Rol de la enfermera en el cuidado al final de la vida del paciente crítico / The role of the nurse at the end of the life of a critically ill patient

Objetivo: Analizar el rol de la enfermera en el cuidado al final de la vida del paciente crítico. Método: Revisión bibliográfica a partir de la búsqueda en bases de datos de ciencias de la salud: PubMed, CINAHL, Cuiden, Scopus, Cochrane Plus, y en plataformas especializadas, buscadores generales y temáticos. Los límites establecidos fueron el idioma (español e inglés) y la fecha de publicación (2005-2015). Resultados: Ciento ochenta artículos cumplieron los criterios de inclusión, seleccionándose 16 para su análisis. Los principales resultados se agruparon en tres categorías de análisis: el cuidado directo al paciente, la atención centrada en la familia y el rol dentro del equipo multidisciplinar. Conclusiones: Los roles descritos sitúan a la enfermera como un elemento clave para humanizar la muerte en las UCI, por ello las enfermeras pueden y deben liderar el cambio desempeñando un papel activo en la creación de estrategias que hagan realidad la integración del enfoque de cuidados paliativos en las UCI

Objective: Analyze the role of the nurse at the end of the life of a critically ill patient. Method: Bibliographic review from a search of the health science databases such as PubMed, CINAHL, Cuiden, Scopus, Cochrane, as well as specialized platforms, general and thematic browsers. The limits were language (English or Spanish) and publication date (2005-2015). Results: 180 articles met the inclusion criteria, and 16 of them were selected for analysis. The main results were grouped into three categories of analysis: direct patient care, family-focussed care and the nurse's role within the team. Conclusions: the described roles place the nurse as a key element in humanising death in the ICU and so nurses can and must lead change, playing an active role in creating strategies that really promote the integration of a palliative care approach in ICU

The role of the nurse at the end of the life of a critically ill patient. / Rol de la enfermera en el cuidado al final de la vida del paciente crítico.

OBJECTIVE: Analyze the role of the nurse at the end of the life of a critically ill patient. METHOD: Bibliographic review from a search of the health science databases such as PubMed, CINAHL, Cuiden, Scopus, Cochrane, as well as specialized platforms, general and thematic browsers. The limits were language (English or Spanish) and publication date (2005-2015). RESULTS: 180 articles met the inclusion criteria, and 16 of them were selected for analysis. The main results were grouped into three categories of analysis: direct patient care, family-focussed care and the nurse's role within the team. CONCLUSIONS: the described roles place the nurse as a key element in humanising death in the ICU and so nurses can and must lead change, playing an active role in creating strategies that really promote the integration of a palliative care approach in ICU.

Vibration-induced compaction of granular suspensions.

We investigate the compaction dynamics of vibrated granular suspensions using both digital imaging technique and MRI measurements. Starting from initialy loose packings, our experimental data suggest the existence of two stages in the compaction dynamics: a fast stage at short times where a rising compaction front propagates through the granular suspension and a slow stage at large times where the packing compacts slowly and homogeneously. The compaction dynamics in each stage can be well fitted to usual stretched exponential laws with stretching exponents equal to 2 and 0.45, respectively. The transition time between these two stages, τ c , depends on the fluid viscosity, vibration intensity and grain diameter. We show that τ c (-1) and the velocity of the front decrease roughly linearly with the lubrication Peclet number, Pe lub related to the competition between the lubrication stress induced by vibrations and the granular pressure.

Vibration-induced liquefaction of granular suspensions.

We investigate the mechanical behavior of granular suspensions subjected to coupled vibrations and shear. At high shear stress, whatever the mechanical vibration energy and bead size, the system behaves like a homogeneous suspension of hard spheres. At low shear stress, in addition to a dependence on bead size, vibration energy drastically influences the viscosity of the material that can decrease by more than 2 orders of magnitude. All experiments can be rationalized by introducing a hydrodynamical Peclet number defined as the ratio between the lubrication stress induced by vibrations and granular pressure. The behavior of vibrated wet and dry granular materials can then be unified by assimilating the hookean stress in dry media to the lubrication stress in suspensions.

Light-responsiveness of C12E6/polymer complexes swollen with dodecane.

The association behavior of light-responsive azobenzene modified poly(sodium acrylate)s (AMPs) with C(12)E(6) (hexa-oxyethyleneglycol n-dodecyl ether) surfactant micelles swollen with dodecane was investigated using dynamic light scattering, UV spectrophotometry, and capillary electrophoresis techniques. AMPs complexes with oligoethyleneglycol n-alkyl ether show promising properties as emulsifiers for the light-triggered control of inversion of emulsions and the present work aims at giving new insights with respect to the nature of their photoresponse. Depending on the dodecane amount, the size of the spherical surfactant micelles was varied with radii ranging from 4 to 8 nm. AMPs can be viewed as long PAANa chains bearing several randomly distributed azobenzene groups. First, the binding behavior of the AMPs chains to the micelles swollen with various amounts of oil was thoroughly studied under dark-adapted conditions, which means that most azobenzene groups are in their trans conformation (less polar than the cis conformation obtained under UV irradiation). The binding of azobenzene to surfactant micelles, which leads to the formation of AMPs/surfactant complexes, is controlled by the energy of transfer of the azobenzene moiety from water to the micelle core and by the energy of loops formation since multiple attachments of azobenzene to a single micelle are expected with long AMPs chains. We show that the change in the energy of transfer of the azobenzene group between water and micelles upon increasing the amount of dodecane within the core of micelles was quite weak (not exceeding 0.7 kT). Within the investigated range of curvature, we observed that the energy of loops formation, which decreases with increasing micelle size (decrease of curvature or increase of oil amount) was similarly weak. The effect of the presence of dodecane on the photoresponse of the complex formation was investigated. It is shown that exposure to UV light markedly weakens the association of the AMPs with surfactant within a domain of surfactant concentrations much larger for swollen micelles than for pure surfactant micelles. Consequently, we suggest that emulsion inversion triggered by light could be due to the photomodulation of the binding of AMPs to colloidal objects with various and/or specific curvatures including surfactant mesophases or small size emulsion droplets.

Imaging of femoroacetabular impingement: pictorial review.

Femoroacetabular impingement (FAI) is a cause of progressive osteoarthritis of the hip in younger patients. Three types of FAI have been described: a cam-type, a pincer-type and a mixed type. Early recognition of the morphologic hip features of each type of impingement is important, because arthroscopic treatment is still successful in the initial stage to prevent or delay further hip degeneration. This article reviews the imaging features of the different types of FAI. Magnetic resonance arthrography (MRA) is the preferred modality to detect, localise and characterise the type of FAI and the resulting injuries of the acetabular hyaline cartilage and fibrocartilaginous labrum.

Comparison of low-dose with standard-dose multidetector CT in cervical spine trauma.

BACKGROUND AND PURPOSE: The purpose of this work was to evaluate the possible use of low-dose multidetector CT (MDCT) in cervical clearance of patients with blunt trauma. MATERIALS AND METHODS: A total of 191 patients underwent cervical spine MDCT with 6- and 16-MDCT: standard-dose (n = 51) and low-dose MDCT with tube current modulation at high (n = 70) and low (n = 70) tube voltage (kilovolts). Effective dose, image noise, and subjective image quality were calculated in all of the patients. RESULTS: MDCT found 18 patients (9.4%) with a cervical spine fracture, 3 in the standard-dose and 15 in the low-dose group, 14 of them with unstable lesions. Tube current modulation reduced the dose by 50%-61% in all of the low-dose examinations. The mean effective dose was 3.75, 1.57, and 1.08 mSv, and mean image noise was 14.82, 17.46, and 19.72 Hounsfield units for standard dose and low dose with high and low kilovolt examinations, respectively. These differences in mean effective dose and image noise were significant between the 3 examination groups (Kruskal-Wallis test: P < .0001 and P = .0001). Evaluation of subjective image quality by 2 radiologists and 2 residents showed no significant difference in image quality score among the 3 examination groups (Kruskal-Wallis tests, P = .61, .32, .18, and .31). All of the reviewers correctly detected 18 fractures, except 1 resident, who missed 3 fractures. CONCLUSION: Low-dose cervical spine MDCT in patients with blunt trauma gives a substantial dose reduction of 61%-71%, compared with standard-dose MDCT, with a small increase in image noise and without difference in subjective image quality evaluation.

Phase behavior and rheological properties of enzymatically synthesized trehalose decanoate aqueous solutions.

Surface tension properties of an enzymatically synthesized equimolar mixture of trehalose mono- and didecanoate in aqueous solutions have been determined. At 20 degrees C a critical micellar concentration (CMC) of 50 micromol/l and a minimal surface tension of 28 mN/m have been obtained. Above the CMC, it has been shown that up to a concentration of 42 wt%, and in a 20-60 degrees C temperature range the sugar ester aqueous solutions do not form any crystalline structure, nor present any phase transition, and the trehalose decanoate molecules form an isotropic worm-like micellar phase. The rheological properties indicate however a more complicated picture in the same concentration and temperature ranges. In steady shear, the viscosity of the trehalose decanoate solutions do not exhibit any shear rate dependence from 1 to 100 s(-1) for concentrations up to 42 wt%. Below 0.8 wt%, the viscosity remains constant and close to that of water; then, between 0.8 and 23 wt%, the viscosity shows a quadratic increase with surfactant concentration. For higher concentrations, up to 42 wt%, no further significant increase in viscosity is observed. In oscillatory shear experiments, the solutions exhibit viscoelastic properties. The observed rheological behavior as a function of concentration and temperature may be due to a progressive evolution of the trehalose decanoate molecular associations: as the concentration increases, the system evolves towards an entangled and/or partially branched or cross-linked micellar network, and eventually a multiconnected network of cross-linked micelles.

Head and neck squamous cell carcinoma transcriptome analysis by comprehensive validated differential display.

Head and neck squamous cell carcinoma (HNSCC) is common worldwide and is associated with a poor rate of survival. Identification of new markers and therapeutic targets, and understanding the complex transformation process, will require a comprehensive description of genome expression, that can only be achieved by combining different methodologies. We report here the HNSCC transcriptome that was determined by exhaustive differential display (DD) analysis coupled with validation by different methods on the same patient samples. The resulting 820 nonredundant sequences were analysed by high throughput bioinformatics analysis. Human proteins were identified for 73% (596) of the DD sequences. A large proportion (>50%) of the remaining unassigned sequences match ESTs (expressed sequence tags) from human tumours. For the functionally annotated proteins, there is significant enrichment for relevant biological processes, including cell motility, protein biosynthesis, stress and immune responses, cell death, cell cycle, cell proliferation and/or maintenance and transport. Three of the novel proteins (TMEM16A, PHLDB2 and ARHGAP21) were analysed further to show that they have the potential to be developed as therapeutic targets.

Physical alginate hydrogels based on hydrophobic or dual hydrophobic/ionic interactions: bead formation, structure, and stability.

Hydrophobically associating alginate (AA) derivatives were prepared by covalent fixation of dodecyl or octadecyl chains onto the polysaccharide backbone (AA-C12/AA-C18). In semidilute solution, intermolecular hydrophobic interactions result in the formation of physical hydrogels, the physicochemical properties of which can be controlled through polymer concentration, hydrophobic chain content, and nonchaotropic salts such as sodium chloride. The mechanical properties of these hydrogels can then be reinforced by the addition of calcium chloride. The combination of both calcium bridges and intermolecular hydrophobic interactions leads to a decrease in the swelling ratio accompanied by an increase of elastic and viscous moduli. Beads made of hydrophobically modified alginate were obtained by dropping an aqueous solution of alginate derivative into a NaCl/CaCl2 solution. As compared to unmodified alginate beads, modified alginate particles proved to be stable in the presence of nongelling cations or calcium-sequestering agents. However, evidence is presented for a more heterogeneous structure than that of plain calcium alginate hydrogels with, in particular, an increase in the effective gel mesh size, as determined by partition and diffusion coefficient measurements.

Differential expression profiling of head and neck squamous cell carcinoma (HNSCC).

Head and neck squamous cell carcinoma (HNSCC) is the fifth most common cancer in men with an incidence of about 780000 new cases per year worldwide and a poor rate of survival. There is a need for a better understanding of HNSCC, for the development of rational targeted interventions and to define new prognostic or diagnostic markers. To address these needs, we performed a large-scale differential display comparison of hypopharyngeal HNSCCs against histologically normal tissue from the same patients. We have identified 70 genes that exhibit a striking difference in expression between tumours and normal tissues. There is only a limited overlap with other HNSCC gene expression studies that have used other techniques and more heterogeneous tumour samples. Our results provide new insights into the understanding of HNSCC. At the genome level, a series of differentially expressed genes cluster at 12p12-13 and 1q21, two hotspots of genome disruption. The known genes share functional relationships in keratinocyte differentiation, angiogenesis, immunology, detoxification, and cell surface receptors. Of particular interest are the 13 'unknown' genes that exist only in EST, theoretical cDNA and protein databases, or as chromosomal locations. The differentially expressed genes that we have identified are potential new markers and therapeutic targets.

Amphiphilic derivatives of sodium alginate and hyaluronate for cartilage repair: rheological properties.

Various amphiphilic derivatives of sodium alginate and hyaluronate were prepared by covalent fixation of long alkyl chains (dodecyl and octadecyl) with various ratios on the polysaccharide backbones via ester functions. In the semidilute regime, aqueous solutions of the resulting compounds exhibited the typical rheological properties of hydrophobically associating polymers: tremendous enhancement of zero shear rate Newtonian viscosity, steep shear-thinning behavior, and formation of physically cross-linked gel-like networks. The influence of the alkyl chain length, its content on the polysaccharide and of the polymer concentration in the solution was well identified. All obtained results are discussed with respect to the schedule of conditions related to materials, which could be used for cartilage repair, such as in synovial fluid viscosupplementation as well as in cartilage replacement. In particular, it is seen that HA-C(12)-5 (hyaluronate substituted with 5% of dodecyl chains) and HA-C(18)-1 (hyaluronate substituted with 1% of octadecyl chains) in a 0.15N NaCl solution at 8 g/L have rheological properties quite similar to those of healthy synovial fluid. On the other hand, the rheological parameters of solutions at 8 g/L in 0.15N NaCl of some of derivatives, such as, for example, AA-C(12)-8 (alginate substituted with 8% of dodecyl chains) or HA-C(18)-2, are well fitted for a use in cartilage repair.

Streptococcus salivarius acute meningitis with latent petromastoiditis.

A 48-y-old woman, with a previous history of neurosurgical intervention for a trigeminal neurinoma, presented with acute meningitis due to Streptococcus salivarius. There were significant changes in the petrous region, as revealed by MRI, leading to the diagnosis of associated latent subacute mastoiditis.

1H nuclear magnetic resonance relaxometric characterization of fat and water states in soft and hard cheese.

The aim of this work was to study the spin spin (T2) relaxation components of one hard cheese and three soft cheeses to characterize fat and water states. NMR signals were measured at 6 degrees C with a 0.47 T NMR device. The transverse relaxation decay was fitted using the Marquardt method. The T2 relaxometric behaviour of the cheeses under consideration was characterized by four relaxation components. To understand the chemical composition of each NMR component, we studied anhydrous milk fat extracted from each cheese analysed. At 6 degrees C, the fat was 60% crystalline. In cheese, the solid fat was found mainly in the shorter relaxation component with a T2 of 17 micros. The intensity of the NMR relaxation with a T2 > 1 ms was explained by the amount of water, liquid fat and proteins, and the associated relaxation time varied as a function of the process used. The composition of each relaxation component was confirmed by the temperature effect and the influence of the fat content on the NMR cheese signal. NMR relaxometry was able to provide information on water behaviour (i.e. the quantity and level of interactions with proteins) and on the solid:liquid ratio of anhydrous milk fat in the cheese.

Fatal Mycobacterium tuberculosis brain abscess in an immunocompetent patient.

A non-HIV-infected 63-y-old woman presented seizures and coma during the course of Mycobacterium tuberculosis infection. Computerized tomography scan led to the diagnosis of a large compressive brain abscess. The patient died with multiorgan failure. Systematic central nervous system investigations should be done in cases of disseminated tuberculosis.

Embryonic electronics.

Within the general domain of bio-inspired computing, a particular trend over the past few years has been that of constructing actual hardware devices that are inspired by nature. This paper describes one such project-Embryonics (embryonic electronics)-inspired in particular by the process of embryogenesis. Our ultimate objective is the construction of large-scale integrated circuits, exhibiting the properties of self-repair (healing) and self-replication, found until now only in living beings. We present the silicon-based artificial cell, followed by a description of mechanisms operating at the cellular level: cellular differentiation, cellular division, regeneration, and replication. We then present the cell's composition as an ensemble of lower-level elements, known as 'molecules'. As electronic chips grow evermore complex, the need for self-repair capabilities will become increasingly crucial. The Embryonics approach represents one possible way of confronting this pivotal problem.

Quality of pig adipose tissue: relationship between solid fat content and lipid composition.

The dependence of solid fat content at 20°C of adipose tissues on their fatty acid and triacylglycerol compositions was studied on lipids extracted from tissues from 166 pigs. The solid fat content (SFC20) was 20% on average but varied widely (9-35%). The SFC20 variability was closely related to the proportions of disaturated triacylglycerols and more specifically to palmitoyl-stearoyl-oleoyl-glycerol (R(2)=0.92). The SFC20 variability was also related to the proportions of the saturated fatty acids, palmitic and stearic acids (R(2)=0.94). The part of the variance of SFC20 explained by the proportion of polyunsaturated fatty acids was lower (R(2)=0.48). The iodine value showed a high correlation with SFC20 (R(2)=0.81) but carcass lean content was a poor indicator of the solid fat content of adipose tissues (R(2)=0.06).