Langzeitmedikation und perioperatives Management

Zusammenfassung: Anästhesisten und Operateure sehen sich zunehmend mit Patienten konfrontiert, die unter einer medikamentösen Dauertherapie stehen. Ein Teil dieser Medikamente können mit Anästhetika oder anästhesiologischen und/oder chirurgischen Interventionen interagieren. Als Folge können Komplikationen wie Blutungen, Ischämien, Infektionen oder schwere Kreislaufreaktionen auftreten. Andererseits birgt oft gerade das perioperative Absetzen von Medikamenten die größere Gefahr. Der Anteil ambulant durchgeführter Operationen hat in den letzten Jahren stark zugenommen und wird voraussichtlich auch in Zukunft zunehmen. Seit Einführung der Fallpauschalen (in der Schweiz bevorstehend) wird der Patient in der Regel erst am Vortag der Operation stationär aufgenommen. Somit sind sowohl zuweisende Ärzte als auch Anästhesisten und Operateure gezwungen, sich frühzeitig mit Fragen der perioperativen Pharmakotherapie auseinanderzusetzen. Dieser Übersichtsartikel behandelt das Management der wichtigsten Medikamentenklassen während der perioperativen Phase. Neben kardial und zentral wirksamen Medikamenten und Wirkstoffen, welche auf die Hämostase und das endokrine System wirken, werden Spezialfälle wie Immunsuppressiva und Phytopharmaka behandel

Fundamental progress in investigating drug resistance with electronic multidrug compliance monitoring (e-MCM)

Current definitions of drug resistance are shaped by the pharmacotherapeutic fields they occurred in. They usually mention various contributing factors and refer either to the clinical or the biomarker level. Particular attention has been attracted by antiplatelet resistance, a phenomenon with clinical, cellular and pharmacogenetical contributors. However, the impact of every single factor to antiplatelet resistance in outpatients under prescribed antiplatelet therapy has not been comprehensively evaluated so far, neither has the temporal pattern of drug intake been studied as a possible contributor

Measuring the effects through time of the influence of visuomotor and visuotactile synchronous stimulation on a virtual body ownership illusion

Previous studies have examined the experience of owning a virtual surrogate body or body part through specific combinations of cross-modal multisensory stimulation. Both visuomotor (VM) and visuotactile (VT) synchronous stimulation have been shown to be important for inducing a body ownership illusion, each tested separately or both in combination. In this study we compared the relative importance of these two cross-modal correlations, when both are provided in the same immersive virtual reality setup and the same experiment. We systematically manipulated VT and VM contingencies in order to assess their relative role and mutual interaction. Moreover, we present a new method for measuring the induced body ownership illusion through time, by recording reports of breaks in the illusion of ownership ("breaks") throughout the experimental phase. The balance of the evidence, from both questionnaires and analysis of the breaks, suggests that while VM synchronous stimulation contributes the greatest to the attainment of the illusion, a disruption of either (through asynchronous stimulation) contributes equally to the probability of a break in the illusion

Consecutive alcoholic fermentations of white grape musts with yeasts immobilized on grape skins : effect of biocatalyst storage and SO2 concentration on wine characteristics

Abstract Saccharomyces cerevisiae yeasts, immobilized by natural adsorption on grape skins, were used to carry out the alcoholic fermentation step of a winemaking process. The viability of the immobilized cells was evaluated by the implementation of 7 successive fermentations of a white grape must containing 30 mg/L of SO2. The time to complete alcoholic fermentation, the physicochemical characteristics of the produced wines (ethanol, glycerol, organic acids, volatile compounds, color) and sensory properties were evaluated. A traditional fermentation with free cells was used as control. Three other fermentations were conducted after storage of the immobilized biocatalyst (30 d, 4 oC), the first one in the same conditions of the earlier assays, and the other two with higher amounts of SO2 (60 mg/L, 90 mg/L). Wines produced with immobilized cells presented physicochemical and sensory characteristics similar to those traditionally produced with free cells. After three consecutive fermentations, chromatic characteristics became similar to those of traditional wines, but the fermentation time had been reduced from 7 d to 4 d. The fermentative process and the characteristics of the produced wines were not significantly affected by the use of higher amounts of SO2. Immobilized biocatalysts could be stored at least one month without losing its activity.Zlatina Genisheva gratefully acknowledges FCT (Contract/grant number: SFRH/BD/48186/2009) and the Project "BioInd - Biotechnology and Bioengineering for improved Industrial and Agro-Food processes", REF. NORTE-07-0124-FEDER-000028 Co-funded by the Programa Operacional Regional do Norte (ON.2 - O Novo Norte), QREN, FEDER, for the financial support of this work

The infuence of skin colour on the experience of ownership in the rubber hand illusion

Racial prejudice is associated with a fundamental distinction between "us" and "them"-a distinction linked to the perceived overlap between representations of the self and others. Implicit prejudice has been shown to reduce the intensity of White individuals' hand ownership sensation as induced by the Rubber Hand Illusion (RHI) with dark rubber hands. However, evidence for this link to implicit prejudice comes from self-report questionnaire data regarding the RHI. As an alternative, we assessed the onset time of the RHI. We hypothesized that onset time of the RHI would be higher for the black compared to the white RH, acting as the mediator between implicit prejudice and magnitude of the RH illusion and proprioceptive drift. As expected, participants took longer to incorporate the black RH and presented lower RH illusion magnitude and a smaller proprioceptive drift for the black RH. Mediation analysis revealed a significant indirect effect of implicit racial bias on proprioceptive drift and magnitude of illusion through onset time to illusion only for the black RH. These findings further illuminate the connection between implicit prejudice and embodied perception, suggesting new perspectives on how implicit biases operate.This work was supported by Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq; grant numbers: 466922/2014-0 and 401143/2014-7).info:eu-repo/semantics/publishedVersio

Changing the size of a mirror-reflected hand moderates the experience of embodiment but not proprioceptive drift: a repeated measures study on healthy human participants.

Mirror visual feedback is used for reducing pain and visually distorting the size of the reflection may improve efficacy. The findings of studies investigating size distortion are inconsistent. The influence of the size of the reflected hand on embodiment of the mirror reflection is not known. The aim of this study was to compare the effect of magnifying and minifying mirror reflections of the hand on embodiment measured using an eight-item questionnaire and on proprioceptive drift. During the experiment, participants (n = 45) placed their right hand behind a mirror and their left hand in front of a mirror. Participants watched a normal-sized, a magnified and a minified reflection of the left hand while performing synchronised finger movements for 3 min (adaptive phase). Measurements of embodiment were taken before (pre) and after (post) synchronous movements of the fingers of both hands (embodiment adaptive phase). Results revealed larger proprioceptive drift post-adaptive phase (p = 0.001). Participants agreed more strongly with questionnaire items associated with location, ownership and agency of the reflection of the hand post-adaptive phase (p < 0.001) and when looking at the normal-sized reflection (p < 0.001). In conclusion, irrespective of size, watching a reflection of the hand while performing synchronised movements enhances the embodiment of the reflection of the hand. Magnifying and minifying the reflection of the hand has little effect on proprioceptive drift, but it weakens the subjective embodiment experience. Such factors need to be taken into account in future studies using this technique, particularly when assessing mirror visual feedback for pain management

The role of the right temporoparietal junction in perceptual conflict: detection or resolution?

The right temporoparietal junction (rTPJ) is a polysensory cortical area that plays a key role in perception and awareness. Neuroimaging evidence shows activation of rTPJ in intersensory and sensorimotor conflict situations, but it remains unclear whether this activity reflects detection or resolution of such conflicts. To address this question, we manipulated the relationship between touch and vision using the so-called mirror-box illusion. Participants' hands lay on either side of a mirror, which occluded their left hand and reflected their right hand, but created the illusion that they were looking directly at their left hand. The experimenter simultaneously touched either the middle (D3) or the ring finger (D4) of each hand. Participants judged, which finger was touched on their occluded left hand. The visual stimulus corresponding to the touch on the right hand was therefore either congruent (same finger as touch) or incongruent (different finger from touch) with the task-relevant touch on the left hand. Single-pulse transcranial magnetic stimulation (TMS) was delivered to the rTPJ immediately after touch. Accuracy in localizing the left touch was worse for D4 than for D3, particularly when visual stimulation was incongruent. However, following TMS, accuracy improved selectively for D4 in incongruent trials, suggesting that the effects of the conflicting visual information were reduced. These findings suggest a role of rTPJ in detecting, rather than resolving, intersensory conflict

A Gamification Engine Architecture for Enhancing Behavioral Change Support Systems

This paper presents a gamified framework designed to offer behavioural change support and treatment adherence services to people living with Dementia (PLWD), their caregivers and medical/social professionals

Seeing through each other's hearts: Inferring others' heart rate as a function of own heart rate perception and perceived social intelligence

Successful social interactions require a good understanding of the emotional states of other people. This information is often not directly communicated but must be inferred. As all emotional experiences are also imbedded in the visceral or interoceptive state of the body (i.e., accelerating heart rate during arousal), successfully inferring the interoceptive states of others may open a window into their emotional state. But how well can people do that? Here, we replicate recent results showing that people can discriminate between the cardiac states (i.e., the resting heartrate) of other people by simply looking at them. We further tested whether the ability to infer the interoceptive states of others depends on one's own interoceptive abilities. We measured people's performance in a cardioception task and their self-reported interoceptive accuracy. Whilst neither was directly associated to their ability to infer the heartrate of another person, we found a significant interaction. Specifically, overestimating one's own interoceptive capacities was associated with a worse performance at inferring the heartrate of others. In contrast, underestimating one's own interoceptive capacities did not have such influence. This pattern suggests that deficient beliefs about own interoceptive capacities can have detrimental effects on inferring the interoceptive states of other people

Impairment of Auditory-Motor Timing and Compensatory Reorganization after Ventral Premotor Cortex Stimulation

Integrating auditory and motor information often requires precise timing as in speech and music. In humans, the position of the ventral premotor cortex (PMv) in the dorsal auditory stream renders this area a node for auditory-motor integration. Yet, it remains unknown whether the PMv is critical for auditory-motor timing and which activity increases help to preserve task performance following its disruption. 16 healthy volunteers participated in two sessions with fMRI measured at baseline and following rTMS (rTMS) of either the left PMv or a control region. Subjects synchronized left or right finger tapping to sub-second beat rates of auditory rhythms in the experimental task, and produced self-paced tapping during spectrally matched auditory stimuli in the control task. Left PMv rTMS impaired auditory-motor synchronization accuracy in the first sub-block following stimulation (p<0.01, Bonferroni corrected), but spared motor timing and attention to task. Task-related activity increased in the homologue right PMv, but did not predict the behavioral effect of rTMS. In contrast, anterior midline cerebellum revealed most pronounced activity increase in less impaired subjects. The present findings suggest a critical role of the left PMv in feed-forward computations enabling accurate auditory-motor timing, which can be compensated by activity modulations in the cerebellum, but not in the homologue region contralateral to stimulation