Spatiotemporal Co-occurrence of Flanders and West Nile Viruses Within Culex Populations in Shelby County, Tennessee.

West Nile virus (WNV) and Flanders virus (FLAV) can cocirculate in Culex mosquitoes in parts of North America. A large dataset of mosquito pools tested for WNV and FLAV was queried to understand the spatiotemporal relationship between these two viruses in Shelby County, TN. We found strong evidence of global clustering (i.e., spatial autocorrelation) and overlapping of local clustering (i.e., Hot Spots based on Getis Ord Gi*) of maximum likelihood estimates (MLE) of infection rates (IR) during 2008-2013. Temporally, FLAV emerges and peaks on average 10.2 wk prior to WNV based on IR. Higher levels of WNV IR were detected within 3,000 m of FLAV-positive pool buffers than outside these buffers.

The missing association: sequencing-based discovery of novel SNPs in VKORC1 and CYP2C9 that affect warfarin dose in African Americans.

It is well recognized that the genetic variants VKORC1-1639, CYP2C9*2, and CYP2C9*3 contribute to warfarin dose response. This has led to warfarin dosing algorithms that include these polymorphisms and explains between 47% and 56% of variability in dose in Caucasians. However, these polymorphisms explain significantly less of the variance in dose among African Americans. In order to identify novel variations that affect warfarin dose in African Americans, we used a targeted resequencing strategy that examined evolutionarily conserved sequences and regions of putative transcriptional binding. Through ethnicity-specific warfarin dose model building in 330 African Americans, we identified two novel genetic associations with higher warfarin dose, namely, VKORC1-8191 (rs61162043, P = 0.0041) and 18786 in CYP2C9 (rs7089580, P = 0.035). These novel finds are independent of the previous associations with these genes. Our regression model, encompassing both genetic and clinical variables, explained 40% of the variability in warfarin dose in African-American subjects, significantly more than any model thus far.

Optimizing Fungicide Timing for the Control of Rhizoctonia Crown and Root Rot of Sugar Beet Using Soil Temperature and Plant Growth Stages.

Azoxystrobin is applied early in the sugar beet growing season in north-central United States for control of Rhizoctonia damping-off and Rhizoctonia crown and root rot caused by Rhizoctonia solani anastomoses groups (AGs) 4 and 2-2, respectively. Fungicide application timings based on crop growth stage and soil temperature thresholds were evaluated in inoculated small-scale trials and in commercial fields with a history of Rhizoctonia crown and root rot. Soil temperature thresholds of 10, 15, and 20°C were selected for fungicide application timings and used to test whether soil temperature could be used to better time applications of azoxystrobin. In both small- and large-plot trials, timing applications after attainment of specific soil temperature thresholds did not improve efficacy of azoxystrobin in controlling damping-off or Rhizoctonia crown and root rot compared with application timings based on either planting date, seedling development, or leaf stage in a susceptible (E-17) and a resistant (RH-5) cultivar. Application rate and split application timings of azoxystrobin had no significant effect on severity of crown and root rot. Other environmental factors such as soil moisture may interact with soil temperature to influence disease development. Cv. RH-5 had higher sugar yield attributes than the susceptible cultivar (E-17) in seasons conducive and nonconducive to crown and root rot development. All isolates recovered from both small- and large-plot trials in all years were AG 2-2. R. solani AG 4 was not identified in any samples from any year.

Nutritional assessment of patients with extended left ventricular assist device support.

The nutritional status of nine patients with end-stage heart disease who were supported by a left ventricular assist device (LVAD) for more than 30 days while awaiting cardiac transplantation was evaluated. Nutritional status was indicated by the following scale: 0-2, adequate nourishment; 3-5, moderate malnourishment; greater than 5, severe malnourishment. This scale was based on serial assessments of albumin, transferrin, total lymphocyte count, percentage of ideal body weight, midarm circumference, triceps skinfold, and arm muscle circumference. Each variable was compared with established standards before implantation and before transplantation times and assessed 1 point if less than the normal value and 0 points if within the normal range. At the time of LVAD implantation, 5 patients had a score of 0-2, 3 patients had a score of 3-5, and 1 patient had a score greater than 5. At the time of cardiac transplantation, 7 patients had a score of 0-2, 2 patients had a score of 3-5, and no patients had a score greater than 5. The patients who were able to meet at least 50% of their daily caloric and protein requirements by oral intake alone were noted. At LVAD implantation, only 2 patients (22%) met this requirement; however, 6 patients (67%) met this requirement at the time of cardiac transplantation. All 9 patients underwent cardiac transplantation, and 8 survived. Thus, it appears that extended LVAD support and maintenance of hemodynamic stability allow patients to regain the desire and ability to achieve adequate nutritional status, which may considerably reduce their perioperative transplant risks.

Risk factors for development of accelerated coronary artery disease in cardiac transplant recipients.

Allograft coronary artery disease (CAD) is the major determinant of long-term survival following heart transplantation (HTx). In a group of 210 heart transplant recipients, we diagnosed CAD in 54 (27.1%) by coronary angiography, postmortem examination or examination of the transplanted heart at the time of retransplantation. Retrospective analysis of potential risk factors for the development of CAD was performed for both immunological (rejection pattern, immunosuppressive therapy, cytomegalovirus [CMV] infection), and nonimmunological (hyperlipidemia, smoking, hypertension, diabetes mellitus, obesity) risk factors. The total number of rejection episodes correlated significantly with the occurrence of CAD (P less than 0.05), showing that patients who experienced two or more rejection episodes had an incidence of CAD of 40%, as opposed to a 23% incidence in patients who experienced no rejection. A composite rejection score derived from multivariate regression analysis of the severity, frequency, and timing of acute cardiac rejection episodes was found to correlate with the development of CAD (P less than 0.05). Postoperative arterial hypertension also correlated significantly with the onset of CAD (P less than 0.01), with a 92.6% incidence of hypertension in the group with CAD versus 76.3% in the group without CAD. Smoking after transplantation correlated significantly with the occurrence of CAD (P less than 0.05). There was no significant correlation with other analyzed factors in this group of patients. In this review, the development of CAD after heart transplantation correlated with treated allograft rejection. Aggressive treatment of hypertension and cessation of smoking may contribute to alleviation of this serious complication.

Nutritional management of the heart transplant recipient.

From July 1982 through February 1985, 52 patients underwent an orthotopic heart transplantation at the Texas Heart Institute. Immunosuppressive therapy consisted of cyclosporine and corticosteroids. Compromised preoperative nutritional status did not preclude acceptance into the heart transplant program. However, nutritional assessment provided a means of identifying patients who may benefit from preoperative nutritional support. The goal of postoperative nutritional therapy was to provide adequate nutrients to promote rapid wound healing and minimize complications associated with suboptimal nutritional status.