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Atrial fibrillation (AF) and coronary artery disease are frequently associated and, when so, lead to a grim prognosis. Recent studies suggest the presence of interconnected pathophysiological pathways between the 2 conditions that can promote and aggravate each other, igniting a vicious cycle. Notwithstanding, in contrast with the attention dedicated to the management of antithrombotic treatment, research on other aspects of coronary artery disease in AF is only recently gaining traction. The clinical impact of correct assessment of coronary artery stenosis in AF is especially high, due to the antithrombotic therapy imposed by both AF and coronary stenting. Until recently, an in‐depth characterization of coronary microcirculation in AF was lacking. However, contemporary studies indicate that coronary microvascular dysfunction is a frequent encounter in AF, possibly explaining the ischemic symptoms even in the absence of obstructive coronary artery disease and interfering with the use of pressure‐based indices to evaluate the hemodynamic significance of coronary artery stenosis. This comprehensive review addresses our current knowledge on coronary physiology in AF and its repercussion on the invasive management of coronary artery disease in this setting.

[Display omitted] [ABSTRACT FROM AUTHOR]

Aim: Safety-net hospitals (SNHs) look after a higher proportion of uninsured patients and are often located in deprived areas. This study aimed to determine whether there are differences in the clinical characteristics, treatments and outcomes of patients presenting with acute myocardial infarction (AMI) in SNHs versus non-SNHs (N-SNHs).Methods: All hospitalizations with a principal diagnosis of AMI in the United States' National Inpatient Sample between 2016 and 2019 were stratified by safety-net hospital status. Multivariable logistic regression with adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) was conducted to investigate invasive management and clinical outcomes.Results: A total of 2,544,009 weighted discharge records were analyzed, including 601,719 records from SNHs (23.7 %). Compared with N-SNHs, SNH AMI patients were younger (median 66 years vs. 67 years, p < 0.001), and had a higher proportion in the lowest quartile of median household income (37.3 % vs. 28.5 %, p < 0.001). Patients from SNHs were less likely to receive coronary angiography (aOR 0.92, 95 % CI 0.91-0.93, p < 0.001), percutaneous coronary intervention (aOR 0.94, 95 % CI 0.93-0.95, p < 0.001), and coronary artery bypass grafting (aOR 0.93, 95 % CI 0.92-0.94, p < 0.001). In addition, they had increased all-cause mortality (aOR 1.11, 95 % CI 1.09-1.12, p < 0.001), major adverse cardiovascular/cerebrovascular events (composite of mortality, stroke and reinfarction) (aOR 1.11, 95 % CI 1.09-1.12, p < 0.001), and stroke (aOR 1.11, 95 % CI 1.08-1.14, p < 0.001), while there was no difference in major bleeding (aOR 1.02, 95 % CI 1.00-1.04, p = 0.107).Conclusion: Among AMI patients, treatment in SNHs was associated with lower utilization of coronary angiography and revascularization and worse clinical outcomes. [ABSTRACT FROM AUTHOR]

Question: This study aimed to assess the impact of the invasion of Asclepias syriaca, a perennial non-native herbaceous species, on basic soil attributes and vegetation composition, and to study the effect of mechanical control, namely the cutting of Asclepias, on target and other plant species. Location: Sandy region of Kiskunság National Park, Hungary, Central Europe. Methods: In ten old-fields, four 4 m × 4 m plots were established (n = 40), of which three were invaded by Asclepias, and one was uninvaded. The invaded plots were treated as: (1) all Asclepias shoots removed, (2) half of the Asclepias shoots removed, or (3) untreated. The treatment was conducted twice a year in summer during the period 2019-2021. Before the first treatment, soil and vegetation were sampled. Afterwards, vegetation monitoring was performed twice a year: the cover of each vascular plant species and the number of Asclepias shoots were recorded in each plot. Result: There were no differences in the studied soil attributes between the uninvaded and invaded plots. However, there were differences in vegetation composition, namely, the cover of sand grassland specialists was higher in uninvaded plots. Short-term cutting negatively affected Asclepias after two years. The cover of specialists did not change in response to treatments, but the cover of other neophyte plant species increased. Conclusions: Based on our results, the invasion of Asclepias changes the vegetation composition, but not the soil. Although short-term mowing can reduce the cover of Asclepias, but the grassland specialist plants do not regenerate; instead, secondary invasion occurs. We conclude that more time or additional treatment is required for native plant recovery. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) and coronary artery disease are frequently associated and, when so, lead to a grim prognosis. Recent studies suggest the presence of interconnected pathophysiological pathways between the 2 conditions that can promote and aggravate each other, igniting a vicious cycle. Notwithstanding, in contrast with the attention dedicated to the management of antithrombotic treatment, research on other aspects of coronary artery disease in AF is only recently gaining traction. The clinical impact of correct assessment of coronary artery stenosis in AF is especially high, due to the antithrombotic therapy imposed by both AF and coronary stenting. Until recently, an in-depth characterization of coronary microcirculation in AF was lacking. However, contemporary studies indicate that coronary microvascular dysfunction is a frequent encounter in AF, possibly explaining the ischemic symptoms even in the absence of obstructive coronary artery disease and interfering with the use of pressure-based indices to evaluate the hemodynamic significance of coronary artery stenosis. This comprehensive review addresses our current knowledge on coronary physiology in AF and its repercussion on the invasive management of coronary artery disease in this setting.

Background: Guidelines recommend early coronary angiography (CA) in patients with non‐ST‐elevation myocardial infarction (NSTEMI) irrespective of age. However, elderly patients are less likely to be treated according to these guidelines due to their perceived high risk and medical comorbidities. Whether an invasive strategy is associated with improved survival in patients aged ≥85 years remains uncertain due to their exclusion from randomised trials. Aims: Patients were stratified based on whether they underwent invasive management with CA with a view to revascularisation versus conservative management. The primary outcome was long‐term mortality. Methods: Consecutive patients aged ≥85 years presenting to a tertiary centre with NSTEMI between 2008 and 2018 were included in this retrospective cohort study. Results: Of 7591 patients with NSTEMI, 1052 patients aged ≥85 years were included. Ninety‐nine (9.4%) patients underwent CA. Those undergoing CA were more likely to be younger, male, live independently, without mobility or cognitive issues (all P < 0.01). Overall, 495 (47%) patients died during a mean follow up of 1.3 ± 1 year. On Cox regression, after adjusting for age, pre‐morbid functional status, cognition and cardiovascular risk factors, invasive management was the strongest predictor for survival (hazard ratio 0.47; 95% confidence interval 0.26–0.85; P = 0.01). Invasive management was associated with a trend to increased risk of in‐hospital bleeding (6.1% vs 2.6%; P = 0.054) with no significant difference in stroke (2.0% vs 3.8%; P = 0.37). Conclusion: In patients aged ≥85 years who presented with NSTEMI, invasive management was associated with improved survival without significant differences in bleeding or stroke. A randomised controlled study assessing the efficacy and safety of invasive management in very elderly patients with NSTEMI is warranted. [ABSTRACT FROM AUTHOR]

Studies of biological invasions at the macroscale or across multiple scales can provide important insights for management, particularly when localized information about invasion dynamics or environmental contexts is unavailable. In this study, we performed a macroscale analysis of the roles of invasion drivers on the local scale dynamics of a high‐profile pest, Lymantria dispar dispar L., with the purpose of improving the prioritization of vulnerable areas for treatment. Specifically, we assessed the relative effects of various anthropogenic and environmental variables on the establishment rate of 8010 quadrats at a localized scale (5 × 5 km) across the entire L. dispar transition zone (the area encompassing the leading population edge, currently from Minnesota to North Carolina). We calculated the number of years from first detection of L. dispar in a quadrat to the year when probability of establishment of L. dispar was greater than 99% (i.e., waiting time to establishment after first detection). To assess the effects of environmental and anthropogenic variables on each quadrat's waiting time to establishment, we performed linear mixed‐effects regression models for the full transition zone and three subregions within the zone. Seasonal temperatures were found to be the primary drivers of local establishment rates. Winter temperatures had the strongest effects, especially in the northern parts of the transition zone. Furthermore, the effects of some factors on waiting times to establishment varied across subregions. Our findings contribute to identifying especially vulnerable areas to further L. dispar spread and informing region‐specific criteria by invasion managers for the prioritization of areas for treatment. [ABSTRACT FROM AUTHOR]

Abstract Native biodiversity is threatened by invasive species in many terrestrial and marine systems, and conservation managers have demonstrated successes by responding with eradication or control programs. Although invasive species are often the direct cause of threat to native species, ecosystems can react in unexpected ways to their removal or reduction. Here, we use theoretical models to predict boom‐bust dynamics, where the removal of predatory or competitive pressure from a native herbivore results in oscillatory population dynamics (boom‐bust), which can endanger the native species’ population in the short term. We simulate control activities, applied to multiple theoretical three‐species Lotka‐Volterra ecosystem models consisting of vegetation, a native herbivore, and an invasive predator. Based on these communities, we then develop a predictive tool that—based on relative parameter values—predicts whether control efforts directed at the invasive predator will lead to herbivore release followed by a crash. Further, by investigating the different functional responses, we show that model structure, as well as model parameters, are important determinants of conservation outcomes. Finally, control strategies that can mitigate these negative consequences are identified. Managers working in similar data‐poor ecosystems can use the predictive tool to assess the probability that their system will exhibit boom‐bust dynamics, without knowing exact community parameter values.

Background The role of invasive management compared with medical management in patients with non–ST‐segment–elevation myocardial infarction (NSTEMI) and advanced chronic kidney disease (CKD) is uncertain, given the increased risk of procedural complications in patients with CKD. We aimed to compare clinical outcomes of invasive management with medical management in patients with NSTEMI‐CKD. Methods and Results We identified NSTEMI and CKD stages 3, 4, 5, and end‐stage renal disease admissions using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) codes from the Nationwide Readmission Database 2016 to 2018. Patients were stratified into invasive and medical management. Primary outcome was mortality (in‐hospital and 6 months after discharge). Secondary outcomes were in‐hospital postprocedural complications (acute kidney injury requiring dialysis, major bleeding) and postdischarge 6‐month safety and major adverse cardiovascular events. Out of 141 052 patients with NSTEMI‐CKD, 85 875 (60.9%) were treated with invasive management, whereas 55 177 (39.1%) patients were managed medically. In propensity‐score matched cohorts, invasive strategy was associated with lower in‐hospital (CKD 3: odds ratio [OR], 0.47 [95% CI, 0.43–0.51]; P

Recently, the European Society of Cardiology (ESC) has updated its guidelines for the management of patients with acute coronary syndrome (ACS) without ST-segment elevation. The current consensus document of the Dutch ACS working group and the Working Group of Interventional Cardiology of the Netherlands Society of Cardiology aims to put the 2020 ESC Guidelines into the Dutch perspective and to provide practical recommendations for Dutch cardiologists, focusing on antiplatelet therapy, risk assessment and criteria for invasive strategy. [ABSTRACT FROM AUTHOR]

Invasive non-native trees (INNTs) are increasingly recognized to have negative effects on biodiversity and ecosystem services in protected areas. The management of INNTs is one of the major challenges to preserving native species and ecosystems, to which more and more efforts and resources are bound to be destined in the coming decades. Indeed, the combined effects of climate change and increasing disturbance factors (e.g. wildfires) are likely to aid the spread of many INNTs in the Mediterranean protected areas, as well as favouring their competitive relationships with native species. However, the effective implementation of control measures is far from being fully achieved. I assessed how the problem of INNTs is currently addressed within the Natura 2000 sites in Sicily, designed according to the Habitats Directive (92/43/EEC). In particular, I will check the management plans of some selected Special Areas of Conservation searching for the activities provided for the management and control of INNTs. My research will be focused on the most widespread INNTs occurring on the island, such as Ailanthus altissima and Acacia saligna, along with taxa characterized by a very recent spread such as Parkinsonia aculeata and Vachellia karroo. Furthermore, some of these non-native trees are included in the list of Invasive Alien Species of Union concern pursuant to Regulation (EU) 1143/2014 on invasive alien species. The study will address some main questions: (1) Are invasive non-native trees well managed in protected sites in Sicily? (2) Do different protected sites deal with the same non-native species in the same way? (3) Are planned activities effectively implemented and successful? The result of the study could be used to favour the cooperation and exchange of information about the control of INNTs between the managing bodies of different protected sites, thus increasing the efficacy of the necessary interventions.

Native biodiversity is threatened by invasive species in many terrestrial and marine systems, and conservation managers have demonstrated successes by responding with eradication or control programs. Although invasive species are often the direct cause of threat to native species, ecosystems can react in unexpected ways to their removal or reduction. Here, we use theoretical models to predict boom‐bust dynamics, where the removal of predatory or competitive pressure from a native herbivore results in oscillatory population dynamics (boom‐bust), which can endanger the native species' population in the short term. We simulate control activities, applied to multiple theoretical three‐species Lotka‐Volterra ecosystem models consisting of vegetation, a native herbivore, and an invasive predator. Based on these communities, we then develop a predictive tool that—based on relative parameter values—predicts whether control efforts directed at the invasive predator will lead to herbivore release followed by a crash. Further, by investigating the different functional responses, we show that model structure, as well as model parameters, are important determinants of conservation outcomes. Finally, control strategies that can mitigate these negative consequences are identified. Managers working in similar data‐poor ecosystems can use the predictive tool to assess the probability that their system will exhibit boom‐bust dynamics, without knowing exact community parameter values. [ABSTRACT FROM AUTHOR]

Background and aim: Patients with chronic kidney disease (CKD) have an increased risk of adverse cardiovascular outcomes after non-ST elevation acute coronary syndrome (NSTE-ACS). However, the information available on this specific population is scarce. We evaluate the impact of CKD on long-term prognosis in patients with NSTE-ACS managed with invasive strategy. Methods: We conduct a prospective registry of patients with NSTE-ACS and coronary angiography. CKD was defined as a glomerular filtration rate

Background: Myocardial infarction (MI) remains a major burden for healthcare systems. Therefore, we intended to analyze the determinants of cost management of patients hospitalized for MI in Poland., Methods: Data on patients hospitalized and discharged with the diagnosis of acute MI were derived from the public payer claims database. Adult patients, reported between October 1, 2017 and December 31, 2019, were included. Costs of hospitalization for acute MI and cumulative one-year follow-up were analyzed., Results: The median (IQR) of the total direct cost was €3804.7 (2674.1-5712.7) per patient and 29% (€1113.6 [380.5-2490.4]) of these were costs related to the use of post-hospitalization healthcare resources. The median cost of cardiovascular disease management was €3624.7 (2582.1-5258.5), and 26% of this sum were follow-up costs. The analysis of the total cost for individual years showed a slight increase in median costs in subsequent years: €3450.7 (2407.8-5205.2) in 2017, €3753.8 (2642.6-5681.9) in 2018, and €3944.9 (2794.8-5844.4) in 2019. Male sex, heart failure, atrial fibrillation, diabetes, kidney disease, chronic obstructive pulmonary disease, and history of stroke in addition to hospitalization in a department other than cardiology or internal disease were independently related to the cost of MI patient management., Conclusions: The high cost of management of MI patients was independently related to sex, heart failure, atrial fibrillation, diabetes, kidney disease, chronic obstructive pulmonary disease, and history of stroke as well as hospitalization in other than cardiology or internal disease department.

Objective: To find out the outcome of surgical treatment for primary postpartum hemorrhage (PPH). Methodology: It was a descriptive case series study conducted in Department of Gynecology and Obstetrics Lady Reading Hospital Peshawar from January to December 2017. Total 292 patients with primary PPH were enrolled in which 53 women had failed to improve with medical management or required invasive treatment in first instance. Those 53 patients were managed accordingly either with uterine compression suture, pelvic vessel ligation or hysterectomy. Their outcomes were measured as rate of use of specific procedure, failure of invasive therapy and reverting from one to another procedure. Data were entered and analyzed with SPSS version 17 for descriptive statistics. Results: Postpartum hemorrhage was treated using second line surgical procedures in 53 patients out of 292 cases of PPH. The primary cause of PPH in these patients who underwent surgery was uterine atony in half of the patients followed by other pathologies. Most patients received conservative treatment including uterotonic therapy before undergoing 2nd line management of invasive therapy. Majority (32 patients underwent subtotal abdominal hysterectomy (STAH). Seventeen patients had b lynch uterine compression suture, 3 patients had repair of ruptured uterus while 1% had uterine artery ligation (UAL). Various morbidities were seen in these patients with massive hemorrhage, ICU admission, anemia, renal failure and septicemia. Conclusion: Invasive therapy in the form of surgery including hysterectomy was effective in controlling bleeding in life threatening situations when first-line treatment fails. [ABSTRACT FROM AUTHOR]

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Background Comorbid elderly patients with non-ST-elevation myocardial infarction (non-STEMI) are underrepresented in randomized trials and undergo fewer cardiac catheterizations according to registries. Our aim was to compare the conservative and invasive strategies in these patients. Methods Randomized multicenter study, including 106 patients (January 2012–March 2014) with non-STEMI, over 70 years and with comorbidities defined by at least two of the following: peripheral artery disease, cerebral vascular disease, dementia, chronic pulmonary disease, chronic renal failure or anemia. Patients were randomized to invasive (routine coronary angiogram, n = 52) or conservative (coronary angiogram only if recurrent ischemia or heart failure, n = 54) strategy. Medical treatment was identical. The main endpoint was the composite of all-cause mortality, reinfarction and readmission for cardiac cause (postdischarge revascularization or heart failure), at long-term (2.5-year follow-up). Analysis of cumulative event rate (incidence rate ratio = IRR) and time to first event (hazard ratio = HR), were performed. Results Cardiac catheterization/revascularization rates were 100%/58% in the invasive versus 20%/9% in the conservative arm. There were no differences between groups in the main endpoint (invasive vs conservative: IRR = 0.946, 95% CI 0.466–1.918, p = 0.877) at long-term. The invasive strategy, however, tended to improve 3-month outcomes in terms of mortality (HR = 0.348, 95% CI 0.122–0.991, p = 0.048), and of mortality or ischemic events (reinfarction or postdischarge revascularization) (HR = 0.432, 95% CI 0.190–0.984, p = 0.046). This benefit declined during follow-up. Conclusions Invasive management did not modify long-term outcome in comorbid elderly patients with non-STEMI. The finding of a tendency towards an improvement in the short-term needs confirmation in larger studies ( clinicaltrials.gov NCT1645943). [ABSTRACT FROM AUTHOR]

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited condition defined by left ventricular wall thickness greater than 15 mm in the absence of other conditions that could explain that degree of hypertrophy. Obstructive HCM associated with left ventricular outflow tract obstruction is defined by an intraventricular systolic pressure gradient greater than or equal to 30 mm Hg. Over the past couple of decades, there has been an expansion of both invasive and pharmacotherapeutic options for patients with HCM, with recent guidelines calling for a melody of invasive and non-invasive treatment strategies. There are several invasive therapies including proven therapies such as alcohol septal ablation and septal myectomy. Novel invasive therapies such as MitraClip, radiofrequency septal ablation and SESAME procedure have more recently been promoted. Pharmacological therapy has also dramatically evolved and includes conventional medications such as beta-blockers, calcium channel blockers, and disopyramide. Mavacamten, a novel cardiac myosin inhibitor, may significantly change management. Other myosin inhibitors and modulators are also being developed and tested in large clinical trials. Given significant phenotypical variability in patients with HCM, clinical management can be challenging, and often requires an individualized approach with a combination of invasive and non-invasive options.

To determine whether native butterflies had colonized a marsh in Ottawa that was entirely dominated by the invasive alien European Lake Sedge (Carex acutiformis), we surveyed two adjacent stands of the sedge and surrounding habitats. Dion Skipper (Euphyes diori), Mulberry Wing (Poanes massasoit), Broad-winged Skipper (P. viator), and browns (Lethe spp.) were all abundant in the introduced sedge, but absent from surrounding habitats. This is the first report of the use of invasivedominated wetland by native Canadian butterflies. Reduced nectar resources because of dominance of the invasive species over native nectar-producing plants did not prevent significant colonization. The known restriction of the butterflies to native Lakebank Sedge (Carex lacustris) as a larval host plant, but its absence in the area, coupled with dominance of its close relative, European Lake Sedge, provides strong circumstantial evidence of the use of the latter as larval food. This report doubles the number of recently localized native butterflies that have been able to increase their distribution by switching to habitat dominated by invasive plants. [ABSTRACT FROM AUTHOR]

Recently Prévot-Julliard and colleagues presented a concept paper on biological conservation strategies using exotic species as a case study. They emphasized the difficulty of integrating conservation into a broad picture that accounts for public perception as well as scientific knowledge. We support this general call for better integration of society in conservation research, but we believe that the original framework might misguide conservation practices if wrongly interpreted. Our objective is to complement their paper and correct a few misleading points, by showing that (1) for regions of high endemicity 'reservation' may be the best conservation practice, and does not prevent public participation, (2) aiming for broad societal agreement is valuable, but in some cases risky, and always complex, and (3) calling a harmful invasive species harmful shouldn't be an issue. The Australian context provides us with many cases of the labeling of exotic species as harmful or not, using inputs from scientists, industry, and the public. Integration of social and scientific points of view can only improve conservation on the ground if it allows managers to use the ecological, economic and social impacts of exotic species to prioritize conservation actions in an operative way. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to investigate whether a relationship exists between an acute reduction in resting left ventricular outflow tract (LVOT) gradient with balloon occlusion and the final invasive gradient response following alcohol septal ablation (ASA). Background: ASA is an alternative therapy to myectomy surgery to reduce the basal septal thickness and decrease the resting and/or provocable LVOT gradient in patients with hypertrophic cardiomyopathy. Patients have a variable gradient response to occlusion of the septal perforator artery before ethanol infusion for ASA. Methods: From November 1998 to November 2008, 120 patients (mean age 60 years [range 16 to 87 years], 50% women) with hypertrophic cardiomyopathy underwent ASA at our institution. The resting LVOT gradient (peak systolic left ventricle [LV] pressure – peak systolic aortic pressure) was measured continuously during the ASA procedure. The time to significant LVOT gradient decrease (defined as >50% decrease from baseline) was recorded following balloon occlusion of the dominant septal perforator coronary artery, which was found to perfuse the basal septum based on contrast echocardiographic studies. Results: The mean baseline resting LVOT gradient was 86 ± 43 mm Hg, and it decreased to 17 ± 11 mm Hg following ASA (−80.2%). The mean time to significant gradient reduction was 3.6 ± 2 min (range 25 s to 11 min). The time to significant LVOT gradient reduction strongly correlated with the final magnitude of gradient reduction following ASA (r = –0.81, p < 0.001). Conclusions: This study demonstrates a correlation between the time to significant LVOT gradient reduction following septal perforator balloon occlusion and the magnitude of final gradient response after ASA. [ABSTRACT FROM AUTHOR]

Background: Perioperative myocardial infarction is frequently attributed to type 2 myocardial infarction, a mismatch in myocardial oxygen supply-demand without unstable coronary artery disease. Our aim was to identify characteristics, management, and outcomes of perioperative type 1 versus type 2 myocardial infarction among surgical inpatients.Methods: Adults age ≥45 years hospitalized for noncardiac surgery were identified in the United States. Perioperative myocardial infarction were identified using International Classification of Diseases, 10th revision (ICD-10) codes. Clinical characteristics, invasive myocardial infarction management, mortality, and readmissions were assessed by myocardial infarction subtype.Results: Among 4,755,382 surgical hospitalizations, we identified 38,975 perioperative myocardial infarctions (0.82%), with type 2 infarction in 42%. Patients with type 2 myocardial infarction were older, more likely to be women, and less likely to have cardiovascular comorbidities compared with type 1 myocardial infarction. Fewer patients with type 2 myocardial infarction underwent invasive management than type 1 myocardial infarction (6.7% vs 28.8%, P < .001). Type 2 myocardial infarction mortality was lower than type 1 myocardial infarction mortality (12.1% vs 17.4%, P < .001; adjusted odds ratio [aOR] 0.51, 95% confidence interval [CI] 0.45-0.59). Invasive management of perioperative myocardial infarction was associated with lower mortality in type 1 (aOR 0.56, 95% CI 0.49-0.74) but not type 2 (aOR 1.19, 95% CI 0.77-1.85) myocardial infarction. Among survivors, there was no difference in 90-day hospital readmission between type 2 and type 1 perioperative myocardial infarction (36.5% vs 36.1%, P = .72).Conclusions: Type 2 myocardial infarctions account for approximately 40% of perioperative myocardial infarctions. Patients with type 2 perioperative myocardial infarction are less likely to undergo invasive management and have lower mortality compared with those with type 1 perioperative myocardial infarction. [ABSTRACT FROM AUTHOR]

The golden apple snail (Pomacea maculata Perry) is an invasive species that lays its eggs out of water but is otherwise aquatic. To investigate this behavior and potential management techniques, we conducted experiments to examine the physical effects of immersion and underwater egg predation on hatching success. Predation on submerged eggs by P. maculata adults reduced hatching success by ∼99%. In predator-free Conditions, hatching success was reduced 75% by immersion in water and was negatively correlated with time submerged. Our results suggest that both underwater egg predation and low immersion tolerance may be exploited to limit the spread of P. maculata. [ABSTRACT FROM AUTHOR]

Background: Acute coronary syndromes (ACS) management is now well informed by guidelines extrapolated from clinical trials. However, most of these data have been acquired outside the local context. We sought to describe the current patterns of ACS care in Australia. Methods: The Acute Coronary Syndrome Prospective Audit study is a prospective multi-centre registry of ST-segment elevation myocardial infarction (STEMI), high-risk non-ST-segment elevation ACS (NSTEACS-HR) and intermediate-risk non-ST-segment elevation ACS (NSTEACS-IR) patients, involving 39 metropolitan, regional and rural sites. Data included hospital characteristics, geographic and demographic factors, risk stratification, in-hospital management including invasive services, and clinical outcomes. Results: A cohort of 3402 patients was enrolled; the median age was 65.5 years. Female and non-metropolitan patients comprised 35.5% and 23.9% of the population, respectively. At enrolment, 756 (22.2%) were STEMI patients, 1948 (57.3%) were high-risk NSTEACS patients and 698 (20.5%) were intermediate-risk NSTEACS patients. Evidence-based therapies and invasive management use were highest among suspected STEMI patients compared with other strata (angiography: STEMI 89%, NSTEACS-HR 54%, NSTEACS-IR 34%, P < 0.001) (percutaneous coronary intervention: STEMI 68.1%, NSTEACS-HR 22.2%, NSTEACS-IR 8.1%, P < 0.001). In hospital mortality was low (STEMI 4.0%, NSTEACS-HR 1.8%, NSTEACS-IR 0.1%, P < 0.001), as was recurrent MI (STEMI 2.4%, NSTEACS-HR: 2.8%, NSTEACS-IR 1.2%, P = 0.052). Conclusion: There appears to be an ‘evidence-practice gap’ in the management of ACS, but this is not matched by an increased risk of in-hospital clinical events. Objective evaluation of local clinical care is a key initial step in developing quality improvement initiatives and this study provides a basis for the improvement in ACS management in Australia. [ABSTRACT FROM AUTHOR]

Background The role of invasive management compared with medical management in patients with non-ST-segment-elevation myocardial infarction (NSTEMI) and advanced chronic kidney disease (CKD) is uncertain, given the increased risk of procedural complications in patients with CKD. We aimed to compare clinical outcomes of invasive management with medical management in patients with NSTEMI-CKD. Methods and Results We identified NSTEMI and CKD stages 3, 4, 5, and end-stage renal disease admissions using International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD-10-CM ) codes from the Nationwide Readmission Database 2016 to 2018. Patients were stratified into invasive and medical management. Primary outcome was mortality (in-hospital and 6 months after discharge). Secondary outcomes were in-hospital postprocedural complications (acute kidney injury requiring dialysis, major bleeding) and postdischarge 6-month safety and major adverse cardiovascular events. Out of 141 052 patients with NSTEMI-CKD, 85 875 (60.9%) were treated with invasive management, whereas 55 177 (39.1%) patients were managed medically. In propensity-score matched cohorts, invasive strategy was associated with lower in-hospital (CKD 3: odds ratio [OR], 0.47 [95% CI, 0.43-0.51]; P <0.001; CKD 4: OR, 0.79 [95% CI, 0.69-0.89]; P <0.001; CKD 5: OR, 0.72 [95% CI, 0.49-1.06]; P =0.096; end-stage renal disease: OR, 0.51 [95% CI, 0.46-0.56]; P <0.001) and 6-month mortality. Invasive management was associated with higher in-hospital postprocedural complications but no difference in postdischarge safety outcomes. Invasive management was associated with a lower hazard of major adverse cardiovascular events at 6 months in all CKD groups compared with medical management. Conclusions Invasive management was associated with lower mortality and major adverse cardiovascular events but minimal increased in-hospital complications in patients with NSTEMI-CKD compared with medical management, suggesting patients with NSTEMI-CKD should be offered invasive management.

Background: Admission electrocardiographic (ECG) findings of non-ST-segment elevation myocardial infarction (NSTEMI) include transient ST-segment elevation (TSTE), ST-segment depression (STD), T-wave inversion (TWI), and no ischemic changes (NIC)., Hypothesis: This study aimed to assess the prognostic value of qualitative ECG findings at presentation and to clarify the influence of invasive treatment on the prognostic value of admission ECG findings., Methods: We analyzed the Acute Coronary Syndrome Quality Improvement in Kerala (ACS QUIK) study post hoc. NSTEMI patients were included and classified into four groups per ECG findings. Study endpoints were in-hospital and 30-day mortality rates and major adverse events (MAE). We performed multivariate logistic regression, adjusting for covariates in the Global Registry of Acute Coronary Events risk model, with subset analyses of patients treated with or without invasive management., Results: STD patients had significantly higher in-hospital and 30-day mortality rates/MAE than TWI patients, which had lower in-hospital mortality rate/MAE than the NIC group. TSTE patients had intermediate outcomes. In multivariate logistic regression using the TWI group as the reference, STD and NIC remained independently associated with worse outcomes. Subset analysis showed prognostic value of admission ECG in non-invasively managed but not in invasively managed patients., Conclusions: STD was associated with adverse outcomes, TWI with benign prognoses. NIC should not be taken to indicate low risk. Qualitative analysis of admission ECG is suitable for rapid risk stratification of NSTMI patients at presentation. However, it may not be predictive of short-term outcomes of NSTEMI patients after invasive management., (© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.)

The incidence of human immunodeficiency virus (HIV) in pregnancy worldwide is increasing. We have more invasive diagnostic and therapeutic abilities in feto-maternal medicine, creating a dilemma in our management of these pregnancies. Do we aggressively manage them with the risks of vertical transmission or do we try to avoid invasive interventions? In this case, the fetus of a 36-year-old immigrant with HIV is diagnosed with hydrops fetalis. The patient's viral load was 5800 copies/mL, therefore, early intervention was unwise. Optimal HIV management, combined with referral to a specialist feto-maternal medicine unit, regular ultrasound scans and insertion of a pleuroamniotic shunt when the viral load was low, resulted in the delivery of an HIV-negative baby with excellent outcome for both mother and baby. [ABSTRACT FROM AUTHOR]