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  • 1
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2023-01-20)
    Abstract: The connection between Pediatric Inflammatory Multisystem Syndrome (PIMS) and Kawasaki Disease (KD) is not yet fully understood. Using the same national registry, clinical features and outcome of children hospitalized in Germany, and Innsbruck (Austria) were compared. Reported to the registry were 395 PIMS and 69 KD hospitalized patients. Patient age in PIMS cases was higher than in KD cases (median 7 [IQR 4–11] vs. 3 [IQR 1–4] years). A majority of both PIMS and KD patients were male and without comorbidities. PIMS patients more frequently presented with organ dysfunction, with the gastrointestinal (80%), cardiovascular (74%), and respiratory (52%) systems being most commonly affected. By contrast, KD patients more often displayed dermatological (99% vs. 68%) and mucosal changes (94% vs. 64%), plus cervical lymph node swelling (51% vs. 34%). Intensive care admission (48% vs. 19%), pulmonary support (32% vs. 10%), and use of inotropes/vasodilators (28% vs. 3%) were higher among PIMS cases. No patients died. Upon patient discharge, potentially irreversible sequelae—mainly cardiovascular—were reported (7% PIMS vs. 12% KD). Despite differences in age distribution and disease severity, PIMS and KD cases shared many common clinical and prognostic characteristics. This supports the hypothesis that the two entities represent a syndrome continuum.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2615211-3
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  • 2
    In: Genomics, Proteomics & Bioinformatics, Oxford University Press (OUP), Vol. 20, No. 2 ( 2022-04-01), p. 405-417
    Abstract: High-quality DNA extraction is a crucial step in metagenomic studies. Bias by different isolation kits impairs the comparison across datasets. A trending topic is, however, the analysis of multiple metagenomes from the same patients to draw a holistic picture of microbiota associated with diseases. We thus collected bile, stool, saliva, plaque, sputum, and conjunctival swab samples and performed DNA extraction with three commercial kits. For each combination of the specimen type and DNA extraction kit, 20-gigabase (Gb) metagenomic data were generated using short-read sequencing. While profiles of the specimen types showed close proximity to each other, we observed notable differences in the alpha diversity and composition of the microbiota depending on the DNA extraction kits. No kit outperformed all selected kits on every specimen. We reached consistently good results using the Qiagen QiAamp DNA Microbiome Kit. Depending on the specimen, our data indicate that over 10 Gb of sequencing data are required to achieve sufficient resolution, but DNA-based identification is superior to identification by mass spectrometry. Finally, long-read nanopore sequencing confirmed the results (correlation coefficient & gt; 0.98). Our results thus suggest using a strategy with only one kit for studies aiming for a direct comparison of multiple microbiotas from the same patients.
    Type of Medium: Online Resource
    ISSN: 1672-0229 , 2210-3244
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2233708-8
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  • 3
    Online Resource
    Online Resource
    Frontiers Media SA ; 2023
    In:  Frontiers in Cardiovascular Medicine Vol. 10 ( 2023-6-23)
    In: Frontiers in Cardiovascular Medicine, Frontiers Media SA, Vol. 10 ( 2023-6-23)
    Abstract: Mitral annular alterations in the context of heart failure often lead to severe functional mitral regurgitation (FMR), which should be treated with transcatheter edge-to-edge repair (M-TEER) according to current guidelines. M-TEER's effects on mitral valve (MV) annular remodeling have not been well elucidated. Methods 141 consecutive patients undergoing M-TEER for treatment of FMR were included in this investigation. Comprehensive intraprocedural transesophageal echocardiography was used to assess the acute effects of M-TEER on annular geometry. Results Average patient age was 76.2 ± 9.6 years and 46.1% were female patients. LV ejection fraction was reduced (37.0% ± 13.7%) and all patients had mitral regurgitation (MR) grade ≥III. M-TEER achieved optimal MR reduction (MR ≤ I) in 78.6% of patients. Mitral annular anterior-posterior diameters (A-Pd) were reduced by −6.2% ± 9.5% on average, whereas anterolateral-posteromedial diameters increased (3.7% ± 8.9%). Overall, a reduction in MV annular areas was observed (2D: −1.8% ± 13.1%; 3D: −2.7% ± 13.7%), which strongly correlated with A-Pd reduction (2D: r  = 0.6, p   & lt; 0.01; 3D: r  = 0.65, p   & lt; 0.01). Patients that achieved A-Pd reduction above the median (≥6.3%) showed significantly lower rates of the composite endpoint rehospitalization for heart failure or all-cause mortality than those with less A-Pd reduction (9.9% vs. 28.6%, p  = 0.037, log-rank p  = 0.039). Furthermore, patients reaching the composite endpoint had an increase in annular area (2D: 3.0% ± 15.4%; 3D: 1.9% ± 15.3%), whereas those not reaching the endpoint showed a decrease (2D: −2.7% ± 12.4%; 3D: −3.6% ± 13.3%), although residual MR after M-TEER was similar between these groups ( p  = 0.57). In multivariate Cox regression adjusted for baseline MR, A-Pd reduction ≥6.3% remained a significant predictor of the combined endpoint (OR: 0.35, 95% CI: 0.14–0.85, p  = 0.02). Conclusion Our findings indicate that effects of M-TEER in FMR are not limited to MR reduction, but also have significant impact on annular geometry. Moreover, A-Pd reduction, which mediates annular remodeling, has a significant impact on clinical outcome independent of residual MR.
    Type of Medium: Online Resource
    ISSN: 2297-055X
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2023
    detail.hit.zdb_id: 2781496-8
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  • 4
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2023
    In:  npj Climate and Atmospheric Science Vol. 6, No. 1 ( 2023-06-05)
    In: npj Climate and Atmospheric Science, Springer Science and Business Media LLC, Vol. 6, No. 1 ( 2023-06-05)
    Abstract: The Baltic Sea watershed includes the territories of 14 countries in Northern, Central, and Eastern Europe. Long-term observations have shown that the climate in this area is characterised by a pronounced multidecadal variability, with a period of about 30 years, but its origin is thus far unknown. We propose that the observed ~30-year fluctuations in Baltic Sea salinity are caused by the Atlantic Multidecadal Variability and the North Atlantic Oscillation, which together modulate precipitation over the watershed and hence the river discharge into the Baltic Sea. The return of a large portion of the outflowing brackish Baltic Sea water with the inflowing salt water, due to mixing at the entrance area results in a positive feedback mechanism that amplifies the multidecadal variations in salinity. The strength of this self-amplification is considerable since atmospheric forcing has nearly the same periodicity as the response time of the freshwater content to external freshwater inputs.
    Type of Medium: Online Resource
    ISSN: 2397-3722
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2925628-8
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  • 5
    In: Vascular, SAGE Publications, Vol. 31, No. 5 ( 2023-10), p. 850-857
    Abstract: To report and compare neoaortoiliac system reconstruction and cryopreserved human allograft in treating aortic graft infections. Methods We retrospectively analysed the data of the patients treated for aorto graft infections between January 2015 and May 2021 in our hospital. The clinical data, diagnostic procedures, and surgical options were evaluated. The primary endpoint of this study was the 30-day and 1-year mortality; secondary endpoints were major postoperative complications. Results We retrospectively reviewed a series of 31 consecutive patients (28 males; median age 72 years, range, 50–87 years) with aortic graft infection treated with NAIS (n = 20, 65%) or cryopreserved allograft (n = 11, 36%). The clinical presentation included fever attacks in 18 (58%) patients, abdominal pain in 15 (48%) patients, haemodynamic instability in 6 (19%) patients, and haematemesis in 2 (7%) patients. The median operative time of the NAIS was longer than CHA without a statistically significant difference (458 min vs. 359 min, p = .505). The postoperative morbidity for all patients was 81%, with no significant difference between NAIS and CHA groups (85% vs. 73%, p = .638). There was no limb thrombosis of the new reconstructions. Limb loss occurred in 4 (13%) patients, including 2 (10%) NAIS patients and 2 (18%) CHA patients. One NAIS patient developed complications in the form of a distal (femoral) disruption of the vein 15 days after surgery. There were no significant differences between NAIS and CHA groups in ICU stay (12 vs 8 days, .984) but in hospitalization (22 vs 33, p = .033). The most common bacteria isolated were staphylococci strains in 15 (48%). In 13 (36%) patients, candida was positive. The in-hospital 30-day and 1-year mortality for all patients was 16% (5/31) and 29% (9/31), with no significant differences between NAIS and CHA at 30 days (25% vs. 0, p = .133) or 1 year (35% vs. 18%, .429). Five NAIS patients died during the hospital stay; three of them had end-of-life decisions. After a median follow-up of 16 months (1–66 months), 12 (39%) patients died, including 9 patients with NAIS and 3 with CHA reconstructions. The causes of death included overwhelming sepsis in 5 (42%) patients, graft disruption in one (8%) NAIS patient, non–small cell lung cancer in one (8%) patient, COVID-19 in one (8%) patient and unknown causes (8%) in one. Conclusions Non-staged neoaortoiliac system reconstruction and cryopreserved human allografts show comparable short- and midterm results for treating aortic graft infections. However, both procedures remain challenging with high morbidity and mortality rates.
    Type of Medium: Online Resource
    ISSN: 1708-5381 , 1708-539X
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2143006-8
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  • 6
    In: Clinical Research in Cardiology, Springer Science and Business Media LLC, Vol. 112, No. 10 ( 2023-10), p. 1436-1445
    Abstract: The development of transcatheter tricuspid edge-to-edge repair for tricuspid regurgitation is a therapeutic milestone but a specific periprocedural risk assessment tool is lacking. TRI-SCORE has recently been introduced as a dedicated risk score for tricuspid valve surgery. Aims This study analyzes the predictive performance of TRI-SCORE following transcatheter edge-to-edge tricuspid valve repair. Methods 180 patients who underwent transcatheter tricuspid valve repair at Ulm University Hospital were consecutively included and stratified into three TRI-SCORE risk groups. The predictive performance of TRI-SCORE was assessed throughout a follow-up period of 30 days and up to 1 year. Results All patients had severe tricuspid regurgitation. Median EuroSCORE II was 6.4% (IQR 3.8–10.1%), median STS-Score 8.1% (IQR 4.6–13.4%) and median TRI-SCORE 6.0 (IQR 4.0–7.0). 64 patients (35.6%) were in the low TRI-SCORE group, 91 (50.6%) in the intermediate and 25 (13.9%) in the high-risk groups. The procedural success rate was 97.8%. 30-day mortality was 0% in the low-risk group, 1.3% in the intermediate-risk and 17.4% in the high-risk groups ( p   〈  0.001). During a median follow-up of 168 days mortality was 0%, 3.8% and 52.2%, respectively ( p   〈  0.001). The predictive performance of TRI-SCORE was excellent (AUC for 30-day mortality: 90.3%, for one-year mortality: 93.1%) and superior to EuroSCORE II (AUC 56.6% and 64.4%, respectively) and STS-Score (AUC 61.0% and 59.0%, respectively). Conclusion TRI-SCORE is a valuable tool for prediction of mortality after transcatheter edge-to-edge tricuspid valve repair and its performance is superior to EuroSCORE II and STS-Score. Graphical abstract
    Type of Medium: Online Resource
    ISSN: 1861-0684 , 1861-0692
    RVK:
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2218331-0
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  • 7
    Online Resource
    Online Resource
    Wiley ; 2023
    In:  Catheterization and Cardiovascular Interventions Vol. 102, No. 3 ( 2023-09), p. 528-537
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 102, No. 3 ( 2023-09), p. 528-537
    Abstract: To evaluate the impact of tricuspid regurgitation (TR) on echocardiographic and functional outcome after mitral valve transcatheter edge‐to‐edge‐repair (M‐TEER). Methods and Results A total of 740 patients underwent M‐TEER at our center from 2010 to 2021. Patients were analyzed according to severity of concomitant TR at the time of M‐TEER procedure: low‐grade TR (grade ≤I [trace–mild], 279 patients [37.7%] ), moderate TR (grade II, 170 patients [23.0%]) and high‐grade TR (grade III‐V [severe–torrential] , 291 patients [39.3%]). Patients with moderate to high‐grade TR had higher morbidity. Procedural success of M‐TEER was achieved similarly in all groups (98.2% vs. 97.6% vs. 95.9%, p  = 0.22). TR severity decreased rapidly and consistently after M‐TEER to only 48.0% of high‐grade TR patients after 3 months ( p   〈  0.001) and to 46.8% after 12 months ( p  = 0.99). High‐grade TR patients had significantly higher mortality (21.5% vs. 18.2% vs. 11.1%,  p  = 0.003) up to 12 months after M‐TEER. However, high‐grade TR did not independently predict mortality (HR 1.302, 95% CI 0.937–1.810; p  = 0.116). Echocardiographic and functional outcome was similar in both secondary and primary MR patients. Conclusions High‐grade concomitant TR did not independently predict adverse outcome following M‐TEER. A wait‐and‐observe approach for these patients is reasonable.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2001555-0
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  • 8
    In: Journal of Advances in Modeling Earth Systems, American Geophysical Union (AGU), Vol. 12, No. 8 ( 2020-08)
    Abstract: The regionally coupled model shows reduced oceanic biases in the North Atlantic and a better simulation of the atmospheric circulation The Arctic reaches a seasonally ice‐free state by 2055 with the regionally coupled model under RCP8.5 scenario Changes in biogeochemistry are generally stronger and show enhanced details in the regionally coupled model
    Type of Medium: Online Resource
    ISSN: 1942-2466 , 1942-2466
    Language: English
    Publisher: American Geophysical Union (AGU)
    Publication Date: 2020
    detail.hit.zdb_id: 2462132-8
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  • 9
    In: Limnology and Oceanography, Wiley, Vol. 65, No. 9 ( 2020-09), p. 2170-2187
    Abstract: Eutrophication and climate change will affect habitats of species and more generally, the structure and functioning of ecosystems. We used a three‐dimensional, coupled hydrodynamic‐biogeochemical model to investigate potential future changes in size and location of potential habitats of marine species during the 21 st century in a large, eutrophicated brackish sea (the Baltic Sea, northern Europe). We conducted scenario projections under the combined impact of nutrient load and climate change. Possible future changes of the eutrophication state of this sea were also assessed through two policy‐relevant indicators. The results imply a physiologically more stressful environment for marine species by the end of the 21 st century: volumes of higher salinity water become more hypoxic/anoxic and the volumes of low salinity, oxic water increase. For example, these results impact and reduce cod reproductive habitats. The decrease is mainly climate change induced in the Baltic basins less directly influenced by inflows of saline, oxic water to the Baltic Sea (E Gotland and Gdansk Basins). In basins more directly influenced by such inflows (Arkona and Bornholm Basins), the combined effect from climate change and nutrient loads is of importance. The results for the eutrophication state indicators clearly indicate a more eutrophic sea than at present without a rigorous nutrient reduction policy, that is, the necessity to implement the Baltic Sea Action Plan. The multidisciplinary, multiscenario assessment strategy presented here provides a useful concept for the evaluation of impacts from cumulative stresses of changing climate and socioeconomic pressures on future eutrophication indicators and habitats of marine species.
    Type of Medium: Online Resource
    ISSN: 0024-3590 , 1939-5590
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2033191-5
    detail.hit.zdb_id: 412737-7
    SSG: 12
    SSG: 14
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  • 10
    In: Earth System Dynamics, Copernicus GmbH, Vol. 12, No. 3 ( 2021-09-16), p. 939-973
    Abstract: Abstract. Nonlinear responses to externally forced climate change are known to dampen or amplify the local climate impact due to complex cross-compartmental feedback loops in the Earth system. These feedbacks are less well represented in the traditional stand-alone atmosphere and ocean models on which many of today's regional climate assessments rely (e.g., EURO-CORDEX, NOSCCA and BACC II). This has promoted the development of regional climate models for the Baltic Sea region by coupling different compartments of the Earth system into more comprehensive models. Coupled models more realistically represent feedback loops than the information imposed on the region by prescribed boundary conditions and, thus, permit more degrees of freedom. In the past, several coupled model systems have been developed for Europe and the Baltic Sea region. This article reviews recent progress on model systems that allow two-way communication between atmosphere and ocean models; models for the land surface, including the terrestrial biosphere; and wave models at the air–sea interface and hydrology models for water cycle closure. However, several processes that have mostly been realized by one-way coupling to date, such as marine biogeochemistry, nutrient cycling and atmospheric chemistry (e.g., aerosols), are not considered here. In contrast to uncoupled stand-alone models, coupled Earth system models can modify mean near-surface air temperatures locally by up to several degrees compared with their stand-alone atmospheric counterparts using prescribed surface boundary conditions. The representation of small-scale oceanic processes, such as vertical mixing and sea-ice dynamics, appears essential to accurately resolve the air–sea heat exchange over the Baltic Sea, and these parameters can only be provided by online coupled high-resolution ocean models. In addition, the coupling of wave models at the ocean–atmosphere interface allows for a more explicit formulation of small-scale to microphysical processes with local feedbacks to water temperature and large-scale processes such as oceanic upwelling. Over land, important climate feedbacks arise from dynamical terrestrial vegetation changes as well as the implementation of land-use scenarios and afforestation/deforestation that further alter surface albedo, roughness length and evapotranspiration. Furthermore, a good representation of surface temperatures and roughness length over open sea and land areas is critical for the representation of climatic extremes such as heavy precipitation, storms, or tropical nights (defined as nights where the daily minimum temperature does not fall below 20 ∘C), and these parameters appear to be sensitive to coupling. For the present-day climate, many coupled atmosphere–ocean and atmosphere–land surface models have demonstrated the added value of single climate variables, in particular when low-quality boundary data were used in the respective stand-alone model. This makes coupled models a prospective tool for downscaling climate change scenarios from global climate models because these models often have large biases on the regional scale. However, the coupling of hydrology models to close the water cycle remains problematic, as the accuracy of precipitation provided by atmosphere models is, in most cases, insufficient to realistically simulate the runoff to the Baltic Sea without bias adjustments. Many regional stand-alone ocean and atmosphere models are tuned to suitably represent present-day climatologies rather than to accurately simulate climate change. Therefore, more research is required into how the regional climate sensitivity (e.g., the models' response to a given change in global mean temperature) is affected by coupling and how the spread is altered in multi-model and multi-scenario ensembles of coupled models compared with uncoupled ones.
    Type of Medium: Online Resource
    ISSN: 2190-4987
    Language: English
    Publisher: Copernicus GmbH
    Publication Date: 2021
    detail.hit.zdb_id: 2578793-7
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