Coupling hydrological, habitat and water supply indicators to improve the management of environmental flows.

Highly regulated basins have traditionally required management practices to mitigate the negative environmental impacts and ensure human well-being. This paper proposes and assesses environmental and water supply deficit indicators to assist in the management of environmental flows (e-flows). For that, a water allocation model is applied, and hydrological alteration, habitat alteration and water supply indicators are quantified, normalized and integrated into a general basin management indicator. This basin management indicator is analyzed for four management approaches and seven e-flow scenarios in the Júcar River Basin (eastern Spain). Hydrological alteration indicators show a less pronounced alteration in the river sections located upstream of the basin while a higher alteration in the downstream sections. As for the habitat indicators, they experience an improvement compared to the natural regime. Based on the values of the basin management indicator, the best e-flow scenario to adopt in the Júcar River Basin is selected. The indicators proposed in this work are useful for supporting decision-making regarding the planning and management of e-flows in regulated river basins worldwide.

Incidence and predictors of sternal surgical wound infection in cardiac surgery: A prospective study.

Sternal surgical wound infection (SSWI) in cardiac surgery is associated with increased morbidity. We investigated the incidence of SSWI, the main germs implicated and predictors of SSWI. Prospective study including patients undergoing full median sternotomy between January 2017 and December 2019. Patients were followed-up for 3 months after hospital discharge. All sternal wound infections up to 90 days after discharge were considered SSWI. 1004 patients were included. During follow-up, 68 (6.8%) patients presented SSWI. Patients with SSWI had a higher incidence of postoperative renal failure (29.4% vs 17.1%, P = .007), a higher incidence of early postoperative reoperation for non-infectious causes (42.6% vs 9.1%, P < .001), longer ICU stay (3 [2-9] days vs 2 [2-4] days, P = .006), and longer hospital stay (24.5 [14.8-38.3] days vs 10 [7-18] days, P < .001). Gram-positive germs were presented in 49% of the cultures, and gram-negative bacteria in 35%. Early reoperation for non-infectious causes (OR 4.90, 95% CI 1.03-23.7), and a longer ICU stay (OR 1.37 95% CI 1.10-1.72) were independent predictors of SSWI. SSWI is rare but leads to more postoperative complications. The need for early reoperation because of non-infectious cause and a longer ICU stay were independently associated with SSWI.

Accessory left atrial cords: A case report and literature review.

INTRODUCTION: Accessory left atrial cords are fibroelastic structures found in the left atrium. Left atrial cords may be associated with mitral valve disease, atrial fibrillation, stroke, and other congenital left-side anomalies. METHODS: We presented the case of a man with severe Mitral Regurgitation and two accessories left atrial cords attached to P2 scallop by a single tendon and performed a literature review using PUBMED/MEDLINE, Web of Science, and EMBASE databases on December 4, 2021. RESULTS: According to our review, accessory left atrial cords were found more frequently in women (36 patients, 62%), more frequently attached to the mitral valve (66% of reports) and mitral regurgitation was the most frequently reported pattern of mitral valve disease (64.2%). No other cases of double left atrial cords attached to P2 segment were found. CONCLUSION: Accessory left atrial chords may be related to mitral valve disease and other left-side congenital abnormalities. These structures were found more frequently in females and A2 insertion was the most frequently observed pattern in the review.

Effects of environmental flows on hydrological alteration and reliability of water demands.

This paper presents a methodology to assess the effects of management strategies of environmental flows on the hydrological alteration of river basins on a daily scale. It comprises the collection and analysis of data, the implementation and calibration of a water allocation model; the computation of the natural flow regime; and the estimation, normalization, and aggregation of hydrological alteration indicators to obtain a global indicator of the hydrological alteration. The methodology was applied to a case study in the Iberian Peninsula: The Orbigo River basin, which belongs to the Duero River basin district. For that, three management scenarios were defined: the current scenario, a scenario without any environmental flow and the scenario with the environmental flows initially projected for the period 2022-2027. These scenarios were modelled with the SIMGES water allocation model, which is calibrated in the study site, and the hydrological alterations in four river stretches with different locations and characteristics were assessed. The implications of each environmental flow scenario on the demand reliabilities were also analysed. The global indicator of hydrological alteration obtained in the projected scenario was greater (better) than those of the other two scenarios, but the reliabilities of the water demands were worse. The methodology proposed in this work can be helpful to design environmental flow regimes considering both the effects on the hydrological alteration and the implication on the water demand reliabilities.

Mid-term outcomes of rapid deployment aortic prostheses in patients with small aortic annulus.

OBJECTIVES: The Edwards Intuity valve is a rapid deployment aortic prosthesis that favours less invasive approaches. However, evidence about the clinical behaviour of their smaller sizes is scarce. Herein, we studied haemodynamic behaviours and clinical outcomes of small Intuity prostheses (19-21 mm) in comparison to larger Intuity prostheses (>21 mm). METHODS: This is an observational study including patients implanted with an Edwards Intuity rapid deployment aortic prosthesis. Patients with prosthesis sizes 19-21 and >21 mm were included. Baseline and perioperative variables, as well as adverse events during the follow-up were recorded and compared between groups. RESULTS: A total of 122 patients (37% female, mean age 75 ± 4.5 years) were included, of whom 54 (45%) were implanted with a small prosthesis and 68 (55%) with a prosthesis >21 mm. There were no significant differences between patients with small Intuity prostheses and patients with larger prostheses regarding in-hospital mortality (2% vs 4%, P = 0.43) or mortality during the follow-up (3.41 vs 2.45 per 100 patients-years; P = 0.58). Survival in the small Intuity valve group was 95% at 1 year and 83% at 6 years, whereas in the larger Intuity valve group was 96% at 1 year and 78% at 6 years. The presence of a small prosthesis did not influence mid-term survival (log-rank P-value = 0.62). CONCLUSIONS: This study showed good clinical performance of Intuity aortic prostheses with appropriate mid-term survival in patients with the small aortic annulus. Thus, the Edwards Intuity rapid deployment aortic prosthesis may be considered as a potential option in patients with the small aortic annulus.

Transient upper limb ischaemia during veno-arterial extracorporeal membrane oxygenation in a child.

Neck cannulation is the most common cannulation strategy performed to provide veno-arterial extracorporeal membrane oxygenation support in paediatric patients, especially in small children. Upper limb ischaemia is a rare complication of neck cannulation and is likely caused by arterial cannula malposition. We describe a case of right arm ischaemia caused by extrinsic compression of the right subclavian artery by the venous drainage cannula inserted through the right internal jugular vein. Upper limb hypoperfusion was resolved immediately after changing the venous drainage cannula from the right jugular vein to the right femoral vein.

Pediatric Tricuspid Valve Replacement With Transcatheter Bioprosthetic Valve: An Alternative Option in High-Risk Patients.

Transcatheter valve can be an alternative option of pediatric valve replacement in high-risk patients. We present 2 cases of Edwards Sapien 3 implantation in tricuspid position.

Myocardial protection in the arterial switch operation: Custodiol versus cold blood cardioplegia.

OBJECTIVES: The optimal myocardial protective solution in the neonatal arterial switch operation remains controversial. The aim of this study was to demonstrate that Bretschneider's histidine-tryptophan-ketoglutarate crystalloid solution (Custodiol) offers protection at least similar to that of cold blood cardioplegia. METHODS: Patients who underwent the neonatal arterial switch operation with Custodiol between January 2016 and December 2018 (n = 23) were compared with an historical cohort from August 2010 to December 2015 in which cold blood cardioplegia was used (n = 41). A linear mixed-effect model for repeated measures was performed to test the recovery of myocardial function based on inotropic and vasoactive inotropic scores, cardiac enzyme release and left ventricular ejection fraction. RESULTS: Patients in the cold blood cardioplegia group had higher inotropic scores in the first 24 h (0 h, P = 0.001 and 24 h, P = 0.006) and higher vasoactive inotropic scores in the first 72 h (0 h, 24 h and 48 h, P < 0.001; 72 h, P = 0.012). Cardiac troponin-I concentrations were higher in the cold blood cardioplegia group at postoperative hours 1-72 (1 h, 6 h, 12 h and 24 h, P < 0.001; 48 h, P = 0.001 and 72 h, P = 0.003). Creatinine-kinase-MB concentrations were higher in the cold blood cardioplegia group at postoperative hours 1-24 (1 h, 6 h and 12 h, P < 0.001; 24 h, P = 0.042). The left ventricular ejection fraction was higher in the Custodiol group just after the operation (P = 0.005), at 24 h (P = 0.001) and on the first day without inotropic support (P = 0.011). CONCLUSIONS: Neonatal myocardium protected with Custodiol during the arterial switch operation presented optimal ventricular function recovery with less inotropic support and less myocardial damage compared with cold blood cardioplegia.

Epidemiología del mixoma cardiaco en una población española. Una serie quirúrgica de 30 años / Epidemiology of cardiac myxoma in a Spanish population. A 30-year surgical series

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Late Dissection of a Contegra Conduit: A Rare Complication.

Surgical palliation of many types of congenital heart defects requires the use of a conduit between the right ventricle and the pulmonary artery. Dissections of these conduits are very infrequent. We report a case of a ten-year-old girl who developed acute right heart failure related to a Contegra conduit dissection. She underwent a new conduit replacement on an emergency basis.

Selective visceral perfusion improves renal flow and hepatic function in neonatal aortic arch repair.

OBJECTIVES: The aortic arch repair in the neonatal period is a complex procedure with significant morbidity. We define a useful double-perfusion technique and its effect on the function of abdominal organs in the postoperative course. METHODS: Nine patients with double perfusion (Group 1) were compared with 14 patients with antegrade cerebral perfusion (Group 2). The objective was to discern the incidence of postoperative acute kidney injury and impaired hepatic function, as well as tissue perfusion and myocardial function parameters. Mechanical ventilation time, postoperative length of stay and 30-day mortality were measured. We excluded patients with extracorporeal membrane oxygenation, early mortality (<72 h) and preoperative renal or hepatic insufficiency. RESULTS: Nine (39%) patients developed postoperative acute kidney injury, with 22% (n = 2) in Group 1 and 50% (n = 7) in Group 2 (P = 0.183). A higher urine output was observed during the first 24 h for Group 1 (P = 0.032). Eleven patients developed impaired hepatic function in the immediate postoperative period: 2 (18.2%) in Group 1 and 9 (81.8%) in Group 2 (P = 0.04). The international normalized ratio (P = 0.006-0.031) and prothrombin time (P = 0.007-P = 0.016) were significantly lower in the double-perfusion group during the first 72 h. Significant difference was observed in lactate levels in the first 72 h (P = 0.001-0.009). There was no postoperative mortality in either group. CONCLUSIONS: Selective visceral perfusion is a safe procedure that provides a better urine output, hepatic function and tissue perfusion. This technique allows for the repair of complex aortic arch anomalies in neonates without deep hypothermic circulatory arrest.

Linking Pan-European data to the local scale for decision making for global change and water scarcity within water resources planning and management.

This study focuses on a novel type of methodology which connects Pan-European data to the local scale in the field of water resources management. This methodology is proposed to improve and facilitate the decision making within the planning and management of water resources, taking into account climate change and its expected impacts. Our main point of interest is focused on the assessment of the predictability of extreme events and their possible effects, specifically droughts and water scarcity. Consequently, the Júcar River Basin was selected as the case study, due to the ongoing water scarcity problems and the last drought episodes suffered in the Mediterranean region. In order to study these possible impacts, we developed a modeling chain divided into four steps, they are: i) data collection, ii) analysis of available data, iii) models calibration and iv) climate impact analysis. Over previous steps, we used climate data from 15 different regional climate models (RCMs) belonging to the three different Representative Concentration Pathways (RCPs) coming from a hydrological model across all of Europe called E-HYPE. The data were bias corrected and used to obtain statistical results of the availability of water resources for the future (horizon 2039) and in form of indicators. This was performed through a hydrological (EVALHID), stochastic (MASHWIN) and risk management (SIMRISK) models, all of which were specifically calibrated for this basin. The results show that the availability of water resources is much more enthusiastic than in the current situation, indicating the possibility that climate change, which was predicted to occur in the future has already happened in the Júcar River Basin. It seems that the so called "Effect 80", an important decrease in water resources for the last three decades, is not well contemplated in the initial data.

Corrección de defectos cardiacos congénitos con la matriz extracelular CorMatrix en pacientes pediátricos. ¿Es realmente seguro? / Correction of congenital cardiac defects with CorMatrix extracellular matrix in pediatric patients: is it really safe?

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Water accounting for stressed river basins based on water resources management models.

Water planning and the Integrated Water Resources Management (IWRM) represent the best way to help decision makers to identify and choose the most adequate alternatives among other possible ones. The System of Environmental-Economic Accounting for Water (SEEA-W) is displayed as a tool for the building of water balances in a river basin, providing a standard approach to achieve comparability of the results between different territories. The target of this paper is to present the building up of a tool that enables the combined use of hydrological models and water resources models to fill in the SEEA-W tables. At every step of the modelling chain, we are capable to build the asset accounts and the physical water supply and use tables according to SEEA-W approach along with an estimation of the water services costs. The case study is the Jucar River Basin District (RBD), located in the eastern part of the Iberian Peninsula in Spain which as in other many Mediterranean basins is currently water-stressed. To guide this work we have used PATRICAL model in combination with AQUATOOL Decision Support System (DSS). The results indicate that for the average year the total use of water in the district amounts to 15,143hm(3)/year, being the Total Water Renewable Water Resources 3909hm(3)/year. On the other hand, the water service costs in Jucar RBD amounts to 1634 million € per year at constant 2012 prices. It is noteworthy that 9% of these costs correspond to non-conventional resources, such as desalinated water, reused water and water transferred from other regions.