Araujia sericifera New Host of Alfalfa mosaic virus in Italy.

Araujia sericifera Brot. (Fam. Apocynaceae) is an evergreen climbing plant native of South America, originally introduced in Europe as an ornamental. In spring 2012, virus-like symptoms including bright yellow mosaic of calico-type and leaf distortion were observed in three A. sericifera plants growing in an abandoned field located in Pomigliano d'Arco (Campania region, Italy). Leaves from the three plants were collected and examined using commercial antisera (Bioreba AG, Reinach, Switzerland) by double antibody sandwich (DAS)-ELISA against Cucumber mosaic virus (CMV), Alfalfa mosaic virus (AMV), and by indirect plate trapped antigen (PTA)-ELISA against potyviruses (Potygroup test). Only AMV was detected serologically in the three A. sericifera samples. The virus was mechanically transmitted from the ELISA-positive samples to four plants each of Chenopodium quinoa, C. amaranticolor, tobacco (Nicotiana tabacum cv. Xanthi nc), cowpea (Vigna unguiculata, cv. Black eyes), basil (Ocimum basilicum, cv. Gigante), and tomato (Solanum lycopersicum cv. San Marzano), using chilled 0.03 M sodium phosphate buffer, containing 0.2% sodium diethyldithiocarbamate, 75 mg/ml of active charcoal, and traces of Carborundum (600 mesh). Inoculated plants were kept in an insect-proof greenhouse with natural illumination and temperatures of 24 and 18°C day/night. Under these conditions, plants showed the following symptoms after 1 to 3 weeks, consistent with symptoms caused by AMV (1): chlorotic local lesions following by mosaic in C. quinoa and C. amaranticolor, reddish local lesions following by mosaic in cowpea, necrotic local lesions followed by systemic necrosis in tomato, bright yellow mosaic (calico type) in basil, and mosaic and strong deformation of the apical leaves in tobacco. The presence of AMV in ELISA-positive A. sericifera and host plants was further confirmed by conventional reverse transcription (RT)-PCR. Total RNAs were extracted with an RNeasy Plant Mini Kit (Qiagen, Hilden, Germany). RT-PCR was performed with the One-Step RT-PCR Kit (Qiagen) using primers for the coat protein gene (CP) previously used for the molecular characterization of AMV isolates (2). An Italian isolate of AMV from Lavandula stoechas (GenBank Accession No. FN667967) and RNA extracted from a healthy A. sericifera plant were used as positive and negative controls, respectively. An amplicon of the correct predicted size (∼750 bp) was obtained from each of the infected plants assayed, and that derived from A. sericifera isolate Ars2 was purified (QIAqick PCR Purification Kit, Qiagen), cloned in pGEMT easy vector (Promega, Fitchburg, WI) and sequenced (HF570950). Sequence analysis of the CP gene, conducted with MEGA5 software, revealed the highest nucleotide identity of 98% (99% amino acid identity) with the AMV isolate Tef-1 (FR854391), an isolate belonging to subgroup I (3). To our knowledge, this is the first report of AMV infecting A. sericifera in Italy. Since A. sericifera is considered an invasive plant, in continuous expansion to new areas in Italy and in other European countries, particular attention should be paid to the possibility that this species may play a role in the epidemiology of aphid-transmitted viruses such as AMV and CMV, representing a threat to susceptible crops growing nearby. References: (1) G. Marchoux et al. Page 163 in: Virus des Solanacées. Quae éditions, Versailles, 2008. (2) G. Parrella et al. Arch. Virol. 145:2659, 2000. (3) G. Parrella et al. Plant Dis. 96:249, 2012.

[Anticoagulation in patients with heart valve prosthesis]. / L'anticoagulazione nei pazienti portatori di protesi valvolari cardiache.

The growing number of recipients of artificial heart valves draws ever more frequent attention to the problem of anticoagulant therapy, not only in its daily management but also in the event of specific conditions such as pregnancy, extra-cardiac surgery and invasive cardiac procedures in which specific measures must be adopted. In each case it is necessary to take into account not only the characteristics of the individual prosthesis but also those of the individual patient, each time making an overall assessment of the specific thromboembolic risk without forgetting possible complications of hemorrhage. This review examines the various mechanisms underlying the thromboembolic risk and, in the light of the leading literature on the topic, seeks to identify the most appropriate behaviors to adopt in the management of each individual case.

[Growing complexity of cardiologic intensive rehabilitation: motor rehabilitation resources and programs of physical training]. / Riabilitazione intensiva cardiologica in pazienti a complessità crescente: percorsi riabilitativi motori e programmi di training fisico.

In the last few years the population referred to cardiac rehabilitation centers has changed profoundly: the number of survivors of acute cardiac events has increased and heart surgery is being proposed to ever greater numbers of elderly patients with frequent and greater comorbidities, which make the management of physical training programs more complex. Consequently, just as rehabilitation cardiologists have had to expand their field of analyses and professional skills and nurses have had to integrate their care protocols, physiotherapists too have had to adapt the management of motor rehabilitation programs to the various needs and problems of each patient in the different phases of recovery. The aim of this paper is to present and discuss the procedures followed in our center concerning both the mode and contents of a standard course of motor rehabilitation for patients without complications and those for patients with complications. The paper analyzes the various assessments, the training program, the instruments of control and verification of the results, and discusses the instruments of intervention in patients affected by complications such as respiratory disturbances, musculoskeletal impairment, complications arising from injury, neurological deficit and severe deconditioning. Finally, the role of the physiotherapist in the active, propositive management of a recovery program is discussed.

Specialty-related differences in the epidemiology, clinical profile, management and outcome of patients hospitalized for heart failure; the OSCUR study. Oucome dello Scompenso Cardiaco in relazione all'Utilizzo delle Risore.

AIMS: This study was designed to identify potential specialty-related differences in the epidemiology, clinical profile, management and outcome of patients hospitalized for congestive heart failure in departments of cardiology or internal medicine. METHODS AND RESULTS: From 1 July to 31 December 1998, we prospectively recorded epidemiological and clinical data from patients with congestive heart failure consecutively admitted to 11 departments of cardiology and 12 departments of internal medicine in Liguria, a northern area of Italy. The overall study population included 749 patients; 22% were treated by cardiologists and 78% by internists (P<0.0001). Patients managed by cardiologists were more likely to undergo echocardiography (92% vs 37%), Holter monitoring (25% vs 3%) and exercise stress testing (20% vs 0.5%) than those managed by internists (P=0.001). At discharge, patients treated by cardiologists were more likely to be prescribed beta-blockers (41% to 4%) and ACE inhibitors (100% to 74%) than those treated by internists (P<0.0001), and the latter medication at higher dosages by cardiologists than internists. In addition, patients followed by cardiologists were younger (70+/-9 to 79+/-1 years;P<0.0001), more likely to be male (61% to 50%;P=0.011) and to have coronary artery disease (57% to 45%;P<0.006) than those followed by internists. Conversely, patients followed by internists were more likely to have diabetes, chronic obstructive pulmonary disease, atrial fibrillation and renal failure (P<0.03). In the overall study population, 53 patients (7%) died during hospitalization. Patients treated by cardiologists had a mortality not significantly different from that of patients treated by internists (10% and 6%, respectively;P=0.067), although congestive heart failure was more severe on admission in patients treated by cardiologists. CONCLUSION: Cardiologists follow published guidelines for congestive heart failure more strictly than internists, but treat a smaller number of patients who are younger, have more severe congestive heart failure and fewer co-morbidities than those managed by internists.

[Use of digitalis in chronic heart failure: an unresolved problem?]. / Utilizzo della digitale nello scompenso cardiaco cronico: una questione irrisolvibile?

The role of digitalis in the treatment of patients with heart failure is still being debated. The DIG study, a trial which enrolled about 6800 patients with the aim at overcoming the doubts on efficiency and safety of digoxin, showed a neutral effect on mortality but there was a statistically significant decreased risk of hospitalization due to worsening heart failure in the digoxin group compared to the placebo group. The trial disclosed several problems about patient selection (many patients were on digitalis before the start of the trial), digoxin dosage, which seemed to be high, and about the true reported beneficial effects of this therapy. Finally the data available do not permit any evaluation on the use of beta-blockers and the association between digitalis and beta-blockers considering the properties of these drugs in suppressing orthosympathetic activation.

[Good reasons to propose to the cardiology patient a cardiologic rehabilitation program]. / Le buone ragioni per proporre al cardiopatico un programma di riabilitazione cardiologica.

According to the latest data available, in Italy a cardiac rehabilitation program is currently proposed to only 17% of patients after an acute myocardial infarction and to 76% of patients after a coronary artery bypass grafting. One possible explanation for this difference is an underestimation of the rehabilitating techniques and some doubts about its efficacy on the quality of life and on secondary prevention. Regarding secondary prevention, many research results and independent reviews are now available and they give us the opportunity to develop a sufficiently evidence-based analysis of cardiac rehabilitation program results. Great improvements in functional capacity and substantial changes in the way of life seem to have been demonstrated, with good-health oriented behaviors and improvements in the whole risk profile (less cigarette smoking, more sports activities, less stress, improvement in lipid profile). It has been well proven that with comprehensive rehabilitation programs, there is a relevant slow down in atherosclerosis progression. Rehabilitation programs also have favorable effects on the quality of life in patients with cardiac disorders, with fewer symptoms and more psychological and social well being. Three high-quality meta-analyses resulted in a significant reduction in total and cardiovascular mortality, mostly linked to sudden death and fatal reinfarction reduction, equal to the one obtained by currently recommended postinfarct treatments. Certainly, there are still difficulties to overcome before definitive conclusions can be reached, because of differences both in rehabilitation programs in the various studies and because of the results achieved in recent years through changes in the pharmacological approach to secondary prevention. The Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction (GOSPEL study) from the Italian Study Group on Cardiac Rehabilitation (GICR) has been designed to answer to some of these questions. One of its goals is to evaluate whether an intensive intervention of cardiac rehabilitation in the postinfarct patients is actually applicable and efficacious.

Seventy-five nuclear DNA polymorphisms in an Italian sample: a comparative worldwide study.

A well defined Italian sample from Trino Vercellese (Northern Italy) is analysed for 75 nuclear DNA RFLPs. It represents the only European sample [Matullo et al 1994] which is unmixed in a comparative study of eight populations from four continents [Bowcock et al 1991a; Lin et al 1994]. Genetic substructure of this sample has been investigated by allele sharing distances and no bias or higher homogeneity is shown. Genetic variability between populations was measured by the FST statistics (average FST was 0.138 +/- 0.086). Average heterozygosity for eight populations was 0.312 +/- 0.069. Genetic distances were evaluated between pairs of populations. Phylogenetic trees were reconstructed and principal component analysis performed. Particular attention has been given to the genetic relationship between our sample and the mixed-Caucasoid sample: 14 out of 75 markers show statistically significant frequency differences (P < 0.05), 5 of which are significant at a probability level < 1%: GH/Bg1II (Lower system), D7S1/HindIII, D17S71/MspI, EPB3/PstI, HLA-DQA. Hypotheses on admixed origin of Europeans has been discussed.

Genetic analysis of Sardinia: I. data on 12 polymorphisms in 21 linguistic domains.

(1) The microgeographic structure of Sardinia, well documented from a historical and linguistic point of view, further supported by archaeological evidence, can also be dissected at the genetic level: gene frequencies show heterogeneities which are statistically significant. (2) Dendrogram analyses performed with different methods lead to the same result: even if gene frequencies cluster linguistically defined geographic domains in agreement with historical and archaeological evidence, no phylogenetic tree can be inferred, very likely because the assumptions which allow a phylogenetic tree to be a valid model of evolution (mainly constant evolutionary rates and independence between branches) do not apply to the genetic history of Sardinia. (3) Evidence of a qualitative association between distribution of genes and distribution of languages or dialects seems to emerge also at the microgeographic level of our analysis. More linguistic and genetic data are planned to be considered.

Analysis of HLA-A, C, B, DR and DQ loci in an Italian sample of possible Celtic origin.

Trino Vercellese, a village of Piedmont (Italy), was selected with the aim at reconstructing the genetic history of a putative Celtic sample known to be settled in Italy with the name of Rigomagus since pre-roman times. The HLA-A, Cw, B, DR and DQ antigens of 101 unrelated individuals have been typed. The antigens characterizing this sample for their higher frequency are shown to be A3, A11, A32, B35, B39, Bw52, Cw4, DRw11, DRw13, DQw7. Gene frequencies are estimated by maximum likelihood and Hardy-Weinberg equilibrium was tested with no deviant genetic locus. Two-locus haplotype frequencies were also estimated and those with significant associations tabulated. "Extended" haplotypes were reconstructed: the three most frequent haplotypes (covering a total frequency of 11.5%) share the same Cw, B, DR and DQ alleles. Comparisons with other Italian and European samples are indicated to challenge archeological evidence of a pre-roman genetic stratification of the people living in our old Rigomagus.

RFLP analysis on a sample from northern Italy.

We analysed a sample of 55 unrelated individuals from Trino Vercellese, a village in northern Italy. It represents the only European sample which is unmixed in a comparative study of eight populations from four continents [Bowcock et al 1991a; Lin et al 1994]. RFLP analysis was performed on 32 DNA markers, for a total of 37 independent alleles. Genetic variability between populations was measured by the FST statistics (average FST is 0.138). Average heterozygosity was calculated for each marker and for each population. Genetic distances were evaluated between pairs of populations. Phylogenetic trees were reconstructed and principal component analysis performed.

Predicting cardiac mortality after uncomplicated myocardial infarction by exercise radionuclide ventriculography and exercise-induced ST segment elevation.

In 183 consecutive patients with recent, uncomplicated myocardial infarction, the following variables were associated with 4-year cardiac death: haemodynamic decompensation with exercise (P = 0.01), left ventricular ejection fraction at rest (P = 0.004) and at peak exercise (P = 0.003), persistent ST segment elevation at rest in the area of infarction = (P = 0.004), exercise-induced ST segment elevation (P = 0.02), and late aneurysmal evolution (P = 0.01). Exercise left ventricular ejection fraction was the sole variable selected by Cox regression analysis as an independent predictor of cardiac death. In 40 patients with ST segment elevation at rest, left ventricular ejection fraction was 42 +/- 17% at rest and 40 +/- 18% at peak exercise, versus 52 +/- 12% and 52 +/- 14% in the remaining patients (both P less than 0.01). Among these 40, 16 (all with anterior infarction) also had exercise-induced ST segment elevation; their ejection fraction was 32 +/- 13% at rest, 30 +/- 13% during exercise, versus 53 +/- 15% and 53 +/- 15% in 129 patients with no ST segment elevation either at rest, or during exercise (both P less than 0.01). The 4-year risk of death was 20% in the former 40 patients, 36% in the latter 16, while in the complete absence of ST segment elevation, such risk was 3%. All 14 patients with ST segment elevation only during exercise were alive after 4 years: their left ventricular ejection fraction was 47 +/- 12% at rest, 45 +/- 13% with exercise. ST segment elevation was associated with late aneurysmal evolution but not with exercise-induced ischaemia.(ABSTRACT TRUNCATED AT 250 WORDS)

The distribution of HLA antigens in Italy.

Human histocompatibility (HLA) gene frequencies were studied in the Italian population. A random sample of healthy individuals born in several Italian regions and provinces was studied to estimate HLA-A, -B, -C and -DR gene frequencies using the maximum likelihood method. The goodness of fit to Hardy-Weinberg proportions was evaluated by the likelihood ratio statistics. Different Italian regions and provinces show significant differences in the HLA alleles, providing further evidence for the genetic heterogeneity in the Italian population. This heterogeneity is also displayed by a synthetic geographical representation which uses colour to map the most informative gene differences. Statistically significant gametic associations between HLA-A, -B, -C and -DR loci are reported. The difference between northern and southern Italy and between continental Italy and Sardegna is clearly shown also by their heterogeneous linkage disequilibria.

Exercise radionuclide ventriculography after uncomplicated myocardial infarction: what could we gain from the analysis of LVEF throughout the whole test?

To assess the usefulness of a step by step evaluation of exercise left ventricular ejection fraction (LVEF), 219 consecutive patients with recent uncomplicated myocardial infarction and 30 normal subjects underwent a symptom-limited cycloergometer test followed by exercise radionuclide ventriculography (ExRNV). LVEF was monitored throughout the whole test. 49 patients underwent coronary arteriography for clinical reasons. 5 patterns of exercise LVEF could be observed: progressive increase: 55 patients (25%) and 27 normal subjects (90%); progressive decrease: 37 patients (17%); initial increase followed by significant decrease: 54 patients (25%); lack of initial modification and terminal decrease: 35 patients (16%); no modification: 38 patients (17%) and 3 normal subjects (10%). Grouping the patients in this fashion allowed us to increase the specificity of ExRNV from 70% to 100%, without loss of sensitivity (95%). As for the patients in subgroup C, 32/54 showed unequivocal ECG ischaemic changes, occurring simultaneously with LVEF decrease; in 33/54 LVEF dropped during the last workload; in 25/54 the last stage LVEF was equal to or higher than the basal LVEF. The statistical analysis showed that ischaemic ECG changes (P less than 0.0001), exercise-induced wall-motion abnormalities (P less than 0.0001), and the presence of multivessel coronary artery disease (P less than 0.0001) were significantly more frequent in patients showing patterns (b)-(d), which should be considered as ischaemic. Our method allowed the unequivocal identification of ischaemic patterns in LVEF during exercise, which might be missed if only its basal and final values are considered.