One-pot chemo- and photo-enzymatic linear cascade processes.

The combination of chemo- and photocatalyses with biocatalysis, which couples the flexible reactivity of the photo- and chemocatalysts with the highly selective and environmentally friendly nature of enzymes in one-pot linear cascades, represents a powerful tool in organic synthesis. However, the combination of photo-, chemo- and biocatalysts in one-pot is challenging because the optimal operating conditions of the involved catalyst types may be rather different, and the different stabilities of catalysts and their mutual deactivation are additional problems often encountered in one-pot cascade processes. This review explores a large number of transformations and approaches adopted for combining enzymes and chemo- and photocatalytic processes in a successful way to achieve valuable chemicals and valorisation of biomass. Moreover, the strategies for solving incompatibility issues in chemo-enzymatic reactions are analysed, introducing recent examples of the application of non-conventional solvents, enzyme-metal hybrid catalysts, and spatial compartmentalization strategies to implement chemo-enzymatic cascade processes.

[Bringing clinical simulation into anesthesiology and postoperative recovery care residency training]. / Integración de la simulación clínica en el programa formativo de la especialidad de anestesiología y reanimación.

This article describes the use of clinical simulations for training residents in anesthesiology and postoperative recovery care at Hospital Universitario Marqués de Valdecilla. A working group defined criteria for the competencies residents would acquire by means of simulation training, designed the scenarios to be used, and took responsibility for coordinating and funding the program. We used the platform of the Critical Events Training Center of the Marcelino Botin Foundation, now part of our center's virtual hospital. The simulation-based training modules include 4 activities in the residents' first year, 3 in each of the second and third years, and 4 in the fourth year; all center on acquisition of the identified competencies and take into consideration the time availability of residents and instructors and the budget. We have concluded that integrating clinical simulations into residency training is a challenge for educators, given that a large part of the benefit derived from this tool comes from complementing it with other instructional resources and adapting it to the syllabus. More studies are required to establish criteria to guide the integration of this tool into the curriculum in those areas of the specialty where it can work most efficiently; the effectiveness of the approach also needs to be assessed. Simulations facilitate training without putting patients at risk and provide residents with early exposure to situations that might otherwise be difficult to observe. This tool also encourages the practice of reflective clinical decision-making.

Epidural analgesia for post-caesarean pain relief: a comparison between morphine and fentanyl.

In 20 post-operative patients who had undergone caesarean section, morphine 2 mg or fentanyl 75 micrograms in 0.9% saline were given epidurally in a randomized study, to compare their effectiveness in providing post-operative pain relief and the incidence of untoward reaction. There was a faster onset of action (P less than 0.01) and the quality of pain relief was substantially better after epidural fentanyl (P less than 0.01). However, the duration of action was markedly longer after epidural morphine (P less than 0.01). There was a significantly greater incidence of urinary retention after morphine administration (P less than 0.05). It is suggested that fentanyl gives better relief of pain than morphine when given epidurally.