Technetium-99m-labeled macroaggregated albumin lung perfusion scan for diagnosis of hepatopulmonary syndrome: A prospective study comparing brain uptake and whole-body uptake

BACKGROUND Hepatopulmonary syndrome (HPS) is an arterial oxygenation defect induced by intrapulmonary vascular dilatation (IPVD) in the setting of liver disease and/or portal hypertension.This syndrome occurs most often in cirrhotic patients(4%-32%) and has been shown to be detrimental to functional status,quality of life,and survival.The diagnosis of HPS in the setting of liver disease and/or portal hypertension requires the demonstration of IPVD (i.e.,diffuse or localized abnormally dilated pulmonary capillaries and pulmonary and pleural arteriovenous communications) and arterial oxygenation defects,preferably by contrast-enhanced echocardiography and measurement of the alveolar-arterial oxygen gradient,respectively.AIM To compare brain and whole-body uptake of technetium for diagnosing HPS.METHODS Sixty-nine patients with chronic liver disease and/or portal hypertension were prospectively included.Brain uptake and whole-body uptake were calculated using the geometric mean of technetium counts in the brain and lungs and in the entire body and lungs,respectively.RESULTS Thirty-two (46%) patients had IPVD as detected by contrast-enhancedechocardiography.The demographics and clinical characteristics of the patients with and without IPVD were not significantly different with the exception of the creatinine level (0.71±0.18 mg/dL vs 0.83±0.23 mg/dL;P=0.041),alveolararterial oxygen gradient (23.2±13.3 mmHg vs 16.4±14.1 mmHg;P=0.043),and arterial partial pressure of oxygen (81.0±12.1 mmHg vs 90.1±12.8 mmHg;P=0.004).Whole-body uptake was significantly higher in patients with IPVD than in patients without IPVD (48.0%±6.1%vs 40.1%±8.1%;P=0.001).The area under the curve of whole-body uptake for detecting IPVD was significantly higher than that of brain uptake (0.75 vs 0.54;P=0.025).The optimal cut-off values of brain uptake and whole-body uptake for detecting IPVD were 5.7%and 42.5%,respectively,based on Youden’s index.The sensitivity,specificity,and accuracy of brain uptake> 5.7%and whole-body uptake> 42.5%for detecting IPVD were23%,89%,and 59%and 100%,52%,and 74%,respectively.CONCLUSION Whole-body uptake is superior to brain uptake for diagnosing HPS.

Hepatopulmonary syndrome: What we know and what we would like to know

Hepatopulmonary syndrome (HPS) is characterized by abnormalities in blood oxygenation caused by the presence of intrapulmonary vascular dilations (IPVD) in the context of liver disease, generally at a cirrhotic stage. Knowledge about the subject is still only partial. The majority of the information about the etiopathogenesis of HPS has been obtained through experiments on animals. Reported prevalence in patients who are candidates for a liver transplantation (LT) varies between 4% and 32%, with a predominance of mild or moderate cases. Although it is generally asymptomatic it does have an impact on their quality of life and survival. The diagnosis requires taking an arterial blood gas sample of a seated patient with alveolar-arterial oxygen gradient (AaO2) ≥ 15 mm Hg, or ≥ 20 mm Hg in those over 64 years of age. The IPVD are identified through a transthoracic contrast echocardiography or a macroaggregated albumin lung perfusion scan (99mTc-MAA). There is currently no effective medical treatment. LT has been shown to reverse the syndrome and improve survival rates, even in severe cases. Therefore the policy of prioritizing LT would appear to increase survival rates. This paper takes a critical and clinical look at the current understanding of HPS, as well as the controversies surrounding it and possible future research.

Organic matter fractions within macroaggregates in response to long-term fertilization in calcareous soil after reclamation

Soil organic carbon(SOC)plays a key role in improving soil quality and optimizing crop yield.Yet little is known about the fate of macroaggregates(>0.25 mm)under long-term fertilization and their relative importance in SOC sequestration in reclaimed calcareous soil.Therefore,the effects of mineral fertilizers and organic manure on the mechanisms of organic carbon(OC)stabilization in macroaggregates were investigated in this study.Four treatments were used:unfertilized control(CK),mineral fertilizer(NPK),compost chicken manure alone(M),and mineral fertilizers plus manure(MNPK).Samples from the 0–20 cm layer of soil receiving 11-year-long fertilization were separated into four fractions based on the macroaggregates present(unprotected coarse and fine particulate organic matter,cPOM and fPOM;physically protected intra-microaggregate POM,i POM;and biochemically protected mineral associated OM,MOM)by the physical fractionation method.Compared with the control,the long-term application of NPK had little effect on SOC content,total nitrogen(TN)content,and OC and TN contents of macroaggregate fractions.In contrast,incorporation of organic manure(MNPK)significantly increased SOC(45.7%)and TN(24.3%)contents.Application of MNPK increased OC contents within macroaggregate-extracted fractions of cPOM(292.2%),fPOM(136.0%)and iPOM(124.0%),and TN contents within cPOM(607.1%),fPOM(242.5%)and iPOM(127.6%),but not the mineral associated organic carbon(MOM-C)and nitrogen(MOM-N)contents.Unprotected C fractions were more strongly and positively correlated with SOC increase than protected C fractions,especially for cPOM-C,indicating that SOC sequestration mainly occurred via cPOM-C in the studied calcareous soil.In conclusion,MNPK increased the quantity and stability of SOC by increasing the contents of cPOM-C and cPOM-N,suggesting that this management practice(MNPK)is an effective strategy to develop sustainable agriculture.

Soil macroaggregates and organic-matter content regulate microbial communities and enzymatic activity in a Chinese Mollisol

The formation and turnover of macroaggregates are critical processes influencing the dynamics and stabilization of soil organic carbon(SOC).Soil aggregate size distribution is directly related to the makeup and activity of microbial communities.We incubated soils managed for>30 years as restored grassland(GL),farmland(FL)and bare fallow(BF)for 60 days using both intact and reduced aggregate size distributions(intact aggregate distribution(IAD)<6 mm;reduced aggregate distribution(RAD)<1 mm),in treatments with added glucose,alanine or inorganic N,to reveal activity and microbial community structure as a function of aggregate size and makeup.Over a 60-day incubation period,the highest phospholipid fatty acid(PLFA)abundance was on day 7 for bacteria and fungi,on day 15 for actinomycete.The majority of the variation in enzymatic activities was likely related to PLFA abundance.GL had higher microbial abundance and enzyme activity.Mechanically reducing macroaggregates(>0.25 mm)by 34.7%in GL soil with no substrate additions increased the abundance of PLFAs(average increase of 15.7%)and activities of β-glucosidase(increase of 17.4%)and N-acetyl-β-glucosaminidase(increase of 7.6%).The addition of C substrates increased PLFA abundance in FL and BF by averages of 18.8 and 33.4%,respectively,but not in GL soil.The results show that the effect of habitat destruction on microorganisms depends on the soil aggregates,due to a release of bioavailable C,and the addition of substrates for soils with limited nutrient availability.The protection of SOC is promoted by larger size soil aggregate structures that are important to different aggregate size classes in affecting soil C stabilization and microbial community structure and activity.

Engineered biochar improves nitrogen use efficiency via stabilizing soil water-stable macroaggregates and enhancing nitrogen transformation

The use of inorganic nitrogen(N)fertilizers has increased drastically to meet the food requirements of the world’s growing population.However,the excessive use of chemical nitrogen fertilizer has caused a series of soil and environmental problems,such as soil hardening,lower nitrogen use efficiency(NUE),nitrate pollution of water sources,nitrous oxide emissions,etc.In this review,we aimed to elaborate and discuss the role of engineered biochar in inducing the stability of water-stable macroaggregates,improving inorganic N transformation,and utilization efficiency to address the current uncertainties of nitrogen loss and maintaining soil and water quality.Firstly,we elucidated the characteristics of engineered biochar in improving biochar quality to work as a multifunctional player in the ecosystem and promote resource utilization,soil conservation,and ecosystem preservation.Secondly,we discussed how the engineered biochar modulates the stability of water-stable macroaggregates and soil inorganic nitrogen transformation to enhance plant response under various toxic or deficient nitrogen conditions in the soil.Thirdly,the role of engineered biochar in biological nitrogen fixation,mediating nirK,nirS,and nosZ genes to promote the conversion of N_(2)O to N_(2),and decreasing denitrification and N_(2)O emission was reviewed.Altogether,we suggest that engineered biochar amendment to soil can regulate soil water-stable macroaggregates,reduce N input,improve nitrogen metabolism,and finally,NUE and crop growth.To the best of our knowledge,this is the first time to evaluate the combined interactions of"engineered biochar×soil×NUE×crop growth,"providing advantages over the increasing N and water utilization and crop productivity separately with the aim of enhancing the stability of water-stable macroaggregates and NUE together on a sustainable basis.

SOIL AGGREGATE AND ITS RESPONSE TO LAND MANAGEMENT PRACTICES

This paper provides a broad review of the existing study on soil aggregate and its responses to land management practices. Soil aggregate is used for structural unit, which is a group of primary soil particles that cohere to each other more strongly than other surrounding particles. The mechanism of soil particle aggregation may be expressed by a hierarchical model, which is based upon the hypothesis that macroaggregates （〉250μm） are collections of smaller microaggregates （〈250μm） held together with organic binding agents. Primary particles form microaggregates and then macroaggregates. Carbon （C）-rich young plant residues form and stabilize macroaggregates, whereas old organic C is occluded in the microaggregates. The interaction of aggregate dynamics with soil organic carbon （SOC） is complex and embraces a range of spatial and temporal processes within macroaggregates and microaggregates. The nature and properties of aggregates are determined by the quantity and quality of coarse residues and humic compounds and by the degree of their interaction with soil particles. The mechanisms resulting in the binding of primary soil particles into stable aggregates vary with soil parent material, climate, vegetation, and land management practices. Land management practices, including tillage methods, residue management, amendments, and soil fertility management, enhance soil aggregation. However, there is still much uncertainty in the dynamics of organic matter in macroaggregation and microaggregation, and research is still needed to understand further the mechanisms of aggregate formation and its responses to human activities.

Effects of Tillage Practices and Land Use Management on Soil Aggregates and Soil Organic Carbon in the North Appalachian Region,USA

Promoting soil carbon sequestration in agricultural land is one of the viable strategies to decelerate the observed climate changes. However, soil physical disturbances have aggravated the soil degradation process by accelerating erosion. Thus, reducing the magnitude and intensity of soil physical disturbance through appropriate farming/agricultural systems is essential to management of soil carbon sink capacity of agricultural lands. Four sites of different land use types/tillage practices, i） no-till （NT） corn （Zea mays L.） （NTC）, ii） conventional till （CT） corn （CTC）, iii） pastureland （PL）, and iv） native forest （NF）, were selected at the North Appalachian Experimental Watershed Station, Ohio, USA to assess the impact of NT farming on soil aggregate indices including water-stable aggregation, mean weight diameter （MWD） and geometric mean diameter （GMD）, and soil organic carbon and total nitrogen contents. The NTC plots received cow manure additions （about 15 t ha-1） every other year. The CTC plots involved disking and chisel ploughing and liquid fertilizer application （110 L ha-l）. The results showed that both water-stable aggregation and MWD were greater in soil for NTC than for CTC. In the 0-10 cm soil layer, the 〉 4.75-mm size fraction dominated NTC and was 46% more than that for CTC, whereas the 〈 0.25-mm size fraction was 380% more for CTC than for NTC. The values of both MWD and GMD in soil for NTC （2.17 mm and 1.19 mm, respectively） were higher than those for CTC （1.47 and 0.72 mm, respectively） in the 0-10 cm soil layer. Macroaggregates contained 6%-42% and 13%-43% higher organic carbon and total nitrogen contents, respectively, than microaggregates in soil for all sites. Macroaggregates in soil for NTC contained 40% more organic carbon and total nitrogen over microaggregates in soil for CTC. Therefore, a higher proportion of microaggregates with lower organic carbon contents created a carbon-depleted environment for CTC. In contrast, soil for NTC had more aggregation and contained higher organic carbon content within water-stable aggregates. The soil organic carbon and total nitrogen stocks （Mg ha-1） among the different sites followed the trend of NF 〉 PL 〉 NTC 〉 CTC, being 35%-46% more for NTC over CTC. The NT practice enhanced soil organic carbon content over the CT practice and thus was an important strategy of carbon sequestration in cropland soils.

Aggregate Development and Organic Matter Storage in Mediterranean Mountain Soils

Soil aggregation and organic matter of soils from the pre-Pyrenean range in Catalonia (NE Spain) were studied,in order to assess their quality as carbon sinks and also to select the best soil management practices to preserve their quality.Aggregate stability,organic carbon and micromorphology were investigated.The highest amount of organic carbon was found in alluvial,deep soils (228 Mg C ha -1 ),and the lowest was in a shallow,stony soil with a low plant cover (78 Mg C ha -1 ).Subsurface horizons of degraded soils under pastures were the ones with smaller and less-stable aggregates.Fresh residues of organic matter (OM) were found mostly in interaggregate spaces.Within the aggregates there were some organic remains that were beginning to decompose,and also impregnative nodules of amorphous OM.Although OM was evenly distributed among the aggregate fractions,the larger blocky peds had more specific surface,contained less decomposed OM and had a lower organic/mineral interphase than smaller crumb aggregates,which were also more stable.Soil carbon storage was affected primarily by the OM inputs in the surface horizons.In order to store organic carbon over the mid- and long-term periods,the mechanisms favouring structuration through biological activity and creating small aggregates with intrapedal stable microporosities seemed to be the most effective.

Short-Term Effect of Nitrogen Intensification on Aggregate Size Distribution, Microbial Biomass and Enzyme Activities in a Semi-Arid Soil Under Different Crop Types

There is a lack of quantitative assessments available on the effect of agricultural intensification on soil aggregate distribution and microbial properties. Here, we investigated how short-term nitrogen(N) intensification induced changes in aggregate size distribution and microbial properties in a soil of a hot moist semi-arid region(Bangalore, India). We hypothesised that N intensification would increase the accumulation of macroaggregates > 2 mm and soil microbial biomass and activity, and that the specific crop plant sowed would influence the level of this increase. In November 2016, surface(0–10 cm) and subsurface(10–20 cm) soil samples were taken from three N fertilisation treatments, low N(50 kg N ha-1), medium N(75 and 100 kg N ha-1 for finger millet and maize, respectively),and high N(100 and 150 kg N ha-1 for finger millet and maize, respectively). Distribution of water-stable aggregate concentrations,carbon(C) and N dynamics within aggregate size class, and soil microbial biomass and activity were evaluated. The high-N treatment significantly increased the concentration of large macroaggregates in the subsurface soil of the maize crop treatment, presumably due to an increased C input from root growth. Different N fertilisation levels did not significantly affect C and N concentrations in different aggregate size classes or the bulk soil. High-N applications significantly increased dehydrogenase activity in both the surface soil and the subsurface soil and urease activity in the surface soil, likely because of increased accumulation of enzymes stabilised by soil colloids in dry soils. Dehydrogenase activity was significantly affected by the type of crop, but urease activity not. Overall, our results showed that high N application rates alter large macroaggregates and enzyme activities in surface and subsurface soils through an increased aboveground and corresponding belowground biomass input in the maize crop.

Organic amendment effects on nematode distribution within aggregate fractions in agricultural soils

To evaluate the effect of organic amendments on soil nematode community composition and diversity within aggregate fractions,a study was initiated in agricultural soils with four-year organic amendments.Soil samples were collected from the plow layer(0-20 cm)under three cornfield management scenarios:1)conventional cropping(CK,corn straw removal and no organic manure application);2)straw retention(SR,incorporation of chopped corn stalk);and 3)manure application(MA,chicken manure input).The soil samples were fractionated into four aggregate sizes,i.e.,>2 mm(large macroaggregates),1-2 mm(macroaggregates),0.25-1 mm(small macroaggregates),and<0.25 mm(microaggregates,silt and clay fractions).The composition and diversity of soil nematode communities were determined within each aggregate fraction.The results showed that both SR and MA treatments significantly increased the percentage of macroaggregates(>1 mm)and only MA treatment strongly increased the mean weight diameter compared to the CK(P<0.05).The abundance of total nematodes and four trophic groups were affected significantly by the aggregate fractions and their higher abundance occurred in the larger aggregates.The effects of aggregate size on most nematode genera were significant.Bacterivores in the small macroaggregates and microaggregates,and fungivores in the large macroaggregates were significantly different among treatments.The percentage of bacterivores increased after the application of organic materials,while that of fungivores decreased.It can be concluded that organic management significantly affects soil aggregation and soil characteristics within aggregates,and the aggregate size subsequently influences the distribution of nematode communities.

Distribution and stability of water-stable aggregates as affected by long-term cattle manure application to saline-sodic soil in the black soil region of northeastern China

Saline-sodic soil has a poor structure,low nutrient content,and excessive sodium in the western Heilongjiang Province,resulting in low crop productivity.Experimental treatments were established by applying manure to the soil for 5 years,12 years,and 16 years and soil without manure application was used as a control treatment(CK).The results indicate that the application of manure significantly increased soil macroaggregates,the mean weight diameter(MWD)and the geometric mean diameter(GMD)compared to those for the CK treatment.The soil organic matter(SOM)concentration increased from 17.8 to 47.9 g/kg,the soil pH decreased from 10.18 to 7.89,and the electrical conductivity(EC)decreased from 4.92 to 0.19 dS/m.The soil exchangeable Na^(+)was decreased and exchangeable Ca^(2+)was increased in the treatments with manure application compared with the CK treatment.And a decrease in the CaCO_(3)content was observed in the treatment with manure.Water-stable aggregates(WSAs)of greater than 2.0 mm were the dominant factor driving the changes in the MWD,and WSAs of 1.0-2.0 mm were the dominant factor driving the changes in the GMD.The correlation matrix showed that the SOM and soil exchangeable Ca^(2+)concentration was positively correlated with the stability of the WSAs,while the pH,EC,and soil exchangeable Na^(+)were negatively and significantly correlated.We conclude that the long-term application of manure to saline-sodic soil can increase the proportion of soil macroaggregates and thus increase the stability of WSAs,as a result of the formation of soil macroaggregates mainly caused by the increase in the organic colloidal matter and soil exchangeable Ca^(2+),and by the decrease in soil exchangeable Na^(+).