Delayed, severe thrombocytemia after abciximab infusion for primary angioplasty in acute coronary syndromes: Moving between systemic bleeding and stent thrombosis

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Addressing reproductive stochasticity and grazing impacts in the restoration of a canopy-forming brown alga by implementing mitigation solutions

1. The worldwide decline of marine forests, due to human impacts and climate change, emphasizes the need to develop and implement effective and sustainable solutions to restore these endangered habitats and to re-establish the services they provide. 2. In this study, the ex situ restoration of Treptacantha barbata, a Mediterranean subtidal habitat-forming species of brown seaweed, was for the first time implemented in a marine protected area in the Adriatic Sea. Two restoration efforts were performed in 2019. The first one was started in winter, after a marine heatwave that triggered early fertility, the second one in spring, when the species usually reproduces. 3. This study aimed to evaluate: 1) the disruptive effects of a thermal anomaly on the reproductive biology and performance in culture of T. barbata; and 2) the impact of the grazing pressure on juveniles after the outplanting. 4. The first cultivation was more productive than the second one, in terms of zygote release and germling growth. To mitigate the low efficiency of the second culture and to avoid prolonged highly-demanding maintenance in the mesocosms, the cultivation period was extended outdoors using a structure suspended in the water column. 5. The modular frames conceived for outplanting T. barbata proved to be effective because of their easy operability and low cost. Controlling for herbivorous fish had significant positive effects on both juvenile survival and growth. 6. The outcomes highlighted that an unpredictable climatic event and fish grazing were major threats that impaired the restoration process of T. barbata. These stressors should be considered when developing plans to implement effective large-scale restoration of canopy-forming macroalgae

Cultivation of Gongolaria barbata (Fucales, Phaeophyceae) with a seaweed-derived biostimulant in order to improve photophysiological fitness and promote fertility to advance the restoration of marine macroalgal forests

As a result of several anthropogenic factors, Cystoseira sensu lato forests have declined or become regionally extinct in many coastal regions of the Mediterranean. Given the low natural recovery of lost populations, research efforts have been encouraged to develop sustainable and efficient restoration of macroalgal forests on a large scale. By promoting growth and fertility of collected thallus branches under controlled laboratory conditions, the availability of seedlings for restoration could be ensured without jeopardizing natural populations. Here we investigated the effect of a commercial algal biostimulant (AlgatronCifo (R)) on the photophysiology, growth and fertility of Gongolaria barbata (Stackhouse) Kuntze (Fucales, Phaeophyceae). In a factorial laboratory experiment, two different temperatures (10 oC and 14 degrees C) and two culture media [i.e. seawater (SW) and Algatron (AT)] were tested. The photosynthetic performance of G. barbata doubled after three weeks of culture with AT, while it decreased by 25% when cultivated in SW. The highest photosynthetic performance and growth were achieved at 14oC with AT, where fertile receptacles also developed, followed by seedling settlements. The thalli cultured in AT had similar or better photosynthetic performance than the initial control thalli. AT-cultured thalli had a greater ability to quench energy via photochemical pathways (q(P)) than those from the SW, which on the contrary, had higher levels of non-photochemical responses (q(N), NPQ(max)). This limited photosynthetic performance was probably linked to the higher P-limitation experienced under that treatment. The algal biostimulant enhanced the physiological performance and induced fertility of G. barbata, demonstrating its valorization potential and setting a new path for improved restoration applications

Malignant Cough Syncope from Idiopathic Vagal Inflammation

We describe the case of a patient with malignant vasodepressive cough syncope. We demonstrated a vaso-vagal mechanism related to left vagal neuritis, by means of laryngoscopy and laryngeal electromyography. The condition resolved with steroid therapy

Anemia and acute coronary syndrome: current perspectives

Reference hemoglobin (Hb) values for the definition of anemia are still largely based on the 1968 WHO Scientific Group report, which established a cutoff value of <13 g/dL for adult men and <12 g/dL for adult nonpregnant women. Subsequent studies identified different normal values according to race and age. Estimated prevalence of anemia on admission in the setting of an acute coronary syndrome (ACS) is between 10% and 43% of the patients depending upon the specific population under investigation. Furthermore, up to 57% of ACS patients may develop hospital-acquired anemia (HAA). Both anemia on admission and HAA are associated with worse short- and long-term mortality, even if different mechanisms contribute to their prognostic impact. Baseline anemia can usually be traced back to preexisting disease that should be specifically investigated and corrected whenever possible. HAA is associated with clinical characteristics, medical therapy and interventional procedures, all eliciting cardiovascular adaptive response that can potentially worsen myocardial ischemia. The intrinsic fragility of anemic patients may limit aggressive medical and interventional therapy due to an increased risk of bleeding, and could independently contribute to worse outcome. However, primary angioplasty for ST elevation ACS should not be delayed because of preexisting (and often not diagnosed) anemia; delaying revascularization to allow fast-track anemia diagnosis is usually feasible and justified in non-ST-elevation ACS. Besides identification and treatment of the underlying causes of anemia, the only readily available means to reverse anemia is red blood cell transfusion. The adequate transfusion threshold is still being debated, although solid evidence suggests reserving red blood cell transfusions for patients with Hb level <8 g/dL and considering it in selected cases with Hb levels of between 8 and 10 g/dL. No evidence supports the use of iron supplements and erythropoiesis-stimulating agents in the setting of ACS

Time from adenosine di-phosphate receptor antagonist discontinuation to coronary bypass surgery in patients with acute coronary syndrome: meta-analysis and meta-regression

BACKGROUND: Adenosine di-phosphate receptor antagonists (ADPRAs) blunt hemostasis for several days after administration. This effect, aimed at preventing cardiac ischemic complications particularly in patients with acute coronary syndromes (ACS), may increase perioperative bleeding in the case of cardiac surgery. Practice Guidelines recommend withholding ADPRAs for at least 5days prior to surgery, though with a weak base of evidence. The purpose of this study was to systematically review observational and experimental studies of early or late preoperative discontinuation of ADPRAs prior to coronary artery bypass grafting (CABG) for patients with ACS. METHODS: MEDLINE, EMBASE, the Cochrane Library databases up to December 2011; and reference lists. Observational and experimental studies that compared early ADPRA discontinuation with late discontinuation, or no discontinuation, in patients with ACS undergoing CABG. RESULTS: There were 19 studies, including 14,046 participants, 395 deaths and 309 reoperations due to bleeding. ADPRA late discontinuation up to CABG was associated with an increased risk of postoperative mortality (OR 1.46, 95% confidence interval (CI) 1.10 to 1.93) and reoperations due to bleeding (OR 2.18; 95% CI 1.47 to 2.62). Between-study heterogeneity was low. Meta-analysis limited to high quality or prospective studies gave consistent results. In most instances, the 95% prediction intervals for summary risk estimates confirmed the risk across study groups. CONCLUSIONS: ADPRA late discontinuation prior to CABG is associated with an increased risk of death and reoperations due to bleeding in patients with ACS. The confidence in the estimates of risk for late discontinuation is moderate to high

Zoo-led initiatives and their role in lemur conservation in situ

© 2022 The Authors. Published by MDPI. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.3390/ani12202772We examined wider society’s ability to achieve biodiversity conservation and management targets using lemurs as a case study. We evaluated the impact on lemur conservation in situ by conservation initiatives led by European zoos in Madagascar exploring the European Association of Zoos and Aquaria’s Conservation Database projects in terms of performed actions and achieved goals as well as communication to the public. We found that zoo-led conservation initiatives may have a positive impact on the ground and tend to achieve most conservation goals related to wild lemurs. However, we suggest that such conservation programmes should underline that they target further lemur species beyond the flagship charismatic species and that enhanced communication efforts would be beneficial to further raise public awareness.Publication fees were funded by the University of Wolverhampton’s Research Investment Fund scheme—Phase 4 (Biosciences Research Project) to S.V

Fifteen years trends of cardiogenic shock and mortality in patients with diabetes and acute coronary syndromes

PURPOSE: Our study was intended to examine time trends of management and mortality of acute coronary syndrome patients with associated diabetes mellitus. METHODS: We analyzed data from 5 nationwide registries established between 2001 and 2014, including consecutive acute coronary syndrome patients admitted to the Italian Intensive Cardiac Care Units. RESULTS: Of 28,225 participants, 8521 (30.2%) had diabetes: as compared with patients without diabetes, they were older and had significantly higher rates of prior myocardial infarction and comorbidities (all P &lt; .0001). Prevalence of diabetes and comorbidities increased over time (P for trend &lt; .0001). Cardiogenic shock rates were higher in patients with diabetes, as compared with those without diabetes (7.8% vs 2.8%, P &lt; .0001), and decreased significantly over time only in patients without diabetes (P = .007). Revascularization rates increased over time in patients both with and without diabetes (both P for trend &lt; .0001), although with persistingly lower rates in patients with diabetes. All-cause in-hospital mortality was higher in patients with diabetes (5.4 vs 2.5%, respectively, P &lt; .0001) and decreased more consistently in patients without diabetes (P for trend = .007 and &lt; .0001, respectively). At multivariable analysis, diabetes remains an independent predictor of both cardiogenic shock (odds ratio 2.03; 95% confidence interval, 1.77-2.32; P &lt; .0001) and mortality (odds ratio 1.95; 95% confidence interval, 1.69-2.26; P &lt; .0001). CONCLUSIONS: Despite significant mortality reductions observed over 15 years in acute coronary syndromes, patients with diabetes continue to show threefold higher rates of cardiogenic shock and lower revascularization rates as compared with patients without diabetes. These findings may explain the persistingly higher mortality of patients with diabetes and acute coronary syndromes