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Acute myocardial infarction (AMI) is the main cause of morbidity and mortality worldwide and is characterized by severe and fatal arrhythmias induced by cardiac ischemia/reperfusion (CIR). However, the molecular mechanisms involved in these arrhythmias are still little understood. To investigate the cardioprotective role of the cardiac Ca2+/cAMP/adenosine signaling pathway in AMI, L-type Ca2+ channels (LTCC) were blocked with either nifedipine (NIF) or verapamil (VER), with or without A1-adenosine (ADO), receptors (A1R), antagonist (DPCPX), or cAMP efflux blocker probenecid (PROB), and the incidence of ventricular arrhythmias (VA), atrioventricular block (AVB), and lethality (LET) induced by CIR in rats was evaluated. VA, AVB and LET incidences were evaluated by ECG analysis and compared between control (CIR group) and intravenously treated 5 min before CIR with NIF 1, 10, and 30 mg/kg and VER 1 mg/kg in the presence or absence of PROB 100 mg/kg or DPCPX 100 µg/kg. The serum levels of cardiac injury biomarkers total creatine kinase (CK) and CK-MB were quantified. Both NIF and VER treatment were able to attenuate cardiac arrhythmias caused by CIR; however, these antiarrhythmic effects were abolished by pretreatment with PROB and DPCPX. The total serum CK and CK-MB were similar in all groups. These results indicate that the pharmacological modulation of Ca2+/cAMP/ADO in cardiac cells by means of attenuation of Ca2+ influx via LTCC and the activation of A1R by endogenous ADO could be a promising therapeutic strategy to reduce the incidence of severe and fatal arrhythmias caused by AMI in humans.

Introduction: Therapeutic plasmapheresis is a therapeutic procedure in which the patient’s blood is passed through a medical device which separates out plasma from other components of blood. The plasma is removed and replaced with a replacement solution. Studies on the use of plasmapheresis in critically ill patients are scarce. The aim of this study was to review all therapeutic plasmapheresis sessions carried out in the Hospital Beatriz Ângelo intensive care unit. Material and Methods: An observational retrospective study was conducted between April 2012 and March 2019. All patients who underwent therapeutic plasmapheresis in the intensive care unit were included, and plasmapheresis sessions held outside the intensive care unit were excluded. Results: Of 46 patients, 63% were men (n = 29), with a median age of 53 years. The most frequent diagnoses were hypertriglyceridemia-induced pancreatitis, vasculitis, autoimmune haemolytic anaemia, and atypical haemolytic-uremic syndrome. A total of 198 plasmapheresis sessions were carried out in the intensive care unit. Most of the used replacement solutions were fresh frozen plasma (34.4%), albumin/crystalloid (24.2%), and albumin/fresh frozen plasma (19.2%). The most common complications were hydroelectrolytic changes (84; 42.4%) and coagulation disorders/thrombocytopenia (65; 32.8%). There was no need to interrupt any plasmapheresis session due to complications related to the patient. Conclusion: Therapeutic plasmapheresis is a complex technique that requires specific training. The indications are diverse, and some are not consensual. Complications were frequent, but they did not increase morbidity.

Primary Sjögren’s syndrome (SS) is a chronic, systemic autoimmune disease, most commonly presenting with sicca symptoms—xerostomia and xerophthalmia. Up to one-half of affected individuals also develop extra-glandular involvement. Early diagnosis is important to prevent further complications. This paper describes an atypical case of SS in a 21-year-old woman who presented first with neuropsychiatric symptoms and fever. She was diagnosed and treated for a presumed psychotic episode. However, because she remained febrile, a thorough investigation resulted in the challenging diagnosis of SS.

Acute myocardial infarction (AMI) is the main cause of morbidity and mortality worldwide and is characterized by severe and fatal arrhythmias induced by cardiac ischemia/reperfusion (CIR). However, the molecular mechanisms involved in these arrhythmias are still little understood. To investigate the cardioprotective role of the cardiac Ca2+/cAMP/adenosine signaling pathway in AMI, L-type Ca2+ channels (LTCC) were blocked with either nifedipine (NIF) or verapamil (VER), with or without A1-adenosine (ADO), receptors (A1R), antagonist (DPCPX), or cAMP efflux blocker probenecid (PROB), and the incidence of ventricular arrhythmias (VA), atrioventricular block (AVB), and lethality (LET) induced by CIR in rats was evaluated. VA, AVB and LET incidences were evaluated by ECG analysis and compared between control (CIR group) and intravenously treated 5 min before CIR with NIF 1, 10, and 30 mg/kg and VER 1 mg/kg in the presence or absence of PROB 100 mg/kg or DPCPX 100 µg/kg. The serum levels of cardiac injury biomarkers total creatine kinase (CK) and CK-MB were quantified. Both NIF and VER treatment were able to attenuate cardiac arrhythmias caused by CIR; however, these antiarrhythmic effects were abolished by pretreatment with PROB and DPCPX. The total serum CK and CK-MB were similar in all groups. These results indicate that the pharmacological modulation of Ca2+/cAMP/ADO in cardiac cells by means of attenuation of Ca2+ influx via LTCC and the activation of A1R by endogenous ADO could be a promising therapeutic strategy to reduce the incidence of severe and fatal arrhythmias caused by AMI in humans. [ABSTRACT FROM AUTHOR]

Stroke remains one of the most serious complications of sickle cell disease. Near 11% of the patients will have a stroke before the age of 20. Most cases are from ischemic stroke, but a small part are hemorrhagic which have a higher mortality. We present the case of a 19 year-old patient, with sickle cell disease and multiple associated complications. He was admitted with acute chest syndrome and developed a hemorrhagic stroke while hospitalized.

Revealing the place addresses the referential role of sacred architecture elements that dot the Portuguese Atlantic coastline in contemporary architectural pedagogy and in the practice of architecture. The long Portuguese coastline, the case study of the research, is dotted with sacred architectural elements—sanctuaries, churches, chapels and crosses—oriented according to both compositional and canonical cosmological principles. The character of the space of articulation between the land and the sea is made evident by the tension between the sacred elements and the landscape. This paper addresses this relation, resorting to decomposition interpretative drawings and arguments that uncover the formal relationships between sacred architecture and the landscape, proposing an interpretative reading of the built elements that combines type and place. Furthermore, it discusses the transposition of composition principles from sacred to secular architecture, building an analogy for the typological transfer process, considering the transference of existing qualities in sacred architecture for contemporary architectural projects. The hypothesis discussed is that the decoding of the architectural composition of sacred elements in the landscape remains useful both in the pedagogy and practice of architecture. Finally, it is evidenced that this exercise allows us to transfer formal relations established between sacred buildings and the landscape for contemporary architectural practice, revealing type and topos. [ABSTRACT FROM AUTHOR]

Divergent selection and local adaptation are responsible for many phenotypic differences between populations, potentially leading to speciation through the evolution of reproductive barriers. Here we evaluated the morphometric divergence among west European populations of Reed Bunting in order to determine the extent of local adaptation relative to two important selection pressures often associated with speciation in birds: migration and diet. We show that, as expected by theory, migratory E. s. schoeniclus had longer and more pointed wings and a slightly smaller body mass than the resident subspecies, with the exception of E. s. lusitanica, which despite having rounder wings was the smallest of all subspecies. Tail length, however, did not vary according to the expectation (shorter tails in migrants) probably because it is strongly correlated with wing length and might take longer to evolve. E. s. witherbyi, which feed on insects hiding inside reed stems during the winter, had a very thick, stubby bill. In contrast, northern populations, which feed on seeds, had thinner bills. Despite being much smaller, the southern E. s. lusitanica had a significantly thicker, longer bill than migratory E. s. schoeniclus, whereas birds from the UK population had significantly shorter, thinner bills. Geometric morphometric analyses revealed that the southern subspecies have a more convex culmen than E. s. schoeniclus, and E. s. lusitanica differs from the nominate subspecies in bill shape to a greater extent than in linear bill measurements, especially in males. Birds with a more convex culmen are thought to exert a greater strength at the bill tip, which is in agreement with their feeding technique. Overall, the three subspecies occurring in Western Europe differ in a variety of traits following the patterns predicted from their migratory and foraging behaviours, strongly suggesting that these birds have became locally adapted through natural selection.

Reed bunting Emberiza schoeniclus subspecies vary considerably in bill size and shape and seem to be at an early stage of speciation, in which bill might be indirectly causing reproductive isolation. Hence, we evaluated whether bill size, as well as age and sex, are associated with foraging niche in three west European subspecies of reed bunting: the thin-billed schoeniclus, the intermediate-billed lusitanica and the thick-billed witherbyi. Blood sampling was undertaken at three sites in southwest Europe during the winter (when these subspecies co-occur), and stable isotope analyses (carbon and nitrogen) were performed to assess their foraging niches. Stable isotope analyses of potential food items confirmed uniform baseline isotopic composition among sites. schoeniclus showed a significantly broader isotopic niche than lusitanica and witherbyi, which seemed otherwise similar despite the fact that witherbyi is more divergent in bill traits. Stable isotope ratios were consistent with the latter two subspecies feeding on C3-plant-feeding insects, whereas schoeniclus diet also included C4 plant material. Despite its lower sexual dimorphism, sex and age differences were found only in schoeniclus, but these differences vary between locations in a complex manner. Our results suggest that bill size and shape differentiated between northern, migratory and southern, resident subspecies as a consequence of natural selection through competition during the winter, which is now reflected in isotopic niche divergence between subspecies. The potential roles of sexual selection, reed thickness and summer temperature on the difference in bill size (and greater sexual dimorphism) between lusitanica and witherbyi are discussed. [ABSTRACT FROM AUTHOR]

Acoustic divergence among populations may result in assortative mating, behavioral isolation, and speciation. In birds, the recognition of suitable mates depends to a large extent on learning, generally resulting in a tendency to discriminate against nonlocal stimuli. However, there may be geographical variation in the discrimination against nonlocal stimuli, and this may allow inferring the mechanisms behind the evolution of vocal recognition. We tested territorial males of 3 west European subspecies of reed bunting (Emberiza schoeniclus schoeniclus, Emberiza schoeniclus lusitanica, and Emberiza schoeniclus witherbyi) using song playback to determine the level of song discrimination. We found that witherbyi and, to some extent lusitanica, males largely ignored schoeniclus songs. However, witherbyi reacted less strongly to the songs of lusitanica than lusitanica did to songs of witherbyi. In contrast, schoeniclus males did not discriminate the songs of the different subspecies, reacting strongly to all. Differential territorial defense behavior suggest that intruding males with different songs do not represent the same competitive threat, and provide evidence of premating reproductive isolation among these recently evolved subspecies. The high discrimination exhibited by witherbyi and lusitanica seems associated with the high level of local adaptation. Overall, the pattern of premating reproductive isolation appears to agree more with the ecological than with the neutral genetic divergences between subspecies, suggesting that there is an ongoing process of ecological speciation in this study system. [ABSTRACT FROM AUTHOR]

Arterioportal fistulas are a rare complication of abdominal interventions. They can remain asymptomatic for a long time and manifest with symptoms of portal hypertension. We present the case of a 65-year-old man admitted to the emergency room with increasing fatigue and melena. He had a history of partial gastrectomy with Billroth II reconstruction 40 years earlier for peptic ulcer perforation. On physical examination, he was pale and presented a machinery-type murmur in the epigastric area. Blood tests revealed iron deficiency anaemia of 5.6 g/dL. During hospitalisation, he required several blood transfusions and maintained melenas. An abdominal CT angiography showed a fusiform aneurysm of the left gastric artery draining to the venous portal-splenic confluent. He was successfully treated with transarterial coil embolisation of the left gastric artery aneurysm. The correct diagnosis of arterioportal fistulas can be very challenging, whereas the standard treatment with coil embolisation offers a low morbidity resolution of symptoms. [ABSTRACT FROM AUTHOR]

Hunting and its associated management have significant costs and benefits for biodiversity conservation, which makes this socio-economic activity highly controversial at both international and regional levels. We investigated relationships between management for small game species (mainly Red-legged Partridges Alectoris rufa and rabbits Oryctolagus cuniculus) and both abundance and richness of farmland and scrubland songbirds, raptors and ground-nesting birds, and on the abundance of three species of conservation concern (Little Bustard Tetrax tetrax, Eurasian Thick-knee Burhinus oedicnemus and Montagu’s Harrier Circus pygargus) in southern Portugal farmland. We compared 12 game estates and 12 matching areas with similar sizes and land uses but no game management. Richness and abundance were estimated from fixed point counts, and were related to game regime (managed or unmanaged), habitat characteristics and census period. Our results showed that game management was associated, albeit weakly, with higher abundance of raptors and ground-nesting birds, but no relationship (either positive or negative) was found for other guilds and species. Habitat was generally the most important factor explaining bird species richness and abundance. Our results suggest possibilities for promoting management systems that could maximize both hunting sustainability and conservation value of managed areas, particularly when management helps to improve or maintain beneficial habitats or practices for farmland birds. [ABSTRACT FROM PUBLISHER]

Divergent selection and local adaptation are responsible for many phenotypic differences between populations, potentially leading to speciation through the evolution of reproductive barriers. Here we evaluated the morphometric divergence among west European populations of Reed Bunting in order to determine the extent of local adaptation relative to two important selection pressures often associated with speciation in birds: migration and diet. We show that, as expected by theory, migratory E. s. schoeniclus had longer and more pointed wings and a slightly smaller body mass than the resident subspecies, with the exception of E. s. lusitanica, which despite having rounder wings was the smallest of all subspecies. Tail length, however, did not vary according to the expectation (shorter tails in migrants) probably because it is strongly correlated with wing length and might take longer to evolve. E. s. witherbyi, which feed on insects hiding inside reed stems during the winter, had a very thick, stubby bill. In contrast, northern populations, which feed on seeds, had thinner bills. Despite being much smaller, the southern E. s. lusitanica had a significantly thicker, longer bill than migratory E. s. schoeniclus, whereas birds from the UK population had significantly shorter, thinner bills. Geometric morphometric analyses revealed that the southern subspecies have a more convex culmen than E. s. schoeniclus, and E. s. lusitanica differs from the nominate subspecies in bill shape to a greater extent than in linear bill measurements, especially in males. Birds with a more convex culmen are thought to exert a greater strength at the bill tip, which is in agreement with their feeding technique. Overall, the three subspecies occurring in Western Europe differ in a variety of traits following the patterns predicted from their migratory and foraging behaviours, strongly suggesting that these birds have became locally adapted through natural selection. [ABSTRACT FROM AUTHOR]

Introduction: Different environmental conditions can influence the effects of toxic agents on living beings. Recently, a series of experiments performed in Artemia salina submitted to different kinds of intoxication have shown that both, isotherapic and succussed water can change Artemia salina´s bio resilience at different levels. Moreover, it seems to vary according to the circalunar cycle. Objective: To verify if circalunar phases and water agitation can modify the toxicity of lead chloride on Artemia salina in vitro. Methodology: Artemia salina cysts were exposed to seawater containing 0.04% of lead chloride (equal to EC10 or 10% effective concentration, previously determined in a pilot study) in 96-well culture plates. Thirty-six experimental repetitions were performed in four series to observe the possible effects of adding stirred water, the so-called succussed water, and the moon phases. The hatched cysts were recorded after 48 hours using a digital microscope (1000x magnification) to identify the hatching percentage and the viability and mobility of the born nauplii. Results: The exposition of cysts to PbCl2 led to an increase in the hatching rate, and it was more evident during the full moon (p = 0.00014) The addition of succussed water into the seawater medium reduced this effect to the baseline levels. An increase in mobility was seen in nauplii born from exposed cysts during the full moon (p = 0.00077), but this effect was not affected by the treatment with succussed water. Discussion: Although the effects of lead chloride EC10 on the increase of nauplii hatching were expected, two environmental variables changed the sensitivity of cysts to this harmful stimulus. The circalunar cycle varied the hatching rate according to the moon phase, even in laboratory conditions, and the addition of succussed water into the medium reduced the hatching rate, even with different intensities according to the moon phase. The organization of nano and microbubbles generated after the succussion of water could be related to this protective effect and can explain, at least partially the effects of high diluted preparations on this biological context. Conclusion: Environmental factors, such as the circalunar cycle and products of water agitation, can modulate the adaptative control of hatching in Artemia salina exposed to lead chloride at EC10. [ABSTRACT FROM AUTHOR]

Introduction: Solvatochromic dyes are probes to detect variations on the dipole moment of solvents after the insertion of homeopathic potencies. Recent studies have shown they can be useful tools in laboratory and field studies to detect the activity of homeopathic remedies. Objective: Determine whether solvatochromic dyes can be a diagnostic tool for cells infected by different agents and/or markers to identify the activity of homeopathic medicines. Methods: Ethilicum 1cH, Silicea terra 6, 30, 200cH; Zincum metallicum 6, 30, 200cH and Phosphorus 6, 30 and 200cH were analyzed by pouring the samples (in a 1:60 rate) into a series of seven dyes (rhodamine, ET 33, ET 30, coumarin 7, NN DMIA, Nile red, methylene violet) diluted in absolute ethanol using pre-established working concentrations. Oscillations of dye absorbance were observed at visible light spectrophotometry according to the remedy and potency. Water and succussed water were used as controls. In a second moment, the absorbance profile of the remedies will be compared with those of biological samples (supernatants) and checked with the biological effect previously obtained from each treatment. Supernatants of RAW 264.7 macrophages stimulated by Calmette-Guérin bacilli (BCG) or infected with Encephalitozoon cuniculi will be analyzed. Results: Preliminary results have shown that Silicea terra 6cH, Phosphorus 30 and 200cH and Zincum metallicum 6, 30 and 200cH reduced the absorbance of methylene violet (p=0.01). Repetitions and analysis of supernatants are expected to be performed in the next steps of the study. Future perspectives: Establish a pattern of reactivity of the studied medicines with different dyes and the putative relation with the corresponding supernatants, as an attempt to obtain a "physicochemical signature" for each kind of infection and/or treatment. [ABSTRACT FROM AUTHOR]

Stroke remains one of the most serious complications of sickle cell disease. Almost 11% of the patients will have a stroke before the age of 20. The etiology is hemorrhagic in a small part of the cases, which is associated with a high mortality. We present the case of a 19 year-old patient, with sickle cell disease and multiple associated complications. The patient was admitted with acute chest syndrome and developed a hemorrhagic stroke while hospitalized. [ABSTRACT FROM AUTHOR]

Recently, several authors have shown the benefits of homeopathy in improving the quality of life and survival of cancer patients. Preliminary data from the group showed that B16F10 murine melanoma cells treated with Viscum album (Va), collected from the host tree Quercus robur during the Swiss summer (VaQr.s) and prepared in different homeopathic scales: 12 dH, 200 cH and 5 lm decreased both viability and production of reactive oxygen species (ROs) and monocyte chemoattractant protein-1 (MCP-1) cytokine, when compared to B16F10 cells treated with the chemotherapy drug carboplatin (p<0.05). However, the in vivo effects of these treatments have not been evaluated. Therefore, the aim of the present work was to investigate the effects of different homeopathic preparations of VaQr.s in mice with melanoma. For this, C57BL/6 mice were inoculated subcutaneously (s.c) on the left flank with B16F10 cells. After appearance of tumor nodule, mice were treated three times a week, orally, during 3 weeks with mother tincture (TM) or different potencies of VaQr.s (12 dH, 200 cH or 5 lm). As controls, mice were treated with ultrapure water or vehicle (10%-alcohol) or chemotherapy (carboplatin). Assessment of the general conditions and tumor growth were performed on alternate days until approximately 30 days after tumor cell inoculation. The results obtained showed that mice treated with VaQr 12 dH or 5 lm have increased survival and body weight, as well as a tendency to increase the quality of life of animals with melanoma, since these presented less clinical manifestations when compared to the other treatments, mainly the carboplatin group. Together, the data presented here demonstrated for the first time, the effects of Va potencies on alleviating cancer-related fatigue in an in vivo model of murine melanoma. Furthermore, this work provides relevant information for understanding the molecular events induced by homeopathic preparations of Va as a support for future studies with ultradiluted Va. [ABSTRACT FROM AUTHOR]

Considering that there are few published studies that specifically address the exclusive use of Carcinosinum in different potencies and, most of them focused on genotypic and clinical effects, the present study was proposed to identify possible phenotypic changes, including viability, expression of HER-2 and metastatic abilities, using 4T1 cells in vitro as a model. Carcinosinum was tested in different homeopathic potencies (12cH; 30cH; 200cH) mechanically prepared using sterile pure water. The time space between preparing the potencies and using them was 24 hours.The final dilutions were inserted into the culture medium in a volume equal to 10%, at the time of cell seeding. The same succussed vehicle used to prepare the drugs (70% ethanol) diluted 1:100 in sterile pure water was used as control. All treated cells were cultured in 25 mL flasks, with cell density of 5 x 105 cells/mL. After 24 hours of treatment, cells were analyzed for apoptosis index using Annexin V kit and the Countess® system. The morphology of 4T1 cells was monitored by staining cell smears with hematoxylin-eosin and Giemsa methods. HER-2 expression was assessed by immunocytochemistry and metalloproteinase activity was assessed by zymography. The determination of the cytokine profile was performed using Cytometric Bead Array (CBA). The samples were evaluated in quadruplicate and the data were analyzed by one-way ANOVA. Carcinosinum 30cH presented the highest apoptotic index and reduction of MMP-9-Pro expression; Carcinosinum 200cH produced the highest positivity for HER-2 and no specific effect was seen after the treatment with Carcinosinum 12cH. No change in cytokine expression was seen among treatments. We conclude that Carcinosinum 30cH and 200cH can change phenotypic features important to tumor development in vitro. The clinical meaning of these data deserves further investigation. [ABSTRACT FROM AUTHOR]

A 47-year-old Caucasian man with arterial hypertension was admitted after a seizure. At the emergency department, he presented with high blood pressure, bilateral vision loss (evidenced by unresponsiveness to threatening stimuli), right hemiplegia and severe agitation. The brain CT angiography showed a diffuse basal cisterns subarachnoid haemorrhage with a ruptured basilar aneurysm. He was admitted for neurovascular procedure and embolisation. The patient's neurological examination improved but blindness persisted. A funduscopic examination revealed a left eye vitreous haemorrhage and diffuse retinal haemorrhages in the posterior pole. Assuming the haemorrhages were the cause of blindness, Terson syndrome was diagnosed. The patient underwent vitrectomy surgery being discharged 5 days later maintaining left eye blindness and able to count fingers from 1 m distance with the right eye. Two months after discharge, he was re-evaluated at our clinic with left eye blurred vision and almost normal right eye visual acuity., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)