Proteomic analysis of human plasma and peripheral blood mononuclear cells in Systemic Lupus Erythematosus patients.

Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease with a broad spectrum of clinical presentations and incompletely understood pathogenesis. This autoimmune disease is characterized by alterations in both the innate and adaptive immune system that lead to the loss of immunologic tolerance. In autoimmune diseases particularly in SLE, early diagnosis, flare or remission phases can be difficult to identify. Proteomics can help to find new therapeutic targets and it also could help to better understand the cellular mechanisms. The aim of this study was to observe the variations in plasma and Peripheral Blood Mononuclear Cells (PBMCs) proteome in order to increase our knowledge about pathogenesis and to find possible diagnostic markers and/or therapeutic targets for improving diagnosis and treatment. The comparative proteomic analyses showed that several proteins were differentially expressed in the PBMCs from SLE patients. Among these, PRDX2 may be used as candidate biomarker or target protein for further investigations. In plasma, we showed that plasma clusterin levels increased in SLE patients compared to healthy controls, but this increase is not statistically significant. These proteomic results provide suggestions for understanding the molecular mechanisms of SLE, as well as the physiological changes correlated with SLE disease.

PRE-CLINICAL SKILLS: A competency-based assessment integrated course implemented early in the curriculum to prepare second-year medical students prior to entering clinical settings.

This article was migrated. The article was marked as recommended. Objective: This Case Study describes the experience of Rovira i Virgili University School of Medicine (URV) with the early introduction of pre-clinical skills learning in the undergraduate medical curricula to monitor and assessing these competencies as a prerequisite for medical students accessing their training in clinical settings. Course Development: A PRE-CLINICAL SKILLS course has been developed to guarantee medical student's performance in managing clinically relevant basic medical sciences to interpret clinical scenarios, to develop technical communication skills and to value professional behavior throughout the first two years of medical education. The set of pre-clinical competencies evaluated in this course as well as the corresponding assessment methods have been established according to an international reference standards review work in collaboration with the regional quality assurance agency. An integrated formative assessment is being used. Course Advantages, Added Values and Outcome Measures: Since the academic year 2009-2010 about 130 students from second-year of Medicine follows this integrated trunk-course while being enrolled in parallel in other core courses as Physiology, Anatomy, and Histology. The program doesn't include lectures but only learning activities to train and monitor the successful achievement of the pre-clinical skills by medical students. A good majority of the participants achieve readiness for start training in clinical settings. As a whole, this course is useful ensuring patient's safety by identifying weaknesses acquisition of pre-clinical skills and predicting medical students who will have difficulty during their clinical training. Conclusions: Reflecting on our experience, we believe that the named course "PRE-CLINICAL SKILLS" overcomes the disadvantages of the traditional teaching methods. Helping students to conceptualize rather than memorize and encouraging them to integrate clinically relevant basic medical sciences concepts and principles by training pre-clinical skills in this competence-based assessment course prior entering into clinical settings.

Interleukin 1, interleukin 6, interleukin 10, and tumor necrosis factor α in active and quiescent systemic lupus erythematosus.

OBJECTIVES: Several studies have investigated the cytokine profile of patients with systemic lupus erythematosus (SLE); however, their role is still controversial, mostly because SLE has a heterogeneous disease manifestation. We measured 4 of the most important cytokines in patients with SLE after dividing them in uniform groups according to disease activity and organ involvement. MATERIALS AND METHODS: Eighty-two adult female patients with SLE were divided into 3 groups according to disease activity and organ involvement: Group A (SLE activity index [SLEDAI] score, 7 ± 0.4) included subjects with newly diagnosed, active SLE, investigated before starting therapy. Group B (SLEDAI score, < 6) included patients without renal involvement, treated with prednisone and azathioprine or hydroxychloroquine. Group C (SLEDAI score, < 6) included patients with lupus nephritis, treated with methylprednisolone and cyclophosphamide, reaching complete remission. Fourteen healthy females served as controls. RESULTS: Interleukin-1 levels were 1.0, 0.8, 0.7, and 0.25 pg/mL in groups A, B, C, and D, respectively. Interleukin-6 levels were 3.2, 3.6, 4.0, and 1.4 pg/mL in groups A, B, C, and D, respectively; Il-10 levels, 3.05, 1.1, 1.5, and 1.65; tumor necrosis factor-α levels, 8.75, 5.8, 5.4, and 3.6. Interleukin 1, IL-6, and tumor necrosis factor-α were significantly higher in the patients with SLE than in the healthy controls; IL-1 was significantly higher in group A than in group C. Interleukin 10 showed positive correlation with C-reactive protein, whereas it showed negative correlation with C3. CONCLUSIONS: Data from our cohort, one of the largest so far reported, add to the evidence that proinflammatory cytokines such as Interleukin-1, Interleukin-6, Interleukin-10 and tumor necrosis factor-α are important in SLE pathogenesis.

Teaching radiological anatomy

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[Double vascular pedicle iliac crest flap]. / Colgajo de cresta ilíaca de doble pedículo vascular.

INTRODUCTION: The iliac crest flap is commonly used in reconstructions of the head and neck. The vascularisation of this region depends on the deep circumflex iliac artery and vein (ACIP/VCIP). The present study describes for the first time, the simultaneous use of the deep and superficial circumflex iliac systems to obtain an iliac crest flap for head and neck reconstructions. MATERIAL AND METHOD: Ten inguinal regions were dissected in five cadavers in the Human Anatomy and Embryology Unit of the Faculty of Medicine of the Rovira i Virgili University. In the period 2005-2007, three patients required mandibular reconstruction with a microvascularised iliac crest osteocutaneous flap at the Maxillofacial Surgery Unit of the Joan XXIII University Hospital. RESULTS: The 3 cases showed a favourable outcome. This "supercharging" variation guarantees the perfusion to the skin flap, provides a better three-dimensional arrangement of the soft tissue and lowers the morbidity at the donor site, as much less internal oblique muscle cuff is harvested. CONCLUSIONS: This technique may be of great interest in the reconstruction of complex maxillofacial defects instead of having to carry out a vascular dissection and its extra anastomosis.

Colgajo de cresta ilíaca de doble pedículo vascular / Double vascular pedicle iliac crest flap

Introducción: el colgajo de cresta ilíaca (CCI) es uno de los utilizados con mayor frecuencia en la reconstrucción facial. Su vascularización depende de los vasos circunflejos ilíacos profundos (ACIP, VCIP). Este trabajo describe, por primera vez, la posibilidad de doble irrigación de la isla cutánea del CCI incluyendo el sistema circunflejo ilíaco superficial para la reconstrucción de cabeza y cuello. Material y método: se diseccionaron 10 regiones inguinales de 5 cadáveres en el Departamento de Anatomía de la Facultad de Medicina Rovira i Virgili de Reus (Tarragona). En el periodo 2005-2007, 3 pacientes fueron intervenidos en el Servicio de Cirugía Maxilofacial del Hospital Joan XXIII de Tarragona, requiriendo un colgajo osteomiocutáneo microvascularizado de cresta ilíaca. Resultados: los 3 casos clínicos mostraron una evolución satisfactoria. Esta técnica proporciona una mayor vascularización del colgajo y una mayor disponibilidad tridimensional e implica menor morbilidad de la zona donante, ya que se necesita tallar menos cantidad de oblicuo pues la irrigación de los vasos perforantes no depende de la ACIP. Conclusiones: esta variación técnica del colgajo de cresta ilíaca puede sernos de gran utilidad en la reconstrucción de defectos complejos maxilofaciales a cambio de realizar una disección vascular y su anastomosis extra (AU)

Introduction. The iliac crest flap is commonly used in reconstructions of the head and neck. The vascularisation of this region depends on the deep circumflex iliac artery and vein(ACIP/VCIP). The present study describes for the first time, the simultaneous use of the deep and superficial circumflex iliac systems to obtain an iliac crest flap for head and neck reconstructions. Material and method: Ten inguinal regions were dissected in five cadavers in the Human Anatomy and Embryology Unit of the Faculty of Medicine of the Rovira i Virgili University. In the period 2005-2007, three patients required mandibular reconstruction with a microvascularisediliac crest osteocutaneous flap at the Maxillofacial Surgery Unit of the Joan XXIII University Hospital. Results: The 3 cases showed a favourable outcome. This “supercharging” variation guarantees the perfusion to the skin flap, provides a better three-dimensional arrangement of the soft tissue and lowers the morbidity at the donor site, as much less internal oblique muscle cuff is harvested Conclusions: This technique may be of great interest in the reconstruction of complex maxillofacial defects instead of having to carry out a vascular dissection and its extra anastomosis (AU)

Extended transcaruncular approach using detachment and repositioning of the inferior oblique muscle for the traumatic repair of the medial orbital wall.

The fracture of the medial orbital wall is relatively common in orbital trauma. Titanium mesh is possibly the actual standard material for orbital wall reconstruction. When the floor of the orbit and the medial wall are simultaneously affected, one larger mesh gives better results than two independent meshes that need to be fixated independently. However, large meshes need a wider surgical field. To gain sufficient exposure to the medial and inferior orbital walls simultaneously, we present an approach that combines the transconjunctival and transcaruncular incisions, detaching if needed the inferior oblique muscle and, placing our mesh, repositioning it beside the lacrimal duct. This technique should not entirely displace traditional approaches, but it widens the surgical exposure for middle- and upper-third facial trauma. This alternative has minimum morbidity and can save a great deal of surgery time.

Hormonal strategies for fertility preservation in patients receiving cyclophosphamide to treat glomerulonephritis: a nonrandomized trial and review of the literature.

BACKGROUND: Prepubertal patients receiving chemotherapy are relatively resistant to cyclophosphamide-induced germinal cell alterations. We studied the possible protective effect of testosterone and triptorelin to inhibit gonadal activity in men and women receiving cyclophosphamide, respectively. STUDY DESIGN: Nonrandomized trial. SETTING & PARTICIPANTS: 28 consecutive patients, 11 men and 17 women, from a university medical center with various forms of glomerulonephritis, treated with cyclophosphamide. INTERVENTION: Men received cyclophosphamide plus testosterone; women were divided into 2 groups: 13 patients (group A) received cyclophosphamide plus triptorelin; 4 (group B) received only cyclophosphamide. OUTCOMES & MEASUREMENTS: Serum follicle-stimulating hormone (FSH) and serum luteinizing hormone levels and, in addition, sperm counts and testosterone levels in men and estradiol levels in women were measured before and after treatment with cyclophosphamide. RESULTS: All 10 men became azoospermic or severely oligospermic during treatment; after 12 months, all except 1 had a normal sperm count and FSH levels were normal. In women during cyclophosphamide therapy, amenorrhea occurred in all patients. After cessation of therapy, all women in group A started to menstruate regularly, and at the end of follow-up, ovulatory cycles were demonstrated in all women. Hormone levels showed no significant changes throughout the observation period. Six women conceived, and the pregnancies were brought to term successfully without complications. In group B, all 4 women developed sustained amenorrhea; serum FSH and luteinizing hormone levels at the end of therapy and follow-up were significantly higher with respect to baseline; estradiol levels at the end of follow-up were significantly lower compared with baseline and corresponding values in group A. LIMITATIONS: The substudy in men is uncontrolled, the substudy in women is nonrandomized. CONCLUSIONS: The study suggests a protective effect of testosterone and triptorelin against cyclophosphamide-induced gonadal damage in men and women with various forms of kidney disease, respectively.

Static electromagnetic field effects on pineal vesicles: a morphological and morphometric study in chick embryos / Efectos de un campo magnético estático sobre las vesículas pineales: estudio morfológico y morfométrico en embriones de pollo

The effects of static electromagnetic field exposure on the development of pineal cell aggregates were studied in chick embryos. Static electromagnetic fields were created by a solenoidal coil (110×160 mm) kept inside the incubators and connected to a power supply. The magnetic field generated was static and uniform (frequency = 0; wavelength = 0) and the intensities were 18 mT and 36 mT. Eggs were incubated either under control or static electromagnetic field conditions, and embryos were sacrificed after 5, 10 and 15 days of incubation. The morphology, number and density of pineal aggregates were determined in three pineal areas (apical, anterior and posterior). In exposed embryos, the vesicles appeared earlier (by the 5th day) and after 15 days of incubation the number of vesicles was higher and stroma compaction was greater than in controls. These changes in vesicle morphology and density suggest that a static electromagnetic field might be able to stimulate pineal maturation and development in the chick embryo (AU)

Se investigaron los efectos de la exposición a un campo magnético estático sobre el desarrollo de agregaciones de células pineales en embriones de pollo. Los campos electromagnéticos estáticos fueron creados utilizando un resorte solenoidal (110 x 160 mm) mantenido dentro de las incubadoras y conectado a una fuente eléctrica. El campo magnético así generado era estático y uniforme (frecuencia = 0; longitud de onda = 0) y las intensidades eran de 18 mT y 36 mT. Los huevos fueron incubados bajo condiciones bien de control bien de campo electromagnético y los embriones fueron sacrificados a los días 5, 10 y 15 de incubación. La morfología, número y densidad de agregaciones pineales fueron determinados en tres áreas de la glándula pineal (apical, anterior y posterior). En los embriones expuestos, las vesículas aparecieron antes (antes del día 5) y a los 15 días de incubación el número de vesículas era mayor y el grado de compactación del estroma era mayor que en los controles. Estos cambios en la morfología y en la densidad de las vesículas sugieren que un campo magnético estático quizá pueda estimular la maduración y desarrollo de los embriones de pollo (AU)