Species composition and relative abundance of the genus Culicoides (Diptera: Ceratopogonidae) in Romania

Background

Culicoides biting midges are vectors involved in the biological transmission cycle of important animal diseases such as bluetongue and African horse sickness. In Romania, the first outbreaks of bluetongue were reported in 2014, leading to increased activities within the existing entomological surveillance network. The main goals of the surveillance activities were the establishment of the vector free period in relation to animal trade and the identification of Culicoides species involved in the transmission of the pathogen. This study was conducted on the composition and relative abundance of the species belonging to the genus Culicoides (Diptera: Ceratopogonidae) in certain regions of Romania and provided the opportunity to update the existing checklist of Culicoides species of this country.

Methods

The study was conducted in 33 of the 42 administrative units (counties), including a total of 659 catches, in 102 locations. The collections were carried out with UV blacklight suction traps (OVI type). The collected insects were preserved in 70% ethanol. Morphological insect identification was carried out using a stereomicroscope, according to established identification keys. In ten localities the relative abundance of the cryptic species of the Obsoletus complex was determined by multiplex PCR assay based on the ITS2 segment. The identification of the Culicoides chiopterus (Meigen) species by morphological examination was confirmed by PCR assay based on the ITS1 segment.

Results

Eleven species were identified using morphological and PCR tools. The rest of the individuals were separated into five taxa. The species of the Obsoletus complex (grouping Culicoides obsoletus (Meigen) and Culicoides scoticus Downes & Kettle) were the most abundant, accounting for 59% of the total number of captured Culicoides spp. Three of the identified species are mentioned, according to our knowledge, for the first time in Romania: Culicoides newsteadi Austen, Culicoides flavipulicaris Dzhafarov and Culicoides bysta Sarvašová, Kočisová, Candolfi & Mathieu.

Conclusions

Our study demonstrates that the Culicoides species most commonly cited as being involved in the transmission of arboviruses in Europe (i.e. bluetongue and Schmallenberg viruses) make up a high proportion of adult Culicoides trapped in Romania.

Vector Competence of Italian Populations of Culicoides for Some Bluetongue Virus Strains Responsible for Recent Northern African and European Outbreaks

The distribution of Bluetongue virus (BTV) in Europe can be represented by two distinct and interconnected epidemiological systems (episystems), each characterized by different ecological characteristics and vector species. This study investigated the vector competence of Italian populations of Culicoides imicola and Culicoides obsoletus/scoticus to some representative BTV strains after artificial oral infection. The BTV strains were selected according to their ability to spread to one or both episystems and included BTV-4 ITA, responsible of the recent Italian and French BTV-4 outbreaks; the BTV-2 strain which caused the first BTV incursion in Italy, Corsica, and Balearic Islands; BTV-4 MOR, responsible for the epidemic in Morocco; and BTV-8, the strain which spread through Europe between 2006 and 2008. Blood-soaked cotton pledgets and Hemotek membrane feeder using Parafilm® membrane were used to artificially feed midges. For each population/strain, recovery rates (positive/tested heads) were evaluated using serogroup- and serotype-specific RT-PCR. The trial demonstrated that, except for the Abruzzo population of C. obsoletus/C. scoticus, which was refractory to BTV-4 MOR infection, all the investigated Culicoides populations are susceptible to the selected BTV strains and that, if prompt vaccination programs and restriction measures had not been implemented, BTV-2 and BTV-4 MOR could have spread all over Europe.

Mosquito species involved in the circulation of West Nile and Usutu viruses in Italy

Usutu (USUV) and West Nile (WNV) are mosquito-borne Flavivirus emerged in Italy in 1996 and 1998, respectively, and reappeared 10 years later. The aim of this work is to review the Italian mosquito species found positive for WNV and USUV between 2008 and 2014. Moreover, the role of mosquitoes in promoting the overwintering of these viruses is discussed, as a result of the mosquito collections performed in Molise region between September 2010 and April 2011. Overall 99,000 mosquitoes were collected: 337 and 457 mosquito pools tested positive by real time reverse transcriptase polymerase chain reaction (real time RT-PCR) for WNV and USUV, respectively. West Nile virus was detected in pools of Culex pipiens s.l. (329), Ochlerotatus caspius (4), Culex modestus (2), and Culex spp. (2). Positive USUV pools were from Cx. pipiens s.l. (435), Aedes albopictus (12), Oc. caspius (5), Culex spp. (2), Anopheles maculipennis s.l. (1), Culiseta annulata (1), and Ochlerotatus detritus (1). In Molise region, 1,694 mosquitoes were collected, and USUV was identi ed in Cx. pipiens s.l., Cs. annulata, and Oc. detritus pools. This paper shows that Cx. pipiens s.l. is the mosquito species most involved in the WNV and USUV circulation in Italy, although other species would also support the spread of both the viruses during Winter.

Epizootic haemorrhagic disease in Italy: vector competence of indigenous Culicoides species and spatial multicriteria evaluation of vulnerability

Epizootic haemorrhagic disease (EHD) is an infectious non-contagious viral disease transmitted by Culicoides, which affects wild and domestic ruminants. The disease has never been reported in Europe, however recently outbreaks of EHD occurred in the Mediterranean Basin. Consequently, the risk that Epizootic haemorrhagic disease virus (EHDV) might spread in Italy cannot be ignored. The aim of this study was to evaluate the risk of EHDV transmission in Italy, in case of introduction, through indigenous potential vectors. In Italy, the most spread and abundant Culicoides species associated to livestock are Culicoides imicola and the members of the Obsoletus complex. Culicoides imicola is a competent vector of EHDV, whereas the vector status of the Obsoletus complex has not been assessed yet. Thus, its oral susceptibility to EHDV was here preliminary evaluated. To evaluate the risk of EHDV transmission a geographical information system-based Multi-Criteria Evaluation approach was adopted. Distribution of vector species and host density were used as predictors of potential suitable areas for EHDV transmission, in case of introduction in Italy. This study demonstrates that the whole peninsula is suitable for the disease, given the distribution and abundance of hosts and the competence of possible indigenous vectors.

The 'Culicoides obsoletus group' in Italy: relative abundance, geographic range, and role as vector for Bluetongue virus

As Bluetongue virus (BTV) spread in Italy following its first incursion in 2000, it soon became apparent that, besides Culicoides imicola, additional species of the subgenus Avaritia were involved as vectors, namely one or more of the species that belong to the so-called 'Culicoides obsoletus group', which comprises C. dewulfi, C. chiopterus, C. obsoletus sensu stricto, C. scoticus and C. montanus; the three last named species are considered generally as forming the Obsoletus complex. This study presents the findings made over the last decade and more, within the Italian entomological surveillance program for Bluetongue. It describes the integrated morphological and molecular approach used to identify the species of the 'C. obsoletus group', maps in detail their relative abundances and geographic ranges in Italy, clarifies the hitherto unknown comparative seasonal abundances of C. obsoletus s.s. and C. scoticus in a site in Central Italy, and provides further details on the potential vector status of five species of the 'C. obsoletus group', with emphasis on C. obsoletus s.s., C. scoticus and C. montanus. Unlike the situation in Northern Europe, Culicoides dewulfi and C. chiopterus are uncommon to rare in Italy. In contrast, the Obsoletus complex occurs abundantly throughout Italy, with C. obsoletus s.s. being the most prevalent and ecologically adaptive of the three species making up the complex. A longitudinal study conducted at a site in Central Italy revealed that: (i) species of the Obsoletus complex prefer horses to sheep; (ii) their parity rates range from 10% (March) to 56% (November); (iii) throughout the year C. scoticus is consistently more abundant than C. obsoletus s.s.; (iv) abundances in both, C. obsoletus s.s. and C. scoticus, peak in May-June, with the peak of the latter species being more evident. Bluetongue virus was first isolated from wild caught midges of the Obsoletus complex in 2002. Thereafter, pools of selected parous midges collected across Italy, and during multiple outbreaks of BT, have been found consistently PCR-positive for the virus. More recently, viral RNA has been detected in field specimens of C. dewulfi, C. obsoletus s.s., C. scoticus and C. montanus.

Eco-climatic indicators for three Culicoides species of the Obsoletus complex in Italy

Bluetongue, Schmallenberg and African horse sickness viruses are transmitted by vectors belonging to the genus Culicoides (Diptera: Ceratopogonidae). Among this genus, species of the Obsoletus complex play a crucial role in Europe. In Italy the complex includes three species: Culicoides obsoletus sensu strictu, Culicoides scoticus and Culicoides montanus. These three sibling species were identified in 80 collection sites across Italy through a multiplex PCR test. Sixty‑four sites were classified with a predominant species through a Bayesian approach. Environmental, topographic and climatic factors together with landscape metrics were investigated in each species group using the non‑parametric Mann‑Whitney test. Culicoides obsoletus s.s. resulted the most widely distributed species across the peninsula (51 sites). This species was collected in many eco‑climatic conditions, at a wide range of temperature and altitudes, mainly in anthropogenic landscape. Conversely C. scoticus collection sites were dominated by natural vegetated areas or forest, at medium higher altitudes, preferably in a wilder and more pristine environment (predominant species in 8 sites). Culicoides montanus was a rarer species, statistically predominant in only 3 sites located in Southern Italy, characterized by temperatures higher than the other species. These results, together with other on‑going researches on the vector competence of the species belonging to the Obsoletus complex, and with investigation of larval and breeding habitats, could greatly improve epidemiological knowledge of possible spreading Culicoides‑borne viruses.

Analysis of climatic factors involved in the BTV-1 incursion in Central Italy in 2014

In 2012, six years after the previous epidemic, Bluetongue virus serotype 1 (BTV-1) re-emerged in Sardinia causing a limited number of outbreaks. Due to impossibility of implementing a vaccination campaign, the BTV-1 then spread all over the island in 2013 with about 7,000 outbreaks and, in September 2013, the virus reached Central Italy, with a limited number of outbreaks located along the Tyrrhenian coast. The surveillance system in place in Italy detected viral circulation during the following winter, when a few seroconversions were notified. Starting from mid July 2014, a huge number of outbreaks were reported and the disease spread toward inland territories, affecting Umbria, Abruzzo and Marche. In 2014, BTV-1 affected areas where Culicoides species belonging to the Obsoletus and Pulicaris complexes were identified as main vectors. The analysis of temperature and rainfall in Central Italy revealed a significant warmer winter (2013-2014) and a cooler and rainy summer season (2014). These climatic aspects might have certainly favored the overwintering of the virus in local vector or host populations in the Tyrrhenian coast, and, then, the spread of the virus to the rest of Central Italy. However, the heavy circulation of BTV-1 and the severity of clinical outbreaks recorded leave a number of 'open questions' that are currently under investigations.

Vector species of Culicoides midges implicated in the 2012‑2014 Bluetongue epidemics in Italy

In 2012, serotypes 1 and 4 of bluetongue virus (BTV) entered and co‑circulated in Sardinia. The following year, BTV‑1 spread all over Sardinia and invaded Sicily and the Italian Tyrrenian coast. In 2014, this strain spread extensively in mainland Italy, causing severe outbreaks. In late 2014, BTV‑4 was detected in Southern Italy (Apulia region). This study reports the detection of BTV in species of Culicoides (Diptera: Ceratopogonidae) collected in Italy during the epidemics between 2012 and 2014. A total of 2,925 pools (83,102 midges), sorted from 651 collections made on 339 affected farms of 12 Italian regions, were tested for the presence of BTV by real time polymerase chain reaction (RT‑PCR). The study clearly shows that Culicoides imicola and Obsoletus complex have played a crucial role in the bluetongue (BT) epidemics in Italy in 2012‑2014. Nevertheless, it also shows that other species may have played a role in transmitting BTV during these outbreaks. Culicoides dewulfi and at least 3 species of the Pulicaris complex, namely Culicoides pulicaris, Culicoides newsteadi and Culicoides punctatus, were found positive to BTV. Serotype 1 was detected in all species tested, whereas the BTV‑4 was detected in the Obsoletus complex, C. imicola, and C. newsteadi.

Akt expression in mouse oocytes matured in vivo and in vitro

To improve developmental competence of in vitro matured oocytes, culture medium can be supplemented with hypoxanthine (Hx) and FSH or epidermal growth factor (EGF) to trigger the activation of essential signalling pathways regulating meiotic resumption and progression. Since the serine/threonine kinase, Akt, contributes to the regulation of the meiotic cell cycle, this study analysed its expression level and localization at the meiotic spindle in oocytes matured in vivo or in vitro in the presence of Hx-FSH or Hx-EGF. Independently of culture conditions adopted, Akt mRNA concentration did not vary from germinal vesicle to metaphase I (MI), while at MII a significant decrease in Akt1 mRNA concentration was recorded in oocytes matured in vivo and in those stimulated by Hx-EGF (P < 0.05). Phoshorylated Akt protein content was similar in the different groups of MI oocytes, but it decreased at MII in oocytes matured either in vivo or in vitro with Hx-EGF. Ser-473-phosphorylated Akt was localized uniformly to the meiotic spindle in more than 90% of oocytes. These results indicate that, in mouse oocytes, Akt expression is differentially regulated during in vivo and in vitro maturation and suggest that EGF could be a positive modulator, even stronger than FSH, of oocyte meiotic maturation.

Solvent vapour monitoring in work space by solid phase micro extraction

Solid phase micro extraction (SPME) is a fast, solvent-less alternative to conventional charcoal tube sampling/carbon disulfide extraction for volatile organic compounds (VOC). In this work, SPME was compared to the active sampling technique in a typical lab atmosphere. Two different types of fibre coatings were evaluated for solvent vapour at ambient concentration. A general purpose 100 microm film polydimethylsiloxane (PDMS) fibre was found to be unsuitable for VOC work, despite the thick coating. The mixed-phase carboxen/PDMS fibre was found to be suitable. Sensitivity of the SPME was far greater than charcoal sorbent tube method. Calibration studies using typical solvent such as dichloromethane (DCM), benzene (B) and toluene (T) showed an optimal exposure time of 5 min, with a repeatability of less than 20% for a broad spectrum of organic vapour. Minimum detectable amount for DCM is in the range of 0.01 microg/l (0.003 ppmv). Variation among different fibres was generally within 30% at a vapour concentration of 1 microg DCM/l, which was more than adequate for field monitoring purpose. Adsorption characteristics and calibration procedures were studied. An actual application of SPME was carried out to measure background level of solvent vapour at a bench where DCM was used extensively. Agreement between the SPME and the charcoal sampling method was generally within a factor of two. No DCM concentration was found to be above the regulatory limit of 50 ppmv.

Left ventricular hypertrophy, treadmill tests, and 24-hour blood pressure in pediatric transplant patients

BACKGROUND

Hypertension and left ventricular hypertrophy (LVH) are possible complications in pediatric patients after renal transplantation.

METHODS

We performed left ventricular echocardiography, 24-hour ambulatory blood pressure monitoring (24-hr ABPM), and treadmill tests in 28 pediatric renal transplant patients (mean age 16.1 +/- 3.7; time since transplantation 36 +/- 23 months). Left ventricular mass (LVM) was indexed for height 2.7.

RESULTS

LVH was found in 82% of the patients. Seven of these patients were normotensive by 24-hour ABPM, but five patients showed a hypertensive systolic BP response during the treadmill test. LVM/height 2.7 correlated significantly with the mean 24-hour systolic BP (P = 0.002) and with the maximal exercise systolic BP (P = 0.002).

CONCLUSION

LVH is frequent in pediatric renal transplant patients. More information is needed with respect to the risk for LVH, including data from 24-hour ABPM and treadmill testing.

Isolated neonatal atrial flutter: clinical features, prognosis and therapy

BACKGROUND

Concern exists in literature about the clinical course, the best acute and chronic treatment and the prognosis of idiopathic neonatal atrial flutter. The aim of our study was to evaluate this in a population of our patients with this type of arrhythmia.

METHODS

Six infants (3 M, 3 F, mean age 42 +/- 62 days, range 1-150) affected with atrial flutter without structural heart disease were studied and then acutely and chronically treated. The effectiveness of chronic antiarrhythmic treatment was evaluated with Holter monitoring every 3 months for the first year of life and with transesophageal atrial pacing.

RESULTS

Mean arrhythmia cycle length was 180 +/- 34 ms with atrioventricular conduction ratio ranging between 1:1 and 3:1. Two patients with clinical signs of heart failure were successfully treated with DC shock. Transesophageal overdrive atrial pacing was successfully used in one patient treated with i.v. propafenone without benefit. In the remaining three patients, cardioversion was achieved with amiodarone after digoxin had failed in all three and propafenone had failed in two of them. To prevent recurrences, we treated four patients with amiodarone, one with amiodarone combined with propranolol and one with digoxin. During the follow-up (22 +/- 11 months), neither arrhythmia recurrences nor side-effects of the therapy occurred.

CONCLUSIONS

Neonatal atrial flutter is an arrhythmia with significant acute morbidity but an excellent long-term prognosis. Electrical cardioversion is the first-choice treatment when the arrhythmia is not well-tolerated hemodynamically, while class III antiarrhythmic drugs such as amiodarone should be preferred in the other cases.

[The heart of anorexic adolescents]

BACKGROUND

Anorexia nervosa (AN) is often associated with cardiac changes, such as thinning of the left ventricle (LV), reduction of LV mass, abnormalities of mitral valve function and systolic dysfunction. Some authors have reported QT interval prolongation and sudden death in these patients.

METHODS

We studied 23 adolescent females, aged 14.7 +/- 2 years (mean +/- SD), with AN. Serum electrolytes, proteins and albumin were measured in all patients. Electrocardiogram, Doppler-echocardiogram and chest X-rays were also performed on the same day. Eighteen patients were also examined via indirect calorimetry (difference from basal metabolic rate) and 21 underwent dosage of thyroid hormones.

RESULTS

The patients, who were of normal height (159 +/- 7.4 cm), were underweight (36 +/- 4.8 kg) and had a body mass index (BMI) of less than 19 (14.2 +/- 1.3). Serum electrolytes, proteins, albumin and chest X-rays were substantially normal in all patients; 74% of them showed reduction of FT3. The calorimetry was reduced (-27.1 +/- 10.6%) with the exception of one patient. Resting heart rate was 58 +/- 12 bpm. We found normal values for PR, QRS, QT (0.41 +/- 0.03 s1/2) and QTc intervals (0.40 +/- 0.03 s1/2) and QT dispersion (40.9 +/- 14.1 ms). Echocardiography showed a reduction in the dimensions of the interventricular septum (52% of patients), LV free wall (61%), left atrium (31%) and LV mass (61%). Fractional shortening was normal in all but one patient. In 61% of cases, there was mild or moderate pericardial effusion that was clinically silent and inversely related to BMI (r = -0.38, p 0.08, ns), to calorimetry (r = -0.56, p < 0.0055), to FT3 (r = -0.53, p < 0.05) and to sodium concentration (r = -0.43, p 0.04).

CONCLUSIONS

Teen-agers with AN often show a reduction in LV thickness and mass, as well as clinically silent pericardial effusion that is inversely related to BMI, calorimetry, FT3 and sodium serum concentrations. We did not find any prolongation of QTc interval or of QT dispersion.

Permanent overdrive atrial pacing in the chronic management of recurrent postoperative atrial reentrant tachycardia in patients with complex congenital heart disease

This study investigated the value of permanent atrial pacing as an adjunct to the current therapy in the chronic management of recurrent postoperative atrial reentrant tachycardia in patients with complex congenital heart disease. We studied the postpacing clinical course in 18 patients with recurrent atrial reentrant tachycardias unresponsive to conventional therapy who had an implanted atrial pacemaker. The pacemaker was programmed at a lower pacing rate 20% faster than the spontaneous mean daily rate previously determined with 24-hour Holter monitoring. Serial Holter recordings and pacemaker programming sessions were subsequently performed trying to maintain a paced atrial rhythm overdriving the spontaneous rhythm as long as possible. Twenty-four hour Holter monitoring documented a prevalent (> 80%) paced rhythm during the daily hours in all patients during the follow-up; all patients, however, required at least once a variation in programmed mode and pacing rate. Antiarrhythmic medications were discontinued after 6 months if the patient remained arrhythmia free while on pacing. Recurrences of atrial reentrant tachycardia occurred in five patients (29%) during the initial 6 months interval after the pacemaker implantation, while late recurrences occurred in only two patients (11%). One patient died suddenly 10 months after the pacemaker implant. At the end of the follow-up, 15 patients (83%) were arrhythmia-free and only 2 of them were still on antiarrhythmic drugs. We conclude that permanent atrial overdrive pacing can be an important tool in the management of patients with atrial reentrant tachycardia following repair of congenital heart disease.

Exercise tolerance and behavior of blood pressure in children and adolescents after renal transplant

OBJECTIVE

The purpose of the study was to evaluate the exercise tolerance and the behaviour of blood pressure during a maximal exercise testing on treadmill for a group of patients with renal transplant carried out at least 6 months earlier. EXPERIMENTAL DESIGN, SETTING AND PATIENTS: In a retrospective study, nineteen patients were examined in our laboratory: 13 boys and 6 girls, mean age 15.8 years (range 10.5-22).

INTERVENTIONS

All patients were given a clinical examination, an ECG at rest, a maximal exercise testing on treadmill (Bruce protocol), a mono-2D echo, a lung function test and 24-hour Holter monitoring. The results of the exercise test were compared with those of two control groups of same age and body surface area.

RESULTS

The clinical examination of their cardiovascular apparatus gave normal results. The echo revealed anatomical and heart function anomalies related to the original disease. Exercise testing on treadmill showed a reduction in exercise tolerance (p < 0.001) and the maximal heart rate showed a statistically significant difference (p < 0.001) in comparison to control groups. Maximal systolic blood pressure was higher than in patients with same body surface area (p < 0.001) and higher than in peers (p = 0.133).

CONCLUSIONS

In view of this hypertensive response, strenuous physical activity should be undertaken with caution and indeed submaximal aerobic activity is more suitable for this population of patients.

Reciprocating supraventricular tachycardia in children: low rate at rest as a major factor related to propensity to syncope during exercise

Reciprocating supraventricular tachycardia may have several clinical presentations, with symptoms often more severe during exercise or emotional stress. This study shows by using transesophageal atrial pacing, the factors related to syncope during exercise. Between May 1989 and June 1994, transesophageal atrial pacing was performed at rest and during exercise in 75 children aged > 6 years with suspected or documented episodes of paroxysmal supraventricular tachycardia. Reciprocating supraventricular tachycardia could be induced both at rest and during exercise in 22 patients (8 girls, 14 boys; mean age 10.6 +/- 2.7 years, range 7 to 15 years) with ventriculoatrial interval < 70 msec in 11 patients and > 70 msec in 11. At rest, all patients had palpitations caused by the induction of tachycardia. After conversion to sinus rhythm, when tachycardia was induced during exercise, symptoms did not change in 14 patients (group A), whereas symptoms worsened (presyncope) in eight (group B). The statistical analysis showed a significant difference of mean reciprocating supraventricular tachycardia rate at rest between the two groups (group A, 211 +/- 23 beats/min; group B, 173 +/- 33 beats/min; p = 0.0057) and reciprocating supraventricular tachycardia rate variation from rest to exercise (group A, 62 +/- 18 beats/min; group B, 105 +/- 24 beats/min; p = 0.0001). These data suggest that children with low tachycardia rate during normal activities may have syncope more frequently, independently of the tachycardia rate during exercise or emotional stress.

[Transesophageal atrial stimulation in the oral treatment of supraventricular reciprocal paroxysmal tachycardia in infants]

INTRODUCTION

The aim of the study was the evaluation of the usefulness of transesophageal atrial pacing in predicting chronic oral treatment efficacy of symptomatic reciprocating supraventricular tachycardia in infants and in avoiding the risk of very dangerous recurrences at home.

METHODS

We studied 13 infants (11 males, 2 females, mean age 43 +/- 31 days) with symptomatic reciprocating supraventricular tachycardia and no structural heart disease. All patients had chronic oral therapy, using the drug effective in acute i.v. somministration. Each patient was discharged when supraventricular tachycardia was not inducible with transesophageal atrial pacing after 5 half-lives of the drug used in chronic oral treatment. All patients, every 6 months, were retested with transesophageal atrial pacing alternatively during chronic oral therapy and after complete wash out. Oral therapy was stopped in each patient when supraventricular tachycardia was not inducible after the wash out.

RESULTS

The number of oral treatments tested for each patient were 2 +/- 1 (range 1-5). The number of transesophageal studies performed for each patient were 4 +/- 2 (range 3-7). No patient had symptomatic episodes of supraventricular tachycardia or needed to change therapy during the follow-up. The oral treatment was stopped after the twelfth month of life in 8 patients and after the twenty-fourth in 2 others without recurrences.

CONCLUSION

Transesophageal atrial pacing seems to be useful in predicting accurately and rapidly the oral treatment efficacy of supraventricular tachycardia in infants. Our protocol seems to be effective to avoid dangerous recurrences of tachycardia and to decide when we can stop therapy without risk.

[The life style and physical activity of the child operated on for congenital cardiopathy]

The parents of 151 children operated on for congenital heart disease have answered some questions about the scholastic, extrascholastic and physical activity of their children. Approximately 94% of the children are at the correct school level for their age. Extrascholastic activities of the city children is the same as children living in the country. During their free time 22% of the child population engages in physical activity, whereas 78% of the child population engages in physical activity at school. Among the parents, 61% think the activity of their children is normal, and 27% think it is too active. Our results demonstrate that the children operated on for congenital heart disease have a normal life during scholastic and free time, whereas, the introduction of these children to sport activities is anomalous and insufficient.

Rehabilitation of children after total correction of tetralogy of Fallot

Nine children who had undergone total correction of tetralogy of Fallot were studied with the purpose of observing the physical changes that might be produced by a period of rehabilitation in hospital and comparing these results with those of a control group having the same pathology but which had not followed a protocol for physical activity. Precise criteria were used in the selection of the patients. Careful clinical examinations and exercise tests were conducted before and after the programme, in particular maximal stress testing on the bicycle ergometer and submaximal exercise on the treadmill. The sessions were held three times weekly in a gymnasium over three months, gradually increasing the duration of each session to a maximum of one hour. During the session, heart rate was monitored with a Sport-tester 3000 so as not to exceed 60%, then 70%, of the maximal heart rate recorded during the stress test. Testing at the end of the programme demonstrated an improvement in tolerance under maximal stress in 7 of the 9 patients. As for submaximal performance, 8 out of 9 children covered a greater distance using the same parameters as for initial testing. At the end of the programme, the children all showed increased independence and initiative and more self-confidence in establishing social relations. The programme has proven to be a comprehensive method for safely improving physical fitness in these patients and represents an important starting point for a better future.

[Cycloergometric exercise test in normal children: comparison of an Italian and a North American population]

The need for a more complete protocol for bicycle ergometer exercise testing in children in our country, induced the Authors to apply the F.W. James protocol to healthy Italian children and then compare the results with a study on a similar american sample population. A total of 102 children, 67 males and 35 females, age range 4.4 - 17 years (mean 10.3 yrs), were examined following the F.W. James protocol. The Authors report the anthropometric and ergometric data obtained, the comparison with James' results and the linear correlation coefficients. Normal reference data were obtained. There were no significant differences between the results obtained from the Italian and American groups, and the correlation coefficients were satisfactory. The results will enable us to benefit from a simple and complete protocol which can be applied to healthy and sick children alike in our country.

[Diagnostic usefulness of Holter monitoring in pediatric fainting and syncope]

The aim of the study was to assess the diagnostic efficacy of ambulatory electrocardiographic monitoring in children with a previous history of fainting and/or syncope. Sixty-one children, from 2 months to 17 years of age, all at the time undergoing different physical examinations because of previous syncopal episodes were examined. All the children had a normal electrocardiogram at rest and all underwent 24 hour electrocardiographic monitoring (Holter). The ECG was normal in 48 patients. Eight children had several dysrhythmias, classified as "borderline" and five children showed a clearly pathological trend. These results are even more significant considering that standard electrocardiogram results are negative. These data underline the diagnostic importance of the dynamic electrocardiogram particularly in cases of very frequently repeated symptoms.