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3.
STAR Protoc ; 4(4): 102570, 2023 Dec 15.
Article En | MEDLINE | ID: mdl-37729059

Micro-light-emitting-diode (µLED) silicon probes feature independently controllable miniature light-emitting-diodes (LEDs) embedded at several positions in each shank of a multi-shank probe, enabling temporally and spatially precise optogenetic neural circuit interrogation. Here, we present a protocol for performing causal and reproducible neural circuit manipulations in chronically implanted, freely moving animals. We describe steps for introducing optogenetic constructs, preparing and implanting a µLED probe, performing simultaneous in vivo electrophysiology with focal optogenetic perturbation, and recovering a probe following termination of an experiment. For complete details on the use and execution of this protocol, please refer to Watkins de Jong et al. (2023).1.


Optogenetics , Silicon , Animals , Optogenetics/methods , Neurons/physiology , Electrophysiological Phenomena , Electrophysiology/methods
4.
Cir. plást. ibero-latinoam ; 49(3): 225-230, Juli-Sep. 2023. ilus, tab
Article Es | IBECS | ID: ibc-227155

Introducción y objetivo: Para obtener buenos resultados en reconstrucción mamaria autóloga con colgajo de dorsal ancho se requiere verificar la presencia de una vascularización tóracodorsal adecuada. En el presente trabajo evaluamos la aportación de la ecografía Doppler-Dúplex para la localización de la arteria torácodorsal, previa a la reconstrucción mamaria diferida con colgajo de dorsal ancho. Material y método: Revisión de 51 pacientes con antecedentes de cirugía axilar por cáncer de mama candidatas a reconstrucción diferida con colgajo homolateral del músculo dorsal ancho. La exploración ecográfica la realizó un solo radiólogo utilizando la modalidad ecográfica Doppler-Dúplex. Resultados: Entre las 51 pacientes, se localizó la arteria tóracodorsal mediante ecografía en 39 casos (76.47%). En 12 casos no se pudo localizar o bien su identificación resultó dudosa. Entre estos 12 casos, en 8 se realizó angio-tomografía computarizada o bien angio-resonancia magnética que identificaron la arteria en 5 casos. En los otros 3, las pacientes rechazaron las exploraciones y no se sometieron a reconstrucción mediante la técnica estudiada o bien no se reconstruyeron. Se dispone de datos confirmados en 47 casos, entre los cuales no se ha visualizado vascularización tóracodorsal en 3 casos, lo que supone un 6.38%. Los parámetros diagnósticos resultantes fueron: sensibilidad 88.63%; especificidad 100%; valor predictivo positivo 100%;y valor predictivo negativo 37.50%, con una exactitud del 89.36%. Conclusiones: En base a nuestra experiencia podemos concluir que, siempre que se disponga de la experiencia y los medios técnicos adecuados, la ecografía Doppler-Dúplex debería ser el primer procedimiento a utilizar para la evaluación de la vascularización tóracodorsal. y en el caso de no reunir tales requisitos o bien si la ecografía fuera dudosa/negativa, realizar otros métodos como la angio-tomografía computarizada o la angio-resonancia magnética(AU).


Background and objective: To obtain good results with autologous latissimus dorsi flap in breast reconstruction it's necessary to verify the presence of adequate thoracodorsal vascularity. In this paper we evaluate the contribution of Doppler-Duplex ultrasound for the localization of the thoracodorsal vessels prior to delayed breast reconstruction with a dorsal fap. Methods: Review of 51 patients with a history of axillary surgery for breast cancer, candidates for delayed breast reconstruction with an ipsilateral flap of the latissimus dorsi muscle. The ultrasound examination was performed by a single radiologist using the Doppler-Duplex ultrasound modality. Results: Among the 51 patients, the thoracodorsal artery was located by ultrasound in 39 cases (76.47%). In 12 cases it could not be located or its identification was doubtful. Among these 12 cases, 8 underwent computed tomography angiography or magnetic resonance angiography, which identified the artery in 5 cases. In the remaining 3 cases the patients refused such examinations and did not undergo reconstruction. Confirmed data are available in 47 cases, among which thoracodorsal vasculature was not visualized in 3 cases, which represents 6.38%,The resulting diagnostic parameters were: sensitivity 88.63%; specificity 100%; positive predictive value 100%; and negative predictive value 37.50%, with an accuracy of 89.36%. Conclusions: From our experience we can conclude that,when the appropriate experience and equipment are available, Doppler-Duplex ultrasound should be the first procedure to be used for the evaluation of the thoracodorsal vasculature. And in the case of not meeting these requirements or the ultrasound was doubtful/negative, perform other methods such as computed tomography angiography or magnetic resonance angiography. Level of evidence 5c Diagnostic.(AU)


Humans , Female , Adult , Middle Aged , Mammaplasty , Breast Neoplasms/surgery , Breast/diagnostic imaging , Ultrasonography, Doppler, Duplex , Predictive Value of Tests , Surgery, Plastic , Breast Implants , Retrospective Studies , Physical Examination , False Positive Reactions , False Negative Reactions , Sensitivity and Specificity
6.
Sensors (Basel) ; 22(22)2022 Nov 08.
Article En | MEDLINE | ID: mdl-36433195

Currently, wearable technology is present in different fields that aim to satisfy our needs in daily life, including the improvement of our health in general, the monitoring of patient health, ensuring the safety of people in the workplace or supporting athlete training. The objective of this bibliometric analysis is to examine and map the scientific advances in wearable technologies in healthcare, as well as to identify future challenges within this field and put forward some proposals to address them. In order to achieve this objective, a search of the most recent related literature was carried out in the Scopus database. Our results show that the research can be divided into two periods: before 2013, it focused on design and development of sensors and wearable systems from an engineering perspective and, since 2013, it has focused on the application of this technology to monitoring health and well-being in general, and in alignment with the Sustainable Development Goals wherever feasible. Our results reveal that the United States has been the country with the highest publication rates, with 208 articles (34.7%). The University of California, Los Angeles, is the institution with the most studies on this topic, 19 (3.1%). Sensors journal (Switzerland) is the platform with the most studies on the subject, 51 (8.5%), and has one of the highest citation rates, 1461. We put forward an analysis of keywords and, more specifically, a pennant chart to illustrate the trends in this field of research, prioritizing the area of data collection through wearable sensors, smart clothing and other forms of discrete collection of physiological data.


Wearable Electronic Devices , Humans , Bibliometrics , Delivery of Health Care , Technology , Switzerland
7.
Article En | MEDLINE | ID: mdl-36231583

Research into assisted living environments -within the area of Ambient Assisted Living (ALL)-focuses on generating innovative technology, products, and services to provide medical treatment and rehabilitation to the elderly, with the purpose of increasing the time in which these people can live independently, whether they suffer from neurodegenerative diseases or disabilities. This key area is responsible for the development of activity recognition systems (ARS) which are a valuable tool to identify the types of activities carried out by the elderly, and to provide them with effective care that allows them to carry out daily activities normally. This article aims to review the literature to outline the evolution of the different data mining techniques applied to this health area, by showing the metrics used by researchers in this area of knowledge in recent experiments.


Human Activities , Machine Learning , Aged , Data Mining , Humans , Technology
8.
Cancers (Basel) ; 14(17)2022 Aug 30.
Article En | MEDLINE | ID: mdl-36077734

Precise prognosis is crucial for selection of adjuvant therapy in breast cancer. Molecular subtyping is increasingly used to complement immunohistochemical and pathological classification and to predict recurrence. This study compares both outcomes in a clinical setting. Molecular subtyping (MammaPrint®, TargetPrint®, and BluePrint®) and pathological classification data were compared in a cohort of 143 breast cancer patients. High risk clinical factors were defined by a value of the proliferation factor Ki67 equal or higher than 14% and/or high histological grade. The results from molecular classification were considered as reference. Core needle biopsies were found to be comparable to surgery samples for molecular classification. Discrepancies were found between molecular and pathological subtyping of the samples, including misclassification of HER2-positive tumors and the identification of a significant percentage of genomic high risk T1N0 tumors. In addition, 20% of clinical low-risk tumors showed genomic high risk, while clinical high-risk samples included 42% of cases with genomic low risk. According to pathological subtyping, a considerable number of breast cancer patients would not receive the appropriate systemic therapy. Our findings support the need to determine the molecular subtype of invasive breast tumors to improve breast cancer management.

9.
Front Endocrinol (Lausanne) ; 13: 875865, 2022.
Article En | MEDLINE | ID: mdl-35795145

The adrenal medulla plays a critical role in mammalian homeostasis and the stress response. It is populated by clustered chromaffin cells that secrete epinephrine or norepinephrine along with peptides into the bloodstream affecting distant target organs. Despite been heavily studied, the central control of adrenal medulla and in-situ spatiotemporal responsiveness remains poorly understood. For this work, we continuously monitored the electrical activity of individual adrenomedullary chromaffin cells in the living anesthetized rat using multielectrode arrays. We measured the chromaffin cell activity under basal and physiological stress conditions and characterized the functional micro-architecture of the adrenal medulla. Under basal conditions, chromaffin cells fired action potentials with frequencies between ~0.2 and 4 Hz. Activity was almost completely driven by sympathetic inputs coming through the splanchnic nerve. Chromaffin cells were organized into independent local networks in which cells fired in a specific order, with latencies from hundreds of microseconds to a few milliseconds. Electrical stimulation of the splanchnic nerve evoked almost exactly the same spatiotemporal firing patterns that occurred spontaneously. Hypoglycemic stress, induced by insulin administration resulted in increased activity of a subset of the chromaffin cells. In contrast, respiratory arrest induced by lethal anesthesia resulted in an increase in the activity of virtually all chromaffin cells before cessation of all activity. These results suggest a stressor-specific activation of adrenomedullary chromaffin cell networks and revealed a surprisingly complex electrical organization that likely reflects the dynamic nature of the adrenal medulla's neuroendocrine output during basal conditions and during different types of physiological stress.


Adrenal Medulla , Chromaffin Cells , Adrenal Medulla/innervation , Adrenal Medulla/metabolism , Animals , Chromaffin Cells/metabolism , Epinephrine , Mammals/metabolism , Norepinephrine , Rats , Splanchnic Nerves/metabolism
10.
BMJ Open ; 12(2): e051187, 2022 02 03.
Article En | MEDLINE | ID: mdl-35115349

OBJECTIVE: Successful clinical trials are subject to recruitment. Recently, the REJUVENATE trial, a prospective phase 2a open-label, single-arm interventional clinical trial conducted within the Innovative Medicines Initiative-supported Combatting Bacterial Resistance in Europe-Carbapenem Resistance project, was published, with 85% of the recruitment performed in Spain. We analysed the recruitment success in this trial by establishing a model of recruitment practice. METHODS: A descriptive qualitative study was performed from May 2016 to October 2017 at 10 participating Spanish centres. Data were extracted from: (1) feasibility questionnaires to assess the centre's potential for patient enrolment; (2) delegation of responsibility records; (3) pre-screening records including an anonymised list of potentially eligible and (4) screening and enrolment records. A descriptive analysis of the features was performed by the participating centre. Pearson's and Spearman's correlation coefficients were calculated to determine factors of recruitment success. RESULTS: The highest recruitment rate was observed in Hospitals 3 and 6 (58.8 and 47.0 patients per month, respectively). All the study teams were multidisciplinary with a median of 15 members (range: 7-22). Only Hospitals 3, 5 and 6 had dedicated nursing staff appointed exclusively to this study. Moreover, in those three hospitals and in Hospital 9, the study coordinator performed exclusive functions as a research planner, and did not assume these functions for the other hospitals. The univariate analysis showed a significant association between recruitment success and months of recruitment (p=0.024), number of staff (p<0.001), higher number of pharmacists (p=0.005), infectious disease specialists (p<0.001), the presence of microbiologist in the research team (p=0.018) and specifically dedicated nursing staff (p=0.036). CONCLUSIONS: The existence of broad multidisciplinary teams with staff dedicated exclusively to the study as well as the implementation of a well-designed local patient assessment strategy were the essential optimisation factors for recruitment success in Spain. TRIAL REGISTRATION NUMBER: NCT02655419; EudraCT 2015-002726-39; analysis of pre-screened patients.


Aztreonam , Azabicyclo Compounds , Humans , Prospective Studies , Spain , Surveys and Questionnaires
11.
Article En | MEDLINE | ID: mdl-34444075

Due to the large number of elderly people with physical and cognitive issues, there is a strong need to provide indoor location systems that help caregivers monitor as many people as possible and with the best quality possible. In this paper, a fuzzy indoor location methodology is proposed in a smart environment based on mobile devices and Bluetooth Low Energy (BLE) beacons where a set of Received Signal Strength Indicators (RSSI) is received by mobile devices worn by the inhabitants. The use of fuzzy logic and a fuzzy linguistic approach is proposed to deal with the imprecise nature of the RSSI values, which are influenced by external factors such as radio waves, causing significant fluctuations. A case study carried out at the Smart Lab of the University of Jaén (UJAmI Smart Lab) is presented to demonstrate the effectiveness of the proposed methodology, where our proposal is compared with a non-fuzzy logic approach, obtaining an accuracy of 91.63%, approximately 10 points higher than the methodology without using fuzzy logic. Finally, our theoretical proposal is accompanied by a description of the UJAmI Location system, which applies the theory to the functionality of locating elderly people in indoor environments.


Computers, Handheld , Fuzzy Logic , Aged , Humans
12.
Sensors (Basel) ; 21(7)2021 Mar 26.
Article En | MEDLINE | ID: mdl-33810606

We live in complex times in the health, social, political, and energy spheres, and we must be aware of and implement new trends in intelligent social health systems powered by the Internet of Things (IoT). Sustainable development, energy efficiency, and public health are interrelated parameters that can transform a system or an environment for the benefit of people and the planet. The integration of sensors and smart devices should promote energy efficiency and ensure that sustainable development goals are met. This work is carried out according to a mixed approach, with a literature review and an analysis of the impact of the Sustainable Development Goals on the applications of the Internet of Things and smart systems. In the analysis of results, the following questions are answered about these systems and applications: (a) Are IoT applications key to the improvement of people's health and the environment? (b) Are there research and case studies implemented in cities or territories that demonstrate the effectiveness of IoT applications and their benefits to public health?


Internet of Things , Sustainable Development , Cities , Delivery of Health Care , Goals , Humans
13.
Rev. senol. patol. mamar. (Ed. impr.) ; 34(1): 3-10, ene. -mar. 2021. ilus, tab, graf
Article Es | IBECS | ID: ibc-EMG-601

Objetivos Evaluar la utilidad de la biopsia ecoguiada con aguja gruesa diagnóstica (BAG1) para la determinación del perfil de expresión génica tumoral (PEG), en los tumores malignos de mama. Materiales y métodos Revisión de 130 biopsias ecoguiadas con aguja gruesa (BAG), con resultado de malignidad. Se consideraron «aptas» las muestras con, al menos, un 30% de células tumorales. Se estudió la influencia del tamaño tumoral (menor de 1 cm, entre 1-2 cm y mayor de 2 cm) y se analizaron las causas que motivaron muestras no aptas. Se utilizó la plataforma MammaPrint® (70 genes). Se evaluó la influencia del grado histológico y del riesgo genómico en los resultados. Resultados En la BAG1 se obtuvieron muestras aptas en 100 biopsias (76,92%). Entre los 36 casos en los que se utilizó la BAG para obtener el PEG, en 32 (88,89%) se realizó a partir de la BAG1. Entre los 30 casos en los que la BAG1 no resultó apta, en 26 casos no se obtuvo el porcentaje mínimo de células tumorales en la muestra. Ni el grado histológico ni el riesgo genómico influyeron en los resultados. Conclusiones Las muestras diagnósticas de la biopsia ecoguiada con aguja gruesa (BAG1) pueden ser válidas para la determinación del perfil de expresión génica. Ello facilita y acelera el proceso de evaluación pronóstica en los tumores infiltrantes de mama. Por ello, proponemos que, de manera rutinaria y ante el diagnóstico de tumor maligno infiltrante, conste el porcentaje de células tumorales en los informes anatomopatológicos. (AU)


Objectives To assess the utility of diagnostic ultrasound-guided core needle biopsy (CNB1) for determining tumour gene expression profile (GEP) in malignant breast tumours. Materials and Methods Review of 130 diagnostic ultrasound-guided core needle biopsies (CNB1) indicating malignancy. Samples with at least 30% tumour cells were considered suitable. The influence of tumour size (less than 1 cm, between 1-2 cm and greater than 2 cm) was studied and the causes of unsuitable samples were analysed. The MammaPrint® platform (70 genes) was used. The influence of histological grade and genomic risk was evaluated. Results Suitable CNB1 samples were obtained in 100 biopsies (76.92%). Among the 36 cases in which CNB was used to obtain the GEP, in 32 (88.89%) it was performed using the CNB1. Among the 30 cases in which CNB1 was not suitable, the minimum percentage of tumour cells in the sample was not obtained in 26 cases. Neither histological grade nor genomic risk influenced the results. Conclusions Diagnostic samples from ultrasound-guided biopsy (CNB1) can be valid to determine GEP. This facilitates and accelerates the prognostic evaluation process in infiltrating breast tumours. Therefore, we propose that, when diagnosing an infiltrating malignant tumour, the percentage of tumour cells should be routinely recorded in the pathology reports. (AU)


Breast Neoplasms/diagnosis , Biopsy, Large-Core Needle , Gene Expression
14.
Rev. senol. patol. mamar. (Ed. impr.) ; 34(1): 3-10, ene. -mar. 2021. ilus, tab, graf
Article Es | IBECS | ID: ibc-230547

Objetivos Evaluar la utilidad de la biopsia ecoguiada con aguja gruesa diagnóstica (BAG1) para la determinación del perfil de expresión génica tumoral (PEG), en los tumores malignos de mama. Materiales y métodos Revisión de 130 biopsias ecoguiadas con aguja gruesa (BAG), con resultado de malignidad. Se consideraron «aptas» las muestras con, al menos, un 30% de células tumorales. Se estudió la influencia del tamaño tumoral (menor de 1 cm, entre 1-2 cm y mayor de 2 cm) y se analizaron las causas que motivaron muestras no aptas. Se utilizó la plataforma MammaPrint® (70 genes). Se evaluó la influencia del grado histológico y del riesgo genómico en los resultados. Resultados En la BAG1 se obtuvieron muestras aptas en 100 biopsias (76,92%). Entre los 36 casos en los que se utilizó la BAG para obtener el PEG, en 32 (88,89%) se realizó a partir de la BAG1. Entre los 30 casos en los que la BAG1 no resultó apta, en 26 casos no se obtuvo el porcentaje mínimo de células tumorales en la muestra. Ni el grado histológico ni el riesgo genómico influyeron en los resultados. Conclusiones Las muestras diagnósticas de la biopsia ecoguiada con aguja gruesa (BAG1) pueden ser válidas para la determinación del perfil de expresión génica. Ello facilita y acelera el proceso de evaluación pronóstica en los tumores infiltrantes de mama. Por ello, proponemos que, de manera rutinaria y ante el diagnóstico de tumor maligno infiltrante, conste el porcentaje de células tumorales en los informes anatomopatológicos. (AU)


Objectives To assess the utility of diagnostic ultrasound-guided core needle biopsy (CNB1) for determining tumour gene expression profile (GEP) in malignant breast tumours. Materials and Methods Review of 130 diagnostic ultrasound-guided core needle biopsies (CNB1) indicating malignancy. Samples with at least 30% tumour cells were considered suitable. The influence of tumour size (less than 1 cm, between 1-2 cm and greater than 2 cm) was studied and the causes of unsuitable samples were analysed. The MammaPrint® platform (70 genes) was used. The influence of histological grade and genomic risk was evaluated. Results Suitable CNB1 samples were obtained in 100 biopsies (76.92%). Among the 36 cases in which CNB was used to obtain the GEP, in 32 (88.89%) it was performed using the CNB1. Among the 30 cases in which CNB1 was not suitable, the minimum percentage of tumour cells in the sample was not obtained in 26 cases. Neither histological grade nor genomic risk influenced the results. Conclusions Diagnostic samples from ultrasound-guided biopsy (CNB1) can be valid to determine GEP. This facilitates and accelerates the prognostic evaluation process in infiltrating breast tumours. Therefore, we propose that, when diagnosing an infiltrating malignant tumour, the percentage of tumour cells should be routinely recorded in the pathology reports. (AU)


Breast Neoplasms/diagnosis , Biopsy, Large-Core Needle , Gene Expression
15.
Article En | MEDLINE | ID: mdl-32174815

Background: The spinal cord's central pattern generators (CPGs) have been explained by the symmetrical half-center hypothesis, the bursts generator, computational models, and more recently by connectome circuits. Asymmetrical models, at odds with the half-center paradigm, are composed of extensor and flexor CPG modules. Other models include not only flexor and extensor motoneurons but also motoneuron pools controlling biarticular muscles. It is unknown whether a preferred model can explain some particularities that fictive scratching (FS) in the cat presents. The first aim of this study was to investigate FS patterns considering the aiming and the rhythmic periods, and second, to examine the effects of serotonin (5HT) on and segmental inputs to FS. Methods: The experiments were carried out first in brain cortex-ablated cats (BCAC), then spinalized (SC), and for the midcollicular (MCC) preparation. Subjects were immobilized and the peripheral nerves were used to elicit the Monosynaptic reflex (MR), to modify the scratching patterns and for electroneurogram recordings. Results: In BCAC, FS was produced by pinna stimulation and, in some cases, by serotonin. The scratching aiming phase (AP) initiates with the activation of either flexor or extensor motoneurons. Serotonin application during the AP produced simultaneous extensor and flexor bursts. Furthermore, WAY 100635 (5HT1A antagonist) produced a brief burst in the tibialis anterior (TA) nerve, followed by a reduction in its electroneurogram (ENG), while the soleus ENG remained silent. In SC, rhythmic phase (RP) activity was recorded in the soleus motoneurons. Serotonin or WAY produced FS bouts. The electrical stimulation of Ia afferent fibers produced heteronymous MRes waxing and waning during the scratch cycle. In MCC, FS began with flexor activity. Electrical stimulation of either deep peroneus (DP) or superficial peroneus (SP) nerves increased the duration of the TA electroneurogram. Medial gastrocnemius (MG) stretching or MG nerve electrical stimulation produced a reduction in the TA electroneurogram and an initial MG extensor burst. MRes waxed and waned during the scratch cycle. Conclusion: Descending pathways and segmental afferent fibers, as well as 5-HT and WAY, can change the FS pattern. To our understanding, the half-center hypothesis is the most suitable for explaining the AP in MCC.


Ablation Techniques , Cerebral Cortex/physiology , Decerebrate State/physiopathology , Peripheral Nerves/physiology , Reflex, Monosynaptic/physiology , Spinal Cord/physiology , Ablation Techniques/methods , Animals , Brain/drug effects , Brain/physiology , Brain/surgery , Cats , Cerebral Cortex/drug effects , Cerebral Cortex/surgery , Electric Stimulation/methods , Motor Neurons/drug effects , Motor Neurons/physiology , Peripheral Nerves/drug effects , Reflex, Monosynaptic/drug effects , Serotonin/administration & dosage , Serotonin Antagonists/administration & dosage , Spinal Cord/drug effects , Spinal Cord/surgery , Superior Colliculi/drug effects , Superior Colliculi/physiology , Superior Colliculi/surgery
16.
Oncogene ; 38(17): 3151-3169, 2019 04.
Article En | MEDLINE | ID: mdl-30622340

Increased cancer stem cell content during development of resistance to tamoxifen in breast cancer is driven by multiple signals, including Sox2-dependent activation of Wnt signalling. Here, we show that Sox2 increases and estrogen reduces the expression of the transcription factor Sox9. Gain and loss of function assays indicate that Sox9 is implicated in the maintenance of human breast luminal progenitor cells. CRISPR/Cas knockout of Sox9 reduces growth of tamoxifen-resistant breast tumours in vivo. Mechanistically, Sox9 acts downstream of Sox2 to control luminal progenitor cell content and is required for expression of the cancer stem cell marker ALDH1A3 and Wnt signalling activity. Sox9 is elevated in breast cancer patients after endocrine therapy failure. This new regulatory axis highlights the relevance of SOX family transcription factors as potential therapeutic targets in breast cancer.


Breast Neoplasms/metabolism , Breast/metabolism , Drug Resistance, Neoplasm , Neoplastic Stem Cells/metabolism , SOX9 Transcription Factor/metabolism , SOXB1 Transcription Factors/metabolism , Breast/cytology , Breast Neoplasms/drug therapy , Breast Neoplasms/genetics , Cell Line , Cell Proliferation , Epithelial Cells/cytology , Estrogens/pharmacology , Female , Gene Expression Regulation, Neoplastic , Humans , MCF-7 Cells , SOX9 Transcription Factor/genetics , Signal Transduction , Tamoxifen/pharmacology , Up-Regulation
17.
Cir. Esp. (Ed. impr.) ; 97(1): 3-10, ene. 2019. tab
Article Es | IBECS | ID: ibc-181097

El modelo Acute Care Surgery agrupa bajo una misma disciplina el trauma, la cirugía de urgencias y los cuidados intensivos posquirúrgicos. Concebido y extendido durante las 2 últimas décadas por territorio norteamericano, la magnitud e idiosincrasia clínica de la urgencia quirúrgica han hecho que este modelo se haya asumido en muchos otros puntos de la geografía mundial. En nuestro país, el reflejo ha sido la creación e implantación de las denominadas unidades de trauma y cirugía de urgencias, cuyos objetivos son comunes a las publicadas para el modelo original: evitar la nocturnidad en las urgencias quirúrgicas, liberar a los profesionales vinculados a la cirugía electiva en horario laboral y convertirse en el eslabón y referente perfectos de la continuidad asistencial. En el presente artículo se resumen el nacimiento y la expansión del modelo original, la evidencia aportada en cuanto a resultados y la situación actual en nuestro país


The Acute Care Surgery model groups trauma and emergency surgery with surgical critical care. Conceived and extended during the last 2 decades throughout North America, the magnitude and clinical idiosyncrasy of emergency general surgery have determined that this model has been expanded to other parts of the world. In our country, this has led to the introduction and implementation of the so-called trauma and emergency surgery units, with common objectives as those previously published for the original model: to decrease the rates of emergency surgery at night, to allow surgeons linked to elective surgery to develop their activity in their own disciplines during the daily schedule, and to become the perfect link and reference for the continuity of care. This review summarizes how the original model was born and how it expanded throughout the world, providing evidence in terms of results and a description of the current situation in our country


Humans , Traumatology/organization & administration , Models, Organizational , Emergency Service, Hospital , Health Plan Implementation/organization & administration , Trauma Centers/trends , Hospital Units/organization & administration , Societies, Medical/organization & administration , Societies, Medical/standards , Postoperative Care
18.
Cir Esp (Engl Ed) ; 97(1): 3-10, 2019 Jan.
Article En, Es | MEDLINE | ID: mdl-30415793

The Acute Care Surgery model groups trauma and emergency surgery with surgical critical care. Conceived and extended during the last 2 decades throughout North America, the magnitude and clinical idiosyncrasy of emergency general surgery have determined that this model has been expanded to other parts of the world. In our country, this has led to the introduction and implementation of the so-called trauma and emergency surgery units, with common objectives as those previously published for the original model: to decrease the rates of emergency surgery at night, to allow surgeons linked to elective surgery to develop their activity in their own disciplines during the daily schedule, and to become the perfect link and reference for the continuity of care. This review summarizes how the original model was born and how it expanded throughout the world, providing evidence in terms of results and a description of the current situation in our country.


Critical Care/organization & administration , Emergency Service, Hospital/organization & administration , Models, Organizational , Surgery Department, Hospital/organization & administration , Trauma Centers/organization & administration , Humans , Spain
19.
Neuroscience ; 358: 37-48, 2017 09 01.
Article En | MEDLINE | ID: mdl-28663091

The current decerebration procedures discard the role of the thalamus in the motor control and decortication only rules out the brain cortex part, leaving a gap between the brain cortex and the subthalamic motor regions. In here we define a new preparation denominated Brain Cortex-Ablated Cat (BCAC), in which the frontal and parietal brain cortices as well as the central white matter beneath them were removed, this decerebration process may be considered as suprathalamic, since the thalamus remained intact. To characterize this preparation cat hindlimb electromyograms (EMG), kinematics and cutaneous reflexes (CR) produced by electrical stimulation of sural (SU) or saphenous (SAPH) nerves were analyzed during locomotion in intact and in BCAC. In cortex-ablated cats compared to intact cats, the hindlimb EMG amplitude was increased in the flexors, whereas in most extensors the amplitude was decreased. Bifunctional muscle EMGs presented complex and speed-dependent amplitude changes. In intact cats CR produced an inhibition of extensors, as well as excitation and inhibition of flexors, and a complex pattern of withdrawal responses in bifunctional muscles. The same stimuli applied to BCAC produced no detectable responses, but in some cats cutaneous reflexes produced by electrical stimulation of saphenous nerve reappeared when the locomotion speed increased. In BCAC, EMG and kinematic changes, as well as the absence of CR, imply that for this cat preparation there is a partial compensation due to the subcortical locomotor apparatus generating close to normal locomotion.


Cerebral Cortex/physiology , Cerebral Decortication , Evoked Potentials, Motor/physiology , Locomotion/physiology , Reflex/physiology , Animals , Biomechanical Phenomena , Cats , Electromyography , Muscle, Skeletal/physiology , Torso/innervation
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