Transesophageal echocardiography in cryptogenic stroke and patent foramen ovale: analysis of putative high-risk features from the risk of paradoxical embolism database

BACKGROUND Patent foramen ovale (PFO) is associated with cryptogenic stroke (CS), although the pathogenicity of a discovered PFO in the setting of CS is typically unclear. Transesophageal echocardiography features such as PFO size, associated hypermobile septum, and presence of a right-to-left shunt at rest have all been proposed as markers of risk. The association of these transesophageal echocardiography features with other markers of pathogenicity has not been examined. METHODS AND RESULTS We used a recently derived score based on clinical and neuroimaging features to stratify patients with PFO and CS by the probability that their stroke is PFO-attributable. We examined whether high-risk transesophageal echocardiography features are seen more frequently in patients more likely to have had a PFO-attributable stroke (n=637) compared with those less likely to have a PFO-attributable stroke (n=657). Large physiologic shunt size was not more frequently seen among those with probable PFO-attributable strokes (odds ratio [OR], 0.92; P=0.53). The presence of neither a hypermobile septum nor a right-to-left shunt at rest was detected more often in those with a probable PFO-attributable stroke (OR, 0.80; P=0.45; OR, 1.15; P=0.11, respectively). CONCLUSIONS We found no evidence that the proposed transesophageal echocardiography risk markers of large PFO size, hypermobile septum, and presence of right-to-left shunt at rest are associated with clinical features suggesting that a CS is PFO-attributable. Additional tools to describe PFOs may be useful in helping to determine whether an observed PFO is incidental or pathogenically related to CS.

Reducing CD4 Monitoring in Children on Antiretroviral Therapy With Virologic Suppression.

BACKGROUND Ongoing CD4 monitoring in patients on antiretroviral therapy (ART) with viral suppression has been questioned. We evaluated the probability of CD4 decline in children with viral suppression and CD4 recovery after 1 year on ART. METHODS We included children from 8 South African cohorts with routine HIV-RNA monitoring if (1) they were "responders" [HIV-RNA < 400 copies/mL and no severe immunosuppression after ≥1 year on ART (time 0)] and (2) ≥1 HIV-RNA and CD4 measurement within 15 months of time 0. We determined the probability of CD4 decline to World Health Organization-defined severe immunosuppression for 3 years after time 0 if viral suppression was maintained. Follow-up was censored at the earliest of the following dates: the day before first HIV-RNA measurement >400 copies/mL; day before a >15-month gap in testing and date of death, loss to follow-up, transfer out or database closure. RESULTS Among 5984 children [median age at time 0: 5.8 years (interquartile range: 3.1-9.0)], 270 children experienced a single CD4 decline to severe immunosuppression within 3 years of time 0 with probability of 6.6% (95% CI: 5.8-7.4). A subsequent CD4 measurement within 15 months of the first low measurement was available for 63% of children with CD4 decline and 86% showed CD4 recovery. The probability of CD4 decline was lowest (2.8%) in children aged 2 years or older with no or mild immunosuppression and on ART for <18 months at time 0. This group comprised 40% of children. CONCLUSIONS This finding suggests that it may be safe to stop routine CD4 monitoring in children older than 2 years and rely on virologic monitoring alone.

Annotated record and chemical composition of iron-manganese nodules from the Baltic Sea

Iron-manganese concretions, closely related to lacustrine ores and deep sea manganese nodules, are presently forming in different parts of Gulfs of Bothnia and Finland. They can be divided according to physical form into three distinct groups: (1) round pea-shaped concretions, (2) ring-shaped concrections, and (3) flat sheets and crusts of concretionary material. A definite correlation was found to exist between the form i.e. type of concretions and their chemical composition (Mn/Fe ratio). Trace element concentrations were generally rather high, although not as high as in deep sea manganese nodules. X-ray and DTA was used to study the mineralogy and crystal structure of the concretions. Surface concentrations and geographical distribution of the concretions were estimated on the basis of samples, diving observations and echo-grams.

The amount of water loss was determined by drying at 110°C

Deep-sea deposits, which resemble in nearly every respect the deep-sea oozes have been observed in many islands of the East-Indian Archipelago, notably the islands of Borneo, Rotti and Timor. Manganese nodules are found in equivalents of deeep-sea red clays on Timor and Rotti island. In this paper, those relative to red clay deposits dating from a Cretaceous ocean are analysed in detail in the vicinity of the town of Niki Niki in Western Timor.

(Table 1) Contents of chlorophyll a over the Northern Sea Route according to data of field measurements and estimated from MODIS data on measurement days

New maps of mean monthly distribution of chlorophyll and primary production in the Kara Sea were compiled using joint processing of CZCS (1978-1986), SeaWiFS (1998-2005), and MODIS (2002-2006) satellite data and field measurements. The annual primary production of phytoplankton is estimated at 22.3 x 10**6 t C per year or 70 mg C/m**2 per day. Results of calculations of the organic carbon budget in the Kara Sea are presented.

Detailed measurements of radium inside a nodule of Albatross 1899-1900 - for Stations 13, 173 and 4658

Thanks to the courtesy of the British Museum of Natural History the author obtained from their Challenger collections two small nodules, and through a similar courtesy of the Mineralogical Department of the Riksmuseum in Stockholm one half of a much larger nodule, also from the Challenger Expedition. Results from his initial measurements of the radium contents of these samples convinced the author that the radium in the nodules is accumulated from the surrounding sediment. In the present paper the author conducted a much more thorough investigation on nodules obtained during the U.S. Albatross cruises of Dr. Agassiz. Detailed measurements of radium were conducted on individual layers and spots inside each nodule.

Physical properties and velocity measurement comparison for sediments from DSDP Holes 92-597B and 92-597C

The bulk and grain densities, porosity, water content, and ultrasonic compressional- and shear-wave velocities of 25 basalt samples from DSDP Holes 597B and 597C were measured. The velocities were measured at in situ pore and confining pressures. The bulk densities of the samples vary between 2.690 and 3.050 g/cm**3. Porosities of selected samples vary between 2.4 and 9.3%. The grain densities vary between 2.993 and 3.117 g/cm3, a range that suggests that bulk density differences are due primarily to variations in porosity. Compressional-wave velocities range from 5.70 to 6.81 km/s, and shear-wave velocities range from 1.66 to 3.84 km/s. The variation in compressional velocity appears to be due primarily to variations in grain size and the associated greater density of grain-boundary cracks for samples with a smaller average grain size. On the basis of these results we would expect compressional and shear velocities to increase with increasing depth in the shallow crust, primarily as the result of the effects of confining pressure on crack density.

Annotated record of the detailed examination of Mn deposits from seventh cruise of the Carnegie (1928-1929)

The Carnegie, on its seventh cruise and last cruise, collected seventy-five samples of deep-sea deposits in the southeastern and the north Pacific. This report contains an account of the general character of the deep-sea samples collected and of the distribution of the various deposit types, together with the results of chemical, mechanical, X-ray, and other types of analyses. As indicated in the text, many of the analyses were carried out in whole or in part by other investigators.

BSRN Toolbox V2.0 - a tool to create quality checked output files from BSRN datasets and station-to-archive files

The BSRN Toolbox is a software package supplied by the WRMC and is freely available to all station scientists and data users. The main features of the package include a download manager for Station- to-Archive files, a tool to convert files into human readable TAB-separated ASCII-tables (similar to those output by the PANGAEA database), and a tool to check data sets for violations of the "BSRN Global Network recommended QC tests, V2.0" quality criteria. The latter tool creates quality codes, one per measured value, indicating if the data are "physically possible," "extremely rare," or if "intercomparison limits are exceeded." In addition, auxiliary data such as solar zenith angle or global calculated from diffuse and direct can be output. All output from the QC tool can be visualized using PanPlot (doi:10.1594/PANGAEA.816201).