Nurses in specialistic surgery: centrality of a role

According international trend patients over 70 submitted surgery in our Thoracic Surgery Unit are increasing. Therefore these patients are at higher risk of complications in the post-operative period owing to advanced age and comorbidities; most important among them BPCO and cardiovascular diseases. In our study most frequent and best evaluable complication was pneumonia. However postoperative pneumonia percentage decreased since 2000, when a nurse dedicated for thoracic patients only was instituted. Since then in our unit assistance model consisted of two thoracic surgeons supported by a nurse in charge to General Surgery Paramedic Unit. Innovation did not request adjunctive costs and contributed to a significant increase in professional level of nursing standard.     

Oxidative stress at the vascular wall. Mechanistic and pharmacological aspects

During the process of energy production in aerobic respiration, vascular cells produce reactive oxygen species (ROS). A growing body of evidence indicates that oxidative stress refers to a condition in which cells are subjected to excessive levels of ROS. Overall vascular function is dependent upon a fine balance of oxidant and antioxidant mechanisms, which determine endothelial functions. Considerable experimental and clinical data indicate that intracellular oxidant milieu is also involved in several redox-sensitive cellular signaling pathways such as ion transport systems, protein phosphorylation, and gene expression and thus also plays important roles as modulator of vascular cell functions such as cell growth, apoptosis, migration, angiogenesis and cell adhesion. Overproduction of ROS under pathophysiologic conditions is integral in the development of cardiovascular diseases. This fact has raised an intensive search of new pharmacological approaches to improve vascular hemostasis and particularly those intended to decrease oxidative stress or augment the antioxidant defense mechanisms.     

Spatial frequency rows in the striate visual cortex

We have recorded the unitary activity of the neurons of area 17 of the cat either in penetrations perpendicular to the surface of the cortex or parallel to it. We have examined the functional architecture of this cortical area with respect to the spatial frequency of the visual stimulus (sinusoidal gratings) at which each neuron is most sensitive. In penetrations perpendicular to the surface of the cortex (columns) the cells of the various layers or even of the same layer have the same preferred orientation but different preferred spatial frequencies. In penetrations parallel to the surface of the cortex the cells of the same layer or sublayer present a variety of preferred orientations, but maintain the same preferred spatial frequency and visual acuity over long microelectrode track distances.     

Lumbar total disc arthroplasty: outdated surgery or here to stay procedure? A systematic review of current literature

Background

The purpose of this study was to summarize the available evidence about total lumbar disc replacement (TDR), focusing our attention on four main topics: clinical and functional outcomes, comparison with fusion surgery results, rate of complications and influence on sagittal balance.

Materials and methods

We systematically searched Pubmed, Embase, Medline, Medscape, Google Scholar and Cochrane library databases in order to answer our four main research questions. Effective data were extracted after the assessment of methodological quality of the trials.

Results

Fifty-nine pertinent papers were included. Clinical and functional scores show statistically significant improvements, and they last at all time points compared to baseline. The majority of the articles show there is no significant difference between TDR groups and fusion groups. The literature shows similar rates of complications between the two surgical procedures.

Conclusions

TDR showed significant safety and efficacy, comparable to lumbar fusion. The major advantages of a lumbar TDR over fusion include maintenance of segmental motion and the restoration of the disc height, allowing patients to find their own spinal balance. Disc arthroplasty could be a reliable option in the treatment of degenerative disc disease in years to come.

Level of evidence

II.

     

Ependymoma of the mediastinum

A case of primary ependymoma of the mediastinum is reported. The tumor was adherent to the lung and metastasized to adjacent mediastinal lymph nodes. An autopsy showed no evidence of tumor in the central nervous system. The diagnosis of ependymoma was confirmed by the immunohistochemical positivity for glialfibrillary acidic protein. To the best of our knowledge, this is the first reported example of an ependymoma in this location.     

The action of neurotrophins in the development and plasticity of the visual cortex

Nerve growth factor (NGF) and the other members of the the NGF gene family have been extensively characterized as neurotrophic factors. Recently a modulatory action of these neurotrophic factors on synapse efficacy has emerged. The developing visual system has provided a convenient model to test the role of neurotrophins on neural plasticity in vivo.NGF does not interfere with the development of the visual cortex but has an effect only when the visual system is confronted with abnormal vision. All the effects of manipulations of the visual experience such as monocular deprivation, strabismus and dark rearing are prevented if NGF is provided exogenously. NGF can antagonize the destabilization of cortical connections induced by manipulations of the visual input during early postnatal development. Anti-NGF has complementary effects, delaying the stabilization of visual cortical synapses.The mechanism of NGF action remains unclear. The cells expressing NGF receptors in the visual system are yet to be identified, but some lines of evidence suggest that NGF exerts a direct action on cortical neurons.The distribution of BDNF and its receptor trkB in the visual system is known in much greater detail, BDNF production is regulated by visual input and BDNF responsive cells are present along the entire visual pathway. Yet, the effects of BDNF on the visual cortex are difficult to interpret. BDNF interferes with the development of the visual cortex and induces a paradoxical plasticity in monocularly deprived kittens. The effects of exogenous administration of BDNF on the visual cortex are dramatic, but the action of BDNF under physiological conditions is still unclear.     

Point de vue des patients concernant la prise en charge anesthésique

PURPOSE: Whereas patients most often select their surgeon, they don't usually select their anesthesiologist. Further, anesthesia frequently involves different physicians at different stages perioperatively. This inability to choose and the multiplicity of interveners may reduce patient satisfaction. Our study examined patients' willingness to choose their anesthesiologist for the operation, as well as their opinion on the way anesthesia is practiced presently. CLINICAL FEATURES: Nine hundred and twelve patients (mean age 51 +/- 16 yr, 58% moles) were requested, immediately after the preoperative visit, to choose their anesthesiologist for the operation. The request was formuled by a nurse, in the absence of the anesthesiologist, in order to avoid a courteous response. After surgery, prior to leaving the hospital, patients were invited to give their opinion on the anesthesia core received and to name the anesthesiologist(s) and surgeon involved. RESULTS: Women chose an anesthesiologist more frequently than men, but only 34% of patients overall elected to do so. Eighty percent of patients were cared for by an anesthesiologist other than the one seen at the preoperative visit. Four percent of patients regretted the change. Patients recalled the surgeon's name more frequently (60%) than the attending anesthesiologist's (4%). CONCLUSION: In France, the preoperative visit is required by law and must precede the operation by at least 48 hr. Despite this preoperative interview, patients were unwilling to choose the anesthesiologist responsible for surgery, did not object to multiple interveners and seldom remembered their anesthesiologist's name. Efforts to improve the image of the profession are required.     

Functional Interpretations of Sadness,Stress and Demoralization among an Urban Population of Low-Income Mothers

Objectives We sought to understand how low-income urban mothers explain feelings of sadness, stress or demoralization in the context of their life experiences. Methods 28 in-depth qualitative interviews, constituting part of a community-based participatory research (CBPR) project aimed at developing a culturally relevant, community-based intervention for maternal depression. Qualitative data validity was ensured through investigator and expert triangulation, and through member checking. Results The following themes emerged: (1) Informants spoke of wanting reprieves from chaos, and discussed this desire relative to wanting to be alone. By contrast, informants expressed loneliness not only in interpersonal terms, but also related to having problems that precluded future relationships, or feeling unique in experiencing an adversity. (2) Informants spoke of demoralization associated with feeling that their problems were externally imposed and therefore beyond their control, but spoke of empowerment associated with owning one’s problems. (3) Informants discussed degrees of sadness in relation to their own abilities to adjust or modify their mood, or their ability to contain their feelings. Conclusions Our data suggest that helping a mother find reprieves from chaos, increasing her perception of her own locus of control around externally imposed adversities, and empowering her to recognize and self-manage her own feelings may constitute important elements of a culturally relevant, community-based intervention for depression.