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OBJECTIVES Despite evidence, frailty is not routinely assessed before cardiac surgery. We compared five brief frailty tests for predicting poor outcomes after aortic valve replacement and evaluated a strategy of performing comprehensive geriatric assessment (CGA) in screen-positive patients. DESIGN Prospective cohort study. SETTING A single academic center. PARTICIPANTS Patients undergoing surgical aortic valve replacement (SAVR) (n = 91; mean age = 77.8 y) or transcatheter aortic valve replacement (TAVR) (n = 137; mean age = 84.5 y) from February 2014 to June 2017. MEASUREMENTS Brief frailty tests (Fatigue, Resistance, Ambulation, Illness, and Loss of weight [FRAIL] scale; Clinical Frailty Scale; grip strength; gait speed; and chair rise) and a deficit-accumulation frailty index based on CGA (CGA-FI) were measured at baseline. A composite of death or functional decline and severe symptoms at 6 months was assessed. RESULTS The outcome occurred in 8.8% (n = 8) after SAVR and 24.8% (n = 34) after TAVR. The chair rise test showed the highest discrimination in the SAVR (C statistic = .76) and TAVR cohorts (C statistic = .63). When the chair rise test was chosen as a screening test (≥17 s for SAVR and ≥23 s for TAVR), the incidence of outcome for screen-negative patients, screen-positive patients with CGA-FI of .34 or lower, and screen-positive patients with CGA-FI higher than .34 were 1.9% (n = 1/54), 5.3% (n = 1/19), and 33.3% (n = 6/18) after SAVR, respectively, and 15.0% (n = 9/60), 14.3% (n = 3/21), and 38.3% (n = 22/56) after TAVR, respectively. Compared with routinely performing CGA, targeting CGA to screen-positive patients would result in 54 fewer CGAs, without compromising sensitivity (routine vs targeted: .75 vs .75; P = 1.00) and specificity (.84 vs .86; P = 1.00) in the SAVR cohort; and 60 fewer CGAs with lower sensitivity (.82 vs.65; P = .03) and higher specificity (.50 vs .67; P

This study provides data on the genetic structuring of the pipefish Syngnathus abaster in the western Mediterranean and Adriatic Seas. A total of 109 specimens were collected in brackish-water biotopes. The control region and three other regions of the mitochondrial genome were analysed. The most relevant result was the high genetic structuring found by Bayesian inference (BI), maximum likelihood (ML) and network analyses, which were consistent in showing three well-separated clusters of S. abaster populations. Furthermore, BI and ML did not support the monophyly of the taxon S. abaster. These results suggest the occurrence of a species complex in the study area, whose differentiation may have occurred since the Pleistocene. The results also show a very high genetic variability at the inter-population level, with no shared haplotypes among sites. Evolutionary forces due to the fragmented nature of the brackish-water habitats may account for the high genetic divergence found among the groups and populations. Finally, although dispersal by rafting over long distances may occasionally occur, this study suggests linear stepping-stone model of colonization to be most likely. The complexity of the results obtained suggests that further studies are needed to elucidate the phylogeny of S. abaster.

BACKGROUND: The crayfish Procambarus clarkii inflicts severe ecological and economic damages in Europe. To develop an efficient method for its control, four experiments were carried out to assess the impact of natural pyrethrum (i.e. Pyblast) on crayfish: (1) the 24 h LC100 and LC50 were quantified on crayfish; (2) the breakdown time of the 24 h LC100 was assessed using Daphnia magna as a bioindicator; the effects of 24 h LC100 on crayfish were investigated by applying the biocide into burrows (3) and in a drainage channel (4). RESULTS: Pyblast concentrations of 0.05 and 0.02 mg L−1 corresponded to 24 h LC100 and LC50 respectively. The concentration of 0.05 mg L−1 broke down after 72 h, whereas 0.02 mg L−1 did not cause any significant mortality in D. magna after 24 h. However, 0.05 mg L−1 had no effect on crayfish when introduced into the burrows, but led to a mortality of 95% when applied in the water. CONCLUSION: Experimental evidence is provided for the efficacy of Pyblast to control invasive crayfish. Obviously, before its use on a large scale, further studies are needed to find a concentration that will achieve the target 100% mortality with the shortest recovery time of the environment. Copyright © 2012 Society of Chemical Industry

Background: The normal and dilated heart behaves as a single functional unit during preload reduction; volume unloading in the setting of diastolic ventricular interaction allows for increased left ventricular (LV) filling. Hypothesis: We hypothesized that reduction of venous return induced by a physiologic stimulus (tilting) or by acute angiotensin-converting enzyme (ACE) inhibitors in dilated heart is likely to have a marked and similar effect on ventricular chamber geometry and filling. This study was designed to assess how the normal and dilated heart adapts to preload reduction. Methods: Twenty normal subjects and 20 patients with moderate heart failure due to dilated cardiomyopathy were studied with two-dimensional and Doppler echocardiography in supine position (B) and after 40° of head-up tilting (T). The following day, patients repeated supine (C) and tilting test (TC) after administration of captopril (25 mgs.1.). Right ventricular (RV) and LV dimensions, LV geometry, and tricuspid, mitral, and pulmonary venous flow patterns were recorded at each step of the study. Results: In the two groups, T was associated with reduction of RV area and LV volumes; C and TC produced a similar effect on RV and LV. Changes in LV septal-lateral diameter and anterior-posterior diameter were different at each step of the study: during T (both groups) and after C and TC, the septallateral diameter increased slightly while the anterior-posterior diameter decreased. During T, mitral and tricuspid peak flow velocities decreased, peak late velocities were unchanged, and the deceleration time of mitral flow increased; the systolic forward flow of pulmonary venous flow decreased, the diastolic forward flow did not change, and the difference in duration between reverse pulmonary flow and mitral peak late flow decreased; C and CT induced similar changes. Conclusion: Preload reduction induced by tilting or by ACE inhibitors induces profound and similar effects on LV and RV dimensions, LV geometry, and biventricular filling. Reduction of RV dimension is associated with adaptation of LV geometry and decrease of LV diastolic pressure, which facilitates LV filling and pulmonary venous drainage; ACE inhibition associated with tilting exerts an additional effect on these changes. These data confirm the role of ventricular interaction in modulating LV filling in heart failure.

Background: Peripheral adaptations and ventricular abnormalities influence physical performance in chronic heart failure. However, the role of the heart in determining exercise capacity has not been completely elucidated. Aims: To define cardiac determinants of exercise capacity in patients with dilated cardiomyopathy. Methods: In 101 patients with heart failure (NYHA class II–III) due to primary or ischemic dilated cardiomyopathy we measured peak exercise oxygen consumption (Pvo2), left ventricular ejection fraction (EF), left and right atrial and ventricular cavity dimensions, mitral and tricuspid flows. Patients were subdivided in class A (Pvo2>20 ml/min per kg; n=44), class B (Pvo2 16–20 ml/min per kg; n=42) and class C (Pvo2

A total of 150 individuals from Aphanius fasciatus from coastal brackish-water habitats was analysed by allozyme electrophoresis to collect data on its genetic variation. From 22 enzymes, 43 putative enzyme-coding loci were resolved, 12 of which were polymorphic at P0·99 level. Only one of the 31 probability tests showed a significant departure from the Hardy-Weinberg equilibrium. Aphanius fasciatus showed low levels of genetic polymorphism, with expected heterozygosity values ranging from 0·027 (S.E.=0·013) to 0·064 (s.e.=0·023). Nei's genetic distances between populations ranged from 0·002 to 0·042. Weir & Cockerham F-statistics showed high levels of genetic heterogeneity among populations (jackknifed θ=0·302, s.e.=0·045) and estimates of Nm were < 1, indicating restricted gene flow. Significant positive correlation between genetic distance and geographical distance matrices, detected by Mantel's test (g=1·941; P0·001), is consistent with the prediction that the species is genetically structured by isolation-by-distance.

In this study, 6 chronic anuric uremic patients underwent lactate hemofiltration (HF) with a substitution fluid, prepared in bags, for 3 months and bicarbonate HF, with continuous on-line preparation of the substitution fluid, for 3 months. We determined Na+, Cl-, K+, total calcium (Ca), ionized calcium (Ca2+), phosphate, intact parathormone (I-PTH), pH, Pco2, Po2, and HCO3- in plasma before, during, and after the treatment, as well as Ca, Ca2+, phosphate, and I-PTH in the ultrafiltrate. Moreover, heart rate (HR) and mean arterial pressure (MAP) were continually recorded during the procedure. Furthermore, the patients underwent echocardiographic study before and after the session. In comparison with lactate, bicarbonate HF caused a significant increase in HCO3- and a decrease in K+ plasma concentrations. This was detectable, with lower significance, even 44 h after the end of the treatment. At the end of the long interdialytic period (68 h after the end of the treatment), no significant difference was detectable. pH and Pco2 showed a significant but transient increase during HF. The other parameters investigated did not differ significantly between the two methods.