Optimization of Radiation Dose and Image Quality in Musculoskeletal CT: Emphasis on Iterative Reconstruction Techniques (Part 2).

Computed tomography (CT) is a modality of choice for the study of the musculoskeletal system for various indications including the study of bone, calcifications, internal derangements of joints (with CT arthrography), as well as periprosthetic complications. However, CT remains intrinsically limited by the fact that it exposes patients to ionizing radiation. Scanning protocols need to be optimized to achieve diagnostic image quality at the lowest radiation dose possible. In this optimization process, the radiologist needs to be familiar with the parameters used to quantify radiation dose and image quality. CT imaging of the musculoskeletal system has certain specificities including the focus on high-contrast objects (i.e., in CT of bone or CT arthrography). These characteristics need to be taken into account when defining a strategy to optimize dose and when choosing the best combination of scanning parameters. In the first part of this review, we present the parameters used for the evaluation and quantification of radiation dose and image quality. In the second part, we discuss different strategies to optimize radiation dose and image quality of CT, with a focus on the musculoskeletal system and the use of novel iterative reconstruction techniques.

Use of drama techniques as a methodology to teach english in infant education by teachers in Catalonia

L’aprenentatge de la llengua anglesa com a llengua estrangera és una oportunitat que cada vegada més escoles de Catalunya presenten a l’etapa d’educació Infantil. La metodologia utilitzada per introduir aquesta llengua és variada en cada cas. Aquesta recerca es centra en l’estudi de l’ús de tècniques dramàtiques com a metodologia per ensenyar anglès a infantil. A partir d’un qüestionari contestat per 129 professors d’anglès de Catalunya s’ha analitzat la percepció que tenen sobre les tècniques dramàtiques i la seva utilització. Els resultats mostren una manca de coneixement general sobre la metodologia.

Multidetector-row computed tomography in the preoperative diagnosis of intestinal complications caused by clinically unsuspected ingested dietary foreign bodies: a case series emphasizing the use of volume rendering techniques

Objective The present study was aimed at describing a case series where a preoperative diagnosis of intestinal complications secondary to accidentally ingested dietary foreign bodies was made by multidetector-row computed tomography (MDCT), with emphasis on complementary findings yielded by volume rendering techniques (VRT) and curved multiplanar reconstructions (MPR). Materials and Methods The authors retrospectively assessed five patients with surgically confirmed intestinal complications (perforation and /or obstruction) secondary to unsuspected ingested dietary foreign bodies, consecutively assisted in their institution between 2010 and 2012. Demographic, clinical, laboratory and radiological data were analyzed. VRT and curved MPR were subsequently performed. Results Preoperative diagnosis of intestinal complications was originally performed in all cases. In one case the presence of a foreign body was not initially identified as the causal factor, and the use of complementary techniques facilitated its retrospective identification. In all cases these tools allowed a better depiction of the entire foreign bodies on a single image section, contributing to the assessment of their morphology. Conclusion Although the use of complementary techniques has not had a direct impact on diagnostic performance in most cases of this series, they may provide a better depiction of foreign bodies' morphology on a single image section.

Le reflux gastro-oesophagien de l'enfant: indications chirurgicales, techniques et suivi.

Contexte: Présent sous forme physiologique chez environ 60% des nourrissons normaux de moins de quatre mois, le reflux gastro-oesophagien (RGO) n'est symptomatique que chez 10% d'entre eux. Il est également plus fréquent chez les enfants atteints de troubles neurologiques quelque soit leur âge. Non traité, il peut avoir des conséquences graves (oesophagite, sténose peptique, endobrachyoesophage (Barrett) puis adénocarcinome de l'oesophage). Il s'agit donc d'un problème qu'il faut savoir détecter et traiter précocement. Les signes et symptômes du RGO sont multiples et varient en fonction de l'âge. Ils ne se limitent pas au seul vomissement. Le traitement initial du RGO chez l'enfant est médical. En cas d'échec de celui-ci ou dans certaines indications (comme les RGO récidivants, les malformations congénitales, les anomalies morphologiques ou les pathologies neurologiques) un traitement chirurgical est nécessaire. L'évolution des traitements conservateurs et des techniques chirurgicales lors de ces dernières années en font un bon sujet pour une étude rétrospective. Objectif: Le but de cette étude est de mettre en évidence dans une population d'enfants ayant bénéficié d'une cure chirurgicale anti-reflux la fréquence relative des symptômes selon la pathologie initiale de l'enfant, puis de préciser le choix de traitement et sa durée. Nous analyserons également les risques d'échec qui s'y rapportent. Ces conclusions devraient nous permettre de proposer un algorithme décisionnel de prise en charge du RGO de l'enfant en pré et post-opératoire. Méthodologie: Étude rétrospective sur 9 ans se basant sur les dossiers médicaux-chirurgicaux de 132 enfants opérés d'un reflux gastro-oesophagien dans le Service de Chirurgie Pédiatrique du Centre Hospitalier Universitaire Vaudois (CHUV) par le Professeur Olivier Reinberg et son équipe entre le 1er janvier 2003 et le 31 décembre 2012. Résultats: Sur les 132 enfants, 93 ont bénéficié d'une fundoplicature selon Toupet, 34 selon Nissen et 5 selon Dor. 57% des enfants présentant un déficit neurologique ont été opérés selon la technique de Nissen contre 7% des enfants "sains". Les taux de démontage et de récidive sont respectivement 5.4% et 3.5 % pour la technique selon Toupet et 2.9% et 0% pour la technique de Nissen. Le taux de démontage global de la fundoplicature est de 4.6% (N=6) Conclusions: La fundoplicature est une méthode de choix pour les enfants chez qui tous les autres traitements ont échoué ou chez qui la présence concomitante du RGO et des comorbidités est délétère à une croissance harmonieuse. Grâce à la chirurgie, la qualité de vie d'au moins 95% des enfants est grandement améliorée après la disparition de symptômes quotidiens et qui peuvent donner lieu à des complications graves.

Pervaporação: uma técnica de separação contínua não-cromatográfica

A brief discussion of the non-chromatographic continuous separation techniques is presented emphasizing the pervaporation process. It makes interesting choices for implementing various preliminary operations of the analytical process in order to accommodate the raw sample to the measuring instrument. Discussions include the perceived advantages and disadvantages, the underlying principles of pervaporation process, the flexible module and fields of application.

Classificação e definição dos métodos de análises em fluxo (Recomendações - IUPAC 1994)

The aim of this report is to classify analytical methods based on flowing media and to define (standardize) terminology. After the classification and a discussion of terms describing the systems and component parts, a section is devoted to terms describing the performance of flow systems. The list of terms included is restricted to the most relevant ones; especially "self-explanatory" terms are left out. It is emphasised that the usage of terms or expressions that do not adequately describe the processes or procedures involved should be strongly discouraged. Although belonging to the category of methods based on flowing media, chromatographic methods are not comprised in the present document. However, care has been taken that the present text is not in conflict with definitions in that domain. In documents in which flow methods are described, it should be clearly indicated how the sample and/or reagent is introduced and how the sample zone is transported. When introducing new techniques in the field, or variants of existing techniques, it is strongly recommended that descriptive terms rather than trivial or elaborate names are used.

The Pelosi-type versus the modified Misgav-Ladach: a randomized trial of two surgical techniques for cesarean section

Cesarean section (CS) is now the most common major surgical procedure performed on women worldwide. A quarter of deliveries in Spain are performed by cesarean section. With the increasing rates of the operation, there is the need to use evidence-based techniques to optimize outcomes and minimize complications. The goal of this study is to employ a well-designed randomized controlled trial to evaluate the intraoperative blood loss of two surgical techniques for cesarean section, the Pelosi-type and the modified Misgav-Ladach. The trial will take place in Hospital Universitari de Girona Dr. Josep Trueta From 2014 to 2015, 512 pregnant women undergoing delivery by their first lower segment cesarean section in this center will be selected through a consecutive nonprobability sampling. We will collect the main obstetrical characteristics, intraoperative outcomes, short-term outcomes for the baby and postoperative outcomes. We will evaluate the intraoperative blood loss by comparing the changes in hemoglobin levels, pre and postoperatively. Patients will be followed during the postoperative period and in a two-week postoperative appointment. We will analyze the continuous variables, such as the differences in hemoglobin levels, using an unpaired two-sided Student’s t-test, while for the categorical variables Fischer’s exact test will be used

Determinacion de la configuracion E-Z de los acidos Fumarico y Maleico. Un experimento orientado a incentivar el desarrollo de la investigacion cientifica en alumnos de Pregrado

In this work we intend to eliminate the idea that laboratory exercises seem like cookbooks. That is, exercises shall be presented as a problematic situation. Based on observation and experimentation, the students should determine the E-Z configuration of maleic and fumaric acids. The basis of this laboratory exercise is the acid-catalyzed isomerization of maleic acid to fumaric acid. Students are given the starting material, reagents and the experimental procedure. They are told that the starting material is a dicarboxylic acid containing a C=C double bond of formula C4H4O4. Students determine melting points, solubilities, acidity and chromatographic patterns for both the starting material and the product, so that a configuration of each acid can be proposed. This type of experiment yields excellent results, because the students are left to deduce that maleic acid is less stable than fumaric acid. Additionally, they conclude that maleic acid is the "Z" isomer and fumaric acid is the "E" isomer. Finally, this laboratory exercise allows the students to develop simultaneously their critical-thinking skills with the respective laboratory techniques and not to see chemistry as recipes to be followed.

Fluidos supercríticos em química analítica. I. Cromatografia com fluido supercrítico: conceitos termodinâmicos

Under the chromatographic point of view, the physico-chemical properties of a supercritical fluid are intermediate to those of the gases and liquids. Many times they approach the best features of each one, as for example, the solubilization power of liquids and low viscosity of gases. The thermodynamic definitions and main physico-chemical features of a supercritical fluid will be presented in this article. The use of supercritical fluids in analytical chemistry has been extremely modest in Brazil, even considering the enormous potential of their applications, and their use in several techniques, such as chromatography (SFC) and supercritical fluid extration (SFE). This article series is intended to discuss the historical evolution, instrumentation features and potential and limitations of the supercritical fluid use in analytical chemistry. A special focus will be centered on chromatography and extration techniques using supercritical fluids.