Instantaneous wave-free ratio and fractional flow reserve in clinical practice

Objectives

To compare fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) measurements in an all-comer patient population with moderate coronary artery stenoses.

Background

Visual assessment of the severity of coronary artery stenoses is often discordant in moderate lesions. FFR allows reliable functional severity assessment in these cases but requires adenosine-induced hyperaemia with associated additional time, costs and side effects. The iFR is a hyperaemia-independent index.

Methods and results

Between November 2015 and February 2017, 356 consecutive patients were included in whom 515 coronary stenoses were measured using both iFR and FFR. Mean iFR and FFR were 0.90?±?0.09 and 0.86?±?0.08, respectively. iFR correlated well with FFR [r?=?0.75; p?<?0.001]. Receiver operating characteristic analysis identified an area under the curve of 0.92. An iFR-only strategy with a treatment cut-off ≤0.89 revealed a diagnostic classification agreement with the FFR-only strategy in 420 lesions (82%) with a sensitivity of 87%, a specificity of 80%, a positive predictive value of 56% and a negative predictive value of 96%.

Conclusions

Real-time iFR measurements have good negative predictive value compared to FFR, but moderate diagnostic accuracy (82%). It exposes fewer patients to adenosine, reduces procedure time and costs. Further prospective trials are needed to evaluate specific clinical settings, cut-off values and endpoints.

     

Species assignment and population genetic studies of Gran Paraná pejerrey (<Emphasis Type="Italic">Odontesthes</Emphasis> sp., Atheriniformes,Atherinopsidae) from La Plata Basin in South America

Since 2013, the pelagic zone of Upper Lake Constance (ULC) has been subject to a massive invasion of the non-native three-spined stickleback (Gasterosteus aculeatus Linnaeus, 1758). Data from monthly monitoring of pelagic whitefish (Coregonus wartmanni Bloch, 1784) were used to compare weight-at-age and abundance of pelagic whitefish for years before (1997–2012) and after the invasion (2013–2015). Growth and abundance of pelagic whitefish is shown to be heavily influenced by stickleback presence. Mean autumn weight-at-age of whitefish decreased by 33.3% after the invasion took place and a significant decline in autumn CPUE in otherwise unfished cohorts of the population was also recorded. The results imply direct effects of stickleback presence on pelagic whitefish, including interspecific competition for food leading to reduced growth and survival, and predation of eggs and larvae, hampering recruitment. These observations coincide with a sharp decline in whitefish yield. In conclusion, this study shows that the invasion of stickleback has substantially altered the pelagic fish community of ULC, with severe consequences for commercial fisheries.     

Father-to-Mother-to-Infant Transmission of HIV-1: Clonally Transmitted Isolate of Infant Mutates More Rapidly than That of the Mother and Rapidly Loses Reactivity with Neutralizing Antibody

The sequences of the V3 loop and surrounding regions of human immunodeficiency virus type-1 from a father-to-mother-to-infant trimmer were studied and the horizontal and vertical transmissions compared. The father's virus was variable for reactivity with neutralizing antibody and sequences of the V3 loop central core sequence. In contrast, the mother's viral sequences were much less diverse and reacted with a virus neutralizing antibody. The infant's viral sequences were also less diverse than those of the father, and N-glycosylation sites were conserved. By phylogenetic analysis, the major clone, of which V3-peptide reacted with the neutralizing antibody, was found to be transmitted from the mother to her infant; however, the mutated minor clones did not bind to the antibody. These findings suggest that both horizontal and vertical virus transmission were selective, and that the clonally transmitted virus in infants mutates more rapidly than viruses in the mother, to whom the virus was horizontally transmitted.     

Assortative mating in two populations of Short‐tailed Albatross Phoebastria albatrus on Torishima

Assortative mating is an important pre‐mating isolation mechanism that has been observed in some wild populations of seabirds. The Short‐tailed Albatross Phoebastria albatrus is a globally Vulnerable seabird that breeds mainly on Torishima and the Senkaku Islands in the north‐western Pacific Ocean. Our previous studies suggested that two genetically distinct populations exist, one on Torishima and the other on the Senkaku Islands. Recently, however, several un‐ringed birds in subadult plumage have been observed breeding on Torishima in the Hatsunezaki colony. As almost all birds hatched on Torishima since 1979 have been ringed, the natal site of the un‐ringed birds was suspected to be the Senkaku Islands. Genetic differences between the two populations would reveal the natal sites of un‐ringed birds. By observing the ring status (ringed or un‐ringed) of mating pairs and analysing the mitochondrial DNA (mtDNA) control region 2 of un‐ringed birds, we assessed whether birds that originated from Torishima and the Senkaku Islands achieved pre‐mating isolation. There was a small number of pairs on Torishima that consisted of one ringed and one un‐ringed bird, but the observed number was significantly lower than that expected if ringed and un‐ringed birds mated randomly. Furthermore, mtDNA analyses of nine un‐ringed birds demonstrated that all belonged to a particular haplotype clade from the Senkaku Islands. These results show that birds from Torishima and the Senkaku Islands mate assortatively but that there is incomplete pre‐mating isolation between birds from the two island groups. The pre‐mating isolation of these two populations of Short‐tailed Albatross could arise from differences in the timing of breeding and incompatibility in mating displays. As the divergence between the two populations is unlikely to be sufficient to achieve complete post‐mating isolation, the two groups are likely to be hybridizing. Further studies using molecular and/or behavioural analyses would be required to reveal the evolutionary significance of hybridization between these two populations.     

Reproduction in the Mediterranean endemic gorgonian Spinimuricea klavereni (Anthozoa,Octocorallia, Plexauridae)

Spinimuricea klavereni is a Mediterranean endemic gorgonian that is rarely encountered, probably because it typically occurs at depths below 50 m. It is exceptionally common in the northern Marmara Sea, with an unusually shallow upper depth limit of ~20 m. The reproductive biology of this species was studied during a one year period off Büyükada, in the northeastern Marmara Sea. Spinimuricea klavereni is a gonochoric broadcast spawner with an almost even sex ratio. Colonies were ~15 cm in height at first reproduction. Gametogenesis was continuous, characterized by high male and female fecundities year‐round. Oocytes and sperm sacs of all developmental stages were found throughout the year, with small‐sized oocytes and sperm sacs dominant throughout the year. The reproduction of S. klavereni did not seem to exhibit any marked seasonal pattern, unlike most other studied Mediterranean octocorals. Modest variation in gamete output was probably related to slight alterations in food availability and temperature. The non‐seasonal reproductive pattern we observed may be related to the low intra‐annual variation in temperature in the Marmara Sea, and the fact that the mesotrophic‐eutrophic level of productivity in the Marmara Sea can support the energetic requirements of continuous gametogenesis in this gorgonian. Whether these patterns are local adaptations or intrinsic characteristics for this Mediterranean endemic species remains to be studied.     

Prognostic Value of SUVmax Measured by Pretreatment Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Patients with Ewing Sarcoma

AimThe aim of this retrospective study was to determine whether glucose metabolism assessed by using Fluorine-18 (F-18) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) provides prognostic information independent of established prognostic factors in patients with Ewing sarcoma.MethodsWe retrospectively reviewed the medical records of 34 patients (men, 19; women, 15; mean age, 14.5 ± 9.7 years) with pathologically proven Ewing sarcoma. They had undergone F-18 FDG PET/CT as part of a pretreatment workup between September 2006 and April 2012. In this analysis, patients were classified by age, sex, initial location, size, and maximum standardized uptake value (SUVmax). The relationship between FDG uptake and survival was analyzed using the Kaplan-Meier method with the log-rank test and Cox’s proportional hazards regression model.ResultsThe median survival time for all 34 subjects was 999 days and the median SUV by using PET/CT was 5.8 (range, 2–18.1). Patients with a SUVmax ≤ 5.8 survived significantly longer than those with a SUVmax > 5.8 (median survival time, 1265 vs. 656 days; p = 0.002). Survival was also found to be significantly related to age (p = 0.024), size (p = 0.03), and initial tumor location (p = 0.036). Multivariate analysis revealed that a higher SUVmax (p = 0.003; confidence interval [CI], 3.63–508.26; hazard ratio [HR], 42.98), older age (p = 0.023; CI, 1.34–54.80; HR, 8.59), and higher stage (p = 0.03; CI, 1.21–43.95; HR, 7.3) were associated with worse overall survival.ConclusionsSUVmax measured by pretreatment F-18-FDG PET/CT can predict overall survival in patients with Ewing sarcoma.