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Background: Although laparoscopic donor nephrectomy (LDN) represents the gold-standard technique for kidney living donation, robotic donor nephrectomy (RDN) settled as another appealing minimally invasive technique over the past decades. A comparison between LDN and RDN outcomes was performed. Methods: RDN and LDN outcomes were compared, focusing on operative time and perioperative risk factors affecting surgery duration. Learning curves for both techniques were compared through spline regression and cumulative sum models. Results: The study analyzed 512 procedures (154 RDN and 358 LDN procedures) performed between 2010 and 2021 in 2 different high-volume transplant centers. The RDN group presented a higher prevalence of arterial variations (36.2 versus 22.4%; P = 0.001) compared with the LDN cohort. No open conversions occurred; operative time (210 versus 195 min; P = 0.011) and warm ischemia time (WIT; 230 versus 180 s; P

Sapajus libidinosus is a New World primate belonging to the Cebidae family that lives in the caatinga and cerrado, which are known Brazilian biomes. It is currently classified as near threatened, almost endangered, by the main animal protection organizations. Knowledge of biochemistry, the C-reactive protein, and the proteinogram are important for the preservation of this species. Our study established reference intervals for several biochemical variables and the proteinogram. For this purpose, blood samples were collected from 50 S. libidinosus monkeys (25 males and 25 females) kept in captivity at the Brazilian state of Paraíba. Descriptive analysis and reference intervals were estimated following the guidelines of the American Society of Veterinary Clinical Pathology, using the Reference Value Advisor 2.1 software. In the overall population (n=50), significant differences (P < 0.05) were noted for creatinine and total proteins when considering the age factor (higher in adults), as well as for albumin and indirect bilirubin (higher in juveniles). Sex-associated differences (females versus males, P < 0.05) were reported for serum urea and creatinine (higher in males), as well as for albumin and Beta-Globulins (higher in females). In conclusion, to the authors’ best knowledge, the present results are innovative and can be used as reference intervals for assessing the animals’ health status. Moreover, it is also pioneer in determining the C-reactive protein in this species. It is important to emphasize that gender and age categories can have an influence and should be considered when interpreting the tests results.

Toda atividade física necessita de ajustes rápidos no sistema cardiovascular para manter a homeostase circulatória. A regulação da frequência cardíaca e a modulação de suas variações tão em grande parte na dependência do sistema nervoso autonômico. O presente trabalho de pesquisa teve como objetivo geral realizar a análise da frequência cardíaca em pacientes com insuficiência cardíaca congestiva durante o atendimento de fisioterapia, através de uma revisão de literatura sistemática. E os seguintes objetivos específicos: Analisar o percentual de frequência cardíaca relacionada com a técnica utilizada e Investigar o nível de esforço do paciente, relacionada a técnica utilizada no atendimento de fisioterapia. Este trabalho foi realizado a partir de uma revisão da literatura de caráter sistemático. Através de artigos científicos publicados no período de 2004 a 2010. As bases de dados foram acessadas por meio do site da Bireme, onde foram encontrados 427 artigos os quais inicialmente tiveram seus resumos analisados. Destes foram separados para serem lidos, 29 artigos que tinham relevância com o tema, e destes somente 4 entraram no critério de inclusão. Os artigos revisados sugerem que a monitorização da frequência cardíaca é de extrema importância para o acompanhamento do treinamento cardiovascular do individuo cardiopata. Esses estudos mostram que os treinamentos anaeróbicos exigem uma resposta cardiovascular maior do paciente e não apresentam resultados tão satisfatórios quanto aos treinos aeróbicos.

A insuficiência cardíaca é uma das causas mais predominantes de morbidade e mortalidade no mundo inteiro, onde expressa níveis de prevalência e incidência cada vez maiores com o avanço crescente da idade. A cardiopatia isquêmica é em sua grande maioria dos casos, resultado de uma arteriosclerose das artérias coronárias. Essa por vez se desenvolve quando a demanda do fluxo sanguíneo é insuficiente para atender as necessidades do coração. A escala de Gunnar Borg é o instrumento mais frequente empregado para avaliar a percepção subjetiva de esforço. Esta integra um apontador de intensidade de esforço que tem alcançado crescente popularidade no âmbito da prescrição de exercício para populações especiais e populações saudáveis. O presente tem como objetivo verificar através de uma revisão de literatura o nível de esforço durante a reabilitação cardíaca de pacientes com insuficiência cardíaca isquêmica utilizando a Escala Modificada de Borg. Foi realizado uma pesquisa de revisão de literatura integrativa. Foi realizado um levantamento bibliográfico nas publicações das bases de dados SCIELO Brasil (Scientific Electronic Library Online), BIREME e LILACS (literatura latino-americana e do Caribe em ciências da saúde). Essa escala de Borg possui uma maneira fácil de aplicar e não envolve nenhum tipo de custos adicionais para realização de estudos, sendo assim uma vantagem nos protocolos de reabilitação cardíaca. Muitos estudos nos falam sobre a evolução clínica de pacientes com insuficiência cardíaca junto ao esforço, mas esses dados surgem como informações secundárias em estudos que têm outros objetivos, o que indica uma grande necessidade de formular estudos empíricos e originais voltados para a finalidade de investigar a evolução destes pacientes com insuficiência cardíaca.

INTRODUÇÃO: Os Núcleos de Apoio à Saúde da Família foram criados com o intuito de ampliar e apoiar a gestão e a atenção da saúde na Atenção Básica e Saúde da Família. Nos últimos anos, surgiram várias experiências sobre a atuação do profissional de fisioterapia na atenção básica vêm sendo criadas. Essas experiências vêm ocorrendo em alguns municípios brasileiros e também inseridos no âmbito acadêmico, em extensões universitárias e dentro da graduação do curso de fisioterapia como recomendam as Diretrizes Curriculares Nacionais. O presente estudo teve como objetivo observar através de uma revisão de literatura os desafios e dificuldades encontrados pelos profissionais de fisioterapia nos núcleos de apoio a família. METODOLOGIA: Este é um trabalho de revisão literária onde a coleta de dados foi feita a partir de artigos originais com o tema relacionado aos desafios encontrados pelo profissional de fisioterapia no núcleo de apoio a saúde da família. RESULTADOS E DISCUSSÃO: O fisioterapeuta enfrenta vários desafios na atenção básica, mas o mais gritante é a falta de infraestrutura e materiais para a realização das ações que são necessárias e fundamentais para o trabalho e prevenção e promoção de saúde. CONCLUSÃO: A partir de pesquisas e leituras de artigos científicos, foi possível evidenciar que o fisioterapeuta, quando inserido no Núcleo de Apoio a Saúde da Família, enfrenta alguns problemas que o sistema de serviço de saúde possui. Visto que a fisioterapia ainda está em processo de construção na atenção básica e essas dificuldades e problemas precisam ser superados diante das experiências conhecidas. ABSTRACT BACKGROUND: The Centers of Support for Family Health were created in order to expand and support the management and health care in Primary Care and Family Health. In recent years, several experiments on the role of professional physiotherapy in primary care are being created emerged. These experiences are occurring in some Brazilian cities and also inserted in the academic context, in universities and in the graduation course in physiotherapy extensions as recommended by the National Curriculum Guidelines. The present study aimed to observe through a literature review of the challenges and difficulties encountered by physical therapists in the nuclei of supporting the family. METHODOLOGY: This is a work of literary review where data collection was made from original articles with the theme related to the challenges faced by the physiotherapy professional at the Core of support for family Health. RESULTS AND DISCUSSION: The physiotherapist faces several challenges in primary care, but the most glaring is the lack of infrastructure and materials to perform the actions that are necessary and fundamental to work and prevention and health promotion. CONCLUSION: From research and readings of scientific articles, it became clear that the physiotherapist, when inserted into the Support Center for Family Health, faces some problems that the system of health service has. Since physical therapy is still in process of construction in primary care and the difficulties and problems need to be overcome before the known experiments.

A ocorrência de dor cefálica ou cefaléia é a manifestação de maior prevalência na população, sendo ainda a causa mais freqüente de encaminhamento aos consultórios clínicos, bem como responsável pelo elevado índice de absenteísmo tanto no trabalho como na escola. As cefaléias de origem tensional tem se mostrado como o tipo de maior freqüência, por essa razão uma variedade de métodos e técnicas tem sido utilizadas com foco para promover o alivio dos sintomas e, sobretudo melhora da qualidade de vida. Este estudo tem como objetivo identificar e descrever o que as evidencias cientificas dizem sobre a influência das técnicas cranianas e sua utilização nos casos de cefaléias. Quanto à metodologia, caracteriza-se por um estudo de revisão integrativa de literatura com caráter descritivo, sendo realizada no período de março a junho de 2020 a partir de publicações disponíveis no bando de dados da biblioteca virtual de saúde – BVS, Pubmed, SciELO, LILACS e Pedro. Após analise dos sete trabalhos selecionados foi possível verificar que o uso das técnicas de osteopatia tem como foco a liberação das estruturas profundas do crânio com melhora do fluxo sanguíneo. Em todos os estudos avaliados foi possível verificar que após a aplicação das técnicas de osteopatia os indivíduos relataram relaxamento muscular e/ou sensação de conforto corporal com aumento significativo da amplitude de movimento e rotação cervical constatado pela fleximetria assim como o alivio do quadro de cefaléia. Entre as principais técnicas osteopáticas utilizadas estiveram à manipulação vertebral de alta velocidade, o tratamento manipulativo osteopático (TMO) e a Técnica Articulatória Rítmica Cervical – TARC. Podemos concluir que a realização deste estudo foi essencial para compreendermos como se da o uso da osteopatia e seus benefícios no tratamento de pacientes com cefaléia crônica, vale ressaltar que este estudo cumpriu com o objetivo proposto, sendo assim poderá servir como base para estudos posteriores envolvendo a temática.

espanolPresentamos un estudio multicentrico realizado a traves de una en-cuesta en linea a 1826 familias de personas con TEA de Argentina, Brasil, Chile, Mexico, Peru, Republica Dominicana, Uruguay y Venezuela. Nuestro objetivo es describir el impacto de la pandemia –y el aislamiento social– en la conducta, el es-tado de animo, el sueno y la alimentacion de las personas con TEA. A tal fin hemos relevado caracteristicas sociodemograficas, habitacionales y modalidad de confina-miento. Analizamos los efectos de la discontinuidad de los servicios educativos y te-rapeuticos y valoramos los alcances de las intervenciones a distancia. Algunas de las consecuencias del confinamiento –obligatorio para la mayoria– han sido el aumento de irritabilidad en las personas con TEA, el incremento de la conducta de deambular, mayores niveles de ansiedad, dificultades en alimentacion, sueno y concentracion. La mayor parte de las familias han notado retrocesos en sus hijos durante el encie-rro. Se destacan los efectos beneficiosos de salidas y paseos. Muchos tratamientos y clases se han suspendido. Se subrayan positivamente las intervenciones a distancia. La crisis actual deberia ser una oportunidad para reorganizar dispositivos de educa-cion y tratamiento, atendiendo a la necesidad de cambios, con una perspectiva mas ecologica, inclusiva y amigable con el autismo. EnglishWe present a multicenter study conducted through an online survey of 1826 families of people with ASD from Argentina, Brazil, Chile, Mexico, Peru, the Dominican Republic, Uruguay and Venezuela. Our objective is to describe the impact of the pandemic –and social isolation– on the behavior, mood, sleep and diet of people with ASD. To this end, we have surveyed sociodemographic and housing characteris-tics and the modality of confinement. We analyze the effects of discontinuity in edu-cational and therapeutic services and assess the scope of remote interventions.Some of the consequences of confinement –obligatory for the majority– has been increased ir-ritability in people with ASD, increased wandering behavior, higher levels of anxiety, and difficulties in eating, sleeping and concentrating. Most of the families have noticed setbacks in their children during the confinement. The beneficial effects of outings and walks are highlighted. Many treatments and classes have been discontinued. Remote interventions are positively highlighted.The current crisis should be an opportunity to reorganize education and treatment devices, attending to the need for changes, with a more ecological, inclusive and autism-friendly perspective.

Simple Summary The AB blood group system has been identified in wild felids, as well as in the domestic cat. In both, type A blood seems to be the most common, although the majority of wild felid species exhibit one single blood type, showing that there seems to be variation between species, but not within species, and no evidence of geographical variation was yet found, showing apparently no genetic variability. Further studies are necessary to determine the clinical relevance of the AB blood group on wild felids. This manuscript makes a complete and comprehensive review of the knowledge on wild felids blood groups and transfusion medicine. Abstract Wild felids and domestic cats share the AB blood group. However, there have been few studies regarding the characterization and prevalence of the different blood types in wild animals. The erythrocyte membrane glycolipids of the wild cats correspond to the major disialoganglioside patterns observed in domestic cats. Like in domestic cats, type A blood seems to be the most common, although wild felid species seem to exhibit one single blood type. Of the species studied, the wild domestic cats, and the Panthera and ocelot lineages, all had type A blood; the Puma lineage showed almost exclusively type B blood. The prevalence of wild felids blood types show that there seems to be variation between species, but not within species, and no evidence of geographical variation has yet been found, showing apparently no genetic variability. The presence of alloantibodies has also been demonstrated, so the risk of life-threatening transfusion reactions due to mismatched transfusions and neonatal isoerythrolysis is a possibility. Like in other species, the recognition of wild felids blood groups is clinically relevant, as it can also be important in establishing phylogenetic relationships within the Felidae family. We will review the current knowledge on this topic and give insights into the wild felids blood groups potential for zoo transfusion medicine and phylogenetic studies in order to help support reintroduction projects and to preserve genetic diversity.

Background: The impact of sugammadex in patients with end-stage renal disease undergoing kidney transplantation is still far from being defined. The aim of the study is to compare sugammadex to neostigmine for reversal of rocuronium- and cisatracurium-induced neuromuscular block (NMB), respectively, in patients undergoing kidney transplantation.Methods: A retrospective, observational study was performed. A total of 350 patients undergoing kidney transplantation, equally divided between a sugammadex group (175 patients) and a neostigmine group (175 patients), were considered. Postoperative kidney function, evaluated by monitoring of serum creatinine and urea and estimated glomerular filtration rate (eGFR), was the endpoint. Other endpoints were anaesthetic and surgical times, post-anaesthesia care unit length of stay, postoperative intensive care unit admission, and recurrent NMB or complications.Results: No significant differences in patient or, with the exception of drugs involved in NMB management, anaesthetic and surgical characteristics were observed between the two groups. Serum creatinine (median [interquartile range]: 596.0 [478.0-749.0] vs 639.0 [527.7-870.0] μmol/L, p=0.0128) and serum urea (14.9 [10.8-21.6] vs 17.1 [13.1-22.0] mmol/L, p=0.0486) were lower, while eGFR (8.0 [6.0-11.0] vs 8.0 [6.0-10.0], p=0.0473) was higher in the sugammadex group than in the neostigmine group after surgery. The sugammadex group showed significant lower incidence of postoperative severe hypoxemia (0.6% vs 6.3%, p=0.006), shorter PACU stay (70 [60-90] min vs 90 [60-105] min, pConclusions: Compared to neostigmine for reversal of NMB, sugammadex resulted in a better recovery profile in patients undergoing kidney transplantation.

Objective: The aim of the study was to assess results and quality of life after kidney transplant in adult patients with previously bladder augmentation or urinary diversion due to significant lower urinary tract dysfunction.Materials and methods: This cross-sectional study examines the outcome of 19 renal allografts transplanted in patients with augmented bladder or urinary diversion over a ten years period; moreover we submitted SF36 questionnaire to evaluate quality of life of these patients and compared the results with the general population. Result: Between January 1, 2005 and 31 December 2015 we performed 19/1093 renal transplantations in patients with abnormal lower urinary tract previously treated with bladder augmentation or bladder recycling. Current post-transplant follow-up was 47 months (range 18-188). No patient developed any episode of acute or chronic rejection. Mean serum creatinine after one year from transplant was 102 umol/L. Overall survival is 94.8% at the end of follow-up and graft survival is 89.6%. No significant differences emerged between patients undergoing transplant with lower urinary tract dysfunction and patients without, regarding to recurrent urinary tract infection. There was not statistically significant difference for vitality (p = 0.8088) and mental health (p = 0.8668). Conclusions: Presence of a previously augmented bladder or other lower urinary tract dysfunction treated in kidney transplant patients doesn’t worsen the final outcome. Mental health and the vitality of these patients are similar to the general population.

Desensitization strategies to safely perform ABO incompatible living donor kidney transplantations are various and still evolving. Given the successful outcome of the majority of the approaches, the current trend is focused on a minimization of treatments. Based on this consideration, the evolution at a single Center of the desensitization protocol is herein described. Starting from 2010, 58 AB0 incompatible living donor kidney transplantations were performed at the University-Hospital of Padua. Over the years, the initial desensitization strategy with rituximab single-dose induction, pre-and post-transplant plasmapheresis and CMV-specific immunoglobulin administration has been shifted to a minimized approach, omitting post-transplant antibody removal in 25 cases. The results of such reduction in post-transplant antibody removal did not affect the outcome of AB0-incompatible kidney transplants, with a reduction in costs and hospitalization.

Este trabalho investiga o futuro subjuntivo em orações relativas restritivas no português brasileiro considerando noções de modo, tempo e aspecto. Partindo de Quer (1998, 2008), assumimos que o modo subjuntivo em orações relativas indica sempre uma leitura não-referencial/atributiva do antecedente e observamos que o futuro do subjuntivo nesse ambiente só é selecionado quando há alguma referência de futuro na matriz, como um verbo no futuro do presente ou um predicado intensional como querer. Para questões temporais, tomamos por base a teoria referencial de tempo de Partee (1993) e o conceito de tempo de tópico de Klein (1994, 2009) e propomos que o futuro do subjuntivo deve ser considerado um tempo referencial não-passado a) relacionado a um tempo de tópico evidente no contexto; b) concomitante ou posterior ao momento de fala; c) também concomitante ou anterior ao tempo da matriz, nunca posterior a ele. Abordamos as classes de aspecto lexical propostas por Vendler (1957) para investigar os contrastes entre presente e futuro do subjuntivo em orações relativas, duas formas subjuntivas que autores como Comrie e Holmback (1984) e Marques (2010) consideram competidoras entre si no sistema verbal do português. Concluímos que o contraste entre eles pode parecer pouco relevante a princípio, em especial em casos de predicados estativos, mas que ele se torna mais claro à medida em que se evidencia o tempo de tópico relacionado ao futuro do subjuntivo. Por último, com fins descritivos, voltamos nossa atenção a noções de aspecto gramatical, partindo da relação entre o tempo de situação e o tempo de tópico também proposta por Klein (1994, 2009) para definir o futuro do subjuntivo como um tempo referencial não-passado em que, em oposição aos tempos pretéritos do português, não há marcação morfológica de aspecto perfectivo ou imperfectivo. This work investigates the future subjunctive in relative restrictive clauses in Brazilian Portuguese considering notions of mood, tense and aspect. From Quer (1998, 2008) we assume that subjunctive mood in relative clauses indicates a non-referential / attributive reading of the antecedent. We also observe that the future subjunctive in this environment is only selected when there is some future reference in the matrix clause, as a verb in the simple future or an intensional predicate as to want. In discussing temporal features, we take Partee\'s (1993) referential theory of tense and the concept of topic time by Klein (1994, 2009) to propose that the future subjunctive should be considered a non-past referential tense a)related to a topic time highlighted in the context; b)concomitant or subsequent to the speech moment; c)also concomitant or prior to the time of the matrix clause. We approach the aspectual classes proposed by Vendler (1957) to investigate the contrasts between present and future subjunctive in relative clauses, two subjunctive forms that authors like Comrie and Holmback (1984) and Marques (2010) consider to be competitors in the Portuguese verbal system. We conclude that the contrast between them may seen little relevant at first, specially with stative predicates, but it becomes clearer if the topic time related to the future subjunctive is evidenced. At last, for descriptive purposes, we turn our attention to grammatical aspectual notions, considering the relation between the time of the situation and the topic time also proposed by Klein (1994, 2009), to define the future subjunctive as a non-past referential tense in which, in opposition to the past tenses in portuguese, there is no morphological marker of perfective or imperfective aspect.

Background.Occupational performance (OP) and interventions during post-traumatic amnesia (PTA) following traumatic brain injury are poorly understood.Purpose.This study aims to describe a study protocol to (a) track person factors of OP throughout PTA and (b) assess the feasibility of a randomized controlled trial (RCT) protocol comparing an occupation-based multisensory stimulation and environmental enrichment intervention with usual care during PTA.Method.A prospective observational study will be conducted with an embedded Phase II RCT with 30 participants in PTA. Participants will be randomly assigned to group and regularly assessed on PTA and OP measures. Feasibility aspects will be recorded in a logbook. All measures will be repeated at PTA resolution and 1 month later, with a follow-up questionnaire completed at 6 months postinjury.Findings.Observational data will be analyzed using correlations. Feasibility will be examined descriptively, and group comparisons will be conducted to determine effect size.Implications.Results will provide a broader understanding of OP during PTA and inform future trials.

Background With the aging of recipients of renal transplantation (RT) one of the emerging issues is the incidence of low urinary tract symptoms (LUTS), which may have negative consequences on the graft survival and function. The aim of our study was to assess the influence of LUTS and the treatment with transurethral resection of the prostate (TURP) on the outcome of RT. Materials and Methods We collected data from men over 55 who underwent RT at our center from January 2007 to December 2016. We analyzed the incidence of LUTS; the rate of treatment with TURP; the eGFR (estimated glomerular filtration rate) at 6 months and 1, 3, and 5 years from transplantation; and graft survival. Results Fifty-five patients out of 268 experienced LUTS, and 19 of them had a bladder outlet obstruction (BOO). Patients experiencing BOO had a significantly higher hazard ratio (HR) of graft failure (HR 5.7, CI 1.56-21.4) compared to the other recipients. Of the 18 patients treated with TURP, 10 received the procedure within 6 months from the LUTS onset. They had a significantly absolute eGFR improvement at 6 months from the intervention (+14.25 mL/min ± 8.10) compared to the patients treated later (-8.4 mL/min ± 14.43). Discussion We showed the negative effects of LUTS on kidney graft function and survival. Although TURP is the standard therapy for such an issue, the best timing for it still has to be defined. Our experience supports the need for an early treatment of the LUTS for promoting the outcome of the RT.

Background: The utilization of deceased donor kidneys to initiate chains of living donor kidney paired donation (KPD) has been proposed, although the potential gain of this practice needs to be quantified and the ethical implications must be addressed before starting its application.Methods: The gain of implementing deceased donor-initiated chains has been measured through a mathematical algorithm, using retrospective data on the pool of donor/recipient incompatible pairs at a single Center. Allocation rules of chain ending kidneys and characteristics/quality of the chain initiating kidney (CIK) are described.Results: the quantification of benefit analysis showed that with a pool of 69 kidneys from deceased donors and 16 pairs enrolled in the KPD program, over a period of 3 years it is possible to transplant 8/16 recipients (50%). Following the approval of the Bioethical Committee of the Veneto Region and the revision of the allocation policies by the Italian National Transplant Center, the first successful case has been performed. The waiting time of the recipient (male, 53 yo) after entering the program for the CIK with a kidney donor risk index (KDRI) equal to 0.61 and a kidney donor profile index (KDPI) of 3%, was 4 days. His willing donor (female, 53 yo) with a living kidney donor profile index (LKDPI) of 2, donated 2 days later to a chain ending recipient (male, 47 yo,) who had been on dialysis for 5 years. Conclusions: This is the first report of a deliberate deceased donor-initiated chain, which has been successfully performed. This has been made possible thanks to an extensive phase of evaluation of the ethical issues and allocation policy impact. This paper includes a preliminary efficacy assessment and the development a dedicated algorithm.

Background Ulcerative colitis patients and transplant recipients are at risk for colorectal cancer. Here, we show that immunosuppressive regimens for kidney transplants are associated with the progression of ulcerative colitis-related carcinogenesis. Methods We describe the case of a patient diagnosed with colorectal cancer in ulcerative colitis while on immunosuppressive therapy for a kidney transplant. The immunological microenvironment of the cancer and its mutational status were analyzed, and a mouse colon cancer model was created to replicate the unique clinical conditions. AOM/DSS mice were randomized into seven experimental groups that received different immunosuppressants and an untreated control group to assess the frequencies of adenocarcinoma and high-grade dysplasia. Histopathology, immunohistochemistry, and flow cytometry were also performed on the harvested mouse colons. Results All mice treated with an immunosuppressive regimen developed at least an adenoma, and several of those receiving anti-CD3, anti-CD8, and mycophenolate mofetil also developed adenocarcinomas. In contrast, mice receiving rapamycin did not develop adenocarcinomas, and the extent of high-grade dysplasia in those mice was similar to that in control mice. Conclusions Patients with pre-neoplastic conditions, such as ulcerative colitis, who are undergoing a solid organ transplant might benefit from the use of mTOR inhibitors given their intrinsic anti-tumor properties., Among transplant recipients, colorectal cancer is more aggressive. This report highlights the association between immunosuppression and the disruption of the immune surveillance mechanisms against colorectal cancer.

Background Ulcerative colitis patients and transplant recipients are at risk for colorectal cancer. Here, we show that immunosuppressive regimens for kidney transplants are associated with the progression of ulcerative colitis-related carcinogenesis. Methods We describe the case of a patient diagnosed with colorectal cancer in ulcerative colitis while on immunosuppressive therapy for a kidney transplant. The immunological microenvironment of the cancer and its mutational status were analyzed, and a mouse colon cancer model was created to replicate the unique clinical conditions. AOM/DSS mice were randomized into seven experimental groups that received different immunosuppressants and an untreated control group to assess the frequencies of adenocarcinoma and high-grade dysplasia. Histopathology, immunohistochemistry, and flow cytometry were also performed on the harvested mouse colons. Results All mice treated with an immunosuppressive regimen developed at least an adenoma, and several of those receiving anti-CD3, anti-CD8, and mycophenolate mofetil also developed adenocarcinomas. In contrast, mice receiving rapamycin did not develop adenocarcinomas, and the extent of high-grade dysplasia in those mice was similar to that in control mice. Conclusions Patients with pre-neoplastic conditions, such as ulcerative colitis, who are undergoing a solid organ transplant might benefit from the use of mTOR inhibitors given their intrinsic anti-tumor properties.

Este projeto surgiu das dificuldades evidenciadas por duas educadoras de infância de uma creche do concelho de Cascais, na construção de portfólios de avaliação das aprendizagens das crianças. Partindo desta dificuldade e do interesse das educadoras em aprender a construir portfólios, deu-se início a um projeto de investigação ação que tinha como objetivo a melhoria da construção de portfólio com crianças, considerando a importância que assume nesta discussão o direito da participação, acreditando que é possível ‘dar voz’ às crianças pequenas. Tendo por base um quadro teórico que integra o contributo das três áreas do saber que estudam a infância – Pedagogia, Sociologia e Psicologia – procurou-se esclarecer o conceito de portfólio de aprendizagem. Foram proporcionados momentos de partilha de dúvidas e co-construção de aprendizagens acerca da construção dos portfólios com as duas educadoras, que expressaram vontade de saber mais e de dar inicio a um caminho de melhoria, que não se pretende ver terminado no final deste projeto. Os resultados revelam que é possível incluir as crianças de creche na construção dos seus portfólios. Evidenciam ainda que, num curto espaço de tempo, as 40 crianças (dois grupos com 21 e 19 crianças) envolveram-se ativamente, uma vez que a sua opinião não só é tida em conta como é decisiva neste processo. A duas educadoras envolvidas consideram que este é um processo que traz grandes vantagens para as crianças, apesar de algumas dificuldades que a equipa sentiu na sua construção. Acreditam ainda que este é um instrumento que promove a aprendizagem ativa e o desenvolvimento das crianças de creche e que, criando uma ‘cultura de portfólio’ em que todos os implicados conhecem e compreendem o instrumento, é possível assegurar o direito de participação nos processos de avaliação destas crianças, que são pequenas mas competentes., This project emerged from the difficulties highlighted by the educators of a nursery in Cascais, in building children learning portfolios. With this difficulty and interest of educators on learning to build portfolios, has begun an action-research project to improve portfolio construction with children, focusing on the right of participation and believing that it is possible to 'give voice' to infants 'hearing them'. Based on a theoretical framework that integrates the contribution of the three areas of knowledge that study childhood - Pedagogy, Sociology and Psychology – we attempted to clarify the concept of learning portfolio and meet some theories. Sharing moments of doubt and co - construction of learning in the group that joined the project, emerged the desire to learn more and to start a path of improvement, that will not be completed at the end of this project. The results reveal that it is possible to include children from nursery to build their portfolios. Also show that in a short period of time, children are actively involved in a way that their opinion is not only taken into account as it is decisive in this process. The educators believe that this is a process that brings great advantages for children, despite some difficulties that the team felt in its construction. Still believe that this is an instrument that promotes active learning and development of children and childcare and by creating a 'culture of portfolio' in which all involved know and understand the instrument, it is possible to ensure the right to participate in their assessment, to children who are small but competent.

This study reports on a large series of 200 dual kidney transplantations (DKTs) from expanded criteria donors (ECDs) and proposes specific ways to optimize outcomes. Data concerning 200 DKTs performed in the last 14 yr were retrospectively analyzed. Kidneys from high-risk ECD were allocated for use in DKTs on an old-for-old basis after histological assessment. Different surgical techniques and immunosuppressant regimens were used over time, and the outcomes are discussed. Donors and recipients were a median 73 (70-77) and a 62 (58-67) yr old, respectively. Delayed graft function occurred in 31.5% of cases, and acute rejection in 13.5%. Patient and graft survival at five yr were 90.4% and 85.8%, respectively. Unilateral kidney placement was preferred for 75% of patients, and was associated with a low rate of surgical complications. Our current standard therapy comprising low-dose calcineurin inhibitors (CNIs) associated with mammalian target of rapamycin inhibitors (mTOR) and steroids appears to offer the best risk/benefit profile for elderly patients undergoing DKT. In our experience, outcomes after DKT can be improved by: (i) kidney clinical-histological assessment; (ii) unilateral kidney placement; (iii) minimal use of CNI associated with mTOR.

The aging of the on-dialysis population raises the issue of whether to propose elderly patients for kidney transplantation and how to manage their immunosuppression. This study aims to analyze the outcome of kidney transplantation on an Italian series of elderly recipients. We included in this retrospective study all patients over 60 years, receiving a deceased-donor kidney transplantation from January 2004 to December 2014 in two north Italian Centers. We analyzed the correlation of recipient age with graft's and patient's survival, delayed graft function (DGF), acute cellular rejection (ACR), surgical complications, infections and glomerular filtration rate (GFR). Forty hundred fifty two patients with a median age of 65 years were included in the study. One, three and five-year patient's and graft's survival were respectively of 98.7%, 93%, 89% and 94.4%, 87.9%, 81.4%. The increasing recipient age was an independent risk factor only for the patient's (p=0.008) and graft's survival (p=0.002). ACR and neoplasia were also associated to a worse graft survival. The reduced graft survival in elderly kidney recipients seems to be related more to the increasing recipient's age than to the donor's features. In this population the optimization of organ allocation and immunosuppression may be the key factors to endorse improvements. This article is protected by copyright. All rights reserved.

Kidney transplant recipients (KTRs) present with compromised functional capacity, low levels of physical activity, muscle atrophy, and peripheral nerve dysfunction that may result in high postural instability. This study aimed to compare the static balance control of 19 KTRs with 19 healthy adults (HA). All participants completed the Romberg test on a stabilometric platform with eyes open (EO), eyes closed (EC) and during a dual task (DT) condition. Centre of pressure (COP) measures (COP velocity (COPv) and sway area (SA)), as well as position-based outcomes such as anterior-posterior (AP) and medio-lateral (ML) ranges of COP displacements were recorded. Independent ANCOVA revealed an overall lower performance of KTRs compared to HA (p < 0.05) with the EC condition exhibiting the worst relative performance for KTRs, suggesting a poorer capacity of relying on proprioceptive information when maintaining the upright posture. The addition of a cognitive task did not further worsen balance performance in KTRs. As impaired postural control is one of the main predictors of falls in elderly subjects, these data might also indicate that this constitutes an equivalent risk factor for falling in middle-aged KTRs.

Dissertação de Mestrado Integrado em Arquitetura, com a especialização em Arquitetura, apresentada na Faculdade de Arquitetura da Universidade de Lisboa para obtenção do grau de Mestre. Na era de grande progresso tecnológico em que vivemos e que assume um papel importante nas nossas vidas, torna-se quase impensável regressar às formas rudimentares de construir. A Arquitectura vernacular assume-se, aos olhos dos entusiastas do progresso, como um método retrógrado de criar habitação, que nos transporta a um passado nostálgico, carregado de elementos obsoletos. No entanto, esquecemo-nos de que estes métodos vernaculares são uma forma de combater problemas ambientais catastróficos que assolam o planeta, bem como de solucionar a actual crise habitacional e de carência económica; trata-se da forma mais simples de satisfazer as necessidades habitacionais mais básicas. Assim, tomemos como ponto de partida o bambú como material emergente e em abundância na China, onde já possui um grande passado histórico, para desenvolver o presente estudo. Apesar de ser um material quase esquecido, devido ao fraco desenvolvimento da tecnologia a ele associado, possui um carácter bastante ecológico, resistente e versátil, tratando-se da planta de mais rápido crescimento no planeta. Desde que há registo que tem sido aplicado nas mais diversas construções, com uma vasta aplicabilidade, do pavimento à estrutura. Com esta investigação procura-se, portanto, fazer uma aproximação entre Oriente e Ocidente, através do estudo de um material ecológico e de grande poder estético, capaz de se proliferar em ambientes diversos, já que cada vez mais procuramos alternativas e métodos de construção sustentáveis, com base em materiais que a Natureza nos disponibiliza, de forma a minimizar o impacto ambiental. Numa última parte, ao percebermos como o bambú é aplicado e de que forma pode ser melhorado para corresponder às exigências do contexto Europeu, mais concretamente de Portugal, o material recolhido culminará no desenvolvimento de um protótipo habitacional sustentável, que parte do bambú enquanto material base para a sua estruturação. Será interessante contornar as fraquezas do bambú face às características do clima mediterrânico de Portugal Continental, mediante a sua conjugação com outro material igualmente sustentável: a terra crua ABSTRACT: In an era of great technological progress, which we live and plays an important role in our lives, it is almost unthinkable to return to the rudimentary forms of building. The vernacular architecture is assumed, in the eyes of progress enthusiasts, as a retrograde method of creating shelter, which leads us to a nostalgic past, loaded with obsolete elements. However, we forget that these vernacular methods are a way to fight catastrophic environmental problems facing the planet, and to solve the current housing crisis and economic hardship; it is the simplest way to meet the most basic housing needs. So, let us take bamboo as an emerging and abundant material in China as a starting point, where it already has a great historical past, to develop this study. Despite being an almost forgotten material, due to the weak development of the technology associated with it, it has a very eco-friendly, durable and versatile character, as it is the fastest growing plant on the planet. Since it is known, bamboo has been applied in several buildings, with a wide applicability, from the pavement till the structure. This investigation seeks to make a rapprochement between East and West, through the study of a material with an ecological and great aesthetic power, able to proliferate in many environments, as we increasingly seek for alternative and sustainable construction methods, based on materials available in nature, to minimize environmental impact. In a last part, when we realize how bamboo is used and how it can be improved to match the European context requirements, specifically in Portugal, the collected data will culminate in the development of a sustainable housing prototype, that takes bamboo as the material base for structuring. It will be interesting to contour the bamboo weaknesses, due to the characteristics of our Mediterranean climate of Continental Portugal, through the conjugation of it with an equally sustainable material: raw land. N/A

Assessing cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) represents an appealing strategy for identifying transplant recipients at risk of infection. In this study, we compared two gamma interferon-releasing assays (IGRAs), Quantiferon-CMV and CMV enzyme-linked immunosorbent spot (ELISPOT), to determine the ability of each test to predict protective CMV-specific T-cell responses. Two hundred twenty-one Quantiferon-CMV and ELISPOT tests were conducted on 120 adult kidney transplant recipients (KTRs), including 100 CMV-seropositive transplant recipients (R + ) and 20 CMV-seronegative transplant recipients of a CMV-positive donor (D + /R − ). As a control cohort, 39 healthy adult subjects (including 33 CMV-seropositive and 6 CMV-seronegative subjects) were enrolled. CMV IgG serology was used as a reference for both tests. In the CMV-seropositive individuals, the ELISPOT and Quantiferon-CMV assays provided 46% concordance with the serology, 12% discordance, 18% disagreement between ELISPOT or Quantiferon-CMV and the serology, and 24% gray areas when one or both tests resulted in weak positives. None of the CMV-seronegative subjects showed detectable responses in the ELISPOT or the Quantiferon-CMV test. In transplant recipients, both the ELISPOT and Quantiferon-CMV assays positively correlated with each other and negatively correlated with CMV DNAemia in a significant way ( P < 0.05). During the antiviral prophylaxis, all 20 D + /R − KTRs we examined displayed undetectable Quantiferon-CMV and ELISPOT results, and there was no evidence of CMV seroconversion. The receiving operator curve (ROC) statistical analysis revealed similar specificities and sensitivities in predicting detectable viremia (areas under the curve [AUC], 0.66 and 0.62 for Quantiferon-CMV and ELISPOT, respectively). ELISPOT and Quantiferon-CMV values of >150 spots/200,000 peripheral blood mononuclear cells (PBMCs) and >1 to 6 IU gamma interferon (IFN-γ) were associated with protection from CMV infection (odds ratios [OR], 5 and 8.75, respectively). In transplant recipients, the two tests displayed similar abilities for predicting CMV infection. Both the ELISPOT and Quantiferon-CMV assays require several ameliorations to avoid false-negative results.

Dissertação de mestrado em Gestão e Economia da Saúde, apresentada à Faculdade de Economia da Universidade de Coimbra, sob a orientação de Pedro Lopes Ferreira e Manuela Frederico. A insuficiência cardíaca (IC) é uma das principais prioridades entre as doenças crónicas, acarretando grande impacto económico, social e individual. Apesar da melhoria dos tratamentos farmacológicos, ainda existe possibilidade de melhoria em termos de educação terapêutica. O presente trabalho tem como objetivo principal a adaptação cultural e validação dos instrumentos Dutch Heart Failure Knowledge Scale (DHFKS) e Heart Failure Compliance Questionnaire (HFCQ). Pretende-se ainda avaliar a adesão terapêutica e o conhecimento de pessoas com IC, e a sua correlação com variáveis sociodemográficas, clínicas e com a qualidade de vida. Desenvolveu-se um estudo quantitativo, transversal, descritivo-correlacional. Foi utilizado um questionário que incorpora as duas escalas traduzidas e o EQ-5D-3L. A amostragem foi não-probabilística consecutiva de doentes seguidos em consulta externa e internamento em hospital universitário. A tradução seguiu os passos preconizados por Ferreira e Marques (1998). Recorreu-se a estatística descritiva e aos testes U de Mann-Whitney, H de Kruskall-Wallis e correlação de Spearman para testar as hipóteses. Avaliou-se a consistência interna da DHFKS. Participaram 43 doentes (idade média= 60,4±10,7; 76,7% homens; duração de doença média= 12,2±14,9 anos). A DHFKS apresentou um Alpha de Cronbach de 0,62. Em termos de conhecimento, o número de respostas corretas variou entre 5 e 14 (em 15), com 72% dos doentes a responderem corretamente a 10 ou mais questões. Globalmente, a adesão terapêutica foi de 65,7% (±8,5%), sendo maior na dimensão fumar (78,1%±10,9%) e menor no exercício físico (54,5%±18,2%). A adesão (manutenção de saúde) correlaciona-se positivamente com o conhecimento (rs=0,40; p

Patients with diabetes are at increased cardiovascular risk. Simultaneous pancreas-kidney transplantation (SPKT) is the treatment of choice in patients with type 1 diabetes mellitus and diabetic nephropathy. We assessed coronary flow reserve (CFR) by transthoracic echocardiography as a marker of major adverse cardiac events (MACE) in SPKT patients.We studied 48 consecutive SPKT patients (28 male, age at SPKT 54 ± 8 years). Time from transplantation was 8.5 ± 3 years. Follow-up was 4.6 ± 1.8 years. Coronary flow velocity in the left anterior descending coronary artery was detected by Doppler echocardiography at rest and during adenosine infusion. CFR was the ratio of hyperemic diastolic flow velocity (DFV) to resting DFV. A CFR ≤ 2 was considered abnormal and a sign of coronary microvascular dysfunction. MACE were cardiac death, myocardial infarction, and heart failure.CFR was 2.55 ± 0.8. CFR was ≤2 in 13 (27%) patients. CFR was lower in SPKT patients with MACE (2.1 ± 0.7 vs 2.7 ± 0.8, P = .03) and patients with MACE had a higher incidence of CFR ≤ 2 (P = .03). Time from transplantation was shorter in patients with MACE (P .0001). Patients with CFR ≤ 2 had a lower MACE-free survival (P = .03). CFR ≤ 2 predicted the risk of MACE (P = .007) independently from coronary artery disease and metabolic control. However, this predicted role is lost when adjusted for the time from transplantation, which plays a protective role (P = .001).In SPKT, CFR ≤ 2 may be a reliable marker for MACE, independent of coronary artery disease diagnosis. However, this role seems to be reduced over time. This finding suggests a gradual reduction of cardiovascular risk in SPKT patients.

This paper aims to highlight the capital relations that permeate the story the Great Gatsby, Francis Scott Fitzgerald, considered here as the hipotexto, founding text on design of Gerard Genette (2010) and your the most recent film adaptation, hypertext (GENETTE, 2010, p. 12) that works as transposition and/or updating the previous text made by the Australian Director Baz Luhrmann in 2013. In this sense, from the theoretical formulations proposed by Pierre Bourdieu (1996) about the art as social, historical and cultural phenomenon, the product of a structured and stratified society, we use the concepts of capital and symbolic power to highlight the logic financier that articulates the personal relationships and emotional in the narrative of Fitzgerald, above all, from a reading of their analytical structural elements. In this analysis, we focused on conflict cells established between the characters, the Narrator, the spaces and the temporal dynamics established in hipotexto interaction written with filmic hypertext.O Grande Gatsby: Amores e o Acúmulo de Capitais Financeiros e Simbólicos O presente trabalho se propõe a evidenciar as relações capitais que permeiam a narrativa O Grande Gatsby, de Francis Scott Fitzgerald, considerada aqui como o hipotexto, texto fundante na concepção de Gerard Genette (2010) e sua adaptação cinematográfica mais recente, hipertexto (GENETTE, 2010, p.12) que funciona como transposição e/ou atualização do texto anterior realizada pelo diretor australiano Baz Luhrmann em 2013. Nesse sentido, a partir das formulações teóricas propostas por Pierre Bourdieu (1996) acerca da arte como fenômeno social, histórico e cultural, produto de uma sociedade estruturada e estratificada, utilizamos as noções de capital e poder simbólico para evidenciar a lógica financista que articula as relações pessoais e afetivas na narrativa de Fitzgerald, sobretudo, a partir de uma leitura analítica de seus elementos estruturais. Nessa análise, enfocamos as células de conflito estabelecido entre as personagens, o discurso do narrador, os espaços e a dinâmica temporal que se estabelece na interação do hipotexto escrito com o hipertexto fílmico.

Background Despite potential renal and cardiovascular advantages of proliferation signal inhibitors, their de novo use in kidney transplantation (KT) from elderly donors (ED) is poorly documented. We retrospectively analyzed two consecutive cohorts of KT from ED: low-dose extended-release tacrolimus (Tac) was used from 2010 to 2012 and cyclosporine (Csa) was used from 2008 to 2010. Methods Associated maintenance drugs were everolimus (Eve) and steroids. Outcomes were compared between groups over a 12-month follow-up. Fifty-six patients were analyzed in the Tac-Eve group and 54 in the Csa-Eve group. Results There were no significant differences at baseline with the exception of older donors age in the Tac-Eve cohort (74 vs 71 years, P = .002). There were no deaths, primary non functions, or graft losses. Eight (14%) Tac-Eve and 15 (28%) Csa-Eve patients had delayed graft function ( P = .10). Renal function was fairly stable over time (median cGFR 36–49 mL/min and 51–55 mL/min in single kidney transplantation and dual kidney transplantation patients, respectively) with no significant differences between groups at month 12. Surgical complications were infrequent and observed mostly in dual kidney transplantation recipients. Thirty-nine (70%) and 30 (56%) patients remained under their initial Tac-Eve or Csa-Eve regimen, respectively. Conclusions Induction with Thymoglobuline and maintenance with Eve and low-dose extended-release Tac and steroids is safe and effective in renal transplant from ED.

Objective Blood group incompatibility in kidney transplants from a living donor can be successfully overcome by using various desensitization protocols: intravenous immunoglobulin, plasmapheresis (PP), immunoadsorption, and double filtration PP. Patients and Methods From July 2010 to October 2013, we performed 10 ABO incompatible kidney transplantation (KT) procedures from a living donor. The desensitization protocol was based on rituximab and PP + cytomegalovirus immune globulin. All patients received induction with basiliximab, except 1 case treated with Thymoglobuline ® (ATG) for the simultaneous presence of donor-specific antibody. Tacrolimus and mycophenolate mofetil were initiated at the time of desensitization and continued after the transplant. Results After a mean follow-up of 11.6 ± 10.4 months, all patients are alive with a functioning graft. The mean serum creatinine concentration at 1 month, 3 months, 6 months, and 1 year was 1.48 ± 0.29, 1.47 ± 0.18, 1.47 ± 0.27, and 1.5 ± 0.27 mg/dl. Three episodes of acute cellular rejection occurred in 2 patients. There was only 1 case of BK virus infection, treated with reduction of immunosuppressive therapy. The protocol biopsy specimens at 1, 3, and 6 months were C4d positive in the absence of acute rejection. Conclusions Desensitization with rituximab, PP, and anti–cytomegalovirus immune globulin allowed us to perform transplants from living donors to ABO incompatible recipients with excellent results and reduced costs.