Long-acting somatostatin analogue treatments in autosomal dominant polycystic kidney disease and polycystic liver disease : a systematic review and meta-analysis

Objectives A number of randomised control trials (RCTs) investigating the effects of long-acting somatostatin analogues in autosomal dominant polycystic kidney disease (ADPKD) and polycystic liver disease (PLD) have been recently reported. We sought to evaluate all available RCTs investigating the efficacy of somatostatin analogues treatment in ADPKD and PLD. Data sources Electronic databases; Pubmed, Clincaltrials.gov and Cochrane Central Register of Controlled Trials Eligibility criteria for selecting studies RCTs and randomised cross-over trials comparing the effects of somatostatin analogue treatment with controls in patients with ADPKD or PLD. Data extraction and synthesis Data extraction and bias assessments were performed by two independent reviewers between January and May 2019. Outcomes assessed included estimated glomerular filtration rate (eGFR), total kidney volume (TKV), total liver volume (TLV), progression to end stage renal failure (ESRF) and adverse effects. Data were pooled using a random-effects model and reported as relative risk or mean difference with 95% CIs. Results Meta-analysis was performed of six RCTs or randomised cross-over trials and three secondary analyses. A total of 592 patients were included. Compared with controls, somatostatin analogue treatment significantly reduced TLV (mean difference −0.15 L, 95% CI −0.26 to −0.03, p=0.01). There was no significant effect on TKV (mean difference −0.19 L, 95% CI −0.50 to 0.12, p=0.23) or eGFR (mean difference 0.27 mL/min/1.73 m2, 95% CI −2.03 to 2.57, p=0.82). There was no effect on progression to ESRF. Somatostatin analogues were associated with known adverse effects such as gastrointestinal symptoms. Conclusions The available RCT data show improvement in TLV with somatostatin analogue treatment. There was no benefit to TKV or eGFR in patients with ADPKD, while being associated with various side effects. Further studies are needed to assess potential benefit in reducing cyst burden in patients with PLD

Organic Pollutants, Heavy Metals and Toxicity in Oil Spill impacted Salt Marsh Sediment Cores, Staten Island, New York City, USA

Sediment cores from Staten Island's salt marsh contain multiple historical oil spill events that impact ecological health. Microtox solid phase bioassay indicated moderate to high toxicity. Multiple spikes of TPH (6524 to 9586 mg/kg) and Σ16 PAH (15.5 to 18.9 mg/kg) were co-incident with known oil spills. A high TPH background of 400–700 mg/kg was attributed to diffuse sources. Depth-profiled metals Cu (1243 mg/kg), Zn (1814 mg/kg), Pb (1140 mg/kg), Ni (109 mg/kg), Hg (7 mg/kg), Cd 15 (mg/kg) exceeded sediment quality guidelines confirming adverse biological effects. Changes in Pb206/207 suggested three metal contaminant sources and diatom assemblages responded to two contamination events. Organic and metal contamination in Saw Mill Creek Marsh may harm sensitive biota, we recommend caution in the management of the 20–50 cm sediment interval because disturbance could lead to remobilisation of pre-existing legacy contamination into the waterway

Derivation and validation of a prognostic model for postoperative risk stratification of critically ill patients with faecal peritonitis

Background Prognostic scores and models of illness severity are useful both clinically and for research. The aim of this study was to develop two prognostic models for the prediction of long-term (6 months) and 28-day mortality of postoperative critically ill patients with faecal peritonitis (FP). Methods Patients admitted to intensive care units with faecal peritonitis and recruited to the European GenOSept study were divided into a derivation and a geographical validation subset; patients subsequently recruited to the UK GAinS study were used for temporal validation. Using all 50 clinical and laboratory variables available on day 1 of critical care admission, Cox proportional hazards regression was fitted to select variables for inclusion in two prognostic models, using stepwise selection and nonparametric bootstrapping sampling techniques. Using Area under the receiver operating characteristic curve (AuROC) analysis, the performance of the models was compared to SOFA and APACHE II. Results Five variables (age, SOFA score, lowest temperature, highest heart rate, haematocrit) were entered into the prognostic models. The discriminatory performance of the 6-month prognostic model yielded an AuROC 0.81 (95% CI 0.76–0.86), 0.73 (95% CI 0.69–0.78) and 0.76 (95% CI 0.69–0.83) for the derivation, geographic and temporal external validation cohorts, respectively. The 28-day prognostic tool yielded an AuROC 0.82 (95% CI 0.77–0.88), 0.75 (95% CI 0.69–0.80) and 0.79 (95% CI 0.71–0.87) for the same cohorts. These AuROCs appeared consistently superior to those obtained with the SOFA and APACHE II scores alone. Conclusions The two prognostic models developed for 6-month and 28-day mortality prediction in critically ill septic patients with FP, in the postoperative phase, enhanced the day one SOFA score’s predictive utility by adding a few key variables: age, lowest recorded temperature, highest recorded heart rate and haematocrit. External validation of their predictive capability in larger cohorts is needed, before introduction of the proposed scores into clinical practice to inform decision making and the design of clinical trials

Projected sea surface temperatures over the 21st century: Changes in the mean, variability and extremes for large marine ecosystem regions of Northern Oceans

Global climate models were used to assess changes in the mean, variability and extreme sea surface temperatures (SSTs) in northern oceans with a focus on large marine ecosystems (LMEs) adjacent to North America, Europe, and the Arctic Ocean. Results were obtained from 26 models in the Community Model Intercomparison Project Phase 5 (CMIP5) archive and 30 simulations from the National Center for Atmospheric Research Large Ensemble Community Project (CESM-LENS). All of the simulations used the observed greenhouse gas concentrations for 1976–2005 and the RCP8.5 “business as usual” scenario for greenhouse gases through the remainder of the 21st century. In general, differences between models are substantially larger than among the simulations in the CESM-LENS, indicating that the SST changes are more strongly affected by model formulation than internal climate variability. The annual SST trends over 1976–2099 in the 18 LMEs examined here are all positive ranging from 0.05 to 0.5°C decade–1. SST changes by the end of the 21st century are primarily due to a positive shift in the mean with only modest changes in the variability in most LMEs, resulting in a substantial increase in warm extremes and decrease in cold extremes. The shift in the mean is so large that in many regions SSTs during 2070–2099 will always be warmer than the warmest year during 1976–2005. The SST trends are generally stronger in summer than in winter, as greenhouse gas heating is integrated over a much shallower climatological mixed layer depth in summer than in winter, which amplifies the seasonal cycle of SST over the 21st century. In the Arctic, the mean SST and its variability increases substantially during summer, when it is ice free, but not during winter when a thin layer of ice reforms and SSTs remain near the freezing point

HOx observations over West Africa during AMMA: impact of isoprene and NOx

Aircraft OH and HO2 measurements made over West Africa during the AMMA field campaign in summer 2006 have been investigated using a box model constrained to observations of long-lived species and physical parameters. "Good" agreement was found for HO2 (modelled to observed gradient of 1.23 ± 0.11). However, the model significantly overpredicts OH concentrations. The reasons for this are not clear, but may reflect instrumental instabilities affecting the OH measurements. Within the model, HOx concentrations in West Africa are controlled by relatively simple photochemistry, with production dominated by ozone photolysis and reaction of O(1D) with water vapour, and loss processes dominated by HO2 + HO2 and HO2 + RO2. Isoprene chemistry was found to influence forested regions. In contrast to several recent field studies in very low NOx and high isoprene environments, we do not observe any dependence of model success for HO2 on isoprene and attribute this to efficient recycling of HOx through RO2 + NO reactions under the moderate NOx concentrations (5–300 ppt NO in the boundary layer, median 76 ppt) encountered during AMMA. This suggests that some of the problems with understanding the impact of isoprene on atmospheric composition may be limited to the extreme low range of NOx concentrations

Seasonal trends and phenology shifts in sea surface temperature on the North American northeastern continental shelf

The northeastern North American continental shelf from Cape Hatteras to the Scotian Shelf is a region of globally extreme positive trends in sea surface temperature (SST). Here, a 33-year (1982–2014) time series of daily satellite SST data was used to quantify and map spatial patterns in SST trends and phenology over this shelf. Strongest trends are over the Scotian Shelf (>0.6°C decade –1 ) and Gulf of Maine (>0.4°C decade –1 ) with weaker trends over the inner Mid-Atlantic Bight (~0.3°C decade –1 ). Winter (January–April) trends are relatively weak, and even negative in some areas; early summer (May–June) trends are positive everywhere, and later summer (July–September) trends are strongest (~1.0°C decade –1 ). These seasonal differences shift the phenology of many metrics of the SST cycle. The yearday on which specific temperature thresholds (8° and 12°C) are reached in spring trends earlier, most strongly over the Scotian Shelf and Gulf of Maine (~ –0.5 days year –1 ). Three metrics defining the warmest summer period show significant trends towards earlier summer starts, later summer ends and longer summer duration over the entire study region. Trends in start and end dates are strongest (~1 day year –1 ) over the Gulf of Maine and Scotian Shelf. Trends in increased summer duration are >2.0 days year –1 in parts of the Gulf of Maine. Regression analyses show that phenology trends have regionally varying links to the North Atlantic Oscillation, to local spring and summer atmospheric pressure and air temperature and to Gulf Stream position. For effective monitoring and management of dynamically heterogeneous shelf regions, the results highlight the need to quantify spatial and seasonal differences in SST trends as well as trends in SST phenology, each of which likely has implications for the ecological functioning of the shelf

Cleaning up our acts: Psychological interventions to reduce engine idling and improve air quality

A large-scale field experiment tested psychological interventions to reduce engine idling at long-wait stops. Messages based on theories of normative influence, outcome efficacy, and self-regulation were displayed approaching railway crossing on street poles. Observers coded whether drivers (N = 6049) turned off their engine while waiting at the railway crossings (only 27.2% did so at baseline). Automatic air quality monitors recorded levels of pollutants during barrier down times. To different degrees, the social norm and outcome efficacy messages successfully increased the proportion of drivers who turned off their engines (by 42% and 25%, respectively) and significantly reduced concentrations of atmospheric particulate matter (PM2.5) 2 m above ground level. Thus, the environment was improved through behavior change. Moreover, of both practical and theoretical significance, there was an ‘accelerator effect’, in line with theories of normative influence whereby the social norm message was increasingly effective as the volume of traffic increased