968 resultados para Doente terminal


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Cystic fibrosis is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, which encodes a chloride channel present in many cells. In cardiomyocytes, we report that multiple exon 1 usage and alternative splicing produces four CFTR transcripts, with different 5'-untranslated regions, CFTRTRAD-139, CFTR-1C/-1A, CFTR-1C, and CFTR-1B. CFTR transcripts containing the novel upstream exons (exons -1C, -1B, and -1A) represent more than 90% of cardiac expressed CFTR mRNA. Regulation of cardiac CFTR expression, in response to developmental and pathological stimuli, is exclusively due to the modulation of CFTR-1C and CFTR-1C/-1A expression. Upstream open reading frames have been identified in the 5'-untranslated regions of all CFTR transcripts that, in conjunction with adjacent stem-loop structures, modulate the efficiency of translation initiation at the AUG codon of the main CFTR coding region in CFTRTRAD-139 and CFTR-1C/-1A transcripts. Exon(-1A), only present in CFTR-1C/-1A transcripts, encodes an AUG codon that is in-frame with the main CFTR open reading frame, the efficient translation of which produces a novel CFTR protein isoform with a curtailed amino terminus. As the expression of this CFTR transcript parallels the spatial and temporal distribution of the cAMP-activated whole-cell current density in normal and diseased hearts, we suggest that CFTR-1C/-1A provides the molecular basis for the cardiac cAMP-activated chloride channel. Our findings provide further insight into the complex nature of in vivo CFTR expression, to which multiple mRNA transcripts, protein isoforms, and post-transcriptional regulatory mechanisms are now added.

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Immunizing pregnant women with a malaria vaccine is one approach to protecting the mother and her offspring from malaria infection. However, specific maternal Abs generated in response to vaccination and transferred to the fetus may interfere with the infant's ability to respond to the same vaccine. Using a murine model of malaria, we examined the effect of maternal 19-kDa C-terminal region of merozoite surface protein-1 (MSP1(19)) and Plasmodium yoelii Abs on the pups' ability to respond to immunization with MSP1(19). Maternal MSPI,g-specific Abs but not A yoelii-specific Abs inhibited Ab production following MSP1(19) immunization in 2-wk-old pups. This inhibition was correlated with the amount of maternal MSP1(19) Ab present in the pup at the time of immunization and was due to fewer specific B cells. Passively acquired Ab most likely inhibited the development of an Ab response by blocking access to critical B cell epitopes. If a neonate's ability to respond to MSP1(19) vaccination depends on the level of maternal Abs present at the time of vaccination, it may be necessary to delay immunization until Abs specific for the vaccinating Ag have decreased.

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Sperm ultrastructure is examined and described for the actinocyclidid nudibranchs Actinocyclus verrucosus, Hallaxa iju and Hallaxa indecora. Although general characteristics were consistent with previously described heterobranch observations, present investigations revealed ultrastructural synapomorphies for the family based on the morphology of the terminal region of the spermatozoon. In actinocyclidids, the axonemal microtubules penetrate for some distance beyond the annulus, and the annular accessory body elongates to completely seal the terminal region. Chromodoris also has an annular accessory body that completely seals the axoneme and terminal region, but it does not extend far beyond the annulus, and it is possible that these states were derived independently. Cytochemical staining confirmed that there was no glycogen present in the posterior region of the sperm for H. indecora or Chromodoris kuniei. However, representatives of other chromodoridid genera (Noumea, Risbecia) have an axoneme that penetrates through the entire annular complex, after which it is sheathed by a glycogen deposit. Similarities in the acrosomal complex support the proposed sister group relationship between the Actinocyclidae and Chromodorididae.

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The mammalian long-chain acyl-CoA thioesterase, the enzyme that catalyses the hydrolysis of acyl-CoAs to free fatty acids, contains two fused 4HBT (4-hydroxybenzoyl-CoA thioesterase) motifs. The C-terminal domain of the mouse long-chain acyl-CoA thioesterase (Acot7) has been expressed in bacteria and crystallized. The crystals were obtained by vapour diffusion using PEG 2000 MME as precipitant at pH 7.0 and 290 K. The crystals have the symmetry of space group R32 ( unit-cell parameters a = b = 136.83, c = 99.82 angstrom, gamma = 120 degrees). Two molecules are expected in the asymmetric unit. The crystals diffract to 2.4 angstrom resolution using the laboratory X-ray source and are suitable for crystal structure determination.

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The RKKEE cluster of charged residues located within the cytoplasmic helix of the bacterial mechanosensitive channel, MscL, is essential for the channel function. The structure of MscL determined by x-ray crystallography and electron paramagnetic resonance spectroscopy has revealed discrepancies toward the C-terminus suggesting that the structure of the C-terminal helical bundle differs depending on the pH of the cytoplasm. In this study we examined the effect of pH as well as charge reversal and residue substitution within the RKKEE cluster on the mechanosensitivity of Escherichia coli MscL reconstituted into liposomes using the patch-clamp technique. Protonation of either positively or negatively charged residues within the cluster, achieved by changing the experimental pH or residue substitution within the RKKEE cluster, significantly increased the free energy of activation for the MscL channel due to an increase in activation pressure. Our data suggest that the orientation of the C-terminal helices relative to the aqueous medium is pH dependent, indicating that the RKKEE cluster functions as a proton sensor by adjusting the channel sensitivity to membrane tension in a pH-dependent fashion. A possible implication of our results for the physiology of bacterial cells is briefly discussed.

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Background There is limited information regarding the clinical utility of amino-terminal pro-B-type natriuretic pepticle (NT-proBNP) for the detection of left ventricular (LV) dysfunction in the community. We evaluated predictors of circulating NT-proBNP levels and determined the utility of NT-proBNP to detect systolic and diastolic LV dysfunction in older adults. Methods. A population-based sample of 1229 older adults (mean age 69.4 years, 50.1% women) underwent echocardiographic assessment of cardiac structure and function and measurement of circulating NT-proBNP levels. Results Predictors of NT-proBNP included age, female sex, body mass index, and cardiorenal parameters (diastolic dysfunction [DID] severity; LV mass and left atrial volume; right ventricular overload; decreasing ejection fraction [EF] and creatinine clearance). The performance of NT-proBNP to detect any degree of LV dysfunction, including mild DID, was poor (area under the curve 0.56-0.66). In contrast, the performance of NT-proBNP for the detection of EF 0.90 regardless of age and sex; history of hypertension, diabetes, coronary artery disease; or body mass category. The ability of NT-proBNP to detect EF

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The c-Jun N-terminal kinases (JNKs) are members of a larger group of serine/ threonine (Ser/Thr) protein kinases from the mitogen-activated protein kinase family. JNKs were originally identified as stress-activated protein kinases in the livers of cycloheximide-challenged rats. Their subsequent purification, cloning, and naming as JNKs have emphasized their ability to phosphorylate and activate the transcription factor c-Jun. Studies of c-Jun and related transcription factor substrates have provided clues about both the preferred substrate phosphorylation sequences and additional docking domains recognized by JNK There are now more than 50 proteins shown to be substrates for JNK These include a range of nuclear substrates, including transcription factors and nuclear hormone receptors, heterogeneous nuclear ribonucleoprotein K and the Pol I-specific transcription factor TIF-IA, which regulates ribosome synthesis. Many nonnuclear substrates have also been characterized, and these are involved in protein degradation (e.g., the E3 ligase Itch), signal transduction (e.g., adaptor and scaffold proteins and protein kinases), apoptotic cell death (e.g., mitochondrial Bcl2 family members), and cell movement (e.g., paxillin, DCX, microtubule-associated proteins, the stathmin family member SCG10, and the intermediate filament protein keratin 8). The range of JNK actions in the cell is therefore likely to be complex. Further characterization of the substrates of JNK should provide clearer explanations of the intracellular actions of the JNKs and may allow new avenues for targeting the JNK pathways with therapeutic agents downstream of JNK itself.

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Agrin is a proteoglycan secreted by motor neurite terminals that functions to initiate and maintain AChR clusters at the nerve terminal. This led to the theory that neurite terminals decide where neuromuscular synapses form by secreting agrin. However, initiation of AChR clustering occurs in the absence of the innervating motoneuron and in the absence of agrin. In this instance, the muscle, not the nerve, is deciding the location of neuromuscular synapses by drawing neurite terminals towards pre-existing AChR clusters. If this were true, one would expect the initial innervation patterns to be the same in agrin-deficient mice and wild-type mice. To test this we quantified the intramuscular axonal branching and synapse formation in the diaphragm at E14.5 in agrin-deficient mice and wild-type mice. Heterozygote mothers were anaesthetised with Nembutal (30 mg) and killed via cervical dislocation. In the diaphragm, the nerve trunk runs down the centre of the muscle and extends branches primarily toward the lateral side. In agrin-deficient mice however, we found significantly more branches exited the phrenic nerve trunk, branched in the periphery and extended further on the medial side. Moreover, we found that the percentage α-bungarotoxin/synaptophysin colocalisations, markers of pre- and postsynaptic differentiation, respectively, was the same in agrin-deficient mice and wild-type mice. These results show that initial innervation patterns are not the same in agrin-deficient mice and wild-type mice indicating neurite terminals, not muscle, decide the placement of neuromuscular synapses in the absence of agrin.

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O presente estudo teve como objetivo, por meio de uma pesquisa qualitativa segundo a abordagem fenomenológica existencial, investigar os pensamentos, sentimentos e atitudes do oncologista na informação do diagnóstico de câncer à paciente. Foram realizadas 5 entrevistas semi-dirigidas com oncologistas que atendem em consultório particular, e foi delimitada a análise compreensiva fenomenológica do conteúdo. Os resultados obtidos mostraram que: A informação do diagnóstico de câncer de mama para pacientes jovens em idade reprodutiva foi considerada a mais marcante para os médicos, lhes causando maior preocupação, medo e tristeza, devido às limitações impostas pela doença aos planos de vida da paciente e às questões da maternidade. Os entrevistados referiram que em qualquer caso, o momento da notícia lhes repercute emocionalmente, pela vivência do sentimento de tristeza, ou por fantasias relacionadas à responsabilidade pela doença. Eles apontaram como mais difícil nesse processo, o confronto com as reações emocionais da paciente e falar sobre o câncer utilizando palavras para amenizar o impacto dessa informação. Diante dessas dificuldades, a evolução da medicina, a possibilidade de cirurgia conservadora e a reconstrução mamária foram consideradas atenuantes. Os médicos afirmaram que informam a paciente de maneira clara, objetiva e gradativa, mas nem todos eles utilizam sempre a palavra câncer . Procuram encorajar a paciente com otimismo e solidariedade, engajando-a no tratamento como participante ativa. Além disso, sentem-se responsáveis por motivar aquela que demonstra desânimo ou que reluta em seguir o tratamento. Eles percebem que a partir da informação do diagnóstico a paciente estabelece um vínculo de confiança e dependência, e identificam que em alguns casos eles também se vinculam à paciente. Entretanto, reconhecem que desse vínculo deriva um desgaste emocional que os leva ao questionamento sobre a escolha de sua especialidade. Constatou-se que alguns oncologistas podem emitir sua opinião sobre determinado diagnóstico, às vezes, a pedido da paciente, mas que ao errarem nesse pré-julgamento, evidenciam sentimentos de impotência, ou fracasso, ou culpa, por não se prepararem, nem à paciente, para o momento da informação. Os casos em que a família interfere com questionamentos ou com o pedido de ocultação da informação não foram vistos por eles de modo negativo, contudo, o pedido de ocultação nem sempre é acatado. Os entrevistados referiram algum tipo de aprendizado através do contato com a paciente oncológica, ou por meio da reavaliação de seus valores morais, ou da reflexão sobre sua própria finitude. Particularmente nos casos de câncer avançado ou terminal, esse aprendizado abrangeu o apoio nos momentos que precedem a morte, ou o reconhecimento da própria impotência. Conclusão: A análise dos resultados revelou os conflitos e as dúvidas do médico como ser ético , que assume os riscos ao escolher quanto, quando e como informar o diagnóstico à paciente, sua consciência de culpabilidade, a ansiedade existencial desencadeada pelas reações emocionais da paciente, a manifestação de sua maneira preocupada de existir no mundo, a busca pelo encontro autêntico e criativo, a subjetividade utilizada como caminho para a compreensão do ser doente e a possibilidade do fracasso de um projeto resultar em frustração e num rebaixamento temporário da confiança em sua própria capacidade. Desse modo, esse trabalho demonstra a inevitável influência dos fatores subjetivos na atitude do médico que informa o diagnóstico de câncer para sua paciente e que esse processo está muito além de qualquer pretensa objetividade.

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The Saccharomyces cerevisiae gene FPS1 encodes an aquaglyceroporin of the major intrinsic protein (MIP) family. The main function of Fps1p seems to be the efflux of glycerol in the adaptation of the yeast cell to lower external osmolarity. Fps1p is an atypical member of the family, because the protein is much larger (669 amino acids) than most MIPs due to long hydrophilic extensions in both termini. We have shown previously that a short domain in the N-terminal extension of the protein is required for restricting glycerol transport through the channel (Tamás, M. J., Karlgren, S., Bill, R. M., Hedfalk, K., Allegri, L., Ferreira, M., Thevelein, J. M., Rydström, J., Mullins, J. G. L., and Hohmann, S. (2003) J. Biol. Chem. 278, 6337-6345). Deletion of the N-terminal domain results in an unregulated channel, loss of glycerol, and osmosensitivity. In this work we have investigated the role of the Fps1p C terminus (139 amino acids). A set of eight truncations has been constructed and tested in vivo in a yeast fps1Δ strain. We have performed growth tests, membrane localization following cell fractionation, and glycerol accumulation measurements as well as an investigation of the osmotic stress response. Our results show that the C-terminal extension is also involved in restricting transport through Fps1p. We have identified a sequence of 12 amino acids, residues 535-546, close to the sixth transmembrane domain. This element seems to be important for controlling Fps1p function. Similar to the N-terminal domain, the C-terminal domain is amphiphilic and has a potential to dip into the membrane.