Anti-glomerular Basement Membrane Glomerulonephritis: A Study in Real Life.

Introduction: Anti-glomerular basement membrane (anti-GBM) disease is a severe entity with few therapeutic options including plasma exchange and immunosuppressive agents. The aim of this study was to analyze the clinical and pathological features that predict the evolution of end-stage kidney disease (ESKD) and the kidney survival in a cohort of patients with anti-GBM disease with renal involvement in real life. Methods: A retrospective multicentre observational study including 72 patients from 18 nephrology departments with biopsy-proven anti-GBM disease from 1999 to 2019 was performed. Progression to ESKD in relation to clinical and histological variables was evaluated. Results: Creatinine at admission was 8.6 (± 4) mg/dL and 61 patients (84.7%) required dialysis. Sixty-five patients (90.3%) underwent plasma exchange. Twenty-two patients (30.6%) presented pulmonary hemorrhage. Kidney survival was worse in patients with creatinine levels > 4.7 mg/dL (3 vs. 44% p < 0.01) and in patients with > 50% crescents (6 vs. 49%; p = 0.03). Dialysis dependence at admission and creatinine levels > 4.7 mg/dL remained independent significant predictors of ESKD in the multivariable analysis [HR (hazard ratio) 3.13 (1.25-7.84); HR 3 (1.01-9.14); p < 0.01]. The discrimination value for a creatinine level > 4.7 mg/dL and 50.5% crescents had an area under the curve (AUC) of 0.9 (95% CI 0.82-0.97; p < 0.001) and 0.77 (95% CI 0.56-0.98; p = 0.008), respectively. Kidney survival at 1 and 2 years was 13.5 and 11%, respectively. Patient survival at 5 years was 81%. Conclusion: In real life, patients with severe anti-GBM disease (creatinine > 4.7 mg/dL and > 50% crescents) remained with devastating renal prognosis despite plasma exchange and immunosuppressive treatment. New therapies for the treatment of this rare renal disease are urgently needed.

Toward spatio-temporal delineation of positive interactions in ecology.

Given unprecedented rates of biodiversity loss, there is an urgency to better understand the ecological consequences of interactions among organisms that may lost or altered. Positive interactions among organisms of the same or different species that directly or indirectly improve performance of at least one participant can structure populations and communities and control ecosystem process. However, we are still in need of synthetic approaches to better understand how positive interactions scale spatio-temporally across a range of taxa and ecosystems. Here, we synthesize two complementary approaches to more rigorously describe positive interactions and their consequences among organisms, across taxa, and over spatio-temporal scales. In the first approach, which we call the mechanistic approach, we make a distinction between two principal mechanisms of facilitation-habitat modification and resource modification. Considering the differences in these two mechanisms is critical because it delineates the potential spatio-temporal bounds over which a positive interaction can occur. We offer guidance on improved sampling regimes for quantification of these mechanistic interactions and their consequences. Second, we present a trait-based approach in which traits of facilitators or traits of beneficiaries can modulate their magnitude of effect or how they respond to either of the positive interaction mechanisms, respectively. Therefore, both approaches can be integrated together by quantifying the degree to which a focal facilitator's or beneficiary's traits explain the magnitude of a positive effect in space and time. Furthermore, we demonstrate how field measurements and analytical techniques can be used to collect and analyze data to test the predictions presented herein. We conclude by discussing how these approaches can be applied to contemporary challenges in ecology, such as conservation and restoration and suggest avenues for future research.

Offspring polymorphism and bet hedging: a large-scale, phylogenetic analysis.

Offspring polymorphism is a reproductive strategy where individual organisms simultaneously produce offspring that differ in morphology and ecology. It occurs across the Tree of Life but is particularly common among plants, where it is termed seed (diaspore) heteromorphism. The prevalence of this strategy in unpredictably varying environments has resulted in the assumption that it serves as a bet-hedging mechanism. We found 101 examples of this strategy in southwestern North America. We provide phylogenetically informed evidence for the hypothesis that the occurrence of seed heteromorphism increases with increasing environmental variability, though this pattern was only significant for aridity, one of our two rainfall variability metrics. We provide a strong test of bet hedging for a large, taxonomically diverse set of seed heteromorphic species, lending support to the hypothesis that bet hedging is an important mechanistic driver for the evolution of seed heteromorphism.

State of the science in reconciling top-down and bottom-up approaches for terrestrial CO2 budget.

Robust estimates of CO2 budget, CO2 exchanged between the atmosphere and terrestrial biosphere, are necessary to better understand the role of the terrestrial biosphere in mitigating anthropogenic CO2 emissions. Over the past decade, this field of research has advanced through understanding of the differences and similarities of two fundamentally different approaches: "top-down" atmospheric inversions and "bottom-up" biosphere models. Since the first studies were undertaken, these approaches have shown an increasing level of agreement, but disagreements in some regions still persist, in part because they do not estimate the same quantity of atmosphere-biosphere CO2 exchange. Here, we conducted a thorough comparison of CO2 budgets at multiple scales and from multiple methods to assess the current state of the science in estimating CO2 budgets. Our set of atmospheric inversions and biosphere models, which were adjusted for a consistent flux definition, showed a high level of agreement for global and hemispheric CO2 budgets in the 2000s. Regionally, improved agreement in CO2 budgets was notable for North America and Southeast Asia. However, large gaps between the two methods remained in East Asia and South America. In other regions, Europe, boreal Asia, Africa, South Asia, and Oceania, it was difficult to determine whether those regions act as a net sink or source because of the large spread in estimates from atmospheric inversions. These results highlight two research directions to improve the robustness of CO2 budgets: (a) to increase representation of processes in biosphere models that could contribute to fill the budget gaps, such as forest regrowth and forest degradation; and (b) to reduce sink-source compensation between regions (dipoles) in atmospheric inversion so that their estimates become more comparable. Advancements on both research areas will increase the level of agreement between the top-down and bottom-up approaches and yield more robust knowledge of regional CO2 budgets.

Role of forest regrowth in global carbon sink dynamics.

Although the existence of a large carbon sink in terrestrial ecosystems is well-established, the drivers of this sink remain uncertain. It has been suggested that perturbations to forest demography caused by past land-use change, management, and natural disturbances may be causing a large component of current carbon uptake. Here we use a global compilation of forest age observations, combined with a terrestrial biosphere model with explicit modeling of forest regrowth, to partition the global forest carbon sink between old-growth and regrowth stands over the period 1981-2010. For 2001-2010 we find a carbon sink of 0.85 (0.66-0.96) Pg year-1 located in intact old-growth forest, primarily in the moist tropics and boreal Siberia, and 1.30 (1.03-1.96) Pg year-1 located in stands regrowing after past disturbance. Approaching half of the sink in regrowth stands would have occurred from demographic changes alone, in the absence of other environmental changes. These age-constrained results show consistency with those simulated using an ensemble of demographically-enabled terrestrial biosphere models following an independent reconstruction of historical land use and management. We estimate that forests will accumulate an additional 69 (44-131) Pg C in live biomass from changes in demography alone if natural disturbances, wood harvest, and reforestation continue at rates comparable to those during 1981-2010. Our results confirm that it is not possible to understand the current global terrestrial carbon sink without accounting for the sizeable sink due to forest demography. They also imply that a large portion of the current terrestrial carbon sink is strictly transient in nature.

Land use change and El Niño-Southern Oscillation drive decadal carbon balance shifts in Southeast Asia.

An integrated understanding of the biogeochemical consequences of climate extremes and land use changes is needed to constrain land-surface feedbacks to atmospheric CO2 from associated climate change. Past assessments of the global carbon balance have shown particularly high uncertainty in Southeast Asia. Here, we use a combination of model ensembles to show that intensified land use change made Southeast Asia a strong source of CO2 from the 1980s to 1990s, whereas the region was close to carbon neutral in the 2000s due to an enhanced CO2 fertilization effect and absence of moderate-to-strong El Niño events. Our findings suggest that despite ongoing deforestation, CO2 emissions were substantially decreased during the 2000s, largely owing to milder climate that restores photosynthetic capacity and suppresses peat and deforestation fire emissions. The occurrence of strong El Niño events after 2009 suggests that the region has returned to conditions of increased vulnerability of carbon stocks.

Enhanced response of global wetland methane emissions to the 2015-2016 El Niño-Southern Oscillation event.

Wetlands are thought to be the major contributor to interannual variability in the growth rate of atmospheric methane (CH4) with anomalies driven by the influence of the El Niño-Southern Oscillation (ENSO). Yet it remains unclear whether (i) the increase in total global CH4 emissions during El Niño versus La Niña events is from wetlands and (ii) how large the contribution of wetland CH4 emissions is to the interannual variability of atmospheric CH4. We used a terrestrial ecosystem model that includes permafrost and wetland dynamics to estimate CH4 emissions, forced by three separate meteorological reanalyses and one gridded observational climate dataset, to simulate the spatio-temporal dynamics of wetland CH4 emissions from 1980-2016. The simulations show that while wetland CH4 responds with negative annual anomalies during the El Niño events, the instantaneous growth rate of wetland CH4 emissions exhibits complex phase dynamics. We find that wetland CH4 instantaneous growth rates were declined at the onset of the 2015-2016 El Niño event but then increased to a record-high at later stages of the El Niño event (January through May 2016). We also find evidence for a step increase of CH4 emissions by 7.8±1.6 Tg CH4 yr-1 during 2007-2014 compared to the average of 2000-2006 from simulations using meteorological reanalyses, which is equivalent to a ~3.5 ppb yr-1 rise in CH4 concentrations. The step increase is mainly caused by the expansion of wetland area in the tropics (30°S-30°N) due to an enhancement of tropical precipitation as indicated by the suite of the meteorological reanalyses. Our study highlights the role of wetlands, and the complex temporal phasing with ENSO, in driving the variability and trends of atmospheric CH4 concentrations. In addition, the need to account for uncertainty in meteorological forcings is highlighted in addressing the interannual variability and decadal-scale trends of wetland CH4 fluxes.

Vasculitis asociada a anticuerpo anticitoplasma de neutrófilo en paciente con enfermedad de Crohn en tratamiento con adalimumab / Antineutrophil cytoplasmic antibodies associated vasculitis in patient with Crohn's disease treated with adalimumab

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