Celiac plexus block: an anatomical study and simulation using computed tomography

Objective: To analyze anatomical variations associated with celiac plexus complex by means of computed tomography simulation, assessing the risk for organ injury as the transcrural technique is utilized. Materials and Methods: One hundred eight transaxial computed tomography images of abdomen were analyzed. The aortic-vertebral, celiac trunk (CeT)-vertebral, CeT-aortic and celiac-aortic-vertebral topographical relationships were recorded. Two needle insertion pathways were drawn on each of the images, at right and left, 9 cm and 4.5 cm away from the midline. Transfixed vital organs and gender-related associations were recorded. Results: Aortic-vertebral - 45.37% at left and 54.62% in the middle; CeT-vertebral - T12, 36.11%; T12-L1, 32.4%; L1, 27.77%; T11-T12, 2.77%; CeT-aortic - 53.7% at left and 46.3% in the middle; celiac-aortic-vertebral - L-l, 22.22%; M-m, 23.15%; L-m, 31.48%; M-l, 23.15%. Neither correspondence on the right side nor significant gender-related associations were observed. Conclusion: Considering the wide range of abdominal anatomical variations and the characteristics of needle insertion pathways, celiac plexus block should not be standardized. Imaging should be performed prior to the procedure in order to reduce the risks for injuries or for negative outcomes to patients. Gender-related anatomical variations involved in celiac plexus block should be more deeply investigated, since few studies have addressed the subject.

Ultrasonographic study and Doppler flow velocimetry of maternal kidneys and liver in low-risk pregnancy

AbstractObjective:Longitudinal study with B-mode ultrasonography and Doppler ultrasonography of maternal kidneys and liver in low-risk pregnancy, to establish and quantify normality parameters, correlating them with physiological changes.Materials and Methods:Twenty-five pregnant women were assessed and selected to participate in the study, each of them undergoing four examinations at the first, second, third trimesters and postpartum.Results:Findings during pregnancy were the following: increased renal volume, pyelocaliceal dilatation with incidence of 45.4% in the right kidney, and 9% in the left kidney; nephrolithiasis, 18.1% in the right kidney, 13.6% in the left kidney. With pyelocaliceal dilatation, mean values for resistivity index were: 0.68 for renal arteries; 0.66 for segmental arteries; 0.64 for interlobar arteries; 0.64 for arcuate arteries. Without pyelocaliceal dilatation, 0.67 for renal arteries; 0.64 for segmental arteries; 0.63 for interlobar arteries; and 0.61 for arcuate arteries. Portal vein flow velocities presented higher values in pregnancy, with mean value for maximum velocity of 28.9 cm/s, and 22.6 cm/s postpartum. The waveform pattern of the right hepatic vein presented changes persisting in the postpartum period in 31.8% of the patients. Cholelithiasis was observed in 18.1% of the patients.Conclusion:Alterations in renal volume, pyelocaliceal dilatation, nephrolithiasis, cholelithiasis, changes in portal vein flow velocity, alterations in waveform pattern of the right hepatic vein, proved to be significant.

Aetiologies of pulseless electrical activity in out-of-hospital cardiac arrests:A retrospective study and analysis of specific causes

Background: Pulseless electrical activity (PEA) cardiac arrest is defined as a cardiac arrest (CA) presenting with a residual organized electrical activity on the electrocardiogram. In the last decades, the incidence of PEA has regularly increased, compared to other types of CA like ventricular fibrillation or pulseless ventricular tachycardia. PEA is frequently induced by reversible conditions. The "4 (or 5) H" & "4 (or 5) T" are proposed as a mnemonic to asses for Hypoxia, Hypovolemia, Hypo- /Hyperkalaemia, Hypothermia, Thrombosis (cardiac or pulmonary), cardiac Tamponade, Toxins, and Tension pneumothorax. Other pathologies (intracranial haemorrhage, severe sepsis, myocardial contraction dysfunction) have been identified as potential causes for PEA, but their respective probability and frequencies are unclear and they are not yet included into the resuscitation guidelines. The aim of this study was to analyse the aetiologies of PEA out-of-hospital CA, in order to evaluate the relative frequencies of each cause and therefore to improve the management of patients suffering a PEA cardiac arrest. Method: This retrospective study was based on data routinely and prospectively collected for each PEMS intervention. All adult patients treated from January 1st 2002 to December 2012 31st by the PEMS for out-of-hospital cardiac arrest, with PEA as the first recorded rhythm, and admitted to the emergency department (ED) of the Lausanne University Hospital were included. The aetiologies of PEA cardiac arrest were classified into subgroups, based on the classical H&T's classification, supplemented by four other subgroups analysis: trauma, intra-cranial haemorrhage (ICH), non-ischemic cardiomyopathy (NIC) and undetermined cause. Results: 1866 OHCA were treated by the PEMS. PEA was the first recorded rhythm in 240 adult patients (13.8 %). After exclusion of 96 patients, 144 patients with a PEA cardiac arrest admitted to the ED were included in the analysis. The mean age was 63.8 ± 20.0 years, 58.3% were men and the survival rate at 48 hours was 29%. 32 different causes of OHCA PEA were established for 119 patients. For 25 patients (17.4 %), we were unable to attribute a specific cause for the PEA cardiac arrest. Hypoxia (23.6 %), acute coronary syndrome (12.5%) and trauma (12.5 %) were the three most frequent causes. Pulmonary embolism, Hypovolemia, Intoxication and Hyperkaliemia occurs in less than 10% of the cases (7.6 %, 5.6 %, 3.5%, respectively 2.1 %). Non ischemic cardiomyopathy and intra-cranial haemorrhage occur in 8.3 % and 6.9 %, respectively. Conclusions: According to our results, intra-cranial haemorrhage and non-ischemic cardiomyopathy represent noticeable causes of PEA in OHCA, with a prevalence equalling or exceeding the frequency of classical 4 H's and 4 T's aetiologies. These two pathologies are potentially accessible to simple diagnostic procedures (native CT-scan or echocardiography) and should be included into the 4 H's and 4 T's mnemonic.

Concerted changes in N and C primary metabolism in alfalfa (Medicago sativa) under water restriction

Although the mechanisms of nodule N2 fixation in legumes are now well documented, some uncertainty remains on the metabolic consequences of water deficit. In most cases, little consideration is given to other organs and, therefore, the coordinated changes in metabolism in leaves, roots, and nodules are not well known. Here, the effect of water restriction on exclusively N2-fixing alfalfa (Medicago sativa L.) plants was investigated, and proteomic, metabolomic, and physiological analyses were carried out. It is shown that the inhibition of nitrogenase activity caused by water restriction was accompanied by concerted alterations in metabolic pathways in nodules, leaves, and roots. The data suggest that nodule metabolism and metabolic exchange between plant organs nearly reached homeostasis in asparagine synthesis and partitioning, as well as the N demand from leaves. Typically, there was (i) a stimulation of the anaplerotic pathway to sustain the provision of C skeletons for amino acid (e.g. glutamate and proline) synthesis; (ii) re-allocation of glycolytic products to alanine and serine/glycine; and (iii) subtle changes in redox metabolites suggesting the implication of a slight oxidative stress. Furthermore, water restriction caused little change in both photosynthetic efficiency and respiratory cost of N2 fixation by nodules. In other words, the results suggest that under water stress, nodule metabolism follows a compromise between physiological imperatives (N demand, oxidative stress) and the lower input to sustain catabolism.

Pere Puig i Adam: ahir, avui i sempre

El tema central d'aquesta Lliçó serà doncs la figura emblemàtica del gran professor i matemàtic català Pere Puig i Adam (1900-1960). Si bé el centenari del seu naixement ja justifica per si mateix l'oportunitat de l'homenatge, hi ha un valor afegit al fet de parlar d'en Pere Puig i Adam : tots nosaltres com a catalans i com a gent de Matemàtiques podem unir a l'orgull de rememorar una figura senyera del nostre passat científic, el goig de conservar avui el seu patrimoni i el deure de projectar el seu exemple vers el nostre futur. Així doncs parlarem de qui va ser i qué va fer en Pere Puig i Adam, per després analitzar, amb ulls d'avui, la vigència i possible projecció del seu llegat.

A virtual mathematics learning environment for engineering students

Teachers of the course Introduction to Mathematics for Engineers at the UOC, an online distance-learning university, have designed,developed and tested an online studymaterial. It includes basic pre-university mathematics, indications for correct follow-up of this content and recommendations for finding appropriate support and complementarymaterials. Many different resources are used,depending on the characteristics of thecontents: Flash sequences, interactive applets, WIRIS calculators and PDF files.During the last semester, the new study material has been tested with 119 students. The academic results and student satisfaction have allowed us to outline and prioritise future lines of action.

A virtual learning environment for pregraduate mathematical students

Peer-reviewed

A Virtual Mathematics Learning Environment for Engineering Students

Teachers of the course Introduction to Mathematics for Engineers at the UOC, an online distance-learning university, have designed and produced online study material which includes basic pre-university mathematics, instructions for correct follow-up of this content and recommendations for finding appropiate support and complementary materials.

Interactive Calculus in a Virtual Learning Environment

The teaching of higher level mathematics for technical students in a virtual learningenvironment poses some difficulties, but also opportunities, now specific to that virtuality.On the other hand, resources and ways to do now manly available in VLEs might soon extend to all kinds of environments.In this short presentation we will discuss anexperience carried at Universitat Oberta deCatalunya (UOC) involving (an on line university), first, the translation of LaTeX written existent materials to a web based format(specifically, a combination of XHTML andMathML), and then the integration of a symbolic calculator software (WIRIS) running as a Java applet embedded in the materials, intending to achieve an evolution from memorising concepts and repetitive algorithms to understanding and experiment concepts and the use of those algorithms.

Técnicas de estudio en estudiantes de Secundaria que asisten a clases extraescolares en la provincia de Girona

Study techniques in out of school secondary education in the province of Girona. It is important to provide students with different ways to study so they can find the most appropriate method for them. Our research focuses on the study techniques used in secondary education by those students attending classes out of school time. In order to conduct this research, we have developed a general questionnaire after reviewing the existing literature on the topic. Some of the results obtained with this study are the following: adolescents attach great importance to learn study techniques, being summaries, diagrams and underlining the most well-known strategies for them, and mind maps and teamwork the least popular ones; they prefer dynamic teaching and learning methodologies, such as making interactive discussions; tutoring is the most valued element. Based on the results obtained with the study, we have developed some proposals to facilitate the work of the teacher when teaching study techniques and helping students to improve their academic performance

Hacia la alfabetización numérica en Educación Infantil: algunos avances en Chile y España

This article reviews the main contemporary international references on numerical knowledge acquisition in the kindergarten stage. Secondly it analyzes the instructions curricular in two countries-one Spanish-speaking Latin America (Chile) and one European (Spain) - to determine the extent to assume international benchmarks while comparing the curricula of both countries. Finally, it presents a proposal for intervention in the classroom that the combination of different learning contexts and processes to investigate mathematical teaching practices and most effective in promoting and numeracy of children from the earliest ages

Formal Education, Mismatch and Wages After Transition: Assessing the Impact of Unobserved Heterogeneity using Matching Estimators

This paper studies the incidence and consequences of the mismatch between formal education and the educational requirements of jobs in Estonia during the years 1997-2003. We fi nd large wage penalties associated with the phenomenon of educational mismatch. Moreover, the incidence and wage penalty of mismatches increase with age. This suggests that structural educational mismatches can occur after fast transition periods. Our results are robust for various methodologies, and more importantly regarding departures from the exogeneity assumptions inherent in the matching estimators used in our analysis

Práctica educativa y adquisición de la lengua de la escuela

El trabajo que presentamos pretende establecer e implamentar criterios respecto la organización escolar y la práctica educativa para mejorar las competencias básicas del alumnado extranjero que participa en las aulas de Cataluña con una gran diversidad respecto el conocimiento de la lengua de la escuela. En concreto, buscamos profundizar y localizar los factores y elementos relevantes para la organización escolar y la práctica educativa en escuelas plurilingües con estas características

Evolución y retos de la educación virtual : construyendo el e-learning del siglo XXI

Las autoras y autores de este libro ofrecen una descripción de la evolución general del e-learning apuntando los elementos clave hacia los que debe ir evolucionando. Parten de la experiencia y la práctica contrastada con las investigaciones sobre el tema. A lo largo de los distintos capítulos nos muestran cómo vive un estudiante virtual, su papel y la manera en que plantea y organiza sus actividades; nos acercan al profesorado analizando su rol en el diseño de la formación y la comunicación con los estudiantes; hablan de la colaboración, analizando cómo diseñar actividades colaborativas y señalando sus ventajas y límites; describen los diferentes recursos de aprendizaje que podemos disponer en el diseño de los cursos y, por último, acompañan nuestra mirada hacia el futuro próximo analizando las tendencias y los retos a los que debemos hacer frente para construir el e-learning del siglo XXI.