Fire, water, and biodiversity in the sierra nevada: A possible triple win

Reducing the risk of large, severe wildfires while also increasing the security of mountain water supplies and enhancing biodiversity are urgent priorities in western US forests. After a century of fire suppression, Yosemite and Sequoia-Kings Canyon National Parks located in California’s Sierra Nevada initiated programs to manage wildfires and these areas present a rare opportunity to study the effects of restored fire regimes. Forest cover decreased during the managed wildfire period and meadow and shrubland cover increased, especially in Yosemite’s Illilouette Creek basin that experienced a 20% reduction in forest area. These areas now support greater pyrodiversity and consequently greater landscape and species diversity. Soil moisture increased and drought-induced tree mortality decreased, especially in Illilouette where wildfires have been allowed to burn more freely resulting in a 30% increase in summer soil moisture. Modeling suggests that the ecohydrological co-benefits of restoring fire regimes are robust to the projected climatic warming. Support will be needed from the highest levels of government and the public to maintain existing programs and expand them to other forested areas

Microparticles are new biomarkers of septic shock-induced disseminated intravascular coagulopathy

PURPOSE: Septic shock-induced disseminated intravascular coagulopathy (DIC) contributes to multiple organ failure. Mechanisms governing vascular responses to open occurrence of DIC have not yet been established. Circulating plasma microparticles (MPs), released upon cell stress, constitute a catalytic procoagulant surface and are surrogates of vascular cell activation/injury. Herein, MPs were assessed as possible markers of haemostatic and vascular dysfunction in the DIC time course. METHODS: One hundred patients with septic shock from three ICUs were enrolled and their haemostatic status evaluated at admission (D1), D2, D3 and D7. Circulating procoagulant MPs were isolated, quantified by prothrombinase assay and their cellular origin determined. DIC diagnosis was made according to the JAAM 2006 score. RESULTS: Ninety-two patients were analysed and 40 had DIC during the first 24 h. Routine clotting times and factor/inhibitor activity did not allow assessing vascular cell involvement. At admission, thrombin generation and fibrinolysis were observed in both groups while impaired fibrin polymerisation was evidenced only in DIC patients. Sustained thrombin generation persisted over time in both groups at D7. While total microparticle concentrations were in the same range regardless of DIC diagnosis, specific phenotypes were already detected at admission in DIC patients. Endothelial- and leucocyte-derived MPs were higher in DIC while an increased soluble glycoprotein V/platelet ratio was delayed, underscoring the first involvement of endothelial cells and leucocytes whereas platelet activation was delayed. Endothelium-derived CD105-MPs (OR 6.55) and CD31-MPs (OR 0.49) were strongly associated with early DIC in multivariate analysis. CONCLUSION: Endothelial-derived microparticles are relevant biomarkers of septic shock-induced DIC and could be used to evaluate early vascular injury

Wildfires misunderstood

Rain is a natural process that provides a range of services to humans but certainly not all rainfall events (eg those generating floods) are beneficial to human societies. Biodiversity can also deliver a variety of services, even though there are species capable of harming humans. Likewise, the vast majority of life depends (directly or indirectly) on sunlight, yet we can get sunburn and develop skin cancer after overexposure. In the same way, wildfires can offer a range of ecosystem services (Pausas and Keeley 2019) but obviously not all fires, and not all fire regimes, provide services to humankind; indeed, wildfires can have negative (even catastrophic) impacts on society. For instance, if we build houses in a fire-prone (or flood-prone) area, then the inhabitants of those houses are likely to suffer negative impacts when a wildfire (or a major rainfall event) occurs. Similarly, when we substantially increase fuel loads and landscape homogeneity (eg due to a fire exclusion policy, or with a massive and poorly managed tree plantation), the impact of wildfires – especially under novel climatic conditions – can be catastrophic (eg the case of the 2017 fires in Portugal and Chile; Bowman et al. 2019).Peer reviewe

Intensive Care Med

PURPOSE: Septic shock-induced disseminated intravascular coagulopathy (DIC) contributes to multiple organ failure. Mechanisms governing vascular responses to open occurrence of DIC have not yet been established. Circulating plasma microparticles (MPs), released upon cell stress, constitute a catalytic procoagulant surface and are surrogates of vascular cell activation/injury. Herein, MPs were assessed as possible markers of haemostatic and vascular dysfunction in the DIC time course. METHODS: One hundred patients with septic shock from three ICUs were enrolled and their haemostatic status evaluated at admission (D1), D2, D3 and D7. Circulating procoagulant MPs were isolated, quantified by prothrombinase assay and their cellular origin determined. DIC diagnosis was made according to the JAAM 2006 score. RESULTS: Ninety-two patients were analysed and 40 had DIC during the first 24 h. Routine clotting times and factor/inhibitor activity did not allow assessing vascular cell involvement. At admission, thrombin generation and fibrinolysis were observed in both groups while impaired fibrin polymerisation was evidenced only in DIC patients. Sustained thrombin generation persisted over time in both groups at D7. While total microparticle concentrations were in the same range regardless of DIC diagnosis, specific phenotypes were already detected at admission in DIC patients. Endothelial- and leucocyte-derived MPs were higher in DIC while an increased soluble glycoprotein V/platelet ratio was delayed, underscoring the first involvement of endothelial cells and leucocytes whereas platelet activation was delayed. Endothelium-derived CD105-MPs (OR 6.55) and CD31-MPs (OR 0.49) were strongly associated with early DIC in multivariate analysis. CONCLUSION: Endothelial-derived microparticles are relevant biomarkers of septic shock-induced DIC and could be used to evaluate early vascular injury

Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI‐MESH registry

International audienceObjective: To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair.Design: Prospective cohort study using a registry.Setting: Nineteen French surgical centres.Population: A total of 2309 women participated between 2017 and 2019.Methods: A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups.Main outcome measures: Serious complications and subsequent reoperations for POP recurrence.Results: The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups.Conclusions: Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making