Estudi sobre l'eficàcia dels mètodes de reescalfament in situ en el tractament de la hipotèrmia accidental en muntanya

En la última dècada, els esports de muntanya, en qualsevol de les seves modalitats, s’han vist incrementats en nombre de practicants. Aquest fet ha comportat un important augment d’incidència de la hipotèrmia accidental. La hipotèrmia accidental és defineix com un estat patològic caracteritzat per la disminució de la temperatura corporal central per sota dels 35ºC, com a resultat de la incapacitat de l’organisme per generar el calor necessari per garantir el manteniment de les funcions fisiològiques. A través d’aquest estudi es vol demostrar que l’actuació in situ, a través de certes mesures de reescalfament, de la víctima que pateix hipotèrmia, milloren la supervivència i les complicacions secundàries d’aquesta patologia, a més a més d’avaluar l’eficàcia d’aquestes tècniques. És a dir, volem demostrar l’efectivitat de l’aplicació terapèutica extrahospitalaria de les tècniques de reescalfament. Realitzarem un estudi quantitatiu observacional analític de caràcter prospectiu a la zona dels Alps francesos d’una mostra de 237 casos d’hipotèrmia en persones practicants d’esports de muntanya que reuneixin uns criteris d’inclusió i exclusió. Els professionals de rescat aplicaran les mesures de reescalfament prèviament pautades, per les quals hauran estat formats, i enregistraran en el full de recollida de dades tota la informació sobre les variables d’estudi. És un estudi on la intervenció principal es porta a terma al medi natural i que per tant les condicions climatològiques i medioambientals poden actuar com a gran limitador de l’estudi, cal afegir també com a limitació el fet que el participant no vulgui formar part de l’estudi o que el professional de rescat que ha de portar a terme el pla terapèutic no ho faci adequadament.

The relationship between virtual body ownership and temperature sensitivity.

In the rubber hand illusion tactile stimulation seen on a rubber hand, that is synchronous with tactile stimulation felt on the hidden real hand, can lead to an illusion of ownership over the rubber hand. This illusion has been shown to produce a temperature decrease in the hidden hand, suggesting that such illusory ownership produces disownership of the real hand. Here we apply immersive virtual reality (VR) to experimentally investigate this with respect to sensitivity to temperature change. Forty participants experienced immersion in a VR with a virtual body (VB) seen from a first person perspective. For half the participants the VB was consistent in posture and movement with their own body, and in the other half there was inconsistency. Temperature sensitivity on the palm of the hand was measured before and during the virtual experience. The results show that temperature sensitivity decreased in the consistent compared to the inconsistent condition. Moreover, the change in sensitivity was significantly correlated with the subjective illusion of virtual arm ownership but modulated by the illusion of ownership over the full virtual body. This suggests that a full body ownership illusion results in a unification of the virtual and real bodies into one overall entity - with proprioception and tactile sensations on the real body integrated with the visual presence of the virtual body. The results are interpreted in the framework of a"body matrix" recently introduced into the literature.

The relationship between virtual body ownership and temperature sensitivity.

In the rubber hand illusion tactile stimulation seen on a rubber hand, that is synchronous with tactile stimulation felt on the hidden real hand, can lead to an illusion of ownership over the rubber hand. This illusion has been shown to produce a temperature decrease in the hidden hand, suggesting that such illusory ownership produces disownership of the real hand. Here we apply immersive virtual reality (VR) to experimentally investigate this with respect to sensitivity to temperature change. Forty participants experienced immersion in a VR with a virtual body (VB) seen from a first person perspective. For half the participants the VB was consistent in posture and movement with their own body, and in the other half there was inconsistency. Temperature sensitivity on the palm of the hand was measured before and during the virtual experience. The results show that temperature sensitivity decreased in the consistent compared to the inconsistent condition. Moreover, the change in sensitivity was significantly correlated with the subjective illusion of virtual arm ownership but modulated by the illusion of ownership over the full virtual body. This suggests that a full body ownership illusion results in a unification of the virtual and real bodies into one overall entity - with proprioception and tactile sensations on the real body integrated with the visual presence of the virtual body. The results are interpreted in the framework of a"body matrix" recently introduced into the literature.

Cannabinoid withdrawal syndrome is reduced in pre-proenkephalin knock-out mice

The functional interactions between the endogenous cannabinoid and opioid systems were evaluated in pre-proenkephalin-deficient mice. Antinociception induced in the tail-immersion test by acute Delta9-tetrahydrocannabinol was reduced in mutant mice, whereas no difference between genotypes was observed in the effects induced on body temperature, locomotion, or ring catalepsy. During a chronic treatment with Delta9-tetrahydrocannabinol, the development of tolerance to the analgesic responses induced by this compound was slower in mice lacking enkephalin. In addition, cannabinoid withdrawal syndrome, precipitated in Delta9-tetrahydrocannabinol-dependent mice by the injection of SR141716A, was significantly attenuated in mutant mice. These results indicate that the endogenous enkephalinergic system is involved in the antinociceptive responses of Delta9-tetrahydrocannabinol and participates in the expression of cannabinoid abstinence.

CB1 cannabinoid receptor modulates MDMA acute responses and reinforcement

Background: 3, 4-methylenedioxymethamphetamine (MDMA) is a popular recreational drug widely abused by young people. The endocannabinoid system is involved in the addictive processes induced by different drugs of abuse. However, the role of this system in the pharmacological effects of MDMA has not been yet clarified.Methods: Locomotion, body temperature and anxiogenic-like responses were evaluated after acute MDMA administration in CB1 knockout mice. Additionally, MDMA rewarding properties were investigated in the place conditioning and the intravenous self-administration paradigms. Extracellular levels of DA in the nucleus accumbens were also analyzed after a single administration of MDMA by in vivo microdialysis. Results: Acute MDMA administration increased locomotor activity, body temperature and anxiogenic-like responses in wild type mice, but these responses were lower or abolished in knockout animals. MDMA produced similar conditioned place preference and increased dopamine extracellular levels in the nucleus accumbens in both genotypes. Nevertheless, CB1 knockout mice failed to self-administer MDMA at any of the doses used. Conclusions: These results indicate that CB1 cannabinoid receptors play an important role in the acute prototypical effects of MDMA, and are essential in the acquisition of an operant behavior to self-administer this drug.

MDMA attenuates THC withdrawal syndrome in mice

3, 4-Methylenedioxymethamphetamine (MDMA) and cannabis are widely abused illicit drugs that are frequently consumed in combination. Interactions between these two drugs have been reported in several pharmacological responses observed in animals, such as body temperature, anxiety, cognition and reward. However, the interaction between MDMA and cannabis in addictive processes such as physical dependence has not been elucidated yet. In this study, the effects of acute and chronic MDMA were evaluated on the behavioral manifestations of Δ9-tetrahydrocannabinol (THC) abstinence in mice. THC withdrawal syndrome was precipitated by injecting the cannabinoid antagonist rimonabant (10 mg/kg, i.p.) in mice chronically treated with THC, and receiving MDMA (2.5, 5 and 10 mg/kg i.p.) or saline just before the withdrawal induction or chronically after the THC administration. Both, chronic and acute MDMA decreased in a dose-dependent manner the severity of THC withdrawal. In vivo microdialysis experiments showed that acute MDMA (5 mg/kg, i.p.) administration increased extracellular serotonin levels in the prefrontal cortex, but not dopamine levels in the nucleus accumbens. Our results also indicate that the attenuation of THC abstinence symptoms was not due to a direct interaction between rimonabant and MDMA nor to the result of the locomotor stimulating effects of MDMA. The modulation of the cannabinoid withdrawal syndrome by acute or chronic MDMA suggests a possible mechanism to explain the associated consumption of these two drugs in humans.

THC prevents MDMA neurotoxicity in mice

The majority of MDMA (ecstasy) recreational users also consume cannabis. Despite the rewarding effects that both drugs have, they induce several opposite pharmacological responses. MDMA causes hyperthermia, oxidative stress and neuronal damage, especially at warm ambient temperature. However, THC, the main psychoactive compound of cannabis, produces hypothermic, anti-inflammatory and antioxidant effects. Therefore, THC may have a neuroprotective effect against MDMA-induced neurotoxicity. Mice receiving a neurotoxic regimen of MDMA (20 mg/kg ×4) were pretreated with THC (3 mg/kg ×4) at room (21°C) and at warm (26°C) temperature, and body temperature, striatal glial activation and DA terminal loss were assessed. To find out the mechanisms by which THC may prevent MDMA hyperthermia and neurotoxicity, the same procedure was carried out in animals pretreated with the CB1 receptor antagonist AM251 and the CB2 receptor antagonist AM630, as well as in CB1, CB2 and CB1/CB2 deficient mice. THC prevented MDMA-induced-hyperthermia and glial activation in animals housed at both room and warm temperature. Surprisingly, MDMA-induced DA terminal loss was only observed in animals housed at warm but not at room temperature, and this neurotoxic effect was reversed by THC administration. However, THC did not prevent MDMA-induced hyperthermia, glial activation, and DA terminal loss in animals treated with the CB1 receptor antagonist AM251, neither in CB1 and CB1/CB2 knockout mice. On the other hand, THC prevented MDMA-induced hyperthermia and DA terminal loss, but only partially suppressed glial activation in animals treated with the CB2 cannabinoid antagonist and in CB2 knockout animals. Our results indicate that THC protects against MDMA neurotoxicity, and suggest that these neuroprotective actions are primarily mediated by the reduction of hyperthermia through the activation of CB1 receptor, although CB2 receptors may also contribute to attenuate neuroinflammation in this process.

Uso de la hipotermia en el síndrome posparada cardíaca

Antecedentes: La parada cardiorrespiratoria es uno de los principalesproblemas sanitarios en los países desarrollados, además de por la mortalidadproducida, por las importantes repercusiones neurológicas posteriores quepresentan las personas que sobreviven. Hasta un 64% de los supervivientespuede presentar secuelas de gravedad, y tan solo un 1,4% queda exento dealgún tipo de alteración neurológica. Distintos ensayos clínicos, muestran quela hipotermia inducida ligera, es decir, el descenso controlado de latemperatura corporal mejora la supervivencia y los daños neurológicos en lospacientes adultos inconscientes tras una resucitación cardiopulmonar. Sinembargo, no está del todo claro cuáles son los pacientes más indicados pararecibir la terapia, la técnica de inducción ideal, la temperatura objetivo, suduración y la tasa idónea de recalentamiento.Objetivos: El objetivo del estudio es conocer la técnica de hipotermiaterapéutica como cuidado posresucitación tras sufrir una parada cardíaca.Metodología: Para ello, se realizó una búsqueda bibliográfica a través de lassiguientes bases de datos: CSIC, Medline PubMed, CINAHL, BibliotecaCochrane, Cuiden Plus, Dialnet, Scopus y ScienceDirect. Finalmente, seaceptaron 8 artículos que pertenecían a los criterios de inclusión: revisionessistemáticas, ensayos clínicos, revisiones bibliográficas y documentos deconsenso tras consejo de expertos, en español o inglés, publicados desde elaño 2005 hasta el año 2013 cuyos sujetos de estudio son adultos.Resultados: en la actualidad, se recomienda que los pacientes adultosinconscientes, con recuperación de la circulación espontánea tras una paradacardíaca extrahospitalaria, deben ser enfriados a 32-34ºC durante un periodode 12-24 horas cuando el ritmo inicial sea fibrilación ventricular. Se establecen4 periodos de tratamiento: inducción (desde el ingreso en la unidad hasta quese alcanzan los 33ºC), mantenimiento (desde el logro de los 33ºC hasta 24horas después), recalentamiento (12 horas de incremento de la temperatura,hasta alcanzar los 37ºC) y estabilización térmica (12 horas posteriores aalcanzar los 37ºC). Los métodos de inducción y mantenimiento de la hipotermiason diversos y se establecen dos grupos: técnicas invasivas y no invasivas.Palabras clave: hipotermia inducida, parada cardíaca, técnicas enfriamiento

Aproximación a los ritmos de rendimiento escolar: fundamentos y aplicaciones actuales

El análisis de los ritmos se realiza desde el contexto de dos disciplinas interrelacionadas: la cronopsicología, que se ocupa de estudiar los ritmos de comportamiento por ellos mismos (Fraisse, 1980) y la cronobiología, que estudia las oscilaciones rítmicas de los parámetros biológicos (Halberg, 1979). El objetivo de las investigaciones cronopsicológicas consiste básicamente en analizar la variabilidad temporal que presentan distintas variables comportamentales, como la memoria, la atención o el rendimiento escolar, entre otros. Desde una perspectiva cronobiológica, en cambio, el interés se centra en el estudio de distintos aspectos biológicos, como el ritmo sueño-vigilia, la temperatura corporal, los ritmos nutricionales, el ritmo cardíaco, etc