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BackgroundDespite poor cardiovascular outcomes, there are no dedicated, validated risk stratification tools to guide investigation or treatment in type 2 myocardial infarction.ObjectivesThe goal of this study was to derive and validate a risk stratification tool for the prediction of death or future myocardial infarction in patients with type 2 myocardial infarction.MethodsThe T2-risk score was developed in a prospective multicenter cohort of consecutive patients with type 2 myocardial infarction. Cox proportional hazards models were constructed for the primary outcome of myocardial infarction or death at 1 year using variables selected a priori based on clinical importance. Discrimination was assessed by area under the receiving-operating characteristic curve (AUC). Calibration was investigated graphically. The tool was validated in a single-center cohort of consecutive patients and in a multicenter cohort study from sites across Europe.ResultsThere were 1,121, 250, and 253 patients in the derivation, single-center, and multicenter validation cohorts, with the primary outcome occurring in 27% (297 of 1,121), 26% (66 of 250), and 14% (35 of 253) of patients, respectively. The T2-risk score incorporating age, ischemic heart disease, heart failure, diabetes mellitus, myocardial ischemia on electrocardiogram, heart rate, anemia, estimated glomerular filtration rate, and maximal cardiac troponin concentration had good discrimination (AUC: 0.76; 95% CI: 0.73-0.79) for the primary outcome and was well calibrated. Discrimination was similar in the consecutive patient (AUC: 0.83; 95% CI: 0.77-0.88) and multicenter (AUC: 0.74; 95% CI: 0.64-0.83) cohorts. T2-risk provided improved discrimination over the Global Registry of Acute Coronary Events 2.0 risk score in all cohorts.ConclusionsThe T2-risk score performed well in different health care settings and could help clinicians to prognosticate, as well as target investigation and preventative therapies more effectively. (High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome [High-STEACS]; NCT01852123)

Two experiments addressed the spontaneous spawning of red snapper, Lutjanus campechanus, under controlled temperatures and photoperiods and the effect of broodstock diets supplemented with oils rich in polyunsaturated fatty acids. In Experiment 1, broodfish were fed a standard diet (ST1) and one enriched with menhaden oil (ER1) over a 355-d period. ER1-influenced egg fatty acid profile, however, did not positively influence egg production. Both diets produced highly viable eggs and larvae but results varied within treatments. In Experiment 2, broodfish were fed either a standard diet (ST2) or one supplemented with oils (ER2) rich in docosahexaenoic and arachidonic acid using a 203-d cycle. Both treatments produced eggs but fertilization rates ranged 0–10%. There was no clear influence of the diets on egg fatty acid profiles. These results indicate that red snapper can spawn spontaneously in tanks under controlled environmental conditions and produce viable eggs and larvae when fed diets based on squid, shrimp, and fish. The fatty acid composition of the diets was reflected in the eggs to some degree, but the oil enrichments did not further enhance the reproductive performance and egg quality under the conditions of this study.