Revascularization Strategies in Patients with Diabetes and Acute Coronary Syndromes.

PURPOSE OF REVIEW: To review the current evidence for coronary revascularization in patients with diabetes mellitus (DM) in the setting of an acute coronary syndrome (ACS). RECENT FINDINGS: In patients with DM and stable multivessel ischemic heart disease, coronary artery bypass graft surgery (CABG) has been observed to be superior to percutaneous coronary intervention (PCI) in long-term follow-up, leading to lower rates of all-cause mortality, myocardial infarction, and repeat revascularization. In the ACS setting, PCI remains the most frequently performed procedure. In patients with an ST-segment-elevation myocardial infarction (STEMI), primary PCI should be the revascularization method of choice, whenever feasible. Controversy still exists regarding when and how to deal with possible residual lesions. In the non-ST-segment-elevation (NSTE) ACS setting, although there are no data from randomized controlled trials (RCTs), recent observational data and sub-analyses of randomized studies have suggested that CABG may be the preferred approach for patients with DM and multivessel coronary disease. There is a paucity of RCTs evaluating revascularization strategies (PCI and CABG) in patients with DM and ACS. CABG may be a viable strategy, leading to improved outcomes, especially following NSTE-ACS.

Inflammatory Bowel Disease and Breastfeeding: A Narrative Review.

Inflammatory bowel disease (IBD) frequently affects women of childbearing age who may consider breastfeeding. Although breastfeeding has numerous benefits, there remain concerns regarding the safety of breastfeeding among women with IBD. Breastfeeding is important in developing the immune system of infants and has been shown to protect against the development of IBD. The risk of developing an increase in disease activity postpartum is the same regardless of breastfeeding status. Most IBD medications are also considered safe in breastfeeding and have no major risks to infants. Despite this, breastfeeding rates remain low among women with IBD, mostly due to concerns about the safety of IBD therapy with breastfeeding. Many women self-discontinue their IBD medications to breastfeed, and there is often uncertainty among health professionals to make recommendations about therapy. Dedicated IBD clinics can greatly support mothers during pregnancy and breastfeeding periods to enhance their knowledge, optimize their medication adherence, and improve their postpartum outcomes. This review aims to provide the most recent evidence-based literature regarding the safety of breastfeeding in women with IBD and the current recommendations about medical therapies with breastfeeding.

The literature supports breastfeeding as a generally safe and beneficial practice for mothers with inflammatory bowel disease, though misconceptions around the safety of this practice persist. Multidisciplinary care models are essential for improving outcomes for women with inflammatory bowel disease who are breastfeeding.

Work Productivity Impairment in Persons with Inflammatory Bowel Diseases: A Systematic Review and Meta-analysis.

BACKGROUND AND AIMS: The impact of inflammatory bowel disease [IBD] on work productivity remains unclear. In this systematic review and meta-analysis, we quantify work-related outcomes and employment data among persons with IBD. METHODS: A systematic literature search was conducted in MEDLINE, EMBASE, the Cochrane library, Scopus, ProQuest, and clinicaltrials.gov from inception to February 2023, to identify studies on work productivity in persons with IBD aged > 18 years. Work productivity was defined primarily by the Work Productivity and Activity Impairment [WPAI] questionnaire which includes absenteeism, presenteeism, overall work impairment, and non-work activity impairment. In addition, we included data on employment, sick leaves, disability pensions, and indirect costs due to productivity loss. Pooled effect analysis was conducted using a random-effects model for pooled estimates of continuous and proportional data with 95% confidence intervals. RESULTS: Among all patients with IBD, the pooled estimates were 16.4% for absenteeism, 35.9% for presenteeism, 39.4% for overall work impairment, and 46.0% for non-work activity impairment. Indirect costs from overall work impairment were 5131.09 euros/patient/year. Only two-thirds of IBD patients were employed, and one in three lost their jobs due to IBD. Among those employed, 39.5% report sick days, 21.3% report work disability, and 12.3% receive disability pensions. Most studies demonstrate clinically meaningful improvements in work productivity with medical and/or surgical therapies. CONCLUSION: Persons with IBD experience significant work impairment and associated indirect costs. This highlights the need for appropriate workplace accommodations and timely medical therapy to alleviate the burden of disease and improve work outcomes.

Functional response and size-selective clearance of suspended matter by an invasive mussel.

Filter feeding activities link suspension feeders with their environment and underpin their impact on aquatic ecosystems. Despite their ecological and economic impacts, the functional response and size-selective capture of suspended particulates have not been well documented for the golden mussel Limnoperna fortunei. Here we demonstrated that golden mussels had a type I functional response, with an attack rate a = 0.085 and negligible handling time (h). Clearance rate ranged between 72.6 ± 27.0 and 305.5 ± 105.9 mL ind.-1h-1 (Mean ± S.E.), depending on food concentrations, which exhibited an inverse relationship with clearance rate. Presence of golden mussels suppressed chlorophyll a concentration in experimental mesocosms, the extent of which was dependent on mussel abundance. Concentration of suspended particles in experimental mesocosms experienced a sharp initial decline across all size categories (≤1->50 µm), though with increased final concentration of large particles (>25 µm), indicating packaging and egestion by golden mussels of fine particles (down to ≤1 µm). Capture efficiency of quantitatively-dominant suspended matter (≤1-50 µm) by golden mussels was inversely related to particle size. Animal abundance, particle size, and their interaction (abundance × particle size) determined the extent to which matter was removed from the water column. Presently L. fortunei occurs primarily in the southern end of the central route of South to North Water Diversion Project (China), but the species is spreading north; we anticipate that impacts associated with filtering of L. fortunei will correspond with local population abundance along this gradient.

Comparative feeding rates of native and invasive ascidians.

Ascidians have a recent history of species introductions globally, often with strong ecological impacts. Comparisons of per capita effects of invaders and comparable natives are useful to assess such impacts. Here, we explore ingestion rates (IR) and clearance rates (CR) of Ciona intestinalis and Ciona robusta, co-occurring native and non-native ascidians, respectively, from Brittany, France. IR was positively related to food concentration, with the invader responding more strongly to increasing food concentration. CR also differed by species, with the invader demonstrating higher values. C. robusta exhibited a higher functional response (Type I) than did C. intestinalis (Type II). Relative impact measured using seasonal abundance and IR revealed that C. robusta has a much greater impact than C. intestinalis at all food concentrations tested, though the former has a constrained distribution which limits its regional impact. Nevertheless, when abundant, we expect C. robusta to exert a greater impact on algal foods.