Bilateral symmetry of radial pulse in high-level tennis players : implications for the validity of central aortic pulse wave analysis

Rapport de synthèse Ce travail de thèse s'articule autour de l'importance de l'évaluation de la fonction vasculaire et des répercussions au niveau central, cardiaque, des perturbations du réseau vasculaire. Les maladies cardiovasculaires sont prédominantes dans notre société et causes de morbidité et mortalité importante. La mesure de la pression artérielle classique reste le moyen le plus utilisé pour suivre la santé des vaisseaux, mais ne reflète pas directement ce qui se passe au niveau du coeur. La tonométrie d'aplanation permet depuis quelques années de mesurer l'onde de pouls radial, et par le biais d'une fonction mathématique de transfert validée, il est possible d'en déduire la forme et Γ amplitude de l'onde de pouls central, donc de la pression aortique centrale. Cette dernière est un reflet bien plus direct de la post-charge cardiaque, et de nombreuses études cliniques actuelles s'intéressent à cette mesure pour stratifier le risque ou évaluer l'effet d'un traitement vasculaire. Toutefois, bien que cet outil soit de plus en plus utilisé, il est rarement précisé si la latéralité de la mesure joue un rôle, sachant que certaines propriétés des membres supérieurs peuvent être affectées par un usage préférentiel (masse musculaire, densité osseuse, diamètre des artères, capillarisation musculaire, et même fonction endothéliale). On a en effet observé que ces divers paramètre étaient tous augmentés sur un bras entraîné. Dès lors on peut se poser la question de l'influence de ces adaptations physiologiques sur la mesure indirecte effectuée par le biais du pouls radial. Nous avons investigué les deux membres supérieurs de sujets jeunes et sédentaires (SED), ainsi que ceux de sujets sportifs avec un développement fortement asymétrique des bras, soit des joueurs de tennis de haut niveau (TEN). Des mesures anthropométriques incluant la composition corporelle et la circonférence des bras et avant-bras ont montré que TEN présente une asymétrie hautement significative aux deux mesures entre le bras dominant (entraîné) et l'autre, ce qui est aussi présent pour la force de serrage (mesurée au dynamomètre de Jamar). L'analyse des courbes centrales de pouls ne montre aucune différence entre les deux membres dans chaque groupe, par contre on peut observer une différence entre SED et TEN, avec un index d'augmentation diastolique qui est 50 % plus élevé chez TEN. Les index d'augmentation systolique sont identiques dans les deux groupes. On peut retenir de cette étude la validité de la méthode de tonométrie d'aplanation quel que soit le bras utilisé (dominant ou non-dominant) et ce même si une asymétrie conséquente est présente. Ces données sont clairement nouvelles et permettent de s'affranchir de cette variable dans la mesure d'un paramètre cardiovasculaire dont l'importance est actuellement grandissante. Les différences d'index diastolique sont expliquées par la fréquence cardiaque et la vitesse de conduction de l'onde de pouls plus basses chez TEN, causant un retard diastolique du retour de l'onde au niveau central, phénomène précédemment bien décrit dans la littérature.

Financial crisis: theory and practice

In the last 50 years, we have had approximately 40 events with characteristics related to financial crisis. The most severe crisis was in 1929, when the financial markets plummet and the US gross domestic product decline in more than 30 percent. Recently some years ago, a new crisis developed in the United States, but instantly caused consequences and effects in the rest of the world.This new economic and financial crisis has increased the interest and motivation for the academic community, professors and researchers, to understand the causes and effects of the crisis, to learn from it. This is the one of the main reasons for the compilation of this book, which begins with a meeting of a group of IAFI researchers from the University of Barcelona, where researchers form Mexico and Spain, explain causes and consequences of the crisis of 2007.For that reason, we believed this set of chapters related to methodologies, applications and theories, would conveniently explained the characteristics and events of the past and future financial crisisThis book consists in 3 main sections, the first one called "State of the Art and current situation", the second named "Econometric applications to estimate crisis time periods" , and the third one "Solutions to diminish the effects of the crisis". The first section explains the current point of view of many research papers related to financial crisis, it has 2 chapters. In the first one, it describe and analyzes the models that historically have been used to explain financial crisis, furthermore, it proposes to used alternative methodologies such as Fuzzy Cognitive Maps. On the other hand , Chapter 2 , explains the characteristics and details of the 2007 crisis from the US perspective and its comparison to 1929 crisis, presenting some effects in Mexico and Latin America.The second section presents two econometric applications to estimate possible crisis periods. For this matter, Chapter 3, studies 3 Latin-American countries: Argentina, Brazil and Peru in the 1994 crisis and estimates the multifractal characteristics to identify financial and economic distress.Chapter 4 explains the crisis situations in Argentina (2001), Mexico (1994) and the recent one in the United States (2007) and its effects in other countries through a financial series methodology related to the stock market.The last section shows an alternative to prevent the effects of the crisis. The first chapter explains the financial stability effects through the financial system regulation and some globalization standards. Chapter 6, study the benefits of the Investor activism and a way to protect personal and national wealth to face the financial crisis risks.

Lymphome surrénalien primaire bilatéral [Primary bilateral adrenal lymphoma]

When abdominal imaging reveals the existence of unsuspected adrenal masses, a diagnostic strategy is necessary. We report the case of a woman presenting with pulmonary embolism, in whom abdominal ultrasound revealed voluminous masses in both adrenals without clinical or biological signs of hormone hypersecretion, but with mild primary adrenal failure. From a CT scan-directed needle biopsy of the right adrenal mass and subsequent staging we were able to diagnose a primary bilateral adrenal lymphoma, diffuse large B-cell type (REAL/WHO). On CHOP chemotherapy both adrenal masses decreased dramatically and the patient is in remission 18 months later. Primary adrenal lymphoma is a rare condition, since 65 cases have been reported to date. Histological diagnosis is nevertheless important, in view of the excellent response to specific therapy observed in some cases.

Bilateral Sequential NAION: A Comparison of Visual Outcomes in Fellow Eyes Using Quantitative Analysis of Goldmann Visual Fields

Purpose: Previous studies of the visual outcome in bilateral non-arteritic anterior ischemic optic neuropathy (NAION) have yielded conflicting results, specifically regarding congruity between fellow eyes. Prior studies have used measures of acuity and computerized perimetry but none has compared Goldmann visual field outcomes between fellow eyes. In order to better define the concordance of visual loss in this condition, we reviewed our cases of bilateral sequential NAION, including measures of visual acuity, pupillary function and both pattern and severity of visual field loss.Methods: We performed a retrospective chart review of 102 patients with a diagnosis of bilateral sequential NAION. Of the 102 patients, 86 were included in the study for analysis of final visual outcome between the affected eyes. Visual function was assessed using visual acuity, Goldmann visual fields, color vision and RAPD. A quantitative total visual field score and score per quadrant was analyzed for each eye using the numerical Goldmann visual field scoring method previously described by Esterman and colleagues. Based upon these scores, we calculated the total deviation and pattern deviation between fellow eyes and between eyes of different patients. Statistical significance was determined using nonparametric tests.Results: A statistically significant correlation was found between fellow eyes for multiple parameters, including logMAR visual acuity (P = 0.0101), global visual field (P = 0.0001), superior visual field (P = 0.0001), and inferior visual field (P = 0.0001). In addition, the mean deviation of both total (P = 0.0000000007) and pattern (P = 0.000000004) deviation analyses was significantly less between fellow eyes ("intra"-eyes) than between eyes of different patients ("inter"-eyes).Conclusions: Visual function between fellow eyes showed a fair to moderate correlation that was statistically significant. The pattern of vision loss was also more similar in fellow eyes than between eyes of different patients. These results may help allow better prediction of visual outcome for the second eye in patients with NAION. These findings may also be useful for evaluating efficacy of therapeutic interventions.

El republicanismo y la crisis del rawlsismo metodológico

Cinco generaciones de utilitaristas, apoyados en la ciencia social posterior a la revolución marginalista neoclásica, destruyeron la conexión clásica entre la reflexión filosófica normativa y el mundo de los derechos y de las instituciones sociales. El estilo de hacer filosofía política inaugurado por Rawls no sólo prometía romper a su vez con todo eso, sino que, aparentemente, apuntaba a una consciente reanudación de la manera clásica -preutilitarista, preneoclásica- de hacer filosofía política: derechos, virtudes, contratos, clases sociales y entramados institucionales -no sólo utilidades maximizadas por individuos atomísticamente y a -institucionalmente concebidos- volvían al núcleo de una filosofía política que se presentaba como «neocontractualista». En este artículo se argumenta que algunas de las opciones metodológicas asociadas al legado de Rawls (el «rawlsismo metodológico») explican el que la promesa fuera sólo muy parcialmente cumplida. A partir de la crisis del «rawlsismo metodológico» que se ha hecho patente en los últimos años, los autores, republicanos avant la mode, tratan de explicar(se) el espectacular auge experimentado recientemente -a favor y en contra- por la vieja tradición republicana.

Successful bilateral lung transplantation after previous pneumonectomy.

We report successful bilateral lung transplantation for end-stage suppurative lung disease after a previous right-sided pneumonectomy performed for a destroyed lung. Our results demonstrate the feasibility of the procedure even in the context of mechanical ventilation and extracorporeal artificial oxygenation. Posttransplantation follow-up revealed excellent gas exchanges, no airway complications, and well-functioning grafts with right-sided ventilation and perfusion of 37% and 22%, respectively.

La crisis del diseño directivo subnacional de la educación chilena

El texto analiza el hacer de los directivos superiores subnacionales de educación en Chile, contrastando las normas que les rigen con las funciones cumplidas. Se trata de un estudio exploratorio, cualitativo, sustentado en entrevistas semiestructuradas aplicadas a quienes ejercieron el cargo de Secretario Regional Ministerial de Educación. Los antecedentes permiten comprender las brechas entre lo definido y lo realizado, y por tanto, identificar nudos críticos que requieren ser resueltos en diversos planos. A partir de estos antecedentes se formulan propuestas en el marco de una nueva organización de la educación en el plano subnacional que orienten e impulsen su rediseño, objetivo político clave en las propuestas de modernización de la gestión del Estado.

The protracted Permo-Triassic crisis and multi-episode extinction around the Permian-Triassic boundary

The Permo-Triassic crisis was a major turning point in geological history. Following the end-Guadalupian extinction phase, the Palaeozoic biota underwent a steady decline through the Lopingian (Late Permian), resulting in their decimation at the level that is adopted as the Permian-Triassic boundary (PTB). This trend coincided with the greatest Phanerozoic regression. The extinction at the end of the Guadalupian and that marking the end of the Permian are therefore related. The subsequent recovery of the biota occupied the whole of the Early Triassic. Several phases of perturbations in [delta]13Ccarb occurred through a similar period, from the late Wuchiapingian to the end of the Early Triassic. Therefore, the Permian-Triassic crisis was protracted, and spanned Late Permian and Early Triassic time. The extinction associated with the PTB occurred in two episodes, the main act with a prelude and the epilogue. The prelude commenced prior to beds 25 and 26 at Meishan and coincided with the end-Permian regression. The main act itself happened in beds 25 and 26 at Meishan. The epilogue occurred in the late Griesbachian and coincided with the second volcanogenic layer (bed 28) at Meishan. The temporal distribution of these episodes constrains the interpretation of mechanisms responsible for the greatest Phanerozoic mass extinction, particularly the significance of a postulated bolide impact that to our view may have occurred about 50,000[no-break space]Myr after the prelude. The prolonged and multi-phase nature of the Permo-Triassic crisis favours the mechanisms of the Earth's intrinsic evolution rather than extraterrestrial catastrophe. The most significant regression in the Phanerozoic, the palaeomagnetic disturbance of the Permo-Triassic Mixed Superchron, widespread extensive volcanism, and other events, may all be related, through deep-seated processes that occurred during the integration of Pangea. These combined processes could be responsible for the profound changes in marine, terrestrial and atmospheric environments that resulted in the end-Permian mass extinction. Bolide impact is possible but is neither an adequate nor a necessary explanation for these changes.

Tratamiento combinado en un pie cavo varo bilateral

Paciente femenina de 34 años de edad, acude a la consulta con dolor agudo selectivo en la zona plantar del antepie a nivel de las cabezas del 1er y 2º metatarsiano. Realizada la anamnesis descartamos cualquier posibilidad de traumatismo o neuralgia. A lo largo de este trabajo expondremos las características principales de la paciente observadas durante la exploración tanto en estática como en dinámica, diseño del plan de tratamiento con los objetivos que pretendemos alcanzar, metodología de aplicación y conclusiones.

Clinically silent subdural hemorrhage causes bilateral vocal fold paralysis in newborn infant.

Bilateral congenital vocal fold paralysis (BVFP) may result from multiple etiologies or remain idiopathic when no real cause can be identified. If obstructive dyspnea is significant and requires urgent stabilization of the airway, then intubation is performed first and an MRI of the brain is conducted to rule out an Arnold-Chiari malformation that can benefit from a shunt procedure and thus alleviate the need for a tracheostomy. Clinically silent subdural hemorrhage without any birth trauma represents another cause of neonatal BVFP that resolves spontaneously within a month. It is of clinical relevance to recognize this potential cause of BVFP as its short duration may alleviate the need for a tracheostomy. In this article, we present such a case and review the literature to draw the otolaryngologist's attention to this possible etiology.