Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation

Background: Scientific guidelines consider atrial fibrillation (AF) complicating degenerative mitral regurgitation (DMR) a debated indication for surgery. Objectives: This study analyzed the prognostic/therapeutic implications of AF at DMR diagnosis and long-term. Methods: Patients were enrolled in the MIDA (Mitral Regurgitation International Database) registry, which reported the consecutive, multicenter, international experience with DMR due to flail leaflets echocardiographically diagnosed. Results: Among 2,425 patients (age 67 \ub1 13 years; 71% male, 67% asymptomatic, ejection fraction 64 \ub1 10%), 1,646 presented at diagnosis with sinus rhythm (SR), 317 with paroxysmal AD, and 462 with persistent AF. Underlying clinical/instrumental characteristics progressively worsened from SR to paroxysmal to persistent AF. During follow-up, paroxysmal and persistent AF were associated with excess mortality (10-year survival in SR and in paroxysmal and persistent AF was 74 \ub1 1%, 59 \ub1 3%, and 46 \ub1 2%, respectively; p < 0.0001), that persisted 20 years post-diagnosis and independently of all baseline characteristics (p values <0.0001). Surgery (n = 1,889, repair 88%) was associated with better survival versus medical management, regardless of all baseline characteristics and rhythm (adjusted hazard ratio: 0.26; 95% confidence interval: 0.23 to 0.30; p < 0.0001) but post-surgical outcome remained affected by AF (10-year post-surgical survival in SR and in paroxysmal and persistent AF was 82 \ub1 1%, 70 \ub1 4%, and 57 \ub1 3%, respectively; p < 0.0001). Conclusions: AF is a frequent occurrence at DMR diagnosis. Although AF is associated with older age and more severe presentation of DMR, it is independently associated with excess mortality long-term after diagnosis. Surgery is followed by improved survival in each cardiac rhythm subset, but persistence of excess risk is observed for each type of AF. Our study indicates that detection of AF, even paroxysmal, should trigger prompt consideration for surgery

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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Use of otolith shape to differentiate two lagoon populations of Pagellus erythrinus (Actinopterygii: Perciformes: Sparidae) in Tunisian waters

Background. The common pandora, Pagellus erythrinus (Linnaeus, 1758), is widely distributed in the Black and the Mediterranean seas. Therefore, P. erythrinus is a valuable component of the commercial fishery in Tunisia and plays an important role in microeconomics of local areas. The goal of this study was to investigate the stock structure and otolith asymmetry for specimens of the common pandora sampled from two lagoons—Ghar El Melh and Bizerte. Materials and methods. We collected a total of 119 specimens of P. erythrinus from the two lagoons, from May through July 2016. The Elliptical Fourier Analysis (EFA) was determined to evaluate the degree of similarity in the otoliths and detect the reciprocal variability. Results. The Discriminant Factor Analysis for the sagitta shape clearly demonstrated an asymmetry when comparing otoliths (left–right) (P < 0.05) within each population and a difference in shape when comparing the same side between the two populations: between the two sides (right–right and left–left). Conclusion. The comparison of the otolith morphology of the two populations showed a clear difference in shape and a left–right asymmetry of otoliths between and within populations. This result is probably related to genetic and local environmental factors. In fact, this investigation improves the knowledge on the stock discrimination for P. erythrinus and provides useful information for analysing fisheries management of this species in Tunisia

Stock discrimination of two insular populations of Diplodus annularis (Actinopterygii: Perciformes: Sparidae) along the coast of Tunisia by analysis of otolith shape

Background. The annular seabream, Diplodus annularis (Linnaeus, 1758), is the most common sparid fish in the Mediterranean Sea. This species is widespread in Tunisia. Despite their economic importance, due to their excellent white and delicate flesh (demersal fish) and their significant size, few studies have hitherto focused on stock discrimination and on the fisheries management. The goal of this research was to evaluate the stock structure of D. annularis for two Tunisian insular populations  based on the otolith shape, using different statistical approaches. Materials and methods. The specimens of Diplodus annularis were collected during five months ranging from May through September 2014 at two sites: Djerba and Kerkennah. In total, 120 fish were collected from the two study sites: 60 specimens of each population (30 males and 30 females) and were included in different statistical analyses. The Fourier coefficients were determined to evaluate the degree of similarity in the otoliths and detect the reciprocal variability. Results. By comparing the two studied populations, we revealed statistical significant differences, an asymmetry (left–right), of otoliths (P < 0.05). In the same population, symmetry (left–right) was detected for the males, females of Kerkennah, and females of Djerba. However, an asymmetry was detected only for the males of Djerba. Also, sexual dimorphism was observed only for the Djerba population. Conclusion. The comparison of the otolith morphology of the two populations showed a clear difference in shape and a left–right asymmetry of otoliths. This asymmetry indicates that the two populations belong to different stock of fish. The stocks characterization is considered as an important tool for fisheries management. Further studies are necessary to determine the origin of the otolith shape differences and whether they are related only to environmental conditions or a genetic basis may also be responsible

Use of otolith shape to differentiate two lagoon populations of Pagellus erythrinus (Actinopterygii: Perciformes: Sparidae) in Tunisian waters

Background. The common pandora, Pagellus erythrinus (Linnaeus, 1758), is widely distributed in the Black and the Mediterranean seas. Therefore, P. erythrinus is a valuable component of the commercial fishery in Tunisia and plays an important role in microeconomics of local areas. The goal of this study was to investigate the stock structure and otolith asymmetry for specimens of the common pandora sampled from two lagoons—Ghar El Melh and Bizerte. Materials and methods. We collected a total of 119 specimens of P. erythrinus from the two lagoons, from May through July 2016. The Elliptical Fourier Analysis (EFA) was determined to evaluate the degree of similarity in the otoliths and detect the reciprocal variability. Results. The Discriminant Factor Analysis for the sagitta shape clearly demonstrated an asymmetry when comparing otoliths (left–right) (P < 0.05) within each population and a difference in shape when comparing the same side between the two populations: between the two sides (right–right and left–left). Conclusion. The comparison of the otolith morphology of the two populations showed a clear difference in shape and a left–right asymmetry of otoliths between and within populations. This result is probably related to genetic and local environmental factors. In fact, this investigation improves the knowledge on the stock discrimination for P. erythrinus and provides useful information for analysing fisheries management of this species in Tunisia

Survival implication of left ventricular end-systolic diameter in mitral regurgitation due to flail leaflets a long-term follow-up multicenter study.

OBJECTIVES: This study analyzed the association of left ventricular end-systolic diameter (LVESD) with survival after diagnosis in organic mitral regurgitation (MR) due to flail leaflets.BACKGROUND: LVESD is a marker of left ventricular function in patients with organic MR but its association to survival after diagnosis is unknown.METHODS: The MIDA (Mitral Regurgitation International Database) registry is a multicenter registry of echocardiographically diagnosed organic MR due to flail leaflets. We enrolled 739 patients with MR due to flail leaflets (age 65 +/- 12 years; ejection fraction: 65 +/- 10%) in whom LVESD was measured (36 +/- 7 mm).RESULTS: Under conservative management, 10-year survival and survival free of cardiac death were higher with LVESD or =40 mm (64 +/- 5% vs. 48 +/- 10%; p or =40 mm independently predicted overall mortality (hazard ratio [HR]: 1.95, 95% confidence interval [CI]: 1.01 to 3.83) and cardiac mortality (HR: 3.09, 95% CI: 1.35 to 7.09) under conservative management. Mortality risk increased linearly with LVESD >40 mm (HR: 1.15, 95% CI: 1.04 to 1.27 per 1-mm increment). During the entire follow-up (including post-surgical), LVESD > or =40 mm independently predicted overall mortality (HR: 1.86, 95% CI: 1.24 to 2.80) and cardiac mortality (HR: 2.14, 95% CI: 1.29 to 3.56), due to persistence of excess mortality in patients with LVESD > or =40 mm after surgery (HR: 1.86, 95% CI: 1.11 to 3.15 for overall death, and HR: 1.81, 95% CI: 1.05 to 3.54 for cardiac death).CONCLUSIONS: In MR due to flail leaflets, LVESD > or =40 mm is independently associated with increased mortality under medical management but also after mitral surgery. These findings support prompt surgical rescue in patients with LVESD > or =40 mm but also suggest that best preservation of survival is achieved in patients operated before LVESD reaches 40 mm