La figura docente del profesor contratado doctor vinculado: situación actual en España y la experiencia de Andalucía / The figure of the tenure-eligible lecturer: current situation Spain and experience in Andalusia

En este documento se refieren las bases legales nacionales y, más en concreto, las autonómicas andaluzas que dan respaldo a la figura del profesor contratado doctor vinculado y a la posibilidad de convocar las plazas correspondientes en las facultades de medicina de las universidades públicas españolas. Se exponen, asimismo, las características asistenciales y académicas que deben darse para llevar a cabo la convocatoria pública de dichas plazas. Se resume, a continuación, cuál es la situación actual existente en relación con dicha figura del profesorado en las facultades de medicina españolas. Se analizan también las ventajas y las posibles limitaciones que actualmente se derivan de contar con profesores contratados doctores vinculados y ello tanto para los médicos especialistas eventualmente interesados en optar a una de estas plazas como para el centro sanitario y la facultad de medicina correspondientes. Finalmente, se reseña la posible utilidad del documento elaborado por la Conferencia Nacional de Decanos de Facultades de Medicina de España (CNDFME) en la Asamblea General que se celebró en la Facultad de Medicina de Oviedo del 17 al 19 de mayo del 2018 y actualizado en marzo de 2020

A discussion is presented on the national legal foundations, and more specifically, those of Andalusia, that support the figure of the tenure-eligible lecturer and the possibility of filling the corresponding positions in the faculties of medicine in Spanish public universities are discussed. The clinical and academic characteristics that they must have in order to fill those public positions are also presented. The current situation as regards such a figure as a lecturer in Spanish faculties of medicine is then summarised. An analysis is made of the advantages and the possible limitations arising from having a tenure-eligible lecturer, and how this affects both the medical specialists possibly interested in opting for one of these positions, as well as for the corresponding health centres and faculties of medicine. Finally, mention is made of the possible use of the document prepared by the National Conference of Medical Faculty Deans (CNDFME) in the General Assembly held in the Oviedo Faculty of Medicine from 17 to 19 May 2018, and updated in March 2020

MTA index: a simple 2D-method for assessing atrophy of the medial temporal lobe using clinically available neuroimaging.

BACKGROUND AND PURPOSE: Despite a strong correlation to severity of AD pathology, the measurement of medial temporal lobe atrophy (MTA) is not being widely used in daily clinical practice as a criterion in the diagnosis of prodromal and probable AD. This is mainly because the methods available to date are sophisticated and difficult to implement for routine use in most hospitals-volumetric methods-or lack objectivity-visual rating scales. In this pilot study we aim to describe a new, simple and objective method for measuring the rate of MTA in relation to the global atrophy using clinically available neuroimaging and describe the rationale behind this method. DESCRIPTION: This method consists of calculating a ratio with the area of 3 regions traced manually on one single coronal MRI slide at the level of the interpeduncular fossa: (1) the medial temporal lobe (MTL) region (A); (2) the parenchima within the medial temporal region, that includes the hippocampus and the parahippocampal gyrus-the fimbria taenia and plexus choroideus are excluded-(B); and (3) the body of the ipsilateral lateral ventricle (C). Therefrom we can compute the ratio "Medial Temporal Atrophy index" at both sides as follows: MTAi = (A - B)× 10/C. CONCLUSIONS: The MTAi is a simple 2D-method for measuring the relative extent of atrophy in the MTL in relation to the global brain atrophy. This method can be useful for a more accurate diagnosis of AD in routine clinical practice. Further studies are needed to assess the usefulness of MTAi in the diagnosis of early AD, in tracking the progression of AD and in the differential diagnosis of AD with other dementias.

La inervación del disco intervertebral / Innervation of the intervertebral disc

Hasta hace poco la inervación del disco intervertebral fue objeto de debate. La introducción de técnicas de inmunohistoquímica asociadas a anticuerpos específicos y los estudios con trazadores nerviosos retrógrados han permitido conocer mejor la inervación del disco en condiciones normales y patológicas así como las características de las terminaciones y sus patrones de distribución en ambas situaciones. Las controversias que existen acerca de las bases estructurales del dolor discogénico han despertado el interés por conocer la influencia de la inervación en el dolor lumbar de origen discal y sus características. Actualmente sabemos que la neoinervación patológica de las fisuras radiales es un factor importante en la génesis del dolor discogénico dentro de un complejo mecanismo en que están implicados factores neurobioquímicos, inflamatorios y biomecánicos (AU)

Until very recently, intervertebral disc innervation was a subject of considerable debate. Nowadays, the introduction of inmunohistochemical techniques associated to specific antibodies and studies with retrograde tracers in nerves have allowed greater understanding of disc innervation in physiological and pathological conditions and also endings characteristics and their patterns of distribution in both situations. The existing controversies regarding structural basis of discogenic pain, have raised the interest of knowing the influence of innervation in back pain from discal origin and its characteristics. Today, we know that pathologic neoinnervation accompanying radial fissures is an important factor in the genesis of discogenic pain; within a complex mechanism in which other neurobiomechemical, inflammatory and biomechanical factors are involved

[Innervation of the intervertebral disc]. / La inervación del disco intervertebral.

Until very recently, intervertebral disc innervation was a subject of considerable debate. Nowadays, the introduction of inmunohistochemical techniques associated to specific antibodies and studies with retrograde tracers in nerves have allowed greater understanding of disc innervation in physiological and pathological conditions and also endings characteristics and their patterns of distribution in both situations. The existing controversies regarding structural basis of discogenic pain, have raised the interest of knowing the influence of innervation in back pain from discal origin and its characteristics. Today, we know that pathologic neoinnervation accompanying radial fissures is an important factor in the genesis of discogenic pain; within a complex mechanism in which other neurobiomechemical, inflammatory and biomechanical factors are involved.

Clinical implication of Meissner`s corpuscles.

During the last decade skin biopsy has been confirmed as a tool to provide diagnostic information on some peripheral neuropathies. Most studies were focused on intraepithelial nerve fibers and few studies have investigated large myelinated fibers or whether corpuscles in human skin change quantitatively or qualitatively in pathologies of the peripheral or central nervous system. The main objective of this article is to provide a comprehensive review of Meissner's corpuscles including their distribution, density and age changes, development, molecular composition, cellular anatomy and physiology. We also describe their involvement in several pathologies and suggest including this dermal structure in the routine study of skin biopsies, looking for changes to be used as potential markers for several disorders. Finally the article draws the main aspects of how to study Meissner's corpuscles in skin biopsies and gives a view on future perspectives for implementing their use in clinical practice.

Evidence of nestin-positive cells in the human cutaneus Meissner and Pacinian corpuscles.

Nestin is an intermediate filament protein expressed in neuroepithelial stem cells during development and it is later replaced by cell specific neuronal or glial filaments. Nevertheless, nestin⁺ cells remain within adult tissues and they can be regarded as potential neural stem cell (NSC). Nestin⁺ cells have been detected in Schwann cells related with sensory corpuscles of rodent and they have been demonstrated to be NSC. We have investigated the existence of nestin⁺ in human cutaneous cells Meissner and Pacinian corpuscles through the use of immunohistochemistry techniques and in situ hybridization. S100 protein (also regarded as a marker for NSC) and vimentin (the intermediate filament of mature Schwann cells in sensory corpuscles) were also investigated. The results show that the adult human cutaneous sensory Meissner and Pacinian corpuscles contains a small population of Schwann-related cells (vimentin⁺) which on the basis of their basic immunohistochemical characteristics (S100 protein⁺, nestin⁺) can be potential NSCs. Cells sharing identical immunohistochemical profile were also found in the close vicinity of Meissner corpuscles. Because their localization they are easily accessible and may represent a peripheral niche of NSC to be used for therapeutic goals.

Impact of CD68/(CD3+CD20) ratio at the invasive front of primary tumors on distant metastasis development in breast cancer.

Tumors are infiltrated by macrophages, T and B-lymphocytes, which may favor tumor development by promoting angiogenesis, growth and invasion. The aim of this study was to investigate the clinical relevance of the relative amount of macrophages (CD68⁺), T-cells (CD3⁺ and B-cells (CD20⁺) at the invasive front of breast carcinomas, and the expression of matrix metalloproteases (MMPs) and their inhibitors (TIMPs) either at the invasive front or at the tumor center. We performed an immunohistochemical study counting CD3, CD20 and CD68 positive cells at the invasive front, in 102 breast carcinomas. Also, tissue sections were stained with MMP-2, -9, -11, -14 and TIMP-2 antibodies, and immunoreactivity location, percentage of reactive area and intensity were determined at the invasive front and at the tumor center. The results showed that an increased CD68 count and CD68/(CD3+CD20) ratio were directly associated with both MMP-11 and TIMP-2 expression by mononuclear inflammatory cells at the tumor center (p = 0.041 and p = 0.025 for CD68 count and p = 0.001 and p = 0.045 for ratio, respectively for MMP-11 and TIMP-2). In addition, a high CD68/(CD3+CD20) ratio (>0.05) was directly associated with a higher probability of shortened relapse-free survival. Multivariate analysis revealed that CD68/(CD3+CD20) ratio was an independent factor associated with distant relapse-free survival (RR: 2.54, CI: (1.23-5.24), p<0.01). Therefore, CD68/(CD3+CD20) ratio at the invasive front could be used as an important prognostic marker.

Intervertebral disc, sensory nerves and neurotrophins: who is who in discogenic pain?

The normal intervertebral disc (IVD) is a poorly innervated organ supplied only by sensory (mainly nociceptive) and postganglionic sympathetic (vasomotor efferents) nerve fibers. Interestingly, upon degeneration, the IVD becomes densely innervated even in regions that in normal conditions lack innervation. This increased innervation has been associated with pain of IVD origin. The mechanisms responsible for nerve growth and hyperinnervation of pathological IVDs have not been fully elucidated. Among the molecules that are presumably involved in this process are some members of the family of neurotrophins (NTs), which are known to have both neurotrophic and neurotropic properties and regulate the density and distribution of nerve fibers in peripheral tissues. NTs and their receptors are expressed in healthy IVDs but much higher levels have been observed in pathological IVDs, thus suggesting a correlation between levels of expression of NTs and density of innervation in IVDs. In addition, NTs also play a role in inflammatory responses and pain transmission by increasing the expression of pain-related peptides and modulating synapses of nociceptive neurons at the spinal cord. This article reviews current knowledge about the innervation of IVDs, NTs and NT receptors, expression of NTs and their receptors in IVDs as well as in the sensory neurons innervating the IVDs, the proinflammatory role of NTs, NTs as nociception regulators, and the potential network of discogenic pain involving NTs.

Relationship between morphological features and kinetic patterns of enhancement of the dynamic breast magnetic resonance imaging and clinico-pathological and biological factors in invasive breast cancer.

BACKGROUND: To investigate the relationship between the magnetic resonance imaging (MRI) features of breast cancer and its clinicopathological and biological factors. METHODS: Dynamic MRI parameters of 68 invasive breast carcinomas were investigated. We also analyzed microvessel density (MVD), estrogen and progesterone receptor status, and expression of p53, HER2, ki67, VEGFR-1 and 2. RESULTS: Homogeneous enhancement was significantly associated with smaller tumor size (T1: < 2 cm) (p = 0.015). Tumors with irregular or spiculated margins had a significantly higher MVD than tumors with smooth margins (p = 0.038). Tumors showing a maximum enhancement peak at two minutes, or longer, after injecting the contrast, had a significantly higher MVD count than those which reached this point sooner (p = 0.012). The percentage of tumors with vascular invasion or high mitotic index was significantly higher among those showing a low percentage (150%) of enhancement rate (p = 0.016 and p = 0.03, respectively). However, there was a significant and positive association between the mitotic index and the peak of maximum intensity (p = 0.036). Peritumor inflammation was significantly associated with washout curve type III (p = 0.042). CONCLUSIONS: Variations in the early phase of dynamic MRI seem to be associated with parameters indicatives of tumor aggressiveness in breast cancer.

Plasmatic level of neurosin predicts outcome of mild cognitive impairment.

BACKGROUND: Mild Cognitive Impairment (MCI) is a disorder considered to be a transitional stage from health to dementia. Diagnosis of dementias at these early stages is always troublesome because the pathophysiologic events leading to dementia precede clinical symptoms. Thus, the development of biomarkers that can be used to support the diagnosis of dementias at early stages is rapidly becoming a high priority. We have recently reported the value of measuring plasmatic levels of neurosin in the diagnosis of Alzheimer's disease (AD). The aim of this study is to determine whether measuring plasmatic concentration of neurosin is a valuable test to predict progression of MCI. METHODS: Plasmatic neurosin concentrations were measured in 68 MCI patients and 70 controls subjects. Blood samples were obtained at the beginning of the study. Sixty six patients diagnosed with MCI were observed for 18 months. In 36 patients a second blood sample was obtained at the endpoint. RESULTS: The mean value of plasmatic neurosin concentration differs significantly between MCI patients who converted to Dementia with vascular component, those who converted to AD, or those who remained at MCI stage. The relative risk of developing Dementia with vascular component when neurosin levels are higher than 5.25 ng/ml is 13 while the relative risk of developing mild AD when neurosin levels are lower than 5.25 ng/ml is 2. Increases in the levels of neurosin indicate progression to Dementia with vascular component. CONCLUSION: The measurement of plasmatic neurosin level in patients diagnosed with MCI may predict conversion from MCI to Dementia with vascular component. A single measurement is also valuable to estimate the risk of developing AD and Dementia with vascular component. Finally, repeated measurement of plasmatic neurosin might be a useful test to predict outcome in patients with MCI.

Radiographic analysis of fusion mass using fresh autologous bone marrow with ceramic composites as an alternative to autologous bone graft.

OBJECTIVE: To determine whether a biphasic calcium phosphate (BCP) ceramic supplemented with fresh autologous bone marrow (BMA) can give rise to adequate bone to achieve a vertebral fusion mass. MATERIALS AND METHODS: A prospective nonrandomized, radiographic study on 35 patients with posterolateral fusion using rigid transpedicular instrumentation for degenerative lumbar disease. At least 2-year follow-up. On the left side: autologous bone graft obtained from decompression. On the right side: a mixture of BCP and fresh autogenous bone marrow from the right iliac crest. Single-level fusion in 22 patients and two or more levels in 13. Patients assessed with x-rays and computed tomography by an orthopedic surgeon and an independent radiologist. Fusion mass was considered "good" when there was a continuous block of bone without radiolucent areas. No intersegmental bony bridging fusion was considered "poor" mass. McNemar, Fisher, and kappa tests were used for statistical analysis. RESULTS: The interobserver agreement (kappa) had an average of 0.75 for the fusion masses. The interobserver average in the radiologic evaluation of ceramic resorption was 0.68. No differences between smokers and nonsmokers were found. Plain radiography findings: good left fusion masses (autologous bone) in 31 patients and poor in 4; good right masses (BMA plus BCP) in 31 patients and poor in 4 (P > 0.05). Computed tomography evaluation: good left fusion masses in 28 patients and poor in 7; good right fusion masses in 31 patients and poor in 4 (P > 0.05). One patient was reoperated, allowing biopsies to be performed: compact bone tissue was observed around hydroxyapatite in the right fusion mass. CONCLUSIONS: The differences detected between right-side and left-side masses are not statistically significant. This indicates that, BMA and BCP, when mixed, behave like composite grafts and are able to generate sufficient bone mass for arthrodesis when a rigid instrumentation is used. However, a larger number of cases and longer follow-up are needed to generalize the indication.

Chondrocytes are released as viable cells during cartilage resorption associated with the formation of intrachondral canals in the rat tibial epiphysis.

The development of cartilage canals is the first event of the ossification of the epiphyses in mammals. Canal formation differs from vascular invasion during primary ossification, since the former involves resorption of resting cartilage and is uncoupled from bone deposition. To learn more about the fate of resorbed chondrocytes during this process, we have carried out structural, cell proliferation, and in situ hybridization studies during the first stages of ossification of the rat tibial proximal epiphysis. Results concerning the formation of the cartilage canals implied the release of resting chondrocytes from the cartilage matrix to the canal cavity. Released chondrocytes had a well-preserved structure, expressed type-II collagen, and maintained the capacity to divide. All these data suggested that chondrocytes released into the canals remained viable for a specific time. Analysis of the proliferative activity at different regions of the cartilage canals showed that the percentage of proliferative chondrocytes at areas of active cartilage resorption was significantly higher than that in zones of low resorption. These results are consistent with the hypothesis that resting chondrocytes surrounding canals have a role in supplying cells for the development of the secondary ossification center. Since released chondrocytes are at an early stage of differentiation greatly preceding their entry into the apoptotic pathway and are exposed to a specific matrix, cellular, and humoral microenvironment, they might differentiate to other cell types and contribute to the ossification of the epiphysis.

Anomalías congénitas de las arterias coronarias del adulto descritas en 31 años de estudios coronariográficos en el Principado de Asturias: principales características angiográficas y clínicas / Adult Congenital Anomalies of the Coronary Arteries Described over 31 Years of Angiographic Studies in the Principado de Asturias: Angiographic and Clinical Characteristics

Objetivo. Conocer la incidencia de las anomalías congénitas de las arterias coronarias del adulto en 31 años de estudios coronariográficos, describiendo sus principales características angiográficas y clínicas. Se comparan los resultados con las principales series publicadas. Métodos. Se revisan los informes de las coronariografías diagnósticas realizadas en el Principado de Asturias desde 1968 hasta 1999. En aquellos en los que se diagnosticó una anomalía, se estudiaron la historia clínica y la angiografía. El trayecto inicial de la coronarias anómalas fue definido siguiendo criterios coronariográficos. Resultados. Se revisaron 13.500 informes que describían 75 pacientes con 75 anomalías (0,5 por ciento): circunfleja anómala (n = 24), fístulas (n = 21), origen de ambas coronarias en el seno coronario izquierdo (n = 15), coronarias únicas (n = 6), origen de ambas coronarias en el seno derecho (n = 3), origen separado de la descendente anterior y circunfleja (n = 3), origen de la descendente anterior en el seno derecho (n = 2) y otras (n = 1). La coronariografía se realizó por las siguientes causas: angina (59 por ciento), disnea (25 por ciento), dolor atípico (7 por ciento), síncope (3 por ciento), mareos (3 por ciento) y palpitaciones (3 por ciento). El trayecto inicial fue: retroaórtico en las circunflejas, interarterial en las derechas, retroaórtico, septal y combinado en las izquierdas y anterior en las descendentes anteriores. Conclusiones. Las anomalías congénitas de las arterias coronarias del adulto son poco frecuentes y suelen ser hallazgos casuales en las coronariografías diagnósticas. Las anomalías de la arteria circunfleja son las más frecuentes (AU)

Valoración de las regiones organizadoras nucleares en lesiones melánicas benignas y malignas de piel / Assessment of nucleolar organizer regions in benign and malign melanocytic skin lesions

Se valoraron las regiones organizadoras nucleares (AgNORs), especialmente el número de partículas por núcleo en nevus melanocíticos y en melanomas malignos, y su correlación con los factores pronósticos y la supervivencia. Se estudiaron 29 casos de melanoma maligno en fase de crecimiento vertical (MMFCV),30 nevus melanocíticos (20 intradérmicos y 10 compuestos) y 30 biopsias cutáneas sanas. Se halló que en piel normal y en NM, el número de partículas de AgNORs por célula era, respectivamente, 1,22 ñ 0,41 y 1,35 ñ 0,54 (menos 3 por núcleo), que los AgNORs estaban bien definidos, pequeños e independientes. Los AgNORs por núcleo en los MMFCV mostraba un número de 8,02 ñ 5,31 y su morfología estaba mal definida, mayor tamaño y tendencia a confluir. El número de AgNORs en los MMFCV depende significativamente del espesor (Breslow) y del número de mitosis, pero resulta independiente del nivel infiltrante (Clark) del tumor. El número de AgNORs estaba correlacionado con la supervivencia teórica, pero era independiente de la supervivencia real. Estos resultados sugieren que los AgNORs, especialmente su número y morfología, es un claro indicador diagnóstico y tiene interés como parámetro pronóstico en los MMFCV, es además una técnica rápida, barata y asequible, por lo cual debe incorporarse a la rutina oncológica del melanoma maligno

Efectos de la extirpación del area piriforme sobre la ultraestructura de la corteza suprerrenal / Effects of resection of piriform area on suprarenal cortex ultrastructure

Hemos estudiado la ultraestructura de la corteza suprarrenal de 40 ratas macho Wistar, de pesos entre 200 y 259 gm. Los animales fueron divididos en 3 grupos: grupo control (animales intactos o animales de operación simulada); grupo experimental I (animales sacrificados al mes de la operación) y grupo experimental II (animales sacrificados a los dos meses de la operación). Los animales experimentales fueron sometidos a la extirpación bilateral del área piriforme. Hemos observado un progresivco decremento de las gotitas lipídicas ( y de la esteroidogénesis) y un incremento de las alteraciones mitocondriales en las células de la capa fasciculada y también en las células de la capa reticular; lo que indica la existencia de una disminución en la elaboración de las hormonas cortico-suprerrenales. Estos hallazgos nos sugieren que el área piriforme estimula la elaboración de hormonas por la corteza suprarrenal

Efectos de la extirpación estereotaxica del nucleo amigdalino basolateral sobre la ultraestructura del nucleo hipotalámico ventromedial

Hemos empleado 40 ratas macho, cepa Wistar, de 2 meses de edad. Los animales se dividieron en 20 ratas controles (10 ratas intactas y 10 ratas sometidas a operación simulada), y 20 animales experimentales (10 sacrificados al mes y 10 sacrificados a los dos meses de la operación quirúrgica). El método experimental fue la extirpación extereotáxica del nucleo amigdalino basolateral de la amígala cerebral. Hemos estudiado la ultraestructura del nucleo ventromedial del hipotálamo. Hemos observado un incremento de la actividad de las neuronas del nucleo hipotalámico ventromedial en los animales experimentales (aumento del retículo endodplasmático rugoso, del aparato de Golgi, de los cuerpos densos, y de las mitocondrias con matriz densa), y en las sinapsis (un incremento de las vesículas y de los gránulos densos). Nuestros resultados demuestran que el nucleo amigdalino basolateral ejerce un efecto inhibidor de la actividad neuronal del nucleo hipotalámico ventromedial

Modificaciones de los ácidos nucleicos en ratones inyectados con endotoxina de Escherichia coli: ventajas de la corticoterapia / Modifications of nucleic acids in mice infected with endotoxin of Escherichia coli: advantages of corticotherapy

Recibieron inyecciones intraperitoneales de endotoxina de Escherichia coli 100 ratones MNRI. Algunos se trataron con corticosteroides. A 20 animales testigos se inyectó suero apirógeno. Los animales se sacrificaron 1,6 y 24 horas después de la inyección. Se estudiaron los higados al microscopio óptico (por la técnica de verde metilo y pironina) y al microscopio eletrónico. En el grupo experimental se observaron una reducción escasa del DNA nuclear, especialmente a las 24 horas y una disminución del RNA citoplasmático desde la sexta hora acompañada de redución en el número de los riosomas y en el tamaño del retículo endoplásmico. Los cambios del ADN y el ARN observados en el hígado fueron tardíos; por lo tanto, los trastornos metabólicos son secundarios a las alteraciones vasculares del choque endotóxico. Los resultados sugieren lo adecuado de la corticoterapia para el tratamiento del choque por microorganismo gramnegativos