Associations of omega-3 fatty acids vs. fenofibrate with adverse cardiovascular outcomes in people with metabolic syndrome: propensity matched cohort study.

AIMS: Omega-3 fatty acids and fenofibrates have shown some beneficial cardiovascular effects; however, their efficacy has not been compared. This study aimed to compare the effectiveness of currently available omega-3 fatty acids and fenofibrate for reducing major adverse cardiovascular events (MACE). METHODS AND RESULTS: From a nationwide population-based cohort in South Korea (2008-2019), individuals with metabolic syndrome (≥30 years) who received statin with omega-3 fatty acids and those receiving statin with fenofibrate were matched by propensity score (n = 39 165 in both groups). The primary outcome was MACE, including ischaemic heart disease (IHD), ischaemic stroke (IS), and death from cardiovascular causes. The risk of MACE was lower [hazard ratio (HR), 0.79; 95% confidence interval (CI), 0.74-0.83] in the fenofibrate group than in the omega-3 fatty acid group. Fenofibrate was associated with a lower incidence of IHD (HR, 0.72; 95% CI, 0.67-0.77) and hospitalization for heart failure (HR, 0.90; 95% CI, 0.82-0.97), but not IS (HR, 0.90; 95% CI, 0.81-1.00) nor death from cardiovascular causes (HR, 1.07; 95% CI, 0.97-1.17). The beneficial effect of fenofibrate compared to omega-3 fatty acids was prominent in patients with preexisting atherosclerotic cardiovascular disease and those receiving lower doses of omega-3 fatty acids (≤2 g per day). CONCLUSION: In a real-world setting, fenofibrate use was associated with a lower risk of MACE compared with low-dose omega-3 fatty acids when added to statins in people with metabolic syndrome.

Seasonal Water Quality and Algal Responses to Monsoon-Mediated Nutrient Enrichment, Flow Regime, Drought, and Flood in a Drinking Water Reservoir.

Freshwater reservoirs are a crucial source of urban drinking water worldwide; thus, long-term evaluations of critical water quality determinants are essential. We conducted this study in a large drinking water reservoir for 11 years (2010-2020). The variabilities of ambient nutrients and total suspended solids (TSS) throughout the seasonal monsoon-mediated flow regime influenced algal chlorophyll (Chl-a) levels. The study determined the role of the monsoon-mediated flow regime on reservoir water chemistry. The reservoir conditions were mesotrophic to eutrophic based on nitrogen (N) and phosphorus (P) concentrations. An occasional total coliform bacteria (TCB) count of 16,000 MPN per 100 mL was recorded in the reservoir, presenting a significant risk of waterborne diseases among children. A Mann-Kendall test identified a consistent increase in water temperature, conductivity, and chemical oxygen demand (COD) over the study period, limiting a sustainable water supply. The drought and flood regime mediated by the monsoon resulted in large heterogeneities in Chl-a, TCB, TSS, and nutrients (N, P), indicating its role as a key regulator of the ecological functioning of the reservoir. The ambient N:P ratio is a reliable predictor of sestonic Chl-a productivity, and the reservoir was P-limited. Total phosphorus (TP) had a strong negative correlation (R2 = 0.59, p < 0.05) with the outflow from the dam, while both the TSS (R2 = 0.50) and Chl-a (R2 = 0.32, p < 0.05) had a strong positive correlation with the outflow. A seasonal trophic state index revealed oligo-mesotrophic conditions, indicating a limited risk of eutrophication and a positive outcome for long-term management. In conclusion, the Asian monsoon largely controlled the flood and drought conditions and manipulated the flow regime. Exceedingly intensive crop farming in the basin may lead to oligotrophic nutrient enrichment. Although the reservoir water quality was good, we strongly recommend stringent action to alleviate sewage, nutrient, and pollutant inflows to the reservoir.

Long-Term Interannual and Seasonal Links between the Nutrient Regime, Sestonic Chlorophyll and Dominant Bluegreen Algae under the Varying Intensity of Monsoon Precipitation in a Drinking Water Reservoir.

Long-term variations in reservoir water chemistry could provide essential data in making sustainable water quality management decisions. Here, we analyzed the spatiotemporal variabilities of nutrients, sestonic chlorophyll-a (CHL-a), nutrient enrichment, dominant algal species, and overall chemical water health of the third-largest drinking water reservoir in South Korea during 2000-2020. Our results distinctly explained the strong influence of monsoon rainfall on spatial and annual water chemistry variations. We observed a consistent increase in the chemical oxygen demand alluding to organic matter pollutants, while a steady declining trend in the sestonic CHL-a. The long-term total phosphorus (TP) level showed a steady reduction from the riverine zone to the lacustrine area. However, a higher total coliform bacteria (TCB) was observed at the water intake tower sites. TP displayed a strong link to algal CHL-a and ambient nitrogen phosphorus ratios, suggesting a robust phosphorus-limitation state. The severe phosphorus-limitation was also corroborated by the findings of trophic state index deviation. The high and low flow dynamics exhibited the strong influence of intensive rainfall carrying many nutrients and sediments and flushing out the sestonic CHL-a. Successive eutrophic conditions prevailed along with dominating blue-green algae species (Microcystis and Anabaena). We observed a strong positive correlation (r = 0.62) between water temperature and CHL-a and between total suspended solids and TP (r = 0.65). The multi-metric water pollution index characterized the overall water quality as 'good' at all the study sites. In conclusion, the long-term spatiotemporal variabilities of the ecological functions based on the nutrient-CHL-a empirical models are regulated mainly by the intensive monsoon precipitation. The drinking water could become hazardous under the recurrent eutrophication events and chemical degradations due to uncontrolled and untreated inflow of sewage and wastewater treatment plant effluents. Therefore, we strongly advocate stringent criteria to mitigate phosphorus and organic pollutant influx for sustainable management of Daecheong Reservoir.

A bidirectional network for appetite control in larval zebrafish.

Medial and lateral hypothalamic loci are known to suppress and enhance appetite, respectively, but the dynamics and functional significance of their interaction have yet to be explored. Here we report that, in larval zebrafish, primarily serotonergic neurons of the ventromedial caudal hypothalamus (cH) become increasingly active during food deprivation, whereas activity in the lateral hypothalamus (LH) is reduced. Exposure to food sensory and consummatory cues reverses the activity patterns of these two nuclei, consistent with their representation of opposing internal hunger states. Baseline activity is restored as food-deprived animals return to satiety via voracious feeding. The antagonistic relationship and functional importance of cH and LH activity patterns were confirmed by targeted stimulation and ablation of cH neurons. Collectively, the data allow us to propose a model in which these hypothalamic nuclei regulate different phases of hunger and satiety and coordinate energy balance via antagonistic control of distinct behavioral outputs.

How soon after a meal do you start feeling hungry again? The answer depends on a complex set of processes within the brain that regulate appetite. A key player in these processes is the hypothalamus, a small structure at the base of the brain. The hypothalamus consists of many different subregions, some of which are responsible for increasing or decreasing hunger. Wee, Song et al. now show how two of these subregions interact to regulate appetite and feeding, by studying them in hungry zebrafish larvae. The brains of zebrafish have many features in common with the brains of mammals, but they are smaller and transparent, which makes them easier to study. Wee, Song et al. show that as larvae become hungry, an area called the caudal hypothalamus increases its activity. But when the larvae find food and start feeding, activity in this area falls sharply. It then remains low while the hungry larvae eat as much as possible. Eventually the larvae become full and start eating more slowly. As they do so, the activity of the caudal hypothalamus goes back to normal levels. While this is happening, activity in a different area called the lateral hypothalamus shows the opposite pattern. It has low activity in hungry larvae, which increases when food becomes available and feeding begins. When the larvae finally reduce their rate of feeding, the activity in the lateral hypothalamus drops back down. The authors posit that by inhibiting each other's activity, the caudal and lateral hypothalamus work together to ensure that animals search for food when necessary, but switch to feeding behavior when food becomes available. Serotonin ­ which is produced by the caudal hypothalamus ­ and drugs that act like it have been proposed to suppress appetite, but they have varied and complex effects on food intake and weight gain. By showing that activity in the caudal hypothalamus changes depending on whether food is present, the current findings may provide insights into this complexity. More generally, they show that mapping the circuits that regulate appetite and feeding in simple organisms could help us understand the same processes in humans.

Curative chemoradiotherapy in patients with stage IVB cervical cancer presenting with paraortic and left supraclavicular lymph node metastases.

PURPOSE: To evaluate the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) with curative intent in patients with stage IVB cervical cancer initially presenting with paraortic and left supraclavicular lymph node metastases. METHODS AND MATERIALS: The medical records of 25 patients with both paraortic and left supraclavicular lymph nodal metastases (group I) were reviewed and compared with those of 101 women with paraortic lymph node metastases alone (group II). Group I received a mean 59.4 Gy to the paraortic and left supraclavicular areas and 50.4 Gy to the pelvis, followed by 30 Gy of high-dose-rate brachytherapy in 6 fractions. Group II received the same dose to the paraortic area and pelvis followed by intracavitary brachytherapy. All patients received platinum-based chemotherapy simultaneously. RESULTS: Of the 25 patients in group I, 16 (64%) experienced acute grade 3-4 hematologic toxicities, and 1 had a late grade 3 genitourinary toxicity. Complete responses, including the primary mass and pelvic, paraortic, and left supraclavicular lymph nodes, were observed in 13 patients (52%). At a median follow-up of 32 months for surviving patients, 3 experienced in-field failure, 6 showed distant failure, and 9 showed both. The 3-year overall and disease-free survival rates were 49% and 33%, respectively. In comparison, of the 101 patients in group II, 16 showed in-field failure, 14 experienced distant failure, and 11 showed both. The 3-year overall and disease-free survival rates were 69% and 57%, respectively. CONCLUSIONS: Curative CCRT is feasible in patients with stage IVB cervical cancer presenting with paraortic and left supraclavicular lymph nodal metastases, with acceptable late toxicity and high response rates, despite high rates of acute hematologic toxicity.

Transurethral resection of the prostate with a bipolar tissue management system compared to conventional monopolar resectoscope: one-year outcome.

The purpose of the present study was to evaluate the efficacy and safety of bipolar transurethral prostatectomy (TURP) using the Gyrus PlasmaKinetic System compared with conventional monopolar TURP. This study included 102 patients with benign prostatic hyperplasia (BPH) who underwent TURP from January 2003 to March 2005. In all, 49 consecutive patients had bipolar and 53 had monopolar TURP. All patients were assessed by preoperative and postoperative International Prostate Symptom Score (IPSS), uroflowmetry, transrectal ultrasonography, operative time, weight of resected tissue, change in serum sodium and hemoglobin, duration of catheter use, length of hospital stay, and complication rates. Significant improvement was seen postoperatively in both groups, and no difference was observed in the resection time, weight of resected tissue, change in serum sodium and hemoglobin, improvement of IPSS and peak flow rate (Qmax), or complication rates over the 12-month follow-up in both groups. There was, however, a significant difference in duration of catheter use and hospital stay. Duration of catheter use (2.28 days vs. 3.12 days) and hospital stay (3.52 days vs. 4.27 days) were shorter in the bipolar group (p = 0.012 vs. p = 0.034, respectively). Our results demonstrate that bipolar TURP using the Gyrus Plasma Kinetic System is as effective as conventional monopolar TURP with the additional advantage of reduced length of catheter use and hospital stay. Bipolar TURP is a promising new technique that may prove to be a good alternative to conventional TURP in the future.

Incident analysis of Bucheon LPG filling station pool fire and BLEVE.

An LPG filling station incident in Korea has been studied. The direct cause of the incident was concluded to be faulty joining of the couplings of the hoses during the butane unloading process from a tank lorry into an underground storage tank. The faulty connection of a hose to the tank lorry resulted in a massive leak of gas followed by catastrophic explosions. The leaking source was verified by calculating the amount of released LPG and by analyzing captured photos recorded by the television news service. Two BLEVEs were also studied.