Interactions between respiration and systemic hemodynamics. Part II: practical implications in critical care.

In Part I of this review, we have covered basic concepts regarding cardiorespiratory interactions. Here, we put this theoretical framework to practical use. We describe mechanisms underlying Kussmaul's sign and pulsus paradoxus. We review the literature on the use of respiratory variations of blood pressure to evaluate volume status. We show the possibilities of attaining the latter aim by investigating with ultrasonography how the geometry of great veins fluctuates with respiration. We provide a Guytonian analysis of the effects of PEEP on cardiac output. We terminate with some remarks on the potential of positive pressure breathing to induce acute cor pulmonale, and on the cardiovascular mechanisms that at times may underly the failure to wean a patient from the ventilator.

Tissue-adapted invasion strategies of the rice blast fungus Magnaporthe oryzae.

Magnaporthe oryzae causes rice blast, the most serious foliar fungal disease of cultivated rice (Oryza sativa). During hemibiotrophic leaf infection, the pathogen simultaneously combines biotrophic and necrotrophic growth. Here, we provide cytological and molecular evidence that, in contrast to leaf tissue infection, the fungus adopts a uniquely biotrophic infection strategy in roots for a prolonged period and spreads without causing a loss of host cell viability. Consistent with a biotrophic lifestyle, intracellularly growing hyphae of M. oryzae are surrounded by a plant-derived membrane. Global, temporal gene expression analysis used to monitor rice responses to progressive root infection revealed a rapid but transient induction of basal defense-related gene transcripts, indicating perception of the pathogen by the rice root. Early defense gene induction was followed by suppression at the onset of intracellular fungal growth, consistent with the biotrophic nature of root invasion. By contrast, during foliar infection, the vast majority of these transcripts continued to accumulate or increased in abundance. Furthermore, induction of necrotrophy-associated genes during early tissue penetration, previously observed in infected leaves, was not seen in roots. Collectively, our results not only report a global characterization of transcriptional root responses to a biotrophic fungal pathogen but also provide initial evidence for tissue-adapted fungal infection strategies.

European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients: summary of the ECIL 3--2009 update.

In 2005, several groups, including the European Group for Blood and Marrow Transplantation, the European Organization for Treatment and Research of Cancer, the European Leukemia Net and the Immunocompromised Host Society created the European Conference on Infections in Leukemia (ECIL). The main goal of ECIL is to elaborate guidelines, or recommendations, for the management of infections in leukemia and stem cell transplant patients. The first sets of ECIL slides about the management of invasive fungal disease were made available on the web in 2006 and the papers were published in 2007. The third meeting of the group (ECIL 3) was held in September 2009 and the group updated its previous recommendations. The goal of this paper is to summarize the new proposals from ECIL 3, based on the results of studies published after the ECIL 2 meeting: (1) the prophylactic recommendations for hematopoietic stem cell transplant recipients were formulated differently, by splitting the neutropenic and the GVHD phases and taking into account recent data on voriconazole; (2) micafungin was introduced as an alternative drug for empirical antifungal therapy; (3) although several studies were published on preemptive antifungal approaches in neutropenic patients, the group decided not to propose any recommendation, as the only randomized study comparing an empirical versus a preemptive approach showed a significant excess of fungal disease in the preemptive group.

Mycovellosiella robbsii sp. nov. causing leaf-spot on Mimosa caesalpiniaefolia

This is a description of the new species Mycovellosiella robsii, a cercosporoidal hyphomycete, associated with leaf spots on Mimosa caesalpiniaefolia, an important hedge plant with multiple uses in Brazil. The new species was compared to other cercosporoid species associated with plants of the genus Mimosa and other species of the genus Mycovellosiella described on legumes, and is recognized as a distinct taxon. Koch's postulates were carried out and the disease was reproduced by inoculating healthy plants with mycelial suspension or disk, confirming the pathogenicity. This is the first report of a fungal disease on this host.

Effect of extracts from citric biomass, rusted coffee leaves and coffee berry husks on Phoma costarricencis of coffee plants

Phoma leaf spot, caused by Phoma costarricensis poses a serious threat to coffee (Coffea arabica) production, especially in the highlands of the state of Minas Gerais, Brazil. Extracts of citric biomass, coffee berry husks and coffee leaves severely affected by rust caused by Hemileia vastatrix, were evaluated against P. costarricensis. In an in vitro assay, aqueous extracts of rusted leaves and berry husks plus the commercial extracts based on citric biomass named Ecolife® and Agromil® were tested at various dilutions on the mycelial growth inhibition of P. costarricensis. In vivo, coffee seedlings maintained in glasshouse, were sprayed with these extracts seven days before inoculation of P. costarricensis. Only extracts from citric biomass had inhibitory effects on the fungus. In vivo, Ecolife® (5 ml/l), Agromil® (5 g/l) and the aqueous extract of rusted coffee leaves (dilution 1:6) reduced Phoma leaf spot. Both, Ecolife® and the extract of rusted coffee leaves were significantly more effective in reducing the area under the lesion progress curve when applied at lower doses, indicating a possible effect on the induction of resistance.

A mathematical framework for group analysis of von Willebrand factor multimeric composition following luminography

The objective of the present study was to establish a method for quantitative analysis of von Willebrand factor (vWF) multimeric composition using a mathematical framework based on curve fitting. Plasma vWF multimers from 15 healthy subjects and 13 patients with advanced pulmonary vascular disease were analyzed by Western immunoblotting followed by luminography. Quantitative analysis of luminographs was carried out by calculating the relative densities of low, intermediate and high molecular weight fractions using laser densitometry. For each densitometric peak (representing a given fraction of vWF multimers) a mean area value was obtained using data from all group subjects (patients and normal individuals) and plotted against the distance between the peak and IgM (950 kDa). Curves were constructed for each group using nonlinear fitting. Results indicated that highly accurate curves could be obtained for healthy controls and patients, with respective coefficients of determination (r²) of 0.9898 and 0.9778. Differences were observed between patients and normal subjects regarding curve shape, coefficients and the region of highest protein concentration. We conclude that the method provides accurate quantitative information on the composition of vWF multimers and may be useful for comparisons between groups and possibly treatments.

Meningoencephalitis caused by a zygomycete fungus (Basidiobolus) associated with septic shock in an immunocompetent patient: 1-year follow-up after treatment

Zygomycosis is an infection caused by opportunistic fungi of the Zygomycetes class, specifically those from the Mucorales and Entomophthorales orders. It is an uncommon disease, mainly restricted to immunocompromised patients. We report a case of a 73-year-old male patient with a history of fever (39°C) lasting for 1 day, accompanied by shivering, trembling, and intense asthenia. The patient was admitted to the intensive care unit with complex partial seizures, and submitted to orotracheal intubation and mechanical ventilation under sedation with midazolam. The electroencephalogram showed evidence of non-convulsive status epilepticus. There is no fast specific laboratory test that permits confirmation of invasive fungal disease. Unless the physician suspects this condition, the disease may progress rapidly while the patient is treated with broad-spectrum antibiotics. Differential diagnosis between fungal and bacterial infection is often difficult. The clinical presentation is sometimes atypical, and etiological investigation is not always successful. In the present case, the histopathological examination of the biopsy obtained from the right temporal lobe indicated the presence of irregular, round, thick-walled fungi forming papillae and elongated structures of irregular diameter, with no septa, indicative of zygomycete (Basidiobolus). Treatment with liposomal amphotericin B and fluconazole was initiated after diagnosis of meningoencephalitis by zygomycete, with a successful outcome.

Identification de composés naturels contre Saprolegnia sp., un champignon pathogène en aquaculture

La saprolégniose est une maladie fongique causée par le champignon aquatique Saprolegnia sp. qui affecte les poissons sauvages et ceux provenant des piscicultures. L’apparition de touffes cotonneuses semblables à de la ouate de couleur blanche à grise est souvent la première indication de l’infection. Ce saprophyte ubiquitaire se nourrit habituellement des œufs de poissons morts, mais peut se propager rapidement aux œufs sains causant la mort de ces derniers. La saprolégniose est souvent une infection secondaire, mais des souches virulentes peuvent facilement se développer sur les salmonidés ayant subi un stress ou une mauvaise manipulation. De grandes pertes économiques associées à la saprolégniose sont rapportées chaque année à travers le monde surtout dans l’industrie de la pisciculture. Jusqu’en 2002, le contrôle de la saprolégniose pouvait se faire par l’utilisation du vert de malachite, un colorant organique ayant une grande activité antifongique. Malheureusement, cette molécule a été bannie à cause de ses propriétés cancérigènes. Aucun composé aussi efficace n’est actuellement disponible pour traiter les infections de la saprolégniose. Des molécules ou extraits naturels ayant un potentiel antifongique ont donc été testés à l’aide de deux techniques (par graines de chanvre et par cylindre d’agar). Les molécules d’un extrait de propolis (cire de ruches d’abeilles) démontrant de l’activité anti-Saprolegnia ont été identifiées. De plus, une bactérie, Pseudomonas aeruginosa, pouvant être retrouvée dans le même environnement que Saprolegnia sp. a démontré un effet antagoniste au champignon. Une molécule de signalisation intercellulaire produite par P. aeruginosa, 4-hydroxy-2-heptylquinoline (HHQ), a été identifiée comme responsable de l’effet antagoniste contre Saprolegnia sp.

Le rôle de l’aldostérone sur le remodelage structurel pulmonaire et la fonction ventriculaire droite en insuffisance cardiaque congestive

INTRODUCTION : L’insuffisance cardiaque congestive (ICC) induit remodelage pulmonaire et dysfonction ventriculaire droite (VD) qui contribuent de façon importante à la morbidité/mortalité. Malgré l’efficacité prouvée, l’antagonisme des récepteurs minéralocorticoïdes est sous-utilisé en ICC et ses mécanismes d’actions demeurent incompris. Nous avons évalué si l’Aldostérone contribue au remodelage pulmonaire et à la dysfonction VD en stimulant la prolifération des myofibroblastes (MYFs) pulmonaires. MÉTHODE ET RÉSULTATS : L’étude a été réalisée chez des rats avec infarctus du myocarde (IM) de taille modérée à grande permettant le développement de l’ICC. Deux semaines après l’IM, les rats ont été traités avec 100mg/kg/jour d’Aldactone ou non, pendant trois semaines et comparé à un groupe témoin (N=21;24;8). Comparativement au groupe témoin, les rats IM ont développé une ICC caractérisée par une réduction de la fraction de raccourcissement du VG (53±1%vs.16±2%, moyenne±ESM, P<0.0001), une hypertension pulmonaire (PSVD:27±1vs.40±3mmHg, P<0.01) et une hypertrophie VD (VD/(VG+Septum):24±1%vs.38±3%, P<0.05). L’Aldactone n’a eu aucun effet sur ces paramètres. Les rats IM ont développé un syndrome pulmonaire caractérisé par un abaissement de la courbe respiratoire pression-volume, un remodelage structurel pulmonaire avec doublement du poids poumon sec (P<0.01) et de la fibrose pulmonaire avec augmentation du taux de collagène dans les poumons (P<0.05). L’Aldactone n’a pas restauré la fonction pulmonaire. Enfin, les MYFs pulmonaires isolés n’ont pas proliféré avec l’exposition de 48h aux deux traitements d’Aldostérone (10-7M, 10-6M). CONCLUSION : L’Aldostérone ne contribue pas au remodelage pulmonaire et à la dysfonction VD associés à l’ICC. D’autres mécanismes d’actions sont responsables des effets bénéfiques de l’Aldactone.

Développement de nouvelles formulations d’antifongiques et évaluation de l’activité sur Candida spp. et Aspergillus spp.

Les travaux effectués dans le cadre de cette thèse de doctorat avaient pour but de mettre au point des nouvelles formulations d’antifongiques sous forme de nanoparticules polymériques (NP) en vue d’améliorer l’efficacité et la spécificité des traitements antifongiques sur des souches sensibles ou résistantes de Candida spp, d’Aspergillus spp et des souches de Candida albicans formant du biofilm. Dans la première partie de ce travail, nous avons synthétisé et caractérisé un polymère à base de polyester-co-polyéther branché avec du poly(éthylène glycol) (PEG-g-PLA). En plus d’être original et innovant, ce co-polymère a l’avantage d’être non-toxique et de posséder des caractéristiques de libération prolongée. Trois antifongiques couramment utilisés en clinique et présentant une biodisponibilité non optimale ont été choisis, soient deux azolés, le voriconazole (VRZ) et l’itraconazole (ITZ) et un polyène, l’amphotéricine B (AMB). Ces principes actifs (PA), en plus des problèmes d’administration, présentent aussi d’importants problèmes de toxicité. Des NP polymériques encapsulant ces PA ont été préparées par une technique d’émulsion huile-dans-l’eau (H/E) suivie d’évaporation de solvant. Une fois fabriquées, les NP ont été caractérisées et des particules de d’environ 200 nm de diamètre ont été obtenues. Les NP ont été conçues pour avoir une structure coeur/couronne avec un coeur constitué de polymère hydrophobe (PLA) et une couronne hydrophile de PEG. Une faible efficacité de chargement (1,3% m/m) a été obtenue pour la formulation VRZ encapsulé dans des NP (NP/VRZ). Toutefois, la formulation AMB encapsulée dans des NP (NP/AMB) a montré des taux de chargement satisfaisants (25,3% m/m). En effet, le caractère hydrophobe du PLA a assuré une bonne affinité avec les PA hydrophobes, particulièrement l’AMB qui est le plus hydrophobe des agents sélectionnés. Les études de libération contrôlée ont montré un relargage des PA sur plusieurs jours. La formulation NP/AMB a été testée sur un impacteur en cascade, un modèle in vitro de poumon et a permis de démontrer le potentiel de cette formulation à être administrée efficacement par voie pulmonaire. En effet, les résultats sur l’impacteur en cascade ont montré que la majorité de la formulation s’est retrouvée à l’étage de collecte correspondant au niveau bronchique, endroit où se situent majoritairement les infections fongiques pulmonaires. Dans la deuxième partie de ces travaux, nous avons testé les nouvelles formulations d’antifongiques sur des souches planctoniques de Candida spp., d’Aspergillus spp. et des souches de Candida albicans formant du biofilm selon les procédures standardisées du National Committee for Clinical Laboratory Standards (NCCLS). Les souches choisies ont démontré des résistances aux azolés et aux polyènes. Les études d’efficacité in vitro ont permis de prouver hors de tout doute que les nouvelles formulations offrent une efficacité nettement améliorée comparée à l’agent antifongique libre. Pour mettre en lumière si l’amélioration de l’efficacité antifongique était due à une internalisation des NP, nous avons évalué le comportement des NP avec les cellules de champignons. Nous avons procédé à des études qualitatives de microscopie de fluorescence sur des NP marquées avec de la rhodamine (Rh). Tel qu’attendu, les NP ont montré une localisation intracellulaire. Pour exclure la possibilité d’une simple adhésion des NP à la surface des levures, nous avons aussi confirmé leur internalisation en microscopie confocale de fluorescence. Il est important de noter que peu d’études à ce jour ont mis l’accent sur l’élaboration de nouvelles formulations d’antifongiques à base de polymères non toxiques destinées aux traitements des mycoses, donnant ainsi une grande valeur et originalité aux travaux effectués dans cette thèse. Les résultats probants obtenus ouvrent la voie vers une nouvelle approche pour contourner les problèmes de résistances fongiques, un problème de plus en plus important dans le domaine de l’infectiologie.

Hallazgos radiológicos de la enfermedad pulmonar en pacientes Colombianos con esclerodermia

La esclerosis sistémica (ES) es una enfermedad autoinmune multisistémica que afecta principalmente la piel, los pulmones, el tracto gastrointestinal, el corazón y los riñones. La enfermedad pulmonar, presente en casi el 100% de los casos, es el factor con mayor influencia en la mortalidad. El propósito de este estudio es realizar un análisis detallado de la enfermedad pulmonar por tomografía computarizada de alta resolución(TCAR) en pacientes Colombianos con ES, para lo cual se realizó un estudio de prevalencia analítica en 44 pacientes con ES valorados en el Hospital Universitario Mayor Méderi en los últimos 7 años. Los resultados mostraron características demográficas y clínicas similares a las previamente descritas. La prevalencia de enfermedad pulmonar intersticial fue alta, y los hallazgos de fibrosis pulmonar como vidrio esmerilado y panal de abejas se asociaron con la presencia del autoanticuerpo antiSCL70. La medida del diámetro esofágico por TCAR fue mayor en los pacientes con disfagia, antiSCL 70 y linfopenia, los cuales son marcadores de mal pronóstico.

Relationships between Oak powdery mildew incidence and severity and commensal fungi

Oak (Quercus robur) powdery mildew is a common and damaging fungal disease. In a local survey at Reading, UK, oak powdery mildew was common on trees of all height classes but was most common on trees of 3-9m. A variety of other fungal species were commonly found growing in association with oak powdery mildew colonies. The abundance of such fungi was estimated through stratified sample surveys for 2.5 years. The taxa most commonly associated with oak powdery mildew were Acremonium sp., Trichoderma sp., Ampelomyces/Phoma sp. and Leptosphaerulina australis. Nearly 90% of mildew colonies were associated with L. australis, which is not generally considered as a mycoparasite or antagonist, in contrast with the other three fungi. Abundance varied between June and October surveys. Acremonium sp. abundance was greater in summer samplings whereas L. australis and Trichoderma sp. abundances were greater in autumn samplings. Ampelomyces/Phoma sp. was never observed in the absence of powdery mildew. Relationships between the mildew-associated fungi and oak powdery mildew appeared curved and differed significantly between sampling years. L. australis was positively correlated with the other three associated fungi studied when powdery mildew was also present. The variety and high population densities of the mildew associated fungi suggest that they may be important in determining the final density of oak mildew and the damage caused by it.

Avaliação da eficiência de co-transformação de soja (Glycine max (L.) Merrill) via bombardeamento de partículas utilizando um gene de seleção e um gene de interesse em plamídeos diferentes

Visando aumentar a resistência a moléstias fúngicas, o presente trabalho teve como objetivo introduzir um gene (chit1) que codifica uma quitinase do fungo Metarhizium anisopliae em cultivares de soja [Glycine max (L.) Merrill]. A co-transformação foi a estratégia escolhida, visando a obtenção de plantas livres de transgenes marcadores na progênie das plantas transformadas. A co-transformação foi realizada via biolística, tendo como tecido-alvo conjuntos de embriões somáticos globulares das cultivares MG/BR46 Conquista e IAS-5. O plasmídeo pGusHyg, que contém o gene repórter gusA e o gene marcador hpt, foi bombardeado concomitantemente com o plasmídeo pMOG463chit1, que porta o gene chit1. Os conjuntos de embriões bombardeados foram transferidos para meio seletivo contendo higromicina, visando a obtenção de material estavelmente transformado. Os conjuntos embriogênicos higromicina-resistentes foram transferidos seqüencialmente para meios de proliferação D-20 (sem higromicina), maturação e regeneração. No total, foram obtidos 387 e 380 embriões histodiferenciados das cultivares MG/BR46 Conquista e IAS-5, respectivamente. Plantas transgênicas adultas e férteis foram regeneradas. Para avaliar a eficiência da estratégia de cotransformação, foram realizadas análises moleculares de embriões histodiferenciados e de plantas regeneradas. Os resultados obtidos neste trabalho permitiram o cálculo da taxa de co-transformação de 44% para os embriões histodiferenciados da cultivar MG/BR46 Conquista e de 50% para plantas de IAS-5. Não existem, até o momento, relatos de trabalhos em soja utilizando embriões somáticos globulares em proliferação como alvo para estudos de co-transformação.

Evaluation of tangerine hybrid resistance to Alternaria alternata

The Alternaria Brown Spot, caused by Alternaria alternata, is a major fungal disease in some kinds of tangerines, tangor, mandarins and pomelos. In Brazil as well as worldwide, A. alternata can cause necrosis in fruits, branches and leaves, causing substantial profit loss. In the present research, in laboratory conditions and in the field, we evaluated the resistance to the fungus, in leaves and fruits, for 22 varieties and hybrids of tangerines. To this end, we evaluated genotypes belonging to the Germplasm Bank of the Estacao Experimental de Citricultura de Bebedouro. The resistant genetic materials (found in leaves and fruits) represented four varieties of clementines (Citrus clementina); six varieties of mandarins (two belonging to C. reticulata, two to C. tangerina, one to C. deliciosa and one to C. nobilis); one tangelo (C. tangerina x C. paradisi); two mandarin hybrids (one resulting from crossing C nobilis x C. deliciosa and the other from crossing C. clementina x C. reticulata); one tangor hybrid (C. clementina) and two satsuma hybrids (C. unshiu x C. deliciosa). We also determined a relation between the inoculation of leaves and fruits. The resistance and susceptibility following inoculation in leaves and fruits supports a relationship between these organs and the physiological responses observed for the evaluated genotypes. (C) 2009 Elsevier B.V. All rights reserved.

A new method for inoculation of fruit with Guignardia citricarpa, the causal agent of citrus black spot

Citrus black spot (CBS) is a fungal disease, caused by Guignardia citricarpa, that has a high economic impact on citrus. Although G. citricarpa has been associated with black spot of citrus, an adequate pathogenicity test is still not available. Thus, our objective was to develop and evaluate a simple, safe, and practical pathogenicity test. We used fruits from Pera-Rio and Valencia sweet orange trees from two different orchards, located in the State of São Paulo, Brazil. Inoculation was performed by placing six disks colonized by G. citricarpa, onto the peel of healthy fruits, previously bagged. In the Pera-Rio sweet orange grove, initial symptoms of the false melanose type resulting from the inoculations were observed 55 days after inoculation (dai). In the Valencia grove, initial symptoms also of the false melanose type resulting from the inoculations occurred 73 dai. A total of 92.8% and 86.6% of the Pera Rio and Valencia fruits inoculated, respectively, showed symptoms of CBS. Citrus black spot symptoms were not observed in any of the control fruits.