Intravascular ultrasound: validation and clinical application

Atherogenesis is a process with an insidious onset and course. Once clinical signs and symptoms have become manifest, the obstructive lesion is usually at an advanced stage. Arteriography is the standard method for evaluation of atherosclerotic disease and has been useful in identifying the location and approximate severity of the stenotic lesion. Although arteriography provides a silhouette of the vessel lumen, it does not provide accurate knowledge on cross-sectional lumen area, vessel area, shape and morphology of the stenotic lesion. Intravascular ultrasound (lVUS) may overcome these limitations by providing a tomographic image of the vessel. The aim of this work is to validate IVUS and to evaluate subsequent clinical application of this imaging technique. The subjects dealt with in this dissertation are categorised into 5 main topics. I) displacement sensing device; 2) validation of IVUS-derived parameters; 3) the spectrum of vascular morphology before and after intervention determined by IVUS; 4) IVUS as a research tool; 5) IVUS as a clinical too

Glastuinbouw: stikstofverbruik in kaart gebracht

Dit artikel beschrijft het jaarlijkse stikstofverbruik uit kunstmest in de glastuinbouw op gewasniveau. Het gebruik van dierlijke mest bedraagt in de glastuinbouw minder dan 1% van het totale meststofgebruik en wordt daarom buiten beschouwing gelaten. De analyse is gebaseerd op gegevens uit het Informatienet van het LEI. De resultaten zijn vervolgens vergeleken met de gebruiksnormen per gewas voor stikstof in het Besluit Glastuinbouw dat in 2002 in werking trad. De gebruiksnormen voor stikstof (N) en fosfaat voor substraatteelten (teelten die los van de grond/ondergrond) plaatsvinden zullen waarschijnlijk binnen enkele jaren vervangen worden door emissienormen. Aangezien bij substraatteelt in beginsel geen onderlinge uitwisseling van meststoffen plaats vindt tussen het productiesysteem en de bodem of het grondwater, zijn emissienormen een goede indicator voor de milieubelastin

What have we learned from in vitro intravascular ultrasound?

In vitro studies have established that intravascular ultrasound is a reliable technique for accurate assessment of vascular anatomic structure and disease conditions before and after intervention. In addition, quantitative data from intravascular ultrasound studies correspond well with histologic findings, which serve as the gold standard. These in vitro studies permit the understanding and interpretation of ultrasound images obtained in vivo, although differences between the two settings should be taken into account. New ultrasound modalities currently being developed may enhance the diagnostic differentiation of plaque morphologic characteristics and facilitate on-line quantitative assessment of vessel structure

Strategic Cooperation in Peripheral Ports: The Case of Atlantic Canada’s Ports

This paper examines ports on the geographical periphery of the port business: they are off the main shipping routes or not located proximal to large domestic markets. These ports have development potential, but reaching it requires specific strategies. The paper first discusses the nature of peripheral ports followed by a conceptualization of two development strategies: cooperation among seaports and coordination of supply chain operators with the emphasis on cooperation. The paper considers Atlantic Canada’s ports and their current cooperation initiatives concluding with recommendations on how these ports may better serve their interests through applying cooperation strategies found elsewhere

Kleine bedrijven hebben weinig vertrouwen in de toekomst van het bedrijf

Het vertrouwen van boeren en tuinders in de toekomst van hun bedrijf is een graadmeter voor de economische gesteldheid van de agrarische sector. Een groot deel van de agrariërs ziet de toekomst op korte termijn optimistisch tegemoet. Op lange termijn hebben ondernemers op grotere bedrijven meer vertrouwen in de toekomst dan die op kleinere bedrijve

Low-Dose Computed Tomography With Two- and Three-Dimensional Postprocessing as an Alternative to Plain Radiography for Intrathecal Catheter Visualization: A Phantom Pilot Study

Objectives: In intrathecal drug delivery, visualization of the device has been performed with plain radiography. However, the visibility of the related structures can be problematic. In troubleshooting, after the contrast material injection via the cathe

Reduced cortical complexity in children with prader-willi syndrome and its association with cognitive impairment and developmental delay

Background: Prader-Willi Syndrome (PWS) is a complex neurogenetic disorder with symptoms involving not only hypothalamic, but also a global, central nervous system dysfunction. Previously, qualitative studies reported polymicrogyria in adults with PWS. However, there have been no quantitative neuroimaging studies of cortical morphology in PWS and no studies to date in children with PWS. Thus, our aim was to investigate and quantify cortical complexity in children with PWS compared to healthy controls. In addition, we investigated differences between genetic subtypes of PWS and the relationship between cortical complexity and intelligence within the PWS group.Methods: High-resolution structural magnetic resonance images were acquired in 24 children with genetically confirmed PWS (12 carrying a deletion (DEL), 12 with maternal uniparental disomy (mUPD)) and 11 age- and sex-matched typically developing siblings as healthy controls. Local gyrification index (lGI) was obtained using the FreeSurfer software suite.Results: Four large clusters, two in each hemisphere, comprising frontal, parietal and temporal lobes, had lower lGI in children with PWS, compared to healthy controls. Clusters with lower lGI also had significantly lower cortical surface area in children with PWS. No differences in cortical thickness of the clusters were found between the PWS and healthy controls. lGI correlated significantly with cortical surface area, but not with cortical thickness. Within the PWS group, lGI in both hemispheres correlated with Total IQ and Verbal IQ, but not with Performance IQ. Children with mUPD, compared to children with DEL, had two small clusters with lower lGI in the right hemisphere. lGI of these clusters correlated with cortical surface area, but not with cortical thickness or IQ.Conclusions: These results suggest that lower cortical complexity in children with PWS partially underlies cognitive impairment and developmental delay, probably due to alterations in gene networks that play a prominent role in early brain development

Advancements in diagnostic and interventional radiology for stroke treatment:the path from trial to bedside through the pre-MR CLEAN, MR CLEAN, and MR CLEAN II eras

The stroke field is inevitably connected with imaging in which radiologists fulfill a central role. Our landmark MR CLEAN trial led to the implementation of baseline computed tomography angiography or magnetic resonance angiography in the acute stroke workup and subsequent endovascular treatment (EVT) for ischemic stroke patients with a large vessel occlusion in the anterior circulation, resulting in numerous patients worldwide currently being treated often successfully. A reversal of the pathophysiologic process behind an acute cerebrovascular event was made possible. Subsequently, in the MR CLEAN II trials, the clinical impact of both diagnostic and interventional radiologists remained a cornerstone of our research, which means value-based radiology. Within these MR CLEAN II trials, we proved that aspirin and heparin during EVT should be avoided due to increased symptomatic intracranial hemorrhage risk (MR CLEAN-MED). We concluded there is additional benefit of EVT in the 6-to-24-h window after stroke in the presence of good collaterals on baseline CTA (MR CLEAN-LATE). The impactful success of our stroke trials that changed many guidelines was mainly attributable to (1) the societal burden of the disease, with two thirds of patients dying or being independent at 3 months; (2) the fact that stroke is a common disease, (3) the relatively simple and pragmatic approach of the trials resembling real-world setting; (4) the acceleration of implementation in clinical practice facilitated by a structured approach to guideline development and conditional funding; and foremost (5) the excellent collaboration on a professional level between-disciplines, i.e., diagnostic radiologists, interventionalists, and neurologists. Critical relevance statement The MR CLEAN and MR CLEAN II trials have had tremendous impact on clinical practice, directly by more patients being treated with an effective intervention and indirectly through adoption of evidence-based guidelines. It is in this setting of stroke treatment that diagnostic and interventional radiologists have played a crucial role and created clinical impact.</p

Advancements in diagnostic and interventional radiology for stroke treatment:the path from trial to bedside through the pre-MR CLEAN, MR CLEAN, and MR CLEAN II eras

The stroke field is inevitably connected with imaging in which radiologists fulfill a central role. Our landmark MR CLEAN trial led to the implementation of baseline computed tomography angiography or magnetic resonance angiography in the acute stroke workup and subsequent endovascular treatment (EVT) for ischemic stroke patients with a large vessel occlusion in the anterior circulation, resulting in numerous patients worldwide currently being treated often successfully. A reversal of the pathophysiologic process behind an acute cerebrovascular event was made possible. Subsequently, in the MR CLEAN II trials, the clinical impact of both diagnostic and interventional radiologists remained a cornerstone of our research, which means value-based radiology. Within these MR CLEAN II trials, we proved that aspirin and heparin during EVT should be avoided due to increased symptomatic intracranial hemorrhage risk (MR CLEAN-MED). We concluded there is additional benefit of EVT in the 6-to-24-h window after stroke in the presence of good collaterals on baseline CTA (MR CLEAN-LATE). The impactful success of our stroke trials that changed many guidelines was mainly attributable to (1) the societal burden of the disease, with two thirds of patients dying or being independent at 3 months; (2) the fact that stroke is a common disease, (3) the relatively simple and pragmatic approach of the trials resembling real-world setting; (4) the acceleration of implementation in clinical practice facilitated by a structured approach to guideline development and conditional funding; and foremost (5) the excellent collaboration on a professional level between-disciplines, i.e., diagnostic radiologists, interventionalists, and neurologists. Critical relevance statement The MR CLEAN and MR CLEAN II trials have had tremendous impact on clinical practice, directly by more patients being treated with an effective intervention and indirectly through adoption of evidence-based guidelines. It is in this setting of stroke treatment that diagnostic and interventional radiologists have played a crucial role and created clinical impact.</p