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Estrategias humanas y paleoclima en los Andes (34°S): Variaciones en la intensidad de ocupación de Laguna del Diamante (ca. 2000-500 años aP)
- Lucía Yebra, Valeria Cortegoso, Erik Marsh, María Eugenia de Porras, Antonio Maldonado, Silvina Castro, Ramiro Barberena, Diego Winocur, Víctor Durán
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- Journal:
- Latin American Antiquity , First View
- Published online by Cambridge University Press:
- 18 August 2023, pp. 1-18
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El área de Laguna del Diamante (3.000 m snm) tiene una oferta de recursos atractiva para las sociedades humanas durante los últimos 2.000 años. Este trabajo evalúa la variable intensidad en la ocupación humana en Laguna del Diamante en cinco segmentos temporales entre 2030 y 440 años cal aP. Estos segmentos se modelaron a partir de 14 fechados radiocarbónicos procedentes de tres sitios; la densidad de lascas proximales se evalúa como proxy de intensidad de ocupación. Se comparan los pulsos registrados arqueológicamente con la variabilidad ambiental vinculada a aumento/disminución de temperatura y humedad, de los últimos milenios en tres lagunas: Aculeo, Chepical y del Maule (33°-35°S). A partir de diversos indicadores —cobertura vegetal, extensión/disminución de la cubierta de hielo, cambios de la precipitación relacionados al sistema de vientos del oeste y su variabilidad debido a El Niño Oscilación del Sur— se observó en casi toda la secuencia una asociación positiva entre condiciones favorables y ocupaciones intensas. Se discute el registro de dos pulsos de mayor intensidad: entre 1200 y 1280 años cal aP, asociado con aumento de temperatura de verano e intensificación de precipitaciones; y entre 450 y 500 años cal aP, vinculado con condiciones frías y coincidente con la presencia incaica en el área.
Pre-Glenn aorto-pulmonary collaterals in single-ventricle patients
- Varun J. Sharma, Laura Carlson, Jesse Esch, Mallika Gopal, Kimberlee Gauvreau, Isaac Wamala, Angelika Muter, Diego Porras, Meena Nathan
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- Journal:
- Cardiology in the Young / Volume 33 / Issue 12 / December 2023
- Published online by Cambridge University Press:
- 17 April 2023, pp. 2589-2596
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Background:
In single-ventricle patients undergoing staged-bidirectional Glenn, 36–59% have aorto-pulmonary collateral flow, but risk factors and clinical outcomes are unknown. We hypothesise that shunt type and catheter haemodynamics may predict pre-bidirectional Glenn aorto-pulmonary collateral burden, which may predict death/transplantation, pulmonary artery or aorto-pulmonary collateral intervention.
Methods:Retrospective cohort study of patients undergoing a Norwood procedure for single-ventricle anatomy. Covariates included clinical and haemodynamic characteristics up to/including pre-bidirectional Glenn catheterisation and aorto-pulmonary collateral burden at pre-bidirectional Glenn catheterisation. Multivariable models used to evaluate relationships between risk factors and outcomes.
Results:From January 2011 to March 2016, 104 patients underwent Norwood intervention. Male sex (odds ratio 3.36, 95% confidence interval 1.17–11.4), age at pre-bidirectional Glenn assessment (2.12, 1.33–3.39 per month), and pulmonary to systemic flow ratio (1.23, 1.08–1.41 per 0.1 unit) were associated with aorto-pulmonary collateral burden. Aorto-pulmonary collateral burden was not associated with death/transplantation (hazard ratio 1.19, 95% confidence interval 0.37–3.85), pulmonary artery (sub-hazard ratio 1.38, 0.32–2.61), or aorto-pulmonary collateral interventions (sub-hazard ratio 1.11, 0.21–5.76). Longer post-Norwood length of stay was associated with greater risk of death/transplantation (hazard ratio 1.22 per week, 95% confidence interval 1.08–1.38), but lower risk of aorto-pulmonary collateral intervention (sub-hazard ratio 0.86 per week, 95% confidence interval 0.75–0.98). Time to pre-bidirectional Glenn catheterisation was associated with lower risk of pulmonary artery (sub-hazard ratio 0.80 per month, 95% confidence interval 0.65–0.98) and aorto-pulmonary collateral intervention (sub-hazard ratio 0.79, 0.63–0.99). Probability of moderate/severe aorto-pulmonary collateral burden increased with left-to-right shunt (22.5% at <1.0, 57.6% at >1.4) and the age at pre-bidirectional Glenn catheterisation (10.6% at <2 months, 56.9% at >5 months).
Conclusions:Aorto-pulmonary collateral burden is common after Norwood procedure and increases as age at bidirectional Glenn increases. As expected, higher pulmonary to systemic flow ratio is a marker for greater aorto-pulmonary collateral burden pre-bi-directional Glenn; aorto-pulmonary collateral burden does not confer risk of death/transplantation or pulmonary artery intervention.