The River Orontes in Syria and Turkey: downstream variation of fluvial archives in different crustal blocks

The geomorphology and Quaternary history of the River Orontes in western Syria and south-central Turkey have been studied using a combination of methods: field survey, differential GPS, satellite imagery, analysis of sediments to determine provenance, flow direction and fluvial environment, incorporation of evidence from fossils for both palaeoenvironments and biostratigraphy, uranium-series dating of calcrete cement, reconciliation of Palaeolithic archaeological contents, and uplift modelling based on terrace height distribution. The results underline the contrasting nature of different reaches of the Orontes, in part reflecting different crustal blocks, with different histories of landscape evolution. Upstream from Homs the Orontes has a system of calcreted terraces that form a staircase extending to ~200 m above the river. New U-series dating provides an age constraint within the lower part of the sequence that suggests underestimation of terrace ages in previous reviews. This upper valley is separated from another terraced reach, in the Middle Orontes, by a gorge cut through the Late Miocene–Early Pliocene Homs Basalt. The Middle Orontes terraces have long been recognized as a source of mammalian fossils and Palaeolithic artefacts, particularly from Latamneh, near the downstream end of the reach. This terraced section of the valley ends at a fault scarp, marking the edge of the subsiding Ghab Basin (a segment of the Dead Sea Fault Zone), which has been filled to a depth of ~ 1 km by dominantly lacustrine sediments of Pliocene–Quaternary age. Review of the fauna from Latamneh suggests that its age is 1.2–0.9 Ma, significantly older than previously supposed, and commensurate with less uplift in this reach than both the Upper and Lower Orontes. Two localities near the downstream end of the Ghab have provided molluscan and ostracod assemblages that record somewhat saline environments, perhaps caused by desiccation within the former lacustrine basin, although they include fluvial elements. The Ghab is separated from another subsiding and formerly lacustrine depocentre, the Amik Basin of Hatay Province, Turkey, by a second gorge, implicit of uplift, this time cut through Palaeogene limestone. The NE–SW oriented lowermost reach of the Orontes is again terraced, with a third and most dramatic gorge through the northern edge of the Ziyaret Dağı mountains, which are known to have experienced rapid uplift, probably again enhanced by movement on an active fault. Indeed, a conclusion of the research, in which these various reaches are compared, is that the crust in the Hatay region is significantly more dynamic than that further upstream, where uplift has been less rapid and less continuous

Saccular Abdominal Aortic Aneurysms Patient Characteristics, Clinical Presentation, Treatment, and Outcomes in the Netherlands

Objective: The aim of this was to analyze differences between saccularshaped abdominal aortic aneurysms (SaAAAs) and fusiform abdominal aortic aneurysms (FuAAAs) regarding patient characteristics, treatment, and outcome, to advise a threshold for intervention for SaAAAs.Background: Based on the assumption that SaAAAs are more prone to rupture, guidelines suggest early elective treatment. However, little is known about the natural history of SaAAAs and the threshold for intervention is not substantiated.Methods: Observational study including primary repairs of degenerative AAAs in the Netherlands between 2016 and 2018 in which the shape was registered, registered in the Dutch Surgical Aneurysm Audit (DSAA). Patients were stratified by urgency of surgery; elective versus acute (symptomatic/ruptured). Patient characteristics, treatment, and outcome were compared between SaAAAs and FuAAAs.Results: A total of 7659 primary AAA-patients were included, 6.1% (n = 471) SaAAAs and 93.9% (n = 7188) FuAAAs. There were 5945 elective patients (6.5% SaAAA) and 1714 acute (4.8% SaAAA). Acute SaAAApatients were more often female (28.9% vs 17.2%, P = 0.007) compared with acute FuAAA-patients. SaAAAs had smaller diameters than FuAAAs, in elective (53.0mm vs 61 mm, P = 0.000) and acute (68mm vs 75 mm, P = 0.002) patients, even after adjusting for sex. In addition, 25.2% of acute SaAAA-patients presented with diameters <55mm and 8.4% <45 mm, versus 8.1% and 0.6% of acute FuAAA-patients (P = 0.000). Postoperative outcomes did not significantly differ between shapes in both elective and acute patients.Conclusions: SaAAAs become acute at smaller diameters than FuAAAs in DSAA patients. This study therefore supports the current idea that SaAAAs should be electively treated at smaller diameters than FuAAAs. The exact diameter threshold for elective treatment of SaAAAs is difficult to determine, but a diameter of 45mm seems to be an acceptable threshold.Vascular Surger