Mountain glaciers of NE Asia in the near future: a projection based on climate-glacier systems' interaction

International audienceIn this study we consider contrasting continental (Orulgan, Suntar-Khayata and Chersky ranges located in the Pole of Cold area at the contact of Atlantic and Pacific influences) and maritime (Kamchatka under the Pacific influence) Russian glacier systems. Our purpose is to present a simple method for the projection of change of the main parameters of these glacier systems with climate change. To achieve this aim, we constructed vertical profiles of mass balance (accumulation and ablation) based both on meteorological observations for the mid to late 20th century and an ECHAM4 GCM scenario for 2040?2069. The observations and scenario were used for defining the recent and future equilibrium line altitude (ELA) for each glacier system. The altitudinal distributions of the areas covered with glacier ice were determined for present and future states of the glacier systems, taking into account the correlation of the change of the ELA and glacier-termini levels. We also give estimates of the possible changes of the areas and morphological structure of North-eastern Asia glacier systems and their mass balance characteristics from the ECHAM4 scenario. Finally, we compare characteristics of the continental and maritime glacier systems stability under conditions of global warming

Natriuresis as a Way to Assess the Effectiveness of Diuretic Therapy for Acute Decompensated Heart Failure: Data from a Pilot Study

Aim. To analyze the clinical significance of the sodium level in a single urine test obtained 2 hours after the first dose of a loop diuretic was administered in patients with acute decompensation of chronic heart failure (ADHF).Material and methods. An observational study was conducted on the basis of a rapid-care hospital. The concentration of sodium in urine analysis obtained 2 hours after intravenous administration of the first dose of loop diuretic and natriuresis for the first day of hospitalization were evaluated. The development of resistance to diuretics was taken as the primary endpoint (the need to increase the daily dose of furosemide by more than 2 times compared to the initial one or the addition of another class of diuretic drugs).Results. 25 patients with ADHF were included. The average age of patients was 69.0±14.8 years, 16 (64%) of them were men. The average left ventricular ejection fraction was 49.0±13.5%. The level of the N‐terminal fragment of the brain natriuretic peptide (NT-proBNP) was 3416 (2128; 5781) pg/ml. The average sodium concentration in the urine analysis obtained 2 hours after the start of treatment was 100.6±41.0 mmol / l. The concentration of sodium in urine for the first day was 102.2±39.0 mmol/l. 2 hours after the start of treatment, the sodium concentration in a single urine test was less than 50 mmol/l in 5 (20%) patients. Upon further observation, oligoanuria (defined as diuresis of less than 400 ml within 24 hours) developed in 2 of them. Oligoanuria was not detected among patients whose sodium concentration was more than 50 mmol/l. The need for escalation (any increase in the dose of a loop diuretic and/or the addition of another class of diuretic drugs) arose in 7 (28%) patients; at the same time, we diagnosed the development of resistance to diuretics in 5 (20%) of them. Resistance to diuretics was more common among patients with a sodium concentration in a single urine test obtained 2 hours after the start of furosemide administration, less than 50 mmol/l (p=0.037); when dividing the recruited patient population into subgroups with a sodium concentration in a single urine test ≥50 mmol/l and <50 mmol/l there was no significant difference in the need for any escalation of diuretic therapy [3 (60%) vs 4 (20%), p=0.07].Conclusion. Resistance to diuretics is more common among patients with a sodium concentration in a single urine test obtained 2 hours after the first dose of furosemide, less than 50 mmol / l. Evaluation of natriuresis allows to identify insufficient effectiveness of diuretic therapy already at the beginning of treatment

The Northeast Asia mountain glaciers in the near future by AOGCM scenarios

We studied contrasting glacier systems in continental (Orulgan, Suntar-Khayata and Chersky) mountain ranges, located in the region of the lowest temperatures in the Northern Hemisphere at the boundary of Atlantic and Pacific influences – and maritime ones (Kamchatka Peninsula) – under Pacific influence. Our purpose is to present a simple projection method to assess the main parameters of these glacier regions under climate change. To achieve this, constructed vertical profiles of mass balance (accumulation and ablation) based both on meteorological data for the 1950–1990s (baseline period) and ECHAM4 for 2049–2060 (projected period) are used, the latter – as a climatic scenario. The observations and scenarios were used to define the recent and future equilibrium line altitude and glacier terminus altitude level for each glacier system as well as areas and balance components. The altitudinal distributions of ice areas were determined for present and future, and they were used for prediction of glacier extent versus altitude in the system taking into account the correlation between the ELA and glacier-terminus level change. We tested two hypotheses of ice distribution versus altitude in mountain (valley) glaciers – "linear" and "non-linear". The results are estimates of the possible changes of the areas and morphological structure of northeastern Asia glacier systems and their mass balance characteristics for 2049–2060. Glaciers in the southern parts of northeastern Siberia and those covering small ranges in Kamchatka will likely disappear under the ECHAM4 scenario; the best preservation of glaciers will be on the highest volcanic peaks of Kamchatka. Finally, we compare characteristics of the stability of continental and maritime glacier systems under global warming

Additional Features in the Treatment of Patients with Chronic Heart Failure. From EMPA-REG OUTCOME Study to EMPEROR-REDUCED Study. Resolution of the On-line Scientific Meeting of Moscow Experts

The results of the international multicenter study EMPEROR-REDUCED were reviewed the on-line scientific meeting of Moscow experts on October 30, 2020. Some proposals and recommendations for further study of the cardiovascular and renal effects of empagliflozin and its use in clinical practice in patients with chronic heart failure with reduced ejection fraction were accepted