The real relationship between patient and therapist: an updated literature review.

openLa conoscenza dei singoli processi che si vanno a creare in un qualsiasi rapporto psicoterapeutico tra paziente e clinico è fondamentale, poiché permette di rendere maggiormente funzionale ed efficace la terapia stessa, così che possa portare a maggiori benefici per il paziente. Questo studio ha la finalità di applicare una revisione della letteratura su uno specifico processo della psicoterapia, cioè la relazione reale. Con questo termine si intende il rapporto che si va a creare tra paziente e terapeuta, non in quanto protagonisti della terapia, ma in quanto esseri umani che entrano in contatto tra loro. Lo scopo principale di questo studio è quello di andare a identificare le caratteristiche specifiche della relazione reale, come essa vada ad influenzare l’outcome della terapia e quali dinamiche interpersonali tra i membri della diade terapeutica, possono modificarla. Dall’analisi dei vari articoli in letteratura è emerso che più la relazione reale è forte, più ci sarà un outcome positivo. La relazione reale che si va ad istaurare dipende dai singoli individui della diade terapeutica; più i due si mostrano per come sono realmente e più comprendono l’altro per come è, più la relazione reale sarà forte. Nonostante le varie conoscenze, che vengono esaminate in maniera approfondita, il tema della relazione reale è ancora ben poco indagato, quindi è bene che in futuro si vadano a ricercare maggiormente le specifiche variabili che possano influenzare il rapporto tra paziente e terapeuta

Human mesenchymal stem cells from chorionic villi and amniotic fluid are not susceptible to transformation after extensive in vitro expansion.

Mesenchymal stem cells (MSCs) are promising candidates for cell therapy and tissue engineering. Increasing evidence suggests that MSCs isolated from fetal tissues are more plastic and grow faster than adult MSCs. In this study, we characterized human mesenchymal progenitor cells from chorionic villi (CV) and amniotic fluid (AF) isolated during the first and second trimesters, respectively, and compared them with adult bone marrow-derived MSCs (BM). We evaluated 10 CV, 10 AF, and 6 BM samples expanded until the MSCs reached senescence. We used discarded cells from prenatal analyses for all the experiments. To evaluate the replicative stability of these cells, we studied the telomerase activity, hTERT gene transcription, and telomere length in these cells. Spontaneous chromosomal alterations were excluded by cytogenetic analysis. We studied the expression of c-myc and p53, tumor-associated genes, at different passage in culture and the capacity of these cells to grow in an anchorage-independent manner by using soft agar assay. We isolated homogeneous populations of spindle-shaped CV, AF, and BM cells expressing mesenchymal immunophenotypic markers throughout the period of expansion. CV cells achieved 14 ± 0.9 logs of expansion in 118 days and AF cells achieved 21 ± 0.9 logs in 118 days, while BM cells achieved 11 × 0.4 logs in 84 days. Despite their high proliferation capacity, fetal MSCs showed no telomerase activity, no hTERT and c-myc transcriptions, and maintained long, stable telomeres. A constant expression level of p53 and a normal karyotype were preserved throughout long-term expansion, suggesting the safety of fetal MSCs. In conclusion, our results indicate that fetal MSCs could be an alternative, more accessible resource for cell therapy and regenerative medicine

Molecular and functional characterization of human bone marrow adipocytes

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The skeletal effect of post-natal treatment with N-acetylcysteine in a diastrophic dysplasia mouse model

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Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Caratterizzazione fenotipica, molecolare e proprietà immunoregolatorie delle cellule staminali mesenchimali

Le cellule staminali mesenchimali (Mesenchymal Stem Cells, MSCs) sono una popolazione con elevata capacità proliferativa e con potenziale di differenziazione multilineare; rappresentano, quindi, delle buone candidate per la terapia cellulare e la medicina rigenerativa. In questo studio sono state valutate MSCs fetali isolate da villi coriali (Chorionic Villi, CV) e da liquido amniotico (Amniotic Fluid, AF), confrontandole con le MSCs ottenute da midollo osseo (Bone Marrow, BM), per la capacità di crescita in presenza di siero umano allogenico (human serum, HS) o di lisato piastrinico (platelet lysate, PL), per le caratteristiche immunofenotipiche, il profilo di espressione citochinico e l’attività immunoregolatoria su linfociti allogenici stimolati e sottopopolazioni immunoselezionate. Data l’elevata potenzialità di espansione delle MSCs fetali, le cellule studiate sono state valutate per la loro stabilità replicativa tramite lo studio della lunghezza dei telomeri, l’attività dell’enzima telomerasi, l’espressione dei geni hTERT, c-myc e p53 e l’analisi del cariotipo. Una popolazione omogenea di cellule fibroblastoidi positiva ai tipici marcatori di superficie mesenchimali è stata isolata da tutti i campioni di CV ed AF analizzati. Le cellule di CV espandono rapidamente in HS (20 raddoppiamenti di popolazione, PDs, in 59 giorni e 6 passaggi di coltura), mentre in siero animale (fetal bovine serum, FBS) raggiungono 27 PDs in 65 giorni e 7 passaggi. Il PL determina un’espansione nel 60% dei campioni CV, comunque minore rispetto a quella in HS. I campioni di AF espandono, invece, 40 PDs in 90 giorni, ma solo nel 20% dei campioni analizzati, non proliferano in PL, mentre in FBS espandono 28.5 PDs in 66 giorni. Le cellule fetali studiate inibiscono la proliferazione di linfociti allogenici stimolati e regolano la crescita anche di popolazioni linfocitarie selezionate CD4+ e CD8+. Nonostante il loro elevato potenziale di espansione, le MSCs fetali studiate hanno mostrato una lunghezza stabile dei telomeri durante la cultura a lungo termine, assenza dell’attività telomerasica, nessuna espressione di hTERT, livelli costanti di espressione di c-myc e p53 e nessuna anomalia cromosomica. In conclusione, i risultati mostrano che i CV rappresentano un’ottima fonte di MSCs con proprietà immunoregolatorie, capace di espandere in un sistema di proliferazione umanizzato a lungo termine senza alterazioni genetiche. In più del 90% dei campioni di CV analizzati si ottiene un’espansione su larga scala in presenza di siero umano, incoraggiante per potenziali applicazioni cliniche

Key‐genes regulating the liposecretion process of mature adipocytes

Abstract White mature adipocytes (MAs) are plastic cells able to reversibly transdifferentiate toward fibroblast‐like cells maintaining stem cell gene signatures. The main morphologic aspect of this transdifferentiation process, called liposecretion, is the secretion of large lipid droplets and the development of organelles necessary for exocrine secretion. There is a considerable interest in the adipocyte plastic properties involving liposecretion process, but the molecular details are incompletely explored. This review analyzes the gene expression of MAs isolated from human subcutaneous fat tissue with respect to bone marrow (BM)‐derived mesenchymal stem cells (MSC) focusing on gene regulatory pathways involved into cellular morphology changes, cellular proliferation and transports of molecules through the membrane, suggesting potential ways to guide liposecretion. In particular, Wnt, MAPK/ERK, and AKT pathways were accurately described, studying up‐ and down‐stream molecules involved. Moreover, adipogenic extra‐ and intra‐cellular interactions were analyzed studying the role of CDH2, CDH11, ITGA5, E‐Syt1, PAI‐1, IGF1, and INHBB genes. Additionally, PLIN1 and PLIN2 could be key‐genes of liposecretion process regulating molecules transport through the membrane. All together data demonstrated that liposecretion is regulated through a complex molecular networks that are able to respond to microenvironment signals, cytokines, and growth factors. Autocrine as well as external signaling molecules might activate liposecretion affecting adipocytes physiology

Human white adipocytes convert into rainbow adipocytes in vitro

White adipocytes are plastic cells able to reversibly transdifferentiate into brown adipocytes and into epithelial glandular cells under physiologic stimuli in vivo. These plastic properties could be used in future for regenerative medicine, but are incompletely explored in their details. Here, we focused on plastic properties of human mature adipocytes (MA) combining gene expression profile through microarray analysis with morphologic data obtained by electron and time lapse microscopy. Primary MA showed the classic morphology and gene expression profile of functional mature adipocytes. Notably, despite their committed status, MA expressed high levels of reprogramming genes. MA from ceiling cultures underwent transdifferentiation towards fibroblast-like cells with a well-differentiated morphology and maintaining stem cell gene signatures. The main morphologic aspect of the transdifferentiation process was the secretion of large lipid droplets and the development of organelles necessary for exocrine secretion further supported the liposecretion process. Of note, electron microscope findings suggesting liposecretion phenomena were found also in explants of human fat and rarely in vivo in fat biopsies from obese patients. In conclusion, both MA and post-liposecretion adipocytes show a well-differentiated phenotype with stem cell properties in line with the extraordinary plasticity of adipocytes in vivo