No abstract

The distribution and mobility of heavy metals in the non-saturated zone of the alluvial plain of a wadi in the Cartagena-La Union mining district was investigated. The elemental chemistry of soils, indepth sediments and different plant species (namely Hirsfeldia incana, Ditrichia viscosa and Piptatherum miliaceum) was carried out by using X-ray fluorescence and X-ray diffraction techniques. Potential mobility of metals was assessed by using lixiviation test runs (DIN 38414-S4). Concentrations detected in soils and sediments were higher than the acceptable limits reported in official regulations. Regarding metals mobility, values obtained for Pb, Zn and As exceed the limits established by European Union for DIN 38414-S4 leachates. Whilst the obtained leaching percentages for Pb, Cu and As were not especially high (<2%), Zn exhibit a very high leaching potential (up to 60% of the total metal content), involving potential risk of pollution events.

Heavy metals and some major element concentrations were investigated in overbank sediments and stream bed sediments of the ephemeral Beal wadi creek in the Cartagena-La Union mining district (SE Spain). Two vertical sediment profiles were extracted and the chemical and mineralogical compositions were both investigated by X-ray fluorescence and X-ray diffraction. Geochemical variations in vertical profiles of these two kinds of sediments allow observing noticeable heavy metals pollution (especially Fe, Pb, and Zn) in both kind of sediments but especially in the overbank sediments (reaching values of approximately 13% Fe, 6% Pb, and 6% Zn). A single extraction (DIN 38414-S4 leaching test) was made to observe the transfer of metals from solids to liquid phase. Pb, Zn, Cu, and Cd contents surpass the leaching values established by the DIN 38414-S4 limits established by Spanish legislation to consider these wastes as hazardous wastes. Geochemical comparison between leaching behavior of the two types of sediments reveals a major ability of overbank sediments in transferring heavy metals to the water flow.

Left ventricular assist devices (LVADs) have become an established treatment for advanced heart failure, although with long-term support these patients are potentially exposed to serious complications. Our purpose was to assess the role of the neutrophil to lymphocyte ratio (NLR) in LVAD complications and to evaluate if higher values of NLR after 4–6 months on LVAD support (NLR 4_6m) are associated with worse prognosis. All consecutive patients who received a HeartWare LVAD (N = 188, age 50 ± 13 years), as bridge to transplant from December 2009 to January 2018 were included. Neutrophil to lymphocyte ratio was recorded pre-LVAD, post-LVAD, after 4–6 months on support and in case of a first adverse event to occur after the 4–6 months NLR was recorded. Median NLR values were pre-LVAD 4.26 (interquartile range [IQR], 3.1–6.9), at 1 day postoperative 11.6 (IQR, 8.3–16.6), and NLR 4_6m 4.4 (IQR, 3.0–6.4) (p < 0.001). Neutrophil to lymphocyte ratio increased significantly when patients had an infection, stroke, or pump thrombosis, as compared with the NLR 4_6m (all p < 0.05). Patients with NLR 4_6m ≥ median had higher rates of stroke and mortality. Survival time was shorter among patients with NLR 4_6m ≥ 4.4 (log-rank test p = 0.006). Neutrophil to lymphocyte ratio 4_6m was found to be predictive of increased mortality (area under the curve of 0.62, p = 0.007). After multivariate analysis, NLR 4_6m remained independently associated with increased mortality (hazard ratio [HR] 1.67; 95% confidence interval [CI], 1.03–2.7; p = 0.037). Neutrophil to lymphocyte ratio 4_6m values significantly increase in association with adverse events on LVAD support and are independently associated with mortality. This association suggests presence of inflammation adversely affects LVAD outcomes.

Background Infections and thrombotic events remain life‐threatening complications in patients with ventricular assist devices (VAD). Methods We describe the relationship between both events in our cohort of patients (n = 220) supported with the HeartWare VAD (HVAD). This is a retrospective analysis of patients undergoing HVAD implantation between July 2009 and March 2019 at the Freeman Hospital, Newcastle upon Tyne, United Kingdom. Results Infection was the most common adverse event in HVAD patients, with 125 patients (56.8%) experiencing ≥ one infection (n = 168, 0.33 event per person year (EPPY)), followed by pump thrombosis (PT) in 61 patients (27.7%, 0.16 EPPY). VAD‐specific infections were the largest group of infections. Of the 125 patients who had an infection, 66 (53%) had a thrombotic event. Both thrombotic events and infections were related to the duration of support, though there was only limited evidence that infections predispose to thrombosis. Those with higher than median levels of C‐reactive protein during the infection were more likely to have an ischaemic stroke (IS) (34.5% vs 16.7%, p = .03), though not PT or a combined thrombotic event (CTE: first PT or IS). However, in multivariate analysis, there was no significant effect of infection predisposing to CTE. Conclusions Infection and thrombotic events are significant adverse events related to the duration of support in patients receiving HVADs. Infections do not clearly predispose to thrombotic events.