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Currently comprising only about 430 species, Dipsocoromorpha or minute litter bugs are one of the small infraorders of Heteroptera. They are classified into five morphologically distinct families--Ceratocombidae, Dipsocoridae, Hypsipterygidae, Schizopteridae and Stemmocryptidae--but relationships among and within these families are poorly understood owing to the lack of phylogenetic studies. A phylogenetic hypothesis based on combined molecular and morphological data is important to both evaluate and revise the higher-level classification and to explore the evolutionary history of morphological features including elytriform (or beetle-like) forewings, that seem to have evolved multiple times in this group, jumping devices, and the highly modified and diverse male genitalia. We here use a dataset combining Sanger-derived (~4500 bp; 108 taxa) and Illumina-generated (~7500 bp; 24 taxa) sequence data with a morphological matrix (159 characters) and taxon sampling that comprises all currently recognized family-, subfamily- and tribal-level taxa and comprehensive genus-level sampling to investigate phylogenetic relationships within litter bugs. Our results support the monophyly of Dipsocoromorpha, Schizopteridae and Dipsocoridae, whereas Ceratocombidae and the schizopterine subfamily "Ogeriinae" are polyphyletic and paraphyletic, respectively. A new classification is proposed that recognizes six families, including Trichotonannidae, stat.n., and two subfamilies each within the two larger families Ceratocombidae and Schizopteridae. Ancestral state reconstructions outline the complex evolutionary history of many morphological characters, including 15 independent origins of elytriform forewings, and at least five shifts in the degree of genitalic asymmetry.

Guapinannus Wygodzinsky, 1951 (Hemiptera: Schizopteridae) was described based on a single female specimen from Costa Rica. Some additional specimens representing this genus have since become available and were incorporated into a comparative male genitalic study across Dipsocoromorpha and into combined molecular and morphological hypotheses of the infraorder. However, the species-level diversity of Guapinannus has remained unexplored and undocumented. Based on examination of 264 specimens from central and South America, we here revise the taxonomy of Guapinannus, describing 19 species as new (Guapinannus anaticulus, sp. n.; Guapinannus artus, sp. n.; Guapinannus auriculus, sp. n.; Guapinannus castigatus, sp. n.; Guapinannus clava, sp. n.; Guapinannus dispar, sp. n.; Guapinannus falcis, sp. n.; Guapinannus graziae, sp. n.; Guapinannus minutus, sp. n.; Guapinannus orbiculatus, sp. n.; Guapinannus plurilobus, sp. n.; Guapinannus policis, sp. n.; Guapinannus robustus, sp. n.; Guapinannus sinuosus, sp. n.; Guapinannus tatumbia, sp. n.; Guapinannus tenuis, sp. n.; Guapinannus tergus, sp. n.; Guapinannus trilobus, sp. n.; Guapinannus uncus, sp. n.). In addition, we provide photos of the female holotype of Guapinannus bierigi Wygodzinsky, 1951, SEM documentation for Guapinannus clava, sp. n., habitus photos and a map for all species, and line drawings of male genitalic features for all species for which males are known.

Despite a recent surge of taxonomic work on the dipsocoromorphan family Schizopteridae, new genus-level taxa remain to be documented and described. The curation of Malaise and Yellow Pan Trap sample residues from Central and South America and Cameroon resulted in the discovery of five undescribed species that based on combined molecular and morphological phylogenetic analyses represent four phylogenetically isolated lineages within non-hypselosomatine Schizopteridae. To accommodate these new species, we here describe the four new genera Caucanannus gen. n. (Colombia, Ecuador, and Brazil) with Caucanannus perplexus sp. n. and Caucanannus novissimis sp. n.; Kamakonocoris gen. n. (Cameroon) with Kamakonocoris carinata sp. n.; Perittonannus gen. n. (Costa Rica) with Perittonannus antiquus sp. n.; and Rimanannus gen. n. (Cameroon) with Rimanannus camerunensis sp. n. The four genera are characterized by distinctive wing venation and male and female genitalic features. We provide habitus photographs and document morphological details using digital macrophotography as well as light compound microscopic and scanning electron microscopic images. Maps and measurements are also included.

The genus Voragocoris Weirauch, 2012 is composed of Voragocoris schuhi Weirauch, 2012 and Voragocoris amrishi Makhan, 2013, previously recorded from Peru and Suriname, respectively. In this paper, a new species, Voragocoris weirauchae sp.n., is described based on specimens collected in the Brazilian Amazon, representing the first record of the genus from Brazil. We provide diagnosis, description, photographs of habitus, and scanning electron micrographs of the diagnostic features. A key to species based on males of Voragocoris is also presented.

Insect male genitalia show an evolutionarily variable morphology that has proven to be valuable for both, species identifications and phylogenetic analyses at higher taxonomic levels. Accurate usage of genitalic characters in taxonomic descriptions and phylogenetic analyses depends on consistency of terminology and validity of homology hypotheses. Both areas are underdeveloped in many insect groups. We here document the morphology and advance homology hypotheses of male genitalic features for the hemipteran infraorder Dipsocoromorpha, the minute litter bugs. Genitalic structures and the pregenital abdomen in Dipsocoromorpha are strikingly modified and diverse compared to other Heteroptera. In addition to variation in the shape of phallic structures (parameres and aedeagus), minute litter bug genitalia vary in the direction and degree of asymmetry and feature a plethora of processes derived from various abdominal segments with significant variation at low taxonomic levels. Here, male genitalic structures for an extensive taxonomic sample (32 genera and 71 specimens) are documented using scanning electron and confocal microscopy, and a universal terminology for genitalic structures across minute litter bugs is established that will facilitate species discovery and evolutionary research. We conclude by proposing primary homology hypotheses across the infraorder that now can be tested in a phylogenetic framework.

Hoplonannus McAtee & Maloch, 1925 comprises three species described from Central America. Females of all these species are known only from brachypterous specimens. This paper describes the first South American species of the genus, Hoplonannus australis sp. nov. The new species differs from its congeners, in females, by the submacroptery, presence of ocelli and a basal bulge in the seventh sternite; in males, it differs by the presence of a process in the eighth tergite and the right paramere bifurcate apically, with branches subparallel. These traits entail a new diagnosis for the genus.

OBJECTIVES: Hypertrophic cardiomyopathy is a complex and relatively common genetic cardiac disease and has been the subject of intensive scrutiny and investigation for over 40 years. The aim of this non-randomized cohort study was to compare subjective and objective outcomes in hypertrophic cardiomyopathy patients undergoing drug therapy, surgical myotomy-myectomy, dual-chamber pacing and alcohol septal ablation. METHODS: We examined 194 patients: 103 with non-obstructive hypertrophic cardiomyopathy and 91 with obstructive hypertrophic cardiomyopathy. All the patients with a non-obstructive form were on drug therapy. Ninety-one consecutive patients with drugrefractory obstructive hypertrophic cardiomyopathy were treated invasively. Dual-chamber pacemaker implantation was performed for 49 patients with previous positive temporary pacing test (Group 1). In 28 patients with massive left ventricle hypertrophy and obliteration of its cavities, extensive myotomy-myectomy was performed (Group 2). In 14 patients with midventricular obstruction and appropriate coronary anatomy, alcohol septal ablation was performed (Group 3). RESULTS: The peak left ventricle outflow tract gradient was 84.1±15.2 mmHg in Group 1, 113.3±14.9 mmHg in Group 2 and 97.5±8.9 mmHg in Group 3. Dual-chamber pacing in Group 1 with optimal atrio-ventricular delay (85–180 ms for atrium pacing and 45–120 ms for atrial sensing) leads to dramatic decreases in left ventricle outflow tract gradient to 17.6±11.8 mmHg and degree of mitral regurgitation. After extensive myectomy in Group 2, we observed a reduction of left ventricle outflow tract gradient to 17.3±10.2 mmHg. Septal alcohol ablation in Group 3 leads to a left ventricle outflow tract gradient decrease from 97.5 ± 8.9 to 25.3 ± 5.8 mmHg. CONCLUSIONS: Surgical myectomy, dual-chamber pacing and alcohol septal ablation are equally effective in reducing obstruction in case of correct indications. Dual-chamber pacing is indicated in functional reversible states characterized by excitation delay. Alcohol septal ablation is preferable in cases with midventricular obstruction and appropriate coronary anatomy. Surgical methods are indicated in anatomical irreversible changes and remain the gold standard for obstructive hypertrophic cardiomyopathy treatment.

The peculiarities of rotational motion of left ventricular (LV) walls in patients on mitral valve insufficiency (MVI) were studied. In normal heart and MVI the rotation of basal and apical portions of the LV occurs in inter-reverse directions: the basal portion rotates clockwise and apical portion rotates counterclockwise. In patients with MVI the increase of the LV volumes is accompanied by compensatory rise of LV myocardium torsion up to (23.7 ± 5.0)degrees. The increase of indices of LV myocardium torsion in MVI occurs due to basal portions of the heart only. This is a compensatory factor in preserving of normal cardiac output for a long period of time in such disease.

Activity of the heart is assured by the myocardium motion with a composite path, which can be described with various quantitative indices, in particular the strain ones. The invention and implementation into clinical practice the "Speckle Tracking" ultrasonic technology, based on the two-dimensional echocardiography, allows to study of normal myocardium function as well as its functioning in various hart lesions, in particular, dilated cardiomyopathy (DCMP). Peculiarities of the features of longitudinal strain parameters of left ventricular (LV) walls in patients with DCMP, according to the occurrence of the total left branch of atrioventricular bundle block were studied. In DCMP the indices of longitudinal myocardial strain of the LV were strongly decreasing with the augmenting of heart failure signs. The appearance of the total left branch of atrioventricular bundle block, manifested by the total decrease of amplitude of longitudinal strain of the lateral and posterior walls of the LV, led to the augmenting of mitral regurgitation (up to 2+) and increase of the pulmonary hypertension, augmenting of circulatory deficiency signs.

The Mediterranean orthotyline genus Platycranus is revised. Updated diagnoses and descriptions, data on distribution and hosts are provided for the genus and included species, and a key is presented to facilitate identification of species. Pictures of the dorsal habitus, scanning electron micrographs, and figures of genital structures are given. The following new synonymies are established: P. putoni Reuter, 1879 = P. eckerleini Wagner, 1962 = P. jordanicus Linnavuori, 1984; P. metriorrhynchus Reuter 1883 = P. longicornis Wagner, 1955 = P. rumelicus Simov, 2006; P. remanei Wagner, 1955 = P. minutus Wagner, 1955 = P. orientalis Linnavuori, 1965 = P. jurineae Putshkov, 1985 = P. boreae Gogala, 2002. P. erberi Fieber, 1870 is for the first time reported from Syria, and P. remanei is reported as new to Portugal.

Peculiarities of longitudinal shift of the left ventricle (LV) walls were studied in patients in various variants of dilated cardiomyopathy (DCMP). In patients, suffering DCMP, the enhancement of the end-diastolic (EDI) and the end-systolic (ESI) indexes are noted, as well as of the punch index and expulsion fraction, the pulmonary artery hypertension, moderate insufficiency of mitral and tricuspid valves. These changes are aggravated in complete blockade of left pedicle of atrio-ventricular fascicle (AVF). In cardiac contractions, in normal conditions and in DCMP as well, a maximally pronounced longitudinal myocardial shift is revealed in basal segments of LV, while cardiac apex remains practically immobile. In DCMP a longitudinal shift of the LV myocardium reduces significantly while cardiac insufficiency progression. In complete blockade of left pedicle of AVF, presented by total reduction of amplitude of longitudinal myocardial shift in the LV lateral and posterior walls, aggravation of a mitral valve insufficiency (up to 2+) and raising of pressure in pulmonary artery--up to (60.1 ± 7.5) mm Hg, further progression of the blood circulation insufficiency were noted.

Own experience of the ischemic heart disease (IHD) surgical treatment, combined with the ascending aorta (AA) atherosclerosis, was analyzed. Basing on results of surgical treatment for IHD there were noted mostly informative methods of diagnosis of the AA atherosclerotic affection severity and optimal approaches to surgical treatment of such patients.

Background: Infective endocarditis morbidity remains high: 3 to 8 cases per 100,000 of population. Antibiotic therapy is ineffective. Its surgical treatment experience is relatively limited. Aim: To share the surgical treatment experience of 855 patients with acute infective valvular endocarditis (AIVE) treated during 1982 to 2000 in the Institute of Cardiovascular Surgery AMS, Ukraine. Materials and Methods: 855 (75.4%) of 1128 hospitalized patients with AIVE were operated upon. Surgical interventions included removal of diseased tissues, heart chambers treatment with antiseptic solutions, wash out with normal saline solution, replacement or plastic procedure of valves. Results: Heart abscesses were found in 132 (15.5%) patients. Hospital mortality was after aortic valve replacement 12.6%; mitral valve replacement 9.7%; plastic procedure on mitral valve 0%; aortic and mitral valve replacement 30%; tricuspid valve replacement 15.4%; and plastic procedure on tricuspid valve 6.1%. Recurrences of infective process occurred in 51 (6.0%) patients. Infections were observed more frequently in patients with heart abscesses: 10.6% versus 5.7% (p > 0.02). Results: 716 (96.7%) patients were studied 2 to 194 (87.4 ± 39.4) months postoperatively. Tenth year postoperative survival was 62.1 ± 27.7% including hospital mortality. Conclusions: (1) AIVE has become one of the most frequent causes of acquired heart lesions in the postChernobyl nuclear power station catastrophe era. (2) Heart failure development in postoperative period is stipulated by the disease duration. (3) Presence of heart abscesses favors recurrence of development of infective endocarditis. (4) Postoperative antibiotic therapy for more than 3 weeks does not help in prevention of recurrences.

There was performed the retrospective analysis of 23 consecutive patients, to whom beside the ascending aorta aneurysm correction the aorta arch prosthesis was done in conditions of deep hypothermia, the blood circulation arrest with retrograde cerebral perfusion via vena cava superior. For an acute layering and aneurysm of aorta with pericardium tamponade or hemothorax occurrence 16 (69.6%) of patients were operated on in emergency. Hospital mortality had constituted 21.7%, including after an urgent operation performance--25% and elective surgery--14.3%.

Objective: Ebstein’s anomaly is the most common pathology associated with the accessory conduction pathways. Methods: From January 1990 to August 1999 48 patients underwent surgical repair of Ebstein’s anomaly by various plastic techniques. The pathways were identified and characterized at preoperative electrophysiologic mapping in 17 (34.5%) patients. There were seven males and ten females. The patients age ranged 6‐35 years (mean 12.7 ^ 2.1 years). Five patients were in NYHA class II and were in 12 in NYHA class III. The cardiothoracic ratio ranged from 0.59 to 0.69 (mean 0.65 ^ 0.08). Tachycardia was present in 15 patients with Wolf‐Parkinson‐White (WPW) syndrome. Atrial septal defect was present in 12 patients (70.6%). Accessory conduction pathways were in the right posterior septal area in seven patients, in right posterior septal area and free wall in seven patients and in right free wall in three. The pathways were successfully ablated in all patients during cardiopulmonary bypass. Results: There were no deaths, no relapses. Follow-up ranged from 4 months to 7 years (mean 4.7 ^ 1.1 years). There were no late deaths, but one patient required successful tricuspid valve replacement because of severe tricuspid insufficiency. At follow-up 57.8% of patients were in NYHA class I. Conclusions: Preoperative electrophysiologic study allows to identify the accessory conduction pathways in patients with Ebstein’s anomaly. The combined approach of tricuspid valve repair and surgical ablation of accessory atrioventricular connections has been proved safe and effective. This operative procedure allows to improve functional results in patients with Ebstein’s malformation and concomitant accessory conduction pathways. q 2000 Elsevier Science B.V. All rights reserved.

Background. Study of the long-term results from 1 to 24 years after coarctation of the aorta repair in 891 patients showed that in 48 (5.4%, mean age, 30.9 ± 1.1 years) aneurysms had developed at the site of repair. Aneurysms arose in 43 (89.6%) of the patients in whom repair was done with help of synthetic patch aortoplasty, in 4 (8.3%) of the patients after coarctectomy with "end-to-end" anastomosis, and in 1 patient (2.1%) after coarctectomy with a prosthetic graft replacement. Methods. Reoperation included aneurysm resection, which was performed in 30 patients (62.5%), followed by prosthetic graft replacement (n = 19), synthetic patch aortoplasty (n = 6), aneurysmorrhaphy (n = 3), or prosthetic bypass graft (n = 2). Results. Four (13.8%) patients died after reoperation. All 18 patients who were not reoperated on died of a ruptured aortic aneurysm 7 to 15 years after repair of coarctation of the aorta. Conclusions. With the aim to prevent aneurysm development at the site of coarctation of the aorta repair, severe limitation of indications for synthetic patch aortoplasty is necessary. It can be used only in adult patients with a not too big narrowing. Patients after primary correction of coarctation of the aorta must avoid strenuous physical activity. Chest roentgenography should be performed in these patients each year, and each year they have to be seen by a cardiac surgeon. Suspicion of aneurysm development demands hospitalization, aortography, and reoperation. Preference is given to prosthetic graft replacement using an approach through the left fourth intercostal space with distal circulatory support by means of temporary bypass shunting. Infected aneurysms can be primarily bypassed through the right anterior thoracotomy with the creation of permanent bypass with the help of a vascular graft between the ascending and descending thoracic aorta.

New biologic prosthesis of the arterial vessels manufactured of the bird trachea was elaborated and approved upon the test bench and experimental conditions. Sufficient mechanical durability and elasticity of the prosthesis was ascertained, alike the possibility of his application for the arterial vessels replacement. New bioprosthesis have such advantages as handiness at work, steadiness for twist and deformation, negligible thrombogenicity, relatively high endothelialization speed, functioning stability and nonreactivity.

The authors analyze 144 surgeries in patients with single and multiple valvular defects combined with multiple involvement of the coronary arteries; multiple (3-4) coronary artery shunting was carried out in 21 patients, the mortality being 19.4%. Recovery of the blood stream in all involved coronary arteries and correction of defective valves were found conducive to reduction of incidence of myocardial infarction and acute heart failure. Retrograde blood cardioplegia to a considerable measure shortened the duration of aorta clamping and improved myocardial protection. Such methods and improvement of surgical technique helped us reduce the mortality rate by 2-3 times.

The patency of coronary arteries and morphofunctional features of myocardial microhemocirculation were studied in 40 males with coronary heart disease (CHD) aged 36-59 using intravital coronary angiography, intraoperative left ventricular biopsies assessed electron-microscopically and by semithin sections. In spite of various impairment of the coronary arteries, there was similar clinical presentation. It was found that in addition to atherosclerosis stenosing the main subepicardial vessels in CHD, there appeared a peripheral barrier for the tissue circulation with defective permeability of the myocardial microvessels. Intramyocardial vascular disorders were characterized by noticeable changes in blood rheology, reactivity of resistive vessels and angiosclerosis. The role of multifactor endothelial deformities rose significantly as well as of extravasal compression of the microvessels in interstitial edema and sclerosis, in affected cardiomyocytes. Moreover, the permeability of the histohematic barrier came to be destroyed. The above changes can be considered as reversible, irreversible and amenable to correction. The findings led the investigators to the conclusion on a role of the dysfunction of the intramyo cardial vascular bed as an essential mechanism of CHD pathogenesis responsible for realization of the functional factors.

To examine the time course of changes in the coronary arteries in patients with coronary heart disease after aortocoronary bypass (ACB), the authors studied 2 groups of patients: (1) 23 who had conservative treatment and (2) 23 who were selected for ACB. Repeated angiography was performed 14.6 +/- 2.5 months after the initiation of the study. Following ACB, changes in lesions were observed in 17 coronary artery segments in 39.1% of the patients. Grafted artery stenoses largely proximal to the site of transplantation became progressive. There was a relationship between the changes in coronary arteries to graft patency. In Group 1, the time course of coronary atherosclerosis was found in 8 segments in 26% of the cases. Atherosclerosis progressed in all artery segments virtually in a steady way. Application of vein grafts may change intracoronary hemodynamics, creating conditions for more rapid and common progression of coronary artery lesions.

Every fourth patient over 45 years of age in a group of patients with valvular heart diseases suffers from affection of the coronary arteries. Experience in 71 operations for the combination of these diseases showed that the success of surgical treatment is determined by the method of myocardial protection. First the shunts are sutured and then additional cardioplegia is carried out through them. Valvular prosthetics is performed after that. Blood cardioplegia is preferred. Most surgical failures are connected with the complex character of the initial pathology. The direct and late-term results show the developed method for surgical management of this complicated pathology is effective and justified.

The hemodynamic pattern of the antianginal effects of calcium antagonists was examined in 111 patients with Functional Classes II-IV angina pectoris relapsing on an average of 36.7 +/- 1.1 months following aortocoronary bypass surgery, as evidenced by radionuclide ventriculography performed in the acute drug test with finoptin and corinfar. The clinical and functional status improved in 49 patients on finoptin and in 62 on corinfar. In three fourths, the efficacy of finoptin was achieved by decreased myocardial diastolic stiffness and only in a fourth, it was due to lower afterload. In three fourths, the efficacy of corinfar was attained by the action of the vascular component and only in a fourth, it was attributable to its effects on diastolic relaxation--to its direct action on the myocardium.

Fifty patients with coronary heart disease underwent repeated coronary ventriculography in different periods after aortocoronary bypass. The myocardial contractility in the patients after direct myocardial revascularization was comparatively analyzed in relation to the function of imposed aortocoronary anastomoses. Myocardial segmental contractility considerably improved in 23 patients after aortocoronary bypass who had functioning shunts, the integral function being satisfactory within the whole follow-up, whereas left ventricular myocardial function progressively diminished in 27 patients with closed anastomoses. Progressive coronary bed atherosclerosis was found to have a noticeable effect on myocardial contractility.

The features of the clinical course of coronary heart disease were examined in 325 patients 40.24 +/- 1.4 months after coronary bypass grafting. Based on the results of the comprehensive examination of the patients, its following patterns were identified: 1) asymptomatic without myocardial ischemia (30.8%); 2) asymptomatic in the presence of silent ischemia (3.5%); 3) effort angina pectoris (36.0%); 4) effort-and-rest angina (17.8%); 5) non-coronarogenic pain syndrome (11.7%), that is the patients in whom myocardial ischemia could not be provoked. The objective assessment of the patient's status in the preoperative period was demonstrated to predict a postoperative prognosis to a greater extent. Arterial hypertension and two prior myocardial infarctions, the number of diseased coronary arteries, the overall cardiac artery lesions and residual myocardial reserve were ascertained to be the most informative clinicofunctional measures in the assessment of the clinical course of coronary heart disease.

Forty patients with idiopathic hypertrophic subaortic stenosis have been studied. It was established that these patients had early signs of cardiac insufficiency (cardiac palpitations, fainting fits, dyspnoea) as a result of morphological changes in the myocardium (micro- and macrofocal cardiosclerosis). With the aid of contrast methods of investigation and phonography it was shown that in microfocal cardiosclerosis the index of the systolic murmur varies from 0.5 to 3, the planimetric index from 0.8 to 1.0. In macrofocal cardiosclerosis from 1.5 to 0 and less than 0.8, respectively.

The authors studied late results of replacement of the aortic valve by a ball prosthesis in 292 patients up to 11 years. Good results were obtained in 82.2% of the patients, satisfactory in 7.4%, unsatisfactory in 3%; 7.4% of patients died during late periods. The factors that deteriorate the late results of aortic valve prosthesis are the duration of subjective symptomatics over 5 years before the operation, the presence of the right ventricular decompensation, cardiomegaly, high end diastolic pressure in the left ventricle, neglected stage of the disease. These data are confirmed by the analysis of actual curves of survival and stability of the good late results of the operation.

A study of 67 coronary patients with isolated stenosing atherosclerosis of the anterior interventricular branch of the left coronary artery demonstrated proximal arterial stenosis in 2/3 of the cases; it was hemodynamically significant in 83% of those. Clinically, coronary heart disease in this condition was manifested as severe angina pectoris. Fifty-two percent of the patients had a history of myocardial infarction. Long-term conservative treatment, administered in 33 cases, produced an improvement in 67%, and controlled anginal attacks in 20%. Aortocoronary shunting, performed in 34 patients, had a complete antianginal effect in 2/3 of those. Clinical improvement was accompanied with somewhat improved stress tolerance.