"A la recherche du temps perdu" : on geological condensation, with examples from the Jurassic Subbetic Plateau in Southeastern Spain

Eine kondensierte Ablagerung ist eine marine Rückstandsbildung, die sich autochthon und kontinuierlich über einen längeren Zeitraum hinweg gebildet hat. Kondensation kann synsedimentar durch Abschirmung, Ablenkung oder Abtragung von Schlamm erfolgen; diagenetisch läuft Kondensation vor allem über Bioerosion auf Hartboden in Verbindung mit unterschiedlich tiefgreifender Erosion ab. Im Jura des subbetischen Plateaus (früher "externes Subbetikum") wird das Umkippen in eine Kondensations-Situation durch tektonische Bewegungen gesteuert, indem benachbarte Plattformen den Export von Schlamm selbssteuernd regulieren. Das subbetische Plateau durchlief vier Phasen stark reduzierter Sedimentation: Carixien - Unter-Domerien(Kondensatlonsepisode 1), Obertoarcien - Unter-Bajocien (Kondensationsepisode 2), Unterbathonien - Unter-Oxfordien (Kondensationsepisode 3) und unterstes Kimmeridgien (Kondensationsepisode 4). Hartboden, die sich während dieser Episoden bildeten, sind meistens von Goethitkrusten und Goethitonkoiden bedeckt. Die meisten Goethitkrusten bestehen entweder aus sehr dünnen (20 - 50 p.) Laminae mit krümeligem und pseudofilamentösem Gefüge, die für einen mikrobiellen Ursprung der Krusten sprechen, oder sie bestehen aus strukturlosem, "sterilen" Goethiterz. Aus einer Abschätzung der Wachstumsraten folgern wir, daß der überwiegende Teil der Zeit, die in solchen Krusten versteckt ist, entweder im nur wenige Milimeter dicken Goethiterz dokumentlert ist oder in Hartböden bzw. Erosionsflächen gelöscht wurde. Kondensierte Abfolgen zelgen meistens eine hierarchische Gliederung in Sequenzen, die vom Meter- bis zum Millimeterbereich reichen und nahezu stets denselben Aufbau haben: sie beginnen mit reduzierter Sedimentation, auf die ein Omissionsstadium folgt und schließen melstens mlt Goethitkrusten ab. Unter den vielen Faktoren, die für eine solche Abfolge verantwortlich sein konnen, kristallisiert sich als kleinster gemeinsamer Nenner ein (nicht eindeutig kalibrierbares) eustatisches Signal heraus. Wir betrachten deshalb kondensierte Sequenzen, die Goethitkrusten enthalten, als pelagische Parasequenzen

Characteristics of Patients Lost to Follow-up after Bariatric Surgery

After bariatric surgery lifelong follow-up is recommended. Evidence of the consequences and reasons for being lost to follow-up (LTFU) is sparse. In this prospective study follow-up data of all patients who underwent bariatric surgery between 2008 and 2017 at a certified obesity centre were investigated. LTFU patients were evaluated through a structured telephone interview. Overall, 573 patients (female/male 70.9%/29.1%), aged 44.1 ± 11.2 years, preoperative BMI 52.1 ± 8.4 kg/m2 underwent bariatric surgery. Out of these, 33.2% had type 2 diabetes mellitus and 74.4% had arterial hypertension. A total of 290 patients were LTFU, of those 82.1% could be reached. Baseline characteristics of patients in follow-up (IFU) and LTFU were comparable, but men were more often LTFU (p = 0.01). Reported postoperative total weight loss (%TWL) and improvements of comorbidities were comparable, but %TWL was higher in patients remaining in follow-up for at least 2 years (p = 0.013). Travel issues were mentioned as the main reason for being LTFU. A percentage of 77.6% of patients reported to regularly supplement micronutrients, while 71.0% stated regular monitoring of their micronutrient status, mostly by primary care physicians. Despite comparable reported outcomes of LTFU to IFU patients, the duration of the in-centre follow-up period affected %TWL. There is a lack of sufficient supplementation and monitoring of micronutrients in a considerable number of LTFU patients

Medikamentöse Therapie der Adipositas – Konkurrenz zur bariatrischen Chirurgie oder sinnvolle Ergänzung?

Obesity is a complex chronic disease and requires a long-term multimodal approach. The current treatment algorithm for treatment of obesity mainly consists of a stepwise approach, which starts with a lifestyle intervention followed by or combined with medication treatment, whereas bariatric surgery is often reserved for the last option. This article provides an overview of the currently available conservative medicinal treatment regimens and the currently approved medications as well as medications currently undergoing approval studies with respect to the efficacy and possible side effects. Special attention is paid to the importance of combination treatment of pharmacotherapy and surgery in the sense of a multimodal treatment. The data so far show that using a multimodal approach an improvement in the long-term weight loss and metabolic benefits can be achieved for the patients. [Abstract copyright: © 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

Anaesthesia-related complications and side-effects in TAVI: a retrospective study in Germany

Objectives This study was performed to analyse anaesthesia-related complications and side effects in patients undergoing transcatheter aortic valve implantation (TAVI) under general anaesthesia. Design Retrospective study. Setting The study was performed as a single-centre study in a hospital of tertiary care in Germany. Participants All 853 patients, who underwent TAVI at the Universitatsklinikum Regensburg between January 2009 and July 2015, were included. 52.5% were female patients. Primary and secondary outcome measures We gathered information, such as recent illness, vital parameters and medication administered during the intervention and postoperatively for 12 hours. We analysed all anaesthesia-related complications and anaesthesia-related side effects that occurred during the intervention and entire hospital stay. Results We analysed all 853 TAVI procedures. The mean patient age was 79 +/- 6 years. In 99.5% of cases, we used volatile-based anaesthesia. 2.8% (n=24; transfemoral (TF): n=19 [3.8%]; transapical (TA): n=5 [1.4%]) of all cases suffered from anaesthesia-related complications. 819 (TF: n=447; TA: n=372) anaesthesia-related side effects occurred in 586 (68.7%, TF: n=325 [64.2%], TA: n=261 [75.2%]) patients. Neither the complications nor the side effects had any serious consequences. Intraoperative hypothermia in 44% of cases (TF: n=202 [39.9%]; TA: n=173 [49.9%]) and postoperative nausea and vomiting in 27% (n=232; TF: n=131 [25.9%], TA: n=101 [29.1%]) of cases were the most common anaesthesia-related side effects. Conclusion In this study, serious anaesthesia-related complications were rarely seen, and non-critical anaesthesia-related side effects could have been avoided through consistent prophylaxis and management. Therefore, despite their high anaesthetic risk, general anaesthesia is justifiable in patients who underwent TAVI

Regulation of β1 Integrin-Klf2-mediated angiogenesis by CCM proteins

International audienceGraphical Abstract Click here to download high resolution imag

Bariatric surgery for spontaneous ovulation in women living with polycystic ovary syndrome: the BAMBINI multicentre, open-label, randomised controlled trial

BackgroundPolycystic ovary syndrome (PCOS) is the most common cause of an ovulatory infertility. Obesity exacerbates the reproductive complications of PCOS; however, the management of obesity in women with PCOS remains a large unmet clinical need. Observational studies have indicated that bariatric surgery could improve the rates of ovulatory cycles and prospects of fertility; however, the efficacy of surgery on ovulation rates has not yet been compared with behavioural modifications and medical therapy in a randomised trial. The aim of this study was to compare the safety and efficacy of bariatric surgery versus medical care on ovulation rates in women with PCOS, obesity, and oligomenorrhoea or amenorrhoea.MethodsIn this multicentre, open-label, randomised controlled trial, 80 women older than 18 years, with a diagnosis of PCOS based on the 2018 international evidence-based guidelines for assessing and managing PCOS, and a BMI of 35 kg/m2 or higher, were recruited from two specialist obesity management centres and via social media. Participants were randomly assigned at a 1:1 ratio to either vertical sleeve gastrectomy or behavioural interventions and medical therapy using a computer-generated random sequence (PLAN procedure in SAS) by an independent researcher not involved with any other aspect of theclinical trial. The median age of the entire cohort was 31 years and 79% ofparticipants were White. The primary outcome was the number of biochemicallyconfirmed ovulatory events over 52 weeks, and was assessed using weekly serumprogesterone measurements. The primary endpoint included the intention-to-treatpopulation and safety analyses were per-protocol population. This study isregistered with the ISRCTN registry (ISRCTN16668711).FindingsParticipants were recruited from Feb 20, 2020 to Feb 1, 2021.40 participants were assigned to each group and there were seven dropouts in the medical group and ten dropouts in the surgical group. The median number of ovulations was 6 (IQR 3·5–10·0) in the surgical group and 2 (0·0–4·0) in the medical group. Women in the surgical group had 2.5 times more spontaneous ovulations compared with the medical group (incidence rate ratio 2·5 [95% CI1·5–4·2], p&lt;0·0007). There were more complications in the surgical group than the medical group, although without long-term sequelae. There were 24(66·7%) adverse events in the surgical group and 12 (30·0%) in the medical group. There were no treatment-related deaths.InterpretationBariatric surgery was more effective than medical care for the induction of spontaneous ovulation in women with PCOS, obesity, and oligomenorrhoea or amenorrhoea. Bariatric surgery could, therefore, enhance the prospects of spontaneous fertility in this group of women.</p

Methane Clumped Isotopes: Progress and Potential for a New Isotopic Tracer

The isotopic composition of methane is of longstanding geochemical interest, with important implications for understanding petroleum systems, atmospheric greenhouse gas concentrations, the global carbon cycle, and life in extreme environments. Recent analytical developments focusing on multiply substituted isotopologues (‘clumped isotopes’) are opening a valuable new window into methane geochemistry. When methane forms in internal isotopic equilibrium, clumped isotopes can provide a direct record of formation temperature, making this property particularly valuable for identifying different methane origins. However, it has also become clear that in certain settings methane clumped isotope measurements record kinetic rather than equilibrium isotope effects. Here we present a substantially expanded dataset of methane clumped isotope analyses, and provide a synthesis of the current interpretive framework for this parameter. In general, clumped isotope measurements indicate plausible formation temperatures for abiotic, thermogenic, and microbial methane in many geological environments, which is encouraging for the further development of this measurement as a geothermometer, and as a tracer for the source of natural gas reservoirs and emissions. We also highlight, however, instances where clumped isotope derived temperatures are higher than expected, and discuss possible factors that could distort equilibrium formation temperature signals. In microbial methane from freshwater ecosystems, in particular, clumped isotope values appear to be controlled by kinetic effects, and may ultimately be useful to study methanogen metabolism

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries