Análisis de las barreras para la unificación de una Historia Clínica Electrónica -HCE- en Colombia

Objetivo: Identificar las barreras para la unificación de una Historia Clínica Electrónica –HCE- en Colombia. Materiales y Métodos: Se realizó un estudio cualitativo. Se realizaron entrevistas semiestructuradas a profesionales y expertos de 22 instituciones del sector salud, de Bogotá y de los departamentos de Cundinamarca, Santander, Antioquia, Caldas, Huila, Valle del Cauca. Resultados: Colombia se encuentra en una estructuración para la implementación de la Historia Clínica Electrónica Unificada -HCEU-. Actualmente, se encuentra en unificación en 42 IPSs públicas en el departamento de Cundinamarca, el desarrollo de la HCEU en el país es privado y de desarrollo propio debido a las necesidades particulares de cada IPS. Conclusiones: Se identificaron barreras humanas, financieras, legales, organizacionales, técnicas y profesionales en los departamentos entrevistados. Se identificó que la unificación de la HCE depende del acuerdo de voluntades entre las IPSs del sector público, privado, EPSs, y el Gobierno Nacional.

Evaluation of Eph receptor and ephrin expression within the human cornea and limbus

Eph receptor tyrosine kinases and their ligands, the ephrins, regulate the development and maintenance of multiple organs but little is known about their potential role within the cornea. The purpose of this study was to perform a thorough investigation of Eph/ephrin expression within the human cornea including the limbal stem cell niche. Initially, immunohistochemistry was performed on human donor eyes to determine the spatial distribution of Eph receptors and ephrins in the cornea and limbus. Patterns of Eph/ephrin gene expression in (1) immortalised human corneal endothelial (B4G12) or corneal epithelial (HCE-T) cell lines, and (2) primary cultures of epithelial or stromal cells established from the corneal limbus of cadaveric eye tissue were then assessed by reverse transcription (RT) PCR. Limbal epithelial or stromal cells from primary cultures were also assessed for evidence of Eph/ephrin-reactivity by immunofluorescence. Immunoreactivity for ephrinA1 and EphB4 was detected in the corneal endothelium of donor eyes. EphB4 was also consistently detected in the limbal and corneal epithelium and in cells located in the stroma of the peripheral cornea. Expression of multiple Eph/ephrin genes was detected in immortalised corneal epithelial and endothelial cell lines. Evidence of Eph/ephrin gene expression was also demonstrated in primary cultures of human limbal stromal (EphB4, B6; ephrinA5) and epithelial cells (EphA1, A2; ephrinA5, B2) using both RT-PCR and immunofluorescence. The expression of Eph receptors and ephrins within the human cornea and limbus is much wider than previously appreciated and suggests multiple potential roles for these molecules in the maintenance of normal corneal architecture.

Assessment of freestanding membranes prepared from Antheraea pernyi silk fibroin as a potential vehicle for corneal epithelial cell transplantation

Freestanding membranes created from Bombyx mori silk fibroin (BMSF) offer a potential vehicle for corneal cell transplantation since they are transparent and support the growth of human corneal epithelial cells (HCE). Fibroin derived from the wild silkworm Antheraea pernyi (APSF) might provide a superior material by virtue of containing putative cell- attachment sites that are absent from BMSF. Thus we have investigated the feasibility of producing transparent, freestanding membranes from APSF and have analysed the behaviour of HCE cells on this material. No significant differences in cell numbers or phenotype were observed in short term HCE cell cultures established on either fibroin. Production of transparent freestanding APSF membranes, however, proved to be problematic as cast solutions of APSF were more prone to becoming opaque, displayed significantly lower permeability and were more brittle than BMSF-membranes. Cultures of HCE cells established on either membrane developed a normal stratified morphology with cytokeratin pair 3/12 being immuno-localized to the superficial layers. We conclude that while it is feasible to produce transparent freestanding membranes from APSF, the technical difficulties associated with this biomaterial, along with an absence of enhanced cell growth, currently favours the continued development of BMSF as a preferred vehicle for corneal cell transplantation. Nevertheless, it remains possible that refinement of techniques for processing APSF might yet lead to improvements in the handling properties and performance of this material.

Treatment of silk fibroin with poly(ethylene glycol) for the enhancement of corneal epithelial cell growth

A silk protein, fibroin, was isolated from the cocoons of the domesticated silkworm (Bombyx mori) and cast into membranes to serve as freestanding templates for tissue-engineered corneal cell constructs to be used in ocular surface reconstruction. In this study, we sought to enhance the attachment and proliferation of corneal epithelial cells by increasing the permeability of the fibroin membranes and the topographic roughness of their surface. By mixing the fibroin solution with poly(ethylene glycol) (PEG) of molecular weight 300 Da, membranes were produced with increased permeability and with topographic patterns generated on their surface. In order to enhance their mechanical stability, some PEG-treated membranes were also crosslinked with genipin. The resulting membranes were thoroughly characterized and compared to the non-treated membranes. The PEG-treated membranes were similar in tensile strength to the non-treated ones, but their elastic modulus was higher and elongation lower, indicating enhanced rigidity. The crosslinking with genipin did not induce a significant improvement in mechanical properties. In cultures of a human-derived corneal epithelial cell line (HCE-T), the PEG treatment of the substratum did not improve the attachment of cells and it enhanced only slightly the cell proliferation in the longer term. Likewise, primary cultures of human limbal epithelial cells grew equally well on both non-treated and PEG-treated membranes, and the stratification of cultures was consistently improved in the presence of an underlying culture of irradiated 3T3 feeder cells, irrespectively of PEG-treatment. Nevertheless, the cultures grown on the PEG-treated membranes in the presence of feeder cells did display a higher nuclear-to-cytoplasmic ratio suggesting a more proliferative phenotype. We concluded that while the treatment with PEG had a significant effect on some structural properties of the B. mori silk fibroin (BMSF) membranes, there were minimal gains in the performance of these materials as a substratum for corneal epithelial cell growth. The reduced mechanical stability of freestanding PEG-treated membranes makes them a less viable choice than the non-treated membranes.

Role of Basement Membrane and Extracellular Matrix Proteins in the Adhesion and Spreading of Immortalized Human Corneal Epithelial Cells

The repair of corneal wounds requires both epithelial cell adhesion and migration. Basement membrane (BM) and extracellular matrix (ECM) proteins function in these processes via integrin and non-integrin receptors. We have studied the adhesion, spreading and migration of immortalized human corneal epithelial (HCE) cells and their interactions with the laminins (Lms), fibronectins and tenascins produced. Human corneal BM expresses Lms-332 and -511, while Lm-111 was not found in these experiments. HCE cells produced both processed and unprocessed Lm-332, whereas neither Lm-111 nor Lm-511 was produced. Because HCE cells did not produce Lm-511, although it was present in corneal BM, we suggest that Lm-511 is produced by stromal keratocytes. The adhesion of HCE cells to Lms-111, -332 and -511 was studied first by determining the receptor composition of HCE cells and then by using quantitative cell adhesion assays. Immunofluorescence studies revealed the presence of integrin α2, α3, α6, β1 and β4 subunits. Among the non-integrin receptors, Lutheran (Lu) was found on adhering HCE cells. The cells adhered via integrin α3β1 to both purified human Lms-332 and -511 as well as to endogenous Lm-332. However, only integrin β1 subunit functioned in HCE cell adhesion to mouse Lm-111. The adhesion of HCE cells to Lm-511 was also mediated by Lu. Since Lm-511 did not induce Lu into focal adhesions in HCE cells, we suggest that Lm-511 serves as an ECM ligand enabling cell motility. HCE cells produced extradomain-A fibronectin, oncofetal fibronectin and tenascin-C (Tn-C), which are also found during corneal wound healing. Monoclonal antibodies (MAbs) against integrins α5β1 and αvβ6 as well as the arginine-glycine-aspartic acid (RGD) peptide inhibited the adhesion of HCE cells to fibronectin. Although the cells did not adhere to Tn-C, they adhered to the fibronectin/Tn-C coat and were then more efficiently inhibited by the function-blocking MAbs and RGD peptide. During the early adhesion, HCE cells codeposited Lm-332 and the large subunit of tenascin-C (Tn-CL) beneath the cells via the Golgi apparatus and microtubules. Integrin β4 subunit, which is a hemidesmosomal component, did not mediate the early adhesion of HCE cells to Lm-332 or Lm-332/Tn-C. Based on these results, we suggest that the adhesion of HCE cells is initiated by Lm-332 and modulated by Tn-CL, as it has been reported to prevent the assembly of hemidesmosomes. Thereby, Tn-CL functions in the motility of HCE cells during wound healing. The different distribution of processed and unprocessed Lm-332 in adhering, spreading and migrating HCE cells suggests a distinct role for these isoforms. We conclude that the processed Lm-332 functions in cell adhesion, whereas the unprocessed Lm-332 participates in cell spreading and migration.

Estudio de los sueros ricos en factores de crecimiento y de su efecto sobre células de epitelio corneal

Objetivos: Estudiar cómo afecta a la concentración de determinados factores de crecimiento presentes en los sueros la filtración (utilizado como método de esterilización) y el tratamiento por calor (utilizado para la inactivación del complemento). Además de estudiar el efecto de un bioadhesivo (ácido hialurónico, HaNa), aplicado solo o conjuntamente con el suero rico en factores de crecimiento (s-PRGF), sobre la capacidad de las células de epitelio corneal (HCE) para proliferar y migrar. Materiales y métodos: Se midió mediante kits ELISA comerciales la concentración en las diferentes condiciones de filtración y calentamiento de las siguientes biomoléculas EGF (Epidermal Growth Factor), VEGF (Vascular Endothelial Growth Factor), HGF (Hepatocyte Growth Factor), PDGF (Platelet-derived Growth Factor) y la Fibronectina. Teniendo en cuenta el papel de la proliferación y migración celular en los procesos de cicatrización se han realizado dos ensayos diferentes in vitro: un ensayo MTT para estudiar la viabilidad y la proliferación celular y el método de la herida (Scratch wound-healing assay) para determinar la capacidad migratoria de células bajo ciertos tratamientos: BSA (Bovine Serum Albumin) al 1% como control, FBS (Fetal Bovine Serum) al 10%, s-PRGF al 45%, s-PRGF al 45% con HaNa 0,1% y HaNa al 0,1% Resultados: En el caso de la filtración, se observa una mayor pérdida de factores utilizando un filtro con una membrana de PVDF (Durapore®) para todos los factores estudiados. El calentamiento produce una reducción de la concentración superior al 50% en el caso del HGF y EGF, manteniéndose constante en el caso del VEGF.La mezcla de diferentes muestras con el complemento inactivado para formar un pool no presenta cambios en la concentración al compararlo con la media de las muestras utilizadas. Por tanto, la utilización de un pool del hemoderivado no supone perdida de factores de crecimiento, haciendo de ello un procedimiento perfectamente aceptable para los ensayos celulares. El tratamiento con s-PRGF y el combinado con el bioadhesivo promueven la proliferación y migración de las células de epitelio corneal humano(HCE) in vitro de manera similar, no encontrándose diferencias estadísticamente significativas entre ambos. Conclusiones: La adicción del bioadhesivo no produce efecto tóxico en las células, sin embargo, no se han encontrado efectos beneficiosos en cuanto a proliferación y migración se refiere. A este respecto, creemos que hay que dar un paso más haciendo comprobaciones in vivo, ya que, a diferencia de la experimentación in vitro los componentes de los hemoderivados no están indefinidamente en contacto con las células sino por un espacio de tiempo muy reducido. Por ello, la concentración de factores de crecimiento en la aplicación in vivo es especialmente importante, y no sería conveniente reducirla mediante procedimientos físicos como la filtración o el calentamiento.

黄海葵神经毒素基因和牙鲆孵化酶基因分子克隆及相关生物技术研究

聚合酶链反应（PCR）是体外 DNA 扩增技术，用于扩增确定长度的特异 DNA 片段或从少量复合性模板中扩增目的的 DNA 序列。随着聚合酶链式反应技术的不断革新和仪器设备的优化，聚合酶链式反应已经成为分子生物学领域中广泛应用的技术，并对以分子生物学为基础的相关领域产生重要影响。本文研究了利用聚合酶链式反应分别克隆黄海葵神经毒素基因和牙鲆孵化酶基因。海葵神经毒素是一类海洋多肽毒素，它们能广泛作用于可激动细胞的电压门控的钠离子通道，并且有心肌刺激活性。在所有已知海葵毒素中，来源于黄海葵的 Anthopleurin-B 拥有最强的心肌刺激活性，因此 Anthopleurin-B 被广泛认为是未来设计强心药物的理想分子模型。孵化酶是特异存在于鱼类胚胎孵化腺中的一种金属蛋白酶。由于孵化酶存在时空特异性，它被认为是从细胞水平和分子水平研究胚胎分化的良好探针，克隆其基因将促进胚胎发育与分化的系统研究。海葵组织存在大量的粘我糖物质，目前采用的许多标准方法提取海葵组织中核酸的效果均不理想。在已有的核酸提取方法的基础上，西文设计了一种新方案用于分离总 RNA 和基因组 DNA ，其要点为：用强变性剂异硫氰酸胍匀浆海葵组织，在一定离子强度下，用表面活性剂溴化十六烷基三甲基胺（CTAB）处理匀浆液，并有氯仿抽提，可将粘多糖从核酸溶液中分离；或在一定离子强度下，通过二乙胺乙基（DEAE）纤维素层析柱，将多糖和其它杂质分离。结果表明这种新组合的方法效果良好，获得的总 RNA 和基因组 DNA 在 260nm 和 280nm 紫外吸光度的比值分别为 1.96－1.97 和 1.73－1.75。同时总 RNA 的完整性良好，基因组 DNA 为大片段。根据黄海葵神经毒素 Anthopleurin-B C 末端氨基酸序列密码子简并度低的特点，本文设计了四种方案，用聚合酶链式反应扩增 Anthopleurin-B 的 cDNA 序列。其中用连接锚定聚合酶链式反应，即末端 DNA 快速扩增技术（RACE）成功扩增了 Anthopleurin-B 的全长 cDNA 序列，表明末端 DNA 快速扩增技术适合于较小的多肽或蛋白基因序列的扩增。本研究还修改了胚胎细胞总 RNA 标准提取和纯化方法，删除了胚胎细胞匀浆步骤，改为在缓冲溶液中，于 55℃ 用高浓度蛋白酶 K 裂解胚胎细胞，从而减少细胞核的破损，用苯酚／氯仿抽提将细胞核除去。获得的总 RNA 不受基因组 DNA 的污染，RNA 在 260nm 和 280nm 紫外吸光度的比值为 1.93－1.99 之间。用反转录聚合酶链式反应获得了目的基因序列，证明该方法切实可行。通过反转录聚合酶链式反应获得了牙鲆孵化酶部分 cDNA 克隆，经过 DNA 测序并且与青鳉孵化酶（HCE）比较，两者之间的以应 cDNA 序列的同源性分别为 86.0%, 推演氨基酸序列的同源性为 80.7%，由此可知，两者之间的同源性确实很高，因此，我们推测在硬骨鱼纲中，孵化酶基因可能是一类保守性很强的 DNA 序列。

Plasma parameter characterization of a reflex plasma source operating in oxygen

A reflex discharge plasma, obtained as a hybrid between a Penning discharge plasma (PDP) and a hollow-cathode discharge (HCD) plasma, is analysed as a possible direction-current, high-density plasma source. The experiment is run in oxygen at pressures of 10 mTorr and 1 mTorr, and for discharge currents of 100 to 200 mA. Although the gas pressure is considerably lower than those used in HCDs, the hollow-cathode effect (HCE) occurs for current levels higher than 100 mA and leads to plasma densities comparable with those obtained using inductive plasma sources. The presence of a constant magnetic field leads to the enhancement of electron emission from cathodes under ion bombardment, and to the decreasing of the ion loss by diffusion to the wall.

Are coffee silverskin extracts safe for topical use? An in vitro and in vivo approach

Recent changes in regulatory requirements and social views on animal testing have incremented the development of reliable alternative tests for predicting skin and ocular irritation potential of products based on new raw materials. In this regard, botanical ingredients used in cosmetic products are among those materials, and should be carefully reviewed concerning the potential presence of irritant constituents. In particular, cosmetic products used on the face, in vicinity of the eyes or that may come in contact with mucous membranes, should avoid botanical ingredients that contain, or are suspected to contain, such ingredients. In this study, we aimed to evaluate the effect of a new cosmetic ingredient, namely, coffee silverskin (CS), with an in vitro skin and ocular irritation assay using reconstructed human epidermis, EpiSkin™, and human corneal epithelial model, SkinEthics™ HCE, and an in vivo assay. Three different extracts of CS were evaluated. The histology of the models after extracts applications was analysed. The in vitro results demonstrated that extracts were not classified as irritant and the histological analyses proved that extracts did not affect both models structure. The content of caffeine, 5-hydroxymethyl furfural and chlorogenic acid was quantified after the epidermal assay. The in vivo test carried out with the most promising extract (hydroalcoholic) showed that, with respect to irritant effects, these extracts can be regarded as safe for topical application.

Prospecção de moléculas químicas com propriedades alelopáticas em Acacia mangium (Willd.)

Muito se tem estudado sobre o potencial que algumas plantas têm de inibir o desenvolvimento de outras plantas. Em busca de alternativas para reduzir a dependência de herbicidas sintéticos, diminuindo os danos ambientais e prejuízos à saúde humana e procurando alternativas à resistência aos herbicidas do mercado, os compostos naturais oferecem excelentes perspectivas. Este trabalho isola, identifica as estruturas e caracteriza a atividade alelopática de duas substâncias químicas produzidas pela espécie Acacia mangium. Para isso, procede-se com solução hidroalcoólica (7:3) extração exaustiva das folhas secas caídas, folhas verdes, raízes e sementes dessa espécie, passando-se pela recuperação do etanol (evaporador rotativo) e liofilização dos extratos para a desidratação e obtenção do extrato bruto hidroalcoólico (EBHA). Para identificar qual parte da planta possui maior potencial alelopático, é preparado um bioensaio com a utilização de solução hidroalcoólica (7:1) de cada EBHA em concentração de 1%. É determinado o potencial inibitório sobre a germinação, desenvolvimento do hipocótilo e desenvolvimento da radícula das sementes das plantas daninhas malícia (Mimosa pudica), mata-pasto (Senna alata) e puerária (Pueraria phaseoloides). 10 g do EBHA das folhas caídas são submetidas à CCVU para separação das substâncias, a partir do qual são obtidas quatro reuniões de substâncias semelhantes. Três delas são refracionadas em colunas menores (R1’, R2- R3’, R4’) e da coluna R1’ são isoladas as substâncias Lupenona e Lupeol. Nos bioensaios com os extratos, o das folhas secas apresenta as inibições mais acentuadas, notadamente sobre a germinação (99%). Nesta característica, mata-pasto é a espécie de menor sensibilidade, com inibições abaixo de 12%. São realizados bioensaios com as substâncias isoladas e em par (solubilizadas em clorofórmio), na concentração de 140 ppm, sobre as sementes de Mimosa pudica e Senna obtusifolia. Para a germinação das sementes, as substâncias em todos os tratamentos não evidenciam qualquer efeito. Para o desenvolvimento da radícula, ambas as substâncias, isoladamente, promovem inibições em torno de 40% sobre duas espécies de plantas daninhas, enquanto que em par, observa-se que há antagonismo entre as substâncias, já que os resultados são inferiores, ficando ao redor de 30%. Com relação ao crescimento do hipocótilo a inibição em todos os tratamentos fica em torno de 15% e não há diferença significativa entre os resultados. É testado também o efeito do pH (3,0 e 9,0) na atividade alelopática das substâncias, isoladas e em par, sobre a germinação das sementes de malícia e observa-se que há interação para os fatores pH e germinação, havendo maior atividade inibitória da lupenona em condições ácidas e do lupeol em condições alcalinas. Não há efeito aditivo ou negativo quando da associação das substâncias. É realizada também análise por HPLC nos extratos brutos hidroalcoólicos de três partes da planta Acacia mangium para a detecção dos flavonóides catequina e epicatequina (substâncias com comprovado efeito alelopático), sendo que a epicatequina é a substância com absorção para os espetros selecionados, mostrando que esta substância pode ter contribuído para os resultados expressivos observados nos primeiros bioensaios com os extratos brutos das partes das plantas.

Percutaneous treatment of biliary cast syndrome after orthotopic liver transplantation: comparison of mechanical versus hydraulic rheolytic cast extraction

Biliary cast syndrome (BCS) is the presence of casts within the intrahepatic or extrahepatic biliary system after orthotopic liver transplantation. Our work compares two percutaneous methods for BCS treatment: the mechanical cast-extraction technique (MCE) versus the hydraulic cast-extraction (HCE) technique using a rheolytic system.

Detection of surfactant proteins A and D in human tear fluid and the human lacrimal system

PURPOSE: To evaluate the expression and presence of surfactant protein (SP) A and SP-D in the lacrimal apparatus, at the ocular surface, and in tears in healthy and pathologic states. METHODS: Expression of mRNA for SP-A and SP-D was analyzed by RT-PCR in healthy lacrimal gland, conjunctiva, cornea, and nasolacrimal ducts as well as in a spontaneously immortalized conjunctival epithelial cell line (HCjE; IOBA-NHC) and a SV40-transfected cornea epithelial cell line (HCE). Deposition of SP-A and SP-D was determined by Western blot, dot blot, and immunohistochemistry in healthy tissues, in tears, aqueous humor, and in sections of different corneal abnormalities (keratoconus, herpetic keratitis, and Staphylococcus aureus-based ulceration). Cell lines were stimulated with different cytokines and bacterial components and were analyzed for the production of SP-A and SP-D by immunohistochemistry. RESULTS: The presence of SP-A and SP-D on mRNA and protein levels was evidenced in healthy lacrimal gland, conjunctiva, cornea, and nasolacrimal duct samples. Moreover, both proteins were present in tears but were absent in aqueous humor. Immunohistochemistry revealed the production of both peptides by acinar epithelial cells of the lacrimal gland and epithelial cells of the conjunctiva and nasolacrimal ducts, whereas goblet cells revealed no reactivity. Healthy cornea revealed weak reactivity on epithelial surface cells only. In contrast, SP-A and SP-D revealed strong reactivity in patients with herpetic keratitis and corneal ulceration surrounding lesions and in several immigrated defense cells. Reactivity in corneal epithelium and endothelium was also seen in patients with keratoconus. Cell culture experiments revealed that SP-A and SP-D are produced by both epithelial cell lines without and after stimulation with cytokines and bacterial components. CONCLUSIONS: These results show that SP-A, in addition to SP-D, is a peptide of the tear film. Based on the known direct and indirect antimicrobial effects of collectins, the surfactant-associated proteins A and D seem to be involved in several ocular surface diseases.

Meprins, membrane-bound and secreted astacin metalloproteinases

The astacins are a subfamily of the metzincin superfamily of metalloproteinases. The first to be characterized was the crayfish enzyme astacin. To date more than 200 members of this family have been identified in species ranging from bacteria to humans. Astacins are involved in developmental morphogenesis, matrix assembly, tissue differentiation and digestion. Family members include the procollagen C-proteinase (BMP1, bone morphogenetic protein 1), tolloid and mammalian tolloid-like, HMP (Hydra vulgaris metalloproteinase), sea urchin BP10 (blastula protein) and SPAN (Strongylocentrotus purpuratus astacin), the 'hatching' subfamily comprising alveolin, ovastacin, LCE, HCE ('low' and 'high' choriolytic enzymes), nephrosin (from carp head kidney), UVS.2 from frog, and the meprins. In the human and mouse genomes, there are six astacin family genes (two meprins, three BMP1/tolloid-like, one ovastacin), but in Caenorhabditis elegans there are 40. Meprins are the only astacin proteinases that function on the membrane and extracellularly by virtue of the fact that they can be membrane-bound or secreted. They are unique in their domain structure and covalent subunit dimerization, oligomerization propensities, and expression patterns. They are normally highly regulated at the transcriptional and post-translational levels, localize to specific membranes or extracellular spaces, and can hydrolyse biologically active peptides, cytokines, extracellular matrix (ECM) proteins and cell-surface proteins. The in vivo substrates of meprins are unknown, but the abundant expression of these proteinases in the epithelial cells of the intestine, kidney and skin provide clues to their functions.