Estado funcional y mortalidad en pacientes neoplásicos hospitalizados

Objetivos: Analizar el estado funcional y su relación con morbimortalidad en pacientes con neoplasias internados en Cínica Médica. Material y métodos: Estudio descriptivo, protocolizado y observacional. Se analizaron variables clínicas, estado funcional, situación anímica y morbimortalidad en pacientes oncológicos hospitalizados y se compararon pacientes con Índice de Karnofsky <40 puntos (grupo A) y >40 puntos (grupo B). Los datos fueron analizados en EPI Info 6.04. Informe de los primeros 3 meses. Resultados: En el período de estudio, ingresaron 66 pacientes con neoplasias, 21 (31.8%) en A, con Karnofsky promedio de 25 puntos (DS±12.09) y 45 (68.2%) en B, con Karnofsky promedio de 77 puntos (DS±16.65). El 77.3% presentó tumores sólidos y el 22.7% hematológicos y las neoplasias más frecuentes fueron del tracto gastrointestinal (19.6%), mama (12.1%), pulmón (9.1%) y primario oculto (7.6%). El estadio tumoral IV fue el más frecuente en ambos grupos (89.5% de A y 88.9% de B)(pNS). La edad media en A fue de 59.57 (DS±13.71) y 52.48 años (DS±15.65) en B (pNS) y el género masculino fue más frecuente en A (66.7 y 44.4% respectivamente) (p<0.05). La permanencia media fue de 17.57 en A (DS±20.84) y de 13.53 días (DS±16.29) en B (pNS). La evaluación de Actividades Básicas de la Vida Diaria [0.81 (DS±1.25) vs 4.57 puntos (DS±1.15)] y Actividades Instrumentales [0.57 (DS±0.74) vs 4 puntos (DS±1.37)] fue superior en B (p<0.05) y no hubo diferencias en la comorbilidad (85.7 vs 82.2%)(pNS). Las infecciones (52.4 vs 26.7%), causa social (38.1 vs 4.4%), complicaciones neoplásicas (81 vs 51.1%) y dolor (81 vs 51.1%) fueron los motivos de internación más frecuentes en A (p<0.05). Los pacientes de A recibieron con mayor frecuencia cuidados paliativos (90.5 vs46.7%) y quimioterapia (90.5 vs 46.7%)(p<0.05), sin diferencias en radioterapia (23.8 vs 13.3%) y cirugía (33.3 vs 33.3%)(pNS). No hubo diferencias entre ambos grupos en la presencia de depresión clínica (69.9 vs 53.3%) y pérdida de peso (86.4 vs 84.2%)(pNS). El síndrome confusional (85.7 vs 11.1%), postración (61.9 vs 6.7%) y escaras (23.8 vs 4.4%) fueron más frecuentes en A (p<0.05). La mortalidad hospitalaria fue 52.4% en A y 8.9% en B (p<0.05). Conclusiones: El grado de estado funcional evaluado por Karnofsky menor de 40 puntos se asoció significativamente a: mayor mortalidad, uso de quimioterapia, cuidados paliativos, internación por infecciones, dolor y complicaciones neoplásicas y presencia de síndrome confusional, postración y escaras de decúbito (p<0.05).

Distribution of planktonic foraminifera in Pleistocene sediments of the New Jersey margin, NW Atlantic Ocean

Abundance records of planktonic foraminifera (>150 µm) from the upper 520 m of ODP Site 1073 (Hole 1073A, Leg 174A, 639 m water depth) have been integrated with SPECMAP-derived isotope stratigraphy, percentage of calcium carbonate, and coarse sediment fraction data in order to investigate the Pleistocene climatic history of the New Jersey margin. Six planktonic taxonomic groups dominate the foraminiferal assemblage at Site 1073: Neogloboquadrina pachyderma (d) (mean 33.8%), Turborotalita quinqueloba (18.5%), N. pachyderma (s) (18.4%), Globigerina bulloides group (11.4%), Globorotalia inflata group (9.4%), and Globigerinita glutinata (4.1%). Based on the distributions of these six foraminiferal groups, the Pleistocene section can be divided into three paleoclimatic intervals: Interval I (intermediate) corresponds to the Quaternary sediments from sequence boundary pp1 to the seafloor (79.5-0 mbsf; Emiliania huxleyi acme [85 ka] at 72 mbsf); Interval II (warm) occurs between sequence boundaries pp3 and pp1 (325-79.5 mbsf; last occurrence of Pseudoemiliania lacunosa [460 ka] at 330 mbsf); and Interval III (coldest) occurs between sequence boundaries pp4 and pp3 (520-325 mbsf; Calcareous nannofossils and dinocysts in proximity to pp4 indicate that the sedimentary record for 0.9-1.7 Ma is either missing altogether or highly condensed within the basal few meters of the section). Neogloboquadrina pachyderma (d) displays eight peaks of abundance which correlate, for the most part, with depleted delta18O values, increases in calcium carbonate percentages, low coarse fraction percentages, increased planktonic fragmentation (greater dissolution), and low N. pachyderma (s) abundances. These intervals are interpreted as representing warmer/interglacial conditions. Neogloboquadrina pachyderma (s) displays seven peaks of abundance which correlate, for the most part, with delta18O increases, decreases in calcium carbonate percentages, increases in coarse fraction percentages, and low N. pachyderma (d) abundances. These intervals are interpreted as representing cooler/glacial conditions. In Interval III, a faunal response to relative changes in sea-surface temperature is reflected by abundance peaks in Neogloboquadrina pachyderma (d), followed by Turborotalita quinqueloba and then N. pachyderma (s) (proceeding from warmest to coolest, respectively). This tripartite response is consistent with the oxygen isotope record and, although not as clear, also occurs in Intervals I and II. Six peaks/peak intervals of Globigerina bulloides abundance are closely matched by peaks in Globigerinita glutinata and occur within oxygen isotope stage (OIS) 2 (latter part) 3, 4, 5, 8, 9, 13(?), 14(?), and 15(?). We speculate that these intervals reflect increased upwelling and nutrient levels during both glacials and interglacials. Eight peak intervals of Globorotalia inflata show a general inverse correlation with G. bulloides and may reflect lowered nutrient and warmer surface waters.

Organic geochemistry of two sediment cores from the Kara Sea

Within the Russian-German research project on "Siberian River Run-off (SIRRO)" devoted to the freshwater discharge and its influence on biological, geochemical, and geological processes in the Kara Sea, sedimentological and organic-geochemical investigations were carried-out on two well-dated sediment cores from the Yenisei Estuary area. The main goal of this study was to quantify the terrigenous organic carbon accumulation based on biomarker and bulk accumulation rate data, and its relationship to Yenisei river discharge and climate change through Holocene times. The biomarker data at both cores clearly indicate the predominance of terrigenous organic matter, reaching 70 to 100% and 50 to 80% of the total organic carbon within and directly north of the estuary, respectively. During the last about 9 Cal. kyrs. BP represented in the studied sediment section, siliciclastic sediment and (terrigenous) organic carbon input was strongly influenced by postglacial sea-level rise and climate-related changes in river discharge. The mid-Holocene Climatic Optimum is documented by maximum river discharge between 8.2 and 7.3 Cal. kyrs. BP. During the last 2000 years river discharge probably became reduced, and accumulation of both terrigenous and marine organic carbon increased due to increased coagulation of fine-grained material.

Geochemistry of the lower sheeted dike complex of ODP Holes 137-504B and 140-504B

Sixty-three samples representing 379 m of sheeted dikes from Deep Sea Drilling Project/Ocean Drilling Program Site 504B have been analyzed for major and selected trace elements by X-ray fluorescence. The samples range from microcrystalline aphyric basalts to moderately phyric (2%-10% phenocrysts) diabase that are typically multiply saturated with plagioclase, olivine, and clinopyroxene, in order of relative abundance. All analyzed samples are classified as Group D compositions with moderate to slightly elevated compatible elements (MgÆ-value = 0.65% ± 0.03%; Al2O3 = 15.5% ± 0.8%; CaO = 13.0% ± 0.3%; Ni = 114 ± 29 ppm), and unusually depleted levels of moderate to highly incompatible elements (Nb < 1 ppm; Zr = 44 ± 7 ppm; Rb < 0.5 ppm; Ba ~ 1 ppm; P2O5 = 0.07% ± 0.02%). These compositions are consistent with a multistage melting of a normal ocean ridge basaltic mantle source followed by extensive fractionation of olivine, plagioclase, and clinopyroxene. Leg 140 aphyric to sparsely phyric (0%-2% phenocrysts) basalts and diabases are compositionally indistinguishable from similarly phyric samples at higher levels in the hole. An examination of the entire crustal section, from the overlying volcanics through the sheeted dikes observed in Leg 140, reveals no significant trends indicating the enrichment or depletion of Costa Rica Rift Zone source magmas over time. Similarly, significant trends toward increased or decreased differentiation cannot be identified, although compositional patterns reflecting variable amounts of phenocryst addition are apparent at various depths. Below ? 1700 mbsf to the bottom of the Leg 140 section, there is a broadly systematic pattern of Zn depletion with depth, the result of high-temperature hydrothermal leaching. This zone of depletion is thought to be a significant source of Zn for the hydrothermal fluids depositing metal sulfides at ridge-crest hydrothermal vents and the sulfide-mineralization zone, located in the transition between pillow lavas and sheeted dikes. Localized zones of intense alteration (60%-95% recrystallization) are present on a centimeter to meter scale in many lithologic units. Within these zones, normally immobile elements Ti, Zr, Y, and rare-earth elements are strongly depleted compared with "fresher" samples centimeters away. The extent of compositional variability of these elements tends to obscure primary igneous trends if the highly altered samples are not identified or removed. At levels up to 40% (or possibly 60%) recrystallization, Ti, Zr, and Y retain their primary signatures. Although the mechanisms are unclear, it is possible that these intense alteration zones are a source of Y and rare-earth elements for the typically rare-earth-element-enriched hydrothermal vent fluids of mid-ocean ridges.

Age determination, planktic foraminifera and stable istopes of sediment core MSM05/5_712-2

A sediment core from the West Spitsbergen continental margin was studied to reconstruct climate and paleoceanographic variability during the last ~9 ka in the eastern Fram Strait. Our multiproxy evidence suggests that the establishment of the modern oceanographic configuration in the eastern Fram Strait occurred stepwise, in response to the postglacial sea-level rise and the related onset of modern sea-ice production on the shallow Siberian shelves. The late Early and Mid Holocene interval (9 to 5 ka) was generally characterized by relatively unstable conditions. High abundance of the subpolar planktic foraminifer species Turborotalita quinqueloba implies strong intensity of Atlantic Water (AW) inflow with high productivity and/or high AW temperatures, resulting in a strong heat flux to the Arctic. A series of short-lived cooling events (8.2, 6.9. and 6.1 ka) occurred superimposed on the warm late Early and Mid Holocene conditions. Our proxy data imply that simultaneous to the complete postglacial flooding of Arctic shallow shelves and the initiation of modern sea-ice production, strong advance of polar waters initiated modern oceanographic conditions in the eastern Fram Strait at ~5.2 ka. The Late Holocene was marked by the dominance of the polar planktic foraminifer species Neogloboquadrina pachyderma, a significant expansion of sea ice/icebergs, and strong stratification of the water column. Although planktic foraminiferal assemblages as well as sea surface and subsurface temperatures suggest a return of slightly strengthened advection of subsurface Atlantic Water after 3 ka, a relatively stable cold-water layer prevailed at the sea surface and the study site was probably located within the seasonally fluctuating marginal ice zone during the Neoglacial period.

Stable Water Isotopologue data collected during HCCT-2010

Cloud samples for the isotopic analysis were collected in the framework of the Hill Cap Cloud Thuringia 2010 (HCCT-2010) campaign on Schmücke (50° 39'N/ 10° 46'E, 937 m a.s.l.; Germany) in September and October 2010 with a three-stage Caltech Active Strand Cloudwater Collector (CASCC) during 13 different cloud events with a temporal resolution of 1 to 3 hours. In a first step, we ensured that no additional fractionation occurred during sampling with the CASCC. The d values of the three sizes classes of the CASCC (4 µm to 16 µm, 16 µm to 22 µm and >22 µm) did not differ significantly, revealing that the cloud droplets of different sizes quickly equilibrate their delta value with the one of the surrounding vapor. delta values in the cloud droplets varied from -77 per mil to -15 per mil in d2H and from -12.1 per mil to -3.9 per mil in d18O and were fitted by d2H =7.8*d18O +13*10**-3. delta values decreased with temperature as well as towards the end of the campaign, representing a seasonal trend which is known from d values in precipitation. The deuterium excess of the cloud samples was generally higher than the Local Meteoric Water Line of the closest GNIP (Global Network of Isotopes in Precipitation) station. Rain decreases its deuterium excess during falling through an unsaturated air column, while the cloud droplets conserve the deuterium excess of the initial evaporation and thus have been found to be a good indicator for the airmass source region: higher deuterium excess was measured for polar air masses and lower deuterium excess for Mediterranean air masses. Changes in d values during one cloud event were up to 3.6 per mil (d2H) and 0.23 per mil (d18O), except for frontal passages, which were associated with increases of ~6 per mil per hour (d2H) and ~0.6 per mil per hour (d18O). Using a box model, we showed that the influence of condensation only was able to explain the variation in the isotope signal of two cloud passages. Consequently, we deduced that the water vapor "feeding" the cloud advected the measured changes. A trajectory analysis and moisture source diagnostic revealed that it is very likely that the variations were either related to rain out along the trajectories or to meteorological changes in the moisture source region. This was the first study using stable water isotopologues in cloud water manifesting their potential in the context of atmospheric water vapor circulation.

Relative abundances of selected radiolarian species in sediments of ODP Leg 199 sites

During Ocean Drilling Program (ODP) Leg 199, sediments were recovered from eight sites in the Central Pacific. Late Oligocene and early Miocene radiolarians are common to abundant and moderately well preserved in Cores 199-1218A-8H through 11H and 199-1219A-5H through 9H. More than 110 radiolarian species were encountered during this study. Of these species, 100 are identifiable forms and the rest are undescribed or unfamiliar forms. This report presents the relative abundances of described forms from the upper Oligocene to lower Miocene sediments.

Partial pressure of carbon dioxide along the Transatlantic section from 7 November till 19 December 2000

Along a transatlantic section from 57°N to 60°S that was carried out from November 7 till December 19, 2000 on board R/V Horizont II concentrations of CO2 were measured in the near-water layer of the air and differences between partial pressures in water and air in various climatic zones were calculated. It was shown that variations of CO2 concentrations in the near-water layer of air and those of values of water-air partial pressure difference were from 324x10**-6 to 426x10**-6 and from 150x10**-6 to 100x10**-6 atm, respectively. Maximum value of CO2 partial pressure in air in the near-water layer (426x10**-6 atm) was noted at 45°-47°N; minimum of 324x10**-6 atm was found in Antarctica at 59°S. During measurenents maximum value of CO2 partial pressure difference in water and air (150 x10**-6) was observed at 45°-48°N; maximum flux in this case was directed from the atmosphere to water. Maximum value of CO2 partial pressure difference in water and air for flux directed from the ocean to air (100 x10**-6) was observed at 59°-60°S. Comparison of calculated values of partial pressure difference in water and air with previous data points to more intense exchange of CO2 between the ocean and atmosphere during the survey period was considered. According to values of CO2 partial pressure difference in air and water as compared to 1975, exchange intensity in the Northern Hemisphere (absorption from the atmosphere) increased. A well-pronounced latitudinal effect of distribution of CO2 partial pressure in air was observed. Along the route variations in CO2 concentrations in zones of water divergence and convergence were registered.

Middle Miocene stable carbon and oxygen isotope record of foraminifera of ODP Hole 120-747A

Paleoceanographic variability at southern high latitude Ocean Drilling Program (ODP) Site 747 was investigated in this study through the interval which spans the Middle Miocene Climate Transition (MMCT). Between 15.0 and 12.2 million years ago (Ma), foraminiferal d18O records derived from both benthic (Cibicidoides spp.) and planktonic taxa (Globorotalia praescitula and Globigerina bulloides) reveal a history of changes in water column thermal and salinity structure and a strong imprint of seasonality. Prior to the MMCT, in the interval between 14.35 and 13.9 Ma, G. bulloides displays relatively high d18O values similar to those of G. praescitula, interpreted to indicate weakening of the thermocline and/or increased seasonality with cooler early-spring and/or late-fall temperatures. Following this interval, G. bulloidesd18O values diverge significantly from benthic and G. praescitula values, with G. bulloides values remaining relatively low for at least 600 kyr following the benthic foraminiferal d18O shift during the MMCT at ~13.9 Ma. This divergence in d18O records occurs in direct association with the Mi3 cooling and glaciation event and may suggest: (1) a strengthening of the vertical temperature gradient, with greater cooling of deep waters than surface waters, (2) changes in the depth habitat of G. bulloides, (3) changes in the dominant season of G. bulloides calcification, (4) modification of surface-water d18O values in association with enhanced sea-ice formation, (5) increased surface-water carbonate ion concentration, and/or (6) a significant decrease in surface-water salinity across the MMCT. The first of these possible scenarios is not likely, particularly in light of recent Mg/Ca evidence for significant surface-water cooling in the Southern Ocean associated with the MMCT. Of the remaining possibilities, we favor a change in surface salinity to explain the observed trends in d18O values and hypothesize that surface salinity may have decreased by up to 2 salinity units at ~13.9 Ma. In this scenario, the development of a lower-salinity Antarctic surface layer coincided with regional cooling of both surface and deep waters of the Southern Ocean during the Mi3 glaciation of East Antarctica, and contributed into the dominance of Neogloboquadrina spp. between 13.8 and 13.2 Ma. Additionally, the distinct patterns observed in planktonic foraminiferal d18O records spanning the MMCT correspond with changes in the vertical d13C gradient between planktonic and benthic foraminiferal records and major changes in planktonic foraminiferal assemblages at Site 747, providing further evidence of the environmental significance of this climatic transition.