Typically 20-40 extreme cyclone events (sometimes called 'weather bombs') occur in the Arctic North Atlantic per winter season, with an increasing trend of 6 events/decade over 1979-2015, according ...to 6 hourly station data from Ny-Ålesund. This increased frequency of extreme cyclones is consistent with observed significant winter warming, indicating that the meridional heat and moisture transport they bring is a factor in rising temperatures in the region. The winter trend in extreme cyclones is dominated by a positive monthly trend of about 3-4 events/decade in November-December, due mainly to an increasing persistence of extreme cyclone events. A negative trend in January opposes this, while there is no significant trend in February. We relate the regional patterns of the trend in extreme cyclones to anomalously low sea-ice conditions in recent years, together with associated large-scale atmospheric circulation changes such as 'blockinglike' circulation patterns (e.g. Scandinavian blocking in December and Ural blocking during January-February).
Background
For many cancer resections, a hospital volume-outcome relationship exists. The data regarding gastric cancer resection—especially in the western hemisphere—are ambiguous. This study ...analyzes the impact of gastric cancer surgery caseload per hospital on postoperative mortality and failure to rescue in Germany.
Methods
All patients diagnosed with gastric cancer from 2009 to 2017 who underwent gastric resection were identified from nation-wide administrative data. Hospitals were grouped into five equal caseload quintiles (I–V in ascending caseload order). Postoperative deaths and failure to rescue were determined.
Results
Forty-six thousand one hundred eighty-seven patients were identified. There was a significant shift from partial resections in low-volume hospitals to more extended resections in high-volume centers. The overall in-house mortality rate was 6.2%. The crude in-hospital mortality rate ranged from 7.9% in quintile I to 4.4% in quintile V, with a significant trend between volume categories (
p
< 0.001). In the multivariable logistic regression analysis, quintile V hospitals (average of 29 interventions/year) had a risk-adjusted odds ratio of 0.50 (95% CI 0.39–0.65), compared to the baseline in-house mortality rate in quintile I (on average 1.5 interventions/year) (
p
< 0.001). In an analysis only evaluating hospitals with more than 30 resections per year mortality dropped below 4%. The overall postoperative complication rate was comparable between different volume quintiles, but failure to rescue (FtR) decreased significantly with increasing caseload.
Conclusion
Patients who had gastric cancer surgery in hospitals with higher volume had better outcomes and a reduced failure to rescue rates for severe complications.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
The impact of hospital volume after rectal cancer surgery is seldom investigated. This study aimed to analyse the impact of annual rectal cancer surgery cases per hospital on postoperative ...mortality and failure to rescue.
Methods
All patients diagnosed with rectal cancer and who had a rectal resection procedure code from 2012 to 2015 were identified from nationwide administrative hospital data. Hospitals were grouped into five quintiles according to caseload. The absolute number of patients, postoperative deaths and failure to rescue (defined as in‐hospital mortality after a documented postoperative complication) for severe postoperative complications were determined.
Results
Some 64 349 patients were identified. The overall in‐house mortality rate was 3·9 per cent. The crude in‐hospital mortality rate ranged from 5·3 per cent in very low‐volume hospitals to 2·6 per cent in very high‐volume centres, with a distinct trend between volume categories (P < 0·001). In multivariable logistic regression analysis using hospital volume as random effect, very high‐volume hospitals (53 interventions/year) had a risk‐adjusted odds ratio of 0·58 (95 per cent c.i. 0·47 to 0·73), compared with the baseline in‐house mortality rate in very low‐volume hospitals (6 interventions per year) (P < 0·001). The overall postoperative complication rate was comparable between different volume quintiles, but failure to rescue decreased significantly with increasing caseload (15·6 per cent after pulmonary embolism in the highest volume quintile versus 38 per cent in the lowest quintile; P = 0·010).
Conclusion
Patients who had rectal cancer surgery in high‐volume hospitals showed better outcomes and reduced failure to rescue rates for severe complications than those treated in low‐volume hospitals.
Antecedentes
El impacto del volumen hospitalario en los resultados de la cirugía del cáncer de recto ha sido poco investigado. Este estudio tuvo como objetivo analizar el impacto de los casos anuales de cirugía de cáncer de recto por hospital en la mortalidad postoperatoria (postoperative mortality, POM) y el fracaso en el rescate (failure to rescue, FtR).
Métodos
Todos los casos de pacientes hospitalizados con un diagnóstico de cáncer de recto y un código de procedimiento de resección rectal, tratados de 2012 a 2015, se identificaron a partir de datos hospitalarios administrativos a nivel nacional. Los hospitales se agruparon en cinco quintiles según el volumen de casos. Se determinó el número absoluto de pacientes, la POM y el FtR por complicaciones postoperatorias graves. El FtR se definió como la mortalidad hospitalaria después de una complicación postoperatoria documentada.
ResultadosSe identificaron 64.349 casos entre 2012 y 2015. La tasa de mortalidad hospitalaria global fue del 3,89% (n = 2.506). Las tasas brutas de mortalidad hospitalaria variaron de 5,34% (n = 687) en hospitales de muy bajo volumen a 2,63% (n = 337) en centros de muy alto volumen, con una tendencia distinta entre las categorías de centros (P < 0,001).
En el análisis de regresión logística multivariante utilizando el volumen hospitalario como efecto aleatorio, los hospitales de muy alto volumen (53 intervenciones/año) tenían una razón de oportunidades (odds ratio, OR) ajustada por riesgo de 0,58 (i.c. del 95%: 0,47‐0,73) en comparación con la tasa basal de mortalidad hospitalaria en hospitales de muy bajo volumen (6 intervenciones/año) (P < 0,001). La tasa global de complicaciones postoperatorias fue comparable entre los diferentes quintiles de volumen, pero el FtR disminuyó significativamente con el aumento del volumen de casos (15,63% FtR tras una embolia pulmonar en el quintil más alto versus 38,4% en el hospital del quintil más bajo, P = 0,01).
Conclusión
Los pacientes sometidos a cirugía de cáncer de recto en hospitales de gran volumen presentaron mejores resultados y una disminución de las tasas de fracaso en el rescate por complicaciones graves en comparación con los pacientes tratados en hospitales de bajo volumen.
In‐hospital mortality after rectal cancer surgery is strongly correlated with annual hospital caseload. This is the result of an increased failure‐to‐rescue rate in the case of postoperative complications in low‐volume hospitals rather than the result of an increased overall rate of complications.
Rectal cancer surgery and hospital volume
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background
Colonic cancer is the most common cancer of the gastrointestinal tract. The aim of this study was to determine mortality rates following colonic cancer resection and the effect of hospital ...caseload on in‐hospital mortality in Germany.
Methods
Patients admitted with a diagnosis of colonic cancer undergoing colonic resection from 2012 to 2015 were identified from a nationwide registry using procedure codes. The outcome measure was in‐hospital mortality. Hospitals were ranked according to their caseload for colonic cancer resection, and patients were categorized into five subgroups on the basis of hospital volume.
Results
Some 129 196 colonic cancer resections were reviewed. The overall in‐house mortality rate was 5·8 per cent, ranging from 6·9 per cent (1775 of 25 657 patients) in very low‐volume hospitals to 4·8 per cent (1239 of 25 825) in very high‐volume centres (P < 0·001). In multivariable logistic regression analysis the risk‐adjusted odds ratio for in‐house mortality was 0·75 (95 per cent c.i. 0·66 to 0·84) in very high‐volume hospitals performing a mean of 85·0 interventions per year, compared with that in very low‐volume hospitals performing a mean of only 12·7 interventions annually, after adjustment for sex, age, co‐morbidity, emergency procedures, prolonged mechanical ventilation and transfusion.
Conclusion
In Germany, patients undergoing colonic cancer resections in high‐volume hospitals had with improved outcomes compared with patients treated in low‐volume hospitals.
Antecedentes
El cáncer de colon es el cáncer más frecuente del tracto digestivo. El objetivo de este estudio fue determinar las tasas de mortalidad tras resección de cáncer de colon y el efecto del volumen de casos del hospital sobre la mortalidad intrahospitalaria en Alemania.
Métodos
Los pacientes ingresados con el diagnóstico de cáncer de colon sometidos a resección colónica entre 2012 y 2015 se identificaron a partir de un registro nacional utilizando los códigos de los procedimientos. La medida de resultado fue la mortalidad intrahospitalaria. Los hospitales se clasificaron de acuerdo con su número de casos de resecciones de cáncer de colon y los pacientes fueron categorizados en 5 diferentes subgrupos en la base del volumen del hospital.
Resultados
Se revisaron 129.196 resecciones de cáncer de colon. La tasa de mortalidad fue de 5,75%, variando desde 6,92% (n = 1.775) en hospitales de bajo volumen hasta 4,80% (n = 1.239) en centros con alto volumen, con una diferencia significativa entre los escenarios de bajo y alto volumen (P < 0,001). El análisis de regresión logística multivariable puso de manifiesto que la razón de oportunidades (odds ratio, OR) ajustada al riesgo de la mortalidad intrahospitalaria fue de 0,75 (i.c. del 95% 0,66‐0,84) en hospitales con volumen muy alto que realizaban más de 85,0 intervenciones/año, en comparación con hospitales de volumen muy bajo que realizaban menos de 13 intervenciones/año, tras ajustar por sexo, edad, comorbilidad, procedimiento urgente, ventilación mecánica prolongada y transfusiones.
Conclusión
En Alemania, los pacientes sometidos a resección de cáncer de colon en hospitales de alto volumen tienen mejores resultados en comparación con los pacientes tratados en centros de bajo volumen.
In Germany, perioperative mortality for colonic cancer resection at the national level is high. Patients undergoing resection of colonic cancer in high‐volume hospitals have improved outcomes compared with those treated in low‐volume hospitals.
Mortality rate, hospital volume and CRC resections
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
The Central Yakutian permafrost landscape is rapidly being modified by land use and global warming, but small‐scale thermokarst process variability and hydrological conditions are poorly understood. ...We analyze lake‐area changes and thaw subsidence of young thermokarst lakes on ice‐complex deposits (yedoma lakes) in comparison to residual lakes in alas basins during the last 70 years for a local study site and we record regional lake size and distribution on different ice‐rich permafrost terraces using satellite and historical airborne imagery. Statistical analysis of climatic and ground‐temperature data identified driving factors of yedoma‐ and alas‐lake changes. Overall, lake area is larger today than in 1944 but alas‐lake levels have oscillated greatly over 70 years, with a mean alas‐lake‐radius change rate of 1.6 ± 3.0 m/yr. Anthropogenic disturbance and forest degradation initiated, and climate forced rapid, continuous yedoma‐lake growth. The mean yedoma lake‐radius change rate equals 1.2 ± 1.0 m/yr over the whole observation period. Mean thaw subsidence below yedoma lakes is 6.2 ± 1.4 cm/yr. Multiple regression analysis suggests that winter precipitation, winter temperature, and active‐layer properties are primary controllers of area changes in both lake types; summer weather and permafrost conditions additionally influence yedoma‐lake growth rates. The main controlling factors of alas‐lake changes are unclear due to larger catchment areas and subsurface hydrological conditions. Increasing thermokarst activity is currently linked to older terraces with higher ground‐ice contents, but thermokarst activity will likely stay high and wet conditions will persist within the near future in Central Yakutian alas basins.
Key Points:
Remote sensing, field, and statistical analysis of thermokarst‐lake change in relation to long‐term climate records and geomorphology
Type and degree of climatic and geomorphological influence depend on lake type, size, origin, and evolution
Thermokarst activity will remain at a high level and wet conditions within alas basins will persist in the near future
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
While wave heights globally have been growing over recent decades, observations of their regional trends vary. Simulations of future wave climate can be achieved by coupling wave and climate models. ...At present, wave heights and their future trends in the Arctic Ocean remain unknown. We use the third‐generation wave forecast model WAVEWATCH‐III forced by winds and sea ice concentration produced within the regional model HIRHAM, under the anthropogenic scenario SRES‐A1B. We find that significant wave height and its extremes will increase over different inner Arctic areas due to reduction of sea ice cover and regional wind intensification in the 21st century. The opposite tendency, with a slight reduction in wave height appears for the Atlantic sector and the Barents Sea. Our results demonstrate the complex wave response in the Arctic Ocean to a combined effect of wind and sea ice forcings in a climate‐change scenario during the 21st century.
Key Points
Significant wave height will increase over the Arctic Ocean in the 21st centuryReduction in wave height is expected for the Atlantic sector and the Barents Sea
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Despite tremendous efforts in the search for safe, efficacious and non-addictive opioids for pain treatment, morphine remains the most valuable painkiller in contemporary medicine. Opioids exert ...their pharmacological actions through three opioid-receptor classes, mu, delta and kappa, whose genes have been cloned. Genetic approaches are now available to delineate the contribution of each receptor in opioid function in vivo. Here we disrupt the mu-opioid-receptor gene in mice by homologous recombination and find that there are no overt behavioural abnormalities or major compensatory changes within the opioid system in these animals. Investigation of the behavioural effects of morphine reveals that a lack of mu receptors abolishes the analgesic effect of morphine, as well as place-preference activity and physical dependence. We observed no behavioural responses related to delta- or kappa-receptor activation with morphine, although these receptors are present and bind opioid ligands. We conclude that the mu-opioid-receptor gene product is the molecular target of morphine in vivo and that it is a mandatory component of the opioid system for morphine action.
Morphine-6-glucuronide (M6G) is a metabolite of morphine with potent analgesic properties. The influence of M6G on respiratory and antinociceptive responses was investigated in mice lacking the ...μ-opioid receptor (MOR) and compared with morphine.
Experiments were performed in mice lacking exon 2 of the MOR (n=18) and their wild type (WT) littermates (n=20). The influence of M6G and morphine on respiration was measured using whole body plethysmography during three elevations of inspired carbon dioxide. Antinociception was assessed using tail flick and hotplate tests.
In WT but not null mutant mice, a dose-dependent depression of the slope of the ventilatory carbon dioxide response was observed after M6G and morphine. Similarly, both opioids were devoid of antinociceptive effects in null mutant mice, but showed potent dose-dependent analgesia in WT animals. Potency differences between M6G and morphine in WT mice were of the same order of magnitude for analgesia and respiration.
The data indicate that the desired (antinociceptive) and undesired (respiratory depression) effects of M6G and morphine are linked to the same gene product; that is the MOR. Other opioid- and non-opioid-receptor systems may play a minor role in the actions of M6Gs and morphine. The clinical implications of our findings are that any agent acting at the MOR will invariably cause (potent) analgesia in combination with (variable) respiratory depression.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Measurements of hyperspectral canopy reflectance provide a detailed snapshot of information regarding canopy biochemistry, structure and physiology. In this study, we collected 5 years of repeated ...canopy hyperspectral reflectance measurements for a total of over 100 site visits within the flux footprints of two eddy covariance towers at a pasture and rice paddy in northern California. The vegetation at both sites exhibited dynamic phenology, with significant interannual variability in the timing of seasonal patterns that propagated into interannual variability in measured hyperspectral reflectance. We used partial least-squares regression (PLSR) modeling to leverage the information contained within the entire canopy reflectance spectra (400-900 nm) in order to investigate questions regarding the connection between measured hyperspectral reflectance and landscape-scale fluxes of net ecosystem exchange (NEE) and gross primary productivity (GPP) across multiple timescales, from instantaneous flux to monthly integrated flux. With the PLSR models developed from this large data set we achieved a high level of predictability for both NEE and GPP flux in these two ecosystems, where the R2 of prediction with an independent validation data set ranged from 0.24 to 0.69. The PLSR models achieved the highest skill at predicting the integrated GPP flux for the week prior to the hyperspectral canopy reflectance collection, whereas the NEE flux often achieved the same high predictive power at daily to monthly integrated flux timescales. The high level of predictability achieved by PLSR in this study demonstrated the potential for using repeated hyperspectral canopy reflectance measurements to help partition NEE into its component fluxes, GPP and ecosystem respiration, and for using quasi-continuous hyperspectral reflectance measurements to model regional carbon flux in future analyses.
Previous pharmacological studies have indicated the possible existence of functional interactions between mu-, delta- and kappa-opioid receptors in the CNS. We have investigated this issue using a ...genetic approach. Here we describe in vitro and in vivo functional activity of delta- and kappa-opioid receptors in mice lacking the mu-opioid receptor (MOR). Measurements of agonist-induced 35SGTPgammaS binding and adenylyl cyclase inhibition showed that functional coupling of delta- and kappa-receptors to G-proteins is preserved in the brain of mutant mice. In the mouse vas deferens bioassay, deltorphin II and cyclicD-penicillamine2, D-penicillamine5 enkephalin exhibited similar potency to inhibit smooth muscle contraction in both wild-type and MOR -/- mice. delta-Analgesia induced by deltorphin II was slightly diminished in mutant mice, when the tail flick test was used. Deltorphin II strongly reduced the respiratory frequency in wild-type mice but not in MOR -/- mice. Analgesic and respiratory responses produced by the selective kappa-agonist U-50,488H were unchanged in MOR-deficient mice. In conclusion, the preservation of delta- and kappa-receptor signaling properties in mice lacking mu-receptors provides no evidence for opioid receptor cross-talk at the cellular level. Intact antinociceptive and respiratory responses to the kappa-agonist further suggest that the kappa-receptor mainly acts independently from the mu-receptor in vivo. Reduced delta-analgesia and the absence of delta-respiratory depression in MOR-deficient mice together indicate that functional interactions may take place between mu-receptors and central delta-receptors in specific neuronal pathways.
PDF
