Xenopus tropicalis osteoblast-specific open chromatin regions reveal promoters and enhancers involved in human skeletal phenotypes and shed light on early vertebrate evolution.

While understanding the genetic underpinnings of osteogenesis has far-reaching implications for skeletal diseases and evolution, a comprehensive characterization of the osteoblastic regulatory landscape in non-mammalian vertebrates is still lacking. Here, we compared the ATAC-Seq profile of Xenopus tropicalis (Xt) osteoblasts to a variety of non mineralizing control tissues, and identified osteoblast-specific nucleosome free regions (NFRs) at 527 promoters and 6747 distal regions. Sequence analyses, Gene Ontology, RNA-Seq and ChIP-Seq against four key histone marks confirmed that the distal regions correspond to bona fide osteogenic transcriptional enhancers exhibiting a shared regulatory logic with mammals. We report 425 regulatory regions conserved with human and globally associated to skeletogenic genes. Of these, 35 regions have been shown to impact human skeletal phenotypes by GWAS, including one trps1 enhancer and the runx2 promoter, two genes which are respectively involved in trichorhinophalangeal syndrome type I and cleidocranial dysplasia. Intriguingly, 60 osteoblastic NFRs also align to the genome of the elephant shark, a species lacking osteoblasts and bone tissue. To tackle this paradox, we chose to focus on dlx5 because its conserved promoter, known to integrate regulatory inputs during mammalian osteogenesis, harbours an osteoblast-specific NFR in both frog and human. Hence, we show that dlx5 is expressed in Xt and elephant shark odontoblasts, supporting a common cellular and genetic origin of bone and dentine. Taken together, our work (i) unravels the Xt osteogenic regulatory landscape, (ii) illustrates how cross-species comparisons harvest data relevant to human biology and (iii) reveals that a set of genes including bnc2, dlx5, ebf3, mir199a, nfia, runx2 and zfhx4 drove the development of a primitive form of mineralized skeletal tissue deep in the vertebrate lineage.

Neostigmine for acute colonic pseudo-obstruction: A meta-analysis.

INTRODUCTION: Acute colonic pseudo-obstruction (ACPO) is an uncommon condition that occasionally develops in hospitalized patients with serious underlying ailments. Its early recognition is essential to reduce life-threatening complications. Few low-powered randomized clinical trials (RCTs) have confirmed the effectiveness of neostigmine for treatment. AIM: To analyse the effectiveness and main side effects of neostigmine in the treatment of ACPO. EXPERIMENTAL: A literature search was performed for all published RCTs, reporting on neostigmine as treatment for ACPO. RESULTS: Four studies fulfilled the inclusion criteria, evaluating 127 patients: treatment group = 65, control group = 62. Neostigmine effectiveness to resolve ACPO with only one dose was 89.2% versus 14.65% (P < 0.001, NNT = 1 [95% CI 1-2]). CONCLUSIONS: Neostigmine is a safe and effective option for patients with ACPO who failed to respond to conservative management.

Pan-American League of Associations for Rheumatology (PANLAR) recommendations and guidelines for musculoskeletal ultrasound training in the Americas for rheumatologists.

OBJECTIVE: To develop guidelines for Musculoskeletal Ultrasound (MSKUS) training for rheumatologists in the Americas. METHODS: A total of 25 Rheumatologists from 19 countries of the American Continent participated in a consensus-based interactive process (Delphi method) using 2 consecutive electronic questionnaires. The first questionnaire included the following: the relevance of organizing courses to teach MSKUS to Rheumatologists, the determination of the most effective educational course models, the trainee levels, the educational objectives, the requirements for passing the course(s), the course venues, the number of course participants per instructor, and the percentage of time spent in hands-on sessions. The second questionnaire consisted of questions that did not achieve consensus (>65%) in the first questionnaire, topics, and pathologies to be covered at each course MSKUS level. RESULTS: General consensus was obtained for MSKUS courses to be divided into 3 educational levels: basic, intermediate, and advanced. These courses should be taught using a theoretical-didactic and hands-on model. In addition, the group established the minimum requirements for attending and passing each MSKUS course level, the ideal number of course participants per instructor (4 participants/instructor), and the specific topics and musculoskeletal pathologies to be covered. In the same manner, the group concluded that 60% to 70% of course time should be focused on hands-on sessions. CONCLUSION: A multinational group of MSKUS sonographers using a consensus-based questionnaire (Delphi method) established the first recommendations and guidelines for MSKUS course training in the Americas. Pan-American League of Associations for Rheumatology urges that these guidelines and recommendations be adopted in the future by both national and regional institutions in the American continent involved in the training of Rheumatologists for the performance of MSKUS.

¿Conocemos el bienestar psicológico de nuestro personal sanitario? / Do we know the psychological well-being of our health personnel?

Introducción: En los últimos años se ha producido un aumento de la enfermedad psíquica con graves repercusiones en el mundo laboral (aumento de los accidentes y del absentismo por enfermedad común, descensos en la productividad, mala calidad de los servicios) y en la calidad de vida de los trabajadores (problemas físicos, psíquicos, bajo nivel de satisfacción, etc.). El personal sanitario es uno de los más afectados. Hay numerosos estudios sobre síndrome de burnout, estresores en personal sanitario, mobbing, etc., pero no hay datos sobre la percepción que tiene el personal sanitario en su bienestar psicológico. Con el propósito de confirmar la hipótesis sobre la existencia de probables alteraciones psiquiátricas menores en personal sanitario, nos planteamos este trabajo de investigación. Objetivo: Identificar los posibles casos de alteraciones psiquiátricas menores en el personal sanitario. Analizar los factores sociodemográficos y laborales de riesgo en los casos de probables alteraciones psíquicas. Describir la disposición de los síntomas (somáticos, ansiedad e insomnio, depresión y disfunción social), en los casos de alteraciones psíquicas. Material y método: Estudio descriptivo transversal, realizado en una muestra de personal sanitario del Área 10 de Madrid. La recogida de información se realizó mediante cuestionarios autoadministrados. Para medir la variable respuesta (bienestar psicológico) se utilizó el cuestionario de Salud General de Goldberg en la versión de 28 ítems (GHQ-28). Resultado: La prevalencia de malestar psíquico para el total de la muestra es del 18,2%, con diferencias significativas que superan el punto de corte en las variables: lugar de trabajo (hospital), sexo (mujeres), edad (entre 36 y 50 años), categoría profesional (auxiliar de enfermería), contrato (fijo), turno (rotatorio) y llevar trabajando (entre 11 y 15 años). Conclusiones: Es necesario incluir cuestionarios psicosociales en la vigilancia de la salud, que puedan objetivar enfermedades no recogidas de otra forma y permitan tener un indicador de salud mental para elaborar medidas preventivas adecuadas. Una mayor atención a los procesos organizativos y una cultura de "cuidar al cuidador" puede contribuir a disminuir el problema creciente de distrés psicológico en el personal sanitario

Introduction: In the last few years, psychological distress among the population has increased with serious repercussions for employers (an increase in accidents and absenteeism due to common illnesses, lower productivity, poor quality of services) and for workers' quality of life (physical and psychological problems, low levels of satisfaction, etc.). Health workers are among the collectives most affected by this increase. Numerous studies have been published on burnout syndrome, stressors among health workers, and mobbing, among other phenomena, but data on health workers' perception of their psychological well-being are lacking. Objective: To identify possible cases of minor psychiatric disturbances among health workers. To analyze the sociodemographic and occupational risk factors in workers with psychiatric disturbances. To describe the type of symptoms (somatic, anxiety and insomnia, depression and social dysfunction) in workers with psychiatric alterations. Material and method: We performed a cross-sectional descriptive study in a sample of the health workers in Area 10 of Madrid. Information was gathered through self-administered questionnaires. To measure the response variable (psychological well-being), the 28-item Goldberg General Health Questionnaire was used (GHQ-28). Result: The prevalence of psychological distress for the sample as a whole was 18.2%. Significant differences and scores exceeding the cut-off point indicating vulnerability to psychiatric disturbances were found for the following variables: place of work (hospital), gender (women), age (between 36 and 50 years), professional status (nurse's aide), contract (permanent), shift (rotating), and years of service (between 11 and 15 years). Conclusions: Psychosocial questionnaires should be included in health surveillance. These questionnaires could identify alterations undetected by other measures and would allow appropriate preventive measures to be designed. Greater attention to organizational factors and a culture of "caring for the carer" could help to reduce the growing problem of psychological distress among health workers