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Flood protection measures can have large impacts on ecosystems and their biodiversity, yet direct comparisons of active and inactive floodplains are rare. We compared the number of roadkilled individuals of two semiaquatic water snakes (Natrix natrix and N. tessellata) on 58 km of road sections bordered either by an active floodplain or a flood-protected former floodplain in NE Hungary based on surveys conducted once every two weeks in three years. We found unexpectedly high road mortality of snakes, which was rather similar across years. Mortality had a spring and an autumn peak, corresponding to the times when snakes emerge from and return to hibernating sites. Road mortality was more severe and more predictable in the flooded than in the flood-protected area, even though traffic was more intense in the latter. Our results show that small-scale spatial differences in road mortality are mediated by landscape structure along the road, while the effects of traffic intensity and the age and sex of the individuals were negligible. For conservation implications, our study suggests that establishing culvert passages under the road and artificial hibernating sites on the floodplain-side of the roads in critical sections to reduce the road-related mortality.

Despite efforts on ecosystem restoration and management, biodiversity loss remains one of the major environmental concerns of our time. Beyond the focus on threatened species, animals that indicate regional biodiversity hotspots and population trends, such as brood parasites, should also be targeted by conservation actions. We studied how reed habitat quality and management influence brood parasitism rate and offspring survival in Common Cuckoos

1. Understanding animals’ selection of microhabitats is important in both ecology and biodiversity conservation. However, there is no generally accepted methodology for the characterisation of microhabitats, especially for vegetation structure. 2. Here we present a method that objectively characterises vegetation structure by using automated processing of images taken of the vegetation against a whiteboard under standardised conditions. We developed an R script for automatic calculation of four vegetation structure variables derived from raster data stored in the images: leaf area (LA), height of closed vegetation (HCV), maximum height of vegetation (MHC), and foliage height diversity (FHD). 3. We demonstrate the applicability of this method by testing the influence of vegetation structure on the occurrence of three viperid snakes in three grassland ecosystems: Vipera graeca in mountain meadows in Albania, V. renardi in loess steppes in Ukraine and V. ursinii in sand grasslands in Hungary. 4. We found that the variables followed normal distribution and there was minimal correlation between those. Generalized linear mixed models revealed that snake occurrence was positively related to HCV in V. graeca, to LA in V. renardi and to LA and MHC in V. ursinii, and negatively to FHD in V. renardi, and to HCV in V. ursinii. 5. Our results demonstrate that biologically meaningful vegetation structure variables can be derived from automated image processing. Our method minimises the risk of subjectivity in measuring vegetation structure, allows upscaling if neighbouring pixels are combined, and is suitable for comparison of or extrapolation across different grasslands, vegetation types or ecosystems.

Background Understanding predator–prey relationships is fundamental in many areas of ecology and conservation. In reptiles, basking time often increases the risk of predation and one way to minimise this risk is to reduce activity time and to stay within a refuge. However, this implies costs of lost opportunities for foraging, reproduction, and thermoregulation. We aimed to determine the main potential and observed predators of Vipera graeca, to infer predation pressure by estimating the incidence and the body length and sex distribution of predation events based on body injuries, and to assess whether and how the activity of V. graeca individuals is modified by predation pressure. Results We observed n = 12 raptor bird species foraging at the study sites, of which Circaetus gallicus, Falco tinnunculus and Corvus cornix were directly observed as predators of V. graeca. We found injuries and wounds on 12.5% of the studied individuals (n = 319). The occurrence of injuries was significantly positively influenced by the body length of vipers, and was more frequent on females than on males, while the interaction of length and sex showed a significant negative effect. The temporal overlap between predator and viper activity was much greater for the vipers’ potential activity than their realised activity. Vipers showed a temporal shift in their bimodal daily activity pattern as they were active earlier in the morning and later in the afternoon than could be expected based on the thermal conditions. Conclusion The time spent being active on the surface has costs to snakes: predation-related injuries increased in frequency with length, were more frequent in females than in males and occurred in shorter length for males than for females. Our results suggest that vipers do not fully exploit the thermally optimal time window available to them, likely because they shift their activity to periods with fewer avian predators.

Soda pans in Central Europe are inland saline waters of nonmarine origin that represent dynamically changing environments with unique species and communities. Our aim was to explore the spatial and temporal variation in water bug assemblages among soda pans at 3 temporal scales (years, seasons, and months). Data on 9005 individuals belonging to 18 species collected in 3 seasons per year for 4 years in 5 soda pans demonstrated large interannual and seasonal fluctuations of water bugs. Two water boatman species (Paracorixa concinna, Sigara lateralis) were dominant, and species composition varied little among soda pans, seasons, or years. Species richness and abundance were influenced by interactions among soda pans, year, and season and showed cyclic changes in dry years and serial changes in wet years. Richness and abundance were highest in 2000 when water levels were high in spring and early summer. Richness was also high but abundance was lowest in 2010, a year with extremely high precipitation after a dry year. Richness and abundance peaks (individual numbers up to 2100 m−2) occurred in late summer, suggesting that water bugs are important in the trophic network of soda pans. Our results suggest that weather-driven extreme fluctuations in soda pans determine the spatial and temporal variation of water bug assemblages, with cycles of local extinction and recolonization maintained by good dispersal ability.

Grassland ecosystems are among the most threatened biomes, and their restoration has become common in nature conservation. Yet restoration is rarely applied specifically for reptiles, which are among the most threatened vertebrates. The Meadow Viper (Vipera ursinii) has become extinct in most of lowland Europe, and an endangered subspecies (Vipera ursinii rakosiensis) has been a target of habitat restoration and captive breeding in Hungary since 2004. We quantified vegetation properties and the density of reptiles that either spontaneously colonised (three species) or were reintroduced (V. ursinii) in a grassland restored specifically for this purpose. We used a fine-scale survey to estimate the cover, and compositional and vertical diversity of the vegetation. We characterised sampling units along three habitat gradients: wetness, openness and grass tussock size. Model selection based on data from replicated counts showed that Green Lizards (Lacerta viridis) responded positively to vegetation cover and negatively to tussock area and height, and number of burrows. The Sand Lizard (Lacerta agilis) responded positively to vegetation cover, vertical diversity and wetness, and negatively to openness. The Balkan Wall Lizard (Podarcis tauricus) responded positively to tussock height and negatively to vegetation cover. Finally, V. ursinii responded positively to vegetation cover and tussock height, and negatively to compositional diversity. Our results show the general importance of structural and compositional diversity of vegetation to reptiles. These results suggest that adaptive management should focus on increasing the total cover (for lizards) and the structural diversity of vegetation (for each species) to benefit reptiles in restored grasslands.

Spatial prioritization in systematic conservation planning has traditionally been developed for several to many species and/or habitats, and single-species applications are rare. We developed a novel spatial prioritization model based on accurate estimates of remotely-sensed data and maps of threats potentially affecting long-term species persistence. We used this approach to identify priority areas for the conservation of the Endangered Greek meadow viper Vipera graeca, a cold-adapted species inhabiting mountaintops in the Pindos Mountains of Greece and Albania. We transformed the mapped threats into nine variables to estimate conservation value: habitat suitability (climate suitability, habitat size, occupancy, vegetation suitability), climate change (future persistence, potential for altitudinal range shift) and land-use impact (habitat alteration, degradation, disturbance). We applied the Zonation systematic conservation planning tool with these conservation value variables as biodiversity features to rank the areas currently occupied by the species and to identify priority areas where the chances for population persistence are highest. We found that 90% of current habitats will become unsuitable by the 2080s and that conservation actions need to be implemented to avoid extinction as this is already a threatened species with a narrow ecological niche. If threats are appropriately quantified and translated into variables of conservation value, spatial conservation planning tools can successfully identify priority areas for the conservation of single species. Our study demonstrates that spatial prioritization for single umbrella, flagship or keystone species is a promising approach for the conservation of species for which few data are available.

Cardiovascular diseases are still the leading cause of mortality due to increased atherosclerosis worldwide. In the background of accelerated atherosclerosis, the most important risk factors include hypertension, age, male gender, hereditary predisposition, diabetes, obesity, smoking and lipid metabolism disorder. Arterial stiffness is a firmly established, independent predictor of cardiovascular risk. Patients with familial hypercholesterolemia are at very high cardiovascular risk. Non-invasive measurement of arterial stiffness is suitable for screening vascular dysfunction at subclinical stage in this severe inherited disorder. Some former studies found stiffer arteries in patients with familial hypercholesterolemia compared to healthy controls, while statin treatment has a beneficial effect on it. If conventional drug therapy fails in patients with severe familial hypercholesterolemia, PCSK9 inhibitor therapy should be administered; if these agents are not available, performing selective LDL apheresis could be considered. The impact of recent therapeutic approaches on vascular stiffness is not widely studied yet, even though the degree of accelerated athero and arteriosclerosis correlates with cardiovascular risk. The authors provide an overview of the diagnosis of familial hypercholesterolemia and the findings of studies on arterial dysfunction in patients with familial hypercholesterolemia, in addition to presenting the latest therapeutic options and their effects on arterial elasticity parameters.

Background: Takotsubo cardiomyopathy (TTC) is an important complication of subarachnoid hemorrhage (SAH), that may delay surgical or endovascular treatment and may influence patient outcome. This prospective follow-up study intended to collect data on the prevalence, severity, influencing factors and long-term outcome of TTC in patients suffering from non-traumatic SAH. Methods: Consecutive patients admitted with the diagnosis of non-traumatic SAH were included. Intitial assessment consisted of cranial CT, Hunt-Hess, Fisher and WFNS scoring, 12-lead ECG, transthoracic echocardiography (TTE), transcranial duplex sonography and collecting laboratory parameters (CK, CK-MB, cardiac troponin T, NT-proBNP and urine metanephrine and normetanephrine). Diagnosis of TTC was based on modified Mayo criteria. TTC patients were dichotomized to mild and severe forms. Follow-up of TTE, Glasgow Outcome Scale assessment, Barthel’s and Karnofsky scoring occurred on days 30 and 180.Results: One hundred thirty six patients were included. The incidence of TTC in the entire cohort was 28.7 %; of them, 20.6% and 8.1% were mild and severe, respectively. TTC was more frequent in females (30/39; 77%) than in males (9/39; 23%) and was more severe. The occurrence of TTC was related to mFisher scores and WFNS scores. Although the severity of TTC was related to mFisher score, Hunt-Hess score, WFNS score and GCS, multivariate analysis showed the strongest relationship with mFisher scores. Ejection fraction differences between groups were present on day 30, but disappeared by day 180, whereas wall motion score index was still higher in the severe TTC group at day 180. By the end of the follow-up period (180 days), 70 (74.5%) patients survived in the non-TTC, 22 (81.5%) in the mild TTC and 3 (27%) in the severe TTC group (n = 11) (p = 0.002). At day 180, GOS, Barthel, and Karnofsky outcome scores were higher in patients in the control (non-TTC) and the mild TTC groups than in the severe TTC group. Conclusions: Takotsubo cardiomyopathy is a frequent finding in patients with SAH, and severe TTC may be present in 8% of SAH cases. The severity of TTC may be an independent predictor of mortality and outcome at 6 months after disease onset. Therefore, a regular follow-up of ECG and TTE abnormalities is warranted in patients with subrachnoid hemorrhage for early detection of TTC. Trial registration: The study was registered at the Clinical Trials Register under the registration number of NCT02659878 (date of registration: January 21, 2016)

High‐quality information on predator–prey relationships is fundamental in understanding food webs, community assembly and ecosystem functioning. Recent analytical advances have made it possible to develop new trait‐based approaches to study trophic relationships and evaluate trait matching between predators and prey. Here, we develop a novel analytical approach based on generalized linear mixed‐effects models (GLMM) to test the importance of prey availability and to identify the set of prey traits that best explain the occurrence and number of prey in the predator's diet. We demonstrate that the approach by using an extensive dataset on prey availability, prey traits and gut content collected in all known populations of Vipera graeca, a little‐known, endangered snake of alpine grasslands in the Pindos Mountains of the Balkan Peninsula. We show that V. graeca is a unique, venomous snake specialized on bush‐crickets and grasshoppers (Orthoptera). Prey selection GLMMs showed that the ideal prey of V. graeca is abundant, large‐bodied, has poor escape abilities (flightless, slow‐moving and bad jumper) and prefers loose grasslands (as opposed to bare ground/rock or closed sward). Vipers restrict their feeding to periods of high Orthoptera abundance in the late summer and need to reach a certain body size to become able to catch large‐sized prey. Our analytical approach provides a framework for trait matching between predators and prey and unprecedented fine‐scale information on the importance of prey traits in prey selection by a specialist predator. The narrow trophic niche of V. graeca likely increases the vulnerability of this cold‐adapted snake to extinction. A free Plain Language Summary can be found within the Supporting Information of this article.

Background The paucity of easy-to-use, reliable objective neuromuscular monitors is an obstacle to universal adoption of routine neuromuscular monitoring. Electromyography (EMG) has been proposed as the optimal neuromuscular monitoring technology since it addresses several acceleromyography limitations. This clinical study compared simultaneous neuromuscular responses recorded from induction of neuromuscular block until recovery using the acceleromyography-based TOF-Watch SX and EMG-based TetraGraph. Methods Fifty consenting patients participated. The acceleromyography and EMG devices analyzed simultaneous contractions (acceleromyography) and muscle action potentials (EMG) from the adductor pollicis muscle by synchronization via fiber optic cable link. Bland–Altman analysis described the agreement between devices during distinct phases of neuromuscular block. The primary endpoint was agreement of acceleromyography- and EMG-derived normalized train-of-four ratios greater than or equal to 80%. Secondary endpoints were agreement in the recovery train-of-four ratio range less than 80% and agreement of baseline train-of-four ratios between the devices. Results Acceleromyography showed normalized train-of-four ratio greater than or equal to 80% earlier than EMG. When acceleromyography showed train-of-four ratio greater than or equal to 80% (n = 2,929), the bias was 1.3 toward acceleromyography (limits of agreement, –14.0 to 16.6). When EMG showed train-of-four ratio greater than or equal to 80% (n = 2,284), the bias was –0.5 toward EMG (–14.7 to 13.6). In the acceleromyography range train-of-four ratio less than 80% (n = 2,802), the bias was 2.1 (–16.1 to 20.2), and in the EMG range train-of-four ratio less than 80% (n = 3,447), it was 2.6 (–14.4 to 19.6). Baseline train-of-four ratios were higher and more variable with acceleromyography than with EMG. Conclusions Bias was lower than in previous studies. Limits of agreement were wider than expected because acceleromyography readings varied more than EMG both at baseline and during recovery. The EMG-based monitor had higher precision and greater repeatability than acceleromyography. This difference between monitors was even greater when EMG data were compared to raw (nonnormalized) acceleromyography measurements. The EMG monitor is a better indicator of adequate recovery from neuromuscular block and readiness for safe tracheal extubation than the acceleromyography monitor. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Összefoglaló. A cardiovascularis megbetegedések kialakulását és progresszióját jelentősen befolyásolja az életmód, ezen belül a fizikai aktivitás. A rendszeres testmozgás csökkenti a szív- és érrendszeri kórképek kockázatát, többek között a magas vérnyomásra, a zsíranyagcsere-eltérésekre és az elhízásra gyakorolt kedvező hatásán keresztül, továbbá független tényező a cardiovascularis halálozás szempontjából is. Az artériás érfali merevség az elasztikus artériák falát alkotó extracelluláris mátrix degeneratív eltéréseinek következtében alakul ki a különböző kockázati tényezők hatására. Korábban, különböző populációkon már igazolták az érfali merevség prediktív értékét a cardiovascularis események kialakulásának tekintetében. A pulzushullám-terjedési sebesség mérése a leggyakrabban alkalmazott módszer az érfali merevség meghatározására. A pulzushullám-terjedési sebesség mérésének hasznát a cardiovascularis kimenetel és élettartam becslésében számos populációs szintű követéses vizsgálat igazolja. Jelen munkánkban áttekintjük a rendszeres fizikai aktivitás, az érfali merevség, az érelmeszesedés és a cardiovascularis események közötti összefüggéseket. Összefoglaljuk az edzésnek és az érfali merevség paramétereinek kapcsolatát egészséges populáción vizsgáló legfontosabb tanulmányok eredményeit. Megállapítjuk, hogy az érfali merevség figyelemre méltó, érdekes biomarker a cardiovascularis kockázat becslése során a rendszeresen sportoló személyek esetén is. Mindezek alapján, tekintve annak prognosztikai hasznát, felmerül a pulzushullám-terjedési sebesség mérésének beillesztése a klinikai döntéshozatali folyamatba mind amatőr, mind professzionális sportolók esetében. Orv Hetil. 2021; 162(16): 615-622. Summary. The development and progression of cardiovascular disorders is importantly dependent on lifestyle factors, including physical activity. Regular physical activity decreases cardiovascular morbidity by ameliorating risk factors such as hypertension, dyslipidemia and obesity, moreover, also independently affects cardiovascular mortality. Arterial stiffness results from a degenerative process affecting mainly the extracellular matrix of elastic arteries under the effect of risk factors. Previously, the independent predictive value of arterial stiffness for cardiovascular events has been demonstrated in various populations. Pulse wave velocity is the most commonly used method for the assessment of arterial stiffness. The value of measuring pulse wave velocity to predict cardiovascular health outcomes and longevity has been established in several population-based longitudinal studies. In this review, we summarize the main associations between regular physical exercise, arterial stiffness, atherosclerotic burden and incident cardiovascular events. We cite findings from the major studies focusing on the effect of training on arterial stiffness parameters in healthy subjects. We conclude that arterial stiffness is emerging as an interesting biomarker for cardiovascular risk stratification in subjects doing regular physical activity. Therefore, the incorporation of pulse wave velocity measurement into clinical decision-making could be indicated in the case of both amateur and professional athletes, given the prognostic information it provides. Orv Hetil. 2021; 162(16): 615-622.

A Biologiai Sokfeleseg es Okoszisztema-szolgaltatas Kormanykozi Testulet (IPBES) negy regionalis ertekelő tanulmanyt keszitett 2015 es 2018 kozott. Jelen munkaban az Europa es Kozep-Azsia biodiverzitasaval es okoszisztema-szolgaltatasaival foglalkozo regionalis ertekelő tanulmanyt ismertetjuk, melyet 118 szerző 4750 informacioforras felhasznalasaval keszitett. Az ertekelő tanulmany fő megallapitasai: (i) a biodiverzitas es okoszisztema-szolgaltatasok fogyatkozasa a legtobb előlenycsoport es okoszisztema eseten aggaszto mertekű, (ii) a fogyatkozas fő oka a tajhasznalat valtozasa (mező- es erdőgazdalkodas, urbanizacio), de egyre nő a klimavaltozas szerepe is, (iii) ha a jelenlegi trendek folytatodnak, az aktualis fenntarthatosagi es biodiverzitas-vedelmi celkitűzesek nem teljesulnek, es (iv) a biodiverzitas-vedelmi szempontok politikai fősodorba kerulese es jobb integralasa a szektoralis szakpolitikakba elengedhetetlen a negativ tendenciak lassitasahoz vagy megallitasahoz.

Background Certain surgical interventions may require a deep neuromuscular block (NMB). Reversal of such a block before tracheal extubation is challenging. Because anticholinesterases are ineffective in deep block, sugammadex 4 mg/kg has been recommended for the reversal of rocuronium- or vecuronium-induced deep NMB. However, this recommendation requires opening 2 vials of 200 mg sugammadex, which results in an increase in drug costs. Therefore, we sought a less expensive solution for the induction and reversal of deep NMB. Although the optimal dose of sugammadex for antagonism of deep block from pipecuronium has not been established, data pertaining to moderate block are available. Accordingly, we hypothesized that sugammadex 2 mg/kg would be a proper dose to reverse deep pipecuronium block, enabling us to avoid cost increases. In the present study, we compared sugammadex 2 mg/kg with the standard dose of 4 mg/kg for reversal of deep block from pipecuronium. Methods This single-center, randomized, double-blind, 2 parallel-arms, noninferiority study comprised 50 patients undergoing general anesthesia with propofol, sevoflurane, fentanyl, and pipecuronium. Neuromuscular monitoring was performed with acceleromyography (TOF-Watch SX). Noninferiority margin was specified beforehand as an increase in reversal time of no >10% (corresponding to 1 minute for the primary outcome). When the block spontaneously recovered to posttetanic count 1, the patients randomly received sugammadex 2 or 4 mg/kg, and the time from the injection to the train-of-four (TOF) ratio of 1.0 was measured. Primary outcome was the time to achieve the normalized TOF ratio of 0.9 in a particular patient. Residual or recurrent postoperative NMB was additional end point. Results Each patient recovered to the normalized TOF ratio of 0.9. In the 2 mg/kg group, reversal time was 1.73 ± 1.03 minutes (95% confidence interval [CI], 1.33-2.13; n = 25), and in the 4 mg/kg group, reversal time was 1.42 ± 0.63 minutes (mean ± standard deviation) (95% CI, 1.17-1.67; n = 25). The mean difference in reversal times between the 2 groups was 0.31 minutes (95% CI, -0.18 to 0.8), and the upper limit of CI was below the noninferiority margin of 1 minute. Postoperative block did not occur. Conclusions The effect of sugammadex 2 mg/kg was noninferior to that of 4 mg/kg in reversing posttetanic count-1 degree pipecuronium block. Sugammadex reversal of deep pipecuronium block appears to be effective.

One of the main goals of the EU Biodiversity Strategy for 2030 is to avoid further loss of biodiversity and to restore ecosystems. These efforts can be facilitated by compiling the main research topics related to conservation biology to provide new evidence for the most urgent knowledge gaps, and publicise it to researchers, research funders and policy makers. We used the possible future statements from the Hungarian Environmental Foresight Report for 2050 which identified region-specific problems. To highlight likely future environmental and conservation questions, in this study we asked researchers from the fields of ecology and conservation to define research questions addressing these future statements in line with international research trends and challenges. The study resulted in fourteen priority research topics, split into seven clusters relevant to biological conservation that should be targeted by stakeholders, primarily policy makers and funders to focus research capacity to these topics. The main overarching themes identified here include a wide range of approaches and solutions such as innovative technologies, involvement of local stakeholders and citizen scientists, legislation, and issues related to human health. These indicate that solutions to conservation challenges require a multidisciplinary approach in design and a multi-actor approach in implementation. Although the identified research priorities were listed for Hungary, they are in line with European and global biodiversity strategies, and can be tailored to suit other Central and Eastern European countries as well. We believe that our prioritisation can help science–policy discussion, and will eventually contribute to healthy and well-functioning ecosystems.

International audience; The biodiversity crisis has led to a surge of interest in the theory and practice of biodiversity monitoring. Although guidelines for monitoring have been published since the 1920s, we know little on current practices in existing monitoring schemes.Based on metadata on 646 species and habitat monitoring schemes in 35 European countries, we developed indicators for sampling design, sampling effort, and data analysis to evaluate monitoring practices. We also evaluated how socio-economic factors such as starting year, funding source, motivation and geographic scope of monitoring affect these indicators.Sampling design scores varied by funding source and motivation in species monitoring and decreased with time in habitat monitoring. Sampling effort decreased with time in both species and habitat monitoring and varied by funding source and motivation in species monitoring.The frequency of using hypothesis-testing statistics was lower in species monitoring than in habitat monitoring and it varied with geographic scope in both types of monitoring. The perception of the minimum annual change detectable by schemes matched spatial sampling effort in species monitoring but was rarely estimated in habitat monitoring.Policy implications: Our study identifies promising developments but also options for improvement in sampling design and effort, and data analysis in biodiversity monitoring. Our indicators provide benchmarks to aid the identification of the strengths and weaknesses of individual monitoring schemes relative to the average of other schemes and to improve current practices, formulate best practices, standardize performance and integrate monitoring results.

Management of reed beds primarily includes controlling water levels and removing vegetation by mowing, burning, or grazing. Although recent studies have demonstrated increased diversity and abundance of wetland specialists after reed bed management, documenting demographic benefits to individual species would add additional support to the advantages of appropriate management. Here, we explore the effects of reed management on the philopatry of Great Reed Warblers (Acrocephalus arundinaceus) over 7 yr. Reed beds were managed in the winter by occasional burning at mining ponds and large canals, infrequent burning in marshes, and frequent mowing of small canals. Based on resightings and recaptures of 1,243 adult and 1,428 nestlings individually marked at 57 sites in 6 different reed habitats, we built Cormack-Jolly-Seber models to estimate the apparent annual survival and encounter probabilities of birds banded as nestlings or as adults. Apparent survival varied in time for both age groups and both ...

Electronic neuromuscular monitoring is not widely used to determine either the reversal requirements for neuromuscular block before extubation of the trachea, or to determine if there is any subsequent postoperative residual neuromuscular block (PORNB).To investigate the incidence of PORNB using acceleromyography after spontaneous recovery of rocuronium-induced block and to compare this with the administration of sugammadex, neostigmine or a placebo.Partially randomised, partially randomised, placebo-controlled, double-blind, four-group parallel-arm study.Single-centre study performed between October 2013 and December 2015 in a university hospital.Of the 134 eligible patients, 128 gave their consent and 125 of these completed the study.Patients received general anaesthesia with propofol, sevoflurane, fentanyl and rocuronium. Neuromuscular transmission was measured by acceleromyography (TOF-Watch-SX; Organon Teknika B.V., Boxtel, the Netherlands) but the anaesthetist was blind to the results. If the anaesthetist deemed pharmacological reversal to be necessary before extubation of the trachea then patients were assigned randomly to receive either sugammadex (2.0 mg kg), neostigmine (0.05 mg kg) or a placebo. In the postanaesthesia care unit, an independent anaesthetist, unaware of the treatment given, assessed the neuromuscular function using acceleromyography.The incidence of a normalised train-of-four ratio less than 0.9 on arrival in the recovery room.In total, 125 patients were recruited. Neuromuscular block was allowed to recover spontaneously in 50 patients, whereas the remainder received either sugammadex (27), neostigmine (26) or placebo (22). The number of cases with PORNB were one (3.7%), four (15%), 13 (26%) and 10 (45%) after sugammadex, neostigmine, spontaneous recovery and placebo, respectively. Sugammadex and neostigmine were more effective than placebo [odds ratio (OR): 0.05, 95% confidence interval (CI): 0.005 to 0.403, P = 0.005; OR: 0.22, 95% CI: 0.056 to 0.85, P = 0.028, respectively]. Sugammadex performed better than spontaneous recovery (OR: 0.11, 95% CI: 0.014 to 0.89, P = 0.039) unlike neostigmine (OR: 0.52, 95% CI: 0.15 to 1.79, P = 0.297). Yet, antagonism (pooled data) was more effective than spontaneous recovery (OR: 0.3, 95% CI: 0.1 to 0.9, P = 0.03).Although pharmacological reversal based on clinical signs was superior to spontaneous recovery it did not prevent PORNB, irrespective of the reversal agent.The study is registered under EUDRACT number 2013-001965-17.

Background Rocuronium-induced neuromuscular block that spontaneously recovered to a train-of-four count of four can be reversed with sugammadex 0.5 or 1.0 mg/kg. We investigated whether these doses of sugammadex can also reverse vecuronium at a similar level of block. Methods Sixty-five patients were randomly assigned, and 64 were analyzed in this controlled, superiority study. Participants received general anesthesia with propofol, sevoflurane, fentanyl, and vecuronium. Measurement of neuromuscular function was performed with acceleromyography (TOF-Watch-SX, Organon Teknika B.V., The Netherlands ). Once the block recovered spontaneously to four twitches in response to train-of-four stimulation, patients were randomly assigned to receive sugammadex 0.5, 1.0, or 2.0 mg/kg; neostigmine 0.05 mg/kg; or placebo. Time from study drug injection to normalized train-of-four ratio 0.9 and the incidence of incomplete reversal within 30 min were the primary outcome variables. Secondary outcome was the incidence of reparalysis (normalized train-of-four ratio less than 0.9). Results Sugammadex, in doses of 1.0 and 2.0 mg/kg, reversed a threshold train-of-four count of four to normalized train-of-four ratio of 0.9 or higher in all patients in 4.4 ± 2.3 min (mean ± SD) and 2.6 ± 1.6 min, respectively. Sugammadex 0.5 mg/kg reversed the block in 6.8 ± 4.1 min in 70% of patients (P < 0.0001 vs. 1.0 and 2.0 mg/kg), whereas neostigmine produced reversal in 11.3 ± 9.7 min in 77% of patients (P > 0.05 vs. sugammadex 0.5 mg/kg). The overall frequency of reparalysis was 18.7%, but this incidence varied from group to group. Conclusions Sugammadex 1.0 mg/kg, unlike 0.5 mg/kg, properly reversed a threshold train-of-four count of four vecuronium-induced block but did not prevent reparalysis.

Summary The conservation of freshwater ecosystems has lagged behind that of marine and terrestrial ecosystems and often requires the integration of large-scale approaches and transboundary considerations. This study aims to set the foundations of a spatial conservation strategy by identifying the most important catchments for the conservation of freshwater biodiversity in Europe. Using data on 1296 species of fish, mollusc, odonate and aquatic plant, and the key biodiversity area criteria (species Red List status, range restriction and uniqueness of species assemblages), we identified a network of Critical Catchments for the conservation of freshwater biodiversity. Applying spatial prioritisation, we show how the prioritised network differs from the ideal case of protecting all Critical Catchments and how it changes when protected areas are included, and we also identify gaps between the prioritised network and existing protected areas. Critical Catchments (n = 8423) covered 45% of the area of Europe, with 766 qualifying (‘trigger’) species located primarily in southern Europe. The prioritised network, limited to 17% of the area of Europe, comprised 3492 catchments mostly in southern and eastern Europe and species targets were met for at least 96% of the trigger species. We found the majority of Critical Catchments to be inadequately covered by protected areas. However, our prioritised network presents a possible solution to augment protected areas to meet policy targets while also achieving good species coverage. Policy implications. While Critical Catchments cover almost half of Europe, priority catchments are mostly in southern and eastern Europe where the current level of protection is not sufficient. This study presents a foundation for a Europe-wide systematic conservation plan to ensure the persistence of freshwater biodiversity. Our study provides a powerful new tool for optimising investment on the conservation of freshwater biodiversity and for meeting targets set forth in international biodiversity policies, conventions and strategies.

Although Albania has a rich reptile fauna, efforts to reveal its diversity have so far been limited. To fill this gap, we collected available published and unpublished (museum collections, online sources) records of reptile occurrences and conducted several expeditions to search for reptiles in areas with few or no previous records. Our georeferenced database contains 3731 records of 40 species from between 1918 and 2015. Based on this comprehensive dataset, we prepared distribution maps for each reptile species of the country. Applying spatial statistics, we revealed that overall sampling effort was clustered, with hotspots associated with easily accessible areas and natural heritage sites. The maximum number of species per cell was 26 with an average of seven. Cells harbouring large reptile diversity were located along the Adriatic and Ionian coasts, on the western slopes of south Albanian mountains, i.e. in areas generally considered as Balkans biodiversity hotspots or potential historical refugia. We found that species presence and diversity is strongly influenced by landscape features. Diversity of land cover, altitudinal variation, temperature and precipitation variation explained the observed pattern in our models. Our study presents the largest database of reptile occurrences to date and is the first to analyse reptile diversity patterns in Albania. The database and the diversity patterns can provide a basis for future macroecological studies and conservation planning.

Albania is part of the Mediterranean biodiversity hotspot. Yet its amphibian fauna is poorly known due to little scientific exploration during the long political isolation of the country. To fill this gap, we constructed a georeferenced database with occurrences of all known amphibian species based on records from published sources and personal data collected during expeditions to poorly known areas. Our database includes 1097 records of 16 species collected between 1920 and 2017. Based on aggregated records, we analysed richness patterns of amphibians in 10 × 10 km grid cells as a function of altitude, climate, land cover diversity and distance from the sea. The mean number of species per cell was 1.8 ± 0.11 S.E. (maximum: 10 species) and at least one species occurred in 238 of the 349 cells. Sampling effort was uneven and sampling hotspots were mostly in popular sites of natural heritage. Cells with high amphibian diversity were near the Prokletije Mountains in the North-West, near Lura, Korab and Grammos Mountains and Ohrid and Prespa Lakes in the East, and near Çikës Mountains and in coastal areas of Vlorë in the South-West. General linear models showed that the most important predictors of presence and diversity of amphibian species are land cover diversity and precipitation. Our study presents the largest database of amphibian occurrences in Albania to date that will be useful for biogeographical and ecological studies and for conservation purposes.