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•126 Metarhizium spp. isolates from roots of oat, rye and cabbage were analyzed.•13 unique Metarhizium multilocus genotypes (MLG) were identified by SSR markers.•One MLG of M. ...brunneum was most frequent on all three crops (66.7%, 79.1%, 79.2%).•No plant associations of any of the Metarhizium MLGs were observed.
Metarhizium spp. have recently been shown to be associated with the roots of different plants. Here we evaluated which Metarhizium species were associated with roots of oat (Avena sativa), rye (Secale cereale) and cabbage (Brassica oleracea), common crop plants in Denmark. Thirty-six root samples from each of the three crops were collected within an area of approximately 3ha. The roots were rinsed with sterile water, homogenized and the homogenate plated onto selective media. A subset of 126 Metarhizium isolates were identified to species by sequencing of the 5′ end of the gene translation elongation factor 1-alpha and characterized by simple sequence repeat (SSR) analysis of 14 different loci. Metarhizium brunneum was the most common species isolated from plant roots (84.1% of all isolates), while M. robertsii (11.1%) and M. majus (4.8%) comprised the remainder. The SSR analysis revealed that six multilocus genotypes (MLGs) were present among the M. brunneum and M. robertsii isolates, respectively. A single MLG of M. brunneum represented 66.7%, 79.1% and 79.2% of the total isolates obtained from oat, rye and cabbage, respectively. The isolation of Metarhizium spp. and their MLGs from roots revealed a comparable community composition as previously reported from the same agroecosystem when insect baiting of soil samples was used as isolating technique. No specific MLG association with a certain crop was found. This study highlights the diversity of Metarhizium spp. found in the rhizosphere of different crops within a single agroecosystem and suggests that plants either recruit fungal associates from the surrounding soil environment or even govern the composition of Metarhizium populations.
Biological control agents based on entomopathogenic fungi traditionally contain a single strain that is efficient under certain biotic and abiotic conditions. Since particularly abiotic conditions ...vary, biological control efficiency may become more resilient at extreme temperatures if two or more fungal strains are combined based on their adaptations to their original environment. Here we evaluated the in vitro temperature-dependent germination and growth rate for six Beauveria spp. isolates originating from either arctic or tropical regions. Isolates of arctic origin showed higher germination and growth rate at 8°C and 12°C than isolates from the tropics while the latter group showed highest germination and in vitro growth at 32°C. Three of the isolates belonging to Beauveria bassiana were further tested in vivo for temperature-dependent infection in the mealworm beetle Tenebrio molitor both individually and combined. The same amounts of conidia were used in all bioassays. Virulence was isolate dependent at all temperatures with no additional effect at the low (12°C) and high (32°C) temperatures of combinations of arctic and tropical isolates. The results therefore indicate that adaptations to abiotic conditions in the natural environment do not directly reflect the effect of biotic environment (such as host infection) under similar conditions. Selection of isolates for biocontrol agents should not be based solely on in vitro experiments, while isolate selection based on virulence should also include considerations of the abiotic conditions the isolates are expected to function.
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•Predators were exposed to Metarhizium brunneum in the soil.•Gaeolaelaps aculeifer was the species least affected by M. brunneum.•Orius majusculus was the species most affected by M. ...brunneum.•Dalotia coriaria and Aphidoletes aphidimyza showed an intermediate response.
Biological control with entomopathogenic fungi is a feasible option for regulation of pest insect populations. However, possible effects on beneficial arthropods must be considered. We assessed the non-target effects of the microbial biological control agent Metarhizium brunneum (isolate BIPESCO 5/F 52) applied in soil on four different predatory arthropods: the predatory mite Gaeolaelaps aculeifer (Canestrini), the predatory bug Orius majusculus (Reuter), the rove beetle Dalotia coriaria (Kraatz) and the gall midge Aphidoletes aphidimyza Rondani. All are widespread and naturally occurring in Europe, they represent different classes of arthropods and different insect orders; furthermore, their life cycles involve different levels of contact with the soil. Adult G. aculeifer, O. majusculus, and D. coriaria, and last instar A. aphidimyza larvae were exposed to natural soil (control) or natural soil inoculated with M. brunneum at a concentration of 5 × 106 conidia/g of soil; this represents a worst-case scenario. Mortality, longevity, fecundity and Metarhizium outgrowth on dead individuals were assessed for the first three species; for A. aphidimyza, only mortality (non-emergence rate) and fecundity of emerged females were assessed. The fungal treatment resulted in a significantly higher mortality of O. majusculus and D. coriaria, 96%, and 7.3% respectively, compared with 19%, and 2% for their respective controls. Mortality of G. aculeifer was not significantly affected by exposure to the fungus in the soil. Longevity of O. majusculus and D. coriaria was significantly reduced following exposure to the fungus in the soil (log-rank test: p < 0.0001, Wilcoxon test p < 0.0001 and log-rank test: p = 0.029, Wilcoxon test: p = 0.027, respectively), while G. aculeifer longevity was not affected. Fecundity of O. majusculus and D. coriaria was negatively affected following exposure to the fungus in the soil, which reduced their oviposition by 20% and 4%, respectively, compared with the control, while G. aculeifer fecundity was not affected. Aphidoletes aphidimyza larval mortality was higher following exposure to the fungus in the soil (60% dead) than in the control (40% dead) but its fecundity was not statistically significantly affected by treatment. In conclusion, the predatory arthropods studied demonstrated a range of fitness responses to M. brunneum exposure in the soil, from no response (G. aculeifer), to intermediate (D. coriaria and A. aphidimyza) and high response (O. majusculus). This study demonstrates the relevance of using several fitness parameters and different arthropod species to determine whether a biological control agent should be considered a low-risk substance with respect to non-target effects.
Abstract Background The incidence of complications after implantable cardioverter-defibrillator (ICD) and cardiac resynchronisation therapy (CRT-D) implantations is dependent on the number of ...implanted leads. The majority of CRT-D patients have unimpaired sinus node function and do not require atrial pacing. A two-lead CRT-D system with a floating atrial sensing dipole mounted on the right ventricular lead ((CRT-DX) allows dual chamber tachyarrhythmia detection, and atrio-ventricular sequential pacing with a reduced amount of implanted material. Purpose This study investigated the clinical efficacy and safety of the CRT-DX system. Methods This multicentre, single-arm study observed patients after de novo implantation of a CRT-DX system for 12 months. Patients were eligible for the study when chronotropic competence was proven by heart rates ≥100 bpm during exercise, premature ventricular contractions rate of < 5%/h and absence of atrioventricular block ≥ II. Intraoperatively measured p-wave amplitude of ≥ 1 mV was recommended. The primary safety endpoint was the additional implantation of a right atrial (RA) lead after the initial implantation. As indicators of efficacy, we report the changes in left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) class over the follow-up period. Results Overall, 110 patients were implanted with the complete CRT-DX system. Mean age of study participants was 62 ± 12 years and 77 (70%) were male. The underlying heart disease was non-ischemic in 66 (60%) patients and 103 (93%) had a left bundle branch block. NYHA class was II in 60 (54.5%) and III in 50 (45.5%) patients. ICD placement was performed in 13 (11.8%) patients for the secondary prevention of sudden cardiac death. A total of 104 patients completed the follow-up, 2 patients died, 1 had the system explanted for infection, 2 withdrew consent and 1 was lost to follow-up. The primary endpoint of RA lead implantation was met in 2 (1.8%) participants (Figure 1). One patient required atrial pacing and one patient, who had shown a p-wave amplitude < 1 mV at implantation, lost atrial sensing. The mean RA sensing amplitude remained stable during follow-up (4.6 ± 1.8 mV, 4.9 ± 1.8 mV and 4.6 ± 1.8 mV at 1, 6 and 12 months, respectively; Figure 2). The LVEF improved by 14.7% ± 11.0%, from 26.3% ± 6.9% to 40.8% ± 10.7% (p < 0.00001). Changes in NYHA class were available in 87 patients with 35 (40.2%) improved by one class and 13 (14.9 %) by two classes. Thirty-four (39.1%) had no change and 5 (5.7%) worsened by one class (global p < 0.00001). Conclusion The two-lead CRT-DX system showed a low requirement of subsequent RA lead implantations (1.8%) and stable RA sensing amplitudes. Our results suggest a CRT response similar to that of conventional three-lead CRT-D systems. CRT-DX systems appear to be a feasible alternative for patients with chronotropic competence.Kaplan-Meier curve for primary endpointDaily mean RA sensing amplitude
Permanent cardiac pacing is the only effective treatment for symptomatic bradycardia, but complications associated with conventional transvenous pacing systems are commonly related to the pacing lead ...and pocket. We describe the early performance of a novel self-contained miniaturized pacemaker.
Patients having Class I or II indication for VVI pacing underwent implantation of a Micra transcatheter pacing system, from the femoral vein and fixated in the right ventricle using four protractible nitinol tines. Prespecified objectives were >85% freedom from unanticipated serious adverse device events (safety) and <2 V 3-month mean pacing capture threshold at 0.24 ms pulse width (efficacy). Patients were implanted (n = 140) from 23 centres in 11 countries (61% male, age 77.0 ± 10.2 years) for atrioventricular block (66%) or sinus node dysfunction (29%) indications. During mean follow-up of 1.9 ± 1.8 months, the safety endpoint was met with no unanticipated serious adverse device events. Thirty adverse events related to the system or procedure occurred, mostly due to transient dysrhythmias or femoral access complications. One pericardial effusion without tamponade occurred after 18 device deployments. In 60 patients followed to 3 months, mean pacing threshold was 0.51 ± 0.22 V, and no threshold was ≥2 V, meeting the efficacy endpoint (P < 0.001). Average R-wave was 16.1 ± 5.2 mV and impedance was 650.7 ± 130 ohms.
Early assessment shows the transcatheter pacemaker can safely and effectively be applied. Long-term safety and benefit of the pacemaker will further be evaluated in the trial.
ClinicalTrials.gov ID NCT02004873.
Pulmonary vein isolation (PVI) is recommended to treat paroxysmal and persistent atrial fibrillation (AF). This analysis aimed to assess the hospital efficiency of single-shot cryoballoon ablation ...(CBA) and point-by-point radiofrequency ablation (RFA).
The discrete event simulation used PVI procedure times from the FREEZE Cohort study to establish the electrophysiology (EP) lab occupancy time. 1000 EP lab days were simulated according to an illustrative German hospital, including 3 PVI cases per day using CBA at one site and RFA at the other.
The analysis included 1560 CBA patients and 1344 RFA patients from the FREEZE Cohort. Some baseline patients' characteristics were different between groups (age, AF type, and some concomitant diseases), without being statistically associated to ablation procedure time. Mean procedure time was 122.2 ± 39.4 min for CBA and 160.3 ± 53.5 min for RFA (p < 0.0001). RFA was associated with a more than five-fold increase of cumulative overtime compared to CBA over the simulated period (1285 h with RFA and 253 h with CBA). 70.7% of RFA lab days included overtime versus 25.7% for CBA. CBA was associated with more days with an additional hour at the end of the EP lab shift compared to RFA (47.8% vs 11.5% days with one hour left, respectively).
CBA is faster and more predictable than point-by-point RFA, and enables improvements in EP lab efficiency, including: fewer cumulative overtime hours, more days where overtime is avoided and more days with remaining time for the staff or for any EP lab usage. Clinical trial registration NCT01360008 (first registration 25/05/2011).
Abstract
Introduction
Takotsubo syndrome (TTS) is an important form of acute heart failure with significant risk of acute complications and death. In this analysis we sought to identify predictors ...for in-hospital clinical outcome in TTS patients by concentrating on routine laboratory parameters at admission.
Methods
In this analysis from the Austrian national TTS registry, univariable and multivariable analyses were performed to identify significant predictors for severe in-hospital complications requiring immediate invasive treatment or leading to irreversible damage, such as cardiogenic shock, intubation, stroke, arrhythmias and death. Furthermore, the influence of identified predictors with long-term survival was evaluated.
Results
A total of 338 patients (median age 72 years, 86.9% female) from 6 centres were included. Severe in-hospital complications occurred in 14.5% of patients, including cardiogenic shock (9.8%), death (3.3%) and intubation (1.2%), respectively. Patients with complications during the hospital stay had more prevalent chronic kidney disease (CKD), were less often previous smokers and TTS was less often preceded by an emotional trigger. C-reactive protein and neutrophile lymphocyte ratio (NLR) was higher in patients with complications, and midventricular ballooning and reduced left ventricular ejection fraction (LVEF) were more prevalent. In multivariable analysis, high NLR (OR 1.04 95% CI 1.02–1.07, p=0.009) and low LVEF (OR 0.92 0.90–0.95 per %, p<0.001) remained significant predictors for severe in-hospital complications. Both the highest NLR tercile and the lowest LVEF tercile were associated with significantly reduced 5-year survival.
Discussion
Low LVEF and high NLR at admission were independently associated with increased in-hospital complications and reduced long-term survival in TTS patients. NLR is a new easy-to-measure tool to predict worse short and long-term outcome after TTS.
Funding Acknowledgement
Type of funding sources: None.
Introduction. Occupational therapists have shown low adoption rates for many evidence-based practices. One such practice is the limited uptake of standardized outcome measures such as the Canadian ...Occupational Performance Measure. Use of this measure has not consistently translated into practice despite decades of encouragement. Theory-based approaches to understanding healthcare provider behaviour change are needed if we are to realize the goal of attaining practice that is in keeping with evidence. This study utilized the Theoretical Domains Framework, a theory-based approach for understanding barriers to evidence-based practice, in order to increase our understanding of the limited uptake of the Canadian Occupational Performance Measure in occupational therapy practice. Methods. Theoretical Domains Framework methods were followed. First, primary data was collected from occupational therapists through semistructured interviews that focused on key behaviour change domains as they related to the use of the Canadian Occupational Performance Measure. Two independent researchers coded interview data into domains, derived belief statements from the data, and used belief strength, conflict, and frequency to determine the more and less influential domains for using the Canadian Occupational Performance Measure. Results. Interviews with 15 practicing occupational therapists across a range of practice areas yielded six key behaviour change domains for increasing the use of the Canadian Occupational Performance Measure. The more relevant domains were Social influences, Social professional role and identity, Beliefs about consequences, Beliefs about capabilities, Skills, and Behavioural regulation). The other eight domains were found to be less relevant. Conclusion. We identified important domains and beliefs that influence the use of the Canadian Occupational Performance Measure by occupational therapists. Results inform our understanding of the use of this measure in practice and identify potential targets for behaviour change interventions.
Abstract
Introduction
Left atrial appendage closure is associated with a relevant procedural complication rate. Baseline risk factors, such as pre-procedural lab results, may identify patients that ...develop acute complications.
Methods
We performed a retrospective analysis of the impact of baseline characteristics and preprocedural lab results on the acute procedural outcome in patients undergoing left atrial appendage closure from the Austrian Left Atrial Appendage Closure Registry between 2010 and 2019. The endpoint for procedural complications was defined as death, stroke, major bleeding, necessity for intensive care, other complications requiring invasive interventions or failure to implant the device. We also evaluated a modified endpoint with the exclusion of bleeding events. Logistic regression was performed using stepwise approach (backward method with p_out = 0.1) and forced inclusion of age, left-ventricular function and kidney function.
Results
A total of 320 consecutive patients from 9 centres with a median age of 75 years (36.6% female) were included. Seventy-eight percent had a history of bleeding and 35% had a history of stroke. Median CHA2DS2-VASc score was 5 (interquartile range, 3–5) and median HAS-BLED score was 3 (2–4). Procedural complications occurred in 15.3% of cases. Low haemoglobin and low activated partial thromboplastin time were associated with an increased complication rate. Other significant baseline factors were liver disease, absence of intracranial haemorrhage and severe aortic stenosis. In multivariate analysis, low haemoglobin remained a significant predictor, even after adjustment for age, left-ventricular function and kidney function (Table). In the modified procedural complication endpoint excluding major bleeding events (14.1%), low haemoglobin remained a significant predictor (haemoglobin 11.9±2.0 vs. 12.8±2.0 g/dL in patients with vs. without modified endpoint, p=0.013). A baseline haemoglobin lower than 12 g/dL was present in 39.4% and it increased relative risk of procedural complications by 89% (21.4 vs. 11.3% in patients with reduced vs. normal haemoglobin), and risk of complications without bleeding by 92% (19.8 vs. 10.3%).
Conclusion
Low baseline haemoglobin is independently associated with a higher complication rate after left appendage closure compared to patients with normal haemoglobin levels, even in a modified endpoint excluding bleeding and requirement for transfusion.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific - unrestricted grant Table 1
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