A record of microplastic in the marine nearshore waters of South Georgia.

The polar plastics research community have recommended the spatial coverage of microplastic investigations in Antarctica and the Southern Ocean be increased. Presented here is a baseline estimate of microplastics in the nearshore waters of South Georgia, the first in situ study of the north-east coast of the island. Our results show that the microplastic concentration in seawater at twelve stations in proximity to King Edward Point Research Station ranged from 1.75 ± 5.17 MP/L (mean ± SD), approximately one order of magnitude higher than similar studies of sea surface waters south of the Polar Front. Levels of microplastics in freshwater (sampled from Gull Lake) and precipitation (collected adjacent to the research station) were 2.67 ± 3.05 MP/L, and 4.67 ± 3.21 MP/L respectively. There was no significant difference in the microplastic concentration between seawater sites, and no significant bilateral relationship between concentration and distance from the research station outlets. We report an average concentration of 1.66 ± 3.00 MP/L in wastewater collected from the research station but overall, the counts of microplastics were too low to attach any statistical significance to the similarity in the microplastic assemblages of seawater and wastewater, or assemblages retrieved from penguin species in the region in other studies. Using a calculation described in contemporary literature we estimate the number of microfibres potentially being released from ships and stations annually in the region but acknowledge that further samples are needed to support the figures generated. More extensive research into microplastic distribution, characteristics, and transport in the region is recommended to fully compute the level of risk which this pollutant represents to the ecosystem health of this remote region.

Stroke Mimics in the Acute Setting: Role of Multimodal CT Protocol.

BACKGROUND AND PURPOSE: Ischemic stroke can be mimicked by nonischemic conditions. Due to emphasis on the rapid treatment of acute ischemic stroke, it is crucial to identify these conditions to avoid unnecessary therapies and potential complications. We investigated the performance of the multimodal CT protocol (unenhanced brain CT, CTA, and CTP) to discriminate stroke mimics from acute ischemic stroke. MATERIALS AND METHODS: We retrospectively selected multimodal CT studies performed for clinical suspicion of acute ischemic stroke in our center in a 24-month period, including patients with at least 1 follow-up imaging study (brain CT or MR imaging). Hemorrhagic strokes were excluded. We measured the performance of multimodal CT, comparing the original diagnostic results with the final clinical diagnosis at discharge. RESULTS: Among 401 patients, a stroke mimic condition was diagnosed in 89 (22%), including seizures (34.8%), migraine with aura attack (12.4%), conversion disorder (12.4%), infection (7.9%), brain tumor (7.9%), acute metabolic condition (6.7%), peripheral vertigo (5.6%), syncope (5.6%), transient global amnesia (3.4%), subdural hematoma (1.1%), cervical epidural hematoma (1.1%), and dural AVF (1.1%). Multimodal CT sensitivity, specificity, and accuracy were 24.7%, 99.7%, and 83%. Multimodal CT revealed peri-ictal changes in 13/31 seizures and diagnosed 7/7 brain tumors, 1/1 dural AVF, and 1/1 subdural hematoma. CT perfusion played a pivotal diagnostic role. CONCLUSIONS: Multimodal CT demonstrated low sensitivity but high specificity in the diagnosis of stroke mimics in the acute setting. The high specificity of multimodal CT allows ruling out stroke and thereby avoiding unnecessary revascularization treatment in patients with diagnosis of a stroke mimic.

Under pressure: Nanoplastics as a further stressor for sub-Antarctic pteropods already tackling ocean acidification.

In the Southern Ocean (SO), plastic debris has already been found in waters and sediments. Nanoplastics (<1 µm) are expected to be as pervasive as their larger counterparts, but more harmful to biological systems, being able to enter cells and provoke toxicity. In the SO, (nano)plastic pollution occurs concomitantly with other environmental threats such as ocean acidification (OA), but the potential cumulative impact of these two challenges on SO marine ecosystems is still overlooked. Here the single and combined effects of nanoplastics and OA on the sub-Antarctic pteropod Limacina retroversa are investigated under laboratory conditions, using two surface charged polystyrene nanoparticles (PS NPs) as a proxy for nanoplastics. Sub-Antarctic pteropods are threatened by OA due to the sensitivity of their shells to changes in seawater carbonate chemistry. Short-term exposure (48 h) to PS NPs compromised the ability of pteropods to counteract OA stress, resulting in a negative effect on their survival. Our results highlights the importance of addressing plastic pollution in the context of climate change to identify realistic critical thresholds of SO pteropods.

Continuous moulting by Antarctic krill drives major pulses of carbon export in the north Scotia Sea, Southern Ocean.

Antarctic krill play an important role in biogeochemical cycles and can potentially generate high-particulate organic carbon (POC) fluxes to the deep ocean. They also have an unusual trait of moulting continuously throughout their life-cycle. We determine the krill seasonal contribution to POC flux in terms of faecal pellets (FP), exuviae and carcasses from sediment trap samples collected in the Southern Ocean. We found that krill moulting generated an exuviae flux of similar order to that of FP, together accounting for 87% of an annual POC flux (22.8 g m-2 y-1). Using an inverse modelling approach, we determined the krill population size necessary to generate this flux peaked at 261 g m-2. This study shows the important role of krill exuviae as a vector for POC flux. Since krill moulting cycle depends on temperature, our results highlight the sensitivity of POC flux to rapid regional environmental change.

Nanoplastics affect moulting and faecal pellet sinking in Antarctic krill (Euphausia superba) juveniles.

Plastic debris has been identified as a potential threat to Antarctic marine ecosystems, however, the impact of nanoplastics (<1 µm) is currently unexplored. Antarctic krill (Euphausia superba) is a keystone species of Southern Ocean pelagic ecosystems, which plays a central role in the Antarctic food webs and carbon (C) cycle. Krill has been shown to rapidly fragment microplastic beads through the digestive system, releasing nanoplastics with unknown toxicological effects. Here we exposed krill juveniles to carboxylic (COOH, anionic) and amino- (NH2, cationic) polystyrene nanoparticles (PS NPs) and we investigated lethal and sub-lethal endpoints after 48 h. The analysis of PS NP suspensions in Antarctic sea water (SW) media showed that PS-COOH formed large agglomerates (1043 ± 121 nm), while PS-NH2 kept their nominal size (56.8 ± 3 nm) during the exposure time. After 48 h, no mortality was found but increase in exuviae production (12.6 ± 1.3%) and reduced swimming activity were observed in juveniles exposed to PS-NH2. The microbial community composition in SW supports the release of krill moults upon PS NP exposure and stimulates further research on the pivotal role of krill in shaping Southern Ocean bacterial assemblages. The presence of fluorescent signal in krill faecal pellets (FPs) confirmed the waterborne ingestion and egestion of PS-COOH at 48 h of exposure. Changes in FP structure and properties were also associated to the incorporation of PS NPs regardless of their surface charge. The effects of PS NPs on krill FP properties were compared to Control 0 h as a reference for full FPs (plastic vs food) and Control 48 h as a reference for more empty-like FPs (plastic vs lack of food). Exposure to PS NPs led to a FP sinking rate comparable to Control 48 h, but significantly lower than Control 0 h (58.40 ± 23.60 m/d and 51.23 ± 28.60 m/d for PS-COOH and PS-NH2; 168.80 ± 74.58 m/d for Control 0 h). Considering the important role played by krill in the food web and C export in the Southern Ocean, the present study provides cues about the potential impact of nanoplastics on Antarctic pelagic ecosystems and their biogeochemical cycles.

Krill faecal pellets drive hidden pulses of particulate organic carbon in the marginal ice zone.

The biological carbon pump drives a flux of particulate organic carbon (POC) through the ocean and affects atmospheric levels of carbon dioxide. Short term, episodic flux events are hard to capture with current observational techniques and may thus be underrepresented in POC flux estimates. We model the potential hidden flux of POC originating from Antarctic krill, whose swarming behaviour could result in a major conduit of carbon to depth through their rapid exploitation of phytoplankton blooms and bulk egestion of rapidly sinking faecal pellets (FPs). Our model results suggest a seasonal krill FP export flux of 0.039 GT C across the Southern Ocean marginal ice zone, corresponding to 17-61% (mean 35%) of current satellite-derived export estimates for this zone. The magnitude of our conservatively estimated flux highlights the important role of large, swarming macrozooplankton in POC export and, the need to incorporate such processes more mechanistically to improve model projections.

Abnormal calcium signalling and the caffeine-halothane contracture test.

BACKGROUND: The variable clinical presentation of malignant hyperthermia (MH), a disorder of calcium signalling, hinders its diagnosis and management. Diagnosis relies on the caffeine-halothane contracture test, measuring contraction forces upon exposure of muscle to caffeine or halothane (FC and FH, respectively). Patients with above-threshold FC or FH are diagnosed as MH susceptible. Many patients test positive to halothane only (termed 'HH'). Our objective was to determine the characteristics of these HH patients, including their clinical symptoms and features of cytosolic Ca2+ signalling related to excitation-contraction coupling in myotubes. METHODS: After institutional ethics committee approval, recruited patients undergoing contracture testing at Toronto's MH centre were assigned to three groups: HH, doubly positive (HS), and negative patients (HN). A clinical index was assembled from musculoskeletal symptoms and signs. An analogous calcium index summarised four measures in cultured myotubes: resting [Ca2+]cytosol, frequency of spontaneous cytosolic Ca2+ events, Ca2+ waves, and cell-wide Ca2+ spikes after electrical stimulation. RESULTS: The highest values of both indexes were found in the HH group; the differences in calcium index between HH and the other groups were statistically significant. The principal component analysis confirmed the unique cell-level features of the HH group, and identified elevated resting [Ca2+]cytosol and spontaneous event frequency as the defining HH characteristics. CONCLUSIONS: These findings suggest that HH pathogenesis stems from excess Ca2+ leak through sarcoplasmic reticulum channels. This identifies HH as a separate diagnostic group and opens their condition to treatment based on understanding of pathophysiological mechanisms.

Threatened species drive the strength of the carbonate pump in the northern Scotia Sea.

The efficiency of deep-ocean CO2 sequestration is regulated by the relative balance between inorganic and organic carbon export respectively acting through the biological carbon pump (BCP) and the carbonate counter pump (CCP). The composition and abundance of calcifying species in the prevailing oceanic plankton community plays a major role in driving the CCP. Here we assess the role of these calcifying organisms in regulating the strength of the CCP in a Southern Ocean region (northern Scotia Sea) known to be a major hotspot for the drawdown of atmospheric CO2. We show that, when shelled pteropods dominate the calcifying community, the total annual reduction of CO2 transferred to the deep ocean doubles (17%) compared to when other plankton calcifiers dominate (3-9%). Furthermore, predation enhances their contribution through the removal of organic soft tissue. Pteropods are threatened in polar regions by ocean warming and acidification. We determine that their potential decline would have major implications to the comparative strengths of the BCP and CCP.

The potential role of Antarctic krill faecal pellets in efficient carbon export at the marginal ice zone of the South Orkney Islands in spring.

Antarctic krill (Euphausia superba) play a central role in the food web of the Southern Ocean, forming a link between primary production and large predators. Krill produce large, faecal pellets (FP) which can form a large component of mesopelagic particulate organic carbon (POC) fluxes. However, the patchy distribution of krill swarms, highly variable pellet composition, and variable sinking and attenuation rates means that these episodic, but potentially large, carbon fluxes are difficult to sample or model. We measured particle flux and type using Marine Snow Catchers (MSC) in the marginal ice zone near the South Orkneys, Antarctica. Krill FP were the dominant component of the POC flux in the upper 200 m (typically 60-85%). FP sinking velocities measured onboard were highly variable (15-507 m d-1) but overall high, with mean equivalent velocities of 172, 267, and 161 m d-1 at our three stations. The high numbers of krill FP sinking through the mesopelagic suggest that krill FP can be transferred efficiently and/or that rates of krill FP production are high. We compared our direct MSC-derived estimates of krill FP POC flux (33-154 mg C m-2 d-1) and attenuation to estimates of krill FP production based on previous measurements of krill density and literature FP egestion rates, and estimated net krill FP attenuation rates in the upper mesopelagic. Calculated attenuation rates are sensitive to krill densities in the overlying water column but suggest that krill FP could be transferred efficiently through the upper mesopelagic, and, in agreement with our MSC attenuation estimates, could make large contributions to bathypelagic POC fluxes. Our study contrasts with some others which suggest rapid FP attenuation, highlighting the need for further work to constrain attenuation rates and assess how important the contribution of Antarctic krill FP could be to the Southern Ocean biological carbon pump.

Rituximab for treatment of inhibitors in haemophilia A. A Phase II study.

The development of antibodies against infused factor VIII (FVIII) in patients with haemophilia A is a serious complication leading to poorly controlled bleeding and increased morbidity. No treatment has been proven to reduce high titre antibodies in patients who fail immune tolerance induction or are not candidates for it. The Rituximab for the Treatment of Inhibitors in Congenital Hemophilia A (RICH) study was a phase II trial to assess whether rituximab can reduce anamnestic FVIII antibody (inhibitor) titres. Male subjects with severe congenital haemophilia A and an inhibitor titre ≥5 Bethesda Units/ml (BU) following a FVIII challenge infusion received rituximab 375 mg/m² weekly for weeks 1 through 4. Post-rituximab inhibitor titres were measured monthly from week 6 through week 22 to assess treatment response. Of 16 subjects who received at least one dose of rituximab, three (18.8%) met the criteria for a major response, defined as a fall in inhibitor titre to <5 BU, persisting after FVIII re-challenge. One subject had a minor response, defined as a fall in inhibitor titre to <5 BU, increasing to 5-10 BU after FVIII re-challenge, but <50% of the original peak inhibitor titre. Rituximab is useful in lowering inhibitor levels in patients, but its effect as a solo treatment strategy is modest. Future studies are indicated to determine the role of rituximab as an adjunctive therapy in immune tolerisation strategies.

The eye-tracking computer device for communication in amyotrophic lateral sclerosis.

OBJECTIVE: To explore the effectiveness of communication and the variables affecting the eye-tracking computer system (ETCS) utilization in patients with late-stage amyotrophic lateral sclerosis (ALS). METHODS: We performed a telephone survey on 30 patients with advanced non-demented ALS that were provisioned an ECTS device. Median age at interview was 55 years (IQR = 48-62), with a relatively high education (13 years, IQR = 8-13). A one-off interview was made and answers were later provided with the help of the caregiver. The interview included items about demographic and clinical variables affecting the daily ETCS utilization. RESULTS: The median time of ETCS device possession was 15 months (IQR = 9-20). The actual daily utilization was 300 min (IQR = 100-720), mainly for the communication with relatives/caregiver, internet surfing, e-mailing, and social networking. 23.3% of patients with ALS (n = 7) had a low daily ETCS utilization; most reported causes were eye-gaze tiredness and oculomotor dysfunction. CONCLUSIONS: Eye-tracking computer system is a valuable device for AAC in patients with ALS, and it can be operated with a good performance. The development of oculomotor impairment may limit its functional use.

Cryoglobulinemic membranoproliferative glomerulonephritis: beyond conventional therapy.

Membranoproliferative glomerulonephritis associated with Type II cryoglobulinemia is the predominant type of HCV-related glomerulonephritis. Immunosuppressive and anti-viral therapy is alternately used to treat it, but the results are not always satisfactory or lasting. In this paper we report 3 cases of cryoglobulinemic membranoproliferative glomerulonephritis, treated with different and personalized therapeutic approaches by using conventional therapy and new drugs such as mycophenolate mofetil and rituximab. Our case series report emphasizes the importance of choosing the treatment for each patient, taking into account many factors: age, severity of liver and renal involvement, extra-renal manifestations, any previous treatment, contraindications or adverse events and last but not least the balance between immunosuppression and virus activity.

Ovine catarrhal fever (Bluetongue): analysis of Culicoides species in seropositive farms.

Bluetongue (BT) is an orbiviral disease of wild and domestic ruminants, mainly sheep. In Sicily, the first Bluetongue outbreak occurred in October 2000; there have been 76 recorded outbreaks so far. The National Surveillance Plan, based on European Union Commission Decision 138/2001/CE, establishes serological and entomological surveys. This plan consists of controls of seronegative cattle, called 'sentry' as indicators for the presence and circulation of virus in defined areas. To check the seroconversions, the regional territory has been subdivided in 400 km(2) areas including 58 seronegative cattle, periodically checked by serological tests. All positive sera have been tested to detect the specific serotype by the National Reference Centre for Exotic Diseases (CESME) at the Istituto Zooprofilattico Sperimentale Abruzzo e Molise in Teramo (IZS Teramo). Moreover, entomological surveillance has been implemented in seropositive herds, to investigate the presence of insect vectors belonging to Culicoides genus. The goal of the present communication is to report on the different species of Culicoides found in the farms with Bluetongue virus and to investigate on the probable role of new competent vectors. This paper concerns data analysis of 581 light-trap catches collected in 321 farms from 2003 to 2008. We observed that 82% of checked farms were positive for Culicoides spp., and only 10% of the farms were positive for Culicoides imicola.

Bone morphogenetic protein-2 may represent the molecular link between oxidative stress and vascular stiffness in chronic kidney disease.

Oxidative stress and vascular calcifications are emergent risk factors for the accelerated atherosclerosis process featuring chronic kidney disease (CKD). Vascular calcification is an active process similar to bone modelling, where BMP-2 may play a pathogenic role. Aim of our study was to investigate the link between oxidative stress, BMP-2 protein expression and vascular disease in CKD. We enrolled 85 CKD patients (K-DOQI stage II or higher) and 41 healthy individuals. 8-Oxo-7,8-dihydro-2'-deoxyguanosine (8-OHdG) was used as a marker of oxidative stress. Brachial-ankle pulse wave velocity (baPWV) was used as a measure of arterial stiffness. BMP-2 serum levels were significantly higher in CKD patients than in controls (p<0.0001). Serum 8-OHdG levels were significantly higher in CKD patients compared to controls (p<0.05). BMP-2 serum levels were inversely associated with eGFR (r=-0.3; p=0.01) and directly correlated with 8-OHdG serum concentrations (r=-0.3; p=0.03). Arterial stiffness was inversely correlated with eGFR (r=-0.4; p=0.001) and directly correlated with BMP-2 (r=0.3; p=0.03), 8-OHdG (r=0.4, p=0.02) and phosphorus serum levels (r=0.3; p=0.007). In a multiple regression model, phosphorus and BMP-2 were independently correlated with baPWV. In vitro exposure to H(2)O(2) induced a time and dose-dependent increase in BMP-2 expression in an immortalized endothelial cell line. Moreover, H(2)O(2) pre-incubation of cultured vascular smooth muscle cell enhanced the BMP-2-induced up-regulation of ALPL, an osteoblastic phenotype marker. Our data suggest that in CKD BMP-2 may represent the molecular link between oxidative stress and arterial stiffness due to vascular calcification.

[The usefulness of Cochrane systematic reviews in nephrology]. / Le principali revisioni sistematiche Cochrane all'attenzione della Societa' Italiana di Nefrologia: a cosa servono?

Systematic reviews (SRs) of the literature are clinical research studies carried out according to rigorous methodological criteria. They are aimed at searching, critically appraising and summarizing all studies with similar characteristics that address the same research question. The Cochrane Collaboration is the main institution that coordinates the production of SRs. The Cochrane Renal Group is one of the 50 research groups of the Cochrane Collaboration and is in charge of SRs in nephrology. This group compiled the Renal Health Library, an annually updated collection of SRs (Cochrane and not) and randomized controlled trials in nephrology, dialysis and renal transplantation. We searched the Renal Health Library to identify SRs useful to answer clinical questions in patients with renal disease and/or following kidney transplant. The SRs identified were summarized and the results were expressed as relative risk, weighted mean difference, standardized mean difference, and 95% confidence intervals. Since the number of randomized controlled trials is quite large and SRs are a reliable summary of the scientific evidence, their distribution is of paramount importance. Here we show several clinical cases where related SRs in the Renal Health Library provide useful guidance for treatment.