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Admissão do paciente em Cuidados Paliativos (CP) altera a rotina do Cuidador Informal (CI). Este estudo objetivou identificar correlações entre Sobrecarga, Qualidade de Vida (QdV) e Suporte Social em CIs de pacientes paliados. Participaram do estudo 30 CIs em um hospital de alta complexidade. Foram utilizadas as escalas MOS-SSS (Medical Outcome Study – Social Support Survey); QASCI (Questionário de Avaliação da Sobrecarga em Cuidadores Informais); SF-36 (Short Form Health Survey) e questionário sociodemográ­fico. 67,5% dos participantes apresentaram altos escores em suporte social. Aspectos emo­cionais e físicos apresentaram as menores médias em QdV. Foram encontradas correlações significativas e negativas, fracas ou moderadas entre sobrecarga e a maioria dos domínios de QdV. Sobrecarga apresentou correlação negativa e moderada com suporte social no domínio apoio material; entre QdV e Suporte Social as correlações foram positivas, fracas ou modera­das. Vitalidade e saúde mental se correlacionaram com todos os domínios de suporte social. O papel de CI implica uma alteração da rotina. Cuidadores podem experienciar dificuldades nesta nova função. Acúmulo de tarefas e necessidade da ampliação do repertório para lidar com essa nova função de cuidador pode se relacionar com a sobrecarga relatada.

Objectives The aim of this AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial subgroup analysis was to examine rivaroxaban monotherapy benefits and their relation to the time between stenting and enrollment among patients after coronary stenting. Background Of 2,215 patients with atrial fibrillation and stable coronary artery disease in the AFIRE trial, rivaroxaban monotherapy was noninferior to rivaroxaban plus antiplatelet therapy (combination therapy) in terms of efficacy and superior for safety endpoints. However, thrombotic risk after antiplatelet therapy cessation remained a concern among 1,444 patients who had undergone coronary stenting >1 year before enrollment. Methods The benefits of rivaroxaban monotherapy in coronary stenting subgroups were assessed for efficacy (a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death of any cause), safety (major bleeding defined according to International Society on Thrombosis and Haemostasis criteria), ischemic endpoints, net adverse clinical event, and time between stenting and enrollment. Results Efficacy and safety endpoints for monotherapy were superior to combination therapy, with HRs of 0.70 for efficacy (95% CI: 0.50-0.98; P = 0.036) and 0.55 for safety (95% CI: 0.33-0.92; P = 0.019). For ischemic endpoints, the HR was 0.82 (95% CI: 0.58-1.15; P = 0.240). The HR became smaller with longer time between stenting and enrollment (efficacy, P for interaction = 0.158; safety, P = 0.097). Conclusions In patients with atrial fibrillation after coronary stenting, the benefits of rivaroxaban monotherapy for efficacy and safety endpoints were consistent with those in the whole AFIRE trial population. The benefits became apparent with longer time between stenting and enrollment. (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease Study [AFIRE]; UMIN000016612 , NCT02642419 )

Background Currently, few baseline imaging biomarkers can predict chemotherapy induced cardiotoxicity (CTx). The early identification of CTx is critically important as it determines the prospect of LV function recovery (1). Purpose We aimed to determine if baseline left atrial (LA) reservoir strain (LAS) is predictive of CTx. Methods We performed retrospective analysis of the SUCCOUR study, an international multicentre randomized controlled trial. CTx was defined as an asymptomatic drop of >10% in left ventricular ejection fraction (LVEF) compared to baseline to Results After excluding 78 with inadequate images, 229 were included in the analysis. Most participants were female (n=215, 94%), with a mean age of 54±12 years. Median follow up was 1.02 years (IQR 0.98–1.07). A smoking history was the commonest cardiac risk factor (n=68, 30%). Breast cancer was the main cancer type (n=205, 90%). The mean baseline 3D LVEF, LV global longitudinal strain (GLS), LAS, and LA volume index (LAVI) were 61±4%, 20.6±2.5%, 28.6±7.9%, and 28±9ml/m2, respectively. Participants that developed CTx had a lower LAS at baseline compared to those that did not (25.5±7.4% vs 29.0±7.9% respectively; p=0.027). At 1-year follow-up, 29 patients (13%) developed CTx. On univariable Cox proportional hazard analysis, higher baseline LAS was associated with a lower risk of CTx (HR 0.95, 95% CI 0.90–0.99; p=0.026) but other parameters including baseline GLS was not (p=0.17). In nested Cox models (Figure 1), adding LAS significantly improved the model's predictive accuracy for CTx compared to other clinical and imaging parameters. When LAS was added to the same models it showed improvements in the c-statistics and AIC score (Figure 1). Conclusion Baseline LAS is an independent and incremental predictor of CTx. LAS could be used for baseline risk stratification in oncology patients who receive potentially cardiotoxic chemotherapy. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): GE Healthcare

Funding Acknowledgements Type of funding sources: None. Aims Cryoballoon (CB) based pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF). The most frequent complication during CB-based PVI is right-sided phrenic nerve injury which is leading to premature abortion of the freeze cycle. Here we analysed repeat procedures and reconnection rates after CB-based PVI and phrenic nerve injury in a large-scale population. Due to the fact that the freezing process was prematurely interrupted the data may offer unique findings in optimizing the CB dosing protocols. Methods and Results In the YETI registry a total of 17356 patients underwent CB-based PVI in 33 centers and 731 (4.2%) patients experienced phrenic nerve injury. A total of 111 / 731 (15.2%) patients received a repeat procedure utilizing a 3D mapping system due to AF recurrence. In 94/111 (84.7%) of patients data on repeat procedures was available. During their initial PVI procedures, phrenic nerve injury occurred during treatment of RSPV (n=80), RIPV (n=13) and LSPV (n=1). A total of 89/94 (94.7%) target PVs have been isolated during the initial PVI (RSPV: 75/80, 94%; RIPV: 13/13; 100%; LSPV: 1/1; 100%). The mean freezing time was 127±46s and the mean minimal temperature was -49±7°C. During the repeat procedures 67 of initially 89 isolated PVs showed persistent isolation (75%, for RSPV: 55/75; 73%; RIPV: 11/13; 85%; LSPV: 1/1; 100%). Conclusion In patients initially treated by CB-based PVI with interruption of the freezing due to phrenic nerve injury, a high rate of durable isolated PVs has been detected at repeat procedures. Our data may help to identify the optimal dosing protocol in CB-based PVI procedures

We present the results of a systematic X-ray analysis of optically rich galaxy clusters detected by the Subaru HSC survey in the eROSITA eFEDS field. Through a joint analysis of SRG/eROSITA and Subaru/HSC surveys, we aim to study the dynamical status of the optically selected clusters and derive the cluster scaling relations. The sample consists of 43 optically selected galaxy clusters with a richness $>40$ in $0.16, Comment: 12 pages, 4 figures, A&A accepted, minor correction

The eFEDS survey is a proof-of-concept mini-survey designed to demonstrate the survey science capabilities of SRG/eROSITA. It covers an area of 140 square degrees where 542 galaxy clusters have been detected out to a redshift of 1.3. The eFEDS field is partly embedded in the Hyper Suprime-Cam Subaru Strategic Program (HSC-SSP) S19A data release, which covers 510 square degrees, containing approximately 36 million galaxies. This galaxy catalogue is used to construct a sample of 180 shear-selected galaxy clusters. In the common area to both surveys, about 90 square degrees, we investigate the effects of selection methods in the galaxy cluster detection by comparing the X-ray selected, eFEDS, and the shear-selected, HSC-SSP S19A, galaxy cluster samples. There are 25 shear-selected clusters in the eFEDS footprint. The relation between X-ray bolometric luminosity and weak-lensing mass is investigated, and it is found that the normalization of the bolometric luminosity and mass relation of the X-ray selected and shear-selected samples is consistent within $1\sigma$. Moreover, we found that the dynamical state and merger fraction of the shear-selected clusters is not different from the X-ray selected ones. Four shear-selected clusters are undetected in X-rays. A close inspection reveals that one is the result of projection effects, while the other three have an X-ray flux below the ultimate eROSITA detection limit. Finally, 43% of the shear-selected clusters lie in superclusters. Our results indicate that the scaling relation between X-ray bolometric luminosity and true cluster mass of the shear-selected cluster sample is consistent with the eFEDS sample. There is no significant population of X-ray underluminous clusters, indicating that X-ray selected cluster samples are complete and can be used as an accurate cosmological probe., Comment: A&A accepted for the Special Issue: The Early Data Release of eROSITA and Mikhail Pavlinsky ART-XC on the SRG Mission

Pseudomonas syringae pv. actinidiae (Psa) has been shown to have heterotypic populations including a pandemic highly virulent strain (Psa3 or Psa-V). Although Psa was first recorded in Japan, the virulent strain Psa3 had not been observed until spring of 2014, when the sudden outbreak of Psa3 took place in Japan. Also in Shizuoka Prefecture, we noticed the incidence of bacterial leaf spots in several kiwifruit orchards in June 2014. Isolation of the causal bacterium and identification through PCR and other techniques confirmed that the pathogen was Psa3. In one representative field, the disease was observed on Actinidia deliciosa 'Hayward'. Similar leaf spots were also observed on A. chinensis cultivars planted in the same field, however, the pathogen was identified as a strain of Pseudomonas syringae causing flower-rot (blossom blight) disease of kiwifruit (Ps-fr). The differences between Psa3, Psa1 and Ps-fr were confirmed. Sometimes, Psa3 and Ps-fr were isolated from a single lesion. The transition of the disease incidence from 2014 to 2015 was described. It was demonstrated that Ps-fr inhibited the growth of Psa3 in vitro.

While it is known that the degenerated intervertebral disc (IVD) is one of the primary reasons for low-back pain and subsequent need for medical care, there are currently no established effective methods for direct treatment. Nuclear factor-κB (NF-κB) is a transcription factor that regulates various genes’ expression, among which are inflammatory cytokines, in many tissues including the IVD. NF-κB decoy is an oligodeoxynucleotide containing the NF-κB binding site that entraps NF-κB subunits, resulting in suppression of NF-κB activity. In the present preclinical study, NF-κB decoy was injected into degenerated IVDs using the rabbit anular-puncture model. In terms of distribution, NF-κB decoy persisted in the IVDs up to at least 4 weeks after injection. The remaining amount of NF-κB decoy indicated that it fit a double-exponential-decay equation. Investigation of puncture-caused degeneration of IVDs showed that NF-κB decoy injection recovered, dose-dependently, the reduced disc height that was associated with reparative cell cloning and morphological changes, as assessed through histology. Gene expression, by quantitative real-time polymerase chain reaction (qRT-PCR), showed that NF-κB decoy attenuated inflammatory gene expression, such as that of interleukin-1 and tumor necrosis factor-α, in rabbit degenerated IVDs. NF-κB decoy also reduced the pain response as seen using the “pain sensor” nude rat xenograft-radiculopathy model. This is the first report demonstrating that NF-κB decoy suppresses the inflammatory response in degenerated IVDs and restores IVD disc height loss. Therefore, the intradiscal injection of NF-κB decoy may have the potential as an effective therapeutic strategy for discogenic pain associated with degenerated IVDs.

Objective: In the largest avascular low-nutrient intervertebral disc, resident cells would utilize autophagy, a stress-response survival mechanism by self-digestion and recycling wastes. Our goal was to elucidate the involvement of autophagy in disc homeostasis through RNA interference of autophagy-related gene 5 (Atg5). Design: In vitro, small interfering RNAs (siRNAs) targeting autophagy-essential Atg5 were transfected into rat disc cells. Cell viability with levels of autophagy including Atg5 expression, apoptosis, and senescence was assessed under serum starvation and/or pro-inflammatory interleukin-1 beta (IL-1β) stimulation. In vivo, time-course autophagic flux was monitored following Alexa Fluor® 555-labeled Atg5-siRNA injection into rat tail discs. Furthermore, 24-h temporary static compression-induced disruption of Atg5 siRNA-injected discs was observed by radiography, histomorphology, and immunofluorescence. Results: In disc cells, three different Atg5 siRNAs consistently suppressed autophagy with Atg5 protein knockdown (mean 44.4% [95% confidence interval: −51.7, −37.1], 51.5% [−80.5, −22.5], 62.3% [−96.6, −28.2]). Then, Atg5 knockdown reduced cell viability through apoptosis and senescence not in serum-supplemented medium (93.6% [−0.8, 21.4]) but in serum-deprived medium (66.4% [−29.8, −8.6]) further with IL-1β (44.5% [−36.9, −23.5]). In disc tissues, immunofluorescence detected intradiscal signals for the labeled siRNA even at 56-d post-injection. Immunoblotting found 56-d autophagy suppression with prolonged Atg5 knockdown (33.2% [−52.8, −5.3]). With compression, Atg5 siRNA-injected discs presented radiographic height loss ([−43.9, −0.8]), histological damage ([−5.5, −0.2]), and immunofluorescent apoptosis ([2.2, 22.2]) and senescence ([4.1, 19.9]) induction compared to control siRNA-injected discs at 56 d. Conclusions: This loss-of-function study suggests Atg5-dependent autophagy-mediated anti-apoptosis and anti-senescence. Autophagy could be a molecular therapeutic target for degenerative disc disease.

The eROSITA Final Equatorial-Depth Survey (eFEDS), covering ~140 square degrees, was performed as part of the performance verification phase of the eROSITA telescope on board of the Russian-German satellite Spectrum-Roentgen-Gamma (SRG). In this paper we present the optical follow-up of 542 X-ray extent selected galaxy group and cluster candidates providing redshifts and cluster confirmation for the full sample. We use optical imaging data from the Hyper Suprime-Cam Subaru Strategic Program and from the Legacy Survey to run the cluster redshift and confirmation tool MCMF as well as the optical cluster finder CAMIRA at the location of the X-ray candidates. While providing redshift estimates for all 542 candidates, we construct an optically confirmed sample of 477 clusters and groups with a residual contamination of 6%. Of these, 470 (98.5%) are confirmed using MCMF and 7 systems are added through cross matching with spectroscopic group catalogs. Using observable to observable scaling and the applied confirmation threshold, we predict 8 +/- 2 real systems have been excluded with the MCMF cut required to build this low contamination sample. This number is in good agreement with the 7 systems recovered through cross matching. Thus, we expect those 477 systems to include >99% of all true clusters in the candidate list. Using an MCMF independent method, we confirm the catalog contamination of the confirmed subsample to be 6 +/- 3% and find 17 +/- 3% contamination for the full X-ray sample. The estimated contamination of the fulls sample is in agreement with MCMF dependent estimate of ~17% and the expectation from dedicated X-ray simulations of ~20%. We further present a sample of optically selected merging cluster candidates., 24 pages, 26 figures, accepted to appear on A&A, Special Issue: "The Early Data Release of eROSITA and Mikhail Pavlinsky ART-XC on the SRG Mission". Catalog available at: https://erosita.mpe.mpg.de

A new polyurethane adhesive was evaluated to fix a hydrophilic-lipophilic-balanced sorbent and to produce modified stir-bars. It presented high mechanical and chemical resistance, indicating that it is an adequate adhesive. The homemade bars were employed to determine bisphenol A, diclofenac, ibuprofen and triclosan in aqueous medium. Satisfactory figures of merit were observed, with LOD between 0.06 and 0.30 ng mL-1 and enrichment factors between 133 and 195 times, using an extraction time of 2 h. The stir-bars were employed to determine the four analytes in water samples, presenting recovery results from 53 to 135% and RSD between 0.7 and 20%. In general, the results observed here indicated that the adhesive is an appropriate alternative material to fix HLB particles, and could probably be applied to other sorbents.

High temperature application of modern Ti-alloys is often limited by their insufficient oxidation resistance at temperatures exceeding 650 °C. One way to overcome this obstacle is application of an overlay coating made of TiAl-based alloys. In this study kinetically sprayed coatings of Ti-46Al-8.5Nb-1Ta (at%) on a commercial alloy IMI-834 were investigated. The feedstock powder fabricated by gas atomization consisted of non-equilibrium α-Ti and β-Ti phases. Heat treatment of the powder at 750 °C triggered transformation to the equilibrium ordered γ-TiAl and α 2 -Ti 3 Al phases. Mechanical properties of both the as-atomized and the heat treated powders were tested, showing that the as-sprayed one possesses lower hardness and higher ductility. Since such properties of the as-atomized powder are more suited for kinetic spraying, the as-atomized powder was used for coating fabrication. The as-sprayed coatings inherited the non-equilibrium phases of the atomized powder with significant deformation. The coatings were annealed at 750 °C and immediate transformation to a refined microstructure containing the γ-TiAl and α 2 -Ti 3 Al phases was observed in

The XXL survey currently covers two 25 sq. deg. patches with XMM observations of ~10ks. We summarise the scientific results associated with the first release of the XXL data set, that occurred mid 2016. We review several arguments for increasing the survey depth to 40 ks during the next decade of XMM operations. X-ray (z 1 cluster density. It will eventually constitute a reference study and an ideal calibration field for the upcoming eROSITA and Euclid missions.

Background Second-generation cryoballoon (CB2) based pulmonary vein isolation (PVI) has emerged as a safe and effective treatment option for symptomatic atrial fibrillation (AF). Although published complication rates of CB2 based-PVI are relatively low and several safety algorithms have been implemented in the protocols the most frequent complication is right-sided phrenic nerve injury (PNI). The reported incidence of PNI varies from 2–5% of patients. However data on PNI characteristics as well as follow-up is sparse. Purpose We aimed to evaluate the incidence, characteristics and outcome of PNI during after CB2 based-PVI in a large patients population. Methods and results From July 2012 to November 2018 a total of 13693 patients received CB2 or CB3 (third-generation) based-PVI in 23 EP centers (Germany: 12, China: 1, Turkey: 3, Japan: 3, USA: 1, Austria: 1, Poland: 1, Swizerland: 1). A total of 596 (4.4%) of patients experienced PNI during treatment of the right superior (84%) right inferior (15%) right middle (0.3%) (and left superior (0.3%) pulmonary veins. The mean time to PNI was 127±51 seconds and the mean temperature at the time of PNI was −49±7 °C. The target PV was isolated at time of PNI in 84% of cases. The applications were interrupted using double-stop technique in (71%). In 212/306 (52%) a CMAP was utilized. At the end of the procedure PNI persistent in 45% of patients. Fluoroscopic or sonographic evaluation of PNI was performed 1–3 days after the procedure and revealed persistent PNI in 35% of patients. Dyspnea before discharge was reported in 18% of patients with persistent PNI. Patients follow up at 1–3, and 6–12 months included fluoroscopy and a visit in an outpatient clinic. After 1–3 months 18% of patients showed persistent PNI including 13% of patients complaining of dyspnea. After 6–12 months of follow-up including fluoroscopic evaluation PNI was persistent in 1.8% of patients while dyspnea was reported by 1.7% patients. Only 0.08% of the overall population of 13693 patients showed permanent and symptomatic PNI. Conclusion The incidence of PNI during CB2-based PVI is low. About 55% of PNI recovered until the end of the procedure. Most of PNI recovered within 12 months. Symptomatic permanent PNI is very rare in patients after CB2/CB3-based PVI.

We report the discovery of a $Spitzer$ microlensing planet OGLE-2018-BLG-0596Lb, with preferred planet-host mass ratio $q \sim 2\times10^{-4}$. The planetary signal, which is characterized by a short $(\sim 1~{\rm day})$ "bump" on the rising side of the lensing light curve, was densely covered by ground-based surveys. We find that the signal can be explained by a bright source that fully envelops the planetary caustic, i.e., a "Hollywood" geometry. Combined with the source proper motion measured from $Gaia$, the $Spitzer$ satellite parallax measurement makes it possible to precisely constrain the lens physical parameters. The preferred solution, in which the planet perturbs the minor image due to lensing by the host, yields a Uranus-mass planet with a mass of $M_{\rm p} = 13.9\pm1.6~M_{\oplus}$ orbiting a mid M-dwarf with a mass of $M_{\rm h} = 0.23\pm0.03~M_{\odot}$. There is also a second possible solution that is substantially disfavored but cannot be ruled out, for which the planet perturbs the major image. The latter solution yields $M_{\rm p} = 1.2\pm0.2~M_{\oplus}$ and $M_{\rm h} = 0.15\pm0.02~M_{\odot}$. By combining the microlensing and $Gaia$ data together with a Galactic model, we find in either case that the lens lies on the near side of the Galactic bulge at a distance $D_{\rm L} \sim 6\pm1~{\rm kpc}$. Future adaptive optics observations may decisively resolve the major image/minor image degeneracy., 34 pages, 8 figures, Submitted to AAS journal

We report the discovery of a sub-Jupiter mass planet orbiting beyond the snow line of an M-dwarf most likely in the Galactic disk as part of the joint Spitzer and ground-based monitoring of microlensing planetary anomalies toward the Galactic bulge. The microlensing parameters are strongly constrained by the light curve modeling and in particular by the Spitzer-based measurement of the microlens parallax, $\pi_\mathrm{E}$. However, in contrast to many planetary microlensing events, there are no caustic crossings, so the angular Einstein radius, $\theta_\mathrm{E}$ has only an upper limit based on the light curve modeling alone. Additionally, the analysis leads us to identify 8 degenerate configurations: the four-fold microlensing parallax degeneracy being doubled by a degeneracy in the caustic structure present at the level of the ground-based solutions. To pinpoint the physical parameters, and at the same time to break the parallax degeneracy, we make use of a series of arguments: the $\chi^2$ hierarchy, the Rich argument, and a prior Galactic model. The preferred configuration is for a host at $D_L=3.73_{-0.67}^{+0.66}~\mathrm{kpc}$ with mass $M_\mathrm{L}=0.30_{-0.12}^{+0.15}~\mathrm{M_\odot}$, orbited by a Saturn-like planet with $M_\mathrm{planet}=0.43_{-0.17}^{+0.21}~\mathrm{M_\mathrm{Jup}}$ at projected separation $a_\perp = 1.70_{-0.39}^{+0.38}~\mathrm{au}$, about 2.1 times beyond the system snow line. Therefore, it adds to the growing population of sub-Jupiter planets orbiting near or beyond the snow line of M-dwarfs discovered by microlensing. Based on the rules of the real-time protocol for the selection of events to be followed up with Spitzer, this planet will not enter the sample for measuring the Galactic distribution of planets., Comment: Submitted to AAS Journals

Purpose Blood flow through the left ventricular assist device (LVAD) is dependent on the rotation speed of the impeller, and inversely dependent on the differential pressure across the LVAD (HQ relationship). We developed a novel approach to estimate intraventricular pressure difference (IVPD) in patients with LVAD and assess the change of IVPD according to pump speed during ramp study. Methods We developed in-house code of 1-dimensional incompressible Euler equation written in MATLAB (MathWorks, Natick, MA, USA) which allows us to measure IVPD by analyzing transesophageal echocardiographic images. Color M-mode images in mid-esophageal long axis view were obtained at 3 different pump speeds (low, optimized, high) in 10 patients who had LVAD implant (Figure). The optimal rotation speed was defined by stable hemodynamic conditions and the septal shape on transesophageal imaging. Pairwise comparison between each group was performed using Steel-Dwass analysis. Results Images were successfully obtained in all patients. Median IVPD values were 0.88 mmHg [IQR 0.73 - 1.02] at pre-LVAD implant, 1.86 mmHg [IQR 1.50 - 2.15] at low speed, 2.12 mmHg [IQR 1.72 - 2.71] at optimal speed, 2.09 mmHg [IQR1.72 - 2.31] at high speed, respectively (figure). There was significant difference between pre-implantation and the remaining 3 groups ( p Conclusion These data illustrate a novel approach to estimate IVPD during early diastole in patients with LVAD. Importantly, data suggests that setting of pump speed can be informed by analyzing IVPD during early diastole.