Distal tephrochronology in volcanic regions: Challenges and insights from Kamchatkan lake sediments

Kamchatka is one of the world’s most active volcanic regions and has hosted many explosive eruptions during the Holocene. These eruptions had the potential to disperse tephra over wide areas, forming time-synchronous markers wherever those tephras are found. Recent research in Kamchatka has begun to focus on the geochemical analysis of individual glass shards in order to characterise tephra layers. We have applied this approach to the study of visible tephras from three lakes – one in central and two in northern Kamchatka – with the aim of identifying key tephras and potential issues in the application of distal (>100 km from an active volcano) tephra in volcanically complex regions. In total, 23 tephras from 22 tephra beds have been geochemically analysed, representing products from at least four volcanic systems in Kamchatka. We demonstrate that distal lake sediments in the region can yield reliable tephrostratigraphies, capturing tephra from eruptions that have the greatest potential to disperse volcanic ash beyond the region. We draw attention to issues relating to correlating and distinguishing key marker horizons from the highly active Shiveluch Volcano, namely the need to ensure inter-lab comparability of geochemical data and good chronological control of the proximal and distal tephras. Importantly, we have also extended the known distribution of two key tephra isochrons from the Ksudach volcano. Our work contributes valuable glass geochemical on data several key marker beds that will facilitate future tephra and palaeoenvironmental research within and beyond Kamchatka.

Current treatments for renal cell carcinoma

Renal cell carcinoma (RCC), also known as kidney cancer, renal adenocarcinoma or hypernephroma, and metastatic renal cell carcinoma is a global burden. This article aims to provide a brief overview of RCC. It outlines epidemiology and presentation; invesitgation and staging; treatments and prognosis. The article also includes a focus on currently available drug treatments, and serves as an introduction to the topic.

Fluid balance, intradialytic hypotension, and outcomes in critically ill patients undergoing renal replacement therapy: a cohort study

Introduction: In this cohort study, we explored the relationship between fluid balance, intradialytic hypotension and outcomes in critically ill patients with acute kidney injury (AKI) who received renal replacement therapy (RRT).

Methods: We analysed prospectively collected registry data on patients older than 16 years who received RRT for at least two days in an intensive care unit at two university-affiliated hospitals. We used multivariable logistic regression to determine the relationship between mean daily fluid balance and intradialytic hypotension, both over seven days following RRT initiation, and the outcomes of hospital mortality and RRT dependence in survivors.

Results: In total, 492 patients were included (299 male (60.8%), mean (standard deviation (SD)) age 62.9 (16.3) years); 251 (51.0%) died in hospital. Independent risk factors for mortality were mean daily fluid balance (odds ratio (OR) 1.36 per 1000 mL positive (95% confidence interval (CI) 1.18 to 1.57), intradialytic hypotension (OR 1.14 per 10% increase in days with intradialytic hypotension (95% CI 1.06 to 1.23)), age (OR 1.15 per five-year increase (95% CI 1.07 to 1.25)), maximum sequential organ failure assessment score on days 1 to 7 (OR 1.21 (95% CI 1.13 to 1.29)), and Charlson comorbidity index (OR 1.28 (95% CI 1.14 to 1.44)); higher baseline creatinine (OR 0.98 per 10 mu mol/L (95% CI 0.97 to 0.996)) was associated with lower risk of death. Of 241 hospital survivors, 61 (25.3%) were RRT dependent at discharge. The only independent risk factor for RRT dependence was pre-existing heart failure (OR 3.13 (95% CI 1.46 to 6.74)). Neither mean daily fluid balance nor intradialytic hypotension was associated with RRT dependence in survivors. Associations between these exposures and mortality were similar in sensitivity analyses accounting for immortal time bias and dichotomising mean daily fluid balance as positive or negative. In the subgroup of patients with data on pre-RRT fluid balance, fluid overload at RRT initiation did not modify the association of mean daily fluid balance with mortality.

Conclusions: In this cohort of patients with AKI requiring RRT, a more positive mean daily fluid balance and intradialytic hypotension were associated with hospital mortality but not with RRT dependence at hospital discharge in survivors.

Exceptionally Long Distance Transport of Volcanic Ash: Implications for Stratigraphy, Hazards and the Sourcing of Distal Tephra Deposits

Cryptotephras (tephra not visible to the naked eye) form the foundation of the tephrostratigraphic frameworks used in Europe to date and correlate widely distributed geologic, paleoenvironmental and archaeological records. Pyne-O'Donnell et al. (2012) established the potential for developing a similar crypto-tephrostratigraphy across eastern North America by identifying multiple tephra, including the White River Ash (east; WRAe), St. Helens We and East Lake, in a peat core located in Newfoundland. Following on from this work, several ongoing projects have examined additional peat cores from Michigan, New York State, Maine, Nova Scotia and Newfoundland to build a tephrostratigraphic framework for this region. Using the precedent set by recent research by Jensen et al.(in press) that correlated the Alaskan WRAe to the European cryptotephra AD860B, unknown tephras identified in this work were not necessarily assumed to be from "expected" source areas (e.g. the Cascades). Here we present several examples of the preservation of tephra layers with an intercontinental distribution (i.e. WRAe and Ksudach 1), from relatively small magnitude events (i.e. St. Helens layer T, Mono Crater), and the first example of a Mexican ash in the NE (Volcan Ceboruco, Jala pumice). There are several implications of the identification of these units. These far-travelled ashes: (1) highlight the need to consider "ultra" distal source volcanoes for unknown cryptotephra deposits,. (2) present an opportunity for physical volcanologists to examine why some eruptions have an exceptional distribution of ash that is not necessarily controlled by the magnitude of the event. (3) complicate the idea of using tephrostratigraphic frameworks to understand the frequency of eruptions towards aiding hazard planning and prediction (e.g. Swindles et al., 2011). (4) show that there is a real potential to link tropical and mid to high-latitude paleoenvironmental records. Jensen et al. (in press) Transatlantic correlation of the Alaskan White River Ash. Geology. Pyne-O'Donnell et al. (2012). High-precision ultra-distal Holocene tephrochronology in North America. Quaternary Science Reviews, 52, 6-11. Swindles et al. (2011). A 7000 yr perspective on volcanic ash clouds affecting northern Europe. Geology, 39, 887-890.

Tacrolimus is not associated with gingival overgrowth in renal transplant patients

BACKGROUND: Cyclosporin A is used extensively to prevent the rejection of allogenic renal transplants. However, it is associated with a variety of undesirable side effects including gingival overgrowth. Tacrolimus (FK506), has been marketed as an effective alternative immunosuppressant to cyclosporin A and recent subjective reports suggest patients taking it complain infrequently of gingival problems. This clinical investigation was undertaken to confirm whether or not tacrolimus adversely affected the gingival health of renal transplant recipients.

METHODS: Renal transplant patients (RTPs) under the care of the Renal Transplantation Service at the Manchester Royal Infirmary, who had received a renal allograft at least 18 months earlier, were recruited for this study. All but one of the RTPs had been taking tacrolimus since transplantation. The other had commenced tacrolimus therapy two months after receiving her allograft. A hospital based control group was recruited from non transplanted individuals attending the Turner Dental School, Manchester. Each patient underwent a detailed dental assessment and had dental impressions taken. The extent of gingival overgrowth was determined from plaster models.

RESULTS: 25 renal transplant recipients and 26 control patients were included in the study. None of the individuals in either the tacrolimus or control groups had clinically significant overgrowth. The patients in the tacrolimus group with the highest overgrowth scores were those also taking calcium antagonists as treatment for hypertension.

CONCLUSION: This study demonstrates that tacrolimus has no adverse effects on the gingival tissues and thus has potential as an alternative immunosuppressant for individuals susceptible to developing cyclosporin A-induced gingival overgrowth.