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Coupled numerical models, which simulate water and energy fluxes in the subsurface–land-surface–atmosphere system in a physically consistent way, are a prerequisite for the analysis and a better understanding of heat and matter exchange fluxes at compartmental boundaries and interdependencies of states across these boundaries. Complete state evolutions generated by such models may be regarded as a proxy of the real world, provided they are run at sufficiently high resolution and incorporate the most important processes. Such a simulated reality can be used to test hypotheses on the functioning of the coupled terrestrial system. Coupled simulation systems, however, face severe problems caused by the vastly different scales of the processes acting in and between the compartments of the terrestrial system, which also hinders comprehensive tests of their realism. We used the Terrestrial Systems Modeling Platform (TerrSysMP), which couples the meteorological Consortium for Small-scale Modeling (COSMO) model, the land-surface Community Land Model (CLM), and the subsurface ParFlow model, to generate a simulated catchment for a regional terrestrial system mimicking the Neckar catchment in southwest Germany, the virtual Neckar catchment. Simulations for this catchment are made for the period 2007–2015 and at a spatial resolution of 400 m for the land surface and subsurface and 1.1 km for the atmosphere. Among a discussion of modeling challenges, the model performance is evaluated based on observations covering several variables of the water cycle. We find that the simulated catchment behaves in many aspects quite close to observations of the real Neckar catchment, e.g., concerning atmospheric boundary-layer height, precipitation, and runoff. But also discrepancies become apparent, both in the ability of the model to correctly simulate some processes which still need improvement, such as overland flow, and in the realism of some observation operators like the satellite-based soil moisture sensors. The whole raw dataset is available for interested users. The dataset described here is available via the CERA database (Schalge et al., 2020): https://doi.org/10.26050/WDCC/Neckar_VCS_v1.

We present a method to estimate spatially and temporally variable uncertainty of areal precipitation data. The aim of the method is to merge measurements from different sources, remote sensing and in situ, into a combined precipitation product and to provide an associated dynamic uncertainty estimate. This estimate should provide an accurate representation of uncertainty both in time and space, an adjustment to additional observations merged into the product through data assimilation, and flow dependency. Such a detailed uncertainty description is important for example to generate precipitation ensembles for probabilistic hydrological modelling or to specify accurate error covariances when using precipitation observations for data assimilation into numerical weather prediction models. The presented method uses the Local Ensemble Transform Kalman Filter and an ensemble nowcasting model. The model provides information about the precipitation displacement over time and is continuously updated by assimilation of observations. In this way, the precipitation product and its uncertainty estimate provided by the nowcasting ensemble evolve consistently in time and become flow-dependent. The method is evaluated in a proof of concept study focusing on weather radar data of four precipitation events. The study demonstrates that the dynamic areal uncertainty estimate outperforms a constant benchmark uncertainty value in all cases for one of the evaluated scores, and in half the number of cases for the other score. Thus, the flow dependency introduced by the coupling of data assimilation and nowcasting enables a more accurate spatial and temporal distribution of uncertainty. The mixed results achieved in the second score point out the importance of a good probabilistic nowcasting scheme for the performance of the method.

Although forest management is one of the instruments proposed to mitigate climate change, the relationship between forest management and canopy albedo has been ignored so far by climate models. Here we develop an approach that could be implemented in Earth system models. A stand-level forest gap model is combined with a canopy radiation transfer model and satellite-derived model parameters to quantify the effects of forest thinning on summertime canopy albedo. This approach reveals which parameter has the largest affect on summer canopy albedo: we examined the effects of three forest species (pine, beech, oak) and four thinning strategies with a constant forest floor albedo (light to intense thinning regimes) and five different solar zenith angles at five different sites (40° N 9° E–60° N 9° E). During stand establishment, summertime canopy albedo is driven by tree species. In the later stages of stand development, the effect of tree species on summertime canopy albedo decreases in favour of an increasing influence of forest thinning. These trends continue until the end of the rotation, where thinning explains up to 50% of the variance in near-infrared albedo and up to 70% of the variance in visible canopy albedo. The absolute summertime canopy albedo of all species ranges from 0.03 to 0.06 (visible) and 0.20 to 0.28 (near-infrared); thus the albedo needs to be parameterised at species level. In addition, Earth system models need to account for forest management in such a way that structural changes in the canopy are described by changes in leaf area index and crown volume (maximum change of 0.02 visible and 0.05 near-infrared albedo) and that the expression of albedo depends on the solar zenith angle (maximum change of 0.02 visible and 0.05 near-infrared albedo). Earth system models taking into account these parameters would not only be able to examine the spatial effects of forest management but also the total effects of forest management on climate.

Background: The prevalence of chronic kidney disease (CKD) requiring dialysis therapy is increasing globally. Survival and mortality data of these patients in Germany are fragmentary since the nationwide registry was terminated in 2006., Objective: The objective of this study was to analyze the survival, causes of death, and co-morbidities of dialysis patients in a German population cohort as well as to assess the factors influencing mortality in these patients., Materials and Methods: We included adult, prevalent chronic dialysis patients from the German population who underwent hemodialysis and peritoneal dialysis at our centers between 2014 and 2018. We compared the characteristics of living and deceased patients and assessed survival. Patients with and without diabetes mellitus were also examined, and their co-morbidities were analyzed., Results: Of the 425 patients included in our study (m/f: 235/190), 182 died within the observation period. Mean survival of patients with coronary artery disease (CAD) (n = 217), peripheral artery disease (PAD) (n = 128), and cardiorenal syndrome (CRS) (n = 99) was significantly reduced compared to patients without the disease (CAD: 4.2 vs. 6.4 years; PAD: 4.3 vs. 6.5 years; CRS: 3.7 vs. 7.3 years, p < 0.001, respectively). Patients with diabetes mellitus (n = 110) showed no reduced survival compared to patients without the disease (n = 315) (4.8 vs. 4.9 years, p = 0.421). Diastolic blood pressure (DBP) and C-reactive protein (CRP) levels were associated with dialysis time in linear regression analysis (DBP: R = 0.029, p < 0,001; CRP: R = 0.085, p < 0.001)., Conclusion: Our results provide novel data regarding German CKD patients requiring dialysis and factors influencing mortality, which could serve as a useful reference for further studies.

Objective: Diagnosing cardiorenal syndrome (CRS) in patients with chronic kidney disease (CKD) continues to remain challenging in outpatient practice. In this study, we investigate whether a newly developed venous velocity ultrasound index (VVI) can differentiate between patients with CRS and patients with CKD of other cause or normal renal function (NRF)., Methods: Patients with CRS (n = 30), CKD (n=30), and NRF (n=30) were included in the study. For each patient, duplex ultrasound scans of intrarenal segmental veins were retrospectively analyzed. The VVI was calculated from the renal venous doppler curve as the ratio of the maximal positive venous velocity to the maximal negative venous velocity. Patients with CRS were compared to age-matched controls with NRF and to GFR-matched controls with CKD., Results: The GFRs of patients with CRS and those with CKD were comparable (26.4±5 and 25.6±7 ml/min/m2), as was the age in patients with CRS and NRF (6 ±12 years and 68±16 years, respectively). There was no significant difference in ejection fraction between patients with CRS and those with CKD (44.2±6.2% vs. 47.4 ±7.2), but there was a significant decrease compared to those with NRF (52.6 ±5.1, p<0.01). The VVI was significantly higher in the CRS group (0.81± 0.18) compared to the CKD group (0.18± 0.17, p<0.01) or NRF group (0.22± 0.20, p<0.01). The positive predictability of CRS was 96.4% in patients with VVI values of >0.6., Conclusion: The newly developed VVI was useful in successfully predicting severe diastolic dysfunction (CRS) in patients with severe kidney injury in outpatient care.

Tako-tsubo cardiomyopathy is characterized by a transient and reversible left ventricular dysfunction and shows clinical similarities with the acute coronary syndrome. Here, the authors report and discuss a case of a patient with tako-tsubo cardiomyopathy triggered by adrenaline injection after a wasp sting.

Apolipoprotein A5 (APOA5) is associated with differences in triglyceride levels and familial combined hyperlipidemia. In genetically engineered mice, apoAV plasma levels are inversely correlated with plasma triglycerides. To elucidate the mechanism by which apoAV influences plasma triglycerides, metabolic studies and in vitro assays resembling physiological conditions were performed. In human APOA5 transgenic mice (hAPOA5tr), catabolism of chylomicrons and very low density lipoprotein (VLDL) was accelerated due to a faster plasma hydrolysis of triglycerides by lipoprotein lipase (LPL). Hepatic VLDL and intestinal chylomicron production were not affected. The functional interplay between apoAV and LPL was further investigated by cross-breeding a human LPL transgene with the apoa5 knock-out and the hAPOA5tr to an lpl-deficient background. Increased LPL activity completely normalized hypertriglyceridemia of apoa5-deficient mice; however, overexpression of human apoAV modulated triglyceride levels only slightly when LPL was reduced. To reflect the physiological situation in which LPL is bound to cell surface proteoglycans, we examined hydrolysis in the presence or absence of proteoglycans. Without proteoglycans, apoAV derived either from triglyceride-rich lipoproteins, hAPOA5tr high density lipoprotein, or a recombinant source did not alter the LPL hydrolysis rate. In the presence of proteoglycans, however, apoAV led to a significant and dose-dependent increase in LPL-mediated hydrolysis of VLDL triglycerides. These results were confirmed in cell culture using a proteoglycan-deficient cell line. A direct interaction between LPL and apoAV was found by ligand blotting. It is proposed, that apoAV reduces triglyceride levels by guiding VLDL and chylomicrons to proteoglycan-bound LPL for lipolysis.

Estradiol-17beta, estradiol-benzoate, estradiol-valerianate, and estradiol-undecylate were injected intravenously and intramuscularly to postmenopausal woman and to female castrates. Equal doses were used corresponding to 20 mg of free estradiol-17beta. Estradiol-17beta, estrone, FSH and LH were measured in serum by radioimmunoassay before and after application of the hormone and the estradiol esters. Thus the depot effect of the different esters could be compared.