Proceso de acreditación de residencias de Pediatría por el Consejo de Acreditación de Espacios de Formación / Pediatric residency program accreditation process by the Council for the Accreditation of Education Institutions

Introducción. La formación médica de posgrado en un sistema de residencias constituye el mejor modelo para la formación de especialistas. La acreditación de residencias implica un proceso de armonización y normalización de criterios. Establece una base común y reproducible, que asegura una formación de calidad y con lineamientos curriculares universales.Objetivo. Describir el proceso de acreditación de residencias de Pediatría por el Consejo de Acreditación de Espacios de Formación entre enero de 2011 y julio de 2017.Métodos. El proceso de acreditación se desarrolló acorde al marco de referencia, que definía 6 dominios y 28 ítems. De acuerdo con su cumplimiento, se especificaron 3 categorías de acreditación. El análisis de las residencias acreditadas se categorizó en tres regiones geográficas: provincia de Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA) y otras regiones. Se dicotomizó cada ítem evaluado en no cumplimiento y cumplimiento parcial o total. Las variables categóricas se expresaron en números totales y porcentajes.Resultados. Se evaluaron 94 programas de residencia de Pediatría: 34 (el 36 %) correspondieron a provincia de Buenos Aires; 25 (el 27 %), a CABA, y 35 (el 37 %), a otras regiones. Pertenecían a la gestión pública 79 (el 85 %). Alcanzaron la máxima categoría de acreditación 35 (el 37 %). No fueron acreditadas 4 (el 4 %). El cumplimiento de la mayoría de los ítems pertenecientes a los 6 dominios evaluados fue superior al 80 %.Conclusión. La mayoría de las residencias evaluadas fueron acreditadas y cumplieron con los estándares de referencia

Introduction. Postgraduate medical education as part of a residency system is the best model for specialist training. The accreditation of residency programs entails a harmonization and standardization process. It defines a common and reproducible basis to ensure high-quality training and universal curricular guidelines.Objective. To describe the pediatric residency program accreditation process by the Council for the Accreditation of Education Institutions between January 2011 and July 2017.Methods. The accreditation process was developed according to a reference framework that defined 6 domains and 28 items. Based on compliance, 3 accreditation categories were established. The analysis of accredited residency programs was categorized into 3 geographic regions: province of Buenos Aires, Autonomous City of Buenos Aires (CABA), and other regions. Each analyzed item was dichotomized into non-compliance and partial or total compliance. Categorical outcome measures were expressed in absolute numbers and percentage.Results. Ninety-four pediatric residency programs were assessed: 34 (36%) corresponded to the province of Buenos Aires; 25 (27 %), to CABA; and 35 (37 %), to other regions. In total, 79 (85 %) were in the public sector. The maximum accreditation category was achieved by 35 (37 %). Four (4 %) were not accredited. Compliance for most items corresponding to the 6 domains was over 80 %.Conclusion. Most assessed residency programs were accredited and complied with the reference standards

Pediatric residency program accreditation process by the Council for the Accreditation of Education Institutions. / Proceso de acreditación de residencias de Pediatría por el Consejo de Acreditación de Espacios de Formación.

INTRODUCTION: Postgraduate medical education as part of a residency system is the best model for specialist training. The accreditation of residency programs entails a harmonization and standardization process. It defines a common and reproducible basis to ensure high-quality training and universal curricular guidelines. OBJECTIVE: To describe the pediatric residency program accreditation process by the Council for the Accreditation of Education Institutions between January 2011 and July 2017. METHODS: The accreditation process was developed according to a reference framework that defined 6 domains and 28 items. Based on compliance, 3 accreditation categories were established. The analysis of accredited residency programs was categorized into 3 geographic regions: province of Buenos Aires, Autonomous City of Buenos Aires (CABA), and other regions. Each analyzed item was dichotomized into noncompliance and partial or total compliance. Categorical outcome measures were expressed in absolute numbers and percentage. RESULTS: Ninety-four pediatric residency programs were assessed: 34 (36%) corresponded to the province of Buenos Aires; 25 (27 %), to CABA; and 35 (37 %), to other regions. In total, 79 (85 %) were in the public sector. The maximum accreditation category was achieved by 35 (37 %). Four (4 %) were not accredited. Compliance for most items corresponding to the 6 domains was over 80 %. CONCLUSION: Most assessed residency programs were accredited and complied with the reference standards. Introducción. La formación médica de posgrado en un sistema de residencias constituye el mejor modelo para la formación de especialistas. La acreditación de residencias implica un proceso de armonización y normalización de criterios. Establece una base común y reproducible, que asegura una formación de calidad y con lineamientos curriculares universales.

Objetivo. Describir el proceso de acreditación de residencias de Pediatría por el Consejo de Acreditación de Espacios de Formación entre enero de 2011 y julio de 2017. Métodos. El proceso de acreditación se desarrolló acorde al marco de referencia, que definía 6 dominios y 28 ítems. De acuerdo con su cumplimiento, se especificaron 3 categorías de acreditación. El análisis de las residencias acreditadas se categorizó en tres regiones geográficas: provincia de Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA) y otras regiones. Se dicotomizó cada ítem evaluado en no cumplimiento y cumplimiento parcial o total. Las variables categóricas se expresaron en números totales y porcentajes. Resultados. Se evaluaron 94 programas de residencia de Pediatría: 34 (el 36 %) correspondieron a provincia de Buenos Aires; 25 (el 27 %), a CABA, y 35 (el 37 %), a otras regiones. Pertenecían a la gestión pública 79 (el 85 %). Alcanzaron la máxima categoría de acreditación 35 (el 37 %). No fueron acreditadas 4 (el 4 %). El cumplimiento de la mayoría de los ítems pertenecientes a los 6 dominios evaluados fue superior al80 %. Conclusión. La mayoría de las residencias evaluadas fueron acreditadas y cumplieron con los estándares de referencia.

Hydroxytyrosol inhibits cancer stem cells and the metastatic capacity of triple-negative breast cancer cell lines by the simultaneous targeting of epithelial-to-mesenchymal transition, Wnt/ß-catenin and TGFß signaling pathways.

PURPOSE: This study was aimed to determine the impact of hydroxytyrosol (HT), a minor compound found in olive oil, on breast cancer stem cells (BCSCs) and the migration capacity of triple-negative breast cancer (TNBC) cell lines through the alteration of epithelial-to-mesenchymal transition (EMT) and embryonic signaling pathways. METHODS: BCSCs self-renewal was determined by the mammosphere-forming efficiency in SUM159PT, BT549, MDA-MB-231 and Hs578T TNBC cell lines. Flow cytometric analysis of CD44+/CD24-/low and aldehyde dehydrogenase positive (ALDH+) subpopulations, migration by the "wound healing assay", invasion and Western blot of EMT markers and TGFß signaling were investigated in SUM159PT, BT549 and MDA-MB-231 cell lines. Wnt/ß-catenin signaling was assessed by Western blot in BT549 cells expressing WNT1 and MDA-MB-231 cells. Changes in TGFß activity was determined by SMAD Binding Element (SBE) reporter assay. RESULTS: HT reduced BCSCs self-renewal, ALDH+ (aldehyde dehydrogenase) and CD44+/CD24-/low subpopulations, tumor cell migration and invasion. Consistently, HT suppressed Wnt/ß-catenin signaling by decreasing p-LRP6, LRP6, ß-catenin and cyclin D1 protein expression and the EMT markers SLUG, ZEB1, SNAIL and VIMENTIN. Finally, HT inhibited p-SMAD2/3 and SMAD2/3 in SUM159PT, BT549 and MDA-MB-231 cells, what was correlated with a less TGFß activity. CONCLUSION: In conclusion, we report for the first time the inhibitory role of HT on BCSCs and tumor cell migration by targeting EMT, Wnt/ß-catenin and TGFß signaling pathways. Our findings highlight the importance of the chemopreventive compound HT as a novel candidate to be investigated as an alternative targeted therapy for TNBC.

Activating Transcription Factor 4 Modulates TGFß-Induced Aggressiveness in Triple-Negative Breast Cancer via SMAD2/3/4 and mTORC2 Signaling.

Purpose: On the basis of the identified stress-independent cellular functions of activating transcription factor 4 (ATF4), we reported enhanced ATF4 levels in MCF10A cells treated with TGFß1. ATF4 is overexpressed in patients with triple-negative breast cancer (TNBC), but its impact on patient survival and the underlying mechanisms remain unknown. We aimed to determine ATF4 effects on patients with breast cancer survival and TNBC aggressiveness, and the relationships between TGFß and ATF4. Defining the signaling pathways may help us identify a cell signaling-tailored gene signature.Experimental Design: Patient survival data were determined by Kaplan-Meier analysis. Relationship between TGFß and ATF4, their effects on aggressiveness (tumor proliferation, metastasis, and stemness), and the underlying pathways were analyzed in three TNBC cell lines and in vivo using patient-derived xenografts (PDX).Results: ATF4 overexpression correlated with TNBC patient survival decrease and a SMAD-dependent crosstalk between ATF4 and TGFß was identified. ATF4 expression inhibition reduced migration, invasiveness, mammosphere-forming efficiency, proliferation, epithelial-mesenchymal transition, and antiapoptotic and stemness marker levels. In PDX models, ATF4 silencing decreased metastases, tumor growth, and relapse after chemotherapy. ATF4 was shown to be active downstream of SMAD2/3/4 and mTORC2, regulating TGFß/SMAD and mTOR/RAC1-RHOA pathways independently of stress. We defined an eight-gene signature with prognostic potential, altered in 45% of 2,509 patients with breast cancer.Conclusions: ATF4 may represent a valuable prognostic biomarker and therapeutic target in patients with TNBC, and we identified a cell signaling pathway-based gene signature that may contribute to the development of combinatorial targeted therapies for breast cancer. Clin Cancer Res; 24(22); 5697-709. ©2018 AACR.

Successful treatment of severe nodular scleritis with adalimumab.

Ocular features may occur in longstanding rheumatoid arthritis. Among them, scleritis represents the most frequent manifestation of ophthalmologic rheumatoid disease. There are three types of anterior scleritis: diffuse, nodular, and necrotizing with and without inflammation (scleromalacia perforans). Nodular scleritis is the second cause of anterior scleritis representing 20% of all types of scleritis. The conventional treatment of nodular scleritis consists in topical steroids and DMARDS. In severe cases, the therapy with immunosuppressive agents to avoid complications is necessary. We describe a 46-year-old woman presented right nodular scleritis with rheumatoid arthritis. She was treated initially with topical steroids and DMARDs but was unable to received systemic steroids due to left open angle glaucoma in the opposite eye. After an ocular exacerbation, we initiated adalimumab with complete resolution of nodular scleritis. This is the first report of adalimumab in the treatment of nodular scleritis. Adalimumab could be a good alternative in patients with severe nodular scleritis who fail to have conventional treatment with DMARDs and unable to receive systemic steroids.