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[PMID]:29176519
[Au] Autor:Brewer-Smyth K; Pohlig RT
[Ad] Endereço:Author Affiliations: College of Health Sciences, University of Delaware.
[Ti] Título:Risk Factors for Women Being Under the Influence of Alcohol Compared With Other Illicit Substances at the Time of Committing Violent Crimes.
[So] Source:J Forensic Nurs;13(4):186-195, 2017 Oct/Dec.
[Is] ISSN:1939-3938
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: We investigated women under the influence of alcohol compared with other illicit substances at the time of committing a crime to identify predictors of being under the influence of alcohol and female-enacted crime. METHODS: Analyses of data, obtained from private interviews and examinations of female prison inmates, included regression analyses exploring predictors of being under the influence of alcohol at the time of the crime and predictors of violent crime. In addition, a reanalysis of a previously reported model, predicting conviction of a violent crime, was conducted including a new variable, being under the influence of alcohol at the time of the crime. RESULTS: Those under the influence of alcohol at the time of their crime had experienced greater nonfamilial childhood sexual abuse and traumatic brain injuries with loss of consciousness predating their crime. They were more likely to have committed a violent, rather than nonviolent, crime compared with those under the influence of other substances, with the latter being not significantly different for those not under the influence of any substance. Being under the influence of alcohol increased the risk of committing a violent crime, adjusting for other predictors of female violence. CONCLUSION: Women under the influence of alcohol are at a greater risk for committing violent crimes than those under the influence of other substances. Female nonfamilial childhood sexual abuse and traumatic brain injury victims were at a higher risk for being under the influence of alcohol, in comparison with other substances, at the time of committing a violent crime.
[Mh] Termos MeSH primário: Intoxicação Alcoólica/epidemiologia
Crime
Prisioneiros/estatística & dados numéricos
Violência
[Mh] Termos MeSH secundário: Adulto
Adultos Sobreviventes de Maus-Tratos Infantis/estatística & dados numéricos
Lesões Encefálicas Traumáticas/epidemiologia
Estudos de Casos e Controles
Feminino
Seres Humanos
Fatores de Risco
Transtornos Relacionados ao Uso de Substâncias/epidemiologia
Inconsciência/epidemiologia
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1097/JFN.0000000000000177


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[PMID]:29443785
[Au] Autor:Warraich S; Ali A; Nizami A; Bakhiet M
[Ad] Endereço:King Hamad University Hospital, Al Sayh.
[Ti] Título:Can endotracheal intubation be the first step in management of nonconvulsive status epilepticus?: A case report.
[So] Source:Medicine (Baltimore);97(7):e9950, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Nonconvulsive status epilepticus (NCSE) is prolonged seizure activity without motor manifestations. Clinically, there are certain examination findings, in addition to elements of history, that help differentiate it from other encephalopathies. When diagnosing NCSE, the physician faces significant difficulties due to inconsistent clinical presentation and somewhat nonspecific electroencephalogram (EEG) criteria. PATIENT CONCERNS: To highlight the problems faced when dealing with such a patient, a case of a 29-year-old male who presented with an altered state of consciousness is put forth for the reader. Only after an extensive laboratory and radiological workup had ruled out other causes, an eventual diagnosis was established when clinical features were correlated with suggestive EEG results. DIAGNOSES: The diagnosis that was reached was NCSE. INTERVENTIONS: The initial therapeutic interventions generally deployed in such a scenario ultimately failed and consequently the patient had to be sedated and intubated, while being kept on antiepileptic medication. OUTCOMES: This measure resulted in satisfactory recovery. LESSONS: Accordingly, we recommend consideration of NCSE in any unconscious patient whose presentation cannot be explained by other disorders. Furthermore, we suggest moving directly to utilizing anesthetic agents and endotracheal intubation, together with anti-epileptic drugs, in the treatment regimen in order to optimize patient outcomes.
[Mh] Termos MeSH primário: Intubação Intratraqueal
Estado Epiléptico/terapia
[Mh] Termos MeSH secundário: Adulto
Anticonvulsivantes/uso terapêutico
Eletroencefalografia
Seres Humanos
Masculino
Estado Epiléptico/complicações
Estado Epiléptico/diagnóstico
Estado Epiléptico/tratamento farmacológico
Inconsciência/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticonvulsants)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009950


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[PMID]:29245361
[Au] Autor:Koh JC; Park J; Kim NY; You AH; Ko SH; Han DW
[Ad] Endereço:aDepartment of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Republic of KoreabDepartment of Anesthesia and Pain Medicine, Pusan National University, Yangsan Hospital, YangsancDepartment of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
[Ti] Título:Effects of remifentanil with or without midazolam pretreatment on the 95% effective dose of propofol for loss of consciousness during induction: A randomized, clinical trial.
[So] Source:Medicine (Baltimore);96(49):e9164, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Propofol is a rapid, efficient hypnotic agent with antiemetic effects. However, a high dosage is related to hemodynamic abnormalities such as hypotension and bradycardia. Pretreatment with remifentanil can decrease injection pain and stabilize hemodynamics during the induction period. Remifentanil or midazolam in combination with propofol can provide synergistic or additive effects during anesthesia induction. However, the hypnotic doses of propofol required in patients who receive pretreatment with remifentanil or midazolam remain unclear. METHODS: Patients aged 20 to 50 years who were scheduled to undergo surgery under general anesthesia were enrolled in this study. The patients were randomized into 3 groups using a computer-generated randomization table. Patients in Group P (Propofol) received only propofol for loss of consciousness, those in Group PR (Propofol-Remifentanil) received remifentanil prior to propofol, and those in Group PMR (Propofol-Midazolam-Remifentanil) received remifentanil and midazolam prior to propofol. After propofol administration, loss of both the eyelash reflex and verbal response represented success. The 95% effective dose of propofol for loss of consciousness in each group, which was the primary outcome, was determined using a modified biased coin up-and-down method. RESULTS: A total of 124 patients were initially enrolled. Of these, 4 were excluded, and the remaining 120 patients were randomized to each (n = 40) of the 3 groups. The 95% effective dose of propofol for loss of consciousness was 1.74 , 1.38, and 0.92 mg/kg in Groups P, PR, and PMR, respectively. Blood pressure decreased at 2 minutes after propofol administration in all the groups. However, compared with Group P, Groups PR and PMR exhibited a significant decrease in blood pressure. CONCLUSIONS: The effective dose of propofol for loss of consciousness could be decreased by 21% and 47% when remifentanil pretreatment was used without and with midazolam, respectively. However, the decrease in blood pressure was greater with pretreatment than sole propofol use. These findings suggest that the combination of remifentanil with or without midazolam may have no benefit on hemodynamic stability during induction using propofol. TRIAL REGISTRATION: NCT02536690 (clinicaltrials.gov).
[Mh] Termos MeSH primário: Anestésicos Intravenosos/administração & dosagem
Hipnóticos e Sedativos/farmacologia
Midazolam/farmacologia
Piperidinas/farmacologia
Propofol/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Relação Dose-Resposta a Droga
Quimioterapia Combinada
Feminino
Hemodinâmica/efeitos dos fármacos
Seres Humanos
Hipnóticos e Sedativos/administração & dosagem
Masculino
Midazolam/administração & dosagem
Meia-Idade
Piperidinas/administração & dosagem
Inconsciência
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anesthetics, Intravenous); 0 (Hypnotics and Sedatives); 0 (Piperidines); P10582JYYK (remifentanil); R60L0SM5BC (Midazolam); YI7VU623SF (Propofol)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009164


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[PMID]:28450776
[Au] Autor:Tolesa K; Gebreal GW
[Ad] Endereço:Department of Ophthalmology, Jimma University, Ethiopia.
[Ti] Título:Brainstem Anesthesia after Retrobulbar Block: A Case Report and Review of Literature.
[So] Source:Ethiop J Health Sci;26(6):589-594, 2016 Nov.
[Is] ISSN:2413-7170
[Cp] País de publicação:Ethiopia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Retro-bulbar anesthesia is one of the most common regional blocks used for intraocular surgeries. Complications associated with regional blocks may be limited to the eye or may be systemic. CASE REPORT: After a retro-bulbar block for glaucoma surgery, a 60-year-old man developed loss of consciousness, apnea with hypotension and bradycardia-features of brainstem anesthesia. We present the clinical features, treatment and comments on how to prevent the problem as well as a review of the literature on reported cases. CONCLUSION: Although it is rare, treating physicians should be aware of the potentially lethal consequences of retro-bulbar block, understand measures to reduce the risks and early recognition and treatment. Facilities where ophthalmic surgeries are performed under local anesthesia should be properly equipped and staffed for advanced resuscitation.
[Mh] Termos MeSH primário: Anestésicos Locais/efeitos adversos
Tronco Encefálico/efeitos dos fármacos
Bupivacaína/efeitos adversos
Trabeculectomia/efeitos adversos
[Mh] Termos MeSH secundário: Anestésicos Locais/administração & dosagem
Apneia/induzido quimicamente
Bupivacaína/administração & dosagem
Glaucoma/cirurgia
Seres Humanos
Hipotensão/induzido quimicamente
Masculino
Meia-Idade
Trabeculectomia/métodos
Inconsciência/induzido quimicamente
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics, Local); Y8335394RO (Bupivacaine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE


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Registro de Ensaios Clínicos
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[PMID]:28742911
[Au] Autor:Kirkegaard H; Søreide E; de Haas I; Pettilä V; Taccone FS; Arus U; Storm C; Hassager C; Nielsen JF; Sørensen CA; Ilkjær S; Jeppesen AN; Grejs AM; Duez CHV; Hjort J; Larsen AI; Toome V; Tiainen M; Hästbacka J; Laitio T; Skrifvars MB
[Ad] Endereço:Research Center for Emergency Medicine and Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
[Ti] Título:Targeted Temperature Management for 48 vs 24 Hours and Neurologic Outcome After Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial.
[So] Source:JAMA;318(4):341-350, 2017 07 25.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: International resuscitation guidelines recommend targeted temperature management (TTM) at 33°C to 36°C in unconscious patients with out-of-hospital cardiac arrest for at least 24 hours, but the optimal duration of TTM is uncertain. Objective: To determine whether TTM at 33°C for 48 hours results in better neurologic outcomes compared with currently recommended, standard, 24-hour TTM. Design, Setting, and Participants: This was an international, investigator-initiated, blinded-outcome-assessor, parallel, pragmatic, multicenter, randomized clinical superiority trial in 10 intensive care units (ICUs) at 10 university hospitals in 6 European countries. Three hundred fifty-five adult, unconscious patients with out-of-hospital cardiac arrest were enrolled from February 16, 2013, to June 1, 2016, with final follow-up on December 27, 2016. Interventions: Patients were randomized to TTM (33 ± 1°C) for 48 hours (n = 176) or 24 hours (n = 179), followed by gradual rewarming of 0.5°C per hour until reaching 37°C. Main Outcomes and Measures: The primary outcome was 6-month neurologic outcome, with a Cerebral Performance Categories (CPC) score of 1 or 2 used to define favorable outcome. Secondary outcomes included 6-month mortality, including time to death, the occurrence of adverse events, and intensive care unit resource use. Results: In 355 patients who were randomized (mean age, 60 years; 295 [83%] men), 351 (99%) completed the trial. Of these patients, 69% (120/175) in the 48-hour group had a favorable outcome at 6 months compared with 64% (112/176) in the 24-hour group (difference, 4.9%; 95% CI, -5% to 14.8%; relative risk [RR], 1.08; 95% CI, 0.93-1.25; P = .33). Six-month mortality was 27% (48/175) in the 48-hour group and 34% (60/177) in the 24-hour group (difference, -6.5%; 95% CI, -16.1% to 3.1%; RR, 0.81; 95% CI, 0.59-1.11; P = .19). There was no significant difference in the time to mortality between the 48-hour group and the 24-hour group (hazard ratio, 0.79; 95% CI, 0.54-1.15; P = .22). Adverse events were more common in the 48-hour group (97%) than in the 24-hour group (91%) (difference, 5.6%; 95% CI, 0.6%-10.6%; RR, 1.06; 95% CI, 1.01-1.12; P = .04). The median length of intensive care unit stay (151 vs 117 hours; P < .001), but not hospital stay (11 vs 12 days; P = .50), was longer in the 48-hour group than in the 24-hour group. Conclusions and Relevance: In unconscious survivors from out-of-hospital cardiac arrest admitted to the ICU, targeted temperature management at 33°C for 48 hours did not significantly improve 6-month neurologic outcome compared with targeted temperature management at 33°C for 24 hours. However, the study may have had limited power to detect clinically important differences, and further research may be warranted. Trial Registration: clinicaltrials.gov Identifier: NCT01689077.
[Mh] Termos MeSH primário: Hipotermia Induzida
Parada Cardíaca Extra-Hospitalar/terapia
[Mh] Termos MeSH secundário: Idoso
Temperatura Corporal
Encefalopatias/etiologia
Reanimação Cardiopulmonar/métodos
Feminino
Seres Humanos
Hipotermia Induzida/efeitos adversos
Masculino
Meia-Idade
Parada Cardíaca Extra-Hospitalar/complicações
Parada Cardíaca Extra-Hospitalar/mortalidade
Fatores de Tempo
Inconsciência/etiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; PRAGMATIC CLINICAL TRIAL; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180124
[Lr] Data última revisão:
180124
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170726
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.8978


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[PMID]:29227992
[Au] Autor:Soplata AE; McCarthy MM; Sherfey J; Lee S; Purdon PL; Brown EN; Kopell N
[Ad] Endereço:Graduate Program for Neuroscience, Boston University, Boston, Massachusetts, United States of America.
[Ti] Título:Thalamocortical control of propofol phase-amplitude coupling.
[So] Source:PLoS Comput Biol;13(12):e1005879, 2017 12.
[Is] ISSN:1553-7358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The anesthetic propofol elicits many different spectral properties on the EEG, including alpha oscillations (8-12 Hz), Slow Wave Oscillations (SWO, 0.1-1.5 Hz), and dose-dependent phase-amplitude coupling (PAC) between alpha and SWO. Propofol is known to increase GABAA inhibition and decrease H-current strength, but how it generates these rhythms and their interactions is still unknown. To investigate both generation of the alpha rhythm and its PAC to SWO, we simulate a Hodgkin-Huxley network model of a hyperpolarized thalamus and corticothalamic inputs. We find, for the first time, that the model thalamic network is capable of independently generating the sustained alpha seen in propofol, which may then be relayed to cortex and expressed on the EEG. This dose-dependent sustained alpha critically relies on propofol GABAA potentiation to alter the intrinsic spindling mechanisms of the thalamus. Furthermore, the H-current conductance and background excitation of these thalamic cells must be within specific ranges to exhibit any intrinsic oscillations, including sustained alpha. We also find that, under corticothalamic SWO UP and DOWN states, thalamocortical output can exhibit maximum alpha power at either the peak or trough of this SWO; this implies the thalamus may be the source of propofol-induced PAC. Hyperpolarization level is the main determinant of whether the thalamus exhibits trough-max PAC, which is associated with lower propofol dose, or peak-max PAC, associated with higher dose. These findings suggest: the thalamus generates a novel rhythm under GABAA potentiation such as under propofol, its hyperpolarization may determine whether a patient experiences trough-max or peak-max PAC, and the thalamus is a critical component of propofol-induced cortical spectral phenomena. Changes to the thalamus may be a critical part of how propofol accomplishes its effects, including unconsciousness.
[Mh] Termos MeSH primário: Propofol/farmacologia
Tálamo/efeitos dos fármacos
[Mh] Termos MeSH secundário: Idoso
Ritmo alfa
Simulação por Computador
Eletroencefalografia
Seres Humanos
Tálamo/fisiologia
Inconsciência
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, U.S. GOV'T, P.H.S.
[Nm] Nome de substância:
YI7VU623SF (Propofol)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180111
[Lr] Data última revisão:
180111
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pcbi.1005879


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[PMID]:29050394
[Au] Autor:Altwegg-Boussac T; Schramm AE; Ballestero J; Grosselin F; Chavez M; Lecas S; Baulac M; Naccache L; Demeret S; Navarro V; Mahon S; Charpier S
[Ad] Endereço:Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France.
[Ti] Título:Cortical neurons and networks are dormant but fully responsive during isoelectric brain state.
[So] Source:Brain;140(9):2381-2398, 2017 Sep 01.
[Is] ISSN:1460-2156
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:A continuous isoelectric electroencephalogram reflects an interruption of endogenously-generated activity in cortical networks and systematically results in a complete dissolution of conscious processes. This electro-cerebral inactivity occurs during various brain disorders, including hypothermia, drug intoxication, long-lasting anoxia and brain trauma. It can also be induced in a therapeutic context, following the administration of high doses of barbiturate-derived compounds, to interrupt a hyper-refractory status epilepticus. Although altered sensory responses can be occasionally observed on an isoelectric electroencephalogram, the electrical membrane properties and synaptic responses of individual neurons during this cerebral state remain largely unknown. The aim of the present study was to characterize the intracellular correlates of a barbiturate-induced isoelectric electroencephalogram and to analyse the sensory-evoked synaptic responses that can emerge from a brain deprived of spontaneous electrical activity. We first examined the sensory responsiveness from patients suffering from intractable status epilepticus and treated by administration of thiopental. Multimodal sensory responses could be evoked on the flat electroencephalogram, including visually-evoked potentials that were significantly amplified and delayed, with a high trial-to-trial reproducibility compared to awake healthy subjects. Using an analogous pharmacological procedure to induce prolonged electro-cerebral inactivity in the rat, we could describe its cortical and subcortical intracellular counterparts. Neocortical, hippocampal and thalamo-cortical neurons were all silent during the isoelectric state and displayed a flat membrane potential significantly hyperpolarized compared with spontaneously active control states. Nonetheless, all recorded neurons could fire action potentials in response to intracellularly injected depolarizing current pulses and their specific intrinsic electrophysiological features were preserved. Manipulations of the membrane potential and intracellular injection of chloride in neocortical neurons failed to reveal an augmented synaptic inhibition during the isoelectric condition. Consistent with the sensory responses recorded from comatose patients, large and highly reproducible somatosensory-evoked potentials could be generated on the inactive electrocorticogram in rats. Intracellular recordings revealed that the underlying neocortical pyramidal cells responded to sensory stimuli by complex synaptic potentials able to trigger action potentials. As in patients, sensory responses in the isoelectric state were delayed compared to control responses and exhibited an elevated reliability during repeated stimuli. Our findings demonstrate that during prolonged isoelectric brain state neurons and synaptic networks are dormant rather than excessively inhibited, conserving their intrinsic properties and their ability to integrate and propagate environmental stimuli.
[Mh] Termos MeSH primário: Córtex Cerebral/citologia
Córtex Cerebral/fisiologia
Neurônios/fisiologia
Estado Epiléptico/fisiopatologia
Tiopental/farmacologia
Inconsciência/fisiopatologia
[Mh] Termos MeSH secundário: Potenciais de Ação/fisiologia
Adolescente
Adulto
Idoso
Animais
Encéfalo/efeitos dos fármacos
Encéfalo/fisiologia
Estudos de Casos e Controles
Estimulação Elétrica
Eletroencefalografia
Potenciais Evocados/fisiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Vias Neurais/fisiologia
Células Piramidais/fisiologia
Ratos
Estado Epiléptico/tratamento farmacológico
Tiopental/uso terapêutico
Inconsciência/induzido quimicamente
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
JI8Z5M7NA3 (Thiopental)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171021
[St] Status:MEDLINE
[do] DOI:10.1093/brain/awx175


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[PMID]:28821646
[Au] Autor:Minert A; Yatziv SL; Devor M
[Ad] Endereço:Department of Cell and Developmental Biology, Institute of Life Sciences, and Center for Research on Pain, The Hebrew University of Jerusalem, Jerusalem 91904, Israel.
[Ti] Título:Location of the Mesopontine Neurons Responsible for Maintenance of Anesthetic Loss of Consciousness.
[So] Source:J Neurosci;37(38):9320-9331, 2017 Sep 20.
[Is] ISSN:1529-2401
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The transition from wakefulness to general anesthesia is widely attributed to suppressive actions of anesthetic molecules distributed by the systemic circulation to the cerebral cortex (for amnesia and loss of consciousness) and to the spinal cord (for atonia and antinociception). An alternative hypothesis proposes that anesthetics act on one or more brainstem or diencephalic nuclei, with suppression of cortex and spinal cord mediated by dedicated axonal pathways. Previously, we documented induction of an anesthesia-like state in rats by microinjection of small amounts of GABA -receptor agonists into an upper brainstem region named the mesopontine tegmental anesthesia area (MPTA). Correspondingly, lesioning this area rendered animals resistant to systemically delivered anesthetics. Here, using rats of both sexes, we applied a modified microinjection method that permitted localization of the anesthetic-sensitive neurons with much improved spatial resolution. Microinjected at the MPTA hotspot identified, exposure of 1900 or fewer neurons to muscimol was sufficient to sustain whole-body general anesthesia; microinjection as little as 0.5 mm off-target did not. The GABAergic anesthetics pentobarbital and propofol were also effective. The GABA-sensitive cell cluster is centered on a tegmental (reticular) field traversed by fibers of the superior cerebellar peduncle. It has no specific nuclear designation and has not previously been implicated in brain-state transitions. General anesthesia permits pain-free surgery. Furthermore, because anesthetic agents have the unique ability to reversibly switch the brain from wakefulness to a state of unconsciousness, knowing how and where they work is a potential route to unraveling the neural mechanisms that underlie awareness itself. Using a novel method, we have located a small, and apparently one of a kind, cluster of neurons in the mesopontine tegmentum that are capable of effecting brain-state switching when exposed to GABA -receptor agonists. This action appears to be mediated by a network of dedicated axonal pathways that project directly and/or indirectly to nearby arousal nuclei of the brainstem and to more distant targets in the forebrain and spinal cord.
[Mh] Termos MeSH primário: Anestésicos Gerais/administração & dosagem
Mesencéfalo/efeitos dos fármacos
Ponte/efeitos dos fármacos
Ponte/fisiologia
Inconsciência/induzido quimicamente
Inconsciência/fisiopatologia
[Mh] Termos MeSH secundário: Animais
Feminino
Masculino
Muscimol/administração & dosagem
Neurônios/efeitos dos fármacos
Ratos
Ratos Sprague-Dawley
Ratos Wistar
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics, General); 2763-96-4 (Muscimol)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170820
[St] Status:MEDLINE
[do] DOI:10.1523/JNEUROSCI.0544-17.2017


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[PMID]:28720183
[Au] Autor:Kim S; Cho T; Lee Y; Koo H; Choi B; Kim D
[Ti] Título:G-LOC Warning Algorithms Based on EMG Features of the Gastrocnemius Muscle.
[So] Source:Aerosp Med Hum Perform;88(8):737-742, 2017 Aug 01.
[Is] ISSN:2375-6314
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: G-induced loss of consciousness (G-LOC) is mainly caused by failure to sustain an oxygenated blood supply to the pilot's brain because of the sudden acceleration in the direction of the +Gz axis, and is considered a critical safety issue. The purpose of this study was to develop G-LOC warning algorithms based on monitoring electromyograms (EMG) of the gastrocnemius muscle on the calf. METHODS: EMG data was retrieved from a total of 67 pilots and pilot trainees of the Korean Air Force during high-G training on a human centrifugal simulator. Seven EMG features were obtained from root mean square (RMS), integrated absolute value (IAV), and mean absolute value (MAV) for muscle contraction, slope sign changes (SSC), waveform length (WL), zero crossing (ZC), and median frequency (MF) for muscle contraction and fatigue. RESULTS: Out of seven EMG features, IAV and WL showed a rapid decay before G-LOC. Based on these findings, this study developed two algorithms which can detect G-LOC during flight and provide warning signals to the pilots. The probability of G-LOC occurrence was detected through monitoring the decay trend for representing muscle endurance and climb rate of the IAV and WL value during sudden acceleration above 6 G, representing muscle power. The sensitivity of the algorithms using IAV and WL features was 100% and the specificity was 66.7%. DISCUSSION: This study suggests that a G-LOC detecting and warning system may be a customized, real-time countermeasure by improving the accuracy of detecting G-LOC.Kim S, Cho T, Lee Y, Koo H, Choi B, Kim D. G-LOC warning algorithms based on EMG features of the gastrocnemius muscle. Aerosp Med Hum Perform. 2017; 88(8):737-742.
[Mh] Termos MeSH primário: Aceleração/efeitos adversos
Algoritmos
Gravitação
Hipergravidade/efeitos adversos
Militares
Músculo Esquelético/fisiopatologia
Pilotos
Inconsciência/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Medicina Aeroespacial
Eletromiografia
Seres Humanos
Treinamento por Simulação
Inconsciência/etiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM; S
[Da] Data de entrada para processamento:170720
[St] Status:MEDLINE
[do] DOI:10.3357/AMHP.4781.2017


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[PMID]:28690732
[Au] Autor:Obimakinde OS; Ogundipe KO; Rabiu TB; Okoje VN
[Ad] Endereço:Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria.
[Ti] Título:Maxillofacial fractures in a budding teaching hospital: a study of pattern of presentation and care.
[So] Source:Pan Afr Med J;26:218, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Previous reports indicated that there is geographic and sociodemographic variation in the epidemiology of maxillofacial fractures. Audit of maxillofacial injuries managed at any institution is therefore necessary to understand the trends and proffer strategies for prevention. We therefore embarked on this study to determine the pattern of maxillofacial fractures and concomitant injuries in our institution. METHODS: We carried out a retrospective review of information on demography, aetiology and type of maxillofacial fracture, patients' status, type of crash, level of consciousness and concomitant injuries. The data collected was analysed with SPSS Version 20. RESULTS: A total of 233 patients aged 2 to 66 years were reviewed. A higher male preponderance (M:F 3.4:1) was observed. Road traffic crashes (RTC) accounted for 78.5% of injuries. Motorcycle related crashes were responsible for 69.4% of RTC and 54.5% of all fractures. Fracture of the mandible (63.2% n=172) was the most predominant skeletal injury and the body (25% n=43) was the most common site of fracture while the zygoma (29%) was predominantly affected in the midface. Ninety three patients (40%) suffered loss of consciousness. The relationship between aetiology of injuries and consciousness level of the patients was statistically significant (p=0.001). Of the 43 patients who had concomitant injuries, craniocerebral affectation (60.5%) was the commonest. CONCLUSION: RTC remains the major aetiology of maxillofacial fractures. The mandible was mostly affected and nearly half of the patients have associated loss of consciousness. There is need for continual advocacy and enforcement of laws on preventive measures among road users.
[Mh] Termos MeSH primário: Acidentes de Trânsito/estatística & dados numéricos
Fraturas Mandibulares/epidemiologia
Traumatismos Maxilofaciais/epidemiologia
Fraturas Zigomáticas/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Criança
Pré-Escolar
Feminino
Hospitais de Ensino
Seres Humanos
Masculino
Fraturas Mandibulares/etiologia
Traumatismos Maxilofaciais/etiologia
Traumatismos Maxilofaciais/patologia
Meia-Idade
Motocicletas
Estudos Retrospectivos
Inconsciência/epidemiologia
Adulto Jovem
Fraturas Zigomáticas/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170711
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2017.26.218.11621



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