Ocean Circulation over North Atlantic underwater features in the path of the Mediterranean Outflow Water: Ormonde and Formigas seamounts, and the Gazul mud volcano

Seamounts constitute an obstacle to the ocean circulation, modifying it. As a result, a variety of hydrodynamical processes and phenomena may take place over seamounts, among others, flow intensification, current deflection, upwelling, Taylor caps, and internal waves. These oceanographic effects may turn seamounts into very productive ecosystems with high species diversity, and in some cases, are densely populated by benthic organisms, such corals, gorgonians, and sponges. In this study, we describe the oceanographic conditions over seamounts and other underwater features in the path of the Mediterranean Outflow Water (MOW), where populations of benthic suspensions feeders have been observed. Using CTD, LADPC and biochemical measurements carried out in the Ormonde and Formigas seamounts and the Gazul mud volcano (Northeast Atlantic), we show that Taylor caps were not observed in any of the sampled features. However, we point out that the relatively high values of the Brunt–Väisälä frequency in the MOW halocline, in conjunction with the slope of the seamount flanks, set up conditions for the breakout of internal waves and amplification of the currents. This may enhance the vertical mixing, resuspending the organic material deposited on the seafloor and, therefore, increasing the food availability for the communities dominated by benthic suspension feeders. Thus, we hypothesize that internal waves could be improving the conditions for benthic suspension feeders to grow on the slope of seamounts.En prens

Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data

Background: Evidence regarding whether imaging can be used effectively to select patients for endovascular thrombectomy (EVT) is scarce. We aimed to investigate the association between baseline imaging features and safety and efficacy of EVT in acute ischaemic stroke caused by anterior large-vessel occlusion. Methods: In this meta-analysis of individual patient-level data, the HERMES collaboration identified in PubMed seven randomised trials in endovascular stroke that compared EVT with standard medical therapy, published between Jan 1, 2010, and Oct 31, 2017. Only trials that required vessel imaging to identify patients with proximal anterior circulation ischaemic stroke and that used predominantly stent retrievers or second-generation neurothrombectomy devices in the EVT group were included. Risk of bias was assessed with the Cochrane handbook methodology. Central investigators, masked to clinical information other than stroke side, categorised baseline imaging features of ischaemic change with the Alberta Stroke Program Early CT Score (ASPECTS) or according to involvement of more than 33% of middle cerebral artery territory, and by thrombus volume, hyperdensity, and collateral status. The primary endpoint was neurological functional disability scored on the modified Rankin Scale (mRS) score at 90 days after randomisation. Safety outcomes included symptomatic intracranial haemorrhage, parenchymal haematoma type 2 within 5 days of randomisation, and mortality within 90 days. For the primary analysis, we used mixed-methods ordinal logistic regression adjusted for age, sex, National Institutes of Health Stroke Scale score at admission, intravenous alteplase, and time from onset to randomisation, and we used interaction terms to test whether imaging categorisation at baseline modifies the association between treatment and outcome. This meta-analysis was prospectively designed by the HERMES executive committee but has not been registered. Findings: Among 1764 pooled patients, 871 were allocated to the EVT group and 893 to the control group. Risk of bias was low except in the THRACE study, which used unblinded assessment of outcomes 90 days after randomisation and MRI predominantly as the primary baseline imaging tool. The overall treatment effect favoured EVT (adjusted common odds ratio [cOR] for a shift towards better outcome on the mRS 2·00, 95% CI 1·69–2·38; p<0·0001). EVT achieved better outcomes at 90 days than standard medical therapy alone across a broad range of baseline imaging categories. Mortality at 90 days (14·7% vs 17·3%, p=0·15), symptomatic intracranial haemorrhage (3·8% vs 3·5%, p=0·90), and parenchymal haematoma type 2 (5·6% vs 4·8%, p=0·52) did not differ between the EVT and control groups. No treatment effect modification by baseline imaging features was noted for mortality at 90 days and parenchymal haematoma type 2. Among patients with ASPECTS 0–4, symptomatic intracranial haemorrhage was seen in ten (19%) of 52 patients in the EVT group versus three (5%) of 66 patients in the control group (adjusted cOR 3·94, 95% CI 0·94–16·49; pinteraction=0·025), and among patients with more than 33% involvement of middle cerebral artery territory, symptomatic intracranial haemorrhage was observed in 15 (14%) of 108 patients in the EVT group versus four (4%) of 113 patients in the control group (4·17, 1·30–13·44, pinteraction=0·012). Interpretation: EVT achieves better outcomes at 90 days than standard medical therapy across a broad range of baseline imaging categories, including infarcts affecting more than 33% of middle cerebral artery territory or ASPECTS less than 6, although in these patients the risk of symptomatic intracranial haemorrhage was higher in the EVT group than the control group. This analysis provides preliminary evidence for potential use of EVT in patients with large infarcts at baseline. Funding: Medtronic

Variability of deep-sea megabenthic assemblages along the western pathway of the Mediterranean outflow water

The presence of different water masses in depth may influence the species distribution and community structure in deep-sea benthic ecosystems. In the North Atlantic, the Mediterranean Outflow Water (MOW) represents an important forcing water mass, whose influence on the distribution of cold-water corals in the northern European margins has been particularly investigated. However, the MOW also spreads westwards into the central North Atlantic bathing several seamounts and seafloor elevations, whose deep-sea benthic communities are still poorly known. In this study, we provide a local to large-scale comprehensive description of deep-sea megabenthic assemblages along the western branch of the MOW, from its origin in the western Mediterranean Sea to the Central North Atlantic close to the Azores archipelago. For some of the studied seafloor elevations, such as Ormonde (Gorringe bank, offshore SW Portugal margin) and Formigas seamounts (SE Azores archipelago), this is the first time these assemblages have been characterized and quantified. The results indicate a strong effect of substrate type in the structure and diversity of the assemblages at local scales; but the effect of water masses becomes more relevant when a large bathymetrical gradient is considered. The results also suggest a potential role of the MOW for biodiversity and biogeographic patterns at the North Atlantic basin, suggesting a potential enhancement of the biodiversity of some deep-sea megabenthic assemblages. Understanding water masses as an integrative tool to delineate biodiversity and biogeographic patterns from local to large scale will contribute to identify different megabenthic assemblages, including vulnerable marine ecosystems, as well as potential regions of refugia under future climate change conditions.En prensa2,42

Ocean Circulation over North Atlantic underwater features in the path of the Mediterranean Outflow Water: Ormonde and Formigas seamounts, and the Gazul mud volcano

Seamounts constitute an obstacle to the ocean circulation, modifying it. As a result, a variety of hydrodynamical processes and phenomena may take place over seamounts, among others, flow intensification, current deflection, upwelling, Taylor caps, and internal waves. These oceanographic effects may turn seamounts into very productive ecosystems with high species diversity, and in some cases, are densely populated by benthic organisms, such corals, gorgonians, and sponges. In this study, we describe the oceanographic conditions over seamounts and other underwater features in the path of the Mediterranean Outflow Water (MOW), where populations of benthic suspensions feeders have been observed. Using CTD, LADPC and biochemical measurements carried out in the Ormonde and Formigas seamounts and the Gazul mud volcano (Northeast Atlantic), we show that Taylor caps were not observed in any of the sampled features. However, we point out that the relatively high values of the Brunt–Väisälä frequency in the MOW halocline, in conjunction with the slope of the seamount flanks, set up conditions for the breakout of internal waves and amplification of the currents. This may enhance the vertical mixing, resuspending the organic material deposited on the seafloor and, therefore, increasing the food availability for the communities dominated by benthic suspension feeders. Thus, we hypothesize that internal waves could be improving the conditions for benthic suspension feeders to grow on the slope of seamounts

Ocean Circulation over North Atlantic underwater features in the path of the Mediterranean Outflow Water: Ormonde and Formigas seamounts, and the Gazul mud volcano

Seamounts constitute an obstacle to the ocean circulation, modifying it. As a result, a variety of hydrodynamical processes and phenomena may take place over seamounts, among others, flow intensification, current deflection, upwelling, Taylor caps, and internal waves. These oceanographic effects may turn seamounts into very productive ecosystems with high species diversity, and in some cases, are densely populated by benthic organisms, such corals, gorgonians, and sponges. In this study, we describe the oceanographic conditions over seamounts and other underwater features in the path of the Mediterranean Outflow Water (MOW), where populations of benthic suspensions feeders have been observed. Using CTD, LADPC and biochemical measurements carried out in the Ormonde and Formigas seamounts and the Gazul mud volcano (Northeast Atlantic), we show that Taylor caps were not observed in any of the sampled features. However, we point out that the relatively high values of the Brunt–Väisälä frequency in the MOW halocline, in conjunction with the slope of the seamount flanks, set up conditions for the breakout of internal waves and amplification of the currents. This may enhance the vertical mixing, resuspending the organic material deposited on the seafloor and, therefore, increasing the food availability for the communities dominated by benthic suspension feeders. Thus, we hypothesize that internal waves could be improving the conditions for benthic suspension feeders to grow on the slope of seamounts

Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Background: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. Methods: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Findings: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09–2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75–3·10, p<0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14–2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons