Trends in incidences and risk factors for hepatocellular carcinoma and other liver events in HIV and hepatitis C virus co-infected individuals from 2001 to 2014: a multi-cohort study.

BACKGROUND  While liver-related deaths in HIV and hepatitis C virus (HCV) co-infected individuals have declined over the last decade, hepatocellular carcinoma (HCC) may have increased. We described the epidemiology of HCC and other liver events in a multi-cohort collaboration of HIV/HCV co-infected individuals. METHODS  We studied all HCV antibody-positive adults with HIV in the EuroSIDA Study, the Southern Alberta Clinic Cohort, the Canadian Co-infection Cohort, and the Swiss HIV Cohort Study from 2001 to 2014. We calculated the incidence of HCC and other liver events (defined as liver-related deaths or decompensations, excluding HCC) and used Poisson regression to estimate incidence rate ratios. RESULTS  Our study comprised 7,229 HIV/HCV co-infected individuals (68% male, 90% white). During follow-up, 72 cases of HCC and 375 other liver events occurred, yielding incidence rates of 1.6 (95% confidence interval (CI): 1.3, 2.0) and 8.6 (95% CI: 7.8, 9.5) cases per 1,000 person-years of follow-up, respectively. The rate of HCC increased 11% per calendar year (95% CI: 4%, 19%) and decreased 4% for other liver events (95% CI: 2%, 7%), but only the latter remained statistically significant after adjustment for potential confounders. High age, cirrhosis, and low current CD4 cell count were associated with a higher incidence of both HCC and other liver events. CONCLUSIONS  In HIV/HCV co-infected individuals, the crude incidence of HCC increased from 2001 to 2014, while other liver events declined. Individuals with cirrhosis or low current CD4 cell count are at highest risk of developing HCC or other liver events.

Silicon isotopes of sediment core GeoB2107-3

The supply of nutrients to the low-latitude thermocline is largely controlled by intermediate-depth waters formed at the surface in the high southern latitudes. Silicic acid is an essential macronutrient for diatoms, which are responsible for a significant portion of marine carbon export production. Changes in ocean circulation, such as those observed during the last deglaciation, would influence the nutrient composition of the thermocline and, therefore, the relative abundance of diatoms in the low latitudes. Here we present the first record of the silicic acid content of the Atlantic over the last glacial cycle. Our results show that at intermediate depths of the South Atlantic, the silicic acid concentration was the same at the Last Glacial Maximum (LGM) as it is today, overprinted by high silicic acid pulses that coincided with abrupt changes in ocean and atmospheric circulation during Heinrich Stadials and the Younger Dryas. We suggest these pulses were caused by changes in intermediate water formation resulting from shifts in the subpolar hydrological cycle, with fundamental implications for the nutrient supply to the Atlantic.

Table 1. Radiocarbon dates from TPC522 and box core surface samples from BC521 and BC523

Recent intensification of wind-driven upwelling of warm upper circumpolar deep water (UCDW) has been linked to accelerated melting of West Antarctic ice shelves and glaciers. To better assess the long term relationship between UCDWupwelling and the stability of theWest Antarctic Ice Sheet, we present a multi-proxy reconstruction of surface and bottom water conditions in Marguerite Bay, West Antarctic Peninsula (WAP), through the Holocene. A combination of sedimentological, diatom and foraminiferal records are, for the first time, presented together to infer a decline in UCDW influence within Marguerite Bay through the early to mid Holocene and the dominance of cyclic forcing in the late Holocene. Extensive glacial melt, limited sea ice and enhanced primary productivity between 9.7 and 7.0 ka BP is considered to be most consistent with persistent incursions of UCDW through Marguerite Trough. From 7.0 ka BP sea ice seasons increased and productivity decreased, suggesting that UCDW influence within Marguerite Bay waned, coincident with the equatorward migration of the Southern Hemisphere Westerly Winds (SWW). UCDW influence continued through the mid Holocene, and by 4.2 ka BP lengthy sea ice seasons persisted within Marguerite Bay. Intermittent melting and reforming of this sea ice within the late Holocene may be indicative of episodic incursions of UCDW into Marguerite Bay during this period. The cyclical changes in the oceanography within Marguerite Bay during the late Holocene is consistent with enhanced sensitively to ENSO forcing as opposed to the SWW-forcing that appears to have dominated the early to mid Holocene. Current measurements of the oceanography of the WAP continental shelf suggest that the system has now returned to the early Holocene-like oceanographic configuration reported here, which in both cases has been associated with rapid deglaciation.

Stable carbon isotope record and geochemistry of late Miocene-early Pliocene sediments from DSDP Site 90-590 in the Tasman Sea

Biogenic components of sediment accumulated at high rates beneath frontal zones of the Indian and Pacific oceans during the late Miocene and early Pliocene. The delta13C of bulk and foraminiferal carbonate also decreased during this time interval. Although the two observations may be causally linked, and signify a major perturbation in global biogeochemical cycling, no site beneath a frontal zone has independent records of export production and delta13C on multiple carbonate phases across the critical interval of interest. Deep Sea Drilling Project (DSDP) site 590 lies beneath the Tasman Front (TF), an eddy-generating jetstream in the southwest Pacific Ocean. To complement previous delta13C records of planktic and benthic foraminifera at this location, late Neogene records of CaCO3 mass accumulation rate (MAR), Ca/Ti, Ba/Ti, Al/Ti, and of bulk carbonate and foraminiferal delta13C were constructed at site 590. The delta13C records include bulk sediment, bulk sediment fractions (<63 µm and 5-25 µm), and the planktic foraminifera Globigerina bulloides, Globigerinoides sacculifer (with and without sac), and Orbulina universa. Using current time scales, CaCO3 MARs, Ca/Ti, Al/Ti and Ba/Ti ratios are two to three times higher in upper Miocene and lower Pliocene sediment relative to overlying and underlying units. A significant decrease also occurs in all delta13C records. All evidence indicates that enhanced export production - the 'biogenic bloom' - extended to the southwest Pacific Ocean between ca. 9 and 3.8 Ma, and this phenomenon is coupled with changes in delta13C - the 'Chron C3AR carbon shift'. However, CaCO3 MARs peak ca. 5 Ma whereas elemental ratios are highest ca. 6.5 Ma; foraminiferal delta13C starts to decrease ca. 8 Ma whereas bulk carbonate delta13C begins to drop ca. 5.6 Ma. Temporal discrepancies between the records can be explained by changes in the upwelling regime at the TF, perhaps signifying a link between changes in ocean-atmosphere circulation change and widespread primary productivity.

The life and letters of Madame Élisabeth de France, followed by the Journal of the Temple,

Edition limited to 800 numbered sets.

Evaluation of the corridor safety improvement program.

Oregon Department of Transportation, Salem

Completed tales of my Knights and Ladies,

"White Knights on Dartmoor and Tales of my Knights and Ladies are now recalled from circulation and this book will take the place of both. It contains the essential matter from the other two, beside the end of each Knight who appeared in Tales."--Author's note.

Ballad book,

Preface dated: March, 1904.