Characterization, pathogenicity and anastomosis groups of Rhizoctonia solani from watermelon

The objective of this study was to characterize the morphological and pathogenic variation of Rhizoctonia solani isolates as well as to determine mycelial compatibility and hyphal fusion. The R. solani isolates CMM1053, CMM2967, CMM1052, CMM2983, CMM2971 and CMM3890 from watermelon were used. The determination of aggressiveness was evaluated using the six isolates inoculated in the Crimson Sweet susceptible cultivar in a completely randomized design (CRD) with five replicates, the sample unit consisting of one plant. The experiment of mycelial growth rate was installed in the factorial scheme, 6 isolates x 3 culture media, using the following culture media Nutrient Agar, PDA and PSA, and a total of 5 replicates. The color characterization and sclerotia formation was performed 15 days after the fungal inoculation in each culture medium. For the characterization of vegetative compatibility and occurrence of hyphal fusion, the experiments were performed in CDR with three and two replicates, respectively. CMM1053 and CMM1052 isolates were the most aggressive; however, they were statistically different only from CMM2967 isolate. The PSA medium was the most promising for the mycelial growth. It was possible to observe that there was variability in the colonies color, being higher in the Nutrient Agar medium. Based on evaluations of vegetative compatibility and hyphal fusion, the six isolates belong to the same anastomosis group.The objective of this study was to characterize the morphological and pathogenic variation of Rhizoctonia solani isolates as well as to determine mycelial compatibility and hyphal fusion. The R. solani isolates CMM1053, CMM2967, CMM1052, CMM2983, CMM2971 and CMM3890 from watermelon were used. The determination of aggressiveness was evaluated using the six isolates inoculated in the Crimson Sweet susceptible cultivar in a completely randomized design (CRD) with five replicates, the sample unit consisting of one plant. The experiment of mycelial growth rate was installed in the factorial scheme, 6 isolates x 3 culture media, using the following culture media Nutrient Agar, PDA and PSA, and a total of 5 replicates. The color characterization and sclerotia formation was performed 15 days after the fungal inoculation in each culture medium. For the characterization of vegetative compatibility and occurrence of hyphal fusion, the experiments were performed in CDR with three and two replicates, respectively. CMM1053 and CMM1052 isolates were the most aggressive; however, they were statistically different only from CMM2967 isolate. The PSA medium was the most promising for the mycelial growth. It was possible to observe that there was variability in the colonies color, being higher in the Nutrient Agar medium. Based on evaluations of vegetative compatibility and hyphal fusion, the six isolates belong to the same anastomosis group

Characterization, pathogenicity and anastomosis groups of Rhizoctonia solani from watermelon

The objective of this study was to characterize the morphological and pathogenic variation of Rhizoctonia solani isolates as well as to determine mycelial compatibility and hyphal fusion. The R. solani isolates CMM1053, CMM2967, CMM1052, CMM2983, CMM2971 and CMM3890 from watermelon were used. The determination of aggressiveness was evaluated using the six isolates inoculated in the Crimson Sweet susceptible cultivar in a completely randomized design (CRD) with five replicates, the sample unit consisting of one plant. The experiment of mycelial growth rate was installed in the factorial scheme, 6 isolates x 3 culture media, using the following culture media Nutrient Agar, PDA and PSA, and a total of 5 replicates. The color characterization and sclerotia formation was performed 15 days after the fungal inoculation in each culture medium. For the characterization of vegetative compatibility and occurrence of hyphal fusion, the experiments were performed in CDR with three and two replicates, respectively. CMM1053 and CMM1052 isolates were the most aggressive; however, they were statistically different only from CMM2967 isolate. The PSA medium was the most promising for the mycelial growth. It was possible to observe that there was variability in the colonies color, being higher in the Nutrient Agar medium. Based on evaluations of vegetative compatibility and hyphal fusion, the six isolates belong to the same anastomosis group

Terutroban versus aspirin in patients with cerebral ischaemic events (PERFORM): a randomised, double-blind, parallel-group trial

Background: Patients with ischaemic stroke or transient ischaemic attack (TIA) are at high risk of recurrent stroke or other cardiovascular events. We compared the selective thromboxane-prostaglandin receptor antagonist terutroban with aspirin in the prevention of cerebral and cardiovascular ischaemic events in patients with a recent non-cardioembolic cerebral ischaemic event. <p/>Methods: This randomised, double-blind, parallel-group trial was undertaken in 802 centres in 46 countries. Patients who had an ischaemic stroke in the previous 3 months or a TIA in the previous 8 days were randomly allocated with a central interactive response system to 30 mg per day terutroban or 100 mg per day aspirin. Patients and investigators were masked to treatment allocation. The primary efficacy endpoint was a composite of fatal or non-fatal ischaemic stroke, fatal or non-fatal myocardial infarction, or other vascular death (excluding haemorrhagic death). We planned a sequential statistical analysis of non-inferiority (margin 1·05) followed by analysis of superiority. Analysis was by intention to treat. The study was stopped prematurely for futility on the basis of the recommendation of the Data Monitoring Committee. This study is registered, number ISRCTN66157730. <p/>Findings: 9562 patients were assigned to terutroban (9556 analysed) and 9558 to aspirin (9544 analysed); mean follow-up was 28·3 months (SD 7·7). The primary endpoint occurred in 1091 (11%) patients receiving terutroban and 1062 (11%) receiving aspirin (hazard ratio [HR] 1·02, 95% CI 0·94–1·12). There was no evidence of a difference between terutroban and aspirin for the secondary or tertiary endpoints. We recorded some increase in minor bleedings with terutroban compared with aspirin (1147 [12%] vs 1045 [11%]; HR 1·11, 95% CI 1·02–1·21), but no significant differences in other safety endpoints. <p/>Interpretation: The trial did not meet the predefined criteria for non-inferiority, but showed similar rates of the primary endpoint with terutroban and aspirin, without safety advantages for terutroban. In a worldwide perspective, aspirin remains the gold standard antiplatelet drug for secondary stroke prevention in view of its efficacy, tolerance, and cost

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)