Patients on the Waiting List for Liver Transplantation: Caregiver Burden and Stress

Over the last few decades, informal caregivers of patients with chronic diseases have received more attention, and there is a growing volume of studies demonstrating high rates of burden, stress, and mental disorders in this group of individuals. The objective of this study was to evaluate the burden, stress, and psychosocial characteristics of informal caregivers of liver transplantation candidates. Participants were assessed by individual evaluations with the following instruments: a semi-structured interview, the Caregiver Burden Scale, the Inventario de Sintomas de Stress para Adultos de Lipp, and the Beck Depression Inventory. The Mann-Whitney test was used for statistical analysis with a significance level of 0.05. The characteristics of the study group (n = 61) were similar to those of groups in other studies with respect to gender (82% were women), kinship (64% were spouses), and age (the mean age was 47.6 years). The main stressors identified by the participants were as follows: doubts about ways to react in a crisis or in emergency situations (42.6%), mood swings of the patient (29.5%), and care involving food and medications (27.9%). Approximately 25% of the caregivers reported that they felt unprepared to adequately perform their roles. Data analysis indicated a greater burden overall on caregivers when the patient`s Model for End-Stage Liver Disease score was greater than or equal to 15 points (P = 0.041). Furthermore, caregivers of patients with alcoholic liver disease showed higher depression (P = 0.034) and overall burden scores (P = 0.031) versus caregivers of patients with liver disease due to other etiologies. In conclusion, the participants showed significantly high levels of burden, stress, and depression. Support measures and caregiver preparation should be implemented by health care providers. Liver Transpl 16: 1164-1168, 2010. (C) 2010 AASLD.

Leishmanicidal and cholinesterase inhibiting activities of phenolic compounds of Dimorphandra gardneriana and Platymiscium floribundum, native plants from Caatinga biome

Nos últimos anos, o Ministério da Saúde do Brasil e a Organização Mundial da Saúde tem apoiado a investigação de novas tecnologias que possam contribuir para a vigilância, novos tratamentos e controle da leishmaniose visceral no país. Assim, o objetivo deste trabalho foi isolar compostos de plantas do bioma Caatinga, e investigar a toxicidade destes compostos contra as formas promastigotas e amastigotas de Leishmania infantum chagasi, principal parasita responsável pela leishmaniose visceral na América do Sul, e avaliar a sua capacidade para inibir a enzima acetil-colinesterase (AChE). Após a exposição aos compostos em estudo, foram realizados testes utilizando a forma promastigota que expressa luciferase e ELISA in situ para medir a viabilidade das formas promastigotas e amastigota, respectivamente. O ensaio colorimétrico MTT foi realizado para determinar a toxicidade destas substâncias utilizando células monocíticas murina RAW 264.7. Todos os compostos foram testados in vitro para as sua propriedade anti-colinesterásica. Um cumarina, escoparona, foi isolada a partir de hastes de Platymiscium floribundum, e os flavonóides, rutina e quercetina, foram isolados a partir de grãos de Dimorphandra gardneriana. Estes compostos foram purificados, utilizando cromatografia em coluna gel eluída com solventes orgânicos em misturas de polaridade crescente, e identificados por análise espectral. Nos ensaios leishmanicidas, os compostos fenólicos mostraram eficácia contra as formas extracelulares promastigotas, com EC50 para escoporona de 21.4µg/mL e para quercetina e rutina 26 e 30.3µg/mL, respectivamente. Os flavonóides apresentaram resultados comparáveis à droga controle, a anfotericina B, contra as formas amastigotas com EC50 para quercetina e rutina de 10.6 e 43.3µg/mL, respectivamente. Os compostos inibiram a enzima AChE com halos de inibição variando de 0,8 a 0,6cm, indicando um possível mecanismo de ação para a atividade leishmanicida.

Exercise Performance and Dynamic Hyperinflation in Lymphangioleiomyomatosis

Rationale: Lymphangioleiomyomatosis (LAM) is characterized by exercise performance impairment. Although airflow limitation is common, no previous studies have evaluated the prevalence and impact of dynamic hyperinflation (DH) in LAM. Objectives: To investigate the dynamic responses during maximal exercise and the prevalence, predictors, and repercussions of DH in LAM. Methods: Forty-two patients with LAM performed symptom-limited incremental cycle exercise and pulmonary functions tests (PFTs) and were compared with 10 age-matched healthy women. Dyspnea intensity, inspiratory capacity, oxygen saturation, and cardiac, metabolic, and respiratory variables were assessed during exercise. Patients with LAM also performed a 6-minute walk test (6MWT). Measurements and Main Results: Patients with LAM had higher baseline dyspnea, poorer quality of life, obstructive pattern, air trapping, and reduced diffusing capacity of carbon monoxide in PFTs. Although they had the same level of regular physical activity, their maximal exercise performance was reduced and was associated with ventilatory limitation, greater desaturation, and dyspnea. The prevalence of DH was high in LAM (55%), even in patients with mild spirometric abnormalities, and was correlated with airflow obstruction, air trapping, and diffusing capacity of carbon monoxide. Compared with the non-DH subgroup, the patients who developed DH had a ventilatory limitation contributing to exercise cessation on cycling and higher desaturation and dyspnea intensity during the 6MWT. Conclusions: Ventilatory limitation and gas exchange impairment are important causes of exercise limitation in LAM. DH is frequent in LAM, even in patients with mild spirometric abnormalities. DH was associated with the severity of disease, higher dyspnea, and lower oxygen saturation. In the 6MWT, desaturation and dyspnea were greater in patients with DH.

Comparison of lung preservation solutions in human lungs using an ex vivo lung perfusion experimental model

OBJECTIVE: Experimental studies on lung preservation have always been performed using animal models. We present ex vivo lung perfusion as a new model for the study of lung preservation. Using human lungs instead of animal models may bring the results of experimental studies closer to what could be expected in clinical practice. METHOD: Brain-dead donors whose lungs had been declined by transplantation teams were used. The cases were randomized into two groups. In Group 1, Perfadex (R) was used for pulmonary preservation, and in Group 2, LPDnac, a solution manufactured in Brazil, was used. An ex vivo lung perfusion system was used, and the lungs were ventilated and perfused after 10 hours of cold ischemia. The extent of ischemic-reperfusion injury was measured using functional and histological parameters. RESULTS: After reperfusion, the mean oxygenation capacity was 405.3 mmHg in Group 1 and 406.0 mmHg in Group 2 (p=0.98). The mean pulmonary vascular resistance values were 697.6 and 378.3 dyn.s.cm(-5), respectively (p=0.035). The mean pulmonary compliance was 46.8 cm H2O in Group 1 and 49.3 ml/cm H2O in Group 2 (p=0.816). The mean wet/dry weight ratios were 2.06 and 2.02, respectively (p=0.87). The mean Lung Injury Scores for the biopsy performed after reperfusion were 4.37 and 4.37 in Groups 1 and 2, respectively (p=1.0), and the apoptotic cell counts were 118.75/mm(2) and 137.50/mm(2), respectively (p=0.71). CONCLUSION: The locally produced preservation solution proved to be as good as Perfadex (R). The clinical use of LPDnac may reduce costs in our centers. Therefore, it is important to develop new models to study lung preservation.

The influence of pore size on osteoblast phenotype expression in cultures grown on porous titanium

This study investigated the effect of pore size on osteoblastic phenotype development in cultures grown on porous titanium (Ti). Porous Ti discs with three different pore sizes, 312 mu m (Ti 312), 130 mu m (Ti 130) and 62 mu m (Ti 62) were fabricated using a powder metallurgy process. Osteoblastic cells obtained from human alveolar bone were cultured on porous Ti samples for periods of up to 14 days. Cell proliferation was affected by pore size at day 3 (p = 0.0010), day 7 (p = 0.0005) and day 10 (p = 0.0090) in the following way: Ti 62 < Ti 130 < Ti 312. Gene expression of bone markers evaluated at 14 days was affected, RUNX2 (p = 0.0153), ALP (p = 0.0153), BSP (p = 0.0156), COL (p = 0.0156), and OPN (p = 0.0156) by pore size as follows: Ti 312 < Ti 130 < Ti 62. Based on these results, the authors suggest that porous Ti surfaces with pore sizes near 62 mu m, compared with those of 312 mu m and 130 mu m, yield the highest expression of osteoblast phenotype as indicated by the lower cell proliferation rate and higher gene expression of bone markers.

Witzkeite: A new rare nitrate-sulphate mineral from a guano deposit at Punta de Lobos, Chile

Witzkeite, ideally Na4K4Ca(NO3)(2)(SO4)(4)center dot 2H(2)O, is a new mineral found in the oxidation zone of the guano mining field at Punta de Lobos, Tarapaca region, Chile. It occurs as colorless, tabular crystals up to 140 mu m in length, associated with dittmanite and nitratine. Witzkeite is colorless and transparent, with a white streak and a vitreous luster. It is brittle, with Molts hardness 2 and distinct cleavage on {001}. Measured density is 2.40(2) g/cm(3), calculated density is 2.403 g/cm(3). Witzkeite is biaxial (-) with refractive indexes alpha = 1.470(5), beta = 1.495(5), gamma = 1.510(5), measured 2V = 50-70 degrees. The empirical composition is (electron microprobe, mean of five analyses, H2O, CO2, and N2O5 by gas chromatography; wt%): Na2O 12.83, K2O 22.64, CaO 7.57, FeO 0.44, SO3 39.96, N2O5 12.7, H2O 4.5, total 100.64; CO2 was not detected. The chemical formula, calculated based on 24 O, is: Na3.40K3.95Ca1.11Fe0.05(NO3)(1.93)(SO4)(4.10)(H4.10O1.81). Witzkeite is monoclinic, space group C2/c, with unit-cell parameters: a = 24.902(2), b = 5.3323(4), c = 17.246(1) angstrom, beta = 94.281(7)degrees, V = 2283.6(3) angstrom(3) (Z = 4). The crystal structure was solved using single-crystal X-ray diffraction data and refined to R-1(F) = 0.043. Witzkeite belongs to a new structure type and is noteworthy for the very rare simultaneous presence of sulfate and nitrate groups. The eight strongest X-ray powder-diffraction lines [d in angstrom (I in %) (h k l)] are: 12.38 (100) (2 0 0), 4.13 (19) (6 0 0), 3.10 (24) (8 0 0), 2.99 (7) ((8) over bar 02), 2.85 (6) (8 02), 2.69 (9) ((7) over bar 1 3), 2.48 (12) (10 0 0), and 2.07 (54) (12 0 0). The IR spectrum of witzkeite was collected in the range 390-4000 cm(-1). The spectrum shows the typical bands of SO42- ions (1192, 1154, 1116, 1101, 1084, 993, 634, and 617 cm(-1)) and of NO3- ions (1385, 1354, 830, 716, and 2775 cm(-1)). Moreover, a complex pattern of bands related to H2O is visible (bands at 3565, 3419, 3260, 2405, 2110, 1638, and 499 cm(-1)). The IR spectrum is discussed in detail.

Behavior of triple-gate Bulk FinFETs with and without DTMOS operation

In this paper, the combination of the Dynamic Threshold (DT) voltage technique with a non-planar structure is experimentally studied in triple-gate FinFETs. The drain current, transconductance, resistance, threshold voltage, subthreshold swing and Drain Induced Barrier Lowering (DIBL) will be analyzed in the DT mode and the standard biasing configuration. Moreover, for the first time, the important figures of merit for the analog performance such as transconductance-over-drain current, output conductance. Early voltage and intrinsic voltage gain will be studied experimentally and through three-dimensional (3-D) numerical simulations for different channel doping concentrations in triple-gate DTMOS FinFETs. The results indicate that the DTMOS FinFETs always yield superior characteristic; and larger transistor efficiency. In addition, DTMOS devices with a high channel doping concentration exhibit much better analog performance compared to the normal operation mode, which is desirable for high performance low-power/low-voltage applications. (C) 2011 Elsevier Ltd. All rights reserved.

Analysis of temperature variation influence on the analog performance of 45 degrees rotated triple-gate nMuGFETs

This work presents the analog performance of n-type triple-gate MuGFETs with high-k dielectrics and TiN gate material fabricated in 45 degrees rotated SOI substrates comparing their performance with standard MuGFETs fabricated without substrate rotation. Different fin widths are studied for temperatures ranging from 250 K up to 400 K. The results of transconductance, output conductance, transconductance over drain current ratio, intrinsic voltage gain and unit-gain frequency are studied. It is observed that the substrate rotation improves the carrier mobility of narrow MuGFETs at any temperature because of the changing in the conduction plane at the sidewalls from (1 1 0) to (1 0 0). For lower temperatures, the improvement of the carrier mobility of rotated MuGFETs is more noticeable as well as the rate of mobility improvement with the temperature decrease is larger. The output conductance is weakly affected by the substrate rotation. Although this improvement in the transconductance of rotated MuGFETs is negligibly transferred to the intrinsic voltage gain, the unity-gain frequency of rotated device is improved due to the larger carrier mobility in the entire range of temperatures studied. (C) 2011 Elsevier Ltd. All rights reserved.

Temperature impact on the tunnel fet off-state current components

In this work, the temperature impact on the off-state current components is analyzed through numerical simulation and experimentally. First of all, the band-to-band tunneling is studied by varying the underlap in the channel/drain junction, leading to an analysis of the different off-state current components. For pTFET devices, the best behavior for off-state current was obtained for higher values of underlap (reduced BTBT) and at low temperatures (reduced SRH and TAT). At high temperature, an unexpected off-state current occurred due to the thermal leakage current through the drain/channel junction. Besides, these devices presented a good performance when considering the drain current as a function of the drain voltage, making them suitable for analog applications. (C) 2012 Elsevier Ltd. All rights reserved.

GIDL behavior of p- and n-MuGFET devices with different TiN metal gate thickness and high-k gate dielectrics

This work studies the gate-induced drain leakage (GIDL) in p- and n-MuGFET structures with different TiN metal gate thickness and high-k gate dielectrics. As a result of this analysis, it was observed that a thinner TiN metal gate showed a larger GIDL due to the different gate oxide thickness and a reduced metal gate work function. In addition, replacing SiON by a high-k dielectric (HfSiON) results for nMuGFETs in a decrease of the GIDL On the other hand, the impact of the gate dielectric on the GIDL for p-channel MuGFETs is marginal. The effect of the channel width was also studied, whereby narrow fin devices exhibit a reduced GIDL current in spite of the larger vertical electric field expected for these devices. Finally, comparing the effect of the channel type, an enhanced GIDL current for pMuGFET devices was observed. (C) 2011 Elsevier Ltd. All rights reserved.

Fossilized bacteria in a Cretaceous pterosaur headcrest

Pinheiro F.L., Horn B.L.D., Schultz C.L., de Andrade J.A.F.G. and Sucerquia P.A., 2012: Fossilized bacteria in a Cretaceous pterosaur headcrest. Lethaia, Vol. 45, pp. 495-499. We report herein the first evidence of bacterial autolithification in the Crato Formation of Araripe Basin, Brazil. The fossilized bacteria are associated with a tapejarid pterosaur skull, replacing the soft-tissue extension of the headcrest. EDS analyses indicate that the bacteria were replaced by phosphate minerals, probably apatite. The bacterial biofilm was likely part of the prokaryotic mat that decomposed the pterosaur carcass at the bottom of the Araripe lagoon. This work suggests that bacterial autolithification could have played a key-role on soft-tissue preservation of Crato Formation Lagerstatte. ?Bacterial autolithification, Crato Formation, phosphatization, pterosaur, soft-tissue preservation.

Mechanical Measurements Of Two Exogenous Surfactants Using A Langmuir Film Balance:A Comparative Study

Rationale: The primary function of surfactant is to reduce the surface tension at air-liquid interface. In this study, the surface tension behavior of two commercial surfactants, poractant alfa (ChiesiFarmaceuticals,ltaly) and beractant (Abbott Laboratories,USA), were evaluated,using new parameters. Methods: We used a Langmuir film balance (Minitrough,KSV lnstruments,Finland) to measure of surface tension of both poractant alfa and beractant samples. For both samples,we prepared a solution of 1 mg/mdl dissolved in chloroform. The solution (1uL) was applied over a subphase of milli-Q water (175 ml) in the chamber of the balance. The chamber has two moving barriers that can change its surface area between a maximum value of 112.5 cm2 anda minimum value of 22.5 cm2, defining a balance cycle.lhree sample's films were evaluated for each sample, during 20 balance cycles. Here quantify two new variables, which is the mean hysteresis area of the measured curve surface tension of the last 16 balance cycles,defined here as Mean Work Cycle (MWC), and the moment that the surfactant is active in the surface, this measure is defined here as Active Surface Area Critical in the compression (ASACC) and the expansion (ASACE). The test was applied to compare the statistical significance of the results.

Influence of chest wall on lung mechanics during inspiration

RATIONALE: The interaction between lungs and chest wall influences lung volume, that determines lung history during respiration cycle. In this study, the influence of chest wall mechanics on respiratory system is assessed by the evaluation of inspiration pressure-volume curve (PV curve) under three different situations: closed-chest, open-chest and isolated lung. The PV curve parameters in each situation allow us to further understand the role played by different chest wall elements in the respiratory function. Methods: Twenty-four male Wistar rats (236 ± 29 g) were used. The animals were weighted and then anesthetized with xylazine 2% (O,SmL/kg) and ketamine 10% (0,9mL/kg), exsanguinated and later tracheostomies with a metallic cannula (14 gauge).The cannula was connected to an automatic small animal insufflator. This setup was connected to a pressure transducer (32 samples/s). The 24 animals were randomly separated in three groups:(i) closed chest,(ii) open chest and (iii) isolated lung. The rats were insufflated with 20mL quasi-statically (constant speed of 0,1mUs). lnsufflated volume and measured pressure data were kept and PV curves were obtained for all animals. The PV curves were fitted (non-linear least squares) against the sigmoid equation (1) to obtain the sigmoid equation parameters (a,b,c,d). Elastance measurements were obtained from linear regression of pressure/volume measurements in a 0,8s interval before and after the calculated point. Results: The parameters a,b and c showed no significant change, but the parameter d showed a significant variation among the three groups. The initial elastance also varied between open and closed chest, indicating the need of a higher pressure for the lung expansion, as can be seen in Table 1. Conclusion: A supporting effect of the chest wall was observed at the initial moments of inspiration, observed as a higher initial elastance in open chest situations than in closed chest situations (p=0,00001). The similar initial elastance for the isolated lung and closed chest may be explained by the specific method used for the isolated lung experiment. As the isolated lung is supported by the trachea vertically, the weight of the tissue may have a similar effect of the residual negative pressure in the thorax, responsible for maintaining the residual volume.

Influence of chest wall on lung mechanics during inspiration.

RATIONALE: The interaction between lungs and chest wall influences lung volume, that determines lung history during respiration cycle. In this study, the influence of chest wall mechanics on respiratory system is assessed by the evaluation of inspiration pressure-volume curve (PV curve) under three different situations: closed-chest, open-chest and isolated lung. The PV curve parameters in each situation allow us to further understand the role played by different chest wall elements in the respiratory function. Methods: Twenty-four male Wistar rats (236 ± 29 g) were used. The animals were weighted and then anesthetized with xylazine 2% (0,5mL/kg) and ketamine 10% (0,9mL/kg), exsanguinated and later tracheostomized with a metallic cannula (14 gauge). The cannula was connected to an automatic small animal insufflator. This setup was connected to a pressure transducer (32 samples/s). The 24 animals were randomly separated in three groups: (i) closed chest, (ii) open chest and (iii) isolated lung. The rats were insufflated with 20mL quasi-statically (constant speed of 0,1mL/s). Insufflated volume and measured pressure data were kept and PV curves were obtained for all animals. The PV curves were fitted (non-linear least squares) against the sigmoid equation (1) to obtain the sigmoid equation parameters (a,b,c,d). Elastance measurements were obtained from linear regression of pressure/volume measurements in a 0,8s interval before and after the calculated point. Results: The parameters a, b and c showed no significant change, but the parameter d showed a significant variation among the three groups. The initial elastance also varied between open and closed chest, indicating the need of a higher pressure for the lung expansion, as can be seen in Table 1. Table 1: Mean and Standard Deviation of parameters obtained for each protocol. Protocol: Closed Chest – a (mL) -0.35±0.33; b (mL) 13.93±0.89; c (cm H2O) 21.28±2.37; d (cm H2O) 6.17±0.84; r²** (%) 99.4±0.14; Initial Elastance* (cm H2)/mL) 12.72±6.66; Weight (g) 232.33±5.72. Open Chest - a (mL) 0.01±0.28; b (mL) 14.79±0.54; c (cm H2O) 19.47±1.41; d (cm H2O) 3.50±0.28; r²** (%) 98.8±0.34; Initial Elastance* (cm H2)/mL) 28.68±2.36; Weight (g) 217.33±7.97. Isolated Lung - a (mL) -0.09±0.46; b (mL) 14.22±0.75; c (cm H2O) 21.76±1.43; d (cm H2O) 4.24±0.50; r²** (%) 98.9±0.19; Initial Elastance* (cm H2)/mL) 7.13±8.85; Weight (g) 224.33±16.66. * Elastance measures in the 0-0,1 mL range. ** Goodness of sigmoid fit versus measured data Conclusion: A supporting effect of the chest wall was observed at the initial moments of inspiration, observed as a higher initial elastance in open chest situations than in closed chest situations (p=0,00001). The similar initial elastance for the isolated lung and closed chest may be explained by the specific method used for the isolated lung experiment. As the isolated lung is supported by the trachea vertically, the weight of the tissue may have a similar effect of the residual negative pressure in the thorax, responsible for maintaining the residual volume.