bluuebunny/crossref_metadata_2025 huggingface dataset:
Prepectoral Two-Stage Implant-Based Breast Reconstruction with and without Acellular Dermal Matrix: Do We See a Difference?
Authors: Manrique Oscar J. , Huang Tony Chieh-Ting , Martinez-Jorge Jorys , Ciudad Pedro , Forte Antonio J. , Bustos Samyd S. , Boughey Judy C. , Jakub James W. , Degnim Amy C. , Galan Ricardo
Published: January 2020

Background:

Prepectoral implant-based breast reconstruction has gained popularity because of advantages over the subpectoral technique. Acellular dermal matrix use with implant-based breast reconstruction has become common because of its perceived superior aesthetic outcome. Matrices are expensive, however, and recent evidence has pointed to several potential complications. This article reports a series of prepectoral implant-based breast reconstructions with and without acellular dermal matrix and compared their outcomes.

Methods:

This is a single-surgeon retrospective review of patients who underwent staged prepectoral implant-based breast reconstruction following nipple-sparing mastectomy over two periods. Patients with well-perfused mastectomy skin flaps with a homogeneous thickness underwent reconstruction with acellular dermal matrix initially. On evolution of the practice, it was not used. Patient demographics, operative data, and complications were analyzed. Aesthetic outcome was measured by the BREAST-Q survey and the Aesthetic Item Scale. A cost analysis was also performed.

Results:

Forty patients were included (acellular dermal matrix group, n = 19; non–acellular dermal matrix group, n = 21). The nonmatrix group had one case (5 percent) of seroma and one case (5 percent) with hematoma; there were none in the acellular dermal matrix group. Average BREAST-Q and Aesthetic Item Scale scores were 82.3 versus 81.6 (p = 0.954) and 20.98 versus 20.43 (p = 0.640) for the matrix and nonmatrix groups, respectively. The direct cost savings for the authors’ institution over 1 year if matrix was not used in all cases of implant-based breast reconstruction would be estimated at $3,105,960 to $6,211,920 for unilateral and bilateral cases, respectively, for Medicare reimbursement.

Conclusions:

With adequate patient selection, acellular dermal matrix is not always required during two-stage prepectoral implant-based breast reconstruction for good aesthetic outcomes. The economic burden on patients and the health care system could be lessened with selective matrix use.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
The Effect of Sequential Compression Devices on Fibrinolysis in Plastic Surgery Outpatients: A Randomized Trial
Authors: Swanson Eric
Published: January 2020

Background:

Sequential compression devices are often considered a mainstay of prophylaxis against deep venous thromboses in surgical patients. The devices are believed to produce a milking action on the deep veins to prevent venous stasis. A systemic fibrinolytic effect has also been proposed, adding a second mechanism of action. The plasma levels of tissue plasminogen activator and plasminogen activator inhibitor-1 reflect fibrinolytic activity.

Methods:

A randomized trial was conducted among 50 consecutive plastic surgery outpatients undergoing cosmetic surgery performed by the author under total intravenous anesthesia and without paralysis. Patients were randomized to receive calf-length sequential compression devices or no sequential compression devices during surgery. Blood samples were obtained from the upper extremity preoperatively and at hourly intervals until the patient was discharged from the postanesthesia care unit. Tissue plasminogen activator and plasminogen activator inhibitor-1 levels were measured. Ultrasound surveillance was used in all patients. There was no outside funding for the study.

Results:

All patients agreed to participate (inclusion rate, 100 percent). No patient developed clinical signs or ultrasound evidence of a deep venous thrombosis. There were no significant changes in tissue plasminogen activator levels or plasminogen activator inhibitor-1 levels from the preoperative measurements at any hourly interval and no differences in levels comparing patients treated with or without sequential compression devices.

Conclusions:

No significant change in systemic fibrinolytic activity occurs during outpatient plastic surgery under total intravenous anesthesia. Sequential compression devices do not affect tissue plasminogen activator or plasminogen activator inhibitor-1 levels, suggesting no fibrinolytic benefit.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, I.
Preventing Lateral Canthal Malposition in Modern Blepharoplasty
Authors: Rohrich Rod. J. , Mohan Raja
Published: January 2020

Current goals in lower eyelid blepharoplasty include blending the lower eyelid-cheek junction, which is highlighted in the authors’ six-step lower lid blepharoplasty technique. One major question in lower lid blepharoplasty is how to prevent lower lid malposition and ectropion, because these are untoward outcomes after an aesthetic procedure. In the authors’ technique, they perform a superficial lateral retinacular canthopexy that is effective and safe and also prevents lower lid malposition or ectropion. A retrospective review of 104 patients who underwent six-step lower lid blepharoplasty was performed. In the authors’ series, there was no significant difference between preoperative and postoperative intercanthal angles (p < 0.05), and the lateral canthal position did not change significantly from its preoperative position. The authors’ six-step blepharoplasty technique addresses signs of midfacial aging, and the lateral canthopexy technique has been shown to have a minimal complication rate and maintains canthal position.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
The Reducing Opioid Use in Children with Clefts Protocol: A Multidisciplinary Quality Improvement Effort to Reduce Perioperative Opioid Use in Patients Undergoing Cleft Surgery
Authors: Lee Alfred , Chang Brian L. , Yan Chen , Fox Justin P. , Magee Leanne , Scott Michelle , Maguire Meg Ann , Ross Karen , Rakow Cara , Drake Francesca , McGinnis Andrea , Watson Adam , Burlingame Caroline , Kraemer F. Wickham , Muhly Wallis T. , Ruby Jordan , Jackson Oksana A.
Published: January 2020

Background:

Cleft repair requires multiple operations from infancy through adolescence, with repeated exposure to opioids and their associated risks. The authors implemented a quality improvement project to reduce perioperative opioid exposure in their cleft lip/palate population.

Methods:

After identifying key drivers of perioperative opioid administration, quality improvement interventions were developed to address these key drivers and reduce postoperative opioid administration from 0.30 mg/kg of morphine equivalents to 0.20 mg/kg of morphine equivalents. Data were retrospectively collected from January 1, 2015, until initiation of the quality improvement project (May 1, 2017), tracked over the 6-month quality improvement study period, and the subsequent 14 months. Metrics included morphine equivalents of opioids received during admission, administration of intraoperative nerve blocks, adherence to revised electronic medical record order sets, length of stay, and pain scores.

Results:

The final sample included 624 patients. Before implementation (n =354), children received an average of 0.30 mg/kg of morphine equivalents postoperatively. After implementation (n = 270), children received an average of 0.14 mg/kg of morphine equivalents postoperatively (p < 0.001) without increased length of stay (28.3 versus 28.7 hours; p = 0.719) or pain at less than 6 hours (1.78 versus 1.74; p = 0.626) or more than 6 hours postoperatively (1.50 versus 1.49; p = 0.924).

Conclusions:

Perioperative opioid administration after cleft repair can be reduced in a relatively short period by identifying key drivers and addressing perioperative education, standardization of intraoperative pain control, and postoperative prioritization of nonopioid medications and nonpharmacologic pain control. The authors’ quality improvement framework has promise for adaptation in future efforts to reduce opioid use in other surgical patient populations.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Migraine Surgery at the Frontal Trigger Site: An Analysis of Intraoperative Anatomy
Authors: Ortiz Ricardo , Gfrerer Lisa , Hansdorfer Marek A. , Nealon Kassandra P. , Lans Jonathan , Austen William G.
Published: January 2020

Background:

The development of migraine headaches may involve the entrapment of peripheral craniofacial nerves at specific sites. Cadaveric studies in the general population have confirmed potential compression points of the supraorbital and supratrochlear nerves at the frontal trigger site. The authors’ aim was to describe the intraoperative anatomy of the supraorbital and supratrochlear nerves at the level of the supraorbital bony rim in patients undergoing frontal migraine surgery and to investigate associated pain.

Methods: Patients

scheduled for frontal-site surgery were enrolled prospectively. The senior author (W.G.A.) evaluated intraoperative anatomy and recorded variables using a detailed form and operative report. The resulting data were analyzed.

Results:

One hundred eighteen sites among 61 patients were included. The supraorbital nerve traversed a notch in 49 percent, a foramen in 41 percent, a notch plus a foramen in 9.3 percent, and neither a notch nor a foramen in one site. The senior author noted macroscopic nerve compression at 74 percent of sites. Reasons included a tight foramen in 24 percent, a notch with a tight band in 34 percent, and supraorbital and supratrochlear nerves emerging by means of the same notch in 7.6 percent or by means of the same foramen in 4.2 percent. Preoperative pain at a site was significantly associated with nerve compression by a foramen.

Conclusions:

The intraoperative anatomy and cause of nerve compression at the frontal trigger site vary greatly among patients. The authors report a supraorbital nerve foramen prevalence of 50.3 percent, which is greater than in previous cadaver studies of the general population. Lastly, the presence of pain at a specific site is associated with macroscopic nerve compression.
Staged Abbe-Rhinoplasty Technique to Correct Bilateral Cleft Deformity
Authors: Veeramani Anamika , Wilson Alexander T. , Sawh-Martinez Rajendra , Steinbacher Derek M.
Published: January 2020

The mature bilateral cleft nasolabial deformity exhibits prolabial and vermilion deficiency, a broad depressed nasal tip, and short columella.
1
Many strategies attempt to correct these stigmata, with varying degrees of success. The purpose of this communication is to describe a novel sequenced approach, staging an Abbe flap and rhinoplasty, with morphometric analysis of results.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Review of Insurance Coverage for Abdominal Contouring Procedures in the Postbariatric Population
Authors: Ngaage Ledibabari M. , Elegbede Adekunle , Pace Lauren , Rosen Carly , Tannouri Sami , Rada Erin M. , Kligman Mark D. , Rasko Yvonne M.
Published: January 2020

Background:

Following bariatric surgery, patients develop problems related to lax abdominal skin that may be addressed by contouring procedures. Third-party insurers have subjective requirements for coverage of these procedures that can limit patient access. The authors sought to determine how well third-party payers cover abdominal contouring procedures in this population.

Methods:

The authors conducted a cross-sectional analysis of insurance policies for coverage of panniculectomy, lower back excision, and circumferential lipectomy. Abdominoplasty was evaluated as an alternative to panniculectomy. Insurance companies were selected based on their market share and state enrolment. A list of medical necessity criteria was abstracted from the policies that offered coverage.

Results:

Of the 55 companies evaluated, 98 percent had a policy that covered panniculectomy versus 36 percent who would cover lower back excision (p < 0.0001), and one-third provided coverage for circumferential lipectomy. Of the insurers who covered panniculectomy, only 30 percent would also cover abdominoplasty. Documentation of secondary skin conditions was the most prevalent criterion in panniculectomy policies (100 percent), whereas impaired function and secondary skin conditions were most common for coverage of lower back excision (73 percent and 73 percent, respectively). Frequency of criteria for panniculectomy versus lower back excision differed most notably for (1) secondary skin conditions (100 percent versus 73 percent; p = 0.0030), (2) weight loss (45 percent versus 7 percent; p = 0.0106), and (3) duration of weight stability (82 percent versus 53 percent; p = 0.0415).

Conclusions:

For the postbariatric population, panniculectomy was covered more often and had more standardized criteria than lower back excision or circumferential lipectomy. However, all have vast intracompany and interpolicy variations in coverage criteria that may reduce access to procedures, even among patients with established indications.
The Robotic DIEP Flap
Authors: Selber Jesse C.
Published: January 2020

The history of autologous breast reconstruction has been characterized by the desire for progressively increasing reliability with decreasing donor-site morbidity. The robotic deep inferior epigastric artery perforator flap permits the longest possible pedicle harvest through the smallest possible fascial incision and, for this reason, may be the next stage in the evolution of minimally invasive, autologous breast reconstruction.
Signal Enhancement and Enhancement Kinetics of Gadobutrol, Gadoteridol, and Gadoterate Meglumine in Various Body Regions
Authors: Knobloch Gesine , Frenzel Thomas , Pietsch Hubertus , Jost Gregor
Published: January 2020

Objectives

The signal enhancement (SE) and enhancement kinetics of gadolinium-based contrast agents (GBCAs) in T1-weighted magnetic resonance (MR) images depend on the relaxivity of the GBCA and its pharmacokinetic profile. This in vivo study systematically compared the SE (technical efficacy) and the enhancement kinetics of the 3 macrocyclic GBCAs gadobutrol, gadoteridol, and gadoterate meglumine in various body regions.

Materials and Methods

A total of 15 healthy male white New Zealand rabbits were randomly divided into 3 groups (n = 5/group). The GBCAs were injected intravenously (0.1 mmol/kg body weight) and signal intensities from multiphase T1-weighted MR images (1.5 T; volumetric interpolated breath-hold examination (VIBE); repetition time/echo time/α: 4.74 milliseconds/2.38 milliseconds/10°) before and up to approximately 23 minutes after contrast injection were determined in the brain, tongue, submandibular gland, liver, spleen, prostate, muscle, and blood/aorta). Thirty minutes after injection, the animals were sacrificed and Gadolinium (Gd) concentrations were determined in the above-mentioned tissue samples by inductively coupled plasma optical emission spectrometry. Gadolinium tissue concentrations were correlated with the respective SE measurements in each tissue.

Results

The time course of SE, representing the pharmacokinetic profile of the GBCA, was similar for all 3 agents in all tissues. The magnitude of SE was, however, tissue dependent and consistently higher for gadobutrol (P < 0.05 in all tissues but brain). No significant difference in the magnitude of SE was found between gadoteridol and gadoterate meglumine. The inductively coupled plasma optical emission spectrometry analysis revealed no differences in Gd-tissue concentrations between the GBCAs. A linear correlation was observed between SE and the respective Gd concentrations for all 3 GBCAs. A significantly higher enhancement efficacy, that is, SE per Gd concentration, was observed for gadobutrol.

Conclusions

Gadobutrol-enhanced MR imaging showed greater SE compared with gadoteridol and gadoterate meglumine, whereas the SE kinetics were similar among the 3 GBCAs. For all 3 GBCAs, the SE was independent of the body region.
The Charles Procedure as Part of the Modern Armamentarium Against Lymphedema
Authors: Hassan Kareem , Chang David W.
Published: January 2020

Background

Over the past 2 decades, the surgical treatment of lymphedema has advanced considerably with lymphovenous bypass and vascularized lymph node transfer. Despite these advances, some patients can only be treated with a radical debulking procedure, commonly known as Charles procedure. However, the Charles procedure is not a commonly performed procedure and can have significant risks such as fluid shifts, blood loss and wound infections. In this article, we present our experience with Charles procedure and share pearls to perform this procedure expediently while avoiding potential pitfalls.

Methods

Patients with severe lymphedema who were treated by the senior author with Charles procedure were evaluated. The medical record was queried for their pertinent medical history, including cause of lymphedema, prior treatments for the condition, medical comorbidities and preoperative and postoperative course. The surgical technique and lessons learned from each case are described.

Results

Three patients were identified within the study period who underwent treatment with the Charles procedure. All patients had secondary lower extremity lymphedema. All patients had single-stage direct excision and skin grafting. One patient required postoperative ICU stay due to significant fluid shifts and blood loss, another suffered from a wound infection. All 3 patients ultimately recovered to exceed their preoperative activity levels with satisfactory outcomes.

Conclusions

The Charles procedure continues to have clinical utility in modern lymphedema treatment. Despite potential risks, it can be done successfully with proper planning and careful attention to technical details; it can be life changing for patients suffering from most extreme lymphedema.
Optimization of the Parameters of Different Purification Techniques and Comparison of Their Purification Efficiency and Their Effects on the Metabolic Activity of Adipose Tissue in Autologous Fat Transplantation
Authors: Li Yilin , Lu Haibing , Yang Xiaonan , Jin Xiaolei , Qi Zuoliang
Published: January 2020

There is still no unified standardized or optimal procedure for lipoaspirate purification and we explored the optimal parameters of 3 purification techniques and compared their efficiencies and effects on the metabolic activity of adipose tissue. The purification efficiency of each technique was compared by analyzing the composition ratio of the processed compounds. The effects of the purification techniques on the dynamic metabolic activity of adipose tissue were evaluated in vitro using the glucose transfer assay. We found that the cotton pad adsorption technique displayed the greatest ability to remove aqueous and oil fractions, followed by centrifugation and sedimentation techniques (P < 0.01). The in vitro metabolic activity of adipose tissue peaked at 4 hours. The glucose transfer rates in the cotton pad group and the sedimentation group were significantly higher (P < 0.05) than that of the centrifugation group, and the centrifugation method exerted the greatest effect on the metabolic activity of adipose tissue. To sum up, the optimal processing parameters were the following: sedimentation technique, 30 minutes of sedimentation; centrifugation technique, 3 to 5 minutes of centrifugation and centrifugation force of 200 g; and cotton pad adsorption technique, contact area of 5 cm2/mL and contact time of 5 minutes. The cotton pad adsorption technique yielded the best purification of the aqueous and oil fractions, followed by the centrifugation technique, whereas the sedimentation technique exhibited the lowest efficiency. The in vitro metabolic activity of adipose tissue peaked at 4 hours, and the cotton pad and sedimentation technique exerted decreased effects on metabolic activity than the centrifugation technique.
Midline Intranasal Dermoid Cyst With Intracranial Extension: Technical Details of a Multidisciplinary Approach to a Rare Condition
Authors: Davis Matthew J. , Abu-Ghname Amjed , Davies Lesley W. , Xue Amy S. , Masoumy Mohamad , Lam Sandi , Buchanan Edward P.
Published: January 2020

Dermoid cysts are rare, benign neoplasms that develop when ectodermal tissue is ectopically included during neural tube closure. Only 0.7% to 1.8% of dermoid cysts occur intracranially, and these make up only 0.3% of all intracranial tumors. Definitive management of intracranial dermoid cysts is achieved with surgical excision, with the primary goal being removal of the lesion before rupture or infection occurs. The authors report the multidisciplinary management of a 6-month-old patient with a midline intranasal dermoid cyst with intracranial involvement successfully treated with surgical resection. The surgical approach included Neurosurgical access with a bifrontal approach to remove the intracranial portion, then Plastic Surgery accessed and removed the intranasal portion through a transcolumellar and infracartilaginous dissection. The entire cyst was successfully removed without rupture. The patient's postoperative course was without complication.

Timely preoperative imaging and diagnosis were crucial to the success of this operation. When considering the possibility of a midline dermoid cyst with intracranial extension, it is essential to obtain proper imaging to distinguish between lesions on the differential diagnosis and to define extent of extension. Once diagnosed, surgical planning requires a multidisciplinary approach. Considerations for the optimal surgical approach to intracranial, intranasal dermoids include maximizing surgical exposure and ensuring an aesthetically pleasing reconstructive outcome.
Sequential Cohort Analysis After Liver Transplantation Shows de Novo Extended Release Tacrolimus Is Safe, Efficacious, and Minimizes Renal Dysfunction
Authors: Lim Tiong Yeng , McPhail Mark J. , Shah Amar , Mahgoub Sara , Nayagam Jeremy , Cramp Matthew , Bernal William , Menon Krish , Jassem Wayel , Joshi Deepak , Heneghan Michael A. , Agarwal Kosh , Heaton Nigel D. , Suddle Abid , O’Grady John G. , Aluvihare Varuna R.
Published: January 2020

Background.

The use of once-daily extended-release tacrolimus (ERT) is associated with improved long-term graft and patient survival when compared with twice-daily tacrolimus (BDT), but the underlying reasons for differential survival are unclear. The aim of the study was to compare clinical outcomes known to impact on posttransplant survival for de novo BDT and ERT in liver transplantation (LT) recipients.

Methods.

We conducted a single-center, prospective sequential cohort analysis of adult patients undergoing LT during a change in protocol from de novo BDT to ERT, with a 6-month post-LT follow-up.

Results.

A total of 160 transplanted patients were evaluated; 82 were in the BDT group and 78 were in the ERT group. The cohorts were matched for standard variables and a similar proportion in each group received induction interleukin-2 receptor antibody (36% and 31%). There were no significant differences in the measured outcomes of patient and graft survival, biopsy-proven acute rejection episodes, post LT diabetes, and toxicity. A significantly lower number of patients developed chronic kidney disease Stage3–4 in the ERT cohort compared with BDT cohort. In patients with pre-LT renal dysfunction who received antibody induction, estimated glomerular filtration rate decreased significantly in the BDT but not the ERT group.

Conclusions.

We show that once-daily ERT is as safe and efficacious as BDT in de novo LT but optimally conserves renal function post-LT.
Safe and Successful Treatment of Acute Cellular Rejection of an Intestine and Abdominal Wall Transplant With Vedolizumab
Authors: Trentadue Guido , Kats-Ugurlu Gursah , Blokzijl Tjasso , Diercks Gilles FH , Haveman Jan Willem , Faber Klaas Nico , Dijkstra Gerard
Published: January 2020

Background.

Graft survival rates after intestinal transplantation (ITx) are still the lowest in comparison to other solid organ transplants. One of the main reasons is the frequent occurrence of acute cellular rejection (ACR). Vedolizumab is an antibody against α4β7+ integrin involved in gut-homing of T cells which has been approved for inflammatory bowel diseases (IBD). We report its off-label use to treat ACR after ITx.

Methods.

Following abdominal wall transplantation (AWTx) and ITx, clinical course was followed biochemically. Sequential small intestinal biopsies were taken preceding, during, and after ACR treatment with vedolizumab, following the standard therapy regime for IBD. Rejection was diagnosed histologically, and proinflammatory (α4β7+, interleukin-17+) and regulatory (FoxP3+) T cells were analyzed by immunohistochemistry.

Results.

ACR in both the ITx and AWTx resolved upon vedolizumab treatment, which was safe, evidenced by clearing an astrovirus and primary cytomegalovirus infection. Only a slight reduction of α4β7+ cells in the mucosa was observed, and α4β7+ and regulatory T cells could still move into the lamina propria upon infection.

Conclusions.

Vedolizumab is a safe treatment option for ACR after ITx but its mechanism is probably not only based on inhibition of gut-selective T-cell homing.
Climate change and ecosystems: threats, opportunities and solutions
Authors: Malhi Yadvinder , Franklin Janet , Seddon Nathalie , Solan Martin , Turner Monica G. , Field Christopher B. , Knowlton Nancy
Published: January 2020

The rapid anthropogenic climate change that is being experienced in the early twenty-first century is intimately entwined with the health and functioning of the biosphere. Climate change is impacting ecosystems through changes in mean conditions and in climate variability, coupled with other associated changes such as increased ocean acidification and atmospheric carbon dioxide concentrations. It also interacts with other pressures on ecosystems, including degradation, defaunation and fragmentation. There is a need to understand the ecological dynamics of these climate impacts, to identify hotspots of vulnerability and resilience and to identify management interventions that may assist biosphere resilience to climate change. At the same time, ecosystems can also assist in the mitigation of, and adaptation to, climate change. The mechanisms, potential and limits of such nature-based solutions to climate change need to be explored and quantified. This paper introduces a thematic issue dedicated to the interaction between climate change and the biosphere. It explores novel perspectives on how ecosystems respond to climate change, how ecosystem resilience can be enhanced and how ecosystems can assist in addressing the challenge of a changing climate. It draws on a Royal Society-National Academy of Sciences Forum held in Washington DC in November 2018, where these themes and issues were discussed. We conclude by identifying some priorities for academic research and practical implementation, in order to maximize the potential for maintaining a diverse, resilient and well-functioning biosphere under the challenging conditions of the twenty-first century.

This article is part of the theme issue ‘Climate change and ecosystems: threats, opportunities and solutions’.
Plant community diversity will decline more than increase under climatic warming
Authors: Harrison Susan
Published: January 2020

Regions and localities may lose many species to extinction under rapid climate change and may gain other species that colonize from nearby warmer environments. Here, it is argued that warming-induced species losses will generally exceed gains and there will be more net declines than net increases in plant community richness. Declines in richness are especially likely in water-limited climates where intensifying aridity will increasingly exceed plant tolerances, but also in colder temperature-limited climates where steep climatic gradients are lacking, and therefore, large pools of appropriate species are not immediately adjacent. The selectivity of warming-induced losses may lead to declines in functional and phylogenetic diversity as well as in species richness, especially in water-limited climates. Our current understanding of climate-caused diversity trends may be overly influenced by numerous studies coming from north-temperate alpine mountaintops, where conditions are unusually favourable for increases—possibly temporary—in local species richness.

This article is part of the theme issue ‘Climate change and ecosystems: threats, opportunities and solutions’.
Benthic-based contributions to climate change mitigation and adaptation
Authors: Solan Martin , Bennett Elena M. , Mumby Peter J. , Leyland Julian , Godbold Jasmin A.
Published: January 2020

Innovative solutions to improve the condition and resilience of ecosystems are needed to address societal challenges and pave the way towards a climate-resilient future. Nature-based solutions offer the potential to protect, sustainably manage and restore natural or modified ecosystems while providing multiple other benefits for health, the economy, society and the environment. However, the implementation of nature-based solutions stems from a discourse that is almost exclusively derived from a terrestrial and urban context and assumes that risk reduction is resolved locally. We argue that this position ignores the importance of complex ecological interactions across a range of temporal and spatial scales and misses the substantive contribution from marine ecosystems, which are notably absent from most climate mitigation and adaptation strategies that extend beyond coastal disaster management. Here, we consider the potential of sediment-dwelling fauna and flora to inform and support nature-based solutions, and how the ecology of benthic environments can enhance adaptation plans. We illustrate our thesis with examples of practice that are generating, or have the potential to deliver, transformative change and discuss where further innovation might be applied. Finally, we take a reflective look at the realized and potential capacity of benthic-based solutions to contribute to adaptation plans and offer our perspectives on the suitability and shortcomings of past achievements and the prospective rewards from sensible prioritization of future research.

This article is part of the theme issue ‘Climate change and ecosystems: threats, opportunities and solutions'.
Soil microbial community responses to climate extremes: resistance, resilience and transitions to alternative states
Authors: Bardgett Richard D. , Caruso Tancredi
Published: January 2020

A major challenge for advancing our understanding of the functional role of soil microbial communities is to link changes in their structure and function under climate change. To address this challenge requires new understanding of the mechanisms that underlie the capacity of soil microbial communities to resist and recover from climate extremes. Here, we synthesize emerging understanding of the intrinsic and extrinsic factors that influence the resistance and resilience of soil microbial communities to climate extremes, with a focus on drought, and identify drivers that might trigger abrupt changes to alternative states. We highlight research challenges and propose a path for advancing our understanding of the resistance and resilience of soil microbial communities to climate extremes, and of their vulnerability to transitions to alternative states, including the use of trait-based approaches. We identify a need for new approaches to quantify resistance and resilience of soil microbial communities, and to identify thresholds for transitions to alternative states. We show how high-resolution time series coupled with gradient designs will enable detecting response patterns to interacting drivers. Finally, to account for extrinsic factors, we suggest that future studies should use environmental gradients to track soil microbial community responses to climate extremes in space and time.

This article is part of the theme issue ‘Climate change and ecosystems: threats, opportunities and solutions’.
If the trees burn, is the forest lost? Past dynamics in temperate forests help inform management strategies
Authors: Iglesias Virginia , Whitlock Cathy
Published: January 2020

Forest dynamics are driven by top-down changes in climate and bottom-up positive (destabilizing) and negative (stabilizing) biophysical feedbacks involving disturbance and biotic interactions. When positive feedbacks prevail, the resulting self-propagating changes can potentially shift the system into a new state, even in the absence of climate change. Conversely, negative feedbacks help maintain a dynamic equilibrium that allows communities to recover their pre-disturbance characteristics. We examine palaeoenvironmental records from temperate forests to assess the nature of long-term stability and regime shifts under a broader range of environmental forcings than can be observed at present. Forest histories from northwestern USA, Patagonia, Tasmania and New Zealand show long-term trajectories that were governed by (i) the biophysical template, (ii) characteristics of climate and disturbance, (iii) historical legacies that condition the ecological capacity to respond to subsequent disturbances, and (iv) thresholds that act as irreversible barriers. Attention only to current forest conditions overlooks the significance of history in creating path dependency, the importance of individual extreme events, and the inherent feedbacks that force an ecosystem into reorganization. A long-time perspective on ecological resilience helps guide conservation strategies that focus on environmental preservation as well as identify vulnerable species and ecosystems to future climate change.

This article is part of the theme issue ‘Climate change and ecosystems: threats, opportunities and solutions’.
Climatic and local stressor interactions threaten tropical forests and coral reefs
Authors: França Filipe M. , Benkwitt Cassandra E. , Peralta Guadalupe , Robinson James P. W. , Graham Nicholas A. J. , Tylianakis Jason M. , Berenguer Erika , Lees Alexander C. , Ferreira Joice , Louzada Júlio , Barlow Jos
Published: January 2020

Tropical forests and coral reefs host a disproportionately large share of global biodiversity and provide ecosystem functions and services used by millions of people. Yet, ongoing climate change is leading to an increase in frequency and magnitude of extreme climatic events in the tropics, which, in combination with other local human disturbances, is leading to unprecedented negative ecological consequences for tropical forests and coral reefs. Here, we provide an overview of how and where climate extremes are affecting the most biodiverse ecosystems on Earth and summarize how interactions between global, regional and local stressors are affecting tropical forest and coral reef systems through impacts on biodiversity and ecosystem resilience. We also discuss some key challenges and opportunities to promote mitigation and adaptation to a changing climate at local and global scales.

This article is part of the theme issue ‘Climate change and ecosystems: threats, opportunities and solutions'.
Pleistocene Arctic megafaunal ecological engineering as a natural climate solution?
Authors: Macias-Fauria Marc , Jepson Paul , Zimov Nikita , Malhi Yadvinder
Published: January 2020

Natural climate solutions (NCS) in the Arctic hold the potential to be implemented at a scale able to substantially affect the global climate. The strong feedbacks between carbon-rich permafrost, climate and herbivory suggest an NCS consisting of reverting the current wet/moist moss and shrub-dominated tundra and the sparse forest–tundra ecotone to grassland through a guild of large herbivores. Grassland-dominated systems might delay permafrost thaw and reduce carbon emissions—especially in Yedoma regions, while increasing carbon capture through increased productivity and grass and forb deep root systems. Here we review the environmental context of megafaunal ecological engineering in the Arctic; explore the mechanisms through which it can help mitigate climate change; and estimate its potential—based on bison and horse, with the aim of evaluating the feasibility of generating an ecosystem shift that is economically viable in terms of carbon benefits and of sufficient scale to play a significant role in global climate change mitigation. Assuming a megafaunal-driven ecosystem shift we find support for a megafauna-based arctic NCS yielding substantial income in carbon markets. However, scaling up such projects to have a significant effect on the global climate is challenging given the large number of animals required over a short period of time. A first-cut business plan is presented based on practical information—costs and infrastructure—from Pleistocene Park (northeastern Yakutia, Russia). A 10 yr experimental phase incorporating three separate introductions of herds of approximately 1000 individuals each is costed at US$114 million, with potential returns of approximately 0.3–0.4% yr−1towards the end of the period, and greater than 1% yr−1after it. Institutional friction and the potential role of new technologies in the reintroductions are discussed.

This article is part of the theme issue ‘Climate change and ecosystems: threats, opportunities and solutions'.
Nature-based approaches to managing climate change impacts in cities
Authors: Hobbie Sarah E. , Grimm Nancy B.
Published: January 2020

Managing and adapting to climate change in urban areas will become increasingly important as urban populations grow, especially because unique features of cities amplify climate change impacts. High impervious cover exacerbates impacts of climate warming through urban heat island effects and of heavy rainfall by magnifying runoff and flooding. Concentration of human settlements along rivers and coastal zones increases exposure of people and infrastructure to climate change hazards, often disproportionately affecting those who are least prepared. Nature-based strategies (NBS), which use living organisms, soils and sediments, and/or landscape features to reduce climate change hazards, hold promise as being more flexible, multi-functional and adaptable to an uncertain and non-stationary climate future than traditional approaches. Nevertheless, future research should address the effectiveness of NBS for reducing climate change impacts and whether they can be implemented at scales appropriate to climate change hazards and impacts. Further, there is a need for accurate and comprehensive cost–benefit analyses that consider disservices and co-benefits, relative to grey alternatives, and how costs and benefits are distributed across different communities. NBS are most likely to be effective and fair when they match the scale of the challenge, are implemented with input from diverse voices and are appropriate to specific social, cultural, ecological and technological contexts.

This article is part of the theme issue ‘Climate change and ecosystems: threats, opportunities and solutions’.
Harnessing employment-based social assistance programmes to scale up nature-based climate action
Authors: Norton Andrew , Seddon Nathalie , Agrawal Arun , Shakya Clare , Kaur Nanki , Porras Ina
Published: January 2020

As the severity of the triple challenges of global inequality, climate change and biodiversity loss becomes clearer, governments and international development institutions must find effective policy instruments to respond. We examine the potential of social assistance policies in this context. Social assistance refers to transfers to poor, vulnerable and marginalized groups to reduce their vulnerability and livelihood risks, and to enhance their rights and status. Substantial public funds support social assistance programmes globally. Collectively, lower- and middle-income countries spend approximately 1.5% of their GDP on social assistance annually. We focus on the potential of paid employment schemes to promote effective ecosystem stewardship. Available evidence suggests such programmes can offer multiple benefits in terms of improvements in local ecosystems and natural capital, carbon sequestration and local biodiversity conservation. We review evidence from three key case studies: in India (the Mahatma Gandhi National Rural Employment Guarantee Scheme), Ethiopia (the Productive Safety Nets Programme) and Mexico (the Temporary Employment Programme). We conclude that, to realize the potential of employment-based social assistance for ecosystem benefits it will be necessary to address two challenges: first, the weak design and maintenance of local public works outputs in many schemes, and second, the concern that social protection schemes may become less effective if they are overburdened with additional objectives. Overcoming these challenges requires an evolution of institutional systems for delivering social assistance to enable a more effective combination of social and environmental objectives.

This article is part of the theme issue ‘Climate change and ecosystems: threats, opportunities and solutions’.
Mapping co-benefits for carbon storage and biodiversity to inform conservation policy and action
Authors: Soto-Navarro C. , Ravilious C. , Arnell A. , de Lamo X. , Harfoot M. , Hill S. L. L. , Wearn O. R. , Santoro M. , Bouvet A. , Mermoz S. , Le Toan T. , Xia J. , Liu S. , Yuan W. , Spawn S. A. , Gibbs H. K. , Ferrier S. , Harwood T. , Alkemade R. , Schipper A. M. , Schmidt-Traub G. , Strassburg B. , Miles L. , Burgess N. D. , Kapos V.
Published: January 2020

Integrated high-resolution maps of carbon stocks and biodiversity that identify areas of potential co-benefits for climate change mitigation and biodiversity conservation can help facilitate the implementation of global climate and biodiversity commitments at local levels. However, the multi-dimensional nature of biodiversity presents a major challenge for understanding, mapping and communicating where and how biodiversity benefits coincide with climate benefits. A new integrated approach to biodiversity is therefore needed. Here, we (a) present a new high-resolution map of global above- and below-ground carbon stored in biomass and soil, (b) quantify biodiversity values using two complementary indices (BIp and BIr) representing proactive and reactive approaches to conservation, and (c) examine patterns of carbon–biodiversity overlap by identifying 'hotspots' (20% highest values for both aspects). Our indices integrate local diversity and ecosystem intactness, as well as regional ecosystem intactness across the broader area supporting a similar natural assemblage of species to the location of interest. The western Amazon Basin, Central Africa and Southeast Asia capture the last strongholds of highest local biodiversity and ecosystem intactness worldwide, while the last refuges for unique biological communities whose habitats have been greatly reduced are mostly found in the tropical Andes and central Sundaland. There is 38 and 5% overlap in carbon and biodiversity hotspots, for proactive and reactive conservation, respectively. Alarmingly, only around 12 and 21% of these proactive and reactive hotspot areas, respectively, are formally protected. This highlights that a coupled approach is urgently needed to help achieve both climate and biodiversity global targets. This would involve (1) restoring and conserving unprotected, degraded ecosystems, particularly in the Neotropics and Indomalaya, and (2) retaining the remaining strongholds of intactness.

This article is part of the theme issue ‘Climate change and ecosystems: threats, opportunities and solutions’.
Comparing the impact of future cropland expansion on global biodiversity and carbon storage across models and scenarios
Authors: Molotoks Amy , Henry Roslyn , Stehfest Elke , Doelman Jonathan , Havlik Petr , Krisztin Tamás , Alexander Peter , Dawson Terence P. , Smith Pete
Published: January 2020

Land-use change is a direct driver of biodiversity and carbon storage loss. Projections of future land use often include notable expansion of cropland areas in response to changes in climate and food demand, although there are large uncertainties in results between models and scenarios. This study examines these uncertainties by comparing three different socio-economic scenarios (SSP1–3) across three models (IMAGE, GLOBIOM and PLUMv2). It assesses the impacts on biodiversity metrics and direct carbon loss from biomass and soil as a direct consequence of cropland expansion. Results show substantial variation between models and scenarios, with little overlap across all nine projections. Although SSP1 projects the least impact, there are still significant impacts projected. IMAGE and GLOBIOM project the greatest impact across carbon storage and biodiversity metrics due to both extent and location of cropland expansion. Furthermore, for all the biodiversity and carbon metrics used, there is a greater proportion of variance explained by the model used. This demonstrates the importance of improving the accuracy of land-based models. Incorporating effects of land-use change in biodiversity impact assessments would also help better prioritize future protection of biodiverse and carbon-rich areas.

This article is part of the theme issue ‘Climate change and ecosystems: threats, opportunities and solutions’.
Combined vitrectomy, near-confluent endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma
Authors: Strzalkowski P. , Strzalkowska A. , Göbel W. , Ach T. , Loewen N.A. , Hillenkamp J.
Published: January 2020

Purpose

Evaluated the safety and efficacy of an integrative surgical approach to neovascular glaucoma (NVG).

Methods

Consecutive interventional case series of NVG with one-year follow-up. Eyes underwent pars plana vitrectomy, near-confluent panretinal photocoagulation, intravitreal bevacizumab, and transscleral cyclophotocoagulation. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), glaucoma medication score (GMS), visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6 and 12 months. Blind eyes were excluded.

Results

83 eyes of 83 patients (53 male, 30 female, mean age 74.6±11.6 years) were included and 53 completed a one-year follow-up. NVG underlying conditions included retinal vein occlusion (n=41), proliferative diabetic retinopathy (n=25), central retinal artery occlusion (n=10), and ocular ischemic syndrome (n=6). Mean IOP decreased postoperatively from 46.0±10.3 mmHg to 14.2±8.9 mmHg (p<0.001), GMS from 4.8 to 1.8 (p<0.001) and VAPS from 6 to 0. BCVA was unchanged. All postoperative complications had resolved at 1 month postop. 26 eyes did not require additional surgical treatment during follow-up.

Conclusions

A single, comprehensive surgery session was able to significantly lower IOP, reduce GMS and control pain.