Combined cerebellar and bilateral cervical posterior spinal artery stroke demonstrated on MRI

Combined cerebellar and spinal ischemic stroke is a rare, critical condition. We report a patient with combined cerebellar and bilateral posterolateral cervical spinal cord infarction due to bilateral stenosis of the vertebral arteries. MRI is the method of choice for imaging this condition; diffusion-weighted imaging of the spinal cord gives reliable results

High-sensitivity cardiac troponin T and copeptin assays to improve diagnostic accuracy of exercise stress test in patients with suspected coronary artery disease

Background: The average diagnostic sensitivity of exercise stress tests (ESTs) is lower than that of other non-invasive cardiac stress tests. The aim of the study was to examine whether high-sensitivity cardiac troponin T (hs-cTnT) or copeptin concentrations rise in response to inducible myocardial ischaemia and may improve the diagnostic accuracy of ESTs. Methods and results: An EST was performed stepwise on a bicycle ergometer by 383 consecutive patients with suspected or progression of coronary artery disease (CAD). In addition venous blood samples for measurement of hs-cTnT and copeptin were collected prior to EST, at peak exercise, and 4 h after EST. Coronary angiography was assessed for all patients. Patients with significant CAD (n=224) were more likely to be male and older compared to patients with non-significant CAD (n=169). Positive EST was documented in 125 (55.8%) patients with significant CAD and in 69 (43.4%) patients with non-significant CAD. Copeptin and hs-cTnT concentrations at baseline were higher in patients with significant CAD (copeptin: 10.8 pmol/l (interquartile range (IQR) 8.1–15.6) vs 9.4 pmol/l (IQR 7.1–13.9); p=0.04; hs-cTnT: 3.0 ng/l (IQR <3.0–5.4) vs <3.0 ng/l (IQR <3.0); p=0.006). Hs-cTnT improved sensitivity (61.6% vs 55.8%), specificity (67.7% vs 56.6%) and the positive predictive value (PPV) (72.3% vs 64.4%) and negative (55.2% vs 47.6%) predictive value (NPV) of EST. Copeptin could not improve sensitivity (55.4% vs 55.8%) and reduced specificity, PPV and NPV. Conclusions: The measurement of hs-cTnT during EST improves sensitivity, specificity, and positive and negative predictive values. In contrast, measurement of copeptin does not improve diagnostic sensitivity and reduces specificity

EMP and SIMS studies on Mn/Ca and Fe/Ca systematics in benthic foraminifera from the Peruvian OMZ: a contribution to the identification of potential redox proxies and the impact of cleaning protocols

In this study we present an initial dataset of Mn/Ca and Fe/Ca ratios in tests of benthic foraminifera from the Peruvian oxygen minimum zone (OMZ) determined with SIMS. These results are a contribution to a better understanding of the proxy potential of these elemental ratios for ambient redox conditions. Foraminiferal tests are often contaminated by diagenetic coatings, like Mn rich carbonate- or Fe and Mn rich (oxyhydr)oxide coatings. Thus, it is substantial to assure that the cleaning protocols are efficient or that spots chosen for microanalyses are free of contaminants. Prior to the determination of the element/Ca ratios, the distributions of several elements (Ca, Mn, Fe, Mg, Ba, Al, Si, P and S) in tests of the shallow infaunal species Uvigerina peregrina and Bolivina spissa were mapped with an electron microprobe (EMP). To visualize the effects of cleaning protocols uncleaned and cleaned specimens were compared. The cleaning protocol included an oxidative cleaning step. An Fe rich phase was found on the inner test surface of uncleaned U. peregrina specimens. This phase was also enriched in Al, Si, P and S. A similar Fe rich phase was found at the inner test surface of B. spissa. Specimens of both species treated with oxidative cleaning show the absence of this phase. Neither in B. spissa nor in U. peregrina were any hints found for diagenetic (oxyhydr)oxide or carbonate coatings. Mn/Ca and Fe/Ca ratios of single specimens of B. spissa from different locations have been determined by secondary ion mass spectrometry (SIMS). Bulk analyses using solution ICP-MS of several samples were compared to the SIMS data. The difference between SIMS analyses and ICP-MS bulk analyses from the same sampling sites was 14.0–134.8 μmol mol−1 for the Fe/Ca and 1.68(±0.41) μmol mol−1 for the Mn/Ca ratios. This is in the same order of magnitude as the variability inside single specimens determined with SIMS at these sampling sites (1σ[Mn/Ca] = 0.35–2.07 μmol mol−1; 1σ[Fe/Ca] = 93.9–188.4 μmol mol−1). The Mn/Ca ratios in the calcite were generally relatively low (2.21–9.93 μmol mol−1) but in the same magnitude and proportional to the surrounding pore waters (1.37–6.67 μmol mol−1). However, the Fe/Ca ratios in B. spissa show a negative correlation to the concentrations in the surrounding pore waters. Lowest foraminiferal Fe/Ca ratios (87.0–101.0 μmol mol−1) were found at 465 m water depth, a location with a strong sharp Fe peak in the pore water next to the sediment surface and respectively, high Fe concentrations in the surrounding pore waters. Previous studies found no living specimens of B. spissa at this location. All these facts hint that the analysed specimens already were dead before the Fe flux started and the sampling site just recently turned anoxic due to fluctuations of the lower boundary of the OMZ near the sampling site (465 m water depth). Summarized Mn/Ca and Fe/Ca ratios are potential proxies for redox conditions, if cleaning protocols are carefully applied. The data presented here may be rated as base for the still pending detailed calibration

The effect of long-term and decadal climate and hydrology variations on estuarine marsh dynamics: An identifying case study from the Río de la Plata

The vertical growth of coastal wetlands is known to primarily be controlled by local tidal range and sediment availability as well as the occurrence of storm events. In estuaries, sediment availability additionally depends on riverine sediment input, the effect of which may be more pronounced in some parts of the estuary, thereby introducing a distinct spatial pattern that depends on the estuary's shape as well as the riverine sediment input and the hydro-meteorological regime. In the present study, we investigate how estuarine marshes along the whole Río de la Plata (RdlP) are affected by decadal and long-term variations in river discharge and storm activity. The El Niño Southern Oscillation (ENSO), in this context, appears to introduce a pronounced decadal variability on sediment loads brought into the RdlP. Based on 15 sediment cores, recovered along the RdlP and adjacent Atlantic coast, vertical marsh growth rates were studied using radionuclide dating (210Pb and 137Cs) and grain size distributions. By comparing these sedimentological records with historic river discharge and storm surge data, we spatially interpret the relative importance of temporal variations in river discharge and storm activity on estuarine marsh growth. By delivering the first estimates for vertical growth rates of the RdlP marshes, we conclude that with average vertical marsh growth rates between 0.4 and 2.6 cm year− 1, the RdlP marshes are highly resilient against drowning under present and future sea-level rise (SLR) conditions. Furthermore, our results confirm a large spatial variability of the drivers for vertical marsh growth; extreme storm surges appear to play a role in the development of the outer RdlP marshes whereas the temporal variations in river discharge seem to be hierarchically more important for the marshes in the inner estuary.This project was financially supported by a grant of the Cluster of Excellence 80 ‘The Future Ocean’ to Mark Schuerch (grant CP1211). ‘The Future Ocean’ is funded within the framework of the Excellence Initiative by the ‘Deutsche Forschungsgemeinschaft’ (DFG) on behalf of the German federal and state governments (EXC 80). Felipe García-Rodríguez acknowledges ‘Agencia Nacional de Investigación e Innovación’ (ANII) and PEDECIBA. Jan Scholten acknowledges the support provided by the FP7 EU Marie Curie Career Integration Grant (grant PCIG09-GA-2011-293499).This is the author accepted manuscript. The final version is available from Elsevier at http://dx.doi.org/10.1016/j.geomorph.2016.06.029

Benthic fluxes of trace metals in the Chukchi Sea and their transport into the Arctic Ocean

Highlights • Frequent sediment resuspension may have buffered D-Fe released from shelf sediments. • 228Ra was used to estimate trace element fluxes from the Chukchi shelf sediments. • The estimated sediment 228Ra flux ranks among the highest reported globally. • About 10–25% of the Chukchi shelf sediment Fe flux is exported to the Arctic Ocean. The Chukchi Sea is a primary site for shelf-ocean exchange in the Arctic region and modifies Pacific-sourced water masses as they transit via the Bering Strait into the Arctic Ocean. The aim of this study was to use radium and trace metal distributions to improve our understanding of biogeochemical cycles in the Bering and Chukchi Seas, and evaluate their potential response to future changes in the Arctic. We investigated the distributions of dissolved and total dissolvable trace metals (Cd, Fe, Ni, Cu, Zn, Mn, Co, and Pb) in the Bering and Chukchi Seas during spring. In addition, the long-lived radium isotopes (226Ra and 228Ra) were measured as tracers of benthic trace metal inputs. Trace metal concentrations, especially Fe and Mn, were highly elevated in Chukchi shelf waters compared with the open Arctic Ocean and Bering Strait. Trace metal, nutrient, and Ra patterns suggested that Fe, Mn, and Co concentrations were predominantly controlled by reductive benthic inputs, whereas the other trace metals were influenced by biological uptake and release processes. We propose that Fe, Mn, and Co in the Chukchi Sea are supplied from shelf sediments during winter overturning, and we combine the 228Ra fluxes with the distributions of Fe, Mn, and Co to provide a first estimate of their benthic fluxes in the region. The average benthic flux of 228Ra was 1.49 × 108 atoms m−2 d−1, which is among the highest rates reported globally. Estimated dissolved Fe (D-Fe) flux from the sediments was 2.5 μmol m−2 d−1, whereas D-Mn and D-Co fluxes were 8.0 μmol m−2 d−1 and 0.2 μmol m−2 d−1, respectively. The off-shelf transport of D-Fe to the Arctic Ocean is estimated to be about 10–25% of the benthic Fe flux, with the remainder retained on the shelf due to scavenging and/or phytoplankton uptake. Our results highlight the importance of the Chukchi Sea as a major source of the micro-nutrients to the Arctic Ocean, thereby supporting primary production. Long-term changes in factors that affect cross-shelf mixing, such as the observed reduction in ice cover, may therefore enhance shelf nutrient inputs and primary productivity in the Arctic

Valvulotomy of the great saphenous vein in ex situ non-reversed and in situ setting: a multicenter post-market study to assess the safety and efficacy of the AndraValvulotome™”

Purpose To evaluate the safety and technical success of the AndraValvulotome™ device (Andramed GmbH, Reutlingen, Germany) in patients with peripheral arterial disease (PAD) requiring bypass surgery using the great saphenous vein (GSV) as graft. Methods This was a multicenter, post-market observational study conducted in 2021 in 11 German centers. Safety and efficacy data were prospectively collected and analyzed. Primary endpoints were the absence of device-related serious adverse events until 30 ± 7 days follow-up, the clinical efficacy of valvulotomy, which was defined as pulsatile blood flow in the bypass and the number of insufficiently destroyed vein valves. Secondary endpoints were the number of valvulotomy passages, the primary patency rate of the venous bypass (determined by a color-duplex sonography showing a normal blood flow through the bypass and absence of stenosis or occlusion), and the primary technical success defined as the absence of product-specific (serious) adverse events and clinical efficacy. Results Fifty-nine patients were enrolled. The mean age of the patients was 71 years (46–91), and 74.6% were males. The vein material used for bypass grafting had a median length of 47.5 cm (range 20–70 cm) with a median diameter of 5.0 mm (range 3–6 mm) and 4.0 mm (range 2–6 mm) in the proximal and distal segments, respectively. The technical success rate was 96.6%. The primary patency rate was 89.9% at 30 days follow-up. The clinical efficacy was rated as very good in 81% of patients, fair in 17%, and poor in 2%. Between 1 and 5 (average 2.9) valvulotome passages were performed. One product-related serious adverse event was recorded (bypass vein dissection). Conclusion The AndraValvulotome™ can be considered a safe and effective device to disrupt venous valves during in situ non-reversed bypass surgeries using GSV grafts in patients with PAD