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こもれび Heart LINK クラブのグループ

Hunter Montgomery
Hunter Montgomery

RefleX !FREE!

Currently variety of career development tools is available, some of them are formal and structured, other are based on informal and self-directed approach. But how to ensure that these tools, usually designed for the use in certain research environments, can be transferred to other contexts? And how to make them more reflexive to the increasing variability of career patterns and opportunities which arise with the creation of brand new jobs in the near future?


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From the root of a Reflex Platform checkout, run ./scripts/hack-on haskell-overlays/reflex-packages/dep/reflex. This will check out the reflex source code into the haskell-overlays/reflex-packages/dep/reflex directory. You can then point that checkout at your fork, make changes, etc. Use the ./try-reflex or ./scripts/work-on scripts to start a shell in which you can test your changes.

Reflexes are involuntary movements or actions. Some movements are spontaneous and occur as part of the baby's normal activity. Others are responses to certain actions. Healthcare providers check reflexes to determine if the brain and nervous system are working well. Some reflexes occur only in specific periods of development. The following are some of the normal reflexes seen in newborn babies:

This reflex starts when the corner of the baby's mouth is stroked or touched. The baby will turn his or her head and open his or her mouth to follow and root in the direction of the stroking. This helps the baby find the breast or bottle to start feeding. This reflex lasts about 4 months.

Rooting helps the baby get ready to suck. When the roof of the baby's mouth is touched, the baby will start to suck. This reflex doesn't start until about the 32nd week of pregnancy and is not fully developed until about 36 weeks. Premature babies may have a weak or immature sucking ability because of this. Because babies also have a hand-to-mouth reflex that goes with rooting and sucking, they may suck on their fingers or hands.

When a baby's head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow. This is often called the fencing position. This reflex lasts until the baby is about 5 to 7 months old.

Stroking the palm of a baby's hand causes the baby to close his or her fingers in a grasp. The grasp reflex lasts until the baby is about 5 to 6 months old. A similar reflex in the toes lasts until 9 to 12 months.

Some people do outgrow their seizures, but the decrease in the chance for seizures may not happen for many years: 75% of people with photosensitive reflex epilepsy continue to have seizures after age 25 if not treated.

Clinically, the Bezold-Jarisch reflex is an inhibitory reflex usually denoted as a cardioinhibitory reflex defined as bradycardia, vasodilation, and hypotension resulting from stimulation of cardiac receptors.

The Bezold-Jarisch reflex (BJR) was initially used an eponym for the triad of responses (apnea, bradycardia, and hypotension) following intravenous injection of veratrum alkaloids in experimental animals. The triad depends on intact vagi and is mediated through cranial nervous medullary centers controlling respiration, heart rate, and vasomotor tone.

The Bezold-Jarisch reflex originates from inhibitory mechanoreceptors in the left ventricle (particularly the inferoposterior wall). Stimulation of these inhibitory cardiac receptors by stretch (poorly filled ventricle), chemical substances or drugs increases renin and vasopressin release and parasympathetic activity and inhibits sympathetic activity. These effects promote reflex bradycardia, vasodilation and hypotension (Bezold-Jarisch reflex).

1937-1940 Adolf Jarisch, Jr (1891-1965) and colleagues investigated the effects of viscum album and of veratrine. They confirmed that the depressor effect was reflex in origin. Like von Bezold and Hirt, Jarisch believed that the sensory receptors were in the heart because the effect could be produced after removal of one lung and section of the vagus nerves to the other. They termed the response the Bezold effect

First described in 1908, the oculocardicac reflex (OCR; also known as the Aschner reflex or trigeminovagal reflex) is a reduction of the heart rate resulting from direct pressure placed on the extraocular muscles (EOM), globe, or conjunctiva.[1] The reflex is defined by a decrease in heart rate by greater than 20% following the exertion of the aforementioned eye pressure.[2] The reflex is mediated by the connection between the ophthalmic branch of the trigeminal nerve and the vagus nerve. Most commonly, the reflex induces bradycardia, though it has also been reported to cause arrhythmias and, in extreme cases, cardiac arrest. The reflex has most often been encountered during ophthalmologic procedures such as strabismus surgery, though it has also been seen in cases of facial trauma, regional anesthetic nerve blocks, and mechanical stimulation.[3] Historically, the oculocardiac reflex was used as a diagnostic tool to evaluate syncope, as well as to terminate supraventricular tachycardias, but this is no longer done given the limited clinical application and the associated risks.[4]

The OCR arc is comprised of an afferent limb (carried by the trigeminal nerve (CN V)) and an efferent limb (carried by the vagus nerve (CN X)). The reflex begins with the activation of stretch receptors in periorbital and ocular tissues. The long and short ciliary nerves carry the impulses to the ciliary ganglion, where the ophthalmic division of CN V carries the impulses to the Gasserian ganglion, and subsequently to the trigeminal nucleus. The afferent nerves synapse with the visceral motor nucleus of the vagus nerve in the reticular formation of the brain stem, where the impulses are then carried to the myocardium to activate the vagal motor response at the sinoatrial (SA) node, resulting in bradycardia.[5]

Incidence of the OCR varies widely in literature depending on the clinical conditions. Two studies reported the incidence of the OCR during strabismus surgery as 56% and 68%, while rates were lower in facial surgery (specifically an orbitozygomatic approach), where the rate was 31.7%.[6][7] Incidence of the OCR does appear to decrease with age, with the pediatric population being most at risk.[2] Pediatric patients are not only more likely to be in a situation where the reflex is triggered (i.e., strabismus surgery), but they are also at higher risk of susceptibility to worse outcomes due to their higher dependence on heart rate to maintain cardiac output as compared to adults.[8] There does not appear to be a clear consensus on whether incidence is dependent the specific extraocular muscle (EOM). One source mentions that the medial rectus muscle is particularly sensitive to the induction of the OCR, while other studies show that the EOM being operated on makes no significant difference in the occurrence of the reflex.[9][10] Though incidence is reportedly higher in younger populations, the reflex occurs in adults and has been seen during many facial trauma surgeries with stimulation of the branches of the trigeminal nerve.[11]

Intra-operative diagnosis is made based on the acute change in cardiac function during facial/ocular surgery, where the trigeminal nerve may be involved. The reflex should be suspected in anyone who has a sudden drop in heart rate that is not attributable to other causes and the patient should be stabilized prior to continuing on with the surgery.[2] Patients who are considered at-risk for the OCR should warrant particular attention [see Management for more].

When patients who have sustained ocular trauma (particularly orbital fractures) present with symptoms described in the previous section and OCR is suspected, an electrocardiogram (ECG) should be performed to assess cardiac function. If heart block is present, immediate surgery is indicated. Not only could this prevent death from fatal arrhythmias induced by the reflex, but it will improve outcomes for ocular motility as well.[14] The OCR can evolve over time, so the patient needs to be monitored closely for changes to their wellbeing and stability.[15]

The use of prophylaxis for the OCR and its efficacy has been long debated. The consensus is that most pediatric patients who are undergoing strabismus surgery should be treated with prophylactic IV anticholinergics (glycopyrrolate has been shown to be somewhat more effective with a 5% reduction in OCR incidence versus the 2% reduction from atropine ). Oral or IM administration for preoperative treatments is less effective and not recommended. Those who oppose using atropine as a prophylactic measure worry that atropine itself can cause dysrhythmias (i.e. ventricular tachycardia and ventricular fibrillation). These dysrhythmias can be more concerning and more difficult to mitigate than those caused by the OCR; these consequences are also more common in adult patients, making the use of prophylaxis in adults less favorable. Given that healthy pediatric patients can typically tolerate the tachycardic effects of atropine, administration of the prophylaxis should be safe in this population. Retrobulbar blocks have been shown to be effective in the prevention of the OCR, though they are not commonly used during pediatric procedures and have been known to trigger the reflex during their placement. One study found that administration of topical lidocaine was associated with a 60% decrease in the incidence of the OCR, though the study had a limited sample size and this topic has not been studied since then.[3] 041b061a72




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