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Abstract In the latest ESUR contrast media guidelines, standard prophylaxis is no longer recommended for patients with moderate chronic kidney disease (CKD). In the absence of solid evidence, guideline updates are often based on indirect evidence and expert opinion. Likewise, evidence supporting the withdrawal of standard prophylaxis in moderate CKD patients was scarce and mostly indirect, but did include one randomised controlled trial evaluating guideline-recommended standard prophylactic intravenous hydration against a group receiving no prophylaxis (A MAastricht Contrast-Induced Nephropathy Guideline (AMACING) trial). Since then, benefits of the updated guideline recommendation for patient and hospital burden have been numerated and were shown to be substantial. The current special report provides data on long-term safety from the AMACING randomised controlled trial. Key Points • In the latest version of ESUR clinical practice guidelines for safe use of contrast media, standard prophylaxis is no longer recommended for patients with moderate chronic kidney disease. • Benefits of this change in recommendations for patient and hospital burden have been numerated. The current report provides data on long-term safety from the AMACING randomised controlled trial. • No disadvantage of withholding prophylaxis could be discerned. Results suggest that, in this population, underlying disease is more relevant for survival and prognosis than contrast administration itself.

Drought and salt exposure are among the most prevalent and severe abiotic stressors causing serious agricultural yield losses, alone and in combination. Little is known about differences and similarities in the effects of these two stress factors on plant metabolic regulation, particularly on nitrogen metabolism. Here, we studied the effects of water deprivation and salt exposure on water relations and nitrogen metabolites in leaves and roots of date palm seedlings. Both, water deprivation and salt exposure had no significant effects on plant water content or stable carbon (C) and nitrogen (N) isotope signatures. Significant effects of water deprivation on total C and N concentrations were only observed in roots, i.e., decreased total C and increased total N concentrations. Whereas salt exposure initially decreased total C and increased total N concentrations significantly in roots, foliar total C concentration was increased upon prolonged exposure. Initially C/N ratios declined in roots of plants from both treatments and upon prolonged salt exposure also in the leaves. Neither treatment affected soluble protein and structural N concentrations in leaves or roots, but resulted in the accumulation of most amino acids, except for glutamate and tryptophan, which remained stable, and serine, which decreased, in roots. Accumulation of the most abundant amino acids, lysine and proline, was observed in roots under both treatments, but in leaves only upon salt exposure. This finding indicates a similar role of these amino acids as compatible solutes in the roots in response to salt und drought, but not in the leaves. Upon prolonged treatment, amino acid concentrations returned to levels found in unstressed plants in leaves of water deprived, but not salt exposed, plants. The present results show both water deprivation and salt exposure strongly impact N metabolism of date palm seedlings, but in a different manner in leaves and roots.

Background Post-stroke heart rate (HR) and heart rate variability (HRV) changes have been proposed as outcome predictors after stroke. We used data lake-enabled continuous electrocardiograms to assess post-stroke HR and HRV, and to determine the utility of HR and HRV to improve machine learning-based predictions of stroke outcome. Methods In this observational cohort study, we included stroke patients admitted to two stroke units in Berlin, Germany, between October 2020 and December 2021 with final diagnosis of acute ischemic stroke or acute intracranial hemorrhage and collected continuous ECG data through data warehousing. We created circadian profiles of several continuously recorded ECG parameters including HR and HRV parameters. The pre-defined primary outcome was short-term unfavorable functional outcome after stroke indicated through modified Rankin Scale (mRS) score of > 2. Results We included 625 stroke patients, 287 stroke patients remained after matching for age and National Institute of Health Stroke Scale (NIHSS; mean age 74.5 years, 45.6% female, 88.9% ischemic, median NIHSS 5). Both higher HR and nocturnal non-dipping of HR were associated with unfavorable functional outcome (p Conclusions Our data suggest that a lack of circadian HR modulation, specifically nocturnal non-dipping, is associated with short-term unfavorable functional outcome after stroke, and that including HR into machine learning-based prediction models may lead to improved stroke outcome prediction.

ObjectivesDuring the COVID-19 pandemic, the staff in the intensive care unit (ICU) was materially, physically and emotionally challenged. This qualitative study investigated the effects that ICU staff experienced and were considered of value to be permanently implemented.SettingICU in an university medical centre during the first wave of the COVID-19 pandemic.DesignAn opportunity-centric approach was applied in individual semi-structured interviews to optimise the achieved results and was guided by the theoretical model of appreciative inquiry (AI).ParticipantsFifteen ICU staff members (8 nurses and 7 intensivists) participated.ResultsWorking during the COVID-19 pandemic catalysed interprofessional collaboration and team learning in the ICU on an individual and team level, centred around a common goal: taking care of critically ill patients with COVID-19. The effect of interprofessional collaboration was that provisions were taken care of quicker than usual, without bureaucratic delays. However, this effect was experienced to be transient. Also, ICU staff perceived limited possibilities to help patients and families around the palliative phase, and they perceived a lack of appreciation from higher management. This is a point of future attention: how to make this perceived lack of appreciation more visible to all (ICU) staff.ConclusionRegarding our primary question, the ICU staff voiced that the direct communication and collaboration are the most important elements of the COVID-19 peak they would like to preserve. Furthermore, it was learnt that consolation and support for family members should not be forgotten. Considering the results, we believe that further research concerning team reflexivity might contribute to (or enhance) our knowledge about working together during and after a crisis.

Background The cactus family (Cactaceae) has been reported to have evolved a minimal photosynthetic plastome size, with the loss of inverted-repeat (IR) regions and NDH gene suites. However, there are very limited genomic data on the family, especially Cereoideae, the largest subfamily of cacti. Results In the present study, we assembled and annotated 35 plastomes, 33 of which were representatives of Cereoideae, alongside 2 previously published plastomes. We analyzed the organelle genomes of 35 genera in the subfamily. These plastomes have variations rarely observed in those of other angiosperms, including size differences (with ~ 30 kb between the shortest and longest), dramatic dynamic changes in IR boundaries, frequent plastome inversions, and rearrangements. These results suggested that cacti have the most complex plastome evolution among angiosperms. Conclusion These results provide unique insight into the dynamic evolutionary history of Cereoideae plastomes and refine current knowledge of the relationships within the subfamily.

Background Cerebral microbleeds (CMBs) are increasingly recognized as “covert” brain lesions indicating increased risk of future neurological events. However, data on CMBs in patients undergoing catheter‐based structural heart interventions are scarce. Therefore, we assessed occurrence and predictors of new CMBs in patients undergoing catheter‐based left atrial appendage closure and percutaneous mitral valve repair using the MitraClip System. Methods and Results We conducted an exploratory analysis using data derived from 2 prospective, observational studies. Eligible patients underwent cerebral magnetic resonance imaging (3 Tesla) examinations and cognitive tests (using the Montreal Cognitive Assessment) before and after catheter‐based left atrial appendage closure and percutaneous mitral valve repair. Forty‐seven patients (53% men; median age, 77 years) were included. New CMBs occurred in 17 of 47 patients (36%) following catheter‐based structural heart interventions. Occurrences of new CMBs did not differ significantly between patients undergoing catheter‐based left atrial appendage closure and percutaneous mitral valve repair (7/25 versus 10/22; P =0.348). In univariable analysis, longer procedure time was significantly associated with new CMBs. Adjustment for heparin attenuated this association (adjusted odds ratio [per 30 minutes]: 1.77 [95% CI, 0.92–3.83]; P =0.090). Conclusions New CMBs occur in approximately one‐third of patients after catheter‐based left atrial appendage closure and percutaneous mitral valve repair using the MitraClip System. Our data suggest that longer duration of the procedure may be a risk factor for new CMBs. Future studies in larger populations are needed to further investigate their clinical relevance. Clinical Trial Registration German Clinical Trials Register: DRKS00010300 ( https://drks.de/search/en/trial/DRKS00010300 ); ClinicalTrials.gov : NCT03104556 ( https://clinicaltrials.gov/ct2/show/NCT03104556?term=NCT03104556&draw=2&rank=1 ).

BackgroundMechanical thrombectomy (MT) is highly effective in large vessel occlusion (LVO) stroke. In north-east Germany, many rural hospitals do not have continuous neurological expertise onsite and secondary transport to MT capable comprehensive stroke centers (CSC) is necessary. In metropolitan areas, small hospitals often have neurology departments, but cannot perform MT. Thus, interhospital transport to CSCs is also required. Here, we compare time-to-care metrics and outcomes in patients receiving MT after interhospital transfer from primary stroke centers (PCSs) to CSCs in rural vs. metropolitan areas.MethodsPatients from ten rural telestroke centers (RTCs) and nine CSCs participated in this study under the quality assurance registry for thrombectomies of the Acute Neurological care in North-east Germany with TeleMedicine (ANNOTeM) telestroke network. For the metropolitan area, we included patients admitted to 13 hospitals without thrombectomy capabilities (metropolitan primary stroke centers, MPSCs) and transferred to two CSCs. We compared groups regarding baseline variables, time-to-care metrics, clinical, and technical outcomes.ResultsBetween October 2018 and June 2022, 50 patients were transferred from RTCs within the ANNOTeM network and 42 from MPSCs within the Berlin metropolitan area. RTC patients were older (77 vs. 72 yrs, p = 0.05) and had more severe strokes (NIHSS 17 vs. 10 pts., p < 0.01). In patients with intravenous thrombolysis (IVT; 34.0 and 40.5%, respectively), time from arrival at the primary stroke center to start of IVT was longer in RTCs (65 vs. 37 min, p < 0.01). However, RTC patients significantly quicker underwent groin puncture at CSCs (door-to-groin time: 42 vs. 60 min, p < 0.01). Despite longer transport distances from RTCs to CSCs (55 vs. 22 km, p < 0.001), there was no significant difference of times between arrival at the PSC and groin puncture (210 vs. 208 min, p = 0.96). In adjusted analyses, there was no significant difference in clinical and technical outcomes.ConclusionDespite considerable differences in the setting of stroke treatment in rural and metropolitan areas, overall time-to-care metrics were similar. Targets of process improvement should be door-to-needle times in RTCs, transfer organization, and door-to-groin times in CSCs wherever such process times are above best-practice models.

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Introduction: Cardiac biomarkers, such as high-sensitivity cardiac troponin T (hs-cTnT), are frequently elevated in ischemic stroke patients but the mechanisms underlying this elevation are insufficiently understood. We determined the presence of cardiac damage, assessed using cardiac magnetic resonance imaging (CMR), in stroke patients with elevated hs-cTnT and brain natriuretic peptide (BNP). Methods: This is a post hoc analysis of the prospective, investigator-initiated, cross-sectional HEart and BRain interfaces in Acute Stroke (HEBRAS) study. All patients underwent the measurement of hs-cTnT and BNP as well as gadolinium-enhanced CMR in the acute phase of ischemic stroke. We performed unadjusted and adjusted logistic regression models to assess the association between hs-cTnT and BNP elevation and the presence of pathological CMR findings. Results: Two hundred and thirty-three stroke patients (median age 67 years, 33% female) were included, of whom 43 (21%) had elevated hs-cTnT and 109 (47%) had elevated BNP. Hundred of the 233 (43%) patients had pathological findings on CMR had focal fibrosis as detected by late-gadolinium enhancement (LGE) in 51 (23%), left-ventricular hypertrophy (LVH) in 38 (16%), reduced LVEF in 32 (14%), and left-atrial dilatation in 34 (15%). After adjustment for potential confounders, both hs-cTnT (adjOR 5.0 (95%CI 2.1–11.7), p Conclusion: Elevated cardiac biomarkers in acute stroke including CMR are strongly associated with pathological findings on CMR. In acute stroke patients, the elevation of cardiac biomarkers may identify patients who require a more thorough cardiology work-up.

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Key message Sessile oak leaves showed a high degree of plasticity to atmospheric and pedospheric conditions. Abstract The aim of the present study was to elucidate the significance of current weather conditions for foliar traits of adult sessile oak (Quercus petraea), one of the most valuable forest tree species in Central Europe. For this purpose, structural and functional traits were analysed in fully expanded, sun exposed leaves collected in south-west Germany from five old-growth forest stands, representing the meteorological and pedospheric conditions in the growing region, but differing in aridity during the 12 days before harvest in two consecutive years. Across the forest stands, most foliar traits differed significantly between wet and dry weather conditions before harvest as indicated by partial least square discriminant analysis (PLS-DA). These traits included fresh weight/dry weight ratio, leaf hydration, leaf-C content, leaf-C/N ratio, structural N, soluble protein-N, total amino acid-N, cell wall composition, numerous specific amino acids as well as soluble sugar content. Structural biomass, δ13C signature, total N and total C as well as H2O2 contents were not affected by the weather before harvest. These results indicate a high plasticity of the foliar metabolism of drought-tolerant sessile oak to current weather conditions. They also suggest that sessile oak is characterized by a high potential to cope with the growth conditions expected as a consequence of future climate change.

Supplemental digital content is available in the text., Objective In this systematic review, we evaluate 2 of the most used trigger tools according to the criteria of the World Health Organization for evaluating methods. Methods We searched Embase, PubMed, and Cochrane databases for studies (2000–2017). Studies were included if medical record review (MRR) was performed with either the Global Trigger Tool or the Harvard Medical Practice Study in a hospital population. Quality assessment was performed in duplicate. Fifty studies were included, and results were reported for every criterion separately. Results Medical record review reveals more adverse events (AEs) than any other method. However, at the same time, it detects different AEs. The costs of an AE were on average €4296. Considerable efforts have been made worldwide in health care to improve safety and to reduce errors. These have resulted in some positive effects. The literature showed that MRR is focused on several domains of quality of care and seems suitable for both small and large cohorts. Furthermore, we found a moderate to substantial agreement for the presence of a trigger and a moderate to good agreement for the presence of an AE. Conclusions Medical record review with a trigger tool is a reasonably well-researched method for the evaluation of the medical records for AEs. However, looking at the World Health Organization criteria, much research is still lacking or of moderate quality. Especially for the cost of detecting AEs, valuable information is missing. Moreover, knowledge of how MRR changes quality and safety of care should be evaluated.

Aims Root exudates are known to shape microbial activities in the rhizosphere and to be of fundamental importance for plant-soil-microbe-carbon–nitrogen interactions. However, it remains unclear how and to what extent the amount and composition of root exudation affects rhizosphere denitrification. Methods In this study root exudation patterns and rhizosphere denitrification enzyme activity of three different grass species grown on two agricultural soils under two different soil water contents were investigated under controlled conditions. Results We found that root exudation of primary metabolites largely depends on plant species, soil type, soil moisture and root exudation medium. In dependence of soil properties and soil moisture levels, plants largely controlled amount and quality of root exudation. Exudates affected denitrification activity and plant–microbe competition for nitrate. Specifically, exudation of organic acids stimulated denitrifying activity while the sugar lyxose exhibited an inhibitory effect. Conclusion We show that interactive effects of physicochemical soil properties and species-specific effects of plant metabolism on root exudation act as a dominant control of rhizosphere denitrification, thereby explaining more than half of its variance.

To alleviate the enhanced frequency, duration, and intensity of drought as a consequence of global warming, admixing drought-sensitive European beech (Fagus sylvatica L.) with deep rooting silver fir (Abies alba Mill.) has been proposed. However, information on the performance of the admixtures of seedlings of these tree species at limited water availability has so far not been reported. In the present study, we investigated the significance of water deprivation in mixtures of beech and fir seedlings on the foliar relative water content (RWC), δ13C signature, total C and N contents, and C:N ratios of both species in a drought-rewetting cycle. Surprisingly, moderate drought triggered increased RWC in beech leaves and current year fir needles indicating drought hardening. The enhanced foliar RWC was preserved after rewatering in beech leaves, but not in current year fir needles. Drought did not significantly affect δ13C abundance in beech leaves, but enhanced the δ13C abundance (less negative values) in current and one-year old fir needles, indicating stomatal control in fir needles but not in beech leaves upon moderate drought. Total C contents of beech leaves were significantly increased upon drought and rewatering, but remained constant in fir needles. Foliar total N increased in both species upon drought and decreased upon rewatering. Accordingly, C:N ratios decreased in response to drought and recovered after rewatering. These results suggest that drought hardening may be achieved at least partially via osmotic adjustment by different compatible solutes in beech leaves and fir needles. No apparent effects of the number of neighbours were observed, although more fir neighbours tended to increase the RWC and total C contents of beech leaves. These results indicate that drought hardening in mixtures of beech and fir seedlings is largely independent of the number of interspecies neighbours.

BackgroundCervical artery dissection (CAD) is a rare cause of acute ischemic stroke (AIS) with large vessel occlusion (LVO) and may constitute a challenge for mechanical thrombectomy (MT). We compared procedural characteristics, reperfusion rates, and clinical outcome in AIS patients undergoing MT with and without CAD.MethodsWe performed a pre-specified analysis of patients registered within the German Stroke Registry, a prospectively maintained multicenter registry of consecutive patients with AIS patients treated by MT. Procedural characteristics included time periods and additional application of medication.ResultsOf 2589 patients, 62 (2.4%) were diagnosed with CAD. CAD patients were younger, had lower rates of known vascular risk factors and larger baseline stroke volumes. MT in CAD patients took significantly longer (median [IQR] groin-puncture-to-flow restoration time: 98 [67–136] versus 70 [45–100] minutes;p p p = 0.690) and favorable functional outcome after 3 months (modified Rankin Scale score ≤ 2: 70.9% versus 36.4%, adjustedp = 0.086) did not differ significantly between patients with and without CAD. The latter findings held true for both CAD in the anterior and posterior circulation.ConclusionCAD in AIS requiring MT is rare. MT in patients with CAD constitutes a particular procedural challenge, but still achieves favorable radiological and functional outcomes in most patients. Our data provide indirect evidence that MT is of clinical benefit in patients with AIS due to LVO and CAD.

Chronic ozone (O

Recent studies indicate that a multitude of microbial processes are involved in nitric oxide production and consumptions in the pedosphere. Due to its dual function as a toxic metabolite and signaling compound, we speculate that this pedospheric nitric oxide of microbial origin can significantly interact with mycorrhizal symbioses and symbiotic nitrogen fixation of legumes.

Despite tremendous improvement in molecular properties over the last century, intravascular injection of iodinated contrast material may still have systemic and hemodynamic consequences. Patients with pre-existing renal insufficiency may be at risk for acute kidney injury, which may be associated with an increased risk of the need for dialysis and mortality in the long term. Many questions as to the physiological pathways, optimal definition, and incidence of contrast-induced acute kidney injury remain open. These uncertainties are reflected in the changing landscape of this field in terms of nomenclature, research, and clinical practice. Clinical practice guidelines for the prevention of post-contrast acute kidney injury all recommend giving prophylaxis in the form of intravenous hydration to high-risk patients. Solid evidence for this strategy is lacking. This article gives an overview of the changing landscape of post-contrast acute kidney injury and prophylactic intravenous hydration, with the aim of supporting informed decision-making in clinical practice. Recent data have caused a shift in guideline recommendations: 90 % of patients formerly considered high-risk for contrast-induced acute kidney injury no longer qualify for prophylaxis. The remaining high-risk patients, with severe chronic kidney disease, represent a vulnerable population for whom intravenous hydration may provide some benefits but also carries risk. Intravenous hydration may benefit 'new' high-risk patients. However, it also confers risk. A dual approach to screening patients will help avoid this risk in clinical practice. · Intravenous hydration is the cornerstone for preventing contrast-induced acute kidney injury. · Solid evidence is lacking; recent data caused a shift in guideline recommendations. · Intravenous hydration may benefit 'new' high-risk patients with severe chronic kidney disease; however, it also confers risk. · A dual approach to screening patients will help avoid this risk in clinical practice.· Nijssen E, Rennenberg R, Nelemans P et al. Post-Contrast Acute Kidney Injury and Intravenous Prophylactic Hydration: An Update. Fortschr Röntgenstr 2021; 193: 151 - 159. Die intravaskuläre Applikation jodhaltiger Kontrastmittel kann, trotz kontinuierlicher Verbesserung ihrer pharmakologischen Eigenschaften, systemische bzw. hämodynamische Nebenwirkungen haben. Insbesondere Patienten mit eingeschränkter Nierenfunktion sind gefährdet. Ein akutes Nierenversagen im Nachgang einer intravaskulären Kontrastmittelgabe hat für betroffene Patienten im Langzeitverlauf ein erhöhtes Dialyse- und Mortalitätsrisiko. Weder ist der zugrunde liegende Pathomechanismus vollständig geklärt, noch ist die wirkliche Inzidenz eines akuten Nierenversagens im Rahmen einer kontrastmittelinduzierten Nephropathie bekannt. Diese Unsicherheiten spiegeln sich in vielen weiteren Aspekten wider: so fehlt beispielsweise eine allgemein verbindliche Definition und ist der Umgang in der klinischen Praxis uneinheitlich. Klinische Leitlinien zur Prävention einer kontrastmittelinduzierten Nierenschädigung empfehlen klassischerweise eine prophylaktische intravenöse Hydrierung von Hochrisikopatienten. In der vorliegenden Übersicht werden die gültigen Empfehlungen zur intravenösen Prophylaxe in diesem Kontext zusammengefasst und ein 2-stufiger Praxisleitfaden auf Basis der letzten Leitlinienempfehlungen vorgestellt. Jüngere Forschungsergebnisse haben zu einer weitreichenden Anpassung der klinischen Leitlinienempfehlungen geführt: 90 % der bis dato als Hochrisiko für kontrastmittelinduzierte Nephropathie eingestuften Patienten gehören nicht länger in diese Risikokategorie, eine diesbezügliche Prophylaxe vor Kontrastmittelgabe wird nicht mehr empfohlen. Für eine kleine Patientengruppe kann diese Prophylaxe sehr wohl hilfreich sein, unter sorgfältiger Abwägung im Rahmen einer Nutzen-Risiko-Analyse. Dies betrifft insbesondere Patienten mit chronischer Niereninsuffizienz im Stadium CKD 4 und 5. Intravenöse Hydratation kann einen positiven Effekt haben für Hochrisikopatienten gemäß der „neuen” Definition; eine Risikoabwägung bleibt notwendig. Ein 2-stufiger Screening-Ansatz bietet Hilfestellung für die praktische Implementierung in der Klinik. · Prophylaktische Prähydrierung ist ein wesentlicher Baustein, um eine kontrastmittelinduzierte Nephropathie zu vermeiden.. · Jüngere Publikationen haben zu einer Anpassung der gegenwärtigen Leitlinienempfehlungen beigetragen.. · Intravenöse Hydratation kann einen positiven Effekt haben für Hochrisikopatienten gemäß der „neuen” Definition; eine Risikoabwägung bleibt notwendig.. · Ein 2-stufiger Screening-Ansatz bietet Hilfestellung für die praktische Implementierung in der Klinik..

Background: Myocardial injury as indicated by elevation of cardiac troponin levels is common after acute ischemic stroke (AIS) and linked to poor outcomes. Previous studies rarely reported on serial hs-cTn measurements to distinguish whether myocardial injury is acute or chronic. Thus, little is known about frequency, associated variables, and outcome of acute myocardial injury in AIS. Methods and patients: In this single-centered observational cohort study, from 01/2019 to 12/2020, consecutive patients with neuroimaging-confirmed AIS ®, hs-cardiac troponin T) were prospectively registered. Acute myocardial injury was defined according to the fourth Universal Definition of Myocardial Infarction (troponin above the upper reference limit and rise/fall>20%). Outcomes of interest were in-hospital mortality and unfavorable functional status at discharge (modified Rankin Scale >1). Results: Out of 1067 analyzed patients, 25.3% had acute myocardial injury, 40.4% had chronic myocardial injury and 34.3% had no myocardial injury. Older age, higher stroke severity, thrombolytic treatment, and impaired kidney function were independently associated with acute myocardial injury. In-hospital mortality was higher in patients with acute myocardial injury than in those without (13% vs 3%, adjusted OR, 2.9% [95% CI, 1.6–5.5]). Compared with no myocardial injury, both acute and chronic myocardial injury were associated with unfavorable functional status at discharge (adjusted OR, 1.6 [95% CI, 1.1–2.5] and OR, 1.7 [95% CI, 1.2–2.4], respectively). Conclusions: A quarter of patients with AIS have evidence of acute myocardial injury according to the fourth Universal Definition of Myocardial Infarction. The strong association with in-hospital mortality highlights the need for clinical awareness and future studies on underlying mechanisms.

Selenium-binding proteins (SBPs) represent a ubiquitous protein family implicated in various environmental stress responses, although the exact molecular and physiological role of the SBP family remains elusive. In this work, we report the identification and characterization of CrSBD1, an SBP homolog from the model microalgae Chlamydomonas reinhardtii. Growth analysis of the C. reinhardtii sbd1 mutant strain revealed that the absence of a functional CrSBD1 resulted in increased growth under mild oxidative stress conditions, although cell viability rapidly declined at higher hydrogen peroxide (H2O2) concentrations. Furthermore, a combined global transcriptomic and metabolomic analysis indicated that the sbd1 mutant exhibited a dramatic quenching of the molecular and biochemical responses upon H2O2-induced oxidative stress when compared to the wild-type. Our results indicate that CrSBD1 represents a cell regulator, which is involved in the modulation of C. reinhardtii early responses to oxidative stress. We assert that CrSBD1 acts as a member of an extensive and conserved protein–protein interaction network including Fructose-bisphosphate aldolase 3, Cysteine endopeptidase 2, and Glutaredoxin 6 proteins, as indicated by yeast two-hybrid assays.

The paradigm that permafrost-affected soils show restricted mineral nitrogen (N) cycling in favor of organic N compounds is based on the observation that net N mineralization rates in these cold climates are negligible. However, we find here that this perception is wrong. By synthesizing published data on N cycling in the plant-soil-microbe system of permafrost ecosystems we show that gross ammonification and nitrification rates in active layers were of similar magnitude and showed a similar dependence on soil organic carbon (C) and total N concentrations as observed in temperate and tropical systems. Moreover, high protein depolymerization rates and only marginal effects of C:N stoichiometry on gross N turnover provided little evidence for N limitation. Instead, the rather short period when soils are not frozen is the single main factor limiting N turnover. High gross rates of mineral N cycling are thus facilitated by released protection of organic matter in active layers with nitrification gaining particular importance in N-rich soils, such as organic soils without vegetation. Our finding that permafrost-affected soils show vigorous N cycling activity is confirmed by the rich functional microbial community which can be found both in active and permafrost layers. The high rates of N cycling and soil N availability are supported by biological N fixation, while atmospheric N deposition in the Arctic still is marginal except for fire-affected areas. In line with high soil mineral N production, recent plant physiological research indicates a higher importance of mineral plant N nutrition than previously thought.Our synthesis shows that mineral N production and turnover rates in active layers of permafrost-affected soils do not generally differ from those observed in temperate or tropical soils. We therefore suggest to adjust the permafrost N cycle paradigm, assigning a generally important role to mineral N cycling. This new paradigm suggests larger permafrost N climate feedbacks than assumed previously.

Due to climate change, sessile oak (Quercus petraea) seedlings experience an increasing risk of drought during regeneration of forest stands by management practices. The present study was aimed at elucidating the potential of sessile oak seedlings originating from sites with different aridity and nitrogen (N) supply to acclimate to contrasting water availability. For this purpose, a free-air cross-exchange experiment was conducted between a dry and a humid forest stand with high and low soil N contents, respectively, during two consecutive years differing in aridity before harvest. Almost all structural and physiological foliar traits analyzed did not differ consistently between seed origins during both years, when cultivated at the same site. As an exception, the arid provenance upregulated foliar ascorbate contents under drought, whereas the humid provenance accumulated the phenolic antioxidants vescalagin and castalagin (VC) under favorable weather conditions and consumed VC upon drought. Apparently, differences in long-term aridity at the forest sites resulted in only few genetically fixed differences in foliar traits between the provenances. However, structural and physiological traits strongly responded to soil N contents and weather conditions before harvest. Foliar N contents and their partitioning were mostly determined by the differences in soil N availability at the sites, but still were modulated by weather conditions before harvest. In the first year, differences in aridity before harvest resulted in differences between most foliar traits. In the second year, when weather conditions at both sites were considerably similar and more arid compared to the first year, differences in foliar traits were almost negligible. This pattern was observed irrespective of seed origin. These results support the view that leaves of sessile oak seedlings generally possess a high plasticity to cope with extreme differences in aridity by immediate acclimation responses that are even better developed in plants of arid origin.

Objective Guidelines on safe use of iodinated contrast material recommend intravenous prophylactic hydration to prevent post-contrast adverse (renal) effects. Recently, guidelines have been updated and standard prophylaxis is no longer recommended for the majority of patients. The current study aims to evaluate the consequences for clinical practice of the updated guidelines in terms of complications, hospitalisations, and costs. Methods The Contrast-Induced Nephropathy After Reduction of the prophylaxis Threshold (CINART) project is a retrospective observational study. All elective procedures with intravascular iodinated contrast administration at Maastricht University Medical Centre (UMC+) in patients aged > 18 years, formerly eligible for prophylaxis (eGFR 30–44 ml/min/1.73 m2 or eGFR 45–59 ml/min/1.73 m2 in combination with diabetes or > 1 predefined risk factor), and currently eligible for prophylaxis (eGFR 2) were included. Data were used to calculate relative reductions in complications, hospitalisations, and costs associated with standard prophylactic intravenous hydration. CINART is registered with Clinicaltrials.gov: NCT03227835. Results Between July 1, 2017, and July 1, 2018, 1992 elective procedures with intravascular iodinated contrast in patients formerly and currently eligible for prophylaxis were identified: 1808 in patients formerly eligible for prophylaxis and 184 in patients currently eligible for prophylaxis. At Maastricht UMC+, guideline updates led to large relative reductions in numbers of complications of prophylaxis (e.g. symptomatic heart failure; − 89%), extra hospitalisations (− 93%), and costs (− 91%). Conclusion Guideline updates have had a demonstrable impact on daily clinical practice benefiting patient, hospital, and health care budgets. Clinical practice varies between institutions and countries; therefore, a local estimation model is provided with which local impact on costs, hospitalisations, and complications can be calculated. Key Points • Clinical practice guidelines recommend prophylactic intravenous hydration to prevent post-contrast adverse outcomes such as contrast-induced acute kidney injury. • Clinical practice guidelines have recently been updated, and standard prophylaxis is no longer recommended for the majority of patients. • The guideline updates have a large impact on daily clinical practice: relative reductions at Maastricht UMC+ were − 89% prophylaxis complications, − 93% hospitalisations, and − 91% costs, and similar reductions are expected for Dutch and adherent European medical centres.

Beech (Fagus sylvatica) and silver fir (Abies alba) are often cultivated in mixed stands and, hence, compete for water and nutrients. Besides nitrogen (N), also phosphorus (P) is an important nutrient for growth and development. Beech trees in Central Europe grow on both P-poor and P-rich soils, thereby showing similar growth and low variation in foliar P. The central aim of the present study was to test the hypothesis that variations in foliar P contents of beech are driven by seasonal changes rather than by the competition with silver fir. It was further hypothesized that P contents in silver fir needles depend on needle age and forest site. To test these hypotheses, P contents and P fractions, i.e. organic-bound P (Porg) and inorganic phosphate P (Pi), were measured in the foliage of beech trees from pure beech and mixed beech/silver fir plots as well as in needles of silver fir of the mixed plots. The forest sites investigated are located in Central Europe in the Black Forest, Germany, and in Croatia near the south-eastern distribution limit of beech and are all poor in plant-available soil P. The analyses showed that the main driver of P contents and P fractions in beech leaves at all forest sites is the season and that competition with silver fir had no effect. Hence, the present results demonstrate the high plasticity of beech trees to adapt to both poor plant-available soil P and competition with silver fir. Total P contents of silver fir needles were higher at the Croatian site compared to the Black Forest sites and originated from higher foliar Pi contents. One third of the P present in current-year needles in late summer was remobilized and exported until the needles reached the age of 1 year. The difference in P contents between current-year and 1-year-old needles can be seen as the amount of P resorbed from 1-year-old needles in summer during the generation of new needles to support the P demand of current-year needles for growth and development.

The present study explores the interaction of water supply and rhizobia inoculation on CO

The paradigm that permafrost-affected soils show restricted mineral nitrogen (N) cycling in favor of organic N compounds is based on the observation that net N mineralization rates in these cold climates are negligible. However, we find here that this perception is wrong. By synthesizing published data on N cycling in the plant-soil-microbe system of permafrost ecosystems we show that gross ammonification and nitrification rates in active layers were of similar magnitude and showed a similar dependence on soil organic carbon (C) and total N concentrations as observed in temperate and tropical systems. Moreover, high protein depolymerization rates and only marginal effects of C:N stoichiometry on gross N turnover provided little evidence for N limitation. Instead, the rather short period when soils are not frozen is the single main factor limiting N turnover. High gross rates of mineral N cycling are thus facilitated by released protection of organic matter in active layers with nitrification gaining particular importance in N-rich soils, such as organic soils without vegetation. Our finding that permafrost-affected soils show vigorous N cycling activity is confirmed by the rich functional microbial community which can be found both in active and permafrost layers. The high rates of N cycling and soil N availability are supported by biological N fixation, while atmospheric N deposition in the Arctic still is marginal except for fire-affected areas. In line with high soil mineral N production, recent plant physiological research indicates a higher importance of mineral plant N nutrition than previously thought. Our synthesis shows that mineral N production and turnover rates in active layers of permafrost-affected soils do not generally differ from those observed in temperate or tropical soils. We therefore suggest to adjust the permafrost N cycle paradigm, assigning a generally important role to mineral N cycling. This new paradigm suggests larger permafrost N climate feedbacks than assumed previously. peerReviewed

Very limited information is available on the drought tolerance of European beech and silver fir in mixed cultivation, both for mature forests and natural regeneration. Particularly, little information is available regarding the significance on memory effects of drought exposure. Therefore, drought memory was analyzed in seedlings of these species grown in mixed cultivation in the present study. The results showed that previous-year drought hardening mediated enhanced biomass accumulation of beech leaves and root in the subsequent year, but did not impact fir growth. Total carbon (C) content was decreased by drought hardening in both the leaves and roots of beech and previous-year needles and roots of fir, in beech probably as a consequence of increased growth. Previous-year drought hardening had no significant effect on relative water contents, total nitrogen (N), or soluble protein contents in leaves and roots of beech and fir, but resulted in decreased total amino acid contents of beech leaves and fir needles. It further reduced structural N in current-year fir needles and decreased C/N ratios in roots of both beech and silver fir seedlings. Generally, the number of interspecific neighbors had no considerable effect on biomass or total C or N contents, as well as N partitioning in leaves and roots of beech and fir seedlings. The present study highlights that drought hardening induces memory effects in European beech and silver fir seedlings in their mixture in the subsequent year of growth, but these memory effects are stronger in beech than in fir.

In their natural environment, date palms are exposed to chronic atmospheric ozone (O3) concentrations from local and remote sources. In order to elucidate the consequences of this exposure, date palm saplings were treated with ambient, 1.5 and 2.0 times ambient O3 for three months in a free-air controlled exposure facility. Chronic O3 exposure reduced carbohydrate contents in leaves and roots, but this effect was much stronger in roots. Still, sucrose contents of both organs were maintained at elevated O3, though at different steady states. Reduced availability of carbohydrate for the Tricarboxylic acid cycle (TCA cycle) may be responsible for the observed reduced foliar contents of several amino acids, whereas malic acid accumulation in the roots indicates a reduced use of TCA cycle intermediates. Carbohydrate deficiency in roots, but not in leaves caused oxidative stress upon chronic O3 exposure, as indicated by enhanced malonedialdehyde, H2O2 and oxidized glutathione contents despite elevated glutathione reductase activity. Reduced levels of phenolics and flavonoids in the roots resulted from decreased production and, therefore, do not indicate oxidative stress compensation by secondary compounds. These results show that roots of date palms are highly susceptible to chronic O3 exposure as a consequence of carbohydrate deficiency.

Infection with the necrotrophic fungus Diplodia sapinea (Fr.) Fuckel is among the economically and ecologically most devastating diseases of conifers in the northern hemisphere and is accelerated by global climate change. This study aims to characterize the changes mediated by D. sapinea infection on its pine host (Pinus sylvestris L.) that lead to the death of its needles. For this purpose, we performed an indoor infection experiment and inoculated shoot tips of pine seedlings with virulent D. sapinea. The consequences for foliar traits, including the phytohormone profile, were characterized at both the metabolite and transcriptome level. Our results showed that D. sapinea infection strongly affected foliar levels of most phytohormones and impaired a multitude of other metabolic and structural foliar traits, such as reactive oxygen species scavenging. Transcriptome analysis revealed that these changes are partially mediated via modified gene expression by fungal exposure. Diplodia sapinea appears to overcome the defense reactions of its pine host by reprogramming gene expression and post-transcriptional controls that determine essential foliar metabolic traits such as the phytohormone profile, cell wall composition and antioxidative system.

Supplemental material, sj-docx-1-wso-10.1177_17474930221095698 for Elevation of cardiac biomarkers in stroke is associated with pathological findings on cardiac MRI—results of the HEart and BRain interfaces in Acute Stroke study by Regina von Rennenberg, Juliane Herm, Thomas Krause, Simon Hellwig, Helena Stengl, Jan F Scheitz, Thomas Elgeti, Sebastian N Nagel, Matthias Endres, Karl Georg Haeusler and Christian H Nolte in International Journal of Stroke

The paradigm that permafrost-affected soils show restricted mineral nitrogen (N) cycling in favor of organic N compounds is based on the observation that net N mineralization rates in these cold climates are negligible. However, we find here that this perception is wrong. By synthesizing published data on N cycling in the plant-soil-microbe system of permafrost ecosystems we show that gross ammonification and nitrification rates in active layers were of similar magnitude and showed a similar dependence on soil organic carbon (C) and total N concentrations as observed in temperate and tropical systems. Moreover, high protein depolymerization rates and only marginal effects of C:N stoichiometry on gross N turnover provided little evidence for N limitation. Instead, the rather short period when soils are not frozen is the single main factor limiting N turnover. High gross rates of mineral N cycling are thus facilitated by released protection of organic matter in active layers with nitrification gaining particular importance in N-rich soils, such as organic soils without vegetation. Our finding that permafrost-affected soils show vigorous N cycling activity is confirmed by the rich functional microbial community which can be found both in active and permafrost layers. The high rates of N cycling and soil N availability are supported by biological N fixation, while atmospheric N deposition in the Arctic still is marginal except for fire-affected areas. In line with high soil mineral N production, recent plant physiological research indicates a higher importance of mineral plant N nutrition than previously thought. Our synthesis shows that mineral N production and turnover rates in active layers of permafrost-affected soils do not generally differ from those observed in temperate or tropical soils. We therefore suggest to adjust the permafrost N cycle paradigm, assigning a generally important role to mineral N cycling. This new paradigm suggests larger permafrost N climate feedbacks than assumed previously.

In the literature, there is evidence of an association between cardiac diseases and clinical cognitive impairment as well as subclinical brain injury. We examined whether there is a link between elevated cardiac troponin levels (hs-cTnT) as a marker of subclinical myocardial injury and severity of white matter lesions (WML) as a marker of subclinical brain injury in stroke patients since those patients are a high-risk population in terms of both cognitive decline and cardiac comorbidity. We conducted a retrospective analysis of consecutive acute ischemic stroke patients admitted to Charit��-University Hospital, Berlin from 2011-2013. All included participants underwent 3T-cMRI and serial hs-cTnT measurements as part of the clinical routine. Severity of WML was graded using the age- related white matter severity score (ARWMS). Patients with hs-cTnT >52ng/l or dynamic change of hs- cTnT >50%, which may indicate acute myocardial damage, were excluded. We performed unadjusted and adjusted quantile regression models to determine whether there is an association between hs- cTnT (dichotomized at the 99th percentile of a healthy reference population, 14ng/l) and WML. The data of 860 patients were examined (median age 73 years, 44.8% female, median ARWMS 6). In patients with elevated hs-cTnT, WML were more severe than in patients with normal hs-cTnT (median ARWMS 8 vs. 5, adjusted beta for the 50th percentile 1.12, 95% CI 0.41-1.84). There was a more pronounced association between WML and elevated hs-cTnT in patients with moderate to severe WML (beta 1.77, 95% CI 0.26-3.27 for 80th percentile). Further division of patients with elevated hs- cTnT values showed that the association was independent of the severity of hs-cTnT elevation. Our data indicate an association between subclinical myocardial injury and severity of white matter lesions. Longitudinal studies are needed to assess the impact of risk-modifying therapy on the prevention of cognitive impairment and the value of hs-cTnT as a parameter for therapy monitoring., In der Literatur finden sich Hinweise auf einen Zusammenhang zwischen kardialen Erkrankungen und sowohl kognitiver Beeintr��chtigung als auch subklinischer Sch��digung des Gehirns. In dieser Arbeit wurde untersucht, ob ein Zusammenhang zwischen einer Erh��hung des kardialen Troponins (hs-cTnT) als Marker einer subklinischen Myokardsch��digung und dem Schweregrad zerebraler ���white matter lesions��� (WML) als Marker einer subklinischen Hirnsch��digung bei Schlaganfallpatienten besteht. Es handelt sich um eine retrospektive Auswertung von Patienten mit akutem isch��mischem Schlaganfall, die von 2011-2013 am Campus Benjamin Franklin station��r behandelt worden sind. Bei allen eingeschlossenen Patienten wurden im Rahmen der klinischen Routine ein 3T-cMRT und serielle Bestimmungen der Troponinwerte durchgefu��hrt. Der Schweregrad der zerebraler WML wurde anhand des ���age-related white matter severity scores��� (ARWMS) bestimmt. Patienten mit einem hs-cTnT > 52 ng/l oder einer ��nderung des hs-cTnT > 50% in seriellen Kontrollen wurden ausgeschlossen, da diese Konstellationen auf einen akuten Myokardschaden hindeuten. Es wurden unadjustierte und adjustierte Quantilsregressionsanalysen durchgefu��hrt, um festzustellen, ob ein Zusammenhang zwischen erh��htem hs-cTnT (cut-off 14 ng/l, entsprechend der 99. Perzentile einer gesunden Kontrollpopulation) und WML besteht. Insgesamt wurden die Daten von 860 Patienten untersucht (medianes Alter 73 Jahre, 44.8% weibliches Geschlecht, medianer ARWMS 6). Patienten mit erh��htem hs-cTnT hatten ein gr����eres Ausma�� an WML als Patienten mit normwertigem hs-cTnT (medianer ARWMS 8 vs. 5, adjustiertes beta fu��r die 50. Perzentile 1.12, 95% CI 0.41-1.84). Der Zusammenhang zwischen WML und erh��htem hs-cTnT war st��rker bei Patienten mit h��herem Schweregrad an WML (beta 1.77, 95% CI 0.26-3.27 fu��r die 80. Perzentile). Eine weitere Aufteilung der Studienpopulation nach hs-cTnT-Werten zeigte, dass der Zusammenhang unabh��ngig vom Ausma�� der hs-cTnT-Erh��hung war. Die Ergebnisse weisen auf einen Zusammenhang zwischen subklinischem Myokardschaden und zerebralen WML hin. Es braucht longitudinale Studien, um den Einfluss einer risikomodifizierenden Therapie zur Vorbeugung einer kognitiven Einschr��nkung und den m��glichen Stellenwert von Troponin als Marker eines Therapieerfolgs zu untersuchen.

Supplemental material, sj-docx-1-wso-10.1177_17474930221095698 for Elevation of cardiac biomarkers in stroke is associated with pathological findings on cardiac MRI—results of the HEart and BRain interfaces in Acute Stroke study by Regina von Rennenberg, Juliane Herm, Thomas Krause, Simon Hellwig, Helena Stengl, Jan F Scheitz, Thomas Elgeti, Sebastian N Nagel, Matthias Endres, Karl Georg Haeusler and Christian H Nolte in International Journal of Stroke

Background Myocardial injury as indicated by cardiac troponin elevation is associated with poor prognosis in acute stroke patients. Coronary angiography (CAG) is the diagnostic gold-standard to rule-out underlying obstructive coronary artery disease (CAD) in these patients. However, weighing risks and benefits of coronary angiography (CAG) against each other is particularly challenging, because stroke patients undergoing CAG may have a higher risk for secondary intracranial bleeding. Current guidelines remain vague. Thus, the aim of this study was to analyze frequency of pathological findings of CAG and associated clinical factors. Methods We analyzed indications and frequency of CAG performed in acute ischemic stroke patients in clinical routine in two European tertiary care hospitals from 2011 to 2018. All data were obtained retrospectively. Multiple logistic regression analyses were performed to identify variables associated with absence of obstructive coronary artery disease defined as presence of at least one coronary vessel stenosis ≥ 50%. Results A total of 139 AIS patients underwent CAG. Frequent indications for CAG were suspected acute coronary syndrome (N = 114) or scheduled cardiac surgery (N = 25). Acute coronary stenting was applied in 51/139 patients. Among patients with suspected acute coronary syndrome, no obstructive CAD was found in 27/114 patients. Absence of obstructive CAD was associated with insular cortex lesions, no clinical symptoms for ACS, less than three cardiovascular risk factors, younger age and normal wall motion. Conclusion Several variables suggest absence of CAD in AIS patients and may help in clinical decision making in stroke patients with myocardial injury.

AimsThe aim of this study is to evaluate whether agreement with autopsy-determined cause of death (COD) increases by use of postmortem CT (PMCT) or PMCT in combination with postmortem sampling (PMS), when compared with clinical assessment only.MethodsThis prospective observational study included deceased patients from the intensive care unit and internal medicine wards between October 2013 and August 2017. The primary outcome was percentage agreement on COD between the reference standard (autopsy) and the alternative postmortem examinations (clinical assessment vs PMCT or PMCT+PMS). In addition, the COD of patient groups with and without conventional autopsy were compared with respect to involved organ systems and pathologies.ResultsOf 730 eligible cases, 144 could be included for analysis: 63 underwent PCMT without autopsy and 81 underwent both PMCT and autopsy. Agreement with autopsy-determined COD was significantly higher for both PMCT with PMS (42/57, 74%), and PMCT alone (53/81, 65%) than for clinical assessment (40/81, 51%; p=0.007 and p=0.03, respectively). The difference in agreement between PMCT with PMS and PMCT alone was not significant (p=0.13). The group with autopsy had a significantly higher prevalence of circulatory system involvement and perfusion disorders, and a lower prevalence of pulmonary system involvement.ConclusionPMCT and PMS confer additional diagnostic value in establishing the COD. Shortcomings in detecting vascular occlusions and perfusion disorders and susceptibility to pulmonary postmortem changes could in future be improved by additional techniques. Both PMCT and PMS are feasible in clinical practice and an alternative when autopsy cannot be performed.

Introduction: There is evidence of an association between markers of cardiac injury and cognition in patients with cardiovascular disease. We hypothesized that levels of high-sensitivity cardiac troponin T (hs-cTnT) are associated with cognitive performance and cognitive decline in a population of predominantly healthy older adults. Methods: We included 1,226 predominantly healthy adults ≥60 years from the Berlin Aging Study II. Participants were recruited from the general population of the Berlin metropolitan area from 2009 to 2014. At baseline, participants underwent measurement of hs-cTnT and cognitive testing using the extended Consortium to Establish a Registry for Alzheimer’s Disease (CERAD-Plus) battery. In addition, the Digit Symbol Substitution Test (DSST) was performed at baseline and at follow-up (7.3 ± 1.4 years after the baseline visit). The CERAD test results were summarized into four cognitive domains (processing speed, executive function, visuo-construction, and memory). After summing-up the respective raw scores, we calculated standardized z scores. We performed unadjusted and adjusted linear regression models to assess links between hs-cTnT and cognitive domains. We used linear mixed models to analyze associations between hs-cTnT and cognitive decline according to changes in DSST scores over time. Results: The mean age of study participants at baseline was 68.5 (±3.6) years, 49% were female, and median hs-cTnT levels were 6 ng/L (IQR 4–8 ng/L). We detected no significant association between hs-cTnT and different cognitive domains at baseline after adjustment for age, sex, education, and cardiovascular risk factors. Hs-cTnT was associated with cognitive decline, which remained statistically significant after full adjustment (adjusted beta-coefficient −0.82 (−1.28 to −0.36), p = 0.001). After stratification for sex, the association with hs-cTnT remained statistically significant in men but not in women. Conclusion: Higher hs-cTnT levels in older men are associated with cognitive decline measured with the DSST.

Background Vitamin K is associated with reduced cardiovascular disease risk such as heart failure, possibly by carboxylation of matrix-gla protein (MGP), a potent inhibitor of vascular calcification. The relationship of vitamin K intake or status with cardiac structure and function is largely unknown. Therefore this study aims to investigate the prospective association of vitamin K status and intake with echocardiographic measures. Methods This study included 427 participants from the Hoorn Study, a population-based cohort. Vitamin K status was assessed at baseline by plasma desphospho-uncarboxylated MGP (dp-ucMGP) with higher concentrations reflecting lower vitamin K status. Vitamin K intake was assessed at baseline with a validated food-frequency questionnaire. Echocardiography was performed at baseline and after a mean follow-up time of 7.6, SD=±0.7 years. We used linear regression for the association of vitamin K status and intake with left ventricular ejection fraction (LVEF), left atrial volume index (LAVI) and left ventricular mass index (LVMI), adjusted for potential confounders. Results The mean age was 66.8, SD=±6.1 years (51% were male). A high vitamin K status was prospectively associated with decreased LVMI (change from baseline to follow-up: -5.0, 95% CI: -10.5;0.4 g/m2.7) for the highest quartile compared to the lowest in women (P-interaction sex=0.07). No association was found in men. Vitamin K status was not associated with LVEF or LAVI. Vitamin K intake was not associated with any of the echocardiographic measures. Conclusions This study showed a high vitamin K status being associated with decreased LVMI only in women, while intakes of vitamin K were not associated with any cardiac structure or function measures. These results extend previous findings for a role of vitamin K status to decrease heart failure risk.

BACKGROUND Patients with stroke secondary to occlusions of the anterior cerebral artery (ACA) often have poor outcomes. The optimal acute therapeutic intervention for these patients remains unknown. METHODS Patients with isolated ACA-stroke were identified from 10 centers participating in the EndoVascular treatment And ThRombolysis in Ischemic Stroke Patients (EVATRISP) prospective registry. Patients treated with endovascular thrombectomy (EVT) were compared to those treated with intravenous thrombolysis (IVT). Odds ratios with 95% confidence intervals (OR; 95%CI) were calculated using multivariate regression analysis. RESULTS Included were 92 patients with ACA-stroke. Of the 92 ACA patients, 55 (60%) were treated with IVT only and 37 (40%) with EVT (��bridging IVT). ACA patients treated with EVT had more often wake-up stroke (24% vs. 6%, p��=��0.044) and proximal ACA occlusions (43% vs. 24%, p��=��0.047) and tended to have higher stroke severity on admission [NIHSS: 10.0 vs 7.0, p��=��0.054). However, odds for favorable outcome, mortality or symptomatic intracranial hemorrhage did not differ significantly between both groups. Exploration of the effect of clot location inside the ACA showed that in patients with A1 or A2/A3 ACA occlusions the chances of favorable outcome were not influenced by treatment allocation to IVT or EVT. DISCUSSION Treatment with either IVT or EVT could be safe with similar effect in patients with ACA-strokes and these effects may be independent of clot location within the occluded ACA.

Nitrogen (N) remobilization is an important physiological process that supports the growth and development of trees. However, in evergreen broad-leaved tree species, such as citrus, the mechanisms of N remobilization are not completely understood. Therefore, we quantified the potential of N remobilization from senescing leaves of spring shoots to mature leaves of autumn shoots of citrus trees under different soil N availabilities and further explored the underlying N metabolism characteristics by physiological, proteome and gene expression analyses. Citrus exposed to low N had an approximately 38% N remobilization efficiency (NRE), whereas citrus exposed to high N had an NRE efficiency of only 4.8%. Integrated physiological, proteomic and gene expression analyses showed that photosynthesis, N and carbohydrate metabolism interact with N remobilization. The improvement of N metabolism and photosynthesis, the accumulation of proline and arginine, and delayed degradation of storage protein in senescing leaves are the result of sufficient N supply and low N remobilization. Proteome further showed that energy generation proteins and glutamate synthase were hub proteins affecting N remobilization. In addition, N requirement of mature leaves is likely met by soil supply at high N nutrition, thereby resulting in low N remobilization. These results provide insight into N remobilization mechanisms of citrus that are of significance for N fertilizer management in orchards.

Climate change, specifically the increasing frequency and intensity of summer heat and drought, has severe influences on the performance of beech forests, including decline in growth, reduced nutrient turnover, enhanced mortality, and a shift in spatial distribution northwards and towards higher elevations. The present study aimed to characterize the physiological responses of Croatian beech saplings originating from 10 natural forest stands to experimentally applied water deprivation in a common-garden experiment. The aim was to evaluate the extent to which external factors such as climate, as well as nitrogen (N) and phosphorus (P) availability in the soil of the natural habitats, control the response of beech saplings to water deprivation. For this purpose, beech saplings from 10 forest stands that differed in terms of soil type, chemical soil properties, as well as climate were collected in winter, cultivated in an artificial soil substrate under controlled conditions for one year, and then subjected to 29 days of water deprivation. Responses to water deprivation were observed in the antioxidative system (total ascorbate, reduced ascorbate, oxidized ascorbate, and redox state) in leaves and fine roots. The latter allowed us to categorize saplings as adapted or sensitive to water deprivation. P over N availability in the soil rather than climatic conditions in the natural habitats controlled the response of beech saplings to the water-deprivation event. The categorization of saplings as adapted or sensitive to water deprivation was related to genetic parameters. The results of this multidisciplinary study (tree physiology, climate, and genetic data) are considered to be highly significant and beneficial for the adaptation of European beech forests to changing climatic conditions.