RESUMEN
Autoimmune diseases are characterized by a breakdown of immune tolerance partly due to environmental factors. The short-chain fatty acid acetate, derived mostly from gut microbial fermentation of dietary fiber, promotes antiinflammatory Tregs and protects mice from type 1 diabetes, colitis, and allergies. Here, we show that the effects of acetate extend to another important immune subset involved in tolerance, the IL-10-producing regulatory B cells (B10 cells). Acetate directly promoted B10 cell differentiation from mouse B1a cells both in vivo and in vitro. These effects were linked to metabolic changes through the increased production of acetyl-coenzyme A, which fueled the TCA cycle and promoted posttranslational lysine acetylation. Acetate also promoted B10 cells from human blood cells through similar mechanisms. Finally, we identified that dietary fiber supplementation in healthy individuals was associated with increased blood-derived B10 cells. Direct delivery of acetate or indirect delivery via diets or bacteria that produce acetate might be a promising approach to restore B10 cells in noncommunicable diseases.
Asunto(s)
Acetatos/metabolismo , Acetatos/farmacología , Artritis Experimental/terapia , Linfocitos B Reguladores/efectos de los fármacos , Fibras de la Dieta/farmacología , Acetatos/sangre , Acetilcoenzima A/metabolismo , Acetilación , Animales , Artritis Experimental/inmunología , Linfocitos B Reguladores/fisiología , Linfocitos B Reguladores/trasplante , Diferenciación Celular/efectos de los fármacos , Ácidos Grasos Volátiles/metabolismo , Ácidos Grasos Volátiles/farmacología , Femenino , Humanos , Interleucina-10 , Masculino , Ratones Endogámicos C57BL , Ratones Mutantes , Neutrófilos/citología , Neutrófilos/efectos de los fármacos , Receptores Acoplados a Proteínas G/genéticaRESUMEN
BACKGROUND: The Spanish Family Medicine National Commission is proposing a new portfolio-type Specialist Training Book (STB). OBJECTIVE: To pilot its contents, structure, and implementation strategies. DESIGN: Cross-sectional, descriptive study. SETTING: A Provincial Family Medicine Teaching Unit. PARTICIPANTS: Twenty-eight tutors and 36 residents. METHODS: For 9 months the participants conducted a training assessment on diverse areas of competence by means of tasks at work. Tutors recorded information on the quality of reflection achieved by residents and the tasks they performed by means of the card model proposed in the STB. Residents filled in an ad hoc survey. A univariate analysis of quantitative data was conducted. RESULTS: Thirty-three surveys were received from residents; 21 tutors handed in 67 evaluation reports (average: 3 per tutor). They dealt with all the areas of competence, particularly those of communication, teaching, and ethics. Tasks most used were clinical sessions, critical incidents and video-recording. Both tutors and residents thought that the new method could be useful for reflecting on clinical practice, understanding their own areas of competence better and for strengthening the tutor-trainee relationship, especially if some suggestions to improve its practical use and reduce time and effort involved were taken into account. CONCLUSIONS: The new STB in its current version or with some modifications is a useful tool for residents' training assessment and is probably accepted well in our ambit.
Asunto(s)
Competencia Clínica , Medicina Familiar y Comunitaria/educación , Estudios Transversales , Docentes Médicos , Internado y Residencia , Proyectos Piloto , Encuestas y CuestionariosRESUMEN
Objetivo: Conocer las ventajas e inconvenientes del uso de la episotomía. Método: Revisión bibliográfica de los últimos 20 años en las bases de datos bibliográficas IME, Medline, CUIDEN y BDIE con los descriptores episotomía, desgarros, suelo pélvico. Resultados: La prevalencia de la episotomía en nuestro país oscila entre el 70-90 por ciento, cifra similar a la de otros países de nuestro nivel asistencial, a excepción del Reino Unido, y muy por encima del 30 por ciento recomendado por la OMS. La episotomía sólo previene de desgarros de grado III y IV cuando es mediolateral y se realiza en primíparas. Genera morbilidad en cuanto al dolor posparto y dispareunia se refiere y, sobre todo, si es mediolateral. Para el alivio del dolor son útiles diferentes formas de aseo y baño, el fomento del autocuidado y la lidocaína al 5 por ciento en base acuosa. Los fármacos utilizados son paracetamol e ibuprofeno. La incontinencia urinaria no está relacionada con la episiotomía. Conclusiones. El uso restrictivo de la episiotomía tiene más beneficios que el uso rutinario. Es necesario valorar los antecedentes y los factores implicados en el periodo expulsivo y actuar en consecuencia (AU)