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By: Joseph St. Geme, MD

  • Chair, Department of Pediatrics, Professor of Pediatrics and Microbiology, Perelman School of Medicine at the University of Pennsylvania
  • Physician-in-Chief, Leonard and Madlyn Abramson Endowed Chair in Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

https://www.chop.edu/doctors/st-geme-joseph-w

In addition to medicine rheumatoid arthritis order requip pills in toronto the destruction of melanocytes comprising the lentigo in treatment online safe requip 2 mg, adjacent and subadjacent melanocytes may be destroyed or injured 606 treatment syphilis cheap 1mg requip with amex, resulting in lesional and/or perilesional depigmentation medications used for depression discount requip 0.5 mg online, hypopigmentation, or hyperpigmentation. In a study using liquid nitrogen cryotherapy to lentigines on the dorsum of the hands in ten subjects, 50% of the treatment group experienced hypopigmentation at 6 months posttreatment [81]. Therefore, given the unpredictability of the response with cryotherapy, this modality is limited to the treatment of solar lentigines in lightly pigmented individuals. Laser selection and techniques and intense pulse light for treatment of photoaging is discussed extensively in Chap. Briefly, many lasers have the capability of treating pigmentation associated with photoaging but not in all skin types. Inappropriate destruction of melanocytes remains a potential problem for darker skin types. Taylor 3 ported the fading of 196 solar lentigines in eight women after treatment with the Q-switched ruby laser [82]. Rosenbach treated 21 lentigines in 11 patients with the Q-switched alexandrite laser [83]. A range of adverse events occurred with all three lasers, including hyperpigmentation, hypopigmentation, and erythema. Again, they are not appropriate for darker skin types given the risks of postinflammatory hyperpigmentation. Intense pulse light has been utilized for the treatment of lentigines and vascular lesions associated with photoaging. Ninety-seven patients received three to six treatments using 550 nm and 570 nm cutoff filters. A rating of good or excellent was given to more than 90% of patients for pigmentation. Kawada examined the efficacy of intense pulse light in the treatment of lentigines in Asian subjects [86]. Forty percent of those patients with lentigines demonstrated a 50% improvement with treatment. Superficial exfoliation of the upper layer of the skin is a strategy used to treat pigmentary disorders of photoaging. Cotellessa examined the efficacy of treatment with microdermabrasion of lenti- gines on the faces of 20 subjects [87]. Forty percent had complete remission, 50% partial remission, and 10% no response after a total of eight treatments administered every 2 weeks. The addition of trichloroacetic acid to microdermabrasion did not substantially improve the results in that study. Superficial, medium, and deep chemical peels may be employed for the treatment of pigmentary abnormalities associated with photoaging. Lugo-Janer treated lentigines on the hands of 25 subjects with 30% trichloroacetic acid [88]. An improvement of 50% or more was reported in 47% in the trichloroacetic acid treated group. Improved efficacy was noted with the addition of liquid nitrogen cryotherapy with 71% of subjects displaying 50% improvement. Similarly, a study by Li demonstrated improvement in lentigines after treatment with 35% trichloroacetic acid [89]. These changes include fine and coarse wrinkling, precancerous and cancerous growths, and pigmentary alterations, to name just a few. However, there is variability in the severity and manifestations of photoaging between Asians, African Americans, and Caucasians due to epidermal melanin content and melanosomal distribution the pigmentary alterations most commonly associated with photoaged skin are mottled, focal, and confluent hyperpigmentation; ephelides; lentigines; pigmented seborrheic keratoses; and dermatosis papulosa nigra. Advances in invasive and noninvasive ther- Photoaging and Pigmentary Changes of the Skin Chapter 3 18. Marcel Dekker, New York, pp 15­32 49 apeutic modalities for the treatment of photoaging have lead to the burgeoning field of cosmetic dermatology. Barzilai N (2001) Searching for human longevity genes: the future history of gerontology in the postgenomic era. Adhoute H, Grossman R, Cordier M, Soler B (1994) Chromametric quantification pigmentary changes in the solar lentigo after sunlight exposure. Toyoda M, Bhawan J (1995) Electron-microscopic observations of cutaneous photoaging versus intrinsic aging. Halaban R, Langdon R, Birchall N, Cuono C, Baird A, Scott G, Moellmann G, McGuire J (1988) Basic fibroblast growth factor from human keratinocytes is a natural mitogen for melanocytes. Yada Y, Higuchi K, Imokawa G (1991) Effects of endothelins on signal transduction and proliferation in human melanocytes. Imokawa G, Yada Y, Miyagishi M (1992) Endothelins secreted from human keratinocytes are intrinsic mitogens for human melanocytes J Biol Chem 267: 24675­24680 60. Darr D, Combs S, Dunston S, Manning T, Pinnell S (1992) Topical vitamin C protects porcine skin from ultraviolet radiation-induced damage. Ruiz-Maldonado R, Orozco-Covarrubias M, de la Luz (1997) Post inflammatory Hypopigmentation and hyperpigmentation. Yoshimura K, Aoyama T, Iga T (2000) Experience with a strong bleaching treatment for skin hyperpigmentation in Orientals. Dermatology 194: 338­343 Rosenbach A (2002) Treatment of medium-brown solar lentigines using an alexandrite laser designed for hair reduction. Marcel Dekker, New York, pp 343­364 Negishi K, Tezuka Y, Kushidata N, Wakamatsu S (2001) Photorejuvenation for Asian skin by intense pulsed light. Dermatol Surg 27: 627­632 Kawada A, Shiraish H, Asai M, Kameyama H, Sangen Y, Aragene Y, Tezuka T (2002) Clinical improvement of solar lentigines and ephelides with an intense pulsed light source. Downtime and complications are minimal, and it is found to be suitable for any skin type. Treatment and Clinical Management Preprocedure Rejuvenation Regimen Application of the Wounding Agent Postpeel Management. Treatment and Clinical Management Preprocedure Rejuvenation Regimen Application of the Wounding Agent Postprocedure Management. The first chemical peels date back to the Egyptians who used sour milk baths (lactic acid), various chemicals. For nearly 20 years, a newer technique for superficial skin resurfacing, microdermabrasion, has become a key player in the arena of noninvasive anti-aging medicine. To date, chemical peeling and microdermabrasion are among the most common procedures performed in dermatologic offices and are an important component of our armamentarium in the management of both cosmetic and noncosmetic skin conditions. Chemical resurfacing procedures involve the application of a caustic chemical agent to the skin, which produces a controlled, partialthickness injury, thereby promoting the growth of new skin with improved surface characteristics. Chemical peeling is intended to produce a controlled partial-thickness injury to the skin, destroying varying amounts of epidermis and upper portions of the dermis. Chemical peels are categorized into superficial, medium-depth, and deep types of wounding (Table 4. In this section, the focus will be on superficial peels with a target depth penetration from the stratum corneum through to the superficial papillary dermis (0. With very light peels, the level of injury is generally limited to the stratum corneum, which creates exfoliation without clinical vesiculation but may also penetrate into the stratum granulosum. There are several different chemical Chemexfoliation and Superficial Skin Resurfacing Table 4. Lotsikas-Baggili agents classified under superficial peels, which will be discussed individually. The preoperative consultation is important in identifying at-risk patients who are best avoided or who necessitate an extra-cautious approach, as well as selecting patients who are ideal candidates for the resurfacing procedure. The patient must fully understand the potential benefits, limitations, and risks, and an informed consent must be signed prior to performing the surgical procedure. Several different factors must be assessed to determine if the patient is an appropriate candidate for skin resurfacing. A thorough history and physical examination must be taken during the initial evaluation. Past (within the last 6 months) or present use of systemic isotretinoin must be ascertained, since retinoids are known to be associated with a greater risk of scarring after peeling [5]. Patients should be asked about prior resurfacing procedures or cosmetic procedures such as rhytidectomy, coronal brow lift, or blepharoplasty as these procedures can increase the risk of complications following medium-depth and deep resurfacing [6]. An interval of 4­12 weeks is recommended between peeling and procedures involving undermining [7]. Patients, irrespective of their history of recurrent herpes simplex, should be give prophylactic acyclovir, valacyclovir, or famciclovir beginning the day of the procedure and continuing for 3­5 days postprocedure whereas previously, treatment was continued for 10­14 days [9].

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Sour rot is caused by Geotrichum citri-aurantii symptoms checklist purchase requip 2mg free shipping, which enters lemons initially through wounds made by insects treatment 5th metatarsal fracture quality 0.25 mg requip. Then infected fruit is digested by the pathogens symptoms 5th week of pregnancy requip 1mg amex, which spread rapidly from fruit to medicines discount requip online amex fruit. Partial control can be obtained by immersing fruit in soda ash, sodium bicarbonate, or sodium ortho-phenyl phenate after harvest and using minimal storage temperatures. Other pathogens are occasionally troublesome in lemon storage, including Alternaria citri and the stem-end rot fungi Diplodia natalensis, as well as Phomopsis citri, Botrytis cinerea, Trichoderma spp. Quarantine Issues Most quarantine concerns for lemons address eliminating fruit flies, such as the Caribbean, Oriental, Mediterranean, and Mexican fruit flies. Heat, cold, and methyl bromide treatments are certified for this purpose, but they all pose risk of injury to lemons. Harvest and export of fruit from certified pest-free zones is another option to control fruit flies that eliminates risks of fruit injury, and this approach has also been employed against citrus black fly and Fuller rose beetle. Quarantine authorities are concerned that citrus black spot, an unsightly rind blemish caused by Guignardia citricarpa that occurs in South Africa and parts of Asia and South America, could potentially become established in Mediterranean countries and in North America. Suitability as Fresh-Cut Product Lemon sections, prepared by both manual and automatic processors, are distributed for use in the food service industry. We express our appreciation to Laurie Houck, University of California, Davis, as well as to Bob Elliott and Chuck Orman, Sunkist Growers Fruit Sciences Division, for their helpful review of this chapter. Effect of temperature and holding periods on physical and chemical characteristics of lemon fruit. Effect of reduced ethylene levels in storage atmospheres on lemon keeping quality. Horticultural Maturity Indices Head lettuce is harvested when the heads are well formed and solid (Ryall and Lipton 1979). Maturity is based on head compactness, and the firmness of the head is related to its susceptibility to certain postharvest disorders. Soft heads are easily damaged, while fairly firm heads have higher respiration rates. Firm heads have maximal storage life, while hard and extra-hard heads are more prone to develop russet spotting, pink rib, and other physiological disorders. Scientific Name and Introduction Four distinct types of lettuce are produced in the United States: crisphead or iceberg (Lactuca sativa L. Crisphead lettuce produces large, heavy, compact folded heads with crisp, brittle, prominently veined leaves. Cos lettuce does not form a true head, but is composed of upright, large, elongated, and often coarser leaves. Leaf lettuce also does not produce a head, and the leaves are more spreading, delicate, smaller, and less elongate than cos. Crisphead lettuce is the main type grown in the United States and is best adapted for long distance shipment. A greater percentage of all types of lettuce are being processed into fresh-cut salad mixes for commercial and home use. With proper vacuum-cooling and packaging, refrigerated transportation under controlled atmosphere can supply whole and packaged lettuce to national and international markets. Grades, Sizes, and Packaging Head lettuce is graded by size and firmness, while leafy types are graded by size (Hardenburg et al. Lettuces, as with other leafy vegetables, must be kept clean and free of soil and mud. A strong bitter taste and toughness develops if harvest is delayed or if lettuce is overmature, and then the product becomes unmarketable. Field packing and palletizing eliminate a major source of mechanical damage, but they require specialized handling equipment and vacuum-cooling facilities to be practical. Harvesting and field packing by hand is assisted by various equipment including conveyors and mobile packing stations. Wrapped or loose heads are then placed in cardboard containers that are stapled closed and palletized. Leaf, butterhead, and cos types are cut, trimmed, and tied into compact bundles before being placed in cartons. Crisphead or iceberg lettuce is usually packaged in 20- to 22-kg (43- to 48-lb), 24-count cartons. Leaf lettuce is usually packaged in 9- to 11-kg (20- to 25-lb) or 24-count cartons. Butterhead or Boston lettuce is usually packaged Quality Characteristics and Criteria Head lettuce should be solid with no seed-stem, defects, or decay. In general, high-quality lettuce should be clean, free of browning, crisp and turgid, and bright light green. Lettuce harvested for processing is placed in large bulk bins for transportation to the precooling or processing facility. At the processing facility, heads are cut, washed in cold water, and centrifuged to remove excess water. Cut lettuce is often mixed with other types of lettuce or greens, shredded carrot, and red cabbage to produce a salad bag mix. The mix may be treated with a processing aid composed of a chlorine-containing compound and/or an antioxidant or preservative during washing or before packaging. The bags are then placed in cartons for temporary cold storage or for immediate shipment to market. Since gas composition in bags results from a dynamic interplay between tissue respiration and film permeability, it is important to maintain proper temperature and to know the respiratory characteristics of the enclosed tissue. Head types are better adapted to prolong storage than are the other types, but none keep longer than 4 weeks, and about half that time at 5 °C (41 °F). Lettuce is easily damaged by freezing, so all parts of the storage room must be kept above the highest freezing point of lettuce, -0. Though most lettuce is hand-harvested, some mechanical harvesters are available for product destined for processing into bag mixes. For effective vacuumcooling, containers and film wraps are perforated or readily permeable to water vapor. If heads of lettuce are dry and warmer than 25 °C (77 °F), clean water is sprinkled on them the before closing the cartons to aid cooling. Thorough precooling is essential because mechanically refrigerated trucks do not have enough cooling capacity to cool warm lettuce during transit. Field heat retained in the densely packed cartons can be removed by forced air where vacuum-cooling facilities are not available, but it is much less effective. Hydrocooling is effective for nonheading lettuce types but should not be used with head lettuce since the water retained in the head fosters decay. Levels of 1 to 3% O2 at temperatures of 0 to 5 °C (32 to 41 °F) reduce russet spotting in susceptible lots. A 2 to 5% O2 atmosphere maintains appearance of lettuce and inhibits pink rib and butt discoloration compared to air. Brown stain is intensified when O2 is reduced to 2 to 3%, but the effect differs by cultivar. Physiological Disorders Some of the more common disorders of head lettuce include tipburn, russet spotting, brown stain, and pink rib (Ryall and Lipton 1979, Saltveit 1997b). Russet spotting, which is caused by exposure to ethylene and its induction of the synthesis, accumulation, and oxidation of phenolic compounds at temperatures around 5 °C (41 °F), occasionally causes serious losses. Russet spots appear as dark brown, oval lesions on the midribs, and on the green leaf tissue in severe cases. It is easily controlled by making sure the storage atmosphere is free of ethylene and that the temperature is below 2 °C (36 °F). Lettuce should not be stored with ethyleneproducing commodities such as apples, cantaloupes, pears, and peaches. Storage in a low-O2 atmosphere (1 to 8%) is very effective in controlling russet spotting. Pink rib occurs in overmature heads stored at elevated temperatures and appears as a diffuse pink discoloration of the midrib; the cause of this disorder is unknown. Retail Outlet Display Considerations Lettuce should be maintained under cold conditions to maximize storage and shelflife.

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Even holding chambers and spacers introduced to symptoms 9dpo bfp discount requip 2 mg visa address these issues present additional problems 4 medications at target cheapest generic requip uk. Table 20 lists the common errors and mistakes that can occur with each type of device 911 treatment cheap 0.25 mg requip mastercard. Common Patient Errors with Holding Chambers/Spacers Common errors that can occur with valved holding chambers/spacers are also listed in Table 20 treatment lyme disease order 2mg requip. Incorrect assembly of the holding chamber/spacer is a potential 56 Pulmonary Disease Aerosol Delivery Devices, 3rd Edition American Association for Respiratory Care, © 2017 problem. The available dose can also be reduced if multiple puffs are fired into a valved holding chamber/spacer followed by a single inhalation. An electrostatic charge may be present on the inside walls of new plastic valved holding chambers/spacers. Electrostatic charge can be minimized by soaking the spacer/valved holding chamber in a mixture of 3-4 drops of common liquid dish detergent in 2-3 cups of lukewarm water. After soaking for 5-10 minutes, only rinse the detergent from the mouthpiece and the outside of the spacer/valved holding chamber. Next, allow the spacer/ valved holding chamber to air dry so the dried detergent coats the inside and creates a barrier to the clinging particles. An alternate strategy is to purchase a spacer/valved holding chamber that has been specially manufactured to resist electrostatic charges. Disadvantages include bulk and size of equipment, need for external power source (compressed gas or electricity), and lengthy treatment times. Of all the inhaler devices, however, nebulizers are the simplest for patients to use. Patients use normal tidal breathing and approximately 60-90 inhalations (with most devices) to inhale the aerosol. In addition, newer nebulizer technology is directed at reducing the overall size of devices, eliminating the need for an external power source, providing shorter treatment times, and eliminating drug loss during exhalation. Instructing and Evaluating Patients in the Use of Inhaler Devices There is an increasing variety of aerosol devices and operation, even within the same category of device type. The following general steps are recommended for clinicians to ensure correct patient use: 1. Review device instructions carefully and practice with a placebo device prior to teaching others. Provide the patient with written instructions on how to use the device and include a written plan for use of the medication (frequency based on symptoms). Have the patient practice using the device while being observed by the clinician, and repeat this return demonstration at every patient visit. Review the understanding of the patient on the proper use of the devices at each return visit (when to use, purpose of drug, prescribed frequency). Newer designs are decreasing the number of steps needed to deliver the medication to the lungs and making dose indicators more visible. Combining medications into one inhaler is decreasing the number of inhalers needed. Cost and frequent formulary changes remain a problem for both patients and prescribers. Confusion with duplications of therapy is common when an insurance formulary change occurs. Effect of different modes of inhalation on drug delivery from a dry powder inhaler. Effect of InspirEase on the deposition of metered-dose aerosols in the human respiratory tract. New liquid aerosol generation devices: systems that force pressurized liquids through nozzles. The bronchodilator effects of terbutaline: route of administration and patterns of response. Fractional deposition from a jet nebulizer: how it differs from a metered-dose inhaler. Factors affecting aerosol performance during nebulization with jet and ultrasonic nebulizers. Prediction and experimental determination of solute output from a Collison nebulizer. Microbiologic contamination study of nebulizers after aerosol therapy in patients with cystic fibrosis. Low bacterial contamination of nebulizers in home treatment of cystic fibrosis patients. Performance comparison of nebulizer designs: constant-output, breath-enhanced, and dosimetric. Guidelines for aerosol devices in infants, children and adults: which to choose, why and how to achieve effective aerosol therapy. Factors affecting total and "respirable" dose delivered by a salbutamol metered dose inhaler. Variability in delivered dose from pressurized metered-dose inhaler formulations due to a delay between shake and fire. Improvement of drug delivery with a breath actuated pressurised aerosol for patients with poor inhaler technique. The importance of a pause between the inhalation of two puffs of terbutaline from a pressurized aerosol with a tube spacer. Pressurized bronchodilator aerosol technique: influence of breath-holding time and relationship of inhaler to the mouth. Fluticasone propionate/ salmeterol hydrofluoroalkane via metered-dose inhaler with integrated dose counter: Performance and patient satisfaction. Comparing clinical features of the nebulizer, metered-dose inhaler, and dry powder inhaler. Characteristics predicting incorrect metered-dose inhaler technique in older subjects. Ability to learn inhaler technique in relation to cognitive scores and tests of praxis in old age. Improper patient techniques with metered-dose inhalers: clinical consequences and solutions to misuse. Parental concern towards the use of inhaled therapy in children with chronic asthma. Promoting adherence to inhaled therapy: building partnerships through patient education. Beta-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: a systematic review with meta-analysis. Deposition pattern of radiolabeled salbutamol inhaled from a metered-dose inhaler by means of a spacer with mask in young children with airway obstruction. Jet nebulizers versus pressurized metered dose inhalers with valved holding chambers: effects of the facemask on aerosol delivery. Breath-synchronized nebulization diminishes the impact of patient-device interfaces (face mask or mouthpiece) on the inhaled mass of nebulized budesonide. Measurement of bronchial hyperreactivity in infants and preschool children using a new method. An investigation of nebulized bronchodilator delivery using a pediatric lung model of spontaneous breathing. Mouthpiece versus facemask for delivery of nebulized salbutamol in exacerbated childhood asthma. Aerosol therapy with valved holding chambers in young children: importance of the facemask seal. Facemasks and aerosol delivery by metereddose inhaler valved holding chamber in young children: a tight seal makes the difference. Home-use nebulizers: a potential primary source of Burkholderia cepacia and other colistin-resistant, gram-negative bacteria in patients with cystic fibrosis. Infection control recommendations for patients with cystic fibrosis: microbiology, important pathogens, and infection control practices to prevent patient-to-patient transmission.

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A metered flow of ethylene from either a catalytic unit or compressed cylinder is used to medicine 968 purchase genuine requip on line produce a diluted medicine 035 2 mg requip with amex, active concentration of ethylene in the ripening room treatment nausea order cheap requip. Quarantine Issues Tomato fruit are a host for fruit flies and are subject to treatment 0 rapid linear progression buy 0.5mg requip otc inspection in quarantined areas. Methyl bromide has been employed on a wide range of fruits and vegetables; however, its use is being phased out. Tomatoes have a phytotoxic response, characterized by delayed ripening and reduced sensitivity to exposure to ethylene (Brecht 1994). Bartz, Plant Pathology Department, University of Florida, Gainesville, for assistance with the Postharvest Pathology section. Tomato response to ethylene at high temperatures: are pressure ripening systems worth considering? Comparative physiology of field grown tomatoes during ripening on the plant or retard ripening in controlled atmospheres. Possible involvement of altered gibberellin metabolism in the induction of tomato irregular ripening in dwarf cherry tomato by silverleaf whitefly. Maintaining quality of fresh-cut tomato slices through modified atmosphere packaging and low temperature storage. Biochemical and physiological basis for effects of controlled and modified atmospheres on fruits and vegetables. Correlating subjective and objective measurements of maturation and ripeness of tomatoes. Aroma volatile profiles from ripe tomato fruit are influenced by physiological maturity at harvest: an application for electronic nose technology. Recommended commercial storage temperatures affect tomato flavor and aroma quality. Chemical composition and physical properties of pericarp, locule and placental tissues of tomatoes with internal bruising. Delayed ripening does not alleviate symptoms of internal bruising in tomato fruit. Storage potential of tomatoes harvested at the breaker stage using modified atmosphere storage. Sensitivity of tomatoes at mature-green and breaker ripeness stages to internal bruising. Heat-evolution rates of some [Lower Rio Grande Valley] Texas-grown fruits and vegetables. Postharvest: An Introduction to the Physiology and Handling of Fruits, Vegetables and Ornamentals. Precooling conditions Only summer truffles or truffles grown in hot areas need precooling because of their higher metabolic rates. Hydrocooling at 0 °C (32 °F) is best, and must be done by immersion, which can be part of the washing procedure. After washing, excess water should be removed in a well-ventilated room at 4 to 5 °C (39 to 41 °F). Scientific Name and Introduction "Truffle" is the common name for several hypogous fungi-the most highly prized white truffle (Tuber magnatum Pico:Fr. The market is concentrated in France, Italy, and Spain; but truffles are now being produced all over the world, with China as one of the biggest producers. Attention must be paid to fluctuation of the refrigeration temperature around 0 °C (32 °F) that could freeze truffles and completely destroy their texture. Quality Characteristics and Criteria A high-quality truffle is characterized by a strong odor. No commercial standards exist, and only the kind of truffle and its geographical origin influence market price. The size (larger is more appreciated), soundness, regular shape, and uniform distribution of color are important quality characteristics. Quality characteristics and aroma can be maintained in low permeability plastic film packages. Horticultural Maturity Indices Maturity indices do not exist for truffles, but truffles harvested for immediate sale should be collected during the normal season because they are bigger and develop stronger smell. Truffles harvested at the beginning of the season store better because they have lower water content and are less prone to superficial mold development. Grades, Sizes, and Packaging No standards exist for grading, sizing, or packaging. Only those truffles that can be sold that day should be displayed unwrapped; the others should be kept sealed in impermeable plastic trays in the cold section. Chilling Sensitivity Truffles are not chilling sensitive and should be stored as cold as possible without freezing. Suitability as Fresh-Cut Product Ethylene Production and Sensitivity Truffles produce only very low amounts of ethylene and are not sensitive to ethylene exposure (Mencarelli et al. Production of ethylene in storage can therefore be a good indicator of internal decay. Special care must used with mixed loads because truffles can significantly affect the aroma of other commodities. Internal browning of whitefleshed truffles can be caused by overmaturity, while worms and growing conditions can cause sponginess. Postharvest Pathology Bacteria are present inside and on the surface, but they usually do not cause decay. The frequent presence of worms inside truffles is often undetectable from the outside. Turnips are sold bunched with tops not less than 15 cm (6 in) long, short-trimmed roots with tops not more than 10 cm (4 in) long, and topped turnips with tops removed to not more than 2 cm (0. Some roots are waxed, but most are packaged as fresh roots and leaves or topped, and packed in vented plastic film or mesh 11. Scientific Name and Introduction Turnip (Brassica campestris, Rapaceum group) is often confused with rutabaga or swede (B. Turnips have a small, whitefleshed root, often with the surface of the top half purple. Quality Characteristics and Criteria High-quality turnips are firm and are free of growth cracks, woodiness, rot, injury, and pithiness. Horticultural Maturity Indices Root diameter and freedom from woodiness are maturity indices for turnips. Chilling Sensitivity Turnips are not sensitive to chilling and should be stored as cold as possible without freezing. Grade 1 roots are well trimmed, firm, fairly smooth and clean, and free from injury, growth cracks, woodiness, water core, dry rot, 590 Ethylene Production and Sensitivity Turnips produce no detectable ethylene and are insensitive to ethylene. Special Considerations Turnips are susceptible to freezing damage when held at 0 °C (32 °F). Storage at warmer temperatures, >5 °C (41 °F), accelerates weight loss and development of soft rot. Waxing roots with a water-miscible, carnauba-based wax slightly delays weight loss and intensifies the purple color of the roots (Perkins-Veazie and Collins 1991). Physiological Disorders Turnips can develop growth cracks from overmaturity or boron deficiency, brown heart from boron deficiency, and pithiness from water stress (Snowdon 1992). Postharvest Pathology Dry rot or phoma rot (Leptospharia maculans), watery soft rot (Sclerotina minor or S. Suitability as Fresh-Cut Product Turnips may be peeled and diced as a fresh market pre-cut product (Snowdon 1992). The plant is a hydrophyte (water-loving) and is grown under flooded conditions similar to paddy rice. There are two types: the sweet hon matai and the starchy sui matai, with the former more popular in the United States. Precooling Conditions Though amenable to faster cooling methods such as hydrocooling and forced-air cooling, waterchestnuts are usually room-cooled for storage and prior to shipping. Immersion in cold, chlorinated water (see "Special Considerations" section) may be an effective precooling treatment. An initial concentration of about 1,000 µL L-1 falls to essentially zero within 3 to 5 days. Anaerobiosis was not a problem when 23 kg (50 lb) lots were stored in open containers with the solution 60 cm (24 in) deep (Kanes and Vines 1977). Quality Characteristics and Criteria High-quality hon matai waterchestnuts are tender, crisp, and somewhat sweet with a white interior tissue.

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