The role of tropical volcanic eruptions in exacerbating Indian droughts.

The Indian summer monsoon rainfall (ISMR) is vital for the livelihood of millions of people in the Indian region; droughts caused by monsoon failures often resulted in famines. Large volcanic eruptions have been linked with reductions in ISMR, but the responsible mechanisms remain unclear. Here, using 145-year (1871-2016) records of volcanic eruptions and ISMR, we show that ISMR deficits prevail for two years after moderate and large (VEI > 3) tropical volcanic eruptions; this is not the case for extra-tropical eruptions. Moreover, tropical volcanic eruptions strengthen El Niño and weaken La Niña conditions, further enhancing Indian droughts. Using climate-model simulations of the 2011 Nabro volcanic eruption, we show that eruption induced an El Niño like warming in the central Pacific for two consecutive years due to Kelvin wave dissipation triggered by the eruption. This El Niño like warming in the central Pacific led to a precipitation reduction in the Indian region. In addition, solar dimming caused by the volcanic plume in 2011 reduced Indian rainfall.

Elevated aerosol layer over South Asia worsens the Indian droughts.

Droughts have become more severe and recurrent over the Indian sub-continent during the second half of the twentieth century, leading to more severe hydro-climatic and socio-economic impacts over one of the most densely populated parts of the world. So far, droughts have mostly been connected to circulation changes concomitant with the abnormal warming over the Pacific Ocean, prevalently known as "El Niño". Here, exploiting observational data sets and a series of dedicated sensitivity experiments, we show that the severity of droughts during El Niño is amplified (17%) by changes in aerosols. The model experiments simulate the transport of boundary layer aerosols from South Asian countries to higher altitudes (12-18 km) where they form the Asian Tropopause Aerosol Layer (ATAL) (~ 60-120°E, 20-40°N). During El Niño, the anomalous overturning circulation from the East Asian region further enriches the thickness of aerosol layers in the ATAL over the northern part of South Asia. The anomalous aerosol loading in the ATAL reduces insolation over the monsoon region, thereby exacerbating the severity of drought by further weakening the monsoon circulation. Future increases in industrial emissions from both East and South Asia will lead to a wider and thicker elevated aerosol layer in the upper troposphere, potentially amplifying the severity of droughts.

Decline and poleward shift in Indian summer monsoon synoptic activity in a warming climate.

Cyclonic atmospheric vortices of varying intensity, collectively known as low-pressure systems (LPS), travel northwest across central India and produce more than half of the precipitation received by that fertile region and its ∼600 million inhabitants. Yet, future changes in LPS activity are poorly understood, due in part to inadequate representation of these storms in current climate models. Using a high-resolution atmospheric general circulation model that realistically simulates the genesis distribution of LPS, here we show that Indian monsoon LPS activity declines about 45% by the late 21st century in simulations of a business-as-usual emission scenario. The distribution of LPS genesis shifts poleward as it weakens, with oceanic genesis decreasing by ∼60% and continental genesis increasing by ∼10%; over land the increase in storm counts is accompanied by a shift toward lower storm wind speeds. The weakening and poleward shift of the genesis distribution in a warmer climate are confirmed and attributed, via a statistical model, to the reduction and poleward shift of low-level absolute vorticity over the monsoon region, which in turn are robust features of most coupled model projections. The poleward shift in LPS activity results in an increased frequency of extreme precipitation events over northern India.

Determining the effects and challenges of incorporating genetic testing into primary care management of hypertensive patients with African ancestry.

People of African ancestry (Blacks) have increased risk of kidney failure due to numerous socioeconomic, environmental, and clinical factors. Two variants in the APOL1 gene are now thought to account for much of the racial disparity associated with hypertensive kidney failure in Blacks. However, this knowledge has not been translated into clinical care to help improve patient outcomes and address disparities. GUARDD is a randomized trial to evaluate the effects and challenges of incorporating genetic risk information into primary care. Hypertensive, non-diabetic, adults with self-reported African ancestry, without kidney dysfunction, are recruited from diverse clinical settings and randomized to undergo APOL1 genetic testing at baseline (intervention) or at one year (waitlist control). Providers are educated about genomics and APOL1. Guided by a genetic counselor, trained staff return APOL1 results to patients and provide low-literacy educational materials. Real-time clinical decision support tools alert clinicians of their patients' APOL1 results and associated risk status at the point of care. Our academic-community-clinical partnership designed a study to generate information about the impact of genetic risk information on patient care (blood pressure and renal surveillance) and on patient and provider knowledge, attitudes, beliefs, and behaviors. GUARDD will help establish the effective implementation of APOL1 risk-informed management of hypertensive patients at high risk of CKD, and will provide a robust framework for future endeavors to implement genomic medicine in diverse clinical practices. It will also add to the important dialog about factors that contribute to and may help eliminate racial disparities in kidney disease.

Impacts of the ENSO Modoki and other Tropical Indo-Pacific Climate-Drivers on African Rainfall.

The study diagnoses the relative impacts of the four known tropical Indo-Pacific drivers, namely, El Niño Southern Oscillation (ENSO), ENSO Modoki, Indian Ocean Dipole (IOD), and Indian Ocean Basin-wide mode (IOBM) on African seasonal rainfall variability. The canonical El Niño and El Niño Modoki are in general associated with anomalous reduction (enhancement) of rainfall in southern (northern) hemispheric regions during March-May season. However, both the El Niño flavours anomalously reduce the northern hemispheric rainfall during June-September. Interestingly, during boreal spring and summer, in many regions, the Indian Ocean drivers have influences opposite to those from tropical Pacific drivers. On the other hand, during the October-December season, the canonical El Niño and/or positive IOD are associated with an anomalous enhancement of rainfall in the Eastern Africa, while the El Niño Modoki events are associated with an opposite impact. In addition to the Walker circulation changes, the Indo-Pacific drivers influence the African rainfall through modulating jet streams. During boreal summer, the El Niño Modoki and canonical El Niño (positive IOD) tend to weaken (strengthen) the tropical easterly jet, and result in strengthening (weakening) and southward shift of African easterly jet. This anomalously reduces (enhances) rainfall in the tropical north, including Sahelian Africa.

Transcutaneous access to retrograde axonal flow.

Transcutaneous entry of fluorescent tracer and subsequent retrograde neuronal transport achieved by the use of dimethyl sulfoxide (DMSO) as a vehicle fluorescent dye dissolved in DMSO and applied topically to the hind limb of rats was found in corresponding dorsal root ganglia; aqueous absorption of tracer dye by neuronal tissue was not demonstrated. This example of transcutaneous access and retrograde transport may have implications as to the entry of various toxins, viruses, chemicals, and therapeutic agents to the nervous system.

Improvement in the polyneuropathy associated with familial amyloid polyneuropathy after liver transplantation.

OBJECTIVE: To study, following liver transplantation, the neurologic progression or regression of the polyneuropathy in a cohort of patients with familial amyloidotic polyneuropathy (FAP). BACKGROUND: FAP is characterized by the relentless progression of neurologic and cardiac impairment, leading to death within 7 to 15 years after disease onset. No effective treatment to slow or halt the progression of this disease has been found to date. DESIGN/METHODS: Over the past 3 years, our FAP patients were offered liver transplantation as treatment. We report on nine patients who were followed longitudinally with serial neurologic examinations since transplantation. RESULTS: Clinically, all patients evaluated for neurologic progression reported significant improvement in general well being. No patient showed any progression in neurologic disease since receiving a liver transplant. Improvements are documented in symptomatic, autonomic, and sensorimotor neurologic disease in all patients. CONCLUSION: Our experience suggests that liver transplantation may offer hope for arrest of progression and neurologic improvement in patients with FAP.

Alpha Interferon in AIDS-Related Progressive Multifocal Leukoencephalopathy.

OBJECTIVE: To determine the efficacy of recombinant interferon alpha in the treatment of progressive multifocal leukoencephalopathy associated with the acquired immunodeficiency syndrome (AIDS). DESIGN: Open label, uncontrolled study. SETTING: Neurological unit and clinical AIDS program, Boston City Hospital, Boston, MA. PATIENTS: Four consecutive AIDS patients with pathologically confirmed progressive multifocal leukoencephalopathy. INTERVENTION: Each patient received alpha interferon for 4-12 weeks in a dose of 5-10 million units daily, administered subcutaneously. In addition, two of the four were taking acyclovir 2400 mg/day orally over the same period. RESULTS: None of the patients showed any clinical response to the therapy; the mean survival was 14 weeks. No adverse effects of the treatment were encountered. CONCLUSIONS: Despite anecdotal evidence that alpha interferon is effective in the treatment of progressive multifocal leukoencephalo pathy in non-AIDS patients, the experience of these patients suggests that the drug is of no benefit in AIDS-related PML.

Seasonal and tissue variation in taxane concentrations of Taxus brevifolia.

Analysis of seven taxanes: taxol, baccatin III, 10-deacetyltaxol, 10-deacetylbaccatin III, 7-xylosyl-10-deacetyltaxol, cephalomannine and brevifoliol in extracts from bark and foliage of pacific yew (Taxus brevifolia) showed a gradient of decreasing concentration from stem base to branch tip. This decrease is attributed to the generally higher concentration of taxanes in the phloem tissue and the decrease in inner bark thickness from base to branch tip. Analysis of taxanes extracted from stem bark and needles sampled over a growing season showed that most taxane concentrations were significantly lower in the needles than in the bark. Typically, taxane concentrations in bark increased from May through August; whereas, in needles, concentrations changed little during that period. Two exceptions were baccatin III, which in the summer reached levels equivalent to bark, and brevifoliol which increased from March to August, reaching levels in needles nine times greater than bark.

Lateral ventricular size and social network differentiation in young, nonchronic schizophrenic patients.

The authors correlated lateral cerebral ventricular size with social network differentiation and social outcome in 15 young, nonchronic patients with schizophrenia and schizophreniform disorder. Patients with fewer social contexts, fewer types of relationships, and less independent residence had larger ventricles.

Classification of peripheral neuropathy: the long and the short of it.

Insights into how the nervous system functions have often sprung from knowledge of the localization of nervous system diseases. Indeed, the recent rebirth of behavioral neurology has been sparked by new insights into the topography of higher cortical functions. Yet, the localization of disease affecting the peripheral nervous system is simply assumed to be a by-product of the beginning course in gross anatomy! Indeed, the anatomic sophistication laid out by Sunderland and reflected in the daily practice of electromyography might cause doubt as to the need for further inquiry into the problem of localization of disease within peripheral nervous system. There are, however, numerous problems in clinical practice that do not yield to the traditional root-plexus-nerve analysis of localization.

Temporal arteritis-like presentation of carotid atherosclerosis.

A 68 year-old woman presented with a two-week history of amaurosis fugax, ipsilateral fronto-temporal headache and jaw claudication suggesting carotid giant cell arteritis. However, this syndrome proved to be due to atherosclerosis causing complete occlusion of the external carotid artery at its origin and narrowing of the internal carotid artery. Combined external and internal carotid endarterectomy relieved the symptoms. The symptom complex of temporal arteritis may be rarely mimicked by carotid atherosclerotic occlusive disease.

Universal dissociated anesthesia due to bilateral brain-stem infarcts.

A 59-year-old man had loss of pin-prick and temperature sensation over his head, face, neck, trunk, and all extremities while light touch, vibration, joint position sense, and deep pain were preserved. This was the cumulative result of infarctions in the territories of the right superior cerebellar and left posterior inferior cerebellar arteries that occurred three years apart. To our knowledge, a syndrome of bilateral discrete interruption of spinothalamic tracts and of the spinal tracts of the trigeminal system in the brain stem has not been reported. Dissociated sensory loss enveloping the entire body accompanied by truncal and limb ataxia without weakness demonstrated a striking clinical picture. The preservation of deep somatic and visceral pain when cutaneous pain sensation was lost was another notable feature. We review the causes of widespread dissociated sensory loss and discuss the implications of the dissociation of deep from superficial pain.