Posible influencia de factores no controlados en las concentraciones séricas de uracilo / Possible influence of uncontrolled factors on serum uracil concentrations

Antecedentes y objetivos: el déficit de dihidropirimidina deshidrogenasa (DPD) se ha asociado con un mayor riesgo de toxicidad tras exposición a fluoropirimidinas (FP). La determinación de las concentraciones plasmáticas de uracilo endógeno (U) es la prueba recomendada para identificar el déficit de DPD. Sin embargo, el valor de U puede verse afectado por diversos factores. El objetivo fue determinar la concentración sérica de U en una población candidata a recibir tratamiento con FP y comprobar si su distribución era compatible con la prevalencia del déficit parcial de DPD estimada en población caucásica. Material y métodos: estudio observacional prospectivo en el que se incluyeron pacientes oncológicos candidatos a tratamiento con FP. Para la determinación analítica se empleó un sistema Dionex Ultimate 3000 UHPLC, acoplado a un espectrómetro de masas cuadrupolo-orbitrap híbrido Q-exactive. Resultados: se incluyeron 77 pacientes con una edad media de 71 años. La media y la mediana de las concentraciones séricas de U fue 30,4 y 24,0 ng/ml, respectivamente. El rango fue de 7,1 a 139,7 ng/ml. Un 79,2% de los pacientes presentó un nivel de U comprendido entre 16 y 150 ng/ml, mostrando una diferencia estadísticamente significativa al compararlo con la prevalencia estimada en población caucásica (8%) (p-valor <0,0001). El método analítico empleado tiene un coeficiente de correlación R2 > 0,99 y un límite de detección <0,2 ng/ml. Conclusiones: es necesario llevar a cabo más estudios con un diseño dirigido a establecer las condiciones óptimas relativas al pretratamiento de las muestras a fin de evitar o minimizar la influencia de estos factores sobre los valores del analito. (AU)

Background and objective: dihydropyridine dehydrogenase (DPD) deficiency has been associated with an increased risk of toxicity after exposure to fluoropyrimidines (FP). Determination of endogenous uracil (U) plasma concentrations is the recommended test to identify DPD deficiency. However, the value of U can be affected by various factors. The objective was to determine the serum concentration of U in a population candidate to receive treatment with FP and to verify if its distribution was compatible with the prevalence of partial DPD deficiency estimated in the Caucasian population. Material and methods: prospective observational study in which cancer patients candidates for FP treatment were included. For the analytical determination, a Dionex Ultimate 3000 UHPLC system coupled to a Q-exactive hybrid quadrupole-orbitrap mass spectrometer was used. Results: 77 patients, with a mean age of 71 years, were included. The mean and median serum U concentrations were 30.4 and 24.0 ng/ml, respectively. The range was from 7.1 to 139.7 ng/ml. 79.2% of the patients presented a U level between 16 and 150ng/ml, showing a statistically significant difference when compared to the estimated prevalence in the Caucasian population (8%) (p-value <0.0001). The analytical method used has a correlation coefficient R2 > 0.99 and a detection limit <0.2 ng/ml. Conclusions: it is necessary to carry out more studies with a design aimed at establishing the optimal conditions related to the pretreatment of the samples in order to avoid or minimize the influence of these factors on the analyte values. (AU)

Single nucleotide polymorphisms in ADAM17, IL23R and SLCO1C1 genes protect against infliximab failure in adults with Crohn's disease.

BACKGROUND: To predict primary failure of infliximab (IFX) therapy in Crohn's disease (CD) and to identify patients who maintain long-term effectiveness to IFX is currently not feasible. Some genetic variations are proposed as potential biomarkers. AIM: We assessed a set of single nucleotide polymorphisms (SNPs) in genes related to the IFX mechanism of action and the presence of HLA-DQA1 * 05 allele on the primary response and long-term durability in CD patients. METHODS: A multi-centre cross-sectional study of IFX-exposed adult patients with CD was undertaken. Treatment persistence and time to failure were co-primary endpoints. DNA from the 131 patients was genotyped. Association between SNPs and clinical variables with IFX persistence was assessed. RESULTS: Failure to IFX was documented in 65 (49.6%) out of 131 patients. IFX persistence was associated either with carrying the TT genotype in ADAM17 rs10929587 (ORa=0.2; 95%CI=0.1-0.8; p = 0.021), or the CC genotype in SLCO1C1 rs3794271 (ORa=0.2; 95%CI=0.1-0.7; p = 0.008), according to multivariate logistic regression. In contrast, previous bowel resection increased the risk of IFX failure (ORa=2.8; 95%CI=1.1-7.3; p = 0.025). Cox regression analysis confirmed these findings and also identified IL23R rs10489629-TT (HRa 0.41; 95%CI=0.22-0.75; p = 0.004) and concomitant immunosuppressants (HRa 0.46; 95%CI=0.27-0.77; p = 0.003) as protection from IFX failure. However, no association between HLA-DQA1 * 05 allele and persistence of IFX therapy was found, with similar failure rates among carriers and non-carriers (52.8% vs. 47.4%, respectively; p = 0.544). CONCLUSIONS: SNPs rs10929587-TT in ADAM17, rs10489629-TT in IL23R and rs3794271-CC in SLCO1C1, together with no previous bowel surgery and concomitant immunosuppression, were identified as protection from failure to IFX.

Consensus of experts from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology for the genotyping of DPYD in cancer patients who are candidates for treatment with fluoropyrimidines.

5-Fluorouracil (5-FU) and oral fluoropyrimidines, such as capecitabine, are widely used in the treatment of cancer, especially gastrointestinal tumors and breast cancer, but their administration can produce serious and even lethal toxicity. This toxicity is often related to the partial or complete deficiency of the dihydropyrimidine dehydrogenase (DPD) enzyme, which causes a reduction in clearance and a longer half-life of 5-FU. It is advisable to determine if a DPD deficiency exists before administering these drugs by genotyping DPYD gene polymorphisms. The objective of this consensus of experts, in which representatives from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology participated, is to establish clear recommendations for the implementation of genotype and/or phenotype testing for DPD deficiency in patients who are candidates to receive fluoropyrimidines. The genotyping of DPYD previous to treatment classifies individuals as normal, intermediate, or poor metabolizers. Normal metabolizers do not require changes in the initial dose, intermediate metabolizers should start treatment with fluoropyrimidines at doses reduced to 50%, and poor metabolizers are contraindicated for fluoropyrimidines.

Genes differentially expressed by methylprednisolone in vivo in CD4 T lymphocytes from multiple sclerosis patients: potential biomarkers.

Intravenous methylprednisolone (IVMP) is the gold standard treatment in acute relapses of multiple sclerosis. Knowing the response to IVMP in advance could facilitate earlier selection of patients for subsequent courses of therapy. However, molecular mechanisms and changes in gene expression induced by methylprednisolone remain unknown. The aim of the study was to identify in vivo differentially expressed genes in relapsing-remitting multiple sclerosis patients after 3-6 days of treatment with IVMP. For this purpose, whole-genome transcription profiling of CD4+ T lymphocytes was performed before and after treatment with IVMP in 8 relapsing-remitting multiple sclerosis patients during relapse using Human GE 4x44K v2 microarrays. Differentially expressed genes were identified using a paired t test on GeneSpring v13.0 software. A P-value <0.001 and a twofold change were considered significant. Microarray data were confirmed using real-time PCR. Microarray revealed changes in gene expression: four genes were downregulated (B3GNT3, ZNF683, IFNG and TNF) and seven upregulated (DEFA4, CTSG, DEFA8P, AZU1, MPO, ELANE and PRTN3). Pathway analysis revealed the transforming growth factor-ß signaling pathway to be affected. Comparison with previously published data on in vitro methylprednisolone-regulated genes showed that SMAD7, TNF and CHI3L1 were also downregulated in vivo in relapsing-remitting multiple sclerosis patients. In summary, we performed the first in vivo transcriptome analysis in CD4+ T lymphocytes before and after the treatment with IVMP in patients with multiple sclerosis. Identification of differentially expressed genes in patients receiving IVMP could improve our understanding of the molecular mechanisms underlying the therapeutic effects of IVMP and highlight potential biomarkers of the response to IVMP.

[Validation of genetic polymorphisms associated to the toxicity of chemotherapy in colorectal cancer patients]. / Validación de polimorfismos genéticos asociados a toxicidad al tratamiento quimioterápico en pacientes de cáncer colorrectal.

OBJECTIVE: To validate the associations previously found in three cohorts of patients from the General University Hospital Gregorio Marañón, between the polymorphisms rs1128503, rs2032582 and rs1045642 of the ABCB1 gene and the hand-foot syndrome and diarrhea in colorectal cancer patients treated with chemotherapy regimes containing Capecitabine and 5-Fluorouracil, respectively, and between the polymorphisms rs2297595 of the DPYD gene and nausea/vomiting, rs11615 of ERCC1 and neutropenia, and rs28399433 CYP2A6 and neutropenia, in colorectal cancer patients treated with FOLFOX or XELOX as adjuvant therapy. METHOD: Colorectal cancer patients treated with chemotherapy regimes, containing Capecitabine (n = 157), 5-Fluorouracil (n = 99) were included in the study, as well as patients treated with XELOX or FOLFOX (n = 83) as adjuvant therapy. The patients included were recruited from the Doce de Octubre University Hospital and from the Gregorio Marañón General University Hospital, and signed the informed consent form. DNA was obtained from blood samples. Genotyping was carried out with SNaPshot. Contingency tables were created for analyzing the associations between the genotypes and the adverse reactions. RESULTS: None of the associations previously identified was replicated in the validation cohort. CONCLUSIONS: Pharmacogenetic studies with a limited sample size must be validated with bigger cohorts, if possible by means of multicentre studies, reducing the variables to the maximum and should never be used in clinical practice without validation.

OBJETIVO: Validar las asociaciones, encontradas previamente en tres cohortes de pacientes del Hospital General Universitario Gregorio Marañón, entre los polimorfismos rs1128503, rs2032582 y rs1045642 del gen ABCB1 con síndrome manopie y diarrea en pacientes de cáncer colorrectal tratados con regímenes que contenían capecitabina y 5-Fluorouracilo, respectivamente, y entre los polimorfismos rs2297595 del gen DPYD con nauseas/vómitos, rs11615 ERCC1 y neutropenia, y rs28399433 CYP2A6 y neutropenia en pacientes de cáncer colorrectal tratados con FOLFOX o XELOX en adyuvancia. MÉTODO: Se incorporaron al estudio pacientes de cáncer colorrectal tratados con regímenes quimioterápicos que contenían capecitabina (n = 157), 5-fluorouracilo (n = 99) y pacientes tratados en adyuvancia con XELOX o FOLFOX (n = 83). Los pacientes participantes fueron reclutados en el Hospital Universitario Doce de Octubre y en el Hospital General Universitario Gregorio Marañón tras firmar consentimiento informado. Se extrajo ADN a partir de muestras de sangre. Los genotipados se realizaron mediante SNaPshot. Se realizaron tablas de contingencia para analizar las asociaciones entre genotipos y reacciones adversas. RESULTADOS: Ninguna de las asociaciones previamente identificadas fue replicada en la cohorte de validación. CONCLUSIONES: Los estudios farmacogenéticos con un tamaño muestral limitado deben ser validados en cohortes más numerosas, a ser posible en estudios multicéntricos, reduciendo al máximo las variables y nunca deben ser utilizados en clínica sin validar.

A genome-wide association study on copy-number variation identifies a 11q11 loss as a candidate susceptibility variant for colorectal cancer.

Colorectal cancer (CRC) is a complex disease, and therefore its development is determined by the combination of both environmental factors and genetic variants. Although genome-wide association studies (GWAS) of SNP variation have conveniently identified 20 genetic variants so far, a significant proportion of the observed heritability is yet to be explained. Common copy-number variants (CNVs) are one of the most important genomic sources of variability, and hence a potential source to explain part of this missing genetic fraction. Therefore, we have performed a GWAS on CNVs to explore the relationship between common structural variation and CRC development. Phase 1 of the GWAS consisted of 881 cases and 667 controls from a Spanish cohort. Copy-number status was validated by quantitative PCR for each of those common CNVs potentially associated with CRC in phase I. Subsequently, SNPs were chosen as proxies for the validated CNVs for phase II replication (1,342 Spanish cases and 1,874 Spanish controls). Four common CNVs were found to be associated with CRC and were further replicated in Phase II. Finally, we found that SNP rs1944682, tagging a 11q11 CNV, was nominally associated with CRC susceptibility (p value = 0.039; OR = 1.122). This locus has been previously related to extreme obesity phenotypes, which could suggest a relationship between body weight and CRC susceptibility.

Estradiol downregulates NF-κb translocation by Ikbkg transcriptional repression in dendritic cells.

To reconcile immunity and reproduction, females must allow spermatozoa to survive and control the presence of commensal microbiota and sexually transmitted pathogens during ovulation. Female steroid sex hormones exert a powerful effect on the immune system, as do the hormonal changes associated with the ovarian cycle. Dendritic cells (DCs) are immunological sentinels that link innate immunity to adaptive immunity. Upon exposure to microbial invaders in tissue, they undergo a maturational process that culminates in the lymph nodes and activates T-cell-specific immune responses. Estradiol, which is highly expressed during ovulation, has an effect on the maturation of DCs, although the molecular mechanism remains elusive. We detected that estradiol regulates expression of Ikbkg in DCs and modulates nuclear factor-κb translocation to the nucleus, thus explaining the reduced DC function observed during ovulation. This change may be an adaptive mechanism to reconcile control of infection and reproductive functions.

Pharmacogenomics in colorectal cancer: a genome-wide association study to predict toxicity after 5-fluorouracil or FOLFOX administration.

The development of genotyping technologies has allowed for wider screening for inherited causes of variable outcomes following drug administration. We have performed a genome-wide association study (GWAS) on 221 colorectal cancer (CRC) patients that had been treated with 5-fluorouracil (5-FU), either alone or in combination with oxaliplatin (FOLFOX). A validation set of 791 patients was also studied. Seven SNPs (rs16857540, rs2465403, rs10876844, rs10784749, rs17626122, rs7325568 and rs4243761) showed evidence of association (pooled P-values 0.020, 9.426E-03, 0.010, 0.017, 0.042, 2.302E-04, 2.803E-03) with adverse drug reactions (ADRs). This is the first study to explore the genetic basis of inter-individual variation in toxicity responses to the administration of 5-FU or FOLFOX in CRC patients on a genome-wide scale.

BMP2/BMP4 colorectal cancer susceptibility loci in northern and southern European populations.

Genome-wide association studies have successfully identified 20 colorectal cancer susceptibility loci. Amongst these, four of the signals are defined by tagging single nucleotide polymorphisms (SNPs) on regions 14q22.2 (rs4444235 and rs1957636) and 20p12.3 (rs961253 and rs4813802). These markers are located close to two of the genes involved in bone morphogenetic protein (BMP) signaling (BMP4 and BMP2, respectively). By investigating these four SNPs in an initial cohort of Spanish origin, we found substantial evidence that minor allele frequencies (MAFs) may be different in northern and southern European populations. Therefore, we genotyped three additional southern European cohorts comprising a total of 2028 cases and 4273 controls. The meta-analysis results show that only one of the association signals (rs961253) is effectively replicated in the southern European populations, despite adequate power to detect all four. The other three SNPs (rs4444235, rs1957636 and rs4813802) presented discordant results in MAFs and linkage disequilibrium patterns between northern and southern European cohorts. We hypothesize that this lack of replication could be the result of differential tagging of the functional variant in both sets of populations. Were this true, it would have complex consequences in both our ability to understand the nature of the real causative variants, as well as for further study designs.

Carbosilane dendrimer nanotechnology outlines of the broad HIV blocker profile.

Researchers have been working hard for more than 20 years to develop safe and effective microbicides to empower women to better control their own sexual life and to protect themselves against HIV and other sexually transmitted infections (STIs). Microbicide classes include moderately specific macromolecular anionic polymers that block HIV and other STIs, and HIV specific drugs that inhibit viral entry and reverse transcription. Based on innovative nanotechnology design, we showed a novel water-soluble anionic carbosilane dendrimer (2G-S16) as a propitious molecule against HIV-infection. A state-of-the-art research was accomplished that focused on biomedical cutting-edge techniques such as in vitro and in vivo cytotoxicity assays performed on female rabbit genital tracts, simulate in vitro model of vaginal epithelium in order to evaluate HIV transmission blockade through the monolayer, complete gene expression profiling experiment to study deregulated genes after 2G-S16 exposition, molecular dynamics simulation of 2G-S16 molecule against principal proteins of HIV particles and pro- and anti-inflammatory cytokine profile study. Therefore, a high-throughput study and detailed analysis of the results were achieved in this article. We provided promising outcomes to encourage 2G-S16 as a hopeful microbicide.

Patient expectations are not always the same.

OBJECTIVE: To validate a scale that measures patients' expectations when seeking advice for health problems of different types. METHODS: 360 patients who had consulted their general practitioner (GP) during the previous 12 months were randomly selected from the lists of 30 GPs. A questionnaire, including a 13-item expectation scale, was administered by interview in the patient's home to assess expectations in relation to five health problems, three biomedical (strong chest pain, genital discharge and the common cold) and two psychosocial (depression/sadness and serious family problem), repeating the expectation scale for each one. The frequency distribution of items was analysed, multi-level factorial analysis was performed and the reliability of the expectation scale was tested for each hypothetical clinical condition. RESULTS: The response rate was 90%. Mean age of patients was 47.3 years (SD 16.5); 51% were women. Expectations were high but varied according to the nature and severity of the condition. The percentage of patients wanting the doctor alone to make decisions ranged from 50% for "family problem" to 68% for "chest pain". The five factorial structures differed and explained 49.3-63.9% of the variance. Similarities were observed depending on the type of problem. "Communication" and "Experience of disease" were thus separate dimensions for the biomedical diseases but mixed for the psychosocial conditions. CONCLUSIONS: The factorial structure of expectations varied, indicating that expectations are not homogeneous in all clinical situations. The desire of the patient to participate in decision-making also differs according to the type of health problem.

Effect of ammonia on ciliary neurotrophic factor mRNA and protein expression and its upstream signalling pathway in cultured rat astroglial cells: possible implication of c-fos, Sp1 and p38MAPK.

Ciliary neurotrophic factor (CNTF) may be implicated in the pathogenetic mechanisms of hepatic encephalopathy. We tested this hypothesis by treating confluent primary cultures of rat astroglial cells with ammonium chloride for various periods and analysing the effect of ammonia on the signalling pathway that regulates CNTF mRNA and protein expression. Ammonia treatment induced a dose- and time-dependent reduction in CNTF mRNA and protein expression. Surface-enhanced laser desorption/ionization-time-of-flight mass spectrometry analysis of CNTF in the culture medium demonstrated that ammonia also induced a significant decrease in CNTF release. In addition, ammonia affected Sp1 and c-fos, transcription factors that regulate CNTF mRNA and protein expression, which showed partial dephosphorylation and significantly lower mRNA and protein levels. Total content of p38MAPK (for which Sp1 and c-fos are substrates) was unaffected by ammonia, although the diphosphorylated (active) form was significantly reduced after ammonia exposure.

Differential expression of Ran GTPase during HMBA-induced differentiation in murine erythroleukemia cells.

Murine erythroleukemia (MEL) cells undergo erythroid differentiation in vitro when treated with hexamethylene bisacetamide (HMBA). To identify genes involved in the commitment of MEL cells to differentiate, we screened a cDNA library constructed from HMBA-induced cells by differential hybridization and isolated GTPase Ran as a down-regulated gene. We observed that Ran was expressed in a biphasic mode. Following a decrease in mRNA level during the initial hours of induction, Ran re-expressed at 24-48 h, and gradually declined again. To investigate the role of Ran during MEL differentiation we constructed MEL transfectants capable to express or block Ran mRNA production constitutively. No effects were observed on cell growth and proliferation. Blockage of Ran, however, interfered with MEL cell differentiation resulting in a decrease of cell survival in the committed population.

[Community activities in primary care in Spain. An analysis based on the network of the Program of Community Activities (PACAP)]. / Las actividades comunitarias en atención primaria en España. Un análisis a partir de la Red del Programa de Actividades Comunitarias (PACAP).

OBJECTIVE: To describe, analyse and discuss the activities in the Network of Community Activities of the Programme of Community Activities in Primary Care of the Spanish Society of Family and Community Medicine. DESIGN: Description of the activities within this Network.Setting. Network of Community Activities of the Spanish Society of Family and Community Medicine. MAIN MEASUREMENTS: Specifications of the variables of geography, target population and experience descriptives were obtained from the qualitative analysis of the activity summary composed by its authors. The measurements are frequency tables expressed in graphs and analysis of the summaries contributed by the groups on objectives, kinds of programme, methodologies, evaluation and conclusions reached. The community orientation activities undertaken by the health centres registered on the Network came mostly (54%) from the autonomous communities of Madrid and Andalusia. A great many of them were aimed at the adult population, tackling problems of chronic diseases, and particularly at women, in this case tackling gender themes such as menopause and pregnancy, etc. CONCLUSIONS: There was uneven distribution between autonomous communities of the experiences included on the web. Central to community orientation are the replies to questions such as: inside or out of the health centre?, the importance of transferring leadership to society, and adaptation to the needs and demands of the population cared for.

Las actividades comunitarias en atención primaria en España. Un análisis a partir de la red del programa de actividades comunitarias (pacap) / Community activities in primary care in spain. An analysis based on the network of the programme of community activities

Objetivo. Describir, analizar y discutir las actividades de la Red de Actividades Comunitarias del Programa de Actividades Comunitarias en Atención Primaria de la Sociedad Española de Medicina de Familia y Comunitaria. Diseño. Descripción de las actividades incorporadas a la citada Red. Emplazamiento. Red de Actividades Comunitarias de la Sociedad Española de Medicina de Familia y Comunitaria. Mediciones principales. Especificación de las variables geográfica, población diana y descriptores de la experiencia obtenidos del análisis cualitativo del texto del 'resumen de la actividad' redactado por sus autores. Las medidas son tablas de frecuencia expresadas en gráficos y análisis de los resúmenes aportados por los grupos respecto de objetivos, tipos de programa, metodologías, evaluación y conclusiones obtenidas. Las actividades de orientación comunitaria realizadas por los centros de salud que se han adscrito a la Red proceden en su mayoría (54 por ciento) de la Comunidad Autónoma de Madrid y de Andalucía y un porcentaje elevado de las mismas se dirigen a población adulta, abordando la problemática de las enfermedades crónicas, y específicamente a mujeres, abordando en este caso temáticas 'de género' tales como menopausia, embarazo, etc. Conclusiones. Se aprecia una distribución desigual entre comunidades autónomas de las experiencias incorporadas a la Red. Parecen reflexiones centrales, en relación con la orientación comunitaria, las respuestas a cuestiones como: ¿dentro o fuera del centro de salud?, la importancia de la cesión del protagonismo a la sociedad y la adaptación a las necesidades y demandas de la población atendida (AU)

Ilf2 is regulated during meiosis and associated to transcriptionally active chromatin.

Analysis of gene expression during testis development demonstrated accumulation of Ilf2 mRNA in pachytene spermatocytes. In these cells, the protein was localized in the nucleus, but it was absent from chromatin of the XY pachytene bivalent, in which there is no transcriptional activity. Nucleolar signal is inmmunolocalized in spermatogonia, Sertoli cells and oocytes. By in situ hybridisation, Ilf2 expression is detected in proliferative cells of adult ovary and a defined pattern is also exhibited in different tissues of embryos. The presence of ILF2 in active chromatin is corroborated in NIH3T3 cultured cells after transfection with Ilf2-EGFP constructs.

[Being a male or female doctor is different in medical practice]. / Ser médico o médica marca diferencias en la práctica asistencial.

OBJECTIVES: To identify the differences between the clinical practice (conduct) of male and female doctors and its determining factors; and to find the variability in the various conducts studied which is explained by a set of variables, gender among them. DESIGN: Cross-sectional, multi-centre descriptive study. SETTING: Andalusian health centres with populations of over 100000 inhabitants. PARTICIPANTS: Selection of 159 primary care doctors with postgraduate training by means of simple randomised sampling. 56% were men, 44% women, with power of comparisons at 68%. MEASUREMENTS AND MAIN RESULTS: Self-administered questionnaire to measure the dependent variable, overall conduct (clinical practice) and 11 dimensions of this conduct. Independent variables were: determinants of conduct identified by the theory of reasoned action (attitudes and subjective norm) and by the theory of social learning (self-efficacy and control locus), gender and other social and demographic variables and work conditions variables. Multiple linear regression models were constructed to explain each conduct analysed. Being a female doctor affects positively overall conduct and conduct in information, psycho-social guidance, prevention of obesity, active recruitment for family planning and collaboration with nurses. CONCLUSIONS: In Andalusia women general practitioners have a more marked orientation towards the psycho-social sides of care than their male colleagues. They give more information to their patients and more frequently perform preventive activities linked to their gender. They also rely on the work of their nurses more than male doctors.

Ser médico o médica marca diferencias en la práctica asistencial / Being a male or female doctor marks differences in care practice

Objetivos. Identificar las diferencias existentes entre médicos y médicas en la práctica clínica (conducta) y en sus determinantes, y conocer la variabilidad de las diferentes conductas estudiadas que es explicada por un conjunto de variables, entre ellas el género. Diseño. Estudio descriptivo, transversal, multicéntrico. Emplazamiento. Centros de salud andaluces de poblaciones de más de 100.000 habitantes. Participantes. Selección de 159 médicos de atención primaria con formación posgraduada mediante muestreo aleatorio simple; 56 por ciento, varones; 44 por ciento, mujeres; potencia de las comparaciones, 68 por ciento. Mediciones y resultados principales. Cuestionario autoadministrado para medir la variable dependiente, conducta global (práctica clínica) y 11 dimensiones de ésta, así como las variables independientes: determinantes de la conducta identificados por la teoría de la acción razonada -actitudes y norma subjetiva- y por la teoría del aprendizaje social -autoeficacia y locus de control-, el sexo y otras variables sociodemográficas y de las condiciones de trabajo. Se construyen modelos de regresión lineal múltiple para explicar cada conducta analizada. Ser médica influye de forma positiva en la conducta global y en las conductas de información, la conducta de orientación psicosocial, la conducta de prevención de la obesidad, la conducta de captación activa para planificación familiar y la conducta de colaboración con la enfermera. Conclusiones. Las médicas de familia en Andalucía presentan una orientación más acusada hacia los aspectos psicosociales de la atención que sus colegas varones, proporcionan más información a sus pacientes y realizan con más frecuencia actividades preventivas congruentes con su sexo. Además cuentan con las enfermeras para trabajar más que los médicos (AU)

Gene trap analysis of germ cell signaling to Sertoli cells: NGF-TrkA mediated induction of Fra1 and Fos by post-meiotic germ cells.

Analysis of complex signalisation networks involving distinct cell types is required to understand most developmental processes. Differentiation of male germ cells in adult mammals involves such a cross-talk between Sertoli cells, the somatic component which supports and controls germinal differentiation, and germ cells at their successive maturation stages. We developed a gene trapping strategy to identify genes, which, in Sertoli cells, are either up- or down-regulated by signals emitted by the germinal component. A library of approximately 2,000 clones was constituted from colonies independently selected from the Sertoli line 15P-1 by growth in drug-containing medium after random integration of a promoter-less (beta)geo transgene (neo(r)-lacZ fusion), which will be expressed as a fusion transcript from a 'trapped' cellular promoter, different in each clone. A first screen conducted on 700 events identified six clones in which beta-galactosidase activity was increased and one in which it was repressed upon addition of germ cells. The targeted loci were identified by cloning and sequencing the genomic region 5' of the insert. One of them was identified as the gene encoding Fra1, a component of the AP1 transcription regulatory complex. Accumulation of Fra1 mRNA was induced, both in 15P-1 and in freshly explanted Sertoli cells, by addition of either round spermatids or nerve growth factor (NGF). The effect of NGF was mediated by the TrkA receptor and the ERK1-ERK2 kinase kinase pathway. Fos and Fra1 transcription were induced within the first hour after addition of the neurotrophin, but, unlike what is observed after serum induction in the same cells, a second wave of transcription of Fra1, but not of Fos, started 16 hours later and peaked at higher levels at about 20 hours. These results suggest that AP1 activation may be an important relay in the Sertoli-germ cell cross-talk, and validate the gene trapping approach as a tool for the identification of target genes in cell culture systems.