Dexmedetomidina : aliado o enemigo en la intubación del paciente despierto? una revisión sistemática

Hasta hoy no existe un medicamento o mezcla de estos estandarizado para intubar a los pacientes despiertos; son muchos los medicamentos que se han usado intentando conseguir las condiciones adecuadas de sedación, analgesia que permitan la colaboración del paciente para que sea un procedimiento efectivo y no desagradable. La dexmedetomidina es un medicamento de reciente aparición que ofrece las condiciones adecuadas de sedación para la intubación del paciente despierto. Esta revisión evalúa el uso de la dexmedetomidina en sedación para intubación despierto mediante una revisión sistemática de literatura. Metodología: Se realizó una búsqueda en diferentes bases electrónicas de publicaciones realizadas desde 1997 hasta hoy, obteniendo un total de 29 artículos que fueron analizados. Resultados: La dexmedetomidina ofrece adecuada sedación, amnesia, analgesia, ansiolisis y disminución en la producción de secreciones en la vía aérea, sin repercusión hemodinámica significativa en la intubación del paciente despierto. Discusión: La dexmedetomidina es útil en sedación para procedimientos en los que se requiere que el paciente este cómodo pero que obedezca órdenes para facilitar el trabajo del operador. Demostró utilidad en la sedación para la intubación del paciente despierto, como en el caso de pacientes con riesgo de lesión neurológica durante la intubación o el posicionamiento para la intervención quirúrgica, en pacientes con masas de mediastino anterior por la ventaja de conservar la ventilación espontánea como medida protectora contra el colapso de la vía aérea.

Patología didáctica de la enseñanza universitaria.

Conferencia presentada en el Ciclo de Conferencias sobre la Enseñanza, organizada por la Universidad de Sevilla durante los meses de marzo y abril de 1992

Recuperar la memoria histórica : cinco años después continuamos insistiendo.

Los medios de comunicación se han hecho eco en los últimos tiempos de la memoria histórica, con posicionamientos ideológicos y políticos variopintos sobre la necesidad de recuperarla o de olvidarla, prolongando la amnesia colectiva sobre la guerra civil y el franquismo. Se plantean las interpretaciones y los usos que se hacen de la memoria. Se trata de un pequeño artículo introductorio que recoge el posicionamiento del coordinador de este monográfico y de unos cuentos de los autores desde la didáctica crítica. Se reivindica la contramemoria para diferenciarla de algunos discursos oficiales combinando las reflexiones, orientaciones, experiencias metodológicas y recursos.

Self-deception as a mechanism for the maintenance of drug addiction

Resumen tomado de la publicaci??n

Hermenéutica de los altares domésticos en Quito

La “hermenéutica de los altares domésticos en Quito”, propone una lectura política de sentido e interpretación en la relación psicoanálisis comunicación en el momento en que los grandes símbolos están en retirada. En comunicación los altares son una interpretación simbólica-reflexiva de la cotidianidad, en el psicoanálisis son catexis, sin pretensiones universales; necesarios para unos, de malestar sobrante para otros, en los dos casos ponen en discusión a la sociedad y a Dios. Los altares son artefactos de posibilidades interpretativas que aseguran la existencia de los creyentes católicos en la mixtura de los manes y los santos, son lugares en donde el poder divino es apropiado por el poder del sentido cotidiano, o si se quiere, lo divino habita en un rincón de la casa bajo la vigilancia de los deseos y búsquedas humanas. Las imágenes del altar no son tanto arte como vida, comunican sentimientos del ser, estar y la nada, conectan perseverancia y memoria para trascender la amnesia de los límites, los imaginarios; en el que cada uno se reconoce sin necesidad de cursos y talleres de autoestima. Se estudió el valor contemplativo del koinos (comunión) como síntoma y metáfora entre psicoanálisis y comunicación, la otra mixtura: deseo y transgresión en los altares en la ciudad de Quito, en el año 2003. La entrada fenomenológica permite que la cotidianidad se muestre “haciéndose”, no se pierde el valor pragmático del pasado, nada es irrelevante; todo está construyéndose, es un psicoanálisis que busca arreglar el pasado porque nada esta hecho para mañana. La sospecha, el filicidio, la transmutación del sufrimiento al dolor, el recuerdo del material visual que construyen la luz y la memoria, la configuración simbólica-reflexiva de la madre devenida en memoria, las metáforas temporales y las estéticas del pasado, la violencia simbólica de los fundamentalismos y los objetos, hacen el altar y la vida altarera.

Temps, memoire et monstres: le monde arthurien de Culhwch et Olwen

The Arthurian world of Culhwch and Olwen initially appears as a resolutely masculine, warrior-based society with little or no place for women. As a rule, the names of the mothers of the many characters remain unmentioned, and even the young hero clearly had no idea of his family ties on his mother’s side. It comes as news to him that Arthur is his cousin. The Arthurian world is equally afflicted with a form of wilful amnesia of the existence of relatives on the distaff side, allowing the giant Ysbaddaden to victimise Custennin and his family with impunity. The hair-cutting ritual represents an intrusion of female memory and a reminder of the biological imperative of reproduction, which means that in order to survive, Arthur’s clan has to be prepared to face destruction.

Emotion strengthens high priority memory traces but weakens low priority memory traces

When people encounter emotional events, their memory for those events is typically enhanced. But it has been unclear how emotionally arousing events influence memory for preceding information. Does emotional arousal induce retrograde amnesia or retrograde enhancement? The current study revealed that this depends on the top-down goal relevance of the preceding information. Across three studies, we found that emotional arousal induced by one image facilitated memory for the preceding neutral item when people prioritized that neutral item. In contrast, an emotionally arousing image impaired memory for the preceding neutral item when people did not prioritize that neutral item. Emotional arousal elicited by both negative and positive pictures showed this pattern of enhancing or impairing memory for the preceding stimulus depending on its priority. These results indicate that emotional arousal amplifies the effects of top-down priority in memory formation.

Femininity, feminism and the terrorist

This chapter aims to discuss the relationship between femininity and representations of women involved in violence, focussing on visual representations. Miranda Alison has made the point that the repeated necessity to qualify the term 'combatant' with the descriptor 'female' draws attention to how women soldiers, female freedom fighters, female suicide bombers and female terrorists are exceptional figures. That the female combatant or the female terrorist is an aberration or a deviation from a masculine norm is undermined by the lengthy history of women as warriors, fighters, and terrorists. In that sense it is not so much that fighting women are rare but that there is amnesia within cultural memories concerning the woman fighter. However, in representations of conflict, the dominant image associated with femininity is passive; that is as the defenceless and the defended, or as the allegory of peace. Moreover, representations of men in wars as defeated or wounded means feminising such figures. Miriam Cooke, in her Women and the War Story, 1996, points out how a mythic war story provides men with political roles, in the politikon or public arena, whereas women are domesticated in the space of the oikon. In the mythic war story women may function as Mater Dolorosa, Patriotic Mother or Spartan Mother. It follows then that there are conditions in which it is permissible to represent women fighting on behalf of their children or in defence of the home, and in the absence of men. These images are also found in wider culture: Sarah Connor in Terminator or Ripley in Alien, for example. Images of the female terrorist raise new issues but I want to argue that it is also the case that discussing femininity and the terrorist must involve relating such imagery to representations of the female warrior over a longer timespan. Some questions have shifted since the late twentieth century. Dating from the early 1990s, most Western nations increasingly incorporated women into combat roles within their armed forces. This paper will aim to unpick some of the intricate connections between the increasing presence of women in the armed forces, what relationship this has to emancipation and the participation of women in violence classed as terrorist.

Transport of animals between rooms: A little-noted aspect of laboratory procedure that may interfere with memory

This study investigated the effects of transporting animals from the experimental room to the animal facility in between experimental sessions, a procedure routinely employed in experimental research, on long-term social recognition memory. By using the intruder-resident paradigm, independent groups of Wistar rats exposed to a 2-h encounter with an adult intruder were transported from the experimental room to the animal facility either 0.5 or 6h after the encounter. The following day, residents were exposed to a second encounter with either the same or a different (unfamiliar) intruder. Resident`s social and non-social behaviors were carefully scored and subjected to Principal Component Analysis, thus allowing to parcel out variance and relatedness among these behaviors. Resident rats transported 6h after the first encounter exhibited reduced amount of social investigation towards familiar intruders, but an increase of social investigation when exposed to a different intruder as compared to the first encounter. These effects revealed a consistent long-lasting (24h) social recognition memory in rats. In contrast, resident rats transported 0.5 h after the first encounter did not exhibit social recognition memory. These results indicate that this common, little-noted, laboratory procedure disturbs long-term social recognition memory. (C) 2011 Elsevier B.V. All rights reserved.

Contextual, but not auditory, fear conditioning is disrupted by neurotoxic selective lesion of the basal nucleus of amygdala in rats

The basolateral amygdala complex (BLA) is involved in acquisition of contextual and auditory fear conditioning. However, the BLA is not a single structure but comprises a group of nuclei, including the lateral (LA), basal (BA) and accessory basal (AB) nuclei. While it is consensual that the LA is critical for auditory fear conditioning, there is controversy on the participation of the BA in fear conditioning. Hodological and neurophysiological findings suggest that each of these nuclei processes distinct information in parallel; the BA would deal with polymodal or contextual representations, and the LA would process unimodal or elemental representations. Thus, it seems plausible to hypothesize that the BA is required for contextual, but not auditory, fear conditioning. This hypothesis was evaluated in Wistar rats submitted to multiple-site ibotenate-induced damage restricted to the BA and then exposed to a concurrent contextual and auditory fear conditioning training followed by separated contextual and auditory conditioning testing. Differing from electrolytic lesion and lidocaine inactivation, this surgical approach does not disturb fibers of passage originating in other brain areas, restricting damage to the aimed nucleus. Relative to the sham-operated controls, rats with selective damage to the BA exhibited disruption of performance in the contextual, but not the auditory, component of the task. Thus, while the BA seems required for contextual fear conditioning, it is not critical for both an auditory-US association, nor for the expression of the freezing response. (C) 2009 Elsevier Inc. All rights reserved.

A brief introduction to the history of the ß-amyloid protein (Aß) of Alzheimer's disease

Alzheimer’s disease (AD) is the most common cause of dementia in the elderly. Typically, the disease progresses in a prolonged, inexorable manner [1]. Patients initially show symptoms of mild cognitive impairment, which may include some memory loss. As the disease progresses, more severe memory loss occurs (e.g., retrograde amnesia) leading to confusion and lack of orientation. The patient is often institutionalized in this period, as it becomes increasingly difficult for family members to cope with the constant requirements of care. In later stages of the disease, apathy and stupor can occur, and the patient becomes bedridden.

Anti-amnesic effect of enzyme extracted stevioside from Stevia rebaudiana

The increasing consumption of sucrose has resulted in several nutritional and medicinal problems, including obesity. There is an alarming rise in the prevalence of obesity, type 2 diabetes mellitus, and metabolic syndrome in children and adults around the world, partly related to increasing availability of energy-dense, high-calorie foods, and perhaps to increased consumption of sugar and particularly fructose sweetened beverages. Therefore, low calorie sweeteners are urgently required to substitute table sugar.

Stevioside, a diterpene glycoside, is well known for its intense sweetness and is used as a non-caloric sweetener. Its potential widespread use requires an easy and effective extraction method. Enzymatic extraction of stevioside from Stevia rebaudiana leaves with cellulase, pectinase and hemicellulase using various parameters such as concentration of enzyme, incubation time and temperature was optimized. The extraction conditions were further optimized using response surface methodology (RSM). Under the optimized conditions, the experimental values were in close agreement with predicted model and resulted in a three times yield enhancement of stevioside.

Various studies have revealed that in addition to sweetening nature of stevisoide, it exerts beneficial effects including antihypertensive, anti-hyperglycemic, anti-human rotavirus, antioxidant, anti-inflammatory and antitumor actions. Its anti-amnesic potential remains to be explored, therefore the present study has been undertaken to investigate the beneficial effect of stevioside in memory deficit of rats employing scopolamine induced amnesia as an animal model.

Significance: Stevia is gaining significance in different parts of the world and is expected to develop into a major source of high potency sweetener for the growing natural food market. There is a strong possibility that Stevia sweeteners could replace aspartame in some diet variants. In addition, Stevia is expected to be used as a part substitute for sugar and also used in combination with other artificial sweeteners in the emerging phase of life cycle.

Alzheimer's, angiotensin IV and an aminopeptidase

The angiotensin AT₄ receptor was originally defined as the specific, high affinity binding site for the hexapeptide angiotensin IV (Ang IV). Subsequently, the peptide LVV-hemorphin 7 was also demonstrated to be a bioactive ligand of the AT₄ receptor. Central administration of Ang IV or LVV-hemorphin 7 (LVV-H7) markedly enhances learning and memory in normal rodents and reverse memory deficits observed in animal models of amnesia. The high affinity binding site has a broad distribution in the brain including areas such as the hippocmapus that are involved in memory processing. The high affinity Ang IV binding site (AT₄ receptor) has been identified as the transmembrane enzyme, insulin-regulated membrane aminopeptidase (IRAP). Insulin-regulated aminopeptidase is a type II integral membrane spanning protein belonging to the M1 family of aminopeptidases and in insulin-responsive cells colocalizes with GLUT4 in specific intra-cellular vesicles. Both Ang IV and LVV-H7 are competitive inhibitors of IRAP catalytic activity and are not substrates of the enzyme.

The angiotensin IV/AT4 receptor

The angiotensin AT4 receptor was originally defined as the specific, high-affinity binding site for the hexapeptide angiotensin IV (Ang IV). Subsequently, the peptide LVV-hemorphin 7 was also demonstrated to be a bioactive ligand of the AT4 receptor. Central administration of Ang IV, its analogues or LVV-hemorphin 7 markedly enhance learning and memory in normal rodents and reverse memory deficits observed in animal models of amnesia. The AT4 receptor has a broad distribution and is found in a range of tissues, including the adrenal gland, kidney, lung and heart. In the kidney Ang IV increases renal cortical blood flow and decreases Na+ transport in isolated renal proximal tubules. The AT4 receptor has recently been identified as the transmembrane enzyme, insulin-regulated membrane aminopeptidase (IRAP). IRAP is a type II integral membrane spanning protein belonging to the M1 family of aminopeptidases and is predominantly found in GLUT4 vesicles in insulin-responsive cells. Three hypotheses for the memory-potentiating effects of the AT4 receptor/IRAP ligands, Ang IV and LVV-hemorphin 7, are proposed: (i) acting as potent inhibitors of IRAP, they may prolong the action of endogenous promnestic peptides; (ii) they may modulate glucose uptake by modulating trafficking of GLUT4; (iii) IRAP may act as a receptor, transducing the signal initiated by ligand binding to its C-terminal domain to the intracellular domain that interacts with several cytoplasmic proteins.

Every day's a festival!

Despite their ubiquity and cultural prominence, the academic study of arts festivals has long been neglected. The burgeoning festivals industry is, however, firmly embedded in both the arts funding and weekly calendar of European cities, and there is no doubt that festivals are fast becoming a defining feature of urban life in the twenty-first century. Understanding their nature and their potential impact is now more pressing than ever before. The contributors to this volume explore the modern urban festival and the difference it makes to the experience and management of diversity in the city. Their research reveals an unsettling coupling of the celebration of local diversity with institutional amnesia, in which the memory of a festival hardly ever outlasts its funding. This book documents a key phenomenon of our time, the supplanting of community-based remembering with the repetitive structures of events whose historic and interpretative depth is lost amid a spiraling velocity of "festivalization."