miércoles, 8 de diciembre de 2010

Across and Down, the Wizard Who Is Fastest of All

PUZZLER AT WORK | DAN FEYER

Across and Down, the Wizard Who Is Fastest of All


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The cameras were set to shoot for only eight minutes.
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This week: The magic, and science, of puzzles.
 Science Update
The Saturday, November 20, 2010 crossword puzzle, as completed by Daniel Feyer.
“Oh, it won’t take that long,” Dan Feyer said, with the hint of a smile.
Hubris, anyone?
The pressure was on. Mr. Feyer (FAY-er), 33, a soft-spoken, balding musician, had come to a photo studio at The New York Times to demonstrate one of his odder talents.
With the clock ticking and the shutters clicking, he put pencil to crossword. Not just any puzzle, but the Saturday one from The New York Times — the week’s hardest, notoriously clever and tricky. Fiendish, even, some would say. A form of mental cruelty. There are people who spend hours on this puzzle, people who give up, people who won’t even touch it. And then there is Dan Feyer.
His left hand tracked the clues while his right skittered over the grid. He pressed his lips together and grimaced. He erased, and rapidly filled in more boxes. Then he paused, erased again, and resumed skittering. Nearly five minutes had passed and he still seemed to be working the top left corner of the puzzle, the very beginning. He mumbled once and erased three more times. Was he in trouble? He wrote something, looked up, put his pencil down.
Done. Five minutes, 29 seconds. Penmanship, neat as a nun’s. Mr. Feyer, in jeans, sneakers and a black T-shirt, hadn’t broken a sweat.
Who is this guy? What kind of person knows the name of Gorbachev’s wife (Raisa), a synonym for no-good (dadblasted), the Rangers coach in 1994 (Keenan), a platinum-group element (iridium) and the meaning of objurgation (rant)?
The kind of person who whips through 20 crosswords a day (at least 20,000 in the last three years), who won this year’s American Crossword Puzzle Tournament and who has 100,000 puzzles saved on his computer.
“I feel I want to do them all, somehow,” Mr. Feyer said. “I’ve probably done more crosswords than anybody in the world in the last three years. I don’t know if that’s something to be proud of, but it’s a claim to fame.”
He does have another life, as a pianist and music director for musical theater productions. His most recent shows were “With Glee,” which ran Off Broadway in Manhattan last summer, and “Dracula, a Rock Opera,” which ran in Rochester, Mich., in October.
“Music directors teach actors the music, accompany them in rehearsals and conduct the band,” Mr. Feyer said. “On Broadway, the music director is the guy with the baton in the pit. Off Broadway, it’s the guy sitting at a piano conducting with his head.”
So how does that guy become a puzzle ace? Besides training like an athlete, Mr. Feyer said, it helps to have “underlying brain power and a head for trivia.” He always had high grades and test scores, he said. He excelled at math as well as music, abilities that he thinks go together with crossword solving.
What they all have in common, he said, is pattern recognition — as he begins filling in a puzzle grid, he starts recognizing what the words are likely to be, even without looking at the clues, based on just a few letters.
“A lot of the time, crossword people are musicians,” he said, noting that Jon Delfin, who has won the tournament seven times, is a pianist and music director. “Mathematicians and computer scientists are also constructors.”
Arthur Schulman, a crossword constructor and retired psychology professor from theUniversity of Virginia, who taught a seminar called “The Mind of the Puzzler,” agreed that there is a strong correlation between skill at word puzzles and talent for math and music. All, he said, involve playing with symbols that in and of themselves are not meaningful. “There’s an underlying connection, but I’m not sure what it might be,” Professor Schulman said. “It’s finding meaning in structure.”
Mr. Feyer is a relative newcomer to the world of competitive crosswords, though he has liked all sorts of puzzles since childhood, when his parents bought him books of brain teasers to make up for his boredom at school. He grew up in San Francisco, where his father is a municipal bond lawyer, his mother a law professor. He has two younger brothers, one a management consultant and the other an English teacher in Bhutan. His grandfather George Feyer was a pianist, and played for decades in the lounges of some of Manhattan’s most elegant hotels.
Mr. Feyer went to Princeton, majoring in music. He did crosswords from time to time over the years, but he didn’t get hooked on them until he saw the 2006 movie “Wordplay”, a documentary about crosswords, the tournament and Will Shortz, the New York Times puzzle editor and the founder and director of the tournament.
“I didn’t realize this whole puzzle world existed,” he said.
He bought a book of crosswords, and then another, and began following crossword blogsand downloading puzzles. Before he knew it, he had become one with the puzzle people.
In 2008 he entered his first tournament, in which hundreds of people in a hotel ballroom race to finish a series of puzzles. He had found his niche: the sound of 700 people turning over a piece of paper at the same time thrilled him. He finished “50-somethingth,” he said. But that put him at the top of the rookie division for which he had qualified. The following year, he finished fourth. This year he won, beating many veterans, including Tyler Hinman, the champion of five previous tournaments.

This article has been revised to reflect the following correction:
Correction: December 8, 2010
An article on Tuesday about Dan Feyer, the winner of this year’s American Crossword Puzzle Tournament, misstated the top prize given at the equivalent Sudoku tournament. It is $10,000, not $20,000 (but still more than the $5,000 crossword grand prize.)

Propofol y neuroprotección

Farmacología clínica y experimental de propofol; un anestésico con propiedades neuroprotectoras
The Experimental and Clinical Pharmacology of Propofol, an Anesthetic Agent with Neuroprotective Properties
Yoshinori Kotani, Masamitsu Shimazawa, Shinichi Yoshimura, Toru Iwama, Hideaki Hara.
CNS Neuroscience & Therapeutics 14 (2008) 95-10

Propofol (2,6-diisopropylphenol) is a versatile, short-acting, intravenous (i.v.) sedative-hypnotic agent initially marketed as an anesthetic, and now also widely used for the sedation of patients in the intensive care unit (ICU). At the room temperature propofol is an oil and is insoluble in water. It has a remarkable safety profile. Its most common side effects are dose-dependent hypotension and cardiorespiratory depression. Propofol is a global central nervous system (CNS) depressant. It activates γ-aminobutyric acid (GABAA) receptors directly, inhibits the N-methyl-D-aspartate (NMDA) receptor and modulates calcium influx through slow calcium-ion channels. Furthermore, at doses that do not produce sedation, propofol has an anxiolytic effect. It has also immunomodulatory activity, and may, therefore, diminish the systemic inflammatory response believed to be responsible for organ dysfunction. Propofol has been reported to have neuroprotective effects. It reduces cerebral blood flow and intracranial pressure (ICP), is a potent antioxidant, and has antiinflammatory properties. Laboratory investigations revealed that it might also protect brain from ischemic injury. Propofol formulations contain either disodium edetate (EDTA) or sodium metabisulfite, which have antibacterial and antifungal properties. EDTA is also a chelator of divalent ions such as calcium, magnesium, and zinc. Recently, EDTA has been reported to exert a neuroprotective effect itself by chelating surplus intracerebral zinc in an ischemia model. This article reviews the neuroprotective effects of propofol and its mechanism of action.
Keywords: Anesthesia; chelation; disodium edetate (EDTA); middle cerebral artery occlusion (MCAO); neuroprotection;propofol;zinc

Puede leer el artículo en PDF en este enlace:
Efectos neuroprotectores del propofol en el daño cerebral agudo
Neuroprotective Effects of Propofol in Acute Cerebral Injury
Chiara Adembri, Luna Venturi, Domenico E. Pellegrini-Giampietro
Keywords: Cerebral ischemia; Neurodegeneration; Neuroprotection;Neuroresuscitation;Propofol;Traumatic brain injury
CNS Drug Reviews 2007;13:333-351

Abstract
Propofol (2,6-diisopropylphenol) is one of the most popular agents used for induction of anesthesia and long-term sedation, owing to its favorable pharmacokinetic profile, which ensures a rapid recovery even after prolonged administration. A neuroprotective effect, beyond that related to the decrease in cerebral metabolic rate for oxygen, has been shown to be present in many in vitro and in vivo established experimental models of mild/moderate acute cerebral ischemia. Experimental studies on traumatic brain injury are limited and less encouraging. Despite the experimental results and the positive effects on cerebral physiology (propofol reduces cerebral blood flow but maintains coupling with cerebral metabolic rate for oxygen and decreases intracranial pressure, allowing optimal intraoperative conditions during neurosurgical operations), no clinical study has yet indicated that propofol may be superior to other anesthetics in improving the neurological outcome following acute cerebral injury. Therefore, propofol cannot be indicated as an established clinical neuroprotectant per se, but it might play an important role in the so-called multimodal neuroprotection, a global strategy for the treatment of acute injury of the brain that includes preservation of cerebral perfusion, temperature control, prevention of infections, and tight glycemic control.

Lea el artículo completo en PDF en el siguiente enlace:
Atentamente
Anestesiología y Medicina del Dolor

Propofol y neuroprotección

Farmacología clínica y experimental de propofol; un anestésico con propiedades neuroprotectoras
The Experimental and Clinical Pharmacology of Propofol, an Anesthetic Agent with Neuroprotective Properties
Yoshinori Kotani, Masamitsu Shimazawa, Shinichi Yoshimura, Toru Iwama, Hideaki Hara.
CNS Neuroscience & Therapeutics 14 (2008) 95-10

Propofol (2,6-diisopropylphenol) is a versatile, short-acting, intravenous (i.v.) sedative-hypnotic agent initially marketed as an anesthetic, and now also widely used for the sedation of patients in the intensive care unit (ICU). At the room temperature propofol is an oil and is insoluble in water. It has a remarkable safety profile. Its most common side effects are dose-dependent hypotension and cardiorespiratory depression. Propofol is a global central nervous system (CNS) depressant. It activates γ-aminobutyric acid (GABAA) receptors directly, inhibits the N-methyl-D-aspartate (NMDA) receptor and modulates calcium influx through slow calcium-ion channels. Furthermore, at doses that do not produce sedation, propofol has an anxiolytic effect. It has also immunomodulatory activity, and may, therefore, diminish the systemic inflammatory response believed to be responsible for organ dysfunction. Propofol has been reported to have neuroprotective effects. It reduces cerebral blood flow and intracranial pressure (ICP), is a potent antioxidant, and has antiinflammatory properties. Laboratory investigations revealed that it might also protect brain from ischemic injury. Propofol formulations contain either disodium edetate (EDTA) or sodium metabisulfite, which have antibacterial and antifungal properties. EDTA is also a chelator of divalent ions such as calcium, magnesium, and zinc. Recently, EDTA has been reported to exert a neuroprotective effect itself by chelating surplus intracerebral zinc in an ischemia model. This article reviews the neuroprotective effects of propofol and its mechanism of action.
Keywords: Anesthesia; chelation; disodium edetate (EDTA); middle cerebral artery occlusion (MCAO); neuroprotection;propofol;zinc

Puede leer el artículo en PDF en este enlace:
Efectos neuroprotectores del propofol en el daño cerebral agudo
Neuroprotective Effects of Propofol in Acute Cerebral Injury
Chiara Adembri, Luna Venturi, Domenico E. Pellegrini-Giampietro
Keywords: Cerebral ischemia; Neurodegeneration; Neuroprotection;Neuroresuscitation;Propofol;Traumatic brain injury
CNS Drug Reviews 2007;13:333-351

Abstract
Propofol (2,6-diisopropylphenol) is one of the most popular agents used for induction of anesthesia and long-term sedation, owing to its favorable pharmacokinetic profile, which ensures a rapid recovery even after prolonged administration. A neuroprotective effect, beyond that related to the decrease in cerebral metabolic rate for oxygen, has been shown to be present in many in vitro and in vivo established experimental models of mild/moderate acute cerebral ischemia. Experimental studies on traumatic brain injury are limited and less encouraging. Despite the experimental results and the positive effects on cerebral physiology (propofol reduces cerebral blood flow but maintains coupling with cerebral metabolic rate for oxygen and decreases intracranial pressure, allowing optimal intraoperative conditions during neurosurgical operations), no clinical study has yet indicated that propofol may be superior to other anesthetics in improving the neurological outcome following acute cerebral injury. Therefore, propofol cannot be indicated as an established clinical neuroprotectant per se, but it might play an important role in the so-called multimodal neuroprotection, a global strategy for the treatment of acute injury of the brain that includes preservation of cerebral perfusion, temperature control, prevention of infections, and tight glycemic control.

Lea el artículo completo en PDF en el siguiente enlace:
Atentamente
Anestesiología y Medicina del Dolor

Estudos Avançados em Doenças C



Alternativas a la laringoscopia directa para la intubación traqueal


REMI envía todos sus contenidos gratuitamente por correo electrónico a más de 8.600 suscriptores. [Suscripción]
Artículo nº 1580. Vol 12, diciembre 2010.
Autor:Antonio García Jiménez

Alternativas a la laringoscopia directa para la intubación traqueal

Artículo original: Comparison of GlideScope video laryngoscope and intubating laryngeal mask airway with direct laryngoscopy for endotracheal intubation. Cinar O, Cevik E, Yildirim AO, Yasar M, Kilic E, Comert B. Eur J Emerg Med 2010. [Resumen] [Artículos relacionados]

Introducción: El laringoscopio directo (LD) convencional es una de las herramientas básicas para el control de la vía aérea en manos de los intensivistas y en el campo de la Anestesiología, pero en los últimos años han aparecido nuevos dispositivos para facilitar el acceso a la vía aérea inferior, como los dispositivos de video-laringoscopia y la intubación con mascarilla laríngea. La facilidad en el aprendizaje se considera uno de los aspectos fundamentales a la hora de recomendar una u otra técnica.

Resumen: En un estudio prospectivo realizado con 121 personas que se estaban formando para trabajar como paramédicos, y a los que ya se les había formado previamente en intubación traqueal con LD, se les impartió una sesión formativa sobre el uso del video-laringoscopio GlideScope (VL) y otra sobre intubación con mascarilla laríngea Fastrach (ML). Posteriormente realizaron todos ellos intentos de intubación traqueal en maniquí con los 3 métodos a comparar. La tasa de éxitos de intubación traqueal del grupo de estudio con los 3 métodos fue del 78,5%, 91,7% y 92,7% cuando se usaron LD, VL y ML, respectivamente. En conclusión de los autores, los sistemas de intubación con VL y ML fueron superiores a la intubación tradicional con LD en el aprendizaje de la intubación traqueal por paramédicos.

Comentario: El presente trabajo tiene limitaciones evidentes como el ser realizado con maniquís y no con humanos, ser personal en formación para trabajo como paramédicos, y haber sido realizado en un solo centro con escaso número de ensayos. Probablemente estemos todavía bastante lejos de olvidar nuestro casi inseparable “laringo”, pero es cierto que cada vez existen más dispositivos eficaces y opciones a la hora de intubar a un paciente; en el ámbito de la práctica clínica del intensivista, estos dispositivos pueden ser especialmente útiles en casos de vía aérea difícil.
Antonio García Jiménez
Hospital Arquitecto Marcide, Ferrol, La Coruña
©REMI, http://remi.uninet.edu. Diciembre 2010.

Búsqueda en PubMed:
  • Enunciado: Intubación con dispositivos de video-laringoscopia
  • Sintaxis: glidescope OR airtraq OR videolaryngoscopy
  • [Resultados]
Palabras clave: Vía aérea, Videolaringoscopia, GlideScope, Mascarilla larínga.

Propofol. Complicaciones

Síndrome de infusión por propofol: Actualización de sus manifestaciones clínicas y su patofisiología.
Propofol infusion syndrome: update of clinical manifestation and pathophysiology.
Fudickar A, Bein B.
Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany. fudickar@anaesthesie.uni-kiel.de
Minerva Anestesiol. 2009 May;75(5):339-44.
Abstract
Propofol infusion syndrome (PRIS) is defined as acute bradycardia progressing to asystole combined with lipemic plasma, fatty liver enlargement, metabolic acidosis with negative base excess >10 mmol l(-1), rhabdomyolysis or myoglobinuria associated with propofol infusion. The purpose of this review was to provide a new update of reported case reports and to describe recent retrospective studies and animal research relevant for the pathophysiology and clinical presentation of PRIS. New case reports of PRIS have confirmed previously identified risk factors, and have also further revealed the incidence of PRIS in patients previously not estimated to be at risk for this syndrome. Retrospective studies contributed new evidence to the incidence of PRIS and development of PRIS even at propofol doses commonly used for surgical anesthesia. An animal study confirmed potential pathophysiological pathways and showed new organ manifestations possibly associated with propofol infusion. Further clinical and experimental evidence has confirmed the existence of PRIS as a rare but highly lethal complication of propofol use not limited to prolonged use of propofol. PRIS has to be kept in mind if propofol is used for anesthesia or sedation. Recommendations for the limitation of propofol use have to be adhered to. Early warning signs must prompt immediate cessation of propofol infusion and adequate treatment

 
Dolor con la inyección de la microemulsión de propofol
Pain on injection with microemulsion propofol
Ji-Yeon Sim, Soo-Han Lee, Do-Yang Park, Jin-Ah Jung, Kyoung-Ho Ki, Dong-Ho Lee and Gyu-Jeong Noh
British Journal of Clinical Pharmacology 2009;67:316-325,
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT. Aqueous free propofol in lipid emulsion elicits pain. No data on the incidence and severity of injection pain for Aquafol™ (Daewon Pharmaceutical Co., Ltd, Seoul, Korea), a lipid-free microemulsion propofol, are available. Two hypotheses involving plasma bradykinin generation have been proposed to explain propofol-induced pain; one implicates aqueous free propofol, the other implicates the lipid solvent.
WHAT THIS STUDY ADDS. Microemulsion propofol produces more frequent and severe pain on injection, an effect that may be attributable to the high concentration of aqueous free propofol. There was no evidence that plasma bradykinin generation caused propofol-induced pain. In addition, agents known to prevent propofol-induced pain did not decrease aqueous free propofol concentrations.
AIMS. To evaluate the incidence and severity of injection pain caused by microemulsion propofol and lipid emulsion propofol in relation to plasma bradykinin generation and aqueous free propofol concentrations.
METHODS. Injection pain was evaluated in 147 patients. Aqueous free propofol concentrations in each formulation, and in formulation mixtures containing agents that reduce propofol-induced pain, were measured by high-performance liquid chromatography. Plasma bradykinin concentrations in both formulations and in their components mixed with blood sampled from six volunteers were measured by radioimmunoassays. Injection pain caused by 8% polyethylene glycol 660 hydroxystearate (PEG660 HS) was evaluated in another 10 volunteers.
RESULTS. The incidence of injection pain [visual analogue scale (VAS) >30 mm] caused by microemulsion and lipid emulsion propofol was 69.7 and 42.3% (P < 0.001), respectively. The median VAS scores for microemulsion and lipid emulsion propofol were 59 and 24 mm, respectively (95% confidence interval for the difference 12.5, 40.0). The aqueous free propofol concentration of microemulsion propofol was seven times higher than that of lipid emulsion propofol. Agents that reduce injection pain did not affect aqueous free propofol concentrations. Microemulsion propofol and 8% PEG660 HS enhanced plasma bradykinin generation, whereas lipid emulsion propofol and lipid solvent did not. PEG660 HS did not cause injection pain.
CONCLUSIONS. Higher aqueous free propofol concentrations of microemulsion propofol produce more frequent and severe pain. The plasma kallikrein-kinin system may not be involved, and the agents that reduce injection pain may not act by decreasing aqueous free propofol concentrations.

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Encuesta sobre el abuso de propofol en programas académicos de anestesia
A Survey of Propofol Abuse in Academic Anesthesia Programs
Paul E. Wischmeyer, Bradley R. Johnson, Joel E. Wilson, Colleen Dingmann, RN, Heidi M. Bachman, Evan Roller, Zung Vu Tran, Thomas K. Henthorn.
Anesth Analg 2007;105:1066 -71.

BACKGROUND: Although propofol has not traditionally been considered a drug of abuse, subanesthetic doses may have an abuse potential. We used this survey to assess prevalence and outcome of propofol abuse in academic anesthesiology programs. METHODS: E-mail surveys were sent to the 126 academic anesthesiology training
programs in the United States. RESULTS: The survey response rate was 100%. One or more incidents of propofol abuse or diversion in the past 10 yr were reported by 18% of departments. The observed incidence of propofol abuse was 10 per 10,000 anesthesia providers per decade, a fivefold increase from previous surveys of propofol abuse (P 0.005). Of
the 25 reported individuals abusing propofol, 7 died as a result of the propofol abuse (28%), 6 of whom were residents. There was no established system to control or monitor propofol as is done with opioids at 71% of programs. There was an association between lack of control of propofol (e.g., pharmacy accounting) at the time of abuse and incidence of abuse at the program (P 0.048).  CONCLUSIONS: Propofol abuse in academic anesthesiology likely has increased over the last 10 yr. Much of the mortality is in residents. Most programs have no pharmacy accounting or control of propofol stocks. This may be of concern, given that all programs reporting deaths from propofol abuse were centers in which there was no pharmacy accounting for the drug.

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Anestesiología y Medicina del Dolor

Test Your Insight

Test Your Insight

Scientists have found indications that your ability to jump to intuitive answers — what they term the “Aha!” moment — may be affected by your mood. After watching a humorous video, brain imaging and test results of subjects suggested that a positive mood prepares the brain’s insight.

martes, 7 de diciembre de 2010

Las mejores páginas web en Alimentación infantil para profesionales

Las mejores páginas web en Alimentación infantil para profesionales

http://www.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=13187661&pident_usuario=0&pcontactid&pident_revista=45&ty=141&accion=L&origen=elsevier&web=www.elsevier.es&lan=es&fichero=45v17n09a13187661pdf001.pdf