DNA barcoding of pear psyllids (Hemiptera: Psylloidea: Psyllidae), a tale of continued misidentifications.

Pear psyllids (Hemiptera: Psylloidea: Psyllidae: Cacopsylla spp.) belong to the most serious pests of pear (Pyrus spp.). They damage pear trees by excessive removal of phloem sap, by soiling the fruits with honeydew which, in turn, provides a substrate for sooty mould, and by transmission of Candidatus Phytoplasma spp., the causal agents of the pear decline disease. The morphological similarity, the presence of seasonal dimorphism that affects adult colour, size and wing morphology and uncritical use of species names, led to much confusion in the taxonomy of pear psyllids. As a result, pear psyllids have been frequently misidentified. Many of the entries attributed to Cacopsylla pyricola and other species in the GenBank are misidentifications which led to additional, unnecessary confusion. Here we analysed DNA barcodes of 11 pear psyllid species from eastern Asia, Europe and Iran using four mitochondrial gene fragments (COI 658 bp, COI 403 bp, COI-tRNAleu-COII 580 bp and 16S rDNA 452 bp). The efficiency of identification was notably high and considerable barcoding gaps were observed in all markers. Our results confirm the synonymies of the seasonal forms of Cacopsylla jukyungi ( = C. cinereosignata, winter form) and C. maculatili ( = C. qiuzili, summer form) previously suggested based on morphology. Some previous misidentifications (C. chinensis from China, Japan and Korea = misidentification of C. jukyungi; C. pyricola and C. pyrisuga from East Asia = misidentification of C. jukyungi and C. burckhardti, respectively; C. pyricola from Iran = misidentification of C. bidens, C. pyri and Cacopsylla sp.) are also corrected. There is no evidence for the presence of European pear psyllid species in East Asia.

[Long-term outcome after endovascular treatment of high-risk patients with recurrently symptomatic intracranial stenoses of the posterior circulation]. / Langzeitergebnisse nach endovaskulärer Behandlung von Hochrisiko-Patienten mit mehrfach symptomatischen intrakraniellen Stenosen der vertebrobasilären Strombahn.

PURPOSE: We present long-term clinical and duplex data from high-risk patients with severe, recurrent symptomatic stenoses of the vertebrobasilar circulation. We hypothesized that despite the greater risk of periprocedural complications in this patient group, interventional treatment would reduce the risk of recurrent strokes relative to the expected natural risk. We also predicted that the long-term treatment outcome would be positively influenced by the use of stents and by the periprocedural technical success rate. MATERIALS AND METHODS: An analysis of our patient data base yielded 45 cases of stenosis of the vertebrobasilar circulation treated endovascularly in 42 patients between 1998 and 2006. Clinical and vascular diagnostic tests, both periinterventionally and during follow-up, were performed independently by experienced neurologists. RESULTS: The technical success rate was 93%. Stents were used in 67% of the procedures. After 30 days, 24% of the patients showed post-procedural clinical deterioration. After an average period of 26.3 months, 17.8 % of the patients had deteriorated. 11.1% of the patients suffered severe permanent damage as a result of the procedure (mRs 3 - 6). Restenosis was found in 9.5% of the cases. There were no instances of a recurrent stroke during follow-up. CONCLUSION: For this population of high-risk patients with recurrently symptomatic intracranial stenoses of the vertebrobasilar axis, endovascular treatment reduced the risk of stroke and death relative to the expected natural risk. The use of stents had no significant effect on the long-term results.

Phylogenetic analysis of vertically transmitted psyllid endosymbionts (Candidatus Carsonella ruddii) based on atpAGD and rpoC: comparisons with 16S-23S rDNA-derived phylogeny.

Psyllids are insects that harbor endosymbionts (Candidatuus Carsonella ruddii) within specialized cells found in the insect's body cavity. Previous phylogenetic analyses based on endosymbiont 16S-23S ribosomal DNA and a host gene were concordant (M.L. Thao, et al., Appl. Env. Microbiol. 66:2898, 2000). Additional analyses with atpAGD and rpoBC gave similar trees showing the agreement expected from organisms that evolve through vertical transmission with no gene exchange.

Combined corrections for attenuation, depth-dependent blur, and motion in cardiac SPECT: a multicenter trial.

BACKGROUND: The diagnostic accuracy of cardiac single photon emission computed tomography (SPECT) is limited by image-degrading factors, such as heart or subject motion, depth-dependent blurring caused by the collimator, and photon scatter and attenuation. We developed correction approaches for motion, depth-dependent blur, and attenuation and performed a multicenter validation. METHODS AND RESULTS: Motion was corrected both transversely and axially with a cross-correlation technique. Depth-dependent blurring was corrected by first back-projecting each projection and then applying a depth-dependent Wiener filter row by row. Attenuation was corrected with an iterative, nonuniform Chang algorithm, based on a transmission scan-generated attenuation map. We validated these approaches in 112 subjects, including 36 women (20 healthy volunteers, 8 angiographically normal patients, and 8 patients with coronary artery disease [CAD] found by means of angiography) and 76 men (23 healthy volunteers, 10 angiographically normal patients, and 43 patients with CAD found by means of angiography). Either technetium 99m or thallium 201 was used for emission; either gadolinium 153 or Tc-99m was used for transmission. Images were reconstructed and blindly interpreted with a 5-point scale for receiver operating characteristic analysis in 2 ways: motion correction plus a Butterworth filter, and combined motion and blur and attenuation corrections. The interpretation by means of consensus was for the overall presence of CAD and vascular territory. The receiver operating characteristic curves for overall presence and each of the 3 main coronary arteries were all shifted upward and to the left and had larger areas under the curve, for combined corrections compared with motion correction and Butterworth. Sensitivity/specificity for motion correction and Butterworth were 84/69, 64/71, 32/94, and 71/81 overall for the left anterior descending, the right coronary artery, and circumflex territories, respectively, compared with 88/92, 77/93, 50/97, and 74/95, respectively, for the combined corrections. CONCLUSIONS: The proposed combined corrections for motion, depth-dependent blur, and attenuation significantly improve diagnostic accuracy, when compared with motion correction alone.

Cospeciation of psyllids and their primary prokaryotic endosymbionts.

Psyllids are plant sap-feeding insects that harbor prokaryotic endosymbionts in specialized cells within the body cavity. Four-kilobase DNA fragments containing 16S and 23S ribosomal DNA (rDNA) were amplified from the primary (P) endosymbiont of 32 species of psyllids representing three psyllid families and eight subfamilies. In addition, 0.54-kb fragments of the psyllid nuclear gene wingless were also amplified from 26 species. Phylogenetic trees derived from 16S-23S rDNA and from the host wingless gene are very similar, and tests of compatibility of the data sets show no significant conflict between host and endosymbiont phylogenies. This result is consistent with a single infection of a shared psyllid ancestor and subsequent cospeciation of the host and the endosymbiont. In addition, the phylogenies based on DNA sequences generally agreed with psyllid taxonomy based on morphology. The 3' end of the 16S rDNA of the P endosymbionts differs from that of other members of the domain Bacteria in the lack of a sequence complementary to the mRNA ribosome binding site. The rate of sequence change in the 16S-23S rDNA of the psyllid P endosymbiont was considerably higher than that of other bacteria, including other fast-evolving insect endosymbionts. The lineage consisting of the P endosymbionts of psyllids was given the designation Candidatus Carsonella (gen. nov.) with a single species, Candidatus Carsonella ruddii (sp. nov.).

[Incidence of thromboembolism after heart valve replacement: modifying factors]. / Thromboembolie-Häufigkeit nach Klappenersatz: Beeinflussende Faktoren.

The most important factors influencing thromboembolic rates after valve replacement are: 1) Cardiogenic factors such as left ventricular function, left atrial size and atrial rhythm. 2) Prosthesis-related factors such as type of prosthesis, position of prosthesis, and time after implantation. 3) Patient-related factors such as quality of anticoagulation and gender. 4) Conditions with hypercoagulability.

[Survived sudden cardiac death in aortic stenosis and Wolff-Parkinson-White syndrome: Differential diagnosis and therapy]. / Uberlebter plötzlicher Herztod bei Aortenstenose und WPW-Syndrom: Differentialdiagnose und Therapie.

Based on a case of a 72 year old woman with hemodynamically non-significant aortic stenosis. WPW-syndrome and out-of-hospital cardiac arrest, the diagnostic assessment and differential diagnosis of potentially fatal arrhythmias are discussed. In particular, the incidence of supraventricular and ventricular arrhythmias in patients with WPW-syndrome, their prognostic impact and therapeutic options are outlined.

Benefits and limitations of rate adaptive pacing under laboratory and daily life conditions in patients with minute ventilation single chamber pacemakers.

Rate adaptive pacing has been shown to improve hemodynamic performance and exercise tolerance during acute testing. However, there remain concerns about its benefit in daily life and possible complications incurred by unnecessary pacing. This double-blind crossover study compared the benefit of rate adaptive (SSIR) versus fixed rate (SSI) pacing under laboratory and daily life conditions in 20 rate incompetent patients with minute ventilation single chamber pacemakers (META II). The heart rate (HR) response during three different exercise tests (treadmill, bicycle ergometry, walking test) was correlated with the Holter findings during daily life in either pacing mode. The maximal HR was significantly higher in the SSIR-mode compared to the SSI-mode, both during laboratory testing (treadmill: 123 +/- 15 vs 93 +/- 29 beats/min; ergometry: 118 +/- 15 vs 89 +/- 27 beats/min; walking test: 127 +/- 9 vs 95 +/- 26 beats/min, all P values < 0.01) as well as during daily life (Holter: 126 +/- 13 vs 103 +/- 24 beats/min, P < 0.01). On Holter, the average HR (71 +/- 14 vs 71 +/- 8 beats/min) and the percentage of paced rhythm (54% vs 62%, SSI- vs SSIR-mode, P = NS) were not different in either mode. However, despite a 30% rate gain in the SSIR-mode, the exercise capacity remained unchanged, and only 38% of patients preferred the SSIR-mode. Minute ventilation pacemakers provide a physiological rate response to exercise. Irrespective of the protocol used, the findings of laboratory testing are comparable to those during daily life. However, patient selection for rate adaptive single chamber pacing should be made with caution, since the objective benefit of restoring normal chronotropy may subjectively be negligible for most patients.

[Cerebral ischemic events: when and how to look for a cardiac embolism source?]. / Zerebrale ischämische Ereignisse: Wann und wie soll eine kardiale Emboliequelle gesucht werden?

In industrialized countries, cerebral ischemic events rank third among the most frequent causes of death. In survivors, long-term disability may result. The diagnosis and therapy of preventable causes is therefore a major task. Echocardiography has proven to be most helpful in the search for cardioembolic sources, and the transesophageal approach (TEE) is superior to the transthoracic (TTE) in this specific indication. In patients in whom a cardioembolic source can be identified by clinical examination, 12-lead surface ECG or chest X-ray, an additional echocardiographic examination is not necessary. Patients under 50 with cerebral ischemic events should undergo TEE. In patients over 70 with a contraindication for long-term anticoagulant therapy, TEE has no therapeutic consequences and should therefore not be performed. In patients aged between 50 and 70 the diagnostic procedure of choice must be considered in each individual patient. It should be kept in mind that a more aggressive approach using TEE, from which therapeutic conclusions are drawn, has not clearly been shown to improve the prognosis of patients with cerebral ischemic events.

[Recommendations for prevention of thromboembolism in heart valve diseases. Working Group on Valvular Heart Disease, European Society of Cardiology]. / Empfehlungen zur Thromboembolieprophylaxe bei Herzklappenerkrankungen der Working Group on Valvular Heart Disease, European Society of Cardiology.

Thromboembolic events are still a major cause of morbidity and mortality in patients with native valvular heart disease and in patients with prosthetic heart valves. Although the introduction of oral anticoagulation reduced this risk, thromboembolism and anticoagulation-related hemorrhages still represent significant problems in the management of these patients. In this article the guidelines developed by the Working Group on Valvular Heart Disease of the European Society of Cardiology for the management of antithrombotic therapy in heart valve disease are thoroughly discussed. The indication for and intensity of anticoagulation in various clinical situations, the concept of risk factor-adjusted intensity of anticoagulation, and the concept of control of oral anticoagulation with the International Normalized Ratio are presented.

Antibiotic prophylaxis for infective endocarditis from an international group of experts towards a European consensus. Group of Experts of the International Society for Chemotherapy.

Antibiotic prophylaxis for infective endocarditis is recommended for cardiac patients at risk who undergo an at-risk procedure. Efforts should focus on patients with the highest risk, i.e., those with a prosthetic valve undergoing a dental procedure. Amoxicillin is the main recommendation in patients who are not allergic to penicillin. In patients allergic to penicillin clindamycin orally or vancomycin intravenously are proposed. Aminoglycosides are added for gastrointestinal or urological procedures.

High intensity transcranial Doppler signals (hits) after prosthetic valve implantation.

High intensity transcranial Doppler signals (HITS), assumed to be caused by microemboli, have been reported to occur in many patients with mechanical heart valve prostheses. The aim of our study was to quantify these phenomena and to find possible differences. Furthermore, parameters which might influence the prevalence of HITS were investigated. Monitoring of both middle cerebral artery frequency shift spectra was carried out for 10 minutes in 100 patients having an aortic (n = 64) and (n = 5)/or (n = 31) mitral mechanical heart valve prosthesis. The spectra were off-line screened for HITS by ear. The findings were correlated with the degree of anticoagulation and with the time period since implantation. To examine if platelet aggregates would be the underlying cause, another HITS count was done for 10 minutes prior to and 40 minutes after i.v. injection of 250 mg aspirin (ASA) as well as after four days of 100 mg/day ASA orally in a group of seven patients. Prior to surgery, HITS were present in only one patient. Postoperatively, HITS were detected in 54 of 100 patients. There was no significant difference between left and right sides, no correlation with anticoagulation, and only a borderline correlation with the time interval since implantation. Sixty-six percent of the 50 patients monitored within the first three postoperative weeks had HITS as compared to only 42% in 50 subjects who were examined three months or later after surgery (p < 0.05). With regard to the number of HITS an inverse behaviour was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Transesophageal echocardiography in the diagnosis of endocarditis]. / Die transösophageale Echokardiographie in der Endokarditisdiagnostik.

Transesophageal echocardiography is a new diagnostic method for visualization of retrocardial structures and heart valves with high resolution. This retrospective analysis describes the use of and the findings by transesophageal echocardiography in patients suspected to suffer from endocarditis studied in three hospitals. 50 patients were studied; the diagnosis was confirmed in 64%, whereas 36% (controls) had other findings. The leading initial symptoms were fever and valvular incompetence. Laboratory parameters were altered in both groups with equal frequency. One or more diagnostic features were detected by transesophageal echocardiography in 88% of patients with endocarditis: vegetations (approximately with equal frequency on the mitral and the aortic, rarely on the tricuspid valve) were detected in 75% and/or abscesses in 22% of them. Only one patient in the control group with a history of endocarditis had vegetation-like structures on the aortic valve. Transesophageal echocardiography was on the average performed on the seventh day of hospitalization. With the exception of one female patient, all had been treated with antibiotics. Valve replacement was recommended in 65% of the patients with endocarditis and was in 59% also performed (single or double valve replacement), most frequently because of aortic or mitral regurgitation. The other patients were treated with antibiotics. Transesophageal echocardiography thus detects vegetations and abscesses in endocarditis frequently, findings that influence treatment in a significant manner.

[Transesophageal echocardiography: indications and findings. Experiences from 3 centers]. / Die transösophageale Echokardiographie: Indikationen und Befunde. Erfahrungen aus 3 Zentren.

The introduction of transoesophageal echocardiography has greatly enhanced the noninvasive diagnostic possibilities in cardiology. This multicentre report analyses the findings in different indications as well as the rate of complications in 335 consecutive patients on whom transoesophageal echocardiography was performed. The most frequent indication was the search for a cardiac source of embolism (36%). Compared to patients with other indications, thrombi in the left atrial appendage, atrial septal aneurysms and protruding aortic atheromas were significantly more frequent in this group. Transoesophageal echocardiography was performed in 20% for the diagnosis of suspected endocarditis and vegetations and/or paravalvular abscesses could be demonstrated in 46% of these patients. Other important indications included the assessment of mitral valve disease, congenital heart disease, valve prosthesis dysfunction and aortic dissection. Clinically relevant complications occurred in 1.8% and were spontaneously reversible in all cases. Transoesophageal echocardiography is an extremely valuable and safe diagnostic tool in cardiology.

Diminished vascular response to inhibition of endothelium-derived nitric oxide and enhanced vasoconstriction to exogenously administered endothelin-1 in clinically healthy smokers.

BACKGROUND: Smoking is a major risk factor for the development of atherosclerosis. Because endothelial dysfunction may be a marker for future atherosclerosis, we investigated the effects of smoking on endothelium-dependent control of vascular tone. METHODS AND RESULTS: The effects of brachial arterial infusions of NG-monomethyl-L-arginine (L-NMMA), a nitric oxide synthesis inhibitor; sodium nitroprusside; endothelin-1; and norepinephrine on forearm blood flow (strain-gauge plethysmography) were compared in 29 long-term smokers and 16 nonsmokers. The acute effects of smoking on systemic hemodynamics, plasma catecholamines, and forearm vascular responses to these compounds were investigated in smokers only. Smokers did not differ from nonsmokers (n = 16) regarding the vascular effects of sodium nitroprusside (n = 13) or vasoconstriction due to norepinephrine and endothelin-1 (n = 16). Low-dose endothelin-1-induced vasodilation, believed to reflect endothelial prostacyclin or nitric oxide release, was absent in smokers (n = 16), and their increase of forearm vascular resistance (FVR) after L-NMMA (n = 13) was impaired (35.6 +/- 27.9% versus 118.8 +/- 43.2%, P < .001). Short-term smoking (n = 11) increased blood pressure, heart rate, and plasma epinephrine concentrations (P < .05 or less); enhanced endothelin-1-induced vasoconstriction (delta FVR, 457 +/- 192% versus 254 +/- 143%, P < .01); and decreased norepinephrine-induced vasoconstriction (P < .05), but had no effect on the other interventions. CONCLUSIONS: Long-term smoking is associated with a diminished nitric oxide-dependent component of basal vascular tone and an impaired endothelium-dependent vasodilator response to low-dose endothelin-1 and short-term smoking enhances endothelin-1-induced vasoconstriction. Impaired endothelial control of vascular tone might reflect impairment of normal antiatherosclerotic endothelial functions in smokers, but the relevance of smoking-induced enhancement of endothelin-1 vasoconstriction remains to be determined.

Aortic valve replacement in elderly patients with aortic stenosis.

OBJECTIVE: To assess the risk of aortic valve replacement and long-term follow-up in elderly patients with dominant aortic stenosis. DESIGN: Retrospective analysis of patients who had aortic valve replacement over a 10 year period and were routinely seen in an outpatient clinic. SETTING: University hospital. PATIENTS: 93 patients aged > or = 60 and 47 patients > or = 70 years with symptomatic aortic stenosis undergoing aortic valve replacement. MAIN OUTCOME MEASURES: Early and late mortality in different age groups. Influence of preoperative signs and symptoms on overall outcome. RESULTS: The proportion of patients older than 70 years increased from 11% in 1978 to 54% in 1986. Perioperative mortality was 3.6% and mortality after 2 and 5 years was 9% and 13% respectively. Survival was similar (85% and 83%, respectively) in patients aged 60-69 years (group 1, n = 93, mean age 64.5 (2.7) and patients aged > or = 70 years (group 2, n = 47, mean age 72.6 (2.5)). Additional coronary artery disease and coronary bypass grafting did not significantly affect survival. The cardiothoracic ratio was inversely related to survival (Cox regression, p < 0.05). Preoperative symptoms (syncope, angina pectoris, and dyspnoea) were similar in both patient groups. After a mean (SD) follow up of 51 (33) months 96% of surviving patients were in NYHA functional class I or II with no difference between the two age groups. Similarly, the cardiothoracic ratio and Sokolow index decreased to near normal values in both age groups. CONCLUSION: The risk of aortic valve replacement in patients with dominant aortic stenosis is low and not significantly influenced by age. Therefore replacement may be performed without increased risk in elderly patients and with a good long-term outcome.

[Subjective tolerance to transesophageal echocardiography]. / Subjektive Toleranz der transösophagealen Echokardiographie.

Transesophageal echocardiography (TEE) is a new semi-invasive diagnostic tool in cardiology. We studied tolerance of TEE. 95 out of 121 consecutive patients were interviewed using a detailed, structured questionnaire (42 questions). Most patients (97%) received midazolam prior to TEE. TEE was tolerated well by 89% (n = 84) of the patients. Patients receiving a higher dose of midazolam (> 0.04 mg/kg bodyweight) tolerated TEE better than those in the lower-dose group (p < 0.0005), but they experienced side effects more often (p < 0.05) and did not tolerate fatigue as well (p < 0.0005). TEE was tolerated less well by younger patients (age < or = 45 years); they experienced more often local irritation than older patients due to the endoscope (52% versus 20% in older patients, p < 0.005) and complained more often about dysphagia (70% versus 24%) and sore throat (60% versus 19%) (p < 0.0005) after TEE. Patients < or = 45 years reported more side effects by midazolam than older patients, such as palpitations (30% versus 2%), hiccups (17% versus 0%), poor concentration (20% versus 3%), nausea (13% versus 2%), ataxia (17% versus 3%) or fatigue (88% versus 59%) (p < 0.05 to 0.0005). Females were more often afraid of TEE (53%) and the endoscope (56%) than males (35% and 23%, p < 0.08 and p < 0.002) and also disliked the endoscope more often (42%) than men (19%, p < 0.03). Some women complained about headaches after TEE (10%), whereas men did not (p < 0.05). Thus, TEE, after premedication with midazolam, is subjectively well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)

The Omnicarbon tilting-disc heart valve prosthesis. A clinical and Doppler echocardiographic follow-up.

From 1986 to 1990, 172 patients with a median age of 60.5 years (range 20 to 79 years) received 187 Omnicarbon valves (109 aortic valve replacements, 48 mitral valve replacements, and 15 double valve replacements). Patients were followed-up for a median observation period of 2.5 years (range 4 months to 5.2 years) by clinical and Doppler echocardiographic examination. Follow-up was complete in 98%. Operative mortality (death within 30 days) was 1.7%, and linearized late mortality was 2.6% per patient-year, corresponding to an actuarial survival rate for operative survivors of 89% after 4 years. The overall 4-year postoperative survival was 87% (93% for aortic valve replacement, 77% for mitral valve replacement). Compared with age- and sex-adjusted Swiss death rates, there was an excess mortality of 5% after 4 years. Percentages for freedom from valve-related complications at 4 years are as follows: thromboembolism, 98% (aortic valve replacement, 98%, and mitral valve replacement, 96%); anticoagulant-related hemorrhage, 95%; valve endocarditis, 96%; reoperation, 96%; and permanent valve-related impairment, 99%. The overall 4-year event-free survival was 76% (80% for aortic valve replacement and 69% for mitral valve replacement). New York Heart Association class improved in 88% of the patients by 1 to 3 grades, and only 3% remained in class III after operation. For the most commonly used aortic valve (23 mm), Doppler echocardiography revealed a peak pressure gradient of 29 +/- 10 mm Hg, a fractional shortening/peak pressure gradient ratio of 1.34 +/- 0.61, and a performance index of 0.35 +/- 0.08. In the most commonly used mitral valve (27 mm), the mean pressure gradient was 4.0 +/- 2.1 mm Hg. We conclude that excellent clinical and hemodynamic results can be obtained with the Omnicarbon prosthesis, in both the aortic and mitral positions.