Surgical repair for aortic dissection accompanying a right-sided aortic arch

Aortic anomaly in which a right-sided aortic arch associated with Kommerell's diverticulum and aberrant left subclavian artery is rare. The present report describes a patient with type-B aortic dissection accompanying aortic anomalies consisting of right-sided aortic arch and the left common carotid and left subclavian artery arising from Kommerell's diverticulum. As dissecting aortic aneurysm diameter increased rapidly, Single-stage surgical repair of extensive thoracic aorta was performed through median sternotomy and right posterolateral fifth intercostal thoracotomy, yielding favorable results. Our surgical procedures are discussed

Hypoinsulinemia Regulates Amphetamine-Induced Reverse Transport of Dopamine

The behavioral effects of psychomotor stimulants such as amphetamine (AMPH) arise from their ability to elicit increases in extracellular dopamine (DA). These AMPH-induced increases are achieved by DA transporter (DAT)-mediated transmitter efflux. Recently, we have shown that AMPH self-administration is reduced in rats that have been depleted of insulin with the diabetogenic agent streptozotocin (STZ). In vitro studies suggest that hypoinsulinemia may regulate the actions of AMPH by inhibiting the insulin downstream effectors phosphotidylinositol 3-kinase (PI3K) and protein kinase B (PKB, or Akt), which we have previously shown are able to fine-tune DAT cell-surface expression. Here, we demonstrate that striatal Akt function, as well as DAT cell-surface expression, are significantly reduced by STZ. In addition, our data show that the release of DA, determined by high-speed chronoamperometry (HSCA) in the striatum, in response to AMPH, is severely impaired in these insulin-deficient rats. Importantly, selective inhibition of PI3K with LY294002 within the striatum results in a profound reduction in the subsequent potential for AMPH to evoke DA efflux. Consistent with our biochemical and in vivo electrochemical data, findings from functional magnetic resonance imaging experiments reveal that the ability of AMPH to elicit positive blood oxygen level–dependent signal changes in the striatum is significantly blunted in STZ-treated rats. Finally, local infusion of insulin into the striatum of STZ-treated animals significantly recovers the ability of AMPH to stimulate DA release as measured by high-speed chronoamperometry. The present studies establish that PI3K signaling regulates the neurochemical actions of AMPH-like psychomotor stimulants. These data suggest that insulin signaling pathways may represent a novel mechanism for regulating DA transmission, one which may be targeted for the treatment of AMPH abuse and potentially other dopaminergic disorders

Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe†‡

OBJECTIVES To conduct a survey across European cardiac centres to evaluate the methods used for cerebral protection during aortic surgery involving the aortic arch. METHODS All European centres were contacted and surgeons were requested to fill out a short, comprehensive questionnaire on an internet-based platform. One-third of more than 400 contacted centres completed the survey correctly. RESULTS The most preferred site for arterial cannulation is the subclavian-axillary, both in acute and chronic presentation. The femoral artery is still frequently used in the acute condition, while the ascending aorta is a frequent second choice in the case of chronic presentation. Bilateral antegrade brain perfusion is chosen by the majority of centres (2/3 of cases), while retrograde perfusion or circulatory arrest is very seldom used and almost exclusively in acute clinical presentation. The same pumping system of the cardio pulmonary bypass is most of the time used for selective cerebral perfusion, and the perfusate temperature is usually maintained between 22 and 26°C. One-third of the centres use lower temperatures. Perfusate flow and pressure are fairly consistent among centres in the range of 10-15 ml/kg and 60 mmHg, respectively. In 60% of cases, barbiturates are added for cerebral protection, while visceral perfusion still receives little attention. Regarding cerebral monitoring, there is a general tendency to use near-infrared spectroscopy associated with bilateral radial pressure measurement. CONCLUSIONS These data represent a snapshot of the strategies used for cerebral protection during major aortic surgery in current practice, and may serve as a reference for standardization and refinement of different approache

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Información Investigador: Murzi Buitriago, Euro H.

Universitario57 - 2001Mayo de 2004Médico+58 274 2403111Facultad de [email protected]

Understanding international students' barriers in their first-year at a U.S. University

International students in the United States face several challenges when transitioning into college. The purpose of this paper is to understand how international students perceive the barriers they face in their first year attending college in the United States and to learn about the resources international students are utilizing for support. Data were collected qualitatively through individual interviews with 6 first-year international students. Data were transcribed and analysed using thematic analysis procedures. Results suggest that the barriers international engineering students face when attending college in the United States are complex and are summarized in terms of academic challenges, social and emotional adaptability, cultural clashes, and relationships with domestic students. Our findings provide implications for engineering education research on how to study international students' barriers, for practice on how to make first year classrooms more inclusive, and for advising on how to provide support that is required for international students

The Knowability Paradox in the light of a Logic for Pragmatics

The Knowability Paradox is a logical argument showing that if all truths are knowable in principle, then all truths are, in fact, known. Many strategies have been suggested in order to avoid the paradoxical conclusion. A family of solutions –ncalled logical revision – has been proposed to solve the paradox, revising the logic underneath, with an intuitionistic revision included. In this paper, we focus on so-called revisionary solutions to the paradox – solutions that put the blame on the underlying logic. Specifically, we analyse a possibile translation of the paradox into a modified intuitionistic fragment of a logic for pragmatics (KILP) inspired by Dalla Pozza and Garola in 1995. Our aim is to understand if KILP is a candidate for the logical revision of the paradox and to compare it with the standard intuitionistic solution to the paradox

Give Them Grace: An Autoethnographic Study on Instructors’ Adaptation to Online Technology in Education as a Result of COVID-19

This research paper describes the study of instructors' experiences in K-12 and higher education as they adapted to new technology while education shifted to an online format as a result of COVID-19. This autoethnographic study sought to understand commonalities in five instructors' attitudes toward online education tools, external variables that affected their adaptation, and their overall perceptions of the technology and its usefulness. The research design was guided by the Technology Acceptance Model (TAM). Deductive analysis of reflections, interviews, and focus group transcripts demonstrated the presence of TAM constructs in participants' experiences. Participants recognized the usefulness of various technologies and tools but did not inherently view them or the experience of teaching online in a positive way compared to teaching in-person. Participants noted the need to practice empathy with their students and themselves, the effect that external factors (such as administrative support) had on their acceptance of technologies, and the lessons learned on how their instruction has changed as a result of online instruction.Immediate accessThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Developing global engineers: a comparison between Chile, Scotland, and the United States

Engineering-accredited programmes are reviewed every 4-5 years by professional bodies with the aim of assuring standards that guarantee that graduate engineers can fulfill the highest technical demands of the industry workforce in order to achieve a sustainable economy and society. The approaches to develop these require global engineering competences, such as international and intercultural teamwork, language skills, critical thinking, and ethical and human-centered problem solving, are proving insufficient to meet the emerging challenges that this century's society is facing. To develop these global competences, engineering programmes have been working on including physical mobility such as study abroad opportunities and virtual mobility such as Collaborative Online International Learning (COIL) together with other experiential learning interventions in order to provide the necessary requirements to become a global engineer. The aim of this practice paper is to compare and to discuss how three different universities, located in Chile, Scotland, and the United States have designed their engineering programmes to develop global engineers. This research provides preliminary results, based on an autoethnographic approach to analyse the curriculum design approaches and structures, that highlight opportunities (virtual mobility: Collaborative Online International Learning, COIL) as well as more country- and institution-specific approaches (Engineers Without Borders) that support the development of these global engineering competences. This research is part of a larger investigation that will analyse how engineering graduates perceive their development of global engineering competences