The potential clinical utility of intravascular ultrasound guidance in patients undergoing percutaneous coronary intervention with drug-eluting stents

AIMS: To assess the impact on clinical outcomes of intravascular ultrasound (IVUS) guidance during drug-eluting stent (DES) implantation. IVUS guidance during percutaneous coronary intervention (PCI) has been demonstrated to be useful in optimizing stent deployment. However, it is not proved that routine use of IVUS guidance with DES implantation can prevent stent thrombosis or restenosis. METHODS AND RESULTS: The clinical outcomes of 884 patients undergoing IVUS-guided intracoronary DES implantation from April 2003 to May 2006 were compared with the outcomes of a propensity-score matched population undergoing DES implantation with angiographic guidance alone. The primary endpoint of the study was definite stent thrombosis at 12 months. The secondary endpoint was major adverse cardiac events (MACE). After propensity-score matching, the two groups were well matched for clinical and angiographic characteristics. Patients undergoing IVUS-guided DES implantation underwent less direct stenting, more post-dilation, and had greater cutting balloon and rotational atherectomy use. At 30 days and at 12 months, a higher rate of definite stent thrombosis was seen in the No IVUS group (0.5 vs. 1.4%; P = 0.046) and (0.7 vs. 2.0%; P = 0.014), respectively. There were no major differences in late stent thrombosis and MACE (14.5 vs. 16.2%; P = 0.33) at 12 month follow-up between the groups. Rates of death and Q-wave myocardial infarction were similar, and there was no significant difference between groups in target vessel revascularization. However, a trend was seen in favour of the IVUS group in target lesion revascularization (5.1 vs. 7.2%; P = 0.07). IVUS guidance was an independent predictor of freedom from cumulative stent thrombosis at 12 months (adjusted HR 0.5, CI 0.1-0.8; P = 0.02). CONCLUSION: IVUS guidance during DES implantation has the potential to influence treatment strategy and reduce both DES thrombosis and the need for repeat revascularization.7 page(s

Restricted home ranges reduce children’s opportunities to connect to nature: demographic, environmental and parental influences

While many studies have documented the decline in the extent of children’s independent movements, none have explicitly evaluated the impact of this change in behaviour on opportunities to connect with nature. We estimate and compare the biodiversity values within urban children’s home ranges, and relate exposure to biodiversity to children’s perceptions and use of their neighbourhoods. We interviewed 178 children aged 9–11 years in three New Zealand cities. While children often had biodiverse areas present within 500 m of their home, their restricted home range size meant many of these natural areas fell outside of the range of their daily movements. Children’s declining independent mobility, strongly influenced by parental restrictions, appears to limit their freedom to use diverse and natural habitats within their urban neighbourhood, with use instead focused on private gardens and formal greenspaces. Development of a connection to nature in urban areas must therefore take place primarily in private gardens, which are threatened by urban planning approaches that promote dense residential developments with public rather than private greenspace

The Aquatic Macroinvertebrate Biodiversity of Urban Ponds in a Medium-sized European Town (Loughborough, UK)

Urbanisation is one of the greatest threats to freshwater biodiversity, with the area of land covered by towns and cities predicted to increase significantly in the future. Ponds are common features in the urban landscape and have been created for a variety of reasons ranging from ornamental/amenity purposes through to the detention of urban runoff and pollution. This paper aims to quantify the aquatic macroinvertebrate biodiversity associated with garden, ornamental and other urban ponds in Leicestershire, UK. We examined the macroinvertebrate biodiversity of 41 urban ponds (13 garden, 12 park and 16 other urban ponds) within the town of Loughborough, UK. Park ponds supported greater macroinvertebrate richness than garden or other urban ponds. Garden ponds were the most taxon poor. Pond size was strongly correlated with macroinvertebrate diversity. Collectively, urban ponds were found to be physically and biologically heterogeneous and were characterised by high community dissimilarity. Urban ponds provide a diverse range of habitats for a mixture of common and rare aquatic macroinvertebrate taxa and represent a valuable biodiversity resource within anthropogenically dominated landscapes. Recognition of the significant contribution of ponds to urban freshwater biodiversity is important for future aquatic conservation within anthropogenically dominated landscapes