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The tremendous diversity of Hymenoptera is commonly attributed to the evolution of parasitoidism in the last common ancestor of parasitoid sawflies (Orussidae) and wasp-waisted Hymenoptera (Apocrita). However, Apocrita and Orussidae differ dramatically in their species richness, indicating that the diversification of Apocrita was promoted by additional traits. These traits have remained elusive due to a paucity of sawfly genome sequences, in particular those of parasitoid sawflies. Here, we present comparative analyses of draft genomes of the primarily phytophagous sawfly Athalia rosae and the parasitoid sawfly Orussus abietinus. Our analyses revealed that the ancestral hymenopteran genome exhibited traits that were previously considered unique to eusocial Apocrita (e.g., low transposable element content and activity) and a wider gene repertoire than previously thought (e.g., genes for CO2 detection). Moreover, we discovered that Apocrita evolved a significantly larger array of odorant receptors than sawflies, which could be relevant to the remarkable diversification of Apocrita by enabling efficient detection and reliable identification of hosts.

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Left ventricular ejection fraction (LVEF) is a key parameter in the decision about drug treatment of chronic heart failure (HF). In the case of adequate echocardiography image quality, it is recommended to prefer quantitative measurement of LVEF to visual estimation. Four drugs with a documented mortality benefit in patients with HF with reduced LVEF are as follows: a renin-angiotensin-aldosterone blocker (angiotensin receptor-neprilysin inhibitor should be preferred), a beta-blocker, a mineralocorticoid receptor antagonist, and a sodium-glucose cotransporter-2 inhibitor (SGLT2i). The first three drugs show a reduction in benefit with increasing LVEF and the benefit disappears at normal LVEF. Studies with empagliflozin and dapagliflozin showed a mortality and morbidity profit in patients with an LVEF over 40%. A prespecified meta-analysis of EMPEROR-Preserved and DELIVER trials (patients with LVEF > 40%) was performed to clear the uncertainty around the consistency of clinical benefits across the preserved and normal LVEF, impact on cardiovascular mortality, and their effect in different subgroups of patients. Three other trials (DAPA-HF, EMPEROR-Reduced, and SOLOIST-WHF) were added post hoc into the comprehensive five-trial meta-analysis. The prespecified meta--analysis showed a significant 20% reduction of cardiovascular mortality or first hospitalization for HF in patients with LVEF = 60%. A comprehensive meta-analysis of five studies showed that dapagliflozin and empagliflozin reduce cardiovascular mortality and morbidity in patients with HF across the whole spectrum of LVEF. However, heart imaging, most often echocardiography, remains vital in patients with a suspicion of HF. It brings key information necessary for further diagnostic and therapeutic management. [ABSTRACT FROM AUTHOR]

Pharmacological therapy for heart failure (HF) shows the strongest evidence in patients with reduced ejection fraction (HFrEF). The four drug pillars with proven mortality benefit in patients with HFrEF are as follows: a renin-angiotensin-aldosterone blocker (angiotensin receptor – neprilysin inhibitor should be preferred), a beta-blocker, a mineralocorticoid receptor antagonist, and a sodium-glucose cotransporter-2 inhibitor (SGLT2i). Furthermore, their early prescription reduces mortality more markedly. Optimally, they should be prescribed during hospitalization, after hemodynamic stabilization. The goal is to initialize all four drugs but strategy of drug selection, sequence of application and dosage adjustment should follow the individual patient profile. For the treatment of patients with HF with mildly reduced ejection fraction (EF) the same drugs as for HFrEF can be used, in spite of a weaker evidence of benefit. It has been confirmed recently that SGLT2i reduce mortality and hospitalization for HF in patients with HF with preserved ejection fraction. SGLT2i (dapagliflozin and empagliflozin) are drugs with prognostic benefit in patients with HF regardless of the left ventricular EF. Renin-angiotensin-aldosterone blockers, beta-blockers, and mineralocorticoid antagonists show weak evidence of benefit in patients with HF with preserved EF. Diuretics are indicated in all patients with HF and congestion to alleviate symptoms and to maintain euvolemic state. In patients with improved EF, including asymptomatic patients, as well as patients with normalized EF and chamber geometry, continuation of disease- modifying therapy is recommended to avoid relapse of the disease. [ABSTRACT FROM AUTHOR]

Despite significant recent therapeutic advances, pulmonary arterial hypertension remains an incurable disease with an unfavourable prognosis. Treatment decisions are based on risk assessment at diagnosis as well as at regular structured follow-up assessments. Risk stratification according to the European Society of Cardiology is comprehensive. Interpretation of the mosaic of risk status can be subjective and is associated with several issues. This is why risk stratification schemes able to simplify and quantify the risk assessment are needed. This could provide for the objective and optimal choice of treatment strategy. Risk stratification of French and German researchers is based on the European guidelines. An American risk scheme utilizes parameters from the REVEAL Registry. Drug combination becomes the standard of care in all risk groups. Recently, several retrospective analyses have been published documenting haemodynamic and clinical benefits of triple combination including parenteral prostanoids. This initial triple combination seems to have a beneficial effect on long-term survival, especially in high-risk patients. However, evidence from prospective and randomized trials is lacking. In patients with high and high-intermediate risks, initial triple combination including parenteral prostanoids could be optimal. In patients with low-intermediate and low risks, double combination or triple oral combination is warranted. Monotherapy is suitable for a marginal group of patients with unambiguously low risk or few other particular subgroups. The risk of mortality should be regularly assessed using structured follow-up. The aim of treatment is to achieve the low-risk status according to an appropriate risk scheme. In case the patient does not achieve the low risk status, treatment escalation and initiation of parenteral prostanoid should be considered. [ABSTRACT FROM AUTHOR]