Shelf-ocean exchange and hydrography west of the Antarctic Peninsula: a review.

The West Antarctic Peninsula (WAP) is a highly productive marine ecosystem where extended periods of change have been observed in the form of glacier retreat, reduction of sea-ice cover and shifts in marine populations, among others. The physical environment on the shelf is known to be strongly influenced by the Antarctic Circumpolar Current flowing along the shelf slope and carrying warm, nutrient-rich water, by cold waters flooding into the northern Bransfield Strait from the Weddell Sea, by an extensive network of glaciers and ice shelves, and by strong seasonal to inter-annual variability in sea-ice formation and air-sea interactions, with significant modulation by climate modes like El Niño-Southern Oscillation and the Southern Annular Mode. However, significant gaps have remained in understanding the exchange processes between the open ocean and the shelf, the pathways and fate of oceanic water intrusions, the shelf heat and salt budgets, and the long-term evolution of the shelf properties and circulation. Here, we review how recent advances in long-term monitoring programmes, process studies and newly developed numerical models have helped bridge these gaps and set future research challenges for the WAP system.This article is part of the theme issue 'The marine system of the West Antarctic Peninsula: status and strategy for progress in a region of rapid change'.

Antiretroviral regimens in pregnancy and breast-feeding in Botswana.

BACKGROUND: The most effective highly active antiretroviral therapy (HAART) to prevent mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) in pregnancy and its efficacy during breast-feeding are unknown. METHODS: We randomly assigned 560 HIV-1-infected pregnant women (CD4+ count, > or = 200 cells per cubic millimeter) to receive coformulated abacavir, zidovudine, and lamivudine (the nucleoside reverse-transcriptase inhibitor [NRTI] group) or lopinavir-ritonavir plus zidovudine-lamivudine (the protease-inhibitor group) from 26 to 34 weeks' gestation through planned weaning by 6 months post partum. A total of 170 women with CD4+ counts of less than 200 cells per cubic millimeter received nevirapine plus zidovudine-lamivudine (the observational group). Infants received single-dose nevirapine and 4 weeks of zidovudine. RESULTS: The rate of virologic suppression to less than 400 copies per milliliter was high and did not differ significantly among the three groups at delivery (96% in the NRTI group, 93% in the protease-inhibitor group, and 94% in the observational group) or throughout the breast-feeding period (92% in the NRTI group, 93% in the protease-inhibitor group, and 95% in the observational group). By 6 months of age, 8 of 709 live-born infants (1.1%) were infected (95% confidence interval [CI], 0.5 to 2.2): 6 were infected in utero (4 in the NRTI group, 1 in the protease-inhibitor group, and 1 in the observational group), and 2 were infected during the breast-feeding period (in the NRTI group). Treatment-limiting adverse events occurred in 2% of women in the NRTI group, 2% of women in the protease-inhibitor group, and 11% of women in the observational group. CONCLUSIONS: All regimens of HAART from pregnancy through 6 months post partum resulted in high rates of virologic suppression, with an overall rate of mother-to-child transmission of 1.1%. (ClinicalTrials.gov number, NCT00270296.)

Durability of botulinum toxin treatment for axillary hyperhidrosis.

OBJECTIVES: Botulinum toxin injection effectively treats axillary hyperhidrosis. Durability estimates of 3-14 months, based on self re-referral may overestimate duration. Our objective was to determine treatment durability by active follow-up of patients. DESIGN: Audit of current practice. MATERIALS AND METHODS: Patients presenting with severe primary axillary hyperhidrosis were actively followed up for 24 months after intradermal injections of Botulinum Toxin A (Dysport 120 units/axilla). A 10-point Likert Scale (1=worst imaginable symptoms, 10=absolute resolution) and the Hyperhidrosis Disease Severity Score (HDSS) were used at 1 day and 3, 6, 12 and 24 months. We offered re-treatment when symptoms returned to the pre-intervention state. RESULTS: We treated 45 patients with a mean age of 29 (15-49) years of whom 36 (78%) were women. The median pre-treatment Likert score (i.q.r.) of 3 (2-3) improved to 10 (10-10) on day 1. Scores at 3 (n=44), 6 (n=43) and 12 (n=39) months were 10 (10-10), 8 (7.5-10), and 7 (5-8) respectively. The median 24-month score was 3 (3-6) for 35 patients, including 11 patients with scores >/=6 who have not required re-treatment. HDSS scores followed a similar pattern. CONCLUSIONS: Axillary botulinum toxin treatment is durable. Patients experience gradual return of symptoms between 6 and 24 months. A minority do not require re-treatment at this time.

An assessment of persistent organic pollutants (POPs) in wild and rope grown blue mussels (Mytilius edulis) from Scottish coastal waters.

Farmed, rope grown mussels (Loch Etive and Loch Ewe, both on the west coast of Scotland) and wild mussels (Straad on the west coast and Shell Bay and Aberdeen Breakwater, both on the east coast of Scotland) were collected on a monthly basis and analysed for persistent organic pollutants (POPs) with the aim of assessing the status of Scottish mussels, with respect to concentrations of POPs, and investigating site-specific and seasonal differences. Samples were analysed for polycyclic aromatic hydrocarbons (PAHs), polybrominated diphenyl ethers (PBDEs) and chlorobiphenyls (CBs). Total PAH (2- to 6-ring parent and alkylated) concentrations in mussels from three pristine sites (ref. 1: ICES Marine Chemistry Working Group Report 2008, http://www.ices.dk/reports/MHC/2007/MCWG07.pdf) (Loch Etive, Loch Ewe and Straad) were significantly lower than in mussels from sites with greater coastal influences (Aberdeen Breakwater and Shell Bay). Seasonal trends in the PAH concentrations were evident at the pristine sites, with concentrations being significantly higher for samples collected between November and March compared to those collected between April and October. The PAH data was assessed using a recently proposed traffic light system, based on the assessment criteria adopted by OSPAR for use in the 2008 Coordinated Environmental Monitoring Programme (CEMP) assessment. Concentrations were compared to Background Assessment Concentrations (BAC; blue/green transition) and Environmental Assessment Concentrations (EACs; green/red transition). All sites were classed as 'green' for the PAHs analysed, being below EACs, where available. The pristine sites were also below BACs for some PAHs and therefore would be classed as 'blue' for these PAHs. CBs and PBDEs were measured in mussels collected between 2006 and 2008 inclusive. Concentrations for CB and PBDEs were significantly higher in the Aberdeen Breakwater mussels than for all other sites. Concentrations at all sites were low with many congeners being below the detection limits for both contaminant groups. No seasonal trends were observed in the CBs or PBDE concentrations or composition at any of the five sites. The green-red transition (described by the EACpassive) was exceeded for CB118 in mussels from Aberdeen Breakwater and surprisingly at the pristine site of Loch Etive. As such both sites were classed as 'red'. All other ICES7 CBs were below EACs and therefore classed as 'blue' or 'green'.

Bioaccumulation of persistent organic pollutants in female common dolphins (Delphinus delphis) and harbour porpoises (Phocoena phocoena) from western European seas: geographical trends, causal factors and effects on reproduction and mortality.

Concentrations of polychlorinated biphenyls (PCBs) in blubber of female common dolphins and harbour porpoises from the Atlantic coast of Europe were frequently above the threshold at which effects on reproduction could be expected, in 40% and 47% of cases respectively. This rose to 74% for porpoises from the southern North Sea. PCB concentrations were also high in southern North Sea fish. The average pregnancy rate recorded in porpoises (42%) in the study area was lower than in the western Atlantic but that in common dolphins (25%) was similar to that of the western Atlantic population. Porpoises that died from disease or parasitic infection had higher concentrations of persistent organic pollutants (POPs) than animals dying from other causes. Few of the common dolphins sampled had died from disease or parasitic infection. POP profiles in common dolphin blubber were related to individual feeding history while those in porpoises were more strongly related to condition.

Application of SSH and a macroarray to investigate altered gene expression in Mytilus edulis in response to exposure to benzo[a]pyrene.

The lack of genomic resources for aquatic invertebrates restricts their use as sentinel species in coastal environments. It is known that where genomic data are not available, suppression subtractive hybridisation (SSH) can generate cDNA libraries representative of pollutant-responsive gene transcription in aquatic vertebrates. To assess whether the approach was equally suited to aquatic invertebrates, altered gene expression in digestive gland of the mussel, Mytilus edulis, in response to exposure to benzo[a]pyrene (BaP) (1 mg/l) was investigated with SSH and a nylon macroarray. Screening of the subtracted libraries showed 112/250 up-regulated and 25/55 down-regulated clones were positive for differential expression and characterisation of these identified 87 with unique sequence suitable for array on a nylon membrane. The transcripts isolated were from a diverse range of genes involved in general stress, oxidative stress, cell adhesion, transcriptional and translational regulation, transport mechanisms, energy metabolism, cell metabolism, lipid metabolism, protein turnover and activation, lysosomal activity and 22 cryptic clones. Subsequent use of the clones in macroarray format to analyse expression of BaP-responsive genes (0 vs 4 day exposed) showed 0-100-fold increased levels of the forward-subtracted probes and between 0 and 0.1-fold down-regulation of the reverse-subtracted probes. Only 15% of the clones showed less than 2-fold change in expression. The gene ontology of the transcripts isolated demonstrates that BaP elicits a multitude of responses with a major feature being disruption of cellular redox status. The results indicate that the use of SSH and a macroarray is a robust method to discover novel pollutant-responsive genes in aquatic invertebrates.

Diaphragm disease: the limitation of laparoscopy and assessment of the small bowel for strictures using a ball bearing.

Diaphragm disease is a rare cause of intestinal obstruction that will be seen with increasing frequency with the widespread use of nonsteroidal anti-inflammatory drugs (NSAIDs). We present a case study of a patient with diaphragm disease where the diagnosis was not apparent at laparoscopy, and passage of a steel ball through the small intestine was required to identify all strictures present. A high index of suspicion, recognition of the limitations of conventional diagnostic aids, and the need to assess the full length of the small bowel are all important in the surgical management of this condition.

The effects of oil exploration and production in the Fladen Ground: composition and concentration of hydrocarbons in sediment samples collected during 2001 and their comparison with sediment samples collected in 1989.

Due to the potentially accumulative nature of the Fladen Ground, an area of intense oil activity in the North Sea, a survey was carried out in 1989 to map the distribution of contamination in relation to these oil activities. All the sediments collected were screened by ultraviolet fluorescence (UVF) for polycyclic aromatic hydrocarbons (PAHs) and selected samples were analysed for n-alkanes (by GC-FID), PAHs and biomarkers (by GC-MSD). This survey was repeated in 2001, with all the 1989 sites being resampled. All of these sediments were analysed for UVF oil equivalents, PAHs, n-alkanes and biomarkers. The concentrations of these parameters decreased between 1989 and 2001, with average decreases ranging from 43% to 88%. In addition, no significant difference was found, for all the parameters, between near field (<5 km from an oil installation) and far field (>5 km from an oil installation) sites in 2001 indicating that the Fladen Ground is approaching a 'steady state' or background concentration for contamination.

Cellular immune findings in Lyme disease. Correlation with serum IgM and disease activity.

Cellular immune findings were studied in 48 patients with various stages of Lyme disease. At each stage, some patients, particularly those with neuritis or carditis, had elevated serum IgM levels and lymphopenia. During early disease, mononuclear cells tended to respond normally to phytohemagglutinin, and spontaneous suppressor cell activity was greater than normal. Later, during active neuritis, carditis, or arthritis, the trend was toward heightened phytohemagglutinin responsiveness and less suppression than normal. By multiple regression analysis, serum IgM levels correlated directly with disease activity (p = 0.025) and inversely with the number of T cells (p = 0.02); during acute disease only, elevated IgM levels correlated with increased phytohemagglutinin responsiveness (p = 0.004) and decreased suppressor cell activity (p = 0.03). Decreased suppression, observed later in the disease, may permit damage to host tissues because of either autoimmune phenomena or a heightened response to the Lyme spirochete.

Dietary intake and tissue concentration of fatty acids in omnivore, vegetarian and diabetic pregnancy.

The aim of this study was to determine the effect of fatty acid intake and insulin dependent diabetes on the fatty acid composition of maternal erythrocytes, the placenta and cord. Fatty acid intake (from food frequency questionnaire) and the fatty acid composition of maternal erythrocytes, the placenta and cord from pregnant vegetarians (n = 4) and insulin dependent diabetics (n = 5) was compared with pregnant omnivores (n = 10). There was a significantly lower intake of n-6 long chain polyunsaturated fatty acid (LCPUFA) (-75% P < 0.01) and n-3 LCPUFA (-92% P < 0.01) and increased ratio of n-6/n-3 LCPUFA in the vegetarians (103%; P < 0.001). The concentrations of 22:4 n-6 (+28%; P < 0.05) and 22:5 n-3 (+40%; P < 0.05) were higher in vegetarian erythrocytes. Placental 18:2 n-6 (+26.9%; P < 0.05) 18:3 n-3 (+139%; P < 0.05) and 22:5 n-3 (+24%; P < 0.05) were increased while 20:5 n-3 (-36%; P < 0.05), 22:6 n-3 (-16%; P = 0.059), and the ratios of 20:4 n-6/18:2 n-6 (P < 0.01) and 22:6 n-3/18:3 n-3 were reduced. 22:6 n-6 (-49%; P < 0.05) and total n-3 LCPUFA (-11%; P < 0.01) were reduced in vegetarian cord. For the diabetic mothers, all of the n-6 LCPUFA and n-3 LCPUFA were reduced in the maternal erythrocytes; 22:4 n-6 (-42%; P < 0.05), 22:5 n-6 (-46%; P < 0.05) and 22:6 n-3 (-41%; P < 0.05). For the diabetic placenta and cord the general pattern of n-3 LCPUFA was the same as that in the vegetarians. In the vegetarian mothers, the PUFA profiles in the maternal erythrocytes, placenta and cord are consistent with an elevation in the rate of LCPUFA synthesis in order to make up the relative deficit in LCPUFA intake. However, it may be that the higher level of desaturase activity is not able to overcome the dietary deficit of 22-6 n-3 and 22:6 n-6. Despite the fact that the dietary LCPUFA intake in the pregnant diabetic was comparable with that in the pregnant 'normal' omnivore mothers, the pattern of PUFA in the tissues resembled that of the vegetarian mothers.

A study of the composition of fish liver and body oil triglycerides.

Silver-ion high-performance liquid chromatography (Ag(+)-HPLC) was used to study the range and variations in molecular species of triglycerides from industrial, retail and laboratory extracted fish oils. These were contrasted with a typical plant oil. Selected fish oils were fractionated and the fatty acid distribution of the fractions determined by gas-liquid chromatography. Fish oils gave a characteristic Ag(+)-HPLC profile, typified by sharp, intense peaks at the start of the chromatogram and broad, multiple nongaussian peaks for the late eluting components. Triglycerides ranging from those that were wholly saturated to those containing 16 double bonds were isolated. Cod (Gadus spp.), saithe (Pollachius virens) and monkfish (Squatina squatina) liver oils gave similar triglyceride profiles. Mackerel (Scomber scombrus), capelin (Mallotus villosus) and herring (Clupea harengus) body oils gave characteristic triglyceride profiles which were associated with high concentrations of 20:1 and 22:1 fatty acids. Only small amounts of these particular triglycerides were observed for menhaden (Brevoortia spp.), South African anchovy (Engraulis capensis) and Indian sardine (Sardinella longiceps) oils, all of which contained minor amounts of these acids. The latter oils contained highly unsaturated triglycerides, whereas only traces of these were noted for the former. Chromatography with Ag(+)-HPLC can be used for the rapid screening of fish oils and for selecting those oils rich in polyunsaturated acids that may be suitable for enrichment. Cottonseed oil gave well-defined and discrete peaks. Similar peaks were observed in the chromatogram of Omega-combination, a mixture of primrose and fish oils. Thus, fish, plant and a mixture of these oils can be readily distinguished.

Implications from a field study regarding the relationship between polycyclic aromatic hydrocarbons and glutathione S-transferase activity in mussels.

An aluminium smelter on the west coast of Scotland discharges an aqueous effluent containing polycyclic aromatic hydrocarbons (PAHs) at the head of Loch Leven. The loch also supports two mussel (Mytilus edulis) farms. Data are presented on burdens of PAHs in the soft tissues of mussels and the effect of these contaminants on glutathione S-transferase (GST) activity in mussel hepatopancreas. GST activity is shown to be correlated with total PAH burden and also with the concentrations of certain individual PAHs. These field data show that high molecular weight PAHs are closely correlated to GST activity, whereas low molecular weight PAHs are not. This suggests that 5- and 6-ring PAHs have a more pronounced role than 2- to 4-ring compounds in inducing GST activity in mussels from Loch Leven. It is proposed that it may be more appropriate to link GST activity with 5- and 6-ring compounds only, rather than with the total PAH burden.

Can foam sclerotherapy be used to safely treat bilateral varicose veins?

OBJECTIVE: We assessed the use of ultrasound guided foam sclerotherapy (UGFS) to treat bilateral varicose veins either as synchronous or interval procedures. We specifically assessed total foam volume usage and its influence on early outcome and complications. METHODS: We reviewed our prospectively compiled computerised database of patients with bilateral varicose veins who have undergone UGFS. Duplex findings, foam volumes used and clinical outcome were assessed. RESULTS: One hundred and twelve patients had undergone UGFS for bilateral varicose veins. Sixty-one had bilateral UGFS (122 legs) and 51 had interval UGFS (102 legs). Seventy-eight percent bilateral and 60% interval procedures were for single trunk disease. Median foam volumes per treatment episode were: 17.5 mls bilateral, and 10 mls interval FS. At two weeks 81% of legs had complete occlusion after bilateral UGFS compared to 70% after interval UGFS. One patient in the bilateral UGFS developed transient visual disturbance. There was no systemic complications in the interval UGFS. CONCLUSIONS: Bilateral foam sclerotherapy treatment did not adversly affect vein occlusion rates and there was no significant difference in complication rates between the two groups. Bilateral UGFS can be safely performed in selected patient presenting with bilateral varicose veins.

Chronic edema of the lower extremities: international consensus recommendations for compression therapy clinical research trials.

Chronic edema is a multifactorial condition affecting patients with various diseases. Although the pathophysiology of edema varies, compression therapy is a basic tenant of treatment, vital to reducing swelling. Clinical trials are disparate or lacking regarding specific protocols and application recommendations for compression materials and methodology to enable optimal efficacy. Compression therapy is a basic treatment modality for chronic leg edema; however, the evidence base for the optimal application, duration and intensity of compression therapy is lacking. The aim of this document was to present the proceedings of a day-long international expert consensus group meeting that examined the current state of the science for the use of compression therapy in chronic edema. An expert consensus group met in Brighton, UK, in March 2010 to examine the current state of the science for compression therapy in chronic edema of the lower extremities. Panel discussions and open space discussions examined the current literature, clinical practice patterns, common materials and emerging technologies for the management of chronic edema. This document outlines a proposed clinical research agenda focusing on compression therapy in chronic edema. Future trials comparing different compression devices, materials, pressures and parameters for application are needed to enhance the evidence base for optimal chronic oedema management. Important outcomes measures and methods of pressure and oedema quantification are outlined. Future trials are encouraged to optimize compression therapy in chronic edema of the lower extremities.

Preliminary assessment of polybrominated diphenyl ethers (PBDEs) in the Scottish aquatic environment, including the Firth of Clyde.

This paper presents preliminary data on polybrominated diphenyl ethers (PBDEs) in the Scottish aquatic environment. Sediment and biota (fish liver, fish muscle and mussels) from a number of locations around Scotland were analysed for PBDEs with samples being from both remote and from potentially contaminated areas such as the former sewage sludge dump site at Garroch Head in the Clyde. PBDEs were measured in both cultivated, rope grown mussels and wild mussels collected from 5 sites around Scotland in 2006. Total PBDE concentrations (sum of tri- to hepta-BDEs) ranged from

Composition and concentration of hydrocarbons in sediment samples from the oil producing area of the East Shetland Basin, Scotland.

The East Shetland Basin is one of the areas that the Fisheries Research Services (FRS) has concentrated on to assess the possible impacts of oil exploration and production on the marine environment. A stratified random survey of the sediment was carried out in 2002. TOCs were low across the basin and were positively correlated with grain size. The total PAH concentrations (2- to 6-ring parent and alkylated PAHs, including the 16 US EPA PAHs) were less than 150 microg kg(-1) dry weight and their composition indicated a predominantly pyrolytic input to the basin in 2002. Minor unresolved complex mixtures in the n-alkane profiles indicated a slight petrogenic input but further examination of the biomarkers (hopanes and steranes) showed a mixed North Sea and Middle Eastern source. The Middle Eastern source is likely due to inputs from shipping activity, as it is widely used as bunker fuel. Grid surveys were carried out in 1986, 1988-89 and 1994 and areas were selected for which there was data for all the historic grid surveys and the 2002 stratified random survey. Although referring to only a small part of the East Shetland Basin, comparison with these historic surveys shows clearly that the concentrations of Forties crude oil equivalents and total PAH concentrations were highest in 1988-89 and by 2002 had returned to concentrations the same as or less than observed in the original survey in 1986.