Bu garip kapak, Luxenberg'in Die syro-aramäische Lesart des Koran Ein Beitrag zur Entschlüsselung der Koransprache eserinin ön kapağında bulunmaktadır. İşin gülünç verici kısmı başlığıyla övünen bir kitabın, başlığıyla alakası olmayan bir kapak sayfasına sahip olmasıdır.
🛡️ The Superior Costotransverse Ligament (SCTL) is more than just a ligament — it is a continuation of the Posterior Intercostal Membrane (PIM).
Together, they form a protective fascial roof over the thoracic paravertebral space, critically influencing the spread of local anesthetic during blocks like the Paravertebral Block (PVB).
🧠 In contrast, the Lateral Costotransverse Ligament (LCTL) is purely a bone-to-bone stabilizer, anchoring the tip of the transverse process to the rib tubercle — without any fascial continuation from the intercostal membranes.
💉 Clinical Pearl:
During PVB, successful access to the paravertebral space often requires the needle to pass through or beneath the SCTL/PIM plane.
The LCTL, while important for rib stability, does not directly affect needle path or anesthetic spread.
Why it matters:
Appreciating these small but critical transitions — from membranes to ligaments — allows for sharper targeting, improved block reliability, and safer clinical practice.
✨ Bonus Tip:
The Intertransverse Ligaments — connecting transverse processes — aren't pierced directly during PVB either, but their fenestrations can allow anesthetic seepage during plane blocks like ESPB!
➡️THI is an advanced ultrasound technique that uses harmonic frequencies (created by the body’s own tissues) to produce sharper, clearer images, helping to visualize nerves, fascial planes, and needle tips more confidently during regional blocks.
➡️Analogy - Think of a song being played on a speaker in a noisy room. Standard ultrasound picks up the song plus all the background chatter. THI acts like noise-canceling headphones, filtering out the unwanted noise and letting you hear the song (important tissue details) clearly.
➡️Simple Explanation: When an ultrasound wave (say, at 2 MHz) travels through the body, the tissues don't just reflect that exact wave. They distort it a bit, and in doing so, they generate new waves at higher frequencies - like 4 MHz, 6 MHz, etc. These are called harmonics.
The original wave = fundamental frequency (e.g., 2 MHz).
The new wave = harmonic frequency (e.g., 4 MHz, which is the second harmonic)
🌊 What Are Harmonic Waves?
📡 Ultrasound usually transmits a base frequency (fundamental wave).
🧬 As this wave travels through tissues, nonlinear propagation causes the wave to distort and produce new frequencies called harmonics.
🔁 The second harmonic (2× the original frequency) is the most useful — it's cleaner and less noisy.
🎯 Harmonics form only within the tissue, avoiding skin-level artifacts and improving deep structure imaging.
⚡Higher-order harmonics (like 3rd or 4th) fade too quickly and are not used in clinical ultrasound.
⚙️ How Does THI Work?
🔄 1. Nonlinear Propagation
🔊 Sound wave speed changes with pressure inside tissues.
🔃 This distortion creates harmonic waves naturally as the wave travels.
🎯 These harmonics help create more detailed ultrasound images.
📈 2. Harmonic Formation
⚡ As energy shifts from the original frequency to harmonics, second harmonics dominate.
🧊 Higher-order harmonics (3rd, 4th...) fade too fast to be useful.
🛠️ 3. THI Technologies
🧽 Harmonic Band Filtering: Filters out the basic (fundamental) frequency and keeps only the second harmonic. Result: A cleaner, high-contrast image from deeper structures.
🧲 Pulse Phase Inversion: Sends two sound pulses, one normal and one inverted. When their echoes return, the fundamental signals cancel out, and the harmonic signals add up, giving a stronger and cleaner image.
💉 Why THI Matters in Regional Anesthesia?
👁️🗨️ See nerves and fascial planes more clearly
🪡 Track needle tips with better precision
💧 Observe LA spread in real-time
💪 Boost confidence and safety in deep or challenging anatomy (e.g., obese patients)
🙌How THI helps in RA?
💡Improved Image Clarity: THI reduces "speckle" and background noise. Makes tissues look less grainy and more defined. You get crisper outlines of nerves and muscles.
💡Better Deep Structure Visualization: Especially useful in blocks like QL, sciatic, or infraclavicular, where the targets are deeper. THI helps make deep structures stand out more clearly.
💡Enhanced Needle Tip Tracking: The cleaner image makes the echogenic needle tip easier to identify. Especially important when doing in-plane techniques or in patients with challenging anatomy (e.g., obese patients).
💡Safer and More Accurate Blocks: With clearer images, you reduce the chance of accidental vascular puncture or nerve injury. It builds more confidence, especially for novice practitioners.
✅ Advantages of THI
✨ Sharper images with better tissue contrast
🚫 Reduced clutter and reverberation artifacts
🔬 Enhanced visibility of low-contrast structures (like nerves)
🧭 Improved lateral resolution due to a narrower harmonic beam
⚠️ Limitations of THI
📉 Lower signal-to-noise ratio in superficial targets
🧱 Less penetration depth (harmonics fade faster in deep tissues)
🔎 Axial resolution may be limited for very small targets
✨THI is less effective for very superficial structures because harmonic signals build up only after some depth (usually ~1.5 cm or more).
🚫In shallow blocks like superficial cervical plexus or TAP, fundamental imaging might be better.
🧱It may slightly reduce frame rate, which can be adjusted.
🏥 Clinical Use Examples (Beyond RA)
🏷️ Liver: Better lesion margin visibility
🧊 Kidneys: Distinguishes between cysts and solid masses
🤰 Pregnancy: Enhances views of chorioamniotic separation
🚰 Urinary tract: Improves detection of pelvicaliectasis
📌 Take-Home Messages
✅ THI uses harmonic waves generated naturally within tissues - not just reflected echoes.
✅ It provides cleaner, high-resolution images that enhance accuracy and safety in RA.
✅Harmonic signals build up only after some depth (usually ~1.5 cm or more)
✅ Especially helpful for deep structures, challenging patients, and precise needle tracking.
✅ Limitations exist, but with smart use, THI significantly improves the quality of ultrasound-guided blocks.
This study analysed published Y-STR data for 186 populations and regions, including 14,504 individuals from 52 Middle Eastern and 134 African populations.
The most common haplogroups in the Middle Eastern populations were J1a (29.4%), while in the African populations, E1b1a (43.2%) was the most prevalent.
Phylogenetic tree of genetic relationships among the 43 Middle Eastern and African populations. Five clusters (K = 5) were created. The red-coloured cluster is the largest (15 populations), followed by the cyan-coloured cluster (7 populations), and the purple-coloured cluster (6 populations). The remaining two clusters each have five populations. This phylogenetic tree was generated using POPTREE2 software
The most dominant migration routes within the African continent. The numbers in front of the dominant migration routes represent the dominant migration model. The most probable routes were: west→south1, south→ east1, east→central1 and central→north2
@Elsa_Marcel Non ! la police et la gendarmerie n'ont pas la légitimité de la violence.
On parle de force légitime..
"Toute violence est illégale". 1/ ◾Dans quel cadre les policiers ont-ils le droit d'utiliser la force? share.google/KSw2ZqMoxszJcL…
@Elsa_Marcel Nicolas Pucheu, responsable de la communication du syndicat policier @UNSAPOLICE Paris, contacté par @BFMTV, rejette l'expression "violence légitime" ; "il s'agit plutôt de 'force légitime', utilisée qd quelqu'un refuse d'obtempérer ou qd on se retrouve ds un danger immédiat".
2/
רק באוגוסט ממשלת לבנון אימצה את מתווה השליח האמריקאי, תום בארק, לפירוק חזבאללה מנשקו עד סוף השנה. השבוע בארק כבר הצהיר שמדובר ביעד "לא ריאלי". לדבריו, לבנון מדינה כושלת החוששת ממלחמת אזרחים ולא תפרק את חזבאללה.
לאן זה הולך ומה ישראל צריכה לעשות?
>>
"רוחות מלחמה"
בצה"ל מזהירים שמאמצי חזבאללה להתחמש מחדש יובילו להרחבת הפעילות נגדו, שכבר התעצמה בימים האחרונים. על רקע זה, התחזק החשש, בלבנון ובאזור, מחידוש המלחמה. דברי השליח בארק, שתמך, במשתמע, בתקיפות ישראל בלבנון רק הגבירו את הדאגה.
>> haaretz.co.il/news/politics/…
ברקע לדברים, תדרוכי אמ"ן לתקשורת כי חזבאללה משקם את יכולותיו הצבאיות באופן מואץ, וכי צבא לבנון (צל"ב) נזהר מלהתעמת עם הארגון וכמעט שאינו פועל למנוע ממנו להשתקם. בנוסף, שירותי מודיעין זרים העריכו כי הושמש חלקית, מחדש, ציר העברות הנשק לחזבאללה מאיראן דרך עיראק וסוריה.
>>
Das Deutsche Institut für Menschenrechte
Das Deutsche Institut für Menschenrechte achtet darauf,
dass in Deutschland die Menschenrechte eingehalten
werden.
👇👇👇👇 share.google/NJNGMrnTIz6Huu…
Menschenrechte sind wichtige Rechte, die für alle
Menschen gelten.
▶️ Dazu gehören zum Beispiel das Recht
auf Meinungsfreiheit und das Recht auf Schutz vor Gewalt
und Folter.
▶️ Es gehört auch zu den Menschenrechten, dass
kein Mensch aus irgendeinem Grund schlechter
behandelt
werden darf als andere.
▶️ Das Deutsche Institut für
Menschenrechte kontrolliert, ob Deutschland die
Menschenrechte einhält. ▶️ Das Deutsche Institut für
Menschenrechte arbeitet dabei mit vielen Organisationen
in Deutschland und auf der ganzen Welt zusammen.