Functional heterogeneity of mesenchymal stem cells from natural niches to culture conditions: implications for further clinical uses.

Mesenchymal stem cells (MSC) are present in all organs and tissues. Several studies have shown the therapeutic potential effect of MSC or their derived products. However, the functional heterogeneity of MSC constitutes an important barrier for transferring these capabilities to the clinic. MSC heterogeneity depends on their origin (biological niche) or the conditions of potential donors (age, diseases or unknown factors). It is accepted that many culture conditions of the artificial niche to which they are subjected, such as O2 tension, substrate and extracellular matrix cues, inflammatory stimuli or genetic manipulations can influence their resulting phenotype. Therefore, to attain a more personalized and precise medicine, a correct selection of MSC is mandatory, based on their functional potential, as well as the need to integrate all the existing information to achieve an optimal improvement of MSC features in the artificial niche.

Conditioned Medium from Human Uterine Cervical Stem Cells Regulates Oxidative Stress and Angiogenesis of Retinal Pigment Epithelial Cells.

INTRODUCTION: Retinal homeostasis is essential to avoid retinal pigment epithelium (RPE) damage resulting in photoreceptor death and blindness. Mesenchymal stem cells-based cell therapy could contribute to the maintenance of the retinal homeostasis. We have explored the effect of human uterine cervical stem cells (hUCESCs)-conditioned medium (hUCESC-CM) on RPE cells under oxidative stress condition. METHODS: ARPE-19 cells were treated with hydrogen peroxide (H2O2) in the presence or absence of hUCESC-CM. qRT-PCR and Western blot were used to evaluate the expression of oxidative stress-related (HO-1, GCLC, and HSPB1) and vasculogenesis-related (VEGFA, PDGFA, and PDGFB) factors. Also, we assessed in vitro effects of hUCESC-CM on endothelial-cell (HUVEC) tube formation. RESULTS: mRNA expression of HO-1, GCLC, HSPB1, VEGFA, PDGFA, and PDGFB were significantly increased in ARPE-19 cells treated with H2O2 + hUCESC-CM compared to cells treated with H2O2 only. Regarding the tube formation assay, HUVEC treated with supernatant from ARPE-19 cells treated with H2O2 + hUCESC-CM showed a significant increase in average vessel length, number of capillary-like junctions, and average of vessels area compared with HUVEC treated with supernatant from ARPE-19 cells treated with H2O2 only. CONCLUSION: Our results show potential therapeutic effects of hUCESC-CM on RPE, such as protection from damage by oxidative stress, stimulation of detoxifying genes, and a better vascularization.

Risk Factors and Reconstruction Techniques for Persistent Cerebrospinal Fluid Leak in Patients Undergoing Endoscopic Endonasal Approach to the Posterior Fossa.

Background High-flow skull base dural defects are associated with an increased risk of postoperative cerebrospinal fluid (CSF) leaks. Objective This study aimed to identify the risk factors for persistent postoperative CSF leak after endoscopic endonasal surgery (EES) and determine the ideal reconstruction strategy after initial failed repair. Methods Patients with CSF leak after intradural EES between October 2000 and February 2017 were identified. Cases with persistent CSF leak were compared with patients with similar pathologic diagnosis without a persistent leak to identify additional risk factors. Results Two hundred and twenty-three out of 3,232 patients developed postoperative CSF leak. Persistent leaks requiring more than one postoperative repair occurred in 7/223 patients (3.1%). All seven had undergone intradural approach to the posterior fossa for resection of recurrent/residual clival chordomas. This group was matched with 25 patients with recurrent/residual clival chordoma who underwent EES without postoperative CSF leak (control group). Age, gender, history of diabetes, smoking, or radiotherapy were not statistically different between the groups. Obesity (body mass index > 30) was significantly more common in the group with persistent leak (86%) compared with controls (36%) ( p = 0.02). All patients with a persistent CSF leak developed meningitis ( p = 0.001). Five patients with persistent leak required a pericranial flap to achieve definitive repair. Conclusion Multiple recurrent CSF leak after EES primarily occurs following resection of recurrent/residual posterior fossa chordoma. Obesity is a major risk factor and meningitis is universal with persistent leak. Flap necrosis may play a role in the development of persistent CSF leaks, and the use of secondary vascularized flaps, specifically extracranial-pericranial flaps, should be considered as an early rescue option in obese patients.

Patients' and professionals' preferences in terms of the attributes of home enteral nutrition products in Spain. A discrete choice experiment.

BACKGROUND/OBJECTIVES: To elicit and compare preferences in terms of the attributes of home enteral nutrition (HEN) among patients and physicians, using a discrete choice experiment (DCE). SUBJECTS/METHODS: A DCE comprising eight choice scenarios, with six HEN attributes (tolerability, adaptation to comorbidities, nutrition and calories, handling, connections and information; two levels each) was designed. The Relative Importance (RI) for patients and physicians of each attribute was estimated. Sociodemographic and clinical variables, as well as additional questions (n = 8) were compiled to analyze possible explanatory variables and other preferences. RESULTS: A total of 148 HEN patients (71 needing caregivers to answer on their behalf) and 114 physicians completed the DCE. The most important attributes for patients were adaptation to comorbidities (33% RI), tolerability (33% RI), and nutrition and calories (26% RI). Significantly, younger patients had stronger preferences for tolerability whereas elderly ones (≥75 years) were more concerned about handling. In comparison, physicians gave a higher RI to tolerability, and nutrition and calories compared to patients (p = 0.002). Overall, a higher percentage of physicians answered that HEN characteristics such as easy-handling bags (85.1 vs. 64.9%; p = 0.001), container material (69.3 vs. 57.1%; p = 0.003) or reusable containers (79.8 vs. 70.3%; p = 0.01) were "important" or "very important" compared to patients. CONCLUSIONS: Our findings showed that although patients and physicians have a similar perception about the relevance of different HEN attributes, the relative weight given to each one varies between them. Therefore, both points of view should be considered when choosing a HEN product in order to improve patients' satisfaction and clinical outcomes.

[Preferences for the attributes of home enteral nutrition (HEN) in Spain. Do caregivers know their patients' preferences?] / Preferencias por los atributos de la nutrición enteral domiciliaria (NED) en España. ¿Conocen los cuidadores las preferencias de los pacientes?

INTRODUCTION: Establishing a home enteral nutrition (HEN) that is adapted to the patient's needs and preferences can improve their quality of life and adherence, contributing to a higher treatment efficiency, better prognosis and cost reduction. As in most cases, patients need total or partial help from their caregivers, and there is a need for evaluating how well do caregivers know their patients' priorities. OBJECTIVES: Exploring patients' preferences for HEN characteristics in Spain, and the concordance between patients and caregivers. METHODS: A cross-sectional observational study based on the discrete choice experiment methodology. A set of eight choice scenarios generated from six attributes with two levels each was presented along with an ad hoc questionnaire on the importance and satisfaction with HEN. The relative importance (RI) of each attribute and the patient-caregiver concordance was estimated in every question. RESULTS: One hundred and forty-eight patients participated, and in 77 cases both the patient and the caregiver took the survey. The most important attributes (RI) for HEN were adaptation to comorbidities (33%), tolerability (33%), nutrients and calories (26%) and package characteristics (8%). Patients showed a high degree of satisfaction with the assistance received. Concordance between patient and caregiver was found in every question, being it moderate to good. CONCLUSIONS: According to patients, an ideal HEN product would be adaptable to comorbidities, easy to tolerate, providing the necessary nutrients and calories, with an easy to handle package. Caregivers know well their patients' preferences.

Preferencias por los atributos de la nutrición enteral domiciliaria (NED) en España. ¿Conocen los cuidadores las preferencias de los pacientes? / Preferences for the attributes of home enteral nutrition (HEN) in Spain. Do caregivers know their patients’ preferences?

Introducción: establecer una nutrición enteral domiciliaria (NED) adaptada a las necesidades y preferencias del paciente puede mejorar la calidad de vida y la adherencia, contribuyendo a una mayor eficiencia del tratamiento, mejor pronóstico y reducción de costes. En muchos casos los pacientes requieren ayuda total o parcial de cuidadores, por lo que es importante evaluar hasta qué punto estos conocen sus preferencias. Objetivos: explorar las preferencias de los pacientes por las características de la NED en España, y la concordancia entre paciente y cuidador. Métodos: estudio observacional, transversal, basado en la metodología del experimento de elección discreta. Se presentaron ocho escenarios de elección generados a partir de seis atributos con dos niveles, y un cuestionario ad hoc de importancia y satisfacción con la NED. Se estimó la importancia relativa (IR) de cada atributo y la concordancia paciente-cuidador en todas las cuestiones. Resultados: participaron 148 pacientes; en 77 casos cumplimentaron las cuestiones los pacientes y sus cuidadores. Los atributos más importantes (IR) en la NED fueron adaptabilidad a comorbilidades (33%), tolerabilidad (33%), aporte de nutrientes y calorías (26%) y características del envase (8%). Los pacientes mostraron un elevado grado de satisfacción con la asistencia recibida. Se encontró concordancia paciente-cuidador en todas las cuestiones, siendo esta de moderada a buena. Conclusiones: según los pacientes, el producto para NED ideal se adapta a las comorbilidades, es fácilmente tolerable, y aporta los nutrientes y calorías necesarios, con un envase de fácil manejo. Los cuidadores conocen bien las preferencias del paciente (AU)

Introduction: Establishing a home enteral nutrition (HEN) that is adapted to the patient's needs and preferences can improve their quality of life and adherence, contributing to a higher treatment efficiency, better prognosis and cost reduction. As in most cases, patients need total or partial help from their caregivers, and there is a need for evaluating how well do caregivers know their patients' priorities. Objectives: Exploring patients' preferences for HEN characteristics in Spain, and the concordance between patients and caregivers. Methods: A cross-sectional observational study based on the discrete choice experiment methodology. A set of eight choice scenarios generated from six attributes with two levels each was presented along with an ad hoc questionnaire on the importance and satisfaction with HEN. The relative importance (RI) of each attribute and the patient-caregiver concordance was estimated in every question. Results: One hundred and forty-eight patients participated, and in 77 cases both the patient and the caregiver took the survey. The most important attributes (RI) for HEN were adaptation to comorbidities (33%), tolerability (33%), nutrients and calories (26%) and package characteristics (8%). Patients showed a high degree of satisfaction with the assistance received. Concordance between patient and caregiver was found in every question, being it moderate to good (AU)

Un estudio con adolescentes usuarios ocasionales de cocaína / Study with adolescents occasional cocaine users

En este estudio se analizan los rasgos de personalidad y conducta de adolescentes usuarios ocasionales de cocaína encontrándose que el 100%de la muestra presenta rasgos de inseguridad, agresividad, dependencia e inmadurez que se relaciona con un déficit en el rendimiento académico, comportamiento emocional, intelectual y social. Los sujetos fueron sometidos a un plan psicoterapéutico de psicodrama y terapia racional así como a Consejo Psicológico a la familia. El psicodrama permitió modificaciones significativas positivas tanto a nivel de sus motivaciones y comportamientos en un 67%de los casos tomados