Systematics and phytogeography of selected Eocene Okanagan Highlands plants

The diverse Early to Middle Eocene Okanagan Highlands floras of south central British Columbia and northeastern Washington reflect a time of rapid evolution and the early radiation of many dicot families that are currently significant elements of temperate floras. Recent studies of the Republic, Washington flora (Klondike Mountain Formation) and related Okanagan floras in British Columbia have documented both the earliest, and sometimes the only, known fossil occurrences of genera. Today many once more widespread taxa are restricted, particularly to Asian and (or) eastern North American refugia. Examples include members of the families Betulaceae (birch, hazelnut), Rosaceae (rose), Hamamelidaceae (witch hazel), and the endemic Asian family Trochodendraceae. Earliest occurrences are noted for Neviusia (Rosaceae), Trochodendron (Trochodendraceae), Corylus and Carpinus (both Betulaceae). The first unequivocal leaf records of Corylopsis and Fothergilla (both Hamamelidaceae), and two new Eocene species of the extinct fruit Palaeocarpinus (Betulaceae) are also recognized. Today, Trochodendron and Corylopsis are restricted to Asia, whereas Neviusia and Fothergilla, genera with close Asian relatives, occur only in North America. Corylus johnsonii from Republic is most similar to the extant Asian species C. heterophylla, C. wangii, and C. ferox. Neviusia leaves from One Mile Creek near Princeton, British Columbia are more similar to N. cliftonii, an endemic from Mount Shasta, California, than to N. alabamensis of southeastern North America. A better documentation of the Okanagan Highlands floras is essential to our understanding of the evolution of North American temperate floras and the nature of Asian - North American disjunct taxa

New diversity among the Trochodendraceae from the Early/Middle Eocene Okanogan Highlands of British Columbia, Canada, and northeastern Washington State, United States

Newly recognized fossil infructescences and leaves of the Trochodendraceae are described from the Early/ Middle Eocene McAbee and One Mile Creek sites of British Columbia, Canada, and Republic, eastern Washington State, United States. Trochodendron drachukii Pigg, Dillhoff, DeVore, & Wehr sp. nov., from McAbee, is an infructescence similar to that of extant Trochodendron aralioides Sieb. & Zucc. but strongly paniculate rather than racemose. This new species is larger and more robust than those of the Eocene flora of Republic, Washington, and has attached fruits quite similar to both extant Trochodendron Sieb. & Zucc. and Miocene fossils from Asia and western North America. Associated leaves are similar to those of extant Trochodendron except for sometimes bearing short basal auriculate extensions of the lamina. They differ from Trochodendron nastae Pigg, Wehr, & Ickert-Bond leaves from Republic that have palmate rather than pinnate venation. Tetracentron hopkinsii Pigg, Dillhoff, DeVore, & Wehr sp. nov. from One Mile Creek and Tetracentron sp. from Republic have leaves remarkably like those of extant Tetracentron Oliver, firmly establishing the presence of this genus in the Eocene. This study demonstrates that within the Trochodendraceae, a poorly understood group within the eudicot grade, both extinct forms as well as plants with quite modern-appearing fruits and leaves were present by the Eocene in northwestern North America

Reduced Time for Urinary Alkalinization Before High-Dose Methotrexate with Preadmission Oral Bicarbonate

Purpose: Hydration and urinary alkalinization are essential for reducing renal dysfunction with high dose methotrexate (HDMTX). This report presents an analysis of institutional methods used to achieve adequate urinary alkalinization and output for patients receiving single agent HDMTX. Renal and metabolic parameters of tolerance were examined. Methods: Medical records of adult patients receiving HDMTX during the calendar years of 2008–2009 were retrospectively reviewed to determine the time to achieve urine pH\u3e7. Number of hospital days, bicarbonate dose, ordered hydration rate, urine output, and urine pH were assessed. A survival analysis model was run for time to urine pH\u3e7 using preadmission oral bicarbonate as a predictor variable and including a frailty term. Observational statistics were performed for other parameters. Results: The analysis included 79 encounters for ten patients. Urine pH\u3e7 was achieved more rapidly in patients receiving preadmission oral bicarbonate (P¼0.012). The number of patients receiving HDMTX on the same day as admission was greater for those receiving preadmission oral bicarbonate (47%) in comparison to those who did not (2%), and they spent less time in the hospital. A standard regimen for hydration and urinary alkalinization based on this project is reported. The nature and frequency of adverse events were as expected for this treatment. Conclusion: At our institution, the time to achieve urinary alkalinization was reduced for patients receiving preadmission oral bicarbonate which facilitated chemotherapy infusion on the same day as admission and decreased the number of calendar days that patients stayed in the hospital

Autoimmunity and Inflammation in X-linked Agammaglobulinemia

PURPOSE: In the past, XLA was described as associated with several inflammatory conditions, but with adequate immune globulin treatment, these are presumed to have diminished. The actual prevalence is not known. METHODS: A web-based patient survey was conducted December 2011- February 2012. Respondents were recruited from the Immune Deficiency Foundation (IDF) patient database, online patient discussion forums and physician recruitment of patients. The questionnaire was developed jointly by IDF and by members of the USIDNET-XLA Disease Specific Working Group. Information regarding inflammatory conditions in patients with XLA was also obtained from the United States Immune Deficiency Network (USIDNET) Registry. RESULTS: Based on 128 unique patient survey responses, the majority of respondents (69 %) reported having at least one inflammatory symptom, with 53 % reporting multiple symptoms. However, only 28 % had actually been formally diagnosed with an inflammatory condition. Although 20 % reported painful joints and 11 % reported swelling of the joints, only 7 % were given a diagnosis of arthritis. Similarly, 21 % reported symptoms of chronic diarrhea and 17 % reported abdominal pain, however only 4 % had been diagnosed with Crohn’s disease. Data from the USIDNET Registry on 149 patients with XLA, revealed that 12 % had pain, swelling or arthralgias, while 18 % had been diagnosed with arthritis. Similarly, 7 % of these patients had abdominal pain and 9 % chronic diarrhea. CONCLUSIONS: Although patients with XLA are generally considered to have a low risk of autoimmune or inflammatory disease compared to other PIDD cohorts, data from this patient survey and a national registry indicate that a significant proportion of patients with XLA have symptoms that are consistent with a diagnosis of arthritis, inflammatory bowel disease or other inflammatory condition. Documented diagnoses of inflammatory diseases were less common but still increased over the general population. Additional data is required to begin implementation of careful monitoring of patients with XLA for these conditions. Early diagnosis and proper treatment may optimize clinical outcomes for these patients