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Objetivo: analizar la evolución de la investigación en enfermería en Ecuador a través de las publicaciones realizadas en este sector. Método: se realizó una revisión de las publicaciones científicas incluidas en CUIDEN, BIREME y PUBMED desde 2000 a 2019. Resultados: se encontraron 94 artículos (53 en CUIDEN; 27 en BIREME y 14 en PUBMED) relacionados con el conocimiento enfermero en Ecuador, distribuidos en 31 revistas indexadas, de las cuales 3 eran nacionales y 28 internacionales. Se observó un inicio de publicaciones desde 2003, con variaciones, logrando un aumento sostenido desde 2017 hasta 2019. Más del 90 % de las publicaciones fueron realizadas por profesionales afiliados a la educación superior con el predominio del género femenino. Conclusiones: existe la necesidad de promover la accesibilidad de las revistas, así como la interculturización en las trece lenguas reconocidas oficialmente en Ecuador. Se precisa aumentar la producción de conocimiento enfermero con impacto, así como publicar el contenido, ya sea ancestral o de otra línea, de los materiales que se quedan en los repositorios de las universidades nacionales.(AU)

Objective: to analyze the evolution of nursing research in Ecuador through the publications made in this sector. Method: a review was carried out of the scientific publications included in CUIDEN, BIREME and PUBMED from 2000 to 2019. Results: there were 94 articles (53 in CUIDEN; 27 in BIREME and 14 in PUBMED) related to nursing knowledge in Ecuador, distributed in 31 indexed journals, out of which 3 were national and 28 internationals. The start of publications was observed since 2003, with variations, achieving a sustained increase from 2017 to 2019. More than 90 % of the publications were made by professionals affiliated to higher education with a predominance of the female gender. Conclusions: there is a need to promote the accessibility to journals, as well as interculturation in the thirteen officially recognized languages ​​in Ecuador. It is necessary to increase the production of nursing knowledge with impact, as well as to publish the content, whether ancestral or from another line, of the materials that remain in the repositories of national universities.(AU)

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Over the last few years, research on silica nanoparticles has rapidly increased. Particularly on mesoporous silica nanoparticles (MSNs), as nanocarriers for the treatment of various diseases because of their physicochemical properties and biocompatibility. The use of MSNs combined with therapeutic agents can provide better encapsulation and effective delivery. MSNs as nanocarriers might also be a promising tool to lower the therapeutic dosage levels and thereby to reduce undesired side effects. Researchers have explored several routes to conjugate both imaging and therapeutic agents onto MSNs, thus expanding their potential as theranostic platforms, in order to allow for the early diagnosis and treatment of diseases. This review introduces a general overview of recent advances in the field of silica nanoparticles. In particular, the review tackles the fundamental aspects of silicate materials, including a historical presentation to new silicates and then focusing on the key parameters that govern the tailored synthesis of functional MSNs. Finally, the biomedical applications of MSNs are briefly revised, along with their biocompatibility, biodistribution and degradation. This review aims to provide the reader with the tools for a rational design of biocompatible MSNs for their application in the biomedical field. Particular attention is paid to the role that the synthesis conditions have on the physicochemical properties of the resulting MSNs, which, in turn, will determine their pharmacological behavior. Several recent examples are highlighted to stress the potential that MSNs hold as drug delivery systems, for biomedical imaging, as vaccine adjuvants and as theragnostic agents.

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OBJECTIVE: To provide a practical guide for the implementation and use of  Pharmaceutical Care through Telepharmacy by healthcare professionals and  patients in its different scopes of application. To establish a definition of  Telepharmacy and describe the technological tools necessary, advantages, and  keys to facilitating its implementation. METHOD: Between December 2020 and January 2021, the Board of Directors of the Spanish Society of Hospital Pharmacy, along with the coordinators of the  project "Outpatient Care Strategies" ("Mapa Estratégico para la Atención al  Paciente Externo") designed a strategy to foster the development and  expansion of Telepharmacy in Spain. This strategy involved four courses of  action. To develop the first course of action, a call was made in March 2021  among the Spanish Society of Hospital Pharmacy members to develop seven  methodological guidelines. The purpose of these documents was to meet the  needs for the implementation of Telepharmacy, the most relevant being the  development of specific guides for professionals and patients. The guides were  developed in four stages between May and October 2021, including a literature review; consensus-based interviews, online workshops, and, finally, the  drafting and validation of the final documents. Once the final draft was  prepared, a public evaluation of suggestions and observations was performed  for a month. The documents were also presented to the Patient Committee of  the Spanish Society of Hospital Pharmacy. RESULTS: The Guide for Professionals provides guidelines for the development and implementation of Telepharmacy in its different scopes of  application. These guides provide a description of specific goals, healthcare benefits, tools required, and keys to the implementation of  Telepharmacy. The Guide for Patients is complementary to face-to-face  pharmaceutical care from the point of view of the patient, with special  emphasis being placed on the most frequently used tools, the potential  benefits, and the keys to facilitating patients' understanding of the purpose  and use of Telepharmacy. CONCLUSIONS: A Practical Guide for Professionals and Patients was developed to ensure the standard development, implementation, and spread of Telepharmacy in all its scopes. This guide is intended to help Hospital Pharmacy professionals benefit from Telepharmacy as a  complementary tool to face-to-face pharmaceutical care.

OBJETIVO: Desarrollar una guía práctica sobre atención farmacéutica mediante  Telefarmacia para profesionales y pacientes, en cada uno de sus ámbitos de  aplicación. Definir en qué consiste, las herramientas utilizadas, los potenciales  beneficios y las claves para facilitar su comprensión.Método: Entre diciembre de 2020 y enero de 2021, la Junta directiva de la  Sociedad Española de Farmacia Hospitalaria, junto con coordinadores del  proyecto "Mapa Estratégico para la Atención al Paciente Externo", diseñaron  una estrategia para favorecer el desarrollo y expansión de la Telefarmacia en  España. Esta estrategia incluyó cuatro líneas de actuación. Para el desarrollo  de la primera, en marzo de 2021 se llevó a cabo una convocatoria dirigida a los socios de la Sociedad Española de Farmacia Hospitalaria con objeto de  desarrollar siete documentos de apoyo metodológico destinados a cubrir las  necesidades para la implantación de la Telefarmacia, entre las cuales se  consideraron como claves el desarrollo de una guía específica para  profesionales y otra para pacientes. Las guías se desarrollaron en cuatro fases  entre mayo y octubre de 2021: revisión de literatura, entrevistas de consenso,  desarrollo de improtalleres de trabajo online y debate y, por último,  laboración y validación de los documentos finales. Una vez elaborado el borrador  definitivo se llevó a cabo una valoración pública de sugerencias y alegaciones durante un mes, así como una presentación al comité de pacientes de la Sociedad Española de Farmacia Hospitalaria. RESULTADOS: La guía para profesionales se ha orientado para dar las pautas  para el desarrollo e implementación de programas de Telefarmacia en cada uno de sus ámbitos de aplicación. Está estructurada de forma que resalte los  objetivos concretos, los beneficios asistenciales, las herramientas necesarias,  así como las claves para implantarla. La guía para pacientes se ha desarrollado como herramienta complementaria a la atención farmacéutica presencial desde la visión del paciente, destacando las herramientas más comúnmente  utilizadas, los potenciales beneficios y las claves para facilitar la comprensión  sobre la finalidad y uso de estas intervenciones. CONCLUSIONES: Se ha desarrollado una guía práctica de apoyo, tanto a profesionales como a pacientes, para estandarizar el desarrollo, implantación  y expansión de la Telefarmacia en todos sus ámbitos de  actuación. La guía pretende ayudar al colectivo de farmacia hospitalaria a  alcanzar los potenciales beneficios de una herramienta que se presenta como  complementaria a la atención farmacéutica presencial.

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Objetivo: Desarrollar una guía práctica sobre atención farmacéuticamediante Telefarmacia para profesionales y pacientes, en cada uno desus ámbitos de aplicación. Definir en qué consiste, las herramientas utilizadas, los potenciales beneficios y las claves para facilitar su comprensión.Método: Entre diciembre de 2020 y enero de 2021, la Junta directivade la Sociedad Española de Farmacia Hospitalaria, junto con coordinadores del proyecto “Mapa Estratégico para la Atención al PacienteExterno”, diseñaron una estrategia para favorecer el desarrollo y expansión de la Telefarmacia en España. Esta estrategia incluyó cuatro líneasde actuación. Para el desarrollo de la primera, en marzo de 2021 sellevó a cabo una convocatoria dirigida a los socios de la SociedadEspañola de Farmacia Hospitalaria con objeto de desarrollar siete documentos de apoyo metodológico destinados a cubrir las necesidades parala implantación de la Telefarmacia, entre las cuales se consideraron comoclaves el desarrollo de una guía específica para profesionales y otra parapacientes. Las guías se desarrollaron en cuatro fases entre mayo y octubrede 2021: revisión de literatura, entrevistas de consenso, desarrollo de talleres de trabajo online y debate y, por último, elaboración y validación de los documentos finales. Una vez elaborado el borrador definitivose llevó a cabo una valoración pública de sugerencias y alegacionesdurante un mes, así como una presentación al comité de pacientes de laSociedad Española de Farmacia Hospitalaria.(AU)

Objective: To provide a practical guide for the implementation and useof Pharmaceutical Care through Telepharmacy by healthcare professionals and patients in its different scopes of application. To establish a definition of Telepharmacy and describe the technological tools necessary,advantages, and keys to facilitating its implementation.Method: Between December 2020 and January 2021, the Board ofDirectors of the Spanish Society of Hospital Pharmacy, along with thecoordinators of the project “Outpatient Care Strategies” (“Mapa Estratégico para la Atención al Paciente Externo”) designed a strategy to fosterthe development and expansion of Telepharmacy in Spain. This strategyinvolved four courses of action. To develop the first course of action, acall was made in March 2021 among the Spanish Society of HospitalPharmacy members to develop seven methodological guidelines. The purpose of these documents was to meet the needs for the implementationof Telepharmacy, the most relevant being the development of specificguides for professionals and patients. The guides were developed in fourstages between May and October 2021, including a literature review; consensus-based interviews, online workshops, and, finally, the draftingand validation of the final documents. Once the final draft was prepared,a public evaluation of suggestions and observations was performed for amonth. The documents were also presented to the Patient Committee of theSpanish Society of Hospital Pharmacy. (AU)

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Advanced endometrial cancer (EC) lacks therapy, thus, there is a need for novel treatment targets. CXCR4 overexpression is associated with a poor prognosis in several cancers, whereas its inhibition prevents metastases. We assessed CXCR4 expression in EC in women by using IHC. Orthotopic models were generated with transendometrial implantation of CXCR4-transduced EC cells. After in vitro evaluation of the CXCR4-targeted T22-GFP-H6 nanocarrier, subcutaneous EC models were used to study its uptake in tumor and normal organs. Of the women, 91% overexpressed CXCR4, making them candidates for CXCR4-targeted therapies. Thus, we developed CXCR4+ EC mouse models to improve metastagenesis compared to current models and to use them to develop novel CXCR4-targeted therapies for unresponsive EC. It showed enhanced dissemination, especially in the lungs and liver, and displayed 100% metastasis penetrance at all clinically relevant sites with anti-hVimentin IHC, improving detection sensitivity. Regarding the CXCR4-targeted nanocarrier, 60% accumulated in the SC tumor; therefore, selectively targeting CXCR4+ cancer cells, without toxicity in non-tumor organs. Our CXCR4+ EC models will allow testing of novel CXCR4-targeted drugs and development of nanomedicines derived from T22-GFP-H6 to deliver drugs to CXCR4+ cells in advanced EC. This novel approach provides a therapeutic option for women with metastatic, high risk or recurrent EC that have a dismal prognosis and lack effective therapies.

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Patients with advanced endometrial cancer (EC) show poor outcomes. Thus, the development of new therapeutic approaches to prevent metastasis development in high-risk patients is an unmet need. CXCR4 is overexpressed in EC tumor tissue, epitomizing an unexploited therapeutic target for this malignancy. The in vitro antitumor activity of two CXCR4-targeted nanoparticles, including either the C. diphtheriae (T22-DITOX-H6) or P. aeruginosa (T22-PE24-H6) toxin, was evaluated using viability assays. Apoptotic activation was assessed by DAPI and caspase-3 and PARP cleavage in cell blocks. Both nanotoxins were repeatedly administrated to a subcutaneous EC mouse model, whereas T22-DITOX-H6 was also used in a highly metastatic EC orthotopic model. Tumor burden was assessed through bioluminescence, while metastatic foci and toxicity were studied using histological or immunohistochemical analysis. We found that both nanotoxins exerted a potent antitumor effect both in vitro and in vivo via apoptosis and extended the survival of nanotoxin-treated mice without inducing any off-target toxicity. Repeated T22-DITOX-H6 administration in the metastatic model induced a dramatic reduction in tumor burden while significantly blocking peritoneal, lung and liver metastasis without systemic toxicity. Both nanotoxins, but especially T22-DITOX-H6, represent a promising therapeutic alternative for EC patients that have a dismal prognosis and lack effective therapies.

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Ischemic stroke is a leading cause of death and disability worldwide with effective acute thrombolytic treatments. However, brain repair mechanisms related to spontaneous or rehabilitation-induced recovery are still under investigation, and little is known about the molecules involved. The present study examines the potential role of angiogenin (ANG), a known regulator of cell function and metabolism linked to neurological disorders, focusing in the neurogenic subventricular zone (SVZ). Angiogenin expression was examined in the mouse SVZ and in SVZ-derived neural stem cells (NSCs), which were exposed to exogenous ANG treatment during neurosphere formation as well as in other neuron-like cells (SH-SY5Y). Additionally, male C57Bl/6 mice underwent a distal permanent occlusion of the middle cerebral artery to study endogenous and exercise-induced expression of SVZ-ANG and neuroblast migration. Our results show that SVZ areas are rich in ANG, primarily expressed in DCX+ neuroblasts but not in nestin+NSCs. In vitro, treatment with ANG increased the number of SVZ-derived NSCs forming neurospheres but could not modify SH-SY5Y neurite differentiation. Finally, physical exercise rapidly increased the amount of endogenous ANG in the ipsilateral SVZ niche after ischemia, where DCX-migrating cells increased as part of the post-stroke neurogenesis process. Our findings position for the first time ANG in the SVZ during post-stroke recovery, which could be linked to neurogenesis.

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El Dengue es la enfermedad de más rápida propagación en el mundo y una permanente amenaza para la salud pública, puesto que la mitad de la población global corre el riesgo de contraer la enfermedad. Ante la gravedad del cuadro de la enfermedad a nivel nacional y mundial, es necesario generar nuevas metodologías de predicción útiles para la adopción de decisiones en salud pública. Por ello, se caracterizó los casos notificados de dengue entre el 2015 y el 2020 en Ecuador. Se hizo un estudio descriptivo retrospectivo, utilizando la base de datos de las gacetas oficiales, caracterizando los casos de dengue. Se elaboraró un canal endémico describiendo la metodología empleada. Se evidenció que la tendencia del dengue en provincias es positiva, lo que indica que en los últimos cinco años se ha incrementado el número de casos, junto a la afectación de un ciclo epidemiológico común en el primer periodo de cada año del último quinquenio. El estudio de los datos actuales de la enfermedad del dengue en Ecuador, su tendencia epidémica y el contexto en que se desarrolla, permiten concluir en la importante necesidad de planificar y administrar la salud pública, aplicando la metodología planteada de elaboración de canales endémicos en la vigilancia de situaciones de interés en salud pública que conlleven a acciones de control de alcance tanto nacional como territorial que se sostengan el tiempo(AU)

Dengue is the fastest spreading disease in the world and a permanent threat to public health, since half of the global population is at risk of contracting the disease. Given the seriousness of the disease at the national and global level, it is necessary to generate new useful prediction methodologies for decision-making in public health. Therefore, the reported cases of dengue between 2015 and 2020 in Ecuador were characterized. A retrospective descriptive study was carried out, using the official gazette database, characterizing dengue cases. An endemic channel was developed describing the methodology used. It was evidenced that the dengue trend in the provinces is positive, which indicates that in the last five years the number of cases has increased, together with the involvement of a common epidemiological cycle in the first period of each year of the last five years. The study of current data on dengue disease in Ecuador, its epidemic trend and the context in which it develops, allow us to conclude on the important need to plan and administer public health, applying the methodology proposed for the elaboration of endemic channels in the surveillance of situations of interest in public health that lead to control actions of both national and territorial scope that are sustained over time(AU)

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El trabajo se refiere a una de las principales actividades del ser humano y representa aproximadamente la tercera parte de su vida, por lo que tratar de entender los fenómenos laborales desde la óptica de los trabajadores es fundamental. Por tanto considerar la percepción sobre riesgos laborales, como un elemento importante para comprender el comportamiento que tienen los trabajadores frente a un determinado riesgo a nivel de su ocupación u oficio, deber ser estudiado minuciosamente. Objetivo: determinar la percepción sobre riesgos ergonómicos del personal de salud de la consulta externa del Hospital "Delfina Torres de Concha" en el año 2019. Materiales y métodos: la metodología utilizada fue bajo el paradigma positivismo de enfoque cuantitativo y según su alcance descriptivo, contó como parte de un diseño de investigación de campo, no experimental transversal, ya que en primer lugar no se realizó la manipulación deliberada de la variable, se observaron situaciones ya existentes y, en segundo lugar, permitió el análisis de la información basado en cantidades o dimensiones numéricas. Resultados: el 44% se encuentra en un nivel regular de conocimiento representado por 12-13 respuestas correctas de un total de 14 preguntas. El 40% se encuentra en un rango deficiente por tener entre 0-11 respuestas correctas. Y, por último, el 16% que presenta 8 personas está en un rango bueno por tener 14 respuestas. Conclusión: se determinó que la percepción sobre riesgo ergonómicos del personal de salud de la consulta externa, no es adecuada, debido a que en esta área se debería tener un nivel de conocimiento mayor acerca de este tipo de riesgo, para prevenir enfermedades ocupacionales(AU)

Work refers to one of the main activities of human beings and represents approximately one third of their lives, so trying to understand labor phenomena from the workers' point of view is essential. Therefore, considering the perception of occupational hazards, as an important element to understand the behavior of workers in the face of a certain risk at the level of their occupation or trade, should be studied carefully. Objective: to determine the perception of ergonomic risks of the outpatient clinic's health personnel in the "Delfina Torres de Concha" Hospital in 2019. Materials and methods: the methodology used was under the positivism paradigm of quantitative approach. In addition, according to its descriptive scope, it counted as part of a cross-sectional, non-experimental field research design, since in the first place the deliberate manipulation of the variable was not carried out. Existing situations were observed and, secondly, it allowed the analysis of information based on quantities or numerical dimensions. Results: 44% are at a regular level of knowledge represented by 12-13 correct answers out of 14 total questions. The 40% are in a poor range for having 0-11 correct answers. Finally, the 16% representing eight people is in a good range for having 14 responses. Conclusion: it was determined that the ergonomic risk perception of health personnel in the outpatient clinic is not adequate, because in this area there should be a higher level of knowledge about this type of risk, to prevent occupational diseases(AU)

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Objetivo: Analizar la evolución a largo plazo de la calidad de vida relacionada con la salud (CVRS) en pacientes con artritis reumatoide (AR) tratados con terapias biológicas. Método: Estudio observacional prospectivo realizado entre octubre de 2006 y mayo de 2011. Se seleccionó a pacientes mayores de edad, diagnosticados de AR, tratados durante al menos un año con anti-TNF (infliximab o etanercept) y que no hubieran recibido otros tratamientos biológicos previos. Completaron el estudio 41 pacientes, cumplimentando el cuestionario específico validado QOL-AR en 3ocasiones: E1 (entre septiembre de 2006 y febrero de 2007), E2 (entre abril de 2008 y enero de 2009) y E3 (entre julio de 2010 y mayo de 2011). Los datos se analizaron con Epi-Info versión 3.3-2004 para Windows (R) y Excel 2007; la comparación de las medias con la prueba t de Student y la relación entre valores de un mismo paciente, mediante regresión lineal. Resultados: Resultados globales: tendencia descendente no estadísticamente significativa: 7,09±1,15 en E1; 6,90±1,60 en E2 y 6,52±1,59 en E3. Los ítems con mayor puntuación fueron los relacionados con aspectos psicosociales (ayuda familiar, interacción con familia y amigos). La dimensión física fue la peor valorada (habilidad física, dolor artrítico, artritis). Entre E2 y E3 aumentó significativamente la valoración de la ayuda familiar (p=0,0008) y disminuyeron significativamente tensión nerviosa (p=0,0119) y estado de ánimo (p=0,0451). Conclusiones: La CVRS de los pacientes es buena y se ha mantenido prácticamente invariable tras unos 6años de estudio. Es probable que parte de la estabilidad en la CVRS sea atribuible al tratamiento

Objective: To analyze the changes in health-related quality of life (HRQoL) of patients with rheumatoid arthritis (RA) treated with biological therapies. Method: Observational prospective study performed from October 2006 to May 2011. The inclusion criteria were adult patients, diagnosed with RA, treated for at least one year with anti-tumor necrosis factor therapy (infliximab or etanercept), who had not received other biological treatments previously. A total of 41 patients who completed the study undertook the specific and validated questionnaire QoL-RA Scale 3 times: E1 (September 2006-February 2007), E2 (April 2008-January 2009) and E3 (July 2010- May 2011). Data analysis was conducted using Epi-Info version 3.3 2004 for Windows(R) and Excel 2007; mean comparisons were evaluated by Student's t-test and the relationship between the 3 outcomes for each patient by lineal regression. Results: Overall results show a downward trend which was not statistically significant: 7.09 (standard deviation [SD]=1.15) in E1; 6.90 (SD=1.60) in E2; and 6.52 (SD=1.59) in E3. Items with higher scores were those related to psychosocial aspects (help from family, interaction with family and friends), whereas the physical dimension was valued more poorly (physical ability, arthritis pain, arthritis). Between E2 and E3 there was a significant increase in help from family (P=.0008), whereas level of tension (P=.0119) and mood (P=.0451) decreased significantly. Conclusions: In all, HRQoL reported by patients is good and has remained unchanged after approximately 6 years of study. The stability of HRQoL is probably partly attributable to treatment

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BACKGROUND AND PURPOSE: Endothelial progenitor cells (EPCs) have been extensively investigated as a therapeutic approach for repairing the vascular system in cerebrovascular diseases. Beyond vascular regeneration per se, EPCs may also release factors that affect the entire neurovascular unit. Here, we aim to study the effects of the EPC secretome on oligovascular remodeling in a mouse model of white matter injury after prolonged cerebral hypoperfusion. METHODS: The secretome of mouse EPCs was analyzed with a proteome array. In vitro, the effects of the EPC secretome and its factor angiogenin were assessed on primary oligodendrocyte precursor cells and mature human cerebral microvascular endothelial cells (hCMED/D3). In vivo, mice were subjected to permanent bilateral common carotid artery stenosis, then treated with EPC secretome at 24 hours and at 1 week, and cognitive outcome was evaluated with the Y maze test together with oligodendrocyte precursor cell proliferation/differentiation and vascular density in white matter at 4 weeks. RESULTS: Multiple growth factors, cytokines, and proteases were identified in the EPC secretome, including angiogenin. In vitro, the EPC secretome significantly enhanced endothelial and oligodendrocyte precursor cell proliferation and potentiated oligodendrocyte precursor cell maturation. Angiogenin was proved to be a key factor since pharmacological blockade of angiogenin signaling negated the positive effects of the EPC secretome. In vivo, treatment with the EPC secretome increased vascular density, myelin, and mature oligodendrocytes in white matter and rescued cognitive function in the mouse hypoperfusion model. CONCLUSIONS: Factors secreted by EPCs may ameliorate white matter damage in the brain by boosting oligovascular remodeling.

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OBJECTIVE: To analyze the changes in health-related quality of life (HRQoL) of patients with rheumatoid arthritis (RA) treated with biological therapies. METHOD: Observational prospective study performed from October 2006 to May 2011. The inclusion criteria were adult patients, diagnosed with RA, treated for at least one year with anti-tumor necrosis factor therapy (infliximab or etanercept), who had not received other biological treatments previously. A total of 41 patients who completed the study undertook the specific and validated questionnaire QoL-RA Scale 3 times: E1 (September 2006-February 2007), E2 (April 2008-January 2009) and E3 (July 2010- May 2011). Data analysis was conducted using Epi-Info version 3.3 2004 for Windows® and Excel 2007; mean comparisons were evaluated by Student's t-test and the relationship between the 3 outcomes for each patient by lineal regression. RESULTS: Overall results show a downward trend which was not statistically significant: 7.09 (standard deviation [SD]=1.15) in E1; 6.90 (SD=1.60) in E2; and 6.52 (SD=1.59) in E3. Items with higher scores were those related to psychosocial aspects (help from family, interaction with family and friends), whereas the physical dimension was valued more poorly (physical ability, arthritis pain, arthritis). Between E2 and E3 there was a significant increase in help from family (P=.0008), whereas level of tension (P=.0119) and mood (P=.0451) decreased significantly. CONCLUSIONS: In all, HRQoL reported by patients is good and has remained unchanged after approximately 6 years of study. The stability of HRQoL is probably partly attributable to treatment.

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Exosomes are gaining importance because they show great promise in therapeutic applications for several diseases. Particularly in stroke, exosomes derived from mesenchymal stem cell (MSC) therapy work as paracrine effectors responsible for promoting neurovascular remodeling and functional recovery. Adult male rats were subjected to intracerebral hemorrhage (ICH) by intrastriatal injection of collagenase type IV; 24 h after surgery, MSC-derived exosomes were administered through the tail vein. The rats were euthanized at 7 or 28 days after treatment. Functional evaluation, lesion size, fiber tract integrity, axonal sprouting and white matter repair markers, biodistribution of exosomes and secretome proteomics were analyzed. DiI-labeled exosomes were found in the brains of the ICH-treated group and in the liver, lung and spleen. Animals receiving treatment with exosomes showed significantly better results in terms of functional recovery, lesion size, fiber tract integrity, axonal sprouting and white matter repair markers compared with the control group 28 days after stroke. Proteomics analysis of the exosomes identified more than 2000 proteins that could be implicated in brain repair function. In conclusion, white matter integrity was partly restored by exosome administration mediated by molecular repair factors. Exosomes as a treatment could be a heterogeneous process by nature and presents many factors that can influence brain plasticity in an adaptable and versatile manner.

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