Nonischemic or Dual Cardiomyopathy in Patients With Coronary Artery Disease.

BACKGROUND: Randomized trials in obstructive coronary artery disease (CAD) have largely shown no prognostic benefit from coronary revascularization. Although there are several potential reasons for the lack of benefit, an underexplored possible reason is the presence of coincidental nonischemic cardiomyopathy (NICM). We investigated the prevalence and prognostic significance of NICM in patients with CAD (CAD-NICM). METHODS: We conducted a registry study of consecutive patients with obstructive CAD on coronary angiography who underwent contrast-enhanced cardiovascular magnetic resonance imaging for the assessment of ventricular function and scar at 4 hospitals from 2004 to 2020. We identified the presence and cause of cardiomyopathy using cardiovascular magnetic resonance imaging and coronary angiography data, blinded to clinical outcomes. The primary outcome was a composite of all-cause death or heart failure hospitalization, and secondary outcomes were all-cause death, heart failure hospitalization, and cardiovascular death. RESULTS: Among 3023 patients (median age, 66 years; 76% men), 18.2% had no cardiomyopathy, 64.8% had ischemic cardiomyopathy (CAD+ICM), 9.3% had CAD+NICM, and 7.7% had dual cardiomyopathy (CAD+dualCM), defined as both ICM and NICM. Thus, 16.9% had CAD+NICM or dualCM. During a median follow-up of 4.8 years (interquartile range, 2.9, 7.6), 1116 patients experienced the primary outcome. In Cox multivariable analysis, CAD+NICM or dualCM was independently associated with a higher risk of the primary outcome compared with CAD+ICM (adjusted hazard ratio, 1.23 [95% CI, 1.06-1.43]; P=0.007) after adjustment for potential confounders. The risks of the secondary outcomes of all-cause death and heart failure hospitalization were also higher with CAD+NICM or dualCM (hazard ratio, 1.21 [95% CI, 1.02-1.43]; P=0.032; and hazard ratio, 1.37 [95% CI, 1.11-1.69]; P=0.003, respectively), whereas the risk of cardiovascular death did not differ from that of CAD+ICM (hazard ratio, 1.15 [95% CI, 0.89-1.48]; P=0.28). CONCLUSIONS: In patients with CAD referred for clinical cardiovascular magnetic resonance imaging, NICM or dualCM was identified in 1 of every 6 patients and was associated with worse long-term outcomes compared with ICM. In patients with obstructive CAD, coincidental NICM or dualCM may contribute to the lack of prognostic benefit from coronary revascularization.

Introduction-First Billion Years: Habitability.

The physical processes active during the first billion years (FBY) of Earth's history, such as accretion, differentiation, and impact cratering, provide constraints on the initial conditions that were conducive to the formation and establishment of life on Earth. This motivated the Lunar and Planetary Institute's FBY topical initiative, which was a four-part conference series intended to look at each of these physical processes to study the basic structure and composition of our Solar System that was set during the FBY. The FBY Habitability conference, held in September 2019, was the last in this series and was intended to synthesize the initiative; specifically, to further our understanding of the origins of life, planetary and environmental habitability, and the search for life beyond Earth. The conference included discussions of planetary habitability and the potential emergence of life on bodies within our Solar System, as well as extrasolar systems by applying our knowledge of the Solar System's FBY, and in particular Earth's early history. To introduce this Special Collection, which resulted from work discussed at the conference, we provide a review of the main themes and a synopsis of the FBY Habitability conference.

Habitability Models for Astrobiology.

Habitability has been generally defined as the capability of an environment to support life. Ecologists have been using Habitat Suitability Models (HSMs) for more than four decades to study the habitability of Earth from local to global scales. Astrobiologists have been proposing different habitability models for some time, with little integration and consistency among them, being different in function to those used by ecologists. Habitability models are not only used to determine whether environments are habitable, but they also are used to characterize what key factors are responsible for the gradual transition from low to high habitability states. Here we review and compare some of the different models used by ecologists and astrobiologists and suggest how they could be integrated into new habitability standards. Such standards will help improve the comparison and characterization of potentially habitable environments, prioritize target selections, and study correlations between habitability and biosignatures. Habitability models are the foundation of planetary habitability science, and the synergy between ecologists and astrobiologists is necessary to expand our understanding of the habitability of Earth, the Solar System, and extrasolar planets.

A two-tiered approach to assessing the habitability of exoplanets.

In the next few years, the number of catalogued exoplanets will be counted in the thousands. This will vastly expand the number of potentially habitable worlds and lead to a systematic assessment of their astrobiological potential. Here, we suggest a two-tiered classification scheme of exoplanet habitability. The first tier consists of an Earth Similarity Index (ESI), which allows worlds to be screened with regard to their similarity to Earth, the only known inhabited planet at this time. The ESI is based on data available or potentially available for most exoplanets such as mass, radius, and temperature. For the second tier of the classification scheme we propose a Planetary Habitability Index (PHI) based on the presence of a stable substrate, available energy, appropriate chemistry, and the potential for holding a liquid solvent. The PHI has been designed to minimize the biased search for life as we know it and to take into account life that might exist under more exotic conditions. As such, the PHI requires more detailed knowledge than is available for any exoplanet at this time. However, future missions such as the Terrestrial Planet Finder will collect this information and advance the PHI. Both indices are formulated in a way that enables their values to be updated as technology and our knowledge about habitable planets, moons, and life advances. Applying the proposed metrics to bodies within our Solar System for comparison reveals two planets in the Gliese 581 system, GJ 581 c and d, with an ESI comparable to that of Mars and a PHI between that of Europa and Enceladus.

Algunas reflexiones sobre el Melanoma Cutáneo en Cuba / Some thoughts on the Cutaneous Melanoma in Cuba

El melanoma no es una neoplasia frecuente en Cuba; sin embargo, su relación etiológica con factores del ambiente como la radiación ultravioleta de la luz solar, su baja curabilidad cuando es diagnosticado en etapas avanzadas y la implicación de este hecho en la supervivencia de los pacientes aquejados, hace necesaria una atención particular sobre el tema que pueda dar lugar a acciones intervencionistas. Este artículo pretende alertar sobre aspectos negativos que inciden actualmente en la conducta ante los pacientes con esta enfermedad en nuestro medio y que van desde la información a la población, la prevención primaria y secundaria hasta la necesidad de la atención especializada en centros de referencia nacional para la enfermedad o en grupos cooperativos con este propósito(AU)