Inducing Water Productivity from Snow Cover for Sustainable Water Management in Ibrahim River Basin, Lebanon

International audienceThe aim of this paper is to explore the effects and linkages between snow cover areas, distribution, probability and measured water discharge along east Mediterranean coastal watershed using moderate-resolution satellite images (MODIS-Terra). The Nahr Ibrahim River is a typical Lebanese watershed with an area of 326 km2 stretching between the sea and mountainous terrain to the east. The largest snow cover often exists in January-February with snow-free conditions between June and November. Image analysis enabled to analyze the temporal variability of the mean and maximum monthly areas of snow cover between 2000 and 2013. Snow cover dynamics were compared with the discharge from main springs (Afqa and Rouaiss) feeding the river and the probability of snow cover was estimated. The mean monthly snow cover, snow melting rates and springs discharge were found to be in direct relationship. In addition, the measured water discharge at the river mouth was found to be higher than the discharge of the two main feeding springs. This indicates a contribution of groundwater to the stream flow, which is again in direct connection with snow melting at the upper bordering slopes and probably from neighboring watersheds. Considering the characteristics of the mountainous rocks (i.e. Sinkholes, fissured and karstified limestone), the pedo-climatic and land cover conditions affect the hydrological regime which is directly responding to the area and temporal distribution of snow cover, which appears after two months from snowing events. This is reflected on water productivity and related disciplines (Agricultural yield, floods). This study highlights the potential of satellite snow detection over the watershed to estimate snow cover duration curve, forecast the stream flow regime and volume for better water management and flood risk preparedness

Metformin therapy effects on the expression of sodium-glucose cotransporter 2, leptin, and sirt6 levels in pericoronary fat excised from pre-diabetic patients with acute myocardial infarction

Background and purpose: pericoronary fat over-inflammation might lead to the development and destabilization of coronary plaque in patients with pre-diabetes (PDM). Notably, pericoronary fat could over-express the sodium-glucose cotransporter 2 (SGLT2) and leptin, along with decreased sirtuin 6 (SIRT6) expression in PDM vs. normoglycemic (NG) patients undergoing coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI). However, in the current study, we evaluated inflammatory markers, SGLT2, SIRT6, and leptin levels in pericoronary fat and, subsequently, 12-month prognosis comparing PDM to NG subjected to CABG for AMI. In addition, we evaluated in PDM patients the effects of metformin therapy on SIRT6 expression, leptin, and SGLT2 levels, and assessed its beneficial effect on nitrotyrosine and inflammatory cytokine levels. Methods: we studied AMI patients referred for CABG, divided into PDM and NG-patients. PDM patients were divided into never-metformin users and metformin users. Finally, we evaluated major adverse cardiac events (MACE) at a 12-month follow-up. Results: the MACE was 9.1% in all PDM and 3% in NG patients (p < 0.05). Metformin users presented a significantly lower MACE rate in PDM than never-metformin users (p < 0.05). PDM showed higher inflammatory cytokines, 3-nitrotyrosine levels, SGLT2, and leptin content, and decreased SIRT6 protein levels in pericoronary fat compared to NG-patients (p < 0.05). PDM never-metformin-users showed higher SGLT2 and leptin levels in pericoronary fat than current-metformin-users (p < 0.05). Conclusions: metformin therapy might ameliorate cardiovascular outcomes by reducing inflammatory parameters, SGLT2, and leptin levels, and finally improving SIRT6 levels in AMI-PDM patients treated with CABG

The Ubiquitin-Proteasome System and Inflammatory Activity in Diabetic Atherosclerotic Plaques

The role of ubiquitin-proteasome system in the accelerated atherosclerotic progression of diabetic patients is unclear. We evaluated ubiquitin-proteasome activity in carotid plaques of asymptomatic diabetic and nondiabetic patients, as well as the effect of rosiglitazone, a peroxisome proliferator–activated receptor (PPAR)-γ activator, in diabetic plaques. Plaques were obtained from 46 type 2 diabetic and 30 nondiabetic patients undergoing carotid endarterectomy. Diabetic patients received 8 mg rosiglitazone (n = 23) or placebo (n = 23) for 4 months before scheduled endarterectomy. Plaques were analyzed for macrophages (CD68), T-cells (CD3), inflammatory cells (HLA-DR), ubiquitin, proteasome 20S activity, nuclear factor (NF)-κB, inhibitor of κB (IκB)-β, tumor necrosis factor (TNF)-α, nitrotyrosine, matrix metalloproteinase (MMP)-9, and collagen content (immunohistochemistry and enzyme-linked immunosorbent assay). Compared with nondiabetic plaques, diabetic plaques had more macrophages, T-cells, and HLA-DR+ cells (P &lt; 0.001); more ubiquitin, proteasome 20S activity (TNF-α), and NF-κB (P &lt; 0.001); and more markers of oxidative stress (nitrotyrosine and O2− production) and MMP-9 (P &lt; 0.01), along with a lesser collagen content and IκB-β levels (P &lt; 0.001). Compared with placebo-treated plaques, rosiglitazone-treated diabetic plaques presented less inflammatory cells (P &lt; 0.01); less ubiquitin, proteasome 20S, TNF-α, and NF-κB (P &lt; 0.01); less nitrotyrosine and superoxide anion production (P &lt; 0.01); and greater collagen content (P &lt; 0.01), indicating a more stable plaque phenotype. Similar findings were obtained in circulating monocytes obtained from the two groups of diabetic patients and cultured in the presence or absence of rosiglitazone (7.0 μmol/l). Ubiquitin-proteasome over-activity is associated with enhanced inflammatory reaction and NF-κB expression in diabetic plaques. The inhibition of ubiquitin-proteasome activity in atherosclerotic lesions of diabetic patients by rosiglitazone is associated with morphological and compositional characteristics of a potential stable plaque phenotype, possibly by downregulating NF-κB-mediated inflammatory pathways

ANMCO/AIAC/SICI-GISE/SIC/SICCH Consensus Document : percutaneous occlusion of the left atrial appendage in non-valvular atrial fibrillation patients: Indications, patient selection, staff skills, organisation, and training

Atrial fibrillation (AF) is the most common arrhythmia and its prevalence is increasing due to the progressive aging of the population. About 20% of strokes are attributable to AF and AF patients are at five-fold increased risk of stroke. The mainstay of treatment of AF is the prevention of thromboembolic complications with oral anticoagulation therapy. Drug treatment for many years has been based on the use of vitamin K antagonists, but recently newer and safer molecules have been introduced (dabigatran etexilate, rivaroxaban, apixaban, and edoxaban). Despite these advances, many patients still do not receive adequate anticoagulation therapy because of contraindications (relative and absolute) to this treatment. Over the last decade, percutaneous closure of left atrial appendage, main site of thrombus formation during AF, proved effective in reducing thromboembolic complications, thus offering a valid medical treatment especially in patients at increased bleeding risk. The aim of this consensus document is to review the main aspects of left atrial appendage occlusion (selection and multidisciplinary assessment of patients, currently available methods and devices, requirements for centres and operators, associated therapies and follow-up modalities) having as a ground the significant evolution of techniques and the available relevant clinical data

Transcatheter aortic valve therapy is not aortic valve replacement

I read with interest the increasing number of scientific articles involving transcatheter aortic valve replacement. The meaning of the term “replacement” is to substitute something with something else. Yet, at present, the only way to substitute a stenotic aortic valve is to take away the calcific or fibrotic tissue and put in a new prosthetic valve, which is a surgical (traditional or minimally invasive) approach. I believe this is not merely a semantic question. As a matter of fact, the presence of the native valve left in situ could be one of the major potential issues affecting the outcome of the transcatheter procedures: peri-procedural risk of stroke and perivalvular leak or infection could be highly related to this aspect. For these reasons, I believe that the transcatheter procedure could be defined as “implant, insertion, overlapping or therapy,” but not as aortic valve replacement

The Controversial Role of Glucose-6-Phosphate Dehydrogenase Deficiency on Cardiovascular Disease: A Narrative Review

Cardiovascular disorders (CVD) are highly prevalent and the leading cause of death worldwide. Atherosclerosis is responsible for most cases of CVD. The plaque formation and subsequent thrombosis in atherosclerosis constitute an ongoing process that is influenced by numerous risk factors such as hypertension, diabetes, dyslipidemia, obesity, smoking, inflammation, and sedentary lifestyle. Among the various risk and protective factors, the role of glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common inborn enzyme disorder across populations, is still debated. For decades, it has been considered a protective factor against the development of CVD. However, in the recent years, growing scientific evidence has suggested that this inherited condition may act as a CVD risk factor. The role of G6PD deficiency in the atherogenic process has been investigated using in vitro or ex vivo cellular models, animal models, and epidemiological studies in human cohorts of variable size and across different ethnic groups, with conflicting results. In this review, the impact of G6PD deficiency on CVD was critically reconsidered, taking into account the most recent acquisitions on molecular and biochemical mechanisms, namely, antioxidative mechanisms, glutathione recycling, and nitric oxide production, as well as their mutual interactions, which may be impaired by the enzyme defect in the context of the pentose phosphate pathway. Overall, current evidence supports the notion that G6PD downregulation may favor the onset and evolution of atheroma in subjects at risk of CVD. Given the relatively high frequency of this enzyme deficiency in several regions of the world, this finding might be of practical importance to tailor surveillance guidelines and facilitate risk stratification

Monitoring the Drainage Efficiency of Infiltration Trenches in Fractured and Karstified Limestone via Time-Lapse Hydrogeophysical Approach

In the test site of Castellana Grotte (Southern Italy), since 2016, around 2300 m3d&minus;1 of tertiary treated wastewater has been alternatively spread in nine infiltration trenches, dug into fractured and karstified limestone. In one of these trenches, located upstream, seasonal variations in the infiltration rate were observed, with a lower infiltration rate during summer than in winter. This effect could be due to the occurrence of a bioclogging phenomenon in the warm season. In addition, time-lapse electrical resistivity tomography (ERT) was carried out in two different periods, corresponding to the wet and dry seasons, in order to investigate the infiltration process dynamics below the bottom of the trench. Remarkable variability was observed between the south and north sides of the trench&mdash;clearly related to the local-scale heterogeneity of the rock formation of the trenches. The results suggest that such an integrated approach should be considered of great interest in case of using infiltration trenches as managed aquifer recharge (MAR) plants. This methodology could provide useful information about the heterogeneities of the rock formation, supporting an alert system for the identification of clogging effects during the life cycle of the plant