The central role of Italy in the spatial spread of USUTU virus in Europe.

USUTU virus (USUV) is an arbovirus maintained in the environment through a bird-mosquito enzootic cycle. Previous surveillance plans highlighted the endemicity of USUV in North-eastern Italy. In this work, we sequenced 138 new USUV full genomes from mosquito pools (Culex pipiens) and wild birds collected in North-eastern Italy and we investigated the evolutionary processes (phylogenetic analysis, selection pressure and evolutionary time-scale analysis) and spatial spread of USUV strains circulating in the European context and in Italy, with a particular focus on North-eastern Italy. Our results confirmed the circulation of viruses belonging to four different lineages in Italy (EU1, EU2, EU3 and EU4), with the newly sequenced viruses from the North-eastern regions, Veneto and Friuli Venezia Giulia, belonging to the EU2 lineage and clustering into two different sub-lineages, EU2-A and EU2-B. Specific mutations characterize each European lineage and geographic location seem to have shaped their phylogenetic structure. By investigating the spatial spread in Europe, we were able to show that Italy acted mainly as donor of USUV to neighbouring countries. At a national level, we identified two geographical clusters mainly circulating in Northern and North-western Italy, spreading both northward and southward. Our analyses provide important information on the spatial and evolutionary dynamics of USUTU virus that can help to improve surveillance plans and control strategies for this virus of increasing concern for human health.

Molecular Diagnosis of Emmonsia-Like Fungi Occurring in Wild Animals.

Using specific primers based on the ribosomal operon, positive DNA amplification was obtained from lungs of 11/215 tested small burrowing animals, both terrestrial and aquatic, and including frozen (n = 4) and formalin-fixed paraffin-embedded (n = 7) samples. The main species detected in Europe in mice, otters and river rats was Emmonsia crescens. Two strains from otters and weasels were Blastomyces parvus. Two Australian wombats revealed the presence of a hitherto unknown species of the geophilic genus Emmonsiellopsis.

Indoor and outdoor winter activity of Culicoides biting midges, vectors of bluetongue virus, in Italy.

Indoor and outdoor winter activity of Culicoides spp. (Diptera: Ceratopogonidae) in central Italy was investigated in order to evaluate whether indoor activity might account for the overwintering of bluetongue virus, as has been hypothesized by some authors. Weekly Culicoides collections were performed at three farms over three consecutive winter seasons. At each farm, two black-light traps were operated simultaneously, indoors and outdoors. Culicoides were identified using both morphological and molecular means. The Culicoides obsoletus group accounted for 98.2% of sampled specimens. Within this group, C. obsoletus s.s. accounted for 56.8% and Culicoides scoticus for 43.2% of samples. Nulliparous, parous and engorged females were caught throughout the entire winter, both indoors and outdoors. At times, indoor catch sizes outnumbered outdoor collections. A significant inverse correlation was found between minimum temperature and the proportion of indoor Culicoides of the total midge catch, thus indicating that lower outdoor temperatures drive Culicoides midges indoors. High rates of engorged females were recorded indoors, possibly as the result of the propensity of C. obsoletus females to feed indoors. Higher proportions of parous females were found in indoor than in outdoor catches, indicating higher survival rates indoors and, consequently, higher vectorial capacities of midges sheltering indoors compared with those remaining outdoors.

Frequency of DEA 1 antigen in 1037 mongrel and PUREBREED dogs in ITALY.

BACKGROUND: The prevalence of dog erythrocyte antigen (DEA 1) in canine population is approximately 40-60%. Often data are limited to a small number of breeds and/or dogs. The aims of this study were to evaluate frequency of DEA 1 in a large population of purebred and mongrel dogs including Italian native breeds and to recognize a possible association between DEA 1 and breed, sex, and genetic and phenotypical/functional classifications of breeds. Frequencies of DEA 1 blood group collected from screened/enrolled blood donors and from healthy and sick dogs were retrospectively evaluated. The breed and the sex were recorded when available. DEA 1 blood typing was assessed by immunocromatographic test on K3EDTA blood samples. The prevalence of DEA 1 antigen was statistically related to breed, gender, Fédération Cynologique Internationale (FCI) and genotypic grouping. RESULTS: Sixty-two per cent dogs resulted DEA 1+ and 38% DEA 1-. DEA 1- was statistically associated with Dogo Argentino, Dobermann, German Shepherd, Boxer, Corso dogs, the molossian dogs, the FCI group 1, 2 and 3 and the genetic groups "working dogs" and "mastiff". DEA 1+ was statistically associated with Rottweiler, Briquet Griffon Vendéen, Bernese mountain dog, Golden Retriever, the hunting breeds, the FCI group 4, 6, 7 and 8 and the genetic groups "scent hounds" and "retrievers". No gender association was observed. CONCLUSIONS: Data obtained by this work may be clinically useful to drive blood donor enrollment and selection among different breeds.

Concomitant Infection with Leishmania donovani and L. major in Single Ulcers of Cutaneous Leishmaniasis Patients from Sudan.

In Sudan human leishmaniasis occurs in different clinical forms, that is, visceral (VL), cutaneous (CL), mucocutaneous (ML), and post-kala-azar dermal leishmaniasis (PKDL). Clinical samples from 69 Sudanese patients with different clinical manifestations were subjected to a PCR targeting the cytochrome oxidase II (COII) gene for Leishmania species identification. Mixed infections were suspected due to multiple overlapping peaks presented in some sequences of the COII amplicons. Cloning these amplicons and alignment of sequences from randomly selected clones confirmed the presence of two different Leishmania species, L. donovani and L. major, in three out of five CL patients. Findings were further confirmed by cloning the ITS gene. Regarding other samples no significant genetic variations were found in patients with VL (62 patients), PKDL (one patient), or ML (one patient). The sequences clustered in a single homogeneous group within L. donovani genetic group, with the exception of one sequence clustering with L. infantum genetic group. Findings of this study open discussion on the synergetic/antagonistic interaction between divergent Leishmania species both in mammalian and vector hosts, their clinical implications with respect to parasite fitness and response to treatment, and the route of transmission with respect to vector distribution and or adaptation.

[The surgical treatment of chronic ischemic mitral insufficiency]. / Il trattamento chirurgico dell'insufficienza mitralica ischemica cronica.

BACKGROUND: Operative correction of chronic ischemic mitral regurgitation (CIMR) is associated with a high-risk approach. The objective of this retrospective study was to evaluate the short- and long-term results of surgical treatment of CIMR. METHODS: From 1989 to 1997, mitral valve replacement or repair was performed on 46 patients with CIMR. The average age range was 63.7 +/- 6.9; 8 patients were females; 30 patients (65.2%) were in New York Heart Association (NYHA) functional class III or IV; 4 patients (8.6%) were in chronic atrial fibrillation and preoperative myocardial infarction was lower in 23 patients (50%). Preoperative echo-Doppler analysis showed severe mitral insufficiency in 15 patients (32.6%). Preoperative mean pulmonary artery pressure (PAP) was 33.6 +/- 13.6 mmHg, mean ejection fraction (EF) 37.8 +/- 13.5%. Mitral valve replacement was performed in 12 patients (26%). Mitral valve repair was performed in 34 patients (73.9%). Myocardial revascularization was performed in 42 patients (91.3%) (mean graft/patient 2.2 +/- 0.8); aneurysmectomy was performed in 5 patients (10.8%), and in 2 patients (4.3%) tricuspid insufficiency was corrected by performing annuloplasty. RESULTS: The overall operative mortality was 8.6% (4 patients). The operative mortality for repair was 5.8% (2 patients) and for replacement was 16.6% (2 patients). One patient was reoperated three days after first operation due to annuloplasty dehiscence. Postoperative morbidity included low output syndrome in 7 patients (15.2%), bleeding in 2 patients (4.3%), and cerebral embolism in 2 patients (4.3%). The mean length of stay in intensive care was 6.5 +/- 10.5 days. Follow-up (mean 27.6 +/- 3.3 months) was 88% complete and revealed good functional and clinical results: 86.4% of the patients in I-II NYHA class. One patient was reoperated due to mitral insufficiency progression. Two late deaths occurred, one due to acute myocardial infarction and the other to lung cancer. CONCLUSION: While long-term follow-up is mandatory, our results suggest that: a) surgical treatment of CIMI is feasible with acceptable operative risks; b) mid-term functional and clinical results are favorable; c) the choice of treatment--valve replacement or repair--is still debatable.

Mitral valve repair for anterior leaflet papillary fibroelastoma: two case descriptions and a literature review.

Cardiac papillary fibroelastomas are rare cardiac tumors and have been considered a 'benign' incidental finding that may have significant clinical manifestations. In this paper we report two cases of mitral valve fibroelastoma: one was discovered by chance with transthoracic echocardiography in a young healthy man, the other was an intraoperative incidental finding in a middle aged man with a recent history of acute myocardial infarction. The mitral valve was repaired in both cases after excising the tumor. The patients did well and remain asymptomatic. A literature review was compiled which comprises previous case reports of 34 patients with mitral valve papillary fibroelastomas. Most were asymptomatic, but when symptoms occurred, they could be disabling, such as stroke, cardiac heart failure, myocardial infarction, and sudden death. Papillary fibroelastoma is amenable to simple surgical excision or in addition to mitral valve repair or replacement. Recurrence has not been reported.

[Echo-Doppler study of myxomatous mitral valve insufficiency and the results of reparative surgery]. / Studio eco-Doppler dell'insufficienza mitralica mixomatosa e dei risultati della chirugia riparativa.

The aim of conservative management of mitral regurgitation caused by floppy mitral valve is to restore a valvular function which closely resembles that of normal physiology. Fifty-eight patients affected by floppy mitral valve underwent surgical procedures for severe mitral regurgitation due to chordal elongation and/or rupture. Of these, 28 presented posterior mitral prolapse corrected by quadrangular excision of the prolapsed part and posterior anuloplasty achieved by apposition of a polytetrafluoroethylene conduit. The remaining 30 patients presented anterior or bilateral prolapse corrected by transposition of chordae from the posterior leaflet to the anterior cusp together together with anuloplasty. A complete echo-Doppler study was performed preoperatively, 10 days after the operation and every 6 months thereafter. Mean follow-up was 16.1 +/- 6.3 months. Preoperatively, 44 patients presented severe mitral regurgitation and 14 had moderate regurgitation (quantified by means of pulsed Doppler). All patients showed severe enlargement of the left cavities (LVDD 67.1 +/- 8.6 mm, left atrium 53.4 +/- 10.9 mm) with normal mitral area (6.08 +/- 2.14 sqcm, Doppler measurement). Following surgery we found a significant reduction in: 1) the degree of mitral regurgitation (29 patients had no regurgitation; 20 had mild protosystolic mitral regurgitation (29 patients had no regurgitation; 20 had mild protosystolic mitral regurgition, confirmed by color-M-mode; moderate or severe regurgitation was found in 6 cases); 2) the left ventricle and left atrium dimensions (LVDD 53.4 +/- 5.2 mm, p less than 0.01; left atrium 43.8 +/- 11.1 mm, p less than 0.01). Color flow imaging provided information about the recovery of a normal valvular function.(ABSTRACT TRUNCATED AT 250 WORDS)

[Echocardiographic study of left ventricular performance during sitting bicycle exercise (author's transl)]. / L'ecocardiografia da sforzo nello studio computerizzato della funzione ventricolare sinistra.

Twelve healthy volunteers, mean age 25.4 +/- 4.18 years, performed sitting bicycle ergometer graded exercise to exhaustion. Recordings of left ventricular echocardiographic dimension, heart rate, arterial blood pressure, were obtained at rest and at two minutes intervals during exercise and recovery. Echocardiographic tracings were digitized and the values of three complexes were combined and means determined for the overall analysis. Heart rate increased from 76.92 +/- 15.09 to 154.91 +/- 12.13 (p less than 0.001) at peak exercise and decreased to 98.50 +/- 11.60 (P less than 0.001) at six minutes recovery. Similarly behaved blood pressure. End diastolic Echo dimension varied significantly from 46.50 +/- 4.66 mm to 51.44 +/- 5.38 mm (P less than 0.005) at peak exercise and to 45.91 +/- 4.52 mm (P less than 0.005) at six minutes recovery, but resulted unchanged at lower levels of exercise. It started to return towards resting values, from two to four minutes of recovery. End systolic dimension did not change significantly at any heart rate. Shortening fraction increased progressively and significantly at every step of exercise, decreasing in the same way during recovery: rest 38.42 +/- 3.62%; peak exercise 44.28 +/- 5.32% (P less than 0.005); end recovery 39.28 +/- 5.89% (P less than 0.001). So did respectively: Stroke volume (Teichholtz) 69.50 +/- 12.16 cc; 84.92 +/- 24.14 cc (P less than 0.005); 67.64 +/- 16.48 cc (P less than 0.005). Cardiac output 5.27 +/- 1.18 lt/min; 12.46 +/- 3.83 (P less than 0.001); 6.25 +/- 1.00 (P less than 0.005). Ejection fraction 68.33 +/- 4.68%, 78.58 +/- 8.80 (P less than 0.001); 68.82 +/- 8.16 (P less than 0.005). Mean normalized velocity of circumferential fibre shortening 1.33 +/- 0.25 circ/sec; 2.37 +/- 0.33 (P less than 0.001); 1.55 +/- 0.031 (P less than 0.001). These results indicate that in untrained healthy subjects, variations of cardiac output during exercise and recovery depend mainly on heart rate and left ventricular fibre shortening rate. Severe exertion produces an increase of left ventricular dimension due to a Frank-Starling effect. Sitting bicycle exercise Echocardiography appears to be a suitable method to assess Left ventricular performance with a chest position relevant to normal human conditions.