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Neocortical neurons in vivo process each of their individual inputs in the context of ongoing synaptic background activity, produced by the thousands of presynaptic partners a typical neuron has. Previous work has shown that background activity affects multiple aspects of neuronal and network function. However, its effect on the induction of spike-timing dependent plasticity (STDP) is not clear. Here we report that injections of simulated background conductances (produced by a dynamic-clamp system) into pyramidal cells in rat brain slices selectively reduced the magnitude of timing-dependent synaptic potentiation while leaving the magnitude of timing-dependent synaptic depression unchanged. The conductance-dependent suppression also sharpened the STDP curve, with reliable synaptic potentiation induced only when EPSPs and action potentials (APs) were paired within 8 ms of each other. Dual somatic and dendritic patch recordings suggested that the deficit in synaptic potentiation arose from shunting of dendritic EPSPs and APs. Using a biophysically detailed computational model, we were not only able to replicate the conductance-dependent shunting of dendritic potentials, but show that synaptic background can truncate calcium dynamics within dendritic spines in a way that affects potentiation more strongly than depression. This conductance-dependent regulation of synaptic plasticity may constitute a novel homeostatic mechanism that can prevent the runaway synaptic potentiation to which Hebbian networks are vulnerable.
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Potenciais de Ação/fisiologia , Condução Nervosa/fisiologia , Plasticidade Neuronal/fisiologia , Células Piramidais/fisiologia , Animais , Animais Recém-Nascidos , Potenciais Pós-Sinápticos Excitadores/fisiologia , Ratos , Ratos Sprague-Dawley , Filtro Sensorial/fisiologia , Potenciais Sinápticos/fisiologia , Transmissão Sináptica/fisiologia , Fatores de TempoRESUMO
The POCUS-CA (Point-of-care ultrasound in cardiac arrest) is a diagnostic tool in the Intensive Care Unit and Emergency Department setting. The literature indicates that in the patient in a cardiorespiratory arrest it can provide information of the etiology of the arrest in patients with non-defibrillable rhythms, assess the quality of compressions during cardiopulmonary resuscitation (CPR), and define prognosis of survival according to specific findings and, thus, assist the clinician in decision-making during resuscitation. This narrative review of the literature aims to expose the usefulness of ultrasound in the setting of cardiorespiratory arrest as a tool that allows making a rapid diagnosis and making decisions about reversible causes of this entity. More studies are needed to support the evidence to make ultrasound part of the resuscitation algorithms. Teamwork during cardiopulmonary resuscitation and the inclusion of ultrasound in a multidisciplinary approach is important to achieve a favorable clinical outcome.
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Increased age and female sex are suggested risk factors for drug-induced hepatotoxicity (DILI). We studied the influence of these variables on the propensity to develop DILI, as well as its clinical expression and outcome. All cases of DILI submitted to the Spanish Registry between April 1994 and August 2007 were analyzed. Six hundred three DILI cases (310 men; mean age, 54 years) showed a similar sex distribution, reaching two peaks in the 40- to 49-year-old and 60- to 69-year-old age groups. No cases were recorded in the 20- to 29-year-old group. Patients aged > or =60 years accounted for 46% of the cases, with a male predominance (158 males, 118 females; P= 0.009), as opposed to younger patients. Older age was independently associated with cholestatic type of injury (odds ratio for an age interval for 1 year: 1.024 [95% confidence interval: 1.010-1.038]; male/female ratio, 1:2; P = 0.001) and younger age with hepatocellular damage (odds ratio: 0.983 [95% confidence interval: 0.972-0.994]; female/male ratio, 1:2; P = 0.002). In the mixed group, no age effect was evident. Outcome with fulminant liver failure/liver transplantation was more frequently encountered in women (P < 0.01). conclusion: Neither older age nor female sex are predisposing factors to overall DILI. However, older age is a determinant for cholestatic damage with a male predominance, whereas younger age is associated with cytolytic damage and a female overrepresentation. Women distinctly exhibit the worst outcome. Knowledge of these phenotypic associations could guide differential diagnosis and attribution of causality in DILI.
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Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Doença Hepática Induzida por Substâncias e Drogas/genética , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Distribuição por Sexo , Fatores Sexuais , Adulto JovemRESUMO
INTRODUCCIÓN: El carcinoma basocelular (CBC) es la neoplasia cutánea maligna más común. OBJETIVO: se investigó el riesgo de recurrencia y de nueva neoplasia cutánea maligna después del tratamiento de CBC. MÉTODO: Estudio retrospectivo. Fueron identificados los pacientes con diagnóstico histopatológico de CBC primario, de enero de 2007 a diciembre de 2009, y se revisaron los expedientes para investigar el número de recurrencias, la localización, el tipo de tratamiento y la variante histopatológica, determinando nuevas neoplasias cutáneas malignas. El análisis incluyó estadística descriptiva e inferencial, considerando significativa una p < 0.05. RESULTADOS: Se incluyeron 397 pacientes, con un seguimiento promedio de 4 ± 1.5 años. La recurrencia se presentó en el 4% y se relacionó con un mayor tiempo de evolución (36 vs. 32 meses; p = 0.04) y haber sido tratado mediante técnicas destructivas (electrofulguración, criocirugía o imiquimod; 31 vs. 4%; p = 0.0004). No hubo relación con la localización ni con la variante histopatológica. El riesgo de desarrollar una nueva neoplasia maligna fue del 25%, y de ellas el 66% correspondió a un nuevo CBC y el 30% a carcinoma espinocelular. CONCLUSIONES: Es importante el seguimiento de los pacientes con CBC para identificar tanto las recurrencias como las nuevas neoplasias malignas, independientemente de la localización y de la variante histopatológica del primario. El tratamiento con técnicas quirúrgicas condiciona una menor recaída que las técnicas destructivas. INTRODUCTION: Basal cell carcinoma (BCC) is the most common skin malignant neoplasm. OBJECTIVE.: Investigate the risk of recurrence and of new skin malignant neoplasms, after treatment of BCC. METHOD: Retrospective study. We examined the files of patients with histopathological diagnosis of primary BCC, between January 2007 and December 2009, and we investigate number of recurrences and their relationship with localization, treatment type, and histopathological variant, and the number of new skin malignant neoplasms. For analysis, we employed descriptive and inferential statistics; p < 0.05 was considered significant. RESULTS: A total of 397 patients, with an average follow-up of 4 ± 1.5 years. Recurrences presented in 4%. Recurrences were related with longer time of evolution (36 vs. 32 months; p = 0.04) and treatment with destructive techniques (electrofulguration, cryosurgery or imiquimod; 31 vs. 4%; p < 0.001). There was no relationship with localization, or the histopathological variant. The risk of developing a new malignant neoplasm was 25%; 66% corresponded to a new BCC and 30% to squamous cell carcinoma. CONCLUSIONS: Follow-up of patients with BCC should be conducted independently of their localization and histopathological variant, especially in patients with greater evolution time, principally with surgical techniques.
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Carcinoma Basocelular/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Carcinoma Basocelular/tratamento farmacológico , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/epidemiologia , Criocirurgia , Eletrocoagulação , Feminino , Humanos , Imiquimode/uso terapêutico , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Cirurgia de Mohs/estatística & dados numéricos , Recidiva , Estudos Retrospectivos , Risco , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Adulto JovemRESUMO
OBJECTIVE: The main objective of this research is the design and implementation of a new fuzzy logic tool for automatic drug delivery in patients undergoing general anesthesia. The aim is to adjust the drug dose to the real patient needs using heuristic knowledge provided by clinicians. A two-level computer decision system is proposed. The idea is to release the clinician from routine tasks so that he can focus on other variables of the patient. METHODS: The controller uses the Bispectral Index (BIS) to assess the hypnotic state of the patient. Fuzzy controller was included in a closed-loop system to reach the BIS target and reject disturbances. BIS was measured using a BIS VISTA monitor, a device capable of calculating the hypnosis level of the patient through EEG information. An infusion pump with propofol 1% is used to supply the drug to the patient. The inputs to the fuzzy inference system are BIS error and BIS rate. The output is infusion rate increment. The mapping of the input information and the appropriate output is given by a rule-base based on knowledge of clinicians. RESULTS: To evaluate the performance of the fuzzy closed-loop system proposed, an observational study was carried out. Eighty one patients scheduled for ambulatory surgery were randomly distributed in 2 groups: one group using a fuzzy logic based closed-loop system (FCL) to automate the administration of propofol (42 cases); the second group using manual delivering of the drug (39 cases). In both groups, the BIS target was 50. CONCLUSIONS: The FCL, designed with intuitive logic rules based on the clinician experience, performed satisfactorily and outperformed the manual administration in patients in terms of accuracy through the maintenance stage.
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Anestesia Intravenosa/instrumentação , Anestésicos Intravenosos/administração & dosagem , Ondas Encefálicas/efeitos dos fármacos , Monitores de Consciência , Sistemas de Apoio a Decisões Clínicas , Técnicas de Apoio para a Decisão , Eletroencefalografia/instrumentação , Lógica Fuzzy , Monitorização Neurofisiológica Intraoperatória/instrumentação , Propofol/administração & dosagem , Processamento de Sinais Assistido por Computador , Adulto , Tomada de Decisão Clínica , Feminino , Humanos , Bombas de Infusão , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de TempoRESUMO
En las últimas décadas, secundario al desarrollo científico y tecnológico, las prácticas de la medicina crítica y los cuidados intensivos se han caracterizado por alcanzar una mayor supervivencia asociada a prácticas poco humanizadas, la cual se enfoca de forma exclusiva en el manejo de una patología, dejando un vacío en importantes aspectos característicos de cada paciente y su familia. Actualmente, durante la pandemia de SARS-CoV-2, la implementación de prácticas de humanización para el paciente gravemente enfermo y sus familiares es una necesidad imperiosa para los sistemas de salud (AU)
In recent decades, due to scientific and technological development, the practices of critical care and intensive medicine have been characterized by achieving greater survival associated with practices that are not very humanized, which focuses exclusively on the management of a pathology leaving a gap in the aspects that are important for patients and relatives. Currently, during the SARS-CoV-2 pandemic, the implementation of humanization practices for the seriously ill patient and their families, it is a pressing need for health systems (AU)
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Humanos , Cuidados Críticos/tendências , Humanização da Assistência , COVID-19RESUMO
Resumen Introducción: La depresión en adolescentes es un problema silente de salud mundial, la cual, en ausencia de tratamiento, tiene efectos deletéreos en la salud física, bienestar psicosocial y rendimiento académico. Se requiere la validación de un instrumento que pueda emplearse como tamizaje en población adolescente, que permita conocer la prevalencia síntomas depresivos en una población universitaria. Objetivo: Calcular la prevalencia, de síntomas depresivos, factores asociados y validar dos instrumentos que puedan emplearse como método de tamizaje en poblaciones universitarias. Método: Estudio de corte transversal en adolescentes mayores de 18 años matriculados durante el primer semestre de 2016 en la Universidad Tecnológica de Pereira. La información recopilada incluye variables sociodemográficas y los resultados de la escala del Centro de Estudios Epidemiológicos para Depresión (CES-D) y el test de depresión de ZUNG. Resultados: Se obtuvo una muestra de 350 adolescentes, de los cuales se identificaron síntomas depresivos en la última semana de 8,85% y 36,28% para la escala de ZUNG y el CES-D respectivamente. La presencia de sintomatología depresiva se vio asociada con inactividad física (odds ratio [OR] = 2,1; intervalo de confianza de 95% [IC 95%], 1,1-5,8), consumo de alcohol (OR = 3,1; IC 95%, 1,8-5,3) y de sustancias psicoactivas (OR = 3,6; IC 95%, 1,9-6,6). Conclusiones: Se realiza por primera vez en el Eje Cafetero Colombiano una validación de la escala de ZUNG y CES-D, las cuales pueden ser utilizadas en población universitaria para tamizaje de sintomatología depresiva, siendo ambas equiefectivas con alpha de Cronbach de 0,84 y 0,87 respectivamente.
Background: Adolescent depression is a silent global health problem, untreated depression has detrimental effects on physical health, psychosocial well-being, and academicproductivity. Validation of an instrument that can be used as screening in adolescents and which would allow determination of its prevalence is required. Objectives: Estimate the prevalence of depressive symptoms, associated factors and validate two instruments that can be used as a screening tool in university students. Methodology: Cross-sectional study in adolescents 18 years and older enrolled in first half of 2016 at the Universidad Tecnológica de Pereira. Information collected included sociodemographic variables and the results of scale epidemiological studies center for depression (CES-D) and the Zung depression test. Results: A sample of350 adolescents, of whom depressive symptoms were identified in the last week of 8.85% and 36.28% for the Zung scale and CES-D was obtained respectively. The presence of depressive symptoms was associated with physical inactivity (odds ratio [OR] = 2.1; confidence interval 95% [95% CI], 1.1 to 5.8), alcohol consumption (OR = 3,1; 95% CI, 1.8 to 5.3) andpsychoactivesubstances (OR = 3.6,95% CI 1.9 to 6.6). Conclusions: For the first time in Coffe region area is realized the validation of the Zung and CES-D depression test, which can be used in university population screening for depressive symptoms, both of them are equieffective with Cronbach's alpha of 0.84 and 0.87 respectively.
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Humanos , Masculino , Feminino , População , Estudantes , Universidades , Programas de Rastreamento , Depressão , Desempenho Acadêmico , Estudos Transversais , ColômbiaRESUMO
La disección del septum interventricular y su rotura constituyen una posible causa de la comunicación interventricular luego de un infarto de miocardio. En esta presentación se describe el caso de un varón de 68 años con un infarto agudo de miocardio inferior que fue intervenido en forma satisfactoria de un seudoaneurisma septal diagnosticado intraoperatoriamente.
Septal dissection after inferior acute myocardial infarction Septal dissection and rupture are a possible cause of ventricular septal defect after acute myocardial infarction. This presentation reports the case of a 68 year-old man with inferior acute myocardial infarction, who was satisfactorily operated of a septal pseudoaneurysm diagnosed intraoperatively.
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Electroporation has been the method of election for transfection of murine embryonic stem cells for over 15 years; however, it is a time consuming protocol because it requires large amounts of DNA and cells, as well as expensive and delicate equipment. Lipofection is a transfection method that requires lower amounts of cells and DNA than electroporation, and has proven to be efficient in a large number of cell lines. It has been shown that after lipofection, mouse embryonic stem cells remain pluripotent, capable of forming germ line chimeras and can be transfected with greater efficiency than with electroporation; however, gene targeting of mouse embryonic stem cells by lipofection has not been reported. The objective of this work was to find out if lipofection can be used as efficiently as electroporation for regular gene targeting protocols. This context compares gene targeting efficiency between these techniques in mouse embryonic stem cells E14TG2a, using a gene replacement type vector. No differences were found in gene targeting efficiency between groups; however, lipofection was three times more efficient than electroporation in transfection efficiency, which makes lipofection a less expensive alternative method to produce gene targeting in mouse embryonic stem cells.
Durante los últimos 15 años se ha demostrado que la electroporación representa el método ideal para la transfección de células troncoembrionarias de ratón; sin embargo, demanda grandes cantidades de ADN y células, así como equipo caro y delicado, ello hace que este proceso sea costoso y laborioso. La lipofección es un método de transfección que requiere menos de células y ADN que la electroporación; asimismo, ha probado ser eficiente en gran número de líneas celulares. Se ha demostrado que después de lipofectar células troncoembrionarias de ratón, éstas mantienen su pluripotencia y son capaces de formar quimeras de línea germinal y se transfectan con mayor eficiencia que con electroporación, pero no se ha notificado la mutagénesis dirigida mediante la lipofección de células troncoembrionarias de ratón. El objetivo del presente trabajo fue saber si la lipofección puede ser utilizada con la misma o mayor eficiencia que la electroporación para los protocolos regulares de mutagénesis dirigida; en este contexto, se compara la eficiencia en mutagénesis dirigida entre estas técnicas en células troncoembrionarias de ratón E14TG2a, utilizando un vector de reemplazo. Entre las células transfectadas no se hallan diferencias en la eficiencia en mutagénesis dirigida entre grupos; sin embargo, los resultados que aquí se ofrecen muestran que la lipofección es tres veces más eficiente en la transfección, lo cual indica que la lipofección es un método alternativo menos costoso para obtener mutagénesis dirigida en células troncoembrionarias de ratón.
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Treinta pacientes con heridas anfractuosas con pérdida de sustancia y no susceptibles de ser suturadas, fueron tratados tópicamente con un ungüento a base de fibrinolisina y desoxirribonucleasa. Se observó que el tejido de granulación en las heridas apareció en un promedio de cuatro días; el tiempo en que el tejido de granulación cubrió la herida fue, en promedio, de 13 días, con mínimo de ocho días. El exudado desapareció en 6.5 días como promedio. No hubo efectos secundarios. Se concluye que el medicamento acelera y favorece, en forma muy considerable, el proceso de cicatrización en este tipo de heridas, y que se trata de un compuesto eficaz como desbridante enzimático, no tóxico