Temporal relations between peripheral and central arousals in good and poor sleepers.

Good sleepers and patients with insomnia symptoms (poor sleepers) were tracked with two measures of arousal; conventional polysomnography (PSG) for electroencephalogram (EEG) assessed cortical arousals, and a peripheral arterial tonometry device was used for the detection of peripheral nervous system (PNS) arousals associated with vasoconstrictions. The relationship between central (cortical) and peripheral (autonomic) arousals was examined by evaluating their close temporal dynamics. Cortical arousals almost invariably were preceded and followed by peripheral activations, while large peripheral autonomic arousals were followed by cortical arousals only half of the time. The temporal contiguity of these two types of arousals was altered in poor sleepers, and poor sleepers displayed a higher number of cortical and peripheral arousals compared with good sleepers. Given the difference in the number of peripheral autonomic arousals between good and poor sleepers, an evaluation of such arousals could become a means of physiologically distinguishing poor sleepers.

Inspiratory muscle endurance is similarly reduced in the early and late stages of chronic Chagas heart disease.

OBJECTIVE: Inspiratory muscle strength (IMS) appears to be reduced in subjects with chronic Chagas heart disease (CHD), especially in the presence of heart failure (HF). However, only one study about IMS and inspiratory muscle endurance (IME) in those with CHD without heart failure is available. This study aimed to compare IMS and IME in subjects with CHD in the presence and absence of HF. METHODS: This is a cross-sectional study in which 30 CHD adult patients were divided into CHD-CC group (initial phase of CHD, without HF; n = 15) and CHD-HF group (advanced phase of CHD, with HF; n = 15). We assessed IMS by maximum inspiratory pressure (MIP) and IME by incremental (Pthmax) and constant load (TLim) tests. Reduced IMS and IME were considered by predicted MIP values <70% and Pthmax/MIP <75%, respectively. RESULTS: Inspiratory muscle weakness (IMW) was more frequent in CHD-HF than in CHD-CC (46.7% vs. 13.3%; p = 0.05), and both groups had high frequencies of reduced IME (93.3% CHD-CC vs. 100.0% CHD-HF; p = 0.95). Age-adjusted logistic regression analysis using HF as a dependent variable showed that HF was associated with an increased chance of IMW compared with the CHD-CC group (OR = 7.47; p = 0.03; 95% CI 1.20-46.19). CONCLUSION: This study suggests that, in patients with CHD, HF is associated with IMW, and that reduction of IME is already present in the initial phase, similar to the advanced phase with HF.

Interesting case from Argentina: Kidney transplant recipient with skin lesions-A Latin American perspective.

This is a case of a kidney transplant recipient who presented with skin lesions, low-grade fevers, and pancytopenia 2 months after his transplant.

Drug screening and development cascade for Chagas disease: an update of in vitro and in vivo experimental models.

Chagas disease is a tropical neglected disease that affects millions of people worldwide, still demanding a more effective and safer therapy, especially in its chronic phase which lacks a treatment that promotes substantial parasitological cure. The technical note of Romanha and collaborators published in 2010 aimed establish a guideline with the set of minimum criteria and decision gates for the development of new agents against Trypanosoma cruzi with the focus on developing new antichagasic drugs. In this sense, the present review aims to update this technical note, bringing the state of the art and new advances on this topic in recent years.

Mechanical Interlocking to Unlock the Reinforcing Potential of Carbon Nanotubes.

Single-walled carbon nanotubes (SWNTs) present extraordinary mechanical properties, with Youngs' modulus>1 TPa and tensile strength>50 GPa; this makes them ideal candidates as fillers for the reinforcement of polymers. However, the performance of SWNTs in this field has fallen behind expectations. This is due to a combination of imperfect individualization of the SWNTs and poor load transfer from the polymer to the SWNTs. Here, we study the reinforcement of polymers of different chemical nature using mechanically interlocked derivatives of single-walled carbon nanotubes (MINTs). We compare the mechanical properties of fibers made of poly (methyl methacrylate) (PMMA) and polysulfone (PSU) and their composites made with pristine SWNTs, MINTs, and the corresponding supramolecular models. With very low loading of MINTs (0.01 % w/w), improvements of more than 100 % on Youngs Modulus and the tensile strength are observed for both the nonpolar aliphatic PMMA and the very polar aromatic PSU polymers, while pristine carbon nanotubes and the supramolecular nanofillers showed smaller reinforcement. These data, together with our previous report on the reinforcement of polystyrene (nonpolar and aromatic), indicate that derivatization of SWNTs as MINTs is a valid general strategy to optimize the interaction between SWNT fillers and the polymer matrix.

Predictors of Trypanosoma cruzi PCR positivity in patients with chronic Chagas disease.

BACKGROUND: A positive Trypanosoma cruzi polymerase chain reaction (PCR) is associated with a worse prognosis in patients with chronic Chagas disease (CD). OBJECTIVES: To study the association of clinical, electrocardiographic, and echocardiographic characteristics and biomarker blood levels with positive T. cruzi PCR in chronic CD. METHODS: This is a single-centre observational cross-sectional study. Positive T. cruzi PCR association with clinical, electrocardiographic, and echocardiographic characteristics, and biomarker blood levels were studied by logistic regression analysis. p values < 0.05 were considered significant. FINDINGS: Among 333 patients with chronic CD (56.4% men; 62 ± 10 years), T. cruzi PCR was positive in 41.1%. Stepwise multivariate logistic regression showed an independent association between positive T. cruzi PCR and diabetes mellitus {odds ratio (OR) 0.53 [95% confidence interval (CI) 0.30-0.93]; p = 0.03}, right bundle branch block [OR 1.78 (95% CI 1.09-2.89); p = 0.02], and history of trypanocidal treatment [OR 0.13 (95% CI 0.04-0.38); p = 0.0002]. Among patients with a history of trypanocidal treatment (n = 39), only four (10%) patients had a positive T. cruzi PCR. MAIN CONCLUSIONS: Among several studied parameters, only diabetes mellitus, right bundle branch block, and history of trypanocidal treatment showed an independent association with positive T. cruzi PCR. History of trypanocidal treatment was a strong protective factor against a positive T. cruzi PCR.

Mechanically interlocked derivatives of carbon nanotubes: synthesis and potential applications.

Single-walled carbon nanotubes (SWNTs) present one of the most interesting collections of properties among nanomaterials. Some sort of chemical modification of SWNTs is often used as a strategy to make the most of their intrinsic properties. In the last few years, the mechanical bond has been added to the chemistry toolbox for SWNT modification. In this Tutorial Review, we first discuss the characteristics of the mechanical bond that make it appealing for materials science in general and SWNTs in particular. We then describe the potential advantages of making mechanically-interlocked derivatives of SWNTs (MINTs), as compared to covalent or classic supramolecular derivatives of SWNTs. We go on to explain the different methods of synthesis of MINTs, highlighting their common features as an indication towards possible future synthetic strategies. Finally, we illustrate with examples how the making of MINTs can contribute to modifying the surface properties of SWNTs, modulating their electronic properties, and linking them to functional molecular fragments. The overall objective of this Review is to introduce the reader to the application of the chemistry of the mechanical bond to SWNTs: why it is relevant, how it is done in practice, what it has shown already as potential contributions towards applications, and what could be done in the future.

Giant sigmoid diverticulum.

Unlike acute diverticulitis, giant diverticulum larger than 4 cm is a rare entity with few cases described in the literature. We present a case of a 66-year-old male patient diagnosed with colonic diverticulosis. He presented to the emergency department with symptoms of acute abdomen and was diagnosed by CT scan with a 13x14 cm giant diverticulum showing signs of complication. Given the findings, an urgent surgical intervention was decided, and diverticulectomy at the diverticular neck was performed using an endostapler. The etiology of giant diverticula is related to a mechanism of one-way valve at the diverticular neck. Diagnosis poses a challenge as the clinical presentation is nonspecific. The imaging modality of choice is CT scan, which reveals a large cystic image dependent on the sigmoid colon. Definitive treatment is surgical, either by resecting the affected segment including the lesion or by performing a simple diverticulectomy in uncomplicated cases.

Cost-effectiveness of an exercise-based cardiovascular rehabilitation program in patients with chronic Chagas cardiomyopathy in Brazil: An analysis from the PEACH study.

OBJECTIVES: The present study aimed to perform a cost-effectiveness analysis of an exercise-based cardiovascular rehabilitation (CR) program in patients with chronic Chagas cardiomyopathy (CCC). METHODS: Cost-effectiveness analysis alongside a randomised clinical trial evaluating the effects of a 6-month exercise-based CR program. The intervention group underwent 3 weekly exercise sessions. The variation of peak oxygen consumption (VO2peak ) was used as a measurement of clinical outcome. Cost information from all healthcare expenses (examinations, healthcare visits, medication and hospitalisation) were obtained from the medical records in Brazilian reais (R$) and transformed into dollars using the purchasing power parity ($PPP). The longitudinal costs variation was evaluated through linear mixed models, represented by ß coefficient, adjusted for the baseline values of the dependent variable. The cost-effectiveness evaluation was determined through an incremental cost-effectiveness ratio using the HEABS package (Stata 15.0). RESULTS: The intervention group presented higher costs with healthcare visits (ß = +3317.3; p < 0.001), hospitalisation (ß = +2810.4; p = 0.02) and total cost (ß = +6407.9; p < 0.001) after 3 months of follow-up. Costs related to healthcare visits (ß = +2455.8; p < 0.001) and total cost (ß = +4711.4; p < 0.001) remained higher in the intervention group after 6 months. The CR program showed an incremental cost-effectiveness ratio (ICER) of $PPP 1874.3 for each increase of 1.0 ml kg-1  min-1 of VO2peak . CONCLUSIONS: The CR program can be considered a cost-effective alternative and should be included as an intervention strategy in the care of patients with CCC.

Single-Walled Carbon Nanotubes Encapsulated within Metallacycles.

Mechanically interlocked derivatives of carbon nanotubes (MINTs) are interesting nanotube products since they show high stability without altering the carbon nanotube structure. So far, MINTs have been synthesized using ring-closing metathesis, disulfide exchange reaction, H-bonding or direct threading with macrocycles. Here, we describe the encapsulation of single-walled carbon nanotubes within a palladium-based metallosquare. The formation of MINTs was confirmed by a variety of techniques, including high-resolution transmission electron microscopy. We find the making of these MINTs is remarkably sensitive to structural variations of the metallo-assemblies. When a metallosquare with a cavity of appropriate shape and size is used, the formation of the MINT proceeds successfully by both templated clipping and direct threading. Our studies also show indications on how supramolecular coordination complexes can help expand the potential applications of MINTs.

A detailed analysis of the spatial distribution of Schöningen 13II-4 'Spear Horizon' faunal remains.

The Middle Pleistocene Schöningen 13II-4 'Spear Horizon' (Germany) is a key site for the study of human evolution, most notably for the discovery of Paleolithic wooden weaponry and evidence for developed hunting strategies. On the other hand, the 'Spear Horizon' offers an excellent opportunity to approach hominin spatial behavior, thanks to the richness of the archeological assemblage, its exceptional preservation, and the vast expanse of the excavated surface. Analyzing how space was used is essential for understanding hominin behavior at this unique open-air site and, from a wider perspective, for approaching how humans adapted to interglacial environments. In this article, we present an exhaustive spatial study of the complete Schöningen 13II-4 'Spear Horizon' faunal assemblage and its archeological context, combining zooarcheology and spatial analysis through the extensive application of geographic information systems. Our results indicate the existence of different activity areas related to changes in the position of the shoreline due to fluctuations of water table levels of the Schöningen paleolake. These activity areas were likely used on a seasonal basis, whereas the spatial patterning observed in the distribution of faunal remains suggests a diversity of behavioral strategies in terms of intensity and/or duration of occupations. This study refines previous interpretations of the site and reconstructs human behavioral adaptations and the occupational changing lakeland environment during the Middle Pleistocene in Europe.

Factors related to the discontinuation and mortality rates of a cardiac rehabilitation programme in patients with Chagas disease: a 6-year experience in a Brazilian tertiary centre.

OBJECTIVES: To describe the clinical and sociodemographic characteristics of participants as well as discontinuation and mortality rates in a cardiac rehabilitation programme (CRP) tailored to Chagas disease (CD). METHODS: Participants underwent functional capacity, anthropometry and cardiac function evaluations before beginning a CRP. Univariate and multivariate Cox proportional hazards models were performed to investigate the associations between clinical and sociodemographic characteristics at baseline with discontinuation rates and deaths. RESULTS: Forty-two patients were enrolled in the CRP (61.9% men, mean age of 58.1 ± 11.8 years). During a median follow-up period of 10.8 months, 74% discontinued and 14% died while enrolled in CRP. 34% of the patients who discontinued CRP died during follow-up. White race (HR = 0.09; 95% CI 0.01-1.00), right ventricular systolic dysfunction (HR = 10.54; 95% CI 1.24-89.50) and oxygen pulse (HR = 0.69; 95% CI 0.48-0.99) were independently associated with death while enrolled in CRP. Married status (HR = 0.44; 95% CI 0.21-0.95) was independently associated with discontinuation rates from CRP. VO2 peak (HR = 0.85; 95% CI 0.74-0.98) and CRP discontinuation due to CD-related reasons (HR = 8.33; 95% CI 1.91-36.27) were the variables independently associated with death after discontinuation of CRP. CONCLUSION: In this population, sociodemographic aspects and severity of CD were important determinants of CRP discontinuation and mortality.

OBJECTIFS: Décrire les caractéristiques cliniques et sociodémographiques des participants ainsi que les taux d'abandon et de décès dans un programme de réadaptation cardiaque (PRC) adapté à la maladie de Chagas (MC). MÉTHODES: Les participants ont subi des évaluations de la capacité fonctionnelle, de l'anthropométrie et de la fonction cardiaque avant de commencer un PRC. Des modèles de risques proportionnels de Cox univariés et multivariés ont été appliqués pour étudier les associations entre les caractéristiques cliniques et sociodémographiques au départ avec les taux d'abandon et les décès. RÉSULTATS: 42 patients ont été enrôlés dans le PRC (61,9% d'hommes, âge moyen de 58,1 ± 11,8 ans). Au cours d'une période médiane de suivi de 10,8 mois, 74% ont abandonné et 14% sont décédés durant leur enrôlement au PRC. 34% des patients qui ont arrêté le PRC sont décédés au cours du suivi. La race blanche (HR = 0,09; IC95%: 0,01-1,00), le dysfonctionnement systolique ventriculaire droite (HR = 10,54; IC95%: 1,24-89,50) et le pouls d'oxygène (HR = 0,69; IC95%: 0,48-0,99) étaient indépendamment associés avec le décès lors de l'enrôlement au PRC. Le statut marié (HR = 0,44; IC95%: 0,21-0,95) était indépendamment associé aux taux d'abandon de la CRP. Le pic de VO2 (HR = 0,85; IC95%: 0,74-0,98) et l'arrêt du PRC pour des raisons liées à la MC (HR = 8,33; IC95%: 1,91 à 36,27) étaient les variables indépendamment associées au décès après l'arrêt du PRC. CONCLUSION: Dans cette population, les aspects sociodémographiques et la sévérité de la MC étaient des déterminants importants de l'arrêt du PRC et du décès.

The timing and spatiotemporal patterning of Neanderthal disappearance.

The timing of Neanderthal disappearance and the extent to which they overlapped with the earliest incoming anatomically modern humans (AMHs) in Eurasia are key questions in palaeoanthropology. Determining the spatiotemporal relationship between the two populations is crucial if we are to understand the processes, timing and reasons leading to the disappearance of Neanderthals and the likelihood of cultural and genetic exchange. Serious technical challenges, however, have hindered reliable dating of the period, as the radiocarbon method reaches its limit at ∼50,000 years ago. Here we apply improved accelerator mass spectrometry (14)C techniques to construct robust chronologies from 40 key Mousterian and Neanderthal archaeological sites, ranging from Russia to Spain. Bayesian age modelling was used to generate probability distribution functions to determine the latest appearance date. We show that the Mousterian ended by 41,030-39,260 calibrated years bp (at 95.4% probability) across Europe. We also demonstrate that succeeding 'transitional' archaeological industries, one of which has been linked with Neanderthals (Châtelperronian), end at a similar time. Our data indicate that the disappearance of Neanderthals occurred at different times in different regions. Comparing the data with results obtained from the earliest dated AMH sites in Europe, associated with the Uluzzian technocomplex, allows us to quantify the temporal overlap between the two human groups. The results reveal a significant overlap of 2,600-5,400 years (at 95.4% probability). This has important implications for models seeking to explain the cultural, technological and biological elements involved in the replacement of Neanderthals by AMHs. A mosaic of populations in Europe during the Middle to Upper Palaeolithic transition suggests that there was ample time for the transmission of cultural and symbolic behaviours, as well as possible genetic exchanges, between the two groups.

Residency and diel movement patterns of the endangered scalloped hammerhead Sphyrna lewini in the Revillagigedo National Park.

This study is the first description of the residency and diel movements of Sphyrna lewini at the Revillagigedo National Park, Mexico. Eleven adult scalloped hammerheads of total length 200-300 cm were monitored using acoustic telemetry during 2013-2015 at four sites at San Benedicto Island. Diel and residency patterns were described based on 58,055 detections by four autonomous receivers. The sharks displayed high daytime residency in two of the four sites, with movements away into the pelagic environment at night. This study generates a baseline for effective monitoring to improve the conservation and management of an iconic but endangered species at this marine reserve.

Study of aromatic profile of different crosses of Monastrell white wines.

BACKGROUND: Aromatic compounds are responsible for the final quality of wines. A semi-quantitative analysis was carried out during two consecutive seasons aiming to determine the volatile composition of 12 new white crosses obtained between Monastrell (M) and other varieties, such as Cabernet Sauvignon (C), Syrah (S) and Tempranillo (T) (MC10, MC180, MC9, MC69, MS30, MS33, MS82, MT103, MT19, MV11, MV67 and MV7), using a methodology based on gas chromatography-solid phase microextraction-mass spectrometry. RESULTS: On the one hand, 30 aromatic compounds were identified belonging to different chemical groups (alcohols, acids, terpenes, norisoprenoids and esters). The results showed how some crosses presented significant differences with respect to their parental. For example, in 2016, Monastrell and Cabernet Sauvignon showed high concentration of alcohols, acids and some terpenes, whereas the corresponding crosses showed a predominance of aromas belonging to esters. In 2017, as a result of edaphoclimatic conditions, the white crosses had higher concentrations of esters and acids. In addition, Monastrell and Cabernet Sauvignon showed similar concentrations of alcohols compared to 2016. On the other hand, sensorial analyses confirmed these results, so that mint and peppermint aromas and a fresh quality were detected in MC69 wine, especially in 2016, and fruity and acid aromas were detected in MC180 wine, which gave it a wide ranging complexity and aromatic potential. CONCLUSION: The present study reports the first investigation of the volatile composition and sensory characteristics of directed crosses white wines obtained from Monastrell and other varieties, such as Cabernet Sauvignon, Syrah, Tempranillo and Verdejo. The results obtained indicate that the use of some of these white crosses could be a good option for growing them in this Mediterranean area as a result of the contribution of a good quality in the wine aroma. © 2019 Society of Chemical Industry.

Layer-Stacking-Driven Fluorescence in a Two-Dimensional Imine-Linked Covalent Organic Framework.

Schiff-condensation reactions carried out between 1,6-diaminopyrene (DAP) and the tritopical 1,3,5 benzenetricarbaldehyde (BTCA) or 2,4,6-triformylphloroglucinol (TP) ligands give rise to the formation of two-dimensional imine-based covalent-organic frameworks (COFs), named IMDEA-COF-1 and -2, respectively. These materials show dramatic layer-packing-driven fluorescence in solid state arising from the three-dimensional arrangement of the pyrene units among layers. Layer stacking within these 2D-COF materials to give either eclipsed or staggered conformations can be controlled, at an atomic level through chemical design of the building blocks used in their synthesis. Theoretical calculations have been used to rationalize the different preferential packing between both COFs. IMDEA-COF-1 shows green emission with absolute photoluminescence quantum yield of 3.5% in solid state. This material represents the first example of imine-linked 2D-COF showing emission in solid state.

Quality of life and associated factors in patients with chronic Chagas disease.

OBJECTIVES: To evaluate the quality of life (QoL) of patients with Chagas disease (CD) and the association between QoL domains and several clinical, socioeconomic and lifestyle characteristics of this population. METHODS: Cross-sectional observational study conducted from March 2014 to March 2017 including a total of 361 outpatients followed at Evandro Chagas National Institute of Infectious Disease, Brazil. QoL was assessed using the Portuguese shorter version of the original WHO Quality of Life questionnaire (WHOQOL-BREF). Information about clinical CD presentation, presence of comorbidities, functional class, previous benznidazole treatment, socioeconomic profile and lifestyle was also obtained. RESULTS: Environment and physical domains presented the worst QoL scores, while the social relationship domain presented the highest score. Multivariate regression analysis demonstrated that variables independently associated with QoL were functional class, sex, clinical presentation of CD, sleep duration, schooling, physical activity level, smoking, income per capita and residents by domicile. CONCLUSIONS: The low socioeconomic status and the physical limitations imposed by the disease presented an important impact on the QoL reduction among CD patients, especially on environment and physical domains. Strategies to improve QoL among CD patients should be tailored and consider many different variables to maximise improvements not only of patients' physical but also of their mental health.

And Now, Please Sign on the Dotted Line: Teaching Residents About Professional Life After Residency.

OBJECTIVES: Despite possible long-term repercussions, few training programs teach their residents about the business of medicine. In particular, certain contractual issues can adversely affect a young physician's career mobility. METHODS: We designed a business-of-medicine curriculum and used a survey to determine whether the curriculum satisfied attendees' perceived knowledge gaps about the topics covered in the course, which included four key contractual matters: physician employment contracts (including restrictive covenants), malpractice insurance, job search, and interviewing skills. We used a postsurvey in 2015 and added a presurvey for the course in 2016. The same content was delivered in a 1-hour conference to internal medicine residents attending a regular noon conference series in 2015 and a regional academic meeting in 2016. Survey data are presented in terms of descriptive statistics. We used χ2 tests for comparisons of pre- and post-Likert scale survey data. RESULTS: Of 108 residents, 50 returned the surveys for an overall response rate of 46% across the 2 years of the course. Overwhelmingly, residents found the conference to be beneficial to the understanding of the four key contractual matters, with each topic having a statistically significant difference in perceived knowledge between the pre- and postconference questionnaires (P < 0.001). The majority of the residents indicated that they wanted to learn more about business-of-medicine topics, in particular financial challenges (76%) and job opportunities (68%). CONCLUSIONS: Our results confirm that our curriculum is effective in increasing the residents' perceived understanding of restrictive covenants, malpractice insurance, negotiating skills, and job search. Our results also demonstrate that residents have a desire to learn more about job searches; negotiating skills; and contractual issues, including restrictive covenants and malpractice insurance.

Comparison of biometric measurements obtained by the Verion Image-Guided System versus the auto-refracto-keratometer.

PURPOSE: To compare the biometric measurements obtained from the Verion Image-Guided System to those obtained by auto-refracto-keratometer in normal eyes. METHODS: This is a prospective, observational, comparative study conducted at the Asociación para Evitar la Ceguera en México I.A.P., Mexico. Three sets of keratometry measurements were obtained using the image-guided system to assess the coefficient of variation, the within-subject standard deviation and intraclass correlation coefficient (ICC). A paired Student t test was used to assess statistical significance between the Verion and the auto-refracto-keratometer. A Pearson's correlation coefficient (r) was obtained for all measurements, and the level of agreement was verified using Bland-Altman plots. RESULTS: The right eyes of 73 patients were evaluated by each platform. The Verion coefficient of variation was 0.3% for the flat and steep keratometry, with the ICC being greater than 0.9 for all parameters measured. Paired t test showed statistically significant differences between groups (P = 0.0001). A good correlation was evidenced for keratometry values between platforms (r = 0.903, P = 0.0001 for K1, and r = 0.890, P = 0.0001). Bland-Altman plots showed a wide data spread for all variables. CONCLUSION: The image-guided system provided highly repeatable corneal power and keratometry measurements. However, significant differences were evidenced between the two platforms, and although values were highly correlated, they showed a wide data spread for all analysed variables; therefore, their interchangeable use for biometry assessment is not advisable.