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Heart failure (HF) remains a prevalent syndrome with significant morbidity and mortality. Optimal drug and device therapies are crucial to reduce the risk of death or HF admission. Yet, less symptomatic patients with good functional capacity are often perceived as having a low risk of adverse events and their attending physicians may suffer from prescription inertia or refrain from performing therapy optimization. Maximum or peak oxygen consumption (pVOSingle-center retrospective observational study enrolling consecutive HF patients with LVEF40% (HFrEF) performing CPET between 2003 and 2018. Those with pVOSeventy-two patients were included (mean age of 53±10 years; 86% male; 90% NYHA I-II; median LVEF 32%; median pVOIn a clinically stable HFrEF population with good functional capacity, persistent neurohormonal activation was present in the majority, and one in ten patients died or had a HF admission at two years' follow-up. These findings support the urgent need to motivate clinicians to pursue optimal drug uptitration even in less symptomatic patients.

Despite constant medical evolution, the reimbursement policy of Portuguese National Health Service (NHS) for the study and risk stratification of coronary heart disease has remained unchanged for several decades. Lack of adjustment to contemporary clinical practice has long been evident. However, the recent publication of the European Guidelines for diagnosis and treatment of chronic coronary syndromes further highlighted this gap and the urgent need for a change. Prompted by these Guidelines, the Working Group on Nuclear Cardiology, Cardiac Magnetic Resonance and Cardiac CT, the Working Group on Echocardiography and the Working Group on Stress Pathophysiology and Cardiac Rehabilitation of the Portuguese Society of Cardiology, began a process of joint reflection on the current limitations and how these recommendations could be applied in Portugal. To this end, the authors suggest that the new imaging methods (stress echocardiogram, cardiac computed tomography and cardiac magnetic resonance), should be added to exercise treadmill stress test and myocardial perfusion scintigraphy in the available exam portfolio within the Portuguese NHS. This change would allow full adoption of European guidelines and a better use of tests, according to clinical context, availability and local specificities. The adoption of clinical guidance standards, based on these assumptions, would translate into a qualitative improvement in the management of these patients and would promote an effective use of the available resources, with potential health and financial gains.

Resumo Introducao e objetivos Os anticoagulantes diretos (direct anticoagulants, DOACs) mudaram o panorama do tratamento da fibrilhacao auricular (FA), trazendo novos desafios de acessibilidade e adesao terapeutica. O objetivo deste estudo foi avaliar a adesao terapeutica com DOACs, e os seus fatores determinantes, numa populacao de doentes com FA. Metodos Estudo retrospetivo de centro unico incluindo doentes com FA nao valvular sob terapeutica com DOAC seguidos em consulta de Cardiologia, cuja primeira prescricao de DOAC foi realizada entre 1 de abril de 2016 e agosto de 2018. Foram contabilizadas as embalagens de DOAC levantadas desde a primeira prescricao ate 31 de agosto de 2018, utilizando a Prescricao Eletronica Medica. Foi calculada a adesao a terapeutica atraves da divisao entre o numero de dias cobertos pela dispensa efetiva na farmacia e os dias sob terapeutica. Definiu‐se “nao adesao” como uma adesao inferior a 90%. Resultados Foram incluidos 264 doentes (120 homens, idade media 74 ± 12 anos). O score CHA2DS2VASC mediano foi 3 (IIQ 2‐5) e o score HAS‐BLED mediano foi 1 (IIQ 1‐2). Os DOAC rivaroxabano, apixabano, dabigatrano e edoxabano foram prescritos em 45%, 41%, 24% e 13% dos doentes, respetivamente. Ao longo do periodo avaliado, 51 doentes (19%) tomaram pelo menos dois DOACs diferentes. Os doentes estiveram sob DOAC durante uma mediana de 439 dias (IIQ 269‐638), durante os quais aderiram a terapeutica em mediana 90% (IIQ 75‐100%) do tempo. Cerca de metade (51%) dos doentes foi considerada nao aderente; a maior duracao da terapeutica (OR ajustado de 1,06/mes, IC95% 1,03‐1,08, p Conclusao Metade dos doentes (51%) com FA sob DOAC foram classificados como nao aderentes (adesao

Cigarette smoking is associated with neurocognitive dysfunction in various populations, including those seeking treatment for an alcohol use disorder (AUD). This study compared the rate and extent of recovery on measures of processing speed, executive functions, general intelligence, visuospatial skills and working memory in treatment-seeking alcohol dependent individuals (ALC) who were never-smokers (nvsALC), former-smoker (fsALC), and active smokers (asALC), over approximately 8 months of abstinence from alcohol. Methods: ALC participants were evaluated at approximately 1 month of abstinence (AP1; n = 132) and reassessed after 8 months of sobriety (AP2; n = 54). Never-smoking controls (CON; n = 33) completed a baseline and follow-up (n = 19) assessment approximately 9 months later. Domains evaluated were executive functions, general intelligence, processing speed, visuospatial skills and working memory; a domain composite was formed from the arithmetic average of the foregoing domains. nvsALC showed greater improvement than fsALC, asALC and CON on most domains over the AP1-AP2 interval. fsALC demonstrated greater recovery than asALC on all domains except visuospatial skills; fsALC also showed greater improvements than CON on general intelligence, working memory and domain composite. asALC did not show significant improvement on any domain over the AP1-AP2 interval. At 8 months of abstinence, asALC were inferior to CON and nvsALC on multiple domains, fsALC performed worse than nvsALC on several domains, but nvsALC were not different from CON on any domain. Our results provide robust evidence that smoking status influenced the rate and extent of neurocognitive recovery between 1 and 8 months of abstinence in this ALC cohort. Chronic smoking in AUD likely contributes to the considerable heterogeneity observed in neurocognitive recovery during extended abstinence. The findings provide additional strong support for the benefits of smoking cessation and the increasing clinical movement to offer smoking cessation resources concurrent with treatment for AUD.

Despite constant medical evolution, the reimbursement policy of Portuguese National Health Service (NHS) for the study and risk stratification of coronary heart disease has remained unchanged for several decades. Lack of adjustment to contemporary clinical practice has long been evident. However, the recent publication of the European Guidelines for diagnosis and treatment of chronic coronary syndromes further highlighted this gap and the urgent need for a change. Prompted by these Guidelines, the Working Group on Nuclear Cardiology, Cardiac Magnetic Resonance and Cardiac CT, the Working Group on Echocardiography and the Working Group on Stress Pathophysiology and Cardiac Rehabilitation of the Portuguese Society of Cardiology, began a process of joint reflection on the current limitations and how these recommendations could be applied in Portugal. To this end, the authors suggest that the new imaging methods (stress echocardiogram, cardiac computed tomography and cardiac magnetic resonance), should be added to exercise treadmill stress test and myocardial perfusion scintigraphy in the available exam portfolio within the Portuguese NHS. This change would allow full adoption of European guidelines and a better use of tests, according to clinical context, availability and local specificities. The adoption of clinical guidance standards, based on these assumptions, would translate into a qualitative improvement in the management of these patients and would promote an effective use of the available resources, with potential health and financial gains. Apesar dos avanc ̧os da medicina, há já várias décadas que os exames comparticipados pelo Servic ̧o Nacional de Saúde (SNS) para o estudo e estratificac ̧ão de risco da doenc ̧a coronária se mantêm inalterados em cuidados de saúde primários. Apesar do desajuste à prática clínica contemporânea ser há muito evidente, a recente publicac ̧ão das Recomendac ̧ões Europeias para o diagnóstico e tratamento da síndrome coronária crónica veio realc ̧ar ainda mais este desfasamento e evidenciar a necessidade imperiosa de mudanc ̧a na forma como são estudados estes pacientes em Portugal. No seguimento desta publicac ̧ão, o Grupo de Estudo de Cardiologia Nuclear, Ressonância Magnética (RM) e Tomografia Computorizada (TC) Cardíaca, o Grupo de Estudo de Ecocardiografia e o Grupo de Estudos de Patofisiologia do Esforc ̧o e Reabilitac ̧ão Car- díaca da Sociedade Portuguesa de Cardiologia iniciaram um processo de reflexão conjunta sobre as limitac ̧ões atuais e a forma como poderiam ser aplicadas as recomendac ̧ões internacionais no nosso país. Para tal, os autores sugerem que os novos métodos de imagem (ecocardiograma de esforc ̧o ou de sobrecarga, TC e RM cardíaca) se associem à prova de esforc ̧o e cintigrafia de perfusão do miocárdio no portfólio de exames oferecidos pelo SNS. Esta alterac ̧ão permitiria uma plena adoc ̧ão das recomendac ̧ões europeias e uma melhor utilizac ̧ão dos meios, de acordo com o contexto clínico, a disponibilidade e as particularidades locais. A adoc ̧ão de ‘‘normas de orientac ̧ão clínica’’ baseadas nestes pressupostos traduzir-se-ia numa melhoria qualitativa na abordagem e otimizac ̧ão terapêutica destes pacientes, ao mesmo tempo em que potenciaria uma gestão eficaz dos recursos disponíveis, com potenciais ganhos de saúde e financeiros.

The article shows new designed cermets and processes concerning primary to applications as thermal insulation materials with low emissivity. A new projected microstructure was obtained where dense regions (micropellets) rest inside the main porous pellet. The feature resembles a frozen hypercube, therefore such architecture is called hyper-pellet/ cermet. The processing method to obtain the hyper-cermet is based on sequential tape castings and sintering techniques. Ni-zirconia lamellae were prepared by a special mechanochemical process followed by sintering, which remain inside the main pellets as a dense region. The whole pellet is turned to be porous by employing pore-forming additives. All the constituents and porosity shapes are aligned along the disc/ flake planes. Thermal conductivity is estimated for the materials up to 800 °C by a flash diffusivimeter. Ceramographic analyses show graded density regions with directional constituents and pores. Applications of such materials are foreseen as temperature insulation materials and thermal radiation shields.

The IEA-R1 is an open pool research reactor that operated for many years at 2 MW. The reactor uses plate type fuel elements which are formed by assembling eighteen parallel fuel plates. During the years of reactor operation at 2 MW, thermohydraulic safety margins with respect to design limits were always very high. However, more intense oxidation on some external fuel plates was observed when the reactor power was increased to 5 MW. At this new power level, the safety margins are significantly reduced due to the increase of the heat flux on the plates. In order to measure, experimentally, the fuel plate temperature under operation, an instrumented fuel element was constructed to obtain temperature experimental data at various positions of one or more fuel plates in the fuel element. The manufacturing method is characterized by keeping the original fuel element design specifications. Type K stainless sheathed thermocouples are mounted into supports pads in unrestricted positions. During the fuel element assembling, the supports pads with the thermocouples are mechanically fixed by interference between two adjacent fuel plates. The thermocouple wires are directed through the space existing at the bottom of the mounting slot where the fuel plate is fixed to the side plates. The number of thermocouples installed is not restricted and depends only on adaptations that can be made on the mounting slots of the standard fuel element side plates. This work describes the manufacturing procedures for assembling such an instrumented fuel element.

Italian food is very popular around the world, but the knowledge of the proximate composition of traditional composite dishes consumed in Italy is limited. This is mainly due to the large regional variety and complexity of such dishes. The present study provides new analytical data in order to fill this gap. Thirty dishes from different regions in Italy were selected including main courses, side dishes and desserts. For each dish, samples were prepared and then analyzed to determine the nutrient composition in terms of moisture, protein, fat, starch, sugars, dietary fibre and energy value. The nutrients varied between the dishes as can be expected. Moreover, to assess their specific nutritional quality, in terms of adequacy or deficit, the nutrients of one portion of every dish were compared with the Dietary References Values (DRVs) for the Italian population. Our results provide an important update of the national Food Composition Database (FCDB) of the CREA Research Centre for Food and Nutrition. The new data widen the nutritional knowledge of a variety of traditional Italian dishes and provide dietary information to health workers, the food industry and consumers.

Introduction: Resveratrol (3,5,4'-trihydroxy-trans-stilbene) is a polyphenol obtained from diverse groups of plants, especially in the muscadine grape, red wine, lingonberry, cranberry and redcurrant. Resveratrol's health benefits were first highlighted in the study of the French paradox, which opened up an expansive research endeavor into this compound. Ever since, an array of pharmacological activities, including antioxidant, anti-aging, anti-inflammatory, anti-cancer and antidiabetic have been attributed to resveratrol. For many poly-phenols, low solubility in biological fluids, as well as by rapid in vivo metabolization, limits their bioavailability. However, improving resveratrol formulation could enhance oral bioavailability and have other beneficial properties. The development of innovative methodological approaches, such as the utilization of innovative formulations has been developed to overcome these limitations and provide a considerable therapeutic amount of resveratrol.Results: In this narrative review, a brief outline of historical perspectives of resveratrol is provided, together with an extensive and inclusive overview of various approaches and contemporary developments on the bioavail-ability, pharmacodynamics and pharmacokinetics of this nutraceutical, along with its biotechnological appli-cations and drug formulations.

Molybdenum-99 is the most important isotope because its daughter isotope, technetium-99m, has been the most used medical radioisotope. The primary method used to produce Mo-99 derives from the fission of U-235 incorporated in so-called irradiation targets. Two routes are being developed to make Mo-99 by fissioning with low enriched uranium (LEU) fuel. The first adopts UAlx-Al dispersion plate targets. The second uses uranium metal foil annular targets. The significant advantage of uranium foil targets over UAlx-Al dispersion targets is the high density of uranium metal. This work presents the experience obtained in the development of the uranium metal annular target manufacturing steps. An innovative method to improve the procedure for assembling the uranium foil on the tubular target was presented. The experience attained will help the future production of Mo-99 in Brazil through the target irradiation in the Brazilian Multipurpose Reactor (RMB).

The incorporation of burnable neutron absorbers into nuclear fuel pellets is important regarding reactivity compensation, which enables longer fuel cycles. The dry mechanical blending route is the most attractive process to accomplish absorbers incorporation because of its simplicity. By using this route, the present work has investigated the sintering behavior of UO2 Er2O3 mixed fuel. A comparison with UO2 Gd2O3 sintering behavior was presented. The behavior of UO2 Er2O3 fuel sintering was similar to that reported for UO2 Gd2O3 fuel, e.g. two-stage sintering with two peaks in the shrinkage rate curves. The effect showed to be less pronounced for Er2O3. This was attributed to the characteristics of the Er2O3 powder particles used as raw-material, whose agglomerates can be more easily broken and thus better homogenized during the blending with UO2 powder. These results confirmed that sinterability depends directly on the quality of the homogenization of the powders, as seen previously. A second phase was experimentally detected in the UO2 Er2O3 system, but its impact on the sintering behavior of this mixed fuel has not yet been clarified.

The aim of the study was to investigate the feasibility of Fourier Transformed Infrared Spectroscopy (FTIR) on Attenuated Total Reflectance (ATR) in the determination of the fatty acid content in meat and meat products. The Multivariate calibrations were developed and proposed for Saturated Fatty Acids (SFA), Monounsatured Fatty Acids (MUFA), Polyunsatured Fatty Acids (PUFA) and Palmitic Acid. SFA and MUFA models, developed using the first derivative and the selected region 3022.33–650.15 cm−1, gave the best performance, with a coefficient of calibration r2 0.9834 and 0.9775, respectively, and the relative Root Mean Square Error of Calibration (RMSEC) 0.594 and 0.699. The best model for PUFA was obtained for region 4000.12–650.15 using the first derivative (r2 0.9817, RMSEC 0.724). Palmitic acid, chosen as the case study of single fatty acids, showed a best linear regression for the first derivative approach in region 4000.12–650.15. Results were less satisfactory in prediction in the proposed models.

Background Magnetic resonance imaging studies of cigarette smoking-related effects on human brain structure primarily focused on cortical volumes. Much less is known about the effects of smoking on cortical thickness. Smokers and Non-smokers were compared on regional cortical thickness. We predicted smokers would demonstrate greater age-related thinning localized to anterior frontal regions that serve as nodes for the executive, salience, and emotional regulation networks (ESER regions) and those demonstrating significant atrophy in early Alzheimer’s Disease (AD regions). Methods Non-smokers (n = 41) and smokers (n = 41), 22–70 years of age, completed a 4 T MRI study. Regional cortical thickness was quantitated via FreeSurfer. In smokers, associations between smoking severity, decision-making, impulsivity, and regional cortical thickness were examined. Results Smokers demonstrated cortical thinning in the medial and lateral OFC, insula, entorhinal, fusiform, middle temporal, and Composite AD regions. In Smokers, greater pack-years were associated with thinner lateral OFC, middle temporal, inferior parietal, fusiform, precuneus, and Composite AD regions. In Smokers, poorer decision-making/greater risk taking was related to thinner cortices in caudal ACC, rostral middle frontal and superior frontal gyri, and Composite ESER. Higher self-reported impulsivity was associated with thinner rostral and caudal ACC. Conclusions This study provides additional evidence that cigarette smoking is associated with thinner cortices in regions implicated in the development and maintenance of substance use disorders and in regions demonstrating significant atrophy in early AD. The novel structure-function relationships in Smokers further our understanding of the neurobiological substrates potentially underlying the neuropsychological abnormalities documented in smokers.

Uranium aluminide (UAlx) is a mixture of three distinct intermetallic compounds comprised of UAl2, UAl3 and UAl4, where the “x” is used to denote a mixture of those phases. Usually UAlx is formed during the target fabrication process by means of a solid state reaction between the uranium aluminide and aluminum. Quantitative techniques such as image analysis and X-ray diffraction using the Rietveld method were compared for their applicability in the determination of the UAl2, UAl3 and UAl4 concentrations, both in the UAl2 primary ingot and in the UAlx-Al dispersion. The UAlx composition was quantified in all stages of the target manufacturing. The image analysis method was shown to be useful for UAlx phase quantification in the primary UAl2 ingot, but was not applicable in the case of UAlx-Al dispersions. The X-ray diffraction method allowed the quantification of the existing UAlx phases in both the primary ingot and UAlx-Al dispersions. Possible sources of error are discussed. The method of quantification based on X-ray diffraction was shown to be appropriate to monitor the evolution of UAlx phases during the manufacturing process.