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Many of us suffer from nail fungus which we want to get rid of as quickly as possible because on one hand they are not pleasant to look at and on the other hand, we do not want to carry a disease with us.
Is nail fungus a contagious disease? The brief answer to that question is yes. If you are seeing signs of the nail fungus, yellowing of the nails, green, crusty or bumpy in features, odds are, you picked up an infection from another person.
A lot of people think nail fungus is not an infectious illness and do not worry too much about taking additional precautions of treating it. Just in case you have it, you must be additionally careful, particularly with members of the family. You could spread it to all who live at home as well as to any one in public.
Your obligation as a nail fungus sufferer must be to keep a high degree of hygiene. Refrain from visiting public services like a community swimming pool. At the local gym for instance, wear protective footwear. Do not utilize the showers or walk around bare legs in places where others may come in touch with fungus bacteria.
Manicures and pedicures must be out of the question, particularly if your routine is to visit nail salons usually. The incredibly infectious nature of nail fungus is spread to others in the form of bacteria. The most recent estimates say that over 35 million individuals are affected.
Do not share your shoes, particularly your flip flops with anyone. Avoid walking in public areas bare foot, for example, poolside, showers and public baths. Around the house, wear cotton socks so that others do not contract the disease. If you have to wear socks, change your shoes and socks often.
Dry legs thoroughly after showers and use an anti fungal powder in your shoes and then apply a topical solution directly to the contaminated nail. Applying VicksVapoRub and apple cider vinegar also stops the disease from spreading and in ultimately curing the nail fungus.


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This Christmas tree skirt coloring page has stars and ornaments. Did you know that the skirt can make the base of the tree look pretty? It also helps cushion and protect any ornaments that fall.
Fuzzy's Home › Holidays › Christmas Trees › Christmas Tree Skirt Coloring Page
My PDF printable coloring pages are fun to customize and color. Add your name or write a birthday message in your favorite fonts, SIZES, and colors. You'll love my interactive coloring pages to print!
Get your favorite crayons, coloring pencils, and watercolors for my relaxing adult coloring pages! ~Fuzzy

subset: commoncrawl


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GraphicRiver Fabric Fancy Perfectly Tileable 95745
Texture \ Fabric
Textures \ Texture \ Fabric \ Upholstery \ Background \ Tileable \ Textile
Texture - Fabric Fancy Perfectly Tileable 95745 by holypixel @ GraphicRiver
Texture \ Fabric
This file contains 1 highly detailed texture in 4 extra colors. This texture is taken from an upholstery sample pack.
The textures are 3504×2336px, PLUS they are perfectly tileable.
The textures can be used when designing;
- Web pages
- Twitter pages
- Posters
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- Business Cards
- Backgrounds
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- Anything you can imagine!
The tileable versions (aka seamless) can be used where it is important to have the image repeat itself horizontally and/or vertically. An example of this would be on a web page background, where the browser window may be resized or scrolled and you want the background to continue without any 'seams' or edges.
Keywords: fabric, textile, material, upholstery, plain, simple, tight weave, felt, fiber, cloth, furniture, seat, chair, couch, soft, fluffy, thread, warm, cosy, gentle, fashion
Thank you for taking the time to look at my textures!
- If you purchase this item, please add a quick comment and rating. Doing this helps me make decisions on how to add value to the Graphic River community.
Layered: Yes; Tileable: No; Graphics Files Included: JPG Image; Minimum Adobe CS Version: CS; Pixel Dimensions: 3504x2336.
10 Seamless Dirt and Soil Textures; 10 Seamless Gravel and Rock Textures; 10 Seamless Clay Textures; 10 Seamless Plant and Hedge Textures; 10 Seamless Smooth Bark Textures; 6 Seamless Rusty Metal Textures; 10 Seamless Sand Textures.
Keywords: 3ds max, cinema 4d, fabric, fiber, green, maya, pattern, purple, red, textile, texture, textures, upholstery.


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Ramnagar (Uttarakhand), Apr 20 (ANI): Despite preventive steps being taken by the authorities, poaching continues in Jim Corbett National Park in Uttarakhand's Ramnagar district.
Security guards and several Forest Rangers are deployed to keep the wild animals safe from poaching.
Ramnagar district shares about 30 kilometres boundary with the park and 90 kilometres of a village adjoins it. Therefore, there is more activity of the locals in this forest area.
"The staff there is more focused on production and protection of forests. They are focused on these two things. Somewhere or the other, the percentage of locals visiting their forest region is more than ours. Our forests are not that affected by the general public coming and going as the adjoining forests are. There is a lot of pressure from the locals there," said Umesh Chandra Tiwari, Park Warden of Corbett Tiger Reserve. Forest officials say they are using the available infrastructure effectively.
" In accordance with all these things, we make protection plans and we get a result according to that. This is definitely a challenging job," said P.K. Patra, Divisional Forest Officer (DFO), Ramnagar.
Patra claimed that they have successfully handled many poaching cases and many people have been prosecuted. (ANI)


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Allevyn Gentle Border Lite Foam Dressing
Average Customer Rating(3 ratings)
Featured Customer ReviewGood product for certain uses. [ read more ]By bugman from Tempe, az.
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Smith & Nephew Allevyn Gentle Border Lite Foam Dressing
- Advanced triple-layered construction
- Absorbent hydrocellular pad
- Perforated soft gel adhesive wound contact layer
- Highly permeable waterproof outer film
Product Overview
Smith & Nephew Allevyn Gentle Border Lite Foam Dressing
Allevyn Foam Dressing Gentle Border Lite
AllegroMedical.com presents The Allevyn Gentle Border Lite foam dressing. ALLEVYN Gentle Border Lite is a new addition to the ALLEVYN Gentle Border range of products which all target the reduction of pain associated with dressing changes. The dressings benefit the patient as the gentleness of a silicone gel adhesive minimizes pain and trauma to the wound on removal. In addition this new dressing fits the wound better thanks to a slimmer foam core to provide dressing conformability.
- Conformable and light
- Easily molds to body contours and hard to dress areas
- Showerproof dressing
- Contains a thinner foam core
- Minimal pain on removal
- Optimal fluid management
- Optimal fluid management - Lower risk of maceration, extensive wear time and retention, resistant to leakage
- Provides a bacterial barrier - May help reduce risk of infection
- Extensible and flexible - Easily molds to body contours and hard to dress areas 2
- Adheres gently to surrounding skin - Soft silicone adhesive ideal for fragile skin
ALLEVYN Gentle Border Lite is indicated for wound management by secondary intention on shallow, granulating wounds, chronic and acute low exuding wounds full and partial thickness wounds including:
- Skin tears
- Pressure ulcers
- Diabetic foot ulcers
- Leg ulcers
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- Malignant wounds
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- First and second degree burns
Do not use ALLEVYN Gentle Border Lite dressing with oxidizing agents such as hypochlorite solutions (e.g. EUSOL) or hydrogen peroxide, as these can breakdown the absorbent polyurethane component of the dressing. If reddening or sensitization occur discontinue use and consult a healthcare professional.
Place Your Order Here
Smith & Nephew Allevyn Gentle Border Lite Foam Dressing
Allevyn Gentle Border Lite Foam Dressing Reviews Summary
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Allevyn Gentle Border Lite Foam Dressing
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1 Question | 1 Answer
How long can each adhesive dressings be left on?
Asked on Oct 8, 2013 4:23:00 PM by lovbyfan
Yeah, good question!
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1 answer
Answered on Jan 7, 2014 1:06:47 PM by BUSH from CHICAGO
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Part Number(s): 730 567151 01, 730 6110, 730 6253, 730 567151 02, 730 6274, 730 2062, 730 6114, 730 6454, 730 2069, 730 2216, 730 6208, 730 2219
Mfg Part Number(s): 66800833, 66800834, 66800836, 66800835, 66800840
Scrip Part Number(s): 730 2216, 730 2062, 730 6110, 730 6208, 730 6253, 730 2069, 730 6274, 730 6114, 730 6454, 730 567151 02, 730 567151 01, 730 2219
Because our price on this item is lower than the manufacturer's suggested retail price, the manufacturer does not allow us to show you our price until you place the item in your shopping cart. Retailers like Allegro Medical have the legal right to sell products at prices we set. However, adding the item to your cart allows us to show you our lower price consistent with our promise of always offering you the lowest possible prices on the widest selection of medical supplies, medical equipment and life enhancing products.
Adding this item to your shopping cart won't require you to buy it. However, our prices do change. If you decide to purchase this item now you are guaranteed the price now displayed in your shopping cart. Complete your purchase by clicking on the "checkout" button or simply remove the product from your cart if you decide not to make your purchase at this time.


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Beautiful beaches with lots of facilities and activities. Park office staff are very helpful in setting you in the right direction to enjoy your time there.
Pros: Good parking
All reviews seem positive
From family friendly trips with kid friendly activities to local plumbers lawyers, spas, and contractors. Judy's Book has millions of listings and reviews for the best and not so great. Whether you're looking for a specific business or just trying to discover great places we make it easy. We're a family oriented site focusing on bringing trusted reviews and recommendations to moms and others. Green and Sustainable places are becoming more relevant to Judy's Book users, have a favorite place? Write a review and tell users why it's Green!


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Separate names with a comma.
Sign up and join the fastest growing Yuneec drone community.
Discussion in 'General Discussion' started by BillyTexas, Sep 14, 2016.
So will we have to install anti collision lights on our H for commercial use?
Bill W.
No Billy, The FAA testing facility I took my 107 at told me(As I had the same question) That the lights that the H and DJI's have are sufficient to satisfy that requirement. And anti collision lights are only required "If" you want to fly after twilight hours( nighttime) and to do that, you have to have the Pilots Certificate and request a COA and get one! Hobbyist can not request a COA and thus cannot fly in the dark regardless of lights or no lights.
It was mainly a regulation for commercial SUAS's that may not have lighting at all!
Bill W.
Does any one have the phone number for yuneec in cal.i cannot get to their web site tells me unsafe site.tried 3 computers.need to check on my bird set it in for repairs.
Hope some one can help.


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Original paper
Batisivite, the first silicate related to the derbylite-hemloite group
Armbruster, Thomas; Kadiyski, Milen; Reznitsky, Leonid Z.; Sklyarov, Evgeny V.; Galuskin, Evgeny V.
European Journal of Mineralogy Volume 20 Number 5 (2008), p. 975 - 981
published: Nov 5, 2008
ArtNo. ESP147052005023, Price: 29.00 €
The crystal structure (space group Pī1, a = 7.5208(4), b = 7.6430(4), c = 9.5724(4) Å, α = 110.204(3), β = 103.338(6), γ = 98.281(7)°, V = 487.14(7) Å3, Z = 1) of the new mineral batisivite, (V, Cr)8Ti6[Ba(Si2O7)]O22, has been determined and refined from single-crystal X-ray data to R = 2.59%. Strong and sharp X-ray reflections define a C-centred monoclinic lattice with a = 4.9878(3), b = 14.1899(16), c = 7.0813(2) Å, β = 103.598(4)°, characteristic for members of the derbylite group. Considering additional weak and slightly diffuse reflections, the pattern could be indexed with a primitive triclinic cell as cited above. There are eight metal (M) sites, with M1-M4 defining octahedral α-PbO2 double chains and M5-M8 defining octahedral columns as in the structure of V3O5. The stacking of both units defines the structure of the derbylite type with channels that may be described as chains of empty cube-octahedra running parallel to [011] in triclinic setting. In batisivite adjacent cube-octahedra are alternately occupied by Ba and disilicate units, lowering the symmetry to triclinic. However, Ba-disilicate order is not complete. One cubeoctahedron is statistically filled by ca. ¾ Ba and ¼ disilicate, the other is occupied by ca. ¾ disilicate and ¼ Ba. This type of disorder is in qualitative agreement with the observed slight diffusivity of the super-structure reflections. The bridging oxygen of the disilicate group occupies the same site as disordered central Ba.
batisivite • disilicate • derbylite-hemloite group of minerals • single crystal x-ray diffraction • structure solution


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A large crowd of spectators turned out to watch the Anzac Parade make its way to Freedom Park.
Topics: anzac day 2016 hervey bay
Lest We Forget and thanks were left by those passing by on Anzac Day. Genesis Hair Creation's Rebecca Rae explains why she papers her windows every Anzac Day.
Kasthoory Jayankanth, a Anzac centenary scholarship 2016 winner, gives her speech on the Anzacs.
THE legend of the Anzac spirit lived on as thousands turned up to the dawn service in Hervey Bay.


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Penguin Gifts Kids T-Shirts
HILARIOUS HAPPY PENGUINS: Such a perfect shirt to show support for friends, siblings, partners or peers. NOT A SLAP BUT A HIGH FIVE: Need to boost someone's confidence or provide a reality slap? You can never go wrong with this High Five Your Face Slap You tee!
Tags: funny-penguin, funny-penguin-gifts, penguin-lovers-design, funny-design, high-five
This little penguin wants to be your friend :)Cool and cute illustrations drawn by hand with markers. Mostly cute animals and flowers (though not all!) :) Some work really well on clothing and some on other products so please check everything :) Thank you :) I hope my designs will help spread positive feelings in our gloomy world. Peace and love :)
Tags: gift, animal, penguin-doodle, cold, ice


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Otoya 1155
Avenida 9 Calle 11 y 13
San Jose Centro
Wednesday Jul 23, 2014 | San Jose Centro
Founder Night Out
If you have a startup idea or idea-stage company and you are interested in the Founder Institute program, then join us for the Founder Night Out. Meet fellow peers that are applying to the program or already enrolled, as well as the program Directors and Mentors. Socialize over drinks with other entrepreneurs at the same stage of development. Meet potential Co-Founders. Meet potential partners. Most of all, have fun!
- Start Date: Wed Jul 23, 2014
- Starts at: 07:00 PM
- Ends at: 09:00 PM
About the Event
Who should Attend?
- Anyone interested in joining the Founder Institute program
- Anyone who has an idea for a startup or an early-stage company
- Anyone interested in meeting Founder Institute Graduates, Directors or Mentors
What is the Agenda?
- Networking, Socializing and Drinks
This event is free to attend. Join us for a fun evening! For more free startup events, visit http://fi.co/events.
Share this Event with other Founders
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- Sully Bholat (Htet Aung Latt), João Dutra (Jo Aung), Tun Naung Win
- Phandeeyar , 10th floor, Royal River View Condominium, 628/636 Merchant Road, between 29th and 30th streets , Yangon
November 20, 2017Register
Graduate Startup Panel & Networking Event
- Piotr Boulangé, Andrzej Dobrucki, Zuzanna Przybyła, Paweł Sieczkiewicz
- Mindspace , Koszykowa 61 , Warsaw
November 20, 2017Register
Startup Legal 101: Advice from Top Startup Lawyers
- Nils Erik Jansson, Hampus Lofgren
- Hive workspace , Östra larmgatan 16 , Göteborg
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|Регистрация доменного имени
|Почтовый ящик вида firstname.lastname@example.com
|CMS административная панель
|Дизайн на основе шаблона
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|Социальные сети
|Маркетинг-Кит (рекламная презентация)
|Онлайн платежи (безналичный расчет)
|Форма обратной связи (регистрация, быстрый контакт и т.д.)
Makeinsite plans are paid monthly or yearly. We make it simple to start — and stop — your service at any time.
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After bringing in $782 million at the worldwide box office, it seems safe to say that a ton of us watched Deadpool at the cinema. The R-rated film became an unexpected hit after it became a sort of "people's film," having been pushed into production after large fan support emerged following the leak of test footage in 2014:
But back in 2013, before the movie morphed into the swear-y masterpiece we know and love today, 20th Century Fox debated whether or not to make the film with Tim Miller at the helm (the visual effects producer had never directed a feature length film before Deadpool), and in order to cover all their bases, accepted pitches from other filmmakers, including Kick-Ass 2 director Jeff Wadlow.
Conceptual artist Kelton Cram worked on the artwork to accompany Wadlow's pitch, which had Deadpool going up against a team of super-villains called the Maraders, lead by the mutant Random (who is actually a member of the Acolytes in the comics). Because Random (real name Marshall Evan Stone III) as one huge unit, in the concept art Cram imagined him being played by one of the biggest, toughest units out there: Stone Cold Steve Austin!
I got to say, even though the studio didn't end up going with Wadlow's pitch, Austin would definitely suits the role of a villain. Take a look at Cram's concept art, which he shared via Comicbook.com and see what you think:
Pretty awesome, right?!
Cram also shared a couple of concept images of Deadpool in his suit, which interestingly doesn't include the traditional white-eyes look the merc with the mouth is usually drawn with:
Cram said he believed that the white-eyes were left out because Wadlow was going for "a more gritty/realistic approach," and thought "the white eyes [were] a bit campy." He does, however, think that in the finished product, Fox totally pulled off the white eyes look.
What do you think of this concept art and Wadlow's idea for The Marauders as villains?
Source: Comicbook.com


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Christmas is the time where we also thank our friends from the media world for their support all year long. Similarly to last year, we held our party by the pool where we served miniature main courses, canapes and a foie gras station pairing with a tasting of our Sauternes. From the sweet side, this … Read more
Live show with Crystal Kwok on RTHK Radio 3December 29th, 2011 | Posted by in Books | Daily life... - (2 Comments)
Friday 30th of December, just after the news at one, I'll have the honor to be the guest of star host Crystal Kwok for her live show "Kwok Talk" on RTHK3 – and let me tell you, I'd better be ready to talk! Whilst a more visual broadcast (hint hint) is on its way, I … Read more


text: Bøger af A J Stephens Matters of the Heart af A J Stephens Paperback Set til: kr. 185,00 The Opinion of Mr. A.J. Stephens, Q.C., LL.D., on Behalf of the Lord Archbishop of Armagh, Primate of All Ireland; With an Appendix of Documents, and Communications to Her Majesty's Government Respecting Synodical Action af A J Stephens Paperback Set til: kr. 158,00


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- Cars
- New cars
- Toyota
- Toyota Etios Liva
- Reviews
- sweet acceleration !!!! great drive
sweet acceleration !!!! great drive
User review on Toyota Etios Liva written by Devika on 12 August 2014
Devika's review on Toyota Etios Liva J PS
Year of Manufacture : 2010 | Driven no. of Kms. : NA
- Pros: Low price, good mileage.
- Cons: Average interiors
The acceleration of the Etios Liva is sweet and it's because of the power-to-weight that despite lower power ratings, it's sensible acceleration. Toyota factory-made vehicles are famous for his or her performance, power and responsibleness. The corporate is simply too possessive of its nonetheless feral image and for that the corporate has return up with some hanging figures in terms of acceleration and acquire. The acceleration of Toyota Etios Liva gasolene car is sort of spectacular with an 1197 cc, 3 NR-FE, Gasoline, 4-Cylinder 16 V, DOHC engine, and 80 annotation of peak power. The car encompasses a total weight of solely 890 kg and this plays a serious role in displaying high acceleration. In terms of suspension, Toyota Etios Liva comes fitted with McPherson Strut suspensions at the front and Torsion Beam at the rear. The Liva gasolene reaches a 100 kmph mark in only 14 seconds.
Read more →
User Reviews for Toyota Etios Liva Competitors
Honda Brio
Hyundai Elite i20
Ford Figo
Hyundai Grand i10
Maruti Suzuki Baleno


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When an unprecedented amount of sinkholes erupt all over Florida, a new nest of fire spitting LAVALANTULAS is awakened… wreaking their fiery havoc all over the sunshine state.
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English to Spanish (Latin America) Transcription Professional Román Monteverde
Member since November 14, 2015
Hello, my name is Román, I live in Venezuela. My native lenguage is Spanish.
I started speaking english since the age of 8 and I started translating in 2012, I can produce an exact english to spanish and vice versa translations of an extensive variety of texts, specialy from general culture, engineering, agriculture, Social Science and tourism. Also, I regulary translate subtitles of movies, TV shows and audios.
My translation can cover from the most informal coversation between people to a highly academic level writing.
Spanish (Latin America)
Specializes In
High School


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Larry Pritchett
Last quote by Larry Pritchett
We have some damage here in Miller County. There were some people trapped in houses that trees have fallen into. It's mostly trees down that caused quite a bit of damage.feedback
Apr 12 2016
Larry Pritchett has most recently been quoted in an article called Brace for More Hail; Tornado Hits Arkansas. Larry Pritchett said, "Fortunately no one was injured.". Larry Pritchett has been quoted a grand total of 2 times in 1 article.
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Lift Creative ROI with Neuroscience
Brings Opportunities to Your Hands
Increasing Your Commercial Capabilities through Comprehensive and Integrated Workhop along 2016. You can choose all Workshop Series or certain workshop according to your professional needs.
Pelajari cara menciptakan tata ruang untuk pemajangan toko dan kategori yang efektif, untuk membantu dan mempengaruhi pembeli dalam keterbatasan operasional dalam sebuah toko di situasi pasar yang berkembang sangat cepat. Anda dapat mengembangkan perencanaan toko, mengkoordinasikan keputusan mengenai tata ruang pemajangan, dan meningkatkan kemampuan navigasi pembeli dengan mengikuti workshop interaktif selama dua hari yang meliputi presentasi, diskusi grup, latihan, serta studi kasus.
Get equipped to embark on Category Management projects with your industry partners in this excitingly evolving retail channel.
Date: Thursday, 4 December 2014
Location: Webinar
Speakers: Thurein Nyein, Nielsen and Sagar Phadke, Nielsen
Myanmar is primed for business expansion with a population of 51.4 million first-time consumers and, according to the IMF, forecast GDP growth of 8.5% this year – one of the fastest growth rates in the world. Amid these opportunities, how can global giants and regional brands win the hearts, minds and wallets of Myanmar consumers?
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ASEAN 2015 will usher in a new era for Asian business and the new consumer class. Are Asian companies ready to seize these new opportunities and create smarter outcomes? What will ASEAN 2015 mean for business and investment? Why is the changing economic and consumer landscape important? What strategies must business leaders employ to ensure growth and minimise risk in a single economic zone?
Learn how to create effective floor and category layouts to assist and influence shoppers within the operational constraints of a store in this fast-pace evolving market. You can Develop store planning, coordinate space decisions and improve shopper navigability with two-days interactive workshop covering presentations, group discussions, exercises, case studies.
Nielsen is partnering with Storewars International, world's leading business management simulation again this year to bring an intense Storewars International business simulation workshop to help manufacturers and retailers develop the skills needed to succeed in the modern trade environment.


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I Married a Younger Man
Personal Stories, Advice, and Support 7 People
I'm a Cougar! LolI am 39-years-old and my husband is 25-years-old. Some people have issues with our age difference. I've heard all the jokes. My personal favorite being.."No wonder it took so long for you to find Mr. Right, you were looking on all the wrong playgrounds!" Yuk, yuk, yuk...
LeighLeigh 36-40, F 6 Responses 2 Jun 6, 2009


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Jackie Robinson in a run down between third and home with apparently the entire other team trying to catch him. I'm also pretty sure there were four other guys up the left field line not shown here. Get this, Jackie scored on the play. He had them right where he wanted them!
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Radisson Hotels Doddington properties are provided below. Search for cheap and discount Radisson Hotels hotel rates in Doddington, United Kingdom for your upcoming meeting or individual travels. We list the best Radisson Hotels Doddington hotels/properties so you can review the Doddington Radisson Hotels hotel list below to find the perfect place.
This service will also provide Doddington, United Kingdom hotels & motels that get similar quality scores of a Radisson Hotels.
How should we direct your call?
With a stay at Park Inn by Radisson Thurrock in Grays (North Stifford), you'll be convenient to Arena Essex Raceway and Lakeside Shopping Centre.
With a stay at Radisson Blu Edwardian New Providence Wharf Hotel in London (Canary Wharf), you'll be minutes from Billingsgate Market and O2 Arena.
When you stay at Park Inn by Radisson Harlow in Harlow, you'll be within the vicinity of Lee Valley Park.


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Unanswered: Db2 Performance Optimization features
We are in the process of migrating DB2 from z/OS to DB2 V9.7 EE Linux. The exisiting system DB size of around 200GB. As we all know DB2 V9.7 EE doesn't come up with performance optimization features like WLM, PE, QP. It involves extra cost in obtaining the licence from IBM. How feasible to have these features in the new environment? Could you please add your thoughts? Ours is financial application which have both batch and OLTP parallelly.


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Vocabulario: El Día de los Muertos. Skulls (often made of sugar)/ skeleton figurines Ghosts Offerings to the dead Candies/ sweets To scare/ frighten Cemetaries/ tombs Altar for the dead To celebrate life. Calaveras/calacas Fantasmas Ofrendas Dulces Para dar miedo
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Differentiation of Viable and Nonviable Myocardium by the Use of Three-Dimensional Tagged MRI in 2-Day-Old Reperfused Canine Infarcts
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Background—To limit ischemic myocardial injury, it is important to differentiate viable from infarcted myocardium. Three dimensional (3D) tagged MRI has the ability to quantify myocardial 3D deformation and strain (noninvasively and precisely), and can achieve a true comparison of contraction not only from region to region, but also at different levels of function. In this study, we investigated whether regional strain mapping obtained by 3D-tagged MRI can differentiate between viable but stunned myocardium and nonviable myocardium.
Methods and Results—We examined 7 dogs 2 days after a 90-minute closed-chest left anterior descending coronary artery occlusion followed by 48 hours of reperfusion. 3D-tagged MR images spanning the entire left ventricle were acquired both at rest and during dobutamine infusion (5 μg · kg−1 · min−1 IV). Regional blood flow was measured with radioactive microspheres and used to define risk regions. Infarcted regions were defined as 2,3,5 triphenyltetrazolium chloride negative regions. Strains in infarcted regions were greatly impaired compared with remote regions (P<0.001) and remained unchanged during dobutamine stress. Risk regions showed a dysfunction at rest, with improved function during dobutamine infusion. Receiver operating characteristics analysis showed that radial strain was more accurate for identifying viable regions.
Conclusions—When coupled with a stress test, 3D strain mapping by the use of tagged MRI is a sensitive and noninvasive method for characterizing ischemic injury. Regional strain can be used to differentiate between viable but stunned and nonviable myocardium within the postischemic injured myocardium.
The rapid and accurate assessment of reperfusion and its functional consequence has become one of the most important issues in the management of the patient with a myocardial infarction.1 The timing and adequacy of reperfusion of the infarct-related artery are important determinants of patient prognosis in acute myocardial infarction.2 In the majority of the cases, however, only partial restoration of coronary blood flow is achieved after significant injury to the jeopardized segment of the ventricular wall. Experimental and clinical studies have established that early intervention to reestablish as much coronary flow as possible has a significant positive effect on the degree of functional recruitment.3 The failure to open an occluded vessel or the reocclusion of an initially reperfused coronary artery both have significant implications for therapeutic management. Thus, the efficacy of revascularization procedures must be evaluated in the early phase after ischemic injury to determine the exact extent of irreversible infarction and, more importantly, to show evidence of restoration of function of the salvaged myocardium. Even if the myocardium escapes necrosis, as a consequence of timely reperfusion, this challenge is made difficult by the delayed functional recovery of the stunned myocardium.4
To date, the assessment of viability has been based either on tracer techniques or on low-dose dobutamine stress echocardiography, which has been shown capable of identifying stunned myocardial regions.5 6 Those methods suffer, however, either from limited spatial resolution or from the inherent limitation of any 2-dimensional method to qualitatively assess contraction because of the complex motion of the heart and the global shape changes during systole that occur during rest and stress. Three-dimensional (3D) tagged MRI has the ability to quantify myocardial 3D deformation and strain noninvasively and precisely, and to permit a true comparison of contraction not only from region to region, but also at different levels of function. In this study, we compared regional strain differences and changes of myocardial contractility occurring under low-dose dobutamine stress 48 hours after reperfusion to investigate whether regional strain mapping obtained by 3D-tagged MRI can differentiate between viable but stunned myocardium and nonviable myocardium.
The animals in this study were handled according to the animal welfare regulations of and after the approval of the animal committee of our institution. These regulations are in accordance with the Position of the American Heart Association on Research Animal Use, adopted November 15, 1984. These animals were involved in a recently published study7 that determined the mechanisms of contrast enhancement in fast MRI of reperfused infarcts.
Experimental Preparation
We studied 7 mongrel dogs (20 to 25 kg). On day 1, the animals were anesthetized with sodium pentobarbital (35 mg/kg IV), intubated, and connected to a Harvard respirator. An intravenous femoral catheter was placed for drug administration. A catheter sheath was placed in the right femoral artery and was used to introduce a 6F pigtail catheter into the left ventricle (LV) under fluoroscopic guidance. This catheter was used for microsphere administration and for monitoring LV pressure. The sheath of this catheter was used for microsphere reference sampling from the femoral artery. A second catheter sheath was then placed in the left femoral artery and used to introduce a 7F JL 2.5 (Left Judkins 2.5-cm) guiding catheter into the left main coronary artery. A 3.5F angioplasty balloon catheter was passed through the guiding catheter and slid into the left anterior descending (LAD) coronary artery over a 0.35-mm guidewire that was positioned in the proximal left anterior descending coronary artery under fluoroscopic guidance. The balloon was then inflated, and the aVL lead of the ECG was monitored for ST-segment elevation. The balloon remained inflated for 90 minutes to produce myocardial infarction and then was deflated to allow reperfusion of the infarcted myocardium. Regional myocardial blood flow was measured immediately before LAD occlusion and 80 minutes after occlusion by LV injection of ±2 million sonicated microspheres (15±1 μm diameter) labeled with 1 of several radionuclides (153Gd, 113Sn, 103Ku, 95Nb, or 46Sc; DuPont). The animals were then allowed to recover for 48 hours.
Imaging Protocol
MRI was performed 48 hours after reperfusion. The animals were again anesthetized and mechanically ventilated, and a pigtail catheter was advanced into the LV under fluoroscopic guidance to monitor LV pressure, for administration of the third and fourth sets of microspheres injected at rest, and in a subset of 3 animals during dobutamine stress. Animals were transported to the MRI facility for scanning in a whole-body 1.5T scanner (Signa; GE Medical Systems). The animals were placed in the right anticubital position with electrodes for ECG gating, and a flexible surface coil was wrapped around the chest.
The imaging protocol is based on an ECG-triggered segmented k-space SPGR pulse sequence. Contiguous stacks of short-axis images in double obliquity were prescribed at end systole to cover the entire heart from base to apex. Six long-axis views were also prescribed from the midventricular short-axis image and were distributed in a radial fashion every 30°. Imaging parameters were as follows: 32-cm field of view; 8-mm slice thickness; repetition time, 6.5 ms; echo time, 2.3 ms; 15° tip angle; 256×110 image matrix; 1 signal acquired; and 5 phase-encoded views per movie frame (temporal resolution of 32 ms). Slab saturation achieved "black blood" in the LV cavity. To describe the 3D deformation of the heart, we used myocardial tissue tagging to encode the motion in 3 orthogonal directions (Figure 1⇓).8 9 The tagging pulse consisted of nonselective radiofrequency pulses separated by spatial modulation of magnetization encoding gradients9 to achieve a tag separation of 6 mm. Tagging pulses were applied immediately before the imaging pulse and were triggered by the upslope of the QRS from the ECG. Reproducible diaphragmatic positions between image sets were obtained by stopping the respirator at end expiratory volume during acquisition time. A total of 15 (5 image planes×3 sets) breathholds was needed to acquire a complete set of tagged images. Without removing the animal from the magnet, we administered dobutamine intravenously during continuous ECG monitoring and blood pressure recording. A dose of 5 μg · kg−1 · min−1 of dobutamine was infused into the intravenous femoral catheter 10 minutes before imaging and during 3D tagged imaging. The rest/stress imaging protocol lasted ≈1 hour.
Definition of Infarct, Risk, and Remote Regions
After MR imaging, the hearts were arrested with KCl and excised. The LV was isolated, then sectioned from base to apex into 5 short-axis slices. The junctions of the right ventricular (RV) walls and the interventricular septum were identified to determine the position of the midseptum point on the most basal slice used as a landmark for later registration of the stack with corresponding MR images. The slices were then incubated in a 2% solution of 2,3,5 triphenyltetrazolium chloride (TTC) for 20 minutes at 37°C. Regions that failed to demonstrate brick red staining were considered to represent infarcted myocardium.10 For each slice, a shallow cut was made to divide the LV circumference into 12 pie-shaped sections. Each of the pie-shaped sections was further divided into 3 to 5 pieces of approximately equal thickness from the endocardial to epicardial surfaces. The exact locations of these cuts were recorded before the slices were photographed to relate TTC regions to the location from which tissue samples were taken for microsphere blood-flow counting. After the slices were photographed, myocardial samples (0.1 to 0.5 g) were obtained for microsphere counting. Each of the samples was then weighted and counted in a gamma-emission well spectrometer (model 5986, Hewlett-Packard) along with the reference blood samples at appropriate energy windows. Regional myocardial blood flow (mL/min per 100 g) was then calculated by standard methods.11 On the basis of TTC staining and regional myocardial blood flow findings for each animal, we assigned samples to 1 of the 3 following regions: infarcted, risk (but noninfarcted), and remote regions. Samples that were partly located in >1 zone were excluded from the analysis. The infarcted regions corresponded to samples failing to stain with TTC. The risk (but noninfarcted) region was defined as those noninfarcted samples (outside the TTC negative zones) in which myocardial blood flow was reduced by ≥50% during the occlusion compared with remote regions at the time of the occlusion. Remote regions were chosen on the side of the ventricle opposite the infarction.
Data Analysis
Strain Computation
Tagged-image data consisted of sets of 120 to 180 images (5 slices×8 to 12 phases×3 directions). When a stress study was performed, a second set of images was acquired. Images were processed by the use of an in-house developed software program on a Silicon Graphics workstation. Contour and tag detection was performed by the use of a semiautomated detection algorithm described in detail elsewhere.12 Then, 3D displacement and strain throughout the LV were determined at each time point using the displacement field-fitting method13 at rest and at stress. This technique uses all of the available information in the 3 orthogonal tag patterns to compute the 3D deformation gradient tensor at any point in the heart wall. A material point mesh is defined within the heart wall at end diastole as the point at which 3D displacement and deformation is calculated over time. The mesh density was set to 12 angular locations equally spaced around the circumference, at 3 points radially through the wall at each circumferential location, and at 5 levels equally spaced in the longitudinal direction. A total of 180 material points were defined that corresponded to 180 volume elements of myocardium. The inner and outer shell of points was distributed radially 2 mm into the myocardium from the fitted endocardial and epicardial surfaces, and the midwall shell of points was distributed at an equal distance from the endocardial and epicardial surfaces. The shape of the mesh was determined by the end-diastolic endocardial and epicardial contours and the density of material points was chosen to match the microsphere sampling layout for spatial registration purposes. Coordinates of the RV-LV junctions and the corresponding midseptum points were calculated on the most basal slice at end-diastole on the stack of MR images and were used as reference landmarks for strain calculation and to display reconstructed 3D strain maps. The same mesh dimensions were used for rest and stress studies allowing to match spatially the corresponding regions on the rest and stress strain maps. A data processing time of 3 to 4 hours was required to analysis a full 3D data set at rest and stress.
Circumferential registration (in-plane registration) between 3D strain maps and pathology sampling layouts was achieved by matching landmark locations. Axial registration (between-slice levels) was controlled by the use of the same number of levels (n=5) when prescribing the stack of slices during MR imaging, when choosing the size of the reconstruction mesh of the 3D strain maps, and when sectioning the isolated heart into short-axis slices for sampling.
In this study, we report strain changes between the reference state (end diastole) and the deformed state (usually end systole) by the use of the fractional changes in length (in percent) for each of the 3 orthogonal normal strains in the radial, circumferential, and longitudinal directions (see Appendix A). Radial strain was calculated by the use of the tissue incompressibility correction that improves the robustness of wall thickening measurements (see Appendix B). We calculated in addition end-systolic first principle strain E1 (maximum thickening), and reported the vector magnitude and its direction, given by the angles between the eigen vector, the local circumferential direction (E1ac) and the longitudinal direction (E1al), respectively (Figure 2⇓).
Accuracy of Viability Detection
To assess the accuracy of strain mapping for the detection of viable regions and nonviable regions, we performed receiver operating characteristic (ROC) analysis to compare observer performance to differentiate viable from nonviable regions based on strain mapping.
For each animal we plotted strain time course at rest and under dobutamine stress of each strain components as an array of graphs in which each of the 60 midwall volume elements was considered to be a separate region (Figure 3⇓). Each region (box) of the array was categorized as either viable or nonviable on the basis of the transmural extent of the infarction (as determined by TTC staining) in that region. Regions were considered viable when transmural extent of the infarction was equal or less than 1/3 of the wall thickness in that region. Regions were considered nonviable when transmural extent of the infarction was >1/3 of the wall thickness in that region. Arrays of graphs were then reviewed independently by 3 readers in a blind fashion without knowledge of the pathology results. Observers were given an unrestricted amount of time to evaluate the cases. On the basis of the degree of contraction at rest and stress and the functional recruitment that occurred under dobutamine stress, they were asked to identify viable regions and to assign a level of confidence for that particular finding. Level of confidence was graded on a 4-point scale as follows: 4=definitely viable, 3=probably viable, 2=probably nonviable, and 1=definitely nonviable.
Statistical Analysis
All measurements are presented as mean (SEM). Changes in hemodynamic variables were compared by the use of paired t tests. Differences in microsphere blood flow measurements between regions and over time were assessed by the use of repeated-measures ANOVA. To compare strain values between regions, data were averaged by region in each animal. Differences between regions at rest were analyzed by the use of a 1-way ANOVA. To test the effect of low-dose dobutamine stress on differences in strain between regions, we used repeated-measures ANOVA. Whenever applicable, a posteriori comparisons were made according to the Tukey HSD method. The CORROC2 and LABMRMC programs (C. Metz, PhD, University of Chicago) were used to conduct the ROC analysis for this study with a maximum-likelihood estimation technique to obtain binomial ROC data.14 Comparison of the observed responses across readers and for the different strains was achieved with a multireader multicases ROC ANOVA by the use of the LABMRMC algorithm.15 A z score test was further used to calculate, when required, the statistical significance of the difference between the areas under 2 estimated ROC curves. Statistical significance was inferred when P≤0.05, and all reported P values were 2-tailed.
There was no change in average heart rate (HR) at the end of ischemia (90 minutes) compared with baseline (130 [5 bpm] versus 136 [6 bpm], P=NS), whereas systolic arterial blood pressure (SBP) decreased significantly (110 [6] versus 138 [5 mm Hg], P<0.01). At the time of imaging (48 hours of reperfusion), HR was 129 (6 bpm) and SBP was 107 (4 mm Hg). During infusion of dobutamine, HR increased from 127 (8 bpm) to 151 (7 bpm) (P<0.05), whereas SBP rose from 119 (6 mm Hg) to 136 (7 mm Hg) (P=NS). Accordingly, the rate-pressure product increased by 35 (5%), from 15 236 (1015) to 20 502 (1340) (P=0.01).
Myocardial Blood Flow
During LAD occlusion, blood flow decreased markedly in both infarcted (0.09 [0.03 mL · min−1 · g]) and risk regions (0.15 [0.04 mL · min−1 · g−1]) compared with remote regions (0.82 [0.07] mL · min−1 · g−1) (P<0.01). After 48 hours of reperfusion, blood flow returned to near normal values in risk regions (0.68 [0.11 mL · min−1 · g−1]) compared with remote regions (0.95 [0.11] mL · min−1 · g−1) (P=0.1), but remained decreased in infarcted regions (0.50 [0.12] mL · min−1 · g−1) (P<0.01). Low-dose dobutamine slightly increased regional blood flow (from 0.48 [0.07] mL · min−1 · g−1 to 0.57 [0.12] mL · min−1 · g−1) in infarcted regions, and increased of a greater extent in risk regions (from [0.62 [0.10] mL · min−1 · g−1 to 1.05 [0.18] mL · min−1 · g−1) and normal regions (from [1.05 [0.2] mL · min−1 · g−1 to 1.46 [0.26] mL−1 · min · g−1).
Strain Analysis
Overall, the size of infarcted regions (TTC-negative regions) was 6.4 (1.8%) of total LV mass and of risk regions, 23.5 (2.9%). A total of 436 of 1260 samples from all 7 dogs fulfilled the selection criteria, and each of these 436 assigned to 1 of the predefined infarcted, risk, or remote regions. Among them, there were 91 samples in the infarcted regions, 188 in the risk region, and 157 in the remote regions. The number of samples in each animal varied from 4 to 37 for the infarcted region and from 13 to 71 for the risk regions. Figure 3⇑ shows array plots of normal strains as a function of time for 1 animal 48 hours after reperfusion at rest and under dobutamine stress. Figure 4⇓ shows 3D strain maps of maximum principal strain E1 at end systole obtained in the same animal studied at rest and then under dobutamine stress.
End-Systolic Strains: Rest
Radial strain exhibited at rest an overall significant difference across regions at end systole (P<0.0001), with a depressed radial strain in both infarcted and risk regions of 5.2 (1.3%) and 6.1 (1.5%), which contrasted with remote regions, in which wall thickening was 23.2 (1.9%) (P<0.01) (Figure 5⇓). However, radial strain was not significantly different in infarcted and risk regions. Circumferential and longitudinal strains demonstrated comparable trends, even if circumferential strain failed to show overall differences across all regions. Both showed decreased negative strains in both infarcted and risk regions (P=NS) compared with remote regions. Maximum principal strain E1 (or greatest thickening) at end systole showed results similar to those observed with radial normal strain (Figure 6⇓). The magnitude of E1 was reduced in both infarcted and risk regions (P=NS) compared with remote regions (P<0.001). Maximum principal strain direction changed in infarcted and risk regions compared with remote regions. Angle from the local longitudinal direction (E1al) decreased in both regions (P<0.01), whereas angle from the local circumferential direction (E1ac) decreased only in risk regions (P<0.01).
End-Systolic Strains: Stress
Figure 5⇑ summarizes end-systolic strain results grouped by region for all experiments at rest and under low-dose dobutamine infusion. Under dobutamine challenge, end-systolic radial strain increased as expected in the remote regions from 23.2 (1.9%) to 41.7 (4.2%) (P<0.001). Whereas end-systolic strains remained unchanged in the infarcted regions, a significant increase in end-systolic radial strain was observed in the risk regions (6.1 [1.7]% versus 20.1 [2.2]%; P=0.002). The difference between end-systolic radial strain in infarcted and risk regions became significant (P=0.002) under dobutamine stress. Again, circumferential and longitudinal strains exhibited a comparable trend, but the differences between and within regions between rest and stress were not statistically significant. Maximum principal strain E1 allowed identification of the increase of the magnitude of maximum thickening in the risk regions 14.2 (1.5%) to 36.4 (4%) (P=0.005), whereas the average magnitude of maximum thickening remained almost unchanged (11 [1.8%] versus 18 [2.2%]; P=NS) (Figure 6⇑). Changes in direction of maximum principal strain that occurred under dobutamine stress were not statistically significant.
Accuracy of Viability Detection
Of a total of 420 regions analyzed (7×60 midwall volume elements), 39 were categorized as nonviable regions. Figure 7⇓ shows ROC curves from the data pooled across observers for the different strain parameters. Multireaders multicase ROC ANOVA showed that all 3 readers performed consistently better with radial strain than with circumferential (P=0.002) or longitudinal strain (P<0.001). The use of the incompressibility correction for the calculation of radial strain improved reader performance for the differentiation of viable regions (P=0.01). No interaction with other factors was detected. When comparing accuracy of strains at an arbitrary specificity level (1-FPF) of 80%, sensitivities were respectively of 94% for radial strain calculated with the incompressibility correction (Sri), 73% for radial strain (Srr), 44% for circumferential strain (Scc), and 35% for longitudinal strain (Sll).
This study shows that, in a closed-chest canine model 48 hours after reperfusion, 3D strain mapping obtained at rest and under low-dose dobutamine stress by the use of 3D-tagged MRI reveals viable but stunned regions and differentiates between viable but stunned and nonviable myocardium within the postischemic injured territory. Regions that are dysfunctional at rest but recover under inotropic stimulation (viable myocardium) correspond to noninfarcted (TTC positive) regions, which were at risk at the time of the occlusion but are normally perfused 48 hours after reperfusion (stunned regions). Alternatively, regions that are dysfunctional at rest and remain dysfunctional under stress (nonviable myocardium) correspond to infarcted (TTC negative) regions. Within the postischemic territory, regional strains increased significantly under low-dose dobutamine only within the noninfarcted but at risk regions, whereas regional strain remained unchanged within infarcted regions, thus allowing the identification of salvaged viable regions. 3D strain mapping quantifies accurately the extent of viable and nonviable regions. Accuracy will depend on the criteria used to define viability.
At rest, the degree of dysfunction was comparable for all strain components within the infarcted regions and the noninfarcted but at risk regions. Within the infarcted regions, end-systolic strains were severely depressed but showed on average the persistence of a residual positive thickening (+5%) and negative shortening (−2%). Because infarcted regions were circumscribed to only subendocardial layers, it appears that this residual active deformation 48 hours after reperfusion within the infarcted regions could be related to the ability of the outer wall to generate greater force than the endocardial wall.16 17
Our results suggest that radial strains differentiate viable from nonviable regions better than do longitudinal or circumferential strains. This finding confirms that radial thickening is a valid integrated measurement of regional function not only across all layers but also within a specific layer. Indeed, radial thickening accounts for the complex 3D fiber rearrangements that occur within the wall during contraction.16 Although local radial strain can be estimated directly from the radial component of the stretch tensor, its precision, which relies on the tag density orthogonal to the strain direction, is supported by the lowest density of tag data (2 to 3 tags). In contrast, in our experiments, strains involving the circumferential and longitudinal directions were the best supported with tag data that were distributed continuously across the wall. Using these 3D strain components and the incompressibility assumption to recalculate radial function, we found that Sri gave a more robust radial strain estimate.
In our study, the direction of maximum principal strain E1 showed only limited differences across regions at rest, and differences decreased, becoming not significant under dobutamine infusion. Our results are confirmed by a recent study in a reperfusion model in rabbits showing that postischemic dysfunction does not alter the direction of maximal shortening deformation.18 However, in nonreperfused infarction models, more radical changes in principal strain direction have been reported.19 20
Experimental studies with isoproterenol or dopamine demonstrated that stunned myocardium maintains functional reserve that may be recovered after moderate inotropic stimulation without deleterious effects.21 22 Several clinical studies have subsequently shown that dobutamine stress echocardiography is a useful method to predict reversible dysfunction.6 23 Although the exact mechanism of stunning is still unknown, this observation raises the possibility that stunning is due in part to increased local mechanical stress secondary to endocardial damage that increases local afterload. In this hypothesis, stunned myocardium generates tension but no observable shortening, unless inotropic stimulation is used to reduce local afterload earlier in systole by increased contractility of the normal regions, consequently unmasking the function of the stunned myocardium. More accurate measures of contractile recruitment that can be afforded by 3D tagging can thus be of value because they provide a more accurate map of the extent of viable regions.
Our study is the first to report noninvasive measurements of 3D strain in the postischemic myocardium after reperfusion and is also the first to report strain changes that occur under low-dose dobutamine stress. Accurate measurements of myocardial deformation with implanted markers have been recently reported in postischemic injury.18 24 Implantation of markers is limited, however, to a focal region of the myocardium and is too invasive for clinical use. MR tagging has the unique ability to provide noninvasive measurements of tissue deformation. Recent experimental studies with MR tagging have reported the mechanical behavior of nonreperfused transmural infarction by the use of 2D-tagged MR.20 25 The combination of parallel-tag MR imaging and displacement field fitting has the major advantage of providing an accurate and robust method to calculate 3D deformation in a particular region of the myocardium as well as its time course. The accuracy and robustness of this method is based on its reliance on accurately identifiable tag profiles26 rather than poorly defined heart contours;27 also, it uses all the available data along the entire length of each tag line in all 3 directions rather than only points that intersect with other tags or contours.28 29 The field-fitting technique has the advantage of giving an analytical representation of LV displacement for calculation of smooth estimates of strain and of being robust on uncertainty in the tag position estimates. The reproducibility of tag position is extremely good, even with noisy images,26 30 especially when compared with the reproducibility of myocardial contours, which is lessened by the variable interpretation of the endocardium position between observers. Because 3D-tagged MRI has the ability to register strain maps spatially, a true and accurate comparison of contractility within the same region or between different regions can be achieved under varying physiological conditions (such as during a stress test) and despite conformation changes of the heart during systole.
The experimental model is an important determinant of the mechanisms for postischemic dysfunction. By using a closed-chest canine model with a 90-minute balloon catheter LAD occlusion reperfused for 48 hours, we found that not only was the invasiveness of the experimental procedure limited, but also the infarct size and the time window for tissue salvage were close to the clinical circumstances of performance of an early thrombolysis. In addition, the time of MR imaging (48 hours after reperfusion) was chosen to correspond to that at which assessment of viability is required for therapeutic planning. The results of our study form a framework on which to base ongoing and future clinical evaluations. 3D strain mapping with tagged MRI is an entirely noninvasive technique that is directly applicable clinically.31 This technique should constitute a diagnostic tool and an alternative to existing methods when more accurate assessment of regional mechanics is required.
Appendix AA
The strain tensor is solved at each point of the myocardium on the basis of the orthogonal parallel-tagged MR image sets that provide the 1-dimensional displacement field of the heart for each direction of the space. For each material point of the mesh, the local displacement gradient tensor (∇U) was computed mathematically by evaluating the directional derivatives of the local displacement field in the deformed state. From this, the lagrangian finite deformation gradient tensor (F) was calculated according to F=(I+∇U)−1, where I is the identity tensor. The lagrangian finite deformation strain tensor (E) and linearized strain tensor (S) were then calculated from E=1/2(FTF−I) and S=(FTF)1/2−I. The tensor (S) is useful because its axial components (Srr, Scc, and Sll) represent the percent change in length from end diastole when multiplied by 100.
Appendix AB
Because there were often only 2 tag lines across the heart wall, the radial component of S (Srr) was the least well supported by the tag data and was subject to higher variability. For this reason, the other components of the stretch tensor, which were well supported by the tag data and the assumption of tissue incompressibility, were used to estimate the radial thickening (Sri). The incompressibility correction was performed by the use of all the components of the right stretch tensor U except Urr, and the incompressibility constraint (determinate of U=1.0) to solve for the radial thickening component Sri.
This study was supported in part by a Research Award from the SCBT/MR (Society of Computed Body Tomography and Magnetic Resonance), a Société Française de Radiologie grant, and NIH grants RO1HL45090 and LH45683.
Presented in part at the 68th Scientific Sessions of the American Heart Association, Anaheim, Calif, November 13–16, 1995, and previously published in abstract form (Circulation. 1995;92:I-508).
- Received July 22, 1998.
- Revision received August 24, 1998.
- Accepted August 31, 1998.
- Copyright © 1999 by American Heart Association
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Moore CC, Lugo Olivieri CH, Lee L, Lima JAC, McVeigh ER, Zerhouni EA. 3D deformation of the normal human ventricle: assessment by MR tissue tagging. Proc Soc Magn Reson. 1995;3:1427.Three-dimensional tagged MRI at rest and during low-dose dobutamine infusion was performed in 7 dogs 2 days after left anterior descending coronary artery occlusion. Risk and infarcted regions were respectively defined with radioactive microspheres and triphenyltetrazolium chloride staining. Strains in infarcted regions were greatly impaired and remained unchanged during dobutamine stress. Risk regions were dysfunctional at rest but improved function during stress. Receiver operating characteristics analysis showed that radial strain was more accurate for identifying viable regions. When coupled with a stress test, regional strain can be used to differentiate between viable but stunned and nonviable myocardium within the postischemic injured myocardium.
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- Differentiation of Viable and Nonviable Myocardium by the Use of Three-Dimensional Tagged MRI in 2-Day-Old Reperfused Canine InfarctsP. Croisille, C. C. Moore, R. M. Judd, J. A. C. Lima, M. Arai, E. R. McVeigh, L. C. Becker and E. A. ZerhouniCirculation. 1999;99:284-291, originally published January 19, 1999https://doi.org/10.1161/01.CIR.99.2.284
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- Differentiation of Viable and Nonviable Myocardium by the Use of Three-Dimensional Tagged MRI in 2-Day-Old Reperfused Canine InfarctsP. Croisille, C. C. Moore, R. M. Judd, J. A. C. Lima, M. Arai, E. R. McVeigh, L. C. Becker and E. A. ZerhouniCirculation. 1999;99:284-291, originally published January 19, 1999https://doi.org/10.1161/01.CIR.99.2.284Permalink:


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NGN 39,500 per night


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Day 2 of Las Vegas
Las Vegas Travel Blog› entry 2 of 4 › view all entries
Las Vegas Adventure Day 2
Well it is day 2 of my Las Vegas Adventure. I get up this morning and make it to the Burger Palace and have some typical American Breakfast of bacon and grease. I then go walk on to the Las Vegas Strip and complete the rest of the strip I did not see yet. I walk down the other direction toward the Stratosphere hotel. It is the hotel with the high tower on it. I then make it to the hotel the Wynn, which is the newest and richest hotel in all of Las Vegas.
Then I make the journey down the street to the Stratosphere. I go past some old areas past the sign of the El Rancho. It was an older hotel I stayed at years ago, it is gone but sign is still here.
I make it to the hotel and my feet are killing me. As I was wearing sandals the whole time and my feet are full of blisters. Inside the casino I walk barefoot as my feet feel better. I realize I got here too early in the morning as the tower is closed. I have 2 hours to wait for it to open. Well I decide I am not waiting. I then walk back down the strip to the old Circus Circus. I go to the main casino area and realize they have not done anything new to this place since I was last here 15 years ago. It is still quite dodgy and slummy. I check out the midway and its nothing but a old carpet and nothing is going on here. I go have a donut from Crispy Crème. I Was going to line up for the all you can eat Buffet for 10 bucks but the line up was miles long, too much for me.
It was not the best pool area to be in but it was something to do regardless.
Anyhow, onto the evening activities.
Later this evening it was time to go to the show. To see Jerry Seinfeld at Caesars Palace which was across the street. I go across and to the theatre. I have good seat in the upper level but you can see the stage quite well. The show starts, for the first half hour this one unknown comedian does a routine, he is quite funny. Then Jerry Seinfeld comes on and the crowd goes wild. His show was about an hour and half and he was very funny.
After the show I go and check out the local nightlife going on as it is Saturday night. I check out Pure at Caesars and its impossible to get into. There is a line up of a line up to get into. So I decided to pass on that. I then make my way to the Flamingo and hang out at some piano bar the rest of the evening. Quite good.


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- 67 years old
- Date of birth: Mar 3, 1939
- Date of passing: Aug 27, 2006
|Let the memory of SOPHIE NANA be with us forever
This memorial website was created in memory of our loved one, SOPHIE BOPAPE, 67, born on March 3, 1939 and passed away on August 27, 2006. We will remember her forever.
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If you weren't feeling lucky enough this weekend, Circa Waves recently dropped a reworked track with friends Pvris on St. Patrick's Day. The song, "Fire That Burns" debuted on the band's March 10 release Different Creatures, but now features Lynn Gunn's voice.
The maturation in Gunn's voice is evident from the moment she jumps into the jam. With Pvris' sophomore album awaiting on the horizon, it begs to question what fan's of the three-piece can expect this time around.
Read more: Muse, Thirty Seconds To Mars, Pvris merge for summer tour
Regardless, the track is top-notch collaboration that's a must listen. Hear it for yourself below (or above):


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Mumbai, Apr 2: IVRCL Infrastructures and Projects Limited has announced that its Buildings and Industrial Structure (B&IS) Division has bagged contracts worth Rs 484 crore from various parts of the country including Kolkata, Delhi and Jharkhand.
The Company has received a Rs 250-crore contract from Kolkata-based River Bank Developers for a project to be completed in 42 months. It has also received a Rs 114-crore contract from Delhi State Industrial and Infrastructure Development Corporation for a project to be completed in 48 months.
Besides, it has received a Rs 55-crore contract from Jharkhand based Jindal Steel and Power, and a Rs 40-crore contract from Bharat Heavy Electricals in Kolkata. Other miscellaneous cntracts add up to Rs 484 crore, the Company has told the BSE.


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Borchers Auto Services
Review for Borchers Auto Services
Charles M. on 12/16/2013
Charles said they took his vehicle in immediately at this business and fixed it. His vehicle has been running fine ever since his visit.
Vehicle: Hyundai Sonata
Category: Service
Service Date: 12/12/2013
Review Created: 12/16/2013
This review was collected via phone interview by Customer Research Inc.


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A Balancing Act for TriBeCa Zoning
By DAVID W. DUNLAP
Published: February 14, 1993
IN TriBeCa, city planners have seen the present. And they think it may work.
They are trying to reconcile zoning policy with the realities of the existing neighborhood. Also, in something of a departure, they are trying to coordinate their work with simultaneous designations by the Landmarks Preservation Commission. "I thought it was important to see if we could have zoning and historic district designation complementary," said Richard L. Schaffer, director of the City Planning Department and chairman of the City Planning Commission.
"That's a major breakthrough," said Marla G. Simpson, director of land-use planning for Borough President Ruth W. Messinger of Manhattan. "It's not that anybody has been working against that direction but I think it takes a lot of willpower on the part of agencies to bring their agendas into sync. It's really encouraging that they did that."
Not everyone is encouraged, however. "The worry at our end is that preservation is determining what planning goals should be," said Michael Slattery, a senior vice president of the Real Estate Board of New York. "They've got things upside down."
As it stands today, much of the zoning in TriBeCa seems upside down, at least in its relation to the streetscape. Where five-story structures predominate, zoning allows skyscrapers like the financially troubled 52-story Tribeca Tower apartment building at 105 Duane Street, west of Broadway. Where zoning is meant to retain manufacturers and wholesalers, these industries are drying up and departing.
TriBeCa -- the triangle below Canal Street -- was for many years home to the wholesale butter, cheese and egg markets; dealers in textiles and dry groceries; graphic-arts concerns; warehousers and manufacturers of shoes, electrical goods and machinery.
Planners once called it the "Northwest Goods Handling Area" (although the acronym NoGoHa was never coined). A 1966 plan described the area as one of "small businesses in older buildings, declining employment and an increasingly unattractive environment."
Then something happened that planners had not foreseen. The residential population exploded. Loft dwellers, artists and entrepreneurs were drawn to TriBeCa by the 19th-century scale, by little architectural gems that lined its small streets and by the mix of tranquility and grittiness in the old quarter.
On the other hand were landlords who had held, purchased or assembled properties against the plausible assumption that Wall Street firms might migrate north and city bureaucracies might shift to the west.
As the number of residents increased, so did their concern that the very qualities that attracted them to TriBeCa in the first place would be jeopardized by high-intensity development. But owners feared that preservation or rezoning would greatly limit their ability to exploit these trends, leaving them saddled with antiquated, decrepit structures.
Two years ago, the Landmarks Preservation Commission created the first of four historic districts in TriBeCa. The remaining three were designated in December. A month later, the Planning Department recommended rules to reduce density and preserve the "street wall" formed by buildings in eastern TriBeCa. For the western blocks, planners recommended an increase in density and the removal of some restrictions on residential construction and commercial development.
"What we tried to do was make zoning much more sensitive to the existing fabric of the community," Mr. Schaffer said.
The Planning Commission underscored this aim Monday, when it endorsed the new historic districts, 11 to 1. In its report to the City Council, which can modify or even deny the designations, the Planning Commission concluded that each district "will help sustain the physical and economic revitalization already under way in the area" and is "consistent with plans for the area's future development and improvement."
IF the fate of TriBeCa West is a reliable guide, the Council may remove some properties but otherwise leave the areas alone. The zoning recommendations are now being circulated for comment and are not likely to reach the Council until next year.
The chairwoman of the TriBeCa-Washington Market committee of Community Board 1, Madelyn Wils, said, "The whole idea that the Planning Commission has accepted the fact that preservation makes for good economics is a very big step for the city."
"I believe this is a precedent," she said, "to actually look at a community which is presently in the process of being landmarked and to look at zoning at the same time, and work hand in hand."
City planners noted the 34-page "TriBeCa West Historic District Manual," by the landmarks commission, New York Landmarks Conservancy and Ehrenkrantz & Eckstut Architects, and urged that similar handbooks be prepared for the other districts.
The manual describes building characteristics and materials -- sidewalks, entrances, walls, windows, fire escapes, cornices, parapets -- indicating the contribution made by each to the overall quality of the district.
Metal awnings, for example, are noted as being "significant features in the TriBeCa West district" that "should be retained."


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Hey, Legends!
Today, I respeced my rogue out of curiosity to see what exactly how 1 DEX, 1 STR, and 1 INT affect the stats of the rogue. I'm here to share my results with you guys!
Background Info
- Level 61 Rogue
- No house location buffs
- No pet buffs
- No passive buffs
- No elixir buffs
- No armor or weapon buffs
Bare minimum stats for a level 61 Rogue
As you can see, at level 61, a rogue has 360 stat points to spend. And I figured out how much each DEX, STR, and INT stat effects the rogue class. Here's a table for a summary:
x Stat Points Affect on Rogue's Stats
x is the number of stat in STR, DEX, or INT
x Points Strength Dexterity Intelligence Health 10x 3x 5x Bonus Damage 0x% 0.5x% 0x% Dodge 0x% 0.075x% 0x% Critical 0x% 0.025x% 0.015x% Damage 0x 0.0002x^2 + 0.035x 0.0275x Mana 0x 0x 10x
I've also found out that stat point DEX is equivalent to item DEX, which means that all DEX affects rogue stats in the same manner. For example:
A Leprechaun's Fire Pendant with 3 Weak Finesse Jewels gives +12 DEX so it's stats should give me the following:
and if I remove the pendant and add +12 to my DEX using stat points, I get the following:
I hope you guys enjoy my finds, and I hope this helps you in choosing how to build your rogue.


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Points of Pride
UNG is a growing regional university that has great momentum and energy. Here are just a few reasons UNG is one of Georgia's top public universities.
Stature and Value
- #16 Best public universities in the South (U.S. News & World Report, 2015)
- Third-most efficient regional university in the South based on spending and educational quality (U.S. News & World Report, 2015)
- Best public regional university in the South for the least amount of debt load (U.S. News & World Report, 2015)
- One of the top five public universities in Georgia on Money magazine's 2014 "Best Colleges" list, which measures educational quality, affordability and career outcomes.
- One of "100 Best Values in Public Colleges" (Kiplinger Personal Finance, 2014)
- Best for Vets College (Military Times, 2016)
- Military Friendly School (Victory Media, 2016)
- Safest college in Georgia (Niche.com, 2015)
- In fall 2015, across its five campuses, UNG enrolled 17,289 students, making us one of the largest public universities in Georgia.
- UNG's students are from 46 states and 56 countries.
- UNG is one of only six senior military colleges in the United States. As such, it is designated as The Military College of Georgia® and as a State Leadership Institution.
Academic Excellence
- Seven colleges and institutes offer more than 100 programs of study at the certificate, associate, bachelor's, master's, and doctoral levels.
- UNG is accredited by the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC), which demonstrates the university's commitment to the highest educational standards.
- In support of its mission to prepare students as leaders for a diverse and global society, UNG offers programs of study in 10 languages and holds a prestigious designation as an ROTC Chinese Flagship Program.
- Each year, the University of North Georgia assists outstanding students with applications for nationally competitive scholarships – elite opportunities open to all students nationwide. These extremely competitive scholarships are considered some of the most prestigious, merit-based awards in the country. Since 2012, UNG students have earned:
- One Critical Language Scholarship
- Five Boren Scholarships
- Three Fulbright Scholarships
- 22 Gilman Scholarships
- Two Jack Kent Cooke Undergraduate Transfer Scholarships
- Two NIH Undergraduate Scholarships
- Four Newman Civic Fellowships
- One Truman Scholarship (Finalist)
- One Udall Scholarship
- Seven Freeman-Asia Scholarships
- Five Chinese Government Scholarships
- UNG commissioned 76 cadets as military officers in 2014-2015, and 15 earned honors as Distinguished Military Students. For the past two years, cadets from UNG have placed in top 10 among more than 5,500 cadets nationally – at the number one spot in 2014 and number 8 in 2015.
- In 2016, UNG was designated as a National Center of Academic Excellence in Cyber Defense by the Department of Homeland Security and the National Security Agency, who jointly sponsor the National Centers of Academic Excellence program. UNG's Center for Cyber Operations Education, a collaboration of the Mike Cottrell College of Business and the Institute for Leadership and Strategic Studies, is focused on planning and supporting cyber education to produce graduates with the necessary skills to protect national security information systems, commercial networks, and critical information infrastructure in the private and public sectors.
Global Engagement
- UNG enjoys more than 30 partnerships across the globe that provide UNG students opportunities for a variety of international experiences, including study abroad, teaching, internships, volunteer work, and faculty-led study tours.
- 325 students studied abroad in 2014-2015.
- In fall 2015, UNG created a partnership with the Goethe-Institut, the premiere global German language and cultural organization, which will provide advanced courses for UNG students and expand the university's German language program. It is the Geothe-Institut's first partnership with an American university to offer language credit.
- In 2014-2015, UNG enrolled 267 international students from 56 countries.
Research and Engagement
- UNG was one of the first public universities in Georgia to earn the prestigious Community Engagement Classification from The Carnegie Foundation for the Advancement of Teaching, which promotes service-learning and community partnerships and the many ways they can enhance the educational experience.
- UNG supports robust undergraduate research opportunities through its Center for Undergraduate Research and Creative Activity (CURCA) that enable students to gain practical experience and strengthen problem-solving and critical thinking skills.
- The faculty and staff of UNG have been awarded 35 grants for a total of $2,658,791 in support of our mission as a Carnegie-classified Engaged Institution. These awards represent the work of more than 50 people at UNG and provide support in areas such as teaching world languages and providing cultural experiences and internships around the world, developing electronic textbooks to save money for students around the state, reaching out to students and teachers in local school districts to prepare them for college, providing opportunities for UNG students and faculty to participate in relevant research with their professors or on their own and providing free summer meals for economically disadvantaged children and youth.
- Students from UNG have presented at local, state, regional, and national undergraduate research conferences, including the National Conference on Undergraduate Research.
- The BB&T Center for Ethical Business Leadership has developed the Business Ethics Education program to help educate regional high school students on the importance of business ethics; more than 800 students participated in the program in 2014-2015.
- Dr. April Nelms and Dr. Sanghee Choi from the College of Education and Dr. Mark Spraker from the Department of Physics obtained a federal grant to increase elementary students' science achievement by strengthening their teachers' content knowledge and teaching skills. The grant, awarded through the federal Mathematics and Science Partnership (MSP) program, involves UNG, Hall County Schools, Lumpkin County Schools, the Dahlonega-Lumpkin Chamber of Commerce, and the Greater Hall Chamber of Commerce.
- NCAA DII National Softball Champions (2015)
- UNG competes in the elite Peach Belt Conference and has 13 NCAA teams.
- UNG Athletics Director Lindsay Reeves was selected as a NCAA DII Athletic Director of the Year (2016).


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> Dining
> Restaurants
> Franck Bistrot
Add:Ferguson Lane, 376 Wukang Rd
Tel:021-6437 6465
Time:6-11pm, dinner only
At Franck, the Menu du jour changes almost daily. Timeless classical parisian bistrot fares, generous, the bistrot cuisine's soul hasn't changed, since grand-mother's time. The Starters are to be shared, with generous portions, just like a diner at home. Guests love the casual service, helping themselves to the Terrine de campagne, cold cuts or fresh oysters.
Call us to book a table at Send us an email at Opening hours.
From ¥280
From ¥280
From ¥35


text:
Through much of the 20th century, federal policy toward Indians sought to extinguish all remnants of native life and culture. That policy was dramatically confronted in the late 1960s when a loose coalition of hippies, civil rights advocates, Black Panthers, unions, Mexican-Americans, Quakers and other Christians, celebrities, and others joined with Red Power activists to fight for Indian rights.
In Hippies, Indians and the Fight for Red Power, Sherry Smith offers the first full account of this remarkable story. Hippies were among the first non-Indians of the post-World War II generation to seek contact with Native Americans. The counterculture saw Indians as genuine holdouts against conformity, inherently spiritual, ecological, tribal, communal - the original "long hairs". Searching for authenticity while trying to achieve social and political justice for minorities, progressives of various stripes and colors were soon drawn to the Indian cause. Black Panthers took part in Pacific Northwest fish-ins. Corky Gonzales' Mexican American Crusade for Justice provided supplies and support for the Wounded Knee occupation. Actor Marlon Brando and comedian Dick Gregory spoke about the problems Native Americans faced. For their part, Indians understood they could not achieve political change without help. Non-Indians had to be educated and enlisted. Smith shows how Indians found, among this hodge-podge of dissatisfied Americans, willing recruits to their campaign for recognition of treaty rights; realization of tribal power, sovereignty, and self-determination; and protection of reservations as cultural homelands. The coalition was ephemeral but significant, leading to political reforms that strengthened Indian sovereignty.
Thoroughly researched and vividly written, this book not only illuminates this transformative historical moment but contributes greatly to our understanding about social movements.
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Earnhardt Jr. Optimistic for 2013
By: Pete Pistone - @PPistone | MRN.com on January 11, 2013 | 11:13 P.M. EST
"We can be one of those teams that are sitting there in Homestead with a shot at it. I really believe that." (Photo: Getty Images)
The Hendrick Motorsports driver feels confident about the No. 88 team's chances to be competitive in 2013 and plans to be back in the Chase to run for a championship.
Even though Earnhardt's run for a title last year was derailed by a slow performance in the playoff portion of the season and ultimately being sidelined for two races because of a concussion, he thinks there were enough positives in 2012 to build on.
"For some reason last year we were really strong in the summer time," said Earnhardt during Friday's Preseason Thunder test session at Daytona. "It was a disappointment not to finish as well as we had hoped in the Chase and really go for the championship. We felt like we were a strong enough team at certain parts of the year to definitely do that. We definitely have some unfinished business."
After being forced out of his ride to recover from the concussion suffered in October at Talladega, Earnhardt was glad to have a chance to finish out last season behind the wheel.
"It was good to get in the car at the end of the year and be able to run a couple of races and get that out of the way, get any kind of doubts or questions that you personally had about yourself or your recovery out of the way," Earnhardt said.
"I felt like all that went really good the last several weeks. … I feel really good down here. The off time has been great, but I feel good, ready to go. I'm glad I did it the way I did. It gave me a good opportunity to get better faster and come back right and come back sharp."
So forget dwelling on any of the negatives that took place during the campaign. Earnhardt is solely focused on what lies ahead.
"I really don't look back that much," Earnhardt. "I only look back on the positives when I think about last year.
"To find motivation and excitement, I look back on how well we performed throughout the year."
He's made the Chase the last two seasons with crew chief Steve Letarte calling the shots. Although he hasn't been able to mount a championship charge, Earnhardt is still confident the window of opportunity to finally win a Sprint Cup crown has not closed.
"We have an opportunity," Earnhardt said. "Our time is now. We have a chance if we can just find some more pieces and keep improving. We have steadily gotten better over the last couple of years.
"We can be one of those teams that are sitting there in Homestead with a shot at it. I really believe that."
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September 7th, 2004, 10:26 PM #1
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