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Five yeast strains isolated from forest habitats in Hungary and Germany were characterized phenotypically and by sequencing of the D1/D2 domain of the large subunit rRNA gene and the ITS1-5.8S-ITS2 (ITS) region of the rRNA gene. The strains have identical D1/D2 domain and ITS region sequences. By sequence comparisons, Candida mycetangii and Candida maritima were identified as the closest relatives among the currently recognized yeast species. The DNA sequences of the investigated strains differ by 1.2 % (six substitutions) in the D1/D2 domain and by 3.5 % (12 substitutions and eight indels) in the ITS region from the type strain of C. mycetangii (CBS 8675 T ) while by 1.2 % (six substitutions and one indel) in the D1/D2 domain and by 7 % (32 substitutions and seven indels) in the ITS region from the type strain of C. maritima (CBS 5107 T ). Because the intraspecies heterogeneity seems to be very low and the distance to the most closely related species is above the commonly expected level for intraspecies variability Cyberlindnera sylvatica sp. nov. (holotype, CBS 16335 T ; isotype, NCAIM Y.02233 T ; MycoBank no., MB 835268) is proposed to accommodate the above-noted five yeast strains. Phenotypically the novel species can be distinguished from C. mycetangii and C. maritima by the formation of ascospores. Cyberlindnera sylvatica forms one or two hat-shaped ascospores per ascus on many different media as well as well-developed pseudohyphae and true hyphae. Additionally, we propose the transfer of three anamorphic members of the Cyberlindnera americana sub-clade to the genus Cyberlindnera as the following new taxonomic combinations Cyberlindnera maritima f.a., comb. nov., Cyberlindnera mycetangii f.a., comb. nov. and Cyberlindnera nakhonratchasimensis f.a., comb. nov.

Purpose: The Woven EndoBridge (WEB) device has been proven to be a safe and efficient endovascular treatment option for wide-necked bifurcation aneurysms. The study aimed to evaluate the incidence and risk factors of procedural complications related to WEB embolization of ruptured and unruptured intracranial aneurysms., Methods: This was a multicenter, observational study of consecutive patients with ruptured and unruptured aneurysms who were treated with the WEB at three German tertiary care centers between May 2011 and February 2018. Patient characteristics, anatomical details and procedural aspects were retrospectively collected and the impact on procedure-related complications was evaluated., Results: Among 120 patients (mean age 58.5 ± 11.9 years) with 120 aneurysms (mean size: 8.5 ± 4.5 mm), WEB implantation was successful in 112 patients (93.3%). The rates for overall and symptomatic complications were 11.7% and 5.0%, respectively. At 6‑month follow-up device-related morbidity was 1.2% among unruptured aneurysms and 2.6% among ruptured aneurysms. In the univariate analysis, a lower aspect ratio (p = 0.04) and an increased width-to-height ratio (p = 0.03) were significant risk factors for procedural complications., Conclusion: The results of this study confirmed the WEB to be a safe treatment option, which is associated with low complication rates and minimal morbidity. Complications tended to occur more often in aneurysms with an unfavorable ratio between aneurysm height and aneurysm/neck width.

Objective: To determine feasibility and safety of stroke care organization within our Neurovascular Network of Southwest Bavaria (NEVAS) in a rural area with distances of up to 100 kilometers, we compared patients who underwent mechanical thrombectomy (MT) in large vessel occlusion admitted directly to our center (direct to center [DTC]) to patients who were transferred for MT via NEVAS (drip and ship [DS])., Methods: This is a retrospective analysis of prospectively collected data of all MT patients between January 2015 and May 2018. Successful recanalization was defined as a thrombolysis in cerebral infarction score of 2b-3. Symptomatic intracerebral hemorrhage (sICH) was defined according to European Cooperative Acute Stroke Study 3. Modified Rankin Scale (mRS) score of 0-2 at 3 months indicated good outcome., Results: MT was performed in 410 patients: 221 DTC and 189 DS. Median NIH Stroke Scale (NIHSS) score was 16 and premorbid mRS score was 0. Thrombolysis was applied in 62.2% with the same time from symptom onset in both groups (94.5 vs 95 minutes). Successful recanalization (79.3% vs 77.8%) and NIHSS score reduction from admission to discharge (16-7 vs 17-6) were comparable. Time delay from onset to revascularization was 96 minutes in DS (212 vs 308 minutes, p = 0.001). At follow-up, DTC patients had a trend to better outcome (33.5% vs 24.3%, p = 0.056). Neither sICH (6.3% vs 5.9%, p = 0.840) nor mortality (31.2% vs 34.4%, p = 0.387) differed between the groups., Conclusion: DS patients benefit from MT without relevant safety concerns, but with a trend to unfavorable outcome compared to DTC patients. These results suggest that DS is suitable to provide MT in rural areas where DTC is not possible., (© 2019 American Academy of Neurology.)

Background and Purpose- Endovascular treatment for large vessel occlusion in ischemic stroke has proven to be effective in large clinical trials. We aimed to provide real-world estimates of endovascular treatment reperfusion rates and functional outcome on a countrywide scale. Methods- Two thousand seven hundred ninety-four patients with large vessel occlusion were included into an investigator-initiated, industry-independent, prospective registry in 25 sites in Germany between June 2015 and April 2018. The primary outcome was the score on the modified Rankin Scale ranging from zero (no symptoms) to 6 (death) at 3 months. Secondary analyses included the prediction of a good outcome (modified Rankin Scale, 0-2). Dichotomized analyses of predictors were performed using logistic regression adjusted for potential confounders. Results- Median age was 75 years (interquartile range, 64-82); median National Institutes of Health Stroke Scale score was 15 (interquartile range, 10-19). Vessel occlusion was in the anterior circulation in 2265 patients (88%) and in the posterior circulation in 303 patients (12%). Intravenous alteplase before endovascular treatment was given in 1457 patients (56%). Successful reperfusion was achieved in 2143 subjects (83%). At 3 months, 854 patients (37%) showed a good outcome; mortality was 29%. There was no difference between anterior and posterior circulation occlusions (P=0.27). Significant predictors for a good outcome were younger age (odds ratio [OR], 1.06; 95% CI, 1.05-1.07), no interhospital transfer (OR, 1.39; 95% CI, 1.03-1.88), lower stroke severity (OR, 1.10; 95% CI, 1.08-1.13), smaller infarct size (OR, 1.26; 95% CI, 1.15-1.39), alteplase use (OR, 1.49; 95% CI, 1.08-2.06), and reperfusion success (OR, 1.69; 95% CI, 1.45-1.96). Conclusions- High rates of favorable outcome can be achieved on a countrywide scale by endovascular treatment. Mortality appears to be greater in the daily routine than otherwise reported by authors of large randomized trials. There were no outcome differences between the anterior and posterior circulation. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT03356392.

Eight yeast strains that asexually reproduce by cell fission were isolated from bee bread of different solitary bees in Germany. DNA sequence analysis revealed that the strains shared the same sequence in the D1/D2 domain of the nuclear large subunit (LSU) rRNA gene with a strain that was previously isolated from a fig snack from Spain. The closest related type strain was that of Schizosaccharomyces octosporus, which showed 98.2% sequence similarity (11 substitutions) with the new strains. By clone sequence analysis of the internal transcribed spacer (ITS) region (ITS1, 5.8S rDNA, and ITS2) a total of nine different copy types were identified. The new strains differed from S. octosporus by approximately 31% in the ITS region. Sequence analysis of the RNAse P gene further supported the description of a new species. The strains isolated during this study show some phenotypic characteristics that separate them from the closest related species, S. octosporus and S. cryophilus. Since all strains showed true osmophily the name of the new species is S. osmophilus (holotype: CBS 15793T; isotype: CLIB 3267 T = NCAIM Y.02225 T, MycoBank no.: MB829586)., (© FEMS 2019.)

Background: Endovascular treatment has become standard of care for the treatment of acute ischemic stroke with large vessel occlusion. However, patients treated in clinical practice differ from the selected populations randomized in clinical trials., Aims: The German Stroke Registry Endovascular Treatment (GSR-ET) aims at a systematic evaluation of outcome, safety, and process parameters of endovascular stroke treatment in standard of care in Germany., Methods: The GSR-ET is an academic, independent, prospective, multicenter, observational registry study. Participating stroke centers from all over of Germany consecutively enroll patients transferred to the angiography suite with an intention to be treated with endovascular stroke treatment. Patients receive regular care. Data are collected as part of clinical routine. Baseline clinical and procedural information and clinical follow-up information after 90 days are recorded. Here, we present an analysis of baseline data of the first 1662 patients included in the GSR-ET., Results: The registry was established in June 2015. By 31 December 2017, 1662 patients were enrolled in 23 active sites. Mean age was 72 ± 13 years, 50% were female, and median National Institutes of Health Stroke Scale on admission was 15 (IQR 10-19), 88% had anterior circulation occlusion. Median ASPECT score was 8 (IQR 7-10) prior to intervention. Fifty-nine percent of patients received intravenous thrombolysis prior to thrombectomy. Mean "onset-to-groin" time was 224 ± 176 min., Conclusions: Baseline characteristics of stroke patients undergoing thrombectomy in clinical practice differ from those in the randomized trials. The GSR-ET will provide valuable insights into practices of endovascular treatment in routine care of acute ischemic stroke. (GSR-ET ClinicalTrials.gov Identifier: NCT03356392.).

Purpose: Digital subtraction angiography (DSA) is deemed necessary to precisely visualize intracranial aneurysms and define individual treatment strategies. In patients with unruptured intracranial aneurysms (UIA) who were diagnosed by MRI, a four-vessel DSA is usually performed to detect additional aneurysms. This study aimed to evaluate whether the evaluation of all vessels beyond the aneurysm-harboring artery is really necessary., Material and Methods: Patients with an UIA that was detected on MRA (TOF/ceMRA) were prospectively included. All patients underwent a four-vessel DSA (including 3D-DSA) and two experienced neuroradiologists independently analyzed the MRI sequences before DSA. The number of aneurysms, size and anatomic localization were documented and correlated with the angiographic findings., Results: The DSA revealed a total of 134 aneurysms in 106 patients. Overall sensitivity and negative predictive value of MRA were 95.6% and 95.6%, respectively. In patients with multiple (≥2) aneurysms, 4 very small aneurysms <3 mm in the A2 segment, posterior communicating artery (PcomA), extradural internal carotid artery (ICA) were missed with MRI alone. In one patient with an ICA aneurysm, an additional small MCA bifurcation aneurysm was overlooked by MRA but detected by DSA. The periprocedural complication rate was 0.9%., Conclusion: The rate of aneurysms that were detected by DSA but not by MRA was very low, thus potentially justifying visualization of the vessel harboring aneurysm alone; however, the four-vessel angiography detected further small aneurysms in patients with multiple aneurysms and therefore seems to be indicated in this specific subgroup. This approach has the potential to reduce the risk of complications, the intervention time and thus radiation exposure.

The distribution patterns of the three Saccharomyces species, Saccharomyces paradoxus, S. uvarum and S. cerevisiae, were investigated by a culture-dependent approach in order to understand better how these species propagate in the cultural landscape of Germany. Saccharomyces paradoxus, the closest relative of S. cerevisiae, is shown to be a true woodland species. It was frequently found in the soil under conifers indicating that S. paradoxus is an autochthonous member of the microbial community in this habitat. Physiological characteristics of the species like the Crabtree effect and high tolerance against ethanol suggest that the species is adapted to regular supply with considerable amounts of sugars. Additionally, a high proportion of the S. paradoxus strains isolated in this study are shown to have the rare ability to ferment melezitose. For these reasons, it is hypothesized that S. paradoxus may be closely associated with the honeydew system in forests. Saccharomyces cerevisiae was rare in most habitats and only exceeded the frequency of S. paradoxus in habitats characterized by modern agricultural mass production of fruit. Both the landscape structure and the agricultural system heavily influence the frequencies of Saccharomyces species., (© FEMS 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The yeast diversity on wine grapes in Germany, one of the most northern wine growing regions of the world, was investigated by means of a culture dependent approach. All yeast isolates were identified by sequence analysis of the D1/D2 domain of the 26S rDNA and the ITS region. Besides Hanseniaspora uvarum and Metschnikowia pulcherrima, which are well known to be abundant on grapes, Metschnikowia viticola, Rhodosporidium babjevae, and Curvibasidium pallidicorallinum, as well as two potentially new species related to Sporidiobolus pararoseus and Filobasidium floriforme, turned out to be typical members of the grape yeast community. We found M. viticola in about half of the grape samples in high abundance. Our data strongly suggest that M. viticola is one of the most important fermenting yeast species on grapes in the temperate climate of Germany. The frequent occurrence of Cu. pallidicorallinum and strains related to F. floriforme is a new finding. The current investigation provides information on the distribution of recently described yeast species, some of which are known from a very few strains up to now. Interestingly yeasts known for their role in the wine making process, such as Saccharomyces cerevisiae, Saccharomyces bayanus ssp. uvarum, Torulaspora delbrueckii, and Zygosaccharomyces bailii, were not found in the grape samples., (Copyright © 2015. Published by Elsevier B.V.)

A novel asexual ascomycetous yeast, Candida kunwiensis (SG99-26T = KCTC 17041T = CBS 9067T), was isolated from sweet potato (Ipomoea batatas) flowers in Korea and from the body surface of pollinating bumblebees in Germany. Comparative analysis of the D1/D2 domain of 26S rDNA of all available sequences for ascomycetous yeasts showed that the novel species was phylogenetically related to the genus Metschnikowia, but the sequence similarity was low. Morphologically and physiologically, C. kunwiensis in many ways resembles Metschnikowia pulcherrima, but can be distinguished from this species by its ability to assimilate lactic acid and its inability to produce pulcherrimin.