Minimally invasive extracorporeal circulation resuscitation in hypothermic cardiac arrest.

Current guidelines for the treatment of hypothermic cardiocirculatory arrest recommend extracorporeal life support and rewarming, using cardiopulmonary bypass or extracorporeal membrane oxygenation circuits. Both have design-related shortcomings which may result in prolonged reperfusion time or insufficient oxygen delivery to vital organs. This article describes clear advantages of minimally invasive extracorporeal circulation systems during emergency extracorporeal life support in hypothermic arrest. The technique of minimally invasive extracorporeal circulation for reperfusion and rewarming is represented by the case of a 59-year-old patient in hypothermic cardiocirculatory arrest at 25.3°C core temperature, with multiple trauma. With femoro-femoral cannulation performed under sonographic and echocardiographic guidance, extracorporeal life support was initiated using a minimally invasive extracorporeal circulation system. Perfusing rhythm was restored at 28°C. During rewarming on the mobile circuit, trauma surveys were completed and the treatment initiated. Normothermic weaning was successful on the first attempt, trauma surgery was completed and the patient survived neurologically intact. For extracorporeal resuscitation from hypothermic arrest, minimally invasive extracorporeal circulation offers all the advantages of conventional cardiopulmonary bypass and extracorporeal membrane oxygenation systems without their shortcomings.

Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke: A Matched-Pairs Analysis.

BACKGROUND AND PURPOSE Five randomized controlled trials have consistently shown that mechanical thrombectomy (MT) in addition to best medical treatment (±intravenous tissue-type plasminogen activator) improves outcome after acute ischemic stroke in patients with large artery anterior circulation stroke. Whether direct MT is equally effective as combined intravenous thrombolysis with MT (ie, bridging thrombolysis) remains unclear. METHODS We retrospectively compared clinical and radiological outcomes in 167 bridging patients with 255 patients receiving direct MT because of large artery anterior circulation stroke. We matched all patients from the direct MT group who would have qualified for intravenous tissue-type plasminogen activator with controls from the bridging group, using multivariate and propensity score analyses. Functional independence was defined as modified Rankin Scale score of 0 to 2. RESULTS From February 2009 to August 2014, 40 patients from the direct MT group would have qualified for bridging thrombolysis but were treated with MT only. Clinical and radiological characteristics did not differ from the bridging cohort, except for higher rates of hypercholesterolemia (P=0.019), coronary heart disease (P=0.039), and shorter intervals from symptom onset to endovascular intervention (P=0.01) in the direct MT group. Functional independence, mortality, and intracerebral hemorrhage rates did not differ (P>0.1). After multivariate matching analysis outcome in both groups did not differ, except for lower rates of asymptomatic intracerebral hemorrhage (P=0.023) and lower mortality (P=0.007) in the direct MT group. CONCLUSIONS In patients with large anterior circulation stroke, direct mechanical intervention seems to be equally effective as bridging thrombolysis. A randomized trial comparing direct MT with bridging therapy is warranted.

A Model Study of the Circulation in the Pearl River Estuary (PRE) and Its Adjacent Coastal Waters: 2. Sensitivity Experiments

The Princeton Ocean Model is used to study the circulation in the Pear River Estuary (PRE) and the adjacent coastal waters in the winter and summer seasons. Wong et al. [2003] compares the simulation results with the in situ measurements collected during the Pearl River Estuary Pollution Project (PREPP). In this paper, sensitivity experiments are carried out to examine the plume and the associated frontal dynamics in response to seasonal discharges and monsoon winds. During the winter, convergence between the seaward spreading plume water and the saline coastal water sets up a salinity front that aligns from the northeast to the southwest inside the PRE. During the summer the plume water fills the PRE at the surface and spreads eastward in the coastal waters in response to the prevailing southwesterly monsoon. The overall alignment of the plume is from the northwest to the southeast. The subsurface front is similar to that in the winter and summer except that the summer front is closer to the mouth and the winter front closer to the head of the estuary. Inside the PRE, bottom flows are always toward the head of the estuary, attributed to the density gradient associated with the plume front. In contrast, bottom flows in the shelf change from offshore in winter to onshore in summer, reflecting respectively the wintertime downwelling and summertime upwelling. Wind also plays an essential role in controlling the plume at the surface. An easterly wind drives the plume westward regardless winter or summer. The eastward spreading of the plume during the summer can be attributed to the southerly component of the wind. On the other hand, the surface area of the plume is positively proportional to the amount of discharge.

OPAC Design Enhancements and Their Effects on Circulation and Resource Sharing within the Library Consortium Environment

A longitudinal study of three discrete online public access catalog (OPAC) design enhancements examined the possible effects such changes may have on circulation and resource sharing within the automated library consortium environment. Statistical comparisons were made of both circulation and interlibrary loan (ILL) figures from the year before enhancement to the year after implementation. Data from sixteen libraries covering a seven-year period were studied in order to determine the degree to which patrons may or may not utilize increasingly broader OPAC ILL options over time. Results indicated that while ILL totals increased significantly after each OPAC enhancement, such gains did not result in significant corresponding changes in total circulation.

(Table 1) Insoluble aerosol concentrations and vertical fluxes at the eastern shelf of the Black Sea during breeze circulation in October 1987

Amounts of aerosols transported to the shelf surface were calculated on the basis of in situ measurements of concentrations of eolian matter (insoluble aerosol fraction) and vertical fluxes of settling dust in five areas of the Black Sea shelf from the Danube delta to the Inguri River mouth. More than 8.3 mln t of eolian matter are annually transported from the land over the shelf of the former USSR. At the same time more than 5.4 mln t are supplied to the northwestern shelf area, 1.7 mln t are supplied to the Crimean area, about 0.8 mln t are supplied to the Kerch-Taman' area, and about 0.45 mln t are supplied to the Caucasian area.

High-resolution marine record of sediment core MD99-2343 in the Balearic Sea

The IMAGES core MD99-2343, recovered from a sediment drift north of the island of Minorca, in the north-western Mediterranean Sea, holds a high-resolution sequence that is perfectly suited to study the oscillations of the overturning system of the Western Mediterranean Deep Water (WMDW). Detailed analysis of grain-size and bulk geochemical composition reveals the sensitivity of this region to climate changes at both orbital and centennial-millennial temporal scales during the last 50 kyr. The dominant orbital pattern in the K/Al record indicates that sediment supply to the basin was controlled by the insolation evolution at 40°N, which forced changes in the fluvial regime, with more efficient sediment transport during insolation maxima. This orbital control also modulated the long-term pattern of the WMDW intensity as illustrated by the silt/clay ratio. However, deep convection was particularly sensitive to climatic changes at shorter time-scales, i.e. to centennial-millennial glacial and Holocene oscillations that are well documented by all the paleocurrent intensity proxies (Si/Al, Ti/Al and silt/clay ratios). Benthic isotopic records (d13C and d18O) show a Dansgaard-Oeschger (D-O) pattern of variability of WMDW properties, which can be associated with changing intensities of the deep currents system. The most prominent reduction on the WMDW overturning was caused by the post-glacial sea level rise. Three main scenarios of WMDW overturning are revealed: a strong mode during D-O Stadials, a weak mode during D-O Interstadials and an intermediate mode during cooling transitions. In addition, D-O Stadials associated with Heinrich events (HEs) have a very distinct signature as the strong mode of circulation, typical for the other D-O Stadials, was never reached during HE due to the surface freshening induced by the inflowing polar waters. Consequently, the WMDW overturning system oscillated around the intermediate mode of circulation during HE. Though surface conditions were more stable during the Holocene, the WMDW overturning cell still reacted synchronously to short-lived events, as shown by increments in the planktonic d18O record, triggering quick reinforcements of the deep water circulation. Overall, these results highlight the sensitivity of the WMDW to rapid climate change which in the recent past were likely induced by oceanographic and atmospheric reorganizations in the North Atlantic region.

Deep thermohaline Circulation in the low-latitude Atlantic during the Last Glacial

Present-day low-latitude eastern and western Atlantic basins are geochemically distinct below the sill depth of the Mid-Atlantic Ridge. While Antarctic Bottom Water (AABW) circulates freely in the western Atlantic, flow into the eastern Atlantic is restricted below 4 km which results in filling the abyssal depths of this basin with water of geochemical similarity to nutrient depleted North Atlantic Deep Water. Using carbon isotopes and Cd/Ca ratios in benthic foraminifera we reconstruct the geochemistry of these basins during the last glacial maximum. Results indicate that deep eastern and western Atlantic basins became geochemically identical during the last glacial. This was achieved by shoaling of the upper surface of AABW above the sill depth of the Mid-Atlantic Ridge, which allowed bottom waters in both basins to be filled with the same water mass. Although AABW became the dominant water mass in the deep eastern Atlantic basin during the glacial, Holocene-glacial delta13C-PO4 shifts in this basin are in Redfield proportions, unlike the disproportionate Holocene-glacial delta13C-PO4 shifts observed in the Southern Ocean. By examining the composition of deep and intermediate waters throughout the Atlantic, we show that this effect was induced by a change in gradient of the delta13C-PO4 deepwater mixing line during glacial times. Evidence from high-latitude planktonic data suggests that the change in gradient of the deepwater mixing line was brought about through a significant reduction in the thermodynamic effect on Southern Ocean surface waters. By using coupled delta13C-PO4 data to constrain the composition of end member water masses in the glacial Atlantic, we conclude that deep waters in the low-latitude glacial Atlantic were composed of a mixture of northern and southern source waters in a ratio of 1:3.

Stable isotope ratios of foraminifera from sediment cores off northeastern Brazil

The western South Atlantic boundary currents represent a sensitive system within the global thermohaline circulation (THC). We investigated the impact of deglacial THC changes on the western tropical Atlantic studied in six high resolution sediment cores from the upper continental slope of Brazil. The stratigraphy of the cores is mainly based on 14C AMS dating of monospecific foraminiferal samples. Changes in the upper layer tropical ocean during the deglaciation are inferred from stable oxygen isotope measurements on planktic and benthic foraminifera. Variations in the delta18O residuals are assumed to be mainly temperature related. During the Oldest and Younger Dryas cooling periods, two major deglacial THC disturbances are reported from North Atlantic sediment cores. Concomitant to the repeated THC slowdown, we observe an upper layer warming in the tropical ocean. A reduced northward heat export from the tropical areas during these periods (weak North Brazil Current) is additionally reflected by low meridional gradients in the stable oxygen records. This generally agrees with results from coupled ocean atmosphere models.

Stable carbon and oxygen isotope ratios of Paleogene planktonic foraminifera from the Maud Rise

The oxygen and carbon isotopic composition has been measured for numerous Paleogene planktonic foraminifer species from Maud Rise, Weddell Sea (ODP Sites 689 and 690), the first such results from the Antarctic. The results provide information about large-scale changes in the evolution of temperatures, seasonally, and structure of the upper water column prior to the development of a significant Antarctic cryosphere. The early Paleocene was marked by cooler surface-water conditions compared to the Cretaceous and possibly a less well developed thermocline. The late Paleocene and early Eocene saw the expansion of the thermocline as Antarctic surface waters became warm-temperate to subtropical. The late Paleocene to early Eocene thermal maximum was punctuated by two brief excursions during which time the entire Antarctic water column warmed and the meridional temperature gradient was reduced. The first of these excursions occurred at the Paleocene/Eocene boundary, in association with a major extinction in deep sea benthic foraminifers. The second excursion occurred within the early Eocene at ~54.0 Ma. These excursions are of global importance and represent the warmest intervals of the entire Cenozoic. The excursions were associated with fundamental changes in deep-water circulation and global heat transport. The thermal maximum of the early Eocene ended with the initiation of a long-term cooling trend at 52.0 Ma. This cooling trend was associated with reduced seasonality, and diminished structure and/or duration of the seasonal thermocline. The cooling trend was punctuated by three major cooling steps at 43.0, 40.0, and -36.0 Ma.