Restoring Access in a Thrombosed Hemodialysis Reliable Outflow Graft Using the InThrill Thrombectomy System.

Arteriovenous grafts (AVGs) provide vascular access for hemodialysis in patients with end-stage renal disease (ESRD). However, vascular access thrombosis often occurs, requiring frequent reinterventions to maintain access patency. This report describes the successful use of the InThrill Thrombectomy System (Irvine, CA: Inari Medical) for macerating and removing thrombus from an occluded and heavily thrombosed AVG. A 47-year-old male was sent to our institute for a thrombosed right upper extremity arteriovenous access with a HeRO graft (South Jordan, UT: Merit Medical). The patient underwent interventions for the thrombosis of the same AVG two weeks prior using an Aspirex catheter (Franklin Lakes, NJ: BD Medical), and again two days prior with a Fogarty balloon catheter (Irvine, CA: Edwards Lifesciences). The patient presented with a recurrent completely occluded AVG. Using the InThrill Thrombectomy System and balloon angioplasty, the stenosis was reduced to less than 20%, resulting in brisk flow. The patient tolerated the procedure well without complication and recovered in the holding area with no acute distress. He was discharged the same day on anticoagulation therapy. This study highlights the successful use of the InThrill Thrombectomy System for the treatment of thrombosed AVG in a hemodialysis-dependent ESRD patient. The device was easy to use and efficient. Device and procedure times are unparalleled when compared with thrombolytic-based procedures. The patient's AVG remained patent at a 14-day follow-up.

Vascular access challenges in hemodialysis patients with superior vena cava syndrome.

BACKGROUND: Superior vena cava syndrome in hemodialysis patients resulting from previous or current use of a tunneled central vein catheter is a rare but potentially severe condition. Two aspects have to be addressed during management and treatment: the restoration of central venous flow and the creation of an alternative vascular access to guarantee hemodialysis. RESEARCH DESIGN: Conforming to the current guidelines and literature, we present a stepwise approach and discuss therapeutic options. The removal of the tunneled central vein catheter should be attempted and a native vascular access created whenever feasible. RESULTS: First, an upper extremity AVF should be preserved or, as in our case, made functional. Endovascular treatment of CVSO should primarily consist of balloon dilatation. Placement of a stent or stent graft should be considered as a secondary option. HeRO graft placement may be considered in recurrent CVSO and recanalization with a Surfacer. LL-AVF or AVG need to be discussed and may be an alternative for certain HD patients when the risk of lower limb ischemia and infection is considered. CONCLUSION: Several therapeutic options are available and the basic principles are well established in the literature, although the level of evidence is not high. Therefore, we propose a stepwise and interdisciplinary approach to guide the challenging decision-making process in SVC.

Association between performance measures and clinical outcomes in patients with heart failure in China: Results from the HERO study.

BACKGROUND: There is great heterogeneity in the quality of care among hospitals in China, but studies on the performance measures and prognosis of patients with heart failure (HF) are still deficient. HYPOTHESIS: Performance measures have been used as a guideline to clinicans, however, the association between them and outcomes among HF patients in China remains unclear. METHODS: We analyzed 4497 patients with HF from the Heart Failure Registry of Patient Outcomes study. Performance measures were determined according to the guidelines, and the patients were divided into four groups based on a composite performance score. Multiple imputation and Cox proportional-hazard regression models were used to assess the association between the performance measures and clinical outcomes. RESULTS: Overall, only 12.5% of patients met the top 25% of the performance measures, whereas 33.5% of patients met the bottom 25% of the measures. A total of 992 (22.2%) patients died within 1 year, involving a larger proportion of patients who had met only the bottom 25% of the performance measures than had met the top 25% (27.0% vs. 16.3%, respectively). The patients who met the top 25% of the measures had a lower 1-year mortality rate (adjusted hazard ratio: 0.78, 95% confidence interval: 0.61-0.98). CONCLUSIONS: The association between performance measures and mortality appeared to follow a dose-response pattern with a larger degree of compliance with performance measures being associated with a lower mortality rate in patients with HF. Accordingly, the quality of care for patients with HF in China needs to be further improved.

The HeRO score: Enhancing prognosis and predicting nosocomial infections in newborns: Insights from the neonatal intensive care unit.

BACKGROUND: Nosocomial infections pose a significant health risk to neonates, and traditional biomarkers used for diagnosis often fall short in predicting such infections. In this study, we evaluate the efficacy of the HeRO (Heart Rate Observation score), a novel predictive tool for late-onset neonatal sepsis, in improving neonatal prognosis and reducing morbidity and mortality rates. METHODS: A prospective study was conducted from September 2020 to May 2021, reviewing patient evaluation for all neonates admitted to the neonatal intensive care unit during this period after the implementation of the HeRO score. RESULTS: Of the 100 cases studied, preterm neonates accounted for the majority (51%), with 65% being born at gestational age greater than 32 weeks and 35% born at less than 32 weeks. A male-to-female sex ratio of 1.56. Perinatal asphyxia was the primary reason for initial hospitalization, often accompanied by pulmonary neonatal infection. The HeRO score showed an increase within 24 hours of the onset of clinical signs of sepsis in 52% of cases and after 24 hours in 47% of cases. In 51% of cases, the score exhibited an increase greater than 2. Blood cultures were positive in 91% of cases. The duration of hospital stays for newborns ranged from 7 to 42 days, with an average stay for newborns whose score rose 24 hours before clinical signs. CONCLUSION: This study highlights the significance of utilizing the HeRO score for predicting nosocomial infections in neonates, despite the possibility of false assumptions. Implementing the HERO score enables early intervention, thereby improving the assumption of responsibility and reducing neonatal morbidity and mortality rates.

Preliminary Effectiveness of a Brief School-Based HERO Intervention: Improving the Wellbeing of Final Year Adolescent Female Students.

Young people face multiple challenges, including appearance dissatisfaction, academic stressors, anxiety and depression. These challenges may increase during the final year of high school and may have become further exacerbated by the COVID-19 pandemic. This study examines the preliminary effectiveness of a brief, uncontrolled school-based intervention aimed at enhancing Psychological Capital (PsyCap), consisting of positive resources of hope, self-efficacy, resilience and optimism (HERO), and reducing mental health symptoms among female year 12 students (n = 95, Mage = 16.78, SD = 0.45). Outcomes on measures of HERO and secondary outcomes of flourishing, appearance dissatisfaction, anxiety and depression were measured at pre and post-intervention. In the overall cohort, no significant changes were found on the HERO outcomes or flourishing post-intervention, while symptoms of depression, anxiety and appearance dissatisfaction decreased significantly. For students with higher baseline anxiety, optimism and anxiety symptoms improved significantly at post-intervention. However, students with lower baseline anxiety experienced significant decreases in self-efficacy and optimism, as well as a significant increase in anxiety symptoms post-intervention. Baseline depression levels did not impact intervention outcomes. The findings, although mixed and limited by the lack of control group, suggest that a brief intervention grounded in PsyCap theory may improve student wellbeing under challenging circumstances.

Comparing the EdgeFile X3, GenEndo, HeroGold, and ProTaper Gold Rotary Instruments Regarding the Effect of Different Concentrations and Temperature of NaOCl on Cyclic Fatigue Resistance.

AIM: This research was carried out with the objective of comparison between GenEndo, Protaper Gold, Hero Gold and EdgeFile X3 regarding the effect of different concentrations of NaOCl. MATERIALS AND METHODS: About 720 study specimens were included in the study. They were divided into four groups. Each group consisted of 180 files. Group A: GenEndo, Group B: Protaper Gold, Group C: Hero Gold, Group D: EdgeFile X3. Each group of instruments were further subdivided into nine subgroups (n = 20 for each subgroup). Testing of the cyclic fatigue was carried out in artificial canals which were prepared inside the blocks of stainless steel. The stainless steel blocks with artificial canals were established in a receiver that was packed with experimental solutions like distilled water, 5.25% NaOCl and 2.5% NaOCl. The adjustment of temperature was done at 25, 37, and 60°C. The rotation of the instrument was carried out inside the artificial canal as per the instructions of the manufacturer. The instrument was rotated until it got fractured. The time taken by the instrument to fracture was recorded in seconds. The number of cycles to fracture (NCF) was analyzed with the help of the equation (NCF = time to fracture × rpm/60). Surfaces at the site of fracture were examined with the help of a scanning electron microscope (EVOLS10, ZEISS) at magnification (300x and 2000x). RESULTS: It was noticed that there was a statistically significant increase in cyclic fatigue when sodium chloride was used as an endodontic irrigant instead of distilled water. The increase in cyclic fatigue was also observed when 5.25% sodium chloride was used instead of 2.5% sodium hypochlorite. Cyclic fatigue increased on change in temperature from 25 to 37°C and from 37 to 60°C. The difference was statistically significant (p < 0.05). It was observed that resistance against cyclic fatigue on treatment with different irrigation solutions at different temperatures was in the order of GenEndo > Protaper Gold > Hero Gold > EdgeFile X3. CONCLUSION: The resistance against cyclic fatigue in new NiTi rotary files can be affected significantly by different concentrations of sodium hypochlorite irrigant solution and the GenEndo rotary endodontic instrument has the maximum resistance against cyclic fatigue. CLINICAL SIGNIFICANCE: Irrigation of the root canal with irrigants, such as sodium hypochlorite (NaOCl) has been recommended strongly. NaOCl is used in the range of 0.5 and 6.5% concentration owing to its antimicrobial activity and tissue dissolution activities, particularly at higher temperatures. It has been postulated that fatigue of rotary endodontic instruments can be influenced by adjoining medium and their concentration.

Central vein stenosis in hemodialysis vascular access: clinical manifestations and contemporary management strategies.

Central venous stenosis is a significant and frequently encountered problem in managing hemodialysis (HD) patients. Venous hypertension, often accompanied by severe symptoms, undermines the integrity of the hemodialysis access circuit. In central venous stenosis, dialysis through an arteriovenous fistula is usually inefficient, with high recirculation rates and prolonged bleeding after dialysis. Central vein stenosis is a known complication of indwelling intravascular and cardiac devices, such as peripherally inserted central catheters, long-term cuffed hemodialysis catheters, and pacemaker wires. Hence, preventing this challenging condition requires minimization of central venous catheter use. Endovascular interventions are the primary approach for treating central vein stenosis. Percutaneous angioplasty and stent placement may reestablish vascular function in cases of elastic and recurrent lesions. Currently, there is no consensus on the optimal treatment, as existing management approaches have a wide range of patency rates.

Scanning Electron Microscopic Analysis of Deformation of TruNatomy File Systems: An Ex-vivo Study.

Aim The aim of the study was to assess the instrument deformation following the usage of the TruNatomy (Dentsply Sirona, USA) file system in extracted premolars using Scanning Electron Microscopy (SEM). Materials and Methods For the present study, 84 extracted mandibular bicuspids were selected. The teeth were divided into two groups: Group 1, TruNatomy (n=42), and Group 2, Hero Shaper (Micro Mega, France) (n=42). The samples were shaped with 0.03 taper to size 36 with TruNatomy instruments and 0.04 taper to size 30 with Hero Shaper instruments. 5 ml of 5.25% Sodium Hypochlorite (NaOCl) and 2 ml of 17% ethylenediaminetetraacetic acid (EDTA) were used for the final irrigation of root canals. The master apical file was used to instrument seven teeth samples for assessing the safety of the instruments after multiple uses and autoclaving. So, a total of six files per group was used for the analysis of any distortions, cracks or micro-fractures after instrumentation of 42 teeth, at the tip (D0) and 5 mm from the tip (D5) of the rotary file under SEM at 500x magnification. Statistical analysis To determine the significance between the groups, the Mann-Whitney U-test was applied. Results The mean surface wear of the instruments, at the tip (D0) in Group 1 was 1.2857 and in Group 2 was 1.4762. The mean spiral distortion of the instruments, at the tip (D0) in Group 1 was 1.1905 and in Group 2 was 1.4286. A statistically significant difference (P<0.05) was observed between the groups for surface wear and spiral distortion at the tip of the file (D0). There was no significant difference between groups for surface wear and spiral distortion values of the instruments at 5 mm from the tip (D5) (P>0.05). Conclusion The instrument distortion of the rotary file systems analysed was minimal following the biomechanical preparation of seven mandibular bicuspids without root curvature, using a single file. Therefore, both rotary file systems can be considered safe.

Jungian Analysis of the Chinese Mythological Image of Sun Wukong.

This paper examines the symbolism of the cultural image Sun Wukong (the Monkey King), a Chinese legendary hero, and how it influenced an eight-year-old boy's psychic development. Through an analysis of Sun Wukong's life from his birth to attaining Buddhahood, a three-phase healing process is identified in Sun Wukong's tale and the psychotherapeutic process: "naming and initiating," "nurturing and taming," and "transforming and transcending," proposed by Dr. Heyong Shen. Sandplay visually highlighted these key clinical changes in conscious awareness and developmental behaviour influencing the boy's individuation process. Images found either in cultural traditions or spontaneously emerging from the unconscious in individuals are of significance in human life, offering pathways to psychic healing and development. Further, myths and cultural resources used in clinical work demonstrate that having cultural competency is invaluable in Jungian analysis. Pathogenic and health-maintenance factors of culture can be explored in future clinical practice and research.

Cet article étudie le symbolisme de l'image culturelle d'un héros légendaire chinois; Sun Wukong (le roi singe). L'article explore comment cette image a influencé le développement psychique d'un garçon de huit ans. À travers une analyse de la vie de Sun Wukong depuis sa naissance jusqu'à ce qu'il atteigne la bouddhéité, un processus de guérison en trois phases est identifié dans le conte de Sun Wukong et dans le processus psychothérapeutique, et proposé par le Dr Heyong Shen : « nommer et initier ¼, « apprivoiser et nourrir ¼ et « transformer et transcender ¼. La thérapie par le jeu de sable a ensuite mis en évidence visuellement ces changements cliniques clés dans la prise de conscience et le comportement développemental, qui ont influencé le processus d'individuation du garçon. Les images trouvées dans les traditions culturelles ou qui émergent spontanément de l'inconscient chez les individus sont importantes dans la vie des êtres humains : elles fournissent des voies de guérison et de développement psychiques. De plus, les mythes et les ressources culturelles utilisés dans le travail clinique montrent que la compétence culturelle est inestimable dans l'analyse jungienne. Les facteurs pathogènes et les facteurs de maintien de la santé - présents dans la culture - peuvent être explorés dans la pratique clinique et la recherche futures.

Este artículo explora el simbolismo de la imagen cultural de Sun Wukong (el Rey Mono), un héroe legendario chino, y cómo influyó en el desarrollo psíquico de un niño de ocho años. A través de un análisis de la vida de Sun Wukong desde su nacimiento hasta alcanzar la Budeidad, se identifica un proceso de curación en tres fases en el cuento de Sun Wukong y en el proceso psicoterapéutico: "nombrar e iniciar", "domar y nutrir" y "transformar y trascender", propuestos por el Dr. Heyong Shen. A continuación, el juego de arena puso de relieve visualmente estos cambios clínicos en la conciencia y en el desarrollo del comportamiento, influyendo en el proceso de individuación del niño. Las imágenes que se encuentran tanto en las tradiciones culturales, como las que que emergen espontáneamente del inconsciente de los individuos son importantes en la vida humana, ya que ofrecen vías para la curación psíquica y el desarrollo. Además, los mitos y los recursos culturales utilizados en el trabajo clínico demuestran que tener competencia cultural es inestimable en el análisis junguiano. Los factores patógenos y de mantenimiento de la salud de la cultura pueden explorarse en la práctica clínica y la investigación futuras.

Fatal Budd-Chiari syndrome associated with Hemodialysis Reliable Outflow (HeRO) graft.

Population aging and prolonged time on dialysis pose challenges to vascular access for nephrologists and vascular surgeons. HeRO grafts are an option used for patients with central venous obstruction and without the possibility of other vascular access on upper limbs. Some long-term complications, namely access thrombosis, infection, and limb ischemia, have already been reported. There are few data on thromboembolic complications associated with this device. We report the first case in the literature of Budd-Chiari Syndrome associated with the HeRO graft.

Where Does I Stand? Reflections on Home and Identity Ensnared in a Cultural Narrative.

In this paper the author explores a cultural narrative that she suggests rests on the concepts of the Feminine and Masculine as such, employing both as though they contain an agreed set of universal givens. These givens are extrapolated from an androcentric perspective on female and male bodies, in particular their biological functions regarding reproduction. The metaphors of the baby-in-womb, mother's preoccupation with child and heteronormative sexual relations are the primary cyphers for the narrative. She suggests that remaining unconscious of this narrative, such that it is taken as a universal given, can hamper a person's relation to themselves, the world and others. The author names two concepts, Home and Identity: Home being an hospitable and accommodating space with Identity denoting the one who inhabits the space. In the narrative these two are unhelpfully categorized as belonging to the Feminine and the Masculine respectively. For ease of understanding the author uses a capital letter to designate an abstract idea, and lower case when referring to the concrete or particular. Clinical examples are given throughout the paper to illustrate how acknowledgement and awareness of this narrative might free the analyst or therapist to think more broadly around issues pertaining to space and identity.

Dans cet article, l'auteur explore un récit culturel qui, selon elle, repose sur les concepts du Féminin et du Masculin en tant que tels, utilisant ces deux termes comme s'ils contenaient un ensemble convenu de données universelles. Ces données sont dérivées à partir d'une perspective androcentrique des corps féminins et masculins, en particulier leurs fonctions biologiques en matière de reproduction. Les métaphores du bébé dans le ventre de la mère, de la préoccupation de la mère pour les enfants et des relations sexuelles hétéro-normatives sont les principaux codes du récit. Elle suggère que si l'on reste inconscient de ce récit, et que l'on continue à le considérer comme une donnée universelle, cela peut entraver la relation d'une personne à elle-même, au monde et aux autres. L'auteur nomme deux concepts, « Home ¼ et Identité: « Home ¼ étant un espace hospitalier et accueillant, et « Identité ¼ désignant celui qui habite l'espace. Dans le récit, ces deux termes sont catégorisés comme appartenant respectivement au Féminin et au Masculin, ce qui pose problème. Pour faciliter la compréhension, l'auteur utilise une majuscule pour désigner une idée abstraite, et des minuscules lorsqu'elle se réfère au concret ou au particulier. Des exemples cliniques sont donnés tout au long de l'article pour illustrer que prendre la mesure de ce récit et développer la prise de conscience pourraient libérer l'analyste ou le thérapeute et lui permettre de réfléchir de manière plus large aux questions relatives à l'espace et à l'identité.

En este artículo la autora explora una narrativa cultural que, según sugiere, se basa en los conceptos de lo Femenino y lo Masculino como tales, empleando ambos como si contuvieran un conjunto consensuado de datos universales. Estas premisas se extrapolan desde una perspectiva androcéntrica de los cuerpos femenino y masculino, en particular de sus funciones biológicas en relación con la reproducción. Las metáforas del bebé en el vientre materno, la preocupación de la madre por el niño y las relaciones sexuales heteronormativas son las principales claves de la narrativa. Sugiere que permanecer inconsciente de esta narrativa, de modo que se tome como un hecho universal, puede obstaculizar la relación de una persona consigo misma, con el mundo y con los demás. La autora nombra dos conceptos, Hogar e Identidad: El hogar es un espacio hospitalario y acogedor, mientras que la identidad designa a la persona que lo habita. En la narrativa, estos dos conceptos se clasifican de manera infructuosa como pertenecientes a lo Femenino y lo Masculino, respectivamente. Para facilitar la comprensión, la autora utiliza la mayúscula para designar una idea abstracta, y la minúscula cuando se refiere a lo concreto o particular. A lo largo del artículo se ofrecen ejemplos clínicos para ilustrar cómo el reconocimiento y la toma de conciencia de esta narrativa pueden liberar al analista o al terapeuta para pensar de forma más amplia en torno a cuestiones relacionadas con el espacio y la identidad.

Intrastent HeROgraft deployment as a catheter-sparing procedure.

Current vascular access (VA) practice adopts arteriovenous fistulas (AVF) as first option for haemodialysis, relegating arteriovenous grafts (AVG) for patients with exhausted upper limb venous patrimony. The Hemodialysis Reliable Outflow graft (HeRO®) is a device assuring direct venous outflow to the right atrium, thus avoiding central venous obstructive disease. Its use together with early access grafts avoids the need for central venous catheters (CVC) bridging periods. We report the deployment of the HeRO device using a previous stentgraft as pathway for the placement of the outflow component, in a patient with no-option for further autogenous upper limb access. This technique spared the usual central vein's exit point for the HeRO graft and, using an early-access dialysis graft, allowed for next-day successful haemodialysis.

Polymorphism of SERF2, the gene encoding a heat-resistant obscure (Hero) protein with chaperone activity, is a novel link in ischemic stroke.

Background: Ischemic stroke (IS) is one of the most serious cardiovascular events associated with high risk of death or disability. The growing body of evidence highlights molecular chaperones as especially important players in the pathogenesis of the disease. Since six small proteins called "Hero" have been recently identified as a novel class of chaperones we aimed to evaluate whether SNP rs4644832 in SERF2 gene encoding the member of Hero-proteins, is associated with the risk of IS. Methods: A total of 1929 unrelated Russians (861 patients with IS and 1068 healthy individuals) from Central Russia were recruited into the study. Genotyping was done using a probe-based PCR approach. Statistical analysis was carried out in the whole group and stratified by age, gender and smoking status. Results: Analysis of the link between rs4644832 SERF2 and IS showed that G allele is the risk factor of IS only in females (OR=1.29, 95%CI 1.02-1.64, Padj=0.035). In addition, the analysis of associations of rs4644832 SERF2 and IS depending on the smoking status revealed that this genetic variant is associated with an increased risk of IS exclusively in non-smoking individuals (OR=1.26, 95%CI 1.01-1.56, P = 0.041). Discussion: Sex- and smoking interactions between rs4644832 polymorphism and IS may be related to the impact of tobacco components metabolism and sex hormones on SERF2 expression. Conclusion: The present study reveals the novel genetic association between rs4644832 polymorphism and the risk of IS suggesting that SERF2, the part of the protein quality control system, contributes to the pathogenesis of the disease.

SERPINE1 mRNA Binding Protein 1 Is Associated with Ischemic Stroke Risk: A Comprehensive Molecular-Genetic and Bioinformatics Analysis of SERBP1 SNPs.

The SERBP1 gene is a well-known regulator of SERPINE1 mRNA stability and progesterone signaling. However, the chaperone-like properties of SERBP1 have recently been discovered. The present pilot study investigated whether SERBP1 SNPs are associated with the risk and clinical manifestations of ischemic stroke (IS). DNA samples from 2060 unrelated Russian subjects (869 IS patients and 1191 healthy controls) were genotyped for 5 common SNPs-rs4655707, rs1058074, rs12561767, rs12566098, and rs6702742 SERBP1-using probe-based PCR. The association of SNP rs12566098 with an increased risk of IS (risk allele C; p = 0.001) was observed regardless of gender or physical activity level and was modified by smoking, fruit and vegetable intake, and body mass index. SNP rs1058074 (risk allele C) was associated with an increased risk of IS exclusively in women (p = 0.02), non-smokers (p = 0.003), patients with low physical activity (p = 0.04), patients with low fruit and vegetable consumption (p = 0.04), and BMI ≥25 (p = 0.007). SNPs rs1058074 (p = 0.04), rs12561767 (p = 0.01), rs12566098 (p = 0.02), rs6702742 (p = 0.036), and rs4655707 (p = 0.04) were associated with shortening of activated partial thromboplastin time. Thus, SERBP1 SNPs represent novel genetic markers of IS. Further studies are required to confirm the relationship between SERBP1 polymorphism and IS risk.

Hero or hazard: A systematic review of individual differences linked with reduced accident involvement and influencing success during emergencies.

Objectives: This review aimed to integrate previous research to gain a deeper understanding of which individual factors are associated with reduced accident involvement, and which factors may be linked to success during emergency situations when they do occur. Better understanding how the human will react in these situations, combined with technological enhancements is vital to risk mitigation and ensuring successful performance. This review will also identify gaps in the literature that have yet to be addressed. Method: A systematic literature review was undertaken, beginning with 18,319 articles from three multidisciplinary databases. After careful review and exclusion, a final sample of 22 relevant articles were retained. This analysis was spread across various high risk, sociotechnical industries, including aviation, rail, mining, nuclear power, etc. Findings: The findings show that previous research has identified cognitive ability, leadership, situation awareness, personality, and risk perception as the most prominently considered factors in reducing accident involvement. Training, skill, situation awareness, and emotional stability were the most commonly associated factors to success through emergencies. Conclusion: While the research around individual differences impacting success during emergencies is scarce, this review provides future direction on potential factors influencing reduced accident involvement and/or potential factors that could influence a person's success through a disaster or emergency. This information could be implemented in recruitment and training of front-line workers in high-reliability organisations to reduce risk, increase safety and work towards reducing the number of accidents.

Devouring and Asphyxia: Paradigm Crisis, the Depletion of the Hero and Complex Thought1.

This article deals with the profound paradigm crisis that affects modernity and threatens the destiny of humanity. This crisis results from the lack of perspective offered by the paradigm of modernity with its emphasis on unilateral rationality, scientific objectivity, and exploitation of natural resources by a hyper development of an inflated Hero archetype. The emergence of a new paradigm of complexity, C. G. Jung's complex psychology, and Ameridian perspectivism, may offer new paths to approach these serious problems lived by modern man. A clinical vignette illustrates how complex psychology may also help with individual patients suffering from psychosomatic complaints.

Cet article traite de la profonde crise de paradigme qui affecte la modernité et qui menace le destin de l'humanité. Cette crise est le résultat du manque de perspective offert par le paradigme de la modernité, qui met l'accent sur la rationalité unilatérale, l'objectivité scientifique, et l'exploitation des ressources naturelles dans un hyper-développement de l'archétype du Héros, affecté par l'inflation. L'émergence d'un nouveau paradigme de la complexité, la psychologie complexe de C.G. Jung, et le perspectivisme Amérindien peuvent offrir de nouvelles ouvertures pour aborder ces problèmes sérieux que vit l'homme moderne. Une vignette clinique illustre comment la psychologie complexe peut aussi aider en ce qui concerne les patients individuels souffrants de problèmes psychosomatiques.

Este artículo aborda la profunda crisis de paradigma que afecta a la modernidad y amenaza el destino de la humanidad. Esta crisis es el resultado de la falta de perspectiva que ofrece el paradigma de la modernidad con su énfasis en la racionalidad unilateral, la objetividad científica y la explotación de los recursos naturales mediante el hiperdesarrollo de un arquetipo de Héroe inflado. La emergencia de un nuevo paradigma de la complejidad, la psicología compleja de C.G. Jung y el perspectivismo Amerindio pueden ofrecer nuevas vías para abordar estos graves problemas que vive el hombre moderno. Una viñeta clínica ilustra cómo la psicología compleja también puede ayudar con pacientes individuales que sufren dolencias psicosomáticas.

The Hero-Villain-Fool Narrative Construction Method: Assessing hidden organizational phenomena.

In the following paper, I present the hero-villain-fool narrative construction method in order to assess hidden organizational phenomena. Psychologists can analyze organizations in two ways either by focusing upon formal networks (e.g. organigram) or by taking a closer look into informal networks. The present paper tries to help organizational psychologists to generate meaning making within informal networks. These informal networks are important semiotic spaces where knowledge is generated that lies in the taboo zone of talking for the formal networks. Thus, my open interview guide proposes a flexible method that can reverse the taboo zone of talking and expand the talkability zone. As a consequence, meaning making is generated that bears conflicts showing urgent - yet not fulfilled - needs within the organization. The proposed method is instanced by a microgenetic analysis of a single case study showing that the hero works as a meta-organizer for adaptive trajectories that lead into a multilateral negotiation of concrete strategies fulfilling urgent pressing needs within organizations. Limitations are made explicit such as by arguing for expanding the research design into focus groups inviting various employees and leaders to the generation of meaning making that operates between the talkability and taboo zone of talking.

Management of concomitant central venous disease.

Symptomatic central venous disease (CVD) is a significant common problem in patients with end-stage renal disease given its adverse impact on hemodialysis (HD) vascular access (VA). The current mainstay management is percutaneous transluminal angioplasty (PTA) with or without stenting which is typically reserved for unsatisfactory angioplasty or more challenging lesions. Despite factors such as target vein diameters and lengths and vessel tortuosity that may determine the choice of bare-metal versus covered stents (CS), current scientific literature is pointing out the superiority of the latter one. Alternative management options such as hemodialysis reliable outflow (HeRO) graft showed favorable results in terms of high patency rates and fewer infections, however, complications such as a steal syndrome and, to a lesser extent, graft migration and separation are major concerns. The surgical reconstruction approaches such as bypass, patch venoplasty, or chest wall arteriovenous graft with or without endovascular interventions as a hybrid procedure are still viable options and may be considered. However, further long-term investigations are needed to highlight the comparative outcomes of these approaches. Open surgery might be an alternative before proceeding to more unfavorable approaches such as lower extremity vascular access (LEVA). The appropriate therapy should be selected based upon a patient-centered interdisciplinary discussion utilizing the locally available expertise in the area of VA creation and maintenance.

On Cultural Differences of Heroes: Evidence From Individualistic and Collectivistic Cultures.

Building on earlier research that examined the characteristics people associate with heroes, our research examined similarities and differences of the hero stereotype across cultures. Specifically, in Study 1 (N = 209) and Study 2 (N = 298), we investigated lay perceptions of heroes among participants from a collectivistic culture. In Study 3 (N = 586), we examined whether group membership could be determined by participants' centrality ratings of the combined set of hero features. In Study 4 (N = 197), we tested whether the hero features that distinguish American and Chinese participants, when used to describe a target person, influence the impression that the target person is a hero. In Study 5 (N = 158) and Study 6 (N = 591), we investigated cultural differences in perceptions of different types of heroes (e.g., social, martial, civil) and the influence of individualism and collectivism on the perception of those heroes.

Spatial orientation - a stable marker for vascular cognitive impairment?

Vascular cognitive impairment (VCI) is the second most prevalent form of dementia, but little is known about the early cognitive and neuroimaging markers. Spatial navigation deficits are an emerging marker for Alzheimer's disease (AD), yet less is known about spatial orientation deficits sensitive to VCI. This case report follows up on the first VCI patient identified to have an egocentric orientation deficit. The study aimed to examine the patient's spatial deficits three years on and gain insights from the addition of the patient's MRI brain scan. A battery of spatial navigation tasks were administered following neuropsychological assessment. Results continue to show spatial orientation deficits. Critically, these changes appear stable and are sensitive to novel spatial tests. Whereas conventional screening tools demonstrate patient recovery. MRI DTI analysis indicates a non-significant trend towards loss of structural integrity to the posterior tracts of the longitudinal superior fasciculus (SLF), while the medial temporal lobe, typically implicated in spatial navigation, is unaffected. This finding potentially reflects reduced network connectivity in posterior to anterior white matter tracts co-existing with spatial orientation deficits. Findings have clinical utility and show spatial orientation as a potential sensitive cognitive marker for VCI.