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Funding: This research was funded by four naval organizations: the US Navy Living Marine Resources program (LMR), the Netherlands Ministry of Defence, the UK Ministry of Defense (Dstl) and the French Ministry of Defense (DGA-TN). Controlled exposure experiments (CEEs) have demonstrated that naval pulsed active sonar (PAS) can induce costly behavioral responses in cetaceans similar to antipredator responses. New generation continuous active sonars (CAS) emit lower amplitude levels but more continuous signals. We conducted CEEs with PAS, CAS and no-sonar control on free-ranging sperm whales in Norway. Two panels blind to experimental conditions concurrently inspected acoustic-and-movement-tag data and visual observations of tagged whales and used an established severity scale (0–9) to assign scores to putative responses. Only half of the exposures elicited a response, indicating overall low responsiveness in sperm whales. Responding whales (10 of 12) showed more, and more severe responses to sonar compared to no-sonar. Moreover, the probability of response increased when whales were previously exposed to presence of predatory and/or competing killer or long-finned pilot whales. Various behavioral change types occurred over a broad range of severities (1–6) during CAS and PAS. When combining all behavioral types, the proportion of responses to CAS was significantly higher than no-sonar but not different from PAS. Responses potentially impacting vital rates i.e., with severity ≥4, were initiated at received cumulative sound exposure levels (dB re 1 μPa2 s) of 137–177 during CAS and 143–181 during PAS. Publisher PDF

Background: Hepatic injury secondary to congestive heart failure is well described, however, only limited data exist about the possible impact of acute cardiac dysfunction on the liver. We aimed to explore the possible cardio-hepatic interaction in patients with myocardial infarction. Material and methods: A single-center retrospective cohort study of 1339 ST elevation myocardial infarction (STEMI) patients who underwent primary coronary intervention between June 2012 to June 2019. Echocardiographic examinations were performed to assess left ventricular ejection fraction (LVEF) and central venous pressure (CVP). Patients were stratified into four groups by their LVEF and CVP levels: LVEF ≥ 45%, and CVP ≤ 10 mm/Hg (n = 853), LVEF < 45% with CVP ≤ 10 mm/Hg (n = 364), EF ≥ 45%, with CVP > 10 mm/Hg (n = 61), and LVEF < 45% with CVP > 10 mm/Hg (n = 61). Patients were evaluated for baseline and peak liver enzymes including alanine transaminase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), and bilirubin. Results: Greater severity of cardiac dysfunction was associated with worse elevation of liver enzymes. We found a graded increase in mean levels of maximal ALT, first and maximal ALP, and first and maximal GGT values. Using propensity score matching to estimate the impact of cardiac dysfunction on liver injury, we chose patients with the worst cardiac function parameters: (LVEF < 45% and CVP >10 mm/Hg; n = 61) and compared them to matched patients with better cardiac function (n = 45). We found a significantly higher level of maximal ALT, first and maximal ALP, and GGT values in the group with the worst cardiac function parameters (p < 0.05). Conclusions: Among patients with STEMI, the combination of decreased LVEF and venous congestion was associated with liver enzymes elevation suggesting a possible cardio-hepatic syndrome.