Psychosocial Issues and Bereavement.

Patients with serious illness and their family caregivers face numerous ongoing psychological and social concerns and stressors throughout the disease trajectory. Common challenges relate to the need to manage the disease by making complex and often difficult medical decisions. In addition, the presence of psychological and psychiatric distress, including depression and anxiety, may significantly add to the overall symptom burden for the patient and family caregivers. These challenges negatively impact mood, cognitive function, interpersonal relationships, and medical decision making. If not recognized and adequately addressed, they can seriously undermine coping and resilience, eroding psychological well-being and quality of life.

Desempenho reprodutivo de ovelhas mestiças da raça Santa Inês em Brachiaria humidícula e efeito do sexo no ganho de peso de cordeiros / Reproductive performance of crossbred ewes race Santa Ines in Brachiaria humidicula and e ffect of sex on weight gain of lambs

Objetivou-se avaliar o desempenho reprodutivo de ovelhas deslanadas em função do manejo alimentar das crias e idade de desmame, além de mensurar o efeito do sexo no ganho de peso de cordeiros. Sessenta e quatro ovelhas mestiças da raça Santa Inês foram distribuídas em delineamento inteiramente ao acaso, em esquema fatorial 4 x 2 x 2 - quatro idades de desmame (56, 70, 84 e 98 dias), sexo e manejo alimentar das crias, cada tratamento com quatro repetições. As ovelhas foram manejadas com a cria ao pé, em 14 piquetes de 1,5 ou 2,0 hectares, formados com pastagem de Brachiaria humidícola. As crias nascidas de partos simples, filhos de reprodutores Santa Inês puros de origem (PO). Após o desmame de todos os grupos, sessenta e quatro cordeiros (32 machos e 32 fêmeas) foram distribuídos ao acaso em baias individuais e confinados por 30 dias. A comparação dos parâmetros foi realizada pelo ajuste do modelo de regressão linear simples. Verificou-se vício de tempo longo do manejo alimentar das crias de + 3,7% (P<0,05) para o intervalo entre partos e de + 1,4% (P<0,05) para o período de serviço. Houve efeito linear crescente (P<0,05) da idade de desmame sobre o intervalo entre partos e período de serviço. Verificou-se vício de tempo longo do sexo das crias de + 2,0% (P<0,05) para o intervalo entre partos e de + 0,8% (P<0,05) para o período de serviço das ovelhas. Constatou-se vício de tempo longo do sexo de + 35,2% e + 36,9% (P<0,05), respectivamente, para o ganho de peso diário de cordeiros do nascimento ao desmame e pós desmame em confinamento. A suplementação das crias em alimentador privativo e a antecipação da idade de desmame reduzem o intervalo entre partos e período de serviço de ovelhas deslanadas em pastagem de Brachiaria humidícula. O sexo da cria é fonte de variação na análise da eficiência reprodutiva de matrizes ovinas e no ganho de peso de cordeiros mestiços da raça Santa Inês do nascimento ao desmame e após o desmame.

The purpose was to evaluate the reproductive performance of woolless ewes due to the feeding management of offsprings and weaning age in addition to measuring the effect of gender on weight gain of lambs. Sixty-four Santa Inês crossbred ewes were distributed in a completely randomized design in a factorial 4 x 2 x 2 - four weaning ages (56, 70, 84 and 98 days), sex and feeding management of the offspring, each treatment with four replications. The ewes were managed with the offsprings at the foot in 14 paddocks of 1,5 or 2,0 hectares, formed with Brachiaria humidícola. The offsprings were born by single birth, of Santa Inês pure of origin (PO). After the weaning of all groups, sixty-four lambs (32 males and 32 females) were randomly assigned in individual stalls and confined for 30 days. The comparison of the parameters was carried out by the adjustment of the simple linear regression model. It was verified over time addiction of the offspring feed management of + 3,7% (P<0,05) for the calving intervals and of + 1,4% (P<0,05) for the service period. There was increasing linear effect (P<0,05) of weaning age on calving intervals and service period. It was verified over time, addiction of the offspring sex of + 2,0% (P<0,05) for the calving intervals and + 0,8% (P<0,05) for the ewes service period. It was observed over time addiction of sex of + 35,2% and + 36,9% (P<0,05), respectively, for the daily weight gain of lambs from birth to weaning and post-weaning in feedlot. The supplementation of the offspring in private feeder and the anticipation of the weaning age reduce the calving intervals and the service period of woolless ewes in Brachiaria humidicula pasture. The offspring sex is the source of variation in the analysis of reproductive efficiency of ewe's mat rices and in the weight gain of Santa Inês crossbred lambs from birth to weaning, and after weaning.

Spiritual well-being in patients with advanced heart and lung disease.

OBJECTIVE: The purpose of this study was to evaluate levels of spiritual well-being over time in populations with advanced congestive heart failure (CHF) or chronic obstructive lung disease (COPD). METHOD: In a prospective, longitudinal study, patients with CHF or COPD (each n = 103) were interviewed at baseline and every 3 months for up to 30 months. At each interview, patients completed: the basic faith subscale of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) questionnaire, the Memorial Symptom Assessment Scale (MSAS), the Rand Mental Health Inventory (MHI), the Multidimensional Index of Life Quality (MILQ), the Sickness Impact Profile (SIP), and the Short Portable Mental Health Questionnaire (SPMSQ). RESULT: The mean age was 65 years, 59% were male, 78% were Caucasian, 50% were married, 29% lived alone, and there was no significant cognitive impairment. Baseline median FACIT-Sp score was 10.0 on a scale of 0-16. FACIT-Sp scores did not change over time and multivariate longitudinal analysis revealed higher scores for black patients and lower scores for those with more symptom distress on the MSAS-Global Distress Index (GDI) (both p = 0.02). On a separate multivariate longitudinal analysis, MILQ scores were positively associated with the FACIT-Sp and the MHI, and negatively associated with the MSAS-GDI and the SIP (all p-values < 0.001). SIGNIFICANCE OF RESULTS: In advanced CHF and COPD, spiritual well-being remains stable over time, it varies by race and symptom distress, and contributes to quality of life, in combination with symptom distress, mental health and physical functioning.

Stiles-Crawford effect of the first kind: assessment of photoreceptor alignments following dark patching.

Properties of presumed mechanisms controlling photoreceptor alignments are partially defined. A phototropic mechanism normally dominates alignment, but do modest changes in orientations occur with dark patching? Here, new photopic Stiles-Crawford (SCE-I) determinations were made before patching (pre-patch), just after 8-days of dark-patching (post-patch), and 3 days after patch removal (recovery test). We tested at 0, 11 and 22 degrees in the temporal retina of both eyes. Ten eyes of adult subjects were tested. SCE-I peak positions and Stile's parameter 'rho' were assessed. Dark-patching effects were small. Observations revealed meaningful corrective alignment overshoots with recovery in the light. Results suggest (1) the presence of multiple weak mechanisms affecting receptor alignments in the dark; (2) the phototropic mechanism to be dominant in the light; (3) the need for multiple test loci to be sampled in such studies, and (4) small changes in the SCE-I in the pupil plane can reflect meaningful events occurring at the retina.

Performance on the three-point Vernier alignment or acuity test as a function of age: measurement extended to ages 5 to 9 years.

The three-point Vernier alignment (or acuity) test was conducted on children from 5 to 9 years old. There is a significant difference between the 5-9 year old subjects and those in age groups 10 to 19 and 20 to 29 years in Vernier performance. These data were also compared with previously published data from older subjects (up to age 70). We conclude that Vernier function has not fully matured within the age range of 5 to 9 years; this finding is consistent with previous results reported in the literature.

The three point vernier alignment or acuity test (3Pt VA test): an analysis of variance.

A very useful clinical vernier acuity or vernier alignment test has been developed in this and associated laboratories over a span of two decades. We seek to refine further this test, to seek internal inconsistencies and to optimize parameters used in a variety of devices and environments. Vernier testing, and many aspects of this work have been considered by numerous able scientists over a long time period (not reviewed here), but none have encountered conditions faced by this group, particularly in the developing world. The three point vernier alignment (acuity) threshold test (3Pt VeA test) employed here has broad applications; it can be used as a clinical test of vision status, for triage, and as a reference standard for vision testing (in general). As one example, if sufficient luminance is employed, the test is applicable in the presence of truly dense media disorders, even advanced leucomas, mature cataracts, intraocular bleeds, as well as combinations of these disorders, with or without a window to the retina. Only retinal and centrally-based neural disorders, eccentricity from fixation, and about 50% of hypermature cataracts affect outcomes. With minor alterations, this test can be employed to assess the visual field. An analysis of variance (ANOVA) was performed on a defined set of parameters, to enable us to understand better the special properties and requirements associated with this test. Results are not significantly altered between ages 10-94 years (not assessed here). Employing settings well above threshold for test spot detection and well separated individual test spots, changes in test spot luminance, or background luminance (or adaptation level), contrast, veiling glare, test spot size, clear and variously degraded images, seem not to affect meaningfully measured outcomes. If an observer can define well a center of gravity for each test spot viewed, he can align the three points with remarkable precision.

Altered intercellular glycoconjugates and dilated intercellular spaces of esophageal epithelium in reflux disease.

BACKGROUND AND AIMS: The usefulness of histological diagnosis of gastroesophageal reflux disease (GERD) is limited by poor specificity or sensitivity of available diagnostic tools. Recently, ultrastructural morphometry showed interstitial space dilation (ISD) to be a reliable sign of reflux disease. Aims of this study were to (a) search for a light microscopy equivalent of ISD, (b) test its diagnostic value, and (c) look for a possible role of intercellular glycoconjugates in its genesis. METHODS: Esophageal grasp biopsies were taken during endoscopy, 2-3 cm and 6-7 cm above the squamocolumnar junction, from patients under investigation for GERD symptoms. The biopsies were fixed in aldehyde solutions and embedded in resin for electron microscopy or in paraffin for routine histology, and the glycoconjugates underwent immunohistochemistry using 3-fucosyl-N-acetylactosamine antibodies. RESULTS: Irregular intercellular space dilation was detected in the basal and prickle layers using both light and electron microscopy. Hematoxylin-eosin preparations showed ISD in 20 of 22 (90%) erosive esophagitis cases, 30 of 44 (68%) endoscopy negative GERD cases, and 1 of 12 (8%) controls, with good interobserver (K = 0.75) and bioptic site reproducibility. ISD correlated with loss or rearrangement of intercellular glycoconjugates of the overlying layers and with granulocyte (eosinophil and/or neutrophil) infiltration. CONCLUSIONS: Light microscopy ISD is a suitable index of GERD. Alterations of intercellular glycoconjugates are likely to have a role in the genesis of ISD and GERD.

[Gastrointestinal stromal tumor as the cause of intestinal hemorrhage: description of a clinical case]. / Tumore stromale gastrointestinale come causa di enterorragia: descrizione di un caso clinico.

The term gastrointestinal stromal tumor describes a heterogeneous group of tumors of mesenchymal origin with particular histologic features. Their classification has recently been made possible thanks to numerous immunohistochemical and ultrastructural studies. We report the case of a patient who came to our attention because of serious anemia due to a gastrointestinal stromal tumor located between the second and third portion of the duodenum. This pathology, although not frequent, should be considered in the differential diagnosis of gastrointestinal bleeding. In these cases it is important to perform careful endoscopic inspection to the third portion of th duodenum, even when previous tracts evidence lesions that could be responsible for the patient's symptoms.

Successful pregnancy following gonadotropin therapy in a young female with juvenile idiopathic hemochromatosis and secondary hypogonadotropic hypogonadism.

Heart failure and hypogonadotropic hypogonadism are the most frequent clinical problems encountered in patients with juvenile idiopathic hemochromatosis (JIH). In this context, amenorrhea is one of the first symptoms in female patients, and hormone therapy must be added to phlebotomy to restore menstrual cycles. Here we report the case of a woman in childbearing age with hypogonadotropic hypogonadism due to JIH. Following therapy with gonadotropinic hormones the patient had a twin pregnancy with term delivery. The newborns presented a normal iron status. This confirms that early diagnosis and treatment of JIH are important to prevent irreversible organ damage and shows that the female reproductive function can be preserved in adequately treated patients.

Kinetics of anti-Xa activity during combined defibrotide-heparin administration in hemodialysis.

Defibrotide, a polydesoxyribonucleotide derivative with antithrombotic and fibrinolytic activity, capable of inducing the release of PGI2 from vascular endothelia, was proposed as an alternative to standard heparin coverage during blood dialysis for patients at risk of bleeding. The original procedure featured the preliminary washing of the dialysis circuit with heparin, which was then recirculated and eliminated, and the two drugs, heparin and defibrotide, are known to interact with each other. The purpose of this present study was to explore the ex-vivo heparin activity (assessed as anti-Xa activity) in diverse hemodialysis models using defibrotide (800 mg intravenous, in 4 bolus injections) and various dosages of heparin. Anti-Xa activity is negligible in dialysis conducted with defibrotide alone. When the circuit was prewashed with heparin (5000 and 2500 IU), there was evident anti-Xa activity (0.3-0.5 U/ml) in the first 30-60 minutes of dialysis; continuous heparin infusion (500 U/hour) resulted in high anti-Xa activity levels at the end of dialysis. Thus the best hemodialysis procedure for patients at high risk of bleeding should be one utilizing only defibrotide, or defibrotide plus small amounts of calcium heparin infused at the rate of 500 U/hour for not more than two hours.