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Background Overviews of trials suggest that percutaneous transluminal coronary angioplasty (PTCA) may be more effective than thrombolysis. However, whether these effects are sustained beyond hospital discharge, and the extent to which the results are applicable to a broad cross section of patients and the wider community are unknown. We compared the effectiveness of primary PTCA and thrombolysis in acute myocardial infarction during a 6-month follow-up period.Methods Detailed individual patient data were collected from randomized trials commenced from 1989 to 1996 that compared primary PTCA with thrombolysis. Data were combined to produce estimates of relative reduction in events at 30 days and 6 months for the group and for predefined clinical subgroups. Treatment effects were also assessed in relation to several study-related factors.Results Eleven trials were identified. The mortality rate at 30 days was 4.3% for 1348 patients randomized to undergo PTCA, and 6.9% for 1377 patients assigned to thrombolytic therapy (relative risk [RR] 0.62, 95% Cl 0.44-0.86, P = .004). At 6 months, the mortality rate was 6.2% for PTCA and 8.2% for thrombolysis (RR 0.73, 95% Cl 0.55-0.98, P = .04). Combined death and reinfarction rates at 30 days were 7.0% for PTCA and 12.9% for thrombolysis, with a sustained effect at 6 months (RR 0.60, 95% Cl 0.48-0.75, P Conclusion In the context of these trials, primary PTCA was more effective than thrombolytic therapy in reducing death, reinfarction, and stroke, with the greatest absolute benefit in patients who were at the highest risk. These benefits appear to be sustained for 6 months. The effect of treatment varied significantly across the trials, and this raises issues about how widely the results can be applied.

Eur Heart J

Coral reefs have emerged as one of the ecosystems most vulnerable to climate variation and change. While the contribution of climate warming to the loss of live coral cover has been well documented across large spatial and temporal scales, the associated effects on fish have not. Such information is important as coral reef fish assemblages are the most species dense vertebrate communities on earth, contribute critical ecosystem functions and provide crucial ecosystem services to the burgeoning human societies in tropical countries. Here we assess the impacts of the 1998 mass bleaching event on coral cover, reef structural complexity, and the functionality and abundance of reef fishes across the Indian Ocean. Using Bayesian meta-analysis we show changes in the size structure, diversity and trophic composition of the reef fish community have followed coral declines. Furthermore, using Bayesian predictive intervals we predict how different components of the fish community will respond to any future changes to coral cover across the region. Although ocean scale integrity of these coral reef ecosystems has been lost, it is positive to see the effects are spatially variable at various scales with impacts and vulnerability affected by geography, oceanography and management regime. Existing no-take marine protected areas still support high biomass of fish, however they had no positive affect on the response of the ecosystem to large-scale disturbance. This suggests that it is imperative that future planning identifies regional refugia from climate change as priorities for protection

Since 2005, Spray underwater gliders have been used to sample sections across the southern California Current System (CCS). Properties measured are depth-averaged velocity and profiles of temperature, salinity, Acoustic Doppler Profiler shear, chlorophyll a fluorescence, and 750-kHz acoustic backscatter. Although slow and carrying a relatively small sensor suite, gliders observed multiple 350-700-km sections that reveal details of known elements of the CCS circulation like the California Current and Undercurrent as well as a previously undescribed undercurrent 100-200 km offshore. The long time series with high spatial resolution disclose the close link between fronts in physical and biological variables, both the main pycnocline front and secondary weaker but sharp fronts farther offshore. These fronts appear to organize chlorophyll and acoustic backscatter fields, particularly during spring. Much of the patchiness of chlorophyll is associated with vertical displacements of fields that are much smoother within potential density surfaces. The horizontal structure of both chlorophyll and spice (the dynamically passive variable formed from temperature and salinity) appear to be formed by mesoscale stirring. © 2008, by the American Society of Limnology and Oceanography, Inc.

This report summarizes physical and biological conditions in the California Current System (CCS), from Oregon to Baja California, in 2001 and 2002. The principal sources of the observations described here are the CalCOFI (California Cooperative Oceanic Fisheries Investigations), IMECOCAL (Investigaciones Mexicanas de la Corriente de California), and U.S. GLOBECLTOP (Global Ecosystems Long-term Observation Program) programs. Large-scale atmospheric and oceanic conditions in the Pacific point to a fourth consecutive La Niña-like year. This has contributed to generally stronger than normal upwelling and uncharacteristically cool waters in much of the CCS, a pattern that has persisted since late 1998. Biological productivity has been generally higher as well, particularly off Oregon. Within the observed interannual fluctuations of recent years, these conditions suggest a generally elevated production off California and Oregon, but cool conditions have led to lower than normal zooplankton biomass off Baja California. Although the tropical Pacific has exhibited some indications of a developing El Niño, it is not likely to impact the CCS during the productive upwelling season of 2002. These observations are continuing evidence that a regime shift may have occurred in 1998, resulting in substantial change in ecosystem structure in the CCS. Continued monitoring and analysis of the state of the CCS in this context is needed. We outline a plan for an integrated monitoring program for the entire region, through the creation of ACCEO (Alliance for California Current Ecosystem Observation).

Large randomised trials have demonstrated that fibrinolytic therapy can reduce mortality in patients with suspected acute myocardial infarction (AMI). The indications for, and contraindications to, this treatment in some categories of patient are disputed, examples being late presentation, elderly patients, and those in cardiogenic shock. This overview aims to help resolve some of the remaining uncertainties. From all trials of fibrinolytic therapy versus control that randomised more than 1000 patients with suspected AMI, information was sought and checked on deaths during the first 5 weeks and on major adverse events occurring during hospitalisation. The nine trials included 58,600 patients, among whom 6177 (10.5%) deaths, 564 (1.0%) strokes, and 436 (0.7%) major non-cerebral bleeds were reported. Fibrinolytic therapy was associated with an excess of deaths during days 0-1 (especially among patients presenting more than 12 h after symptom onset, and in the elderly) but this was outweighed by a much larger benefit during days 2-35. This "early hazard" should not obscure the very clear overall survival advantage that is produced by fibrinolytic therapy. Benefit was observed among patients presenting with ST elevation or bundle-branch block (BBB)--irrespective of age, sex, blood pressure, heart rate, or previous history of myocardial infarction or diabetes--and was greater the earlier treatment began. Among the 45,000 patients presenting with ST elevation or BBB the relation between benefit and delay from symptom onset indicated highly significant absolute mortality reductions of about 30 per 1000 for those presenting within 0-6 h and of about 20 per 1000 for those presenting 7-12 h from onset, and a statistically uncertain benefit of about 10 per 1000 for those presenting at 13-18 h (with more randomised evidence needed in this latter group to assess reliably the net effects of treatment). Fibrinolytic therapy was associated with about 4 extra strokes per 1000 during days 0-1: of these, 2 were associated with early death and so were already accounted for in the overall mortality reduction, 1 was moderately or severely disabling, and 1 was not. This overview indicates that fibrinolytic therapy is beneficial in a much wider range of patients than is currently given such treatment routinely.