Extensional orogenic collapse captured by strike-slip tectonics:

The late Paleozoic collision between Gondwana and Laurussia resulted in the polyphase deformation and magmatism that characterizes the Iberian Massif of the Variscan orogen. In the Central Iberian Zone, initial con- tinental thickening (D1; folding and thrusting) was followed by extensional orogenic collapse (D2) responsible for the exhumation of high-grade rocks coeval to the emplacement of granitoids. This study presents a tectonometamorphic analysis of the Trancoso-Pinhel region (Central Iberian Zone) to ex- plain the processes in place during the transition froman extension-dominated state (D2) to a compression-dom- inated one (D3).Wereveal the existence of low-dipping D2 extensional structures later affected by several pulses of subhorizontal shortening, each of them typified by upright folds and strike-slip shearing (D3, D4 and D5, as identified by superimposition of structures). The D2 Pinhel extensional shear zone separates a low-grade domain from an underlying high-grade domain, and it contributed to the thermal reequilibration of the orogen by facil- itating heat advection from lower parts of the crust, crustal thinning, decompression melting, and magma intru- sion. Progressive lessening of the gravitational disequilibrium carried out by this D2 shear zone led to a switch from subhorizontal extension to compression and the eventual cessation and capture of the Pinhel shear zone by strike-slip tectonics during renewed crustal shortening. High-grade domains of the Pinhel shear zone were folded together with low-grade domains to define the current upright folded structure of the Trancoso-Pinhel re- gion, the D3 Tamames-Marofa-Sátão synform. Newdating of syn-orogenic granitoids (SHRIMP U\\Pb zircon dat- ing) intruding the Pinhel shear zone, together with the already published ages of early extensional fabrics constrain the functioning of this shear zone to ca. 331–311 Ma, with maximum tectonomagmatic activity at ca. 321–317 Ma. The capture and apparent cessation of movement of the Pinhel shear zone occurred at ca. 317– 311 Ma

Strike-slip shear zones of the Iberian Massif: Are they coeval?

Strike-slip shear zones of the Variscan orogen are used to derive the evolution of paleostrain and discuss the kinematics of the waning stages of the Gondwana-Laurussia collision during the amalgamation of Pangea. In the Iberian Massif, the recognition of three late Carboniferous deformation events related to strike-slip tectonics (D3, D4, D5) in the Trancoso-Pinhel region (Portugal) reveals that late orogenic transcurrent deformation was episodic and occurred in a short period of time (<15 m.y.). Early stages of strike-slip deformation included dextral and sinistral shear zones and orogen-parallel upright folds (D3; ca. 311 Ma). These structures followed the development of extensional shear zones (D2) during the tectonothermal reequilibration of the orogen. D3 structures were deflected and folded by the sinistral D4 Juzbado-Penalva do Castelo shear zone, dated as ca. 309–305 Ma by SHRIMP (sensitive high-resolution ion microprobe) U-Pb zircon dating of synkinematic granitoids. D3 and D4 structures were folded under east-west compression (D5) influenced by the strike-slip movement of the dextral Porto-Tomar shear zone. Variscan movement along the Porto-Tomar shear zone started ca. 304 Ma (onset of the Buçaco basin and syn-D5 granites), but ceased before ca. 295 Ma (age of the final closure of the Ibero-Armorican arc and crosscutting granites). The contrasting geometry, kinematics, and timing of these strike-slip shear zones are explained by deformation partitioning upon a rheologically inhomogeneous crust with structural and tectonothermal anisotropies generated during previous deformation. The convergence vector between Gondwana and Laurussia during D3–D5 remained the same, and was equivalent to the vector that explains the previous tectonic record (D2) in central and northwestern Iberia

Peralkaline and alkaline magmatism of the Ossa-Morena Zone (SW Iberia): age, source and implications for the Paleozoic evolution of Gondwanan lithosphere

The Ossa-Morena zone in SW Iberia represents a section of the northern margin of West Gondwana that formed part of a Cordilleran-type orogenic system during the Neoproterozoic (Cadomian orogeny). The crustal section in this zone preserves the record of rifting that led to the opening of the Rheic Ocean in the early Paleozoic and the collision of Gondwana and Laurussia in the late Paleozoic (Variscan orogeny). We present U-Pb zircon data from three alkaline to peralkaline syenites that intruded Neoproterozoic and Cambrian strata and give crystallization ages ranging between ca. 490 Ma and 470 Ma. Lu/Hf isotopic data from these zircons give positive initial eHf values (0 ≤ eHf(t) ≤ +11.5) that approach the model values for the depleted mantle at the time of crystallization. This suggests that a significant proportion of the magma was derived from the mantle, with limited mixing/assimilation with crustal-derived melts. Alkaline/peralkaline magmatic suites of similar age and chemical composition intruded other sections of the northern margin of West Gondwana and along the boundaries of the continental blocks that today make up Iberia. These blocks are further characterized by the presence of high-pressure metamorphic belts that formed during accretion and subsequent collision of peri-Gondwanan domains against Laurussia during the Devonian and Carboniferous (Variscan orogeny). Our U-Pb and Lu-Hf data set indicates that during the Cambrian–Ordovician transition, lithosphere extension reached a stage of narrow intracontinental rifting, where deeply sourced magmas, probably coming from the lower crust and/or the upper mantle, intruded continental upper crust across various sections of previously stretched crust. We propose that necking of the Gondwana lithosphere into several continental microblocks with fertile mantle beneath them compartmentalized extension (multiblock model), which favored the onset of early Paleozoic peralkaline and alkaline magmas. The boundaries of microblocks represent zones of inherited crustal weakness that were later reactivated during the late Paleozoic as major accretionary faults related to the amalgamation of Pangea during the Variscan orogeny. Our dynamic model provides an explanation for the unusual spatial relationship between peralkaline and alkaline igneous provinces (usually shallow in the crust) and the occurrence of high-pressure rocks. Our observations suggest that Cordilleran-type orogens subjected to extension after long-lived subduction can develop wide continental platforms that feature multiple continental blocks. In addition, the formation of sequenced high-pressure belts in collisional orogens can be explained as the ultimate consequence of multiple necking events within continental lithosphere during previous collapse of a Cordilleran-type orogen

Tectonic evolution of Variscan Iberia: Gondwana–Laurussia

An integrated interpretation of the late Paleozoic structural and geochronological record of the Iberian Massif is presented and discussed under the perspective of a Gondwana-Laurussia collision giving way to the Variscan orogen. Compressional and extensional structures developed during the building of the Variscan orogenic crust of Iberia are linked together into major tectonic events operating at lithosphere scale. A review of the tectonometamorphic and magmatic evolution of the IberianMassif reveals backs and forths in the overall conver- gence between Gondwana and Laurussia during theamalgamation of Pangea in late Paleozoic times. Stages dom- inated by lithosphere compression are characterized by subduction, both oceanic and continental, development of magmatic arcs, (over- and under-) thrusting of continental lithosphere, and folding. Variscan convergence re- sulted in the eventual transference of a large allochthonous set of peri-Gondwanan terranes, the Iberian Allochthon, onto the Gondwana mainland. The Iberian Allochthon bears the imprint of previous interaction be- tween Gondwana and Laurussia, including their juxtaposition after the closure of the Rheic Ocean in Lower De- vonian times. Stages governed by lithosphere extension are featured by the opening of two short-lived oceanic basins that dissected previous Variscan orogenic crust, first in the Lower-Middle Devonian, following the closure of the Rheic Ocean, and then in the early Carboniferous, following the emplacement of the peri-Gondwanan allochthon. An additional, major intra-orogenic extensional event in the early-middle Carboniferous dismem- bered the Iberian Allochthon into individual thrust stacks separated by extensional faults and domes. Lateral tec- tonics played an important role through the Variscan orogenesis, especially during the creation of new tectonic blocks separated by intracontinental strike-slip shear zones in the late stages of continental convergence

Identification of MRP4/ABCC4 as a target for reducing the proliferation of pancreatic ductal adenocarcinoma cells by modulating the cAMP efflux

Pancreatic cancer is one of the most lethal types of tumors with no effective therapy available; is currently the third leading cause of cancer in developed countries; and is predicted to become the second deadliest cancer in the United States by 2030. Due to the marginal benefits of current standard chemotherapy, the identification of new therapeutic targets is greatly required. Considering that cAMP pathway is commonly activated in pancreatic ductal adenocarcinoma (PDAC) and its premalignant lesions, we aim to investigate the multidrug resistance-associated protein 4 (MRP4)-dependent cAMP extrusion process as a cause of increased cell proliferation in human PDAC cell lines. Our results from in silico analysis indicate that MRP4 expression may influence PDAC patient outcome; thus, high MRP4 levels could be indicators of poor survival. In addition, we performed in vitro experiments and identified an association between higher MRP4 expression levels and more undifferentiated and malignant models of PDAC and cAMP extrusion capacity. We studied the antiproliferative effect and the overall cAMP response of three MRP4 inhibitors, probenecid, MK571, and ceefourin-1 in PDAC in vitro models. Moreover, MRP4-specific silencing in PANC-1 cells reduced cell proliferation (P, 0.05), whereas MRP4 overexpression in BxPC-3 cells significantly incremented their growth rate in culture (P, 0.05). MRP4 pharmacological inhibition or silencing abrogated cell proliferation through the activation of the cAMP/Epac/Rap1 signaling pathway. Also, extracellular cAMP reverted the antiproliferative effect of MRP4 blockade. Our data highlight the MRP4-dependent cAMP extrusion process as a key participant in cell proliferation, indicating that MRP4 could be an exploitable therapeutic target for PDAC.Fil: Carozzo, Alejandro Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; ArgentinaFil: Yaneff, Agustín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; ArgentinaFil: Gomez, Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; ArgentinaFil: Di Siervi, Nicolás. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; ArgentinaFil: Sahores, Ana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; ArgentinaFil: Diez, Federico Ruben. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; ArgentinaFil: Attorresi, Alejandra Inés. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigación en Biomedicina de Buenos Aires - Instituto Partner de la Sociedad Max Planck; ArgentinaFil: Rodriguez Gonzalez, Angela Paola. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Monczor, Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; ArgentinaFil: Fernandez, Natalia Cristina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; ArgentinaFil: Abba, Martín Carlos. Universidad Nacional de La Plata; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Shayo, Carina Claudia. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Davio, Carlos Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; Argentin

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation