Downscaling global ocean climate models improves estimates of exposure regimes in coastal environments.

Climate change is expected to warm, deoxygenate, and acidify ocean waters. Global climate models (GCMs) predict future conditions at large spatial scales, and these predictions are then often used to parameterize laboratory experiments designed to assess biological and ecological responses to future change. However, nearshore ecosystems are affected by a range of physical processes such as tides, local winds, and surface and internal waves, causing local variability in conditions that often exceeds global climate models. Predictions of future climatic conditions at local scales, the most relevant to ecological responses, are largely lacking. To fill this critical gap, we developed a 2D implementation of the Regional Ocean Modeling System (ROMS) to downscale global climate predictions across all Representative Concentration Pathway (RCP) scenarios to smaller spatial scales, in this case the scale of a temperate reef in the northeastern Pacific. To assess the potential biological impacts of local climate variability, we then used the results from different climate scenarios to estimate how climate change may affect the survival, growth, and fertilization of a representative marine benthic invertebrate, the red abalone Haliotis rufescens, to a highly varying multi-stressor environment. We found that high frequency variability in temperature, dissolved oxygen (DO), and pH increases as pCO2 increases in the atmosphere. Extreme temperature and pH conditions are generally not expected until RCP 4.5 or greater, while frequent exposure to low DO is already occurring. In the nearshore environment simulation, strong RCP scenarios can affect red abalone growth as well as reduce fertilization during extreme conditions when compared to global scale simulations.

Models with environmental drivers offer a plausible mechanism for the rapid spread of infectious disease outbreaks in marine organisms.

The first signs of sea star wasting disease (SSWD) epidemic occurred in just few months in 2013 along the entire North American Pacific coast. Disease dynamics did not manifest as the typical travelling wave of reaction-diffusion epidemiological model, suggesting that other environmental factors might have played some role. To help explore how external factors might trigger disease, we built a coupled oceanographic-epidemiological model and contrasted three hypotheses on the influence of temperature on disease transmission and pathogenicity. Models that linked mortality to sea surface temperature gave patterns more consistent with observed data on sea star wasting disease, which suggests that environmental stress could explain why some marine diseases seem to spread so fast and have region-wide impacts on host populations.

Local oceanographic variability influences the performance of juvenile abalone under climate change.

Climate change is causing warming, deoxygenation, and acidification of the global ocean. However, manifestation of climate change may vary at local scales due to oceanographic conditions. Variation in stressors, such as high temperature and low oxygen, at local scales may lead to variable biological responses and spatial refuges from climate impacts. We conducted outplant experiments at two locations separated by ~2.5 km and two sites at each location separated by ~200 m in the nearshore of Isla Natividad, Mexico to assess how local ocean conditions (warming and hypoxia) may affect juvenile abalone performance. Here, we show that abalone growth and mortality mapped to variability in stress exposure across sites and locations. These insights indicate that management decisions aimed at maintaining and recovering valuable marine species in the face of climate change need to be informed by local variability in environmental conditions.

[Staging with 18F-FDG-PET/CT influences stage-specific survival in advanced non-small cell lung cancer (NSCLC)]. / Der Einfluss des F-18-FDG-PET/CT auf das stadienbezogene Gesamtüberleben beim fortgeschrittenen nicht-kleinzelligen Lungenkarzinom (NSCLC).

BACKGROUND: PET/CT investigation with 18F-fluorodeoxyglucose (FDG) has a high sensitivity (89 - 100 %) and good specificity (79 - 95 %) for the diagnosis of NSCLC. Currently, it is mainly used in preoperative staging. This leads in approximately 15 % of these cases to the diagnosis of metastatic disease that was neither clinically suspected nor seen in previously performed conventional imaging. We hypothesised that including these cases in the palliative stage IV group would have an influence on overall survival. AIM: The aim of this study was to compare the overall survival (OS) of patients with stage IV NSCLC who underwent FDG-PET/CT staging with patients in whom conventional imaging procedures were performed. METHODS: We analysed the OS of all stage IV NSCLC patients diagnosed in our clinic in 2009 (n = 254), 96/254 (38 %) patients were staged with PET/CT and 158/254 (62 %) with conventional imaging (CT group). Survival data were compared by Kaplan-Meier statistics. RESULTS: Patients in the PET/CT group were younger (65 ± 11) than in the CT group (68 ± 10 years; p = 0.008). The median OS of all patients was 246 (range: 217 - 275) days; 338 (range: 247 - 429) days in the PET/CT group and 207 (range: 161 - 253) days in the CT group (p = 0.001), stating a difference of 131 days (4.4 months) in median OS. CONCLUSION: The use of FDG-PET/CT staging mainly in the preoperative setting leads to stage migration of patients with a better prognosis into the worst stage (IV) and thus longer survival within this subgroup. This survival benefit is unrelated to treatment and needs to be addressed in future studies.

Free Gracilis muscle transfer to restore elbow flexion in brachial plexus injuries.

INTRODUCTION: Restoration of elbow flexion is an important step in managing brachial plexus injuries. After more than one year of functional denervation, the muscle atrophy is significant enough that transferring a free muscle to act as a new effector becomes a treatment option. The goal of this study was to evaluate the effectiveness of transferring a gracilis free muscle, innervated by three intercostal nerves, to restore elbow flexion. MATERIAL AND METHODS: This was a retrospective study of a series of gracilis transfer procedures in 12 men having an average age of 25.6 years (23-37) and average follow-up of 112 months (28-260). The patients were operated on average at 42 months (14-153) following their motor vehicle accident; five had a partial paralysis (C5C6C7) and seven had a complete paralysis (C5-T1). The surgical technique and rehabilitation protocol were the same for all the patients. RESULTS: There were two cases of acute arterial thrombosis (17%) that led to functional failure. When these two cases were excluded from the analysis, all the remaining patients had a useful result (British Medical Research Council score ≥ M4) and 2.5 kg of elbow flexion strength measured on a dynamometer. The strength was 3.8 kg (2.7 to 55) for partial plexus injuries and 1.6 kg (0.3 to 1.5) for complete plexus injuries. For partial injuries, active elbow flexion was 128° and extension -38°, versus 103° and -23° for complete injuries. The average DASH score was 42 for partial injuries and 32 for complete injuries. DISCUSSION: Free Gracilis muscle transfer is a challenging technique that leads to reproducible and encouraging results, but has vascular failure rate that cannot be ignored. When compared to published results, our series provides similar results to primary suturing performed within 6 months for cases of complete paralysis and within 12 months for cases of C5C6C7 partial paralysis; our series was better for cases beyond 12 months.

[Myocardial infarction and ovarian stimulation: case report]. / Infarctus du myocarde et stimulation ovarienne : à propos d'un cas.

Female infertility treated by ovarian stimulation can lead to arterial thrombosis particularly when ovarian hyperstimulation syndrome emerges. Myocardial infarction have been reported thrice, in one case even before artificial ovulation induction. A 25-year-old female with primary infertility underwent ovarian stimulation and eight days after ovulation induction and intra-uterine insemination suffered from a troponin positive non-ST-elevation myocardial infarction of the inferior wall. Coronary angiogram was normal and contrast-enhanced cardiovascular magnetic resonance imaging confirmed the subendocardial inferior infarct. This protocol included sole triptorelin administration followed by 23 recombinant follicle stimulating hormone injections and concluded by recombinant choriogonadotrophin. There was no ovarian hyperstimulation syndrome. Large biological screening did not retrieve any predisposition for arterial thrombosis. Clinical outcome was excellent. Despite weak causal link, we emphasize that chest pain during ovarian stimulation protocol should rise clinical concern for acute coronary syndrome.

[CK-MB isoenzyme in the diagnosis of myocardial infarction after myocardial revascularization surgery]. / Isoenzyme CK-MB dans le diagnostic d'infarctus myocardique après chirurgie de revascularisation myocardique.

The usefulness of measuring serum MB creatine kinase activity (CK-MB) for the diagnosis of per- and postoperative myocardial infarction (MI) was assessed in 104 patients undergoing coronary artery bypass grafts. In each patient, 15 samples were taken during the week which followed the surgical procedure. New Q waves were considered to be a criteria of MI. 19 patients developed new Q waves (MI group), whereas 57 had no significant ECG changes (control group); 13 showed only ST changes, whilst 15 had unassessable recordings. In the MI group, CK-MB was greater than in the control group, both at the first peak (8 to 10 h after induction of anaesthesia) and at the greater peak (13 to 21 h after induction) (p less than 0.05). Significant differences were also seen between both groups between 8 and 32 h after induction, but there was also a large overlap. An area under the curve (AUC) greater than 50,000 IU.l-1.min-1 had a positive predictive value of 0.64, and an AUC less than 50,000 IU.l-1.min-1 a negative predictive value of 0.89 if all the groups of patients were taken into account. An AUC greater than 65,000 IU.l-1.min-1 was always seen in MI patients, but only 25% of MI patients had a value greater than this threshold. There were no significant differences between the patient groups in the first peak time, nor in the CK-MB/total CK ratio. CK-MB appeared therefore as a less reliable criterium of per- and postoperative MI during coronary artery bypass operations than previously reported, especially when intermediate values are found.

[A clinical trial of the effectiveness and tolerance of bepridil in unstable angina pectoris]. / Etude clinique de l'efficacité et de la tolérance du bépridil dans l'angor instable.

Bepridil, a new anti-anginal drug, was given in a daily dosage of 400 to 600 mg to twenty patients with unstable angina pectoris. The trial was designed to evaluate the effectiveness of bepridil in this indication and to determine the optimal dosage. A positive response evidenced by the arrest of progression towards infarction was recorded in 17 patients. Tolerance was satisfactory in 19 cases: in one diabetic patient under insulin symptoms of hypoglycemia resolved once insulin was discontinued. With the dosages used the effectiveness of bepridil in unstable angina pectoris is similar to that recorded in effort angina with 300 mg per day.