Total fertilization failure and idiopathic subfertility

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Three year outcome of the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) technique for aortoiliac occlusive disease

Objective:The objective of the current study was to demonstrate the three year outcome of the CERAB technique for the treatment of extensive aortoiliac occlusive disease (AIOD). Methods:Between February 2009 and July 2016, all patients treated with the CERAB technique for AIOD were identified in the local databases of two centers and analyzed. Demographics and lesion characteristics were scored. Follow-up (FU) consisted of clinical assessment, duplex ultrasound and ankle brachial indices (ABI). Patency rates and clinically driven target lesion revascularization (CD-TLR) were calculated by Kaplan-Meier analysis. Results: 130 patients (69 male and 61 female) were treated of which 68% patients were diagnosed with intermittent claudication and 32% suffered from critical limb ischemia. The vast majority (89%) were TASC-II D lesions and the remaining were TASC-II B and C (both 5%). Median follow-up was 24 months (range 0-67 months). The technical success rate was 97% and 67% of cases were performed completely percutaneously. The ABI improved significantly from 0.65 plusminus 0.22 preoperatively to 0.88 plusminus 0.15 after the procedure. The 30-day minor and major complication rate was 33% and 7%. The median hospital stay was 2 days (range 1-76 days). At 1 and 3-years FU 94% and 96% of the patients clinically improved at least 1 Rutherford category (2% and 0% unchanged, 4% and 4% worsened). Limb salvage rate at 1-year was 98% and 97% at three year follow-up. Primary, primary-assisted and secondary patency was 86%/91%/97% at 1-year, 84%/89%/97% at 2-year and 82%/87%/97% at 3-year FU. Freedom from CD-TLR was 87% at 1-year and 86% at both 2 and 3-year FU. Conclusions:The CERAB technique is a safe and feasible technique for the treatment of extensive aortoiliac occlusive disease with good three year results regarding patency and clinical improvement

Neo-Atlantis: The Netherlands under a 5-m sea level rise

What could happen to the Netherlands if, in 2030, the sea level starts to rise and eventually, after 100 years, a sea level of 5 m above current level would be reached? This question is addressed by studying literature, by interviewing experts in widely differing fields, and by holding an expert workshop on this question. Although most experts believe that geomorphology and current engineering skills would enable the country to largely maintain its territorial integrity, there are reasons to assume that this is not likely to happen. Social processes that precede important political decisions - such as the growth of the belief in the reality of sea level rise and the framing of such decisions in a proper political context (policy window) - evolve slowly. A flood disaster would speed up the decision-making process. The shared opinion of the experts surveyed is that eventually part of the Netherlands would be abandoned. © 2008 The Author(s)

Modeling the Spatial Distribution and Fruiting Pattern of a Key Tree Species in a Neotropical Forest: Methodology and Potential Applications

Damien Caillaud is with UT Austin and Max Planck Institute for Evolutionary Anthropology; Margaret C. Crofoot is with the Smithsonian Tropical Research Institute, Max Planck Institute for Ornithology, and Princeton University; Samuel V. Scarpino is with UT Austin; Patrick A. Jansen is with the Smithsonian Tropical Research Institute, Wageningen University, and University of Groningen; Carol X. Garzon-Lopez is with University of Groningen; Annemarie J. S. Winkelhagen is with Wageningen University; Stephanie A. Bohlman is with Princeton University; Peter D. Walsh is with VaccinApe.Background -- The movement patterns of wild animals depend crucially on the spatial and temporal availability of resources in their habitat. To date, most attempts to model this relationship were forced to rely on simplified assumptions about the spatiotemporal distribution of food resources. Here we demonstrate how advances in statistics permit the combination of sparse ground sampling with remote sensing imagery to generate biological relevant, spatially and temporally explicit distributions of food resources. We illustrate our procedure by creating a detailed simulation model of fruit production patterns for Dipteryx oleifera, a keystone tree species, on Barro Colorado Island (BCI), Panama. Methodology and Principal Findings -- Aerial photographs providing GPS positions for large, canopy trees, the complete census of a 50-ha and 25-ha area, diameter at breast height data from haphazardly sampled trees and long-term phenology data from six trees were used to fit 1) a point process model of tree spatial distribution and 2) a generalized linear mixed-effect model of temporal variation of fruit production. The fitted parameters from these models are then used to create a stochastic simulation model which incorporates spatio-temporal variations of D. oleifera fruit availability on BCI. Conclusions and Significance -- We present a framework that can provide a statistical characterization of the habitat that can be included in agent-based models of animal movements. When environmental heterogeneity cannot be exhaustively mapped, this approach can be a powerful alternative. The results of our model on the spatio-temporal variation in D. oleifera fruit availability will be used to understand behavioral and movement patterns of several species on BCI.The National Center For Ecological Analysis is supported by NSF Grant DEB-0553768, the University of California Santa Barbara and the State of California. The Forest Dynamics Plots were funded by NSF Grants to Stephen Hubbell DEB-0640386, DEB-0425651, DEB-0346488, DEB-0129874, DEB-00753102, DEB-9909347, DEB-9615226, DEB-9615226, DEB-9405933, DEB-9221033, DEB-9100058, DEB-8906869, DEB-8605042, DEB-8206992, DEB-7922197, and by the Center for Tropical Forest Science, the Smithsonian Tropical Forest Research Institute, The John D. and Catherine T. MacArthur Foundation, the Mellon Foundation and the Celera Foundation. DC is supported by NSF grant DEB-0749097 to L.A. Meyers. SS is supported by an NSF Graduate Research Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Biological Sciences, School o

Treatment of the femoropopliteal artery with the bioresorbable REMEDY stent

Objective: Bioresorbable stents are an emerging technology in the endovascular treatment of femoropopliteal lesions. They address the issue of leaving permanent stents in the treated arterial segment that are only temporarily needed to treat dissection or recoil. The REMEDY stent (Kyoto Medical Planning Co, Kyoto, Japan) was the first commercially available biodegradable scaffold for peripheral use. We evaluated its performance and safety in the treatment of short femoropopliteal stenosis or occlusion. Methods: A prospective, multicenter, observational registrywas set up of patients in Rutherford-Becker categories 2 to 5 with femoropopliteal lesions that could be treated with one REM EDY stent. Clinical examination and duplex ultrasound imaging were performed at 1, 6, and 12 months. The primary end point was absence of clinically driven target lesion revascularization at 12 months. Secondary end points were technical and clinical success, primary and secondary patency rate, clinically driven target vessel revascularization, major complications, and Rutherford-Becker classification at 6 and 12 months. Results: The registry enrolled 99 patients between January 2011 and July 2013 in 12 centers in Belgium. Most lesions were determined as TransAtlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) A (n = 80) and located in the superficial femoral artery (n = 91). There were 19 total occlusions (mean length, 41.3 mm) and 80 stenoses (mean length, 37.5 mm). Technical success was achieved in 96 patients, and clinical success was obtained in 95. Target lesion revascularization, which equalled target vessel revascularization, was 19% at 6 months and rose to 33% at 12 months. Primary patency was 68% at 6 months and 58% at 12 months. Secondary patency was 85% at 6 months and 86% at 12 months. After 12 months, two patients had undergone an amputation. Conclusions: The 1-year follow-up results of the REMEDY stent do not meet current standards set by nitinol stents. Given the significant issues concerning bioresorbable stents in femoropopliteal arteries, their use outside clinical trials should be withheld until improvements are made and better data are available

Total fertilization failure and idiopathic subfertility

Abstract Background To gain more insight in whether failure of intrauterine insemination (IUI) treatment in patients with idiopathic subfertility could be related to diminished fertilization, the aim of this study is to compare the fertilization of an initial IVF procedure after six cycles of IUI and the fertilization of an initial IVF procedure without preceding IUI cycles in couples with idiopathic subfertility. Methods We performed a complimentary analysis of a randomized controlled trial, in which the number of total fertilization failure (TFF) in the first IVF procedure after unsuccessful IUI was compared to those of IVF without preceding IUI in patients with idiopathic subfertility. These patients participated in a previous study that assessed the cost effectiveness of IUI versus IVF in idiopathic subfertility and were randomized to either IUI or IVF treatment. Results 45 patients underwent IVF after 6 cycles of unsuccessful IUI and 58 patients underwent IVF immediately without preceding IUI. In 7 patients the IVF treatment was cancelled before ovum pick. In the IVF after unsuccessful IUI group TFF was seen in 2 of the 39 patients (5%) versus 7 of the 56 patients (13%) in the immediate IVF group. After correction for confounding factors the TFF rate was not significantly different between the two groups (p = 0.08, OR 7.4; 95% CI: 0.5–14.9). Conclusion Our data showed that TFF and the fertilization rate in the first IVF treatment were not significantly different between couples with idiopathic subfertility undergoing IVF after failure of IUI versus those couples undergoing IVF immediately without prior IUI treatment. Apparently, impaired fertilization does not play a significant role in the success rate of IUI in patients with idiopathic subfertility.</p