Water Running Down Glacial Rocks in New York’s Central Park

Water Running Down Glacial Rocks in Central Park in New York City, Target Health Inc.

 

Last week, the snow had melted after a March storm. As we were returning from dinner along Central Park West, we noticed water running down these gorgeous glacial rocks behind a park bench. We quickly took this picture with our iPhone and wanted to share this almost surreal view of a modern-day park bench juxtaposed with wet ancient rocks.

 

For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 165). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website.

 

Joyce Hays, Founder and Editor in Chief of On Target

Jules Mitchel, Editor

 

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Doctors Find Air Pocket Hidden in Man’s Brain

Pneumocephalus and comminuted fracture of the frontal sinus

Photo credit: CT scan by James Heilman, MD – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=49086936

 

Doctors treating a patient who had complained of repeatedly losing his balance made an unexpected discovery: The 84-year-old man had a 3.5 inch pocket of air in his brain. A CT scan of the man’s head revealed a large air cavity compressing his right frontal 1) ___. The condition is known as pneumocephalus (PNC). Treatment for PNC depends on may factors, including symptoms. Condition commonly compresses the frontal lobe, can affect voluntary muscle movement. The man had been referred to the emergency room by his primary physician in Northern Ireland. He told his doctor about weeks of recurrent falls and three days of left-side arm and leg weakness, according to the report, published in the journal BMJ Case Reports, March 2018. The patient did not have any visual or speech impairments and did not seem confused or have facial weakness, according to the authors. The physicians performed scans of the brain to identify any signs of bleeding or brain damage caused by blocked blood vessels, but what they found was much more unusual, a small benign tumor. A computed tomography scan of the patient’s 2) ___ showed a large pocket of air — also called a pneumatocele — in the patient’s right frontal lobe. When pneumatoceles are present in the brain, the condition is often referred to as PNC. They most commonly compress the frontal lobe, which plays a large role in voluntary muscle movement. The air pocket was right behind the frontal sinus and above the cribriform plate, which separates the nasal cavity from the cranial cavity. This was a rare presentation with a lot of 3) ___ in his brain. An MRI of the man’s brain also showed a small benign bone tumor, or osteoma, that had formed in the man’s paranasal sinuses and was eroding through the base of the skull, causing air to leak into the cranial cavity. Sometimes, there can be a one-way valve, and air comes in and can’t get 4) ___. The pressure from the air cavity may have also caused a small stroke in the patient’s frontal lobe, resulting in the left-side weakness and gait instability that prompted his hospital visit.

 

According to a 2015 study in the journal Surgical Neurology International, trauma is responsible for approximately 75% of pneumocephalus cases. The remaining cases are often complications of neurosurgery; ear, nose, and throat surgery; sinus infections; or, as in this case, bone tumors. Treatment for pneumocephalus depends on several factors, particularly the symptoms involved. Many cases of pneumocephalus have no symptoms and eventually become absorbed by the body without treatment. In more serious cases, such as those that cause high 5) ___ pressure in the brain or impaired consciousness, decompression surgery to alleviate pressure on the brain may be required. In this case, the patient was offered surgical treatment from a team of neurosurgeons and ENT surgeons. The procedure would have involved temporary surgical removal of part of the frontal bone of the skull and excision of the bone tumor to close the leak that was sending air into the brain. However, due to his age and other health factors, the patient declined surgery and instead chose conservative treatment involving medication to prevent a secondary 6)___. When the patient returned for a 12-week follow up visit, he felt better and no longer complained of left-side muscle weakness.

 

Background: Pneumocephalus (PNC) is the presence of air in the intracranial cavity. The most frequent cause is trauma, but there are many other etiological factors, such as surgical procedures. PNC with compression of frontal lobes and the widening of the interhemispheric space between the tips of the frontal lobes is a characteristic radiological finding of the “Mount Fuji sign.“

 

Case Description: A 74-year-old male was diagnosed with meningioma of olfactory groove. After no improvement, surgery of the left frontal craniotomy keyhole type was conducted. A CT (computed 7) ___tomography) scan of the skull performed 24 hours later showed a neuroimaging that it is described as the silhouette of Mount Fuji. The treatment was conservative and used continuous oxygen for 5 days. Control CT scan demonstrated reduction of the intracranial air with normal brain parenchyma.

Conclusion: In a review of the literature, there was no finding of any cases of tension PNC documented previously through a supraorbital keyhole approach. There are a few cases reported of patients with Mount Fuji signs that do not require surgical procedures. The conservative treatment in our report leads to clinical and radiological improvement as well as a reduction in hospitalization time.

 

PNC and TP: The terms pneumocephalus (PNC) and tension pneumocephalus (TP) were created by research scientists, Wolff and Ectors, respectively, even though TP has been described in the early literature. PNC is the presence of air within the intracranial cavity. When this circumstance causes increased intracranial pressure that leads to neurological deterioration, it is known as TP. Ishiwata et al. described the image produced by PNC in subdural collections that separated both frontal lobes as similar in appearance to the silhouette of the famous Fuji Volcano in 8) ___. CT is a golden standard for PNC or TP diagnostics and it only requires 0.55 mL of air to be detected, whereas a simple skull radiograph requires at least 2 mL. Air between the frontal tips is a characteristic finding of the “Mount Fuji sign,“ which means there is the greater pressure of air than the surface tension of cerebral fluid between the frontal lobes. In anterior cranial fossa, the dura mater is thin and closely applied to bone and the arachnoids adherent to frontal lobes; therefore, the air is trapped in the subdural space of the anterior cranial fossa. When there is a bilateral compression of the frontal lobes without separation of the frontal tips, it is called “peaking sign,“ which was previously linked to TP. An MRI axial view of fluid-attenuated inversion recovery revealed the Mount Fuji sign with collapsed frontal lobes and widening of the interhemispheric space between the bilateral tips of the frontal lobes. The Mount Fuji sign indicates more severe PNC than the peaking sign and the necessity of emergent decompression, although in some cases, a patient with Mount Fuji sign sometimes does not need a surgical procedure.

 

PNC usually gets absorbed without any clinical manifestations. The conservative treatment involves placing the patient in the Fowler position of 30o, avoiding Valsalva maneuver (coughing and sneezing), administering pain and antipyretic medications to prevent hyperthermia, and osmotic diuretics. With these measures, reabsorption was observed in 85% of cases after 2-3 weeks. In other cases, different procedures have been used, like hyperbaric oxygenation (HBO2) therapy sessions, where normobaric oxygenation is administered continuously at 5 L/min for 5 days, resulting in the reabsorption of nitrogen into the blood stream and a reduction in the volume of the intracranial air. In a clinical trial, clinical improvement was seen in all patients; however, the treated group experienced a lower rate of meningitis compared to the control group, and the length of the hospital stay was significantly higher in the control group compared to the treated group. The use of an oxygen mask increases the reabsorption of PNC compared to a nasal catheter. When clinical signs appear, such as intracranial hypertension or impaired consciousness that endangers the life of the patient, treatment consists of emergent decompression to alleviate pressure on the brain parenchyma. Also, air is toxic to neurons, causing further damage to the already compromised parenchyma, and that leads to cerebral edema surrounding the air that evolves into encephalomalacia. Treatment options for TP include the drilling of burr holes, needle aspiration, and closure of the dural defect. If the frontal sinus is open during surgery, it is aggressively managed with exenteration of the mucosa, sinus packing with abdominal fat or a piece of temporal muscle and covered with frontal fascia. There are a few cases reported of asymptomatic massive PNC or patients with Mount Fuji signs that do not require surgical procedures. Traveling by plane is considered high 9) ___ because as the height increases, atmospheric pressure decreases, and the gasses expand. Therefore, a pneumothorax could become hypertensive, a bulla could expand or break, and PNC could enlarge and produce more intracranial hypertension. However, it has been observed that military patients with posttraumatic and/or post craniotomy PNC, who underwent long-range air evacuation from a combat theater in military aircraft, did not sustain a temporary or permanent neurologic decline as a result of air transportation. Therefore, PNC in patients with head injuries and craniotomies was not likely by itself to be an absolute contraindication to air evacuation. Finally, the medical guideline recommends waiting at least 7 days to fly after a transcranial or spinal surgery that could introduce gas into the skull.

 

TP must be treated by surgical revision when it causes intracranial hypertension and/or deterioration of consciousness. There are a few cases reported of patients with Mount Fuji signs that do not require surgical procedures. The conservative treatment in these patients is with HBO2 therapy sessions in a monoplace hyperbaric chamber with 100% 10) ___ concentration or normobaric oxygenation administered continuously at 5 L/min at least for 5 days. This treatment should lead to clinical and radiological improvement as well as a reduction in hospitalization time.

 

Sources: Medline.com; nih.gov; Wikipedia; PubMed.gov; Mark Lieber CNN Health.com; Copyright: © 2015 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this URL: Dabdoub CB, Salas G, N. Silveira Ed, Dabdoub CF. Review of the management of pneumocephalus. Surg Neurol Int 29-Sep-2015;6:155. Available from: http://surgicalneurologyint.com/surgicalint-articles/review-of-the-management-of-pneumocephalus/

 

ANSWERS: 1) lobe; 2) brain; 3) air; 4) out; 5) blood; 6) stroke; 7) tomography; 8) Japan; 9) risk; 10) oxygen

 

Most Mysterious Human Organ

Hieroglyphic for the word “brain” (c.1700 BCE)

Source: The Edwin Smith Surgical Papyrus (17th century BCE), Public Domain, Wikipedia Commons

 

From the ancient Egyptian mummifications to 18th century scientific research on “globules“ and neurons, there is evidence of neuroscience practice throughout the early periods of history. The early civilizations lacked adequate means to obtain knowledge about the human brain. Their assumptions about the inner workings of the mind, therefore, were not accurate. Early views on the function of the brain regarded it to be a form of “cranial stuffing“ of sorts. In ancient Egypt, from the late Middle Kingdom onwards, in preparation for mummification, the brain was regularly removed, for it was the heart that was assumed to be the seat of intelligence.

 

According to Herodotus, during the first step of mummification: “The most perfect practice is to extract as much of the brain as possible with an iron hook, and what the hook cannot reach is mixed with drugs.“ Over the next five thousand years, this view came to be reversed; the brain is now known to be the seat of intelligence, although colloquial variations of the former remain as in “memorizing something by heart“.

 

The Edwin Smith Surgical Papyrus, written in the 17th century BCE, contains the earliest recorded reference to the brain. The hieroglyph for brain, occurring eight times in this papyrus, describes the symptoms, diagnosis, and prognosis of two patients, wounded in the head, who had compound fractures of the skull. The assessments of the author (a battlefield surgeon) of the papyrus allude to ancient Egyptians having a vague recognition of the effects of head trauma. While the symptoms are well written and detailed, the absence of a medical precedent is apparent. The author of the passage notes “the pulsations of the exposed brain“ and compared the surface of the brain to the rippling surface of copper slag (which indeed has a gyral-sulcal pattern). The laterality of injury was related to the laterality of symptom, and both aphasia (“he speaks not to thee“) and seizures (“he shutters exceedingly“) after head injury were described. Observations by ancient civilizations of the human brain suggest only a relative understanding of the basic mechanics and the importance of cranial security. Furthermore, considering the general consensus of medical practice pertaining to human anatomy was based on myths and superstition, the thoughts of the battlefield surgeon appear to be empirical and based on logical deduction and simple observation.

 

During the second half of the first millennium BCE, the Ancient Greeks developed differing views on the function of the brain. However, due to the fact that Hippocratic doctors did not practice dissection, because the human body was considered sacred, Greek views of brain function were generally uninformed by anatomical study. It is said that it was the Pythagorean Alcmaeon of Croton (6th and 5th centuries BCE) who first considered the brain to be the place where the mind was located. According to ancient authorities, “he believed the seat of sensations is in the brain. This contains the governing faculty. All the senses are connected in some way with the brain; consequently they are incapable of action if the brain is disturbed, the power of the brain to synthesize sensations makes it also the seat of thought: The storing up of perceptions gives memory and belief and when these are stabilized you get knowledge.“ In the 4th century BCE Hippocrates, believed the brain to be the seat of intelligence (based, among others before him, on Alcmaeon’s work). During the 4th century BCE Aristotle thought that, while the heart was the seat of intelligence, the brain was a cooling mechanism for the blood. He reasoned that humans are more rational than the beasts because, among other reasons, they have a larger brain to cool their hot-bloodedness.

 

In contrast to Greek thought regarding the sanctity of the human body, the Egyptians had been embalming their dead for centuries, and went about the systematic study of the human body. During the Hellenistic period, Herophilus of Chalcedon (c.335/330 – 280/250 BCE) and Erasistratus of Ceos (c. 300 – 240 BCE) made fundamental contributions not only to brain and nervous systems’ anatomy and physiology, but to many other fields of the bio-sciences. Herophilus not only distinguished the cerebrum and the cerebellum, but provided the first clear description of the ventricles. Erasistratus used practical application by experimenting on the living brain. Their works are now mostly lost, and we know about their achievements due mostly to secondary sources. Some of their discoveries had to be re-discovered a millennium after their death.

 

During the Roman Empire, the Greek anatomist Galen dissected the brains of sheep, monkeys, dogs, swine, among other non-human mammals. He concluded that, as the cerebellum was denser than the brain, it must control the muscles, while as the cerebrum was soft, it must be where the senses were processed. Galen further theorized that the brain functioned by movement of animal spirits through the ventricles. “Further, his studies of the cranial nerves and spinal cord were outstanding. He noted that specific spinal nerves controlled specific muscles, and had the idea of the reciprocal action of muscles. For the next advance in understanding spinal function we must await Bell and Magendie in the 19th Century.“ Circa 1000, Al-Zahrawi, living in Islamic Iberia, evaluated neurological patients and performed surgical treatments of head injuries, skull fractures, spinal injuries, hydrocephalus, subdural effusions and headache. Concurrently in Persia, Avicenna also presented detailed knowledge about skull fractures and their surgical treatments. Between the 13th and 14th centuries, the first anatomy textbooks in Europe, which included a description of the brain, were written by Mondino de Luzzi and Guido da Vigevano.

 

Andreas Vesalius noted many structural characteristics of both the brain and general nervous system during his dissections of human cadavers. In addition to recording many anatomical features such as the putamen and corpus collusum, Vesalius proposed that the brain was made up of seven pairs of ‘brain nerves’, each with a specialized function. Other scholars furthered Vesalius’ work by adding their own detailed sketches of the human brain. Ren? Descartes also studied the physiology of the brain, proposing the theory of dualism to tackle the issue of the brain’s relation to the mind. He suggested that the pineal gland was where the mind interacted with the body after recording the brain mechanisms responsible for circulating cerebrospinal fluid. Thomas Willis studied the brain, nerves, and behavior to develop neurologic treatments. He described in great detail the structure of the brainstem, the cerebellum, the ventricles, and the cerebral hemispheres.

 

The role of electricity in nerves was first observed in dissected frogs by Luigi Galvani in the second half of the 18th century. In the 1820s, Jean Pierre Flourens pioneered the experimental method of carrying out localized lesions of the brain in animals describing their effects on motricity, sensibility and behavior. Richard Caton presented his findings in 1875 about electrical phenomena of the cerebral hemispheres of rabbits and monkeys. Studies of the brain became more sophisticated after the invention of the microscope and the development of a staining procedure by Camillo Golgi during the late 1890s that used a silver chromate salt to reveal the intricate structures of single neurons. His technique was used by Santiago Ramon y Cajal and led to the formation of the neuron doctrine, the hypothesis that the functional unit of the brain is the neuron. Golgi and Cajal shared the Nobel Prize in Physiology or Medicine in 1906 for their extensive observations, descriptions and categorizations of neurons throughout the brain. The hypotheses of the neuron doctrine were supported by experiments following Galvani’s pioneering work in the electrical excitability of muscles and neurons. In the late 19th century, Emil du Bois-Reymond, Johannes Peter Muller, and Hermann von Helmholtz showed neurons were electrically excitable and that their activity predictably affected the electrical state of adjacent neurons. In parallel with this research, work with brain-damaged patients by Paul Broca suggested that certain regions of the brain were responsible for certain functions.

 

Tell me where is fancie bred,

In the heart or in the head?

 

William Shakespeare (Merchant of Venice)

 

CRISPR Helps Find New Genetic Suspects Behind ALS/FTD

 

Disease-causing mutations in C9orf72, insert extra sequences of DNA into the gene, called hexanucleotide repeats, account for nearly 40% of inherited cases of amyotrophic lateral sclerosis (ALS) and 25% of inherited frontotemporal dementia (FTD) cases. These repeats produce potentially toxic RNA and protein molecules that kill neurons resulting in problems with movement and eventually paralysis for ALS patients and language and decision-making problems for FTD patients.

 

According to an article published in Nature Genetics (5 March 2018), a new study provides a roadmap for using CRISPR to investigate neurological disorders. For the study, the authors used the gene editing tool CRISPR-Cas9 to rapidly identify genes in the human genome that might modify the severity of ALS and FTD caused by mutations in a gene called C9orf72. The results of the search uncovered a new set of genes that may hasten neuron death during the disease.

 

For the study, the authors used CRISPR to disable each gene, one-by-one, in a line of human leukemia cells and then tested whether the cells would survive exposure to toxic proteins derived from the hexanucleotide repeats, called DPRs. Any disabled genes that caused cells to live longer or die faster than normal were considered suspects in DPR toxicity. The authors confirmed that genes that control the movement of molecules in and out of a cell’s nucleus may be partners. They also identified several new players, including genes that modify chromosomes and that help cells assemble proteins passing through a maze-like structure called the endoplasmic reticulum (ER). A second CRISPR search conducted on mouse brain cells confirmed the initial results. Disabling the top 200 genes identified in the leukemia cells helped neurons survive DPR exposure. Finally, further experiments highlighted the importance of the ER genes, especially one called TMX2. For example, the authors could cause neurons derived from the skin cells of ALS patients with C9orf72 to live longer than normal when they silenced the TMX2 gene, suggesting it could be exploited in designing novel therapies for ALS. Decreasing TMX2 in cells caused an increase in the production of “survival proteins” that the authors hypothesized protected the cells against DPR toxicity.

 

Previously such studies needed a few months to find candidate genes and could only be performed on yeast, worm, and fly genomes. With CRISPR, the authors needed just about two weeks to conduct a complete search of the human genome. The results suggest that this faster and more comprehensive approach may be used to rapidly identify genes that may be involved in other neurological disorders.

 

Biological Clock and Aging Brain Disorders

 

Preclinical studies suggest that Cdk5 is a gene that is important for the normal wiring of the brain during early development and may be involved in some neurodegenerative disorders, including ALS, Parkinson’s and Alzheimer’s disease.

 

According to an article published online in Disease Models & Mechanisms (8 March 2018), a study of flies suggests neurodegenerative disorders may speed up aging process. To better understand the link between aging and neurodegenerative disorders such as Alzheimer’s disease, the various genetic clocks that tick during the lives of normal and mutant flies were compared. Results showed that altering the activity of a gene called Cdk5 appeared to make the clocks run faster than normal, and that the affected flies presented older than their chronological age, including problems walking or flying later in life, showing signs of neurodegeneration, and shortened life expectancy.

 

On average, the normal flies in the study lived for 47 days. To create a genetic clock, the authors measured the levels of every gene encoded in messenger RNA molecules from cells from the heads and bodies of flies at 3, 10, 30, and 45 days after birth. This allowed the authors to use advanced analysis techniques to search for the genes that seemed to be sensitive to aging, and create a standard curve, or timeline, that described the way they changed. When the same experiments were performed on 10-day-old mutant flies and the results were compared with the standard curve, it was found that the flies were “older“ than their chronological age. Altering Cdk5 activity made the brains of the flies appear genetically to be about 15 days old and their bodies to be about 20 days old. The study found that eliminating or increasing Cdk5 activity beyond normal levels shortened the lives of the flies to about 30 days. After 10 days of age, the manipulations reduced the distance flies could climb up tubes and the alterations caused older flies to have signs of neurodegeneration, including higher than normal levels of brain cell death and degradation. More analysis showed that altering Cdk5 activity changed the level of several groups of genes that were also affected by aging, including those that control immunity, energy, and antioxidant activity.

 

To explore this idea further, the authors tested the strength of the flies’ antioxidant defenses against toxic versions of several chemicals found in cells called oxygen free radicals. Initial experiments showed that aging reduced these defenses in normal flies. Three-day-old healthy flies lived for about 100 hours after exposure to free radicals, and that time decreased with age. In contrast, the defenses of Cdk5 mutant flies were even weaker as they died sooner than the control flies at all ages.

 

According to the authors, the results suggest that aging may not just predispose an individual to degeneration, but that acceleration of aging may actually be part of the mechanism by which degenerative disease disrupts the structure and function of the brain.

 

Screening Test to Help Reduce Risk of Transfusion-Transmitted Babesiosis

 

Babesiosis is caused by Babesia parasites that are transmitted by Ixodes scapularis ticks, also known as blacklegged or deer ticks. B. microti is the main species that causes infection in the U.S. There are about 1,000 to 2,000 cases of babesiosis reported in the U.S. each year, with the majority reported from states in the Northeast and upper Midwest. Babesia can also be transmitted by transfusion of blood or blood components collected from an infected donor. The vast majority of people infected with B. microti do not have symptoms and are never diagnosed. Some people develop flu-like symptoms, such as fever, headache and body aches. The U.S. Centers for Disease Control and Prevention (CDC) warns that for certain people, especially those with a weak immune system, it can be a severe, life-threatening disease and that while bloodborne transmission of babesiosis is thought to be uncommon, it is the most frequently reported transfusion-transmitted parasitic infection in the U.S. and remains an important concern.

 

The FDA approved the Imugen Babesia microti Arrayed Fluorescent Immunoassay (AFIA), for the detection of antibodies to Babesia microti (B. microti) in human plasma samples, and the Imugen Babesia microti Nucleic Acid Test (NAT), for the detection of B. microti DNA in human whole blood samples. These tests are intended to be used as donor screening tests on samples from individual human donors, including volunteer donors of whole blood and blood components, as well as living organ and tissue donors.

 

The investigational use of Babesia donor testing has been in place since August 2012 in selected Babesia endemic areas under investigational new drug applications (INDs). The use of the investigational tests has resulted in the removal of a significant number of infected units from the blood supply. The data collected from this testing and from additional studies performed by the manufacturer prevented the release of hundreds of potentially infectious donations and demonstrated that the tests are effective in screening donors for B. microti infection. The tests approved today are not intended for use in the diagnosis of babesiosis infections.

 

These applications were granted Priority Review, under which the FDA’s goal is to take action on an application within six months where the agency determines that the product, if approved, would significantly improve the safety or effectiveness of treating, diagnosing or preventing a serious condition.

 

There currently is no FDA guidance for the testing of donor samples for Babesia. However, the FDA is planning to issue draft guidance with recommendations for reducing the risk of transfusion-transmitted babesiosis later this year.

 

The approval of the Imugen Babesia microti AFIA and NAT tests was granted to Oxford Immunotec, Inc. Both assays are in-house tests that can only be performed at the Norwood, Massachusetts facility.

 

Stuffed Dates with Blood Oranges & Mandarins

©Joyce Hays, Target Health Inc.

 

Because citrus is still at its peak, the idea of delicious fresh fruit, for dessert, has great appeal. Here is what we feasted on with guests, for dessert this weekend. Healthy and delicious with a colorful presentation, this is one dessert to consider. Oh, and btw, it’s quick and easy to prepare.

 

Ingredients

1.  4 mandarin or Clementine oranges

2.  2 blood oranges

3.  splash of Cointreau or orange blossom water

4.  8 ripe Medjool dates

5.  8 teaspoons mascarpone

6.  30 roasted/salted pistachios, shelled and coarsely chopped seeds from 1/2 pomegranate

 

Directions

Prep mandarins and blood oranges by slicing a small piece of the top and bottom off the unpeeled fruit. Now, with a sharp knife, slowly cut away strips of peel and pith.  Once the peel is removed, slice the citrus horizontally into nice pinwheels. You can use a mandolin, carefully or a sharp knife. Scatter the citrus rounds onto a plate. Add a light splash of Cointreau or orange blossom water to the citrus – It’s amazing how the Cointreau or orange blossom water enhances the natural perfume of the fresh citrus slices. I bought my orange blossom water and pistachios from Amazon.com.

Cut each date with a slice large enough to remove and discard the pits. Carefully stuff each date cavity with 1 teaspoon mascarpone. Press some chopped pistachio and pomegranate seeds onto the mascarpone. Scatter the remaining pistachio and pomegranate onto the plate. I bought pomegranate arils from FreshDirect.com, which is so much easier than prying each seed from a pomegranate.

 

Here’s the orange blossom water, I used purchased from Amazon. ©Joyce Hays, Target Health Inc.

 

Arrange a colorful dessert platter, sprinkled with chopped pistachios. ©Joyce Hays, Target Health Inc.

 

We had an experimental tofu recipe, along with our recent favorite, The Vice, chardonnay.  ©Joyce Hays, Target Health Inc.

 

Jules and I tried this delicious fresh fruit in three ways: 1) without any additions  2) with about 1 teaspoon Cointreau on each orange slice. 3) with about 1/2 teaspoon orange blossom water (non-alcoholic) on each slice. I liked all three versions. Jules didn’t like the orange blossom water, but did like the other two versions, with a preference for the Cointreau.

 

Coffee and tea goes well with this dessert.  If you want to serve an alcoholic beverage and you’re using Cointreau on the orange slices, you might as well stick to the same in glasses, or consider a grappa.

 

Have a great week everyone!

From Our Table to Yours

Bon Appetit!