An earth system model (MIROC-ESM 2010) is fully described in terms of each model component and their interactions. Results for the CMIP5 (Coupled Model Inter-comparison Project phase 5) historical ...simulation are presented to demonstrate the model's performance from several perspectives: atmosphere, ocean, sea-ice, land-surface, ocean and terrestrial biogeochemistry, and atmospheric chemistry and aerosols. An atmospheric chemistry coupled version of MIROC-ESM (MIROC-ESM-CHEM 2010) reasonably reproduces transient variations in surface air temperatures for the period 1850-2005, as well as the present-day climatology for the zonal-mean zonal winds and temperatures from the surface to the mesosphere. The historical evolution and global distribution of column ozone and the amount of tropospheric aerosols are reasonably simulated in the model based on the Representative Concentration Pathways' (RCP) historical emissions of these precursors. The simulated distributions of the terrestrial and marine biogeochemistry parameters agree with recent observations, which is encouraging to use the model for future global change projections.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Two atmospheric general circulation models (AGCMs), differing in numerics and physical parameterizations, are employed to test the hypothesis that El Niño–induced sea surface temperature (SST) ...anomalies in the tropical Indian Ocean impact considerably the Northern Hemisphere extratropical circulation anomalies during boreal winter January–March +1 (JFM +1) of El Niño years. The hypothesis grew out of recent findings that ocean dynamics influence SST variations over the southwest Indian Ocean (SWIO), and these in turn impact local precipitation. A set of ensemble simulations with the AGCMs was carried out to assess the combined and individual effects of tropical Pacific and Indian Ocean SST anomalies on the extratropical circulation. To elucidate the dynamics responsible for the teleconnection, solutions were sought from a linear version of one of the AGCMs.
Both AGCMs demonstrate that the observed precipitation anomalies over the SWIO are determined by local SST anomalies. Analysis of the circulation response shows that over the Pacific–North American (PNA) region, the 500-hPa height anomalies, forced by Indian Ocean SST anomalies,opposeanddestructively interferewith those forced by tropical Pacific SST anomalies. The model results validated with reanalysis data show that compared to the runs where only the tropical Pacific SST anomalies are specified, the root-mean-square error of the height anomalies over the PNA region is significantly reduced in runs in which the SST anomalies in the Indian Ocean are prescribed in addition to those in the tropical Pacific. Among the ensemble members, both precipitation anomalies over the SWIO and the 500-hPa height over the PNA region show high potential predictability. The solutions from the linear model indicate that the Rossby wave packets involved in setting up the teleconnection between the SWIO and the PNA region have a propagation path that is quite different from the classical El Niño–PNA linkage.
The results of idealized experiments indicate that the Northern Hemisphere extratropical response to Indian Ocean SST anomalies is significant and the effect of this response needs to be considered in understanding the PNA pattern during El Niño years. The results presented herein suggest that the tropical Indian Ocean plays an active role in climate variability and that accurate observation of SST there is of urgent need.
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BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Donor age for intestinal transplantation (ITx) is somewhat younger than that for other solid organs. Clear criteria for adequate donors have not been established. There is a donor scarcity for ITx in ...Japan due to the shortage of young donors.
We reviewed outcomes associated with ITx in Japan based on donor age for cadaveric and living donation.
Standardized report forms were sent to all known ITx programs, asking for information on ITxs performed between 1996 and 2016. All programs responded. Patient and graft survival estimates were obtained using the Kaplan-Meier method. Five institutions provided data on 27 grafts in 24 patients. There were 14 cadaveric and 13 living donor transplants. Median donor age for ITxs was 40 (range, 17–60) years. Graft survival at 5 years was 66% for patients >40 years old (n = 18) and 47% for those <40 years old (n = 9), not a statistically significant difference (P = .49). Graft survival at 5 years was 60% in those >50 years old (n = 5) and 57% for those <50 years old (n = 22), again not a significant difference (P = .27).
There is no difference in survival between for those with donor age <40 vs >40 years. Donor age for ITx can be extended from >40 to up to 50 years, which may help to mitigate the donor shortage. It will be necessary to clarify the donor criteria for ITx through accumulation of further data on ITx.
•The graft survival rates were not different by donor age in intestinal transplantation (ITx).•Donor age can be extended to over 40 years old.•It is necessary to clarify donor criteria for ITx by accumulating data.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Paleoclimate experiments using contemporary climate models are an effective measure to evaluate climate models. In recent years, Earth system models (ESMs) were developed to investigate carbon cycle ...climate feedbacks, as well as to project the future climate. Paleoclimate events can be suitable benchmarks to evaluate ESMs. The variation in aerosols associated with the volcanic eruptions provide a clear signal in forcing, which can be a good test to check the response of a climate model to the radiation changes. The variations in atmospheric CO2 level or changes in ice sheet extent can be used for evaluation as well. Here we present implementations of the paleoclimate experiments proposed by the Coupled Model Intercomparison Project phase 5/Paleoclimate Modelling Intercomparison Project phase 3 (CMIP5/PMIP3) using MIROC-ESM, an ESM based on the global climate model MIROC (Model for Interdisciplinary Research on Climate). In this paper, experimental settings and spin-up procedures of the mid-Holocene, the Last Glacial Maximum, and the Last Millennium experiments are explained. The first two experiments are time slice experiments and the last one is a transient experiment. The complexity of the model requires various steps to correctly configure the experiments. Several basic outputs are also shown.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background
Severe sepsis is a life‐threatening complication after liver transplantation (LT) that can be difficult to diagnose and appropriately treat after LT because of patients being treated with ...immunosuppressants. The present study examines perioperative changes in serum procalcitonin (PCT), a specific marker of systemic bacterial infection, and determines the value of PCT as a diagnostic tool for bacteremia or rejection.
Methods
Perioperative serum PCT levels were prospectively assessed in 104 consecutive adult patients undergoing LT (living‐donor LT, n = 90; deceased‐donor LT, n = 14) between May 2010 and August 2012.
Results
Serum PCT levels remarkably increased soon after LT and gradually decreased thereafter, but were not increased in patients diagnosed with cytomegalovirus infection or acute cellular rejection. Serum PCT levels in patients who underwent deceased‐donor LT were significantly higher than in those who underwent living‐donor LT until postoperative day (POD) 7. Serum PCT levels were significantly higher in patients with bacteremia than in those without bacteremia after POD 14. In patients with post‐transplant bacteremia, PCT levels increased again after POD 7 in patients who died within 3 months of LT, while levels remained low after POD 7 in patients who were alive. A positive predictive value of 83.3% for bacteremia and a negative predictive value of 97.4% were obtained at PCT cutoffs of 2.0 and 0.5 ng/mL, respectively.
Conclusion
Serum PCT measurement, using appropriate cutoff values, could help diagnose severe infection, and might be able to differentiate bacteremia from acute cellular rejection.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Long-term climate experiments up to the year 2300 have been conducted using two full-scale complex Earth system models (ESMs), CESM1(BGC) and MIROC-ESM, for a CO2 emissions reduction pathway, termed ...Z650, where annual CO2 emissions peak at 11 PgC in 2020, decline by 50% every 30 years, and reach zero in 2160. The results have been examined by focusing on the approximate linear relationship between the temperature increase and cumulative CO2 emissions. Although the temperature increase is nearly proportional to the cumulative CO2 emissions in both models, this relationship does not necessarily provide a robust basis for the restriction of CO2 emissions because it is substantially modulated by non-CO2 forcing. CO2-induced warming, estimated from the atmospheric CO2 concentrations in the models, indicates an approximate compensation of nonlinear changes between fast-mode responses to concentration changes at less than 10 years and slow-mode response at more than 100 years due to the thermal inertia of the ocean. In this estimate, CESM1(BGC) closely approximates a linear trend of 1.7 °C per 1000 PgC, whereas MIROC-ESM shows a deviation toward higher temperatures after the emissions peak, from 1.8 °C to 2.4 °C per 1000 PgC over the range of 400-850 PgC cumulative emissions corresponding to years 2000-2050. The evolution of temperature under zero emissions, 2160-2300, shows a slight decrease of about 0.1 °C per century in CESM1(BGC), but remains almost constant in MIROC-ESM. The fast-mode response toward the equilibrium state decreases with a decrease in the airborne fraction owing to continued CO2 uptake (carbon cycle inertia), whereas the slow-mode response results in more warming owing to continued heat uptake (thermal inertia). Several specific differences are noted between the two models regarding the degree of this compensation and in some key regional aspects associated with sustained warming and long-term climate risks. Overall, elevated temperatures continue for at least a few hundred years under zero emissions.
Colon cancer accompanying decompensated liver cirrhosis is a rare clinical condition. Usually, treatment of colon cancer is prioritized, with cirrhosis dealt with later.
We present a case of ...end-stage liver disease due to nonalcoholic steatohepatitis evaluated for living donor liver transplant. During the pretransplant examination, an ascending colon cancer was detected. Liver function was too poor to perform colon resection first. Simultaneous living donor liver transplant and colonic resection were carried out. The patient developed left lung metastasis at 2 different times during the first postoperative year, and both of them were resected. The patient received the standard chemoradiotherapy. Now, the patient is alive at 42 months postprocedure and recurrence-free at 31 months postoperatively.
Simultaneous liver transplantation and colon resection are possible with acceptable long-term outcomes. Immunosuppressive therapy after transplantation increases the risk for cancer recurrence. So the patient should undergo close surveillance.
•Colon cancer accompanying decompensated liver cirrhosis is a rare clinical condition. Usually, treatment of colon cancer is prioritized over cirrhosis being dealt with later on.•We present a case of End-stage liver disease due to nonalcoholic steatohepatitis evaluated for living donor liver transplant. During the pretransplant examination, an ascending colon cancer was detected. Liver function was too poor to perform colon resection first. A simultaneous living donor liver transplant and colonic resection were carried on.•The patient developed left lung metastasis at 2 different times during the first year postoperatively, and both of them were resected. Patient received only radiotherapy for right lung.•Now, the patient is alive 42 months and recurrence-free 31 months, postoperatively.•Simultaneous LT and colon resection are possible with acceptable long-term outcomes. Immunosuppressive therapy after transplantation increases the risk for cancer recurrence. So, the patient should undergo close surveillance.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Background
Herpes zoster (HZ) is the most common manifestation of latent varicella zoster virus reactivation, which occurs naturally as a result of aging or in immunocompromised patients. Solid organ ...transplant recipients are at increased risk for HZ owing to their chronic immunosuppression. Although several reports investigated risk factors for the development of HZ in heart or renal transplantation, data in liver transplantation (LT) are limited.
Methods
We evaluated clinical data retrospectively in 377 adult patients undergoing LT between January 2005 and December 2012 in our institution. We analyzed the incidence rate of HZ and the standardized incidence ratio (SIR) by comparing with the general Japanese population. We additionally investigated risk factors for HZ after LT.
Results
HZ developed in 27 (7.16%) of the 377 patients after LT. The incidence rate of HZ after LT was 17.83 per 1000 person‐years, which was significantly higher than in the general Japanese population (SIR = 4.61; 95% confidence interval CI, 4.13–5.14). Multivariate analysis showed that older age (hazard ratio HR = 3.95; P < 0.001) and exposure to mycophenolate mofetil (HR = 3.03; P = 0.007) were independent risk factors for HZ after LT.
Conclusions
This is the first and largest study, to our knowledge, to investigate the incidence rate of HZ and risk factors for development of HZ after LT in the Japanese population. Further investigations to focus on immunosuppressive regimens to reduce the risk for HZ incidence in this high‐risk population could establish a new protocol of immunosuppression after LT.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
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