El currículo integrado: la integración de las básicas y las clínicas en el grado / The integrated curriculum: integration of basic and clinical sciences in medical degree

En este artículo se describen los argumentos a favor de la integración basicoclínica en los currículos de las facultades de medicina encontrados en la bibliografía, y se exponen las ventajas de tales currículos y las dificultades para su implementación. Asimismo, se describe la situación actual en las facultades de medicina españolas y se plantean algunas preguntas para la reflexión

This article describes the arguments in favour of basic - clinical integration into the curricula of medical schools found in literature. The advantages of such curricula and the difficulties for its implementation are discussed. Likewise, the current situation in the Spanish Medical Schools is described and some questions are proposed for reflection

La adquisición progresiva de las competencias en la formación médica / No disponible

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Use of transduction proteins to target trabecular meshwork cells: outflow modulation by profilin I.

PURPOSE: Fusion proteins containing a protein transduction domain (PTD4) are able to cross biological membranes. We tested the applicability of the protein transduction method for study of the aqueous humor trabecular outflow pathway by targeting the actin cytoskeleton, which is known to be involved in outflow facility regulation. METHODS: Expression vectors useful for generating fusion proteins with the PTD4 domain and the actin-binding protein Profilin I were constructed. The transductional and functional properties of these proteins were tested in bovine trabecular meshwork cells in culture. The effects of PTD4-Profilin I on outflow facility were evaluated in perfused bovine anterior segments. PTD4-beta-galactosidase was used to visually check correct delivery of fusion proteins to trabecular meshwork cells. RESULTS: The fusion proteins generated were characterized by western blot. Immunocytochemistry experiments showed intracellular staining for PTD4-Profilin I in trabecular meshwork cells in culture. The fusion protein was found in the cytoplasm associated with actin filaments and in the leading edge of the cellular membrane. In contrast, control Profilin I, without the PTD4 domain, was unable to cross the cell membrane. In perfused anterior segments, 2 microM PTD4-Profilin I increased trabecular outflow facility in a reversible manner, while Profilin I had no significant effect. Anterior segments perfused with PTD4-beta-galactosidase showed positive staining in the trabecular meshwork tissue. CONCLUSIONS: Protein transduction technology is a valuable tool for targeting trabecular meshwork tissue, not only for performing physiological studies, but also as a potential drug-delivery method. Profilin I action on the actin cytoskeleton further reinforces the importance of this structure in outflow facility regulation.

Modulation of aqueous humor outflow by ionic mechanisms involved in trabecular meshwork cell volume regulation.

PURPOSE: Trabecular meshwork (TM) cell shape, volume, contractility and their interactions with extracellular matrix determine outflow facility. Because cell volume seems essential to TM function, this study was conducted to investigate further the ionic channels and receptors involved in regulatory volume decrease and their roles in modulating outflow facility. METHODS: Primary cultures of bovine TM cells were used. K(+) and Cl(-) currents were studied with whole-cell patch clamping. Swelling was induced by hypotonic shock. [Ca(2+)](i) was measured in TM cells loaded with fura-2. Bovine anterior segments were perfused at constant pressure to measure outflow facility. RESULTS: Hypotonic media activated both the high-conductance Ca(2+)-activated K(+) channel (BK(Ca)) and swelling-activated Cl(-) channel (Cl(swell)) currents and induced release of adenosine 5'-triphosphate (ATP) from TM cells. ATP activated P2Y(2) receptors with the following profile: ATP = uridine 5'-triphosphate (UTP) > adenosine 5'-O-(3-thiotriphosphate) (ATP-gamma S) > adenosine 5'-diphosphate (ADP) = uridine 5'-diphosphate (UDP), and increased BK(Ca) current. Hypotonic medium initially decreased outflow facility in perfused anterior segments, which recovered with time to baseline levels. Addition of tamoxifen or iberiotoxin (Cl(swell) and BK(Ca) blockers, respectively) lengthened the recovery phase, which implies that these channels participate in cell volume regulation. In contrast, an activator of BK(Ca)s (NS1619) produced the opposite effect. CONCLUSIONS: Cell swelling activates a regulatory volume decrease mechanism that implies activation of K(+) and Cl(-) currents and participation of P2Y(2) receptors. Because previous studies have shown that intracellular volume of TM cells is an important determinant of outflow facility, it seems feasible that cell volume regulation would be part of the homeostatic mechanisms of the TM, to regulate the outflow pathway.

Cell membrane stretch modulates the high-conductance Ca2+-activated K+ channel in bovine trabecular meshwork cells.

PURPOSE: Anterior chamber structures are subjected to changes in intraocular pressure (IOP). Several studies have pointed out that trabecular meshwork (TM) cells are sensitive to mechanical stretch and that cell-signaling mechanisms are activated in response to elevated pressure. Because membrane stretch has been shown to be a modulator of several ionic conductances, this study was conducted to determine its effects on the high-conductance Ca(2+)-activated K(+) (BK(Ca)) channels present in TM cells. METHODS: Primary cultures of TM cells from bovine eyes were used. Patch-clamp recordings were performed in the cell-attached, inside-out, and whole-cell configurations. To stretch the cell membrane, both suction to the rear end of the patch pipette and hypotonic shock were used. Intracellular calcium concentration ([Ca(2+)](i)) was measured in TM cells loaded with fura-2, using an epifluorescence microscope coupled to a charge-coupled device (CCD) camera. RESULTS: Electrophysiological characterization of BK(Ca) channels was in agreement with previous studies. In cell-attached patches, the open probability of the BK(Ca) channel (i.e., the amount of time the channel is open) increased consistently when 14- to 45-mm Hg suctions were applied at a constant depolarized voltage. At a constant pressure (25 or 45 mm Hg), channel openings increased when depolarizing pulses were applied to the patch. Stretch activation of the BK(Ca) channel was not mediated by increases in [Ca(2+)](i), because it was present in inside-out patches maintained at a constant Ca(2+) concentration. Nevertheless, it cannot be ruled out that at low suction levels, a minimum Ca(2+) concentration is necessary for channel activation. Whole-cell currents carried by BK(Ca) channels increased when the isotonic solution in the bath was exchanged with a hypotonic solution and were selectively blocked by iberiotoxin. In our conditions, the hypotonic shock did not modify [Ca(2+)](i). CONCLUSIONS: The data show that in TM cells, open probability of the BK(Ca) channel is enhanced by membrane stretching as well as by membrane depolarization and [Ca(2+)](i). Changes in membrane tension induced by cell volume increase also activated whole-cell BK(Ca) currents. Homeostatic mechanisms in TM cells may involve BK(Ca) channel activation in response either to changes in cell volume or changes in IOP.