Morphological Brain Changes after Climbing to Extreme Altitudes-A Prospective Cohort Study.

BACKGROUND Findings of cerebral cortical atrophy, white matter lesions and microhemorrhages have been reported in high-altitude climbers. The aim of this study was to evaluate structural cerebral changes in a large cohort of climbers after an ascent to extreme altitudes and to correlate these findings with the severity of hypoxia and neurological signs during the climb. METHODS Magnetic resonance imaging (MRI) studies were performed in 38 mountaineers before and after participating in a high altitude (7126m) climbing expedition. The imaging studies were assessed for occurrence of new WM hyperintensities and microhemorrhages. Changes of partial volume estimates of cerebrospinal fluid, grey matter, and white matter were evaluated by voxel-based morphometry. Arterial oxygen saturation and acute mountain sickness scores were recorded daily during the climb. RESULTS On post-expedition imaging no new white matter hyperintensities were observed. Compared to baseline testing, we observed a significant cerebrospinal fluid fraction increase (0.34% [95% CI 0.10-0.58], p = 0.006) and a white matter fraction reduction (-0.18% [95% CI -0.32--0.04], p = 0.012), whereas the grey matter fraction remained stable (0.16% [95% CI -0.46-0.13], p = 0.278). Post-expedition imaging revealed new microhemorrhages in 3 of 15 climbers reaching an altitude of over 7000m. Affected climbers had significantly lower oxygen saturation values but not higher acute mountain sickness scores than climbers without microhemorrhages. CONCLUSIONS A single sojourn to extreme altitudes is not associated with development of focal white matter hyperintensities and grey matter atrophy but leads to a decrease in brain white matter fraction. Microhemorrhages indicative of substantial blood-brain barrier disruption occur in a significant number of climbers attaining extreme altitudes.

Time-varying signal analysis to detect high-altitude periodic breathing in climbers ascending to extreme altitude.

This work investigates the performance of cardiorespiratory analysis detecting periodic breathing (PB) in chest wall recordings in mountaineers climbing to extreme altitude. The breathing patterns of 34 mountaineers were monitored unobtrusively by inductance plethysmography, ECG and pulse oximetry using a portable recorder during climbs at altitudes between 4497 and 7546 m on Mt. Muztagh Ata. The minute ventilation (VE) and heart rate (HR) signals were studied, to identify visually scored PB, applying time-varying spectral, coherence and entropy analysis. In 411 climbing periods, 30-120 min in duration, high values of mean power (MP(VE)) and slope (MSlope(VE)) of the modulation frequency band of VE, accurately identified PB, with an area under the ROC curve of 88 and 89%, respectively. Prolonged stay at altitude was associated with an increase in PB. During PB episodes, higher peak power of ventilatory (MP(VE)) and cardiac (MP(LF)(HR) ) oscillations and cardiorespiratory coherence (MP(LF)(Coher)), but reduced ventilation entropy (SampEn(VE)), was observed. Therefore, the characterization of cardiorespiratory dynamics by the analysis of VE and HR signals accurately identifies PB and effects of altitude acclimatization, providing promising tools for investigating physiologic effects of environmental exposures and diseases.

Trends of mean and extreme temperature indices since 1874 at low-elevation sites in the Southern Alps

We describe the recovery of three daily meteorological records for the southern Alps (Domodossola, Riva del Garda, and Rovereto), all starting in the second half of the nineteenth century. We use these new data, along with additional records, to study regional changes in the mean temperature and extreme indices of heat waves and cold spells frequency and duration over the period 1874–2015. The records are homogenized using subdaily cloud cover observations as a constraint for the statistical model, an approach that has never been applied before in the literature. A case study based on a record of parallel observations between a traditional meteorological window and a modern screen shows that the use of cloud cover can reduce the root-mean-square error of the homogenization by up to 30% in comparison to an unaided statistical correction. We find that mean temperature in the southern Alps has increased by 1.4°C per century over the analyzed period, with larger increases in daily minimum temperatures than maximum temperatures. The number of hot days in summer has more than tripled, and a similar increase is observed in duration of heat waves. Cold days in winter have dropped at a similar rate. These trends are mainly caused by climate change over the last few decades.

Increased endothelial microparticles and oxidative stress at extreme altitude.

PURPOSE Hypoxia and oxidative stress affect endothelial function. Endothelial microparticles (MP) are established measures of endothelial dysfunction and influence vascular reactivity. To evaluate the effects of hypoxia and antioxidant supplementation on endothelial MP profiles, a double-blind, placebo-controlled trial, during a high altitude expedition was performed. METHODS 29 participants were randomly assigned to a treatment group (n = 14), receiving vitamin E, C, A, and N-acetylcysteine daily, and a control group (n = 15), receiving placebo. Blood samples were obtained at 490 m (baseline), 3530, 4590, and 6210 m. A sensitive tandem mass spectrometry method was used to measure 8-iso-prostaglandin F2α and hydroxyoctadecadienoic acids as markers of oxidative stress. Assessment of MP profiles including endothelial activation markers (CD62+MP and CD144+MP) and cell apoptosis markers (phosphatidylserine+MP and CD31+MP) was performed using a standardized flow cytometry-based protocol. RESULTS 15 subjects reached all altitudes and were included in the final analysis. Oxidative stress increased significantly at altitude. No statistically significant changes were observed comparing baseline to altitude measurements of phosphatidylserine expressing MP (p = 0.1718) and CD31+MP (p = 0.1305). Compared to baseline measurements, a significant increase in CD62+MP (p = 0.0079) and of CD144+MP was detected (p = 0.0315) at high altitudes. No significant difference in any MP level or oxidative stress markers were found between the treatment and the control group. CONCLUSION Hypobaric hypoxia is associated with increased oxidative stress and induces a significant increase in CD62+ and CD144+MP, whereas phosphatidylserine+MP and CD31+MP remain unchanged. This indicates that endothelial activation rather than an apoptosis is the primary factor of hypoxia induced endothelial dysfunction.

Wie sich die politischen Extreme versöhnen : In den Armen liegen sich Beide ...

Welsch (Projektbearbeiter): Karikatur auf ein Zweckbündnis der Abgeordneten Schlöffel und Radowitz von der äußersten Linken und Rechten der Frankfurter Nationalversammlung. "Gerade die Diskussion um das Reichsoberhaupt und das Wahlrecht (15.2. - 2.3. 1849 brachte Bündnisse zwischen der extremen Rechten und ... Linken hervor." [Zeit f. neue Ideen; Wiesbaden 1998, S. 168]

Extreme River Floods in Western Switzerland and the Lake of Constance Region in the Period Prior to Instrumental Measurements

The floods that occurred on the Aare and Rhine rivers in May 2015 and the mostly successful handling of this event in terms of flood protection measures are a good reminder of how important it is to comprehend the causes and processes involved in such natural hazards. While the needed data series of gauge measurements and peak discharge calculations reach back to the 19th century, historical records dating further back in time can provide additional and useful information to help understanding extreme flood events and to evaluate prevention measures such as river dams and corrections undertaken prior to instrumental measurements. In my PhD project I will use a wide range of historical sources to assess and quantify past extreme flood events. It is part of the SNF-funded project “Reconstruction of the Genesis, Process and Impact of Major Pre-instrumental Flood Events of Major Swiss Rivers Including a Peak Discharge Quantification” and will cover the research locations Fribourg (Saane R.), Burgdorf (Emme R.), Thun, Bern (both Aare R.), and the Lake of Constance at the locations Lindau, Constance and Rorschach. My main goals are to provide a long time series of quantitative data for extreme flood events, to discuss the occurring changes in these data, and to evaluate the impact of the aforementioned human influences on the drainage system. Extracting information given in account books from the towns of Basel and Solothurn may also enable me to assess the frequency and seasonality of less severe river floods. Finally, historical information will be used for remodeling the historical hydrological regime to homogenize the historical data series to modern day conditions and thus make it comparable to the data provided by instrumental measurements. The method I will apply for processing all information provided by historical sources such as chronicles, newspapers, institutional records, as well as flood marks, paintings and archeological evidence has been developed and successfully applied to the site of Basel by Wetter et al. (2011). They have also shown that data homogenization is possible by reconstructing previous stream flow conditions using historical river profiles and by carefully observing and re-constructing human changes of the river bed and its surroundings. Taken all information into account, peak discharges for past extreme flood events will be calculated with a one-dimensional hydrological model.

Timing of extreme drought modifies reproductive output in semi-natural grassland

Questions Do extreme dry spells in late summer or in spring affect abundance and species composition of the reproductive shoots and the seed rain in the next annual crop? Are drought effects on reproductive shoots related to the rooting depths of species? Location Species-rich semi-natural grassland at Negrentino, Switzerland. Methods In plots under automated rain-out shelters, rainwater was added to simulate normal conditions and compare them with two experimentally effected long dry spells, in late summer (2004) and in the following spring (2005). For 28 plots, numbers of reproductive shoots per species were counted in 1-m2 areas and seed rain was estimated using nine sticky traps of 102 cm2 after dry spells. Results The two extreme dry spells in late summer and spring were similar in length and their probability of recurrence. They independently reduced the subsequent reproductive output of the community, while their seasonal timing modified its species composition. Compared to drought in spring, drought in late summer reduced soil moisture more and reduced the number of reproductive shoots of more species. The negative effects of summer drought decreased with species’ rooting depth. The shallow-rooted graminoids showed a consistent susceptibility to summer drought, while legumes and other forbs showed more varied responses to both droughts. Spring drought strongly reduced density (–53%) and species richness (–43%) of the community seed rain, while summer drought had only a marginally significant impact on seed density of graminoids (–44%). Reductions in seed number per shoot vs reproductive shoot density distinguished the impacts of drought with respect to its seasonal timing. Conclusion The essentially negative impact of drought in different seasons on reproductive output suggests that more frequent dry spells could contribute to local plant diversity loss by aggravating seed deficiency in species-rich grassland.

Trends in mean and extreme precipitation in the Mount Kenya region from observations and reanalyses

Land and water management in semi-arid regions requires detailed information on precipitation distribution, including extremes, and changes therein. Such information is often lacking. This paper describes statistics of mean and extreme precipitation in a unique data set from the Mount Kenya region, encompassing around 50 stations with at least 30 years of data. We describe the data set, including quality control procedures and statistical break detection. Trends in mean precipitation and extreme indices calculated from these data for individual rainy seasons are compared with corresponding trends in reanalysis products. From 1979 to 2011, mean precipitation decreased at 75% of the stations during the ‘long rains’ (March to May) and increased at 70% of the stations during the ‘short rains’ (October to December). Corresponding trends are found in the number of heavy precipitation days, and maximum of consecutive 5-day precipitation. Conversely, an increase in consecutive dry days within both main rainy seasons is found. However, trends are only statistically significant in very few cases. Reanalysis data sets agree with observations with respect to interannual variability, while correlations are considerably lower for monthly deviations (ratios) from the mean annual cycle. While some products well reproduce the rainfall climatology and some the spatial trend pattern, no product reproduces both.

Impact of reactive oxygen species (ROS) on the control of parasite loads and inflammation in Leishmania amazonensis infection

Background: Reactive oxygen species (ROS) protect the host against a large number of pathogenic microorganisms. ROS have different effects on parasites of the genus Leishmania: some parasites are susceptible to their action, while others seem to be resistant. The role of ROS in L. amazonensis infection in vivo has not been addressed to date. Methods: In this study, C57BL/6 wild-type mice (WT) and mice genetically deficient in ROS production by phagocytes (gp91phox−/− ) were infected with metacyclic promastigotes of L. amazonensis to address the effect of ROS in parasite control. Inflammatory cytokines, parasite loads and myeloperoxidase (MPO) activity were evaluated. In parallel, in vitro infection of peritoneal macrophages was assessed to determine parasite killing, cytokine, NO and ROS production. Results: In vitro results show induction of ROS production by infected peritoneal macrophages, but no effect in parasite killing. Also, ROS do not seem to be important to parasite killing in vivo, but they control lesion sizes at early stages of infection. IFN-γ, TNF-α and IL-10 production did not differ among mouse strains. Myeloperoxidase assay showed augmented neutrophils influx 6 h and 72 h post - infection in gp91phox−/− mice, indicating a larger inflammatory response in gp91phox−/− even at early time points. At later time points, neutrophil numbers in lesions correlated with lesion size: larger lesions in gp91phox−/− at earlier times of infection corresponded to larger neutrophil infiltrates, while larger lesions in WT mice at the later points of infection also displayed larger numbers of neutrophils. Conclusion: ROS do not seem to be important in L. amazonensis killing, but they regulate the inflammatory response probably by controlling neutrophils numbers in lesions.

Health impacts of extreme weather: Flood fatalities in Texas

Floods are the leading cause of fatalities related to natural disasters in Texas. Texas leads the nation in flash flood fatalities. From 1959 through 2009 there were three times more fatalities in Texas (840) than the following state Pennsylvania (265). Texas also leads the nation in flood-related injuries (7753). Flood fatalities in Texas represent a serious public health problem. This study addresses several objectives of Healthy People 2010 including reducing deaths from motor vehicle accidents (Objective 15-15), reducing nonfatal motor vehicle injuries (Objective 15-17), and reducing drownings (Objective 15-29). The study examined flood fatalities that occurred in Texas between 1959 and 2008. Flood fatality statistics were extracted from three sources: flood fatality databases from the National Climatic Data Center, the Spatial Hazard Event and Loss Database for the United States, and the Texas Department of State Health Services. The data collected for flood fatalities include the date, time, gender, age, location, and type of flood. Inconsistencies among the three databases were identified and discussed. Analysis reveals that most fatalities result from driving into flood water (77%). Spatial analysis indicates that more fatalities occurred in counties containing major urban centers – some of the Flash Flood Alley counties (Bexar, Dallas, Travis, and Tarrant), Harris County (Houston), and Val Verde County (Del Rio). An intervention strategy targeting the behavior of driving into flood water is proposed. The intervention is based on the Health Belief model. The main recommendation of the study is that flood fatalities in Texas can be reduced through a combination of improved hydrometeorological forecasting, educational programs aimed at enhancing the public awareness of flood risk and the seriousness of flood warnings, and timely and appropriate action by local emergency and safety authorities.^