Long-term outcomes of patients with Wilson disease in a large Austrian cohort

BACKGROUND & AIMS Wilson disease is an autosomal recessive disorder that affects copper metabolism, leading to copper accumulation in liver, central nervous system, and kidneys. There are few data on long-term outcomes and survival from large cohorts; we studied these features in a well-characterized Austrian cohort of patients with Wilson disease. METHODS We analyzed data from 229 patients diagnosed with Wilson disease from 1961 through 2013; 175 regularly attended a Wilson disease outpatient clinic and/or their physicians were contacted for information on disease and treatment status and outcomes. For 53 patients lost during the follow-up period, those that died and reasons for their death were identified from the Austrian death registry. RESULTS The mean observation period was 14.8 ± 11.4 years (range, 0.5-52.0 years), resulting in 3116 patient-years. Of the patients, 61% presented with hepatic disease, 27% with neurologic symptoms, and 10% were diagnosed by family screening at presymptomatic stages. Patients with a hepatic presentation were diagnosed younger (21.2 ± 12.0 years) than patients with neurologic disease (28.8 ± 12.0; P < .001). In 2% of patients, neither symptoms nor onset of symptoms could be determined with certainty. Most patients stabilized (35%) or improved on chelation therapy (26% fully recovered, 24% improved), but 15% deteriorated; 8% required a liver transplant, and 7.4% died within the observation period (71% of deaths were related to Wilson disease). A lower proportion of patients with Wilson disease survived for 20 years (92%) than healthy Austrians (97%), adjusted for age and sex (P = .03). Cirrhosis at diagnosis was the best predictor of death (odds ratio, 6.8; 95% confidence interval, 1.5-31.03; P = .013) and need for a liver transplant (odds ratio, 07; 95% confidence interval, 0.016-0.307; P < .001). Only 84% of patients with cirrhosis survived 20 years after diagnosis (compared with healthy Austrians, P =.008). CONCLUSION Overall, patients who receive adequate care for Wilson disease have a good long-term prognosis. However, cirrhosis increases the risk of death and liver disease. Early diagnosis, at a precirrhotic stage, might increase survival times and reduce the need for a liver transplant.

Transient sediment supply in a high-altitude Alpine environment evidenced through a 10Be budget of the Etages catchment (French Western Alps)

Although beryllium-10 (10Be) concentrations in stream sediments provide useful synoptic views of catchment-wide erosion rates, little is known on the relative contributions of different sediment supply mechanisms to the acquisition of their initial signature in the headwaters. Here we address this issue by conducting a 10Be-budget of detrital materials that characterize the morphogenetic domains representative of high-altitude environments of the European Alps. We focus on the Etages catchment, located in the Ecrins-Pelvoux massif (southeast France), and illustrate how in situ 10Be concentrations can be used for tracing the origin of the sand fraction from the bedload in the trunk stream. The landscape of the Etages catchment is characterized by a geomorphic transient state, high topographic gradients, and a large variety of modern geomorphic domains ranging from glacial environments to scarcely vegetated alluvial plains. Beryllium-10 concentrations measured in the Etages catchment vary from similar to 1 x 104 to 4.5 x 105 atoms per gram quartz, while displaying consistent 10Be signatures within each representative morphogenetic unit. We show that the basic requirements for inferring catchment-wide denudation from 10Be concentration measurements are not satisfied in this small, dynamic catchment. However, the distinct 10Be signature observed for the geomorphic domains can be used as a tracer. We suggest that a terrestrial cosmogenic nuclide (TCN) budget approach provides a valuable tool for the tracing of material origin in basins where the let nature do the averaging' principles may be violated.

Exploring sustainability through stakeholders' perspectives and hybrid water in the Swiss alps

Can the concept of water as a socio-natural hybrid and the analysis of different users’ perceptions of water advance the study of water sustainability? In this article, I explore this question by empirically studying sustainability values and challenges, as well as distinct types of water as identified by members of five water user groups in a case study region in the Swiss Alps. Linking the concept of water as a socio-natural hybrid with the different water users’ perspectives provided valuable insights into the complex relations between material, cultural, and discursive practices. In particular, it provided a clearer picture of existing water sustainability challenges and the factors and processes that hinder more sustainable outcomes. However, by focusing on relational processes and individual stakeholder perspectives, only a limited knowledge could be created regarding a) what a more sustainable water future would look like and b) how current unsustainable practices can be effectively transformed into more sustainable ones. I conclude by arguing that the concept of water as a socio-natural hybrid provides an interesting analytical tool for investigating sustainability questions; however, if it is to contribute to water sustainability, it needs to be integrated into a broader transdisciplinary research perspective that understands science as part of a deliberative and reflective process of knowledge co-production and social learning between all actor groups involved.

Bedrock bedding, landsliding and erosional budgets in the Central European Alps

We explore the controls of the litho-tectonic architecture on the erosional flux in the 370-km2 Glogn basin (European Alps). In this basin, the bedding and schistosity of the bedrock dip parallel to the topographic slope on the NW valley flank, leading to a non-dip slope situation on the opposite SE valley side. While the dip slope condition has promoted the occurrence of landslides (e.g. the c. 30-km2 deep-seated Lumnezia landslide), the opposite non-dip slope side of the valley hosts >100-m-deeply incised tributary streams. 10Be concentrations of stream sediments yield catchment-averaged denudation rates that vary between 0.27 ± 0.03 and 2.19 ± 0.37 mm a−1, while the spatially averaged denudation rate of the entire basin is 1.99 ± 0.34 mm a−1. Our 10Be-based approach reveals that the Lumnezia landslide front contributes c. 30–65% of the entire sediment budget, although it covers <5% of the Glogn basin. This suggests a primary control of the bedrock bedding on erosion rates and processes.

Efficiency of frost-cracking processes through space and time: An example from the eastern Italian Alps

It is widely accepted that climate has a strong impact and exerts important feedbacks on erosional processes and sediment transport mechanisms. However, the extent at which climate influences erosion is still a matter of debate. In this paper we test whether frost-cracking processes and related temperature variations can influence the sediment production and surface erosion in a small catchment situated in the eastern Italian Alps. To this extent, we first present a geomorphic map of the region that we complement with published 10Be-based denudation rates. We then apply a preexisting heat-flow model in order to analyze the variations of the frost-cracking intensity (FCI) in the study area, which could have controlled the sediment production in the basin. Finally, we compare the model results with the pattern of denudation rates and Quaternary deposits in the geomorphic map. The model results, combined with field observations, mapping, and quantitative geomorphic analyses, reveal that frost-cracking processes have had a primary role in the production of sediment where the intensity of sediment supply has been dictated and limited by the combined effect of temperature variations and conditions of bedrock preservation. These results highlight the importance of a yet poorly understood process for the production of sediment in mountain areas.

P-T-t estimation of syn-kinematic strain in low-grade quartz-feldspar bearing rocks using thermodynamic modeling and 40Ar/39Ar dating techniques: example of the Plan-de-Phasy shear zone unit (Briançonnais Zone, Western Alps)

Pressure–Temperature–time (P–T–t) estimates of the syn-kinematic strain at the peak-pressure conditions reached during shallow underthrusting of the Briançonnais Zone in the Alpine subduction zone was made by thermodynamic modelling and 40Ar/39Ar dating in the Plan-de-Phasy unit (SE of the Pelvoux Massif, Western Alps). The dated phengite minerals crystallized syn-kinematically in a shear zone indicating top-to-the-N motion. By combining X-ray mapping with multi-equilibrium calculations, we estimate the phengite crystallization conditions at 270 ± 50 °C and 8.1 ± 2 kbar at an age of 45.9 ± 1.1 Ma. Combining this P–T–t estimate with data from the literature allows us to constrain the timing and geometry of Alpine continental subduction. We propose that the Briançonnais units were scalped on top of the slab during ongoing continental subduction and exhumed continuously until collision.

The deglaciation history of the Simplon region (southern Swiss Alps) constrained by 10Be exposure dating of ice-molded bedrock surfaces

The deglaciation history of the Swiss Alps after the Last Glacial Maximum involved the decay of several ice domes and the subsequent disintegration of valley glaciers at high altitude. Here we use bedrock exposure dating to reconstruct the temporal and spatial pattern of ice retreat at the Simplon Pass (altitude: ∼2000 m) located 40 km southwest of the ‘Rhône ice dome’. Eleven 10Be exposure ages from glacially polished quartz veins and ice-molded bedrock surfaces cluster tightly between 13.5 ± 0.6 ka and 15.4 ± 0.6 ka (internal errors) indicating that the Simplon Pass depression became ice-free at 14.1 ± 0.4 ka (external error of mean age). This age constraint is interpreted to record the melting of the high valley glaciers in the Simplon Pass region during the warm Bølling–Allerød interstadial shortly after the Oldest Dryas stadial. Two bedrock samples collected a few hundred meters above the pass depression yield older 10Be ages of 17.8 ± 0.6 ka and 18.0 ± 0.6 ka. These ages likely reflect the initial downwasting of the Rhône ice dome and the termination of the ice transfluence from the ice dome across the Simplon Pass toward the southern foreland. There, the retreat of the piedmont glacier in Val d’Ossola was roughly synchronous with the decay of the Rhône ice dome in the interior of the mountain belt, as shown by 10Be ages of 17.7 ± 0.9 ka and 16.1 ± 0.6 ka for a whaleback at ∼500 m elevation near Montecrestese in northern Italy. In combination with well-dated paleoclimate records derived from lake sediments, our new age data suggest that during the deglaciation of the European Alps the decay of ice domes was approximately synchronous with the retreat of piedmont glaciers in the foreland and was followed by the melting of high-altitude valley glaciers after the transition from the Oldest Dryas to the Bølling–Allerød, when mean annual temperatures rose rapidly by ∼3 °C.

Minor inheritance inhibits the calibration of the 10Be production rate from the AD 1717 Val Ferret rock avalanche, European Alps

To calibrate the in situ 10Be production rate, we collected surface samples from nine large granitic boulders within the deposits of a rock avalanche that occurred in AD 1717 in the upper Ferret Valley, Mont Blanc Massif, Italy. The 10Be concentrations were extremely low and successfully measured within 10% analytical uncertainty or less. The concentrations vary from 4829 ± 448 to 5917 ± 476 at g−1. Using the historical age exposure time, we calculated the local and sea level-high latitude (i.e. ≥60°) cosmogenic 10Be spallogenic production rates. Depending on the scaling schemes, these vary between 4.60 ± 0.38 and 5.26 ± 0.43 at g−1 a−1. Although they correlate well with global values, our production rates are clearly higher than those from more recent calibration sites. We conclude that our 10Be production rate is a mean and an upper bound for production rates in the Massif region over the past 300 years. This rate is probably influenced by inheritance and will yield inaccurate (e.g. too young) exposure ages when applied to surface-exposure studies in the area. Other independently dated rock-avalanche deposits in the region that are approximately 103 years old could be considered as possible calibration sites.

36Cl production rate from K-spallation in the European Alps (Chironico landslide, Switzerland)

The abundant production of in situ cosmogenic 36Cl from potassium renders 36Cl measurements in K-rich rocks or minerals, such as K-feldspars, potentially useful for precisely dating rock surfaces, either in single-nuclide or in multi-nuclide studies, for example combined with 10Be measurements in quartz. However, significant discrepancies in experimentally calibrated 36Cl production rates from spallation of potassium (36PK-sp), referenced to sea-level/high-latitude (SLHL), limit the accuracy of 36Cl dating from K-rich lithologies. We present a new 36Cl calibration using K-feldspars, in which K-spallation is the most dominant 36Cl production pathway (>92% of total 36Cl), thus minimizing uncertainties from the complex multi-pathway 36Cl production systematics. The samples are derived from boulders of an ∼13.4 ka-old landslide in the Swiss Alps (∼820 m, 46.43°N, 8.85°E). We obtain a local 36PK-sp of 306 ± 16 atoms 36Cl (g K)−1 a−1 and an SLHL 36PK-sp of 145.5 ± 7.7 atoms 36Cl (g K)−1 a−1, when scaled with a standard scaling protocol (‘Lm’). Applying this SLHL 36PK-sp to determine 36Cl exposure ages of K-feldspars from 10Be-dated moraine boulders yields excellent agreement, confirming the validity of the new SLHL 36PK-sp for surface exposure studies, involving 36Cl in K-feldspars, in the Alps.

Chronology of Lateglacial ice flow reorganization and deglaciation in the Gotthard Pass area, Central Swiss Alps, based on cosmogenic 10Be and in situ 14C

We reconstruct the timing of ice flow reconfiguration and deglaciation of the Central Alpine Gotthard Pass, Switzerland, using cosmogenic 10Be and in situ14C surface exposure dating. Combined with mapping of glacial erosional markers, exposure ages of bedrock surfaces reveal progressive glacier downwasting from the maximum LGM ice volume and a gradual reorganization of the paleoflow pattern with a southward migration of the ice divide. Exposure ages of ∼16–14 ka (snow corrected) give evidence for continuous early Lateglacial ice cover and indicate that the first deglaciation was contemporaneous with the decay of the large Gschnitz glacier system. In agreement with published ages from other Alpine passes, these data support the concept of large transection glaciers that persisted in the high Alps after the breakdown of the LGM ice masses in the foreland and possibly decayed as late as the onset of the Bølling warming. A younger group of ages around ∼12–13 ka records the timing of deglaciation following local glacier readvance during the Egesen stadial. Glacial erosional features and the distribution of exposure ages consistently imply that Egesen glaciers were of comparatively small volume and were following a topographically controlled paleoflow pattern. Dating of a boulder close to the pass elevation gives a minimum age of 11.1 ± 0.4 ka for final deglaciation by the end of the Younger Dryas. In situ14C data are overall in good agreement with the 10Be ages and confirm continuous exposure throughout the Holocene. However, in situ14C demonstrates that partial surface shielding, e.g. by snow, has to be incorporated in the exposure age calculations and the model of deglaciation.

Sediments of Lake Vens (SW European Alps, France) record large-magnitude earthquake events

We studied sediment cores from Lake Vens (2,327 m asl), in the Tinée Valley of the SW Alps, to test the paleoseismic archive potential of the lake sediments in this particularly earthquake-sensitive area. The historical earthquake catalogue shows that moderate to strong earthquakes, with intensities of IX–X, have impacted the Southern Alps during the last millennium. Sedimentological (X-ray images, grain size distribution) and geochemical (major elements and organic matter) analyses show that Lake Vens sediments consist of a terrigenous, silty material (minerals and organic matter) sourced from the watershed and diatom frustules. A combination of X-ray images, grain-size distribution, major elements and magnetic properties shows the presence of six homogenite-type deposits interbedded in the sedimentary background. These sedimentological features are ascribed to sediment reworking and grain sorting caused by earthquake-generated seiches. The presence of microfaults that cross-cut the sediment supports the hypothesis of seismic deposits in this system. A preliminary sediment chronology is provided by 210Pb measurement and AMS 14C ages. According to the chronology, the most recent homogenite events are attributable to damaging historic earthquakes in AD 1887 (Ligure) and 1564 (Roquebillière). Hence, the Lake Vens sediment recorded large-magnitude earthquakes in the region and permits a preliminary estimate of recurrence time for such events of ~400 years.

The tectonometamorphic evolution of the Sesia–Dent Blanche nappes (internal Western Alps): review and synthesis

This study reviews and synthesizes the present knowledge on the Sesia–Dent Blanche nappes, the highest tectonic elements in the Western Alps (Switzerland and Italy), which comprise pieces of pre-Alpine basement and Mesozoic cover. All of the available data are integrated in a crustal-scale kinematic model with the aim to reconstruct the Alpine tectono-metamorphic evolution of the Sesia–Dent Blanche nappes. Although major uncertainties remain in the pre-Alpine geometry, the basement and cover sequences of the Sesia–Dent Blanche nappes are seen as part of a thinned continental crust derived from the Adriatic margin. The earliest stages of the Alpine evolution are interpreted as recording late Cretaceous subduction of the Adria-derived Sesia–Dent Blanche nappes below the South-Alpine domain. During this subduction, several sheets of crustal material were stacked and separated by shear zones that rework remnants of their Mesozoic cover. The recently described Roisan-Cignana Shear Zone of the Dent Blanche Tectonic System represents such a shear zone, indicating that the Sesia–Dent Blanche nappes represent a stack of several individual nappes. During the subsequent subduction of the Piemonte–Liguria Ocean large-scale folding of the nappe stack (including the Roisan-Cignana Shear Zone) took place under greenschist facies conditions, which indicates partial exhumation of the Dent Blanche Tectonic System. The entrance of the Briançonnais micro-continent within the subduction zone led to a drastic change in the deformation pattern of the Alpine belt, with rapid exhumation of the eclogite-facies ophiolite bearing units and thrust propagation towards the foreland. Slab breakoff probably was responsible for allowing partial melting in the mantle and Oligocene intrusions into the most internal parts of the Sesia–Dent Blanche nappes. Finally, indentation of the Adriatic plate into the orogenic wedge resulted in the formation of the Vanzone back-fold, which marks the end of the pervasive ductile deformation within the Sesia–Dent Blanche nappes during the earliest Miocene.

Geometry and kinematics of the Roisan-Cignana Shear Zone, and the orogenic evolution of the Dent Blanche Tectonic System (Western Alps)

The Dent Blanche Tectonic System (DBTS) is a composite thrust sheet derived from the previously thinned passive Adriatic continental margin. A kilometric high-strain zone, the Roisan-Cignana Shear Zone (RCSZ) defines the major tectonic boundary within the DBTS and separates it into two subunits, the Dent Blanche s.s. nappe to the northwest and the Mont Mary nappe to the southeast. Within this shear zone, tectonic slices of Mesozoic and pre-Alpine meta-sediments became amalgamated with continental basement rocks of the Adriatic margin. The occurrence of high pressure assemblages along the contact between these tectonic slices indicates that the amalgamation occurred prior to or during the subduction process, at an early stage of the Alpine orogenic cycle. Detailed mapping, petrographic and structural analysis show that the Roisan-Cignana Shear Zone results from several superimposed Alpine structural and metamorphic stages. Subduction of the continental fragments is recorded by blueschist-facies deformation, whereas the Alpine collision is reflected by a greenschist facies overprint associated with the development of large-scale open folds. The postnappe evolution comprises the development of low-angle brittle faults, followed by large-scale folding (Vanzone phase) and finally brittle extensional faults. The RCSZ shows that fragments of continental crust had been torn off the passive continental margin prior to continental collision, thus recording the entire history of the orogenic cycle. The role of preceding Permo-Triassic lithospheric thinning, Jurassic rifting, and ablative subduction processes in controlling the removal of crustal fragments from the reactivated passive continental margin is discussed. Results of this study constrain the temporal sequence of the tectono-metamorphic processes involved in the assembly of the DBTS, but they also show limits on the interpretation. In particular it remains difficult to judge to what extent precollisional rifting at the Adriatic continental margin preconditioned the efficiency of convergent processes, i.e. accretion, subduction, and orogenic exhumation.