Perceptions of patients and health professionals about the quality of care provided to chronic obstructive pulmonary disease patients].

Objetivo: Explorar la percepción y el conocimiento de pacientes y profesionales sanitarios sobre factores que influyen en la calidad de los cuidados prestados en atención primaria (AP) a personas con enfermedad pulmonar obstructiva crónica (EPOC). Objetivo Explorar la percepción y el conocimiento de pacientes y profesionales sanitarios sobre factores que influyen en la calidad de los cuidados prestados en atención primaria (AP) a personas con enfermedad pulmonar obstructiva crónica (EPOC). Diseño Estudio cualitativo realizado entre febrero y marzo de 2010. Emplazamiento Centros de salud urbanos. Participantes Profesionales médicos y de enfermería de AP y pacientes con EPOC. Métodos Muestreo intencional no probabilístico con criterios de representatividad del discurso. Se realizaron 2 entrevistas grupales y 6 individuales. Las entrevistas fueron grabadas, transcritas literalmente e interpretadas mediante el análisis social del discurso. Resultados Los pacientes no identifican bien la sintomatología ni asumen la importancia de la EPOC hasta estadios avanzados. La falta de conocimiento sobre la evolución de la enfermedad y el impacto en la calidad de vida dificulta la adopción de los cambios necesarios. Los profesionales refieren problemas con la realización de espirometrías. Entre los médicos se identifica escepticismo respecto a la efectividad de las intervenciones dirigidas al cambio de conductas. Como factores organizativos destacan la existencia de Guías de Práctica Clínica (GPC), la coordinación entre profesionales y el alineamiento de prioridades entre gestores y profesionales. Conclusiones Los factores identificados sugieren la posibilidad de mejorar la asistencia sanitaria, adecuando la comunicación con los pacientes para motivarlos a adoptar las modificaciones conductuales necesarias y mejorar la adherencia a los tratamientos. Para ello puede mejorarse la concienciación y la formación de los profesionales, la coordinación asistencial, la implementación de GPC y la utilización de indicadores en un proceso de evaluación de la calidad. Objective To explore the understanding and knowledge of patients and health professionals about factors that influence the quality of care provided in Primary Care to people with Chronic Obstructive Pulmonary Disease (COPD). Design Qualitative study performed between February and March 2010. Location Primary Care Centers. Participants Medical and nursing professionals and patients with COPD. Methods Non-probabilistic intentional sampling with representation criterion of the discourse. Two group (focus group) and 6 individual interviews were performed. The interviews were recorded, literally transcribed and interpreted by social discourse analysis. Results Patients neither identify properly the symptomatology nor they assume the COPD importance until advanced states. The lacks of knowledge about the evolution of the disease and the impact on quality of life hinders the necessary changes. Professionals reports problems with performing spirometry. Among doctors, scepticism regarding to the effectiveness of the interventions aimed at change of behaviour is identified. The existence of Clinical Guides, the improvement of the coordination between professionals and the alignment of priorities between managers and professionals stand out as organizational factors. Conclusions The identified factors suggest the possibility of improving the health care through improved communication to motivate them to take the recommended changes and to increase the adherence to treatments. To this effect, the awareness and training of professionals, the healthcare coordination, the implementation of Clinical Guides and the use of indicators in a process of quality assessment

Osteonecrosis de los maxilares: Documento de consenso

Nuestro objetivo ha sido elaborar un documento de posición sobre el riesgo de desarrollar una osteonecrosis de maxilares (ONM) en los pacientes que reciben bifosfonatos para el tratamiento de la osteoporosis, identificando y valorando el grado de evidencia que apoyan las recomendaciones. Para ello se revisaron los estudios publicados sobre la definición, epidemiología, fisiopatología, clínica, diagnóstico y tratamiento de la ONM, elaborándose tras su análisis las presentes recomendaciones. Éstas se efectuaron tras un proceso pre-especificado y reproducible, que incluyó un modelo aceptado para la evaluación y la cita de la evidencia que las apoyaban. El documento, una vez elaborado por los coordinadores, fue revisado y discutido por todos los miembros del panel, elaborándose las recomendaciones provisionales que finalmente fueron estudiadas y aprobadas por los expertos de las sociedades médicas relacionadas con el metabolismo mineral óseo, que se muestran en el Anexo 2

Slug down-regulation by RNA interference inhibits invasion growth in human esophageal squamous cell carcinoma

<p>Abstract</p> <p>Background</p> <p>Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive carcinomas of the gastrointestinal tract. We assessed the relevance of Slug in measuring the invasive potential of ESCC cells <it>in vitro </it>and <it>in vivo </it>in immunodeficient mice.</p> <p>Methods</p> <p>We utilized RNA interference to knockdown Slug gene expression, and effects on survival and invasive carcinoma were evaluated using a Boyden chamber transwell assay <it>in vitro</it>. We evaluated the effect of Slug siRNA-transfection and Slug cDNA-transfection on E-cadherin and Bcl-2 expression in ESCC cells. A pseudometastatic model of ESCC in immunodeficient mice was used to assess the effects of Slug siRNA transfection on tumor metastasis development.</p> <p>Results</p> <p>The EC109 cell line was transfected with Slug-siRNA to knockdown Slug expression. The TE13 cell line was transfected with Slug-cDNA to increase Slug expression. EC109 and TE13 cell lines were tested for the expression of apoptosis-related genes bcl-2 and metastasis-related gene E-cadherin identified previously as Slug targets. Bcl-2 expression was increased and E-cadherin was decreased in Slug siRNA-transfected EC109 cells. Bcl-2 expression was increased and E-cadherin was decreased in Slug cDNA-transfected TE13 cells. Invasion of Slug siRNA-transfected EC109 cells was reduced and apoptosis was increased whereas invasion was greater in Slug cDNA-transfected cells. Animals injected with Slug siRNA-transfected EC109 cells exhihited fewer seeded nodes and demonstrated more apoptosis.</p> <p>Conclusions</p> <p>Slug down-regulation promotes cell apoptosis and decreases invasion capability <it>in vitro </it>and <it>in vivo</it>. Slug inhibition may represent a novel strategy for treatment of metastatic ESCC.</p

RNA Methylation by the MIS Complex Regulates a Cell Fate Decision in Yeast

For the yeast Saccharomyces cerevisiae, nutrient limitation is a key developmental signal causing diploid cells to switch from yeast-form budding to either foraging pseudohyphal (PH) growth or meiosis and sporulation. Prolonged starvation leads to lineage restriction, such that cells exiting meiotic prophase are committed to complete sporulation even if nutrients are restored. Here, we have identified an earlier commitment point in the starvation program. After this point, cells, returned to nutrient-rich medium, entered a form of synchronous PH development that was morphologically and genetically indistinguishable from starvation-induced PH growth. We show that lineage restriction during this time was, in part, dependent on the mRNA methyltransferase activity of Ime4, which played separable roles in meiotic induction and suppression of the PH program. Normal levels of meiotic mRNA methylation required the catalytic domain of Ime4, as well as two meiotic proteins, Mum2 and Slz1, which interacted and co-immunoprecipitated with Ime4. This MIS complex (Mum2, Ime4, and Slz1) functioned in both starvation pathways. Together, our results support the notion that the yeast starvation response is an extended process that progressively restricts cell fate and reveal a broad role of post-transcriptional RNA methylation in these decisions

Hypoxia, Snail and incomplete epithelial–mesenchymal transition in breast cancer

BACKGROUND: Hypoxia is an element of the tumour microenvironment that impacts upon numerous cellular factors linked to clinical aggressiveness in cancer. One such factor, Snail, a master regulator of the epithelial-mesenchymal transition (EMT), has been implicated in key tumour biological processes such as invasion and metastasis. In this study we set out to investigate regulation of EMT in hypoxia, and the importance of Snail in cell migration and clinical outcome in breast cancer. METHODS: Four breast cancer cell lines were exposed to 0.1% oxygen and expression of EMT markers was monitored. The migratory ability was analysed following Snail overexpression and silencing. Snail expression was assessed in 500 tumour samples from premenopausal breast cancer patients, randomised to either 2 years of tamoxifen or no adjuvant treatment. RESULTS: Exposure to 0.1% oxygen resulted in elevated levels of Snail protein, along with changes in vimentin and E-cadherin expression, and in addition increased migration of MDA-MB-468 cells. Overexpression of Snail increased the motility of MCF-7, T-47D and MDA-MB-231 cells, whereas silencing of the protein resulted in decreased migratory propensity of MCF-7, MDA-MB-468 and MDA-MB-231 cells. Moreover, nuclear Snail expression was associated with tumours of higher grade and proliferation rate, but not with disease recurrence. Interestingly, Snail negativity was associated with impaired tamoxifen response (P = 0.048). CONCLUSIONS: Our results demonstrate that hypoxia induces Snail expression but generally not a migratory phenotype, suggesting that hypoxic cells are only partially pushed towards EMT. Furthermore, our study supports the link between Snail and clinically relevant features and treatment response

Changes in Cardiac Substrate Transporters and Metabolic Proteins Mirror the Metabolic Shift in Patients with Aortic Stenosis

In the hypertrophied human heart, fatty acid metabolism is decreased and glucose utilisation is increased. We hypothesized that the sarcolemmal and mitochondrial proteins involved in these key metabolic pathways would mirror these changes, providing a mechanism to account for the modified metabolic flux measured in the human heart. Echocardiography was performed to assess in vivo hypertrophy and aortic valve impairment in patients with aortic stenosis (n = 18). Cardiac biopsies were obtained during valve replacement surgery, and used for western blotting to measure metabolic protein levels. Protein levels of the predominant fatty acid transporter, fatty acid translocase (FAT/CD36) correlated negatively with levels of the glucose transporters, GLUT1 and GLUT4. The decrease in FAT/CD36 was accompanied by decreases in the fatty acid binding proteins, FABPpm and H-FABP, the β-oxidation protein medium chain acyl-coenzyme A dehydrogenase, the Krebs cycle protein α-ketoglutarate dehydrogenase and the oxidative phosphorylation protein ATP synthase. FAT/CD36 and complex I of the electron transport chain were downregulated, whereas the glucose transporter GLUT4 was upregulated with increasing left ventricular mass index, a measure of cardiac hypertrophy. In conclusion, coordinated downregulation of sequential steps involved in fatty acid and oxidative metabolism occur in the human heart, accompanied by upregulation of the glucose transporters. The profile of the substrate transporters and metabolic proteins mirror the metabolic shift from fatty acid to glucose utilisation that occurs in vivo in the human heart

The Stress Response Factors Yap6, Cin5, Phd1, and Skn7 Direct Targeting of the Conserved Co-Repressor Tup1-Ssn6 in S. cerevisiae

Maintaining the proper expression of the transcriptome during development or in response to a changing environment requires a delicate balance between transcriptional regulators with activating and repressing functions. The budding yeast transcriptional co-repressor Tup1-Ssn6 is a model for studying similar repressor complexes in multicellular eukaryotes. Tup1-Ssn6 does not bind DNA directly, but is directed to individual promoters by one or more DNA-binding proteins, referred to as Tup1 recruiters. This functional architecture allows the Tup1-Ssn6 to modulate the expression of genes required for the response to a variety of cellular stresses. To understand the targeting or the Tup1-Ssn6 complex, we determined the genomic distribution of Tup1 and Ssn6 by ChIP-chip. We found that most loci bound by Tup1-Ssn6 could not be explained by co-occupancy with a known recruiting cofactor and that deletion of individual known Tup1 recruiters did not significantly alter the Tup1 binding profile. These observations suggest that new Tup1 recruiting proteins remain to be discovered and that Tup1 recruitment typically depends on multiple recruiting cofactors. To identify new recruiting proteins, we computationally screened for factors with binding patterns similar to the observed Tup1-Ssn6 genomic distribution. Four top candidates, Cin5, Skn7, Phd1, and Yap6, all known to be associated with stress response gene regulation, were experimentally confirmed to physically interact with Tup1 and/or Ssn6. Incorporating these new recruitment cofactors with previously characterized cofactors now explains the majority of Tup1 targeting across the genome, and expands our understanding of the mechanism by which Tup1-Ssn6 is directed to its targets

Prospect theory and the effects of bankruptcy laws on entrepreneurial aspirations

We apply prospect theory to explain how personal and corporate bankruptcy laws affect risk perceptions of entrepreneurs at time of entry and therefore their growth ambitions. Previous theories have reached ambiguous conclusions as to whether countries with more debtor-friendly bankruptcy laws (i.e. laws that are more forgiving towards debtors in bankruptcy proceedings) are likely to have more entrepreneurs, or whether, creditorfriendly regimes have positive effects on new ventures via enhanced incentives for the supply of credit to entrepreneurs. Responding to this ambiguity, we apply prospect theory to propose that entrepreneurs do not attach the same significance to different elements of bankruptcy codes—and to explain which aspects of debtor-friendly bankruptcy laws matter more to entrepreneurs. Based on this, we derive and confirm hypotheses about the impact of aspects of bankruptcy codes on entrepreneurial activity using the Global Entrepreneurship Monitor combined with data on both personal and corporate bankruptcyregulations for 15 developed OECD countries. We use multilevel random coefficient logistic regressions to take account of the hierarchical nature of the data (country and individual levels). Because entrepreneurs and creditors are sensitive to different elements of the codes, there is scope for optimisation of the legal design of bankruptcy law to achieve both an adequate supply of credit and to encourage high-ambition entrepreneurship

Study of behaviour on simulated daylight ageing of artists¿ acrylic and poly(vinyl acetate) paint films

[EN] This work proposes a multi-method approach that combines advanced microscopy (SEM/EDX, AFM) and spectroscopy (UV-vis and FTIR) techniques. This approach not only characterises the behaviour of the additives of two commercial poly(vinyl acetate) (PVAc) and acrylic emulsion paints but also simultaneously characterises the changes in chemical composition and morphology observed in the paint films as a result of ageing due to the paints being exposed to an intense source of simulated daylight. In parallel, a series of mechanical tests were performed that correlate the chemical changes in composition and the changes observed in the films' mechanical properties. This work was a comparative study between both types of acrylic and PVAc paints. The results obtained are of great interest for the modern paint conservation field as they provide valuable information on the mid- and long-term behaviours of these synthetic paints.Financial support is gratefully acknowledged from the Spanish "I+D+I MICINN" project CTQ2008-06727-C03-01/BQU supported by ERDEF funds and from the "Generalitat Valenciana" I+D project ACOMP/2009/171 and the AP2006-3223 project ascribed to the Predoctoral Stages Programme of Universitary Researchers in Spanish Universities and Research Centres from the Spanish Ministry of Science and Innovation (MICINN). The authors wish to thank Mr. Manuel Planes i Insausti and Dr. Jose Luis Moya Lopez, the technical supervisors responsible for the Electron Microscopy Service at the Polytechnic University of Valencia.Domenech Carbo, MT.; Silva, MF.; Aura Castro, E.; Fuster López, L.; Kröner ., SU.; Martínez Bazán, ML.; Mas Barberà, X.... (2011). Study of behaviour on simulated daylight ageing of artists¿ acrylic and poly(vinyl acetate) paint films. Analytical and Bioanalytical Chemistry. 399:2921-2937. https://doi.org/10.1007/s00216-010-4294-3S2921293739