Exclusion Site Research Articles

Soil and plant attributes under grazing exclusion in semi-steppic semi-arid rangelands, Iran

The aim of this study was to investigate the effect of exclusion (20 years) on the attributes of soil and vegetation in northwest of Iran. Three sites in grazed and three sites in exclusion areas were selected. At each site, three 100 m transects were established for sampling purposes. Soil attributes, including electrical conductivity, pH, calcium carbonate, organic carbon, nitrogen, phosphorus, potassium, clay, silt, calcium, magnesium, and bicarbonate were measured in the lab. Additionally, the primary and secondary attributes of vegetation including density, canopy cover, aboveground net primary production (ANPP) of plant functional types (PFTs), diversity, richness and evenness indices were recorded. The findings of our study indicate that the exclusion site exhibited significantly higher levels of soil organic carbon (1.91%), total nitrogen (0.95%), available phosphorus (1.75 ppm), and soluble potassium (163.52 ppm) compared to the grazed site. However, no significant differences were observed in other soil characteristics between the two sites. Density, canopy cover percentage, ANPP of PFTs (p < .01), diversity (1.92), and richness index (9.64), were higher in the exclusion area (p < .05), while, evenness showed no significant difference. The total species density and canopy cover within the exclusion area were also found to be higher than in grazed areas. Results suggest that exclusion in semi-arid semi-steppes plays an important role in rangeland management.

Before‐after‐control‐impact field experiment shows anti‐predator netting enhances occupancy of the threatened Hungarian meadow viper (Vipera ursinii rakosiensis)

The Hungarian meadow viper is an endangered grassland‐dwelling species, which faces high predation pressure, partially due to avian species that forage in its habitat. Predation pressure by avian predators is caused not only by abundant game species (e.g. hooded crow, Corvus cornix) but also by protected and threatened species (e.g. short‐toed eagle, Cricaetus gallicus; common buzzard, Buteo buteo; roller, Coracias garrulus) in the project area (Felső‐kiskunsági turjánvidék, Hungary). Mark–recapture data of a reintroduced viper population showed a very low, 42% yearly average apparent survival rate. To establish a strong sub‐population we applied anti‐predator netting (APN) by building a 200 × 200 × 3 m (4 ha) totally closed exclusion site with a mesh net, lateral sides boosted with a 1 m high steel field fence to exclude mammals as well as birds. To test the effect of APN we monitored viper occupancy at 50 × 50 m sampling plots in a before–after/control–intervention (BACI) design, where we randomly placed quadrats 0.25 ha (50 × 50 m) to be surveyed, n = 26 at control habitats and n = 4 below the APN enclosure. We collected data across four years (2020–2023), in each year during the spring by 10 surveys replicates in each plot resulting in 1200 surveys to record viper detection/non‐detection data. We applied a multi‐season occupancy model to estimate site occupancy changes to test the effects of the BACI design. Occupancy probabilities were increasing during the four consecutive survey years in both the control and the intervention sites, however except for the initial occupancy, the occupancy probability became significantly higher at APN sites, and the APN intervention had a significant positive effect on viper occupancy, while the distance to APN showed negative effect. Predator exclusion is an effective method to minimise predation pressure and potentially has a deterministic positive demographic outcome, however, due to the high logistical and maintenance costs, this measure can be applied at only a few sites.

Diagnostic accuracy of ultrasound in the diagnosis of Placenta accreta spectrum: systematic review and meta-analysis

ObjectiveTo evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS).Data sourcesScreening of MEDLINE, CENTRAL, other bases from inception to February 2022 using the keywords related to placenta accreta, increta, percreta, morbidly adherent placenta, and preoperative ultrasound diagnosis.Study eligibility criteriaAll available studies- whether were prospective or retrospective- including cohort, case control and cross sectional that involved prenatal diagnosis of PAS using 2D or 3D ultrasound with subsequent pathological confirmation postnatal were included. Fifty-four studies included 5307 women fulfilled the inclusion criteria, PAS was confirmed in 2025 of them.Study appraisal and synthesis methodsExtracted data included settings of the study, study type, sample size, participants characteristics and their inclusion and exclusion criteria, Type and site of placenta previa, Type and timing of imaging technique (2D, and 3D), severity of PAS, sensitivity and specificity of individual ultrasound criteria and overall sensitivity and specificity.ResultsThe overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. The estimate of Odd ratio, negative likelihood ratio and positive likelihood ratio were 34.225, 0.155 and 4.990 respectively.The overall estimates of loss of retroplacental clear zone sensitivity and specificity were 0.820 and 0.898 respectively with 0.129 negative correlation. The overall estimates of myometrial thinning, loss of retroplacental clear zone, the presence of bridging vessels, placental lacunae, bladder wall interruption, exophytic mass, and uterovesical hypervascularity sensitivities were 0.763, 0.780, 0.659, 0.785, 0.455, 0.218 and 0.513 while specificities were 0.890, 0.884, 0.928, 0.809, 0.975, 0.865 and 0.994 respectively.ConclusionsThe accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases.Trial registrationNumber CRD42021267501.

Abstract A003: ASAP1 regulates myogenic differentiation in rhabdomyosarcoma by modulating YAP localization

Abstract Despite aggressive, multimodal therapies, the prognosis of patients with refractory or recurrent rhabdomyosarcoma (RMS) has not improved in four decades. RMS is thought to arise due to defective differentiation in skeletal muscle precursor cells. Differentiation-inducing therapy may improve outcomes for RMS patients with advanced disease. In RAS-mutant PAX fusion-negative RMS (FN-FMS), targeting ERK1/2 activation through MEK1/2 inhibition (MEKi) induces differentiation, slows tumor growth, and extends survival in preclinical studies. However, the duration of therapeutic response is short lived. Identifying additional targets for differentiation therapy is necessary. We propose that ASAP1, an Arf GTPase-activating protein (Arf GAP) highly expressed in FN-RMS and implicated in breast and colorectal cancer progression as well as osteogenic and retinal endothelium differentiation, contributes to FN-RMS differentiation. We find that knockdown (KD) of ASAP1 inhibits differentiation in myoblasts and FN-RMS cells, and its overexpression enhances differentiation. Moreover, myogenic differentiation-associated genes are not enriched upon loss of ASAP1. We discover that KD of ASAP1 homologs, ASAP2 and ASAP3, also blocks differentiation. However, loss of a paralogous Arf GAP, ARAP1, does not, indicating that ASAP regulates differentiation through a mechanism not explained by GAP activity alone. Interestingly, KD of Arf1 or Arf5, small GTPases inactivated by ASAP, also blocks differentiation of FN-RMS, suggesting a novel relationship between Arf and ASAP. Using RNAseq, qPCR, and immunoblotting techniques, we show that loss of ASAP blocks myogenic transcription factor expression. To determine the mechanism by which ASAP1 regulates myogenic transcription factor expression, we investigate the PI3K/AKT, MAPK, and Hippo pathways, which are known to be regulated by ASAP1. While the PI3K/AKT and MAPK pathways are unaffected, downstream components of the Hippo pathway are modulated by ASAP1 KD in FN-RMS cells treated with MEKi. YAP and TAZ are transcriptional coactivators that promote proliferation. Upon Hippo pathway activation, YAP/TAZ activity is blocked by phosphorylation at a nuclear exclusion site. Using cell fractionation and immunoblotting techniques, we find that induction of differentiation by MEKi increases TAZ phosphorylation, excluding it from the nucleus and blocking pro-proliferative transcription. Further, upon ASAP1 KD, TAZ phosphorylation is blocked, restoring nuclear localization, and inhibiting MEKi-induced differentiation. In conclusion, we discover that ASAP1 regulates MEKi-induced differentiation of FN-RMS cells by modulating TAZ localization and supports targeting the YAP pathway as a strategy for FN-RMS differentiation therapy. Our work also identifies ASAP1 as a potential effector of Arf1 activity, a novel interaction of these two proteins. The results described herein provide a deeper understanding of differentiation in FN-RMS and establish the groundwork for advancing differentiation therapy in FN-RMS. Citation Format: Katie E. Hebron, Olivia Feehan-Nelson, Angela Kim, Xiaoying Jian, Sofia A Girald, Paul Randazzo, Marielle E. Yohe. ASAP1 regulates myogenic differentiation in rhabdomyosarcoma by modulating YAP localization [abstract]. In: Proceedings of the AACR Special Conference: Sarcomas; 2022 May 9-12; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2022;28(18_Suppl):Abstract nr A003.

A conceptual methodology for site exclusion boundary and site large early release frequency for multi-unit nuclear power plants site

Probabilistic Safety Assessment (PSA) risk metrics Core Damage Frequency (CDF) and Large Early Release Frequency (LERF) are currently applied for single NPP unit. The purpose of the work is to arrive at quantitative value for LERF for a site consisting of many NPPs. For this objective, the work proposes to define an exclusion boundary for the whole site (site exclusion boundary) which is different from exclusion boundary for one NPP. At a site, the exclusion boundaries of the individual NPPs may overlap or can be separate. In the present research, various concepts of total exclusion boundary length for the site are delineated upon using the exclusion radius/boundary of individual NPPs. A case study for a hypothetical site consisting of three NPP units was considered for the demonstration of the proposed methodology. The NPPs have same power level and equal radius of exclusion boundary. LERF results are available for individual NPPs and those accident sequences are relevant that (initiating events are independent events or common cause events) that cause release of more than 4% of core I-131 radioactive nuclide within 10 h of accident. The radionuclide dispersion was calculated using Gaussian plume model for dose at various locations on the site exclusion boundary for the multiple NPP site. The calculation of site LERF was carried out for various locations on the site exclusion boundary for a specific configuration of NPPs at site.

Grazing exclusion mediates the trade-off between plant diversity and productivity in Leymus chinensis meadows along a chronosequence on the Songnen Plain, China

Grazing exclusion has become an effective approach for restoring the structure and function of natural grassland ecosystems on the Songnen Plain, China. Variations in, and trade-offs between, plant diversity and productivity throughout the restoration processes are critical for understanding the successional mechanisms of vegetation. In this study, we selected five Leymus chinensis meadow sites at different restoration stages (0, 6, 11, 15, and 23 year) to determine the effects of grazing exclusion on the plant community. Grazing exclusion practices substantially changed the plant composition of degraded L. chinensis meadows. Annuals and biennials accounted for the highest proportion (42.8%) at the grazing site (i.e., the 0-year site), whereas perennial rhizome grasses accounted for the highest proportion of plants (67.5%) at the 11-year grazing exclusion site. Plant species diversity decreased and then increased with time since grazing exclusion over the 11 years. Plant height and cover were highest at the 15-year grazing exclusion site. Restoration of the aboveground biomass took longer than that of the belowground biomass. The relative benefits of grazing exclusion for different restoration objectives changed with time, changing from higher greater benefits for diversity to greater benefits for productivity. The 15-year grazing exclusion site had the lowest trade-off index (0.02), indicating a similar benefit for both species diversity and productivity. Considering the changes in plant communities, the trade-off index is a reliable indicator for evaluating the restoration process; therefore, we recommended grazing exclusion for 15 years as a reasonable duration. This study provides important guidelines for maintaining ecosystem structure and function during grazing exclusion grasslands.

The effectiveness of subcutaneous furosemide for symptoms related to congestion in adults with heart failure: A limited systematic review

Heart failure is a major cause of morbidity and mortality worldwide (Bui et al., 2010, Savarese and Lund, 2017 and Metra, and Teerlink, 2017). It usually progresses, leading to repeated hospital admissions and significant symptom burden for patients (Beattie and Johnson MJ, 2012). Therapeutic options to achieve diuresis are of extreme importance for symptom relief. Subcutaneous furosemide might be a useful medication and its use is increasing in heart failure, especially in the field of palliative medicine (Beattie and Johnson MJ, 2012). Limited systematic review, searching five databases. We included only randomized controlled trials (RCTs), for their higher level of evidence. Study design was evaluated including inclusion and exclusion criteria, method and site of recruitment, blinding. We also evaluated population characteristics, intervention and comparison, primary and secondary outcomes, adverse effects and follow-up. The data will be analyzed using narrative synthesis. Fifteen articles, of which 3 were included, reporting on eligible RCTs, all published in 2018. Studies found that subcutaneous furosemide might be an effective option to achieve therapeutic plasma doses, better than oral furosemide. Studies found no statistical difference in diuresis in comparison with oral or intravenous furosemide or in hospitalization rates between groups, which suggests that subcutaneous furosemide might prevent acute hospital admissions. No major adverse events were reported. There are few studies and the evidence suggests that subcutaneous furosemide may be a therapeutic option for patients with heart failure requiring parenteral diuresis. However, the evidence to date at the time of the systematic review is limited and as such this therapeutic approach is off license and currently requires more evidence. L’insuffisance cardiaque est une cause majeure de morbidité et de mortalité dans le monde (Bui et al., 2010, Savarese et Lund, 2017 et Metra, et Teerlink, 2017). Elle progresse généralement, entraînant des hospitalisations répétées et une charge de symptômes importante pour les patients (Beattie et Johnson MJ, 2012). Les options thérapeutiques pour réaliser la diurèse sont extrêmement importantes pour le soulagement des symptômes. Le furosémide sous-cutané pourrait être un médicament utile et son utilisation augmente dans l’insuffisance cardiaque, en particulier dans le domaine de la médecine palliative (Beattie et Johnson MJ, 2012). Revue systématique limitée, recherche dans cinq bases de données. Nous n’avons inclus que des essais contrôlés randomisés (ECR), pour leur niveau de preuve plus élevé. La conception de l’étude a été évaluée, y compris les critères d’inclusion et d’exclusion, la méthode et le site de recrutement, et l’aveuglement. Nous avons également évalué les caractéristiques de la population, l’intervention et la comparaison, les résultats primaires et secondaires, les effets indésirables et le suivi. Les données seront analysées à l’aide d’une synthèse narrative. Quinze articles, dont 3 inclus, rendant compte des ECR éligibles, tous publiés en 2018. Les études ont montré que le furosémide sous-cutané pourrait être une option efficace pour obtenir des doses plasmatiques thérapeutiques, mieux que le furosémide oral. Les études n’ont trouvé aucune différence statistique dans la diurèse chez une comparaison avec le furosémide par voie orale ou intraveineuse ou dans les taux d’hospitalisation entre les groupes, ce qui suggère que le furosémide sous-cutané pourrait empêcher les hospitalisations aiguës. Aucun événement indésirable majeur n’a été signalé. Il existe peu d’études et les preuves suggèrent que le furosémide sous-cutané peut être une option thérapeutique pour les patients souffrant d’insuffisance cardiaque nécessitant une diurèse médicamenteusement facilitée. Cependant, les preuves à ce jour au moment de l’analyse de la littérature sont limitées et, à ce titre, cette approche thérapeutique est hors autorisation de mise sur le marché (AMM) et nécessite actuellement plus de preuves.

Effect of grazing exclusion on soil and vegetation characteristics in desert steppe rangelands: a case study from north-western Iran

This case study examined the effect of grazing exclusion on the soil and vegetation characteristics to provide support for the restoration of the degraded desert steppe rangelands of the Arshagh ecoregion. Six sampling sites were selected (three overgrazed and three not grazed sites) from the ecoregion. Vegetation sampling (1 m2 area at 10 intervals) was carried out along 18 pieces of 90 m long transects. Soil samples were collected from the plots at the beginning, middle, and end of each transect from 0–15 cm depths and then combined to get one sample per transect. Differences between vegetation and soil properties of the grazing exclusion and overgrazed sites were analyzed using the t-test statistic. Species richness index (2.32), the diversity index (1.87), and plant cover (69.46%) were maximum at sites after 20-years of grazing exclusion. All species of plant functional types at the exclusion sites were significantly (p < 0.05) different from those at the overgrazed site. Total aboveground net primary production was greater at the exclusion sites (56.50 g/m2) than at the overgrazed sites. Soil pH was significantly (p < 0.05) higher at the exclusion site than at the overgrazed sites. Electrical conductivity was significantly higher at the overgrazed sites than at the exclusion sites. These results imply that livestock exclusion plays an important role in such vegetation parameters as the diversity, cover and soil properties of degraded rangeland ecosystems. Moreover, grazing exclusion in Arshagh rangelands may be a promising management option for the restoration of such rangelands.

Interactions of soil bacteria and fungi with plants during long-term grazing exclusion in semiarid grasslands

Microbial succession has been extensively investigated during the restoration of degraded environments, but the interactions of microbes with plants and soils have not been well documented. We examined changes in the plant communities, soil variables, and microbial communities of grasslands after different periods of grazing exclusion (0, 10, 25, and 35 y) on the Loess Plateau in China. The microbial communities were characterized based on their biomass, enzymatic activities, quantity of functional microbes, and composition using high-throughput sequencing. Grazing exclusion increased the plant diversity, above- and belowground biomass, organic carbon content, total nitrogen content, microbial biomass, enzymatic activities, abundance of ammonia-oxidizing microbes, and diversities of the bacterial and fungal communities; however, the highest values of these variables occurred at the 25-y exclusion site and subsequently declined, indicating that long-term exclusion could have a negative effect on this grassland. Decreases in the abundances of Alphaproteobacteria and Leotiomycetes and increases in Acidobacteria and Sordariomycetes along the chronosequence indicated different successional patterns in the microbial communities. The patterns of change in the composition and diversity of the plant, bacterial, and fungal communities suggest that plant and bacterial succession occurred in parallel and proceeded faster than fungal succession. Indicators of the bacterial and fungal communities, including their biomass, enzymatic activities, and community composition and diversity, were affected by the plant diversity and organic carbon, total nitrogen, and nitrate nitrogen contents. Fungal succession was also susceptible to changes in the soil moisture content. These results suggest that plant diversity plays an important role in shaping the microbial communities, likely by altering the levels of soil nutrients and moisture.

Effects of deer on the photosynthetic performance of invasive and native forest herbs.

Overabundant generalist herbivores can facilitate non-native plant invasions, presumably through direct and indirect modifications to the environment that affect plant performance. However, ecophysiological mechanisms behind ungulate-mediated plant invasions have not been well-studied. At a long-term Odocoileus virginianus (white-tailed deer) exclusion site in a temperate deciduous forest, we quantified deer-mediated ecophysiological impacts on an invasive biennial Alliaria petiolata (garlic mustard) and two palatable native herbaceous perennials, Maianthemum racemosum and Trillium grandiflorum. In mid-summer, we found that leaf-level light availability was higher in unfenced areas compared with areas fenced to exclude deer. Alliaria in unfenced areas exhibited 50 % higher mean maximum photosynthetic rates compared with fenced areas. Further, specific leaf area decreased by 48 % on average in unfenced areas, suggesting leaf structural responses to higher light levels. Similarly, Maianthemum had 42 % higher mean photosynthetic rates and 33 % decreased mean specific leaf area in unfenced areas, but these functional advantages were likely countered by high rates of deer herbivory. By contrast, Trillium exhibited significantly lower (26 %) maximum photosynthetic rates in unfenced areas, but SLA did not differ. Deer-mediated differences in light saturated photosynthetic rates for all three species were only significant during months with overstory tree canopy cover, when light availability in the herb layer was significantly lower in fenced areas. Alliaria's enhanced photosynthetic rates implicate overabundant deer, a situation that is nearly ubiquitous across its invaded range. Collectively, our results provide empirical evidence that generalist herbivores can alter non-native plant physiology to facilitate invasion.

Using nested connectivity models to resolve management conflicts of isolated water networks in the Sonoran Desert

AbstractConnectivity is essential to organisms for dispersal, mate finding, and resource access. Management conflicts may arise if the attempts to maintain connectivity in the face of habitat loss result in opening up dispersal corridors to invasive species and disease vectors to already‐threatened native species. Using the mule deer (Odocoileus hemionus) and American bullfrog (Lithobates catesbeianus) as examples in a network of surface waters in the Sonoran Desert, we illustrate and propose a resolution to these conflicts. We used structural and functional metrics from graph and circuit theory to quantify landscape connectivity within a spatially nested framework under current and future climate‐based scenarios at regional and local scales to project structural and functional climate impacts for both species. Results indicated that climate impacts may reduce both structural and functional potential connectivity for each species. Mule deer, however, will be impacted to a lesser degree, and the proposed management mitigation of exclusion areas will have a potential lesser impact on this species. From our results, we propose a method to create exclusion areas and site new waters to help mitigate increasing spread of invasive species like the bullfrog while maintaining resource availability and local connectivity for economically important species like the mule deer. The isolation of local clusters from invasive species may be a successful and useful way to reduce management conflicts in the Sonoran Desert isolated waters network and beyond.

Long-Term Effects of White-Tailed Deer Exclusion on the Invasion of Exotic Plants: A Case Study in a Mid-Atlantic Temperate Forest.

Exotic plant invasions and chronic high levels of herbivory are two of the major biotic stressors impacting temperate forest ecosystems in eastern North America, and the two problems are often linked. We used a 4-ha deer exclosure maintained since 1991 to examine the influence of a generalist herbivore, white-tailed deer (Odocoileus virginianus), on the abundance of four exotic invasive (Rosa multiflora, Berberis thunbergii, Rubus phoenicolasius and Microstegium vimineum) and one native (Cynoglossum virginianum) plant species, within a 25.6-ha mature temperate forest dynamics plot in Virginia, USA. We identified significant predictors of the abundance of each focal species using generalized linear models incorporating 10 environmental and landscape variables. After controlling for those predictors, we applied our models to a 4-ha deer exclusion site and a 4-ha reference site, both embedded within the larger plot, to test the role of deer on the abundance of the focal species. Slope, edge effects and soil pH were the most frequent predictors of the abundance of the focal species on the larger plot. The abundance of C. virginianum, known to be deer-dispersed, was significantly lower in the exclosure. Similar patterns were detected for B. thunbergii, R. phoenicolasius and M. vimineum, whereas R. multiflora was more abundant within the exclosure. Our results indicate that chronic high deer density facilitates increased abundances of several exotic invasive plant species, with the notable exception of R. multiflora. We infer that the invasion of many exotic plant species that are browse-tolerant to white-tailed deer could be limited by reducing deer populations.

Grazing Exclusion Effect on Soil and Vegetation Properties in Imam Kandi Rangelands, Iran

Most of the rangeland of Urmia in Iran is degraded and will require considerable reclamation to achieve a desirable state. The aim of this study was to evaluate the effects of 14 years of grazing exclusion on vegetation and soil properties in Imam Kandi rangelands. Sampling in both grazing exclosure and grazed areas were conducted using a systematic randomized sampling method. Six 100-m long transects were randomly located in each area and ten 1 × 1 m sampling plots were located along each transect. Within each plot, species presence, canopy cover, species yield, and plant densities were measured. Soil cores were taken in the center of each vegetation sampling plot at 0–30 cm and 30–60 cm depths. Organic matter, nitrogen content, the amounts of phosphorus and potassium, electrical conductivity (ECe), pH, the percentage of CaCO3, and soil texture were determined for each sample. Results indicate differences in plant canopy cover, species composition, and yield between the grazing exclosure and the control site. All plant growth forms at the exclusion site differed from those at the grazed site. Biomass of perennial grasses, perennial forbs and annual forbs was greater at the exclusion site than at the grazed site, and biomass of annual grasses and shrubs at the control site was greater than at the exclusion site. Overall grazing exclosure site improved the vegetation composition and soil quality parameters ECe, pH, organic matter, nitrogen, phosphorus, and potassium content relative to the grazed site.

Sediment-mediated effects of lugworms on intertidal meiofauna

Based on a large-scale, long-term lugworm exclusion experiment established on an intertidal sand flat in Königshafen (Sylt, North Sea), the effect of ecosystem engineering by the lugworm Arenicola marina on the meiofaunal community was studied. Samples for sediment and meiofauna analyses were taken from a lugworm exclusion plot three years after lugworms were excluded, a disturbed control plot and a pristine ambient plot. Statistical analyses revealed significantly higher concentrations of total organic matter and chloroplastic pigments at the lugworm exclusion site. The median abundance of total meiofauna was 21–29% higher at the lugworm-free site as compared to the lugworm-inhabited sites. Copepoda and Nematoda were distributed homogeneously over all experimental plots while Ostracoda and copepod nauplii reached their highest abundances in the absence of lugworms. Univariate and multivariate analyses revealed significant differences between the copepod species composition of the experimental sites. While the harpacticoid copepod Arenosetella germanica reacted with a decline in individual numbers to lugworm exclusion, Halectinosoma gothiceps and Asellopsis intermedia benefited from the induced changes in the sediment characteristics. Overall, a higher copepod species diversity and evenness was observed at the lugworm exclusion site. The results of this study indicate that sediment-mediated effects of bioturbating organisms influence the abundance and diversity of surface-living meiofauna.

Use of quantitative analysis of remote myocardial fibrosis with delayed-enhancement magnetic resonance imaging to predict outcomes after surgical ventricular restoration for ischemic cardiomyopathy

Preserved myocardial function remote from surgical site is crucial for good outcome after surgical ventricular restoration in ischemic cardiomyopathy. We hypothesized that left ventricular scarring untouched by operation would negatively affect postoperative outcome. In 15 consecutive patients (mean age 61 +/- 12 years, mean left ventricular ejection fraction 20% +/- 7.5%), left ventricular assessments by magnetic resonance imaging and right heart catheterization were performed before and after operation. Left ventricular basal scarring remote from surgical exclusion site was quantified from hyperenhancement area on preoperative delayed-enhancement magnetic resonance imaging as percentage of fibrosis (total infarct size relative to ventricular mass). Calculated percentage of fibrosis varied from 0% to 29.9% (mean 12% +/- 9.6%). Percentage of fibrosis linearly correlated with significantly worse postoperative hemodynamic variables and left ventricular function recovery: left ventricular ejection fraction (P = .0005, R = -0.79), left ventricular end-systolic volume index (P = .05, R = 0.51), mean pulmonary arterial pressure (P = .004, R = 0.70), pulmonary capillary wedge pressure (P = .009, R = 0.65), and cardiac index (P = .005, R = -0.69). At mean 30-month follow-up, 4 patients with recurrent heart failure had significantly greater percentage of fibrosis than did those without recurrence (19% +/- 8.2% vs 8.8% +/- 8.6%, P = .04). Amount of myocardial scarring at left ventricular base affected postoperative left ventricular function and hemodynamic improvements. Preoperative quantitative assessment of remote myocardial status with delayed-enhancement magnetic resonance imaging may predict outcomes for patients undergoing surgical ventricular restoration.

Selected ventriculoplasty for idiopathic dilated cardiomyopathy with advanced congestive heart failure: midterm results and risk analysis

To treat advanced heart failure due to idiopathic dilated cardiomyopathy, surgical ventricular restoration with mitral reconstruction was conducted and evaluated. In 95 patients (81 men, mean age: 54 years), New York Heart Association class III/IV was 44/51, and 33 patients (36%) were inotropic dependent preoperatively. Mitral regurgitation (>or=2+) was noted in all patients. All patients underwent left ventriculoplasty (septal anterior ventricular exclusion in 38, partial left ventriculectomy in 57) and mitral reconstruction (repair 53, replacement 42). Fifty-two patients (55%) had concomitant tricuspid repair. Intra-aortic balloon pumping and left ventricular assist device was used in 24 patients and two patients, respectively. Hospital mortality was 11.6% (11 of 95), with 6.6% (5 of 76) in elective and 31.6% (6 of 19) in emergency operations. The ejection fraction and cardiac index increased from 22.3+/-6.3% to 27.2+/-8.0% and from 2.3+/-0.5 ml/m2/min to 2.8+/-0.5 ml/m2/min, respectively (p<0.001). The endodiastolic volume index, endosystolic volume index and diastolic dimension decreased from 232.9+/-56.1 ml/m2 to 160.0+/-49.8 ml/m2, from 178.9+/-46.7 ml/m2 to 113.8+/-44.7 ml/m2 and from 82.0+/-9.0 mm to 68.9+/-11.6 mm, respectively (p<0.001). Late death occurred in 27 patients with 22 cardiac deaths. The mean NYHA class was 1.7 among the survivors. One-, 3- and 5-year survival rates were 72.8%, 61.4% and 50.5%, respectively. In the 62 patients who were non-inotropic dependent preoperatively, 1-, 3-, and 5-year survival rates (81.8%, 73.7% and 62.9%) were significantly better than the inotropic-dependent group (55.3%, 37.3% and 28.0%). Patients with mitral annuloplasty showed a significantly higher 5-year survival rate than patients with mitral valve replacement (59.6% vs 43.6%) in univariate analysis. By application of the exclusion site selection method, the two different ventriculoplasty procedures did not show significant difference in survival rates. Multivariate analysis showed that preoperative inotropes and old age were significant predictors for postoperative mortality. The selected ventriculoplasty in combination with mitral annuloplasty is a useful option for patients with an extremely dilated left ventricle in idiopathic dilated cardiomyopathy. Surgery should be considered before inotropic dependency occurs when prior medical treatment has failed.

Bioturbation and bioirrigation extend the open exchange regions in permeable sediments

Large‐scale experimental exclusion of lugworms (Arenicola marina) from 400 m2 intertidal fine sand revealed significant effects of their bioturbation and bioirrigation on sediment characteristics, benthic infauna composition, and the dominant mineralization and benthic‐pelagic exchange processes in the sediment. Absence of lugworms resulted in sediment clogging with organic‐rich fine particles, an eightfold decrease in sediment permeability, low oxygen penetration depths, and accumulation of reduced mineralization products in the pore water. The sand flat inhabited by lugworms had low fine‐particle and chlorophyll contents and low sulfide and nutrient concentrations in the pore water. The effects were not limited to the vicinity of lugworm burrows but extended throughout the entire sediment down to ~20‐cm depth. Sediments with the lugworm shared the characteristic of low‐organic, advection‐driven permeable sand rather than of muddy, diffusion‐dominated sediments in the absence of lugworms. Areal oxygen uptake rates depended strongly on hydrodynamic conditions: under calm conditions, sedimentary oxygen uptake was slightly higher at the exclusion site. Experimental flushing using controlled hydrodynamic conditions showed that oxygen uptake at the lugworm site would be higher during more dynamic conditions (e.g., storms) due to significantly deeper oxygen penetration permitted by higher sediment permeability. Our results indicate an interactive effect of bioturbating organisms and hydrodynamics on water‐sediment exchange processes and highlight the importance of benthic infauna for sedimentary processes even in physically dominated systems.

A new concept of ventricular restoration for nonischemic dilated cardiomyopathy

Left ventricular restoration is used to treat patients with chronic progressive heart failure caused by nonischemic dilated cardiomyopathy. This study addresses the use of site selection to determine either lateral wall or septal exclusion. Evolution of intraoperative echocardiography to define the site of poorest contraction and use of multiple biopsies to show the nonhomogeneous nature of damage are reviewed. To address the heterogeneity of extent of fibrosis in nonischemic cardiomyopathy, target selection was used to determine the mode of left ventriculoplasty. Either the lateral wall was excluded by partial left ventriculectomy (PLV) or septal anterior ventricular exclusion (SAVE or Pacopexy) was employed if the septum was primarily diseased. Surgical results in 107 high-risk (43% NYHA (New York Heart Association) class III and 57% class IV) patients with idiopathic dilated cardiomyopathy over the past 9 years are reviewed. Overall hospital mortality was 7.1% in 84 elective operations and 60.9% in 23 emergency operations, and fell from 42.8% (6 of 14) to 15.0% (14 of 93), when site selection for the area of left ventricular excision or exclusion was determined by the intraoperative echocardiography test. The SAVE/Pacopexy procedure was performed in 36 patients with 62.2% 5-year survival rate. For the entire cohort of PLV and SAVE/Pacopexy population, overall ejection fraction increased from 20 to 31%, and NYHA class improved from 3.6 to 1.8. The 1-, 5-, and 7-year survival rates were 66.9, 46.0, and 36.2%, respectively. In patients having the operation before inotropic dependent, the survival rate was 78.1, 58.0, and 50.2%, respectively. Left ventriculoplasty is effective for patients with idiopathic dilated cardiomyopathy with heart failure by proper patient selection, appropriate timing of the operation, and choice of the surgical procedure (exclusion site selection).

Role of Site Selection for Left Ventriculoplasty to Treat Idiopathic Dilated Cardiomyopathy

Ventriculoplasty was introduced to treat patients with chronic progressive heart failure from end-stage non ischemic dilated cardiomyopathy, which was presumed to be a homogeneous disease. However ventriculoplasty is not commonly used today, because variable results follow using only lateral ventriculoplasty as the treatment tool. This report traces our evolution in surgical management, defines that the homogeneous disease concept is not correct, and centers upon the importance of site selection, appropriate timing, and methods of patient selection. Left ventriculoplasty by either partial left ventriculoplasty (PLV) or septal anterior ventricular exclusion (SAVE or Pacopexy) was performed in 96 high risk (44% NYHA Class III, and 56% Class IV) patients with idiopathic dilated cardiomyopathy over the past 8 years. Overall hospital mortality was 8% in elective operations and 57% in emergency operations. Hemodynamic and functional improvement was evident from ejection fraction rising from 20% to 31%, and improved NYHA Class 3.6 to 1.8. The global series showed 1, 5 and 7 year survival rate was 66.4, 44.7 and 41.3%, respectively. However surgical results improved as experience allowed development of a strategy for timing, and defining proper exclusion site selection. Non homogeneous ventricular disease was identified, and 69% 4 year survival resulted from our intraoperative definition of the most diseased segment (septum or lateral wall), and then exclusion of this site. This evolving experience indicates that left ventriculoplasty is effective treatment for patients with end-stage cardiomyopathy, provided proper patient selection, appropriate timing of the operation, and choice of procedure are used as keys to a successful outcome.

Surgical procedures for digestive fistulae caused by radiation therapy.

We evaluated the effectiveness of surgery to treat ileal fistulations associated with radiation exposure. SUBJECTS. An ileal fistula developed in eight patients, 13-102 months after 60 Gy of irradiation to the pelvic cavity, given as initial treatment or supportive therapy following resection of the primary tumor. The underlying diseases were cervical cancer in seven women and bladder cancer in one man. Two patients had an ileorectal fistula, two had an ileosigmoidal fistula, three had an ileovesical fistula, and one had an ileourethral fistula. We performed a partial enterectomy in one patient, a simple bypass operation without exclusion in one, and bypass operations with exclusion in the other six. Intestinal expansion in the exclusion site occurred in one patient, but there were no other complications related directly to surgery, such as sutural insufficiency. The patient who underwent a simple bypass operation died of emaciation 2 months after the surgery, but all of the other patients were discharged capable of oral ingestion. Our findings showed that surgery was beneficial for alleviating the various conditions related to digestive fistulation following radiation therapy.