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Little is known about symptoms associated with frailty in institutionalized Portuguese older adults. This study aimed to investigate the association of frailty with diverse geriatric health characteristics. Cross-sectional data from 140 women aged between 75 and 85 years were analyzed. Data were collected between March and June, 2016. Fried's definition of physical frailty, psychological, sex hormones, disability and physical fitness outcomes were examined. The prevalence of frailty was 40%. Frail women had lower scores in cognitive and physical fitness, and higher scores for depressive symptoms and comorbidities. Significant correlations emerged between frailty and disability, fear of falling, aerobic resistance and cognition. Regression analyses and Receiver Operating Only aerobic resistance (sensitivity [93-96%]; specificity [74-77%]

BackgroundBurnout syndrome has adverse consequences for individuals, causing a variety of cognitive, affective, physical, behavioural and motivational problems. We aim to assess burnout in Portuguese radiation therapists, for who high levels of contact with patients may potentially lead to burnout.MethodsRadiation therapists working in Portugal were invited via e-mail to participate in the study by filling in a survey. The latter had two components: a social-demographic questionnaire and the Maslach Burnout Inventory – Human Services Survey.ResultsA total of 103 people responded to the survey, 95 of which employed as radiation therapists. The mean burnout scores were 20.60 ± 11.21, 7.43 ± 5.34 and 35.02 ± 6.02, for the emotional exhaustion, depersonalisation and personal accomplishment subscales, respectively. In the same order, the total of radiation therapists presenting high levels of burnout were 29%, 14.9% and 29.3% for the different dimensions. The mean scores of burnout did not differ significantly regarding gender, civil status, working in the public or private sector and years of service. Radiation therapists aged 40 years or older presented greater scores of burnout, though with no statistical significance.ConclusionRadiation therapists working in Portugal were seen to have average scores of burnout in the emotional exhaustion, depersonalisation and personal accomplishment subscales.

Rationale and Objectives The objective of this study was to evaluate the ultrasound features of thyroid nodules and their association with malignancy, focusing on establishing feature-oriented ultrasound criteria to determine proper management of a thyroid nodule. Materials and Methods A sample of 379 thyroid nodules were biopsied (from a total of 357 patients aged 59.8 ± 14.8 years) and 300 were included in the final study (271 benign nodules and 29 malignant ones). Ultrasound features were recorded for each nodule: size, echogenicity, homogeneity, contours, shape, texture, peripheral halo, calcifications, and the presence of adenopathy. Statistical analysis of the data was performed using the Mann-Whitney U test and chi-square test. The sensitivity and the specificity of variables seen to have a statistically significant association with the malignancy of nodules were assessed and a logistic regression was performed. Results A taller-than-wide shape, an ill-defined contour, the presence of a halo, microcalcifications, and adenopathy were found to have a statistically significant relationship (P Conclusions The ultrasound features of thyroid nodules alone do not allow the radiologist to make a confident diagnosis regarding the malignancy of a nodule without performing a biopsy. However, a nodule showing a taller-than-wide shape, microcalcifications, a peripheral halo, an ill-defined contour, or associated adenopathy should be considered for cytology.

Background: Following a stroke event, patients often are severely affected by disabilities that hinder their quality-of-life. There are currently several rehabilitative options and strategies, and it is crucial to find the most effective interventions. The applicability of transcranial magnetic stimulation (TMS) to the recovery of nonmotor functions such as communication skills, swallowing ability and spatial attention after stroke remains important clinical questions. Summary: We searched PubMed and ISI Web of Science for articles that used repetitive TMS protocols to rehabilitate post-stroke deficits. We analysed qualitatively 38 articles that met the eligibility criteria; of these, 21 dealt with aphasia, 8 with dysphagia, 8 with neglect and 1 with visual extinction. The efficacy of TMS as an intervention for post-stroke rehabilitation of these nonmotor deficits was studied as well as the current limitations were assessed. Key Messages: Most part of the included studies reported statistically significant functional improvements, supporting the use of TMS for the rehabilitation of aphasia, dysphagia and neglect. Future research, with larger sample sizes, is mandatory to confirm its efficacy, determine the optimal stimulation parameters and investigate inter-subject variability.

Associations between frailty and physical-functional fitness (PFF) indicators in frail women over 65 years of age remain largely unexplored. This study analyzed the relationship between frailty syndrome (FS) and PFF indicators and assessed how the latter might predict the former. Participants were 119 elderly women (81.96 ± 7.89 years) recruited from four social and healthcare centers. PFF was assessed through muscle strength tests of upper and lower limbs, endurance, agility-dynamic balance, flexibility, and body composition. The following FS indicators were assessed: weight loss, exhaustion, weakness, slowness, and low physical activity level. Significant correlations were found between FS and endurance, agility-dynamic balance, upper and lower limbs muscle strength tests. Comparitive analyses also revealed that, among FS groups, the frail subgroup performed significantly poorer on all PFF measures except body composition. Additionally, a receiving operating characteristics curve analysis revealed good diagnostic accuracy for predicting FS using the agility-dynamic balance test (Area Under Curve [AUC] = .82, 95% CI [0.74, 0.90]; sensitivity and specificity were 70.4% and 84.8% for the cutoff = 16.22 seconds). Accurately, the risk of frail condition (not pre-frail) increases about 2.12% per second spent in this test. Thus, the agility-dynamic balance test is a promising tool for screening institutionalized older people for risk of FS.

There are several statistical hypothesis tests available for assessing normality assumptions, which is an a priori requirement for most parametric statistical procedures. The usual method for compa...

Progressive supranuclear palsy (PSP) is a neurodegenerative disorder showing predominant brainstem involvement, characterized by marked slowing of rapid eye movements (saccades), particularly along the vertical plane. While the contribution of the brainstem damage for the saccadic disturbance in PSP has been extensively studied, much less is known about its cortical and subcortical pathomechanisms. We measured reflexive (prosaccades) and voluntary (antisaccades) saccades in the vertical and horizontal plane in PSP patients (n=8) and controls (n=10) in an eye tracking study, followed by the measurement of blood oxygenation-level dependent (BOLD) activation (PSP, n=6; controls, n=10) during similar saccade paradigms. Behaviorally, PSP patients evidenced slower and lower amplitude prosaccades (horizontal and vertical) and lower amplitude antisaccades (vertical) than controls. Functionally, patients showed decreased frontostriatal BOLD activation during prosaccades (horizontal and vertical) and antisaccades (vertical), relative to controls. Additionally, PSP patients showed less default mode network (DMN) deactivation than controls for all types of saccades. Within groups, controls showed no BOLD differences between horizontal and vertical prosaccades while PSP patients demonstrated greater DMN deactivation during vertical prosaccades. Both groups evidenced greater DMN deactivation during vertical antisaccades when compared to their horizontal counterpart and patients further showed relative frontostriatal BOLD hypoactivity during vertical antisaccades. We found fMRI evidence of frontostriatal hypoactivity in PSP patients relative to controls, especially during vertical saccades. These new findings highlight the impact of cortical impairment in saccadic disturbance of PSP.

Purpose Many people experience aging-related losses in different physical domains, which leads to a condition often called physical frailty (PF). The aim of this study was to analyse the effects of two different, 28-weeks, class chair-exercise protocols on salivary steroid hormones (SH), PF, and functional disabilities (FD) in frail older women. Methods A sample of older frail individuals (n = 60, 817.84 years) participated in the study and were divided into three groups: chair elastic-band muscle strength exercises (CSE), n = 20), chair-multimodal exercise (CME, n = 21) and a control non-exercise group (CGne, n = 19). Both exercise programs consisted of 45 min of supervised chair-based exercise group classes, carried out 3 times/week. CME participants performed a progressive training using walking, mobility and body weight resistance exercises. The CSE participants exercised using an elastic-band system of progressive exercises. Both CSE and CME followed a circuit training protocol. The controls did not change their usual lifestyle. The indicators of PF, FD and SH concentrations were analyzed before and after the intervention. Results Both exercise programs diminished the PF status showing significant time and time versus treatment interactions (p Conclusion Both chair-exercise based programs were effective in stimulating positive changes in physical health and in steroid hormone responses, especially in DHEA. The control group did show a negative trend towards an increased PF status and decreased levels of SH. It is crucial for public health to identify the main factors associated with Functional Disability and Physical Frailty that underlie the development of new methods for complementary therapies, such as the use of low doses of hormonal supplementation combined with long-term exercise interventions.

Objective Presumed microvascular ischemia is the most frequent cause of ocular motor palsy (OMP). Ischemic stroke incidence after an episode of microvascular OMP (mOMP) is not established, contrasting with other common vascular conditions, such as lacunar ischemic stroke (LS). We sought to compare the incidence of subsequent ischemic stroke between mOMP and LS populations. Methods A retrospective observational analysis was conducted on acute patients presenting with either mOMP or LS. A propensity score match was applied to ensure a balance between groups. We compared the incidence of subsequent ischemic stroke during an 80-month follow-up. Results A total of 110 patients were included in the study (57, mOMPs; 53, LS). During follow-up, the annual occurrence rate of ischemic stroke was 2.1% per year in mOMP group and 0.6% per year in the LS group. After performing Cox regression, we found no statistical significance difference between groups in the incidence of subsequent ischemic stroke (P=0.801). Conclusions Patients with presumed mOCP seem to share similar incidence of subsequent ischemic stroke with patients with LS. Presumed mOCP may be an underrecognized independent risk factor for ischemic stroke.

Varicella is a viral and usually benign disease, which commonly affects children. This disease main complication is bacterial superinfection of the skin. Ibuprofen administration, although not contraindicated, seems to increase risk of severe skin complications. – We report a case of a 21-month-old child with no family or personal relevant medical history who developed varicella with high fever since the second day of the disease. Paracetamol 15mg/kg every 8 hours and ibuprofen 7mg/kg every 8 hours were administered to the [...]

Saccadic behaviour ranges from reflexive (e.g., prosaccade) to goal oriented voluntary movements (e.g., antisaccade). Behavioural asymmetries between vertical and horizontal saccades have been described both in normal individuals (greater delay of vertical prosaccades) and in disease states such as Parkinson's disease (PD) (prosaccades are short and antisaccades are delayed, especially in the vertical plane, possibly due to a frontostriatal deficit). Importantly, the cortical mechanisms for the generation of vertical saccades are largely unknown, both in health and disease, when compared with their horizontal counterpart. Moreover, studies exploring saccadic neural correlates and putative compensatory mechanisms at a functional level in PD are scarce. We investigated horizontal and vertical prosaccades and antisaccades in an eye tracking paradigm in 19 PD patients off medication and 22 healthy controls, followed by a block-design functional Magnetic Resonance Imaging (fMRI) study, consisting of two runs (prosaccade, antisaccade) of 6 blocks each (3 vertical, 3 horizontal). While saccade metrics were not significantly different between groups, PD showed left frontal underactivation during horizontal prosaccades and right parietal overactivation during horizontal and vertical prosaccades and horizontal antisaccades. Moreover, controls showed greater deactivation of the default-mode network (DMN) during antisaccades. Vertical prosaccades were associated with greater right frontal and cerebellar activity in controls, and cuneus hypoactivity in PD. Vertical antisaccades were associated with greater DMN deactivation in both groups and left frontal hypoactivity in PD. Putative functional compensatory changes in the right parietal cortex in PD patients may help to keep saccadic behaviour at the same level as the healthy controls. We provide first time evidence showing that functional cortical asymmetries between vertical and horizontal saccades occur distinctively in PD patients and healthy controls.

Type 2 diabetes mellitus is a complex metabolic disease, and cardiovascular disease is a leading complication of diabetes. Epicardial adipose tissue surrounding the heart displays biochemical, thermogenic, and cardioprotective properties. However, the metabolic cross-talk between epicardial fat and the myocardium is largely unknown. This study sought to understand epicardial adipose tissue metabolism from heart failure patients with or without diabetes. We aimed to unravel possible differences in glucose and lipid metabolism between human epicardial and subcutaneous adipocytes and elucidate the potential underlying mechanisms involved in heart failure. Insulin-stimulated [14C]glucose uptake and isoproterenol-stimulated lipolysis were measured in isolated epicardial and subcutaneous adipocytes. The expression of genes involved in glucose and lipid metabolism was analyzed by reverse transcription-polymerase chain reaction in adipocytes. In addition, epicardial and subcutaneous fatty acid composition was analyzed by high-resolution proton nuclear magnetic resonance spectroscopy. The difference between basal and insulin conditions in glucose uptake was significantly decreased ( P = 0.006) in epicardial compared with subcutaneous adipocytes. Moreover, a significant ( P < 0.001) decrease in the isoproterenol-stimulated lipolysis was also observed when the two fat depots were compared, and it was strongly correlated with lipolysis, lipid storage, and inflammation-related gene expression. Moreover, the fatty acid composition of these tissues was significantly altered by diabetes. These results emphasize potential metabolic differences between both fat depots in the presence of heart failure and highlight epicardial fat as a possible therapeutic target in situ in the cardiac microenvironment.

Growth impairment in infants with unrestrictive ventricular septal defects (VSD) is common, and normalisation of growth has been reported after surgical correction. Literature is inconsistent about growth velocity after surgery in term and preterm infants. We aimed to establish the pattern of catch-up growth in term and preterm infants submitted to VSD surgical correction before 1 year of age. Fifty-two infants (41 term, 11 preterm) were studied. Anthropometric data at birth, surgery and 3, 6, 12 and 24 months after surgery were collected retrospectively. Statistic analyses were performed in SPSS® version 21. At the time of surgery, growth was severely impaired in term and preterm infants. Term infants underwent a period of fast growth within the first 6 months after surgery, achieving posteriorly a normal growth pattern, as both weight and height were not significantly different from the reference population at 24 months after surgery. Preterms caught-up later than term infants but with a significant weight gain within 3 months after surgery.Early surgical repair of VSD leads to a significant acceleration of growth within 3 to 6 months after surgery, for both groups.• Growth impairment in infants with unrestrictive ventricular septal defects is well documented in literature. • Surgical correction in the first months of life is the current option for most ventricular septal defects, leading to a more favourable growth pattern. • Rapid growth during infancy may be associated with the development of insulin resistance, metabolic syndrome, obesity and cardiovascular disease later in life. What is New: • Literature is inconsistent about catch-up growth velocities after ventricular correction for term infants. • Preterm infants have never been enrolled in previous studies that aimed to establish a pattern of growth after surgery. • This group of children, who underwent a rapid post-surgery catch-up growth that follows a period of failure to thrive, may be at a higher risk of insulin resistance, metabolic syndrome, obesity and cardiovascular disease.

Identification of older populations at increased risk of physical frailty using biochemical approaches could improve screening accuracy. The aim of this study was to study the relationship between immune markers and independent components of physical frailty in institutionalized older women. A sample of 358 institutionalized-dwelling women, aged 75 years and older, were assessed for biosocial factors and general health status, pro and anti-inflammatory cytokines, sex steroid hormones, salivary anti-microbial proteins, blood cells counts and the five Fried's physical frailty components that allowed for classification of the sample into frail, prefrailty and not-frail subgroups. Results showed that cytokines IL-6, IL-10, IL-1β, TNF-α, and the TNF-α/IL-10 ratio, mean corpuscular haemoglobin, salivary cortisol and α-amylase were all associated with frailty. Weakness and Exhaustion were the frailty components that were most strongly associated with these biomarkers. Salivary α-amylase was the biomarker that best explained frailty, as it was associated with all five components of physical frailty, and could be used as a potential screening tool. Future research needs to investigate the causal-effect association between salivary innate immune makers, susceptibility to infection and frailty.

The main aim of this review is to evaluate the burnout levels experienced by radiation therapists. PubMed, Lilacs and Google Scholar were searched for articles reporting burnout levels in radiation therapists. Only studies explicitly assessing burnout and using a validated instrument were retrieved. Meta-analyses were undertaken, based on articles that used the Maslach Burnout Inventory to assess burnout, to determine 95% confidence intervals for the overall prevalence of radiation therapists with high burnout risk in three dimensions: emotional exhaustion, depersonalisation or low personal accomplishment. Additionally, meta-analyses were also performed to determine the overall mean reported for each of the three dimensions. A total of eleven studies were found to be eligible for inclusion in this systematic review, nine of which used the Maslach Burnout Inventory questionnaire. The 95% confidence intervals for radiation therapists with high emotional exhaustion scores, high depersonalisation scores and low personal accomplishment scores were [24.8; 54.6], [10.1; 40.2] and [17.4; 41.6] respectively. The 95% confidence intervals for the corresponding means were found to be [20.0; 26.2], [5.1; 8.8] and [35.9, 39.6] respectively. The meta-analysis revealed an arguably high prevalence of burnout in radiation therapists in spite of it varying substantially between studies.

The aim of this study was to evaluate subfoveal choroidal thickness (SFCT) as a marker of outcome in real-world treatment of diabetic macular edema (DME) and to correlate it with choroidal thicknesses (CT) collected around the fovea. Prospective interventional case series included a total of 126 eyes from 126 patients with recently diagnosed DME treated with a 3-monthly loading dose of ranibizumab or aflibercept and PRN thereafter until 24 months (M). CT was manually measured in the central 3500 μm area, subfoveally (SFCT), at 1750 μm right and left from the center in the horizontal plane and at 1750 μm up and down from the center in the vertical plane, by OCT. Anatomic (10% decrease in central retinal thickness) and functional (gain ≥ 5 letters) responses were assessed using univariate and multivariate analyses. The areas under ROC curves were used to assess whether baseline SFCT was a predictor of outcome. CT significantly decreased in all follow-ups (3 months after the 3 injections’ loading dose (3M), 6 months (6M), 12 months (12M), 18 months (18M), 24 months (24M)). SFCT and other CT parameters are correlated. SFCT decrease from baseline was related with treatment (p = 0.003 to p

Background The goal of this exploratory study was to develop and assess a prediction model which can potentially be used as a biomarker of breast cancer, based on anthropometric data and parameters which can be gathered in routine blood analysis. Methods For each of the 166 participants several clinical features were observed or measured, including age, BMI, Glucose, Insulin, HOMA, Leptin, Adiponectin, Resistin and MCP-1. Machine learning algorithms (logistic regression, random forests, support vector machines) were implemented taking in as predictors different numbers of variables. The resulting models were assessed with a Monte Carlo Cross-Validation approach to determine 95% confidence intervals for the sensitivity, specificity and AUC of the models. Results Support vector machines models using Glucose, Resistin, Age and BMI as predictors allowed predicting the presence of breast cancer in women with sensitivity ranging between 82 and 88% and specificity ranging between 85 and 90%. The 95% confidence interval for the AUC was [0.87, 0.91]. Conclusions These findings provide promising evidence that models combining age, BMI and metabolic parameters may be a powerful tool for a cheap and effective biomarker of breast cancer. Electronic supplementary material The online version of this article (10.1186/s12885-017-3877-1) contains supplementary material, which is available to authorized users.

Usually, PET images are evaluated statically and qualitatively, seeking for regions with abnormally high or low uptake. Quantification allows for a more thorough understanding of the physiological process, benefiting not only diagnoses but also allowing for longitudinal studies and inter subject normalization. Quantification can be performed using compartmental analysis that requires the knowledge of concentration of the radiotracer present in the arterial blood at each instant - the arterial input function (AIF). Measuring the AIF is usually an invasive and challenging process, making this a real obstacle to performing in patients and in healthy volunteers. In this work, a prototype for measuring the AIF non-invasively is presented. The system is composed by several gamma detectors that are placed near superficial arteries. The main idea is to obtain signals from arteries and their surroundings using different locations and combining the signals in order to accurately estimate the AIF. We assembled proportional radiation detectors comprising essentially a bismuth germanium oxide (BGO) crystal and a photodiode. The first prototypes are being tested for energy resolution, efficiency, linearity and adaptation to the patient body during real PET exams. Energy resolution was estimated to be 14% FWHM (Full Width at Half Maximum), efficiency 1.4% and proportionality between response and activity of radioactivity sources was observed. The detectors were placed on the wrist and close to the ankle in two patients that underwent PET scans. Measures from the wrist are compatible to the AIF but movements of the patients show that shielding the detectors is necessary to prevent contamination from other sources other than the radial artery. Regarding the ankle detector, it is difficult to have it fixed during the exam, which has yet to be tackled. Results so far permit to conclude that the system exhibits suitable characteristics for measuring the AIF for PET quantification..

The objective of this study was to evaluate the ultrasound features of thyroid nodules and their association with malignancy, focusing on establishing feature-oriented ultrasound criteria to determine proper management of a thyroid nodule.A sample of 379 thyroid nodules were biopsied (from a total of 357 patients aged 59.8 ± 14.8 years) and 300 were included in the final study (271 benign nodules and 29 malignant ones). Ultrasound features were recorded for each nodule: size, echogenicity, homogeneity, contours, shape, texture, peripheral halo, calcifications, and the presence of adenopathy. Statistical analysis of the data was performed using the Mann-Whitney U test and chi-square test. The sensitivity and the specificity of variables seen to have a statistically significant association with the malignancy of nodules were assessed and a logistic regression was performed.A taller-than-wide shape, an ill-defined contour, the presence of a halo, microcalcifications, and adenopathy were found to have a statistically significant relationship (P 0.05) with malignancy, although with a low sensitivity and a high specificity. The presence of at least one suspicious feature yields great sensitivity (89.7%) in detecting malignant disease.The ultrasound features of thyroid nodules alone do not allow the radiologist to make a confident diagnosis regarding the malignancy of a nodule without performing a biopsy. However, a nodule showing a taller-than-wide shape, microcalcifications, a peripheral halo, an ill-defined contour, or associated adenopathy should be considered for cytology.

Objectives Stroke is a leading cause of disability. Alternative and more effective techniques for stroke rehabilitation have been sought to overcome limitations of conventional therapies. Repetitive transcranial magnetic stimulation (rTMS) arises as a promising tool in this context. This systematic review aims to provide a state of the art on the application of rTMS in stroke patients and to assess its effectiveness in clinical rehabilitation of motor function. Methods Studies included in this review were identified by searching PubMed and ISI Web of Science. The search terms were (rTMS OR “repetitive transcranial magnetic stimulation”) AND (stroke OR “cerebrovascular accident” OR CVA) AND (rehab OR rehabilitation OR recover*). The retrieved records were assessed for eligibility and the most relevant features extracted to a summary table. Results Seventy out of 691 records were deemed eligible, according to the selection criteria. The majority of the articles report rTMS showing potential in improving motor function, although some negative reports, all from randomized controlled trials, contradict this claim. Future studies are needed because there is a possibility that a bias for non-publication of negative results may be present. Conclusions rTMS has been shown to be a promising tool for stroke rehabilitation, in spite of the lack of standard operational procedures and harmonization. Efforts should be devoted to provide a greater understanding of the underlying mechanisms and protocol standardization.

Tremor is a manifestation of a variety of human neurodegenerative diseases, notably Parkinson’s disease (PD) and Essential Tremor (ET), both affecting millions worldwide. PD is primarily caused by a progressive loss of dopamine neurons in the nigrostriatal system that leads to widespread motor symptoms such as bradykinesia, rigidity, tremor and postural instability. ET typically involves a tremor of the arms, hands or fingers. No definitive test or biomarker is yet available for PD or ET, so the rate of misdiagnosis is relatively high. As tremor is a very common feature at the onset of both diseases, it is crucial to be able to characterize it. This is made possible using acce?lerometers to quantify the tremor amplitude and frequency. In this work we aim to find tasks involving upper limb movements that are suitable to modulate both types of tremor. Four tasks were tested, differing on whether the arms moved together or alternatingly and whether loads were added. Significant differences in tremor measures were found when patients were asked to perform simultaneous rapid arms movements with loads placed on their wrists. These results may allow the design of an efficient fMRI protocol for identifying the cortical circuits responsible for the modulation of tremor.

To investigate the association between dysphotopsia and neural responses in visual and higher-level cortical regions in patients who recently received multifocal intraocular lens (IOL) implants.Cross-sectional study.Thirty patients 3 to 4 weeks after bilateral cataract surgery with diffractive IOL implantation and 15 age- and gender-matched control subjects.Functional magnetic resonance imaging (fMRI) was performed when participants viewed low-contrast grating stimuli. A light source surrounded the stimuli in half of the runs to induce disability glare. Visual acuity, wavefront analysis, Quality of Vision (QoV) questionnaire, and psychophysical assessment were performed.Cortical activity (blood oxygen level dependent [BOLD] signal) in the primary visual cortex and in higher-level brain areas, including the attention network.When viewing low-contrast stimuli under glare, patients showed significant activation of the effort-related attention network in the early postoperative period, involving the frontal, middle frontal, parietal frontal, and postcentral gyrus (multisubject random-effects general linear model (GLM), P0.03). In contrast, controls showed only relative deactivation (due to lower visibility) of visual areas (occipital lobe and middle occipital gyrus, P0.03). Patients also had relatively stronger recruitment of cortical areas involved in learning (anterior cingulate gyrus), task planning, and solving (caudate body). Patients reporting greater symptoms induced by dysphotic symptoms showed significantly increased activity in several regions in frontoparietal circuits, as well as cingulate gyrus and caudate nucleus (q0.05). We found no correlation between QoV questionnaire scores and optical properties (total and higher order aberration, modulation transfer function, and Strehl ratio).This study shows the association between patient-reported subjective difficulties and fMRI outcomes, independent of optical parameters and psychophysical performance. The increased activity of cortical areas dedicated to attention (frontoparietal circuits), to learning and cognitive control (cingulate), and to task goals (caudate) likely represents the beginning of the neuroadaptation process to multifocal IOLs.

The use of the theory of splines to approximate the potential energy surface in molecular dynamics is examined. It is envisaged that such an approximation should be able to accurately capture the potentials’ behavior and be computationally cost effective, both for one-dimensional and $$n$$ -dimensional problems with $$n$$ arbitrary. In this regard, the problem of dimensionality is pinpointed, with shape-preserving splines emerging as a viable alternative for fitting surfaces in multidimensional spaces. An algorithm is also presented to allow the use of non-uniform meshes with high accuracy fitting and less interpolation points.

Breast cancer is the most common malignancy among women worldwide. There is extensive literature on the relationship between body weight and breast cancer risk but some doubts still remain about the role of adipokines per se, the role of insulin and glucose regardless of obesity, as well as the crosstalk between these players. Thus, in this study, we intend to determine the relation between body mass index (BMI), glycaemia, insulinemia, insulin-resistance, blood adipokine levels and tumour characteristics in a Portuguese group of pre- and postmenopausal overweight/obese women with breast cancer. We evaluated clinical and biochemical data in 154 participants, divided in 4 groups: (1) control with BMI25 kg/m(2), n = 29 (CT); (2) control with BMI25 kg/m(2), n = 48 (CTOb); (3) breast cancer with BMI25 kg/m(2), n = 30 (BC); and (4) breast cancer with BMI25 kg/m(2), n = 47 (BCOb). In women with breast cancer, we also performed tumour characterization. We found that BCOb present increased fasting blood glucose, insulin, resistin and monocyte chemoattractant protein 1, insulin resistance and more aggressive tumours. Notably, this profile is not correlated with BMI, proposing the involvement of other processes than adiposity. Altogether, our results suggest that glucose dysmetabolism, insulin resistance and changes in adipokine secretion, in particular resistin, may be involved in the development and progression of breast cancer in overweight/obese pre- and postmenopausal women.

Quantification of positron emission tomography (PET) images using compartmental models requires the estimation of the tracer concentration in plasma as a function of time. Estimating this function directly from PET images, by measuring the tracer concentration on the carotid arteries, is an attractive alternative to the invasive gold-standard method of arterial cannulation of the radial artery. Nevertheless, most image-derived input function methods still rely on extracting a small number of blood samples to correct for partial volume effects, metabolites and plasma fraction (blood-based). In this work, we assess two non-invasive image-derived input function techniques (blood-free). The two blood-free methods were first applied to a computational phantom and compared with a well established blood-based method. Using image-derived input functions, parametric maps of the binding potential were obtained for [11C]-Raclopride PET images from ongoing studies. These were in turn compared to maps that had been obtained using a reference-region based quantification approach. Although good quantification estimates were found for some subjects, it was hard to guarantee consistency. The biggest obstacle seems to be an underestimation of the spill-out effects, which can be minimized using a small number of venous blood samples.

Internal organ dose estimates have always depended on standard reference models that mimic the interior and exterior anatomical features of the human body. These models are based on 20–30 year-old and healthy average European and North American populations, their organ masses and body weights and heights corresponding to the 50th percentile data [1]. However, if an individual patient deviates greatly from the reference anatomy, the use of a standard phantom can hinder the precision of the dose assessment being performed. Published anthropometric studies [2] suggest that the Portuguese population deviates from the parameters defined for the reference dosimetric models [3]. The general aim of the present research is to develop and validate two new anthropomorphic models of the human body (one male and one female), that specifically represent Portuguese adult patients who undergo PET/CT examinations. A secondary goal of this project is to profile the Portuguese patients undergoing PET/CT examinations, in respect to their age and internal and external anatomical features. In order to achieve this goal, anthropometric patient data regarding 18F-FDG PET/CT examinations performed at the Institute of Nuclear Sciences Applied to Health (ICNAS) were collected and analyzed. Statistical hypothesis tests (sign-tests) confirmed that the Portuguese adult patient population anatomy deviates greatly from that of the reference anthropometric phantoms most commonly used in internal dosimetry, at least where age, weight and height are concerned. This supports recent approaches in Internal Radiation Dosimetry, which challenge the “Reference Man paradigm”, that is, the application of reference computational phantoms to the overall population [1]. New anthropomorphic models of the human body, representing Portuguese adult patients who undergo PET/CT examinations, will be created by combining Monte Carlo simulation of the radiation transport and image quantification techniques. These models will facilitate an accurate estimation of internal radiation doses.

Chromosomes are long molecules that naturally vibrate in different modes and are subject to random perturbations of the medium. Inducing vibration at the resonance frequency may be sufficient to cause the inactivation of the molecule by breaking chemical bonds. In this study we create a computational model of chromosomes and analyse the corresponding resonance frequencies. A simplified geometry is proposed to mimic chromosome arms. Each is represented by considering an eccentric cone. Running the simulations on a numerical package, the natural frequency was found for various chromosomes, in two modes of vibrations. Results show that each chromosome type presents different resonance frequencies in a range from 1.2 kHz up to 105 kHz. Changing mass and length of chromosome arm in a significant manner will produce a change in resonant frequency, as illustrated in the following graphics. This behavior may be use to derive new therapy forms targeting the destruction of mutated chromosomes.

In order to ensure the safe usage of new radiopharmaceuticals in Positron Emission Tomography (PET), it is necessary to quantify the doses delivered to the organs and tissues within the patients’ bodies. A framework that allows estimating the dose delivered by PET has been established by the MIRD Committee [1, 2] and ICRP [3]. Although this covers the most important terms and concepts in Internal Radiation Dosimetry (IRD), it does not provide a detailed guide to assist in the development of a full dosimetric study. We discuss the development, implementation, assessment and validation of an accurate method for IRD studies of PET radiotracers. We undertook a systematic review [4, 5] of previous PET dosimetry studies to identify the current biodistribution data acquisition and analysis methodologies. The methods reported were compared, particularly in terms of the collection of biokinetic data and the estimation of dose results. As a wide heterogeneity of approaches was found, it is important to assessthe impact of different choices in the internal dose calculation protocol. In particular, we quantify the variation in internal dose with different assumptions regarding organ activity uptake - namely, instantaneous uptake vs. different methods to extrapolate to zero activity at time zero. For that purpose, whole-body 11C-Raclopride PET data have been acquired and the corresponding internal doses estimated.

Tremor is a manifestation of a variety of human neurodegenerative diseases, notably Parkinson’s disease (PD), a chronic disease that affects one in 100 people over age 60 years. Recent research indicates that more than five million worldwide have PD. This disease is primarily caused by a progressive loss of dopamine neurons in the nigrostriatal system that leads to widespread motor symptoms such as bradykinesia, rigidity, tremor and postural instability. Although the diagnosis of PD remains clinical, advances in functional and structural imaging have improved the ability to differentiate between PD and Essential Tremor (ET), as well as between different akinetic-rigid syndromes. No definitive test or biomarker is available for PD, so the rate of misdiagnosis is relatively high. It is therefore crucial to be able to characterize tremor in PD and ET as it is a very common feature at the onset of both diseases. This is made possible with a combination of a neuroscientific and methodological multi-modal imaging approaches, namely kinetic recording methods using accelerometers to quantify tremor amplitude and frequency and functional magnetic resonance imaging (fMRI). These allow the identification of the neural underpinnings of tremor in both PD and ET patients, which in fact have been surprisingly difficult to decipher. In this work we aim to find which tasks involving upper limb movements are suitable to modulate both PD and ET tremor. The same tasks are considered with and without added loading. The resulting analysis will allow designing an efficient fMRI protocol aiming at the identification of the cortical circuits responsible for the modulation of tremor.

The identification of genetic markers associated with oral cancer is considered essential to improve the diagnosis, prognosis, early tumor and relapse detection and, ultimately, to delineate individualized therapeutic approaches. Here, we aimed at identifying such markers.Multiplex Ligation-dependent Probe Amplification (MLPA) analyses encompassing 133 cancer-related genes were performed on a panel of primary oral tumor samples and its corresponding resection margins (macroscopically tumor-free tissue) allowing, in both types of tissue, the detection of a wide arrange of copy number imbalances on various human chromosomes.We found that in tumor tissue, from the 133 cancer-related genes included in this study, those that most frequently exhibited copy number gains were located on chromosomal arms 3q, 6p, 8q, 11q, 16p, 16q, 17p, 17q and 19q, whereas those most frequently exhibiting copy number losses were located on chromosomal arms 2q, 3p, 4q, 5q, 8p, 9p, 11q and 18q. Several imbalances were highlighted, i.e., losses of ERBB4, CTNNB1, NFKB1, IL2, IL12B, TUSC3, CDKN2A, CASP1, and gains of MME, BCL6, VEGF, PTK2, PTP4A3, RNF139, CCND1, FGF3, CTTN, MVP, CDH1, BRCA1, CDKN2D, BAX, as well as exon 4 of TP53. Comparisons between tumor and matched macroscopically tumor-free tissues allowed us to build a logistic regression model to predict the tissue type (benign versus malignant). In this model, the TUSC3 gene showed statistical significance, indicating that loss of this gene may serve as a good indicator of malignancy.Our results point towards relevance of the above mentioned cancer-related genes as putative genetic markers for oral cancer. For practical clinical purposes, these genetic markers should be validated in additional studies.

Understanding the neurobiological mechanisms underlying different types of tremor and the altered functional connectivity of the involved areas is a timely goal in clinical neuroscience. If successful, this quest may open new perspectives on how to achieve tremor modulation, which is notably relevant, in Parkinson's disease (PD). Tremor can be characterized by simple parameters such as frequency and amplitude. It is therefore prone to be objectively targeted by neuromodulation and quantitatively investigated using multimodal techniques, such as, accelerometry, EMG and functional Magnetic Resonance Imaging (fMRI). Embarking on the latter challenge requires an a priori knowledge of how effective functional connectivity is altered in PD tremor. This works aims to ascertain which postural and voluntary movement tasks with distinct types of physical load are suitable for designing efficient fMRI protocols, by performing an accelerometry analysis to measure spontaneous and imposed tremor modulation on cohorts of PD patients, essential tremor patients and a group of voluntary healthy controls.

Alzheimer's disease (AD) is a neurodegenerative disease recognized as one of the most important medical problems affecting the elderly. It is characterized by an irreversible loss of neurons which is mostly pronounced in the grey matter and specifically in the hippocampus. The aim of this paper is to identify alterations in grey matter in MRI images of AD patients, when compared to those of healthy volunteers, using Voxel-Based Morphometry (VBM). The latter is a widely used statistical-based technique that allows the detection of alterations in brain tissue. In our study, we used VBM to detect significant grey matter alterations of the hippocampal region in AD patients, which is consistent with previous findings reported in the literature. We also examined how the Mini Mental State Examination (MMSE) scores relates to the volume differences detected by VBM1.

Upon reentering the terrestrial atmosphere, the IXV endures a sneak flow phenomenon which is a result of the existence of thermal protection joints in between the tiles that shield the spacecraft’s cold structure from friction and high temperatures. Placing a low-permeability porous material as a sealer in between this structure and the tiles will prevent cold structure overheating but at the same time increase the global mass. To aid the selection of an adequate sealing foam-like material the relevant thermal phenomena which occur during the atmospheric reentry are translated into a boundary value problem which couples the Navier–Stokes, Brinkman and heat transfer equations. The resolution of this problem, accomplished resorting to finite element methods, provides tools to predict the maximum temperature achieved at the outer wall of the cold structure, for each set of material parameters. An algorithm that implements a domain decomposition approach is presented in order to increase the accuracy of the numerical solution and decrease the computational complexity of the problem. Finally, it is discussed how the ideal properties for a sealing material may be sought; a second algorithm is proposed to this end.

Failure to thrive is common in children with non-restrictive ventricular septal defect (VSD). Normalisation of growth has been reported after early surgical correction. However the literature is inconsistent about growth velocity after surgery in term and preterm infants. Objective Establishing the pattern of catch-up growth in infants submitted to VSD surgical repair before 1 year of age, for term and preterm infants. Methods 52 infants (41 term, 11 preterm) were studied. Anthropometric data at birth, at time of surgery and 3, 6, 12 and 24 months after surgery, collected retrospectively, were converted to z-scores. Statistic analyses was performed in SPSS® version 21, α=0,05. Results Mean weight and height z scores at the time of surgery were significantly lower for term infants (-2,24 and -1,42, respectively; p Conclusions Early surgical repair of VSD leads to a significant acceleration of growth, mainly in the first 3–6 months after surgery. An increased weight gain velocity has been associated with higher cardiovascular risk later in life. Knowledge of this specific catch-up growth pattern is important and should influence nutritional goals after surgery.

In this paper the effect of the local structure of a highly heterogeneous composite material on the parameters that characterise crack propagation is analysed. The evaluation of stress intensity factors is discussed. A hybrid approach based on domain decomposition and homogenisation methods is employed to obtain accurate solutions with reduced computational complexity.

The purpose of this study was to identify the independent components of physical frailty that most influence disability indicators in institutionalized older women. A cross-sectional study with 319 participants (81.96+/-7.89 years old) was performed. Disability was assessed through dynamic and static balance tests, activities of daily life and falls risk screen. Fried physical frailty protocol was used to access physical frailty. The frail subgroup displayed the weakest results for all disability indicators (p < 0.05). Regression analysis showed that in the two models tested, low physical activity levels and slowness were the physical frailty independent components that better associated with the disability indicators. More studies with larger samples will help to better understand the independent relationship of each physical frailty component with disability outcomes and assist to design a co-adjuvant treatment to reverse physical frailty.