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Objective: Transcatheter mitral valve interventions (TMVI) have been proven to reduce symptom burden and improve outcomes in patients with severe mitral regurgitation (MR). However, the impact of right ventricular function (RVF) on exercise capacity in MR patients is less well understood., Methods: Cardiopulmonary exercise testing (CPET) is the most comprehensive approach to assess maximum exercise capacity. Submaximal exercise capacity (SEC), assessed by constant work rate exercise time testing (CWRET), is presumed to be relevant in daily life activities and gives a more differentiated physiological insight into the nature of exercise intolerance. Thus, 28 MR patients underwent CPET and CWRET (at 75% of the maximum work rate in the initial incremental exercise test) prior to TMVI and 3 months post-procedurally., Results: Patients' mean age was 75.0 ± 8.7 years and 32.1% were female. One patient presented with an MR reduction of less than two grades. RVF was at least moderately impaired in 25% of the patients. SEC of these patients was lower but did not significantly differ (416.4s ± 359.6 vs. 296.1 ± 216.5s; p=) from patients without RVF-deterioration. At follow-up, the SEC improved significantly (from 337.4 ± 262.2s to 517.4 ± 393.5s; p = 0.006). Maximum oxygen uptake (peakVO 2 ) showed a positive trend, but no statistically significant difference (10.3 ± 3.1 ml/min/kg vs. 11.3 ± 3.4 ml/min/kg; p = 0.06). RVF improved in 35.7% of the patients and these patients showed a significantly higher SEC increase (471.7 ± 153.9s vs. 82.7 ± 47.0s, p = 0.003)., Conclusion: SEC is significantly increased in MR patients undergoing TMVI, reflecting an improvement, especially regarding daily life activities. This may be related to TMVIś beneficial effect on right ventricular remodeling., Competing Interests: Disclosures Volker Rudolph, Kai P. Friedrichs, and Maria Ivannikova received speaker honoraria and grants from Abbott and Edwards. Muhammed Gerçek received consulting honoraria from Edwards. The other authors declare no conflict of interest., (Copyright © 2024 Hellenic Society of Cardiology. Publishing services by Elsevier Inc. All rights reserved.)

Background: Transcatheter tricuspid valve intervention (TTVI) has shown promising results with persistent reduction of tricuspid regurgitation (TR) and improvements in functional class and quality of life (QOL)., Objectives: To analyze the impact of TTVI on maximal and submaximal exercise capacity (SEC)., Methods: Constant work-rate exercise-time (CWRET) testing reflects SEC, which is more likely to be relevant for daily life activities and provides more differentiated physiological insight into the nature of exercise intolerance. Thus, 30 patients undergoing TTVI (21 direct annuloplasty and 9 edge-to-edge repair) received cardiopulmonary exercise testing (CPET) and CWRET (at 75% of maximum work rate in the initial CPET) before and 3 months after TTVI., Results: Patients' age was 80.5 [74.8-82.3] years and 53.3% were female. TR reduction ≥ 2 grades was achieved in 93.3% (TR grade ≤ moderate in 83.3%). Echocardiography revealed improved right ventricular (RV) characteristics with decreased RV basal diameter (47.0 mm [43.0-54.3] vs. 41.5 mm [36.8-48.0]; p < 0.001) and decreased inferior caval vein diameter. CWRET testing showed a significantly improved SEC (246.5 s [153.8-416.8] vs. 338.5 s [238.8-611.8] p = 0.001). Maximum oxygen uptake showed a positive trend without statistically significant differences (9.9 ml/min/kg [8.6-12.4] vs. 11.7 ml/min/kg [9.7-13.3]; p = 0.31). In contrast to the six-minute-walking distance (6MWD), SEC correlated moderately with effective regurgitation orifice area reduction (r = 0.385; p = 0.036), increased cardiac output (r = 0.378; p = 0.039), and improved QOL (r = 387; p = 0.035)., Conclusion: Improvements in exercise capacity after TTVI mainly occur in the submaximal rather than in the maximal exercise range and correlate with hemodynamic effects and QOL. This may have a methodological impact on assessment of exercise capacity in these patients., (© 2024. The Author(s).)

Background: Pulmonary vein (PV) occlusion is crucial for adequate lesion formation during cryoballoon-guided pulmonary vein isolation (CB-PVI). PV occlusion is usually confirmed by angiographies over the inflated balloon device. The aim of our study was to analyze the safety and efficacy of pressure waveform-based PV occlusion assessment during CB-PVI utilizing a novel fully integrated pressure analysis tool., Methods: Consecutive patients with symptomatic atrial fibrillation (AF) scheduled for CB-PVI were prospectively enrolled for pressure waveform-based PV occlusion assessment. A patient cohort receiving conventional angiographies served as control group. Patients with common PV ostia were excluded., Results: The study group consisted of 40 patients (16 females, mean age was 64.5 ± 9.7, 45% persistent AF). The control group consisted of 40 matched patients. All 160 PVs in the study group were successfully isolated without the use of additional venograms confirming PV occlusion. The mean procedure duration was 69 ± 12 min in the study group with a mean fluoroscopy duration of 11.5 ± 4.4 min. The mean contrast medium volume was 22 ± 9 ml in the study group and 36 ± 12 ml in the control group (p = 0.0001). Mean procedure duration, mean balloon temperatures, and mean ablation application durations did not differ significantly between the study and the control group. No periprocedural complications occurred., Conclusion: CB-PVI utilizing a fully integrated pressure waveform analysis tool to assess PV occlusion is feasible and safe and significantly reduces the amount of contrast medium without impact on procedural parameters and freedom from arrhythmia recurrence., (© 2024. The Author(s).)

Plant diversity effects on community productivity often increase over time. Whether the strengthening of diversity effects is caused by temporal shifts in species-level overyielding (i.e., higher species-level productivity in diverse communities compared with monocultures) remains unclear. Here, using data from 65 grassland and forest biodiversity experiments, we show that the temporal strength of diversity effects at the community scale is underpinned by temporal changes in the species that yield. These temporal trends of species-level overyielding are shaped by plant ecological strategies, which can be quantitatively delimited by functional traits. In grasslands, the temporal strengthening of biodiversity effects on community productivity was associated with increasing biomass overyielding of resource-conservative species increasing over time, and with overyielding of species characterized by fast resource acquisition either decreasing or increasing. In forests, temporal trends in species overyielding differ when considering above- versus belowground resource acquisition strategies. Overyielding in stem growth decreased for species with high light capture capacity but increased for those with high soil resource acquisition capacity. Our results imply that a diversity of species with different, and potentially complementary, ecological strategies is beneficial for maintaining community productivity over time in both grassland and forest ecosystems., (© 2024. The Author(s).)

Introduction: Workplace health interventions aim to motivate employees toward healthy behaviors to improve fitness and health in the long-term. We investigated whether CrossFit® is an effective training concept to achieve these goals in inactive employees with sedentary occupations., Methods: The study followed a prospective, controlled intervention design. Employees were invited to participate in intervention group (IG) or control group (CG) on their own preferences. Inclusion criteria were a predominantly sedentary occupation and execution of less than two muscle and/or mobility enhancing training sessions per week at the time of enrolling. The IG did at least two times a week a CrossFit training of 1 h. Mobility, strength, well-being, and back-issues were measured at the beginning, after 6, and 12 months. Participants in the CG were free to choose any other activities offered at the same time (e.g., circuit training, meditation, full body stability training). Adherence, respectively, behavioral change and maintenance qualities were evaluated based on the COM-B system and presence of behavior maintenance motives., Results: 89 employees were enrolled into the trial, from where 21 dropped out due to external factors (24%). From the remaining participants, 10 out of 39 (26%) in the IG and 1 out of 29 (4%) in the CG stopped for intrinsic reasons, leading to a non-adherence to the intervention of 22 percentage points. Motivation for behavioral change and maintenance in the IG was primarily driven by enhanced physical and psychological capability. Development of physical capability was evident by significant improvements ( p  < 0.001) in the IG compared to the CG for mobility ( d  = 3.3), maximal isometric strength (min. d  = 1.7, max. d  = 2.5), as well as reduction in pain intensity ( p  = 0.003, r  = 0.4) and frequency ( p  = 0.009, r  = 0.35) after 12 months. Significant improvements between the 6-month and the 12-month measurement in mobility and 6 out of 8 strength measures within the IG indicated the effectiveness of CrossFit beyond the beginner phase., Conclusion: CrossFit is a motivating training concept that led to long-term health and fitness improvements in inactive employees doing sedentary work and should be given greater consideration in workplace health promotion., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Brandt, Heinz, Klaaßen, Limbara, Mörsdorf, Schinköthe and Schmidt.)

Selective browsing by deer on young trees may impede the management goal of increasing forest resilience against climate change and other disturbances. Deer population density is often considered the main driver of browsing impacts on young trees, however, a range of other variables such as food availability also affect this relationship. In this study, we use browsing survey data from 135 research plots to explore patterns of roe deer ( Capreolus capreolus ) browsing pressure on woody plants in mountainous forests in central Europe. We fitted species-specific generalised linear mixed models for eight woody taxa, assessing the potential effects of understory characteristics, roe deer abundance and lying deadwood on browsing intensity. Our study reveals conspecific and associational effects for woody taxa that are intermediately browsed by roe deer. Selective browsing pressure was mediated by preferences of plants, in that, browsing of strongly preferred woody taxa as for example mountain ash ( Sorbus aucuparia ) and of least preferred woody taxa, for example Norway spruce ( Picea abies ) was not affected by the surrounding understory vegetation, while browsing pressure on intermediately browsed species like for example silver fir ( Abies alba ) was affected by understory characteristics. Contrary to our expectations, roe deer abundance was only positively associated with browsing pressure on silver fir and bilberry ( Vaccinium myrtillus ), while all other plants were unaffected by deer abundance. Finally, we did not find an influence of lying deadwood volume on the browsing pressure on any woody-plant species. Overall, our results indicate that patterns in browsing preference and intensity are species-specific processes and are partly affected by the surrounding understory vegetation. Current management strategies that aim to reduce browsing pressure through culling may be inefficient as they do not address other drivers of browsing pressure. However, managers also need to consider the characteristics of the local understory vegetation in addition to deer abundance and design species-specific plans to reduce browsing on woody plant taxa., Competing Interests: The authors declare no conflict of interests., (© 2023 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Introduction: Approaches applying higher energy levels for shorter periods (high power short duration, HPSD) to improve lesion formation for atrial fibrillation (AF) ablation have been introduced. This single-center study aimed to compare the efficacy, safety, and lesion formation using the novel DiamondTemp (DT) catheter or an ablation index (AI)-guided HPSD ablation protocol using a force-sensing catheter with surround-flow irrigation., Methods: One hundred thirteen consecutive patients undergoing radiofrequency-guided catheter ablation (RFCA) for AF were included. Forty-five patients treated with the DT catheter (50 W, 9 s), were compared to 68 consecutive patients undergoing AI-guided ablation (AI anterior 550; AI posterior 400) adherent to a 50 W HPSD protocol. Procedural data and AF recurrence were evaluated., Results: Acute procedural success was achieved in all patients (n = 113, 100%). DT-guided AF ablation was associated with a longer mean procedure duration (99.10 ± 28.30 min vs. 78.24 ± 25.55, p < .001) and more RF applications (75.24 ± 30.76 min vs. 61.27 ± 14.06, p = .019). RF duration (792.13 ± 311.23 s vs. 1035.54 ± 287.24 s, p < .001) and fluoroscopy dose (183.81 ± 178.13 vs. 295.80 ± 247.54 yGym 2 , p = .013) were lower in the DT group. AI-guided HPSD was associated with a higher AF-free survival rate without reaching statistical significance (p = .088). Especially patients with PERS AF (p = .009) as well as patients with additional atrial arrhythmia substrate (p = .002) benefited from an AI-guided ablation strategy., Conclusion: Temperature- and AI- controlled HPSD RFCA using 50 W was safe and effective. AI-guided HPSD ablation seems to be associated with shorter procedure durations and fewer RF applications. Particularly in advanced AF, freedom from AF-recurrence may be improved using an AI-guided HPSD approach., (© 2022 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)

Background and Aims: Sedentary behavior and physical inactivity are associated with musculoskeletal disorders (MSD). Muscle and mobility enhancing training is recommended to promote musculoskeletal fitness and prevent MSD. A functional fitness program emphasizing the importance of musculoskeletal fitness is provided by CrossFit®. However, data from long-term CrossFit® interventions assessing measures of musculoskeletal fitness in sedentary and inactive individuals does not exist., Methods: Thi s prospective, controlled study investigates the effects of 6 months CrossFit® training (2×60 min/week) in inactive adults (in terms of <2 muscle or mobility enhancing training sessions per week) with predominantly sitting or standing occupations. 91 participants were initially assessed, 2 were excluded, 55 self-selected for intervention (IG), and 34 for the control group (CG). Primary endpoint was a change in mobility (Functional Movement Screen score). Secondary endpoints were changed in strength (maximum isometric strength in kg; Dr. Wolff BackCheck®), and well-being (WHO-5 score). Key exploratory endpoints were changes in back-issue measures (pain intensity, limitation, and frequency)., Results: 39 participants of IG and 31 of CG completed the evaluation after 6 months. The IG improved significantly more ( p  < 0.001) compared with the CG in the FMS ( η ² = 0.58), trunk extension ( η ² = 0.46), trunk flexion ( η ² = 0.47), trunk lateral flexion left ( η ² = 0.41), trunk lateral flexion right ( η ² = 0.42), upper body push ( η ² = 0.4), upper body pull ( η ² = 0.25), hip extension left ( η ² = 0.18), and hip extension right ( η ² = 0.4). Change of WHO-5 scores did not significantly differ between groups ( p  = 0.55; η ² = 0.01). Exploratory analysis of back-issue data showed a higher decrease for pain intensity, limitation, and frequency in the IG compared with the CG., Conclusion: This study proves for the first time within the scope of a prospective, controlled study the broad benefits of CrossFit® in inactive adults doing predominantly sedentary work., Competing Interests: The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute an endorsement by the American College of Sports Medicine. Professional relationships with companies or manufacturers who will benefit from the results of the present study do not exist. The authors declare that they have no conflict of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Research in global change ecology relies heavily on global climatic grids derived from estimates of air temperature in open areas at around 2 m above the ground. These climatic grids do not reflect conditions below vegetation canopies and near the ground surface, where critical ecosystem functions occur and most terrestrial species reside. Here, we provide global maps of soil temperature and bioclimatic variables at a 1-km 2 resolution for 0-5 and 5-15 cm soil depth. These maps were created by calculating the difference (i.e. offset) between in situ soil temperature measurements, based on time series from over 1200 1-km 2 pixels (summarized from 8519 unique temperature sensors) across all the world's major terrestrial biomes, and coarse-grained air temperature estimates from ERA5-Land (an atmospheric reanalysis by the European Centre for Medium-Range Weather Forecasts). We show that mean annual soil temperature differs markedly from the corresponding gridded air temperature, by up to 10°C (mean = 3.0 ± 2.1°C), with substantial variation across biomes and seasons. Over the year, soils in cold and/or dry biomes are substantially warmer (+3.6 ± 2.3°C) than gridded air temperature, whereas soils in warm and humid environments are on average slightly cooler (-0.7 ± 2.3°C). The observed substantial and biome-specific offsets emphasize that the projected impacts of climate and climate change on near-surface biodiversity and ecosystem functioning are inaccurately assessed when air rather than soil temperature is used, especially in cold environments. The global soil-related bioclimatic variables provided here are an important step forward for any application in ecology and related disciplines. Nevertheless, we highlight the need to fill remaining geographic gaps by collecting more in situ measurements of microclimate conditions to further enhance the spatiotemporal resolution of global soil temperature products for ecological applications., (© 2022 The Authors. Global Change Biology published by John Wiley & Sons Ltd.)

One of the most important drivers for the coexistence of plant species is the resource heterogeneity of a certain environment, and several studies in different ecosystems have supported this resource heterogeneity-diversity hypothesis. However, to date, only a few studies have measured heterogeneity of light and soil resources below forest canopies to investigate their influence on understory plant species richness. Here, we aim to determine (1) the influence of forest stand structural complexity on the heterogeneity of light and soil resources below the forest canopy and (2) whether heterogeneity of resources increases understory plant species richness. Measures of stand structural complexity were obtained through inventories and remote sensing techniques in 135 1-ha study plots of temperate forests, established along a gradient of forest structural complexity. We measured light intensity and soil chemical properties on six 25 m² subplots on each of these 135 plots and surveyed understory vegetation. We calculated the coefficient of variation of light and soil parameters to obtain measures of resource heterogeneity and determined understory plant species richness at plot level. Spatial heterogeneity of light and of soil pH increased with higher stand structural complexity, although heterogeneity of soil pH did not increase in conditions of generally high levels of light availability. Increasing light heterogeneity was also associated with increasing understory plant species richness. However, light heterogeneity had no such effects in conditions where soil resource heterogeneity (variation in soil C:N ratios) was low. Our results support the resource heterogeneity-diversity hypothesis for temperate forest understory at the stand scale. Our results also highlight the importance of interaction effects between the heterogeneity of both light and soil resources in determining plant species richness., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Objective: Cerebral vasospasm (VSP) is one of the most important risk factors for the development of a delayed neurological deficit after subarachnoid hemorrhage (SAH). Perfusion-weighted magnetic resonance imaging (pwMRI) provides the possibility of detecting tissue at risk for infarction. The objective of our study was to evaluate the feasibility and impact of pwMRI in the management of SAH patients., Methods: From a consecutive series of 180 patients experiencing SAH and treated at our institution over a 3-year period, we identified 20 who underwent pwMRI during their acute illness. For these 20 patients, the results of pwMRI were compared with the results of diffusion-weighted MRI, transcranial Doppler sonography, and neurological examinations performed at the same time and with repeated pwMRI examinations of the same patient at different times., Results: Nineteen of 20 patients showed perfusion changes predominantly in the time maps. Fifteen of 19 patients with changes in pwMRI had a neurological deficit at the same time. In 7 of 15 patients with neurological deterioration, transcranial Doppler sonography showed signs of VSP, whereas all 15 patients showed alterations in pwMRI. The areas of perfusion changes in pwMRI correlated well with the neurological deficits of the patients and were larger than the areas of changed diffusion in diffusion-weighted MRI performed at the same time. There were no clinical complications with regard to the pwMRI examinations., Conclusion: pwMRI is safe and helpful in the management of patients with VSP after SAH. The sensitivity of pwMRI is higher than that of transcranial Doppler sonography in the detection of decreased perfusion as a result of VSP. pwMRI can detect tissue at risk before definitive infarction occurs and therefore may lead to a change of therapy in those patients.