Push-pull driving of the Central America Forearc in the context of the Cocos-Caribbean-North America triple junction.

Different kinematic models have been proposed for the triple junction between the North American, Cocos and Caribbean plates. The two most commonly accepted hypotheses on its driving mechanism are (a) the North American drag of the forearc and (b) the Cocos Ridge subduction push. We present an updated GPS velocity field which is analyzed together with earthquake focal mechanisms and regional relief. The two hypotheses have been used to make kinematic predictions that are tested against the available data. An obliquity analysis is also presented to discuss the potential role of slip partitioning as driving mechanism. The North American drag model presents a better fit to the observations, although the Cocos Ridge push model explains the data in Costa Rica and Southern Nicaragua. Both mechanisms must be active, being the driving of the Central American forearc towards the NW analogous to a push-pull train. The forearc sliver moves towards the west-northwest at a rate of 12-14 mm/yr, being pinned to the North American plate in Chiapas and western Guatemala, where the strike-slip motion on the volcanic arc must be very small.

Efficacy and safety of sugammadex in the reversal of deep neuromuscular blockade induced by rocuronium in patients with end-stage renal disease: A comparative prospective clinical trial.

BACKGROUND: Renal failure affects the pharmacology of nondepolarizing neuromuscular blockers making recovery of neuromuscular function unpredictable. Sugammadex antagonises rocuronium-induced neuromuscular blockade by encapsulating rocuronium, creating a stable complex molecule that is mainly excreted by the kidneys. Previous studies suggest that sugammadex is effective in reversing moderate neuromuscular block in the presence of renal failure, but no data are available regarding reversal of profound neuromuscular block in patients with renal failure. OBJECTIVE: The objective of this study is to compare the efficacy and safety of sugammadex in reversing profound neuromuscular block induced by rocuronium in patients with end-stage renal disease and those with normal renal function. DESIGN: A prospective clinical trial. SETTING: Two university hospitals, from 1 October 2011 to 31 January 2012. PATIENTS: Forty patients undergoing kidney transplant: 20 with renal failure [creatinine clearance (ClCr) <30 ml min] and 20 control patients (ClCr >90 ml min). INTERVENTION: Neuromuscular monitoring was performed by acceleromyography and train-of-four (TOF) stimulation. Profound neuromuscular block (posttetanic count, one to three responses) was maintained during surgery. Sugammadex 4 mg kg was administered on completion of skin closure. Recovery of the TOF ratio to 0.9 was recorded. Monitoring of neuromuscular function continued in the postanesthesia care unit for a further 2 h. MAIN OUTCOME MEASURES: The efficacy of sugammadex was evaluated by the time taken for the TOF ratio to recover to 0.9. The safety of sugammadex was assessed by monitoring for recurrence of neuromuscular block every 15 min for 2 h. Secondary variables were time to recovery of TOF ratio to 0.7 and 0.8. RESULTS: After sugammadex administration, the mean time for recovery of the TOF ratio to 0.9 was prolonged in the renal failure group (5.6 ±â€Š3.6 min) compared with the control group (2.7 ±â€Š1.3 min, P = 0.003). No adverse events or evidence of recurrence of neuromuscular block were observed. CONCLUSION: In patients with renal failure, sugammadex (4 mg kg) effectively and safely reversed profound rocuronium induced neuromuscular block, but the recovery was slower than healthy patients. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT01785758.

Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial.

BACKGROUND: Sugammadex, a specifically designed gamma-cyclodextrin, is a selective relaxant binding drug that rapidly reverses rocuronium-induced and, to a lesser extent, vecuronium-induced neuromuscular blockade. In this study, we compared the efficacy of sugammadex and neostigmine for the reversal of vecuronium-induced neuromuscular blockade in patients scheduled for elective surgery. METHODS: Patients aged > or = 18 yr, ASA Class I-III, and scheduled for a surgical procedure under sevoflurane/opioid anesthesia received an intubating dose of vecuronium (0.1 mg/kg) and maintenance doses of 0.02-0.03 mg/kg at reappearance of the second twitch (T(2)) of train-of-four (TOF) if required. Neuromuscular blockade was monitored using acceleromyography (TOF-Watch SX, Schering-Plough Ireland, Dublin, Ireland). At end of surgery, at reappearance of T(2) after the last dose of vecuronium, patients were randomized to receive either sugammadex (2 mg/kg) or neostigmine (50 microg/kg) plus glycopyrrolate (10 microg/kg) i.v.. The primary efficacy end-point was time from start of administration of sugammadex or neostigmine to recovery of TOF ratio to 0.9. RESULTS: The geometric mean time to recovery of the TOF ratio to 0.9 was significantly faster with sugammadex compared with neostigmine (2.7 min [95% confidence interval {CI}]: 2.2-3.3) versus 17.9 min [95% CI: 13.1-24.3], respectively; P < 0.0001). The mean recovery times to a TOF ratio of 0.8 and 0.7 were also significantly shorter with sugammadex. No serious adverse events or unexpected side effects were reported with either drug. CONCLUSION: Sugammadex provided significantly faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine.

Uso terapéutico del color como método tradicional / Therapeutic use of color as a traditional method

La terapia por el color es un método tradicional natural y las enfermedades se deben a desequilibrios de un determinado color del espectro, en el organismo humano, donde cada color tiene un efecto compensador para conseguir el equilibrio orgánico. Teniendo en cuenta todos estos aspectos acerca del efecto del color en sus múltiples acciones, realizamos un ensayo clínico en el que se estudiaron 80 pacientes de un área de salud del policlínico "Wilfredo Santana Rivas" de La Habana del Este, con el objetivo de identificar cuál es el color responsable del equilibrio energético en el organismo; identificar cuál es el color deficitario en los pacientes, con alteraciones en su estado emocional y comprobar los resultados obtenidos en la terapia con el uso del color en la ropa y en los alimentos, después de haber realizado un test visual de equilibrio por los colores. Fueron evaluados durante las 4 semanas que duró el experimento. El método estadístico utilizado fue la prueba de chi cuadrado y se llegó a las siguientes conclusiones: el equilibrio energético del organismo lo constituyó el color opuesto al que les gusta y el que les disgusta en orden de frecuencia. El color deficitario en los pacientes con alteración de su estado emocional lo constituyó el azul, el verde cuando hay ansiedad y el rojo cuando se está deprimido(AU)

Color therapy is a natural traditional method and diseases are caused by unbalances in a certain color of the spectrum in the human organism, where each color has a compensating effect to attain the organic balance. Taking into consideration all these aspects about the effect of color in its multiple actions, we conducted a clinical trial in which 80 patients from a health area of "Wilfredo Santana Rivas" Polyclinic, in Eastern Havana, were studied aimed at identifying the color in charge of the energetic balance in the organism and the deficient color in those patients with emotional disorders and to verify the results obtained in the therapy with the use of color in clothes and food, after having made a visual test of balance by colors. They were evaluated during the 4 weeks of the experiment. The statistical method used was the chi square test and it was concluded that the energetic balance of the organism was composed of the color opposed to the one they like and the one they dislike in order of frequency. The deficient color in those patients with alteration of their emotional state was the blue color, the green color when they were anxious and the red color when they were depressed(AU)