Late reoperation in vascular surgery

Objectives:Assessment of late reoperation (after 30 days) following vascular surgery.Design:Analysis of a prospectively collected database of consecutive patients undergoing vascular surgery.Setting:A single teaching unit's experience between 1986–1993.Materials:Patients undergoing 2501 primary arterial reconstructions.Chief outcome measures:Reoperation after 30 days.Main results:One hundred and fifty eight patients (6%) underwent further operations, at more than 1 month after the primary procedure. Primary procedures at highest risk for reoperations were axillobifemoral bypasses and femorodistal bypasses with respective late reoperation rates of 20% and 16%. The majority of patients required late reoperation because of graft occlusion or stenosis. Overall, of the 158 late reoperations performed, 114 were related to the same arterial segment with the same presenting symptoms as the primary operation, and 44 for a different indication. A second or subsequent reoperation was required in 54 patients and the overall operative mortality was 11%.Conclusion:Patients undergoing certain vascular procedures, should be informed of the high risk of a subsequent procedure when consent is obtained

Semigroup Closures of Finite Rank Symmetric Inverse Semigroups

We introduce the notion of semigroup with a tight ideal series and investigate their closures in semitopological semigroups, particularly inverse semigroups with continuous inversion. As a corollary we show that the symmetric inverse semigroup of finite transformations $\mathscr{I}_\lambda^n$ of the rank $\leqslant n$ is algebraically closed in the class of (semi)topological inverse semigroups with continuous inversion. We also derive related results about the nonexistence of (partial) compactifications of classes of semigroups that we consider.Comment: With the participation of the new coauthor - Jimmie Lawson - the manuscript has been substantially revised and expanded. Accordingly, we have also changed the manuscript titl

Compression ultrasonography for false femoral artery aneurysms: Hypocoagulability is a cause of failure

Objectives:false femoral artery aneurysm is an occasional complication of percutaneous cardiovascular radiological procedures. Compression ultrasonography causes thrombosis non-invasively, reducing need for operative intervention. The technique fails in a proportion of cases. Analysis was undertaken to identify causes of failure.Design:prospective open study.Materials and Methods:patients presenting with false femoral artery aneurysm since 1984 were identified from a computerised database (BIPAS). Since 1993 compression ultrasonography has been performed as first line treatment according to a standard protocol. Prospectively collected ultrasonographic data and case notes were reviewed to identify causes of failed compression.Results:false femoral artery aneurysm occurred as a complication in 32/26 687 (0.12%) cardiovascular radiological procedures. Eighteen aneurysms were treated by compression. The technique was successful in 11/18 (61%) cases but primary failure occurred in seven cases. Six out of seven had bleeding abnormalities (Chi-squared analysis with Yates correction 10.55, p=0.0012), four were anticoagulated and compression was subsequently successful following reversal of warfarin therapy in three of these patients. In 4/18 cases surgical repair was necessary.Conclusions:compression ultrasonography is an effective treatment of false femoral aneurysms, however, hypocoagulability is a significant cause of failure. For patients in whom anticoagulation cannot be reversed, primary surgical repair should be considered

A test of trophic cascade theory: fish and benthic assemblages across a predator density gradient on coral reefs

Removal of predators is often hypothesized to alter community structure through trophic cascades. However, despite recent advances in our understanding of trophic cascades, evidence is often circumstantial on coral reefs because fishing pressure frequently co-varies with other anthropogenic effects, such as fishing for herbivorous fishes and changes in water quality due to pollution. Australia’s outer Great Barrier Reef (GBR) has experienced fishing-induced declines of apex predators and mesopredators, but pollution and targeting of herbivorous fishes are minimal. Here, we quantify fish and benthic assemblages across a fishing-induced predator density gradient on the outer GBR, including apex predators and mesopredators to herbivores and benthic assemblages, to test for evidence of trophic cascades and alternative hypotheses to trophic cascade theory. Using structural equation models, we found no cascading effects from apex predators to lower trophic levels: a loss of apex predators did not lead to higher levels of mesopredators, and this did not suppress mobile herbivores and drive algal proliferation. Likewise, we found no effects of mesopredators on lower trophic levels: a decline of mesopredators was not associated with higher abundances of algae-farming damselfishes and algae-dominated reefs. These findings indicate that top-down forces on coral reefs are weak, at least on the outer GBR. We conclude that predator-mediated trophic cascades are probably the exception rather than the rule in complex ecosystems such as the outer GBR

Shelter from the storm? Use and misuse of coastal vegetation bioshields for managing natural disasters

Vegetated coastal ecosystems are known to provide myriad ecosystem services to billions of people globally. However, in the aftermath of a series of recent natural disasters, including the Indian Ocean Tsunami, Hurricane Katrina and Cyclone Nargis, coastal vegetation has been singularly promoted as a protection measure against large storm surges and tsunami. In this paper, we review the use of coastal vegetation as a "bioshield" against these extreme events. Our objective is to investigate the long-term consequences of rapid plantation of bioshields on local biodiversity and human capital. We begin with an overview of the scientific literature, in particular focusing on studies published since the Indian Ocean Tsunami in 2004 and discuss the science of wave attenuation by vegetation. We then explore case studies from the Indian subcontinent and evaluate the detrimental impacts bioshield plantations can have upon native ecosystems. We draw a clear distinction between coastal restoration and the introduction of exotic species in inappropriate locations in the name of coastal protection. We conclude by placing existing bioshield policies into a larger socio-political context and outline a new direction for coastal vegetation policy and research

Associations between personal care product use patterns and breast cancer risk among white and black women in the sister study

BACKGROUND: Many personal care products include chemicals that might act as endocrine disruptors and thus increase the risk of breast cancer. OBJECTIVE: We examined the association between usage patterns of beauty, hair, and skin-related personal care products and breast cancer incidence in the Sister Study, a national prospective cohort study (enrollment 2003–2009). METHODS: Non-Hispanic black (4,452) and white women (n = 42,453) were examined separately using latent class analysis (LCA) to identify groups of individuals with similar patterns of self-reported product use in three categories (beauty, skin, hair). Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between product use and breast cancer incidence. RESULTS: A total of 2,326 women developed breast cancer during follow-up (average follow-up = 5:4 y). Among black women, none of the latent class hazard ratios was elevated, but there were <100 cases in any category, limiting power. Among white women, those classified as “moderate” and “frequent” users of beauty products had increased risk of breast cancer relative to “infrequent” users [HR = 1:13 (95% CI: 1.00, 1.27) and HR = 1:15 (95% CI: 1.02, 1.30), respectively]. Frequent users of skincare products also had increased risk of breast cancer relative to infrequent users [HR = 1:13 (95% CI: 1.00, 1.29)]. None of the hair product classes was associated with increased breast cancer risk. The associations with beauty and skin products were stronger in postmenopausal women than in premenopausal women, but not significantly so. CONCLUSIONS: This work generates novel hypotheses about personal care product use and breast cancer risk. Whether these results are due to specific chemicals or to other correlated behaviors needs to be evaluated. https://doi.org/10.1289/EHP1480

Pregnancy-related fibroid reduction

We tested the hypothesis that the protective effect of parity on fibroids is due to direct pregnancy-related effects by following women from early pregnancy to postpartum period with ultrasound. Of 171 women with one initial fibroid, 36% had no identifiable fibroid at the time of postpartum ultrasound, and 79% of the remaining fibroids decreased in size

Coral larvae are poor swimmers and require fine-scale reef structure to settle

Reef coral assemblages are highly dynamic and subject to repeated disturbances, which are predicted to increase in response to climate change. Consequently there is an urgent need to improve our understanding of the mechanisms underlying different recovery scenarios. Recent work has demonstrated that reef structural complexity can facilitate coral recovery, but the mechanism remains unclear. Similarly, experiments suggest that coral larvae can distinguish between the water from healthy and degraded reefs, however, whether or not they can use these cues to navigate to healthy reefs is an open question. Here, we use a meta-analytic approach to document that coral larval swimming speeds are orders of magnitude lower than measurements of water flow both on and off reefs. Therefore, the ability of coral larvae to navigate to reefs while in the open-ocean, or to settlement sites while on reefs is extremely limited. We then show experimentally that turbulence generated by fine scale structure is required to deliver larvae to the substratum even in conditions mimicking calm back-reef flow environments. We conclude that structural complexity at a number of scales assists coral recovery by facilitating both the delivery of coral larvae to the substratum and settlement