Storylines for unprecedented heatwaves based on ensemble boosting.

Recent temperature extremes have shattered previously observed records, reaching intensities that were inconceivable before the events. Could the possibility of an event with such unprecedented intensity as the 2021 Pacific Northwest heatwave have been foreseen, based on climate model information available before the event? Could the scientific community have quantified its potential intensity based on the current generation of climate models? Here, we demonstrate how an ensemble boosting approach can be used to generate physically plausible storylines of a heatwave hotter than observed in the Pacific Northwest. We also show that heatwaves of much greater intensities than ever observed are possible in other locations like the Greater Chicago and Paris regions. In order to establish confidence in storylines of 'black swan'-type events, different lines of evidence need to be combined along with process understanding to make this information robust and actionable for stakeholders.

Sexual selection for genetic compatibility: the role of the major histocompatibility complex on cryptic female choice in Chinook salmon (Oncorhynchus tshawytscha).

Cryptic female choice (CFC), a form of sexual selection during or post mating, describes processes of differential sperm utilization by females to bias fertilization outcomes towards certain males. In Chinook salmon (Oncorhynchus tshawytscha) the ovarian fluid surrounding the ova of a given female differently enhances the sperm velocity of males. Sperm velocity is a key ejaculate trait that determines fertilization success in externally fertilizing fishes, thus the differential effect on sperm velocity might bias male fertilization outcomes and represent a mechanism of CFC. Once sperm reach the oocyte, CFC could potentially be further facilitated by sperm-egg interactions, which are well understood in externally fertilizing marine invertebrates. Here, we explored the potential genetic basis of both possible mechanisms of CFC by examining whether the genotypic combinations of mates (amino-acid divergence, number of shared alleles) at the major histocompatibility complex (MHC) class I and II explain the variation in sperm velocity and/or male fertilization success that is not explained by sperm velocity, which might indicate MHC-based sperm-egg interactions. We recorded sperm velocity in ovarian fluid, employed paired-male fertilization trials and evaluated the fertilization success of each male using microsatellite-based paternity assignment. We showed that relative sperm velocity was positively correlated with fertilization success, confirming that the differential effect on sperm velocity may be a mechanism of CFC in Chinook salmon. The variation in sperm velocity was independent of MHC class I and II. However, the MHC class II divergence of mates explained fertilization success, indicating that this locus might influence sperm-egg interactions.

A new species of Tanycarpa Förster (1862) (Hymenoptera, Braconidae: Alysiinae) from Itatiaia National Park, Rio de Janeiro, Brazil / Uma nova espécie de Tanycarpa Förster (1862) (Hymenoptera: Braconidae: Alysiinae) do Parque Nacional do Itatiaia, Rio de Janeiro, Brasil

Abstract This is the first description of a species of the genus Tanycarpa Förster (1862) for Brazil. Forty-eight specimens were collected in High Montane Dense Ombrophilous Forest area at National Park of Itatiaia, RJ, using four Malaise traps installed, respectively, at four different altitudes. This study is based on a description of two species of Tanycarpa from Colombia, Tanycarpa edithae and Tanycarpa sarmientoi, which are the only species of this genus recognized for the neotropics.

Resumo Esta é a primeira descrição de uma espécie do gênero Tanycarpa Förster (1862) para o Brasil. Foram coletados 48 espécimes em uma área de Floresta Ombrófila Densa Alto Montana do Parque Nacional do Itatiaia, RJ, com o uso de quatro armadilhas Malaise instaladas, respectivamente, em quatro altitudes diferentes. Este trabalho foi baseado na descrição de duas espécies de Tanycarpa da Colômbia, Tanycarpa edithae e Tanycarpa sarimentoi, as únicas espécies desse gênero reconhecidas para a região Neotropical.

A new species of Tanycarpa Förster (1862) (Hymenoptera, Braconidae: Alysiinae) from Itatiaia National Park, Rio de Janeiro, Brazil.

This is the first description of a species of the genus Tanycarpa Förster (1862) for Brazil. Forty-eight specimens were collected in High Montane Dense Ombrophilous Forest area at National Park of Itatiaia, RJ, using four Malaise traps installed, respectively, at four different altitudes. This study is based on a description of two species of Tanycarpa from Colombia, Tanycarpa edithae and Tanycarpa sarmientoi, which are the only species of this genus recognized for the neotropics.

[Angiogenin, bFGF and VEGF: angiogenic markers in breath condensate of patients with pulmonary hypertension]. / Die angiogenetischen Faktoren VEGF, Angiogenin und bFGF im Atemkondensat von Patienten mit pulmonaler Hypertonie.

Pulmonary arterial hypertension (PAH) is associated with a change in vascular architecture. A characteristic histological feature is the plexiform lesion. Similar alterations are observed in the pulmonary vascular bed of patients with chronic thromboembolic pulmonary hypertension (CTEPH). Cytokines involved in angiogenesis were found in both serum and lung tissue of patients with PAH and CTEPH, although their role in the formation of plexiform lesions remains unclear. The examination of breath condensate is a noninvasive technique to analyse proteins possibly associated with the pathogenesis of various lung diseases.Breath condensate of 22 patients with pulmonary hypertension (PAH: n = 12; CTEPH: n = 10) and 7 healthy volunteers was examined using a multiplex fluorescent bead immunoassay to determine the concentrations of the biomarkers angiogenin, bFGF, VEGF, IL-8, and TNF-α. Significantly higher levels of angiogenin, bFGF and TNF-α were observed in breath condensate of patients with pulmonary hypertension in comparison to healthy controls. Similarly, breath condensate levels of VEGF were elevated in patients with PAH as against healthy volunteers. However, IL-8 levels in breath condensate did not differ between the two groups. The data suggest that breath condensate of patients with pulmonary hypertension is characterized by increased levels of the angiogenic factors angiogenin, VEGF and bFGF as well as TNF-α, but not IL-8. A larger study is needed to confirm these results and to determine the prognostic and therapeutic implications of these findings.

[Smelling diseases? A short review on electronic noses]. / Krankheiten erriechen? Eine kurze Übersicht über elektronische Nasen.

Non-invasive pulmonary diagnostics is a promising and interesting field in respiratory medicine. Beside exhaled breath condensate, there is an increasing interest in alternative and faster techniques such as electronic noses (EN). EN aim to mimic or improve the sense of smelling. Different types of EN have been employed in research so far. In addition to ion mobility spectrometry and mass spectrometry, ENs that consist of various biopolymer sensors for the sensing of volatile organic compounds (VOCs) have been tested. VOCs bind to the sensors depending on size, structure, hydrogen binding and polarity. This leads to physical alterations, e. g., swelling resulting in a change of resistance. The smell print represents composite patterns in contrast to single compounds, and the distinction between different categories is achieved by pattern recognition algorithms. Other types of EN like mass spectrometry and ion mobility spectrometry are capable of identifying even single analyte fractions provided that their characteristics have been saved in data repositories. The non-invasive nature, onsite availability and relatively cheap sampling are advantages of ENs that underly the increasing interest in their use for medical purposes. Some promising results have already been published. This review aims to describe the state of the art in brief form.

Angiogenic markers in breath condensate identify non-small cell lung cancer.

Early recognition of lung cancer is a prerequisite for any strategy to improve lung cancer treatment outcome. Here we report a cross-sectional study intended as a proof of principle investigation using breath based detection (exhaled breath condensate, EBC) of angiogenic markers (VEGF, bFGF, angiogenin), TNF-alpha and IL-8 to discriminate 74 individuals, with confirmed presence or absence (X-ray, CT) of non-small lung cancer (NSCLC). Levels of angiogenic markers bFGF, angiogenin and VEGF in EBC significantly discriminated between 17 individuals with newly detected NSCLC versus stable and exacerbated chronic obstructive pulmonary disease (COPD) patients as well as healthy volunteers. Levels of IL-8 and TNF-alpha in EBC indicated acute inflammation, e.g. in acute exacerbated COPD (AECOPD) and were not indicative of lung cancer. In a different group of patients that were already treated with two cycles of chemotherapy and who responded with at least a 25% reduction in primary tumor diameter, levels of angiogenic markers were lower compared to patients with newly diagnosed NSCLC. We suggest that breath based detection of angiogenic markers may help in the early detection of lung cancer.

[Lymphomatoid granulomatosis--a short description of an unusual case of the disease]. / Lymphomatoide Granulomatose--eine kurze Darstellung der Erkrankung anhand eines aussergewöhnlichen Falles.

Lymphomatoid granulomatosis (LYG) is a rare disease with an unknown pathogenesis. It is considered as a B-cell disorder with an uncertain malignant potential. The disease is classified as an angiocentric and angiodestructive lymphoproliferative disorder. EBV-association (LMP1) and the detection of the surface antigens CD20 and CD30 are the characteristic pathological findings. The lung, the nervous system, the kidneys and the liver are affected most frequently. In the present report the case of a 79-year-old man is described, who showed a cavity in the upper right lobe which was opened out into the trachea. The initial CXR and CT scan demonstrated a large nodular air space opacity (reversed halo sign) on the upper right area and a smaller one on the left side. In addition to CT and bronchoscopy, a surgical biopsy was performed to confirm the diagnosis of lymphomatoid granulomatosis. Treatment consisted in chemotherapy with rituximab, cyclophosphamide, vincristine and prednisolone (R-CVP). Three months after confirmation of diagnosis the patient died of an abscess-forming pneumonia.

[Tuberculosis and travelling]. / Tuberkulose und Reisen.

Tuberculosis (TB) in Germany in the year 2007 with 5020 reported cases (incidence: 6.1 newly diagnosed cases per 100 000 inhabitants) was continuously in decline. 43.1 % of these persons were from countries with a higher TB incidence as compared to Germany. However, not only migration but also personal journeys from low- to high-incidence countries carries an increased risk of infection with M. tuberculosis (MTB). An early active TB follows only rarely, more common, however, is a latent TB infection (LTBI). Not only the active form of TB but also LTBI, with a potential for reactivation years or decades later, can be of enormous relevance for the individual and the social environment. The early detection of an MTB infection and its possible sequelae are decisive for a continued successful battle against tuberculous diseases, especially in view of increasing travel activities.

[Clinical features and diagnosis of bronchopulmonary infections in the elderly]. / Klinik und Diagnose bronchopulmonaler Infektionen im Alter.

Diseases of the lung are one of the main causes of morbidity and mortality in the elderly. The risk of respiratory infections is increased due to structural changes, malnutrition, co-morbidity, and a variety of other factors. Bacterial and viral pathogens cause acute bronchitis and exacerbations of chronic bronchitis (AECB). Community acquired pneumonias (CAP) show a different spectrum of pathogens and clinical course in comparison to nosocomial pneumonias (hospital acquired pneumonia, HAP). Institutionalised patients are at risk of a health care associated pneumonia (HCAP), with often a different spectrum of pathogens in comparison to CAP and HAP. Elderly patients with cerebrovascular disease and impairment of swallowing or cough reflexes often suffer from aspiration pneumonias. The mortality is highest in the elderly, comorbid, and immunocompromised patient with nosocomial pneumonia. Important preventive measures include influenza and pneumococcal vaccination, avoidance of immobility, oral hygiene, and sufficient nutrition.

[Friend or foe: combination therapy with inhaled corticosteroids and long-acting beta2-agonists in chronic obstructive pulmonary disease (COPD)]. / Indikationen und Limitationen einer fixen Kombinationstherapie mit inhalativen Kortikosteroiden und langwirksamen beta2-Mimetika bei der chronisch-obstruktiven Lungenerkrankung (COPD).

Inhaled corticosteroids (ICS) used in COPD (chronic obstructive pulmonary disease) are recommended only in combination with a long-acting beta2-agonist (LABA) in stage 3 and higher in COPD treatment guidelines. In comparison to placebo and the single components, a superior control by means of the ICS/LABA fixed combination therapy has been demonstrated for clinical improvement in the following parameters: reduction of exacerbation rate and hospitalisations, reduction of dyspnoea and improvement of forced expiratory volume in one second (FEV1). In contrast to data from database studies, the large prospective TORCH (Towards a Revolution in COPD Health) trial found in the ICS/LABA group a beneficial effect on the reduction of mortality only as a trend in the ICS/LABA group, which did not reach statistical significance. In long-term trials, ICS treated patients experienced up to 10% oral and/or pharyngeal candidiasis. ICS was associated with an excess risk of pneumonia, which doubles the pneumonia incidence in patients not receiving ICS. The probability of having pneumonia reported as an adverse event was 18-19 % in the ICS groups and resulted in a 1.7-2.2 elevated pneumonia risk. Because ICS therapy is recommended only in conjunction with a bronchodilator, fixed ICS/LABA combinations are a logical consequence for COPD long-term therapy.

[Ultrasound guided transthoracic biopsy - safety and efficaces]. / Ultraschall gestützte Biopsie mit Durchleuchtungskontrolle zur Diagnostik thoraxwandnaher Raumforderungen - sicher und diagnostisch effektiv.

BACKGROUND: The biopsy of pulmonary neoplasms localized in close proximity of the thoracic wall and the histological examination of the specimens represent an important diagonstic tool in the work up of benign and malign pulmonary tumours. The biopsy techniques differ with respect to the guiding imaging method, the devices used and the quantity of specimen. This study investigates efficacy and safety of the ultrasound guided transthoracic biopsy. PATIENTS: 46 consecutive patients (n = 37 male; n = 9 female) with a mean age of 64.4 years were included in this analysis. 13 patients suffered from COPD with a mean residual volume in per cent of total lung capacity of 61.9 +/- 12.6 %. 43 pulmonary or pleural and 3 mediastinal neoplasms were investigated. The neoplasm reached the pleura in 41 cases. The mean tumours sizes was 59.1 +/- 30.6 mm. METHOD: The target structure was localized by ultrasound. The ultrasound probe and in its orientation to the target structure was fluoroscopically visualized. Local anaesthesia and sampling were performed in the same orientation under fluoroscopic control. Using the BioPince device (Medical Device Technologies, Inc.; Florida, USA; length 150 mm; Gauge: 18) two to five biopsy cylinders were taken. Chest X-ray was performed within some hours to rule out pneumothorax. RESULTS: The histological examination provided the diagnosis in 44 of 46 cases (95.6 %): lung cancer n = 29, other malign tumours n = 9; benign tumours n = 6). Complications were observed in three patients: haemoptysis, cutaneous emphysema (without need for intervention), pneumothorax with consecutive chest tube placement (one case each). CONCLUSION: The ultrasound guided transthoracic biopsy may be regarded as a safe diagnostic procedure. Complications, even in patients with structural lung disease are in the range of comparable techniques.

[Acute bronchitis: when are antibiotics, and when is symptomatic treatment indicated?]. / Akute Bronchitis. Wann symptomatisch, wann mit Antibiotika behandeln?

Acute bronchitis is usually caused by a virus, while the chronic form is due to inhalative noxae (in most cases decades of cigarette smoking). Both varieties are diagnosed on a clinical basis. Treatment of acute bronchitis is symptomatic. A sore throat is treated locally, and a troublesome, in particular nocturnal, cough with antitussive agents applied for a limited period (14 days). If bronchial mucus is viscous and difficult to clear, short-term treatment with a secretolytic or mucolytic substance is justified. Management of chronic bronchitis consists primarily in the elimination of the noxae. Treatment with antibiotics (usually oral) makes good sense only when there is a bacteriological infection of the upper or lower airways in an acute stage, such as infection-driven exacerbation of chronic obstructive bronchitis (COPD).

[Health significance of inhaled particles]. / Gesundheitliche Bedeutung inhalierter Stäube.

Particulates refer to particles, dust, dirt, soot and aerosol mists that has suspended in the surrounding air. They may consist of solids of various forms including fibres or liquids. Long term exposure to silicon dioxide containing dusts (crystalline silica: quartz, tridymite, cristobalite, coesite, stishovite) may cause pneumoconiosis in the form of acute or/either chronic silicosis. Asbestos refers to a divers family of crystalline hydrated fibrous siliates typically exhibiting a greater tha 3:1 length ot diameter ratio. It is subdivided into serpentine (Chrysotile) and amphibole (crocidolite, amosite, anthophyllite, tremolite, actinolite). Exposure to asbestos fibres may cause lung fibrosis and promote cancer of the lung or the pleura. Besides the induction of malignant diseases dust exposure may result in obstructive as well as restrictive lung diseases which may be compensate in case of the recognition as a occupational diseases. Other occupational exposures leading to pneumoconiosis are caused be talc, or metals including aluminium containing dusts. Also the group of man-made mineral (MMMFs) or vitreous fibres (MMVFs), including glass wool, rock wool, slag wool, glass filaments, microfibres, refractory ceramic fibres are bioactive under certain experimental conditions. Although it has been shown that MMMFs may cause malignancies when injected intraperitoneally in high quantities in rodents, inhalation trials and human studies could not reproduce these results in the same precision. Fine particles (particulate matter = PM) comprise one of the most widespread and harmful air pollutants in the industrialized world. PM may cause worsening of asthma and other respiratory diseases, reduce lung function development in children, potentially increased the risk of premature death in the elderly and enhance mortality from cardiac diseases. Because of the small size PM2.5 is seen to be even more hazardous than PM10.

[Talc pleurodesis in malignant pleural effusions]. / Effektivität und zugrunde liegende Mechanismen der Talkumpleurodese bei malignem Pleuraerguss.

Pleural effusions associated with malignancy--either malignant or paramalignant diseases--were found in ca. 20% of these patients. Large pleural effusions cause mainly dyspnoea but also cough and chest pain. The presence and degree of dyspnoea depend on the size of the effusion and the patient's underlying pulmonary function. In acute cases and large effusions immediate chest drainage is indicated in symptomatic patients, followed by the treatment of the underlying disease, e. g. chemotherapy. The most effective therapy for controlling reiterated malignant pleural effusions is the thoracoscopic talc poudrage (2.5-10 g) which has been shown to have a success rate of > 90%. Talc induces a broad inflammatory reaction involving mesothelial cells of the pleura, coagulation parameters, fibroblast proliferation eventually leading to symphysis of the pleura. This procedure is reserved for patients who are in good general conditions, who are expected to have a reasonably long survival, and who failed chemical pleurodesis. A good predictor for longer survival time is a Karnofsky Performance Scale > or = 40 indicating a survival time > 30 days, which therefore should be considered prior to the procedure. The adult respiratory distress syndrome (ARDS) is the most important complication initially observed in the US in up to 9% of all cases. ARDS incidence was strongly related to high number (50%) of small talc particles < 15 microm. In summary, talc poudrage or slurry (talc particle size > 10 microm) in malignant pleura effusions is a safe and effective method to induce pleura symphysis. Complaints and complications such as chest pain, transient fever, and empyema are rare or very are which are almost exclusively related to the therapeutic procedure itself.

Exhaled breath condensate: methodological recommendations and unresolved questions.

Collection of exhaled breath condensate (EBC) is a noninvasive method for obtaining samples from the lungs. EBC contains large number of mediators including adenosine, ammonia, hydrogen peroxide, isoprostanes, leukotrienes, nitrogen oxides, peptides and cytokines. Concentrations of these mediators are influenced by lung diseases and modulated by therapeutic interventions. Similarly EBC pH also changes in respiratory diseases. The aim of the American Thoracic Society/European Respiratory Society Task Force on EBC was to identify the important methodological issues surrounding EBC collection and assay, to provide recommendations for the measurements and to highlight areas where further research is required. Based on the currently available evidence and the consensus of the expert panel for EBC collection, the following general recommendations were put together for oral sample collection: collect during tidal breathing using a noseclip and a saliva trap; define cooling temperature and collection time (10 min is generally sufficient to obtain 1-2 mL of sample and well tolerated by patients); use inert material for condenser; do not use resistor and do not use filter between the subject and the condenser. These are only general recommendations and certain circumstances may dictate variation from them. Important areas for future research involve: ascertaining mechanisms and site of exhaled breath condensate particle formation; determination of dilution markers; improving reproducibility; employment of EBC in longitudinal studies; and determining the utility of exhaled breath condensate measures for the management of individual patients. These studies are required before recommending this technique for use in clinical practice.

[Rare cause of pectangina after coronary artery surgery]. / Ungewöhnliche Ursache pektanginöser Beschwerden nach Bypassoperation.

The coronary subclavian-steal-syndrome is a rare cause for angina pectoris following A. mammaria interna bypass operation. A 72-year-old male patient presented with vertigo and angina pectoris. A three vessel coronary artery disease was known and coronary artery surgery with three aortocoronary bypasses had been performed a year prior to presentation. A difference in peripheral arterial pressure between the right (150/80 mmHg) and the left (125/75 mmHg) arm was noted at physical examination. Color Doppler sonography of the left vertebral arteria exhibited a retrograde flow suggesting a coronary subclavian-steal-syndrome. Angiography revealed a significant stenosis of the left arteria subclavia. The stenosis was successfully treated with percutaneous transluminal angioplasty and stent implantation.