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Dilson Palhares Ferreira,1,&ast; Claudia Vicari Bolognani,2,3,&ast; Levy Aniceto Santana,2,&ast; Sergio Eduardo Soares Fernandes,2,3,&ast; Matheus Serwy Fiuza de Moraes,3,&ast; Luana Argollo Souza Fernandes,3,&ast; Daniella Queiroz de Oliveira,3,&ast; Rosália Bezerra de Santana,3,&ast; Leila Bernarda Donato Gottems,2,3,&ast; Fabio Ferreira Amorim1– 4,&ast; 1Graduation Program in Health Sciences, University of Brasília (Unb), Brasília, Brazil; 2Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil; 3Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil; 4Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil&ast;These authors contributed equally to this workCorrespondence: Fabio Ferreira Amorim; Dilson Palhares Ferreira, Graduation Program in Health Sciences, University of Brasília (UnB), Faculty of Health Sciences Campus University Darcy Ribeiro S/N - Asa Norte, Federal District, Brasília, CEP: 70910-900, Brazil, Email ffamorim@gmail.com; palhares.dilson@gmail.comPurpose: The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in surgical services. The primary objective of the study was to assess the impact of COVID-19 on elective and emergency surgeries in a Brazilian metropolitan area. The secondary objective was to compare the postoperative hospital mortality before and during the pandemic.Patients and Methods: Time-series cohort study including data of all patients admitted for elective or emergency surgery at the hospitals in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. A causal impact analysis was used to evaluate the impact of COVID-19 on elective and emergency surgeries and hospital mortality.Results: There were 174,473 surgeries during the study period. There was a reduction in overall (absolute effect per week: − 227.5; 95% CI: − 307.0 to − 149.0), elective (absolute effect per week: − 170.9; 95% CI: − 232.8 to − 112.0), and emergency (absolute effect per week: − 57.7; 95% CI: − 87.5 to − 27.7) surgeries during the COVID-19 period. Comparing the surgeries performed before and after the COVID-19 onset, there was an increase in emergency surgeries (53.0% vs 68.8%, P < 0.001) and no significant hospital length of stay (P = 0.112). The effect of the COVID-19 pandemic on postoperative hospital mortality was not statistically significant (absolute effect per week: 2.1, 95% CI: − 0.01 to 4.2).Conclusion: Our study showed a reduction in elective and emergency surgeries during the COVID-19 pandemic, possibly due to disruptions in surgical services. These findings highlight that it is crucial to implement effective strategies to prevent the accumulation of surgical waiting lists in times of crisis and improve outcomes for surgical patients.Keywords: COVID-19, surgical procedures, operative, elective surgical procedures, acute care surgery, hospital mortality

In order to predict the static deformations and free vibration behaviour of thin and thick cross-ply laminated plates, we integrate Carrera’s unified formulation with a radial basis function collocation technique on a pseudospectral framework, using Reissner’s mixed variational theorem. Numerical examples illustrate the precision and effectiveness of this collocation technique for static and vibration problems.

We propose a Mutual Language Policy to mediate shared interests between Chinese and indigenous workers in minimalizing frictions related to language attitudes, socio-cultural attitudes, ideologies and identities. So far, language policy has only sided with indigenous interests initiated by the government and has not involved foreign interests. By using multiple case study, we analyzed language attitudes, socio-cultural attitudes, as well as ideologies and identities of Chinese and indigenous workers to understand the frictions that occurred. We found that the language attitude of the Chinese workers was considered positive while the dominant use of Mandarin was only caused by the lack of mastery of both Indonesian and English. Next, the socio-cultural attitude of Chinese workers that seemed exclusive was basically caused by two main things,firstly, their concern about counterculture and contra behavior towards indigenous people.Secondly, the social class in employment context. Finally, the defense of the ideology and identity of the indigenous community seemed so strong was because of the collective defense system. Shared interests among them in a mutual language policy concept are also discussed.

Ricardo Machado Soares,&ast; Catarina Cunha Ferreira,&ast; Joana da Silva Fernandes, Carolina Madeira, Luís MA Silva, Eduardo Saraiva, Lígia Ribeiro, Sofia Fonseca Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal&ast;These authors contributed equally to this workCorrespondence: Ricardo Machado Soares, Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia e Espinho, EPE, Rua Conceição Fernandes, S/N, 4434-502, Vila Nova de Gaia, Porto, Portugal, Tel +351 915045174, Email ricardo.machado.soares@chvng.min-saude.ptPurpose: To report the long-term functional, anatomical and safety outcomes of 0.2 μg/day fluocinolone acetonide 0.19mg in patients with persistent or recurrent diabetic macular edema (DME).Methods: Retrospective, observational, single-center study of patients with recurrent or persistent DME. All patients received 0.2 μg/day of fluocinolone acetonide 0.19mg, and data were collected at baseline and months 1, 3, 6, 12, 24 and 36 after implantation. Outcomes measured included best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), and safety outcomes.Results: A total of 28 eyes from 28 patients were included. The mean age was 66.5 years (95% CI 62.8– 70.2) with a mean duration of DME of 8.8 years (95% CI 7.7– 10.0). Only two eyes were phakic. Mean follow-up was 25.4 months (95% CI 21.2– 29.6). Mean BCVA at baseline was 48.6 ETDRS letters (95% CI 41.3– 55.8) and improved as early as month 1 of follow-up with a mean gain in BCVA of 7.8 (95% CI 4.3– 11.3) ETDRS letters (p< 0.001). Statistically significant improvements in BCVA were also observed at months 6, 12 and 24. At baseline, patients had a mean CMT of 530.5μm (95% CI 463.0– 598.0), and a decrease in CMT was observed, starting at the first month of follow-up (mean CMT reduction of − 170.5μm, 95% CI − 223.8– − 117.1; p< 0.001). Statistically significant decreases in CMT were also observed at months 6, 12, 24, and 36, with the maximum decrease observed at month 12 (p< 0.001). Mean IOP at baseline was 16.4mmHg (95% CI 15.3– 17.5) and nine eyes (32.1%) had an IOP ≥ 21mmHg during follow-up.Conclusion: Our results support the effectiveness and safety profile of fluocinolone acetonide. Although additional long-term real-world evidence is required, fluocinolone acetonide may represent a safe strategy for daily, low-dose, sustained and localized release to the posterior segment of the eye, providing both functional and anatomical benefits in DME.Keywords: diabetic macular edema, intravitreal implant, best corrected visual acuity, intravitreal corticosteroid, sub-optimal response

Guilherme Peixoto Tinoco Arêas,1,2 Cássia da Luz Goulart,3 Thaís Sant’Anna,4 Tiótrefis Gomes Fernandes,4 Rafael de Oliveira Alvim,1 Fernanda Facioli dos Reis Borges,1 Camila Miriam Suemi Sato Barros do Amaral,3 Suzy Cristina França Rodrigues,1 Jefferson Valente,3 João Marcos Bemfica Barbosa Ferreira,5 Anna Gabriela Rezende,1,3 Edival Ferreira de Oliveira Júnior,6 Marcus Vinícius Guimarães de Lacerda,3,7,8 Fernando Fonseca de Almeida-Val1– 4 1Department of Physiological Sciences, Exercise Physiology Laboratory, Federal University of Amazonas, Manaus, AM, Brasil; 2Cardiopulmonary Laboratory, Getúlio Vargas University Hospital, UFAM, Manaus, AM, Brasil; 3Dr Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, AM, Brasil; 4Faculty of Physical Education and Physiotherapy, Respiratory and Cardiovascular Physiotherapy Laboratory, Federal University of Amazonas, Manaus, AM, Brasil; 5Higher School of Health Sciences, Faculty of Medicine, State University of Amazonas, Manaus, AM, Brasil; 6Francisca Mendes University Hospital, Manaus, AM, Brasil; 7Leônidas and Maria Deane Institute, Fiocruz Amazonas, Manaus, AM, Brasil; 8University of Texas Medical Branch at Galveston, Galveston, TX, USACorrespondence: Guilherme Peixoto Tinoco Arêas, Departamento de Ciências Fisiológicas, Universidade Federal Do Amazonas, Avenida Rodrigo Otávio, 6200, Manaus, AM, 69080-900, Brasil, Email guilhermepta@ufam.edu.brBackground: The coronavirus disease-2019 (COVID-19) pulmonary rehabilitation (PR) seems to be a better choice to improve physical and functional capacity after acute infection. However, there is a lack of evidence regarding the effects of different strategies to optimize post-acute phase rehabilitation and reduce long COVID-19 physical deteriorations.Objective: To compare the use of a noninvasive ventilation (NIV) plus aerobic exercise strategy during PR program with to a standard PR (without NIV) on physical capacity and quality of life outcomes in post-COVID-19.Methods: Double-blinded randomized controlled clinical trial. A total of 100 individuals discharged from hospital in a post-acute phase of severe COVID-19 will be randomized into two groups: PR + NIV (Group 1) and PR (Group 2). Inclusion criteria include participants who present symptomatic dyspnea II and III by the modified Medical Research Council, aged 18 years or older. Both groups will receive aerobic and resistance exercise, and inspiratory muscle training. However, group 1 will perform aerobic training with bilevel NIV. Cardiopulmonary exercise test will assess the O2 peak uptake, 6-minute walk test will assess the walking distance and short-form 36 will assess the quality of life before and after 8 weeks (after 24 PR sessions). Moreover, patients will be contacted by telephone every 3 months for one year to record possible adverse events, hospitalizations, and death. All data will be registered in RedCap, and analyses will be performed in the STATA v13 software.Clinical Trial Registration: RBR-3t9pkzt.Keywords: COVID-19, noninvasive ventilation, pulmonary rehabilitation

Considering gastronomy as a source of expression of local culture, its use in tourism can contribute to enhancing and adding value to the destination, as well as encourage the pride of the local community, stimulating its production and consumption, and its dissemination outside the region. Bucho Raiano is a gastronomic product of identity and representativeness for the inland border region of Portugal (Riba Côa), for which its confraternity seeks the dissemination, the promotion of its consumption, and enhancement as a cultural resource. In this context, we seek to frame the Bucho Raiano gastronomic product, its identity, and the role of the confreres in its promotion and dissemination. Thus, this research aims to contextualize the Confraria do Bucho Raiano as a case study, evaluate the confreres’ perception of the confraternity’s mission, its strategies and contributions to the promotion and enhancement of this gastronomic product. The aim is to find out whether Bucho can be an important tourist product for this region and, consequently, strengthen the link between traditional local gastronomy and the tourist destination, according to the confreres’ perception.

Uniform symmetric bodies can be observed floating asymmetrically under certain circumstances. Previous explanations of this are mostly abstract and lack experimental verification, making their understanding and application difficult. This article presents in detail alternative insights into the floating equilibria of uniform prisms and parabolic cylinders. The intrinsic characteristics of the equilibrium curves are investigated, and several equilibria different from those in the literature are found. The inflection points in the equilibrium curves are analyzed quantitatively due to their significance for floating states. Furthermore, experiments have been conducted for the square prism which validate the derived equilibrium curve, and provide a practical impression of the asymmetric floating phenomenon of symmetric bodies. These results have the potential to be applied in naval and ocean engineering, such as in the design of vessels and floating offshore structures.

The aim of this study was to assess whether toothbrushing with a dentifrice containing an antimicrobial phthalocyanine derivative (APD) can reduce the intraoral viral load of SARS-CoV-2. Twenty COVID-19-positive dentate patients aged ≥18 years were selected instructed to brush their teeth for 2 min with a dentifrice containing APD. Self-collected samples of unstimulated saliva were carried out three times: T0 (baseline), T5 (5 min after toothbrushing), and T30 (30 min after toothbrushing). The analysis of viral RNA was performed by RT-qPCR for detection of three viral genes (ORF1ab, N and S genes). Results were statistically tested using Friedman’s test and pairwise comparison with Bonferroni corrections, with a significance level of 5%. There was an increase in the cycle threshold (Ct) value from T0 to T5 in 13 patients (72.2%), and from T0 to T30 in 14 patients (77.8%). In two patients (11.1%) no SARS-CoV-2 was detected at T5 and five patients (27.8%) at T30. The Ct values were statistically significantly higher (p=0.020) at T30 in comparison to T0 and T5. This pilot study suggests that toothbrushing with a dentifrice containing APD could reduce the SARS-CoV-2 viral load in the oral cavity. However, further studies are needed to confirm this possible beneficial effect against SARS-CoV-2.

Previous literature showed a complex interpretation of recall tasks due to the complex relationship between Executive Functions (EF) and Long Term Memory (M). The Test of Memory Strategies (TMS) could be useful for assessing this issue, because it evaluates EF and M simultaneously. This study aims to explore the validity of the TMS structure, comparing the models proposed by Vaccaro et al. (2022) and evaluating the measurement invariance according to three countries (Italy, Spain, and Portugal) through Confirmatory Factor Analysis (CFA). Four hundred thirty-one healthy subjects (Age mean = 54.84, sd = 20.43; Education mean = 8.85, sd =4.05; M = 177, F = 259) were recruited in three countries (Italy, Spain, and Portugal).Measurement invariance across three country groups was evaluated through Structural Equation modeling. Also, convergent and divergent validity were examined through the correlation between TMS and classical neuropsychological tests. CFA outcomes suggested that the best model was the three-dimensional model, in which list 1 and list2 reflect EF, list 3 reflects a mixed factor of EF and M (EFM) and list4 and list5 reflect M. This result is in line with the theory that TMS decreases EF components progressively. TMS was metric invariant to the country, but scalar invariance was not tenable. Finally, the factor scores of TMS showed convergent validity with the classical neuropsychological tests.The overall results support cross-validation of TMS in the three countries considered.

Jaquellyne Gurgel Penaforte-Saboia,1,2,&ast; Carlos Eduardo Barra Couri,3,&ast; Natasha Vasconcelos Albuquerque,2,4,&ast; Lana Livia Peixoto Linard,1,2,&ast; Daniel Autran Cavalcante Araújo,5,&ast; Sherida Karanini Paz de Oliveira,6 Thisciane Ferreira Pinto Gomes,2 Marcelo Maia Pinheiro,7 Maria Helane Costa Gurgel Castelo,2 Virgínia Oliveira Fernandes,2,4 Renan Magalhães Montenegro Júnior1,2,4,&ast; 1Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; 2Clinical Research Unit, Walter Cantídio University Hospital, Federal University of Ceará/ EBSERH Fortaleza, Fortaleza, CE, Brazil; 3Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil; 4Department of Community Health, Federal University of Ceará, Fortaleza, CE, Brazil; 5Department of Internal Medicine, Sinai Grace Hospital/Detroit Medical Center, Detroit, MI, USA; 6Ceará State University, Fortaleza, CE, Brazil; 7UNIVAG, University Center, Faculty of Medicine, Várzea Grande, Mato Grosso, Brazil&ast;These authors contributed equally to this workCorrespondence: Renan Magalhães Montenegro Júnior, Hospital Complex (CH) of UFC/EBSERH, Rua Coronel Nunes de Melo 1142, Fortaleza, Ceará, 60430-270, Brazil, Tel +55 8533668600, Fax +55 8533668619, Email renanmmjr@gmail.comBackground: The incidence of Type 1 Diabetes Mellitus (T1DM) is on the rise. Since there is no curative treatment, it is urgent to look for therapies that can delay disease progression and protect pancreatic β-cells. Dipeptidyl peptidase-4 inhibitors (DPP-4i) have shown potential in modulating inflammation and preventing β-cell destruction. This protocol describes an upcoming trial to evaluate the effectiveness of the DPP-4i alogliptin in delaying the progression of stage 2 (presymptomatic) to stage 3 (symptomatic) T1DM.Patients and Methods: We propose a two-year, two-arm, multicenter, randomized, open-label clinical trial targeting Brazilian patients aged 18 to 35 with stage 2 T1DM. The study, facilitated by the custom-developed “PRE1BRAZIL” web application, aims to enroll 130 participants. They will be randomly assigned in a 1:1 ratio to either a treatment group (alogliptin 25 mg daily plus regular clinical and laboratory assessments) or a control group (regular assessments only). The primary outcome is the rate of progression to stage 3 T1DM. Secondary outcomes include changes in A1c levels, glucose levels during a 2-hour oral glucose tolerance test (OGTT), C-peptide levels, exogenous insulin requirements, Insulin-Dose Adjusted A1c (IDAA1c), and the incidence of diabetic ketoacidosis (DKA) in those advancing to stage 3.Discussion: This protocol outlines the first randomized clinical trial (RCT) to investigate the impact of a DPP-4i in the presymptomatic stage of T1DM. The trial is designed to provide critical insights into the role of DPP-4i in the secondary prevention of T1DM. Utilizing the “PRE1BRAZIL” web application is expected to enhance participant enrollment and reduce operational costs.Registration: Brazilian Registry of Clinical Trials.Keywords: type 1 diabetes, web applications, DPP-4i, stage 2 T1DM, clinical trial protocol

In order to extract meaningful interpretation from the large data and provide their value to the application areas, chemical data analysis has become a serious challenge in the development and applications of new protocols, technique and methodologies for the mathematical modelling communities and other data science societies. Therefore, in the present work a rapid and robust box-and-whisker plot and multivariate principal component statistical techniques (PCA) are being proposed for the evaluations of the thermodynamic molecular properties data of the benign fuel structures. We observed that, the box-and-whisker plot technique successfully explored all of the thermochemical molecular properties precisely, and described symmetrical distribution of the data along the median values with respect to the rise in temperature. Moreover, applying the PCA technique, the score-plots of PCs diagnosed the peculiar molecular properties variations after a certain peak of temperature with descendant variation in the statistical parameters. Furthermore, PCA parameters not only segregated the thermodynamic properties of propanol and butanol but also, their variations with the temperature. Thus, we concluded that, Box-whisker and PCA statistical techniques are robust and rapid method for the assessment and evaluation of the large molecular thermodynamic quantities data.

Dilson Palhares Ferreira,1,&ast; Cláudia Vicari Bolognani,2,3,&ast; Levy Aniceto Santana,2,&ast; Sérgio Eduardo Soares Fernandes,2,3,&ast; Matheus Serwy Fiuza de Moraes,3,&ast; Luana Argollo Souza Fernandes,3,&ast; Camila de Sousa Pereira,3,&ast; Gabriela Billafan Ferreira,3,&ast; Leila Bernarda Donato Göttems,2,3,&ast; Fábio Ferreira Amorim1– 4,&ast; 1Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil; 2Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil; 3Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil; 4Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil&ast;These authors contributed equally to this workCorrespondence: Fábio Ferreira Amorim; Dilson Palhares Ferreira, Coordenação de Pesquisa e Comunicação Científica - Escola Superior de Ciências da Saúde, SMHN Quadra 03, conjunto A, Bloco 1 - Edifício FEPECS, Brasília, Federal District, CEP 70701-907, Brazil, Email ffamorim@gmail.com; palhares.dilson@gmail.comPurpose: The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in healthcare. The primary objective of the study was to assess the impact of the COVID-19 pandemic on birth, vaginal delivery, and cesarian section (c-section) rates. The secondary objective was to compare the maternal mortality before and after the pandemic.Patients and Methods: Time-series cohort study including data of all women admitted for childbirth (vaginal delivery or c-section) at the maternities in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. Causal impact analysis was used to evaluate the impact of COVID-19 on birth, vaginal delivery, and c-section using the CausalImpact R package, and a propensity score matching was used to evaluate the effect on maternal mortality rate using the Easy R (EZR) software.Results: There were 150,617 births, and considering total births, the effect of the COVID-19 pandemic was not statistically significant (absolute effect per week: 5.5, 95% CI: − 24.0− 33.4). However, there was an increase in c-sections after COVID-19 (absolute effect per week: 18.1; 95% CI: 11.9− 23.9). After propensity score matching, the COVID-19 period was associated with increased maternal mortality (OR: 3.22, 95% CI: 1.53− 6.81). The e-value of the adjusted OR for the association between the post-COVID-19 period and maternal mortality was 5.89, with a 95% CI: 2.43, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect.Conclusion: Our study revealed a rise in c-sections and maternal mortality during the COVID-19 pandemic, possibly due to disruptions in maternal care. These findings highlight that implementing effective strategies to protect maternal health in times of crisis and improve outcomes for mothers and newborns is crucial.Keywords: COVID-19, cesarean section, maternal health services, maternal mortality

The use of regional kinematic reference frames (mRFs) in seismic zones is uncommon worldwide. This article proposes a solution implemented for Chilean mining, whose current projects are based on the classic reference frames (PSAD56 and SAD69). The approach is to move from a classic reference frame to an mRF in seismic countries where earthquakes constantly alter the frame. Our research group calculated an mRF (REDGEOMIN) that includes interseismic, coseismic, and postseismic deformation using CORS with open data from 2009 to 2022 and processed with scientific standards global navigation satellite system. REDGEOMIN consists of a deformation model (ADELA) with an interpolation approach through thin plate spline, allowing the greatest deformation to be modelled at campaign points. The relationship between classical and modern systems was explored with conformal transformations and NTv2 grids to include deformations, especially coming from PSAD56 and SAD69. The results demonstrate that REDGEOMIN aligns with the IGb14 reference frame (

Background: Maternity hospitals everywhere are seeing a rise in the trend of Caesarean deliveries, the indications for which are varied and could be maternal, fetal or fetomaternal. The objective of the study was to find out the factors associated with the indications for emergency Caesarean sections. Methodology: Retrospective case-control study conducted in Kasturba Medical College Hospital, Attavar and Govt. Lady Goschen Hospital, Mangalore, among women who underwent caesarean sections as cases, and equal number of age matched women who underwent normal deliveries as controls, a total sample size of 70, during the study period 12th April 2016 to 22nd April 2016. A questionnaire was used to collect details including the social- demographic details, antenatal history, and indications for caesarean section. Results: The study showed that 37.1% of women who underwent emergency LSCS were ≤25 years, 34.3% were between 26-30 years, and 28.6% were ≥31 years. Regarding occupation 88.6%of our cases did non strenuous work whereas 11.4% did strenuous work(manual labourer). 20% of our cases were vegetarians and 80% consumed a mixed diet. 71.4% cases were primigravids and 28.6% were non primis. Regarding antenatal visits 85.7% who underwent emergency LSCS made regular antenatal visits and 14.3% were irregular. Conclusion: Among the women that underwent full term vaginal delivery (FTVD), it was observed that they did moderate physical work. Older women (above 30 years) were observed to have undergone emergency LSCS rather than vaginal deliveries. It was seen that most of the women who had a full-term vaginal delivery consumed a mixed diet. Those who underwent emergency LSCS were observed to be mostly primigravida and primipara.

Marc Miravitlles,1 Sudeep Acharya,2 Bhumika Aggarwal,2 Frederico LA Fernandes,3 Jorge Dreyse,4 José R Jardim,5 Siwasak Juthong,6 Gur Levy,7 Martin Sivori8 1Pneumology Department, Hospital Universitari Vall d’Hebron/Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 2Emerging Markets, GlaxoSmithKline, Singapore; 3Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; 4Internal Medicine and Critical Care Center Departments, Clínica Las Condes and School of Medicine, Universidad Finis Terrae, Santiago, Chile; 5Respiratory Division, Escola Paulista de Medicina, Federal University of São Paulo, Sao Paulo, Brazil; 6Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; 7Emerging Markets, GlaxoSmithKline, Panama City, Panama; 8Pneumonology University Center, School of Medicine, University of Buenos Aires, Argentina, Unit of Pneumonology Hospital “Dr.J.M. Ramos Mejia”, Buenos Aires, ArgentinaCorrespondence: Marc Miravitlles, Pneumology Department, Hospital Universitari Vall d’Hebron, Pg. Vall d’Hebron 119-129, Barcelona, 08035, Spain, Tel/Fax +34 932746083, Email marcm@separ.esPurpose: Role of triple therapy in chronic obstructive pulmonary disease (COPD) management is supported by growing evidence, but consensus is lacking on various aspects. We conducted a Delphi survey in respiratory experts on the effects of triple therapy on exacerbation reduction, early optimization, pneumonia risk, and mortality benefits in COPD management.Methods: The study comprised 2-round online surveys and a participant meeting with 21 respiratory experts from 10 countries. The 31-statement questionnaire was prepared using Decipher software after literature review. Responses were recorded using Likert scale ranging from 1 (disagreement) to 9 (agreement) with a consensus threshold of 75%.Results: All experts participated in both surveys and 14/21 attended participant meeting. Consensus was reached on 13/31 questions in first survey and 4/14 in second survey on: mortality benefits of triple therapy; comparable pneumonia risk between single inhaler triple therapy (SITT) and multiple inhaler triple therapy (81%); preference of SITT for patients with high eosinophil count (95%); exacerbation risk reduction and healthcare cost benefits with early initiation of SITT post exacerbation-related hospitalization (< 30 days) (86%). No consensus was reached on first line SITT use after first exacerbation resulting in COPD diagnosis (62%).Conclusion: This study demonstrated that there is consensus among experts regarding many of the key concepts about appropriate clinical use and benefits of triple therapy in COPD. More evidence is required for evaluating the benefits of early optimisation of triple therapy.Keywords: SITT, MITT, triple inhaled therapy, Delphi procedure, COPD exacerbations, COPD mortality

Habitat loss and fragmentation have been impacting ecosystem services essential for human survival. The Brazilian Atlantic rainforest, a biodiversity hotspot, has suffered from historical deforestation and, more recently, from an environmental disaster caused by the Fundão dam collapse that released ore tailings drastically affecting a large territory in the Doce River watershed. This work aims to assess the relationships between soil properties and vegetation in a reference ecosystem to provide guidelines for restoration projects in areas affected by the dam collapse. We conducted phytosociological (vegetation characteristic) and soil quality studies in three distinct natural sites and studied different vegetation strata to better understand plant species composition in reference sites along the impacted Doce River and their potential role in community structuring and functioning. We recorded 140 species, 78 in the tree stratum, and 90 in the sapling stratum. Furthermore, our results highlight the influence of soil on floristic composition in the Atlantic rainforest. Small-scale edaphic variation influenced species composition in both sapling and tree strata. We also identified species of the same genus with strong association with the extremes of the edaphic gradient. Therefore, we highlight that studies in various regions along the Doce River watershed are of utmost importance to evaluate the association between species and soils. The particularities of the species are crucial to the effectiveness of restoration processes since this plant-soil correlation should not be extrapolated even within the same genus. This knowledge is of strategic relevance to provide scientific-based guidance for restoring these environments, aiming at the recovery of biodiversity and ecosystem services.

Débora de Fátima Camillo Ribeiro,1,2 Paula Karina Hembecker,2 Adriane Muller Nakato,2 Beatriz Luci Fernandes,2 Percy Nohama2,3 1Neonatal Services, Waldemar Monastier Hospital, Campo Largo, Paraná, Brazil; 2Graduate Program on Health Technology, Pontifícia Universidade Católica Do Paraná, Curitiba, Paraná, Brazil; 3Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal Do Paraná, Curitiba, Paraná, BrazilCorrespondence: Percy Nohama, Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Curitiba, Paraná, CEP 80215-901, Brazil, Tel +55 41 3271-1357, Email percy.nohama@pucpr.brPurpose: To evaluate the health professionals’ satisfaction regarding the short binasal prong used in Neonatal Intensive Care Units (NICU), evaluate the difficulties related to its use, and present possible improvements in the design of this device.Patients and Methods: Observational, cross-sectional study with prospective data collection carried out in the NICU of a public hospital in southern Brazil. This research was presented into two stages. In the first stage, the Quebec User Evaluation of Satisfaction with Assistive Technology was applied with 90 health professionals to evaluate the satisfaction regarding the short binasal prong. In the second stage, the health professional’s experiences and difficulties in using the binasal prongs in 14 newborns (NBs) that required non-invasive ventilation was collected. The short binasal prongs used was the Fanem® brand and the CPAP circuit was Gabisa Medical International (GMI®). Finally, improvements and recommendations were presented to optimize the device’s design.Results: The mean score of the health professionals’ satisfaction with short binasal prongs was 3.8 ± 0.6. Ease of adjustment (3.27) and dimensions (3.62) variables had the worst scores. The main difficulties pointed out by health professionals were: circuit disconnection (57.1%), the size of the prong did not correspond to NBs’ anatomical characteristics (35.7%), air leakage (21.4%), and difficulty in fixing and positioning the prong in the NB (14.28%). The improvements suggested were: appropriate prong sizes based on the anatomical characteristics of the NBs; adjustable distance between insertion and base catheters; manufactured with malleable material, however not easily foldable; curved and adjustable insertion catheters and functional system of tracheas’ connection.Conclusion: The dissatisfaction of health professionals with the dimensions and prongs adjustments and the difficulties faced in clinical practice indicate the need for improvements in these interfaces. The recommendations presented in this study may contribute to optimizing the design of the binasal prong in the future.Keywords: assistive technology, neonatal intensive care, non-invasive ventilation, surveys and questionnaires

Joshua Ghofrani,1,2 Allan Bowen,2 Jie Chen,2 Preethi Bala Balakrishnan,2 Allison B Powell,1,2 Kondareddy Cherukula,2 Conrad Russell Y Cruz,2,3 R Brad Jones,4 Rebecca M Lynch,5 Elizabeth E Sweeney,2,6 Rohan Fernandes1,2,7 1The Institute for Biomedical Sciences, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA; 2The George Washington Cancer Center, The George Washington University, Washington, DC, USA; 3Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, USA; 4Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA; 5Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; 6Department of Biochemistry and Molecular Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA; 7Department of Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC, USACorrespondence: Rohan Fernandes, 800 22nd St. NW, Science and Engineering Hall, Suite 8410, Washington, DC, 20052, USA, Tel +1 202 994 0899, Email rfernandes@gwu.eduPurpose: Current antiretroviral therapies (ART) for human immunodeficiency virus (HIV) are not curative, as the virus persists in latent reservoirs, requiring lifelong adherence to ART and increasing the risk of co-morbidities. “Shock and kill” approaches to reactivate HIV from latent reservoirs followed by administration of anti-HIV drugs represent a promising strategy for eradicating latent HIV. To achieve effective shock and kill, we describe a strategy to eradicate the HIV reservoir that combines latency reversing agents (LRAs), broadly neutralizing antibodies (bnAbs), and natural killer (NK) cells. This strategy utilizes a polymer nanodepot (ND) that co-encapsulates the LRA and bnAb to reactivate latent infection and elicit enhanced cytotoxicity from co-administered NK cells.Methods: Poly(lactic-co-glycolic acid) (PLGA) NDs were synthesized using the nanoprecipitation method to co-encapsulate an LRA (TNF-α) and a bnAb (3BNC117) (TNF-α-3BNC117-NDs). ACH-2 cells were used as a cellular model of latent HIV infection. An NK92 subline, genetically modified to constitutively express the Fc receptor CD16, was administered to ACH-2 cells in combination with TNF-α-3BNC117-NDs. ACH-2 cell death and extracellular p24 were measured via flow cytometry and ELISA, respectively.Results: Stable PLGA NDs co-encapsulated TNF-α and 3BNC117 with high efficiencies and released these agents in physiological conditions. NK92 phenotype remained similar in the presence of TNF-α-3BNC117-NDs. TNF-α released from NDs efficiently reactivated HIV in ACH-2 cells, as measured by a 3.0-fold increase in the frequency of intracellular p24 positive cells. Released 3BNC117 neutralized and bound reactivated virus, targeting 57.5% of total ACH-2 cells. Critically, TNF-α-3BNC117-NDs significantly enhanced NK92 cell-mediated killing of ACH-2 cells (1.9-fold) and reduced extracellular levels of p24 to baseline.Conclusion: These findings suggest the therapeutic potential of our novel ND-based tripartite strategy to reactivate HIV from latently infected cells, generate an HIV-specific site for bnAb binding, and enhance the killing of reactivated HIV-infected target cells by NK92 cells.Keywords: latent HIV reservoirs, latency reversing agent, broadly neutralizing antibody, shock and kill strategies, NK cell therapy, PLGA nanodepots, TNF-α, 3BNC117, ACH-2 cells

Carlos Alexandre Antunes de Brito,1– 4 Lívia Medeiros Soares Celani,2,5 Marcelo Vicente Toledo de Araújo,2,6 Maurilio Toscano de Lucena,7 Graciana Bandeira Salgado Vasconcelos,1,2,8 Gustavo André Silva Lima,1,2,4 Fernando Jorge Firmino Nóbrega,2,6 George Tadeu Nunes Diniz,9 Norma Lucena-Silva,9 Germano Tose Toneto,4 João Victor de Carvalho Falcão,4 Pedro Martinelli Barbosa,4 Priscylla Rayanne Fernandes de Oliveira,7 Luan Samy Xavier Dantas,5 Luanna Karen Chagas Fernandes,6 Samara Amorim de Araújo,6 Valéria Ferreira Martinelli1,2,4 1Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil; 2Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil; 3Department of Internal Medicine, Centre of Medical Sciences of the Federal University of Pernambuco, Recife, Pernambuco, Brazil; 4Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil; 5Department of Gastroenterology, Onofre Lopes Hospital, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; 6Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil; 7Department of Coloproctology, Barão de Lucena Hospital, Recife, Pernambuco, Brazil; 8Department of Gastroenterology, University of Pernambuco, Recife, Pernambuco, Brazil; 9Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, BrazilCorrespondence: Carlos Alexandre Antunes de Brito, Division of Immunology, Autoimune Research Institute, 715 Rui Barbosa Avenue, Recife, Pernambuco, 52011-040, Brazil, Tel +55 81 31480101, Email cbritoc@gmail.comPurpose: Ulcerative colitis (UC) and Crohn’s disease (CD) are inflammatory bowel diseases (IBDs) with multifactorial causes. They are becoming more prevalent in developing countries such as Brazil; however, relevant studies in poorer regions of the country are limited. Here, we report the clinical–epidemiological profile of patients with IBD treated at reference centers in three states of Northeast Brazil.Patients and Methods: This was a prospective cohort study involving patients at referral outpatient clinics for IBD from January 2020 through December 2021.Results: Of 571 patients with IBD, 355 (62%) had UC, and 216 (38%) had CD. The patients were predominantly women (355, 62%) for both UC and CD. Extensive colitis was the pattern present in 39% of the UC cases. For CD, ileocolonic disease was the predominant manifestation (38%), with 67% of cases showing penetrating and/or stenosing behavior. The majority of patients were diagnosed between the ages of 17 and 40, corresponding to 60.2% in CD and 52.7% in UC. The median time between symptom onset and diagnosis was 12 months for CD and 8 months for UC (p=0.042). Joint involvement was the most frequent extraintestinal manifestation, with arthralgia and arthritis present in 41.9% and 18.6% of the patients, respectively. Biological therapy was prescribed to 73% of CD patients and 26% of UC patients. A progressive increase in new cases was observed in every 5-year interval over the last five decades, with 58.6% being diagnosed in the last 10 years.Conclusion: More extensive disease behavior patterns predominated in UC, while forms associated with complications were prevalent in CD. A prolonged time to diagnosis may have contributed to these findings. A progressive increase in IBD incidence was observed and may be related to greater urbanization and better access to specialized outpatient clinics, resulting in improvements in diagnosis.Keywords: inflammatory bowel disease, ulcerative colitis, Crohn’s disease, epidemiology

When considering the long list of translations by the Portuguese poet and translator José Bento (1933–2019), the most striking feature is probably the diversity of Spanish poets, novelists and playwrights that he translated (and often commented on) during his lifelong career. Diversity, however, does not mean randomness, and despite any particular circumstances, it may be argued that this list of translated works suggests that Bento had a clear idea of what should be made available in Portuguese translation as key texts of Spanish literature, including both classical and modern authors, titles and genres. The translator’s comments to his published translations show that they were intended for a large Portuguese audience of the late twentieth and early twenty-first centuries, the most emblematic statement being that the anthologies he organized were “neither erudite nor didactic” (Bento 2001: 728). This article will focus on José Bento’s selection, translation and paratextual comment of several Spanish literary works, eventually taking into account he was also a published poet, with clear ideas about literary reading and creative writing. This will allow us to discuss some specificities of the translation of Spanish literature into Portuguese, as well as Bento’s conceptualization of the translator’s task as a reader and re-writer of the Iberian literary tradition.

Jesse Lopes da Silva,1 Giselle de Souza Carvalho,1 Lucas Zanetti de Albuquerque,1 Fabiana Resende Rodrigues,2 Priscila Valverde Fernandes,2 Daniel Kischinhevsky,1 Andreia Cristina de Melo1 1Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro, Brazil; 2Division of Pathology, Brazilian National Cancer Institute, Rio de Janeiro, BrazilCorrespondence: Jesse Lopes da Silva, Brazilian National Cancer Institute (INCA), Clinical Research Division, 37 André Cavalcanti Street, 5th Floor, Annex Building, Rio de Janeiro, 20231-050, Brazil, Tel/Fax +55 21 32076585, Email jesse.silva@inca.gov.brPurpose: This study aimed to compare the clinical behavior, clinicopathological and sociodemographic characteristics of patients with early-stage triple-negative breast cancer (TNBC) who belong to the HER2-low and HER2-zero subgroups.Patients and Methods: This study involved a thorough search in the internal database of a single Brazilian institution to identify women with TNBC who underwent neoadjuvant chemotherapy (NACT) followed by curative surgery within the period from January 2010 to December 2014. HER2 analysis through immunohistochemistry (IHC) and, if required, amplification by in situ hybridization, was conducted using core biopsy samples. The study assesses outcomes of residual cancer burden (RCB), event-free survival (EFS), and overall survival (OS).Results: A total of 170 cases were analyzed, with a mean age of 51.4 years (standard deviation, SD 11.2). The HER2 status was categorized as IHC 0, 1+, or 2+ in 80 (47.1%), 73 (42.9%), and 17 (10%) patients, respectively. No significant differences were observed in the prevalence of clinical pathological characteristics among the subgroups. The absence of significant results for clinicopathological and demographic features hindered the multivariate analysis of HER2 subgroups. Similarly, no significant differences were found in the RCB, EFS, and OS outcomes between HER2 subgroups.Conclusion: The findings of this study suggest that, in early-stage TNBC, the clinical behavior and survival outcomes of the HER2-low subgroup may not differ significantly from those of the HER2-zero subgroup.Keywords: HER2 status, HER2-low, biomarker, triple-negative breast cancer

The Enhanced recovery after surgery (ERAS) program is designed to achieve faster recovery by maintaining pre-operative organ function and reducing stress response following surgery. A two part ERAS guidelines specific for Cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) was recently published with intent of extending the benefit to patients with peritoneal surface malignancies. This survey was performed to examine clinicians’ knowledge, practice and obstacles about ERAS implementation in patients undergoing CRS and HIPEC.

Remote controlled laboratories had a great push during the COVID-19 pandemic. In fact, they were already out there but lacking in visibility. This external trigger pushed the academy to face a global challenge to start offering remote experiments more consistently and maturely. Instituto Superior Técnico (IST) has been offering several remote experiments since 2000 but with the need for an update due to technological aging. As such, the framework for remote experiments in education (FREE) was created based on new web technologies. In addition to the most diverse experiments that had already been developed, FREE includes two experiments that aimed at advanced-level physics students: the Langmuir probe and the electromagnetic (EM) cavity. Both allow users to configure the various parameters and to access the results in real time or check back later. All this access is done using a browser (on a PC or mobile phone) without the need to install additional software. The results of an experimental execution are stored in a database and are downloadable, allowing users to do various analyses and to determine the corresponding plasma density and temperature. In this paper, we will introduce how FREE was used in the implementation of both experiments and give an insight into their didactic approach, such as: (i) how to perform an experimental execution, (ii) the typical data set obtained with, and (iii) the corresponding analysis necessary for the user to retrieve information from it.

Marcelo de Oliveira Maia,1,2 Carlos Darwin Gomes da Silveira,1,3,4 Maura Gomes,5 Sérgio Eduardo Soares Fernandes,3 Rosália Bezerra de Santana,3 Daniella Queiroz de Oliveira,3 Felipe Ferreira Pontes Amorim,4 Francisco de Assis Rocha Neves,2 Fábio Ferreira Amorim1,2 1Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil; 2Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil; 3Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil; 4Medical School, Centro Universitário do Planalto Central (UNICEPLAC), Brasília, Federal District, Brazil; 5Intensive Care Unit, Hospital Santa Luzia Rede D’Or São Luiz, Brasília, Federal District, BrazilCorrespondence: Fábio Ferreira Amorim, Coordenação de Pesquisa e Comunicação Científica - Escola Superior de Ciências da Saúde, SMHN Quadra 03, conjunto A, Bloco 1 - Edifício FEPECS, Brasília, Federal District, 70701-907, Brazil, Email ffamorim@gmail.com Marcelo de Oliveira Maia, Programa de Pós-Graduação em Ciências da Saúde - Escola Superior de Ciências da Saúde, SMHN Quadra 03, conjunto A, Bloco 1 - Edifício FEPECS, Brasília, Federal District, 70701-907, Brazil, Email zazad186@gmail.comPurpose: To evaluate the effect of MDRO infection on hospital mortality and the risk factors among critically ill patients with sepsis at hospital admission.Patients and Methods: A cross-sectional study was performed between April 2019 and May 2020, followed by a cohort to evaluate hospital mortality that prospectively included all consecutive patients 18 years or older with sepsis admitted within 48 hours of hospital admission to an adult ICU in Brazil. Patients’ characteristics, blood samples within one hour of ICU admission, and microbiological results within 48h of hospital admission were collected. In addition, descriptive statistics, binary logistic regression, and propensity score matching were performed.Results: At least one MDRO was isolated in 85 patients (9.8%). The extended-spectrum beta-lactamase-producing Enterobacterales are the most frequent organism (56.1%). Hypoxemic acute respiratory failure (OR 1.87, 95% CI 1.02– 3.40, p = 0.04), Glasgow Coma Score below 15 (OR 2.57, 95% CI 1.38– 4.80, p < 0.01), neoplasm (OR 2.66, 95% CI 1.04– 6.82, p = 0.04) and hemoglobin below 10.0 g/dL (OR 1.82, 95% CI 1.05– 3.16, p = 0.03) were associated with increased MDRO. Admission from the Emergency Department (OR 0.25, 95% CI 0.14– 0.43, p < 0.01) was associated with decreased MDRO. In the multivariate analysis, MDRO at hospital admission increased hospital mortality (OR 2.80, 95% CI 1.05– 7.42, p = 0.04). After propensity score-matching adjusted to age, APACHE II, SOFA, and dementia, MDRO at hospital admission was associated with significantly high hospital mortality (OR 2.80, 95% CI 1.05– 7.42, p = 0.04). The E-value of adjusted OR for the effect of MDRO infection on hospital mortality was 3.41, with a 95% CI of 1.31, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect.Conclusion: MDRO infection increased hospital mortality, and MDRO risk factors should be accessed even in patients admitted to ICU within 48 hours of hospital admission.Keywords: drug resistance, multiple, bacterial, community-acquired infections, sepsis, risk factors, mortality

Camila Valpaços,1 Stéphanie Leclerc-Mercier,2 Luana Lopes,1 Diego Svoboda,1 Daniele Miranda,1 Priscila Correia,3 José Junior,3 Erika Fernandes,1 Veronique Francois-Newton,4 Madiiha Bibi Mandary,4 Audrey Gueniche,2 Jerry Tan,5 Delphine Kerob6 1Centre International de Développement Pharmaceutique (Research Institute), Rio de Janeiro, Brazil; 2Vichy Laboratoires, Levallois-Perret, France; 3L’Oréal Brasil, Rio de Janeiro, Brazil; 4Centre International de Développement Pharmaceutique (Research Institute), Phoenix, Mauritius; 5Western University, Department of Medicine and Windsor Clinical Research Inc, Windsor, ON, Canada; 6CAI, L’Oréal Paris, Paris, FranceCorrespondence: Camila Valpaços, Centre International de Développement Pharmaceutique (Research Institute), Rua dos Inválidos, 212, 401/402, Lapa, Rio de Janeiro, 20231-048, Brazil, Tel +55 21 2221-6180, Email c.valpacos@cidp-cro.comPurpose: Tretinoin is a topical gold standard for photoaging treatment. However, patient adherence can be impaired by local tolerability in the first 1– 2 weeks of treatment. Mineral 89 Probiotic Fractions® (M89PF) containing Vichy volcanic mineralizing water®, probiotic fractions, hyaluronic acid, niacinamide and tocopherol was developed to fulfill the need for adjunctive products that can reinforce skin barrier and manage retinoid induced irritation.Patients and Methods: The study included 38 women, aged 44– 60 years, phototype II–VI, applying 0.025% tretinoin gel once nightly for 84 days. For 28 days, one hemi face was treated with M89PF and sunscreen SPF 50+ while other hemi face received sunscreen only. Then, M89PF application was changed to full face. Evaluations were performed at days 0, 7, 28 and 84. Erythema, dryness, fine lines, skin tone, radiance and pore appearance were assessed by a dermatologist. Tolerability was evaluated through self-assessment questionnaire. Skin hydration levels, inflammatory and oxidative stress biomarkers were analyzed by immunological assay: Interleukin(IL)-8, IL1-alpha, IL1-Receptor Antagonist (IL-1Ra), Prostaglandin E2 (PGE2), Catalase and Superoxide Dismutase (SOD).Results: Hemiface analysis showed that erythema, fine lines, skin tone, radiance, pore appearance, hydration, tightness, dryness, burning, itching and stinging sensations were improved (p< 0.05) on the M89PF side. At full face analysis on D84, erythema, fine lines, skin tone, radiance and pore appearance were improved compared to D0 (p< 0.001). Tightness, dryness, burning, itching and stinging were reduced when compared to D7 (p< 0.05). Dermatology Life Quality Index (DLQI) and Skindex 16 showed improvement in quality of life (p< 0.05). IL-1RA increased at D28 (p=0.003) and PGE2 decreased at D28 and D84 compared to D0 (p< 0.01).Conclusion: M89PF reduced retinoid induced irritation with a good tolerability profile and, used as an adjunct to topical tretinoin, significantly improved skin hydration, erythema, fine lines, skin tone, radiance and pore appearance.Keywords: skin barrier, irritation, Vichy volcanic mineralizing water®, hyaluronic acid, niacinamide, tocopherol

Background: Present the relevance of the study and highlights the key points of literature overview. Purpose: As of May 25, 2018, General Data Protection Regulation (GDPR) has become mandatory for all organizations, public or private, that handle personal data of European citizens, regardless of their physical location. Higher education institutions (HEIs), namely public universities, are no exception to this requirement and, as in many other organizations, many HEIs begin the process of implementing the GDPR without meeting the minimum conditions necessary for implementation. The purpose of this study, therefore, is to present a model to determine the level of readiness of HEIs regarding the implementation of the GDPR. Study design/methodology/approach: With the objective of designing a new artefact as a readiness model for the implementation of the GDPR, this study follows Design Science Research as an approach to be used to build the readiness model, based on a set of 16 critical success factors (CSFs) previously determined. Findings/conclusions: A readiness model was designed, based on a set of 16 CSFs related to the implementation of GDPR in HEIs. Limitations/future research: This is a new area of study that needs further development, namely through the practical application of the model, allowing the improvement of the measurement levels of the different CSFs. Practical implications: The determined readiness model allows HEIs to realize a priori if they have the necessary conditions for the implementation of the GDPR, giving useful indications of the organizational dimensions and the CSFs that compose them where better performance is necessary to ensure a successful implementation. Originality/Value: As far as we know, this is the first model of readiness based on CSFs related to the implementation of GDPR in HEIs, being therefore a first contribution to the development of this area.

Mario Lima-Fontes,1 Mariana Leuzinger-Dias,1 Rita Rodrigues,1 Ricardo Barros-Pereira,1 Manuel Falcão,1,2 Vítor Fernandes,1 Pedro Alves-Faria,1,2 Fernando Falcão-Reis,1,2 Amândio Rocha-Sousa1,2 1Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal; 2Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4200-319, PortugalCorrespondence: Mario Lima-Fontes, Department of Ophthalmology, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal, Email marioruifontes@gmail.comPurpose: The purpose of this study was to characterize the clinical presentation, management strategy and visual outcomes of patients diagnosed with Terson syndrome and followed in a tertiary centre in Portugal.Patients and Methods: A single-centre retrospective study was performed, based on the survey review of the medical records of every consecutive patient diagnosed with Terson syndrome and followed from January 2018 to August 2021. The change in best-corrected visual acuity (BCVA) from baseline to the final evaluation was the primary outcome.Results: Fifteen eyes from 8 patients (50% female) were included. The mean age at diagnosis was 55± 7 years. The neurological event was traumatic brain injury in 37.5% (n=3) and subarachnoid haemorrhage in 62.5% of the patients (n=5). Bilateral intraocular haemorrhage occurred in 875% (n=7) of the patients. Vitreous and preretinal haemorrhages occurred each in 66.7% (n=10), intraretinal in 30% (n=3) and subretinal in 13.3% (n=2) of the eyes. In 40% of the eyes (n=6), spontaneous resolution of intraocular haemorrhage occurred, while PPV was performed in the remaining 60% (n=9). Ocular haemorrhage detection occurred 58.47 ± 40.94 days after the neurological event (range 11 to 121 days). Baseline BCVA was 1.11 ± 1.01 logMAR and improved to 0.32 ± 0.69 logMAR in the follow-up period (p=0.004). A positive correlation was found between initial and final BCVA (Spearman’s rho = 0.643, p=0.01). Baseline BCVA of eyes undergoing PPV was lower than of those conservatively managed (1.84± 0.72 vs 0.20± 0.28 logMAR, p< 0.001). However, there were no statistically significant differences in final BCVA after surgery or observation (0.56 ± 0.90 vs 0.04 ± 0.04 logMAR, p=0.149). Longer periods between the neurological and the ophthalmological diagnosis were correlated with worse final BCVA (Spearman’s rho = 0.688, p=0.005).Conclusion: Terson syndrome is a potential cause of irreversible visual loss. Diagnosis delay may affect visual prognosis. PPV is indicated when intraocular haemorrhage is dense and does not resolve spontaneously or when visual acuity at presentation is low, allowing for good visual outcomes with minimal complications.Keywords: Terson syndrome, management, vitrectomy, visual outcomes, clinical presentation

Marta Fernandes de Carvalho,1,&ast; Susana Franco,1,2,&ast; Vera Simões,1,2 Liliana Ramos,1,2 Rita Santos-Rocha1,3,&ast; 1Department of Physical Activity and Health, Sport Sciences School of Rio Maior (ESDRM), Polytechnic Institute of Santarém (IPSANTAREM), Rio Maior, Portugal; 2Life Quality Research Center (CIEQV), Polytechnic Institute of Santarém / Polytechnic Institute of Leiria, Rio Maior, Portugal; 3Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal&ast;These authors contributed equally to this workCorrespondence: Rita Santos-Rocha, Email ritasantosrocha@esdrm.ipsantarem.ptIntroduction: The exercise professional’s role is to provide proper exercise prescription and selection, regular feedback, positive reinforcement, and behavioral strategies to enhance adherence. Thus, knowing the preferences of the consumers will enhance pedagogical skills.Objective: To characterize pregnant women’s preferences regarding the fitness instructor’s quality characteristics in specific group exercise sessions for this population.Methods: A qualitative study was conducted in 2021. The Fitness Instructor Quality Questionnaire was applied to 29 pregnant women engaged in prenatal group fitness classes, aged between 24 and 48 years. This questionnaire includes 25 items, grouped in two dimensions, scored with a Likert scale with 7 levels of importance (1 = not at all important; 7 = extremely important). Descriptive statistics were used to characterize pregnant women’s opinion (mean, standard deviation, minimum and maximum).Results: The global average of items was 6.41, showing that pregnant women give importance to the Quality of the fitness instructor. Relational Quality has the highest average (6.48), close to Pedagogical-Technical Quality dimension (6.34). The most important items for pregnant women were Ethics (6.76), Communication (6.72), and Availability, Motivation, and Punctuality (6.69). The less important items were Musical Domain (5.24), Image (5.69), and Physical Fitness (5.86).Conclusion: Pregnant women give great importance to the Quality of the fitness instructor, although they value some indicators more than others, as identified in other studies in different populations. Considering the results of this study, it can be recommended that fitness instructors delivering prenatal exercise programs should address these factors related to Quality. It can be emphasized that the fitness instructor should have an intervention that shows willingness to listen to pregnant women, allows them time to perform the exercises, encourages them to practice, without overestimating aspects related to image or fitness level.Keywords: exercise, pregnant, fitness, instructor, quality, group classes, Fitness Instructor Quality Questionnaire

Zenith Tropospheric Delays (ZTDs) are used to correct tropospheric effects that cause a delay in the signal measured by Global Navigation Satellite Systems (GNSS) receivers and obtain accurate measurements. ZTD can be estimated from GNSS processing, which means they may suffer from occasional or systematic errors. Therefore, it is necessary to assess the quality and stability of these data over time, since ZTDs are used in several applications that require centimeter precision. Within this context, this work aims to assess the available ZTD of the whole Geodetic Reference System for the Americas Continuously Operating Network (SIRGAS-CON), consisting of 467 stations, spanning the period from January 2014 to December 2020 using the most recent Numerical Weather Model ERA5 from the European Centre for Medium-Range Weather Forecasts and common stations to the International GNSS Service (IGS) for an intercomparison. Results show that 10% of the stations present some instability, such as periods of highly dispersed data or discontinuities, with more occurrence in stations located in Argentina, Uruguay and Colombia. The remaining 90% proved to have stable and reliable ZTD, both in comparison with ERA5 and IGS.

The wet tropospheric correction (WTC) is a required correction to satellite altimetry measurements, mainly due to the atmospheric water vapor delay. On-board microwave radiometers (MWR) provide information for WTC estimation but fail in coastal zones and inland waters. In view to recover the WTC in these areas, the Global Navigation Satellite System (GNSS)-derived Path Delay Plus (GPD+) method, developed by the University of Porto, uses Zenith Tropospheric Delays from GNSS global and regional networks’ stations combined with other sources of information, providing a WTC solution for all along-track altimeter points. To densify the existing dataset used by GPD+, it is necessary to add new GNSS stations, mainly in the southern hemisphere, in regions such as South America, Africa and Oceania. This work aims to exploit the SIRGAS-CON data and its potential for densification of the GPD+ input dataset in Latin America and to improve GPD+ performance. The results for the three analyzed satellites (Sentinel-3A, Sentinel-3B and CryoSat-2) show that, when compared with the WTC from GNSS and radiosondes, the densified GPD+ WTC leads to a reduction in the RMS of the WTC differences with respect to the non-densified GPD+ solution, up to 2 mm for the whole region and up to 5 mm in some locations.

Elizabeth do Espirito Santo Cestario,1,&ast; Jose Fernando Vilela-Martin,1,&ast; Luciana Neves Cosenso-Martin,1 Tatiane Azevedo Rubio,1 Jessica Rodrigues Roma Uyemura,1 Valquiria da Silva Lopes,1 Letícia Aparecida Barufi Fernandes,1 Lucia Helena Bonalume Tacito,2 Heitor Moreno Junior,3 Juan Carlos Yugar-Toledo1,&ast; 1Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil; 2Endocrinology Division, Internal Medicine Department, Medical School in São José Rio Preto (FAMERP), São Paulo, Brazil; 3Cardiovascular Pharmacology Laboratory, Faculty of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil&ast;These authors contributed equally to this workCorrespondence: Jose Fernando Vilela-Martin, Ave Brig Faria Lima 5416, Sao Jose do Rio Preto, São Paulo, SP, 15090-000, Brazil, Tel +55 17 32015727, Email vilelamartin@uol.com.brIntroduction: Hypertension is the most important modifiable risk factor for cardiovascular disease and a leading public health concern.Objectives: The primary aim was to compare sequential nephron blockade (SNB) versus dual renin-angiotensin system blockade (DRASB) plus bisoprolol in patients with resistant hypertension to observe reductions in systolic and diastolic blood pressure (SBP and DBP) levels after 20 weeks of treatment.Material and Methods: This trial was an open-label, prospective, randomized, parallel-group, clinical study with optional drug up-titration. Participants were evaluated during five visits at 28-day intervals.Results: The mean age was 55.5 years in the SNB and 58.4 years in the DRASB + bisoprolol group (p=NS). Significant office BP reductions were observed in both groups. SNB group, SBP decreased from 174.5± 21.0 to 127.0± 14.74 mmHg (p< 0.0001), and DBP decreased from 105.3± 15.5 to 78.11± 9.28 mmHg (p< 0.0001). DRASB group, SBP decreased from 178.4± 21.08 to 134.4 ± 23.25 mmHg (p< 0.0001) and DBP decreased from 102.7± 11.07 to 77.33± 13.75 mmHg (p< 0.0001). Ambulatory blood pressure monitoring (ABPM) showed also significant SBP and DBP reductions in both groups (p< 0.0001).Conclusion: In patients with RHTN adherent to treatment, SNB and DRASB plus bisoprolol showed excellent therapeutic efficacy, although SNB was associated with earlier SBP reduction.Keywords: resistant hypertension, natriuretic agents, dual blockade of the renin-angiotensin system, bisoprolol

Karine Lino Rodrigues,1 Vivian Vieira Dias Da Silva,1 Evelyn Nunes Goulart da Silva Pereira,1 Raquel Rangel Silvares,1 Beatriz Peres de Araujo,1 Edgar Eduardo Ilaquita Flores,1 Isalira Peroba Ramos,2 Juliana Pereira Borges,3 Caroline Fernandes-Santos,1,4 Anissa Daliry1 1Laboratory of Cardiovascular Investigation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ, Brazil; 2National Center of Structural Biology and Bio-imaging, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; 3Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; 4Department of Basic Sciences, Federal Fluminense University, Nova Friburgo, RJ, BrazilCorrespondence: Anissa Daliry, Laboratory of Cardiovascular Investigation, Oswaldo Cruz Institute, FIOCRUZ, Pavilhão Ozorio de Almeida Av. Brasil, 4365 (Room 14), Manguinhos, Rio de Janeiro, RJ, CEP: 21040-900, Brazil, Tel +55 212562-1312, Email daliry@ioc.fiocruz.brPurpose: Type 2 diabetic (T2D) patients have liver and adipose tissue microcirculation disturbances associated with metabolic dysfunction and disease progression. However, the potential role of aerobic training on hepatic and white adipose tissue (WAT) microcirculation and the underlying mechanisms have not been elucidated to date. Therefore, we investigated the role of aerobic training on liver and WAT microcirculation and AGE-RAGE modulation in T2D mice.Methods: The control group (CTL) was fed standard chow, and T2D was induced by feeding male C57BL/6 a high-fat, high-carbohydrate diet for 24 weeks. In the following 12 weeks, mice underwent aerobic training (CTL EX and T2D EX groups), or were kept sedentary (CTL and T2D groups). We assessed metabolic parameters, biochemical markers, oxidative damage, the AGE-RAGE axis, hepatic steatosis, hepatic stellate cells activation (HSC) and liver and WAT microcirculation.Results: Hepatic microcirculation was improved in T2D EX mice which were associated with improvements in body, liver and fat mass, blood pressure, hepatic steatosis and fibrosis, and decreased HSC and AGE-RAGE activation. In contrast, improvement in WAT microcirculation, that is, decreased leukocyte recruitment and increased perfusion, was associated with increased catalase antioxidant activity.Conclusion: Physical training improves hepatic and adipose tissue microcirculatory dysfunction associated with T2D, likely due to downregulation of AGE-RAGE axis, decreased HSC activation and increased antioxidant activity.Keywords: microcirculation, physical training, AGE-RAGE, hyperglycemia

Mariana Morais,1,2,&ast; Vera Machado,1,&ast; Francisca Dias,1 Patrícia Figueiredo,3 Carlos Palmeira,4– 6 Gabriela Martins,4,5 Rui Fernandes,7,8 Ana Rita Malheiro,7,8 Kirsi S Mikkonen,3,9 Ana Luísa Teixeira,1,2 Rui Medeiros1,2,6,10,11 1Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC), Research Center-LAB2, Porto, 4200-072, Portugal; 2ICBAS, Abel Salazar Institute for the Biomedical Sciences, University of Porto, Porto, 4050-513, Portugal; 3Department of Food and Nutrition, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, FI-00014, Finland; 4Department of Immunology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, 4200-072, Portugal; 5Experimental Pathology and Therapeutics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC), Research Center-LAB2, Porto, 4200-072, Portugal; 6Biomedical Research Center (CEBIMED, Faculty of Health Sciences, Fernando Pessoa University (UFP), Porto, 4249-004, Portugal; 7HEMS-Histology and Electron Microscopy, i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, 4200-135, Portugal; 8IBMC, Instituto de Biologia Molecular e Celular da Universidade do Porto, Porto, Portugal; 9Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, Helsinki, FI-00014, Finland; 10Research Department, LPCC- Portuguese League Against Cancer (NRNorte), Porto, Portugal; 11Faculty of Medicine, University of Porto (FMUP), Alameda Prof. Hernâni Monteiro, University of Porto, Porto, 4200-319, Portugal&ast;These authors contributed equally to this workCorrespondence: Rui Medeiros; Ana Luísa Teixeira, Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC), Research Center-LAB2, E Bdg 1st floor, Rua Dr António Bernardino de Almeida, Porto, 4200-072, Portugal, Tel +351 225 084 000 Ext:5115, Fax +351 225 084 001, Email ruimedei@ipoporto.min-saude.pt; ana.luisa.teixeira@ipoporto.min-saude.ptPurpose: Silver nanoparticles (AgNPs) have shown great potential as anticancer agents, namely in therapies’ resistant forms of cancer. The progression of prostate cancer (PCa) to resistant forms of the disease (castration-resistant PCa, CRPC) is associated with poor prognosis and life quality, with current limited therapeutic options. CRPC is characterized by a high glucose consumption, which poses as an opportunity to direct AgNPs to these cancer cells. Thus, this study explores the effect of glucose functionalization of AgNPs in PCa and CRPC cell lines (LNCaP, Du-145 and PC-3).Methods: AgNPs were synthesized, further functionalized, and their physical and chemical composition was characterized both in water and in culture medium, through UV-visible spectrum, dynamic light scattering (DLS), transmission electron microscopy (TEM) and Fourier-transform infrared spectroscopy (FTIR). Their effect was assessed in the cell lines regarding AgNPs’ entering pathway, cellular proliferation capacity, ROS production, mitochondrial membrane depolarization, cell cycle analysis and apoptosis evaluation.Results: AgNPs displayed an average size of 61nm and moderate monodispersity with a slight increase after functionalization, and a round shape. These characteristics remained stable when redispersed in culture medium. Both AgNPs and G-AgNPs were cytotoxic only to CRPC cells and not to hormone-sensitive ones and their effect was higher after functionalization showing the potential of glucose to favor AgNPs’ uptake by cancer cells. Entering through endocytosis and being encapsulated in lysosomes, the NPs increased the ROS, inducing mitochondrial damage, and arresting cell cycle in S Phase, therefore blocking proliferation, and inducing apoptosis.Conclusion: The nanoparticles synthesized in the present study revealed good characteristics and stability for administration to cancer cells. Their uptake through endocytosis leads to promising cytotoxic effects towards CRPC cells, revealing the potential of G-AgNPs as a future therapeutic approach to improve the management of patients with PCa resistant to hormone therapy or metastatic disease.Keywords: castration-resistant prostate cancer, hormonal therapy, therapy resistance, Warburg Effect