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INTRODUCTION: Arteriovenous Malformations (AVMs) are high-flow anomalous connections between the arterial and venous systems composed of dysplastic vessels resulting from aberrant angiogenesis. They are congenital and when symptomatic they rarely manifest before adolescence. Depending on the location, size, stage and severity of the symptoms, treatment options vary from conservative management to surgical resection. We report a case of a giant arteriovenous malformation of abdominal wall (tipe IIIb of Yakes Classification) treated with surgical resection after prior attempts of scleroembolization.. CLINICAL CASE: 54-year-old woman with known history of osteoarticular pathology and dyspepsia presented a mass on the left side of the abdominal wall with hard consistency, warm, slightly pulsating and tenderness to touch with several years of evolution. The mass showed infiltration of the internal and external oblique muscles sparing the transverse muscle. Clinically she presented easy fatigue with efforts. Due to the risk of abdominal wall herniation after excision of the AVM, scleroembolization was considered first-line treatment in this case. This strategy resulted in regression of the mass and symptoms improvement. Four years after the last intervention, the patient presented lesion growth, recurrence and worsening of symptoms with severe interference in the quality of life (QoL). After multidisciplinary discussion, she was proposed for complete resection of the AVM. She was first submitted to scleroembolization with Onyx of identified arterial afferents and sclerosis of the lesion nidus with 2% polidocanol. One month after she underwent successfully total resection of the AVM with the collaboration of General Surgery. CONCLUSION: No unified agreement exists on the best treatment of these complex high flow lesions and it is difficult to establish a comprehensive strategy given the pathology’s clinical variability, complex stratification and the risk of relapse. A case-by-case approach is needed in managing these types of lesions.

Objective: Portuguese nationwide estimates indicate that 20% of abdominal aortic aneurysms (AAAs) are treated when ruptured. In these cases, intra-operative unfractionated heparin (UFH) usage rates vary widely. Evidence on this topic is scarce and focused on patients treated by open repair (OSR). The aim was to determine the influence of UFH on peri-operative thromboembolic events (TEs) and death in a cohort of ruptured AAA (rAAA). Methods: Retrospective, single-centre, comparative study. From 2011 to April 2023, all consecutive rAAAs (endovascular repair [EVAR] and OSR) were considered. Primary outcomes were 30-day TE free survival and TE rates. The secondary outcome was 30-day death. Safety endpoints were procedural blood loss, blood product requirements, and secondary interventions due to haemorrhage. Using propensity score matching (PSM) each UFH patient was matched with one no UFH patient in a 1:1 ratio. Results: The study included 250 patients. After PSM, 190 patients were analysed (EVAR: 60.0% no-UFH vs. 64.4% UFH). TE free survival estimates favoured the UFH group (67.3% vs. 47.2%, p = .009; UFH adjusted odds ratio [aOR] 2.01, 95% confidence interval [CI] 1.04–4.17). TEs were more frequent in the no UFH group (20.0% vs. 44.2% patients, p < .001; UFH aOR 0.31, 95% CI 0.15–0.65 for any TE), driven by an increase in bowel ischaemia (17.9% no UFH vs. 3.2% UFH, p = .001). Most events occurred in the first 72 hours. EVAR was associated with reduced TE and improved TE free survival (aOR 0.20, 95% CI 0.09–0.45 and aOR 5.54, 95% CI 2.34–13.08, respectively). No significant differences in 30-day survival were noted (75% no-UFH vs. 83% UFH, p = .26; aOR 1.08, 95% CI 0.48–2.43) nor in blood loss, peri-operative red blood cell and fresh frozen plasma requirements, or secondary interventions due to haemorrhage (p = .10; p = .11; p = .13 and p = .18 respectively). Conclusion: In this cohort, intra-operative UFH was safe and associated with improved TE free survival, driven by a reduction in bowel ischaemia. Conversely, mortality remained unaffected. Randomised controlled trials are required to confirm these findings.

INTRODUCTION: After endovascular aortic repair (EVAR), many patients develop a systemic inflammatory response called post-implantation syndrome (PIS). AAA and procedure-related characteristics have been linked with increased odds of developing this syndrome. Similarly, some short- and long-term consequences have been associated with PIS. This study aims to review the literature on the diagnosis and predictors of post-implantation after endovascular repair of aortic aneurysms. RESULTS: A non-systematic review of the MEDLINE and Scopus databases was performed using the keywords "abdominal aortic aneurysm," "inflammation," and "endovascular techniques.” No time or language limitations were imposed. Manuscripts were considered irrespective of study design. Articles of interest were analyzed, and the relevant information was organized in tables. RESULTS: PIS is defined as a combination of constitutional symptoms, including fatigue and fever, and elevated inflammatory markers. There are several proposed diagnostic criteria, most including a combination of fever with leukocytosis and/or elevated C-reactive protein (CRP). These result in discrepant rates, as low as 2% and up to 100%. The typical evolution of this syndrome is spontaneous resolution, although pharmacologic measures for symptom relief may be needed. These symptoms often resolve within two weeks; no significant permanent complications remain. Most PIS cases will present up to the first 72 postoperative hours. Endograft material, particularly polyester-based stent grafts, has been consistently linked to increased odds of PIS, up to five-fold, compared to polytetrafluoroethylene (PTFE) grafts. Aneurysm thrombus load (both pre-existing and new-onset) has also been related to an increased odds of PIS. Bacterial translocation, contrast media, and other patient or procedure-related characteristics have not been linked to an increased risk of PIS. CONCLUSION: PIS is a common finding after EVAR. Universal diagnostic criteria for diagnosis are required. Polyester-based stent grafts present the highest risk of developing this syndrome. Aneurysm thrombus load may also relate to this increased risk. The impact of other clinical or anatomical factors remains undetermined.

INTRODUCTION: Portuguese estimates point out that nearly 20% of aortic aneurysms are treated in a ruptured setting, with in-hospital mortality reaching up to 50%. Although unfractionated heparin (UFH) is routine during elective surgery, this technical point is debatable when treating ruptured aneurysms. The authors aimed to review the literature on the topic of intraoperative heparinization with UFH within the intraoperative period of ruptured aortic aneurysms. METHODS: A MEDLINE and Scopus database search using the terms “unfractionated heparin," “aortic aneurysm," and “ruptured aortic aneurysm” was performed. No time or language limitations were imposed. The last search was run in July 2023. Manuscripts were considered irrespective of study design. Additional articles of scientific interest for the purpose of this non-systematic review were included by cross-referencing. RESULTS: In the rupture setting, UFH usage rates have widely varied throughout time and geographical sites, and they are reported to be as low as 16%. Overall, the evidence of UFH in clinical practice in this scenario is limited. Notwithstanding, there is some evidence from observational studies of an increased pro-coagulant activity in this clinical scenario, favoring a theoretical physiologic benefit. A prospective, non-randomized study of 131 OSR patients found that patients treated with UFH had improved 30-day survival (84% vs 67%, P=0.001). Non-significant differences in blood product usage were noted. Therefore, societal guideline recommendations about intraoperative UFH in ruptured aortic aneurysms are often missing. CONCLUSION: UFH may potentially reduce death after open repair of rAAA. These findings should be carefully interpreted, as the evidence is scarce and heterogeneous and only portrays open repair.

BACKGROUND: Vascular malformations are a heterogeneous group of vascular development disorders with historically few treatment options. Recent studies have shown the potential benefit of mTOR inhibitors—such as sirolimus—in their treatment, particularly in low-flow malformations. However, reports on their efficacy in highflow malformations are scarce and controversial. We report the case of a patient with a combined malformation who benefited from treatment with sirolimus. REPORT: A three-year-old patient was referred to our center with a diffuse and progressive vascular malformation on her right leg, difficult to classify according to ISSVA, with disabling pain, limb deformity, and walking impairment. The initial MRI showed a diffuse malformation on the deep subcutaneous tissue without muscle or bone involvement, measuring 18cm on the largest axis. A progressive clinical worsening occurred, and after discussion with an international reference center in vascular malformations, it was classified as a diffuse vascular malformation with the involvement of contiguous structures without defined borders, with both a low and high-flow component. The high-flow component now behaves like a type IV Yakes AVM. Nevertheless, longterm therapy with sirolimus was instituted when the patient was nine years old, resulting in complete remission of pain, recovery of walking ability, and partial recovery of knee valgus. No side effects were reported. With 38 months of follow-up, the 13-year-old remains pain-free and has improved quality of life despite no imagological improvement. CONCLUSION: Although the available evidence for mTOR inhibitors is mainly for low-flow malformations, it may be a safe and effective option for selected high-flow malformations when intervention is not possible or carries significant morbidity risks. Some studies showed a reduction in the size of the malformation with treatment; however, this was not the case in our patient, notwithstanding the clear improvement in quality of life for four years without other intervention.

Complex anatomical restrictions can lead to further interventions after the emergence of a postoperative aneurysm enlargement in thoracic endovascular aortic repair (TEVAR) for a thoracoabdominal aortic aneurysm (TAAA). A 75-year-old male underwent a TEVAR for a Crawford extent I TAAA. The main device and the distal extension were placed using a fenestrated technique, outside of the instructions for use. The aneurysm expanded because of an endoleak and stent graft migration; and was surgically repaired by fully salvaging the previous endografts 38 months after the first TEVAR. However, the distal extension, which was the proximal anastomosis site with a prosthetic graft, became completely dislocated from the main device eight months after the open surgical conversion, resulting again in the enlargement of the aneurysm. An additional TEVAR was successfully performed to correct the dislocated stent graft. An appropriate treatment strategy is crucial to prevent multiple reinterventions for TAAA with complex anatomical restrictions.

There is a lack of multi-session P300 datasets for Brain-Computer Interfaces (BCI). Publicly available datasets are usually limited by small number of participants with few BCI sessions. In this sense, the lack of large, comprehensive datasets with various individuals and multiple sessions has limited advances in the development of more effective data processing and analysis methods for BCI systems. This is particularly evident to explore the feasibility of deep learning methods that require large datasets. Here we present the BCIAUT-P300 dataset, containing 15 autism spectrum disorder individuals undergoing 7 sessions of P300-based BCI joint-attention training, for a total of 105 sessions. The dataset was used for the 2019 IFMBE Scientific Challenge organized during MEDICON 2019 where, in two phases, teams from all over the world tried to achieve the best possible object-detection accuracy based on the P300 signals. This paper presents the characteristics of the dataset and the approaches followed by the 9 finalist teams during the competition. The winner obtained an average accuracy of 92.3% with a convolutional neural network based on EEGNet. The dataset is now publicly released and stands as a benchmark for future P300-based BCI algorithms based on multiple session data.

Este trabalho apresenta uma abordagem computacional paralela que visa a ampliação da área de cobertura e/ou da série temporal a ser simulada pelo modelo de crescimento da cultura do trigo chamado de CSM-Cropsim: Wheat. A abordagem de paralelização da execução do modelo escolhida foi a mestre-escravo, juntamente com a utilização da biblioteca de comunicação MPI, que mostrou ser adequada, visto que cada uma das execuções (rodadas do modelo) são independentes dos resultados das outras no modelo avaliado. Os resultados obtidos com os testes realizados demonstraram-se satisfatórios, demonstrando a validade da aplicação desta abordagem na execução em larga escala do CSM-Cropsim: Wheat.

The DSSAT is a collection of computer programs and tools integrated into a single software package in order to facilitate the application of crop simulation models in research and decision making. The DSSAT Shell, an user interface program, enables users to easily select and use any of the DSSAT components. It reads text files, both input and output with fixed width format, to provide information to the users and to be able to run the models. The logic to read DSSAT files and process the information to display to the user relies on the Shell itself and cannot be reusable by any other system, which makes it harder to implement alternatives for the DSSAT Shell since there are no frameworks available that implements the complexity of processing DSSAT files. The DSSAT tools were built using old programming technologies such Visual Basic which is in end-of-life support and Delphi, these technologies should be replaced for a modern and standardized software development approach for a better maintainability. Besides, these tools are stand-alone and they do not share code which increases the effort to maintain them. This work presents the jDSSAT, a multiplatform JavaScript module. The jDSSAT provides a standard and reusable approach for reading and processing DSSAT files. Through this approach, we isolate the complexity of processing DSSAT files to allow DSSAT integration on any environment. It also integrates with DSSAT-CSM to make it easier to run DSSAT models in Linux, Windows and MacOS. As a result, we present a multiplatform user interface prototype created to run DSSAT crop models using the main features of the jDSSAT. Also, the integration with the R environment that expands the possibilities of the DSSAT integration. Keywords: DSSAT, Crop simulation, JavaScript

Deficits in the interpretation of others' intentions from gaze-direction or other social attention cues are well-recognized in ASD. Here we investigated whether an EEG brain computer interface (BCI) can be used to train social cognition skills in ASD patients. We performed a single-arm feasibility clinical trial and enrolled 15 participants (mean age 22y 2m) with high-functioning ASD (mean full-scale IQ 103). Participants were submitted to a BCI training paradigm using a virtual reality interface over seven sessions spread over 4 months. The first four sessions occurred weekly, and the remainder monthly. In each session, the subject was asked to identify objects of interest based on the gaze direction of an avatar. Attentional responses were extracted from the EEG P300 component. A final follow-up assessment was performed 6-months after the last session. To analyze responses to joint attention cues participants were assessed pre and post intervention and in the follow-up, using an ecologic “Joint-attention task.” We used eye-tracking to identify the number of social attention items that a patient could accurately identify from an avatar's action cues (e.g., looking, pointing at). As secondary outcome measures we used the Autism Treatment Evaluation Checklist (ATEC) and the Vineland Adaptive Behavior Scale (VABS). Neuropsychological measures related to mood and depression were also assessed. In sum, we observed a decrease in total ATEC and rated autism symptoms (Sociability; Sensory/Cognitive Awareness; Health/Physical/Behavior); an evident improvement in Adapted Behavior Composite and in the DLS subarea from VABS; a decrease in Depression (from POMS) and in mood disturbance/depression (BDI). BCI online performance and tolerance were stable along the intervention. Average P300 amplitude and alpha power were also preserved across sessions. We have demonstrated the feasibility of BCI in this kind of intervention in ASD. Participants engage successfully and consistently in the task. Although the primary outcome (rate of automatic responses to joint attention cues) did not show changes, most secondary neuropsychological outcome measures showed improvement, yielding promise for a future efficacy trial.(clinical-trial ID: NCT02445625—clinicaltrials.gov).

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Objetivo: Caracterizar a forma como os Médicos de Família Portugueses percebem e integram a perspetiva psicossomática na sua prática clínica. Tipo de estudo: Estudo transversal. Local/População: Médicos especialistas em Medicina Geral e Familiar a exercer em Portugal (amostra de conveniência). Método: Aplicou-se um questionário de autopreenchimento, entre agosto e novembro de 2013. Resultados: Foram incluídos 100 médicos (77% do sexo feminino), com idades entre os 26 e os 70 anos. Os sujeitos fazem por integrar a perspetiva psicossomática na sua prática clínica e concordam com a definição de psicossomática apresentada. Conclusões: Encontrámos indicadores no sentido da pertinência e necessidade de maior informação e orientação dos médicos de medicina geral e familiar.

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Introdução: A acne é uma doença com consequências psicológicas nos pacientes, alicerçadas em fatores pessoais e sociais, as quais influenciam decisivamente a qualidade de vida. A falta de informação contribui e alimenta a proliferação de crenças e mal entendidos sobre a acne que, apesar de não terem evidência científica que os comprove, encontram apoio popular na sua mistificação, em todo o mundo. Material e Métodos: O presente estudo baseou-se em 75 entrevistas semiestruturadas, 45 a pacientes com experiência de ter acne e 30 a profissionais de saúde portugueses, e pretende contribuir para uma melhor compreensão da acne em Portugal, criando um instrumento que possa identificar as principais convicções dos indivíduos sobre a acne, enquadradas em três dimensões: crenças, comportamentos e tratamento. Resultados: Identificámos alguns fatores que são transversais a várias crenças em diversos países quanto à sua influência sobre a acne: a dieta, o stresse e a falta de higiene como causas do agravamento da doença, a luz solar e a lavagem da face, como agentes atenuantes da mesma doença. Conclusões: É importante saber em que medida os sujeitos com acne se informam, procuram tratamento e como decorre esse tratamento. Ter um instrumento descritivo que possa recolher a informação das atitudes dos pacientes face à acne pode facilitar a sistematização e o tratamento dos dados, no sentido de compreender e melhorar a educação dos pacientes.

The CPTEC, Centro de Previsão de Tempo e Estudos Climáticos, provides information about forecast for all Brazilian territory, however, only restricted part of the society has enough knowledge to get and manipulate these kind of data. Therefore, this paper has as goal to present a computational structure capable to supply information about forecasts, through the use of technologies and georeferentials data. The tests, prototypes and validations show the functionalities, viability and usability of this solution.

O desenvolvimento de modelos de simulação na agricultura, assim como em outras áreas, requer uma análise profunda do sistema em estudo, sendo crucial o emprego de métodos e ferramentas de engenharia de software. A modularidade e a forma genérica são os termos que descrevem a nova e amplamente aceita metodologia para superar as complexidades no desenvolvimento e reúso de modelos. A arquitetura MVC (Model-View-Controler), um padrão de projeto amplamente aceito no desenvolvimento de software, auxilia na definição das regras e responsabilidades dos objetos num sistema, possibilitando o desenvolvimento de aplicações com fluxo simplificado, robusto, flexível e de fácil manutenção. Um dos principais aspectos do MVC reside na separação entre os módulos da aplicação, de forma a possibilitar o reaproveitamento e o desenvolvimento genérico de modelos. Este artigo tem como objetivo apresentar uma estrutura para o desenvolvimento de simuladores de doenças de plantas, acoplados a modelos de crescimento, com a utilização extensiva de padrões de projeto orientados a objetos. Com os resultados, observou-se que a aplicação de técnicas e padrões no desenvolvimento de sistemas complexos, como os modelos de simulação, os tornam mais robustos, bem documentados, reusáveis, compatíveis e facilmente acopláveis a outras soluções já existentes.

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ABSTRACT: Long bone fractures are commonly in surgery routine and several bone imobilization techniques are currently available. Technological progress has enabled to use low cost materials in surgical procedures. Thus, the aim of this study was to evaluate the applicability of polyamide 12 rods, solid and hollow in swine femurs, comparing them through flexion strength. This study had as second aim to fix the locking errors, commom place in interlocking nails, once polyamide 12 allows perforation in any direction by orthopaedic screw. Six groups were used: G1 - eight whole swine femurs; G2 - eight whole swine femurs with drilled medullary canal; G3 - two solid polyamide 12 rods; G4 - two hollow polyamide 12 rods; G5 - eight osteotomized drilled swine femurs with a solid polyamide 12 rod implanted in the medullary canal and locked by four 316L stainless steel screws; and G6 - similar to G5 but using hollow rods instead of solid ones. No significant differences were observed for the modulus of rupture between solid and hollow rods, demonstrating that both rods had similar performances. These results led to the speculation that the addition of other polymers to the hollow rods could increase their strength and thus the bone-implant system. Furthermore, the comparison between G1, G5 and G6 could be analyzed using the finite element method in future. New polymeric materials may be developed based on the data from this study, strengthening the bone-implant system and making possible screws to be placed in any direction, nullifying the detrimental forces on the fracture site.