Late Quaternary climatic changes in southern Chile, as recorded in a diatom sequence of Lago Puyehue (40 degrees 40 ' S)

A late Quaternary diatom stratigraphy of Lago Puyehue (40 degrees 40'S, 72 degrees 28'W) was examined in order to infer past limnological and climatic changes in the South-Chilean Lake District. The diatom assemblages were well preserved in a 1,122 cm long, C-14-dated sediment core spanning the last 17,900 years, and were in support of an early deglaciation of Lago Puyehue. The presence of a short cold spell in South Chile, equivalent to the Younger Dryas event in the Northern Hemisphere, the Antarctic Cold Reversal in Antarctica, or the Huelmo-Mascardi event in southern South America, was not clearly evidenced in the diatom data, although some climate instability may have occurred between 13,400 and 11,700 cal. yr. BP, and a relatively long period (between 16,850 and 12,810 cal. yr. BP) with low absolute abundances and biovolumes could be tentatively interpreted as a period of low rainfall and/or temperatures. An increase in the moisture supply to the lake was tentatively inferred at 12,810 cal. yr. BP. After 9,550 cal. yr. BP, inferred stronger and longer persisting summer stratification, may have been the result of the higher temperatures associated with an early-Holocene thermal optimum. The mid-Holocene appeared to be characterized by a decrease in precipitation, culminating around 5,000 cal. yr. BP, and rising again after 3,000 cal. yr. BP, likely associated with a previously documented lowered frequency and amplitude of El Nino events. An increase in precipitation during the late Holocene (3,000 cal. yr. BP-present) might have marked subsequent increased frequency of El Nino occurrences, leading to drier summers and slightly moister winters in the area

10-year stroke prevention after successful carotidendarterectomy for asymptomatic stenosis (ACST-1):a multicentre randomised trial

Backgroun: If carotid artery narrowing remains asymptomatic (ie, has caused no recent stroke or other neurological symptoms), successful carotid endarterectomy (CEA) reduces stroke incidence for some years. We assessed the longterm effects of successful CEA. Methods Between 1993 and 2003, 3120 asymptomatic patients from 126 centres in 30 countries were allocated equally, by blinded minimised randomisation, to immediate CEA (median delay 1 month, IQR 0·3–2·5) or to indefi nite deferral of any carotid procedure, and were followed up until death or for a median among survivors of 9 years (IQR 6–11). The primary outcomes were perioperative mortality and morbidity (death or stroke within 30 days) and non-perioperative stroke. Kaplan-Meier percentages and logrank p values are from intention-to-treat analyses. This study is registered, number ISRCTN26156392. Findings 1560 patients were allocated immediate CEA versus 1560 allocated deferral of any carotid procedure. The proportions operated on while still asymptomatic were 89·7% versus 4·8% at 1 year (and 92·1% vs 16·5% at 5 years). Perioperative risk of stroke or death within 30 days was 3·0% (95% CI 2·4–3·9; 26 non-disabling strokes plus 34 disabling or fatal perioperative events in 1979 CEAs). Excluding perioperative events and non-stroke mortality, stroke risks (immediate vs deferred CEA) were 4·1% versus 10·0% at 5 years (gain 5·9%, 95% CI 4·0–7·8) and 10·8% versus 16·9% at 10 years (gain 6·1%, 2·7–9·4); ratio of stroke incidence rates 0·54, 95% CI 0·43–0·68, p<0·0001. 62 versus 104 had a disabling or fatal stroke, and 37 versus 84 others had a non-disabling stroke. Combining perioperative events and strokes, net risks were 6·9% versus 10·9% at 5 years (gain 4·1%, 2·0–6·2) and 13·4% versus 17·9% at 10 years (gain 4·6%, 1·2–7·9). Medication was similar in both groups; throughout the study, most were on antithrombotic and antihypertensive therapy. Net benefi ts were signifi cant both for those on lipid-lowering therapy and for those not, and both for men and for women up to 75 years of age at entry (although not for older patients). Interpretation Successful CEA for asymptomatic patients younger than 75 years of age reduces 10-year stroke risks. Half this reduction is in disabling or fatal strokes. Net benefit in future patients will depend on their risks from unoperated carotid lesions (which will be reduced by medication), on future surgical risks (which might differ from those in trials), and on whether life expectancy exceeds 10 years