Hemodialysis‐induced bradycardia, “a plumbing issue”: Resolved with catheter repositioning

Sudden cardiac death (SCD) is reported as leading cause of death in patients on chronic hemodialysis. Arrhythmias are proposed to be a major predisposing factor for SCD. However, triggers for potentially lethal arrhythmias are not well understood. Here we describe a case of 72‐year‐old man on chronic hemodialysis via permanent Central venous catheter (CVC) who was admitted for evaluation after unwitnessed fall. Within 10 minutes of his first routine dialysis session in the hospital, he had cardiac‐arrest. He was successfully resuscitated within 3 minutes. The next day, fifteen minutes into the dialysis session, he had bradycardia with telemetry demonstrating long sinus pause and he lost consciousness. After few minutes of Advanced Cardiac Life Support (ACLS) he regained pulse and consciousness. Further review of the chest X‐ray revealed the tip of CVC to be directly touching the distal Superior Vena Cava (SVC) wall. We felt the catheter tip may have migrated after the fall and now is irritating the Sinoatrial node and triggering bradyarrhythmia. Next day, the CVC was exchanged, and the tip was placed higher up in superior vena‐cava. After repositioning, we started him on dialysis under intensive monitoring, and he tolerated well without any arrhythmia. Subsequent dialysis was uneventful. We describe a case of recurrent symptomatic intra‐dialytic bradycardia due to abnormal positioning of CVC that resolved after the repositioning of the catheter. This case in addition to similar case in nondialysis settlings provides additional insights into mechanisms of fatal arrhythmias in hemodialysis patient having CVC.     

Corn,cochineal, and quina: The “Zilsel Thesis” in a colonial Iberian setting

Edgar Zilsel's famous thesis, which argues that modern experimental science was born from the union of artisans and intellectuals in the 16th century, received little support when Zilsel proposed it in the 1940s. In recent years, however, with the turn toward social and cultural history of science, the “Zilsel Thesis” has undergone something of a revival as historians rethink the relevance of artisanal knowledge for the history of early modern science. This essay looks at the Zilsel Thesis in a global setting – specifically a colonial Iberian setting – and argues for its relevance in framing natural history, medicine, and the impact of science on everyday life. Using the examples of corn, quina, and cochineal, this essay argues that the agronomic, chemical, and entomological knowledge accumulated over generations of practice by indigenous practitioners was in fact artisanal knowledge that was passed on to European intellectuals in “global trading zones” to become part of the Western scientific patrimony.     

Guides “bimorphes” d''ondes ultrasoniques “bimorph” ultrasonic wave guides”

An analysis of the dispersion of elastic waves is presented for two types of long ultrasonics wave-guides that we qualify of “bimorph”: (i) a “three-layer” guide made of two different materials and (ii) a “clad core” guide built up of a rectangular core surrounded by a cladding, the materials of the rod and cladding having different properties. An analytical model is proposed to describe the extensional, flexural and torsional motions in “bimorph” wave guides having two geometrical and material symmetry axes. The asymptotic behaviour of the model allows one to select the material properties which lead to modes guided essentially either in the central layer or in the core of the bimorph guide. Moreover, the dispersive properties of a “bimorph” can be controlled through the choice of geometrical and material parameters.