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This study compared a percutaneous, catheter-based method, in which a clip is placed to approximate the edges of the two mitral-valve leaflets, with conventional surgery. The procedure obviated the need for open-heart surgery in 80% of the patients who received it. Severe mitral regurgitation is associated with progressive left ventricular dysfunction and congestive heart failure. 1 Without intervention, symptomatic patients have an annual rate of death of 5% or more. 1 – 3 Medical management alleviates symptoms but does not alter the progression of the disease. 2 Current guidelines recommend surgery for moderate-to-severe (grade 3+) or severe (4+) mitral regurgitation in patients with symptoms or evidence of left ventricular dysfunction. 4 – 6 One surgical approach for mitral-valve repair involves approximation of the mitral leaflets with suture to create a double orifice. 7 – 9 This procedure has been described for treatment of degenerative mitral regurgitation and is usually . . .

Placement of an interatrial shunt device reduces pulmonary capillary wedge pressure during exercise in patients with heart failure and preserved or mildly reduced ejection fraction. We aimed to investigate whether an interatrial shunt can reduce heart failure events or improve health status in these patients. In this randomised, international, blinded, sham-controlled trial performed at 89 health-care centres, we included patients (aged ≥40 years) with symptomatic heart failure, an ejection fraction of at least 40%, and pulmonary capillary wedge pressure during exercise of at least 25 mm Hg while exceeding right atrial pressure by at least 5 mm Hg. Patients were randomly assigned (1:1) to receive either a shunt device or sham procedure. Patients and outcome assessors were masked to randomisation. The primary endpoint was a hierarchical composite of cardiovascular death or non-fatal ischemic stroke at 12 months, rate of total heart failure events up to 24 months, and change in Kansas City Cardiomyopathy Questionnaire overall summary score at 12 months. Pre-specified subgroup analyses were conducted for the heart failure event endpoint. Analysis of the primary endpoint, all other efficacy endpoints, and safety endpoints was conducted in the modified intention-to-treat population, defined as all patients randomly allocated to receive treatment, excluding those found to be ineligible after randomisation and therefore not treated. This study is registered with ClinicalTrials.gov, NCT03088033. Between May 25, 2017, and July 24, 2020, 1072 participants were enrolled, of whom 626 were randomly assigned to either the atrial shunt device (n=314) or sham procedure (n=312). There were no differences between groups in the primary composite endpoint (win ratio 1·0 [95% CI 0·8–1·2]; p=0·85) or in the individual components of the primary endpoint. The prespecified subgroups demonstrating a differential effect of atrial shunt device treatment on heart failure events were pulmonary artery systolic pressure at 20W of exercise (pinteraction=0·002 [>70 mm Hg associated with worse outcomes]), right atrial volume index (pinteraction=0·012 [≥29·7 mL/m2, worse outcomes]), and sex (pinteraction=0·02 [men, worse outcomes]). There were no differences in the composite safety endpoint between the two groups (n=116 [38%] for shunt device vs n=97 [31%] for sham procedure; p=0·11). Placement of an atrial shunt device did not reduce the total rate of heart failure events or improve health status in the overall population of patients with heart failure and ejection fraction of greater than or equal to 40%. Corvia Medical.

As newer interventional devices continue to enter the marketplace, balloon angioplasty remains the standard by which all devices are judged with regard to both safety and efficacy. It has been observed that predilating a stenosis with a small balloon followed by dilatation with an optimally sized larger balloon creates a more controlled arterial injury, reduces complications, and thus improves success rates. Exchanging two balloons for each lesion, however, increases the complexity and cost of the procedure in addition to increasing the amount of time required and the amount of radiation exposure. Therefore an “over-the-wire” dual-balloon catheter was developed with a small distal balloon and a larger proximal balloon on a 2.9F shaft to allow progressive coronary dilatation with a single device, without necessitating a balloon catheter exchange. The device was used successfully in 45 of 47 patients (78 lesions). The two failures were related to an inability to cross the lesion in one and failure of the device in the other. Twenty-one patients (47%) underwent a multivessel procedure. There were 29 left anterior descending/diagonal, 17 circumflex/marginal, 20 right coronary artery/posterior descending artery, and 10 vein graft lesions. The device was successfully delivered in the native anatomy to 12 distal, 27 mid, and 27, proximal lesions of which nine were osteal, for a procedural success rate of 97%. The mean stenosis was reduced from 80.7 ± 11.5% to 15.2 ± 11.9%. There were no major dissections, only 9 (11.2%) minor dissections, and no myocardial infarctions. One abrupt closure occurred at 24 hours requiring subsequent coronary artery by-pass graft. One death was recorded 5 days after the procedure and was not related to the procedure or the device. The duration of the procedure was 23.1 min/lesion and the fluoroscopy time (including passage of the wire) was 16.7 min/lesion. The amount of contrast medium used was 132.5cc/lesion. Thus this dual-balloon catheter allows progressive coronary dilatation of a stenosis with high success and low complication rates in both simple and complex lesions while possibly reducing the complexity and cost of the procedure. Further investigation is warranted.

The brown marmorated stink bug (BMSB), Halyomorpha halys (Stål, 1855) (Hemiptera: Pentatomidae), is a highly polyphagous pest native to South Korea, North Korea, Japan, Taiwan, and China, which has become invasive in the Americas and Europe. H. halys has spread rapidly in invaded areas, causing crop damage and nuisance problems due to large overwintering populations. In recent years, several studies have investigated parasitoids of H. halys within its invaded regions. These studies recovered the coevolved parasitoids Trissolcus japonicus and Tr. mitsukurii in the regions. The present research surveyed parasitoids of H. halys in Hungary and cities in Southeastern Europe (Oradea, Novi Sad, and Sofia). Several native European parasitoids belonging to the families Encyrtidae, Eupelmidae, and Scelionidae were recorded parasitizing eggs of H. halys under field conditions, with the most common species being Anastatus bifasciatus . In addition to native parasitoids, Tr. japonicus and Tr. mitsukurii were recorded for the first time in Hungary and Oradea, respectively. Further studies are needed to explore the relationship between native and exotic species and to evaluate their impacts, which will help identify the optimal approach for utilizing these parasitoid species in managing H. halys .

The chemical signatures emitted by fungal substrates are key components for mycophagous insects in the search for food source or for suitable oviposition sites. These volatiles are usually emitted by the fruiting bodies and mycelia. The volatiles attract fungivorous insects, like flowers attract pollinators; certain flowers mimic the shape of mushroom fruiting bodies and even produce a typical mushroom odor to exploit on fungus-insect mutualism. There are numerous insects which are mycophagous or eat fungi additionally, but only a few are considered a threat in agriculture. Lycoriella ingenua is one of the most serious pests in mushroom cultivation worldwide. Here we attempt to examine the role of environmental volatiles upon behavioral oviposition preference. In two-choice bioassays, fungus gnats preferred uncolonized compost compared to colonized compost but preferred colonized compost against nothing. However, when colonized compost was paired against distilled water, no significant choice was observed. The comparison of fresh casing material and mycelium colonized casing material resulted in no significant preference. From colonized compost headspace, three antennally active volatiles were isolated by gas chromatography coupled with electroantennography and subsequently identified with gas chromatography coupled mass spectrometry as 1-hepten-3-ol, 3-octanone and 1-octen-3-ol. In behavioral assays the addition of said synthetic volatiles to uncolonized compost separately and in combination to mimic colonized compost resulted in avoidance. We thus partially elucidate the role of fungal volatiles in the habitat seeking behavior of Lycoriella ingenua.

The onion thrips ( Thrips tabaci Lindeman, 1889) is a key pest of a wide range of crops because of its ecological attributes such as polyphagy, high reproduction rate, ability to transmit tospoviruses and resistance to insecticides. Recent studies revealed that T. tabaci is a cryptic species complex and it has three lineages (leek-associated arrhenotokous L1-biotype, leek-associated thelytokous L2-biotype and tobacco-associated arrhenotokous T-biotype), however, the adults remain indistinguishable. T. tabaci individuals were collected from different locations of Hungary to create laboratory colonies from each biotypes. Mitochondrial COI (mtCOI) region was sequenced from morphologically identified individuals. After sequence analysis SNPs were identified and used for CAPS marker development, which were suitable for distinguishing the three T. tabaci lineages. Genetic analysis of the T. tabaci species complex based on mtCOI gene confirmed the three well-known biotypes (L1, L2, T) and a new biotype because the new molecular evidence presented in this study suggests T-biotype of T. tabaci forming two distinct (sub)clades (T1 and T2). This genetic finding indicates that the genetic variability of T. tabaci populations is still not fully mapped. We validated our developed marker on thrips individuals from our thrips colonies. The results demonstrated that the new marker effectively identifies the different T. tabaci biotypes. We believe that our reliable genotyping method will be useful in further studies focusing on T. tabaci biotypes and in pest management by scanning the composition of sympatric T. tabaci populations.

Purpose: To determine midterm clinical outcomes among patients with lower extremity peripheral arterial disease who underwent revascularization with catheter-based plaque excision (PE). Methods: Between August 2003 and February 2005, 19 institutions participating in the observational, nonrandomized, multicenter TALON registry enrolled 601 consecutive patients (353 men; mean age 70±11, range 36–98) with 1258 symptomatic lower extremity atherosclerotic lesions (748 limbs) treated by plaque excision with the SilverHawk catheter. Approximately 50% of the patients had diabetes, and nearly one third of the procedures were indicated for Rutherford ischemia category ≥4. Mean lesion lengths above and below the knee, respectively, were 62.5±68.5 mm (interquartile range [IQR], 20.0–80.0) and 33.4±42.7 mm (IQR 15.0–37.5). The primary endpoints of the study were target lesion revascularization (TLR) at 6 and 12 months. Results: The device achieved ≤50% residual diameter stenosis in 94.7% of lesions; procedural success was 97.6%. Nearly half (41.9%) of the procedures involved PE of ≥2 lesions. Nearly three quarters (73.3%) of the lesions did not require adjunctive therapy, and stent placement following PE occurred in only 6.3% of lesions. The 6- and 12-month rates of survival free of TLR were 90% and 80%, respectively. Rates of TLR were similar among patients with diabetes (11%) and without diabetes (9%). In the multivariate analysis, significant predictors of TLR at 6 months were a history of MI or coronary revascularization (HR 5.49, 95% CI 1.87 to 16.10, p=0.0008), multiple (≥2) lesions (HR 1.37, 95% CI 1.11 to 1.70, p=0.0019), and increasing Rutherford category (HR 1.84, 95% CI 1.28 to 2.65, p=0.0003). Lesion length >50 mm was associated with a 2.9-fold increased risk for TLR (HR 2.88, 95% CI 1.18 to 7.01, p=0.012); lesion length >100 mm was associated with a 3.3-fold increase in TLR (HR 3.32, 95% CI 1.15 to 9.56, p=0.016). Conclusion: In patients undergoing revascularization for lower extremity atherosclerotic disease, catheter-based PE achieves favorable procedural success and avoids the need for repeat revascularization at midterm follow-up. These findings support PE as a primary endovascular therapy for patients undergoing lower extremity arterial revascularization.

Purpose: To examine the safety and efficacy of catheter-based plaque excision as an alternative therapy to surgery, conventional angioplasty, and/or stenting in high-risk patients with critical limb ischemia (CLI). Methods: Between August 2003 and August 2004, a prospective evaluation was conducted of consecutive patients with CLI (Rutherford category ≥5) who were treated with endovascular plaque excision at 7 institutions. This study enrolled 69 patients (37 women; mean age 70±12 years, range 43–93) with CLI involving 76 limbs. Clinical outcomes were prospectively followed for 6 months. The primary endpoint was major adverse events (death, myocardial infarction, unplanned amputation, or repeat target vessel revascularization) at 30 days. Visible healing of ulcerated tissue, avoidance of any amputation, and performance of less extensive amputation than initially planned were also assessed. Results: Procedural success was achieved in 99% of cases. Major adverse events occurred in 1% of patients at 30 days and 23% at 6 months. The target lesion revascularization rate was 4%, and there were no unplanned limb amputations. Amputation was less extensive than initially planned or avoided altogether in 92% of patients at 30 days and 82% at 6 months. Conclusion: Catheter-based plaque excision is a safe and effective revascularization method for patients with CLI. These findings support further study of this modality as a singular or adjunctive endovascular therapy for limb salvage in CLI.

Background: Reliable estimation of severity of neurological impairments early after stroke is essential for research and audit of acute stroke care. Obtaining this information prospectively requires significant resources. We wished to assess the reliability of estimating the Scandinavian Stroke Scale (SSS) score retrospectively from routine hospital admission records. Methods: Acute stroke admissions to a large urban hospital were examined and had their SSS scored by an experienced physician within 4 h of the examination performed by the medical admissions team. Two examiners (a trained research nurse and a second physician), blinded to the patients’ clinical condition, later independently estimated retrospective SSS scores using information documented in the medical admission notes. Results: Fifty patients were recruited [median age 73 years (interquartile range 61, 79)]. Weighted kappa statistics for agreement between domains of the face-to-face and retrospective SSS were as follows: consciousness 0.73, eye movements 0.60, arm motor power 0.83, hand motor power 0.71, leg motor power 0.81, orientation 0.81, speech 0.80, and facial palsy 0.53. The intraclass correlation coefficient for face-to-face and retrospective SSS composite scores was 0.97 (95% CI 0.96–0.98), p < 0.0001. Interobserver reliability for the different components of the retrospective SSS was excellent (kappa values greater than 0.75) apart from consciousness (0.71) and eye movements (0.58). Conclusions: The composite SSS score and most of its individual components can be reliably estimated retrospectively from routine hospital admission records. This method is potentially useful both in observational studies and in case-mix adjustment for audit purposes.