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Calcifying organisms such as benthic foraminifera are susceptible to changes in ocean pH and alkalinity. Responses to these changes include variations in mortality, calcification rates or assemblage composition, which have been observed in field and experimental studies. Here we applied a growth experiment with benthic foraminiferal propagules under different pH conditions to gather insights into the effect of pH on the composition of grown assemblages. A homogeneous propagule assemblage from a local mudflat in Corfu Island (Greece) was exposed to a range of pH conditions (6.5, 7.2, 7.8 and 8.5) for 5 weeks. In a second experiment, the assemblages were first exposed to low and subsequently to high conditions for a total of 8 weeks. After termination of the experiments, we recorded high survivability and growth throughout the treatments. Analysis of the assemblage composition of the first experiments revealed a shift from porcelaneous dominated taxa in the higher pH treatments to an assemblage with higher numbers of agglutinated taxa in the lower pH treatments. Soft-shelled monothalamous species were common throughout. The second experiment revealed assemblages that were significantly dominated by porcelaneous taxa with monothalamous taxa being almost absent. The results of this study are congruent with other observations on changing assemblage compositions with changing pH from both laboratory and field studies. The fast response of the assemblages through activation of potentially dormant propagules adds insights into the mechanisms behind seasonal composition changes in naturally variable environments such as river estuaries. They also shed new light on possible effects of continuous decreases in ocean pH on shallow-water foraminiferal assemblages in future.

We present a journey through the history of the Austrian Arctic collections stored in Geological-Paleontological Department of the Natural History Museum Vienna (NHMW). The NHMW-material was mainly acquired during four expeditions. The first was an Isbjørn expedition designed as a test cruise by Julius Payer and Carl Weyprecht in 1871. One year later, there was a second Isbjørn expedition under the command of Count Johann Wilczek. In 1873, Richard von Drasche, an industrial magnate with geological expertise, organized a private trip to eastern Spitzbergen (Svalbard). The fourth one was from 1872 to 1874, when Payer and Weyprecht led the Austro-Hungarian North Pole Expedition on the ship Admiral Tegetthoff. The latter, which almost ended in a catastrophe, discovered Franz-Josef-Land. After these expeditions, Austria took part in the First International Polar Year (1882–1883), with its own research station at Jan Mayen. There are numerous types provided by these expeditions that make this collection and its archival material an important source for the geological history of the Arctic region.

Jullienella foetida is probably the largest agglutinated foraminifer in modern oceans and can reach a length of up to ~14 cm. Because of its large size, the species was initially considered to be a bryozoan, but later correctly described as a single-chambered (monothalamous) foraminifer with a large, flat or slightly undulating plate-like test, leaf-like, or fan-like in overall shape and with the chamber interior subdivided by longitudinal partitions. It occupies a restricted geographical range around part of the NW African margin where it is found in eutrophic settings with a preference for energetic environments.We have applied a suite of non-destructive methods, namely light microscopy, SEM, X-ray and high-resolution micro-computed tomography (micro-CT) to 1) explore its external and internal test characteristics and 2) to provide a first-order estimate of its possible contribution to sea floor biomass. High-resolution SEM images show the test wall to comprises a smooth, outer veneer of small mineral grains that overlies the much thicker inner layer, which has a porous structure and is composed of grains measuring several hundreds of microns in size. X-ray images of the test reveal an elaborate system of radial partitions that subdivides the test interior into channels that may serve to direct the flow of the cytoplasm, and perhaps increase its surface to volume ratio. Micro-CT scans suggest that much of the test interior is filled with cytoplasm with a biomass comparable to that of slightly larger xenophyophores. This remarkable species appears to play an important, perhaps keystone, role in benthic ecosystems where it is abundant, providing the only common hard substrate on which sessile organisms can settle.

Shallow-water banks of foraminiferal propagules (tiny juveniles To date, propagule assemblages have only been analyzed “passively” through growth experiments with propagule banks under laboratory conditions. Here, we apply for the first time a combination of a multi-week cultivation experiment and eDNA metabarcoding of the different size fractions.Sediment samples were taken from a shallow lagoon in Corfu (Greece) and sieved over 63 µm to separate the propagule bank from the coarser fraction. The in-situ material of the sampling site was used as a baseline for the subsequent experiment (T0). The finer fraction (63 µm) every 5 weeks (T1–T3). At the same intervals, samples were taken and re-sieved over 63 µm for eDNA metabarcoding of both size fractions.The morphology-based count data of the foraminiferal specimens revealed significantly different assemblage compositions after each harvest (T0–T3). The differences between the in-situ (T0) and the experimental samples (T1–T3) were most distinct, indicating a specific composition of the propagule bank. The differences between in-situ and experimental assemblages as well as the shifting assemblage compositions over time were mirrored by the metabarcoding data from the respective intervals. Our results highlight the potential for metabarcoding to complement and expand insights gained from morphology-based approaches in foraminiferal studies.

We present new observations on

Benthic foraminifera are important indicators for ecological studies. The assemblage composition of local communities can be used to analyze influences of environmental variables such as temperature, salinity, pH, and others. In recent years, the experimental propagule method has emerged as an effective tool to evaluate the influence of these variables on assemblage dynamics of benthic foraminifera. Propagules (tiny juveniles) of benthic foraminifera are widespread and can survive outside of a species’ natural distribution range. Their ability to become dormant and be re-activated once local conditions become suitable, is an important driver behind the capacity of foraminiferal assemblages to react quickly to environmental changes. In the laboratory, the propagules are first separated from the coarser fractions by sieving and then cultured under different conditions.In the present study, we analyzed the effect of ocean pH on the composition of shallow-water assemblages from Corfu Island (Greece). Like other calcifying organisms, assemblages of foraminifera are susceptible to pH variations and have revealed compositional shifts along natural or experimental pH gradients. Our experimental set-up included four pH treatments between 6.5 and 8.5 at constant temperature and salinity (22°C and 38 ppt) for 5 weeks.At the conclusion of the cultivation experiment, we found high numbers of grown specimens (825–1564 per replicate) and a high survivability rate throughout all treatments (78–87%). Higher pH (7.8 and 8.5) resulted in assemblages that were dominated by monothalamous and porcelaneous species, whereas lower pH (6.5 and 7.2) lead to a reduction in porcelaneous and an increase in agglutinated species. Several taxa showed significant positive or negative correlations with decreasing pH values.Our results are congruent with previous findings that reported compositional shifts from calcareous to agglutinated taxa with decreasing pH (both from culture and field observations). Our study also indicates that the activation of propagules is an important mechanism behind assemblage dynamics in shallow-water foraminifera. As such, it offers an improved insight into potential resilience and recovery mechanisms of foraminiferal assemblages with regard to local or seasonal pH variations as well as ongoing ocean acidification.

Transport of foraminiferal propagules is an important mode of dispersal in benthic foraminifera. Known to occur from tidal marshes and estuaries to deep-water environments, the former are particularly vulnerable to ongoing climate change. Because rising sea levels can have profound implications on local salinity and associated faunal compositions, transport of foraminiferal propagules within these environments can be crucial for local assemblages to respond to changing conditions. Here we focus on a shallow-water environment in southeastern Georgia to evaluate whether propagule transport occurs evenly or whether it shows a predominant direction, such as land- or seaward. Two sites were sampled in the Doboy Sound area: the southern tip of Sapelo Island and a site on the North River located approximately 10 km inland. We applied the propagule method using the fine fraction of the sediments that contains the propagule bank. Experimental conditions in the laboratory included three temperatures (18, 24 and 30°C) and three salinities (15, 25 and 35) to simulate a range of environments that might trigger the growth of various foraminiferal species. While adult in situ assemblages of both sites were at least partly influenced by the adjacent salt marshes, experimentally grown assemblages were dominated by mudflat, estuarine or more open marine species. Thus, propagule transport from the more terrestrial side of the assemblage gradient is limited, while propagules of more marine species can be transported far into the extensive estuarine system of the study area, where they can remain viable within the local propagule banks. Results provide important insights into possible changes in foraminiferal assemblages with rising sea-level on the Georgia coast.

Tropical tide and rock pools are extreme environments with regard to temperature. They undergo diurnal heating and constitute natural laboratories to assess the fate of marine calcifiers under scenarios of global change. This study focuses on benthic foraminiferal assemblages from tide and rock pool sites from eastern Africa as “natural” laboratories to document the diverse spectrum of foraminiferal biotas potentially capable to succeed under conditions of future global warming. To date, the majority of foraminiferal thermal tolerance data have been compiled from laboratory experiments, anthropogenically heat-polluted or extreme hydrothermal vent areas. A total of 111 species of benthic foraminifera were recorded within the tide pool samples. Perforate species were most abundant (up to 84%), followed by porcellaneous taxa (up to 45%), while agglutinated species were only rare (up to 5%). Larger benthic foraminifera represented between 30 and 75% of the total assemblages with 8 observed genera. Species richness varied between 23 and 63 species per sample. The foraminiferal communities of most sites were dominated by larger perforate taxa such as Neorotalia calcar and Amphistegina spp., followed by a variety of small miliolid taxa (54 species) and small rotaliids (27 species). The surprisingly high foraminiferal species richness suggests that a large range of shallow-water benthic taxa appear to be capable to tolerate exposure to diurnally occurring temperature extremes (35°–> 40 °C). The large spectrum of benthic taxa recorded provides insight into potential acclimatization capacities of foraminiferal assemblages with regard to ongoing ocean warming and projected temperature changes. We infer that calcification in heat-tolerant benthic foraminifera, a group of productive carbonate producers, is more widespread than previously thought and will continue in future decades when water temperatures are significantly elevated. Tolerance to thermal stress is imperative for intertidal foraminifera and assemblages from tropical rock and tide pools appear to be less susceptible to future change. This capacity is central to the resilience to rising ocean temperatures and dictates how warming affects these delicate environments. Intertidal foraminiferal assemblages could potentially act as source populations for restocking and to mitigate detrimental effects of global change.

Critical limb ischemia (CLI) is the most severe presentation of peripheral arterial disease. We developed cell-based therapy entailing intra-arterial injection of autologous venous endothelial cells (ECs) modified to express angiopoietin 1, combined with autologous venous smooth muscle cells (SMCs) modified to express vascular endothelial growth factor. This combination promoted arteriogenesis in animal models and was safe in patients with limiting claudication. In an open-label, phase Ib study, we assessed the safety and efficacy of this therapy in CLI patients who failed or were unsuitable for surgery or intravascular intervention. Of 23 patients enrolled, 18 with rest pain or non-healing ulcers (Rutherford categories 4 and 5) were treated according to protocol, and 5 with significant tissue loss (Rutherford 6) were treated under compassionate treatment. Patients were assigned randomly to receive 1 × 107 or 5 × 107 (EC-to-SMC ratio, 1:1) of the cell combination. One-year amputation-free survival rate was 72% (13/18) for Rutherford 4 and 5 patients; all 5 patients with Rutherford 6 underwent amputation. Of the 12 with unhealing ulcers at dosing, 6 had complete healing and 2 others had >66% reduction in ulcer size. Outcomes did not differ between the dose groups. No severe adverse events were observed related to the therapy.

Foraminiferal propagule banks occur in fine sediment fractions that contain small individuals of benthic foraminifera. These sediments include locally sourced juveniles and propagules, as well as allochthonous propagules that have dispersed from surrounding areas. Such propagules can remain viable even under unfavorable local conditions. When exposed to more favorable conditions, they may grow to adult stages. Accordingly, during environmental changes, propagule banks have the potential to function as species pools and allow quick assemblage reactions. The propagule method was designed to study responses of foraminiferal assemblages by exposing propagule banks to controlled conditions in the laboratory, an approach that is applicable to a variety of ecological questions. Therefore it is important to understand the nature and dynamics of propagule banks, including local and seasonal influences. To obtain insights into the composition of local propagule banks, we studied experimentally grown assemblages from two shallow-water lagoons on Corfu Island in western Greece, and compared the results with in situ assemblages. We sampled in spring and autumn of 2017 and experimental treatments included the use of different substrates in our experiments to account for potential effects on assemblage compositions. Results revealed that sediments from each lagoon contained a distinct propagule bank. We found abundant allochthonous taxa among specimens grown in all experimental treatments, indicating dispersal of propagules, and possibly also juveniles, from adjacent regions into both lagoons. The time of sampling had a significant effect on experimental assemblages, indicating that the composition of propagule banks can vary throughout the year. However, no significant differences were found in assemblages grown in different substrata, suggesting a stronger influence of water variables (e.g., temperature or salinity) on assemblage compositions. Moreover, the experimental set-ups favored small, fast-growing, sediment-dwelling species tolerant of relatively high organic content. Our findings highlight the potential of propagule banks as species pools and will help to refine and improve future applications of the method.

This study updates the current distribution, range expansion and establishment status of the non-indigenous species Amphistegina lobifera Larsen, 1976 and other foraminifera that are cryptogenic in the Sicily Channel. Prior to this study, amphisteginids were reported from the Levantine Basin, the Central Mediterranean (Tunisia, Malta, Pelagian islands) and the southern Adriatic Sea. Here, we provide new records documenting a north-western expansion in the Central Mediterranean. In summer-autumn 2017 and spring-summer 2018, we collected algae and sediment samples from shallow coastal habitats along the shores of the Maltese archipelago, southern and north-western Sicily, Pantelleria and the Aegadian islands. Analysis of the foraminiferal assemblages showed that A. lobifera is effectively established around Malta and in southern/south-eastern Sicily, and has reached the oceanographic boundary between the Central and Western Mediterranean. Our results also show that the thermotolerant A. lobifera is at an advanced stage of invasion in the Sicily Channel, probably favoured by a recent rise in Mediterranean sea surface temperatures. New species distribution models are provided for the years 2040–2050 and 2090–2100, indicating that the predicted warming trend will facilitate north-westward migration of Mediterranean amphisteginids along the coast of northern Africa into the Alboran Sea, and deep into the Adriatic Sea.

Environmental changes such as ocean warming or sea-level rise have a profound impact on shallow-water coastal environments. Benthic foraminifera have long been successfully used as indicators for ecologic responses. The propagule method is a useful tool to evaluate the reactions of entire assemblages of foraminifera when exposed to different environmental conditions. Here we present results from growth experiments of foraminiferal assemblages from three sites in coastal Georgia and Florida (USA) under different temperatures (18, 24 and 30 °C) and salinities (15 and 35). Results show that assemblages grown at the higher temperatures had greater abundances of foraminifera, whereas salinity was the primary factor in shaping the composition of the experimentally grown assemblages from the three sites. We also show that experimentally grown assemblages contain high numbers of ‘exotic’ species that result from successful propagule recruitment from outside of the original environments (e.g. the open shelf). Overall, opportunistic and previously termed ‘pioneer species’ proved to be the most successful constituents of the experimental assemblages, showing that reactions of foraminiferal assemblages to environmental changes can appear remarkably quickly (e.g. in the course of several weeks). Our observations on the faunal reactions to different temperatures and salinities indicate that ongoing environmental alterations of coastal areas will likely result in significant changes in the shallow-water foraminiferal assemblages of the coasts of Georgia and Florida. As such, our study provides general insights into the ecologic effects of current climate change.

The State Institute of Viticulture and Oenology (WBI) Freiburg Germany has been breeding disease-tolerant grape varieties (Piwis) since the 1930s. Since that time, 15 fungus-resistant white and red wine varieties and 4 table grape varieties have been cultivated. All these grape varieties are approved as Vitis vinifera. Until now, fungus resistance has been the focus of breeding work. Due to climate changings, it will be necessary in future to delay budding and ripening of grapevines. This would protect the vines from late frosts in spring and delay the ripening of the berries in autumn. In addition, the loosening of the grape structure and dry resistance will be future breeding goals. To improve the resistance and a later ripeness of the berries, new grape varieties which are currently being tested have been developed in cooperation with the INRA in Colmar (France).

The opening of the Suez Canal in 1869 has created a pathway of migration for biota from the Red Sea into the Mediterranean Sea. This has a substantial impact on the marine ecology, endangering many local and endemic taxa. Larger foraminifera of the genus Amphistegina are among the most successful invaders, as evidenced by their abundance, ubiquity and wide extension in the Aegean and Ionian Sea. Because global climate change will amplify the entry and range expansion of tropical species in the Mediterranean, the interest in predicting species ranges and forecasting potentially negative impacts on ecosystems has grown substantially. We modeled the potential distribution of Amphistegina spp. and projected the result on future climate scenarios for 2050 and 2100, to predict range extensions of the taxon in future and compare these to range expansions under warm climate as documented in the fossil record. Results indicate that further warming is likely to cause a continued range extension, and predicts dispersal along the central Mediterranean coasts. The average range expansion rates were computed between 11.76 and 13.82 km per year, and are projected to lead to a total range expansion of 525 km (4.71° latitude) and 1035 km (11.87° longitude) in the year 2100. The results corroborate findings from the fossil record showing that some larger symbiont-bearing foraminifera cope well with rising water temperatures and are beneficiaries of warmer climate. It is anticipated that the ongoing warming trend will convey the northwestward migration of Mediterranean amphisteginids, implicating substantial consequences for marine ecosystems.

Larger symbiont-bearing foraminifers of the genus Amphistegina are currently expanding their biogeographic range in the Mediterranean Sea. They are rapidly progressing northwestward, closely approaching the Adriatic and the Tyrrhenian seas. The shift in range locally leads to profound ecological changes where amphisteginids have become the dominant species along entire stretches of coastline. Mass deposits of amphisteginids reflect an increased carbonate production and reduced assemblage diversity, and these are likely to trigger major changes in ecosystem functioning. It is anticipated that the ongoing warming trend will convey the northwestward migration of amphisteginid foraminifers. To project future species distributions we applied a species-distribution model (SDM) that is based on ecological niche constraints of current distribution ranges. Our model indicates that further warming is likely to cause a northwest-ward range extension and predicts dispersal through the straits of Sicily, Messina, and Otranto into the Tyrrhenian and Adriatic seas. Our results corroborate reports that show a remarkable increase and range expansion of tropical species, indicating a continued meridionalization of the Mediterranean Sea.

Fully calcified megalospheric juveniles were found to be closely packed within a brood chamber of the larger symbiont-bearing foraminifer Peneroplis sp. (d’Orbigny) from Chuuk Island (Micronesia). The juveniles exhibit a notable variation in size of the proloculi and various forms of test deformations. Both the size variation of the megalospheric proloculi and the test deformations are indicative of asynchronous calcification and are a potential source of natural polymorphism in Peneroplis. The results of this study have implications for the interpretation of abnormal shell forms as bioindicators and place constraints on the classic definition of three size classes in Peneroplis.

The objective of this chapter is to let a representative cross-section of practitioners, drawn from several regions of the world, reflect on their experiences through short illustrations of the approaches they have adopted to address a PUB problem. The chosen case studies cover the full range of runoff predictions in ungauged basins, using a wide range of methods, in places across broad climatic and geographic gradients. We then undertook a limited assessment of PUB practice seen in the case studies from two perspectives: (i) what lessons can be learned from the experiences of the case studies towards strengthening the outcomes of the synthesis?, and (ii) how can the outcomes of the synthesis help advance the practice of PUB globally?

Planktonic cyprid larvae of the intertidal barnacle, Semibalanus balanoides (L.) and the infralittoral/sublittoral Balanus crenatus Brug., are readily captured in small, chambered, passive traps deployed on rocky shores. Several structural developments of a previous trap design improved urea (killing solution) retention and capture of cyprids of both species. The design adopted for assessment of the larval supply/settlement relationship of the focal species, S . balanoides , included additional internal baffles and the replacement of the cylindrical trap opening with a coned aperture. Three sizes of cone aperture area were compared, with the intermediate size (1 cm 2 ) being optimal for measuring larval supply over the full range of wave action on local shores. Most daily catches included larvae that were recognizable as having been dead before they were trapped, and had recently passed through the guts of grazing limpets ( Patella vulgata L.). One site showed that ∼32% of trapped S . balanoides were so-called ‘faecal’ cyprids. An inability to distinguish these in trap samples would lead to a significant over-estimation of larval supply. Preliminary data indicated that S . balanoides larval supply to the intertidal is enhanced by onshore winds (or perhaps increased wave turbulence), whereas B . crenatus supply was positively correlated with offshore winds (or decreased turbulence). A clear ‘supply/settlement’ relationship for S . balanoides at six sites along ∼40 km of coastline was derived from 1 cm 2 coned trap catches and daily counts of settlement on ceramic tiles. There were no instances of disproportionately high settlement in relation to larval supply, but at five sites there were days when settlement apparently failed. The identification and explanation of settlement success and failure is fundamental to understanding the importance of larval supply in structuring marine benthic populations and communities.

We report on a patient with Takayasu's disease who suffered from severe headache and vomiting due to hyperperfusion syndrome after aorto-carotid-vertebral-bypass surgery. There was no significant systemic blood pressure elevation, focal neurological signs, seizures or CT scan changes. The headache was successfully treated by mannitol and furosemide. We conclude that osmotic diuresis may be an effective treatment in early stages of the hyperperfusion headache.

Purpose: The objective of this report is to emphasize the importance of saphenopopliteal junction (SPJ) reflux in the genesis of lateral leg ulcers and to suggest a proper diagnostic and therapeutic approach. Methods: Twenty legs with isolated lateral perimalleolar ulcers form the basis for this report. None had medial ankle ulcers, and most showed no hyperpigmentation or lipodermatosclerosis. Fifteen had been treated with a nonvenous diagnosis. Reflux at the SPJ was detected by handheld continuous wave Doppler and was confirmed with duplex scans. No other abnormalities were found. Brief conservative treatment and duplex localization of the SPJ preceded its ligation and division. Results: All ulcers healed within 12 weeks, but one in a radiated leg recurred at 9 months. Other complications included two hematomas and one each of ankle edema, superficial wound infection, and sural neuropathy. Conclusions: Even isolated lateral leg and ankle ulcers with minimal accessory venous stigmata can be of venous reflux origin. Detection with the continuous wave Doppler and confirmation of reflux and localization of the SPJ allow surgical correction to proceed swiftly with an expectation of satisfactory results.

Species-range expansions are a predicted and realized consequence of global climate change. Climate warming and the poleward widening of the tropical belt have induced range shifts in a variety of marine and terrestrial species. Range expansions may have broad implications on native biota and ecosystem functioning as shifting species may perturb recipient communities. Larger symbiont-bearing foraminifera constitute ubiquitous and prominent components of shallow water ecosystems, and range shifts of these important protists are likely to trigger changes in ecosystem functioning. We have used historical and newly acquired occurrence records to compute current range shifts of Amphistegina spp., a larger symbiont-bearing foraminifera, along the eastern coastline of Africa and compare them to analogous range shifts currently observed in the Mediterranean Sea. The study provides new evidence that amphisteginid foraminifera are rapidly progressing southwestward, closely approaching Port Edward (South Africa) at 31°S. To project future species distributions, we applied a species distribution model (SDM) based on ecological niche constraints of current distribution ranges. Our model indicates that further warming is likely to cause a continued range extension, and predicts dispersal along nearly the entire southeastern coast of Africa. The average rates of amphisteginid range shift were computed between 8 and 2.7 km year(-1), and are projected to lead to a total southward range expansion of 267 km, or 2.4° latitude, in the year 2100. Our results corroborate findings from the fossil record that some larger symbiont-bearing foraminifera cope well with rising water temperatures and are beneficiaries of global climate change.

Credit for fundamental studies leading to our current understanding of deep-vein thrombosis should be given to Bauer, who used phlebography to diagnose deep-vein thrombosis complicating fractures of the tibia,1 and to Sevitt and Gallagher for their autopsy-based studies of the prevalence of venous thromboembolism in patients with other injuries2,3. The development of objective methods for the diagnosis of deep-vein thrombosis has facilitated the investigation of its natural history and has provided a rational basis for its prevention and treatment. Diagnosis Most venous thrombi are clinically silent when they are first detectable by objective methods,2,4 probably because they . . .

Post-transfusion purpura is a rare syndrome characterized by severe thrombocytopenia and bleeding caused by alloimunization to human platelet specific antigens following a blood component transfusion. The suggested incidence is 1:50,000-100,000 transfusions, most often occurring in multiparous women. The diagnosis is not easy because these patients, who are often critically ill or post-surgery, have alternative explanations for thrombocytopenia such as infection, drugs, etc.To describe patients with initially misdiagnosed PTP and to emphasize the diagnostic pitfalls of this disorder.During a period of 11 years we diagnosed six patients with PTP, four women and two men. The incidence of PTP was approximately 1:24,000 blood components transfused. We present the detailed clinical course of three of the six patients in whom the diagnosis was particularly challenging. The patients were initially misdiagnosed as having heparin-induced thrombocytopenia, systemic lupus erythematosus complicated by autoimmune thrombocytopenia, and disseminated intravascular coagulation. A history of recent blood transfusion raised the suspicion of PTP and the diagnosis was confirmed by appropriate laboratory workup.PTP seems to be more frequent than previously described. The diagnosis should be considered in the evaluation of life-threatening thrombocytopenia in both men and women with a recent history of blood transfusion.

The chronic progressive course of peripheral arterial occlusive disease with its limb-threatening and life-threatening potential is associated with physical, psychological and social distress for elderly patients and their families.To evaluate the influence of infra-inguinal bypass surgery for limb salvage, and social support, on quality of life in elderly patients (over 60 years old).Sixty patients aged 60 years and above diagnosed with limb-threatening ischemia were evaluated using the SF-36 generic questionnaire for quality of life, and the MOS-SS questionnaire for social support. Thirty patients (group I) were evaluated in the hospital prior to reconstructive surgery and 30 postoperative patients (group II) were evaluated at home at least 6 months after infra-inguinal bypass operations. Both groups were comparable in terms of age, gender, prevalence of ischemic heart disease, diabetes, and other athero-sclerosis risk factors.All quality of life parameters were higher among patients who underwent limb salvage surgery (group II) as compared to preoperative patients (group I), yet the obtained values were lower than those in the general population. Patients in the surgical intervention group had higher levels of function, lower pain levels, and higher emotional and social well-being and, in addition, were spared limb amputation. The findings also indicate that the social support dimensions (emotional support, receipt of information, affection and positive social interaction), as measured in terms of perceived availability, do not operate as one entity. Different types of social support were more beneficial along different stages of the disease.Peripheral arterial occlusive disease causes severe impairment of the quality of life in elderly patients. Arterial reconstructive surgery improves the quality of life though it still remains low compared to the general population. Social support is beneficial in the treatment of these patients, and the social worker in the vascular surgery department has a key role in identifying the various needs of the patients along the path of their chronic illness.

Chronic venous insufficiency, which traditionally has been attributed to failure of the deep venous system, may result from reflux in the superficial venous system. Chronic venous insufficiency is common in elderly patients, but surgical treatment is seldom offered to this patient population. We evaluated the results of superficial venous surgery for the treatment of severe chronic venous insufficiency in a cohort of elderly patients. The authors assessed patients aged 70 years or more with chronic venous insufficiency that had failed conventional conservative treatment. The superficial and deep venous systems were thoroughly investigated by duplex ultrasonography. Associated medical conditions were reevaluated and their treatment optimized. Twenty-eight patients (11 men, 17 women), aged between 70 and 89 years (mean 79), underwent superficial venous surgery. Open ulcers, active dermatitis and recurrent erysipelas were evident in 12, 9 and 7 patients, respectively. Limb swelling and severe pain were present in 25 (89%). The operations were performed under general or regional anesthesia with overnight hospitalization. Surgical treatment consisted of ligation of the points of reflux at the junctions of the superficial and deep systems, as defined by the duplex examination (21 saphenofemoral junctions, 5 saphenopopliteal junctions, 10 perforator veins), and stripping of the long saphenous vein to knee level (15 patients). Postoperative ambulatory treatment was continued until the wounds were completely closed. All ulcers healed completely within 8 weeks. No cardiac, respiratory, or renal complications were encountered. Wound infection at the groin occurred in 1 patient. Cellulitis of the calf area developed in 4 patients. Two ulcers recurred during follow-up of 1 to 5 years (mean 2.5). Surgery of the superficial venous system for treatment of severe chronic venous insufficiency is effective and can be achieved with minimal morbidity in selected elderly patients. The risk/benefit ratio for this procedure has been reduced sufficiently to ensure a major improvement in the quality of life of such patients.

For more than 30 years central venous catheterization has provided an important means of long-term vascular access and circulatory monitoring. Thrombosis of central veins is one of the serious complications of this procedure, The reported incidence of thrombosis varies and it is often underestimated clinicaIly due to the pau city of signs and symptoms. Symptomatic subelavian vein thrombosis is estimated to occur in up to 15% of patients with indwelling venous access devices.

The distribution of modern symbiont-bearing larger foraminifera is confined to tropical and subtropical shallow water marine habitats and a narrow range of environmental variables (e.g. temperature). Most of today's taxa are restricted to tropical and subtropical regions (between 30°N and 30°S) and their minimum temperature limits are governed by the 14 to 20°C isotherms. However, during times of extensive global warming (e.g., the Eocene and Miocene), larger foraminifera have been found as far north as 50°N (North America and Central Europe) as well as towards 47°S in New Zealand. During the last century, sea surface temperatures have been rising significantly. This trend is expected to continue and climate change scenarios for 2050 suggest a further increase by 1 to 3°C. We applied Species Distribution Models to assess potential distribution range changes of three taxa of larger foraminifera under current and future climate. The studied foraminifera include Archaias angulatus, Calcarina spp., and Amphistegina spp., and represent taxa with regional, superregional and global distribution patterns. Under present environmental conditions, Amphistegina spp. shows the largest potential distribution, apparently due to its temperature tolerance. Both Archaias angulatus and Calcarina spp. display potential distributions that cover currently uninhabited regions. Under climate conditions expected for the year 2050, all taxa should display latitudinal range expansions between 1 to 2.5 degrees both north- and southward. The modeled range projections suggest that some larger foraminifera may colonize biogeographic regions that so far seemed unsuitable. Archaias angulatus and Calcarina spp. also show an increase in habitat suitability within their native occurrence ranges, suggesting that their tolerance for maximum temperatures has yet not been fully exploited and that they benefit from ocean warming. Our findings suggest an increased role of larger foraminifera as carbonate producers and reef framework builders in future oceans.

Patients with heparin-induced thrombocytopenia (HIT) require an alternative antithrombotic treatment to heparin during arterial reconstruction. Ancrod and Iloprost have been employed but are not readily available and carry the risks of systemic side effects (depletion of fibrinogen, hypotension). A patient with HIT in whom intraoperative intraarterial urokinase (UK) was successfully utilized to enable safe arterial reconstruction is described. An 80 year old white female with diffuse arteriosclerotic cardiovascular disease and multiple vascular reconstructions had thrombotic complications following use for heparin during two of her prior operations associated with documented thrombocytopenia and anti-platelet antibodies. She presented with limb-threatening ischemia which was evaluated with angiography revealing severe stenosis of the proximal left superficial femoral artery, occlusion of both anterior tibial and peroneal arteries and several digital vessels, with intact posterior tibial runoff. A common femoral to mid-superficial femoral artery bypass was performed, utilizing contralateral reversed greater saphenous vein, while being treated with aspirin and a continuous intravenous infusion of low molecular weight dextran. During the procedure the clamped arteries were locally perfused with a high volume of dilute UK solution to prevent blood stasis, and enable local delivery of a thrombolytic agent. Although clot formation was observed in the operative field, none occurred within the clamped arteries. A total of 191,200 units of UK were employed with no bleeding complications. Following surgery the patient had a palpable pedal pulse and markedly improved perfusion of her toes. She was discharged on aspirin and coumadin on postoperative day five. It is concluded that for patients with HIT, systemic aspirin and dextran combined with local intraarterial UK are a simple and effective substitute for systemic anticoagulation with heparin during arterial reconstruction.

We tested the ability of recombinant human (rhu) mast cell growth factor (MGF), also known as c-kit ligand, to stimulate the colony formation of human bone marrow cells in semisolid medium alone and in combination with rhu erythropoietin (EPO), rhu Interleukin 3 (IL-3), rhu granulocyte colony stimulating factor (G-CSF) and rhu granulocyte-macrophage colony stimulating factor (GM-CSF). The addition of MGF to cultures containing EPO or EPO + IL-3, GM-CSF and G-CSF, resp., resulted in macroscopic erythroid burst-forming units (BFU-E). Multipotential (colony-forming unit granulocyte, erythroid, monocyte, megakaryocyte [CFU-GEMM]) progenitors were stimulated by MGF in the presence of EPO. Colony-forming unit granulocyte-macrophage (CFU-GM) were activated by MGF only in combination with GM-CSF. The combination of MGF with EPO was used for synergism studies in healthy cynomolgus monkeys. In the chosen concentration MGF alone had no effect on white blood cell (WBC) counts and on platelets, but a slight effect on reticulocytes. EPO by itself increased reticulocyte counts with no effects on WBC or platelets. The combination of both factors resulted in a significant increase of reticulocytes. No other effects were seen. These studies demonstrate the potent synergistic interaction of MGF and other hematopoietic growth factors.

Recently, we showed in a cynomolgus monkey model that the combination of interleukin-3 (IL-3) and granulocyte-macrophage colony stimulating factors (GM-CSF) demonstrates synergistic effects, if administered sequentially. Not only were progenitor cells of the myelocytic lineage stimulated cooperatively, but platelet release was also observed. These effects could not be found using these factors alone. In this study, GM-CSF was administered with erythropoietin (EPO) in a sequential manner. This treatment of GM-CSF and EPO resulted in a GM-CSF-stimulated increase in cells of myelomonocytic differentiation, and enhanced stimulation of erythroid and megakaryocytic lineages. The observed effects of growth factor combination were seen to the same extent with intravenous or subcutaneous administration. The results obtained may predict the potential usefulness of GM-CSF treatment together with EPO. This could improve the effectiveness of single growth factors in only limited indications, e.g., reduced need for transfusion (platelets, blood), correction of iatrogenic anemia, and recovery from myelosuppression due to chemo- and radiotherapeutic agents.

The potency of purified chick embryo cell rabies vaccine Rabipur was evaluated by four different in vivo test systems: (1) NIH test with homologous strain LEP challenge; (2) intramuscular challenge of vaccinated laboratory animals; (3) postexposure vaccine treatment trials in laboratory animals; and (4) antibody induction tests in laboratory animals. These different test systems were compared with the Standard NIH test and an in vitro test, the modified ABT. Each of the four in vivo methods chosen demonstrated potency values superior to that of the Standard NIH test in which challenge was with CVS strain. Potency relations were: Standard NIH test versus alternative methods versus modified ABT 1.0-2.2-1.85 respectively. There was good correlation between alternative in vivo methods and the ABT. In addition examples of antibody induction in man following administration of various postexposure treatment regimens are presented which lead to the conclusion that postexposure vaccination method and composition of the study group play a more important role in achieving optimum treatment results than vaccine potency, provided that it corresponds to WHO requirements (minimum 2.5 IU per dose).

The primary growth factor for erythropoiesis is the glycoprotein hormone erythropoietin (EPO) [1], which acts through high-affinity cell surface receptors [2, 3]. However, EPO is not the sole regulatory erythropoietic hormone, and other factors such as interleukin-3 (IL-3) [4], erythroid-potentiating activity (EPA) [5], and murine granulocyte-macrophage colony-stimulating factor (GM-CSF) [6] appear to have an interactive role with EPO in mediating erythropoiesis. The mechanisms involved in these interactions are as yet unclear, although it has been demonstrated that EPA induces increased activity of EPO receptors, whereas IL-3 induces a rapid down-modulation of EPO receptors [7]. GM-CSF has been shown in the murine system to have no effect on EPO-binding [8].

The regulation of blood cell formation is mediated by a group of polypeptides classified as hematopoietic growth and differentiation factors. Overlapping as well as distinct functions have been described for three of these cytokines: interleukin 3 (IL-3), granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF). Furthermore, interleukin 1 (IL-1) has been shown to promote hematopoietic regeneration after cytoreductive drug treatment. Evidence has been provided by in vitro studies that combinations of these factors exert a highly synergistic action on the proliferation and differentiation of committed hematopoietic progenitor cells. Additionally, these findings have been supported by studies of in vivo blood cell formation in nonhuman primates. We report here that IL-3 acts synergistically with GM-CSF or G-CSF on myelocytic cell development only if an administration time of eight days of IL-3 is followed by GM-CSF or G-CSF. Short-time IL-3 application of two and four days only resulted in platelet production. The reverse administration schedule did not show synergistically enhanced stimulation of myelocytic cells. However, G-CSF treatment followed by IL-3 did induce a two-fold increase in platelet numbers. This would appear to confirm previously reported in vitro findings that G-CSF shortens the G0 period of human hematopoietic stem cells, which subsequently proliferate in the presence of IL-3. The effects of IL-3 on myelocytic and megakaryocytic development seems to be differently regulated. Whereas, IL-1 failed to display synergistic activity with GM-CSF or G-CSF is sequentially applied. Only simultaneous application either in combination with GM-CSF or with G-CSF demonstrated enhanced efficacy.