Ecosystem services mapping for green infrastructure planning-The case of Tehran.

Cities are responsible for more than 70% of carbon-related energy emissions. In order to cope with the widespread effects of these emissions-in addition to improving technology and the use of green energy-it is necessary to reduce the volume of emissions with the help of green spaces at the point of origin. Green spaces provide extensive ecosystem services that improve the quality of life and urban ecosystem livability. Due to the expansion of urban areas, the volume of ecological resources has declined and these resources have become more disconnected. The ongoing reduction of these ecological resources makes their management and planning a critical necessity. We need to evaluate the multiple benefits of urban ecosystem services for appropriate ecosystem management and integrate those ecological benefits with the social characteristics of neighborhoods. This paper provides some analysis, as the first step, to assess the ecosystem services (ES) provided by the green spaces (supply analyses) and the social-ecological needs in these spaces (needs analyses). Next, these assessments are used to find the urban areas with the highest social-ecological needs and with the lowest supply of green spaces in order to provide a reliable basis for the multi-functional planning of green spaces. These assessments are also used to analyze the status of services provided in the environment and the services needed to respond to the people's cultural and ecological needs.

Complete endograft collapse 91/2 years following endograft repair of an abdominal aortic aneurysm.

Endografts are a common method of treating abdominal aortic aneurysms (AAA) because of the short-term benefits of endovascular aneurysm repair (EVAR). However, the short-term benefits of endovascular repair must be balanced against long-term complications, such as the need for conversion to open repair, device migration, persistent or de novo endoleaks, and most concerning the potential for subsequent rupture of the aneurysm. Lifelong postimplantation surveillance is mandatory because the incidence of some complications increases over time. This report describes our recent experience in a patient in whom complete endograft collapse was discovered 9(1/2) years following EVAR necessitating conversion to open repair.

In vivo cerebrovascular actions of amyloid beta-peptides and the protective effect of conjugated estrogens.

Vascular dysfunction and inflammatory processes may be early events in the pathology of Alzheimer's disease (AD). Even though amyloid beta-peptides (Abeta) play a prominent role in the initiation and progression of cellular dysfunction in AD, the precise in vivo actions of various Abeta-peptides has not been established. The cerebrovascular actions of the major Abeta-peptides (1-40) and (1-42) in live animals were investigated using an open cranial window technique. We show here that the Abeta-peptides cause vascular lesions, especially in the arterioles. In one set of experiments, leukocytes and platelets were tagged with Rhodamine 6G, soluble Abeta(1-40) infused intravenously for 2 minutes, and the vasculature video recorded for 90 minutes. In a second set of experiments, soluble Abeta(1-40) infusion was followed 30 minutes later by an infusion of soluble Abeta(1-42) and the vasculature recorded for 90 minutes. Fluorescent and transmission electron microscopic examinations demonstrated the following cerebrovascular action of Abeta-peptides: endothelial cell damage, leukocyte adhesion, platelet activation, thrombus formation, impeded blood flow, and smooth muscle cell damage. The vascular disruption observed were similar to those observed in the brains of some AD patients and may represent the initial phase of a vascular inflammatory response associated with cerebral amyloid angiopathy. The combination of Abeta(1-40) and (1-42) produced significantly more vascular disruption than Abeta(1-40) alone. Oral administration of conjugated estrogens in ovariectomized female rats protected them from the deleterious actions of Abeta-peptides. The reported protective effect of estrogen against AD may be mediated in part through prevention of cerebrovascular Abeta toxicity.

Safety, efficacy, and cost analysis of thymoglobulin induction therapy with intermittent dosing based on CD3+ lymphocyte counts in kidney and kidney-pancreas transplant recipients.

BACKGROUND: In view of the superior T-cell depletion and prolonged half-life of thymoglobulin, we initiated a protocol to administer thymoglobulin intermittently based on peripheral blood CD3+ lymphocyte counts. METHODS: In this prospective study, 41 consecutive high-risk cadaver transplant recipients (panel reactive antibody level >30%, repeat transplant recipients, simultaneous pancreas and kidney or pancreas after kidney recipients, prolonged cold-ischemia time, prolonged donor hypotension, non-heart-beating donors) who received thymoglobulin induction therapy were included. The first dose (1.5 mg/kg) of thymoglobulin was administered intraoperatively. CD3+ lymphocyte count in the peripheral blood was determined daily and repeat doses were administered when the CD3+ count was >20 cells/mm3. Calcineurin inhibitors (CI) in low doses were introduced when the allograft function recovered and the serum creatinine level dropped by at least 25% from the pretransplant level. Thymoglobulin treatment was discontinued once therapeutic CI drug levels were achieved. Concomitant immunosuppression consisted of mycophenolate mofetil and prednisone. RESULTS: The mean individual thymoglobulin dose was 104 mg (1.4 mg/kg), and the total cumulative dose per patient was 318 mg (4.2 mg/kg). Patients received an average of three doses and a mean of six CD3 counts were obtained per patient. Introduction of CI was delayed for an average of 6 days posttransplantation. At a mean follow-up of 340 days, two (4.9%) patients died; three (7.3%) renal allografts and two (18.2%) pancreas allografts were lost. Five (12.2%) patients developed a total of six acute rejection episodes. The mean serum creatinine in the 38 patients with a functioning kidney was 1.47 mg/dl, and the mean blood glucose in the 9 pancreas allograft recipients was 89 mg/dl. Cytomegalovirus (CMV) infection occurred in one (2.4%) patient. No posttransplant lymphoproliferative disorders were seen in this patient cohort. The hospital pharmacy charge for a 100-mg dose of thymoglobulin at this center was $2,165, and the laboratory charge for a single CD3 determination was $70. In this study, the average charges per patient for the total dose of thymoglobulin and six CD3 determinations were $7305. In comparison, the charge for daily administration of 104 mg of thymoglobulin (which was the mean dose) for 6 days (mean time to CI therapy initiation) would be $13,510 and for 10 days (mean time to therapeutic CI levels) would be $22,516. This represents a savings of 46% and 68%, respectively. CONCLUSIONS: Intermittent thymoglobulin therapy, based on peripheral blood CD3+ lymphocyte counts, is safe and associated with low acute rejection rate in high-risk kidney and kidney-pancreas transplant recipients. A mean of three doses resulted in adequate suppression of CD3+ lymphocytes permitting delayed introduction of CI in low doses until recovery of renal function occurred. When compared to traditional daily administration, intermittent therapy results in significant cost savings and reduces the total cumulative dose of this potent immunosuppressive agent.