Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry

Aims To determine clinical correlates and optimal treatment strategy in patients with cardiogenic shock (CS) on admission. Methods and results In SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? (SHOCK) trial and registry patients with left ventricular (LV) dysfunction (n=1053), CS on admission occurred in 26% of directly admitted patients (n=166/627). Time from myocardial infarction to CS was shorter, initial haemodynamic profile poorer, and aggressive treatment less frequent in CS on admission than in delayed CS patients. CS on admission patients constituted a smaller relative proportion (11%) of the transferred (n=48/426) when compared with the directly admitted cohort (P<0.001). In-hospital mortality was higher (75 vs. 56%; P<0.001) with more rapid death (24-h mortality 40 vs. 17%; P<0.001) in CS on admission than in delayed CS patients. Emergency revascularization reduced in-hospital mortality in CS on admission (60 vs. 82%; P=0.001) and in delayed CS patients similarly (46 vs. 62%; P<0.001; interaction P=0.25). After adjustment for clinical differences, CS on admission was an independent predictor of in-hospital mortality (P=0.008). Conclusion CS on admission patients have a worse outcome but benefit equally from emergency revascularization as delayed CS patients, emphasizing the need for rapid and direct access of CS on admission patients to facilities providing this car

Effects of environmental factors on development of Pyrenopeziza brassicae (light leaf spot) apothecia on oilseed rape debris

Publication no. P-2001-0221-01R. This article is in the public domain and not copyrightable. It may be freely reprinted with customary crediting of the source. The American Phytopathological Society, 2001The development of Pyrenopeziza brassicae (light leaf spot) apothecia was studied on petiole debris from artificially infected oilseed rape leaves incubated at temperatures from 6 to 22 degreesC under different wetness regimes and in 16 h light/8 h dark or continuous darkness. There was no significant difference between light treatments in numbers of apothecia that developed. Mature apothecia developed at temperatures from 5 to 18 degreesC but not at 22 degreesC. The rate of apothecial development decreased as temperature decreased from 18 to 5 degreesC; mature apothecia were first observed after 5 days at 18 degreesC and after 15 days at 6 degreesC. Models were fitted to estimates of the time (days) for 50% of the maximum number of apothecia to develop (t(1); model 1, t(1) = 7.6 + 55.8(0.839)(T)) and the time for 50% of the maximum number of apothecia to decay (t(2); model 2, t(2) = 24.2 + 387(0.730)(T)) at temperatures (T) from 6 to 18 degreesC. An interruption in wetness of the petiole debris for 4 days after 4, 7, or 10 days of wetness delayed the time to observation of the first mature apothecia for approximate to4 days and decreased the number of apothecia produced (by comparison with continuous wetness). A relationship was found between water content of pod debris and electrical resistance measured by a debris-wetness sensor. The differences between values of tl predicted by model 1 and observed values of t(1) were 1 to 9 days. Model 2 did not predict t(2); apothecia decayed more quickly under natural conditions than predicted by model 2.Peer reviewe

Understanding disease control: influence of epidemiological and economic factors

We present a local spread model of disease transmission on a regular network and compare different control options ranging from treating the whole population to local control in a well-defined neighborhood of an infectious individual. Comparison is based on a total cost of epidemic, including cost of palliative treatment of ill individuals and preventive cost aimed at vaccination or culling of susceptible individuals. Disease is characterized by pre- symptomatic phase which makes detection and control difficult. Three general strategies emerge, global preventive treatment, local treatment within a neighborhood of certain size and only palliative treatment with no prevention. The choice between the strategies depends on relative costs of palliative and preventive treatment. The details of the local strategy and in particular the size of the optimal treatment neighborhood weakly depends on disease infectivity but strongly depends on other epidemiological factors. The required extend of prevention is proportional to the size of the infection neighborhood, but this relationship depends on time till detection and time till treatment in a non-nonlinear (power) law. In addition, we show that the optimal size of control neighborhood is highly sensitive to the relative cost, particularly for inefficient detection and control application. These results have important consequences for design of prevention strategies aiming at emerging diseases for which parameters are not known in advance

Repositionable Versus Balloon-Expandable Devices for Transcatheter Aortic Valve Implantation in Patients With Aortic Stenosis.

The safety and effectiveness of the fully repositionable LOTUS valve system as compared with the balloon-expandable Edwards SAPIEN 3 prosthesis for the treatment of aortic stenosis has not been evaluated to date. All patients undergoing transcatheter aortic valve implantation with the Edwards SAPIEN 3 or the LOTUS valve system were included into the Swiss Transcatheter Aortic Valve Implantation Registry. An adjusted analysis was performed to compare the early clinical safety outcome according to the Valve Academic Research Consortium-2 definition. Between February 2014 and September 2015, 140 and 815 patients were treated with the LOTUS and the Edwards SAPIEN 3 valve, respectively. There was no difference in crude and adjusted analyses of the early safety outcome between patients treated with LOTUS (14.3%) and those treated with Edwards SAPIEN 3 (14.6%) (crude hazard ratio, 0.97; 95% CI, 0.61-1.56 [P=0.915]; adjusted hazard ratio, 1.03; 95% CI, 0.64-1.67 [P=0.909]). More than mild aortic regurgitation was &lt;2% for both devices. A total of 34.3% of patients treated with LOTUS and 14.1% of patients treated with Edwards SAPIEN 3 required a permanent pacemaker (HR, 2.76; 95% CI, 1.97-3.87 [P&lt;0.001]). The repositionable LOTUS valve system and the balloon-expandable Edwards SAPIEN 3 prosthesis appeared comparable in regard to the Valve Academic Research Consortium-2 early safety outcome, and the rates of more than mild aortic regurgitation were exceedingly low for both devices. The need for new permanent pacemaker implantation was more frequent among patients treated with the LOTUS valve

Guidance on the environmental risk assessment of plant pests

The European Food Safety Authority (EFSA) requested the Panel on Plant Health to develop a methodology for assessing the environmental risks posed by harmful organisms that may enter, establish and spread in the European Union. To do so, the Panel first reviewed the methods for assessing the environmental risks of plant pests that have previously been used in pest risk assessment. The limitations identified by the review led the Panel to define the new methodology for environmental risk assessment which is described in this guidance document. The guidance is primarily addressed to the EFSA PLH Panel and has been conceived as an enhancement of the relevant parts of the “Guidance on a harmonised framework for pest risk assessment and the identification and evaluation of pest risk management options by EFSA”. Emphasizing the importance of assessing the consequences on both the structural (biodiversity) and the functional (ecosystem services) aspects of the environment, this new approach includes methods for assessing both aspects for the first time in a pest risk assessment scheme. A list of questions has been developed for the assessor to evaluate the consequences for structural biodiversity and for ecosystem services in the current area of invasion and in the risk assessment area. To ensure the consistency and transparency of the assessment, a rating system has also been developed based on a probabilistic approach with an evaluation of the degree of uncertainty. Finally, an overview of the available risk reduction options for pests in natural environments is presented, minimum data requirements are described, and a glossary to support the common understanding of the principles of this opinion is provided

Scientific Opinion on the phytosanitary risk associated with some coniferous species and genera for the spread of pine wood nematode

The European Commission requested the Panel on Plant Health to deliver a scientific opinion on the phytosanitary risk of plants (other than fruits and seeds) of Pinus pinea and of the genera Chamaecyparis, Cryptomeria and Juniperus for the spread of pine wood nematode (PWN) via movement of infested plants or untreated plant products or by supporting natural spread of PWN in conjunction with European species of the vector. The Panel analysed the data submitted by Portugal regarding surveys on the Tróia Peninsula where P. pinaster and P. pinea co-occur, and the related laboratory results of Naves et al. (2006) on feeding and oviposition preferences of Monochamus galloprovincialis. The Panel also undertook a comprehensive review of the literature. The zero infestation of PWN recorded on P. pinea on the Tróia Peninsula was not significantly different from the result for P. pinaster, because of the small P. pinea sample. Hence, the conclusion that P. pinea is not a host plant for PWN is not supported by the data submitted, principally because of low statistical confidence arising from the few P. pinea trees present. Moreover, the limited presence of P. pinea in the study areas means that the results are representative neither of the Tróia Peninsula nor of other parts of Portugal. Naves et al. (2006) recorded some oviposition by M. galloprovincialis on P. pinea, but less than on other hosts. No differences in feeding of M. galloprovincialis on P. pinaster and P. pinea were detected, thus potentially allowing PWN transmission to trees by this route. The available information regarding the genera Chamaecyparis, Cryptomeria and Juniperus as potential hosts of Monochamus spp. and PWN suggests overall a low susceptibility to PWN or its vectors; the uncertainty concerning PWN is high and would require supplementary research

Scientific Opinion on the evaluation of the pest risk analysis on Pomacea insularum, the island apple snail, prepared by the Spanish Ministry of Environment and Rural and Marine Affairs

The Panel considers the Spanish pest risk analysis (PRA) to be clear and to provide appropriate supporting evidence. However, (i) the environmental impact assessment is incomplete and (ii) the estimates for the potentially endangered area are too limited. The Panel points out that large areas of the European Union have climatic conditions, that are very similar to those of the areas of native distribution of Pomacea spp. snails, and suitable host plants are available. The Panel agrees with the Spanish PRA on the following points with regard to the risk assessment area: (i) the potential consequences of the organism for rice crops are major; (ii) the probability for establishment of the organism is very likely and (iii) the probability of spread is estimated as likely. The Panel disagrees with the Spanish PRA on the following points and considers (i) the effects on the environment to be massive under suitable environmental conditions in the PRA area and (ii) the probability of entry of the organism to be high. Regarding risk reduction options the Panel agrees with the Spanish PRA that no single risk reduction method is sufficient to halt the introduction and spread of Pomacea spp. snails in the PRA area. However, a legislative ban on import of Pomacea spp. is the only risk reduction option identified that can reduce the probability of entry. The many other risk reduction options listed will help to reduce the probability of spread within the PRA area. The Panel considers that the risk reduction options should target the canaliculata complex, as Pomacea insularum and P. canaliculata, as well as other species from the complex, are almost indistinguishable. This is of particular importance for risk reduction options addressing both breeding and trade of the organism

Impacts of climate change on plant diseases – opinions and trends

There has been a remarkable scientific output on the topic of how climate change is likely to affect plant diseases in the coming decades. This review addresses the need for review of this burgeoning literature by summarizing opinions of previous reviews and trends in recent studies on the impacts of climate change on plant health. Sudden Oak Death is used as an introductory case study: Californian forests could become even more susceptible to this emerging plant disease, if spring precipitations will be accompanied by warmer temperatures, although climate shifts may also affect the current synchronicity between host cambium activity and pathogen colonization rate. A summary of observed and predicted climate changes, as well as of direct effects of climate change on pathosystems, is provided. Prediction and management of climate change effects on plant health are complicated by indirect effects and the interactions with global change drivers. Uncertainty in models of plant disease development under climate change calls for a diversity of management strategies, from more participatory approaches to interdisciplinary science. Involvement of stakeholders and scientists from outside plant pathology shows the importance of trade-offs, for example in the land-sharing vs. sparing debate. Further research is needed on climate change and plant health in mountain, boreal, Mediterranean and tropical regions, with multiple climate change factors and scenarios (including our responses to it, e.g. the assisted migration of plants), in relation to endophytes, viruses and mycorrhiza, using long-term and large-scale datasets and considering various plant disease control methods

Statement on a heat treatment to control Agrilus planipennis

In 2011, the EFSA Panel on Plant Health was asked by the European Commission to provide an opinion on a technical file submitted by the US Authorities to support a request to list a new heat treatment (60 °C/60 min) among the EU import requirements for wood of Agrilus planipennis host plants. After a thorough analysis of the documents provided the Panel concluded that, with a low uncertainty, A. planipennis is likely to survive the proposed heat treatment of 60 °C/60 min, and that, to ensure a control level of 99 % the temperature of the heat treatment of 60 min should be higher than 70 °C. Following the publication of this scientific opinion, the US Authorities submitted a new proposal to the European Commission, consisting in a new heat treatment (71.1 °C/60 min). The EFSA Panel on Plant Health was asked to consider whether this new proposal was within the scope of the published opinion and, if not, to clarify its conclusion and indicate what data would be needed to assess the effectiveness of the new treatment. The Panel concluded that the new proposal is not within the scope of the opinion as the data provided by the US Authorities cannot be used to evaluate the effectiveness of the new proposed heat treatment. An accurate assessment of the new proposed heat treatment (71.1 °C/60 min) would require an experiment including several temperatures higher than 70 °C (one corresponding to the proposed treatment). Regarding the data requirements for assessing the effectiveness of the new treatment, the Panel lists the information required in the checklist presented in the Panel’s draft guidance document on methodology for evaluation of the effectiveness of options to reduce the risk of introduction and spread of organisms harmful to plant health in the EU territory, currently under public consultation on EFSA website