Spatial characterization of the seawater upconing process in a coastal Mediterranean aquifer (Plana de Castellon, Spain): Evolution and controls

In this contribution, we describe the formation and evolution of the upconing process in a Mediterranean coastal aquifer. The study area has experienced severe salinization over the last 40 years because of intensive exploitation of groundwater. We used historical and current records of piezometric levels and chloride concentrations to trace the development of the salinization of the aquifer. We defined the 3D shape of the saline wedge from the spatial distribution of chloride concentrations and vertical well logs of electrical conductivity using monitoring network data. Upconing first appeared in the early 90s and has continued until the present day. In this study, we examined the intensity of the upconing process. Dry periods and the associated increases in pumping caused the advance of seawater intrusion. The sharp reduction in groundwater withdrawals over the last 10 years has caused the saline wedge to move backwards, although the ongoing pumping and the climate conditions mean that this retreat is quite slow

La agrupación de balnearios de Villavieja (Castellón). Origen de sus aguas. Condicionantes geológicos e hidrogeológicos

La Villavella Health Spas Association is situated in the province of Castellón, in the township limit of La Vilavella in the Southeastern area of the Castellón plain surrounded by the township of Nules. In the connection between the plain and the mountain areas, there are several springs and some water wells, with warmer waters then the others in their surroundings. Some of these natural fountains are exploited as health spas since roman times. The actual spa has a special quality water because of its facies and high temperature classified, by the valid legislation, as a mineral‐medical and thermal water. The land lithology in the spa surroundings has an important permeability which the underground waters flow and store, making a big hydrogeological formation known as Sistema Sierra de Espadán‐Plana de Castellón, where a series of important aquifers are placed, like the Sierra de Espadán very interesting for their composition and high temperature waters in some places. The aquifer is made by sandstones belonged to the medium Buntsandstein section whose natural recharge is the rain infiltration or side flow from others formations. These waters will flow througt different channels depending on the faults or fractures system, ones deeper than others, meaning that some circuits are longer and deeper than others. Along that run, the waters have a different physical‐chemical composition due to the contact with different lithology materials and the temperature in the geothermical gradient. These reasons fixe the physical‐chemical characteristics of the waters on the well‐drilling exploited by the La Vilavella Spa Association, different from the natural ones that rise in other area surroundings. La Agrupación de Balnearios de Villavieja, enclavada dentro del núcleo urbano de esta localidad de la provincia de Castellón, se sitúa en el sector suroriental de la comarca de La Plana. En dicho sector, coincidente con la ruptura de pendiente entre la zona llana que conforma La Plana y la montañosa de la sierra del Espadán, se encuentra una serie de manantiales y pozos con aguas de temperatura elevada y muy superior a la de zonas aledañas, circunstancia que ha permitido el aprovechamiento de alguna de estas fuentes naturales como balnearios desde la época romana. Por sus facies y alta temperatura el agua del actual Balneario presenta unas características especiales, motivo por el cual está catalogada por la legislación vigente como agua minero‐medicinal y termal. Por su litología, las formaciones geológicas en el entorno de las instalaciones presentan una permeabilidad significativa que permite la circulación y almacenamiento de las aguas subterráneas. Estas formaciones tienen especial interés por la composición de sus aguas y la alta temperatura que registran en algunas zonas. Las surgencias termales de La Vilavella están relacionadas con los acuíferos de areniscas ortocuarcíticas del tramo medio del Buntsandstein y de calizas y dolomías de la base del Muschelkalk, materiales que han sido afectados por intensos procesos tectónicos. En concreto, estas manifestaciones termales están especialmente asociadas a la presencia de dos grandes fracturas o conjunto de fracturas que hunden las formaciones del macizo mesozoico varios centenares de metros bajo la llanura de la Plana de Castellón. Dichas formaciones se alimentan de manera natural por infiltración directa del agua de lluvia, que recorren caminos diferentes según sea interceptada por sistemas de fallas y fracturas de menor o mayor profundidad. En este último caso, los circuitos son más largos con tiempos de residencia también más altos, por lo que las aguas adquieren progresivamente una mayor temperatura, debido al gradiente geotérmico, y diferente composición físico‐química condicionada por la litología de los materiales sobre los que transitan. Finalmente, ascienden a la superficie de forma rápida en ciertos puntos, o sectores especialmente favorables, a través de fracturas de gran entidad que minimizan, en mayor o menor grado, los procesos de mezcla con aguas más superficiales, más frías y menos mineralizadas. Todas estas circunstancias confluyen en el entorno de la localidad de La Vilavella, y son la causa de las particulares características físico‐químicas de las aguas aprovechadas por su Agrupación de Balnearios.

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database

The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Stress neuropeptide levels in adults with chest pain due to coronary artery disease: potential implications for clinical assessment

: Substance P (SP) and neuropeptide Y (NPY) are neuropeptides involved in nociception. The study of biochemical markers of pain in communicating critically ill coronary patients may provide insight for pain assessment and management in critical care. Purpose of the study was to to explore potential associations between plasma neuropeptide levels and reported pain intensity in coronary critical care adults, in order to test the reliability of SP measurements for objective pain assessment in critical care

Outcome of acute hypoxaemic respiratory failure: insights from the LUNG SAFE Study

Background: Current incidence and outcome of patients with acute hypoxaemic respiratory failure requiring mechanical ventilation in the intensive care unit (ICU) are unknown, especially for patients not meeting criteria for acute respiratory distress syndrome (ARDS). Methods: An international, multicentre, prospective cohort study of patients presenting with hypoxaemia early in the course of mechanical ventilation, conducted during four consecutive weeks in the winter of 2014 in 459 ICUs from 50 countries (LUNG SAFE). Patients were enrolled with arterial oxygen tension/inspiratory oxygen fraction ratio ≤300 mmHg, new pulmonary infiltrates and need for mechanical ventilation with a positive end-expiratory pressure of ≥5 cmH2O. ICU prevalence, causes of hypoxaemia, hospital survival and factors associated with hospital mortality were measured. Patients with unilateral versus bilateral opacities were compared. Findings: 12 906 critically ill patients received mechanical ventilation and 34.9% with hypoxaemia and new infiltrates were enrolled, separated into ARDS (69.0%), unilateral infiltrate (22.7%) and congestive heart failure (CHF; 8.2%). The global hospital mortality was 38.6%. CHF patients had a mortality comparable to ARDS (44.1% versus 40.4%). Patients with unilateral-infiltrate had lower unadjusted mortality, but similar adjusted mortality compared to those with ARDS. The number of quadrants on chest imaging was associated with an increased risk of death. There was no difference in mortality comparing patients with unilateral-infiltrate and ARDS with only two quadrants involved. Interpretation: More than one-third of patients receiving mechanical ventilation have hypoxaemia and new infiltrates with a hospital mortality of 38.6%. Survival is dependent on the degree of pulmonary involvement whether or not ARDS criteria are reached