Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time: a randomized clinical trial.

BACKGROUND Anesthetics and neuraxial anesthesia commonly result in vasodilation/hypotension. Norepinephrine counteracts this effect and thus allows for decreased intraoperative hydration. The authors investigated whether this approach could result in reduced postoperative complication rate. METHODS In this single-center, double-blind, randomized, superiority trial, 166 patients undergoing radical cystectomy and urinary diversion were equally allocated to receive 1 ml·kg·h of balanced Ringer's solution until the end of cystectomy and then 3 ml·kg·h until the end of surgery combined with preemptive norepinephrine infusion at an initial rate of 2 µg·kg·h (low-volume group; n = 83) or 6 ml·kg·h of balanced Ringer's solution throughout surgery (control group; n = 83). Primary outcome was the in-hospital complication rate. Secondary outcomes were hospitalization time, and 90-day mortality. RESULTS In-hospital complications occurred in 43 of 83 patients (52%) in the low-volume group and in 61 of 83 (73%) in the control group (relative risk, 0.70; 95% CI, 0.55-0.88; P = 0.006). The rates of gastrointestinal and cardiac complications were lower in the low-volume group than in the control group (5 [6%] vs. 31 [37%]; relative risk, 0.16; 95% CI, 0.07-0.39; P < 0.0001 and 17 [20%] vs. 39 [48%], relative risk, 0.43; 95% CI, 0.26-0.60; P = 0.0003, respectively). The median hospitalization time was 15 days [range, 11, 27d] in the low-volume group and 17 days [11, 95d] in the control group (P = 0.02). The 90-day mortality was 0% in the low-volume group and 4.8% in the control group (P = 0.12). CONCLUSION A restrictive-deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy and urinary diversion significantly reduced the postoperative complication rate and hospitalization time.

Response of a First-Order Stream in Maine to Short-Term In-Stream Acidification

An experimental short-term acidification with HCl at a first-order stream in central Maine, USA was used to study processes controlling the changes in stream chemistry and to assess the ability of stream substrate to buffer pH. The streambed exerted a strong buffering capacity against pH change by ion exchange during the 6-hour acidification. Streambed substrates had substantial cation and anion exchange capacity in the pH range of 4.1 to 6.5. The ion exchange for cations and SO42- were rapid and reversible. The speed of release of cations from stream substrates was Na1+ > Ca2+ > Mg2+ > Aln+ > Be2+, perhaps relating to charge density of these cations. Ca2+ desorption dominated neutralisation of excess H+ for the first 2 hr. As the reservoir of exchangeable Ca diminished, desorption land possibly dissolution) of Al3+ became the dominant neutralising mechanism. The exchangeable land possibly soluble) reservoir of Al was not depleted during the 6-hour acidification. Sulphate adsorption during the acidification reduced the concentration of SO42- in stream water by as much as 20 mu eq L-1 (from 70 mu eq L-1). Desorption of SO42- and adsorption of base cat ions after the artificial acidification resulted in a prolongation of the pH depression. The streambed had the capacity to buffer stream water chemistry significantly during an acidifying event affecting the entire upstream catchment.

p.L1612P, a Novel Voltage-gated Sodium Channel Nav1.7 Mutation Inducing a Cold Sensitive Paroxysmal Extreme Pain Disorder

BACKGROUND Mutations in the SCN9A gene cause chronic pain and pain insensitivity syndromes. We aimed to study clinical, genetic, and electrophysiological features of paroxysmal extreme pain disorder (PEPD) caused by a novel SCN9A mutation. METHODS Description of a 4-generation family suffering from PEPD with clinical, genetic and electrophysiological studies including patch clamp experiments assessing response to drug and temperature. RESULTS The family was clinically comparable to those reported previously with the exception of a favorable effect of cold exposure and a lack of drug efficacy including with carbamazepine, a proposed treatment for PEPD. A novel p.L1612P mutation in the Nav1.7 voltage-gated sodium channel was found in the four affected family members tested. Electrophysiologically the mutation substantially depolarized the steady-state inactivation curve (V1/2 from -61.8 ± 4.5 mV to -30.9 ± 2.2 mV, n = 4 and 7, P < 0.001), significantly increased ramp current (from 1.8% to 3.4%, n = 10 and 12) and shortened recovery from inactivation (from 7.2 ± 5.6 ms to 2.2 ± 1.5 ms, n = 11 and 10). However, there was no persistent current. Cold exposure reduced peak current and prolonged recovery from inactivation in wild-type and mutated channels. Amitriptyline only slightly corrected the steady-state inactivation shift of the mutated channel, which is consistent with the lack of clinical benefit. CONCLUSIONS The novel p.L1612P Nav1.7 mutation expands the PEPD spectrum with a unique combination of clinical symptoms and electrophysiological properties. Symptoms are partially responsive to temperature but not to drug therapy. In vitro trials of sodium channel blockers or temperature dependence might help predict treatment efficacy in PEPD.

Pollen records and age determinations from 2 profiles at Lake Nikolay, Lena Delta

Radiocarbon-dated pollen, rhizopod, chironomid and total organic carbon (TOC) records from Nikolay Lake (73°20'N, 124°12'E) and a pollen record from a nearby peat sequence are used for a detailed environmental reconstruction of the Holocene in the Lena Delta area. Shrubby Alnus fruticosa and Betula exilis tundra existed during 10,300-4800 cal. yr BP and gradually disappeared after that time. Climate reconstructions based on the pollen and chironomid records suggest that the climate during ca. 10,300-9200 cal. yr BP was up to 2-3 °C warmer than the present day. Pollen-based reconstructions show that the climate was relatively warm during 9200-6000 cal. yr BP and rather unstable between ca. 5800-3700 cal. yr BP. Both the qualitative interpretation of pollen data and the results of quantitative reconstruction indicate that climate and vegetation became similar to modern-day conditions after ca. 3600 cal. yr BP. The chironomid-based temperature reconstruction suggests a relatively warm period between ca. 2300 and 1400 cal. yr BP, which corresponds to the slightly warmer climate conditions reconstructed from the pollen. Modern chironomid and rhizopod assemblages were established after ca. 1400 cal. yr BP.

Pollen and macroremains from sediment core Aschenhütte

The Upper Pleistocene sediments of the Aschenhütte sink-hole (west of Herzberg am Harz, Lower Saxony) enable one to make interesting correlations between palynological and geological results. The sequence is composed of limnic-telmatic deposits (Eemain to Lower Weichselian) and loess with paleosoils (Weichselian). Sedimentation started during the hornbeam-dominated phase of the Eemian interglacial period and continued throughout the Eemian, the Weichselian Brörup interstadial (sensu Andersen) and parts of the preceding and the following stadial phases, the Herning and the Rederstall stadials. As opposed to most of the known Eemian sites spruce was a major tree species during the hornbeam-dominated phase of the Eemian. The vegetational development during the interstadial phase does not show a period of climatic deterioration as is the case for the Brörup interstadial when considering regions with a more demanding vegetation or regions close to the natural boundaries of the tree species concerned. Pollen or seeds of Bruckenthalia and Picea omoricoides have not been found in the Aschenhütte cores. The limnic-telmatic sediments interlock with loess-paleosoils (Eemian soil and Lower Weichselian bleaching soils) at the lake shore. They are overlaid by loess paleosoils of the Stillfried-B interstadial (Hattorf soil and Lohne soil). Lake level fluctuations were determined by means of the facies distribution and isochrones as defined by pollen analysis. A relatively high stand of the lake level existed after the end of the Eemian interglacial and during the Brörup interstadial periods. In the course of the Herning stadial period the water level dropped, whereas during the Rederstall stadial phase the lake basin was covered by sediments and therefore dried up.

Pollen record with radiocarbon datings from Faddeyevskiy Island, Laptev Sea

Pollen, plant macrofossil, loss-on-ignition and radiocarbon analyses of a 1.4-m section in thermokarst topography from Faddeyevskiy Island (75°20'N, 143°50'E, 30 m elevation) provides new information on Late Pleistocene interstadial environmental history of this high Arctic region. Conventional radiocarbon dates (25,700 ± 1000, 32,780 ± 500, 35,200 ± 650 yr BP) and two AMS dates (29,950 ± 660 and 42,990 ± 1280 yr BP) indicate that the deposits accumulated during the Kargian (Boutellier) interval. Numerous mammoth (Mammuthus primigenius) remains that have been collected in vicinity of the site in this study were radio-carbon dated to 36,700-18,500 yr BP. Rare bison (Bison priscus) bones were dated to 32,200 ± 600 and 33,100 ± 320 yr BP. Poaceae, Cyperaceae, and Artemisia pollen dominate the spectra with some Ranunculaceae, Caryophyllaceae, Rosaceae, and Asteraceae. The pollen spectra reflect steppe-like (tundra-steppe) vegetation, which was dominant on the exposed shelf of the Arctic Ocean. Numerous Carex macrofossils suggest that the summer climate was at least 2°C warmer than today. The productivity of the local vegetation during the Kargian interstadial was high enough to feed the population of grazing mammals.

Pollen record from Golkow, Poland

Janczyk-Kopikowa (1966): The series of the organic deposits, developed in the vicinity of Golkow near Warsaw as oil shales and peats, was laid down in a grough valley and now rests on the deposits of the Middle Polish Glaciation (Riss). The organic deposits are overlain by the fluviale deposits of the North Polish Glaciation (Würm). The locality Golkow occurs beyond the extent of the continental glacier of this glaciation. Polen analysis completed by microfloristic examinations allows to determine the age of the organic series that is thought to be Eemian. The pollen diagram from Golkow does not call in question the stratigraphical position of the deposits investigated mainly due to its characteristic features such as minimum content of coniferous trees in the climatic optimum - about 5%, high percentage of Corylus - 77.5% and well developed phase of hornbeam. It may be well compared with other Eemian diagrams from the area of Poland and reveals much similar features. The development of vegetation at Golkow has depended upon the prevailing climate. At first, the cool climate brings about the development of plants having small thermal requirements. Here belong thin, park-like forests with pine and birch (Pinus, Betula) accompanied by the heliophilic plants such as Hippohäe and Ephedra. Improvement of climate that becomes warm and humid provides for development of deciduous forests prevailing in the climatic optimum, of the interglacial. Decrease of temperature causes a repeated change in the type of forest. This latter changes into coniferous forest with prevailing spruce (Picea) and fir (Abies) at the beginning, and then with pine (Pinus) and birch (Betula). During the Eemian Interglacial, the development of plants at Golkow terminates with a new and long-lasting predominance of pine-birch forests. However, such a longevity may be apparent only. Apparent character of this phenomenon is proved by a fact that the pollen spectra of the warm climatic periods have found their reflex in the oil shale that increased considerably slower than the layers off feebly decomposed peat evidencing the existence of cool pine-birch forests from the decline of the Interglacial. The water basin, in which the polen grains were laid down from surrounding plants is characterized by a calm sedimentation as proved by the occurrence of the oil shale. An insignificant water flow left behind some thin sand laminae. The not too deep basin becomes shallower owing to the growing water vegetation, and marshy vegetation. The growing of the plants causes a complete shallowing of the basin and formation of peat bog in situ, as proved by the peat beds occurring in the section. ---- Gadomska (1966): In the vicinity of Golków a series of organic deposits occurs amounting to 6.5-9.3 m in thickness, and consisting of oil shales, lacustrine silts and sands, as well as peats and peaty silts. The organic deposits fill up an old, small, but fairly deep lake basin, probably of finger-lake origin. It may be seen to-day as a slight lowering of the relief, filled up with soaked ground, stretching from north to south. On the basis of palaeobotanical examinations the organic deposits considered are of Eemian Interglacial age (Z. Janczyk-Kopikowa, 1063). The lower part of the organic series consists of a compact oil shale horizon, the maximum thickness of which may attain up to 8 m. The oil shales contain particularly in their upper part, numerous intercalations of arenaceous silts, dark grey or black in colour, or of sands mainly of lacustrine provenance. At the top of the oil shales are found peats, up to 2.5 m in thickness, covered by black, humus silts with numerous plant remains. The Eemian Interglacial deposits are covered by a series of fluviatile sands belonging partly to the Baltic Glaciation (bottom part of the series), partly to the Holocene (top part of the series). The thickness of the sands is 0.5-3.7 m. Higher up, there are found the Holocene and present-day deposits developed as clayey alluvion, or arenaceous slide rocks, or arenaceous-silty soil.

Pollen profiles from 8 sediment cores from the Degersee, Southern Germany

The discovery of a neolithic pile field in the shallow water near the eastern shore of the Degersee confirmed earlier palynological and sedimentological studies stating that early man was active in the region since more than 6000 years. The already available off-site data were freshly assessed, completed by additional data from old and new cores and the interpretations revised. A common time scale for the off-site data and the on-site data was obtained by AMS dating of terrestrial macro remains of the neolithic section of off-site core De_I+De_H. The ages can thus be parallelled with AMS ages of construction timber on-site. Pollen analyses from all cores provide a further time scale. The continuously and densely sampled pollen profile of the profundal zone embracing the entire Late glacial and Holocene serves as a reference. From the Boreal onwards the relative ages are transformed by AMS ages and varve counts into calibrated and absolute. A transect cored close to the neolithic pile field across the lake marl-platform demonstrates its geological architecture in the shallow water since the Lateglacial. Studies of the microfabric of thin sections of drilled cores and of box cores from the excavations demonstrate that neolithic settlements now at 2-3,5 m water depth had been erected on lake marl freshly fallen dry, thus indicating earlier lake levels dropped by 1.5-2 m. The neolithic section of the highly resolved off-site profile in the lake=s profundal zone has laminated and calcareous zones alternating with massive ones. Assemblages of diatoms and concentrations of trace elements changing simultaneously characterise the calcareous sections as deposits of low lake levels that lasted between some 40 and more than 300 years. The ages of discovered lake shore dwellings fall into calcareous segments with low lake levels. From the end of the Upper Atlantic period (F VII) appear Secondary Forest Cycles in the beech forest, a man-made sequence of repeated vegetational development with an identical pattern: With a decrease of beech pollen appear pollen of grasses, herbs and cultural indicators. These are suppressed by the light demanding hazel and birch, those again by ash, and finally by the shade demanding beech forming a new pollen peak. Seven main Forest Cycles are identified In the upper Neolithic period each comprising some 250, 450 or 800 years. They are subdivided into subcycles that can be broken down by very dense sampling in even shorter cycles of decadal length. Farming settlers have caused minor patchy clearances of the beech-mixed-forest with the use of fire. The phases of clearance coincide with peaks of charcoal and low stands of the lake levels. The Secondary Forest Cycles and the continuous occurrence of charcoal prove a continued occupation of the region. Together with the repeated restoration of the beech climax forest they point to pulsating occupation probably associated with dynamic demography. The synchronism of the many palynological, sedimentological and archaeological data point to an external forcing as the climate that affects comprehensively all these proxies. The fluctuations of the activity of the sun as manifested in the residual d14C go largely along with the proxies. The initial clearances at the begin of the forest cycles are linked to low lake levels and negative values of d14C that point to dry and warm phases of a more continental climate type. The subcycles exist independent from climatic changes, indicating that early man acted largely independent from external forces.

Pollen records and age determination of site Bokanjacko Blato

In summary, one may conclude that human influence in the Bokanjac area started in the Eneolithic or Earlier Bronze Age - the third to second millennia Cal. BC. Traces of agriculture are weak or missing in the pollen diagram but grazing is indicated. Chestnut and walnut were introduced by humans to the area in classical times. These findings are in general agreement with the results of earlier studies at coastal sites north-west and south-east of Bokanjacko Blato.

Pollen record and age determination of a sediment profile from Lake Teletskoye, Russia

A high-resolution pollen record from Lake Teletskoye documents the climate-related vegetation history of the northern Altai Mountain region during the last millennium. Siberian pine taiga with Scots pine, fir, spruce, and birch dominated the vegetation between ca. AD 1050 and 1100. The climate was similar to modern. In the beginning of the 12th century, birch and shrub alder increased. Lowered pollen concentrations and simultaneous peaks in herbs (especially Artemisia and Poaceae), ferns, and charcoal fragments point to colder and more arid climate conditions than before, with frequent fire events. Around AD 1200, regional climate became warmer and more humid than present, as revealed by an increase of Siberian pine and decreases of dry herb taxa and charcoal contents. Climatic conditions were rather stable until ca. AD 1410. An increase of Artemisia pollen may reflect slightly drier climate conditions between AD 1410 and 1560. Increases in Alnus, Betula, Artemisia, and Chenopodiaceae pollen and in charcoal particle contents may reflect further deterioration of climate conditions between AD 1560 and 1810, consistent with the Little Ice Age. After AD 1850 the vegetation gradually approached the modern one, in conjunction with ongoing climate warming.

Pollen records of the Bykovsky Peninsula

New pollen and radiocarbon data from the Bykovsky Peninsula document the Late Pleistocene and Holocene environmental history of the Laptev Sea coast. More than 60 AMS-14C and conventional 14C dates indicate that the deposits accumulated during the last 60,000 radiocarbon yr BP. High concentration of green alga colonies (Pediustrum and Botryococcus) in the investigated sediment show that sedimentation was mostly in shallow water environments. Scarce grass and sedge communities dominated the vegetation 53-60 kyr BP. Climate was cold and dry. Open Poaceae and Cypcraccae associations with Asteraceae, Ranunculaceae, and Cichoriaceac, dominated in the area about 48-42.5 kyr BP. Steppic communities with Artemisia and shrubby tundra communities with Salix and Betula sect. Nanae were also present. Climate was dry, but relatively warm. Vegetation cover became denser about 42.5-33.5 kyr BP, reflecting more favorable climate conditions. Scarce Poaceae communities with some Caryophyllaceae, Asteraceae, Cichoriaceae, and Selaginella rupestris covered the Bykovsky Peninsula area during the Sartan (Late Weichselian) stage about 26-16 kyr BP. Disturbed, uncovered soils were very common in the area. Climate was extremely cold and dry. Poaceae and Cyperaceae associations with Caryophyllaceae, Asteraceae, Cichoriaceae dominated the vegetation in the late Sartan, ca 16-12.2 kyr BP. Climate was significantly warmer than in the early Sartan time. The lee Complex sedimentation was interrupted about 12 kyr BP; most likely it was connected with the beginning of the Allerod warnring. Shrubby (Betula sect. Nanae, Alnusfnuicosa, Salix, Ericales) tundra was widely distributed on the Bykovsky Peninsula during the early-middle Holacene. Climate was most favorable between 8200 and 4500 yr BP. Vegetation became similar to modern after 4500 yr BP, suggesting a deterioration of climate.

Pollen record and age determinations on four sites from Taymyr Peninsula, Russia

Pollen data from a Levinson-Lessing Lake sediment core (74°28'N, 98°38'E) and Cape Sabler, Taymyr Lake permafrost sequences (74°33'N, 100°32'E) reveal substantial environmental changes on the northern Taymyr Peninsula during the last c. 32 000 14C years. The continuous records confirm that a scarce steppe-like vegetation with Poaceae, Artemisia and Cyperaceae dominated c. 32 000-10 300 14C yr BP, while tundra-like vegetation with Oxyria, Ranunculaceae and Caryophyllaceae grew in wetter areas. The coldest interval occurred c. 18 000 yr BP. Lateglacial pollen data show several warming events followed by a climate deterioration c. 10 500 14C yr BP, which may correspond with the Younger Dryas. The Late Pleistocene/Holocene transition, c. 10 300-10 000 14C yr BP, is characterized by a change from the herb-dominated vegetation to shrubby tundra with Betula sect. Nanae and Salix. Alnus fruticosa arrived locally c. 9000-8500 14C yr BP and disappeared c. 4000-3500 14C yr BP. Communities of Betula sect. Nanae, broadly distributed at c. 10 000-3500 14C yr BP, almost disappeared when vegetation became similar to the modern herb tundra after 3500-3000 14C yr BP. Quantitative climate reconstructions show Last Glacial Maximum summer temperature about 4°C below the present and Preboreal (c. 10 000 14C yr BP) temperature 2-4°C above the present. Maximum summer temperature occurred between 10 000 and 5500 14C yr BP; later summers were similar to present or slightly warmer.