Recanalization of the Chronically Occluded Internal Carotid Artery: Review of the Literature.

Introduction: We reviewed the literature on interventions for patients with medically refractory chronically occluded internal carotid artery (COICA) to assess the risks and/or benefits after recanalization via an endovascular technique (ET) or hybrid surgery (HS, i.e., ET plus carotid endarterectomy). Methods: A systematic search of the electronic databases was performed. Patients with COICA were classified into 4 different categories according to Hasan et al classification. Results: Eighteen studies satisfied the inclusion criteria. Only 6 studies involved an HS procedure. We identified 389 patients with COICA who underwent ET or HS; 91% were males. The overall perioperative complication rate was 10.1% (95% confidence interval [CI]: 7.4%-13.1%). For types A and B, the successful recanalization rate was 95.4% (95% CI: 86.5%-100%), with a 13.7% (95% CI: 2.3%-27.4%) complication rate. For type C, the success rate for ET was 45.7% (95% CI: 17.8%-70.7%), with a complication rate of 46.0% (95% CI: 20.0%-71.4%) for ET and for the HS technique 87.6% (95% CI: 80.9%-94.4%), with a complication rate of 14.0% (95% CI: 7.0%-21.8%). For type D, the success rate of recanalization was 29.8% (95% CI: 7.8%-52.8%), with a 29.8% (95% CI: 6.1%-56.3%) complication rate. Successful recanalization resulted in a symmetrical perfusion between both cerebral hemispheres, resolution of penumbra, normalization of the mean transit time, and improvement in Montreal Cognitive Assessment (MoCA) score (ΔMoCA = 9.80 points; P = 0.004). Conclusions: Type A and B occlusions benefit from ET, especially in the presence of a large penumbra. Type C occlusions can benefit from HS. Unfortunately, we did not identify an intervention to help patients with type D occlusions. A phase 2b randomized controlled trial is needed to confirm these findings

Stenting in the Treatment of Acute Ischemic Stroke: Literature Review

Recanalization of acute large artery occlusions is a strong predictor of good outcome. The development of thrombectomy devices resulted in a significant improvement in recanalization rates compared to thrombolytics alone. However, clinical trials and registries with these thrombectomy devices in acute ischemic stroke (AIS) have shown recanalization rates in the range of 40–81%. The last decade has seen the development of nickel titanium self-expandable stents (SES). These stents, in contrast to balloon-mounted stents, allow better navigability and deployment in tortuous vessels and therefore are optimal for the cerebral circulation. SES were initially used for stent-assisted coil embolization of intracranial aneurysms and for treatment of intracranial stenosis. However, a few authors have recently reported feasibility of deployment of SES in AIS. The use of these devices yielded higher recanalization rates compared to traditional thrombectomy devices. Encouraged by these results, retrievable SES systems have been recently used in AIS. These devices offer the advantage of resheathing and retrieving of the stent even after full deployment. Some of these stents can also be detached in case permanent stent placement is needed. Retrievable SES are being used in Europe and currently tested in clinical trials in the United States. We review the recent literature in the use of stents for the treatment of AIS secondary to large vessel occlusion

Propuesta de un modelo de mejoramiento de la calidad del servicio y satisfacción de los usuarios del transporte público y comercial del cantón Chambo, provincia de Chimborazo

La “Propuesta de un modelo de mejoramiento de la calidad del servicio y satisfacción de los usuarios del transporte público y comercial del Cantón Chambo, Provincia de Chimborazo”, se desarrolló con el fin de evaluar la calidad en el servicio por parte de las 7 operadoras de transporte público y comercial. La investigación parte en identificar las dimensiones intervienen directamente en la calidad y prestación del servicio, posteriormente se diagnosticó la situación actual calculando el nivel de satisfacción de los usuarios respecto al servicio prestado. Para la recolección de datos, fue preciso la aplicación de entrevistas dirigidas a los representantes de las operadoras, a la vez se utilizó encuestas hacia los usuarios y por último fue necesario el uso de fichas técnicas de observación sobre el estado de: vías, paradas, vehículos y el terminal terrestre de pasajeros. Finalizada la investigación se pudo determinar que: la administración de las operadoras se maneja de forma empírica, además de no contar con procesos de gestión del Talento Humano adecuados; en cuanto al Índice Calidad del servicio ofertado por las operadoras es de (-44,20) lo cual determina una insatisfacción de los usuarios, ubicando las dimensiones en estratos como: Empatía (-55), Fiabilidad (-52), Aseguramiento (-48), Elementos Tangibles (-36), Capacidad de Respuesta (-30). En la parte técnica se notó el mal estado de vías, falta de información al usuario, señalética inadecuada e infraestructura insegura. La finalidad de la presente investigación fue el desarrollo de acciones de mejora desde la parte administrativa, dimensiones de calidad y aspectos técnicos que permita a los usuarios incrementar sus niveles de satisfacción hacia el servicio prestado. Por tal motivo se recomienda la implementación total del modelo con el objetivo de que las operadoras brinden un servicio de calidad acorde a las necesidades de los usuarios.The proposal of an improvement model of the quality of service and the users satisfaction of the public and commercial transport in Chambo, -Chimborazo province-was developed in order to evaluate the quality of the service by the seven operators of public and commercial transport. The investigation starts from identifying the dimensions that directly intervene in the quality and performance of the service, later the current situation was diagnosed by calculating the level satisfaction of the users concerning the service provided. For the collection of data, it was necessary to carry out interviews directed to the representatives of the operators, at the same time surveys were used towards the users and finally it was necessary to use technical observation sheets about the state of roads, stops, vehicles and the passenger land terminal. After the investigation it was possible to determine that the management of the operators is handled empirically, in addition to not having adequate Human Resource Management processes. Regarding the service quality index offered by the operators is (-44,20) which determines a dissatisfaction of the users, placing the dimensions in strata as: Empathy (-55), Reliability (-52), Assurance (-48), Tangible elements (-36), Response capacity (-30). In the technical part, the poor state of the roads, lack of user information, inadequate signage and unsafe infrastructure were noted. The purpose of this research was the development of improvement actions from the administrative side, quality dimensions and technical aspects that allow users to increase their levels of satisfaction with the service provided. For this reason, it is recommended the total implementation of the model with the aim that operators provide a quality service according to the users needs

Antioxidant Purple Corn Protein Concentrate from Germinated Andean Purple Corn Seeds

Ecuador Andean purple corn (Zea mays L.) was subjected to a germination process at 15–40 °C for 24–168 incubation hours. Purple corn protein concentrates (PCPCs) were obtained by alkaline extraction at pH 8.0 and pH 10.0, followed by an isoelectric precipitation process at pH 4.0, pH 5.0 and pH 6.0. Proteins and phenolic content of PCPCs was calculated. PCPC antioxidant properties were determined by the ferric-reducing antioxidant power (FRAP) in vitro method and by the 2,2-azinobis, 3-ethyl-benzothiazoline-6-sulfonic acid, (ABTS) in vitro method. Andean purple corn seeds were able to germinate under the germination conditions tested in this study. The higher percentage of germination was of 63.33% at 168 h/25 °C. The PCPCs protein profile was characterized for the presence of six bands with molecular weights of 14.50 kDa, 20.12 kDa, 25.18 kDa, 41.85 kDa, 59.59 kDa, and 65.87 kDa. Germinated PCPC presented a high TPC content with ranges of 605.71–1820.00 mg gallic acid equivalents (GAE)/g PCPC dry weight (DW), germinated PCPC/72 h/25 °C presented a higher value of 1820.00 mg GAE/g PCPC, DW. All germinated PCPCs samples assayed presented strong antioxidant activity when measured by the ABTS and FRAP methods. Germinated PCPC/144 h/35 °C presented high antioxidant activity by ABTS with 804.35 µmol Trolox equivalents (TE)/g PCPC DW and germinated PCPC/144 h/30 °C presented a high value by the FRAP method, 987.83 µmol TE/g PCPC DW

Plasma Soluble Human Elastin Fragments as an Intra-Aneurysmal Localized Biomarker for Ruptured Intracranial Aneurysm

Background—Fragmentation of the tunica media is a hallmark of intracranial aneurysm formation, often leading to aneurysmal progression and subsequent rupture. The objective of this study is to determine the plasma level of elastin fragments in the lumen of ruptured versus unruptured human intracranial aneurysms. Methods and Results—One hundred consecutive patients with/without ruptured saccular intracranial aneurysms undergoing endovascular coiling or stent-assisted coiling were recruited. Blood samples were collected from the lumen of intracranial aneurysm using a microcatheter. The tip of the microcatheter was placed inside the aneurysm’s sac in close proximity to the inner wall of the dome. Plasma levels of elastin fragments were measured using an ELISA-based method. Mean plasma level of soluble human elastin fragments was significantly greater in ruptured aneurysms when compared with nonruptured aneurysms (102.0±15.5 versus 39.3±9.6 ng/mL; P\u3c0.001). Mean plasma level of soluble human elastin fragments did not have significant correlation with age, sex, size, or aneurysm location. Conclusions—The present study revealed that a significantly higher concentration of soluble human elastin fragments in the lumen of ruptured intracranial aneurysms when compared with nonruptured ones. © 2018 The Authors

Percepción de los estudiantes de Medicina hacia la enseñanza entre pares en una universidad de México

Introduction: peer teaching is common in universities and allows students to teach their peers from the early academic years. During the COVID-19 pandemic, medical students have had to learn through online classes, but peer teaching has helped them overcome these educational challenges. Objective: to describe the experiences and perceptions of Medicine students about the peer teaching model. Method: an observational, descriptive and cross-sectional study was carried out. A self-conducted survey was applied integrating sociodemographic variables and personal experiences. It was shared among the medical students and the model was evaluated, the number of 366 students between 1-12 semester of the Autonomous University of Nuevo León was found as the minimum necessary sample. Results: 258 (61 %) women were identified, it was considered by 334 (79 %) that the instructors taught in a good or excellent way, it was referred by 333 (78.7 %) that they had a good or excellent clarity of the explanations. In addition, 295 (69.7 %) stated that the instructors explained better than the teachers almost always or always and 359 (84.9 %) explained that they felt satisfied with the instructors. The best rated departments were radiology (72.3 %) rating it as good, pathology (69 %) and embryology (68.7 %). Conclusions: It was found that the students' perception of the peer teaching model is positive, that it can serve to complement the teaching of teachers and can be very useful in the current pandemic situation.Introducción: la enseñanza entre pares es común en universidades y permite a los estudiantes enseñar a sus compañeros desde los primeros años académicos. Durante la pandemia de COVID-19 los estudiantes de Medicina han tenido que aprender mediante clases online, pero la enseñanza entre iguales les ha ayudado a superar estos retos educativos.Objetivo: describir las experiencias y percepciones del alumnado de Medicina sobre el modelo de enseñanza entre pares.Método: se realizó un estudio observacional, descriptivo y transversal. Se aplicó una encuesta de realización propia integrando variables sociodemográficas y experiencias personales. Se compartió entre los estudiantes de Medicina y se evaluó el modelo, se encontró como muestra mínima necesaria la cantidad de 366 estudiantes entre 1-12 semestre de la Universidad Autónoma de Nuevo León.Resultados: se identificaron 258 (61 %) mujeres, se consideró por 334 (79 %) que los instructores enseñaban de una manera buena o excelente, se refirió por 333 (78,7%) que se tenía una claridad buena o excelente de las explicaciones. Además, 295 (69,7 %) nombró que los instructores explicaban mejor que los profesores casi siempre o siempre y 359 (84,9 %) explicó sentirse satisfechos con los instructores. Los departamentos mejor valorados fueron radiología (72,3 %) calificándola como buena, patología (69 %) y embriología (68,7%).Conclusiones: se encontró que la percepción de los estudiantes al modelo de enseñanza de pares es positiva, que puede servir para complementar la enseñanza de profesores y puede ser de gran utilidad ante la situación actual de pandemia

Elaboración de un manual para procedimientos, para el mantenimiento eléctrico, en la industria textil Indutexma

Elaboración de un manual de procedimientos para el mantenimiento eléctrico en la industria textil “INDUTEXMA”El presente trabajo está constituido por las siguientes secciones: Capítulo I, En esta sección se detalla las necesidades que actualmente tiene la fábrica Indutexma como es el de poseer un manual de procedimientos para el mantenimiento eléctrico preventivo del equipo electro-mecánico, en la cual detalle el modelo, el tipo, la frecuencia y las herramientas necesarias para realizar un óptimo mantenimiento, dándose así a la justificación para el desarrollo del proyecto. En el Capítulo II, se describe en forma teórica las características de los equipos existentes en la industria y las principales normas de seguridad que se debe tener en la manipulación de herramientas, maquinarias y sistemas eléctricos, en la parte final se encuentra el glosario de términos con el significado de las palabras técnicas más utilizadas en el manual. En el Capítulo III se refiere a la Metodología que se utilizó para realizar la investigación mediante la tabulación y análisis de la encuesta la misma que nos proporcionó obtener un esquema para la propuesta. El Capítulo IV está constituido por los recursos humanos, materiales, financieros y la bibliografía que corresponde a la siguiente investigación. Capítulo V contempla la redacción de las conclusiones y en base a esto se exponen las recomendaciones que se perfilan para la solución del problema, mientras que el Capítulo VI se presenta la propuesta de solución que se plantea como alternativa al problema formulado en el capítulo I y luego se detalla todos los anexos como son fotografías y esquema de la encuesta realizada a los trabajadores de la fábrica textil Indutexma

Prototipo de un mapa virtual para la orientación de las personas en un establecimiento público empleando tecnología Arduino

The project involves the development of a prototype virtual map to guide people in a public place using Arduino technology, adapting through a mobile application developed on the Android operating system. Use serial communication between the Arduino and Android platform via a Bluetooth module in which the user application manages locate your position and information of where it is located.El proyecto consiste en el desarrollo de un prototipo de mapa virtual para orientar a las personas dentro de un lugar público utilizando tecnología Arduino, adaptándolo a través de una aplicación móvil desarrollada en el sistema operativo Android. Utiliza comunicación serial entre la plataforma Arduino y Android a través de un módulo Bluetooth en el cual el usuario de la aplicación logra ubicar su posición y obtener información del lugar en el que se encuentra