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Thank You For Your Purchase!
We look forward to meeting you, and helping you live a more grounded, pain-free life. We are here to support you on your wellness journey. Massage Therapy is not a luxury, but simply a practical way to take better care of your body, mind & heart.

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Ramos, J. A. P. & Granato, E. & Achim, C. V. & Ying, S. C. & Elder, K. R. & Ala-Nissilä, Tapio. 2008. Thermal fluctuations and phase diagrams of the phase-field crystal model with pinning. Physical Review E. Volume 78, Issue 3. P. 031109/1-7. ISSN 1539-3755 (printed). DOI: 10.1103/physreve.78.031109.
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- Bar d'office
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Studio van A
Footwear design
Studio van A accompanies brands in every step of the design and development phase to translate the brand into a commercial & wearable product.
We create unique outcomes by combining cross-industry tools and influences.
We energize, listen and question to get goals that once seemed scary far away.
Footwear is our playground.
Productontwikkeling, Textiel en mode
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Why French Immersion
Studies show that exposing your child to an additional language from a young age can benefit him or her for a lifetime of learning! The following articles are just a few of many boasting the amazing results bilingualism has on the brain's ability and capacity for learning many skills and subject matter; language skills are just the beginning!
"My daughter started Le Petit Jardin when she was 24 months and through familiar contexts she could understand French immediately.
Within a few weeks she was speaking several words and attempting a nursery rhyme and two songs. Her French language acquisition is much like her English; she learns what she's interested in learning, and she associates French words with certain activities and practices them as part of her normal routine.
Instead of a rigid curriculum, the entire language is available to her as she plays & interacts with Mme Ambi and the other children.
We feel that she has an invaluable opportunity at Le Petit Jardin to learn French in an easy, natural, much more effective way."
Celeste - Parent of San Anselmo Campus Child
"My daughter has really thrived at Le Petit Jardin and we value the French immersion greatly. Amber is so good with her that she felt immediately comfortable there, engaging in all the activities and playing well with the other children.
When I come in to pick her up, she is always excited to show me the latest art project that she's done with Amber.
As she is our first child, we were nervous with leaving her in someone else's care, but Amber has created such a warm, loving and stimulating environment that we feel very lucky to have her there."
Tara - Parent of San Anselmo Campus Child


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[Daemian: Um, hi everybody. Welcome to the Demon Files.
Werewolf Demons
Location: Rokenthia, Almatierra, Northern Aitahki
Lifestyle/Other: Werewolf demons live in often large "packs", though they're more similar to villages. They tend to stay primarily in one area, only moving if absolutely necessary. They typically live in small shelters built from whatever materials are available to them. Packs work in much the same way as normal wolf packs, with different ranks and some, usually ritualized, fights for dominance. Werewolf demons, however, consider themselves more "civilized" than wolves. They're frequently seen wearing clothing, wielding weapons, and occasionally "lone wolves" will make their homes in multi-race/species towns. They also possess the ability to learn human languages as well as those of animals. Werewolf demons' average life spans are only somewhat shorter than humans', and typically couples mate for life, producing 2-4 pups on average, usually one or two at a time.
[Luna: Anyone who asks why I don't have a pack or mate will be impaled on the spot.
Spike Demons (Lesser)
Location: Rokenthia, Terrasuenia, some in Khartaesia
Lifestyle/Other: Lesser spike demons live in groups of anywhere from 3 to 20, usually led by a single or mated pair of greater spike demons. They hunt in small groups or alone, usually for small prey like birds, squirrels and rabbits. Typically found in forests. Not particularly intelligent, but vicious fighters. Cannot speak human languages or take other forms. Typically mate once only, producing litters of 3-8. Upon reaching maturity, the lesser Spike Demons will either choose to leave the group and join another, or remain with the same.
Spike Demons (Greater)
Location: Rokenthia, Terrasuenia, some in Khartaesia.
Lifestyle/Other: Greater Spike Demons usually lead packs of Lesser Spike demons, either alone or with a mate. Their groups can have anywhere from 3 to 20 members, and the Greater makes all major decisions on hunting, food and labor division and other factors.
[Riza: You know, Raus and his pack are the only spike demons I've ever seen around here. Shouldn't there be others?
Luna: There are, he's just the only one stupid enough and lazy enough to try to steal from me instead of hunting for himself.]
Rat Demons
Location: All continents.
Lifestyle/Other: Rat Demons usually live in large packs, are very territorial, and area always hungry. Anything that wanders into their area that isn't a member of the group is more than likely going to be dinner. The packs usually have an alpha male and female, who fight for their position rather than inherit it.
[Riza: You know, you're sounding progressively less professional here.
Dae: I know, shut up.]
Spirit Demons (Lesser)
Location: All continents.
Lifestyle/Other: Very little is actually known about spirit demons due to their lack of a consistent form and the general danger of being around them. They tend to appear out of thin air and then disappear just as quickly. It is speculated that what you see of them is not their true form at all, but rather just a chosen form to make themselves seen, with the creature itself being invisible to the human eye. Also, no one knows what exactly the inside of their mouths are made of but seeing as no one has ever been bitten by a spirit demon and lived to tell the tale, it's probably safe to say it's dangerous.
[Riza: It is not a stupid stick! It's a cool stick!
Spirit Demons (Greater)
Blackheart Demons
Millennium Demons
Poison Demons
Horn Demons
Sirius Demons
Arma Demons
Puma Demons
Hunter Demons
Taurus Demons
Bonehare Demons
Vulpe Demons
[Dae: Well, there's supposed to be more here, but my notes seem to have disappeared...*glances at Riza*
Luna: *sigh* And people wonder why I don't like kids.]
Luna: *sigh* And people wonder why I don't like kids.]


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Mr Lee Hsien Yang and his family are in the process of leaving the country out of fear that his brother, Lee Hsien Loong who is the current Prime Minister of Singapore will use the state organs against him and his wife. Children of late Lee Kuan Yew, Dr Lee Wei Ling and Mr Lee Hsien Yang have earlier issued a public …Read More »
Daily Archives: 2017-06-14
Lim Tean: Duty of every Singaporean to stand up and speak up for Singapore
Lawyer and former National Solidarity Secretary General, Lim Tean issued a statement of his own on his Facebook post this afternoon in response to the joint statement by the two children of late Lee Kuan Yew, Dr Lee Weiling and Mr Lee Hsien Yang, commending the two for their courage for speaking up against their brother and acknowledging how difficult …Read More »
Why has MOM changed the definition of re-entry into employment in the midst of labour downturn
I refer to the article "Longer job search more common, with PMETs hit hardest" (Straits Times, Jun 14). It states that "It is also seen in the share of local residents, including permanent residents, who can get a job within six months of being laid off. "This rate in the first quarter of this year slipped to 64.4 per cent, …Read More »
Prime Minister Lee disappointed at statement issued by his sibilings
Singapore's Prime Minister, Lee Hsien Loong has posted a response in relation to the statement earlier published by his two siblings. PM Lee who is currently on overseas leave, expressed his disappointment towards the choice of publicising private family matters and denies allegations made by the two against him, especially on the point that he has political ambitions for his …Read More »
Prime Minister Lee's siblings denounce him in statement, state misuse of his position and influence over Singapore government
Siblings of Prime Minister Lee Hsien Loong, Dr Lee Wei Ling and Mr Lee Hsien Yang have issued a public statement to express their non confidence in PM Lee Hsien Loong and wrote that they are worried about Singapore's future in his hands. The statement that was posted online by Dr Lee Wei Ling and Mr Lee Hsien Yang who …Read More »


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We are big fans of Design Thinking and Human Centered Design as techniques for service design. In its simplest form, design thinking is a process of creating new and innovative ideas and solving problems. It is not limited to a specific industry or area of expertise.
Below are some great resources for learning about how to implement Design Thinking in your organisation's service design:


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IIT-JEE Sample Papers
To aid our future engineers, we provide the IIT JEE sample papers download at our website www.edurite.com. You really need to go through each and every IIT sample paper before the big decision day. Through our IIT sample papers free download feature, we aim to provide you the supervision needed.
Remember it, every IIT sample paper that we have provided in our web catalog is going to test your skills. Prepare for them as if you are preparing to attempt the IIT JEE. The IIT sample papers should be solved thrice. First when you have not started your studies to gain the insight of what you have to go through. Second time, solve the particular questions in the IIT JEE sample papers unit - wise when you complete each chapter. Practice each and every IIT sample paper thoroughly the third time when you have completed all your necessary studies and revisions.
Make a good use of the IIT sample papers free download feature to crack the Joint Entrance Examination and study in your dream college.
IIT-JEE Sample Papers by Year
IIT-JEE Sample Papers by Subject
IIT-JEE Sample Papers for Math
Students need to strengthen their fundamentals to crack maths section of IIT-JEE exam and that could only be done by sincere practice. In form of IIT JEE maths paper, we are offering students an excellent study material to help them in their preparation. These IIT maths sample papers also include many previous year questions and the other important questions to guid...Read More
IIT-JEE Sample Papers for Physics
Students who are appearing for the IIT-JEE exam, needs to practice hard to perform extremely well in all the three sections i.e. Maths, Physics and Chemistry. IIT JEE Physics Paper are here to help them practice the physics section. They can also get previous year question papers for the other subject sections via our online portal. When they practice all these s...Read More
IIT-JEE Sample Papers for Chemistry
Chemistry is a mystery for those who do not study it properly and those who prepare well, it's a subject which guarantees of excellent marks in IIT-JEE exam. IIT JEE Chemistry Paper contains a lot of questions from topics like block elements, nuclear chemistry, gaseous state etc. The other such scoring topics are transition elements, chemical equilibrium and c...Read More
IIT-JEE Best Sellers
In order to keep pace with technological advancement and to cope up with IIT-JEE examinations, Pearson group has launched Edurite to help students by offering Books and CDs of different courses online.
Get help on IIT-JEE Sample Question Paper Now


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Trump Punishes Ayatollah Ali Khamenei With New Sanctions
U.S. President Donald Trump targeted Iranian Supreme Leader Ayatollah Ali Khamenei and other senior Iranian officials with new U.S. sanctions on Monday, looking for a fresh blow to Iran's economy after Tehran's downing of an unmanned American drone. With tensions running high between the two countries, Trump signed an executive order imposing the sanctions, which U.S. Treasury Secretary Steven Mnuchin said would lock billions of dollars more in Iranian assets. Trump said the new sanctions were in part a response to last week's downing of a U.S. drone, but would have happened anyway. He said the supreme leader was ultimately responsible for what Trump called "the hostile conduct of the regime." "Sanctions imposed through the executive order … will deny the Supreme Leader and the Supreme Leader's office, and those closely affiliated with him and the office, access to key financial resources and support," Donald Trump said. The Trump administration wants to force Tehran to open talks on its nuclear and missile programmes and its activities in the region. Tensions between the United States and Iran have grown since May when Washington ordered all countries to halt imports of Iranian oil. There was no immediate reaction in Iranian official media but at the weekend, state-run news agency IRIB quoted Foreign Ministry spokesman Abbas Mousavi as saying any new sanctions would be "just propaganda" and "there are no more sanctions left." Mnuchin said Iranian Foreign Minister Mohammad Javad Zarif would be targeted with U.S. sanctions later this week. Sanctions were alsoContinue reading


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US natural-gas production will hit a record in 2018, just as oil will, says Liam Denning on Bloomberg Gadfly. Output should exceed 80 billion cubic feet per day, marking a 60% increase since 2005. The biggest annual jump in US production on record will take place this year, with another 7 billion cubic feet anticipated (equivalent to the annual output of Turkmenistan, a key gas exporter). Pipelines capable of transporting seven billion cubic feet from the "prolific" Appalachian region come into operation in 2018. Thanks to shale, the US – a gas importer in the 2000s – is now an exporter.
"[Does] anyone seriously think that the railways were better run in the halcyon days of state ownership? They were starved of investment, having to plead for cash from the same pot that funds schools, hospitals, the armed forces – and much else. In the five years that preceded privatisation there was virtually no investment in new trains. Since privatisation, more than £10bn has been spent on new rolling stock… The railways are also a good deal safer today for passengers and workers alike, and they are also a great deal more popular now than before. Passenger journeys have doubled to 1.6 billion per year in the 18 years since privatisation despite the ever-rising fares."
Michael Harrison, Evening Standard


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In September of 2018 POH completed a second year at the Gitihia Primary School in Lari Kenya. A team of 30 committed men and women completed a revenue generating dairy farm, a week long medical clinic, enrichment camp and lunch program.
The 2018 mission marked the second time POH built of full scall dairy farm. With the purchase of two full grown pregnant cows, a cow shed with enough room to house 6 cows, as well as a building remodel to be used for supplies and shelter for the new born calves, the Gitithia Dairy Farm was complete. By December Hope2 and Peace2 gave birth to healthy calves.
The POH medical team doubled for this mission and was able to treat and triage the schools students as well as the adults of the community for a total of 748 patients seen.


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Currently workshopping Anywhere But Here, a new commission piece by Electric Company Theatre artist in residence Carmen Aguirre, in collaboration with Canadian hip-hop artist, Shad. In development with Playwrights Theatre Centre, this kick ass new play, set along the US/Mexico border, follows a family on a journey backwards towards Chile from Canada. Anywhere But Here confronts the cost of exile, and the true nature of home, through the Latinx lens. Full of humanity, humour, and music, the show will premiere in 2020 at The Vancouver Playhouse.
Free staged reading:
Friday August 3, 2018
Shadbolt Centre for the Arts
6450 Deer Lake Avenue
Burnaby, BC
*Clothing donations for the Inland Refugee Society of BC will be accepted at the reading.


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Blessed is She
Luke 1:26-38
The woman who would be called the Mother of God lived in a small town called Nazareth. Nazareth was part of an unimportant district known to the Romans simply as "the Circuit," a word that comes to us as "Galilee." I grew up in the West Texas Panhandle, also an unimportant district with lots of tiny towns. Some of these only have one traffic light or one restaurant (often a Dairy Queen). These towns are little more than wide spots in the road where a few shops and houses have been built near each other. We call them "one horse towns." That's what Nazareth was--a one horse town, a rest stop between other places. A tiny insignificant place inside a larger insignificant place.
We know that Mary was unmarried and a virgin. Scholars agree that she was around the age of 14. It is most likely that her engagement with Joseph was arranged by her parents. There would have been a combination of political, social, and economic reasons why he was chosen above other possible suitors. In their culture, Mary would be given over to Joseph along with some of her father's possessions (a dowry) and she would become his wife. Being a wife was a great deal like being a piece of property. Mary would be expected to have children, care for her family, and engage in the life of the village as she had been trained and taught since childhood. There was no reason for Mary to believe her life would be any different from all the other women she saw around her and knew so well.
Mary's life took an unexpected turn when an Angel came to her. We don't know where this encounter happened, what time of day or night. We have no description of Gabriel or of Mary. We do know that this visit changed everything.
In just a few sentences in the Book of Luke, Mary reveals her distress, her fear, her astonishment, and her curiosity. She is a person just like us. When an angel from God tells her that she will give birth to a king who will reign forever, she focuses not on the brilliant future but the practical reality staring her in the face. She hasn't had relations with a man. Every person who lives around animals (like girls in ancient small towns) knows exactly where babies come from. When the angel tells Mary that this will be the work of the Holy Spirit, Mary immediately gives herself over the God. She accepts that she will become pregnant without sex, and that this is the divine will.
I went to school in a small, religious town. In my high school we had a couple of girls who got pregnant and carried the baby to term. I saw how those girls suffered--the stares, the gossip, and the abandonment they must have experienced from former friends. As their pregnancies progressed, our public school wouldn't even let them come to class. Instead, they received "tutoring" in their homes. I don't believe any of these girls graduated.
Consider Mary's situation. She lived in a society that was much more sexually conservative than ours. She lived in a tiny, close knit community. In our society we have credit scores and reputations and social standing acquired through education or wealth. These things tell other people who we are and what we are worth. In Mary's society, they had "honor." By being unmarried and pregnant, Mary had dishonored herself, her father, her family, and Joseph. She was in danger of losing everything. By becoming pregnant outside of her relationship with Joseph, there was a very real possibility that Mary would be driven out of her father's house and left to wander. She could possibly end up in slavery or prostitution or both.
Mary accepted the angel's message and took an enormous risk. She did this for her people and for us as well. She did it through the work of God's grace. This was not her strength alone. Gabriel tells her that she has received grace (favor), and he's right. Nonetheless, she cooperated in God's work. As Advent begins to draw to a close and Christmas comes ever closer, I give thanks to God for the gift of Christ. I also give him thanks for the grace he gave that little Palestinian girl. She inspires me today to trust the Lord and let him take care of the outcomes.
If you are reading this as a note on facebook, may I recommend you visit www.ThomasMcKenzie.com for the full service version?


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Pencil holders.
Desk-organizational thingies.
Anything cute with a drawer
Waste Paper Baskets.
You name it. I love it. Take me to Office Max, and that's the first place I'll go and drool. Opening and closing drawers, imagining what I could put in this box, in that container, just besieged and smiling at all the Stuff That Holds Stuff. (Then I would head over to the Sharpie aisle, but that's a different story.)
[Disregard the Dwight Bobblehead. I just wanted to show it off.]
I recently added to my collection by purchasing something called The Really Useful Box. And I have to say, this Thing That Holds Things actually is a Really Useful Box. At three by five inches, I could put anything in it. Anything in the world. Currently, it's holding my Spanish flashcards.
[Hey there, gorgeous.]
And now there's one less item that doesn't have it's own cute little place in my room. Ah, Things That Hold Things, I love you. I truly love you.


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The end of war on November 11, 1918 made headlines in Edmonton's newspapers: The Morning Bulletinnoted: "GERMANY ACCEPTS TERMS"; The Bulletin reported: "EDMONTON CELEBRATES PEACE NEWS WITH IMPROMPTU DEMONSTRATION"; and The Edmonton Journal observed: "SIRENS, BONFIRES AND BIG PARADES NOTIFY THE CITY ARMISTICE IS SIGNED."Read More
Frank Reginald Hasse was the son of the Reverend Lewis St. Aubin Hassé, a Moravian minister who was born in Ireland, and his wife Sarah Louisa Ridgley. Their sons, Frank Reginald (born September 15, 1891) and Edwin Ridgley (born ca. 1894), were born in Kimbolton, Huntingdonshire, England, and homesteaded in Alberta near Lake Wabamum.Read More
Lieut.-Colonel G. R. Stevens, OBE wrote an exciting account of the very special role of Edmonton's 49th Battalion at the Battle of Vimy Ridge in his book A City Goes to War: History of the Loyal Edmonton Regiment (3 PPCLI). Stevens was born in Nova Scotia and graduated from the University of Alberta in 1915. He served for three years with the Princess Patricia's Canadian Light Infantry and was wounded twice.Read More
Harold Osborne Ross is typical of the many young soldiers who were killed in the First World War. He was born in Birkenhead, Cheshire, England and immigrated to Canada. He lived for a time with his wife Winnifred in Edmonton and served with the 19th Alberta Dragoons.Read More
French-born Raymond Brutinel immigrated to Edmonton in 1904 and made his fortune in Alberta through land and railway development. He had completed military service in France and had met Auguste de Verchère de Reffye, the inventor of an early model of the machine gun. With the declaration of war on August 4, 1914, Brutinel immediately thought of the potential use of machine guns.Read More
When the First World War broke out on August 4, 2014, the University of Alberta had 439 students and a small staff. By 1918, 484 staff and students had served in the armed forces, of whom 82 of were killed.Read More
Edmonton had a strong militia tradition and, in 1908, the 19th Alberta Dragoons and 101st Regiment were established. The latter, in 1909, became the Edmonton Fusiliers and, later still, the Loyal Edmonton Regiment.Read More


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January 5, 2014
Americans need to prepare for bone-chilling cold they probably haven't experienced in years.
A deep freeze gush of wind is rapidly spreading across a large part of the United States this following weekend.
Sunday temperatures are expected to hit 30 degrees below zero in North Dakota and other sections of the Plains and Midwest; the wind chill will make it feel like minus 50, the National Weather Service said.
By Wednesday, nearly half the nation — 140 million people — will shiver in temperatures of zero or lower.
The arctic blast threatens to sweep subzero lows as far south as Alabama and plunge much of the Deep South into the single digits.
Winter weather in the past week has claimed at least 13 lives, CNN has confirmed.
Eleven people died in road accidents — including one man crushed as he was moving street salt with a forklift.
A man in Wisconsin died of hypothermia. And in Byron, New York, a 71-year-old woman with Alzheimer's disease wandered away from her home Thursday night and was found dead in the snow in a wooded area about 100 yards away.
Source : http://edition.cnn.com/2014/01/04/us/winter-weather/


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Mexico, Missouri, and Home/
Whoa! The past three weeks have been full of traveling, laundry, new ventures, and lots of puke (sorry this post is going to get real...so look away if you must).
I'll start with our trip to Mexico! BJ and I were lucky enough to travel with some friends to Cancun at the end of July. We stayed at Ocean Coral & Turquesa resort. My first thought was, "This is beautiful!" My second thought was, " What in the world is that smell." Unfortunately, we picked to go the week after they had a seaweed anomaly. Seaweed, waist high, had washed up on the beautiful beach. That mixed with the 100 degree weather equaled a very pungent smell. It wasn't the hotels fault, in fact they worked very hard every day disposing of the seaweed! It took us a day or two but we all got used to the smell eventually!
We spent our week, lounging in and by the pool, relaxing, and eating till our hearts were content.
It was really beautiful! BJ and I spent most of our time in the pool so we had awesome tans... from the shoulders up. We even got to enjoy the beach on the last few days after they cleaned up the seaweed.
Faces burnt and a few pounds heavier, we headed home on a Friday. BJ and I's luggage didn't make it back to the Minneapolis airport so we had to head home without it. The baggage claim assured us that Fedex would have it to us by Monday, which was not so good for us considering we were going out of town Sunday night. Thank goodness I thought to put my make-up in my carry-on!
So, Saturday was spent trying to find clothes to pack because the majority of our summer clothes were in our luggage that was lost. On Sunday (a few hours before we were supposed to leave), BJ informed me he didn't have any underwear to wear during the week. My first thought was, "What have you been wearing the past two days?" but I thought it was better not to ask in this situation. So I set off to try and get him some while he went to work. Alright so lets be honest, I have never bought boys underwear before so I had no idea what size to get. I presented them to BJ (very proud of myself I might add, because I assumed I had gotten the right kind and they were on clearance!) and his response was, "Oh no, these are too small!" Awesome. So he preceded to try on a pair just to be sure. "Yep, too small," I hear him say from the other room, "let me try on all the other pairs just to be sure." That's right, instead of just trying on one pair and saying these won't work, he needed to try on all 6 pairs (ruining the packaging they came in) and paraded around the house in each pair before deciding I needed to take them back. Sorry Store-That-Will-Remain-Nameless, and the person who ends up buying these not-so-clearly used underwear. We vow to never do this again.
We finally made it out of the house by 8:30 p.m to make the 7 hour drive home to see our family and friends. I might add that sometime between Friday and Sunday my face had broken out in a horrific rash, so I looked like I had a face full of chicken pox. Again, awesome. We spent the week seeing as much family and friends as we possibly could and BJ spent time recording music. My nephew and niece were the highlight of my trip and we got to spend a few hours giggling and snuggling on the couch.
Our luggage finally arrived at our house on Tuesday. I know this because our older neighbor text me at 10 pm asking if we knew that our luggage had been left on our doorstep (Fedex=Fail). She was so nice to drag it into her garage, but I am still baffled as to why Fedex thought it was ok to leave our personal things on our porch.
BJ had a gig on the last night of our trip at a local venue. Our plan was for him to play till about 11 P.M, then we would have to make the long drive home so he could play at another gig in Iowa in the morning. After the gig, we ran to my Dad's house to get our things to head home when it happened; a bathroom emergency. I had hoped it was food poisoning and that it wouldn't last because I felt ok other than my stomach. I was so wrong. To make a long story short, the 7 hour drive home was full of tears, sweat, pulling over every twenty minutes, a heated discussion wondering if we should go to the hospital, and a little swervy driving as BJ drove through the night trying to get us home. It was gruesome and yet, I like to think our marriage is a little stronger because of it. I was sick for another 3 days, but I'm happy to report I am finally healthy and down 5 pounds! So all is well that ends well.
Don't forget to follow my blog and my Instagram! And please leave me comments!


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song: hey my friend (tommy february)
ignore the picture spoiler xDthe food that i ordered, Harmony Chicken!
it was ゼオン's birthday.. so, they even got a piece of cake for him.. xD
kiddo! xD
It was a really nice and classy place.. xD
It was a really nice and classy place.. xD
Aiyer! Zeon looks so ke ai on the first pix! Dah lah birthday growing older but at kawaii! LOL!~
By the way the restaurant looks really nice!!!~ And why on earth is the chicken like so BLACK!~ "yat phek yeh" lidat! LOL!~ Not enough flash ker or the chicken "chau hoay ta"!
Oh by the way, Happy Belated Birthday, Zeon!!!~
hahaha thx xher for your present, it really helped alot for my guitar :D and thx for being with me all the time when i need you lol... and yea for following us to that restaurant or should i say uhhh good environment sight-seeing restaurant lol .. and the best part was one ANG MOH has the same bday with me on the opposite table lol .. :D neeeway thx alot lol ..
wei emily that chicken black black but damn nice k .. the steak can go up to rm100+ .. wad to do FINE DINING MA lol .. but overall i love that place lol :D
hey nice place...where 's the place


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These are movies thats aired on TV when its not some special weekend or no good movie is out or no award show videos are available. I have watched both these movies more than a dozen times and it has always been on cable only. Godzilla: The story of the big lizard that becomes a … Continue reading A to Z Challenge: G
Month: June 2016
A to Z Challenge: H
Hachiko: One of those movies that would make you cry like a baby. Well if you don't cry that would say two things. You don't have a heart. You don't have a soul. he he he This is a movie about the legendary Hachiko who waited for his master for 10 years after his master … Continue reading A to Z Challenge: H
Its so simple!
People say that life is complicated. I say life is complicated. But generally its not. It us who makes it too complicated by thinking it is. My father used to say there is no answer between yes and no. Its very much true. Either something works or something else works. That is all. Why make … Continue reading Its so simple!
Late night delivery
Ramya sat in her room browsing through the restaurants that offered late night food delivery. It was around 1 am and she had the sudden craving for some briyani. Given that she hadn't eaten anything since brunch didn't help her much. Opening one such restaurant's site she quickly looked through the menu. They had briyani within … Continue reading Late night delivery
A to Z Challenge: I
I think I am the only one to still be doing A to Z challenge. But meh!! Who cares.. Definitely not going to talk or rant about the epic called I.... That you can find here Inglorious Bastards: I am not a big fan of war films. Its usually depressing and gory. This alternate ending … Continue reading A to Z Challenge: I
The Leibster Award : Well… Thanks!
I had no idea there was something like this actually. An award for blogs where your friends or readers could nominate you. Well thanks to Gokulane. He nominated me for this award and it feels good when people want to motivate you like this. The Liebster Award is an award that exists only on the … Continue reading The Leibster Award : Well… Thanks!
இறைவி- okay?? So??
I pretty much walked out of the screen with the exact feel once the movie got over. Now all those sweethearts saying this is a cult movie and all, please... Stfu! First learn what cult movie means and then celebrate it. If you knew what that meant you won't actually celebrate this half cooked movie. … Continue reading இறைவி- okay?? So??


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I wrote about my gradual return to shooting film a while back and I mentioned having some 100% analog projects in the pipeline. I can finally share one of them with you. Horse and I have been talking about doing a shoot where it's just us, camera and the beach for quite some time and earlier this year we drove up to the beautiful St. Cyrus Beach on the East coast of Scotland where we spent a couple of hours walking, talking and taking pictures. We shot 3 rolls of film (2 black and white and a colour one) and I really enjoyed working like that again. It reminded me of the very first shoots I did as a teenager where there was no pressure, no assistants, no stylists, no crazy light equipment - just a camera and the person in front of it. Enjoy!
Nikon FM + 50mm f1.4
Kodak 400 TX
Kodak Portra 400


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Crosby High (CHS) Class of 1994 Alumni List
Help us Update the Crosby High 1994 Class List by adding any names missing from the list below:
Registered Alumni
1994 Class List
- Christina Bosques
- Carlye DiStasio
- Jason Leopold
- Robert O'Neill
- Jon Oliver
- David Pagan
- Calvin Peterson
- Banmatie Ramlal
- Ivette Rivera
- Paulo Salgado
- Steven Santucci
- Stephanie Soto
- Jennifer Wynn
Know Crosby High Class of 1994 graduates that are NOT on this List? Help us Update the 1994 Class List by adding missing names.
The most popular movie of 1994 was The Lion King which has grossed over $422,780,140 since its release. The TV series 60 Minutes was the most popular show of 1994.
Hit Songs From 1994
Hit Movies From 1994
Hit TV Shows From 1994
Reunions and Crosby High School News
More 1994 alumni from Crosby HS Waterbury, CT have posted profiles on Classmates.com®. Click here to register for free at Classmates.com® and view other 1994 alumni.
Alumni from the Crosby High School class of 1994 that have been added to this alumni directory are shown on this page. All of the people on this page graduated in '94 from Crosby High. You can register for free to add your name to the CHS alumni directory.
Don't forget to upload your Crosby High School pictures and check on the latest info about any Crosby High School reunion.


text: The disturbing true story of Disney's Aladdin. Subscribe to our channel: https://goo.gl/cv6b96 ---------------------------------------------------------------------- The Disney movie, "Aladdin" is full of colorful, funny characters singing catchy songs as they fly around on a magic carpet. It's a high-flying tale of romance, magic, and adventure. But what's the real story behind this classic folktale? There has been a lot of buzz surrounding Disney's remake of the animated story of "Aladdin." But will Disney learn from the mistakes that they made in the past? This story has been around for centuries. But you will be astonished to learn how the story was created in the first place. It seems "Aladdin," and all of the "Arabian Nights," or "One Thousand and One Nights," folktales were told as a desperate attempt to save the author's life. We were able to uncover some pretty messed up facts about the real story of "Aladdin." You're not going to believe racist song lyrics Disney was forced to change after the animated film's release. ---------------------------------------------------------------------- Our Social Media: Facebook: https://www.facebook.com/TheThingscom/ ---------------------------------------------------------------------- For more videos and articles visit: http://www.thethings.com/


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This ocean voyage gives you an opportunity to see the largest animal to ever live on the earth, the blue whale. Blue whales can range up to about 90 feet in length and weigh almost 190 tons. Their body's are various shades of bluish-grey, and have markings unique to each animal. The Harbor Breeze Cruise doesn't guarantee that you will see whales, but when you do it's exciting. Scientists from Long Beach's Aquarium of the Pacific are on board to explain most anything that you want to know about these magnificent sea creatures. An added bonus is the Whales: A Journey with Giants (a large screen, multimedia presentation), and the interactive kiosk Whales: Voices in the Sea.
|Trips depart from Dock #2 twice daily, at 12:00 p.m. and 3:30 p.m. seasonally. 9:00 a.m. trips on weekends.
|Includes Aquarium admission:
$59.95 adult,
$38.95 child (3-11)
$54.95 senior (62+)Members:
$45 adult
$25 child (3-11)
$35 senior (62+)
|Purchase your Aquarium and Blue Whale and Sea Life combo tickets online
|(562) 590-3100, ext. 0
The Aquarium is open 9 a.m. to 6 p.m., every day of the year, except December 25 and the weekend of the Grand Prix of Long Beach in April 13-15, 2012. Open until 9:00 p.m. on select summer and holidays days. ADMISSION: General adult admission $24.95 (12+), senior (62+) $21.95, child (3-11) $13.95, and free for children under age 3 and Aquarium members!
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Exhausto: Power Venters
November 28, 2003
The RSIF line of power venters is designed to vent flue gases from boilers and water heaters. Features of the power venters include a variable-speed, high-temperature, Class H TEFC motor; capacities up to 1,000 cfm (0 to 2,000 MBtuh); access door to chimney; insulated housing for a low noise level; installation versatility; and several control options. The products come with a two-year warranty.
Exhausto, 1200 Northmeadow Pkwy., Ste. 180, Roswell, GA 30076; 770-587-3238 or 800-255-2923; 770-587-4731 (fax); firstname.lastname@example.com; www.us.exhausto.com.
eProduct #183


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This Mediterranean inspired roasted eggplant dip is a perfect alternative to salsa and hummus. It's delicious served with veggies, crackers, or chips and you can also add it to wraps and sandwiches (or eat it right out of the bowl with a spoon, like I do. No worries, I always make sure that nobody is looking).
Many eggplant dip recipes call for tahini (sesame seed paste). Tahini is fabulous but I rarely have it on hand because it goes bad really fast, so I prefer this roasted eggplant dip recipe because it tastes great without tahini.
If you prefer to make it dairy-free you can just skip feta cheese.
This roasted eggplant dip is really easy to make because all you have to do is place the veggies in the oven and wait until they are roasted to perfection. Once the vegetables are done, just wait a bit until they are cool enough to handle then place them into a blender or food processor, pulse a few times and the eggplant dip is done.
This dip tastes absolutely delicious served with these Clean Eating Spelt Crackers. And if you like eggplant, check out this Eggplant Vegetable Soup and this Mediterranean Roasted Eggplant Salad.
Roasted Eggplant and Feta Dip
This roasted eggplant dip is great as an appetizer served with some healthy crackers or veggies. You can also use it in wraps or sandwiches.
- Prep Time: 15 mins
- Cook Time: 60 mins
- Total Time: 1 hour 15 mins
- Yield: about 2 cups 1x
- Category: Appetizer
- Method: Roast
- Cuisine: Mediterranean, Gluten-Free, Vegetarian
- 3 Tbsp olive oil, divided
- 1 eggplant, (about 2.5 to 3 pounds)
- 1 red bell pepper, cored and cut into 4 large pieces
- 1/2 medium onion, cut into 4 wedges
- 2 garlic cloves, peeled
- 1 tomato
- 3/4 cup crumbled feta
- 1 Tbsp fresh lemon juice
- salt and pepper to taste
- Cut the eggplant in half lengthwise. Place it on a cutting board sliced side up, sprinkle with salt and leave for 30 minutes. The eggplant will release some moisture which helps to get rid of the slightly bitter taste typical for larger eggplant varieties. (You don't have to do this if you don't mind the bitter taste).
- Preheat the oven to 375F.
- Rinse the eggplant slices, pat them dry with a paper towel and generously rub with olive oil. Place the eggplant on a baking sheet and roast for 15 minutes.
- Rub the red pepper, garlic, and onion with olive oil and place on the baking sheet beside the eggplant. Place the tomato on the baking sheet as well and roast the vegetables for another 45 minutes or until tender.
- Let the veggies cool a bit. Once cold enough to handle, place the onion and garlic into a food processor or blender.
- Remove the skin from the red pepper. Scrape the eggplant flesh and remove the skin and seeds from the tomato and place everything into the food processor. Add the feta cheese, lemon juice, and 1 tablespoon of olive oil. Pulse a few times until the desired consistency.
- Taste the dip and add salt and pepper if needed. (If you use feta, you might not need any salt as feta is usually quite salty).
- Sprinkle with some fresh herbs before serving.
Nutrition information is a rough estimate for 1 of 6 servings.
- Serving Size: 1/3 cup
- Calories: 148
- Sugar: 5.9g
- Sodium: 224.8mg
- Fat: 11g
- Saturated Fat: 3.8g
- Unsaturated Fat: 6.7g
- Trans Fat: 0g
- Carbohydrates: 9.8g
- Fiber: 3.7g
- Protein: 4.2g
- Cholesterol: 16.7mg
Keywords: roasted eggplant dip, Greek eggplant dip


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News Briefs: Shale Gas Shipment to go to Brazil
Petroleo Brasileiro SA, Brazil's state-owned energy company, is scheduled to receive the first cargo of shale gas to be shipped from the U.S., according to Bloomberg news services.…
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Pemex, Mexico's state-owned petroleum company, signed an agreement March 27 that will give two investment funds a 45 percent stake in a natural gas pipeline in exchange for $900…
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Onshore oil storage is nearing capacity, causing some companies to store crude oil in offshore tankers, according to a CNBC story.
The American Petroleum Institute released…


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About Our Firm
At Duggar and Duggar, P.A., we practice exclusively in marital and family law, with an emphasis on superior personal attention to our clients.
We provide the following professional services:
Settling, mediating, and litigating all aspects of dissolution of marriage, from routine to complex, including equitable distribution of marital assets, modification of alimony and child support awards, parenting arrangements, and business valuation.
Collaborative divorce.
Prenuptial and postnuptial agreements, including drafting and litigation.
Enforcement and modification of family law matters.
Estate plans, including wills, living wills, and durable powers of attorney, and probate matters.
Private and stepparent adoption.


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Imaging of the Carotid Artery Vulnerable Plaque
- 4.1k Downloads
- Citations
Atherosclerosis involving the carotid arteries has a high prevalence in the population worldwide. This condition is significant because accidents of the carotid artery plaque are associated with the development of cerebrovascular events. For this reason, carotid atherosclerotic disease needs to be diagnosed and those determinants that are associated to an increased risk of stroke need to be identified. The degree of stenosis typically has been considered the parameter of choice to determine the therapeutical approach, but several recently published investigations have demonstrated that the degree of luminal stenosis is only an indirect indicator of the atherosclerotic process and that direct assessment of the plaque structure and composition may be key to predict the development of future cerebrovascular ischemic events. The concept of "vulnerable plaque" was born, referring to those plaque's parameters that concur to the instability of the plaque making it more prone to the rupture and distal embolization. The purpose of this review is to describe the imaging characteristics of "vulnerable carotid plaques."
KeywordsCarotid artery Vulnerable plaque CTA MRA US-ECD
Atherosclerosis involving the carotid arteries is a disease with a high prevalence in the population, particularly in elderly patients, and carotid artery narrowing has been reported in up to 75 % of men and 62 % of women aged 65 years [1]. Atherosclerotic disease of the carotid arteries is a significant condition as accidents of the carotid artery plaques have been associated with the development of cerebrovascular events [2]. For this reason, detection of carotid atherosclerotic disease and identification of those determinants that are associated to an increased risk of stroke are critical components to the prevention of stroke.
The degree of luminal stenosis typically has been considered as the most important element to grade the severity of carotid atherosclerotic disease. However, several recent investigations have demonstrated that the plaque structure and composition may represent a more direct biomarker for the development of cerebrovascular ischemic events [3, 4, 5, 6]. From a conceptual point of view, this is easy to understand: the majority of ischemic infarcts occur because emboli originating from the heart or a carotid plaque occlude an arterial vessel of the brain and not because there is a reduced blood flow from a luminal stenosis, usually well-compensated thanks to the Circle of Willis and other cerebral collateralization.
In the late 1980s, coronary artery angiographic studies showed that coronary artery plaques causing only a moderate degree of stenosis can lead to an acute myocardial infarction [7, 8], confirming that luminal narrowing was not the cause of the myocardial infarction. Histopathological studies demonstrated that erosion and disruption was present in those plaques associated with myocardial infarction. Similar conclusions were reached for the carotid arteries as studies found that cerebrovascular events also can occur in patients with carotid plaques causing low-grade stenosis (<30 %) and with no other identifiable cause for their stroke [9, 10, 11].
AHA classification and imaging techniques
Incorporation of scattered macrophages and foam cells within the arterial wall triggered by intralesional atherogenic lipoprotein
Development of fatty streaks
Extracellular fats that break up cell–cell connections in smooth muscle layers
The classic atheroma that contains a fatty necrotic core. The presence of atheroma may not narrow the vascular lumen since that the affected vessels can compensate for the increase in plaque volume through a widening of their external circumference rather than protrusion of plaque into the vascular lumen
Stage V is further classified as three different classes: Stage Va indicates those plaques having a fatty core as well as a multilayered thick fibrous cap (fibroatheroma); Stage Vb lesions are largely calcified; and Stage Vc lesions are predominantly fibrous
"Complex" plaque: there are areas of internal haemorrhage or focal apposition thrombosis. These lesions may undergo repeated cycles of rupture, thrombosis, and remodelling
The Concept of Vulnerable Plaque and its Clinical Impact
A number of carotid plaque features have been associated with an increase risk of stroke [16, 17], whereas others are associated with a reduced risk of ischemic events [18]. Howard et al. found that different types of plaque are associated with different types of ischemic events. Carotid plaques from patients treated with endarterectomy because of previous ocular ischemic events have fewer vulnerable plaque features than those from patients with recent cerebral ischemic events, possibly explaining some of the differences in risk of stroke between these groups [19].
Plaque Surface Morphology
Several studies compared different imaging techniques to assess carotid plaque ulcerations [26, 27], and the best imaging modality for this purpose is CTA [22, 28, 29]. Saba et al. [22, 28] showed in 2007 that CTA had significantly better sensitivity compared to US-ECD for the detection of plaque ulcerations (93 vs. 37.5 %). The use of post-processing techniques, especially volume-rendering algorithms, may further help in the detection\characterization of carotid plaque ulcerations [28]. One of the limitations of CTA in the assessment and detection of small ulcerations is the presence of a halo or edge blur that may mask these ulcers [30, 31].
MRI can detect the presence of carotid plaque ulcerations with sensitivity similar to the CTA [32]. In a recently published paper by Etesami et al. [32], contrast-enhancement MR was superior to time-of-flight (TOF) MRA for the detection of carotid ulcerations; the latter has a sensitivity of only 55 %, whereas contrast-enhancement MR has a sensitivity of 81.5 %. The false negatives on TOF MRA were related to ulcer orientation, location relative to point of maximum stenosis, and neck-to-depth ratio.
The Fibrous Cap
The FC plays a critical role in determining vulnerability of atherosclerotic plaques; particularly, the thickness and morphology are important predictors of rupture. Histologically, the FC is constituted by smooth muscle cells within a collagen-proteoglycan matrix associated with macrophages and T lymphocytes [33]. Inflammatory cells are also present at the interface with the underlying necrotic core [34]. According to histological findings, whereas an intact FC is associated to a low-risk plaque rupture, a thin FC is associated to a mild-risk plaque rupture and a fissured FC, to a high-risk plaque rupture.
Unstable and vulnerable plaques are thus characterized by a thin FC covering a large necrotic core containing macrophages and interstitial collagen. After the FC rupture, the exposure of thrombogenic subendothelial plaque constituents to the luminal blood flow represents a critical event that eventually leads to thromboembolic complications.
Intraplaque Hemorrhage
IPH is currently recognized as a high risk factor for plaque instability, because it contributes to plaque progression and destabilization [39, 40], causing complications by promoting vulnerability, luminal occlusion or embolic events. Several studies have found a strong association between IPH and cerebrovascular events [41, 42, 43]. Gross and microscopic pathological investigations suggested that IPH occurs more often in symptomatic patients undergoing CEA and that the age of the hematoma correlates with the timing of the symptoms [44, 45]. Histopathological examinations have revealed the association between IPH and the presence of neovessels [46]. Particularly, a study suggested the possible rupture of neovessels as cause of production and expansion of IPH [47].
The Plaque Composition
Carotid artery plaques are constituted by different components and the relative proportion of these components can vary greatly from one plaque to the other. These differences are important because different types of plaque are associated with different risks of stroke. Ultrasound, and especially CT and MRI, can offer information about the carotid artery plaque composition.
On ultrasonography, the analysis of the echogenicity is the main parameter that reflects the plaque composition. One of the most used method is the Gray-Weale's classification modified by Geroulakos [60] that classifies the plaque in five types according to the level of echogenicity: type 1 (anechogenic with echogenic FC); type 2 (predominantly anechogenic but with echogenic areas representing less than 25 % of the plaque); type 3 (predominantly hyperechogenic but with anechogenic areas representing less than 25 % of the plaque); type 4 (echogenic and homogeneous plaque); and type 5 (unclassified plaques reflecting calcified plaques with areas of acoustic shadowing which hide the deeper part of the arterial layers). It was demonstrated that types 1 and 2 are similar to CT fatty plaques, types 3 and 4 as mixed plaques, and type 5 as calcified plaques [61, 62] (Fig. 5).
MRI can depict carotid artery plaque composition but, as described in the previous section, its best potential lies in its ability to identify the presence of haemorrhage within a plaque and to characterize its age [40]. The type of the plaque is associated not only with the potential development of cerebrovascular events but also with the presence of other conditions that affect the brain such as cerebral micro-bleeds and leukoaraiosis [63, 64, 65].
This information also is extremely important for risk assessment of carotid artery stenting (CAS) because some conditions (circumferential calcification or large necrotic cores with thin or ruptured FC) are considered as a counterindication to the CAS procedure. In particular, Kamenskiy et al. [66] recently found that patients with circumferential, heavily calcified plaques, located in the distal portion of the internal carotid artery are most likely to have poststenting geometric changes and complications, whereas Tsutsumi et al. [67] found that in those calcified plaques that were treated with CAS there were multiple fragmentations of the calcifications (assessed by MDCT) in 94.4 % of the cases.
The Plaque Volume
The lipid component volume appears to be associated with the presence of plaque ulcerations, which represent a significant risk factor for the development of cerebrovascular events [70]. The plaque composition changes with increasing plaque volume. More specifically, there is an increase in the proportion of lipid and calcification with increasing plaque volume.
The Plaque Neovascularization
Several histopathological studies revealed that the ectopic neovascularization in the intima and media is a hallmark of advanced atherosclerotic lesions [71]. The presence of neovascularization in carotid artery plaques is considered as an element of vulnerability because these microvessels are prone to rupture, and IPH has been shown to accelerate plaque evolution [72].
MRI also can assess the presence of neovasculature in carotid artery plaques [82, 83, 84, 85]. A recent study by Gaens et al. [85] showed that dynamic contrast-enhanced MR of carotid atherosclerotic plaques can assess plaque neovasculature and that the Patlak model is well-suited for describing carotid plaque enhancement; the authors found that the K(trans) is an indicator of plaque microvasculature (validated by histology) and that the reproducibility of K(trans) was good.
Contrast Enhancement (US–MRI–CT)
Contrast-Enhanced Ultrasound
CEUS represents a simple and noninvasive technique for the evaluation of plaque vascularization, allowing for the detection of plaque vasa vasorum that are abundant in vulnerable plaques [86, 87, 88].
Different ultrasound contrast agents are commercially available. They differ basing on their composition (protein, lipid, phospholipid, or sulfur hexafluoride microbubbles), but they have the common characteristic that they resonate when exposed to an ultrasound wave. The enhancement of the arterial lumen allows to assess the degree of stenosis and to evaluate luminal irregularities, dissections, or ulcerations. At the same time, the technique allows direct visualization of the adventitial vasa vasorum and intraplaque angiogenesis. A recent article by Staub et al. [89] concluded that vulnerable plaques frequently have a greater degree of neovascularization and that the presence of plaque neovessels correlates with lesion severity and with morphologic features of plaque instability. Therefore, contrast-enhanced ultrasound can represent a valuable tool for risk stratification of unstable plaques [89].
High-Resolution and Contrast-Enhanced Magnetic Resonance Imaging
High-resolution magnetic resonance imaging is a useful noninvasive tool for characterizing atherosclerotic plaque composition and provides excellent images of the arterial wall. The high field strength (1.5–3 T), the high-contrast resolution and the use of dedicated surface radiofrequency coils that increase the signal-to-noise ratio allow to go beyond the assessment of stenosis degree and to depict plaque components (FC, lipidic core, calcification, IPH), Contrast-enhanced magnetic resonance angiography (CE-MRA) has been demonstrated to be a very accurate noninvasive test for the detection of significant (70–99 %) symptomatic carotid artery stenosis [90]. Different contrast agents are currently used to characterize carotid plaque. Gadolinium-chelates contrast agents are most commonly used for MRA examinations; for the assessment of unstable plaques, the vascular enhancement of the carotid plaques themselves has been demonstrated to hallmark the presence of an increased endothelial permeability due to plaque inflammation that facilitates the entry of contrast agents [83, 91, 92, 93, 94, 95].
A study by Kerwin et al. confirmed the usefulness of contrast-enhanced MR imaging in both the depiction of plaque inflammation and the differentiation of the plaque components such as fibrous or necrotic portions. Moreover, they showed that early plaque enhancement is due to the presence of internal neovessels, while late enhancement is related neovasculature supply and endothelial permeability [94]. The correlation between the degree of plaque enhancement and the degree of neovascularization, which is itself linked to the degree of plaque inflammation, also was confirmed at histology in a recent study by Millon et al. [96].
Finally, small particles-based contrast agents (iron oxide) can be used to evaluate the presence of plaque inflammation because of their ability to enter atherosclerotic plaques with an increased endothelial permeability and accumulate in migrated macrophages [99]. High-risk inflamed plaques may be identified with a focal area of signal loss visualized on MR images, due to contrast accumulation [100]. Moreover, ultrasmall superparamagnetic iron oxide (USPIO)-enhanced MR imaging has been experimentally used as a biomarker for the screening and the assessment of therapeutic response to statins treatment.
Computed Tomography Angiography
The widespread availability of multi-detector-row CT scanners has made CT angiography the most used noninvasive technique to assess carotid arteries after color-duplex ultrasound. The advantages of this technique are several: velocity of execution, large Z-axis coverage, possibility to use several postprocessing techniques, and the high confidence of the clinicians and surgeons with the CT images. The high spatial resolution combined with very short acquisition times make computed tomography angiography (CTA) of the carotid arteries a very useful tool for the assessment of carotid plaque burden.
A meta-analysis conducted by Koelemay et al. reported sensitivity and specificity values for CTA of 97 and 99 %, respectively, in terms of characterizing the degree of carotid stenosis. In particular, CTA was accurate to characterize 70–99 % stenoses and for the diagnosis or exclusion of occlusions [101]. The ability to scan with very thin slices allows for the accurate evaluation of carotid plaques and of possible intimal irregularities or ulcerations. In terms of CT characterization of plaque components, the presence of high-calcified plaques can hamper a correct estimation of the other components (lipidic core and initial signs of inflammation) because of the blurring artifacts. This limit does not exist for soft plaques.
Finally, CTA is particularly useful for the evaluation of carotid artery remodeling (modifications of lumen diameters following the development of a wall plaque) [102]. The main disadvantage of CTA is the radiation dose delivered to the patient. It is important to underline that the radiation dose can significantly change according to the type of the CT scanner used. In particular, there is a difference between the use of the single source CT versus the dual source CT technology. In a recently published paper [103], the CDTI of single source CT was 12.5 mGy, whereas using dual energy CT system was 10.64 mGy.
Dual-Energy Imaging
Mannelli et al. [105], in a recently published "ex vivo" study, compared the size of the calcifications in the carotid artery plaques measured on the different keV images to a histological standard and found that calcium area measured on the 80 keV image set was most comparable to the amount of calcium measured on histology. Saba et al. [106] assessed "in vivo" the effect of the multispectral imaging in terms of carotid artery plaque classification and found that the HU values of carotid artery plaque significantly change according to the selected keV. Results from this study demonstrated that the HU-based plaque type (fatty and mixed) classification can be improved with the use of multienergy imaging.
Clinical Practice and Results from the Scientific Studies
In the past years, several studies have demonstrated that the degree of luminal stenosis represents only one of the parameter that can determine the ischemic stroke and gradually we have evolved to the concept of vulnerable plaque from the concept of risk arising from the degree of stenosis [9, 10, 107]. However, currently there is a discrepancy between these scientific studies and clinical practice; despite of many publications and discussions, plaque imaging techniques are not really the basics of clinical decision making or current guidelines and in the majority of cases decision towards revascularization are not based on plaque morphology but on the degree of stenosis [108, 109, 110]. Evaluation of the role of predictive effects of the previously described imaging parameters are needed and further studies are necessary to incorporate the potential of the advanced imaging techniques in the identification of the vulnerable plaque to selection of the therapeutical approach. Only in this way the identification of the features of plaque vulnerability will have a bigger clinical impact. Another important issue is the economic impact of the application of CTA or MRA in the diagnostic flowcharts. Previous study demonstrated that the cost of digital subtraction angiography is very high and it can be replaced by CTA or MRA [111]; however, there is no consensus when these techniques should be used and more data are required to define the economic impact of these techniques [112].
Nowadays, imaging can identify and characterize determinants of carotid atherosclerotic plaque vulnerability and stratify the risk of stroke for patients affected by atherosclerotic disease of carotid arteries. Ultrasound imaging can offer valuable information about the general composition of the plaque and also about the presence and degree of neovascularization within the plaques, when combined with the use of microbubble contrast agents. CT imaging allows assessment of several characteristics of the vulnerable plaques: total volume (and the volume of the subcomponents), classification of the plaque types (fatty, mixed, calcified), analysis of the neovascularization. MRI offers the best level of assessment of carotid artery plaques by analysing features, such as the status of the FC and the presence of IPH. The use of specific contrast agents can target specific cell population, such as macrophages, which are a marker of the inflammatory process within vulnerable plaques. Further studies are necessary to incorporate the potential of the advanced imaging techniques in the identification of the vulnerable plaque to selection of the therapeutical approach.
Conflict of interest
The authors declare that they have no conflict of interest.
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