Frequency of Ascending Aorta Replacement: A Description of 105 Patients with Bicuspid Aortic Valve Undergoing Aortic Valve Replacement

Background: It has been well documented that patients with a congenital bicuspid aortic valve suffer from earlier valve dysfunction and abnormalities of the ascending aorta, frequently requiring aortic valve replacement and some requiring replacement of the ascending aorta. There have been a few reports with variable data on the frequency of aortic complications, including dilation, aneurysm and dissection, at the time of surgery. Whether or not to replace the ascending aorta at the time of AVR is certainly influenced by the presence of these aortic complications but there is no clear evidence to suggest at a definitive marker. With more evidence that increasing aortic size leads to increased rate of rupture and dissection, in addition to recent evidence that suggests that ascending aorta dilation continues after AVR, it is questionable whether or not this has affected the rate of ascending aorta replacement at the time of AVR. Objectives: (1) To assess the frequency of aortic abnormalities in bicuspid aortic valve patients at the time of aortic valve replacement, (2) identify the predictors for ascending aortic complications and ascending aortic replacement in bicuspid aortic valve patients undergoing aortic valve replacement and (3) describe the clinical and echocardiographic characteristics of patients with bicuspid aortic valve requiring aortic valve replacement. Methods: With permission from the IRB, we retrospectively searched all echocardiographic and transcription reports from 1995-2002 for patients with a bicuspid aortic valve. Of these patients, we identified 105 patients that had undergone an aortic valve replacement and had sufficient echocardiographic evidence of a BAV. Trans-esophageal and trans-thoracic echocardiograms were reviewed, data was gathered on the dimensions of the ascending aorta and valve function. Medical records were reviewed for information on the patients’ past medical history, operative reports were reviewed to verify intra-operative assessment of aortic valve morphology. Results: The majority of our patient population was male, 83.8%. The average age at the time of surgery was 53.2. Of the 105 patients in our study, 28 (27.2%) had the ascending aorta replaced in addition to the aortic valve replacement. Aortic dilation was considered to be 4.2 cm or greater for males and 3.6 cm or greater for females; 36.3% of the total population had aortic dilation, 33.7% of males and 50% of females. In terms of valve function, 48.5% of the population had aortic stenosis; of the males 45.3% had aortic stenosis and of the females 64.7% had aortic stenosis. Aortic insufficiency was present in 34 % of the population, 37.2% of the males and 17.6% of the females. 12.6 % of the population had both aortic stenosis and aortic insufficiency and 6% had normal functioning aortic valves. Conclusion: Compared to previously reported ascending aorta replacement rates of 17%, the rate of replacement at our institution was higher at 27.2%. The rates of ascending aorta dilation and valve function abnormalities were very similar to previously reported frequencies. With evidence to suggest that rates of aortic rupture and dissection are greater than previously expected in patients with dilated ascending aortas, we would expect to see an even greater increase in the replacement of the ascending aorta with AVR. In addition, studies that suggest aortic dilation continues after AVR may also influence an increase in this frequency as well

The neural correlates of regulating positive and negative emotions in medication-free major depression

Depressive cognitive schemas play an important role in the emergence and persistence of major depressive disorder (MDD). The current study adapted emotion regulation techniques to reflect elements of cognitive behavioural therapy (CBT) and related psychotherapies to delineate neurocognitive abnormalities associated with modulating the negative cognitive style in MDD. Nineteen non-medicated patients with MDD and 19 matched controls reduced negative or enhanced positive feelings elicited by emotional scenes while undergoing functional magnetic resonance imaging. Although both groups showed significant emotion regulation success as measured by subjective ratings of affect, the controls were significantly better at modulating both negative and positive emotion. Both groups recruited regions of dorsolateral prefrontal cortex and ventrolateral prefrontal cortex (VLPFC) when regulating negative emotions. Only in controls was this accompanied by reduced activity in sensory cortices and amygdala. Similarly, both groups showed enhanced activity in VLPFC and ventral striatum when enhancing positive affect; however, only in controls was ventral striatum activity correlated with regulation efficacy. The results suggest that depression is associated with both a reduced capacity to achieve relief from negative affect despite recruitment of ventral and dorsal prefrontal cortical regions implicated in emotion regulation, coupled with a disconnect between activity in reward-related regions and subjective positive affect

Canine parvovirus detected from a serval (Leptailurus serval) in South Africa

Canine parvovirus first emerged in domestic dogs (Canis familiaris), most likely as a variant of the feline panleucopaenia virus. Relatively recently, canine parvovirus-2a and canine parvovirus-2b infections have been identified in both symptomatic and asymptomatic domestic cats, while canine parvovirus infections have also been demonstrated in wild felids. This report documents the first known case of canine parvovirus-2b detected in unvaccinated serval (Leptailurus serval) from South Africa. The serval presented with clinical signs of vomiting, anorexia and diarrhoea that responded to symptomatic treatment. Two weeks later, severe leucopaenia, thrombocytopenia and death occurred. Typical enteric histological lesions of parvovirus infection were not observed on histopathological examination of the small intestine; however, histological lesions consistent with septicaemia were present. Canine parvovirus was detected in formalin-fixed paraffin-embedded small intestine using polymerase chain reaction. Phylogenetic analysis of the sequence of the canine parvovirus viral capsid protein gene showed similarities between the sample from the serval and canine parvovirus-2b isolates from domestic dogs in Argentina and South Africa. A case of canine parvovirus-2b in a domestic dog from South Africa in 2012 that fell within the same clade as the serval sample appears distantly related because of the long branch length. The significance of these findings is explored. More extensive surveys of canine parvovirus in domestic and wild felids and canids are needed to understand the epidemiology of canine parvovirus in non-domestic felids in South Africa

Neural effects of oxytocin and mimicry in frontotemporal dementia: A randomized crossover study

OBJECTIVE: To determine whether intranasal oxytocin, alone or in combination with instructed mimicry of facial expressions, would augment neural activity in patients with frontotemporal dementia (FTD) in brain regions associated with empathy, emotion processing, and the simulation network, as indexed by blood oxygen-level dependent (BOLD) signal during fMRI. METHODS: In a placebo-controlled, randomized crossover design, 28 patients with FTD received 72 IU intranasal oxytocin or placebo and then completed an fMRI facial expression mimicry task. RESULTS: Oxytocin alone and in combination with instructed mimicry increased activity in regions of the simulation network and in limbic regions associated with emotional expression processing. CONCLUSIONS: The findings demonstrate latent capacity to augment neural activity in affected limbic and other frontal and temporal regions during social cognition in patients with FTD, and support the promise and need for further investigation of these interventions as therapeutics in FTD. CLINICALTRIALSGOV IDENTIFIER: NCT01937013. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that a single dose of 72 IU intranasal oxytocin augments BOLD signal in patients with FTD during viewing of emotional facial expressions

The association between green space and cause-specific mortality in urban New Zealand: an ecological analysis of green space utility

<b>Background:</b> There is mounting international evidence that exposure to green environments is associated with health benefits, including lower mortality rates. Consequently, it has been suggested that the uneven distribution of such environments may contribute to health inequalities. Possible causative mechanisms behind the green space and health relationship include the provision of physical activity opportunities, facilitation of social contact and the restorative effects of nature. In the New Zealand context we investigated whether there was a socioeconomic gradient in green space exposure and whether green space exposure was associated with cause-specific mortality (cardiovascular disease and lung cancer). We subsequently asked what is the mechanism(s) by which green space availability may influence mortality outcomes, by contrasting health associations for different types of green space. <b>Methods:</b> This was an observational study on a population of 1,546,405 living in 1009 small urban areas in New Zealand. A neighbourhood-level classification was developed to distinguish between usable (i.e., visitable) and non-usable green space (i.e., visible but not visitable) in the urban areas. Negative binomial regression models were fitted to examine the association between quartiles of area-level green space availability and risk of mortality from cardiovascular disease (n = 9,484; 1996 - 2005) and from lung cancer (n = 2,603; 1996 - 2005), after control for age, sex, socio-economic deprivation, smoking, air pollution and population density. <b>Results:</b> Deprived neighbourhoods were relatively disadvantaged in total green space availability (11% less total green space for a one standard deviation increase in NZDep2001 deprivation score, p < 0.001), but had marginally more usable green space (2% more for a one standard deviation increase in deprivation score, p = 0.002). No significant associations between usable or total green space and mortality were observed after adjustment for confounders. <b>Conclusion</b> Contrary to expectations we found no evidence that green space influenced cardiovascular disease mortality in New Zealand, suggesting that green space and health relationships may vary according to national, societal or environmental context. Hence we were unable to infer the mechanism in the relationship. Our inability to adjust for individual-level factors with a significant influence on cardiovascular disease and lung cancer mortality risk (e.g., diet and alcohol consumption) will have limited the ability of the analyses to detect green space effects, if present. Additionally, green space variation may have lesser relevance for health in New Zealand because green space is generally more abundant and there is less social and spatial variation in its availability than found in other contexts

Small Unmanned Aerial Vehicles (Micro-UAVs, Drones) in Plant Ecology

Premise of the study: Low-elevation surveys with small aerial drones (micro–unmanned aerial vehicles [UAVs]) may be used for a wide variety of applications in plant ecology, including mapping vegetation over small- to medium-sized regions. We provide an overview of methods and procedures for conducting surveys and illustrate some of these applications. Methods: Aerial images were obtained by flying a small drone along transects over the area of interest. Images were used to create a composite image (orthomosaic) and a digital surface model (DSM). Vegetation classification was conducted manually and using an automated routine. Coverage of an individual species was estimated from aerial images. Results: We created a vegetation map for the entire region from the orthomosaic and DSM, and mapped the density of one species. Comparison of our manual and automated habitat classification confirmed that our mapping methods were accurate. A species with high contrast to the background matrix allowed adequate estimate of its coverage. Discussion: The example surveys demonstrate that small aerial drones are capable of gathering large amounts of information on the distribution of vegetation and individual species with minimal impact to sensitive habitats. Low-elevation aerial surveys have potential for a wide range of applications in plant ecology

Adapting to dynamic stimulus-response values: differential contributions of inferior frontal, dorsomedial, and dorsolateral regions of prefrontal cortex to decision making.

Dorsomedial prefrontal cortex (dmPFC), dorsolateral prefrontal cortex (dlPFC), and inferior frontal gyrus (IFG) have all been implicated in resolving decision conflict whether this conflict is generated by having to select between responses of similar value or by making selections following a reversal in reinforcement contingencies. However, work distinguishing their individual functional contributions remains preliminary. We used functional magnetic resonance imaging to delineate the functional role of these systems with regard to both forms of decision conflict. Within dmPFC and dlPFC, blood oxygen level-dependent responses increased in response to decision conflict regardless of whether the conflict occurred in the context of a reduction in the difference in relative value between objects, or an error following a reversal of reinforcement contingencies. Conjunction analysis confirmed that overlapping regions of dmPFC and dlPFC were activated by both forms of decision conflict. Unlike these regions, however, activity in IFG was not modulated by reductions in the relative value of available options. Moreover, although all three regions of prefrontal cortex showed enhanced activity to reversal errors, only dmPFC and dlPFC were also modulated by the magnitude of value change during the reversal. These data are interpreted with reference to models of dmPFC, dlPFC, and IFG functioning

Bed of roses? The role of garden space in older people’s well-being

The purpose of this research was to investigate the role of outdoor housing environment (OHE), including front and back gardens, yards, courtyards, patios and balconies, in older people’s well-being. Descriptions of their OHEs were collected from 2558 individuals living in 526 distinct housing developments using a postal questionnaire. A large range of background variables were measured, mainly through the questionnaire. Characteristics of respondents’ immediate neighbourhood environments were measured from digital maps and satellite/bird’s-eye images. Among the OHE variables, statistically significant predictors of well-being were having one’s own patio (as opposed to shared or none), and having a green view from one’s living area (a positive effect on well-being). The authors conclude that it would be beneficial for older people’s housing to include private patio space, where possible, as well as a large amount of greenery. The research supports the claim that older people benefit from green space as much by viewing it from inside as spending time in it. If older people have no or very little garden space, a green street environment is likely to increase their well-being, especially if it can be seen from their home

Weak Coupling Among Barrier Loci and Waves of Neutral and Adaptive Introgression Across an Expanding Hybrid Zone

Hybridization can serve as an evolutionary stimulus, but we have little understanding of introgression at early stages of hybrid zone formation. We analyze reproductive isolation and introgression between a range-limited and a widespread species. Reproductive barriers are estimated based on differences in flowering time, ecogeographic distributions, and seed set from crosses. We find an asymmetrical mating barrier due to cytonuclear incompatibility that is consistent with observed clusters of coincident and concordant tension zone clines (barrier loci) for mtDNA haplotypes and nuclear SNPs. These groups of concordant clines are spread across the hybrid zone, resulting in weak coupling among barrier loci and extensive introgression. Neutral clines had nearly equal introgression into both species’ ranges, whereas putative cases of adaptive introgression had exceptionally wide clines with centers shifted toward one species. Analyses of cline shape indicate that secondary contact was initiated within the last 800 generations with the per-generation dispersal between 200 and 400 m, and provide some of the first estimates of the strength of selection required to account for observed levels of adaptive introgression. The weak species boundary between these species appears to be in early stages of dissolution, and ultimately will precipitate genetic swamping of the range-limited species