Mapping and monitoring High Nature Value farmlands: challenges in European landscapes.

The importance of low intensity farming for the conservation of biodiversity throughout Europe was acknowledged early in the 1990s when the concept of 'High Nature Value farmlands' (HNVf) was devised. HNVf has subsequently been given high priority within the EU Rural Development Programme. This puts a requirement on each EU Member State not only to identify the extent and condition of HNVf within their borders but also to track trends in HNVf over time. However, the diversity of rural landscapes across the EU, the scarcity of (adequate) datasets on biodiversity, land cover and land use, and the lack of a common methodology for HNVf mapping currently represent obstacles to the implementation of the HNVf concept across Europe. This manuscript provides an overview of the characteristics of HNVf across Europe together with a description of the development of the HNVf concept. Current methodological approaches for the identification and mapping of HNVf across EU-27 and Switzerland are then reviewed, the main limitations of these approaches highlighted and recommendations made as to how the identification, mapping and reporting of HNVf state and trends across Europe can potentially be improved and harmonised. In particular, we propose a new framework that is built on the need for strategic HNVf monitoring based on a hierarchical, bottom-up structure of assessment units, coincident with the EU levels of political decision and devised indicators, and which is linked strongly to a collaborative European network that can provide the integration and exchange of data from different sources and scales under common standards. Such an approach is essential if the scale of the issues facing HNVf landscapes are to be identified and monitored properly at the European level. This would then allow relevant agri-environmental measures to be developed, implemented and evaluated at the scale(s) required to maintain the habitats and species of high nature conservation value that are intimately associated with those landscapes.

Pancreaticodudonectomy in trauma: One or two stages?

INTRODUCTION: Duodenopancreatic trauma is rare and presents high morbidity and mortality rates. Pancreaticoduodenectomy (PD) is the only possible treatment indicated for the most complex injuries (grades IV and V). Although, it is commonly a one-stage procedure, damage control surgery corroborates with a two-stage PD performed on unstable trauma victims. OBJECTIVES: Compare the mortality rate of one and two-stage PD in trauma patients. MATERIALS AND METHODS: A systematic electronic search of PubMed, Elsevier, LILACS, Scielo, and Capes was conducted on all studies written in English, Portuguese and Spanish with no restriction to publication dates. Review articles, case reports, editorials, animal studies, pediatric and non-trauma scenarios were excluded. RESULTS: We selected twenty-two publications, with a total of 149 duodenopancreatic trauma victims who underwent PD, with an overall mortality rate of 42 patients (28.2%). Two-stage PD was exclusively performed on unstable patients (N = 31) with a mortality rate of 38.7%. In a sample of 79 patients submitted to a one-stage PD, 38 patients (48.1%) were unstable with a mortality rate of 34.2%. One-stage PD for stable patients had a mortality rate of 14.6% DISCUSSION: Since 1983, hemodynamic state impacts on surgery methods and strategies for trauma patients. Prior to that, one stage PD was not restricted to stable patients. CONCLUSION: There were no differences in mortality rates when comparing two and one-stage PD in hemodynamic unstable patients, who had duodenopancreatic lesions (grades IV or V).

Comparison of the efficacy of rosuvastatin versus atorvastatin in reducing apolipoprotein B/apolipoprotein A-1 ratio in patients with acute coronary syndrome: results of the CENTAURUS study.

BACKGROUND: The mechanism underlying statin-induced event reduction in patients with acute coronary syndrome remains unclear. AIMS: To assess the efficacy of rosuvastatin 20mg versus atorvastatin 80 mg in reducing the apolipoprotein B/apolipoprotein A-1 (apoB/apoA-1) ratio at 3 months. Non-inferiority of rosuvastatin 20mg versus atorvastatin 80 mg in reducing low-density lipoprotein cholesterol at 1 and 3 months was also assessed. METHODS: Patients with non-ST-elevation acute coronary syndrome were enrolled into this randomized, double blind, parallel-group trial. RESULTS: In total, 753 patients (369, rosuvastatin 20mg; 384, atorvastatin 80 mg) were included in the intention-to-treat analysis; 478 patients (226, rosuvastatin 20mg; 252, atorvastatin 80 mg) were included in the per-protocol analysis. Rosuvastatin 20mg was more effective than atorvastatin 80 mg in decreasing apoB/apoA-1 ratio at 1 month (-44.4% vs -42.9%, p=0.02) but not at 3 months (both -44.4%, p=0.87). Low-density lipoprotein cholesterol decreased by approximately 50% after 1 and 3 months in both groups. Non-inferiority of rosuvastatin 20mg versus atorvastatin 80 mg was demonstrated at 1 month (difference, -0.3% [95% confidence interval, -2.7; +2.1]), but not at 3 months (+1.0% [-1.6; 3.5]) (intention-to-treat analysis). In the per-protocol analysis, non-inferiority of rosuvastatin 20mg was demonstrated at both 1 (-0.7% [-3.5; 2.0]) and 3 (-0.5% [-3.5; 2.5]) months. CONCLUSION: In patients with non-ST-elevation acute coronary syndrome, rosuvastatin 20mg decreased apoB/apoA-1 ratio at 1 month more than atorvastatin 80 mg. No difference could be shown at 3 months; thus, the primary endpoint was not met.

Effects of rosuvastatin and atorvastatin on the apolipoprotein B/apolipoprotein A-1 ratio in patients with an acute coronary syndrome: The CENTAURUS trial design.

BACKGROUND: The mechanism underlying rapid, statin-induced event reduction in patients with an acute coronary syndrome (ACS) remains to be clarified. AIM: The primary objective is to compare the efficacy of rosuvastatin 20 mg/day and atorvastatin 80 mg/day in reducing the apolipoprotein B/apolipoprotein A-1 (apoB/apoA-1) ratio at three months, in ACS patients. Secondary objectives include a comparison of the effects of early-started rosuvastatin and placebo on inflammatory markers. METHODS: This is a randomized, double-blind, parallel-group study. Patients with non-ST-segment elevation ACS, symptom onset less than 48 h before admission, and for whom a percutaneous coronary intervention is planned, are eligible for inclusion and are randomized into three groups (G1, G2 and G3). The study comprises two double-blind periods. Period 1 starts at hospital admission and lasts until Day 0 (discharge or less or equal to 6 days after admission); patients in G1 receive one tablet of rosuvastatin 20 mg/day and patients in G2 and G3 receive one matching placebo tablet per day. Period 2 starts at Day 0 and lasts for three months; patients in G1 continue to receive rosuvastatin 20 mg/day, patients in G2 receive rosuvastatin 20 mg/day and patients in G3 receive atorvastatin 80 mg/day. Recruitment of 1075 patients will ensure an 80 power to detect a 3% difference in percentage change in the apoB/apoA-1 ratio and a 20% difference in percentage change in high-sensitivity C-reactive protein. RESULTS: Inclusion phase is complete; results will be reported at a later date. CONCLUSION: This is the first trial investigating the effect of statins on apolipoproteins in ACS patients.