Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Sociedad Española de Medicina Interna (SEMI) y Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) para la definición de competencias mínimas de ecografía en Cuidados Intensivos y Urgencias y la obtención del Diploma acreditativo

The use of ultrasound as a clinical diagnostic tool and guide of bedside procedures has become an indispensable examination in the acute critically ill patient. The training of professionals in minimum skills of knowledge, management and indications of use of ultrasound required to be defined by the Scientific Societies. The Intensive Care Ultrasound Working Group of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Emergency Medicine (SEMES) has developed this consensus document in which the recommended training program and the minimum competencies to be achieved with regard to the use of Ultrasound in Intensive Care, Anesthesia and Emergency medicine are defined.This document defines the training program and the skills to acquire in order to achieve the diploma in lung, abdominal and vascular ultrasound. This document can serve as a guide to define the skills to be acquired in the training programs of residents (MIRs) of specialists working in intensive care, anesthesia, and emergency medicine.     

Improvements in Negative Symptoms and Functional Outcome After a New Generation Cognitive Remediation Program: A Randomized Controlled Trial

Cognitive remediation improves cognition in patients with schizophrenia, but its effect on other relevant factors such as negative symptoms and functional outcome has not been extensively studied. In this hospital-based study, 84 inpatients with chronic schizophrenia were recruited from Alava Hospital (Spain). All of the subjects underwent a baseline and a 3-month assessment that examined neurocognition, clinical symptoms, insight, and functional outcome according to the Global Assessment of Functioning (GAF) scale and Disability Assessment Schedule from World Health Organization (DAS-WHO). In addition to receiving standard treatment, patients were randomly assigned either to receive neuropsychological rehabilitation (REHACOP) or to a control group. REHACOP is an integrative program that taps all basic cognitive functions. The program included experts’ latest suggestions about positive feedback and activities of daily living in the patients’ environment. The REHACOP group showed significantly greater improvements at 3 months in the areas of neurocognition, negative symptoms, disorganization, and emotional distress compared with the control group (Cohen’s effect size for these changes ranged from d = 0.47 for emotional distress to d = 0.58 for disorganization symptoms). The REHACOP group also improved significantly in both the GAF (d = 0.61) and DAS-WHO total scores (d = 0.57). Specifically, the patients showed significant improvement in vocational outcomes (d = 0.47), family contact (d = 0.50), and social competence (d = 0.56). In conclusion, neuropsychological rehabilitation may be useful for the reduction of negative symptoms and functional disability in schizophrenia. These findings support the integration of neuropsychological rehabilitation into standard treatment programs for patients with schizophrenia.Key words: schizophrenia, negative symptoms, functional outcome, cognitive rehabilitation, REHACOP     

Combination of intracortically administered VEGF and environmental enrichment enhances brain protection in developing rats

Postnatal development of the visual cortex is modulated by experience, especially during the critical period. In rats, a stable neuronal population is only acquired after this relatively prolonged period. Vascular endothelial growth factor (VEGF) is the most important angiogenic factor and also has strong neuroprotective, neurotrophic and neurogenic properties. Similar effects have been described for rearing in enriched environments. Our aim is to investigate the vascular and neuronal effects of combining VEGF infusion and environmental enrichment on the visual cortex during the initial days of the critical period. Results showed that a small percentage of Cleaved Caspase-3 positive cells colocalized with neuronal markers. The lesion produced by the cannula implantation resulted in decreased vascular, neuronal and Caspase-3 positive cell densities. Rearing under enriched environment was unable to reverse these effects in any group, whereas VEGF infusion alone partially corrected those effects. A higher effectiveness was reached by combining both the procedures, the most effective combination being when enriched-environment rearing was introduced only after minipump implantation. In addition to the angiogenic effect of VEGF, applied strategies also had synergic neuroprotective effects, and the combination of the two strategies had more remarkable effects than those achieved by each strategy applied individually.     

Physical exercise is required for environmental enrichment to offset the quantitative effects of dark-rearing on the S-100β astrocytic density in the rat visual cortex

After birth, exposure to visual inputs modulates cortical development, inducing numerous changes in all of the components of the visual cortex. Most of the cortical changes thus induced occur during what is called the critical period. Astrocytes play an important role in the development, maintenance and plasticity of the cortex as well as in the structure and function of the vascular network. Visual deprivation induces a decrease in the astroglial population, whereas enhanced experience increases it. Exposure to an enriched environment has been shown to prevent the effects of dark‐rearing in the visual cortex. Our purpose was to study the effects of an enriched environment on the density of astrocytes per reference surface at the visual cortex of dark‐reared rats, in order to determine if enhanced experience is able to compensate the quantitative effects of visual deprivation and the role of physical exercise on the enrichment paradigm. Pregnant Sprague‐Dawley rats were raised in one of the following rearing conditions: control rats with standard housing (12‐h light/dark cycle); in total darkness for the dark‐rearing experiments; and dark‐rearing in conditions of enriched environment without and with physical exercise. The astrocytic density was estimated by immunohistochemistry for S‐100β protein. Quantifications were performed in layer IV. The somatosensorial cortex barrel field was also studied as control. The volume of layer IV was stereologically calculated for each region, age and experimental condition. From the beginning of the critical period, astrocyte density was higher in control rats than in the enriched environment group without physical exercise, with densities of astrocytes around 20% higher at all of the different ages. In contrast, when the animals had access to voluntary exercise, densities were significantly higher than even the control rats. Our main result shows that strategies to apply environmental enrichment should always consider the incorporation of physical exercise, even for sensorial areas such as the visual area, where complex enriched experience by itself is not enough to compensate the effects of visual deprivation.     

Recognition of the physiological actions of the triphasic EMG pattern by a dynamic recurrent neural network

Triphasic electromyographic (EMG) patterns with a sequence of activity in agonist (AG1), antagonist (ANT) and again in agonist (AG2) muscles are characteristic of ballistic movements. They have been studied in terms of rectangular pulse-width or pulse-height modulation. In order to take into account the complexity of the EMG signal within the bursts, we used a dynamic recurrent neural network (DRNN) for the identification of this pattern in subjects performing fast elbow flexion movements. Biceps and triceps EMGs were fed to all 35 fully-connected hidden units of the DRNN for mapping onto elbow angular acceleration signals. DRNN training was supervised, involving learning rule adaptations of synaptic weights and time constants of each unit. We demonstrated that the DRNN is able to perfectly reproduce the acceleration profile of the ballistic movements. Then we tested the physiological plausibility of all the networks that reached an error level below 0.001 by selectively increasing the amplitude of each burst of the triphasic pattern and evaluating the effects on the simulated accelerating profile. Nineteen percent of these simulations reproduced the physiological action classically attributed to the 3 EMG bursts: AG1 increase showed an increase of the first accelerating pulse, ANT an increase of the braking pulse and AG2 an increase of the clamping pulse. These networks also recognized the physiological function of the time interval between AG1 and ANT, reproducing the linear relationship between time interval and movement amplitude. This task-dynamics recognition has implications for the development of DRNN as diagnostic tools and prosthetic controllers.     

Accuracy analysis of complete-arch digital scans in edentulous arches when using an auxiliary geometric device

Statement of problem

Obtaining reliable digital scans of edentulous patients is challenging because of the absence of anatomic landmarks/geometric variations along the dental arch. Whether adding an auxiliary geometric device (AGD) will improve scanning is unclear.

Development of a kinematic coordination pattern in toddler locomotion: planar covariation

The purpose of this study is to analyze the coordination patterns of the elevation angles of lower limb segments following the onset of unsupported walking in children and to look for the existence of a planar covariation rule as previously described in adult human locomotion. The kinematic patterns of locomotion were recorded in 21 children (11–144 months of age) and 19 adults. In 4 children we monitored the very first unsupported steps. The extent to which the covariation of thigh, shank, and foot angles was constrained on a plane in 3D space was assessed by means of orthogonal regression and statistically quantified by means of principal component analysis. The orientation of the covariation plane of the children was compared with the mean value of the adults' plane. Trunk stability with respect to the vertical was assessed in both the frontal (roll) and sagittal (pitch) planes. The evolution with walking experience of the plane orientation and trunk oscillations demonstrated biexponential profiles with a relatively fast time constant (<6 months after the onset of unsupported locomotion) followed by a much slower progression toward adult values. The initial fast changes of these walking parameters did not parallel the slow, monotonic maturation of anthropometric parameters. The early emergence of the covariation plane orientation and its correlation with trunk vertical stability reflect the dynamic integration of postural equilibrium and forward propulsion in a gravity-centered frame. The results support the view that the planar covariation reflects a coordinated, centrally controlled behavior, in addition to biomechanical constraints. The refinement of the planar covariation while morphological variables drastically change as the child grows implies a continuous update of the neural command. Electronic Publication     

Effect of intrathecal baclofen on gait control in human hereditary spastic paraparesis

Using immunocytochemistry with an antibody raised to a specific rat bradykinin B1 receptor sequence, we showed that the B1 receptor was expressed in the naive rat sensory nervous system. B1 immunoreactivity was seen in laminae 1 and 2 of the dorsal horn of the spinal cord, where primary afferents terminate, and on peripheral nerve terminals in the bladder. B1 receptor was co-expressed preferentially with IB4 positive, but not calcitonin gene-related peptide (CGRP) containing C-cell bodies in the dorsal root ganglion. B1 activation has an important role in the hyperalgesia associated with inflammation, but the site of action of B1 antagonists has generally been believed to be on peripheral, non-neuronal cells. The striking distribution of B1 receptors on sensory neurones suggests that a direct action of B1 activators on the nervous system may also contribute to hyperalgesia.