A molecular beam apparatus for performing single photon initiated dissociative rearrangement reactions (SPIDRR) with transition metal cation bound organic clusters.

The study of gas-phase ion-molecule reactions has been influential in the investigation of transition metal mediated bond activation and catalysis. We have furthered this field by developing a new technique capable of measuring the microcanonical kinetics for reactions between transition metal cations and neutral organic molecules. This novel method has been designated as single photon initiated dissociative rearrangement reaction (SPIDRR) technique and provides a nearly direct measurement of microcanonical reaction rate constants. For this reason, SPIDRR offers unique insight into reaction mechanisms and dynamics by assessing the energy dependence of the microcanonical rate constant, as well as measuring product branching fractions and kinetic isotope effects. The following paper provides a detailed overview of SPIDRR and its advantages in the field of gas-phase catalysis research.

Submerged Barriers in the Ni(+) Assisted Decomposition of Propionaldehyde.

The reaction dynamics of the Ni(+) mediated decarbonylation of propionaldehyde was assessed using the single photon initiated decomposition rearrangement reaction (SPIDRR) technique. The exothermic production of Ni(+)CO was temporally monitored and the associated rate constants, k(E), were extracted as a function of activating photon energy. In addition, the reaction potential energy surface was calculated at the UCCSD(T)/def2-TZVP//PBEPBE/cc-pVDZ level of theory to provide an atomistic description of the reaction profile. The decarbonylation of propionaldehyde can be understood as proceeding through parallel competitive reaction pathways that are initiated by Ni(+) insertion into either the C-C or C-H bond of the propionaldehyde carbonyl carbon. Both paths lead to the elimination of neutral ethane and are governed by submerged barriers. The lower energy sequence is a consecutive C-C/C-H addition process with a submerged barrier of 14 350 ± 600 cm(-1). The higher energy sequence is a consecutive C-H/C-C addition process with a submerged barrier of 15 400 ± 600 cm(-1). Both barriers were determined using RRKM calculations fit to the experimentally determined k(E) values. The measured energy difference between the two barriers agrees with the DFT computed difference in rate limiting transition-state energies, 18 413 and 19 495 cm(-1).

Everolimus-based immunosuppression in patients with hepatocellular carcinoma at high risk of recurrence after liver transplantation: a case series.

BACKGROUND: Liver transplantation offers the most effective treatment in patients with hepatocellular carcinoma (HCC). However, transplant patients outside the Milan criteria have a high risk of tumor recurrence, which has been linked to standard immunosuppression regimens. Everolimus is a mammalian target of rapamycin inhibitor that has been used for immunosuppression, but its effect on recurrence and survival in HCC patients with a high risk of tumor recurrence has not been examined. We compared long-term survival and cumulative recurrence in high-risk patients receiving everolimus-based immunosuppression after liver transplantation for HCC with an historic control group. METHODS: The everolimus group comprised 21 patients receiving a liver transplant at our center from February 2005 to December 2010. The control group comprised 31 patients receiving a liver transplant from May 1994 to January 2005. All patients received cyclosporine or tacrolimus as initial post-transplant immunosuppression. Patients in the everolimus group switched to everolimus 2 weeks later. RESULTS: There were no differences between the two groups in number of rejection episodes or of infectious or surgical complications. Five-year survival was 60.2% in the everolimus group and 32.3% in the control group (P = .05). Five-year cumulative recurrence rate was 61.3% in the control group and 41.3% in the everolimus group. Treatment with everolimus was identified as an independent predictor of longer survival (hazard ratio = 0.34; P = .02). CONCLUSIONS: Patients receiving liver transplantation for HCC with a high risk of tumor recurrence may well benefit from everolimus-based immunosuppression, with no added risks of rejection or other post-transplant complications.

Liver transplantation as treatment in a massive metastasis from Gruber-Frantz pancreatic tumor: a case report.

The Gruber-Frantz tumor or solid pseudopapillary tumor of the pancreas accounts for 1% to 2% of pancreatic tumors. It occurs more frequently among women between 20 and 40 years of age and in the Asian population. These tumors are of low malignant potential and show slow growth. The symptoms are subtle, the most striking being pain and an abdominal mass. The most common site is the pancreatic tail. The location and local invasion determine the surgical technique. With R0 resection, survival is 95% at 5 years. In 15% of cases metastatic disease appears, mostly in the liver. The treatment of liver metastases is surgical resection. In the case of multiple liver metastases, the treatment is controversial. QT has been used, as well as radiofrequency ablation, arterial embolization, and intraarterial chemotherapy. Herein we have described the case of a 44-year-old woman with massive liver metastases who did not respond to QT lines and underwent successful liver transplantation with survival free of recurrence at 1 year later. This is the first liver transplantation for a metastatic pancreatic pseudopapillary tumor in Spain and the second described in the literature.

Comparison of different methods for thin section EM analysis of Mycobacterium smegmatis.

Bacteria are generally difficult specimens to prepare for conventional resin section electron microscopy and mycobacteria, with their thick and complex cell envelope layers being especially prone to artefacts. Here we made a systematic comparison of different methods for preparing Mycobacterium smegmatis for thin section electron microscopy analysis. These methods were: (1) conventional preparation by fixatives and epoxy resins at ambient temperature. (2) Tokuyasu cryo-section of chemically fixed bacteria. (3) rapid freezing followed by freeze substitution and embedding in epoxy resin at room temperature or (4) combined with Lowicryl HM20 embedding and ultraviolet (UV) polymerization at low temperature and (5) CEMOVIS, or cryo electron microscopy of vitreous sections. The best preservation of bacteria was obtained with the cryo electron microscopy of vitreous sections method, as expected, especially with respect to the preservation of the cell envelope and lipid bodies. By comparison with cryo electron microscopy of vitreous sections both the conventional and Tokuyasu methods produced different, undesirable artefacts. The two different types of freeze-substitution protocols showed variable preservation of the cell envelope but gave acceptable preservation of the cytoplasm, but not lipid bodies, and bacterial DNA. In conclusion although cryo electron microscopy of vitreous sections must be considered the 'gold standard' among sectioning methods for electron microscopy, because it avoids solvents and stains, the use of optimally prepared freeze substitution also offers some advantages for ultrastructural analysis of bacteria.

[Analysis of the practical use of terms attributed to nursing phenomena in the ICNP (International Classification for Nursing Practice)--alpha version]. / Análise da utilização na prática dos termos atribuídos aos fenômenos de enfermagem da cipe--versão alfa.

This study had the purpose of analysing the utilization of terms attributed to nursing phenomena in the practice of nurses from the state of Paraiba, Brazil. The results showed that all terms are used by nurses in some frequency. In respect to the utilization of the terms, according to a stratified sample, the results showed that nurses from other municipal districts use a higher number of terms, statistically significant, when compared with data from the cities of João Pessoa and Campina Grande. From the results of the study, it can be concluded that terms attributed to phenomena contained in the CIPE--Alpha Version represent problems or situations in the nursing practice of nurses from Paraiba, corroborating the affirmation of the International Council of Nurses that these terms are common to nurses all over the world.

[Nature and classification of nursing interventions in an adult outpatient clinic for chemotherapy]. / Natureza e classificação das intervenções de enferma gem em ambulatório de quimioterapia de adultos.

The purpose of the present descriptive study was to identify, through a retrospective analysis of records, the nature of nursing interventions as well as to establish the relationship between the nature of these interventions and the problems found. The sample was formed by 184 records of patients in their first nursing consultation at the Adult Chemotherapy Outpatient Unit of Hospital São Paulo from January to June, 1997; 37 records were selected at random: 19 male and 18 female patients. Results showed the predominance of interventions centered in patients' psychobiological needs. Educative interventions were more frequently performed when related to patients psychosocial needs. The correspondence between the identified problems and proposed interventions was evidenced when the psychobiological needs were met.

[Identification of the defining characteristics of the nursing diagnosis of excess fluid volume]. / Identificação das características definidoras do diagnóstico de enfermagem excesso de volume de líquidos.

This study aimed at verifying the defining characteristics of the nursing diagnosis "Fluid Volume Excess" proposed by NANDA. Data collection was carried out within a specialized Cardiology health care setting where the 29 patients were selected by two expert nurses. The conclusion showed consonance of opinions between the two professionals in regard to the identification of nine patients with diagnosis and 20 without this type of diagnosis. The identified defining characteristics appeared in different percentages considering the studied patients.

Semantic equivalence of the Nursing Phenomena Classification of ICNP: Alpha Version in Brazilian Portuguese.

This study presents the results obtained in the first phase of research carried out to adapt the Nursing Phenomena Classification of ICNP Alpha to the Brazilian context. This phase intended to attain semantic equivalence of the terms of this classification through the use of the back-translation technique, with some modifications. From the results obtained, it may be stated that the semantic adaptation of the classification attained a rate of agreement of 98% for the titles and the definitions of nursing phenomena. The 2% of terms that did not reach an acceptable rate of agreement are related to coping, in the following phenomena: coping; defensive coping; coping: disabling; ineffective coping specific: rapetrauma, death, divorce; compromised health coping; and inadequate family coping. From this result, it may be concluded that the Nursing Phenomena Classification was translated in a semantically correct form.

Recognition of the immunocompromised patient.

The host defense systems in humans are highly specialized with respect to categories of infectious pathogens; yet, there is just enough overlap to protect one from minor defects. It is also important to appreciate that not all abnormalities reported from the laboratory are clinically significant. By appreciating the clinical syndromes that accompany various deficiencies, the surgeon can be aware of the at-risk patient.

[Trauma severity assessment in prehospital setting]. / Gravidade do trauma avaliada na fase pré-hospitalar.

UNLABELLED: The trauma severity assessment and basic life support maneuvers in prehospital setting can represent to the trauma victim the opportunity of survival until his/her can get assistance in the hospital. PURPOSE: To study external cause victims assessed in the prehospital phase by the physiologic index named Trauma Score modificado (TSm). METHODS: Retrospective analyses were made of 1414 victims attended by Sistema de Atendimento Móvel às Urgências (SAMU-RESGATE-SP) in the Municipality of São Paulo during 1991. Data were gathered from prehospital data recording sheets and necropsy records. RESULTS: Prehospital attendance was carried out in 81.31% until 40 minutes. Non-fatal victims (83.96%) had 12 and 11 TSm scores while 53.96% of the fatal victims had 0, 1 and 2 scores. External surface (30.25%) and head/neck (20.98%) were most injured areas and 63.63% fatal victims with Injury Severity Score (ISS) > or = 16 died within first 24 hours. Comparing the fatal victims TSm and ISS scores verified that 81.20% victims with TSm score between 0 and 11 had major trauma (ISS > or = 16). CONCLUSION: Strong trends were also found out in that fatal victims with low TSm scores showed relations to the high ISS scores.

Gravidade do trauma avaliada na fase pré-hospitalar / Trauma severity assessment in prehospital setting

A avaliaçao da gravidade do trauma e a instituiçao de manobras para manutençao básica da vida, no local do evento, podem representar a oportunidade de sobrevida para as vítimas de trauma até a sua chegada ao hospital. Objetivo. Estudar vítimas de causas externas avaliadas por um índice fisiológico denominado Trauma Scorre modificado (TSm) aplicado durante o atendimento pré-hospitalar. Material e Método. Analisaram-se, retrospectivamente, 1.414 vítimas de causas externas atendidas pelo Sistema de Atendimento Móvel às Urgências (SAMU-RESGATE-SP) no município de Sao Paulo, no ano de 1991. Os dados foram obtidos da ficha de atendimento pré-hospitalar e laudo de necropsia. Resultados. O atendimento pré-hospitalar em 81,31 por cento ocorreu até 40 minutos, dos quais 83,96 por cento das vítimas nao-fatais obtiveram escores TSm 12 e 11, e 53,96 por cento das vítimas fatais obtiveram escores 0, 1 e 2. Superfície externa (30,25 por cento) e regiao da cabeça/pescoço (20,98 por cento) foram as mais acometidas. Das vítimas fatais, 63,63 por cento com Injury Severity Score (ISS) ò16 morreram nas primeiras 24 horas. No cotejamento dos escores TSm e ISS, verificou-se que vítimas fatais com escore TSm entre 0 e 11 foram confirmadas como com ISS crítico (ISS ò 16). Conclusao. Constataram-se fortes indícios de que vítimas fatais com escores TSm baixos relacionaram-se com escores ISS altos.

[Nursing process and structure for cancer patients]. / Estrutura e processo assistencial de enfermagem ao paciente com câncer.

This study aimed at evaluating the structure for cancer patient assistance and antineoplasic chemotherapy assistance process. It has been performed at six internation units and one out-patient unit at a university hospital. Systematized observation and semistructured interview were used from January to June, 1996. It was noticed the there were some deficiencies in the physical area and installations of the studied units. Generally, nursing team had no formal training in Oncology, except for Chemotherapy Sector. The absence of a systematized nursing assistance and differences among the studied units as for technical organizational aspects for antineoplasic administration as well as patients and staff interaction has been observed. Inadequations observed could be minimized with such a politics which would be able to increase public sector financing, planting of systematized care and inclusion of Oncology in the permanent nursing team education.

Ethno-medical beliefs and practices of Mexican-Americans.

Family nurse practitioners working with Mexican-Americans are acutely aware that some of their clients are skeptical of typical Western medical techniques. Examination of their health-care seeking behavior shows that they will seek professional medical care when their self-treatment and folk-healing practices have not been successful. FNPs working in a primary care setting need to have a working knowledge and understanding of these beliefs which are deeply rooted in tradition. Only then can the FNP and other health care practitioners render care that is culturally sensitive and acceptable to the client. This article examines some of the more common afflictions in the Mexican-American culture (and their causative factors) in an effort to broaden health care providers' perspective of cultural differences in health and illness.