ABSTRACT
Coastal and marine ecosystems supply multiple Ecosystem Services (ES). Nevertheless, these ecosystems are among the most impacted by human activities, harming the ES sustainable supply. Since ES are a spatial phenomenon, mapping can contribute to understand ES supply. For this, we use quantitative spatio-temporal frameworks to map and assess the supply of one provisioning (food from fisheries) and two regulating ES (nursery habitats and nutrient regulation), considering two periods: Baltic Sea Holistic Assessment (HOLAS) 2 (2011-2016) and 3 (2016-2021). The ES supply was assessed following a process-based modelling approach, using bio-physical indicators as proxies. The three ES models were applied and validated, showing moderate results. For fisheries and nursery ES the results showed a significantly higher supply in HOLAS 3 than in 2, and for nutrient ES the opposite. This indicates that the assessed ES changed due to environmental activities. The Anselin Local Moran's results showed that most ES index values aggregate in the High-High cluster; Moran's I and semi-variogram results showed a clustered pattern; and the Getis Ord* analysis showed that hot and cold spots corresponded to high and low supply areas. For fisheries, high ES supply areas were located in the central-southern part of the Baltic Sea, while low-supply regions were located in the northern part. For nursery ES, high supply areas were located in the southwestern Finnish and western Estonian coasts. For nutrient ES, high supply areas occurred in the central- and eastern-southern parts close to the coast. Correlations showed a statistically significant negative correlation between fisheries and nursery ES and a significant positive correlation between fisheries and nutrient ES. No statistically significant correlations were observed between nursery and nutrient ES supply. The results obtained are essential to support coastal and marine management and planning in the Baltic Sea as well as international environmental policies and directives.
Subject(s)
Ecosystem , Environmental Monitoring , Fisheries , Oceans and Seas , Environmental Monitoring/methods , Fisheries/statistics & numerical data , Conservation of Natural Resources/methods , Baltic StatesABSTRACT
The record of Mesozoic reptiles in the Northern region of Brazil is extremely limited, with the only definite occurrence consisting of two ziphodont teeth recovered from an oil well core in the municipality of Nova Olinda do Norte, Amazonas state, from strata of the Alter do Chão Formation (Cenomanian) of the Amazonas Basin. In this study, we aim to reevaluate MCT.R.514 using the most recent methodologies available for the identification of isolated theropod teeth. The cladistic analyses recovered MCT.R.514 as a possible metriacanthosaurid or non carcharodontosaurid allosauroid while the LDAs showed affinities between the specimen and Abelisauridae, Piatniktzysauridae, and Tyrannosauridae. MCT.R.514 was assigned as an abelisaurid due to its overall morphology that lacked metriacanthosaurid synapomorphies (i.e. spiraling mesial carina, strongly labially displaced distal carina, and well-marked mesiolingual longitudinal groove), while maintaining homoplastic features between both groups (i.e. irregular enamel texture, a lingually biconcave cross section, and a straight distal margin). This, together with a mostly Laurasian distribution of Metriacanthosauridae favors the assignment of MCT.R.514 as an abelisaurid as the most parsimonious hypothesis in this occasion. The identification of the specimen as an abelisaurid further expands the still scarce "Mid'' Cretaceous record of this clade in Brazil.
Subject(s)
Dinosaurs , Fossils , Tooth , Animals , Dinosaurs/classification , Dinosaurs/anatomy & histology , Brazil , Fossils/anatomy & histology , Tooth/anatomy & histology , PhylogenyABSTRACT
Tertiary lymphoid structures (TLS) resemble follicles of secondary lymphoid organs and develop in nonlymphoid tissues during inflammation and cancer. Which cell types and signals drive the development of TLS is largely unknown. To investigate early events of TLS development in the lungs, we repeatedly instilled p(I:C) plus ovalbumin (Ova) intranasally. This induced TLS ranging from lymphocytic aggregates to organized and functional structures containing germinal centers. We found that TLS development is independent of FAP+ fibroblasts, alveolar macrophages, or CCL19 but crucially depends on type I interferon (IFN-I). Mechanistically, IFN-I initiates two synergistic pathways that culminate in the development of TLS. On the one hand, IFN-I induces lymphotoxin (LT)α in lymphoid cells, which stimulate stromal cells to produce the B-cell-attracting chemokine CXCL13 through LTßR-signaling. On the other hand, IFN-I is sensed by stromal cells that produce the T-cell-attracting chemokines CXCL9, CXCL10 as well as CCL19 and CCL21 independently of LTßR. Consequently, B-cell aggregates develop within a week, whereas follicular dendritic cells and germinal centers appear after 3 weeks. Thus, sustained production of IFN-I together with an antigen is essential for the induction of functional TLS in the lungs.
Subject(s)
Bone Density Conservation Agents , Denosumab , Hypocalcemia , Recurrence , Renal Insufficiency, Chronic , Humans , Denosumab/adverse effects , Denosumab/therapeutic use , Hypocalcemia/chemically induced , Hypocalcemia/diagnosis , Bone Density Conservation Agents/adverse effects , Bone Density Conservation Agents/therapeutic use , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/diagnosis , Treatment Outcome , Female , Calcium/blood , Aged , Severity of Illness IndexABSTRACT
INTRODUCTION: The anaerobic threshold (AT) is an important physiological index used as a parameter for predicting performance and evaluating adaptations induced by training. The aim of this study was to carry out a systematic literature review to survey the randomized studies that compared the effects of high-intensity interval training (HIIT) with the effects of moderate intensity continuous training (MICT) on the anaerobic threshold of highly trained athletes in endurance sports. EVIDENCE ACQUISITION: The following databases were searched: MEDLINE, Embase, Cochrane Wiley, PubMed, SPORTDiscus, Web of Science, and ProQuest for randomized trials. The search terms covered the areas of HIIT and MICT. This study was registered in the International Prospective Register of Systematic under the number CRD42020155474. EVIDENCE SYNTHESIS: Three studies were included for the qualitative and quantitative synthesis, totaling 72 participants, of whom 28 belonged to the MICT group and 44 to the HIIT group. CONCLUSIONS: The summary result showed that HIIT promotes greater adaptation in the AT of highly trained athletes compared to continuous training (ES=0.73; 95% CI: 0.25-1.21); however, the certainty of evidence evaluated by the GRADE method is low and heterogeneity is high (I2=82%; P<0.01).
Subject(s)
Anaerobic Threshold , High-Intensity Interval Training , Humans , High-Intensity Interval Training/methods , Anaerobic Threshold/physiology , Physical Endurance/physiology , Athletes , Adaptation, Physiological , Athletic Performance/physiology , Physical Conditioning, Human/methods , Physical Conditioning, Human/physiology , Randomized Controlled Trials as TopicABSTRACT
Humans have moved domestic animals around the globe for thousands of years. These have occasionally established feral populations in nature, often with devastating ecological consequences. To understand how natural selection shapes re-adaptation into the wild, we investigated one of the most successful colonizers in history, the European rabbit. By sequencing the genomes of 297 rabbits across three continents, we show that introduced populations exhibit a mixed wild-domestic ancestry. We show that alleles that increased in frequency during domestication were preferentially selected against in novel natural environments. Interestingly, causative mutations for common domestication traits sometimes segregate at considerable frequencies if associated with less drastic phenotypes (for example, coat colour dilution), whereas mutations that are probably strongly maladaptive in nature are absent. Whereas natural selection largely targeted different genomic regions in each introduced population, some of the strongest signals of parallelism overlap genes associated with neuronal or brain function. This limited parallelism is probably explained by extensive standing genetic variation resulting from domestication together with the complex mixed ancestry of introduced populations. Our findings shed light on the selective and molecular mechanisms that enable domestic animals to re-adapt to the wild and provide important insights for the mitigation and management of invasive populations.
Subject(s)
Alleles , Domestication , Introduced Species , Selection, Genetic , Animals , Rabbits/geneticsABSTRACT
Although urban areas negatively impact the environment, they supply a wide range of ecosystem services (ES), mainly cultural ones. Recreation near urban green areas is widespread, including fishing. In northern latitudes, during the winter, lakes are frozen, and several urban dwellers practice ice fishing. Although this activity is well known, no attempts were made to assess and map winter recreational fishery ES supply in lakes. In this work, we developed a methodology to map this ES, taking an urban lake in Vilnius (Lithuania) as an example. A standardized protocol was developed using an unmanned aerial vehicle (proximal sensing), further georeferencing and correcting the gathered images, vectorizing the fishing ice holes, and mapping them using two different methods: Kernel and Point Density. The method developed in this work can be applied in northern areas to identify recreational fishing ES during the winter.â¢A novel method was developed to map winter recreational fishery ES supply in lakes;â¢High-resolution images were taken from an unmanned aerial vehicle to identify fishing ice holes in an urban lake.â¢The method maps a cultural ES, which is trendy in northern latitudes.
ABSTRACT
Background and objectives Discectomy for lumbar disc herniation is the most common spinal surgical procedure. Technological advances have led to the emergence of minimally invasive surgical approaches such as tubular microdiscectomy (TMD) and percutaneous endoscopic lumbar discectomy (PELD). The purpose of this study was to compare the clinical outcomes of PELD to those of TMD at one-year follow-up. Materials and methods This observational registry-based (Spine Tango) cohort study included patients with symptomatic lumbar disc herniation submitted to PELD or TMD. The inclusion criteria were patients who underwent minimally invasive lumbar discectomy (PELD or TMD), patients who attended a follow-up after a minimum of 12 months post surgery, and valid pre- and postoperative questionaries. The primary endpoint was defined as the difference between pre- and postoperative Core Outcome Measures Index (COMI) for the back. The matching was based on a 1:1 nearest neighbor matching without replacement. Results A total of 109 patients were included in this study. Propensity score matching (PSM) was performed achieving 86 patients in the matched sample. Regarding COMI improvement, we found no significant difference between the PELD and TMD groups (paired t-test: estimate, -0.23; standard error, 0.6; p=0.7), and we also did not find any significant difference between groups concerning Oswestry Disability Index (ODI) and EuroQol 5 Dimension (EQ-5D). Medication usage and return to work were similar among the matched groups. Conclusions PELD is a technique that minimizes tissue damage achieving good clinical outcomes similar to TMD. This was observed one year after surgery from patient-reported outcome measures (PROMs) that measured pain improvement, disability, and quality of life.
ABSTRACT
BACKGROUND: Surgical risk stratification is crucial for enhancing perioperative assistance and allocating resources efficiently. However, existing models may not capture the complexity of surgical care in Brazil. Using data from various healthcare settings nationwide, we developed a new risk model for 30-day in-hospital mortality (the Ex-Care BR model). METHODS: A retrospective cohort study was conducted in 10 hospitals from different geographic regions in Brazil. Data were analysed using multilevel logistic regression models. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC), Brier score, and calibration plots. Derivation and validation cohorts were randomly assigned. RESULTS: A total of 107,372 patients were included, and 30-day in-hospital mortality was 2.1% (n=2261). The final risk model comprised four predictors related to the patient and surgery (age, ASA physical status classification, surgical urgency, and surgical size), and the random effect related to hospitals. The model showed excellent discrimination (AUROC=0.93, 95% confidence interval [CI], 0.93-0.94), calibration, and overall performance (Brier score=0.017) in the derivation cohort (n=75,094). Similar results were observed in the validation cohort (n=32,278) (AUROC=0.93, 95% CI, 0.92-0.93). CONCLUSIONS: The Ex-Care BR is the first model to consider regional and organisational peculiarities of the Brazilian surgical scene, in addition to patient and surgical factors. It is particularly useful for identifying high-risk surgical patients in situations demanding efficient allocation of limited resources. However, a thorough exploration of mortality variations among hospitals is essential for a comprehensive understanding of risk. CLINICAL TRIAL REGISTRATION: NCT05796024.
Subject(s)
Hospital Mortality , Humans , Male , Female , Brazil/epidemiology , Middle Aged , Retrospective Studies , Aged , Risk Assessment/methods , Adult , Surgical Procedures, Operative/mortality , Cohort Studies , Aged, 80 and over , ROC Curve , Young Adult , Risk FactorsABSTRACT
Cold regions around the world include Arctic, Antarctic and High Mountain regions featuring low temperatures, ice-covered landscapes, permafrost, and unique ecologic interrelations. These environments are among the most sensitive to climate change and are changing rapidly as the global climate gets warmer. This editorial explores the complexity of the impacts of climate change on cold regions, highlighting recent changes across Earth system. The Special Issue here presented compiles studies that explore the climate change in different cold regions from various perspectives, including paleoclimatic reconstructions, isotherm shifts and climate projections. Despite progress, significant questions remain, demanding interdisciplinary approaches to better understand the interconnected factors shaping cold regions.
ABSTRACT
BACKGROUND: Seroepidemiological studies provide estimates of population-level immunity, prevalence/incidence of infections, and evaluation of vaccination programs. We assessed the seroprevalence of protective antibodies against influenza and evaluated the correlation of seroprevalence with the cumulative annual influenza incidence rate. METHODS: We conducted an annual repeated cross-sectional seroepidemiological survey, during June-August, from 2014 to 2019, in Portugal. A total of 4326 sera from all age groups, sex, and regions was tested by hemagglutination inhibition assay. Seroprevalence and geometric mean titers (GMT) of protective antibodies against influenza were assessed by age group, sex, and vaccine status (65+ years old). The association between summer annual seroprevalence and the difference of influenza incidence rates between one season and the previous one was measured by Pearson correlation coefficient (r). RESULTS: Significant differences in seroprevalence of protective antibodies against influenza were observed in the population. Higher seroprevalence and GMT for A(H1N1)pdm09 and A(H3N2) were observed in children (5-14); influenza B seroprevalence in adults 65+ was 1.6-4.4 times than in children (0-4). Vaccinated participants (65+) showed significant higher seroprevalence/GMT for influenza. A strong negative and significant correlation was found between seroprevalence and ILI incidence rate for A(H1N1)pdm09 in children between 5 and 14 (r = -0.84; 95% CI, -0.98 to -0.07); a weak negative correlation was observed for A(H3N2) and B/Yamagata (r ≤ -0.1). CONCLUSIONS: The study provides new insight into the anti-influenza antibodies seroprevalence measured in summer on the ILI incidence rate in the next season and the need for adjusted preventive health care measures to prevent influenza infection and transmission.
Subject(s)
Antibodies, Viral , Influenza, Human , Humans , Seroepidemiologic Studies , Cross-Sectional Studies , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Influenza, Human/immunology , Female , Male , Adult , Incidence , Antibodies, Viral/blood , Child, Preschool , Child , Middle Aged , Adolescent , Young Adult , Aged , Portugal/epidemiology , Infant , Influenza Vaccines/immunology , Influenza Vaccines/administration & dosage , Influenza A Virus, H1N1 Subtype/immunology , Influenza A Virus, H3N2 Subtype/immunology , Hemagglutination Inhibition Tests , Influenza B virus/immunology , Seasons , Infant, Newborn , Aged, 80 and overABSTRACT
Introduction: The effectiveness of post-surgical rehabilitation following lumbar disc herniation (LDH) surgery is unclear. Research question: To investigate the effectiveness and safety of rehabilitation interventions initiated within three months post-surgery for adults treated surgically for LDH. Material and methods: This systematic review searched seven databases from inception to November 2023. Independent reviewers screened studies, assessed and extracted data, and rated the certainty of the evidence using the GRADE approach. Results: This systematic review retrieved 20,531 citations and included 25 randomized controlled trials. The high certainty evidence suggests that adding Pilates exercise to routine care and cognitive behavioral therapy may improve function immediately post-intervention (1 RCT), and that adding whole-body magnetic therapy to exercise, pharmacological and aquatic therapy may reduce low back pain intensity (1 RCT) immediately post-intervention. Compared to placebo, pregabalin did not reduce low back pain or leg pain intensity (1 RCT) (moderate to high certainty evidence). We found no differences between: 1) behavioral graded activity vs. physiotherapy (1 RCT); 2) exercise and education vs. neck massage or watchful waiting (1 RCT); 3) exercise, education, and in-hospital usual care vs. in-hospital usual care (1 RCT); 4) functional or staged exercise vs. usual post-surgical care including exercise (2 RCTs); and 5) supervised exercise with education vs. education (1 RCT). No studies assessed adverse events. Discussion and conclusion: Evidence on effective and safe post-surgical rehabilitation interventions is sparse. This review identified two interventions with potential short-term benefits (Pilates exercises, whole-body magnetic therapy) but safety is unclear, and one with an iatrogenic effect (pregabalin).
ABSTRACT
The relationship between Leptospira infection and reproductive failures, as well as the mechanisms that lead to it, has not yet been fully established. It has been hypothesized that the presence of Leptospira spp. in the follicular fluid (FF) could impair the oocyte developmental competence. Thus, the impact of the presence of Leptospira spp. in the FF on in vitro embryo production (IVEP) outcomes was assessed. Dairy cows (n=244) from different farms were subjected to ovum pick-up for cumulus-oocyte complexes (COCs) collection. After PCR analysis of the FF, cows were retrospectively allocated into either: positive (POS-FF) or negative (NEG-FF) group. Statistical modeling was conducted using the farm, PCR result, and laboratory in which the IVEP was performed as effects. Noteworthy, 26.6% of the animals were positive for Leptospira spp., and 70% of farms had at least one POS-FF cow in the herd. POS-FF cows had a lower number of COCs recovered (22.6 ± 1.2 vs 15.0 ± 2.8, P=0.036), rate of viable COCs (85.6 ± 0.9% vs 78.1 ± 2.8%, P=0.015), number of good-quality COCs (16.0 ± 0.9 vs 9.8 ± 2.1, P=0.026), cleaved embryos (11.9 ± 0.7 vs 7.5 ± 1.5, P=0.032), and blastocysts (7.3 ± 0.4 vs 2.3 ± 0.7, P=0.044) yielded per cow. In conclusion, the presence of Leptospira spp. in the FF of naturally infected cows impaired the amount of COCs recovered, decreasing the overall IVEP efficiency.
Subject(s)
Cattle Diseases , Fertilization in Vitro , Follicular Fluid , Leptospira , Leptospirosis , Animals , Cattle , Follicular Fluid/microbiology , Female , Leptospira/isolation & purification , Leptospirosis/veterinary , Leptospirosis/microbiology , Cattle Diseases/microbiology , Fertilization in Vitro/veterinary , Retrospective Studies , Embryo Culture Techniques/veterinaryABSTRACT
The ecosystems in China's arid and semiarid regions are notably fragile and experiencing dramatic land degradation. At the 12th Conference of the Parties (COP12) to the United Nations Convention to Combat Desertification (UNCCD) in October 2015, a definition for land degradation neutrality (LDN) was proposed and subsequently integrated into the Sustainable Development Goals (SDGs). Research on LDN has developed in terms of conceptual framework constructions, quantitative assessments, and empirical studies. However, LDN and its drivers must be clarified in China's arid and semiarid regions since some representative processes have yet to be fully considered in the assessment. Here, we develop an LDN indicator system specialised for the area, assess their LDN status, and determine the impacts of human activities and climate change on LDN. Our research aims to refine the LDN indicator system tailored for China's arid and semiarid regions by incorporating the trends of wind and water erosion. We also identify the influence of human activity and climate change on LDN, which provides insightful strategies for ecological restoration and sustainable development in drylands with climate-sensitive ecosystems. The results show that: (1) In 2020, more than half of areas of China's arid and semiarid regions achieved LDN, with more pronounced success in the southeastern areas compared to the central regions. (2) For LDN drivers, elevation shows negligible influence on LDN, whereas increased temperature promotes LDN achievement. Conversely, factors like vapour pressure deficit and v-direction wind speed hinder it. In conclusion, China's arid and semiarid regions achieved LDN, and the dominant factor that substantially influences LDN varies across geographical zones, with higher wind speeds and elevated GDP levels generally obstructing LDN in most areas.
ABSTRACT
BACKGROUND: The Woven EndoBridge (WEB) device is a minimally invasive endovascular treatment option for patients with cerebral aneurysms. Transradial access (TRA) is a technique that involves accessing the arterial system through the radial artery in the wrist rather than the femoral artery in the groin. Several studies have investigated the use of TRA for WEB device deployment in treating intracranial aneurysms. METHODS: A systematic review was conducted to evaluate the TRA for WEB device deployment in treating intracranial aneurysms. The databases PubMed, Cochrane, Embase, Scopus, and Web of Science were searched. To reduce the risk of bias, this systematic review only included studies reporting on using TRA in WEB device deployment for intracranial aneurysm treatment with a minimum of four patients. RESULTS: In this systematic review, 186 patients were included across five studies, with TRA used in 183 cases analyzed. The study population had a higher proportion of females (n = 118%-69%) than males, with a mean age of 62 years old. Among the aneurysms treated, 46 were ruptured, and 119 were located at bifurcation sites, with a mean maximum diameter/width of 6.6 mm and mean height of 5.9 mm. Adjunctive coiling was used in three cases, and adjunctive stenting was used in nine cases. In two cases, conversion to a femoral artery access was necessary. CONCLUSION: The available results suggest TRA with the WEB device is a safe and effective alternative. However, using TRA versus TFA should be individualized based on patient factors and operator experience.
ABSTRACT
Nowadays, when the human impact on the environment becomes prominent daily, specific steps are needed to mitigate or halt those changes. By far, agricultural land is most affected by the degradation process, leading to soil erosion and decreased soil quality. Sustainable measures are needed to find a solution to that problem. This study, located in an agricultural area in northwestern Croatia, gives an insight into how different tillage systems (conventional and conservation) with the addition of manure will affect soil physicochemical properties, hydrology response, and overall yield. To assess hydrological response, a rainfall simulator was used; meanwhile, soil samples were taken to determine bulk density, soil water content, water-stable aggregates, and soil organic matter. Soil water content did not show significant differences, whereas bulk density and penetration resistance yielded significantly higher values at 15-30 cm depth compared to 0-15 cm depth. Also, the conservation manure recorded lower bulk density and penetration resistance values than conventional tilled treatments. Water-stable aggregates and soil organic matter were severely affected by manure addition and yielded an increase after harvest. Hydrological response was delayed for the treatments with manure addition. Crop yield was also significantly higher for the conventional treatment with manure addition, whereas the control plots had lower yields. The results of this study show the positive aspects of conservation tillage, especially with manure addition, where soil quality is preserved or even increased.
ABSTRACT
Fermentation, a critical post-harvest process, can be strategically manipulated to augment coffee quality. This enhancement is achieved through the activity of microorganisms, which generate metabolites instrumental in the formation of distinct sensory profiles. This study investigated the impact of different fermentation methods on the quality of coffee beverages, specifically utilizing the Catiguá MG2 variety. The experimental setup involved fermenting the coffee in 200 L bioreactors, employing both natural and pulped coffee beans. The fermentation process utilized was self-induced anaerobic fermentation (SIAF), conducted in either a solid-state or submerged medium over a 96 h period. Analytical sampling was conducted initially and at 24 h intervals thereafter to quantify the concentration of sugars, alcohols, and organic acids. Sensory evaluation was performed using the established protocols of the Specialty Coffee Association (SCA). The outcomes of this investigation reveal that fermentation substantially enhances the quality of coffee, with each treatment protocol yielding divergent profiles of acids and alcohols, thereby influencing the sensory characteristics of the resulting beverage. Notably, superior quality beverages were produced from naturally processed coffee subjected to solid-state fermentation for durations exceeding 24 h. These findings underscore the significant influence of fermentation techniques and duration on the sensory attributes and overall quality of coffee.
ABSTRACT
BACKGROUND: Cerebral aneurysms, especially large and giant aneurysms, pose challenges in neurointerventional surgery. Treatment choices involve clinical presentation, aneurysm details, and global resource variations. Neurointerventional methods, while innovative, may be cost restrictive in certain regions. In public healthcare, cost is crucial, notably in countries like Brazil. This study examines the device specific cost estimation of flow diverters (FD) and traditional stent assisted coiling (SAC) for large and giant cerebral aneurysms, providing insights into optimizing neurosurgical interventions within the Brazilian public health system's unique challenges. METHODS: A comprehensive retrospective analysis was conducted at our medical center of cases of large and giant aneurysms treated between 2013 and 2023. Determination of the estimated number of coils for aneurysms previously treated with FDs at our center was made, with the cost of each case, and the difference between both treatments was calculated. RESULTS: We investigated the profiles of 77 patients: 40 had large aneurysms (51.9%) and 37 had giant aneurysms (48.1%). Large aneurysms had a mean cost difference of US$274 (standard deviation (SD) $2071), underscoring the device specific cost estimation of FDs over SAC in their treatment. For giant aneurysms, the mean cost difference increased to $6396 (SD $2694), indicating FDs as the more economically sound choice. CONCLUSION: Our study indicated that, for the treatment of giant aneurysms and some large aneurysms, the FD intervention was more economical than SAC.