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Patient State Index Detects Changes in Cerebral Blood Flow and May Predict New Ischemic Lesions during Carotid Stenting—Case Report

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Open Journal of Anesthesiology 2015年第1期5卷 20-22页

作者： ana B. fernández Department of Anesthesiology Intensive Care and Pain Treatment Nuestra Sra De Candelaria University Hospital Santa Cruz de Tenerife Canary Islands Spain

Carotid angioplasty and stenting (CAS) was developed to be a less invasive and complex procedure compared to carotid endarterectomy (CEA). It has emerged as an alternative for patients who are considered to have high surgical risks due to medical comorbidities or anatomical high-risk features [1]. The procedure is usually done under local anesthesia with light sedation, with the subsequent expectation of less neurologic injury, venous thromboembolisms, and myocardial infarctions—all well-known clinical risks of undergoing surgical procedures under general anesthesia. CAS, however, carries some increased risks of arterial dissection, dislocation of atherothrombotic debris and embolization to the brain or eye, late embolization due to thrombus formation on the damaged plaque, and bradycardia and hypotension as a result of carotid sinus stimulation. Electroencephalography can detect cerebral ischemia and hypoxia along with measuring hypnotic effects, but has not been reported to be used during CAS to signal impending neurological deficit and allow for intervention to prevent stroke. We report on the use of patient state index (PSI), an electroencephalographic (EEG) derived variable used by SEDLine monitor (Masimo Inc., San Diego, CA) to monitor changes in cerebral blood flow during carotid angioplasty and stenting in an awake patient under local anesthesia. PSI was developed to measure the level of hypnosis and sedation during anesthesia and in the ICU. The PSI is based on quantitative electroencephalogram features, recorded from anterior and posterior scalp sites, as input to a multivariate algorithm that quantifies the most probable level of anesthesia or sedation. The PSI is reported as a range from 0 to 100, with decreasing values indicating increasing levels of anesthesia or sedation. Adequate depth of anesthesia is reflected by PSI value of 25 - 50, and a fully awake state by a PSI of 100 [2]. Other EEG analysis techniques have been explored to detect changes in

关键词： Patient State Index (PSI) Carotid Angioplasty Cerebral Ischemia EEG analysis

Central Neurogenic Hyperventilation Secondary to a Critic Thyroid Status after Aortoaortic Bypass: A Peculiar Case Report

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Open Journal of Anesthesiology 2017年第5期7卷 130-133页

作者： ana Belén fernández Department of Anesthesiology and Critical Care Unit Ntra Sra de Candelaria University Hospital Santa Cruz de Tenerife Spain

Central neurogenic hyperventilation (CNH) is a rare condition and defined as a syndrome comprising normal or elevated arterial oxygen tension, decreased arterial carbon dioxide tension, respiratory alkalosis with hyperventilation even during sleep, and the absence of a peripheral respiratory stimulus. The diagnosis of CNH requires the exclusion of pulmonary, cardiac, metabolic-immunological disorders and some medicines that can result in hyperventilation. We detailed the case of CNH in the 4th day after vascular surgery probably secondary to acute metabolic acidosis with hyperlactatemia, due to severe hypothyroidism in the context of critically ill patient.

关键词： Lactic Acidosis Metabolic Acidosis Myxedema Coma Central Neurogenic Hyperventilation

Mineralogical signatures and sources of recent sediment in a large tropical lake

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International Journal of Sediment Research 2018年第2期33卷 183-190页

作者： Jorge Feliciano Ontiveros-Cuadras ana Carolina Ruiz-fernández Joan-Albert Sanchez-Cabeza Libia Hascibe Pérez-Bernal Michel Preda Federico Páez-Osuna Polytechnic University of Sinaloa (UPSIN) Mazatlan Academic Unit Institute of Marine Sciences and LimnologyNational Autonomous University of Mexico (UNAM) Oceanic and Coastal Processes Academic Unit Institute of Marine Sciences and LimnologyNational Autonomous University of Mexico (UNAM).University City Department of Earth and Atmospheric Sciences University of Quebec in Montreal (UQAM)

Two lead-210(210Pb) dated sediment cores from Chapala Lake were studied to identify the mineral composition of the sediments and to discuss its relation with trace metals. Minerals and trace metals reflected the domain of volcanic rocks(i.e. basalts, rhyolite and andesite) that characterize Chapala Lake and the Lerma River watershed. Redundancy analyses(RDA) were used to identify the sedimentary variables(magnetic susceptibility, organic matter, sand content, and mineral composition) that could be related to elemental composition. Despite the distance between the two cores(7.3 km) and hydrodynamic circulation the RDA showed that the main mechanism that controls the input of mineral species,and, therefore, element distributions in the lacustrine sediment of Chapala Lake, is related to the weathering of volcanic rocks in the Lerma-Chapala watershed, the consequent runoff and transport of fine grained catchment materials, and later in-lake processes. These findings highlight the importance of controlling watershed erosion to contribute to the improvement of the environmental quality of the lake.

关键词： Chapala Lake Trace metals Mineralogy Lacustrine sediments

Communication between bone marrow mesenchymal stem cells and multiple myeloma cells:Impact on disease progression

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World Journal of Stem Cells 2023年第5期15卷 421-437页

作者： Daniel García-Sánchez Alberto González-González ana Alfonso-fernández Mónica Del Dujo-Gutiérrez Flor M Pérez-Campo Department of Molecular Biology_IDIVAL Faculty of MedicineUniversity of CantabriaSantander 39011CantabriaSpain Servicio de Traumatología y Cirugía Ortopédica Hospital Universitario Marqués de ValdecillaInstituto de Investigación Sanitaria Valdecilla(IDIVAL)Facultad de MedicinaUniversidad de CantabriaSantander 39008CantabriaSpain

Multiple myeloma(MM)is a hematological malignancy characterized by the accumulation of immunoglobulin-secreting clonal plasma cells at the bone marrow(BM).The interaction between MM cells and the BM microenvironment,and specifically BM mesenchymal stem cells(BM-MSCs),has a key role in the pathophysiology of this *** data support the idea that BM-MSCs not only enhance the proliferation and survival of MM cells but are also involved in the resistance of MM cells to certain drugs,aiding the progression of this hematological *** relation of MM cells with the resident BM-MSCs is a two-way *** modulate the behavior of BM-MSCs altering their expression profile,proliferation rate,osteogenic potential,and expression of senescence *** turn,modified BM-MSCs can produce a set of cytokines that would modulate the BM microenvironment to favor disease *** interaction between MM cells and BM-MSCs can be mediated by the secretion of a variety of soluble factors and extracellular vesicles carrying microRNAs,long non-coding RNAs or other ***,the communication between these two types of cells could also involve a direct physical interaction through adhesion molecules or tunneling ***,understanding the way this communication works and developing strategies to interfere in the process,would preclude the expansion of the MM cells and might offer alternative treatments for this incurable disease.

关键词： Multiple myeloma Mesenchymal stem cells Bone marrow microenvironment Soluble factors Extra-cellular vesicles Cells adhesion molecules Tunnellingnanotubes

Relevance of Family in Academic Success on Children

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Health 2017年第2期9卷 279-288页

作者： Patricia Martínez Lanz ana Cristina Losada fernández Fabiola Pecchioni fernández Martha Patricia Hernández Valdez Universidad Aná huac Mé xico M&eacute xico City M&eacute xico

The purpose of this study was to analyze the relationship between academic success and functional and dysfunctional families. A non-experimental, cross-sectional, descriptive correlational design was used. A convenience sample of 200 children between 6 and 13 years old, primary and junior high school students was conducted (32.3% were female and 67.7% were male). To assess the relationship, a study case of 21 reagents was designed to empty the obtained information from medical review records from a psychopedagogic clinic. Academic success was measured as from the revision of informal tests and standardized tests. Results showed that the population levels of academic success were average. However, a significant relationship between the age of the parents and the level of academic success was found, indicating that these variables are associated with this problem. Besides that, it was found that there is a tendency in children with cognitive, emotional and sensory problems reflected in low academic success. The findings provide information that could be considered for the development of programs of psychopedagogic intervention to treat children with learning disabilities and low academic success.

关键词： Academic Success Low Academic Success Functional Family Dysfunctional Family Children

Presacral venous bleeding during mobilization in rectal cancer

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World Journal of Gastroenterology 2017年第9期23卷 1712-1719页

作者： Jose Enrique Casal Núnez Vincenzo Vigorita Alejandro Ruano Poblador ana María Gay fernández Maria ángeles Toscano Novella Nieves Cáceres Alvarado Lucinda Pérez Dominguez Coloproctology Unit and General and Digestive Surgery Unit Vigo University Hospital Complex36212 VigoSpain

To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal *** review of the databases MEDLINE® and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were *** is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious *** series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.

关键词： Presacral hemorrhaging Rectal surgery Sacral venous plexus Pelvic surgery Sacral anatomy

Malignant Cerebral Edema Secondary to Gliadel Wafers in the Early Postsurgical Period

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Open Journal of Anesthesiology 2015年第4期5卷 72-74页

作者： ana B. fernández Antonio Garcia Eglis Lazo Department of Anesthesiology Intensive Care and Pain Treatment Nuestra Sra de Cande-laria University Hospital Santa Cruz de Tenerife Spain Department of Neurosurgery Nuestra Sra de Candelaria University Hospital Santa Cruz de Tenerife Spain

High grade gliomas are the commonest intrinsic brain tumours and account for more average years of life lost than all the common cancers. It has become the commonest cause of cancer death in men under the age of 45 and women under the age of 35. Although surgical resection can greatly reduce tumour bulk, complete excision is virtually impossible due to the infiltrative nature of these tumours. In an attempt to treat the infiltrating tumour cells, there has been much interest in using local therapies inserted at the time of surgery. The authors report a case of fatal cerebral edema unresponsive to aggressive medical and surgical assessment that finally evolved to premature death in the early postsurgical period, after the craniotomy and implantation of Gliadel wafers. They note that high doses of dexamethasone were insufficient to prevent cerebral edema and death. A search for corticosteroid use and dosing for patients treated with Gliadel wafers in the published literature revealed no recommendations on the doses of steroids to be administered. In our opinion this is a very important issue and maybe the key point for the treatment of this disease, and may need to be addressed with treatment guidelines in the near future in order to ensure better results on patient’s survival. Prior to this case review there had been two similar report but a later presentation. So we think that this is the first case report of acute fulminant cerebral edema secondary to gliadel wafers in the early period.

关键词： Malignant Glioma Carmustine Wafer Cerebral Edema Cytotoxic Effect

Postanesthetic Emergence Delirium in Children: Qualitative Differences between Sevoflurane vs Desflurane: A Randomized Clinical Trial

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Open Journal of Anesthesiology 2022年第10期12卷 322-337页

作者： Elena fernández Dueñas Pascual Sanabria Carretero Francisco Reinoso-Barbero ana fernández Dueñas Leopoldo Martínez Martínez Department of Pediatric Anesthesia-Critical Care-Pain Treatment La Paz University Hospital Madrid Spain Idipaz Foundation La Paz University Hospital Madrid Spain Directorate General of Public Health Ministry of Health Madrid Spain Department of Pediatric Surgery La Paz University Hospital Madrid Spain

Background: Emergence Delirium (ED) is considered a usual complication in pediatric anesthesia. Aim: analyze the quantitative and qualitative differences in ED in children receiving general anesthesia with sevoflurane or desflurane in day case surgery. Materials and Methods: Two hundred and two children, ASA I-II, who required outpatient elective day case surgery, were assigned to receive anesthesia with sevoflurane or desflurane. ED was assessed by a masked investigator using the Pediatric Anesthesia Emergence Delirium (PAED) scale at 5 and 15 minutes (min). Results: Mean time to wake up was shorter with desflurane compared with sevoflurane (6.0 versus 8.3 min, p = 0.0001). The overall incidence of ED was 21.3% and Postoperative Maladaptive Behavior Changes (POMBC) incidence was 22%;however, these were not related. Main factors found to be associated with ED were younger age, postoperative pain and preoperative anxiety. Although there were not statistically significant differences in ED incidence between sevoflurane (26.4%, 95% CI 17.3% - 35.4%) and desflurane anesthesia (16.3%, 95% CI 8.8% - 23.8%) (p = 0.18), scores of items 1 and 2 from PAED scale (eye contact and purposeful actions, items related to the patients’ connection with their surroundings) were significantly higher in sevoflurane than in desflurane group (p = 0.034 and p = 0.021 respectively). Conclusion: Recovery after anesthetic maintenance with desflurane is faster and as safe as sevoflurane, including postoperative behavioral disorders. Although desflurane did not statistically decrease ED incidence as compared with sevoflurane, patients who were agitated with desflurane were qualitatively less disoriented and disconnected from their surroundings.

关键词： Inhaled Agents Sevoflurane Desflurane Emergence Agitation Pediatric

Efficacy of bevacizumab-containing chemotherapy in metastatic colorectal cancer and CXCL5 expression: Six case reports

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World Journal of Gastroenterology 2020年第16期26卷 1979-1986页

作者： Apolonia Novillo María Gaibar Alicia Romero-Lorca María Fuencisla Gilsanz Laura Beltrán Miguel Galán Beatriz Antón Diego Malón Amalia Moreno ana fernández-Santander Department of Pre-clinical Dentistry Health Sciences FacultyUniversidad Europea de MadridVillaviciosa de OdónMadrid 28670Spain Department of Health Sciences Health Sciences FacultyUniversidad Europea de MadridVillaviciosa de OdónMadrid 28670Spain Department of Medicine Health Sciences FacultyUniversidad Europea de MadridVillaviciosa de OdónMadrid 28670Spain Department of Oncology University Hospital of FuenlabradaFuenlabradaMadrid 28942Spain Department of Pathological anatomy University Hospital of FuenlabradaFuenlabradaMadrid 28942Spain

BACKGROUND In metastatic colorectal cancer(mCRC),the anti-vascular endothelial growth factor drug bevacizumab(BVZ)plus chemotherapy significantly improves progression-free survival compared to chemotherapy(CT)*** benefit is not,however,observed in all *** increased chemokine CXCL5 gene expression promoting angiogenesis has been proposed as a prognostic mCRC biomarker,few studies have examined its relationship with drug *** study sought to analyze tumor CXCL5 gene expression in six patients with different efficacy of BVZ-containing CT in terms of the tumor response to *** SUMMARY We report six cases of stage IV KRAS-mutated *** were given first line treatment with BVZ-containing chemotherapy in University Hospital of *** six patients differed in terms of primary tumor location(right/left side),tumor burden(mostly hepatic and peritoneal disease)and clinical disease *** treatment onset,total RNA was isolated from paraffinated tumor biopsy specimens and CXCL5 gene expression quantified through conventional RT-qPCR *** main finding was that CXCL5 expression levels were several times higher in three patients with lower progression free survival(under 6 mo)from the start of *** A higher expression of CXCL5 was observed in the three patients showing worse tumor response to treatment.

关键词： Colorectal cancer Bevacizumab Chemokine CXCL5 Gene expression Progression-free survival Case report