The Dutch experience of open access echocardiography.

Cardiac disease is not easy to recognise in general practice. An echocardiogram is an excellent way to provide information about left ventricular mass and diastolic (dys)function and the presence of valvular heart disease. To improve diagnostic care of cardiac patients, an open access echocardiography service was established in the referral area of our hospital, where general practitioners were able to ask for an echocardiogram without referring the patient to the cardiologist. Between December 2002 and October 2006 echocardiograms were requested for 471 patients. Thirteen percent of the patients referred for dyspnoea and 3% of patients with a cardiac murmur had a left ventricular ejection fraction <40%. In 28% of patients no cardiac abnormality could be found. If we looked at the prevalence of hypertension in the referred patients, this was very high with a prevalence of up to 60% in the older age groups. If we included hypertension in the analysis, only 16% of patients had no structural cardiac or vascular abnormality. The study shows that the advantage of open access echocardiography in the Netherlands is that the general practitioner is able to make a better diagnosis and unnecessary referrals of patients with suspected cardiac disease can be avoided. (Neth Heart J 2007;15:342-7.).

Multiple CMS-restorer gene polymorphism in gynodioecious Plantago coronopus.

The mode of inheritance of the male sterility trait is crucial for understanding the evolutionary dynamics of the sexual system gynodioecy, which is the co-occurrence of female and hermaphrodite plants in natural populations. Both cytoplasmic (CMS) and nuclear (restorer) genes are known to be involved. Theoretical models usually assume a limited number of CMS genes with each a single restorer gene, while reality is more complex. In this study, it is shown that in the gynodioecious species Plantago coronopus two new CMS-restorer polymorphisms exist in addition to the two that were already known, which means four CMS-restorer systems at the species level. Furthermore, three CMS types were shown to co-occur within a single population. All new CMS types showed a multilocus system for male fertility restoration, in which both recessive and dominant restorer alleles occur. Our finding of more than two co-occurring CMS-restorer systems each with multiple restorer genes raises the question how this complex of male sterility systems is maintained in natural populations.

The dynamics of gynodioecy in Plantago lanceolata L. II. Mode of action and frequencies of restorer alleles.

Male fertility in Plantago lanceolata is controlled by the interaction of cytoplasmic and nuclear genes. Different cytoplasmic male sterility (CMS) types can be either male sterile or hermaphrodite, depending on the presence of nuclear restorer alleles. In three CMS types of P. lanceolata (CMSI, CMSIIa, and CMSIIb) the number of loci involved in male fertility restoration was determined. In each CMS type, male fertility was restored by multiple genes with either dominant or recessive action and capable either of restoring male fertility independently or in interaction with each other (epistasis). Restorer allele frequencies for CMSI, CMSIIa and CMSIIb were determined by crossing hermaphrodites with "standard" male steriles. Segregation of male steriles vs. non-male steriles was used to estimate overall restorer allele frequency. The frequency of restorer alleles was different for the CMS types: restorer alleles for CMSI were less frequent than for CMSIIa and CMSIIb. On the basis of the frequencies of male steriles and the CMS types an "expected" restorer allele frequency could be calculated. The correlation between estimated and expected restorer allele frequency was significant.