To determine the role of early acquisition of blood oxygen level-dependent (BOLD) signals and diffusion tensor imaging (DTI) for analysis of the connectivity of the ascending arousal network (AAN) in predicting neurological outcomes after acute traumatic brain injury (TBI), cardiopulmonary arrest (CPA), or stroke. A prospective analysis of 50 comatose patients was performed during their ICU stay. Image processing was conducted to assess structural and functional connectivity of the AAN. Outcomes were evaluated after 3 and 6 months. Nineteen patients (38%) had stroke, 18 (36%) CPA, and 13 (26%) TBI. Twenty-three patients were comatose (44%), 11 were in a minimally conscious state (20%), and 16 had unresponsive wakefulness syndrome (32%). Univariate analysis demonstrated that measurements of diffusivity, functional connectivity, and numbers of fibers in the gray matter, white matter, whole brain, midbrain reticular formation, and pontis oralis nucleus may serve as predictive biomarkers of outcome depending on the diagnosis. Multivariate analysis demonstrated a correlation of the predicted value and the real outcome for each separate diagnosis and for all the etiologies together. Findings suggest that the above imaging biomarkers may have a predictive role for the outcome of comatose patients after acute TBI, CPA, or stroke.

Objective: The aim of this study was to characterize the capability of detection of the resting state networks (RSNs) with functional magnetic resonance imaging (fMRI) in healthy subjects using a 1.5T scanner in a middle-income country. Materials and methods: Ten subjects underwent a complete blood-oxygen-level dependent imaging (BOLD) acquisition on a 1.5T scanner. For the imaging analysis, we used the spatial independent component analysis (sICA). We designed a computer tool for 1.5 T (or above) scanners for imaging processing. We used it to separate and delineate the different components of the RSNs of the BOLD signal. The sICA was also used to differentiate the RSNs from noise artifact generated by breathing and cardiac cycles. Results: For each subject, 20 independent components (IC) were computed from the sICA (a total of 200 ICs). From these ICs, a spatial pattern consistent with RSNs was identified in 161 (80.5%). From the 161, 131 (65.5%) were fit for study. The networks that were found in all subjects were: the default mode network, the right executive control network, the medial visual network, and the cerebellar network. In 90% of the subjects, the left executive control network and the sensory/motor network were observed. The occipital visual network was present in 80% of the subjects. In 39 (19.5%) of the images, no any neural network was identified. Conclusions: Reproduction and differentiation of the most representative RSNs was achieved using a 1.5T scanner acquisitions and sICA processing of BOLD imaging in healthy subjects.

Antecedentes. Parte de la enseñanza-aprendizaje en las residencias médicas se genera con los compañeros de residencia; los programas de residentes como docentes (PRCD) fortalecen esta práctica pedagógica. Objetivos. Analizar los principios curriculares de un PRCD siguiendo la postura de Tyler e identificar las estrategias educativas que cambian el comportamiento en el aprendizaje del residente y en la organización educativa según el modelo de Kirkpatrick. Métodos. Se realizó una revisión de revisiones sistemáticas en MEDLINE, EMBASE, ERIC, EPISTEMONIKOS, The Cochrane Database of Systematic Reviews y LILACS. La calidad global fue evaluada usando la herramienta AMSTAR. Por medio de la literatura publicada, se respondió a la postura curricular de Tyler al describir las estrategias educativas, su evaluación e impacto de la evaluación según Kirkpatrick. Resultados. Se incluyeron siete revisiones sistemáticas; una de ellas obtuvo alta calidad metodológica. Según la literatura, un PRCD requiere una valoración continua de sus participantes. Las estrategias educativas más usadas fueron el taller y el seminario. Los temas que pueden incluirse en el PRCD son liderazgo, habilidades de enseñanza al lado del paciente, evaluación y retroalimentación. En la práctica, actividades pedagógicas similares a One-minute preceptor pueden ser fomentadas. El seguimiento de los PRCD requiere de la observación directa por medio de los OSTE (ejercicios de enseñanza estructurados y objetivos). Conclusiones. El PRCD tiene como finalidad la generación de momentos de enseñanza que alimenten la reflexión de la práctica pedagógica. El PRCD debe contar con estrategias educativas que aumenten la confianza en la enseñanza, habilidades pedagógicas y evaluaciones válidas de la práctica docente. Background. Part of the teaching-learning in medical residences is generated with the residence partners; Programs of resident- as-teachers (PRAT) strengthen this pedagogical practice. Objectives. To analyze curricular principles of a PRAT according to Tyler's posture and to identify educational strategies that change behavior in resident learning and educational organization according to Kirkpatrick model. Methods. A review of systematic reviews was conducted in MEDLINE, EMBASE, ERIC, EPISTEMONIKOS, The Cochrane Database of Systematic Reviews and LILACS. The overall quality was evaluated using the AMSTAR tool. Through the published literature, Tyler's curriculum posture was answered by describing educational strategies, their evaluation and impact of evaluation according to Kirkpatrick. Results. Seven systematic reviews were included; one of them obtained high methodological quality. According to the literature, a PRAT requires continuous evaluation of its participants. The most used educational strategies were the workshop and the seminar. Topics that can be included in PRAT are leadership, bedside teaching skills, evaluation, and feedback. In practice, pedagogical activities similar to One-minute preceptor can be encouraged. The monitoring of the PRCD requires direct observation through OSTE (Objective Structured Teaching Exercises). Conclusions. The PRAT aims to generate teaching moments that feed the reflection of pedagogical practice. The PRAT must have educational strategies that increase confidence in teaching, pedagogical skills, and valid assessments of teaching practice.

Object: To determine the role of early acquisition of blood oxygen level-dependent (BOLD) signals and diffusion tensor imaging (DTI) for analysis of the connectivity of the ascending arousal network (AAN) in predicting neurological outcomes after acute traumatic brain injury (TBI), cardiopulmonary arrest (CPA), or stroke.Methods: A prospective analysis of 50 comatose patients was performed during their ICU stay. Image processing was conducted to assess structural and functional connectivity of the AAN. Outcomes were evaluated after 3 and 6 months.Results: Nineteen patients (38%) had stroke, 18 (36%) CPA, and 13 (26%) TBI. Twenty-three patients were comatose (44%), 11 were in a minimally conscious state (20%), and 16 had unresponsive wakefulness syndrome (32%). Univariate analysis demonstrated that measurements of diffusivity, functional connectivity, and numbers of fibers in the gray matter, white matter, whole brain, midbrain reticular formation, and pontis oralis nucleus may serve as predictive biomarkers of outcome depending on the diagnosis. Multivariate analysis demonstrated a correlation of the predicted value and the real outcome for each separate diagnosis and for all the etiologies together.Conclusion: Findings suggest that the above imaging biomarkers may have a predictive role for the outcome of comatose patients after acute TBI, CPA, or stroke.