Immediate and delayed flap reconstruction have equivalent outcomes and associated costs following soft tissue sarcoma surgery.

BACKGROUND AND OBJECTIVES: Surgical treatment of soft tissue sarcoma (STS) involves wide resection of the tumor, which can necessitate soft tissue reconstruction with local or free tissue flaps. This retrospective study compares cost, surgical and oncologic outcomes between patients undergoing reconstruction with immediate versus delayed flap coverage following STS resection. METHODS: Thirty-four patients who underwent planned flap reconstruction following resection of primary STS were identified retrospectively. Twenty-four (71%) received immediate reconstruction during the index surgery and 10 (29%) underwent planned delayed reconstruction. Preoperative patient-specific metrics, tumor characteristics, and surgical and patient outcomes were collected. Total hospital charges associated with every encounter during the perioperative period were obtained. RESULTS: Patient demographics, comorbidities, tumor metrics, and surgical characteristics were equivalent between groups. Postoperative wound complications, reoperations, readmissions, and disease-specific survival did not differ between cohorts. Costs associated with each reconstruction strategy were equivalent on bivariate and multivariate testing, when accounting for operating room time, hospital length of stay, and reoperation rate. CONCLUSIONS: Our study identifies no significant difference in patient outcome measures or cost between planned immediate and delayed flap reconstruction following STS resection. These results support the implementation of either treatment strategy in keeping with patient-centered, multidisciplinary care principles.

Ingurgitación mamaria desde la fisioterapia a través de agentes físicos y técnicas manuales: revisión sistemática con meta-análisis / Breast Engorgement from Physical Therapy using Physical Agents and Manual Techniques: A Systematic Review with Meta-analysis / O ingurgitamento mamário abordado a partir da fisioterapia por meio de agentes físicos e técnicas manuais: revisão sistemática com meta-análise

Objetivo:analizar la evidencia de estudios previos sobre las diferentes alternativas de tratamientos con el uso de agentes físicos y técnicas manuales utilizados en la fisioterapia para la ingurgitación mamaria a nivel internacional. Material y método:estudio de revisión sistemática con meta-análisis según el pro-tocolo prisma. Búsqueda en las bases de datos de Scopus y Medline a través de PubMed, publicados desde el 01 de enero de 2015 hasta el 31 de diciembre de 2021. La estrategia de búsqueda empleó los siguien-tes términos: breastengorgement, treatment, breastfeeding, six-pointengorgementscale, physiotherapy, breastcancer, physicaltherapy. Los 5 estudios elegidos para esta revisión sistemática fueron valorados con la Escala pedro para conocer la calidad metodológica. Resultados:diferencias medias estandarizadas oscilaron entre 0,5959 y 2,7373, la mayoría de las estimaciones positivas. El resultado promedio difirió significativamente de cero (z = 3,5686, p = 0,0004). Según prueba Q, los resultados reales parecen ser heterogéneos (Q (5) = 23,2212, p = 0,0003, tau² = 0,4759, I² = 83,6163%). Intervalo de predicción del 95 % para los resultados reales viene dado por -0,3733 a 2,5931. Un intervalo de predicción del 95 % para los resultados reales viene dado por -3,6762 a 11,5933. Conclusiones: las técnicas estudiadas disminuyen el dolor y la congestión mamaria, sin embargo, se ha visto que la combinación entre ellas puede favorecer aún más la mejora de los mismos. Al aplicarse en las mujeres con ingurgitación generaron beneficios a corto y largo plazo para disminuir el dolor y la ingurgitación mamaria

Objective: To analyze the evidence of previous studies on the different treatment alternatives with the use of physical agents and manual techniques used in physiotherapy for breast engorgement at an international level. Method: Systematic review study with meta-analysis according to the prisma pro-tocol. Search in Scopus and Medline databases through PubMed, published from January 1, 2015 to December 31, 2021. The search strategy employed the following terms: breast engorgement, treatment, breastfeeding, six-point engorgement scale, physiotherapy, breast cancer, Physical therapy. The 5 stu-dies chosen for this systematic review were assessed with the PEDro Scale for methodological quality. Results: Standardized mean differences ranged from 0.5959 to 2.7373, most of the positive estimates. The average result differed significantly from zero (z = 3.5686; p = 0.0004). According to Q test, the actual results appear to be heterogeneous (Q(5) = 23.2212; p = 0.0003; tau² = 0.4759; I² = 83.6163%). The 95% prediction interval for the actual results is given by −0.3733 to 2.5931. A 95% prediction interval for the actual results is given by −3.6762 to 11.5933. Conclusions: The techniques studied decrease breast pain and engorgement; however, it has been seen that the combination between them can further favor their improvement. When applied in women with engorgement, they generated short and long term benefits in reducing pain and breast engorgement

Objetivo: analisar as evidências de estudos anteriores sobre as diferentes alternativas de tratamento com uso de agentes físicos e técnicas manuais utilizadas na fisioterapia para ingurgitamento mamá-rio internacionalmente. Material e método: estudo de revisão sistemática com meta-análise segundo protocolo prisma. Pesquisa nas bases de dados Scopus e Medline por meio do PubMed, publicadas de 1º de janeiro de 2015 a 31 de dezembro de 2021. A estratégia de busca utilizou os seguintes termos: breastingorgement, treatment, breastfeeding, six-pointengorgementscale, physiotherapy, breastcancer, physi-caltherapy. Os 5 estudos escolhidos para esta revisão sistemática foram avaliados com a Escala pedro para determinar a qualidade metodológica. Resultados: as diferenças médias padronizadas variaram de 0,5959 a 2,7373, com a maioria das estimativas positivas. O resultado médio diferiu significativamente de zero (z = 3,5686, p = 0,0004). Segundo o teste Q, os resultados reais parecem ser heterogêneos (Q (5) = 23,2212, p = 0,0003, tau² = 0,4759, I² = 83,6163%). O intervalo de previsão de 95% para resultados reais é dado por -0,3733 a 2,5931. Um intervalo de previsão de 95% para os resultados reais é dado por -3,6762 a 11,5933. Conclusões: as técnicas estudadas reduzem a dor e a congestão mamária, porém, constatou-se que a combinação entre elas pode melhorar ainda mais a sua melhora. Quando aplicados em mulheres 2024com ingurgitamento, geraram benefícios de curto e longo prazo para reduzir a dor e o ingurgitamento mamário.

Experimentally-guided in silico design of engineered heart tissues to improve cardiac electrical function after myocardial infarction.

Engineered heart tissues (EHTs) built from human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) showed promising results for cardiac function restoration following myocardial infarction. Nevertheless, human iPSC-CMs have longer action potential and lower cell-to-cell coupling than adult-like CMs. These immature electrophysiological properties favor arrhythmias due to the generation of electrophysiological gradients when hiPSC-CMs are injected in the cardiac tissue. Culturing hiPSC-CMs on three-dimensional (3D) scaffolds can promote their maturation and influence their alignment. However, it is still uncertain how on-scaffold culturing influences the overall electrophysiology of the in vitro and implanted EHTs, as it requires expensive and time consuming experimentation. Here, we computationally investigated the impact of the scaffold design on the EHT electrical depolarization and repolarization before and after engraftment on infarcted tissue. We first acquired and processed electrical recordings from in vitro EHTs, which we used to calibrate the modeling and simulation of in silico EHTs to replicate experimental outcomes. Next, we built in silico EHT models for a range of scaffold pore sizes, shapes (square, rectangular, auxetic, hexagonal) and thicknesses. In this setup, we found that scaffolds made of small (0.2 mm2), elongated (30° half-angle) hexagons led to faster EHT activation and better mimicked the cardiac anisotropy. The scaffold thickness had a marginal role on the not engrafted EHT electrophysiology. Moreover, EHT engraftment on infarcted tissue showed that the EHT conductivity should be at least 5% of that in healthy tissue for bidirectional EHT-myocardium electrical propagation. For conductivities above such threshold, the scaffold made of small elongated hexagons led to the lowest activation time (AT) in the coupled EHT-myocardium. If the EHT conductivity was further increased and the hiPSC-CMs were uniformly oriented parallel to the epicardial cells, the total AT and the repolarization time gradient decreased substantially, thus minimizing the likelihood for arrhythmias after EHT transplantation.

Estado nutricional y actividad física en estudiantes universitarios. Una revisión sistemática

El objetivo del presente trabajo fue sintetizar la evidencia de estudios previos sobre la relación entre los niveles del estado nutricional y la actividad física en estudiantes universitarios. Las estrategias de búsqueda siguieron las directrices de la declaración PRISMA y se basaron en los términos: "Physical activity" and "Nutritional Status" and "University Students". En las siguientes bases de datos de revistas académicas: Web of Science (Core Collection), Scopus, Medline a través de Pubmed y Scielo. La revisión sistemática se realizó con 12 estudios seleccionados. Cinco estudios se realizaron en estudiantes universitarios de Europa para un 42% del total), seis en Latinoamérica para un 50%, y uno en Asia que representa un 8%. La suma de las muestras de los estudios fue de 5071 estudiantes (X= 422,6). En 4 estudios el muestreo fue probabilístico en sus diferentes tipos (33,3%). La mayor parte de los estudios fueron de tipo descriptivos transversales (7 para un 58,2%), 3 estudios de tipo correlacionales (25%), un estudio de tipo analítico y un estudio cuasi experimental (8,4% cada uno). El estado nutricional y la actividad física tuvieron una relación inversamente proporcional. Predominaron los niveles moderados de obesidad y de práctica de actividad física.

We aim to synthesize evidence from previous studies on the relationship between nutritional status levels and physical activity in university students. The search strategies followed the guidelines of the PRISMA statement and were based on the terms: "Physical activity" "Nutritional Status" and "University Students". In the following academic journal databases: Web of Science (Core Collection), Scopus, Medline through Pubmed, and Scielo. The systematic review was carried out with 12 selected studies. Five studies were conducted on university students in Europe (42% of the total), six in Latin America (50%), and one in Asia (8%). The sum of the study samples was 5071 students (X= 422.6). In 4 studies the sampling was probabilistic in its different types (33.3%). Most of the studies were descriptive cross-sectional studies (7 for 58.2%), 3 correlational studies (25%), one analytical study, and one quasi-experimental study (8.4% each). Nutritional status and physical activity had an inversely proportional relationship. Moderate levels of obesity and physical activity were predominant.

Ballistic Facial Trauma Reconstruction: Incidence and Practice Patterns in the Civilian Population.

BACKGROUND: Management of nonfatal ballistic facial trauma is well described in the literature for wounds secondary to military combat. However, there is little literature describing such management in civilian practice. We aimed to describe nonmilitary patients with recent nonfatal facial injuries from ballistic trauma using the California Office of Statewide Health Planning and Development patient database. METHODS: A retrospective study was performed using the California Office of Statewide Health Planning and Development Ambulatory Surgery and Inpatient datasets. All adults with the International Classification of Diseases, 10th Revision codes of severe nonfatal facial trauma from firearms requiring emergent surgery during 2016-2018 were included. Outcomes assessed include number and type of facial procedures performed, hospital length of stay, number of admissions, timing of definitive management, and lifetime hospitalization costs. RESULTS: A total of 331 traceable patients were identified over this 3-year period. The average age was 35.4 years (SD, 15.2), and 87% were male. The median index admission length of stay was 8 days (interquartile range, 3-15 days). Subsequent readmission was required for 123 (37.2%) patients with 10% mortality in the index admission. Total median charges per patient for all admissions were $257,804 (interquartile range, $105,601-$531,916). A total of 215 patients (65%) had at least 1 facial repair performed. Of all 331 patients, 64.3% underwent musculoskeletal repair (n = 213), 31.4% underwent digestive system repair (n = 104), and 29.6% underwent respiratory system repair (n = 98). The average number of repairs per patient was 2.52 (SD, 3.38), with 35% not having any of the specified International Classification of Diseases, 10th Revision repair codes. A total of 27% of patients had 1 procedure performed, whereas 38% received 2 or more, for an average of 3.87 (SD, 3.5) repairs over the study duration. DISCUSSION: To our knowledge, this is the first assessment of civilian characteristics of nonfatal ballistic facial trauma in California. Nonfatal facial ballistic trauma results in complex injuries to multiple body systems, requiring long admissions, costly hospital stays, and coordination of care across several surgical specialties. Many patients require a variety of procedures over multiple admissions, highlighting the overall morbidity of these injuries. Future studies will look at how care for these patients differs between various hospitals and geographic regions and whether current civilian management aligns with well-defined military reconstructive protocols for facial ballistic injuries.

Integrated Measurement for Early Detection (MIDO) as a digital strategy for timely assessment of non-communicable disease profiles and factors associated with unawareness and control: a retrospective observational study in primary healthcare facilities in Mexico.

OBJECTIVES: The Carlos Slim Foundation implemented the Integrated Measurement for Early Detection (MIDO), a screening strategy for non-communicable diseases (NCDs) in Mexico as part of CASALUD, a portfolio of digital health services focusing on healthcare delivery and prevention/management of NCDs. We investigated the disease profile of the screened population and evaluated MIDO's contribution to the continuum of care of the main NCDs. DESIGN: Using data from MIDO and the chronic diseases information system, we quantified the proportion of the population screened and diagnosed with NCDs, and measured care linkage/retention and level of control achieved. We analysed comorbidity patterns and estimated prevalence of predisease stages. Finally, we estimated characteristics associated with unawareness and control of NCDs, and examined efficacy of the CASALUD model in improving NCD control. SETTING: Public primary health centres in 27/32 Mexican states. PARTICIPANTS: Individuals aged ≥20 years lacking healthcare access. RESULTS: From 2014 to 2018, 743 000 individuals were screened using MIDO. A predisease or disease condition was detected in ≥70% of the population who were unaware of their NCD status. The screening identified 38 417 new cases of type 2 diabetes, 53 133 new cases of hypertension and 208 627 individuals with obesity. Dyslipidaemia was found in 77.3% of individuals with available blood samples. Comorbidities were highly prevalent, especially in people with obesity. Only 5.47% (n=17 774) of individuals were linked with their corresponding primary health centre. Factors associated with unawareness of and uncontrolled NCDs were sex, age, and social determinants, for example, rural/urban environment, access to healthcare service, and education level. Patients with type 2 diabetes treated at clinics under the CASALUD model were more likely to achieve disease control (OR: 1.32, 95% CI: 1.09 to 1.61). CONCLUSION: Patient-centred screening strategies such as MIDO are urgently needed to improve screening, access, retention and control for patients with NCDs.

Prevalence of burnout syndrome in university students: A systematic review / Prevalencia del síndrome de burnout en estudiantes universitarios: Una revisión sistemática

Abstract Introdution Burnout syndrome is a social and health problem in college students. Objective To synthesize evidence from previous studies on the prevalence of burnout syndrome in university students in their three-dimensional approach. Method The search strategies followed the PRISMA guidelines and were based on the following descriptive terms: "burnout," "studies," "prevalence," "students." Pubmed, Web of Science Core Collection, PsicINFO, and Scielo were consulted. An evaluation of the quality of the information was carried out applying the STROBE positioning guidelines. Results We found 1,406 studies that were reduced to 46 studies for final analysis using the STROBE statement, eventually leaving 20 studies. One study (5%) was conducted in North America, five (25%) in Asia, nine (45%) in Latin America, and five (25%) in Europe. Of the 20 studies evaluated in the systematic review, those that had the best overall evaluation in the STROBE analysis were selected for discussion, corresponding to 10 (out of 75% of STROBE). Overall prevalence of each dimension of the syndrome was estimated at 55.4% for emotional exhaustion, 31.6% for cynicism, and 30.9% for academic efficacy. Discussion and conclusion Moderate levels of burnout syndrome prevail in the different populations of university students of different careers worldwide. In only a few studies is the prevalence low and this could be due to multiple evaluative variables.

Resumen Introducción El síndrome de burnout es un problema social y de salud en los estudiantes universitarios. Objetivo Sintetizar las pruebas de estudios anteriores sobre la prevalencia del síndrome de burnout en estudiantes universitarios en su enfoque tridimensional. Método Las estrategias de búsqueda siguieron las pautas de PRISMA y se basaron en los siguientes términos descriptivos: "burnout", "estudios", "prevalencia", "estudiantes". Se consultaron Pubmed, Web of Science Core Collection, PsicINFO y Scielo. Se llevó a cabo una evaluación de la calidad de la información aplicando las directrices de posicionamiento de STROBE. Resultados Se encontraron 1,406 estudios que se redujeron a 46 estudios para el análisis final utilizando la declaración STROBE, con lo que quedaron finalmente 20 estudios. Un estudio (5%) se llevó a cabo en América del Norte, cinco (25%) en Asia, nueve (45%) en América Latina y cinco (25%) en Europa. De los 20 estudios evaluados en la revisión sistemática, se seleccionaron para su discusión aquellos que tuvieron la mejor evaluación general en el análisis de la STROBE, correspondientes a 10 (de un 75% de la STROBE). La prevalencia general de cada dimensión del síndrome se estimó en un 55.4% para el agotamiento emocional, un 31.6% para el cinismo y un 30.9% para la eficacia académica. Discusión y conclusión Los niveles moderados del síndrome de burnout prevalecen en las diferentes poblaciones de estudiantes universitarios de distintas carreras en todo el mundo. En sólo unos pocos estudios la prevalencia es baja y esto podría deberse a múltiples variables evaluativas.

Ejercicios físicos en los niveles de Síndrome de Burnout y la Variabilidad de la Frecuencia Cardíaca de estudiantes universitarios: un estudio de intervención / Physical exercise on Burnout Syndrome levels and Heart Rate Variability in university students: an intervention study

RESUMEN: Los programas de intervención para prevenir o tratar el Síndrome de Burnout son esenciales para mejorar la salud de los estudiantes. Pero la mayoría de las investigaciones realizadas son intervenciones psicológicas y cognitivas.Objetivo: Determinar los efectos de los ejercicios físicos en los niveles de Síndrome de Burnout y la Variabilidad de la Frecuencia Cardíaca en estudiantes universitarios.Métodos: Estudio experimental con pre-test y post-test, con 2 grupos de intervención y un grupo de control. La muestra fue probabilística y estratificada con participación proporcional. Instrumentos utilizados: Maslach Burnout Inventory Students Survey (MBI-SS) y Variabilidad de la Frecuencia Cardíaca (HRV): cálculo de la media RR, SDNN y RMSSD. Para el ejercicio físico, se aplicaron ejercicios aeróbicos y de fuerza durante 3 sesiones semanales de una hora, en días alternos, durante 16 semanas.Resultados: El grupo de aeróbicos con Agotamiento MBI-SS fue mayor, reduciendo sus niveles en un 26,4% (d=0,532), en Cinismo (-21,06, d=0,252) y en Eficacia (-13,11, 0,397). Grupo de fuerza en Cinismo (-27,38, d=0,315), en Eficacia (-21,69, d=0,704), Agotamiento (-19,55, d=0,299). El grupo de control Agotamiento aumentó en un 10,26% (d=0,128). En la HVR, con el grupo aeróbico el SDNN tuvo el mayor cambio porcentual, con un aumento del 24,82 %, sobre la media RR y RMSSD (14,40 % y 16,45 %). En el grupo de fuerza y en el grupo de control (21,77%, 14,24%, 12,60%; y 12,59%, 4,97% y 4,99% respectivamente). Hubo un cambio en el RR medio en los grupos aeróbico y de fuerza (d = 1,281 y 1,328).Conclusiones: Efecto de reducción del síndrome de burnout y efecto contrario de incremento de valores del HRV. (AU)

ABSTRACT: Intervention programs to prevent or treat Burnout Syndrome are essential to improve the health of students. But most of the research that has been done is psychological and cognitive interventions.Objective: To determine the effects of physical exercises on Burnout Syndrome levels and Heart Rate Variability in university students.Methods: An experimental study was carried out with pre-test and post-test, with 2 intervention groups and a control group. The sample was probabilistic and stratified with proportional participation. Study variables and instruments were included: Maslach Burnout Inventory Students Survey (MBI-SS) and Heart Rate Variability (HRV): calculation of the average RR, SDNN and RMSSD. For physical exercise, aerobic and strength exercises were applied during 3 weekly sessions of one hour, on alternate days, for 16 weeks.Results: The group of aerobics with MBI-SS exhaustion was higher, reducing its levels by 26.4% (d=0.532), in Cynicism (-21.06, d=0.252) and Efficiency (-13.11, 0.397). Force group in Cynicism (-27.38, d=0.315), in Efficiency (-21.69, d=0.704), Exhaustion (-19.55, d=0.299). The Exhaustion control group increased by 10.26% (d=0.128). In HVR, with the aerobic group, NDL had the greatest percentage change, increasing 24,82 %, over the average RR and RMSSD (14,40 % and 16,45 %). In the force group and in the control group (21.77%, 14.24%, 12.60%; and 12.59%, 4.97% and 4.99% respectively) there was a change in the mean RR in the aerobic and strength groups (d = 1.281 and 1.328).Conclusions: Effect of reduction of burnout syndrome and opposite effect of increase of HRV values. (AU)

A Policy Analysis on the Proactive Prevention of Chronic Disease: Learnings from the Initial Implementation of Integrated Measurement for Early Detection (MIDO).

Mexico, like many low- and middle-income countries (LMICs), faces an epidemic of chronic non-communicable diseases (NCDs), specifically diabetes, hypertension, obesity, and lipid disorders. Many people with these NCDs may not be aware that they have a disease, pointing to the need for broader screening programs. The traditional prevention policy in Mexico was based on screening with a paper-based risk factor questionnaire. However, this was used to screen patients already seeking healthcare services at facilities, and screening goals were set as a function of the number of questionnaires applied, not number of individuals screened. Due to this, Fundación Carlos Slim developed Medición Integrada para la Detección Oportuna (MIDOTM), or Integrated Measurement for Early Detection, an NCD screening and proactive prevention policy. This document is a policy analysis based on early learnings from the initial implementation of MIDO in eight primary healthcare centers in two central Mexican states. MIDO was found to expand screening programs beyond clinic walls, systematize community screening strategies, emphasize the detection of pre-disease phases, incorporate lifestyle counseling, and propose screening goals based on population targets. In collaboration with the Mexican Ministry of Health, MIDO has successfully screened over 500 000 individuals-about 40% of whom would not have been screened under previous policies. Of these more than 500 000 screened individuals, 13.4% had pre-diabetes (fasting glucose between 100 and 125 mg/dL), and 5.8% had undiagnosed diabetes (defined as fasting glucose above 126 mg/dL or random glucose above 200 mg/dL). However, there is still room for improvement in linking positive results from screening with disease confirmation and with patient incorporation into disease management. The experience of implementing MIDO in Mexico suggests that primary and secondary prevention programs in other parts of the world should consider the need for population-based screening targets, a greater focus on pre-disease stages, and the streamlining of the transition between screening, confirmation of diagnosis, and incorporation of patients into the healthcare system.

Alimentación saludable en docentes / A healthy diet in professors

Introducción: en la actualidad, los docentes tienen estilos de vida sedentarios producto a su propio trabajo y esto les provoca en muchos casos enfermedades asociadas. Objetivo: actualizar los conocimientos existentes sobre la alimentación saludable de docentes a nivel internacional. Métodos: revisión documental y bibliográfica de artículos científicos publicados hasta abril de 2016. Las bases de datos consultadas fueron Medline, Scopus y Scielo. Las búsquedas que se han realizado mediante PubMed y clasificadas por dos objetivos de búsqueda. Se usaron las siguientes palabras claves: alimentación, docentes, salud; en idioma español e inglés. Se seleccionaron aquellos estudios de donde se reflejara programas, intervenciones y revisiones sobre la alimentación saludable en docentes o futuros docentes de cualquier tipo de enseñanza a nivel internacional. Conclusiones: la aplicación correcta de programas de alimentación saludable es beneficiosa de forma general en los docentes y futuros docentes(AU)

Introduction: Nowadays, teachers have sedentary lifestyles due to their own work, which causes them, in many cases, associated diseases. Objective: To update the existing knowledge on healthy diets of teachers at the international level. Methods: Document and bibliography review of scientific articles published until April 2016. The databases consulted were Medline, Scopus and Scielo. The searches used PubMed and were classified by two search goals. The following key words were used: food, teachers, health, both in Spanish and English. These studies were selected to reflect programs, interventions and reviews on healthy diet in teachers or future teachers of any kind of schooling at an international level. Conclusions: The correct application of healthy diet programs is generally beneficial for teachers and future teachers(AU)

Aprendizaje por observación de interacciones didácticas de ilustración y retroalimentación / Interbehavioral survey about learning by observation in didactic interactions of illustration and feedback

De acuerdo con los principios del modelo interconductual del desempeño didáctico y de los estudios realizados desde el área del aprendizaje por observación en contextos educativos, el objetivo del presente estudio fue evaluar los efectos de la observación de interacciones didácticas de ilustración y retroalimentación sobre el desempeño efectivo en una tarea de igualación a la muestra de segundo orden con términos metodológicos de la investigación en psicología como instancias. Participaron 20 estudiantes universitarios, quienes fueron asignados de manera aleatoria dentro de tres grupos experimentales y un grupo control. El diseño experimental fue de tipo a-b-a, con una prueba inicial, un entrenamiento y una prueba final. Los grupos experimentales se distinguieron entre sí por el tipo de entrenamiento observacional que recibieron: ilustración, retroalimentación e ilustración-retroalimentación. Los resultados indican que este último fue el más efectivo, de acuerdo con el promedio de intentos realizados para responder a los reactivos del entrenamiento, así como del incremento en el desempeño de los participantes entre ambas pruebas. Estos resultados se discuten en términos de: a) las características de las interacciones didácticas de ilustración y la retroalimentación, y b) la importancia de la regulación lingüística en el aprendizaje por observación en situaciones educativas.

In accordance with the principles of the interbehavioral model of didactic performance and the researches carried out in the area of learning by observation, the objective of the following study was to evaluate the effects of the observation of didactic interactions of illustration and feedback on effective performance in a second-order matching-to-sample task with methodological terms of research in psychology as instances. Twenty university students participated, they were assigned randomly in a trial in three experimental groups and a control group. The experimental design was of A-B-A type, with an initial test, training and a final test. The experimental groups were distinguished by the type of observational training which received: illustration, feedback and illustration-feedback. The results indicate that this latter was the most effective according to the average of attempts made to respond to the reagent of the training, as well, as of the increase in the performance of the participants between both tests. These results are discussed in terms of: a) characteristics of the didactic interactions of illustration and feedback, and b) the importance of the linguistic regulation in learning by observation in real educational situations.

Immune therapy for human papillomaviruses-related cancers.

Human papillomaviruses (HPVs) are a large family of double strand DNA viruses comprising more than 180 types. Infection with HPV is very common and it is associated with benign and malignant proliferation of skin and squamous mucosae. Many HPVs, considered low-risk such as HPV 6 and 11, produce warts; while high-risk viruses, such as HPVs 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, and 58, induce tumors. About 5% of all cancers in men and women are associated with HPV infection. Because there are not antiviral drugs for HPV infection, current therapies for low-risk HPV infections involve physical removal of the lesion by cryotherapy, trichloracetic acid, laser, or surgical removal. Surgical procedures are effective in the treatment of pre-cancerous lesions, however after these procedures, many recurrences appear due to new re-infections, or to failure of the procedure to eliminate the HPV. In addition, HPV can inhibit recognition of malignant cells by the immune system, leading to the development of cancer lesions. When this occurs, radiotherapy and chemotherapy are then used. Unfortunately, about 50% of the HPV-cancer patients still die. In the past decade, a better knowledge of the natural history of the virus-host interaction and of the immune response against this viral infection has brought new therapeutic strategies geared to modulate the immune system to generate an efficient virus-specific cytotoxic response. Novel HPV protein-expressing vaccines have shown some significant clinical efficacy and systemic HPV-specific cytotoxic T cell responses. This review will describe the current status of the several therapeutic strategies used to treat HPV-induced lesions, and discuss the various new therapies now being tested.

Regression of human papillomavirus intraepithelial lesions is induced by MVA E2 therapeutic vaccine.

Human papilloma viruses can induce warts, condylomas, and other intraepithelial cervical lesions that can progress to cancer. Cervical cancer is a serious problem in developing countries because early detection is difficult, and thus proper early treatment is many times missing. In this phase III clinical trial, we evaluated the potential use of MVA E2 recombinant vaccinia virus to treat intraepithelial lesions associated with papillomavirus infection. A total of 1176 female and 180 male patients with intraepithelial lesions were studied. They were injected with 10(7) MVA E2 virus particles directly into their uterus, urethra, vulva, or anus. Patients were monitored by colposcopy and cytology. Immune response was determined by measuring the antibody titer against MVA E2 virus and by analyzing the cytotoxic activity against cancer cells bearing papillomavirus DNA. Papillomavirus was determined by the Hybrid Capture method or by polymerase chain reaction analysis. By histology, 1051 (89.3%) female patients showed complete elimination of lesions after treatment with MVA E2. In 28 (2.4%) female patients, the lesion was reduced to CIN 1. Another 97 (8.3%) female patients presented isolated koilocytes after treatment. In men, all lesions were completely eliminated. All MVA E2-treated patients developed antibodies against the MVA E2 vaccine and generated a specific cytotoxic response against papilloma-transformed cells. Papillomavirus DNA was not detected after treatment in 83% of total patients treated. MVA E2 did not generate any apparent side effects. These data suggest that therapeutic vaccination with MVA E2 vaccine is an excellent candidate to stimulate the immune system and generate regression in intraepithelial lesions when applied locally.

Síndrome de Burnout moderado en estudiantes y su tratamiento con masaje tradicional tailandés / Moderate Burnout Syndrome in Students and its Treatment with Thai Traditional Massage

Introducción: el síndrome de Burnout, afecta a los estudiantes de medicina y es poco estudiado, a nivel internacional y nacional sólo se describe el síndrome y no se validan intervenciones físicas. Objetivo: determinar la efectividad del masaje tradicional tailandés en el tratamiento del síndrome de Burnout en estudiantes de medicina de Holguín. Métodos: se realizó un estudio cuasi experimental durante septiembre y diciembre de 2011. Se aplicó el masaje tradicional tailandés durante 18 semanas con una frecuencia de tres sesiones semanales a cada paciente. La muestra se conformó con los diez estudiantes de primer año de medicina de la Universidad de Ciencias Médicas de Holguín diagnosticados con síndrome de Burnout moderado. De ellos, cinco constituyeron el grupo control (GC) y cinco el grupo experimental (GE), distribuidos aleatoriamente. Para calcular los indicadores se utilizó el paquete estadístico SPSS versión 11,5. Resultados: en el test inicial ambos grupos tenían sus cinco integrantes con Burnout moderado (GC=54,1; GE=54,2), en el test final los estudiantes del grupo experimental mejoraron: GE=35,4 (uno sin Burnout, tres Burnout leve, uno Burnout moderado) en comparación con el grupo control: GC=52,6 (uno leve y tres moderado, uno profundo). Conclusiones: El masaje tradicional tailandés fue eficaz en el tratamiento del síndrome de Burnout moderado en estudiantes de medicina.

Introduction: Burnout syndrome affects medical students. There are no enough international and national studies on this. The syndrome is only described but physical interventions are not validated. Objective: to determine the effectiveness of traditional Thai massage in the treatment of Burnout syndrome in medical students of Holguín. Methods: a quasi- experimental study was performed during September and December 2011. Applied the traditional Thai massage for 18 weeks with a frequency of three weekly sessions for each patient. The sample comprised ten students from the first year of medicine at the University of Medical Sciences of Holguin diagnosed with moderate Burnout syndrome. Five of them, were the control group and the other five represented the experimental group that were randomly distributed. To calculate indicators SPSS version 11.5 was used. Results: in the initial test both groups had five members with moderate Burnout (GC = 54.1; GE = 54.2) in the final test students in the experimental group improved: GE = 35.4 (one without Burnout, Burnout three mild, one moderate Burnout) compared with the control group: GC = 52.6 (one mild and three moderate, deep one). Conclusions: the traditional Thai massage was effective in treating moderate Burnout syndrome in medical students.

Burnout estudiantil universitario: Conceptualización y estudio / University students burnout: Conceptualization and study

Objective To update existing knowledge on burnout in university students, in Cuba and the world. Material and methods Document review and literature from March 2010 to January 2012. The databases searched were Medline and Cochrane through PubMed. Results and discussion It is clear that there are multiple possible causes for the existence of the university student burnout. They have not been studied and systematized to have a proper answer or solution to protect the future health of our university graduates. In diagnostic instruments, this is not a unanimous view among experts, nor on the prevalence and incidence rates, since criteria vary for each study. Conclusions There are very few studies of burnout applied to undergraduate college students, and there are not defined the syndrome difference in such students regarding mid-level groups, upper secondary and graduate students. However there are obvious manifestations of the occurrence of this phenomenon in this important university student population and the specifics of their study and treatment.

Objetivo Actualizar los conocimientos existentes sobre el burnout en estudiantes universitarios en Cuba y el mundo. Material y métodos Revisión documental y bibliográfica durante marzo de 2010 y enero de 2012. Las bases de datos consultadas fueron Medline y Cochrane mediante PubMed. Resultados y discusión Es evidente que son múltiples las posibles causas de la existencia del burnout Estudiantil Universitario. No han sido estudiadas y sistematizadas de manera que se le pueda dar una respuesta o solución adecuada al problema, para proteger la salud de nuestros futuros profesionales universitarios. En los instrumentos de diagnostico no existe un criterio unánime entre los expertos para establecerlo, ni sobre los porcentajes de prevalencia e incidencia, pues los criterios varían para cada estudio. Conclusiones Existen muy pocos estudios del burnout aplicado a los estudiantes universitarios de pregrado, y no se define y diferencia el síndrome en este tipo de estudiantes con respecto a los grupos de nivel medio, medio superior y de postgrado en nuestro país e internacionalmente.

Lupus eritematoso sistémico buloso de la infancia / Childhood bullous systemic lupus erythematosus

El lupus eritematoso sistémico de la infancia es una rara enfermedad ampollar subepidermal mediada por autoanticuerpos. Se caracteriza por una erupción con ampollas y vesiculas tensas con un fondo eritematoso. El prurito está presente en una severidad variable. Se produce principalmente en la segunda y tercera década de la vida. Reportamos el caso de una niña de 14 años de edad quien presenta un tiempo de enfermedad de cinco meses, con erupción ampollar generalizada, además de fiebre, prurito y úlceras en mucosa oral. Los estudios de inmunofluorescencia directa y coloración con hematoxilina-eosina fueron coherentes con lupus eritematoso sistémico bulloso. Después de una evolución tórpida, correlacionamos la historia clínica, examen físico y pruebas de laboratorio, llegando al diagnóstico de lupus eritematoso sistémico buloso de la infancia.

Bullous systemic lupus erythematosus in childhood is a rare subepidermal blistering disease mediated by autoantibodies. It is characterized by a rash with blisters and strained vesicles with an erythematosus base. Pruritus is present in variable severity. It occurs mainly in the second and third decades of life. We report a case of a 14-year-old child who presented symptoms for five months, including a widespread pruritic blistering eruption, in addition to fever, itching, and ulcers in oral mucosa. Direct immunofluorescence studies, and staining with hematoxylin-eosin were consistent with bullous systemic lupus erythematosus. After a torpid evolution, we correlate the clinical history, physical examination and laboratory tests which led to the diagnosis of childhood bullous systemic lupus erythematosus.

Therapeutic effect of recombinant adenovirus encoding interferon-gamma in a murine model of progressive pulmonary tuberculosis.

We constructed recombinant adenoviruses encoding murine interferon-gamma (AdIFNgamma) and tested its therapeutic efficiency in a well characterized model of progressive pulmonary tuberculosis (TB) in Balb/c mice, infected through the trachea with the laboratory drug-susceptible H37Rv strain or multidrug-resistant (MDR) clinical isolate. When the disease was in a late phase, 2 months after infection, we administered by intratracheal cannulation a single dose [1.7 x 10(9) plaque forming units (pfu)] of AdIFNgamma or the control adenovirus. Groups of mice were killed at different time-points and the lungs were examined to determine bacilli colony forming units (CFU), cytokine/chemokine gene expression, and CD4/CD8 subpopulations, and also subjected to automated histomorphometry. In comparison with the control group, after 2 weeks of treatment and during the next 6 months, AdIFNgamma-treated animals infected with either the H37Rv strain or the MDR strain showed significantly lower bacilli loads and tissue damage (pneumonia), higher expressions of IFN-gamma, tumor necrosis factor (TNF), and inducible nitric oxide synthase (iNOS), and bigger granulomas. When compared with the results from conventional chemotherapy or AdIFNgamma treatment alone, the combined treatment with AdIFNgamma plus conventional chemotherapy shortened the time taken for reduction of bacillary load. This shows that gene therapy with AdIFNgamma efficiently reconstituted the protective immune response and controlled the progress of pulmonary TB produced by MDR or non-MDR strains.

Therapeutic Effect of Recombinant Adenovirus Encoding Interferon-γ in a Murine Model of Progressive Pulmonary Tuberculosis.

We constructed recombinant adenoviruses encoding murine interferon-γ (AdIFNγ) and tested its therapeutic efficiency in a well characterized model of progressive pulmonary tuberculosis (TB) in Balb/c mice, infected through the trachea with the laboratory drug-susceptible H37Rv strain or multidrug-resistant (MDR) clinical isolate. When the disease was in a late phase, 2 months after infection, we administered by intratracheal cannulation a single dose [1.7 × 109 plaque forming units (pfu)] of AdIFNγ or the control adenovirus. Groups of mice were killed at different time-points and the lungs were examined to determine bacilli colony forming units (CFU), cytokine/chemokine gene expression, and CD4/CD8 subpopulations, and also subjected to automated histomorphometry. In comparison with the control group, after 2 weeks of treatment and during the next 6 months, AdIFNγ-treated animals infected with either the H37Rv strain or the MDR strain showed significantly lower bacilli loads and tissue damage (pneumonia), higher expressions of IFN-γ, tumor necrosis factor (TNF), and inducible nitric oxide synthase (iNOS), and bigger granulomas. When compared with the results from conventional chemotherapy or AdIFNγ treatment alone, the combined treatment with AdIFNγ plus conventional chemotherapy shortened the time taken for reduction of bacillary load. This shows that gene therapy with AdIFNγ efficiently reconstituted the protective immune response and controlled the progress of pulmonary TB produced by MDR or non-MDR strains.

MVA E2 recombinant vaccine in the treatment of human papillomavirus infection in men presenting intraurethral flat condyloma: a phase I/II study.

BACKGROUND: Human papillomavirus (HPV) is the etiologic agent for warts and cervical cancer. In Mexico, the death rate from cervical cancer is extremely high, and statistical data show that since 1990 the number of deaths is increasing. Condylomas and cancer of the penis are the most common lesions presented in men; bladder and prostate cancer in men are also associated with the presence of HPV. Since HPV is transmitted by sexual intercourse, treating both partners is necessary in order to eliminate the virus in the population. Approaches to this include preventative vaccines such as Gardasil, and therapeutic vaccines to treat established infections in both men and women. This will be the only way to decrease the numbers of deaths due to this malignancy. PATIENTS AND METHODS: We conducted a phase I/II clinical trial to evaluate the potential use of the recombinant vaccinia viral vaccine MVA E2 (composed of modified vaccinia virus Ankara [MVA] expressing the E2 gene of bovine papillomavirus) to treat flat condyloma lesions associated with oncogenic HPV in men. Fifty male patients with flat condyloma lesions were treated with either MVA E2 therapeutic vaccine or fluorouracil (5-fluorouracil). Thirty men received the therapeutic vaccine, at a total of 10(6) virus particles per dose, administered directly into the urethra once every week over a 4-week period. Twenty control patients were treated with 5% fluorouracil 1mL twice weekly over a 4-week period directly into the urethra. Reduction of lesions or absence of papillomavirus infection was monitored by colposcopy and histologic analysis. The immune response after MVA E2 treatment was determined by measuring the antibodies against the MVA E2 virus and by analyzing the lymphocyte cytotoxic activity against cancer cells bearing oncogenic papillomavirus. Presence of papillomavirus was determined by the Hybrid Capture method. RESULTS: Twenty-eight of 30 patients showed no lesion or presence of papillomavirus as diagnosed by colposcopy and brush histologic examination after 4 weeks of MVA E2 treatment. These patients showed complete elimination of flat condyloma in the urethra and no acetowhite spots were detected over the prepuce. In two other patients the acetowhite spots and flat condyloma did not diminish. All patients developed antibodies against the MVA E2 vaccine and E2 protein, and generated a specific cytotoxic response against papilloma-transformed cells. Viral DNA was not detected in MVA E2-treated patients. In the control group, 13 of 20 patients were free of lesions. Three of these patients had recurrence of lesions after 3 months of treatment and none of the patients developed specific antibodies against cancer cells. In contrast, patients treated with MVA E2 did not show any recurrence of lesions after 1 year of treatment. In addition, none of the patients had local or systemic adverse effects according to the WHO classification 1-4. CONCLUSIONS: Therapeutic vaccination with MVA E2 proved to be very effective in stimulating the immune system against papillomavirus, and in generating regression of flat condyloma lesions in men.