Background The underlying causes of mortality in patients with pulmonary embolism have been investigated in the past, yet management of pulmonary emboli has evolved and newer therapeutic options are available. Methods Data from four hospitals during 2022-2025 were analyzed and all patients with intermediate-high risk and high risk pulmonary emboli who died during follow up were included. Results The main cause of mortality in intermediate-high risk PE was unrelated to the PE, contrasting that of high-risk PE. Almost 90% of deaths in patients with high-risk PE occurred during the index hospitalization, whereas intermediate-high-risk PE occurred after discharge. Notably, 11% of the subjects in the cohort had intra-procedural thrombectomy mortality. Conclusions The results depicted in the research letter provide insight into the mechanism of morality in patients with pulmonary emboli by risk category and thereby help improve care and patient selection for interventions.
Introduction Infective endocarditis (IE) remains a severe disease with high mortality despite advances in management. Although it predominantly affects male patients, female patients account for about 1-quarter of cases. Sex-specific differences in outcomes and prognostic factors remain insufficiently explored. Methods We conducted a retrospective study including 519 patients ≥16 years hospitalized for definite or possible IE (ESC 2023 criteria) at La Timone Hospital, Marseille, between March 2019 and October 2023. The primary endpoint was 1-year mortality; secondary endpoints included surgical management, valve involvement, and prognostic factors. Results Of the 519 patients, 26% were female patients. One-year mortality was comparable between sexes (27% in female patients vs 23% in male patients, P = .415). Postdischarge mortality was not significantly different between sexes (P = .096). Mitral valve involvement was more frequent in female patients, and aortic involvement predominated in male patients. Independent predictors of mortality included annular complications and lack of surgery. Importantly, sex-specific differences in prognostic factors were observed in this exploratory analysis: in female patients, TAVI and ischemic heart disease were associated with higher mortality; in male patients, right-sided IE and pacemaker presence were predictive. Furthermore, fatal cases in male patients were marked by more in-hospital complications (heart failure, cardiogenic or septic shock, acute renal failure), suggesting distinct mortality pathways. Conclusion Although overall mortality was similar between sexes, male patients and female patients with IE appeared to show different prognostic profiles in this single-center cohort. These preliminary, hypothesis-generating findings suggest that some established risk factors may largely reflect male data, emphasizing the need for larger, multicenter studies to confirm sex-specific determinants and improve individualized management.
This study investigates the concentrations of potentially toxic elements (PTEs) in sediments from the Sundarbans mangrove region, India. It represents the unique first coast-wide comprehensive assessment of intertidal sediment-associated PTEs across the Indian Sundarbans, integrating GIS-based spatial analysis, Positive Matrix Factorization (PMF) based source apportionment, multiple pollution indices, and human health risk assessment. A total of 50 samples (n = 3 replicates per site) were collected from different intertidal locations along the coast and analyzed for Al, Ba, Cd, Cr, Co, Cu, Fe, Pb, Mn, V, and Zn using Inductively Coupled Plasma- Optical Emission Spectroscopy (ICP-OES). Sediment contamination was evaluated using multiple pollution indices such as contamination factor (CF), enrichment factor (EF), geoaccumulation index (Igeo), ecological risk index (ERI), pollution load index (PLI), and improved Nemerow index (INI). Unlike conventional multivariate approaches, PMF quantitatively resolved the major pollution sources and estimated their relative contributions, providing a more robust basis for source identification and pollution management. The mean concentrations of PTEs followed the descending order: Fe > Al > Mn > Cr > Ba > V > Zn > Cu > Co > Pb > Cd. Among these, Fe (65,545.72 mg/kg), Al (3975.73 mg/kg), Mn (2980.39 mg/kg), and Cr (658.30 mg/kg) were the most abundant elements. The Igeo values (−6.21 to 5.91) and EF values (0.01 to 37.50) suggest significant enrichment of Cd, Cr, and Pb in the sediments. The overall PLI was 1.26, with Cd and Pb identified as the primary contributors to sediment contamination. Health risk assessment indicated that the hazard index (HI) for Cr (2.72) in children exceeds the acceptable safety threshold, suggesting potential non-carcinogenic health risks. The total carcinogenic risk (TCR) for children ranged from 1.15 × 10−5 to 3.67 × 10–3, and for adults, 6.88 × 10−6 to 5.50 × 10−4. Overall, this study, provides a scientific framework for identifying contamination hotspots, pollution sources, and supporting evidence-based environmental management and policy interventions.
Rationale Recent studies have shown natriuresis-guided diuretic adjustment strategies result in greater natriuresis and diuresis than the standard of practice in acute heart failure. There is no consensus for which natriuretic goal optimally balances decongestion with adverse clinical outcomes. Primary hypothesis This study will test the hypothesis that (1) a high-threshold natriuresis target improves natriuresis compared with both a low-threshold natriuretic strategy and traditional methods, and (2) natriuresis in absence of urine output monitoring can safely guide management. The primary endpoint is 24-hour natriuresis. Design Pragmatic, single‐center, randomized, controlled, open‐label with stratification by eGFR (greater than vs less than 60 mL/min/1.73 m²) and number of home diuretics (0-1 vs 2+).
The Maoping PbZn (–Ag–Ge) deposit in northeastern Yunnan is a giant, second largest PbZn deposit in the Sichuan–Yunnan–Guizhou (SYG) metallogenic province, SW China, yet the sources of ore-forming materials and fluids remain controversial, hindering genetic understanding and exploration. This study integrates detailed geological characterization with multiple isotope analyses (S, Pb, HeAr, Sr) of ore-stage sulfides and Emeishan basalts. Hydrothermal mineralization (Stage II) is subdivided into massive sulfide‑carbonate (II-A) and veined sulfide‑carbonate (II-B) substages. Sulfur isotopes of sulfides (δ34S = +9.8‰ to +21.8‰) are distinctly higher than those of Emeishan basalts (+0.9‰ to +2.5‰) and match evaporite-hosted sulfates in Devonian–Carboniferous carbonates. The δ34S order (pyrite > sphalerite > galena) and calculated equilibrium temperatures (159–232 °C) indicate that reduced sulfur was produced by thermochemical sulfate reduction (TSR). Homogeneous Pb isotope ratios (206Pb/204Pb = 18.589–18.821; 207Pb/204Pb = 15.725–15.885; 208Pb/204Pb = 39.009–39.742) overlap with those of Devonian–Carboniferous sedimentary rocks, demonstrating a dominant crustal Pb source from the host strata. Helium isotopes (3He/4He = 0.01–0.02 Ra) and 40Ar/36Ar ratios (620–1040) reveal a crustal-dominated fluid with minor meteoric water input, without mantle contribution. Initial Sr ratios (87Sr/86Sr)₂₀₂.₅Ma of sphalerite (0.71041–0.71709) indicate mixed Sr sources from Devonian–Carboniferous carbonates and minor the Early Cambrian black shales/basement rocks. The ore-forming fluids of the early substage (II-A) likely extracted slightly more Pb and Sr from the deep Early Cambrian black shales and/or basement rocks than those of the late substage (II-B). Collectively, the ore-forming materials (S, Pb, Sr) were mainly derived from evaporite-rich Devonian–Lower Permian carbonate rocks, and the ore fluids were crustal basinal brines mixed with meteoric water. The main mineralization at Maoping occurred during the Late Triassic to Early Jurassic, linked to the closure of the Paleo-Tethys Ocean and the Indosinian orogeny. The Maoping deposit is classified as a SYG-type PbZn deposit, distinct from typical MVT and SEDEX deposits. A preliminary metallogenic model of “tectonic- and gravity-driven large-scale migration of dual-basin brines followed by injection and filling” is proposed.
