REM Group Research Articles

The Study of Remazolam Combined With Propofol on Painless Gastroscopy: A Randomized Controlled Trial

PurposeGastroscopy is one of the most commonly used diagnostic modalities for upper gastrointestinal disorders. Remazolam besylate, a new type of ultrashort-acting benzodiazepine drug, has been less studied in gastroscopy. In this study, we studied the efficacy and safety of remazolam combined with propofol for painless gastroscopy. DesignThis was a single-center, placebo-controlled randomized trial. MethodsOne hundred patients undergoing painless gastroscopy were included in this study and randomly divided into 2 groups (n = 50 per group): the control group (Con group) and the remazolam group (Rem group). Sufentanil, remazolam, and propofol were used to anesthetize the patients, and then, the effects of different solutions on these patients were compared and analyzed. The patient's general condition, vital signs at different times, the dosage of propofol (mg) and additional times, complications, duration of gastroscopy (minutes), recovery time (minutes), length of stay in the recovery room (minutes), and adverse reactions were recorded. FindingsRem group systolic blood pressure was more stable (P < .05). The amount of additional propofol in Rem group was less (P < .05). The incidence of hypotension, bradycardia, and dizziness was lower in Rem group, as well as the time of awakening and stay in the recovery room were shorter (P < .05). ConclusionsRemazolam combined with sufentanil and propofol has less effect on hemodynamics in painless gastroscopy, and the patients have shorter awakening times.

Comparison of sevoflurane and propofol in combination with remifentanil on the quality of postoperative recovery in patients undergoing laparoscopic bariatric surgery.

This study aimed to evaluate and compare the effects of sevoflurane + remifentanil (Sev + Rem) and propofol + remifentanil (Pro + Rem) on the postoperative recovery quality of patients undergoing laparoscopic bariatric surgery to determine which anesthesia regimen provides a better overall recovery experience. Sixty patients were divided into two groups based on the treatments they underwent: Sev + Rem (n = 30) and Pro + Rem (n = 30). The Sev + Rem group received sevoflurane inhalation (0.5%, increasing to 0.5-4%) and remifentanil via target-controlled infusion. The Pro + Rem group received propofol [4-8 mg/(kg·h)] and remifentanil via target-controlled infusion. Anesthesia depth was maintained at a bispectral index of 40-60 in both groups. Perioperative data, hemodynamic parameters, and postoperative recovery quality were assessed. Compared to the Pro + Rem group, the dose of remifentanil in the Sev + Rem group was significantly lower (1693.67 ± 331.75 vs. 2,959 ± 359.77, p < 0.001), the proportion of patients used norepinephrine was markedly higher [16 (53.33) vs. 8 (26.67), p = 0.035], and the time of extubation was earlier (356.33 ± 63.17 vs. 400.3 ± 50.11, p = 0.004). The Hemodynamic results showed the HR in the Sev + Rem group was faster than that in the Pro + Rem group at the beginning of surgery and 1 h post-surgery (67.37 ± 4.40 vs. 64.33 ± 4.44, p = 0.010, 69.07 ± 4.23 vs. 66.40 ± 5.03, p = 0.030). In regard to the assessment of postoperative recovery quality, the emotional state scores in the Sev + Rem group were significantly lower than the Pro + Rem group (36.83 ± 2.79 vs. 39.50 ± 4.64, p = 0.009). The two anesthesia modalities (Sev + Rem and Pro + Rem) have their advantages and disadvantages for patients undergoing laparoscopic bariatric surgery and have comparable effects on postoperative recovery quality.

Effect of sleep deprivation by MMP-WM on rat neurological function and Tau protein in hippocampus.

An in-depth understanding of the pathogenesis and mechanisms of sleep disorders is important for finding reliable treatments and interventions in the future. This study aims to explore the effect of sleep deprivation by modified multiple platform-water maze (MMP-WM) on rat neurological function and Tau protein in the hippocampus, as well as the intervention effect of remimazolam. First, 40 Sprague Dawley (SD) rats were divided into a control group (no treatment), a Rem group (remimazolam), an MMP-WM group (sleep deprivation model in rats established by MMP-WM), and a combined group (MMP-WM + remimazolam). Five rats were randomly selected from each group for behavior tests at 1 d and 7 d of drug administration or sleep deprivation for Morris water maze and open field test. After that, the rats were executed, the hippocampus was isolated for Nissl staining, and the protein expression of phosphorylated Tau (p-Tau) in the CA1 region of the hippocampus was measured by immunohistochemistry. At 1 d, the status in the MMP-WM group was more similar to that in the control group The MMP-WM group showed sparsely arranged hippocampal CA1 neurons, reduced number of Nissl bodies, prolonged escape latency, decreased number of platform crossings and percentage of activity time in the central region, substantially increased p-Tau expression. In contrast, the combined group showed significant improvement in nerve injury, behavior test results, p-Tau at 7 d compared with the MMP-WM group and the same group at 1 d. In addition, detection of brain-derived neurotrophic factor (BDNF) and neurotransmitter levels in the cerebrospinal fluid also showed improved neurologic function in the combined group. These results confirm tha MMP-WM was effective in the establishment of sleep deprivation rat model that accurately reflects the pathological manifestations of sleep disorders in human, and the use of remimazolam effectively reversed the pathological damage in sleep-deprived rats.

The Neuropsychological and Emotional Profile of Adults with Parasomnia: A Case Series

Although parasomnias are nocturnal phenomena occurring during sleep or during arousals from sleep, there is increasing evidence that they are associated with daytime dysfunction as well. However, systematic studies in this field are scarce. The aim of the current case series was to investigate the sleep–wake, neuropsychological and emotional profiles of patients with parasomnias. Thirty patients with parasomnia (13 NREM, 17 REM) and 30 healthy subjects matched for age, sex and educational status were included. All participants underwent comprehensive neuropsychological, cognitive and behavioral evaluation. We found that parasomnia patients scored higher in all neuropsychological, emotional, sleep–wake and quality of life scales compared to healthy subjects. The presence of a parasomnia was associated with major impact on daytime functioning across several domains with increased levels of fatigue (FSS &gt; 4) in 56%, sleepiness (ESS &gt; 10) in 47%, depressive symptoms (BDI &gt; 20) in 17%, anxiety (PSWQ &gt; 52) in 17%, anger expression out (STAXI A &gt; 16) in 27% and anger expression in (STAXI B &gt; 16) in 23%, as well as a reduced average quality of life score (RAND derived from SF-36). Sleep–wake disturbances were significantly correlated with QoL scores. In the intergroup analysis between REM/NREM, we found that the REM group had worse cognitive performance and lower levels of fatigue/energy compared to NREM patients. These findings suggest that parasomnia is associated with difficulties in several aspects of daytime functioning (cognitive, affective/emotional and physical) and, therefore, parasomnia diagnostic workup should not be limited only to nocturnal phenomena.

Remimazolam's Effects on Postoperative Nausea and Vomiting Are Similar to Those of Propofol after Laparoscopic Gynecological Surgery: A Randomized Controlled Trial.

(1) Background: Remimazolam is a novel benzodiazepine that prevents postoperative nausea and vomiting (PONV), is more effective than volatile anesthetics, and was recently approved for use in Japan. (2) Methods: This prospective, double-blind, randomized controlled trial study aimed to compare the efficacy of remimazolam and propofol as general anesthetics in terms of the incidence of PONV after laparoscopic gynecological surgery (UMIN000046237). High-risk female patients who underwent general anesthesia with either remimazolam or propofol for the maintenance of anesthesia were enrolled. The primary outcome was the incidence of PONV in the two groups (i.e., REM versus PROP) 2 h and 24 h after surgery. The incidence of vomiting without nausea, rescue antiemetic use, and the severity of nausea were also evaluated. (3) Results: No significant differences in PONV were identified between the REM and PROP groups at 2 h or 24 h. Furthermore, no differences were observed in any of the measured parameters, and no adverse events were reported. (4) Conclusions: The results of the present study suggest that remimazolam may be as effective as propofol in preventing PONV; however, further investigation is necessary to identify possible differences between these two agents.

Prevalence, associated risk factors, and respiratory event distribution of obstructive sleep apnea in children with Down syndrome.

Children with Down Syndrome (DS) have a high prevalence of obstructive sleep apnea (OSA). We aimed to assess OSA prevalence in a single center cohort of children with DS, identify associated risk factors of obstructive respiratory events, and examine the influence of different sleep stages and body positions on respiratory events distribution. Single center retrospective study that included children with DS who underwent overnight polysomnogram (PSG). OSA severity was categorized by obstructive apnea-hypopnea index (OAHI) as mild (1.5-4.9 events/h), moderate (5-9.9 events/h), and severe (≥ 10 events/h). A logistic regression analysis was used to examine the association between OSA-related risk factors in normal and abnormal OAHI category and in REM and Non-REM predominant AHI groups. PSG data were available for 192 children with a median age of 5years (IQR 7). OSA prevalence was 82.3% (27.1% mild, 19.8% moderate, and 35.4% severe). A logistic regression model identified BMI and being an African American as significant predictors for OAHI severity. In children with OSA, the median OAHI was 7.6 and obstructive respiratory events were more common in REM sleep and in thesupine position. The median REM OAHI was 20 events/h (IQR: 24.4), whereas the median Non-REM OAHI was 5.2 events/h (IQR: 12.6 p < 0.0001). Similarly, supine OAHI was 11.6 (IQR: 19.3) and off supine OAHI was 6.6 (IQR: 11.6, p = 0.0004). Age was a significant predictor (p = 0.012) for Non-REM predominant OSA which was present in 15.2% of children with OSA. Children with DS have a high prevalence of OSA. Higher BMI and being an African American were significant associated risk factors for higher OAHI. Obstructive respiratory events in children with DS occur predominantly in REM sleep and in thesupine position. Non-REM predominant distribution of respiratory events was noted in older children with DS.

The Dichotomy of Wet and Dry Trends Over India by Aerosol Indirect Effects in CMIP5 Models

AbstractAerosol‐cloud interactions, also known as aerosol indirect effect (AIE), substantially impact rainfall frequency and intensity. Here, we analyze NEX‐GDDP, a multimodel ensemble of high‐resolution (0.25°) historical simulations and future projections statistically downscaled from 21 CMIP5 models, to quantify the importance of AIE on extreme climate indices, specifically consecutive dry days (CDD), consecutive wet days (CWD), and simple daily intensity index (SDII). The 21 NEX‐GDDP CMIP5 models are classified into models with reliable (REM) and unreliable (UREM) monsoon climate simulated over India based on their simulations of the climate indices. The REM group is further decomposed based on whether the models represent only the direct (REMADE) or the direct and indirect (REMALL) aerosol effects. Compared to REMADE, including all aerosol effects significantly improves the model skills in simulating the observed historical trends of all three climate indices over India. Specifically, AIE enhances dry days and reduces wet days in India in the historical period, consistent with the observed changes. However, by the middle and end of the 21st century, there is a relative decrease in dry days and an increase in wet days and precipitation intensity. Moreover, the REMALL simulated future CWD and CDD changes are mostly opposite to those in REMADE, indicating the substantial role of AIE in the future projection of dry and wet climates. These findings underscore the crucial role of AIE in future projections of the Indian hydroclimate and motivate efforts to accurately represent AIE in climate models.

Remimazolam decreased the incidence of early postoperative nausea and vomiting compared to desflurane after laparoscopic gynecological surgery.

Postoperative nausea and vomiting (PONV) is a common adverse event after surgery. Remimazolam is a novel sedative agent recently approved for general anesthesia in Japan. This study evaluated the efficacy of remimazolam in the incidence of PONV after laparoscopic gynecological surgery under general anesthesia. This prospective, randomized controlled trial included 64 women who underwent laparoscopic gynecological surgery. The patients were randomly assigned to undergo general anesthesia with either remimazolam (REM group) or desflurane (DES group, n = 30, each group). The primary outcome was the incidence of PONV in the two groups at 2h and 24h after the surgery. The incidence of vomiting, rescue antiemetic use, and severity of nausea were also evaluated. In the REM group, the incidence of PONV (27% versus 60%, respectively; P = 0.02), rescue antiemetic use (0 versus 7, respectively; P = 0.01), and nausea score (P = 0.01) were significantly decreased during the first 2h after surgery. No parameters were significantly different 24h after surgery between the two groups. Remimazolam can reduce the incidence of PONV after laparoscopic gynecological surgery compared to general anesthesia with desflurane during the early postoperative period.

Remifentanil target-controlled infusion with intranasal dexmedetomidine for vitreoretinal procedures: a randomized controlled trial

AimTo evaluate the consumption of remifentanil (as a primary end-point), analgesia, sedation, hemodynamics, respiratory effects, and surgeon and patient satisfaction (as a secondary end-point) with dexmedetomidine sedation compared with those of remifentanil sedation in patients undergoing vitreoretinal surgery.MethodsPatients subjected to retinal ophthalmic surgical procedures were randomized to one of two intraoperative sedation groups: one group (n = 21) received intranasal dexmedetomidine plus intravenous remifentanil (DEX-REMI group), and the other group (n = 19) received intravenous remifentanil only (REM group). The treatment was placebo-controlled. The sedation level was controlled according to the bispectral index, with target values between 80%-90%. Patient levels of comfort, sedation, and pain were documented. The number of intraoperative complications and the level of satisfaction were assessed. Remifentanil consumption and hemodynamic parameters were also included in the statistical analysis.ResultsThe level of remifentanil consumption was significantly lower in the DEX-REMI group, but combination sedation improved the surgeon's, anesthesiologist's, and patients' satisfaction scores. Importantly, the number of complications was zero in the DEX-REMI group, while eight cases of complications were noted in the REM group. The DEX-REMI group showed lower mean minimal arterial pressure, but it was still in the normotensive range.ConclusionsFor patients undergoing ophthalmic procedures, sedation with a combination of intranasal dexmedetomidine and an intravenous infusion of remifentanil provides lower remifentanil consumption, better satisfaction scores, and a lower complication rate than sedation with a remifentanil infusion alone.Clinical trial numberNCT 03251222

Remifentanil injected during analepsia shortens length of postanesthesia care unit stay in patients undergoing laparoscopic surgery for endometrial cancer: a randomized controlled trial.

To guarantee efficient operating room (OR) activity, tracheal extubation is often performed in the postanesthesia care unit (PACU). Therefore, the ability of PACU to accommodate postoperative patients is crucial. Optimizing extubation management may speed up the turnover of PACU beds. The aim of the present study was to investigate the effect of remifentanil, which is used during analepsia, on the length of PACU stay in patients undergoing laparoscopic surgery for endometrial cancer. In this prospective trial, we recruited a total of 99 patients, who were scheduled for laparoscopic surgery for endometrial cancer. At the end of the surgery, all patients were immediately transferred to the PACU and continued mechanical ventilation. Upon PACU admission, sputum aspiration was routinely performed. If the hemodynamic parameters fluctuated >30% of the baseline level, or patients moved unconsciously without reaching the criteria of extubation, a bolus injection of either 1 μg/kg remifentanil (Rem group, n=51) or propofol 1.0 mg/kg (Pro group, n=48) was randomly administered. The primary outcome was the duration of PACU stay. The secondary outcomes included time to respiratory breath recovery and time to extubation, along with bispectral index (BIS) values and hemodynamic status after remifentanil or propofol intervention. Times of repeated intervention, rescue administration of vasoactive drugs, and the incidence of adverse events were recorded. Visual analog scale and satisfaction scores at the time of PACU discharge were also evaluated. The duration of PACU stay was shorter in the Rem group than in the Pro group [49 (46.47-51.06 minutes) vs. 62 minutes (60.75-69.29 minutes), P<0.0001]. Compared with the Pro group, the time to spontaneous breathing recovery, the time to extubation, and the incidence of hypoxemia after extubation were reduced in the Rem group (P<0.0001, P<0.0001, P=0.03, respectively). After anesthetic administration, the BIS value decreased less in the Rem group (P<0.0001); blood pressure and heart rate (HR) declined, but were comparable in both groups. Remifentanil, which is injected during analepsia, significantly shortens the duration of PACU stay without increasing adverse events in the peri-extubation period.

The "respiratory REM sleep without atonia benefit" on coexisting REM sleep behavior disorder - obstructive sleep apnea.

Rapid eye movement sleep behavior disorder (RBD) is a parasomnia characterized by dream-enactment behaviors that emerge during a loss of REM sleep atonia. In patients with RBD, obstructive sleep apneas syndrome (OSAS) frequently occurs as a comorbid entity. It has been reported that the presence of muscle tone during REM sleep (REM sleep without atonia-RSWA) could play a protective role in patients with OSAS RBD. In OSAS, recurrent episodes of complete or partial collapse of the upper airway occur during both, NREM and REM sleep. Particularly during sleep, the withdrawal of excitatory noradrenergic and serotoninergic inputs to the upper airway motor neurons deeply reduces the pharyngeal muscle activity, increasing the propensity for superior airway collapse. The present study compared for the first time the impact of OSAS in RBD patients with a subtype of OSAS patients with predominantly or isolated REM sleep-related OSAS (OSAS REM group) in the search of an adequate model to evaluate future therapeutic strategies. Our study found a significant lower nadir of oximetry values in OSAS RBD in comparison with the OSAS REM group. This reduction, that we called the “respiratory RSWA benefit”, is in accordance with the decrease of the nadir oximetry values observed in patients with Parkinson disease and OSAS with or without RBD. We suggest that the group of OSAS REM patients is a natural model to evaluate the respiratory protective role of RSWA in patients with coexisting RBD-OSAS and Parkinson’s disease.

Discordant biological parameters of remission in acromegaly do not increase the risk of hypertension or diabetes: a study with the Liege Acromegaly Survey database.

Acromegaly is a rare disease due to growth hormone (GH)-secreting pituitary adenoma. GH and IGF-1 levels are usually congruent, indicating either remission or active disease; however, a discrepancy between GH and IGF-1 may occur. We aimed to evaluate the outcome of diabetes mellitus (DM) and hypertension (HT) in acromegalic patients with congruent GH and/or IGF-1 levels vs. discordant biochemical parameters. Retrospective analysis of the data of 3173 patients from the Liege Acromegaly Survey (LAS) allowed us to include 190 patients from 8 tertiary referral centers across Europe, treated by surgery, with available data concerning DM and HT both at diagnosis and at the last follow-up (LFU). We recorded the number of anti-HT and anti-DM drugs used at the first evaluation and at LFU for every patient. Ninety-nine patients belonged to the REM group (concordant parameters), 65 patients were considered as GHdis (high random GH/controlled IGF-1), and 26 patients were considered as IGF-1dis (high IGF-1/controlled random GH). At diagnosis, 72 patients (37.8%) had HT and 54 patients had DM (28.4%). There was no statistically significant difference in terms of the number of anti-HT and anti-DM drugs at diagnosis versus LFU (mean duration: 7.3 ± 4.5 years) between all three groups. The long-term outcome of DM and HT in acromegaly does not tend to be more severe in patients with biochemical discordance in comparison with patients considered as in remission on the basis of concordant biological parameters, suggesting that patients with biochemical discordance do not require a closer follow-up.

SAT-LB60 Discordant Biological Parameters of Remission in Acromegaly Do Not Increase the Risk of Hypertension or Diabetes: A Study With the Liege Acromegaly Survey Database

Introduction: Acromegaly is a rare disease due to growth hormone (GH)-secreting pituitary adenoma. GH and IGF-1 levels are usually congruent, indicating either remission or active disease, however a discrepancy between GH and IGF-1 may occur. We aimed to evaluate the outcome of acromegalic comorbidities in patients with congruent GH and/or IGF-1 levels vs discordant biochemical parameters. Methods: Retrospective analysis of the data of 3173 patients from the Liège Acromegaly Survey (LAS) allowed to include 190 patients from 8 tertiary referral centers across Europe, treated by surgery, with available data concerning diabetes mellitus (DM) and hypertension (HT) both at diagnosis and at last follow-up. We recorded for all the patients the number of antihypertensive and antidiabetic drugs used at the first evaluation and at last follow-up. Results: Ninety-nine patients belonged to the REM group (Concordant parameters), sixty-five patients were considered as GHdis and 26 patients were considered as IGF-1dis. At diagnosis, 63 patients (33.1%) had HT and 54 patients had DM (28.4%). There was no statistically significant difference in terms of number of anti-HT and anti-diabetic drugs at diagnosis versus last follow-up (mean duration=7.3+/-4.5years) between all 3 groups. Discussion: The results highlight that the long-term outcome of acromegaly does not tend to be more severe in patients with biochemical discordance in comparison with patients considered as in remission on the basis of concordant biological parameters, suggesting that patients with biochemical discordance do not require a closer follow-up.

Effects of a Daytime Nap on Primed and Repeated Remote Associates Tests and Relations with Divergent Creativity

The effect of napping versus wakefulness was studied on primed and repeated Remote Associate Tests (RATs) and on divergent creativity tests. The participants were 42 students from the USA, studying international courses at a Swedish university. The hypotheses for the RATs were (1), when the correct answers were primed before the nap, the RAT should be solved better for those who entered REM sleep, compared to those with no REM sleep or a resting condition; and (2), when retested the RAT should be solved better after a nap than after rest. For the creativity tests, hypothesis (3) was that creativity should be higher after the nap than after rest. Hypothesis 1 and hypothesis 3 were not supported. Hypothesis 2 was supported in an ANOVA. The REM group improved more than the rest group on the repeated RAT. Also, the No-REM and rest groups differed, strengthening the importance of both REM and No-REM sleep for creative problem-solving.

Abstract P292: Reversal of Cardiac Remodeling After Surgical Intervention Leads to Distinct Cardiac Function Outcomes

Hypertension is the leading cause of cardiovascular diseases Nevertheless diagnosed hypertension can be controlled and monitored with adequate drug regimens. Yet once cardiac hypertrophy is established, a number of patients develop diastolic cardiac dysfunction resulting from cardiac remodeling with fibrosis and cell death. The present study aims to test the hypothesis that animals with aortic stenosis for five weeks can restore cardiac function after the removal of the aortic constriction. Male mice with 10 weeks of age were randomized in three groups Sham , Rem , and Tac . After five weeks of the establishment of cardiac hypertrophy the aortic constriction was removed and the animals were followed for additional five weeks Rem . The positive control group Tac remained with the clip until ten weeks. Echocardiography was performed after 72 hours of the removal of the five weeks stenosis Rem and at the end of ten weeks. We also used cutoff points based on sham group for the ejection fraction EF≥45% and the ratio of E wave per e’ E/e’≤35 . The Rem group was separated into two outcomes according to the presence of dysfunction. Results were expressed as mean ± standard error of the mean SEM. Statistical analyses were performed and p≤0.05 were considered statistically significant. Septum thickness increased after five weeks of stenosis in both Rem 0.812±0.01mm and Tac 0.764±0.02mm groups as compared to sham group 0.675±0.01mm p≤0.05. Left ventricle mass was significantly different in Sham vs Tac 73.98±2.40mg vs 111.79±11.81mg p&lt;0.0001 After 10 weeks the REM group did not present any hypertrophy markers. Among 18 animals of Rem group, 9 had reduced EF compared to sham after 5 weeks 36.97±1.87%vs52,74±4.17% p&lt;0.0001 and after 10 weeks 49±1.13%vs40±1.06% p&lt;0.0001 constituting an occurrence of systolic problems of 50%. When we analyzed E/e’ 13 animals presented diastolic dysfunction and an increased ratio compared to sham animals 41.07±1.12vs30.79±1.95 p&lt;0.05 at 5 weeks. Therefore, the occurrence of diastolic dysfunction reached 72%. The proposed model induced hypertrophy. Despite that, only half the Rem animals had a reduction in ejection fraction, whereas most developed diastolic dysfunction. These findings open a new path for the investigation of these distinct outcomes

Novel evaluation and treatment techniques for white spot lesions. An in vitro study.

White spot lesions (WSLs) are commonly seen during and after orthodontic treatment. Therefore, the objective of this in vitro study was to assess the effect of 45S5-bioglass in remineralizing WSLs using cross-polarization optical coherence tomography (CP-OCT) and confirm the findings by micro-hardness test. Ceramic orthodontic brackets were bonded to the buccal surface of 45 human premolars with Transbond XT primer followed by Transbond PLUS according to the manufacturer's instructions. Then, all specimens were varnished excluding the area of interest (AOI) around the bonded brackets, immersed in demineralizing solution and divided into three groups: BG, REM and CONT. In BG group, 15 specimens were treated with bioglass paste for 24hours. REM group had 15 specimens stored in remineralization solution for 24hours. CONT group had the remaining 15 specimens with no treatment. All specimens were examined under CP-OCT and tested using cross-sectional micro-hardness techniques. CP-OCT analysis showed that the maximum pixel value after bioglass application was significantly increased at AOI when compared to CONT and REM groups (P>.05), which was confirmed by the cross-sectional micro-hardness results (P>.05). Early enamel demineralization and remineralization can be easily and non-invasively monitored with CP-OCT. Bioglass is a potent remineralizing agent.

Increases in Intrinsic Thalamocortical Connectivity and Overall Cognition Following Cognitive Remediation in Chronic Schizophrenia

BackgroundThalamic projections to the prefrontal cortex (PFC) are critical for cognition, and disruptions in these circuits are thought to underlie the pathophysiology of schizophrenia. Cognitive remediation training (REM) is a behavioral intervention that holds promise for improving cognition and functioning in schizophrenia; however, the extent to which it affects thalamo-prefrontal connections has not been researched. This study sought to determine whether patients with schizophrenia who undergo a placebo-controlled trial of REM show increased functional connectivity between the thalamus and PFC, and whether these changes correspond to improvements in cognition. MethodsTwenty-six patients with chronic schizophrenia were randomized to either 48 hours (over 16 weeks) of a drill-and-practice working memory–focused REM condition or an active placebo condition. All participants underwent cognitive assessment (MATRICS), as well as both resting and task-based functional magnetic resonance imaging before and after their respective intervention. All clinicians, technicians, and raters were blinded to participant condition. ResultsWe observed changes in resting-state connectivity in the PFC for the REM group but not for the placebo group. Increased intrinsic connectivity between the thalamus and right middle frontal gyrus correlated with improvements in overall cognition. Additionally, lower baseline cognition correlated with greater increases in connectivity between the thalamus and PFC. Similar findings were observed when patients were scanned during a working memory task. ConclusionsThese results suggest that increases in thalamo-prefrontal circuitry correspond with training-related improvements of the cognitive deficits associated with schizophrenia.

Sleep before and after learning promotes the consolidation of both neutral and emotional information regardless of REM presence

Sleep may play a role in consolidating emotional memories. However, studies on the effects of REM sleep on negative vs. neutral memories have produced inconsistent evidence. Here, we assess the role of NREM and REM sleep before and after learning in promoting the consolidation of neutral and arousing pleasant and unpleasant memories. Forty-six (32 F) healthy university students were exposed to a set of pictures at 1:00PM (Session 1) and to an equivalent set at 4:45PM (Session 2). All the pictures in Session 1 and Session 2 were presented again, intermixed with new similar pictures at 5:15PM in a memory recognition task. Following Session 1, participants took a 90/120-min nap (NAP group), while 16 participants remained awake (WAKE group). Via polysomnographic recording, the NAP group was segregated into REM (N=14) and NoREM groups (N=16). Indices of memory consolidation for both stimuli presented before (discriminability of Session 1 pictures in Session 3) and after sleep (discriminability of Session 2 pictures in Session 3) were calculated. Memory consolidation for pictures presented both before and after the sleep period was higher in the NAP group as compared to the WAKE group, but no differential role of REM sleep emerged. A memory consolidation advantage was evident for neutral over pleasant (but not unpleasant) pictures. Taken together, these results indicate that a daytime nap (with or without REM sleep) facilitates consolidation of declarative memories presented before and after sleep irrespective of their valence.

Procesos de creación en arquitectura o construcciones ilusorias. Límites difusos en la obra del grupo Utopía

Este articulo busca poner de presente la manera en que los procesos de creacion en arquitectura producen especulaciones sobre el espacio urbano que derivan en discursos pertenecientes al campo del arte -- Para ello se analizaran algunas de las obras bidimensionales del grupo Utopia a traves de discursos propios del arte, la arquitectura y el urbanismo, con el fin de situar su produccion plastica en un horizonte de comprension que a primera vista parece difuso -- El grupo Utopia, conformado por los arquitectos Ana Patricia Gomez, Fabio Antonio Ramirez y Jorge Mario Gomez, constituye uno de los colectivos pioneros en la relacion entre arte y arquitectura en Colombia y se ha encargado, desde 1979, de llevar el lenguaje utilizado en los procesos de diseno arquitectonico a los territorios del arte -- Para el analisis de su obra se acudira tambien a algunos artistas-arquitectos que sirvieron como fuente de referencia desde el panorama internacional a la actividad desarrollada entre 1979 y 1992 por el grupo Utopia, particularmente Rem Koolhaas, Aldo Rossi, Cedric Price, y los colectivos Archigram y Superstudio.

Comparison between remifentanil and dexmedetomidine for sedation during modified awake fiberoptic intubation.

Cricothyroid membrane injections and the application of a coarse fiberoptic bronchoscope (FOB) below the vocal cords for topical anesthesia have a number of limitations for certain patients. Thus, the aim of the present observational study was to assess the effect of a novel modified topical anesthesia method using the effective sedation drugs, remifentanil (Rem) or dexmedetomidine (Dex), during awake fiberoptic orotracheal intubation (AFOI). In total, 90 adult patients, who had been classified as American Society of Anesthesiologists I–II, were included in the study. The patients had anticipated difficult airways and were to undergo orotracheal intubation for elective surgery. The patients were enrolled in the double-blinded randomized pilot study and received Rem or Dex for sedation during the modified AFOI procedure. The two groups received 2% lidocaine for topical anesthesia via an epidural catheter, which was threaded through the suction channel of the FOB. The main clinical outcomes were evaluated by graded scores representing the conditions for intubation and post-intubation. Additional parameters analyzed included airway obstruction, hemodynamic changes, time required for intubation, amnesia level and subjective satisfaction. All 90 patients were successfully intubated using the modified AFOI technique. The comfort scores and airway events during intubation did not significantly differ between the two groups. However, the Rem group experienced less coughing, and less time was required for tracheal intubation when compared with the Dex group. No statistically significant differences were observed in the changes to the mean arterial pressure and heart rate at any time point between the two groups. Therefore, the current study demonstrated that the modified AFOI method is feasible and effective for difficult airway management, and that Dex and Rem exhibit similar efficacy as adjuvant therapies.