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En el proyecto de estudio de factibilidad para una microempresa de asesoría y venta de insumos para huertos familiares en Cd. Delicias, Chihuahua se logró desarrollar un plan de factibilidad económica de la empresa, de publicidad y comercialización de huertos familiares. Como primer paso se realizó un estudio de mercado dirigido a la población de Cd. Delicias, Chihuahua en donde la muestra fue de 400 jefes de familia encuestados. Una vez obtenida esta información se realizaron gráficas y análisis de datos para determinar la aceptación del producto y servicio; se realizó un análisis de competencia con tres empresas de la ciudad dando como resultado una ventaja competitiva derivada de la calidad del producto y la completa variedad que se ofrece para que las familias puedan complementar su dieta alimenticia diaria, además de la adaptación de este a las necesidades del cliente sumado al precio accesible que la empresa ofrece con posible asesoría a mediano plazo para el cuidado oportuno de su producto. Se procedió a la creación de misión, visión, valores, metas organizacionales, distribución de la planta, así como una matriz FODA y el estudio de rentabilidad (TIR, VAN, beneficio-costo y punto de equilibrio) para la posible creación de la microempresa.

El Golfo de Nicoya es uno de los sectores marinos de mayor riqueza del país, de su medio se han extraído grandes cantidades de productos marinos que contribuyen con la alimentación y la economía nacional. Desde hace muchos años se ha presentado una disminución alarmante de especies marinas, por lo cual la problemática que se presenta es insostenible. Por tanto, el objetivo del presente trabajo es buscar la contribución y participación de la comunidad de Isla Venado (Golfo de Nicoya) mediante prácticas acuícolas amigables con el ambiente por medio de un sistema de cultivo de la especie Mytella guyanensis: Mytilidae, para la mejora de la economía y el cuido del ambiente, y a la vez se generen insumos para futuros proyectos de conservación de los recursos naturales en la comunidad.

BackgroundSpinal anaesthesia is commonly used for many surgical procedures. One of its potential complications is arterial hypotension, which is nowadays prevented by an empirical fluid administration without any hemodynamic status assessment. However, this practice could increase the risk of volume overload in cardiovascular high-risk patients. Two non-invasive tests are performed to identify fluid-responsiveness: the Inferior Vena Cava Ultrasound (IVCUS) and the Passive Leg Raising Test (PLRT). Aim of this post-hoc analysis was to compare these two methods in spontaneous-breathing patients to assess fluid responsiveness before spinal anaesthesia. Primary outcome was to analyze the incidence of arterial hypotension after spinal anaesthesia in elective surgery patients. Secondary endpoints compared the total fluids amount, the vasoactive drugs administered and the time needed to accomplish the whole procedure in both groups.ResultsThe patients analyzed were 132 in the IVCUS group and 148 in the PLRT group; 39.6% of all patients developed arterial hypotension after spinal anaesthesia, 34.8% in the IVCUS group and 43.9% in the PLRT group (Chi-square 2.39, df = 1, p = 0.77). The mean total fluids amount was 794 ± 592 ml; 925 ± 631 ml for IVCUS group and 678 ± 529 ml for PLRT group (p < 0.001). Patients needed vasoactive drugs to restore normal arterial pressure were 18.2% of total, 15% in the IVCUS group and 20% in the PLRT group (p = 0.136). The mean time required to complete the entire procedure was 52 ± 18 min, 48 ± 10 min in the IVCUS group and 56 ± 13 min in the PLRT group (p < 0.001). Complications or out of protocol treatment were registered in 4.6% patients.ConclusionsFluid responsiveness assessment in spontaneous breathing patients before spinal anaesthesia could potentially prevent the risk of post-spinal hypotension. In elective surgery, IVCUS could be an accurate method to guide fluid administration in patients undergoing spinal anaesthesia, reducing the incidence of post-spinal hypotension when compared to PLRT.

El inicio de buenos hábitos alimenticios en el aspecto nutricional contribuye en el desarrollo del niño escolar, evitando con ello, la anemia la cual se estima que posee un impacto a nivel mundial de 600 millones de niños que padecen de esta enfermedad según datos registrados por la Organización Mundial de la Salud. Con este estudio se busca demostrar los hábitos alimenticios, calidad nutricional y concentración de hierro sérico en estudiantes con anemia por deficiencia de hierro en el Cantón Jipijapa en Ecuador. La metodología empleada en el análisis del estudio fue de tipo descriptiva observacional, de corte transversal. Para ello, se aplicó un muestreo no probabilístico voluntario, se contó con la participación de 63 escolares del Cantón con previa autorización. Entre los resultados se encontraron que en los 63 escolares predomina el consumo diario (76,4%) en los hábitos alimenticios, mientras tanto que en la calidad nutricional se observó poco saludable (24 y 37 ME) en ciertos alimentos necesarios para el consumo estudiantiles en los rangos establecido, en la anemia se obtuvo un resultado de (10,2%) de escolares con anemia, mientras que para la deficiencia de hierro el (11,1%) de los niños. Se concluye que en los escolares es prevalente los malos hábitos alimenticios, sin embargo, hay casos en los que escolares muestran anemia con deficiencia de hierro y escolares sin anemia con déficit del mismo lo que es elemental las practicas alimenticia tanto en los hábitos como en la calidad nutricional.

Degenerative cervical myelopathy (DCM) is hallmarked by spinal canal narrowing and related cord compression and myelopathy. CSF pressure dynamics are likely disturbed due to spinal canal stenosis. The study aims to investigate the diagnostic value of continuous intraoperative CSF pressure monitoring during surgical decompression. Prospective single center study (NCT02170155) with enrolment of DCM patients that underwent surgical decompression between December 2019 and May 2021. Data from N=17 patients were analyzed, symptom severity graded with the modified Japanese Orthopedic Score (mJOA). CSF pulsations were continuously monitored with a lumbar intrathecal catheter during surgical decompression. Mean patient age was 62±9 years (range 38-73; 8F), symptoms were mild-moderate in most patients (mean mJOA 14±2, range 10-18). Measurements were well tolerated without safety concerns. In 15/16 (94%) CSF pulsations increased at the time of surgical decompression. In one case, responsiveness could not be evaluated for technical reasons. Unexpected CSF pulsation decrease was related to adverse events (i.e., CSF leakage). Median CSF pulsation amplitudes increased from pre-decompression (0.52 mmHg [IQR 0.71]) to post-decompression (0.72 mmHg [IQR 0.96]) (P=0.001). Mean baseline CSF pressure increased with lower magnitude than pulsations, from 9.5±3.5 to 10.3±3.8 mmHg (P=0.003). Systematic relations of CSF pulsations were confined to surgical decompression, independent of arterial blood pressure (P=0.927) or heart rate (P=0.102). Intraoperative CSF pulsation monitoring was sensitive, timely, and specifically related to surgical decompression while in addition adverse events could be discerned. Further investigation of the clinical value of intraoperative guidance for decompression in complex DCM surgery is promising.

The Gulf of Nicoya is one of the richest marine sectors in the country. Large quantities of marine products have been extracted from its environment, contributing to food and the national economy. For many years there has been an alarming decrease in marine species which is an unsustainable. Therefore, the objective of the project is to seek the contribution in the community of Isla Venado, Gulf of Nicoya, using tools from aquaculture practices that are friendly to the environment through a cultivation system of the species Mytella guyanensis: Mytilidae in order to improve the economy and take care of the environment, generating at the same time inputs for future projects of conservation of natural resources in the community. El Golfo de Nicoya es uno de los sectores marinos de mayor riqueza del país, de su medio se han extraído grandes cantidades de productos marinos que contribuyen con la alimentación y la economía nacional. Desde hace muchos años se ha presentado una disminución alarmante de especies marinas, por lo cual la problemática que se presenta es insostenible. Por tanto, el objetivo del presente trabajo es buscar la contribución y participación de la comunidad de Isla Venado (Golfo de Nicoya) mediante prácticas acuícolas amigables con el ambiente por medio de un sistema de cultivo de la especie Mytella guyanensis: Mytilidae, para la mejora de la economía y el cuido del ambiente, y a la vez se generen insumos para futuros proyectos de conservación de los recursos naturales en la comunidad.

The volcano rabbit ( Romerolagus diazi ), endemic to the central-eastern Transmexican Volcanic Belt, is one of the most threatened lagomorphs worldwide. Several factors threaten to decrease its geographical distribution, which is already restricted to the Pelado, Tlaloc, Iztaccihuatl, and Popocatepetl volcanoes. Our study aimed to propose priority areas for the conservation of this rabbit within Iztaccihuatl-Popocatepetl National Park (IPNP) based on species distribution models. Volcano rabbit presence data were collected through different field sampling techniques and public and private databases. The environmental predictors used to model suitability were obtained from both open-access remote sensors and topographic information. The models’ performance was adjusted by evaluating different sets of variables and data to improve the certainty of the results. We obtained an area of 132.5 km 2 within the IPNP potentially occupied by the volcano rabbit and a high suitability area of 7 km 2 . In addition, four priority conservation polygons for the volcano rabbit were identified within the National Park. We showed that the suitability and potential distribution are not uniform in the park, being the alpine meadow dominated by Muhlenbergia sp., the most suitable area for R. diazi . Therefore, the conservation strategies should focus on preserving these meadows in the prioritized polygons, avoiding tourist and unskilled personnel’s access. This work represents a contribution to the conservation of the volcano rabbit and a theoretical and practical tool for use in the IPNP.

La obra todo lo que debes saber sobre fracturas de miembro superior ofrece un detallado tratado sobre las fracturas más comunes de miembro superior así como su correcto manejo en el primer nivel de atención. Obra de gran valor académico para médicos en formación que realizan su rotación y de consulta obligada para especialistas en traumatología

BACKGROUND Diclofenac and other NSAIDs are routinely used in the postoperative period. Their effect on fracture healing remains unclear and controversial. OBJECTIVE The primary outcome was to assess the potential cytotoxicity of clinically relevant concentrations of diclofenac on human osteoblasts. DESIGN Laboratory in vitro study. SETTING Institute of Physiology, Zurich, Center for Integrative Human Physiology, University of Zurich. MATERIALS Monolayers of human osteoblasts. INTERVENTIONS Exposure of human osteoblast monolayers to several concentrations of diclofenac, for different periods of time, with and without an artificially induced inflammatory process. MAIN OUTCOME MEASURES Cell count, cell viability, cell proliferation and apoptosis. RESULTS A concentration-mediated, time and exposure dependent cytotoxic effect of diclofenac-mediated apoptosis was observed. Stimulated inflammatory conditions seemed to reduce toxic effects. CONCLUSION Cytotoxic effects of diclofenac are exposure, time and concentration dependent. Simulating aspects of inflammatory conditions seems to increase resistance to diclofenac cytotoxicity, especially in the presence of higher concentration and longer exposure time.

This article examines the relationship between the family archive and Memory Studies. It analyzes the archive of a young woman, Florence Elizabeth Conard, whose writings of the Spanish Civil War (1936–1939) are archived in the Kautz FamilyYMCA Archive in Minneapolis, Minnesota. Her story is narrated and edited by her father affirming her existence as a literary witness. We, the authors, use Borges’ reading of The Divine Comedy as a productive analogy to approach memory through the lens of literature, opening a path for further interrogation of narrative and moving from that which is narrated to that which is narratable and redactable. It illustrates how the mnemonic practices of memory reside in their narratability. Just the same, the academic field of Memory Studies grappling with these practices is not a fashionable product of the twentieth-century traumas, but has existed as a practice before the archive, which gives it a space.

Purpose: To compare surgical results after phacoemulsification using two different techniques for removal of Ophthalmic Viscoelastic Device (OVD). Methods: A randomized prospective study was conducted on 77 patients who underwent cataract surgery. In the first group, OVD was removed over the optic by small abrupt horizontal and vertical displacements of the IOL. In the second group OVD was removed by placing the I/A probe behind the IOL. Intraocular Pressure (IOP), Intraocular Lens Position (IOLP) and refraction were analyzed over the first six weeks.

El objetivo de este trabajo es establecer la correlación entre la citología y la histopatología en pacientes con tiroidectomía por nódulo tiroideo en el Hospital Regional Rafael Hernández L. del 2011 al 2017. Con respecto a la metodología empleada se utilizó la base de datos del Hospital Regional Rafael Hernández L en donde se encontraron 123 pacientes con los resultados de citología y de histopatología de tiroides. Para el análisis de los datos se utilizaron porcentajes, prueba de x2, P ≤ 0.05, análisis de sensibilidad, especificidad e índice Kappa. Como resultados se obtuvieron: de los 123 pacientes con resultado de histopatología, 47 (38.2%) fueron malignas. De las 28 citologías no diagnósticas, 9 (32%) fueron carcinoma en la histopatología, de los 36 casos con citología benigna, 7 (19%) resultaron carcinoma, de los 28 casos con Bethesda III-IV, 8 (29%) fueron carcinoma tiroideo, de los 20 casos de sospecha de malignidad 15(75%) fueron malignos y de los 11 casos malignos en la citología, 8 (72.7%) fueron malignos. Al aplicar el índice Kappa se obtiene una correlación de mínima a moderada. Como conclusiones, en este estudio existe una correlación mínima a moderada entre la citología tiroidea y la histopatología.

Reconocida como una de las enfermedades neurodegenerativa mas frecuente, por su proceso degenerativo cerebral, es la enfermedad de Parkinson que afecta “la sustancia negra”, zona del cerebro productora de la dopamina, y por lo tanto el sistema motor del cuerpo humano, sin embargo se reconocen algunos sintomas no motores como marcadores prodromicos en la enfermedad, los cuales incluso se manifiestan previo al diagnostico de la Enfermedad de Parkinson (EP). En este sentido, la importancia de identificar cuales son aquellos sintomas no motores, su manifestacion y sus principales causas, que permita identificar tempranamente el cuadro clinico y su tratamiento. En tal sentido, este estudio basado en investigacion documental, se propone discernir aquellos sintomas no motores asociados a la enfermedad en si misma, y aquellos otros que son producto de los efectos colaterales de los medicamentos usados en el tratamiento de la Enfermedad de Parkinson. Los sintomas no motores son multiples, desde los sensoriales, grastrointestinales, hasta los psiquiatricos que conllevan a un analisis a profundidad de los tratamientos sintomaticos asi como aquellas recomendaciones que mitiguen las causas y que permitan la funcionalidad y en definitiva mejorar la calidad de vida del paciente con el diagnostico de esta enfermedad.

An infraclavicular catheter is a very efficient technique to provide excellent perioperative anesthesia/analgesia for upper limb surgery. However, complications can occur and are dependent on the technique used. We report the inadvertent placement of an infraclavicular catheter in the interscalene region when an ultrasound-guided infraclavicular catheter was threaded cranially. We proposed some strategies to avoid the occurrence of complications when performing this block.

INTRODUCTIONThe rice rat (Oryzomys palustris) is a non-conventional laboratory rodent species used to model some human bone disorders. However, no studies have been conducted to characterize the postcranial skeleton. Therefore, we aimed to investigate age- and gender-related features of the appendicular skeleton of this species.METHODSWe used femurs and tibiae from 94 rats of both genders aged 4-28 wks. Bone mineral content (BMC), bone mineral density (BMD), and biomechanical properties were determined in femurs. In addition, bone histomorphometry of tibiae was conducted to assess bone cells activities and bone turnover over time.RESULTSBodyweight, bone length, total metaphysis BMC/BMD, cortical BMC/BMD, cortical thickness, and cortical area progressively augmented with age. Whereas the increase in these parameters plateaued at age 16-22 wks in female rats, they continued to rise to age 28 wks in male rats. Furthermore, bone strength parameters increased with age, with few differences between genders. We also observed a rapid decrease in longitudinal growth between ages 4-16 wks. Whereas young rats had a greater bone formation rate and bone turnover, older rice rats had greater bone volume and trabecular thickness, with no differences between genders.CONCLUSIONS1) Sexual dimorphism in the rice rat becomes grossly evident at age 16 wks; 2) the age-related increases in bone mass, structural cortical parameters, and in some biomechanical property parameters plateau at an older age in male than in female rats; and 3) bone growth and remodeling significantly decreased with age indistinctive of the gender.

Peripheral Regional Anaesthesia for Perioperative Analgesia

BACKGROUND Intra-operative muscle relaxation is often required in orthopaedic surgery and the hand train-of-four (TOF) test is usually used for its quantification. However, even though full muscle relaxation is claimed by anaesthesiologists based on a TOF count of zero, surgeons observe residual muscle activity. OBJECTIVE The aim of the study was to assess if hand or foot TOF adequately represents intra-operative muscle relaxation compared with multiple motor evoked potentials. DESIGN Prospective observational study. SETTING A single-centre study performed between February 2016 and December 2018 at the Balgrist University Hospital, Zurich, Switzerland. PATIENTS Twenty patients scheduled for elective lumbar spinal fusion were prospectively enrolled in this study after giving written informed consent. INTERVENTIONS To assess neuromuscular blockade (NMB) with the intermediate duration nondepolarising neuromuscular blocking agent rocuronium, hand TOF (adductor pollicis) and foot TOF (flexor hallucis brevis) monitoring, and muscle motor evoked potentials (MMEPs) from the upper and lower extremities were assessed prior to surgery under general anaesthesia. Following baseline measurements, muscle relaxation was performed with rocuronium until the spinal surgeon observed sufficient relaxation for surgical intervention. At this timepoint, NMB was assessed by TOF and MMEP. MAIN OUTCOME MEASURES The primary outcome was to determine the different effect of rocuronium on muscle relaxation comparing hand and foot TOF with the paraspinal musculature assessed by MMEP. RESULTS Hand TOF was more resistant to NMB and had a shorter recovery time than foot TOF. When comparing MMEPs, muscle relaxation occurred first in the hip abductors, and the paraspinal and deltoid muscles. The most resistant muscle to NMB was the abductor digiti minimi. Direct comparison showed that repetitive MMEPs simultaneously recorded from various muscles at the upper and lower extremities and from paraspinal muscles reflect muscle relaxation similar to TOF testing. CONCLUSION Hand TOF is superior to foot TOF in assessing muscle relaxation during spinal surgery. Hand TOF adequately represents the degree of muscle relaxation not only for the paraspinal muscles but also for all orthopaedic surgical sites where NMB is crucial for good surgical conditions. TRIAL REGISTRATION clinicalTrials.gov (NCT03318718).

Periodontitis is an important public health concern worldwide. Because rodents from the genus Rattus are resistant to spontaneous periodontitis, experimental periodontitis must be initiated by mechanical procedures and interventions. Due to their exacerbated Th1 response and imbalanced Th17 regulatory T-cell responses, Lewis rats are highly susceptible to inducible inflammatory and autoimmune diseases. We hypothesized that feeding Lewis rats a diet high in sucrose and casein (HSC) would alter the oral microenvironment and induce inflammation and the development of periodontitis lesions without mechanical intervention. A baseline group (BSL, n = 8) was euthanized at age 6 wk. Beginning at 6 wk of age, 2 groups of Lewis rats were fed standard (STD, n = 12) or HSC (n = 20) chow and euthanized at 29 wk of age. We evaluated the degree of periodontitis through histology and μCT of maxillae and mandibles. The HSC-induced inflammatory response of periodontal tissues was assessed by using immunohistochemistry. Gene expression analysis of inflammatory cytokines associated with Th1 and Th17 responses, innate immunity cytokines, and tissue damage in response to bacteria were assessed also. The potential systemic effects of HSC diet were evaluated by assessing body composition and bone densitometry endpoints; serum leptin and insulin concentrations; and gene expression of inflammatory cytokines in the liver. Placing Lewis rats on HSC diet for 24 wk induced a host Th1-immune response in periodontal tissues and mild to moderate, generalized periodontitis characterized by inflammatory cell infiltration (predominantly T cells and macrophages), osteoclast resorption of alveolar bone, and hyperplasia and migration of the gingival epithelium. HSC-fed Lewis rats developed periodontitis without mechanical intervention in the oral cavity and in the absence of any noteworthy metabolic abnormalities. Consequently, the rat model we described here may be a promising approach for modeling mild to moderate periodontitis that is similar in presentation to the human disease.

Resumen: Se examinan la memoria social y la cultura política como elementos para comprender la apropiación del espacio público y el derecho a la ciudad. Este derecho va más allá de la redistribución de bienes y servicios públicos e incluye el reconocimiento de la diferencia, la participación, y la posibilidad de producir el espacio por medio del acto de habitar. Mediante una metodología cualitativa se indagaron dos espacios públicos en Cuenca, Ecuador. El análisis muestra que centralidad, identidad y pertenencia, elementos vinculados a la memoria, dinamizan las interacciones sociales. Mientras, una cultura política con bajo empoderamiento, relaciones jerárquicas y paternalismo afecta las relaciones sociales y la organización social; esta cultura contribuiría a domesticar el conflicto al limitar la configuración de un actor colectivo y reforzar las dependencias institucionales.

Andrea Saporito,1 José Aguirre,2 Alain Borgeat,2 Andreas Perren,3 Luciano Anselmi,1 Roberto Poggi,4 Bruno Minotti,5 Stefano Cafarotti,6 Davide La Regina,7 Samuele Ceruti81Service of Anesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland; 2Department of Anesthesiology, Balgrist University Hospital, Zürich, Switzerland; 3Department of Intensive Care, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland; 4Service of Anesthesiology, Ospedale Regionale di Lugano, Lugano, Switzerland; 5Department of Emergency Medicine, St Gallen General Hospital, St Gallen, Switzerland; 6Service of Thoracic Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland; 7Service of Visceral Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland; 8Department of Intensive Care, Geneva University Hospital (HUG), Geneva, SwitzerlandIntroduction: Breast surgery is associated with persistent postsurgical pain; usually related to poorly treated acute pain. Paravertebral block has been successfully employed in analgesic protocols for breast surgery; its impact on postdischarge pain (PDP) has not been investigated. The aim of this study was to assess characteristics of PDP after breast surgery, the development of chronic postoperative pain (CPP) and its impact on health care costs.Methods: We conducted a retrospective, observational study on a continuous cohort of adult female patients undergoing local breast cancer surgery under combined anesthesia. All patients were interviewed 6 months after hospital discharge. The survey was specifically conceived to assess incidence, features and duration of PDP. The overall cost of additional healthcare resources consumed with a specific relationship to persistent PDP was estimated.Results: A database of 244 patients was preliminarily analyzed. Of these, 188 were included in the following statistical analysis; 123 patients (65.2%) reported significant PDP, with a median intensity on NRS of 6 (IQR=2), more frequently described as burning and associated with paresthesia and/or hyperalgesia (87 patients, 46%). One hundred and six patients (56.5%) reported this pain as interfering with their normal daily activities, work and sleep. In 26.8% of cases (50 patients) symptoms lasted more than 1 month and in 28 patients (15.0%) pain became chronic. The majority of patients self-treated their pain with non-steroideal anti-inflammatory drugs, but in 50 patients (26.8%) this therapy was reported as ineffective. This additional consumption of healthcare resources led to a significant economical impact.Conclusion: PDP and CPP seem to be common complications after breast cancer surgery, even if a combined anesthesia technique with a thoracic paravertebral block is performed, leading to severe consequences on patients’ quality of life and increasing consumption of healthcare resources after discharge.Trial number: NCT03618459 (www.clinicaltrials.gov).Keywords: breast surgery, paravertebral block, regional anesthesia, postoperative pain

Food transportation is a very sensitive process to human health. In the present work an analysis of the thermal behavior of a refrigerated vehicle for food transport is developed, with the purpose of predicting the temperature distribution inside it. The comparison between experimental data measured with the help of encapsulated sensor of temperature DS18B20, and numerical data obtained through the computational dynamics of CFD fluids is made, using the CFX module of ANSYS WORKBENCH 16.0. A quasi-experimental methodology is proposed, based on simulation, in order to estimate the internal temperature in four critical points of the vehicle, and verify if there are heat losses. The numerical results obtained have similarities, when compared with the measured temperature values. The maximum deviation is 0.43 °C, acceptable for this type of engineering application.

Study objectives The aim of this study was to assess the impact of intravenous general anesthesia and controlled hypotension on cerebral saturation (rScO2), cerebral blood flow measured as middle cerebral artery blood flow velocity (Vmax MCA) and neurobehavioral outcome in patients scheduled for shoulder surgery in beach chair position. Design Prospective, assessor-blinded observational study. Setting University hospital, shoulder surgery operating room. Patients Forty ASA I-II patients scheduled for shoulder surgery in beach chair position and controlled hypotension. Interventions Neurological and neurobehavioral tests were performed prior and the day after surgery. The baseline data for near-infrared spectroscopy, bispectral index, cerebral blood flow, PaCO2 and invasive blood pressure (radial artery) were taken prior anesthesia and after anesthesia induction, after beach chair positioning and all 20 min after surgery start until discharge of the patient. Measurements Neurological and neurobehavioral tests, cerebral saturation (rScO2) using near-infrared spectroscopy, BIS, cerebral blood flow using Doppler of the middle cerebral artery (Vmax MCA), PaCO2 and invasive blood pressure assessed at heart and at the external acoustic meatus level. Main results The incidence of cerebral desaturation events (CDEs) was 25%. The blood pressure drop 5 min after beach chair position measured at the acoustic meatus level in the CDE group was higher compared to patients without CDEs (p = 0.009) as was the rScO2 (p = 0.039) and the Vmax MCA (p = 0.002). There were no neurological deficits but patients with CDEs showed a greater negative impact on neurobehavioral tests 24 h after surgery compared to patients without CDEs (p = 0.001). Conclusions In ASA I-II patients intravenous general anesthesia and controlled hypotension in the beach chair position affects cerebral blood flow and cerebral oxygenation with impact on the neurobehavioral outcome.

Degenerative cervical myelopathy (DCM) leads to functional impairment by compression of the spinal cord and nerve roots. In DCM, the dynamics of cerebrospinal fluid pressure (CSFP) and intraspinal pressure (ISP), as well as spinal cord perfusion pressure (SCPP) remain not investigated yet. Recent technical advances have enabled investigation of these parameters in acute spinal cord injury (SCI). We aim to investigate the properties of CSFP/ISP and spinal cord hemodynamics during and after decompressive surgery in DCM.Four patients with DCM were enrolled; during surgery and 24 h postoperative, ISP at level was measured in one patient, and CSFP was measured in two patients. In one patient, CSFP was recorded at bedside before surgery.All measurements were conducted without adverse events and were well tolerated. With CSFP analysis, post-decompression Queckenstedt's test was responsive in two patients (i.e., jugular vein compression resulted in an elevation of CSFP pressure). In the patient whose CSFP was tested at bedside, Queckenstedt's test was not responsive before decompression. Individual optimum SCPPs were calculated to be between 70 and 75 mmHg.ISP and CSFP can reflect spinal compression and sufficient decompression. A better understanding and systematic monitoring possibly lead to improved hemodynamic management and may allow early recognition of postoperative complications such as swelling and bleeding.

BACKGROUND Upper abdominal wall surgical incisions may lead to a severe postoperative pain. Therefore, adequate analgesia is important. Here we investigate whether the low serratus-intercostal interfascial plane block (SIPB) achieves an effective analgesia, considering opioids consumption, pain control and recovery quality in upper abdominal surgeries. METHODS This blinded, randomized controlled study was conducted on 102 patients undergoing open upper abdominal wall surgery under general anesthesia. All patients who received serratus-intercostal plane block at the eighth rib as analgesic technique were included in SIPB group and in control group those who received continuous intravenous morphine analgesia. Pain scores in numeric verbal scale (NVS) and opioids consumption at 0, 6, 12, 24 and 48 hours postoperatively were assessed. The quality of the postoperative recovery was evaluated using the QoR-15 questionnaire at 24 hours. RESULTS This study showed lower postoperative opioid consumption at 24 hours (P