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INTRODUCTION The femoropopliteal biomechanical characteristics make the endovascular treatment of complex lesions particularly challenging. Despite several studies reporting longer patency of femoropopliteal stenting when compared to balloon angioplasty, long-term outcomes are still marginal due to the high rate of restenosis, stent fracture, and thrombosis. This study aims to review the current literature on the outcomes of the endovascular treatment of the femoropopliteal sector with the Supera® stent. MATERIALS AND METHODS A search was carried on Pubmed database under the terms [“Supera” AND “femoropopliteal”]. Prospective and retrospective original studies were selected after title and abstract analysis. RESULTS Twelve studies were analyzed, comprising a total of 1358 limbs with femoropopliteal obstructive disease treated with the Supera® stent. The 12-month primary-patency rate (PPR) ranged from 72.6% to 94.1%, the 24-month PPR ranged from 60.8% to 83.1% and the 36-month PPR ranged from 69.5% to 76.7%. For high-complexity anatomies, including TASC C and D lesions, the 12-month PPR was >64%. There were no stent fractures reported in any of the included studies. DISCUSSION The Supera® stent showed promising results for the endovascular treatment of the femoropopliteal sector, highlighting its performance in high-complexity anatomic patterns.

Abstracts: Iron is one of the heavy metals that present in industrial wastewater and domestic waste which damage agricultural production as well as the landscape if there is no proper treatment. One popular method was to introduce the heavy metal ions into the raw material for the synthesis of tobermorite, as the main cement component. However, the conventional hydrothermal synthesis was time and intense energy consuming. Therefore, microwave hydrothermal synthesis of tobermorite was evaluated by comparing with the conventional method. The experimental results showed that the dominant products were Fe-tobermorite/ tobermorite via conventional method, whilst it turned to be Fe-containing hydrogarnet under microwave hydrothermal synthesis when the Fe/Si ratio was 0.15/0.2, which were found to be more stable, thus enhancing the safety of the solidification. Both methods exhibited 100 % of solidification of iron, and the microwave hydrothermal synthesis consumed a much shorter time than conventional method. Therefore, present work has demonstrated that microwave hydrothermal synthesis of tobermorite is an effective alternative to conventional method for the solidification of iron.

Selective laser sintering (SLS) is one of the most well-regarded additive manufacturing (AM) sub-processes, whose popularity has been increasing among numerous critical and demanding industries due to its capabilities, mainly manufacturing parts with highly complex geometries and desirable mechanical properties, with potential to replace other, more expensive, conventional processes. However, due to its various underlying multi-physics phenomena, the intrinsic complexity of the SLS process often hampers its industrial implementation. Such limitation has motivated academic interest in obtaining better insights into the process to optimize it and attain the required standards. In that regard, the usual experimental optimization methods are time-consuming and expensive and can fail to provide the optimal configurations, leading researchers to resort to computational modeling to better understand the process. The main objective of the present work is to develop a computational model capable of simulating the SLS process for polymeric applications, within an open-source framework, at a particle-length scale to assess the main process parameters’ impact. Following previous developments, virgin and used polymer granules with different viscosities are implemented to better represent the actual process feedstock. The results obtained agree with the available experimental data, leading to a powerful tool to study, in greater detail, the SLS process and its physical parameters and material properties, contributing to its optimization.

INTRODUCTION: Endovascular reconstruction of the thoracoabdominal aorta is highly complex due to the need to preserve the main visceral branches. Optimal treatment with fenestrated and branched aneurysm aortic repair (F/B-EVAR) is usually not possible in urgent situations. Parallel grafting technique as an “off-the-shelf” solution have been described with good short and medium-term results. CASE REPORT: A 44-year-old male, born in Guinea Bissau, presents to the emergency department with epigastric pain radiating to the dorsum. The patient had a history of large vessel vasculitis secondary to Bechet’s disease (HLA B51 allele positivity) and previous thoracic aneurysm aortic repair (TEVAR) to treat a paraceliac aortic pseudoaneurysm. Computed tomography angiography (CTA) demonstrated a pseudoaneurysm with approximately 10 cm diameter at zone 6 immediately distal to the previous endoprosthesis. The pseudoaneurysm was excluded with a parallel grafting technique using a 31mm aortic endoprosthesis with a periscope graft for the right renal artery in a “sandwich-like” configuration and a chimney graft for the superior mesenteric artery (SMA). Postoperative CTA confirmed the exclusion of the pseudoaneurysm and permeable bridging stents. CONCLUSION: The pathology of the thoracoabdominal aorta is technically demanding, requiring experience and detailed planning. The complexity increases in emergency cases. Our case highlights that the parallel grafting technique should be encouraged in life-threatening scenarios as a readily available solution for complex aortic repair, even in a reconstructed aorta.

INTRODUCTION: Kidney autotransplantation (KAT) is a versatile surgical technique used to treat multiple diseases affecting the kidney. This procedure allows the reconstruction of the renal artery or vein with optimal surgical exposure reducing warm ischemia time compared to open direct repair. Although infrequently reported nowadays and despite the growing use of endovascular treatments, KAT still has a place in treating complex kidney vascular conditions. METHODS: We performed a literature review using the MEDLINE®, SCOPUS, and Web of Science databases with the combination of the terms: “kidney autotransplantation,” “renal artery,” “renal vein,” “aorta,” “aneurysm,” and “nutcracker syndrome.” All relevant English-language studies published between January 1990 and June 2022 reporting the outcomes of the KAT technique in vascular disorders were included. RESULTS: A total of 32 articles were included. Ex-vivo repair and KAT is widely described in treating renal artery aneurysms (RAA), with a reported technical success rate of 99.9%, a complication rate ranging from 6.9 to 9.4%, and a graft loss rate of up to 4.1%. The use of the laparoscopic technique for harvesting the kidney was variable throughout the series published, and heterotopic KAT was performed in most treated patients. Ex-vivo repair and KAT was successfully used after failed endovascular therapy and is a viable option in women of childbearing age with bilateral complex RAA. Concerning renal artery stenosis associated with different etiologies (fibromuscular dysplasia, Takayasu's arteritis, and neurofibromatosis type 1), significant reduction of blood pressure and the number of anti-hypertensive drugs have been reported in most patients after KAT. Results of arterial hypertension improvement associated with RAA after KAT are more variable. The use of KAT in treating nutcracker syndrome is reported with good results, even after left renal vein transposition or venous stenting failure. Other reports exist on the successful use of KAT for treating renal vein aneurysms and as an adjunct in open surgical or hybrid aortic reconstructions. CONCLUSION: Renal autotransplantation is a useful technique in the treatment of kidney vascular disorders with good overall results reported in the literature. It may be an essential adjunct in open surgical or hybrid treatments for abdominal and thoracoabdominal aortic diseases. Defining the patients who would benefit from this technique as a preferential treatment choice in different renal vessel disorders would be necessary.

In response to the growing demand for sea urchin gonads (roe or uni) in Asian and European markets and the concerns regarding the overexploitation of wild populations, this preliminary study addresses the need for cost-effective protocols in echinoculture. The primary focus of this research was to evaluate the gonadosomatic index (GI) in captive-conditioned Sphaerechinus granularis over a five-month period and compare it with that of their wild-caught conspecifics. Additionally, two different spawning induction methods were assessed: potassium chloride (KCl) injection and agitation. Results indicate that captive-conditioned sea urchins exhibit significantly higher GI values when compared to their wild-caught counterparts. Furthermore, it was observed that the agitation method is equally effective as the KCl injection in triggering a positive response, i.e., gamete ejection, while maintaining lower mortality rates among the subjected S. granularis. In conclusion, this preliminary study underscores the pivotal role of broodstock conditioning in supporting the sustainability of sea urchin aquaculture. Moreover, the spawning induction method through agitation emerges as a viable alternative to the traditional intracelomic KCl injection, offering comparable efficacy without compromising the survival of the broodstock. These findings have significant implications for the development of sustainable sea urchin farming practices.

Sea urchins play an important role in coastal marine ecosystems and are an economically valuable resource for their gonads (roe or uni). Increased demand by Asian and European countries caused overfishing of wild stocks resulting in a sharp decline of sea urchin populations. The increased efforts in developing cost-effective protocols are focused on larval development up to pre- and post-metamorphosis stages, as they are one of the main difficulties of echinoculture. This is a preliminary study to evaluate the influence of microalgal varying diet rationing on larval development, growth, and survivorship at pre-metamorphosis of Sphaerechinus granularis echinopluteus (30 days post-fertilization). Three microalgae diets based on Dunaliella tertiolecta and Rhodomonas marina and the combination of both species were tested. Each diet used three ration treatments: low ration (500–3000 cells⋅ml−1); medium ration (1000–6000 cells⋅ml−1); and high ration (4000–24,000 cells⋅ml−1), which were cell-density adjusted to larval development. Assays used three triplicated treatments in 8 L cylindrical–conical glass incubators. Results showed that the survival of S. granularis echinopluteus was positively influenced by diets of lower cellular densities and a combined microalgae diet. Adoption of this type of diet regime is expected to improve larval production and provide the groundwork for future research on S. granularis in aquaculture.

INTRODUCTION: Congenital vascular malformations are entities with a broad spectrum of presentations and variable prognosis. They typically present at a young age and are historically associated with extensive resection surgeries and with high morbidity. This study aims to evaluate the results of arteriovenous malformations (AVMs) embolization as a first-line approach in lesions which are not suitable for surgical resection. METHODS: A retrospective analysis of the clinical records of patients with infiltrative arteriovenous malformations who underwent embolization at our center between 2019 and 2021 was performed. The Schobinger Classification was applied to categorize the clinical stage. Angiographic findings were reported according to the Yakes classification. The decrease in the Schöbinger grade after treatment, the need for reintervention and the associated complications were the main outcomes. A descriptive statistical analysis was performed. RESULTS: Nine patients undergoing embolization of infiltrative arteriovenous malformations were evaluated, accounting for a total of seventeen interventions. There was a preponderance of females (n=6; 66.7%) and the mean age of referral to the Vascular Surgery consultation and the first treatment was 16.8 (±12.9) and 20.9 (± 14.5) years, respectively. All patients were in stage II (n=4; 44.4%) or III (n=5; 55.6%) of Schöbinger. The angiographic pattern of the AVMs was classified according to the Yakes Classification, which guided the approach. Yakes type IIa was found most frequently (n=6; 55.6%), followed by type IV (n=2; 22.2%) and type IIb (n=1; 1.1%). Patients underwent AVM embolization via transarterial, transvenous or direct nidus puncture with sclerosing agents, liquid embolizers, microparticles and microcoils, separately or in combination. The median number of interventions per patient was 1 (1 – 5) and Yakes type IV appears to be associated with a higher rate of reintervention. Reduction of the Schöbinger stage was achieved in 7 (77.8%) patients with clinical resolution in 3 (33.3%). Tissue necrosis was the only complication reported in this series (n=2; 11,8%). CONCLUSION: The endovascular approach of arteriovenous malformations through nidus and/or afferent/ efferent embolization requires a detailed angiographic characterization but seems to be an effective strategy with a low risk of complications. The Yakes classification, can be useful both in guiding the approach and inpredicting the need for reintervention.

INTRODUCTION: The ischemic window of kidney parenchyma is narrow, so a rapid development of renal infarction after acute renal artery occlusion is expected. However, patients often present with nonspecific symptoms and laboratory findings, making the early diagnosis challenging and contributing to treatment delay. Irreversible kidney dysfunction seems not to depend on the total warm ischemia time alone, and other factors could play a role. CASE REPORT: A 64-year-old male with chronic kidney disease presented to the emergency department with acute kidney injury of unknown etiology. Unfavorable evolution demanded the initiation of hemodialysis due to ref ractory hypervolemia and resistant high blood pressure some days later. A computed tomography angiography showed aortoiliac occlusion starting below the superior mesenteric artery, conditioning the occlusion of the proximal segment of both renal arteries. A splenorenal retrocaval bypass was done uneventfully, 21 days after the initial presentation, to revascularize the right kidney. After surgery, the patient showed marked improvement of diuresis with decreased nitrogen retention parameters, allowing definitive suspension of the dialysis technique in the first post-operative week and controlled blood pressure. Serum creatinine dropped to baseline and remained stable at one year of follow-up. Chronic limb-threatening ischemia developed later in the left lower limb, and the patient was revascularized with an axillobifemoral bypass. CONCLUSION: Our case highlights the benefit of aggressive late renal revascularization in selected patients with acute renal artery occlusion who maintain residual tubular function and some perfusion of kidneys despite proximal occlusion of the renal artery. More extensive studies would be essential to provide adequate patient selection and management recommendations.

Reducing the use of fossil fuels and the generation of renewable energy have become extremely important in today. A climatic emergency is being experienced and society is suffering due to a high incidence of pollutants. For these reasons, energy harvesting emerges as an essential source of renewable energy, and it benefits from the advancement in the scope of solar and thermal energy which are widely abundant and usually wasted. It is an option to obtain energy without damaging the environment. Recently, energy harvesting devices, which produce electricity, have been attracting more and more attention due to the availability of new sources of energy, such as solar, thermal, wind and mechanical. This article looks at recent developments in capturing energy from the sun. This literature review was performed on research platforms and analyzes studies on solar and thermal energy capture carried out in the last four years. The methods of capturing solar energy were divided according to how they were applied in civil engineering works. The types of experiments carried out were the most diverse, and several options for capturing solar energy were obtained. The advantages and disadvantages of each method were demonstrated, as well as the need for further studies. The results showed that the materials added to the components obtained have a lot of advantages and could be used in different energy capture types, such as photovoltaic, thermoelectric generators, pyroelectricity and thermometrical. This demonstrates that the capture of solar energy is quite viable, and greater importance should be given to it, as the number of research is still small when compared to other renewable energies.

The use of vegetation associated with building materials is beneficial in combating climate change, as highlighted in some articles, the power to adsorb CO2, reduce the surface temperature of materials and the aesthetic and urban landscaping benefits. This review covers the study of substrates and nutrients obtained from virgin raw materials and waste, considering using waste-based substrates and nutrients in the circular economy. On the other hand, this literature review also covers the study of vegetation types associated with building materials. Among the various types of plants, bryophytes, are a type of plant classified as non-vascular, and have been little studied so far because they are not considered economically viable. However, recent studies show that these plants, can strongly contribute to reducing CO2 emissions, justifying their relevance in this study. Therefore, it is expected that they will be more widely used in the future.

INTRODUÇÃO: O fenómeno de nutcracker refere-se à compressão da veia renal esquerda (VRE), habitualmente entre a aorta e a artéria mesentérica superior. Quando sintomático, designa-se síndrome de nutcracker. Os sintomas/sinais estão relacionados com o desenvolvimento de hipertensão venosa renal e o diagnostico depende da conjugação da clínica e alterações laboratoriais na presença de critérios imagiológicos. Habitualmente a indicação terapêutica depende da severidade dos sintomas. Existem várias opções terapêuticas: transposição/ pontagem da VRE para uma implantação mais distal na veia cava inferior, transposição da veia gonadal, auto- transplante renal, e tratamento endovascular. CASO CLÍNICO: Doente de 40 anos, sexo feminino, observada em consulta de cirurgia vascular por varizes pélvicas e vulvares recidivadas. Por suspeita de síndrome de congestão pélvica, realizou estudo complementar com venoTAC que revelou fenómeno de nutcracker com dilatação importante da veia ovárica (VO) e varizes pélvicas. O exame sumário de urina revelou hematúria. Foram ponderadas várias opções de tratamento, tendo sido decidido fazer uma transposição da VO para a veia ilíaca comum (VIC). Através de uma pequena incisão paramediana esquerda (com cerca de 5cm) foi realizada uma abordagem retroperitoneal dos vasos. Procedeu-se à identificação e isolamento da VO (sinalizada com fio guia colocado pela veia femoral comum direita no início do procedimento). Localizada posteriormente à VO, isolou-se a VIC. Procedeu-se à secção transversal da VO e anastomose em termino-lateral da VO à VIC. O tratamento foi complementado com esclerose com espuma de varizes vulvares por via endovascular. A doente teve alta no primeiro dia de pós-operatório. Ao 6o mês de pós- operatório mantem-se sem recidiva das varizes e sem hematúria. DISCUSSÃO: O Síndrome de nutcracker pode implicar uma morbilidade importante, com risco de trombose da VRE e perda da função renal. O melhor tratamento ainda não está definido e a seleção da melhor opção é dificultada pelo reduzido número de casos, ausência de estudos prospetivos randomizados, e pela ausência de follow-up a longo prazo de algumas das opções terapêuticas. A transposição da VRE é o procedimento mais habitual, seguido pelo auto-transplante renal. O nosso serviço tem vasta experiência na transplantação renal e o auto-transplante tem tido bons resultados; no entanto, não deixa de ser uma intervenção complexa, com riscos potenciais não desprezíveis, com uma convalescença prolongada e um impacto estético importante, sobretudo se aferido à idade jovem dos doentes. Corroborado pelo resultado do caso clínico apresentado, os autores consideram que a transposição da VO é uma alternativa terapêutica menos invasiva a ser considerada.

INTRODUCTION: Ectopic kidneys with concomitant aortoiliac aneurysmal disease have been previously reported in the literature, however its exact prevalence is unknown. The objective of this review is to summarize current knowledge on the treatment this special group of patients. METHODS: A non-systematic literature research was performed on the treatment of aortoiliac aneurysmal disease in patients with ectopic kidneys. RESULTS: Literature on the management of patients with aorto-iliac aneurysms and concomitant ectopic kidneys is limited to case reports and very small series. Treatment modalities which include open, endovascular or hybrid techniques, should preserve the variable vasculature of the ectopic kidney. Several different surgical solutions have been proposed, highlighting the uncertainty on the optimal management strategy. However, a growing number of reports suggest safety and efficacy with adapted endovascular techniques. CONCLUSION: In parallel to the general trend in the management of abdominal aortic aneurysm, it is expected that a growing number of patients will concomitant aorto-iliac aneurysm and ectopic kidneys will be treated with endovascular techniques.

A violência atravessa todas as sociedades, presentes e passadas. E em tempos medievos, a violência era percecionada de forma muito diferente da dos nossos dias. A violência em muitos casos era considerada lícita, e até mesmo necessária, pelos homens desses tempos. O presente artigo tem como objetivo principal compreender a violência de cariz senhorial em Portugal nos finais do século XIII, através dos testemunhos registados nas Inquirições Gerais de 1288 e das respetivas sentenças de 1290. É também um desígnio entender, no contexto das lutas entre os diferentes poderes, se a relação entre o mundo senhorial e as políticas de centralização do poder régio, resultaram em ações violentas. Para tanto analisaram-se as diferentes práticas de violência, as suas justificações, os seus agentes e as suas vítimas, bem como se procurou escrutinar a ação do monarca no controlo da violência, permitindo assim entender as tensões existentes, as suas circunstâncias e as suas intenções. Palavras-chave: Violência – Inquirições Gerais - Poder Senhorial – Poder régio – Abusos Senhoriais

Alkali-activated materials have the potential to replace Portland cement in certain applications. To better understand these binders’ properties, it is relevant to study their rheological behaviour at early ages, like in the case of Portland cement paste. There are already many studies on the rheological behaviour of these materials in the available literature, using fly ash, metakaolin, and ground granulated blast furnace slag as precursors. However, this study discusses the rheological behaviour, mechanical properties, and porosity of ternary alkali-activated binders based on mining mud waste, waste glass, and metakaolin. The precursor consisted of a volume mix of 70% of tungsten mining waste mud, 15% glass waste, and 15% of metakaolin. The activator was a combination of sodium hydroxide and sodium silicate solution. Five activator/precursor (A/P) ratios (0.37, 0.38, 0.39, 0.40, and 0.4) were studied. The result showed that the activator/precursor ratio affects the rheology of paste and their rheological behaviour fit the Bingham model. The relative yield stress (g) and plastic viscosity (h) increased inversely with the A/P ratio, while the workability increased proportionally. Furthermore, some empirical models are proposed to describe the characteristic of yield stress: plastic viscosity and spread diameter versus the A/P ratio and time with a correlation between the rheological parameters and the spread diameter. The increase in A/P ratio has also followed a decrease in compressive strength in all tested samples for all the ages. As expected, an increase of the porosity accompanied the increase of the A/P ratio.

Abstract The overexpression of hoxd13a during zebrafish fin development causes distal endochondral expansion and simultaneous reduction of the finfold, mimicking the major events thought to have happened during the fin-to-limb transition in Vertebrates. We investigated the effect of hoxd13a overexpression on putative downstream targets and found it to cause downregulation of proximal fin identity markers (meis1 and emx2) and upregulation of genes involved in skeletogenesis/patterning (fbn1, dacha) and AER/Finfold maintenance (bmps). We then show that bmp2b overexpression leads to finfold reduction, recapitulating the phenotype observed in hoxd13a-overexpressing fins. In addition, we show that during the development of the long finfold in leot1/lofdt1 mutants, hoxd13a and bmp2b are downregulated. Our results suggest that modulation of the transcription factor Hoxd13 during evolution may have been involved in finfold reduction through regulation of the Bmp signalling that then activated apoptotic mechanisms impairing finfold elongation.

The current study evaluates the influence of the static compaction pressure applied during the casting process on Carbonated Reactive Magnesia Cement-based mortars. For this purpose, mortars, embodying biomass fly ash as filler, were designed and moulded through static compaction pressures of 10, 30, 50, and 70 MPa. The moulded specimens were submitted to an accelerated carbonation curing period of 24 h under controlled conditions. The devised mortars were evaluated through compressive strength tests, and their microstructure was assessed through Mercury Intrusion Porosimetry (MIP), Thermogravimetry and Derivative Thermogravimetry (TG-DTG), and Fourier-transform Infrared Spectroscopy (FTIR) analyses. The results showed that the increment in the static compaction pressure during the specimens’ casting process not only led the mortars to reduce their porosity by up to ~30% and increase their compressive strength by up to ~58% (from 19.8 MPa to 31.2 MPa) but also that such a change seems to hinder the CO2 diffusion into the specimens’ core, thus resulting in a lower content of carbonated products. In addition, the MIP analyses demonstrated that the static compaction pressure applied in the mortar casting process changes the pores’ characteristics, while TG-DTG and FTIR analyses provided evidence that the devised mortars were carbonated to a certain degree. Therefore, this work demonstrated that Carbonated Reactive Magnesia Cement-based mortars are highly influenced by the static compaction pressure applied during the casting process, at least up to a certain value.

Introduction: Renal artery aneurysms are rare clinical entities whose treatment criteria are not fully established. Endovascular treatment has gained acceptance in the case of renal artery trunk aneurysms. However, in the case of aneurysms of the renal artery branches, such procedures are often impossible due to high morbidity, so the question remains about the best treatment modality. We present a clinical case of multiple bilateral aneurysms of the renal artery branches in a young patient adequately treated with ex-vivo reconstruction and renal autotransplantation. Case-presentation: A 35-year-old woman was diagnosed with bilateral renal artery aneurysms during an investigation of secondary arterial hypertension (AHT). The patient underwent surgical treatment with renal autotransplantation, and the right kidney was initially treated. Transperitoneal laparoscopic nephrectomy was performed. She underwent ex vivo repair of aneurysms, on the bench, with aneurysmectomy and aneurysmorrhaphy. The graft was implanted in the right iliac fossa with anastomoses to the external iliac artery and vein. After three months, an identical procedure was performed on the left. Upon inspection, a large aneurysm was observed in the renal artery bifurcation and another small aneurysm in one of the branches; both corrected with aneurysmec- tomy and aneurysmorrhaphy. Ex-vivo angiographic control ensured the preservation of graft arteries patency without evidence of residual aneurysms. The kidney was implanted in the left external iliac vessels uneventfully. A study with renal scintigraphy confirmed the adequate function of both kidneys. The patient is asymptomatic at nine months of follow-up with serum creatinine and glomerular filtration rate within normal values. Conclusion: Renal autotransplantation with ex vivo arterial repair seems to be a good solution in treating aneurysms of the renal artery, particularly in complex cases with multiple aneurysms.

Teve-se como objetivo principal validar a "Emergency Contraceptive Pills (ECPs)-Attitude Scale", para a população universitária portuguesa, permitindo avaliar a atitude dos jovens face à contraceção oral de emergência (COE). Procedeu-se à tradução, adaptação e validação da mesma para a população portuguesa. Implementou-se para o efeito um estudo, utilizando uma amostra de 457 jovens universitários, e avaliou-se as suas características psicométricas desenvolvendo estudos de fiabilidade e validade. A amostra era constituída na sua maioria por jovens do sexo feminino (61.71%), com uma idade média de 21.14 anos. Após a realização dos estudos psicométricos foi possível obter valores de coeficiente de alpha de Cronbach, de 0.820, para a Escala de Atitudes face ao uso da Contraceção Oral de Emergência (EACOE), e para o fator 1 (Medo de uso indevido) – 0.83; fator 2 (Fácil acesso) – 0.826 e fator 3 (Preocupações de saúde) – 0.691. A escala revelou-se adequada e de fácil utilização para avaliar as atitudes dos jovens acerca da COE, fundamental, desde logo, na percepção da predisposição dos jovens para a sua utilização, o que se pode revelar pernicioso para a adoção de comportamentos protetores no âmbito da vivência da sua sexualidade.

O objetivo deste estudo foi conhecer os hábitos de saúde e fatores de risco dos turistas que frequentam os cruzeiros no rio Douro com a finalidade de promover estratégias que favoreçam a saúde, a segurança e o conforto dos turistas dos cruzeiros. O estudo foi realizado através de questionários face-a-face junto dos turistas que realizaram cruzeiros no rio Douro na empresa “Barcadouro”, entre abril e outubro de 2018. Participaram 1086 pessoas entre os 18 e os 89 anos (M = 54.9; DP = 14.9) de 36 nacionalidades. Para tratar os dados, utilizou-se estatística descritiva e o teste de Qui-Quadrado. Dos turistas, 91.4% fazem três ou mais refeições por dia, e 74.4% consomem bebidas alcoólicas, sendo o vinho a bebida mais consumida. Apenas 9.7% fumam, e 75.8% praticam exercício físico. Quanto ao IMC, 45.1% dos turistas encontram-se em excesso de peso. Nem todos os turistas têm hábitos saudáveis. Existem, portanto, alguns fatores de risco e é necessário desenvolver estratégias para promover a saúde e o bem-estar a bordo dos cruzeiros.

No desenvolvimento deste estudo tivemos como principais objetivos identificar e avaliar a atitude dos jovens universitários acerca da contraceção oral de emergência, variação em função do género e avaliar qual a relação desta atitude com a adoção de comportamentos sexuais de risco. Para o efeito implementámos um estudo descritivo-correlacional, transversal de natureza quantitativa, com recurso a uma amostra não probabilística de 457 jovens universitários. Verificámos que na nossa amostra a maioria dos jovens eram do sexo feminino (61.7%) sendo a média de idades de 21.04 anos (21.04 ± 2.59), a larga maioria dos estudantes referiu que já teve relações sexuais (80.5%). No que diz respeito ao hábito de falar com os pais sobre sexualidade/contracepção, apenas 36.1% referiu este hábito, Relativamente à atitude face ao uso da contraceção oral de emergência, podemos concluir que, ela é positiva na generalidade dos estudantes com uma pontuação média global de 2.80, não se verificando diferenças estatisticamente significativas entre os sexos (t= .607, p= .544). Também em relação adoção de comportamentos de risco pelos estudantes não se verificou relação com a atitude global face ao uso da contraceção oral de emergência (U= -1.080, p= .662), nem com alguma das subescalas da atitude.

O aumento do índice de envelhecimento, torna fundamental a implementação de medidas que promovam o bem-estar e envelhecimento saudável da população. Em Portugal, existem várias medidas para a promoção do envelhecimento saudável e, na atualidade, começa-se a estudar o impacto que as novas tecnologias podem trazer no processo de envelhecimento. Objetivos: perceber de que forma os idosos institucionalizados estão a utilizar as novas tecnologias; perceber se idosos institucionalizados têm interesse em utilizar novas tecnologias; avaliar o bem-estar psicológico dos idosos e perceber se existe relação entre a utilização das novas tecnologias e o bem-estar psicológico dos idosos institucionalizados. Método/Instrumentos: estudo descritivo, exploratório e transversal, com uma amostra por conveniência de 135 idosos institucionalizados, de uma região do norte de Portugal. Através do instrumento recolheram-se dados sobre: características sociodemográficas; utilização de novas tecnologias e sobre o bem-estar psicológico dos idosos. Conclusões: Após analise estatística é percetível que não existem relações estatísticas significativas entre as variáveis. No entanto, observou-se uma maior apetência para o uso do telemóvel do que para o uso do computador (37% usam telemóvel). Relativamente ao bem-estar, a pontuação media é de 85.95 pontos e as dimensões mais pontuadas são a felicidade (M= 27.52) e a autoestima (M= 14.62).

Foi realizado um estudo transversal, descritivo-correlacional, com os objetivos de caracterizar comportamentos sexuais e de vigilância da saúde de jovens adultos e conhecer os fatores a eles associados. A amostra ficou constituída por 171 jovens adultos (19,9% rapazes e 81,1% raparigas), com uma média de idade de 21 anos, e a frequentar uma instituição de ensino superior do norte de Portugal. A informação sobre características sociodemográficas, comportamentos sexuais e de vigilância da saúde foi obtida através de um questionário. No tratamento dos dados foi utilizada a estatística descritiva e inferencial (qui-quadrado). Da análise de resultados observou-se que nos últimos 12 meses 93,0% dos participantes tiveram relações sexuais e 77,0% utilizaram contraceção, sendo o método mais usado o preservativo (35,7%), embora em 38,6% dos jovens o seu uso tenha sido inconsistente. Os comportamentos de risco sexual foram mais frequentes nos rapazes, e consistiram em ter parceiros ocasionais (p

INTRODUCTION: In situ lesser saphenous vein (LSV) graft has been advocated in cases of lower limb revascularization where target arteries are confined to the lower leg and the greater saphenous vein (GSV) is neither available nor suitable. This often occurs in diabetic or end-stage renal diseased patients, whose occlusive disease pattern typically affects the tibioperoneal vessels, sparing the femoropopliteal segment. In situ technique offers the potential advantages of decreased surgical trauma to the vein, better size-matching and improved hemodynamics. The posterior approach simplifies the surgical procedure; it achieves similar graft patency and limb salvage rates compared to standard procedures. CASE REPORT: We report a case of an 89 years-old male diabetic patient with previous attempts of endovascular revascularization of the posterior tibial and peroneal arteries; he presents with a nonhealing ulcer of the first toe of the right foot. Ultrasonographic vein mapping revealed varicose GSV in both limbs and a linear, ~3mm diameter, LSV in the right leg. The patient underwent right limb retrogeniculate popliteal to distal posterior tibial artery bypass with in situ LSV through a posterior approach. Post-operative bypass thrombosis occurred after seven days; it was resolved with surgical thrombectomy, vein angioplasty and arteriovenous shunt ligation. During follow-up at the outpatient clinic, the bypass remains patent and skin lesions healing without complications. CONCLUSION: In situ LSV is a safe and viable option conduit for popliteal to distal arteries bypasses. Vascular surgeons should be aware of the posterior approach, which simplifies and comfortably exposes the anatomic structures required for this surgery.

Introduction: The development of aneurysms in iliac arteries excluded from high-pressure direct flow from the aorta is very uncommon. We report a case of successful treatment of bilateral metachronous iliac artery aneurysms (MIA), found 10 years after an aortobifemoral bypass, with perfusion only by retrograde flow from the common femoral arteries (CFA). Case Report: A 76-year-old man came for consultation after incidental finding of bilateral MIAs, 10-years after aorto- bifemoral bypass for treatment of an aortic abdominal aneurysm (AAA). Computed tomography angiography (CTA) showed a right internal iliac artery (IIA) aneurysm of 43-mm diameter and a left common iliac artery (CIA) aneurysm of 45-mm diameter that were not present 10-years before. Exclusion of the left CIA aneurysm was achieved with a left IIA to external iliac artery (EIA) endograft using two covered stents (“banana” technique). The right IIA aneurysm was excluded with embolization of the distal internal iliac branches and aneurysm sac with coils and occlusion of the proximal EIA with an occluder. There were no postoperative complications. A CTA two months after surgery showed total exclusion of the left CIA aneurysm and normal filling of the left IIA, as well as complete occlusion of the right IIA aneurysm. Conclusion: This case highlights that aneurysmal degeneration of iliac arteries can be generated by retrograde blood flow after treatment of AAAs with aortobifemoral grafts. An endovascular approach using the “banana” technique proved to be effective in treating MIAs while maintaining patency of one IIA.

Objective: Pheochromocytomas are a hallmark feature of von Hippel–Lindau disease (vHL). To our knowledge, this is the first systematic review wit h meta-analysis evaluating the frequency of pheochromocytomas and/or paragangliomas (PPGLs) in patients with vHL, as well as among patients with different vHL subtypes. Design: Systematic review with meta-analysis. Methods: We searched on MEDLINE, Scopus, and Web of Science. We include d primary studies assessing participants with vHL and reporting on the frequency of PPGL. We performed random-effects meta-analysis to quantitatively assess the frequency of PPGL, followed by meta-regression and subgroup analysis. Risk of bias analysis was performed to assess primary studies’ methodological quality. Results: We included 80 primary studies. In 4263 patients with vHL, the pooled frequency of PPGL was 19.4% (95% CI = 15.9–23.6%, I2 = 86.1%). The frequency increased to 60.0% in patients with vHL type 2 (95% CI = 53.4–66.3%, I2 = 54.6%) and was determined to be of 58.2% in patients with vHL type 2A (95% CI = 49.7–66.3%, I2 = 36.2%), compared to 49.8% in vHL type 2B (95% CI = 39.9–59.7%, I2 = 42.7%), and 84.1% in vHL type 2C (95% CI = 75.1–93.1%, I2 = 0%). In meta-regression analysis, more recent studies were associated with a higher frequency of PPGL. All studies had at least one internal validity item classified as 'high risk of bias,' with 13% studies having low risk of bias in all external validity items. Conclusions: PPGLs are a common manifestation of vHL. Despite methodological limitations and differences across primary studies, our results point to the importance of PPGL screening in patients with vHL.

Introdução: O kinking da artéria renal pós-transplante é uma complicação rara, geralmente associada à disfunção precoce do enxerto. Métodos: Apresentamos um caso clínico de um kinking da artéria renal pós-transplante com uma apresentação clínica incomum. Foi realizada uma revisão dos registos clínicos com o consentimento do doente. Resultados: Homem de 52 anos com doença renal terminal secundária a nefropatia por IgA foi submetido a transplante renal de doador cadavérico. O doente apresentou boa função renal no pós-operatório, no entanto, após três meses iniciou uma redução gradual da diurese e agravamento da função renal a necessitar de permanecer em "posição de cócoras" 5 horas por dia para manter um débito urinário adequado. Foi realizada uma pontagem entre a artéria ilíaca externa esquerda e a artéria renal do enxerto com veia grande safena autóloga para correção de um kinking da artéria renal com recuperação da função do enxerto. Conclusão: A torção da artéria renal comumente manifestada como disfunção do enxerto renal pode-se apresentar de forma singular. A intervenção precoce é essencial para preservar a viabilidade do enxerto.

The effect of different sintering parameters on the mechanical properties of sintered kaolin-GGBS will influence the variation of mechanical properties of sintered kaolin-GGBS geopolymer. Based on previous research, the samples have major cracking and many large pores due to the sintering temperature and holding time during the sintering process. The first objective is to study the effect of different sintering parameters on the mechanical properties of sintered kaolin-GGBS geopolymer and the second objective is to correlate the strength properties of sintered kaolin-GGBS geopolymer with microstructural analysis. In a solid-to-liquid 2:1 ratio, kaolin and GGBS were combined with an alkali activator. The kaolin-GGBS geopolymer was then cured at room temperature for 24 h. The samples were then cured for 14 days at 60 °C, followed by using double-step sintering at temperatures of 500 °C and 900 °C with varying heating rates and holding durations. The compressive strength and shrinkage of the kaolin-GGBS geopolymer were evaluated, and the morphology was examined using a scanning electron microscope. In comparison to other samples, the sintered kaolin-GGBS geopolymer with a heating rate of 2 °C and a holding duration of 2 h had the optimum compressive strength value: 22.32 MPa. This is due to the contribution of MgO from GGBS that refines the pore and increases the strength. The 13.72% shrinkage with a densified microstructure was also obtained at this parameter due to effective particle rearrangement during sintering.

Peripheral bypass grafting with autologous vein is the gold standard treatment of peripheral artery disease. In cases when the great saphenous vein is not available the arm veins or small saphenous veins are possible alternatives. The use of small saphenous vein as a bypass conduit is not a spread practice. We present two cases of revascularization procedures using the small saphenous vein as a conduit and a literature review on the theme.

Background: The surge of the COVID-19 pandemic in Portugal and the implemented public health measures were accompanied with a noticeable decrease in patients’ attendance to the Emergency Department (ED). Objectives: This study aims to evaluate the impact of COVID-19 pandemic on Vascular Surgery ED admissions, by comparing clinical and demographic characteristics of patients visiting the ED during the pandemic and the homologous period of 2019. Methods: We retrospectively collected data from patients admitted to the ED of a Portuguese tertiary hospital centre between March 4th and April 1st, 2020 — two weeks before and two weeks after the governmental implementation of the state of emergency in our country due to the COVID-19 pandemic — and the homologous period of 2019. Individual medical records were revised to obtain patients demographics and characteristics, clinical severity under the Manchester Triage System (MTS), final diagnosis, need for hospitalization or emergent/urgent surgery, in-hospital length of stay and mortality within 30 days of hospital discharge. Results: A total of 119 and 210 patients visited the Vascular Surgery ED during the pandemic and the homologous period of 2019, respectively. Males comprised the majority of patients in both years and the proportion of women visiting the ED was lower in 2020 compared to 2019 (P=0.015). The MTS attributed a lower number of high-priority levels (yellow and orange) to patients visiting the ED in 2020 (P=0.048). A higher proportion of patients required in-hospital treatment or emergent/ urgent surgery (P

The development of geopolymers is in line with the requirements of sustainable development. Creating a new type of material from various industrial and bio-based wastes and by-products can lead to reduced energy consumption, reduced waste generation, reduced global CO2 emissions, as well as reduced resource extraction of natural resources. In this study, geopolymer composites based on class F fly ash with the addition of fine quartz sand and ground walnut shells used as a substitute for sand were examined. The study focused on investigating the effects of different weight percentages of ground walnut shells and quartz sand on the density and strength properties, including compressive and flexural strength, thermal conductivity, efflorescence formation, and water absorption of the fly ash-based geopolymer composites. The microstructure of the studied geopolymers was also analyzed using a scanning electron microscope (SEM). It was observed that the addition of ground walnut shells contributes to the decrease in density and mechanical properties, increase in absorption properties, and decrease in porosity of fly ash-based geopolymers. Furthermore, the addition of ground walnut shells allows for a significant reduction in efflorescence on the surface of the tested geopolymer composites. Moreover, partial or complete replacement of sand by ground walnut shells in geopolymer composites based on fly ash allows for a significant reduction in their thermal conductivity, which makes it possible to use these composites as insulation materials.

Two geopolymer foams were prepared from a thermally activated coal gangue containing kaolinite. As the foaming agent, aluminium powder and 36% hydrogen peroxide were used to obtain two levels of porosity. The materials’ high temperature performances were investigated: tensile and compressive strength evolution with temperature. This study shows that the mechanical performances of developed geopolymer foams are similar to foam concrete of the same apparent density. The geopolymer foams from coal gangue present stable mechanical performances up to 600 °C. When the glass transition temperature is achieved, sintering occurs and mechanical performance increases. SEM observations confirm the glass transition and densification of the matrix at temperatures above 800 °C. Moreover, the XRD measurements revealed a high amount of mullite that forms at 1000 °C that explained the observed strength increase. The synthesis of good-quality geopolymer foams from coal gangue and its application as a thermal barrier is feasible. The constant level of porosity and its stable character in the range of temperatures 20–1000 °C ensures stable thermal insulation parameters with increasing temperature, which is extremely important for fire protection.

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Chronic periaortitis and retroperitoneal fibrosis are related entities that develop with periaortic inflammation and deposition of fibroinflammatory tissue in the retroperitoneal space. This pathological fibroinflammatory process may be associated with endovascular treatment of abdominal aortic aneurysms (EVAR) as well as the treatment of aortoiliac arterial occlusive disease with stent/stent-graft implantation. We performed a systematic review of the literature in the MEDLINE database of original articles that documented the development of periaortitis after endovascular aortoiliac treatment for occlusive and aneurysmatic arterial disease. We included a total of 12 articles describing 14 cases of this complication. Most of the reported cases are related to the development of periaortitis after EVAR in the treatment of abdominal aortic aneurysms (AAA). The majority of patients are male, with ages ranging from 45 to 78 years. This complication was verified with the use of different devices that included nitinol or stainless-steel stents. In the case of stent-grafts this complication occurred with both polyester and polytetrafluoroethylene (PTFE) coverings. The severity of the clinical picture was also highly variable, with some cases presenting with hydronephrosis resulting from urethral obstruction. Treatment with corticotherapy, tamoxifen, or a combination of the two was effective in all cases. Periaortitis is an extremely rare complication of aortoiliac endovascular treatment. Similar to idiopathic retroperitoneal fibrosis, corticosteroid therapy appears to be highly effective and early treatment seems to be essential to avoid complications.

Introdução: A técnica criss-cross combina acesso vascular anterógrado e retrógrado da veia poplítea, de modo a obter recanalização venosa em doentes com trombose venosa profunda (TVP) ileofemoral associada a trombose das veias poplítea e gemelares. Caso clínico: Doente do sexo feminino de 57 anos, com antecedentes de histerectomia radical e linfadenectomia de nódulos linfáticos pélvicos em 2013, devido a neoplasia uterina, com consequente linfedema crónico do membro inferior direito. Admitida na urgência por edema grave do membro inferior direito, com 7 dias de evolução. À observação, a paciente apresentava edema da coxa e perna, cianose da perna, dor gemelar, extremidades quentes e pulsos distais palpáveis. Estudo com ecodoppler a objetivar trombose dos eixos venosos do membro inferior direito. Estudo com TC contrastado excluiu extensão proximal do trombo para a veia ilíaca comum direita ou veia cava; excluiu tromboembolismo pulmonar e evidenciou clips cirúrgicos em proximidade com a veia ilíaca externa direita, causando uma respetiva redução luminal superior a 50%. A doente foi submetida a trombectomia e fibrinólise dirigida por cateter. Obteve-se acesso vascular através de punção ecoguiada da veia poplítea. Após colocação de introdutores em sentido retrógrado e anterógrado, realizou-se trombectomia das veias gemelares até à veia femoral comum, com recurso a aspiração por cateter. Instituiu-se perfusão de alteplase e heparina não fracionada por via periférica, mantidas durante 72 horas, com controlo angiográfico a cada 24h. Após recanalização satisfatória, realizou-se angioplastia com balão 14x40mm, seguida de stent 14x80mm na veia ilíaca externa. Não ocorreram complicações hemorrágicas major. O tratamento invasivo foi complementado com drenagem postural e meia elástica compressiva, permitindo melhoria clínica imediata e progressiva. Após dois dias, a doente recebeu alta medicada com heparina de baixo peso molecular. Em consulta de follow-up após um mês, constatou-se melhoria clínica progressiva e alterada hipocoagulação para rivaroxabano ad aeternum. Conclusão: A técnica de criss-cross permite recanalização do inflow e outflow, restaurando patência venosa e mantendo a função valvular, aspetos com eventual papel crítico nos resultados após TVP ileofemoral extensa.

Introduction: Subclavian arterial puncture is a relatively frequent complication of attempted placement of central venous catheters (CVC). The placement of a CVC in the artery is rarer, but with potential serious complications especially in its withdrawal. Anticipating these complications, control of potential bleeding in catheter withdrawal is usually performed by surgical or endovascular approach with endoprosthesis release. Our goal is to present the treatment with a percutaneous arterial closure device. Materials / Methods: Presentation of a clinical case of a CVC placed in the subclavian artery treated with a percutaneous arterial closure device. Results: A 51-year-old man hospitalized for acute myocardial infarction. On the first day of hospitalization, the introduction of a CVC into the right subclavian vein was attempted. In view of the suspected intraarterial position, CT angiography scan demonstrated that the CVC had been introduced into the subclavian artery with a point of entry proximal to the passage under the clavicle and with a path to the brachiocephalic trunk. Hypocoagulation with UFH was initiated given the risk of pericateter thrombosis and embolization. The use of percutaneous closure device ProGlide® was planned using the CVC pathway. As predictable difficulties for this option was the long CVC path to the arterial entry point, raising questions about the extent of the suture mechanism of the device and the progression of nodes in this path. Under fluoroscopic control, an angioplasty balloon was progressed until the CVC point of entrance for temporary bleeding control in case of ProGlide® failure; in which case the procedure would be completed with a covered endoprosthesis; the subclavian artery had a diameter of 12 mm and was ipsilateral to a brachiocephalic fistula. It was decided to retrograde puncture the fistula and progress the balloon to the subclavian artery. The rigid guide wire was then placed through the CVC and the CVC removed. Two Proglide® closure devices (positioned at 10 p.m. and 2 p.m.) were released. The complete resolution of clinical and imaging hemorrhage was verified. Discussion/Conclusions: Placement of CVC in the subclavian artery is a potentially serious complication since its removal can be complicated with severe haemorrhage. Depending on the point of entry, there may be additional complexities due to the proximity of the vertebral and carotid arteries. In this case we left open several hypotheses (endovascular and ultimately surgical), but our preference was ad initium the percutaneous introduction of closure device given the feasibility, simplicity, less aggressiveness, non-interference with the vertebral ostium, and lower cost compared to a covered endoprosthesis.

Carbonation is one of the factors that can influence the chlorides transport. Despite the combined action of chlorides and carbonation being a reality, there is no consensus on the effect of this coupled deterioration on chloride transport. Accelerated tests were used to simulate this environment. Concrete specimens were cast using 0.60 water/cement ratio and CEM I 42.5R. After curing, half of specimens was submitted to accelerated carbonation test (20ºC, 55% RH and 4% CO2) during 1 and 7 months. The other half was protected with plastic film during the same period. Then, the specimens were submitted to the accelerated chlorides attack using: migration test and immersion test. Finished the immersion test, powder samples were extracted from surface to bulk and analysed to obtain free and total chloride profiles and pH profile. According to migration test results, the carbonation increases chloride transport regardless the test period. According to the immersion test results, there is a decrease in chloride ions transport when the specimens are carbonated for 1 month and a noticeable increase when carbonation period increases to 7 months. The redistribution of pores in carbonated concrete and the difficulty of chlorides binding in carbonated concrete are related to these results.

Introdução: O diagnóstico de aneurismas venosos viscerais é tipicamente incidental. Apesar do uso disseminado de métodos de imagem precisos a identificação destas lesões continua a ser extremamente rara. Dentro destes, os aneurismas da veia renal são o subgrupo menos frequente correspondendo a uma pequena percentagem. Métodos: Apresentamos um caso-clínico de uma doente de 52 anos com um aneurisma gigante da veia do transplante renal associado a uma fístula arteriovenosa. Adicionalmente foi realizada uma revisão da literatura na base de dados MEDLINE. Resultados: Doente de sexo feminino com antecedentes de transplante renal de dador vivo com o enxerto localizado na fossa ilíaca esquerda, recorre ao serviço de urgência com dor no local do enxerto renal e febre. À observação do enxerto com ecografia observa-se uma lesão de grandes dimensões no bacinete com fluxo identificado ao Doppler. Realizou angiotomografia computadorizada que revelou presença de uma fístula arteriovenosa entre artéria e a veia renal, com um volumoso aneurisma da veia renal a ocupar praticamente todo o seio renal, de aproximadamente 5.6cm de maior diâmetro. Numa primeira fase foi realizada embolização da fístula arteriovenosa renal com coils. Pela manutenção do quadro sético com disfunção do enxerto foi posteriormente submetida a nefrectomia do enxerto. Conclusão: Os aneurismas da veia renal são lesões extremamente raras com apenas alguns casos publicados na literatura. Estes aneurismas são passíveis de tratamento por via endovascular ou cirúrgica, no entanto, tendo em conta a escassez de dados publicados desconhecem-se os resultados a longo prazo.

Aortoenteric fistula (AEF) is a rare cause of gastrointestinal (GI) bleeding. There are two types of AEF: primary and secondary. Primary AEF usually occurs in association with abdominal aortic aneurysm (AAA). Secondary AEF are associated to aortic grafts, normally in relation to graft infection, and represent the most common type. A high level of suspicion is essential to a prompt diagnosis. If not promptly diagnosed and treated the associated mortality is very high. The role of endovascular treatment is not yet defined. Our aim is to perform a non-systematic review of the available literature concerning etiology, clinical presentation, diagnosis and treatment of AEF.

Introdução: O linfedema dos membros inferiores é uma patologia relativamente comum que condiciona um marcado impacto na qualidade de vida do doente. Pode ocorrer primariamente ou ser secundário a um fator externo. O seu tratamento na maioria dos casos é conservador através de massagem de drenagem linfática e medidas de compressão externa. No entanto, a cirurgia reconstrutiva do sistema linfático tem vindo a ganhar popularidade. Adicionalmente, nos casos mais graves pode ser necessário a realização de procedimentos cirúrgicos de redução de membro na correção de dismorfias associadas ao linfedema crónico. Métodos: Foi feita a revisão de um caso clínico grave de linfedema do membro inferior que foi tratado com recurso a um procedimento cirúrgico de redução de membro. Posteriormente procedeu-se a uma revisão da literatura utilizando a base de dados MEDLINE. Resultados : Doente de 46 anos com antecedentes de obesidade mórbida seguido por linfedema precoce do membro inferior direito que surgiu na segunda década de vida. O doente foi observado em consulta de cirurgia vascular com queixas de linforragia tendo sido instituído tratamento conservador com terapia compressiva. Apesar da melhoria inicial o linfedema progrediu com agravamento das queixas e recidiva de linforragia na coxa. Foi submetido a cirurgia de redução de membro com evolução favorável e marcada melhoria clínica no pós-operatório. Conclusão: O linfedema dos membros inferiores é uma entidade pouco reconhecida que condiciona um marcado impacto na qualidade de vida dos doentes. Atualmente não existe tratamento curativo e os resultados do tratamento conservador são limitados. O tratamento cirúrgico, nomeadamente com cirurgia de redução do membro visa solucionar os casos mais graves nomeadamente complicações associadas à cronicidade do linfedema.

Homem de 65 anos observado em consulta externa de cirurgia vascular por apresentar edema assimétrico do membro inferior esquerdo após acidente de trabalho que lhe terá condicionado imobilização prolongada. Pela suspeita de trombose venosa profunda, o doente realizou ecodoppler venoso dos membros inferiores que con!rmou ao diagnóstico de trombose venosa profunda iliofemoral tendo concomitantemente sido identi!cada a presença de "uxos arterializados na veia poplítea, levantando a suspeita de uma fístula arteriovenosa de localização infra-poplítea. Procedeu-se à realização de angiografia que revelou a presença de uma fístula arteriovenosa (FAV) entre a artéria tibial posterior e veia homónima. Após 6 meses de anticoagulação, o doente foi proposto para tratamento endovascular da FAV tendo realizado a implantação de um stent recoberto de ePTFE GraftMaster® 3.5×26mm (Abbott Vascular, Santa Clara, CA) com resolução imagiológica da FAV (!gura 3). À data de alta, o ecodoppler de controlo revelou total permeabilidade luminal do stent colocado na artéria tibial posterior esquerda, na qual se detetaram "uxos de morfologia trifásica, sem evidência de "uxos arterializados na veia poplítea. Com um ano de seguimento o doente mantém a artéira tibial posterior permeável.

Introduction: Between 14–20% of patients with critical lower-limb ischemia (CLI) are not candidates for revascularization due to extensive occlusions in crural/pedal vessels. Frequently these patients are young and functionally active. In these cases, the concept of shunting blood through veins to get this reversed flow to reach the nutritive tissue capillary bed becomes attractive. Our aim is to report our very recent experience in venous arterialization. Material/Methods: We retrospectively reviewed the cases of venous arterialization performed in our institution between April 2018–2019. Results: Four patients were treated: 3 males/1 female with mean age of 58.5 years. All patients had PAD stage 4. All patients were studied with arteriography and ultrasound and were considerate no revascularizable (2 of them after an attempt of endovascular/surgical treatment). In one patient a trial with endovenous prostaglandin was performed, without clinical response. In all cases, the patients were facing a major amputation. Arterialization was performed as a last attempt to save the limb. Regarding the surgical procedures, the donor inflow artery was the infragenicular popliteal artery in 2 cases, distal femoral artery in 1 case and anterior tibial artery in 1 case. In 3 cases the bypass used the great saphenous vein (GSV) in situ to arterialize the medial marginal vein; in 1 case was used an inverted GSV bypass with the distal anastomosis at the posterior tibial vein. The venous valves were destroyed by combination of Fogarty catheter (proximally) and angioplasty balloon (distally). Collaterals were ligated to focalize the blood flow. In all patients marked improvement in foot perfusion was achieved. Two of them had excellent evolution in the postoperative period and healed foot lesions. One patient was amputated with permeable bypass. One patient presented good initial evolution but later had bypass thrombosis (presum- ably due to inadequate arterial inflow from the anterior tibial artery) and undergone major amputation. Discussion/Conclusions: Despite advances in surgical and endovascular techniques, an important number of patients with CLI are not candidates to arterial revascularization and most patients with inoperable CLI will face a major amputation. In that setting, venous arterialization should be considered but not all patients are candidates to this procedure and a careful preoperative evaluation is required. Our preliminary experience is encouraging: the procedure was relatively straightforward, the resulting improve in foot perfusion was surprisingly good, the patency rate and limb salvage rate was 75 and 50%. In our opinion the major issues are selection of inflow artery and outflow vein and the learning curve in interpretation of the angiographic result to guide optimal focalization of the blood flow.

The aim of this study was concretes waste recovery by replacing natural aggregates (NA) by recycled aggregates (RA) at rates of 0%, 50% and 100%. Recycled aggregates coming from construction and demolition waste (CDW) present a low quality compared to natural aggregates, the water absorption being their main drawback. Quantities of water absorbed and their variations in times were measured according to the European standard (EN 1097-6). Adding absorbed water during mixing have caused concretes segregations and an excess volume of water was observed at the surface of the concrete. The added water was not totally absorbed by aggregates. The pre-saturation of aggregates 24 hours before mixing and introducing them as a component in concrete was the best method. The initially saturated aggregates did not consume concretes mixture water. Workability by slump test and mechanical strengths developed with pre-saturated aggregates (100 % RA) and (50% RA - 50% NA) were measured on concretes, and then were compared to those of the reference concretes made with 100 % of natural aggregates.

Superficial femoral artery (SFA) aneurysms are rare clinical disorders, with few case reports and small series published concerning atherosclerotic aneurysms. We report a clinical case a giant aneurysm of the SFA, in a patient previously submitted to extensive SFA endarterectomy and vein angioplasty. A 73-year-old man presented at a routine vascular surgery consultation. The patient had been submitted to a right SFA endartectomy and vein patch angioplasty, sixteen years ago, for intermittent claudication. Physical examination demon- strated a large pulsatile mass of the right thigh. His right pedal pulse was palpable. Ultrasound and computed tomography scan confirmed a 78x71x240mm aneurysm of the right superficial femoral artery. He was proposed to aneurysmectomy and femoro-popliteal bypass. During operative intervention, proximal and distal control was obtained and the aneurysm opened. A large amount of thrombus was removed and a femoro-popliteal bypass was performed using the ipsilateral great saphenous vein. The postoperative period was uneventful, as was the patient recovery. In our report, the aneurysmal area matched precisely to the endarterectomised area and no other aneurysms were found. So we are facing an uncommon case of a SFA degeneration into a giant aneurysm after extensive endarterectomy and vein angioplasty.

Mineral geopolymer binders can be an attractive and more sustainable alternative to traditional Portland cement materials for special applications. In geopolymer technology the precursor is a source of silicon and aluminium oxides, the second component is an alkaline solution. In the synthesis of geopolymer binders the most commonly used alkaline solution is a mixture of sodium or potassium water glass with sodium or potassium hydroxide or silicate solution with a low molar ratio, which is more convenient and much safer in use. In this paper, we present the influence of sodium or potassium silicate solution on the physical and mechanical properties of fly ash and ground granulated blast furnace slag-based geopolymer mortars. Mercury intrusion porosimetry and microstructural observation allowed for comparing the structure of materials with a different type of alkaline solution. The evolution of compressive and flexural tensile strength with time determined for composites using 10%, 30% and 50% slag contents (referring to fly ash mass) was analysed. The tests were performed after 3, 7, 14 and 28 days. It was observed that, as the amount of slag used increases in the precursor, the strength of the material grows. Mortars with the sodium alkaline solution were characterised by a higher strength at a young age. However, the values of strength 28 days were higher for geopolymers with potassium alkaline solution reaching 75 MPa in compression. Geopolymer mortar microstructure observation indicates a high matrix heterogeneity with numerous microcracks. Matrix defects may be caused by the rapid kinetics of the material binding reaction or shrinkage associated with the drying of the material.

Introduction: Above-knee stump ischemia is a serious condition. If left untreated usually courses with progression to irreversible ischemia. Without treatment the path from here usually leads to hip disarticulation and death. Our aim is to present our most recent experience in stump revascularization. Material/Methods: We retrospectively reviewed all patients with above-knee stump ischemia treated in our institution between July 2018 to March 2019. Results: We present four clinical cases treated in our institution in the last nine months. Two of them presented with non-acute stump ischemia with pain and skin lesions developed after minor trauma several months after surgery and stump healing. In both cases the computed tomography angiography (CTA) showed occlusion of the common femoral artery (CFA) and was inconclusive regarding the status and quality of the deep femoral artery (DFA). Despite this, ischemia severity deemed obligatory an attempt to revascularization, DFA was surgically exposed and proved to be an adequate target run off to a bypass. In the other two, the ischemia of the stump was acute. In one patient it was after surgical treatment of an ipsilateral false aneurism of the CFA (with ligation of the EIA) treated with a bypass from the EIA to both the superficial and DFA. The other was a patient admitted with aortic bifurcation occlusion and irreversible right leg ischemia that was submitted to primary above-knee amputation. In the next postoperative days, the patient developed severe stump ischemia. An axillo femoral bypass and proximal re-amputation was performed. Three patients resolved the stump ischemia and fared well, the last one died in the postoperative period. Discussion/Conclusions: Above-knee stump ischemia usually leads to progressive stump degradation/necrosis/infection, eventually leading to death. When the common/deep femoral arteries are occluded, re-amputation is usually insufficient and progression of ischemia can dictate the need for a hip disarticulation, a very aggressive and mutilating procedure with high rate of morbidity and mortality that do not prevent progression to pelvic ischemia and death. Revascularization of above-knee amputation stump, based on DFA or hypogastric revascularization, is the best therapeutic alternative and should be attempted even in frail patients. We believe that our small series reinforces the idea that stump revascularization is possible and can save both: stump and life.

This paper presents a study of the electrical and mechanical behavior of several continuous carbon fibers epoxy composites for both strengthening and monitoring of structures. In these composites, the arrangement of fibers was deliberately diversified to test and understand the ability of the composites for self-sensing low strains. Composites with different arrangements of fibers and textile weaves, mainly unidirectional continuous carbon reinforced composites, were tested at the dynamometer. A two-probe method was considered to measure the relative electrical resistance of these composites during loading. The measured relative electrical resistance includes volume and contact electrical resistances. For all tested specimens, it increases with an increase in tensile strain, at low strain values. This is explained by the improved alignment of fibers and resulting reduction of the number of possible contacts between fibers during loading, increasing as a consequence the contact electrical resistance of the composite. Laboratory tests on strengthening of structural elements were also performed, making hand-made composites by the “wet process”, which is commonly used in civil engineering for the strengthening of all types of structures in-situ. Results show that the woven epoxy composite, used for strengthening of concrete elements is also able to sense low deformations, below 1%. Moreover, results clearly show that this textile sensor also improves the mechanical work of the strengthened structural elements, increasing their bearing capacity. Finally, the set of obtained results supports the concept of a textile fabric capable of both structural upgrade and self-monitoring of structures, especially large structures of difficult access and needing constant, sometimes very expensive, health monitoring.