Multimodality Imaging of Heart Valve Disease

Unidentified heart valve disease is associated with a significant morbidity and mortality. It has therefore become important to accurately identify, assess and monitor patients with this condition in order that appropriate and timely intervention can occur. Although echocardiography has emerged as the predominant imaging modality for this purpose, recent advances in cardiac magnetic resonance and cardiac computed tomography indicate that they may have an important contribution to make. The current review describes the assessment of regurgitant and stenotic heart valves by multimodality imaging (echocardiography, cardiac computed tomography and cardiac magnetic resonance) and discusses their relative strengths and weaknesses.

Suplementación de tranquilizantes naturales en la dieta de cerdos con diferente genotipo al estrés: sobre el bienestar animal y la calidad tecnológica y sensorial de la carne

El objetivo principal del proyecto era estudiar el efecto de tranquilizantes naturales sobre el bienestar de los animales y la calidad de la carne desde un punto de vista tecnológico y sensorial. Este objetivo se desglosaba en dos: OBJETIVO 1 – Evaluar la eficacia de tranquilizantes naturales (Magnesio, triptófano) en la disminución del nivel de estrés en cerdos de tres genotipos diferentes respecto del gen Hal, homocigotos dominantes NN, o portadores (Nn y nn) en el período anterior al sacrificio. OBJETIVO 2 – Estudiar el efecto de los tranquilizantes en la calidad tecnológica y sensorial de la carne (pH, capacidad de retención de agua, color, textura, olor sexual, …). Para ello se planteaban dos experimentos, el primero utilizando animales extremos, libres del gen, NN, y Hal +, nn, y el segundo con animales libres, NN, y portadores, Nn.

Itinerari d'educació ambiental i sensorial de Sant Pere del Burgal

El Parc Natural de l’Alt Pirineu (PNAP) va ser creat l’any 2003. Actualment, el parc està desenvolupant una xarxa d’itineraris d’Educació Ambiental (EA). L’Ecomuseu de la Vall d’Àneu (EVA) ofereix rutes guiades al sender del Monestir de Sant Pere del Burgal, ja senyalitzat i equipat pel PNAP, en estar inscrit al seu àmbit territorial. Es tracta d’un sender de fàcil accés i recorregut, molt ample al primer tram tot oferint una gran varietat d’aspectes d’interès. L’objectiu principal del present projecte és plantejar un itinerari d’EA sensorial adaptat als col·lectius amb mobilitat reduïda i persones invidents. Amb aquesta finalitat es desenvolupen continguts i materials didàctics i es determinen les accions que els articularan. En un primer moment s'ha analitzat la viabilitat de l’itinerari aplicant el protocol de valoració dissenyat pel grup Edukamb. La puntuació obtinguda és de 74 punts sobre 100, corroborant la idoneïtat del seu recorregut pels visitants. En el disseny de l’itinerari, s’han determinat els elements i processos d’interès a l’entorn, s’han proposat quatre parades sensorials i una pasarel·la de fusta al primer tram i quatre parades de component antropològica i la instal·lació d’una corda perimetral al segon tram. Finalment també, la instal·lació de maquetes tridimensionals tàctils, una descriptiva dels aspectes i les parades de l’itinerari a l’inici del camí i una arquitectònica de l’entorn del monestir en arrivar al mateix. S’han proposat millores en la senyalització present, alternatives i complements al material pedagògic considerat al projecte i el disseny de protocols de valoració per itineraris adaptats a tot tipus de col·lectius.

Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care : A statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine.

Neurocritical care depends, in part, on careful patient monitoring but as yet there are little data on what processes are the most important to monitor, how these should be monitored, and whether monitoring these processes is cost-effective and impacts outcome. At the same time, bioinformatics is a rapidly emerging field in critical care but as yet there is little agreement or standardization on what information is important and how it should be displayed and analyzed. The Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine, and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to begin to address these needs. International experts from neurosurgery, neurocritical care, neurology, critical care, neuroanesthesiology, nursing, pharmacy, and informatics were recruited on the basis of their research, publication record, and expertise. They undertook a systematic literature review to develop recommendations about specific topics on physiologic processes important to the care of patients with disorders that require neurocritical care. This review does not make recommendations about treatment, imaging, and intraoperative monitoring. A multidisciplinary jury, selected for their expertise in clinical investigation and development of practice guidelines, guided this process. The GRADE system was used to develop recommendations based on literature review, discussion, integrating the literature with the participants' collective experience, and critical review by an impartial jury. Emphasis was placed on the principle that recommendations should be based on both data quality and on trade-offs and translation into clinical practice. Strong consideration was given to providing pragmatic guidance and recommendations for bedside neuromonitoring, even in the absence of high quality data.

Adaptació d'itinerari d'educació ambiental i sensorial a la vall d'Alinyà

Després d’analitzar el potencial de la muntanya d’Alinyà, s’ha observat que és un lloc idoni per desenvolupar activitats d’educació ambiental (EA). Per aquest motiu s’elabora un itinerari d’EA, part del qual és adaptat sensorialment. Havent analitzat els pros i contres de cada itine-rari ja descrit en la muntanya d’Alinyà s’ha escollit l’itinerari 3 que s’amplia fins a la zona de El Ribatell per aconseguir un dels objectius inicials: l’adaptació d’un itinerari d’EA per a persones amb mobilitat reduïda o discapacita-des. En el disseny de l’itinerari s’han inclòs tots els elements d’interès socio-ambiental més desta-cables de la zona, entre els quals es pot destacar els diferents tipus de boscos, aspectes geològics com el Roc de la Pena o els quatre grans rapi-nyaires que es poden trobar a la zona.

Identificació de marcadors biològics amb potencial per a l’optimització sensorial i tecnològica de la carn de porc i pernil curat

L’aplicació de tecnologies innovadores per a l’anàlisi de la qualitat (proteòmica) i per al processat de productes carnis (envasament actiu i altes pressions hidrostàtiques) amb la finalitat d’optimitzar la qualitat i la seguretat de productes carnis llestos per al consum fou evaluat. Els resultats obtinguts amb l’anàlisi proteòmic van permetre la detecció de pèptids/ proteïnes candidats a marcadors proteics de la qualitat dels lloms i dels pernils. La detecció d’aquests marcadors a la matèria primera (llom i pernil fresc) ajudaria a predir la qualitat final dels productes carnis processats (llom cuit i pernil curat), i proporcionaria una eina per al control de la qualitat de la carn de porc. No obstant, la validació del paper d’aquestes proteïnes a la qualitat final dels productes carnis és necessària abans de poder-los considerar marcadors proteics. Per altra banda, es va estudiar la possiblitat de millorar la seguretat alimentària de llonganissa sense sal afegida obtinguda amb el procés QDS® process a través l’ús de tecnologies innovadores (envasament actiu i altes pressions hidrostàtiques). La llonganissa sense sal afegida no va permetre el creixement de L. monocytogenes. No obstant, el patogen seria capaç de sobreviure durant la vida útil del producte en cas de recontaminació. L’envasament antimicrobià amb la inclusió de nisina com a antimicrobià natural es pot considerar un mètode efectiu per a millorar la seguretat de la llonganissa estudiada. L. monocytogenes va sobreviure al tractament d’alta pressió hidrostàtica (600 MPa, 5 min, 12ºC) gràcies a les característiques del producte de baixa activitat d’aigua i presència de lactat a la seva formulació. Per aquest motiu, la APH no es consideraria un tractament apropiat per a reduir la presència de L. monocytogenes en aquest tipus de producte.

Evaluación sensorial de especies hidrobiológicas marinas al estado fresco

Describe las consideraciones generales de la evaluación sensorial de especies hidrobiológicas marinas al estado fresca. Propone esquemas preliminares de calificación por puntos para la merluza, machete, caballa y sardina.

First and second branchial arch syndromes: multimodality approach.

First and second branchial arch syndromes (BAS) manifest as combined tissue deficiencies and hypoplasias of the face, external ear, middle ear and maxillary and mandibular arches. They represent the second most common craniofacial malformation after cleft lip and palate. Extended knowledge of the embryology and anatomy of each branchial arch derivative is mandatory for the diagnosis and grading of different BAS lesions and in the follow-up of postoperative patients. In recent years, many new complex surgical approaches and procedures have been designed by maxillofacial surgeons to treat extensive maxillary, mandibular and external and internal ear deformations. The purpose of this review is to evaluate the role of different imaging modalities (orthopantomogram (OPG), lateral and posteroanterior cephalometric radiographs, CT and MRI) in the diagnosis of a wide spectrum of first and second BAS, including hemifacial microsomia, mandibulofacial dysostosis, branchio-oto-renal syndrome, Pierre Robin sequence and Nager acrofacial dysostosis. Additionally, we aim to emphasize the importance of the systematic use of a multimodality imaging approach to facilitate the precise grading of these syndromes, as well as the preoperative planning of different reconstructive surgical procedures and their follow-up during treatment.

Dramatic malignant progression of a pigmented villonodular synovitis of the knee after 27 years of multimodality treatment

Introduction: Pigmented villonodular synovitis (PVNS) is a rare benign tumour of the synovium, most commonly arising around the knee. Resection remains the treatment of choice. The diffuse variant of the disease is prone to local recurrence (30-50%). However distant dissemination is extremely rare. We report the case of a patient with massive loco-regional and late distant spread to the lungs of PVNS originating in the knee. Case report: A 69 yo women presented to our service 27 years ago with PVNS in her knee. Despite multible surgical resections, synoviorthesis and external beam radiotherapy, no local control was achieved. The disease spread in all thigh compartments. Due to the resistance to all convetional treatment modalities, isolated limb perfusion with TNFα and Melphalan was performed, without any effect on local control. After the disease was diagnosed in iliac lymph nodes, the patient was subjected to a systemic chemotherapy protocol with imitamib, which had to be abandoned, due to intolerance. Due to a giant lymphoedema of the entire limb, making up for a considerable part of the patient's body weight and in view of significant skin invasion, a hip disarticulation was performed. Finally, rapidly growing lung metastases appeared on CT scan, confirmed by core-needle biopsy. Palliative chemotherapy was initiated. Interestingly, histological analysis of the disease throughout the years remained consistent with classic benign PVNS. No sarcomatous dedifferentiation was observed, not even in the pulmonary lesions. Conclusion: PVNS is a benign tumour, with a high risk of local recurrence. Malignant behaviour, with loco-regional and distant metastases remains extremely rare. A histologically benign appearance does not exclude a clinically malignant behaviour with systemic spread.

Radionuclide investigations of the urinary tract in the era of multimodality imaging.

This article presents the role of nuclear medicine procedures in investigating renal and parenchymal disease, as well as upper urinary tract abnormalities. More specifically, the use of scintigraphy is described in the exploration of urinary tract dilatation and UTIs, vesicoureteric reflux, renovascular hypertension, and renal transplants. With a low radiation burden and the absence of sedation, these nuclear medicine procedures are easy to perform and can provide clinicians with valuable data on renal perfusion and the function of individual kidneys, as well as on urinary tract dynamics. However, knowledge of limitations and technical pitfalls is essential in understanding the role of scintigraphy among contemporary imaging methods and the unique information it supplies in nephrourology.

A multimodality vascular imaging phantom with fiducial markers visible in DSA, CTA, MRA, and ultrasound.

The objective was to design a vascular phantom compatible with digital subtraction angiography, computerized tomography angiography, ultrasound and magnetic resonance angiography (MRA). Fiducial markers were implanted at precise known locations in the phantom to facilitate identification and orientation of plane views from three-dimensional (3-D) reconstructed images. A vascular conduit connected to tubing at the extremities of the phantom ran through an agar-based gel filling it. A vessel wall in latex was included around the conduit to avoid diffusion of contrast agents. Using a lost-material casting technique based on a low melting point metal, geometries of pathological vessels were modeled. During the experimental testing, fiducial markers were detectable in all modalities without distortion. No leak of gadolinium through the vascular wall was observed on MRA after 5 hours. Moreover, no significant deformation of the vascular conduit was noted during the fabrication process (confirmed by microtome slicing along the vessel). The potential use of the phantom for calibration, rescaling, and fusion of 3-D images obtained from the different modalities as well as its use for the evaluation of intra- and inter-modality comparative studies of imaging systems are discussed. In conclusion, the vascular phantom can allow accurate calibration of radiological imaging devices based on x-ray, magnetic resonance and ultrasound and quantitative comparisons of the geometric accuracy of the vessel lumen obtained with each of these methods on a given well defined 3-D geometry.

Compostos bioativos em café integral e descafeinado e qualidade sensorial da bebida

O objetivo deste estudo foi determinar a qualidade sensorial de café (Coffea arabica) descafeinado e integral, os níveis de compostos bioativos, antes e após a torração, e a estabilidade destes após a extração da bebida. A análise sensorial foi realizada por meio do método oficial brasileiro de classificação do café. As análises de cafeína, trigonelina e ácido clorogênico foram realizadas por cromatografia líquida de alta eficiência. O delineamento experimental foi o inteiramente ao acaso, em parcelas subdivididas com quatro tipos de café, cinco tempos de análise e três repetições. Na análise sensorial, foi observado que as características sensoriais, presentes na amostra integral, foram perdidas após o processo de descafeinação. Na variável concentração de trigonelina, não houve diferença significativa entre as amostras integrais e descafeinadas. As concentrações para as amostras de café descafeinado verde e integral torrado não foram alteradas após 4 horas de extração. Houve redução significativa na concentração do ácido clorogênico após a torração, após o processo de descafeinação, e com o decorrer do tempo de extração. Quanto à cafeína, não houve diferença significativa após a torração e nem com o passar do tempo após a extração. A descafeinação e a torração afetaram a qualidade sensorial do café e alteraram a concentração dos compostos bioativos.

Brain multimodality monitoring: an update.

PURPOSE OF REVIEW: An important goal of neurocritical care is the management of secondary brain injury (SBI), that is pathological events occurring after primary insult that add further burden to outcome. Brain oedema, cerebral ischemia, energy dysfunction, seizures and systemic insults are the main components of SBI. We here review recent data showing the clinical utility of brain multimodality monitoring (BMM) for the management of SBI. RECENT FINDINGS: Despite being recommended by international guidelines, standard intracranial pressure (ICP) monitoring may be insufficient to detect all episodes of SBI. ICP monitoring, combined with brain oxygen (PbtO(2)), cerebral microdialysis and regional cerebral blood flow, might help to target therapy (e.g. management of cerebral perfusion pressure, blood transfusion, glucose control) to patient-specific pathophysiology. Physiological parameters derived from BMM, including PbtO(2) and microdialysis lactate/pyruvate ratio, correlate with outcome and have recently been incorporated into neurocritical care guidelines. Advanced intracranial devices can be complemented by quantitative electroencephalography to monitor changes of brain function and nonconvulsive seizures. SUMMARY: BMM offers an on-line comprehensive scrutiny of the injured brain and is increasingly used for the management of SBI. Integration of monitored data using new informatics tools may help optimize therapy of brain-injured patients and quality of care.