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Human Wharton's jelly stem cells (HWJSC) can be efficiently isolated from the umbilical cord, and numerous reports have demonstrated that these cells can differentiate into several cell lineages. This fact, coupled with the high proliferation potential of HWJSC, makes them a promising source of stem cells for use in tissue engineering and regenerative medicine. However, their real potentiality has not been established to date. In the present study, we carried out a systematic review to determine the multilineage differentiation potential of HWJSC. After a systematic literature search, we selected 32 publications focused on the differentiation potential of these cells. Analysis of these studies showed that HWJSC display expanded differentiation potential toward some cell types corresponding to all three embryonic cell layers (ectodermal, mesodermal, and endodermal), which is consistent with their constitutive expression of key pluripotency markers such as OCT4, SOX2, and NANOG, and the embryonic marker SSEA4. We conclude that HWJSC can be considered cells in an intermediate state between multipotentiality and pluripotentiality, since their proliferation capability is not unlimited and differentiation to all cell types has not been demonstrated thus far. These findings support the clinical use of HWJSC for the treatment of diseases affecting not only mesoderm-type tissues but also other cell lineages. Impact statement Human Wharton's jelly stem cells (HWJSC) are mesenchymal stem cells that are easy to isolate and handle, and that readily proliferate. Their wide range of differentiation capabilities supports the view that these cells can be considered pluripotent. Accordingly, HWJSC are one of the most promising cell sources for clinical applications in advanced therapies.

espanolIntroduccion. El presente trabajo describe y evalua la implementacion de un modelo de aula invertida en la materia de Histologia para el aprendizaje de ingenieria tisular en el grado de Farmacia con el objetivo de incorporar dichos conocimientos ante su escasa presencia en dicho grado. Sujetos y metodos. El modelo consiste en intercalar en el curso ordinario de Histologia del grado de Farmacia un modulo de autoaprendizaje inverso. Participan 110 alumnos que responden a un cuestionario sobre ambitos conceptuales, procedimentales y actitudinales al comienzo y al final del proceso. Los resultados se analizan estadisticamente. Resultados. Los resultados muestran valores superiores en la evaluacion final con respecto a la evaluacion inicial. Esta diferencia fue estadisticamente significativa (p Conclusion. Los valores mas elevados observados en los componentes actitudinal y procedimental, tras la implementacion del modelo propuesto, ponen de relieve la necesidad de incrementar el componente conceptual en la formacion de la ingenieria tisular en el curriculo de farmacia EnglishIntroduction. This paper describes and evaluates the implementation of a flipped learning model in the discipline of histology for learning tissue engineering contents in the Pharmacy degree, with the aim of incorporating this knowledge for the scarce presence of such matter in that degree. Subjects and methods. The model consists of inserting in the ordinary course of Histology of the pharmacy degree an inverse self-learning module. A questionnaire on conceptual, procedural and attitudinal fields was answered by the 110 students involved in the study at the beginning and end of the process. Results were statistically analysed. Results. The results after the implementation of the flipped learning model show statistically significant higher values (p Conclusion. The highest values observed in the attitudinal and procedural components, after the implementation of the proposed model, highlight the need to increase the conceptual component in the formation of tissue engineering in the pharmacy curriculum

During the last XX century, several changes were applied to traditional educational methods, positioning the student as a central actor in the learning process. One of the pedagogical theories developed was the Threshold Concepts (TC) educational framework, based on education as a space of uncertainty, where the student needs to learn a certain concept or learning experiences that allow developing a new way of thinking. In medical education, written accounts about significant learning experiences, analysis of practice essays and semi-structured focus groups interviews have been applied to identify TC. In that way, our hypothesis is that the use of bibliometrics, as a tool to discover hidden relations between keywords, can overcome traditional difficulties related to TC identification. Keywords are applied to highlight the content of a digital object; they are concepts with a special meaning, similar to TC. Our challenge is to identify the bibliometric indexes that are able to show the relationship between the keywords that make them TC, especially in a medical context. In previous scientific literature, several methods were applied, mainly based on qualitative assessment. In this sense, we propose a quantitative, objective, and reproducible approach that can enrich the learning process from a scientific-based perspective.

Objetivos: El objetivo de este trabajo es la evaluación diagnóstica de las competencias conceptuales, procedimentales y actitudinales en estudiantes de Medicina previo a la realización de un modelo de aprendizaje+servicio sobre hemodonación. Métodos: 161 estudiantes de Medicina participaron en este estudio realizando una encuesta de valoración de 15 competencias cocneptuales, procedimentales y actitudinales justo antes de la rotación por diferentes estaciones de aprendizaje + servicio en un Centro Regional de Transfusión Sanguínea. Las valoraciones fueron analizadas como evaluación diagnóstica previa. Resultados: 12 de las 15 competencias evaluadas obtuvieron una puntuación superior a 3, por lo que las compentecias previas fueron bastante buenas en el alumnado. Las comptencias de tipo actitudinal fueron las más valoradas (4.29 ± 0.54), siendo significativamente superiores a las procedimentales (3.50 ± 0.65); y estas, a su vez, superiores a las de tipo conceptual (2.78 ± 0.77). Las competencias conpcetuales fueron peor valiradas debido a la inclusión de algunas nociones técnicas que los estudiantes deberán aprender. Conclusiones: Los participantes en el estudio mostraron un nivel elevado de competencias a nivel procedimental y actitudinal previa a la relización de un aprendizaje+servicio sobre hemodonación. La adquisición de los nuevos conceptos permitirán reforzar aquellas actitudes y procedimientos que derivan de dichos conceptos, dotando al alumno de una educación sanitaria más completa que la provista por otros métodos pedagógicos tradicionales., Aim: The objective of this work is the diagnostic evaluation of conceptual, procedural and attitudinal skills in medical students previous to the realization of a model of service-learning on blood donation. Methods: 161 medical students participated in this study by conducting a survey to assess 15 conceptual, procedural and attitudinal competencies just before rotation through different servicelearning stations in a Regional Blood Transfusion Center. The assessments were analyzed as a previous diagnostic evaluation. Results: 12 of the 15 competencies evaluated obtained a score higher than 3, so that the previous competences were high in the students. Attitudinal skills were the most valued (4.29 ± 0.54), being significantly higher than procedural skills (3.50 ± 0.65); and these, in turn, were higher than conceptual skills (2.78 ± 0.77). The conceptual competences were less valued due to the inclusion of some technical notions that the students are still to learn. Conclusions: The participants in this study showed a high level of procedural and attitudinal competencies before the performance of a service-learning on blood donation. The acquisition of the new concepts will allow to strengthen those derived attitudes and procedures from those concepts, providing the student with a more complete health education than that provided by other traditional pedagogical methods.

Advanced therapies are increasingly demanded by patients with the intent of treating some incurable conditions. Because family medicine professionals play an important role as health educators, their residency programs should incorporate new knowledge related to advanced therapies. To successfully implement these programs, how family medicine residents perceive these therapies should be investigated. The main components of perception, i.e. conceptual, procedural and attitudinal, refer to knowledge, skills and feelings, respectively. We designed a specific questionnaire to assess the components of perceptions of advanced therapies in 300 medical residents enrolled in the Spanish National Family Medicine Residency Program. Each component consisted of 4 or 5 topics and each topic contained 6 items. Respondents scored highest in the procedural component (average 4.12±1.00), followed by the attitudinal (3.94±1.07) and conceptual component (3.04±1.43). Differences among the three components were statistically significant (p, This work was supported by CTS-115 (Tissue Engineering Group), Junta de Andalucia.

Los autores agradecen a las Profesoras Allice Warley (King’s Co- llege, London) y María del Carmen Sánchez-Quevedo (Universidad de Granada) por el asesoramiento recibido en el desarrollo de las técnicas de microscopía electrónica analítica por energía dispersiva de rayos-X., Objetivo: Aplicar la microscopia electrónica analítica por energía dispersiva de rayos X a la evaluación de la viabilidad celular en constructos tisulares de fibrina agarosa y determinar la viabilidad celular en el seno del constructo Material y Métodos: Se evalúan fibroblastos aislados y fibroblastos en el seno del constructo a los 7 y 21 días con la técnica de Live/Dead y de microscopia electrónica analítica por energía dispersiva de rayos X. Resultados: El estudio demuestra que la aplicación de la técnica es factible y que la viabilidad es elevada en los constructos a los 21 días sin que existan signo de apoptosis en la población celular. Conclusión: La microscopia electrónica analítica por energía dispersiva de rayos X permite evaluar la viabilidad celular en los constructos tisulares y establecer un control de calidad más exigente para su aplicación terapéutica., Objective: Apply X-ray microanalytical electron microscopy to evaluate cell viability in fibrin agarose tissue constructs and determine cell viability within the construct. Material and Methods: Isolated fibroblasts and fibroblasts within the construct are evaluated at 7 and 21 days with the technique of Live/Dead and with X-ray microanalytical electron microscopy. Results: The study shows that the application of the technique is feasible that viability is high in the constructs at 21 days without sign of apoptosis in the cell population. Conclusion: X-ray microanalytical electron microscopy allows the evaluation of cell viability in tissue constructs and establish a more demanding quality control for therapeutic application.

Objetivo. El trabajo que presentamos pretende identificar y realizar un análisis de la percepción que los estudiantes de grado en Medicina presentan sobre los conceptos umbrales en el campo de la Ingeniería Tisular. Ello redundará en una mejor planificación de su formación y permitirá programar la enseñanza para un mejor aprendizaje autorregulado. Material y método. Se elaboró un cuestionario con veinte ítems agrupados posteriormente en tres secciones en función de la condición de cada concepto umbral que se formalizó a los alumnos. El estudio se realizó sobre una muestra de 63 estudiantes de grado en Medicina de la Universidad de Granada, de estos 37 eran mujeres y 26 eran varones, todos ellos se encontraban cursando la asignatura optativa de Ingeniería Tisular. Los distintos ítems existentes en cada una de las secciones fueron evaluados por los estudiantes utilizando una escala de tipo Likert de cinco niveles que oscila entre nivel 1 “totalmente en desacuerdo” y nivel 5 “totalmente de acuerdo”, en función de la consideración que cada alumno tenía sobre el ítem como concepto umbral en el campo de la Ingeniería Tisular. Posteriormente se realizó un análisis estadístico con la prueba t de Student comparando los valores por género (mujer o varón) y las diferencias entre las distintas secciones. Resultados. Los conceptos más valorados fueron los de la sección 1 correspondiente a “conceptos básicos en Ingeniería Tisular” con una media de 4,19 sobre 5, seguido de los conceptos de la sección 2 “control de la calidad celular” y 3 “biofabricación y traslación a la clínica” con unas medias de 3,90 y 3,53 respectivamente. Existen diferencias estadísticamente significativas entre los tres grupos. El concepto más valorado fue el ítem nº 4 “células madre” con una media de 4,63 y el menor fue el ítem nº 9 “bioimpresoras” con una media de 3,13. Solo se observó una diferencia estadísticamente significativa entre la valoración de varones frente a mujeres en el ítem nº 13 “biomecánica”. Conclusiones. Las diferencias observadas deben ser tenidas en cuenta a la hora de la organización del programa de asignaturas específicas como la Ingeniería Tisular y en la formación de todo estudiante de grado de Medicina., Objectives: The aim of this work is to study the threshold concepts’ perceptions in tissue engineering medical students in order to a better planning of their training and a better self-regulated learning. Methods: A twenty item-questionnaire, regarding three grouped sections of threshold concepts in tissue engineering, was carried out by 63 undergraduate medical students (37 women and 26 men) from the University of Granada. The different items in each section were evaluated by students using a five-level Likert scale ranging from level 1 “strongly disagree” to level 5 “strongly agree”, depending on the consideration that each Student had on the item as a threshold concept in the field of Tissue Engineering. Subsequently, a statistical analysis was performed with the Student t test comparing the values by gender (woman or men) and the differences between the different sections. Results: The most valued concepts were those of section 1 corresponding to “basic concepts in tissue engineering” with an average of 4.19 out of 5, followed by the concepts of section 2 “control of cellular quality” and 3 “biofabrication and translation to the clinic “with averages of 3.90 and 3.53 respectively. There are statistical significant differences (p

Purpose The purpose of this study was to determine the histological and functional (immunohistochemical) changes that take place in oral mucosa grafts implanted in the rat urethra. Methods Urethroplasty was performed in 26 male Wistar rats weighing 250 g. All animals received autologous oral mucosa urethra grafting under general anesthesia. Samples were analyzed 10, 20, 30, 40, 50, 60, 90, and 120 days after surgery using light and scanning electron microscopy and immunofluorescence for the determination of the expression of epithelial markers (pancytokeratin, cytokeratin 1, 4, 13, and filaggrin). Results Grafted oral mucosa tissues were subjected to significant histological changes from the beginning with the formation of a well-developed epithelium whose structure was comparable to the native urethra from day 60 of the surgical implant. The immunofluorescence analysis demonstrated that the cytokeratin expression profile tended to mimic the pattern of the native urethra. These data suggest that the oral mucosa is able to efficiently transdifferentiate to the urethral environment. Conclusions The efficient transdifferentiation process of the grafted oral mucosa at both the histological and immunofluorescence levels, and the absence of local complications confirm the clinical usefulness of this type of tissues for the repair of the urethra.

Repair of abdominal wall defects is one of the major clinical challenges in abdominal surgery. Most biomaterials are associated to infection and severe complications, making necessary safer and more biocompatible approaches. In the present work, the adequate mechanical properties of synthetic polymer meshes with tissue-engineered matrices containing stromal mesenchymal cells is combined to generate a novel cell-containing tissue-like artificial stroma (SCTLAS) for use in abdominal wall repair. SCTLAS consisting on fibrin-agarose hydrogels seeded with stromal cells and reinforced with commercial surgical meshes (SM) are evaluated in vitro and in vivo in animal models of abdominal wall defect. Inflammatory cells, collagen, and extracellular matrix (ECM) components are analyzed and compared with grafted SM. Use of SCTLAS results in less inflammation and less fibrosis than SM, with most ECM components being very similar to control abdominal wall tissues. Cell migration and ECM remodeling within SCTLAS is comparable to control tissues. The use of SCTLAS could contribute to reduce the side-effects associated to currently available SM and regenerated tissues are more similar to control abdominal wall tissues. Bioengineered SCTLAS could contribute to a safer treatment of abdominal wall defects with higher biocompatibility than currently available SM.