Predicted change in the number of permanent medical teachers from 2017 to 2026. The training of future physicians in critical condition. / Evolución previsible en el número de profesores permanentes de Medicina del 2017 al 2026. La formación de los futuros médicos en situación crítica.

The significant and progressive reduction in the number of permanent teachers in medical schools (professor, associate professor and assistant professor) is a reason for concern for the National Conference of Deans. This reduction will intensify in the coming decade (2017-2026). Forty-three percent of the permanent faculty will retire, as will 55% of the faculty linked to clinical areas, 34% of the faculty not linked to clinical areas and 32% of the faculty of basic areas. This deficit is significant now, and, in a few years, the situation will be unsustainable, especially in the clinical areas. This report reveals the pressing need to adopt urgent measures to alleviate the present situation and prevent a greater problem. The training of future physicians, immediately responsible for the health of our society, depends largely on the theoretical and practical training taught in medical schools, with the essential collaboration of healthcare institutions. Paradoxically, while the number of teachers decreases substantially, there is an exponential increase in the number of medical schools and students who are admitted every year without academic or healthcare justification.

Acid-sensing ion channels (ASICs) in the taste buds of adult zebrafish.

In detecting chemical properties of food, different molecules and ion channels are involved including members of the acid-sensing ion channels (ASICs) family. Consistently ASICs are present in sensory cells of taste buds of mammals. In the present study the presence of ASICs (ASIC1, ASIC2, ASIC3 and ASIC4) was investigated in the taste buds of adult zebrafish (zASICs) using Western blot and immunohistochemistry. zASIC1 and zASIC3 were regularly absent from taste buds, whereas faint zASIC2 and robust zASIC4 immunoreactivities were detected in sensory cells. Moreover, zASIC2 also immunolabelled nerves supplying taste buds. The present results demonstrate for the first time the presence of zASICs in taste buds of teleosts, with different patterns to that occurring in mammals, probably due to the function of taste buds in aquatic environment and feeding. Nevertheless, the role of zASICs in taste remains to be demonstrated.

Light regulates the expression of the BDNF/TrkB system in the adult zebrafish retina.

The retina of the adult zebrafish express brain-derived neurotrophic factor (BDNF) and its signaling receptor TrkB. This functional system is involved in the biology of the vertebrate retina and its expression is regulated by light. This study was designed to investigate the effects of cyclic (12 h light/12 h darkness) or continuous (24 h) exposure during 10 days to white light, white-blue light, and blue light, as well as of darkness, on the expression of BDNF and TrkB in the retina. BDNF and TrkB were assessed in the retina of adult zebrafish using quantitative real-time polymerase chain reaction and immunohistochemistry. Exposure to white, white-blue, and blue light causes a decrease of BDNF mRNA and of BDNF immunostaining, independently of the pattern of light exposition. Conversely, in the same experimental conditions, the expression of TrkB mRNA was upregulated and TrkB immunostaining increased. Exposition to darkness diminished BDNF and TrkB mRNAs, and abolished the immunostaining for BDNF but not modified that for TrkB. These results demonstrate the regulation of BDNF and TrkB by light in the retina of adult zebrafish and might contribute to explain some aspects of the complex pathophysiology of light-induced retinopathies.

Immunohistochemical detection of the putative mechanoproteins ASIC2 and TRPV4 in avian herbst sensory corpuscles.

The avian Herbst corpuscles are the equivalent of the Pacinian corpuscles in mammals, and detect vibration and the movement of joints and feathers. Therefore, they can be regarded as rapidly adapting low-threshold mechanoreceptors. In recent years, it has been establish that some ion channels are involved in mechanosensation and are present in both mechanosensory neurons and mechanoreceptors. Here we have used immunohistochemistry to localize some putative mechanoproteins in the Herbst corpuscles from the rictus of Columba livia. The proteins investigated were the subunits of the epithelial Na(+) channel (ENaC), the transient-receptor potential vanilloid 4 (TRPV4), and the acid-sensing ion channel 2 (ASIC2). Immunoreactivity for ENaC subunits was never found in Herbst corpuscles, while the axon expressed ASIC2 and TRPV4 immunoreactivity. Moreover, TRPV4 was also detected in the cell forming the inner core. The present results demonstrate for the first time the occurrence of mechanoproteins in avian low-threshold mechanoreceptors and provide further evidence for a possible role of the ion channels in mechanosensation.

Immunohistochemical localization of acid-sensing ion channel 2 (ASIC2) in cutaneous Meissner and Pacinian corpuscles of Macaca fascicularis.

Acid-sensing ion channel 2 (ASIC2) is a member of the degenerin/epithelial sodium channel superfamily, presumably involved mechanosensation. Expression of ASIC2 has been detected in mechanosensory neurons as well as in both axons and Schwann-like cells of cutaneous mechanoreceptors. In these studies we analysed expression of ASIC2 in the cutaneous sensory corpuscles of Macaca fascicularis using immunohistochemistry and laser confocal-scanner microscopy. ASIC2 immunoreactivity was detected in both Meissner and Pacinian corpuscles. It was found to co-localize with neuron-specific enolase and RT-97, but not with S100 protein, demonstrating that ASIC2 expression is restricted to axons supplying mechanoreceptors. These results demonstrate for the first time the presence of the protein ASIC2 in cutaneous rapidly adapting low-threshold mechanoreceptors of monkey, suggesting a role of this ion channel in touch sense.

Treatment of transplant renal artery stenosis by percutaneous transluminal angioplasty and/or stenting: study in 63 patients in a single institution.

OBJECTIVE: Our aim was a retrospective evaluation of technical procedures, clinical success, and follow-up of renal transplant patients with stenosis in the transplant renal artery (TRAS) after endovascular treatment. METHODS: From January 1981 to September 2009, 2,150 allograft renal transplants included 62 patients who underwent endovascular procedures for TRAS >75%. Parameters included technical success, arterial blood pressure, antihypertensive drugs, and creatinine level before and after the intervention. RESULTS: Percutaneous transluminal angioplasty (PTA)/stent placement success was 90.3%. Seventy-nine PTAs with 11 stents were primary interventions with 6 PTAs and 4 stent procedures subsequently performed due to restenosis (mean time to event, 1.5 months). The median follow-up was 39 months (range, 1-236). The mean preprocedure creatinine level was 2.8 ± 1.7 mg/dL, and the 1-month postprocedure value was decreased to 2.1 ± 1.2 mg/dL (P < .001). Systolic arterial blood pressure fell from 147.2 ± 18.7 mm Hg to 131.6 ± 14.2 mm Hg (P < .001) and diastolic blood pressure from 84.4 ± 9.8 mm Hg to 76 ± 9.4 mm Hg (P < .001). Postprocedure number of antihypertensive drugs was reduced from 2.3 ± 1.1 to 1.6 ± 1 (P < .0001). The patency rates were: 95 ± 2.8% at 1 month, 87.9 ± 4.3% at 3 months, and 85 ± 4.7% at 12 months. Secondary patency was 100% with no restenosis on follow-up. Allograft survival after primary and secondary PTA/stenting was 97% at 1, 93% at 3.89% at 5, and 85% at 10 years. The complication included 2 renal artery thromboses, a dissection treated with stents, and a late arterial graft pseudoaneurysm. CONCLUSIONS: TRAS, a problem after kidney transplantation, is detected to be a significant stenosis through the use of Doppler ultrasound. Revascularization is recommended to improve hypertension and graft function. PTA should be primarily planned with stenting for patients with a restenosis or after a lack of response to PTA.

[Abdominal ultrasonography versus abdominal CT in the follow-up of testicular germ cell tumors]. / Comparación de la ecografía abdominal con la tomografía computarizada abdominal en el seguimiento del tumor de células germinales testicular.

INTRODUCTION: Testicular germ cell tumors are common in young men. There is a wide consensus regarding the key points in their diagnosis and treatment, although some elements, including the best approach to follow-up, are being reviewed and revised. We present a statistical study that uses tools for the evaluation of diagnostic tests to compare the usefulness of abdominal ultrasonography (US) in comparison with that of abdominal CT, taken as the gold standard, in the detection of liver metastases and retroperitoneal adenopathies in patients with testicular germ cell tumors. MATERIAL AND METHODS: We analyzed a total of 308 diagnostic tests (154 CT studies and 154 US studies) from 59 patients with at least one year's follow-up at our institution. Patients underwent abdominal US before abdominal CT following a standard protocol. RESULTS: Compared to the gold standard, abdominal US had 95% sensitivity, 92% specificity, 82% PPV, and 98% NPV. CONCLUSION: US is very sensitive and can be used in protocols for the follow-up of primary testicular tumors to rule out disease.

Study comparative of Ki-67 expression in oral lichen planus and oral leukoplakia. Quantitative analysis.

OBJECTIVE: The aim of the present study has been to determine the proliferative differences in oral lichen planus and leukoplakia by means the quantification of Ki- 67 expression. STUDY DESIGN: The tissue analyzed were the following ones: oral lichen planus (n=10), oral leukoplakia (n=10), dysplasia (n=10). Normal oral mucosa (n=10) was used as the control group. The antibody employed was monoclonal PP-67 (Sigma). Immunoperoxidase detection was employed using the streptavidin- biotin complex. The quantification was carried out by a program of image analysis system Qwin colour RGB. In all cases 10 fields differences were scored. For analytic study were used analysis of the variance and Scheffe's exact test were used. The statistical significance level was considered to be P < 0.05. RESULTS: In all tissues analyzed there was some grade of proliferation in the basal layer, and in dysplasias so much in basal as suprabasal layer. Of the analytic results we emphasize that there were differences statistically significant among mean of the positive nuclei per mm of length in normal mucosa and leukoplakia (p=0.031), and between normal mucosa, lichen planus and leukoplakia with dysplasias. In these three cases the values were p=0.000. CONCLUSION: Ki-67 antigen is a marker of nuclear proliferation that allows to settle down the differences proliferatives between lichen planus and oral leukoplakia. Therefore it should take in consideration to think in successive studies that guide therapeutic attitude in these lesions in function of its positivity.

[Adult congenital anomalies of the coronary arteries described over 31 years of angiographic studies in the Asturias Principality: main angiographic and clinical characteristics]. / Anomalías congénitas de las arterias coronarias del adulto descritas en 31 años de estudios coronariográficos en el Principado de Asturias: principales características angiográficas y clínicas.

OBJECTIVE: The aim of this study was to determine the incidence of adult congenital anomalies of the coronary arteries over 31 years of angiographic studies, describing their angiographic and clinical characteristics. The results have been compared with the main series published. METHODS: The diagnostic angiographic reports done in the Principado de Asturias from 1968 to 1999 are reviewed. In those in which a congenital anomaly was diagnosed, the clinical report and the angiography were studied. The initial course of the anomaly was defined following angiographic criteria. RESULTS: Thirteen thousand five hundred reports were reviewed describing 75 patients with 75 anomalies (0.5%) including: anomalous origin of the left circumflex coronary artery (n = 24), coronary artery fistulae (n = 21), both coronary arteries arising from the left coronary sinus (n = 15), single coronary arteries (n = 6), both coronary arteries arising from the right coronary sinus (n = 2), separated origin of anterior descending and left circumflex coronary arteries (n = 3), anterior descending artery arising from the right coronary sinus (n = 2), and others (n = 1). Angiographic studies were done because of: angina (59%), dysnea (25%), atypical chest pain (7%), syncope (3%), dizziness (3%) and palpitations (3%). The initial course was retroaortic in all the circumflex arteries, interarterial in the right coronaries, anterior in the anterior descending arteries and retroaortic, septal and combined, in the left coronaries. CONCLUSIONS: Adult congenital anomalies of the coronary arteries are not very common and are usually casual findings of diagnostic angiographic studies. Left circumflex coronary artery anomalies are the most frequently diagnosed.

[Familial study of patients with hereditary hemorrhagic telangiectasia]. / Estudio familiar de pacientes con telangiectasia hemorrágica hereditaria.

Rendu-Osler-Weber's disease or Hereditary Hemorrhagic Telangiectasia (HTT) is an autosomal dominant hereditary clinical entity characterized by the presence of telangiectasias on skin, mucous membranes and internal organs. The incidence of hepatic, pulmonary or cerebral complications justifies an early diagnostic. A familiar study of patients previously diagnosed of HTT in our hospital was made, establishing a protocol for the identification of asymptomatic or pauci-symptomatic cases. Fourteen patients were studied: 6 with a previous diagnostic, and 8 familiar contacts. Penetrance was of 85%. Epistaxis (80%) and telangiectasias on skin were the most frequent clinical findings. The visceral lesions found were gastrointestinal (28%), hepatic (15%), urological (15%) and pulmonary (7%). All patients were included in an hepatitis B virus vaccination program. It was also made a morphological study with Werhoeff's staining of the elastic layer, that allowed to distinguish both arterial and venous alterations.

[The nerve endings in contact with the parafollicular cells of the thyroid]. / Etude des terminaisons nerveuses au contact des cellules parafolliculaires de la thyroïde.

We studied nerve endings in the parafollicular cells of thyroid glands in necropsy examinations of 50 young males with no know thyroid disorder. The Jabonero and Maillet techniques. ultrastructural and morphology study were performed together with a statistical analysis of nerve endings. Optic microscope visualized preterminal and exceptionally terminal nerve endings located near parafollicular cells. Swellings of the axons without Schwann's cell sheath were identified close to the par follicular cells with electronic microscopy, these swellings had an ellipsoidal or spherical shape and laid close to the cellular membrane (30 nm). Three types of synaptic-like vesicles were found in these nerve endings. a) Abundant clear vesicles, generally spherical in shape (average diameter 50.40 +/- 5.91 nm); b) A few large granural vesicles with an electron-dense core (average diameter 105.49 +/- 9.98 nm); and c) Several small granular vesicles with an electron-dens core (average diameter 55.09 +/- 6.56 nm). Emphasis should be given to the finding of nerve endings (cholinergic-like, adrenergic-like and peptidergic-like nerve endings) in the parafollicular cells. We discuss their possible function.

Oxytocin-immunoreactive nerve cells in the supraoptic nucleus of the hypothalamus after treatment with histamine.

Immunohistochemical, morphometric and statistical methods were used to study oxytocin immunoreactive elements in the supraoptic nucleus (SON) of the hypothalamus of 180 male rats. Untreated rats, rats that were given either an intraperitoneal (ip) or intracerebroventricular (icv) injection of histamine (HA) (n = 40 each group) and control animals that received ip or icv injections of saline were included in our study. Oxytocin immunoreactive neurons and oxytocin-labelled nerve tracts were found in the SON of untreated animals. Treatment with saline either intracerebroventricular or intraperitoneally did not modify the oxytocin immunoreaction described for untreated animals. I.c.v. treatment with HA increased the numbers of oxytocin labelled elements. On the contrary, oxytocin immunoreaction after intraperitoneal treatment with HA was similar to that described for control and untreated animals. The morphometric and statistical studies confirmed these findings. The importance and signification of these results are discussed in this paper.

Influence of luteinizing hormone-releasing hormone (LHRH) treatment on cellular proliferation in the rat anterior pituitary.

This study was designed to gain insight into the action of LHRH on the control of cellular proliferation in the anterior pituitary. The fraction of cells labelled with bromodeoxyuridine (S-phase cells) was studied in cytospin preparations of anterior pituitary cells taken from control male and female rats and from rats treated with daily doses of 2 micrograms/100 g body weight of LHRH (7 days), with doses of 40 micrograms of LHRH given on alternate days for 14 days (7 doses) or, finally, treated with daily doses of 50 ng of busereline acetate (14 days). Treatment with LHRH for 14 days resulted in a significant increase in the fraction of S-phase cells. However, neither the blockade of gonadotrophin secretion with busereline acetate nor its stimulation with LHRH for seven days resulted in a significant change in the proliferative activity of anterior pituitary cells. This action was independent of sex. No significant changes were seen in the proportions of pituitary gonadotrops of the different study groups. Regardless of the treatment-group very few cells doubly-immunostained for BrdU and LH were found. It is concluded that LHRH may stimulate cellular proliferation in the anterior pituitary, but further studies are needed to define which cells are involved in this action.

The vasopressin positive elements in the hypothalamic magnocellular nuclei of rats treated with histamine.

The vasopressin (AVP) positive elements of the hypothalamic supraoptic (SON) and paraventricular (PVN) nuclei, were investigated in 180 male rats through immunohistochemical, morphometric and statistical methods. The rats were subdivided in the next groups: 20 control rats; 40 rats treated with physiological saline intraperitoneal via (ip); 40 rats treated with physiological saline intracerebroventricular via (icv); 40 histamine (HA) treated rats, ip; and 40 HA treated rats, icv. The labeled nerve cells appear in the lateral part of the PNV and the SON of the control animals. These neurons have central nucleus and vasopressin positive cytoplasmic granulations. After the treatment with physiological saline, ip or icv, no alterations were observed. In HA treated rats, icv, numerous neurons strongly labeled were observed in these hypothalamic nuclei. Vasopressin positive nerve fibers and large droplets were also found both in the SON and in the PVN of these animals. The vasopressin positive material in the control rats and in HA treated rats, ip, is similar. The morphometric and statistical studies confirm these findings. The results are discussed in this paper.

The oxytocin positive elements in the hypothalamic magnocellular nuclei of rats treated with histamine.

The oxytocin positive elements of the hypothalamic supraoptic (SON) and paraventricular (PVN) nuclei, were instigated in 160 male rats through immunohistochemical, morphometric and statistical methods. The rats subdivided into five groups: 20 control rats; 20 rats treated with physiological saline intraperitoneal via (ip); 20 rats treated with physiological saline intracerebroventricular via (icv); 20 histamine (HA) treated rats, ip; and 20 HA treated rats, icv. Some labeled nerve cells appear, mainly, in the lateral part of the SON and the PVN of the control animals. These neurons have central nucleus and oxytocin positive cytoplasmic granulations. After the treatment with physiological saline, ip or icv, no alterations were observed. In HA treated rats, icv, numerous neurons and pathways were observed strongly labeled. Large droplets appear in the SON and in the PVN of these animals. In HA treated rats, ip, the oxytocin positive material is similar to that observed in the control rats. The morphometric and statistical studies confirm these findings. The results are discussed in this paper.

[Demonstration of sensor nervous endings in the rat thyroid gland]. / Mise en évidence de terminaisons nerveuses sensorielles dans la thyroïde du rat.

The nerve sensitive endings or receptors of the thyroid gland have been studied in twenty adult male rats. Their morphology, their acetyl-cholinesterase specific activity, their mono-amino-oxidase activity and VIP were investigated. Few but constant nerve sensitive endings were observed in the thyroid gland. These receptors were subdivided by their morphology in the next groups: pear-shaped receptors with capsule; capsuled spherical receptors located near vascular walls; ovoidal receptors with capsule and glomerular structure; simple or complex mace-shaped receptors without capsule. The acetyl-cholinesterase technique could just show a unique type or receptor, which corresponds with last one described. The mono-amino-oxidase technique can not show any type of receptors. VIP was not localized immunohistochemically in the sensitive endings of the thyroid gland.

Acetyl-cholinesterase and mono-amine-oxidase activities in the microganglia of the thyroid gland in the rat.

The nervous microganglia of the thyroid gland have been studied in forty adult male rats, their morphology being analyzed by the osmium-zinc iodide technique their acetyl-cholinesterase activity (AChE) by an histochemical specific technique and their mono-amine-oxidase activity (MAO) by a tetrazolium technique. Few but constant microganglia were observed in the thyroid glands. These microganglia are formed by some 4 to 8 nerve cells. Intense mono-amine-oxidase activity (MAO) was found in the nerve cells of these microganglia, being absent in the rest of the thyroid gland. Intense specific acetyl-cholinesterase (AChE) was observed in the nerve cells scattered along nerve branches located in the connective tissue (single nerve cells or small cellular groups). AChE activity was not observed in the microganglia of the thyroid gland.