Tidal wetland restoration at Ketenisse polder (Schelde Estuary, Belgium): developments in the first year

Ketenisse polder is a former intertidal brackish marsh (30ha) situated in the mesohaline part of the Schelde Estuary. In the 19th century its central part was embanked as a polder. In the mid 1980’s the area was raised above intertidal level when it was used as a dumping site for the excavated soil from the Liefkenshoek tunnel. In 2002 the area was restored, it was levelled with a weak slope below mean high water level, creating the optimal starting conditions for the development of intertidal mudflats and marshes. Geomorphological changes, sediment characteristics and colonisation by phytobenthos, vegetation, zoobenthos, water birds and breeding birds at the restored site are monitored. The monitoring results of the first year after tidal restoration are presented. Sedimentation as well as erosion between 0 and 30cm was observed in the first year. Local changes in stream current patterns caused erosion on parts of the former mudflats; sheltered depressions filled up relatively fast. Median grain size showed large variation. Organic carbon content of the sediment varied between 0.5 and 15% and was closely related to sediment medium grain size. Chlorophyll a concentrations were negatively correlated with median grain size and tended to increase from the low water line to the shore. They were comparable to nearby intertidal areas and displayed similar seasonal variability with a maximum in spring. The large surface covered wtithVaucheria was indicator of initiated succession towards tidal marsh. Scirpus maritimus and transitional vegetations to Chenopodiaceae-vegetations established with increasing altitude. The Chenopodiaceae-vegetations were relicts of earlier vegetations before the tidal restoration, and will probably disappear. The macrobenthos community was dominated by Oligochaetes, which were present in 73% of all samples and attained an average density of about 40*103 ind. m-2. Other macrobenthos species found were nematods, copepods and Corophium. On the sheltered sampling stations macrobenthic densities were high compared to those on nearby intertidal areas. In the first season, 15 breeding bird species were recorded, the most common species being the Pied Avocet (Recurvirostra avosetta). The most common waterbirds were Common Shelduck (Tadorna tadorna), Greylag Goose (Anser anser), Pied Avocet (Recurvirostra avoset) and Lapwing (Vanellus vanellus), typical species for the mesohaline part of the estuary. The first year’s results suggest that Ketenisse polder has the potential to develop towards a varied and normal functional intertidal area

Effects of cobalt-chromium everolimus eluting stents or bare metal stent on fatal and non-fatal cardiovascular events: patient level meta-analysis

Objectives: To examine the safety and effectiveness of cobalt-chromium everolimus eluting stents compared with bare metal stents. Design: Individual patient data meta-analysis of randomised controlled trials. Cox proportional regression models stratified by trial, containing random effects, were used to assess the impact of stent type on outcomes. Hazard ratios with 95% confidence interval for outcomes were reported. Data sources and study selection: Medline, Embase, the Cochrane Central Register of Controlled Trials. Randomised controlled trials that compared cobalt-chromium everolimus eluting stents with bare metal stents were selected. The principal investigators whose trials met the inclusion criteria provided data for individual patients. Primary outcomes: The primary outcome was cardiac mortality. Secondary endpoints were myocardial infarction, definite stent thrombosis, definite or probable stent thrombosis, target vessel revascularisation, and all cause death. Results: The search yielded five randomised controlled trials, comprising 4896 participants. Compared with patients receiving bare metal stents, participants receiving cobalt-chromium everolimus eluting stents had a significant reduction of cardiac mortality (hazard ratio 0.67, 95% confidence interval 0.49 to 0.91; P=0.01), myocardial infarction (0.71, 0.55 to 0.92; P=0.01), definite stent thrombosis (0.41, 0.22 to 0.76; P=0.005), definite or probable stent thrombosis (0.48, 0.31 to 0.73; P<0.001), and target vessel revascularisation (0.29, 0.20 to 0.41; P<0.001) at a median follow-up of 720 days. There was no significant difference in all cause death between groups (0.83, 0.65 to 1.06; P=0.14). Findings remained unchanged at multivariable regression after adjustment for the acuity of clinical syndrome (for instance, acute coronary syndrome v stable coronary artery disease), diabetes mellitus, female sex, use of glycoprotein IIb/IIIa inhibitors, and up to one year v longer duration treatment with dual antiplatelets. Conclusions: This meta-analysis offers evidence that compared with bare metal stents the use of cobalt-chromium everolimus eluting stents improves global cardiovascular outcomes including cardiac survival, myocardial infarction, and overall stent thrombosis

Impact of call-to-balloon time on 30-day mortality in contemporary practice.

OBJECTIVE: Studies reporting an association between treatment delay and outcome for patients with ST segment elevation myocardial infarction (STEMI) have generally not included patients treated by a primary percutaneous coronary intervention (PPCI) service that systematically delivers reperfusion therapy to all eligible patients. We set out to determine the association of call-to-balloon (CTB) time with 30-day mortality after PPCI in a contemporary series of patients treated within a national reperfusion service. METHODS: We analysed data on 16 907 consecutive patients with STEMI treated by PPCI in England and Wales in 2011 with CTB time of ≤6 hours. RESULTS: The median CTB and door-to-balloon times were 111 and 41 min, respectively, with 80.9% of patients treated within 150 min of the call for help. An out-of-hours call time (58.2% of patients) was associated with a 10 min increase in CTB time, whereas inter-hospital transfer for PPCI (18.5% of patients) was associated with a 49 min increase in CTB time. CTB time was independently associated with 30-day mortality (p180-240 min compared with ≤90 min. The relationship between CTB time and 30-day mortality was influenced by patient risk profile with a greater absolute impact of increasing CTB time on mortality in high-risk patients. CONCLUSION: CTB time is a useful metric to assess the overall performance of a PPCI service. Delays to reperfusion remain important even in the era of organised national PPCI services with rapid treatment times and efforts should continue to minimise treatment delays

Integrated monitoring of nature restoration along ecotones, the example of the Yser Estuary

Within the framework of LIFE, one of the larger nature restoration projects in Flanders was realized on the right bank of the estuarine part of the Yser. General aim of the initiative was to restore or create beach-dune-salt marsh ecotones with salt-fresh, dynamic-stable, wet-dry and mud-sand ecotones. In order to reach this goal, several large buildings and roads were broken down, an entire tidal dock was restructured and some 500,000m³ of dredging material was removed to restore or create intertidal and coastal dune habitats and their connecting ecotones. Measures were taken to avoid abrupt topographical transitions along potential ecological gradients. It was decided to begin monitoring (2001-2004) from the very start of the restoration process (1999-2003). Monitoring was multidisciplinary and realized in a partnership between several scientific institutes (Ghent University, Catholic University of Louvain, Royal Belgian Institute of Natural Sciences and Institute of Nature Conservation with facility support of VLIZ). Monitoring included the most relevant abiotic conditions such as sedimentation and erosion, topography and ground water fluctuations, and biological response variables, i.e. flora and vegetation, terrestrial arthropods, benthic macrofauna and birds. It was decided to include two monitoring levels, an area-covering monitoring of the entire nature reserve (ca. 128ha) and a detailed monitoring of changes along transects perpendicular to the main ecological gradients. In this paper we present some results of the first three years of monitoring

Intravenous sodium nitrite in acute ST-elevation myocardial infarction: a randomized controlled trial (NIAMI).

AIM: Despite prompt revascularization of acute myocardial infarction (AMI), substantial myocardial injury may occur, in part a consequence of ischaemia reperfusion injury (IRI). There has been considerable interest in therapies that may reduce IRI. In experimental models of AMI, sodium nitrite substantially reduces IRI. In this double-blind randomized placebo controlled parallel-group trial, we investigated the effects of sodium nitrite administered immediately prior to reperfusion in patients with acute ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: A total of 229 patients presenting with acute STEMI were randomized to receive either an i.v. infusion of 70 μmol sodium nitrite (n = 118) or matching placebo (n = 111) over 5 min immediately before primary percutaneous intervention (PPCI). Patients underwent cardiac magnetic resonance imaging (CMR) at 6-8 days and at 6 months and serial blood sampling was performed over 72 h for the measurement of plasma creatine kinase (CK) and Troponin I. Myocardial infarct size (extent of late gadolinium enhancement at 6-8 days by CMR-the primary endpoint) did not differ between nitrite and placebo groups after adjustment for area at risk, diabetes status, and centre (effect size -0.7% 95% CI: -2.2%, +0.7%; P = 0.34). There were no significant differences in any of the secondary endpoints, including plasma troponin I and CK area under the curve, left ventricular volumes (LV), and ejection fraction (EF) measured at 6-8 days and at 6 months and final infarct size (FIS) measured at 6 months. CONCLUSIONS: Sodium nitrite administered intravenously immediately prior to reperfusion in patients with acute STEMI does not reduce infarct size

Long-Term Outcomes After Transcatheter Aortic Valve Implantation in High-Risk Patients With Severe Aortic Stenosis The U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry

ObjectivesThe objective was to define the characteristics of a real-world patient population treated with transcatheter aortic valve implantation (TAVI), regardless of technology or access route, and to evaluate their clinical outcome over the mid to long term.BackgroundAlthough a substantial body of data exists in relation to early clinical outcomes after TAVI, there are few data on outcomes beyond 1 year in any notable number of patients.MethodsThe U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry was established to report outcomes of all TAVI procedures performed within the United Kingdom. Data were collected prospectively on 870 patients undergoing 877 TAVI procedures up until December 31, 2009. Mortality tracking was achieved in 100% of patients with mortality status reported as of December 2010.ResultsSurvival at 30 days was 92.9%, and it was 78.6% and 73.7% at 1 year and 2 years, respectively. There was a marked attrition in survival between 30 days and 1 year. In a univariate model, survival was significantly adversely affected by renal dysfunction, the presence of coronary artery disease, and a nontransfemoral approach; whereas left ventricular function (ejection fraction <30%), the presence of moderate/severe aortic regurgitation, and chronic obstructive pulmonary disease remained the only independent predictors of mortality in the multivariate model.ConclusionsMidterm to long-term survival after TAVI was encouraging in this high-risk patient population, although a substantial proportion of patients died within the first year

Relative Survival After Transcatheter Aortic Valve Implantation: How Do Patients Undergoing Transcatheter Aortic Valve Implantation Fare Relative to the General Population?

Background: Transcatheter aortic valve implantation (TAVI) is indicated for patients with aortic stenosis who are intermediate‐high surgical risk. Although all‐cause mortality rates after TAVI are established, survival attributable to the procedure is unclear because of competing causes of mortality. The aim was to report relative survival (RS) after TAVI, which accounts for background mortality risks in a matched general population. Methods and Results: National cohort data (n=6420) from the 2007 to 2014 UK TAVI registry were matched by age, sex, and year to mortality rates for England and Wales (population, 57.9 million). The Ederer II method related observed patient survival to that expected from the matched general population. We modelled RS using a flexible parametric approach that modelled the log cumulative hazard using restricted cubic splines. RS of the TAVI cohort was 95.4%, 90.2%, and 83.8% at 30 days, 1 year, and 3 years, respectively. By 1‐year follow‐up, mortality hazards in the >85 years age group were not significantly different from those of the matched general population; by 3 years, survival rates were comparable. The flexible parametric RS model indicated that increasing age was associated with significantly lower excess hazards after the procedure; for example, by 2 years, a 5‐year increase in age was associated with 20% lower excess mortality over the general population. Conclusions: RS after TAVI was high, and survival rates in those aged >85 years approximated those of a matched general population within 3 years. High rates of RS indicate that patients selected for TAVI tolerate the risks of the procedure well