Invasion of spontaneous germinal centers by naive B cells is rapid and persistent.

In autoreactive germinal centers (GC) initiated by a single rogue B cell clone, wild-type B cells expand and give rise to clones that target other autoantigens, known as epitope spreading. The chronic, progressive nature of epitope spreading calls for early interventions, but the kinetics and molecular requirements for wild-type B cell invasion and participation in GC remain largely unknown. With parabiosis and adoptive transfer approaches in a murine model of systemic lupus erythematosus, we demonstrate that wild-type B cells join existing GCs rapidly, clonally expand, persist, and contribute to autoantibody production and diversification. The invasion of autoreactive GCs required TLR7, B cell receptor specificity, antigen presentation, and type I interferon signaling. The adoptive transfer model provides a novel tool for identifying early events in the breaking of B cell tolerance in autoimmunity.

Effects of periodontal non-surgical therapy plus azithromycin on glycemic control in patients with diabetes: a randomized clinical trial.

BACKGROUND AND OBJECTIVE: Periodontitis may alter the systemic condition in patients with diabetes and hence interfere with glycemic control. The objective of this study was to determine the quantifiable changes in glycated hemoglobin (HbA1C) after periodontal non-surgical therapy plus azithromycin in a mixed population of patients with poorly controlled diabetes. MATERIALS AND METHODS: One hundred and five patients were randomized to receive non-surgical therapy plus azythromycin (AZ-Sca =33), non-surgical therapy plus placebo (PB-Sca = 37) and supragingival prophylaxis plus azithromycin (AZ-Pro = 35). Glycated hemoglobin, glycemia and periodontal parameters were measured at baseline, 3, 6 and 9 mo after treatment. RESULTS: Periodontal parameters were improved in the AZ-Sca and PB-Sca groups as compared to the AZ-Pro group. A greater reduction in probing depth was observed in the AZ-Sca as compared to the PB-Sca group. Improvement in clinical attachment level was similar between AZ-Sca and PB-Sca groups. A reduction from 8.0% to 7.2% (∆0.8%; p < 0.05) in HbA1C was observed in the AZ-Sca at 9 mo as compared to the PB-Sca group in which the reduction was from 7.9% to 7.6% (∆0.3%). There was no decrease in HbA1C in the AZ-Pro group over time. Mean glycemia values decreased from 195 mg/dL to 159.2 mg/dL (∆35.8 mg/dL; p < 0.05) in the AZ-Sca group whereas a decrease from 194 mg/dL to 174.8 mg/dL (∆19.2 mg/dL) in the PB-Sca group at 9 mo was observed. There were no differences between the AZ-Sca and PB-Sca groups for glycemic parameters. No improvement in glycemic values in the AZ-Pro group was observed. CONCLUSIONS: A modest improvement in glycemic control was detected with a trend towards the use of non-surgical therapy plus AZ as compared to the placebo.

Integración de diferentes estrategias para impulsar la adopción del Servicio de Seguimiento Farmacoterapéutico en las farmacias comunitarias españolas / The integration of different strategies to boost the adoption of the pharmacotherapy follow-up service in Spanish community pharmacies

La farmacia comunitaria se encuentra en pleno proceso de cambio con el propósito de dar respuesta a las necesidades de los pacientes respecto a su mediación mediante la implantación gradual de nuevos servicios cognitivos, entre los que cabe resaltar el de seguimiento farmacoterapéutico (SFT). La implantación de este servicio está siendo más lenta de lo esperado. Por ello, es preciso renovar esfuerzos para potenciar la adopción de esta innovación por parte de los farmacéuticos españoles. A partir de una revisión bibliográfica se pretende integrar las diferentes estrategias para elaborar un marco, complejo pero interconectado, que permita conocer tanto la situación de los farmacéuticos en el proceso de adopción de esta innovación como la utilidad de los diferentes facilitadores para el cambio en la práctica farmacéutica en las distintas etapas motivacionales, aplicables a los farmacéuticos titulares y a los miembros del equipo de la farmacia. De acuerdo con los estudios realizados hasta el momento, se puede afirmar que la implantación del SFT es un proceso complejo que no depende de un único factor, sino de la interacción de varios de ellos, y debe abordarse de una manera multiestratégica. El pago por el servicio constituye un elemento previo, indispensable no sólo para conseguir su implantación, sino sobre todo para alcanzar su sostenibilidad. Es importante conseguir motivar en primer lugar a los titulares de las farmacias, aunque el objetivo final deba consistir en la motivación de todos los miembros del equipo. Para ello, puede ser útil la utilización de los facilitadores externos junto con otros elementos motivacionales y premotivacionales. Una vez que se alcanza la situación de «intención de cambiar», deben aplicarse los facilitadores internos para avanzar hacia el cambio de comportamiento del farmacéutico y la farmacia como organización (AU)

Community pharmacies are in the middle of a process of change with the objective of meeting patients’ needs in relation to the irmedication, by means of the gradual implementation of new cognitive services, among which the Pharmacotherapy Follow-up service should be high lighted. The implementation of this service istaking longer than expected. Therefore, new efforts must be made to boost the adoption of this innovation by Spanish pharmacists. By means of a literature review the different strategies are integrated in order to create a framework, complex but interconnected. That framework shows both the situation of the pharmacists in the process for the adoption of this innovation, as well as the use of the different facilitators for the changes in pharmaceutical practice in the different motivational stages, applicable to pharmacy owners and the pharmacy team members. According to the studies carried out to date, it can be concluded that the implementation of the Pharmacotherapy Follow-up serviceis a complex process that does not depend on a single factor but rather on the interaction of several factors, which must be approached in a multi-strategic manner. The payment for the service is a prior, indispensible element, not only in order to achieve its implementation but, above all, to guarantee its sustainability. In the first place, it is important to manage to motivate the pharmacy owners, although the final objective should be to achieve the motivation of all the pharmacy team members. Therefore, it might be useful to use the external facilitators together with other motivational and pre-motivational elements. Once the "intention to change" has been achieved, the internal facilitators must be applied in order to advance towards (AU)

[The factors related to job satisfaction and professional burnout in the primary care physicians of Asturias]. / Factores relacionados con la satisfacción laboral y el desgaste profesional en los médicos de atención primaria de Asturias.

OBJECTIVE: To determine the level of work satisfaction and professional wear and tear among primary care doctors, and related factors. DESIGN: Crossover descriptive study. SETTING: Asturias PC. SUBJECTS: General doctors (GD), family doctors (FD), residents, and PC paediatricians (n = 810). MEASUREMENTS: A survey for self-administration with social and demographic variables and suggestions. The Font Roja-PC questionnaire (FR). The Maslach Burnout Inventory (MBI). RESULTS: 497 (55.6% male) responded (61.35%). Mean age was 41 (SD = 7.18) 57.3% worked in an urban environment. 42% were FD, 35% GD, 15% paediatricians, 7% residents. The PC model was: 84% PC teams, 9% traditional model, 7% normal emergency service (NES). Mean seniority was 14 years (SD = 7.5). 89% worked solely in PC. 59% had a permanent contract, 31% provisional contracts, 7% were residents and 3% temporary. Overall mean satisfaction (OMS): 73.73 points. 43% had high professional wear and tear, 23% moderate and 32% low. Statistically significant associations: OMS/social and demographic variables: greater in men, the rural environment, paediatrics, NES, without stand-by, with less bureaucracy and less case pressure. Satisfaction/FR: greater NES, without stand-by, without sole dedication. Case pressure/FR: greater in men, rural environment, paediatrics, without sole dedication, NES, without stand-by and with less demand. Control/FR: greater in permanent and provisional posts. Relationship/FR: greater in men, FD, without stand-by. Suitability/FR: greater in men, paediatricians, permanent doctors, without stand-by. Relaxation/FR: greater in residents, young people, without sole dedication, NES. Variety/FR: greater in young people, those without children, residents, with sole dedication, those with stand-by. MBI/social and demographic variables: greater level of low emotional tiredness in workers in a rural environment and those with children. Greater low level of alienation in women. The older the doctor, the less the professional burnout. CONCLUSIONS: 1. High level of work satisfaction. 2. High-moderate professional wear and tear.

[Complications of inguinal lymphadenectomy for penile carcinoma. Origin, management, and prevention]. / Complicaciones en las linfadenectomías inguinales por carcinoma del pene. Origen, manejo y prevención.

Since inguinal lymphadenectomy (LFD) technique in the treatment of epidermoid carcinoma of the penis was first described, control of its high mobility has been one of the concerns for oncological urologists. Our group has reviewed the complications of 21 inguinal LFDs performed since 1982 in our centre and found that two thirds of these procedures had at least one complication, the most frequent being lower limb lymphedema (28.5%) among those appearing late, and healing alterations (38%) together with fluid collections or persistent lymphorrhea (33.3%) among the early ones. Other complications were infection, local recurrence and haemorrhage of the femoral vessels. Most authors agree on the high morbidity of this technique. We highlight the origin, management and prevention of each of these complications so as to reduce their frequency while placing inguinal LFD in its real position within the therapeutic approach of epidermoid carcinoma of the penis.