Point-of-care transthoracic echocardiography: An essential management tool for acute massive pulmonary thromboembolism.

The pulmonary thromboembolism may be a life-threatening condition. A hip fracture surgery patient aged >90 years old had a sudden post-operative episode of shock, de-saturation, and reverted cardiac arrest. A point-of-care transthoracic echocardiography (TTE) undertaken by an anesthesiologist revealed inferior vena cava dilation/flattening, right cardiac chamber dilation, and McConnell signs (right ventricular apex hyperkinesia and lateral wall hypokinesia); the ventricular septal wall was shifting to the left side, and the left ventricular chamber collapsed at the end-systole, indicating a high ejection fraction in the context of obstructive shock. As such, it revealed signs of pulmonary thromboembolism. Despite the absolute contraindication for thrombolysis and therapeutic hypocoagulation, the treatment was started immediately along with vasopressor support, which was life-saving in this patient. A summary TTE played a pivotal role in our patient's case, helping with the differential diagnosis of the cause of shock.

Single continuous erector spinae plane block for multiple rib, clavicle, and scapula fractures: A case report.

The aim of this study is to describe the ability of a continuous erector spinae plane (ESP) block to provide analgesia in an extended territory (brachial plexus and thoracic nerves) with a single catheter. A continuous ESP block at T4 was performed in a 74-year-old man, two days after trauma involving clavicle, scapula, and multiple posterior rib fractures (first to ninth). The technique was maintained for 12 days and provided effective analgesia not only to the thoracic region but also the scapula and clavicle area (C5-T12 dermatomes). Concomitant respiratory insufficiency was ameliorated, which helped to avoid mechanical ventilation and intensive care unit admission. Moreover, this analgesia technique promoted patient's ambulation. ESP block, as an alternative to a thoracic epidural, is a more straightforward and safer procedure than paravertebral block (PVB). To obtain an extensive dermatome block using PVB, more than one paravertebral catheter would be necessary. Extensive cephalad-caudad spread of the PVB is primarily related to analgesia due to the concomitant epidural spread. PVB frequently causes bilateral block and may produce significant motor or sympathetic block. Additionally, proximal extension of the block under the erector spinae muscle fascia can provide a significant extension of the block to the cervical region, which allows brachial plexus block (cervical plexus block was not observed clinically). This is a unique feature of ESP block, as there is no communication between adjacent paravertebral levels in the cervical region that could allow the same pattern of analgesia using PVB.

Low-dose spinal block combined with epidural volume extension in a high-risk cardiac patient: A case-based systematic literature review.

Background: Anesthetic management of patients with severe cardiac disease can be challenging during prolonged surgical procedures. Thus, alternative neuraxial anesthetic techniques have been described to avoid general anesthesia in these patients. Methods: A case-based systematic literature review on low-dose spinal block combined with different methods of epidural block extension in high-risk cardiac patients was performed. Results: We describe the successful management of a patient with poor left ventricular function who underwent excision arthroplasty of an infected hip prosthesis under low-dose spinal block with levobupivacaine 5 mg and fentanyl 15 µg combined with saline epidural volume extension (EVE). Epidural ropivacaine 0.75% was administered as a bolus of 5 ml followed by an infusion at 5 ml/h later during the course of surgery. Conclusions: Although continuous spinal anesthesia (CSA) or epidural anesthesia may limit hemodynamic instability, the possibility of devastating central nervous system infection may prevent CSA use, and epidural block alone may be less reliable than CSA. Epidural block alone may require large volumes of concentrated local anesthetic to obtain sacral block, which may produce hemodynamic instability. The EVE, particularly using saline EVE, has rarely been described in high-risk cardiac patients as an alternative to CSA or epidural block alone, with the intention to avoid general anesthesia, but it has demonstrated efficacy and a low rate of complications. Hemodynamic stability was maintained in most cases.

Mutation in Drosophila concentrative nucleoside transporter 1 alters spermatid maturation and mating behavior.

Concentrative nucleoside transporters (Cnts) are unidirectional carriers that mediate the energy-costly influx of nucleosides driven by the transmembrane sodium gradient. Cnts are transmembrane proteins that share a common structural organization and are found in all phyla. Although there have been studies on Cnts from a biochemical perspective, no deep research has examined their role at the organismal level. Here, we investigated the role of the Drosophila melanogaster cnt1 gene, which is specifically expressed in the testes. We used the CRISPR/Cas9 system to generate a mutation in the cnt1 gene. The cnt1 mutants exhibited defects in the duration of copulation and spermatid maturation, which significantly impaired male fertility. The most striking effect of the cnt1 mutation in spermatid maturation was an abnormal structure of the sperm tail, in which the formation of major and minor mitochondrial derivatives was disrupted. Our results demonstrate the importance of cnt1 in male fertility and suggest that the observed defects in mating behavior and spermatogenesis are due to alterations in nucleoside transport and associated metabolic pathways.

EMC is required for biogenesis of Xport-A, an essential chaperone of Rhodopsin-1 and the TRP channel.

The ER membrane protein complex (EMC) is required for the biogenesis of a subset of tail anchored (TA) and polytopic membrane proteins, including Rhodopsin-1 (Rh1) and the TRP channel. To understand the physiological implications of EMC-dependent membrane protein biogenesis, we perform a bioinformatic identification of Drosophila TA proteins. From 254 predicted TA proteins, screening in larval eye discs identified two proteins that require EMC for their biogenesis: fan and Xport-A. Fan is required for male fertility in Drosophila and we show that EMC is also required for this process. Xport-A is essential for the biogenesis of both Rh1 and TRP, raising the possibility that disruption of Rh1 and TRP biogenesis in EMC mutants is secondary to the Xport-A defect. We show that EMC is required for Xport-A TMD membrane insertion and that EMC-independent Xport-A mutants rescue Rh1 and TRP biogenesis in EMC mutants. Finally, our work also reveals a role for Xport-A in a glycosylation-dependent triage mechanism during Rh1 biogenesis in the endoplasmic reticulum.

An Apparently Balanced Complex Chromosome Rearrangement Involving Seven Breaks and Four Chromosomes in a Healthy Female and Segregation/Recombination in Her Affected Son.

Duplication of the distal 1q and 4p segments are both characterized by the presence of intellectual disability/neurodevelopmental delay and dysmorphisms. Here, we describe a male with a complex chromosome rearrangement (CCR) presenting with overlapping clinical findings between these 2 syndromes. In order to better characterize this CCR, classical karyotyping, FISH, and chromosomal microarray analysis were performed on material from the patient and his parents, which revealed an unbalanced karyotype with duplications at 1q41q43 and 4p15.2p14 in the proband. The rearrangements, which were derived from a maternal balanced karyotype, included an insertion of a segment from the long to the short arm of chromosome 1, a balanced translocation involving chromosomes 14 and 18, and an insertion of a segment from the short arm of chromosome 4 into the derived chromosome 14. This study aimed to better define the clinical history and prognosis of a patient with this rare category of chromosomal aberration. Our results suggest that the frequency of CCR in the general population may be underestimated; when balanced, they may not have a phenotypic effect. Moreover, they emphasize the need for cytogenetic techniques complementary to chromosomal microarray for proper genetic counseling.

Rational production of highly acidic sulfonated carbons from kraft lignins employing a fractionation process combined with acid-assisted hydrothermal carbonization.

Highly acidic lignin-derived sulfonated carbons (LDSCs) were produced from hardwood and softwood kraft lignins under mild conditions by applying fractionation and/or pre-carbonization treatments combined with acid-assisted hydrothermal carbonization. The use of lignin fraction with higher amount oxygen, obtained from the fractionation process, resulted in carbon with the highest density of surface acid groups and improved catalytic activity. The LDSCs were successful tested in the dehydration reaction of fructose to obtain 5-hydroxymethylfurfural, and the best catalyst can be recycled without loss in its catalytic activity after perform a simple regeneration process. In contrast, the pre-carbonization step, commonly performed in several works, resulted in LDSCs with low acidity. A simple and optimized methodology for obtaining LDSCs under mild conditions was developed, and the correlations between the preparation method and the physicochemical and catalytic properties established in this work may be extendible to other starting materials for rational sulfonated carbons production.

Stress distribution of three-unit fixed partial prostheses (conventional and pontic) supported by three or two implants: 3D finite element analysis of ductile materials.

In implantology, when financial or biological feasibility limitations appear, it is necessary to use prostheses with geometries that deviate from the conventional, with a pontic in the absence of an intermediate implant. The aim of this study was analyze and understand the general differences in the stresses generated in implants, components and infrastructures according to the configuration of the prosthesis over three or two implants. Thus, this paper analyzes the von Mises equivalent stresses (VMES) of ductile materials on their external surfaces. The experimental groups: Regular Splinted Conventional Group (RCG), which had conventional infrastructures on 3 regular-length Morse taper implants (4x11 mm); Regular Splinted Pontic Group (RPG), which had infrastructures with intermediate pontics on 2 regular-length Morse taper implants (4x11 mm). The simulations of the groups were created with Ansys Workbench 10.0 software. The results revealed that the RPG presented greater areas of possible fragility due to higher stress concentrations, for example, in the cervical area of the union between the implant and component the top platform of the abutment, as well as greater coverage of the stress by the cervical implant threads. The RPG infrastructure was also more affected by stresses in the connection areas between the prostheses and on the occlusal surface. There is an advantage to using prostheses supported by a greater number of implants (RCG) because this decreases the stress in the analyzed structures and consequently improves stress dissipation to the supporting bone, which would preserve the system.

Pacientes com acidente vascular cerebral (avc) agudo em cuidados paliativos: uma revisão sistemática / Acute stroke patients in palliative care: a systematic review

INTRODUÇÃO: O acidente vascular encefálico (AVC), um importante problema de saúde pública, pode ter consequências catastróficas para o indivíduo e seus familiares. Cuidados paliativos (CP) são promovidos por equipe multiprofissional, com intuito de prevenir e aliviar sofrimentos de pacientes com doença ameaçadora à vida e de seus familiares. OBJETIVOS: Identificar necessidades de CP em pacientes com AVC agudo grave e seus familiares. MÉTODOS: Uma revisão sistemática foi conduzida nas bases de dados: MEDLINE, PubMed, SciELO, LILACS, DOAJ e Cochrane, em artigos publicados no período de 2000 a 2018. RESULTADOS: Dos 114 artigos encontrados na busca inicial, 16 foram selecionados após aplicação de critérios de inclusão e exclusão. Mostraram discussões sobre prognóstico; prevalência de sintomas e principais barreiras de comunicação. Foi evidenciado que estes pacientes e seus familiares têm necessidades multidimensionais não atendidas. O principal motivo para solicitar CP foi a abordagem de diretivas avançadas de vontade e de cuidados de fim-de-vida. CONCLUSÃO: Há indicação e beneficio à inserção de cuidados paliativos em pacientes acometidos por AVC agudo grave. Para isto, são fundamentais: o trabalho interdisciplinar da equipe de saúde, boa comunicação, estratégias educacionais e deliberação política.

BACKGROUND: Stroke, an important public health problem, can have catastrophic consequences for the individual and his or her family. Palliative care (PC) is promoted by a multiprofessional team to prevent and alleviate the suffering of patients with life-threatening illness and their relatives. OBJECTIVES: To identify needs to PC in severe acute stroke patients and their relatives. METHODS: A systematic review was conducted in the databases MEDLINE, PubMed, SciELO, LILACS, DOAJ and Cochrane in articles published from 2000 to 2018. RESULTS: Of the 114 articles found in the initial search, 16 were selected after application of inclusion and exclusion criteria. They showed discussions about prognosis; prevalence of symptoms and main communication barriers. It was evidenced that these patients and their families have multidimensional needs not met. The main reason for requesting PC was an approach to end-of-life decision-making and end-of-life care. CONCLUSION: There is indication and benefit the insertion of palliative care in patients affected by severe acute stroke. For this, the interdisciplinary work of the health team, good communication, educational strategies and political deliberation are fundamental.

Insight into the mechanisms and consequences of recurrent telomere capture associated with a sub-telomeric deletion.

A complex mosaicism of the short arm of chromosome 1 detected by SNP microarray analysis is described in a patient presenting a 4-Mb 1p36 terminal deletion and associated phenotypic features. The array pattern of chromosome 1p displayed an intriguing increase in divergence of the SNP heterozygote frequency from the expected 50% from the centromere towards the 1p36 breakpoint. This suggests that various overlapping segments of UPD were derived by somatic recombination between the 1p homologues. The most likely explanation was the occurrence of a series of events initiated in either a gamete or an early embryonic cell division involving a 1pter deletion rapidly followed by multiple telomere captures, resulting in additive, stepped increases in frequency of homozygosity towards the telomere. The largest segment involved the entire 1p, and at least four other capture events were observed, indicating that at least five independent telomere captures occurred in separate cell lineages. The determination of breakpoint position by detection of abrupt changes in B-allele frequency using a moving window analysis demonstrated that they were identical in blood and saliva, the tissues available for analysis. We developed a model to explain the interaction of parameters determining the mosaic clones and concluded that, while number, size, and position of telomere captures were important initiating determinants, variation in individual clone frequencies was the main contributor to mosaic differences between tissues. All previous reports of telomere capture have been restricted to single events. Other cases involving multiple telomere capture probably exist but require investigation by SNP microarrays for their detection.

Sericin Composition in the Silk of Antheraea yamamai.

The silks produced by caterpillars consist of fibroin proteins that form two core filaments, and sericin proteins that seal filaments into a fiber and conglutinate fibers in the cocoon. Sericin genes are well-known in Bombyx mori (Bombycidae) but have received little attention in other insects. This paper shows that Antheraea yamamai (Saturniidae) contains five sericin genes very different from the three sericin genes of B. mori. In spite of differences, all known sericins are characterized by short exons 1 and 2 (out of 3-12 exons), expression in the middle silk gland section, presence of repeats with high contents of Ser and charged amino acid residues, and secretion as a sticky silk component soluble in hot water. The B. mori sericins represent tentative phylogenetic lineages (I) BmSer1 and orthologs in Saturniidae, (II) BmSer2, and (III) BmSer3 and related sericins of Saturniidae and of the pyralid Galleria mellonella. The lineage (IV) seems to be limited to Saturniidae. Concerted evolution of the sericin genes was apparently associated with gene amplifications as well as gene loses. Differences in the silk fiber morphology indicate that the cocktail of sericins linking the filaments and coating the fiber is modified during spinning. Silks are composite biomaterials of conserved function in spite of great diversity of their composition.

Synthesis and antitubercular activity of palladium and platinum complexes with fluoroquinolones.

The fluoroquinolones are an important family of synthetic antimicrobial agents being clinically used over the past thirty years. In addition, some fluoroquinolones have been used in the development of anticancer drugs, and others have demonstrated anti-HIV activity. Furthermore, there has been some additional work investigating the effect of metal ions on biological activity. Aiming to obtain novel palladium(II) and platinum(II) complexes that exhibit biological activity, we have synthesized complexes using fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin, sparfloxacin, and gatifloxacin) as ligands. The compounds were characterized using IR and NMR spectroscopy, thermogravimetric and elemental analyses. The complexes show activity against Mycobacterium tuberculosis strain H(37)Rv. The minimal inhibitory concentration (MIC) of the complexes was determined.