Analysing Professional Discourse in Interactive Learning: Integrating Historical and Situational Perspectives

Peer-reviewed

Initial experience with hybrid surgery in congenital heart disease in a single center : P171

Introduction: A hybrid intervention is a joint procedure involving the interventional cardiologist and the cardiac surgeon. At our institution we have opted for this type of approach in congenital heart disease since 2005. We report here our initial experience. Cases: 1. A 3 year old boy with double aortic arch and multiple muscular ventricular septal defects (VSD),was readdressed for pulmonary band (PAB) removal and residual VSD closure after previous palliation. After surgical removal of the PAB, the surgeon provided a minimal transventricular access for placement of a 6mm Amplatzer® muscular VSD occluder by the cardiologist under transoesophageal guidance. The patient was extubated the same day and discharged after 5 days. 2. An 8 year old girl with Williams syndrome was followed for two large VSDs and severe peripheral pulmonary arteries (PA) stenosis. The membranous VSD was closed surgically, the muscular VSD during the same operation by direct placement of a 12 mm Amplatzer® muscular VSD occluder. During rewarming, balloon angioplasty of peripheral PA stenosis was achieved under fluoroscopy. Patient was extubated the following day and discharged after 8 days. 3. A 9 year old boy post tetralogy of Fallot repair had severe distal stenosis of the right ventricular to PA conduit.With patient on partial cardiopulmonary bypass, an incision was made on the conduit and a CP 8 Zig 16 stent placed on the stenosis. The child passed on full bypass and the definitive placement of the stent achieved. The child was extubated at the end of the intervention and discharged after 6 days. 4. A newborn presented at 2 days life with complex aortic arch anatomy: left aortic arch and right descending thoracic aorta perfused directly from a right arterial duct and left PA atresia. The arterial duct was stented with a Genesis XD stent dilated at 7mm. Two days later the cardiac surgeon made banded the right PA. The child was extubated after the operation and discharged a week later. Conclusion: Hybrid approach opens new ways of correction or palliation in congenital heart disease with encouraging results and less morbidity.

The hemodynamics of septic shock: a historical perspective.

In the late 19th century, it was already known that severe infections could be associated with cardiovascular collapse, a fact essentially attributed to cardiac failure. A major experimental work in the rabbit, published by Romberg and Pässler in 1899, shifted attention to disturbed peripheral vascular tone as the mechanism of hypotension in these conditions. In the first half of the 20th century, great progresses were made in the pathophysiologic understanding of hemorrhagic and traumatic shocks, while researchers devoted relatively little attention to septic shock. Progress in the hemodynamic understanding of septic shock resumed with the advent of critical care units. The hyperdynamic state was recognized in the late fifties and early sixties. The present short review ends with landmark studies by Max Harry Weil, demonstrating the importance of venous pooling, and John H. Siegel, which introduced the concept of deficient peripheral utilization of oxygen, inspiring later work on the microvascular disturbances of septic shock.

Endovascular treatment of symptomatic intracranial arterial stenosis: six-year experience in a single-center series of 42 consecutive patients with acute and mid-term results.

BACKGROUND: The limitations of the medical management of symptomatic intracranial arterial stenosis encourage the development of new therapeutic strategies such as intracranial stenting. OBJECTIVE: To report and analyze the results of a series of 42 patients treated with 3 different endovascular techniques: isolated angioplasty, balloon-expandable coronary stents, and the Wingspan self-expandable intracranial stent system. METHODS: Forty-two patients presenting with symptomatic intracranial arterial stenosis were treated with one of these techniques. Computed tomography angiography was performed 6 months after the procedure, and the clinical neurological statuses were categorized using the modified Rankin Scale and the National Institutes of Health Stroke Scale. RESULTS: A total of 42 lesions were treated: 9 with isolated angioplasty, 14 with balloon-expandable coronary stents, and 19 with Wingspan self-expandable intracranial stents. The mean patient age was 62.9 years, and the mean arterial diameter stenosis was 73.9%. Technical success was achieved in 97.6% of the patients. The overall incidence of procedural complications was 21.4%, and the postoperative permanent morbidity/mortality rate was 7.1%. There were 3 cases of in-stent thrombosis (1 fatal) and 5 cases of asymptomatic restenosis (11.9%), 3 in the isolated angioplasty group and 2 in the Wingspan self-expandable intracranial stent group (mean follow-up 20.4 months). The rate of restenosis was higher in the angioplasty group (33%) than in the coronary (0%) and Wingspan stent (10.5%) groups. CONCLUSION: Endovascular treatment of symptomatic intracranial stenosis has significant overall morbidity and mortality rates. Nevertheless, the very critical natural history of severe refractory lesions and the relatively favorable postoperative evolution suggest that it should be considered the first alternative strategy in cases in which medical therapy has failed.

Photographic rectification of the graphic documentation of historical and archaeological heritage: The case of the southern facade of the Praetorium tower in Tarragona (Tarraco, Hispania Citerior)

This article details the use of photographic rectification as support for the graphic documentation of historical and archaeological heritage and specifically the southern facade of the Torre del Pretori (Praetorium Tower) in Tarragona. The Praetorium Tower is part of a larger monumental complex and one of the towers that connected different parts of the Tarraco Provincial Forum, the politic-administrative centre of the ancient capital of Hispania Citerioris. It is therefore a valuable example of the evolution of Roman urban architecture. The aim of this project is to provide accurate graphic documentation of the structure to facilitate the restoration and conservation of the tower, as well as to provide a more profound architectural and archaeological understanding of the Roman forum. The use of photographic rectification enabled us to overcome the spatial and time difficulties involved in collecting data caused by the size and location of the building. Specific software made it easier to obtain accurate two-dimensional images. For this reason, in our case, photographic rectification helped us to make a direct analysis of the monument and facilitated interpretation of the architectural stratigraphy. We currently separate the line of research into two concepts: the construction processes and the architecture of the building. The documentation collected permitted various analyses: the characterisation of the building modules, identification of the tools used to work the building materials, etc. In conclusion, the use of orthoimages is a powerful tool that permits the systematic study of a Roman building that has evolved over the centuries and is now in a modern urban context.

Organisaation innovatiivisuutta edistävät ja estävät tekijät. Case Technology Business Research Center

Tämän työn toimeksiantajaorganisaatio oli Lappeenrannan teknillisen yliopiston alainen, kauppatieteitä, teknologiaa ja tuotantotaloutta työssään yhdistävä tutkimusyksikkö, Technology Business Research Center, TBRC. Erään innovatiivisuustutkimusprojektin (InnoSpring) yhteydessä haluttiin selvittää myös oman tutkimusyksikön innovatiivisuuteen vaikuttavia, edistäviä ja estäviä tekijöitä. Tutkielman tavoitteena oli kartoittaa niitä seikkoja, jotka organisaation - tässä tapauksessa yliopiston tutkimusyksikön - henkilökunnan, projektityöntekijöiden, projektipäälliköiden sekä johdon mukaan vaikuttavat yksikön kykyyn luoda ja omaksua uutta, sen innovatiivisuuteen. Työ toteutettiin focus group-ryhmähaastattelumenetelmällä (kvalitatiivinen tutkimus), joihin osallistuivat omina ryhminään työntekijätaso, projektipäälliköt sekä johto.Haastattelut äänitettiin, litteroitiin ja koodattiin Atlas-Ti-ohjelmistolla. Loppuraportti verkostokuvineen luovutettiin tutkimuslaitokselle heinäkuussa 2005. Ryhmäkeskustelun teemoista ja kysymysten muodosta johtuen tulokset käsittelivät niin tutkimusyksikön nykyistä tilaa kuin eräänlaista "toivetilaa", millainen olisi ihanteellinen ja innovatiivinen työpaikka. Merkillepantavaa oli, että työssä tuli systemaattisesti esiin enemmän innovatiivisuutta edistäviä kuin ehkäiseviä seikkoja - vaikka osa edistävistä seikoista koskikin nimenomaan "toivetilaa". Keskustelluimpia teemoja olivat johtajuus,tavoitteellisuus ja strategian, yhteisen suunnan tarve. Samoin olemassa olevienprosessien kehittäminen, osaamisen (niin oman kuin koko organisaationkin) kokoaminen ja kehittäminen edelleen sekä tulosten jalkauttaminen.

Del gimnàs al lleure-salut. Centres de Fitness, Fitness Center, Fitness & Wellness, Spa, Balnearis, Centres de Talassoteràpia, Curhotel

Actualment, el sector “gimnasos i centres esportius” constitueix una parcel·la de gran importància dins del panorama de la indústria del lleure. L’apogeu creixent del sector lleure-salut s’està produint des de fa diverses dècades, de manera que a hores d’ara el lleure i el temps de lleure, i l’exercici físic i l’esport com a lleure són predictors de qualitat de vida. En aquest sentit, podem relacionar i hem de relacionar el lleure amb la qualitat de vida, un concepte multidimensional que inclou tots els àmbits de la vida humana (estat de la salut, benestar, participació social, condicions de vida...). En aquest treball analitzem de quina forma han anat evolucionat els centres dedicats a la practica esportiva i a la salut. Un sector que des de l’antiguitat fins als nostres dies ha hagut d’anar adaptant i ampliant la seva oferta d’activitats i productes, segons les necessitats dels usuaris.

Cyclicity versus center problem

We prove that there are one-parameter families of planar differential equations for which the center problem has a trivial solution and on the other hand the cyclicity of the weak focus is arbitrarily high. We illustrate this phenomenon in several examples for which this cyclicity is computed.