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Desregulació Proteolítica I Inflamatòria Tissular En L'hèrnia

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Desregulació Proteolítica I Inflamatòria Tissular En L'hèrnia Universitat Autònoma de Barcelona Departament de Cirurgia Vall d’Hebron Institut de Recerca – Hospital Universitari Vall d’Hebron Desregulació proteolítica i inflamatòria tissular en l’hèrnia incisional abdominal humana. Paper del fibroblast com a possible factor de risc independent i nova diana terapèutica. Tesi presentada per JORDI GUILLEM MARTÍ Per optar al grau de doctor Directors de la tesi doctoral: Dra. Mª Antònia Dra. Mª Teresa Dr. Manel Armengol Arbós Via Quiles Pérez Carrasco Barcelona, Setembre de 2012 Als Meus Pares, per donar-m’ho tot Al meu germà, per ser-hi sempre I a tu Agraïments Encara que la majoria de vegades la vida es basa en decisions preses amb antelació i cuidadosament estudiades, algunes vegades en prenem de ràpides sense tenir temps de preveure’n les conseqüències. En aquestes ocasions potser obra el subconscient o potser és una part del conscient, que desconeixem, qui actua amb rapidesa reunint tota la informació possible. En tot cas, aquestes decisions són les que donen emoció a les nostres vides, potser amb un toc de bogeria, però a vegades poden canviar-la per complert. Aquell gener de 2005 em dirigia cap a la planta 14 de l’edifici materno-infantil de l’hospital universitari de la Vall d’Hebron. Aquella parada de metro, on mai havia baixat, es convertiria en la més visitada durant els propers 5 anys. Després de prendre la decisió, accelerada, de realitzar pràctiques en el grup de recerca d’Enginyeria de Teixits de la URB, em dirigia a realitzar una entrevista prèvia. Aquell dia em vaig quedar convençut que aquella decisió accelerada i sense saber què fer amb la meva vida, canviaria el meu futur com tantes altres vegades. I certament, aquelles pràctiques van canviar tant el meu concepte de la investigació que em van empènyer a realitzar la tesi doctoral, sobre un tema que em va apassionar d’inici, i que avui arriba a la seva culminació sobre el paper. Però tots aquests anys, de penes i glòries, formen indubtablement un camí acompanyat de persones meravelloses, que han contribuït a la realització d’aquesta tesi i a la meua formació, professional i personal. Per tant, és moment d’agrair a totes aquestes persones i, sobretot, donar-los les gràcies per ser-hi en tots i cadascun dels moments d’aquesta etapa: En primer lloc, als meus directors de tesi. Al Dr. Manel Armengol, per dipositar la seva confiança en mi, per confiar en una tesi biològica en el món de la cirurgia, i per donar-me tants i tants consells acadèmics i pràctics. A la Dra. Maria Teresa Quiles, per introduir-me en el món del laboratori i ensenyar-me totes les tècniques, i alhora ajudar a formar-me com a investigador. I en especial, a la Dra. Maria Antònia Arbós, la meva mentora en el món de la investigació. Per la seva dedicació, rigor científic i perseverança. Per educar-me científicament de manera excel·lent, no tindré mai prou paraules per agrair-li. Moltes gràcies per confiar en mi des del inici! També, un agraïment per a tota la gent amb qui vaig compartir la primera etapa a la interminablement esfèrica planta 14, on sempre s’elegia la ruta més llarga per arribar als llocs. Als meu companys de pràctiques, que hi van aterrar al mateix temps, la basca Eider i l’esbojarrat Ferran. Als companys del primer laboratori: a l’al·lota accelerada Tònia, a la Marta Monge (per compartir tants i tants biquinis i cafès, i tantes rialles!), a la Marina (per acompanyar-me en l’etapa inicial del doctorat, i també pels cafès!) i al Dr. Miguel Abal (Forza Depor!). I com no, en especial al Ramon. Per ensenyar-me tot el que sé, per les interminables tardes de western, per treballar al mateix equip, per tenir sempre una visió positiva i irònica de la vida, i per passar de ser un company de feina a ser un amic. Gràcies! I també, a la resta de gent d’aquella etapa: el Guillermo (sempre rient) i la Neus, l’Albert i el Jesús (inseparables), el Tomàs i el Toni (doctorands de la vella escola), a la Marta Tec (per tanta dedicació, per fer-ho tot bé i per ser una gran persona), l’Andreas i el Pep. I, finalment, als doctors Jaume Reventós, Rosana Pacciucci i Francina Munell. Però aquella etapa va acabar prematurament i, després d’un senyor trasllat, va donar lloc a la nova etapa al laboratori 122 del Institut de Recerca. I aquesta nova etapa va anar acompanyada dels vells i nous companys de feina. Una menció especial per al laboratori 120, amb tantes hores de conversa i rialla acumulada. A l’Eva, per compartir tantes hores a dins i a fora de la feina, per convertir-se en una amiga i per riure sempre. No deixis mai de fer-ho! A la Marta Llauri, per dedicar-te tant a la ciència i per compartir la primera decepció acadèmica, jeje, i tantes converses. A la Núria, per ser tant natural i riallera, i compartir els dies de màster i els esmorzars. A la Raquel, pel seu entusiasme i la seva visió positiva. I finalment, a la Marta Garcia. Per entendre’ns tant ràpid, com qui ja fa anys que es coneix, per compartir pensaments i per compartir tantes i tantes hores. Per ser com ets. També agrair a les persones que es van incorporar a la URB en la nova etapa. A la Marta Redbull, per ser tant pràctica i eficient. A l’Ana Barbosa i l’Ana Masià, la Lide (no pierdas ese humor!), la Marta Sesé, la Irene, la Tais, la Bea, el Pako, l’Aintzane i a tothom que em deixi. Buf, fa tants anys ja! I és clar, a la Neus. Llàstima que ens vam conèixer tant tard, però vam fer un bonica amistat! Òbviament, no em descuido de vosaltres pallussos. Al Valentí, el Jordi (Romerals), la Lorena, la Marian, la Marta Garcia Bellmunt i l’abuelito Marotta. Per formar un grup inseparable que encara avui dura, una gran amistat!! Per tots els xuut xut i els guinyé als passadissos, els té amb llimona de la màquina, el Xavi fent postures de Matrix o egípcies, el de la perilla del lavabo, la papallona, el Jaume Gol de senyor, el Josep Quer Comor?, el Dr. Zoidberg, les contaminacions de la panadera, la xolo- moto, el Garraforma i Can Juan, el calamar i tota la secció d’ultramarins, i tantes i tantes frases i situacions que vam viure. I perquè us estimo, que coi. També un agraïment per a un grup de futbolistes d’elit que va començar la seva etapa al velòdrom de la vall d’Hebron i després va passar a delectar el públic del club hispano-francés per, finalment, gestar un equip que ha adquirit grans conquestes a la Meiland. Moltes gràcies a tots els components de l’equip Ecogen FC, i en especial al David Selva (i les fotos sèries), al Javi Hernández (casi como el del Barça, incluso en juego), Vicente Peg Adidas, Julian (Dios, no puedo parar de reir con éste hombre) i David Jr. Als components de la UCTS: al Ricardo (gràcies pels arrays!), a la Paqui (ai, quins rècords amb tanta eficiència de la real time!), a la Irene, a la Fàtima, a la Mari Ángeles i, en especial, a la Marta Valeri per tantes, tantes i tantes hores al confocal, de imatges i de converses és clar! També als components de la UEB: a l’Álex Sánchez i, en especial, al Josep Lluís Mosquera per tanta dedicació amb les dades dels arrays. Un especial agraïment per al meu apreciadíssim company de pis durant tota la tesi. A tu Pau, per totes les interminables hores d’intercanvis de coneixement. Per entendre’ns i compartir pis amb tanta facilitat, no és fàcil trobar algú com tu!! I per seguir sent un amic després, i poder formar part d’un grup d’amics tant especials: el Marc, el Miki, el Willy, el Baró, el Xino, el Xano, la Maria, la Mariona, el Xeic, el Kapi, el Moreno, el Mancini i el Cinto. Gràcies per ser com sou!!! A tota la gent de Linyola que han crescut amb mi i m’han format com a persona. Al Pérez i la Èlia, a l’Àlex i la Marta, al Robert i la Montse, al Kubala i la Raquel, al Gerard i la Imma, al Teixi, al Torrades, al Nando, al Perito, i a tots els que em deixo. Finalment, a la meva família. Als meus pares, per donar-ho tot per mi. Per confiar en mi i abocar la vostra vida sobre la meva. Per deixar-me escollir sempre i donar-me la oportunitat de treballar en allò que m’agrada. I per educar-me de la millor manera possible. I a tu Roger, per ser-hi sempre. Per protegir-me (potser a vegades massa, jeje) i per ensenyar-me allò que no sabia. I per obrir el camí. L’etapa al Institut ha acabat per donar pas a una nova etapa a la Universitat. I en aquesta nova etapa he conegut a persones excel·lents amb qui espero compartir grans anys. No us puc dedicar aquí moltes línies, perquè no formeu part d’aquesta tesi, però sí que us agraeixo l’acolliment. Estic segur que ens ho passarem bé. I finalment a tu Maria, per donar la volta que li faltava a la meua vida. Índex Índex I.- Índex Índex de Figures.................................................... Pag 19 Índex de taules...................................................... Pag 25 Abreviatures......................................................... Pag 29 II.- Introducció 1.- Procés quirúrgic de l’hèrnia.
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