Sex-based differences in ischemic cardiovascular and bleeding outcomes following implantation of drug-eluting stent in patients at high bleeding risk.

BACKGROUND: Patients with high bleeding risk (HBR) may exhibit uncertain adherence to dual antiplatelet therapy (DAPT) following drug-eluting stent (DES) implantation. The current population-based cohort study aimed to investigate the sex-based differences in adverse outcomes among the HBR population by analyzing the National Health Insurance Research Database in Taiwan. METHODS: Patients who had HBR features defined by the Academic Research Consortium (ARC) and received DES implantation between January 1, 2007, and December 31, 2017, were enrolled. Propensity score matching was adopted to select 3,981 pairs with similar clinical cardiovascular risks but different sexes. A competing risk model was performed to evaluate the risk of adverse ischemic events (cardiac death, nonfatal myocardial infarction, and ischemic stroke) and any bleeding events in both sexes. Noncardiac death was considered a competing risk. RESULTS: Within a 5-year follow-up, the incidence rates (per 1,000 person-year (95% confidence interval (CI)) of composite ischemic events and any bleeding events in males were respectively 44.09 (40.25-48.30) and 42.55 (38.79-46.68), while those in females were respectively 40.18 (36.51-44.23) and 42.35 (38.57-46.51). After adjustment for clinical variables, male patients had a marginally increased risk in the composite ischemic events (adjusted subdistribution hazard ratio (SHR) = 1.15 (1.00-1.31), p = 0.045) and a similar risk of any bleeding events (adjusted SHR = 1.00 (0.88-1.15), p = 0.946) compared with female patients. CONCLUSIONS: Of the HBR population, males had an increased risk of ischemic outcomes but a similar risk of bleeding compared with females following DES implantation.

Real-World Data on Comparison of Lipid-Lowering Effects between Alirocumab and Evolocumab in Patients with Hypercholesterolemia.

Background: Even though the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, alirocumab and evolocumab, have been approved to reduce plasma low-density lipoprotein cholesterol (LDL-C) and the risk of atherosclerotic cardiovascular disease in high-risk patients, real-world data showing comparisons of the lipid-lowering effects between alirocumab and evolocumab are scarce because of the low prescription rates of PCSK9 inhibitors in clinical practice. Methods: Between Feb 2018 and Sep 2021, 22 patients who received alirocumab and 22 patients who received evolocumab at a tertiary medical center were enrolled. The patients' baseline characteristics, prescribed medications, plasma LDL-C levels, and percentages of reduction in LDL-C were compared between alirocumab users and evolocumab users. Results: The alirocumab users more frequently received ezetimibe treatment (72.7% vs. 40.9%, p = 0.03) and had higher baseline LDL-C (165.6 ± 63.2 mg/dL vs. 130.8 ± 56.3 mg/dL, p = 0.04) compared with the evolocumab users. At 6 months of follow-up, the plasma LDL-C levels in the alirocumab users were similar to those in the evolocumab users (79.3 ± 64.0 mg/dL vs. 63.5 ± 44.1 mg/dL, p = 0.48). Additionally, the percentages of LDL-C reduction following treatment were similar between the alirocumab users and evolocumab users (-47.0% ± 45.0% vs. -49.8 ± 24.9%, p = 0.66). Conclusions: The LDL-C lowering effects of alirocumab are similar to those of evolocumab in clinical practice.

Spatial variations and pools of non-structural carbohydrates in young Catalpa bungei undergoing different fertilization regimes.

Despite the importance of non-structural carbohydrates (NSC) for growth and survival in woody plants, we know little about whole-tree NSC storage. Here, Catalpa bungei trees fertilized using different schedules, including water and fertilizer integration, hole application, and no fertilization, were used to measure the spatial variations of sugar, starch, and NSC concentrations in the leaf, branch, stem, bark, and root. By calculating the volume of whole-tree NSC pools and the contribution of distinct organs, we were also able to compare the storage under various fertilization regimes. We found that the spatial distribution patterns of each organ undergoing different fertilization regimes were remarkably similar. Height-related increases in the sugar and NSC concentrations of the leaf and bark were observed. The concentrations of sugar and NSC in the branch did not appear to vary longitudinally or horizontally. The sugar and NSC concentrations in the stem fluctuated with height, first falling and then rising. The coarse root contained larger amounts of NSC components in comparison to fine root. Contrary to no fertilization, fertilization enhanced the distribution ratio of the leaf, branch, and stem NSC pools while decreasing the distribution ratio of the root NSC pool. Particularly, the addition of fertilizer and water significantly increased the biomass of the organs, enhancing the carbon sink of each organ and whole-tree in comparison to other fertilization regimes. Our main goal was to strengthen the empirical groundwork for comprehending the functional significance of NSC allocation and stock variations at the organ-level of C. bungei trees.

Soil microbial communities response to different fertilization regimes in young Catalpa bungei plantation.

Fertilization is a fundamental aspect of global forest management that enhances forest productivity and drastically affects soil microbial communities. However, few studies have investigated the differences and similarities in the responses of below-ground microbial communities to different fertilization schemes. The effects of fertilization regimes on the composition and diversity of soil fungal and bacterial communities were investigated in a young Catalpa bungei plantation in Shandong Province, Eastern China. Soil microbial communities were assessed undergoing three types of fertilization: (i) no fertilization (CK), (ii) hole fertilization (HF), and (iii) the integration of water and fertilizer (WF). We further analyzed the effects of soil depth (i.e., 0-20 and 20-40 cm) on the structure of soil microbial communities. Our results indicated that the diversity of bacteria (e.g., Chao1 and Shannon indices) reduced undergoing fertilization, and WF had a higher negative impact on bacterial diversity than HF. A lower bacterial diversity was observed in the subsoil compared to the topsoil. In contrast to bacterial diversity, fungal diversity had a slightly increasing trend in the fertilized environments. The primary bacterial function was metabolism, which was independent of fertilization or soil depth. Among fungal functional guilds, symbiotic soil fungi decreased obviously in the fertilized stand, whereas saprotrophic fungi increased slowly. According to the structural equation models (SEM), the diversity and composition of bacterial and fungal communities were jointly regulated by soil nutrients (including N and P contents) directly affected by fertilization and soil layer. These findings could be used to develop management practices in temperate forests and help sustain soil microbial diversity to maintain long-term ecosystem function and services.

Management of Patients with Type V Hyperlipoproteinemia: An Uncommon Phenotype of Dyslipidemia with Chylomicronemia and Severe Hypertriglyceridemia.

Hypertriglyceridemia (HTG) remains a risk-enhancing factor of atherosclerotic cardiovascular disease. We aimed to report real-world data on the management of patients with type V hyperlipoproteinemia (HLP5), an uncommon phenotype of dyslipidemia characterized by fasting chylomicronemia and severe HTG. Between July 2018 and May 2021, 90 patients with HTG, including 83 patients with type IV hyperlipoproteinemia (HLP4) and 7 patients with HLP5, were identified by plasma apolipoprotein B (apoB) and lipoprotein electrophoresis. Patients with HLP5 were younger, had higher total cholesterol (TC) (264.9 ± 26.7 mg/dL vs. 183.9 ± 26.1 mg/dL; p < 0.01) and higher triglyceride (TG) (1296.7 ± 380.5 mg/dL vs. 247.6 ± 96.1 mg/dL; p < 0.01), and had lower high-density lipoprotein cholesterol (HDL-C) (30.6 ± 4.8 mg/dL vs. 40.5 ± 8.7 mg/dL; p < 0.01) and lower low-density lipoprotein cholesterol (LDL-C) (62.9 ± 16.4 vs. 103.0 ± 21.1 mg/dL; p < 0.01) compared with patients with HLP4. Despite an aggressive use of statin and fenofibrate with greater reductions in TG (-65.9 ± 13.7% vs. -27.9 ± 30.5%; p < 0.01) following 6 months of treatment, patients with HLP5 had persistent HTG (440.1 ± 239.0 mg/dL vs. 173.9 ± 94.8 mg/dL; p < 0.01) and an increase in LDL-C (28.3 ± 57.2% vs. -19.5 ± 32.0%; p < 0.01) compared with patients with HLP4. Our findings highlight that the lack of novel TG-lowering medications and management guidelines remains an unmet medical need in patients with HLP5. Closely monitoring lipid profiles, full assessment of individual's risk of cardiovascular disease, and emphasis on medication adherence are of clinical importance.