La experiencia de los pacientes que necesitan trasplante renal en espera de un órgano compatible

The aim of this study was to understand the experience of patients with chronic renal failure, who were included in a list of subjects waiting for a kidney transplant. This is an exploratory, descriptive, and qualitative study, with phenomenology as theoretical basis. Twenty patients have undergone hemodialysis as a renal replacement therapy. These subjects were active while they waited for a kidney transplant. Analysis of material obtained in this study allowed us to understand the fear and insecurity of these patients in view of both dialysis treatment and the possibility that a compatible donor is not found. They have shown faith strength and courage while using self-care to stay well when transplanting arrived. They idealized a new life, a fresh start, away from the machine for hemodialysis. The present study has detected a need for monitoring, by an interdisciplinary team, of patients included in waiting lists in order to help them experiencing such wait.El estudio tuvo como objetivo comprender la vivencia del paciente con insuficiencia renal crónica en lista de espera por un trasplante renal. Tratase de una pesquisa exploratoria, descriptiva de naturaleza cualitativa, que uso como referencial teórico la fenomenología. Los sujetos del estudio fueron veinte pacientes sometidos a hemodiálisis como terapia substitutiva, que esperaban en la lista por un trasplante renal y que estaban activos en la lista de espera. El análisis del material obtenido nos permitió entender el miedo y la inseguridad de los pacientes ante la diálisis y la posibilidad de encontrar un donante compatible. Revelando fuerza y coraje, a través de auto cuidado de mantener bien a la llegada del trasplante. La elaboración de una nueva vida, un nuevo comienzo alejado de la máquina de hemodiálisis. El presente estudio ha revelado la necesidad de acompañamiento del paciente en lista por el equipo interdisciplinario para ayudarle a vivenciar esa espera.O estudo teve como objetivo compreender a vivência do paciente com insuficiência renal crônica em lista de espera por um transplante renal. Trata-se de uma pesquisa exploratória, descritiva, de natureza qualitativa, tendo como referencial teórico a fenomenologia. Os sujeitos do estudo foram vinte pacientes submetidos à hemodiálise como terapia renal substutiva, que aguardavam em lista por um transplante e que estavam ativos na lista de espera. A análise do material obtido possibilitou compreender o medo e a insegurança dos pacientes diante do tratamento dialítico e da possibilidade de não encontrar um doador compatível. Revelando força e coragem, por meio do autocuidado em manter-se bem para a chegada do transplante. Idealizando uma nova vida, um recomeço longe da máquina de hemodiálise. O presente estudo revelou a necessidade de acompanhamento do paciente em lista de espera por equipe interdisciplinar, no sentido de auxiliá-lo a vivenciar essa espera.UNIDAVIHospital Maria AuxiliadoraUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de EnfermagemUNIFESP Escola Paulista de EnfermagemUNIFESP, Escola Paulista de Enfermagem (EPE)UNIFESP, EPESciEL

USO DO INTERCÂMBIO POR TROCA DE FIGURA PARA TRATAMENTO ODONTOLÓGICO DO PACIENTE COM SÍNDROME DO X-FRÁGIL: SÉRIE DE CASOS.

A Síndrome do X-Frágil (SXF) é uma alteração genética ligada ao cromossomo X. É uma das causas hereditárias mais comum de déficit cognitivo e um verdadeiro desafio ao cirurgião-dentista. O objetivo dessa série de casos é abordar o manejo comportamental durante o tratamento odontológico em 3 pacientes com síndrome do X-frágil utilizando o sistema de intercâmbio por troca de figuras (PECs). A amostra foi composta por pacientes do gênero masculino com idades de 15 (P1), 19 (P2) e 29 (P3) anos (P1e P2 melanodermas e P3 leucoderma). Todos os pacientes apresentavam alguma necessidade odontológica específica com indicação de tratamento periodontal. Os pacientes apresentavam alto grau de ansiedade e comprometimento severo na comunicação verbal, porém não eram agressivos. Os pacientes P2 e P3 já possuiam histórico de atendimento odontológico anterior somente possível com anestesia geral. Como uma alternativa para verificar a possibilidade de atendimento ambulatorial desses pacientes, foram utilizados os PECs com o objetivo de acolher e facilitar a comunicação. Sua principal importância é antecipar as atividades a serem realizadas, promovendo ambientação, melhorando a comunicação profissional-paciente e diminuindo o estresse do paciente. A partir dessas atividades, foi possível a realização do atendimento ambulatorial sem sedação oral e sem contenção/restrição física em todos os pacientes, sendo superada as dificuldades comunicativas e comportamentais dos mesmos. Portanto, os PECs são importante ferramenta mediadora que pode facilitar a inserção e o manejo do paciente com SXF com alterações neurocognitivas, possibilitando o atendimento odontológico ambulatorial com o objetivo de promover saúde bucal e qualidade de vida a esses pacientes

The Second Transmembrane Domain of P2X7 Contributes to Dilated Pore Formation

Activation of the purinergic receptor P2X7 leads to the cellular permeability of low molecular weight cations. To determine which domains of P2X7 are necessary for this permeability, we exchanged either the C-terminus or portions of the second transmembrane domain (TM2) with those in P2X1 or P2X4. Replacement of the C-terminus of P2X7 with either P2X1 or P2X4 prevented surface expression of the chimeric receptor. Similarly, chimeric P2X7 containing TM2 from P2X1 or P2X4 had reduced surface expression and no permeability to cationic dyes. Exchanging the N-terminal 10 residues or C-terminal 14 residues of the P2X7 TM2 with the corresponding region of P2X1 TM2 partially restored surface expression and limited pore permeability. To further probe TM2 structure, we replaced single residues in P2X7 TM2 with those in P2X1 or P2X4. We identified multiple substitutions that drastically changed pore permeability without altering surface expression. Three substitutions (Q332P, Y336T, and Y343L) individually reduced pore formation as indicated by decreased dye uptake and also reduced membrane blebbing in response to ATP exposure. Three others substitutions, V335T, S342G, and S342A each enhanced dye uptake, membrane blebbing and cell death. Our results demonstrate a critical role for the TM2 domain of P2X7 in receptor function, and provide a structural basis for differences between purinergic receptors. © 2013 Sun et al

Proton pump inhibitors and the risk of pneumonia: A comparison of cohort and self-controlled case series designs

Background: To compare the results of a new-user cohort study design and the self-controlled case series (SCCS) design using the risk of hospitalisation for pneumonia in those dispensed proton pump inhibitors compared to those unexposed as a case study. Methods: The Australian Government Department of Veterans’ Affairs administrative claims database was used. Exposure to proton pump inhibitors and hospitalisations for pneumonia were identified over a 4 year study period 01 Jul 2007 -30 Jun 2011. The same inclusion and exclusion criteria were applied to both studies, however, the SCCS study included subjects with a least one hospitalisation for pneumonia. Results: There were 105,467 subjects included in the cohort study and 6775 in the SCCS. Both studies showed an increased risk of hospitalisations for pneumonia in the three defined risk periods following initiation of proton pump inhibitors compared to baseline. With the highest risk in the first 1 to 7 days (Cohort RR, 3.24; 95% CI (2.50, 4.19): SCCS: RR, 3.07; 95% CI (2.69, 3.50)). Conclusions: This study has shown that the self-controlled case series method produces similar risk estimates to a new-users cohort study design when applied to the association of proton pump inhibitors and pneumonia. Exposure to a proton pump inhibitor increases the likelihood of being admitted to hospital for pneumonia, with the risk highest in the first week of treatment.Emmae N Ramsay, Nicole L Pratt, Philip Ryan and Elizabeth E Roughea

The evolution of acoustic size exaggeration in terrestrial mammals

Recent studies have revealed that some mammals possess adaptations that enable them to produce vocal signals with much lower fundamental frequency (F0) and formant frequency spacing (ΔF) than expected for their size. Although these adaptations are assumed to reflect selection pressures for males to lower frequency components and exaggerate body size in reproductive contexts, this hypothesis has not been tested across a broad range of species. Here we show that male terrestrial mammals produce vocal signals with lower ΔF (but not F0) than expected for their size in mating systems with greater sexual size dimorphism. We also reveal that males produce calls with higher than expected F0 and ΔF in species with increased sperm competition. This investigation confirms that sexual selection favours the use of ΔF as an acoustic size exaggerator, and supports the notion of an evolutionary trade-off between pre-copulatory signalling displays and sperm production

Increased d-amino acid oxidase expression in the bilateral hippocampal CA4 of schizophrenic patients: a post-mortem study

An important risk gene in schizophrenia is d-amino acid oxidase (DAAO). To establish if expression of DAAO is altered in cortical, hippocampal or thalamic regions of schizophrenia patients, we measured gene expression of DAAO in a post-mortem study of elderly patients with schizophrenia and non-affected controls in both hemispheres differentiating between gray and white matter. We compared cerebral post-mortem samples (granular frontal cortex BA9, middle frontal cortex BA46, superior temporal cortex BA22, entorhinal cortex BA28, sensoric cortex BA1–3, hippocampus (CA4), mediodorsal nucleus of the thalamus) from 10 schizophrenia patients to 13 normal subjects investigating gene expression of DAAO in the gray and white matter of both hemispheres of the above-mentioned brain regions by in situ-hybridization. We found increased expression of DAAO-mRNA in the hippocampal CA4 of schizophrenic patients. Compared to the control group, both hemispheres of the hippocampus of schizophrenic patients showed an increased expression of 46% (right, P = 0.013) and 54% (left, P = 0.019), respectively. None of the other regions examined showed statistically significant differences in DAAO expression. This post-mortem study demonstrated increased gene expression of DAAO in the left and right hippocampus of schizophrenia patients. This increased expression could be responsible for a decrease in local d-serine levels leading to a NMDA-receptor hypofunction that is hypothesized to play a major role in the pathophysiology of schizophrenia. However, our study group was small and results should be verified using larger samples

Transformation-induced changes in the DNA-nuclear matrix interface, revealed by high-throughput analysis of DNA halos

In higher eukaryotic nuclei, DNA is periodically anchored to an extraction-resistant protein structure, via matrix attachment regions. We describe a refined and accessible method to non-subjectively, rapidly and reproducibly measure both size and stability of the intervening chromatin loops, and use it to demonstrate that malignant transformation compromises the DNA-nuclear matrix interface

Writing in Britain and Ireland, c. 400 to c. 800

No abstract available