Efectos de la intervención desde terapia ocupacional sobre la percepción del dolor crónico y la calidad de vida en pacientes con artritis reumatoide / Effects of an occupational therapy intervention in chronic pain perception and quality of life of patients with rheumatoid arthritis

Objetivos: determinar si una propuesta de intervención experimental desarrollada desde el campo de trabajo de la terapia ocupacional, dirigida a la reestructuración del desempeño ocupacional en pacientes con artritis reumatoide, reduce los niveles de dolor percibidos y mejora la autoeficacia y la calidad de vida de los mismos. Esta intervención se llevó a cabo de forma grupal, utilizando modelos de formación y enseñanza de estrategias a los pacientes. Material y método: estudio de intervención controlado aleatorizado de un programa grupal de terapia ocupacional de siete sesiones, de dos horas cada una, realizadas en cinco semanas. Resultados: se detectó una mejora en las puntuaciones de autoeficacia (p < 0,001) y de calidad de vida (p = 0,001; p = 0,08), así como de las puntuaciones de intensidad de dolor medidas con MPQ (McGill Pain Questionnaire), aunque los valores recogidos con EVA (escala visual analógica) se mantienen en el tiempo. Conclusiones: el programa resultó eficaz en la modificación de las variables estudiadas, apreciándose cambios significativos tanto en intensidad de dolor, como en los valores referidos a autoeficacia y calidad de vida. Es recomendable repetir el trabajo con una muestra mayor que permita obtener datos más consistentes (AU)

Objectives: To determine if an occupational therapy based intervention focused on performance reorganization on patients with rheumatoid arthritis reduces pain and improves self-efficacy and quality of life. Material and methods: Randomized controlled intervention study through a group program of seven occupational therapy sessions, conducted in five weeks. Results: We found an improvement in self-efficacy (p<0,001) and quality of life scores (p = 0,001, p = 0,08), as well as pain intensity MPQ (McGill Pain Questionnaire) measures, although the values collected with VAS (visual analogue scale) maintained over time. Conclusions: The program was effective in changing the studied variables, although a new study with a larger sample is required (AU)

Expression of the familial cardiac valvular dystrophy gene, filamin-A, during heart morphogenesis.

Myxoid degeneration of the cardiac valves is a common feature in a heterogeneous group of disorders that includes Marfan syndrome and isolated valvular diseases. Mitral valve prolapse is the most common outcome of these and remains one of the most common indications for valvular surgery. While the etiology of the disease is unknown, recent genetic studies have demonstrated that an X-linked form of familial cardiac valvular dystrophy can be attributed to mutations in the Filamin-A gene. Since these inheritable mutations are present from conception, we hypothesize that filamin-A mutations present at the time of valve morphogenesis lead to dysfunction that progresses postnatally to clinically relevant disease. Therefore, by carefully evaluating genetic factors (such as filamin-A) that play a substantial role in MVP, we can elucidate relevant developmental pathways that contribute to its pathogenesis. In order to understand how developmental expression of a mutant protein can lead to valve disease, the spatio-temporal distribution of filamin-A during cardiac morphogenesis must first be characterized. Although previously thought of as a ubiquitously expressed gene, we demonstrate that filamin-A is robustly expressed in non-myocyte cells throughout cardiac morphogenesis including epicardial and endocardial cells, and mesenchymal cells derived by EMT from these two epithelia, as well as mesenchyme of neural crest origin. In postnatal hearts, expression of filamin-A is significantly decreased in the atrioventricular and outflow tract valve leaflets and their suspensory apparatus. Characterization of the temporal and spatial expression pattern of filamin-A during cardiac morphogenesis is a crucial first step in our understanding of how mutations in filamin-A result in clinically relevant valve disease.

Bidirectional fusion of the heart-forming fields in the developing chick embryo.

It is generally thought that the early pre-tubular chick heart is formed by fusion of the anterior or cephalic limits of the paired cardiogenic fields. However, this study shows that the heart fields initially fuse at their midpoint to form a transitory "butterfly"-shaped, cardiogenic structure. Fusion then progresses bi-directionally along the longitudinal axis in both cranial and caudal directions. Using in vivo labeling, we demonstrate that cells along the ventral fusion line are highly motile, crossing future primitive segments. We found that mesoderm cells migrated cephalically from the unfused tips of the anterior/cephalic wings into the head mesenchyme in the region that has been called the secondary heart field. Perturbing the anterior/cranial fusion results in formation of a bi-conal heart. A theoretical role of the ventral fusion line acting as a "heart organizer" and its role in cardia bifida is discussed.

Perfil académico del estudiante de fisioterapia / Academic profile of physiotherapist student

El presente trabajo pretende analizar el perfil del estudiante de fisioterapia, concretamente en lo que se refiere a diversas áreas: interés y motivación por los estudios, percepción del futuro laboral, influencia familiar en el estudio, relación con la familia, hábitos de estudio y asistencia a clase, percepción de los compañeros y el profesor, percepción de autoeficacia, conocimientos complementarios (idiomas/informática), y ansiedad, estrés y consecuencias asociadas. Los resultados ponen de manifiesto unas características muy positivas en estos estudiantes en lo que se refiere a motivación por los estudios, apoyo familiar y hábitos de estudio. Sin embargo también se observa una baja percepción de autoeficacia y un alto nivel de estrés en estos estudiantes (AU)

Efectos de un programa de habilidades de comunicación en estudiantes de enfermería. Propuesta de un instrumento de evaluación (ISEC) / Effects of a comunication skills training program on a sample of nursing students. A proposal of assessment instrument (ISEC)

Dada la importancia que las habilidades de comunicación han demostrado tener en diferentes profesiones, especialmente en las sanitarias, el presente trabajo tiene por objetivo analizar los efectos de un programa de formación en este tipo de habilidades sobre una muestra de estudiantes de enfermería. El programa pretendía el entrenamiento práctico de las habilidades de comunicación en diferentes situaciones habituales de su práctica profesional, utilizando para ello el ensayo de conducta, el modelado, el empleo de instrucciones, la retroalimentación, el refuerzo, la resolución de problemas y la asignación de tareas para casa. La comparación de resultados pre-post pone de manifiesto que el programa resulta eficaz en la mejora de variables de naturaleza cognitivo-emocional que se encuentran en la base de la competencia interpersonal, tales como la capacidad de planificación, las expectativas de resultado, la autoeficacia percibida o la metapercepción positiva, así como en la disminución de variables tales como la anticipación de efectos negativos en el interlocutor o la disminución en la ansiedad asociada a la situación (AU)

Communication skills are a key ingredient of success in many jobs, especially in health-related ones. A sample of nursing students was exposed to a training program in communication skills. The goal of this study was to analyse whether the program was able to improve communication skills in this sample. This training program was based on common everyday situations in nursing practice. With this purpose, behaviour rehearsal, modelling, instructions, feedback, reinforcement, problem solving and assignments were used. Comparing pre- and post-test results, it is concluded that the program was effective in improving cognitive-emotional variables that are critical for interpersonal competence, such as planning capacity, results expectations, perceived self-efficacy, positive meta-perception, and a decrease of both anticipation of negative effects and anxiety linked to the situation (AU)

Living morphogenesis of the ventricles and congenital pathology of their component parts.

Living morphogenetic studies show that each definitive ventricle is constructed from different primitive cardiac segments, and each has its specific anatomical features. These ventricular segments are the atrioventricular junction; the primitive inlet segment, part of the primary heart tube, which initially provides the inlets of each ventricle; the primitive outlet segment, which gives rise to both ventricular outlets; and the apical trabeculated regions of the right and left ventricles which grow from the primary heart tube, respectively. In this review, we describe regional pathology based on the relationship of these primitive ventricular components. We propose that the abnormal morphogenesis of one of these segments gives origin to regional ventricular pathology. For example, abnormal embryogenesis of the atrioventricular canal produces malformations of the atrioventricular junctions, such as double inlet ventricle, absence of one atrioventricular connection, and straddling and overriding atrioventricular valves. Similarly, abnormal morphogenesis of the primitive outlet segment gives rise to malformations of the subarterial region of each ventricle, along with the valves guarding these vessels. The principal anatomical features of these malformations of the ventricular inlets and outlets are described, and their possible morphogenesis is discussed. Due to the fact that the apical trabeculated region of each ventricle arises from a separate primitive segment, each ventricle can be identified according to the pattern of its apical trabeculations. This feature is crucial in the elucidation of complex congenital pathology, such as discordant atrioventricular connections.

The outflow tract of the heart is recruited from a novel heart-forming field.

As classically described, the precardiac mesoderm of the paired heart-forming fields migrate and fuse anteriomedially in the ventral midline to form the first segment of the straight heart tube. This segment ultimately forms the right trabeculated ventricle. Additional segments are added to the caudal end of the first in a sequential fashion from the posteriolateral heart-forming field mesoderm. In this study we report that the final major heart segment, which forms the cardiac outflow tract, does not follow this pattern of embryonic development. The cardiac outlet, consisting of the conus and truncus, does not derive from the paired heart-forming fields, but originates separately from a previously unrecognized source of mesoderm located anterior to the initial primitive heart tube segment. Fate-mapping results show that cells labeled in the mesoderm surrounding the aortic sac and anterior to the primitive right ventricle are incorporated into both the conus and the truncus. Conversely, if cells are labeled in the existing right ventricle no incorporation into the cardiac outlet is observed. Tissue explants microdissected from this anterior mesoderm region are capable of forming beating cardiac muscle in vitro when cocultured with explants of the primitive right ventricle. These findings establish the presence of another heart-forming field. This anterior heart-forming field (AHF) consists of mesoderm surrounding the aortic sac immediately anterior to the existing heart tube. This new concept of the heart outlet's embryonic origin provides a new basis for explaining a variety of gene-expression patterns and cardiac defects described in both transgenic animals and human congenital heart disease.

Identification of an autocrine signaling pathway that amplifies induction of endocardial cushion tissue in the avian heart.

Endocardial cushion tissue is formed by an epithelial-mesenchymal transformation of endocardial cells, a process which results from an inductive interaction between the myocardium and endocardium within the atrioventricular (AV) and outflow tract (OT) regions of the heart. We report here that a protein previously found to be required for myocardially induced transformation of endocardial cells in vitro, ES/130, is highly expressed within the AV and OT regions not only by myocardial cells, but also by the endocardium and its mesenchymal progeny. Given these findings and others, we have tested the hypothesis that endocardial cushion tissue secretes factors which autoregulate its transformation to mesenchyme. Endocardial cushion tissue was cultured and its conditioned growth medium was harvested and applied to nontransformed endocardial cells maintained in the absence of the inductive myocardium. This treatment resulted in endocardial cell invasion into three-dimensional collagen gels plus increased expression of proteins associated with endocardial cell transformation in vivo. Whereas endocardial cushion tissue was found to express ES/130 protein in vivo and in vitro, minimal detection of ES/130 in its conditioned growth medium was observed in immunoblots. Attempts to inhibit the mesenchyme-promoting activity of the conditioned medium with ES/130 antisense were unsuccessful. However, strong intracellular ES/130 expression was detected in endocardial cells, and this expression correlated with the ability of endocardial cells to transform. For example, the minority of endocardial cultures that failed to transform in response to conditioned medium treatment also failed to undergo increased expression of ES/130. These observations are interpreted to suggest that (i) endocardial cushion tissue secretes factors that promote its transformation to mesenchyme, and (ii) while endocardial cushion tissue appears to signal through secretion of factors other than or in addition to ES/130, intracellular ES/130 expression nevertheless may be a target endocardial cell response required for endocardial cell transformation.

Temporal and spatial asymmetries in the initial distribution of mesenchyme cells in the atrioventricular canal cushions of the developing chick heart.

BACKGROUND: We investigated potential early asymmetries in the distribution of mesenchymal cells within the inferior and superior AV cushions in the developing chick heart. METHODS: Chick embryos stages 16-20 HH were fixed, embedded in polyacrylamide, and the cell nuclei stained with propidium iodide. Cells counts were determined within the cardiac jelly of the atrioventricular canal (AV) by laser confocal microscopy in coronal planes spanning its entire length. RESULTS: Our data show at the different stages studied, 16-20 HH, that the inferior AV cushion invariably contains more cells than the superior AV cushion. In the inferior cushion, the cell distribution is bimodal, i.e., the proximal and distal regions have more mesenchymal cells than the middle part of the AV canal. In the superior cushion, there is a increasing gradient of mesenchymal cells along the longitudinal axis from the atrium to the ventricle. CONCLUSIONS: Our findings reveal that the temporal and spatial characteristics of mesenchyme formation in the inferior vs. superior AV cushion are different. This asymmetry suggests several potential hypotheses: (1) the distribution of the inducer molecule or its receptor has a distribution similar to that of mesenchymal cells, (2) the extracellular matrix has a differential composition or regionally-specific physical associations, (3) the endocardium is heterogeneous with respect to transformation capacity, or (4) these patterns result from an earlier inductive event. The potential importance of the observed asymmetries in the distribution of AV mesenchyme is discussed relative to localization patterns of molecules critical to successful cardiac morphogenesis and remodeling.

Primitive interventricular septum, its primordium, and its contribution in the definitive interventricular septum: in vivo labelling study in the chick embryo heart.

BACKGROUND: Because the studies on the embryological development of the primitive interventricular septum have been done with postmortem material, we do not know the site within the cardiac tube and the developmental stage at which the primordium appears and its anatomical manifestation in the mature heart. Consequently, we do not know its real contribution to the constitution of the definitive interventricular septum. METHODS: With this purpose, we selected an adequate biological model, the chick embryo heart and the in vivo labelling technique. We placed a label of gelatin India ink in the ventral fusion line of both cardiac primordia at the level of the interventricular grooves in the straight tube heart (stage 9+HH), and we traced the ink up to the mature heart (stage 36HH). We made histological sections of some hearts, of the zone where the label was found to investigate the first morphological manifestation of the primitive interventricular septum. We also made microdissections and scanning electron microscopic studies. RESULTS: The label placed at stage 9+HH in the ventral fusion line of both cardiac primordia, at the level of the interventricular grooves, was found at stage 14HH in the greater curvature of the looped heart, opposite the left interventricular groove. This label at stage 17HH was found in the apical trabecular region of the first cardiac septum (8-shaped septum) and in the mature heart (stage 36HH) in the definitive interventricular septum at the limit between the basal and the medial third of the definitive interventricular septum. CONCLUSIONS: Firstly, the primordium of the primitive interventricular septum appears at stage 9+HH, in the ventral fusion line of both cardiac primordia at the level of the interventricular grooves. Secondly, its first morphological manifestation takes place at stage 17HH, and it forms the apical trabeculated region of the first cardiac septum (8-shaped septum). Thirdly, the primitive interventricular septum gives origin to the middle and apical third of the definitive interventricular septum.

[The scientific conceptualization of the female being. Metaphoric use in Galen's writings]. / La ideación científica del ser mujer. Uso metafórico en la doctrina galénica.

This article, a gender study of the writings of Galen, aims to investigate the reasons for the sustained claims of the inferiority of feminine nature with respect to masculine nature. We offer a reconstruction of the social values held by Galen, which conferred to him an androcentric model of knowledge that differed from the other scientific forms in existence at that time. We show that descriptions of the female organism are assiduously associated with maleness or nature, which we interpret as a metaphorical and exemplifying use for the transmission of ethical norms, and the credibility of the doctrine.

[Teratology and epidemiology in the study of environmental teratogens]. / La teratología y la epidemiología en el estudio de los teratógenos ambientales.

The processes of cellular migration, cellular differentiation and cellular multiplication are studied, since these are the basic developmental processes upon which teratogenic agents act resulting in congenital malformations. We also carefully analyze the interactions between teratogen-embryo in order to establish adequate parameters for analysis of environmental teratogens, as well as experimental teratogenesis and epidemiology. Information on the pathogenesis of congenital malformations obtained from experimental teratology in an adequate biological model, can be extrapolated to the human. The etiology of congenital malformations resulting from environmental teratogens can only be elucidated through epidemiology, since there is species specificity. Such a study must fulfill the following prerequisites: diagnosis of the congenital malformation, ruling out genetic factors in the family tree and determination of the exact time of exposure to the possible teratogen during the pregnancy.

Glucose regulation of guinea-pig sperm motility.

Washed guinea-pig spermatozoa from the vas deferens re-acquired progressive motility within 1-2 min of incubation in minimal culture medium containing pyruvate and lactate. When glucose was added, either at the beginning or after 15 min of incubation, the cells showed stimulated motility (increased straight-line velocity, linearity and beat-cross frequency, P less than 0.01). Re-acquisition of progressive motility was preceded by a significant (P less than 0.005) transient increase in sperm concentration of cyclic adenosine 5'-phosphate (cAMP) with or without glucose in the medium. Papaverine caused another large significant (P less than 0.001) increase in cAMP concentration; and 5.56mM glucose with papaverine caused a further stimulation in cAMP beyond that with papaverine alone (P less than 0.005). Although 0.05 or 5.56mM glucose plus alpha-chlorohydrin stimulated sperm motility, they did not further stimulate the increase in cAMP after 30 s of incubation. Thus, there was no apparent correlation between the glucose-stimulating effect on sperm motility and the enhancement of cAMP at 30 s. However, there was a close correlation between glucose-stimulated motility and enhancement of ATP (P less than 0.05) by glucose even under incubation conditions in which glucose caused the Crabtree effect (decrease in respiration rate).