Estudio paleobotánico e implicaciones paleocimáticas de los restos fósiles vegetales hallados en el cenozoico de la zona surpirenaica central o occidental de la provincia de Huesca

Actualmente, los afloramientos documentados de macroflora cenozoica de Aragón se limitan a los yacimientos de Rubielos de Mora (Teruel), Libros (Teruel) y Épila (Zaragoza), junto a los yacimientos descritos en esta tesis. No obstante, es importante mencionar los numerosos fósiles de plantas citados en los informes de prospección de lignitos terciarios llevados a cabo en la cuenca del Ebro, Pirineo aragonés y en la provincia de Teruel realizados por el Instituto Geológico y Minero de España. Estos restos no están estudiados ni publicados, pero muestran la existencia de otras áreas potenciales para el descubrimiento de nuevosyacimientos paleobotánicos en el Cenozoico.En la paleobotánica española, el estudio de la vegetación del Cenozoico ha estado casi siempre centrado en el Neógeno (Mioceno–Plioceno) y el Cuaternario, estando el Paleógeno (Paleoceno–Eoceno–Oligoceno) poco estudiado, en comparación con las otras Épocas, y focalizado principalmente en el Oligoceno Inferior. El descubrimiento de dos nuevos yacimientos paleobotánicos (Estadilla/La Val, Arguis/Casa Migalón) con suficiente material para estudio en la zona limítrofe entre el Prepirineo y la cuenca del Ebro (provincia deHuesca), así como el interés de su edad (Eoceno Medio y Oligoceno Superior), ha llevado a larealización de esta tesis doctoral. En esta tesis se describen diversos restos de fósiles vegetales (hojas, frutos y endocarpos), incluyendo el primer estudio de las interacciones planta–insecto del OligocenoSuperior de la Península Ibérica en el yacimiento de La Val, Estadilla (Huesca). A su vez, tras la determinación taxonómica y estudio tafonómico, se han obtenido diversas deducciones paleoambientales: paleoclimáticas y paleoecológicas. Este estudio está formado de cuatro publicaciones independientes con una misma unidad temática: tres para el yacimiento de La Val (Estadilla, Huesca, España) y una para el yacimiento de Casa Migalón (Arguis, Huesca, España). La edad del yacimiento de La Val, tanto de su macroflora como de sus interacciones planta–insecto, es Chatiense (Oligoceno Superior), mientras que los endocarpos y frutos de Nypa del yacimiento de Casa Migalón es Bartoniense (Eoceno Medio). Los primeros resultados del estudio del yacimiento de La Val se han plasmado en una primera publicación sobre la macroflora. Estos resultados han incluído aspectos taxonómicos y tafonómicos, así como una primera aproximación paleoecológica y paleoclimática donde se compara la composición de dicha flora con otras floras similares a las del resto de Europa. En el segundo trabajo se completan los datos mostrados en el artículo precedente y se redefine la edad del yacimiento. La segunda publicación recoge además el estudio del medio sedimentario del yacimiento, así como las implicaciones paleoecológicas derivadas de la presencia del helecho Acrostichum lanzaeanum. En el tercer artículo y último relativo al yacimiento de La Val, se describen las primerasinteracciones planta–insecto encontradas sobre las hojas de uno de los niveles fosilíferos, realizando una discusión para determinar sus implicaciones paleoclimáticas, cuyas conclusiones han matizado y completado la paleoclimatología inferida en el primer trabajo. La cuarta y última publicación que conforma esta tesis ha versado sobre los frutos y endocarpos fósiles de Nypa encontrados en el yacimiento de Casa Migalón (Arguis, Huesca). En este trabajo se llevó a cabo un estudio taxonómico, tafonómico y paleoambiental. Es importante destacar que este artículo se centra especialmente en un aspecto tafonómico muy poco conocido como es la duración del tiempo de flotación en el mar de este tipo de restos hasta su depósito definitivo.<br /

Intrarenal venous flow in cardiorenal syndrome : a shining light into the darkness

The aim of this case report is to assess the potential role of intrarenal Doppler ultrasonography as a non-invasive method to evaluate intrarenal venous flow (IRVF) in acute heart failure (AHF) and concomitant renal dysfunction. We report a case of an 81-year-old woman with valvular heart disease (previous mitral valve replacement) that presented with acutely decompensated heart failure and concomitant worsening renal function (WRF). In addition to complete physical examination, laboratory analysis, and echocardiography, IRVF was assessed at baseline and 48 h after the administration of diuretic treatment. At admission, physical examination and echocardiography revealed signs of intravascular congestion (jugular venous distension and severely dilated inferior vena cava). In addition, a significant increase in serum creatinine from 1.23 to 1.81 mg/dL was noted without signs of hypoperfusion at clinical evaluation. At baseline, intrarenal Doppler ultrasonography showed a monophasic IRVF pattern indicating a severely elevated interstitial renal pressure. After aggressive decongestion, a dynamic behaviour was found in IRVF changing from monophasic to biphasic pattern in parallel with an improvement in clinical parameters and renal function (serum creatinine changed from 1.81 to 1.44 mg/dL). In this case of a patient with AHF and WRF, IRVF changed after aggressive decongestion in agreement with clinical evolution. According to these findings, this technique could provide valuable information for identifying patients with a 'congestion kidney failure' phenotype. Further studies are needed confirming this observation and evaluating the potential role of this technique for guiding decongestive therapy in patients with AHF and WRF

Prototype Drop Tests of Cube and Cubipod Armor Units

In this paper, an experimental methodology is described to assess the structural strength of unreinforced concrete armor units (CAUs). The methodology is applied to measure the structural integrity under impact loads of the new Cubipod CAU compared with the conventional cube CAU. The casting systems and clamps are described for manufacturing and handling the 15-t conventional cubic block and 16-t Cubipod prototypes used for the drop tests. Two separate reinforced concrete platforms were used for overturning and for free-fall tests, respectively. Compared with conventional cubes of similar size and concrete strength, Cubipods withstand drops that are more than 50% higher. Two extreme free-fall tests confirmed the structural robustness of Cubipod armor units. Manufacturing cycle time, as well as storage and handling procedures, are similar for both Cubipods and conventional cubic blocks. © 2011 American Society of Civil Engineers.The writers are grateful for the logistic support provided by the Port Authority of Alicante and the consortium TMS. Financial support was received from CDTI (CUBIPOD Project). The writers also thank Roman Goumy for his assistance during the prototype drop tests and Debra Westall for revising the manuscript.Medina, JR.; Gómez-Martín, ME.; Corredor-Molguero, A.; Torres-Samper, R.; Miñana, JV.; Fernández, E.; Menéndez, CF.... (2011). Prototype Drop Tests of Cube and Cubipod Armor Units. Journal of Waterway, Port, Coastal, and Ocean Engineering. 137(2):54-63. doi:10.1061/(ASCE)WW.1943-5460.0000064S5463137

Renal function dynamics following co-administration of sacubitril/valsartan and empagliflozin in patients with heart failure and type 2 diabetes

The aim of this study was to evaluate the safety profile in terms of changes in renal function after co-treatment with sacubitril/valsartan and empagliflozin in patients with type 2 diabetes (T2D) and heart failure with reduced ejection fraction (HFrEF). This multicentre observational analysis included 108 patients with T2D and HFrEF treated with both agents: baseline sacubitril/valsartan (Group A; n = 43), baseline empagliflozin (Group B; n = 42), or both agents initiated simultaneously (Group C; n = 23). The primary endpoint was estimated glomerular filtration rate (eGFR) dynamics across treatment groups. A binary characterization of worsening renal function (WRF)/improved renal function (IRF) was included in the primary endpoint. WRF and IRF were defined as an increase/decrease in serum creatinine ≥ 0.3 mg/dL or GFR ≥ 20%. Changes in quantitative variables were evaluated using joint modelling of survival and longitudinal data (JM). Rates and their treatment differences were determined by Poisson regression. The mean left ventricle ejection fraction and eGFR were 32 ± 6% and 70 ± 28 mL/min/1.73 m 2, respectively. At a median follow-up of 1.01 years (inter-quartile range 0.71-1.50), 377 outpatient visits were recorded. Although there were differences in GFR trajectories over time within each treatment, they did not achieve statistical significance (omnibus P = 0.154). However, when these differences were contrasted among groups, there was a significant decrease in GFR in Group A as compared with Group B (P = 0.002). The contrast between Groups C and B was not significant (P = 0.430). These differences were also reflected when the rates for WRF and IRF were contrasted among treatments. The co-administration of sacubitril/valsartan and empagliflozin in patients with HFrEF and concomitant T2D appears to be safe in terms of renal function

Rehospitalization burden and morbidity risk in patients with heart failure with mid-range ejection fraction

Heart failure with mid-range ejection fraction (HFmrEF) has been proposed as a distinct HF phenotype, but whether patients on this category fare worse, similarly, or better than those with HF with reduced EF (HFrEF) or preserved EF (HFpEF) in terms of rehospitalization risks over time remains unclear. We prospectively included 2961 consecutive patients admitted for acute HF (AHF) in our institution. Of them, 158 patients died during the index admission, leaving the sample size to be 2803 patients. Patients were categorized according to their EF: HFrEF if EF ≤ 40% (n = 908, 32.4%); HFmrEF if EF = 41-49% (n = 449, 16.0%); and HFpEF if EF ≥ 50% (n = 1446, 51.6%). Covariate-adjusted incidence rate ratios (IRRs) were used to evaluate the association between EF status and recurrent all-cause and HF-related admissions. At a median follow-up of 2.6 years (inter-quartile range: 1.0-5.3), 1663 (59.3%) patients died, and 6035 all-cause readmissions were registered in 2026 patients (72.3%), 2163 of them HF related. Rates of all-cause readmission per 100 patients-years of follow-up were 150.1, 176.9, and 163.6 in HFrEF, HFmrEF, and HFpEF, respectively (P = 0.097). After multivariable adjustment, when compared with that of patients with HFrEF and HFpEF, HFmrEF status was not significantly associated with a different risk of all-cause readmissions (IRR = 0.99; 95% confidence interval [CI], 0.77-1.27; P = 0.926; and IRR = 0.93; 95% CI, 0.74-1.18; P = 0.621, respectively) or HF-related readmissions (IRR = 1.06; 95% CI, 0.77-1.46; P = 0.725; and IRR = 1.11; 95% CI, 0.82-1.50; P = 0.511, respectively). Following an admission for AHF, patients with HFmrEF had a similar rehospitalization burden and a similar risk of recurrent all-cause and HF-related admissions than had patients with HFrEF or HFpEF. Regarding morbidity risk, HFmrEF seems not to be a distinct HF phenotype

Right Ventricular Dysfunction Staging System for Mortality Risk Stratifiction in Heart Failure with Preserved Ejection Fraction

Right ventricular dysfunction (RVD) parameters are increasingly important features in heart failure with preserved ejection fraction (HFpEF). We sought to evaluate the prognostic impact of a progressive RVD staging system by combining the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (TAPSE/PASP) ratio with functional tricuspid regurgitation (TR) severity. We prospectively included 1355 consecutive HFpEF patients discharged for acute heart failure (HF). Of them, in 471 (34.7%) patients, PASP could not be accurately measured, leaving the final sample size to be 884 patients. Patients were categorized as Stage 1: TAPSE/PASP ≥ 0.36 without significant TR; stage 2: TAPSE/PASP ≥ 0.36 with significant TR; stage 3: TAPSE/PASP < 0.36 without significant TR; and stage 4: TAPSE/PASP < 0.36 with significant TR. By the 1 year follow-up, 207 (23.4%) patients had died. We found a significant and graded association between RVD stages and mortality rates (15.8%, 25%, 31.2%, and 45.4% from stage 1 to stage 4, respectively; log-rank test, p < 0.001). After multivariable adjustment, and compared to stage 1, stages 3 and 4 were independently associated with mortality risk (HR: 1.8219; 95% CI 1.308-2.538; p < 0.001 and HR = 2.2632; 95% CI 1.540-3.325; p < 0.001, respectively). A RVD staging system, integrating TAPSE/PASP and TR, provides a comprehensive and widely available tool for risk stratification in HFpEF

Usefulness of Housekeeping Genes for the Diagnosis of Helicobacter pylori Infection, Strain Discrimination and Detection of Multiple Infection

Background: Helicobacter pylori infects human stomachs of over half the world's population, evades the immune response and establishes a chronic infection. Although most people remains asymptomatic, duodenal and gastric ulcers, MALT lymphoma and progression to gastric cancer could be developed. Several virulence factors such as flagella, lipopolysaccharide, adhesins and especially the vacuolating cytotoxin VacA and the oncoprotein CagA have been described for H. pylori. Despite the extensive published data on H. pylori, more research is needed to determine new virulence markers, the exact mode of transmission or the role of multiple infection. Materials and Methods: Amplification and sequencing of six housekeeping genes (amiA, cgt, cpn60, cpn70, dnaJ, and luxS) related to H. pylori pathogenesis have been performed in order to evaluate their usefulness for the specific detection of H. pylori, the genetic discrimination at strain level and the detection of multiple infection. A total of 52 H. pylori clones, isolated from 14 gastric biopsies from 11 patients, were analyzed for this purpose. Results: All genes were specifically amplified for H. pylori and all clones isolated from different patients were discriminated, with gene distances ranged from 0.9 to 7.8%. Although most clones isolated from the same patient showed identical gene sequences, an event of multiple infection was detected in all the genes and microevolution events were showed for amiA and cpn60 genes. Conclusions: These results suggested that housekeeping genes could be useful for H. pylori detection and to elucidate the mode of transmission and the relevance of the multiple infection

Real-world assessment and characteristics of men with benign prostatic hyperplasia (BPH) in primary care and urology clinics in Spain

Objectives: To describe the real-world demographic and clinical characteristics of patients with lower urinary tract symptoms (LUTS) as a result of benign prostatic hyperplasia (BPH) in Spain. Methodology: This observational, retrospective, multicentre study conducted in primary care and urology clinics in Spain included men aged ≥50 years diagnosed (≤8 years prior to study visit) with LUTS caused by BPH. The primary endpoint was demographic and clinical characteristics; secondary endpoints included disease progression and diagnostic tests across both healthcare settings. Results: A total of 670 patients were included (primary care: n = 435; urology: n = 235). Most patients had moderate/severe LUTS (74.6%) and prostate volume >30 cc (81.7%), with no differences between settings. More patients had prostate-specific antigen (PSA) ≥1.5 ng/mL in primary care (74.5%) versus urology (67.7%). Progression criteria were prevalent (48.9%). Clinical criteria were more commonly used than the International Prostate Symptom Score (IPSS) to evaluate LUTS at diagnosis (primary care: clinical criteria 73.0%; IPSS: 26.9%; urology: clinical criteria 76.5%; IPSS: 23.4%). Proportion of patients with moderate/severe LUTS at diagnosis was lower using clinical criteria than IPSS, and the proportion of patients with 'worsening' LUTS (diagnosis to study visit) was higher when using clinical criteria versus IPSS. In both healthcare settings, the most commonly used diagnostic tests were general and urological clinical history and PSA. Conclusion: Demographic and clinical characteristics of patients with BPH in Spain were similar in primary care and urology; however, assessment criteria to evaluate LUTS severity differ and are not completely aligned with clinical guideline recommendations. Increased use of recommended assessments may enhance optimal BPH management

Sex-Related Differences in Mortality Following Admission for Acute Heart Failure Across the Left Ventricular Ejection Fraction Spectrum

Following a heart failure (HF)-decompensation, there is scarce data about sex-related prognostic differences across left ventricular ejection fraction (LVEF) status. We sought to evaluate sex-related differences in 6-month mortality risk across LVEF following admission for acute HF. We retrospectively evaluated 4812 patients consecutively admitted for acute HF in a multicenter registry from 3 hospitals. Study end points were all-cause, cardiovascular, and HF-related mortality at 6-month follow-up. Multivariable Cox regression models were fitted to investigate sex-related differences across LVEF. A total of 2243 (46.6%) patients were women, 2569 (53.4%) were men, and 2608 (54.2%) showed LVEF≥50%. At 6-month follow-up, 645 patients died (13.4%), being 544 (11.3%) and 416 (8.6%) cardiovascular and HF-related deaths, respectively. LVEF was not independently associated with mortality (HR, 1.02; 95% CI 0.99-1.05; P =0.135). After multivariable adjustment, we found no sex-related differences in all-cause mortality (P value for interaction=0.168). However, a significant interaction between sex and cardiovascular and HF mortality risks was found across LVEF (P value for interaction=0.030 and 0.007, respectively). Compared with men, women had a significantly lower risk of cardiovascular and HF-mortality at LVEF80%). Following an admission for acute HF, no sex-related differences were found in all-cause mortality risk. However, when compared with men, women showed a lower risk of cardiovascular and HF-mortality at the lower extreme of LVEF. On the contrary, they showed a higher risk of HF death at the upper extreme