Restoration of malperfusion during repair of thoracic aortic dissection

A 46- year old male, during intense physical activity, sustained malperfusion of the lower extremities from Type A thoracic aortic dissection. We took him to the operating room. emergently and perfusing both lower extremities using a modified straight graft with side to side anastomosis to one limb and end to side anastomoses to the inflow perfusion and contralateral limb. The patient was successfully discharged and remained to be doing well. for four years.</jats:p

Left Subclavian Artery Revascularization in Preparation for Coronary Artery Bypass Grafting

Coronary subclavian steal syndrome is a rare but important condition that occurs after a left internal mammary artery (LIMA) to coronary artery bypass in the setting of a stenotic left subclavian artery. The lack of blood flow through the subclavian artery causes the reversal of flow in the LIMA so that it essentially steals blood from the myocardium. In order to avoid this complication, many surgeons now opt to either revascularize the stenotic subclavian artery prior to coronary artery bypass grafting or to use an alternate vessel as the bypass graft. Here, we present the case of an asymptomatic patient with poor exercise tolerance who was recently diagnosed with both triple-vessel coronary disease and peripheral arterial disease, which was most notably characterized by occlusion of the left subclavian artery. This case demonstrates the surgical management of this complex clinical entity.</jats:p

Cognitive and metacognitive aspects of the development of lifelong learning competencies in law students

Lifelong learning is one of the main trends in educational and social policy in Europe, aimed at ensuring professional realization and social integrity of an individual. The article describes cognitive and metacognitive aspects of the formation of learning competence, as well as predisposition of law students to lifelong learning. A survey of 218 students and masters was conducted, data on the most popular and effective forms of knowledge acquisition (experience of formal, nonformal and informal learning over the past year), plans for further education and career development were collected. The dynamics of learning at different years of study is described. A group of students with pronounced learning and focus on lifelong learning (45% of the sample) was identified. A comparative analysis of two samples was carried out and qualities that could be considered markers of the LLL orientation were identified: a high level of metacognitive knowledge and metacognitive activity, reflective competence (at the cognitive, metacognitive and personal level), internal involvement in learning, focus on achieving professionalism and personal development, general self-efficacy, the prevalence of progressive and creative motives over consumer ones. Conclusions are drawn about the predominant role of metacognitions and personality determinants in the formation of lifelong learning competency among students. Reflection aimed at recognizing one’s own cognitive processes and understanding their contribution to personal development is the main mechanism for the formation of meta-cognitive abilities. The results obtained in the study determine the ways of pedagogical support and psychological intervention to ensure the development of lifelong learning competencies in different categories of students

Chronic activation of peroxisome proliferator-activated receptor-alpha with fenofibrate prevents alterations in cardiac metabolic phenotype without changing the onset of decompensation in pacing-induced heart failure.

Severe heart failure (HF) is characterized by profound alterations in cardiac metabolic phenotype, with down-regulation of the free fatty acid (FFA) oxidative pathway and marked increase in glucose oxidation. We tested whether fenofibrate, a pharmacological agonist of peroxisome proliferator-activated receptor-alpha, the nuclear receptor that activates the expression of enzymes involved in FFA oxidation, can prevent metabolic alterations and modify the progression of HF. We administered 6.5 mg/kg/day p.o. fenofibrate to eight chronically instrumented dogs over the entire period of high-frequency left ventricular pacing (HF + Feno). Eight additional HF dogs were not treated, and eight normal dogs were used as a control. [3H]Oleate and [14C]Glucose were infused intravenously to measure the rate of substrate oxidation. At 21 days of pacing, left ventricular end-diastolic pressure was significantly lower in HF + Feno (14.1 +/- 1.6 mm Hg) compared with HF (18.7 +/- 1.3 mm Hg), but it increased up to 25 +/- 2 mm Hg, indicating end-stage failure, in both groups after 29 +/- 2 days of pacing. FFA oxidation was reduced by 40%, and glucose oxidation was increased by 150% in HF compared with control, changes that were prevented by fenofibrate. Consistently, the activity of myocardial medium chain acyl-CoA dehydrogenase, a marker enzyme of the FFA beta-oxidation pathway, was reduced in HF versus control (1.46 +/- 0.25 versus 2.42 +/- 0.24 micromol/min/gram wet weight (gww); p < 0.05) but not in HF + Feno (1.85 +/- 0.18 micromol/min/gww; N.S. versus control). Thus, preventing changes in myocardial substrate metabolism in the failing heart causes a modest improvement of cardiac function during the progression of the disease, with no effects on the onset of decompensation