Search

The elderly population is growing worldwide. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed, but their adverse events can pose significant risks. Different NSAID molecules can exhibit varying risk profiles. This study aims to evaluate the cardiovascular, gastrointestinal, and renal safety profiles of ibuprofen, naproxen, acemetacin, diclofenac, celecoxib, and etoricoxib in elderly patients. A comprehensive literature search was conducted in PubMed and Cochrane Library. For the selection of articles, we used Medical Subject Headings (MeSH) terms “aged” sequentially and together with “ibuprofen”, “diclofenac”, “naproxen”, “acemetacin”, “celecoxib”, and “etoricoxib”. To assess the quality and interest of the articles, four independent reviewers screened titles and abstracts to identify potentially eligible studies. Strength of Recommendation Taxonomy (SORT) was used to rate the quality of individual studies and to establish recommendation strengths (RS). From 2086 articles identified, 39 studies met the inclusion criteria. Twenty studies analyzed cardiovascular safety, fourteen gastrointestinal safety, and four renal safety. When CV risk is the main concern celecoxib or naproxen are a good first choice (RS B). In high GI risk addition of PPI to naproxen or celecoxib use should be recommended (RS A). When renal function is on focus, celecoxib remains as first line of therapy (RS A). Diclofenac in the geriatric population should be avoided (RS B). Celecoxib is a good choice for elderly patients for whom it is difficult to direct pain treatment based on a single known risk factor (RS B).

Background The differential diagnosis between benign and malignant thyroid nodules continues to be a major challenge in clinical practice. The rising incidence of thyroid neoplasm and the low incidence of aggressive thyroid carcinoma, urges the exploration of strategies to improve the diagnostic accuracy in a pre-surgical phase, particularly for indeterminate nodules, and to prevent unnecessary surgeries. Only in 2022, the 5th WHO Classification of Endocrine and Neuroendocrine Tumors, and in 2023, the 3rd Bethesda System for Reporting Thyroid Cytopathology and the European Thyroid Association included biomarkers in their guidelines. In this review, we discuss the integration of biomarkers within the routine clinical practice for diagnosis of thyroid nodules and cancer. Methodology The literature search for this review was performed through Pub Med, Science Direct, and Google Scholar. We selected 156 publications with significant contributions to this topic, with the majority (86, or 55.1%) published between January 2019 and March 2024, including some publications from our group during those periods. The inclusion criteria were based on articles published in recognized scientific journals with high contributions to the proposed topic. We excluded articles not emphasizing molecular biomarkers in refine the pre-surgical diagnosis of thyroid nodules. Results We explored genetic biomarkers, considering the division of thyroid neoplasm into BRAF-like tumor and RAS-like tumor. The specificity of BRAF mutation in the diagnosis of papillary thyroid carcinoma (PTC) is nearly 100% but its sensitivity is below 35%. RAS mutations are found in a broad spectrum of thyroid neoplasm, from benign to malignant follicular-patterned tumors, but do not increase the ability to distinguish benign from malignant lesions. The overexpression of miRNAs is correlated with tumor aggressiveness, high tumor node metastasis (TMN) stage, and recurrence, representing a real signature of thyroid cancer, particularly PTC. In addition, associations between the expression levels of selected miRNAs and the presence of specific genetic mutations have been related with aggressiveness and worse prognosis. Conclusions The knowledge of genetic and molecular biomarkers has achieved a high level of complexity, and the difficulties related to its applicability determine that their implementation in clinical practice is not yet a reality. More studies with larger series are needed to optimize their use in routine practice. Additionally, the improvement of new techniques, such as liquid biopsy and/or artificial intelligence, may be the future for a better understanding of molecular biomarkers in thyroid nodular disease.

Este artigo tem como objetivo analisar os discursos de ódio e a dinâmica algorítmica das redes sociais à luz da analítica do poder disciplinar de Foucault. Para tanto, utiliza-se, especialmente, as obras foucaultianas da primeira metade da década de 70. As ideias de Foucault, apesar de serem anteriores à massificação do acesso à internet, são capazes de jogar luz à era digital, onde as redes sociais são utilizadas como forma de controle. Com isso, será apresentada, inicialmente, a analítica foucaultiana de poder; após, serão apresentadas considerações sobre o papel da internet no cenário político atual e como os cookies estão relacionados a esse fenômeno; ainda, será examinada a disseminação dos discursos de ódio nas redes sociais e sua influência no meio político através da chave analítica do poder disciplinar.

BackgroundThe prevalence of overweight and obesity is increasing at an alarming rate in children and adolescents worldwide. Given the dimensions of the problem, the treatment of childhood obesity is considered extremely important. Current evidence indicates that behavioral and cognitive behavioral strategies combined with diet and physical activity approaches may assist in reducing adolescent obesity. ObjectiveThe purpose of this systematic review was to evaluate the use of extrinsic motivators for improving the BMI of obese or overweight adolescents. MethodsThe inclusion criteria were as follows: (1) overweight or obese adolescents, (2) intervention using extrinsic motivators, and (3) outcome variables related to weight status. The exclusion criterion was the presence of an associated chronic disease. The search process was conducted in PubMed and Web of Science (last searched on April 23, 2023). The risk of bias was evaluated independently by 2 authors using Cochrane tools (RoB2 [randomized controlled trials], ROBINS-I, and ROBINS-E). ResultsFrom 3163 studies identified, 20 articles (corresponding to 18 studies) were included in the analysis. The studies differed in terms of study design, sample size, follow-up duration, outcomes reported, and extrinsic motivators used. Most of the studies had videogames or apps as interventions. Of the 18 studies, 9 (50%) reported a statistically significant decrease in BMI. The most used extrinsic motivators were “motivation” (n=13), “feedback” (n=10), and “rewards” (n=9). Among the motivators, “reminders” (100%) and “peer-support” (80%) appeared to have high impacts on BMI reduction. ConclusionsThe heterogeneity of the included studies made analysis difficult. No study evaluated extrinsic motivators in isolation. Most of the studies had a moderate or high risk of bias. The extrinsic motivators “reminders” and “peer-support” appeared to be useful. Further studies are needed, and these should include well-designed randomized controlled trials and studies involving homogeneity in BMI measures, consistent extrinsic motivator definitions, and longer durations to better understand the long-term impacts of extrinsic motivators on weight management success.

Introduction and objectives: To evaluate compliance with per capita food supply at lunch in daycare centers. Methods: Visits were made on five consecutive days at lunchtime to six daycare centers enrolled in the “Creche com Sabor e Saúde” project (C2S), meaning “Daycare Centers with Taste and Health”. To quantify food portions for different age groups (6-8 months, 9-11 months, 12-23 months, and 24-35 months), each meal component (carbohydrate sources, protein sources, and vegetables) and dessert (fruit) underwent random selection and was weighed three times. The averages obtained were compared to C2S project guidelines for per capita food supply, in line with national and international recommendations. Results: One hundred and forty-five dishes and 244 desserts were analyzed. No dishes were served to infants under nine months. Per capita amounts for protein-supplying foods were fulfilled (9-11 months: 14.2 g; 12-23 months: 20.3 g; 24-35 months: 23.9 g). Carbohydrate-rich foods were provided in quantities exceeding the recommendations, particularly for the 12-23 month age group (62.2 g vs. 40 g). For infants under 12 months, no vegetables were offered, and above this age, the average amount provided fell below the minimum guideline of 20 g (12-23 months: 9.4 g; 24-35 months: 10.8 g). The quantity of fruit offered exceeded the recommendations for the 6-8 month (84.6 g > 30-50 g) and 9-11 month (133.3 g > 40-70 g) age groups, aligning with guidelines for the 12-35 months. Discussion: Daycare centers inconsistently followed per capita food supply guidelines for lunch, with deficits in vegetable intake and excesses in carbohydrate-rich foods and fruit that surpassed the recommended quantities.

Objective: The dysregulated host response to infections can lead to sepsis. The disease progression and outcome are determined by a complex balance between mechanisms responsible for controlling the pathogen growth and mechanisms to avoid and repair organ dysfunctions. It is a disease with a spectrum of clinical phenotypes associated with the host immune response and clinical outcomes, making difficult the implementation of specific therapeutic. Despite sepsis phenotypes being well distinguished, the mechanisms underlying the heterogeneous responses are currently limited. The cecal-ligation and puncture (CLP) sepsis model resembles the disease characteristics of the higher inflammation phenotype, which has higher mortality. The CLP induction in the same mice inbred strain and same weight, age, sex, and co-housed evoked a heterogeneous host response, in which approximately half of the mice succumbed. Thus, we take advantage of the CLP-septic survived and non-survived mice immune cell activation profiling, to gain further insights into immunological mechanisms related to the worsening of the hyperinflammatory septic phenotype. Methods: We profiled CLP-septic survived and non-survived mice immune cell activation using single-cell RNA sequencing (scRNA-seq). Results: The initial response is similar between septic mice. However, after 6 hours, mice that did not survive had increased inflammation parameters, organ damage markers, and bacteremia compared with the survived mice. Thus, our data suggest that after the same initial inflammatory response between all mice, the non-surviving mice showed a failure of resistance and tissue damage tolerance mechanisms. Subsequently, we took advantage of the scRNA-seq technology to gain further insight into the cellular diversity and transcriptional landscape of the immunological heterogeneous response at the initial phase of sepsis. Our findings demonstrated an enrichment of the apoptosis pathway in the subsets of T and B cells but not in the CD8+ T ISGs population in the non-survived group. The CD8+ T ISGs population has an immunosuppressive profile, as we observed an enrichment of genes related to the HIF-1alpha and PD-L1 expression. It is interesting that we observed an increased enrichment of IFN-gamma signaling pathways in lymphocytes, neutrophils, and monocytes from non-survived septic mice which is associated with the induction of HIF-1alpha and PD-L1 expression. Neutrophils play both protective and deleterious role in experimental models of sepsis, promoting infection control and increasing organ damage. We observed that non-survived septic mice have an increase of immature CXCR4+ PD-L1+ neutrophils and monocytes frequencies in the bloodstream, followed by an increased accumulation of trafficking-specific neutrophils PD-L1+ CXCR4+ into the lungs. The increased PD-L1 expression on neutrophils is associated with an increase of IFN-gamma signaling pathways, and upon abrogating the IFN-gamma signaling pathway using IFN-gamma deficient mice, we noticed less susceptibility to CLP-sepsis and less induction of PD-L1 expressionon neutrophils. We also demonstrated that the neutrophils PD-L1 were able to do immune sinapsis with linfocytes T CD8+ and T CD4+, which could explain the increase of lymphocyte apoptosis in our results. Conclusions: This study highlights the modulation of IFN-gamma and PD-L1 expression on neutrophils as potential therapeutic targets in the clinical sepsis hyperinflammatory phenotype.

Exposure and vulnerability analysis are valuable tools for wildfire management, especially important for local communities that suffer from very destructive events and that require mitigation approaches adjusted to their abilities and needs. We present a methodological procedure to analyze wildfire exposure levels, social vulnerability conditions and coping capacity at the local scale, for villages or small human settlements. The procedure was developed using GIS (Geographic Information Systems) and programming tools in R and Python, which can be adapted and updated depending on the data available. The development of accessible procedures and easily replicable methodologies facilitates knowledge transfer and supports the application of mitigation and adaptation strategies, tailored to the conditions of the exposed areas. • A step-by-step procedure for the assessment of Exposure, Vulnerability, and Coping Capacity, using Python and R programming language. • Automated processes, easily replicable and adjustable to other areas. • Indications for adapting the methodology using European/international databases.

Abstract Background Higher maternal pre-pregnancy body mass index (BMI) is associated with adverse pregnancy and perinatal outcomes. However, whether these associations are causal remains unclear. Methods We explored the relation of maternal pre-/early-pregnancy BMI with 20 pregnancy and perinatal outcomes by integrating evidence from three different approaches (i.e. multivariable regression, Mendelian randomisation, and paternal negative control analyses), including data from over 400,000 women. Results All three analytical approaches supported associations of higher maternal BMI with lower odds of maternal anaemia, delivering a small-for-gestational-age baby and initiating breastfeeding, but higher odds of hypertensive disorders of pregnancy, gestational hypertension, preeclampsia, gestational diabetes, pre-labour membrane rupture, induction of labour, caesarean section, large-for-gestational age, high birthweight, low Apgar score at 1 min, and neonatal intensive care unit admission. For example, higher maternal BMI was associated with higher risk of gestational hypertension in multivariable regression (OR = 1.67; 95% CI = 1.63, 1.70 per standard unit in BMI) and Mendelian randomisation (OR = 1.59; 95% CI = 1.38, 1.83), which was not seen for paternal BMI (OR = 1.01; 95% CI = 0.98, 1.04). Findings did not support a relation between maternal BMI and perinatal depression. For other outcomes, evidence was inconclusive due to inconsistencies across the applied approaches or substantial imprecision in effect estimates from Mendelian randomisation. Conclusions Our findings support a causal role for maternal pre-/early-pregnancy BMI on 14 out of 20 adverse pregnancy and perinatal outcomes. Pre-conception interventions to support women maintaining a healthy BMI may reduce the burden of obstetric and neonatal complications. Funding Medical Research Council, British Heart Foundation, European Research Council, National Institutes of Health, National Institute for Health Research, Research Council of Norway, Wellcome Trust.

INTRODUÇÂO: As lesões vasculares iatrogénicas são uma causa importante de morbilidade e mortalidade após intervenções cirúrgicas ortopédicas ou neurocirúrgicas. Neste artigo, os autores apresentam dois casos clinicos de quasi-iatrogenia vascular. CASOS CLÍNICOS: Dois casos, um procedimento ortopédico e um procedimento neurocirúrgico, são apresentados. O primeiro caso refere-se a uma mulher de 80 anos com migração do componente acetabular de uma prótese da anca, associado a trombose da veia ilíaca externa. O segundo caso reporta um homem de 27 anos com compressão medular ao nível de D6 por motivo de um hemangioma ósseo. Após a operação, verificou-se a presença de material de fixação (parafuso) fazendo protusão para o lúmen da aorta torácica. Este foi removido num segundo momento. Ambas as operações decorreram sem complicações. CONCLUSION: Os autores consideram que uma abordagem multidisciplinar contribuiu significativamente para o sucesso dos casos apresentados.

As bioindicators, freshwater bivalves are crucial for the assessment of the contamination impact on different levels of biological integration. Escherichia coli is used as a bioindicator of water fecal contamination, representing a critical global concern, especially with the rise of multidrug-resistant (MDR) strains. Phylogenetic diversity, pathotypic characterization, and antibiotic resistance profiles of E. coli isolated from freshwater bivalves (Anodonta anatina) were assessed. Samples were collected from the Tua River in Northern Portugal, from two different sites, Chelas and Barcel, representing different degrees of contamination. Antimicrobial susceptibility testing was performed by the disk diffusion method, and characterizations of the phylogenetic groups and pathotypes were assessed by PCR-multiplex and real-time PCR-multiplex, respectively. Results showed that 60% of isolates were characterized as MDR, including resistance to carbapenems, considered the last resort against multidrug-resistant bacteria. Within this study, it was also possible to verify the antimicrobial resistance (AMR) profile differences between the two sampling sites, with bivalve isolates from the Chelas site showing a higher percentage of antibiotic resistance. Among the E. coli isolates, the highest prevalence (55%) was observed in group B1, followed by group D or E (15%), group A (10%), and group E or Clade I (10%). None of the isolates were classified as diarrheagenic E. coli (DEC). This work highlights the potential transmission of antimicrobial-resistant bacteria through bivalves in the food chain. The ‘One Health’ approach is crucial for combating antimicrobial resistance, namely in edible freshwater species, emphasizing active surveillance to protect human, animal, and environmental health against the spread of antibiotic-resistant bacteria in aquatic environments.

Introdução: A utilização de rotulagem nutricional simplificada é uma ferramenta fundamental para ajudar o consumidor na escolha de alimentos saudáveis. A utilização do Nutri-Score, um sistema de rotulagem europeu, na rotulagem frontal dos produtos alimentares tem aumentado e a evidência científica demonstra que é facilmente compreendido pelos consumidores, associando-se a escolhas alimentares mais saudáveis. Objetivos: Relacionar a classificação Nutri-score atribuída a bolachas comercializadas em Portugal com o perfil nutricional avaliado através do descodificador de rótulos da Direção-Geral da Saúde (DGS). Material e Métodos: Realizou-se um estudo transversal. A recolha de informação foi efetuada através dos websites de grandes superfícies comerciais (Auchan, Carrefour, Intermaché, Continente, Aldi, Macro, Lidl, Pingo Doce, Elerclerc e Celeiro). Identificaram-se 86 bolachas classificadas com a rotulagem Nutri-Score, comercializadas em Portugal. A informação nutricional (açúcares, lípidos, incluindo saturados e sal) por 100g de produto foi recolhida do mesmo modo, nos websites das cadeias de distribuição, entre outubro de 2022 a março de 2023. O perfil nutricional das bolachas foi avaliado recorrendo-se ao descodificador de rótulos da DGS. Resultados: Identificaram-se 86 bolachas com classificação Nutri-Score: 10 bolachas com classificação A, 11 com classificação B, 15 com classificação C, 29 com classificação D e 21 com classificação E. Analisando o perfil nutricional, através do descodificador de rótulos, das bolachas com classificação A verifica-se que 70% tem um nível baixo (verde) de sal e açúcares, porém, o teor de lípidos encontra-se no valor médio (amarelo) em 70% das bolachas e 10% tem mesmo um valor considerado elevado (vermelho). Relativamente às bolachas com classificação B observa-se que 100% dos produtos tem um baixo teor de sal e açúcares, 55% tem um valor médio de ácidos gordos saturados, 73% tem um valor médio de lípidos e 18% destas bolachas tem um teor elevado de lípidos. Conclusões: Globalmente, os resultados suportam uma relação entre o perfil nutricional avaliado pelo Nutri-Score e pelo descodificador de rótulos da DGS. Contudo, 10 e 18% das bolachas com Nutri-Score A e B, respetivamente, apresentam ainda elevados teores de lípidos. Os resultados sugerem a necessidade de promover a contínua literacia alimentar dos consumidores.

IntroductionIn Portugal, the 2017 fire season was particularly extreme, leading to an unprecedented large number of fatalities, injured people, destruction of houses and infrastructures. These dramatic outcomes have contributed to raise awareness regarding the importance of ensuring the safety of people and assets from high intensity uncontrollable wildfires. It is crucial to identify the settlements at higher risk and the most suitable mitigation actions that can maximize the protection of people and assets.MethodsWe developed a simple methodology that combines exposure and vulnerability to estimate wildfire risk at the local level. Exposure was estimated using a fire spread simulation approach that was used to determine the probability of (i) a wildfire generating firebrands that could affect a settlement and (ii) a high intensity wildfire occurring adjacent to a settlement. Exposure was estimated using two fuel scenarios created to represent the current year of 2023 (short-term scenario) and 2030, assuming that no fuel management nor large fires occur in the meantime (medium-term worst-case scenario). Vulnerability was determined by the (i) Index of Total Dependence (IDT), and (ii) evacuation difficulty. Exposure and vulnerability metrics were normalized in percentiles, distributed into quadrants and combined to provide six levels of wildfire risk. For each vulnerability\exposure combination, we proposed a set of priority mitigation actions. The methodology was applied to three areas in Portugal where the risk estimates were analyzed and compared with the implementation rate of two risk mitigation programs already in place.ResultsResults showed that 8.7% of the settlements had “very high” wildfire risk and about 19.5% had “high” wildfire risk, potentially affecting 8,403 and 34,762 inhabitants, respectively. The spatial distribution of settlements at higher risk was very heterogeneous across the study areas and the total fraction ranged between 14% in Coimbra to 36% in Barlavento Algarvio. The overall implementation of mitigation programs in the study areas is very low, with only around 1% of the settlements in “very high” risk having any of the mitigation programs implemented. Conversely, our results also suggest that the implementation rate in settlements classified in lower risk classes is disproportionately high.DiscussionThe application of this risk analysis methodology can be used to assess the implementation status of mitigation actions, and contribute to tailor the actions that maximize the protection of people and assets according to the specific conditions found in each targeted area.

No século XXI, a implementação da educação doutoral em Geografia resultou num aumento do número de teses enquadradas na especialização em Geografia Física. No entanto, pouco é conhecido sobre a dinâmica inerente às técnicas de trabalho de campo, métodos e temas estudados. Com o objetivo de compreender melhor a tendência de aumento e evolução associada, este artigo analisa os 78 estudos de doutoramento publicados em cinco instituições públicas de ensino superior, entre 2000 e 2021. Foi realizada uma análise quantitativa de forma a investigar as fontes de dados, as técnicas de trabalho de campo e os métodos de análise utilizados nos estudos que abrangem as temáticas Biogeografia, Climatologia, Hidrologia, Geomorfologia e Risco e Ordenamento. A partir de 2007, verificou-se um aumento de trabalhos em Risco e Ordenamento, reforçando a componente da Geografia Física aplicada às problemáticas do ordenamento do território. A utilização de Sistemas de Informação Geográfica, análise estatística e quantitativa evidenciam o peso das bases de dados e análises em gabinete. O contexto territorial em que se localizam as instituições estudadas parece influenciar a escolha das áreas de estudo e temáticas associadas. O processo de Bolonha, a atribuição de bolsas de doutoramento pela Fundação para a Ciência e Tecnologia e o aumento dos projetos de investigação com financiamento justificam parcialmente a diversidade de temáticas identificadas e métodos.

This article aims to contribute to the interpretation of artworks from the collection of the Museu de Arte Moderna de São Paulo (MAM-SP), which originated in the 1950s iterations of the Bienal de São Paulo. The paper proposes micro-narratives of modern art in the Brazilian context, opening up the artworks to new interpretations. The goal is to recontextualise the biographies of the collected items as museum objects, going beyond the disputes surrounding the narrative of modern art that occurred in the early years of the Biennial. This will be accomplished through two case studies: Renato Birolli's works at the 1st Bienal de São Paulo in 1951 and Barbara Hepworth's works at the 5th edition of the exhibition in 1963.

Introdução – A miopia é um erro refrativo cujos raios paralelos provenientes do infinito focam antes do plano da retina. Globalmente a prevalência da miopia está a aumentar, sendo a sua progressão controlada através de diversos métodos, nomeadamente lentes de desfocagem periférica, como é o exemplo das lentes de contacto MiSight® 1 day. Objetivos – Avaliar a progressão da miopia em crianças que usaram lentes de contacto MiSight® 1 day. Métodos – Foi implementado um estudo observacional descritivo, retrospetivo e do tipo série de casos. Os dados foram recolhidos após consulta de registo clínico num estabelecimento comercial de ótica, local onde as lentes de contacto foram adaptadas. Foram incluídas crianças com miopia que iniciaram o tratamento com as lentes de contacto MiSight® 1 day para controlo da progressão da miopia. A eficácia do tratamento foi avaliada através da medição do erro refrativo (equivalente esférico) antes, durante e após o início do tratamento. Resultados – Foram incluídas cinco crianças, duas do género masculino e três do feminino, com idades entre os sete e quinze anos. A duração do tratamento variou entre 19 e 61 meses. A progressão da miopia durante o tratamento variou entre 0.00 e -1.75 D. Discussão – Todas as crianças que integraram o estudo demonstraram uma diminuição da progressão da miopia quando comparada com a progressão da miopia antes do tratamento (0.00 e -2.25 D), bem como com a progressão que seria expectável sem tratamento (-1.10 e -2.75 D). Conclusões – O uso da lente de contacto MiSight® 1 day proporcionou um maior controlo na progressão da miopia quando comparado com a progressão que seria expectável sem a utilização da mesma.

Abstract Background Observational studies have reported maternal short/long sleep duration to be associated with adverse pregnancy and perinatal outcomes. However, it remains unclear whether there are nonlinear causal effects. Our aim was to use Mendelian randomization (MR) and multivariable regression to examine nonlinear effects of sleep duration on stillbirth (MR only), miscarriage (MR only), gestational diabetes, hypertensive disorders of pregnancy, perinatal depression, preterm birth and low/high offspring birthweight. Methods We used data from European women in UK Biobank (N=176,897), FinnGen (N=~123,579), Avon Longitudinal Study of Parents and Children (N=6826), Born in Bradford (N=2940) and Norwegian Mother, Father and Child Cohort Study (MoBa, N=14,584). We used 78 previously identified genetic variants as instruments for sleep duration and investigated its effects using two-sample, and one-sample nonlinear (UK Biobank only), MR. We compared MR findings with multivariable regression in MoBa (N=76,669), where maternal sleep duration was measured at 30 weeks. Results In UK Biobank, MR provided evidence of nonlinear effects of sleep duration on stillbirth, perinatal depression and low offspring birthweight. Shorter and longer duration increased stillbirth and low offspring birthweight; shorter duration increased perinatal depression. For example, longer sleep duration was related to lower risk of low offspring birthweight (odds ratio 0.79 per 1 h/day (95% confidence interval: 0.67, 0.93)) in the shortest duration group and higher risk (odds ratio 1.40 (95% confidence interval: 1.06, 1.84)) in the longest duration group, suggesting shorter and longer duration increased the risk. These were supported by the lack of evidence of a linear effect of sleep duration on any outcome using two-sample MR. In multivariable regression, risks of all outcomes were higher in the women reporting

Abstract Background Women experience adverse changes in cardiovascular health in mid-life; whether the menopausal transition influences these remains strongly debated. The aim of this study was to examine associations of reproductive age (time since final menstrual period (FMP)) with change in carotid intima media thickness (CIMT) and cardiovascular risk factors and determine the role of chronological and reproductive age. Methods We used data from 1702 women from a pregnancy-based UK cohort who had up to four repeat cardiovascular health measures between mean age 51 (SD = 4.0) and 56 (SD = 3.6) years and experienced a natural menopause. Multilevel models were used to assess the relationship between cardiovascular measures and time since FMP (reproductive age), whilst adjusting for the underlying effects of chronological age and confounders (socioeconomic factors, body mass index, smoking, alcohol, parity, age at menarche). In addition, we looked at the relationship between cardiovascular measures by chronological age according to menopausal stages (pre-menopause, peri-menopause and post-menopause) using information from women who had and had not experienced menopause (N = 3892). Results There was no strong evidence that reproductive age was associated with CIMT (difference in mean 0.8 μm/year, 95% CI − 0.4, 2.1), whereas there was a strong positive association of chronological age (7.6 μm/year, 95% CI 6.3, 8.9). Consistent with this, we found weaker linear associations of reproductive compared with chronological age for atherosclerotic risk factors, such as with systolic blood pressure (− 0.1 mmHg/year, 95% CI − 0.3, 0.1, and 0.4 mmHg/year, 95% CI 0.2, 0.5, respectively) and non-HDL-cholesterol (0.02 mmol/l/year, 95% CI 0.005, 0.03, and 0.06, 95% CI 0.04, 0.07, respectively). In contrast, associations with fat mass (0.06 kg/m2/year, 95% CI 0.03, 0.10, and 0 kg/m2/year, 95% CI − 0.04, 0.04, respectively) and C-reactive protein (0.01, 95% CI 0.001, 0.02, and 0.01, 95% CI − 0.001, 0.02 natural logged mg/l/year, respectively) were stronger for reproductive compared with chronological age. Both reproductive and chronological age were (weakly) positively associated with glucose (0.002, 95% CI 0.0001, 0.003, and 0.002, 95% CI 0.0001, 0.003 natural logged mmol/l/year, respectively). Conclusions Our results suggest that going through the menopausal transition does not further increase women’s risk of atherosclerosis (measured by CIMT) beyond effects of ageing. Menopausal transition may, in additional to ageing, modestly increase adiposity and glucose levels and therefore a possible associated diabetes risk.

Introduction: Molecular tests can contribute to improve the preoperative diagnosis of thyroid nodules. Tests available are expensive and not adapted to different populations. Aim: This study aimed to compare the cyto-histological genetic profile and to evaluate the reliability of molecular tests using ultrasound-guided fine needle aspiration cytology (US-FNAC) in accurately diagnosing differentiated thyroid carcinomas (DTCs) and predicting biologic behavior of papillary thyroid carcinomas (PTCs). Materials and Methods: The series included 259 patients with paired cyto-histological samples totaling 518 samples. The genetic alterations were analyzed via PCR/Sanger sequencing. The association with clinicopathologic features was evaluated in PTCs. Results/Discussion: From the 259 patients included, histologies were 50 (19.3%) benign controls and 209 (80.7%) DTC cases, from which 182 were PTCs; cytologies were 5.8% non-diagnostic, 18.2% benign, 39% indeterminate, and 37.1% malignant. In histology, indeterminate nodules (n = 101) were 22.8% benign and 77.2% malignant. Mutation frequencies in cytology and histology specimens were, respectively, TERTp: 3.7% vs. 7.9%; BRAF: 19.5% vs. 25.1%; and RAS: 11% vs. 17.5%. The overall cyto-histological agreement of the genetic mutations was 94.9%, with Cohen’s k = 0.67, and in indeterminate nodules agreement was 95.7%, k = 0.64. The identified mutations exhibited a discriminative ability in diagnosing DTC with a specificity of 100% for TERTp and BRAF, and of 94% for RAS, albeit with low sensitivity. TERTp and BRAF mutations were associated with aggressive clinicopathological features and tumor progression in PTCs (p < 0.001). The obtained good cyto-histological agreement suggests that molecular analysis via US-FNAC may anticipate the genetic profile and the behavior of thyroid tumors, confirming malignancy and contributing to referring patients to surgery.

As questões éticas da especialidade constituíram sempre uma preocupação da Sociedade Portuguesa Angiologia e Cirurgia Vascular traduzida, inclusivamente, na formação de um Núcleo de Ética Profissional. A necessidade de conferir aos médicos o consentimento para as intervenções após o devido esclarecimento é uma aquisição relativamente recente. Por exemplo, os gregos achavam que a participação do doente na tomada de decisões médicas prejudicaria a relação de confiança no médico. De facto, o relacionamento médico-doente foi sendo, ao longo dos séculos, o suporte das intervenções terapêuticas uma vez que o seu alcance era limitado e a sua validação, tal como hoje a concebemos, era inexistente. Este padrão foi-se alterando progressivamente após a revolução científica do século XVII com o desenvolvimento do que viriam a ser os métodos científico e experimental modernos. Já no decurso da segunda metade do século XX surge a chamada medicina baseada na evidência com a definição de resultados clínicos testados pela moderna metodologia científica. Este pensamento e forma de agir tornaram-se requisitos mais rigorosos na prestação de cuidados de saúde nos últimos anos. Por outro lado, valoriza-se, na atualidade, a participação dos doentes nas decisões após a devida partilha de informação conferindo o que se convencionou chamar de "consentimento informado". A autodeterminação, isto é, o direito de todo cidadão decidir ou determinar o curso da sua vida é, pois, um direito previsto na lei portuguesa. A autodeterminação no contexto dos cuidados de saúde significa que todo o adulto capaz, tem a liberdade de consentir ou recusar um tratamento médico mesmo quando os profissionais de saúde possam acreditar que ele é benéfico e necessário. Todos estes aspetos são de importância cardinal na nossa especialidade a qual envolve frequentemente questões de risco vital, de perda de função ou de modificação da imagem corporal. Conseguir que os doentes sejam adequadamente informados e tomem decisões partilhadas de forma consciente é um desafio para todos os médicos em geral e para os cirurgiões em particular. Deste modo, o consentimento informado é um processo colaborativo que requer um alto grau de maturidade emocional por parte dos profissionais de saúde os quais devem estar dispostos a explicar o que é conhecido e admitir o que não é. Tal implica que seja utilizado o tempo e o esforço necessários para que os doentes entendam os tratamentos propostos. Cada doente cirúrgico é único; cada um tem a sua própria personalidade, educação, condição emocional e social bem como a capacidade de compreender as informações apresentadas. Alguns doentes têm várias questões, informação prévia com diversos graus de qualidade, e exigem saber cada detalhe do tratamento proposto. Outros, porém, contentam-se com a informação básica e outros há que confiam sem questionar no que lhes é proposto. A todos devemos esclarecer e em especial informar do risco e benefício das intervenções. Para ajudar a lidar com estas questões, foram introduzidos os formulários de consentimento informado que proporcionam informação sobre as intervenções propostas, os benefícios esperados e os riscos inerentes numa linguagem e terminologia que possa ser entendida pela generalidade das pessoas. É importante também a leitura dos formulários uma vez que a informação escrita promove mais facilmente a retenção e compreensão dos conceitos-chave e muitas vezes é superior à explicação verbal fornecida pelos médicos à cabeceira ou em consultório onde os níveis de ansiedade dos doentes são elevados. Para além dos objetivos éticos, há outras dimensões dos "consentimentos informados" a ter em conta. Em primeiro lugar, o propósito médico-legal sendo atualmente indispensáveis às questões deste foro e atestando que a autorização respetiva foi adequadamente obtida. Em segundo lugar, a obtenção do consentimento é um fator de Qualidade do processo assistencial e a respetiva obtenção e preenchimento do formulário um requisito indispensável nas auditorias de acreditação de qualidade das instituições modernas. Finalmente, deve considerar-se que o esclarecimento do doente vascular e a obtenção do consentimento para intervenção devem ser efetuados pelo cirurgião em ambiente de consulta ou de gabinete hospitalar com tranquilidade e disponibilidade para a cabal explicação e esclarecimento de dúvidas. Refletindo sobre estas questões, e à imagem do que já acontece com outras Sociedades, a Direção atual da SPACV iniciou um processo de tentativa de padronização dos formulários de consentimento informado nas múltiplas intervenções da especialidade de Angiologia e Cirurgia Vascular procurando que sejam completos e exaustivos. Acreditamos, no entanto, que este é apenas o início de um projeto havendo a perspetiva futura de revisão e alargamento a outras áreas com uma lista mais completa e atualizada. Este será, portanto, o início da jornada esperando que possa ser útil aos Serviços de Angiologia e Cirurgia Vascular portugueses.

Cardiovascular disease (CVD) is influenced by genetic and environmental factors. Childhood maltreatment is associated with CVD and may modify genetic susceptibility to cardiovascular risk factors. We used genetic and phenotypic data from 100,833 White British UK Biobank participants (57% female; mean age = 55.9 years). We regressed nine cardiovascular risk factors/diseases (alcohol consumption, body mass index [BMI], low-density lipoprotein cholesterol, lifetime smoking behaviour, systolic blood pressure, atrial fibrillation, coronary heart disease, type 2 diabetes, and stroke) on their respective polygenic scores (PGS) and self-reported exposure to childhood maltreatment. Effect modification was tested on the additive and multiplicative scales by including a product term (PGS*maltreatment) in regression models. On the additive scale, childhood maltreatment accentuated the effect of genetic susceptibility to higher BMI (Peffect modification: 0.003). Individuals not exposed to childhood maltreatment had an increase in BMI of 0.12 SD (95% CI: 0.11, 0.13) per SD increase in BMI PGS, compared to 0.17 SD (95% CI: 0.14, 0.19) in those exposed to all types of childhood maltreatment. On the multiplicative scale, similar results were obtained for BMI though these did not withstand to Bonferroni correction. There was little evidence of effect modification by childhood maltreatment in relation to other outcomes, or of sex-specific effect modification. Our study suggests the effects of genetic susceptibility to a higher BMI may be moderately accentuated in individuals exposed to childhood maltreatment. However, gene*environment interactions are likely not a major contributor to the excess CVD burden experienced by childhood maltreatment victims.

Introdução: O início da formação sobre assistência de reabilitação na Enfermagem foi complexo, sendo que a especialidade apenas se associou à disciplina em 1965 com o surgimento do primeiro curso pós-graduado. O objetivo deste estudo é descrever a formação acerca da assistência de reabilitação na enfermagem entre 1881 e 1966, tendo em conta o seu enquadramento legislativo. Metodologia: Recurso ao método histórico com análise documental e interpretação hermenêutica das fontes com referência à formação em enfermagem sobre assistência de reabilitação na enfermagem publicadas entre 1881 e 1966 após recolha documental no Diário do Governo. Resultados: Foram analisados 41 documentos entre Portarias e Decretos-Lei publicados com referência à formação em enfermagem e que contemplassem aspetos inerentes ao processo de recuperação e reabilitação incluindo planos de estudo. Discussão: Foi notória, numa fase inicial, a inclusão da assistência de reabilitação na formação em enfermagem em Portugal, principalmente no curso de enfermagem da cruzada das mulheres. Contudo, verificou-se alguma estagnação até à altura da Guerra Colonial, tendo sido a partir de 1961 aprovadas pelo Governo um conjunto de medidas que vieram preparar o caminho para a programação do primeiro curso pós-graduado de especialização em 1965. Conclusão: A formação acerca da assistência de reabilitação na enfermagem desenvolveu-se com avanços e recuos sobre influência de uma panóplia de alterações políticas e sociodemográficas. A Guerra Colonial em Portugal veio enfatizar necessidades que já eram sentidas anteriormente, criando as condições para a sua inclusão de forma muito específica na enfermagem a partir de 1965.

Zombie companies can be classified as being nonprofitable, having low productivity and being ten years old or over; these businesses continue to exist due to the support of banks and governments. This paper aims to understand the impact of these types of firms on the investment, employment growth and labour productivity of healthy companies from the wholesale and retail trade and the hospitality sector during the period 2011-2018. The data obtained indicate that the prevalence of zombie companies in Portugal (in the sectors under study) is higher in periods of economic crisis and that most of them are old and large companies, especially in the hotel industry sector. By using panel data models with fixed effects, our investigation concludes that zombie firms negatively affect how healthy companies are run, because they reduce the latter’s investment expenditure and workforce productivity.

Objetivo: o objetivo do estudo é compreender de que forma a Teoria do Conforto de Kolcaba influenciou a investigação e a prática clínica em enfermagem através da evolução do conceito. Desenvolvimento: trata-se de um estudo de natureza teórica, resultante da leitura, análise e reflexão de diferentes estudos obtidos por meio da revisão de literatura realizada em dezembro de 2021 em Lisboa, Portugal. A literatura evidencia a presença do construto integrante de várias taxonomias de enfermagem ao longo dos tempos, e mais recentemente, em várias teorias de enfermagem. Da análise conceitual, qualquer que seja a perspectiva teórica, reafirma-se tratar de um fenômeno de interesse, complexo e multifacetado. Conclusão: entende-se que esta reflexão permite compreender o fenômeno do conforto e a forma como este conceito tem vindo a ser estudado e clarificado, afirmando a sua importância para a qualidade dos cuidados em enfermagem.

Objective: The objective of this study is to understand how Kolcaba's Theory of Comfort has influenced research and clinical practice in nursing through the evolution of the concept. Development: This is a study of theoretical nature, resulting from the reading, analysis and reflection of different studies obtained through the literature review conducted in December 2021 in Lisbon, Portugal. The literature evidences the presence of the construct integral to several nursing taxonomies throughout time, and more recently, in several nursing theories. From the conceptual analysis, whatever the theoretical perspective, it is reaffirmed to be a phenomenon of interest, complex and multifaceted. Conclusion: It is understood that this reflection allows us to understand the phenomenon of comfort and how this concept has been studied and clarified, affirming its importance for the quality of nursing care.

Objetivo: el objetivo del estudio es comprender cómo la teoría del confort de Kolcaba ha influido en la investigación y la práctica clínica de la enfermería a través de la evolución del concepto. Desarrollo: Se trata de un estudio de carácter teórico, resultado de la lectura, análisis y reflexión de diferentes estudios obtenidos a través de la revisión bibliográfica realizada en diciembre de 2021 en Lisboa, Portugal. La literatura destaca la presencia del constructo integral en varias taxonomías de enfermería a lo largo del tiempo, y más recientemente, en varias teorías de enfermería. Desde el análisis conceptual, independientemente de la perspectiva teórica, se reafirma que se trata de un fenómeno de interés complejo y multifacético. Conclusión: se entiende que esta reflexión permite comprender el fenómeno del confort y cómo se ha estudiado y aclarado este concepto, afirmando su importancia para la calidad de los cuidados de enfermería.

Osmoregulation plays a vital role in sperm function, encompassing spermatogenesis, maturation, and fertilization. Aquaglyceroporins, a subclass of aquaporins (AQPs), facilitate the transport of water and glycerol across the sperm membrane, with glycerol serving as an important substrate for sperm bioenergetics. This study aimed to elucidate the significance of AQP-mediated glycerol permeability in sperm motility. The presence and localization of AQP3 and AQP7 in human sperm were assessed using immunofluorescence. Subsequently, the glycerol permeability of spermatozoa obtained from normozoospermic individuals (n = 30) was measured, using stopped-flow light scattering, after incubation with specific aquaporin inhibitors targeting AQP3 (DFP00173), AQP7 (Z433927330), or general aquaglyceroporin (phloretin). Sperm from asthenozoospermic men (n = 30) were utilized to evaluate the AQP7-mediated glycerol permeability, and to compare it with that of normozoospermic men. Furthermore, hypermotile capacitated sperm cells were examined, to determine the AQP7 expression and membrane glycerol permeability. AQP3 was predominantly observed in the tail region, while AQP7 was present in the head, midpiece, and tail of human sperm. Our findings indicate that AQP7 plays a key role in glycerol permeability, as the inhibition of AQP7 resulted in a 55% decrease in glycerol diffusion across the sperm membrane. Importantly, this glycerol permeability impairment was evident in spermatozoa from asthenozoospermic individuals, suggesting the dysregulation of AQP7-mediated glycerol transport, despite similar AQP7 levels. Conversely, the AQP7 expression increased in capacitated sperm, compared to non-capacitated sperm. Hence, AQP7-mediated permeability may serve as a valuable indicator of sperm motility, and be crucial in sperm function.

Graves’ disease is an autoimmune disorder that results in hyperthyroidism, caused by autoantibodies to the thyrotropin receptor (TRAbs) stimulating thyroid hormone synthesis, giving rise to a variety of systemic manifestations such as goitre, dermatopathy and orbitopathy. The authors present the case of a 28-year-old man admitted to hospital for a 3-week history of fatigue, shortness of breath, palpitations and diffuse goitre, after recent mild SARS-CoV-2 infection. Laboratory investigation revealed hyperthyroidism with TRAbs elevation. Thyroid ultrasound confirmed a diffusely heterogeneous and irregular thyroid gland and a nodular image below the sternal notch. Thyroid scintigraphy excluded the nodule and confirmed a Graves’ disease pattern. Following the initiation of methimazole, the patient had complete resolution of symptoms and normalization of thyroid values. The results suggest a possible association between Graves’ disease and SARS-CoV-2 infection acting as a trigger. Graves’ disease is an important differential diagnosis to keep in mind when patients present with hyperthyroidism after COVID-19 disease.

N/a.

Wildfire susceptibility maps are a well-known tool for optimizing available means to plan for prevention, early detection, and wildfire suppression in Portugal, especially regarding the critical fire season (1 July − 30 September). These susceptibility maps typically disregard seasonal weather conditions on each given year, being based on predisposing variables that remain constant on the long-term, such as elevation. We employ logistic regression for combining wildfire susceptibility with a meteorological index representing spring conditions (the Seasonal Severity Rating), with the purpose of predicting, for any given year and ahead of the critical fire season, which areas will burn. Results show that the combination of the index with wildfire susceptibility slightly increases the capability to predict which areas will burn, when compared with susceptibility alone. Spring meteorological context was found better suited for predicting if the following summer wildfire season will be more severe, rather than predicting where wildfires will effectively occur. The model can be updated yearly after the critical wildfire season and can be applied to optimize the allocation of human and material resources regarding the prevention, early detection and suppression activities, required to reduce the severity of wildfires in the country.

Abstract In a patient with Usher syndrome and atypical muscle complaints, we have identified two separate variants in MYO7A andNEB genes by exome sequencing. The homozygous variants in these two recessive genes could explain the full phenotype of our patient.

Este texto busca compreender as narrativas construídas em torno da história da curadoria de arte enquanto prática social, por meio da discussão de alguns de seus paradigmas. Propõe-se uma história na contramão da tendência de abordar a curadoria de arte apenas a partir da segunda metade do século XX. Do cuidado com as coleções às exposições temporárias, a curadoria de arte especializou-se ao longo dos séculos e foi responsável por articular diferentes discursos de legitimação sobre a arte. Se num primeiro momento constituíram-se narrativas sobre a arte e os artistas, ao longo do século XX e das experiências de arte moderna o foco voltou-se para a formação de público e de quadros profissionais para os museus. A partir da década de 1960 ocorre a divisão de uma figura que antes era una: o conservador – ou curador de coleção – e o curador independente. Enquanto o primeiro passou a ser considerado um mero funcionário das instituições museológicas, o segundo ganhou protagonismo e estatuto de autor. A inclusão de experiências curatoriais realizadas no Brasil, em diferentes momentos históricos, serve como contraponto crítico às práticas curatoriais de arte realizadas nas instituições tradicionais europeias e estadunidenses, com vistas a uma abordagem que leve em conta o processo de globalização.

Antimicrobial resistance poses one of the most significant medical challenges for humanity. The current burden is overwhelming and is projected to escalate rapidly, with predictions for 2050 indicating 10 million deaths per year due to antibiotic-resistant microorganisms. Enhancing public awareness and education on this topic is crucial in efforts to mitigate this issue. In our study, we translated an existing questionnaire on antimicrobial resistance into Portuguese, validated it, and applied it between December 2020 and March 2021 to a group of Portuguese students (n = 112) and science teachers (n = 95). A majority of the students surveyed (65.1%) incorrectly believed that antibiotics could treat colds/flus. As anticipated, the teachers outperformed the students in the questionnaire. However, difficulties with this topic were evident in both groups. Most notably, the misconception that the human body becomes resistant to antibiotics was prevalent among most participants (77.0% of students and 68.4% of teachers). Consistent with previous studies in other populations and geographic locations, our research reveals a worrying lack of knowledge about antimicrobial resistance among Portuguese students and science teachers. Consequently, it is deemed urgent to implement effective measures to raise awareness and educate on this topic.

Madeira Island is an Atlantic island that was colonized by Portuguese in the year 1420. The first vineyards introduced in the island were Malmsey, imported from Greece, in the XV century leading to the production of liquorish wine, Madeira Wine. Recently, table wine is also produced. The present study aims to understand the contribution of Madeira Wine production on touristic experiences as well its role on landscape maintenance, local identity, natural resources conservation, job creation and economy. A questionnaire survey was delivered to tourists, and two semi-structured interviews: to a local wine producer- Quinta do Barbusano and a Chef- Dúlio Freitas respectively, on December 2018. In Quinta do Barbusano two red wines, two white wines and one Rosé are produced. Since 2018, Quinta do Barbusano promotes a new product “Wine tourism”, offering wine tastings, farm’s visits and a lunch providing regional gastronomy, using local products. Secondary data was also consulted, such as governmental and national Official statistical data, concerning Madeira Wine production and Madeira Wine commercialization. The results presented in this study reflect that Madeira Wine production can play a key role in sustainable tourism. The authors also featured as research limitations the need to improve survey sample size, as well the number of interviews in order to reach particularly relevant actors in this field.

Objetivo deste estudo é mapear e analisar os indicadores de sustentabilidade socioambientais na Comunidade de Rolim de Moura do Guaporé. Por meio de oficina de diálogos socioambientais, aplicação de questionário e visita técnica, construímos a matriz (PEIR) dos Indicadores de Sustentabilidade pela percepção da comunidade com base no proposto pela Organização de Cooperação e Desenvolvimento Econômico. Foram mapeados 48 indicadores, 17 das Pressões exercidas no meio ambiente, 17 de Estado e 14 de Resposta. Os indicadores de Impactos foram identificados 15 pela análise do atual estado do meio ambiente. Diante dos indicadores, sugere mudanças nas atuais políticas públicas aplicadas em comunidades tradicionais, promovendo uma gestão territorial participativa com auxílio da educação ambiental, contribuição técnica, visando minimizar as problemáticas ambientais.

Pheochromocytoma/paraganglioma (PPGL) are neuroendocrine tumors that can secrete catecholamines. The authors describe a challenging case who presented as stress cardiomyopathy and myocardial infarction (MI). A 76-year-old man, with a medical history of Parkinson’s disease, type 2 diabetes mellitus, hypertension, dyslipidaemia and a previous inferior MI in 2001, presented to the emergency department due to chest pain, headaches and vomiting. He also reported worsening blood glucose levels and increasing constipation over the preceding weeks. BP was 185/89 mmHg (no other relevant findings). EKG had ST segment depression in leads V2-V6, T troponin was 600 ng/L (

Seven species in the genus Medetera (Diptera: Dolichopodidae) are described here: Medetera aglaops sp. nov., Medetera corsicana sp. nov., Medetera gibbosipyga sp. nov., Medetera hispanica sp. nov., Medetera lusitana sp. nov., Medetera parva sp. nov., and Medetera rectipyga sp. nov. They all originate from the wider Mediterranean region in southwestern Europe (Iberian Peninsula, southern France, Corsica, Sardinia). The most striking feature in most of the species is the bi- or multicolour pattern of the eyes, most conspicuous in Medetera aglaops sp. nov. and Medetera lusitana sp. nov. This character is shared by the male and female sex and is thus not regarded as Male Secondary Sexual Character. All species belong to the Medetera apicalis species group sensu Bickel and are closely related based on shared characters in the hypandrium and cercus. Interestingly, three species with and four species without the basal pair of anterodorsal and posterodorsal bristles on the mid tibia are represented. This suggests that this diagnostic character has less phylogenetic relevance than previously anticipated. Unlike most Palaearctic Medetera, at least five of the new species are mostly found on rocky substrates in dry biotopes with a sclerophyllous vegetation. This further supports their relationship with species of the Medetera muralis subclade sensu Pollet, Germann and Bernasconi.

Liraglutide is a long-acting glucagon-like peptide-1 receptor agonist prescribed to diabetic patients for glycaemic control. To understand the impact of liraglutide in the real-world setting, this study analysed its effects in a Portuguese cohort of Type 2 diabetes patients. This was an observational, multicentric, and retrospective study that included 191 liraglutide-treated patients with at least 12 months of treatment. Patients’ data were collected and analysed during a 24-month follow-up period. Overall, liraglutide treatment effectively reduced HbA1c levels from 8.3% to around 7.5%, after 6, 12, and 24 months (p < 0.001). In fact, 38.2%, 37.2%, and 44.8% of patients at 6, 12, and 24 months, respectively, experienced an HbA1c reduction of at least 1%. Moreover, a persistent reduction in anthropometric features was also observed, with 44.0%, 47.6%, and 54.4% of patients achieving a weight reduction of at least 3% at 6, 12, and 24 months, respectively. Finally, significant improvements were observed in the HDL-c and LDL-c levels. Our results demonstrate that liraglutide effectively promoted the reduction of HbA1c values during routine clinical practice, which was sustained throughout the study. In addition, there were significant improvements in anthropometric parameters and other cardiovascular risk factors.

Critical review of Rafael Cardoso's book, "Modernity in Black and White", seeking to highlight the main issues tackled by the author. We searched to point out the issues that are inedit and original for art historiography in Brazil, as well as their parallels with other initiatives in and outside the country.

Introdução: A relaqueação da junção safeno-femoral é considerada um procedimento complexo e demorado, com risco de lesões linfáticas e neurológicas. As técnicas endovenosas para tratamento das varizes, a excisão de trajetos e a injeção de espuma substituíram a maioria das indicações para esta técnica. No entanto, ainda no deparamos com alguns doentes, em que essas técnicas não resolverão o problema, pelo que procurámos protocolar uma técnica de relaqueação da crossa que pudesse ser utilizada em ambulatório, com baixa taxa de complicações. Apresentamos aqui a nossa experiência. Materiais e métodos: Foram incluídos os doentes submetidos a re-laqueação da crossa da grande safena em 2015 e 2016 na nossa Unidade de Cirurgia do Ambulatório (UCA) Incluímos doentes sintomáticos (CEAP >3) com varizes significativas dependentes (mais de 3 mm de diâmetro e mais de 3 segundos de refluxo). Excluímos doentes com mais de 65 anos e obesos (IMC > 30), bem como doentes com mau estado de saúde e outras patologias que podem afetar o sucesso desta cirurgia. A topografia da veia varicose inclui 3 áreas: a área femoral, a coxa e a perna. Efetuámos todos os exames ultrassonográficos no nosso laboratório vascular para confirmar a recorrência da junção safeno-femoral e a sua correlação com as varizes. Recorremos ao teste de Brodie-Trendlemburg, associado ao eco doppler quando em dúvida. A técnica cirúrgica foi feita sob anestesia geral e consistiu numa incisão obliqua sobre a artéria femoral, isolamento da veia femoral superior à junção safeno-femoral, descendo distalmente e procedeu-se à laqueação da mesma na origem, junto à veia femoral, evitando o "cavernoma" venoso. Associaram-se, sempre que necessário, avulsão de trajetos. Resultados: Incluímos 67 doentes, com uma idade média de 48,8 anos e 83% eram do sexo feminino. 20% dos pacientes estavam no CEAP, enquanto os outros estavam no CEAP 4. A cirurgia consistiu em re-laqueação bilateral da crossa da grande safena em 20 % dos casos, relaqueação unilateral em 23, 5 % e relaqueação unilateral com outra cirurgia no membro contralateral em 56,5 % dos casos. O tempo médio de cirurgia, incluindo a excisão dos trajetos foi de 42,9 minutos, o que se enquadra nos tepos recomendados para cirurgia do ambulatório. A média total do tempo cirúrgico foi de 42,9 minutos. Todos os pacientes foram tratados na unidade de cirurgia ambulatória, mas 3 pacientes necessitaram de pernoita (2 porque viviam a mais de 100 km de distância e o outro devido à extensão das varizes). Nenhum paciente recorreu ao serviço de urgência ou foi hospitalizado devido a complicações precoces ou tardias. Apenas um paciente se queixou de parestesias, que cederam com medicação. Conclusão: Consideramos a seleção cautelosa dos pacientes, como extremamente, se não determinante para a cirurgia, sendo essencial a comprovação da recorrência de junção safeno-femoral, associada às varizes e CEAP acima de 3. A nossa técnica permite que a re-laqueação seja feita em ambulatório. A cirurgia de redo ainda pode ter lugar para o tratamento de alguns pacientes, com uma baixa taxa de complicações e uma duração razoável da cirurgia.

Résumé Contexte Bien que les récents progrès dans le traitement des cancers aient augmenté la survie des patients et amélioré leur qualité de vie, les effets secondaires sur la reproduction restent encore des motifs d’inquiétude. Une façon de réduire les altérations gonadiques consiste en l’utilisation de cytoprotecteurs. Dans le cancer du testicule, l’étoposide est habituellement utilisée en association avec d’autres agents, mais il n’existe aucune étude in vitro de l’exposition des spermatozoïdes à l’étoposide et à des cytoprotecteurs, notamment la N-acétylcystéine (NAC). Matériel et Méthodes Vingt échantillons de sperme ont été répartis en cinq groupes : témoins, incubés avec NAC seule, incubés avec étoposide seul, exposés séquentiellement à NAC puis à étoposide (pré traitement), et exposés séquentiellement à étoposide puis à NAC (post traitement). Les paramètres spermatiques, la condensation de la chromatine (bleu d’aniline), la fragmentation de l’ADN (TUNEL), le stress oxydatif (marquage OxyDNA) et la quantification du glutathion ont été utilisés pour évaluer les capacités de NAC comme agent prophylactique (pré traitement) ou comme améliorateur (post traitement) des effets causés sur les spermatozoïdes lors d’une exposition in vitro à l’étoposide. Résultats Aucun effet délétère n’a été observé sur la mobilité ou sur l’intégrité de la membrane des spermatozoïdes. Les résultats montrent que l’utilisation prophylactique (pré traitement) de NAC augmente les taux des spermatozoïdes avec chromatine immature en comparaison de l’utilisation amélioratrice (post traitement) de NAC, et augmente les taux de fragmentation de l’ADN des spermatozoïdes par rapport aux témoins. L’utilisation de NAC en pré et post traitement augmente les taux d’oxydation par rapport aux témoins, mais augmente aussi les taux de glutathion anti-oxydant cellulaire. Conclusions Les résultats indiquent que NAC possède la capacité de contrebalancer la toxicité induite par l’étoposide plutôt que celle d’empêcher les effets cytotoxiques de l’étoposide sur l’ADN des spermatozoïdes ; ceci suggère que l’administration de NAC aux cellules préalablement exposées à l’étoposide est préférable à son utilisation prophylactique. Comme les résultats témoignent que NAC semble être plus efficace à atténuer les effets cytotoxiques de l’étoposide sur les spermatozoïdes plutôt que d’être utilisée comme agent chimio prophylactique, ceci renforce l’idée qu’il pourrait exister un nouveau mécanisme de NAC sur l’ADN. Mots-clés N-acétylcystéine (NAC), Etoposide, Fragmentation de l’ADN spermatique, Stress oxydatif spermatique

Maize is the principal staple food/feed crop exposed to mycotoxins, and the co-occurrence of multiple mycotoxins and their metabolites has been well documented. This review presents the infection cycle, ecology, and plant-pathogen interactions of Aspergillus and Fusarium species in maize, and current knowledge on maize chain management to mitigate the occurrence of aflatoxins and fumonisins. Preventive actions include at pre-harvest, as part of cropping systems, at harvest, and at post-harvest, through storage, processing, and detoxification to minimize consumer exposure. Preventive actions in the field have been recognized as efficient for reducing the entrance of mycotoxins into production chains. Biological control of Aspergillus flavus has been recognized to minimize contamination with aflatoxins. Post-harvest maize grain management is also crucial to complete preventive actions, and has been made mandatory in government food and feed legislation.

Abstract Background We describe a female infant with Fragile-X syndrome, with a fully expanded FMR1 allele and preferential inactivation of the homologous X-chromosome carrying a de novo deletion. This unusual and rare case demonstrates the importance of a detailed genomic approach, the absence of which could be misguiding, and calls for reflection on the current clinical and diagnostic workup for developmental disabilities. Case presentation We present a female infant, referred for genetic testing due to psychomotor developmental delay without specific dysmorphic features or relevant family history. FMR1 mutation screening revealed a methylated full mutation and a normal but inactive FMR1 allele, which led to further investigation. Complete skewing of X-chromosome inactivation towards the paternally-inherited normal-sized FMR1 allele was found. No pathogenic variants were identified in the XIST promoter. Microarray analysis revealed a 439 kb deletion at Xq28, in a region known to be associated with extreme skewing of X-chromosome inactivation. Conclusions Overall results enable us to conclude that the developmental delay is the cumulative result of a methylated FMR1 full mutation on the active X-chromosome and the inactivation of the other homologue carrying the de novo 439 kb deletion. Our findings should be taken into consideration in future guidelines for the diagnostic workup on the diagnosis of intellectual disabilities, particularly in female infant cases.

Lithium-induced nephrogenic diabetes insipidus (Li-NDI) is a rare and difficult-to-treat condition. A study in mice and two recent papers describe the use of acetazolamide in Li-NDI in 7 patients (a case report and a 6 patient series). We describe the case of a 63-year-old woman with bipolar disorder treated with lithium and no previous history of diabetes insipidus. She was hospitalized due to a bowel obstruction and developed severe dehydration after surgery when she was water deprived. After desmopressin administration and unsuccessful thiazide and amiloride treatment, acetazolamide was administrated to control polyuria and hydroelectrolytic disorders without significant side effects. To our knowledge, this is the third publication on acetazolamide use in Li-NDI patients.

This article aims to present how women were represented in the newspaper A Tribuna, analyzing the local press discourse on the role and social place attributed to women in the 1980s, seeking to understand the forms of resistance and maintenance of order and of a male-dominated society, who still conceived the place of the woman in the private sphere of and the men in the public sphere. The newspaper A Tribuna began its circulation in the city of Rondonópolis on June 7, 1970 and circulates to the present day in printed format and since 2005 in print and digital format. This device transmits in its pages some stories that present the city of Rondonopolis with a strong emphasis on its economy since 1970, during which time it received a strong migratory flow from various regions of the country, highlighting the northeast and south regions.

Este artigo em duas partes (histórico e análise, seguida da parte de interpretação dos dados obtidos por técnicas analíticas) apresenta um estudo da obra Autorretrato (1919, óleo/tela, 100 x 65 cm) de Amedeo Modigliani, pertencente ao acervo do Museu de Arte Contemporânea da Universidade de São Paulo (MAC USP). Através do cotejamento entre a documentação de procedência da obra, fontes críticas de abordagem da pintura de Modigliani, com as análises técnico-científicas físico-químicas e de imageamento, foi possível reavaliá-la na articulação entre sua materialidade e sua composição, bem como lançar nova luz sobre sua recepção pela crítica dos anos 1950, quando ela chegou ao Brasil e circulou no contexto internacional por meio de publicações e exposições, já como parte de uma coleção brasileira.

The electricity produced through renewable resources is dependent on the variability of weather conditions and, thus, on the availability of the resource, as is the case with wind energy. This study aims to assess the wind resource available and the wind energy potential (WEP) during the December months for the three years 2017, 2018, and 2019, in southwestern Europe, when several high-impact storms affected the region. Additionally, a comparison of Prandtl’s logarithmic law and Power-law equations for extrapolation of the vertical wind profile is performed for onshore conditions, to evaluate the differences in terms of energy production, with the use of different equations. To assess the effect of the strong winds associated with the storms, 10 m wind components are used, with a 6-hourly temporal resolution, for the December months over the southwestern Europe region (30° N–65° N; 40° W–25° E). Results are compared to the climatology (1981–2010) and show an increase of wind intensity of 1.86 m·s−1 in southwestern Europe during December 2019, and a decrease up to 2.72 m·s−1 in December 2018. WEP is calculated for the selected wind turbine, 4 MW E-126 EP3—ENERCON, as well as the values following the wind resource record, that is, (i) higher values in December 2019 in the offshore and onshore regions, reaching 35 MWh and 20 MWh per day, respectively, and (ii) lower values in December 2018, with 35 MWh and 15 MWh per day for offshore and onshore. Differences in WEP when using the two equations for extrapolation of wind vertical profile reached 60% (40%) in offshore (onshore) regions, except for the Alps, where differences of up to 80% were reached. An additional analysis was made to understand the influence of the coefficients of soil roughness and friction used in each equation (Prandtl’s logarithmic law and Power-law), for the different conditions of onshore and offshore. Finally, it is notable that the highest values of wind energy production occurred on the stormy days affecting southwestern Europe. Therefore, we conclude that these high-impact storms had a positive effect on the wind energy production in this region.

This article aims to contribute to an exploration of the relations between familial memories and life course, especially stressing their dialogical and dynamic features. The focal point of this approach is the recognition that, on the one hand, family stories are subject to change over time and deeply rooted in personal biographies. On the other hand, the memory is a central element of the individual's life course, which itself involves the possibility to know, live, remember and share meaningful experiences. A family linked to fado serves as an empirical illustration.

Background: Resistant Hypertension (RH) is associated with an increased risk of cardiovascular events and poor prognosis. Exercise training studies in RH patients have shown promising outcomes, nonetheless, none determine the impact of exercise on endothelial damage and repair. Circulating endothelial cells (CECs) are a reliable indicator of vascular damage and dysfunction. Recent studies in hypertension suggest that increased levels of endothelial progenitor cells (EPCs), a marker of endothelial repair, are related to increased CECs in order to compensate endothelial damage. Purpose: This study aimed to determine the effect of 12-week aerobic exercise program on the percentage of EPCs and CECs in RH patients. Methods: Patients with RH were randomized to a 12-week aerobic exercise program (3 xs/week) (n = 13) and a usual care control group (n = 8). Outcome measures included clinical data, ambulatory blood pressure data and circulating levels of EPCs, hematopoietic stem cells (HSC) and CECs, quantified by flow cytometry. (ClinicalTrials.gov: NCT03090529). Results: Baseline characteristics were similar between groups, including the number of antihypertensive drugs (5.0 ± 0.9 vs. 4.8 ± 0.7, p = 0.517). After 12 weeks, no significant changes were found in the levels of HSCs in both groups. The levels of CECs decreased in the exercise group [0.0073 (0.0016)% to 0.0058 (0.0029), p = 0.019]; no changes were observed in the control group. EPC’s decreased only in the exercise group [0.0071 (0.0027)% to 0.0052 (0.0037)%, p = 0.046]. Conclusions: Exercise training reduces endothelial injury/damage (reduced CECs levels) in RH patients, a specific group who is a challenge for clinicians as the available treatment options have reduced success.