Potential for using simulated altitude as a means of prehabilitation: a physiology study.

The current pandemic of surgical complications necessitates urgent and pragmatic innovation to reduce postoperative morbidity and mortality, which are associated with poor pre-operative fitness and anaemia. Exercise prehabilitation is a compelling strategy, but it has proven difficult to establish that it improves outcomes either in isolation or as part of a multimodal approach. Simulated altitude exposure improves performance in athletes and offers a novel potential means of improving cardiorespiratory and metabolic fitness and alleviating anaemia within the prehabilitation window. We aimed to provide an initial physiological foundation for 'altitude prehabilitation' by determining the physiological effects of one week of simulated altitude (FI O2 15%, equivalent to approximately 2438 m (8000 ft)) in older sedentary volunteers. The study used a randomised, double-blind, sham-controlled crossover design. Eight participants spent counterbalanced normoxic and hypoxic weeks in a residential hypoxia facility and underwent repeated cardiopulmonary exercise tests. Mean (SD) age of participants was 64 (7) y and they were unfit, with mean (SD) baseline anaerobic threshold 12 (2) ml.kg-1 .min-1 and mean (SD) peak V̇O2 15 (3) ml.kg-1 .min-1 . Hypoxia was mild (mean (SD) Sp O2 93 (2) %, p < 0.001) and well-tolerated. Despite some indication of greater peak exercise capacity following hypoxia, overall there was no effect of simulated altitude on anaerobic threshold or peak V̇O2 . However, hypoxia induced a substantial increase in mean (SD) haemoglobin of 1.5 (2.7) g.dl-1 (13% increase, p = 0.028). This study has established the concept and feasibility of 'altitude prehabilitation' and demonstrated specific potential for improving haematological fitness. Physiologically, there is value in exploring a possible role for simulated altitude in pre-operative optimisation.

Temporal Trends in Polybrominated Diphenylethers (PBDEs) in Blubber of Ringed Seals (Pusa hispida) from Ulukhaktok, NT, Canada Between 1981 and 2015.

Blubber taken from ringed seals (Pusa hispida) during a subsistence hunt at Ulukhaktok, NT (formerly Holman, NWT) at intervals between 2002 and 2015 was analysed for polybrominated diphenyl ether (PBDE) congeners. Results from these analyses were combined with others previously published to yield a data set of 18 tri- to hepta-substituted PBDE congeners in 102 animals sampled over a span of 19 year (females) and 34 year (males). In females, mean total PBDE concentrations increased between 1996 and 2015 by approximately 50%, from 1940 to 2780 pg/g wet wt., although not significantly so (p > 0.05) by one-way ANOVA. In males, concentrations ranged from 376 to 6470 pg/g wet wt. between 1981 and 2015 (p < 0.05). In males, the most rapid increase in PBDE concentrations occurred before 2000, but between 2002 and 2015 mean total PBDE concentrations increased by a further 50%. ANCOVA showed PBDE concentrations in females to be correlated (p < 0.05) with sampling year but not with age or condition (as measured by blubber thickness); in males, PBDE concentrations were strongly correlated (p < 0.01) with year, age and condition. The relative proportions of tetra-bromo- congeners declined weakly in both sexes over the sampling period, with a compensatory increase in penta-bromo-congener distribution. Overall, the results show no evidence yet of a decline in PBDE concentrations in western Arctic ringed seals in response to voluntary and regulated restrictions on PBDE use in the early 2000s.

Cancer survivor perspectives on sharing patient-generated health data with central cancer registries.

PURPOSE: Central cancer registries collect data and provide population-level statistics that can be tracked over time; yet registries may not capture the full range of clinically relevant outcomes. Patient-generated health data (PGHD) include health/treatment history, biometrics, and patient-reported outcomes (PROs). Collection of PGHD would broaden registry outcomes to better inform research, policy, and care. However, this is dependent on the willingness of patients to share such data. This study examines cancer survivors' perspectives about sharing PGHD with central cancer registries. METHODS: Three U.S. central registries sampled colorectal, non-Hodgkin lymphoma, and metastatic breast cancer survivors 1-4 years after diagnosis, recruiting them via mail to participate in one of seven focus groups (n = 52). Group discussions were recorded, transcribed, and thematically analyzed. RESULTS: Most survivor-participants were unaware of the existence of registries. After having registries explained, all participants expressed their willingness to share PGHD with them if treated confidentially. Participants were willing to provide information on a variety of topics (e.g., medical history, medications, symptoms, financial difficulties, quality of life, biometrics, nutrition, exercise, and mental health), with a focus on long-term effects of cancer and its treatment. Participants' preferred mode for providing data varied. Participants were also interested in receiving information from registries. CONCLUSIONS: Our results suggest that registry-based collection of PGHD is acceptable to most cancer survivors and could facilitate registry-based efforts to collect PGHD/PROs. Central cancer registry-based collection of PGHD/PROs, especially on long-term effects, could enhance registry support of cancer control efforts including research and population health management.

Imaging characteristics associated with failure of nonoperative management in high-grade pediatric blunt renal trauma.

INTRODUCTION: Some children who sustain high-grade blunt renal injury may require operative intervention. In the present study, it was hypothesized that there are computed tomography (CT) characteristics that can identify which of these children are most likely to need operative intervention. MATERIALS AND METHODS: A retrospective review was performed of all pediatric blunt renal trauma patients at a single level-I trauma center from 1990 to 2015. Inclusion criteria were: children with American Association for the Surgery of Trauma (AAST) Grade-IV or V renal injuries, aged ≤18 years, and having available CT images with delayed cuts. The CTs were regraded according to the revised AAST grading system proposed by Buckley and McAninch in 2011. Radiographic characteristics of renal injury were correlated with the primary outcome of any operative intervention: ureteral stent, angiography, nephrectomy/renorrhaphy, and percutaneous nephrostomy/drain. RESULTS: One patient had a Grade-V injury and 26 patients had Grade-IV injuries. Nine patients (33.3%) underwent operative interventions. Patients in the operative intervention cohort were more likely to manifest a collecting system filling defect (P = 0.040) (Fig. A) and lacked ureteral opacification (P = 0.010). The CT characteristics, including percentage of devascularized parenchyma, medial contrast extravasation, intravascular contrast extravasation, perirenal hematoma distance and laceration location, were not statistically significant. Of the 21 patients who had a collecting system injury, eight (38.1%) needed ureteral stents. Renorrhaphy was necessary for one patient. Although the first operative intervention occurred at a median of hospital day 1 (range 0.5-2.5), additional operative interventions occurred from day 4-16. Thus, it is prudent to closely follow-up these patients for the first month after injury. Two patients with complex renal injuries had an accessory renal artery resulting in well-perfused upper and lower pole fragments, and were managed nonoperatively without readmission (Fig. B). CONCLUSIONS: Collecting system defects and lack of ureteral opacification were significantly associated with failure of nonoperative management. A multicenter trial is needed to confirm these findings and whether nonsignificant CT findings are associated with operative intervention. In the month after renal injury, these patients should be mindful of any changes in symptoms, and maintain a low index of suspicion for an emergency room visit. For the physician, close follow-up and appropriate counseling of these high-risk patients is advised.

A randomized, placebo-controlled trial of the benzoquinone idebenone in a mouse model of OPA1-related dominant optic atrophy reveals a limited therapeutic effect on retinal ganglion cell dendropathy and visual function.

Dominant optic atrophy (DOA) arises from mutations in the OPA1 gene that promotes fusion of the inner mitochondrial membrane and plays a role in maintaining ATP levels. Patients display optic disc pallor, retinal ganglion cell (RGC) loss and bilaterally reduced vision. We report a randomized, placebo-controlled trial of idebenone at 2000 mg/kg/day in 56 Opa1 mutant mice (B6;C3-Opa1(Q285STOP)), with RGC dendropathy and visual loss, and 63 wildtype mice. We assessed cellular responses in the retina, brain and liver and RGC morphology, by diolistic labeling, Sholl analysis and quantification of dendritic morphometric features. Vision was assessed by optokinetic responses. ATP levels were raised by 0.57 nmol/mg (97.73%, p=0.035) in brain from idebenone-treated Opa1 mutant mice, but in the liver there was an 80.35% (p=0.011) increase in oxidative damage. NQO1 expression in Opa1 mutant mice was reduced in the brain (to 30.5%, p=0.002) but not in retina, and neither expression level was induced by idebenone. ON-center RGCs failed to show major recovery, other than improvements in secondary dendritic length (by 53.89%, p=0.052) and dendritic territory (by 2.22 × 10(4) µm(2) or 90.24%, p=0.074). An improvement in optokinetic response was observed (by 12.2 ± 3.2s, p=0.003), but this effect was not sustained over time. OFF-center RGCs from idebenone-treated wildtype mice showed shrinkage in total dendritic length by 2.40 mm (48.05%, p=0.025) and a 47.37% diminished Sholl profile (p=0.029). Visual function in wildtype idebenone-treated mice was impaired (2.9 fewer head turns than placebo, p=0.007). Idebenone appears largely ineffective in protecting Opa1 heterozygous RGCs from dendropathy. The detrimental effect of idebenone in wildtype mice has not been previously observed and raises some concerns.

Calcium oxalate nephrolithiasis and tubular necrosis in recent metamorphs of Rana sylvatica (Lithobates sylvaticus) fed spinach during the premetamorphic (tadpole) stage.

Amphibians in the family Ranidae (true frogs) seem highly susceptible to oxalosis, particularly when fed a diet high in oxalic acid during the premetamorphic (tadpole) stage. The authors describe the mortality of 150 captive-raised wood frogs (Rana sylvatica or Lithobates sylvaticus) from oxalate nephrolithiasis and renal tubular necrosis caused by consumption of boiled spinach during tadpole development. Renal lesions were due to intraluminal transparent crystals which were birefringent under polarized light and were identified morphologically and histochemically as composed of calcium oxalate. Evidence of early fibrosis or squamous metaplasia, and a presentation at least 2 weeks after spinach consumption had ended, suggested a subacute course. Tadpole-feeding protocols should avoid plants with high oxalate content (eg, spinach and rhubarb leaves), and any episode of high mortality in captive amphibians along with nephrolithiasis should prompt an evaluation of the feed sources for material with high oxalate content.

Temporal trends in "legacy" organochlorine contaminants in blubber of ringed seals (Phoca hispida) from Ulukhaktok, NT, Canada between 1972 and 2010.

In blubber of ringed seals (Phoca hispida) from Ulukhaktok, NT, residues of DDT, other organochlorine pesticides, and PCBs declined between 1972 and 2010. The rate of decline varied: concentrations of the DDT-group began to fall after 1981, whereas those of PCBs fell rapidly between 1972 and 1981, and then slowed. Concentrations of cis- and trans-chlordane and of HCB in both sexes, and of cis-nonachlor in males, declined slowly between 1978 and 2010; those of other organochlorine pesticides remained steady. Exponential half-lives of p,p'-DDT and p,p'-DDE in female seals are about 9 and 36 y (corresponding to initial declines of 7.8% and 1.9% per year, respectively) and those of PCB congeners from about 20 to 60 y (declines of 3.2% to <1.5% per year); the more refractory residues may be detectable for centuries to come. Exploratory PCA of PCB congener distribution identified temporal changes apparently not related to molecular structure.

Hexachlorocyclohexanes (HCH) in ringed seal (Phoca hispida) from Ulukhaktok (Holman), NT: trends from 1978 to 2006.

Trends in alpha-, beta-, and gamma-hexachlorocyclohexane (HCH) concentrations were examined in blubber lipid of ringed seals (Phoca hispida) from Ulukhaktok (Holman), NT (Canada) sampled at intervals between 1978 and 2006. alpha-HCH usually represented approximately 90% of the total HCH isomers. alpha-HCH and gamma-HCH concentrations showed no change over the sampling interval, but beta-HCH concentrations increased significantly, about 8-10-fold in females and 4-5-fold in males. Residue concentrations showed no dependence on age. Concentrations (all data as ng/g lipid, GM (range)) of alpha-HCH were significantly higher (P<0.001 by t-test) in males (217 (93.9-517), n=37) than those in females (138 (40.9-402), n=38). beta-HCH concentrations did not differ between the sexes. Concentrations of gamma-HCH were significantly higher (P<0.05) in males (6.74 (0-46.7)) than in females (4.35 (0-19.0)). Although global emissions of both alpha-HCH and beta-HCH have declined since the early 1980's, the "signal" of HCH emission changes has not yet resulted in a "response" in ringed seal residue concentrations. In the light of our current understanding of the dynamics of HCH in the Arctic, we conclude that any such response may not be detected by retrospective analyses of the sort describe here at least for another decade or so, because of the longevity of the seals.

Mutation of the von Hippel-Lindau gene alters human cardiopulmonary physiology.

Intracellular responses to hypoxia are coordinated by the von Hippel-Lindau--hypoxia-inducible factor (VHL-HIF) transcriptional system. This study investigated the potential role of the VHL-HIF pathway in human systems-level physiology. Patients diagnosed with Chuvash polycythaemia, a rare disorder in which VHL signalling is specifically impaired, were studied during acute hypoxia and hypercapnia. Subjects breathed through a mouthpiece and ventilation was measured while pulmonary vascular tone was assessed echocardiographically. The patients were found to have elevated basal ventilation and pulmonary vascular tone, and ventilatory, pulmonary vasoconstrictive and heart rate responses to acute hypoxia were greatly increased, as were heart rate responses to hypercapnia. The patients also had abnormal pulmonary function on spirometry. This study's findings demonstrate that the VHL-HIF signalling pathway, which is so central to intracellular oxygen sensing, also regulates the organ systems upon which cellular oxygen delivery ultimately depends.

PCDD/F and PCB concentrations in Arctic ringed seals (Phoca hispida) have not changed between 1981 and 2000.

Concentrations of polychlorinated dibenzo-p-dioxins (PCDD) and dibenzofurans (PCDF) and of non-ortho-, mono-ortho- and di-ortho-substituted polychlorinated biphenyls (NO-CB, MO-CB and DO-CB) were measured in blubber of ringed seals sampled at Holman, NWT, in 1981, 1991, 1996 and 2000. Total PCDD and PCDF concentrations were usually below approx. 10 and 5 pg/g wet wt., respectively, and did not change significantly between 1981 and 2000, although there were sporadic temporal differences in some congeners. Total NO-CB, MO-CB and DO-CB concentrations were below approx. 1 ng/g, 250 ng/g and 1 microg/g wet wt. respectively; none of the total PCB concentrations changed significantly over the sampling period. Neither PCDD nor PCDF concentrations differed between males and females, nor did they increase with age in male samples. MO-CB and DO-CB concentrations increased with age in males, but not in females, and concentrations of total MO-CB and DO-CB were usually lower in females than in males. Changes in the distribution of PCB congeners between the 1980s and the 1990s are consistent with atmospheric transport processes becoming increasingly important in the introduction of PCBs to the Arctic in recent years.

PCDD/F and PCB in harbour seals (Phoca vitulina) from British Columbia: response to exposure to pulp mill effluents.

Blubber of harbour seals (Phoca vitulina) sampled from the Strait of Georgia, BC, in 1991 and 1992 contained higher concentrations of polychlorinated dibenzo-p-dioxins and furans (PCDD/F) than did samples from Quatsino Sound on western Vancouver Island. The higher proportions of 1,2,3,6,7,8-hexachlorodibenzodioxin and 2,3,7,8-tetrachlorodibenzofuran in the Strait of Georgia samples probably reflect contamination arising from the discharge of effluents from bleached kraft mills. Higher concentrations of non-ortho- and mono-ortho substituted polychlorinated biphenyls were also found in the Strait of Georgia samples, probably as a result of general industrial activity in the region. Principal components analysis showed that residues were distributed differently between males and females. Within males, concentrations of PCDD, PCDF and PCBs appeared to increase with age. Toxic equivalents (TEQ) to 2,3,7,8-tetrachlorodibenzodioxin in the Quatsino Sd. samples were close to the working guidelines for edible fish used by Health Canada; TEQ calculated for the Strait of Georgia samples exceeded these guidelines by up to a factor of five.

Laparoscopic radiofrequency thermal ablation of renal tissue with and without hilar occlusion.

PURPOSE: Few studies have evaluated the effect of radiofrequency thermal ablation on renal tissue, although it has been used clinically to treat small renal masses. We studied the size and histology of lesions created with radiofrequency thermal ablation administered via the laparoscopic approach with and without hilar occlusion in a porcine model. MATERIALS AND METHODS: The lower pole of each kidney was exposed laparoscopically in 11 farm pigs. In each kidney a 7-electrode dry radiofrequency thermal ablation probe was inserted at an identical location and deployed to a diameter of 2 cm. Energy was applied for 8 minutes at an average temperature of 100C. The left renal hilum of each pig was clamped during radiofrequency thermal ablation. Two pigs were sacrificed immediately, and 3 each were sacrificed at 24 hours, 2 and 4 weeks. The size and shape of the lesions created were measured and examined histologically. RESULTS: There were no intraoperative or postoperative complications. Laparoscopic ultrasound confirmed probe placement but did not monitor lesion progression. Acutely lesions were firm and white with a small adjacent hemorrhagic zone. Histological evaluation revealed preserved renal architecture but the loss of distinct cytoplasmic features. Nicotinamide adenine dinucleotide staining demonstrated no viable cells within the lesions. In surviving animals pelvicaliceal integrity was preserved. In the 2 and 4-week survival groups kidneys treated with hilar occlusion had larger lesions than nonoccluded kidneys but the differences were not significant at 4 weeks (3.2 x 2.7 x 2.5 cm. and 3.5 x 1.7 x 2.0, respectively, p >0.05). Histologically untreated parenchyma of hilar occluded kidneys demonstrated changes consistent with chronic pyelonephritis. In 1 kidney radiofrequency thermal ablation with hilar occlusion resulted in complete lower pole loss at 4 weeks. CONCLUSIONS: In the porcine model renal radiofrequency thermal ablation creates rapid and completely devitalized lesions of consistent size and shape. Hilar occlusion may result in slightly larger lesions but risks damage to the whole renal unit.

Renal parenchymal injury after standard and mini percutaneous nephrostolithotomy.

PURPOSE: Mini percutaneous nephrostolithotomy was developed for use in children and in adults with a reduced renal reserve to minimize the morbidity and renal parenchymal damage presumed to occur with traditional percutaneous nephrostolithotomy. We compared the extent of renal injury incurred by different sized nephrostomy tracts in female farm pigs undergoing 11 or 30Fr percutaneous nephrostomy. MATERIALS AND METHODS: Bilateral percutaneous nephrostomy was attempted via a mid or lower pole calix under fluoroscopic guidance in 6 pigs. In 2 pigs the procedure was unsuccessful on 1 side, leaving 5 successfully established nephrostomy tracts on each side. In each pig the right percutaneous tract was dilated with a 28Fr dilating balloon and a 30Fr Amplatz working sheath (Cook Urological, Spencer, Indiana) was positioned in the collecting system. On the left side an 11Fr sheath (Cook Urological) was placed. The sheaths were removed after 1 hour and nephrostomy tubes (22Fr on the right and 8Fr on the left side) were left in place overnight and then removed. Six weeks later the pigs were sacrificed and the kidneys were harvested. The nephrostomy tracts were identified grossly and examined microscopically, and the fibrotic scar was measured using digital analysis. The volume of scar was estimated using the calculated volume of a cylinder. RESULTS: At kidney harvest all 10 kidneys appeared grossly normal. No intra-abdominal urine collection or perirenal hematoma was noted. Mean estimated scar volume of the 30 and 11Fr tracts was 0.29 and 0.40 cc, which translates into a mean fractional loss of parenchyma of 0.63% and 0.91%, respectively (p not significant). CONCLUSIONS: Renal parenchymal damage resulting from the creation of a nephrostomy tract is small compared to overall renal volume regardless of the size of the nephrostomy tract. Consequently there is no advantage to the use of a small access sheath based on renal scarring alone.

Commitment to sexual differentiation in the human malaria parasite, Plasmodium falciparum.

The differentiation of the two sexes in the gametocytogenesis of Plasmodium falciparum was investigated using a plaque assay and antibodies specific for various stages and sexes of gametocytes. Immunofluorescence assays on plaques of cultured parasites grown in monolayers of erythrocytes revealed that the merozoites released from a single sexually-committed schizont became either all male or all female gametocytes. Thus, the commitment of this species to differentiate into one sex or the other is likely to occur prior to the nuclear division of the sexually-committed schizont. The characteristic female-biased gametocyte sex ratio observed for many Plasmodium species is manifested in P. falciparum by a greater percentage of schizonts that produce female gametocytes (67-71%) than those that yield males. From the plaque assay, it was determined that the number of gametocytes produced per sexually-committed schizont was similar for both sexes, indicating that allocation of parasite resources was equal for each sex of gametocyte. The timing of sexual differentiation and features of the gametocyte sex ratio is discussed in relation to previous observations on P. falciparum and related malaria parasites.

Intraerythrocytic development of species of Hepatozoon infecting ranid frogs: evidence for convergence of life cycle characteristics among apicomplexans.

Intraerythrocytic development of the adeleorin apicomplexans Hepatozoon clamatae and Hepatozoon catesbianae were investigated in the bullfrog, Rana catesbeiana, the green frog, Rana clamitans melanota, and the Northern leopard frog, Rana pipiens. Merozoites emerging from hepatic meronts penetrated erythrocytes and underwent 1-3 rounds of binary fission to produce 2-8 merozoites. Following their release from infected erythrocytes, individual merozoites entered new cells and transformed into gamonts. Although this is the first report of intraerythrocytic development for a fully described species of Hepatozoon, a phylogenetic reanalysis of 11 species of Hepatozoon, 6 species representative of the 5 other hemogregarine taxa, 2 species of dactylosomatids, and 2 species of piroplasms, indicates that asexual reproduction of parasites within blood cells of vertebrates has arisen at least 3 times in the apicomplexan lineage that includes adeleorins and piroplasms. This method of asexual development, which is also observed in species of hemospororin genera such as Plasmodium, is discussed in the context of the evolution of apicomplexan life cycles. In addition to supporting the paraphyly of the genus Hepatozoon determined in an earlier study, this phylogenetic analysis featured a monophyletic group, consisting of the sister taxa Hemolivia and Karyolysus, that was the sister group to a clade consisting of the more derived hemogregarines, the dactylosomatids, and the piroplasms.

Direct modulation of basal and angiotensin II-stimulated aldosterone secretion by hydrogen ions.

Disturbances in acid-base balance in vivo are associated with changes in plasma aldosterone concentration, and in vitro changes in extracellular pH (pH(o)) influence the secretion of aldosterone by adrenocortical tissue or glomerulosa cells. There is considerable disparity, however, as to the direction of the effect. Furthermore, the mechanisms by which pH(o) independently affects aldosterone secretion or interacts with other secretagogues are not defined. Thus, bovine glomerulosa cells maintained in primary monolayer culture were used to examine the direct effects of pH(o) on cytosolic free calcium concentration ([Ca(2+)](i))( )and aldosterone secretion under basal and angiotensin II (AngII)-stimulated conditions. pH(o) was varied from 7.0 to 7.8 (corresponding inversely to changes in extracellular H(+) concentration from 16 nM to 100 nM). Whereas an elevation of pH(o) from 7.4 to 7.8 had no consistent effect, reductions of pH(o) from 7.4 to 7.2 or 7.0 caused proportionate increases in aldosterone secretion that were accompanied by increases in transmembrane Ca(2+) fluxes and [Ca(2+)](i). These effects were abolished by removal of extracellular Ca(2+). A decrease in pH(o) from 7.4 to 7.0 also enhanced AngII-stimulated aldosterone secretion. This effect was more pronounced at low concentrations of AngII and was manifested as an increase in the magnitude of the secretory response with no effect on potency. In contrast to its effect on AngII-stimulated aldosterone secretion, a reduction of pH(o) from 7.4 to 7.0 inhibited the Ca(2+) signal elicited by low concentrations (

Sex allocation and population structure in apicomplexan (protozoa) parasites.

Establishing the selfing, rate of parasites is important for studies in clinical and epidemiological medicine as well as evolutionary biology Sex allocation theory offers a relatively cheap and easy way to estimate selfing rates in natural parasite populations. Local mate competition (LMC) theory predicts that the optimal sex ratio (r*; defined as proportion males) is related to the selfing rate (s) by the equation r* = (1-s)/2. In this paper, we generalize the application of sex allocation theory across parasitic protozoa in the phylum Apicomplexa. This cosmopolitan phylum consists entirely of parasites, and includes a number of species of medical and veterinary importance. We suggest that LMC theory should apply to eimeriorin intestinal parasites. As predicted, data from 13 eimeriorin species showed a female-biased sex ratio, with the sex ratios suggesting high levels of selfing (0.8-1.0). Importantly, our estimate of the selfing rate in one of these species, Toxoplasma gondii, is in agreement with previous genetic analyses. In contrast, we predict that LMC theory will not apply to the groups in which syzygy occurs (adeleorins, gregarines and piroplasms). Syzygy occurs when a single male gametocyte and a single female gametocyte pair together physically or in close proximity, just prior to fertilization. As predicted, data from four adeleorin species showed sex ratios not significantly different from 0.5.