Innervation patterns of hamstring muscles, including morphological descriptions and clinical implication.

PURPOSE: The hamstrings muscles are innervated by sciatic nerve branches. However, previous studies assessing which and how many branches innervate each muscle have yielded discrepant results. This study investigated the innervation patterns of hamstrings. MATERIALS AND METHODS: Thirty-five cadaver limbs were investigated. The average age of subjects was 78.6 ± 17.2 years, with 48.6% male and 51.4% female, while 57.1% were right limbs and 42.9% left. The sciatic nerve, hamstrings and associated structures were dissected. The number of nerve branches for each muscle and the level where they penetrated the muscle were recorded. RESULTS: The sciatic nerve was connected by a fibrous band to the long head of the biceps femoris. This muscle was innervated by either one or two branches, which penetrated the muscle into its superior or middle third. The short head of the biceps femoris was innervated by a single nerve that usually penetrated its middle third, but sometimes inferiorly or, less commonly, superiorly. The semitendinosus was always innervated by two branches, the superior branch penetrating its upper third, the inferior mostly the middle third. The semimembranosus usually was innervated by a single nerve branch that penetrated the muscle at its middle or lower third. Four specimens revealed common nerves that innervated than one muscle. CONCLUSIONS: We have characterized hamstring innervation patterns, knowledge that is relevant to neurolysis, surgery of the thigh, and other procedures. Moreover, a mechanical connection between the sciatic nerve and biceps femoris long head was identified that could explain certain neuralgias.

Primary hepatic angiosarcoma: a systematic review.

Background: Hepatic angiosarcoma is a rare type of tumour. In adults, the diagnosis remains challenging as the clinical manifestations are generally nonspecific and are usually made too late when complications or metastases are already present, associated with a poor prognosis. Due to the lack of agreement regarding the optimal treatment approach, a comprehensive analysis of the evidence in the literature on the surgical and survival outcomes in terms of disease-free survival time (DFS) and overall survival (OS) for patients treated for primary hepatic angiosarcoma is needed. Study design: A systematic review of articles published in Pubmed, EMBASE, and Scopus, from 2000 to 2023 with the search terms hepatic angiosarcoma and liver resection or hepatectomy. Pooled individual data concerning the prognosis following various therapies was analyzed. Results: A total of 15 articles involving 886 patients were eligible for inclusion. The male population represents 66.2% (n=586) of the population, with a median age of 57 years (41-66). The median survival rate was 7 months. The median OS after surgical resection was 17.18 months (SD 12.6) vs. 3.72 months (SD 4.6) for patients treated without a surgical approach. The median DFS was 15.2 months (SD 11). Conclusion: Primary liver angiosarcoma remains a surgical challenge with a poor prognosis even with complete surgical resection and adjuvant therapy. Surgical management shows increased overall survival in comparison with non-surgical management. Early diagnosis could change the natural history of the disease. The literature available is scarce, and further studies are required to create standardized diagnostic and treatment protocols.

Early characterization of an adult population at an insurer's point of entry as an opportunity to identify hospitalization risk

Introduction: Health Benefit Plan Administrators must manage the health risk of their members. Therefore, health characterization is performed from enrollment to support decision-making and timely intervention. Objective: To analyze the historical results of characterizing the adult population on admission to the insurance company in relation to the demand for all-cause and psychiatric hospitalization services. Materials and Methods: An observational cross-sectional study with members over 18 years of age, in which an analysis was made of the characterization of the adult population of the insurer and its association with the use of medical consultation services in primary care and all-cause and psychiatric hospitalizations. Bivariate and multivariate analysis was made, and odds ratios (OR) were calculated in logistic regression. Results: Variables significantly associated with having an all-cause hospitalization were identified: having referred history of heart disease OR=1.71(95%CI: 1.33; 2.20), respiratory disease OR= 1. 30(95%CI: 1.04; 1.61), chronic kidney disease OR=1.66(95%CI: 1.13; 2.45), cancer OR=1.65(95%CI: 1.14; 2.40), taking any medication permanently OR=1.35(95%CI: 1.174; 1.56) and smoking OR=1.44(95%CI: 1.12; 1.85). For psychiatric hospitalizations, a history of discouragement, depression, or little hope was relevant with OR=5.12(95%CI: 1.89; 13.87). Discussion: The characterization of patients during enrolment allowed the identification of predictor variables of hospitalization, guiding management from the primary care level minimizing costs and catastrophic health events. Conclusion: The timely identification of specific patient profiles allows timely actions to minimize health costs and catastrophic health events.

Sobreexpresión del factor VIII, riesgo de trombosis y tratamiento / Overexpression of factor VIII: risk for thrombosis and treatment

Introducción: la trombosis venosa profunda (TVP) es una enfermedad multifactorial, la cual se ha relacionado con estados de hipercoagulabilidad, alteraciones del flujo sanguíneo y lesiones vasculares endoteliales. Se ha estimado una tasa de incidencia de 1 a 2 casos por mil habitantes año, y casi 2 millones de nuevos casos anuales en Estados Unidos. Existen factores de riesgo establecidos y las trombofilias parecen ocupar un lugar importante en su etiología y los estados de hipercoagulabilidad secundarios a niveles elevados de factor de coagulación VIII asociado a disfunción endotelial, y al incremento de adhesión plaquetaria confieren también una gran predisposición a la aparición de trombosis. Presentación del caso: paciente de 24 años de edad, sin antecedentes de importancia. Consulta por una masa indurada en región axilar derecha, que resultó ser TVP de la vena yugular externa, confluente yugulosubclavio, vena supraclavicular axilar y humeral con alto riesgo de embolización; a su vez se documentó tromboembolia pulmonar y se sospechó trombosis cerebral. La búsqueda de estados procoagulantes no arrojó ningún resultado, posteriormente se mide Factor VIII con sobreexpresión de 223% del valor normal y tras una revisión literaria del tratamiento documentada en el presente artículo se determina que el tratamiento más adecuado es warfarina

Introduction: Deep vein thrombosis (DVT) is a multifactorial medical condition that has been related to hypercoagulable states, alterations in blood flow and lesions in vessel endothelium. The incidence of DVT ranges between 1 and 2 cases per 1000 people and almost two million new cases per year in the United States. Some risk factors have been identified. Thrombophilias seem to play an important role in DVT etiology. Hypercoagulability states secondary to high blood coagulation factor VIII levels associated with endothelial dysfunction and increased platelet adhesion, pose a higher predisposition for thrombosis. Case report: we present the case of a 24-year-old male patient, with no relevant past history, who presented with an indurated mass in the right axillary region, which turned out to be a DVT of the external jugular vein, jugulo-subclavian confluence, supraclavicular, axillary and humeral veins with high risk of embolism. Pulmonary thromboembolism was documented and cerebral venous thrombosis was suspected. The search for procoagulant states yielded no results. Factor VIII levels were measured revealing an overexpression of factor VIII at 223% [normal range 50 ­ 200%]. A literature review determined warfarin to be the proper treatment

Satisfaction With Head and Neck Scar Appearance in Latin American Patients: A Cross-Sectional Study.

Background: Surgical scars have been related to poor quality of life, and this is important for head and neck scars. There is a paucity of data about the effect of scars on appearance in Latin American patients. The objective of this study was to describe the self-assessment of patient scars using the Patient Scar Assessment Questionnaire (PSAQ). Methods: This is a cross-sectional study. The validated Spanish version of the PSAQ was used. Adult patients who underwent elective head and neck surgery were included. Demographic and clinical data were obtained from clinical charts. Univariate and multivariate analysis using a forward logistic regression was planned to assess the weight of specific subscale items on the overall subscale score for appearance and satisfaction with appearance. Results: 180 patients were recruited. A total of 144 (80%) patients were female, and the most frequent type of surgery was thyroidectomy. The global appearance, the global scar consciousness and the global scar appearance satisfaction was classified as excellent/good in 72.2%, 93.9% and 87.8% of patients, respectively. The multivariate analysis showed that color (OR 5.9, 95% CI 1.7-20.8), width (OR 58.9, [4.3-807.6]), and flatness (OR 5.7, [1.3-23.6]) were the items statistically associated with a regular/bad result in the appearance subscale. Conclusions: There is a high level of satisfaction with head and neck scar appearance, and these data should be used to assess the impact of surgical interventions on cosmesis. The intrinsic characteristics of scars are the most relevant for defining scar satisfaction.

Aortoesophageal fistulae following TEVAR: Case report and literature review.

INTRODUCTION: Aortoesophageal fistulae are an uncommon pathology, primarily due to the aortic pathology in more than 50 % of the cases, followed by foreign body ingestion, and advanced malignancies. Recently it is recognized after surgical management of thoracic aortic pathologies either open or endovascular, with increased rates of morbidity and mortality. PRESENTATION OF THE CASE: We present a 62-year-old male patient with a previous history of thoracic endovascular aortic repair, who enters the emergency room with gastrointestinal bleeding and clinical signs of infection. Positive blood cultures, and tomographic signs include prosthetic gas, with endoscopic findings of aortoesophageal fistulae. Aggressive surgical management was performed including esophageal resection and gastrointestinal exclusion. Bleeding control was reached in the early postoperative period, nevertheless despite multidisciplinary management, the patient died 8 days after surgery. CLINICAL DISCUSSION: Aortoesophageal fistulae, remains to be an uncommon complication either of thoracic aortic aneurysm or after endovascular treatment of aortic aneurysm; with high rates of morbidity and mortality, should be suspected in every case with upper gastrointestinal bleeding in the context of a patient with aortic disease. Non-surgical management should be avoided due to the high risk of complications and mortality, aggressive management needs to be considered in each case according to clinical condition of the patient. CONCLUSION: Aortoesophageal fistulae remain an uncommon complication after TEVAR, with increased mortality and morbidity rates after complete treatment. Conservative management should be avoided to achieve bleeding control and prevent the extension of the infection.

[Humanized prenatal care in Latin America: a stat of the art]. / Atención prenatal humanizada en américa latina: un estado del arte.

Objetive: To identify contributions of the scientific literature produced in the 2009-2019 period in Latin America on humanized prenatal care. Data sources:Articles produced in Latin America that addressed humanized prenatal care, published between 2009 and 2019 in indexed journals (reported in MIAR) and located in recognized databases, were selected. Study selection: A selection based on the source, quality and relevance of the studies was taken into account, excluding gray literature. After applying filters, 26 articles were obtained. Data extraction: The data was recorded, subsequently using an analytical matrix for its coding. Data: the studies, especially from Colombia and Brazil, were largely qualitative. It is established that the quality of care is reflected in the accessibility and satisfaction of the users with the services. Humanized prenatal care affects maternal-perinatal health. The recognition of the particular needs of pregnant women is relevant. The studies recommend qualifying health personnel to strengthen humanized prenatal care, assuming pregnant women as protagonists of the process, dispelling their doubts and concerns, and providing evidence on the relationship humanized prenatal care / reduction of maternal morbidity and mortality. Conclusions: The studies carried out recognize the pregnant woman as the protagonist and her needs as the starting point for humanized prenatal care, conceived as an essential reference for the quality of services with a positive impact on the satisfaction of pregnant women and maternal outcomes. Training of health personnel is required.

Objetivo: Identificar aportes de la literatura científica producida en el periodo 2009-2019 en América Latina sobre atención prenatal humanizada. Fuentes de datos: Se seleccionaron artículos producidos en América Latina que abordaran la atención prenatal humanizada, publicados entre 2009 y 2019 en revistas indexadas (reportadas en MIAR) y localizados en bases de datos reconocidas. Selección de los estudios: Se tuvo en cuenta una selección basada en la fuente, calidad y pertinencia de los estudios, excluyendo la literatura gris. Luego de aplicar filtros se obtuvieron 26 artículos. Extracción de datos: Los datos fueron fichados, utilizando posteriormente una matriz analítica para su codificación. Datos: los estudios, sobre todo provenientes de Colombia y Brasil, fueron en buena parte cualitativos. Se establece que la calidad de la atención se refleja en la accesibilidad y la satisfacción de las usuarias con los servicios. El cuidado prenatal humanizado incide en la salud materno-perinatal. Es relevante el reconocimiento de las necesidades particulares de las gestantes. Los estudios recomiendan cualificar el personal de salud para fortalecer el cuidado prenatal humanizado, asumir las gestantes como protagonistas del proceso, disipando sus dudas y preocupaciones y aportar evidencia sobre la relación atención prenatal humanizada/reducción de la morbimortalidad materna. Conclusiones: Los estudios realizados reconocen a la gestante como protagonista y sus necesidades como el punto de partida para la atención prenatal humanizada, concebida como referente esencial de la calidad de los servicios con impacto positivo sobre la satisfacción de las gestantes y los resultados maternos. Se requiere formar al personal de salud.

Arachnoid membrane as a source of sphingosine-1-phosphate that regulates mouse middle cerebral artery tone.

Growing evidence indicates that perivascular tissue is critical to modulate vessel function. We hypothesized that the arachnoid membrane surrounding middle cerebral artery (MCA) regulates its function via sphingosine-1-phosphate (S1P)-induced vasoconstriction. The MCA from 3- to 9-month-old male and female wild-type (Oncine France 1 and C57BL/6) mice and sphingosine kinase 2 knockout (SphK2-/-) mice in the C57BL/6 background was mounted in pressure myographs with and without arachnoid membrane. Raman microspectroscopy and imaging were used for in situ detection of S1P. The presence of arachnoid tissue was associated with reduced external and lumen MCA diameters, and with an increase in basal tone regardless of sex and strain background. Strong S1P-positive signals were detected in the arachnoid surrounding the MCA wall in both mice models, as well as in a human post-mortem specimen. Selective S1P receptor 3 antagonist TY 52156 markedly reduced both MCA vasoconstriction induced by exogenous S1P and arachnoid-dependent basal tone increase. Compared to 3-month-old mice, the arachnoid-mediated contractile influence persisted in 9-month-old mice despite a decline in arachnoid S1P deposits. Genetic deletion of SphK2 decreased arachnoid S1P content and vasoconstriction. This is the first experimental evidence that arachnoid membrane regulates the MCA tone mediated by S1P.

Evaluating the coupling efficiency of OAM beams into ring-core optical fibers.

In optical communications, space-division multiplexing is a promising strategy to augment the fiber network capacity. It relies on modern fiber designs that support the propagation of multiple spatial modes. One of these fibers, the ring-core fiber (RCF), is able to propagate modes that carry orbital angular momentum (OAM), and has been shown to enhance not only classical but also quantum communication systems. Typically, the RCF spatial modes are used as orthogonal transmission channels for data streams that are coupled into the fiber using different free space beams. Free space beams commonly used are Laguerre-Gaussian (LG) and perfect vortex (PV) beams. Here, we study the optimal conditions to multiplex information into ring-core fibers in this scheme. We study the beam coupling efficiency using the overlap between free space beams and RCF bound beams and determine which are the most relevant LG beams to be considered and how their coupling efficiency can be maximized by properly adjusting the beam width with respect to the fiber parameters. Our results show that the coupling efficiency depends upon the OAM value and that this can limit the achievable transmission rates in SDM systems. In this regard, we find optimal coupling configurations for LG beams based on the RCF fiber and beam parameters. Further, we study the PV beam that allows for nearly perfect coupling efficiencies for all spatial modes supported by these fibers. PV beams present higher coupling efficiencies than LG beams and negligible dependence on the OAM value, thus offering an attractive solution to multiplex high counts of OAM channels from free space into a ring-core fiber using a single coupling configuration.

Morphological study on the origin of the semitendinosus muscle in the long head of biceps femoris.

Hamstring muscle injuries are the most prevalent among athletes who engage in sprinting activities. Their most frequent location is where the long head of the biceps femoris joins with the semitendinosus muscle to form the conjoint hamstring tendon. Just distal to this area, an additional group of fibers of the semitendinosus originate from medial aspect of biceps femoris. The objective of this study was to analyze the morphological characteristics of this union and to discuss its potential role in hamstring tears. Anatomical dissection was performed on 35 thighs. Samples obtained from this region were sectioned and stained with Masson's trichrome for further histological evaluation. A group of fibers from the semitendinosus muscle originating from the long head of the biceps femoris were observed in all 35 specimens. This origin was located 67 ± 12 mm from the ischial tuberosity and was 32 ± 14 mm in length. This group of muscle fibers had a width of 10.9 ± 5.3 mm and a thickness in the anteroposterior axis of 3.2 ± 1.4 mm. Its pennation angle was 9.2 ± 1.5 degrees. Microscopic examination showed muscle cells from both muscles contacting interposed tendinous tissue. In conclusion, fibers of the semitendinosus muscle consistently arise from the proximal aspect of the long head of biceps femoris. The morphological characteristics of this junction have functional implications. The horizontal component of the semitendinosus vector could pull the long head of the biceps femoris medially during its shortening-lengthening cycle, rendering it an intrinsic risk factor for hamstring injuries.

Factores predictores de satisfacción de pacientes en consulta externa pediátrica del Hospital El Cruce Néstor Kirchner / Predictive variables of patient satisfaction in the pediatric outpatient clinic of El Cruce-Néstor Kirchner Hospital

INTRODUCCIÓN: El papel de los pacientes en los sistemas sanitarios es cada vez más relevante. Su satisfacción aparece como uno de los principales indicadores al evaluar la gestión sanitaria y la calidad asistencial. El objetivo del estudio fue determinar variables predictoras de satisfacción con la atención médica en la consulta externa pediátrica del Hospital El Cruce-Néstor Kirchner. MÉTODOS: Se realizó un estudio de corte transversal. Se incluyó a pacientes en edad pediátrica que concurrieron al Hospital a partir de junio de 2018. Se completaron encuestas CAHPS (Consumer Assessment of Healthcare Providers and Systems) después de la visita. Se utilizó test de Kruskal-Wallis para comparar distribución de cada variable predictora; para variables independientes categóricas, se realizó tabla n x p buscando significancia por test de chi cuadrado ajustada por número de comparaciones y chi cuadrado de tendencia lineal buscando asociación entre categorías predictoras ordenadas y variable respuesta. RESULTADOS: Un total de 423 personas respondieron el cuestionario; 368 eran mujeres, 390/415 eran padre o madre. La mayoría estaba conforme; sólo 3 asignaron puntajes menores a 7 (mínimo 0, máximo 10). Ninguna de las variables predictoras analizadas se asoció significativamente con peor evaluación del profesional y satisfacción con la atención. DISCUSIÓN: Hay un alto grado de satisfacción con la atención. Los motivos podrían ser abordados en profundidad mediante estudios cualitativos.

Predictive variables of patient satisfaction in the pediatric üutpatíent clinic of El Cruce-Néstor Kirchner Hospital / Factores predictores de satisfacción de pacientes en consulta externa pediátrica del hospital el cruce-nestor kirchner

RESUMEN INTRODUCCIÓN : El papel de los pacientes en los sistemas sanitarios es cada vez más relevante. Su satisfacción aparece como uno de los principales indicadores al evaluar la gestión sanitaria y la calidad asistencial. El objetivo del estudio fue determinar variables predictoras de satisfacción con la atención médica en la consulta externa pediátrica del Hospital El Cruce-Néstor Kirchner. MÉTODOS : Se realizó un estudio de corte transversal. Se incluyó a pacientes en edad pediátrica que concurrieron al Hospital a partir de junio de 2018. Se completaron encuestas CAHPS (Consumer Assessment of Healthcare Providers and Systems) después de la visita. Se utilizó test de Kruskal-Wallis para comparar distribución de cada variable predictora; para variables independientes categóricas, se realizó tabla n x p buscando significancia por test de chi cuadrado ajustada por número de comparaciones y chi cuadrado de tendencia lineal buscando asociación entre categorías predictoras ordenadas y variable respuesta. RESULTADOS : Un total de 423 personas respondieron el cuestionario; 368 eran mujeres, 390/415 eran padre o madre. La mayoría estaba conforme; sólo 3 asignaron puntajes menores a 7 (mínimo 0, máximo 10). Ninguna de las variables predictoras analizadas se asoció significativamente con peor evaluación del profesional y satisfacción con la atención. DISCUSIÓN : Hay un alto grado de satisfacción con la atención. Los motivos podrían ser abordados en profundidad mediante estudios cualitativos.

ABSTRACT INTRODUCTION : The role of patients in health systems is increasingly relevant. Their satisfaction appears as one of the main indicators to evaluate health management and quality of care. The objective of the study was to determine predictive variables of satisfaction with medical care in the pediatric outpatient clinic of El Cruce Néstor Kirchner Hospital. METHODS : A cross-sectional study was conducted. It included pediatric patients who attended the Hospital since June 2018. Post-visit CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys were completed. Kruskal-Wallis test was used to compare the distribution of each predictor variable; for categorical independent variables, n x p table was performed looking for significance by chi-square test adjusted for number of comparisons and chisquare of linear trend looking for association between ordered predictor categories and response variable. RESULTS : A total of 423 people answered the questionnaire; 368 were female, 390/415 were father or mother. Most respondents reported being satisfied; only 3 of them assigned scores lower than 7 (minimum 0, maximum 10). None of the predictive variables analyzed were significantly associated with worse evaluation of professionals and satisfaction with care. DISCUSSION : There is a high level of satisfaction with the attention. Qualitative studies would help to thoroughly explain the reasons.

Anatomical study of the pial arterial network in human spinal cords.

INTRODUCTION: Multiple collaterals originate from three main longitudinal vessels to perfuse the human spinal cord. Only a few classic studies published in the last century have investigated these collaterals. The current work proposes a possible classification of these vessels and analyzes their relative abundance along spinal cord segments. MATERIALS AND METHODS: Human spinal cords (n = 30) from male and female cadavers were injected with colored latex through the vertebral, ascending cervical, costocervical trunk and segmental arteries and then fixed in formaldehyde solution. Afterwards, spinal vessels were dissected and the relative abundances of each type of collateral were quantified and compared between different spinal cord segments. RESULTS: Collaterals of the anterior longitudinal pathway can be classified as central arteries and arteries for the anterior and lateral columns. Collaterals for the anterior column can be classified into two types: anteromedial and anterolateral. Arteries for the lateral column can be classified, according to their relationship with the dentate ligament, as either preligamentous or post-ligamentous. The collaterals of posterior longitudinal pathways can be divided between those for the posterior and those for the lateral column. In turn, the arteries for the posterior column can be classified into three types: median posterior, posteromedial and posterolateral. The collaterals for the lateral column were also classified as either pre- or post-ligamentous. CONCLUSION: The relative abundance of the various types of collateral and anastomoses between longitudinal pathways was inhomogeneous along the spinal cord, with several statistically significant differences observed between spinal segments.

PyHIST: A Histological Image Segmentation Tool.

The development of increasingly sophisticated methods to acquire high-resolution images has led to the generation of large collections of biomedical imaging data, including images of tissues and organs. Many of the current machine learning methods that aim to extract biological knowledge from histopathological images require several data preprocessing stages, creating an overhead before the proper analysis. Here we present PyHIST (https://github.com/manuel-munoz-aguirre/PyHIST), an easy-to-use, open source whole slide histological image tissue segmentation and preprocessing command-line tool aimed at tile generation for machine learning applications. From a given input image, the PyHIST pipeline i) optionally rescales the image to a different resolution, ii) produces a mask for the input image which separates the background from the tissue, and iii) generates individual image tiles with tissue content.

Tobacco consumption in the population of Risaralda, Colombia.

INTRODUCCIÓN: El tabaquismo tiene una alta prevalencia en todo el mundo, y genera alta mortalidad, morbilidad e inequidad social. OBJETIVO: Determinar la prevalencia e identificar las características del tabaquismo en la población del departamento de Risaralda, Colombia. MATERIAL Y MÉTODOS: Estudio de corte transversal que incluyó 2084 personas mayores de 18 años residentes en los municipios del departamento de Risaralda, en la región cafetalera de Colombia. Se les preguntó por el consumo de tabaco, el grado de dependencia del tabaco (prueba de Fagerström) y el nivel de ansiedad por el consumo (cuestionario QSU-brief). MATERIAL Y MÉTODOS: El 12% fueron fumadores activos, el 17% exfumadores y un 20-24% convivió, trabajó o estudió con alguien que fumaba. El 94% de los fumadores intentó dejar de fumar y el 67% lo logró por más de 1 año. La mediana de la escala de Fagerström fue de 4 (rango intercuartílico [RIC]: 2-5) y la del QSU-brief fue de 28 (RIC: 16-44). El consumo del cigarrillo sin llegar al filtro (p < 0.001), comprar la caja de cigarrillos entera (p < 0.001), haber intentado dejar de fumar (p < 0.001), consumir café (p < 0.001), desear dejar de fumar (p < 0.001) y fumar aunque se esté enfermo (p = 0.002) aumentaron el riesgo de ser fumador actual, mientras que pedirle el cigarrillo a un amigo o familiar (p = 0.004) y haber dejado de fumar en algún momento (p < 0.001) lo disminuyeron. CONCLUSIONES: La frecuencia de consumo fue alta, pero los niveles de dependencia y ansiedad permiten establecer que un programa de cesación de consumo de tabaco sería exitoso en esta población. Se sugiere aplicar la encuesta definida en esta investigación para identificar a los fumadores actuales e implementar estrategias de cesación de consumo de tabaco en este grupo. BACKGROUND: Smoking has a high prevalence worldwide, generates high mortality, morbidity and social inequity. OBJECTIVE: Determine the prevalence and identify the characteristics of tobacco smoking in the population of Risaralda, Colombia. MATERIAL AND METHODS: Cross-sectional study that included 2084 people over 18 years living in the municipalities of the Department of Risaralda, in the coffee region of Colombia. They were asked about tobacco consumption, level of tobacco dependence (Fagerström test) and level of consumption anxiety (QSU-brief questionnaire). MATERIAL AND METHODS: 12% were active smokers, 17% were ex-smokers and 20-24% lived, worked or studied with someone who smoked. 94% of smokers have tried to stop smoking, and 67% achieved it for more than one year. The median of the Fagerström scale was 4 (interquartile range [IQR]: 2-5) and the QSU-brief was 28 (IQR: 16-44). Consumption of the cigarette without reaching the filter (p < 0.001), buying the whole cigarette package (p < 0.001), having tried to stop smoking (p < 0.001), consuming coffee (p < 0.001), wishing to stop smoking (p < 0.001) and smoking even if sick (p = 0.002) increased the risk of being a current smoker, while asking a friend or family member for a cigarette (p = 0.004) and achieved smoking cessation at some point (p < 0.001), decreased it. CONCLUSIONS: The frequency of consumption was high, due and the levels of dependence and anxiety found, it is possible to propose that a smoking cessation program would be successful in this population. It is suggested to apply the survey defined in this research to identify the current smoker and implement tobacco cessation strategies in this group.

Evaluation of the human petrotympanic fissure using anatomized cadaveric specimens and multi-detector CT imaging.

PURPOSE: The purpose of the current study is twofold. First, to investigate the variability of the petrotympanic fissure's (PTF) morphology in anatomized human cadaveric specimens using multi-detector computed tomography (MDCT), and second, to compare the resulting measurements to investigate the possibilities of applying MDCT in the determination of PTF morphology in living humans. METHODS: Specimens (n = 15) containing the temporal bone and TMJ were obtained from embalmed adult female (53.3%) and male (46.7%) cadavers and imaged using a helical 16-row scanner. Afterwards, cryosections were obtained and morphometric parameters were measured. Degree of agreement between both determinations was investigated and morphometric variables were also compared between PTF types. RESULTS: Three different types of PTF were identified. Type 1 was a wide tunnel-shaped structure. It was found in 20% of the cases. Type 2 was wide in the entrance but gradually narrows to the tympanic cavity. It was found in 46.7% of specimens. Finally, type 3, which was observed in 33.3% of the cases, was wide at the entrance of the mandibular fossa, followed by a middle region with flat-shaped tunnel structure and a narrow exit. The PTF's vertical diameters at the mandibular fossa, midpoint, and tympanic cavity and the width at the mandibular fossa all were significantly greater in type 1 specimens. CONCLUSIONS: MDCT is suitable for investigating the variable morphology of human PTF and its association with middle ear's and TMJ pathologies.

Experimental Evaluation of a New Tissue Factor-Based Topical Hemostat (TT-173) for Treatment of Hepatic Bleeding.

Background: Excessive blood loss is a relevant complication of partial liver resection. Topical hemostatic agents have proven useful to improve the control of the bleeding in this among other surgical indications. Until now all of these products have been based on the action of thrombin. In contrast TT-173 is a new topical hemostatic agent based on recombinant tissue factor naturally incorporated into membrane vesicles. This work sought to assess the efficacy and toxicity of TT-173 in an animal model of liver resection.Materials and Methods: Procoagulant activity of 0.15, 0.41, and 1 mg of TT-173 was evaluated in pigs subjected the resection of hepatic lobe margins. The most effective of these doses was also compared against thrombin. In addition, the toxicity, local tolerance, systemic absorption, and immunogenicity of the product were investigated in rats subjected to liver biopsy lesion.Results: The three doses of TT-173 evaluated significantly reduced the bleeding time in liver lesions. The highest dose of product was significantly more effective than the others and thrombin. Application of high doses of TT-173 in rats did not cause any local or systemic alterations. Absorption into blood stream was negligible and no immunogenic reaction against the product was detected.Conclusions: TT-173 shows favorable pharmacodynamic properties for improving hemostasis in partial liver resection which support further investigation of the product in this surgical indication.

Cross-cultural adaptation and psychometric validation of the Patient Scar Assessment Questionnaire to the Spanish language in head and neck surgery.

External appearance is the main aesthetic outcome in patients who undergo surgical procedures. Scars located in exposed areas, such as the neck and face, are important for patients. There are at least eight instruments that are used to evaluate postoperative scars, but few fulfil standard methodological conditions. The Patient Scar Assessment Questionnaire (PSAQ) was designed and validated using psychometric methodology. However, this scale has not been translated or validated in the Spanish language. The aim of this study was to undergo a cross-cultural adaptation and psychometric validation of the PSAQ scale to the Spanish language in patients who underwent head and neck surgery. We followed The Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines for the translation and validation of health-related scales. Forward and back translations were made by independent translators. We included adult patients who underwent thyroidectomy, parathyroidectomy, parotidectomy, and neck dissection. For the psychometric validation, we used a principal axis exploratory factor analysis with oblimin rotation. A reliability test involving Cronbachs alpha and the item-total correlation was performed and for the convergent/concurrent validity, we selected the Spanish version of the Vancouver Scar Scale. A total of 180 patients were recruited. Factor analysis showed a five-factor solution. Cronbachs alpha for the subscales was >0.7. The comparison between the PSAQ appearance subscale and the VSS demonstrated a high correlation (rho = - 0.89). In a sample of 62 patients, the test-retest evaluation showed high correlation (0.74-0.99). Our study supports the Spanish version of the PSAQ as a valid, reliable, and reproducible tool to assess the perception and impact of neck scars in Spanish-speaking patients who undergo head and neck surgery.

Influencia de los procederes de enfermería en la sobrevivencia de los pacientes afectados por el Ébola / Influence of Nursing Procedures in the Survival of Patients Affected by Ebola

Introducción: El virus del Ébola causa una enfermedad grave sumamente infecciosa, que lleva rápidamente a la muerte, con una tasa de letalidad de hasta 90 por ciento, pero puede prevenirse. Objetivo: Describir relevancia de los procederes de enfermería en la sobrevivencia de los pacientes afectados por el Ébola Métodos: Estudio descriptivo, de corte transversal en Liberia, África Occidental, en el periodo de noviembre 2014 a febrero 2015. El universo estuvo constituido por 203 pacientes a quienes se les aplicó procederes de enfermería por enfermeros que integraron la brigada médica cubana. La información se obtuvo de la observación directa y la revisión de la base de datos estadística de la misión cubana en Liberia, se procesó mediante el Sistema SPSSS versión 11,5 a través de técnicas de estadística descriptiva. Resultados: Predominó el sexo masculino (55,66 por ciento), diciembre fue el mes de mayor ingreso (36,45 por ciento), la mayoría de los pacientes fueron ingresados en la salas de sospechosos (60,09 por ciento), predominó la administración de medicamentos por vía oral, con 820 procederes (52,59 por ciento), se logró que 51,25 por ciento de los pacientes atendidos egresaran vivos, siendo el mes de enero el de mayor letalidad (66,70 por ciento). Conclusiones: La labor realizada por los enfermeros cubanos en la lucha contra el Ébola en Liberia, África Occidental, y el cumplimiento estricto de los protocolos según procederes de enfermería contribuyó al control hemodinámico de los pacientes atendidos y a la disminución paulatina de la epidemia, así como la letalidad por dicho evento(AU)

Introduction: Ebola virus causes a highly infectious and serious disease, which quickly leads to death, with a death rate of up to 90 percent, but it can be prevented. Objective: To describe the relevance of nursing procedures in the survival of patients affected by Ebola. Methods: Descriptive, cross-sectional study carried out in West Africa, Liberia in the period from November 2014 to February 2015. The study population consisted of 203 patients who were applied nursing procedures by personnel who were part of the Cuban medical brigade. The information was obtained by direct observation and review of the statistical database of the Cuban mission in Liberia; and processed through the system SPSSS version 11.5, through descriptive statistics techniques. Results: The male sex predominated (55.66 percent). December was the month with highest admittance (36.45 percent); the majority of patients were admitted to the ward of suspects (60.09 percent). The administration of oral medications predominated, with 820 procedures (52.59 percent). It was achieved for 51.25 percent of the patients attended to be discharged alive, the month of January accounting for the highest mortality (66.70 percent). Conclusions: The work carried out by the Cuban nurses in the fight against Ebola in West Africa, Liberia and the strict compliance with the protocols according to nursing procedures contributed to the hemodynamic control of the patients attended and the gradual reduction of the epidemic, as well as the mortality for the event(AU)

Bioactive Food Abates Metabolic and Synaptic Alterations by Modulation of Gut Microbiota in a Mouse Model of Alzheimer's Disease.

Recent investigations have demonstrated an important role of gut microbiota (GM) in the pathogenesis of Alzheimer's disease (AD). GM modulates a host's health and disease by production of several substances, including lipopolysaccharides (LPS) and short-chain fatty acids (SCFAs), among others. Diet can modify the composition and diversity of GM, and ingestion of a healthy diet has been suggested to lower the risk to develop AD. We have previously shown that bioactive food (BF) ingestion can abate neuroinflammation and oxidative stress and improve cognition in obese rats, effects associated with GM composition. Therefore, BF can impact the gut-brain axis and improved behavior. In this study, we aim to explore if inclusion of BF in the diet may impact central pathological markers of AD by modulation of the GM. Triple transgenic 3xTg-AD (TG) female mice were fed a combination of dried nopal, soy, chia oil, and turmeric for 7 months. We found that BF ingestion improved cognition and reduced Aß aggregates and tau hyperphosphorylation. In addition, BF decreased MDA levels, astrocyte and microglial activation, PSD-95, synaptophysin, GluR1 and ARC protein levels in TG mice. Furthermore, TG mice fed BF showed increased levels of pGSK-3ß. GM analysis revealed that pro-inflammatory bacteria were more abundant in TG mice compared to wild-type, while BF ingestion was able to restore the GM's composition, LPS, and propionate levels to control values. Therefore, the neuroprotective effects of BF may be mediated, in part, by modulation of GM and the release of neurotoxic substances that alter brain function.