Early detection of microcirculatory perfusion changes with a high resolution, real time laser Doppler imaging camera--frostbite case study.

A 41-year-old male presented with severe frostbite that was monitored clinically and with a new laser Doppler imaging (LDI) camera that records arbitrary microcirculatory perfusion units (1-256 arbitrary perfusion units (APU's)). LDI monitoring detected perfusion differences in hand and foot not seen visually. On day 4-5 after injury, LDI showed that while fingers did not experience any significant perfusion change (average of 31±25 APUs on day 5), the patient's left big toe did (from 17±29 APUs day 4 to 103±55 APUs day 5). These changes in regional perfusion were not detectable by visual examination. On day 53 postinjury, all fingers with reduced perfusion by LDI were amputated, while the toe could be salvaged. This case clearly demonstrates that insufficient microcirculatory perfusion can be identified using LDI in ways which visual examination alone does not permit, allowing prognosis of clinical outcomes. Such information may also be used to develop improved treatment approaches.

A Dethroned King? The Limits of State Infrastructural Power in France

Since the 1980s in Western Europe, centralized states' control over subnational territories has been deeply affected by processes of Europeanization and regionalization. These changes have raised the issue of state territorial restructuring in a particular fashion: what capacity have formerly centralized states retained to steer and control subnational territories? The article draws on Mann's concept of infrastructural power, which refers to the state's capacity to exercise control and implement political decisions over the national territory. The article applies the two main operationalizations of the concept, namely the capability of the state to exercise control and the weight of the state in the subnational territories. Empirically, the article focuses on the French state in two policy sectors (education and housing). Although France is a most likely case, this article challenges this expectation, and shows the limits of the French state's infrastructural power over the subnational territories since the late 1980s.

Transcranial Doppler after traumatic brain injury: is there a role?

PURPOSE OF REVIEW: To present the practical aspects of transcranial Doppler (TCD) and provide evidence supporting its use for the management of traumatic brain injury (TBI) patients. RECENT FINDINGS: TCD measures systolic, mean, and diastolic cerebral blood flow (CBF) velocities and calculates the pulsatility index from basal intracranial arteries. These variables reflect the brain circulation, provided there is control of potential confounding factors. TCD can be useful in patients with severe TBI to detect low CBF, for example, during intracranial hypertension, and to assess cerebral autoregulation. In the emergency room, TCD might complement brain computed tomography (CT) scan and clinical examination to screen patients at risk for further neurological deterioration after mild-to-moderate TBI. SUMMARY: The diagnostic value of TCD should be incorporated into other findings from multimodal brain monitoring and CT scan to optimize the bedside management of patients with TBI and help guide the choice of appropriate therapies.

3D-partikkelit aloittelijoille : tarkastelussa 3D-Kalevala-projekti

Opinnäytteeni teososana on 3D-Kalevala projektinimellä tunnetun animaation partikkeliefektit. Tarkastelen tarkemmin elokuvan Lumi-, Kylä-, Paja- ja Luola-kohtauksia. 3D-Kalevala on tietokoneella tehty animaatio, joka kertoo Suomen kansalliseepoksen Kalevalan päähenkilöstä Väinämöisestä. Elokuvassa vanha Väinämöinen muistelee nuoruutensa tapahtumia. 3D-Kalevala-projekti käynnistettiin vuonna 2003, mutta sen alkuperäiset tekijät eivät saaneet sitä valmiiksi, ja projektin teko keskeytettiin vuonna 2005. Vuoden 2006 keväällä projektiin perustettiin uusi kahden verkkoviestinnän opiskelijan projektiryhmä, jonka tehtävänä oli saada elokuva valmiiksi vuoden 2007 kevääseen mennessä. Kun aloitimme projektin tekemisen, olin kolmiulotteisessa mallinnuksessa aloittelija. Tästä johtuen opinnäytteen kirjallinen osa on opas aloittelijoille partikkelien maailmaan. Selvitän raportissani miten elokuvan partikkeliefektit rakennettiin, mitä niiden tekeminen minulta vaati ja miten ne loppujen lopuksi mielestäni onnistuivat. Elokuvan efektit tehtiin 3D Studio Max-ohjelman versiolla 6.0, ja tämän takia kirjoitankin efektien rakentamisesta kyseisen ohjelman keinoin. Projektin suuruuden vuoksi molemmat tekijät pääsivät tekemään monenlaisia töitä, mutta päävastuualueet olivat selvät. Minun osani oli tehdä elokuvaan efektejä. Partikkeliefektit ovat proseduraalisia efektejä, joiden avulla on mahdollista tehdä aidon näköisiä luonnonilmiöitä, kuten tulta, savua, kipinöitä ja veden roiskeita. Koska partikkeliefektit mallintavat reaalimaailman ilmiöitä, on tekijän hyvä olla kiinnostunut selvittämään ilmiöiden käyttäytymistä luonnossa. Raportoin myös projektin aikana huomaamistani hyvistä tavoista opiskella itsenäisesti partikkelien rakentamiseen käytettyjä tekniikoita. On hyvä lukea 3D Studio Maxin tasokasta käyttöohjesovellusta, tutustua Internetissä löytyviin 3D-aiheisiin foorumeihin, käydä aiheesta tutoriaaleja läpi sekä tutustua ohjelman ominaisuuksiin kokeilemalla ja tutkimalla itsenäisesti. Elokuvan efektit onnistuivat mielestäni kiitettävästi ottaen huomioon lähtötasoni. Löysin tapoja kehittää itseäni ja helppoja keinoja toteuttaa realistista jälkeä efektien rakentamisessa. Toivon, että raportistani olisi jollekin 3D-partikkeliefekteistä kiinnostuneelle hyötyä.

Keskeytyneen uusmediatuotannon jatkaminen : kohteena 3D-Kalevala

Opinnäytetyöni aiheena on keskeytyneen uusmediatuotannon jatkaminen. Monimuototyön työosana toteutettiin 7-minuuttinen 3D animaatio, joka kertoo Suomen kansalliseepoksen Kalevalan taruhahmosta Väinämöisestä, muistelemassa menneitä. Projekti käynnistettiin alun perin vuonna 2003, mutta resurssien vähetessä se keskeytyi vuoden 2005 loppupuolella. Keväällä 2006 projekti käynnistettiin uuden projektiryhmän voimin, jossa olin itse mukana vastaten muun muassa tuotannonohjauksesta ja hahmoanimoinneista. Uusi projektiryhmä oli henkilöstöresursseiltaan pieni, joten vastuualueet olivat monipuolisia. Keskeytyneen projektin jatkamisen ja haltuunoton haasteellisuus sai minut kiinnostumaan tutkia aihetta tarkemmin. Tuotannonohjaajana vastasin hyvin pitkälle tuotannon uudesta käynnistämisestä ja projektin saattamisesta vihdoin loppuun. Keskeytyneen projektin haltuunotto oli tilanteena kaikille uusi, mikä heijastui vaikeuksina uudelleen käynnistettyyn tuotantoon. Raportin tarkoituksena ei ole olla projektinhallinnallinen käsikirja, sillä käsittelen vain tämän projektin jatkolle oleellisina pidettyjä asioita. Projekti toivottavasti kuitenkin antaa kuvan huolellisen projektinhallinnan ja onnistuneen tuotannonohjauksen tärkeydestä. Jokainen keskeytynyt projekti ei ole aina välttämättä elvytettävissä - ainakaan alkuperäisessä muodossaan. Projektin jatkamista tulisi katsoa aina tapauskohtaisesti. Keskeytymiseen on useimmiten syynsä, joten ongelmien selvittäminen ja niihin puuttuminen on tärkeää ennen jatkopäätöksen tekemistä. Myös projektityöskentelytavat kehittyvät ja pohdin työssäni uusien projektinhallintatapojen, kuten wikien käyttöä projektinhallinnan työkaluna ja projektiyhteisön välistä viestintää edistävänä työkaluna.

Prediction of clinical response after renal angioplasty: respective value of renal Doppler sonography and scintigraphy.

OBJECTIVE: The goal of our study was to compare Doppler sonography and renal scintigraphy as tools for predicting the therapeutic response in patients after undergoing renal angioplasty. SUBJECTS AND METHODS. Seventy-four hypertensive patients underwent clinical examination, Doppler sonography, and renal scintigraphy before and after receiving captopril in preparation for renal revascularization. The patients were evaluated for the status of hypertension 3 months after the procedure. The predictive values of the findings of clinical examination, Doppler sonography, renal scintigraphy, and angiography were assessed. RESULTS: For prediction of a favorable therapeutic outcome, abnormal results from renal scintigraphy before and after captopril administration had a sensitivity of 58% and specificity of 57%. Findings of Doppler sonography had a sensitivity of 68% and specificity of 50% before captopril administration and a sensitivity of 81% and specificity of 32% after captopril administration. Significant predictors of a cure or reduction of hypertension after revascularization were low unilateral (p = 0.014) and bilateral resistive (p = 0.016) indexes on Doppler sonography before (p = 0.009) and after (p = 0.028) captopril administration. On multivariate analysis, the best predictors were a unilateral resistive index of less than 0.65 (odds ratio [OR] = 3.7) after captopril administration and a kidney longer than 93 mm (OR = 7.8). The two best combined criteria to predict the favorable therapeutic outcome were a bilateral resistive index of less than 0.75 before captopril administration combined with a unilateral resistive index of less than 0.70 after captopril administration (sensitivity, 76%; specificity, 58%) or a bilateral resistive index of less than 0.75 before captopril administration and a kidney measuring longer than 90 mm (sensitivity, 81%; specificity, 50%). CONCLUSION: Measurements of kidney length and unilateral and bilateral resistive indexes before and after captopril administration were useful in predicting the outcome after renal angioplasty. Renal scintigraphy had no significant predictive value.

Comparison between standard radiography and spiral CT with 3D reconstruction in the evaluation, classification and management of tibial plateau fractures.

The aim of this study was to compare the diagnostic efficiency of plain film and spiral CT examinations with 3D reconstructions of 42 tibial plateau fractures and to assess the accuracy of these two techniques in the pre-operative surgical plan in 22 cases. Forty-two tibial plateau fractures were examined with plain film (anteroposterior, lateral, two obliques) and spiral CT with surface-shaded-display 3D reconstructions. The Swiss AO-ASIF classification system of bone fracture from Muller was used. In 22 cases the surgical plans and the sequence of reconstruction of the fragments were prospectively determined with both techniques, successively, and then correlated with the surgical reports and post-operative plain film. The fractures were underestimated with plain film in 18 of 42 cases (43%). Due to the spiral CT 3D reconstructions, and precise pre-operative information, the surgical plans based on plain film were modified and adjusted in 13 cases among 22 (59%). Spiral CT 3D reconstructions give a better and more accurate demonstration of the tibial plateau fracture and allows a more precise pre-operative surgical plan.

Ammonium alters creatine transport and synthesis in a 3D culture of developing brain cells, resulting in secondary cerebral creatine deficiency.

Hyperammonemic disorders in pediatric patients lead to poorly understood irreversible effects on the developing brain that may be life-threatening. We showed previously that some of these NH4+-induced irreversible effects might be due to impairment of axonal growth that can be protected under ammonium exposure by creatine co-treatment. The aim of the present work was thus to analyse how the genes of arginine:glycine amidinotransferase (AGAT) and guanidinoacetate methyltransferase (GAMT), allowing creatine synthesis, as well as of the creatine transporter SLC6A8, allowing creatine uptake into cells, are regulated in rat brain cells under NH4+ exposure. Reaggregated brain cell three-dimensional cultures exposed to NH4Cl were used as an experimental model of hyperammonemia in the developing central nervous system (CNS). We show here that NH4+ exposure differentially alters AGAT, GAMT and SLC6A8 regulation, in terms of both gene expression and protein activity, in a cell type-specific manner. In particular, we demonstrate that NH4+ exposure decreases both creatine and its synthesis intermediate, guanidinoacetate, in brain cells, probably through the inhibition of AGAT enzymatic activity. Our work also suggests that oligodendrocytes are major actors in the brain in terms of creatine synthesis, trafficking and uptake, which might be affected by hyperammonemia. Finally, we show that NH4+ exposure induces SLC6A8 in astrocytes. This suggests that hyperammonemia increases blood-brain barrier permeability for creatine. This is normally limited due to the absence of SLC6A8 from the astrocyte feet lining microcapillary endothelial cells, and thus creatine supplementation may protect the developing CNS of hyperammonemic patients.

High-resolution 3D whole-heart coronary MRA: a study on the combination of data acquisition in multiple breath-holds and 1D residual respiratory motion compensation.

OBJECT: To study a scan protocol for coronary magnetic resonance angiography based on multiple breath-holds featuring 1D motion compensation and to compare the resulting image quality to a navigator-gated free-breathing acquisition. Image reconstruction was performed using L1 regularized iterative SENSE. MATERIALS AND METHODS: The effects of respiratory motion on the Cartesian sampling scheme were minimized by performing data acquisition in multiple breath-holds. During the scan, repetitive readouts through a k-space center were used to detect and correct the respiratory displacement of the heart by exploiting the self-navigation principle in image reconstruction. In vivo experiments were performed in nine healthy volunteers and the resulting image quality was compared to a navigator-gated reference in terms of vessel length and sharpness. RESULTS: Acquisition in breath-hold is an effective method to reduce the scan time by more than 30 % compared to the navigator-gated reference. Although an equivalent mean image quality with respect to the reference was achieved with the proposed method, the 1D motion compensation did not work equally well in all cases. CONCLUSION: In general, the image quality scaled with the robustness of the motion compensation. Nevertheless, the featured setup provides a positive basis for future extension with more advanced motion compensation methods.

Pre-procés i segmentació en imatges d’ultrasons 2D i 3D de la pròstata

Aquest projecte s'ha dut a terme amb el Grup de visió per computador del departamentd'Arquitectura i Tecnologia de Computadors (ATC) de la Universitat de Girona. Està enfocat a l'anàlisi d'imatges mèdiques, en concret s'analitzaran imatges de pròstata en relació a desenvolupaments que s'estan realitzant en el grup de visió esmentat. Els objectius fixats per aquest projecte són desenvolupar dos mòduls de processamentm d'imatges els quals afrontaran dos blocs important en el tractament d'imatges, aquests dos mòduls seran un pre-processat d'imatges, que constarà de tres filtres i un bloc de segmentació per tal de cercar la pròstata dintre de les imatges a tractar. En el projecte es treballarà amb el llenguatge de programació C++, concretament amb unes llibreries que es denominen ITK (Insight Toolkit ) i són open source enfocades al tractament d'imatges mèdiques. A part d'aquesta eina s'utilitzaran d'altres com les Qt que és una biblioteca d'eines per crear entorns gràfics

Estudi i implementació d’un mètode de reconstrucció 3D basat en SfM i registre de vistes 3D parcials

Aquest projecte es basarà en reconstruir una imatge 3D gran a partir d’una seqüència d’imatges 2D capturades per una càmera. Ens centrem en l’estudi de les bases matemàtiques de la visió per computador així com en diferents mètodes emprats en la reconstrucció 3D d’imatges. Per portar a terme aquest estudi s’utilitza la plataforma de desenvolupament MatLab ja que permet tractar operacions matemàtiques, imatges i matrius de gran tamany amb molta senzillesa, rapidesa i eficiència, per aquesta raó s’usa en moltes recerques sobre aquest tema. El projecte aprofundeix en el tema descrit anteriorment estudiant i implementant un mètode que consisteix en aplicar Structure From Motion (SFM) a pocs frames seguits obtinguts d’una seqüència d’imatges 2D per crear una reconstrucció 3D. Quan s’han creat dues reconstruccions 3D consecutives i fent servir un frame com a mínim en comú entre elles, s’aplica un mètode de registre d’estructures 3D, l’Iterative Closest Point (ICP), per crear una reconstrucció 3D més gran a través d’unir les diferents reconstruccions obtingudes a partir de SfM. El mètode consisteix en anar repetint aquestes operacions fins al final dels frames per poder aconseguir una reconstrucció 3D més gran que les petites imatges que s’aconsegueixen a través de SfM. A la Figura 1 es pot veure un esquema del procés que es segueix. Per avaluar el comportament del mètode, utilitzem un conjunt de seqüències sintètiques i un conjunt de seqüències reals obtingudes a partir d’una càmera. L’objectiu final d’aquest projecte és construir una nova toolbox de MatLab amb tots els mètodes per crear reconstruccions 3D grans per tal que sigui possible tractar amb facilitat aquest problema i seguir-lo desenvolupant en un futur

RV contractility and exercise-induced pulmonary hypertension in chronic mountain sickness: a stress echocardiographic and tissue Doppler imaging study.

OBJECTIVES: The aim of this study was to evaluate right ventricular (RV) and left ventricular function and pulmonary circulation in chronic mountain sickness (CMS) patients with rest and stress echocardiography compared with healthy high-altitude (HA) dwellers. BACKGROUND: CMS or Monge's disease is defined by excessive erythrocytosis (hemoglobin >21 g/dl in males, 19 g/dl in females) and severe hypoxemia. In some cases, a moderate or severe increase in pulmonary pressure is present, suggesting a similar pathogenesis of pulmonary hypertension. METHODS: In La Paz (Bolivia, 3,600 m sea level), 46 CMS patients and 40 HA dwellers of similar age were evaluated at rest and during semisupine bicycle exercise. Pulmonary artery pressure (PAP), pulmonary vascular resistance, and cardiac function were estimated by Doppler echocardiography. RESULTS: Compared with HA dwellers, CMS patients showed RV dilation at rest (RV mid diameter: 36 ± 5 mm vs. 32 ± 4 mm, CMS vs. HA, p = 0.001) and reduced RV fractional area change both at rest (35 ± 9% vs. 43 ± 9%, p = 0.002) and during exercise (36 ± 9% vs. 43 ± 8%, CMS vs. HA, p = 0.005). The RV systolic longitudinal function (RV-S') decreased in CMS patients, whereas it increased in the control patients (p < 0.0001) at peak stress. The RV end-systolic pressure-area relationship, a load independent surrogate of RV contractility, was similar in CMS patients and HA dwellers with a significant increase in systolic PAP and pulmonary vascular resistance in CMS patients (systolic PAP: 50 ± 12 mm Hg vs. 38 ± 8 mm Hg, CMS vs. HA, p < 0.0001; pulmonary vascular resistance: 2.9 ± 1 mm Hg/min/l vs. 2.2 ± 1 mm Hg/min/l, p = 0.03). Both groups showed comparable systolic and diastolic left ventricular function both at rest and during stress. CONCLUSIONS: Comparable RV contractile reserve in CMS and HA suggests that the lower resting values of RV function in CMS may represent a physiological adaptation to chronic hypoxic conditions rather than impaired RV function. (Chronic Mountain Sickness, Systemic Vascular Function [CMS]; NCT01182792).

Power of Attorney Handbook, January 2006

This booklet is designed to assist those who have been appointed as an attorney-in-fact, those who are considering the need for a power of attorney, or those who have an interest in the subject. This is a general overview.