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There are many heath reasons to give kale recipes a try
In nutrition circles, kale is being called the �Queen of Greens� and the �New Beef,� due to its versatile nutritional benefits.
Kale is low in calories, high in fiber and has zero fat. It is high in iron and calcium, and in Vitamins A, C and K.
It aids in digestion and elimination, supports the oxygenation of body parts for cell growth and liver function, protects against cancers and offers antioxidants and anti-inflammatory agents, lowers cholesterol, supports cardiovascular health, and maintains cartilage and joint flexibility.
There are many reasons to give these recipes a try. Fresh kale is available at the Lenoir County Farmer�s Market.
Grits and Greens Casserole
4 slices bacon, chopped (optional)
2 teaspoons extra-virgin olive oil
1 small onion, diced
4 cloves garlic, minced
2 cups reduced-sodium chicken broth or vegetable broth, divided
1/4 teaspoon salt
16 cups chopped collard greens or kale, stems removed (about 1 large bunch or 2 pounds)
2 cups water, plus more as needed
1 cup grits (not instant)
3/4 cup shredded extra-sharp Cheddar cheese, divided
1/4 cup prepared salsa
1 large egg, lightly beaten
Preheat oven to 400F. Coat an 8-inch-square baking dish with cooking spray.
Place bacon in a large Dutch oven. Cook over medium heat, stirring often, until crispy, 4 to 6 minutes. Remove with a slotted spoon to a paper towel-lined plate to drain. Pour off the bacon fat.
Return the pot to medium-low heat; add oil, onion and garlic and cook, stirring often, until fragrant and starting to brown in spots, 2 to 8 minutes (cooking time will be quicker if you started with bacon).
Add 1 cup broth and salt; bring to a boil over high heat. Add greens; stir until wilted down to about one-third the volume and bright green, 1 to 2 minutes. Cover, reduce heat to medium-low and simmer, stirring occasionally, until tender, 18 to 20 minutes. Adjust heat during cooking to maintain a simmer, and add water, 1/4 cup at a time, if the pan seems dry.
Meanwhile, bring 2 cups water and the remaining 1 cup broth to a boil in a large saucepan. Pour in grits in a steady stream, whisking constantly. Bring to a simmer, whisking constantly. Reduce heat to medium-low and cook, whisking often, until thick, about 5 minutes. Combine 1/2 cup cheese, salsa and egg in a small bowl. Remove the grits from the heat and quickly stir in the cheese mixture until combined.
Working quickly, spread about half the grits in the prepared baking dish. Top with greens, spreading evenly. Spread the remaining grits over the greens. Sprinkle with the remaining 1/4 cup cheese and the reserved bacon.
Bake the casserole until hot and bubbling, about 20 minutes. Let stand for about 10 minutes before serving.
Whole Grain Spaghetti with Kale and Tomatoes
6 ounces whole-grain spaghetti (spaghetti squash is healthy option)
2 tablespoons olive oil
1 medium red onion, thinly sliced
2 cloves garlic, chopped
Kosher salt and black pepper
1 bunch kale, thick stems removed and leaves torn into bite-size pieces (about 8 cups)
2 pints grape tomatoes, halved
1/3 cup chopped roasted almonds
1/4 cup shredded Parmesan Cheese (1 ounce), plus more for serving
Cook the pasta according to the package directions. Reserve 1/4 cup of the cooking water, drain the pasta, and return it to the pot.
Meanwhile, heat the oil in a large skillet over medium-high heat. Add the onion, garlic, 1/4 teaspoon salt, and 1/8 teaspoon pepper. Cook, stirring occasionally, until beginning to brown, 4 to 5 minutes. Add the kale and cook, tossing frequently, until tender, 2 to 3 minutes. Add the tomatoes and cook, tossing frequently, until the tomatoes begin to soften, 1 to 2 minutes more.
Add the kale mixture, almonds, Parmesan cheese and reserved cooking water to the pasta and toss to combine. Serve with additional Parmesan cheese.
Kale and Two-Bean Soup
3 tablespoons olive oil
1 cup chopped onion
1/2 cup chopped carrot
1/2 cup chopped celery
1/2 teaspoon salt, divided
2 garlic cloves, minced
4 cups organic vegetable broth (such as Emeril�s), divided
7 cups stemmed, chopped kale (about 1 bunch)
2 15-ounce cans no-salt-added cannellini beans, rinsed, drained, divided
1 15-ounce can no-salt-added black beans, rinsed and drained
1/2 teaspoon freshly ground black pepper
1 tablespoon red wine vinegar
1 teaspoon chopped fresh rosemary
Heat a large Dutch oven over medium-high heat. Add olive oil to pan; swirl to coat. Add onion, carrot and celery, and saut� 6 minutes or until tender. Stir in 1/4 teaspoon salt and garlic; cook 1 minute. Stir in 3 cups vegetable broth and kale. Bring to a boil; cover, reduce heat, and simmer 3 minutes or until kale is crisp-tender.
Place half of cannellini beans and remaining 1 cup vegetable broth in a blender or food processor; process until smooth. Add pureed bean mixture, remaining cannellini beans, black beans, and pepper to soup. Bring to a boil; reduce heat, and simmer 5 minutes. Stir in remaining 1/4 teaspoon salt, vinegar and rosemary.
Stuffed Roasted Red Peppers
3 medium red bell peppers
1 tablespoon extra-virgin olive oil
1/4 teaspoon salt
Freshly ground pepper, to taste
8 ounces kale, (6 cups lightly packed), trimmed
1 tablespoon extra-virgin olive oil
1 medium onion, chopped
1/2 cup chopped red bell pepper
2 cloves garlic, minced
3/4 cup cooked short-grain brown rice
1/2 cup freshly grated Parmesan cheese
1/4 cup toasted pine nuts, divided
1 tablespoon lemon juice
1/4 teaspoon salt
Freshly ground pepper, to taste
To prepare peppers: Preheat oven to 400F. Halve peppers lengthwise through the stems, leaving them attached. Remove the seeds. Lightly brush the peppers outside and inside with oil; sprinkle the insides with salt and pepper. Place, cut-side down, in a 9- by 13-inch baking dish. Bake until peppers are just tender, 10 to 15 minutes. Let cool slightly. Turn cut-side up.
To prepare filling: Bring 2 cups salted water to a boil in a large wide pan. Stir in kale, cover and cook until tender, 10 to 12 minutes. Drain, rinse under cold water; squeeze dry. Finely chop.
Heat oil in a large nonstick skillet over medium heat. Add onion and chopped bell pepper; cook, stirring often, until onion is golden, 6 to 8 minutes. Add garlic and cook, stirring, for 30 seconds. Stir in the kale. Remove from the heat and let cool slightly. Stir in rice, Parmesan, 2 tablespoons pine nuts and lemon juice. Season with salt and pepper. Divide the filling among the pepper halves. Sprinkle with the remaining 2 tablespoons pine nuts.
Add 2 tablespoons water to the baking dish. Cover the peppers with foil and bake until heated through, 15 to 20 minutes. Uncover and bake for 5 minutes more. Serve hot.
Tammy Kelly is director, Lenoir County Cooperative Extension Center, 1791 N.C. 11/55, Kinston, NC 28504. Reach her at 252-527-2191 or firstname.lastname@example.com.


text:
a very unexpected, heartbreaking development has happened in my life. please forgive me while i take some time to myself to cope.
Wednesday, November 28, 2012
and just like that
a very unexpected, heartbreaking development has happened in my life. please forgive me while i take some time to myself to cope.
64 comments:
Hope you are okay. Take all the time you need -- no need to apologize! As silly as it sounds, I'm sending you a virtual hug right now.ReplyDelete
No need to apologize dear Sending love your way.ReplyDelete
oh dear, i'm so sorry alaina. best wishes to you and yours.ReplyDelete
- AnonymousNovember 28, 2012 at 6:27 AM
Do what you need and remember how much you are loved.ReplyDelete
Sorry you're going through a hard time. Hugs all the way.ReplyDelete
So sorry to hear, prayers being sent your way.ReplyDelete
Oh no...sending healing thoughts your way Alaina.ReplyDelete
Thinking of you, A. xoxoReplyDelete
Alaina I'm so sorry. Sending thoughts and prayers your way.ReplyDelete
Very Sorry to read this. Thinking of you xReplyDelete
So sorry to read this. Thinking of you.ReplyDelete
I'll pray for you throughout this trying time.ReplyDelete
Your in my thoughts and prayers. Hang in there!ReplyDelete
So sorry to hear Alaina. xReplyDelete
Hi Alaina, I don't usually comment, but I wanted to let you know the blog world is sending you positive vibes. Hope everything will get better soon.ReplyDelete
oh no, XOXOX! HOpe to see you soon, so I can give you a HUG!!! Xo-TReplyDelete
Lots of love and prayers for you friend! Hope everything is ok. xoReplyDelete
Sending lots of hugs and prayers your way, Alaina.ReplyDelete
I never comment either, but had to reiterate what everyone else is saying. You have a huge support network (many of us you didn't even know about!!) praying for you and sending happy thoughts your way during this difficult time.ReplyDelete
Hang in there. You WILL come out on the other side.
So sorry to hear this. Thinking of you.ReplyDelete
So sorry to read this, sending lots of love your way!ReplyDelete
I love you more than words can say and even though you know this please never forget that I am here for you. WE will get through this. Take all the time you need. I'm here for you.ReplyDelete
Love you.
Oh Alaina, so sorry to hear this, we all are sending you positive vibes, you'll get through it.ReplyDelete
Take all the time you need, we'll all still be here :) Thinking of you!ReplyDelete
Sending warm thoughts and a big hug your way!ReplyDelete
Take your time and know you have lots of people (including me!) thinking of & praying for you!ReplyDelete
- AnonymousNovember 28, 2012 at 11:24 AM
praying for you and sending good vibes your way. hope everything will be okay.ReplyDelete
sending love and prayers to you. xoxoReplyDelete
So sorry to hear, virtual hugs to you.ReplyDelete
Oh Alaina, I'm so sorry to read this! I'm sending all the positive energy I can muster your way! Keep your strength through these hard times!ReplyDelete
xx Ivana
Macarons and Pearls
- AnonymousNovember 28, 2012 at 12:19 PM
Very sorry to read that you are in crisis. I have been reading your blog for years and hope things improve for you. Take all the time you need for yourself and those that need you, Alaina.ReplyDelete
Sending lots of love your way and keeping you in my prayers.ReplyDelete
Oh no! Thoughts are with you.ReplyDelete
Hang in there. Hugs.ReplyDelete
Every day reader, rare commenter, just echoing everyone else's sentiments. Sending you positive thoughts and support in this difficult time.ReplyDelete
I know I'm just repeating whate everyone else already said but I just wanted to add my good thoughts as well- Sending hugs from Boston!ReplyDelete
Alaina, I'm so, so sorry to hear about your tragedy. You're in my prayers.ReplyDelete
Keeping you in my thoughts + prayers!ReplyDelete
So sorry to hear this. Keeping you in my thoughts and prayers! xxReplyDelete
Just another faithful reader sending thoughts your way. Hang in there.ReplyDelete
This comment has been removed by the author.ReplyDelete
I usually scroll through posts quickly looking specifically for yours (and a few other favorites). I was really sad to hear of this. My life also changed unexpectedly and in a very tragic way earlier this year. My world turned upside down. Be strong, and take comfort with family and friends. HugsReplyDelete
Sending lots of love and prayers your way, Alaina! xx, MollyReplyDelete
This little guy is sending you one very bug hug and a dose of British love from across the pond. Hang in there, friend. We'll all be here for you whenever you're ready. xoReplyDelete
So sorry to hear, Alaina. Please know that you are so cared for, by many people. Take all the time you need, and know that your readers will be here for you always. Sending positive thoughts your way. xoReplyDelete
I'll be keeping you in my thoughts and prayers.ReplyDelete
So sorry to hear that your live has been touched by tragedy. As many others have said, you are in my thoughts and prayers. xoxoReplyDelete
My heart goes out to you. Stay strong.ReplyDelete
- AnonymousNovember 28, 2012 at 9:42 PM
thoughts are with youReplyDelete
Dear Alaina,ReplyDelete
Your readers are here for you. You are in our thoughts and prayers.
Praying for you & sending love.ReplyDelete
Praying for you <3ReplyDelete
So sorry, best whises!ReplyDelete
Hope you're OK. Adding my virtual hug to all the others! :)ReplyDelete
Glad you told us readers so we can send positive energy and love your wayReplyDelete
Take good care of yourself during this difficult time
so sorry to hear that. You are in my thoughts and prayersReplyDelete
Sending positive thoughts your way!ReplyDelete
Sending good vibes your way.ReplyDelete
- AnonymousDecember 1, 2012 at 11:01 PM
So sorry to hear that. Sending positive thoughts your way oxox-L. SchwartzReplyDelete
Thinking of you, Alaina! xoReplyDelete
- AnonymousDecember 4, 2012 at 12:03 PM
I'm praying for you. Take care of yourself.ReplyDelete
thinking of you..ReplyDelete
just saw this dear Alaina, sending you lots of love xxxReplyDelete

subset: commoncrawl


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SA Journal of Radiology
versão On-line ISSN 2078-6778
versão impressa ISSN 1027-202X
S. Afr. J. radiol. (Online) vol.19 no.1 Johannesburg 2015
Pre-interventional assessment and calcification score of the aortic valve and annulus, with multi-detector CT, in transcatheter aortic valve implantation (TAVI) using the Medtronic CoreValve
Antoinette ReindersI; Coert S. de VriesI; G. JoubertII
IDepartment of Clinical Imaging Sciences, University of the Free State, South Africa
IIDepartment of Biostatistics, University of the Free State, South Africa
BACKGROUND: Transcatheter aortic valve implantation (TAVI) provides an acceptable alternative for aortic valve replacement in the elderly, but needs accurate pre-procedural imaging to optimise intervention.
OBJECTIVES: To evaluate an alternative manual aortic valve calcification scoring system with computed tomography, for patients undergoing TAVI. We hypothesise a correlation between the Free State aortic valve calcium computed tomography score (FACTS) scoring system, valve plaque density and procedure-related complications.
METHODS: Twenty patients suitable for TAVI were selected according to standard international guidelines and received multimodality imaging prior to intervention. Images were reviewed by two reviewers who were blinded to each other's scores. Where large inter-individual score variations existed, retraining was done and scores repeated, using a double-blinded method. Matched scores were included in the final analysis. Rosenhek calcification scores were used as a standard of reference.
RESULTS: The study comprised 9 (45%) men and 11 (55%) women, with a median age of 83.5 years. Median EuroSCORE was 15.5. FACTS scores ≥6 were associated with the presence of a paravalvular leak (p = 0.01). Procedure-related complications (left bundle branch block, repositioning of the valve and anaemia) were seen in patients with plaques measuring ≥1000 HU (p = 0.07
CONCLUSION: The FACTS score and averaged valve plaque HU showed potential for predicting a paravalvular leak and procedure-related complications, and could be valuable in the future for optimising patient selection for TAVI.
Aortic stenosis is a global major debilitating health concern that is associated with high mortality and morbidity in the elderly population. Until recently, the only treatment for such patients was surgical aortic valve replacement, showing reasonable peri-operative results, but excluding a large number of symptomatic patients owing to unacceptably high peri-operative risk as indicated by a European Society of Cardiology score >20% (EuroSCORE) or Society of Thoracic Surgeons (STS) score >10.1
In the above pre-interventional scoring systems, patients are allocated specific numerical values according to comorbid conditions such as hypertension, hypercholesterolaemia and chronic obstructive pulmonary disease. Since the early 1990s, alternative routes for aortic valve replacement have been sought. 1,2,3 Transcatheter aortic valve replacement (TAVI) has emerged as a suitable and clinically better-tolerated alternative to surgical aortic valve replacement in selected patients.1 Results from the PARTNER trial (cohort B) showed an absolute reduction in one-year mortality of 20% with marked and durable improvement in functional status and reduced hospitalisation in patients who had undergone TAVI, compared with those who had been treated medically.1
Because TAVI is carried out in selected high-risk patients, pre-interventional assessment of the cardiac and aorta iliac anatomy is of the utmost importance.4 Trials have shown multi-detector computed tomography (MDCT) emerging as a valid alternative, and is in some institutions preferred to catheter angiography in assessing the aorta and ilio-femoral circulation prior to valve deployment. This trend is of particular importance in planning a percutaneous entry site as well as artificial valve sizing. MDCT is often also used as an adjunct to trans-oesophageal echocardiography in assessing the aortic annulus and valve cusps.4,5 This fast-growing approach has intertwined the interventional cardiologist's and radiologist's expertise, as well as heralded the start of a dedicated 'heart team' for adequate assessment of the suitability of a patient prior to TAVI.
Several MDCT acquisition protocols, including dual energy virtual non-contrast (DEVNC),6 have been suggested and reviewed in quantifying the aortic valve and annulus prior to percutaneous intervention with TAVI. Some authors advocate the Agatston7,8 calcium scoring method, whilst others rely on a 'gestalt' or manual scoring system based on the Rosenhek diagrammatic calcium score9 in an attempt to predict post-procedural outcomes in these high-risk patients. Heinsig8 alluded to the fact that patients with a high Agatston aortic valve calcification burden were more prone to paravalvular leaks (PVL) as well as a subsequent increase in hospital morbidity and one-year mortality post TAVI. He demonstrated this within a study population of 120 patients.7, 8 Although the Agatston aortic valve calcium score (AVCS) and its ability to predict the probability of a post-procedural paravalvular leak have been extensively written about in larger study groups,7,8,9 it has fallen out of favour at some institutions owing to its labour-intensive and time-consuming reconstructions. Manual scoring systems, on the other hand, have failed to accurately predict complications in patients undergoing TAVI as they do not take into consideration the density of the calcified plaque.
The aim of the present study was to describe our local experience with MDCT in evaluating patients with clinically significant aortic stenosis, in preparation for TAVI, specifically proposing an alternative manual system for grading the calcification of the aortic valves annulus as well as the cusps, denoting calcification burden and density with single-source MDCT. We aimed to hypothesise a link between the Free State aortic valve calcium CT score (FACTS) and valve plaque averaged Hounsfield units (AHU), with patient/procedure-related complications. We regarded complications such as paravalvular leak, stroke, death and myocardial infarction as major complications, and complications such as anaemia, left bundle branch block, and repositioning of the valve post/during the procedure as minor complications.
Research method and design
Materials and setting
A total of 20 patients from July 2011 - January 2013 were included. Consent was obtained from the hospital superintendent, prospective patients and the Faculty of Health Sciences Ethics Committee, University of the Free State, prior to the study (ECUFS no. 148/2012). Patients were evaluated by the Department of Cardiology, University of the Free State, and found eligible for TAVI. All fulfilled the criteria for clinically significant aortic stenosis, as determined by standardised inclusion criteria.10 No additional cardiac rhythm stabilising drugs were added to the patients' usual drug regime. Renal function was confirmed to be fit for intravenous contrast administration (Omnipaque 350, GE Healthcare Ireland, Cork, Ireland) prior to imaging. Exclusion criteria for imaging were severely impaired renal function <40 ml/min/1.73 m2 or previous severe adverse reaction to iodinated contrast material, such as anaphalactoid reaction, severe bronchospasm and cardiorespiratory collapse.11 Patients were evaluated by cardiac echocardiography (trans-oesophageal echocardiography (TEE) and trans-thoracic echo (TTE)) prior to and after TAVI at the cardiology interventional suite by dedicated echocardiographers using the Sellers technique as a guideline; see Table 1.
This was a pro- and retrospective, double-blinded, cohort analytical study.
Examinations were done on a single source, dual energy, high definition 64-detector CT scanner (HD750 Discovery, General Electric, Milwaukee). Patients were scanned using one of two standardised CT protocols, dependent on body weight (≥70 kg, 120 kV, 160 ml 350 Omnipaque; and ≤70 kg 100 kV 160 ml 350 Omnipaque), with ECG-prospectively gated, single-source energy scan of the chest, including gated cardiac CT and ungated single-source CTA of the abdomen and pelvis. Scan parameters were set with acquisition thickness of 0.625 mm, small field of view of 25 cm, a pitch of 0.16:1 and gantry rotation speed of 0.25 sec. - 0.35 sec., with kV and mAs dependent on body habitus. Scans were done in a craniocaudal direction on 75% of the RR interval. Automated bolus injection was implemented with the region of interest placed over the ascending aorta with scanning of the chest commencing at an attenuation value of 120 HU. Contrast was administered via an automated pump at 5 ml/sec., with a 40 ml saline bolus 'chaser' given after contrast injection.
Imaging analysis
Images were reviewed weekly by a qualified radiologist and a training fellow at the University of the Free State, Universitas Hospital Complex. Post processing of images took place on an Advantage Workstation 4.5 (General Electric) and analyses were performed using standard software (Reformat, General Electric). Data were loaded into a standard multiplanar reformat package, with image reconstructions in the coronal, sagittal and axial orientation and analysed using a multiplanar oblique tool. The coronal image was used to visualise the left ventricular outflow tract, with placement of the oblique tool in the middle of the ascending aorta, producing a sagittal oblique view. Placement of the oblique tool was in the centre axis of the ascending aorta, producing true axial images in the aortic leaflets and annulus planes, on which the calcification scoring was done. The aortic annulus and valve leaflets calcification burden was scored using a bone window level (WW2000 WL350).
Two views were used with the FACTS scoring of the aortic valve. The first view visualised the entire aortic annulus on the modified true axial views as done by using the multiplanar oblique tool. Outer ring scoring was done on this initial view. The second view visualised the distal ends of the leaflets as they converged; inner ring scoring was done on this view. The aortic annulus was divided into quarters on the first view and scored. One point was given for every calcification/plaque seen on the individual regions as described. The total score added to 16, where each valve had 4 possible sections as well as the annulus, which was also divided into 4 sections (Figure 1).
FACTS, Rosenhek and HU Score
FACTS scores were done individually and each observer blinded to the other's score. These scores were correlated to the Rosenhek diagrammatic calcium valve scoring system (Figure 2). The diagrammatic Rosenhek scoring system is shown in Figure 3.
Patients for whom the observers' FACTS scores showed a difference >15%/2 points were rescored, after retraining, by the same two observers and included in the final data set for statistical analysis. An agreement score was seen as a difference of up to 10%-15%/2 points between observers. Complications were associated with scores where the two observers were in agreement after the final scoring. Eighteen patients' FACTS scores and 16 patients' Rosenhek scores matched in the final analysis.
HUs were done separately to the FACTS scores and calculated on each aortic valve cusp. The largest calcified plaque density was taken on each valve cusp and summed. This figure was divided by a factor of 3 for an average score and grouped to either ≥1000 HU or <1000 HU as agreed upon between the observers, taking an HU ≥1000 as denoting calcified bone on routine CT. Correlations between the two observers' AHU scores were measured and 18 scores matched according to category.
All data (original and rescored) were captured and typed into a Microsoft Excel spreadsheet for statistical analysis. Age, race, sex, comorbid factors, grades of dyspnoea, left ventricular outflow fraction (prior and after the procedure) and presence of aortic regurgitation, complications and the presence of a pacemaker prior to and after procedures were included. Complications considered as major were stroke, myocardial infarction, death, paravalvular leak and 'other'. 'Other' included minor complications such as repositioning of the valve, anaemia post procedure and left bundle branch block. Patients' were followed up at 30, 90 and 180 days. No patients died during the follow-up period.
A total of 20 patients (9 men [45%] and 11 women [55%]), who happened to all be white, were enrolled in the study. Only 18 patients' FACTS scores were used in the final analysis. Patient demographics are shown in Table 2.
New York Heart association (NYHA) criteria were recorded prior to and following the procedure, with 35% of patients being NYHA 2, 50% NYHA 3, and 15% NYHA 4 prior to the procedure and showed marginal improvement post TAVI (NYHA 1 (10%), NYHA 2 (70%), and NYHA 3 (20%), but this was not statistically significant (p = 0.41). The median age of the patients was 83.5 years (range 68-95 years), with a EuroSCORE median of 15.5 (range: 5-22).
Sixteen (80%) of the 20 patients had a grade 1 aortic incompetence prior to TAVI, and 17 (85%) had paravalvular leak (PVL) post TAVI, of whom 10 patients had grade 1 PVL, 5 patients had grade 2 PVL, and 1 patient had grade 3 PVL. FACTS scores ≥6 were significantly associated with the presence of a paravalvular leak (p = 0.01) post TAVI. Grade 1 PVL = mild PVL, Grade 2 PVL = moderate PVL, and Grade 3 PVL = severe PVL. The FACTS scores were similar to the Rosenhek score in this regard, and both major and 'other' complications were seen to arise at a Rosenhek score >2, but were not statistically significant (p = 1.00; 'other' complications p = 0.09). No patient suffered from a myocardial infarction or death during or immediately after the procedure (see Figure 2). Nine patients fell into the 'other' complication category. The totals of complications were similar in both Rosenhek score groups, with both groups having close to the same number of complications in the 'other' category.
The median left ventricular ejection fraction (LVEF) was 56.5% (range 27%-77%) and marginally increased to 61.5% (range 29%-75%) at follow-up. Comorbid conditions (see Figure 4) prior to TAVI were recorded and were as follows: hypertension − 80%, diabetes − 15%, renal impairment − 10%), ischaemic heart disease − 35%), hypercholesterolaemia − 24%, chronic lung disease − 65%, peripheral vascular disease − 65%, and congestive cardiac failure − 5%.
Four patients received pacemakers; 1 was inserted prior to TAVI and 3 post TAVI. Left bundle branch block is a known complication of the TAVI procedure. All of our patients had degenerative aortic stenosis. An AHU ≥1000 was associated with 'other complications' amongst which left bundle branch block, anaemia post procedure and repositioning of the valve were seen; this was close to being statistically significant (p = 0.07). A graph of AHU v. complications is shown in Figure 5. AHUs ranged from 795 to 1336.
Only one female patient had a transient ischaemic event, which resolved in 24 hours. She had high FACTS and AHU scores (FACTS = 9 and AHU ≥1000). Male patients also had a higher incidence and grade of PVL than female patients, which we associated with a plaque density ≥1000 HU. One patient had a grade 3 PVL that was the result of initial incorrect positioning of the artificial valve, with a grade 1 PVL after repositioning of the Medtronic valve.
Plaques ≥1000 HU were associated with comorbidities; diabetes was found to be the main comorbid factor in plaque density differences, as seen in Figure 6.
No adverse events were recorded either during or after image acquisition. All TAVI procedures were performed after multidisciplinary discussion, using a transfemoral approach by a dedicated cardiac team, using the self-expandable Medtronic CoreValve.
Statistical analysis
Results were summarised by frequencies and percentages (categorical variables) and means or percentiles (numerical variables, depending on the distribution of the data). Groups were compared using chi-squared, Fisher's exact test or McNemar's test for categorical variables, the Kruskal-Wallis test, or Mann-Whitney test for numerical variables.
Ethical considerations
Benefits and hazards: If an association between plaque burden and density could be drawn to FACTS score ≥6 and HU ≥1000, pre-procedural evaluation could be streamlined and post-procedural complications be anticipated and timeously treated.
Recruitment procedures: Patients undergoing pre-interventional imaging were asked to take part in the study. Prospective and retrospective data capturing was done. No monetary compensation was offered to patients for taking part in the study. There was no discrimination against patients who declined participation.
Informed consent: Each patient received an information document, explaining the goal of the study and the imaging procedure involved. Patients were asked to sign this document prior to imaging, if they agreed to participate in the study.
Data protection: Patients' data were captured onto a standardised Excel sheet and numbers allocated to each patient. Only the first observer/researcher had access to patients' names. Confidentiality was maintained in all circumstances.
All TAVI procedures were performed by a dedicated cardiology team with the same two operators, with the standard use of a transfemoral approach. All patients' aortic valves were reviewed, and calcified valve plaques scored by the same two radiology reviewers on the same GE workstation, using a standard double-blinded method.
TAVI is an established percutaneous method for the treatment of critical aortic stenosis1,2,3,4,5,6,7,8,9,10,11,12 in high-risk patients and is relatively new in the South African context.12 The Agatston calcification scoring system5,7,8,10 for aortic valve calcification has been proposed in the past as well as manual valve plaque calcification scoring systems9 with and without the use of computer software, linking complications such as paravalvular leak and long-term patient survival to these scores13,14,15 and proposing better patient selection prior to intervention.
We aimed to introduce an alternative manual scoring system that was easy to implement, took plaque density into account, was not time consuming, and at the same time could predict clinically significant adverse patient outcomes. In our small study sample, we found that a FACTS score ≥6 was significantly associated with the presence of a paravalvular leak. Literature has shown that paravalvular leak post TAVI is an independent risk factor for longer hospital stay as well as an increased mortality risk factor at one-year follow-up.7 Procedure-related complication was close to statistically significantly associated with average valve plaque densities ≥1000 HU. Unfortunately, we were not able to differentiate between grades of paravalvular leak in our study, which could be attributed to our attempt to introduce a new manual scoring system and/or that our study population was small. Nevertheless, all the artificial valves were inserted by the same dedicated cardiology team, so the fact that an association between AHU score and complications such as anaemia, left bundle branch block and repositioning of the artificial valve could be shown is, we feel, some achievement.
We used the Rosenhek score as a reference standard, although in hindsight the two scoring systems are inherently different in that the FACTS and AHU scores offer quantification as well as qualification of the calcified plaques versus the first-mentioned score that only relies on a 'gestalt' or quantification of the calcification burden of the aortic valves, excluding the aortic annulus. Our score included the aortic annulus which, we postulate, could play a role in the pathology of paravalvular leaks post TAVI in our population. A possible reason for this could be the limited pliability of the aortic annulus with bulky calcified plaque. The Rosenhek score could also not differentiate between specific complications (e.g. stroke v. PVL) in our small study population but was, however, associated with no complications if the score was <2, when compared with the FACTS score; and, interestingly, the Rosenhek scores were seen to match in 80% of cases between the two observers, in the final statistical analysis. The LVEF and NYHA only marginally improved after TAVI procedure and were found to be statistically unrelated to either the FACTS or AHU scores. Pacemaker insertion could also be linked to high AHU scores, although this was not statistically significant and is a known complication of the Medtronic CoreValve.13
In our study population, complications were minimal, which could be due to the small study size or because the TAVIs were done meticulously by a qualified cardiac team. Moderate inter-individual variations were seen with the FACTS scores initially but, after retraining, the differences were markedly less. One explanation for the variation could be the relative inexperience of both observers with a new scoring system or because of the lack of experience in calcification scoring. Only two observers scored in this article. Maybe a larger number of observers could have improved the results. The FACTS and AHU scores were looked at individually and could have been incorporated into a single scoring system.
We recommend the incorporation of the AHU with the FACTS score in future for a uniform score, giving a specific numeral value to a specific HU density as well as a larger sample size. Individual scoring of the annulus versus the cusp calcification could also be considered for future studies.
The FACTS and AHU scores are easy to implement, not labour intensive or time consuming, and show promise in providing important added information for patients undergoing pre-interventional assessment for the TAVI procedure, especially in determining the risk of paravalvular leak, left bundle branch block, repositioning of the artificial aortic valve and anaemia. A larger study sample is necessary to confirm these preliminary findings.
The authors thank Dr W. Harmse, diagnostic radiologist and current fellow in Interventional Radiology, Alberta Health Services, Foothills Medical Centre; Professor S. Brown, Department of Paediatric Cardiology, University of the Free State; Professor H. Theron, Head of Department Cardiology, Universitas Academic Hospital, University of the Free State; and Mrs C. Swanepoel, Chief Radiographer Computed Tomography, Department of Clinical Imaging Sciences, University of the Free State, for their invaluable contribution to the completion and publication of the study.
Competing interests
The authors declare that they have no financial or personal relationships which may have inappropriately influenced them in writing this article.
Authors' contributions
A.R. (University of the Free State) protocol and study design, first blinded observer, writing and planning of the article draft and final version, main corresponding author. C.S.d.V. (University of the Free State) second blinded observer, study coordinator, protocol and final article draft reviewer. Professor G.J. (University of the Free State) is thanked for reviewing the statistics and protocols and for her invaluable input in the final draft of this article.
1. Webb J, Rodes-Cabau J, Fremes S, et al. Transcatheter aortic valve implantation: A Canadian Cardiovascular Society position statement. Can J Cardiol. 2012;28: 520-528. http://dx.doi.org/10.1016/j.cjca.2012.04.015 [ Links ]
2. Anderson HR, Knudsen LL, Hasenkam JM. Transluminal implantation of artificial heart valves: Description of new expandable aortic valve and initial results with implantation by catheter technique in closed chest pigs. Eur Heart J. 1992;13: 704-708. [ Links ]
3. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis. Circulation. 2002;106: 3006-3008.http://dx.doi.org/10.1161/01.CIR.0000047200.36165.B8 [ Links ]
4. Tamborini G, Fusini L, Gripari P, et al. Feasibility and accuracy of 3DTEE versus CT for the evaluation of aorticvalve annulus to left main ostium distance before transcatheter aortic valve implantation. JACC Cardiovasc Imaging. 2012;5: 579-588. http://dx.doi.org/10.1016/j.jcmg.2012.02.012 [ Links ]
5. Rixe J, Schuhbaeck A, Liebetrau C, et al. Multi-detector computed tomography is equivalent to trans-oesophagal echocardiography for the assessment of the aortic annulus before transcatheter aortic valve implantation. Eur Radiol. 2012;22: 2662-2669. http://dx.doi.org/10.1007/s00330-012-2530-2 [ Links ]
6. Mahoney R, Pavitt CW, Gordon D, et al. Clinical validation of dual-source dual-energy computed tomography for coronary and valve imaging in patients undergoing trans-catheter aortic valve implantation. Clin Radiol. 2014;69: 786-794. http://dx.doi.org/10.1016/j.crad.2014.03.010 [ Links ]
7. Haensig M, Lehmkuhl L, Rastan AJ, et al. Aortic valve calcium scoring is a predictor of significant paravalvular aortic insufficiency in transapical-aortic valve implantation. Eur J Cardiothorac Surg. 2012;41:1234-1241.http://dx.doi.org/10.1093/ejcts/ezr244 [ Links ]
8. Haensig M, Rastan JA. Aortic valve calcium load before TAVI: Is it important? Ann Cardiothorac Surg. 2012;1:160-164. http://dx.doi.org/10.3978/j.issn.2225-319X.2012.06.02 [ Links ]
9. Willman JK, Weishaupt D, Lachat M, et al. Electrocardiographically gated multi-detector row CT for asessment of valvular morphology and calcification in aortic stenosis. Radiology. 2002;225:120-128.http://dx.doi.org/10.1148/radiol.2251011703 [ Links ]
10. Leipsic J, Gurvitch R, LaBounty TM, et al. Multidetector computed tomography in transcatheter aortic valve implanation. JACC. 2011;4:416-419. http://dx.doi.org/10.1016/j.jcmg.2011.01.014 [ Links ]
11. Blanke P, Euringer W, Baumann T, et al. Combined assessment of aortic root anatomy and aortoiliac vasculature with dual-source CT as a screening tool in patients evaluated for transcatheter aortic valve replacement. Am J Roentgenol. 2010;195:872-881. http://dx.doi.org/10.2214/AJR.10.4232 [ Links ]
12. Weich H, Mabin T, Van Wyk J, et al. First experience with the Edward SAPIEN transcatheter aortic valve implantation (TAVI). Data from the Western Cape, South Africa. SA Heart J. 2012;9:6-13. [ Links ]
13. Leber AW, Kasel M, Ischinger T, et al. Aortic valve calcium score as a predictor for outcome after TAVI using the Corevalve revalving system. Int J Cardiol. 2011;166:652-657. http://dx.doi.org/10.1016/j.ijcard.2011.11.09 [ Links ]
14. Feuchtner GM, Muller S, Grander W, et al. Aortic valve calcification as quantified with multislice computed tomography predicts short-term clinical outcome in patients with asymptomatic aortic stenosis. J Heart Valve Dis. 2006;15:494-498. [ Links ]
15. Delgado V, Ng ACT, van de Veire N, et al. Transcatheter aortic valve implantation: Role of multidetector row computed tomography to evaluate prosthesis positioning and deployment in relation to valve function. Eur Heart J. 2010;31:1114-1123. http://dx.doi.org/10.1093/eurheartj/ehq018 [ Links ]
Antoinette Reinders
1 Logeman Street
Universitas 9301, Bloemfontein, South Africa
Email: email@example.com
Received: 03 Dec. 2014
Accepted: 12 Feb. 2015
Published: 04 June 2015


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A Malibu property owned by actor Jack Nicholson is on the market at $4.25 million, according to the Multiple Listing Service.
The 70-acre site includes a ranch-style main house, a caretaker home, a tennis court, a cabana, a putting green, a swimming pool and a grotto-style spa. The single-story main home, built in 1966, has mountain and ocean views and is zoned for equestrian use. Its 2,313 square feet of living space include three bedrooms, two bathrooms and maid's quarters.
Photos: New and remodeled houses, condos and apartments across Southern California
Nicholson, 73, won Oscars for his roles in "One Flew Over the Cuckoo's Nest" (1975), "Terms of Endearment" (1983) and "As Good as It Gets" (1997) during a career that also has included playing lawyer George Hanson in "Easy Rider" (1969) and maniacal villain Jack Torrance in "The Shining" (1980).
A representative for Nicholson did not respond to requests for comment. Public records show he bought the retreat in 1977 and owns multiple properties in Los Angeles and Ventura counties, including an estate in Beverly Hills.
Rodrigo Iglesias and Richard Hilton of Hilton & Hyland, Beverly Hills, are the listing agents, according the MLS.
Ready for a new vantage point
Actor Dennis Quaid has put his equestrian estate in Pacific Palisades on the market at $16.9 million.
A French country-style main house, a guesthouse, a studio, a barn and a corral sit on 2 lush acres with a year-round creek. Eight bedrooms and nine bathrooms are part of 8,400 square feet of living space. Maids' quarters above the kitchen have been converted to a gym. A covered loggia with a fireplace overlooks the swimming pool and spa.
Photos: Hot properties for sale in Southern California
Quaid, 57, starred in "Vantage Point" (2008), "Pandorum" (2009) and the TV movie "The Special Relationship" (2010). He is selling because he is moving back to Texas to be closer to family.
Kathrin Nicholson of Westside Estate Agency is the listing agent.
Ex-center scores a beach city sale
Former Calgary Flame Craig Conroy has sold his Manhattan Beach home for $1,965,000, according to the MLS. The Craftsman-style house, built in 2005, has wood-encased windows and vaulted ceilings with beam accents. A family room flows into a kitchen with a breakfast nook. The house, with 4,230 square feet of living space, contains five bedrooms and five bathrooms.
Conroy, 39, retired earlier this year to become a special assistant to the Flames' general manager. The center had played since 1994 with NHL teams, including the Los Angeles Kings.
Public records show he bought the house in 2005 for $2,495,000.
Edward Kaminsky of Shorewood Realtors was the listing agent. Gary James Dempsey of Re/Max Beach Cities represented the buyer.
Giving up the waves in Malibu
Radio and TV personality Jonathon Brandmeier has his Malibu estate for sale at $5,995,000.
The nearly 6,000-square-foot home has ocean-view patios and balconies, an office, a media room, a gym, six bedrooms and five bathrooms. It sits on 1.6 acres that include a swimming pool, a hot tub, a sports court, an art studio and a koi pond.
Brandmeier, 54, has been heard in L.A. on the air on KLSX and KCBS. However, he spent most of his broadcasting career as a staple on Chicago radio. He is selling because he has moved back to Chicago and doesn't need a house of this size in L.A. Brandmeier bought the property new in 1997 for $2,675,000, according to public records.
Beverly Taki and Ed Moloney of Seabreeze Estates Realty, Malibu, are the listing agents.
'Survivor' lists Los Feliz home
Actor and "Survivor" contestant Jonathan Penner and his wife, film director and producer Stacy Title, have listed their Los Feliz home at $1,779,000.
The Monterey colonial revival, built in 1933, is set on more than a quarter-acre of park-like grounds with oak trees and flagstone paths. The 2,745-square-foot house has a paneled den with a fireplace, a vintage-style kitchen, four bedrooms with balconies and 21/2 bathrooms. The converted garage serves as an office-family room.
Penner was in "The Last Supper" (1995), a black comedy Title directed. The couple have worked together on other projects, including the Academy Award-nominated short film "Down on the Waterfront" (1993). He starred in the TV series "Rude Awakening" (1998-2001) and "The Naked Truth" (1995-97).
The property previously sold for $532,000 in 1996, according to public records.
Gary Bergevin of Prudential California Realty, Los Feliz, is the listing agent.


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Gravitational Theory
Numerical Relativity — Relativistic Astrophysics
Numerical relativity is the field of exploring general relativity with the methods of computational physics. The aim is to better understand relativistic gravitational phenomena and to make precise quantitative statements in the strong-field nonperturbative regime of general relativity.
A particular emphasis of our research is on the numerical modelling of sources of gravitational waves which is carried out in the framework of the German research network SFB/TR 7 "Gravitational Wave Astronomy".
The group is lead by Prof. Bernd Brügmann.
The research activity of the group is focused towards the study of the two body problem for two black holes. The classical two body problem in physics is formulated for two point-like masses. In Newtonian physics this problem has the well-known solution in terms of Kepler orbits, but do we really understand how two masses move in their mutual gravitational field? As surprising as it may seem at first, the answer to this question is not really known, even if we restrict ourselves to classical, non-quantum physics and to no more than two bodies.
Einstein's theory of general relativity, which by all accounts is an extremely successful description of the gravitational interaction in the classical regime. In the limit of velocities much below the speed of light and for weak gravitational fields, Newton's theory of gravity is an excellent approximation and with post-Newtonian approximations we can obtain good approximations for about one tenth of the speed of light. However, the question has to be asked how for example two black holes, which are prime examples for extreme gravity, move around each other when they approach each other at relativistic velocities.
Is there perhaps in general relativity a solution to the equations of motion for two black holes which is as simple and simultaneously as astrophysically relevant as the Kepler orbits of Newtonian physics? The answer is, in a rather satisfying manner, no! The motion of two masses generates gravitational waves, which remove energy and momentum from the system, such that a Kepler ellipse is no longer a stable solution for an orbit. Two black holes will rather move on an inward spiral, first slowly, then faster and faster, until they collide and merge to a single black hole.
This loss of stability in the Einstein equations is by no means tragic. Quite to the contrary, a growing international community of gravitational wave researchers emerging after direct detection of gravitational waves in order to establish an entirely new branch of astronomy, namely gravitational wave astronomy. On September 14th, 2015, the twin LIGO (Laser Interferometer Gravitational waves Observatory) located at Livingston and Hanford, USA have measured the ripples in the spacetime (gravitational wave) as a result of two merging black holes in the distant universe. With VIRGO, KAGRA, LIGO-India, detectors are under construction and further improvements are under development, which will result in a worldwide network of detectors.
Bernuzzi, Sebastiano
|+49 3641 9 47111
|Numerical Relativity
PhD Students
Fabbri, Francesco Maria
|Abb. 203
|+49 3641 947116
|Numerical Relativity
Kölsch, Maximilian
|Abb. 205
|+49 3641 947146
|Numerical Relativity
List of Publications


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Bir köprü kurmak istiyorsanız, uzun bir yürüyüş ile sakin bir sohbetin inanılmaz bir birleşim olduğunu öğrendim.
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Learn more about the IHG Green Engage™ system
Conveniently located near Port Columbus International Airport, the Crowne Plaza Downtown Columbus hotel and Lofts offers upscale amenities, exciting features and easy access to the most popular local attractions!
While staying with us, you are just steps away from the Short North Arts District, German Village, and Brewery District. If you're looking for hotels near Ohio State University, we are the perfect choice for any collegiate occasion, including Buckeyes games, college visits and graduations.
As the best of hotels near Nationwide Arena, we offer a prime location for guests to experience all of the action. Catch a Columbus Blue Jackets hockey game, see concerts from all of your favorite artists, and much more!
The Crowne Plaza hotel in Columbus, OH is also the perfect place for business travelers. Of the hotels near Columbus Convention Center, we are certainly the most convenient. We are directly connected to the facility and just a short walk to Nationwide Mutual Insurance, The Ohio Statehouse, AEP, NiSource, Columbia Gas and a number of other local companies. With 13,000 sq. ft. of flexible space, a creative menu, and a dedicated Crowne Meetings Director, we are committed to the success of your next event.
Enjoy a quick workout in our on-site Fitness Center. Looking to venture out? Our hotel can provide directions to many exciting recreational activities!


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Chemists are problem solvers. They think analytically and embrace equations and formulas. They study matter—and what they do matters. Advances in chemistry impact fields including medicine, environmental science, and nanotechnology.
Chemistry is an experimental discipline that uses applied principles and new skills to solve scientific problems. Through foundational courses and collaborative research with professors, students gain an understanding of chemical processes and acquire the tools to apply that knowledge in innovative ways. Faculty-mentored student projects emphasize modern techniques and instrumentation and use Colby's research-grade facilities and laboratories. Recent research has included the synthesis of supramolecular structures, the detection of superoxide in natural water sources, and the molecular basis of cancer therapy.
The department offers concentrations in biochemistry, cell and molecular biology/biochemistry, and environmental science, giving students the opportunity to focus on a particular area of interest.


text:
I know a lot of bloggers do this kind of thing now, and I really like posts like this. I always find new blogs to follow from these posts, and it's a good excuse to just give some love! I'll post one of these at the end of each month and hopefully I'll inspire someone to give these amazing blogs a visit. ^.^
chloe // the little plum
I do blogger outreach as part of my job, so I found Chloe's blog whilst stumbling around bloglovin looking for someone new. Her blog in general is gorgeous, but this outfit in particular is soooo nice. I am all about tailoring and trainers, but the cosy jumper just completes the look by adding that new texture. All that together with the chic bun. Love this.
bryony // bealea
I came across Bryony whilst having a nosy through the #fbloggers tag on Instagram. That was only a couple of weeks ago and she's a firm favourite now! Besides the fact she's wearing trainers which will make any outfit a winner for me, I love the combination of the huge coat and roll-neck with a pair of joggers. I'm also inspired to try and combine this many grey tones in one outfit.
yanin // i dress myselff
Okay, Yanin's blog/YouTube are huge so she doesn't need any help... but I can't pass up mentioning this outfit. I'm not even into animal print and would never consider buying these boots, but by paring such a big print with other low-key items she's making me want them. This is the mark of a good blogger. Mixing a grey basic with blue jeans is a combo from my own heart, and I'm also a fan of the super long scarf. A+
clarissa // vintage doll risa
There wasn't a way to link to this particular post of Clarissa's, so I just had to link to her whole blog (which is fine because all the posts are gorg). I love this post in particular because hey, I just love grey and the many shades of grey there are to possibly combine. I went straight on to asos to check out these items she's wearing and daym they aren't cheap, but look how stunning they are. Also loving her dark lipstick choice to go with. <3
leanne // this is leanne
I actually discovered Leanne's blog because she followed me (thanks Leanne ^.^) and I'm glad she did. For one thing, I love her hair. I'm always trying to get my hair to do that soft middle parting and it just won't work with me. Leanne's outfit is super simple, I just like leather paired with a soft jumper (props for the sky blue) and she's also inspiring me to go out and pick up a pair of pointy flats.
I hope you enjoyed this post!
x G


text: In 100 Wacky Things, players will do some ridiculous things while laughing uncontrollably. The game has two types of cards: Always and Whenever. If you draw an Always Card, you will do the wacky thing on your card every time it's your turn. A Whenever Card directs you to do what the card says whenever another player does something specific. One wacky thing definitely leads to another in this zany game of craziness! For 3 or more players.


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High-speed road accident of single light vehicle against plane tree, not wearing seatbelt.
Initial treatment by Fire Department, Glasgow = 10, obnubilation, both pupils non-reactive, unstable hemodynamics with blood pressure: 75/40,pulse: 110, responding to IV fluid therapy, no respiratory distress, and incarceration of both inferior extremities with open fracture of the right ankle requiring 45 min to be released.
1.5 liters IV fluids, intubation after rapid induction sequence, mechanical ventilation, sedation, reduction of fracture of right inferior extremity. Prophylactic antibiotics.Medical transport to university hospital.
The body scan is provided.
My report:
Cranioencephalic space: No traumatic lesions.
Spinal space:
Stable, unilateral, non-displaced, large-fragment articular fracture of the left occipital condyle (Anderson type II):No other posttraumatic lesion of the cervico-thoraco-abdomino-pelvic spine.No posttraumatic lesions of the neck vessels (note that the right vertebral terminates in the posteroinferior cerebellar artery).
Thoracic space:
Sparse ground-glass pulmonary contusions of the right pulmonary hemi-field and paramediastinal left upper lobe. Layer of bilateral pneumothorax with possible juxto-fissural pneumatocele of the upper part of the left fissure.Gravity-dependent parenchymatous compression of the posterior regions.Flail chest due to bilateral parasternal fractures of the anterior arches of the 3rd to 9th rib.
Abdominopelvic space:
Deep hepatic contusion of the junction of segments V and VII, in contact with the hepatic veins with no active bleeding. Liver fracture involving segments I and IV and reaching the hepatic hilum with no active bleeding. Moderately abundant hemoperitoneum, also present in the omental bursa.Right adrenal hematoma with moderate contact hemoretroperitoneum with no active bleeding.No other posttraumatic lesion in the abdominopelvic space (sequelar linear calcification of the splenic capsule).
Peripheral skeleton:
Comminuted open metaphyso-epiphyseal fracture of the inferior extremity of the right tibia (complete articular fracture, Association for Osteosynthesis classification C3). Comminuted, displaced overlapping fracture of the inferior third of the right fibular diaphysis. Talus intact.
N.B.: Supra and intercondylar fracture of the inferior extremity of the left femur evaluated with standard X-rays.
Occipital Condyle Fracture, Thoracic injuries, Hepatic trauma, Adrenal hemorrhage
- Open reduction and osteosynthesis of the fractures of the right ankle and left knee.
- Monitoring of the liver fracture with CT check-up after 1 month unless a new clinical, hematological, or biochemical element arises.
- Monitoring of pulmonary contusions.- For the condyle fracture: immobilization with rigid neck brace for 3 months followed by CT check-up to be scheduled.
The subsequent follow-up report is not available, as the patient transferred to the hospital closest to his residence.
Important points:
- The C0-C1-C2 hinge is always analyzed in coronal reconstruction.
- Flail chest = at least 2 fracture lines on at least 3 adjacent ribs or fracture of at least 3 symmetric adjacent ribs in relation to the sternum.
- Pulmonary contusions = not confined to one lobe and present from the outset.
- Multi-plane and volume reconstructions provide useful information for the surgeon in the event of joint and/or complex and/or significantly displaced fractures of the peripheral skeleton.
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text:
A bill was introduced in the U.S. Senate on Dec. 19 that would increase the price of the federal duck stamp to $25. The current price of $15 was set in 1991.
Bill introduced to raise price of duck stamps
A bill was introduced in the U.S. Senate on Dec. 19 that would increase the price of the federal duck stamp to $25. The current price of $15 was set in 1991.
�We appreciate the introduction of a federal duck stamp increase bill by Senators Begich, Baucus, Coons and Tester to meet very real on-the-ground wetland habitat conservation needs,� said Ducks Unlimited CEO Dale Hall. �We are committed to seeing this legislation signed into law and look forward to working with Senators on both sides of the aisle to enact this.�
Since its enactment in 1934, the federal duck stamp program has protected more than 6 million acres of wetlands � an area the size of Vermont � through expenditures of more than $750 million. This has contributed to the conservation of more than 2.5 million acres in the Prairie Pothole Region � the most important waterfowl production area in North America.
Land values have drastically increased since the last price increase for duck stamps. In Minnesota, for example, land prices have risen an average of 250 percent since the 1990s. While the duck stamp price remains stagnant, the cost to conserve habitat that host waterfowl and other species has increased tremendously. At its current price, the buying power of the federal duck stamp has never been lower over its 79-year history. The Congressional Budget Office found that because the federal duck stamp is a user fee, such a price increase would have no net impact on federal spending.
�Once again, sportsmen and women have demonstrated their willingness to pay for conservation by supporting a long-overdue increase from $15 to $25. With 98 cents of every $1 from duck stamp receipts going to conserve wetlands habitat, it is vital that the cost of the stamp keep up with inflation and land acquisition costs,� Hall said.
Jan. 11 � The Salt Water Sportsman National Seminar Series will come to the Riverfront Convention Center in New Bern from 9 a.m. to 4 p.m. Television personality George Poveromo will host the event and will be joined by regional and national angling experts who will discuss tactics and techniques for catching the most popular inshore and offshore species. Tickets ($55) are available online at www.nationalseminarseries.com or by phone at 1-800-448-7360.
Hunting Seasons
Deer (eastern region): through Jan. 1
Ducks, coots & mergansers: through Jan. 25
Sea ducks & tundra swan: through Jan. 31
Rails, gallinule and moorhens: through Dec. 28
Canada geese (Resident Population Zone): through Feb. 8
Light geese (snow, blue and Ross� geese): through Mar. 8
Bear (eastern season): through Jan. 1 in Carteret, Duplin, Onslow, Pamlico and select other counties; through Dec. 28 in Beaufort, Craven, Greene, Jones, Lenoir, Pitt, Wayne and select other counties. Check NCWRC Regulations Digest for complete list.
Coyote & Feral Swine: no closed season
Woodcock: through Jan. 25
Pheasant: through Feb. 1
Quail, Bobcat, Grouse, Raccoon, Opossum and Gray Squirrel: through Feb. 28
Fox Squirrel: through Dec. 31 in Greene, Jones, Lenoir, Onslow, Pitt and select other counties; note � no open season in Craven County
Licensed Shooting Preserves � through Mar. 31


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Robert Cowles, MD
Associate Professor of Surgery (Pediatrics)
Departments & Organizations
Surgery: Pediatric Surgery: Fetal Care Center; General Pediatric & Thoracic Surgery; Pediatric Aerodigestive Disorders Program; Pediatric Inflammatory Bowel Disease Surgery Program; Pediatric Trauma Surgery Program
Pediatric Aerodigestive Program
Pediatric Surgery
Yale Medicine
Robert A. Cowles, MD is an Associate Professor of Surgery at Yale School of Medicine. Dr. Cowles obtained his undergraduate education at the University of Pennsylvania and his medical degree at Temple University. He completed a residency in general surgery at the University of Michigan, in Ann Arbor, and spent two additional years pursuing laboratory research which was supported by a training grant from the NIH and by a research grant from the American College of Surgeons. Dr. Cowles then obtained his pediatric surgery training at the Morgan Stanley Children's Hospital at Columbia University in New York City.
Dr. Cowles practices the full range of pediatric surgery with specific expertise and interest in the care of children with diseases of the gastrointestinal tract including the esophagus, stomach, small intestine, colon, liver and biliary tree. He currently co-manages patients with short gut syndrome and intestinal failure as part of a multidisciplinary team.
He has been a Program Director of Pediatric Surgery Fellowships both in New York and now at Yale University with an interest in competency in surgical education.
Dr. Cowles directs a research laboratory focused on the neural control of intestinal adaptation and neural processes involved in recovery from intestinal injury.
Meet Dr. Robert Cowles.
Education & Training
|Temple University School of Medicine (1995)
|Clinical Fellowship
|Columbia University College of Physicians and Surgeons
|University of Michigan
|Research Fellowship
|University of Michigan
|University of Michigan
|Board Certification
|AB of Surgery, Pediatric Surgery (2006, recertified: 2016)