Reflexiones en torno a un perfil profesional: los bibliotecarios de las bibliotecas para pacientes en España

Esta comunicación forma parte de una investigación más amplia sobre las bibliotecas para pacientes en España; actualmente estamos identificando y analizando bibliografía especializada. A partir de estas lecturas hemos detectado distintas cuestiones en relación con el perfil profesional de los responsables de estos centros. Por ejemplo, si durante los años 30 del siglo pasado se valoraba sobre todo su capacidad psicológica para comprender a los enfermos y saber elegir las mejores lecturas teniendo en cuenta su situación, en la actualidad se valora más su capacidad de relaciones públicas. Lo que sí se mantiene constante a lo largo de los años es el hecho que no se le exige titulación específica (mayoritariamente se trata de voluntarios) y, por tanto, se defiende un profesional no profesionalizado. En esta afirmación subyace la convicción de que en este tipo de bibliotecas, más importante que la gestión, la colección y el mantenimiento, es la atención al usuario, entendiendo que esta atención no requiere unas competencias personales o profesionales concretas y que la buena voluntad o una buena disposición son suficientes... La realidad nos demuestra lo contrario. La poca visibilidad de las bibliotecas para pacientes así como el desconocimiento de sus funciones básicas (ofrecer al enfermo ocio, formación e información adecuada a sus capacidades) se hace extensiva a sus profesionales. No existe una descripción más o menos consensuada y normativa de este perfil más allá de una relación de sus tareas, en el mejor de los casos, contrariamente a lo que ocurre con los responsables de los centros especializados en ciencias de la salud. En esta comunicación proponemos mostrar la evolución del perfil de los bibliotecarios de las bibliotecas para pacientes en España siguiendo las aportaciones de la bibliografía especializada.

Human muscular fetal cells: a potential cell source for muscular therapies.

Myoblast transfer therapy has been extensively studied for a wide range of clinical applications, such as tissue engineering for muscular loss, cardiac surgery or Duchenne Muscular Dystrophy treatment. However, this approach has been hindered by numerous limitations, including early myoblast death after injection and specific immune response after transplantation with allogenic cells. Different cell sources have been analyzed to overcome some of these limitations. The object of our study was to investigate the growth potential, characterization and integration in vivo of human primary fetal skeletal muscle cells. These data together show the potential for the creation of a cell bank to be used as a cell source for muscle cell therapy and tissue engineering. For this purpose, we developed primary muscular cell cultures from biopsies of human male thigh muscle from a 16-week-old fetus and from donors of 13 and 30 years old. We show that fetal myogenic cells can be successfully isolated and expanded in vitro from human fetal muscle biopsies, and that fetal cells have higher growth capacities when compared to young and adult cells. We confirm lineage specificity by comparing fetal muscle cells to fetal skin and bone cells in vitro by immunohistochemistry with desmin and 5.1 H11 antibodies. For the feasibility of the cell bank, we ensured that fetal muscle cells retained intrinsic characteristics after 5 years cryopreservation. Finally, human fetal muscle cells marked with PKH26 were injected in normal C57BL/6 mice and were found to be present up to 4 days. In conclusion we estimate that a human fetal skeletal muscle cell bank can be created for potential muscle cell therapy and tissue engineering.

Whole-cell bioprocessing of human fetal cells for tissue engineering of skin.

Current restrictions for human cell-based therapies have been related to technological limitations with regards to cellular proliferation capacity (simple culture conditions), maintenance of differentiated phenotype for primary human cell culture and transmission of communicable diseases. Cultured primary fetal cells from one organ donation could possibly meet the exigent and stringent technical aspects for development of therapeutic products. Master and working cell banks from one fetal organ donation (skin) can be developed in short periods of time and safety tests can be performed at all stages of cell banking. For therapeutic use, fetal cells can be used up to two thirds of their life-span in an out-scaling process and consistency for several biological properties includes protein concentration, gene expression and biological activity. As it is the intention that banked primary fetal cells can profit from the prospected treatment of hundreds of thousands of patients with only one organ donation, it is imperative to show consistency, tracability and safety of the process including donor tissue selection, cell banking, cell testing and growth of cells in out-scaling for the preparation of whole-cell tissue-engineering products.

Intervalo hídrico ótimo no perfil explorado pelas raízes de feijoeiro em um latossolo sob diferentes níveis de compactação

O intervalo hídrico ótimo (IHO) é integrador dos fatores de crescimento das plantas, e a densidade crítica obtida é um indicativo da qualidade estrutural do solo. O objetivo deste trabalho foi determinar o IHO em um Latossolo argiloso. Amostras de solo com estrutura preservada foram coletadas num experimento com três níveis de compactação: PD - plantio direto continuado por seis anos, PDc - plantio direto com compactação adicional e Esc - escarificação. Para a curva de resistência, coletaram-se 107 amostras na camada de 0 a 0,20 m em diferentes condições de umidade. Para a curva de retenção de água, coletaram-se amostras nas camadas de 0 a 0,05; 0,05 a 0,10; 0,10 a 0,15; 0,20 a 0,25; e 0,30 a 0,35 m. O modelo de resistência à penetração ajustado, com base na densidade e umidade, explicou 33 % da variação obtida na resistência do solo à penetração, sendo todos os parâmetros de ajuste significativos. A densidade crítica do IHO é dependente do valor de resistência à penetração considerado limitante, sendo de 1,36; 1,40; 1,45; e 1,49 Mg m-3 para valores de RP de 1,5; 2,0; 2,5; e 3,0 MPa, respectivamente. A aeração do solo passa a ser limitante com densidades acima de 1,32 Mg m-3. A compactação do solo reduziu o seu IHO na camada próxima a 0,10 m de profundidade. Quando se adotou a resistência crítica de 2 MPa, o IHO foi nulo nas camadas de 0,05 a 0,12 m no PD, de 0,05 a 0,17 m no Esc e de 0,03 a 0,22 m no PDc. Com a utilização de 3 MPa como resistência crítica, ocorreu ampliação, em que o IHO tem valor positivo, no perfil do solo; o IHO foi nulo apenas na camada de 0,05 a 0,15 m do PDc. As raízes do feijoeiro não cresceram na camada de solo onde o IHO foi nulo com resistência crítica de 3 MPa.

Dexamethasone stimulates the biochemical differentiation of fetal forebrain cells in reaggregating cultures.

The influence of dexamethasone on the development of neurons and oligodendrocytes was studied in serum-free, aggregating rat brain cell cultures. Synaptogenesis and myelination occur in this culture system. The concentration of myelin basic protein and the activity of 2',3'-cyclic nucleotide 3'-phosphodiesterase were used as oligodendroglia and myelin markers. Choline acetyltransferase and acetylcholinesterase served as neuronal markers, glutamine synthetase reflected astrocyte differentiation, while ornithine decarboxylase served as a general marker for cell growth and maturation. This study showed that dexamethasone stimulated the differentiation of cholinergic neurons and astrocytes. The effect of dexamethasone on oligodendroglial differentiation and myelination depended on the stage of development: during the early phase of myelination dexamethasone had a stimulatory effect, whereas at a later stage it showed a significant inhibition.

Growth and differentiation of aggregating fetal brain cells in a serum-free defined medium.

Aggregating cultures of mechanically dissociated fetal brain cells provide an excellent system for neurobiological studies of cellular growth and differentiation, but, in common with almost all culture systems, they have the disadvantage that crude serum is required in the medium. Although several cell lines have either been adapted to serum-free conditions or grown normally in serum-free media supplemented with hormones, trace elements and defined serum components, this approach has never been applied to differentiating primary cells of the central nervous system. We now describe the successful cultivation of aggregating fetal rat brain cells in a chemically defined, serum-free medium.

The diagnostic dilemma of hyperintense fetal lung on prenatal MRI : 12.03

Purpose: In the last years, MRI appears as a complementary diagnostic method to US in the diagnosis of congenital lung lesions. Focal homogeneous pulmonary hyperintensity on T2-WI constitutes a frequent pattern observed. Our purpose is to determine if this finding is associated with a characteristic pulmonary lesion. Materials and methods: Between 01.01.00 and 31.12.07, a total of 50 prenatal MRI in fetuses with echographic diagnosis of thoracic pathology were performed in our institution, including 12 cases of suspected congenital pulmonary lesions. Prenatal images were correlated with post-natal diagnosis. Results: In 12 cases, fetal MRI detected congenital pulmonary lesions. In 8 patients, typical signs (cystic lesions, septations, anomalous vasculature) clearly suggested a specific pathology. In 4 cases, MRI showed a focal homogeneous increase of the signal intensity (SI) on T2-WI of the pathologic lung related to the normal one. The final diagnosis of these fetuses included 1 patient with congenital cystic adenomatoid malformation type III, 1 patient with segmental emphysema and 2 cases of bronchial atresia. In all 4 cases, a significant post-natal reduction of the lesion size related to prenatal MRI studies was observed. Conclusion: Our study suggests that a focal increment of the SI of the lung on T2-WI is a non specific sign of congenital lung disease, present in different pathologies. Therefore, a prospective diagnosis is not possible.

Modelo para estimativa da infiltração de água e perfil de umidade do solo

A adequada modelagem da infiltração de água no solo é fundamental para estimação do movimento de água, erosão hídrica, recarga e contaminação de aquíferos. Este trabalho apresenta um modelo para estimativa da infiltração de água no solo (GAML-c), com base no modelo de Green-Ampt-Mein-Larson, que provê descrição da geometria e do deslocamento da frente de umedecimento no solo. Testes experimentais foram conduzidos em Latossolo Vermelho-Amarelo para avaliar o GAML-c, usando-se quatro diferentes cenários: considerando a condutividade hidráulica do solo igual à taxa de infiltração estável (Tie) e a umidade máxima do solo igual ao teor de água na zona de transmissão (θw) (TW); condutividade hidráulica do solo igual à do solo saturado (K0) e a umidade máxima do solo igual θw (KW); condutividade hidráulica do solo igual à Tie e a umidade máxima do solo igual ao teor de água na saturação (θs) (TS); e condutividade hidráulica do solo igual a K0 e a umidade máxima do solo igual θs (KS). Verificou-se que o GAML-c no cenário TW foi o melhor estimador do perfil de umidade do solo, resultando em aceitáveis estimativas da infiltração de água.

Análise da determinação da condutividade hidráulica do solo pelo método do perfil instantâneo

A condutividade hidráulica do solo K é uma propriedade que expressa a facilidade com que a água nele se movimenta; é importante para o manejo do solo, para a produção das culturas e para a preservação do solo e do ambiente. A determinação da condutividade hidráulica pode ser feita por métodos de laboratório e de campo; o primeiro, com maior controle das condições experimentais e, o segundo, com menor grau de perturbação no solo. Dentre os métodos de campo, o mais utilizado é o do perfil instantâneo, tanto o original como o modificado, em que se obtém teoricamente uma relação entre o conteúdo de água θ e o tempo de redistribuição t, supondo gradiente de potencial total igual a um. No intuito de realizar uma análise mais profunda desse método, foi desenvolvido um estudo com o objetivo de verificar a possibilidade de se obter uma relação do conteúdo de água no solo, em função do tempo de redistribuição sem a suposição da existência de gradiente de potencial total unitário. O estudo foi desenvolvido com dados de quatro solos e a validação da relação proposta foi realizada por comparação da função K(θ) obtida a partir dela com a alcançada tradicionalmente. Com base na análise dos resultados, pode-se concluir que a relação proposta entre θ e t para o método do perfil instantâneo apresentou-se válida e que o gradiente de potencial total pode influir tanto o parâmetro γ como o parâmetro K0 da equação K = K0 exp [γ (θ-θ0)], ajustada aos dados experimentais. No caso específico dos solos avaliados neste trabalho, o gradiente de potencial teve baixa influência no parâmetro γ, comparada à sua influência no parâmetro K0, levando à possibilidade de uso de um gradiente de potencial total médio para obtenção da função K(θ). Além disso, observou-se que o procedimento para o cálculo da densidade de fluxo a partir da curva da armazenagem em função do tempo de redistribuição da água é muito mais simples do que o procedimento original utilizado no método do perfil instantâneo.

Plasticity of protein expression during culture of fetal skin cells.

In order to gain insight into the biology of fetal skin during culture, cellular proteins were studied during four culture passages (P00, P01, P04 as well as P10) using high-resolution two-dimensional (2-D) gel electrophoresis and mass spectrometry (MS). Bioinformatic analyses were focused on a region of each gel corresponding to pI between 4 and 8 and M(r) from 8000 to 35 000. In this area, 373 +/- 42 spots were detected (N = 18). Twenty-six spots presented an integrated intensity that increased in the higher passages, whereas five spots showed a progressively lower intensity in subsequent passaging. MS analysis was performed on spots that were unambiguously identified on preparative 2-D gels. Among the 26 spots showing an increased size between P00 and P10, 9 were identified, and corresponded to 3 proteins: (i) peptidyl-prolyl cis-trans isomerase A (P05092; cyclophilin A or cyclosporin A-binding protein), (ii) triosephosphate isomerase (P00938), and (iii) enoyl-CoA hydratase (P30084). Among these nine identified spots, three were absent at P00, but were present at P10. They corresponded to isoforms of peptidyl-prolyl cis-trans isomerase and triosephosphate isomerase, respectively. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) analyses of the acidic isoforms of triosephosphate isomerase showed modifications of cysteine residues to cysteic acid. All these isoforms were clearly present in the skin cells of a 4-year-old child, as well as in skin cells from a 80-year-old man, at P00. These observations probably reflect either an oxidative stress related to cell culture, or, alternatively, maturation, differentiation and the aging of the cells.

Neuronal nitric oxide synthase does not contribute to the modulation of pulmonary vascular tone in fetal lambs with congenital diaphragmatic hernia (nNOS in CDH lambs).

AIM: The aim of this study was to determine the presence of the neuronal nitric oxide synthase (nNOS) in near full-term lambs with congenital diaphragmatic hernia (CDH) and its role in the modulation of pulmonary vascular basal tone. METHODS: We surgically created diaphragmatic hernia on the 85th day of gestation. On the 135th, catheters were used to measure pulmonary pressure and blood flow. We tested the effects of 7-nitroindazole (7-NINA), a specific nNOS antagonist and of N-nitro-L-arginine (L-NNA), a nonspecific nitric oxide synthase antagonist. In vitro, we tested the effects of the same drugs on isolated pulmonary vessels. The presence of nNOS protein in the lungs was detected by Western blot analysis. RESULTS: Neither 7-NINA nor L-NNA modified pulmonary vascular basal tone in vivo. After L-NNA injection, acetylcholine (ACh) did not decrease significantly pulmonary vascular resistance (PVR). In vitro, L-NNA increased the cholinergic contractile-response elicited by electric field stimulation (EFS) of vascular rings from lambs with diaphragmatic hernia. CONCLUSION: We conclude that nNOS protein is present in the lungs and pulmonary artery of near full-term lamb fetuses with diaphragmatic hernia, but that it does not contribute to the reduction of pulmonary vascular tone at birth

A post-processing pipeline to reconstruct the developing fetal brain using low-resolution MRI

Introduction. Development of the fetal brain surfacewith concomitant gyrification is one of the majormaturational processes of the human brain. Firstdelineated by postmortem studies or by ultrasound, MRIhas recently become a powerful tool for studying in vivothe structural correlates of brain maturation. However,the quantitative measurement of fetal brain developmentis a major challenge because of the movement of the fetusinside the amniotic cavity, the poor spatial resolution,the partial volume effect and the changing appearance ofthe developing brain. Today extensive efforts are made todeal with the âeurooepost-acquisitionâeuro reconstruction ofhigh-resolution 3D fetal volumes based on severalacquisitions with lower resolution (Rousseau, F., 2006;Jiang, S., 2007). We here propose a framework devoted tothe segmentation of the basal ganglia, the gray-whitetissue segmentation, and in turn the 3D corticalreconstruction of the fetal brain. Method. Prenatal MRimaging was performed with a 1-T system (GE MedicalSystems, Milwaukee) using single shot fast spin echo(ssFSE) sequences in fetuses aged from 29 to 32gestational weeks (slice thickness 5.4mm, in planespatial resolution 1.09mm). For each fetus, 6 axialvolumes shifted by 1 mm were acquired (about 1 min pervolume). First, each volume is manually segmented toextract fetal brain from surrounding fetal and maternaltissues. Inhomogeneity intensity correction and linearintensity normalization are then performed. A highspatial resolution image of isotropic voxel size of 1.09mm is created for each fetus as previously published byothers (Rousseau, F., 2006). B-splines are used for thescattered data interpolation (Lee, 1997). Then, basalganglia segmentation is performed on this superreconstructed volume using active contour framework witha Level Set implementation (Bach Cuadra, M., 2010). Oncebasal ganglia are removed from the image, brain tissuesegmentation is performed (Bach Cuadra, M., 2009). Theresulting white matter image is then binarized andfurther given as an input in the Freesurfer software(http://surfer.nmr.mgh.harvard.edu/) to provide accuratethree-dimensional reconstructions of the fetal brain.Results. High-resolution images of the cerebral fetalbrain, as obtained from the low-resolution acquired MRI,are presented for 4 subjects of age ranging from 29 to 32GA. An example is depicted in Figure 1. Accuracy in theautomated basal ganglia segmentation is compared withmanual segmentation using measurement of Dice similarity(DSI), with values above 0.7 considering to be a verygood agreement. In our sample we observed DSI valuesbetween 0.785 and 0.856. We further show the results ofgray-white matter segmentation overlaid on thehigh-resolution gray-scale images. The results arevisually checked for accuracy using the same principlesas commonly accepted in adult neuroimaging. Preliminary3D cortical reconstructions of the fetal brain are shownin Figure 2. Conclusion. We hereby present a completepipeline for the automated extraction of accuratethree-dimensional cortical surface of the fetal brain.These results are preliminary but promising, with theultimate goal to provide âeurooemovieâeuro of the normal gyraldevelopment. In turn, a precise knowledge of the normalfetal brain development will allow the quantification ofsubtle and early but clinically relevant deviations.Moreover, a precise understanding of the gyraldevelopment process may help to build hypotheses tounderstand the pathogenesis of several neurodevelopmentalconditions in which gyrification have been shown to bealtered (e.g. schizophrenia, autismâeuro¦). References.Rousseau, F. (2006), 'Registration-Based Approach forReconstruction of High-Resolution In Utero Fetal MR Brainimages', IEEE Transactions on Medical Imaging, vol. 13,no. 9, pp. 1072-1081. Jiang, S. (2007), 'MRI of MovingSubjects Using Multislice Snapshot Images With VolumeReconstruction (SVR): Application to Fetal, Neonatal, andAdult Brain Studies', IEEE Transactions on MedicalImaging, vol. 26, no. 7, pp. 967-980. Lee, S. (1997),'Scattered data interpolation with multilevel B-splines',IEEE Transactions on Visualization and Computer Graphics,vol. 3, no. 3, pp. 228-244. Bach Cuadra, M. (2010),'Central and Cortical Gray Mater Segmentation of MagneticResonance Images of the Fetal Brain', ISMRM Conference.Bach Cuadra, M. (2009), 'Brain tissue segmentation offetal MR images', MICCAI.

PROPRIEDADES MECÂNICAS E PERMEABILIDADE AO AR EM TOPOSSEQUÊNCIA ARGISSOLO-GLEISSOLO: VARIAÇÃO NO PERFIL E EFEITO DE COMPRESSÃO

Uma topossequência apresenta solos com características estruturais e morfológicas distintas que podem alterar a susceptibilidade à deformação estrutural em curtas distâncias espaciais. Os objetivos deste estudo foram avaliar a capacidade de suporte de carga e a suscetibilidade à compactação e mensurar o efeito que cargas acima e abaixo da pressão de preconsolidação causam na permeabilidade ao ar de solos numa topossequência da Depressão Central do Rio Grande do Sul, Brasil. Amostras indeformadas foram coletadas nos horizontes de três perfis de Argissolos (Ap, A1, AB, BA, Bt1 e Bt2; Ap, A1, A2, AB, BA, Bt1 e Bt2; e Ap, A1, BA, Bt1 e Bt2) e dois de Gleissolos (A1, A2, Bg; A, Bg e Cg), no longo de uma topossequência. Essas amostras foram submetidas ao teste de compressão uniaxial, sendo avaliada a permeabilidade ao ar antes e após compressão. Na condição de capacidade de campo, os Gleissolos apresentaram menor suscetibilidade à compactação e maior capacidade de suporte de carga que os Argissolos. O teor de argila esteve diretamente correlacionado com a capacidade de suporte de carga. Portanto, foi inversamente proporcional à suscetibilidade à compactação, exceto em condições de elevada umidade do solo quando a água lubrificou as superfícies aumentando a susceptibilidade à compactação de quaisquer solos. Até 25 kPa de carga ao solo não resultou degradação física do solo, mas quando foram aplicadas cargas de 200 kPa, mesmo na condição de capacidade de campo, houve redução significativa do volume de macroporos e porosidade total em níveis inferiores ao limite crítico (0,10 m3 m-3).

Prenatal detection of congenital renal malformations by fetal ultrasonographic examination: an analysis of 709,030 births in 12 European countries.

The study was performed to evaluate the prevalence of prenatal ultrasound diagnoses for renal anomalies in 20 registries of 12 European countries, and to compare the different prenatal scanning policies. Standardized data were acquired from 709,030 livebirths, stillbirths, and induced abortions during the study period of 2.5 years and transmitted for central analysis. At least one renal malformation was diagnosed in 1130 infants and fetuses. Prenatal diagnosis (PD) was given in 81.8% of all cases, 29% of these pregnancies were terminated. The highest detection rate was reported for unilateral multicystic dysplastic kidneys with 97% (102/105). An early diagnosis was documented for exstrophy of bladder at a mean gestational age of 18.5 weeks. Dilatations of the upper urinary tract were seen late in pregnancy at 28.3 weeks. Terminations of pregnancies (TOP) were performed in 67% (58/86) of the detected bilateral renal agenesis/dysgenesis, but only 4% of the unilateral multicystic dysplastic renal malformations (4/102). In about 1/3 of the cases, renal malformations are within the category of associated malformations, which include multiple non-syndromal malformations, chromosomal aberrations, and non-chromosomal syndromes. Renal malformations were detected in 2/3 of the associated category by the first prenatal ultrasound scan. Detection rates vary in the different countries of the European community due to diverse policies, ethical, and religious background. Countries with no routine ultrasound show the lowest rates in detection, and termination of pregnancy. Prenatally detected renal malformations should result in a careful examination for further anomalies. Prenatal ultrasound fulfills the needs of screening examinations and is a good tool in detecting lethal and severe renal malformations.

Role of ATP-dependent potassium channels in pulmonary vascular tone of fetal lambs with congenital diaphragmatic hernia.

High mortality in newborn babies with congenital diaphragmatic hernia (CDH) is principally due to persistent pulmonary hypertension. ATP-dependent potassium (K(ATP)) channels might modulate pulmonary vascular tone. We have assessed the effects of Pinacidil, a K(ATP) channel opener, and glibenclamide (GLI), a K(ATP) channel blocker, in near full-term lambs with and without CDH. In vivo, pulmonary hemodynamics were assessed by means of pressure and blood flow catheters. In vitro, we used isolated pulmonary vessels and immunohistochemistry to detect the presence of K(ATP) channels in pulmonary tissue. In vivo, pinacidil (2 mg) significantly reduced pulmonary vascular resistance (PVR) in both controls and CDH animals. GLI (30 mg) significantly increased pulmonary arterial pressure (PAP) and PVR in control animals only. In vitro, pinacidil (10 microM) relaxed, precontracted arteries from lambs with and without CDH. GLI (10(-5) microM) did not raise the basal tone of vessels. We conclude that activation of K(ATP) channels could be of interest to reduce pulmonary vascular tone in fetal lambs with CDH, a condition often associated with persistent pulmonary hypertension of the newborn.