Perioperative management of the vulnerable and failing right ventricle.

Under recognition combined with suboptimal management of right ventricular (RV) dysfunction and failure is associated with significant perioperative morbidity and mortality. The contemporary perioperative team must be prepared with an approach for early recognition and prompt treatment. In this review, a consensus-proposed scoring system is described to provide a pragmatic approach for expeditious decision-making for these complex patients with a vulnerable RV. Importantly, this proposed scoring system incorporates the context of the planned surgical intervention. Further, as the operating room (OR) represents a unique environment where patients are susceptible to numerous insults, a practical approach to anesthetic management and monitoring both in the OR and in the intensive care unit is detailed. Lastly, an escalating approach to the management of RV failure and options for mechanical circulatory support is provided.

Differential plasma branched-chain amino acid responses following the consumption of Greek-style yogurt and skimmed milk.

We examined postprandial branched-chain amino acid (BCAA), insulin, and glucose responses in blood for 4 h following the consumption of two isonitrogenous doses (2 × 20 g protein) of Greek-style yogurt (GY) and skimmed milk (MILK) in young males. Peak leucine and BCAA concentrations and areas under the curve were greater after GY versus MILK, and time to maximal leucine/BCAA concentrations was similar between conditions. We demonstrated that different protein-matched wholefood dairy products elicit different postprandial aminoacidemic responses.

Differential insecticide resistance in Bemisia tabaci (Hemiptera: Aleyrodidae) field populations in the Punjab Province of Pakistan.

The cotton whitefly Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) has a propensity for developing high-level resistance to insecticides. Management of B. tabaci in cotton grown in Pakistan depends on insecticide use, resistance monitoring has become essential to minimize the development of resistance. In this study, resistance was monitored in adult whiteflies collected from cotton fields in the Bahawalpur, Faisalabad, Lodhran, Multan, and Vehari districts of the Punjab Province, Pakistan during 2017, 2018, and 2019. Resistance monitoring was carried out for two insect growth regulators (pyriproxyfen and buprofezin) four neonicotinoids acetamiprid, imidacloprid, thiamethoxam, thiacloprid, and the historically used pyrethroid, bifenthrin and organophosphate, chlorpyrifos. Results based on resistance ratio (RR) showed that moderate to high level of resistance against noenicitinoids insecticides have been observed in all four districts while whiteflies exhibited very low to low resistance to pyriproxyfen and buprofezin. The RRs for acetamiprid, imidacloprid, thiamethoxam, thiacloprid varied from 7.60 to 50.99, 19.32 to 65.72, 17.18 to 54.65 and 6.49-47.49-fold, respectively. Bifenthrin and chlorpyrifos showed very low toxicity against whiteflies in all districts except Faisalabad, with RRs of 12.28-50.56-fold and 7.94-26.24-fold, respectively. The results will facilitate 'smart' selection and guide rates of insecticide applications for whitefly management in cotton for effective whitefly management while also delaying the development of resistance.

Pancreas fat quantification with quantitative CT: an MRI correlation analysis.

AIM: To assess the fat content of the pancreas using quantitative computed tomography (QCT) and to correlate the results with chemical-shift-encoded magnetic resonance imaging (CSE-MRI) measurements of proton density fat fraction (PDFF). MATERIAL AND METHODS: Institutional review board approval for this research was obtained and 52 participants (25 men, 27 women; mean age 35.1 years; age range 22-50 years), who were enrolled in the Prospective Urban Rural Epidemiology (PURE) Study, underwent QCT and CSE-MRI for quantification of fat content in the pancreas. Two observers placed regions of interest (area of 100-130 mm2) in the head, body, and tail of the pancreas as closely matched as possible on the two scans. Pearson correlation and Bland-Altman analysis were performed to evaluate the correlation between the QCT and CSE-MRI measurements and the systematic difference between the two techniques. RESULTS: The QCT and CSE-MRI measurements of pancreatic fat content were well correlated (r=0.805, p<0.0001), although Bland-Altman analysis showed that the QCT measurements were systematically lower by 6.3% compared to CSE-MRI PDFF. CONCLUSION: In conclusion, the results of this study suggest good correlation between QCT and CSE-MRI measurements of pancreatic fat content. Further studies are required to improve the numerical agreement of QCT measurements with PDFF.

Molecular characterization of two previously undescribed begomovirus-associated alphasatellite molecules infecting malvaceous species in Cameroon.

Two begomovirus-associated alphasatellites were isolated from okra and a malvastrum plant (Malvaceae) in Cameroon. The complete nucleotide sequences of the okra- and malvastrum-infecting alphasatellites were 1375 and 1416-1418 nucleotides, respectively, and both exhibited features characteristic of other alphasatellites. Based on pairwise sequence comparisons, these previously undescribed alphasatellites are members of distinct species in the genera Colecusatellite and Gosmusatellite and have been tentatively named "pepper yellow vein Mali alphasatellite" and "cotton leaf curl Gezira alphasatellite3", respectively. Taken together with previous studies, alphasatellites endemic to Cameroon appear to be more diverse and infect plants of many more species and families than currently recognized.

Norovirus and human adenovirus occurrence and diversity in recreational water in a karst aquifer in the Yucatan Peninsula, Mexico.

AIMS: To determine the seasonal occurrence and diversity of norovirus (NoV) and human adenovirus (HAdV) in groundwater from sinkholes, and brackish water used for recreational activities in the karst aquifer of the Yucatan Peninsula, Mexico. METHODS AND RESULTS: Hollow fibre ultrafiltration was used to concentrate viruses and standard plaque assay methods were used to enumerate somatic and F+ specific coliphages as viral indicators. Real-time quantitative polymerase chain reaction assays were used to estimate the number of genome copies for NoV strains GI, and GII, and HAdVs. The predominant NoV genotypes and HAdV serotypes were identified by comparative sequence analysis. Somatic and male F+ specific coliphages were detected at concentrations up to 94 and 60 plaque-forming units per 100 ml respectively. The NoV genogroup I (GI) was associated with 50% of the sampled sites during the rainy season only, at concentrations ranging from 120 to 1600 genome copies per litre (GC l-1 ). The NoV genogroup II (GII) was detected in 30 and 40% of the sampled sites during the rainy and dry seasons, respectively, at concentrations ranging from 10 to 290 GC l-1 . During the rainy and dry seasons, HAdVs were detected in 20% of the sites, at concentrations ranging from 24 to 690 GC l-1 . Identification of viral types revealed the presence of NoV GI.2, GII.Pe, GII.P16 and GII.P17, and HAdV F serotypes 40 and 41. CONCLUSIONS: These findings demonstrate that NoVs and HAdVs are prevalent as virus contaminants in the karst aquifer, representing potential health risks particularly during the rainy season, in one of the most important areas used for tourism in Mexico. SIGNIFICANCE AND IMPACT OF THE STUDY: This is one of the few studies conducted in karst aquifers that provide a foundational baseline of the distribution, concentrations and diversity of NoVs and HadVs in these particular environments.

Minimal genomic variability in Merremia mosaic virus isolates endemic in Merremia spp and cultivated tomato in Puerto Rico.

Merremia mosaic virus (MerMV), a bipartite begomovirus, was identified for the first time as a pathogen of commercial tomato plantings. Infection of tomato by MerMV caused mild leaf curling and yellow foliar mosaic symptoms. Herein, the MerMV was identified in symptomatic Merremia quinquefolia and M. aegyptia (Convolvulaceae) plants exhibiting bright yellow or yellow-green foliar mosaic symptoms, respectively. The full-length begomoviral components were amplified from total DNA isolated from two wild species of Merremia and commercial tomato plants during 1991-1998. The DNA was subjected to rolling circle amplification, restriction digestion, and DNA sequencing. The resultant 19 and 26 apparently full-length DNA-A and DNA-B components were ~ 2557 and ~ 2492 bases, respectively. The 140-base common region was 97.9% identical between DNA-A and -B components, a predictive evidence for cognate DNA-A and -B components. Although the DNA-A components were highly conserved at 96-100%, the DNA-B components diverged at ~ 89 to 100%, respectively. The overall clonal genomic features strongly suggested that MerMV lineage has been under host-selection for some time, and only recently, has undergone a host-shift, putatively, from wild convolvulaceous species to tomato (Solanaceae). Phylogenetically, MerMV grouped with other bipartite begomoviruses indigenous to the Caribbean region, with MerMV DNA-A components forming three clusters, and the DNA-B components grouped in one clade. Both clades contained only one closet relative, an isolate of MerMV from Venezuela, MerMV-VE. Biolistic inoculation of M. quinquefolia and tomato seedlings with the DNA-A and -B components of PR68 and PR80 resulted in development of symptoms like those observed in naturally-infected species, respectively.

Invasion of previously unreported dicot plant hosts by chickpea chlorotic dwarf virus in Pakistan.

Members of the genus, Mastrevirus (family, Gemniviridae) transmitted by leafhopper vectors infect monocotyledonous or dicotyledonous plants, and infection of agricultural crops results in reduced yield and quality. During 2012, a study was undertaken in the Punjab and Sindh Provinces in Pakistan to determine the identity of suspect geminiviruses associated with symptomatic cotton and vegetable plants exhibiting foliar enations, leaf curling, mosaic, and stunting reminiscent of geminivirus infection. To determine suspect geminiviral identity, fifteen apparently full-length mastrevirus genome (~ 2600 base pairs) were amplified by rolling-circle amplification, digested, cloned into the plasmid vector, pGEM-3Zf+, and sequenced from cucumber, Gossypium arboreum L., Gossypium hirsutum L., okra and tomato. The mastrevirus full-length genome sequences obtained shared their highest pairwise nucleotide sequence identity, at 97.3-98.6%, with previously reported C and L strains of Chickpea chlorotic dwarf virus (CpCDV) from chickpea and cotton in Pakistan, respectively. However, CpCDV has not been previously identified from cucumber, G. arboreum, okra, or tomato. The association of CpCDV with four previously unreported plant hosts suggests that CpCDV strains C and strain L have a broader than expected host range, and therefore may be found to negatively affect vegetable crops, particularly, when grown in proximity to cotton.

Pulmonary toxicity associated with pomalidomide.

Pomalidomide, previously used to treat multiple myeloma, has been reported to cause acute pulmonary toxicity that improves with drug discontinuation. We present a case of delayed pneumonitis with persistent fibrosis associated with pomalidomide. A 61-year-old male treated with pomalidomide and corticosteroids presented with acute on chronic dyspnea, profound hypoxemia, and ground glass opacities on computerized tomographic imaging. Corticosteroid taper and discontinuation of pomalidomide resulted in clinical improvement, but with substantial residual pulmonary fibrosis. Given the temporal improvement, but not resolution, following discontinuation of an agent with an established propensity for lung injury, we attribute this presentation to pomalidomide toxicity.

Population structure of the ash dieback pathogen, Hymenoscyphus fraxineus, in relation to its mode of arrival in the UK.

The ash dieback fungus, Hymenoscyphus fraxineus, a destructive, alien pathogen of common ash (Fraxinus excelsior), has spread across Europe over the past 25 years and was first observed in the UK in 2012. To investigate the relationship of the pathogen's population structure to its mode of arrival, isolates were obtained from locations in England and Wales, either where established natural populations of ash had been infected by wind-dispersed ascospores or where the fungus had been introduced on imported planting stock. Population structure was determined by tests for vegetative compatibility (VC), mating type and single-nucleotide polymorphisms (SNPs). VC heterogeneity was high at all locations, with 96% of isolate pairings being incompatible. Frequencies of the MAT1-1-1 and MAT1-2-1 idiomorphs were approximately equal, consistent with H. fraxineus being an obligate outbreeder. Most SNP variation occurred within study location and there was little genetic differentiation between the two types of location in the UK, or between pathogen populations in the UK and continental Europe. There was modest differentiation between UK subpopulations, consistent with genetic variation between source populations in continental Europe. However, there was no evidence of strong founder effects, indicating that numerous individuals of H. fraxineus initiated infection at each location, regardless of the route of pathogen transmission. The ssRNA virus HfMV1 was present at moderate to high frequencies in all UK subpopulations. The results imply that management of an introduced plant pathogen requires action against its spread at the continental level involving coordinated efforts by European countries.

Molecular characterization of a novel bipartite begomovirus isolated from Lycianthes biflora in China.

A bipartite begomovirus isolate GD was isolated from Lycianthes biflora plants showing yellow mosaic symptoms in Nanxiong, Guangdong Province, China. The apparently full-length DNA-A and DNA-B viral components were cloned after enrichment of circular DNA by rolling circle amplification, restriction digestion, cloning, and DNA sequencing. The DNA-A component (2752nt, KT582302) shares highest (80.2%) nucleotide (nt) sequence identity with tomato leaf curl Sulawesi virus [Indonesia-Sulawesi-Langowan F101-2006] (ToLCSuV- [ID-Sul -LanF09-06], FJ237618), reported in Indonesia as causing yellow leaf curl disease of chilli pepper. The DNA-B component (2704nt, KT582303) shares highest (76.3%) nt sequence identity with pepper yellow leaf curl Indonesia virus-[Indonesia-tomato2-2005] (PepYLCIV-[ID-Tom2-05 AB213599) reported in Indonesia, and associated with yellow leaf curl disease in tomato. Based on the ICTV guidelines for begomoviral species demarcation, the virus is a new, previously undescribed bipartite begomovirus species for which the name "Lycianthes yellow mosaic virus" is proposed.

Early molecular signatures of responses of wheat to Zymoseptoria tritici in compatible and incompatible interactions.

Zymoseptoria tritici, the causal agent of septoria tritici blotch, a serious foliar disease of wheat, is a necrotrophic pathogen that undergoes a long latent period. Emergence of insensitivity to fungicides, and pesticide reduction policies, mean there is a pressing need to understand septoria and control it through greater varietal resistance. Stb6 and Stb15, the most common qualitative resistance genes in modern wheat cultivars, determine specific resistance to avirulent fungal genotypes following a gene-for-gene relationship. This study investigated compatible and incompatible interactions of wheat with Z. tritici using eight combinations of cultivars and isolates, with the aim of identifying molecular responses that could be used as markers for disease resistance during the early, symptomless phase of colonization. The accumulation of TaMPK3 was estimated using western blotting, and the expression of genes implicated in gene-for-gene interactions of plants with a wide range of other pathogens was measured by qRT-PCR during the presymptomatic stages of infection. Production of TaMPK3 and expression of most of the genes responded to inoculation with Z. tritici but varied considerably between experimental replicates. However, there was no significant difference between compatible and incompatible interactions in any of the responses tested. These results demonstrate that the molecular biology of the gene-for-gene interaction between wheat and Zymoseptoria is unlike that in many other plant diseases, indicate that environmental conditions may strongly influence early responses of wheat to infection by Z. tritici, and emphasize the importance of including both compatible and incompatible interactions when investigating the biology of this complex pathosystem.

Asynchronously Calibrated Quantitative Bone Densitometry.

Conventional quantitative computed tomography (QCT) uses a phantom scanned simultaneously with the anatomical region of interest. A newly developed method called asynchronous QCT does not require a phantom to be present during the patient scan. This allows the inclusion of computer tomography scans performed without any calibration standard in a different clinical context than bone densitometry, for example, in a screening context. In the present study, the asynchronous and the conventional quantitative computed tomographies were compared. Specifically, short-term precision, a phantom-induced bias, methodical equivalence of the asynchronous and the conventional methods, and interobserver variability were investigated. Ten phantom scans served for investigation of short-term precision. A prospective dataset of 43 study participants (44-80 years, mean 63.8 ± 8.6 years) was acquired over 3 clinical sites. Trabecular regions of the spine as well as cortical and trabecular regions of the hip (femoral neck, trochanter, intertrochanter, and shaft) were analyzed with respect to the presence or absence of a phantom and with regard to the synchronous and asynchronous calibration methods. Regarding precision, all variations of the mean areal and volumetric densities were lower for the asynchronous method than for the conventional method. The presence of the phantom resulted in a bias of 2.3 mg/cm3, and the choice of the asynchronously or synchronously calibrated analysis resulted in a bias of 3.7 mg/cm3 at the spine. Both were statistically, but not clinically, significant. The total hip was statistically, but not clinically, significantly different by 0.008 g/cm2. The bone density values between the 2 techniques correlated highly with one another at all regions investigated. Interobserver variability between 2 trained observers showed a difference of 0.2 mg/cm3 (spine) and differences less or equal to 0.009 g/cm2 (hip), which again was regarded as clinically nonsignificant. In summary, the asynchronously calibrated QCT provides results comparable to the established synchronously calibrated QCT.

A Mixed Infection of Lettuce chlorosis virus, Papaya ringspot virus, and Tomato yellow leaf curl virus-IL Detected in a Texas Papaya Orchard Affected by a Virus-Like Disease Outbreak.

Severe virus-like symptoms consisting of mosaic, distortion, yellowing, and brittleness were observed on papaya plants in a 20-ha orchard in South Texas during the 2014-15 growing season. Incidence of symptomatic plants increased from ∼40 to 100% within 6 months of the outbreak; the most severely affected plants were stunted, and fruit yield and quality were reduced compared with asymptomatic plants. The orchard papaya plant virome was explored using the Illumina NextSeq 500 platform and results were validated by Sanger DNA sequencing of complete viral genomes obtained by PCR amplification. The combined results revealed the presence of Papaya ringspot virus (PRSV; Potyvirus), Lettuce chlorosis virus (LCV; Crinivirus), and Tomato yellow leaf curl virus-IL (TYLCV-IL; Begomovirus). The RT-PCR analyses of leaves from 51 randomly sampled papaya plants indicated the presence of PRSV, LCV, and TYLCV-IL in 100, 39.2, and 15.7% of the samples, respectively. Plants infected with PRSV, in combination with LCV and/or TYLCV-IL, exhibited more severe symptoms compared with plants infected with PRSV alone. Furthermore, successful whitefly-mediated transmission of TYLCV-IL and LCV was accomplished by exposing virus-free papaya seedlings to viruliferous Bemisia tabaci (Genn.) under greenhouse conditions. The results of this study document a new host record for LCV and the first successful whitefly-mediated transmission of TYLCV-IL and LCV to papaya. As a perennial crop, infected papaya serving as an over-seasoning reservoir for TYLCV-IL and LCV, presents a new challenge to viral disease management in papaya orchards.

Reconsideration of the Effects of Age on Proximal Femur Structure: Implications for Joint Replacement and Hip Fracture.

OBJECTIVES: In recent years quantitative computed tomography (QCT) has allowed precise non-invasive, three dimensional, in vivo measurement of hip structure in large numbers of individuals. The effects of ageing on proximal femur structure are reported and implications for the prevention of hip prosthesis loosening and hip fracture considered. DESIGN, SETTING AND PARTICIPANTS: An observational cross-sectional study of proximal femur QCT in 719 unselected female European descent aged 20 to 89 years recruited from US and Australian populations. MAIN OUTCOMES MEASURES: QCT scans were obtained using software that separates cortical and cancellous bone by a thresholding technique. Voxel based mineral volume and mass was computed for the integral (external), cancellous and cortical compartments of 1 mm wide sections through the femoral neck (FN), trochanter (TR) and intertrochanter (IT) regions. RESULTS: Over the adult life span total integral volumes at the FN, TR and IT sites expand linearly by between 18 and 37% at the same time as bone mass decreased by 22 to 25% resulting in massive reductions in true volumetric BMD (vBMD) of 40 to 50%. Cancellous volume expansion was larger at 65 to 79% at the three sites. Between the ages of 65 and 75 the average increase in cancellous volume at the IT site was 3.74 cm3 (12.1%). Voxel determined FN cortical volume decreased linearly by 43%, as did cortical bone mass so that vBMD did not change substantially. TR and IT cortical volumes decreased 54 and 28% respectively, small reductions in TR and IT cortical vBMD also occurred. CONCLUSIONS: Large endosteal expansion in the area in which hip replacement stem placement occurs may contribute to loosening. Regarding the propensity to hip fracture, periosteal expansion contributes to increased resistance to bending but cortical thinning contributes to loss of bone to resistance to bending forces. Understanding individual hip structure may contribute to individualisation of risk and subsequent targeting of management using pharmaceutical agents.

The Evolution of a Process for Selecting and Prioritizing Plant Diseases for Recovery Plans.

One element of the cost of dealing with invasive species in the United States is the recovery from the arrival of exotic plant pathogens. We review the development of a process used to prioritize plant diseases for the federally mandated United State Department of Agriculture National Plant Disease Recovery System. A team of university, government, and industry scientists worked together over a 10-year period to develop a science-based objective approach to the challenge of effectively preparing for recovery plans from introduced pathogens, when the timing of the introduction of any single disease is unknown. Over time, the process transitioned from ad hoc, in which recovery plans were written when the relevant experts were able to do so, to a formally organized group-prioritization effort from which emerged the concept of generic recovery plan templates for groups of pathogens and diseases that have similar biological characteristics, and therefore, similar management approaches. Key characteristics for each template were determined through a multivariate analysis for 14 plant diseases for which a recovery plan already existed. The process was validated by a larger group of 15 plant pathologists, for which results were compared with those scored by 14 subject matter experts.

Localization of 'Candidatus Liberibacter solanacearum' and Evidence for Surface Appendages in the Potato Psyllid Vector.

The potato psyllid Bactericera cockerelli is implicated as the vector of the causal agent of zebra chip of potato and vein-greening of tomato diseases. Until now, visual identification of bacteria in the genus 'Candidatus Liberibacter' has relied on direct imaging by light and electron microscopy without labeling, or with whole-organ fluorescence labeling only. In this study, aldehyde fixative followed by a coagulant fixative, was used to process adult psyllids for transmission electron microscopy (TEM) colloidal gold in situ hybridization experiments. Results indicated that 'Ca. Liberibacter solanacearum' (CLso)-specific DNA probes annealed to a bacterium that formed extensive, monocultural biofilms on gut, salivary gland, and oral region tissues, confirming that it is one morphotype of potentially others, that is rod-shaped, approximately 2.5 µm in diameter and of variable length, and has a rough, granular cytosol. In addition, CLso, prepared from shredded midguts, and negatively stained for TEM, possessed pili- and flagella-like surface appendages. Genes implicating coding capacity for both types of surface structures are encoded in the CLso genome sequence. Neither type was seen for CLso associated with biofilms within or on digestive organs, suggesting that their production is stimulated only in certain environments, putatively, in the gut during adhesion leading to multiplication, and in hemolymph to afford systemic invasion.

Coxiella burnetii (Q-Fever) Seroprevalence in Prey and Predators in the United Kingdom: Evaluation of Infection in Wild Rodents, Foxes and Domestic Cats Using a Modified ELISA.

Coxiella burnetii, the agent of Q-fever, is recognized as a worldwide zoonosis with a wide host range and potentially complex reservoir systems. Infected ruminants are the main source of infection for humans, but cats and other mammals, including wild rodents, also represent potential sources of infection. There has been a recent upsurge of reported cases in humans, domestic ruminants and wildlife in many parts of the world, and studies have indicated that wild brown rats may act as true reservoirs for C. burnetii and be implicated in outbreaks in livestock and humans. However, investigation of reservoir systems is limited by lack of validated serological tests for wildlife or other non-target species. In this study, serum samples from 796 wild rodents (180 bank voles, 309 field voles, 307 wood mice) 102 wild foxes and 26 domestic cats from three study areas in the UK were tested for the presence of antibodies to C. burnetii using a commercial indirect ELISA kit modified for use in multiple wildlife species. Test thresholds were determined for each species in the absence of species-specific reference sera using a bi-modal latent class mixture model to discriminate between positive from negative results. Based on the thresholds determined, seroprevalence in the wild rodents ranged from 15.6% to 19.1% depending on species (overall 17.3%) and was significantly higher in both foxes (41.2%) and cats (61.5%) than in rodents. This is the first report to quantify seroprevalence to C. burnetii in bank voles, field voles, wood mice, foxes and cats in the UK and provides evidence that predator species could act as indicators for the presence of C. burnetii in rodents. The study demonstrates that wildlife species could be significant reservoirs of infection for both livestock and humans, and the high seroprevalence in domestic cats highlights the potential zoonotic risk from this species.

Isolation and characterization of nine microsatellite loci from Bemisia tabaci (Hemiptera: Aleyrodidae) biotype B.

Nine microsatellites were isolated from Bemisia tabaci (Gennadius) biotype B and screened across 60 individuals from two populations (biotype B) to examine polymorphism. Two to 12 alleles were observed per locus. Observed and expected heterozygosities ranged from 0.033 to 0.967 and 0.033 to 0.854, respectively. There was no significant deviation from Hardy-Weinberg equilibrium and no significant linkage disequilibrium between loci. One locus showed evidence for null alleles. These loci will be useful in future studies of the genetic structure of worldwide biotypes and gene flow analyses between and within biotypes of B. tabaci.