Introduction and evaluation of the ACS BCon basic course in Zaragoza, Spain.

BACKGROUND: The American College of Surgeons Bleeding Control Basic (BCon) course aimed at teaching hemorrhage control techniques in the USA had not yet been taught in Spain. The purpose of this study is to assess its implementation among students and healthcare employees in the Lozano Blesa University Hospital of Zaragoza, a middle-sized Spanish city. METHODS: The study was conducted in a University Hospital and at the University of Zaragoza, scheduling four free B-Con sessions from 2017 to 2018. Two groups were identified as forming the population: healthcare employees and medical students. An anonymous questionnaire was completed at the end of the course regarding content, applicability, usefulness, relevance, and satisfaction. Study variables were ranked from 0 to 10: poor (when graded from 0 to 3), fair (4 to 6) and good (7 to 10). Results were compared between the groups, expressed in percentages and χ2 tested to analyze significant differences if any. RESULTS: Among the 83 individuals who completed the course, 46 were medical students and 37 healthcare employees; 61% women and 39% men; aged 21 years to 52 years. Attendees evaluated satisfaction with the highest grade (84%), followed by usefulness (73%), applicability (70%), and relevance (66%). There was no variable graded as poor. The comparison of perceptions between groups did not reveal statistical differences based on a 0.05 significance level. CONCLUSION: We concluded that the B-Con course was valued as good for relevance, usefulness, applicability, and satisfaction by the majority of the studied population. LEVEL OF EVIDENCE: Level III.

Rodent motor and neuropsychological behaviour measured in home cages using the integrated modular platform SmartCage™.

1. To facilitate investigation of diverse rodent behaviours in rodents' home cages, we have developed an integrated modular platform, the SmartCage(™) system (AfaSci, Inc. Burlingame, CA, USA), which enables automated neurobehavioural phenotypic analysis and in vivo drug screening in a relatively higher-throughput and more objective manner. 2, The individual platform consists of an infrared array, a vibration floor sensor and a variety of modular devices. One computer can simultaneously operate up to 16 platforms via USB cables. 3. The SmartCage(™) detects drug-induced increases and decreases in activity levels, as well as changes in movement patterns. Wake and sleep states of mice can be detected using the vibration floor sensor. The arousal state classification achieved up to 98% accuracy compared with results obtained by electroencephalography and electromyography. More complex behaviours, including motor coordination, anxiety-related behaviours and social approach behaviour, can be assessed using appropriate modular devices and the results obtained are comparable with results obtained using conventional methods. 4. In conclusion, the SmartCage(™) system provides an automated and accurate tool to quantify various rodent behaviours in a 'stress-free' environment. This system, combined with the validated testing protocols, offers powerful a tool kit for transgenic phenotyping and in vivo drug screening.

Protein expression is altered during spontaneous sleep in aged Sprague Dawley rats.

Age-related changes in brain function include those affecting learning, memory, and sleep-wakefulness. Sleep-wakefulness is an essential behavior that results from the interaction of multiple brain regions, peptides, and neurotransmitters. The biological function(s) of sleep, however, remains unknown due to a paucity of information available at the cellular level. Aged rats exhibit alterations in the circadian and homeostatic influences associated with sleep-wake regulation. We recently showed that alterations in cortical profiles occur after timed bouts of spontaneous sleep in young rats. Examination of the cellular response to sleep-wake in old rats may thus provide insight(s) into the biological function(s) of sleep. To test this hypothesis, we monitored cortical profiles in the frontal cortex of young and old Sprague-Dawley rats after timed bouts of spontaneous sleep-wake behavior. Proteins were separated by two-dimensional electrophoresis (2-DE), visualized by fluorescent staining, imaged, and analyzed as a function of behavioral state and age. Old rats showed a 6-fold increase in total protein expression, independent of the behavioral state at sacrifice. When analyzed according to age and behavioral state, there was a decrease (approximately 46%) in the number of phospho-spots present during SWS in aged animals. SWS-associated spots present only in old animals were associated with multiple functions including vesicular transport, cell signaling, oxidation state, cytoskeletal support, and energy metabolism. These data suggest that the intracellular response to the signaling associated with spontaneous sleep is affected by age and is consistent with the idea that the ability of sleep to fulfill its function(s) may become diminished with age.

Rapid alterations in cortical protein profiles underlie spontaneous sleep and wake bouts.

Existing data indicate that sleep-wakefulness is an essential behavior. The biological function(s) of sleep, however, remains unknown, due, in part, to the lack of information available at the intracellular level. Preliminary microarray analyses show that changes in behavioral state influence regional mRNA profiles; however, the impact of sleep on protein signatures is virtually unexplored. In these studies, cortical protein profiles were examined after timed bouts of spontaneous sleep-wakefulness. Within minutes of each behavioral state examined, a small number of spots showing unique expression were detected. Mass spectroscopy analyses of sleep- and wake-related spots identified proteins associated with multiple functional categories. Two sleep-associated proteins were further validated using a sleep deprivation paradigm. We found preliminary evidence for two different post-transcriptional mechanisms-one (GAPDH) in which the amount of protein was increased in the recovery sleep following prolonged waking, while the other (actin) suggested that post-translational modifications may underlie sleep. The similarities between the effects of sleep on both protein and mRNA profiles indicate that dynamic intracellular changes underlie sleep-wake states and are consistent with roles for sleep in multiple biological functions.

GABAA receptors inhibit acetylcholine release in cat pontine reticular formation: implications for REM sleep regulation.

This study used in vivo microdialysis in cat (n=12) to test the hypothesis that gamma aminobutyric acid A (GABAA) receptors in the pontine reticular formation (PRF) inhibit acetylcholine (ACh) release. Animals were anesthetized with halothane to hold arousal state constant. Six concentrations of the GABAA receptor antagonist bicuculline (0.03, 0.1, 0.3, 1, 3, and 10 mM) were delivered to a dialysis probe in the PRF, and endogenously released ACh was collected simultaneously. Bicuculline caused a concentration dependent increase in ACh release (maximal increase=345%; EC50=1.3 mM; r2=0.997). Co-administration of the GABAA receptor agonist muscimol prevented the bicuculline-induced increase in ACh release. In a second series of experiments, the effects of bicuculline (0.1, 0.3, 1, and 3 mM) on ACh release were examined without the use of general anesthesia. States of wakefulness, rapid-eye-movement (REM) sleep, and non-REM sleep were identified polygraphically before and during dialysis delivery of bicuculline. Higher concentrations of bicuculline (1 and 3 mM) significantly increased ACh release during wakefulness (36%), completely suppressed non-REM sleep, and increased ACh release during REM sleep (143%). The finding that ACh release in the PRF is modulated by GABAA receptors is consistent with the interpretation that inhibition of GABAergic transmission in the PRF contributes to the generation of REM sleep, in part, by increasing pontine ACh release.

Muscarinic and GABAA receptors modulate acetylcholine release in feline basal forebrain.

Acetylcholine (ACh) release within the basal forebrain changes significantly as a function of sleep and wakefulness, hence identifying the neurochemical modulators of basal forebrain ACh release will contribute to a mechanistic understanding of sleep cycle regulation. This study tested the hypothesis that muscarinic and gamma aminobutyric acid(A) (GABAA) receptors modulate basal forebrain ACh release. Cats were anaesthetized with halothane to hold arousal state constant and a microdialysis probe was aimed stereotaxically for the substantia innominata region of the basal forebrain. Four concentrations of the muscarinic antagonist scopolamine (0.1, 0.3, 1.0, and 10 nm) and five concentrations of the GABAA antagonist bicuculline (3, 10, 30, 100, and 300 micro m) were delivered by reverse dialysis from the same probes used to collect ACh. These results are based on 27 experiments in nine animals. Scopolamine and bicuculline each caused a concentration dependent enhancement of ACh release. Scopolamine increased ACh by 118% above control levels whereas bicuculline was more effective, causing a 287% increase in ACh release. Scopolamine was more potent (EC50 = 0.16 nm) than bicuculline (EC50 > or = 90 micro m) for increasing ACh release. The results support the hypothesis that substantia innominata ACh release is modulated by muscarinic autoreceptors and inhibited by GABAA receptors. These findings are consistent with the interpretation that inhibition of basal forebrain cholinergic neurotransmission by GABA contributes to the generation of sleep.

The nitric oxide synthase inhibitor NG-Nitro-L-arginine increases basal forebrain acetylcholine release during sleep and wakefulness.

Cholinergic neurotransmission in the basal forebrain changes across the sleep/wake cycle, and considerable data show cortical activation by ACh originating from basal forebrain neurons. These findings have stimulated efforts to elucidate molecular modulators of ACh release within the basal forebrain. Basal forebrain cholinergic neurons contain nitric oxide synthase (NOS), the enzyme that produces the gaseous neuromodulator nitric oxide. This study tested the hypothesis that administration of an NOS inhibitor to the basal forebrain would alter basal forebrain ACh release, sleep, and respiratory rate. Seven cats were instrumented for recording sleep and wakefulness and for in vivo microdialysis and microinjection. Compared with Ringer's solution (control), microdialysis delivery of the NOS inhibitor N(G)-nitro-l-arginine (NLA; 10 mm) increased ACh release during wakefulness (33%), non-rapid eye movement (NREM) sleep (70%), and rapid eye movement (REM) sleep (16%). Mean +/- SEM ACh levels (pmol/10 min) during control and NLA dialysis, respectively, were 0.58 +/- 0.03 and 0.77 +/- 0.06 in wakefulness, 0.36 +/- 0.01 and 0.61 +/- 0.06 in NREM sleep, and 0.68 +/- 0.06 and 0.79 +/- 0.09 in REM sleep. Increases in ACh release were not evoked by dialysis delivery of the less active enantiomer N(G)-nitro-d-arginine. Dialysis administration of NLA did not alter respiratory rate. Sleep-dependent changes in basal forebrain ACh release were localized specifically to lateral basal forebrain regions and did not occur in medial basal forebrain sites. Microinjection of NLA into the lateral basal forebrain did not significantly alter the sleep/wake cycle. In contrast to NLA-induced depression of REM sleep and ACh release in the cat pons, the present results demonstrate that NLA increased ACh release in the cat basal forebrain and had no effect on sleep. The different effects of NLA on ACh release in the cat pons and cat basal forebrain may prove relevant for developing compounds that differentially alter cholinergic neurotransmission in specific brain regions.

Enfermedad hepatica alcoholica / Alcoholic liver disease

Se hace una revisión bibliográfica de los diferentes factores involucrados en la etiopatogenia de la enfermedad hepática alcoholoca. En la medida en que se conozcan con detenimiento los factores etiológicos, de riesgo, y otros, se podra evitar la expresión final de esta enfer edad, la cirrosis hepática, que afecta a un alto porcentaje de la población general. La evolución tórpica de esta entidad hace que a los 48 meses de seguimiento de un paciente con cirrosis hepática, cerca del 50 por ciento fallecido. El principal agente etiológico es el alcohol, seguido por los agentes virales, la coexistencia de ambos factores incrementa ostensiblemente la morbilidad. En ocasiones la supresión de la ingesta alcohólica, en fases iniciales, puede disminuir las complicaciones y en consecuencia prolongar la sobrevida

Endoscopia digestiva superior en la Unidad de Gastrenterología del Hospital "Dr. Victorino Santaella Ruiz": revisión de 1993 a 1997 / Upper digestive endoscopy in the Gastroenterolgy Unit of the Hospital \"Dr. Victorino Santaella Ruíz\": revition of 1993 to 1997

En este centro hospitalario la unidad de gastroenterología fue abierta en el año de 1993, funcionando como parte del Departamento de Medicina Interna hasta la actualidad. Se procedió a realizar una revisión de las Endoscopias Digestivas Superiores (EDS) realizadas en esta unidad desde su apertura hasta el año 1997, un período de 5 años, siendo éstas realizadas únicamente por médicos especialistas. Se encontró que la gastritis (erosiva y no erosiva) representó la patología más frecuente con 826 pacientes (34,89 por ciento), seguida por las gastroduodenitis (erosivas y no erosivas) con 278 pacientes (11,75 por ciento) y la duodenitis (parasitaria y no parasitaria) en 268 pacientes (11,32 por ciento)

Toracotomía mínima / Minim Thoracotomy-

La elevada incidencia de lesiones torácicas en la actualidad hace de la toracotomía mínima o cerrada una técnica indispensable de dominar, haremos una revisión biblográfica de los distintos aspectos y criterios concernientes a la colocación y manejo de tubos de tórax como procedimiento de drenaje y monitoreo de emergencia. Esta técnica, su manejo y posibles complicaciones deben ser conocidos por el personal médico que se enfrenta a diario a pacientes en áreas de emergencia