A global agenda for advancing freshwater biodiversity research

This manuscript is a contribution of the Alliance for Freshwater Life (www.allianceforfreshwaterlife.org). We thank Nick Bond, Lisa Bossenbroek, Lekima Copeland, Dean Jacobsen, Maria Cecilia Londo?o, David Lopez, Jaime Ricardo Garcia Marquez, Ketlhatlogile Mosepele, Nunia Thomas-Moko, Qiwei Wei and the authors of Living Waters: A Research Agenda for the Biodiversity of Inland and Coastal Waters for their contributions. We also thank Peter Thrall, Ian Harrison and two anonymous referees for their valuable comments that helped improve the manuscript. Open access funding enabled and organised by Projekt DEAL

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial

Background Tranexamic acid reduces surgical bleeding and decreases mortality in patients with traumatic extracranial bleeding. Intracranial bleeding is common after traumatic brain injury (TBI) and can cause brain herniation and death. We aimed to assess the effects of tranexamic acid in patients with TBI. Methods This randomised, placebo-controlled trial was done in 175 hospitals in 29 countries. Adults with TBI who were within 3 h of injury, had a Glasgow Coma Scale (GCS) score of 12 or lower or any intracranial bleeding on CT scan, and no major extracranial bleeding were eligible. The time window for eligibility was originally 8 h but in 2016 the protocol was changed to limit recruitment to patients within 3 h of injury. This change was made blind to the trial data, in response to external evidence suggesting that delayed treatment is unlikely to be effective. We randomly assigned (1:1) patients to receive tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Patients were assigned by selecting a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was head injury-related death in hospital within 28 days of injury in patients treated within 3 h of injury. We prespecified a sensitivity analysis that excluded patients with a GCS score of 3 and those with bilateral unreactive pupils at baseline. All analyses were done by intention to treat. This trial was registered with ISRCTN (ISRCTN15088122), ClinicalTrials.gov (NCT01402882), EudraCT (2011-003669-14), and the Pan African Clinical Trial Registry (PACTR20121000441277). Results Between July 20, 2012, and Jan 31, 2019, we randomly allocated 12 737 patients with TBI to receive tranexamic acid (6406 [50·3%] or placebo [6331 [49·7%], of whom 9202 (72·2%) patients were treated within 3 h of injury. Among patients treated within 3 h of injury, the risk of head injury-related death was 18·5% in the tranexamic acid group versus 19·8% in the placebo group (855 vs 892 events; risk ratio [RR] 0·94 [95% CI 0·86-1·02]). In the prespecified sensitivity analysis that excluded patients with a GCS score of 3 or bilateral unreactive pupils at baseline, the risk of head injury-related death was 12·5% in the tranexamic acid group versus 14·0% in the placebo group (485 vs 525 events; RR 0·89 [95% CI 0·80-1·00]). The risk of head injury-related death reduced with tranexamic acid in patients with mild-to-moderate head injury (RR 0·78 [95% CI 0·64-0·95]) but not in patients with severe head injury (0·99 [95% CI 0·91-1·07]; p value for heterogeneity 0·030). Early treatment was more effective than was later treatment in patients with mild and moderate head injury (p=0·005) but time to treatment had no obvious effect in patients with severe head injury (p=0·73). The risk of vascular occlusive events was similar in the tranexamic acid and placebo groups (RR 0·98 (0·74-1·28). The risk of seizures was also similar between groups (1·09 [95% CI 0·90-1·33]). Interpretation Our results show that tranexamic acid is safe in patients with TBI and that treatment within 3 h of injury reduces head injury-related death. Patients should be treated as soon as possible after injury. Funding National Institute for Health Research Health Technology Assessment, JP Moulton Charitable Trust, Department of Health and Social Care, Department for International Development, Global Challenges Research Fund, Medical Research Council, and Wellcome Trust (Joint Global Health Trials scheme)

Integrative phylogenetic, phylogeographic and morphological characterisation of the Unio crassus species complex reveals cryptic diversity with important conservation implications

The global decline of freshwater mussels and their crucial ecological services highlight the need to understand their phylogeny, phylogeography and patterns of genetic diversity to guide conservation efforts. Such knowledge is urgently needed for Unio crassus, a highly imperilled species originally widespread throughout Europe and southwest Asia. Recent studies have resurrected several species from synonymy based on mitochondrial data, revealing U. crassus to be a complex of cryptic species. To address long-standing taxonomic uncertainties hindering effective conservation, we integrate morphometric, phylogenetic, and phylogeographic analyses to examine species diversity within the U. crassus complex across its entire range. Phylogenetic analyses were performed using cytochrome c oxidase subunit I (815 specimens from 182 populations) and, for selected specimens, whole mitogenome sequences and Anchored Hybrid Enrichment (AHE) data on ∼600 nuclear loci. Mito-nuclear discordance was detected, consistent with mitochondrial DNA gene flow between some species during the Pliocene and Pleistocene. Fossil-calibrated phylogenies based on AHE data support a Mediterranean origin for the U. crassus complex in the Early Miocene. The results of our integrative approach support 12 species in the group: the previously recognised Unio bruguierianus, Unio carneus, Unio crassus, Unio damascensis, Unio ionicus, Unio sesirmensis, and Unio tumidiformis, and the reinstatement of five nominal taxa: Unio desectus stat. rev., Unio gontierii stat. rev., Unio mardinensis stat. rev., Unio nanus stat. rev., and Unio vicarius stat. rev. Morphometric analyses of shell contours reveal important morphospace overlaps among these species, highlighting cryptic, but geographically structured, diversity. The distribution, taxonomy, phylogeography, and conservation of each species are succinctly described

The impact of insect herbivory on biogeochemical cycling in broadleaved forests varies with temperature

Herbivorous insects alter biogeochemical cycling within forests, but the magnitude of these impacts, their global variation, and drivers of this variation remain poorly understood. To address this knowledge gap and help improve biogeochemical models, we established a global network of 74 plots within 40 mature, undisturbed broadleaved forests. We analyzed freshly senesced and green leaves for carbon, nitrogen, phosphorus and silica concentrations, foliar production and herbivory, and stand-level nutrient fluxes. We show more nutrient release by insect herbivores at non-outbreak levels in tropical forests than temperate and boreal forests, that these fluxes increase strongly with mean annual temperature, and that they exceed atmospheric deposition inputs in some localities. Thus, background levels of insect herbivory are sufficiently large to both alter ecosystem element cycling and influence terrestrial carbon cycling. Further, climate can affect interactions between natural populations of plants and herbivores with important consequences for global biogeochemical cycles across broadleaved forests

An integrated approach for the surgical treatment of patients with primary hyperparathyroidism

This paper presents the treatment results of 75 patients with primary hyperparathyroidism (PHPT) caused by a solitary parathyroid adenoma (SPA). Patients in Group 1 had PHPT with concomitant diseases of the thy roid gland (TG). Group 2 consisted of patients with PHPT without thyroid disease. Group 3 included patients with PHPT and concurrent diseases of the parathyroid glands (PG) and thyroid gland, which were operated on without the use of the proposed integrated approach. Patients in groups 1 and 2 were operated on using the following techniques. Patients in group 1 underwent surgery usinga traditional incision with photodynamic visualization (PV) of the PG and exposure of the recur rent and superior laryngeal nerves (LN) (in some cases with the use of magnifying devices and neuromyog raphy). Patients in group 2 underwent surgery with minimally invasive access, utilizingendoscopic video devices and the universal retractor “Multifiks1”. During the intervention,PVof the PG and electrophysiolog ical monitoring (EM)of the recurrent LN were carried out. In groups 1 and 2, adequacy of the operationwas determined by the change in the level of intraoperative parathyroid hormone (PTH) and ionized calcium before and after the removal of the PG. Our proposed integrated method for the treatment of patients with PHPT allowed for a significant reduction in the risk of postoperative complications and consequently an improvement in quality of life

Reduced low-traumatic access thyroidectomy with central neck dissection

Background. In the year 2014 in Russia there were about 10 thousand patients with newly diagnosed thyroid cancer (TC), the bulk of which need surgical treatment. Currently, special requirements to the quality of surgical intervention, which is determined by the radicalness, minimum number of complications and a good cosmetic result. Materials and methods. In this paper we present the treatment results of 76 patients with differentiated TC, who received surgical treatment at S.P. Botkin City Clinical Hospital in 2012–2015. All patients underwent an extrafascial operation under general anesthesia in volume thyroidectomy with central lymph node dissection. The operation was carried out with reduced low-traumatic approach length 4–5 sm in front the neck without crossing prelaringeal muscules. For prophylaxis of laryngeal paresis, visualization and indenification laryngeal nerves were performed, with using magnifying devices and neuromyography. To prevent the development of hypoparathyroidism, visualization and preservation of the parathyroid glands was also conducted. To this end, among other measures, a photodynamic method of parathyroid gland visualization using a photosensitizer, a blue light source and local spectroscopy was employed. Results. In the postoperative period, there were 3 (3.9 %) cases of transient hypoparathyroidism. On the scale of intervention POSAS (Patient and observer scar assessment scale) 68 (89.5 %) patient was recognized as a excellent, and 8 (10.5 %) as good. Conclusion. Thus, thyroidectomy and central neck dissection with reduced low-traumatic approach using the suggested methodological approaches gives completeness of our surgical intervention, possibility to avoid the development of permanent specific complications, and better functional and aesthetic results

Geodynamics, seismicity, and seismic hazards of the Caucasus

Being a part of ongoing continental collision between the Arabian and Eurasian plates, the Caucasus region is a remarkable site of moderate to strong seismicity, where devastating earthquakes caused significant losses of lives and livelihood. In this article, we survey geology and geodynamics of the Caucasus and its surroundings; magmatism and heat flow; active tectonics and tectonic stresses caused by the collision and shortening; gravity and density models; and overview recent geodetic studies related to regional movements. The tectonic development of the Caucasus region in the Mesozoic-Cenozoic times as well as the underlying dynamics controlling its development are complicated processes. It is clear that the collision is responsible for a topographic uplift / inversion and for the formation of the fold-and-thrust belts of the Greater and Lesser Caucasus. Tectonic deformations in the region is influenced by the wedge-shaped rigid Arabian block indenting into the relatively mobile region and producing near N-S compressional stress and seismicity in the Caucasus. Regional seismicity is analysed with an attention to sub-crustal seismicity under the northern foothills of the Greater Caucasus, which origin is unclear – whether the seismicity associated with a descending oceanic crust or thinned continental crust. Recent seismic tomography studies are in favour of the detachment of a lithospheric root beneath the Lesser and Greater Caucasus. The knowledge of geodynamics, seismicity, and stress regime in the Caucasus region assists in an assessment of seismic hazard and risk. We look finally at existing gaps in the current knowledge and identify the problems, which may improve our understanding of the regional evolution, active tectonics, geodynamics, shallow and deeper seismicity, and surface manifestations of the lithosphere dynamics. Among the gaps are those related to uncertainties in regional geodynamic and tectonic evolution (e.g., continental collision and associated shortening and exhumation, lithosphere structure, deformation and strain-stress partitioning) and to the lack of comprehensive datasets (e.g., regional seismic catalogues, seismic, gravity and geodetic surveys)

Geodynamics, seismicity, and seismic hazards of the Caucasus

Being a part of ongoing continental collision between the Arabian and Eurasian plates, the Caucasus region is a remarkable site of moderate to strong seismicity, where devastating earthquakes caused significant losses of lives and livelihood. In this article, we survey geology and geodynamics of the Caucasus and its surroundings; magmatism and heat flow; active tectonics and tectonic stresses caused by the collision and shortening; gravity and density models; and overview recent geodetic studies related to regional movements. The tectonic development of the Caucasus region in the Mesozoic-Cenozoic times as well as the underlying dynamics controlling its development are complicated processes. It is clear that the collision is responsible for a topographic uplift / inversion and for the formation of the fold-and-thrust belts of the Greater and Lesser Caucasus. Tectonic deformations in the region is influenced by the wedge-shaped rigid Arabian block indenting into the relatively mobile region and producing near N-S compressional stress and seismicity in the Caucasus. Regional seismicity is analysed with an attention to sub-crustal seismicity under the northern foothills of the Greater Caucasus, which origin is unclear – whether the seismicity associated with a descending oceanic crust or thinned continental crust. Recent seismic tomography studies are in favour of the detachment of a lithospheric root beneath the Lesser and Greater Caucasus. The knowledge of geodynamics, seismicity, and stress regime in the Caucasus region assists in an assessment of seismic hazard and risk. We look finally at existing gaps in the current knowledge and identify the problems, which may improve our understanding of the regional evolution, active tectonics, geodynamics, shallow and deeper seismicity, and surface manifestations of the lithosphere dynamics. Among the gaps are those related to uncertainties in regional geodynamic and tectonic evolution (e.g., continental collision and associated shortening and exhumation, lithosphere structure, deformation and strain-stress partitioning) and to the lack of comprehensive datasets (e.g., regional seismic catalogues, seismic, gravity and geodetic surveys)