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The polyphagous shot hole borer (PSHB) beetle is a recent invader in South Africa. Together with its fungal symbiont, Fusarium euwallaceae, it can rapidly kill highly susceptible host plants. Its impact is most profound in urban areas, but it has also been found infesting important forestry, agricultural crop and native species. Since its first detection in 2012, PSHB has spread to all but one province in the country. The beetle–fungus complex has several biological traits that enhance its anthropogenically mediated dispersal, establishment and survival in novel environments – factors that have likely facilitated its rapid spread across the country. We review the history of the PSHB invasion in South Africa, its taxonomic status and the reasons for its rapid spread. We highlight its potential impact and challenges for its management. Finally, we provide an updated distribution map and list of confirmed host plants in South Africa. Of the 130 plant species identified as hosts, 48 of these (19 indigenous and 29 introduced) are reproductive hosts able to maintain breeding PSHB populations. These reproductive hosts may succumb to beetle infestations and act as ‘pest-amplifiers’. The economic impact on urban forests, plantation forestry and agricultural crops may be severe, but the ecological impact of PSHB invasion in native ecosystems should not be underestimated.Significance: We provide an updated host list and distribution map for South Africa of the globally significant tree pest, the polyphagous shot hole borer (PSHB, Euwallacea fornicatus). The South African PSHB invasion represents the largest outbreak of this pest in its global invaded range. PSHB was confirmed to infest 130 plant species in urban, agricultural, and native ecosystems in South Africa, including 44 previously unreported hosts. Impact in South Africa is in its infancy but will likely be substantial to local economies and ecosystems. Mitigation has proven difficult, but numerous research projects have been initiated throughout the country.

Background Data on the lung microbiome in HIV-infected children is limited. The current study sought to determine the lung microbiome in HIV-associated bronchiectasis and to assess its association with pulmonary exacerbations. Methods A cross-sectional pilot study of 22 children (68% male; mean age 10.8 years) with HIV-associated bronchiectasis and a control group of 5 children with cystic fibrosis (CF). Thirty-one samples were collected, with 11 during exacerbations. Sputum samples were processed with 16S rRNA pyrosequencing. Results The average number of operational taxonomy units (OTUs) was 298 ± 67 vs. 434 ± 90, for HIV-bronchiectasis and CF, respectively. The relative abundance of Proteobacteria was higher in HIV-bronchiectasis (72.3%), with only 22.2% Firmicutes. There was no correlation between lung functions (FEV1% and FEF25/75%) and bacterial community (r = 0.154; p = 0.470 and r = 0.178; p = 0.403), respectively. Bacterial assemblage of exacerbation and non-exacerbation samples in HIV-bronchiectasis was not significantly different (ANOSIM, RHIV-bronchiectasis = 0.08; p = 0.14 and RCF = 0.08, p = 0.50). Higher within-community heterogeneity and lower evenness was associated with CF (Shannon-Weiner (H′) = 5.39 ± 0.38 and Pielou’s evenness (J) 0.79 ± 0.10 vs. HIV-bronchiectasis (Shannon-Weiner (H′) = 4.45 ± 0.49 and Pielou’s (J) 0.89 ± 0.03. Conclusion The microbiome in children with HIV-associated bronchiectasis seems to be less rich, diverse and heterogeneous with predominance of Proteobacteria when compared to cystic fibrosis.

Euphorbia ingens trees have been dying in large numbers in the Limpopo Province of South Africa for approximately 15 years. The ambrosia beetle Cyrtogenius africus is often found infesting diseased and dying trees. The aim of this study was to identify the ophiostomatoid fungi occurring in the galleries of C. africus. Logs infested with this beetle were collected from the KwaZulu-Natal, Limpopo, Mpumalanga, and North West Provinces of South Africa. Fungi belonging to the Ophiostomatales were identified based on morphology and comparison of sequence data for the β-tubulin, ITS1-5.8S-ITS2 and LSU gene regions. A novel species of Ophiostoma and a novel genus in the Ophiostomatales were identified. Inoculation studies with these fungi produced lesions in the branches of healthy E. ingens trees.

Fungi in the genus Geosmithia (Ascomycota: Hypocreales) are frequent associates of bark beetles and woodborers that colonize hardwood and coniferous trees. One species, Geosmithia morbida, is an economically damaging invasive species. The authors surveyed the Geosmithia species of California and Colorado, USA, to (i) provide baseline data on taxonomy of Geosmithia and beetle vector specificity across the western USA; (ii) investigate the subcortical beetle fauna for alternative vectors of the invasive G. morbida; and (iii) interpret the community composition of this region within the emerging global biogeography of Geosmithia. Geosmithia was detected in 87% of 126 beetle samples obtained from 39 plant species. Twenty-nine species of Geosmithia were distinguished, of which 13 may be new species. Bark beetles from hardwoods, Cupressus, and Sequoia appear to be regular vectors, with Geosmithia present in all beetle gallery systems examined. Other subcortical insects appear to vector Geosmithia at lower frequencies. Overall, most Geosmithia have a distinct level of vector specificity (mostly high, sometimes low) enabling their separation to generalists and specialists. Plant pathogenic Geosmithia morbida was not found in association with any other beetle besides Pityophthorus juglandis. However, four additional Geosmithia species were found in P. juglandis galleries. When integrated with recent data from other continents, a global pattern of Geosmithia distribution across continents, latitudes, and vectors is emerging: of the 29 Geosmithia species found in the western USA, 12 have not been reported outside of the USA. The most frequently encountered species with the widest global distribution also had the broadest range of beetle vectors. Several Geosmithia spp. with very narrow vector ranges in Europe exhibited the similar degree of specialization in the USA. Such strong canalization in association could reflect an ancient origin of each individual association, or a recent origin and a subsequent diversification in North America.

Background Asthma is a disease of varying severity and differing disease mechanisms. To date, studies aimed at stratifying asthma into clinically useful phenotypes have produced a number of phenotypes that have yet to be assessed for stability and to be validated in independent cohorts. The aim of this study was to define and validate, for the first time ever, clinically driven asthma phenotypes using two independent, severe asthma cohorts: ADEPT and U-BIOPRED. Methods Fuzzy partition-around-medoid clustering was performed on pre-specified data from the ADEPT participants (n = 156) and independently on data from a subset of U-BIOPRED asthma participants (n = 82) for whom the same variables were available. Models for cluster classification probabilities were derived and applied to the 12-month longitudinal ADEPT data and to a larger subset of the U-BIOPRED asthma dataset (n = 397). High and low type-2 inflammation phenotypes were defined as high or low Th2 activity, indicated by endobronchial biopsies gene expression changes downstream of IL-4 or IL-13. Results Four phenotypes were identified in the ADEPT (training) cohort, with distinct clinical and biomarker profiles. Phenotype 1 was “mild, good lung function, early onset”, with a low-inflammatory, predominantly Type-2, phenotype. Phenotype 2 had a “moderate, hyper-responsive, eosinophilic” phenotype, with moderate asthma control, mild airflow obstruction and predominant Type-2 inflammation. Phenotype 3 had a “mixed severity, predominantly fixed obstructive, non-eosinophilic and neutrophilic” phenotype, with moderate asthma control and low Type-2 inflammation. Phenotype 4 had a “severe uncontrolled, severe reversible obstruction, mixed granulocytic” phenotype, with moderate Type-2 inflammation. These phenotypes had good longitudinal stability in the ADEPT cohort. They were reproduced and demonstrated high classification probability in two subsets of the U-BIOPRED asthma cohort. Conclusions Focusing on the biology of the four clinical independently-validated easy-to-assess ADEPT asthma phenotypes will help understanding the unmet need and will aid in developing tailored therapies. Trial registration NCT01274507 (ADEPT), registered October 28, 2010 and NCT01982162 (U-BIOPRED), registered October 30, 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12931-016-0482-9) contains supplementary material, which is available to authorized users.

Botryosphaeria rhodina (anamorph Lasiodiplodia theobromae) is a common endophyte and opportunistic pathogen on more than 500 tree species in the tropics and subtropics. During routine disease surveys of plantations in Australia and Venezuela several isolates differing from L. theobromae were identified and subsequently characterized based upon morphology and ITS and EF1-alpha nucleotide sequences. These isolates grouped into three strongly supported clades related to but different from the known taxa, B. rhodina and L. gonubiensis, These have been described here as three new species L. venezuelensis sp. nov., L. crassispora sp. nov. and L. rubropurpurea sp. nov. The three could be distinguished easily from each other and the two described species of Lasiodiplodia, thus confirming phylogenetic separations. Furthermore all five Lasiodiplodia spp. now recognized separated from Diplodia spp. and Dothiorella spp. with 100% bootstrap support.

Several recent studies have reviewed the extent of fungal biodiversity, and have used these data as basis for revised estimates of species numbers based on known numbers of plants and insects. None of these studies, however, have focused on fungal biodiversity in South Africa. Coinciding with the 100th anniversary of the National Collection of Fungi (PREM) in South Africa in 2005, it is thus timely to reflect on the taxonomic research that has been conducted in South Africa over the past Century. Information is presented on the extent of fungal collections preserved at PREM, and the associated research publications that have largely resulted from this resource. These data are placed in context of the known plant and insect biodiversity, and used as basis to estimate the potential number of fungi that could be expected in South Africa. The conservative estimate is of approximately 200 000 species without taking into account those associated with a substantial insect biodiversity.

This paper discusses the various methods used to diagnose uterine perforation caused by an IUD. Radiography, or plain film, has a limited use in the diagnosis of uterine perforation since its usefulness depends on the radiopacity of the particular IUD; if the IUD appears on film, plain film does not allow one to conclude whether the device is in its proper position. Several modifications of plain film have been tried but all methods fall short of their goals. Hysterography permits the best diagnostic assessment since it allows the visualization of the entire uterine cavity so that the position of the IUD is immediately evident in cases of embedding and of perforation. Pelvic pneumography can differentiate between intraperitoneal or extraperitoneal locations of perforated IUDs; it can be enhanced by hysterosalpingography and can be done on an ambulatory basis. Ultrasonography simply determines the presence or absence of an IUD, but has the advantage of accurately demonstrating a concomitant pregnancy; the sonogram is not reliable if the IUD is surrounded by omentum or by loops of bowel; ultrasonography can be advantageously coupled with hysterography. Laparoscopy is still the method most used to diagnose uterine IUD perforation; when removal of the device is advisable laparotomy is usually carried out concomitantly; successful laparoscopy requires a skilled and experienced operator. Hysteroscopy is a new and extremely valuable technique which should not be chosen as a primary procedure because it carries a risk of complications. The best prevention of uterine perforation is a meticulous and well executed insertion technique, done only by an experienced operator and after a careful pelvic examination. Uterine size, consistency and position must be exactly known; IUD insertion is easier during or immediately after menstruation. Perforated IUDs should be removed even if considered innocuous, although this is a matter still debated by the specialists. Spontaneous IUD expulsion must be verified, when not proven, by the same methods used by perforation diagnosis, or by dilatation and curettage. Before deciding on the best method for removal it is necessary to know the type of perforation and the location of the ectopic IUD. Removal of an IUD, whether through the vagina or through hysteroscopic, laparoscopic, laparotomy, or hysterotomy procedures, is never easy. Emergency hysterectomy is done under certain circumstances, such as hemorrhage, while elective hysterectomy requires the presence of additional factors, such as a fibroid uterus. Colpotomy is done only when the IUD is lying in the posterior cul-de-sac.

The posterior mediastinum is an infrequent site for an enlarged thyroid. A correct preoperative diagnosis is required, so that the proper surgical approach may be used. Five cases of posterior mediastinal goiter will be presented and the current literature reviewed. Case I: A 68-year-old white female was seen in 1953, with a history of a mass in the neck since 1914. In 1936, a subtotal thyroidectomy had been performed. A nonproductive cough persisted after the thyroidectomy and was associated with some exertional dyspnea and substernal wheezing. More recently, auricular fibrillation had developed. On roentgen examination of the chest in the posteroanterior postion (Fig. 1), a mediastinal mass was seen bilaterally, projecting more toward the right. The trachea was displaced to the right and compressed. A frontal plane film with barium (Fig. 2) showed the esophagus to be displaced to the right. On the oblique and lateral projections (Figs. 3 and 4) the trachea was bowed forward and the esophagus displaced p...

A simple technique to obtain an excellent nephrogram is presented. The additional valuable information that can be obtained from a 20 second nephrogram is discussed and illustrated and the inclusion of the 20 second roentgenogram in routine excretory urography is recommended.

Embolization of metallic mercury, although rare, does occur.The pattern of multiple, small, spherical, metallic densities of varying sizes confined to the distribution of one or several vessels is characteristic and permits a reliable roentgenologic diagnosis.Identification of additional metallic densities in other parts of the body then serves to confirm the diagnosis, define the extent of embolization and indicate the site of entry.Mercurialism, mercury abscesses, and local ischemia may accompany mercury embolization, determining the patient’s presenting complaint.

A series of 1,020 consecutive newborns was examined by means of frontal chest roentgenograms. Particular attention was directed to the patterns of thymic prominence. In about one-half of the cases, there was no prominence of the thymus on either side. In the remaining half, prominence of the thymus involved much more frequently the right lobe than the left. The various grades of thymic prominence on both sides are illustrated. The differential diagnosis of thymic prominence is discussed.Incidental findings in the lung and cardiovascular system, including the frequency of visualization of the horizontal fissure, the presence of skin lines simulating a pneumothorax and other normal variants, are briefly described. No skeletal abnormalities were noted in this series.The reported study shows that wide variations exist in the normal appearance of the newborn thorax. These should be taken into consideration by the interpreting radiologist.

1. A close anatomic relationship exists roentgenologically between the gallbladder and hepatic flexure of the colon, as shown in a series of 419 cases.

The roentgen appearance of the normal azygos vein was first described by Ottonello in 1932. It casts an ovoid or almond-shaped shadow in the right tracheobronchial angle, seen to best advantage on frontal laminagrams of the chest. The width of the normal azygos vein in adults has been reported not to exceed 6 mm. (Fleischner and Udis). Dilatation of the azygos vein has been described under various pathologic circumstances, including right-sided heart failure, portal venous hypertension, obstruction of the superior or inferior vena cava, and absence of the inferior vena cava. Particularly in the latter case, the azygos and hemiazygos venous systems may serve as important collateral channels for return of blood to the right side of the heart. It is our purpose to record the case of a healthy 19-year-old white male who was rejected from military service because a routine induction chest roentgenogram revealed a “mediastinal tumor” (Fig. 1). At a subsequent exploratory thoracotomy, a huge azygos vein was foun...

Pangynecography a term coined for the combined visualization of the uterus and proximal tubes the ovaries distal tubes and serosal surface of the uterus permits the surgeon to anticipate what he will be able to accomplish at surgery. First a Foley catheter and 5 cc bag is inserted in the uterus and inflated. Second N2O is passed into the peritoneum with a plastic cannula. Third conventional pneumography is done in frontal and oblique projections. Fourth water-soluble contrast dye is injected into the uterus through the Foley catheter and x-rays repeated. Finally the catheter is withdrawn and the gas expressed. The patient can be discharged in about 3 hours. In the 4 case histories presented visualization was adequate to plan for salpingostomy end-to-end anastomosis cornual reimplantation or ovarian implantation as may be needed for reversal of tubal ligation. Complications mentioned were latent infection interstitial emphysema intravasation of contrast. Contraindications are pelvic or peritoneal inflammation uterine bleeding or cardiopulmonary disease.

A physiologic and clinical approach has been employed to distinguish two groups of patients who were anatomically similar: one group had pulmonic stenosis, ventricular septal defect with overriding aorta (tetralogy of Fallot); and the second group had pulmonic stenosis, ventricular septal defect with normal aortic root. The former group has a single developmental defect associated with incomplete transposition of the aorta and persistence of a right ventricular aortic flow; therefore, this entity should be considered within the spectrum of the transpositions. The second group, whether in utero development of pulmonic stenosis with interventricular septal defect or postnatal hypertrophy of the right ventricular outflow tract with interventricular septal defect, has evidence of a hyperdynamic left ventricle. It is the physiologic role of the left ventricle that separates these patients into two distinct groups.

Summary A brief review of the simple ventriculopleural bypassing technique for the treatment of hydrocephalus is given and an unusual complication is reported.

The facility for mass movement of segments of our world populations creates the need for physicians to recognize and manage diseases not seen in native patients. Such a need has occurred in New York City, where schistosomiasis, with its protean manifestations has been seen with increasing frequency. The cases of three patients who had different clinical manifestations of infestation by S. mansoni are presented. Clinical, radiologic, and pathologic features are discussed. To avoid delay in treatment, physicians must consider the possibility of this disorder in cases of patients from areas of endemic schistosomiasis.

This report of complete and partial uterine perforation and embedding following IUD insertion is based on a review of the pertinent literature of the past 15 years. An analysis of 356 cases reported in the literature during this time are included. A classification is proposed based on the distinction between complete and partial perforation. Of all perforations of the uterus, be they fundal, lower segmental, or upper cervical, the completely perforated IUD is the type most often encountered, most commonly described, most readily recognized, and most easily removed. To differentiate between perforated IUDs, 3 anatomical compartments are postulated. For the purposes of discussion, the endometrial and serosal layers of the uterus are disregarded, leaving only the myometrium as its truly essential feature. Compartment 1 is the uterine cavity; compartment 2, the myometrium; and compartment 3, the peritoneal cavity. Completely perforated and, less often, partially perforated IUDs may intrude upon neighboring viscera, particularly the intestinal tract, resulting frequently in seriously ill patients who require intensive treatment including intestinal surgery. In the review of 356 case reports, such special situations arose in 53 cases, or 15%. Of the 53 reported cases, 41 concerned the intestinal tract. There were 6 cases in which the IUD was in the bladder. In 1 case, the perforation had been partial (Lippes loop) and, in 5 cases, complete (4 Lippes loop and 1 Dalkon shield). There were 3 cases in which the uterus was involved under special circumstances. There were 5 cases in which death occurred in relation to uterine perforation by IUD. It is probable that, of the various factors responsible for uterine perforation by IUDs, the most important are the consistency and flexion of the uterus, the type and the rigidity of the IUD and its inserter, and the amount of force exerted at insertion, with the result that the IUD stops at a certain point rather than proceeding to complete perforation. If the IUD does not penetrate beyond the uterine wall, i.e., if it is type 1-2 or type-2 perforation, negative intraabdominal pressure does not obtain. If the IUD had penetrated beyond the uterine wall, the theoretical possibility exists for further progression to type 3 perforation more readily than in the type 1-2 or type 2 perforation. In this review of 356 cases, 352 cases were suitable for analysis. Of these there were 53 unusual complications involving the intestinal tract, bladder, and so forth. There were 299 cases of simple perforation involving the uterus only, of which 255 were complete and 44 were partial. The mechanism of cervical perforation appears to depend on the presence of an IUD with a dependent limb in its design. Embedding, diagnosis, and the problem of the missing string are reviewed.

The radiologic aspects of abortion are divided into 2 main categories: (1) sequelae of uterine dilatation and curettage; and (2) problems related to intraamniotic injection of saline.The first category includes uterine synechiae (Asherman syndrome) and incompetence of the internal os, the roentgen features of which are described and illustrated.In the second category, proper placement of the needle in the amniotic sac can be verified by the injection of water soluble contrast medium (amniography). Malpositions in the placenta, vascular system or peritoneal cavity are easily recognized and serious consequences can be averted. The diagnosis of hydatidiform mole is readily established.The use of amniography in other areas of obstetrical diagnosis, the roentgenologic assessment of fetal age and the problem of therapeutic abortion because of exposure to ionizing radiation early in pregnancy are briefly discussed.

Recent advances in angiography have extended into the area of trophoblastic neoplasms, including benign hydatidiform mole, chorioadenoma destruens (malignant hydatidiform mole), and choriocarcinoma. This communication is prompted by the recent observation of a patient in whom a benign hydatidiform mole developed, complicated by a chorioadenoma destruens, which was cured by chemotherapy. Borell et al. (1) have shown by angiography the transition from hydatidiform mole to choriocarcinoma in two patients, while Cockshott and Hendrickse (3) have reported persistent arteriovenous fistulas following chemotherapy of malignant trophoblastic disease in seven patients. Most recently Leibold et al. (6) have reported the surgical excision of a pelvic arteriovenous fistula several years after successful treatment of a chorionepithelioma. In the present case each of the three stages (benign mole, chorioadenoma destruens, and the status after successful chemotherapy) is documented angiographically and verified histologi...

The medical complications of heroin addiction are divided into two categories: those due directly to heroin (overdose syndrome); and infectious complications associated with nonsterile techniques of injection by the addict.The roentgen findings in 15 young patients are described, with particular emphasis on the pulmonary changes encountered in acute heroin intoxication. These findings consist of an alveolar pattern of pulmonary edema, varying in severity but generally showing quick clearing unless the overdose is rapidly fatal or complicated by pulmonary infection. The importance of the roentgen examination for detection of pulmonary edema in these patients is stressed.The roentgen findings in the infectious complications of heroin addiction are also briefly described and include bronchopneumonia, pulmonary abscess, septic thromboembolic phenomena, pyogenic spondylitis and tetanus.

Two female patients in their sixth decades presented with multiple calcified aneurysms involving collateral thoracic arterial channels in association with coarctation of the aorta. The roentgen signs of coarctation of the aorta in the child and in the adult are briefly listed. The differential diagnosis of superior mediastinal calcifications is discussed, and the importance of careful inspection of the roentgenograms in a search for rib notching is emphasized. While rib notching is only suggestive of aortic coarctation, its combination with calcified aneurysms of the brachiocephalic arteries is practically pathognomonic.

This report is made to record the occurrence of an extruded disk migrating to the dorsal extradural space at the level of L3-L4. In a recent survey of the literature, Rubinstein, Stern, and Jacobson (2) reviewed the subject of blocking of the spinal canal, complete and incomplete, by extruded disks. In no instance was the entire nucleus pulposus found dorsal to the thecal sac. Case Report A 39-year-old-male was seen nine days after experiencing a sudden pain in the left calf, upon getting out of bed in the morning. This was so severe that the patient was immediately incapacitated; it subsequently spread to the right buttock and was accompanied by weakness of both legs which soon progressed to complete inability to walk. Two days prior to hospital admission bladder and bowel function failed. The patient was an extremely obese, heavily built man, apparently suffering intense discomfort, with abdominal distention and urinary retention. There was tenderness on deep pressure over the mid-lumbar area, and the s...

Pelvic pneumography can be enhanced by the simultaneous visualization of the uterine cavity and fallopian tubes, here termed pangynecography. A Foley catheter is used in the uterus for hysterosalpingography, simplifying the technique and allowing the patient complete mobility. Clinical applications are illustrated in three specific areas: (a) resolution of adnexal masses into tubal and ovarian components, (b) differentiation between uterine and adnexal masses, and (c) roentgen evaluation of the ligated tube prior to tuboplasty. Contraindications and minor complications are presented.