Shifting Antarctic Circumpolar Current south of Africa over the past 1.9 million years.

The Antarctic Circumpolar Current (ACC) dominates the transfer of heat, salt, and tracers around the Southern Ocean (SO), driving the upwelling of carbon-rich deep waters around Antarctica. Paleoclimate reconstructions reveal marked variability in SO circulation; however, few records exist coupling quantitative reconstructions of ACC flow with tracers of SO upwelling spanning multiple Pleistocene glacial cycles. Here, we reconstruct near-bottom flow speed variability in the SO south of Africa, revealing systematic glacial-interglacial variations in the strength and/or proximity of ACC jets.

Revisiting the mid-Pleistocene transition ocean circulation crisis.

The mid-Pleistocene transition (MPT) [~1.25 to 0.85 million years ago (Ma)] marks a shift in the character of glacial-interglacial climate (, ).

Sedimentary DNA reveals the link between microbial community dynamics and climate during the late last glaciation in the offshore region of the Zambezi River, Southwest Indian Ocean.

Reconstructing the relationship between microbial communities and past abrupt climate change is of great importance for understanding current biodiversity patterns and predicting changes under future climate scenarios. However, little is currently known about how microbial communities respond to changes in key environmental stages due to a lack of research in this area. Here, we examine the variability in the communities of bacteria, archaea, and fungi from sediments deposited offshore region of the Zambezi River between 21.

Indian Ocean salinity build-up primes deglacial ocean circulation recovery.

The Indian Ocean provides a source of salt for North Atlantic deep-water convection sites, via the Agulhas Leakage, and may thus drive changes in the ocean's overturning circulation. However, little is known about the salt content variability of Indian Ocean and Agulhas Leakage waters during past glacial cycles and how this may influence circulation. Here we show that the glacial Indian Ocean surface salt budget was notably different from the modern, responding dynamically to changes in sea level.

Left ventricular blood flow kinetic energy is associated with the six-minute walk test and left ventricular remodelling post valvular intervention in aortic stenosis.

Background: Left ventricular (LV) kinetic energy (KE) assessment by four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) may offer incremental value over routine assessment in aortic stenosis (AS). The main objective of this study is to investigate the LV KE in patients with AS before and after the valve intervention. In addition, this study aimed to investigate if LV KE offers incremental value for its association to the six-minute walk test (6MWT) or LV remodelling post-intervention.

Standard and emerging CMR methods for mitral regurgitation quantification.

Background: There are several methods to quantify mitral regurgitation (MR) by cardiovascular magnetic resonance (CMR). The interoperability of these methods and their reproducibility remains undetermined.

Objective: To determine the agreement and reproducibility of different MR quantification methods by CMR across all aetiologies.

Antarctic icebergs reorganize ocean circulation during Pleistocene glacials.

The dominant feature of large-scale mass transfer in the modern ocean is the Atlantic meridional overturning circulation (AMOC). The geometry and vigour of this circulation influences global climate on various timescales. Palaeoceanographic evidence suggests that during glacial periods of the past 1.

A late Pleistocene dataset of Agulhas Current variability.

The interocean transfer of thermocline water between the Indian and the Atlantic Oceans known as 'Agulhas leakage' is of global significance as it influences the Atlantic Meridional Overturning Circulation (AMOC) on different time scales. Variability in the Agulhas Current regime is key in shaping hydroclimate on the adjacent coastal areas of the African continent today as well as during past climates. However, the lack of long, continuous records from the proximal Agulhas Current region dating beyond the last glacial cycle prevents elucidation of its role in regional and wider global climate changes.

Validation of four-dimensional flow cardiovascular magnetic resonance for aortic stenosis assessment.

The management of patients with aortic stenosis (AS) crucially depends on accurate diagnosis. The main aim of this study were to validate the four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR) methods for AS assessment. Eighteen patients with clinically severe AS were recruited.

Prolonged enoxaparin therapy compared with standard-of-care antithrombotic therapy in opiate-treated patients undergoing primary percutaneous coronary intervention.

A novel enoxaparin regimen consisting of intra-arterial bolus (0.75 mg/kg) followed by intravenous infusion (0.75 mg/kg/6 hours) has been developed as a possible solution to the delayed absorption of oral P2Y inhibitors in opiate-treated ST-elevation myocardial infarction (STEMI) patients undergoing primary angioplasty.

Natural drivers of multidecadal Arctic sea ice variability over the last millennium.

The climate varies due to human activity, natural climate cycles, and natural events external to the climate system. Understanding the different roles played by these drivers of variability is fundamental to predicting near-term climate change and changing extremes, and to attributing observed change to anthropogenic or natural factors. Natural drivers such as large explosive volcanic eruptions or multidecadal cycles in ocean circulation occur infrequently and are therefore poorly represented within the observational record.

Closure of the Bering Strait caused Mid-Pleistocene Transition cooling.

The Mid-Pleistocene Transition (MPT) is characterised by cooling and lengthening glacial cycles from 600-1200 ka, thought to be driven by reductions in glacial CO in particular from ~900 ka onwards. Reduced high latitude upwelling, a process that retains CO within the deep ocean over glacials, could have aided drawdown but has so far not been constrained in either hemisphere over the MPT. Here, we find that reduced nutrient upwelling in the Bering Sea, and North Pacific Intermediate Water expansion, coincided with the MPT and became more persistent at ~900 ka.

Study of Two Dose Regimens of Ticagrelor Compared With Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention for Stable Coronary Artery Disease.

Background: Ticagrelor has superior efficacy to clopidogrel in the management of acute coronary syndromes but has not been assessed in patients undergoing percutaneous coronary intervention for stable coronary artery disease. We compared the pharmacodynamic effects of ticagrelor and clopidogrel in this stable population.

Methods: One hundred eighty aspirin-treated stable coronary artery disease patients, who were planned to undergo elective percutaneous coronary intervention in a single center, were randomized 1:1:1 to either a standard clopidogrel regimen or 1 of 2 regimens of ticagrelor, either 90 mg (T90) or 60 mg twice daily (T60), both with a 180 mg loading dose.

Pharmacodynamic Effects of a 6-Hour Regimen of Enoxaparin in Patients Undergoing Primary Percutaneous Coronary Intervention (PENNY PCI Study).

Delayed onset of action of oral P2Y inhibitors in ST-elevation myocardial infarction (STEMI) patients may increase the risk of acute stent thrombosis. Available parenteral anti-thrombotic strategies, to deal with this issue, are limited by added cost and increased risk of bleeding. We investigated the pharmacodynamic effects of a novel regimen of enoxaparin in STEMI patients undergoing primary percutaneous coronary intervention (PPCI).

Anomalously weak Labrador Sea convection and Atlantic overturning during the past 150 years.

The Atlantic meridional overturning circulation (AMOC) is a system of ocean currents that has an essential role in Earth's climate, redistributing heat and influencing the carbon cycle. The AMOC has been shown to be weakening in recent years ; this decline may reflect decadal-scale variability in convection in the Labrador Sea, but short observational datasets preclude a longer-term perspective on the modern state and variability of Labrador Sea convection and the AMOC. Here we provide several lines of palaeo-oceanographic evidence that Labrador Sea deep convection and the AMOC have been anomalously weak over the past 150 years or so (since the end of the Little Ice Age, LIA, approximately AD 1850) compared with the preceding 1,500 years.

Author Correction: North Atlantic variability and its links to European climate over the last 3000 years.

In the original version of this Article, the third sentence of the first paragraph of the "Changes in the input of polar waters into the Labrador Sea" section of the Results originally incorrectly read 'During the spring-summer months, after the winter convection has ceased in the Labrador Sea, its northwest boundary currents (the EGC and IC) support restratification of the surface ocean through lateral transport.' The correct version states 'northeast' instead of 'northwest'. The fifth sentence of the second paragraph of the same section originally incorrectly read "In contrast, in the western section of the Nordic Seas, under the presence of warm Atlantic waters of the Norwegian Current, Nps was found to calcify deeper in the water column (100-200 m), whereas in the east under the influence of the EGC polar waters it calcified closer to the surface at a similar depth as Tq.

North Atlantic variability and its links to European climate over the last 3000 years.

The subpolar North Atlantic is a key location for the Earth's climate system. In the Labrador Sea, intense winter air-sea heat exchange drives the formation of deep waters and the surface circulation of warm waters around the subpolar gyre. This process therefore has the ability to modulate the oceanic northward heat transport.

Sea level fall during glaciation stabilized atmospheric CO by enhanced volcanic degassing.

Paleo-climate records and geodynamic modelling indicate the existence of complex interactions between glacial sea level changes, volcanic degassing and atmospheric CO, which may have modulated the climate system's descent into the last ice age. Between ∼85 and 70 kyr ago, during an interval of decreasing axial tilt, the orbital component in global temperature records gradually declined, while atmospheric CO, instead of continuing its long-term correlation with Antarctic temperature, remained relatively stable. Here, based on novel global geodynamic models and the joint interpretation of paleo-proxy data as well as biogeochemical simulations, we show that a sea level fall in this interval caused enhanced pressure-release melting in the uppermost mantle, which may have induced a surge in magma and CO fluxes from mid-ocean ridges and oceanic hotspot volcanoes.

Comparison of P2Y inhibitors for mortality and stent thrombosis in patients with acute coronary syndromes: Single center study of 10 793 consecutive 'real-world' patients.

Three oral platelet P2Y inhibitors, clopidogrel, prasugrel, and ticagrelor, are available for reducing the risk of cardiovascular death and stent thrombosis in patients with acute coronary syndromes (ACS). We sought to compare the efficacy of these antiplatelet drugs in contemporary practice. Data were collected for 10 793 consecutive ACS patients undergoing coronary angiography at Sheffield, UK (2009-2015).

First evidence for truffle production from plants inoculated with mycelial pure cultures.

Truffle (Tuber spp.) cultivation is based on raising mycorrhizal trees in greenhouses that have been inoculated with suspensions of ascospores. The problem with this is that pests, pathogens, and other mycorrhizal fungi can contaminate the trees.

Eastern South African hydroclimate over the past 270,000 years.

Processes that control the hydrological balance in eastern South Africa on orbital to millennial timescales remain poorly understood because proxy records documenting its variability at high resolution are scarce. In this work, we present a detailed 270,000 year-long record of terrestrial climate variability in the KwaZulu-Natal province based on elemental ratios of Fe/K from the southwest Indian Ocean, derived from X-ray fluorescence core scanning. Eastern South African climate variability on these time scales reflects both the long-term effect of regional insolation changes driven by orbital precession and the effects associated with high-latitude abrupt climate forcing over the past two glacial-interglacial cycles, including millennial-scale events not previously identified.

Glacial reduction and millennial-scale variations in Drake Passage throughflow.

The Drake Passage (DP) is the major geographic constriction for the Antarctic Circumpolar Current (ACC) and exerts a strong control on the exchange of physical, chemical, and biological properties between the Atlantic, Pacific, and Indian Ocean basins. Resolving changes in the flow of circumpolar water masses through this gateway is, therefore, crucial for advancing our understanding of the Southern Ocean's role in global ocean and climate variability. Here, we reconstruct changes in DP throughflow dynamics over the past 65,000 y based on grain size and geochemical properties of sediment records from the southernmost continental margin of South America.

Hypertensive emergency and type 2 myocardial infarction resulting from pheochromocytoma and concurrent capnocytophaga canimorsus infection.

A diagnosis of myocardial infarction is made using a combination of clinical presentation, electrocardiogram and cardiac biomarkers. However, myocardial infarction can be caused by factors other than coronary artery plaque rupture and thrombosis. We describe an interesting case presenting with hypertensive emergency and type 2 myocardial infarction resulting from Pheochromocytoma associated with Capnocytophaga canimorsus infection from a dog bite.