Arrhythmia and death following percutaneous revascularization in ischemic left ventricular dysfunction: Prespecified analyses from the REVIVED-BCIS2 trial

BACKGROUND: Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these patients before implantation of a cardiac defibrillator because it is assumed that this may reduce the incidence of fatal and potentially fatal ventricular arrhythmias, although this premise has not been evaluated in a randomized trial to date. METHODS: Patients with severe left ventricular dysfunction, extensive coronary disease, and viable myocardium were randomly assigned to receive either percutaneous coronary intervention (PCI) plus optimal medical and device therapy (OMT) or OMT alone. The composite primary outcome was all-cause death or aborted sudden death (defined as an appropriate implantable cardioverter defibrillator therapy or a resuscitated cardiac arrest) at a minimum of 24 months, analyzed as time to first event on an intention-to-treat basis. Secondary outcomes included cardiovascular death or aborted sudden death, appropriate implantable cardioverter defibrillator (ICD) therapy or sustained ventricular arrhythmia, and number of appropriate ICD therapies. RESULTS: Between August 28, 2013, and March 19, 2020, 700 patients were enrolled across 40 centers in the United Kingdom. A total of 347 patients were assigned to the PCI+OMT group and 353 to the OMT alone group. The mean age of participants was 69 years; 88% were male; 56% had hypertension; 41% had diabetes; and 53% had a clinical history of myocardial infarction. The median left ventricular ejection fraction was 28%; 53.1% had an implantable defibrillator inserted before randomization or during follow-up. All-cause death or aborted sudden death occurred in 144 patients (41.6%) in the PCI group and 142 patients (40.2%) in the OMT group (hazard ratio, 1.03 [95% CI, 0.82–1.30]; P =0.80). There was no between-group difference in the occurrence of any of the secondary outcomes. CONCLUSIONS: PCI was not associated with a reduction in all-cause mortality or aborted sudden death. In patients with ischemic cardiomyopathy, PCI is not beneficial solely for the purpose of reducing potentially fatal ventricular arrhythmias. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01920048

Exposure mediates transitions between bare and vegetated states in temperate mangrove ecosystems

The resilience of mangroves is dependent on their regeneration capacity. Patchy mid-19th century clearing dramatically affected this capacity, creating stable vegetated and unvegetated states in a fragmented temperate mangrove ecosystem. Mechanisms of mediation between states were tested by monitoring the survival and growth of planted mangrove seedlings and propagules on formerly forested bare mudflats and inside patches of existing forest. Survival (1 to 76%) and growth (-0.83 to 10.45 mm mo-1 increase in plant height) of seedlings was affected by (1) differing levels of exposure found at varying proximities to remnant forest and (2) differing inundation regimes both within and between sites that were randomly selected from locations that varied in aspect relative to prevailing winds. Increases in hydrodynamic energy within and between sites corresponded to a decrease in survival that was much more pronounced at locations that were exposed to prevailing winds. Growth rates were also generally lower at sites in exposed locations, but inundation regime was a more important determinant within sites, where growth was reduced at lower heights on the shore. Results suggest that stability of the bare mudflat state (caused by historical clearance of the mangrove forest) is dependent on level of exposure to hydrodynamic energy, and a return to a forested state is more likely where this exposure is lower. These results have implications for planning and implementing mangrove restoration projects and illustrate the role that physical factors can play in determining the resilience of disturbed temperate mangrove ecosystems

Nurse plant effects of a dominant shrub (Duma florulenta) on understorey vegetation in a large, semiarid wetland in relation to flood frequency and drying

Questions: Do nurse plant interactions significantly influence understorey vegetation diversity in a large, semi-arid, shrub-dominated wetland? How do the modes and net effects of nurse plant interactions vary spatially along a flood frequency gradient, and temporally in response to drying?\ud \ud Location: Narran Lakes Ramsar site, New South Wales, Australia.\ud \ud Methods: Microhabitat characteristics, understorey vegetation and germinable soil seed banks were investigated in shrub and open habitats across a flood frequency gradient in a large, semi-arid wetland dominated by open shrubland under productive conditions following floodwater recession and again following 6 mo of drought. Split-plot ANOVA and multivariate analyses were used to determine the effects of shrubs on microhabitat character, understorey vegetation cover, species diversity, richness and composition and germinable soil seed banks.\ud \ud Results: Microhabitat characteristics, including canopy cover, litter cover and soil character, all differed between shrub and open habitats, especially in the most frequently flooded sites. Under productive conditions following flooding, lignum shrubs suppressed understorey vegetation cover but increased species richness at the site scale across the flood frequency gradient and, in the most frequently flooded sites, supported higher species density at a microhabitat scale. Under dry conditions, lignum shrubs had a positive effect on understorey vegetation cover, species richness and species density across the flood frequency gradient, but particularly in frequently flooded sites. A significant difference in soil seed bank composition between shrub and open habitats was only observed in frequently flooded sites.\ud \ud Conclusions: Nurse plant interactions appear to play an important role in determining understorey vegetation diversity in the lignum shrubland of the Narran Lakes wetland system. The modes and net effects of these nurse plant interactions vary in space and time in relation to flood history and drying. Positive interactions, probably involving microhabitat amelioration, appear to be particularly important to plant diversity and abundance under dry conditions. Under more favourable wetter conditions, lignum shrubs also contribute to understorey vegetation diversity by facilitating the establishment of different species than those dominating open habitats. Our findings have implications for the management of perennial shrubs and hydrological regimes in such wetlands

Zooplankton dynamics from inundation to drying in a complex ephemeral floodplain-wetland

Ecological responses to wetting and drying in dryland river floodplain systems are often described in terms of &ldquo;boom&rdquo; and &ldquo;bust&rdquo;. We suggest that patterns in floodplain species abundances and assemblage structures will be closely linked to the changes in spatial habitat heterogeneity that accompany flooding and drying phases. This study examined the responses of zooplankton through a wetting and drying cycle in a complex floodplain-wetland system in semi-arid Australia, the Narran Lakes. We illustrate the complexity of the zooplankton &ldquo;boom&rdquo; and &ldquo;bust&rdquo; response. Total densities of zooplankton varied considerably over time and patterns were very dissimilar between sites with abundances varying from &lt;30 animals/L to over 4000 animals/L. We detected different patterns in the proportion of variance in abundances of the broad taxonomic groups (rotifers, cladocerans, ostracods, calanoid copepods, cyclopoid copepods and nauplii) explained by time and space. Site explained the highest proportion of variation in cladoceran and ostracod abundances,whereas variance in calanoid abundances was explained predominantly by time since inundation. Variation in the abundances of the remaining groups was explained largely by the site by time interaction. Zooplankton assemblages were observed to diverge during drying with highest between-site dissimilarities in assemblage structure occurring during the later stages of drying. Such high spatial and temporal variability in zooplankton abundances and community composition could have important consequences for consumers such as fish and some wetland birds that utilize these ephemeral systems for feeding and breeding while they are inundated.<br /

The Progress Report on Boundedness Character of Third Order Rational Equations.

Presents a progress report on the boundedness character of third-order rational equations. Emphasis on the boundedness character of solutions of all special cases of equation; Determination of the region of parameters where every solution of the equation is bounded; Confirmation of the boundedness of 11 more special cases