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Previous studies have revealed the importance of short-term bed-level change on the long-term development of intertidal ecosystems. One of the recent advancements in the short-term bed dynamics observation is the developments of laser-based surface elevation dynamics (LSED) and acoustic surface elevation dynamics (ASED) sensors. These two sensors are developed to automatically monitor tidally induced bed-level changes, and their measuring windows are during emergent and submerged periods, respectively. So far, there is no direct comparison or joint application of these two sensors. Therefore, in the current study, we first compare their observation precision in both laboratory and field conditions. Results show that both sensors' measurements are in good agreement with the manual measurements in the flume (R20.99) and field (R2 ~0.70), indicating the applicability of each sensor in natural environment. Finally, a coupled system (i.e., combining LSED and ASED) is established in a mangrove wetland and both sensors show good agreement with each other (R2 = 0.69). Results also demonstrate that the coupled observation system can well capture the bed-level change during emergent and submerged conditions, which provides detailed continuous data sets to study the bed-level dynamics within a tidal cycle. Furthermore, large-scale monitoring systems can also be established via mobile network module embedded in the sensor, providing real-time monitoring for bed-level changes, which is valuable to coastal morphological research and vital for detecting deterioration of coastal ecosystems and the services they provide to be able to apply adaptive management.

OBJECTIVE In the surgical treatment of isthmic spondylolisthesis, it is debatable whether instrumented fusion is mandatory in addition to decompression. The objective of this prospective cohort study was to assess the long-term effect of decompression alone compared with decompression and instrumented fusion in patients who underwent the intervention of their own preference. The results were compared with those in patients who underwent randomly assigned treatment. METHODS The authors performed a prospective observational multicenter cohort study, including 91 patients with isthmic spondylolisthesis assigned to undergo either decompression alone (n = 44) or decompression and fusion (n = 47). The main outcomes were the Roland-Morris Disability Questionnaire (RDQ) scores and the patient’s perceived recovery at the 2-year follow-up. Secondary outcomes were visual analog scale (VAS) leg pain and back pain scores and the reoperation rate. A meta-analysis was performed for data from this cohort study (n = 91) and from a randomized controlled trial (RCT) previously reported by the authors (n = 84). Subgroup analyses were performed on these combined data for age, sex, weight, smoking, and Meyerding grade. RESULTS At the 12-week follow-up, improvements of RDQ scores were comparable for the two procedures (decompression alone [D group] 4.4, 95% CI 2.3–6.5; decompression and fusion [DF group] 5.8, 95% CI −4.3 to 1.4; p = 0.31). Likewise, VAS leg pain scores (D group 35.0, 95% CI 24.5–45.6; DF group 47.5, 95% CI 37.4–57.5; p = 0.09) and VAS back pain scores (D group 23.5, 95% CI 13.3–33.7; DF group 34.0, 95% CI 24.1–43.8; p = 0.15) were comparable. At the 2-year follow-up, there were no significant differences between the two groups in terms of scores for RDQ (difference −3.1, 95% CI −6.4 to 0.3, p = 0.07), VAS leg pain (difference −7.4, 95% CI −22.1 to 7.2, p = 0.31), and VAS back pain (difference −11.4, 95% CI −25.7 to 2.9, p = 0.12). In contrast, patient-perceived recovery from leg pain was significantly higher in the DF group (79% vs 51%, p = 0.02). Subgroup analyses did not demonstrate a superior outcome for decompression alone compared with decompression and fusion. Nine patients (20.5%) underwent reoperation in total, all in the D group. The meta-analysis including both the cohort and RCT populations yielded an estimated pooled mean difference in RDQ of −3.7 (95% CI −5.94 to −1.55, p = 0.0008) in favor of decompression and fusion at the 2-year follow-up. CONCLUSIONS In patients with isthmic spondylolisthesis, at the 2-year follow-up, patients who underwent decompression and fusion showed superior functional outcome and perceived recovery compared with those who underwent decompression alone. No subgroups benefited from decompression alone. Therefore, decompression and fusion is recommended over decompression alone as a primary surgical treatment option in isthmic spondylolisthesis.

The physical examination is one of the most important diagnostic tools for physicians. Traditionally, a physical examination consists of inspection (looking), palpation (feeling), percussion (reflection of sound) and auscultation (listening). Handheld echography devices could become the new fifth element of a physical examination. The use of handheld echocardiography has recently increased because the devices have become smaller, easier to handle and more affordable. Handheld echocardiography is used by many specialists involved in acute cardiovascular care. In this narrative review we give a summary of the diagnostic accuracy and limitations of cardiovascular physical examination combined with handheld echocardiography. In patients with cardiovascular disease, adding handheld echocardiography to physical examination increases the sensitivity for detecting valvular heart disease (71% vs 46%) and left ventricular dysfunction with an ejection fraction

Attaining the goals of ‘The UN-Decade on Ecosystem Restoration’ requires efficient methods for large-scale restoration of degraded ecosystems. Seed-based approaches may offer opportunities for massive recovery of native vegetation but are prone to failure when applied to highly valued coastal wetlands such as salt marshes. Pinpointing the impact of early life stage transitions on recruitment variation across species and contexts is a critical first step toward amplifying seed-based restoration efficiency.Large-scale field experiments were conducted in 100 microhabitats across eight salt marshes to investigate root causes of variation in seed retention and seedling emergence, using four globally occurring salt marsh species as models. The resulting insights and dataset were then translated into predictors using machine learning, for targeted application in disentangling recruitment bottlenecks.Seed retention, regardless of species, was identified as the principal bottleneck in recruitment with hydrodynamic intensity, bed-level dynamics, and burial depth as critical governing factors. Seedling emergence was discerned as the critical bottleneck driving cross-species recruitment variability and was pivotally influenced by soil salinity and burial depth.Predictions using machine learning under different restoration scenarios indicated that simple management, such as seed burial or species selection, can create opportunities to bypass potential recruitment bottlenecks.Synthesis and applications. Our results suggest that the failure of seed-based coastal wetland restoration should be attributed to multiple recruitment bottlenecks that arise from different life stage transitions and are context/species dependent. In planning future seed-based restoration practices, managers should assess the variability of life stage-specific dominant factors at target sites to identify site-specific recruitment bottleneck(s). Our work underscores the need for strategic management that buffers against recruitment bottlenecks to improve restoration efficiency and advances the application of data-driven techniques to make seed-based restoration predictive.

Background and ObjectivesGuidelines recommend echocardiography to screen for structural sources of cardioembolism in patients with ischemic stroke. Cardiac CT is a promising alternative as a first-line screening method. We aimed to determine whether cardiac CT, acquired during the initial stroke imaging protocol, has a higher yield for detecting high-risk cardioaortic sources of embolism than transthoracic echocardiography (TTE).MethodsWe performed a prospective, single-center, observational cohort study and included consecutive adult patients with acute ischemic stroke who underwent ECG-gated cardiac CT during the initial stroke imaging protocol. Patients also underwent the routine stroke workup, including TTE. The main outcome was the proportion of patients with a predefined high-risk cardioaortic source of embolism on cardiac CT vs TTE in patients undergoing both investigations.ResultsBetween May 2018 and November 2020, 774 patients with a suspected ischemic stroke underwent hyperacute cardiac CT. We excluded 228 patients with a diagnosis other than ischemic stroke and 94 because they did not provide informed consent. Therefore, 452 patients (59.3% male, median age 72) were included. The median additional scan time of cardiac CT was 6 (interquartile range 5–7) minutes with poor scan quality in only 3%. In total, 350 of the 452 patients (77.4%) underwent TTE, 99 of whom were performed in an outpatient setting. Reasons for not undergoing TTE were death (33, 7.3%) and TTE being too burdensome to perform in the outpatient setting (69, 15.3%). A high-risk cardioaortic source of embolism was detected in 40 of the 350 patients (11.4%) on CT, compared with 17 of the 350 (4.9%) on TTE (odds ratio 5.60, 95% CI 2.28–16.33). Cardiac thrombus was the most frequent finding (7.1% vs 0.6%). The diagnostic yield of cardiac CT in the full study population was 55 of the 452 (12.2%). Among the 175 patients with cryptogenic stroke after the routine workup, cardiac CT identified a cause of the stroke in 11 (6.3%).DiscussionCardiac CT acquired in the acute phase of ischemic stroke is technically feasible and has a superior diagnostic yield compared with TTE for the detection of high-risk sources of embolism. Cardiac CT may be considered as an alternative to TTE to screen for cardioembolism.

Background Cardiac CT acquired during the acute stroke imaging protocol is an emerging alternative to transthoracic echocardiography (TTE) to screen for sources of cardioembolism. Currently, its diagnostic accuracy to detect patent foramen ovale (PFO) is unclear. Methods This was a substudy of Mind the Heart, a prospective cohort in which consecutive adult patients with acute ischemic stroke underwent prospective ECG-gated cardiac CT during the initial stroke imaging protocol. Patients also underwent TTE. We included patients Results Of 452 patients in Mind the Heart, 92 were younger than 60 years. Of these, 59 (64%) patients underwent both cardiac CT and cTTE and were included. Median age was 54 (IQR 49–57) years and 41/59 (70%) were male. Cardiac CT detected a PFO in 5/59 (8%) patients, 3 of which were confirmed on cTTE. cTTE detected a PFO in 12/59 (20%) patients. Sensitivity and specificity of cardiac CT were 25% (95% CI 5–57%) and 96% (95% CI 85–99%), respectively. Positive and negative predictive values were 59% (95% CI 14–95) and 84% (95% CI 71–92). Conclusion Prospective ECG-gated cardiac CT acquired during the acute stroke imaging protocol does not appear to be a suitable screening method for PFO due to its low sensitivity. Our data suggest that if cardiac CT is used as a first-line screening method for cardioembolism, additional echocardiography remains indicated in young patients with cryptogenic stroke, in whom PFO detection would have therapeutic consequences. These results need to be confirmed in larger cohorts.

Salt marshes play an important role in coastal protection by reducing the impact of waves and shoreline erosion risks. While mature vegetation is responsible for the persistence and stability of marsh ecosystems, seedling survival of pioneer species is especially crucial for marsh propagation. Marsh seedlings, however, may be threatened by climate change induced increased coastal storm surge intensity and accompanying (extreme) wave conditions, imposing stronger drag forces on marsh seedlings. We test the hypothesis that drag forces experienced by seedlings increase with horizontal orbital velocity (Uw) in a species-specific manner, and that the drag forces experienced are individual-plant trait-mediated. To test our hypotheses, seedlings of four contrasting pioneer marsh species (Bolboschoenus maritimus, Schoenoplectus tabernaemontani, Spartina anglica, and Puccinellia maritima) were exposed to storm wave conditions in a flume, where Uw and experienced drag forces were measured. Linear mixed effect models demonstrated that seedling’s susceptibility to storm wave conditions is at least partly mediated by individual plant traits. Drag forces experienced by seedlings tended to increase with Uw, and with stem length and diameter. The interplay of both traits was complex, with increasing stem length being the most important trait accounting for increases in drag forces experienced at low to moderate Uw, while the stem diameter became more important with increasing Uw. Furthermore, experienced drag forces appeared to be affected by species-specific traits such as rigidity and leaf growth, being highest for Bolboschoenus maritimus and lowest for Puccinellia maritima. Our results provide important mechanistic insights into the drivers of tidal marsh seedling vulnerability to storm wave conditions due to experienced drag, both based on the traits of individual plants and species-specific ones. This type of knowledge is of key importance when modelling saltmarsh establishment and resilience under climate change.

1. Salt marshes fronting coastal structures, such as seawalls and dikes, may offer important ecosystem-based coastal defence by reducing the wave loading and run-up levels during storms. We question (i) how the long-term salt marsh development in the Dutch Wadden Sea relates to the tidal-flat foreshore bathymetry and (ii) how the wave run-up onto dikes, which enhances the risk of dike failure, depends on foreshore bathymetry, the presence/absence of marshes, marsh vegetation properties, tidal range and wind exposure. 2. We analysed 15 years of vegetation and bathymetry maps along the entire Dutch Wadden Sea coast, in combination with detailed process-based measurements at five locations during 3 years, to understand where salt marshes naturally form and what features determine their contribution to coastal protection. 3. The horizontal extent of marshes along the dikes remained relatively stable over the past decade. The presence of marshes was associated with higher elevations of adjacent tidal flats (above ~0.5 m NAP), while landward-directed marsh retreat was associated with surface erosion of the fronting tidal flats. 4. Wave run-up during storms was lower at sites with wider marshes and higher foreshore elevations. This was attributed to the marsh attenuation effect, which led to a reduction in wave heights at the dike toe. As the tidal range varies across the Dutch Wadden Sea, areas to the East with generally higher water levels experienced higher wave run-up. 5. Synthesis and applications. We found that (i) marshes, where present, effectively protected the dikes from wave loading and (ii) the sites where marshes typically do not develop spontaneously were the most vulnerable to high wave run-up. This catch-22 problem implies that increasing reliance on nature-based coastal defences along soft-bottom coasts may require human interventions to stimulate marsh formation at the locations where it is most needed. Alternatively, ‘hard engineering’ solutions may remain necessary where implementing nature-based solutions are either too costly, unachievable, or at the expense of other ecological values, such as causing the loss of mudflats that are important for migratory birds.

Background: Pulmonary hypertension (PH), right ventricular (RV) dysfunction, and tricuspid regurgitation (TR) are commonly present in patients with mitral regurgitation (MR) and known to impair prognosis. This systematic review and meta-analysis aimed to determine the prognostic value of PH, RV function, and TR on mortality after transcatheter mitral valve repair (TMVR). Methods: A systematic search was performed to identify studies investigating PH, RV function, or TR in patients who underwent TMVR. Studies were included for pooled analysis if hazard ratios (HR) for all-cause mortality were given. Results: A total of 8,672 patients from 21 selected studies were included (PH, 11 studies; RV function, nine studies; TR, 10 studies). Mean follow-up was 2.7±1.6 years. The HRs and 95% CIs for all-cause mortality of PH (dichotomised: HR 1.70, 95% CI 1.00–2.87; per 10 mmHg increase in systolic PAP: HR 1.17, 95% CI 1.07–1.29), RV function (dichotomised: HR 1.86, 95% CI 1.45–2.38; per 5 mm decrease in TAPSE: HR 1.18, 95% CI 0.97–1.43) and TR (HR 1.51, 95% CI 1.28–1.79) indicated a significant association. Conclusion: Prognosis after TMVR is worse in patients with significant MR when concomitant PH, RV dysfunction, or TR are present. Careful assessment of these parameters should therefore precede clinical decision-making for TMVR. The current results encourage investigation into whether (1) intervention at an earlier stage of MR reduces incidence of PH, RV dysfunction, and TR; and (2) transcatheter treatment of concomitant TR can improve clinical outcome and prognosis for these patients.

BackgroundIn women, placental corticotropin releasing hormone (CRH) can be detected in maternal blood throughout pregnancy and is important in the regulation of the timing of parturition. However, its role in other mammalian species is unclear. In fact, very little is known about the presence and localization of CRH in placentas other than human. In this study we report for the first time the presence of CRH in feline placenta and maternal serum.MethodsPresence of CRH mRNA and protein was assessed using RT-PCR and Western blot, respectively, in at term domestic cat placentas opportunistically obtained at a local animal shelter and spay clinic. In addition, CRH localization within the placenta was demonstrated via immunohistochemistry. Finally, presence of CRH in maternal blood from early (¾21 days) and mid (25-35 days) stages of pregnancy was investigated by ELISA.ResultsCRH mRNA and protein were detected in feline placentas, and localized to larger decidual cells and fetal trophoblast cells, including the binucleate cells. CRH was detectable in maternal blood collected from early-stage pregnancies, and amounts significantly increased in mid-gestation samples.ConclusionThis is the first report on the presence and localization of CRH in the feline placenta, and its increase in maternal serum during the first half of pregnancy. These data lay the foundation for future studies to determine if CRH can be used as potential novel marker for early pregnancy diagnosis, determination, and monitoring in felids, and could greatly increase efficiency and success in zoo breeding programs utilizing artificial reproductive technologies for endangered feline species.

Forecasting transitions between tidal ecosystem states, such as between bare tidal flats and vegetated marshes, is crucial because it may imply the irreversible loss of valuable ecosystem services. In this study, we combine geospatial analyses of three European estuaries with a simple numerical model to demonstrate that the development of micro-topographic patterning on tidal flats is an early indicator of marsh establishment. We first show that the development of micro-topographic patterns precedes vegetation establishment, and that patterns tend to form only on tidal flats with a slope of

In the transposition of the great arteries (TGA), alterations in hemodynamics and oxygen saturation could result in fibrotic remodeling, but histological studies are scarce. We aimed to investigate fibrosis and innervation state in the full spectrum of TGA and correlate findings to clinical literature. Twenty-two human postmortem TGA hearts, including TGA without surgical correction (n = 8), after Mustard/Senning (n = 6), and arterial switch operation (ASO, n = 8), were studied. In newborn uncorrected TGA specimens (1 day–1.5 months), significantly more interstitial fibrosis (8.6% ± 3.0) was observed compared to control hearts (5.4% ± 0.8, p = 0.016). After the Mustard/Senning procedure, the amount of interstitial fibrosis was significantly higher (19.8% ± 5.1, p = 0.002), remarkably more in the subpulmonary left ventricle (LV) than in the systemic right ventricle (RV). In TGA-ASO, an increased amount of fibrosis was found in one adult specimen. The amount of innervation was diminished from 3 days after ASO (0.034% ± 0.017) compared to uncorrected TGA (0.082% ± 0.026, p = 0.036). In conclusion, in these selected postmortem TGA specimens, diffuse interstitial fibrosis was already present in newborn hearts, suggesting that altered oxygen saturations may already impact myocardial structure in the fetal phase. TGA-Mustard/Senning specimens showed diffuse myocardial fibrosis in the systemic RV and, remarkably, in the LV. Post-ASO, decreased uptake of nerve staining was observed, implicating (partial) myocardial denervation after ASO.

As lateral erosion can threaten valuable saltmarsh habitats and their capacity to protect the hinterland from waves and floods, there is a need to understand the mechanisms of erosion. We monitored lateral saltmarsh erosion at high spatiotemporal resolution during a 2.5 year period. We performed terrestrial laser scans (TLS) with centimetric spatial resolution, ca monthly, as well as before and after 2 wind events to assess morphological change of a saltmarsh cliff (

Sinus of Valsalva aneurysms are abnormal bulges of the aortic root caused by a tissue deficiency resulting in an enlargement of the aortic root in the area between the aortic annulus and the sinotubular junction. Frequently, sinus of Valsalva aneurysms are asymptomatic. However, sinus of Valsalva aneurysms can also be potentially fatal due to their risk of rupture. We present a case of a 49-year old asymptomatic male patient with a rare image of a sinus of Valsalva aneurysm of the non-coronary cusp which was initially mistaken for a right ventricular thrombus. Surgical repair of the sinus of Valsalva aneurysm was eventually achieved by a valve sparing root replacement and the patient was discharged 7 days after surgery. This case report shows that sinus of Valsalva aneurysms are vulnerable to misdiagnosis when it is not initially suspected. Because of the potential fatality of this phenomenon we would like to underline the necessary vigilance in the diagnostic process, as sinus of Valsalva aneurysms can be missed when the physician is not aware of this potential rare diagnosis.

BackgroundThe European Society of Cardiology (ESC) guidelines for the management of adult congenital heart disease (ACHD) recommend screening in patients at risk for arrhythmic events. However, the optimal mode of detection is unknown.MethodsBaseline and follow-up data of symptomatic ACHD patients who received an implantable loop recorder (ILR) or who participated in a smartphone based single-lead electrocardiogram study were collected. The primary endpoint was time to first detected arrhythmia.ResultsIn total 116 ACHD patients (mean age 42 years, 44% male) were studied. The ILR group (n = 23) differed from the smartphone based single-lead electrocardiogram group (n = 93) in having a greater part of males and had more severe CHD and (near) syncope as qualifying diagnosis. In the smartphone based single-lead electrocardiogram group history of arrhythmia and palpitations were more frequent (all p < 0.05). Monitoring was performed for 40 and 79 patient-years for the ILR- and smartphone based single-lead electrocardiogram group, respectively. Arrhythmias occurred in 33 patients with an equal median time for both groups to first arrhythmia of 3 months (HR of 0.7, p = 0.81). Furthermore, atrial fibrillation occurred most often (n = 16) and common therapy changes included medication changes (n = 7) and implantation of pacemaker or Implantable Cardioverter Defibrillator (ICD) (N = 4). Symptoms or mode of detection were not a determinant of the first event.ConclusionNon-invasive smartphone based single-lead electrocardiogram monitoring could be an acceptable alternative for ILR implantation in detecting arrhythmia in symptomatic ACHD patients in respect to diagnostic yield, safety and management decisions, especially in those without syncope.

Ecosystems will play a key role in the future of our planet, as they are capable of great adaptabilty and are resilient to climate (e.g. Bulleri et al., 2018). However, they are also vulnerable to multifactorial disturbances (e.g. anthropic/Gómez et al., 2022). An ecosystem’s long-term response to global change (climate change, biodiversity loss, changes in water cycling, etc.) is also affected by the natural, epistemic, and aleatory uncertainty of the environment.The methods used to evaluate an ecosystem mean that the services it provides are difficult to quantify and predict. While ecosystem conservation strategies should come from a combination of different perspectives, they are commonly tackled via independent disciplines, such as coastal management, coastal engineering, ecology, water quality, etc. and therefore, insights into the long-term conservation of our ecosystems is still a key challenge. The starting point to address ecosystem conservation on a changing planet must be a multidisciplinary characterization of the physical and environmental context.

Mangrove forests are increasingly valued as wave-attenuating buffers in coastal flood defence strategies. However, as mangroves are vulnerable to wave-induced erosion, this raises the question, how can the stability of these protective mangrove forests be promoted? To address this question, we investigate how mangrove dynamics in a microtidal system can be related to different types of foreshores. We used remote sensing to investigate mangrove fringe stability over multiple years in relation to intertidal mudflat width (i.e., emerged at low tide) and the presence stability of cheniers, which are sand bodies on top of muddy foreshores that are characteristic for eroding coastlines. In addition, we investigated local and short-term foreshore effects by measuring wave propagation across two cross-shore transects, one with a mudflat and chenier and one with a deeper tidal flat foreshore. The satellite images (Sentinel-2) revealed that mangrove dynamics over multiple years and seasons were related to chenier presence and stability. Without a chenier, a mudflat width of 110 m (95%CI: 76–183 m) was required to make mangrove expansion more likely than mangrove retreat. When a stable chenier was present offshore for two years or more, a mudflat width of only 16 m (95%CI: 0–43 m) was enough to flip chances in favor of mangrove expansion. However, mangrove expansion remained heavily influenced by seasonal changes, and was highly event driven, succeeding only once in several years. Finally, although mudflat width was a direct driver of mangrove expansion, and could be targeted as such in coastal management, our field measurements demonstrated that cheniers also have an indirect effect on mangrove expansion. These sand banks significantly reduce wave height offshore, thereby likely creating favorable conditions for mudflat accretion landward, and thus mangrove habitat expansion. This makes stabilization - and possibly also the temporary creation - of cheniers an interesting target for mangrove conservation and restoration.

The fate of coastal ecosystems depends on their ability to keep pace with sea-level rise—yet projections of accretion widely ignore effects of engineering fauna. Here, we quantify effects of the mussel, Geukensia demissa, on southeastern US saltmarsh accretion. Multi-season and -tidal stage surveys, in combination with field experiments, reveal that deposition is 2.8-10.7-times greater on mussel aggregations than any other marsh location. Our Delft-3D-BIVALVES model further predicts that mussels drive substantial changes to both the magnitude (±−1) and spatial patterning of accretion at marsh domain scales. We explore the validity of model predictions with a multi-year creekshed mussel manipulation of >200,000 mussels and find that this faunal engineer drives far greater changes to relative marsh accretion rates than predicted (±>0.4 cm·yr−1). Thus, we highlight an urgent need for empirical, experimental, and modeling work to resolve the importance of faunal engineers in directly and indirectly modifying the persistence of coastal ecosystems globally.

Large grazers (megaherbivores) have a profound impact on ecosystem functioning. However, how ecosystem multifunctionality is affected by changes in megaherbivore populations remains poorly understood. Understanding the total impact on ecosystem multifunctionality requires an integrative ecosystem approach, which is especially challenging to obtain in marine systems. We assessed the effects of experimentally simulated grazing intensity scenarios on ecosystem functions and multifunctionality in a tropical Caribbean seagrass ecosystem. As a model, we selected a key marine megaherbivore, the green turtle, whose ecological role is rapidly unfolding in numerous foraging areas where populations are recovering through conservation after centuries of decline, with an increase in recorded overgrazing episodes. To quantify the effects, we employed a novel integrated index of seagrass ecosystem multifunctionality based upon multiple, well-recognized measures of seagrass ecosystem functions that reflect ecosystem services. Experiments revealed that intermediate turtle grazing resulted in the highest rates of nutrient cycling and carbon storage, while sediment stabilization, decomposition rates, epifauna richness, and fish biomass are highest in the absence of turtle grazing. In contrast, intense grazing resulted in disproportionally large effects on ecosystem functions and a collapse of multifunctionality. These results imply that (i) the return of a megaherbivore can exert strong effects on coastal ecosystem functions and multifunctionality, (ii) conservation efforts that are skewed toward megaherbivores, but ignore their key drivers like predators or habitat, will likely result in overgrazing-induced loss of multifunctionality, and (iii) the multifunctionality index shows great potential as a quantitative tool to assess ecosystem performance. Considerable and rapid alterations in megaherbivore abundance (both through extinction and conservation) cause an imbalance in ecosystem functioning and substantially alter or even compromise ecosystem services that help to negate global change effects. An integrative ecosystem approach in environmental management is urgently required to protect and enhance ecosystem multifunctionality.

Intertidal coastal sediments are important centers for nutrient transformation, regeneration, and storage. Sediment resuspension, due to wave action or tidal currents, can induce nutrient release to the water column and fuel primary production. Storms and extreme weather events are expected to increase due to climate change in coastal areas, but little is known about their effect on nutrient release from coastal sediments. We have conducted in-situ sediment resuspension experiments, in which erosion was simulated by a stepwise increase in current velocities, while measuring nutrient uptake or release in field flumes positioned on intertidal areas of a tidal bay (Eastern Scheldt) and an estuary (Western Scheldt). In both systems, the water column concentration of ammonium (NH4+) and nitrite (NO2−) increased predictably with greater erosion as estimated from pore water dilution and erosion depth. In contrast, the phosphate (PO43−) dynamics were different between systems, and those of nitrate (NO3−) were small and variable. Notably, sediment resuspension caused a decrease in the overlying water PO43− concentration in the tidal bay, while an increase was observed in the estuarine sediments. Our observations showed that the concentration of PO43− in the water column was more intensely affected by resuspension than that of NH4+ and NO2−. The present study highlights the differential effect of sediment resuspension on nutrient exchange in two contrasting tidal coastal environments.

Heatwaves affect tidal flat ecosystems by altering the bioturbating behavior of benthic species, with potential consequences for sediment oxygenation, particle mixing, and erodibility. Although the frequency and duration of heatwaves are expected to increase under global warming scenarios, we lack insights into how heatwaves' temporal dynamics affect bioturbating behaviors. Using the widely distributed bioturbator Cerastoderma edule as model species, we quantified how heatwaves with identical heat-sum but different temporal dynamics (i.e., 3- vs. 6-d heating and normal temperature cycles) affect bioturbating behaviors and the sediment mixing processes in tidal mesocosms. Our results show that short but frequent 3-d heatwave cycles increased the magnitude of bioturbating behaviors, thereby resulting in more bio-mixed sediment than observed under infrequent prolonged 6-d heatwave cycles. This unexpected result could be ascribed to the weakening health condition indicated by a high death rate (47.37%) under 6-d heatwave cycles than in 3-d and no-heatwave control cycles. Present findings reveal that the impact of heatwaves on sediment bioturbation will strongly depend on the temporal dynamics of future heatwaves: bioturbation will be enhanced unless the heatwave duration exceeds species resistance and increases mortality.

Reef-forming species form integral aspects of coastal ecosystems, but are rapidly degrading world-wide. To mitigate these declines, nature managers increasingly rely on the restoration of habitat-structuring, reef-forming species by, for example, introducing artificial reefs that may directly function as complex reef habitat. Since the use of biodegradable structures to restore biogenic reefs is becoming a popular technique, its effectiveness as reef habitat must be assessed. Therefore, we examine the trophic complexity on experimental large-scale biodegradable artificial reefs using food web network analysis. We placed biodegradable artificial reefs on soft-sediment intertidal flats in the Dutch Wadden Sea in a large-scale (~650 m) and 2.5-year-long experiment. We compared food web networks and biodiversity indicators between biodegradable reefs and bare controls and quantified species composition inside and near the artificial reef community to assess the expansion of the reef community. During 2.5 years, we observed that artificial reefs changed food web networks compared to bare controls: in species richness (+76%), link density (the number of interactions per species; +15%) and the fraction of basal species (species of lowest trophic level; +40%), but lowered the connectance: the realized fraction of all possible links between species (−33%). Their effects on food web networks increased over time with a higher species richness (+22%) and more complex food web (link density +13%) on the artificial reef 2.5 years after deployment compared to 1.5 years. However, the effects of the reefs did not extend beyond the reef structures; the species composition and biodiversity of macrozoobenthos near the reefs were comparable to the control. Synthesis and applications. This study shows that biodegradable artificial reefs offer an effective tool for the restoration of food web complexity and biodiversity of intertidal soft-sediment systems. However, application needs to be carefully considered as the reef-building species did not expand beyond our structures, despite the ambitious spatial extent of this experiment. Therefore, we recommend restoration practitioners to design artificial reefs in such a way that they generate ecosystem connectivity (facilitation of higher trophic levels) and biogeomorphological effects on a landscape scale (reef expansion beyond the structures).

Despite active seagrass restoration gaining traction as a tool to halt and reverse worldwide seagrass losses, overall success remains limited. Restoration strategies, through seeding or transplantation, face different environmental bottlenecks that limit success. Choosing the most appropriate strategy of the two for a specific location, however, is hampered by lack of direct practical comparisons between strategies within a single system. To investigate potential life stage dependent bottlenecks, we compared seed-based and transplant-based restoration of Zostera marina in the subtidal saltwater Lake Grevelingen. Our results demonstrate that seedling recruitment was negatively impacted by bioturbation from the lugworm Arenicola marina and sediment movement due to hydrodynamic exposure. Transplant-based restoration was clearly more successful butsurprisingly best predicted by leaf gluing by the ragworm Platynereis dumerilii. This previously undescribed interaction caused seagrass leaves to clump and reduce effective photosynthetic surface and leaf movement. We suggest that the observed behavior of these worms may result from a lack of foodweb interactions, illustrating the importance of trophic control for seagrass restoration. Thus, in addition to recognizing life stage dependent environmental bottlenecks for restoration strategy selection, seagrass restoration may also require the active recovery of their associated food webs.

Vegetated coastal ecosystems such as salt marshes, dunes and seagrass meadows occur at the land–sea interface—a dynamic environment typified by harsh growing conditions. These ecosystems are known as biogeomorphic landscapes because their functioning depends on biophysical interactions by which organisms engineer landforms to their own benefit. The strength of such biogeomorphic feedbacks depends on plant traits, such as stem flexibility and shoot density. Recent work demonstrated that dune grasses with similar morphological traits can build contrasting landscapes due to differences in their spatial shoot organization. However, in contrast to dune grasses that trap and stabilize sand particles in aeolian landscapes, flow attenuation in aquatic environments can generate scouring around plant stems and cause uprooting, leading to establishment thresholds for young plants. Yet, it remains unknown how findings from aeolian landscapes translate to aquatic systems and how young clonally expanding plants in hydrodynamically exposed conditions overcome these establishment thresholds by optimizing shoot placement. Here, we measured shoot patterns of 90 establishing cordgrass patches Spartina anglica at 18 European field sites that cover a broad range of hydrodynamic conditions. Next, we carried out a field experiment to investigate how observed spatial shoot patterns affect plant–sediment feedbacks. Surprisingly, field survey analyses reveal highly consistent clustered shoot patterns, regardless of environmental conditions. Experimental results demonstrate that this clustered pattern minimizes scouring compared to densely clumped organizations typically observed in established patches. Synthesis. In contrast to earlier findings highlighting that establishing dune grasses optimize their landscape engineering capacity via a flexible shoot placement strategy, we find that cordgrass instead follows a fixed strategy that minimizes engineering effects in its early life stages. We suggest that marsh grasses avoid physical stress and associated establishment thresholds in their early life stage, and switch to an ecosystem engineering strategy once established. These findings shed new light on how plant traits interact with their environment to shape the landscape and pave the way for improved restoration designs by mimicking the natural shoot organization of establishing vegetation.

Contains fulltext : 294468.pdf (Publisher’s version ) (Open Access) 1. Coastal ecosystems are generally controlled by the combination of bottom-up (resourcedriven) and top-down (consumer-driven) trophic, and non-trophic interactions. Anthropogenic disruption of these interactions, e.g., through eutrophication or overfishing, leads to loss of the foundation species composing these ecosystems. Within degraded ecosystems, new interactions may become dominant, hampering restoration of foundation species. 2. We demonstrate this concept in saltwater Lake Grevelingen, where seagrass restoration was seriously hampered by a newly discovered non-trophic interaction between the seagrass Zostera marina and the ragworm Platynereis dumerilii. Platynereis constructs dwelling tubes between seagrass leaves by gluing and entangling them, leading to loss of biomass and increased epiphyte cover. To test the roles of epiphyte grazing (top-down) and eutrophication (bottom-up) on this newfound interaction, we executed a field experiment introducing the snail Littorina littorea under natural nutrient concentrations and Platynereis densities, and performed a full factorial mesocosm experiment applying Littorina, Platynereis and nutrient treatments. 3. Our field results show that survival of reintroduced Zostera in Lake Grevelingen is seriously hampered by Platynereis, which can be suppressed by grazer addition. 4. In our mesocosm experiment we demonstrate that top-down control by Littorina protected seagrass through two pathways: (1) mitigating bottom-up regulated epiphyte growth by trophic top-down forcing and (2) hampering the non-trophic interaction between Zostera and Platynereis by grazing epiphytes and dwelling tubes. 5. Synthesis and applications. With coastal ecosystems globally under pressure, our study emphasises the importance of understanding ecosystem-specific trophic and non-trophic key interactions when considering restoration. We show how negative interspecific interactions can become dominant in the absence of key facilitating interactions. Next, we show that negative interactions (leaf gluing), inhibiting foundation species restoration, can be overruled by the inclusion of positive interspecific interactions (epiphyte grazing by mesograzers). Finally, we provide a three-step co-introduction approach for restoration management. 10 mei 2023

With the capacity to reduce wave energy and trap sediment, Scirpus mariqueter has become an important native species of annual grass for ecology restoration at the Yangtze Estuary in eastern China. Due to seasonal variances of biophysical characteristics, S. mariqueter usually bends and breaks in winter, resulting in flattened stems that may reduce its wave attenuation capacity. To investigate the effects of vegetation flattening on wave attenuation, a set of flume experiments were conducted for flattened and standing vegetation under different wave conditions. The model vegetation was designed to represent the wilted S. mariqueter collected in winter with dynamic similarity. Results showed that the wave damping coefficient for flattened vegetation (βF) was 33.6%-72.4% of that for standing vegetation (βS) with the same vegetation length. Both βF and βS increased with wave height but decreased with water depth. A wave attenuation indicator (WAI) was defined to generate empirical formulas for βS and βF as well as their ratio βF/βS. The empirical formulas were then applied to modify the existing standing vegetation-based wave attenuation model for flattened vegetation and performed successfully. Understanding the wave attenuation characteristics of flattened vegetation is essential for the management of ecological restoration and coastal protection.

Introduction The notch ratio (NR) in the pulmonary flow predicts in-hospital mortality after pulmonary endarterectomy (PEA) for chronic thrombotic pulmonary hypertension (CTEPH). Purpose We studied whether the echocardiographic parameter NR can also discriminate long term outcome. Methods All patients who underwent PEA between June 2002 and June 2005 were studied. Clinical, hemodynamic and echocardiographic variables were assessed pre-operatively and at 3 months post-PEA. Clinical follow up ended in March 2022. NR was the time from onset pulmonary flow until notch divided by the time from notch until end of pulmonary flow assessed with pulsed Doppler. Results A total of 59 patient are included in this analysis. Mean age was 53±14 years, 34% were male patients and 66% of patients were NYHA class III or IV. Pre-operative mean pulmonary artery pressure (mPAP) was 45±15 mmHg and calculated total pulmonary resistance (TPR) was 870±511 dynes s cm–5. Pre-operatively, 7 patients had no notch, 33 had NR 1. Six patients died in hospital and a total of 19 patients died during the follow up till March 2022. Between survivors and non-survivors, no significant differences were observed in 6-minute walking distance (409±114 m. vs. 364±110 m., p=0.22), plasma BNP (34±47 pmol/l vs. 57±52 pmol/l, p=0.10), mean PAP (43±14 mmHg vs. 49±15 mmHg, p=0.14), TPR (793±493 dynes s cm–5 vs. 1015±525 dynes s cm–5, p=0.13). NR was significant different between survivors and non-survivors (0.73±0.25 vs. 1.1±0.44, p Mean very long term follow-up of 14±6 years. The 1, 5, 8 and 14 year survival for patients with a NR 1 (1, 5, 8 and 14 year survival was 68%, 53%, 42% and 37%, respectively). For patients without a notch (1, 5 and 8 year survival was 100% and 14 year survival was 86%). Conclusion NR predicts in-hospital and long term mortality in CTEPH patients undergoing PEA. NR >1.0 is associated with a higher risk of mortality. NR is a simple echocardiographic parameter that can be used in clinical decision making for PEA. Funding Acknowledgement Type of funding sources: None.

Citrullination, the post-translational modification of arginine residues, is catalyzed by the four catalytically active peptidylarginine deiminase (PAD or PADI) isozymes and alters charge to affect target protein structure and function. PADs were initially characterized in rodent uteri and, since then, have been described in other female tissues including ovaries, breast, and the lactotrope and gonadotrope cells of the anterior pituitary gland. In these tissues and cells, estrogen robustly stimulates PAD expression resulting in changes in levels over the course of the female reproductive cycle. The best-characterized targets for PADs are arginine residues in histone tails, which, when citrullinated, alter chromatin structure and gene expression. Methodological advances have allowed for the identification of tissue-specific citrullinomes, which reveal that PADs citrullinate a wide range of enzymes and structural proteins to alter cell function. In contrast to their important physiological roles, PADs and citrullinated proteins are also involved in several female-specific diseases including autoimmune disorders and reproductive cancers. Herein, we review current knowledge regarding PAD expression and function and highlight the role of protein citrullination in both normal female reproductive tissues and associated diseases.