Productive coexistence and gain in agroforestry systems.

Productive coexistence and coexistence gain of populations were studied using nine years' data from field experiments of Taxodium ascendens-intercrop systems in Lixiahe, Jiangsu Province, China. A theoretical framework for productive coexistence in agroforestry was developed. Interaction patterns between trees and intercrops were presented within this framework. A model framework was developed to describe the coexistence gain and interaction of populations in T. ascendens-intercrop systems. Facilitation and resource sharing were identified as main contribution to the advantage of species combination in agroforestry. The model of population interaction developed in the present study was accepted for describing the interaction of populations in T. ascendens-intercrop systems, because it explained a high proportion of the variance of experimental data and fitted well the observations in most intercropping types. The model developed in the present study provides flexibility for describing different patterns of intra- and inter-specific interactions. Model coefficients were applied to the determination of the ecological compatibility of species. Managed T. ascendens-intercrop systems were advantageous as compared to a monoculture of trees or arable crops. In T. ascendens stands up to the age of three, arable crops contributed about 50-80 % of the total biomass yield of agroforestry. The diameter or height growth of T. ascendens was not significantly influenced by intercrops, indicating that intercropping under trees produced extra yields but did not depress the tree growth. When the trees were young (during the first three years), T. ascendens did not depress the crop yields, and a land equivalent ratio greater than unity was obtained together with a high yield of both components. The diameter and height of the trees were similar in four spacing configurations with an equal number of trees per hectare up to the age of eight, but wider between-rows open range were beneficial for the intercrops. The relationship between open-ranges and species coexistence was also analysed and the distribution of soil nutrients studied.

High-risk patients and high-risk grafts in infrainguinal bypass for critical limb ischaemia

The main purpose of revascularization procedures for critical limb ischaemia (CLI) is to preserve the leg and sustain the patient s ambulatory status. Other goals are ischaemic pain relief and healing of ischaemic ulcers. Patients with CLI are usually old and have several comorbidities affecting the outcome. Revascularization for CLI is meaningless unless both life and limb are preserved. Therefore, the knowledge of both patient- and bypass-related risk factors is of paramount importance in clinical decision-making, patient selection and resource allocation. The aim of this study was to identify patient- and graft-related predictors of impaired outcome after infrainguinal bypass for CLI. The purpose was to assess the outcome of high-risk patients undergoing infrainguinal bypass and to evaluate the usefulness of specific risk scoring methods. The results of bypasses in the absence of optimal vein graft material were also evaluated, and the feasibility of the new method of scaffolding suboptimal vein grafts was assessed. The results of this study showed that renal insufficiency - not only renal failure but also moderate impairment in renal function - seems to be a significant risk factor for both limb loss and death after infrainguinal bypass in patients with CLI. Low estimated GFR (PIENEMPI KUIN 30 ml/min/1.73 m2) is a strong independent marker of poor prognosis. Furthermore, estimated GFR is a more accurate predictor of survival and leg salvage after infrainguinal bypass in CLI patients than serum creatinine level alone. We also found out that the life expectancy of octogenarians with CLI is short. In this patient group endovascular revascularization is associated with a better outcome than bypass in terms of survival, leg salvage and amputation-free survival especially in presence of coronary artery disease. This study was the first one to demonstrate that Finnvasc and modified Prevent III risk scoring methods both predict the long-term outcome of patients undergoing both surgical and endovascular infrainguinal revascularization for CLI. Both risk scoring methods are easy to use and might be helpful in clinical practice as an aid in preoperative patient selection and decision-making. Similarly than in previous studies, we found out that a single-segment great saphenous vein graft is superior to any other autologous vein graft in terms of mid-term patency and leg salvage. However, if optimal vein graft is lacking, arm vein conduits are superior to prosthetic grafts especially in infrapopliteal bypasses for CLI. We studied also the new method of scaffolding suboptimal quality vein grafts and found out that this method may enable the use of vein grafts of compromised quality otherwise unsuitable for bypass grafting. The remarkable finding was that patients with the combination of high operative risk due to severe comorbidities and risk graft have extremely poor survival, suggesting that only relatively fit patients should undergo complex bypasses with risk grafts. The results of this study can be used in clinical practice as an aid in preoperative patient selection and decision-making. In the future, the need of vascular surgery will increase significantly as the elderly and diabetic population increases, which emphasises the importance of focusing on those patients that will gain benefit from infrainguinal bypass. Therefore, the individual risk of the patient, ambulatory status, outcome expectations, the risk of bypass procedure as well as technical factors such as the suitability of outflow anatomy and the available vein material should all be assessed and taken into consideration when deciding on the best revascularization strategy.