Algunas reflexiones sobre el inicio del sistema de drenaje actual del SE del río Ebro: ¿Post- o pre-Messiniense?

[EN] The timing and process leading to the opening of the continental Ebro Basin to the Mediterranean is a fundamental issue in the creation of the present-day drainage network of NE Iberia, yet there is no general consensus. The opening has been dated by different authors as middle Miocene to early Pliocene whilst river piracy or lake overspilling have been invoked as the geomorphic processes. Using a multiple approach to constrain the time and plausible process leading to this event, that include estimates of the age and volume of the correlative marine sediments, paleoaltitudinal reconstructions, estimates of the maximum lake level in the interior Ebro basin and rates of fluvial incision in basement rocks; it is concluded that the Ebro basin was tapped by a steep, mountain river on the E flank of the Catalan Coastal Ranges in pre-Messinian times, probably in the middle-late Tortonian.[ES] El momento de la apertura de la Cuenca del Ebro hacia el Mediterráneo y el proceso que la indujo representan aspectos clave en el desarrollo de la red de drenaje actual del NE de Iberia, aunque todavía no existe un consenso generalizado sobre los mismos. El momento de la apertura ha sido datado por diferentes autores desde el Mioceno medio al Plioceno inferior, mientras que una captura fluvial o el derrame del lago interior han sido propuestos como procesos geomórficos generadores. En este artículo hemos usado una técnica múltiple para precisar el momento y el proceso más verosímil que condujo a la apertura, que incluye estimación de la edad y el volumen de los sedimentos marinos correlativos al evento, reconstrucción paleoaltitudinal de las Cadenas Costero-Catalanas en dicho momento, estimación del nivel máximo del lago interior de la Cuenca del Ebro en dicho momento y la tasa aproximada de incisión del paleo-Ebro durante su periodo inicial en el basamento. Nuestra conclusión es que la Cuenca continental lacustre del Ebro fue capturada por un río corto y de elevada pendiente de la ladera Este de las Cadenas Costero-Catalanas antes del Messiniense, probablemente en el Tortoniense medio-superior.Peer reviewe

Use of speckle-tracking echocardiography–derived strain and systolic strain rate measurements to predict rejection in transplant hearts with preserved ejection fraction

Abstract Background Noninvasive diagnosis of allograft rejection in heart transplant recipients is challenging. The utility of 2-dimensional speckle-tracking echocardiography (2D-STE) to predict severe rejection in heart transplant recipients with preserved left ventricular ejection fraction (LVEF) was evaluated. Methods Adult heart transplant patients with preserved LVEF (> 55%) and severe rejection by biopsy (Rejection Grade ≥ 2R) or no rejection between 1997 and 2011 at the Mayo Clinic in Rochester, Minnesota were evaluated. Transthoracic echocardiography was performed within 1 month of the biopsy. LV global longitudinal and circumferential strain and strain rates (GLS, GLSR, GCS, and GCSR) were analyzed retrospectively. Results Of 65 patients included, 25 had severe rejection and 40 were normal transplant controls without rejection. Both groups had more men than women (64 and 75%, respectively). Baseline clinical variables were similar between the groups. Both groups had normal LVEF (64.3% vs 64.5%; P = .87). All non-strain echocardiographic variables were similar between the 2 groups. Strain analysis showed significantly increased early diastolic longitudinal strain rate (P = .02) and decreased GCS (P < .001) and GCSR (P = .02) for the rejection group compared with the control group. The area under the receiver operating characteristic curve for GCS was 0.77. With a GCS cutoff of − 17.60%, the sensitivity and specificity of GCS to detect severe acute rejection were 81.8 and 68.4%, respectively. Conclusions 2D-STE may be useful in detecting severe transplant rejection in heart transplant patients with normal LVEF

Predictors and long-term impact of de novo aortic regurgitation in continuous flow left ventricular assist devices using vena contracta

The aim of this study was to identify the optimal echocardiographic measurement of aortic regurgitation (AR) in continuous flow left ventricular assist devices (LVAD) and determine risk factors and clinical implications of de novo AR. Echocardiographic images from consecutive patients who underwent LVAD implantation from February 2007 to March 2017 were reviewed. Severity of de novo AR was determined by vena contracta (VC). Preimplant clinical characteristics, LVAD settings at discharge, and outcomes including heart failure hospitalizations, all-cause mortality, and ventricular arrhythmias of patients with greater than or equal to moderate de novo AR were compared with those with mild or no AR. Among 219 patients, greater than or equal to moderate de novo AR occurred in 65 (29.7%). Left ventricular assist devices support duration was longer with greater than or equal to moderate AR than no or mild AR. In multivariable analysis, preimplant trivial AR and persistent aortic valve (AV) closure were independently associated with de novo AR. By time-varying covariate analysis, survival and freedom from cardiovascular events in greater than or equal to moderate AR were significantly worse (hazard ratio [HR] = 3.947, p \u3c 0.001 and HR = 4.666, p \u3c 0.001). In conclusion, de novo greater than or equal to moderate AR measured by VC increases risk of adverse events. Longer LVAD support duration, preimplant trivial AR, and a closed AV are associated with occurrence of greater than or equal to moderate de novo AR

The impact of neurologic complications on outcome after heart transplantation

OBJECTIVE: To study neurologic complications after heart transplant. DESIGN: Retrospective cohort study. SETTING: Cardiac transplant program at Mayo Clinic, Rochester, Minnesota. PATIENTS: We retrospectively studied 313 patients who underwent heart transplant at Mayo Clinic Rochester from January 1, 1988, through October 31, 2006. MAIN OUTCOME MEASURES: Neurologic symptoms, neurologic complications, score on the Glasgow Outcome Scale, and mortality. RESULTS: Causes of end-stage heart failure were idiopathic dilated myopathy (34%), ischemic heart failure (29%), congenital disorders (12%), amyloidosis (11%), and miscellaneous (15%). Perioperative neurologic complications occurred in 23% of patients and included delirium or encephalopathy (9%), cerebrovascular complications (5%), and diseases of the peripheral nerves and muscles (4%); however, only perioperative cerebrovascular complications were associated with 1-year mortality (hazard ratio, 4.17; 95% confidence interval, 1.04-16.76; P = .04). Most of these cerebrovascular complications occurred after the second postoperative day and were related to mechanical support of the circulation. Over 18 years, the risk for neurologic complications was 81%: sleeping disorders, 32%; polyneuropathy, 26%; and cerebrovascular diseases, 14%. Cause of death was neurologic in 12 of 95 patients (13%), and the most common were cerebrovascular disease (n = 6) and central nervous system infectious diseases (n = 3). Adjusting for baseline predictors, central nervous system infection (hazard ratio, 4.29; 95% confidence interval, 1.69-10.91; P = .002), depression (hazard ratio, 1.81; 95% confidence interval, 1.06-3.09; P = .03), and seizures (hazard ratio, 3.44; 95% confidence interval, 1.33-8.85; P = .01) were predictive for mortality. CONCLUSIONS: Perioperative neurologic complications are frequent in heart transplant recipients, but most are transient and inconsequential. However, perioperative stroke is the most important neurologic complication affecting survival in the first year after heart transplant. Infectious diseases of the central nervous system are associated with fatal outcom