Future losses of ecosystem services due to coastal erosion in Europe.

Coastal erosion is a major issue facing Europe that will only worsen under future climate change and the resulting sea level rise. One effect of erosion is the loss of ecosystem services, which are provided by coastal areas, such as provisioning, regulating, habitat, and cultural services. These services can be quantified in monetary terms. Here, we present comprehensive estimates of future decline in coastal ecosystem services due to the erosion of sandy coastlines. We used datasets derived from remote sensing products: a pan-European land cover/use dataset (Corine Land Cover) and new global probabilistic coastal erosion projections constrained by artificial and topographical barriers to erosion. The results include historical changes (2000-2018) and projections under two emission scenarios (RCP4.5 and RCP8.5) for 2050 and 2100 together with uncertainty bounds. We estimate that in 2018, the coastal zone (excluding open sea) included 579,700 km2 of habitats generating 494 billion euros of services annually. The future sea-level rise could erode 1.0% [90% confidence interval 0.7-1.5%] of the 2018 area under RCP4.5, and 1.2% [0.7-2.2%] under RCP8.5. The decline in services would be even greater: 4.2% [3.0-6.1%] under RCP4.5, and 5.1% [3.3-8.5%] under RCP8.5. The highest absolute losses would be sustained by salt marshes, while relative losses would be highest in beaches, sands, and dunes. The most affected countries in relative economic terms would be Denmark, Albania, Greece, Estonia, and Finland, but countries such as Germany, the Netherlands, and France would be among those losing the largest share of their coastal ecosystem services. Regional analysis using NUTS 3 regions shows high diversity of the impacts, with many regions along the North Sea and eastern Mediterranean Sea that are heavily affected by coastal erosion-induced loss of ecosystem services. The study highlights the urgency of undertaking mitigation actions.

Agenesis of the coeliac trunk: a case report and review of the literature.

Vascular anatomical variations of the abdomen are very common. Awareness of these variations is of paramount importance in clinical practice mainly in achieving best results in minimal invasive or surgical vascular procedures. From surgical point of view, the preoperative knowledge of vascular anatomy and the relations to the surrounding structures and tissues aims to minimise inadvertent complications. Agenesis of the coeliac trunk is one of the rare anatomical variations of the abdominal aorta. Limited number of cases have been reported in the medical literature, most of which are based on angiographic and cadaveric studies of adult humans. In this paper, we report a case of absence of the coeliac trunk that has been detected as an incidental radiological finding in a female patient who was admitted with abdominal pain.

More meteorological events that drive compound coastal flooding are projected under climate change.

Compound flooding arises from storms causing concurrent extreme meteorological tides (that is the superposition of storm surge and waves) and precipitation. This flooding can severely affect densely populated low-lying coastal areas. Here, combining output from climate and ocean models, we analyse the concurrence probability of the meteorological conditions driving compound flooding. We show that, under a high emissions scenario, the concurrence probability would increase globally by more than 25% by 2100 compared to present. In latitudes above 40o north, compound flooding could become more than 2.5 times as frequent, in contrast to parts of the subtropics where it would weaken. Changes in extreme precipitation and meteorological tides account for most (77% and 20%, respectively) of the projected change in concurrence probability. The evolution of the dependence between precipitation and meteorological tide dominates the uncertainty in the projections. Our results indicate that not accounting for these effects in adaptation planning could leave coastal communities insufficiently protected against flooding.

Significance of taurine transporter (TauT) in homeostasis and its layers of regulation (Review).

Taurine (2­aminoethanesulfonic acid) contributes to homeostasis, mainly through its antioxidant and osmoregulatory properties. Taurine's influx and efflux are mainly mediated through the ubiquitous expression of the sodium/chloride­dependent taurine transporter, located on the plasma membrane. The significance of the taurine transporter has been shown in various organ malfunctions in taurine­transporter­null mice. The taurine transporter differentially responds to various cellular stimuli including ionic environment, electrochemical charge, and pH changes. The renal system has been used as a model to evaluate the factors that significantly determine the regulation of taurine transporter regulation.

Uncertainties in projections of sandy beach erosion due to sea level rise: an analysis at the European scale.

Sea level rise (SLR) will cause shoreline retreat of sandy coasts in the absence of sand supply mechanisms. These coasts have high touristic and ecological value and provide protection of valuable infrastructures and buildings to storm impacts. So far, large-scale assessments of shoreline retreat use specific datasets or assumptions for the geophysical representation of the coastal system, without any quantification of the effect that these choices might have on the assessment. Here we quantify SLR driven potential shoreline retreat and consequent coastal land loss in Europe during the twenty-first century using different combinations of geophysical datasets for (a) the location and spatial extent of sandy beaches and (b) their nearshore slopes. Using data-based spatially-varying nearshore slope data, a European averaged SLR driven median shoreline retreat of 97 m (54 m) is projected under RCP 8.5 (4.5) by year 2100, relative to the baseline year 2010. This retreat would translate to 2,500 km2 (1,400 km2) of coastal land loss (in the absence of ambient shoreline changes). A variance-based global sensitivity analysis indicates that the uncertainty associated with the choice of geophysical datasets can contribute up to 45% (26%) of the variance in coastal land loss projections for Europe by 2050 (2100). This contribution can be as high as that associated with future mitigation scenarios and SLR projections.

Economic motivation for raising coastal flood defenses in Europe.

Extreme sea levels (ESLs) in Europe could rise by as much as one metre or more by the end of this century due to climate change. This poses significant challenges to safeguard coastal communities. Here we present a comprehensive analysis of economically efficient protection scenarios along Europe's coastlines during the present century. We employ a probabilistic framework that integrates dynamic simulations of all ESL components and flood inundation, impact modelling and a cost-benefit analysis of raising dykes. We find that at least 83% of flood damages in Europe could be avoided by elevating dykes in an economically efficient way along 23.7%-32.1% of Europe's coastline, specifically where high value conurbations exist. The European mean benefit to cost ratio of the investments varies from 8.3 to 14.9 while at country level this ranges between 1.6 and 34.3, with higher efficiencies for a scenario with high-end greenhouse gas emissions and strong socio-economic growth.

Global long-term observations of coastal erosion and accretion.

Changes in coastal morphology have broad consequences for the sustainability of coastal communities, structures and ecosystems. Although coasts are monitored locally in many places, understanding long-term changes at a global scale remains a challenge. Here we present a global and consistent evaluation of coastal morphodynamics over 32 years (1984-2015) based on satellite observations. Land losses and gains were estimated from the changes in water presence along more than 2 million virtual transects. We find that the overall surface of eroded land is about 28,000 km2, twice the surface of gained land, and that often the extent of erosion and accretion is in the order of km. Anthropogenic factors clearly emerge as the dominant driver of change, both as planned exploitation of coastal resources, such as building coastal structures, and as unforeseen side effects of human activities, for example the installment of dams, irrigation systems and structures that modify the flux of sediments, or the clearing of coastal ecosystems, such as mangrove forests. Another important driver is the occurrence of natural disasters such as tsunamis and extreme storms. The observed global trend in coastal erosion could be enhanced by Sea Level Rise and more frequent extreme events under a changing climate.

Global probabilistic projections of extreme sea levels show intensification of coastal flood hazard.

Global warming is expected to drive increasing extreme sea levels (ESLs) and flood risk along the world's coastlines. In this work we present probabilistic projections of ESLs for the present century taking into consideration changes in mean sea level, tides, wind-waves, and storm surges. Between the year 2000 and 2100 we project a very likely increase of the global average 100-year ESL of 34-76 cm under a moderate-emission-mitigation-policy scenario and of 58-172 cm under a business as usual scenario. Rising ESLs are mostly driven by thermal expansion, followed by contributions from ice mass-loss from glaciers, and ice-sheets in Greenland and Antarctica. Under these scenarios ESL rise would render a large part of the tropics exposed annually to the present-day 100-year event from 2050. By the end of this century this applies to most coastlines around the world, implying unprecedented flood risk levels unless timely adaptation measures are taken.

The DNA damage response and immune signaling alliance: Is it good or bad? Nature decides when and where.

The characteristic feature of healthy living organisms is the preservation of homeostasis. Compelling evidence highlight that the DNA damage response and repair (DDR/R) and immune response (ImmR) signaling networks work together favoring the harmonized function of (multi)cellular organisms. DNA and RNA viruses activate the DDR/R machinery in the host cells both directly and indirectly. Activation of DDR/R in turn favors the immunogenicity of the incipient cell. Hence, stimulation of DDR/R by exogenous or endogenous insults triggers innate and adaptive ImmR. The immunogenic properties of ionizing radiation, a prototypic DDR/R inducer, serve as suitable examples of how DDR/R stimulation alerts host immunity. Thus, critical cellular danger signals stimulate defense at the systemic level and vice versa. Disruption of DDR/R-ImmR cross talk compromises (multi)cellular integrity, leading to cell-cycle-related and immune defects. The emerging DDR/R-ImmR concept opens up a new avenue of therapeutic options, recalling the Hippocrates quote "everything in excess is opposed by nature."

Concept of the aortic aneurysm repair-related surgical stress: a review of the literature.

OBJECTIVE: Abdominal aorta aneurysm (AAA) is a serious threat for human life. AAA repair is a high-risk procedure which results in a severe surgical stress response. We aim to give a conceptual description of the underlying pathophysiology of stress after surgical repair of AAA. METHODS: The MEDLINE/PubMed database was searched for publications with the medical subject heading "surgical stress" and keywords "abdominal aortic aneurysms (AAA)", or "cytokines" or "hormones" or "open repair (OR)" or "endovascular repair (EVAR)". We restricted our search to English till 2012 and only in cases of abdominal and thoracoabdominal aneurysms (TAAA). RESULTS: We identified 93 articles that were available in English as abstracts or/and full-text articles that were deemed appropriate for our review. CONCLUSIONS: Literature highlights no statistical significance for early acute TNF-α production in EVAR and no TNF-α production in OR. IL-6 and IL-8 levels are higher after OR especially when compared with those of EVAR. IL-10 peak was observed during ischemic phase in aneurysm surgical repair. Cortisol and epinephrine levels are higher in OR patients in comparison to EVAR patients. Finally, the incidence of systemic inflammatory response syndrome was significantly higher in OR than EVAR patients.

Incidence of exercise-induced asthma in adolescent athletes under different training and environmental conditions.

The aim of this study was to establish if there were differences in the incidence of exercise-induced bronchospasm between athletes in different sports, which take place under different environmental conditions such as open places, closed courses, and swimming pools with similar exercise intensity (football, basketball, water polo) using the free running test. The study included 90 adolescents (3 groups of 30) aged 14-18 years recruited from academies in northern Greece. All the participants were initially subjected to (a) a clinical examination and cardiorespiratory assessment by a physician and (b) free running test of a 6-minute duration and measurement with a microspirometer of the forced expiratory volume in 1 second (FEV1). Only the participants who had measured a decrease in FEV1 ≥ 10% were reevaluated with the microspirometer during a training session. The examination of all the participants during the free running test showed that 22 athletes, that is, 9, 8, and 5 of football, basketball, and water polo athletes, respectively, demonstrated an FEV1 ≥ 10 drop. Reevaluation of the 22 participants during training showed that 5 out 9 (55%) football athletes, 4 out of 8 basketball athletes (50%), and none of the 5 athletes of the water polo team displayed a drop of FEV1 ≥ 10%. Despite the absence of any significant statistical differences between the 3 groups, the analysis of variances did show a trend of a lower incidence of EIA in the water polo athletes. It was found that a football or basketball game can induce EIA in young athletes but to a lesser degree than the free running test can induce. The water polo can be a safer sport even for participants with a medical history of asthma or allergies.

Ivabradine improves coronary flow reserve in patients with stable coronary artery disease.

OBJECTIVES: Although treatment with ivabradine reduces the incidence of hospital admissions for myocardial infarction and coronary revascularisation, there are no data concerning its effect on coronary circulation. The purpose of this study was to assess the effects of ivabradine on coronary flow velocity and flow reserve (CFR) in patients with stable coronary artery disease (CAD). METHODS: During diagnostic coronary angiography (baseline), twenty-one patients with stable CAD underwent coronary flow velocity measurements (APV cm/s) in a non-culprit vessel, using a Doppler guidewire, at rest (r) and after adenosine administration to achieve maximal hyperaemia (h). During programmed coronary intervention in the culprit vessel, the same measurements were repeated one week after treatment with ivabradine (5 mg twice daily), both at the intrinsic heart rate and at a paced heart rate identical to that before treatment. CFR was defined as h-APV/r-APV. RESULTS: Heart rate was significantly lower after treatment with ivabradine (78±14 bpm vs 65±9 bpm, p<0.001). Also, a reduction of r-APV (17.0±5.5 vs 19.7±7.6, p=0.003) and augmentation of h-APV (57.9±17.8 vs 53.5±21.4, p=0.009) leading to CFR improvement (3.51±0.81 vs 2.78±0.61, p<0.001) were observed. During pacing, although r-APV reverted to values similar to those before treatment (20.0±6.5 vs 19.7±7.6, p=NS), a sustained improvement in h-APV was observed (59.5±19.7 vs 53.5±21.4, p=0.007) and CFR remained higher than before treatment (3.04±0.66 vs 2.78±0.61, p<0.001). CONCLUSIONS: Ivabradine treatment significantly improves hyperaemic coronary flow velocity and CFR in patients with stable CAD. These effects remain even after heart rate correction indicating improved microvascular function.

Differential effects of drug-eluting stents on local endothelium-dependent coronary vasomotion.

OBJECTIVES: The aim of our study was to compare coronary vasomotion after implantation of a second-generation biolimus A9-eluting stent (BES) and of a sirolimus-eluting stent (SES). BACKGROUND: Drug-eluting stents (DES) have been associated with impaired local coronary vasomotion, delayed endothelialization, and increased late thrombotic risk. New DES with different drugs, pharmacokinetics, and polymers have been developed. METHODS: Nineteen patients with a BES and 15 patients with a SES were studied 9 months after stent implantation. Endothelium-dependent and -independent coronary vasomotion were tested proximally and distally to the stent as well as at a reference segment during right atrial pacing at increasing heart rates. Quantitative coronary angiographic measurements were performed offline. RESULTS: Of the patients with BES, 2 showed vasoconstriction with increased heart rate and 17 showed vasodilatation. Of the patients with a SES, 9 showed vasoconstriction while 6 showed vasodilatation. The SES showed significant vasoconstriction at both the proximal (-2.3 +/- 10% vs. 7.9 +/- 10%) and the distal (-5.4 +/- 9% vs. 6.1 +/- 8%) segments to the stent compared with the BES (p = 0.003 for proximal, p < 0.001 for distal segment). Endothelium-independent vasomotion after intracoronary nitrates did not differ significantly between the 2 groups (p = NS for proximal and distal segment). CONCLUSIONS: Unlike the case with the SES, endothelium-dependent vasomotion at adjacent stent segments seems to be preserved after BES implantation. This result may be explained by the different drug release kinetics, DES design, or characteristics of polymer used in the stent system.

Isolated atrial microvascular dysfunction in patients with lone recurrent atrial fibrillation.

OBJECTIVES: The purpose of this study was to assess atrial myocardial perfusion in patients with lone recurrent atrial fibrillation (LRAF). BACKGROUND: Although acute atrial ischemia has been implicated in the pathogenesis of atrial fibrillation, there are few data concerning human atrial myocardial perfusion and none for patients with LRAF. METHODS: Sixteen patients with LRAF and 15 control subjects with suitable coronary anatomy underwent time-averaged peak coronary blood flow velocity (APV) measurements (cm/s), using a Doppler guidewire in the proximal left circumflex coronary artery (LCx) and in the left atrial circumflex branch (LACB), at baseline (b) and after adenosine administration to achieve maximal hyperemia (h). Coronary flow reserve was defined as h-APV/b-APV. RESULTS: Although there were no statistically significant differences in b-APV between patients with LRAF and control subjects or between the LACB and LCx, there were significant group (p = 0.002), artery (p = 0.001), and interaction (p < 0.001) effects at maximal hyperemia. In patients with LRAF, the h-APV and coronary flow reserve of the LACB (30.4 +/- 9.5 cm/s and 2.2 +/- 0.4, respectively) were significantly lower than in the LACB of the control subjects (45.8 +/- 12.8 cm/s [p < 0.001] and 2.9 +/- 0.5 [p = 0.001], respectively) or in the patients' LCx (43.0 +/- 10.9 cm/s [p = 0.001] and 3.1 +/- 0.6 [p < 0.001], respectively). CONCLUSIONS: This study confirms for the first time isolated atrial myocardial perfusion abnormalities in patients with LRAF and coronary flow reserve impairment, indicating that microvascular dysfunction is a pathophysiological substrate associated with this arrhythmia.

Combined use of aspiration catheter and distal embolisation protection device to facilitate angioplasty of a totally occluded saphenous vein graft.

Angioplasty of totally occluded saphenous vein grafts is a very challenging procedure and the likelihood of distal embolisation and no-reflow is much higher than in any conventional angioplasty. The use of thrombus aspiration and distal protection devices, although not well studied in a large number of patients, has been shown to be quite effective in preventing such complications. In this case we report our satisfactory experience from the combined use of a novel aspiration catheter and a distal protection device for the treatment of a totally occluded saphenous vein graft.

Successful thrombus removal during angioplasty in a patient with acute myocardial infarction using a new aspiration catheter.

We describe the case of a male patient, aged 62 years, with acute myocardial infarction, who underwent primary angioplasty using a new thrombus aspiration catheter in conjunction with the conventional technique. This catheter is easier to use than similar devices available to date and is extremely effective in the removal of large intracoronary thrombi, thus providing protection against distal embolism during angioplasty procedures.

Stent fracture and restenosis of a paclitaxel-eluting stent.

We describe the case of a patient with restenosis six months after stent implantation, at two points where stent fracture had occurred. Fracture is an unusual and probably underestimated cause of restenosis, which acquires special significance in this era of drug-eluting stents.