Cognitive function, self-management, and outcomes among liver transplant recipients: LivCog, a multicenter, prospective study.

Liver transplantation is a life-saving option for decompensated cirrhosis. Liver transplant recipients require advanced self-management skills, intact cognitive skills, and care partner support to improve long-term outcomes. Gaps remain in understanding post-liver transplant cognitive and health trajectories, and patient factors such as self-management skills, care partner support, and sleep. Our aims are to (1) assess pre-liver transplant to post-liver transplant cognitive trajectories and identify risk factors for persistent cognitive impairment; (2) evaluate associations between cognitive function and self-management skills, health behaviors, functional health status, and post-transplant outcomes; and (3) investigate potential mediators and moderators of associations between cognitive function and post-liver transplant outcomes. LivCog is a longitudinal, prospective observational study that will enroll 450 adult liver transplant recipients and their caregivers/care partners. The duration of the study is 5 years with 24 additional months of patient follow-up. Data will be collected from participants at 1, 3, 12, and 24 months post-transplant. Limited pre-liver transplant data will also be collected from waitlisted candidates. Data collection methods include interviews, surveys, cognitive assessments, and actigraphy/sleep diary measures. Patient measurements include sociodemographic characteristics, pretransplant health status, cognitive function, physical function, perioperative measures, medical history, transplant history, self-management skills, patient-reported outcomes, health behaviors, and clinical outcomes. Caregiver measures assess sociodemographic variables, health literacy, health care navigation skills, self-efficacy, care partner preparedness, nature and intensity of care, care partner burden, and community participation. By elucidating various health trajectories from pre-liver transplant to 2 years post-liver transplant, LivCog will be able to better characterize recipients at higher risk of cognitive impairment and compromised self-management. Findings will inform interventions targeting health behaviors, self-management, and caregiver supports to optimize outcomes.

Synthesis of novel polysubstituted (2SR,4RS)-2-heteroaryltetrahydro-1,4-epoxy-1-benzazepines and cis-2-heteroaryl-4-hydroxytetrahydro-1H-1-benzazepines as antiparasitic agents.

New series of polysubstituted (2SR,4RS)-2-heteroaryltetrahydro-1,4-epoxy-1-benzazepines and cis-2-heteroaryl-4-hydroxytetrahydro-1H-1-benzazepines were designed and synthesized in moderate to high yields using a three-step procedure from ortho-allylanilines. Their antiparasitic activity was evaluated against the extracellular and intracellular forms of Trypanosoma cruzi and Leishmania (Leishmania) infantum parasites. Their cytotoxicity was also determined on Vero and THP-1 mammalian cells. Many of the tested compounds inhibited significantly the growth of extracellular forms of T. cruzi and L. (L.) infantum without showing cytotoxicity on Vero and HTP-1 cells. Only compounds 10h and 14f demonstrated good activity against amastigotes of T. cruzi, but none was able to inhibit the growth of L. (L.) infantum amastigotes.

Bandwidth-length trade-off figures of merit for electro-optic traveling wave modulators.

Closed-form expressions explicitly relating modulation bandwidth and active length in electro-optic traveling wave modulators are presented which fully account for skin-effect electrode loss and optical-electrical wave velocities mismatch. Four operative margins have been identified where the bandwidth-length trade-off figure of merit takes simple forms.

Use of health-care services during chemotherapy for breast cancer.

AIM OF THE STUDY: The authors analyse the effect of chemotherapy on the use of additional health-care resources and report the clinical and demographic factors associated with such use. PATIENTS AND METHODS: In women with breast cancer, eligible to receive first-line (neo)-adjuvant or palliative chemotherapy, consultations with health-care practitioners (general practitioners [GPs] and specialists) and admissions to emergency department and to hospital were prospectively recorded. Differences were studied according to these clinical and demographic variables: age, tumour stage, performance status, weight, height, body mass index, surgery type, chemotherapy type, number of courses, comorbidity, marital status, educational level, social status and occupational status. RESULTS: Among 268 patients, 124 (42.2%) required one or more non-protocol health-care encounters. 180 visits were generated (GP 23.3%, specialist 35.5%, emergency department admission 21.1%, hospital admission 8.3%, others 3.3% and more than one resource 8.3%). Of total consultations 150 (83.3%) were chemotherapy-related. The number of visits was higher in the first courses. Fever and infection were the most frequent reasons for consultation in all resources. The dependent variable: 'need for non-protocol health-care encounter in any course' was statistically associated with age (p=0.002) and marital status (p=0.021); no association was found with other variables. In multivariate analysis, age (p=0.001) and marital status (p=0.009) remained statistically significant. Younger and married patients consumed less extra health resources. CONCLUDING STATEMENT: Many patients receiving chemotherapy consume health-care resources in addition to their routine visits, usually treatment-related. Patients consult less in the later courses. Older and unmarried women in particular need extra care during chemotherapy.

(2RS,4RS)-7-Fluoro-2-(2-phenylethyl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine and (2RS,4RS)-7-chloro-2-(2-phenylethyl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine are isomorphous but not strictly isostructural.

(2RS,4RS)-7-Fluoro-2-(2-phenylethyl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(18)H(18)FNO, (I), and (2RS,4RS)-7-chloro-2-(2-phenylethyl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(18)H(18)ClNO, (II), are isomorphous but not strictly isostructural, as the slight differences in the unit-cell dimensions and molecular conformations are sufficient to preclude, in the structure of (I), the direction-specific intermolecular interactions present in the structure of (II), where the molecules are linked into sheets by a combination of C-H···N and C-H···π(arene) hydrogen bonds.

Nine closely related tetrahydro-1,4-epoxy-1-benzazepines carrying pendant heterocyclic substituents: hydrogen-bonded supramolecular assembly in zero, one and two dimensions.

The structures are reported of nine closely related tetrahydro-1,4-epoxy-1-benzazepines carrying pendant heterocyclic substituents, namely: 2-exo-(5-nitrofuran-2-yl)-2,3,4,5-tetrahydro-1,4-epoxy-1H-1-benzazepine, C(14)H(12)N(2)O(4), (I), 7-fluoro-2-exo-(1-methyl-1H-pyrrol-2-yl)-2,3,4,5-tetrahydro-1,4-epoxy-1H-1-benzazepine, C(15)H(15)FN(2)O, (II), 7-fluoro-2-exo-(5-methylfuran-2-yl)-2,3,4,5-tetrahydro-1,4-epoxy-1H-1-benzazepine, C(15)H(14)FNO(2), (III), 7-fluoro-2-exo-(3-methylthiophen-2-yl)-2,3,4,5-tetrahydro-1,4-epoxy-1H-1-benzazepine, C(15)H(14)FNOS, (IV), 7-fluoro-2-exo-(5-methylthiophen-2-yl)-2,3,4,5-tetrahydro-1,4-epoxy-1H-1-benzazepine, C(15)H(14)FNOS, (V), 7-chloro-2-exo-(5-methylfuran-2-yl)-2,3,4,5-tetrahydro-1,4-epoxy-1H-1-benzazepine, C(15)H(14)ClNO(2), (VI), 2-exo-(5-methylfuran-2-yl)-7-trifluoromethoxy-2,3,4,5-tetrahydro-1,4-epoxy-1H-1-benzazepine, C(16)H(14)F(3)NO(3), (VII), 2-exo-(3-methylthiophen-2-yl)-7-trifluoromethoxy-2,3,4,5-tetrahydro-1,4-epoxy-1H-1-benzazepine, C(16)H(14)F(3)NO(2)S, (VIII), and 2-exo-(5-nitrofuran-2-yl)-7-trifluoromethoxy-2,3,4,5-tetrahydro-1,4-epoxy-1H-1-benzazepine, C(15)H(11)F(3)N(2)O(5), (IX). All nine compounds crystallize in centrosymmetric space groups as racemic mixtures with configuration (2RS,4SR). There are no direction-specific interactions between the molecules in (V). The molecules in (III), (IV), (VI) and (VII) are linked into simple chains, by means of a single C-H...O hydrogen bond in each of (III), (VI) and (VII), and by means of a single C-H...π(arene) hydrogen bond in (IV), while the molecules in (VIII) are linked into a chain of rings. In each of (I) and (II), a combination of one C-H...O hydrogen bond and one C-H...π(arene) hydrogen bond links the molecules into sheets, albeit of completely different construction in the two compounds. In (IX), the sheet structure is built from a combination of four independent C-H...O hydrogen bonds and one C-H...π(arene) hydrogen bond. Comparisons are made with some related compounds.

Sterically shielded pyramidal amino groups in two 4,4'-(arylmethylene)bis(6-allyl-3-chloro-2-methylaniline) derivatives.

4,4'-(Phenylmethylene)bis(6-allyl-3-chloro-2-methylaniline), C(27)H(28)Cl(2)N(2), (I), and 4,4'-(2-thienylmethylene)bis(6-allyl-3-chloro-2-methylaniline), C(25)H(26)Cl(2)N(2)S, (II), adopt similar molecular conformations, although the thienyl group in (II) exhibits orientational disorder over two sets of sites with occupancies of 0.614 (3) and 0.386 (3). The amino groups in both compounds are pyramidal. A single N-H...N hydrogen bond links the molecules of (I) into cyclic centrosymmetric dimers. Molecules of (II) are linked by an ordered C-H...pi(arene) hydrogen bond to form cyclic centrosymmetric dimers, and these dimers are linked into statistically interrupted chains by a second C-H...pi(arene) hydrogen bond involving a donor in the minor component of the disordered thienyl unit.

Different hydrogen-bonded structures in three 2-thienyl-substituted tetrahydro-1,4-epoxy-1-benzazepines.

The molecules of (2RS,4SR)-2-exo-(5-bromo-2-thienyl)-7-chloro-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(14)H(11)BrClNOS, (I), are linked into cyclic centrosymmetric dimers by C-H...pi(thienyl) hydrogen bonds. Each such dimer makes rather short Br...Br contacts with two other dimers. In (2RS,4SR)-2-exo-(5-methyl-2-thienyl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(15)H(15)NOS, (II), a combination of C-H...O and C-H...pi(thienyl) hydrogen bonds links the molecules into chains of rings. A more complex chain of rings is formed in (2RS,4SR)-7-chloro-2-exo-(5-methyl-2-thienyl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(15)H(14)ClNOS, (III), built from a combination of two independent C-H...O hydrogen bonds, one C-H...pi(arene) hydrogen bond and one C-H...pi(thienyl) hydrogen bond.

Three tetrahydro-1,4-epoxy-1-benzazepines carrying pendent heterocyclic substituents: supramolecular structures in zero, one or two dimensions.

(2SR,4RS)-7-Fluoro-2-exo-(2-furyl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(14)H(12)FNO(2), (I), crystallizes with Z' = 2 in the space group P2(1)/c. A combination of three C-H...O hydrogen bonds and one C-H...N hydrogen bond links the molecules into a complex chain of rings, and pairs of such chains are linked into a tube-like structure by two C-H...pi(arene) hydrogen bonds. There are no hydrogen bonds in the structure of racemic (2SR,4RS)-2-exo-(5-bromo-2-thienyl)-7-fluoro-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(14)H(11)BrFNOS, (II), while the molecules of (2S,4R)-2-exo-(5-bromo-2-thienyl)-7-trifluoromethoxy-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(15)H(14)BrF(3)NO(2)S, (III), are linked into sheets by a combination of two C-H...O hydrogen bonds and one C-H...pi(arene) hydrogen bond. The significance of this study lies in its observation of the wide variation in the patterns of supramolecular aggregation, consequent upon modest changes in the peripheral substituents.

Deglucion disfuncional

Tesina inedita(Especializacion) Escuela de Posgrado. Asociacion Odontologica Argentina. 2003

Deglucion disfuncional

Tesina inedita(Especializacion) Escuela de Posgrado. Asociacion Odontologica Argentina. 2003

El prolactinoma en pacientes masculinos: estudio de seis (6) casos / Prolactinomas in male patients: study of 6 cases

Se presentan 6 casos de adenomas hipofisarios secretores de Prolactina (Prl) en hombres con disfuncion sexual, disminucion de agudeza visual, y niveles de (Prl) mayores de 160 ng-dl con niveles bajos de Testosterona. Estos fueron comprobados por Tomografia Axial Computada y por cirugia transesfenoidal o transfrontal y posteriormente por histologia e inmuno-histoquimica. La recuperación posterior fue pobre, pero los sintomas oculares regresaron casi totalmente. En conclusion, el diagnóstico precoz del sindrome hiperprolactinemico en hombres, caracterizado por disminución de la libido e impotencia, puede conducir a curación si no se les deja llegar a desarrollar grandes tumores que compriman las estructuras vecinas