The majority (66 percent) chose an abdominal computed tomographic scan as the initial diagnostic test. One-half used a single intravenous antibiotic with second-generation cephalosporins (27 percent) and ampicillin/sulbactam (16 percent) being the most common. Oral antibiotics given at discharge were ciprofloxacin (18 percent), amoxicillin/clavulanate (14 percent), metronidazole (7 percent), and doxycycline (6 percent). Combinations chosen were ciprofloxacin/metronidazole (28 percent) and metronidazole/trimethoprim sulfamethoxazole (6 percent), whereas 21 percent chose a variety of other antibiotics. The majority (74 percent) prescribed oral antibiotics for 7 to 10 days. Dietary recommendations at discharge were low residue (68 percent), regular (21 percent), and high residue (10 percent). Half of those surveyed believed avoidance of seeds and nuts were of no value. Follow-up examinations chosen included sigmoidoscopy and barium enema (29 percent), colonoscopy (25 percent), sigmoidoscopy (17 percent), barium enema (13 percent), and other (16 percent). Sixty-five percent of colon and rectal surgeons claim to handle more than half of their patients with uncomplicated diverticulitis on an outpatient basis. CONCLUSION: Variations in the management of uncomplicated sigmoid diverticulitis are noted among colon and rectal surgeons, especially in terms of antibiotic choice, discharge instructions, and follow-up outpatient studies. The survey results are compared with the conclusions reached in The American Society of Colon and Rectal Surgeons practice parameters. Documentation of practice pattern variation may serve as an educational tool for physicians to improve their quality and cost of medical care. Consideration should be given to better publicize already existing American Society of Colon and Rectal Surgeons practice parameters for this common entity.

Responses to photic stimulation in patients with occipital spikes.

OBJECTIVE: To determine the effect of intermittent photic stimulation (IPS) and frequency of asymmetric driving responses in patients with occipital spikes. METHODS: The amplitude of the driving response at 4 flash frequencies was measured from a referential montage in 60 patients with occipital spikes and in 60 normal EEG records from age-matched patients. Responses were classified as asymmetric if the amplitude at one occipital area was less than 50% of the amplitude at the other. RESULTS: A measurable photic response occurred significantly less frequently in patients with occipital spikes (48%) compared to the control group (70%; Fisher's test P < 0.05). The driving response was asymmetric in 7/36 patients (37%) with unilateral spike foci versus none in the control group (Fisher's test, P < 0.001). The amplitude was suppressed ipsilateral to the focus in 5 patients, all of whom had an ipsilateral structural lesion or focal slowing. In two cases the amplitude was higher ipsilateral to the focus, neither having slowing or a structural lesion. CONCLUSIONS: Patients with occipital spikes have an increased frequency of asymmetric driving response. An attenuated response ipsilateral to the focus seems to be related to an underlying lesion while the presence of an epileptiform focus in some cases with no slowing on EEG and normal imaging studies may lead to an accentuation of this response.

The proper use of self-report questions in effective measurement of health outcomes.

Outcomes research often relies on the use of general population survey data. The recent efforts to employ cognitive science theory in the development of data collection instruments has led to the establishment of new questionnaire design research methods. Intensive cognitive techniques are used in laboratory interviews to develop and pretest self-report survey questions with the goal of reducing non-sampling response error. This article presents the theoretical and applied approach used in the cognitive laboratory to study the ways people respond to surveys, and offers guidelines for improving self-report survey questions.

Synchronous colon carcinomas: molecular-genetic evidence for multicentricity.

BACKGROUND: The synchronous presentation of multiple colonic adenocarcinomas is an unusual, but well-recognized event accounting for approximately 2-11% of these neoplasms. Synchronous tumors may have a different biology and prognosis than solitary tumors. Evidence based on measurement of DNA ploidy suggests that a significant percentage of synchronous tumors have a common clonal origin, probably resulting from translumenal metastasis. METHODS: Fifteen synchronous colorectal cancers (30 tumors) were examined for histologic differences as well as genetic mutations. p53 gene abnormalities were detected by polymerase chain reaction (PCR) followed by single-strand conformation polymorphism analysis. Ki-ras mutations were detected by PCR followed by oligonucleotide-specific hybridization. RESULTS: p53 gene mutations were detected in 12 of 30 tumors. In only one case was the same p53 mutation present in both tumors from one patient. Similarly, Ki-ras mutations were observed in 9 of 30 tumors. Concordant Ki-ras mutations were observed in only one case, which was also concordant for p53 mutation. CONCLUSION: Because p53 and Ki-ras mutations tend to occur fairly early in tumor development, it seems likely that cases discordant for p53 and Ki-ras mutations represent independently developing tumor foci. Taken together, these findings strongly suggest that the great majority of synchronous colonic adenocarcinomas arise as independent neoplasms and their worsened prognosis is not a result of unusually early metastatic spread.

Computerized tomographic scan-guided drainage of intra-abdominal abscesses. Preoperative and postoperative modalities in colon and rectal surgery.

PURPOSE: Computerized tomographic (CT) scan-guided percutaneous drainage of intra-abdominal abscesses has changed the colon and rectal surgeon's approach to preoperative and postoperative intra-abdominal infections. This study is an effort to prove the efficacy of CT scan-guided percutaneous drainage. METHODS: A retrospective study was performed on 133 patients who underwent CT scan drainage of intra-abdominal abscesses over a 6.3-year period. RESULTS: 67 patients had underlying lower gastrointestinal disease. Twenty-three of these patients (34 percent) had spontaneous abscesses and underwent drainage as a preoperative or final modality, whereas 44 patients (66 percent) were drained postoperatively. In 78 percent of patients, surgery was successfully avoided or delayed. Ten patients had acute diverticulitis associated with a large pelvic abscess. Eight patients underwent successful CT scan-guided percutaneous drainage, yielding an 80 percent success rate. Morbidity from the CT scan-guided percutaneous drainage procedure in spontaneous and postoperative groups was 0 percent and 9 percent, respectively. Mortality was 9 percent and 11 percent, respectively, and associated with an elevated Acute Physiology and Chronic Health Evaluation II (APACHE II) score. CONCLUSION: CT scan-guided percutaneous drainage of intra-abdominal abscesses is an important adjunct to colon and rectal surgery because roughly 80 percent of spontaneous and postoperative abscesses were successfully managed.

Simple method for polyp retrieval during colonoscopy.

Retrieval of small polyps can often be frustrating for the skilled endoscopist. We introduce a technique of polyp retrieval that is simple and effective in yielding intact specimens for accurate pathologic examination.

Recurrent breast cancer: stereotaxic localization for fine-needle aspiration biopsy. Work in progress.

The efficacy of stereotaxic localization for fine-needle aspiration biopsy in the detection of recurrent cancer manifested as calcifications on mammograms was evaluated in 43 patients that had been treated with local resection and radiation therapy. Six patients had malignant aspirates and one had an atypical aspirate; examination of the surgical specimens revealed all seven of these to be malignant. Thirteen patients underwent surgical biopsies, the results of which were malignant in seven and benign in six. The remaining 30 patients were followed up with mammography. The follow-up mammograms were obtained at 6-month intervals and demonstrated no change in appearance. On the basis of this initial experience, stereotaxic localization for aspiration biopsy offers the potential to accurately distinguish benign from malignant lesions.

Invasive papillary carcinoma of the breast: mammographic appearance.

The mammographic findings in 18 patients with invasive papillary carcinoma were studied retrospectively. The mammograms of 10 patients showed a multinodular pattern, and seven patients had solitary nodules. One patient had an irregular, ill-defined mass in the retroareolar region. Two patients were found to have carcinoma in the contralateral breast, and two patients had intraductal carcinoma adjacent to the invasive papillary carcinoma. The varied mammographic features that may occur with this rare breast malignancy are discussed.