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DRUG DESIGN AGAINST COVID-19: A REMOTE TEACHING EXPERIENCE IN PHARMACEUTICAL CHEMISTRY. Infront of with the difficulties faced in making a new drug available to the population, it is essential to seek ways to simplify the process. In silico methodologies are alternatives to benchtop experiments, being frequently used due to their speed and low cost. The present study aimed to formulate a theoretical-practical activity in the Pharmaceutical Chemistry course, where students applied their knowledge of structural modeling and molecular docking to propose bioactive compounds against molecular targets of the SARS-CoV-2 virus. The class was divided, and each group presented a drug candidate, the precursors being natural molecules. In total, seven derivatives were designed and tested against different macromolecules, and then an in silico prediction of their physicochemical characteristics was performed. The docking results were positive for all derivatives, in terms of binding energy, mainly GEND with –9.0 kcal mol-1. In addition, the prototypes exhibited good interactions with the amino acids of the respective targets, mainly KAED, QUED and GEND, in addition to presenting adequate physicochemical properties for meeting the Lipinski restrictions. Therefore, this study presented at least three potential inhibitors of SARS-CoV-2, showing the importance of using computational tools in drug design and development, as well as in teaching practice.

How could writers fail to love a world which has been mapped by stories?Salman Rushdie, "Traveling with Chatwin" in Imaginary Homelands (1991) No início da década de 80 e durante dois anos, Kathleen Stewart habitou um espaço imaginado enquanto periferia (um lugar de atraso, na narrativa dominante da América do progresso). No estado norte-americano da Virgínia Ocidental, foi encontrar um universo em falência, encerradas que estavam as minas de carvão – outrora o sustento económico dos Apalache...

No passado ano de 2000, o Metropolitan Museum of Art apresentou em Nova Iorque uma exposição dedicada ao fotógrafo norte-americano Walker Evans (1903-1975) intitulada Perfect Documents. O livro homónimo que serve de pretexto à presente recensão foi então publicado como catálogo e nele consta um estudo bastante breve de Virginia-Lee Webb sobre o portfólio que Evans realizou em 1935 para divulgação didáctica de um acontecimento expositivo promovido pelo Museum of Modern Art (MOMA). Nesse ano o ...

Nicholas Thomas, australiano, e Johannes Fabian, alemão, são antropólogos com extensa obra publicada e larga divulgação nos meios académicos. Os trabalhos de Thomas no domínio dos estudos da cultura material dos povos oceânicos (nomeadamente Entangled Objects, 1991) e as reflexões críticas de Fabian sobre a retórica etnográfica (Time and the Other, 1983; Time and the Work of Anthropology, 1991) são sobejamente conhecidos dos analistas culturais, tendo obtido notoriedade além dos limites dos c...

presença e a atividade do intermediário tem-se desenvolvido de forma relevante nos últimos anos. Há alguns anos atrás não se verificava uma presença marcante de intermediários como acontece atualmente. Tinha uma intervenção reduzida enquanto hoje em dia tem uma presença ativa e fundamental para o mercado de futebol. Apesar da função ser cada vez mais reconhecida, a informação sobre a atividade e serviços prestados ainda é escassa, existindo um estigma por parte da sociedade em geral quando se aborda a atividade do intermediário de futebol. N/A

This chapter is about Iran’s foreign policy responses to political and security developments in Afghanistan, from the Soviet intervention in 1979 until February 2020, when an agreement was signed between the U.S. and Taliban officials. The study is structured along four periods corresponding to key changes in the Afghan political order and consequent political rearrangement of forces In Kabul. It identifies the rationale behind Teheran’s foreign policy choices to face changes in the political regime in Afghanistan. The chapter discusses the reasons why Iran struggles to increase political influence in Afghanistan, and the strategic options followed by Tehran to reach its goals. For each period, the study addresses the relations that Tehran kept with three different groups of Afghan players: the authorities, the opposition groups (political and military), and the foreign powers with a vested interest in the outcome of the conflict and with an active involvement therein. Iran is considered a rational and pragmatic actor whose relations with Afghanistan aimed, first and foremost, at ensuring its security and preserving the country’s sovereignty, territorial integrity, and national unity. Teheran has promoted a politically stable Afghanistan with a Government that does not run against its interests and does not threaten its national security and has adapted its alliance policies according to the political forces prevailing in Kabul, irrespectively of their ethnic and political background, often against the interests of the Afghan Shia communities. Iran’s policies are fundamentally driven to limiting its opponents’ influence over the Afghan elites and reduce the threat they may pose to Iran’s national security. Iran has neither a hegemonic ambition in Afghanistan nor wants to export a political ideology throughout the region by following a sectarian approach and using its perceived leverage upon Shia groups. As an ultimate ratio, Iran’s exercise of influence reaching out to the elites of all ethnic parties aims at preserving its security.

Quadricuspid aortic valve (QAV) is a rare congenital condition that frequently progresses to aortic regurgitation with clinical impact in adulthood. Surgical treatment is required in the fifth to sixth decade of life in about one fifth of patients.We describe the case of a 64-year-old woman with regular cardiological follow-up for severe aortic valve regurgitation who had suffered recent clinical and echocardiographic deterioration. Conventional open surgery was indicated. During the procedure, a QAV with leaflet retraction and central orifice was observed. The aortic valve was successfully replaced. Resumo: A válvula aórtica quadricúspide é uma malformação congênita rara. A progressão para insuficiência aórtica com significado clínico é frequente na idade adulta. O tratamento cirúrgico, quando indicado, tem habitualmente lugar por volta da quinta ou sexta décadas de vida em cerca de um quinto dos doentes.Descrevemos o caso clínico de uma doente de 64 anos com diagnóstico de regurgitação valvular aórtica severa e deterioração clínica e ecocardiográfica, reunindo critérios para cirurgia convencional. Durante a cirurgia, observou-se uma válvula aórtica composta por quatro folhetos independentes, retraídos e com má coaptação central. O procedimento decorreu sem intercorrências.

Introduction: Spondylodiscitis is a rare infection of the intervertebral disc and nearby bone structures, which incidence has been increasing in the past decades. Conservative treatment is the gold standard, but sometimes surgery is needed to relief the symptoms and eradicate the infection, preserve the neurological function, and restore structural alignment and stability. Case presentation: The authors present a clinical case of a 73-year-old-male with T11-12 and L4-L5 spondylodiscitis with an epidural collection at this last level, treated surgically with an interlaminar endoscopic debridement and posterior percutaneous instrumentation after failing of isolated medical treatment. Discussion: The diagnosis of spondylodiscitis may sometimes be difficult due to its non-specific symptoms and sometimes inconclusive blood tests. Endoscopic surgery along with posterior percutaneous instrumentation provides a minimally invasive surgical option in multimorbid patients and/or in early stages of the disease, reducing the surgical trauma, complications and fastening the recovery. Conclusion: Spondylodiscitis is a highly heterogeneous disease, remaining its diagnosis and treatment a complex challenge. With this case report the authors expect to raise awareness to the use of minimally invasive techniques in treating diseases of this type.

Case A 37-year-old man presented after a sudden snap followed by pain in the medial side of the ankle while playing football. Physical examination showed edema and pain posteriorly to the medial malleolus, and a longitudinal structure was palpable anteriorly. Ultrasound confirmed a dislocated tibialis posterior tendon (TPT). The patient underwent surgery, and the flexor retinaculum was repaired. Six months after the surgery, he was asymptomatic and had resumed his usual physical activity, with an AOFAS score of 100. Conclusion TPT dislocation is rare and orthopaedic surgeons should be aware of this condition in patients with a sudden traumatic medial ankle pain.

Hip fractures are very common in adults, but are rare entities in children, comprising less than 1% of all pediatric fractures. The authors present a clinical case of a 6-year-old girl with an intertrochanteric hip fracture — displaced Delbet’s type IV — treated with a pediatric sliding hip screw. The osteosynthesis material was removed 10 months later. The Delbet type IV hip fractures corresponds to 12% of all pediatric hip fractures. This type of fractures in children older than 3 years old should be treated with internal fixation with a sliding hip screw or a proximal femur locking plate. Preferably the reduction of the fracture should be done within 24 hours. Despite the delay of the surgical procedure, the patient got an excellent recovery without any of the complications described in the literature with a follow-up of 26 months upon the implant-removal surgery.

OBJECTIVES Intraoperative transesophageal echocardiography (iTEE) has an important role in diagnosing the results of mitral valve (MV) replacement and repair. However, intraoperative Doppler features may be dissimilar from those measured at the postoperative follow-up period due to hemodynamic variations. There are no studies regarding MV surgery and comparisons between iTTE and postoperative transthoracic echocardiography (post-TTE). We aimed to evaluate the Doppler flow profiles observed in iTEE after MV replacement and repair and compare them with those observed in post-TTE.METHODS We conducted an observational study of 76 patients who underwent MV surgery (replacement or repair) over a 10-month period. iTEE was performed with Doppler evaluation (mean pressure gradient [MPG] and functional area). Patients were re-evaluated with TTE 72 hours after surgery (post-TTE). iTEE and post-TTE Doppler values were then compared and correlated.RESULTS The patients’ mean age was 59 ± 18 years and 55% were women. The prevalence of severe mitral regurgitation and severe mitral stenosis was 77.6% and 22.4%, respectively. MV repair was performed in 71% of cases. iTEE Doppler parameters correlated with post-TTE parameters, with minimal differences, specially in the MV repair group. The postoperative MPG was +0.4 ± 1 mmHg higher in the MV repair group and +1.0 ± 1.8 mmHg in the MV replacement group. There was global improvement in terms of systolic pulmonary artery pressure, although left ventricular ejection fractions were slightly reduced during the postoperative evaluation.CONCLUSIONS Our study demonstrates the usefulness of iTEE and its importance in establishing possible reference values for postoperative follow-ups.

Introduction: Guidelines recommend lobectomy for early-stage non-small cell lung cancer(NSCLC). However, comorbidities and lung function can limit resection in older patients. We aimed to evaluate the outcomes of sublobar resection(SLR) on elderly patients. Methods: We assessed all patients aged over 70 years submitted to complete resection for early-stage NSCLC over a 5-year period in our centre. We compared SLR and non-SLR groups on demographics, smoking, performance status, comorbidities, lung function, preoperative blood tests, histology, staging, ressected lymph nodes (LN), margins, and postoperative complications. Disease-free survival(DFS) and overall survival(OS) were assessed and compared. Survival was analyzed using univariate log-rank and multivariate Cox tests. Results: SLR was performed in 18 (24.3%) of 74 patients. Non-SLR patients had more resected LN (p=0.04). 5-year DFS was 70%(CI 52 to 81) in non-SLR and 91%(CI 51 to 99) in SLR group. Procedure was not an independent DFS predictor. On the univariable analysis, albumin (p=0.045), C-reactive protein (CRP) (p=0.042) and pleural invasion (p=0.012) were predictors. On multivariable analysis, only albumin (p=0.020), platelets (p=0.032) and pleural invasion (p=0.013) remained. 5-year OS was 55%(CI 35 to 71) in non-SLR and 77%(CI 44 to 92) in SLR group. Procedure was not an OS predictor. A positive association was found with pleural invasion (p=0.006) on univariable analysis; and pleural invasion (p=0.028) and CRP (p=0.048) on multivariate analysis. Conclusion: Survival was not dependent on procedure type in our elderly population. This data is in line with the effectiveness of SLR in this age group and reinforces it as an alternative to lobectomy.

An osteochondroma is a type of cartilaginous tumour, that frequently affects long bones. In the scapula, although rare, this benign tumour is the most frequently encountered. The symptoms at this location are usually related to the mass effect that it can produce. Surgery is recommended when symptoms of compression, pain or an increase in size are noticed. The authors present a case of a 11 year-old-boy with an osteochondroma on the ventral surface of the scapula, that cause a pseudo winging of this bone and pain, with indication for surgical excision. Pseudo scapula alata should be differentiated from the true one, which is a dynamic dyskinesia. In the presence of this static deformity the surgeon must keep in mind other diagnosis as a scapular osteochondroma or other mass effect lesions. This benign tumour does not frequently suffer malignant transformation. Surgery can lead to a complete resolution of the symptoms, and if done properly decrease to almost zero the rate of recurrence. The diagnosis of the tumour in this location can be delayed due to its atypical location and presentation. With this case report the authors expect to raise awareness of the unusual manifestations of osteochondroma, especially in the paediatric setting.

A 73 years old female diagnosed with rheumatoid arthritis for over 30 years with an end-stage right elbow arthritis (stage V of Larsen’s classification) with a major instability. The patient presented gross deformity and severe pain with critical limitation of limb function. The patient was treated with a total elbow arthroplasty with an intraoperative olecranon fracture. At six months follow up, the patient presents with an excellent active range of motion and painless joint, without daily activities limitation.

Complete revascularization is the gold standard of coronary artery bypass grafting (CABG). However, the rationale for revascularization of all diseased vessels is questionable. We aimed at evaluating the impact of multiple versus single grafts in each diseased coronary territory in the long-term survival and incidence of major adverse cardiac and cerebrovascular events (MACCE).From January/00 to November/15, 5.694 consecutive patients were submitted to isolated CABG, of whom 4.243 (74.5%) had complete anatomical revascularization and constituted the study population. Patients were divided into two groups: multiple grafts to each major territory (RCA, LAD, Cx, n=755) a single graft to each territory (n=3.488). Mean follow-up time was 8.5±4.4 years and complete for 96.4% of patients.No differences were found concerning major immediate postoperative complications (cardiogenic shock, acute myocardial infarction or stroke) and thirty-day mortality was similar (0.7%; p=0.871). Long-term survival was 64.4±1.3% vs. 67.7±2.9%, p=0.232. Older age (HR:1.07; 1.06-1.08, p0.001), diabetes mellitus (HR:1.44; 1.24-1-66, p0.001), peripheral vascular disease (HR: 1.52; 1.29-1.81, p0.001), chronic obstructive pulmonary disease (HR:1.38; 1.01-1.89, p=0.042), moderate/ severe cardiac dysfunction (HR:1.95; 1.60-2.38, p0.001) and moderate/severe renal impairment (HR:1.65; 1.40-1.94, p0.001) were independent predictors for late mortality. Freedom from MACCE was higher in multiple graft group (79.4±2.0% vs. 90.7±2.7%; p=0.026, respectively) at 4 years.Isolated CABG can be performed safely and with very low mortality. The number of bypass grafts did not adversely affect the perioperative results and long-term survival. However, implantation of multiple grafts was associated with lower incidence of major adverse events.Introdução: A revascularização completa representa o gold standard para a cirurgia de revascularização miocárdica. No entanto, a pontagem de todas as artérias com doença significativa no mesmo território coronário é controversa. Deste modo, objetivamos avaliar o impacto, na sobrevivência a longo e na incidência de eventos cardio e cerebrovascular major (MACCE), da colocação de um enxerto único versus múltiplos enxertos coronários no mesmo território. Métodos: de Janeiro/00 a Novembro15, 5.694 doentes foram consecutivamente submetidos a CABG isolada, dos quais 4.243 (74.5%) tiveram revascularização anatómica completa, constituindo a população em estudo. Os doentes foram dividos em dois grupos: os que receberam enxertos múltiplos para cada território (CD, DA, CX, n=755) e os que receberam um enxerto único (n=3.488). O tempo médio de seguimento foi de 8.5±4.4 anos e completo em 96.4% dos doentes. Resultados: não foram observadas diferenças no que respeita às complicações major pós-operatórias (choque cardiogénico, enfarte agudo do miocárdio ou acidente vascular cerebral) bem como na mortalidade aos 30 dias (0.7%; p=0.871). A sobrevivência a longo prazo foi 64.4±1.3% vs. 67.7±2.9%, p=0.232. A idade avançada (HR:1.07; 1.06-1.08, p0.001), diabetes (HR:1.44; 1.24-1-66, p0.001), doença vascular periférica (HR:1.52; 1.29-1.81, p0.001), doença pulmonar crónica obstrutiva (HR:1.38; 1.01-1.89, p=0.042), disfunção cardíaca moderada/severa (HR:1.95; 1.60-2.38, p0.001) e disfunção renal moderada/severa (HR:1.65; 1.40-1.94, p0.001) foram preditores de mortalidade a longo prazo. A taxa livre de MACCE foi superior no grupo com múltiplos enxertos aos 4 anos (79.4±2.0% vs. 90.7±2.7%; p=0.026, respetivamente). Conclusão: a CABG é realizada com segurança e com baixa mortalidade. O número de enxertos não afetou os resultados perioperatorios e a sobrevivência a longo prazo. No entanto, a confecção de múltiplos enxertos foi associada a menor incidência de MACCE.

OBJECTIVES To evaluate the long-term survival of patients undergoing aortic root enlargement (ARE) compared with those with small aortic root (SAR), exploring risk factors for late mortality as well as the influence of patient-prosthesis mismatch (PPM). METHODS From January 1999 through December 2010, a total of 3724 patients underwent isolated or combined aortic valve replacement at our institution. From these, 239 (6.4%) had transannular ARE with a pericardial patch, to permit implantation of a larger prosthesis. This study population was compared with a control group of 767 patients (20.6%) who were considered to have SAR, as a prosthesis of size 21 or less was implanted. Mean age was comparable: 70.4 ± 12.5 vs 69.9 ± 9.6 years for ARE and SAR groups, respectively (P = 0.552). Female sex predominated in the control group (81.6 vs 88.0%; P = 0.011). Patients of the ARE group tended to have higher mean body surface area (1.59 ± 0.15 vs 1.57 ± 0.13 m(2); P = 0.061) and were less symptomatic (NYHA III-IV: 49.4 vs 57.9%; P = 0.021). RESULTS Implantation of bioprostheses was more frequent in the ARE group (76.2 vs 52.3%; P < 0.001), while concomitant procedures were more frequent in the SAR group (25.5 vs 32.2%; P = 0.050). Patients in the SAR group had higher moderate PPM (29.7 vs 50.1%; P < 0.001), but no patient was left with severe PPM. Hospital mortality was not statistically different between ARE and SAR groups (0.8 vs 0.5%; P = 0.632). The overall survival rate for ARE group patients at 5, 10 and 15 years was 82.7 ± 2.5, 64.8 ± 3.8 and 36.0 ± 7.5%, respectively, in comparison with 86.2 ± 1.3, 62.9 ± 2.3 and 38.4 ± 4.3% for the SAR group (P = 0.741). There was no significant difference in long-term survival of ARE patients compared with the age- and gender-matched general population (P = 0.794). Long-term survival was not affected by the presence of PPM. Increasing age, male sex, atrial fibrillation, LV end-systolic dimension, preoperative creatinine and NYHA class III-IV were significant predictors of late mortality. CONCLUSIONS ARE can be done safely, effectively reducing PPM. Although no difference was found in early and late mortality compared with the SAR group, long-term survival rates of ARE patients was comparable with that of the general population, unlike those of the SAR group.

A Assessoria Jurídica Hernani Estrella consiste em uma atividade de extensão composta por alunos de diferentes semestres da Faculdade de Direito da UFRGS. A Assessoria surgiu com o objetivo de facilitar o acesso dos pequenos empresários às informações que lhes são essenciais ao desempenho da atividade empresarial, por destinar-se ao atendimento daqueles indivíduos sem condição econômica suficiente para arcar com as custas de um advogado. A AJHE presta assessoria à uma gama variada de empreendedores, sendo os principais assistidos as empresas juniores, havendo, além destas, microempresários, startups e empresários individuais. Ao mesmo tempo em que a AJHE propicia aos estudantes da Universidade o aprimoramento dos conhecimentos no âmbito do direito empresarial, possibilita, ainda, que estes mantenham contato com a prática diária, preparando-os para o mercado externo. Cinco são os grupos que compõem a Assessoria Jurídica Hernani Estrella, quais sejam, Direito Societário, Direito Tributário, Propriedade Intelectual e Direito Contratual, os quais são coordenados pelos próprios alunos, que recebem auxílio, principalmente, de ex-graduandos da Universidade e de ex-membros da Assessoria. The Legal Advice Hernani Estrella is an extension activity composed by students of different levels from the Law School of the Federal University of Rio Grande do Sul. It has begun with the propose of helping small businessmen to access essential business activity information and was focused on individuals without economic conditions to pay for a lawyer. The AJHE provides advice to different businessmen, mainly junior companies, but it also helps microentrepreneurs, startups and individual businessmen. At the same time AJHE improves the knowledge of the students about the context of Business Law, through the contact with the daily experience, preparing them for the professional field. There are five work groups: Corporate Law, Tax Law, Intellectual Property and Contractual Law, which are coordinated by the students themselves and receive assistance from former students of the University and ex-members of the AJHE

The management of induction and maintenance immunosuppression therapy after heart transplantation (HT) remains a controversial issue. The dosage and the timing has been a changing target. We aimed at evaluate the incidence of acute cellular rejection (ACR) [≥1R grade], major infection and survival in first year after HT in patients receiving two different induction immunosuppression regimes and with a reduction in intensity of triple maintenance immunosuppression dose.From November-2003 to June-2016, 317 patients were submitted to HT. After excluding those with pediatric age (n=8), those with previous renal or hepatic transplantation (n=2), those submitted to retransplantation (n=2), patients with early death without endomiocardial biopsy (n=10) and those in a transition maintenance regime (n=26), the study population resulted in 269 patients. These patients were divided in two groups: patients receiving the previous regime of two doses of basiliximab (group A, n=211) and those receiving a single dose of basiliximab (group B, n=58). All the patients were treated with a maintenance standard triple immunosuppressive regimen of corticosteroids, an inhibitor of calcineurin and mycophenolate mofetil but more immunosuppressive load in group A.Mean age of the recipients (group A vs. group B) was 54.6±10.6vs.55.0±9.8 years (p=0.808); 77.3%vs.75.9% were male (p=0.861); 28.4%vs.28.1% were diabetic (p=0.957); and ischemic etiology was present in 39.8%vs 41.0% of the patients (p=0.798), respectively. No differences were found, at first year, between the two groups concerning global ACR incidence (55.0%vs.56.9%, p=0.882, respectively) but major ACR (≥2R grade) was slightly superior in group B (16.6%vs.27.6%, p=0.080, respectively). Time-free from major ACR at 3rd, 6th and 12th months was, respectively 91.0±2.0%vs.84.5%±4.8%; 86.7±2.3%vs.74.1±5.7%; and 83.4±2.6%vs.72.4±5.9% (p=0.048). Time-free from major infection at 3rd, 6th and 12th months was, respectively 89.6±2.1%vs.82.8±5.0%; 87.7±2.3%vs.79.3±5.3%; and 84.4±2.5%vs.79.3±5.3% (p=0.253). No differences were found concerning survival at 3rd, 6th and 12th months (94.3±1.6%vs.94.8±2.9%; 92.4±1.8%vs.93.1±3.3%; and 90.0±2.1%vs.91.4±3.7%, (p=0.771) respectively).With this study, we verified that lowering doses of induction and maintenance therapy was responsible for increase cases of major ACR at first year of heart transplant. However, no differences were found concerning the incidence of major infection and early survival. Hence, effective immunosuppression induction regimen can apparently be done safely with a single dose regime without compromising survival at first year after HT.

Coronary allograft vasculopathy (CAV) is still a serious long-term complication after cardiac transplantation.To evaluate the prevalence of CAV in a single institution, its impact on survival and to explore associated risk factors.From November-2003 through June-2016, 316 patients were submitted to cardiac transplantation. After excluding those with paediatric age (n=8), those with previous renal or hepatic transplantation (n=2) and those who didn't survive the first year after cardiac transplantation (n=40), the study population resulted in 266 patients. Forty two patients (15.8%) with CAV, diagnosed by a new50% coronary artery stenosis in any vessel during follow-up, were compared with a non-CAV group.Both groups share de same median age (54+10years). Recipient male sex predominated in the CAV group (93% vs. 74%), as did ischemic etiology (52% vs. 37%). Although not reaching statistical significance, CAV patients also had more dyslipidemia (60% vs. 50%), history of smoking (52% vs. 44%) and peripheral vascular disease (45% vs. 29%). The incidence of celular acute rejection 1R is more frequent in CAV group (69% vs. 60%) such as 2R or 3R (29% vs. 27%). Prolonged use of inotropic support and mechanical assistance after cardiac transplantation were comparable between both groups. The survival of this patients, who were submitted to cardiac transplantation and had lived at least 1 year, between CAV and non-CAV group was comparable at 5-year (91% vs. 85%), but tended to be lower for CAV patients in 10-year interval (52% vs. 73%).This data confirms CAV as a common long-term complication following cardiac transplantation. Although short to mid-term survival seems not to be affected by CAV, long-term survival appears lower, hence a longer follow-up is needed.

OBJECTIVES: Due to progression of rheumatic disease, percutaneous mitral commissurotomy (PMC) is a palliative procedure. We aimed at evaluating the outcomes of patients requiring surgery for failure of PMC, focusing on the fate of the mitral valve (MV) (repair versus replacement). METHODS: From January 1993 through December 2012, 61 patients with previous PMC were submitted to MV surgery. Detailed operative findings were collected from all patients and an intraoperative anatomical score was introduced to predict reparability. Time to surgery, overall survival and freedom from reoperation were analysed. RESULTS: The mean time to surgery after PMC was 6.9 ± 5.9 years and indications were restenosis in 25 patients (41%) and mitral regurgitation or mixed lesion in 36 (59%). Nine patients (14.8%) had more than one previous intervention. Intraoperative inspection of the valve revealed leaflet laceration outside the commissural area in 27 patients (44.3%). Valve repair was accomplished in 38 patients (62.3%). Pulmonary hypertension, calcification and intraoperative anatomical score were independently associated with the probability of valve replacement (OR 1.12, OR 7.03 and OR 4.49, respectively, P< 0.05). There was no hospital mortality. MV area increased on average 1.6 cm 2 after surgery to 2.7 cm 2 ; 5-, 10- and 20-year survival rates were 98.1 ± 1.9, 91 ± 5.2 and 82.7 ± 9.2%, respectively. The rate of freedom from mitral reoperation (for repaired cases) at 5, 10 and 15 years was 100, 95.8 ± 4.1 and 87.8 ± 8.5%, respectively. There was no difference in survival between repaired or replaced MVs, but the former had less valve-related events during follow-up. CONCLUSION: The MV can be repaired after failed PMC, with very low complication rates and excellent long-term results. Hence, whenever possible, these patients should be sent to reference centres where repair can be successfully achieved.

OBJECTIVES: The timing for mitral valve surgery in asymptomatic patients with severe mitral regurgitation and preserved left ventricular function remains controversial. We analyzed the immediate and long-term outcomes of these patients after surgery. METHODS: From January 1992 to December 2012, 382 consecutive patients with severe chronic degenerative mitral regurgitation, with no or mild symptoms, and preserved left ventricular function (ejection fraction ≥ 60%) were submitted to surgery and followed for up to 22 years (3209 patient-years). Patients with associated surgeries, other than tricuspid valve repair, were excluded. Cox proportional-hazard survival analysis was performed to determine predictors of late mortality and mitral reoperation. Subgroup analysis involved patients with atrial fibrillation or pulmonary hypertension. RESULTS: Mitral valvuloplasty was performed in 98.2% of cases. Thirty-day mortality was 0.8%. Overall survival at 5, 10, and 20 years was 96.3% ± 1.0%, 89.7% ± 2.0%, and 72.4% ± 5.8%, respectively, and similar to the expected age- and gender-adjusted general population. Patients with atrial fibrillation/pulmonary hypertension had a 2-fold risk of late mortality compared with the remaining patients (hazard ratio, 2.54; 95% confidence interval, 1.17-4.80; P = .018). Benefit was age-dependent only in younger patients (

The study aim was to evaluate the immediate and long-term results of surgical treatment of isolated posterior mitral valve leaflet prolapse (PLP), focusing on survival and freedom from recurrent mitral regurgitation (MR).Between January 1998 and December 2012, a total of 492 consecutive patients (375 males, 117 females; mean age 61.8 ± 12.1 years; range: 13-86 years) with isolated PLP [304 (61.8%) with myxomatous degeneration; 188 (38.2%) with fibroelastic deficiency] were treated at the authors' institution. Of these patients, 202 (41.1%) were in NYHA class III-IV, and atrial fibrillation was present in 104 (21.1%). Mitral valve repair was achieved in 484 patients (98.4%), resection was performed in 419 (85.2%), and prosthetic ring annuloplasty was used in 436 (88.6%). Concomitant procedures were performed in 153 patients (31.1%), including tricuspid valve repair in 50 (10.2%), aortic valve surgery in 34 (6.9%), and coronary artery bypass grafting (CABG) in 64 (13%).The hospital mortality rate was 0.2%, and the mean follow up was 7.1 ± 3.9 years. There were 71 late deaths (14.4%), and overall survival at five, 10 and 15 years was 91.7 ± 1.3%, 82.1 ± 2.3% and 64.7 ± 6.1%, respectively. There was no significant difference in long-term survival compared with the age- and gender-matched general population (p = 0.146). Multivariate Cox-proportional hazard analysis showed older age (HR 1.03 per annum), left ventricular dysfunction (HR 2.44), atrial fibrillation (HR 1.96), left ventricular end-diastolic dimension (HR 1.05 per mm) and non-use of prosthetic ring (HR 3.03) as significant predictors of late mortality. Recurrence of moderate or severe MR occurred in 31 patients, six of whom underwent mitral valve reoperation. Predictors of late recurrence of MR were fibroelastic deficiency (HR 2.38), mitral calcification (HR 5.26), posterior leaflet plication (HR 3.58), absence of complete ring annuloplasty (HR 3.84) and systolic pulmonary artery pressure at discharge (HR 1.10 per mmHg). Freedom from mitral valve reoperation at 15 years was 97.4 ± 1.1% CONCLUSIONS: Mitral valve repair in isolated PLP can be achieved in virtually all cases with a very low operative risk and a high durability of repair. Atrial fibrillation or large left ventricles are associated with a poor prognosis. Failure to use a complete ring annuloplasty carries a risk not only for the return of MR but also for survival.

Para ajudar no desenvolvimento de software é recomendado o uso de ferramentas apropriadas como o PSP (personal software process). O PSP é um processo de desenvolvimento de software de elevada maturidade usado para melhorar a capacidade de estimativa e planeamento de projetos, gerir a sua qualidade, assim como reduzir os seus problemas. Ferramentas como o PSP geram grandes quantidades de dados sobre o desempenho do utilizador que periodicamente podem ser analisados para identificar problemas de desempenho (por exemplo, elevada densidade de defeitos nos produtos entregues) determinar as causas dos problemas (por exemplo, número elevado de defeitos que chegam à fase de teste do sistema) e desenvolver ações de melhoria (por exemplo, introduzir testes unitários e revisões de código). No entanto a análise dos dados gerados por estes processos é uma tarefa demorada e cansativa, devido às suas grandes quantidades e ao tempo e conhecimento especializado necessários para realizar a análise. Para resolver este problema da análise manual, foi desenvolvida num trabalho de doutoramento uma aplicação em java, ProcessPAIR, que identifica os problemas de desempenho, determina as causas dos problemas e organiza as causas em diferentes ranks. O principal objetivo desta dissertação será estender a abordagem e ferramenta ProcessPAIR para a web, WebProcessPAIR, com uma nova funcionalidade, desenvolver ações de melhoria. Esta funcionalidade baseia-se em construir um catálogo de possíveis ações de melhoria para abordar as causas dos problemas de desempenho. Para esse efeito pretende-se recorrer não só à literatura existente mas também ao uso de métodos como crowdsourcing, ou seja, recorrer ao conhecimento de uma comunidade de utilizadores e especialistas. Para cada problema de desempenho e respetiva causa referida na aplicação será atribuída uma lista ordenada de ações de melhoria sugerida pelos contribuidores e utilizadores do website (WebProcessPAIR). Estas sugestões poderão ser votadas pela comunidade (por exemplo através de um sistema de likes, ou de upvote/downvote). Para cada lista de ações de melhoria sugeridas a um utilizador, este poderá deixar o seu feedback em relação à lista, dizendo se concorda ou não. Com o feedback dos utilizadores, o sistema usará o método de aprendizagem automática, atualizando o catálogo de ações de melhoria consoante as sugestões dadas pelos contribuidores e o feedback deixado pelos utilizadores, ou seja, aprendendo automaticamente à medida que vai sendo utilizado.

Esta dissertação estuda o comportamento geoquímico dos metais Ag, Cd, Cr, Cu, Fe, Mn, Ni, Pb e Zn contidos em lodos residuais gerados na Estação de Tratamento de Esgotos de Barueri, SP, que ficaram expostos às condições intempéricas superficiais tropicais por um período médio de 18 meses. A ETE de Barueri trata esgotos da Região Metropolitana de São Paulo aplicando o método do Lodo Ativado, com uma etapa de Digestão Anaeróbia e outra de Condicionamento Químico, com adição de FeCl3 e Ca(OH)2. O resíduo resultante do processo, aqui denominado Resíduo Fresco, teve suas principais características químicas, como teores de metais e valores de pH, monitoradas pela própria ETE, e foi disposto ao ar livre por um período de 18 meses. Ao final desse período o Resíduo Disposto constituía um grande corpo tabular com espessura média de 2,20m. Nesse corpo foram coletadas amostras de canal, amostras de trado e amostras indeformadas tanto dos resíduos quanto do solo a eles sotoposto. Essas amostras foram submetidas à determinação do pH, determinação dos teores de Ag, Cd, Cr, Cu, Mn, Fe, Ni, Pb e Zn com abertura por Ácidos Fortes a Quente e abertura por Água Deionizada a Quente, determinação da distribuição granulométrica, determinação da composição mineralógica e investigação de morfologias em Microscópio Ótico e Microscópio Eletrônico de Varredura acoplado a EDS. Essa série de análises levou à conclusão de que os metais contidos no pacote de resíduos estão sendo lixiviados, tendo sido eliminada considerável parcela do seu conteúdo inicial. Por outro lado verificou-se que está havendo a migração vertical interna, do topo para a base do pacote de resíduos, das frações granulométricas mais finas, caracterizando portanto o fenômeno de lescivagem. Essas frações são constituídas por minerais detríticos (Caolinita e Micas) e por compostos neoformados no processo de Condicionamento Químico do lodo (Carbonatos, Fosfatos e Sulfatos de Ca e Mg e Hidróxidos e Carbonatos de Fe). São principalmente esses compostos que contêm os metais pesados no resíduo. O solo sotoposto aos resíduos está retendo apenas uma parcela dos metais e mesmo assim somente numa faixa com 1,30m, mais próxima ao contato. As exceções são os metais Ag e Cu que ocorrem em teores anômalos em posições intermediárias do perfil. Como detectou-se a lixiviação dos metais e eles não estão sendo retidos pelos solos concluiu-se que eles permaneceram em solução, contaminando portanto os cursos d\'água da região. Os resíduos são geoquimicamente ativos, estão interagindo com os compartimentos do ambiente e podem apresentar risco potenciais à qualidade das águas superficiais. The aim of this study is to research the geochemical behavior of the metals Ag, Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn incorporated in the sludges of Wastewater Treatment Plant of Barueri, SP, that remained exposed at tropical climate conditions about 18 months. The Wastewater Treatment Plant of Barueri, SP, that remained exposed at tropical climate conditions about 18 months. The Waste water Treatment Plant of Barueri, SP, processes sewages of São Paulo Metropolitan Region by Activated Sludge method, followed by the stages of Anaerobic Digestion and Chemical Coagulation and Precipitation by FeCl3 and Ca(OH)2. The produced sludge, in this study designated as \"Fresh Waste\"m had its principal chemical characteristics, as metal contents and pH, measured monthly during its production period. Then the \"Fresh Waste\", had its principal chemical characteristics, as metal contents and pH, measured monthly during its production period. Then the \"Fresh Waste\" was disposed on the land in the open air, for about 18 months. During this time the \"Fresh Waste\" to become named by \"Disposed Waste\" and to become constituted as a big sludge layer of 2,20m thickness. The Disposed Waste and the soil under it were then sampled. All samples was analysed for pH, for the Heavy Metals Ag, Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn (digested by HNO3 + HCl processe and by Deionised Water processe), for the Granulometric Distribution, for the Mineralogic Composition and for the Micromorphologic Analysis at Optic Microscope and MEV with EDS equipment. The results of those analysis were conclusive: the metals incorporated in the \"Disposed Waste\" was being removed of the sludge. On the other hand a vertical movement of the fine grain materials (Ø < 2 m\'mü\') is occurring from the top to the basis of the sludge layer. This material is mainly composed by neoformed substances (Ca and Mg Carbonates, Phosphates and Sulphates and Fe Hydroxides and Carbonates) originated in Chemical Coagulation and Precipitation by FeCl3 and Ca(OH)2, and by detritic minerals (Caolinite and Micas) either. These substances incorporate most of the heavy metals in the \"Disposal Waste\". The soil under the sludges is retaining very little of the dissolved metals, only at a 1,30m thickness zone under contact surface. Anomalous values at deeper zones of the soil occur just for the metals Ag and Cu. Since metals dissolution is occurrying and the soil is not retainying them, so they are remaining solubilized and they are reaching both the superficial and the groundwater. In this way the sewage sludges are geochemicaly active, react with the environmental compartments and may be a potential risc to hydric resources.

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Case A 13-year-old girl presented with paresthesia of the fourth and fifth fingers and the dorsal ulnar surface of the left hand that had started 3 months prior. Physical examination showed loss of sensation at the ulnar side of the fourth and fifth fingers and a positive Froment sign. Electromyography showed a severe motor conduction block in the ulnar nerve at the elbow. Eighteen months later, the patient had similar symptoms in the right hand. The diagnosis of hereditary neuropathy with liability to pressure palsies (HNPP) was considered and confirmed with genetic testing. Conclusion HNPP is a rare disease that should be considered not only in patients with multiple compressive neuropathies, but also in patients with any unexpected or unexplained neuropathy, even if it is isolated.

Depression is an extremely heterogeneous disorder. Diverse molecular mechanisms have been suggested to underlie its etiology. To understand the molecular mechanisms responsible for this complex disorder, researchers have been using animal models extensively, namely mice from various genetic backgrounds and harboring distinct genetic modifications. The use of numerous mouse models has contributed to enrich our knowledge on depression. However, accumulating data also revealed that the intrinsic characteristics of each mouse strain might influence the experimental outcomes, which may justify some conflicting evidence reported in the literature. To further understand the impact of the genetic background, we performed a multimodal comparative study encompassing the most relevant parameters commonly addressed in depression, in three of the most widely used mouse strains: Balb/c, C57BL/6, and CD-1. Moreover, female mice were selected for this study taken into account the higher prevalence of depression in women and the fewer animal studies using this gender. Our results show that Balb/c mice have a more pronounced anxious-like behavior than CD-1 and C57BL/6 mice, whereas C57BL/6 animals present the strongest depressive-like trait. Furthermore, C57BL/6 mice display the highest rate of proliferating cells and brain-derived neurotrophic factor (Bdnf) expression levels in the hippocampus, while hippocampal dentate granular neurons of Balb/c mice show smaller dendritic lengths and fewer ramifications. Of notice, the expression levels of inducible nitric oxide synthase (iNos) predict 39.5% of the depressive-like behavior index, which suggests a key role of hippocampal iNOS in depression. Overall, this study reveals important interstrain differences in several behavioral dimensions and molecular and cellular parameters that should be considered when preparing and analyzing experiments addressing depression using mouse models. It further contributes to the literature by revealing the predictive value of hippocampal iNos expression levels in depressive-like behavior, irrespectively of the mouse strain., This work was funded by the Portuguese North Regional Operational Program (ON.2-O Novo Norte) under the National Strategic Reference Framework (QREN), through the European Regional Development Fund (FEDER). The funders had no involvement into the analysis and interpretation of data, writing of the manuscript or the decision to submit the article for publication.

OBJECTIVES To evaluate the feasibility of mitral valve repair in patients with anterior leaflet (ALP) or bileaflet prolapse (BLP) and identify factors predisposing patients to replacement. To compare long-term survival of patients submitted to repair (Group Repair) against those submitted to replacement (Group Replacement), and investigate causes of early and late failures of repair. METHODS From January 1992 through December 2012, 768 patients with ALP or BLP were submitted to mitral valve surgery, of whom 501 had degenerative involvement [Myxomatous (Myx)-336 (67.1%) or fibroelastic deficiency (Fed)-165 (32.9%)] and constituted the study population. Isolated ALP was present in 274 patients (54.7%) and BLP in 227 (45.3%). Associated procedures were admitted. RESULTS Patients with Fed were significantly older (64.4 ± 12.1 vs 54.8 ± 15.5 years, P < 0.001), more symptomatic (63 vs 44.3%; P < 0.001) and with higher incidence of atrial fibrillation (43.6 vs 26.2%; P < 0.001). Repair was achieved in 94.8% of patients with an overall 30-day mortality rate of 1.2% (0.3% in the last decade) and no differences regarding aetiology. Age, moderate to severe left ventricular (LV) dysfunction, previous cardiac surgery, multiple segment prolapse, mitral calcification, leaflet retraction and the performing surgeon were independently associated with replacement. Group Repair patients had a greater adjusted 20-year survival by comparison with Group Replacement (43.4 ± 5.5 vs 13.6 ± 11.3%; P < 0.001) and similar to that of the age- and sex-adjusted general population (P = 0.10). Valve replacement, New York Heart Association (NYHA) class III-IV, pulmonary hypertension and LV dysfunction emerged as independent predictors of late mortality. Patients in NYHA class I-II experienced a higher repair rate (98.4%) and better survival than those in Class III-IV. Two repair patients were reoperated during the first year after surgery (early failure) and both were 'rerepaired'. Late failure was observed in 21 patients, mostly for progression of the disease. The 20-year rate of freedom from reoperation was 88 ± 2.7%, significantly worse in ALP patients (P = 0.040), and not different between Fed and Myx. CONCLUSIONS Patients with ALP or BLP can be submitted to surgery with low mortality and great probability of repair in expert hands. Patients should be operated on at an early phase (asymptomatic or mildly symptomatic), because there is a higher probability of repair and greater benefit on long-term survival.

Dissertação de mestrado em Engenharia Humana, As piscinas, em geral, são estruturas de espaços recreativos e de lazer com múltiplas fontes de ruído. As atividades que ali se praticam são uma dessas fontes que contribuem para a existência de ruído, o qual é muitas vezes incrementado e constitui um elemento de agravamento, aumentando o risco associado a patologias diversas. Os Professores e treinadores que desenvolvem a sua atividade profissional nas piscinas cobertas estão invariavelmente expostos ao ruído oriundo das múltiplas fontes ali existentes, desde os sistemas de ventilação, à música, incluindo a comunicação verbal necessária nesses locais. Este estudo teve como objetivo avaliar e caracterizar o ruído nas piscinas cobertas em contexto de aula e, relacionar uma série de aspetos caracterizados pelos professores e treinadores com os valores de ruido, com o tempo de exposição ao ruído e com os anos de atividade dos professores e treinadores. Para as medições de ruído foi utilizado um sonómetro e para analisar a perceção dos professores e treinadores foi aplicado um questionário. O tratamento estatístico foi fundamentalmente a estatística descritiva e utilizou-se o programa SPSS. Para além disso, utilizou-se também o teste do Qui-quadrado 2x2 e considerado o nível de significância igual a 5% (p=0,05). Os resultados mostraram que os níveis médios de pressão sonora nas piscinas cobertas são muito elevados, situam-se entre os 83 dB(A) e os 89 dB(A). Os dados obtidos dos questionários mostram que a maioria dos professores e treinadores não é sensível ao ruído (52,5%), não valorizando a exposição ao ruido a que estão sujeitos. Os resultados permitiram também verificar que existe uma relação entre perda auditiva reportada e os anos de atividade verificando-se uma relação estatisticamente significativa (p=0,01). Conclui-se que as piscinas apresentam níveis de pressão sonora muito elevados, que são estruturas que não possuem as melhores condições acústicas, que os professores e treinadores estão expostos a níveis de pressão sonora que podem ser prejudiciais à sua saúde, por fim, que a exposição prolongada ao ruído parece, como seria de esperar, vir a ter um efeito no desenvolvimento de perdas auditivas por parte dos professores e treinadores., Swimming pools are, in general, structures developed for recreational and leisure activities and include multiple noise sources. The activities developed at the swimming pools are one of these sources that contribute to the noise levels at those spaces, which are often increased and constitutes an element of aggravation, by increasing the risk associate to several diseases. Teachers and coaches who develop their professional activity indoor swimming pools are invariably exposed to noise arising from multiple noise sources, from ventilation systems, to music, including verbal communication required at these locations. This study aims to evaluated and characterize the noise exposure at swimming pools in the context of classes’ activities, and analyse several aspects reported by teachers and coaches, by relating it with the registered noise levels, time of exposure to noise and the years of professional activity of teachers and coaches. Noise measurements were carried out with a sound level meter and teachers’ perception were obtained by applying a questionnaire. The applied statistical analyses was mainly descriptive statistic, through the application of SPSS. Furthermore, it was also used the chi-square 2x2, with a significance level of 5% (p = 0.05). The results showed that the sound pressure levels in indoor swimming pools are very high, between 83 dB(A) and 89 dB(A). Data obtained from the questionnaire show that most teachers and coaches are not sensitive to noise (52.5%), not values their exposure to noise. The results allowed also to check that there is a relationship between reported hearing loss and years of activity, with a statistically significant (p = 0.01) relationship. It is concluding that swimming pools are places with very high sound pressure levels, and that are buildings that do not possess the best acoustics. Teachers and coaches are exposed to sound pressure levels that can be harmful to their health and, finally, that the prolonged exposure to noise appears to have, as expected, an effect on the hearing loss development among teachers and coaches.

This study aims to characterize the geochemical behavior of Ag, Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn incorporated into the sludges produced at Wastewater Treatment Plant (WTP) of Barueri, SP, contrasting the average metal content of the fresh sludges with metal content measured in the same sludges after their exposition to natural tropical climate conditions for about 15 months. The effects of sludges on the soil were also observed. The WTP of Barueri processes sewages from the Sao Paulo Metropolitan Region applying an activated sludge method followed by anaerobic digestion and chemical coagulation with precipitation by Fel3 and Ca(OH)2. Metal content and pH of the produced sludge ("fresh waste") are ordinarily measured by periodical monitoring at WTP. The fresh waste was cumulatively disposed directly over the soil in open air for about 15 months until forming a 2,20m thick layer. During this study, this air-exposed waste ("disposed waste") and the undrlying soil were sampled for determination of pH and heavy metal (Ag, Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn) content. Results of the analyses showed significant removal of the metais originarily incorporated into the sludge. A superficial l,30m thick layer soil retained small amount of dissolved metais. Anomalous values at deeper zones of the soil profile were obtained only for Ag and Cu. The removal of heavy metais from sludges with no significant retention by the soil below suggests that heavy metais must have remained in solution. Therefore, heavy metais may reach both surface and groundwater, as well as the biota.

Dissertação de Mestrado Integrado em Arquitectura, apresentada ao Departamento de Arquitectura da Faculdade de Ciências e Tecnologia da UC.