Cross-Cultural Validation of the Healthcare Provider's Practices, Attitudes, Self-Confidence, and Knowledge Regarding Bullying Questionnaire.

How can we know the reality of the context of bullying in the field of primary health care? The aim of this study is to obtain a validated and reliable tool that allows measurement of the involvement of primary care professionals in addressing bullying through a systematic content validation process. A cross-cultural validation of the Healthcare Provider's Practices, Attitudes, Self-Confidence, and Knowledge Regarding Bullying Questionnaire was conducted for the Spanish perspective. This involved linguistic adaptation through translation-back-translation, content validity index (CVI) analysis, construct validity using confirmatory factor analysis (CFA), and internal consistency (Cronbach's α). The total CVI was 0.95, with individual item scores ≥ 0.78. CFA revealed a good fit for the three subscales, with discrimination indices (item-total correlation within the dimension) > 0.30. Cronbach's α for each dimension indicated a high level of reliability, with values of 0.735 for attitudes, 0.940 for self-confidence, and 0.895 for knowledge. The questionnaire is valid and reliable for evaluating the knowledge, attitudes, and self-confidence of primary care professionals in Spain regarding bullying. Its validity and reliability guarantee its potential use in other health settings and may lead to better training of professionals and school biopsychosocial health.

Subjective Sleep Quality Versus Objective Accelerometric Measures of Sleep and Systemic Concentrations of Sleep-Related Hormones as Objective Biomarkers in Fibromyalgia Patients.

Poor quality of sleep leads to an increase in severity of the symptoms associated with fibromyalgia (FM) syndrome and vice versa. The aim of this study was to determine if the poor perceived sleep quality in FM patients could be corroborated by objective physiological determinations. Perceived sleep quality was evaluated (through the Pittsburgh Sleep Quality Index) in 68 FM patients compared to an age-matched reference group of 68 women without FM. Objective sleep quality (measured using accelerometry), and systemic concentrations of sleep-related hormones (catecholamines, oxytocin, serotonin, and melatonin) were evaluated in two representative groups from the reference control group (n = 11) and FM patients (n = 11). FM patients reported poorer subjective sleep quality compared to the reference group. However, no significant differences were found in accelerometry parameters, except for a delay in getting in and out of bed. In addition, FM patients showed no significant differences in oxytocin concentration and adrenaline/noradrenaline ratio, as well as a lower serotonin/melatonin ratio. Poor perception of sleep quality in FM patients does not correspond to objective determinations. A dysregulation of the stress response could be associated with the delay in their resting circadian rhythm and difficulty falling asleep. This would be the cause that justifies the perceived lack of rest and the fatigue they feel when waking up.

Nursing Interventions against Bullying: A Systematic Review.

(1) Background: Bullying is a worldwide public health problem, with short- and long-term physical, mental, and socio-economic implications for all involved, including consequences as serious as suicide. (2) Objective: The aim of this study is to compile data on nursing interventions for preventing and addressing bullying at the international level. (3) Methods: A systematic review was conducted in accordance with the guidelines laid out in the PRISMA statement. The search included papers written in Spanish, English, and Portuguese over the previous five years from the following databases: Web of Science, CUIDEN, CINHAL, BDENF, Cochrane, Lilacs, and PubMed. The following descriptors were used: "Acoso escolar AND Enfermería", "Bullying AND Nursing" and "Intimidação AND Enferma-gem". Due to the heterogeneity in the methodology of the studies, a narrative synthesis of the results is provided. (4) The synthesis of results shows nurses' involvement in tackling and preventing bullying. Interventions are categorised into awareness raising; coping mechanisms; and approach/care, nursing skills in the face of bullying, and the role of the family in the face of bullying. (5) Conclusions: It is clear that at the international level, nursing is involved in planning and developing autonomous and interdisciplinary interventions to address and prevent bullying. The evidence paves the way for school nurses and family and community nurses to take steps to tackle this phenomenon.

Influence of Codiagnosis of Chronic Fatigue Syndrome and Habitual Physical Exercise on the Psychological Status and Quality of Life of Patients with Fibromyalgia.

Fibromyalgia (FM) and Chronic Fatigue Syndrome (CFS) are two diseases that are frequently codiagnosed and present many similarities, such as poor tolerance to physical exercise. Although exercise is recommended in their daily routine to improve quality of life, little is known about how CFS codiagnosis affects that. Using scientifically validated questionnaires, we evaluated the psychological state and quality of life of patients with FM (n = 70) and how habitual physical exercise (HPE) reported by patients with only FM (FM-only n = 38) or codiagnosed with CFS (FM + CFS, n = 32) influences those aspects. An age-matched reference group of "healthy" women without FM (RG, n = 70) was used. The FM-only group presented a worse psychological state and quality of life compared to RG, with no influence of CFS codiagnosis. The patients of the FM-only and FM + CFS groups who perform HPE presented better levels of stress and state anxiety, but with no differences between them. Depression and trait anxiety improved only in women with just FM. CFS codiagnosis does not worsen the psychological and quality of life impairment of FM patients and does not have a great influence on the positive effect of HPE.

La seguridad del parto planificado en casa: algunas consideraciones a partir de un estudio cualitativo / A segurança do parto domiciliar planejado: algumas considerações de um estudo qualitativo / The safety of planned home birth: some considerations from a qualitative study

Introduction: The search for safety also involves risks caused by the devices that arecreated to anticipate and control them. This is the case of unnecessary interventionism in hospitalbirths in relation to planned home deliveries. Objectives: To explore the relationship betweenphysiological delivery and obstetric interventionism, and to examine the debate on the safety ofhome delivery and its main repercussions. Methodology: Qualitative research. Collection ofinformation with a questionnaire of open questions completed in writing by 45 women who gave226Cultura de los Cuidados. 1º Cuatrimestre 2022. Año XXVI. nº 62birth at home in the province of Murcia between 2008 and 2017. For its analysis MAXQDAqualitative data analysis software was used. Results: obstetric interventionism hinders thephysiological delivery process; The debate over the safety of planned home birth is polarized,causing various repercussions for those involved. Conclusions: planned home birth in low-riskwomen favors the development of physiological delivery, which avoids many of the unnecessaryobstetric interventions associated in hospitals; Likewise, the polarized debate on the safety ofchildbirth at home does not provide consensual information, which has repercussions on thedifferent positioning of the two health groups that take care of childbirth (gynecologists andmidwives), and on the fact that women who decide to perform the home births are pressurized bymultiple sources (health system, family members, friends ...) that come face to face with therelevant information available to them about home birth and the support of the professional whoaccompanies them in the birth.

Introducción: La búsqueda de la seguridad también comporta riesgos provocados desdelos propios dispositivos que se crean para preverlos y controlarlos. Es el caso del intervencionismoinnecesario en los partos hospitalarios en relación a los partos planificados en el hogar. Objetivos:Explorar la relación entre el parto fisiológico y el intervencionismo obstétrico, y examinar eldebate sobre la seguridad del parto domiciliario y sus principales repercusiones.Metodología: Investigación cualitativa. Recogida de información con cuestionario de preguntasabiertas cumplimentadas por escrito por 45 mujeres que parieron en casa en la provincia deMurcia entre 2008 y 2017. Para su análisis empleamos el software de análisis cualitativo de datosMAXQDA. Resultados: el intervencionismo obstétrico dificulta el proceso del parto fisiológico;el debate de la seguridad del parto planificado en casa está polarizado, provocando diversasrepercusiones para los implicados. Conclusiones: el parto planificado en casa en mujeres de bajoriesgo propicia el desarrollo del parto fisiológico, lo que evita muchas de las intervencionesobstétricas innecesarias vinculadas al ámbito hospitalario; asimismo, el polarizado debate de laseguridad del parto en casa no provee una información consensuada, lo que repercute en eldiferente posicionamiento de los dos colectivos sanitarios que se ocupan del parto (ginecólogos ymatronas), y en que las mujeres que deciden realizar el parto en el hogar reciban múltiplespresiones (sistema sanitario, familiares, amigos…) que se confrontan con la relevanteinformación de que dispone sobre el nacimiento en el hogar y el apoyo del profesional que lasacompaña en el parto.

Introdução: A busca por segurança também envolve riscos causados pelos dispositivoscriados para antecipá-los e controlá-los. É o caso do intervencionismo desnecessário nos partoshospitalares em relação aos partos domiciliares planejados. Objetivos: Explorar a relação entreparto fisiológico e intervencionismo obstétrico e examinar o debate sobre a segurança do partodomiciliar e suas principais repercussões. Metodologia: Pesquisa qualitativa. Recolha deinformação com um questionário de perguntas abertas preenchido por escrito por 45 mulheres227Cultura de los Cuidados. 1º Cuatrimestre 2022. Año XXVI. nº 62que deram à luz em casa na província de Murcia entre 2008 e 2017. Para a sua análise utilizou-seo software de análise de dados qualitativos MAXQDA. Resultados: o intervencionismo obstétricodificulta o processo de parto fisiológico; O debate sobre a segurança do parto domiciliar planejadoé polarizado, causando diversas repercussões para os envolvidos. Conclusões: o parto domiciliarplanejado em mulheres de baixo risco favorece o desenvolvimento do parto fisiológico, o queevita muitas das intervenções obstétricas desnecessárias associadas ao ambiente hospitalar; Damesma forma, o debate polarizado sobre a segurança do parto no domicílio não traz informaçõesconsensuais, o que repercute nos diferentes posicionamentos dos dois grupos de saúde que cuidamdo parto (ginecologistas e parteiras), e no fato de as mulheres decidirem por realizar o partodomiciliar recebe múltiplas pressões (sistema de saúde, familiares, amigos ...) que se deparamcom as informações relevantes de que dispõem sobre o parto domiciliar e com o apoio doprofissional que os acompanha no parto.

Cytotoxic and Bactericidal Effect of Silver Nanoparticles Obtained by Green Synthesis Method Using Annona muricata Aqueous Extract and Functionalized with 5-Fluorouracil.

Nanomaterials obtained by green synthesis technologies have been widely studied in recent years owing to constitute cost-effective and environmental-friendly methods. In addition, there are several works that report the simultaneous performance of the reducer agent as a functionalizing agent, modifying the properties of the nanomaterial. As a simple and economical synthesis methodology, this work presents a method to synthesize silver nanoparticles (AgNPs) using Annona muricata aqueous extract and functionalized with 5-fluorouracil (5-FU). The processes of reduction, nucleation, and functionalization of the nanoparticles were analyzed by UV-Vis absorption spectroscopy, and it was found that they are the function of the contact time of the metal ions with the extract. The structural characterization was carried out by transmission electron microscopy (TEM) and X-ray diffraction patterns (XRD). The antibacterial properties of the synthetized nanomaterials were tested using minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) against Enterococcus faecalis, Staphylococcus aureus, and Escherichia coli growth.

MXD1 localizes in the nucleolus, binds UBF and impairs rRNA synthesis.

MXD1 is a protein that interacts with MAX, to form a repressive transcription factor. MXD1-MAX binds E-boxes. MXD1-MAX antagonizes the transcriptional activity of the MYC oncoprotein in most models. It has been reported that MYC overexpression leads to augmented RNA synthesis and ribosome biogenesis, which is a relevant activity in MYC-mediated tumorigenesis. Here we describe that MXD1, but not MYC or MNT, localizes to the nucleolus in a wide array of cell lines derived from different tissues (carcinoma, leukemia) as well as in embryonic stem cells. MXD1 also localizes in the nucleolus of primary tissue cells as neurons and Sertoli cells. The nucleolar localization of MXD1 was confirmed by co-localization with UBF. Co-immunoprecipitation experiments showed that MXD1 interacted with UBF and proximity ligase assays revealed that this interaction takes place in the nucleolus. Furthermore, chromatin immunoprecipitation assays showed that MXD1 was bound in the transcribed rDNA chromatin, where it co-localizes with UBF, but also in the ribosomal intergenic regions. The MXD1 involvement in rRNA synthesis was also suggested by the nucleolar segregation upon rRNA synthesis inhibition by actinomycin D. Silencing of MXD1 with siRNAs resulted in increased synthesis of pre-rRNA while enforced MXD1 expression reduces it. The results suggest a new role for MXD1, which is the control of ribosome biogenesis. This new MXD1 function would be important to curb MYC activity in tumor cells.

Therapeutic failure with thalidomide in patients with recurrent intestinal bleeding due to angiodysplasias / Fracaso terapéutico a talidomida en paciente con sangrado intestinal recurrente debido a angiodisplasias

Angiodysplasias are one of the reasons of gastrointestinal bleeding, whose origin is usually due to vascular malformations. There are different types of therapies for angiodysplasia such as endoscopic, angiographic and pharmacological techniques. Among the last ones, there is little variety of effective drugs to treat the disease. We describe the therapeutic failure with thalidomide in a male with recurrent gastrointestinal bleeding due to angiodysplasias. A thorough diagnostic work-up, including gastroscopy, enteroscopy, angiography and capsule endoscopy were performed. Despite treatment with high-dose somatostatin analogues and oral iron, the patient continued bleeding. The patient was administered then thalidomide for three months with no clinical response. Thalidomide had to be withdrawn owing to adverse effects (AU)

Una de las causas de sangrado a nivel gastrointestinal son las angiodisplasias, cuyo origen suele deberse a malformaciones a nivel vascular. Existen distintos tipos de terapias para las angiodisplasias, como son las técnicas endoscópicas, angiográficas y farmacológicas. Dentro de estas últimas existe poca variedad de fármacos efectivos para dicha patología. Se describe el fracaso terapéutico con talidomida en un varón con sangrado gastrointestinal recurrente debido a angiodisplasias. Se le realiza un diagnóstico completo, incluyendo gastroscopia, enteroscopia, angiografía y cápsula endoscópica. A pesar del tratamiento con análogos de la somatostatina a altas dosis y hierro oral, el paciente continuó sangrando. El paciente recibió talidomida durante tres meses sin respuesta clínica. La talidomida tuvo que ser retirada debido a los efectos adversos y a la falta de eficacia (AU)

Therapeutic failure with thalidomide in patients with recurrent intestinal bleeding due to angiodysplasias.

Angiodysplasias are one of the reasons of gastrointestinal bleeding, whose origin is usually due to vascular malformations. There are different types of therapies for angiodysplasia such as endoscopic, angiographic and pharmacological techniques. Among the last ones, there is little variety of effective drugs to treat the disease. We describe the therapeutic failure with thalidomide in a male with recurrent gastrointestinal bleeding due to angiodysplasias. A thorough diagnostic work-up, including gastroscopy, enteroscopy, angiography and capsule endoscopy were performed. Despite treatment with high-dose somatostatin analogues and oral iron, the patient continued bleeding. The patient was administered then thalidomide for three months with no clinical response. Thalidomide had to be withdrawn owing to adverse effects.

Una de las causas de sangrado a nivel gastrointestinal son las angiodisplasias, cuyo origen suele deberse a malformaciones a nivel vascular. Existen distintos tipos de terapias para las angiodisplasias, como son las técnicas endoscópicas, angiográficas y farmacológicas. Dentro de estas últimas existe poca variedad de fármacos efectivos para dicha patología. Se describe el fracaso terapéutico con talidomida en un varón con sangrado gastrointestinal recurrente debido a angiodisplasias. Se le realiza un diagnóstico completo, incluyendo gastroscopia, enteroscopia, angiografía y cápsula endoscópica. A pesar del tratamiento con análogos de la somatostatina a altas dosis y hierro oral, el paciente continuó sangrando. El paciente recibió talidomida durante tres meses sin respuesta clínica. La talidomida tuvo que ser retirada debido a los efectos adversos y a la falta de eficacia.

High prevalence of undiagnosed vertebral fractures in patients suffering from hip fracture at their hospital admission: weak concordance among observers.

BACKGROUND: Vertebral fracture is often underdiagnosed. Patients with hip fracture may suffer from vertebral fracture without knowing it. The diagnosis of vertebral fracture is sometimes difficult because there is no consensus regarding the definition of osteoporotic vertebral fracture, and several indexes may be used to diagnose it and the concordance between several observers may not be optimal. OBJECTIVE: To study the concordance in the diagnosis of vertebral fracture done by three different doctors: an orthopedic surgeon, a radiologist, and a bone mineral metabolism expert. METHODS: A lateral thoracic-lumbar spine X-Ray was performed in 177 patients suffering from hip fracture to assess the presence or absence of vertebral fractures. Three different observers applied Genant's criteria for it. Concordance between observers was measured using Cohen's kappa coefficient. RESULTS: Patients suffering from hip fractures have undiagnosed vertebral fractures in a range that varies from 41.8 to 47.5% depending on the observer. The concordance in the diagnosis of vertebral fractures is quite low, ranging a Cohen's kappa coefficient from 0.43 to 0.55 and a percentage of concordance varying from 64 to 72%. The best concordance was found between observers 1 and 3. DISCUSSION: Depending on the observer who made the diagnosis, the prevalence of previously undiagnosed vertebral fractures in patients with HF varied widely. We selected three different observers to assess the possible differences in the diagnosis of vertebral fractures among these patients and using the same method (Genant's semi-quantitative assessment), surprisingly, there was little concordance among the three of them. CONCLUSION: Patients with hip fracture have high prevalence of undiagnosed vertebral fractures. The diagnosis of these fractures varies widely depending on the observers and the Cohen's kappa coefficient and percentage of concordance is rather low.

Osteoporosis and metabolic syndrome according to socio-economic status, contribution of PTH, vitamin D and body weight: The Canarian Osteoporosis Poverty Study (COPS).

BACKGROUND: Poverty is associated with a great number of diseases, but the prevalence of vitamin D deficiency, secondary hyperparathyroidism and the potential association of osteoporosis, osteoporotic fractures and metabolic syndrome in this situation are less well known. OBJECTIVE: To evaluate the associations between poverty, bone density, fragility fractures and metabolic syndrome in a population of southern European postmenopausal women. Also, to assess the potential role of vitamin D and parathyroid hormone (PTH) levels in these associations. METHOD: Cross-sectional study was carried out in 1 250 postmenopausal Caucasian Spanish women. The socio-economic status of the participants was determined after a personal interview, according to the criteria of the Spanish Institute of Statistics. Participants were divided into two socio-economic levels: low (poverty) and medium or high socioeconomic level. The study protocol included a health questionnaire, a complete physical examination, lateral radiograph of the dorsal and lumbar spine and measurement of bone mineral density (BMD) at the lumbar spine (L2-L4) and proximal femur. Fasting blood was obtained to measure 25-hydroxy-vitamin D (25-OHD), intact PTH and selected biochemical variables. RESULTS: Low socio-economic status was associated with 25-OHD insufficiency, higher values of PTH, higher body weight and body mass index (BMI), lower values of BMD at the lumbar spine and a higher prevalence of fragility fractures, both vertebral and nonvertebral. Poverty was also associated with higher prevalence of metabolic syndrome, but this association was driven mainly by the higher BMI and not by poverty itself. Both vitamin D insufficiency and elevated PTH were consistently related to poverty and osteoporotic fractures. CONCLUSIONS: Poor postmenopausal women in southern Europe have a high prevalence of metabolic syndrome and osteoporotic fractures. Poverty was associated with higher BMI and metabolic syndrome on the one hand and, on the other, with 25OHD insufficiency, higher PTH levels and osteoporosis. 25OHD insufficiency and/or secondary hyperparathyroidism do not have a significant influence on the presence of metabolic syndrome in this population.

Discriminative ability of heel quantitative ultrasound in postmenopausal women with prevalent vertebral fractures: application of optimal threshold cutoff values using classification and regression tree models.

Quantitative ultrasound (QUS) of the heel has been proposed as a screening tool to evaluate the bone status and risk of osteoporotic fragility fractures. The aim of this study was to define threshold values that would maximize the predictive ability of QUS to discriminate subjects with vertebral fractures using the classification and regression trees (CART) models. A cross-sectional analysis was made of a cohort of 1,132 postmenopausal women with a mean age of 58 years. A total of 205 women (18.1 %) presented with a history of vertebral fracture. For all patients, a questionnaire of osteoporosis risk factors was given and measurements of the heel QUS and bone mineral density at the lumbar spine and the proximal femur, obtained by dual-energy X-ray absorptiometry (DXA), were made. Spinal radiographs were assessed for vertebral fractures. Sensitivity, specificity, predictive values, likelihood ratios, and receiver operator characteristics (ROC) curve QUS values were calculated using the optimal threshold identified in the CART models. Cutoff values calculated from best CART model (i.e., a QUS index >90.5 %) yielded a sensitivity of 80.3 % (95 % CI 69.2-88.1), a negative predictive value of 94 % (95 % CI 90.1-96.5), and a specificity of 68.8 % (95 % CI 63.3-73.8). This cutoff value would obviate the need to perform DXA in 32.8 % of the women of our population at risk for vertebral fractures. The area under the ROC curve of the best model was 0.8071. QUS was shown to discriminate between women with and without a history of vertebral fracture and constitutes a useful tool for assessing vertebral fracture risk. The application of decision trees (CART analyses) was helpful to define the optimal threshold QUS values.

Discriminative ability of heel quantitative ultrasound in postmenopausal women with prevalent low-trauma fractures: application of optimal threshold cutoff values using CART models.

Quantitative ultrasound (QUS) of the heel has been proposed as a screening tool to evaluate the bone status and risk of osteoporotic fragility fractures. The aim of this study was to define threshold values of QUS that would maximize the predictive ability of this technique to discriminate subjects with fragility fractures. A cross-sectional analysis was made of a cohort of 1132 postmenopausal women with a mean age of 58 yr. A total of 361 women (31.9%) presented with a history of osteoporotic fracture. Most fractures (74.1%) were nonvertebral. For all patients, a questionnaire of osteoporosis risk factors and measurements of the heel QUS and bone mineral density at the lumbar spine and the proximal femur obtained by dual-energy X-ray absorptiometry (DXA) were assessed. Spinal radiographs were assessed for fractures and historical nonvertebral fragility fractures. Sensitivity, specificity, predictive values, likelihood ratios, and receiver operator characteristic (ROC) curve QUS values were calculated using the optimal threshold identified in the classification and regression trees (CART) models. Cutoff values calculated from the best CART model (i.e., a quantitative ultrasound index (QUI) greater than 88.5% in women aged 58 yr or older) yielded 88.8% (95% confidence interval [CI]: 81.4-93.5) for sensitivity, a negative predictive value of 93.8 (95% CI: 89.4-96.4), and 70.4% (95% CI: 64.6-75.7) for specificity. This cutoff value would obviate the need to perform DXA in 43.1% of the population. The area under the ROC curve of the best model was 0.8363 (95% CI: 0.8249-0.8477). In conclusion, QUS was shown to discriminate between women with and without a history of fragility fracture and constitutes a useful tool for assessing fracture risk. The application of decision trees (CART analyses) was helpful to define the optimal threshold QUS values.

Increased association of CD38 with lipid rafts in T cells from patients with systemic lupus erythematosus and in activated normal T cells.

In this study we have determined whether there is a relationship between CD38 expression on T cells, its distribution in different membrane microdomains, and T cell activation in SLE patients. The data show that CD38 expression is augmented in ex vivo CD3+, CD4+, CD8+, and CD25+ SLE T cells, which correlates with its increased insolubility in Brij 98 detergent, and its translocation into lipid rafts. Moreover, SLE T cells show an altered CD4:CD8 ratio, which is due to a decreased proportion of CD4+ T cells and a concomitant increase in the proportion of CD8+ T cells. These data are consistent with the increased CD38 expression and lipid raft formation, and the significant reduction in the CD4:CD8 ratio observed in mitogen-stimulated normal T cells as compared with that in ex vivo untouched normal T cells. Increased expression of CD38 in floating rafts from SLE T cells, or from activated normal T cells may modulate TCR signaling by providing or sequestering signaling molecules to the engaged TCR.

CD38 signaling in T cells is initiated within a subset of membrane rafts containing Lck and the CD3-zeta subunit of the T cell antigen receptor.

In this study we present data supporting that most CD38 is pre-assembled in a subset of Brij 98-resistant raft vesicles, which were stable at 37 degrees C, and have relatively high levels of Lck and the CD3-zeta subunit of T cell antigen receptor-CD3 complex in contrast with a Brij 98-soluble pool, where CD38 is associated with CD3-zeta, and Lck is not detected. Our data further indicate that following CD38 engagement, LAT and Lck are tyrosine phosphorylated exclusively in Brij 98-resistant rafts, and some key signaling components translocate into rafts (i.e. Sos and p85-phosphatidylinositol 3-kinase). Moreover, N-Ras results activated within rafts immediately upon CD38 ligation, whereas activated Erk was mainly found in soluble fractions with delayed kinetics respective to Ras activation. Furthermore, full phosphorylation of CD3-zeta and CD3-epsilon only occurs in rafts, whereas partial CD3-zeta tyrosine phosphorylation occurs exclusively in the soluble pool, which correlated with increased levels of c-Cbl tyrosine phosphorylation in the non-raft fractions. Taken together, these results suggest that, unlike the non-raft pool, CD38 in rafts is able to initiate and propagate several activating signaling pathways, possibly by facilitating critical associations within other raft subsets, for example, LAT rafts via its capacity to interact with Lck and CD3-zeta. Overall, these findings provide the first evidence that CD38 operates in two functionally distinct microdomains of the plasma membrane.