Etiopathogenesis of type 1 diabetes mellitus: prognostic factors for the evolution of residual β cell function

Type 1A diabetes mellitus (T1ADM) is a progressive autoimmune disease mediated by T lymphocytes with destruction of beta cells. Up to now, we do not have precise methods to assess the beta cell mass, "in vivo" or "ex-vivo". The studies about its genetic susceptibility show strong association with class II antigens of the HLA system (particularly DQ). Others genetics associations are weaker and depend on the population studied. A combination of precipitating events may occur at the beginning of the disease. There is a silent loss of immune-mediated beta cells mass which velocity has an inverse relation with the age, but it is influenced by genetic and metabolic factors. We can predict the development of the disease primarily through the determination of four biochemically islet auto antibodies against antigens like insulin, GAD65, IA2 and Znt8. Beta cell destruction is chronically progressive but at clinical diagnosis of the disease a reserve of these cells still functioning. The goal of secondary disease prevention is halt the autoimmune attack on beta cells by redirecting or dampening the immune system. It is remains one of the foremost therapeutic goals in the T1ADM. Glycemic intensive control and immunotherapeutic agents may preserve beta-cell function in newly diagnosed patients with T1ADM. It may be assessed through C-peptide values, which are important for glycemic stability and for the prevention of chronic complications of this disease. This article will summarize the etiopathogenesis mechanisms of this disease and the factors can influence on residual C-peptide and the strategies to it preservation

Disentangling the complexity of groundwater dependent social-ecological systems

Groundwater resources are part of larger social-ecological systems. In this chapter, we review the various dimensions of these complex systems in order to uncover the diversity of elements at stake in the evolution of an aquifer and the loci for possible actions to control its dynamics. Two case studies illustrate how the state of an aquifer is embedded in a web of biophysical and sociopolitical processes. We propose here a holistic view through an IGM-scape that describes the various possible pathways of evolution for a groundwater related social-ecological system. Then we describe the elements of this IGM-scape starting with physical entities and processes, including relations with surface water and quality issues. Interactions with society bring an additional layer of considerations, including decisions on groundwater abstraction, land use changes and even energy related choices. Finally we point out the policy levers for groundwater management and their possible consequences for an aquifer, taking into account the complexity of pathways opened by these levers

Rapid characterisation of vegetation structure to predict refugia and climate change impacts across a global biodiversity hotspot

Identification of refugia is an increasingly important adaptation strategy in conservation planning under rapid anthropogenic climate change. Granite outcrops (GOs) provide extraordinary diversity, including a wide range of taxa, vegetation types and habitats in the Southwest Australian Floristic Region (SWAFR). However, poor characterization of GOs limits the capacity of conservation planning for refugia under climate change. A novel means for the rapid identification of potential refugia is presented, based on the assessment of local-scale environment and vegetation structure in a wider region. This approach was tested on GOs across the SWAFR. Airborne discrete return Light Detection And Ranging (LiDAR) data and Red Green and Blue (RGB) imagery were acquired. Vertical vegetation profiles were used to derive 54 structural classes. Structural vegetation types were described in three areas for supervised classification of a further 13 GOs across the region.Habitat descriptions based on 494 vegetation plots on and around these GOs were used to quantify relationships between environmental variables, ground cover and canopy height. The vegetation surrounding GOs is strongly related to structural vegetation types (Kappa = 0.8) and to its spatial context. Water gaining sites around GOs are characterized by taller and denser vegetation in all areas. The strong relationship between rainfall, soil-depth, and vegetation structure (R2 of 0.8–0.9) allowed comparisons of vegetation structure between current and future climate. Significant shifts in vegetation structural types were predicted and mapped for future climates. Water gaining areas below granite outcrops were identified as important putative refugia. A reduction in rainfall may be offset by the occurrence of deeper soil elsewhere on the outcrop. However, climate change interactions with fire and water table declines may render our conclusions conservative. The LiDAR-based mapping approach presented enables the integration of site-based biotic assessment with structural vegetation types for the rapid delineation and prioritization of key refugia

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

The value of wetlands for water quality improvement: an example from the St. Johns River watershed, Florida

Wetlands provide many valuable ecosystem functions such as sediment and nutrient retention, high biological productivity and biodiversity, flood control, and opportunities to recreate. Despite their importance, estimating the value of wetlands is difficult as the worth of these functions and services is not easily quantified. The overall objective of this study was to estimate the value of freshwater wetlands in the Saint Johns River (SJR) watershed, Florida based on their ability to remove nutrients, namely nitrogen (N) and phosphorus (P). We used a combination of literature review, geospatial analysis of land cover, and regression analysis to determine the total wetland area in the SJR watershed and the rates of nitrogen and phosphorus burial in the wetlands. We then estimated the economic value of these wetlands based on the replacement cost of nutrient removal by wastewater treatment plants. Nitrogen burial rates ranged from 27 g/m2/year to a background rate of 6.56 g/m2/year, and phosphorus burial rates range from 1.31 g/m2/year to a background of 0.11 g/m2/year. Using these rates, we calculate wetlands of the SJR catchment remove 79,873 MT of nitrogen annually just from burial in the soil, with a replacement cost of between $240 million to$150 billion per year. The amount of phosphorus buried yearly is more than 2400 MT with an annual replacement cost of $17 to$497 million. Though they are based on limited data and include a variety of watershed-scale research limitations, these findings highlight the significant potential value of conserving functional wetlands based solely on their nutrient retention functions. If we were to consider the benefits associated with other wetland functions such as flood control, biological productivity, and biodiversity in addition to their ability to retain nutrients, the value of the SJR wetlands would be even greater

Spatial and seasonal variability of polygonal tundra water balance: Lena River Delta, northern Siberia (Russia)

The summer water balance of a typical Siberian polygonal tundra catchment is investigated in order to identify the spatial and temporal dynamics of its main hydrological processes. The results show that, besides precipitation and evapotranspiration, lateral flow considerably influences the site-specific hydrological conditions. The prominent microtopography of the polygonal tundra strongly controls lateral flow and storage behaviour of the investigated catchment. Intact rims of low-centred polygons build hydrological barriers, which release storage water later in summer than polygons with degraded rims and troughs above degraded ice wedges. The barrier function of rims is strongly controlled by soil thaw, which opens new subsurface flow paths and increases subsurface hydrological connectivity. Therefore, soil thaw dynamics determine the magnitude and timing of subsurface outflow and the redistribution of storage within the catchment. Hydraulic conductivities in the elevated polygonal rims sharply decrease with the transition from organic to mineral layers. This interface causes a rapid shallow subsurface drainage of rainwater towards the depressed polygon centres and troughs. The re-release of storage water from the centres through deeper and less conductive layers helps maintain a high water table in the surface drainage network of troughs throughout the summer