Arterial and venous vascular injuries are known but rare complications of severe multiple traumatised patients but are meanwhile more frequently induced iatrogenically. However there are only few ...reports about incidence, causes, surgical techniques and prognosis of these vascular emergencies. We have therefore analysed the causes, type of therapy, localisation of injury, primary dis-ease, morbidity and mortality of all vascular emergencies in patients without preexisting vascular disease. 2.9 % of all vascular repairs in our unit had to be performed for cases of iatrogenic (87 %) and non-iatrogenic (13 %) vascular complications. The overall mortality and major complication rate of these intrahospital iatrogenically aquired lesions were 4.8 % and 5 %, respectively, which are clearly below those of extrahospital vascular injuries. Thereby the observed increase of iatrogenic vascular injuries seems to be due to the increase in complex and even catheter-based techniques in modern therapy. The iliacofemoral region was affected in 45 % of the cases, in 50 % complex reconstructions and specific surgical skills were needed for the repair. This article on the incidence of and reasons for vascular iatrogenic lesions shows the importance of a planned management for the prognosis of these injuries.
Changes in forest cover have a strong effect on climate through the alteration of surface biogeophysical and biogeochemical properties that affect energy, water and carbon exchange with the ...atmosphere. To quantify biogeophysical and biogeochemical effects of deforestation in a consistent setup, nine Earth system models (ESMs) carried out an idealized experiment in the framework of the Coupled Model Intercomparison Project, phase 6 (CMIP6). Starting from their pre-industrial state, models linearly replace 20×106 km2 of forest area in densely forested regions with grasslands over a period of 50 years followed by a stabilization period of 30 years. Most of the deforested area is in the tropics, with a secondary peak in the boreal region. The effect on global annual near-surface temperature ranges from no significant change to a cooling by 0.55 ∘C, with a multi-model mean of -0.22±0.21 ∘C. Five models simulate a temperature increase over deforested land in the tropics and a cooling over deforested boreal land. In these models, the latitude at which the temperature response changes sign ranges from 11 to 43∘ N, with a multi-model mean of 23∘ N. A multi-ensemble analysis reveals that the detection of near-surface temperature changes even under such a strong deforestation scenario may take decades and thus longer than current policy horizons. The observed changes emerge first in the centre of deforestation in tropical regions and propagate edges, indicating the influence of non-local effects. The biogeochemical effect of deforestation are land carbon losses of 259±80 PgC that emerge already within the first decade. Based on the transient climate response to cumulative emissions (TCRE) this would yield a warming by 0.46 ± 0.22 ∘C, suggesting a net warming effect of deforestation. Lastly, this study introduces the “forest sensitivity” (as a measure of climate or carbon change per fraction or area of deforestation), which has the potential to provide lookup tables for deforestation–climate emulators in the absence of strong non-local climate feedbacks. While there is general agreement across models in their response to deforestation in terms of change in global temperatures and land carbon pools, the underlying changes in energy and carbon fluxes diverge substantially across models and geographical regions. Future analyses of the global deforestation experiments could further explore the effect on changes in seasonality of the climate response as well as large-scale circulation changes to advance our understanding and quantification of deforestation effects in the ESM frameworks.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Pulmonary vein isolation (PVI) is an effective treatment strategy in symptomatic atrial fibrillation (AF) patients. ...However, this approach shows worse long-term results in individuals suffering from persistent compared to the paroxysmal type.
Purpose
The objective was to investigate differences of left atrial (LA) as well as left atrial appendage (LAA) anatomy in persistent AF (persAF) and paroxysmal (PAF) and patients.
Methods
An observational single center study with a blinded retrospective analysis of cardiac computed tomography angiography (CCTA) images was conducted. Dimensions of LA, posterior wall box, pulmonary veins (PV) as well as LAA size and morphology were assessed and statistically analyzed. All important measures are depicted in the attached figure.
Results
From 2012 to 2016 a total of 1.103 patients underwent second generation cryoballoon PVI. Prior to PVI, CCTA was available for 725 (65.7%) patients with sufficient quality for measuring in 473 (65.2%). Mean age was 66.3±9.5 years; PAF was present in 277 (58.6%) participants. In persAF LA volume mL (111.8; 128.8; p<0.001), posterior wall box area cm2 (11.9; 13.3; p<0.001) and pulmonary vein ostial dimensions were significantly larger compared to PAF. LAA volume mL (9.0; 10.0; p=0.01) and LAA ostial perimeters (66.5; 70.0; p=0.003) were also identified to be larger in persAF. However, there was no difference in LAA morphology (overall distribution: "windsock" 51%; "chicken-wing" 20%; "cauliflower" 15% and "cactus" 13%).
Conclusion
Compared to PAF, persAF patients had significantly larger LA volumes, posterior wall box areas, PV ostial dimensions as well as LAA volumes and LAA ostial perimeters. LAA morphological types were distributed equally in both groups.
The response of the global climate–carbon-cycle system to anthropogenic perturbations happens differently at different timescales. The unravelling of the memory structure underlying this timescale ...dependence is a major challenge in climate research. Recently the widely applied α–β–γ framework proposed by Friedlingstein et al. (2003) to quantify climate–carbon-cycle feedbacks has been generalized to account also for such internal memory. By means of this generalized framework, we investigate the timescale dependence of the airborne fraction for a set of Earth system models that participated in CMIP5 (Coupled Model Intercomparison Project Phase 5). The analysis is based on published simulation data from C4MIP-type (Coupled Climate–Carbon Cycle Model Intercomparison) experiments with these models. Independently of the considered scenario, the proposed generalization describes at global scale the reaction of the climate–carbon system to sufficiently weak perturbations. One prediction from this theory is how the timescale-resolved airborne fraction depends on the underlying feedbacks between climate and the carbon cycle. These feedbacks are expressed as timescale-resolved functions depending solely on analogues of the α, β, and γ sensitivities, introduced in the generalized framework as linear response functions. In this way a feedback-dependent quantity (airborne fraction) is predicted from feedback-independent quantities (the sensitivities). This is the key relation underlying our study. As a preparatory step, we demonstrate the predictive power of the generalized framework exemplarily for simulations with the Max Planck Institute (MPI) Earth System Model. The whole approach turns out to be valid for perturbations of up to an about 100 ppm CO2 rise above the pre-industrial level; beyond this value the response becomes non-linear. By means of the generalized framework we then derive the timescale dependence of the airborne fraction from the underlying climate–carbon-cycle feedbacks for an ensemble of CMIP5 models. Our analysis reveals that for all studied CMIP5 models (1) the total climate–carbon-cycle feedback is negative at all investigated timescales, (2) the airborne fraction generally decreases for increasing timescales, and (3) the land biogeochemical feedback dominates the model spread in the airborne fraction at all these timescales. Qualitatively similar results were previously found by employing the original α–β–γ framework to particular perturbation scenarios, but our study demonstrates that, although obtained from particular scenario simulations, they are characteristics of the coupled climate–carbon-cycle system as such, valid at all considered timescales. These more general conclusions are obtained by accounting for the internal memory of the system as encoded in the generalized sensitivities, which in contrast to the original α, β, and γ are scenario-independent.
To track progress towards keeping global warming well below 2 ∘C or even 1.5 ∘C, as agreed in the Paris Agreement, comprehensive up-to-date and reliable information on anthropogenic emissions and ...removals of greenhouse gas (GHG) emissions is required. Here we compile a new synthetic dataset on anthropogenic GHG emissions for 1970–2018 with a fast-track extension to 2019. Our dataset is global in coverage and includes CO2 emissions, CH4 emissions, N2O emissions, as well as those from fluorinated gases (F-gases: HFCs, PFCs, SF6, NF3) and provides country and sector details. We build this dataset from the version 6 release of the Emissions Database for Global Atmospheric Research (EDGAR v6) and three bookkeeping models for CO2 emissions from land use, land-use change, and forestry (LULUCF). We assess the uncertainties of global greenhouse gases at the 90 % confidence interval (5th–95th percentile range) by combining statistical analysis and comparisons of global emissions inventories and top-down atmospheric measurements with an expert judgement informed by the relevant scientific literature. We identify important data gaps for F-gas emissions. The agreement between our bottom-up inventory estimates and top-down atmospheric-based emissions estimates is relatively close for some F-gas species (∼ 10 % or less), but estimates can differ by an order of magnitude or more for others. Our aggregated F-gas estimate is about 10 % lower than top-down estimates in recent years. However, emissions from excluded F-gas species such as chlorofluorocarbons (CFCs) or hydrochlorofluorocarbons (HCFCs) are cumulatively larger than the sum of the reported species. Using global warming potential values with a 100-year time horizon from the Sixth Assessment Report by the Intergovernmental Panel on Climate Change (IPCC), global GHG emissions in 2018 amounted to 58 ± 6.1 GtCO2 eq. consisting of CO2 from fossil fuel combustion and industry (FFI) 38 ± 3.0 GtCO2, CO2-LULUCF 5.7 ± 4.0 GtCO2, CH4 10 ± 3.1 GtCO2 eq., N2O 2.6 ± 1.6 GtCO2 eq., and F-gases 1.3 ± 0.40 GtCO2 eq. Initial estimates suggest further growth of 1.3 GtCO2 eq. in GHG emissions to reach 59 ± 6.6 GtCO2 eq. by 2019. Our analysis of global trends in anthropogenic GHG emissions over the past 5 decades (1970–2018) highlights a pattern of varied but sustained emissions growth. There is high confidence that global anthropogenic GHG emissions have increased every decade, and emissions growth has been persistent across the different (groups of) gases. There is also high confidence that global anthropogenic GHG emissions levels were higher in 2009–2018 than in any previous decade and that GHG emissions levels grew throughout the most recent decade. While the average annual GHG emissions growth rate slowed between 2009 and 2018 (1.2 % yr−1) compared to 2000–2009 (2.4 % yr−1), the absolute increase in average annual GHG emissions by decade was never larger than between 2000–2009 and 2009–2018. Our analysis further reveals that there are no global sectors that show sustained reductions in GHG emissions. There are a number of countries that have reduced GHG emissions over the past decade, but these reductions are comparatively modest and outgrown by much larger emissions growth in some developing countries such as China, India, and Indonesia. There is a need to further develop independent, robust, and timely emissions estimates across all gases. As such, tracking progress in climate policy requires substantial investments in independent GHG emissions accounting and monitoring as well as in national and international statistical infrastructures. The data associated with this article (Minx et al., 2021) can be found at https://doi.org/10.5281/zenodo.5566761.
Abstract The left atrial appendage (LAA) is an important part of the heart that can contribute to the formation of blood clots and the development of arrhythmias. Managing the LAA is crucial in ...clinical practice. Besides oral anticoagulation, one approach is LAA occlusion, which can reduce the risk of blood clots in selected patients. Another approach is LAA ablation, which has been proposed in addition to pulmonary vein isolation (PVI) and might improve the success of treating atrial fibrillation (AF). Different types of LAA morphology have been identified, and these differences can affect the choice of treatment and strategies for individual patients. To refine current classification system, a new approach has been proposed. The study utilized an observational single-center trial with blinded retrospective analysis of cardiac computed tomography angiography (CCTA) images from cryoballoon PVI patients. Statistical analysis included baseline characteristics and left atrium/LAA measurements. An LAA bounding box was introduced to enhance the current classification system, particularly focusing on distinguishing "chicken-wing" and "windsock," as well as "cauliflower" and "cactus" morphologies. From 2012 to 2016 a total of 1.103 patients underwent second generation cryoballoon PVI. Prior to PVI, CCTA was available for 725 (65.7%) patients with sufficient quality for measuring in 473 (65.2%). Mean age was 66.3±9.5 years; Paroxysmal AF was present in 277 (58.6%) participants. The distribution of LAA morphological types was as follows: "windsock" 51%, "chicken-wing" 20%, "cauliflower" 15%, and "cactus" 13%. Inter-rater reliability, assessed using Cohen's Kappa with Landis and Koch criteria, demonstrated substantial agreement (Kappa = 0.69; p<0.001). "Chicken-wing" morphology had the largest LAA volume at 9.9 (7.9; 12.8) mL, followed by "windsock" morphology with an LAA volume of 9.7 (7.7; 13.1) mL. "Cactus" and "cauliflower" morphologies had considerably smaller LAA volumes, measuring 5.4 (4.6; 7.5) mL and 5.6 (4.4; 7.6) mL, respectively. Bounding box parameters were utilized to distinguish between "windsock" and "chicken-wing" as well as "cauliflower" and "cactus" morphologies. "Windsock" had a maximal LAA depth of 44.3±7.1 mm, while "chicken-wing" measured 40.1±8.6 mm (p<0.001). The sinus values for the bounding box were 0.40±0.06 for "windsock" and 0.44±0.08 for "chicken-wing" (p<0.001). For "cauliflower," the LAA depth averaged 30.42±5.0 mm, whereas for "cactus," it measured 33.4±4.3 mm (p<0.001). The mean sinus of the bounding box was 0.48±0.08 for "cauliflower" and 0.44±0.07 for "cactus" (p<0.05). The utilization of novel bounding box parameters has the potential to aid in the differentiation between different LAA morphologies, such as 'chicken-wing' and 'windsock', as well as 'cactus' and 'cauliflower', especially in cases where the current classification system may not provide clear distinctions.
Intergovernmental Panel on Climate Change (IPCC) assessments are the trusted source of scientific evidence for climate negotiations taking place under the United Nations Framework Convention on ...Climate Change (UNFCCC), including the first global stocktake under the Paris Agreement that will conclude at COP28 in December 2023. Evidence-based decision-making needs to be informed by up-to-date and timely information on key indicators of the state of the climate system and of the human influence on the global climate system. However, successive IPCC reports are published at intervals of 5-10 years, creating potential for an information gap between report cycles.
In 2018 and 2019, central Europe was affected by two consecutive extreme dry and hot summers (DH18 and DH19). The DH18 event had severe impacts on ecosystems and likely affected vegetation activity ...in the subsequent year, for example through depletion of carbon reserves or damage from drought. Such legacies from drought and heat stress can further increase vegetation susceptibility to additional hazards. Temporally compound extremes such as DH18 and DH19 can, therefore, result in an amplification of impacts due to preconditioning effects of past disturbance legacies.
The global carbon budget (GCB) – including fluxes of CO2 between the atmosphere, land, and ocean and its atmospheric growth rate – show large interannual to decadal variations. Reconstructing and ...predicting the variable GCB is essential for tracing the fate of carbon and understanding the global carbon cycle in a changing climate. We use a novel approach to reconstruct and predict the variations in GCB in the next few years based on our decadal prediction system enhanced with an interactive carbon cycle. By assimilating physical atmospheric and oceanic data products into the Max Planck Institute Earth System Model (MPI-ESM), we are able to reproduce the annual mean historical GCB variations from 1970–2018, with high correlations of 0.75, 0.75, and 0.97 for atmospheric CO2 growth, air–land CO2 fluxes, and air–sea CO2 fluxes, respectively, relative to the assessments from the Global Carbon Project (GCP). Such a fully coupled decadal prediction system, with an interactive carbon cycle, enables the representation of the GCB within a closed Earth system and therefore provides an additional line of evidence for the ongoing assessments of the anthropogenic GCB. Retrospective predictions initialized from the simulation in which physical atmospheric and oceanic data products are assimilated show high confidence in predicting the following year's GCB. The predictive skill is up to 5 years for the air–sea CO2 fluxes, and 2 years for the air–land CO2 fluxes and atmospheric carbon growth rate. This is the first study investigating the GCB variations and predictions with an emission-driven prediction system. Such a system also enables the reconstruction of the past and prediction of the evolution of near-future atmospheric CO2 concentration changes. The Earth system predictions in this study provide valuable inputs for understanding the global carbon cycle and informing climate-relevant policy.
Anthropogenic land-use and land-cover change activities play a critical role in Earth system dynamics through significant alterations to biogeophysical and biogeochemical properties at local to ...global scales. To quantify the magnitude of these impacts, climate models need consistent land-cover change time series at a global scale, based on land-use information from observations or dedicated land-use change models. However, a specific land-use change cannot be unambiguously mapped to a specific land-cover change. Here, nine translation rules are evaluated based on assumptions about the way land-use change could potentially impact land cover. Utilizing the Global Land-use Model 2 (GLM2), the model underlying the latest Land-Use Harmonization dataset (LUH2), the land-cover dynamics resulting from land-use change were simulated based on multiple alternative translation rules from 850 to 2015 globally. For each rule, the resulting forest cover, carbon density and carbon emissions were compared with independent estimates from remote sensing observations, U.N. Food and Agricultural Organization reports, and other studies. The translation rule previously suggested by the authors of the HYDE 3.2 dataset, that underlies LUH2, is consistent with the results of our examinations at global, country and grid scales. This rule recommends that for CMIP6 simulations, models should (1) completely clear vegetation in land-use changes from primary and secondary land (including both forested and non-forested) to cropland, urban land and managed pasture; (2) completely clear vegetation in land-use changes from primary forest and/or secondary forest to rangeland; (3) keep vegetation in land-use changes from primary non-forest and/or secondary non-forest to rangeland. Our analysis shows that this rule is one of three (out of nine) rules that produce comparable estimates of forest cover, vegetation carbon and emissions to independent estimates and also mitigate the anomalously high carbon emissions from land-use change observed in previous studies in the 1950s. According to the three translation rules, contemporary global forest area is estimated to be 37.42×106 km2, within the range derived from remote sensing products. Likewise, the estimated carbon stock is in close agreement with reference biomass datasets, particularly over regions with more than 50 % forest cover.
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