Técnicas anestésicas: ¿Influyen en los resultados? Salengros JC, Huybrechts I, Ducart A, Faraoni D, Marsala C, Barvais L, Cappello M and Engelman E. Different Anesthetic Techniques Associated with Different Incidences of Chronic Post-thoracotomy Pain: Low-Dose Remifentanil Plus Presurgical Epidural Analgesia is Preferable to High-Dose Remifentanil with Postsurgical Epidural Analgesia. J Cardiothorac Vasc Anesth. 2010. (

La posibilidad de que las técnicas anestésicas sean un factor de riesgo para el desarrollo de dolor crónico postquirúrgico, es un tema muy controvertido. Se ha demostrado que las altas dosis de remifentanilo se asocian a grandes zonas de alodinia e hiperalgesia pericicatricial. A su vez, se ha podido demostrar una fuerte correlación entre el grado y la extensión de la alodinia y la incidencia de dolor crónico postoperatorio. Los autores investigan la hipótesis de que dosis bajas de remifentanilo con analgesia epidural continua intraoperatoria con anestésicos locales en cirugía torácica, reduzcan el grado de alodinia mecánica asociada a altas dosis de remifentanilo, sin analgesia epidural intraoperatoria. Se registra además la presencia de dolor crónico post-toracotomía en el primer mes, a los 6 meses y al año, con el fin de definir factores de riesgo asociados

Papel del Bloqueo TAP en la Analgesia Postoperatoria: Petersen PL, Mathiesen O, Torup H, Dahl JB. The transversus abdominis plane block: a valuable option for postoperative analgesia? A topical review. Acta Anaesthesiol Scand. 2010 May;54(5):529-35.

El plano transverso del abdomen (TAP) es un espacio anatómico entre el músculo oblicuo interno y el transverso que se extiende por toda la pared abdominal hasta finalizar en la aponeurosis de los músculos rectos. El bloqueo TAP es una técnica reciente, que está presentando una rápida expansión en anestesia y analgesia regional postoperatoria y que se basa en la inyección de un bolo de anestésico local en este compartimiento anatómico para bloquear las fibras aferentes somáticas antes de salir del TAP, que inervan la pared abdominal anterior desde los dermatomas T6 a L1. Este bloqueo produce una analgesia unilateral entre el margen costal y el ligamento inguinal. Su uso se está extendiendo como parte de la analgesia multimodal postoperatoria de varios procedimientos de cirugía abdominal baja, ginecológica y de pared abdominal

Comentario sobre Analgesia epidural frente a analgesia endovenosa en cirugía ginecológica oncológica

Neus Esteve 16 mayo 2010 Quisiera añadir algunos comentarios a esta excelente revisión del artículo sobre la efectividad de la analgesia epidural en cirugía ginecológica oncológica. Precisamente este artículo fue uno de los comentados en la revisión "Problemas en la evaluación de la Efectividad Analgésica", publicado en http://www.anestesiar.org en abril 2009. La conclusión de este trabajo se basa en la comparación de medias de EVA en reposo, en las primeras 24 h del postoperatorio. Es difícil que este tipo de medidas tengan la capacidad de diferenciar la calidad analgésica entre la analgesia epidural y la intravenosa

Human simulation in stroke patients rehabilitation

Different types of neurological deficits and sequels in the upper extremities that affect the activities of daily living in patients who have undergone stroke, have been analyzed from a subjective clinical point of view. Prognosis recovery after stroke depends on many factors, among which are included individualized program of rehabilitation and cooperation of patients. Simulation patients in the beginning of stroke. The aim of this work is to show a novel environment to simulate the initial improvement upper limb functions a few days after stroke and simulate the functional recovery of patients under a rehabilitation program. Twenty-nine patients in the first four days post stroke were selected. Inclusion criteria were: over eighteen years of age, collaborative patients, and neurological deficits in upper extremities post stroke without a previous history of stroke of motor sequelae second to other neurological or osteoarticular diseases that might identify pre-existing disability. Assessments were performed with 3-4 days and 7 days and 1, and 3 months post stroke recording the following variables: demographics, stroke type, stroke classification according to the Oxford scale, neurological deficit determined by the NIHSS, disability measures (Barthel’s Index, Rankin Scale), assessment of the motor dysfunction of the upper extremities according to the Fugl-Meyer Scale as well as muscle tone (Ashworth’s Scale) and muscle balance of the upper extremities. We measured the deficits of angles, lengths and range of motion for the arm and hand affected. These measures were implemented in a virtual environment with 29 DOF for each arm and hand. The different types of deficit and sequelae seen in the upper extremities of stroke patients impairing their activities of daily living have been analysed from a subjective clinical standpoint based on clinical and functional assessments. The prognosis for recovery of each patient very much depends on many factors, which can be found in the rehabilitation program and individual goals together with the collaboration afforded by the patients themselves while they are unaware a priori of the objective outcome of the rehabilitation process.Postprint (published version

Valoración del daño corporal en personas afectadas de secuelas neurológicas

Objetivo: Mostrar un nuevo sistema para simular la recuperación inicial de las funciones de la extremidad superior los primeros días después del ictus y simular la recuperación funcional de los pacientes bajo los programas de rehabilitación. Pacientes y metodología: Seleccionamos 29 pacientes en los primeros cuatro días después de padecer un ictus, valorados a los tres y siete días y uno, tres y seis meses, recogiendo tipo de ictus, clasificación (escala de Oxford), déficit neurológico (escala de NIHSS), medidas de discapacidad, valoración de la función motora de la extremidad superior (escala de Fugl-Meyer), tono muscular y balance muscular de la extremidad superior. Resultados: Los pacientes que presentaron un tono muscular disminuido tuvieron más dificultad en mejorar el control motor de las articulaciones de la extremidad superior. Los pacientes TACI presentaron mayor déficit neurológico, mientras que los tipos de ictus POCI y LACI tenían una función motora mejor con mayor independencia para el desarrollo de sus actividades de la vida diaria. Conclusión: La simulación virtual del brazo y la mano en pacientes afectados por un ictus proporciona a los médicos y fisioterapeutas una nueva herramienta que permite simular la evolución de los déficits en algunos pacientes.Postprint (published version

Non-linear nanoscale piezoresponse of single ZnO nanowires affected by piezotronic effect

Zinc oxide (ZnO) nanowires (NWs) as semiconductor piezoelectric nanostructures have emerged as material of interest for applications in energy harvesting, photonics, sensing, biomedical science, actuators or spintronics. The expression for the piezoelectric properties in semiconductor materials is concealed by the screening effect of the available carriers and the piezotronic effect, leading to complex nanoscale piezoresponse signals. Here, we have developed a metal-semiconductor-metal model to simulate the piezoresponse of single ZnO NWs, demonstrating that the apparent non-linearity in the piezoelectric coefficient arises from the asymmetry created by the forward and reversed biased Schottky barriers at the semiconductor-metal junctions. By directly measuring the experimental I-V characteristics of ZnO NWs with conductive atomic force microscope together with the piezoelectric vertical coefficient by piezoresponse force microscopy, and comparing them with the numerical calculations for our model, effective piezoelectric coefficients in the range d 33eff ∼ 8.6 pm V¯¹-12.3 pm V¯¹ have been extracted for ZnO NWs. We have further demonstrated via simulations the dependence between the effective piezoelectric coefficient d 33eff and the geometry and physical dimensions of the NW (radius to length ratio), revealing that the higher d 33eff is obtained for thin and long NWs due to the tensor nature proportionality between electric fields and deformation in NW geometries. Moreover, the non-linearity of the piezoresponse also leads to multiharmonic electromechanical response observed at the second and higher harmonics that indeed is not restricted to piezoelectric semiconductor materials but can be generalized to any type of asymmetric voltage drops on a piezoelectric structure as well as leaky wide band-gap semiconductor ferroelectrics

Dialysis and column chromatography for biomass pyrolysis liquids separation

Altres ajuts: acords transformatius de la UABIn the current study, a novel approach for separating value-added chemicals from pine wood residues' pyrolysis liquids (bio-oil) was effectively carried out. It combined two separation techniques used for the first time in this field: dialysis with water, methanol and acetone, and column chromatography with Amberlite™ XAD7 resin. This strategy made it possible to separate bio-oil into four fractions: (1) pyrolytic lignin, which can be utilized in the synthesis of resins, foams, electrodes, asphalt, etc. (2) acid-rich fraction, with particular relevance to the chemical industry, (3) antioxidant fraction, containing phenolic compounds, with a lot of interest for pharmaceutical and nutraceutical industry, and (4) a final fraction containing the most non-polar chemicals from bio-oil. Thus, it was possible to develop a process that allows the obtention of bioproducts from woody biomass, a residue obtained in significant quantities in the management of non-profitable forests, making a step forward within the context of circular economy and bioeconomy

Hand motion analysis during the execution of the action research arm test using multiple sensors

The Action Research Arm Test (ARAT) is a standardized outcome measure that can be improved by integrating sensors for hand motion analysis. The purpose of this study is to measure the flexion angle of the finger joints and fingertip forces during the performance of three subscales (Grasp, Grip, and Pinch) of the ARAT, using a data glove (CyberGlove II®) and five force-sensing resistors (FSRs) simultaneously. An experimental study was carried out with 25 healthy subjects (right-handed). The results showed that the mean flexion angles of the finger joints required to perform the 16 activities were Thumb (Carpometacarpal Joint (CMC) 28.56°, Metacarpophalangeal Joint (MCP) 26.84°, and Interphalangeal Joint (IP) 13.23°), Index (MCP 46.18°, Index Proximal Interphalangeal Joint (PIP) 38.89°), Middle (MCP 47.5°, PIP 42.62°), Ring (MCP 44.09°, PIP 39.22°), and Little (MCP 31.50°, PIP 22.10°). The averaged fingertip force exerted in the Grasp Subscale was 8.2 N, in Grip subscale 6.61 N and Pinch subscale 3.89 N. These results suggest that the integration of multiple sensors during the performance of the ARAT has clinical relevance, allowing therapists and other health professionals to perform a more sensitive, objective, and quantitative assessment of the hand function.Postprint (published version

Quantitative assessment of hand function in healthy subjects and post-stroke patients with the action research arm test

The Action Research Arm Test (ARAT) can provide subjective results due to the difficulty assessing abnormal patterns in stroke patients. The aim of this study was to identify joint impairments and compensatory grasping strategies in stroke patients with left (LH) and right (RH) hemiparesis. An experimental study was carried out with 12 patients six months after a stroke (three women and nine men, mean age: 65.2 ± 9.3 years), and 25 healthy subjects (14 women and 11 men, mean age: 40.2 ± 18.1 years. The subjects were evaluated during the performance of the ARAT using a data glove. Stroke patients with LH and RH showed significantly lower flexion angles in the MCP joints of the Index and Middle fingers than the Control group. However, RH patients showed larger flexion angles in the proximal interphalangeal (PIP) joints of the Index, Middle, Ring, and Little fingers. In contrast, LH patients showed larger flexion angles in the PIP joints of the Middle and Little fingers. Therefore, the results showed that RH and LH patients used compensatory strategies involving increased flexion at the PIP joints for decreased flexion in the MCP joints. The integration of a data glove during the performance of the ARAT allows the detection of finger joint impairments in stroke patients that are not visible from ARAT scores. Therefore, the results presented are of clinical relevancePeer ReviewedPostprint (published version