Effect of delayed acquisition times on Gadolinium-enhanced MRI of the presumably normal canine brain

A delay in imaging following intravenous contrast medium administration has been recommended to reduce misdiagnoses. However, the normal variation of contrast enhancement in dogs following a delay has not been characterized. Contrast enhanced MR imaging of 22 dogs was assessed, in terms of identification of normal anatomic structures, to investigate the variation associated with 10 minute delay between contrast medium administration and imaging. All dogs had a normal brain MR imaging study and unremarkable CSF. Specific ROIs were assessed both objectively, using computer software, and subjectively using three observers. Mean contrast enhancement greater than 10% was seen in the pituitary gland, choroid plexus, meninges, temporal muscle, trigeminal nerve and the trigeminal nerve root. Structures with an active blood-brain-barrier had minimal contrast enhancement (<6%). Enhancing structures had significantly more contrast enhancement at t=1min versus t=10min, except in temporal muscle, the trigeminal nerve and the trigeminal nerve root. Inter-observer agreement was moderate to good in favor of the initial post contrast T1w sequence. The observers found either no difference or poor agreement in identification of the non-vascular structures. Intra-observer agreement was very good with all vascular structures and most non-vascular structures. A degree of meningeal enhancement was a consistent finding. The initial acquisition had higher enhancement characteristics and observer agreement for some structures; however, contrast-to-noise was comparable in the delayed phase or not significantly different. We provide baseline references and suggest that the initial T1w post contrast sequence is preferable but not essential should a delayed post contrast T1w sequence be performed

Placement of metallic biliary endoprostheses in complex hilar tumours

AbstractPurposeTo assess the technical success, clinical success and complications after 1 month of percutaneous biliary drainage with the placement of several metallic endoprostheses in complex hilar liver tumours.Materials and methodsThis is a retrospective study, on a homogenous target population of 68 consecutive patients, who underwent multiple percutaneous biliary drainage for complex hilar tumour (Bismuth type II, III and IV) between August 1998 and August 2010. Patients benefiting from previous endoscopic drainage were excluded from the study. The clinical data, biological data, imaging and interventional radiology procedures were studied.ResultsThe rate of success of the technique was 98.5% and the clinical rate of success was 84% after 1 week and 93% after 1 month. The rate of minor and major complications was 25 and 13% respectively.ConclusionMultiple percutaneous biliary drainage in complex hilar tumour is a safe and effective first intention procedure

On the termination of deep-sea fan channels: Examples from the Rhone Fan (Gulf of Lion, Western Mediterranean Sea)

The termination of a deep-sea turbiditic channel represents the ultimate sink of terrigenous sediment in the oceans or lakes. Such environment is characterized by rapid slope decrease and by loss of confinement of turbidity currents. It results in the deposition of Channel-Mouth-Lobes that can be separated from the channel mouth by an erosional (scoured) or by-pass dominated Channel-Lobe Transition Zone. Several factors can control the occurrence, extent and morphologic expression of the area such as the slope break angle, the upslope and downslope angle and the mud/sand ratio in flows. Disentangling these factors remains challenging due to the scarcity of outcrops and to the usual faint morphologies and low thickness of deposits. With bathymetric and seismic data we calculated the morphometric parameters of 8 channel-levees and their Channel-Mouth Lobes from the deepest area of the Rhone fan, a mud-sand rich system, and among which the youngest one (called neofan) was deposited at the end of the Last Glacial Maximum between 21.5 and 18.3 ka cal. BP. Emplacement and shape (finger-shaped or pear-shaped bulges) of Channel-Mouth Lobes is controlled by the seabed morphology (adjacent channel-levees and salt diapirs). A less prominent morphology of the neofan is attributed to premature quiescence related to the post sea-level rise sediment starvation. We show that the occurrence and expression of a Channel-Lobe Transition Zone is controlled by the gradient upstream of the channel mouth slope break. The extended Channel-Lobe Transition Zone and detached lobe of the neofan are attributed to the high upslope gradient (0.26°) while the less detached or attached lobes of other channel-levees is attributed to lower upslope gradient (0.13°). We show that scouring and scours concatenation into flutes at the Channel-Lobe Transition Zone is a major driver for the inception of channels and further confinement of turbidity current. For the first time we show that concatenation of scours in shingled disposition developed an incipient channel sinuosity at this very early stage of channel development. The channel-levee can extend downslope nearly instantaneously by tens of kilometers when isolated nascent channels connect to the channel mouth

Holocene changes in deep-water circulation of the Western Mediterranean Basin, links to North Atlantic climate variability

preliminary results from multicores recovered in the Minorca sediment drift, south of the Western Mediterranean Deep Water formation area, reveal changes in deep-water circulation during the last 2500 yr. Records of grain-size and SST Mg/Ca derived from G. bulloides show oscillations in deep-water current intensities that could be related to cool periods on land, i.e. the Little Ice Age, but also denote some relationship with changes in sea surface salinity likely associated with changes in continental humid conditions

Informe de la asistencia bucodental en el servicio de odontología de la villa paralímpica durante los IX Juegos Paralímpicos de Barcelona '92

Durante los Juegos Paralímpicos se dispuso de un servicio de Odontología para atender cualquier problema urgente bucodental que se les pudiera presentar a los integrantes de la 'familia paralímpica'. Se hace hincapié en los motivos por los que acudieron al servicio y se quiere llamar la atención sobre el mal estado bucodental de los deportistas

Cellular and molecular mechanisms of IMMunE dysfunction and Recovery from SEpsis-related critical illness in adults: An observational cohort study (IMMERSE) protocol paper

Sepsis is a common illness. Immune responses are considered major drivers of sepsis illness and outcomes. However, there are no proven immunomodulator therapies in sepsis. We hypothesised that in-depth characterisation of sepsis-specific immune trajectory may inform immunomodulation in sepsis-related critical illness. We describe the protocol of the IMMERSE study to address this hypothesis. We include critically ill sepsis patients without documented immune comorbidity and age-sex matched cardiac surgical patients as controls. We plan to perform an in-depth biological characterisation of innate and adaptive immune systems, platelet function, humoral components and transcriptional determinants of the immune system responses in sepsis. This will be done at pre-specified time points during their critical illness to generate an illness trajectory. The sample size for each biological assessment is different and is described in detail. In summary, the overall aim of the IMMERSE study is to increase the granularity of longitudinal immunology model of sepsis to inform future immunomodulation trials

Biomarker-guided implementation of the KDIGO guidelines to reduce the occurrence of acute kidney injury in patients after cardiac surgery (PrevAKI-multicentre) : protocol for a multicentre, observational study followed by randomised controlled feasibility trial

Acute kidney injury (AKI) is a frequent complication after cardiac surgery with adverse short-term and long-term outcomes. Although prevention of AKI (PrevAKI) is strongly recommended, the optimal strategy is uncertain. The Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommended a bundle of supportive measures in high-risk patients. In a single-centre trial, we recently demonstrated that the strict implementation of the KDIGO bundle significantly reduced the occurrence of AKI after cardiac surgery. In this feasibility study, we aim to evaluate whether the study protocol can be implemented in a multicentre setting in preparation for a large multicentre trial. We plan to conduct a prospective, observational survey followed by a randomised controlled, multicentre, multinational clinical trial including 280 patients undergoing cardiac surgery with cardiopulmonary bypass. The purpose of the observational survey is to explore the adherence to the KDIGO recommendations in routine clinical practice. The second phase is a randomised controlled trial. The objective is to investigate whether the trial protocol is implementable in a large multicentre, multinational setting. The primary endpoint of the interventional part is the compliance rate with the protocol. Secondary endpoints include the occurrence of any AKI and moderate/severe AKI as defined by the KDIGO criteria within 72 hours after surgery, renal recovery at day 90, use of renal replacement therapy (RRT) and mortality at days 30, 60 and 90, the combined endpoint major adverse kidney events consisting of persistent renal dysfunction, RRT and mortality at day 90 and safety outcomes. The PrevAKI multicentre study has been approved by the leading Research Ethics Committee of the University of Münster and the respective Research Ethics Committee at each participating site. The results will be used to design a large, definitive trial. Trial registration number NCT03244514

Ruta assistencial de complexitat 2.0 (PCC/MACA) a Catalunya: definició de la ruta i proposta de desplegament

Ruta assistencial; Pacients crònics complexos; DesplegamentVia clínica; Pacientes crónicos complejos; DespliegueClinical pathway; Complex chronic patients; DeploymentLes rutes assistencials s’orienten a donar una millor resposta a les persones amb patologies i problemes de salut crònics i de més prevalença; permeten millorar-ne el maneig, organitzar l’atenció dels professionals partint d’un model d’atenció integrada i proactiva, adequar la prestació de serveis a un model d’atenció compartida entre els diferents àmbits d’atenció, així com definir mecanismes per a la individualització del pla d’atenció i l’adequació en la utilització de recursos. En aquest document es presenta la ruta assistencial de complexitat (PCC/MACA) i es proporcionen instruments i eines per fer-ne el desplegament al territori

El treball social amb famílies. Una mirada des de les facilitats i les dificultats.

El treball social amb les famílies està implicat en el propi desenvolupament de la professió. A partir de les entrevistes realitzades en la fase inicial de l'estudi "El treball social amb famílies", realitzat pel Grup de Recerca i Innovació en Treball social (GRITS) de la Universitat de Barcelona, hem volgut copsar quines dificultats i oportunitats planteja aquest tipus de treball en l'exercici quotidià dels professionals. Els treballadors socials2 estan satisfets dels resultats del treball amb les famílies i el consideren una important eina de canvi que beneficia l'individu i la comunitat. En aquest article es destaquen elements que poden donar suport a aquest treball i d'altres que el poden dificultar com són les institucionals, els propis treballadors socials i la complexitat de les noves situacions familiars