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A 53-year-old male undergoing emergency aortic valve replacement for infective endocarditis developed a hypertensive crisis early during the operation. Suspecting a pheochromocytoma, intravenous phentolamine was immediately administered, after which the procedure was completed as scheduled. Although quite rare, a pheochromocytoma can be encountered during emergency open heart surgery; thus, early recognition of abnormal blood pressure change and appropriate management are important. Here, we present details of blood pressure control mainly by use of phentolamine, in this case, to demonstrate effective management of a hypertensive crisis during emergency cardiac surgery because of a pheochromocytoma.

This study discusses biophysical-based spatial modeling for land-use change in Java Island considering neighborhood interactions between land use types and the changing area. These neighborhood characteristics used in the logistic regression model to estimate the probability of the change events occurrence. Moreover, the future role of land-use change is then projected using the Markov model based on the annual land-use changes map. The results indicate that paddy rice with an irrigation system (double cropping), especially in upland areas has a high positive spatial autocorrelation with the change areas. Residential area, paddy rice, and upland with intensive cropping have a high effect on the probability of change occurrence. Meanwhile, barren lands/dry land, bush-shrub, and mixed garden give a negative correlation to the change occurrences in agricultural lands. In the case of forestland, the results show some land-use types such as upland with intensive cropping and plantation have a positive contribution to the change of land. The accuracy of the model has also assessed through comparison of the projection with the actual area. The results indicate that the future role of each land-use type is different based on the trend period predictor in the model.

In patients with multivessel disease (MVD), functional information on lesions improves the prognostic capability of the SYNTAX score. Quantitative flow ratio (QFR®) is an angiography-derived fractional flow reserve (FFR) that does not require a pressure wire or pharmacological hyperemia. We aimed to investigate the feasibility of QFR-based patient information in Heart Teams' discussions to determine the optimal revascularization strategy for patients with MVD. We hypothesized that there is an acceptable agreement between treatment recommendations based on the QFR approach and recommendation based on the FFR approach. The DECISION QFR study is a prospective, multicenter, randomized controlled trial that will include patients with MVD who require revascularization. Two Heart Teams comprising cardiologists and cardiac surgeons will be randomized to select a revascularization strategy (percutaneous coronary intervention or coronary artery bypass graft) according to patient information either based on QFR or on FFR. All 260 patients will be assessed by both teams with reference to the anatomical and functional SYNTAX score/SYNTAX score II 2020 derived from the allocated physiological index (QFR or FFR). The primary endpoint of the trial is the level of agreement between the treatment recommendations of both teams, assessed using Cohen's κ. As of March 2022, the patient enrollment has been completed and 230 patients have been discussed in both Heart Teams. The current trial will indicate the usefulness of QFR, which enables a wireless multivessel physiological interrogation, in the discussions of Heart Teams to determine the optimal revascularization strategy for MVD.

We implemented our multidisciplinary heart team (MHT) approach since 2012 for patients with coronary artery disease (CAD) and assessed the effectiveness of it by comparing outcomes in patients treated before and after the introduction of the MHT approach. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for CAD were performed in 802 and 57 patients from 2009 to 2011 in Group NH, and were performed in 867 and 160 patients from 2012 to 2014 in Group H, respectively. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), defined as the composite of all-cause death, myocardial infarction, stroke, cardiac-related readmission and target vessel repeat revascularisation (TVR) for PCI or revascularisation on grafted vessels for CABG. MACCE occurred significantly more often in Group NH than in Group H at 3 years postoperatively (28.1% vs 21.1%) (log rank P = 0.001). Cox regression analysis showed that the MHT approach [hazard ratio (HR), 0.737; 95% confidence interval (CI), 0.60–0.91; P = 0.004] and ejection fraction (HR 0.976; 95% CI, 0.97–0.98; P

Objectives Although aortic annulus repair has a long history, there are still no ideal devices to control an aortic annulus. We have developed a new method involving the use of an expanded polytetrafluoroethylene graft with the support of a metallic ring holder during implantation from inside an aorta, with no dissection of the surrounding aortic annulus. Methods We used aortic annular rings of 18 to 24 mm made of Gore-Tex tubed grafts (W.L. Gore & Associates, Flagstaff, AZ, USA) and metallic ring holder. After cutting the graft circumferentially to a 5-mm thickness, it was compressed manually to decrease the thickness. Then, a metallic ring holder corresponding to the graft size was inserted into the graft. The metallic ring holder was fixed to the graft with one 4–0 monofilament suture using 6 holes and the side trench on the metallic ring holder. The proper size for the graft was determined, and the appropriate annuloplasty ring was selected. A row of 4–0 double-needle braided sutures with expanded polytetrafluoroethylene spaghettis was sewn from the aortic side into the left ventricular outflow tract with a horizontal mattress stitch. After all sutures around the annulus were placed, they were tied down and the metallic ring holder was removed. The leaflets were repaired if necessary. Results A total of 9 patients with tricuspid aortic valve have undergone this procedure since January 2015. The sizes of the aortic annular rings were 20 mm ( n = 3), 22 mm ( n = 5), and 24 mm ( n = 2). Aortic leaflets were repaired in 6 patients (6 central plications). Concomitant procedures were total aortic arch replacement ( n = 2), mitral valve repair ( n = 2), tricuspid valve repair ( n = 1), and coronary artery bypass grafting ( n = 2). There were no hospital deaths and no major morbidities. All patients were checked for mild or less than mild aortic regurgitation during the mean follow-up period of 13 months. Postoperative echocardiograms showed excellent peak pressure gradients compared with preoperative echocardiograms. Postoperative cardiac computed tomography scans were performed in 6 patients. The discrepancies between the ring size used and postoperative annular size were Conclusions This new flexible ring is easy to use to fix an aortic annulus from the inside. Early results reveal excellent control of aortic regurgitation with the projected annular size. Further investigations are needed to ensure the effectiveness of the ring.

A 53-year-old male undergoing emergency aortic valve replacement for infective endocarditis developed a hypertensive crisis early during the operation. Suspecting a pheochromocytoma, intravenous phentolamine was immediately administered, after which the procedure was completed as scheduled. Although quite rare, a pheochromocytoma can be encountered during emergency open heart surgery, thus early recognition of abnormal blood pressure change and appropriate management are important. Here, we present details of blood pressure control mainly by phentolamine use in this case to demonstrate effective management of a hypertensive crisis during emergency cardiac surgery because of a pheochromocytoma.

Myxomas account for a majority of the reported primary cardiac tumors that are relatively rare, and biatrial myxomas in an atrial septal defect are extremely rare. Here, we present the case of a healthy 79-year-old woman who was referred to our hospital after a giant mass in the left atrium was incidentally detected by transthoracic echocardiography. Although she was asymptomatic, we surgically resected the mass soon after admission, considering the risk of embolism. During the surgery, we observed the giant bilateral tumor in an atrial septal defect, which was, on pathological evaluation, found to be a myxoma.

Background Helicobacter cinaedi is rarely identified as a cause of infected aneurysms; however, the number of reported cases has been increasing over several decades, especially in Japan. We report three cases of aortic aneurysm infected by H. cinaedi that were successfully treated using meropenem plus surgical stent graft replacement or intravascular stenting. Furthermore, we performed a systematic review of the literature regarding aortic aneurysm infected by H. cinaedi. Case presentation We present three rare cases of infected aneurysm caused by H. cinaedi in adults. Blood and tissue cultures and 16S rRNA gene sequencing were used for diagnosis. Two patients underwent urgent surgical stent graft replacement, and the other patient underwent intravascular stenting. All three cases were treated successfully with intravenous meropenem for 4 to 6 weeks. Conclusions These cases suggest that although aneurysms infected by H. cinaedi are rare, clinicians should be aware of H. cinaedi as a potential causative pathogen, even in immunocompetent patients. Prolonged incubation periods for blood cultures are necessary for the accurate detection of H. cinaedi.

The no-touch saphenous vein harvesting technique is considered to be the ideal procedure to achieve the best quality of vein, whereas the endoscopic vein harvesting (EVH) technique is considered to be ideal for decreasing wound complications. We developed a new technique of EVH with perivascular tissue preservation. This procedure was performed by dissecting the immediate anterior and posterior perivascular connective tissues of the saphenous vein followed by cutting approximately 1 cm laterally from the saphenous vein with the use of a harvester (MAQUET Getinge Group, Getinge AB, Göteborg, Sweden). Histopathological examination revealed preserved perivascular tissue and intimal folding.

The Cat Ba Archipelago is an island chain bordering Hai Phong City in North Vietnam and has been recognized as a biosphere reserve by the United Nations Educational, Scientific and Cultural Organization (UNESCO) since 2004. However, the mangrove forest ecosystem of this reserve has suffered severe degradation due to its partial conversion to shrimp aquaculture. The restoration of the mangroves is expected to play an important role in dealing with climate change impacts, given their ability to mitigate the impact of tropical storms. This study examined the factors influencing the willingness to pay (WTP) for mangrove restoration in the context of climate change in the mangrove forest ecosystems of the Cat Ba Biosphere Reserve (CBBR), Vietnam. We employed a contingent valuation method to estimate household WTP for mangrove restoration, drawing upon data from a survey of 205 respondents in four villages in the buffer and transition zones of the biosphere reserve where mangrove forests are found. The mean WTP is estimated to be 192,780 VND (US$8.64), while the total annual benefit from the mangrove conservation programs of the CBBR is estimated at 712.3 million VND (US$31,943). The results revealed that gender, education level, occupation, the participation of respondents in mangrove restoration activities, and their attitudes toward the impact of climate change were significant factors in their WTP for mangrove restoration. Since mangroves can significantly contribute to mitigating climate change impacts by easing the effect of tropical storms and protecting dyke systems, the local government of Hai Phong City should implement the necessary regulations and policies to conserve the mangrove forests of the Biosphere Reserve.

Aboveground biomass (AGB) of mangrove forest plays a crucial role in global carbon cycle by reducing greenhouse gas emissions and mitigating climate change impacts. Monitoring mangrove forests biom...

Identifying environmentally vulnerable regions is an important aspect of forest resource management, especially in boreal forest ecosystems that exhibit sensitivity to climate change. In this study, an environmental vulnerability index was constructed to describe the vulnerability status of the ecosystem in the Daxing’anling region, Heilongjiang Province, China. Thirteen variables related to exposure, sensitivity and adaptive capacity of the ecosystem were selected and integrated into a comprehensive index using spatial principal component analysis. The vulnerability within each part of the study area was then classified into one of five levels, including potential, slight, light, medium and heavy vulnerability, based on the numerical values. Results showed that the degree of vulnerability was unevenly distributed throughout the Daxing’anling region. The highest environmental vulnerability index value was approximately 0.86 in the southern and central areas, suggesting that these regions are the most vulnerable to environmental changes. The lowest value was approximately 0.036 in the eastern region, which indicates a relatively high-quality environment that is less vulnerable to environmental changes. The results of the environmental vulnerability evaluation may be helpful for decision makers by providing a comparatively rational decision making tool for planning and implementing effective forest resource management.

This study tested the use of machine learning techniques for the estimation of above-ground biomass (AGB) of Sonneratia caseolaris in a coastal area of Hai Phong city, Vietnam. We employed a GIS database and multi-layer perceptron neural networks (MLPNN) to build and verify an AGB model, drawing upon data from a survey of 1508 mangrove trees in 18 sampling plots and ALOS-2 PALSAR imagery. We assessed the model’s performance using root-mean-square error, mean absolute error, coefficient of determination (R2), and leave-one-out cross-validation. We also compared the model’s usability with four machine learning techniques: support vector regression, radial basis function neural networks, Gaussian process, and random forest. The MLPNN model performed well and outperformed the machine learning techniques. The MLPNN model-estimated AGB ranged between 2.78 and 298.95 Mg ha−1 (average = 55.8 Mg ha−1); below-ground biomass ranged between 4.06 and 436.47 Mg ha−1 (average = 81.47 Mg ha−1), and total carbon stock ran...

The effectiveness and sustainability of eco-compensation policy implementation are essential to ecosystem service protection. However, a purely subjective standpoint causes deviations from the compensation benchmark, while decision-making based solely on an objective standpoint fails to offer a profound understanding of local stakeholder conflicts. Therefore, local authorities find it difficult to set reasonable and effective eco-compensation implementation standards. An assessment framework for eco-compensation, defined as the subjective-objective combination analysis (SOCA), which considers both the subjective and objective positions of stakeholders is proposed. Focusing on a typical eco-compensation case, “Returning Tea to Forest”, a compensation range is finally quantified from $443/ha to $2114/ha per year using the SOCA framework. SOCA quantification from multiple perspectives optimized the eco-compensation benchmark determinations and the eco-protection decision-making process.

The spontaneous expansion of tea cultivation has led to the degradation of forest ecosystem services in the Wuyishan national nature reserve (WNNR). In 2008, the local government put forward the policy of “returning tea to forests” (RTTF) to protect the forest ecosystem. However, in order to measure its effects over the past ten years, it is necessary to accurately quantify the economic benefits of this ecological policy. This study tracked the land use changes in WNNR during the last 17 years and estimated the ecosystem service value caused by the RTTF policy. We used virtual market methods to convert different types of public feedback into a unified monetary value, and estimated the economic benefits of RTTF by combining the land use changes. Results showed that the added value of forest ecosystem services not only compensated for the loss of tea profits, but also brought about remarkable economic benefits (approximately US$140 million). Through the combination of ecological changes and economic benefits, we proposed a future direction of the RTTF policy adjustment. More broadly, we provided a method to quantify economic effects (or economic losses) from the perspective of public feedback on the basis of ecological changes. This attempt has contributed to the solving of econometric problems related to ecological policy by combining bioinformatics with ecological economics.

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license The mangrove ecosystem plays a vital role in the global carbon cycle, by reducing greenhouse gas emissions and mitigating the impacts of climate change. However, mangroves have been lost worldwide, resulting in substantial carbon stock losses. Additionally, some aspects of the mangrove ecosystem remain poorly characterized compared to other forest ecosystems due to practical difficulties in measuring and monitoring mangrove biomass and their carbon stocks. Without a quantitative method for effectively monitoring biophysical parameters and carbon stocks in mangroves, robust policies and actions for sustainably conserving mangroves in the context of climate change mitigation and adaptation are more difficult. In this context, remote sensing provides an important tool for monitoring mangroves and identifying attributes such as species, biomass, and carbon stocks. A wide range of studies is based on optical imagery (aerial photography, multispectral, and hyperspectral) and synthetic aperture radar (SAR) data. Remote sensing approaches have been proven effective for mapping mangrove species, estimating their biomass, and assessing changes in their extent. This review provides an overview of the techniques that are currently being used to map various attributes of mangroves, summarizes the studies that have been undertaken since 2010 on a variety of remote sensing applications for monitoring mangroves, and addresses the limitations of these studies. We see several key future directions for the potential use of remote sensing techniques combined with machine learning techniques for mapping mangrove areas and species, and evaluating their biomass and carbon stocks.

Revealing the value of ecosystem services is a prerequisite for economic decision-making to maintain life-support functions, yet how to make the valuating process more universally and extensively applicable remains poorly defined. Herein, we developed a public appraisal method (PAM) to let ecosystem services be appraised by the public directly. Inspired by cultural relic identification, the PAM included four steps: categorize real services, build a virtual market, conduct the public appraisal, and produce a valuation list. Taking the Wuyishan forest ecosystem as a study case, we verified the effectiveness of PAM by comparing it with the traditional comprehensive method (TCM). The total value of ecosystem services assessed by PAM was ¥181.6 billion/year, compared with ¥222.3 billion/year for TCM. A new index, called environmental risk perception (ERP), was introduced. The ERP model was used to analyze the differences in the valuation results, as well as to improve the accuracy of PAM valuation. By building a virtual market for real services, we provide a simple valuation method that can be widely applied for value assessment and importance ranking of multiple ecosystem services.

Congenital left ventricular diverticulum (CLVD) is a rare congenital anomaly and may be associated with fatal adverse events. A previously healthy 20-year-old man collapsed as a result of sudden ventricular fibrillation (VF). Despite intractable VF, he had return of spontaneous circulation with cardiopulmonary resuscitation and subsequent introduction of venoarterial extracorporeal membrane oxygenation (ECMO). After ECMO was discontinued, cardiac magnetic resonance imaging revealed CLVD at the posterolateral wall of the left ventricle. Given the risk of recurrent VF and left ventricular rupture, he underwent surgical repair for CLVD and implantation of a subcutaneous implantable cardioverter defibrillator.

The main objective of this study is to map the spatial distribution of mangrove species and assess their changes from 2010 to 2015 in Hai Phong City of Vietnam located on the tropical region using the ALOS PALSAR data and an optimized rule-based decision tree technique. For this purpose, ALOS PALSAR imagery for the above period and GIS data were collected and used, and then, spatial distributions of mangrove species were derived using logistic model tree (LMT) classifier. The LMT is current state-of-the-art machine learning method that has not been used for mapping of mangrove species. The results showed that incorporation of ALOS PALSAR imagery and GIS in the LMT algorithm provides satisfactory overall accuracy and kappa coefficient. The ALOS-2 PALSAR for 2015 achieved better overall accuracy, with an increment of 3.6% in mapping mangrove species than that of the ALOS PALSAR for 2010. The ALOS-2 PALSAR-derived model yielded the overall accuracy of 83.8% and the kappa coefficient of 0.81, compared with those of the ALOS PALSAR-derived model, 80.2% and 0.78, respectively. The results of classification for 2010 and 2015 were significantly different using the McNemar test. This research demonstrates the potential use of ALOS PALSAR together with machine learning techniques in monitoring mangrove species in tropical areas.

Cat Ba is one of the most well-known islands located in North Vietnam, which has been recognized as a biosphere reserve by United Nations Educational, Scientific and Cultural Organization (UNESCO) since 2004. Despite the large potential carbon stocks in mangrove forests of Cat Ba, the mangrove ecosystem of this island has suffered severe deforestation and forest degradation due to the conversion to shrimp aquaculture. Monitoring mangrove forest changes plays an important role for effective mangrove conservation and management. The objectives of this study were to map the spatial distribution of mangrove forest and to assess their changes between 2010 and 2015 in Cat Ba Biosphere Reserve, Hai Phong city of Vietnam using ALOS PALSAR data and a GIS-based support vector machine algorithm. For this purpose, ALOS PALSAR imagery for the above period and GIS data were collected. Then, spatial distributions of mangroves were derived using the support vector machine classifier. The results showed that the ALOS-2 PALSAR for 2015 achieves the overall accuracy of 85% and the kappa coefficient of 0.81, compared with those of 81% and 0.77, respectively from the ALOS PALSAR for 2010. The mangrove forest areas in the Cat Ba Biosphere Reserve, Vietnam decreased by 15% from 2010 to 2015. This research shows the potential use of ALOS PALSAR data combined with machine learning techniques in monitoring mangrove forest changes in tropical and semi-tropical climates.

There are no previous reports of intraabdominal sarcoma with metastasis to the thoraco-abdominal aorta causing rupture. Here we present the case of a previously healthy 50-year old male who presented to our institution with sudden, sharp back pain. Chest and abdominal computed tomography revealed aortic rupture at the twelfth thoracic level as well as a giant mass in the left upper abdomen. We performed thoracic endovascular aortic aneurysm repair. Histopathology of a biopsy taken from a rib metastasis was thought to be either differentiated liposarcoma or malignant fibrous histocytoma. The patient is currently undergoing chemotherapy. .

Frequent monitoring of the state of wetlands is important in order to sustain these valuable ecosystems. Reliable reference maps make this monitoring more effective. A very high resolution and reliable vegetation map with a nominal spatial resolution of 2 cm by 2 cm was created for a study area in the high moor in the Kushiro wetland, Japan. The reference map was created using aerial photography recorded in the summer of 1998 with a 35 mm, non-metric camera mounted on a balloon. The study site contains 40 wetland plant community types covering about 10 ha of the high moor. The resulting map shows that belt-like spatial patterns of typical wetland plant community groups can be clearly distinguished and confirmed through visual interpretation and spatial pattern analysis. The optimal spatial resolution for monitoring vegetation in this area using remote sensing is 0.3 m or smaller.

This paper deals with characterizing temporal vegetation dynamics continuously in the forestlands of Java, Indonesia and assesses the net change area within the context of forest cover change. We argue that a consistent forestland has typical, distinct and repeated temporal inter-annual vegetation dynamics; therefore, a dynamics change in the forestland could be recognized through a change in the pattern of the long-term vegetation dynamics. We explored 250 m multi-temporal MODIS EVI 16-day composite data from 2001 to 2007 to characterize a change in vegetation dynamics related to forest cover change. The change was recognized based on comparison of annual EVI values for two successive years. The results show that by characterizing temporal vegetation dynamics, it is possible to distinguish the dynamics changes in forestlands caused by several processes, such as deforestation, reforestation and forest regrowth. Although the mixed pixel issue is quite problematic for identification of all actual change events in the area, the results indicate that the set of analyses and techniques in this study is still offers great promise for the monitoring of forest cover change at a large scale.

Simultaneous analysis of land surface attributes and their seasonal changes provides a broader view of land-use and land-cover change. This study attempted to detect the change in inter-annual temporal vegetation dynamics, which reflects a change in land surface attributes. We explored 250-m multi-temporal MODIS EVI 16-day composite data from 2001 to 2007 to characterize a change in vegetation dynamics related to land-use change detection. The MODIS data was filtered in time-frequency space by wavelet function in order to identify and reduce the overall noise so as not to lose useful information from the time series data. The results show that by characterizing temporal vegetation dynamics, it is possible to distinguish actual land-use change based on land-cover dynamics. The result was evaluated using 18,626 reference pixels and showed an overall accuracy of 76.10%. In agricultural land use, such as upland and plantation, the weakest results were caused by mixed pixels from MODIS 250-m grid data as well ...

Improving the understanding of land use and land cover is a major research challenge for the human-environmental sciences and is essential for many aspects of global environmental research. Considering seasonal vegetation dynamics or phenological dynamics in multi-year series leads to a broader view of land use and land cover. This study is based on the hypothesis that a pixel representing a complex but consistent land use has a typical, distinct and repeated temporal pattern of vegetation index inter-annually, which can be used as characteristic signatures for land use classification. Considering the seasonal events and climatic variability in Indonesia, we characterized the temporal vegetation dynamics of long-term land use by using multi-temporal Moderate Resolution Imaging Spectroradiometer (MODIS) enhanced vegetation index 16-day composite data from 2001 to 2007, and then generated a land use map using those characteristics. Accuracy assessment of the results showed the need to evaluate such methods ...

In spite of water scarcity problem in Tunisia, irrigation strategy was adopted and supported by the government. In addition, the introduction of the irrigation in olive sector was also encouraged because it will be the way for maintaining the production of this strategic product. Therefore, the main objective of this work is to detect irrigated and non-irrigated olive growing farms using remote sensing techniques which can be useful to establish efficient and sustainable strategy of water resource management. This study was conducted in olive growing farms of 04 regions (Bouhajla, Nasrallah, Chebika and Oueslatia) in Kairouan prefecture. To monitor the irrigated olive growing farms, we used multi-temporal Landsat 8 imagery from June to September 2015 which were processed to obtain specific vegetation indices such as RVI (ratio vegetation index) and NDVI (Normalized Difference Vegetation Index). Moreover, LST (Land Surface Temperature) and BT (Brightness Temperature) are produced to assess temperature. To drought monitoring, VCI (Vegetation Condition Index), TCI (Temperature Condition Index), and VHI (Vegetation Health Index) were applied as indicators. The validation approach was based on the field survey and data collection. The main results of the study are the detection of irrigated and rainfed olive growing farms using specific vegetation indexes and indicators. The findings are validated by the field observations for checking the accuracy of the results. This study can be useful for stakeholders to detect the olive growing farms which can be helpful to estimate the olive production.