Multi-centre, prospective randomized comparison of three different substrate ablation strategies for persistent atrial fibrillation.

AIMS: The optimal strategy for persistent atrial fibrillation (PerAF) is poorly defined. We conducted a multicentre, randomized, prospective trial to compare the outcomes of different ablation strategies for PerAF. METHODS AND RESULTS: We enrolled 450 patients and randomly assigned them in a 1:1:1 ratio to undergo pulmonary vein isolation and subsequently undergo the following three different ablation strategies: anatomical guided ablation (ANAT group, n = 150), electrogram guided ablation (EGM group, n = 150), and extensive electro-anatomical guided ablation (EXT group, n = 150). The primary endpoint was freedom from atrial fibrillation (AF) lasting longer than 30 s at 12 months after a single ablation procedure. After 12 months of follow-up, 72% (108) of patients in the EXT group were free from AF recurrence, as compared with the 64% (96) in the EGM group (P = 0.116), and 54% (81) in the ANAT group (P = 0.002). The EXT group showed less AF/atrial tachycardia recurrence than the EGM group (60% vs. 50%, P = 0.064) and the ANAT group (60% vs. 37.3%, P < 0.001). The EXT group showed the highest rate of AF termination (66.7%), followed by 56.7% in the EGM group, and 20.7% in the ANAT group. The AF termination signified less AF recurrence at 12 months compared to patients without AF termination (30.1% vs. 42.7%, P = 0.008). Safety endpoints did not differ significantly between the three groups (P = 0.924). CONCLUSIONS: Electro-anatomical guided ablation achieved the most favourable outcomes among the three ablation strategies. The AF termination is a reliable ablation endpoint.

Tolerance of Steinernema carpocapsae infective juveniles in novel nanoparticle formulations to ultraviolet radiation.

Entomopathogenic nematodes (EPNs) are susceptible to abiotic environmental factors including ultraviolet (UV) radiation, which affects the survival and efficacy. This study evaluated nanoparticle (NP) formulations for protecting Steinernema carpocapsae infective juveniles (IJs) from UV radiation. First, silica-NH2 NPs at oil-to-water ratios of 2:8, 3:7 and 4:6 were compared with Barricade Fire Gel (1 % and 2 %) and a water control (aqueous IJs) by exposing IJs to UV light (254 nm) for 0, 10 and 20 min. Barricade gel (especially 2 % Barricade) significantly improved IJs viability after UV treatment, while all three NPs had adverse effects on IJ viability after UV radiation. Subsequently, two silica (SiO2 basic and advanced) and one titania (TiO2) based formulations were tested with Barricade (1 % and 2 %) and a water control. The titania-NH2 NPs provided the highest UV protection, and IJ viability and virulence were not reduced even after 20-min UV. Except TiO2, only 2 % Barricade at 10-min UV and SiO2 basic at 20-min UV had lower IJ mortality than the water control. Only TiO2 formulated IJs caused higher insect mortality and infection levels than aqueous IJs after UV treatment. The UV tolerance of TiO2 was further examined by assessing the number of nematodes invading the hosts. Consistent with virulence tests, the number of invading nematodes in titania-NH2 NPs did not decrease after UV radiation for 10 or 20 min compared with the no-UV control. The anti-UV capability of titania-NH2 NPs has promise as a tool to enhance biocontrol efficacy of EPNs under field conditions.

Value of estimated pulse wave velocity to identify left ventricular hypertrophy prevalence: insights from a general population.

BACKGROUND: Aortic stiffness shares a similar profile of risk factors with left ventricular hypertrophy (LVH) and can also lead to LVH by itself. Published data have demonstrated the correlation between aortic stiffness and LVH. Recent data have revealed estimated pulse wave velocity (ePWV) to be a simple and cost-effective marker of the severity of aortic stiffness. Our analysis aimed to explore the association between ePWV and LVH prevalence, and to investigate the incremental value of ePWV for the identification of LVH prevalence. METHODS: The present analysis based on a cross-sectional survey which included 11,597 participants from rural areas of southeastern China between Sep 2020 and Feb 2021. ePWV was formulated based on mean blood pressure and age according to a published algorithm. RESULTS: The prevalence of LVH was 14.56%. With the adjustment of age, sex, education, income and physical activity level, current drinking and smoking status, BMI, waist circumference, serum creatinine, total cholesterol, high density cholesterol, mean blood pressure, fasting plasma glucose, anti-hypertensive therapy, anti-diabetic therapy, lipid-lowering therapy, and cardiovascular disease history, every standard deviation increment of ePWV associated with a 2.993 times risk of LVH prevalence. When dividing ePWV into quartiles, the top quartile had a 4.520 times risk of LVH prevalence when compared with the bottom quartile. Furthermore, smooth spline analysis displayed that the association was linear in the whole range of ePWV (p for non-linearity = 0.073). Additionally, subgroup analysis revealed the association was robust to sex, obesity and diabetes, and younger people and hypertensive population were more vulnerable to the increase of ePWV than their corresponding counterparts. Finally, ROC analysis showed a significant advancement when introducing ePWV into established risk factors (0.787 vs. 0.810, p for comparison < 0.001), and reclassification analysis also confirmed significant improvement from ePWV to identify LVH prevalence (category-free net reclassification analysis = 0.421, p < 0.001; integrated discrimination index = 0.023, p < 0.001). CONCLUSION: Our analysis demonstrated a linear association between ePWV and LVH prevalence. Furthermore, our results suggest younger people and hypertensive population are more likely to have LVH prevalence with the increase of ePWV. More importantly, our findings implicate the incremental value of ePWV to optimize the identification of LVH prevalence in a general Chinese population.

Usefulness of estimated pulse wave velocity for identifying prevalent coronary heart disease: findings from a general Chinese population.

BACKGROUND: Aortic stiffness and coronary heart disease (CHD) share a similar spectrum of risk factors; previous studies have identified the association between aortic stiffness and CHD. Recent studies have demonstrated estimated pulse wave velocity (ePWV) as a simple and easy-acquired indicator of aortic stiffness. Our work aims to evaluate the association between ePWV and the prevalence of CHD and assess the value of ePWV for the identification of prevalent CHD. METHODS: The current cross-sectional work included 7012 subjects from rural areas of southeastern China between September 2020 and February 2021. ePWV was calculated from age and mean blood pressure by specific algorithm. RESULTS: The prevalence of CHD in our population was 3.58% (251 patients among 7012 subjects). After adjusting for age, sex, education, income and exercise level, current smoking and drinking status, body mass index, waist circumference, fasting plasma glucose, total cholesterol, high density lipoprotein, estimated glomerular filtration rate and cerebrovascular diseases, each standard deviation increment of ePWV would produce an additional 37.8% risk of prevalent CHD. Moreover, after dividing ePWV into quartiles, the 4th quartile of ePWV showed a significant risk of prevalent CHD (OR (95% CI): 3.567 (1.963-6.479)) when compared with the 1st quartile. Additionally, the subgroup analysis showed the association between ePWV and prevalent CHD was robust to several common risk factors of CHD, including age, sex, body mass index, hypertension, diabetes and reduced estimated glomerular filtration rate. Finally, the area under curve (AUC) displayed an improvement when adding ePWV into common CHD risk factors (0.705 vs. 0.718. P = 0.044). Consistently, net reclassification index (0.436, 95% CI: 0.301-0.571, P < 0.001) and integrated discrimination index (0.004, 95% CI: 0.001-0.006, P = 0.002) demonstrated the value of ePWV to optimize the identification of prevalent CHD in the general population. CONCLUSION: The present analysis implicates the robust association between ePWV, a simple, rapid, and practical marker of aortic stiffness, and prevalent CHD in the general Chinese population. More importantly, the results suggest the value of ePWV as a potential marker to improve the identification of prevalent CHD.

Toxicity of Photorhabdus luminescens and Xenorhabdus bovienii bacterial metabolites to pecan aphids (Hemiptera: Aphididae) and the lady beetle Harmonia axyridis (Coleoptera: Coccinellidae).

Toxicity of the metabolites of two bacteria, Photorhabdus luminescens and Xenorhabdus bovienii, symbionts of entomopathogenic nematodes, were tested in the laboratory against the multicolored Asian lady beetle, Harmonia axyridis, the black pecan aphid, Melanocallis caryaefoliae, and the blackmargined aphid, Monellia caryella. Bacterial broth prepared from both P. luminescens and X. bovienii demonstrated high levels of toxicity equivalent to the pyrethroid insecticide bifenthrin and caused higher insect mortality than tryptic soy broth plus yeast extract (TSY) (blank control) against M. caryella; broth culture of P. luminescens was more effective than TSY against M. caryaefoliae. At the levels tested, the metabolites were not toxic to H. axyridis.

Extra-pulmonary vein driver mapping and ablation for persistent atrial fibrillation in obese patients.

AIMS: The aim of this study was to determine whether driver ablation effectively treats persistent atrial fibrillation (AF) in obese patients. METHODS AND RESULTS: We randomly assigned 124 persistent AF obese patients to two groups, one undergoing conventional ablation (n = 62) and the other undergoing driver ablation (n = 62). Sixty-two non-obese patients with persistent AF undergoing driver ablation served as matched controls. Bipolar electrogram dispersion was analysed for driver mapping. Epicardial adipose tissue (EAT) volume was measured using cardiac computed tomography. Obese patients had a higher proportion of driver regions in the posterior wall (56.5% vs. 32.3%, P = 0.007). Driver complexity, measured as the average number and area of driver regions, was higher in the obese group than in the non-obese group (3.5 ± 1.0 vs. 2.9 ± 0.9, P < 0.001; 15.5% ± 4.2% vs. 9.8 ± 2.6%, P < 0.001, respectively). Left atrial EAT volume correlated better with the proportion of area of driver regions than did body mass index (BMI) and total EAT (BMI: r2 = 0.250, P < 0.001; total EAT: r2 = 0.379, P < 0.001; and left atrial EAT: r2 = 0.439, P < 0.001). The rate of AF termination was significantly higher in the driver ablation group than in the conventional ablation group (82.9% vs. 22.8%, P < 0.001). During the follow-up period of 16.9 ± 6.5 months, patients in the driver ablation group had significantly better AF-free survival (91.91% vs. 79.0%, log rank test, P = 0.026) and AF/atrial tachycardia-free survival (83.9% vs. 64.5%, log rank test, P = 0.011) than did patients in the conventional ablation group. CONCLUSION: Obesity is associated with increased driver complexity. Driver ablation improves long-term outcomes in obese patients with persistent AF.

Novel associations in antibiosis stemming from an insect pupal cell.

The pupal soil cell of the pecan weevil, Curculio caryae (Coleoptera: Curculionidae), was reported previously to exhibit antibiosis to an entomopathogenic fungus, Beauveria bassiana. The objectives of this study were to examine 1) if the antimicrobial effect occurs in other insects that form pupal cells, 2) whether the effect extends to plant pathogenic fungi, and 3) identify the source of antibiosis in pupal soil cells of C. caryae. Antibiosis of pupal cells against B. bassiana was confirmed in-vitro in three additional curculionids, Diaprepes abbreviatus, Conotrachelus nenuphar, and Pissodes nemorensis, all of which had fewer fungal colonies relative to controls. Pupal soil cells were found to suppress phytopathogenic fungi in-vitro, including suppression of Alternaria solani by D. abbreviatus pupal cell, and that of Monilinia fructicola by C. caryae. The detection of antibiosis of soil cells formed by surface-sterilized insects using sterile soil implies the antimicrobial effect stemmed from inside the insect. Further, a novel biotic mechanism was identified: a bacterium related to Serratia nematodiphila was isolated from C. caryae pupal soil cells and was found to be associated with antibiosis. The bacterial cultures with or without autoclave had similar effects but were not as potent as pupal soil cells for suppressing B. bassiana. Also, autoclaved soil cells and autoclaved bacterial culture suppressed M. fructicola but were not as inhibitory as non-autoclaved soil cells. This indicates that antibiosis may be due to bacterial metabolites, although other factors may also be involved. Our findings suggest potential to develop the antibiotic compounds as novel bio-fungicides to control plant diseases.

Inheritance of key life-history traits in crosses between northern and southern populations of the cabbage beetle Colaphellus bowringi (Coleoptera: Chrysomelidae).

A southern population (S) from Xiushui County (29°1'N, 114°4'E) and a northern population (N) from Shenyang city (41°48'N, 123°23'E) of the cabbage beetle, Colaphellus bowringi vary greatly in their life-history traits, and may serve as an excellent model with which to study the inheritance of life-history traits. In the present study, we performed intraspecific hybridization using the two populations, comparing the key life-history traits (fecundity, development time, body weight, growth rate, and sexual size dimorphism (SDD)) between the two populations (S♀ × S♂ and N♀ × N♂) and their two hybrid populations (S♀ × N♂ and N♀ × S♂ populations) at 19, 22, 25, and 28°C. Our results showed that there were significant differences in life-history traits between the two parental populations, with the S population having a significantly higher fecundity, shorter larval development time, larger body weight, higher growth rate, and greater weight loss during metamorphosis than the N population at almost all temperatures. However, these life-history traits in the two hybrid populations were intermediate between those of their parents. The life-history traits in the S × N and N × S populations more closely resembled those of the maternal S population and N population, respectively, showing maternal effects. Weight loss for both sexes was highest in the S population, followed by the S × N, N × S, and N populations at all temperatures, suggesting that larger pupae lost more weight during metamorphosis. The changes in SSD with temperature were similar between the S and the S × N populations and between the N and the N × S populations, also suggesting a maternal effect. Overall, our results showed no drastic effect of hybridization on C. bowringi, being neither negative (hybrid inferiority) nor positive (heterosis). Rather, the phenotypes of hybrids were intermediate between the phenotypes of their parents.

Electrogram dispersion-guided driver ablation adjunctive to high-quality pulmonary vein isolation in atrial fibrillation of varying durations.

OBJECTIVE: To investigate the role of driver mechanism and the effect of electrogram dispersion-guided driver mapping and ablation in atrial fibrillation (AF) at different stages of progression. METHODS: A total of 256 consecutive patients with AF who had undergone pulmonary vein isolation (PVI) plus driver ablation or conventional ablation were divided into three groups: paroxysmal atrial fibrillation (PAF; group A, n = 51); persistent atrial fibrillation (PsAF; group B, n = 38); and long standing-persistent atrial fibrillation (LS-PsAF; group C, n = 39). PVI was performed with the guidance of the ablation index. The electrogram dispersion was analyzed for driver mapping. RESULTS: The most prominent driver regions were at roof (28.0%), posterior wall (17.6%), and bottom (21.3%). From patients with PAF to those with PsAF and LS-PsAF: the complexity of extra-pulmonary vein (PV) drivers including distribution, mean number, and area of dispersion region increased (P < .001). Patients who underwent driver ablation vs conventional ablation had higher procedural AF termination rate (76.6% vs 28.1%; P < .001). With AF progression, the termination rate gradually decreased from group A to group C, and the role of PVI in AF termination was also gradually weakened from group A to group C (39.6%, 7.4%, and 4.3%; P < .001) in patients with driver ablation. At the end of the follow-up, the rate of sinus rhythm maintenance was higher in patients with driver ablation than those with conventional ablation (89.1% vs 70.3%; P < .001). CONCLUSION: The formation of extra-PV drivers provides an important mechanism for AF maintenance with their complexity increasing with AF progression. Electrogram dispersion-guided driver ablation appears to be an efficient adjunctive approach to PVI for AF treatment.

A novel TBX5 mutation predisposes to familial cardiac septal defects and atrial fibrillation as well as bicuspid aortic valve.

TBX5 has been linked to Holt-Oram syndrome, with congenital heart defect (CHD) and atrial fibrillation (AF) being two major cardiac phenotypes. However, the prevalence of a TBX5 variation in patients with CHD and AF remains obscure. In this research, by sequencing analysis of TBX5 in 178 index patients with both CHD and AF, a novel heterozygous variation, NM_000192.3: c.577G>T; p.(Gly193*), was identified in one index patient with CHD and AF as well as bicuspid aortic valve (BAV), with an allele frequency of approximately 0.28%. Genetic analysis of the proband's pedigree showed that the variation co-segregated with the diseases. The pathogenic variation was not detected in 292 unrelated healthy subjects. Functional analysis by using a dual-luciferase reporter assay system showed that the Gly193*-mutant TBX5 protein failed to transcriptionally activate its target genes MYH6 and NPPA. Moreover, the mutation nullified the synergistic transactivation between TBX5 and GATA4 as well as NKX2-5. Additionally, whole-exome sequencing analysis showed no other genes contributing to the diseases. This investigation firstly links a pathogenic variant in the TBX5 gene to familial CHD and AF as well as BAV, suggesting that CHD and AF as well as BAV share a common developmental basis in a subset of patients.

Potential of entomopathogenic nematodes against the pupal stage of the apple maggot Rhagoletis pomonella (Walsh) (Diptera: Tephritidae).

The apple maggot, Rhagoletis pomonella (Walsh) (Diptera: Tephritidae), is considered a key pest of apples and is native to the eastern United States. The virulence of seven different species of entomopathogenic nematodes (EPN) was assessed against pupae of R. pomonella under laboratory conditions. Nematode species and strains included Steinernema carpocapsae (ALL strain), Steinernema feltiae (SN strain), Steinernema riobrave (355 strain), Steinernema glaseri (VS strain), Heterorhabditis bacteriophora (VS strain), Heterorhabditis indica (HOM1 strain), and Heterorhabditis megidis (UK211 strain). We conducted three bioassays: (i) short-term exposure cup bioassay (7 d), (ii) long-term cup bioassay (30 d), and (iii) pot bioassay (30 d). In the short-term exposure bioassay, all nematode strains (applied at 54 infective juvenile nematodes (IJs) cm-2) significantly reduced (range: 42.9-73.8%) insect survival relative to the control, but no differences were observed among the treatments. For the long-term exposure bioassay, using the same EPN application rate as the short exposure assay, all treatments reduced adult R. pomonella emergence compared with the control. Steinernema riobrave was the most virulent (28.3% survival), and S. glaseri and H. megidis were the least virulent (53.3% survival). In the pot experiment, S. riobrave and S. carpocapsae (applied at 27 IJs cm-2) had the highest virulence (23.3 and 31.7% survival of R. pomonella, respectively), while H. bacteriophora was the least effective (68.33% survival). Our results indicate that S. riobrave, S. carpocapsae, and S. feltiae have substantial potential to attack R. pomonella pupae, and their field application under the tree canopy (prior to adult emergence) in the spring when temperatures are conducive might be a good option for successful IPM of apple maggot fly.The apple maggot, Rhagoletis pomonella (Walsh) (Diptera: Tephritidae), is considered a key pest of apples and is native to the eastern United States. The virulence of seven different species of entomopathogenic nematodes (EPN) was assessed against pupae of R. pomonella under laboratory conditions. Nematode species and strains included Steinernema carpocapsae (ALL strain), Steinernema feltiae (SN strain), Steinernema riobrave (355 strain), Steinernema glaseri (VS strain), Heterorhabditis bacteriophora (VS strain), Heterorhabditis indica (HOM1 strain), and Heterorhabditis megidis (UK211 strain). We conducted three bioassays: (i) short-term exposure cup bioassay (7 d), (ii) long-term cup bioassay (30 d), and (iii) pot bioassay (30 d). In the short-term exposure bioassay, all nematode strains (applied at 54 infective juvenile nematodes (IJs) cm−2) significantly reduced (range: 42.9-73.8%) insect survival relative to the control, but no differences were observed among the treatments. For the long-term exposure bioassay, using the same EPN application rate as the short exposure assay, all treatments reduced adult R. pomonella emergence compared with the control. Steinernema riobrave was the most virulent (28.3% survival), and S. glaseri and H. megidis were the least virulent (53.3% survival). In the pot experiment, S. riobrave and S. carpocapsae (applied at 27 IJs cm−2) had the highest virulence (23.3 and 31.7% survival of R. pomonella, respectively), while H. bacteriophora was the least effective (68.33% survival). Our results indicate that S. riobrave, S. carpocapsae, and S. feltiae have substantial potential to attack R. pomonella pupae, and their field application under the tree canopy (prior to adult emergence) in the spring when temperatures are conducive might be a good option for successful IPM of apple maggot fly.

Extra pulmonary vein driver mapping and ablation in paroxysmal atrial fibrillation by electrogram dispersion analysis.

BACKGROUND: The adjunctive approach is still unknown for atrial fibrillation (AF), which cannot be terminated after pulmonary vein isolation (PVI). We hypothesized that the driver ablation plus PVI was superior to PVI alone. METHODS AND RESULTS: A total of 98 patients with paroxysmal AF were enrolled in this study and were divided into two groups, with one group undergoing PVI (n = 49) and the other group undergoing PVI + driver ablation (n = 49). The driver regions were defined as clusters of bipolar electrograms that displayed spatial dispersion spread over mean AF cycle length at a minimum of three adjacent bipolars of a PentaRay catheter. During the procedure, the most prominent driver regions before PVI were the roof (n = 27; 55.1%), PV antrum (n = 23; 46.9%), and the inferoposterior wall (n = 11; 22.4%). PVI can eliminate all drivers at PV antrum, but only terminate 30.4% of AF in the driver group. The AF termination rate in the driver ablation group was significantly higher than that in conventional ablation (93.9% vs 40.6%; P < 0.001). The rate of freedom from atrial tachyarrhythmia episodes by a single procedure at 6 months was significantly higher in the driver group than in the conventional group (91.6% vs 72.4%; P = 0.02). CONCLUSION: The present method is effective for AF driver identification. It guided ablation adjunctive to PVI increasing the rate of AF termination and improving the outcomes in patients with paroxysmal AF.

Pheromone extracts act as boosters for entomopathogenic nematodes efficacy.

Inconsistency in entomopathogenic nematode (EPN) efficacy is still one of the biggest challenges for the wider adoption of EPNs as biocontrol agents. Previous studies demonstrated that extracts from EPN-infected hosts enhance dispersal and efficacy, two key factors in success of EPNs. Some active components in the insect host cadavers responsible for dispersal, ascarosides, have been identified as nematode pheromones. We hypothesized that pheromone extracts increase dispersal of EPN infective juveniles (IJs) leading to increased efficacy. First, we determined whether pheromone extracts improved IJ movement/dispersal in soil columns baited with Tenebrio molitor larvae. We found that pheromone extracts induced higher numbers of Steinernema carpocapsae and Steinernema feltiae IJs to move towards T. molitor larvae in the bottom of the column compared to IJs treated with infected cadaver macerate and water, positive and negative controls, respectively. Furthermore, the number of S. carpocapsae IJs that invaded T. molitor larvae was higher for the pheromone extract treatment than the controls. S. feltiae IJs that were pretreated with pheromone extracts and macerate (positive control) infected T. molitor at the same rate but invasion was superior to IJs that were treated with water. Consistent with the soil column tests, both S. carpocapsae and S. feltiae IJs treated with pheromone extracts performed better in killing larvae of two economically important insect larvae, pecan weevil, Curculio caryae, and black soldier fly, Hermetia illucens, in greenhouse tests compared to IJs treated with water. We demonstrated pheromone-mediated behavioral manipulation of a biological control agent to enhance pest control potential. Conceivably, nematodes can be exposed to efficacy-enhancing pheromones prior to field application.

Optimal endpoint for catheter ablation of longstanding persistent atrial fibrillation: A randomized clinical trial.

BACKGROUND: In longstanding persistent atrial fibrillation (LPeAF), the ideal endpoint of ablation remains to be determined. This study was to explore the value of pursuing AF termination or no with the same strategy during ablation on the long-term outcomes in patients with LPeAF. METHODS: Utilized "CCL" strategy is a fixed ablation approach consisting of circumferential pulmonary vein antrum isolation, ablation of complex fractionated atrial electrogram, and linear ablation between two anatomical structures (the mitral isthmus, left atrial roof). Note that 400 patients were randomized to group A (technical endpoint) and group B (pursuing AF termination). RESULTS: A group with technical endpoint had lower rate of acute AF termination (AF→sinus rhythm, 3.5% vs 18.1%; AF→atrial tachycardia, 23.7% vs 44.7%; P < 0.01) and shorter duration of ablation (164.9 ± 20.8 vs 223.4 ± 24.9, P < 0.01), radiofrequency delivery time (69.8 ± 18.1 vs 102.2 ± 26.3, P < 0.01), and x-ray exposure time (18.2 ± 8.8 vs 27.9 ± 12.4, P < 0.01) than those in B group (pursuing AF termination). During follow-up, freedom from atrial arrhythmias did not differ between the two groups after a single ablation procedure (46.5% vs 54.3%, P=0.12) and the final ablation procedure (60.1% vs 65.8%, P  =  0.24). CONCLUSION: In patients of LPeAF, pursuing AF termination during ablation was associated with similar long-term clinical outcome compared to that with technical endpoint. Ablation to termination is not the best strategy during ablation.

Infected host macerate enhances entomopathogenic nematode movement towards hosts and infectivity in a soil profile.

Vertical dispersal and infectivity of the infective juveniles (IJs) of three entomopathogenic nematodes (EPNs), Steinernema carpocapsae, S. feltiae, and Heterorhabditis bacteriophora, were tested in the presence or absence of cadaver macerate of nematode-infected Galleria mellonella. Infected host macerate applied on the top of column surface induced higher numbers of IJs to move to the bottom of the column for all three species, indicating a dispersal-enhancing effect of host cadaver on IJs. Among the three EPNs, H. bacteriophora was the most responsive to host macerate, followed by S. feltiae, and S. carpocapsae was the least. Also, more IJs of H. bacteriophora invaded Tenebrio molitor hosts at the bottom of soil columns in the presence of host macerate compared with the treatment without cadaver macerate. These findings suggest enhanced dispersal and/or infectivity of all three EPNs may be leveraged toward superior biocontrol efficacy.

The role of superior vena cava in catheter ablation of long-standing persistent atrial fibrillation.

AIMS: The superior vena cava (SVC) has been established as an important source of atrial fibrillation (AF). The role of SVC in long-standing persistent AF and the efficacy of empiric electrical isolation of the SVC are still unclear. The purpose of this study was to judge the role of SVC in catheter ablation of long-standing persistent AF. METHODS AND RESULTS: A total of 102 consecutive patients with long-standing persistent AF were enrolled. All patients underwent circumferential pulmonary vein isolation, complex fractionated atrial electrograms ablation, and linear ablation during the index procedure. Superior vena cava-triggered AF and an SVC associated with the maintenance of AF were evaluated by mapping catheters during the procedure. The arrhythmogenicity of the SVC was confirmed in only 1 of the patients (0.98%). At the end of 12 months follow-up, the arrhythmia-free survival rate after a single procedure was 43.1%. After the last procedure (mean 1.47 ± 0.58 procedures), sinus rhythm was maintained in 71 (69.6%) patients, 63 of whom without antiarrhythmic drugs. The patients in AF recurrence group had higher rates of right atrium enlargement (71 vs. 34%, P = 0.03), ≥2 procedures (65 vs. 34%, P < 0.05), longer AF duration (84 ± 46 vs. 45 ± 34 months, P < 0.05), and larger left atrium diameter (50 ± 5 vs. 45 ± 6 mm, P < 0.05). In the multivariate analysis, left atrium diameter and AF duration were independent predictors of AF recurrence. CONCLUSION: The arrhythmogenic SVC is rarely detected in patients with long-standing persistent AF. Empiric SVC electrical isolation in the stepwise approach of long-standing persistent AF seems unnecessary.

Simplified HIV Testing and Treatment in China: Analysis of Mortality Rates Before and After a Structural Intervention.

BACKGROUND: Multistage stepwise HIV testing and treatment initiation procedures can result in lost opportunities to provide timely antiretroviral therapy (ART). Incomplete patient engagement along the continuum of HIV care translates into high levels of preventable mortality. We aimed to evaluate the ability of a simplified test and treat structural intervention to reduce mortality. METHODS AND FINDINGS: In the "pre-intervention 2010" (from January 2010 to December 2010) and "pre-intervention 2011" (from January 2011 to December 2011) phases, patients who screened HIV-positive at health care facilities in Zhongshan and Pubei counties in Guangxi, China, followed the standard-of-care process. In the "post-intervention 2012" (from July 2012 to June 2013) and "post-intervention 2013" (from July 2013 to June 2014) phases, patients who screened HIV-positive at the same facilities were offered a simplified test and treat intervention, i.e., concurrent HIV confirmatory and CD4 testing and immediate initiation of ART, irrespective of CD4 count. Participants were followed for 6-18 mo until the end of their study phase period. Mortality rates in the pre-intervention and post-intervention phases were compared for all HIV cases and for treatment-eligible HIV cases. A total of 1,034 HIV-positive participants (281 and 339 in the two pre-intervention phases respectively, and 215 and 199 in the two post-intervention phases respectively) were enrolled. Following the structural intervention, receipt of baseline CD4 testing within 30 d of HIV confirmation increased from 67%/61% (pre-intervention 2010/pre-intervention 2011) to 98%/97% (post-intervention 2012/post-intervention 2013) (all p < 0.001 [i.e., for all comparisons between a pre- and post-intervention phase]), and the time from HIV confirmation to ART initiation decreased from 53 d (interquartile range [IQR] 27-141)/43 d (IQR 15-113) to 5 d (IQR 2-12)/5 d (IQR 2-13) (all p < 0.001). Initiation of ART increased from 27%/49% to 91%/89% among all cases (all p < 0.001) and from 39%/62% to 94%/90% among individuals with CD4 count ≤ 350 cells/mm3 or AIDS (all p < 0.001). Mortality decreased from 27%/27% to 10%/10% for all cases (all p < 0.001) and from 40%/35% to 13%/13% for cases with CD4 count ≤ 350 cells/mm3 or AIDS (all p < 0.001). The simplified test and treat intervention was significantly associated with decreased mortality rates compared to pre-intervention 2011 (adjusted hazard ratio [aHR] 0.385 [95% CI 0.239-0.620] and 0.380 [95% CI 0.233-0.618] for the two post-intervention phases, respectively, for all newly diagnosed HIV cases [both p < 0.001], and aHR 0.369 [95% CI 0.226-0.603] and 0.361 [95% CI 0.221-0.590] for newly diagnosed treatment-eligible HIV cases [both p < 0.001]). The unit cost of an additional patient receiving ART attributable to the intervention was US$83.80. The unit cost of a death prevented because of the intervention was US$234.52. CONCLUSIONS: Our results demonstrate that the simplified HIV test and treat intervention promoted successful engagement in care and was associated with a 62% reduction in mortality. Our findings support the implementation of integrated HIV testing and immediate access to ART irrespective of CD4 count, in order to optimize the impact of ART.

Simultaneous enantioselective determination of isocarbophos and its main metabolite isocarbophos oxon in rice, soil, and water by chiral liquid chromatography and tandem mass spectrometry.

An efficient enantioselective method for the simultaneous determination of isocarbophos and its main metabolite isocarbophos oxon in rice, soil, and water was developed using liquid chromatography with tandem mass spectrometry. The enantioseparation was performed on a Chiralpak AD-3R column at 30°C using gradient elution. Target compounds were extracted from soil and rice using acetonitrile with omission of a clean-up procedure, while a C18 solid-phase extraction column was used for water samples. Quantification was achieved using matrix-matched calibration. The overall mean recoveries for isocarbophos and isocarbophos oxon enantiomers from the five matrices were 89.7-103 and 90.1-98.7%, with relative standard deviations of 2.1-5.4 and 2.5-4.7%, respectively. Moreover, the absolute configurations of isocarbophos oxon enantiomers were determined by liquid chromatography with tandem mass spectrometry through incubation of each isocarbophos enantiomer in soil, the first eluting enantiomer being confirmed as (R)-(-)-isocarbophos oxon. The proposed method was applied to real soil samples and satisfactory results were obtained.

Differential clinical characteristics and prognosis of patients with longstanding persistent atrial fibrillation presenting with recurrent atrial tachycardia versus recurrent atrial fibrillation after first ablation.

BACKGROUND: It is unknown if baseline characteristics and prognosis of patients with longstanding persistent (defined as history greater than 1 year) atrial fibrillation (LS-AF) differ among those with either recurrent atrial tachycardia (R-AT) or recurrent AF (R-AF) after first ablation. METHODS: In 222 consecutive LS-AF patients treated for R-AT or R-AF after first ablation, activation and entrainment mapping was used to identify R-AT mechanism and to guide the following ablation, and the ablation endpoints for all patients included complete pulmonary vein isolation, bidirectional block of lines, and disappearance of complex fractionated atrial electrograms. RESULTS: There were 102 patients in the R-AF group. LS-AF patients with R-AT as compared to R-AF had shorter AF duration and recurrence interval, smaller left atrium size and left ventricular end-diastolic diameter, and less mitral and aortic regurgitation before first ablation. During follow-up (17.7 ± 4.0 months) after R-AT/R-AF ablation, 78 LS-AF patients developed recurrent atrial tachyarrhythmia, with lower overall and recurrence as AF in R-AT versus R-AF groups. CONCLUSIONS: LS-AF patients who develop R-AT versus R-AF after first ablation have more favorable baseline characteristics and prognosis.