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Introduction: Cardiac surgery may induce acute kidney injury and the need for renal replacement therapy. It is also associated with higher hospital costs, morbidity and mortality. The aims of this study were to investigate predictors of cardiac surgery associated acute kidney injury in our population and to determine the burden of acute kidney injury in elective cardiac surgery, evaluating the potential cost effectiveness of preventing it through the application of the Kidney Disease: Improving Global Outcomes bundle of care to high-risk patient groups identified by the [TIMP-2]x[IGFBP7] used as a screening test. Material and Methods: In a University Hospital single-center retrospective cohort study we analyzed a consecutive sample of adults who underwent elective cardiac surgery between January and March 2015. A total of 276 patients were admitted during the study period. Data from all patients was analyzed until hospital discharge or the patient’s death. The economic analysis was performed from the hospital costs’ perspective. Results: Cardiac surgery associated acute kidney injury occurred in 86 patients (31%). After adjustment, higher preoperative serum creatinine (mg/L, ORadj = 1.09; 95% CI: 1.01 – 1.17), lower preoperative hemoglobin (g/dL, ORadj = 0.79; 95% CI: 0.67 – 0.94), chronic systemic hypertension (ORadj = 5.00; 95% CI: 1.67 – 15.02), an increase in cardiopulmonary bypass time (min, ORadj = 1.01; 95% CI: 1.00 – 1.01) and perioperative use of sodium nitroprusside (ORadj = 6.33; 95% CI: 1.80 – 22.28) remained significantly associated with cardiac surgery related acute kidney injury. The expected cumulative surplus cost for the hospital linked with cardiac surgery associated acute kidney injury (86 patients) was €120 695.84. Based on a median absolute risk reduction of 16.6%, by dosing kidney damage biomarkers in every patient and using preventive measures in high-risk patients, we would expect a break-even point upon screening 78 patients, which would translate, in our patient cohort, into an overall cost benefit of €7145. Conclusion: Preoperative hemoglobin, serum creatinine, systemic hypertension, cardiopulmonary bypass time and perioperative use of sodium nitroprusside were independent predictors of cardiac surgery associated acute kidney injury. Our cost-effectiveness modelling suggests that the use of kidney structural damage biomarkers combined with an early prevention strategy could be associated with potential cost savings.

Abstract Explicitly accounting for phenotypic differentiation together with environmental heterogeneity is crucial to understand the evolutionary dynamics in hybrid zones. Species showing intra-specific variation in phenotypic traits that meet across environmentally heterogeneous regions constitute excellent natural settings to study the role of phenotypic differentiation and environmental factors in shaping the spatial extent and patterns of admixture in hybrid zones. We studied three environmentally distinct contact zones where morphologically and reproductively divergent subspecies of Salamandra salamandra co-occur: the pueriparous S. s. bernardezi that is mostly parapatric to its three larviparous subspecies neighbours. We used a landscape genetics framework to: (i) characterise the spatial location and extent of each contact zone; (ii) assess patterns of introgression and hybridization between subspecies pairs; and (iii) examine the role of environmental heterogeneity in the evolutionary dynamics of hybrid zones. We found high levels of introgression between parity modes, and between distinct phenotypes, thus demonstrating the evolution to pueriparity alone or morphological differentiation do not lead to reproductive isolation between these highly divergent S. salamandra morphotypes. However, we detected substantial variation in patterns of hybridization across contact zones, being lower in the contact zone located on a topographically complex area. We highlight the importance of accounting for spatial environmental heterogeneity when studying evolutionary dynamics of hybrid zones.

Aims: The present study analysed the patterns of physical activity pre-, during and post-lockdown measures for COVID-19 pandemic in patients with chronic heart failure (CHF) and cardiac implantable electronic devices (CIED) under remote monitoring (RM), and assessed the physical activity patterns during these periods. Methods: The raw data from 95 patients with CHF (age 67,7 ± 15,1 years, 71,5% male) corresponding to 2238 RM transmissions of the Medtronic Carelink™ network platform was obtained. The physical exercise profiles and the impact of the lockdown measures on the physical behaviour during and after the measures were analysed. According to the level of activity duration in the pre-lockdown, lockdown and post-lockdown periods, the patterns of behaviour were identified (non-recoverees, incomplete recoverees, recoverees and full-recoverees). Conclusion: RM of CHF patients with CIED using the Carelink™ network is useful for close follow-up and identification of heart failure risk status variations. After relieving the confinement measures there were two groups of patients that did not recover the previous physical activity levels. Physical inactivity in patients with CHF can have a significant impact on outcomes.

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome with high mortality for which there is no proven therapy to improve its prognosis. Thyroid dysfunction is common in heart failure (HF) and is associated with worse prognosis. In this review, we discuss the cardiovascular effects of thyroid hormones, the pathophysiology of HFpEF, the prognostic impact of thyroid function, and the potential of thyroid hormones for treatment of HFpEF. Thyroid hormones have a central role in cardiovascular homeostasis, improving cardiac function through genomic and non-genomic mechanisms. Both overt and subclinical hypothyroidism are associated with increased risk of HF. Even when plasmatic thyroid hormones levels are normal, patients with HF may have local cardiac hypothyroidism due to upregulation of type 3 iodothyronine deiodinase. Thyroid hormones improve several pathophysiological mechanisms of HFpEF, including diastolic dysfunction and extra-cardiac abnormalities. Supplementation with thyroid hormones (levothyroxine and/or liothyronine), modulation of deiodinase activity, and heart-specific thyroid receptor agonists are potential therapeutic approaches for the treatment of HFpEF. Further preclinical and clinical studies are needed to clarify the role of thyroid hormones in the treatment of HFpEF.

The importance of the preservation of water resources has resulted in the application of technologies such as nanostructured materials, which are able to minimize the impact associated with water contamination. This work evaluated the application of polyamide-66 (PA) pellets functionalized with silver nanoparticles (AgNPs) at polymer mass percentages of 0.05, 0.10 and 0.50% to disinfect of drinking water. Studies were carried out in three stages. The first stage was the synthesis of the silver nanoparticles by using silver nitrate as a metal precursor and sodium borohydrate as a reduction agent. The colloidal dispersion was characterized by UV-Vis spectrophotometry and transmission electron microscopy (MET). Afterwards, the nanostructures were incorporated into a polyamide-66 polymeric matrix. In the second stage, the silver ions leached from the polymer matrix in the water after a three-hour period were quantified in order to evaluate the limit established by Conama Resolution 357/2005, which imposes a concentration limit of 0.010 mg L-1. The best results were obtained with the application of 0.05% AgNPs in the polymeric matrix, yielding an average concentration of silver ions lixiviated of 0.008 mg L-1. The last step comprised the quantification of the antibacterial activity of the polymer matrix containing 0.05% of AgNPs against the microorganism E. coli using the Standard Test Method for Determining the Antimicrobial Agents Under Dynamic Contact Conditions. The samples containing 0.05% of AgNPs exhibited an antibacterial reduction of 97.89% after 24 h of incubation under stirring at room temperature (25°C).

This work aimed to synthesize bacterial cellulose (BC) membranes functionalized with Ce(NO3)3 and silver nanoparticles (AgNPs) heat-treated in oven and autoclave. The AgNPs were characterized by TEM and the membranes were characterized by their rehydration capacity, Thermogravimetric Analysis (TGA), Scanning Electron Microscopy with Dispersive Energy Spectroscopy (SEM/EDS), Wide-angle X-ray Diffractometry (XRD), Atomic Absorption Spectroscopy (AAS), antimicrobial activity and cytotoxicity. The BC membranes were white to light yellow or brown indicating functionalization with AgNps with 20 nm. XRD detected a decrease in the degree of crystallinity in functionalized membranes. The autoclaved samples exhibited the largest porosity and good rehydration capacity. AAS showed Ag presence in all samples. The best antibacterial activity was achieved for the membrane’s oven treated with 40 ppm of AgNPs. Among the functionalized membranes, the most recommended to be used as burn dressing is the Ag40A and Ag20CN1.1A since they showed good porosity, good antimicrobial activity, and better suitable cell viability.

The present work developed an experimental and simulation study to evaluate the influence of some operational conditions and mold design on the efficiency of an injection process used to produce polystyrene parts. The software SolidWorks Plastic was used to simulate the injection process and assess the performance of the mold considering the absence and the presence of venting. Experimental results obtained by varying the injection pressure, injection temperature as well as the mold temperature were used to validate the simulation data generated considering both mold designs. The findings revealed air entrapment at the end of the mold cavity and low process efficiency when the mold was operated with no venting, regardless the processing conditions. Simulation results indicated a remarkable increase of the process efficiency when vents were included on the parting line of the mold. In addition, the range of processing conditions which led to the highest process efficiency was virtually identified and tested in the real modified mold (with venting system). The findings revealed that the injection cycle time reduced in approximately 35% and the waste generation diminished from 65% to less than 1% when venting was included in the mold design and the optimal operational conditions were used.

O Alimento contribui para o desenvolvimento e produz a nutrição deseja para o corpo humano. Na fase de formação do indivíduo, o alimento saudável é a amamentação, extraída do leite produzido pela mulher. Após a fase de amamentação, é introduzida o alimentos, onde a criança aprende sobre alguns tipos importantes de alimentos e seus sabores, nesta fase inicial de introdução é muito importante que os pais façam com que o consumo de certos alimentos, como frutas, verduras, carboidratos, grãos, cereais e água, seja prazeroso, para alimentação e a formação da criança, a partir do estudo, o objetivo deste trabalho é analisar os hábitos alimentares, comparando crianças de 01 (um) ano a 05 (cinco) anos de idade de áreas rurais e urbanas. Nesse contexto, buscou fundamentação teórica para embasamento do estudo, além da pesquisa qualitativa - quantitativa, por meio de questionários distribuídos aos pais das crianças. Portanto, eles concluem que mesmo as crianças que vivem em áreas rurais com acesso fácil e gratuito a inúmeras frutas e vegetais, muitas têm os mesmos hábitos alimentares que as crianças da cidade, os alimentos industrializados. No entanto, a pesquisa contribuiu para um debate sobre a formação de hábitos alimentares saudáveis visando a qualidade de vida das crianças.

Electrocardiogram signals acquired through a steering wheel could be the key to seamless, highly comfortable, and continuous human recognition in driving settings. This paper focuses on the enhancement of the unprecedented lesser quality of such signals, through the combination of Savitzky-Golay and moving average filters, followed by outlier detection and removal based on normalised cross-correlation and clustering, which was able to render ensemble heartbeats of significantly higher quality. Discrete Cosine Transform (DCT) and Haar transform features were extracted and fed to decision methods based on Support Vector Machines (SVM), k-Nearest Neighbours (kNN), Multilayer Perceptrons (MLP), and Gaussian Mixture Models - Universal Background Models (GMM-UBM) classifiers, for both identification and authentication tasks. Additional techniques of user-tuned authentication and past score weighting were also studied. The method’s performance was comparable to some of the best recent state-of-the-art methods (94.9% identification rate (IDR) and 2.66% authentication equal error rate (EER)), despite lesser results with scarce train data (70.9% IDR and 11.8% EER). It was concluded that the method was suitable for biometric recognition with driving electrocardiogram signals, and could, with future developments, be used on a continuous system in seamless and highly noisy settings.

Introdução: O xénon, um gás nobre, possui qualidades anestésicas, associadas a uma notável estabilidade hemodinâmica assim como propriedades cardioprotectoras e neuroprotectoras. As suas características físico-químicas conferem-lhe uma rápida indução e emergência anestésica, estando livre de efeitos deletérios importantes nos diversos orgãos e não apresentando teratogenicidade; o que suscitou um recente recrudescimento no interesse de aprofundar o conhecimento sobre este gás nobre, afim de compreender os seus mecanismos de acção e determinar as várias indicações que possui para a prática clínica. Material e Métodos: Revisão da literatura dos artigos considerados relevantes sobre o tema, com recurso à pesquisa de artigos indexados na Medline, com as palavras-chaves: xénon, xénon anestesia, xénon neuroproteção, xénon cardioproteção. Resultados: A aprovação do uso do xénon em doentes ASA I-II, ocorreu em Março 2007, após a realização de dois ensaios clínicos aleatorizados multicêntricos. No entanto, o seu uso na prática clínica, tem sido limitado pelo seu preço elevado. Parece pouco provável que as vantagens que oferece em relação aos restantes anestésicos justifique o seu uso em doentes ASA I-II. No entanto, poderá ser uma preciosa ajuda para a redução das co-morbilidades e mortalidade na anestesia de doentes ASA III-IV. As suas propriedades neuro e cardio-protectoras, são também alvo de intensa investigação, com resultados promissores. Discussão: Infelizmente, ainda não existem estudos de aleatorizados e multicêntricos que comprovem um perfil favorável do custobenefício do xénon em doentes ASA III-IV, em relação aos demais anestésicos. Conclusão: O lugar do xénon na Anestesiologia ainda se encontra por definir.

This paper presents a robotic team suited for bottom sediment sampling and retrieval in mudflats, targeting environmental monitoring tasks. The robotic team encompasses a four-wheel-steering ground vehicle, equipped with a drilling tool designed to be able to retain wet soil, and a multi-rotor aerial vehicle for dynamic aerial imagery acquisition. On-demand aerial imagery, properly fused on an aerial mosaic, is used by remote human operators for specifying the robotic mission and supervising its execution. This is crucial for the success of an environmental monitoring study, as often it depends on human expertise to ensure the statistical significance and accuracy of the sampling procedures. Although the literature is rich on environmental monitoring sampling procedures, in mudflats, there is a gap as regards including robotic elements. This paper closes this gap by also proposing a preliminary experimental protocol tailored to exploit the capabilities offered by the robotic system. Field trials in the south bank of the river Tagus’ estuary show the ability of the robotic system to successfully extract and transport bottom sediment samples for offline analysis. The results also show the efficiency of the extraction and the benefits when compared to (conventional) human-based sampling.

Melipona quadrifasciata quadrifasciata Lepeletier, 1836 (Mandaçaia) is a species of stingless bee, native in Brazil, that produces geopropolis, a physical mixture of propolis and clay, instead of producing conventional propolis. The present work aimed to chemically and thermally characterize Mandaçaia's geopropolis collected at Campo Alegre city, located in southern Brazil, and deepen the range of knowledge about its properties. The propolis extraction was carried out by hydroalcoholic maceration. Characterizations were performed using ultraviolet-visible spectrophotometry (UV-Vis), Fourier transformation infrared spectroscopy (FTIR), nuclear magnetic resonance spectroscopy (NMR), ultra-high performance liquid chromatography (UHPLC), thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). UV-Vis results demonstrated a total polyphenol content of 10.15 ± 0.24 mg GAE.g−1 and total flavonoid content of 22.51 ± 3.47 mg QE.g−1. Chemical species from phenolic compounds such as terpenes, diterpenes, and fatty acids were identified by UHPLC. In conclusion, data showed that Mandaçaia's geopropolis extract has a rich and diverse chemical composition which encourages new studies about its pharmaceutical, cosmetic, and food applications. [ABSTRACT FROM AUTHOR]

ABSTRACT Avulsion of the tibial tubercle is an uncommon injury that occurs in the young athlete, resulting from an eccentric contraction of the extensor mechanism with the leg fixed to the ground. Concomitant injuries to the patellar tendon are very rare, with few cases reported in the literature. The authors present a case of a 15-year-old basketball player who suffered an avulsion of the tibial tubercle associated with complete distal rupture of the patellar tendon while training. It was treated with open reduction of the tibial fragment and reconstruction of the patellar tendon with mini-anchors and cannulated screws, as well as hamstring autograft tendon reinforcement. The patient showed excellent results and returned to sports after 12 months of follow-up.

ABSTRACT BACKGROUND: The Norwich Patellar Instability (NPI) score is a tool for evaluating the impact of patellofemoral instability on joint function. It has not been translated or culturally adapted for the Brazilian population before. OBJECTIVE: This study had the aims of translating and culturally adapting the NPI score for use in Brazilian Portuguese and subsequently assessing its validity for this population. DESIGN AND SETTING: Translation, cross-cultural adaptation and validation study conducted at the State Public Servants’ Institute of São Paulo, Brazil. METHODS: Sixty patients of both sexes (aged 16-40 years) with diagnoses of patellar dislocation were recruited. The translation and cultural adaptation were undertaken through translation into Brazilian Portuguese and back-translation to English by an independent translator. Face validity was assessed by a committee of experts and by 20 patients. Concurrent validity was assessed through comparing the Brazilian Portuguese NPI score with the Brazilian Portuguese versions of the Lysholm knee score and the Kujala patellofemoral disorder score among the other 40 patients. Correlation analysis between the three scores was performed using Pearson correlation coefficients with significance levels of P < 0.05. RESULTS: The Brazilian Portuguese version of the NPI score showed moderate correlation with the Brazilian Portuguese versions of the Lysholm score (r = -0.56; 95% confidence interval, CI: -0.74 to -0.30; P < 0.01) and Kujala score (r = -0.57; 95% CI: -0.75 to -0.31; P < 0.01). CONCLUSION: The Brazilian Portuguese version of the NPI score is a validated tool for assessing patient-reported patellar instability for the Brazilian population.

Background: The non-alcoholic fatty liver disease is the hepatic counterpart of the metabolic syndrome. ZSF1 rats are a metabolic syndrome animal model in which liver changes have not been described yet. Aim: The characterization of liver histological and innate immunity changes in ZSF1 rats. Methods: Five groups of rats were included (n = 7 each group): healthy Wistar-Kyoto control rats (Ctrl), hypertensive ZSF1 lean (Ln), ZSF1 obese rats with a normal diet (Ob), ZSF1 obese rates with a high-fat diet (Ob-HFD), and ZSF1 obese rats with low-intensity exercise training (Ob-Ex). The animals were sacrificed at 20 weeks of age, their livers were collected for: a) measurements of the area of steatosis, fibrosis and inflammation (histomorphological analysis); and b) innate immunity (toll-like receptor [TLR] 2, TLR4, peroxisome proliferator-activated receptor γ [PPARγ], toll interacting protein [TOLLIP]) and inflammatory marker (tumor necrosis factor-alpha [TNFvs], interleukin 1 [IL-1]) expression analysis by real-time PCR. Results: Ob, Ob-HFD and Ob-Ex were significantly heavier than Ln and Ctrl animals. Ob, Ob-HFD and Ob-Ex animals had impaired glucose tolerance and insulin resistance. ZSF1 Ob, Ob-HFD and Ob-Ex presented a higher degree of steatosis (3,5x; p < 0.05) than Ctrl or ZSF1 Ln rats. Steatohepatitis and fibrosis were not observed in any of the groups. No differences in expression were observed between Ctrl, Ln and Ob animals (except for the significantly higher expression of TOLLIP observed in the Ob vs Ln comparison). Ob-HFD and Ob-Ex rats showed increased expression of PPARγ and TOLLIP as compared to other groups. However, both groups also showed increased expression of TLR2 and TLR4. Nevertheless, this did not translate into a differential expression of TNFα or IL-1 in any of the groups. Conclusion: The ZSF1 model is associated with liver steatosis but not with steatohepatitis or a significantly increased expression of innate immunity or inflammation markers.

ABSTRACT Acute compartment syndrome in athletes is a rare orthopedic emergency associated with strenuous exercise. It is often diagnosed late and can lead to severe complications and high morbidity. This report describes the case of a young soccer player with acute compartment syndrome with no history of trauma, diagnosed and treated 24 h after the onset of symptoms, through minimally invasive decompressive fasciotomy, with good postoperative evolution.