Infecciones postneuroquiróºrgicas: Puesta al día y recomendaciones intersociedades / Post-neurosurgical infections. Update and intersociety recommendations

Las infecciones asociadas a procedimientos neuroquiró;ºrgicos son complicaciones graves que contribuyen a la morbimortalidad de los pacientes neurocríticos, así como tambín a la prolongació;n de la estancia en la UTI y/o en el hospital. El diagnó;stico es complejo ya que no se dispone de gold standard y se apoya en la sospecha clínica, las alteraciones físico-químicas del líquido cefalorraquídeo y el aislamiento microbiano. El tratamiento debe ser precoz y guiado por la epidemiología local. La duració;n dependerá del microorganismo causal, su sensibilidad y la disponibilidad de tratamientos antibió;ticos efectivos en el sitio de la infecció;n. La implementació;n de medidas de prevenció;n con evidencia demostrada minimiza el riesgo de infecció;n. Esta puesta al día intersociedades SADI-SATI presenta datos epidemioló;gicos (internacionales y locales), mó;©todos diagnó;sticos, tratamiento, y pautas de prevenció;n, considerando las publicaciones más relevantes de los ó;ºltimos aó;±os sobre el tema.

Infections associated with neurosurgical procedures are serious complications that contribute to the morbidity and mortality of neurocritical patients, as well as to the prolongation of the stay in the ICU and the hospital. The diagnosis is complex since there is no gold standard, so it is based on clinical suspicion, CSF physical-chemical examination, and microbial isolation. Treatment should be initiated early, guided by local epidemiology. The duration will depend on the causative microorganism, its sensitivity and the availability of antibiotic treatments that are effective at the site of infection. The implementation of preventive measures with proven efficacy minimizes the risk of infection. This SADI-SATI intersociety update reviews relevant data recently published on this area at the national at international level regarding epidemiology, diagnostic methodologies, therapeutic approaches, and prevention guidelines.

Evaluation of swallowing ability using swallowing sounds in maxillectomy patients.

Maxillectomy for oral tumours often results in debilitating oral hypofunction, which markedly decreases quality of life. Dysphagia, in particular, is one of the most serious problems following maxillectomy. This study used swallowing sounds as a simple evaluation method to evaluate swallowing ability in maxillectomy patients with and without their obturator prosthesis placed. Twenty-seven maxillectomy patients (15 men, 12 women; mean age 66.0 ± 12.1 years) and 30 healthy controls (14 men, 16 women; mean age 44.9 ± 21.3 years) were recruited for this study. Participants were asked to swallow 4 mL of water, and swallowing sounds were recorded using a throat microphone. Duration of the acoustic signal and duration of peak intensity (DPI) were measured. Duration of peak intensity was significantly longer in maxillectomy patients without their obturator than with it (P < .05) and was significantly longer in maxillectomy patients without their obturator than in healthy controls (P < .025 after Bonferroni correction). With the obturator placed, DPI was significantly longer in maxillectomy patients who had undergone soft palate resection than in those who had not (P < .05). These results suggest swallowing ability in maxillectomy patients could be improved by wearing an obturator prosthesis, particularly during the oral stage. However, it is difficult to improve the oral stage of swallowing in patients who have undergone soft palate resection even with obturator placement.

Judging hardness of an object from the sounds of tapping created by a white cane.

The white cane plays a vital role in the independent mobility support of the visually impaired. Allowing the recognition of target attributes through the contact of a white cane is an important function. We have conducted research to obtain fundamental knowledge concerning the exploration methods used to perceive the hardness of an object through contact with a white cane. This research has allowed us to examine methods that enhance accuracy in the perception of objects as well as the materials and structures of a white cane. Previous research suggest considering the roles of both auditory and tactile information from the white cane in determining objects' hardness is necessary. This experimental study examined the ability of people to perceive the hardness of an object solely through the tapping sounds of a white cane (i.e., auditory information) using a method of magnitude estimation. Two types of sounds were used to estimate hardness: 1) the playback of recorded tapping sounds and 2) the sounds produced on-site by tapping. Three types of handgrips were used to create different sounds of tapping on an object with a cane. The participants of this experiment were five sighted university students wearing eye masks and two totally blind students who walk independently with a white cane. The results showed that both sighted university students and totally blind participants were able to accurately judge the hardness of an object solely by using auditory information from a white cane. For the blind participants, different handgrips significantly influenced the accuracy of their estimation of an object's hardness.

An in-shoe device to measure plantar pressure during daily human activity.

In this work, we report the development of a novel device, integrated into a shoe, to monitor plantar pressure under real-life conditions by reducing the spatial and temporal resolution. The device consists of a shoe insole with seven pressure-sensitive conductive rubber sensors and a wireless data transmission unit incorporated into a smaller measurement unit. One advantage of this approach is that the mass and volume of the measurement unit are less than 1/10th and 1/50th, respectively, of that reported for other devices. A comparison experiment was conducted for validation of the device using the F-scan system, and the initial test of the device was conducted by recording unobstructed gaits of one young adult subject and two elderly subjects. Each subject performed a straight, level walking trial at a comfortable speed for 7 m without any assistive device while wearing the in-shoe device. Changes in the plantar pressure during gait were recorded. Compared with the young subject, the pressure under the heel of the elderly subject was found to be smaller and less steep. This in-shoe device can be used to monitor plantar pressure during daily living and is expected to be useful in various clinical applications.

Transition from overlayer growth to alloying growth of Ga on Si(111)-alpha-(sqrt[3]xsqrt[3])-Au.

Atomic depth distribution and growth modes of Ga on an Si(111)-alpha-(sqrt[3]xsqrt[3])-Au surface at room temperature were studied after each monolayer deposition of Ga via reflection high-energy electron diffraction and characteristic x-ray spectroscopy measurements as functions of glancing angle theta(g) of the incident electron beam. One monolayer of Ga grew on the Au layer, and the sqrt[3]xsqrt[3] periodicity was conserved below the Ga overlayer. Above a critical Ga coverage of about one monolayer, this growth mode drastically changed; i.e., Au atoms dissociated from the sqrt[3]xsqrt[3] structure and Ga grew into islands of Ga-Au alloy.

The influence of moving auditory stimuli on standing balance in healthy young adults and the elderly.

The maintenance of postural balance depends on effective and efficient feedback from various sensory inputs. The importance of auditory inputs in this respect is not, as yet, fully understood. The purpose of this study was to analyse how the moving auditory stimuli could affect the standing balance in healthy adults of different ages. The participants of the study were 12 healthy volunteers, who were divided into two age categories: the young group (mean = 21.9 years) and the elderly group (mean = 68.9 years). The instrument used for evaluation of standing balance was a force plate for measuring body sway parameters. The toe pressure was measured using the F-scan Tactile Sensor System. The moving auditory stimulus produced a white-noise sound and binaural cue using the Beachtron Affordable 3D Audio system. The moving auditory stimulus conditions were employed by having the sound come from the right to left or vice versa at the height of the participant's ears. Participants were asked to stand on the force plate in the Romberg position for 20 s with either eyes opened or eyes closed for analysing the effect of visual input. Simultaneously, all participants tried to remain in the standing position with and without auditory stimulation that the participants heard from the headphone. In addition, the variables of body sway were measured under four conditions for analysing the effect of decreased tactile sensation of toes and feet soles: standing on the normal surface (NS) or soft surface (SS) with and without auditory stimulation. The participants were asked to stand in a total of eight conditions. The results showed that the lateral body sway of the elderly group was more influenced than that of the young group by the lateral moving auditory stimulation. The analysis of toe pressure indicated that all participants used their left feet more than their right feet to maintain balance. Moreover, the elderly had the tendency to be stabilized mainly by use of their heels. The young group were mainly stabilized by the toes of their feet. The results suggest that the elderly may need a more appropriate stimulus of tactile and auditory sense as a feedback system than the young for maintaining and control of their standing postures.

Anomalous X-Ray yields under surface wave resonance during reflection high energy electron diffraction and adatom site determination

In L x-ray emissions from a Si(111)-sqrt[3]xsqrt[3]-In surface induced by electron beam irradiation were measured as functions of the incident glancing angle. Under surface wave resonance conditions, anomalous x-ray intensities were clearly observed. Using dynamical calculations, these intensities are well explained as changes in density of the electron wave field at adatom positions. From these intensities, the adatom site was analyzed, and it was found that the T4 model is better than the H3 model.

Simultaneous determination of residual tetracyclines in foods by high-performance liquid chromatography with atmospheric pressure chemical ionization tandem mass spectrometry.

We established a method for precisely determining residual tetracycline antibiotics (TCs) in foods by atmospheric pressure chemical ionization liquid chromatography-tandem mass spectrometry (APCI LC-MS-MS) using selected reaction monitoring with an internal standard. By setting the nebulizer probe temperature to 475 degrees C, we were able to use a mobile phase containing oxalic acid without clogging problems at the APCI interface, since oxalic acid decomposes to carbon dioxide and water at high temperature. DMCTC was very effective as an internal standard for determining TCs in various foods. TCs were cleaned up using a Bond Elut ENV cartridge and analysed by APCI LC-MS-MS. The recovery of TCs from various foods including animal tissues, honey, milk, eggs, and fish fortified at levels of 0.05, 0.10, and 0.50 ppm averaged 60.1-88.9%, with an RSD of 1.2-8.7%. The detection limits were 0.001 ppm for OTC and TC, 0.004 ppm for CTC, and 0.002 ppm for DC. The present method was also successfully used to determine TCs in swine kidney samples that were previously found by microbiological assay.

[Development of 18F-FDG ([F-18]-2-fluoro-2-deoxy-D-glucose) injection for imaging of tumor reflecting glucose metabolism--results of preclinical studies].

Fluorine-18-2-fluoro-2-deoxy-D-glucose (18F-FDG) injection was prepared by a modification of a method originally developed by Hamacher et al. The dosage form is the injectable solution (2 ml) containing 185 MBq of 18F-FDG at a calibration time. Preclinical studies of the agent were performed. Its radiochemical purity is more than 95% and expiration time is 4 hours after the calibration time at ambient temperature. No toxicity was observed with up to 200 mg/kg and 100 mg/kg of non-radioactive FDG intravenously injected to rats and dogs in single-dose toxicity tests, respectively. Biodistribution studies demonstrated that the radioactivity was mainly distributed into brain (3.0 to 3.3% I.D./Organ at 30 minutes) and heart (4.2 to 5.8% I.D./Organ at 1 to 3 hours) after intravenous injection of the agent to normal rats. In a tumor transplanted mouse model (colon 26), tumor uptake was 10.9 +/- 3.5% I.D./g at 1 hr after intravenous injection of the agent, the radioactivity was retained until 3 hours. The radiation absorbed dose was estimated according to the MIRD Pamphlet based on the biodistribution data both in humans reported by Mejia et al. and rats described in this report. The radiation absorbed dose was not higher than those of commercially available radiopharmaceuticals. In conclusion, the 18F-FDG injection is expected to be useful for further clinical application.

Effects on the location of the centre of gravity and the foot pressure contribution to standing balance associated with ageing.

The aim was to analyse the limitation of the head and lumbar movements in relation to the centre of gravity which is needed to maintain standing balance with ageing. The participants of the study were 25 healthy volunteers divided into two age categories, the young group (mean 22.4 +/- 2.7 years) and the elderly group (mean 71.2 +/- 3.6 years). The instruments for measuring the movements of the lumbar region and head and the centre of pressure (COP) were a 3-D motion analysis system and a force plate. In addition, the peak foot pressure was measured during standing using the F-Scan system. The participants were first asked to stand relaxed for 10 s. They then shifted from the starting position to the four directions of sway: anterior, posterior, right and left. They were asked to maintain standing balance at the maximal distance position for each sway as much as possible for 10 s. Analysis of parameters was performed by measuring the average maximal linear displacement (cm) of the head and lumbar markers, the COP (cm), and the peak foot pressure (% of body weight per cm2) in each participant. The data of the young group for lumbar maximal displacement were greater than those of the elderly group in the anterior, posterior and lateral sways. A significant difference between the young and elderly data was found in the posterior sway. According to the data of the head's maximal displacement, the elderly group's data were greater than the young group's data in all sways, except for the anterior side. For the data of peak foot pressure in the posterior sway, the elderly group's data was greater than the young group's data. The forefoot area data of the young group was significantly greater than that of the elderly group, and the heel area data of the elderly was significantly greater than that of the young group in the right sway. The results suggest that the maximal displacement of head and lumbar positions and the toe's muscle activity in the forefoot are important factors associated with the centre of gravity in elderly adults. It is postulated that each base of support area of the older adults in smaller than that of younger adults. These variables could be made available as a clinical test for the degree of poor balance.

Application of hydrogen absorbing alloys to medical and rehabilitation equipment.

As power sources for rehabilitation equipment, electric, hydraulic, and pneumatic actuators have been used. However a more human-sized and higher powered actuator that can reduce the equipment size is desired. A new metal hydride (MH) actuator that uses the reversible reaction between the heat energy and mechanical energy of a hydrogen absorbing alloy has recently attracted much attention. The MH actuator is characterized by its small size, low weight, noiseless operation and a compliance similar to that of the human elbow joint. Therefore, the MH actuator has the characteristic of being light and easy to use and so is suitable for use in medical and rehabilitation applications. Some lifting devices using this actuator have already been developed and are being used for the care of the aged and disabled. The characteristics of the MH actuator are presented and then some applications are introduced in this paper. It is our opinion that in our aging society the MH actuator will play an important role in the development of medical and rehabilitation equipment.

Age-related changes in postural control associated with location of the center of gravity and foot pressure.

The purpose of this study was to assess the limitations of the head and lumbar movements in relation to the center of gravity which is needed to maintain standing balance with aging. The subjects of the study were 22 healthy volunteers. The subjects were divided into two age categories, the young group (mean 21.7 +/- 2.9 years, 7 males and 6 females); and the elderly group (mean 71.3 +/-2.6 years, 3 males and 4 females). The instruments for measuring lumbar and head movements and the center of pressure (COP) were a three-dimensional motion analysis system and a force plate. In addition, the peak foot pressure was measured during standing using the F-Scan system. The subjects were first asked to stand relaxed for 10 s. They then shifted from the starting position to the four directions (sways); anterior, posterior, right, and left. They tried to maintain standing balance at the maximal possible distance position for each sway for 10 seconds. Analyzing parameters were performed by measuring the average maximal linear displacement (cm) of the head and lumbar markers, the COP (cm), and the peak foot pressure (percent of body weight per squared centimeters; BW%/cm2) in each subject. The data of the young group for lumbar maximal displacement were greater than those of the elderly group in the anterior, posterior, and lateral sways. A significant difference between the young and elderly data was found in the posterior sway. According to the data of the head's maximal displacement, the elderly group was greater than the young group in all sways except for the anterior side. For the data of peak foot pressure in the posterior sway, the elderly group's data was greater than the young group's data. The forefoot area data of the young group was significantly greater than that of the elderly group and the heel area data of the elderly was significantly greater than that of the young group in the right sway. The results suggest that evaluating the maximal displacement of head and lumbar positions and toe's activity in the forefoot are all important factors associated with the center of gravity in healthy adults.

Objective method to determine the contribution of the great toe to standing balance and preliminary observations of age-related effects.

The purpose of this study was to examine the relationship between toe pressure and tactile sensitivity in the great toe and to describe two newly developed measurements of postural stability. The subjects of the study were 21 healthy volunteers. The subjects were divided into two age groups, the young group (mean 21.0 +/- 1.6 years, 7 males and 6 females), and the elderly group (mean 71.4 +/- 2.8 years, 4 males and 4 females). The methods and materials used for the first experiment (balance test): The instrument for measuring standing balance was a force plate. Data were analyzed to provide two main variables: 1) body sway index (SI: mm) and 2) toe pressure (%BW/cm2). The subjects were asked to stand in a relaxed posture for 20 s. The variables of body sway were measured in four conditions: normal surface with eyes open or closed, and soft surface with eyes open or closed. Second experiment (tactile sense test): This experiment utilized a new system which was developed for measuring the tactile sensation. The tactile threshold value was measured with the subject seated in a chair, the back supported, and the hips and knees flexed at 90 degrees. The contactor pulled and pushed the toe longitudinally along its axis at a constant velocity of 1 mm/s. There were significant differences between the young and elderly groups in the tactile sense of the great toe (p < .001). No significant difference between age groups was found for postural sway while the subjects stood on the normal surface with eyes open; however, when they stood on the soft surface with their eyes open and closed, the elderly showed significantly more sway (p < 0.01) than the young. Moreover, the maximal great toe pressure in the elderly group was significantly greater than that in the young group. The results suggest that the reduced tactile sense, deprivation of visual information, and toe pressure weakness are all important factors associated with postural instability.

Analysis of toe pressures under the foot while dynamic standing on one foot in healthy subjects.

Dynamic balance is a crucial element in performing many activities of daily living. The one-leg stance test is a valuable test for balance impairment. The aim of the present study was to assess the relationships between body sway and toe pressure for dynamic balance test of one-leg standing on a perturbation platform. The subjects were 15 volunteers (six males and nine females, age = 21.1 +/- 1.8 years). The instrument used for evaluation of balance was the Balance System, whose software provides information on the subject's stance balance through calculation of two main variables: 1) body sway parameters (cm) and 2) peak pressure (percent of body weight/cm2) under the toes. The Balance System includes actuators which move the foot platform back and forth (+/- 40 mm perturbation at 0.25 Hz) at an average velocity of 20 mm/sec. The subjects were asked to balance on each leg for 20 seconds. The trials were repeated on the opposite foot after 5 minutes of rest. The dynamic postural control induced by low frequency perturbation in the anterior/posterior direction used the ankle strategy. Body sway was more significantly correlated with the peak anterior/posterior sway component than with lateral sway (p < 0.01). The peak pressure value of the great toe was significantly greater (p < 0.01) than the sum of the peak values of the other four toes for both sides. The study indicates the importance of the strength of the toes and somatosensory information from the sole and ankle during the dynamic one-foot standing balance as goals in rehabilitation for poor balance.

Automated synthesis of radiopharmaceuticals for positron emission tomography: an apparatus for [1-C] labeled carboxylic acid.

A fully automated apparatus for the synthesis and formulation of short-lived (11)C (t(1/2) = 20 min)-labeled carboxylic acids for positron emission tomograpy (PET) has been developed. Injectable solutions of [1-(11)C]acetic acid, [1-(11)C]octanoic acid and [1-(11)C]palmitic acid wilh radioactivities of 6.36-8.29 GBq, 0.070-1.43 GBq and 0.42-0.89 GBq were obtained. The preparation time was under 40 min after the end of bombardment. An automatic washing function means that labeled compound of the same or different kinds can be produced several times a day without any maintenance of the system. The control system is sited away from the 'hot laboratory', so operator exposure to radiation is minimized.