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Pseudoleadership for faculty underrepresented in medicine (URM) has been defined as when URM faculty are placed in leadership positions only because of the racial and ethnic diversity they bring, when they are not ready or trained for such roles because of being early in their faculty careers. It occurs when senior leaders push early career URM faculty into spaces where it is difficult for them to be successful. Pseudoleadership can open up URM faculty to manipulation by superiors and impact URM advancement, as work of leadership positions take time away from scholarship and other activities which institutions value for promotion. Pseudoleadership is typically a problem for early career URM faculty and can be seen when ranks such as lecturer or assistant professor are placed in leadership or other administrative positions without careful thought on how to support the advancement and promotion of this group. In this manuscript the authors discuss pseudoleadership, its impact on the advancement and development of faculty who are underrepresented in medicine and a path forward.

Choroidal neovascularization (CNV) is a prevalent cause of vision loss in patients with age-related macular degeneration. Runt-related transcription factor 1 (RUNX1) has been identified as an important mediator of aberrant retinal angiogenesis in proliferative diabetic retinopathy and its modulation has proven to be effective in curbing pathologic angiogenesis in experimental oxygen-induced retinopathy. However, its role in CNV remains to be elucidated. This study demonstrates RUNX1 expression in critical cell types involved in a laser-induced model of CNV in mice. Furthermore, the preclinical efficacy of Ro5-3335, a small molecule inhibitor of RUNX1, in experimental CNV is reported. RUNX1 inhibitor Ro5-3335, aflibercept-an FDA-approved vascular endothelial growth factor (VEGF) inhibitor, or a combination of both, were administered by intravitreal injection immediately after laser injury. The CNV area of choroidal flatmounts was evaluated by immunostaining with isolectin B4, and vascular permeability was analyzed by fluorescein angiography. A single intravitreal injection of Ro5-3335 significantly decreased the CNV area 7 days after laser injury, and when combined with aflibercept, reduced vascular leakage more effectively than aflibercept alone. These data suggest that RUNX1 inhibition alone or in combination with anti-VEGF drugs may be a new therapy upon further clinical validation for patients with neovascular age-related macular degeneration.

Aim To determine in the adult population the crude and the sex- and age-adjusted prevalence rates of hypertriglyceridaemia (HTG) and to assess its association with cardiovascular risk factors, chronic kidney disease, cardiovascular and cardiometabolic diseases. Methods Cross-sectional observational study conducted in Primary Care, with 6,588 adult study subjects, randomly selected on base-population. Patients had HTG if the triglyceride level was ≥150 mg/dL (≥1.7 mmol/L), or were on lipid-lowering therapy to lower triglyceride. Associations were assessed by univariate and multivariate analysis, and crude and sex- and age-adjusted prevalence rates were determined. Results The arithmetic and geometric means of triglyceride levels were respectively 120.5 and 104.2 mg/dL in global population, 135.7 and 116.0 mg/dL in men, and 108.6 and 95.7 mg/dL in women. The crude HTG prevalence rates were 29.6% in global population, 36.9% in men and 23.8% in women. The sex- and age-adjusted HTG prevalence rates were 27.0% in global population, 34.6% in men and 21.4% in women. The independent variables that were most associated with HTG were hypercholesterolemia (OR: 4.6), low HDL-C (OR: 4.1), hepatic steatosis (OR: 2.8), diabetes (OR: 2.0), and obesity. (OR: 1.9). Conclusions The means of triglyceride levels and HTG prevalence rates are intermediate between those of other national and international studies. A fifth of the female adult population and more than a third of the male population had HTG. The independent factors associated with HTG were hypercholesterolemia and low HDL-C, and the cardiometabolic variables diabetes, hepatic steatosis and obesity.

Resumen Objetivo Determinar en la poblacion adulta las tasas de prevalencia brutas y ajustadas por edad y sexo de hipertrigliceridemia (HTG) y valorar su asociacion con factores de riesgo cardiovascular, enfermedad renal cronica y enfermedades cardiovasculares y cardiometabolicas. Metodos Estudio observacional transversal realizado en Atencion Primaria, con 6.588 sujetos de estudio adultos, seleccionados aleatoriamente con base poblacional. Los pacientes tenian HTG si la concentracion de trigliceridos era ≥ 150 mg/dL (≥ 1,7 mmol/L) o estaban en tratamiento hipolipidemiante para reducir los trigliceridos. Se valoraron las asociaciones mediante analisis univariado y multivariante, y se determinaron las prevalencias brutas y ajustadas por edad y sexo. Resultados Las medias aritmeticas y geometricas de las concentraciones de trigliceridos fueron respectivamente 120,5 y 104,2 mg/dL en la poblacion global, 135,7 y 116,0 mg/dL en hombres, y 108,6 y 95,7 mg/dL en mujeres. Las prevalencias brutas de HTG fueron 29,6% en poblacion global, 36,9% en hombres y 23,8% en mujeres. Las prevalencias ajustadas por edad y sexo de HTG fueron 27,0% en poblacion global, 34,6% en hombres y 21,4% en mujeres. Las variables independientes que mas se asociaban con la HTG fueron hipercolesterolemia (OR: 4,6), c-HDL bajo (OR: 4,1), esteatosis hepatica (OR: 2,8), diabetes (OR: 2,0) y obesidad (OR: 1,9). Conclusiones Las medias de trigliceridos y las prevalencias de HTG se encuentran intermedias entre las de otros estudios nacionales e internacionales. La quinta parte de la poblacion adulta femenina y mas de un tercio de la masculina presentaba HTG. Los factores independientes asociados con HTG fueron hipercolesterolemia y c-HDL bajo, y las variables cardiometabolicas diabetes, esteatosis hepatica y obesidad.

Diabetes mellitus presents high prevalence, severe complications, clinical repercussions, costs and occupational implications. Their assessment requires the use of the medical history and support questionnaires. A literature review was conducted on the topic of clinical and occupational evaluation aspects of diabetes; the database searched was Medline. The search showed numerous papers about diabetes clinical and therapeutic aspects as well as social or public health aspects but the results lacked occupational aspects. To assess the disease, the use of questionnaires is generalized and each author selects those which fit best to their purpose. It is concluded that to carry out a clinical and occupational evaluation related to diabetes, an inter-specialities cooperation, based on a complete medical history including occupational risk factors, is recommended. The questionnaires are useful, adapted to the objective, recommending those valued in Spanish as in Fear of hypoglycemia questionnaire (EsHFS) and Diabetes-related quality of life questionnaire (EsDQOL).

Resumen La diabetes mellitus presenta elevada prevalencia, complicaciones severas, repercusion clinica, costes e implicaciones laborales. Su valoracion requiere el uso de la historia clinica y cuestionarios de apoyo. Se revisa en Medline la bibliografia sobre diabetes y la experiencia de los autores en valoracion clinico-laboral, con resultados que muestran cuantiosas publicaciones en aspectos clinicos y terapeuticos relacionados con diabetes o con aspectos sociales y de salud publica, pero reducida en aspectos laborales. El uso de cuestionarios para valoracion de la enfermedad es generalizado y cada autor debe seleccionar el que mejor se adapte a sus objetivos o experiencia. Se concluye que, para la valoracion clinica y laboral en diabetes se recomienda la colaboracion interespecialidades, partiendo de una historia clinica completa que incluya los riesgos del trabajo. Son de ayuda los cuestionarios, adaptados a objetivo, recomendandose los validados en espanol como Encuesta sobre el miedo a la hipoglucemia (EsHFS) y Calidad de vida relacionada con la diabetes (EsDQOL).

Resumen Introducción: Las enfermedades reumáticas son patologías de alta prevalencia, impacto y repercusión, caracterizadas por dolor y limitación funcional. Para valorar la limitación, la historia clínica es el punto de partida, junto con las pruebas específicas necesarias, según el tipo de padecimiento. De forma complementaria, se recomienda el uso de herramientas clinimétricas. Objetivo: Comparar algunas herramientas o cuestionarios usados en las enfermedades reumáticas más prevalentes, revisando la bibliografía para destacar sus aportes y su utilidad en la labor del médico con finalidad clínica o pericial. Método: Se revisan las características básicas de los cuestionarios y herramientas más usadas en: osteoartritis, artritis reumatoide y artritis psoriásica, espondilitis anquilosante y lupus eritematoso sistémico. Se revisa en Medline la experiencia de los autores con algunos cuestionarios en función de la patología y de sus diversos usos. Resultados: Los cuestionarios se utilizan en su mayoría para la valoración de la calidad de vida, la discapacidad y la evolución clínico-terapéutica de los pacientes. No hay acuerdo entre los autores sobre si existe prioridad en el uso de algún cuestionario concreto por patología y se tiende a combinar varios. Los cuestionarios genéricos más utilizados son SF-36, NHP y EQ-5D. Por enfermedades: en artritis reumatoide, HAQy DAS28; en osteoartritis, WOMAC y Knoos; en Lupus, SLEDAI y BICLA, y en espondilitis, BASDAI y ASDAS. Conclusiones: En reumatología los cuestionarios son de uso habitual y resultan de utilidad de forma complementaria a la historia clínica y a las pruebas específicas. La elección por el profesional médico se basa en su experiencia y en la adecuación al objetivo buscado. Abstract Introduction: Rheumatic diseases are high prevalence, high impact and repercussion pathologies characterised by pain and functional limitation. To assess the limitation, the starting point is the clinical history, together with the specific tests required according to the type of condition. The use of complimentary clinometric tools is recommended. Objective: To compare some tools or questionnaires used in the most prevalent rheumatic diseases, and a review of the literature to highlight their contributions and usefulness in medical practice by the clinician or expert. Method: A review is made of the basic characteristics of the questionnaires and the most used tools in osteoarthritis, rheumatoid arthritis and psoriatic arthritis, ankylosing spondylitis and systemic lupus erythematosus. The experience of the authors is reviewed in Medline, with some questionnaires depending on the pathology and its various uses. Results: The questionnaires are used mainly to assess the quality of life, disability, and clinical-therapeutic evolution of patients. There is no agreement among the authors on whether there is a priority in the use of a specific questionnaire by pathology, and there is a tendency to combine several. The most commonly used generic questionnaires are SF-36, NHP and EQ-5D. For diseases: in rheumatoid arthritis, the HAQ and DAS28; in osteoarthritis, WOMAC and Knoos; in lupus, SLEDAI and BICLA; and in spondylitis, BASDAI and ASDAS. Conclusions: In rheumatology, questionnaires are commonly used, and are useful as a complement to the clinical history and specific tests. The choice by the medical professional is based on their experience and on the adaptation to the objective sought.

Introduction Rheumatic diseases are high prevalence, high impact and repercussion pathologies characterized by pain and functional limitation. To assess the limitation, the starting point is the clinical history, together with the specific tests required according to the type of condition. The use of complementary clinimetric tools is recommended. Objective To compare some tools or questionnaires used in the most prevalent rheumatic diseases, and a review of the literature to highlight their contributions and usefulness in medical practice by the clinician or expert. Method A review is made of the basic characteristics of the questionnaires and the most used tools in osteoarthritis, rheumatoid arthritis and psoriatic arthritis, ankylosing spondylitis and systemic lupus erythematosus. The experience of the authors is reviewed in Medline, with some questionnaires depending on the pathology and their various uses. Results The questionnaires are used mainly to assess the quality of life, disability, and clinical-therapeutic evolution of patients. There is no agreement among the authors on whether there is a priority in the use of a specific questionnaire by pathology, and there is a tendency to combine several. The most commonly used generic questionnaires are SF-36, NHP and EQ-5D. For diseases: in rheumatoid arthritis, the HAQ and DAS28; in osteoarthritis, WOMAC and Knoos; in lupus, SLEDAI and BICLA; and in spondylitis, BASDAI and ASDAS. Conclusions In rheumatology, questionnaires are commonly used, and are useful as a complement to the clinical history and specific tests. The choice by the medical professional is based on their experience and on the adaptation to the objective sought.

Polycyclic aromatic compounds (PACs) are organic compounds commonly found in contaminated soil. Previous studies have shown the removal of polycyclic aromatic hydrocarbons (PAHs) in creosote-contaminated soils during steam enhanced extraction (SEE). However, less is known about the removal of alkyl-PAHs and heterocyclic compounds, such as azaarenes, and oxygen- and sulfur-heterocyclic PACs (OPACs and PASHs, respectively). Further, the impact of SEE on the freely dissolved concentration of PACs in soil as well as the soil bioactivity pre- and post-SEE have yet to be addressed. To fulfil these research gaps, chemical and bioanalytical analysis of a creosote-contaminated soil, collected from a U.S. Superfund site, pre- and post-SEE were performed. The decrease of 64 PACs (5-100%) and increase in the concentrations of nine oxygenated-PAHs (OPAHs) (150%) during SEE, some of which are known to be toxic and can potentially contaminate ground water, were observed. The freely dissolved concentrations of PACs in soil were assessed using polyoxymethylene (POM) strips and the concentrations of 66 PACs decreased post-SEE (1-100%). Three in vitro reporter gene bioassays (DR-CALUX®, ERα-CALUX® and anti-AR CALUX®) were used to measure soil bioactivities pre- and post-SEE and all reporter gene bioassays measured soil bioactivity decreases post-SEE. Mass defect suspect screening tentatively identified 27 unique isomers of azaarenes and OPAC in the soil. As a remediation technique, SEE was found to remove alkyl-PAHs and heterocyclic PACs, reduce the concentrations of freely dissolved PACs, and decrease soil bioactivities.

Bovine gammaherpesvirus type 4 (BoHV-4) shows tropism for the endometrium, in which it causes the death of epithelial and stroma cells. Despite having anti-apoptotic genes in its genome, experiments based on immortalized cell lines have shown that BoHV-4 induces cell death by apoptosis. In the present study, we evaluated BoHV-4 replication, pro-apoptotic (Bax) and anti-apoptotic (Bcl-2) mitochondrial genes expression and chromatin condensation in bovine endometrium primary culture cells (BEC) and in the Madin Darby bovine kidney (MDBK) cell line. Results showed that BoHV-4 has a preference for replication in BEC cells over the MDBK cell line, demonstrated by the high viral titer that is consistent with the tropism of the virus. In BEC cells, chromatin condensation was consistent with the values of viral kinetics at the late stage of infection, accompanied with a balance in the mRNA levels of apoptotic mitochondrial proteins. As a consequence, in those cells viral transmission would be enhanced by inhibiting apoptosis in the early stage of virus proliferation, allowing the complete production of viral progeny, and then, the induction of apoptosis in late stages would allow neighboring cells infection. In MDBK cells replication kinetics was coincident with the up-regulation of Bcl-2, which suggests that the productive infection in MDBK is associated with a lytic phase of the virus or another cell death pathway (probably autophagy mechanism) at the late stage of infection. The results agree with the study of nuclear morphology, where a constant chromatin condensation was observed over time. It is clear that the documented BoHV-4 apoptotic responses observed in the cell lines studied above are not valid in cells from primary cultures. The data presented in this study suggest that BoHV-4 could induce apoptosis in BEC cells without a leading role of the mitochondria pathway. Further studies will be necessary to characterize in detail the programmed cell death pathways involved in BoHV-4 infection in the primary cell cultures evaluated.

Background It has been documented that anxiety and depression are prevalent in patients with asthma and are associated with greater frequency of exacerbations, increased use of health care resources, and poor asthma control. Objective To examine the association of asthma diagnosis with symptoms of depression/anxiety and asthma control not only at baseline but also over a 6-month period of specialist supervision. Methods We enrolled 3182 patients with moderate to severe asthma. All were evaluated with spirometry, the Asthma Control Test, and the Hospital Anxiety and Depression Scale at baseline and at 6 months. Treatments were decided by specialists according to published guidelines. Results At baseline, 24.2% and 12% of the patients were diagnosed with anxiety and depression, respectively, according to the Hospital Anxiety and Depression Scale. After 6 months, anxiety and depression improved, affecting 15.3% and 8.1% of patients, respectively (P Conclusion Under standardized asthma care and after a specific visit with the specialist, patients present significant improvement in these psychological disorders and exhibit better asthma control and functional parameters.

The food web composition, assimilation efficiency of Dechlorane Plus (DP) in food web components, and even extrinsic conditions can affect the trophic biomagnification potentials of DP isomers in food webs. Antarctica ecological system is characterized by the presence of few consumers and simple trophic levels (TLs), which are crucial in discussing the behavior of contaminants. To assess the biomagnification potential of DP in the Antarctic food web, nine representative species were sampled and analyzed from the Fildes Peninsula. Results showed the DP concentrations ranged from 0.25 ng g− 1 to 6.81 ng g− 1 lipid weight in Antarctic biota and the concentrations of anti-DP and syn-DP showed significantly positive correlations with TLs (p

Resumen La traqueobroncopatia osteocondroplastica es una enfermedad benigna poco frecuente, caracterizada por el deposito de tejido osteocartilaginoso en la submucosa de la laringe, de la traquea y, ocasionalmente, en los bronquios principales. La etiologia y la patogenia de esta enfermedad son desconocidas, asi como su incidencia y prevalencia. En una serie descrita de 16.888 fibrobroncoscopias la incidencia fue de 1:1299. Habitualmente se trata de un hallazgo casual al realizar una broncoscopia por otro motivo, como ocurrio en los casos que se presentan. Endoscopicamente se observa una mucosa en empedrado con nodulos blancos-amarillentos que protruyen en la luz traqueal y de los bronquios principales. Otros sintomas han sido la hemoptisis y la tos refractaria al tratamiento. A pesar de la baja prevalencia de esta enfermedad, a continuacion describimos dos casos clinicos presentados en un mismo hospital, diagnosticados de forma casual al realizar una fibrobroncoscopia para el estudio de un nodulo pulmonar solitario.

The differential diagnosis for fever of unknown origin in solid organ transplantation is vast and includes rejection, malignancy, adrenal insufficiency, drug fever, and infection. A 64 year-old man's post-cardiac transplantation course was complicated by 6 weeks of fevers and failure to thrive. He

Los grandes avances de la investigacion biomedica situan a los investigadores, las instituciones y las empresas responsables ante problemas eticos y legales. Esta nueva mirada a su quehacer profesional resulta de la necesaria proteccion de los derechos y deberes de los pacientes, que se refleja en documentos internacionales y legislaciones especificas en los diferentes paises, que de forma globalizada estan asumiendo la investigacion transnacional, a su vez vinculada a la traslacional. El caracter multidisciplinario de la investigacion biomedica actual encuentra reflejo en el ambito de los derechos y deberes que hay que proteger. Asi, la etica, la bioetica y el derecho inician un dialogo obligado e intenso que incluso da nombre a nuevas areas de conocimiento, como son el derecho sanitario y el bioderecho. La medicina personalizada dibuja un nuevo criterio asistencial, y la farmacogenetica puede ser un buen modelo de estudio, capaz de promover la deliberacion y la prudencia en las decisiones. Finalmente, la economia de la salud resulta imprescindible no solo por su experiencia tecnica, sino para redescubrir la etica que le dio origen.

The polymerization of styrene in o/w microemulsions stabilized with dodecyltrimethylammonium bromide (DTAB) with or without cosurfactant (n-butanol, n-hexanol or n-octanol) is examined here. The addition of a cosurfactant enhances the one-phase region in the order: n-butanol > n-hexanol > n-octanol. The kinetics of polymerization slows down in the presence of the alcohol. With the alcohol, the molar masses increase, but no particular trend was noticed on particle size of the lattices. However, by changing the surfactant counter-ion to chloride, alcohol effects on the kinetics almost vanish. Possible explanations to these results are given here. To cite this article: J.E. Puig et al., C. R. Chimie 6 (2003).

1-Methyl-3-( o -azidophenyl)quinoline-2-one prepared by cyclization of the corresponding o -vinylsubstituted isocyanate under microwave irradiation is directly converted into cryptotackieine 1 by an intramolecular aza-Wittig reaction with trimethylphosphine; alternatively heating followed by reduction of the resulting indoloquinoline derivative provided cryptosanguinolentine 2 .

A nine-step synthesis of 9-amino-4-methoxypyrido[3 0 ,2 0 :4,5]pyrrolo[1,2-c]pyrimidine, a tricyclic ring system present in the marine alkaloids variolins is described. The natural marine products meridianins C‐E have been synthesized for the first time starting from N-protected 3-acylindoles. # 2000 Elsevier Science Ltd. All rights reserved.

A seven-step synthesis of the 1-methyl-3-( o -azidophenyl)quinolin-2-one, a common intermediate for the synthesis of the cryptotackieine and cryptosanguinolentine alkaloids, is described. This intermediate is directly converted into cryptotackieine 1 by an intramolecular aza-Wittig reaction with trimethylphosphine; alternatively heating followed by reduction of the resulting indoloquinoline derivative provided cryptosanguinolentine 2 .

The synthesis of the marine alkaloid variolin B has been completed in seven steps, starting from the iminophosphorane derived from ethyl α-azido-β-(4-methoxy-7-azaindol-3-yl) acrylate, available by condensation of 2-formyl-4-methoxy-7-aza-indole with ethyl azidoacetate. Formation of the annulated 2-aminopyrimidine ring is achieved by tandem aza-Wittig/carbodiimide-mediated cyclization whereas the 2-aminopyrimidine substituent at C-5 is formed using an acetyl group as C 2 moiety of the pyrimidine ring.

Lateral epicondylitis is a common work-related musculoskeletal disorder. It affects 5.2% of the population and occurs in middle-aged person 30-50 years. Work-related factors are type of work, physical load and psychosocial aspects at work. Associated with lateral epicondylitis are repetitive movements >2h/day, handling tools >1kg, handling loads >20kg 10 times/day. Psychosocial factors are low job control and low social support. The wrist extensor muscles suffer repeated microtrauma, which end up producing their insertion epicondylar injury, developing pain and functional disability. Occupational disease cost, which has been accepted by the Ministry of Labour and Immigration, are 5000 millions in direct costs and EUR 13,000 million in indirect costs in Spain.