Low prevalence of Babesia hongkongensis infection in community and privately-owned cats in Hong Kong.

Domestic cats are susceptible to infection with at least 11 species of Babesia. In Hong Kong, where dogs are commonly infected with B. gibsoni, a single infection in a cat by a novel species, B. hongkongensis, was reported previously. The aim of this study was to investigate the frequency of Babesia spp. detection in cats in Hong Kong. Residual blood-derived DNA from healthy free-roaming community cats (n = 239), and privately-owned cats with and without anaemia undergoing diagnostic investigations (n = 125) was tested for Babesia spp. DNA using a pan-Babesia PCR targeting mitochondrial Cytochrome B, and a B. hongkongensis specific PCR targeting 18S rRNA. Positive samples were confirmed by sequencing and comparative sequence analysis against the GenBank nucleotide database. Babesia hongkongensis was detected in 4/239 (1.7 %) community cats, and 0/125 (0.0 %) privately-owned cats. Babesia gibsoni was detected in 0/239 community cats and 1/125 (0.8 %) privately-owned cats. Cats infected with B. hongkongensis were clinically healthy at the time of sampling. The B. gibsoni-infected cat was anaemic and thrombocytopenic. Cats in Hong Kong can be infected with B. hongkongensis and B. gibsoni, albeit at low frequency. The tick vector for B. hongkongensis is yet to be identified.

A randomized controlled trial of self-regulated modified constraint-induced movement therapy in sub-acute stroke patients.

BACKGROUND AND PURPOSE: Emerging research suggests the use of self-regulation (SR) for improving functional regain in patients post stroke. SR is proposed to produce an added effect to effective modified constraint-induced movement therapy (mCIMT). This study aimed to examine the effect of a self-regulated mCIMT programme (SR-mCIMT) for functional regain in patients with sub-acute stroke. METHODS: Eighty-six patients completed the trial: SR-mCIMT, n = 29; mCIMT, n = 31; or conventional functional rehabilitation, n = 26. All interventions were 2-week therapist-guided training. Outcome measurements, taken by a blinded assessor, examined arm function [Action Research Arm Test (ARAT), Fugl-Meyer Assessment (FMA)], daily task performance [Lawton Instrumental Activities of Daily Living Scale (Lawton IADL)] and self-perceived arm use in functional tasks [Motor Activity Log (MAL)]. RESULTS: Significant differences were found with the SR-mCIMT outperforming the other groups after the intervention (ARAT, P = 0.006; FMA, Lawton IADL and MAL, all Ps < 0.001). In terms of the carry-over effect, the SR-mCIMT group outperformed in the hand and coordination subscales of ARAT and FMA (P = 0.012-0.013) and the self-perceived quality of arm use (P = 0.002). CONCLUSION: A combination of SR and mCIMT could produce an added effect in functional regain in patients post stroke.

Genetic and phenotypic influences on clone-level success and host specialization in a generalist parasite.

Studying resource specialization at the individual level can identify factors constraining the evolution of generalism. We quantified genotypic and phenotypic variability among infective stages of 20 clones of the parasitic trematode Maritrema novaezealandensis and measured their infection success and post-infection fitness (growth, egg output) in several crabs and amphipods. First, different clones varied in their infection success of different crustaceans. Second, neither genetic nor phenotypic traits had consistent effects on infection success across all host species. Although the results suggest a relationship between infection success and phenotypic variability, phenotypically variable clones were not better at infecting more host species than less variable ones. Third, genetic and phenotypic traits also showed no consistent correlations with post-infection fitness measures. Overall, we found no consistent clone-level specialization, with some clones acting as specialists and others, generalists. The trematode population therefore maintains an overall generalist strategy by comprising a mixture of clone-level specialists and generalists.

Body size, trophic level, and the use of fish as transmission routes by parasites.

Within food webs, trophically transmitted helminth parasites use predator-prey links for their own transfer from intermediate prey hosts, in which they occur as larval or juvenile stages, to predatory definitive hosts, in which they reach maturity. In large taxa that can be used as intermediate and/or definitive hosts, such as fish, a host species' position within a trophic network should determine whether its parasite fauna consists mostly of adult or larval helminths, since vulnerability to predation determines an animal's role in predator-prey links. Using a large database on the helminth parasites of 303 fish species, we tested whether the proportion of parasite species in a host that occur as larval or juvenile stages is best explained by their trophic level or by their body size. Independent of fish phylogeny or habitat, only fish body length emerged as a significant predictor of the proportion of parasites in a host that occur as larval stages from our multivariate analyses. On average, the proportion of larval helminth taxa in fish shorter than 20 cm was twice as high as that for fish over 100 cm in length. This is consistent with the prediction that small fishes, being more vulnerable to predation, make better hosts for larval parasites. However, trophic level and body length are strongly correlated among fish species, and they may have separate though confounded effects on the parasite fauna exploiting a given species. Helminths show varying levels of host specificity toward their intermediate host when the latter is the downstream host involved in trophic transmission toward an upstream definitive host. Given this broad physiological compatibility of many helminths with fish hosts, our results indicate that fish body length, as a proxy for vulnerability to predators, is a better predictor of their use by helminth larvae than their trophic level based on diet content.

The marine limpet Notoacmea scapha acts as a transmission sink for intertidal cercariae in Otago Harbour, New Zealand.

Marine limpets, Notoacmea scapha, were collected from an intertidal mud flat in Otago Harbour, New Zealand, and examined for infection with larval trematodes. Three separate species of trematode (opecoelid sp. A, Acanthoparyphium sp. A and Curtuteria australis) were identified from the limpets, based on molecular evidence. This is the first report of these three trematodes in limpets, indicating that the latter are physiologically suitable second-intermediate hosts. However, based on ecological information on the diet of the parasites' definitive hosts, we conclude that the limpet N. scapha does not contribute to the transmission of any of the trematodes. Instead, it acts as a sink for cercariae that fail to locate appropriate second-intermediate hosts.

Latitudinal gradient in the taxonomic composition of parasite communities.

Although latitudinal gradients in diversity have been well studied, latitudinal variation in the taxonomic composition of communities has received less attention. Here, we use a large dataset including 950 surveys of helminth endoparasite communities in 650 species of vertebrate hosts to test for latitudinal changes in the relative contributions of trematodes, cestodes, nematodes and acanthocephalans to parasite assemblages. Although the species richness of helminth communities showed no consistent latitudinal variation, their taxonomic composition varied as a function of both host type and latitude. First, trematodes and acanthocephalans accounted for a higher proportion of species in helminth communities of fish, whereas nematodes achieved a higher proportion of the species in communities of bird and especially mammal hosts. Second, the proportion of trematodes in helminth communities of birds and mammals increased toward higher latitudes. Finally, the proportion of nematodes per community increased toward lower latitudes regardless of the type of host. We present tentative explanations for these patterns, and argue that new insights in parasite community ecology can be gained by searching for latitudinal gradients not only in parasite species richness, but also in the taxonomic composition of parasite assemblages.

Taxonomic resolution in parasite community studies: are things getting worse?

Species identification is crucial for studies of parasite diversity, yet most surveys include taxa identified only to genus or family level. Using a large dataset comprising 950 surveys of helminth communities from 650 different species of fish, bird and mammal hosts, we investigated what determines the level of taxonomic resolution achieved. Identification of all helminths down to species level was achieved in only one-third of surveys, whereas all taxa were identified at least to genus level in two-thirds of surveys. The species richness of a parasite community and past study effort on the host species did not correlate with taxonomic resolution. However, the higher the proportion of parasite taxa occurring as larvae in a community, the lower the resolution achieved. Also, taxonomic resolution was better overall for communities in birds or mammals than for those in fish, and better for trematodes and acanthocephalans than for cestodes and nematodes. Perhaps the most intriguing result was a clear significant effect of year of publication on the taxonomic resolution achieved in parasite surveys: the proportion of helminth taxa identified at least to genus level has remained high until the year 2000, but has dropped in studies published since then. The loss of expertize in parasite taxonomy happening worldwide is one possible explanation. This downward trend needs to be reversed if we are to monitor new parasite occurrences in the face of environmental changes.

Infection success of different trematode genotypes in two alternative intermediate hosts: evidence for intraspecific specialization?

The evolution of host specificity and the potential trade-off between being a generalist and a specialist are central issues in the evolutionary ecology of parasites. Different species of parasites or even different populations of the same species often show different degrees of host specificity. However, less is known about intraspecific variation in host specificity within a population. We investigated intraspecific variation by experimentally exposing cercariae from different clones of the trematode Curtuteria australis to two species of second intermediate hosts, the New Zealand cockle Austrovenus stutchburyi and the wedge shell Macomona liliana. We found an overall difference in infection success between the two bivalve species, with A. stutchburyi being the more heavily infected host. However, the cercariae showed a consistent preference for encysting at the tip of the bivalve's foot, regardless of host species. Importantly, there were no significant differences among parasite clones in either relative infection success in the two hosts or preference for the host foot tip. This lack of intraspecific variation may be due to the life-history traits of both parasite and hosts in our system, which may limit opportunities for variation in performance and exploitation strategies in different hosts to evolve within the population.

Role of genetic testing in arrhythmogenic right ventricular cardiomyopathy/dysplasia.

In a cohort of patients with confirmed or suspected arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D), genetic testing is useful in confirming the diagnosis, particularly in individuals who do not completely fulfil Task Force criteria for the disease, thereby also enabling the adoption of preventive measures in family members. Due to the high percentage of novel mutations that are expected to be identified in ARVC/D, the use of genetic screening technology based on the identification of known mutations seems to have very restricted value. Our results support that the presence of certain genetic variations could play a role in the final phenotype of patients with ARVC/D, where single and compound mutation carriers would have more symptomatic forms of the disease and the polymorphism P366L could be associated to a more benign phenotype.

Nurse-administered propofol-alfentanil sedation using a patient-controlled analgesia pump compared with opioid-benzodiazepine sedation for outpatient colonoscopy.

BACKGROUND AND STUDY AIM: Nurse-administered propofol sedation (NAPS) and patient-controlled sedation using patient-controlled analgesia (PCA) pumps are gaining increasing popularity for gastrointestinal endoscopy. We compared the safety and efficacy of NAPS using PCA pumps with diazemuls-pethidine sedation (DPS) for outpatient colonoscopy. PATIENTS AND METHODS: In a prospective randomized controlled trial patients underwent outpatient colonoscopy with sedation by either NAPS or DPS. For NAPS, following intravenous loading of 0.8 mg/kg propofol, mixtures of 14.3 mg propofol and 35 microgram alfentanil were titrated by nurses using a PCA pump. For DPS, 0.1 mg/kg diazemuls and 0.5 mg/kg pethidine were given as intravenous bolus; further titration was administered as half doses at the endoscopist's discretion. Adequacy of sedation was measured by the Observer's Scale for Sedation and Alertness (OSSA) score (range 1-5). RESULTS: Between July 2005 and June 2006, 88 patients were randomly allocated to NAPS and 90 to DPS. The groups were comparable for baseline characteristics and procedure time. With NAPS, levels of sedation both during colonoscopic intubation and at reaching the cecum were significantly deeper than with DPS (OSSA 3 vs. 5, P < 0.0001). There were no significant differences in cardiopulmonary complication rates, pain scores, satisfaction scores, and patients' willingness to repeat colonoscopy with the same sedation. Drugs cost for NAPS was higher than for DPS (Hong Kong dollars [HKD] 98.34 vs. 5.01). CONCLUSION: Despite higher costs, nurse-administered propofol-alfentanil sedation using a PCA pump can provide deeper conscious sedation, comparable satisfaction, and similar complication risks compared with conventional opioid-benzodiazepine sedation.

Causes of intraspecific variation in body size among trematode metacercariae.

Inequalities in body size among adult helminths can result in inequalities in reproductive output, with consequences for population dynamics and genetics. These inequalities can result from growth differences among larval worms inside intermediate hosts that persist into the adult stage. Here, we investigate the effects of both host body size and intensity of infection on the sizes of metacercariae of the trematode Maritrema novaezealandensis (Microphallidae) inside their second intermediate host, the isopod Paridotea ungulata (Idoteidae). Among the more than 1500 metacercariae recovered and individually measured, there was no relationship between the mean diameter of metacercarial cysts per isopod and isopod body length. However, intensity of infection correlated negatively with the mean diameter of cysts within an isopod, i.e. metacercariae in crowded infections attained smaller sizes on average. In contrast, the variability in cyst sizes per isopod, measured as the coefficient of variation, was independent of both isopod body length and infection intensity. Our results show that a disproportionate number of relatively small metacercariae come from the relatively few hosts in which a large fraction of all metacercariae are aggregated. The combination of aggregation and intensity-dependent growth generates inequalities in sizes among metacercariae that will be passed on to adult worm populations in definitive hosts.

Cryptic species complexes in manipulative echinostomatid trematodes: when two become six.

SUMMARY: Recent studies have shown that some digenean trematodes previously identified as single species due to the lack of distinguishing morphological characteristics actually consist of a number of genetically distinct cryptic species. We obtained mitochondrial 16S and nuclear ITS1 sequences for the redial stages of Acanthoparyphium sp. and Curtuteria australis collected from snails and whelks at various locations around Otago Peninsula, New Zealand. These two echinostomes are well-known host manipulators whose impact extends to the entire intertidal community. Using phylogenetic analyses, we found that Acanthoparyphium sp. is actually composed of at least 4 genetically distinct species, and that a cryptic species of Curtuteria occurs in addition to C. australis. Molecular data obtained for metacercariae dissected from cockle second intermediate hosts matched sequences obtained for Acanthoparyphium sp. A and C. australis rediae, respectively, but no other species. The various cryptic species of both Acanthoparyphium and Curtuteria also showed an extremely localized pattern of distribution: some species were either absent or very rare in Otago Harbour, but reached far higher prevalence in nearby sheltered inlets. This small-scale spatial segregation is unexpected as shorebird definitive hosts can disperse trematode eggs across wide geographical areas, which should result in a homogeneous mixing of the species on small geographical scales. Possible explanations for this spatial segregation of the species include sampling artefacts, local adaptation by first intermediate hosts, environmental conditions, and site fidelity of the definitive hosts.

Effects of interspecific competition on asexual proliferation and clonal genetic diversity in larval trematode infections of snails.

Interactions among different parasite species within hosts can be important factors shaping the evolution of parasite and host populations. Within snail hosts, antagonistic interactions among trematode species, such as competition and predation, can influence parasite abundance and diversity. In the present study we examined the strength of antagonistic interactions between 2 marine trematodes (Maritrema novaezealandensis and Philophthalmus sp.) in naturally infected Zeacumantus subcarinatus snails. We found approximately the same number of snails harbouring both species as would be expected by chance given the prevalence of each. However, snails infected with only M. novaezealandensis and snails with M. novaezealandensis and Philophthalmus sp. co-occurring were smaller than snails harbouring only Philophthalmus sp. In addition, the number of Philophthalmus sp. rediae was not affected by the presence of M. novaezealandensis sporocysts and the within-host clonal diversity of M. novaezealandensis was not influenced by the presence of Philophthalmus sp. Our results suggest that antagonistic interactions may not be a major force influencing the evolution of these trematodes and that characteristics such as host size and parasite infection longevity are shaping their abundance and population dynamics.

Interactions between parasites of the cockle Austrovenus stutchburyi: hitch-hikers, resident-cleaners, and habitat-facilitators.

The patterns of association between parasites within a particular host are determined by a number of factors. One of these factors is whether or not infection by one parasite influences the probability of acquiring other parasite species. This study investigates the pattern of association between various parasites of the New Zealand cockle Austrovenus stutchburyi. Hundreds of cockles were collected from one locality within Otago Harbour, New Zealand and examined for trematode metacercariae and other symbionts. Two interspecific associations emerged from the study. First, the presence of the myicolid copepod Pseudomyicola spinosus was positively associated with higher infection intensity by echinostomes. The side-effect of the copepod's activities within the cockle is suggested as the proximate mechanism that facilitates infection by echinostome cercariae, leading to a greater rate of accumulation of metacercariae in cockles harbouring the copepod. Second, a positive association was also found between infection intensity of the metacercariae of foot-encysting echinostomes and that of gymnophallid metacercariae. This supports earlier findings and suggests that the gymnophallid is a hitch-hiker parasite because, in addition to the pattern of positive association, it (a) shares the same transmission route as the echinostomes, and (b) unlike the echinostomes, it is not capable of increasing the host's susceptibility to avian predation. Thus, both active hitch-hiking and incidental facilitation lead to non-random infection patterns in this parasite community.

Effects of the trematode Maritrema novaezealandensis on the behaviour of its amphipod host: adaptive or not?

There are many recorded cases of parasites that are capable of altering the behaviour of their host to enhance their transmission efficiency. However, not all of these cases are necessarily the results of the parasites actively manipulating host behaviour; they may rather be the 'by-products' of pathology caused by the parasite's presence. This study investigates the effect of the microphallid trematode Maritrema novaezealandensis on the behaviour of one of its crustacean intermediate hosts, the amphipod Paracalliope novizealandiae. Uninfected amphipods were experimentally infected by exposure to M. novaezealandensis cercariae. The activity level and vertical position of experimentally infected amphipods were compared with uninfected amphipods at 2 weeks and 6 weeks post-infection, i.e. both before and after the parasite achieved infectivity to its definitive host. Infected amphipods were found to exhibit significantly lower levels of activity and to occur significantly lower in the water column than uninfected controls during both periods. Based on the timing of the change in behaviour exhibited by infected amphipods, the results suggest that the altered behaviour exhibited by P. novizealandiae infected with M. novaezealandensis is most likely due to pathology caused by the parasite rather than a case of active, and adaptive, behavioural manipulation.

Modeling multivariate survival data by a semiparametric random effects proportional odds model.

In this article, the focus is on the analysis of multivariate survival time data with various types of dependence structures. Examples of multivariate survival data include clustered data and repeated measurements from the same subject, such as the interrecurrence times of cancer tumors. A random effect semiparametric proportional odds model is proposed as an alternative to the proportional hazards model. The distribution of the random effects is assumed to be multivariate normal and the random effect is assumed to act additively to the baseline log-odds function. This class of models, which includes the usual shared random effects model, the additive variance components model, and the dynamic random effects model as special cases, is highly flexible and is capable of modeling a wide range of multivariate survival data. A unified estimation procedure is proposed to estimate the regression and dependence parameters simultaneously by means of a marginal-likelihood approach. Unlike the fully parametric case, the regression parameter estimate is not sensitive to the choice of correlation structure of the random effects. The marginal likelihood is approximated by the Monte Carlo method. Simulation studies are carried out to investigate the performance of the proposed method. The proposed method is applied to two well-known data sets, including clustered data and recurrent event times data.

Marginal likelihood estimation for proportional odds models with right censored data.

One major aspect in medical research is to relate the survival times of patients with the relevant covariates or explanatory variables. The proportional hazards model has been used extensively in the past decades with the assumption that the covariate effects act multiplicatively on the hazard function, independent of time. If the patients become more homogeneous over time, say the treatment effects decrease with time or fade out eventually, then a proportional odds model may be more appropriate. In the proportional odds model, the odds ratio between patients can be expressed as a function of their corresponding covariate vectors, in which, the hazard ratio between individuals converges to unity in the long run. In this paper, we consider the estimation of the regression parameter for a semiparametric proportional odds model at which the baseline odds function is an arbitrary, non-decreasing function but is left unspecified. Instead of using the exact survival times, only the rank order information among patients is used. A Monte Carlo method is used to approximate the marginal likelihood function of the rank invariant transformation of the survival times which preserves the information about the regression parameter. The method can be applied to other transformation models with censored data such as the proportional hazards model, the generalized probit model or others. The proposed method is applied to the Veteran's Administration lung cancer trial data.