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The current study explores structural changes in radio and assesses their impact on music listeners in Pakistan utilizing the theoretical underpinnings of the political economy of communication. A mixed-method approach was used to answer research questions and evaluate hypotheses. A contextual analysis was utilized to evaluate the qualitative analysis after the interviews with 14 experts in the Pakistani radio industry were transcribed. Cross-tabulation with chi-square test, Independent Sample T-test, and AVOVA with Tukey tests were used to analyze survey responses from 200 respondents in order to determine the correlations between variables. The findings show that structural trends in the radio industry's deregulation and commercialization have curtailed access to a varied range of listeners in Pakistan. According to the research, deregulation, licensing fees, new license fees, and the restriction of Indian music, revenue generation, and licensing to nonprofit FM radio have all limited access to a diverse spectrum of radio music listeners in Pakistan. This trend also leads broadcast media in Pakistan to produce and disseminate more entertainment programming rather than information and education programs.

The study was conducted to assess the radioactivity of alpha concentration of different samples of flour in Karbala mills and some samples in local Iraqi markets. Alpha sensitive CR-39 plastic paths detectors commonly know as "Solid State Nuclear paths Detectors" were used measuring the concentrations of uranium, efficaious radium content, and ratio of radon. The results indicate that the exhalation levels of mass and surface radon were between 0.214-0.549 mBq/kg.h, and 4.35 -11.185 mBq/m2.h, respectively, with an mediam of 0.385 mBq/kg.h and 7.691 mBq/m2.h. The effective radium content values range from 28 to 78 mBq/kg with an mediam value of 51.06 mBq/kg, respectively. The concentration of uranium values ranges from 0.334 to 0.858 Bq/kg, with a mean value of 0.602 Bq/kg. The measurements of the radon, radium, and uranium concentration in each sample are significant in terms of health safeguard point of view. Hence, easy, and accurate techniques of analysis are highly demanded.

The objectives of financial autonomy aimed to reduce government commitments in the financing of public hospitals, to increase efficiency in hospital operations, contain costs, and raise the quality of care. The present survey study of Allied Hospital Faisalabad explores that bureaucratic manacles in financial autonomy of these public hospitals end up in creating low job satisfaction levels among the employees of the hospitals. The dissatisfaction among Doctors, Nurses, Paramedical Staff, and Surgeons towards the management of the hospital was observed. , and irregular flows causes low levels of satisfaction in patients towards doctors, nurses and paramedical Staff.

Tennis elbow (TE) is a painful and debilitating condition of the elbow. Recently, the use of orthobiologics, such as platelet-rich-plasma (PRP), has been proposed to promote tendon regeneration. Despite their popularity, there is a paucity of updated reviews on the use of PRP compared with other treatment modalities for treating TE. The aim of this review is to summarise high quality studies that compare the use of PRP therapy with other therapies for TE and to identify areas where further research is warranted. This systematic review was performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search of PubMed, Scopus and Cochrane Library databases was undertaken in May 2021. Articles were screened for the following criteria: randomised control trials (RCTs) involving PRP in at least one of the treatment arms for tennis elbow. The quality of the RCTs included were analysed for their risk of bias using the modified Cochrane Collaboration Risk of Bias Assessment Tool for randomised trials. A total of 20 RCTs of which 1520 TE patients were analysed. The RCTs included in this review compared PRP with various treatment modalities routinely used in clinical practice such as physiotherapy, steroid injections, Autologous Whole Blood (AWB) and surgical interventions. With regards to the quality of RCTs, collectively, selection bias was found to be low risk however, performance bias in terms of blinding of participants and personnel performed poorly. Of the 20 RCTs, only 5 studies were classified as low risk of bias. In these 5 studies, 2 RCTs compared PRP with steroids and reported contrasting results, 1 RCT compared PRP with AWB injections which reported both to be similarly efficacious, 3 RCTs included a placebo group and only 1 reported superior effects with PRP. There are 2 main types of PRP classified according to the number of pro-inflammatory leukocyte i.e. leukocyte-rich and leukocyte-poor PRP. However, only 8 studies documented the formulation of PRP used. While the heterogeneity of PRP formulations could in-part explain the reported differences in outcomes, overall there is limited robust evidence to recommend PRP therapy for TE. Further research is required to establish the optimal formulation and administration of PRP injections. Proper documentation of TE patients need to be standardised before concrete recommendations on the use of PRP therapy may be offered.

Elbow sports injuries are most commonly sustained through collision (fractures and dislocations) or low-impact overuse (cartilage, subchondral bone, ligament, and tendon damage). If treated sub-optimally they can lead to chronic pain and or stiffness.

Adolescence is a period of culmination during which there is a neurodevelopment through processes such as synaptic potentiation and pruning, myelination, and improved connectivity. Recent studies posit a vital role of endocannabinoid signaling in regulating and fine-tuning these processes. Adolescence is also a period of heightened vulnerability for exposure to exogenous cannabinoids (cannabis) which can potentially disrupt the regulatory function of endocannabinoids. While studies in animal models provide more compelling evidence for residual and persistent effects of cannabinoid exposure, human studies present a mixed picture, specifically for the cognitive consequences of adolescent cannabinoid exposure. Few studies have addressed the reward and psychosis-related consequences of early cannabinoid exposure. We review the recent advances in the literature on the endocannabinoid system, its role in neurodevelopment, the consequences of adolescent cannabinoid exposure, and plausible links among these. Further, we examine the epigenetic mechanisms altered by cannabinoids as a potential molecular mechanism underlying the persistent consequences of adolescent exposure. Attitudes towards and patterns of cannabis use among adolescents are rapidly changing as is the landscape of its legal status. The conflicting results between pre-clinical and human studies as well as a lack of understanding of underlying mechanisms call for further research on the residual and persistent consequences of adolescent cannabis exposure.

The posterior interosseous nerve (PIN) is susceptible to a number of traumatic and atraumatic pathologies. In this article, we aim to review our current understanding of the etiology, pathology, diagnosis, treatment options, and published outcomes of atraumatic PIN palsy. In general, the etiology of atraumatic PIN palsy can be divided into mechanical, which is caused by an extrinsic compressive force on the nerve, and nonmechanical, which is caused by an intrinsic inflammatory reaction within the nerve. As per this discussion, there are 3 causes for atraumatic PIN palsy. These are entrapment neuropathy, Parsonage-Turner syndrome, and spontaneous "hourglass" constriction. The typical presentation of atraumatic PIN palsy is a patient with spontaneous onset of weakness of fingers/thumb metacarpophalangeal joints extension. However, the wrist extension is preserved with radial deviation due to preservation of extensor carpi radialis longus/brevis function. Magnetic resonance imaging is the imaging of choice and neurophysiology is indicated in all patients. If there is an obvious structural cause of the nerve palsy, prompt decompression and removal of the causative lesion are recommended to avoid irreversible damage to the nerve/muscles. Otherwise, in general, we would recommend consideration for exploration should there be no sign of recovery after 6 weeks of observation.

Background Few series report the results of total elbow replacement (TER) in patients with juvenile idiopathic arthritis (JIA). Most report the use of a linked implant. There are theoretical benefits to using an unlinked prosthesis, and thus we report our experience of the clinical benefit and survivorship of both this implant and a linked semiconstrained prosthesis. Methods There were 21 elbows replaced in 14 JIA patients (12 women and 2 men; 14 unlinked, 7 linked). Mean age at surgery was 39.5 years (range, 26-52 years). Mean clinical follow-up was 11.7 years (range, 5.4-17.6 years). Results Reoperation, including implant revision, was required in 9 elbows (42.9%). Using revision as an end point, survivorship was 95% (95% confidence interval [CI], 74%-99%) at 5 years and 68% (95% CI, 45%-86%) at 10 years. The 10-year survival was 70% (95% CI, 40%-89%) for the unlinked group and 69% (95% CI, 28%-94%) for the linked group. The need for bilateral TER was found to be a risk factor for revision within 10 years of primary surgery (6/11 vs. 0/7 elbows; P = .037). The rate of aseptic loosening seen on radiographs was high in the unlinked group (12/14, 85.7%), but many of these patients continue to function well without need for revision. Conclusion Both the unlinked Kudo 5 and linked Coonrad-Morrey prostheses for TER can provide benefits in the long-term for most patients with JIA. The need for bilateral TER in this group is associated with higher rate of revision at 10 years.

Background Symptomatic disorders around the sternoclavicular joint (SCJ) are relatively uncommon. Previous cadaveric and radiographic studies have suggested that asymptomatic osteoarthritic changes are relatively common, progressively increasing with age. The purpose of this study was to determine the prevalence of SCJ osteoarthritis in the general population using computed tomography (CT) scans. Methods We assessed 464 SCJs in 232 patients undergoing a standardized axial CT scan of the thorax including both SCJs, across a range of ages from the second to tenth decade. The scans were undertaken for multiple clinical indications; however, none were obtained to investigate SCJ pathology. The predominant changes investigated were for the features associated with osteoarthritis including the presence of osteophytes, subchondral cysts, and subcortical sclerosis. Results The CT scans of 244 SCJs (53%) in 137 patients (59%) showed at least 1 sign of osteoarthritis. No patients younger than 35 years had any features of osteoarthritis. Osteoarthritic changes were present in 89.6% of patients older than 50 years compared with 9.1% younger than this age. All patients above the age of 61 had at least 1 feature of osteoarthritic changes on at least 1 side of the SCJ. Increasing prevalence was noted with increasing age both in the percentage of SCJs showing any positive signs of osteoarthritis and in the severity of osteoarthritis. Conclusion SCJ osteoarthritis is a very common incidental finding on CT scans, particularly with increasing age. This should be taken into consideration when using a CT scan to assess a patient with symptomatic SCJ pathology.

Traumatic glenohumeral joint dislocation and acromioclavicular joint subluxations tend to occur in young active males. Use of the coracoid process either as a transfer in recurrent instability or in suspensory reconstructions of the coracoclavicular ligaments have gained popularity. However this requires careful consideration in the event of concomitant injuries if they both require surgery.

The management of glenoid bone loss is a major challenge in both complex primary and revision arthroplasty surgery. To deal with this problem, a number of techniques have been advocated, although there has been no previous systematic review of the literature. In the present review, we have attempted to identify a coherent strategy for addressing this problem, taking into account the degree of bone loss, the advantages and limits of standard implants, bone reconstruction techniques and the use of customized prostheses.

Purpose: Rockwood classified acromioclavicular (AC) joint injuries by displacement of the joint on radiographs. This classification has driven the management dogma of acute AC dislocation. The correlation between Rockwood grade and symptoms has not been described in acute injury. This study assesses that relationship. Methods: This series included 77 patients with acute AC joint injury (Results: The mean age was 32 years (±11.86; range 17–59 years); 88% were male. Forty-four per cent were professional athletes and 43% suffered injury during rugby. The mean time from injury to presentation was 2 weeks (±1.64; range 0–5 weeks). There was poor correlation between Rockwood classification and pain (visual analogue scale) ( rs = 0.05; p = 0.752). Poor correlation was noted between Rockwood grade and functional deficit (elevation ( rs = 0.18; p = 0.275), abduction ( rs = 0.19; p = 0.246) and strength ( rs = 0.09; p = 0.579) vs. contralateral side). Oxford and Constant scores did not correlate with Rockwood grade ( rs = 0.13; p = 0.972 and 0.01; p = 0.448, respectively). Conclusion: The Rockwood grade does not correlate with clinical symptoms in acute AC joint injury. Previous evidence demonstrates the Rockwood classification’s limitations in predicting the structures injured. Therefore, the reliability of using the Rockwood grade as a decision-making tool in the management of acute AC joint dislocation is unclear.

There is a global trend toward a decline in surgical intervention for rheumatoid arthritis, over a similar period during which medical management has improved. However, surgery continues to play a role in the management of the disease as, while inflammation may vary, structural damage tends to be both cumulative and irreversible. Prosthetic joint arthroplasty is the most common surgical procedure for large joint involvement. Rheumatoid arthritis represents an independent risk factor in prosthetic joint infection, and greater experience of the surgeon with rheumatoid conditions correlates with improved patient outcomes.

Background This study reports the outcome of resurfacing hemiarthroplasty (RHA) in a cohort of patients with juvenile idiopathic arthritis (JIA) affecting the shoulder joint Methods Fourteen uncemented RHA procedures were performed for 11 consecutive patients who required surgery because of JIA. Mean age at surgery was 36.4 years. Mean clinical follow-up was 10.4 years (range, 5.8-13.9 years). A significant humeral head defect (up to 40% surface area) was found in 5 shoulders and filled with autograft from the distal clavicle or femoral head allograft. Results At latest follow-up, no patient required revision. There was excellent relief from pain. The mean Oxford Shoulder Score and Constant-Murley Score improved significantly. No shoulder had a poor outcome, and 6 had a very good or excellent outcome. Worse outcome was associated with an intraoperative finding of significant humeral head erosion. Two shoulders required early arthroscopic subacromial decompression, but there were no other reoperations. There were no instances of radiographic implant loosening or proximal migration. Painless glenoid erosion was seen in 5 shoulders but was not associated with worse outcome. Conclusions The midterm results of RHA for JIA are at least comparable to those for stemmed hemiarthroplasty, with the added benefit of bone conservation.

An experimental and theoretical study has been done to investigate the thermal performance of different types of air solar collectors, In this work air solar collector with a dimensions of (120 cm x90 cm x12 cm) , was tested under climate condition of Baghdad city with a (43° tilt angel) by using the absorber plate (1.45 mm thickness, 115 cm height x 84 cm width), which was manufactured from iron painted with a black matt. The experimental test deals with five types of absorber:- Conventional smooth flat plate absorber , Finned absorber , Corrugated absorber plate, Iron wire mesh on absorber And matrix of porous media on absorber . The hourly and average efficiency of the collectors were investigated for three values of mass flow rates (0.016 kg/s to 0.027 kg/s) for each type of collector and then the porosity for the last collector type was tested by changing the porosity of porous media. A typical air solar collector has been studied Theoretically to build a standard software for testing any type of air solar collectors with local weather data . From the experimental study it can be seen by using some obstacle material to the air flow (fins, corrugated absorber plate, iron wire mesh porous media on the absorber) could be enhanced the efficiencies not less than 4 % for finned type and 8 % for corrugated and 25 % for mesh and 30 % for porous media comparing with flat plate (smooth) collector . Theoretically, the results showed that the collector with high convention heat transfer coefficient porous media has high hourly efficiency about (η = 56 %) and iron wire mesh on absorber ( η = 52 % ), on the other side the minimum performance occurred in the flat plate absorber (η = 28 %). Comparison of results reveals that the theoretical predictions agree reasonably well with experimental results. And the difference between the theoretical and experimental efficiency in general was between (1─ 15 %).

If left untreated, varus posteromedial rotatory injuries of the elbow result in poor functional outcomes. Surgical treatment allows restoration of elbow kinematics, minimizing the chances of chronic varus instability and early onset osteoarthritis. However, large exposures are associated with extensive soft tissue stripping, a high risk of infection, nerve injury, poor visualization of the articular surface and longer recovery. Consequently, there has been renewed interest in the use of elbow arthroscopy to circumvent these problems. Arthroscopic treatment offers the potential advantage of a swift recovery, with instant rehabilitation, less stiffness and swelling than might be expected after open repair. We present the first combined arthroscopic-assisted anteromedial facet coronoid fracture fixation and lateral ulna collateral ligament repair in a varus posteromedial rotatory injury of the elbow.

Purpose To describe the results and functional scores in a group of patients who underwent arthroscopic excision of a symptomatic sternoclavicular joint (SCJ) disk tear with a minimum follow-up period of 2 years. Methods Between April 2010 and December 2014, 14 patients underwent arthroscopic excision of a torn SCJ disk. Patients whose intended surgery was an isolated diskectomy and underwent that surgery only, with no additional procedure, were included. The minimum follow-up period was 24 months. All patients underwent an arthroscopic SCJ diskectomy. Postoperatively, no immobilization was required, and the patients were encouraged to mobilize as pain permitted. The patients were assessed preoperatively and at final follow-up with the visual analog scale score for pain, Rockwood score, and QuickDASH (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) score. Results The average age at surgery was 29.4 years (range, 19-39 years). Ten of the patients had been symptom free before a specific incident, after which SCJ symptoms developed. The other 4 patients reported a gradual onset of symptoms and were considered to have chronic tears. The average duration of symptoms was 22.8 months (range, 6-48 months). At a mean follow-up of 33.4 months (range, 24-59 months), a significant improvement in the Rockwood score was noted, from 7 (range, 5-9; standard deviation [SD], 1.4) to 13.6 (range, 9-15; SD, 1.9) ( P = .001) (minimal clinically important difference not described). The mean QuickDASH score improved from 23.7 points (range, 6.8-40.9 points; SD, 11.8 points) to 8 points (range, 0-29.5 points; SD, 9 points) ( P = .0024) (minimal clinically important difference, 13.4 points). There were no reported complications and specifically no instability. Conclusions The results of this series suggest that arthroscopic SCJ diskectomy is a safe and reproducible procedure for the treatment of patients with symptomatic SCJ disk tears. Level of Evidence Level IV, therapeutic case series.

Background We describe the clinical, radiological and surgical findings of failed distal biceps repair by gapping and report the functional outcomes following revision repair. Methods A retrospective review of five consecutive patients was conducted. Patients presented with radial-sided forearm pain after their distal biceps fixation. All patients had less than 5 cm of retraction of the biceps muscle belly, a palpable tendon although the manoeuvre was painful with weakness on resisted supination. Flexed abducted supinated magnetic resonance imaging (FABS MRI) showed a gap between the distal end of the tendon and the footprint on the radial tuberosity. Results Mean FEA score at presentation was 44/100 (35 to 49). Mean time to re-operation was 18 months (range 4 months to 36 months). At revision, the distal end of the tendon was retracted and not making contact with the bone. All cases were revised to an in-bone endobutton repair. Mean postoperative Functional Elbow Assessment (FEA) scores undertaken at a mean of 14 months (range 5 months to 22 months) after revision improved to 95/100 (90 to 100). Conclusions Patients presenting with persistent radial sided forearm pain and weakness on provocative testing after distal biceps repair with a seemingly intact repair should be investigated with FABS MRI to look for evidence of failure of repair by gapping. Revision repair with an anatomic in-bone technique can lead to good results.

The Modernising Medical Careers 2005 report on SHO training concluded that there was a need to minimise the SHO years that had, until then, involved short-term posts, poor training opportunities and indifferent career progression. In response to this, 'run-through training' was introduced in August 2007. However, numerous problems were highlighted with this system, including lack of confidence in the selection process, concern about how to counsel failing trainees, concerns about staffing the wards at the junior level if all trainees were to have realistic anticipation of promotion and difficulty reconfiguring hospital services to support high-quality training. Consequently, run-through training was uncoupled at CT2 and ST3, reverting back to a system of competitive entry into higher surgical training. Nevertheless, junior doctors in new core training posts could still potentially progress to higher surgical training programmes with as little as nine months of experience in their chosen subspecialty.

This report is of a healthy 49-year-old male with an isolated primary single-joint septic arthritis of the right knee. The patient had no clinical symptoms or signs of systemic meningitis or detectable meningococci in the blood. The presentation is rare and can be unusual. Complete recovery does usually occur if appropriate antibiotics therapy, joint aspiration and repeat washouts are performed early.

Background Many shoulder surgeons use intra-articular corticosteroid injections (IACI) in shoulder osteoarthritis, with the caveat that it precludes arthroplasty for at least 6 months to 12 months because of the theoretical risk of infection. To our knowledge, there is nothing available in the literature to support this notion. Methods We undertook a retrospective, matched cohort study of all patients who underwent shoulder arthroplasty in our unit between December 2010 and December 2013 aiming to assess whether pre-operative IACI had an impact on infective complications. Group I had received an IACI prior to their arthroplasty and Group II had not. A chi-squared analysis was performed ( p Results Group I comprised 23 patients with a mean age of 73 years (range 54 years to 90 years) had 23 shoulder arthroplasties and had mean follow-up of 16.6 months. Patients received an IACI approximately 11.4 months (range 2.5 months to 172.5 months) before their surgery. One patient developed a deep joint infection that warranted revision arthroplasty. Group II comprised 60 patients with a mean age of 75 years (range 34 years to 90 years) had 64 shoulder arthoplasties and a mean follow-up of 20.1 months. No patients developed infective complications ( p > 0.05), implying there was no statistically significant relationship between pre-operative IACI and infective complications. Conclusions We could not establish a causal link between IACI and infective complications after arthoplasty.

Total acromionectomy is now a largely historical procedure due to a number of biomechanical sequelae caused by defunctioning of the deltoid, although its overall effect on joint kinematics is uncertain. This presents a challenge when considering arthroplasty for subsequent glenohumeral arthritis. We report on successful management of such a case, treated with resurfacing hemiarthroplasty 57 years following acromionectomy. The patient continues to enjoy excellent functional outcome of the shoulder at 8 years after arthroplasty.

In recent years there has been a convergence of approaches to the treatment of cardiovascular disease with combined cardiology, radiology and surgical multidisciplinary team (MDT) based management. This is particularly true with the advent of transcatheter (transfemoral and transapical) aortic valve replacement1 as well as the new combined open and endovascular approaches to thoraco‐abdominal aneurysms,2 including single stage combined coronary artery bypass grafting (CABG) and abdominal aortic endovascular aneurysm repair (EVAR).3 However, there has also been a more longstanding, and commonly although not exclusively, staged hybrid approach in the form of combining percutaneous coronary intervention (PCI) with surgical coronary revascularization and surgical valve repair or replacement in appropriate patients.4–6 As such, it is inevitable new operating enviroments have emerged in the form of so‐called ‘hybrid theatres’ allowing single stage, hybrid endovascular and open intervention for a range of morbidities in children and adults.7,8 This manuscript discusses briefly the design and function of a hybrid theatre, including its perceived advantages and disadvantages. By way of example we review our activity in this environment over the first year of opening. We discuss whether this resource is a nicety or necessity in adopting hybrid approaches. Design and function of the hybrid theatre As part of the development of a regional thoracic aortic aneurysm service a purpose‐built hybrid theatre was constructed (Philips) and opened in Liverpool in April 2007. A number of detailed descriptions of hybrid theatres exist8–10 and we therefore restrict the discussion here to a brief overview. Broken down into its basic structural components, the hybrid theatre is simply an operating theatre with built‐in radiological screening capabilities. In truth, however, the hybrid theatre is more than simply the sum of its parts. The bespoke C‐arm image intensifier is built into the ceiling of the operating room and able to move both longitudinally and rotate around the axis of the patient (Figures 1a and b). As such, the theatre complex is designed with ample space, allowing for dedicated cardiopulmonary bypass equipment as well as the paraphernalia associated with general anaesthesia. Other equipment, including transoesophageal echocardiography, cell salvage, electrocautery and pacing, are easily accommodated. Multiple monitors allow easy access to data at all points around the table. High quality overhead lights allow for good visibility. Consistent with a normal catheter laboratory the theatre is designed with a control/viewing room with dedicated image processing, as well as catheter store room, surgical scrub room and anteroom. Lead aprons are available. Other devices such as contrast injector and defibrillator are stored in theatre. It is not only the close proximity of this multidisciplinary equipment which makes this a unique environment, but the fact that it engenders a collaborative approach to the management of complex disease. Figure 1a and 1b Hybrid theatre showing the theatre table, roof-mounted C‐arm, perfusion, anaesthetic and surgical equipment Hybrid approaches to elective cardiovascular disease The hybrid activity in the theatre is coordinated by two MDT meetings attended regularly by consultant representation from cardiology and radiology, as well as both vascular surgery and cardiac surgery, and intensive care medicine. The specialization of these two groups centres on endovascular approaches to thoraco‐abdominal aortic disease and transfemoral/transapical aortic valve replacement. Hybrid thoracic endovascular aneurysm repair (TEVAR)/open procedures A team of three cardiac surgeons with an interest in thoraco‐abdominal aneurysms attend a weekly thoracic aneurysm clinic, with regional and supra regional referrals from the full range of medical specialties. Complex cases requiring endovascular solutions or combined endovascular/open approaches (hybrid or staged) are referred to a monthly MDT meeting attended by cardiac and vascular surgeons with input from both interventional and non-interventional radiologists. During the first year of coming online, a range of truly hybrid interventions have been performed. These include abdominal endovascular aneurysm repairs (EVAR) with simultaneous coronary artery bypass grafting (CABG), arch-related TEVAR with arch vessel bypass, TEVAR with femoral–femoral cross‐over graft, as well as a full range of isolated TEVAR procedures ( Table 1). Table 1 Surgical activity 2007–2008 Transfemoral and transapical aortic valve replacement A regular MDT comprising interventional cardiologists, cardiac surgeons and anaesthetists/intensivists discusses possible suitable patients for this approach. To date we have early experience with transfemoral and transpical aortic valve replacement and found the hybrid theatre exceptionally well suited for this activity.