Intraspecific Variation in the Placement of Campaniform Sensilla on the Wings of the Hawkmoth Manduca Sexta.

Flight control requires active sensory feedback, and insects have many sensors that help them estimate their current locomotor state, including campaniform sensilla (CS), which are mechanoreceptors that sense strain resulting from deformation of the cuticle. CS on the wing detect bending and torsional forces encountered during flight, providing input to the flight feedback control system. During flight, wings experience complex spatio-temporal strain patterns. Because CS detect only local strain, their placement on the wing is presumably critical for determining the overall representation of wing deformation; however, how these sensilla are distributed across wings is largely unknown. Here, we test the hypothesis that CS are found in stereotyped locations across individuals of Manduca sexta, a hawkmoth. We found that although CS are consistently found on the same veins or in the same regions of the wings, their total number and distribution can vary extensively. This suggests that there is some robustness to variation in sensory feedback in the insect flight control system. The regions where CS are consistently found provide clues to their functional roles, although some patterns might be reflective of developmental processes. Collectively, our results on intraspecific variation in CS placement on insect wings will help reshape our thinking on the utility of mechanosensory feedback for insect flight control and guide further experimental and comparative studies.

Abdominal Complications After Lung Transplantation in a Brazilian Single Center.

Surgical and nonsurgical abdominal complications have been described after lung transplantation. However, there is limited data on this event in this population. The objective of this study was to analyze the incidence of abdominal complications in patients undergoing lung transplantation at the Heart Institute of the Faculty of Medicine, University of São Paulo (InCor-HCFMUSP) between the years 2003 and 2016. The main causes of abdominal complications were inflammatory acute abdomen (7 patients; 14%), obstructive acute abdomen (9 patients; 18%), gastroparesis (4 patients; 8%), distal intestinal obstruction syndrome (4 patients; 8%), perforated acute abdomen (7 patients; 14%), cytomegalovirus (CMV; 6 patients; 12%), and other reasons (12 patients; 26%). Separating these patients according to Clavien-Dindo classification, we had 21 patients (43%) with complications grade II, 4 patients (8%) with complications grade IIIa, 7 patients (14%) with grade IIIb complications, 7 patients (14%) with grade IV complications, and 10 patients (21%) with grade complications V. In conclusion, abdominal disorders are seriously increased after lung transplantation and correlate with a high mortality. Early abdominal surgical complication has worse prognosis.

Incidence and Mortality by Cancer in Patients After Lung Transplantation in a Brazilian Institution.

BACKGROUND: The first human lung transplantation was performed by James Hardy in 1963 due to lung cancer. Currently, malignancy has its importance in the follow-up of transplanted patients because cancer risk is higher in this population and the main risk factor for this augmentation is immunosuppression. The most common types of cancer are non-melanoma skin cancer and post-transplantation lymphoproliferative diseases. The objective of this study is to measure the cancer incidence and its related mortality in lung-transplanted patients of a Brazilian institution. METHODS: Review of the records of the 263 patients who underwent lung transplantation between April 2000 and April 2016 at the Heart Institute (InCor), focusing on the incidence of cancer, most common types of malignancies, and cancer mortality rate. We compared incidence and mortality with the International Society for Heart and Lung Transplantation (ISHLT) database. RESULTS: During the 16-year period, the total incidence of cancer was 10.3% with 27 cases diagnosed in 21 patients. The most common types of cancer were non-melanoma skin cancer, prostate cancer, and post-transplantation lymphoproliferative diseases. Comparing the incidences after 1-year, 5-year, and 10-year follow-up with the ISHLT database, they were similar in the first two periods and higher in the third period. As to cancer mortality rate, it was similar to the ISHLT database in both periods analyzed. CONCLUSION: The incidence of malignancies was higher in our transplanted patients in comparison with the Brazilian population, and the most frequent types of cancer are in accordance with the literature, except for prostate cancer. Cancer mortality rate was similar to that from the ISHLT database.

Stents for bronchial stenosis after lung transplantation: should they be removed?

BACKGROUND: Airway complications after lung transplantation are the major cause of morbidity, affecting up to 33% of all cases. Bronchial stenosis is the most common complication. The use of stents has been established as the most effective therapy; however, their removal is recommended after 3-6 months of use. We have been using self-expandable stents as a definitive treatment and remove them only if necessary. For this report, we evaluated the use of self-expandable stents as a definitive treatment for bronchial stenosis after lung transplantation. METHODS: We performed a retrospective cohort study to evaluate patients with bronchial stenosis from August 2003 to April 2014. Clinical and pulmonary function test data were collected. RESULTS: Two hundred lung transplants were performed, 156 of which were bilateral. Sixteen patients experienced airway complications: 4 had dehiscence, 2 necrosis, and 10 bronchial stenosis. Of these patients, 7 had undergone bilateral procedures, and 2 patients developed stenosis in both sides. Twelve anastomotic stenoses were observed. The follow-up after stenting ranged from 1 to 7 years. All patients had increased lung function, and 4 remained stable with sustained increase in pulmonary function without episodes of infection. Three patients required removal of their prosthesis 6 months to 1 year after implantation because of complications. Two patients died owing to unrelated causes. CONCLUSIONS: Definitive treatment of bronchial stenosis with self-expandable stents is a viable option. The 1st year seems to be the most crucial for determining definitive treatment, because no patients required removal of their stent after 1 year.

Topological phase transitions of (BixSb1-x)2Se3 alloys by density functional theory.

We have performed an ab initio total energy investigation of the topological phase transition, and the electronic properties of topologically protected surface states of (BixSb1-x)2Se3 alloys. In order to provide an accurate alloy concentration for the phase transition, we have considered the special quasirandom structures to describe the alloy system. The trivial â†’ topological transition concentration was obtained by (i) the calculation of the band gap closing as a function of Bi concentration (x), and (ii) the calculation of the Z2 topological invariant number. We show that there is a topological phase transition, for x around 0.4, verified for both procedures (i) and (ii). We also show that in the concentration range 0.4 < x < 0.7, the alloy does not present any other band at the Fermi level besides the Dirac cone, where the Dirac point is far from the bulk states. This indicates that a possible suppression of the scattering process due to bulk states will occur.

Switching a normal insulator into a topological insulator via electric field with application to phosphorene.

The study of topological insulators has generally involved search of materials that have this property as an innate quality, distinct from normal insulators. Here we focus on the possibility of converting a normal insulator into a topological one by application of an external electric field that shifts different bands by different energies and induces a specific band inversion, which leads to a topological state. Phosphorene is a two-dimensional (2D) material that can be isolated through mechanical exfoliation from layered black phosphorus, but unlike graphene and silicene, single-layer phosphorene has a large band gap (1.5-2.2 eV). Thus, it was unsuspected to exhibit band inversion and the ensuing topological insulator behavior. Using first-principles calculations with applied perpendicular electric field F⊥ on few-layer phosphorene we predict a continuous transition from the normal insulator to a topological insulator and eventually to a metal as a function of F⊥. The tuning of topological behavior with electric field would lead to spin-separated, gapless edge states, that is, quantum spin Hall effect. This finding opens the possibility of converting normal insulating materials into topological ones via electric field and making a multifunctional "field effect topological transistor" that could manipulate simultaneously both spin and charge carrier. We use our results to formulate some design principles for looking for other 2D materials that could have such an electrical-induced topological transition.

Posterior reversible encephalopathy syndrome in lung transplantation: 5 case reports.

Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiologic entity characterized by typical neurologic symptoms with characteristic cerebral image alterations. It has been reported in solid organ transplantations, especially related to the use of calcineurin inhibitors. The incidence of PRES in lung transplantation is unknown and probably under-reported in the literature. Here we describe 5 cases of PRES after bilateral lung transplantation. One of the reported cases was the first in the literature in which the neurologic onset precluded the introduction of calcineurin inhibitor. Therefore, although calcineurin inhibitors are known to play an important role in the development of PRES in the setting of lung transplantation, other causes seems to be involved in the physiopathology of this syndrome.

Fungal infection by Mucorales order in lung transplantation: 4 case reports.

Mucorales is a fungus that causes systemic, highly lethal infections in immunocompromised patients. The overall mortality of pulmonary mucormycosis can reach 95%. This work is a review of medical records of 200 lung transplant recipients between the years of 2003 and 2013, in order to identify the prevalence of Mucorales in the Lung Transplantation service of Heart Institute (InCor), Hospital das Clínicas da Universidade de São Paulo, Brazil, by culture results from bronchoalveolar lavage and necropsy findings. We report 4 cases found at this analyses: 3 in patients with cystic fibrosis and 1 in a patient with bronchiectasis due to Kartagener syndrome. There were 2 unfavorable outcomes related to the presence of Mucorales, 1 by reduction of immunosuppression, another by invasive infection. Another patient died from renal and septic complications from another etiology. One patient was diagnosed at autopsy just 5 days after lung transplantation, with the Mucor inside the pulmonary vein with a precise, well-defined involvement only of donor's segment, leading to previous colonization hypothesis. There are few case reports of Mucorales infection in lung transplantation in the literature. Surveillance for the presence of Mucor can lead to timely fungal treatment and reduce morbidity and mortality in the immunocompromised patients, especially lung transplant recipients.

Lung transplantation in patients with cystic fibrosis.

Cystic fibrosis (CF) an autosomal recessive genetic disorder, affects many organs. The great majority of deaths occur due to respiratory failure after many years of chronic pulmonary infection. Despite recent progress in early detection by studies of genetic mutations and better understanding to treat nutritional and infectious states, lung transplantation is the CF treatment for most advanced cases. According to the International Society for Heart and Lung Transplantation (ISHLT) data, CF is the third most common reason for lung transplantation (16.8%) showing the best survival rate (60% at 5 years). We have described our experience in lung transplantation of CF patients between January 2000 and December 2011, reviewing medical charts of these patients were for gender, age, body mass index (BMI), comorbidities, disease duration, previous sputum gram stain, ischemic time, incidence of severe primary graft dysfunction (PGD Grade 3), intensive care unit (ICU) length of stay, and Kaplan-Meier survival. Among 150 lung transplantation, the 30 CF patients (20%) represented the second most common cause. The average age was 27.4 ± 9.2 years, with a slight predominance of males (n = 16; 53.3%). The average BMI was 18.9 ± 2.6. Most patients (60%) had pancreatic exocrine dysfunction. Also, 83.3% of patients showed a positive sputum culture for Pseudomonas, while Burkholderia cepacia was identified in only 4 patients (13.3%). The average time of the disease was 20.8 ± 9.7 years. All transplantation were bilateral with an average ischemic time of 472 ± 98.3 minutes and ICU length of stay of 9.9 ± 6.3 days. The survival rates at 1 and 5 years were 92% and 77%, respectively, corresponding to the best outcomes among underlying diseases, comparable with other worldwide series and better than the ISHLT reports. CF, the second most common cause for lung transplantation among our cases, showed the best survival rate among all causes. Our survival rate was comparable with other reports.

[Surgical management of the aortic valve in patients older than 70 years of age]. / Manuseio cirúrgico da valva aórtica em pacientes acima de 70 anos.

PURPOSE: To assess the short and long-term benefits of patients who were submitted to isolated aortic valve replacement or valve replacement (VR) concomitant myocardial revascularization (MR); to evaluate the incidence of postoperative complications, hospital mortality and late mortality. METHODS: From January 1985, through December 1989, 20 consecutive patients underwent surgical intervention, 15 male (75%) and 5 female (25%), the mean age was 74.8% (ranging from 70 to 86 years old), and the aortic valve gradient ranged between 78 and 180 mmHg (mean = 97 mmHg). They presented preoperative diagnosis to have either isolated aortic stenosis (AS) or As and coronary artery disease (CAD). No patient was in NYHA functional class I; 3 patients (15%) were in class II, 14 (70%) in class III and 3 (15%) in class IV. RESULTS: The most frequent post-operative complications found were: extended intubation in 7 patients (35%), bleeding in 4 (20%), acute renal failure in 3 (15%) and ventricular arrhythmia in 3 (15%). Hospital mortality occurred in 2 patients (10%) who had been submitted to VR and concomitant MR. Late mortality occurred in 1 patient (5%). Through December 1989, 11 patients (64%) were in functional class I (NYHA), 3 (18%) in class II, 3 (18%) in class III and none in class IV. CONCLUSION: We concluded that the surgical treatment is indicate to elderly patients with isolated AS os with AS and concomitant CAD. There was a significant post-operative improvement of the functional class (NYHA) to the surviving patients.

[Acute myocardial infarction in patients under 40 years of age]. / Infarto agudo do miocárdio em pacientes com idade inferior a 40 anos.

PURPOSE: To evaluate the short and long-term prognosis of a group of patients aged 40 and under, who developed an acute myocardial infarction. PATIENTS AND METHODS: In the last 15 years we studied a group of 73 patients aged 40 and under with a confirmed diagnosis of first acute myocardial infarction. Patients with infarctions caused by coronary embolisms or to revascularization procedures were excluded. RESULTS: Ninety percent were male and mean the age was 35. The most frequent risk factors observed were cigarette smoking in 64 (88%), hypertension in 16 (22%), hypercholesterolemia in 12 (16%) and diabetes in 3 (4%). Seven (9%) patients had no risk factors. The myocardial infarction was anterior em 50 (68%) cases and inferior in the remaining 23 (32%). Severe heart failure (Killip III and IV) was present in 3 (4%). Angiographic studies were performed in 63 (86%). Cineangiography showed critical coronary lesions (obstruction greater than 70%) in one vessel in 38 (60%) patients, multivessel disease in 18 (28%) and 7 (12%) had normal coronary vessels. In-hospital mortality was 5% (3 patients died due to severe heart failure and 1 due to cerebro-vascular accident). The 56 survivors were followed-up to 15 years, with overall survival of 74%. Fourty-nine (71%) were asymptomatic and 7 (10%) had recurrent chest pain. There were 7 (10%) late deaths and follow-up was lost in 6 (9%). Reinfarctions were observed in 5 cases (7%). Revascularization procedures were performed in 12 (17%) patients (bypass-graft surgery in 9 and coronary angioplasty in 3). CONCLUSION: Young patients with acute myocardial infarction have a low mortality rate in the early phase and a favorable outcome after the discharge of the hospital.

[Adrenergic coronary vasoconstriction during myocardial hypoperfusion]. / Vasoconstricção coronária adrenérgica nas situações de hipoperfusão miocárdica.

The intramural branches of the coronary arteries of dogs were studied using venilite casts. The intramyocardial vessels have a general pattern with straight branches that cross from the epicardium toward the endocardium. Many branches were observed throughout the extension of these vessels, mainly in the subendocardium, where there is a rich interconnecting plexus. Some branches divides immediately in the subepicardium. These anatomic findings concur with the observations that the subendocardium is more susceptible to ischemia, as it is dependent on an extensive vascularization. These anatomic findings indicate that during constant underperfusion, the alpha adrenergically mediated vasoconstriction of the subepicardial vessels have an unexpected beneficial effect because of decreased transmural steal.