Neurocognition and the Suicidal Process.

Early thinking about cognitive process and suicidal behaviors tended to focus on the immediate situation surrounding the individual - typically the underlying psychiatric condition that was seen as leading to his or her distress. However, we now know that the cognitive processes involved in a range of suicidal thoughts and behaviors can exert a significant impact on the expression or development of these behaviors, even without an environmental stressor or psychiatric condition. In this chapter, we summarize theoretical perspectives that led to this realization and explore the current understanding of the link between cognition and suicide from recent research and clinical findings. We present these findings first by psychiatric disorder, then by cognitive domains, and finally by specific suicidal construct in order to highlight the importance of these factors in determining the role of cognition in the suicidal process.Within and across psychiatric disorders, certain cognitive processes - negativistic thinking, impulsivity, cognitive rigidity, and altered emotional processing - are frequently found to be linked to suicidal thoughts and behaviors. Overall cognitive performance, decreased processing speed, executive dysfunction, and negative biases in memory and attention have also been linked to suicidal thoughts and behaviors. However, these findings do not hold true for all populations. There seems to be a role both for cognitive distortions (such as hopelessness) and neurocognitive deficits (such as poor overall cognitive performance, slower processing speed, and executive dysfunction) in the suicidal process, which warrant further exploration both separately and together.

Rehabilitation of sucking and swallowing alterations in premature newborn at the neonatal intensive care unit. / Rehabilitación de las alteraciones en la succión y deglución en recién nacidos prematuros de la unidad de cuidados intensivos neonatales

Over the last 20 years, 640 premature newborns with alterations in suction-deglution have been taken care of in the neonatal intensive care unit at the Hospital Infantil de México Federico Gómez, using techniques for patients with immaturity, and neurological, gastrointestinal, cardiologic and respiratory pathologies. This descriptive study includes the treatment employed mainly in premature newborns during this period. Suction, swallowing and breathing coordination are some of the most complex abilities that premature newborns face, due to their anatomofunctional immaturity and improper sensoriomotor integration for the high energy requirements they must meet. Sucking and swallowing are voluntary and involuntary processes that guarantee the safe passage of food from mouth to stomach, and require the coordination of the cranial nerves, the brain stem and cerebral cortex and muscles of the mouth, pharynx and esophagus. The rehabilitation treatment consists in the positioning of the newborn and caretaker, adaptation of teat, regulation of muscle tone and progressive intake of milk. The feeding processing was reduced to 1.5 weeks in newborns submitted to treatment, whereas in those who did not receive the treatment, the proccess took up to 3 weeks.

En 20 años se han atendido 640 recién nacidos prematuros (RNP) y recién nacidos a término con alteraciones en la coordinación de la succión-deglución en la unidad de cuidados intensivos neonatales del Hospital Infantil de México Federico Gómez, empleado técnicas de tratamiento para pacientes con inmadurez, patologías de tipo neurológico, gastrointestinal, cardiológico y respiratorio. El presente trabajo describe el tratamiento empleado principalmente en RNP durante este periodo. La coordinación de la succión-deglución-respiración es una de las habilidades más complejas a las que se enfrenta el RNP, debido a que presenta inmadurez anatomofuncional y una incorrecta integración sensoriomotriz para los altos requerimientos energéticos a los que debe someterse. La succión y la deglución son procesos voluntarios e involuntarios que garantizan el paso seguro de alimentos de la boca al estómago, y requieren la coordinación de algunos pares craneales, del tronco y la corteza cerebral, y de los músculos de la boca, la faringe y el esófago. El tratamiento de rehabilitación consiste en el posicionamiento del niño y el cuidador al momento de la alimentación, la regulación de la sensibilidad y el tono muscular perioral e intraoral, la coordinación lingual, el cierre labial, la regulación del flujo de leche, el control de la velocidad de las salvas y la adaptación de tetinas tanto para biberón como para seno materno. El procesamiento de la alimentación con el tratamiento se logró reducir a semana y media, mientras que en los RNP sin tratamiento este proceso llegó a tomar hasta 3 semanas.

Rehabilitación de las alteraciones en la succión y deglución en recién nacidos prematuros de la unidad de cuidados intensivos neonatales / Rehabilitation of sucking and swallowing alterations in premature newborn at the neonatal intensive care unit

Resumen En 20 años se han atendido 640 recién nacidos prematuros (RNP) y recién nacidos a término con alteraciones en la coordinación de la succión-deglución en la unidad de cuidados intensivos neonatales del Hospital Infantil de México Federico Gómez, empleado técnicas de tratamiento para pacientes con inmadurez, patologías de tipo neurológico, gastrointestinal, cardiológico y respiratorio. El presente trabajo describe el tratamiento empleado principalmente en RNP durante este periodo. La coordinación de la succión-deglución-respiración es una de las habilidades más complejas a las que se enfrenta el RNP, debido a que presenta inmadurez anatomofuncional y una incorrecta integración sensoriomotriz para los altos requerimientos energéticos a los que debe someterse. La succión y la deglución son procesos voluntarios e involuntarios que garantizan el paso seguro de alimentos de la boca al estómago, y requieren la coordinación de algunos pares craneales, del tronco y la corteza cerebral, y de los músculos de la boca, la faringe y el esófago. El tratamiento de rehabilitación consiste en el posicionamiento del niño y el cuidador al momento de la alimentación, la regulación de la sensibilidad y el tono muscular perioral e intraoral, la coordinación lingual, el cierre labial, la regulación del flujo de leche, el control de la velocidad de las salvas y la adaptación de tetinas tanto para biberón como para seno materno. El procesamiento de la alimentación con el tratamiento se logró reducir a semana y media, mientras que en los RNP sin tratamiento este proceso llegó a tomar hasta 3 semanas.

Abstract Over the last 20 years, 640 premature newborns with alterations in suction-deglution have been taken care of in the neonatal intensive care unit at the Hospital Infantil de México Federico Gómez, using techniques for patients with immaturity, and neurological, gastrointestinal, cardiologic and respiratory pathologies. This descriptive study includes the treatment employed mainly in premature newborns during this period. Suction, swallowing and breathing coordination are some of the most complex abilities that premature newborns face, due to their anatomofunctional immaturity and improper sensoriomotor integration for the high energy requirements they must meet. Sucking and swallowing are voluntary and involuntary processes that guarantee the safe passage of food from mouth to stomach, and require the coordination of the cranial nerves, the brain stem and cerebral cortex and muscles of the mouth, pharynx and esophagus. The rehabilitation treatment consists in the positioning of the newborn and caretaker, adaptation of teat, regulation of muscle tone and progressive intake of milk. The feeding processing was reduced to 1.5 weeks in newborns submitted to treatment, whereas in those who did not receive the treatment, the proccess took up to 3 weeks.

The radiologist's role in the management of papillary renal cell carcinoma. / Carcinoma papilar de células renales: el papel del radiólogo en su manejo.

Papillary carcinoma is the second most common renal cell carcinoma. It has a better prognosis than the more frequent clear cell carcinoma, although this does not hold true for advanced cases, because no specific treatment exists. It presents as a circumscribed peripheral tumor (small and homogeneously solid or larger and cystic/hemorrhagic) or as an infiltrating lesion that invades the veins, which has a worse prognosis. Due to their low vascular density, papillary renal cell carcinomas enhance less than other renal tumors, and this facilitates their characterization. On computed tomography, they might not enhance conclusively, and in these cases they are impossible to distinguish from hyperattenuating cysts. Contrast-enhanced ultrasonography and magnetic resonance imaging are more sensitive for detecting vascularization. Other characteristics include a specific vascular pattern, hypointensity on T2-weighted images, restricted water diffusion, and increased signal intensity in opposed phase images. We discuss the genetic, histologic, clinical, and radiological aspects of these tumors in which radiologists play a fundamental role in management.

p73 is required for endothelial cell differentiation, migration and the formation of vascular networks regulating VEGF and TGFß signaling.

Vasculogenesis, the establishment of the vascular plexus and angiogenesis, branching of new vessels from the preexisting vasculature, involves coordinated endothelial differentiation, proliferation and migration. Disturbances in these coordinated processes may accompany diseases such as cancer. We hypothesized that the p53 family member p73, which regulates cell differentiation in several contexts, may be important in vascular development. We demonstrate that p73 deficiency perturbed vascular development in the mouse retina, decreasing vascular branching, density and stability. Furthermore, p73 deficiency could affect non endothelial cells (ECs) resulting in reduced in vivo proangiogenic milieu. Moreover, p73 functional inhibition, as well as p73 deficiency, hindered vessel sprouting, tubulogenesis and the assembly of vascular structures in mouse embryonic stem cell and induced pluripotent stem cell cultures. Therefore, p73 is necessary for EC biology and vasculogenesis and, in particular, that DNp73 regulates EC migration and tube formation capacity by regulation of expression of pro-angiogenic factors such as transforming growth factor-ß and vascular endothelial growth factors. DNp73 expression is upregulated in the tumor environment, resulting in enhanced angiogenic potential of B16-F10 melanoma cells. Our results demonstrate, by the first time, that differential p73-isoform regulation is necessary for physiological vasculogenesis and angiogenesis and DNp73 overexpression becomes a positive advantage for tumor progression due to its pro-angiogenic capacity.

Cirugía mayor ambulatoria. Evaluación de pautas analgésicas postoperatorias agrupadas por procedimientos quirúrgicos / No disponible

Objetivos: Desde el inicio de la Cirugía Ambulatoria en nuestro hospital, se prescribió la analgesia estableciendo pautas agrupadas según procedimientos quirúrgicos. Se intentaba evitar la variabilidad, minimizar los errores de prescripción y detectar y subsanar posibles deficiencias de la analgesia postoperatoria de forma rápida y ágil. Material y método: Se evaluaron un total de 13.735 pacientes intervenidos en régimen ambulatorio entre los años 1999-2006, a los que se les aplicaron las pautas analgésicas establecidas. La recogida del grado de dolor medido según escala visual analógica (EVA) se realizó por grupos de analgesia establecidos, mediante encuesta telefónica a las 24 horas de la intervención. Resultados: Los resultados se analizaron por grupos de analgesia y de forma global relacionando este resultado con el índice de sustitución y con el grado de riesgo anestésico según la escala ASA y el índice de ingreso y reingresos por dolor. En todos los grupos hubo una disminución del grado de dolor, que inició una tendencia a aumentar en el año 2006, posiblemente debido a un aumento de complejidad en los procedimientos quirúrgicos. Ninguna de las pautas de analgesia superó el 25% de pacientes con dolor medido en la escala EVA superior a 3.Conclusiones: La aplicación de un protocolo de analgesia postoperatoria agrupada según niveles de dolor por procedimientos quirúrgicos, facilita el control del dolor postoperatorio y la posibilidad de modificar las pautas analgésicas de una forma rápida y ágil, adecuándolas a las necesidades de los pacientes de acuerdo con las patologías intervenidas (AU)

Objectives: From the start of our Ambulatory Surgical program at the Hospital de Mataró, postoperative analgesia was prescribed establishing grouped patterns according to surgical procedures. The purpose of this was to avoid variability, to minimize prescription errors and to detect and correct possible deficiencies of postoperative analgesia in a quick and dynamic way. Material and method: This evaluation was carried out between1999 and 2006 applying the established analgesic patterns to 13,735 patients in Ambulatory Surgery. The degree of pain measured by VAS (Visual Analog Scale)was evaluated according to the analgesic groups, using a telephone survey conducted within the first 24 hours after the procedure. Results: Results were analyzed according to the analgesic groups as well as globally, relating them to the substitution index and to the anaesthetic risk according to the ASA scale and also to the number of admissions and readmissions due to pain. There was a decrease in the grade of pain in all groups until2006 when a tendency to increase started, probably related to an increase in the complexity of surgical procedures. None of the analgesic patterns was over 25% of patients with a pain level measured by VAS of more than 3.Conclusions: The implementation of a protocol for postoperative analgesia grouped, according to levels of pain, by surgical procedures, helps in the control of postoperative pain and allows the possibility of changing analgesic patterns in a fast and easy way, adapting them to the needs of patients according to the procedures (AU)

Antiaggressive effects of topiramate in agonistic encounters between male mice.

Topiramate, an antiepileptic drug, has been found to be useful for the treatment of aggression in clinical populations. However, no studies have explored the action of this compound on aggressive behavior in laboratory animals. This work examined the effects of topiramate (10, 20, 40 and 80 mg/kg, i.p.) on agonistic interactions between male mice, using an ethopharmacological approach. Individually housed mice were exposed to anosmic "standard opponents" 30 min after drug administration. Ten minutes of diadic interactions were staged between a singly housed and an anosmic mouse in a neutral area. The encounters were videotaped and the accumulated time allocated by subjects to 10 broad behavioral categories was estimated using an ethologically based analysis. Results showed that topiramate (20-80 mg/kg) produced a significant reduction of offensive behaviors (threat and attack), without affecting immobility. Digging behavior (all doses) was also significantly decreased. The antiaggressive effects of topiramate could be related to its ability for modulating positively GABA-A receptors and/or blocking AMPA subtype of glutamate receptors.

[What do patients think about anesthesia? Survey on postoperative satisfaction in ambulatory surgery comparing general and subarachnoid anesthesia]. / Qué piensan los pacientes de la anestesia? Encuesta de satisfacción postoperatoria en cirugía ambulatoria comparando anestesia general y subaracnoidea.

OBJECTIVES: To conduct a telephone survey to determine the degree of patient satisfaction with the anesthetic technique applied during outpatient arthroscopic surgery on the knee. MATERIAL AND METHODS: We recorded refusals to respond to the survey and the reasons. The patients were distributed randomly in 3 groups to receive 1) general anesthesia with propofol and remifentanil by continuous intravenous infusion at rates of 2 and 0.2-0.4 microgram/Kg/h, respectively; 2) subarachnoid anesthesia with lidocaine, and 3) subarachnoid anesthesia with 1.5% prilocaine. The second and third group received fixed doses of 3 mL of the local anesthetic. All patients were telephoned 48 hours after surgery and asked to answer 8 questions concerning prior experience of anesthesia, degree of satisfaction with the type of anesthesia used, postoperative pain, quality of information received about the anesthetic procedure, and undesirable side effects. RESULTS: We interviewed 120 patients and 32 refused to participate. All patients in the general anesthesia group would accept the same anesthetic technique again in future operations, whereas 85% and 82% in the lidocaine and prilocaine groups, respectively, would accept the same technique (p = 0.026). Satisfaction with anesthesia, postoperative pain, and quality of information about the anesthetic procedure was similar in all 3 groups. No important undesirable side affects were reported in any of the groups. CONCLUSIONS: The overall satisfaction with various types of anesthesia is similar among outpatients undergoing arthroscopic surgery on the knee; therefore, patient preferences for one technique over another should be taken into more consideration.

Effectiveness of a clinical guide for the treatment of postoperative pain in a major ambulatory surgery unit.

A retrospective study to evaluate a clinical guide for the treatment of postoperative pain in our One Day Surgery Unit (ODSU) is presented. A total of 2783 patients, treated during 1 year, were studied. Postoperative pain was evaluated 24 h after surgery by phone-call using a visual analogue scale (VAS) and a verbal response scale (VRS). Results were analysed by groups of analgesia and pain scale values. Admissions due to insufficient analgesia were also evaluated. Mean values obtained in all analgesic groups in relation to the VAS were lower than 2.5. It was found that 86% of patients presented a value of VAS<3, while 84.6% had a VRS value 2. Only two patients were admitted for uncontrolled postoperative pain. The level of postoperative analgesia in our patients was satisfactory. Despite this continuous evaluation of the clinical guides for the treatment of postoperative pain, the use of new powerful analgesic drugs is necessary because the surgical complexity in ODSU is increasing and patients with associated diseases are increasingly accepted.