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Hepatocellular carcinoma (HCC) currently represents a major health concern, mainly for its shifting pre-existing conditions that in turn lead to late diagnosis, thus increasing the mortality rate. An improved training of medical personnel involved in diagnosis, staging and the management of treatment is required.We thus aimed to transition tumor view from two-dimensional, on-screen, methods to real, palpatory three-dimensional (3D) representations that can be printed using generally available tools, thus approachable in virtually any medical setting worldwide.After obtaining ethical clearance, we included imaging contrast-enhanced data from 10 confirmed cases of HCC that we translated into a 3D computer render of the tumor with as much morphological data as possible. In addition, we simulated the inner structure of each tumor, simulating different stiffness levels across their respective surfaces, in order to better gauge possible necrosis or vascular particularities. This translated into 3D printed models that were obtained by using commercially available materials, experimenting with different filling methods in order to better simulate the stiffness of the lesion.We administered a structured questionnaire to 43 students and 12 resident doctors (gastroenterologists and surgeons) that manage HCC cases. We assessed tumor morphology and the usefulness of the proposed model in everyday practice and evaluated their use in an academic environment.The proposed method provides a cheap alternative to costly medical simulators, providing both curricular advantages as well as integrating well into normal HCC medical management.

In the past few years it has been questioned the problem of quantifyingnand accounting the value and explaining the components of the organization's intellectual capital. There are many companies that rely on intangible assets to make profits and gain competitive advantage but the current financial situations don’t capture - and cannot capture - the main key factors of the value that dominates the new economy. This article aims to show what intellectual capital represents, which are its components and after a preliminary research in a Romanian metallurgical enterprise it suggests a way of determining and accounting one of its components: structural capital.

Congenital heart diseases are broadly defined as those cardiac anomalies that are present at birth. By their very nature, such defects have their origin in embryonic development. Congenital mitral valve regurgitation is a rare disease occurring in infancy or childhood. In up to 60% of cases, congenital anomalies of the mitral valve occur in association with other cardiac lesions, and often more than one component of the mitral apparatus is involved. The true incidence of congenital mitral valve regurgitation (MVR) is difficult to determine accurately (0.21-0.42% from total mitral valve regurgitations); isolated congenital mitral regurgitation is uncommon. The Carpentier classification of congenital mitral valve disease is the most commonly used nomenclature based on a functional analysis of the mitral valve leaflet. The contemporary anatomic classification has the advantage of minimizing observer variability in the diagnosis and it offers a much better liaison between the cardiologist and surgeon.

Left main coronary artery (LMCA) stenosis is a relatively infrequent but important cause of symptomatic coronary artery disease. The diagnosis of left main coronary artery disease is made by coronary angiography. Coronary artery bypass grafting is the first-line therapy, the standard treatment for LMCA stenosis, which improves the likelihood of survival, while percutaneous coronary intervention (PCI) is emerging as a possible alternative to surgery. We present the case of a patient with history and symptoms of stable angina pectoris, especially associated with exercise, variable threshold, since four years, and who describes a worsening of symptoms in the last month; the angina had become more frequent, more prolonged and occurred at a lower threshold. At about 20 hours from getting admitted to our hospital, the patient had severe and prolonged rest angina, associated with important changes on ECG, which led to the indication of emergency coronary angiography. This investigation showed severe left main coronary artery stenosis and significant lesions in other important vessels (three-vessel disease), in a patient with normal left ventricular function. The recurrence and the intensity of prolonged angina of our patient have necessitated urgent myocardial revascularization surgery with quadruple coronary-artery bypass grafting. After surgery, the patient was asymptomatic and he was discharged 8 days after in a good clinical state.The advantage of coronary artery bypass grafting performed as urgent surgery for the treatment of our patient with left main coronary artery stenosis and concomitant acute coronary syndrome, shortly after coronary angiography, was obvious, significantly improved the clinical outcome, without postoperative ischemic complications.

In a society where the market value of a company is given in proportion of 75-85% of intangible assets value, we can say that the current accounting does not provide sufficient relevant information for a company in order to take long-term decisions. For Skandia, the company's market value is given by two components: financial capital and intellectual capital. Accounting for intellectual capital is not exactly easy to achieve, both because of the assessment and viability in the accounting process i n view of current legislation. This article aims to show what are hidden intangible assets (intellectual capital), what is their place in the classification of intangible assets, what are the components of hidden intangible assets according to different existing reference models and also the possible solutions such as submission of additional financial situations.

Pulmonary arterial hypertension is defined as a group of diseases characterised by a progressive increase in pulmonary vascular load, leading to marked increase in pulmonary artery pressure, right ventricular failure and premature death. Given the nonspecific nature of its early symptoms and signs, pulmonary arterial hypertension (PAH) is often diagnosed in its advanced stages. Although clinical assessment is essential when initially evaluating patients with suspected PAH, echocardiography is a key screening tool in the diagnostic algorithm, because, in comparison with invasive measurements, it has the advantages of being safe, portable, and repeatable. Therefore, Doppler echo is the modality most frequently used in pulmonary hypertension patients. Several echocardiographic techniques centered on the Doppler principle (both conventional Doppler parameters and tissue Doppler imaging) used in the assessment of PAH magnitude and its cardiac effects are presented in this paper. They provide important data on the severity, possible causes and consequences of pulmonary hypertension, both initially and during follow-up, therefore having the ability to estimate disease progression, prognosis, or to monitor therapeutic response. Doppler echocardiography allows to noninvasively estimate systolic pulmonary arterial pressure (SPAP), mean and end-diastolic pulmonary arterial pressure, as well as the quantification of right ventricular (RV) function and the evaluation of pulmonary vascular resistance (PVR).