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1.
Sci Adv ; 9(45): eadg9921, 2023 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-37939176

RESUMEN

Infantile amnesia is possibly the most ubiquitous form of memory loss in mammals. We investigated how memories are stored in the brain throughout development by integrating engram labeling technology with mouse models of infantile amnesia. Here, we found a phenomenon in which male offspring in maternal immune activation models of autism spectrum disorder do not experience infantile amnesia. Maternal immune activation altered engram ensemble size and dendritic spine plasticity. We rescued the same apparently forgotten infantile memories in neurotypical mice by optogenetically reactivating dentate gyrus engram cells labeled during complex experiences in infancy. Furthermore, we permanently reinstated lost infantile memories by artificially updating the memory engram, demonstrating that infantile amnesia is a reversible process. Our findings suggest not only that infantile amnesia is due to a reversible retrieval deficit in engram expression but also that immune activation during development modulates innate, and reversible, forgetting switches that determine whether infantile amnesia will occur.


Asunto(s)
Trastorno del Espectro Autista , Humanos , Lactante , Masculino , Ratones , Animales , Amnesia , Encéfalo , Modelos Animales de Enfermedad , Cabeza , Mamíferos
2.
Curr Biol ; 33(24): 5368-5380.e5, 2023 12 18.
Artículo en Inglés | MEDLINE | ID: mdl-37992719

RESUMEN

Information derived from experiences is incorporated into the brain as changes to ensembles of cells, termed engram cells, which allow memory storage and recall. The mechanism by which those changes hold specific information is unclear. Here, we test the hypothesis that the specific synaptic wiring between engram cells is the substrate of information storage. First, we monitor how learning modifies the connectivity pattern between engram cells at a monosynaptic connection involving the hippocampal ventral CA1 (vCA1) region and the amygdala. Then, we assess the functional significance of these connectivity changes by artificially activating or inhibiting its presynaptic and postsynaptic components, respectively. Finally, we identify a synaptic plasticity mechanism mediated by postsynaptic density protein 95 (PSD-95), which impacts the connectivity pattern among engram cells and contributes to the long-term stability of the memory. These findings impact our theory of learning and memory by helping us explain the translation of specific information into engram cells and how these connections shape brain function.


Asunto(s)
Región CA1 Hipocampal , Recuerdo Mental , Región CA1 Hipocampal/fisiología , Recuerdo Mental/fisiología , Aprendizaje , Plasticidad Neuronal/fisiología , Amígdala del Cerebelo
3.
bioRxiv ; 2023 Sep 21.
Artículo en Inglés | MEDLINE | ID: mdl-37790352

RESUMEN

Information derived from experiences is incorporated into the brain as changes to ensembles of cells, termed engram cells, that allow memory storage and recall. The mechanism by which those changes hold specific information is unclear. Here we test the hypothesis that the specific synaptic wiring between engram cells is the substrate of information storage. First, we monitor how learning modifies the connectivity pattern between engram cells at a monosynaptic connection involving the hippocampal vCA1 region and the amygdala. Then, we assess the functional significance of these connectivity changes by artificially activating or inhibiting its presynaptic and postsynaptic components respectively. Finally, we identify a synaptic plasticity mechanism mediated by PSD-95, which impacts the connectivity pattern among engram cells and contributes to the long-term stability of the memory. These findings impact our theory of learning and memory by helping us explain the translation of specific information into engram cells and how these connections shape brain function.

4.
Cell Rep ; 42(8): 112999, 2023 08 29.
Artículo en Inglés | MEDLINE | ID: mdl-37590145

RESUMEN

Long-term memories are stored as configurations of neuronal ensembles, termed engrams. Although investigation of engram cell properties and functionality in memory recall has been extensive, less is known about how engram cells are affected by forgetting. We describe a form of interference-based forgetting using an object memory behavioral paradigm. By using activity-dependent cell labeling, we show that although retroactive interference results in decreased engram cell reactivation during recall trials, optogenetic stimulation of the labeled engram cells is sufficient to induce memory retrieval. Forgotten engrams may be reinstated via the presentation of similar or related environmental information. Furthermore, we demonstrate that engram activity is necessary for interference to occur. Taken together, these findings indicate that retroactive interference modules engram expression in a manner that is both reversible and updatable. Inference may constitute a form of adaptive forgetting where, in everyday life, new perceptual and environmental inputs modulate the natural forgetting process.


Asunto(s)
Memoria a Largo Plazo , Memoria , Recuerdo Mental , Optogenética
6.
J Biol Chem ; 298(5): 101866, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35346687

RESUMEN

Memory, defined as the storage and use of learned information in the brain, is necessary to modulate behavior and critical for animals to adapt to their environments and survive. Despite being a cornerstone of brain function, questions surrounding the molecular and cellular mechanisms of how information is encoded, stored, and recalled remain largely unanswered. One widely held theory is that an engram is formed by a group of neurons that are active during learning, which undergoes biochemical and physical changes to store information in a stable state, and that are later reactivated during recall of the memory. In the past decade, the development of engram labeling methodologies has proven useful to investigate the biology of memory at the molecular and cellular levels. Engram technology allows the study of individual memories associated with particular experiences and their evolution over time, with enough experimental resolution to discriminate between different memory processes: learning (encoding), consolidation (the passage from short-term to long-term memories), and storage (the maintenance of memory in the brain). Here, we review the current understanding of memory formation at a molecular and cellular level by focusing on insights provided using engram technology.


Asunto(s)
Aprendizaje , Memoria , Animales , Encéfalo/fisiología , Memoria/fisiología , Neuronas/fisiología
7.
Nat Commun ; 12(1): 3098, 2021 05 25.
Artículo en Inglés | MEDLINE | ID: mdl-34035282

RESUMEN

The human Alzheimer's disease (AD) brain accumulates angiogenic markers but paradoxically, the cerebral microvasculature is reduced around Aß plaques. Here we demonstrate that angiogenesis is started near Aß plaques in both AD mouse models and human AD samples. However, endothelial cells express the molecular signature of non-productive angiogenesis (NPA) and accumulate, around Aß plaques, a tip cell marker and IB4 reactive vascular anomalies with reduced NOTCH activity. Notably, NPA induction by endothelial loss of presenilin, whose mutations cause familial AD and which activity has been shown to decrease with age, produced a similar vascular phenotype in the absence of Aß pathology. We also show that Aß plaque-associated NPA locally disassembles blood vessels, leaving behind vascular scars, and that microglial phagocytosis contributes to the local loss of endothelial cells. These results define the role of NPA and microglia in local blood vessel disassembly and highlight the vascular component of presenilin loss of function in AD.


Asunto(s)
Enfermedad de Alzheimer/genética , Péptidos beta-Amiloides/genética , Vasos Sanguíneos/metabolismo , Encéfalo/metabolismo , Neovascularización Patológica/genética , Placa Amiloide/genética , Enfermedad de Alzheimer/metabolismo , Péptidos beta-Amiloides/metabolismo , Animales , Vasos Sanguíneos/patología , Encéfalo/irrigación sanguínea , Encéfalo/patología , Modelos Animales de Enfermedad , Células Endoteliales/metabolismo , Femenino , Perfilación de la Expresión Génica/métodos , Humanos , Ratones Endogámicos C57BL , Ratones Noqueados , Ratones Transgénicos , Neovascularización Patológica/metabolismo , Placa Amiloide/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos
8.
Curr Opin Neurobiol ; 67: 215-225, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33812274

RESUMEN

Understanding memory requires an explanation for how information can be stored in the brain in a stable state. The change in the brain that accounts for a given memory is referred to as an engram. In recent years, the term engram has been operationalized as the cells that are activated by a learning experience, undergoes plasticity, and are sufficient and necessary for memory recall. Using this framework, and a growing toolbox of related experimental techniques, engram manipulation has become a central topic in behavioral, systems, and molecular neuroscience. Recent research on the topic has provided novel insights into the mechanisms of long-term memory storage, and its overlap with instinct. We propose that memory and instinct may be embodied as isomorphic topological structures within the brain's microanatomical circuitry.


Asunto(s)
Aprendizaje , Memoria , Encéfalo , Almacenamiento y Recuperación de la Información
9.
Nat Aging ; 1(4): 385-399, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-37117599

RESUMEN

Genetic Alzheimer's disease (AD) risk factors associate with reduced defensive amyloid ß plaque-associated microglia (AßAM), but the contribution of modifiable AD risk factors to microglial dysfunction is unknown. In AD mouse models, we observe concomitant activation of the hypoxia-inducible factor 1 (HIF1) pathway and transcription of mitochondrial-related genes in AßAM, and elongation of mitochondria, a cellular response to maintain aerobic respiration under low nutrient and oxygen conditions. Overactivation of HIF1 induces microglial quiescence in cellulo, with lower mitochondrial respiration and proliferation. In vivo, overstabilization of HIF1, either genetically or by exposure to systemic hypoxia, reduces AßAM clustering and proliferation and increases Aß neuropathology. In the human AD hippocampus, upregulation of HIF1α and HIF1 target genes correlates with reduced Aß plaque microglial coverage and an increase of Aß plaque-associated neuropathology. Thus, hypoxia (a modifiable AD risk factor) hijacks microglial mitochondrial metabolism and converges with genetic susceptibility to cause AD microglial dysfunction.


Asunto(s)
Enfermedad de Alzheimer , Hipoxia de la Célula , Factor 1 Inducible por Hipoxia , Microglía , Mitocondrias , Enfermedad de Alzheimer/fisiopatología , Mitocondrias/metabolismo , Microglía/metabolismo , Factor 1 Inducible por Hipoxia/metabolismo , Péptidos beta-Amiloides/metabolismo , Hipocampo , Factores de Riesgo , Animales , Ratones , Humanos , Línea Celular , Fosforilación Oxidativa
10.
Aging Cell ; 17(5): e12821, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30058223

RESUMEN

The striatum integrates motor behavior using a well-defined microcircuit whose individual components are independently affected in several neurological diseases. The glial cell line-derived neurotrophic factor (GDNF), synthesized by striatal interneurons, and Sonic hedgehog (Shh), produced by the dopaminergic neurons of the substantia nigra (DA SNpc), are both involved in the nigrostriatal maintenance but the reciprocal neurotrophic relationships among these neurons are only partially understood. To define the postnatal neurotrophic connections among fast-spiking GABAergic interneurons (FS), cholinergic interneurons (ACh), and DA SNpc, we used a genetically induced mouse model of postnatal DA SNpc neurodegeneration and separately eliminated Smoothened (Smo), the obligatory transducer of Shh signaling, in striatal interneurons. We show that FS postnatal survival relies on DA SNpc and is independent of Shh signaling. On the contrary, Shh signaling but not dopaminergic striatal innervation is required to maintain ACh in the postnatal striatum. ACh are required for DA SNpc survival in a GDNF-independent manner. These data demonstrate the existence of three parallel but interdependent neurotrophic relationships between SN and striatal interneurons, partially defined by Shh and GDNF. The definition of these new neurotrophic interactions opens the search for new molecules involved in the striatal modulatory circuit maintenance with potential therapeutic value.


Asunto(s)
Cuerpo Estriado/fisiología , Neuronas Dopaminérgicas/fisiología , Interneuronas/fisiología , Red Nerviosa/fisiología , Sustancia Negra/fisiología , Acetilcolina/metabolismo , Potenciales de Acción , Animales , Animales Recién Nacidos , Supervivencia Celular , Factor Neurotrófico Derivado de la Línea Celular Glial/metabolismo , Proteínas Hedgehog/metabolismo , Ratones Endogámicos C57BL , Ratones Transgénicos , Degeneración Nerviosa/patología , Transducción de Señal
11.
Dis Model Mech ; 11(5)2018 05 18.
Artículo en Inglés | MEDLINE | ID: mdl-29784659

RESUMEN

Amnesia - the loss of memory function - is often the earliest and most persistent symptom of dementia. It occurs as a consequence of a variety of diseases and injuries. These include neurodegenerative, neurological or immune disorders, drug abuse, stroke or head injuries. It has both troubled and fascinated humanity. Philosophers, scientists, physicians and anatomists have all pursued an understanding of how we learn and memorise, and why we forget. In the last few years, the development of memory engram labelling technology has greatly impacted how we can experimentally study memory and its disorders in animals. Here, we present a concise discussion of what we have learned about amnesia through the manipulation of engrams, and how we may use this knowledge to inform novel treatments of amnesia.


Asunto(s)
Amnesia/complicaciones , Trastornos de la Memoria/complicaciones , Amnesia/fisiopatología , Amnesia/terapia , Animales , Modelos Animales de Enfermedad , Humanos , Trastornos de la Memoria/fisiopatología , Recuerdo Mental
12.
Front Neuroanat ; 10: 73, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27445711

RESUMEN

Glial cell line-derived neurotrophic factor (GDNF) is proposed as a therapeutic tool in Parkinson's disease, addiction-related disorders, and neurodegenerative conditions affecting motor neurons (MNs). Despite the high amount of work about GDNF therapeutic application, the neuronal circuits requiring GDNF trophic support in the brain and spinal cord (SC) are poorly characterized. Here, we defined GDNF and GDNF family receptor-α 1 (GFRα1) expression pattern in the brain and SC of newborn and adult mice. We performed systematic and simultaneous detection of EGFP and LacZ expressing alleles in reporter mice and asked whether modifications of this signaling pathway lead to a significant central nervous system (CNS) alteration. GFRα1 was predominantly expressed by neurons but also by an unexpected population of non-neuronal cells. GFRα1 expression pattern was wider in neonatal than in adult CNS and GDNF expression was restricted in comparison with GFRα1 at both developmental time points. The use of confocal microscopy to imaging X-gal deposits and EGFP allowed us to identify regions containing cells that expressed both proteins and to discriminate between auto and non-autotrophic signaling. We also suggested long-range GDNF-GFRα1 circuits taking advantage of the ability of the EGFP genetically encoded reporter to label long distance projecting axons. The complete elimination of either the ligand or the receptor during development did not produce major abnormalities, suggesting a preponderant role for GDNF signaling during adulthood. In the SC, our results pointed to local modulatory interneurons as the main target of GDNF produced by Clarke's column (CC) cells. Our work increases the understanding on how GDNF signals in the CNS and establish a crucial framework for posterior studies addressing either the biological role of GDNF or the optimization of trophic factor-based therapies.

13.
Crit Care ; 17(5): R257, 2013 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-24168808

RESUMEN

INTRODUCTION: Delirium is an acute disturbance of consciousness and cognition that has been shown to be associated with poor outcomes, including increased mortality. We aimed to evaluate outcome after postoperative delirium in a cohort of surgical intensive care unit (SICU) patients. METHODS: This prospective study was conducted over a 10-month period in a SICU. Postoperative delirium was diagnosed in accordance with the Intensive Care Delirium Screening Checklist (ICDSC). The primary outcome was mortality at 6-month follow-up. Hospital mortality and becoming dependent were considered as secondary outcomes, on the basis of the evaluation of the patient's ability to undertake both personal and instrumental activities of daily living (ADL) before surgery and 6 months after discharge from the SICU. For each dichotomous outcome - hospital mortality, mortality at 6-month follow-up, and becoming dependent - a separate multiple logistic regression analysis was performed, which included delirium as an independent variable. Another outcome analyzed was changes in health-related quality of life, as determined using short-form 36 (SF-36), which was administered before and 6 months after discharge from the SICU. Additionally, for each SF-36 domain, a separate multiple linear regression model was used for each SF-36 domain, with changes in the SF-36 domain as a dependent variable and delirium as an independent variable. RESULTS: Of 775 SICU-admitted adults, 562 were enrolled in the study, of which 89 (16%) experienced postoperative delirium. Delirium was an independent risk factor for mortality at the 6-month follow-up (OR = 2.562, P <0.001) and also for hospital mortality (OR = 2.673, P <0.001). Delirium was also an independent risk factor for becoming dependent for personal ADL (P-ADL) after SICU discharge (OR = 2.188, P <0.046). Moreover, patients who experienced postoperative delirium showed a greater decline in SF-36 domains after discharge, particularly in physical function, vitality, and social function, as compared to patients without postoperative delirium. CONCLUSIONS: Postoperative delirium was an independent risk factor for 6-month follow-up mortality, hospital mortality, and becoming independent in P-ADL after SICU discharge. It was also significantly associated with a worsening in the quality of life after surgery.


Asunto(s)
Delirio/epidemiología , Unidades de Cuidados Intensivos , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Cuidados Críticos , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Estudios Prospectivos , Factores de Riesgo , Resultado del Tratamiento
14.
Rev Port Cardiol ; 32(9): 665-71, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24011864

RESUMEN

BACKGROUND: Postoperative delirium (POD) is a frequent post-surgical complication that is associated with increased mortality and poor patient outcomes. POD is a complex disorder with multiple risk factors such as pre-existing patient comorbidities and perioperative complications. The aim of this study was to evaluate the incidence of POD and to identify risk factors for the development of POD in a post-anesthesia care unit (PACU). METHODS: We enrolled 97 adult patients admitted to a PACU over a five-day period (start date September 6, 2010). Patient demographics and intraoperative and postoperative data were collected. Patients were followed for the development of delirium using the Intensive Care Delirium Screening Checklist. Descriptive analyses of variables were used to summarize data, and the Mann-Whitney U test was used to compare continuous variables; the chi-square or Fisher's exact test was used for comparisons. Univariate analysis was performed using simple binary logistic regression with odds ratios (OR) and 95% confidence intervals (95% CI). The significance level for multiple comparisons was controlled by applying the Bonferroni correction for multiple comparisons and variables were deemed significant if p≤0.0025. RESULTS: Six percent of patients developed POD. These patients were older and more likely to have higher American Society of Anesthesiologists (ASA) physical status (83 vs. 22% with ASA III/IV, p=0.004) as well as a higher frequency of congestive heart failure (50 vs. 3%, p=0.003) and a higher Revised Cardiac Risk Index (RCRI) score (33 vs. 6% with RCRI ≥2, p=0.039). The duration of anesthesia for patients with POD was also longer and they received a greater volume of crystalloids, colloids, and erythrocytes during surgery. Congestive heart disease was an independent risk factor for POD (OR 29.3, 95% CI 4.1-210.6; p<0.001). In addition, patients who developed POD had higher in-hospital mortality and longer PACU and hospital stays. CONCLUSIONS: Patients who developed POD had longer hospital and PACU stays and higher in-hospital mortality. Congestive heart disease was considered an independent risk factor for POD.


Asunto(s)
Delirio/etiología , Insuficiencia Cardíaca/complicaciones , Complicaciones Posoperatorias/etiología , Anciano , Delirio/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo
15.
BMC Anesthesiol ; 13: 4, 2013 Feb 02.
Artículo en Inglés | MEDLINE | ID: mdl-23374538

RESUMEN

BACKGROUND: Most studies that follow up hepatectomy cases are limited in scope to an investigation of mortality and morbidity rates or the costs and length of hospital stay. In this study the authors aimed to characterize the quality of life and to evaluate mortality and its determinants after hepatectomy. METHODS: This prospective study was carried in a Post-Anaesthesia Care Unit (PACU) over 15 months, and 70 patients submitted to hepatectomy were enrolled. Demographic and peri-operative characteristics were evaluated for associations with mortality. At admission and 6 months after discharge, patients completed a Short Form-36 questionnaire (SF-36) and have their independence in Activities of Daily Living (ADL) was evaluated. Binary and multiple logistic regression analyses were used to evaluate of associations with mortality, and the Wilcoxon signed rank test was used to compare SF-36 scores before and after 6 months after hepatectomy. RESULTS: The mortality rate was 19% at 6 months. Multivariate analysis identified postoperative delirium as an independent determinant for mortality. Six months after discharge, 46% patients stated that their health in general was better or much better than that 1 year previously. Six months after hepatectomy, patients had worse scores in the physical function domain of SF-36; however, scores for all the other domains did not differ. At this time point, patients were more dependent in instrumental ADL than before surgery (32% versus 7%, p = 0.027). CONCLUSION: This study identified postoperative delirium as an independent risk factor for mortality 6 months after hepatectomy. After 6 months, survivors were more dependent in instrumental ADL tasks and had worse scores in the physical function domain of SF-36.

16.
Rev. bras. anestesiol ; 62(4): 476-483, jul.-ago. 2012. tab
Artículo en Portugués | LILACS | ID: lil-643842

RESUMEN

JUSTIFICATIVA E OBJETIVOS: O delirium pós-operatório (DPO) em pacientes cirúrgicos em terapia intensiva é um resultado independente importante e determinante. O objetivo do nosso estudo foi avaliar a incidência e os determinantes do DPO. MÉTODOS: Estudo prospectivo de coorte realizado durante um período de 10 meses em uma unidade de recuperação pós-anestesia (URPA) com cinco leitos especializados em terapia intensiva. Todos os consecutivos pacientes adultos submetidos à cirurgia de grande porte foram incluídos. Os dados demográficos, as variáveis perioperatórias, o tempo de internação (TI) e a mortalidade na URPA, no hospital e nos 6 meses de acompanhamento foram registrados. Delirium pós-operatório foi avaliado utilizando o Checklist para triagem de delirium em terapia intensiva (Intensive Care Delirium Screening Checklist - ICDSC). Análises descritivas foram realizadas e o teste de Mann-Whitney, qui-quadrado ou teste exato de Fisher foram usados para comparações. Análise de regressão logística avaliou os fatores determinantes do DPO com o cálculo da razão de chances (RC) e seu intervalo de confiança de 95% (IC 95%). RESULTADOS: Houve admissão de 775 pacientes adultos na URPA e 95 pacientes não atenderam aos critérios de inclusão. Dos 680 pacientes restantes, 128 (18,8%) desenvolveram DPO. Os determinantes independentes de DPO identificados foram a idade, ASA-PS, cirurgia de emergência e a quantidade total de plasma fresco congelado (PFC) administrada durante a cirurgia. Os pacientes com delirium tiveram taxas mais elevadas de mortalidade, estavam mais gravemente doente e permaneceram mais tempo na URPA e no hospital. DPO foi um fator de risco independente para mortalidade hospitalar. DISCUSSÃO: A incidência de delirium foi elevada nos pacientes cirúrgicos em terapia intensiva. DPO foi associado a uma pior pontuação de gravidade da doença, tempo de permanencia mais longo no hospital e na URPA e a taxas mais elevadas de mortalidade. Os fatores de risco independentes para DPO foram a idade, ASA-PS, cirurgia de emergência e quantidade de plasma administrado durante a cirurgia.


BACKGROUND AND OBJECTIVES: Postoperative delirium (POD) in Surgical Intensive Care patients is an important independent outcome determinant. The purpose of our study was to evaluate the incidence and determinants of POD. METHODS: Prospective cohort study conducted during a period of 10 months in a Post-Anesthesia Care Unit (PACU) with five intensive care beds. All consecutive adult patients submitted to major surgery were enrolled. Demographic data, perioperative variables, length of stay (LOS) and the mortality at PACU, hospital and at 6-months follow-up were recorded. Postoperative delirium was evaluated using the Intensive Care Delirium Screening Checklist (ICDSC). Descriptive analyses were conducted and the Mann-Whitney test, Chi-square test or Fisher's exact test were used for comparisons. Logistic regression analysis evaluated the determinants of POD with calculation of odds ratio (OR) and its confidence interval 95% (95% CI). RESULTS: There were 775 adult PACU admissions and 95 patients had exclusion criteria. Of the remaining 680 patients, 128 (18.8%) developed POD. Independent determinants of POD identified were age, ASA-PS, emergency surgery and total amount of fresh frozen plasma administered during surgery. Patients with delirium had higher mortality rates, were more severely ill and stayed longer at the PACU and in the hospital. POD was an independent risk factor for hospital mortality DISCUSSION: There was a high incidence of delirium had a high incidence in intensive care surgical patients. POD was associated with worse severity of disease scores, longer LOS in hospital, and in PACU and higher mortality rates. The independent risk factors for POD were age, ASA-PS, emergency surgery and the amount of plasma administered during surgery.


JUSTIFICATIVA Y OBJETIVOS: El delirio postoperatorio (DPO) en pacientes quirúrgicos en cuidados intensivos es un resultado independiente y un importante determinante. El objetivo de nuestro estudio fue evaluar la incidencia y los determinantes del DPO. MÉTODOS: Estudio prospectivo de cohorte realizado durante un período de 10 meses en una unidad de recuperación de postanestesia (URPA) con cinco camas especializadas en cuidados intensivos. Todos los pacientes adultos consecutivos que fueron sometidos a cirugía mayor fueron incluidos. Los datos demográficos, las variables perioperatorias, el tiempo de ingreso (TI) y la mortalidad en la URPA en el hospital y en los 6 meses de seguimiento quedaron registrados. El delirio postoperatorio se evaluó utilizando el Checklist para la selección de delirio en cuidados intensivos (Intensive Care Delirium Screening Checklist - ICDSC). Los análisis descriptivos fueron realizados y el test de Mann-Whitney, Xi-Cuadrado (Xi²) y el test exacto de Fisher fueron usados para las comparaciones. El análisis de regresión logística evaluó los factores determinantes del DPO con el cálculo de la razón de chances (RC) y su intervalo de confianza de 95% (IC 95%). RESULTADOS: La admisión fue de 775 pacientes adultos en la URPA y 95 pacientes no respetaron los criterios de inclusión. De los 680 pacientes restantes, 128 (18,8%) desarrollaron DPO. Los determinantes independientes de DPO identificados fueron la edad, ASA-PS, cirugía de emergencia y la cantidad total de plasma fresco congelado (PFC) administrado durante la cirugía. Los pacientes con delirio tuvieron tasas más elevadas de mortalidad, estaban más gravemente enfermos y permanecieron más tiempo en la URPA y en el hospital. El DPO fue un factor de riesgo independiente para la mortalidad hospitalaria. DISCUSIÓN: La incidencia de delirio fue elevada en los pacientes quirúrgicos en cuidados intensivos. El DPO estuvo asociado con una peor puntuación de gravedad de la enfermedad, tiempo de permanencia más largo en el hospital y en la URPA y tasas más elevadas de mortalidad. Los factores de riesgo independientes para DPO fueron la edad, ASA-PS, cirugía de emergencia y cantidad de plasma administrado durante la cirugía.


Asunto(s)
Humanos , Complicaciones Posoperatorias/epidemiología , Periodo de Recuperación de la Anestesia , Cuidados Críticos/estadística & datos numéricos , Estudios Prospectivos , Factores de Riesgo , Estudios de Cohortes
17.
Rev Bras Anestesiol ; 62(4): 469-83, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22793963

RESUMEN

BACKGROUND AND OBJECTIVES: Postoperative delirium (POD) in Surgical Intensive Care patients is an important independent outcome determinant. The purpose of our study was to evaluate the incidence and determinants of POD. METHODS: Prospective cohort study conducted during a period of 10 months in a Post-Anesthesia Care Unit (PACU) with five intensive care beds. All consecutive adult patients submitted to major surgery were enrolled. Demographic data, perioperative variables, length of stay (LOS) and the mortality at PACU, hospital and at 6-months follow-up were recorded. Postoperative delirium was evaluated using the Intensive Care Delirium Screening Checklist (ICDSC). Descriptive analyses were conducted and the Mann-Whitney test, Chi-square test or Fisher's exact test were used for comparisons. Logistic regression analysis evaluated the determinants of POD with calculation of odds ratio (OR) and its confidence interval 95% (95% CI). RESULTS: There were 775 adult PACU admissions and 95 patients had exclusion criteria. Of the remaining 680 patients, 128 (18.8%) developed POD. Independent determinants of POD identified were age, ASA-PS, emergency surgery and total amount of fresh frozen plasma administered during surgery. Patients with delirium had higher mortality rates, were more severely ill and stayed longer at the PACU and in the hospital. POD was an independent risk factor for hospital mortality DISCUSSION: There was a high incidence of delirium had a high incidence in intensive care surgical patients. POD was associated with worse severity of disease scores, longer LOS in hospital, and in PACU and higher mortality rates. The independent risk factors for POD were age, ASAPS, emergency surgery and the amount of plasma administered during surgery.


Asunto(s)
Cuidados Críticos , Delirio/epidemiología , Complicaciones Posoperatorias/epidemiología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo
18.
Rev cienc méd pinar río ; 16(2)abr. 2012.
Artículo en Español | CUMED | ID: cum-50427

RESUMEN

La formación de valores es un constante propósito de la acción pedagógica. Cada día resulta menos necesario insistir entre los educadores en la necesidad de educar en determinados valores, lo que no resulta igualmente claro es cómo lograrlo y qué métodos o estrategias didácticas deben ser empleadas en la llamada educación en valores. El objetivo de este trabajo fue la elaboración de un sistema de tareas para la formación del valor responsabilidad a través de la asignatura de idioma Inglés con propósitos específicos en los estudiantes de cuarto año de Medicina de la Universidad de Ciencias Médicas de Pinar del Río. Para abordar el objeto de estudio se usaron métodos teóricos como el histórico-lógico, análisis-síntesis e inducción-deducción. Como método empírico se usó la encuesta para constatar el impacto social del sistema de tareas propuesto en este trabajo. Se encuestó a 25 docentes y 8 directivos vinculados al proceso de enseñanza-aprendizaje del idioma Inglés los cuales expresaron que el sistema de tareas desarrollado para la formación del valor responsabilidad en los alumnos es funcional, novedoso, muy apropiado y práctico para conducir el proceso de enseñanza-aprendizaje(AU)


The formation of moral values is a permanent aim of the pedagogical action. Nowadays it is less necessary insisting among the educators on the need of teaching certain moral values, which is not yet clear, is the fact of how to accomplish it, and the didactic methods or strategies that must be used in the so called moral values-based education. This research paper was aimed at building a system of teaching tasks to develop the sense of responsibility as a moral value through the subject of English language for specific purposes in fourth academic year of medical studies at the Medical Science University in Pinar del Rio. To deal with the object of study, theoretical methods such as: historical-logical, analysis-synthesis and induction-deduction were applied. The survey was used as an empirical method to establish the social impact of the system of teaching tasks subjected on this research paper. Twenty five (25) professors and 8 directors within the teaching-learning process of the English language expressed that, the system of teaching tasks to the formation of the moral value of responsibility in medical students is efficient, original, appropriate and convenient to accomplish teaching-learning process(AU)


Asunto(s)
Humanos , Valores Sociales , Enseñanza
19.
Rev. cienc. med. Pinar Rio ; 16(2): 199-210, mar.-abr. 2012.
Artículo en Español | LILACS | ID: lil-739786

RESUMEN

La formación de valores es un constante propósito de la acción pedagógica. Cada día resulta menos necesario insistir entre los educadores en la necesidad de educar en determinados valores, lo que no resulta igualmente claro es cómo lograrlo y qué métodos o estrategias didácticas deben ser empleadas en la llamada educación en valores. El objetivo de este trabajo fue la elaboración de un sistema de tareas para la formación del valor responsabilidad a través de la asignatura de idioma Inglés con propósitos específicos en los estudiantes de cuarto año de Medicina de la Universidad de Ciencias Médicas de Pinar del Río. Para abordar el objeto de estudio se usaron métodos teóricos como el histórico-lógico, análisis-síntesis e inducción-deducción. Como método empírico se usó la encuesta para constatar el impacto social del sistema de tareas propuesto en este trabajo. Se encuestó a 25 docentes y 8 directivos vinculados al proceso de enseñanza-aprendizaje del idioma Inglés los cuales expresaron que el sistema de tareas desarrollado para la formación del valor responsabilidad en los alumnos es funcional, novedoso, muy apropiado y práctico para conducir el proceso de enseñanza-aprendizaje.


The formation of moral values is a permanent aim of the pedagogical action. Nowadays it is less necessary insisting among the educators on the need of teaching certain moral values, which is not yet clear, is the fact of how to accomplish it, and the didactic methods or strategies that must be used in the so called "moral values-based education". This research paper was aimed at building a system of teaching tasks to develop the sense of responsibility as a moral value through the subject of English language for specific purposes in fourth academic year of medical studies at the Medical Science University in Pinar del Rio. To deal with the object of study, theoretical methods such as: historical-logical, analysis-synthesis and induction-deduction were applied. The survey was used as an empirical method to establish the social impact of the system of teaching tasks subjected on this research paper. Twenty five (25) professors and 8 directors within the teaching-learning process of the English language expressed that, the system of teaching tasks to the formation of the moral value of responsibility in medical students is efficient, original, appropriate and convenient to accomplish teaching-learning process.

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