Do We Need to Clamp the Renal Hilum Liberally during the Initial Phase of the Learning Curve of Robot-Assisted Nephron-Sparing Surgery?

Objective. We aimed to compare the results of our initial robot-assisted nephron-sparing surgeries (RANSS) performed with or without hilar clamping. Material and Method. Charts of the initial RANSSs ( = 44), which were performed by a single surgeon, were retrospectively reviewed. R.E.N.A.L. nephrometry system, modified Clavien classification, and M.D.R.D. equation were used to record tumoral complexity, complications, and estimated glomerular filtration rate (eGFR), respectively. Outcomes of the clamped (group 1, = 14) versus off-clamp (group 2, = 30) RANSSs were compared. Results. The difference between the two groups was insignificant regarding mean patient age, mean tumor size, and mean R.E.N.A.L. nephrometry score. Mean operative time, mean estimated blood loss amount, and mean length of hospitalization were similar between groups. A total of 4 patients in each group suffered 11 Clavien grade ≥2 complications early postoperatively. Open conversion rates were similar. The difference between the 2 groups in terms of the mean postoperative change in eGFR was insignificant. We did not encounter any local recurrence after a mean follow-up of 18.9 months. Conclusions. Creating warm-ischemic conditions during RANSS should not be a liberal decision, even in the initial phases of the learning curve for a highly experienced open surgeon

Surface salinity of the North Atlantic : can we reconstruct its fluctuations over the last one hundred years ?

Surface samples have been collected in the North Atlantic in the past one hundred years for determining the ocean salinity and its temperature. A large share of the data we have used were collected by merchant vessels of weather ships of European countries and to a large extent are listed in reports, in particular in the "Bulletin Hydrographique". We investigate whether these data are relevant for determining low frequency fluctuations of the sea surface salinity. We find many crossing in the 1920s for which salinity is anomalously high compared with the climatology or with other crossings collected on the same ship line. These anomalies are indicative of a contamination of the sample. By examining hydrographic data, reports and recent experience in collectionand storage in sea water, we can attribute these large errors to unclean buckets where salt crystals dissolve into the sample and to breathing of the samples during the storage. Each of these stages contributes in estimating a too large salinity and adds to the scatter of the measurements. (D'après résumé d'auteur

Toward mountains without permanent snow and ice

The cryosphere in mountain regions is rapidly declining, a trend that is expected to accelerate over the next several decades due to anthropogenic climate change. A cascade of effects will result, extending from mountains to lowlands with associated impacts on human livelihood, economy, and ecosystems. With rising air temperatures and increased radiative forcing, glaciers will become smaller and, in some cases, disappear, the area of frozen ground will diminish, the ratio of snow to rainfall will decrease, and the timing and magnitude of both maximum and minimum streamflow will change. These changes will affect erosion rates, sediment, and nutrient flux, and the biogeochemistry of rivers and proglacial lakes, all of which influence water quality, aquatic habitat, and biotic communities. Changes in the length of the growing season will allow low-elevation plants and animals to expand their ranges upward. Slope failures due to thawing alpine permafrost, and outburst floods from glacier- and moraine-dammed lakes will threaten downstream populations. Societies even well beyond the mountains depend on meltwater from glaciers and snow for drinking water supplies, irrigation, mining, hydropower, agriculture, and recreation. Here, we review and, where possible, quantify the impacts of anticipated climate change on the alpine cryosphere, hydrosphere, and biosphere, and consider the implications for adaptation to a future of mountains without permanent snow and ice.ISSN:2328-427

Effect of anthropogenic sulphate aerosol in China on the drought in the western-to-central US

In recent decades, droughts have occurred in the western-to-central United States (US), significantly affecting food production, water supplies, ecosystem health, and the propagation of vector-borne diseases. Previous studies have suggested natural sea surface temperature (SST) forcing in the Pacific as the main driver of precipitation deficits in the US. Here, we show that the aerosol forcing in China, which has been known to alter the regional hydrological cycle in East Asia, may also contribute to reducing the precipitation in the western-to-central US through atmospheric teleconnections across the Pacific. Our model experiments show some indications that both the SST forcing and the increase in regional sulphate forcing in China play a similar role in modulating the western-to-central US precipitation, especially its long-term variation. This result indicates that regional air quality regulations in China have important implications for hydrological cycles in East Asia, as well as in the USopen1

Emissions pathways, climate change, and impacts on California

The magnitude of future climate change depends substantially on the greenhouse gas emission pathways we choose. Here we explore the implications of the highest and lowest Intergovernmental Panel on Climate Change emissions pathways for climate change and associated impacts in California. Based on climate projections from two state-of-the-art climate models with low and medium sensitivity (Parallel Climate Model and Hadley Centre Climate Model, version 3, respectively), we find that annual temperature increases nearly double from the lower B1 to the higher A1fi emissions scenario before 2100. Three of four simulations also show greater increases in summer temperatures as compared with winter. Extreme heat and the associated impacts on a range of temperature-sensitive sectors are substantially greater under the higher emissions scenario, with some interscenario differences apparent before midcentury. By the end of the century under the B1 scenario, heatwaves and extreme heat in Los Angeles quadruple in frequency while heat-related mortality increases two to three times; alpine subalpine forests are reduced by 50–75%; and Sierra snowpack is reduced 30–70%. Under A1fi, heatwaves in Los Angeles are six to eight times more frequent, with heat-related excess mortality increasing five to seven times; alpine subalpine forests are reduced by 75–90%; and snowpack declines 73–90%, with cascading impacts on runoff and streamflow that, combined with projected modest declines in winter precipitation, could fundamentally disrupt California’s water rights system. Although interscenario differences in climate impacts and costs of adaptation emerge mainly in the second half of the century, they are strongly dependent on emissions from preceding decades

Public Health-Related Impacts of Climate Change in California

In June 2005 Governor Arnold Schwarzenegger issued Executive Order S-3-05 that set greenhouse gas emission reduction targets for California, and directed the Secretary of the California Environmental Protection Agency to report to the governor and the State legislature by January 2006 and biannually thereafter on the impacts to California of global warming, including impacts to water supply, public health, agriculture, the coastline, and forestry, and to prepare and report on mitigation and adaptation plans to combat these impacts. This report is a part of the report to the governor and legislature, and focuses on public health impacts that have been associated with climate change. Considerable evidence suggests that average ambient temperature is increasing worldwide, that temperatures will continue to increase into the future, and that global warming will result in changes to many aspects of climate, including temperature, humidity, and precipitation (McMichael and Githeko, 2001). It is expected that California will experience changes in both temperature and precipitation under current trends. Many of the changes in climate projected for California could have ramifications for public health (McMichael and Githeko, 2001), and this document summarizes the impacts judged most likely to occur in California, based on a review of available peer-reviewed scientific literature and new modeling and statistical analyses. The impacts identified as most significant to public health in California include mortality and morbidity related to temperature, air pollution, vector and water-borne diseases, and wildfires. There is considerable complexity underlying the health of a population with many contributing factors including biological, ecological, social, political, and geographical. In addition, the relationship between climate change and changes in public health is difficult to predict for the most part, although more detailed information is available on temperature-related mortality and air pollution effects than the other endpoints discussed in this document. Consequently, these two topics are discussed in greater detail. Where possible, estimates of the magnitude and significance of these impacts are also discussed, along with possible adaptations that could reduce climate-related health impacts. In the context of this review, weather refers to meteorological conditions at a specific place and time over a relatively short time frame, such as up to a year or two. Climate, on the other hand, refers to the same meteorological conditions, but over a longer time frame, such as decades or centuries

Duration and severity of Medieval drought in the Lake Tahoe Basin

This paper is not subject to U.S. copyright. The definitive version was published in Quaternary Science Reviews 30 (2011): 3269-3279, doi:10.1016/j.quascirev.2011.08.015.Droughts in the western U.S. in the past 200 years are small compared to several megadroughts that occurred during Medieval times. We reconstruct duration and magnitude of extreme droughts in the northern Sierra Nevada from hydroclimatic conditions in Fallen Leaf Lake, California. Stands of submerged trees rooted in situ below the lake surface were imaged with sidescan sonar and radiocarbon analysis yields an age estimate of ∼1250 AD. Tree-ring records and submerged paleoshoreline geomorphology suggest a Medieval low-stand of Fallen Leaf Lake lasted more than 220 years. Over eighty more trees were found lying on the lake floor at various elevations above the paleoshoreline. Water-balance calculations suggest annual precipitation was less than 60% normal from late 10th century to early 13th century AD. Hence, the lake’s shoreline dropped 40–60 m below its modern elevation. Stands of pre-Medieval trees in this lake and in Lake Tahoe suggest the region experienced severe drought at least every 650–1150 years during the mid- and late-Holocene. These observations quantify paleo-precipitation and recurrence of prolonged drought in the northern Sierra Nevada.Support for this work was provided by US Geological Survey/ Desert Research Institute under Project ID# 2003NV39B, a Geological Society of America graduate research grant and the IRIS undergraduate internship program. F. Biondiwas supported, in part by NSF Cooperative Agreement EPS-0814372 to the Nevada System of Higher Education. N. Driscoll was supported in part by a grant from CA DWR

Temporal clustering of Kawasaki disease cases around the world

In a single-site study (San Diego, CA, USA), we previously showed that Kawasaki Disease (KD) cases cluster temporally in bursts of approximately 7 days. These clusters occurred more often than would be expected at random even after accounting for long-term trends and seasonality. This finding raised the question of whether other locations around the world experience similar temporal clusters of KD that might offer clues to disease etiology. Here we combine data from San Diego and nine additional sites around the world with hospitals that care for large numbers of KD patients, as well as two multi-hospital catchment regions. We found that across these sites, KD cases clustered at short time scales and there were anomalously long quiet periods with no cases. Both of these phenomena occurred more often than would be expected given local trends and seasonality. Additionally, we found unusually frequent temporal overlaps of KD clusters and quiet periods between pairs of sites. These findings suggest that regional and planetary range environmental influences create periods of higher or lower exposure to KD triggers that may offer clues to the etiology of KD

Changes in the Seasonality of Precipitation over the Contiguous USA

Consequences of possible changes in annual total precipitation are dictated, in part, by the timing of precipitation events and changes therein. Herein, we investigated historical changes in precipitation seasonality over the US using observed station precipitation records to compute a standard seasonality index (SI) and the day of year on which certain percentiles of the annual total precipitation were achieved (percentile day of year). The mean SI from the majority of stations exhibited no difference in 1971–2000 relative to 30-year periods earlier in the century. However, analysis of the day of year on which certain percentiles of annual total precipitation were achieved indicated spatially coherent patterns of change. In some regions, the mean day of the year on which the 50th percentile of annual precipitation was achieved differed by 20–30 days between 1971–2000 and both 1911–1940 and 1941–1970. Output from the 10-Atmosphere-Ocean General Circulation Models (AOGCM) simulations of 1971–2000, 2046–2065, and 2081–2100 was used to determine whether AOGCMs are capable of representing the seasonal distribution of precipitation and to examine possible future changes. Many of the AOGCMs qualitatively captured spatial patterns of seasonality during 1971–2000, but there was considerable divergence between AOGCMs in terms of future changes. In both the west and southeast, 7 of 10 AOGCMs indicated later attainment of the 50th percentile accumulation in 2047–2065, implying a possible reversal of the twentieth-century tendency toward relative increases in precipitation receipt during winter and early spring over the southeast. However, this is also a region characterized by considerable interannual variability in the percentile day of year during the historical period