Peripheral Artery Disease Patients May Benefit More from Aggressive Secondary Prevention than Aneurysm Patients to Improve Survival

BACKGROUND AND AIMS: Although it has become clear that aneurysmal and occlusive arterial disease represent two distinct etiologic entities, it is still unknown whether the two vascular pathologies are prognostically different. We aim to assess the long-term vital prognosis of patients with abdominal aortic aneurysmal disease (AAA) or peripheral artery disease (PAD), focusing on possible differences in survival, prognostic risk profiles and causes of death. METHODS: Patients undergoing elective surgery for isolated AAA or PAD between 2003 and 2011 were retrospectively included. Differences in postoperative survival were determined using Kaplan-Meier and Cox regression analysis. Prognostic risk profiles were also established with Cox regression analysis. RESULTS: 429 and 338 patients were included in the AAA and PAD groups, respectively. AAA patients were older (71.7 vs. 63.3 years, p < 0.001), yet overall survival following surgery did not differ (HR: 1.16, 95% CI: 0.87-1.54). Neither was type of vascular disease associated with postoperative cardiovascular nor cancer-related death. However, in comparison with age- and gender-matched general populations, cardiovascular mortality was higher in PAD than AAA patients (48.3% vs. 17.3%). Survival of AAA and PAD patients was negatively affected by age, history of cancer and renal insufficiency. Additional determinants in the PAD group were diabetes and ischemic heart disease. CONCLUSIONS: Long-term survival after surgery for PAD and AAA is similar. However, overall life expectancy is significantly worse among PAD patients. The contribution of cardiovascular disease towards mortality in PAD patients warrants more aggressive secondary prevention to reduce cardiovascular mortality and improve longevity

Coronary Revascularization Induces a Shift From Cardiac Toward Noncardiac Mortality Without Improving Survival in Vascular Surgery Patient

OBJECTIVE: Although evidence has shown that ischemic heart disease (IHD) in vascular surgery patients has a negative impact on the prognosis after surgery, it is unclear whether directed treatment of IHD may influence cause-specific and overall mortality. The objective of this study was to determine the prognostic implication of coronary revascularization (CR) on overall and cause-specific mortality in vascular surgery patients. METHODS: Patients undergoing surgery for abdominal aortic aneurysm, carotid artery stenosis, or peripheral artery disease in a university hospital in The Netherlands between January 2003 and December 2011 were retrospectively included. Survival estimates were obtained by Kaplan-Meier and Cox regression analysis. RESULTS: A total of 1104 patients were included. Adjusted survival analyses showed that IHD significantly increased the risk of overall mortality (hazard ratio [HR], 1.50; 95% confidence interval, 1.21-1.87) and cardiovascular death (HR, 1.93; 95% confidence interval, 1.35-2.76). Compared with those without CR, patients previously undergoing CR had similar overall mortality (HR, 1.38 vs 1.62; P = .274) and cardiovascular mortality (HR, 1.83 vs 2.02; P = .656). Nonrevascularized IHD patients were more likely to die of IHD (6.9% vs 35.7%), whereas revascularized IHD patients more frequently died of cardiovascular causes unrelated to IHD (39.1% vs 64.3%; P = .018). CONCLUSIONS: This study confirms the significance of IHD for postoperative survival of vascular surgery patients. CR was associated with lower IHD-related death rates. However, it failed to provide an overall survival benefit because of an increased rate of cardiovascular mortality unrelated to IHD. Intensification of secondary prevention regimens may be required to prevent this shift toward non-IHD-related death and thereby improve life expectancy

Major and trace element geochemistry of El Chichón volcano-hydrothermal system (Chiapas, Mexico) in 2006-2007: implications for future geochemical monitoring

We report a detailed study of isotopic, major and trace element composition in the crater lake, Soap Pool and thermal springs at El Chichón volcano for the period November 2006-October 2007. After two decades of studying the crater lake, it is possible to confirm the complex relationship between the annual rainfall distribution and the crater lake volume and chemistry: during three years (2001, 2004 and 2007) a large volume high-Cl lake can be related to the reactivation of high discharge (>10 kg/s) of saline near-neutral water from the Soap Pool boiling springs towards the lake, only a few months (~January) after the end of the rainy season (June-October). The highest lake volume ever observed occurred in March 2007 (~6x105 m3). Despite the fact that the Agua Tibia 2 thermal springs discharge at the foot of the SW dome, their chemistry indicates a lower temperature regime, an enhanced water-rock interaction and basement contribution (evaporites and carbonates), and anhydrite leaching from the 1982 pyroclastic deposits, rather than dome activity. New suggestions on crater lake seepage are evidenced by the Agua Caliente thermal springs. Existing models on the “crater lake-Soap Pool spring” and the deep hydrothermal system are justified and detailed. We believe that chemical changes in the deep geothermal aquifer feeding the thermal springs will anticipate dome rise. Future volcanic surveillance should focus on the changes in spring chemistry, besides crater lake monitoring

Major and trace element geochemistry of El Chichón volcano-hydrothermal system (Chiapas, México) in 2006-2007: implications for future geochemical monitoring

Isotopic, major and trace element composition studies for the crater lake, the Soap Pool and thermal springs at El Chichón volcano in November 2006-October 2007 confirm the complex relationship between annual rainfall distribution and crater lake volume and chemistry. In 2001, 2004 and 2007 high volume high-Cl lake may be related to reactivation of high discharge (>10 kg/s) saline near-neutral water from the Soap Pool boiling springs into the lake, a few months (~January) after the end of the rainy season (June-October). The peak lake volume occurred in March 2007 (~6 x 105 m3). Agua Tibia 2 thermal springs discharge near the foot of the SW dome but their chemistry suggests a lower temperature regime, an enhanced water-rock interaction and basement contribution (evaporites and carbonates), anhydrite leaching from the 1982 pyroclastic deposits, rather than dome activity. New suggestions of crater lake seepage are evidenced by the Agua Caliente thermal springs. Existing models on the “crater lake-Soap Pool spring” and the deep hydrothermal system are discussed. Chemical changes in the deep geothermal aquifer feeding the thermal springs may predict dome rise. Future volcanic surveillance should focus on spring chemistry variations, as well as crater lake monitoring

The crater lake of Ilamatepec (Santa Ana) volcano, El Salvador: insights into lake gas composition and implications for monitoring

We here present the first chemical characterization of the volcanic gas plume issuing from the Santa Ana crater lake, a hyper-acidic crater lake (pH of − 0.2 to 2.5) in north-western El Salvador. Our results, obtained during regular surveys in 2017 and 2018 using a Multi-GAS instrument, demonstrate a hydrous gas composition (H2O/SO2 ratios from 32 to 205) and SO2 as the main sulfur species (H2S/SO2 = 0.03–0.1). We also find that gas composition evolved during our investigated period, with the CO2/SO2 ratio decreasing by one order of magnitude from March 2017 (37.2 ± 9.7) to November 2018 (< 3). This compositional evolution toward more magmatic (SO2-rich) compositions is interpreted in the context of the long-term evolution of the volcano following its 2005 and 2007 eruptions. We find that, in spite of reduced (background-level) seismicity, the magmatic gas supply into the lake was one order of magnitude higher in March 2017 (total volatile flux: 20,200–30,200 t/day) than in the following periods (total volatile flux: 900–10,167 t/day). We propose that the elevated magmatic/hydrothermal transport in March 2017, combined with a 15% reduction in precipitation, caused the volume of the lake to decrease, ultimately reducing its sulfur absorbing and scrubbing capacity, and hence causing the gas plume CO2/SO2 ratio to decrease. The recently observed increases in temperature, acidity, and salinity of the lake are consistent with this hypothesis. We conclude that the installation of a continuous, fully-automated Multi-GAS is highly desirable to monitor any future change in lake plume chemistry, and hence the level of degassing activity

Hypoxia induces dilated cardiomyopathy in the chick embryo: mechanism, intervention, and long-term consequences

Background: Intrauterine growth restriction is associated with an increased future risk for developing cardiovascular diseases. Hypoxia in utero is a common clinical cause of fetal growth restriction. We have previously shown that chronic hypoxia alters cardiovascular development in chick embryos. The aim of this study was to further characterize cardiac disease in hypoxic chick embryos. Methods: Chick embryos were exposed to hypoxia and cardiac structure was examined by histological methods one day prior to hatching (E20) and at adulthood. Cardiac function was assessed in vivo by echocardiography and ex vivo by contractility measurements in isolated heart muscle bundles and isolated cardiomyocytes. Chick embryos were exposed to vascular endothelial growth factor (VEGF) and its scavenger soluble VEGF receptor-1 (sFlt-1) to investigate the potential role of this hypoxia-regulated cytokine. Principal Findings: Growth restricted hypoxic chick embryos showed cardiomyopathy as evidenced by left ventricular (LV) dilatation, reduced ventricular wall mass and increased apoptosis. Hypoxic hearts displayed pump dysfunction with decreased LV ejection fractions, accompanied by signs of diastolic dysfunction. Cardiomyopathy caused by hypoxia persisted into adulthood. Hypoxic embryonic hearts showed increases in VEGF expression. Systemic administration of rhVEGF165 to normoxic chick embryos resulted in LV dilatation and a dose-dependent loss of LV wall mass. Lowering VEGF levels in hypoxic embryonic chick hearts by systemic administration of sFlt-1 yielded an almost complete normalization of the phenotype. Conclusions/Significance: Our data show that hypoxia causes a decreased cardiac performance and cardiomyopathy in chick embryos, involving a significant VEGF-mediated component. This cardiomyopathy persists into adulthood

Escalating CO2 degassing at the Pisciarelli fumarolic system, and implications for the ongoing Campi Flegrei unrest

This short communication aims at providing an updated report on degassing activity and ground deformation variations observed during the ongoing (2012–2019) Campi Flegrei caldera unrest, with a particular focus on Pisciarelli, currently its most active fumarolic field. We show that the CO2 flux from the main Pisciarelli fumarolic vent (referred as “Soffione”) has increased by a factor > 3 since 2012, reaching in 2018–2019 levels (>600 tons/day) that are comparable to those typical of a medium-sized erupting arc volcano. A substantial widening of the degassing vents and bubbling pools, and a further increase in CO2 concentrations in ambient air (up to 6000 ppm), have also been detected since mid-2018. We interpret this escalating CO2 degassing activity using a multidisciplinary dataset that includes thermodynamically estimated pressures for the source hydrothermal system, seismic and ground deformation data. From this analysis, we show that degassing, deformation and seismicity have all reached in 2018–2019 levels never observed since the onset of the unrest in 2005, with an overall uplift of ~57 cm and ~448 seismic events in the last year. The calculated pressure of the Campi Flegrei hydrothermal system has reached ~44 bar and is rapidly increasing. Our results raise concern on the possible evolution of the Campi Flegrei unrest and reinforce the need for careful monitoring of the degassing activity at Pisciarelli, hopefully with the deployment of additional permanent gas monitoring units

The ups and downs of volcanic unrest: Insights from integrated geodesy and numerical modelling

Part of the Advances in Volcanology book seriesThis is the final version of the chapter. Available from the publisher via the DOI in this record.Volcanic eruptions are often preceded by small changes in the shape of the volcano. Such volcanic deformation may be measured using precise surveying techniques and analysed to better understand volcanic processes. Complicating the matter is the fact that deformation events (e.g., inflation or deflation) may result from magmatic, non-magmatic or mixed/hybrid sources. Using spatial and temporal patterns in volcanic deformation data and mathematical models it is possible to infer the location and strength of the subsurface driving mechanism. This can provide essential information to inform hazard assessment, risk mitigation and eruption forecasting. However, most generic models over-simplify their representation of the crustal conditions in which the deformation source resides. We present work from a selection of studies that employ advanced numerical models to interpret deformation and gravity data. These incorporate crustal heterogeneity, topography, viscoelastic rheology and the influence of temperature, to constrain unrest source parameters at Uturuncu (Bolivia), Cotopaxi (Ecuador), Soufrière Hills (Montserrat), and Teide (Tenerife) volcanoes. Such model complexities are justified by geophysical, geological, and petrological constraints. Results highlight how more realistic crustal mechanical conditions alter the way stress and strain are partitioned in the subsurface. This impacts inferred source locations and magmatic pressures, and demonstrates how generic models may produce misleading interpretations due to their simplified assumptions. Further model results are used to infer quantitative and qualitative estimates of magma supply rate and mechanism, respectively. The simultaneous inclusion of gravity data alongside deformation measurements may additionally allow the magmatic or non-magmatic nature of the source to be characterised. Together, these results highlight how models with more realistic, and geophysically consistent, components can improve our understanding of the mechanical processes affecting volcanic unrest and geodetic eruption precursors, to aid eruption forecasting, hazard assessment and risk mitigation.s Work presented herein has received funding by the European Commission (FP7; Theme: ENV.2011.1.3.3-1; Grant 282759: VUELCO)

Extracellular matrix defects in aneurysmal Fibulin-4 mice predispose to lung emphysema

Background: In this study we set out to investigate the clinically observed relationship between chronic obstructive pulmonary disease (COPD) and aortic aneurysms. We tested the hypothesis that an

Event trees and epistemic uncertainty in long‐term volcanic hazard assessment of Rift Volcanoes: the example of Aluto (Central Ethiopia)

Aluto is a peralkaline rhyolitic caldera located in a highly populated area in central Ethiopia. Its postcaldera eruptive activity has mainly consisted of self‐similar, pumice‐cone‐building eruptions of varying size and vent location. These eruptions are explosive, generating hazardous phenomena that could impact proximal to distal areas from the vent. Volcanic hazard assessments in Ethiopia and the East African Rift are still limited in number. In this study, we develop an event tree model for Aluto volcano. The event tree is doubly useful: It facilitates the design of a conceptual model for the volcano and provides a framework to quantify volcanic hazard. We combine volcanological data from past and recent research at Aluto, and from a tool to objectively derive analog volcanoes (VOLCANS), to parameterize the event tree, including estimates of the substantial epistemic uncertainty. Results indicate that the probability of a silicic eruption in the next 50 years is highly uncertain, ranging from 2% to 35%. This epistemic uncertainty has a critical influence on event‐tree estimates for other volcanic events, like the probability of occurrence of pyroclastic density currents (PDCs) in the next 50 years. The 90% credible interval for the latter is 5–16%, considering only the epistemic uncertainty in conditional eruption size and PDC occurrence, but 2–23% when adding the epistemic uncertainty in the probability of eruption in 50 years. Despite some anticipated challenges, we envisage that our event tree could be translated to other rift volcanoes, making it an important tool to quantify volcanic hazard in Ethiopia and elsewhere