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De novo donor-specific antibodies (dDSA) relevance in simultaneous pancreas-kidney (SPK) transplantation has been scarcely investigated. We analyzed dDSA relationship with grafts outcomes in a long-term follow-up SPK-transplanted cohort. In 150 patients that received SPK transplant between 2000 and 2013, post-transplant anti-human leukocyte antigen (HLA) antibodies were screened and identified using Luminex-based assays in sera collected at 3, 6, and 12 months, then yearly. dDSA were detected in 22 (14.7%) patients at a median 3.1 years after transplant. Pretransplant anti-HLA sensitization (OR = 4.64), full HLA-DR mismatch (OR = 4.38), and previous acute cellular rejection (OR = 9.45) were significant risk factors for dDSA. dDSA were significantly associated with kidney (in association with acute rejection) and pancreas graft failure. In dDSA+ patients, those with at least one graft failure presented more frequently dDSA against class II or I + II (P = 0.011) and locusDQ (P = 0.043) and had a higher median dDSA number (P = 0.014) and strength (P = 0.030). Median time between dDSA emergence and pancreas and kidney graft failure was 5 and 12 months, respectively. Emergence of dDSA increased the risk of grafts failure in SPK-transplanted patients. Full HLA-DR mismatch was associated with dDSA emergence. dDSA characteristics might help identify patients at a higher risk of graft failure.

The symptoms of chronic renal disease-related mineral and bone disease improve significantly in patients after successful simultaneous pancreas-kidney transplantation (SPKT); however, bone pathology is still present even after many post-transplant years. The aim of this study was to analyze the bone densitometry in different periods after SPKT. Three-point densitometry was performed with the dual-energy X-ray absorptiometry (DXA) technique. Serum levels of alkaline phosphatase (ALP), total serum calcium, phosphate and parathyroid hormone were analyzed as markers of mineral metabolism. The study population consisted of 48 patients (28 females, 20 males) with a mean age of 35 ± 6 years and mean 24 ± 6 years of prior diabetes. Mean period of maintenance dialysis was 36 ± 26 months. The median time from SPKT and DXA measurement was 0.53, 26.2 and 41.9 months, respectively. Based on the DXA technique, 35.4 % of patients were categorized as having osteoporosis at the lumbar spine and 39.6 % at the femoral neck. Patients with diagnosed osteoporosis had significantly higher levels of ALP (OR = 1.5; 95 % CI = 1.1–2.2; p < 0.05 at the lumbar spine; OR = 1.4; 95 % CI = 1.0–1.9; p < 0.05 at the femoral neck). In addition, subjects with lumbar osteoporosis were characterized by a significantly lower body mass index (BMI) (OR = 0.5; 95 % CI = 0.3–0.9; p < 0.05). In the long-term follow-up, BMD increased significantly at the lumbar spine (T-score −1.86 ± 1.07 to −1.08 ± 0.89) and femoral neck (T-score −2.12 ± 0.78 to −1.63 ± 0.65). A multivariate linear model identified a BMI increase as a significant factor associated with improvement in BMD. Results of our study led us to conclude that, according to three-point densitometry, BMD among patients with functioning kidney and pancreas grafts improved. Increased serum levels of ALP were significantly associated with a decrease in BMD, suggesting a higher risk of osteoporosis. BMI gain was predictive of BMD improvement.

Donated kidney volume influences post-transplant outcomes and graft survival. We evaluated the relationship between living-donor kidney volume and recipient graft function at 12 months post-transplantation, exploring a volume threshold for a suboptimal graft function, and compared two different formulas of volume estimation. A retrospective analysis of 82 pairs of living-donor kidney transplants was conducted. Donor renal volumes were estimated from computerized tomography scans using the ellipsoid formula and the voxel counting technique. Linear and restricted cubic regression spline was used to analyze the association of volume with graft function. Additionally, we determined the correlation between the two volume estimation formulas and established a correction factor for the ellipsoid formula. Renal volume (adjusted to recipient BSA) had the strongest independent effect (B = 1.65 per 10 ml/m2 increase, p value

Background The relevance of preformed donor specific antibodies (DSA) detected by Luminex assays, with a negative complement-dependent cytotoxicity (CDC) crossmatch, remains unsettled in kidney transplantation (KT). We aimed to analyze the impact of preformed DSA characteristics on kidney graft outcomes. Methods In 462 patients that received a kidney graft in our unit, between 2007 and 2012, pre-transplant sera were analyzed by Luminex screening assay to determine the presence of anti-human leukocyte antigen (HLA) antibodies and single-antigen bead assay [positive if mean fluorescence intensity (MFI) ≥ 1000] to assign anti-HLA specificities. Results Anti-HLA antibodies were present in 95 patients (20.6%), but only 40 (8.7%) had DSA. Antibody-mediated rejection (AMR) at 1-year was higher in patients with DSA (35.0%) than in those without them (0.9%) (P 3000 were significantly associated with AMR occurrence. Receiver operator curves revealed that a MFI of > 4900 in the highest DSA bead had a high sensitivity (85.7%) and that the sum of all DSA beads MFI > 11,000 had a high specificity (92.3%) for AMR prediction. Anti-thymocyte globulin versus basiliximab induction was more frequent in DSA + AMR − (65.4%) versus DSA + AMR + (34.6%) patients (P = 0.072). Five-year censored graft survival was lower in DSA + than in DSA − patients (respectively, 84.8% versus 94.9%, P = 0.006), although survival was only reduced in DSA + AMR + (68.8%) versus DSA + AMR − (96.0%) patients (P = 0.038). Conclusions Preformed DSA is associated with kidney graft loss, in relation with AMR occurrence. DSA strength may be used to improve immunological risk stratification of sensitized patients and their clinical management.

This article presents a benchmark for Portuguese agrarian output for the 1311–20 decade. This benchmark is built from the supply side using the value of church tithes combined with contemporary parish accounts. Two main findings emerge: first, per capita agrarian output was similar in the recently conquered South and the North, hinting that internal migration after the Reconquista led to the equalization of marginal product across the country; second, that Portuguese real per capita agrarian output was above subsistence and higher than that of contemporary England and Wales. This result, which is robust to the assumptions used, confirms that by 1320 Portugal was a “frontier economy” with a high land/labor ratio and a high per capita output. This seems to reinforce the Malthusian theory that the amount of land per person was key in determining living standards. The article discusses the implication of these results for the inequality among nations.

ProcessPAIR is a novel tool for helping software developers analyzing their personal performance. Based on a performance model calibrated from the anonymized performance data of many developers and the performance data submitted by an individual developer, it automatically identifies and ranks potential performance problems and their root causes for that developer. In this work we present WebProcessPAIR, which extends ProcessPAIR with the ability to recommend improvement actions to address the root causes identified, based on a crowdsourcing approach. A case study illustrates WebProcessPAIR usage.

O elevado desenvolvimento industrial, os novos hábitos de consumo e o crescimento populacional tem levado a uma discussão nos vários setores da sociedade acerca da escassez de recursos, das emissões poluentes, e da produção de resíduos. Desta forma, e em contraposição com o modelo económico linear, no qual os produtos após produzidos e consumidos são eliminados, emerge um novo modelo de negócio: “A Economia Circular”. Este é um modelo baseado na reutilização, recuperação, reciclagem e reparação durante o ciclo de conceção e utilização de um produto. Este trabalho pretende fazer um estudo da economia circular na indústria de pasta, papel e cartão. Este foi o setor escolhido porque para além de representar cerca de 8% da produção industrial nacional, tem feito esforços significativos para promover o desenvolvimento ambientalmente sustentável. Assim a dissertação pretende dar a conhecer o ponto de situação do setor pasta, papel e cartão no âmbito da economia circular, fazendo uma comparação ibérica nos anos compreendidos entre 2011 e 2015 através do desenvolvimento de um índice comparativo baseado nos resultados de alguns indicadores ambientais. Também é feito um levantamento das atuais barreiras existentes, bem como a sua respetiva relevância na implementação plena da economia circular através da utilização do método Delphi. Segundo o estudo realizado o setor pasta, papel e cartão em Portugal apresenta um valor de cerca de 26% superior na implementação da economia circular face ao registado no setor em Espanha em 2015, com a peculiaridade que esta diferença tem vindo a diminuir nos últimos cinco anos. Quanto aos resultados do estudo relativo às atuais barreiras na implementação da economia circular no setor pasta, papel e cartão em Portugal, o estudo aponta que, entre outras, as três mais relevantes são a falta de regulamentação de flexibilização e promoção do intercâmbio de subprodutos, a demora no processo de classificação de substâncias como subprodutos e a perceção de que o produto final proveniente da utilização de subprodutos é de qualidade inferior quando comparado com um produto que use matéria prima virgem.

The role of de novo donor-specific anti-human leukocyte antigen (anti-HLA) antibodies (dnDSA) within the pathways leading to graft failure remains not fully understood. We investigated 56 patients who were transplanted between 2002 and 2014 with kidney graft failure (cases), for a possible association of development of dnDSA with graft failure. The 56 patients with failed transplants were matched with 56 patients with a functioning graft at present for the variables deceased or living donor, transplant number, transplant year, recipient age and gender, donor age and gender, dialysis vintage time, transplant induction therapy. All patients had at least one serum collected 1 year before failure (in cases) or end of follow-up (in controls). Cases and controls were very well-matched in several baseline characteristics. Post-transplant anti-HLA antibodies were found in 84% of cases and only 36% of controls (P < .001), with 54% of cases and 16% of controls (P < .001) having dnDSA at time of detection. Chronic active antibody-mediated rejection was significantly more common (P < .001) in patients with dnDSA (61% vs 12%), in 53 (47%) patients that had at least one graft biopsy performed during follow-up. dnDSA was a significant risk factor (odds ratio [OR] = 6.06; P = .003) for graft failure in a multivariable conditional logistic regression model. dnDSA as a time-dependent variable, was also an independent predictor [hazard ratio (HR) = 2.46; P = .002] of graft failure in a multivariable Cox regression analysis. In both statistical approaches, only dnDSA-II (OR = 11.90; P = .006) (HR = 2.30; P = .014) was significantly associated with graft failure. Post-transplant dnDSA was clearly associated with graft loss, particularly if against HLA class II antigens. dnDSA detection should be a tool for post-transplant monitoring of kidney graft recipients, allowing for the identification of those with a higher risk of graft failure.

The detrimental impact of preformed anti-HLA donor-specific antibodies (DSA) is well defined, contrarily to non-donor-specific antibodies (NDSA). We sought to evaluate their clinical impact in a cohort of 724 kidney graft recipients in whom anti-HLA antibodies were thoroughly screened and identified in pre-transplant sera by solid-phase assays. NDSA or DSA were detected in 100 (13.8%) and 47 (6.5%) recipients respectively, while 577 (79.7%) were non-allosensitized (NaS). Incidence of antibody-mediated rejection at 1-year was 0.7%, 4.0% and 25.5% in NaS, NDSA and DSA patients, respectively (NaS vs. NDSA P=0.004; NaS vs. DSA P0.001; NDSA vs. DSA P0.001). Graft survival was lowest in DSA (78.7%), followed by NDSA (88.0%) and NaS (93.8%) recipients (NaS vs. NDSA P=0.015; NaS vs. DSA P0.001; NDSA vs. DSA P=0.378). Multivariable competing risk analysis confirmed both NDSA (sHR=2.19; P=0.025) and DSA (sHR=2.87; P=0.012) as significant predictors of graft failure. The negative effect of NDSA and DSA on graft survival was significant in patients receiving no induction (P=0.019) or an anti-IL-2 receptor antibody (P0.001), but not in those receiving anti-thymocyte globulin (P=0.852). The recognition of the immunological risk associated with preformed DSA but also NDSA have important implications in patients' risk stratification, and may impact clinical decisions at transplant.

This paper builds on global experience and Guinea-Bissau's specific context to identify an effective nutrition approach along with costs and benefits of key nutrition interventions. It is intended to help guide the selection of the most cost-effective interventions as well as strategies for scaling these up. We estimate that the costs and benefits of implementing 10 nutrition-specific interventions in all regions of Guinea-Bissau would require a public investment of USD 17 million over five years (with about USD 3 million needed to maintain the current coverage of the interventions and USD 14 million needed to expand the coverage to reach 90 percent of the population). The two key conclusions of this paper are, first, that investing in nutrition in Guinea-Bissau is cost-effective based on international standards and, second, that investments in nutrition can generate very substantial health and economic benefits, with one dollar spent on nutrition interventions resulting in about 10 dollars of returns over the productive lives of children covered by high-impact nutrition interventions. Economic productivity could potentially increase by USD 120 million (discounted at 3 percent) over the productive lives of the beneficiaries, with an impressive internal rate of return of 9 percent annually. Theses findings point to a powerful set of nutrition-specific interventions that represent a high cost-effective approach to reducing child malnutrition and stunting in Guinea-Bissau.

This paper builds on global experience and Guinea-Bissau's specific context to identify an effective nutrition approach along with costs and benefits of key nutrition interventions. It is intended to help guide the selection of the most cost-effective interventions as well as strategies for scaling these up. We estimate that the costs and benefits of implementing 10 nutrition-specific interventions in all regions of Guinea-Bissau would require a public investment of USD 17 million over five years (with about USD 3 million needed to maintain the current coverage of the interventions and USD 14 million needed to expand the coverage to reach 90 percent of the population). The two key conclusions of this paper are, first, that investing in nutrition in Guinea-Bissau is cost-effective based on international standards and, second, that investments in nutrition can generate very substantial health and economic benefits, with one dollar spent on nutrition interventions resulting in about 10 dollars of returns over the productive lives of children covered by high-impact nutrition interventions. Economic productivity could potentially increase by USD 120 million (discounted at 3 percent) over the productive lives of the beneficiaries, with an impressive internal rate of return of 9 percent annually. Theses findings point to a powerful set of nutrition-specific interventions that represent a high cost-effective approach to reducing child malnutrition and stunting in Guinea-Bissau.

We report a patient who had received a first kidney transplant and had preformed DSA anti-HLA-Cw, developing AMR C4d+ soon after transplant. Classically anti-HLA-Cw are considered less immunogenic and are not considered in many organ allocation systems or immunologic risk stratification algorithms, including in Portugal. However, data from literature confirms that their presence is as deleterious as DSA anti-HLA A/B/DR/DQ. Thus we should take HLA-C typing and respective antibody identification into account in sensitized patients, in order to access risk stratification and establish the need for correct induction or desensitization therapies. info:eu-repo/semantics/publishedVersion

Kidney transplantation in children has shown steady improvement in graft survival outcome over the last decades. Using data obtained from the transplantation registry of our center between 1984 and 2012, we assessed the independent determinants of graft failure using the Cox proportional hazards regression. Altogether, 128 recipients younger than 18 years of age at the time of kidney transplantation and who had >3 months graft survival were studied. During 9.95 years of medium follow-up, 27 censored graft failures occurred. Censored graft survival rates at 5, 10, 15, and 20 years post-transplantation were 93%, 82%, 70%, and 63%, respectively. Studied factors included recipient and donor age, recipient gender, dialysis vintage, donor/recipient cytomegalovirus (CMV) serology, panel-reactive antibody percentage, human leukocyte antigen mismatching, previous transplantation number, donor type (deceased vs living donation), cold ischemia time, induction therapy with antithymocyte globulin, occurrence of acute tubular necrosis, and development of acute rejection. Using univariate analysis, the significant predictors for graft-censored failure were adult donor (P < .001), recipient age (P = .035), human leukocyte antigen mismatching (P = .025), antithymocyte globulin induction (P = .03), and development of acute rejection (P < .001). Two factors independently predicted graft-censored failure in multivariate analysis. The odds ratios for graft failure in patients with acute rejection and in children who received an organ of an adult were 3.744 and 4.962, respectively. Pediatric recipients should receive the first priority for allografts from pediatric donors and acute rejection should be meticulously prevented.

Background Kidney transplantation is the treatment of choice for end-stage renal disease, with improved mortality and quality of life compared with dialysis. Desensitization protocols have allowed kidney transplantation of highly sensitized patients, who have a lower probability to receive a matching kidney from a deceased or living donor. The aim of this work was to analyze the post-transplantation period of highly HLA-sensitized patients with positive flow cytometry crossmatch against donor cells. Methods Following an observational, retrospective design, we investigated 16 highly sensitized patients who underwent kidney or kidney-pancreas transplantation, assessing the impact of desensitization protocols and investigating treatment-related complications, graft function, antibody-mediated rejection (AMR) rate, and graft and patient survivals. Results We studied 16 patients with positive flow cytometry crossmatch, who were divided into 2 groups based on whether they were submitted to a desensitization protocol or not. Patients who were desensitized underwent transplantation in later years, had higher immunologic risk (panel reactive antibody peak 62% vs 33%; P = .038), higher percentage of 2nd kidney transplant (75% vs 25%; P = .066), and higher percentage of donor-specific anti-HLA antibodies identified (P = .028). A majority of patients were desensitized with high-dose intravenous immunoglobulin and plasmapheresis, and 5 patients received rituximab. Acute AMR rate was of 38%, and rituximab was associated with fewer episodes of AMR. Only 1 patient had graft failure, due to chronic humoral rejection, and the remaining maintained good graft function (mean serum creatinine value of 1.33 mg/dL). No patient died and few complications related to immunossupression were observed. Conclusions Desensitization protocols were safe and allowed kidney transplantation in highly sensitized patients that probably would never undergo transplantation and gave the opportunity of living-donor transplant to patients with anti-HLA antibodies against the donor.

Introduction: Infections are a major cause of morbidity and mortality in pediatric patients undergoing kidney transplantation (KT). Aim and Methods: To determine the patterns of infectious complications during the first 6 months post transplantation, we report our single center experience with data from pediatric kidney recipients transplanted between 2006 and 2011. Results: Thirty-two children (20 males) were submitted to KT. The most common cause of end-stage renal disease (ESRD) was congenital anomalies of the kidney and urinary tract (CAKUT) accounting for 62%. Over the first 6 months post-transplant period, twenty-eight (87.5%) children developed a total of 77 infections, mainly urinary tract infections (UTI) (64.9%). CAKUT etiology of ESRD and UTI before KT increased the risk to develop more than one episode of UTI [71.4% vs. 14.3% and 81.8% vs. 18.2%, respectively; p < 0.05]. Twenty-three (29.9%) viral infections occurred. Cytomegalovirus (CMV) was the most common opportunistic pathogen, occurred in 11 patients and was more frequently in those with a donor (D)+/recipient (R)- CMV sero-status [74.5% vs. 25.5% (p < 0.05)]. A polyomaviruses (BKV) disease with nephropathy and meningitis was registered. The majority of infectious episodes had mild or moderate severity. No deaths occurred. Conclusion: A significant number of patients presented infectious complications during the first 6 months post transplantation. UTI are the most common type of infection, followed by viral infections, particularly CMV. Recognition, prevention and early treatment of infections are of major importance.

In the cold space of information objects drift in the void. All is abandoned in junk space or fiercely organized. The difference between an object as a form and formations - or interacting populations of elements in an environment - is still disregarded. In Cartesian space objects are preconceived by an external observer, in static and timeless space. In parametric space Euclidian geometries persist as preconfigured objects. The flux of information between physical and digital realities is still archaic: is done with effort, demanding physical strength and time. There is low interaction between physical and digital realities. Seems like a dystopian reality in a past?future. The theory of relativity asserts that space and time are interdependent, being modified and modifying us. In organic and synthetic biology, form results from the dynamic interaction of elements. This Research argues that form and environment are interdependent in physical and digital dimensions. A two-part applied research method is proposed: preliminary research and further development via workshop. Preliminary research identified the knowledge areas involved, defined problem search space and tested methods and techniques to solve it. The successfully developed design methodology - combining the preliminary research and workshop - can be used to solve future design problems.

An important benefit associated with kidney transplantation (KT) in women of childbearing age is increased fertility. We retrospectively evaluated the complications associated with 24 pregnancies among our KT over 28 years. In particular, we examined the evolution of serum creatinine as well as maternal and fetal complications. To assess the impact on graft survival, our control group included women without pregnancy who were matched for age at KT, year of KT, and follow-up time. Most women (79.2%) were primiparous. All were prescribed a calcineurin inhibitor, which in 75% of the cases was cyclosporine. Overall, 45.8% had prior hypertension, only one of whom remained on the previous antihypertensive regimen. The drugs most often used were nifedipine and methyldopa. The median age at time of KT was 24.16 (interquartile range [IQR] 21.33 to 29.72) years and at delivery, 28.39 (IQR 25.59 to 33.88) years. The average interval between KT and delivery was 4.5 ± 2.7 years (range, 1 to 10 years). Maternal complications were anemia (n = 16), graft pyelonephritis (n = 6), preeclampsia (n = 6), de novo proteinuria > 1 g/d (n = 3), or gestational diabetes mellitus (n = 2). There was no acute rejection episode or opportunistic infection. The fetal complications included delayed intrauterine growth (n = 8), preterm deliveries (n = 13), or congenital enzymatic deficit (n = 1). One case was a twin pregnancy. The average gestational age was 35.2 ± 3 weeks, and the mean birth weight 2318.2 ± 597.1 grams. In 16 pregnancies, deliveries were performed by caesarean section. The median serum creatinine at 1 month before conception was 1.20 (IQR 0.97 to 1.37) mg/dL and at 1 year after delivery it had tended to increase to 1 to 20 (IQR 1.03 to 1.50) mg/dL. Death-censored graft survival did not differ from the control group. In conclusion, pregnancy after KT may be associated with serious maternal and fetal complications. We did not observe an increased risk of graft loss.

This research aims to develop a skylight system that responds to both external, environmental conditions and adjustable internal functional demands. The system adapts to different geometries, uses, locations, times and sky conditions. In the design process, the disposition and size of skylights are customized to the context. After construction, the apertures of the skylights control interior conditions. This paper focuses on the dynamic process to control daylight using a case study. The goal is to assure adequate illuminance and low visual contrast. Parametric and environmental software analysis is used to generate and assess solutions. Heuristics strategies are developed to find adequate configurations, given that optimization methods are time and resource consuming. The performance of such configurations is evaluated in specific conditions. An interpolation method is proposed to find configurations adequate to other conditions. A friendly-interface allows selecting the best configuration in real-time using multi-criteria.

Detrimental impact of preformed donor-specific antibodies (DSAs) against human leucocyte antigens on outcomes after kidney transplantation are well documented, however, the value of their capacity to bind complement for predicting antibody-mediated rejection (AMR) and graft survival still needs to be confirmed. We aimed to study DSA characteristics (strength and C1q binding) that might distinguish harmful DSA from clinically irrelevant ones. We retrospectively studied 60 kidney-transplanted patients with preformed DSA detected by single antigen bead (SAB) assays (IgG and C1q kits), from a cohort of 517 kidney graft recipients (124 with detectable anti-HLA antibodies). Patients were divided into DSA strength (MFI < vs. ≥ 15 000) and C1q-binding ability. AMR frequency was high (30%) and it increased with DSA strength (P = 0.002) and C1q+ DSA (P < 0.001). The performance of DSA C1q-binding ability as a predictor of AMR was better than DSA strength (diagnostic odds ratio 16.3 vs. 6.4, respectively). Furthermore, a multivariable logistic regression showed that C1q+ DSA was a risk factor for AMR (OR = 16.80, P = 0.001), while high MFI DSAs were not. Graft survival was lower in high MFI C1q+ DSA in comparison with patients with C1q- high or low MFI DSA (at 6 years, 38%, 83% and 80%, respectively; P = 0.001). Both DSA strength and C1q-binding ability assessment seem valuable for improving pretransplant risk assessment. Since DSA C1q-binding ability was a better predictor of AMR and correlated with graft survival, C1q-SAB may be a particularly useful tool.

Over the last 15 years, better immunosuppressive drugs have decreased acute rejection rates in kidney transplantation but have also led to an increase in the incidence and impact of BK virus nephropathy. The authors report the case of a 62 -year -old man submitted to a renal transplant of a deceased donor with an immunosuppression regimen free of rabbit anti -thymocyte globulin and tacrolimus, in whom BK nephropathy was diagnosed at seven weeks post -transplant. Intravenous human immunoglobulin (IVIG) was administered after immunosuppression reduction. Instituted treatment was successful. This clinical case highlights the importance of a high index of suspicion for an atypical presentation of BK nephropathy in renal transplant recipients and strengthens the need for other therapeutic interventions beyond the reduction of immunosuppression. It was the starting point for a review of BK virus nephropathy in kidney transplantation with a focus on risk factors, diagnosis and treatment. info:eu-repo/semantics/publishedVersion

Submitted by José Pereira (jro.pereira@gmail.com) on 2016-04-26T14:03:02Z No. of bitstreams: 1 Pancreas.pdf: 245460 bytes, checksum: 1783845f7503318a0ab0218efcd62614 (MD5) Made available in DSpace on 2016-04-26T14:03:02Z (GMT). No. of bitstreams: 1 Pancreas.pdf: 245460 bytes, checksum: 1783845f7503318a0ab0218efcd62614 (MD5) Previous issue date: 2016

Introduction: Kidney transplant improves survival even in highly‑sensitized (HS) patients. To overcome their disadvantage in accessing transplantation, those with high Complement Dependent Cytotoxic PRA (CDC‑PRA) receive additional points during allocation. Whether this strategy reaches all HS patients and how long they wait for a transplant is largely undetermined. Methods: Patients on our unit’s active wait‑list for kidney transplantation in the year 2014 were analyzed. CDC‑PRA and calculated PRA (cPRA) were recorded. To obtain cPRA, antibodies in the last serum available specific for HLA‑A, ‑B or –DR with an intensity > 1000 MFI were considered. Results: The cPRA values in the population (N=551) were 0% (N=312), 1‑79% (N=118) and ≥ 80% (22%; N=121). Among these groups, the proportion of women (29.5, 55.9 and 61.2%, P 50%. Moreover, only 30% of HS by cPRA patients received the extra points designed to improve their transplantability. We consider that both CDC‑PRA and cPRA should be taken into account when defining HS status. info:eu-repo/semantics/publishedVersion

s in other parts of Europe, Portugal experienced great advances during the twentieth century. It started with more than 100 years of monarchy, then a Republic (1910), and a dictatorial regime that lasted more than forty years (until 1974). The dictatorship ended by a peaceful “Revolution of the Carnations”1, the most decisive event at the end of the century. Alongside these political events, other factors contributed to (re)configure Portuguese society, harmonizing its modernization process with that of other European countries. In fact, improvements in population’s welfare sometimes took place unnoticed while occurring, only intelligible in the long term. It reflected the interdependence between demography, economy, wellbeing and public policy, in particular those implemented in healthcare areas. At the beginning of the twenty first century, long and stable life cycle emerged, replacing the previous short and instable life cycle. This new life cycle is accompanied by a stagnation in natural growth, more recently in Portugal. Since 2009, a new trend in Portuguese demography break-out, it has been continuously negative. The continuous drop in fertility, the decrease of mortality levels, not only of infant mortality but also in older age groups, contributed to an ageing society. Ageing has, in fact, become a dominant feature not only in Portugal but worldwide with consequences on support services for the elderly, adaptation of healthcare to new population groups and reformation of the public pension system. Our aim with this paper is to give an overview of the Portuguese health and demographic change through the twentieth century up until today, with special focus on the 1970’s until 2013, identifying the characteristics and specificities of the demographic and epidemiological transition model as well as the phases of the ageing process in Portugal in order to understand the different impacts on the health system. We base this article on own research; literature in different fields e.g. history

This research is part of a broader investigation into the use of digital technologies in the Architecture, Engineering and Construction (AEC) sector. The intention is to improve the ability of buildings to respond to context by proposing a skylight system that can adjust to external environmental conditions and internal functional demands. We call this responsive ability customisation. The proposed skylight system can adapt to different geometries, uses, locations, times of day and other contextual conditions. Customisation can be achieved by static and dynamic processes. Static customisation is achieved during the design process by selecting the form and size of the building, as well as the number, arrangement and size of the skylights, among other features. Dynamic customisation is accomplished after construction by changing the skylight aperture in real-time to control interior conditions. This paper focuses on the static process to find an adequate skylight configuration for a case-study pavilion.

Kidney transplantation is the optimal treatment of end -stage renal disease (ESRD) improving survival and quality of life for most recipients. In our country, potential living donors have been refused due to the ABO incompatibility barrier. However, ABO -incompatible living donor kidney transplant is presently common practice in several countries with good outcomes. The authors describe a case of a 49 -year -old female patient, with chronic kidney disease due to autosomal dominant polycystic kidney disease, who had started haemodialysis 10 months before and with blood group O. The living donor was a 53-year-old sister with blood group B. The desensitization protocol was based on rituximab and plasmapheresis. The induction protocol used was basiliximab, tacrolimus, mofetil mycophenolate and metilprednisolone. Five days post -transplant she presented a normal graft function that remained during the eight months follow -up. This case reveals the first ABO incompatible living donor kidney transplant performed in Portugal with excellent outcome O transplante renal é a modalidade de tratamento da doença renal crónica estadio 5 associada a melhores sobrevivência e qualidade de vida. No nosso país muitos potenciais dadores vivos têm sido recusados devido à incompatibilidade ABO. Contudo, o transplante renal de dador vivo ABO incompatível é hoje prática comum em diversos países com resultados positivos. Os autores descrevem o caso de doente do sexo feminino, de 49 anos, com doença renal crónica secundária a doença renal poliquística autossómica dominante, que havia iniciado hemodiálise 10 meses antes e com grupo sanguíneo O. O dador vivo foi uma irmã de 53 anos, grupo sanguíneo B. O protocolo de dessensibilização baseou-se em rituximab e plasmaferese. O protocolo de indução foi com basiliximab, tacrolimus, micofenolato de mofetil e metilprednisolona. Evoluiu com função normal do enxerto 5 dias pós -transplante que se manteve durante o follow -up de 8 meses. Este caso clinico ilustra o primeiro transplante renal de dador vivo ABO incompatível efectuado em Portugal com excelente resultado