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Introduction: Brainstem symptoms can be the first manifestation of neuromyelitis optica (NMO) and related spectrum disorders (NMOSD). They can result from a cervical spinal cord lesion extending to the medullary region or as a brainstem-restricted lesion. These lesions commonly cause intractable nausea, vomiting and/or hiccups, however, oculomotor symptoms or ataxia are infrequent. Few studies have investigated the prevalence of brainstem symptoms in NMOSD. Materials and Methods: A retrospective study was conducted involving 206 NMO/NMOSD patients followed at the Hospital das Clínicas, University of São Paulo. Patients satisfied the Wingerchuk 2006 and 2007 diagnostic criteria for NMO/NMOSD. Brainstem lesions were evaluated using 1.5t MM. Aquaporin-4 (AQP4) antibody was tested using a cell-based assay. Results: From the total of patients, 46.6% (96/206) had NMO and 53.4% (110/206) had NMOSD. In the NMOSD group, 75 patients had longitudinally extensive transverse myelitis (LETM) and 35 had optic neuritis (ON). The anti-AQP4 was positive in 72.3% (149/206) of the cases. The clinical diagnosis of anti-AQP4+ cases were: NMO in 57.7% (86/149), LETM in 26.2% (39/149) and ON in 16.1% (24/149). Brainstem symptoms were the first clinical symptom of NMOSD in 17% (35/206) of the total and anti-AQP4 was positive in all these cases. Brainstem symptoms as a first attack without an extension of a cervical spinal cord lesion were seen in 13.6% (28/206) of cases and as an extension of LETM in 3.4% (7/206). Brainstem symptoms were present in at least one attack in 47.6% (98/206) of the patients, however, brainstem lesions on the MRI were found in only 40.8% (40/98) of these patients. No patients who presented exclusively with brainstem symptoms as the first attack without an extension of a cervical spinal cord lesion were properly diagnosed at the first attack. Discussion and Conclusion: Brainstem symptoms as the first manifestation of NMOSD may not be uncommon. NMOSD should be suspected in patients with intractable nausea, vomiting and/or hiccups, especially those with brainstem lesions on MRI. [ABSTRACT FROM AUTHOR]

An abstract of the article "Hydrogen Cyanide Synthesis and Antagonistic Activity of Two Pseudomonas Strains" by C. P. Strano and colleagues is presented.

Objectives: To assess the diagnostic ability in detecting oral lesions among dentists, dental hygienists, dentistry students, oral hygiene students, and non-healthcare subjects., Materials and Methods: Participants were invited to classify 30 images of oral lesions in "benign" or "suspected malignant" only based on the visual appearance of the lesion. Diagnostic accuracy was assessed by calculating sensitivity and specificity with 95% confidence intervals and stratified by population group and image features (color, shape, and size of the lesions)., Results: A total of 16,590 examinations by 553 subjects were analyzed. Overall sensitivity and specificity were 57% (95% confidence interval 56%-58%) and 64% (95% confidence interval 63%-65%). Diagnostic accuracy varied among population groups, with experienced dentists showing the lowest sensitivity (52%) and the highest specificity (71%). Red lesions, flat lesions, and large lesions had the lowest sensitivity (42%, 36%, 57%) but the highest specificity (70%, 75%, 76%)., Conclusions: We found worrying low ability to detect suspected malignant oral lesions by both healthcare workers and non-healthcare subjects. Lesion-specific characteristics may lead to differences in recognition. Specific courses and more adequate teaching methods should be proposed to increase identification of oral lesions., (© 2023 The Authors. Oral Diseases published by Wiley Periodicals LLC.)

Tomato is subject to several diseases that affect both field- and greenhouse-grown crops. To select cost-effective potential biocontrol agents, we used laboratory throughput screening to identify bacterial strains with versatile characteristics suitable for multipurpose uses. The natural diversity of tomato root-associated bacterial communities was bioprospected under a real-world environment represented by an intensive tomato cultivation area characterized by extraseasonal productions in the greenhouse. Approximately 400 tomato root-associated bacterial isolates, in majority Gram-negative bacteria, were isolated from three compartments: the soil close to the root surface (rhizosphere, R), the root surface (rhizoplane, RP), and the root interior (endorhizosphere, E). A total of 33% of the isolates produced siderophores and were able to solubilize phosphates and grow on NA with 8% NaCl. A total of 30% of the root-associated bacteria showed antagonistic activity against all the tomato pathogens tested, i.e., Clavibacter michiganesis pv. michiganensis , Pseudomonas syringae pv. tomato , Pseudomonas corrugata and Xanthomonas euvesicatoria pv. perforans , and Fusarium oxysporum f. sp. lycopersici . We found that the sampling site rather than the root compartment of isolation influenced bacterial composition in terms of analyzed phenotype. This was demonstrated through a diversity analysis including general characteristics and PGPR traits, as well as biocontrol activity in vitro . Analysis of 16S rRNA gene (rDNA) sequencing of 77 culturable endophytic bacteria that shared multiple beneficial activity revealed a predominance of bacteria in Bacillales, Enterobacteriales, and Pseudomonadales. Their in vitro antagonistic activity showed that Bacillus species were significantly more active than the isolates in the other taxonomic group. In planta activity against phytopathogenic bacteria of a subset of Bacillus and Pseudomonas isolates was also assessed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Anzalone, Di Guardo, Bella, Ghadamgahi, Dimaria, Zago, Cirvilleri and Catara.)

Background: The recent advances in the analysis of tumor immunobiology suggest the possibility of biologically manipulating the efficacy and toxicity of cancer chemotherapy by endogenous or exogenous immunomodulating substances. Aloe is one of the of the most important plants exhibiting anticancer activity and its antineoplastic property is due to at least three different mechanisms, based on antiproliferative, immunostimulatory and antioxidant effects. The antiproliferative action is determined by anthracenic and antraquinonic molecules, while the immunostimulating activity is mainly due to acemannan., Patients and Methods: A study was planned to include 240 patients with metastatic solid tumor who were randomized to receive chemotherapy with or without Aloe. According to tumor histotype and clinical status, lung cancer patients were treated with cisplatin and etoposide or weekly vinorelbine, colorectal cancer patients received oxaliplatin plus 5-fluorouracil (5-FU), gastric cancer patients were treated with weekly 5-FU and pancreatic cancer patients received weekly gemcitabine. Aloe was given orally at 10 ml thrice/daily., Results: The percentage of both objective tumor regressions and disease control was significantly higher in patients concomitantly treated with Aloe than with chemotherapy alone, as well as the percent of 3-year survival patients., Conclusion: This study seems to suggest that Aloe may be successfully associated with chemotherapy to increase its efficacy in terms of both tumor regression rate and survival time.

The technique of laparoscopic antegrade sphincterotomy is described. This procedure was used to clear the common bile duct in 22 selected patients with documented choledocholithiasis. Indications for attempting laparoscopic antegrade sphincterotomy included multiple common bile duct stones, one or more common hepatic or intrahepatic stones, a dilated common bile duct requiring a drainage procedure, and suspicion of papillary stenosis. No major complications or mortality was observed. Mild hyperamylasemia was observed in two patients. However, both were asymptomatic, and serum amylase levels rapidly returned to normal. One patient was noted to have a drop in her hematocrit from a preoperative value of 39% to a postoperative value of 33%. Laparoscopic antegrade sphincterotomy added a mean of 17 min to the operative procedure. The mean postoperative stay was 1.4 days. The results of this study suggest that laparoscopic antegrade sphincterotomy may prove to be a useful modality in selected patients with complicated choledocholithiasis.