Ultrasound-Assisted, Catheter-Directed Thrombolysis for Acute Intermediate/High-Risk Pulmonary Embolism: Design of the Multicenter USAT IH-PE Registry and Preliminary Results.

Catheter-based revascularization procedures were developed as an alternative to systemic thrombolysis for patients with intermediate-high- and high-risk pulmonary embolisms. USAT IH-PE is a retrospective and prospective multicenter registry of such patients treated with ultrasound-facilitated, catheter-directed thrombolysis, whose preliminary results are presented in this study. The primary endpoint was the incidence of pulmonary hypertension (PH) at follow-up. Secondary endpoints were short- and mid-term changes in the echocardiographic parameters of right ventricle (RV) function, in-hospital and all-cause mortality, and procedure-related bleeding events. Between March 2018 and July 2023, 102 patients were included. The majority were at intermediate-high-risk PE (86%), were mostly female (57%), and had a mean age of 63.7 ± 14.5 years, and 28.4% had active cancer. Echocardiographic follow-up was available for 70 patients, and in only one, the diagnosis of PH was confirmed by right heart catheterization, resulting in an incidence of 1.43% (CI 95%, 0.036-7.7). RV echocardiographic parameters improved both at 24 h and at follow-up. In-hospital mortality was 3.9% (CI 95%, 1.08-9.74), while all-cause mortality was 11% (CI 95%, 5.4-19.2). Only 12% had bleeding complications, of whom 4.9% were BARC ≥ 3. Preliminary results from the USAT IH-PE registry showed a low incidence of PH, improvement in RV function, and a safe profile.

Convergence in phosphorus constraints to photosynthesis in forests around the world.

Tropical forests take up more carbon (C) from the atmosphere per annum by photosynthesis than any other type of vegetation. Phosphorus (P) limitations to C uptake are paramount for tropical and subtropical forests around the globe. Yet the generality of photosynthesis-P relationships underlying these limitations are in question, and hence are not represented well in terrestrial biosphere models. Here we demonstrate the dependence of photosynthesis and underlying processes on both leaf N and P concentrations. The regulation of photosynthetic capacity by P was similar across four continents. Implementing P constraints in the ORCHIDEE-CNP model, gross photosynthesis was reduced by 36% across the tropics and subtropics relative to traditional N constraints and unlimiting leaf P. Our results provide a quantitative relationship for the P dependence for photosynthesis for the front-end of global terrestrial C models that is consistent with canopy leaf measurements.

Cross-biome synthesis of source versus sink limits to tree growth.

Uncertainties surrounding tree carbon allocation to growth are a major limitation to projections of forest carbon sequestration and response to climate change. The prevalence and extent to which carbon assimilation (source) or cambial activity (sink) mediate wood production are fundamentally important and remain elusive. We quantified source-sink relations across biomes by combining eddy-covariance gross primary production with extensive on-site and regional tree ring observations. We found widespread temporal decoupling between carbon assimilation and tree growth, underpinned by contrasting climatic sensitivities of these two processes. Substantial differences in assimilation-growth decoupling between angiosperms and gymnosperms were determined, as well as stronger decoupling with canopy closure, aridity, and decreasing temperatures. Our results reveal pervasive sink control over tree growth that is likely to be increasingly prominent under global climate change.

Global decadal variability of plant carbon isotope discrimination and its link to gross primary production.

Carbon isotope discrimination (Δ13 C) in C3 woody plants is a key variable for the study of photosynthesis. Yet how Δ13 C varies at decadal scales, and across regions, and how it is related to gross primary production (GPP), are still incompletely understood. Here we address these questions by implementing a new Δ13 C modelling capability in the land-surface model JULES incorporating both photorespiratory and mesophyll-conductance fractionations. We test the ability of four leaf-internal CO2 concentration models embedded in JULES to reproduce leaf and tree-ring (TR) carbon isotopic data. We show that all the tested models tend to overestimate average Δ13 C values, and to underestimate interannual variability in Δ13 C. This is likely because they ignore the effects of soil water stress on stomatal behavior. Variations in post-photosynthetic isotopic fractionations across species, sites and years, may also partly explain the discrepancies between predicted and TR-derived Δ13 C values. Nonetheless, the "least-cost" (Prentice) model shows the lowest biases with the isotopic measurements, and lead to improved predictions of canopy-level carbon and water fluxes. Overall, modelled Δ13 C trends vary strongly between regions during the recent (1979-2016) historical period but stay nearly constant when averaged over the globe. Photorespiratory and mesophyll effects modulate the simulated global Δ13 C trend by 0.0015 ± 0.005‰ and -0.0006 ± 0.001‰ ppm-1 , respectively. These predictions contrast with previous findings based on atmospheric carbon isotope measurements. Predicted Δ13 C and GPP tend to be negatively correlated in wet-humid and cold regions, and in tropical African forests, but positively related elsewhere. The negative correlation between Δ13 C and GPP is partly due to the strong dominant influences of temperature on GPP and vapor pressure deficit on Δ13 C in those forests. Our results demonstrate that the combined analysis of Δ13 C and GPP can help understand the drivers of photosynthesis changes in different climatic regions.

Precipitation alters the CO2 effect on water-use efficiency of temperate forests.

Increasing water-use efficiency (WUE), the ratio of carbon gain to water loss, is a key mechanism that enhances carbon uptake by terrestrial vegetation under rising atmospheric CO2 (ca ). Existing theory and empirical evidence suggest a proportional WUE increase in response to rising ca as plants maintain a relatively constant ratio between the leaf intercellular (ci ) and ambient (ca ) partial CO2 pressure (ci /ca ). This has been hypothesized as the main driver of the strengthening of the terrestrial carbon sink over the recent decades. However, proportionality may not characterize CO2 effects on WUE on longer time-scales and the role of climate in modulating these effects is uncertain. Here, we evaluate long-term WUE responses to ca and climate from 1901 to 2012 CE by reconstructing intrinsic WUE (iWUE, the ratio of photosynthesis to stomatal conductance) using carbon isotopes in tree rings across temperate forests in the northeastern USA. We show that iWUE increased steadily from 1901 to 1975 CE but remained constant thereafter despite continuously rising ca . This finding is consistent with a passive physiological response to ca and coincides with a shift to significantly wetter conditions across the region. Tree physiology was driven by summer moisture at multi-decadal time-scales and did not maintain a constant ci /ca in response to rising ca indicating that a point was reached where rising CO2 had a diminishing effect on tree iWUE. Our results challenge the mechanism, magnitude, and persistence of CO2 's effect on iWUE with significant implications for projections of terrestrial productivity under a changing climate.

Impact of the COVID-19 Pandemic on Urologic Oncology Surgery: Implications for Moving Forward.

The COVID-19 pandemic has caused the destruction of routine hospital services globally, leading to an increase in the backlog of elective surgery cases. The aim of the study was to retrospectively investigate the pandemic's impact on the urologic oncology surgical activity of a high-volume center located in Milan, Italy. The number and type of procedures performed in 2020 during the COVID-19 pandemic was evaluated using 2019 data as control. Waiting times for each surgical procedure were compared, on a bimonthly basis, between the two different years. Overall, a 26.7% reduction in the number of urologic oncology surgeries between 2019 and 2020 was observed (2019: 720, 2020: 528). Both the main indication for surgery and the type of procedure performed significantly differed between 2019 and 2020 (all p < 0.0001), with a decrease in the number of radical prostatectomies and an increase in the number of radical cystectomies and radical nephrectomies/nephroureterectomies performed in 2020. Waiting time decreased by 20% between 2019 and 2020, with the most significant reduction seen after the first wave of the COVID-19 pandemic (July-October 2020), in particular for partial nephrectomy and radical prostatectomy, possibly due to the underdiagnosis of cases. In conclusion, in accordance with recommendations by international urological societies on prioritization strategies for oncological procedures, a higher proportion of surgeries for high-risk tumors was performed in 2020 at our center at the expense of procedures for lower risk diseases; however, future implications for patients' prognosis still need to be determined.

Physiological and environmental control on ecosystem water use efficiency in response to drought across the northern hemisphere.

Drought, a natural hydrometeorological phenomenon, has been more frequent and more widespread due to climate change. Water availability strongly regulates the coupling (or trade-off) between carbon uptake via photosynthesis and water loss through transpiration, known as water-use efficiency (WUE). Understanding the effects of drought on WUE across different vegetation types and along the wet to dry gradient is paramount to achieving better understanding of ecosystem functioning in response to climate change. We explored the physiological and environmental control on ecosystem WUE in response to drought using observations for 44 eddy covariance flux sites in the Northern Hemisphere. We quantified the response of WUE to drought and the relative contributions of gross primary production (GPP) and evapotranspiration (ET) to the variations of WUE. We also examined the control of physiological and environmental factors on monthly WUE under different moisture conditions. Cropland had a peak WUE value under moderate drought conditions, while grassland, deciduous broadleaf forest (DBF), evergreen broadleaf forest (EBF), and evergreen needleleaf forest (ENF) had peak WUE under slight drought conditions. WUE was mainly driven by GPP for cropland, grassland, DBF, and ENF but was mainly driven by ET for EBF. Vapor pressure deficit (VPD) and canopy conductance (Gc) were the most important factors regulating WUE. Moreover, WUE had negative responses to air temperature, precipitation, and VPD but had a positive response to Gc and ecosystem respiration. Our findings highlight the different effects of biotic and abiotic factors on WUE among different vegetation types and the important roles of VPD and Gc in controlling ecosystem WUE in response to drought.

Climate and atmospheric deposition effects on forest water-use efficiency and nitrogen availability across Britain.

Rising atmospheric CO2 (ca) has been shown to increase forest carbon uptake. Yet, whether the ca-fertilization effect on forests is modulated by changes in sulphur (Sdep) and nitrogen (Ndep) deposition and how Ndep affects ecosystem N availability remains unclear. We explored spatial and temporal (over 30-years) changes in tree-ring δ13C-derived intrinsic water-use efficiency (iWUE), δ18O and δ15N for four species in twelve forests across climate and atmospheric deposition gradients in Britain. The increase in iWUE was not uniform across sites and species-specific underlying physiological mechanisms reflected the interactions between climate and atmospheric drivers (oak and Scots pine), but also an age effect (Sitka spruce). Most species showed no significant trends for tree-ring δ15N, suggesting no changes in N availability. Increase in iWUE was mostly associated with increase in temperature and decrease in moisture conditions across the South-North gradient and over 30-years. However, when excluding Sitka spruce (to account for age or stand development effects), variations in iWUE were significantly associated with changes in ca and Sdep. Our data suggest that overall climate had the prevailing effect on changes in iWUE across the investigated sites. Whereas, detection of Ndep, Sdep and ca signals was partially confounded by structural changes during stand development.

Disentangling the role of photosynthesis and stomatal conductance on rising forest water-use efficiency.

Multiple lines of evidence suggest that plant water-use efficiency (WUE)-the ratio of carbon assimilation to water loss-has increased in recent decades. Although rising atmospheric CO2 has been proposed as the principal cause, the underlying physiological mechanisms are still being debated, and implications for the global water cycle remain uncertain. Here, we addressed this gap using 30-y tree ring records of carbon and oxygen isotope measurements and basal area increment from 12 species in 8 North American mature temperate forests. Our goal was to separate the contributions of enhanced photosynthesis and reduced stomatal conductance to WUE trends and to assess consistency between multiple commonly used methods for estimating WUE. Our results show that tree ring-derived estimates of increases in WUE are consistent with estimates from atmospheric measurements and predictions based on an optimal balancing of carbon gains and water costs, but are lower than those based on ecosystem-scale flux observations. Although both physiological mechanisms contributed to rising WUE, enhanced photosynthesis was widespread, while reductions in stomatal conductance were modest and restricted to species that experienced moisture limitations. This finding challenges the hypothesis that rising WUE in forests is primarily the result of widespread, CO2-induced reductions in stomatal conductance.

Global photosynthetic capacity is optimized to the environment.

Earth system models (ESMs) use photosynthetic capacity, indexed by the maximum Rubisco carboxylation rate (Vcmax ), to simulate carbon assimilation and typically rely on empirical estimates, including an assumed dependence on leaf nitrogen determined from soil fertility. In contrast, new theory, based on biochemical coordination and co-optimization of carboxylation and water costs for photosynthesis, suggests that optimal Vcmax can be predicted from climate alone, irrespective of soil fertility. Here, we develop this theory and find it captures 64% of observed variability in a global, field-measured Vcmax dataset for C3 plants. Soil fertility indices explained substantially less variation (32%). These results indicate that environmentally regulated biophysical constraints and light availability are the first-order drivers of global photosynthetic capacity. Through acclimation and adaptation, plants efficiently utilize resources at the leaf level, thus maximizing potential resource use for growth and reproduction. Our theory offers a robust strategy for dynamically predicting photosynthetic capacity in ESMs.

Isotopic evidence for oligotrophication of terrestrial ecosystems.

Human societies depend on an Earth system that operates within a constrained range of nutrient availability, yet the recent trajectory of terrestrial nitrogen (N) availability is uncertain. Examining patterns of foliar N concentrations and isotope ratios (δ15N) from more than 43,000 samples acquired over 37 years, here we show that foliar N concentration declined by 9% and foliar δ15N declined by 0.6-1.6‰. Examining patterns across different climate spaces, foliar δ15N declined across the entire range of mean annual temperature and mean annual precipitation tested. These results suggest declines in N supply relative to plant demand at the global scale. In all, there are now multiple lines of evidence of declining N availability in many unfertilized terrestrial ecosystems, including declines in δ15N of tree rings and leaves from herbarium samples over the past 75-150 years. These patterns are consistent with the proposed consequences of elevated atmospheric carbon dioxide and longer growing seasons. These declines will limit future terrestrial carbon uptake and increase nutritional stress for herbivores.

Evaluating climate signal recorded in tree-ring δ13 C and δ18 O values from bulk wood and α-cellulose for six species across four sites in the northeastern US.

RATIONALE: We evaluated the applicability of tree-ring δ13 C and δ18 O values in bulk wood - instead of the more time and lab-consuming α-cellulose δ13 C and δ18 O values, to assess climate and physiological signals across multiple sites and for six tree species along a latitudinal gradient (35°97'N to 45°20'N) of the northeastern United States. METHODS: Wood cores (n = 4 per tree) were sampled from ten trees per species. Cores were cross-dated within and across trees at each site, and for the last 30 years. Seven years, including the driest on record, were selected for this study. The δ13 C and δ18 O values were measured on two of the ten trees from the bulk wood and the α-cellulose. The offsets between materials in δ13 C and δ18 O values were assessed. Correlation and multiple regression analyses were used to evaluate the strength of the climate signal across sites. Finally the relationship between δ13 C and δ18 O values in bulk wood vs α-cellulose was analyzed to assess the consistency of the interpretation, in terms of CO2 assimilation and stomatal conductance, from both materials. RESULTS: We found offsets of 1.1‰ and 5.6‰ between bulk and α-cellulose for δ13 C and δ18 O values, respectively, consistent with offset values reported in the literature. Bulk wood showed similar or stronger correlations to climate parameters than α-cellulose for the investigated sites. In particular, temperature and vapor pressure deficit and standard precipitation-evaporation index (SPEI) were the most visible climate signals recorded in δ13 C and δ18 O values, respectively. For most of the species, there was no relationship between δ13 C and δ18 O values, regardless of the wood material considered. CONCLUSIONS: Extraction of α-cellulose was not necessary to detect climate signals in tree rings across the four investigated sites. Furthermore, the physiological information inferred from the dual isotope approach was similar for most of the species regardless of the material considered.

Solar radiation and functional traits explain the decline of forest primary productivity along a tropical elevation gradient.

One of the major challenges in ecology is to understand how ecosystems respond to changes in environmental conditions, and how taxonomic and functional diversity mediate these changes. In this study, we use a trait-spectra and individual-based model, to analyse variation in forest primary productivity along a 3.3 km elevation gradient in the Amazon-Andes. The model accurately predicted the magnitude and trends in forest productivity with elevation, with solar radiation and plant functional traits (leaf dry mass per area, leaf nitrogen and phosphorus concentration, and wood density) collectively accounting for productivity variation. Remarkably, explicit representation of temperature variation with elevation was not required to achieve accurate predictions of forest productivity, as trait variation driven by species turnover appears to capture the effect of temperature. Our semi-mechanistic model suggests that spatial variation in traits can potentially be used to estimate spatial variation in productivity at the landscape scale.

Leaf-level photosynthetic capacity in lowland Amazonian and high-elevation Andean tropical moist forests of Peru.

We examined whether variations in photosynthetic capacity are linked to variations in the environment and/or associated leaf traits for tropical moist forests (TMFs) in the Andes/western Amazon regions of Peru. We compared photosynthetic capacity (maximal rate of carboxylation of Rubisco (Vcmax ), and the maximum rate of electron transport (Jmax )), leaf mass, nitrogen (N) and phosphorus (P) per unit leaf area (Ma , Na and Pa , respectively), and chlorophyll from 210 species at 18 field sites along a 3300-m elevation gradient. Western blots were used to quantify the abundance of the CO2 -fixing enzyme Rubisco. Area- and N-based rates of photosynthetic capacity at 25°C were higher in upland than lowland TMFs, underpinned by greater investment of N in photosynthesis in high-elevation trees. Soil [P] and leaf Pa were key explanatory factors for models of area-based Vcmax and Jmax but did not account for variations in photosynthetic N-use efficiency. At any given Na and Pa , the fraction of N allocated to photosynthesis was higher in upland than lowland species. For a small subset of lowland TMF trees examined, a substantial fraction of Rubisco was inactive. These results highlight the importance of soil- and leaf-P in defining the photosynthetic capacity of TMFs, with variations in N allocation and Rubisco activation state further influencing photosynthetic rates and N-use efficiency of these critically important forests.

The variation of productivity and its allocation along a tropical elevation gradient: a whole carbon budget perspective.

Why do forest productivity and biomass decline with elevation? To address this question, research to date generally has focused on correlative approaches describing changes in woody growth and biomass with elevation. We present a novel, mechanistic approach to this question by quantifying the autotrophic carbon budget in 16 forest plots along a 3300 m elevation transect in Peru. Low growth rates at high elevations appear primarily driven by low gross primary productivity (GPP), with little shift in either carbon use efficiency (CUE) or allocation of net primary productivity (NPP) between wood, fine roots and canopy. The lack of trend in CUE implies that the proportion of photosynthate allocated to autotrophic respiration is not sensitive to temperature. Rather than a gradual linear decline in productivity, there is some limited but nonconclusive evidence of a sharp transition in NPP between submontane and montane forests, which may be caused by cloud immersion effects within the cloud forest zone. Leaf-level photosynthetic parameters do not decline with elevation, implying that nutrient limitation does not restrict photosynthesis at high elevations. Our data demonstrate the potential of whole carbon budget perspectives to provide a deeper understanding of controls on ecosystem functioning and carbon cycling.

Response of Quercus velutina growth and water use efficiency to climate variability and nitrogen fertilization in a temperate deciduous forest in the northeastern USA.

Nitrogen (N) deposition and changing climate patterns in the northeastern USA can influence forest productivity through effects on plant nutrient relations and water use. This study evaluates the combined effects of N fertilization, climate and rising atmospheric CO2on tree growth and ecophysiology in a temperate deciduous forest. Tree ring widths and stable carbon (δ(13)C) and oxygen (δ(18)O) isotopes were used to assess tree growth (basal area increment, BAI) and intrinsic water use efficiency (iWUE) ofQuercus velutinaLamb., the dominant tree species in a 20+ year N fertilization experiment at Harvard Forest (MA, USA). We found that fertilized trees exhibited a pronounced and sustained growth enhancement relative to control trees, with the low- and high-N treatments responding similarly. All treatments exhibited improved iWUE over the study period (1984-2011). Intrinsic water use efficiency trends in the control trees were primarily driven by changes in stomatal conductance, while a stimulation in photosynthesis, supported by an increase in foliar %N, contributed to enhancing iWUE in fertilized trees. All treatments were predominantly influenced by growing season vapor pressure deficit (VPD), with BAI responding most strongly to early season VPD and iWUE responding most strongly to late season VPD. Nitrogen fertilization increasedQ. velutinasensitivity to July temperature and precipitation. Combined, these results suggest that ambient N deposition in N-limited northeastern US forests has enhanced tree growth over the past 30 years, while rising ambient CO2has improved iWUE, with N fertilization and CO2having synergistic effects on iWUE.

Isotopic evidence for the occurrence of biological nitrification and nitrogen deposition processing in forest canopies.

This study examines the role of tree canopies in processing atmospheric nitrogen (Ndep ) for four forests in the United Kingdom subjected to different Ndep : Scots pine and beech stands under high Ndep (HN, 13-19 kg N ha(-1)  yr(-1) ), compared to Scots pine and beech stands under low Ndep (LN, 9 kg N ha(-1)  yr(-1) ). Changes of NO3 -N and NH4 -N concentrations in rainfall (RF) and throughfall (TF) together with a quadruple isotope approach, which combines δ(18) O, Δ(17) O and δ(15) N in NO3 (-) and δ(15) N in NH4 (+) , were used to assess N transformations by the canopies. Generally, HN sites showed higher NH4 -N and NO3 -N concentrations in RF compared to the LN sites. Similar values of δ(15) N-NO3 (-) and δ(18) O in RF suggested similar source of atmospheric NO3 (-) (i.e. local traffic), while more positive values for δ(15) N-NH4 (+) at HN compared to LN likely reflected the contribution of dry NHx deposition from intensive local farming. The isotopic signatures of the N-forms changed after interacting with tree canopies. Indeed, (15) N-enriched NH4 (+) in TF compared to RF at all sites suggested that canopies played an important role in buffering dry Ndep also at the low Ndep site. Using two independent methods, based on δ(18) O and Δ(17) O, we quantified for the first time the proportion of NO3 (-) in TF, which derived from nitrification occurring in tree canopies at the HN site. Specifically, for Scots pine, all the considered isotope approaches detected biological nitrification. By contrast for the beech, only using the mixing model with Δ(17) O, we were able to depict the occurrence of nitrification within canopies. Our study suggests that tree canopies play an active role in the N cycling within forest ecosystems. Processing of Ndep within canopies should not be neglected and needs further exploration, with the combination of multiple isotope tracers, with particular reference to Δ(17) O.