Heart transplantation for Chagas cardiomyopathy in the United States

Since an initial case in 2006, we noted multiple patients undergoing heart transplantation (HTx) for Chagas cardiomyopathy (CC) at our transplant program. The clinical characteristics, laboratory results and outcomes of patients with CC undergoing HTx in the United States have not been reported previously. In 2010, we implemented a systematic screening and management program for patients undergoing HTx for CC. Before HTx, all patients with idiopathic dilated cardiomyopathy who were born in a Chagas disease endemic country were screened for Trypanosoma cruzi (TC) infection with serology. After HTx, monitoring for TC reactivation was performed using clinical visits, echocardiography, endomyocardial biopsy and serial whole blood polymerase chain reaction (PCR) testing. Between June 2006 and January 2012, 11 patients underwent HTx for CC. One patient was empirically treated due to the presence of TC amastigotes in explanted cardiac tissue. Two patients experienced allograft dysfunction due to TC reactivation and three patients experienced subclinical reactivation (positive PCR results), which were treated. Chagas disease is a common cause of dilated cardiomyopathy in patients from endemic countries undergoing HTx at a transplant program in the United States. Reactivation is common after transplantation and can cause adverse outcomes.

Fabrication and testing of chemically micromachined silicon echelle gratings

We have fabricated large, coarsely ruled, echelle patterns on silicon wafers by using photolithography and chemical-etching techniques. The grating patterns consist of 142-microm-wide, V-shaped grooves with an opening angle of 70.6 degrees, blazed at 54.7 degrees. We present a detailed description of our grating-fabrication techniques and the results of extensive testing. We have measured peak diffraction efficiencies of 70% at lambda = 632.8 nm and conclude that the gratings produced by our method are of sufficient quality for use in high-resolution spectrographs in the visible and near IR (lambda approximately = 500-5000 nm).