First Report of Leaf Spot Caused by Corynespora cassiicola on Kiwifruit (Actinidia chinensis) in China.

Kiwifruit (Actinidia) is a common fruit cultivated in many countries. Actinidia deliciosa and A. chinensis are two commercially important kiwifruit species. Over 70,000 ha are grown annually in China. In 2012, a leaf spot disease of A. chinensis was observed in several orchards in Leye County (106°34' E, 24°47' N), Guangxi Zhuang Autonomous Region, China. The disease mainly damaged the leaves during the fruit development stage through to the maturity stage. Initially reddish-brown small lesions appeared on the leaves; later, typical symptoms were tan to taupe lesions surrounded by purple brown margins, nearly circular to irregular, 2 to 10 × 2.2 to 15.5 mm in diameter. Some lesions exhibited a concentric pattern. The lesions eventually coalesced, causing extensive leaf necrosis and defoliation. The fungus that sporulated from lesions had the following morphological characteristics: light brown conidiophores with slightly swollen apexes, light brown conidia formed singly or in acropetal chains, straight or curved, cylindrical to oblavate, 52.9 to 240.5 µm long (avg. 138.9 µm) and 5.3 to 13.6 µm wide (avg. 8.4 µm), 5 to 12 distoseptate, with a flat, darkened, and thickened hilum. These morphological characteristics corresponded with that of Corynespora cassiicola (Berk. & Curt.) Wei (1). To isolate the pathogen of the disease, small pieces of symptomatic foliar tissues, including young lesions, typical older lesions, and atypical older lesions with concentric pattern were surface sterilized with 75% ethanol for 30 to 60 s, disinfected in 0.1% HgCl2 for 1 min followed by washing with sterile water, plated on PDA, and incubated at 28°C for 7 to 10 days. Gray to dark gray colonies and conidia of C. cassiicola were observed. To validate the identity of the fungus, the sequence of the ITS region of one of the purified strains, LYCc-1, was determined. DNA was extracted from the isolate that was grown on PDA at 28°C for 4 days, and the ITS region was amplified using the universal primer pair ITS4/ITS5 (2). The double strand consensus sequence was submitted to GenBank (KJ747095) and had 99% nt identity with published sequences of C. cassiicola in GenBank (JN853778, FJ852574, and FJ852587). Pathogenicity tests were carried out on detached leaves in petri dishes in an incubator at 28°C and on whole plants in a glasshouse at 25 ± 3°C. The isolations did not produce enough conidia in pure culture, so mycelial discs were used in pathogenicity tests. For both assays, 60-day-old healthy kiwifruit leaves were inoculated with a 5-mm mycelial disc obtained from the periphery of a 5-day-old C. cassiicola strain (LYCc-1) grown on PDA. The PDA discs were placed on the leaf surface with their mycelial surface down and secured with sterile wet cotton. Controls consisted of leaves that were inoculated with sterile PDA discs. For the detached leaf assay, the leaves were placed on filter paper reaching water saturation in petri dishes, and for the whole plant assays the inoculated leaves were kept moist with intermittent water sprays for 48 h. Four leaves of each plant were inoculated with the isolate in both assays, and experiment was repeated twice. Eight inoculated leaves of the detached leaf assay all showed the first water soaked lesions 36 h after inoculation, followed by extensive leaf rot 72 h after inoculation, and yielded abundant conidia of C. cassiicola. Six out of eight leaves inoculated on whole plants showed the first lesions 5 days after inoculation, whereas control leaves remained healthy. Only C. cassiicola was re-isolated from the lesions in both assays, fulfilling Koch's postulates. This is the first report of leaf spot caused by C. cassiicola on kiwifruit in China. References: (1) M. B. Ellis. Dematiaceous Hyphomycetes. CMI, Kew, Surrey, UK, 1971. (2) T. J. White et al. In: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

Risk of hepatitis B reactivation and the role of novel agents and stem-cell transplantation in multiple myeloma patients with hepatitis B virus (HBV) infection.

BACKGROUND: The purpose of the study is to analyse the prevalence of hepatitis B virus (HBV) infection and its incidence of reactivation among multiple myeloma (MM) patients treated in the era of novel therapy in an endemic Asian setting. PATIENTS AND METHODS: From 2000 to 2008, 273 patients with newly diagnosed MM were screened for the presence of hepatitis B virus surface antigen and HBV core antibody. HBV-infected patients were prospectively followed for reactivation with serial monitoring of serum alanine transferase and HBV DNA load. The patterns of HBV reactivation in relation to treatment received, exposure to high-dose therapy with autologous stem-cell transplantation (HDT/ASCT) and novel agents were studied. RESULTS: The prevalence of HBV infection was 5.5%. Three cases of HBV reactivation despite lamivudine prophylaxis were reported. Two patients reactivated 3-5 months after HDT/ASCT while receiving thalidomide maintenance and one reactivated 3 years after HDT/ASCT and shortly after bortezomib salvage therapy. Emergence of a mutant HBV strain was documented in one patient. CONCLUSIONS: Use of prophylaxis may reduce but will not preclude HBV reactivation. Highest risk occurs during immune reconstitution phase of HDT/ASCT. The role of immunomodulatory agents in HBV reactivation needs to be further elucidated. Separate HBV prophylaxis and surveillance guidelines ought to be developed for patients with MM.

Characterization of hemopoietic engraftment kinetics and development of secondary cytopenia in AML post auto-SCT and its correlation with survival outcome.

We performed a single center retrospective analysis of 84 autologous hemopoietic stem cell transplants done for AML to characterize the pattern of hemopoietic engraftment, post-transplant cytopenia and their impact on survival outcome. Following autologous transplant and engraftment, 30 patients (35.7%) had a transient secondary decline in their plt counts, which was not associated with graft rejection, relapse or infection. The median time to onset of thrombocytopenia was 59 days post transplant, with spontaneous recovery after a median period of 41 days. A secondary decline in ANC also occurred in eight patients. Patients with secondary plt decline had a significantly earlier primary plt engraftment (median 15 days) and a trend towards earlier neutrophil engraftment compared with patients who maintained steady plt counts (median 21 days). There was a trend towards a lower incidence of secondary plt decline in patients who received BM stem cells compared with those who received PBSC. No cause was evident for the occurrence of a secondary cytopenia, and it did not adversely affect survival. We conclude that secondary cytopenia is a common and harmless occurrence after autologous transplant especially from PBSC graft.

Treatment and outcome of acquired haemophilia A with a standard conventional regimen in a cohort without associated conditions.

Acquired haemophilia A (AH) is a rare bleeding disorder with significant risk of mortality. We conducted a study on the treatment and outcomes of patients with AH diagnosed between 1998 and 2004 in our institution. Fourteen patients (age range 17-89, median 64) were followed-up from between 10-64 months (average 32 months). Inhibitor levels ranged from 5 to 450 BU. Ten patients required either recombinant activated factor VIIa or prothrombin complexes for control of bleeding. All patients received a standard immunosuppressive regimen of prednisolone 1 mg kg day(-1) and oral cyclophosphamide 50-100 mg day(-1). In addition, nine patients received intravenous immunoglobulin. Complete remission (CR) was achieved in 88% (eight of nine evaluable patients) over durations ranging from 5-78 days (average 35 days). There were three mortality; from bleeding, sepsis and cerebral infarct. Two patients were lost to follow-up. There were no relapses among patients achieving CR. Conditions associated with AH were not identified at diagnosis or subsequent follow-up in all patients. This series represent one of the largest aetiologically and treatment-wise, uniformed cohort of AH patients. Despite toxicity concerns, the combination of prednisolone and cyclophosphamide remain an effective regimen and should be among the first line of treatment choices, with careful patient selection.

Fludarabine in comparison to alkylator-based regimen as induction therapy for chronic lymphocytic leukemia: a systematic review and meta-analysis.

The superiority of Fludarabine over conventional therapy as primary induction therapy for patients with chronic lymphocytic leukemia (CLL) has been shown in several studies but no studies have yet reported a pooled estimate of the treatment effect. We performed a systematic review of evidence from 5 randomized controlled trials involving approximately 1300 patients with CLL, comparing Fludarabine with several alkylator-based combination regimens in the primary treatment of CLL. Complete response rate was significantly higher for Fludarabine compared to alkylator-based chemotherapy (RR 1.87, 95% CI 1.10-3.19, P=0.02), while overall response, though superior, did not reach statistical significance (RR 1.22, 95% CI=0.88-1.69, P=0.24). Overall survival was similar for Fludarabine and alkylator-based therapy (the pooled log hazard ratio of death, HR=-0.05, 95% CI=-0.36-0.26, P=0.75). Infection rate was significantly higher (RR 1.58, 95% CI=1.10-2.27, P=0.01), but there was no significant difference in the incidence of thrombocytopenia, neutropenia and anemia. Therefore, this meta-analysis supports the findings that Fludarabine as an induction agent for patients with CLL yields a better clinical response with acceptable toxicity when compared with alkylator-based combination therapy, but without a survival benefit by 5-6 years of follow up.

A small peptide derived from Flt-1 (VEGFR-1) functions as an angiogenic inhibitor.

Vascular endothelial growth factor (VEGF) is an angiogenic stimulator which functions through two endothelial specific tyrosine kinase receptors, Flt-1 and Flk-1. In this work, we show that an 11-amino acid peptide derived from the second immunoglobulin-like domain of Flt-1 functions as an angiogenic inhibitor in chick chorioallantoic membrane and inhibited VEGF-induced vascular permeability in Miles' assay without binding to VEGF directly. Circular dichroism and nuclear magnetic resonance analyses indicate that this peptide forms a stable extended structure in solution, presumably beta-sheet structure and is most likely existing as a dimer. Our results suggest that this small peptide functions as an angiogenic inhibitor by inhibiting VEGF function through a non-VEGF binding mechanism.

[Experience in cancer of the uterine cervix treated with surgery--an analysis of 820 cases].

From 1962 to November 1985, 1000 cases of cervical cancer were treated surgically, of whom 820 (37 Stage 0, 371 Stage I, 399 Stage II, 10 Stage III and 3 Stage IV lesions) had been operated before 1982. In the 820 cases, squamous cell cancer comprised 90.5%, adenocarcinoma 8.8% and adenoacanthoma or adenosquamous cancer 0.7%. Pelvic lymph node metastasis rate was 8.9% and 24.1% in Stages I and II. The obturator region was the most vulnerable to metastasis. The 5-year survival rate was 86.7% in 173 cases of infiltrative cancer treated during 1978-1982. The 10-year survival rate was 85.25% (520/610) in the infiltrative cancer, 95.9% in Stage I and 75.3% in Stage II. Two cases with Stage IV without pelvic lymph node metastasis treated with surgery have survived for over 10 years. All thirty-seven cases of cervical cancer in situ treated with surgery are still alive. Pelvic lymph node metastasis is the major factor influencing operation and survival.