Nuevos materiales sostenibles para el envasado de queso

25 p. : il. -- Bibliogr.: p. 22-25La búsqueda de alternativas al uso de plástico en el envasado de alimentos es un tema de gran interés en la actualidad debido a la problemática que supone para el medio ambiente. Este trabajo se ha centrado en el estudio de tres aplicaciones de materiales sostenibles para el envasado de cuñas queso. Por una parte, se han realizado ensayos para optimizar la preparación de recubrimientos y películas comestibles a base de un subproducto de la industria quesera (proteínas del suero lácteo). Esta aplicación parece ser una opción interesante para la reducción de desechos plásticos no biodegradables, y al mismo tiempo, para revalorizar residuos de la cadena agroalimentaria, hecho que puede contribuir a la sostenibilidad del sector y favorecer la economía circular. Los resultados preliminares obtenidos han puesto de manifiesto el comportamiento favorable de las proteínas del suero lácteo en la formación de cubiertas comestibles, por lo que podría tratarse de una opción con gran potencial para la protección de alimentos como el queso. Por otra parte, se ha estudiado el comportamiento de un material plástico reciclable de alta barrera (polipropileno / EVOH /polietileno) para la conservación de cuñas de queso envasadas en diferentes condiciones de vacío y atmósfera modificada a lo largo de un tiempo de ocho semanas. Los resultados preliminares obtenidos parecen demostrar la eficacia de este material para mantener las condiciones en el interior del envase, y el efecto de la condición de envasado sobre la calidad final del queso

Análisis de la comunicación médico-paciente en el Hospital Clínic: diferencias autoperceptuales entre médicos y pacientes

Se observa con creciente evidencia que una comunicación empática y próxima entre el médico y el paciente tiene un efecto positivo tanto en el diagnóstico como en el tratamiento y la recuperación de la persona enferma. Sin embargo, la existencia de ciertas barreras comunicacionales hoy en día impide que se optimice una relación eficiente y beneficiosa para ambos interlocutores. El presente trabajo tiene la finalidad de analizar distintos aspectos que influyen en la relación médico-paciente desde una perspectiva comunicativa y comparar las percepciones que ambos interlocutores tienen de su interacción en la consulta médica. Para ello, se encuestaron un total de 103 pacientes y los 24 médicos del Institut Clinic Cardiovascular del Hospital Clínic de Barcelona con preguntas relativas a la autonomía del paciente, la proximidad del vínculo asistencial, el uso de recursos empáticos o de cortesía y factores externos como el espacio o el tiempo de consulta. Así, se observó que los médicos consideran que su conducta hacia el paciente es empática y que su relación se basa en un modelo más democrático que paternalista. Por el contrario, los usuarios perciben menor autonomía y un vínculo más distante. Además, tanto un grupo como otro rehúsa cambios en la distribución del espacio de la consulta como medida de proximidad y, concretamente, los pacientes rechazan también alargar el tiempo de la consulta. Se concluye así, que las estrategias de mejora deben orientarse preferiblemente hacia la enseñanza y el desarrollo de habilidades comunicativas entre los profesionales sanitarios. Palabras clave: paciente, médico, relación, comunicación, empatía.Analysis of the doctor-patient communication in the Hospital Clínic: self-perceptual differences between doctors and patients. It is observed with increasing evidence that empathic and close communication between the doctor and the patient has a positive effect both in the diagnosis and in the treatment and recovery of the sick person. However, the existence of certain communication barriers today prevents an efficient and beneficial relationship for both partners from being optimized. The purpose of the present study is to analyze different aspects that currently influence the doctor-patient relationship from a communicative perspective and to contrast the perceptions that doctors and patients have of their interaction in the medical consultation. To this aim, 103 patients and 24 physicians who attended them at the Institut Clinic Cardiovascular of the Hospital Clínic de Barcelona were surveyed with questions regarding patient autonomy, the proximity of the care link, the use of empathic or courtesy resources and the presence of external factors such as the room or the time of consultation. We observed that doctors consider that their behavior towards the patient is empathetic and that their relationship is based on a more democratic than paternalistic model. On the contrary, patients perceive less autonomy and a more distant link. In addition, both groups refuse changes in the distribution of the consultation room as a measure of proximity and, specifically, patients also refuse to extend the time of the consultation to improve their relationship with the doctor. Learning and development of communication skills should be promoted among health professionals in order to optimize their beneficial potential

Biventricular / Left Ventricular Pacing in Hypertrophic Obstructive Cardiomyopathy: An Overview

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited genetic disease characterized by compensatory pathological left ventricle (LV) hypertrophy due to sarcomere dysfunction. In an important proportion of patients with HCM, the site and extent of cardiac hypertrophy results in severe obstruction to LV outflow tract (LVOT), contributing to disabling symptoms and increasing the risk of sudden cardiac death (SCD). In patients with progressive and/or refractory symptoms despite optimal pharmacological treatment, invasive therapies that diminish or abolish LVOT obstruction relieve heart failure-related symptoms, improve quality of life and could be associated with long-term survival similar to that observed in the general population. The gold standard in this respect is surgical septal myectomy, which might be supplementary associated with a reduction in SCD. Percutaneous techniques, particularly alcohol septal ablation (ASA) and more recently radiofrequency (RF) septal ablation, can achieve LVOT gradient reduction and symptomatic benefit in a large proportion of HOCM patients at the cost of a supposedly limited septal myocardial necrosis and a 10-20% risk of chronic atrioventricular block. After an initial period of enthusiasm, standard DDD pacing failed to show in randomized trials significant LVOT gradient reductions and objective improvement in exercise capacity. However, case reports and recent small pilot studies suggested that atrial synchronous LV or biventricular (biV) pacing significantly reduce LVOT obstruction and improve symptoms (acutely as well as long-term) in a large proportion of severely symptomatic HOCM patients not suitable to other gradient reduction therapies. Moreover, biV/LV pacing in HOCM seems to be associated with significant LV reverse remodelling

Septal Flash Assessment on CRT Candidates Based on Statistical Atlases of Motion

International audienceIn this paper, we propose a complete framework for the automatic detection and quantification of abnormal heart motion patterns using Statistical Atlases of Motion built from healthy populations. The method is illustrated on CRT patients with identified cardiac dyssyn-chrony and abnormal septal motion on 2D ultrasound (US) sequences. The use of the 2D US modality guarantees that the temporal resolution of the image sequences is high enough to work under a small displacements hypothesis. Under this assumption, the computed displacement fields can be directly considered as cardiac velocities. Comparison of subjects acquired with different spatiotemporal resolutions implies the reorientation and temporal normalization of velocity fields in a common space of coordinates. Statistics are then performed on the reoriented vector fields. Results show the ability of the method to correctly detect abnormal motion patterns and quantify their distance to normality. The use of local p-values for quantifying abnormal motion patterns is believed to be a promising strategy for computing new markers of cardiac dyssynchrony for better characterizing CRT candidates

Myocardial motion estimation combining tissue Doppler and B-mode echocardiographic images

International audienceWe present a registration framework that combines both tissue Doppler and B-mode echocardiographic sequences. The estimated spatiotemporal transform is diffeomorphic, and calculated by modeling its corresponding velocity field using continuous B-splines. A new cost function using both B-mode image voxel intensities and Doppler velocities is also proposed. Registration accuracy was evaluated on synthetic data with known ground truth. Results showed that our method allows quantifying wall motion with higher accuracy than when using a single modality. On patient data, both displacement and velocity curves were compared with the ones obtained from widely used commercial software using either B-mode images or TDI. Our method demonstrated to be more robust to image noise while being independent from the beam angle

Image based cardiac acceleration map using statistical shape and 3D+t myocardial tracking models; in-vitro study on heart phantom

International audienceIt has been demonstrated that the acceleration signal has potential to monitor heart function and adaptively optimize Cardiac Resynchronization Therapy (CRT) systems. In this paper, we propose a non-invasive method for computing myocardial acceleration from 3D echocardiographic sequences. Displacement of the myocardium was estimated using a two-step approach: (1) 3D automatic segmentation of the myocardium at end-diastole using 3D Active Shape Models (ASM); (2) propagation of this segmentation along the sequence using non-rigid 3D+t image registration (temporal diffeomorphic free-form-deformation, TDFFD). Acceleration was obtained locally at each point of the myocardium from local displacement. The framework has been tested on images from a realistic physical heart phantom (DHP-01, Shelley Medical Imaging Technologies, London, ON, CA) in which the displacement of some control regions was known. Good correlation has been demonstrated between the estimated displacement function from the algorithms and the phantom setup. Due to the limited temporal resolution, the acceleration signals are sparse and highly noisy. The study suggests a non-invasive technique to measure the cardiac acceleration that may be used to improve the monitoring of cardiac mechanics and optimization of CRT

A spatiotemporal statistical atlas of motion for the quantification of abnormal myocardial tissue velocities

International audienceIn this paper, we present a new method for the automatic comparison of myocardial motion patterns and the characterization of their degree of abnormality, based on a statistical atlas of motion built from a reference healthy population. Our main contribution is the computation of atlas-based indexes that quantify the abnormality in the motion of a given subject against a reference population, at every location in time and space. The critical computational cost inherent to the construction of an atlas is highly reduced by the definition of myocardial velocities under a small displacements hypothesis. The indexes we propose are of notable interest for the assessment of anomalies in cardiac mobility and synchronicity when applied, for instance, to candidate selection for cardiac resynchronization therapy (CRT). We built an atlas of normality using 2D ultrasound cardiac sequences from 21 healthy volunteers, to which we compared 14 CRT patients with left ventricular dyssynchrony (LVDYS). We illustrate the potential of our approach in characterizing septal flash, a specific motion pattern related to LVDYS and recently introduced as a very good predictor of response to CRT

Mechanisms of atrial fibrillation in athletes: what we know and what we do not know.

Exercise is an emerging cause of atrial fibrillation (AF) in young individuals without coexisting cardiovascular risk factors. The causes of exercise-induced atrial fibrillation remain largely unknown, and conclusions are jeopardised by apparently conflicting data. Some components of the athlete's heart are known to be arrhythmogenic in other settings. Bradycardia, atrial dilatation and, possibly, atrial premature beats are therefore biologically plausible contributors to exercise-induced AF. Challenging findings in an animal model suggest that exercise might also prompt the development of atrial fibrosis, possibly due to cumulative minor structural damage after each exercise bout. However, there is very limited, indirect data supporting this hypothesis in athletes. Age, sex, the presence of comorbidities and cardiovascular risk factors, and genetic individual variability might serve to flag those athletes who are at the higher risk of exercise-induced AF. In this review, we will critically address current knowledge on the mechanisms of exercise-induced AF

Manifold learning characterization of abnormal myocardial motion patterns: application to CRT-induced changes

International audienceThe present paper aims at quantifying the evolution of a given motion pattern under cardiac resynchronization therapy (CRT). It builds upon techniques for population-based cardiac motion quantifica-tion (statistical atlases, for inter-sequence spatiotemporal alignment and the definition of normal/abnormal motion). Manifold learning is used on spatiotemporal maps of myocardial motion abnormalities to represent a given abnormal pattern and to compare any individual to that pattern. The methodology was applied to 2D echocardiographic sequences in a 4-chamber view from 108 subjects (21 healthy volunteers and 87 CRT candidates) at baseline, with pacing ON, and at 12 months follow-up. Experiments confirmed that recovery of a normal motion pattern is a necessary but not su cient condition for CRT response

Heart morphology differences induced by intrauterine growth restriction and premature birth measured on the ECG in pre-adolescents

Pre-adolescents who had suffered from intrauterine growth restriction (IUGR) during their mothers'' pregnancy usually present more spherical hearts (smaller relation between base to apex measure and basal diameter), measured using echocardiograms, which has been associated with long-term cardiac disfunction. The present work aims to analyse these heart morphology changes by means of the surface ECG so as to have an early diagnostic tool of this pathology. The dataset is conformed by 148 pre-adolescents with either preterm or term births, and with or without IUGR. Once QRS and T-wave loops were obtained from the vectorcardiogram, the angles between the dominant vector of the QRS loop and -XY or -YZ planes(FR-XY, FR-YZ) and the difference between FR-XY and the angle between the dominant vector of T-wave loop (FT-XY) and the XY-plane showed different values for pre-adolescents who suffered from premature birth and IUGR than for control subjects (p < 0.05). These characteristics can open the door for a much easier diagnosis and follow-up of candidates for these disfunctions