Systems medicine and integrated care to combat chronic noncommunicable diseases

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems.

Should biomarkers be used to design personalized medicine for the treatment of glioblastoma?

Significant progress has been made in understanding the molecular pathogenesis of gliomas and in predicting general outcome depending on a limited set of clinical parameters and molecular markers. However, methylation of the O⁶-methylguanine DNA methyltransferase (MGMT) gene promoter is the only molecular marker linked to sensitivity of a specific treatment, that is, alkylating agent chemotherapy, and this predictive value may be limited to glioblastoma. Moreover, in the absence of potent alternative drugs, temozolomide chemotherapy should not be withheld from patients with newly diagnosed glioblastoma without MGMT promoter methylation in general practice. In the context of clinical trials, however, irrespective of whether classical cytotoxic drugs, tyrosine kinase inhibitors or antiangiogenic agents are used, tissue should be centrally collected. Appropriate research programs should seek to define enriched patient populations for future trials and ultimately facilitate individualized cancer treatments.

Lésions buccales du reflux gastro-oesophagien de l'enfant: des réalités et quelques mythes [An interface between pediatrics and oral medicine: oral manifestations of gastroesophageal reflux in children]

Gastro-oesophageal reflux (GOR) is a common disorder in the pediatric population. In association with esophagitis, GOR may impair children's quality of life. Extra-oesophageal manifestations are of specific interest in oral medicine because the refluxate may reach impair both oral mucosa and hard dental tissues. Some oral symptoms are so specific that they should raise the attention for other GOR symptoms. Dental erosion is a potential risk in children with gastroesophageal reflux: the pediatrician should routinely refer children with gastroesophageal reflux to a pediatric dentist to diagnose erosions and if needed restore the teeth. Conversely, in the presence of unexplained dental erosions the dentist and/or the pediatrician should discuss the possibility of an occult GOR.

An experience beyond continuous assessment activities: virtual tour to the medieval medicinal plant garden of the Pedralbes monastery

[eng] The group of teaching innovation in the area of Botany (GIBAF), University of Barcelona (UB), is raised each year to design new accreditation activities under continuous evaluation framework. We present the experience carried out during the academic year 2008-09 in the course of Pharmaceutical Botany. The aim has been to involve students for a semester in the authorship of a tutored project immediately useful and of easy permanence, beyond its assessment proving usefulness. The Medicinal Plants Garden of the Monastery of Pedralbes has been used as a resource and a collaboration agreement has been signed between the UB faculty and the Institute of Culture of Barcelona. The students have developed the work using the Moodle platform CampusvirtualUB into five stages which included preparation of files by students that have been modified in some steps following the various feedbacks from teachers. At the beginning of the activity, students were provided with a complete schedule of activities, the schedule for its implementation, and a total of 18 forced-use library resources. Finally, through Google sites, a website has been implemented, allowing for a virtual tour of the garden, documenting by referenced literature 50 medicinal plants for their nomenclature, botanical description, distribution, uses historical, current and future) and toxicity. The result of the activity was presented at a public ceremony in the Monastery of Pedralbes and is available at: http://sites.google.com/site/jardimedievalpedralbes/ [spa] El grupo de innovación docente integrado por profesores del área de Botánica (GIBAF) de la Universidad de Barcelona (UB) se plantea cada curso el diseño de nuevas actividades acreditativas en el marco de la evaluación continuada. Se presenta la experiencia llevada a cabo durante el curso 2008-09 en la asignatura Botánica Farmacéutica. El objetivo ha sido implicar durante un semestre a los estudiantes en la autoría de un proyecto tutorizado de inmediata utilidad y clara perdurabilidad, más allá de su utilidad acreditativa. Como recurso se ha utilizado el Jardín de Plantas Medicinales del Monasterio de Pedralbes y se ha firmado un convenio de colaboración docente entre la UB y el Instituto de Cultura de Barcelona. Los estudiantes han realizado el trabajo utilizando la plataforma Moodle del Campus virtual de la UB en cinco etapas que han incluido la confección de unas fichas que se han ido modificando en función de las diversas retroacciones de los profesores. Al inicio de la actividad, se facilitó a los estudiantes el cronograma completo de la actividad, la pauta para su realización, así como un total de 18 recursos bibliográficos de uso obligado. Finalmente, a través de GoogleSites, se ha realizado una web que permite realizar un paseo virtual por el jardín, documentando de forma referenciada para las 50 plantas medicinales su nomenclatura, descripción botánica, distribución, usos (históricos, actuales y futuros) y toxicidad. El resultado de la actividad fue presentado en un acto público en el Monasterio de Pedralbes y puede consultarse en: http://sites.google.com/site/jardimedievalpedralbes/

Phytochemical investigation of plants used in African traditional medicine: "Dioscorea sylvatica" (Dioscoreaceae), "Urginea altissima" (Liliaceae), "Jamesbrittenia fodina" and "Jamesbrittenia elegantissima" (Scrophulariaceae)

Les plantes médicinales représentent la seule source de médicaments pour près de 90 % de la population de certains pays d?Afrique. Le savoir-faire des guérisseurs traditionnels, d?une valeur inestimable, représente un point de départ pour l?investigation pharmacologique et phytochimique de ces médicaments naturels. Dans le cadre de ce travail, nous nous sommes dans un premier temps intéressés à valider l?utilisation en médecine traditionnelle de deux plantes, Diuscorea sylvatica (Dioscoreaceae) et Urginea altissima (Liliaceae), qui produisent, lorsqu?elles sont frottées sur la peau, une inflammation et des démangeaisons. Ces réactions cutanées ont pu être expliquées, au moins en partie, par la présence d?aiguilles acérées d?oxalate de calcium dans les organes souterrains. Ces microtraumatismes répétés de l?épiderme risquent de provoquer, lors d?une utilisation prolongée, des lésions granulomateuses. L?histamine n?a pas été détectée, mais d?autres substances pourraient être impliquées dans le processus inflammatoire. La seconde partie de ce travail a consisté en la détection, l?isolement et la caractérisation de nouveaux composés naturels présentant un intérêt thérapeutique potentiel. 70 extraits provenant de 28 plantes supérieures du Zimbabwe ont été soumis à un criblage chimique et biologique. Les extraits méthanoliques des parties aériennes de Jamesbrittenia fodina et J. elegantissima (Scrophulariaceae) ont été sélectionnés sur la base de leurs nombreuses activités. Le fractionnement guidé par l?activité de J. fudina a permis l?isolement des saponines A et B, responsables des activités antifongique, antibactérienne et molluscicide de l?extrait. De plus, les deux saponines ont montré une activité équivalente en tant qu?inhibiteurs de l?acétylcholinestérase, propriété encore non décrite pour cette classe de composés. Une analyse LC/uv/MS de l?extrait a permis d?attribuer l?activité antiradicalaire au verbascoside, un dérivé du phenylpropane; cette analyse a de plus montré la présence d?une série de dérivés de l?acide cinnamique, dont l?isolement a été entrepris. Deux problèmes d?instabilité sont apparus, empêchant l?isolement des composés par des méthodes chromatographiques de pointe, en dépit de très bonnes conditions de séparations. Des analyses LC/?H-NMR combinées à des analyses RMN classiques des mélanges ont permis d?attribuer ces instabilités d?une part à une isomérisation cis/trans induite par la lumière, et d?autre part à une transacylation du groupe cinnamoyl sur une unité de sucre. Ceci a permis l?identification de 12 esters cinnamiques d?iridoïdes, dont 8 nouveaux produits naturels. Ces dérivés présentent un intérêt thérapeutique, car des composés similaires ont montré des propriétés anti-inflammatoires significatives dans différents modèles in vivo. Deux flavanones ont aussi été isolées de l?extrait. Cette classe de composés n?a jamais été rapportée chez un membre des Scrophulariaceae. Une analyse LC/UV/MS comparative des extraits polaires des deux espèces, J. fodina et J. elegantissima, a été effectuée pour détecter la présence éventuelle de compos.és communs. Les saponines A et B et le verbascoside ont été identifiés dans l?extrait de J. elegantissima. Trois flavonoïdes ont de plus été isolés de ce dernier par CPC et HPLC semi-préparative.<br/><br/>In certain African countries, medicinal plants represent the unique source of to 90% of the population. The knowledge of traditional healers represents a basis for the pharmacological and phytochemical investigation of these natural medicines. This work first focused on the validation of use of two plants frequently employed in traditional medicine, Dioscorea sylvatica (Dioscoreaceae) and Urginea altissimu (Liliaceae), which produce mild inflammation and itching when rubbed on the skin. These cutaneous reactions were shown to be due, at least in part, to the presence of sharp needles of calcium oxalate, implying the risk of granulomatous lesions following a long term use. Histamine was not detected, but other compounds could be involved in the inflammatory process. The second part of this work consisted of the detection, isolation and characterisation of new natural compounds of potential therapeutic interest from African plants. Seventy extracts obtained from 28 higher plants of Zimbabwe were submitted to a chemical and biological screening. The methanol extracts of the whole plants of Jamesbrittenia fodina and J. elegantissima (Scrophulariaceae) were selected for their various activities. An activity-guided fractionation of J. fodina led to the isolation of the saponins A and B, responsible for the antifungal, antibacterial and molluscicidal properties. Both saponins were equally active as inhibitors of acetylcholinesterase, a property that has, to our knowledge, never been described for this class of compounds. A LC/UV/MS analysis of the extract allowed the identification of verbascoside as the product with radical scavenging activity, and indicated the presence of a series of potentially interesting cinnamic acid derivatives. Two types of instability problems occurred in the course of their isolation, as some compounds could not be separated despite very good chromatographic conditions. LC/'H-NMR analyses combined with in-mixture NMR analyses enabled the attribution of the cause of the instability in one case to a cidtrans light-induced isomerisation, and in the other case to a transacylation of the cinnamoyl moiety on a sugar residue. These problems of instability have not been the object of previous studies. 12 cinnamic iridoid esters could be characterised, 8 of these being new natural compounds. Several similar substances have displayed significant anti-inflammatory properties in different in vivo models, suggesting a therapeutic interest for these new derivatives. Two flavanones were isolated from the same extract. This class of compound has not been previously reported from species of the Scrophulariaceae family. A comparative LCAJVNS study of the polar extracts of the two species J. elegantissima and J. fodina was performed in order to detect possible common compounds. Saponins A and B and verbascoside were thus identified in .J. elegantissima. Moreover, three supplementary flavonoids were isolated from J. elegantissima..

Sant Llorenç del Montsec (La Noguera): un despoblat medieval

The medieval deserted village of St. Lloreng, a fortified place in the west lands of Catalonia, in Lleida, near Aragon, is studied from its origins in 11th. century unti1 14th.C. The growth and evolution of population during this time is shown by the houses, placed between the castle and the church, some so simply with only one room, some wider. The authors don't know why the village became deserted, but they indicate the possible move of the population into the limits of the Ager valley.

La noció d'Espanya a la Catalunya medieval

A partir de la necessitat de conèixer les bases del propi present i d'assolir puntals on arrelar els discursos de futur, ara i adés les diferents col·lectivitats es remeten als orígens, "l'obsessió pels orígens" deia Marc Bloch. I aquests, en una Europa que parla de l'Edat Mitjana com la infantesa de la pròpia identitat, s'aboquen a una època medieval on conflueixen -en el que des de la llunyania de la nostra quotidianitat pot semblar una amalgama poc destriada- tant les realitats gresoladores dels actuals signes d'identitat culrurals, socials i lingüístics, com les projeccions que delerosament hi cerquen les justificacions del present i els condicionants del furur. Així doncs, convé apamar bé l'espai físic i conceptual per definir adientment la realitat existent en aquells moments que han alimentat les arrels d'identitats que, travessant diferents estímuls al llarg de la història, han menat fins als nostres dies.

El naixement d'un vilar medieval: Moredell (Gironès) en època carolíngia

This is the description of the birth, development and transformations of a small rural community in carolingian epoch through the written documentation and the analysis of the landscape.

Entorn al testament de Brunissèn d'Alentorn i alguns costums funeraris de la Lleida medieval

In this research from the late medieval period, we want to analyze diferent aspects related to funerary world through Brunissèn d’Alentorn’s will. The document is compared with other wills from Lleida’s area that acquire knowledge to these customs, for instance, the draps d’or’s uses. These were provided of deceased’ heraldry, and were comissioned to cover the tomb. Also, in Lleida’s case, they were used to decorate the ancient cathedral’s presbitery during the main festivities, and the patrons’ wedding bed. Artistic patronage, social prestige, family arms ostentation, pomp and devotion are other aspects that would be emphasized in this tour, just as the private devotions in the chapels and altars that were founded regarding this topic.