Patologia e tratamento de sementes: noções gerais.

A importância da patologia de sementes reside no fato de que aproximadamente 90% das culturas utilizadas para a alimentação são propagadas por semente. Dentre essas, nove são consideradas de importância primordial: soja, trigo, arroz, milho, feijão, amendoim, sorgo, cevada e beterraba açucareira.Todas essas culturas podem ser afetadas por patógenos muito agressivos transmitidos através da semente. Assim, o teste de sanidade de semente pode ser considerado como "medicina preventiva", tanto nos programas de quarentena quanto no sistema de produção de semente certificada. Nesta publicação, em sua primeira parte, são abordados os principais aspectos da patologia de sementes, como os seus históricos no mundo e no Brasil, os diferentes métodos utilizados e os fatores que podem causar variação nos resultados dos testes. Em sua segunda parte, são discutidos, em detalhe, os principais patógenos causadores de doenças na cultura da soja que são transmitidos pela semente. Dentre esses, destacam-se, Phomopsis sp. e Fusarium semitectum, causadores de problemas de germinação no laboratório quando ocorrem chuvas durante as fases de maturação e colheita da semente (podridão de semente); Diaporthe phaseolorum f.sp. meridionalis (Phomopsis meridionalis) (cancro da haste); Colletotrichum truncatum (antracnose); Cercospora kikuchii (mancha púrpura); Cercospora sojina (mancha olho-de-rã); Sclerotinia sclerotiorum (podridão branca); Sclerotium rolfsii (tombamento e morte de plantas); Macrophomina phaseolina (podridão de carvão); Rhizoctonia solani (tombamento) e Aspergillus spp. (A. flavus) que, além de ser considerado fungo de armazenagem, é responsável pela podridão da semente no solo, quando a semeadura é feita em solos com baixa disponibilidade de água, sem o tratamento da semente com fungicida. Finalmente é discutida a importância do tratamento de semente de soja com fungicidas, cuja tecnologia, desde a safra 2001/02, vem sendo utilizada em mais de 93% da área semeada com soja no Brasil.

Identificação dos principais fungos das sementes de trigo.

Procedimento para identificação dos fungos das sementes de trigo; Descrição diagnostica dos principais fungos das sementes de trigo; Sclerotium Tode; Rhizoctonia DC; Chaetomium Kunze; Pleospora Rabenh; Sporobolomyces Kluy. & Niel; Rhodotorula Harrison; Phoma Sacc.; Septoria tritici Rob; Stagonospora nodorum (Berk.) Cas. & Germ.; Stagonospora avenae (Frank) Bisset f. sp. triticae; Colletotrichum graminicola (Ces.) Wilson; Fusarium tricinctum (Corda) Sacc; Fusarium moniliforme Sheldon; Fusarium avenaceum (Fr.) Sacc; Fusarium acuminatum Ell. & Kellerm; Fusarium equiseti (Corda) Sacc.; Fusarium graminearum Schw.; Mucor Micheli; Rhizopus Ehrenb; Aspergillus Link.; Penicillium Link.; Alternaria Nees; Epicoccum Link; Cladosporium Link; Nigrospora Zimm; Curvularia Boedijn; Drechslera tritici-repentis (Died.) Drech; Bipolaris sorokiniana (Sacc. in Sorok.) Shoem; Chave sistemática dos principais fungos de sementes de trigo; Ilustrações dos principais fungos encontrados em sementes de trigo.

Doenças de soja: diagnose, epidemiologia e controle.

Página modelo; Simbologia empregada; Doenças causadas por fungos; Míldio da soja (Peronospora manshurica); Oídio da soja (Microsphaera diffusa); Ferrugem asiática (Phakopsora pachyrhizi); Mancha parda da folha (Septoria glycines); Mancha alvo (Corynespora cassiicola); Mancha olho-de-rã (Cercospora sojina); Mancha púrpura (Cercospora kikuchi); Seca da haste e da vagem (Phomopsis spp.); Antracnose (Colletotrichum truncatum); Cancro da haste (Phomopsis phaseoli f. sp. meridionalis); Podridão parda da haste (Phialophora gregata); Podridão vermelha da raiz (Fusarium solani); Mofo branco da haste (Sclerotinia sclerotiorum); Murcha de esclerotium (Sclerotium rolfsii); Podridão da raiz e da haste (Phytophthora megasperma f. sp. glycinea); Mela da folha (Rhizoctonia solani); Tombamento (Rhizoctonia solani); Morte em reboleira (Rhizoctonia solani); Roseliniose (Dematophora necatrix); Podridão negra da raiz (Macrophomina phaseolina); Doenças causadas por nematóides; Nematóide de cisto (Heterodera glycines); Nematóide de galha (Meloidogyne incognita); Doenças causadas por vírus; Mosaico comum da soja; Queima do broto; Doenças causadas por bactérias; Pústula bacteriana (Xanthomonas axonopodis pv. glycines); Fogo selvagem (Pseudomonas syringae pv. tabaci); Crestamento bacteriano (Pseudomonas savastonoi pv. glycinea); Microorganismos que frequentemente causam a morte das sementes a campo; Aspergillus spp.; Penicillium spp.; Bacillus subtilis; Créditos fotográficos; Estádios vegetativos da planta de soja; Estádios reprodutivos da planta de soja.

Identificação dos principais fungos das sementes de trigo.

Procedimento para identificação dos fungos das sementes de trigo; Descrição diagnostica dos principais fungos das sementes de trigo; Sclerotium Tode; Rhizoctonia DC; Chaetomium Kunze; Pleospora Rabenh; Sporobolomyces Kluy. & Niel; Rhodotorula Harrison; Phoma Sacc.; Septoria tritici Rob; Stagonospora nodorum (Berk.) Cas. & Germ.; Stagonospora avenae (Frank) Bisset f. sp. triticae; Colletotrichum graminicola (Ces.) Wilson; Fusarium tricinctum (Corda) Sacc; Fusarium moniliforme Sheldon; Fusarium avenaceum (Fr.) Sacc; Fusarium acuminatum Ell. & Kellerm; Fusarium equiseti (Corda) Sacc.; Fusarium graminearum Schw.; Mucor Micheli; Rhizopus Ehrenb; Aspergillus Link.; Penicillium Link.; Alternaria Nees; Epicoccum Link; Cladosporium Link; Nigrospora Zimm; Curvularia Boedijn; Drechslera tritici-repentis (Died.) Drech; Bipolaris sorokiniana (Sacc. in Sorok.) Shoem; Chave sistemática dos principais fungos de sementes de trigo; Ilustrações dos principais fungos encontrados em sementes de trigo.

Doenças de soja: diagnose, epidemiologia e controle.

Mildio da soja (Peronospera manshurica); Oidio da soja (Microsphaera diffusa); Mancha parda da folha (Septoria glycines); Mancha alvo (Corynespora cassiicola); Mancha de alternaria (Alternaria spp.); Mancha olho-de-rã (Cercospora sojina); Mancha purpura (Cercospora kikuchii); Seca da haste e da vagem (Phomopsis spp.); Antracnose (Colletotrichum truncatum); Cancro da haste (Phomopsis phaseoli f. sp. meridionalis); Podridão parda da haste (Phialophora gregata); Podridão vermelha da raiz (Fusarium solani); Mofo branco da haste (Sclerotinia sclerotiorum); Murcha de esclerotium (Sclerotium rolfsii); Podridão da raiz e da haste (Phytophthora megasperma f. sp. glycinea); Mela da folha (Rhizoctonia solani); Tombamento (Rhizoctonia solani); Morte em reboleira (Rhizoctonia solani); Roseliniose (Dematophora necatrix); Podridão negra da raiz (Macrophomina phaseolina); Nematoide de cisto (Heterodera glycines); Nematoide de galha (Meloidogyne incognita); Mosaico comum da soja; Queima do broto; Pustula bacteriana (Xanthomonas campestris pv. glycines); Fogo selvagem (Pseudomonas syringae pv. tabaci); Crestamento bacteriano (Pseudomonas syringae pv. glycinea); Aspergillus spp.; Penicillium spp.; Bacillus subtilis; Créditos fotográficos; Estádios vegetativos da planta de soja; Estádios produtivos da planta de soja.

Biobased additives as biodegradability enhancers with application in TPU-based footwear components

Among the wide variety of materials employed in the manufacture of shoes, thermoplastic polyurethanes (TPUs) are one of the most widely used. Given its widespread use, and associated waste management problems, the development of more biodegradable and evironmentally compatible solutions is needed. In this work, a polyester-based TPU used in the footwear industry for outsoles production was modified by compounding with lignin, starch and cellulose at content of 4% (w/w). The biodegradability was evaluated by using agar plate tests with the fungi Aspergillus niger ATCC16404, the Gram-negative bacteria Pseudomonas aeruginosa ATCC9027 and an association of both (consortium), and soil tests at 37 °C and 58 °C. The obtained results evidenced a positive effect of the tested biobased additives, the most favourable results being registered with lignin. These results were corroborated by the structural modifications observed by FTIR analysis. Additionally, mechanical tests prove the suitability of using the lignin modified TPUs for footwear outsoles production.

“Green preservatives” – combating fungi in the food industry by applying antifungal lactic acid bacteria

Fungal spoilage is the most common type of microbial spoilage in food leading to significant economical and health problems throughout the world. Fermentation by lactic acid bacteria (LAB) is one of the oldest and most economical methods of producing and preserving food. Thus, LAB can be seen as an interesting tool in the development of novel bio-preservatives for food industry. The overall objective of this study was to demonstrate, that LAB can be used as a natural way to improve the shelf-life and safety of a wide range of food products. In the first part of the thesis, 116 LAB isolates were screened for their antifungal activity against four Aspergillus and Penicillium spp. commonly found in food. Approximately 83% of them showed antifungal activity, but only 1% showed a broad range antifungal activity against all tested fungi. The second approach was to apply LAB antifungal strains in production of food products with extended shelf-life. L. reuteri R29 strain was identified as having strong antifungal activity in vitro, as well as in sourdough bread against Aspergillus niger, Fusarium culmorum and Penicillium expansum. The ability of the strain to produce bread of good quality was also determined using standard baking tests. Another strain, L. amylovorus DSM19280, was also identified as having strong antifungal activity in vitro and in vivo. The strain was used as an adjunct culture in a Cheddar cheese model system and demonstrated the inhibition of P. expansum. Significantly, its presence had no detectable negative impact on cheese quality as determined by analysis of moisture, salt, pH, and primary and secondary proteolysis. L. brevis PS1 a further strain identified during the screening as very antifungal, showed activity in vitro against common Fusarium spp. and was used in the production of a novel functional wortbased alcohol-free beverage. Challenge tests performed with F. culmorum confirmed the effectiveness of the antifungal strain in vivo. The shelf-life of the beverage was extended significantly when compared to not inoculated wort sample. A range of antifungal compounds were identified for the 4 LAB strains, namely L. reuteri ee1p, L. reuteri R29, L. brevis PS1 and L. amylovorous DSM20531. The identification of the compounds was based on liquid chromatography interfaced to the mass spectrometer and PDA detector

Food preservation using antifungal lactic acid bacteria

Fungal spoilage of food and feed prevails as a major problem for the food industry. The use antifungal-producing lactic acid bacteria (LAB) may represent a safer, natural alternative to the use of chemical preservatives in foods. A large scale screen was undertaken to identify a variety of LAB with antifungal properties from plant, animal and human sources. A total of 6,720 LAB colonies were isolated and screened for antifungal activity against the indicator Penicillium expansum. 94 broad-spectrum producers were identified through 16S rRNA sequencing with the majority of the population comprising Lactobacillus plantarum isolates. Six broad-spectrum isolates were consequently characterised. Pedicococcus pentosaceous 54 displayed potent anti-mould capabilities in pear, plum and grape models and may represent an ideal candidate for use in the beverage industry. Two antifungal Lb. plantarum isolates were assessed for their technological robustness and potential as biopreservatives in refrigerated foods. Lb. plantarum 16 and 62 displayed high levels of tolerance to freeze-drying, low temperature exposure and high salt concentrations. Both lactobacilli were introduced as supplements into orange juice to retard the growth of the spoilage yeast Rhodotorula mucilaginosa. Furthermore the isolates were applied as adjuncts in yoghurt production to successfully reduce yeast growth. Lb. plantarum 16 proved to be the optimal inhibitor of yeast growth in both food matrices. To date there is limited information available describing the mechanisms behind fungal inhibition by LAB. The effects of concentrated cell-free supernatant (cCFS), derived from Lb. plantarum 16, on the growth of two food-associated moulds was assessed microscopically. cCFS completely inhibited spore, germ tube and hyphal development. A transcriptomic approach was undertaken to determine the impact of antifungal activity on Aspergillus fumigatus Af293. A variety of genes, most notably those involved in cellular metabolism, were found to have their transcription modulated in response to cCFS which is indicative of global cellular shutdown. This study provides the first insights into the molecular targets of antifungal compounds produced by LAB. The genome sequence of the steep water isolate Lb. plantarum 16 was determined. The complete genome of Lb. plantarum16 consists of a single circular chromosome of 3,044,738 base pairs with an average G+C content of 44.74 % in addition to eight plasmids. The genome represents the smallest of this species to date while harbouring the largest plasmid complement. Some features of particular interest include the presence of two prophages, an interrupted plantaricin cluster and a chromosomal and plasmid encoded polysaccharide cluster. The sequence presented here provides a suitable platform for future studies elucidating the mechanisms governing antifungal production.

Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET).

BACKGROUND: Invasive fungal infections (IFIs) are a major cause of morbidity and mortality among organ transplant recipients. Multicenter prospective surveillance data to determine disease burden and secular trends are lacking. METHODS: The Transplant-Associated Infection Surveillance Network (TRANSNET) is a consortium of 23 US transplant centers, including 15 that contributed to the organ transplant recipient dataset. We prospectively identified IFIs among organ transplant recipients from March, 2001 through March, 2006 at these sites. To explore trends, we calculated the 12-month cumulative incidence among 9 sequential cohorts. RESULTS: During the surveillance period, 1208 IFIs were identified among 1063 organ transplant recipients. The most common IFIs were invasive candidiasis (53%), invasive aspergillosis (19%), cryptococcosis (8%), non-Aspergillus molds (8%), endemic fungi (5%), and zygomycosis (2%). Median time to onset of candidiasis, aspergillosis, and cryptococcosis was 103, 184, and 575 days, respectively. Among a cohort of 16,808 patients who underwent transplantation between March 2001 and September 2005 and were followed through March 2006, a total of 729 IFIs were reported among 633 persons. One-year cumulative incidences of the first IFI were 11.6%, 8.6%, 4.7%, 4.0%, 3.4%, and 1.3% for small bowel, lung, liver, heart, pancreas, and kidney transplant recipients, respectively. One-year incidence was highest for invasive candidiasis (1.95%) and aspergillosis (0.65%). Trend analysis showed a slight increase in cumulative incidence from 2002 to 2005. CONCLUSIONS: We detected a slight increase in IFIs during the surveillance period. These data provide important insights into the timing and incidence of IFIs among organ transplant recipients, which can help to focus effective prevention and treatment strategies.

Presencia de una microflora patógena en lotes comerciales de Syngonium podophyllum

p.145-148

A polysaccharide extracted from sphagnum moss as antifungal agent in archaeological conservation

On the basis of the well-known preservative properties of Sphagnum moss, a potential opportunity to use moss polysaccharides (Sphagnan) in art conservation was tested. Polysaccharides were extracted from the moss (S. palustre spp.) in the amount of 4.1% of the Sphagnum plant dry weight. All lignocelluloses were removed from this extract as a result of the treatment of the moss cellulose with sodium chlorite. The extracted polysaccharide possessed a strong acidic reaction (pH 2.8) and was soluble in water and organic solvents. The extract was tested on laboratory bacterial cultures by the disk-diffusion method. The antibacterial effect was demonstrated for E. coli and P. aeruginosa (both gram-negative) while Staphylococcus aurelus (gram-positive) was shown to be insensitive to Sphagnum polysaccharides. The antifungal effect of Sphagnum extract was tested by the disk-diffusion method on the spores of seventeen fungal species. These fungi were isolated from ethnographic museum objects and from archaeological objects excavated in the Arctic. Twelve of these isolates appeared susceptible to the extract. The inhibiting effect of the extract was also tested by the modified broth-dilution method on the most typical isolate (Aspergillus spp.). In this experiment, in one ml of the nutritious broth, 40µl of 3% solution of polysaccharides in water killed 10,000 fungal spores in 6 hours. The inhibiting effect was not connected to the acidity or osmotic effect of Sphagnum polysaccharides. As an example of the application of Sphagnum polysaccharides in art conservation, they were added as preservative agents to conservation waxes. After three weeks of exposure of microcrystalline wax to test fungi (Aspergillus spp.), 44% of wax was consumed. When, however, ~ 0.1% (w/w) of Sphagnum extract was mixed with wax, the weight loss of wax was only 4% in the same time interval. On the basis of this study it was concluded that Sphagnum moss and Sphagnum products can be recommended for use in art conservation as antifungal agents.

Savory peptides present in Moromi obtained from soy sauce fermentation of yellow soybean

The presence of savory peptides in moromi has been investigated. Moromi was prepared by fermenting yellow soybean using Aspergillus oryzae as the starter at the first step (mold fermentation) and 20% brine solution at the next step (brine fermentation). The moromi was then ultrafiltered stepwise using membranes with MW cut-offs of 10,000, 3,000, and 500 Da, respectively. The fraction with MW <500 Da was chromatographed using Sephadex G-25 SF to yield four fractions, 1-4. Analysis of soluble peptides, NaCl content, alpha-amino nitrogen, amino acid composition, peptide profile using CE coupled with DAD, taste profile and free glutamic acid content, were performed for each fraction. Fraction 2 contained a relatively high total glutamic acid content, but a relatively low free glutamic acid content and had the highest umami taste. This fraction also had more peptides containing non-aromatic amino acids than the other fractions. The peptides present in fraction 2 may play a role, at least in part, in its intense umami taste.

Comparison of techniques to examine the diversity of fungi in adult patients with cystic fibrosis

This study compares conventional and molecular techniques for the detection of fungi in 77 adult cystic fibrosis (CF) patients. Three different methods were investigated, i.e., (1) conventional microbiological culture (including yeasts and filamentous fungi), (2) mycological culture with CF-derived fungal specific culture media, and (3) Non-culture and direct DNA extraction from patient sputa. Fungi isolated from environmental air samples of the CF unit were compared to fungi in sputa from CF patients. Fungi (n = 107) were detected in 14/77(18%) of patients by method 1, in 60/77 (78%) of patients by method 2 and with method 3, in 77/77(100%) of the patients. The majority of yeasts isolated were Candida albicans and C. dubliniensis. Exophiala (Wangiella) dermatitidis, Scedosporiumapiospermum, Penicillium spp., Aspergillus fumigatus, and Aspergillus versicolor were also identified by sequence analysis of the rDNA short internal transcribed spacer (ITS2) region. Conventional laboratory analysis failed to detect fungi in 63 patients mainly due to overgrowth by Gram-negative organisms. Mycological culture with antibiotics dramatically increased the number of fungi that could be detected. Molecular techniques detected fungi such as Saccharomyces cerevisiae, Malassezia spp., Fuscoporia ferrea, Fusarium culmorum, Acremonium strictum, Thanatephorus cucumeris and Cladosporium spp. which were not found with other methods. This study demonstrates that several potentially important fungi may not be detected if mycological culture methods alone are used. A polyphasic approach employing both enhanced mycological culture with molecular detection will help determine the presence of fungi in the sputa of patients with CF and their healthcare environment.

Development of selective media for the isolation of yeasts and filamentous fungi from the sputum of adult patients with cystic fibrosis (CF)

Yeasts and filamentous fungi are beginning to emerge as significant microbial pathogens in patients with cystic fibrosis (CF), particularly in relation to allergic-type responses, as seen in patients with allergic bronchopulmonary aspergillosis (ABPA), Aspergillus bronchitis and in invasive fungal disease in lung transplant patients. Four fungal media were compared in this study, including Sabouraud Dextrose Agar (SDA) and Medium B, with and without the addition of selective antibiotics, where antibiotic-supplemented media were designated with (+). These media were compared for their ability to suppress contaminating, mainly Gram-ve pathogens, in CF sputa (Pseudomonas aeruginosa, Burkholderia cepacia complex [BCC] organisms) and to enhance the growth of fungi present in CF sputum. Medium B consisted of glucose (16.7 g/l), agar (20 g/l), yeast extract (30 g/l) and peptone (6.8 g/l) at pH 6.3 and both SDA(+) and Medium B+ were supplemented with cotrimethoxazole, 128 mg/l; chloramphenicol, 50 mg/l; ceftazidime, 32 mg/l; colistin, 24 mg/l). Employment of SDA(+) or Medium B+ allowed an increase in specificity in the detection of yeasts and moulds, by 42.8% and 39.3%, respectively, over SDA when used solely. SDA(+) had a greater ability than Medium B+ to suppress bacterial growth from predominantly Gram-ve co-colonisers. This is a significant benefit when attempting to detect and isolate fungi from the sputum of CF patients, as it largely suppressed any bacterial growth, with the exception of the BCC organisms, thus allowing for an increased opportunity to detect target fungal organisms in sputum and represented a significant improvement over the commercial medium (SDA), which is currently used. Overall, both novel selective media were superior in their ability to suppress bacteria in comparison with the commercially available SDA medium, which is routinely employed in most clinical microbiology diagnostic laboratories presently. Alternatively, Medium B+ had a great ability to grow fungi than SDA(+) and when employed together, the specificity of combined use was 82%, with a sensitivity for yeasts, filamentous fungi, and combined overall fungi of 96.0%, 92.3% and 96.0%, respectively. Overall, when employing one fungal selective medium for the routine detection of yeasts and filamentous fungi in the sputum of CF patients, we would recommend employment of Medium B+. However, we would recommend the combined employment of SDA(+) and Medium B+, in order to synergistically isolate and detect the greatest number of fungi present in CF sputa. (C) 2008 European Cystic Fibrosis Society. Published by Elsevier B.V All rights reserved.

Development of a novel PCR assay for the identification of the black yeast, Exophiala (Wangiella) dermatitidis from adult patients with cystic fibrosis (CF)

Cystic fibrosis (CF) patients may suffer increased morbidity and mortality through colonisation, allergy and invasive infection from fungi. The black yeast, Exophiala dermatitidis (synonym Wangiella dermatitidis) has been found with increasing frequency in sputum specimens of CF patients, with reported isolation rates ranging from 1.1 to 15.7%. At present, no diagnostic PCR exists to aid with the clinical laboratory detection and identification of this organism. A novel species-specific PCR-based assay was developed for the detection of E. dermatitidis, based on employment of rDNA operons and interspacer (ITS) regions between these rDNA operons. Two novel primers, (designated ExdF & ExdR) were designed in silico with the aid of computer-aided alignment software and with the alignment of multiple species of Exophiala, as well as with other commonly described yeasts and filamentous fungi within CF sputum, including Candida. Aspergillus and Scedosporium. An amplicon of approximately 455 by was generated, spanning the partial ITS I region - the complete 5.8S rDNA region - partial ITS2 region, employing ExdF (forward primer [16-mer], 5'-CCG CCT ATT CAG GTC C-3' and ExdR (reverse primer [16-mer], 5'-TCT CTC CCA CTC CCG C-3', was employed and optimised on extracted genomic DNA from a well characterised culture of E. dermatitidis, as well as with high quality genomic DNA template from a further 16 unrelated fungi, including Candida albicans, C. dubliniensis, C. parapsilosis, C. glabrata, Scedosporium apiospermum, Penicillium sp., Aspergillus fumigatus, Aspergillus versicolor, Pichia guilliermondii, Rhodotorula sp., Trichosporon sp., Aureobasidium pullulans, Fusarium sp., Mucor hiemalis, Bionectria ochroleuca, Gibberella pulicaris. Results demonstrated that only DNA from E. dermatitidis gave an amplification product of the expected sire, whilst none of the other fungi were amplifiable. Subsequent employment of this primer pair detected this yeast from mycological cultures from 2/50 (4%) adult CF patients. These two patients were the only patients who were previously shown to have a cultural history of E. dermatitidis from their sputum. E. dermatitidis is a slow-growing fungus, which usually takes up to two weeks to culture in the microbiology laboratory and therefore is slow to detect conventionally, with the risk of bacterial overgrowth from common co-habiting pan- and multiresistant bacterial pathogens from sputum. namely Pseudomonas aeruginosa and Burkholderia cepacia complex organisms, hence this species-specific PCR assay may help detect this organism from CF sputum more specifically and rapidly. Overall, employment of this novel assay nay help in the understanding of the occurrence. aetiology and epidemiology of E. dermatitidis, as an emerging fungal agent in patients with CF. (C) 2008 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.