Is the Detection of Accelerated Sea Level Rise Imminent?

Global mean sea level rise estimated from satellite altimetry provides a strong constraint on climate variability and change and is expected to accelerate as the rates of both ocean warming and cryospheric mass loss increase over time. In stark contrast to this expectation however, current altimeter products show the rate of sea level rise to have decreased from the first to second decades of the altimeter era. Here, a combined analysis of altimeter data and specially designed climate model simulations shows the 1991 eruption of Mt Pinatubo to likely have masked the acceleration that would have otherwise occurred. This masking arose largely from a recovery in ocean heat content through the mid to late 1990 s subsequent to major heat content reductions in the years following the eruption. A consequence of this finding is that barring another major volcanic eruption, a detectable acceleration is likely to emerge from the noise of internal climate variability in the coming decade

Microscopic Colitis After Fecal Microbiota Transplant

Microscopic colitis (MC) is an inflammatory condition of the large bowel that is associated with chronic, nonbloody diarrhea. Colonoscopy usually demonstrates normal mucosa, while tissue biopsy reveals intraepithelial lymphocytes or a subepithelial collagen band. Although no specific antibody has been discovered, MC is associated with several autoimmune disorders such as celiac disease, Hashimoto\u27s thyroiditis, and rheumatoid arthritis. There are only a small number of case reports documenting possible hereditary MC cases, but up to 12% of patients with MC have a family history of inflammatory bowel disease. Other associations include proton pump inhibitor use, cigarette smoking, HLA-DQ2/86, and possibly some gastrointestinal infections

Are GRACE-era Terrestrial Water Trends Driven by Anthropogenic Climate Change?

To provide context for observed trends in terrestrial water storage (TWS) during GRACE (2003–2014), trends and variability in the CESM1-CAM5 Large Ensemble (LE) are examined. Motivated in part by the anomalous nature of climate variability during GRACE, the characteristics of both forced change and internal modes are quantified and their influences on observations are estimated. Trends during the GRACE era in the LE are dominated by internal variability rather than by the forced response, with TWS anomalies in much of the Americas, eastern Australia, Africa, and southwestern Eurasia largely attributable to the negative phases of the Pacific Decadal Oscillation (PDO) and Atlantic Multidecadal Oscillation (AMO). While similarities between observed trends and the model-inferred forced response also exist, it is inappropriate to attribute such trends mainly to anthropogenic forcing. For several key river basins, trends in the mean state and interannual variability and the time at which the forced response exceeds background variability are also estimated while aspects of global mean TWS, including changes in its annual amplitude and decadal trends, are quantified. The findings highlight the challenge of detecting anthropogenic climate change in temporally finite satellite datasets and underscore the benefit of utilizing models in the interpretation of the observed record

Risks of PEG tube placement in patients with cirrhosis-associated ascites

This study examined the safety of placing percutaneous endoscopic gastrostomy (PEG) tube in people with liver cirrhosis. The target population was further subdivided into people with ascites (case group) and people without ascites (control). We compare the morbidity and the mortality difference of PEG placement in cirrhotic patients with ascites vs cirrhotic patients without ascites. We then examined multiple factors including sex, race, chronic illness including hypertension, congestive heart failure, and others and their influence on the inpatient mortality of all cirrhotic patients who had PEG placement. A total of 38,175 inpatient PEG tube placements were identified. Only 583 patients out of 38,175 had a history of cirrhosis. One hundred seven had ascites and the rest did not. Mean age of the patients was 61.14 years. Patient demography included (65.2%) male and the rest were female, 359 were white (64.4%), 90 black (14.8%), 84 Hispanic (13.7%), 23 Asians (3.3%), 7 Native Americans (0.4%), and 20 others (3.5%). Complications from PEG procedure in cirrhosis with ascites vs non-ascites included bleeding of 4 (0.8%) vs 2 (1.9%) (P=0.35), surgical site infection 2 (0.4%) vs 1 (0.9%) (P=0.51), and urinary tract infection 105 (22.1%) vs 34 (23.8%) (P=0.34), respectively. There was no colonic injury in either group. The total inpatient mortality was 75 out of the 583. Fifty-six (11.8%) were in the ascites group and 19 (17.8%) in the non-ascites group (P=0.097). Factors including ascites, postsurgical bleeding, and surgical site infection did not have influence on the inpatient mortality and there were no statistical differences between the two groups

The Morbidity and Mortality of Laparoscopic Appendectomy in Patients with Cirrhosis

Introduction: The perioperative mortality is significantly higher in patients with cirrhosis undergoing certain surgical procedures. In this study, we examined the inpatient perioperative mortality and morbidities in cirrhotic people who underwent laparoscopic appendectomy. Methods: We performed a retrospective analysis using the National Inpatient Sample database for 2010. Inclusion criteria were all race and sex who are 18 years or older. Those who have laparoscopic appendectomy and have a history of liver cirrhosis were assigned to case group. An equal random number of appendectomy-related admissions and those who have no history of liver cirrhosis were selected and placed in the control group. A binary logistic regression statistical test was used to examine the odds ratio for the mortality difference and postoperative complication including pneumonia, urinary tract infection (UTI), surgical site infection, postoperative bleeding. IBM SPSS statistics was used to execute the analysis. A confidence interval of 95% and P value less than .05 were determined to define the statistical significance. Result: A total of 754 appendectomy-related admissions were identified-376 appendectomy-related admissions and history of cirrhosis and 378 admissions with appendectomy and no history of cirrhosis. Control group was not found to be statistically different from the case group when it comes to age, race, and sex. Of 754, 520 were white (73.5%), 334 (44.3%) were men. The mean age was 43.75 years for the case group and 46.68 years for the control group. Comparing cirrhotic with noncirrhotic group, the mean length of stay was 1.1 vs 1.52 days, inpatient mortality was 2 (0.5%) vs 1 (0.3%) (P = .56), pneumonia 8 (2.1%) vs 3 (0.8%) (P = .142), surgical site infection 3 (0.8%) vs 2 (0.5%) (P = .652), UTI 18 (4.8%) vs 12 (3.2%) (P = .26), and postoperative bleeding 3 (0.8%) vs 2 (0.5%) (P = .65). Conclusions: Appendectomy-related morbidity and mortality in cirrhotic patients are not different from noncirrhotic patients

Comparing efficacy of lumen-apposing stents to plastic stents in the endoscopic management of mature peripancreatic fluid collections: a single-center experience

Introduction: Mature peripancreatic fluid collection (MPFC) is a known and often challenging consequence of acute pancreatitis and often requires intervention. The most common method accepted is the step-up approach, which consists of percutaneous drainage followed, if necessary, by minimally invasive retroperitoneal necrosectomy. Our paper aims to distinguish between plastic stents and lumen-apposing stents in the endoscopic management of MPFC in terms of morbidity, mortality, and haste of fluid collection resolution. Methods: A retrospective analysis was performed at UMass Memorial Medical Center in patients with a diagnosis of MPFC. Utilizing medical records, clinical data, radiology, as well as endoscopic evidence, patients were differentiated by stent type used (plastic versus lumen-apposing) for the management of the MPFC. The primary outcome of the study was to assess the time to MPFC resolution following the placement of either plastic or lumen-apposing stents (on endoscopic ultrasound or computerized tomography scan) using a multivariate analysis with a logistic regression model. Results: A total of 54 patients were included in this study from UMass Memorial Medical Center between 2012 and 2015. Twelve (22%) of these patients received lumen-apposing stents and 42 (78%) of these patients received plastic pigtail stents. For the lumen-apposing stent group, the mean interval between stent placement and resolution of MPFC was 57 days as compared to 102 days for plastic pigtail stents (p=0.02). The mean interval for placement/removal of lumen-apposing stents was 48 days as compared to 81 days for plastic pigtail stents (p=0.01). Stent migration was seen in 5 patients (11%) who received a plastic pigtail stent compared to 0 (0%) patients who received a lumen-apposing stent. Discussion: Our study demonstrates that lumen-apposing stents result in a significant reduction in the interval between stent placement and MPFC resolution as well as the time from stent placement to removal, when compared to plastic pigtail stents, the prior standard-of-care. Our study reached similar conclusions regarding the number of stents placed. However, we did not find a significant difference between the complication rates, specifically peri- and postprocedural bleeding or perforation, between the 2 study groups, as demonstrated in prior papers

Proton pump inhibitors increase the severity of hepatic encephalopathy in cirrhotic patients

BACKGROUND: Liver cirrhosis is the late stage of hepatic fibrosis and is characterized by portal hypertension that can clinically lead to decompensation in the form of ascites, esophageal/gastric varices or encephalopathy. The most common sequelae associated with liver cirrhosis are neurologic and neuropsychiatric impairments labeled as hepatic encephalopathy (HE). Well established triggers for HE include infection, gastrointestinal bleeding, constipation, and medications. Alterations to the gut microbiome is one of the leading ammonia producers in the body, and therefore may make patients more susceptible to HE. AIM: To investigate the relationship between the use of proton pump inhibitors (PPIs) and HE in patients with cirrhosis. METHODS: This is a single center, retrospective analysis. Patients were included in the study with an admitting diagnosis of HE. The degree of HE was determined from subjective and objective portions of hospital admission notes using the West Haven Criteria. The primary outcome of the study was to evaluate the grade of HE in PPI users versus non-users at admission to the hospital and throughout their hospital course. Secondary outcomes included rate of infection, gastrointestinal bleeding within the last 12 mo, mean ammonia level, and model for end-stage liver disease scores at admission. RESULTS: The HE grade at admission using the West Haven Criteria was 2.3 in the PPI group compared to 1.7 in the PPI nonuser group (P = 0.001). The average length of hospital stay in PPI group was 8.3 d compared to 6.5 d in PPI nonusers (P = 0.046). Twenty-seven (31.8%) patients in the PPI user group required an Intensive Care Unit admission during their hospital course compared to 6 in the PPI nonuser group (16.7%) (P = 0.138). Finally, 10 (11.8%) patients in the PPI group expired during their hospital stay compared to 1 in the PPI nonuser group (2.8%) (P = 0.220). CONCLUSION: Chronic PPI use in cirrhotic patients is associated with significantly higher average West Haven Criteria for HE compared to patients that do not use PPIs

The Maunder minimum and the Little Ice Age: an update from recent reconstructions and climate simulations

The Maunder minimum (MM) was a period of extremely low solar activity from approximately AD 1650 to 1715. In the solar physics literature, the MM is sometimes associated with a period of cooler global temperatures, referred to as the Little Ice Age (LIA), and thus taken as compelling evidence of a large, direct solar influence on climate. In this study, we bring together existing simulation and observational studies, particularly the most recent solar activity and paleoclimate reconstructions, to examine this relation. Using northern hemisphere surface air temperature reconstructions, the LIA can be most readily defined as an approximately 480 year period spanning AD 1440–1920, although not all of this period was notably cold. While the MM occurred within the much longer LIA period, the timing of the features are not suggestive of causation and should not, in isolation, be used as evidence of significant solar forcing of climate. Climate model simulations suggest multiple factors, particularly volcanic activity, were crucial for causing the cooler temperatures in the northern hemisphere during the LIA. A reduction in total solar irradiance likely contributed to the LIA at a level comparable to changing land use

Seasonal Variations and Trends in Hospitalization for Peptic Ulcer Disease in the United States: A 12-Year Analysis of the Nationwide Inpatient Sample

BACKGROUND: Peptic ulcer disease (PUD) is a major public health burden significantly impacting the cost of hospitalization in the United States (US). We examined the trends, characteristics, complications, cost, and seasonality of PUD-related hospitalizations from 2000 to 2011. METHODS: With the use of the Nationwide Inpatient Sample from 2000 through 2011, we identified PUD-related hospitalizations using the International Classification of Diseases (ICD-9), 9th Revision, and the Clinical Modification code 531.00 to 534.91 as the principal discharge diagnosis. The total number of hospitalizations for each calendar month of the year were added over a 12-year period, and this number was divided by the number of days in that particular month to obtain the mean hospitalizations per day for each month. RESULTS: The study found that 351,921 hospitalizations with the primary discharge diagnosis of peptic ulcer disease (PUD) occurred in the US between 2000 and 2011. This number dropped significantly from 49,524 to 17,499 between 2000 and 2011, and the rate of PUD-related mortality decreased from 4.3% to 3.1%. The mean age of the study population was 66.2 +/- 17.4 years; 52.3% were males, and 56.8% were white. The number of hospitalizations in the US peaked in the spring season (916/day), and reached a nadir in the fall season (861/day). The mean cost of PUD hospitalization increased significantly from $11,755 in 2001 to$13,803 in 2011 (relative increase of 17%; p \u3c 0.001). CONCLUSION: The incidence of PUD and its mortality has decreased significantly in the last decade, but its economic burden on the healthcare system remains high. A seasonal pattern of PUD hospitalization showed a peak in PUD-related admissions in the spring season and a trough in the fall season

CESM1(WACCM) Stratospheric Aerosol Geoengineering Large Ensemble Project

This paper describes the Stratospheric Aerosol Geoengineering Large Ensemble (GLENS) project, which promotes the use of a unique model dataset, performed with the Community Earth System Model, with the Whole Atmosphere Community Climate Model as its atmospheric component [CESM1(WACCM)], to investigate global and regional impacts of geoengineering. The performed simulations were designed to achieve multiple simultaneous climate goals, by strategically placing sulfur injections at four different locations in the stratosphere, unlike many earlier studies that targeted globally averaged surface temperature by placing injections in regions at or around the equator. This advanced approach reduces some of the previously found adverse effects of stratospheric aerosol geoengineering, including uneven cooling between the poles and the equator and shifts in tropical precipitation. The 20-member ensemble increases the ability to distinguish between forced changes and changes due to climate variability in global and regional climate variables in the coupled atmosphere, land, sea ice, and ocean system. We invite the broader community to perform in-depth analyses of climate-related impacts and to identify processes that lead to changes in the climate system as the result of a strategic application of stratospheric aerosol geoengineering