Identification of new regenerative therapies in reproductive medicine and their application as a future therapeutic approach for endometrial regeneration

El útero es uno de los principales órganos internos del sistema reproductor femenino. Está compuesto de tres capas tisulares: perimetrio, miometrio y endometrio. Esta última capa recubre la cavidad intrauterina y es responsable directa de la implantación embrionaria (para la cual necesita un grosor endometrial mínimo). Entre las patologías que afectan al endometrio pueden distinguirse, entre otras, la atrofia endometrial (insuficiente grosor endometrial) y el síndrome de Asherman (presencia de adhesiones intrauterinas y tejido fibrótico), las cuales conforman el hilo conductor de esta tesis, compuesta de 4 artículos científicos. En ambos casos, el tejido endometrial se encuentra degenerado, lo que dificulta la implantación embrionaria, ocasionando problemas de fertilidad. A día de hoy, ninguna de estas patologías cuenta con una cura totalmente efectiva. Hasta el momento, una de las opciones terapéuticas más prometedora es la inyección de células madre. Por ello, el primer objetivo de esta tesis fue evaluar como la inyección de células madre derivadas de la médula ósea (aisladas con la detección del antígeno CD133), que había resultado ser efectiva tanto en un modelo humano como en uno animal, estaba modificando el endometrio molecularmente. Para así, intentar entender cuáles son los mecanismos paracrinos a través de los cuales llevan a cabo su acción terapéutica. Este primer estudio reveló que estas células madre parecían estar promoviendo la regeneración endometrial mediante la creación de un escenario inmunomodulador (sub-expresión del gen CXCL8), que daría paso a la sobreexpresión de genes involucrados en la regeneración tisular, como SERPINE1, IL4, y JUN. Otro tratamiento que ha ido ganando acepción con los años es el plasma rico en plaquetas, eje central del manuscrito 2. Este manuscrito evidencia como este plasma, especialmente si proviene de sangre de cordón umbilical, es capaz de promover procesos celulares, como la migración y la proliferación de las células endometriales, así como eventos regenerativos en un modelo animal con daño endometrial inducido. Sea cual sea la aproximación terapéutica de elección, se ha hipotetizado que esta regeneración tisular podría surgir de la estimulación del nicho de células madre presente en el endometrio. Es por ello que el objetivo 3 supuso el estudio de los trabajos publicados, tanto de modelos murinos como humanos, relativos a esta población de células madre endometriales. Esta búsqueda permitió concluir que aún quedan lagunas de conocimiento, bien sea en la definición de marcadores celulares específicos o en de la contribución de la médula ósea a este nicho de células madre endometriales. Finalmente, dada la mencionada falta actual de una terapia definitiva para las pacientes con atrofia endometrial o síndrome de Asherman, el cuarto y último objetivo de esta tesis supuso el estudio de todas aquellas aproximaciones que se han llevado a cabo en modelos animales que simulan este tipo de patologías humanas. Este trabajo concluyó que si bien están emergiendo nuevas terapias muy prometedoras, como son aquellas derivadas de la bioingeniería (por ejemplo, uso de hidrogeles o biomoldes), todavía falta perfeccionar y estandarizar los modelos tanto animales como in vitro que permitan una mejor traslación clínica de las mismas.The uterus is one of the main internal organs of the female reproductive system. It is composed of three different tissue layers: perimetrium, myometrium, and endometrium. This last layer covers the intrauterine cavity and is directly responsible for embryo implantation (for which it needs a certain minimum endometrial thickness). Among the pathologies affecting the endometrium, we can distinguish, among others, endometrial atrophy (characterized by an insufficient endometrial thickness) and Asherman's syndrome (a rare disease characterized by the presence of intrauterine adhesions and fibrotic tissue), which form the common thread of this thesis, composed of four original manuscripts. In both cases, the endometrial tissue is degenerated, which hinders the correct embryo implantation, causing then fertility problems. To date, none of these pathologies has a totally effective cure. So far, one of the most promising therapeutic options is the injection of stem cells. Therefore, the first objective was to evaluate how the infusion of bone marrow-derived stem cells (isolated with the antigen CD133), which had proven effective in both a human and an animal model, was modifying the endometrium at the molecular level. Then, this work aimed to understand the paracrine mechanisms through which these cells were carrying out their therapeutic and regenerative action over the endometrial tissue. This first study revealed that these stem cells appeared to be promoting endometrial regeneration by creating an immunomodulatory scenario (down-regulation of the CXCL8 gene), which would give way to the over-expression of genes (SERPINE1, IL4, and JUN) involved in tissue regeneration. Another treatment gaining acceptance over the years is a blood derivate, platelet-rich plasma, which was the focus of the second manuscript. This work shows how this plasma, mainly derived from umbilical cord blood rather than adult peripheral blood, can promote cellular processes, such as cell migration and proliferation of different types of endometrial cells (from primary culture and from stem cell lines). These plasmas also revealed how they triggered the over-expression of certain proteins involved in regenerative events in a mouse model with induced endometrial damage. Whatever the therapeutic approach of choice, it has been hypothesized that regeneration could arise from stimulation of the stem cell niche present in the endometrium. That is why objective three involved studying those works, both murine and human models, concerning this population of endometrial stem cells. This search concluded that there are still gaps in knowledge, either in the definition of specific endometrial stem cell markers or in the contribution of the bone marrow to this endogenous endometrial stem cell niche. Finally, given the aforementioned current lack of definitive therapy for patients with endometrial atrophy or Asherman's syndrome, the last objective involved studying all those approaches that have been carried out in animal models that simulate this type of human pathology. This work concluded that although new therapies are emerging, such as those derived from bioengineering (e.g. use of decellularized scaffolds or hydrogels), there is still a need to perfect and standardize both animal and in vitro models to allow a better clinical translation of these therapies

Diseño y utilización de unas prácticas de Regulación del Metabolismo como herramienta integradora de conocimientos multidisciplinares en el Grado en Biología (II)

Se pretende la creación de espacios multidisdiplinares en el Grado en Biología,con prácticas integradas de asignaturas que se cursan simultáneamente, que pudieran servir de base a propuestas de Trabajos de Fin de Grado

Aripiprazole vs Risperidone Head-to-Head Effectiveness in First-Episode Non-Affective-Psychosis: A 3-Month Randomized, Flexible-Dose, Open-Label Clinical Trial

Background: Antipsychotic choice for the acute phase of a first episode of psychosis (FEP) is of the utmost importance since it may influence long-term outcome. However, head-to-head comparisons between second-generation antipsychotics remain scarce. The aim of this study was to compare the effectiveness in the short term of aripiprazole and risperidone after FEP outbreak. Methods: From February 2011 to October 2018, a prospective, randomized, open-label study was undertaken. Two hundred-sixty-six first-episode drug-naïve patients were randomly assigned to aripiprazole (n = 136) or risperidone (n = 130) and followed-up for 12 weeks. The primary effectiveness measure was all-cause treatment discontinuation. In addition, an analysis based on intention-to-treat principle was conducted to assess clinical efficacy. Results: The overall dropout rate at 12 weeks was small (6.39%). Effectiveness measures were similar between treatment arms as treatment discontinuation rates (? 2 = 0,409; P = .522), and mean time to all-cause discontinuation (log rank ? 2 = -1.009; P = .316) showed no statistically significant differences. Despite no statistically significant differences between groups regarding clinical efficacy, aripiprazole required higher chlorpromazine equivalent dosage (? 2 = 2.160; P = .032) and extended mean time (W = 8183.5; P = .008) to reach clinical response. Sex-related adverse events and rigidity were more frequent in the risperidone group, whereas sialorrhea was on the aripiprazole group. Conclusions: No differences regarding effectiveness were found between aripiprazole and risperidone for the short-phase treatment of FEP. Despite the importance of efficacy during this phase, differences in side effect profiles and patient's preferences are essential factors that may lead clinical decisions for these patients

Sediments as Sentinels of Pollution Episodes in the Middle Estuary of the Tinto River (SW Spain)

Estuaries are excellent environments for identifying pollution episodes that have affected river basins, as their sediments are the final destination of some of the pollutants. This paper studies the geochemical evolution of five elements (As, Co, Cu, Pb, Zn) in a core extracted from the middle estuary of the Tinto River (SW Spain). The results are based on facies interpretation, ICP atomic emission spectrometry analysis, the application of a regional background to obtain the geoaccumulation index and dating. The main objective of this communication is the detection of natural or anthropogenic pollution episodes in the middle estuary of the Tinto River (SW Spain). Four pollution episodes have been detected: (1) ~5.8 cal. kyr BP, probably caused by natural acid rock drainage processes derived from the oxidation of the Iberian Pyritic Belt deposits found in its drainage basin; (2) 4.7–4.5 kyr BP, coming from the first mining activities and characterized by a significant increase in the concentrations of the five elements analyzed; (3) 1850–1960 interval, coinciding with intensive mining and characterized by increasing values of As and, to a lesser extent, Pb (intensive mining); and (4) the second half of the 20th century, with high element concentrations from mining and industrial effluents. All episodes show an increase in their geochemical classes deduced from the geoaccumulation index. This communication can serve as an example for assessing the impact of different types of pollution in estuarine environments.This study was mainly financed by the Palos de la Frontera Council. It was also carried out through the following projects: (a) DGYCIT project CTM2006-06722/MAR; (b) DGYCIT project CGL2006-01412; (c) Roman cities of the Baetica, CORPVS VRBIVM BAETICARVM (I) (CUB) (Andalusian Government); (d) From the Atlantic to the Tyrrhenian, the Hispanic ports and their commercial relations with Ostia Antica, DEATLANTIR II—HAR2017-89154-P (Plan Nacional de I + D + i); and (e) FEDER 2014–2020 project UHU-1260298. Other funds have come from the Andalusian Government (groups HUM-132, RNM-238, and RNM-293). It is a contribution to the Research Center in Historical, Cultural and Natural Heritage (CIPHCN) of the University of Huelva

A Platform for Addressing Individual Magnetite Islands Grown Epitaxially on Ru(0001) and Manipulating Their Magnetic Domains

We have grown high-quality magnetite micrometric islands on ruthenium stripes on sapphire through a combination of magnetron sputtering (Ru film), high-temperature molecular beam epitaxy (oxide islands), and optical lithography. The samples have been characterized by atomic force microscopy, Raman spectroscopy, X-ray absorption and magnetic circular dichroism in a photoemission microscope. The magnetic domains on the magnetite islands can be modified by the application of current pulses through the Ru stripes in combination with magnetic fields. The modification of the magnetic domains is explained by the Oersted field generated by the electrical current flowing through the stripes underneath the magnetite nanostructures. The fabrication method is applicable to a wide variety of rock salt and spinel oxides

Política y libertad.

El debate sobre la libertad y la política es parte obligada del estudio del Centro de Pensamiento de la Universidad Sergio Arboleda. Según la concepción que al respecto se tenga se derivan diversas consecuencias en relación con el manejo y estructuración del Estado. La presente publicación contiene una serie de textos de diferentes personajes cuyo pensamiento aborda el marco político, social y económico sobre el cual deben articularse las libertades ciudadanas. Estimamos que la difusión de estas reflexiones contribuirá a la discusión, siempre fructífera, de las ideas y abrirá el camino para que otros autores planteen sus propios puntos de vista sobre estos temas

Nutrición enteral domiciliaria en España: registro Nadya del año 2011-2012

Objective: To describe the results of the home enteral nutrition (HEN) registry of the NADYA-SENPE group in 2011 and 2012. Material and methods: We retrieved the data of the patients recorded from January 1st 2011 to December 31st 2012. Results: There were 3021 patients in the registry during the period from 29 hospitals, which gives 65.39 per million inhabitants. 97.95% were adults, 51.4% male. Mean age was 67.64 ± 19.1, median age was 72 years for adults and 7 months for children. Median duration with HEN was 351 days and for 97.5% was their first event with HEN. Most patients had HEN because of neurological disease (57.8%). Access route was nasogastric tube for 43.5% and gastrostomy for 33.5%. Most patients had limited activity level and, concerning autonomy, 54.8% needed total help. Nutritional formula was supplied from chemist’s office to 73.8% of patients and disposables, when necessary, was supplied from hospitals to 53.8% of patients. HEN was finished for 1,031 patients (34.1%) during the period of study, 56.6% due to decease and 22.2% due to recovery of oral intake. Conclusions: Data from NADYA-SENPE registry must be explained cautiously because it is a non-compulsory registry. In spite of the change in the methodology of the registry in 2010, tendencies regarding HEN have been maintained, other than oral routeObjetivos: Describir los resultados del registro de nutrición enteral domiciliaria (NED) del grupo NADYASENPE de los años 2011 y 12. Material y métodos: Se recopilaron los datos introducidos en el registro desde el 1 de enero de 2011 al 31 de diciembre de 2012. Resultados: Hubo 3021 pacientes en el registro durante el periodo, procedentes de 29 hospitales, lo que da una prevalencia de 65,39 casos por millón de habitantes. 97.95% fueron adultos, 51,4% varones. La edad media fue 67,64 ± 19,1 años y la mediana 72 años para los adultos y 7 meses para los niños. La duración media de la NED fue 351 días y para el 97,5% fue el primer episodio con NED. La mayoría de pacientes tenían NED por una enfermedad neurológica (57,8%). La vía de acceso fue sonda nasogástrica para el 43,5% y gastrostomía para el 33,5%. La mayoría de pacientes tuvieron un nivel de actividad física limitado y, respecto a la autonomía, 54,8% necesitaba ayuda total. La fórmula de nutrición se suministró desde las oficinas de farmacia para el 73,8% y los fungibles, cuando fueron necesarios, desde los hospitales para el 53,8%. La NED se suspendió en 1.031 pacientes (34,1%) durante el periodo de estudio, 56,6% debido a fallecimiento y 22,2% debido a recuperación de la vía oral. Conclusiones: Los datos del registro NADYA-SENPE deben ser interpretados con precaución ya que se trata de un registro voluntario. A pesar del cambio de metodología del registro en 2010, las tendencias en NED se han mantenido, salvo la importancia cuantitativa de la vía ora

Riesgo quirúrgico tras resección pulmonar anatómica en cirugía torácica. Modelo predictivo a partir de una base de datos nacional multicéntrica

Introduction: the aim of this study was to develop a surgical risk prediction model in patients undergoing anatomic lung resections from the registry of the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). Methods: data were collected from 3,533 patients undergoing anatomic lung resection for any diagnosis between December 20, 2016 and March 20, 2018. We defined a combined outcome variable: death or Clavien Dindo grade IV complication at 90 days after surgery. Univariate and multivariate analyses were performed by logistic regression. Internal validation of the model was performed using resampling techniques. Results: the incidence of the outcome variable was 4.29% (95% CI 3.6-4.9). The variables remaining in the final logistic model were: age, sex, previous lung cancer resection, dyspnea (mMRC), right pneumonectomy, and ppo DLCO. The performance parameters of the model adjusted by resampling were: C-statistic 0.712 (95% CI 0.648-0.750), Brier score 0.042 and bootstrap shrinkage 0.854. Conclusions: the risk prediction model obtained from the GEVATS database is a simple, valid, and reliable model that is a useful tool for establishing the risk of a patient undergoing anatomic lung resection

SARS-CoV-2 Infection in Multiple Sclerosis

To understand COVID-19 characteristics in people with multiple sclerosis (MS) and identify high-risk individuals due to their immunocompromised state resulting from the use of disease-modifying treatments. Retrospective and multicenter registry in patients with MS with suspected or confirmed COVID-19 diagnosis and available disease course (mild = ambulatory; severe = hospitalization; and critical = intensive care unit/death). Cases were analyzed for associations between MS characteristics and COVID-19 course and for identifying risk factors for a fatal outcome. Of the 326 patients analyzed, 120 were cases confirmed by real-time PCR, 34 by a serologic test, and 205 were suspected. Sixty-nine patients (21.3%) developed severe infection, 10 (3%) critical, and 7 (2.1%) died. Ambulatory patients were higher in relapsing MS forms, treated with injectables and oral first-line agents, whereas more severe cases were observed in patients on pulsed immunosuppressors and critical cases among patients with no therapy. Severe and critical infections were more likely to affect older males with comorbidities, with progressive MS forms, a longer disease course, and higher disability. Fifteen of 33 patients treated with rituximab were hospitalized. Four deceased patients have progressive MS, 5 were not receiving MS therapy, and 2 were treated (natalizumab and rituximab). Multivariate analysis showed age (OR 1.09, 95% CI, 1.04-1.17) as the only independent risk factor for a fatal outcome. This study has not demonstrated the presumed critical role of MS therapy in the course of COVID-19 but evidenced that people with MS with advanced age and disease, in progressive course, and those who are more disabled have a higher probability of severe and even fatal diseas