Early identification of symptomatic aortic stenosis using echocardiographic data

Background: Heart failure (CHF) is the most frequent and prognostically severe symptom of aortic stenosis (AS), and the most common indication for surgery. The mainstay of treatment for AS is aortic valve replacement (AVR), and the main indication for an AVR is development of symptomatic disease. ACC/AHA guidelines define severe AS as an aortic valve area (AVA) ≤1cm², but there is little data correlating echocardiogram AVA with the onset of symptomatic CHF. We evaluated the risk of developing CHF with progressively decreasing echocardiographic AVA. We also compared echocardiographic AVA with Jet velocity (V2) and indexed AVA (AVAI) to assess the best predictor of development of symptomatic CHF.^ Methods and Results: This retrospective cohort study evaluated 518 patients with asymptomatic moderate or severe AS from a single community based cardiology practice. A total of 925 echocardiograms were performed over an 11-year period. Each echocardiogram was correlated with concurrent clinical assessments while the investigator was blinded to the echocardiogram severity of AS. The Cox Proportional hazards model was used to analyze the relationship between AVA and the development of CHF. The median age of patients at entry was 76.1 years, with 54% males. A total of 116 patients (21.8%) developed new onset CHF during follow-up. Compared to patients with AVA >1.0cm², patients with lower AVA had an exponentially increasing risk of developing CHF for each 0.2cm² decrement in AVA, becoming statistically significant only at an AVA less than 0.8 cm². Also, compared to V2 and AVAI, AVA added more information to assessing risk for development of CHF (p=0.041). ^ Conclusion: In patients with normal or mildly impaired LVEF, the risk of CHF rises exponentially with decreasing valve area and becomes statistically significant after AVA falls below 0.8cm². AVA is a better predictor of CHF when compared to V2 or AVAI.^

Phytoplankton photosynthetic competence, underway data of SOIREE cruise track 1999-02-08 to 1999-02-24

Active fluorescence (fast repetition rate fluorometry, FRRF) was used to follow the photosynthetic response of the phytoplankton community during the 13-day Southern Ocean Iron RElease Experiment (SOIREE). This in situ iron enrichment was conducted in the polar waters of the Australasian-Pacific sector of the Southern Ocean in February 1999. Iron fertilisation of these high nitrate low chlorophyll (HNLC) waters resulted in an increase in the photosynthetic competence (Fv/Fm) of the resident cells from around 0.20 to greater than 0.60 (i.e. close to the theoretical maximum) by 10/11 days after the first enrichment. Although a significant iron-mediated response in Fv/Fm was detected as early as 24 h after the initial fertilisation, the increase in Fv/Fm to double ambient levels took 6 days. This response was five-fold slower than observed in iron enrichments (in situ and in vitro) in the HNLC waters of the subarctic and equatorial Pacific. Although little is known about the relationship between water temperature and Fv/Fm, it is likely that low water temperatures - and possibly the deep mixed layer - were responsible for this slow response time. During SOIREE, the photosynthetic competence of the resident phytoplankton in iron-enriched waters increased at dissolved iron levels above 0.2 nM, suggesting that iron limitation was alleviated at this concentration. Increases in Fv/Fm of cells within four algal size classes suggested that all taxa displayed a photosynthetic response to iron enrichment. Other physiological proxies of algal iron stress (such as flavodoxin levels in diatoms) exhibited different temporal trends to iron-enrichment than Fv/Fm during the time-course of SOIREE. The relationship between Fv/Fm, algal growth rate and such proxies in Southern Ocean waters is discussed.

Carbon and nitrogen isotopic composition of Early Toarcian sediments

Bulk sedimentary nitrogen isotope (d15Ntot) data have been generated from Lower Jurassic black, carbon-rich shales in the British Isles and northern Italy deposited during the early Toarcian oceanic anoxic event. A pronounced positive d15Ntot excursion through the exaratum Subzone of the falciferum Zone (defined by characteristic ammonites in the British Isles) broadly correlates with a relative maximum in weight percent total organic carbon and, in some sections, with a negative d13Corg excursion. Upwelling of a deoxygenated water mass that had undergone partial denitrification is the likely explanation for relative enrichment of d15Ntot, and parallels may be drawn with Quaternary sediments of the Arabian Sea, Gulf of California, and northwest Mexican margin. The development of Early Toarcian suboxic water masses and consequent partial denitrification is attributed to increases in organic productivity. Approximately coincident phenomena include the following: a relative climatic optimum, realignment of major oceanic current systems, and a possible release of methane gas hydrates from continental margin sediments early in the history of the oceanic anoxic event.

Early - Late Miocene palaeoclimate data and palaefloras of 48 samples from Southern China

Southern China, especially Yunnan, has undergone high tectonic activity caused by the uplift of Himalayan Mountains during the Neogene, which led to a fast changing palaeogeography. Previous study shows that Southern China has been influenced by the Asian Monsoon since at least the Early Miocene. However, it is yet not well understood how intense the Miocene monsoon system was. In the present study, 63 fossil floras of 16 localities from Southern China are compiled and evaluated for obtaining available information concerning floristic composition, stratigraphic age, sedimentology, etc. Based on such reliable information, selected mega- and micro-floras have been analysed with the coexistence approach to obtain quantitative palaeoclimate data. Visualization of climate results in maps shows a distinct spatial differentiation in Southern China during the Miocene. Higher seasonalities of temperature and precipitation occur in the north and south parts of Southern China, respectively. During the Miocene, most regions of Southern China and Europe were both warm and humid. Central Eurasia was likely to be an arid center, which gradually spread westward and eastward. Our data provide information about Miocene climate patterns in Southern China and about the evolution of these patterns throughout the Miocene, and is also crucial to unravel and understand the climatic signals of global cooling and tectonic uplift.

Climatological observations from ship logbooks between 1750 and 1854 (release 2.1)

The Climatological Database for the World's Oceans: 1750-1854 (CLIWOC) project, which concluded in 2004, abstracted more than 280,000 daily weather observations from ships' logbooks from British, Dutch, French, and Spanish naval vessels engaged in imperial business in the eighteenth and nineteenth centuries. These data, now compiled into a database, provide valuable information for the reconstruction of oceanic wind field patterns for this key period that precedes the time in which anthropogenic influences on climate became evident. These reconstructions, in turn, provide evidence for such phenomena as the El Niño-Southern Oscillation and the North Atlantic Oscillation. Of equal importance is the finding that the CLIWOC database the first coordinated attempt to harness the scientific potential of this resource represents less than 10 percent of the volume of data currently known to reside in this important but hitherto neglected source.

Latent tuberculosis infection : a diagnostic challenge : Tuberculin skin testing versus interferon-γ release assays

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014