bluuebunny/crossref_metadata_2025 huggingface dataset:
Anemia in chronic heart failure patients: comparison between invasive and non-invasive prognostic markers
Authors: Ceresa Monica , Capomolla Soccorso , Pinna GianDomenico , Aiolfi Eleonora , La Rovere Maria Teresa , Febo Oreste , Paganini Vincenzo , Rossi Angelo , Guazzotti Giampaolo , Caporotondi Angelo , Maestri Roberto , Cobelli Franco
Published: July 2016

Background: The prognosis of chronic heart failure (CHF) remains poor despite advances in medical management. Several different variables determine prognosis. Recently anemia has emerged as an independent prognostic variable in the evaluation of CHF. It is therefore important to analyze the role of anemia in patients with mild to severe CHF already well characterized by hemodynamic, echo- Doppler, and cardiopulmonary exercise testing. Objective: We performed this study to evaluate, in a large general cohort of CHF patients, the frequency of anemia and its correlation with their clinical profile. We assessed the prognostic value of anemia in relation to other known prognostic variables. Methods: Two-dimensional echocardiography, right heart catheterization, cardiopulmonary tests and laboratory examinations were performed in a population of 980 consecutive patients with CHF (53±9.4 years, 85% male, LVEF 25±8%; 45% with NYHA class III-IV). A hemoglobin (Hb) concentration less than 12 g/dl was used to define anemic patients. The primary end point was cardiac death or urgent heart transplantation. Results: Nineteen percent of patients were anemic. These patients had a lower body mass index (24±3 vs. 25±4 Kg/m2 p <0.0004), a worse functional class (64% were in NYHA class III-IV vs 41% in the non-anemic group, p <0.0001), poorer exercise capacity (12.4 vs. 14.8 ml/kg/min peak VO2, p <0.0001) and increased right (7±5 vs. 5±4 mmHg, p <.0004) and left (21±9 vs. 19±10 p <0.007) ventricular filling pressures. During a 3-year follow-up cardiac deaths occurred in 236 (24%) and 52 (5%) of patients received an urgent heart transplant. On univariate regression analysis anemia was significantly correlated with these “hard” cardiac events (39% of anemic patients vs 27% of non-anemic patients). By multivariate logistic regression analysis different prognostic models were identified using non-invasive, with or without peak VO2, or invasive parameters. The prognostic model including anemia (AUCROC: 0.720) showed similar accuracy in predicting cardiac events to other prognostic models with peak VO2 (AUCROC: 0.719) or invasive variables (AUCROC: 0.719). Conclusions: The present study demonstrates that anemia in CHF patients is associated with prognosis, worse NYHA functional class, exercise capacity and hemodynamic profiles. The relationship between anemia and mortality is independent of other simple non-invasive prognostic factors. Prognostic models with more complex or invasive independent predictors did not increase the accuracy to predict cardiac mortality or the need for urgent transplantation.
The program of Italian Working Group on Cardiac Rehabilitation and Prevention for the period 2004-2005
Authors: Pirelli Salvatore
Published: July 2016

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Is physical training contraindicated in patients with deep vein thrombosis during cardiac rehabilitation?
Authors: Ambrosetti Marco , Salerno Mario , Ageno Walter , Tramarin Roberto , Pedretti Roberto FE
Published: July 2016

admitted to cardiac rehabilitation programs after acute coronary syndromes, episodes of acute congestive heart failure, and cardiac revascularization. A common clinical problem in these patients is to decide whether to start or continue physical training or not, given the risk of pulmonary embolism. Until definite evidence becomes available, careful patient selection and inpatient supervision may avoid the a priori withdrawal of such an important core component of cardiac rehabilitation programs.
Left ventricular geometric patterns and cardiac function in patients with chronic renal failure undergoing hemodialysis
Authors: Manes Maria Teresa , Gagliardi Manlio , Misuraca Gianfranco , Rossi Stefania , Chiatto Mario
Published: July 2016

The aim of this study was to estimate the impact and prevalence of left ventricular geometric alterations and systolic and diastolic dysfunction in hemodialysis patients, as well as the relationship with cardiac troponin as a marker of myocardial damage. Methods: 31 patients (pts), 19 males and 12 females, age 58.1±16.4 (26 on hemodialysis, 5 on peritoneal dialysis) and 31 healthy normal controls were enrolled. Echocardiography measurements were carried out according to the American Society of Echocardiography recommendations. Left ventricular mass was calculated, according to the Devereux formula and indexed to height and weight 2.7. Doppler echocardiography was performed to study diastolic function by measurements of isovolumetric relaxation period (IVRT), E wave deceleretion time (DTE) and E/A ratio. Cardiac troponin was measured by a third generation electrochemiluminescence immunoassay. Statistical analysis was performed using the t-test for between-group comparisons and the Pearson and Spearman’s tests to investigate correlations; p values of <0.05 were considered statistically significant. Results: Eccentric hypertrophy was the most frequent pattern (n=17; 55%), followed by normal cardiac geometry (n=7; 23%), and concentric hypertrophy (n=5; 16%). Only 6% of pts (n=2) showed concentric remodelling. Systolic dysfunction was present in terms of endocardial parameters in 3 pts (9%) (fractional shartening <25%, EF<50%), but in terms of midwall myocardial shortening in 51% (n=16). Diastolic dysfunction was present in 87% (n=27) with a pattern of impaired relaxation (in 5 without left ventricular hypertrophy). E/A was negatively correlated with age (r=-0.41, p=0.02); DTE was positively correlated with posterior wall thickness (r=0.36, p=0.05) and interventricular septum thickness (r=0.45, p=0.01); cardiac troponin was positively correlated with age (r=0.50, p=0.00), left ventricular mass (r=0.41, p=0.02), posterior wall thickness (r=0.41; p=0.02) and interventricular septum thickness (r=0.39, p=0.03) but not with diastolic dysfunction parameters. No significant difference was found in terms of duration of dialysis between patients with normal left ventricular geometry and those with left ventricular hypertrophy, but a significant difference in age was found (p=0.03). Pts with diastolic dysfunction had more frequent hypotensive episodes during dialysis (p <0.01). Conclusion: Impaired geometry and cardiac function is frequently observed in pts undergoing hemodialysis. Diastolic dysfuction is associated to a geometric pattern of left ventricular hypetrophy, although it can be an isolated initial manifestation of myocardial damage. Depressed midwall myocardial shortening can discriminate left ventricular dysfunction better than traditional endocardial systolic indexes.
ISYDE-Ψ* First step of the implementation of guidelines for psychology activities in cardiac rehabilitation and prevention *Italian SurveY on CarDiac REhabilitation – Psychology
Authors: Sommaruga Marinella , Tramarin Roberto , Balestroni Gianluigi , Bettinardi Ornella , Cauteruccio Maria Antonella , Miglioretti Massimo , Monti Marco , Omodeo Ombretta , Pierobon Antonia , Vaghi Paola
Published: July 2016

The Italian SurveY on CarDiac REhabilitation – Psychology (ISYDE-Ψ) was developed, in line with the indications of the Italian National Guidelines Program, as part of a project to implement and apply the guidelines for psychology interventions in cardiac rehabilitation and prevention published in 2003. The Task Force on Psychological Interventions in Cardiac Rehabilitation conducted this pilot survey of the existing situation of Psychology in order to prepare the ground for implementation of the guidelines through interactive training. As part of the evaluation of training requirements a questionnaire was elaborated to gather information on the models of organization of and activities carried out by psychologists working in the surveyed cardiac rehabilitation facilities. Data collection for ISYDE-Ψ terminated at the end of March 2005, with replies from 68/107 (63.6%) structures. In the light of this response, the Task Force has developed a training project for psychologists working in cardiac rehabilitation, sponsored by the Italian Council of Psychologists, that will be implemented in different regions of the country with the aim of disseminating the guidelines and promoting their correct application despite the existing regional disparities in organization.
Inflammatory syndrome after thoracic aortic endoprothesis implantation associated with cortico-surrenal adenoma
Authors: Giallauria Francesco , De Lorenzo Anna , Manakos Athanasio , Pilerci Francesco , Psaroudaki Marianna , De Cristofaro Alessandro , Lucci Rosa , Del Forno Domenico , Vigorito Carlo
Published: July 2016

We report a case of a 68-year-old patient, admitted with diagnosis of aneurysm of the descending thoracic aorta to the Department of Cardiac Surgery, where he underwent percutaneous endovascular application of 4 endoprostheses in the descending thoracic aorta. After antibiotic prophylaxis and hemodynamic stabilization, the patient was admitted to the Cardiac Rehabilitation Unit for the management of the of postoperative course and undergo a program of cardiac rehabilitation. Five days following admission and before starting physical training, the patient developed fever associated with neutrophil leukocytosis, strong activation of inflammatory markers and sideropenic anaemia, compatible with post-implantation inflammatory syndrome. Significant hypokaliemia also occurred. Further investigations showed left cortical-surrenal adenoma. The inflammatory state relapsed spontaneously and the patient was discharged with indication to undergo an endocrinologic consultation.
Remarks on Angina Pectoris
Authors: Scardi Sabino , Perazza Luca
Published: July 2016

In the first volume of the New England Journal of Medicine of 1812, J. Warren published a paper on the subject of angina pectoris, in which clearly emerge the difficulties facing the physicians of that time in trying to formulate a correct diagnosis and prescribe the right therapy. We thought it would be certainly of interest to offer our readers an Italian translation of this article, obviously with some stylistic modifications and supplemented with information coming from other historical scientific works. William Heberden in his report on “ breast pain” was the first physician to use the term “angina” and the description of symptoms that he gave in 1772 is still today valid and correct.
Cytotoxic chemotherapy in advanced non-small cell lung cancer
Authors: Scagliotti G.V. , Novello S. , Selvaggi G.
Published: July 2016

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Mitomycin, ifosfamide, cisplatin for non-small cell lung cancer: an implementation study
Authors: Berghmans T. , Meert A-P , Ninane V. , Sculier J-P
Published: July 2016

Background. The MIP regimen (mitomycin, ifosfamide, cisplatin) demonstrated its effectiveness as firstline chemotherapy in phase II and III trials in NSCLC. We aimed to determine whether these results could be confirmed in a hospital population. Methods. Between 1987 and 2004, 204 patients with NSCLC received MIP in our institution. Patients treated in and off trials received the same combination of cisplatin (50 mg/m2), ifosfamide (3 g/m2) and mitomycin C (6 mg/m2) every three weeks and were staged and followed in a similar way. Results. Response rates for patients treated in or outside trials were 36.8% and 40.7%, respectively. After multiple logistic regressions, the only statistically significant factor predicting objective response was stage. The median survival time was 54.6 and 43.7 weeks respectively for patients treated in and outside trials. In multivariate analysis, four factors were statistically significantly associated with better survival: good performance status (p = 0.003), normal LDH value (p < 0.001), early stage (p = 0.01) and active smoking (p = 0.03). Conclusion. Participation in a clinical trial was not associated with a significant difference in efficacy. This implementation study thus confirms the activity of the MIP regimen when used in the routine management of patients with NSCLC.
Constrictive bronchiolitis obliterans in patient with Castelman’s disease
Authors: Radzikowska E. , Pawlowski J. , Chabowski M. , Langfort R.
Published: July 2016

A 37-year-old woman with hialin- vascular type Castelman’s disease (CD) localised in the retroperitoneal region, incompletely resected, developed progressive dyspnoea. The chest radiograph taken 3 months before the operation was normal. The chest CT scan revealed diffused bronchiectases, hyperinflation and air trapping. Pulmonary function tests disclosed severe obstructive impairment with hyperinflation. The bronchoscopic examination of the bronchial tree was normal. Cultures of sputum, bronchial washing and blood were negative. No pemphigus antibodies were found. Mycoplasmal, chlamydial and viral infections were excluded. Histological examination of specimens obtained by open lung biopsy revealed bronchiolar inflammation, submucosal bronchial fibrosis with obliteration of bronchiolar lumen. Constrictive bronchiolitis obliterans (CBO) was diagnosed. Despite slight clinical and spirometric improvements that were achieved due to corticosteroid therapy, one year later she died as a result of respiratory failure. It is widely known that patients with CD develop CBO during the course of paraneoplastic pemphigus. However we present the case of CBO and CD but without any symptoms of this condition.
Underuse of spirometry in the diagnosis of COPD
Authors: Poels P.J.P. , Schermer T.R.J. , Van Weel C.
Published: July 2016

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Autofluorescence bronchoscopy to identify pre-cancerous bronchial lesions
Authors: Fuso L. , Pagliari G. , Boniello V. , Trovè A. , Varone F. , Longobardi A. , Basso S. , Trodella L.
Published: July 2016

Background. This study aimed to assess the diagnostic yield of autofluorescence bronchoscopy (AFB) in the detection of pre-cancerous bronchial lesions in a non-selected sample of patients. Methods. Both fiberoptic white-light bronchoscopy (WLB) and AFB using the Storz D-light system were performed on 166 consecutive patients. Biopsy specimens were taken in areas of the tracheobronchial tree judged as abnormal or suspicious at WLB and/or AFB. The bronchoscopic procedures were randomly performed by two operators. Results. A total of 93 patients had a positive biopsy specimen: 80 for cancer and 13 for dysplasia. AFB was abnormal or suspicious in 85 of the 93 patients with a sensitivity of 91.4%. Specificity was 50.7%. In 16 patients with normal WLB examination, AFB identified abnormal or suspicious areas which had a positive biopsy. Thus AFB significantly improved sensitivity of WLB (100% vs 82.8%, respectively, p<0.001) in the entire sample of patients studied. Data was further analysed separately for patients with dysplasia and those with cancer. Indeed, 13 of 16 patients recognized only by AFB had a histological diagnosis of dysplasia. The remaining three patients had a diagnosis of cancer (small intraepithelial neoplastic lesions). Since no other patient with dysplasia was found, AFB had a sensitivity of 100% in diagnosing dysplasia. On the other hand, excluding the 13 patients with dysplasia, WLB had a high sensitivity in diagnosing cancer (93.7%). Conclusions. The AFB Storz system showed a high sensitivity. The increase in diagnostic yield of AFB in comparison with WLB was related to the power of AFB to identify pre-cancerous bronchial lesions so showing its usefulness in the early diagnosis of lung cancer.
Comparison of Tuberculin Skin test and Quantiferon immunological assay for latent Tuberculosis infection
Authors: Codecasa L.R. , Ferrarese M. , Penati V. , Lacchini C. , Cirillo D. , Scarparo C. , Piccoli P. , Piersimoni C. , Migliori G.B.
Published: July 2016

Background. Correct identification of individuals with latent tuberculosis infection (LTBI) is a crucial element of the elimination strategy, allowing their adequate treatment. In addition to tuberculin skin test (TST), the Quantiferon test (QFT, based on whole blood γ-interferon release) had been recently proposed. Aim of the study is to compare this test to TST for identification of LTBI in a non-selected population, in order to verify their value in identifying truly infected individuals (entitled to receive preventive chemotherapy), and to exclude from treatment those having a positive TST for other reasons (e.g. after BCG vaccination). Methods. 136 consecutive persons (78 males, mean age 34±9 years) referred to the clinic for TST were recruited (78 born in low - or middle - income countries). Based on their history, the cases were divided into 4 groups: 1) recently traced contacts of whom 18 TST negative and 28 TST positive; 2) 22 screening subjects, all TST negative; 3) BCG vaccinated subjects (14); and 4) 54 subjects already undergoing treatment of LTBI for exposure to TB. Results. The overall agreement between TST and QFT was 72% (64% in TST positive and 88.4% in TST negative subjects). The proportion of TST positive/QFT negative BCG vaccinated individuals was 23.1%. The K coefficient was 0.474 in recently traced contacts, 0.366 in BCG vaccinated individuals and 0.451 overall. Conclusions. The study results suggest that agreement between TST and QFT is lower in TST positive than in negative subjects, being lower in individuals treated for LTBI. Quantiferon does not seem to have brought significant improvement in the diagnosis of LTBI.
Extrapleural hematoma: when is surgery indicated?
Authors: Poyraz A.S. , Kilic D. , Gultekin B. , Ozulku M. , Hatipoglu A.
Published: July 2016

Extrapleural haematoma (EH) is a rare clinical condition of which four cases are presented. Different etiologies were encountered. Identical findings were found on the chest X-ray. Two cases were secondary to spontaneous rib fracture and the other two were iatrogenic. Surgical exploration was necessary in one patient following pleural biopsy. Medical treatment and clinical observation were the treatment of choice in the remaining three stable patients.
Do we need to check for asthma in subjects with allergic rhinitis?
Authors: Di Franco A. , Paggiaro P.L.
Published: July 2016

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Underuse of spirometry by general practitioners for the diagnosis of COPD in Italy
Authors: Caramori G. , Bettoncelli G. , Tosatto R. , Arpinelli F. , Visonà G. , Invernizzi G. , Novelletto B.F. , Papi A. , Adcock I.M. , Ciaccia A.
Published: July 2016

Background. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) underlines that spirometry is the gold standard as the most reproducible, standardised, and objective way of measuring airflow limitation in the diagnosis and assessment of Chronic Obstructive Pulmonary Disease (COPD). However, studies undertaken in different countries have suggested a widespread underuse of spirometry by general practitioners to establish the diagnosis of COPD. Precise estimates of the prevalence of physician-diagnosed COPD in Italy are not currently available. In collaboration with the Italian Academy of General practitioners (SIMG) we have investigated the degree of use of spirometry to establish the diagnosis of COPD in Italy. Methods. A standardised questionnaire has been selfadministered to a sample of 2425 Italian general practitioners (representing 5% of all the Italian doctors involved in general practice). They have been chosen to cover each of the Italian counties. Results. The prevalence of physician-diagnosed COPD was found to be approximately 4%. However, 30% of general practitioners do not use spirometry to establish the diagnosis of COPD. The main reasons given for the failure to use spirometry are (i) that spirometry is not necessary for the diagnosis of COPD or (ii) there are logistical limitations to the access of the patients to lung function laboratories. Conclusions. This data suggests that contrary to GOLD Guidelines, in Italy, as with other countries, spirometry is not always used in the diagnosis of COPD. There is a clear necessity for further education initiatives targeted to this group of physicians.
Nutritional status and airflow obstruction: two independent contributors to CO diffusing capacity impairment in COPD
Authors: Baldi S. , Pinna G.D. , Crotti P. , Montemartini S. , Dacosto E. , Fanfulla F. , Fracchia C. , Bruschi C.
Published: July 2016

Background. The association between weight loss and Chronic Obstructive Pulmonary Disease (COPD) has been recognised from many years. Based on the evidence that nutritional status reflects metabolic disturbances in COPD, the relationship between body mass index (BMI), severity of airflow obstruction and CO diffusing capacity (DLCO), that is the functional hallmark of emphysema, is relevant to the management of COPD phenotypes. Methods. We reviewed 104 patients with COPD (82 males), aged 66±9 years (mean±SD). Height averaged 165±8 cm, weight 71±16 Kg, FEV1 50±18 (% of predicted), RV 169±49%, and DLCO 56±26%. Multiple linear regression was performed using BMI, FEV1 and RV, as explanatory variables for DLCO. Patients were also classified into four groups according to BMI ≤ 18.5 (low), > 18.5 and ≤ 25 (ideal), > 25 and ≤ 30 (overweight), > 30 (obese), and post-bronchodilator FEV1 < 50%. Using this categorisation, a two-factor analysis of variance, testing for interaction and main effects (BMI and FEV1) was performed as confirmatory analysis for the association between BMI (kg/m2), FEV1% and DLCO%. Results. FEV1 and BMI were significantly and independently associated to DLCO according to the equation: DLCO = -18.32 + 0.65·FEV1 + 1.59·BMI (R2 = 0.40, p<0.0001). The contribution of RV % to DLCO % was largely non-significant (p=0.16). A close relationship was found between BMI (kg/m2) and DLCO %, for all of the four BMI groups segregated by post-bronchodilator FEV1%, (p<.0001). No interaction was found between these two factors (p=0.30). Conclusion. Nutritional status as assessed by BMI contributes substantially to impairment of DLCO independently of the severity of airflow obstruction. This data confirms the association between emphysematous process and weight loss in advanced COPD, independent of the airflow obstruction severity.
Smoking habits among the hospital staff of a General Hospital in Northern Greece: a long way for smoke-free hospitals
Authors: Vagropoulos I. , Tsilchorozidou T. , Tsinopoulos G. , Salonikidou Z. , Mouratova M. , Giavropoulou M. , Grigoriadis N.
Published: July 2016

Background and Aim. The aim of the study was to evaluate the smoking habits of all staff working in a General Hospital, and to examine whether these habits comply with the introduction of a tobacco law in July 2002, where smoking in enclosed public areas, including hospital buildings, has been forbidden in Greece. Methods. All hospital staff in Serres General Hospital was asked to complete and return a questionnaire about their smoking habits. The questionnaire was voluntary and anonymous. The survey was conducted from October 2003 to January 2004. Results. Six hundred and twenty three (74%) of the 847 members of staff responded; 310 (50%) were current smokers and 313 (50%) were non-smokers of whom 101 (32%) were ex-smokers. The prevalence of current smokers was the highest among nurses (57%) and the lowest among doctors (31%). Male smokers (42%) were outnumbered by female smokers (54%) in all age groups up to the age of 60 years (p<0,01), although the reverse is the trend in Greek population (47% and 29%, respectively). The highest rate of smokers was found at the age group of 31- 40 years (60%), while these above sixty years had the smallest (29%). Seventy percent of current smokers had at least one family member who was current smoker vs 49% of non-smokers (p<0,001). The vast majority of smokers (94%) continued to smoke in hospital, of whom 62% smoke more than 5 cigarettes while at work. Conclusions. The high rate of smokers among the health professionals compared to those in the general population would probably have a negative influence on the development, implementation and inspection of workplace smoking bans in Greece. Increased efforts to promote tobacco education and intervention among doctors and nurses and to establish specialist smoking cessation services throughout the National Health Service should be the standard component of antismoking policy for the law to be effective.
Interdisciplinary rehabilitation in morbidly obese subjects: an observational pilot study
Authors: Clini E. , Prato F. , Nobile M. , Bondi M. , Serri B. , Cilione C. , Lugli D.
Published: July 2016

Background and aim. To assess the clinical effectiveness of a interdisciplinary rehabillitation programme (CR), in a population of morbidly obese subjects we have undertaken a observational study. Methods. The study included fifty-nine adult subjects (18 M, 60Â±10 years, BMI 47Â±8) with sleep-disturbance related symptoms and disabilities. Assessment and correction of sleep disordered breathing (SDB) abnormalities, improvement of exercise tolerance, body weight and associated psychological features were the aims of this CR, which has been carried out over a 1 month period.Lung functions, apnea/hypopnea index (AHI), 6-minute walking distance (6MWD), body weight (BW), quality of life by means of Sat-P questionnaire and serum metabolic data has been recorded at baseline (T0), at the end (T1) and 6 months after (T2) the CR. Results. The percentage of patients with AHI>10 declined from 65% (at T0) to 20% (at both T1 and T2). 6MWD and BW significantly improved (p<0.005) at T1 and still maintained at T2; a significant relationship (r=0.379, p<0.01) has been found between changes of BW and 6MWD recorded in between T0 and T2. Sat-P item scores dealing with sleep efficiency, problem solving, and social interactions improved (p<0.01) at T1 and still maintained at T2. Conclusions. This hospital-based CR provides indication for effectiveness in advanced morbidly obese subjects and warrants further controlled trials to confirm the results.
Determinants of quality of life after lung transplant: an Italian collaborative study
Authors: Ricotti S. , Vitulo P. , Petrucci L. , Oggionni T. , Klersy C.
Published: July 2016

Background. With the improvement in survival rates after lung transplantation, concern has arisen about evaluating quality of life (QoL). This multicenter cross-sectional study aimed at describing QoL and identifying factors associated with it. Methods. We assessed QoL in 129 lung transplant recipients from 5 centres in Italy, during scheduled followup visits, using the SF-36, GHQ and St Georgeâ€™s respiratory questionnaires (SGRQ). Results. The SF-36 elicited impaired QoL in the physical, but not in the mental domains (PCS=44; MCS=53). The GHQ identified 29 patients (23%) with psychological discomfort and the SGRQ scores were significantly better than those of patients with chronic respiratory disease. On multivariate analysis, exertional dyspnea was an independent predictor of the PCS (adjusted Î” -6.3 (p5. Conclusions. The study identified exertional dyspnea as the main determinant of QoL as measured both by SF36 (PCS) and GHQ. Other objective measures contributed only to the PCS. Thus, the SF-36 (PCS) and GHQ were useful in identifying patients who needed treatment not only for complications but also psychological support and continued physical rehabilitation.
Management of post-intubation tracheal stenoses using the endoscopic approach
Authors: Cavaliere S. , Bezzi M. , Toninelli C. , Foccoli P.
Published: July 2016

Background and Aim. Tracheal stenosis is a common complication of intubation with or without subsequent tracheotomy whose management remains poorly defined. Over 600 post-intubation tracheal stenoses have been treated in our centre since 1982: the aim of this study was to determine the safety and efficacy of our endoscopic approach. Methods. This retrospective study includes 113 new cases treated between 1998 and 2001. We chose this period to have a standardised technique and a significant number of cases with a sufficiently long follow up (28-78 months). Forty patients who did not meet the criteria for â€œtrue stenosisâ€ (granulomas, pseudoglottic stenosis, etc.) were excluded from the study. Results. 73 patients (50Â±21 years) entered the study: 13 (18%) web-like and 60 (82%) complex stenoses. Most web-like stenoses were successfully treated with Laser Assisted Mechanical Dilation (LAMD) alone; among complex stenoses LAMD was sufficient to treat 13 patients (22%), whereas 47 patients (78%) required stent placement: 22 had their stent removed after one year and did not require any further therapy, 13 inoperable patients required permanent stent and 12 were referred to surgery after failure of multiple endoscopic treatments. No permanent complications secondary to endoscopic treatment were observed. 48 patients (66%) obtained a stable, good result with the endoscopic procedure, 13 (18%) required a permanent stent while 12 patients (16%) were referred to surgery. Conclusions. Our results indicate that the endoscopic treatment of post-intubation tracheal stenoses performed in an expert setting can be considered a safe first-line therapy, leaving some selected cases and the relapsing stenoses, for surgical resection.
Los fantasmas de la memoria histórica: Identidad social de la juventud rusa
Authors: Pilgun María , Dzyaloshinsky Iosif M.
Published: July 2016

Los medios de comunicación masiva de élite en Rusia moderna se dedican a fomentar la antigua ideología del aislamiento y contribuyen al creciente militarismo del país. Objetivos. A raíz de ello se ha propuesto detectar y analizar el papel de las imagines del pasado en los procesos de la autoidentificación temporal de la juventud rusa. Se sabe que las imágenes de los acontecimientos históricos forman la mayor parte de la consciencia básica de la identidad nacional y civil de los ciudadanos. Para este fin dentro del presente estudio se ha analizado la memoria histórica de los jóvenes rusos. Metodología. La metodología principal y el material empírico se basaban en cuestionarios y entrevistas grupo focalesefectuados en 12 ciudades del distrito federal de Rusia (excepto Crimea) con la participación de 1.548 personas. Resultados. El estudio de las peculiaridades de la percepción de los acontecimientos históricos del siglo ХХ ayudó a determinar las características de la identidad de la juventud moderna, detectar los factores que influyen en la evaluación de los hechos históricos principales para un país y el papel de los medios de comunicación. Discusión y conclusiones. Mediante el conocimiento del proceso de autoidentificación se pretende resolver varios problemas ideológicos y educativos actuales en vista del hecho de atravesar Rusia en los últimos años tiempos políticamente complicados para Rusia debido en parte a la rebeldía en Ucrania.
Кольца Безу без нецентральных идемпотентов
Authors: Tuganbaev Askar
Published: July 2016

Пусть $A$ - кольцо Безу без нецентральных идемпотентов. Если $A$ - риккартово кольцо, то $A$ - эрмитово кольцо. Если $A$ - заменяемое кольцо, то каждая прямоугольная матрица над $A$ диагонализируема.
Исследование выполнено за счет гранта Российского научного фонда (проект №16-11-10013).
Global fine-mode aerosol radiative effect, as constrained by comprehensive
observations
Authors: Chung Chul E. , Chu Jung-Eun , Lee Yunha , van Noije Twan , Jeoung Hwayoung , Ha Kyung-Ja , Marks Marguerite
Published: July 2016

Abstract. Aerosols directly affect the radiative balance of the Earth through the absorption and scattering of solar radiation. Although the contributions of absorption (heating) and scattering (cooling) of sunlight have proved difficult to quantify, the consensus is that anthropogenic aerosols cool the climate, partially offsetting the warming by rising greenhouse gas concentrations. Recent estimates of global direct anthropogenic aerosol radiative forcing (i.e., global radiative forcing due to aerosol–radiation interactions) are −0.35 ± 0.5 W m−2, and these estimates depend heavily on aerosol simulation. Here, we integrate a comprehensive suite of satellite and ground-based observations to constrain total aerosol optical depth (AOD), its fine-mode fraction, the vertical distribution of aerosols and clouds, and the collocation of clouds and overlying aerosols. We find that the direct fine-mode aerosol radiative effect is −0.46 W m−2 (−0.54 to −0.39 W m−2). Fine-mode aerosols include sea salt and dust aerosols, and we find that these natural aerosols result in a very large cooling (−0.44 to −0.26 W m−2) when constrained by observations. When the contribution of these natural aerosols is subtracted from the fine-mode radiative effect, the net becomes −0.11 (−0.28 to +0.05) W m−2. This net arises from total (natural + anthropogenic) carbonaceous, sulfate and nitrate aerosols, which suggests that global direct anthropogenic aerosol radiative forcing is less negative than −0.35 W m−2.
Chemical aging of atmospheric mineral dust during transatlantic
transport
Authors: Abdelkader Mohamed , Metzger Swen , Steil Benedikt , Klingmüller Klaus , Tost Holger , Pozzer Andrea , Stenchikov Georgiy , Barrie Leonard , Lelieveld Jos
Published: July 2016

Abstract. Transatlantic dust transport has many implications for the atmosphere, ocean and climate. We present a modeling study on the impact of the key processes (dust emissions flux, convection and dust aging parameterizations) that control the transatlantic dust transport. Typically, the Inter-Tropical Convergence Zone (ITCZ) acts as a barrier for the meridional dust transport. To characterize the dust outflow over the Atlantic Ocean, we address two regional phenomena: (i) dust interactions with the ITCZ (DIZ) and (ii) the adjacent dust transport over the Atlantic Ocean (DTA). In the DTA zone, the dust loading shows a steep and linear gradient westward over the Atlantic Ocean where particle sedimentation is the dominant removal process, whereas in the DIZ zone cloud interactions and wet deposition predominate. To study the different impacts of aging, we present two case studies that exclude condensation and coagulation, and include dust aging at various levels of complexity. For dust aging, we consider the uptake of inorganic acids on the surface of mineral particles that form salt compounds. Calcium, used as a proxy for the overall chemically reactive dust fraction, drives the dust-related neutralization reactions leading to higher dust aerosol optical depth (AOD). The aged dust particles are transferred to the soluble aerosol modes in the model and are mixed with other species that originate from anthropogenic and natural sources. The neutralization products (salts) take up water vapor from the atmosphere and increase the dust AOD under subsaturated conditions. We define the "direct effect of dust aging" to refer to the increase in AOD as a result of hygroscopic growth. On the other hand, the aged dust is more efficiently removed (wet and dry) because of the increase in particle size and hygroscopicity. This more efficient removal reduces the dust AOD over the DIZ zone. We define this as the "indirect effect of dust aging", complementary to the direct effect that is dominant in the DTA zone. Distinction of the two aging effects helps develop insight into the regional importance of dust–air-pollution interactions.
Detecting volcanic sulfur dioxide plumes in the Northern Hemisphere using the Brewer spectrophotometer, other networks, and satellite observations
Authors: Zerefos Christos S. , Eleftheratos Kostas , Kapsomenakis John , Solomos Stavros , Inness Antje , Balis Dimitris , Redondas Alberto , Eskes Henk , Amiridis Vassilis , Repapis Christos , Allaart Marc , Engelmann Ronny , Dahlback Arne , De Bock Veerle , Diémoz Henri , Eriksen Paul , Gröbner Julian , Heikkilä Anu , Jarosławski Janusz , Josefsson Weine , Karppinen Tomi , Köhler Ulf , Meleti Charoula , Rimmer John , Savinykh Vladimir , Shirotov Vadim , Siani Anna Maria , Smedley Andrew R. D. , Stanek Martin , Stübi René
Published: July 2016

Abstract. This paper demonstrates that SO2 columnar amounts have significantly increased following the five largest volcanic eruptions of the past decade in the Northern Hemisphere. A strong positive signal was detected by all the existing networks either ground based (Brewer, EARLINET, AirBase) or from satellites (OMI, GOME-2). The study particularly examines the adequacy of the existing Brewer network to detect SO2 plumes of volcanic origin in comparison to other networks and satellite platforms. The comparison with OMI and GOME-2 SO2 space-borne retrievals shows statistically significant agreement between the Brewer network data and the collocated satellite overpasses. It is shown that the Brewer instrument is capable of detecting significant columnar SO2 increases following large volcanic eruptions, when SO2 levels rise well above the instrumental noise of daily observations, estimated to be of the order of 2 DU. A model exercise from the MACC project shows that the large increases of SO2 over Europe following the Bárðarbunga eruption in Iceland were not caused by local sources or ship emissions but are clearly linked to the eruption. We propose that by combining Brewer data with that from other networks and satellites, a useful tool aided by trajectory analyses and modeling could be created which can be used to forecast high SO2 values both at ground level and in air flight corridors following future eruptions.
Complex coastlines responding to climate change: do shoreline
shapes reflect present forcing or "remember" the distant past?
Authors: Thomas Christopher W. , Murray A. Brad , Ashton Andrew D. , Hurst Martin D. , Barkwith Andrew K. A. P. , Ellis Michael A.
Published: July 2016

Abstract. A range of planform morphologies emerge along sandy coastlines as a function of offshore wave climate. It has been implicitly assumed that the morphological response time is rapid compared to the time scales of wave-climate change, meaning that coastal morphologies simply reflect the extant wave climate. This assumption has been explored by focussing on the response of two distinctive morphological coastlines – flying spits and cuspate cusps – to changing wave climates, using a coastline evolution model. Results indicate that antecedent conditions are important in determining the evolution of morphologies, and that sandy coastlines can demonstrate hysteresis behaviour. In particular, antecedent morphology is particularly important in the evolution of flying spits, with characteristic timescales of morphological adjustment on the order of centuries for large spits. Characteristic timescales vary with the square of aspect ratios of capes and spits; for spits, these timescales are an order of magnitude longer than for capes (centuries vs. decades). When wave climates change more slowly than the relevant characteristic timescales, coastlines are able to adjust in a quasi-equilibrium manner. Our results have important implications for the management of sandy coastlines where decisions may be implicitly and incorrectly based on the assumption that present-day coastlines are in equilibrium with current conditions.
A quantitative analysis to objectively appraise drought indicators and model
drought impacts
Authors: Bachmair S. , Svensson C. , Hannaford J. , Barker L. J. , Stahl K.
Published: July 2016

Abstract. Drought monitoring and early warning is an important measure to enhance resilience towards drought. While there are numerous operational systems using different drought indicators, there is no consensus on which indicator best represents drought impact occurrence for any given sector. Furthermore, thresholds are widely applied in these indicators but, to date, little empirical evidence exists as to which indicator thresholds trigger impacts on society, the economy, and ecosystems. The main obstacle for evaluating commonly used drought indicators is a lack of information on drought impacts. Our aim was therefore to exploit text-based data from the European Drought Impact report Inventory (EDII) to identify indicators that are meaningful for region-, sector-, and season-specific impact occurrence, and to empirically determine indicator thresholds. In addition, we tested the predictability of impact occurrence based on the best-performing indicators. To achieve these aims we applied a correlation analysis and an ensemble regression tree approach, using Germany and the UK (the most data-rich countries in the EDII) as test beds. As candidate indicators we chose two meteorological indicators (Standardized Precipitation Index, SPI, and Standardized Precipitation Evaporation Index, SPEI) and two hydrological indicators (streamflow and groundwater level percentiles). The analysis revealed that accumulation periods of SPI and SPEI best linked to impact occurrence are longer for the UK compared with Germany, but there is variability within each country, among impact categories and, to some degree, seasons. The median of regression tree splitting values, which we regard as estimates of thresholds of impact occurrence, was around −1 for SPI and SPEI in the UK; distinct differences between northern/northeastern vs. southern/central regions were found for Germany. Predictions with the ensemble regression tree approach yielded reasonable results for regions with good impact data coverage. The predictions also provided insights into the EDII, in particular highlighting drought events where missing impact reports may reflect a lack of recording rather than true absence of impacts. Overall, the presented quantitative framework proved to be a useful tool for evaluating drought indicators, and to model impact occurrence. In summary, this study demonstrates the information gain for drought monitoring and early warning through impact data collection and analysis. It highlights the important role that quantitative analysis with impact data can have in providing "ground truth" for drought indicators, alongside more traditional stakeholder-led approaches.
Machine learning methods for empirical streamflow simulation: a comparison of model accuracy, interpretability, and uncertainty in seasonal watersheds
Authors: Shortridge Julie E. , Guikema Seth D. , Zaitchik Benjamin F.
Published: July 2016

Abstract. In the past decade, machine learning methods for empirical rainfall–runoff modeling have seen extensive development and been proposed as a useful complement to physical hydrologic models, particularly in basins where data to support process-based models are limited. However, the majority of research has focused on a small number of methods, such as artificial neural networks, despite the development of multiple other approaches for non-parametric regression in recent years. Furthermore, this work has often evaluated model performance based on predictive accuracy alone, while not considering broader objectives, such as model interpretability and uncertainty, that are important if such methods are to be used for planning and management decisions. In this paper, we use multiple regression and machine learning approaches (including generalized additive models, multivariate adaptive regression splines, artificial neural networks, random forests, and M5 cubist models) to simulate monthly streamflow in five highly seasonal rivers in the highlands of Ethiopia and compare their performance in terms of predictive accuracy, error structure and bias, model interpretability, and uncertainty when faced with extreme climate conditions. While the relative predictive performance of models differed across basins, data-driven approaches were able to achieve reduced errors when compared to physical models developed for the region. Methods such as random forests and generalized additive models may have advantages in terms of visualization and interpretation of model structure, which can be useful in providing insights into physical watershed function. However, the uncertainty associated with model predictions under extreme climate conditions should be carefully evaluated, since certain models (especially generalized additive models and multivariate adaptive regression splines) become highly variable when faced with high temperatures.
Effect of the Revisit Interval on the Accuracy of Remote Sensing-based Estimates of Evapotranspiration at Field Scales
Authors: Alfieri Joseph G. , Anderson Martha C. , Kustas William P. , Cammalleri Carmelo
Published: July 2016

Abstract. Accurate spatially distributed estimates of actual evapotranspiration (ET) derived from remotely sensed data are critical to a broad range of practical and operational applications. However, due to lengthy return intervals and cloud cover, data acquisition is not continuous over time, particularly for satellite sensors operating at medium (~ 100 m) or finer resolutions. To fill the data gaps between clear-sky data acquisitions, interpolation methods that take advantage of the relationship between ET and other environmental properties that can be continuously monitored are often used. This study sought to evaluate the accuracy of this approach, which is commonly referred to as temporal upscaling, as a function of satellite revisit interval. Using data collected at 20 Ameriflux sites distributed throughout the contiguous United States and representing 4 distinct land cover types (cropland, grassland, forest, and open canopy) as a proxy for perfect retrievals on satellite overpass dates, this study assesses daily ET estimates derived using 5 different reference quantities (incident solar radiation, net radiation, available energy, reference ET, and equilibrium latent heat flux) and 3 different interpolation methods (linear, cubic spline, and hermite spline). Not only did the analyses find that the temporal autocorrelation, i.e. persistence, of all of the reference quantities was short, it also found that those land cover types with the greatest ET exhibited the least persistence. This carries over to the error associated with both the various scaled quantities and flux estimates. In terms of both the root mean square error (RMSE) and mean absolute error (MAE), the errors increased rapidly with increasing return interval following a logarithmic relationship. Again, those land cover types with the greatest ET showed the largest errors. Moreover, using a threshold of 20 % relative error, this study indicates that a return interval of no more than 5 days is necessary for accurate daily ET estimates. It also found that the spline interpolation methods performed erratically for long return intervals and should be avoided.
Observed El Niño conditions in the eastern tropical Pacific in October
2015
Authors: Stramma Lothar , Fischer Tim , Grundle Damian S. , Krahmann Gerd , Bange Hermann W. , Marandino Christa A.
Published: July 2016

Abstract. A strong El Niño developed in early 2015. Measurements from a research cruise on the R/V Sonne in October 2015 near the Equator east of the Galapagos Islands and off the shelf of Peru are used to investigate changes related to El Niño in the upper ocean in comparison with earlier cruises in this region. At the Equator at 85°30′ W, a clear temperature increase leading to lower densities in the upper 350 m had developed in October 2015, despite a concurrent salinity increase from 40 to 350 m. Lower nutrient concentrations were also present in the upper 200 m, and higher oxygen concentrations were observed between 40 and 130 m. In the equatorial current field, the Equatorial Undercurrent (EUC) east of the Galapagos Islands almost disappeared in October 2015, with a transport of only 0.02 Sv in the equatorial channel between 1° S and 1° N, and a weak current band of 0.78 Sv located between 1 and 2°30′ S. Such near-disappearances of the EUC in the eastern Pacific seem to occur only during strong El Niño events. Off the Peruvian shelf at  ∼  9° S, characteristics of upwelling were different as warm, saline, and oxygen-rich water was upwelled. At  ∼  12,  ∼  14, and  ∼  16° S, the upwelling of cold, low-salinity, and oxygen-poor water was still active at the easternmost stations of these three sections, while further west on these sections a transition to El Niño conditions appeared. Although from early 2015 the El Niño was strong, the October measurements in the eastern tropical Pacific only showed developing El Niño water mass distributions. In particular, the oxygen distribution indicated the ongoing transition from “typical” to El Niño conditions progressing southward along the Peruvian shelf.