ABSTRACT
The dynamic scenario of di-aryls-pyrano-chromenes was investigated using DFT calculations. The symmetry of the chromene scaffold and the presence of two ortho-substituted aryls substituents can generate two syn/anti diastereoisomers and conformational enantiomers with different rotational barriers. The relative conformations and configurations were derived using NOESY-1D experiments. Depending on the energies related to the conformational exchange, the experimental energy barriers were determined through Dynamic NMR, Dynamic HPLC or kinetic studies. The atropisomeric pairs were resolved in the latter scenario, and their absolute configuration was assigned using the ECD/TD-DFT method.
Subject(s)
Benzopyrans , Kinetics , Molecular Conformation , Magnetic Resonance Spectroscopy , Density Functional TheoryABSTRACT
BACKGROUND: The life expectancy of patients with disorders of consciousness (DOCs) is ever-increasing, but little is known about their clinical course over late stages. Several issues (premorbid conditions, complications and pressure sores) are to be considered for their effect on clinical outcome, risk of death and recovery of functional performance. Unfortunately, in late stages of long-term rehabilitation, these aspects are still more neglected than in acute and postacute stages. The aim of this study was to investigate the clinical course and the complications of patients in the late stages of DOCs and to explore the relationship between mortality and specific biomarkers. MATERIALS AND METHODS: A total of 112 patients, admitted over 10 years in a dedicated ward, were retrospectively studied. Sociodemographic data, preadmission and inpatient clinical features were collected. Disability Rating Scale scores, complications including pressure sores and blood markers were assessed monthly. Data were analyzed through descriptive statistics and correlations using SPSS. RESULTS: Most patients were men older than 50 years with a nontraumatic etiology and a history of hypertension (42.86%). The most common complication was pneumonia (76.79%). No association was found between sex and mortality or between etiology and mortality (P > 0.05). Mortality correlated significantly with sepsis (ρ = 0.253), albumin (ρ = -0.558), hemoglobin (ρ = -0.354) and white blood cells (ρ = 0.243). Only 42% of patients remained unchanged at Disability Rating Scale evaluation. CONCLUSIONS: These data confirmed that DOCs are not static conditions and they require ongoing monitoring and assessment of clinical status, level of consciousness and laboratory biomarkers.
Subject(s)
Consciousness Disorders/epidemiology , Pneumonia/epidemiology , Pressure Ulcer/epidemiology , Sepsis/epidemiology , Adult , Aged , Biomarkers/metabolism , Brain Injuries, Traumatic/complications , Cerebrovascular Disorders/complications , Comorbidity , Consciousness Disorders/blood , Consciousness Disorders/etiology , Consciousness Disorders/metabolism , Disease Progression , Female , Hemoglobins/metabolism , Humans , Hypoxia, Brain/complications , Italy/epidemiology , Leukocyte Count , Longitudinal Studies , Male , Middle Aged , Retrospective Studies , Serum Albumin/metabolism , Time FactorsABSTRACT
OBJECTIVE: Previous studies on caregivers of patients with disorders of consciousness (DOCs) have highlighted that their overall burden is not related to disease duration or diagnosis, but mainly to their personal characteristics. The aim of this study was to investigate the impact of attachment style and hopelessness on overall burden in caregivers of patients in both vegetative state and minimally conscious state. METHODS AND PROCEDURE: Nineteen caregivers of patients with DOCs, hosted in a long-term care facility, were assessed using the Caregiver Burden Inventory, the Attachment Style Questionnaire, and the Beck Hopelessness Scale. Socio-demographic information was also collected. Data were analysed through descriptive statistics, correlations, one sample t-test and a multiple regression analysis using SPSS. OUTCOMES AND RESULTS: Burden was not associated with duration of caregiving and gender had no effect on overall burden. Multiple regression analysis indicated that preoccupied attachment style and hopelessness together predicted 49% of the total variability of burden (R(2 )= 0.489; adjusted R = 0.43). CONCLUSIONS: These data suggest that caregivers need psychological assessment and support in order to keep under control the level of burden and to help themselves be a better resource for their relatives.
