不同浓度壳聚糖对炭黑曲霉和硫色镰刀菌生长和发育的影响

【背景】壳聚糖是广泛存在于甲壳动物的一种多糖，具有广谱的抗真菌活性，但壳聚糖是否影响炭黑曲霉(Aspergillus carbonarius)和硫色镰刀菌(Fusarium sulphureum)生长和发育尚未见报道。【目的】明确不同浓度壳聚糖对A. carbonarius和F. sulphureum生长和发育的影响。【方法】通过在PDA培养基中添加不同浓度壳聚糖，测定两种真菌的菌落直径、生物量和菌丝干重，观察产孢量、孢子萌发和芽管长度，比较抑菌的差异。【结果】壳聚糖处理可显著改变两种真菌的菌落形态，处理浓度越高菌落皱缩和变形越明显；壳聚糖还可以有效抑制两种真菌的菌落生长、菌丝干重和菌丝生物量，抑制效果呈明显的浓度依赖，对F. sulphureum的抑制效果更好。壳聚糖可抑制两种真菌的产孢量、孢子萌发和芽管伸长，处理浓度越高抑制效果越好，对F. sulphureum的抑制效果更为明显。壳聚糖对A. carbonarius和F. sulphureum的EC₅₀值分别为0.12 mg/mL和0.075 mg/mL。【结论】壳聚糖可有效抑制A. carbonarius和F. sulphureum的生长发育，抑制效果呈浓度依赖，F. sulphureum对壳聚糖更为敏感。     

产氢菌Enterobacter sp.和Clostridium sp.的分离鉴定及产氢特性

在高温水体中分离得到2株具有较高产氢活性的微生物菌株Z-16和C-32。根据两菌株的16S rDNA序列分析,初步鉴定菌株Z-16为Enterobacter sp.,菌株C-32为Clostridium sp.。研究了起始pH值、反应温度、碳源等对菌株放氢活性的影响。菌株Z-16的最适产氢条件为：反应系统起始pH7.0,反应温度35℃,以蔗糖为产氢底物。在最适条件下,菌株Z-16的氢转化率为2.68mol H₂/mol蔗糖。菌株C-32的最适产氢条件为：反应系统起始pH 8.0,反应温度35℃,以麦芽糖为产氢底物。在最适条件下,菌株C-32的氢转化率为2.71mol H₂/mol 麦芽糖。以葡萄糖为碳源时,菌株Z-16和菌株C-32的氢转化率分别为2.35和2.48mol H₂/mol葡萄糖。     

产氢菌Enterobacter sp.和Clostridium sp.的分离鉴定及产氢特性

在高温水体中分离得到2株具有较高产氢活性的微生物菌株Z-16和C-32。根据两菌株的16S rDNA序列分析,初步鉴定菌株Z-16为Enterobacter sp.,菌株C-32为Clostridium sp.。研究了起始pH值、反应温度、碳源等对菌株放氢活性的影响。菌株Z-16的最适产氢条件为：反应系统起始pH7.0,反应温度35℃,以蔗糖为产氢底物。在最适条件下,菌株Z-16的氢转化率为2.68mol H₂/mol蔗糖。菌株C-32的最适产氢条件为：反应系统起始pH 8.0,反应温度35℃,以麦芽糖为产氢底物。在最适条件下,菌株C-32的氢转化率为2.71mol H₂/mol 麦芽糖。以葡萄糖为碳源时,菌株Z-16和菌株C-32的氢转化率分别为2.35和2.48mol H₂/mol葡萄糖。     

基于双重芯片式数字PCR快速鉴定KPC型碳青霉烯耐药肺炎克雷伯菌的方法

【背景】由于碳青霉烯类药物的泛用和滥用,致使肺炎克雷伯菌碳青霉烯耐药株与日俱增,产碳青霉烯酶是肺炎克雷伯菌对碳青霉烯类药物耐药的主要原因。目前对肺炎克雷伯菌碳青霉烯耐药株的检测方法存在费时费力、特异性差、灵敏度低等问题。【目的】建立一种能同时检测肺炎克雷伯菌和碳青霉烯酶基因bla_KPC的双重芯片式数字PCR方法。【方法】依据肺炎克雷伯菌的特有基因yhaI和碳青霉烯耐药基因bla_KPC保守序列设计特异性引物和探针,确定双重芯片式数字PCR同时对yhaI和bla_KPC两个基因核酸浓度绝对定量的检测范围、检出限和最佳实验体系,并进行方法特异性、灵敏度、重复性分析及临床菌株的检测。【结果】双重芯片式数字PCR检测灵敏度比双重实时荧光定量PCR提高了约1.5个数量级,在两基因同时检出的情况下,最低检出限分别为3.74 copies/μL (yhaI基因)和1.93 copies/μL (bla_KPC基因);优化后的双重芯片式数字PCR对参考菌株检测特异性的结果与双重实时荧光定量PCR结果一致;利用优化后的双重芯片式数字PCR方法共检测58株临床菌株,其中肺炎克雷伯菌43株,属肺炎克雷伯菌且含有bla_KPC基因的菌株13株,这与质谱及耐药谱检测结果一致。【结论】利用双重芯片式数字PCR技术建立了产KPC型碳青霉烯酶肺炎克雷伯菌的绝对定量检测方法。该方法特异性强、灵敏度高、准确度好,可用于检测具有碳青霉烯酶基因bla_KPC的肺炎克雷伯菌的核酸检测和定量分析,也为产其他类型碳青霉烯酶的病原菌检测提供了新的技术参考。     

橡胶树暹罗炭疽菌Zn2Cys6型转录因子CsGcc1的生物学功能

【背景】暹罗炭疽菌（Colletotrichum siamense）是一种重要的病原真菌,可以引起炭疽病,给全球橡胶产业带来巨大的经济损失。Zn₂Cys₆型转录因子是真菌特有的锌指类转录因子,通常参与调控真菌的生长发育过程。【目的】在暹罗炭疽菌中鉴定了一个与稻瘟病菌Gcc1同源的Zn₂Cys₆型转录因子CsGcc1,并研究其功能。【方法】根据同源重组原理构建CsGCC1的基因敲除突变体,并通过营养生长、H₂O₂敏感性、分生孢子产生及萌发、玻璃纸试验和致病性分析,明确CsGcc1的功能。【结果】CsGcc1编码一个含有646个氨基酸的蛋白,而且含有一个GAL4结构域。CsGCC1基因在培养36 h的菌丝及分生孢子中具有较高的表达量。CsGCC1基因敲除突变株营养生长速率降低且对H₂O₂更加敏感。相较于野生型菌株,突变株的分生孢子产量、萌发率及附着胞形成率均降低。此外,CsGCC1的敲除可以明显降低分生孢子的穿透能力,突变株对橡胶叶片的致病力减弱。【结论】Zn₂Cys₆型转录因子CsGcc1参与调控暹罗炭疽菌的营养生长、氧化应激、分生孢子发育及致病性等过程。     

华丽龙胆GsF3′5′H和GsFNS基因的克隆及表达分析

该研究以华丽龙胆(Gentiana sino ornata)5个不同开放阶段(H₁~H₅)的蓝色花冠为试材,利用RT PCR技术克隆GsF3′5′H和GsFNS全长序列,并进行生物信息学分析,比较GsF3′5′H和GsFNS在不同组织和不同开放阶段的基因表达模式。结果显示：(1)所克隆的GsF3′5′H和GsFNS基因分别包含1 560 bp和1 590 bp开放阅读框(OFR),并分别编码520和529个氨基酸。(2)结构分析显示,GsF3′5′H和GsFNS均具有典型的F3′5′H和FNSⅡ蛋白保守结构域。(3)系统进化树分析表明,GsF3′5′H和GsFNS亲缘关系最近的物种是三花龙胆(Gentiana triflora)。(4)qRT PCR结果显示,GsF3′5′H和GsFNS基因在根、茎、叶和花冠中均表达,其中GsF3′5′H基因在花冠H₃阶段表达量最高。GsFNS在根中表达量最高,其次在花冠H₄阶段两基因的表达均较高。研究推测,GsF3′5′H基因表达产生的飞燕草素苷和GsFNS表达产生的黄酮共着色作用可能使华丽龙胆的花冠呈更稳定艳丽的蓝色,为蓝色花分子育种提供重要的基因资源。     

H2O2预处理胜利褐煤镜质组的生物产气研究

【目的】研究H₂O₂处理对煤中镜质组生物产气的影响。【方法】选择内蒙古胜利褐煤作为研究对象,以实验室前期富集保存的产甲烷微生物作为出发菌群,首先通过浮选对煤炭进行显微组分分离(高镜质组GJ、中镜质组ZJ和低镜质组DJ),并对煤的物化性质进行表征,然后在固液比1:15、H₂O₂浓度10%、预处理时间30 d条件下用H₂O₂处理不同镜质组含量的样品,再以处理前后的原煤及残煤进行生物产气实验。采用气相色谱、X射线衍射和傅里叶变换红外光谱等方法分析H₂O₂处理前后产气及煤的物化性质变化。【结果】经过H₂O₂预处理后,煤中镜质组的含量有所下降,挥发成分增加,固定碳减少,H₂O₂与高镜质组煤样反应更剧烈,氧含量增加,碳含量减少。未经过处理的煤在100 d时产甲烷量为GJ＞ZJ＞DJ,分别为174.24、164.31、135.52 μmol/g煤,而经过H₂O₂预处理的煤在20 d后停止产气,最终产甲烷量分别为39.63、39.61、41.55μmol/g煤,比原煤产气减少了77.26%、75.89%和69.34%。随着镜质组含量的增加,经过H₂O₂处理后的煤样芳香环层片的层间距d₀₀₂、单层层片的延展度L_a和层片的堆叠度L_c减小,而芳香层数N增加,表明晶核结构变小。经过H₂O₂处理后煤芳烃碳、芳香族、C=O基团和C=C基团所占比例增加,芳环缩合度增大,含氧官能团变多。【结论】利用H₂O₂长时间处理使煤基质中较易被微生物利用的有机质结构减少,从而降低了产气能力。     

2017–2019年中国南方五省规模化养猪场副猪格拉菌血清型、耐药性及β-内酰胺类耐药基因bla-TEM分子特征分析

【目的】旨在分析当前规模化养殖场副猪格拉菌(Glaesserella parasuis)优势血清型、耐药特性、耐药基因与分子特征。【方法】对源自规模化养猪场21株副猪格拉菌临床分离株,采用PCR鉴定血清型;利用K-B纸片扩散法鉴定其对25种抗生素的耐药表型;采用PCR检测bla-_TEM、bla-_NDM和bla-_CTX等7种耐药基因,并采用Chi-square test和Fisher exact test分析耐药表型和耐药基因型的相关性;耐药基因目的条带测序,并应用CLC Sequence Viewer软件分析β-内酰胺类耐药基因(bla-_TEM)编码蛋白氨基酸关键位点差异与耐药性的关系。【结果】21株副猪格拉菌临床分离株的优势血清型为4和12型;对β-内酰胺类药物苯唑西林的耐药性较强,耐药菌占比达61.9%(13/21);多重耐药菌株占比高达90.5%(19/21);β-内酰胺类耐药基因bla-_TEM携带率较高(52.4%,11/21),且bla-_TEM与β-内酰胺类药物青霉素G、苯唑西林和头孢拉定的耐药性显著相关,部分bla-_TEM编码氨基酸存在可能与副猪格拉菌耐药能力有关的差异位点。【结论】本研究表明,规模化养猪场的副猪格拉菌多重耐药情况仍很严重,并明确了被调查区域β-内酰胺类药物耐药率高的主要原因是携带耐药基因bla-_TEM,为加强对规模化养猪场副猪格拉菌耐药性监测提供理论依据。     

线粒体自噬基因对酿酒酵母抗氧化性能的影响

线粒体自噬是指细胞通过自噬的机制选择性地清除线粒体的过程,对维持细胞内稳态具有重要作用。为探究线粒体自噬基因对酿酒酵母(Saccharomyces cerevisiae)细胞抗氧化性能的影响,本研究分别构建了线粒体自噬相关基因ATG8、ATG11、ATG32的缺失和过表达菌株,发现在过氧化氢(H₂O₂)胁迫6 h后,过表达ATG8、ATG11基因显著降低了细胞内活性氧(reactive oxygen species,ROS)含量,分别仅为初始状态的61.23%和46.35%,并显著提高了菌株线粒体膜电位(mitochondrial membrane potential,MMP)和腺嘌呤核苷三磷酸(adenosine-triphosphate,ATP)含量,有助于提高菌株的抗氧化性能。另一方面,基因ATG8、ATG11、ATG32的缺失会导致线粒体损伤及细胞活力显著下降,同时造成胞内ROS失衡,H₂O₂胁迫6 h后,其胞内ROS含量显著升高至初始状态的174.27%、128.68%和200.92%。结果表明,ATG8、ATG11和ATG32可能是调控酵母抗氧化能力的潜在靶点。本研究为进一步研究通过调节线粒体自噬提高酵母抗氧化活性提供了新的线索。     

温度与CO2浓度升高对集胞藻PCC 6803修复UV损伤的关键基因转录量的影响

通过Taqman探针绝对定量法研究了集胞藻PCC 6803在5种不同的环境条件下:(1)25℃+400μmol/mol CO₂,(2)29℃+400μmol/mol CO₂,(3)25℃+800μmol/mol CO₂,(4)29℃+800μmol/mol CO₂,(5)25℃+1200μmol/mol CO₂,其phrA/psbA1/psbA2/psbA3等UV修复基因和16S rRNA基因的转录本拷贝数的变化情况。结果表明:温度与CO₂浓度的升高可以导致集胞藻PCC 6803的psbA2/psbA3基因和16S rRNA转录本拷贝数的大幅减少,说明温室效应将有可能导致蓝藻的UV损伤修复能力与核糖体合成能力的下降;温度升高和CO₂浓度升高对psbA2/psbA3基因和16S rRNA转录本拷贝数的联合作用表现为互相抵消,说明温度升高与CO₂浓度升高的联合作用的机制较复杂,值得深入研究。     

Foreign exploration for Scirtothrips perseae Nakahara (Thysanoptera: Thripidae) and associated natural enemies on avocado (Persea americana Miller)

Scirtothrips perseae Nakahara was discovered attacking avocados in California, USA, in 1996. Host plant surveys in California indicated that S. perseae has a highly restricted host range with larvae being found only on avocados, while adults were collected from 11 different plant species. As part of a management program for this pest, a “classical” biological control program was initiated and foreign exploration was conducted to delineate the home range of S. perseae, to survey for associated natural enemies and inventory other species of phytophagous thrips on avocados grown in Mexico, Guatemala, Costa Rica, the Dominican Republic, Trinidad, and Brazil. Foreign exploration efforts indicate that S. perseae occurs on avocados grown at high altitudes (>1500 m) from Uruapan in Mexico south to areas around Guatemala City in Guatemala. In Costa Rica, S. perseae is replaced by an undescribed congener as the dominant phytophagous thrips on avocados grown at high altitudes (>1300 m). No species of Scirtothrips were found on avocados in the Dominican Republic, Trinidad, or Brazil. In total, 2136 phytophagous thrips were collected and identified, representing over 47 identified species from at least 19 genera. The significance of these species records is discussed. Of collected material 4% were potential thrips biological control agents. Natural enemies were dominated by six genera of predatory thrips (Aeolothrips, Aleurodothrips, Franklinothrips, Leptothrips, Scolothrips, and Karnyothrips). One genus each of parasitoid (Ceranisus) and predatory mite (Balaustium) were found. Based on the results of our sampling techniques, prospects for the importation of thrips natural enemies for use in a “classical” biological control program in California against S. perseae are not promising.     

Phylogeny of cardinalfishes (Teleostei: Gobiiformes: Apogonidae) and the evolution of visceral bioluminescence

The cardinalfishes (Apogonidae) are a diverse clade of small, mostly reef-dwelling fishes, for which a variety of morphological data have not yielded a consistent phylogeny. We use DNA sequence to hypothesize phylogenetic relationships within Apogonidae and among apogonids and other acanthomorph families, to examine patterns of evolution including the distribution of a visceral bioluminescence system. In conformance with previous studies, Apogonidae is placed in a clade with Pempheridae, Kurtidae, Leiognathidae, and Gobioidei. The apogonid genus Pseudamia is recovered outside the remainder of the family, not as sister to the superficially similar genus Gymnapogon. Species sampled from the Caribbean and Western Atlantic (Phaeoptyx, Astrapogon, and some Apogon species) form a clade, as do the larger-bodied Glossamia and Cheilodipterus. Incidence of visceral bioluminescence is found scattered throughout the phylogeny, independently for each group in which it is present. Examination of the fine structure of the visceral bioluminescence system through histology shows that light organs exhibit a range of morphologies, with some composed of complex masses of tubules (Siphamia, Pempheris, Parapriacanthus) and others lacking tubules but containing chambers formed by folds of the visceral epithelium (Acropoma, Archamia, Jaydia, and Rhabdamia). Light organs in Siphamia, Acropoma, Pempheris and Parapriacanthus are distinct from but connected to the gut; those in Archamia, Jaydia, and Rhabdamia are simply portions of the intestinal tract, and are little differentiated from the surrounding tissues. The presence or absence of symbiotic luminescent bacteria does not correlate with light organ structure; the tubular light organs of Siphamia and chambered tubes of Acropoma house bacteria, those in Pempheridae and the other Apogonidae do not.     

Tracking down the "head blob": comparative analysis of wingless expression in the developing insect procephalon reveals progressive reduction of embryonic visual system patterning in higher insects

The evolution of larval head morphology in holometabolous insects is characterized by reduction of antennal appendages and the visual system components. Little insight has been gained into molecular developmental changes underlying this morphological diversification. Here we compare the expression of the segment polarity gene wingless (wg) in the pregnathal head of fruit fly, flour beetle and grasshopper embryos. We provide evidence that wg activity contributes to segment border formation, and, subsequently, the separation of the visual system and protocerebrum anlagen in the anterior procephalon. In directly developing insects like grasshopper, seven expression domains are formed during this process. The activation of four of these, which correspond to polar expression pairs in the optic lobe anlagen and the protocerebral ectoderm, has shifted to postembryonic stages in flour beetle and Drosophila. The remaining three domains map to the protocerebral neuroectoderm, and form by disintegration of a large precursor domain in flour beetle and grasshopper. In Drosophila, the precursor domain remains intact, constituting the previously described “head blob”. These data document major changes in the expression of an early patterning gene correlated with the dramatic evolution of embryonic visual system development in the Holometabola.     

Molecular phylogeny of Phebalium (Rutaceae: Boronieae) and related genera based on the nrDNA regions ITS 1+2

Parsimony analyses of the internal transcribed spacer regions of nuclear ribosomal DNA (ITS 1 & ITS 2) for 38 taxa sampled from the Phebalium group (Rutaceae: Boronieae) and two outgroups confirm that, with the exception of Phebalium sensu stricto and Rhadinothamnus, six of the currently recognised genera within the group are monophyletic. The data indicate that Phebaliums. str. is paraphyletic with respect to Microcybe, and Rhadinothamnus is paraphyletic with respect to Chorilaena. Rhadinothamnus and Chorilaena together are the sister group to Nematolepis. Drummondita, included as an outgroup taxon, clustered within the ingroup as sister to Muiriantha and related to Asterolasia.The phylogeny suggests that the evolution of major clades within a number of these genera (e.g. Phebalium) relates to vicariance events between eastern and south-western Australia. Leionema is an eastern genus, with the most basal taxon being the morphologically distinct Leionema ellipticum from northern Queensland. Leionema also includes one species from New Zealand, but this species (as with some others) proved difficult to sequence and its phylogenetic position remains unknown. Taxonomic changes at the generic level are recommended.The authors wish to thank Paul G.Wilson, PERTH, for advice and discussion, and Paul Forster, BRI, for collecting and providing material of Leionema ellipticum. The project was supported by a Melbourne University Postgraduate Award (to BM), the Australian Biological Resources Study (ABRS), Australian Systematic Botany Society and Wolf Den (Australia) Investments.     

中国石蕊科地衣研究之四石蕊属地衣新种及中国新记录

摘要:本文报道了中国横断山地区石蕊属地衣12种,其中新种1个:贡嘎石蕊(Cladonia ngganensis S.Y. Guo & Wei),中国新记录11种:类黄粉石蕊(Cl. bacilliformis),比蒙氏石(Cl. beaumontii),小棍棒石蕊(Cl. clavulifera),圆筒石蕊(Cl. cylindrica),具粉石蕊(Cl. farinacea),北海道石蕊(Cl. hokkaidensis),厚叶石蕊(Cl. incrassata),大叶石蕊(Cl. macrophylla),丛杯石蕊( Cl. mateocyatha),多孔石蕊(Cl. multiformis)和亚石蕊(Cl. subrangiformis)。对于每一种的化学成分及地理分布进行了测定和分析。     

A molecular phylogeny of Hebeloma species from Europe

In order to widen the scope of existing phylogenies of the ectomycorrhizal agaric genus Hebeloma a total of 53 new rDNA ITS sequences from that genus was generated, augmented by sequences retrieved from GenBank, and analysed using Bayesian, strict consensus and neighbour joining methods. The lignicolous Hebelomina neerlandica, Gymnopilus penetrans, and two species of Galerina served as outgroup taxa. Anamika indica, as well as representatives of the genera Hymenogaster and Naucoria, were included to test the monophyly of Hebeloma, which is confirmed by the results. Hebeloma, Naucoria, Hymenogaster and Anamika indica cluster in a strongly supported monophyletic hebelomatoid clade. All trees largely reflect the current infrageneric classification within Hebeloma, and divide the genus into mostly well-supported monophyletic groups surrounding H. crustuliniforme, H. velutipes, H. sacchariolens, H. sinapizans, and H. radicosum, with H. sarcophyllum being shown at an independent position; however this is not well supported. The section Indusiata divides with strong support into three groups, the position of the pleurocystidiate Hebeloma cistophilum suggests the possible existence of a third subsection within sect. Indusiata. Subsection Sacchariolentia is raised to the rank of section.     

Molecular identification of Taenia spp. in wolves (Canis lupus), brown bears (Ursus arctos) and cervids from North Europe and Alaska

Taenia tapeworms of Finnish and Swedish wolves (Canis lupus) and Finnish brown bears (Ursus arctos), and muscle cysticerci of Svalbard reindeer (Rangifer tarandus platyrhynchus), Alaskan Grant's caribou (Rangifer tarandus granti) and Alaskan moose (Alces americanus) were identified on the basis of the nucleotide sequence of a 396 bp region of the mitochondrial cytochrome c oxidase subunit 1 gene. Two species were found from wolves: Taenia hydatigena and Taenia krabbei. The cysticerci of reindeer, caribou and one moose also represented T. krabbei. Most of the cysticercal specimens from Alaskan moose, however, belonged to an unknown T. krabbei-like species, which had been reported previously from Eurasian elks (Alces alces) from Finland. Strobilate stages from two bears belonged to this species as well. The present results suggest that this novel Taenia sp. has a Holarctic distribution and uses Alces spp. as intermediate and ursids as final hosts.     

Removal of wastewater pathogen indicators in a constructed wetland in Leon, Spain

This paper studies the seasonal presence and removal of the pathogenous micro-organisms Escherichia coli, total coliforms (TC), Clostridium perfringens (Cp), faecal streptococci (FS), Giardia cysts, Cryptosporidium oocysts and helminth eggs, in a constructed wetland treatment system. The removal efficiency of this system with respect to the indicator micro-organisms achieved maximum values in spring and autumn at 99.9% for E. coli and TC, respectively, in winter at 97.0% for FS, in summer at 100% for Clostridium and throughout the year, also at 100%, in the case of Giardia cysts, Cryptosporidium oocysts and helminth eggs. In general, very low protozoan and helminth egg counts were found, and the system demonstrated efficient reduction of the wastewater indicator pathogens.     

Fungal Thyroiditis: An Overview

The authors review the epidemiology, clinical manifestations, diagnosis, and treatment of fungal thyroiditis cases previously reported in the medical literature. Aspergillus was by far the most common cause of fungal thyroiditis. Immunocompromised patients, such as those with leukemia, lymphoma, autoimmune diseases, and organ-transplant patients on pharmacological immunosuppression were particularly at risk. Fungal thyroiditis was diagnosed at autopsy as part of disseminated infection in a substantial number of patients without clinical manifestations and laboratory evidence of thyroid dysfunction. Local signs and symptoms of infection were indistinguishable from other infectious thyroiditis and included fever, anterior cervical pain, thyroid enlargement sometimes associated with dysphagia and dysphonia, and clinical and laboratory features of transient hyperthyroidism due to the release of thyroid hormone from follicular cell damage, followed by residual hypothyroidism. Antemortem diagnosis of fungal thyroiditis was made by direct microscopy and culture of a fine-needle aspirate, or/and biopsy in most cases. Since most patients with fungal thyroiditis had disseminated fungal infection with delay in diagnosis and treatment, the overall mortality was high.