Mortality Events Research Articles

Model estimation of eastern oyster larval performance from food quantity and quality measures in western Mississippi Sound

Oyster Crassostrea virginica population recovery is critical in degraded estuarine systems, such as Mississippi Sound, USA, where repeated mass mortality events have depleted local oyster stocks. Owing to multiple recent die-offs, the western Mississippi Sound oyster population is recruitment-limited; population growth is constrained by the entry of new individuals into the extant population. Therefore, oyster recovery requires an adequate supply of larvae capable of timely development, growth, and successful metamorphosis. Larval performance and settlement potential are influenced by ambient temperature, salinity, and food supply. Food quantity is important to larvae, but so is food quality, as larvae require a balanced diet of lipids, proteins, and carbohydrates to develop and survive through metamorphosis. In this study, in situ environmental and food conditions during the 2021 and 2022 spawning seasons from 7 oyster reefs in western Mississippi Sound were integrated into an established biochemically based larval performance model to estimate periods facilitative of successful metamorphosis. In 2021, model-estimated larval survivorship was suppressed through much of the spawning season by prolonged, extremely low salinity (<5 ppt) and inadequately balanced food supply. Higher seasonal salinity and more balanced food composition increased model-estimated larval survivorship in 2022, despite lower total food content, suggesting larval performance was primarily governed by the quality of available food. Model-estimated settlement windows were compared to settlement windows derived from concomitant field observations of recruitment. Strong agreement between model-estimated and observed settlement windows validates the effectiveness of the model and informs on the underlying causes of recruitment limitation in western Mississippi Sound.

Serum Soluble Corin and Long-Term Clinical Outcomes After Acute Ischemic Stroke.

Corin plays important roles in the regulation of blood volume and pressure and cardiac function by activating natriuretic peptide pathway, exerting multiple cardioprotective effects. But the impacts of soluble corin on clinical outcomes after ischemic stroke are unclear. We aimed to investigate the associations between serum soluble corin and long-term clinical outcomes after acute ischemic stroke. We measured the concentrations of serum soluble corin in 3162 participants (2010 men and 1152 women) from the China Antihypertensive Trial in Acute Ischemic Stroke. The clinical outcomes were recurrent stroke, cardiovascular events, all-cause mortality, and unfavorable functional outcome within 24 months after stroke. Risk reclassification for study clinical outcomes of models with soluble corin were evaluated. Serum soluble corin was inversely associated with recurrent stroke, cardiovascular events, and unfavorable functional outcome after ischemic stroke. After adjusting for multiple covariates, each additional SD of log-corin was associated with a 21% (95% CI, 11-30), 16% (95% CI, 6-26), and 12% (95% CI, 3-21) decreased risk for recurrent stroke, cardiovascular events, and unfavorable functional outcome, respectively. Furthermore, the addition of soluble corin to the basic model with conventional risk factors significantly improved risk discrimination for recurrent stroke, cardiovascular events, and the composite outcome of all-cause mortality and cardiovascular events, as shown by C-statistics (all P<0.05). Serum soluble corin was associated with decreased risks of long-term clinical outcomes, and may be a promising prognostic biomarker for risk stratification in patients with acute ischemic stroke.

Association between admission blood pressure and spontaneous reperfusion and long-term prognosis in STEMI patients: an observational and multicenter study

BackgroundThis study aims to assess the associations of admission systolic blood pressure (SBP) level with spontaneous reperfusion (SR) and long-term prognosis in ST-elevation myocardial infarction (STEMI) patients.MethodsData from 3809 STEMI patients who underwent primary percutaneous coronary intervention within 24 h, as recorded in the Chinese STEMI PPCI Registry (NCT04996901), were analyzed. The primary endpoint was SR, defined as thrombolysis in myocardial infarction grade 2–3 flow of IRA according to emergency angiography. The second endpoint was 2-year all-cause mortality. The association between admission BP and outcomes was evaluated using Logistic regression or Cox proportional hazards models with restricted cubic splines, adjusting for clinical characteristics.ResultsAdmission SBP rather than diastolic BP was associated with SR after adjustment. Notably, this relationship exhibits a nonlinear pattern. Below 120mmHg, There existed a significant positive correlation between admission SBP and the incidence of SR (adjusted OR per 10-mmHg decrease for SBP ≤ 120 mm Hg: 0.800; 95% CI: 0.706–0.907; p<0.001); whereas above 120mmHg, no further improvement in SR was observed (adjusted OR per 10-mmHg increase for SBP >120 mm Hg: 1.019; 95% CI: 0.958–1.084, p = 0.552). In the analysis of the endpoint event of mortality, patients admitted with SBP ranging from 121 to 150 mmHg exhibited the lowest mortality compared with those SBP ≤ 120mmHg (adjusted HR: 0.653; 95% CI: 0.495–0.862; p = 0.003). In addition, subgroups analysis with Killip class I-II showed SBP ≤ 120mmHg was still associated with increased risk of mortality.ConclusionThe present study revealed admission SBP above 120 mmHg was associated with higher SR,30-d and 2-y survival rate in STEMI patients. The admission SBP could be a marker to provide clinical assessment and treatment.Trial registrationClinicalTrials.gov (NCT04996901), 07/27/2021.

Unravelling a hidden synergy: How pathogen-climate interactions transform habitat hydrology and affect tree growth

Interactions between multiple global change stressors are a defining characteristic of the Anthropocene. Tree-associated pathogens are affecting forested ecosystems worldwide and occur in the context of increased frequency and intensity of extreme climate events such as heat waves, droughts, and floods. The effects of these events, along with subsequent changes in environmental conditions, on remaining and regenerating trees, are not well understood but crucial for the restoration and conservation of forested habitats.In this study, we investigate ash (Fraxinus excelsior) dieback in a temperate broadleaf woodland as a case study to explore the processes influencing non-infected trees during pathogen-induced mortality events. Utilising an experimental setup, we examine tree growth rates at different chronological stages of the disease, including naturally progressing ash dieback (4–5 years since disease outbreak), accelerated ash dieback where ash trees have been girdled (10–15 years), and negligible ash dieback (<20 % ash trees).During a year with typical climatic conditions (2021), soils in accelerated ash dieback plots remained saturated throughout the summer due to insufficient transpiration (57 % higher in the accelerated dieback plots), suggesting a significantly increased risk of summer run-off and floods. However, tree growth rates in these plots were not affected (t-test, t = −0.3 to 1.2, p > 0.05). Conversely, anomalously dry years, such as the 2022 summer drought, saw higher soil moisture in the accelerated ash dieback plots (t-test, t = 4.8, p < 0.01) acting as a buffer, resulting in normal tree growth during drought compared to greatly reduced growth in plots with weaker dieback.These findings emphasise the complex interactions between extreme climate events and pathogen outbreaks. Better understanding of the relationships between pathogens and hydrology on tree growth is imperative and detailed long-term studies on tree growth and hydrology will facilitate and improve mitigation strategies.

High-sensitivity C-reactive protein to high-density lipoprotein cholesterol ratio predicts long-term adverse outcomes in patients who underwent percutaneous coronary intervention: A prospective cohort study.

High-sensitivity C-reactive protein (hsCRP) to high-density lipoprotein cholesterol (HDL-C) ratio (CHR) is associated with coronary artery disease (CAD), but its predictive value for long-term adverse outcomes in patients with CAD following percutaneous coronary intervention (PCI) remains unexplored and is the subject of this study. Patients with CAD who underwent PCI at the Korea University Guro Hospital-Percutaneous Coronary Intervention (KUGH-PCI) Registry since 2004 were included. Patients were categorized into tertiles according to their CHR. The end points were all-cause mortality (ACM), cardiac mortality (CM) and major adverse cardiac events (MACEs). Kaplan-Meier analysis, multivariate Cox regression, restricted cubic spline (RCS) and sensitivity analyses were performed. A total of 3260 patients were included and divided into Group 1 (CHR <0.830, N = 1089), Group 2 (CHR = 0.830-3.782, N = 1085) and Group 3 (CHR >3.782, N = 1086). Higher CHR tertiles were associated with progressively greater risks of ACM, CM and MACEs (log-rank, p < 0.001). Multivariate Cox regression showed that patients in the highest tertile had greater risks of ACM (HR: 2.127 [1.452-3.117]), CM (HR: 3.575 [1.938-6.593]) and MACEs (HR: 1.337 [1.089-1.641]) than those in the lowest tertile. RCS analyses did not reveal a significant non-linear relationship between CHR and ACM, CM or MACEs. The significant associations remained significant in the sensitivity analyses, RCS analyses with or without extreme values, subgroup analyses and multiple imputations for missing data. Elevated CHR is a novel, independent risk factor for long-term ACM, CM and MACEs in CAD patients following PCI.

The Role of Zinc Supplementation in Alleviating Inflammatory Biomarkers in Patients Undergoing Hemodialysis: A Randomized Placebo Controlled, Crossover Trial

Background: Chronic kidney disease (CKD), which progresses to end-stage renal disease (ESRD) and requires maintenance hemodialysis (MHD), is a global health issue. Inflammation in MHD patients is associated with increased mortality and cardiovascular events. Zinc, essential for immune function and possessing anti-inflammatory properties, is frequently deficient in these patients and could potentially help mitigate inflammation. Objectives: This study aims to assess the impact of zinc supplementation on inflammatory biomarkers, specifically (CRP) and the neutrophil-to-lymphocyte ratio (NLR), in MHD patients. Methods: In a double-blind, randomized controlled crossover trial conducted at Labafinejad Hospital, Tehran, MHD patients with zinc deficiency were initially allocated to either a zinc supplementation group or a placebo group. After 30 days, the groups were crossed over, with patients initially receiving zinc now receiving a placebo and vice versa. The primary outcome was changes in serum zinc levels, while secondary outcomes focused on CRP and NLR levels. Results: Significant changes in serum zinc levels were observed in both groups from baseline to Month 2 (drug-placebo group: Mean change -15.9±10.33 µg/dL, P &lt; 0.05; placebo-drug group: Mean change -14.70 ± 12.58 µg/dL, P &lt; 0.05). A significant initial reduction in CRP levels at Month 1 (P = 0.045) was not sustained at Month 2 (P = 0.812). No statistically significant changes in NLR were noted. Improvements in quality of life, including reductions in muscle pain and skin dryness, were significant in the drug-placebo group (P &lt; 0.05). Conclusions: Zinc supplementation in MHD patients significantly improved serum zinc levels and initially reduced CRP levels, highlighting its potential role in managing inflammation. Although the impact on NLR was not significant, overall patient outcomes and quality of life showed promising improvements.

Comparison of High-Dose versus Low-Dose Trimethoprim-Sulfamethoxazole for Treating Pneumocystis jirovecii Pneumonia among Hemodialysis Patients: A Nationwide Database Study in Japan.

Background: Hemodialysis patients are at high risk for developing Pneumocystis jirovecii pneumonia (PJP), and trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line agent for treating this disease. However, there is a lack of consensus on the required dosage of TMP-SMX for hemodialysis patients. Methods: This study used the nationwide Japanese Diagnosis Procedure Combination database to review hemodialysis patients hospitalized for PJP from April 2014 to March 2022. Eligible patients were divided into high-dose and low-dose groups based on the median daily dose per body weight of TMP. The 90-day mortality and adverse events after propensity score matching were compared between the groups. Results: A total of 126 hemodialysis patients with PJP were included, and the median daily dose per body weight of TMP was 5.74 mg/kg/day (interquartile range: 4.33-8.18 mg/kg/day). Thirty-two pairs were analyzed after the propensity score matching. No significant differences in the 90-day mortality and proportion of adverse events were observed between the high-dose and low-dose groups. Conclusions: A high dose of TMP-SMX is unlikely to decrease the in-hospital mortality and adverse events among hemodialysis patients with PJP. However, the results should be interpreted with caution, given the lack of power and lack of long-term follow-up. Additional prospective interventional studies are required to validate these results.

Prognostic significance of the estimated pulse wave velocity in critically ill patients with coronary heart disease: analysis from the MIMIC‑IV database.

There are currently no specialized risk-scoring systems for critically ill patients with coronary heart disease (CHD). Arterial stiffness, as measured by estimated pulse wave velocity (ePWV), has emerged as a potential indicator of mortality or adverse cardiovascular events in individuals with CHD. This study aimed to evaluate the association between ePWV and all-cause mortality among critically ill patients with CHD beyond traditional risk scores. This study included 11 001 participants with CHD from the Medical Information Mart for Intensive Care IV, with a one-year follow-up. The primary endpoint was one-year all-cause mortality, and the secondary endpoint was in-hospital mortality. Elevated ePWV was significantly associated with higher risks of in-hospital (OR 1.15, 95% CI 1.12-1.17, p<0.001) and one-year (HR 1.21, 95% CI 1.20-1.23, p<0.001) mortality. These associations remained consistent when adjusted for traditional risk scores and potential confounders. When ePWV was integrated into traditional risk scoring models (OASIS, SOFA score, APSIII, SIRS score, SAPS II, and LODS score), the predictive accuracy (area under the curve: 64.55 to 70.56, 64.32 to 72.51, 72.35 to 75.80, 55.58 to 67.68, 71.27 to 73.53, 67.24 to 73.40, p<0.001) and reclassification (net reclassification index: 0.230, 0.268, 0.257, 0.255, 0.221, 0.254; integrated discrimination improvement: 0.049, 0.072, 0.054, 0.068, 0.037, 0.061, p<0.001) of these models significantly improved for one-year mortality. Similar results were also found for in-hospital mortality. ePWV is a strong independent predictor of both short- and long-term mortality in critically ill patients with CHD. Importantly, integrating ePWV into traditional risk scores significantly boosts the predictive accuracy for one-year and in-hospital all-cause mortality.

Mediterranean octocoral populations exposed to marine heatwaves are less resilient to disturbances.

The effects of climate change are now more pervasive than ever. Marine ecosystems have been particularly impacted by climate change, with marine heatwaves (MHWs) being a strong driver of mass mortality events. Even in the most optimistic greenhouse gas emission scenarios, MHWs will continue to increase in frequency, intensity and duration. For this reason, understanding the resilience of marine species to the increase of MHWs is crucial to predicting their viability under future climatic conditions. In this study, we explored the consequences of MHWs on the resilience (the ability of a population to resist and recover after a disturbance) of a Mediterranean key octocoral species, Paramuricea clavata, to further disturbances to their population structure. To quantify P. clavata's capacity to resist and recover from future disturbances, we used demographic information collected from 1999 to 2022, from two different sites in the NW Mediterranean Sea to calculate the transient dynamics of their populations. Our results showed that the differences in the dynamics of populations exposed and those not exposed to MHWs were driven mostly by differences in mean survivorship and growth. We also showed that after MHWs P. clavata populations had lower resistance and slower rates of recovery than those not exposed to MHWs. Populations exposed to MHWs had lower resistance elasticity to most demographic processes compared to unexposed populations. In contrast, the only demographic process showing some differences when comparing the speed of recovery elasticity values between populations exposed and unexposed to MHWs was stasis. Finally, under scenarios of increasing frequency of MHWs, the extinction of P. clavata populations will accelerate and their capacity to resist and recover after further disturbances will be hampered. Overall, these findings confirm that future climatic conditions will make octocoral populations even more vulnerable to further disturbances. These results highlight the importance of limiting local impacts on marine ecosystems to dampen the consequences of climate change.

Human impact and environmental conditions lead to a mass mortality event of David's Myotis (Myotis davidii) in Mongolia

Human impact and environmental conditions lead to a mass mortality event of David's Myotis (<i>Myotis davidii</i>) in Mongolia

The Prognostic Value of Left Atrial Function in Patients with Acute Myocardial Infarction.

The prognostic value of left atrial (LA) volume is well-established in acute myocardial infarction (AMI) patients. LA strain provides further patophysological insights. In the present study, we evaluated LA volume and LA strain in AMI patients including those with atrial fibrillation (AF). The aim of the study was to determine if LA strain provide additional prognostic value. Patients with AMI underwent two-dimensional echocardiography within 72 h of admission. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular events. Cox regression analyses were performed. We included 501 patients and during follow-up, 132 patients (26.4%) met the primary outcome. Left ventricular (LV) global longitudinal strain (GLS) (HR 0.94 [95% CI 0.88-0.99], p = 0.029), indexed LA volume (LAVi) (HR 1.02 [95% CI 1.00-1.04], p = 0.015), and LA reservoir strain (HR 0.96 [95% CI 0.93-0.99], p = 0.017) were all independently associated with the primary outcome. A univariate Cox model conducted on the AF patients (n = 32) revealed that LA reservoir strain remained significantly associated with the primary outcome, while LV GLS and LAVi were not significant. The prognostic value of LA reservoir strain was comparable to LA volume and LV GLS, and might even be better in AF patients.

Localization and Tissue Tropism of Ostreid Herpesvirus 1 in Blood Clam Anadara broughtonii.

OsHV-1 caused detrimental infections in a variety of bivalve species of major importance to aquaculture worldwide. Since 2012, there has been a notable increase in the frequency of mass mortality events of the blood clam associated with OsHV-1 infection. The pathological characteristics, tissue and cellular tropisms of OsHV-1 in A. broughtonii remain unknown. In this study, we sought to investigate the distribution of OsHV-1 in five different organs (mantle, hepatopancreas, gill, foot, and adductor muscle) of A. broughtonii by quantitative PCR, histopathology and in situ hybridization (ISH), to obtain insight into the progression of the viral infection. Our results indicated a continuous increase in viral loads with the progression of OsHV-1 infection, reaching a peak at 48 h or 72 h post-infection according to different tissues. Tissue damage and necrosis, as well as colocalized OsHV-1 ISH signals, were observed primarily in the connective tissues of various organs and gills. Additionally, minor tissue damage accompanied by relatively weak ISH signals was detected in the foot and adductor muscle, which were filled with muscle tissue. The predominant cell types labeled by ISH signals were infiltrated hemocytes, fibroblastic-like cells, and flat cells in the gill filaments. These results collectively illustrated the progressive alterations in pathological confusion and OsHV-1 distribution in A. broughtonii, which represent most of the possible responses of cells and tissues to the virus.

Robot-Assisted Minimally Invasive Coronary Artery Bypass Grafting: Total Arterial Revascularization Using the Double-Docking Technique.

The right internal mammary artery is considered to be the second choice for arterial conduits for coronary artery bypass grafting (CABG). However, the widespread use of bilateral internal mammary artery (BIMA) grafting is limited owing to increased technical demands, lengthy procedure, and high incidence of sternal wound complications. We compared the early clinical outcomes of a novel robot-assisted double-docking technique (DDT) with an open sternotomy technique for total arterial revascularization using BIMA. Between June 2019 and June 2023, 445 patients with multivessel coronary artery disease underwent open sternotomy CABG using BIMA grafting and 145 patients underwent robot-assisted BIMA grafting using DDT. Comparative analysis of 104 pairs of matched patients obtained using propensity score matching was performed. Procedural characteristics, postoperative 30-day mortality, and composite outcome (major adverse cardiac and cerebrovascular events) at a median follow-up of 1.5 years were evaluated. Preprocedural characteristics were well balanced between the groups after propensity matching. The number of distal anastomoses performed in the conventional group was statistically higher than that performed using DDT (P < 0.001). The durations of postsurgical ventilation, intensive care unit stay, and in-hospital stay were significantly lower with the DDT than with conventional CABG (P < 0.001). There was no significant difference in all-cause mortality or major adverse cardiac events between the DDT and conventional CABG groups at a median follow-up of 1.5 years. The DDT is feasible and efficacious for revascularization of multiple coronary targets in select individuals. It is equivalent to open sternotomy in terms of early clinical outcomes and superior to open sternotomy with regard to rates of sternal infection and intensive care unit and in-hospital stay.

Pathology of tissue loss in three key gorgonian species in the Mediterranean Sea

The Mediterranean is known for its marine biodiversity, especially gorgonian forests. Unfortunately, these are experiencing rapid declines due to climate change, manifested by repeated marine heat waves resulting in mass mortality events since the early 1990 s. To better understand why gorgonians are declining, more systematic approaches to investigate the exact causes are needed, and pathology may aid in this goal.We described gross and microscopic pathology of tissue loss in three key gorgonian species in the Mediterranean region, Paramuricea clavata, Eunicella cavolini, and Leptogorgia sarmentosa, that were all experiencing various degrees of acute to subacute tissue loss characterized by exposed axial skeleton sometimes partly colonized by epibionts and thinning of adjacent tissues. The most significant variety of lesions was seen in P. clavata followed by L. sarmentosa and E. cavolini. For all species, dissociation of gastrodermal cells was the dominant microscopic lesion followed by necrosis of the gastrodermis. Ciliates invading gastrodermis and associated with necrosis of polyps were seen only in E. cavolini. Epidermal tissue loss was seen only in L. sarmentosa, while P. clavata was distinguished by a prominent inflammatory response and unidentified dark round structures within the tentacle epidermis and gastrodermis with no host response. Further work to understand the cause of death in gorgonians is needed, particularly to elucidate the role of ciliates and environmental co-factors or infectious agents not visible on light microscopy, as well as applications of additional tools such as cytology.

Dapagliflozin in Heart Failure: A Comprehensive Meta-analysis on Functional Capacity, Symptoms, and Safety Outcomes.

To evaluate the comparative effects of dapagliflozin versus placebo in patients with heart failure (HF), focusing on functional capacity, symptoms, and safety outcomes. Despite advancements in heart failure (HF) therapy, HF is still a significant cause of recurrent hospitalization and death worldwide. Dapagliflozin has demonstrated potential in lowering hospitalizations and mortality associated with heart failure; however, its impact on functional capacity, particularly the 6-min walk distance (6MWD), and the comprehensive assessment of safety outcomes in diverse HF populations, including those with preserved or reduced ejection fraction (HFpEF and HFrEF, respectively), requires further investigation. PubMed, Web of Science, Cochrane Library, and Scopus databases were comprehensively searched to identify randomized controlled trials (RCTs) investigating the efficacy of dapagliflozin in comparison with control interventions for heart failure. The primary outcome was a change in the 6MWD, KCCQ score, and safety measures included hospitalization, all-cause mortality, and adverse events. In our meta-analysis of ten studies involving 12,695 patients with heart failure, dapagliflozin showed significantly improved Kansas City Cardiomyopathy Questionnaire (KCCQ) scores [risk ratio (RR) of 2.75, 95% confidence interval (CI) (1.95-3.569), p < 0.00001] and no significant differences in 6-min walk distance [6MWD; RR of 3.59, 95% CI (- 1.44 to 8.63), p = 0.16]. Dapagliflozin demonstrated a notable reduction in hospitalization for heart failure [RR of 0.76, 95% CI (0.68-0.84), p < 0.00001], significant overall reduction on the effect of any cause mortality [RR of 0.90, 95% CI (0.83-0.99), p = 0.03). There was, however, no significant effect on adverse events [RR of 0.96, 95% CI (0.98-1.03), p = 0.39). Our meta-analysis of ten trials concluded that dapagliflozin significantly improved KCCQ scores in both HFrEF and HFpEF. The improvement in 6MWD was not statistically significant but trended toward dapagliflozin. Dapagliflozin also showed a mortality benefit in patients with reduced ejection fraction; however, in patients with preserved ejection fraction, the result was not statistically significant. There was also a statistically significant reduction in heart failure hospitalizations across all classes.

The U -shape relationship between free fatty acid level and adverse outcomes in coronary artery disease patients with hypertension: evidence from a large prospective cohort study

BackgroundEvidence is scarce on the effect of free fatty acid (FFA) level in the prognosis of coronary artery disease (CAD) patients with hypertension. This study.MethodsA large prospective cohort study with a follow-up period of average 2 years was conducted at Xinjiang Medical University Affiliated First Hospital from December 2016 to October 2021. A total of 10,395 CAD participants were divided into groups based on FFA concentration and hypertension status, and then primary outcome mortality and secondary endpoint ischemic events were assessed in the different groups.ResultsA total of 222 all-cause mortality (ACMs), 164 cardiac mortality (CMs), 718 major adverse cardiovascular events (MACEs) and 803 major adverse cardiovascular and cerebrovascular events (MACCEs) were recorded during follow-up period. A nonlinear relationship between FFA and adverse outcomes was observed only in CAD patients with hypertension. Namely, a “U -shape” relationship between FFA levels and long-term outcomes was found in CAD patients with hypertension. Lower FFA level (< 310 µmol/L), or higher FFA level (≥ 580 µmol/L) at baseline is independent risk factors for adverse outcomes. After adjustment for confounders, excess FFA increases mortality (ACM, HR = 1.957, 95%CI(1.240–3.087), P = 0.004; CM, HR = 2.704, 95%CI(1.495–4.890, P = 0.001) and MACE (HR = 1.411, 95%CI(1.077–1.848), P = 0.012), MACCE (HR = 1.299, 95%CI (1.013–1.666), P = 0.040) prevalence. Low levels of FFA at baseline can also increase the incidence of MACE (HR = 1.567,95%CI (1.187–2.069), P = 0.002) and MACCE (HR = 1.387, 95%CI (1.070–1.798), P = 0.013).ConclusionsBaseline FFA concentrations significantly associated with long-term mortality and ischemic events could be a better and novel risk biomarker for prognosis prediction in CAD patients with hypertension.Trial registrationThe details of the design were registered on https://www.chictr.org.cn/ (Identifier NCT05174143).

Routine beta-blocker therapy after acute coronary syndromes: The end of an era?

Beta-blocker therapy, a treatment burdened by side effects including fatigue, erectile dysfunction and depression, was shown to reduce mortality and cardiovascular events after acute coronary syndromes (ACS) in the pre-coronary reperfusion era. Potential mechanisms include protection from ventricular arrhythmias, increased ischaemia threshold and prevention of left ventricular (LV) adverse remodelling. With the advent of early mechanical reperfusion and contemporary pharmacologic secondary prevention, the benefit of beta-blockers after ACS in the absence of LV dysfunction has been challenged. The present narrative review discusses the contemporary evidence based on searching the PubMed database and references in identified articles. Recently, the REDUCE-AMI trial-the first adequately powered randomized trial in the reperfusion era to test beta-blocker therapy after myocardial infarction with preserved left ventricular ejection fraction (LVEF)-showed no benefit on the composite of all-cause death or myocardial infarction over a median 3.5-year follow-up. While the benefit of beta-blockers in patients with reduced LVEF remains undisputed, their value in post-ACS patients with mildly reduced systolic function (LVEF 41%-49%) has not been studied in contemporary randomized trials; in this setting, observational studies have suggested a reduction in cardiovascular events with these agents. The adequate duration of beta-blocker therapy remains unknown, but observational data suggests that any mortality benefit may be lost beyond 1-12 months after ACS in patients with LVEF >40%. We believe that there is sufficient evidence to abandon routine beta-blocker prescription in post-ACS patients with preserved LV systolic function.

A Weight-of-Evidence Approach for Understanding the Recovery of Okanagan Sockeye Salmon.

The productivity of Pacific Sockeye salmon (Oncorhynchus nerka) in the Columbia River has been declining over the past century. Yet, the Okanagan River Sockeye salmon population, which spawns in the Okanagan River, a Canadian tributary of the Columbia River, has seen a remarkable turnaround in abundance. Different hypotheses and lines of evidence covering multiple spatial scales have been proposed to explain this recovery; but they have never been comprehensively assessed. We adopted a weight-of-evidence approach to systematically assess the relative likelihood that each of these causal hypotheses contributed to the observed recovery. Our analysis disentangles the relative consequences of a set of environmental management actions that have been implemented to augment the Sockeye salmon freshwater productivity, while accounting for changes in freshwater and marine environmental conditions. Our list of potentially explanatory causal factors (anthropogenic and natural) included: (1) changes in escapement concurrent with improving local fish passage, (2) the implementation of fish-friendly flows in the Okanagan River, (3) initiating a hatchery restocking program, (4) potential improvements to Columbia dam operations to support higher relative survival of out-migrating juvenile fish, (5) possible shifts in survival-favorable conditions in the coastal marine environment for ocean-going life stages, and (6) broader changes to multi-stock harvest regimes in the Columbia River. Our assessment leveraged comparisons with the population dynamics of another Sockeye salmon stock in the Columbia River basin to differentiate between the impacts of management actions taken within the Okanagan watershed (our focus) from those occurring over the broader basin and marine scale. The results suggest that while shifts towards survival-favorable conditions in the coastal marine environment in 2007 played an important role in the upturn of the Okanagan population, alone it cannot explain the rate at which the Okanagan River Sockeye salmon recovered. Strong evidence supports the combined effect of increased escapement in conjunction with establishing and securing fish-friendly flows during spawning, incubation, and alevin emergence. Additionally, Sockeye salmon restocking improved the resilience of the stock against density-independent mortality events. These combined basin-level management actions played a pivotal role in magnifying the recovery trajectory afforded by improved marine survivorship. The spectacular response of the Okanagan River Sockeye salmon to the holistic perspectives and management interventions of Indigenous and other caretakers provides hope that other Pacific salmon stocks can be stabilized and recovered.

Mass Mortality of the Invasive Sea Urchin Diadema setosum in Türkiye, Eastern Mediterranean Possibly Reveals Vibrio Bacteria Infection

ABSTRACTThe invasive Diadema setosum (Leske, 1778) long‐spined sea urchin has been in the Mediterranean Sea since 2006, and then, it has been known that its population density has reached high values on the southern Aegean coasts of Türkiye. This study aimed to report the mass mortality event of D. setosum with the determined agent on the Aegean coast of Türkiye. In addition, it was targeted to provide information on the current status of its density based on seasonal SCUBA diving observations for the period between January 2023 and November 2023. The results showed that the mass mortality of D. setosum was determined in Muğla, Aegean Sea, in August 2023. Spine loss, the mucoid layer at the bottom of the appendages, and the outer body surface were observed as the clinical symptoms of the diseased samples. Bacterial growth was detected on Vibrio‐selected TCBS agar plates, while no other parasitic agents were determined in the coelomic fluid of sea urchins. The results of the biochemical (API 20E) and molecular tests confirmed the isolated bacteria as Vibrio spp. The density of D. setosum showed statistically significant temporal changes, and the highest and lowest mean density values were recorded in autumn and spring, respectively. Environmental stressors, such as increasing sea temperature levels, affect the marine ecosystem and lead to opportunistic pathogens. Long‐term monitoring of disease outbreaks is necessary to understand the interactions between species and the ecosystem.

Associations between different insulin resistance indices and the risk of all-cause mortality in peritoneal dialysis patients

BackgroundInsulin resistance (IR) is prevalent in individuals undergoing peritoneal dialysis (PD) and is related to increased susceptibility to coronary artery disease and initial peritonitis. In recent investigations, correlations have been found between indices of IR and the incidence of all-cause mortality in various populations. However, such correlations have not been detected among individuals undergoing PD. Hence, the present study’s aim was to explore the connections between IR indices and the incidence of all-cause mortality in PD patients.MethodsPeritoneal dialysis patients (n = 1736) were recruited from multiple PD centres between January 2010 and December 2021. Cox proportional hazards and restricted cubic spline regression models were used to evaluate the connections between the triglyceride–glucose (TyG) index, triglyceride–glucose/body mass index (TyG–BMI), and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio and the occurrence of all-cause mortality. All three IR indices were integrated into the same model to assess the predictive stability. Furthermore, a forest plot was employed to display the findings of the subgroup analysis of PD patients.ResultsOverall, 378 mortality events were recorded during a median follow-up time of 2098 days. Among PD patients, a higher TyG index, TyG–BMI, and TG/HDL-C ratio were identified as independent risk factors for all-cause mortality according to Cox proportional hazards analyses (hazard ratio (HR) 1.588, 95% confidence interval (CI) 1.261–2.000; HR 1.428, 95% CI 1.067–1.910; HR 1.431, 95% CI 1.105–1.853, respectively). In a model integrating the three IR indices, the TyG index showed the highest predictive stability. According to the forest plot for the TyG index, no significant interactions were observed among the subgroups.ConclusionSignificant associations were found between the TyG index, TyG–BMI, and TG/HDL-C ratio and the incidence of all-cause mortality among PD patients. The TyG index may be the most stable of the three surrogate IR markers. Finally, a correlation was identified between IR and the risk of all-cause mortality in patients undergoing PD.