Treatment of Intracranial Aneurysms with the Pipeline Embolization Device Only: a Single Center Experience / 신경중재치료의학

PURPOSE: The aim of this study was to evaluate the technical feasibility and rate of mid-term occlusion in aneurysms treated solely with the Pipeline Embolization Device (PED) in a German tertiary care university hospital. MATERIALS AND METHODS: Forty-nine non-consecutive intracranial aneurysms underwent endovascular treatment using the PED exclusively between March 2011 and May 2017 at our institution. Primary endpoint was a favorable aneurysm occlusion defined as OKM C1-3 and D (O'Kelly Marotta Scale). Secondary endpoints were retreatment rate and delayed complications. Median follow-up was 200 days. RESULTS: The mean aneurysm size was 7.1 ± 5.3 mm. Forty-four aneurysms were located in the anterior circulation (90%). Ten aneurysms were ruptured (20%). Branching vessels from the sac were observed in 11 aneurysms (22%). Favorable obliteration immediately after PED placement was seen in 13/49 aneurysms (27%), of those nine aneurysms were completely occluded (18%). Angiographic and clinical follow-up was available for 45 cases (92%); 36/45 aneurysms (80%) were occluded completely and 40/45 aneurysms (89%) showed a favorable occlusion result. A branching vessel arising from the aneurysm sac was associated with incomplete occlusion (P < .05). All electively treated patients had good outcome (mRS 0). Three aneurysms (6%) required additional treatment due to aneurysm recurrence. CONCLUSION: In our series, treatment of intracranial aneurysms with the PED was associated with favorable occlusion rates and low complication rates at mid-term follow-up. The presence of branching vessels arising from the aneurysms sac was predictive for an incomplete occlusion.

Clinical Study on Acupuncture at Cranial Sutures plus Rehabilitation Training for Post-stroke Spastic Palsy / 上海针灸杂志

Objective To observe the clinical efficacy of acupuncture at cranial sutures plus rehabilitation training in treating post-stroke spastic palsy.Method Sixty patients with post-stroke spastic palsy were randomized into a treatment group and a control group, 30 cases each. The treatment group was intervened by acupuncture at cranial sutures plus rehabilitation training, while the control group was intervened by rehabilitation training alone. The Modified Ashworth Scale (MAS), Fugl-Meyer Assessment, and activities of daily living (ADL) in the Modified Barthel Index (MBI) were observed before and after the treatment for the two groups.Result After the intervention, there was a significant difference in MAS score between the two groups (P<0.05). The FMA and ADL scores were changed significantly after the treatment in both groups (P<0.05). The FMA and ADL scores in the treatment group were significantly different from those in the control group after the treatment (P<0.05).Conclusion Acupuncture at cranial sutures plus rehabilitation is an effective approach in treating post-stroke spastic palsy.

The virulence of Streptococcus pneumoniae partially depends on dprA

Abstract Streptococcus pneumoniae is one of the most frequent opportunistic pathogens worldwide. DNA processing protein A (DprA) is an important factor involved in bacterial uptake and DNA integration into bacterial genome, but its role in S. pneumoniae virulence remains unclear. The aim of this study was to characterize the effects of the pneumococcal dprA gene on the pathogenesis of S. pneumoniae. To construct a dprA-deficient pneumococcal strain, the dprA gene of the S. pneumoniae strain D39 was inactivated. The virulence of this dprA-deficient strain, designated ΔD39, was compared with that of the wild-type strain by evaluating their respective capabilities to adhere to human pulmonary epithelial cells (PEC-A549) and by analyzing their choline-binding protein expression levels. In addition, the expression profiles of genes associated with virulence and host survival assays were also conducted with the mutant and the wild-type strain. Our results indicate that the capability of ΔD39 to adhere to the PEC-A549 airway cells was significantly lower (p < 0.01) compared with D39. Additionally, the 100-KD choline-binding protein was not detected in ΔD39. The addition of competence-stimulating peptide (CSP) lead to a significantly reduction of psaA mRNA expression in the dprA-deficient mutant and an increased level of psaA transcripts in the wild-type strain (p < 0.01). The median survival time of mice intraperitoneally infected with ΔD39 was significantly higher (p < 0.01) than that of mice infected with D39. The results of this study suggest that DprA has a significant effect on virulence characteristics of S. pneumoniae by influencing the expression of choline-binding protein and PsaA.

Caracterización de la sobrecarga y de los estilos de afrontamiento en el cuidador informal de pacientes dependientes / Characterization of overburdening and coping styles in the informal care of dependent patients

Introducción: los recursos y estrategias son elementos de los que el cuidador dispone para tratar de amortiguar el posible impacto de la situación de cuidado. Métodos: Se realizó un estudio descriptivo transversal con el propósito de caracterizar la sobrecarga y los estilos de afrontamiento de los cuidadores informales en el área de salud "Héroes de Girón", del municipio Cerro. Se aplicó una encuesta que incluyó la entrevista de carga del cuidador y el cuestionario COPE. Resultados: la sobrecarga se presentó en el 47,6 % de los cuidadores. Las mujeres representaron el 90 % de esta, y recayó en el grupo de 60 años y más (50 %), casados (50 %), técnicos medios (30 %), los que cuidaban mayor cantidad de horas (63,6 %) y que no habían participado en algún programa educativo (95 %). Los estilos de afrontamiento más frecuentemente usados en los cuidadores fue la aceptación (3,70), el afrontamiento activo (3,53) y la reformulación positiva (3,01). El tipo de afrontamiento más frecuentemente usado fue el conductual activo (3,23). Conclusiones: La sobrecarga se presenta en poco menos de la mitad de los cuidadores, con predominio en las mujeres, en el grupo de 60 años y más, en el nivel técnico medio y en los casados, que cuidan más de 12 horas y que no han participado en ningún programa educativo. Las estrategias de afrontamiento más usadas son las activas dirigidas a resolver los problemas que se presentan con el cuidado, independientemente de la edad, el sexo y el nivel educacional.

Introduction: resources and strategies are elements the caregiver has to try to weaken the possible impact of caregiving situation. Methods: a transversal descriptive study was conducted with the objective to characterize overburdening and coping styles of informal caregivers in "Héroes de Girón" health area, Cerro municipality. A survey was applied which included Caregiver Burden Interview and COPE questionnaire. Results: overburdening was present in the 47, 6 % of caregivers. Women represented the 90 % of this, and it fell in the age group of 60 years or older (50 %), married (50 %), technicians (30 %) those who cared most hours (63.6 %) and those who had not participated in any educational program (95 %). The most frequent coping styles used by caregivers were: acceptance (3.70), active coping (3.53) and positive reframing (3.01). The most frequently used coping style was the active behavioral one (3.23). Conclusions: overburdening is present in slightly less than half of caregivers, it predominates in women, in the age group of 60 years and older, in intermediate levels, in married people, people who care more than 12 hours and in those who have not participated in any educative program. The most used coping styles are the active ones directed to solve the problems which arise with care, regardless the age, sex and educational level.

Anatomic study and clinical application of thinned posterior tibial artery perforator flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and therapeutic effect of thinned posterior tibial artery free perforator flap for the reconstruction of soft tissue defects at dorsum of hands.</p><p><b>METHODS</b>Six fresh adult lower limbs specimens were injected with red latex via arterial cannula and dissected. The number, distribution, branches, and outer diameter of posterior tibia artery perforators were observed. Based on the anatomic study, the perforator flaps were designed to reconstruct soft tissue defects at dorsum of hands and wrists. The redundant fat on the flaps was removed, but preserving the nutrient vascular system. 11 flaps were used with the size ranging from 2 cm x 5 cm to 10 cm x 14 cm.</p><p><b>RESULTS</b>43 skin perforators of posterior tibial artery were observed in six lower limbs, 29 perforators with the outer diameter is greater than 0.5 mm when they threading over the deep fascia plane, on average every 4.8 bundles of sides. The mean outside diameter of perforating artery is (1.8 +/- 0.5) mm, and the length is (44 +/- 15) mm. 6 perforators were founded both in the second and fifth zone which could be used for anastomosis for its better diameters. All flaps survived completely without any complication at donor sites. 7 cases were followed up for 3-12 months. Both satisfactory functional and cosmetic results were achieved with a soft and thinned appearance.</p><p><b>CONCLUSIONS</b>The thinned posterior tibial artery free perforator flap has a reliable blood supply and good appearance. It is very suitable for the reconstruction of small or medium-sized defects at the dorsum of hands and wrists.</p>

Caracterización del cuidado informal de pacientes dependientes en el policlínico Héroes de Girón en el 2009 / Characterization of informal care of dependent patients at the polyclinic Héroes de Girón in 2009

Introducción: con el progresivo envejecimiento de la población y la mayor supervivencia de pacientes con enfermedades crónicas y discapacidades, no solo aumenta el número de personas que necesitan cuidados, sino que además existe una mayor exigencia en la prestación de servicios. Objetivo: caracterizar el cuidado informal de pacientes dependientes en el policlínico Héroes de Girón, en el 2009. Métodos: se realizó un estudio descriptivo, transversal. Se aplicó una encuesta que incluye la entrevista de carga del cuidador. La muestra estuvo constituida por 42 cuidadores informales de pacientes dependientes del policlínico Héroes de Girón, del municipio Cerro, que corresponde con el total de cuidadores informales del área de salud en el momento del estudio. Resultados: el sexo femenino predominó en los pacientes dependientes 30 (71,43 porciento) y en los cuidadores 35 (83,33 porciento), 18 (42,86 porciento) de los cuidadores eran esposas, su edad media era de 52 años, fueron amas de casa 17 (40,48 porciento), y 29 (69,05 porciento) le dedicaba al cuidado más de 12 horas al día. La sobrecarga se presentó en 22 cuidadores (52,38 porciento). Conclusiones: menos de la mitad de los cuidadores presentó sobrecarga; predominaron las mujeres de 60 años de edad o más (amas de casa, hijas o esposas) que dedicaban 12 horas diarias o más ese cuidado. Más del 90 porciento no ha participado en ningún programa educativo

Introduction: with an aging population and increased survival of patients with chronic diseases and disabilities, the number of people needing care not only increases, but also the provision of services increases in demand. Objective: to characterize the informal care of dependent patients at the polyclinic Héroes de Girón, in 2009. Methods: we conducted a cross-sectional study. We used a survey including the caregiver burden interview. The sample consisted of 42 caregivers of dependent patients at the polyclinic Héroes de Girón, Cerro municipality; they correspond to the total of informal caregivers in the health area at the time of this study. Results: most of the dependent patients 30 (71.43 percent) and caregivers 35 (83.33 percent) were females, out of them 18 (42.86 percent) were wives, the average age is 52 years, 17 (40.48 percent) were housewives and 29 (69.05 percent) devoted more than 12 hours a day to this care. The overload was present in 22 caregivers (52.38 percent). Conclusions: less than half of caregivers presented overload; most of them were women aged 60 and over. They were housewives, daughters, or wives. They devoted more than 12 hours a day to this care. Over 90 percent have not participated in any educational program

The tolerance to 188Re-HEDP treatment in patients with bone pain from osseous metastases / 中华核医学杂志

Objective To study the tolerance to 188Re-1-hydroxy-1 ,1-ethylidene disodium phosphonate(HEDP) in patients with bone pain caused by osseous metastases. Methods Thirty-one patients(10with prostate cancer, 9 with breast cancer, 3 with lung cancer, 5 with liver cancer, 2 with rectal cancer, 1with esophageal cancer and 1 with renal cancer) received a single injection dose of 188Re-HEDP. The patients were divided into four groups according to the injection dose: 20 MBq/kg (6 patients), 30 MBq/kg(6 patients), 40 MBq/kg (9 patients), and 50 MBq/kg (10 patients). Haematological toxicity (WHO grading) of grade Ⅲ- Ⅳ was considered unacceptable. Vital signs and adverse effects after injection were recorded for 8 weeks. Blood counts were measured weekly during a period of 8 weeks. Biochemical parameters and electrocardiogram were assayed at week 4 and 8. Statistical analysis was performed for per-protocol (pp) population (t-test). Results Twenty-seven patients belonged to PP population with 5 in the group of 20 MBq/kg, 5 in the group of 30 MBq/kg, 8 in the group of 40 MBq/kg and 9 in the group of 50 MBq/kg.No obvious adverse effects and no significant change of vital signs, electrocardiogram, liver and renal function were found after injection. Alkaline phosphatase was slightly higher than baseline at week 4 and 8 after therapy, but the difference was not statistically significant. In the 20 MBq/kg group, reversible grade Ⅰ leucopenia was noted in 1 patient. In the 30 MBq/kg group, 2 patients showed reversible grade Ⅰ leucopenia including 1 alone with reversible grade Ⅲ thrombopenia. In the 40 MBq/kg group, reversible grade Ⅰ leucopenia and thrombopenia was observed in 1 patient and reversible grade Ⅱ leucopenia and thrombopenia in another patient. In the .50 MBq/kg group, 3 patients showed reversible grade Ⅱ leucopenia. The lowest level of thrombopenia was at week 4(143.5 × 109/L), leucopenia at week 6 (5.4 × 109/L) and anaemia at week 8(t = 3.1325, 3.3156, 3.4917, all P ＜ 0. 05 compared with baseline). At week 8, the mean level of platelet and leucocyte recovered to baseline. "Bounce pain" was found in 2 of 27 patients (7.41%).Conclusions The dose of 20 MBq/kg, 30 MBq/kg, 40 MBq/kg or 50 MBq/kg of 188Re-HEDP do not cause significant side effects on cancer patients with bone metastases, though there is a tendency that the haematological toxicity may increase as the dose of 188Re-HEDP increases.

Consumo de bebidas alcohólicas y ambiente social. Un enfoque multinivel / Alcohol consumption and social context. A multilevel approach

Objetivos: Tradicionalmente las variaciones en el consumo de bebidas alcohólicas se han estudiado en términos de las características individuales. Con este estudio nos propusimos valorar la contribución de los factores contextuales en conjunto con los individuales, en la cantidad de bebidas alcohólicas que los individuos consumen. Métodos: Se midieron variables en 2 niveles: individual y contextuales (vecindarios). Las primeras se obtuvieron de una muestra representativa de la población mayor de 15 años del municipio 10 de Octubre y las contextuales mediante entrevistas con los representantes del gobierno de las áreas del municipio. Se usaron 3 modelos multiniveles: modelo nulo, modelo de interceptos aleatorios y modelo de coeficientes dependientes. Resultados: Existen diferencias regionales en el consumo de bebidas alcohólicas y estas diferencias persisten después de ajustar por las características individuales, por lo que se le pueden atribuir a los contextos. De los factores contextuales estudiados, 4 tienen influencia directa en la cantidad de bebidas alcohólicas que los individuos consumen y 2 de ellos interactúan con la situación laboral de las personas. Por ejemplo, las personas que están desocupadas consumen más que las que tienen alguna ocupación, pero los desocupados que viven en vecindarios con numerosos puntos de venta de bebidas alcohólicas, consumen más que los desocupados que viven en vecindarios con menos puntos de venta. Conclusiones: Los modelos multiniveles son una herramienta importante que permiten estudiar los efectos individuales y contextuales que se relacionan con el consumo de bebidas alcohólicas. Los resultados de la aplicación de una estrategia de modelación multinivel sugieren que los factores individuales y contextuales desempeñan un papel importante en la estructuración del consumo de bebidas alcohólicas.

Objectives: Traditionally the variations in alcohol consumption have been studied in terms of individual characteristics. In the present study we intended to assess the contribution of contextual factors and individual factors as well, in the units of alcohol consumed per person per. Methods: We measured variables in two levels: individual and contextual (neighborhoods). The first ones were obtained by means of a cross-sectional survey of people 15 years an older in Havana City. Contextual variables were obtained through interviews with the representatives of the local government in the city. Three multilevel models were used: null model, random intercept models and dependent coefficients model. Results: Our findings suggest that there are variations in the average number of units consumed among neighborhoods and these differences persist after adjusting for individual characteristics; so part of the variations can be attributed to the contexts. Six contextual factors were studied. Four have direct influence in the average number of units consumed and two of them interact with the economic situation of the respondents. For example, people that are unoccupied consume more than those that have an occupation; but the unoccupied ones that live in neighborhoods with numerous alcohol outlets consume more than the unoccupied ones that live in neighborhoods with less alcohol outlets. Conclusions: The results suggest that individual and contextual factors play an important role in structuring the patterns of alcohol consumption in order to design better health promotions and prevention strategies. The high-level alcohol drinkers tend to group in neighborhoods with a large number of alcohol outlets.

Calidad de vida relacionada con la salud de los adultos mayores en el país, 2001 / Quality of life related to health of elderlies in our country, 2001

El envejecimiento poblacional del mundo y de Cuba es un fenómeno demográfico asociado con la revolución científico técnica del siglo XX; sus consecuencias unidas a características socio-demográficas pueden afectar la calidad de vida. Este trabajo pretende caracterizar la calidad de vida relacionada con la salud de los adultos mayores en el país, con los datos de la II Encuesta Nacional de Factores de Riesgo de Enfermedades no Trasmisibles de Cuba en el 2001. Se calcularon números absolutos, medias, porcentajes y Odds Ratio con sus intervalos de confianza al 95 por ciento. El efecto confusor de las variables se controló con un modelo de regresión logísitica. La calidad de vida relacionada con la salud óptima mejoró significativamente al aumentar la escolaridad de los individuos desde primaria hasta la universidad, de 36,2 a 52,6 por ciento, OR=1,1 (1,019;1,266). La empeoraron significativamente el aumentar la edad, OR=0,96 (0,953; 0,973); percibir desfavorablemente la situación económica, OR=0,61 (0,491; 0,766) y pertenecer al sexo femenino, OR=0,47 (0,416; 0,540). Algunas variables socio-demográficas influyen sobre la calidad de vida relacionada con la salud de los adultos mayores y la magnitud de esta influencia debe valorarse para el manejo de este grupo de edad.

World population aging and of Cuba is a demographic phenomenon associated with the scientific and technical revolution of XX century; its consequences joined to sociodemographic characteristics may to affect the quality of life. The aim of present paper is to characterize the quality of life related to health of elderlies in our country, to data from the II National Survey of Risk Factors of Non-communicable diseases of Cuba for 2001. Authors estimated absolute numbers, means, percentages and odds ratio with their 95 percent confidence intervals. Confuse effect of variables was controlled using a logistic regression model. Quality of life related to an optimal health significantly improved with the increasing schooling of subjects from the primary school up to university level from 36.2 percent to 52.6 percent, OR = 1.1 (1.019; 1.266). There was worsening with age increase, OR = 0.96 (9.953; 0.973); a unfavorable perception of economic situation, OR = 0.61 (0.491; 0.766) and to be of female sex, OR = 0.47 (0.416; 0.540). Some socioeconomic variables influenced on the quality of life related to health of elderlies and to magnitude of this influence must to be assessed to approach this age group.

Influencia familiar en el tabaquismo de los adolescentes / Family influence on tobacco smoking in adolescents

El adolescente está expuesto a factores de riesgo como el tabaquismo, en el cual la familia juega un papel muy importante. Este trabajo describe la influencia familiar en el tabaquismo en los adolescentes de 15 a 19 años, en el marco de la II Encuesta Nacional de Factores de Riesgo de Enfermedades no Trasmisibles del 2001, en Cuba. Se entrevistaron 1 915 adolescentes, de 8 847 familias. Se calcularon porcentajes y Odds Ratio con su intervalo de confianza al 95 por ciento. La prevalencia de vida y el hábito de fumar actual en los adolescentes es de 12,7 por ciento y 9,0 por ciento, respectivamente. Los adolescentes masculinos fuman significativamente más (11,5 por ciento) que las adolescentes femeninas (6,3 por ciento). Los antecedentes familiares de tabaquismo influyen significativamente en el consumo de tabaco de las adolescentes femeninas, aunque la proporción actual de adolescentes cubanos que consumen tabaco es menor que en otras épocas y en otros países.

The adolescent is exposed to risk factors as smoking, in which the family plays a very significant role. This paper describes the family influence on smoking in adolescents aged 15-19, within the framework of the II National Survey of Risk Factors of Non-Communicable Diseases done in Cuba in 2001. 1 915 adolescents from 8 847 families were interviewed. Percentages and odds ratios with 95 percent of confidence intervals (CI) were calculated. Life prevalence and the present smoking habit in adolescents were 12.7 percent and 9.0 percent, respectively. Male adolescents smoke more (11.5 percent) than females (6.3 percent). The family history of smoking significantly influences on the tobacco consumption among female adolescents, although the present proportion of Cuban adolescents consuming tobacco is lower than in other periods and in other countries.

Effect of cranial needling combined with medicine on IL-6 in the patient of acute cerebral hemorrhage / 中国针灸

<p><b>OBJECTIVE</b>To explore the mechanism of cranial needling in treatment of acute intracerebral hemorrhage.</p><p><b>METHODS</b>Forty-three cases were randomly divided into a cranial needling plus medication group (n=21) and a medication group (n=22). The cranial needling plus medication group were treated with needling skull suture 4 days after the attack, once each day, for 10 sessions, on the basis of routine neurological treatment measures. The medication group were treated with the routine neurological treatment measures. Changes of the scores of neural function defect and IIL-6 contents before and after treatment were compared.</p><p><b>RESULTS</b>The IL-6 contents before and after treatment were (11.29 +/- 8.63) pg/mL and (1.91 +/- 1.02) pg/mL in the cranial needling plus medication group, and (12.15 +/- 7.23) pg/mL and (3.61 +/- 2.71) pg/mL in the medication group, respectively, with very significant differences before and after treatment (P<0.01), and with a significant difference between the two groups after treatment (P<0.05). There were very significant differences in the score of neural function defect before and after treatment in the two groups (P<0.01), and there was a significant difference between the two groups after treatment (P<0.05).</p><p><b>CONCLUSION</b>On the basis of medication, cranial needling can promote rapid decrease of serum IL-6 content and improve nervous function in the patient of acute cerebral hemorrhage.</p>

Calidad de vida relacionada con la salud de los expuestos activamente al tabaco. Cuba, 2001 / Quality of life related to the health of people actively exposed to smoking: Cuba, 2001

El consumo de tabaco es nocivo para la salud y puede ocasionar distintas enfermedades como el cáncer y afectaciones en la calidad de vida. El objetivo de este trabajo fue describir la calidad de vida relacionada con la salud de las personas expuestas activamente al tabaco, mediante el EuroQol-5D, tomando los datos de la II Encuesta Nacional de Factores de Riesgo de Enfermedades no Trasmisibles de Cuba en el 2001. Se calcularon números absolutos, porcentajes, odds ratio con su intervalo de confianza al 95 por ciento y se modeló con una regresión logística. Los porcentajes de individuos con calidad de vida relacionada con la salud óptima difieren significativamente entre expuestos y no expuestos de 66,78 a 58,93 por ciento y controlando la exposición también hubo diferencias entre estos porcentajes por sexo, edad y estado civil. Los odds ratio estimados en el modelo fueron 3,36, 1,02 y 3,60, respectivamente.

Smoking is harmful for health and may cause a number of diseases such as cancer and problems in quality of life. The objective of the present paper is to describe the quality of life related to the health of people actively exposed to smoking through EuroQol-5D, taking data from the Second National Survey of Risk Factors for Non-Communicable Diseases in Cuba in 2001. Absolute numbers, percentages, odd ratios with 95 percent confidence intervals were estimated and also logistic regression was modelled. The percentage of individuals with quality of life related to optimal health condition significantly differed between those exposed and those non-exposed to smoking (66,78 percent and 58,93 percent respectively) and controlling for exposure, there were still differences between these percentages according to sex, age and marital status. Estimated odd ratios for this model were 3,36, 1,02 and 3,60, respectively.

Effect of skull acupuncture and scalp acupuncture on serum vascular endothelial growth factor in the patient of acute cerebral infarction / 中国针灸

<p><b>OBJECTIVE</b>To investigate effect of skull suture acupuncture (skull acupuncture) and scalp acupuncture on serum vascular endothelial growth factor (VEGF) in the patient of acute cerebral infarction (CI).</p><p><b>METHODS</b>Twenty cases of CI were treated with skull suture acupuncture at coronal suture, sagittal suture, lambdoid suture, etc. combined with medication (group B), group C (n=20) with scalp acupuncture at contralateral Dingnie Qian-xiexian (MS 6) and Dingnie Houxiexian (MS 7) plus medication, and group A (n=20) with medication. Changes of serum VEGF contents were investigated in the three groups.</p><p><b>RESULTS</b>After treatment, the serum VEGF content did not significantly change in group A (P > 0.05), and significantly increased in group B and group C (P < 0.01, P < 0.05), with significant difference as group B and C compared with that of group A (P < 0.05), and with no significant difference between group B and group C (P > 0.05).</p><p><b>CONCLUSION</b>Skull suture acupuncture combined with medication and scalp acupuncture plus medication have a similar effect on serum VEGF in the patient of acute cerebral infarction.</p>

Consumo de bebidas alcohólicas: sugerencias para su medición en Cuba / Consumption of alcoholic beverages: suggestions for its measurement in Cuba

Entre los problemas asociados con el consumo de bebidas alcohólicas están las enfermedades crónicas, y las consecuencias agudas, como son las intoxicaciones, los accidentes y los problemas relacionados con el comportamiento social. La tasa de incremento de estos riesgos aumenta según la cantidad de bebidas alcohólicas ingeridas. Los estudios sobre el consumo de bebidas alcohólicas se pueden abordar desde una perspectiva individual o ecológica. En este trabajo se brindan las consideraciones metodológicas para aplicar uno u otro enfoque, y se discuten sus ventajas y limitaciones para medir el volumen de bebidas alcohólicas consumidas en la población cubana. Estas ayudarán a los médicos de la atención primaria a prevenir y controlar los problemas relacionados con el consumo excesivo, facilitar las investigaciones en este campo, así como la vigilancia epidemiológica que permita la formulación de políticas de salud pública efectivas. Por último, se presentan ejemplos de preguntas para indagar sobre el consumo individual de bebidas alcohólicas

Estimaciones usadas en diseños muestrales complejos: aplicaciones en la encuesta de salud cubana del año 2001 / Estimate methods used with complex sampling designs: their application in the Cuban 2001 health survey

OBJETIVOS: En el presente trabajo se discuten las particularidades de tres métodos de estimación de parámetros simples -medias, totales y porcentajes, y sus respectivos errores estándar-, así como de los modelos de regresión logística, en el análisis de los datos de muestras complejas. MÉTODOS: Se tomaron los datos de la Segunda Encuesta Nacional de Factores de Riesgo y Afecciones Crónicas No Transmisibles, realizada en Cuba en el año 2001. Se usó un diseño muestral complejo estratificado y por conglomerados polietápicos. Los estratos estuvieron conformados por las 14 provincias de Cuba y el municipio especial Isla de la Juventud, mientras que los conglomerados fueron las áreas geográficas muestrales (AGEM), manzanas y secciones. Las muestras se ponderaron en proporción inversa a las probabilidades de selección y para la estimación se realizó una estratificación por sexo y grupo de edad (15-34, 35-54, 55-74 y 75 años o más). Las varianzas se estimaron mediante las aproximaciones de Taylor. Se compararon tres métodos estadísticos: el análisis convencional, que da por sentado que los datos provienen de un muestreo simple aleatorio; el análisis ponderado, que solo toma en consideración los pesos muestrales para obtener las estimaciones; y el análisis con ajustes, que toma en cuenta la desigualdad en las probabilidades de selección y el efecto de la conglomeración en los datos. RESULTADOS: Las estimaciones puntuales obtenidas mediante las tres estrategias de análisis fueron similares. Los errores estándar estimados para la prevalencia de sobrepeso obtenidos por el análisis convencional se subestimaron en 19,3 por ciento y para la prevalencia de hipertensión en más de 11,5 por ciento en relación con los otros métodos. El análisis ponderado generó valores de los errores estándar mucho menores que los calculados por otros métodos. Resultados similares se encontraron al estimar los valores de la razón de posibilidades. CONCLUSIONES: Los métodos de análisis que toman en cuenta la estructura de los datos y las características del diseño ofrecen una visión más realista del problema estudiado. Con ellos se obtienen estimaciones más precisas de los parámetros y de sus errores estándar. La frecuencia con que se encuentran datos procedentes de diseños muestrales complejos en estudios epidemiológicos y de salud pública exige una mayor utilización de estos métodos y de los paquetes estadísticos que los contemplan.

Activating effect of hepatitis B virus preS/S protein on proliferating cell nuclear antigen gene promoter / 中华实验和临床病毒学杂志

<p><b>BACKGROUND</b>PreS/S gene was derived from hepatitis B virus (HBV) integration fragment of human hepatocellular carcinoma genome, containing the promoter of preS/S and the C terminal truncated preS/S open reading frame. PreS/S protein may have important roles in processing hepatoma in some HBV-infected patients. The aim of the study was to study the activity of HBV preS/S protein on proliferating cell nuclear antigen (PCNA) promoter and to localize compartment of the preS/S protein in the liver cell line L02.</p><p><b>METHODS</b>The authors studied the effect of the 3 -truncated preS/S on human PCNA promoter by co-transfecting the expression plasmids of luciferase reporter gene, used the immunohistochemical method to localize the preS/S protein.</p><p><b>RESULTS</b>The expression product of the plasmid, pKSH7C-HpaI which contained the 3 -truncated preS/S and the flanking cellular sequences, stimulated the expression of PCNA promoter dose dependently,and its effect was 0.5 folds higher than control. Immunohistochemistry showed that the preS/S protein located in the cytosolic region of the liver cell line L02.</p><p><b>CONCLUSIONS</b>The HBV preS/S protein could stimulate the PCNA promoter of the liver cell, its effect was not direct, which suggests that the effect of preS/S protein on PCNA promoter was probably through the cell signal transduction pathway.</p>

Pesquisa de coliformes totais e Escherichia coli em alfaces (Lactuca sativa) comercializadas na cidade de Limeira, São Paulo, Brasil / Research of total coliforms and Escherichia coli in lettuces (Lactuca sativa) marked in Limeira, State of São Paulo

Foram analisadas 42 amostras de alfaces (Lactuca sativa) coletadas de seis redes de comercialização da cidade de Limeira - São Paulo, Brasil. A partir de cada uma das amostras, foram realizadas análises para determinação do Número Mais Provável de coliformes totais e de Escherichia coli, utilizando-se o método do substrato cromogênico e fluorogênico (Simplate) para alimentos. Das 42 amostras analisadas, 41 apresentaram, segundo a metodologia utilizada, cavidades com resultados positivos para coliformes totais, que correspondem a 97,6 por cento das amostras analisadas e 17 amostras apresentaram o mesmo resultado para Escherichia coli, correspondendo a 40,5 por cento do total de amostras. Duas amostras apresentaram contagens para Escherichia coli fora dos padrões estabelecidos pela legislação vigente pare este tipo de alimento.

Evaluación de la calidad de la atención médica en el subsistema de urgencias del municipio 10 de octubre, 1997 / Evaluation of medical care quality in the emergency service subsystem of 10 de octubre municipality 1997

Se realizó un estudio transversal, para evaluar algunos aspectos de la calidad de la atención médica brindada en los policlínicos principales de urgencia (PPU) del municipio 10 de Octubre. Para ello se aplicó un cuestionario autoadministrado a los usuarios seleccionados. La muestra quedó conformada por 328 pacientes. El comportamiento de los criterios seleccionados para medir la estructura y el proceso arrojó valores no aceptables en casi la totalidad de los criterios y manifestó amplias desviaciones de los valores obtenidos en relación con los establecidos. La calidad de estos servicios es susceptible de mejoras que permitan que estén a la altura de lo esperado por los usuarios y la resolutividad de sus problemas, la cual está determinada en gran medida por la falta de medicamentos en la farmacia. Se recomienda realizar estudios periódicos que permitan evaluar la calidad de la atención médica en los PPU del municipio 10 de octubre; con el fin de conocer cómo estos funcionan y si están en correspondencia con los objetivos para los que fueron creados

Neuropatía epidémica cubana: algunos factores de riesgo en la población / Cuban epidemic neuropathy: the risk factors in the population

A cross-sectional study was conducted in 1995 in a representative sample of the Cuban population aged 15 years or over with the objective of describing prevalence and characteristics of smoking, alcohol consumption, and physical inactivity in the urban population which could have been affected by epidemic neuropathy from 1991-1993. The sampling was stratified at provincial and municipal levels and then by cluster samplings. 93 of the sample was surveyed (14 300 people). 30 of the population aged 17 years and over smoked; the highest proportion of smokers was located in 40-49 years age group; men smoked more than woman regardless of age. The prevalence of alcohol consumption was 45.2 in which Eastern provinces exceeded the domestic average with males predominating. The prevalence of physical inactivity at national level was 33, 25.7 for males and 39.8 for females. 47.3 of males and 25.4 of females classified as physically active because of their useful extra activity. It was considered that irregular relationships between these 3 risk factors and the incidence of epidemic neuropathy at the ecological level make it think that, although they have a real influence on the determinants of the disease, other factors may also better account for the occurrence of these cases.

Tabaquismo y sus características en trabajadores de la salud / Smoking and its characteristics in health workers

Los médicos y otros profesionales de la salud constituyen importantes fuentes de influencia para lograr cambios positivos de los niveles de tabaquismo en la comunidad. Se presentan los resultados de un estudio transversal en 221 trabajadores de la salud, del municipio Centro Habana. Su objetivo determinar en ellos la prevalencia del tabaquismo y sus características, cómo percibían el riesgo de fumar, e identificar propuestas para reducir la frecuencia de fumadores y el consumo de cigarrillos. Se aplicaron técnicas cuantitativas y cualitativas de investigación (grupos focales). El cuestionario incluyó variables sociodemográficas, variables relacionadas con el consumo, y variables relacionadas con la percepción del riesgo de fumar. En lo cualitativo, se exploraron propuestas para reducir esta conducta. El 32 porciento de los médicos y el 46 porciento de las enfermeras fumaban en el momento de la encuesta. Los médicos aportaron más fumadores moderados y severos, y se sintieron menos limitados a fumar en sus centros de trabajo que las enfermeras. El 17 porciento de ellos y el 20 porciento de las enfermeras aceptó que fumar le representó más beneficios que daños. En ambos grupos se evidenció una percepción distorsionada del riesgo de fumar. Entre las propuestas hechas por los propios trabajadores, que deberán tenerse en cuenta al implementar proyectos de intervención, se encontraron: fortalecer en la atención primaria los servicios de cesación para fumadores, hacer cumplir en los centros de salud las regulaciones para fumar, aplicar sanciones a los violadores de lo reglamentado y divulgar de manera sistemática la importancia de la función modélica de los médicos y enfermeras, como importantes agentes de cambios en la sociedad