Acute ischemic cerebrovascular events on antiplatelet therapy: what is the optimal prevention strategy?

Even though patients who develop ischemic stroke despite taking antiplatelet drugs represent a considerable proportion of stroke hospital admissions, there is a paucity of data from investigational studies regarding the most suitable therapeutic intervention. There have been no clinical trials to test whether increasing the dose or switching antiplatelet agents reduces the risk for subsequent events. Certain issues have to be considered in patients managed for a first or recurrent stroke while receiving antiplatelet agents. Therapeutic failure may be due to either poor adherence to treatment, associated co-morbid conditions and diminished antiplatelet effects (resistance to treatment). A diagnostic work up is warranted to identify the etiology and underlying mechanism of stroke, thereby guiding further management. Risk factors (including hypertension, dyslipidemia and diabetes) should be treated according to current guidelines. Aspirin or aspirin plus clopidogrel may be used in the acute and early phase of ischemic stroke, whereas in the long-term, antiplatelet treatment should be continued with aspirin, aspirin/extended release dipyridamole or clopidogrel monotherapy taking into account tolerance, safety, adherence and cost issues. Secondary measures to educate patients about stroke, the importance of adherence to medication, behavioral modification relating to tobacco use, physical activity, alcohol consumption and diet to control excess weight should also be implemented.

PAX3/FOXO1 fusion gene status is the key prognostic molecular marker in rhabdomyosarcoma and significantly improves current risk stratification.

PURPOSE: To improve the risk stratification of patients with rhabdomyosarcoma (RMS) through the use of clinical and molecular biologic data. PATIENTS AND METHODS: Two independent data sets of gene-expression profiling for 124 and 101 patients with RMS were used to derive prognostic gene signatures by using a meta-analysis. These and a previously published metagene signature were evaluated by using cross validation analyses. A combined clinical and molecular risk-stratification scheme that incorporated the PAX3/FOXO1 fusion gene status was derived from 287 patients with RMS and evaluated. RESULTS: We showed that our prognostic gene-expression signature and the one previously published performed well with reproducible and significant effects. However, their effect was reduced when cross validated or tested in independent data and did not add new prognostic information over the fusion gene status, which is simpler to assay. Among nonmetastatic patients, patients who were PAX3/FOXO1 positive had a significantly poorer outcome compared with both alveolar-negative and PAX7/FOXO1-positive patients. Furthermore, a new clinicomolecular risk score that incorporated fusion gene status (negative and PAX3/FOXO1 and PAX7/FOXO1 positive), Intergroup Rhabdomyosarcoma Study TNM stage, and age showed a significant increase in performance over the current risk-stratification scheme. CONCLUSION: Gene signatures can improve current stratification of patients with RMS but will require complex assays to be developed and extensive validation before clinical application. A significant majority of their prognostic value was encapsulated by the fusion gene status. A continuous risk score derived from the combination of clinical parameters with the presence or absence of PAX3/FOXO1 represents a robust approach to improving current risk-adapted therapy for RMS.

Logistics Development in Finnish and Swedish Companies with Respect of Russia and Four Asian Countries: Traffic Flow and Warehousing Analysis from Current Situation and Likely Development Trends

On selvää, että tänä päivänä maailmankaupan painopiste on hiljalleen siirtymässä Aasiaan ja varsinkin Kiina on ollut huomion keskipisteessä. Erityisesti valmistavien yritysten perspektiivistä muutos on ollut merkittävä ja tämä tosiasia kasvattaa yrityksissä paineita luoda kustannustehokkaita toimitusketjuratkaisuja,joiden vasteaika on mahdollisimman lyhyt. Samaan aikaan kun tarkastellaan kuljetusvirtoja, huomattaan että maanosien välillä on suuri epätasapaino. Tämä on enimmäkseen seurausta suurten globaalisti toimivien yritysten toimitusketjustrategioista. Useimmat näistä toimijoista optimoivat verkostonsa turvautumalla 'paikalliseen hankintaan', jotta he voisivat paremmin hallita toimitusketjujaan ja saada näitä reagointiherkimmiksi. Valmistusyksiköillä onkin monesti Euroopassa pakko käyttää kalliita raaka-aineita ja puolivalmisteita. Kriittisiksi tekijöiksi osoittautuvat kuljetus- ja varastointikustannukset sekä näiden seurauksena hukka-aika, joka aiheutuu viivästyksistä. Voidakseen saavuttaa optimiratkaisun, on tehtävä päätös miten tuotteet varastoidaan: keskitetysti tai hajautetusti ja integroida tämä valinta sopivien kuljetusmuotojen kanssa. Aasiasta Pohjois-Eurooppaan on halpaa käyttää merikuljetusta, mutta operaatio kestää hyvin pitkään - joissain tapauksessa jopa kahdeksan viikkoa. Toisaalta lentokuljetus on sekä kallis että rajoittaa siirrettävien tuotteiden eräkokoa.On olemassa kolmaskin vaihtoehto, josta voisi olla ratkaisuksi: rautatiekuljetus on halvempi kuin lentokuljetus ja vasteajat ovat lyhyemmät kuin merikuljetuksissa. Tässä tutkimuksessa tilannetta selvitetään kyselyllä, joka suunnattiin Suomessa ja Ruotsissa toimiville yrityksille. Tuloksien perusteella teemme johtopäätökset siitä, mitkä kuljetusmuotojen markkinaosuudet tulevat olemaan tulevaisuudessa sekä luomme kuvan kuljetusvirroista Euroopan, Venäjän, Etelä-Korea, Intian, Kiinan ja Japanin välillä. Samalla on tarkoitus ennakoida sitä, miten tarkastelun kohteena olevat yritykset aikovat kehittää kuljetuksiaan ja varastointiaan tulevien vuosien aikana. Tulosten perusteella näyttää siltä, että seuraavan viiden vuoden kuluessa kuljetuskustannukset eivät merkittävissä määrin tule muuttuman ja meri- sekä kumipyöräkuljetukset pysyvät suosituimpina vaihtoehtoina.Kuitenkin lentokuljetusten osuus laskee hiukan, kun taas rautatiekuljetusten painotus kasvaa. Tulokset paljastavat, että Kiinassa ja Venäjällä kuljetettava konttimäärä kasvaa; Intiassa tulos on saman suuntainen, joskaan ei niin voimakas. Analyysimme mukaan kuljetusvirtoihin liittyvä epätasapaino säilyy Venäjän kuljetusten suhteen: yritykset jatkavat tulevaisuudessakin vientiperusteista strategiaansa. Varastoinnin puolella tunnistamme pienemmän muutoksen, jonka mukaan pienikokoisten varastojen määrät todennäköisesti vähenevät tulevaisuudessa ja kiinnostus isoja varastoja kohtaan lisääntyy. Tässä kohtaa on mainittava, että suomalaisilla yrityksillä on enemmän varastoja Keski- ja Itä-Euroopassa verrattuna ruotsalaisiin toimijoihin, jotka keskittyvät selkeämmin Länsi-Euroopan maihin. Varastoja yrityksillä on molemmissa tapaukissa paljolti kotimaassaan. Valitessaan varastojensa sijoituskohteita yritykset painottavat seuraavia kriteereitä: alhaiset jakelukustannukset, kokoamispaikan/valmistustehtaan läheisyys, saapuvan logistiikan integroitavuus ja saatavilla olevat logistiikkapalvelut. Tutkimuksemme lopussa päädymme siihen, että varastojen sijoituspaikat eivät muutu satamien rakenteen ja liikenneyhteyksien takia kovinkaan nopeasti.

Product Platform Development from the Product Lines' Perspective: Case of Switching Platform

In the era of fast product development and customized product requirements, the concept of product platform has proven its power in practice. The product platform approach has enabledcompanies to increase the speed of product introductions while simultaneously benefit from efficiency and effectiveness in the development and production activities. The product platforms are technological bases, which can be used to develop several derivative products, and hence, the differentiation can be pushed closer to the product introduction. The product platform development has some specific features, which differ somewhat from the product development of single products. The time horizon is longer, since the product platform¿slife cycle is longer than individual product's. The long time-horizon also proposes higher market risks and the use of new technologies increases the technological risks involved. The end-customer interface might be far away, but there is not a lack of needs aimed at the product platforms ¿ in fact, the product platform development is very much balancing between the varying needs set to it by thederivative products. This dissertation concentrated on product platform development from the internal product lines' perspective of a singlecase. Altogether six product platform development factors were identified: 'Strategic and business fit of product platform', 'Project communication and deliverables', 'Cooperation with product platform development', 'Innovativeness of product platform architecture and features', 'Reliability and quality of product platform', and 'Promised schedules and final product platform meeting the needs'. From the six factors, three were found to influence quite strongly the overall satisfaction, namely 'Strategic and business fit of product platform', 'Reliability and quality of product platform', and 'Promised schedules and final product platform meeting the needs'. Hence, these three factors might be the ones a new product platform development unit should concentrate first in order to satisfy their closest customers, the product lines. The 'Project communication and deliverables' and 'Innovativeness of product platform architecture and features' were weaker contributors to the overall satisfaction. Overall, the factors explained quite well the satisfaction of the product lines with product platform development. Along the research, several interesting aspects about the very basic nature of the product platform development were found. The long time horizon of the product platform development caused challenges in the area of strategic fIT - a conflict between the short-term requirements and long term needs. The fact that a product platform was used as basis of several derivative products resulted into varying needs, and hence the match with the needs and the strategies. The opinions, that the releases of the larger product lines were given higher priorities, give an interesting contribution to the strategy theory of powerand politics. The varying needs of the product lines, the strengths of them as well as large number of concurrent releases set requirements to prioritization. Hence, the research showed the complicated nature of the product platform development in the case unIT - the very basic nature of the product platform development might be its strength (gaining efficiency and effectiveness in product development and product launches) but also the biggest challenge (developing products to meet several needs). As a single case study, the results of this research are not directly generalizable to all the product platform development activities. Instead, the research serves best as a starting point for additional research as well as gives some insights about the factors and challengesof one product development unit.

Selective catalytic reduction of nitrogen oxides with ammonia in forced unsteady state reactors - Case based reasoning and mathematical model simulation reasoning

The application of forced unsteady-state reactors in case of selective catalytic reduction of nitrogen oxides (NOx) with ammonia (NH3) is sustained by the fact that favorable temperature and composition distributions which cannot be achieved in any steady-state regime can be obtained by means of unsteady-state operations. In a normal way of operation the low exothermicity of the selective catalytic reduction (SCR) reaction (usually carried out in the range of 280-350°C) is not enough to maintain by itself the chemical reaction. A normal mode of operation usually requires supply of supplementary heat increasing in this way the overall process operation cost. Through forced unsteady-state operation, the main advantage that can be obtained when exothermic reactions take place is the possibility of trapping, beside the ammonia, the moving heat wave inside the catalytic bed. The unsteady state-operation enables the exploitation of the thermal storage capacity of the catalyticbed. The catalytic bed acts as a regenerative heat exchanger allowing auto-thermal behaviour when the adiabatic temperature rise is low. Finding the optimum reactor configuration, employing the most suitable operation model and identifying the reactor behavior are highly important steps in order to configure a proper device for industrial applications. The Reverse Flow Reactor (RFR) - a forced unsteady state reactor - corresponds to the above mentioned characteristics and may be employed as an efficient device for the treatment of dilute pollutant mixtures. As a main disadvantage, beside its advantages, the RFR presents the 'wash out' phenomena. This phenomenon represents emissions of unconverted reactants at every switch of the flow direction. As a consequence our attention was focused on finding an alternative reactor configuration for RFR which is not affected by the incontrollable emissions of unconverted reactants. In this respect the Reactor Network (RN) was investigated. Its configuration consists of several reactors connected in a closed sequence, simulating a moving bed by changing the reactants feeding position. In the RN the flow direction is maintained in the same way ensuring uniformcatalyst exploitation and in the same time the 'wash out' phenomena is annulated. The simulated moving bed (SMB) can operate in transient mode giving practically constant exit concentration and high conversion levels. The main advantage of the reactor network operation is emphasizedby the possibility to obtain auto-thermal behavior with nearly uniformcatalyst utilization. However, the reactor network presents only a small range of switching times which allow to reach and to maintain an ignited state. Even so a proper study of the complex behavior of the RN may give the necessary information to overcome all the difficulties that can appear in the RN operation. The unsteady-state reactors complexity arises from the fact that these reactor types are characterized by short contact times and complex interaction between heat and mass transportphenomena. Such complex interactions can give rise to a remarkable complex dynamic behavior characterized by a set of spatial-temporal patterns, chaotic changes in concentration and traveling waves of heat or chemical reactivity. The main efforts of the current research studies concern the improvement of contact modalities between reactants, the possibility of thermal wave storage inside the reactor and the improvement of the kinetic activity of the catalyst used. Paying attention to the above mentioned aspects is important when higher activity even at low feeding temperatures and low emissions of unconverted reactants are the main operation concerns. Also, the prediction of the reactor pseudo or steady-state performance (regarding the conversion, selectivity and thermal behavior) and the dynamicreactor response during exploitation are important aspects in finding the optimal control strategy for the forced unsteady state catalytic tubular reactors. The design of an adapted reactor requires knowledge about the influence of its operating conditions on the overall process performance and a precise evaluation of the operating parameters rage for which a sustained dynamic behavior is obtained. An apriori estimation of the system parameters result in diminution of the computational efforts. Usually the convergence of unsteady state reactor systems requires integration over hundreds of cycles depending on the initial guess of the parameter values. The investigation of various operation models and thermal transfer strategies give reliable means to obtain recuperative and regenerative devices which are capable to maintain an auto-thermal behavior in case of low exothermic reactions. In the present research work a gradual analysis of the SCR of NOx with ammonia process in forced unsteady-state reactors was realized. The investigation covers the presentationof the general problematic related to the effect of noxious emissions in the environment, the analysis of the suitable catalysts types for the process, the mathematical analysis approach for modeling and finding the system solutions and the experimental investigation of the device found to be more suitable for the present process. In order to gain information about the forced unsteady state reactor design, operation, important system parameters and their values, mathematical description, mathematicalmethod for solving systems of partial differential equations and other specific aspects, in a fast and easy way, and a case based reasoning (CBR) approach has been used. This approach, using the experience of past similarproblems and their adapted solutions, may provide a method for gaining informations and solutions for new problems related to the forced unsteady state reactors technology. As a consequence a CBR system was implemented and a corresponding tool was developed. Further on, grooving up the hypothesis of isothermal operation, the investigation by means of numerical simulation of the feasibility of the SCR of NOx with ammonia in the RFRand in the RN with variable feeding position was realized. The hypothesis of non-isothermal operation was taken into account because in our opinion ifa commercial catalyst is considered, is not possible to modify the chemical activity and its adsorptive capacity to improve the operation butis possible to change the operation regime. In order to identify the most suitable device for the unsteady state reduction of NOx with ammonia, considering the perspective of recuperative and regenerative devices, a comparative analysis of the above mentioned two devices performance was realized. The assumption of isothermal conditions in the beginningof the forced unsteadystate investigation allowed the simplification of the analysis enabling to focus on the impact of the conditions and mode of operation on the dynamic features caused by the trapping of one reactant in the reactor, without considering the impact of thermal effect on overall reactor performance. The non-isothermal system approach has been investigated in order to point out the important influence of the thermal effect on overall reactor performance, studying the possibility of RFR and RN utilization as recuperative and regenerative devices and the possibility of achieving a sustained auto-thermal behavior in case of lowexothermic reaction of SCR of NOx with ammonia and low temperature gasfeeding. Beside the influence of the thermal effect, the influence of the principal operating parameters, as switching time, inlet flow rate and initial catalyst temperature have been stressed. This analysis is important not only because it allows a comparison between the two devices and optimisation of the operation, but also the switching time is the main operating parameter. An appropriate choice of this parameter enables the fulfilment of the process constraints. The level of the conversions achieved, the more uniform temperature profiles, the uniformity ofcatalyst exploitation and the much simpler mode of operation imposed the RN as a much more suitable device for SCR of NOx with ammonia, in usual operation and also in the perspective of control strategy implementation. Theoretical simplified models have also been proposed in order to describe the forced unsteady state reactors performance and to estimate their internal temperature and concentration profiles. The general idea was to extend the study of catalytic reactor dynamics taking into account the perspectives that haven't been analyzed yet. The experimental investigation ofRN revealed a good agreement between the data obtained by model simulation and the ones obtained experimentally.

Background, current status and future prospects of transgenic crop plant development

Les plantes transgèniques són una part integral de l’agricultura contemporània. Durant l’any 2006 més de noranta milions d’hectàrees de plantes transgèniques van ser cultivades en vint-i-un països. Des de la comercialització de la primera planta transgènica el 1996 els nivells d’adopció d’aquests cultius han augmentat anualment amb percentatges de dos dígits. El desenvolupament i la comercialització de les plantes transgèniques van lligats estretament al comerç mundial, a la globalització, a la disponibilitat de suficient menjar, a la protecció del medi ambient i del consumidor i a la propietat intel·lectual. En aquest article exposem els avenços més recents i les tendències actuals en el desenvolupament dels cultius transgènics i de la seva utilització. També ens fem ressò d’alguns assumptes no científics que s’han de solucionar abans que aquests cultius arribin al màxim del seu potencial, proporcionant una agricultura més sostenible i ecològica. Finalment, ressaltarem la importància de com les plantes transgèniques poden contribuir en la disponibilitat de menjar i en la millora de la pobresa en els països en vies de desenvolupament.

The Effect of Switching Ranibizumab to Aflibercept in Refractory Cases of Macular Edema Secondary to Ischemic Central Vein Occlusion.

Background: Macular edema resulting from central retinal vein occlusion is effectively treated with anti-vascular endothelial growth factor injections. However, some patients need monthly retreatment and still show frequent recurrences. The purpose of this study was to evaluate the visual and anatomic outcomes of refractory macular edema resulting from ischemic central retinal vein occlusion in patients switched from ranibizumab to aflibercept intravitreal injections. Patients and Methods: We describe a retrospective series of patients followed in the Medical Retina Unit of the Jules Gonin Eye Hospital for macular edema due to ischemic central retinal vein occlusion, refractory to monthly retreatment with ranibizumab, and changed to aflibercept. Refractory macular edema was defined as persistence of any fluid at each visit one month after last injection during at least 6 months. All patients had to have undergone pan-retinal laser scan. Results: Six patients were identified, one of whom had a very short-term follow-up (excluded from statistics). Mean age was 57 ± 12 years. The mean changes in visual acuity and central macular thickness from baseline to switch were + 20.6 ± 20.3 ETDRS letters and - 316.4 ± 276.6 µm, respectively. The additional changes from before to after the switch were + 9.2 ± 9.5 ETDRS letters and - 248.0 ± 248.7 µm, respectively. The injection intervals could often be lengthened after the switch. Conclusions: Intravitreal aflibercept seems to be a promising alternative treatment for macular edema refractory to ranibizumab in ischemic central retinal vein occlusion.

Vaihtosuuntauksen ja suodatuksen toteuttaminen tasasähkönjakeluverkossa

Pienjännitejakeluverkko Suomessa on toteutettu 400 V:n kolmivaiheisella vaihtosähköllä. Pienestä jännitteestä johtuen 20/0.4 kV:n muuntajat täytyy sijoittaa lähelle kuluttajaa, jotta siirtohäviöt eivät nouse liian suuriksi. Suuremman vaihto- tai tasajännitteen käyttö pienjännitejakelussa kasvattaisi verkon tehonsiirtokapasiteettia ja mahdollistaisi pidempien siirtomatkojen käytön. Käynnissä olevassa tutkimushankkeessa käsitellään vaihtoehtoa, jossa tasajännitettä käytettäisiin 20 kV:n verkon ja kuluttajan välisessä tehonsiirrossa ja kuluttajalla sijaitseva vaihtosuuntaaja muodostaisi tasasähköstä standardien mukaista yksi- tai kolmivaiheista vaihtosähköä. Tässä diplomityössä käsitellään tehoelektroniikan soveltamista kuluttajalle sijoitetussa vaihtosuuntaajassa. Työssä tarkastellaan yksivaiheisia invertteritopologioita, niiden ohjausta ja soveltamista erilaisissa vaihtosuuntaajaratkaisuissa sekä LC- ja LCL-suotimien soveltuvuutta invertterin lähtöjännitteen suodatukseen. Lisäksi esitellään erilaisia rakenneratkaisuja vaihtosuuntauksen toteutukseen ja tarkastellaan näiden järjestelmien vikatilanteita ja sähköturvallisuutta. Lopuksi käsitellään koko järjestelmän häviöitä ja hyötysuhdetta eri suodinkomponenteilla sekä kytkentätaajuuksilla ja esitellään laboratorioprototyyppi. Työssä saatiin selville, että puolisiltainvertteri ei sovellu suurten kondensaattorien vuoksi syöttämään verkkotaajuista kuormaa, vaan joudutaan käyttämään kokosiltainvertteriä. Kokosiltainvertterin ja LC- tai LCL-suotimen käsittävää kokonaisuutta tarkasteltaessa havaittiin, että pienimmät häviöt saavutetaan LC-suotimella 5 %:n ja LCL-suotimella 1 %:n särövaatimuksella. Hyötysuhdekäyrää tarkasteltaessa saatiin sama tulos läpi koko invertterin tehoalueen. Suotimen häviöiden tarkka laskenta on kuitenkin erittäin haasteellista, joten tulokset ovat suuntaa-antavia.

A European survey on current practices in epilepsy monitoring units and implications for patients' safety.

OBJECTIVE: This study aimed to survey current practices in European epilepsy monitoring units (EMUs) with emphasis on safety issues. METHODS: A 37-item questionnaire investigating characteristics and organization of EMUs, including measures for prevention and management of seizure-related serious adverse events (SAEs), was distributed to all identified European EMUs plus one located in Israel (N=150). RESULTS: Forty-eight (32%) EMUs, located in 18 countries, completed the questionnaire. Epilepsy monitoring unit beds are 1-2 in 43%, 3-4 in 34%, and 5-6 in 19% of EMUs; staff physicians are 1-2 in 32%, 3-4 in 34%, and 5-6 in 19% of EMUs. Personnel operating in EMUs include epileptologists (in 69% of EMUs), clinical neurophysiologists trained in epilepsy (in 46% of EMUs), child neurologists (in 35% of EMUs), neurology and clinical neurophysiology residents (in 46% and in 8% of EMUs, respectively), and neurologists not trained in epilepsy (in 27% of EMUs). In 20% of EMUs, patients' observation is only intermittent or during the daytime and primarily carried out by neurophysiology technicians and/or nurses (in 71% of EMUs) or by patients' relatives (in 40% of EMUs). Automatic detection systems for seizures are used in 15%, for body movements in 8%, for oxygen desaturation in 33%, and for ECG abnormalities in 17% of EMUs. Protocols for management of acute seizures are lacking in 27%, of status epilepticus in 21%, and of postictal psychoses in 87% of EMUs. Injury prevention consists of bed protections in 96% of EMUs, whereas antisuffocation pillows are employed in 21%, and environmental protections in monitoring rooms and in bathrooms are implemented in 38% and in 25% of EMUs, respectively. The most common SAEs were status epilepticus reported by 79%, injuries by 73%, and postictal psychoses by 67% of EMUs. CONCLUSIONS: All EMUs have faced different types of SAEs. Wide variation in practice patterns and lack of protocols and of precautions to ensure patients' safety might promote the occurrence and severity of SAEs. Our findings highlight the need for standardized and shared protocols for an effective and safe management of patients in EMUs.

Place actuelle de la papillotomie chirurgicale transduodénale [Current status of surgical transduodenal papillotomy].

The treatment of biliary lithiasis has changed during the past 20 years. Cholecystectomy remains the gold standard for cholelithiasis, but many options are available for calculi of the common bile duct. Among them are surgical open or laparoscopic choledochotomy, biliary-enteric anastomosis, transduodenal sphincterotomy (TDS), endoscopic sphincterotomy. With the aim to describe the current place of TDS, we reviewed the patients operated on in our department between 1976 and 1992. We found 78 patients with a mean age of 58 years (26-89 years). 34 (43%) of them had acute cholecystitis, with 26 being operated on urgently. 47 (60%) were jaundiced, 15 (19%) had pancreatitis and 12 (15%) had cholangitis before operation. Indications for TDS have been impacted stone or absence of progression of the contrast medium on intraoperative cholangiography in 71 patients (91%). 3 patients died (1 pulmonary embolism, 1 sepsis of pulmonary origin, 1 MOF syndrome complicating preoperative necrotizing pancreatitis). 30 patients (38%) had complications, of which 20 were directly related to TDS. Hemorrhage occurred in 4 cases, and resolved spontaneously without transfusion. Hyperamylasemia occurred in 17 instances, but clinical pancreatitis developed in only 1 case, with complete resolution. 1 duodenal fistula healed after conservative therapy. No death is attributable directly to TDS. Today, the importance of endoscopic sphincterotomy is increasing. This retrospective study shows that TDS, if performed with caution, does not increase the operative risks even in emergent operations. During surgical exploration of the common bile duct, TDS is indicated to remove an impacted stone, or as a bilio-enteric anastomosis if multiple stones are present with a thin common duct.(ABSTRACT TRUNCATED AT 250 WORDS)

Desenvolupament des de zero d'un sistema Linux per ser instal·lat als ordinadors de les aules ordinàries d'un institut de secundària

Exposició dels passos que cal seguir per construir un sistema GNU/Linux adreçat a les aules dels instituts de secundària prenent com a base Linux From Scratch versió 7.5.