EEG as an Indicator of Cerebral Functioning in Postanoxic Coma.

Postanoxic coma after cardiac arrest is one of the most serious acute cerebral conditions and a frequent cause of admission to critical care units. Given substantial improvement of outcome over the recent years, a reliable and timely assessment of clinical evolution and prognosis is essential in this context, but may be challenging. In addition to the classic neurologic examination, EEG is increasingly emerging as an important tool to assess cerebral functions noninvasively. Although targeted temperature management and related sedation may delay clinical assessment, EEG provides accurate prognostic information in the early phase of coma. Here, the most frequently encountered EEG patterns in postanoxic coma are summarized and their relations with outcome prediction are discussed. This article also addresses the influence of targeted temperature management on brain signals and the implication of the evolution of EEG patterns over time. Finally, the article ends with a view of the future prospects for EEG in postanoxic management and prognostication.

Coma post-anoxique après arrêt cardiaque et hypothermie, peut-on encore prédire le pronostic en 2014 ?

L'encéphalopathie post-anoxique après arrêt cardiaque (AC) est une cause féquente d'admission pour coma en réanimation. Depuis les recommandations de 2003, l'hypothermie thérapeutique (HT) est devenue un standard de traitement après AC et est à l'origine de l'amélioration du pronostic au cours de cette derniere décennie. Les élements prédicteurs de pronostic validés par l'Académie Américaine de Neurologie avant l'ère de l'HT sont devenus moins précis. En effet, l'HT et la sédation retardent la reprise de la réponse motrice et peuvent altérer la valeur prédictive des réflexes du tronc cérébral. Une nouvelle approche est nécessaire pour établir un pronostic après AC et HT. L'enregistrement (pendant l'HTou peu après) d'une activité électroencéphalographique réactive et/ou continue est un bon prédicteur de récupération neurologique favorable après AC. Au contraire, la présence d'un tracé non réactif ou discontinu de type burst-suppression, avec une réponse N20 absente bilatérale aux potentiels évoqués somatosensoriels, sont presqu'à 100 % prédictifs d'un coma irréversible déjà à 48 heures après AC. L'HT modifie aussi la valeur prédictive de l'énolase neuronale spécifique (NSE), principal biomarqueur sérique de la lésion cérébrale post-anoxique. Un réveil avec bonne récupération neurologique a été récemment observé par plusieurs groupes chez des patients présentant des valeurs de NSE>33 μg/L à 48-72 heures : ce seuil ne doit pas être utilisé seul pour guider le traitement. L'imagerie par résonance magnétique de diffusion peut aider à prédire les séquelles neurologiques à long terme. Un réveil chez les patients en coma post-anoxique est de plus en plus observé, malgré l'absence précoce de signes moteurs et une élévation franche des biomarqueurs neuronaux. En 2014, une nouvelle approche multimodale du pronostic est donc nécessaire, pour optimiser la prédiction d'une évolution clinique favorable après AC. Hypoxic-ischemic encephalopathy after cardiac arrest (CA) is a frequent cause of intensive care unit (ICU) admission. Incorporated in all recent guidelines, therapeutic hypothermia (TH) has become a standard of care and has contributed to improve prognosis after CA during the past decade. The accuracy of prognostic predictors validated in 2006 by the American Academy of Neurology before the era of TH is less accurate. Indeed, TH and sedation may delay the recovery of motor response and alter the predictive value of brainstem reflexes. A new approach is needed to accurately establish prognosis after CA and TH. A reactive and/or continuous electroencephalogram background (during TH or shortly thereafter) strongly predicts good outcome. On the contrary, unreactive/spontaneous burst-suppression electroencephalogram pattern, together with absent N20 on somatosensory evoked potentials, is almost 100% predictive of irreversible coma. TH also affects the predictive value of neuronspecific enolase (NSE), the main serum biomarker of postanoxic injury. A good outcome can occur despite NSE levels >33 μg/L, so this cutoff value should not be used alone to guide treatment. Diffusion magnetic resonance imagery may help predict long-term neurological sequelae. Awakening from postanoxic coma is increasingly observed, despite the absence of early motor signs and pathological elevation of NSE. In 2014, a multimodal approach to prognosis is recommended to optimize the prediction of outcome after CA.

Construção e otimização de um sistema para produção e aplicação de ozônio em escala de laboratório

This paper shows the assembly of an ozonization system to be used in laboratory scale, mainly to study effluent treatability. The system is simple, practical and provides easy acquisition of data when interfaced to a microcomputer. The performance of ozone generation and K La values are also described.

Nitração do fenol, um método em escala semi-micro para disciplina prática de 4 horas

A procedure for the nitration of phenol in a semi-micro scale, followed by separation of the formed orto- and para-nitrophenol isomers by column chromatography, is described. All the experiment, including determination of the melting point of the isolated products, require a period of 4 hours, and it is suitable for organic chemistry laboratory undergraduate courses.

Die ersten offiziellen Ausgrabungen in Ampurias (Empuries, L'Escala, Provinz Girona): 1846

En el año 2008 tuvo lugar el aniversario del centenario de las excavaciones arqueológicas en la ciudad greco-romana de Ampurias. Precisamente las investigaciones de esa época tienen un significado cultural y simbólico muy importante para el desarrollo de la autognosis de Cataluña a comienzos del siglo XX. El presente artículo intenta llamar la atención sobre los verdaderos comienzos de las investigaciones sobre la antigua ciudad, que habían comenzado bastante antes. Si nos concentramos en considerar los lugares de patrocinio público las excavaciones privadas fueron habituales en todas las épocas entonces las excavaciones científicas comenzaron siete décadas antes. Responsable fue la Comisión de Monumentos de Girona, que contó con el apoyo financiero de la Diputación Provincial.

Tratamento dos resíduos gerados na síntese de polianilina em escala pré-piloto

Polyaniline (PAni) is one of the most studied conducting polymer. It can be synthesized by two methods: electrochemical or chemical oxidation. The chemical oxidation is more adequate to produce large quantities of polymer. Regardless of the synthesis scale, the treatment of the residues before its final destination is very important and necessary because it contains toxic aniline derivatives (carcinogens in some cases), acids and inorganic salts, both with low toxicity. In this work we discuss the methods used to treat these residues and to eliminate and discard the toxic substances. These were extracted from the reaction residues by using activated coal and the pH of the residue was neutralized.

Síntese de sulfadiazina e sulfadiazina de prata em escala semi-micro: prática experimental em síntese de fármacos

The total synthesis of sulfadiazine and silver sulfadiazine from readily available starting materials was adapted to semi-micro laboratory scale and is proposed as an experiment in drug synthesis for undergraduate courses.

Cromatografia em leito móvel simulado na produção de substâncias enantiomericamente puras ou enriquecidas em larga escala

There is great interest nowadays in the use of preparative liquid chromatography as an effective tool for the production of enantiomerically pure, or enriched, compounds for the pharmaceutical industry. To make the chromatographic process economically attractive, attention is now focused on the choice of the chromatographic operating mode to minimize eluent consumption and to maximize productivity. Among the alternatives to the traditional batch chromatography, attention is now shifting towards simulated moving bed (SMB) technologies and a review covering the latest developments in this area seems timely. Several aspects of this important analytical technique are presented and details concerning the SMB technology for process optimization are outlined.

La evaluación del estrés y del trauma: presentación de la versión española de la escala de trauma acumulativo (CTS)

This paper reviews some of the most usual definitions of stress and trauma including the notion of accumulative trauma. Then, the Spanish version of the Cumulative Trauma Scale by Kira et al (2008) is presented. It has been developed by following a process of translation and by applying it to two small groups of subjects to test it for comprehension (pilot test).

Escala de satisfacción con el tratamiento recibido (CRES-4): la versión en español

The satisfaction of consumers and users with the products and services is an issue that in recent years has been taking more and more importance and now it even reaches psychotherapy. This paper presents the Spanish adaptation of the Consumer Reports Effectiveness Scale (CRES-4)consisting of four items designed to evaluate whether patients are satisfied with the therapy they have received and if it has been perceived as effective or not. Its global score is intended to reflect treatment effectiveness as percived by the patient. Existing studies suggest that the CRES-4 is a good complementary tool to judge, in particular, satisfaction with treatment received.

Avaliação em escala laboratorial da utilização do processo eletrolítico no tratamento de águas

Water treatment uses chlorine for disinfection causing formation of trihalomethanes. In this work, an electrolytic water pre-treatment was studied and applied to the water from a fountainhead. The action against microorganisms was evaluated using cast-iron and aluminum electrodes. Assays were made in laboratory using the electrolytic treatment. After 5 min of electrolysis the heterotrophic bacteria count was below 500 cfu/mL and complete elimination of total and fecal coliforms was observed. Using electrolytic treatment as a pretreatment of conventional tap water treatment is proposed.

Análisis psicométrico de la escala multidimensional de autoconcepto AF5 en una muestra de adolescentes y adultos de Cataluña

Psychometric analysis of the AF5 multidimensional scale of self-concept in a sample of adolescents and adults in Catalonia. The aim of this study is to carry out a psychometric study of the AF5 scale in a sample of 4.825 Catalan subjects from 11 to 63 years-old. They are students from secondary compulsory education (ESO), from high school, middle-level vocational training (CFGM) and from the university. Using a principal component analysis (PCA) the theoretical validity of the components is established and the reliability of the instrument is also analyzed. Differential analyses are performed by gender and normative group using a 2 6 factorial design. The normative group variable includes the different levels classifi ed into 6 sub-groups: university, post-compulsory secondary education (high school and CFGM), 4th of ESO, 3rd of ESO, 2nd of ESO and 1st of ESO. The results indicate that the reliability of the Catalan version of the scale is similar to the original scale. The factorial structure also fi ts with the original model established beforehand. Signifi cant differences by normative group in the four components of self-concept explored (social, family, academic/occupational and physical) are observed. By gender, signifi cant differences appear in the component of physical self-concept, academic and social but not in the family component

La escala de análisis: un tema central en didáctica de la geografía = The scale of analysis a central didactic theme in Geography

Geographical scale is not merely a technical question. The learning of geographical scale goes beyond geometricunderstanding; it implies the etymological comprehension of the concept, the recognition of the importance of scale in theelaboration of the geographical discourse. It implies placing oneself in the centre of the teaching and learning of Geographyand asking oneself, what scale? Why this scale? What progression of scales? The answer to these questions puts in doubtthe scientific discourse that is presently taught in schools especially on the scale of analysis, the sequencing of studiedspaces and the false dichotomy local and global

Otra mirada al tema del cambio de escala: los nuevos espacios de comercio, ocio y turismo = Another look at the theme of the change of scale: new spaces in commerce, leisure and tourism

The technological advances and new organisation of the economy together with a change in ideas in consumer habits andlifestyle that have happened in the last 25 years have placed us in a new state of capitalism. The spatial translation of thisnew state has been immediate and implies among other changes the overcoming of the concept of scale. Commercialspaces and those of leisure and tourism offer us an unbeatable opportunity of exemplifying these changes because they arethe most effected by the new postmodern tendencies

Separação cromatográfica quiral de anestésicos a partir de soluções diluídas e concentradas em escala preparativa

In this work the separation of the chiral anesthetic compounds ketamine and bupivacaine was development using two chiral stationary phases (CSP). Ketamine enantiomers were well separate in the polysaccharide-based CSP (microcrystalline cellulose triacetate - MCTA) while bupivacaine in the tartardiamide-based CSP (Kromasil CHI-TBB). In both cases, the effect of temperature was investigated under analytical conditions. An improvement in the separation performance with temperature was observed. Thermodynamic parameters were evaluated by the van't Hoff plot. We concluded that enthalpic effects controlled the retention in these chiral columns. The enantiomers of ketamine and bupivacaine were separated under overloaded conditions with a good performance.