Strategies for Multivessel Revascularization in Patients with Diabetes

BACKGROUND In some randomized trials comparing revascularization strategies for patients with diabetes, coronary-artery bypass grafting (CABG) has had a better outcome than percutaneous coronary intervention (PCI). We sought to discover whether aggressive medical therapy and the use of drug-eluting stents could alter the revascularization approach for patients with diabetes and multivessel coronary artery disease. METHODS In this randomized trial, we assigned patients with diabetes and multivessel coronary artery disease to undergo either PCI with drug-eluting stents or CABG. The patients were followed for a minimum of 2 years (median among survivors, 3.8 years). All patients were prescribed currently recommended medical therapies for the control of low-density lipoprotein cholesterol, systolic blood pressure, and glycated hemoglobin. The primary outcome measure was a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke. RESULTS From 2005 through 2010, we enrolled 1900 patients at 140 international centers. The patients' mean age was 63.1 +/- 9.1 years, 29% were women, and 83% had three-vessel disease. The primary outcome occurred more frequently in the PCI group (P=0.005), with 5-year rates of 26.6% in the PCI group and 18.7% in the CABG group. The benefit of CABG was driven by differences in rates of both myocardial infarction (P<0.001) and death from any cause (P=0.049). Stroke was more frequent in the CABG group, with 5-year rates of 2.4% in the PCI group and 5.2% in the CABG group (P=0.03). CONCLUSIONS For patients with diabetes and advanced coronary artery disease, CABG was superior to PCI in that it significantly reduced rates of death and myocardial infarction, with a higher rate of stroke. (Funded by the National Heart, Lung, and Blood Institute and others; FREEDOM ClinicalTrials.gov number, NCT00086450.)

Macrofaunal succession in sediments around kelp and wood falls in the deep NE Pacific and community overlap with other reducing habitats

Sunken parcels of macroalgae and wood provide important oases of organic enrichment at the deep-sea floor, yet sediment community structure and succession around these habitat islands are poorly evaluated. We experimentally implanted 100-kg kelp falls and 200 kg wood falls at 1670 m depth in the Santa Cruz Basin to investigate (1) macrofaunal succession and (2) species overlap with nearby whale-fall and cold-seep communities over time scales of 0.25-5.5 yr. The abundance of infaunal macrobenthos was highly elevated after 0.25 and 0.5 yr near kelp parcels with decreased macrofaunal diversity and evenness within 0.5 m of the falls. Apparently opportunistic species (e.g., two new species of cumaceans) and sulfide tolerant microbial grazers (dorvilleid polychaetes) abounded after 0.25-0.5 yr. At wood falls, opportunistic cumaceans become abundant after 0.5 yr, but sulfide tolerant species only became abundant after 1.8-5.5 yr, in accordance with the much slower buildup of porewater sulfides at wood parcels compared with kelp falls. Species diversity decreased significantly over time in sediments adjacent to the wood parcels, most likely due to stress resulting from intense organic loading of nearby sediments (up to 20-30% organic carbon). Dorvilleid and ampharetid polychaetes were among the top-ranked fauna at wood parcels after 3.0-5.5 yr. Sediments around kelp and wood parcels provided low-intensity reducing conditions that sustain a limited chemoautrotrophically-based fauna. As a result, macrobenthic species overlap among kelp, wood, and other chemosynthetic habitats in the deep NE Pacific are primarily restricted to apparently sulfide tolerant species such as dorvilleid polychaetes, opportunistic cumaceans, and juvenile stages of chemosymbiont containing vesicomyid bivalves. We conclude that organically enriched sediments around wood falls may provide important habitat islands for the persistence and evolution of species dependent on organic- and sulfide-rich conditions at the deep-sea floor and contribute to beta and gamma diversity in deep-sea ecosystems. (C) 2010 Elsevier Ltd. All rights reserved.

Macrofaunal abundance and composition on the West Antarctic Peninsula continental shelf: Evidence for a sediment `food bank` and similarities to deep-sea habitats

To assess the impact and fate of the summer phytoplankton bloom on Antarctic benthos, we evaluated temporal and spatial patterns in macrofaunal abundance and taxonomic composition along a transect crossing the West Antarctic Peninsula (WAP) continental shelf As part of the FOODBANCS project, we sampled three sites at 550-625 m depths during five cruises occurring in November 1999, February-March 2000, June 2000, October 2000 and March 2001. We used a combination of megacore and box-core samplers to take 81 samples, and collected over 30,000 macrofaunal individuals, one of the largest sampling efforts on the Antarctic shelf to date. Comparison of the two sampling methodologies (box core and megacore) indicates similar macrofaunal densities, but with significant differences in taxonomic composition, a reflection of the different spatial scales of sampling. Macrorfaunal abundances on the WAP shelf were relatively high compared to other Antarctic shelf settings. At two of the three sampling sites, macrofaunal abundance remained constant throughout the year, which is consistent with the presence of a sediment `food bank`. Differences were observed in taxonomic composition at the site closest to the coast (Station A), driven by higher abundances of subsurface-deposit feeders. A significant temporal response was observed in the ampharetid polychaetes at Station A, with an abundance peak in the late fall post-bloom period; this may have resulted from juvenile recruitment during the summer bloom. Familial composition of macrofaunal polychaetes on the WAP shelf is more closely related to deep-sea abyssal fauna than to other shelf regions, and we hypothesize that this is a result of both local ecological conditions (low temperatures) and a reflection of historical processes such as extinctions on the Antarctic shelf during previous glacial maxima followed by recolonization from the deep sea. (C) 2008 Elsevier Ltd. All rights reserved.

Trophic structure on the West Antarctic Peninsula shelf: Detritivory and benthic inertia revealed by delta(13)C and delta(15)N analysis

Summer bloom-derived phytodetritus settles rapidly to the seafloor on the West Antarctic Peninsula (WAP) continental shelf, where it appears to degrade relatively slowly, forming a sediment ""food bank"" for benthic detritivores. We used stable carbon and nitrogen isotopes to examine sources and sinks of particulate organic material (POM) reaching the WAP shelf benthos (550-625 m depths), and to explore trophic linkages among the most abundant benthic megafauna. We measured delta(13)C and delta(15)N values in major megafaunal taxa (n = 26) and potential food sources, including suspended and sinking POM, ice algae, sediment organic carbon, phytodetritus, and macrofaunal polychaetes. The range in delta(13)C values (> 14 parts per thousand) of suspended POM was considerably broader than in sedimentary POC, where little temporal variability in stable isotope signatures was observed. While benthic megafauna also exhibited a broad range of VC values, organic carbon entering the benthic food web appeared to be derived primarily from phytoplankton production, with little input from ice algae. One group of organisms, primarily deposit-feeders, appeared to rely on fresh phytodetritus recovered from the sediments, and sediment organic material that had been reworked by sediment microbes. A second group of animals, including many mobile invertebrate and fish predators, appeared to utilize epibenthic or pelagic food resources such as zooplankton. One surface-deposit-feeding holothurian (Protelpidia murrayi) exhibited seasonal variability in stable isotope values of body tissue, while other surface- and subsurface-deposit-feeders showed no evidence of seasonal variability in food source or trophic position. Detritus from phytoplankton blooms appears to be the primary source of organic material for the detritivorous benthos; however, seasonal variability in the supply of this material is not mirrored in the sediments, and only to a minor degree in the benthic fauna. This pattern suggests substantial inertia in benthic-pelagic coupling, whereby the sediment ecosystem integrates long-term variability in production processes in the water column above. Published by Elsevier Ltd.

Biogeochemistry of a deep-sea whale fall: sulfate reduction, sulfide efflux and methanogenesis

Deep-sea whale falls create sulfidic habits Supporting chemoautotrophic communities, but microbial processes underlying the formation Of Such habitats remain poorly evaluated. Microbial degradation processes (sulfate reduction, methanogenesis) and biogeochemical gradients were studied in a whale-fall habitat created by a 30 t whale carcass deployed at 1675 m depth for 6 to 7 yr on the California margin. A variety of measurements were conducted including photomosaicking, microsensor measurements, radio-tracer incubations and geochemical analyses. Sediments were Studied at different distances (0 to 9 in) from the whale fall. Highest microbial activities and steepest vertical geochemical gradients were found within 0.5 m of the whale fall, revealing ex situ sulfate reduction and in vitro methanogenesis rates of up to 717 and 99 mmol m(-2) d(-1), respectively. In sediments containing whale biomass, methanogenesis was equivalent to 20 to 30%, of sulfate reduction. During in vitro sediment studies, sulfide and methane were produced within days to weeks after addition of whale biomass, indicating that chemosynthesis is promoted at early stages of the whale fall. Total sulfide production from sediments within 0.5 m of the whale fall was 2.1 +/- 3 and 1.5 +/- 2.1 mol d(-1) in Years 6 and 7, respectively, of which similar to 200 mmol d(-1) were available as free sulfide. Sulfate reduction in bones was much lower, accounting for a total availability of similar to 10 mmol sulfide d(-1). Over periods of at least 7 yr, whale falls can create sulfidic conditions similar to other chemosynthetic habitats Such as cold seeps and hydrothermal vents.

Temporal changes in benthic megafaunal abundance and composition across the West Antarctic Peninsula shelf: Results from video surveys

The West Antarctic Peninsula (WAP) shelf experiences intense seasonal and interannual variability in phytoplankton production and particulate-organic-carbon flux to the seafloor. To explore the response of the megabenthic community to this production variability, we conducted video surveys of epibenthic megafauna at three stations on the WAP shelf in Nov-Dec 1999, Mar 2000, Jun 2000, Oct-Nov 2000, and Feb-Mar 2001. The epibenthic megafauna was dominated (>90%) by elasipod holothurians, irregular urchins and anthozoans, with total abundances ranging from 19 to 152 ind. 1 00 m(-2). The abundance of three of the dominant taxa (Protelpidia murrayi, Peniagone vignomi, and Amphipneustes spp.) varied significantly across seasons (p <0.05), although variations were not tightly correlated with the summer bloom cycle. The irregular urchins in the genus Amphipneustes varied 5-fold in abundance at single stations, with maximum densities (an average of 10.1 ind. 100 m(-2)) attained in Jun 2000. Abundances of the elasipod holothurians P. murrayi (1-121 ind. 100 m(-2)) and P. vignoni (0.7-27.5 ind. 100 m(-2)) fell within the range for elasipod holothurians from other bathyal regions measured using image analysis. The abundance of P. murrayi increased up to 6-fold from a single Jun-Oct recruitment pulse, while changes in the abundance of P. vignoni (over 2-fold higher in Feb-Mar 2001) apparently resulted from immigration during the presence of a 1-2 cm thick carpet of fresh phytocletritus. Based on the ratio of the number of fecal casts per individual, elasipod holothurians increased surface-deposit feeding rates by >= 2-fold while phytocletritus was present at the seafloor. Nonetheless, these surface-deposit feeders appeared to feed and egest sediments throughout the winter, which is consistent with year-round persistence of a labile food bank in surficial sediments on the deep WAP shelf.

Arsenic and trace metal contents in sediment profiles from the Admiralty Bay, King George Island, Antarctica

Admiralty Bay (Antarctica) hosts three scientific stations (Ferraz, Arctowski and Macchu Picchu), which require the use of fossil fuel as an energy source. Fossil fuels are also considered the main source of pollution in the area, representing important inputs of major pollutants (organic compounds) and trace metals and metalloids of environmental interest. Accordingly, this work presents the results of As, Cd, Cr, Cu, Ni, Pb and Zn in sediment profiles from Admiralty Bay. The sediment results from Ferraz station were slightly higher than the other sampling sites. The highest contents were observed for Cu and Zn (from 44 to 89 mg kg(-1)). Otherwise, by using enrichment factors and geochronology analysis, the most relevant enrichment was observed for As in the samples collected close to the Ferraz station, indicating that increasing As content may be associated with the activities associated with this site. Published by Elsevier Ltd.

Revealing archaeal diversity patterns and methane fluxes in Admiralty Bay, King George Island, and their association to Brazilian Antarctic Station activities

The study of Antarctic archaeal communities adds information on the biogeography of this group and helps understanding the dynamics of biogenic methane production in such extreme habitats. Molecular methods were combined to methane flux determinations in Martel Inlet, Admiralty Bay, to assess archaeal diversity, to obtain information about contribution of the area to atmospheric methane budget and to detect possible interferences of the Antarctic Brazilian Station Comandante Ferraz (EACF) wastewater discharge on local archaeal communities and methane emissions. Methane fluxes in Martel Inlet ranged from 3.2 to 117.9 mu mol CH(4) m(-2) d(-1), with an average of 51.3 +/- 8.5 mu mol CH(4) m(-2) d(-1) and a median of 57.6 mu mol CH(4) m(-2)d(-1). However, three negative fluxes averaging -11.3 mu mol CH(4) m(-2) d(-1) were detected in MacKellar Inlet, indicating that Admiralty Bay can be either a source or sink of atmospheric methane. Denaturing gradient gel electrophoresis (DGGE) showed that archaeal communities at EACF varied with depth and formed a group separated from the reference sites. Granulometric analysis indicated that differences observed may be mostly related to sediment type. However, an influence of wastewater input could not be discarded, since higher methane fluxes were found at CF site. suggesting stimulation of local methanogenesis. DGGE profile of the wastewater sample grouped separated from all other samples, suggesting that methanogenesis stimulation may be due to changes in environmental conditions rather than to the input of allochtonous species from the wastewater. 16S ribosomal DNA clone libraries analysis showed that all wastewater sequences were related to known methanogenic groups belonging to the hydrogenotrophic genera Methanobacterium and Methanobrevibacter and the aceticlastic genus Methanosaeta. EACF and Botany Point sediment clone libraries retrieved only groups of uncultivated Archaea, with predominance of Crenarchaeota representatives (MCG, MG1, MBG-B, MBG-C and MHVG groups). Euryarchaeota sequences found were mostly related to the LDS and RC-V groups, but MBG-D and DHVE-5 were also present. No representatives of cultivated methanogenic groups were found, but coverage estimates suggest that a higher number of clones would have to be analyzed in order to cover the greater archaeal diversity of Martel Inlet sediment. Nevertheless, the analysis of the libraries revealed groups not commonly found by other authors in Antarctic habitats and also indicated the presence of groups of uncultivated archaea previously associated to methane rich environments or to the methane cycle. (C) 2010 Elsevier Ltd. All rights reserved.

Results from a 15-year study on hydrocarbon concentrations in water and sediment from Admiralty Bay, King George Island, Antarctica

Admiralty Bay on the King George Island hosts the Brazilian, Polish and Peruvian research stations as well as the American and Ecuadorian field stations. Human activities in this region require the use of fossil fuels as an energy source, thereby placing the region at risk of hydrocarbon contamination. Hydrocarbon monitoring was conducted on water and sediment samples from the bay over 15 years. Fluorescence spectroscopy was used for the analysis of total polycyclic aromatic hydrocarbons (PAHs) in seawater samples and gas chromatography with flame ionization and/or mass spectrometric detection was used to analyse individual n-alkanes and PAHs in sediment samples. The results revealed that most sites contaminated by these Compounds are around the Brazilian and Polish research stations due to the intense human activities, mainly during the summer. Moreover, the sediments revealed the presence of hydrocarbons from different sources, suggesting a mixture of the direct input of oil or derivatives and derived from hydrocarbon combustion. A decrease in PAH concentrations occurred following improvement of the sewage treatment facilities at the Brazilian research station, indicating that the contribution from human waste may be significant.