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INTRODUCTION: Due to their relative rarity, the natural history of iliac artery aneurysms and treatment outcomes are poorly understood. However, IAA treatment has evolved, and nowadays, there are a variety of open surgery, endovascular therapy, and hybrid options. This study aimed to compare the outcomes of endovascular treatment versus open surgery for patients with iliac artery aneurysms. METHODS: A systematic review was performed according to the PRISMA statement. An online search was conducted using the Medline database from January 2014 to January 31st, 2023. Only original articles in English or Portuguese, reporting on a minimum of 5 cases, were considered. Studies were included if reporting at least one of the following outcomes: peri-operative complications, length of stay (LS), and 30-day mortality. The software Review Manager 5.4 was used for data analysis. RESULTS: The database search identified 418 articles, of which 413 records were excluded by screening by title/ abstract, and five were read in full and subsequently included. A total of 1837 patients were included. Open surgery was performed in 29.02% (442/1523) and endovascular in 70.58% (1075/1523). More than half of endovascular cases included internal iliac artery preservation techniques (iliac branch design grafts). Patients undergoing endovascular treatment were significantly older (mean difference [MD]: 5.49, 95% confidence interval [CI]: 2.34 to 8.65) and more likely to have congestive heart failure (odd ratio [OR]: 3.74, 95% CI: 1.24-11.27). On the other hand, patients undergoing open surgery were more often smokers (OR: 0.59, 95% CI: 0.42-0.82). The primary outcome - 30-day mortality - was significantly higher for open surgery (OR 0.34, 95% CI 0.19-0.61). Considering other peri-operative outcomes, patients undergoing open surgery presented with longer length of hospital stay (MD: -4.68, 95% CI: -6.43 to -2.92), higher risk of surgical wound infection (OR: 0.31, 95% CI: 0.10- 0.94), renal failure (OR: 0.37, 95% CI: 0.18-0.75) and respiratory infection (OR: 0.19, 95% CI: 0.11-0.33). No significant differences regarding buttock claudication and leg and bowel ischemia were found. The 30-day reintervention rates weren ́t significantly different for open and endovascular surgery (OR 0.83, 95% CI 0.33-2.1). CONCLUSION: Endovascular treatment of iliac artery aneurysms can reduce 30-day mortality, peri-operative complications and length of hospitalization. No differences were identified regarding 30-day reintervention rates. Consequently, endovascular treatment has gained preference over open surgery as the initial approach for patients with suitable anatomy. No other meta-analysis in the literature compares the results of open surgery and endovascular treatment, particularly the results of new endovascular techniques (iliac branch design grafts). Comparing long-term reintervention rates will be essential in the future.

This study aims to investigate the impact of national quality programs in mammography and technological advances in digital mammography units on the radiation doses delivered to women in Brazil. Radiation dose assessments in mammography units were conducted through a mail-based dosimetric system. For each unit of facilities that applied to one of the two national quality programs, a postal dosimetric system is dispatched, comprising an optically stimulated luminescent dosimeter (OSL) attached to the surface of a 4.0 cm thick polymethyl methacrylate (PMMA) phantom, simulating a compressed breast with 4.5 cm thickness. Testing instructions to expose the dosimetric phantom for assessing the mean glandular dose (MGD) are provided. Between 2012 and 2023, the programs evaluated the MGD in 1,687 mammography units of computed radiography (CR) and direct digital radiography (DR) technologies from 1,399 facilities located in all Brazilian regions. A total of 1,660 (70.5%) evaluations were carried out on CR technology mammography units and 696 (29.5%) on DR units, totaling 2,356 MGD evaluations. The overall average MGD was 1.60 ± 0.80 mGy, with 1.68 ± 0.83 mGy for CR technology and 1.42 ± 0.68 mGy for DR technology. A comparison of average MGD between the periods 2012 - 2018 and from 2019 onwards shows a dose reduction of 8.6% for CR systems and of 26.0% for DR systems (p = 0.000). As CR systems use analog mammography units, which did not undergo technological advances between the two periods, the reduction in doses observed is due to the actions of national quality certification programs and by using image plates for dual-sided reading or needle-based image plates. The reduction observed in DR systems is due to both national quality programs and technological advances in mammography units, especially the use of radiation beams generated by X-ray tubes with tungsten targets.

Resumo A integração de emigrantes no mercado de trabalho tem efeitos na trajetória migratória da própria pessoa e na sua interação com a sociedade de acolhimento. É frequentemente trespassada por dificuldades de ajustamento do capital humano e das competências profissionais às necessidades do mercado de trabalho. A migração qualificada ilustra com particular acuidade a heterogeneidade destes processos. Com efeito, a empregabilidade da emigração qualificada não é uniforme. Alguns/mas emigrantes, embora com uma qualificação de nível superior, podem encontrar-se a desempenhar profissões não qualificadas - situação de sobre-qualificação. Com base em dois estudos sobre a emigração portuguesa, apuraram-se taxas de sobre-qualificação na ordem dos 18,1% e dos 16,9%. Identificaram-se consequências negativas desta sobre-qualificação: insatisfação com o trabalho e baixos salários. Identificaram-se também fatores associados a esta sobre-qualificação: a idade jovem, a formação em ciências sociais e humanas e a residência em países clássicos da emigração portuguesa com elevado peso de emigração pouco qualificada.

INTRODUCTION: Treatment decision in patients with asymptomatic carotid artery stenosis (ACS) is a matter of current debate with a recent shift towards isolated best medical treatment (BMT) as treatment of choice in most patients. However, poor medical compliance is one of the main constraints to the success of BMT. We hypothesized that more invasive treatment approaches can influence how patients perceive the severity of their illness and hence, treatment compliance. METHODS: A cross-sectional study was performed including patients with asymptomatic >50% carotid artery stenosis (NASCET method) followed-up as outpatients in a Vascular Surgery department from January 2017 to December 2021. Optimal BMT was defined according to the European Society of Vascular Surgery Carotid Atherosclerotic Disease 2023 guidelines. Demographic and risk factor patient data was attained and subsequently a Portuguese translation of the Morisky medication-taking adherence scale (MMAS-4) questionnaire was given to all patients. Several additional questions developed by our group were also applied. RESULTS: A total of 320 patients were identified (186 under BMT alone and 134 submitted to BMT and carotid endarterectomy - CEA). Most patients were male in both groups (75%) and the mean age was similar. Furthermore, patients undergoing CEA presented higher rates of current smoking (51.4% vs 15.9%; p

Resumo A edição especial objetivou especialmente visibilizar estudos sobre a diáspora de povos lusófonos, dada a escassez de pesquisas sobre migrações que tratam de modo agregado países lusófonos, tanto na área da Demografia quanto em outras áreas, em especial a área para a qual essa edição especial foi pensada: a Administração. Compreendemos que as mobilidades contemporâneas assumem contornos cada vez mais complexos e desafiadores, o que amplia ainda mais a análise do fenômeno migratório. Assim, considerando o cenário contemporâneo, alguns pontos para reflexão nortearam essa chamada de trabalhos, quais sejam: a) os movimentos do projeto migracional em países de língua portuguesa; b) as estratégias para a inserção laboral dos sujeitos que migram para (ou de) países lusófonos; c) as migrações forçadas por guerras civis, ataques armados e/ou terroristas, e a consequente desestruturação das economias; d) as alterações climáticas e sua indução de migrações em busca de trabalho; e) as questões de gênero e suas intersecções com as questões migracionais nesses países.

BACKGROUND: Endovascular mechanical thrombectomy (MT) changed acute ischaemic stroke management and is considered the standard of care for patients with proximal anterior circulation occlusion. MT improves functional independence, without an increase in mortality. Despite its advantages, up to 20% of patients treated with MT do not have successful recanalization, leading to poor clinical outcome. We present a case of an acute ischaemic stroke of the anterior circulation due to occlusion of the common carotid artery successfully submitted to surgical thrombectomy after failed MT. CASE REPORT: A 43-year-old male, with prior history of diabetes, hypertension, dyslipidaemia and heart failure was admitted at the emergency unit with acute bilateral lower limb ischaemia, due to cardioembolic phenomena. He was submitted to bilateral femoral thrombectomy and started endovenous unfractionated heparin. On the fifth postoperative day he developed sudden depression of cognitive status and left side hemiplegia of brachial predominance. Computed tomography angiography revealed an occlusion of brachiocephalic trunk, right subclavian artery and common carotid artery, preserving its branches. MT, performed by interventional neuroradiology, was unsuccessful (no recanalization or clinical improvement). After multidisciplinary discussion, the patient underwent urgent surgical thrombectomy through carotid and transaxillary approaches. Postoperatively, the patient’s mental status and left sided motor function recovered progressively over time. Three months after, patient maintains anticoagulation with warfarin, without neurological sequalae. CONCLUSION: The low rate of recanalization and poor clinical outcome after MT failure underlines the need for alternative rescue approaches. Surgical thrombectomy could represent a lifeline. More studies are needed to corroborate its efficacy in patients with anterior circulation acute ischaemic stroke.

INTRODUCTION: The development of a uretero-arterial fistula (UAF) is a rare and life-threatening condition. Owing to its low prevalence, diagnosis and management remains a challenge for both urologists and vascular surgeons and UAF’s high mortality rates may be at least partially attributed to delayed diagnosis. We present a case of UAF in a patient with previous pelvic surgery and indwelling ureter catheter. CASE REPORT: An 82-year-old male presented to the emergency department with haemodynamic instability and gross haematuria that started one hour prior to admission. The laboratory study performed showed an acute anaemia of 7.5g/dl and a contrast enhanced computed tomography revealed a ureteral fistula betweenthe stented left ureter and the common iliac artery. The patient was taken to the angiography suit and a balloon- expandable stent-graft (GORE® VIABAHN® VBX – 11mm diameter and 59mm in length) was deployed. Following the procedure, the haematuria resolved, and the patient had an uneventful post-operative stay. He was discharged two weeks after admission, following a course of large spectrum antibiotic therapy. The patient remained asymptomatic at 3 month follow up. CONCLUSIONS: Uretero-arterial fistula is an uncommon condition but with an increasing prevalence, at least in part due to improved pelvic cancer treatment.

INTRODUÇÃO: A doença quística adventicial é uma patologia que afeta principalmente o leito arterial, porém, em raros casos pode envolver o sistema venoso. O objetivo desta revisão foi padronizar a marcha diagnóstica, tratamento e vigilância de doentes com suspeita de doença quística adventicial venosa. MÉTODO: Para cumprir os objetivos supracitados, uma revisão narrativa sumarizando os principais achados da literatura usando as bases de dados PUBMED e EMBASE foi feita. RESULTADOS: Um total de 33 artigos foram selecionados traduzindo-se num total de 41 casos de vACD. Após analise dos dados, foi possível concluir que o vaso mais frequentemente atingido é a veia femoral comum, e a maior parte dos doentes refere edema unilateral de membro com tempo de evolução variável. Quando perante um doente com edema unilateral de membro, em que a TVP foi excluída, é necessário proceder a outros meios complementares de diagnóstico de forma a confirmar, ou excluir, a vACD.

In many industries, analog gauges are monitored manually, thus posing problems, especially in large facilities where gauges are often placed in hard-to-access or dangerous locations. This work proposes a solution based on a microcontroller (ESP32-CAM) and a camera (OV2640 with a 65° FOV lent) to capture a gauge image and send it to a local computer where it is processed, and the results are presented in a dashboard accessible through the web. This was achieved by first applying a Convolutional Neural Network (CNN) to detect the gauge with the CenterNet HourGlass104 model. After locating the dial, it is segmented using the circle Hough transform, followed by a polar transformation to determine the pointer angle using the pixel projection. In the end, the indicating value is determined using the angle method. The dataset used was composed of 204 gauge images split into train and test sets using a 70:30 ratio. Due to the small size of the dataset, a diverse set of data augmentations were applied to obtain high accuracy and a well-generalized gauge detection model. Additionally, the experimental results demonstrated adequate robustness and accuracy for industrial environments achieving an average relative error of 0.95%.

The emergence of Industry 4.0 and 5.0 technologies has enabled the digital transformation of various processes and the integration of sensors with the internet. Despite these strides, many industrial sectors still rely on visual inspection of physical processes, especially those employing analog gauges. This method of monitoring introduces the risk of human errors and inefficiencies. Automating these processes has the potential, not only to boost productivity for companies, but also potentially reduce risks for workers. Therefore, this paper proposes an end-to-end solution to digitize analog gauges and monitor them using computer vision through integrating them into an IoT architecture, to tackle these problems. Our prototype device has been designed to capture images of gauges and transmit them to a remote server, where computer vision algorithms analyze the images and obtain gauge readings. These algorithms achieved adequate robustness and accuracy for industrial environments, with an average relative error of 0.95%. In addition, the gauge data were seamlessly integrated into an IoT platform leveraging computer vision and cloud computing technologies. This integration empowers users to create custom dashboards for real-time gauge monitoring, while also enabling them to set thresholds, alarms, and warnings, as needed. The proposed solution was tested and validated in a real-world industrial scenario, demonstrating the solution’s potential to be implemented in a large-scale setting to serve workers, reduce costs, and increase productivity.

A 46-year-old male underwent previous endovascular repair for thoracic aortic coarctaction in 2017. Five years later he underwent an angio-computed tomography that revealed a 60mm x 53mm asymptomatic saccular costocervical artery aneurysm (A, yellow arrow). An angiography was subsequently performed, and selective catheterization was possible with a triaxial microcatheter system (B, circle defining the aneurysm extension). Costocervical trunk aneurysms are very rare vascular abnormalities and usually are associated with congenital heart defects or connective tissue disorders. The case is scheduled for discussion in a multidisciplinary meeting with cardiothoracic surgery for elaboration of a treatment strategy.

INTRODUCTION: Aortoiliac occlusive disease (AIOD) can be treated using either open surgical revascularization (OSR) or endovascular revascularization (ER). METHODS: A Medline search was performed in order to identify articles focused on the treatment of aortoiliac occlusive disease. Additional articles of scientific interest for the purpose of this non-systematic review were included by cross-referencing. RESULTS: There are a few articles reporting direct results between both techniques based on retrospective or prospective single center or multicenter studies. In the majority of studies, primary patency is generally better for surgery in comparison to ER, but at a cost of more postoperative complications, with higher rates of respiratory failure and wound infection in the open group. On the other hand, endovascular recanalization is related to higher rates of limb ischemia/thrombosis, renal dysfunction and reinterventions. In the presence of femoral artery calcified disease, the hybrid approach should be considered. CONCLUSIONS: Endovascular treatment is a suitable alternative for extensive AIOD and can be accomplished in a less invasive manner, with most midterm outcomes comparable with open reconstruction. Surgery should be reserved for multilevel calcified disease and after endovascular failure.

OBJECTIVE: Venous stenting of iliocaval obstructions has become a more frequent procedure over the last two decades. In-stent stenosis and thrombosis are potential complications, causing one of the main causes of symptoms recurrence and impacting quality of life. The aim of this review is to report on the impact of venous stent patency loss, as well on risk factors and management. METHODS: A systematic review was conducted according to the recommendations of the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement. RESULTS: After a literature search, 12 studies (two prospective and 10 retrospective studies) were included in the analysis. A total of 1981 patients (34.1% male) and 2388 limbs (63.6% left side) were assessed. Mean age was 43.5 years (range 16-99). Indication for stenting included deep venous thrombosis (DVT) (4%), post-thrombotic syndrome (PTS) (18.8%) and non-thrombotic iliac vein lesions (NIVLs) (77.2%). Regarding treatment, most patients were submitted to angioplasty and stenting only (87%). Associated catheter directed thrombolysis or mechanical thrombectomy was performed when indicated (8.4%), and in the remaining an AVF/endophlebetomy was performed (4.6%). Primary, primary assisted and secondary patency rates at one year ranged from 68-100%, 79-90% and 85.8-100%, respectively. Reported anticoagulation duration after stenting ranged from 1-12 months. In one study involving only patients treated for NIVLs, no anticoagulation was prescribed, and antithrombotic therapy was continued for three months. Follow-up strategies included clinical and imagiological control with a mean follow-up of 19.7 months. Post-procedural stent re-stenosis was reported in 121 limbs (5.1%) and stent occlusion in 81 limbs (3.4%); the latter was distributed as follows: 11.1% after DVT, 77.8% PTS and 11.1% NIVLs. A total of 186 re-interventions were performed in symptomatic patients. The prognostic factor most consistently associated with stent failure was thrombotic inflow veins. Other reported factors were incomplete thrombolysis and age younger than 40 years. Stent placement below the inguinal ligament, type of stent and anticoagulation regimen do not seem to affect stent patency. CONCLUSION: Regarding venous lesions of the lower limbs, a selective approach and planning should focus on identification of risk factors for stent failure. It is noteworthy that most stent occlusions occur in post-thrombotic limbs. Stent failure continued after 6 months, emphasizing the importance of an extended surveillance especially on these patients.

Cerebrovascular risk factors reduce cognitive performance via changes in the integrity of a frontoparietal brain network in ageing. Modification of blood pressure, with antihypertensive treatment in mid-life, mitigates against cognitive decline over a specific blood pressure range.

INTRODUCTION: Inferior vena cava agenesis is one of the most uncommon anomalies of this vessel, with an estimated prevalence of 0.0005–1% in the general population. However, around 5% of the patients younger than 30 years with a diagnosis of deep vein thrombosis have this anomaly. METHODS AND MATERIAL: Report of two clinical cases of inferior vena cava agenesis with different clinical presentations. CLINICAL CASE 1: A 40-year-old man was admitted with a 3 days history of unilateral lower limb swelling and pain, gradually progressing to the inability to walk. On physical examination he had swelling, bruising and tenderness involving leg and thigh and prominent engorged superficial abdominal collateral veins. Venous Doppler Ultrasound showed left deep venous thrombosis extending from popliteal vein to common iliac vein. A computed tomography angiogram showed agenesis of the infrarenal vena cava and patent renal veins draining in to the azygous system and hemiazygous systems. The patient as discharged with rivaroxaban and compression stockings. At 2 months follow up he was asymptomatic and still anticoagulated. CLINICAL CASE 2: A 35 year- old woman, with a previous history of recurrent lower limb varicose veins surgery and left internal malleolar ulcer at 30 years presented at medical department 3 years later with complains of ulcer recurrence. A computed tomography angiogram revealed an absent infrahepatic vena cava, prominently dilated azygos and hemiazygos veins with enlarged retroperitoneal collaterals. The patient initiated dressing care with oxide zinc and oral rivaroxaban. DISCUSSION/CONCLUSION: The majority of cases remain asymptomatic. However, when symptomatic, the majority present as proximal DVT involving the iliac and femoral veins. CT or MRI should be the imagiological methods used to diagnose this anomaly. No clear consensus has been reached on therapeutic strategy, other than long-term antico- agulation and elastic stockings.

Introduction: Traumatic popliteal artery injury is a rare clinical entity, but it is the most common cause of amputation in injured extremities. The aim of this study was to report the incidence of popliteal artery injury after knee trauma and report therapeutic management and results. Methods and material: ICD-10/ ICD-9 codes (S85.0/904.41; S83.1/836.5; S83.4; S83.5; S72,4/821.2; S82,1/823.0) were used to identify patients admitted with popliteal artery injury and/or knee trauma at our tertiary center from 1/1/2010 to 31/5/2021. A statistical analysis was realized using the SPSS program version27. Results: At our center from 1/1/2010 to 31/5/2021 535 patients were admitted due to knee trauma (28 with knee dislocation and 507 with fracture close to the knee) and 9 patients with popliteal artery injury (seven males, median age 39.0 years) The mechanism of PAI was motorcycle (4) or bicycle (1) or work (1) accidents (4); one fall, one running over and one iatrogenic injury. The incidence of PAI after knee trauma was 1.5%, after knee dislocation 17.9% and 0.8% after fracture close to the knee. Regarding associated injuries, four patients had severe soft tissue damage, two had venous injuries and two had nerve disruptions. The median ischemic time was 6.0 hours and mean vascular surgical time was 2.4 hours. Regarding vascular treatment, eight patients were submitted to bypass surgery and one was treated conservatively. Therapeutic fasciotomies were performed in three patients. No primary amputations were performed. A secondary major amputation was performed in one patient. The mean hospital length of stay was 24.9 days and mortality was 0%. Three patients returned to their normal activity level and six were limited in their daily activity. Discussion/Conclusion: The risk of PAI after knee dislocation is higher than after knee fracture (17,9% vs 0.8% in our study, and 3,4-8,2% vs 0,2 % in Swedish registration), so orthopedic surgeons must be aware of that increased risk, to avoid missing this diagnosis. The amputation rate in our serie was lesser than the Swedish registration and the United States National Trauma Data Bank (11% vs 28% and 14,5%, respectively). However, it ́s still a high rate considering that it mostly affects a young and active population and only 33.3% patients return to a normal life. A multidisciplinary approach is essential to decrease ischemia time and to promote a holistic treatment.

Introduction: Involvement of the ascending/aortic arch in the thoracic aorta pathology can preclude thoracic endovas- cular aortic repair (TEVAR) due to the absence of an adequate proximal landing zone. Hybrid interventions combining ascending/aortic arch replacement with TEVAR of the descending thoracic aorta (DTA) are associated with good outcomes. Despite the existence of dedicated devices (E-vita®, Thoraflex®), they may not be available in good time in emergent cases that might require inventive solutions, like the one we present. Case Report: A 53-year-old hypertensive, active smoker male was admitted due to a non-A-non-B acute aortic dissection, complicated with a contained rupture at the aortic isthmus and a left haemothorax. Considering the absence of a secure proximal landing zone we decided on an aortic arch replacement and frozen stented elephant trunk using off-the-shelf devices. Debranching of the innominate and left common carotid arteries was performed with a 16×8mm bifurcated graft. The aortic arch replacement was performed with a 28 mm Dacron, under hypothermic circulatory arrest. A 30×30×157mm stent graft was anterogradely advanced to the DTA, under direct vision, with its proximal part parked at the level of the Dacron anastomosis. The proximal arch anastomosis was completed at the level of the sinotubular junction. Completion angiography revealed appropriately reconstructed aortic arch, successful exclusion of the entry tear and rupture site, as well as adequate renal and visceral perfusion. The patient had an uneventful postoperative course, being discharged on postoperative day 23. Control CTA demonstrated successful arch reconstruction, true lumen expansion and no signs of complications. Conclusion: This hybrid approach with off-the-shelf devices was successful and avoided the cumulative morbidity of an additional left thoracotomy as the technical difficulty of a full open surgery in this setting. In the absence of readily available dedicated devices, hybrid techniques will undoubtedly play a role in the treatment of acute aortic syndromes. The existence of an “Aortic Team” available to evaluate, decide and combine the expertise of cardiothoracic and vascular surgery was essential in this case.

Introduction: Severe ilio-femoral occlusive disease can limit the endovascular treatment of aorto-iliac aneurysms. In high surgical risk patients, inventive and staged hybrid interventions can be the answer to achieve definitive treatment. Clinical Case: A 68-year-old male, with multiple comorbidities, presented with simultaneous occurrence of bilateral common iliac aneurysms and severe ilio-femoral occlusive disease associated with right critical limb-threatening ischemia. In order to exclude the iliac aneurysms, preserve pelvic flow and revascularize the threatened limb we decided for a three-staged hybrid intervention. First, we began with a right external iliac angioplasty with femoral endarterectomy to create adequate arterial access. In a second intervention, we implanted a bifurcated aortoiliac endograft through this access. In order to prevent pelvic ischemia, contralateral leg outflow was directed to the left internal iliac artery with a combination of self-expandable and balloon-expandable covered stents. Finally, a right femoro-posterior tibial artery bypass completed the revascularization. At 1,5-year follow-up, no complications are reported and the patient is asymptomatic. Conclusion: In patients with poor medical condition and complex aorto-iliac aneurysmal and occlusive disease, a staged hybrid approach like the one described in this case-report can be feasible and associated with durable midterm patency and excellent clinical outcome.

Pseudoaneurysms after gastro-intestinal tract surgery are rare. Most of them occur after biliary tract and pancreatic surgery. They can lead to potentially serious consequences, such as rupture, hemorrhage and death. For these reasons, pseudoaneurysms should be diagnosed and treated as soon as possible.

Resumo O principal objetivo deste texto é examinar e discutir as tendências atuais das migrações e da mobilidade internacional, bem como as principais teorias que têm sido desenvolvidas para as explicar. Para além de um estado da arte sumário, o texto procura entrever o que pode suceder no futuro face às mudanças globais, seja uma continuidade e aprofundamento das tendências atuais ou, pelo contrário, uma alteração do paradigma. Apesar de o cenário mais provável ser a continuação do aumento dos movimentos, tudo vai depender do confronto entre os fatores estruturais e a agência individual. Se os primeiros apresentam, hoje, alguns sinais contraditórios, a segunda revela as numerosas possibilidades de ação de migrantes e não migrantes. Existem vários futuros possíveis, sendo que um deles - a transição para a mobilidade - foi teorizado por Zelinsky em 1971.

Caffeine is one of the most used psychoactive substances worldwide, with an impact in multiple spheres (individual, social, and economic). In addition, there is evidence of the physiological, cognitive, and emotional effects after consumption. This study aimed to examine caffeine consumption in a Portuguese sample by characterizing and understanding the pattern of consumption and the reasons for it. The sample was composed of 208 subjects recruited through the university’s social media channels to answer an online questionnaire between April and June 2020. The results showed a higher consumption in males and the group of subjects aged between 31 and 35 years. The coffee “express” is the most consumed source of caffeine in this Portuguese sample (70.2%). The data showed that improvement in alertness and the taste of products with caffeine were the main reasons for consuming caffeinated products. In conclusion, this study calls attention to the characterization of caffeine consumption to understand the need for such consumption and its effects on body functions and health. It is important to highlight the potential benefit of caffeine consumption due to its impact on the quality of life and health since this substance has effects not only on physical and mental health but also on social well-being.

Adventitial cystic disease (ACD) is a rare condition. It affects mostly the popliteal artery, with few cases reported affecting the radial artery. This condition is characterized by accumulation of mucinous content at the adventitious layer.

Introduction: Post-implantation syndrome (PIS) is the clinical and biochemical expression of an inflammatory response following endovascular repair of an aortic aneurysm (EVAR). The reported incidence in literature varies from 14-60%. Recentently, a study has demonstrated that red blood cell distribution width (RDW) is an independent biomarker predictor of the PIS in patients submitted to EVAR in the early postoperative period. Methods: Retrospective institutional review of consecutive patients submitted to elective EVAR (January 2015- April 2020). The primary outcome was to evaluate the incidence of PIS, defined as fever (>38ºC) and leukocytosis (>12000/μL), excluding infection complication. The secondary outcomes were to identify the potential role of clinical and biomarker parameters to predict the risk of developing PIS after EVAR. Results and conclusion: According to the inclusion criteria, 107 patients were identified. The median age was 75 years old (93.5% men). Comorbidities presented: hypertension (75%), smoking (66%), hypercholesterolemia (59%), coronary artery disease (32%), chronic kidney disease (30%), and diabetes mellitus (DM) (18%). The incidence of PIS was 10,2%. Age, gender and cardiovascular risk factors were found to be similar in both groups (P>0.05). Regarding the procedure approach, the majority of patients were treated with percutaneous access (72%) (P=0,49). In both groups (PIS vs. no PIS), the hemoglobin values significantly decreased (P=0,04) after surgery by approximately 14%. The same trend was observed for mean corpuscular volume (MCV) (P=0.032), which reflected the increasing of the RDW although not reaching statistical significance. Although delta variation of hemoglobin and delta RDW did not reach statistical significance comparing both groups (P=0,53 and P= 0,07 respectively), delta MCV was found to be significantly lower in the group with PIS (P=0.012). The importance of having a biomarker which measurement allows the prediction of patients who have more risk to develop PIS, may help with the early management of this condition.

Introduction: In many areas of Medicine, biomarkers have been proving their value in disease management. The inclusion of inflammatory biomarkers in acute limb ischemia (ALI) decision-making remains debatable due to the scarce literature evidence. Nevertheless, much attention has been held towards the prognostic value of these simple, readily available and low-cost biomarkers might have. Therefore, this review aimed to identify studies that support the utility of preoperative inflammatory markers, such as the neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR), for predicting ALI outcome. Methods: A comprehensive systematic search was applied to Medline database to identify all the cohort studies that specifically investigated and compared the outcomes of ALI patients in relation to their preoperative inflammatory biomarkers. Results: Four cohort studies were included in the review: two published citations, one research letter and one unpublished paper from the same authors of this review. In all studies, the primary outcomes were amputation and/or survival. All studies reported that higher NLR values were independently associated with adverse outcomes after treatment. One study stated that NLR ≥ 5.2 was found to have an 83% sensitivity and 63% specificity for predicting amputation within 30 days (Area Under Curve (AUC) 0.8) while other found that NLR ≥ 5.4 demonstrated to have a 90.5% sensitivity and 73.6% specificity for predicting 30-day amputation or death (AUC 0.86). Higher preoperative RDW, MPV, PLR and C-reactive protein were also reported as predictors of amputation in acute arterial thromboembolism patients in another study. Conclusion: This review demonstrates that although limited literature exists, inflammatory biomarkers like NLR and PLR appear to have a role in ALI preoperative risk stratification. Definition of levels and trends of inflammatory biomarkers and their relationship with treatment outcome could be established through multicentric studies, influencing timing and intervention selection and leading to potential improvements in ALI morbimortality.

O objetivo deste artigo é analisar o fluxo mais recente de brasileiros para Portugal, iniciado em 2015 e terminado de forma abrupta no início de 2020, com a pandemia do Covid-19. Este fluxo foi, talvez, o mais volumoso e variado dos que envolveram brasileiros nas últimas décadas, sendo também o mais breve. A sua natureza recente e a escassez de outros estudos sobre o tema tornam difícil uma leitura extensiva e completa. Por isso, a finalidade deste texto é mobilizar e interpretar diversas fontes estatísticas, bem como divulgar os resultados de algumas entrevistas realizadas, entre agosto de 2019 e janeiro de 2020, com representantes institucionais e quarenta imigrantes. A conjugação da informação estatística com as entrevistas permite um retrato dos novos movimentos.

Introduction: Guidewire fracture is a rare complication of percutaneous coronary intervention (PCI). Retained fragments can cause thrombosis, dissection, perforation of the vessel or embolize. When is impossible to withdraw or to trap the fragment during the procedure, management is debatable between surgical removal or conservative approach. When choosing to leave the fragment in place, the patient remains at risk for all of the aforementioned complications. Clinical Case: 65-year-old male patient submitted to PCI with stenting of distal right coronary artery in 2017. A proximal optimization technique was performed, with a guidewire placed in the posterior descending artery (PDA). After stenting, the protection guidewire became entrapped and after several retrieval attempts, it fractured. Wire fragment remained within the RCA and ascending aorta with a free mobile distal part in the beginning of the innominate artery. Multiple attempts went in vain for wire retrieval and a conservative approach was adopted. Two and a half years later, the patient felt a sudden chest pain and then collapsed. He was transferred to our Hospital for emergent surgery due to cardiac tamponade. Intra-operatively, cardiac surgeons found the guidewire perforating the posterior descending artery. When trying to pull it out, the guidewire fractured again. Post-intervention CTA revealed migration of the fragmented guidewire now it was entrapped in a tortuous initial portion of the right internal carotid artery and a small pseudoaneurysm was visible at the distal portion of the wire. Surgical approach was performed revealing the presence of the wire within the carotid medial wall, in a subintimal plane. The 7 cm fragment was successfully withdrawn, through a common carotid transverse incision. Pseudoaneurismectomy was performed and carotid artery bifurcation reconstruction with internal carotid artery re-implantation into the bifurcation, end-to-end anastomosis. The patient had an uneventful postoperative course. Conclusion: Although leaving the wire in place remains an option, coronary guidewire fractured fragments can be associated not only with immediate complications but also with potential adverse events in the long run.

Introduction: Anemia is associated with increased adverse outcomes during the early postoperative period because of high physiologic stress and increased cardiac demand. The aim of this study was to assess the relationship between pre-operative anemia and morbi-mortality outcomes in patients undergoing elective carotid endarterectomy (CEA), open aortic repair (OAR) or endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) and infrainguinal bypass surgery in chronic limb-threatening ischemia. Methods: Retrospective analysis of all elective patients between 2016-2018, who underwent: CEA, OAR, EVAR and infrainguinal bypass surgery in chronic limb-threatening ischemia. Emergency procedures and transfusion of more than 4 units of red blood cells (RBC) were excluded. Hemoglobin levels were categorized according to the WHO definition for anemia: severe (< 8 g/dL), moderate (8-10.9 g/dL), mild (11-11.9 g/dL in women and 11-12.9 g/dL in men) and no anemia (≥12 g/dL in women and ≥13 g/dL in men). Results: Our study population comprised 257 patients, of which 74 (28%) underwent EVAR, 26 (10.1%) OAR, 67 (26.1%) CEA and 90 (35%) infrainguinal bypass. Pre-operative anemia was identified in 37.4% (n = 96) of the patients. Of those, 67.7% (n = 65) had mild anemia and 32.3% (n = 31) had moderate-severe anemia. Anemic patients have longer length of stay when compared with non-anemic patients (16.61±16.5; 7.68±4.92, respectively) (p = 0.022) and also longer stay in the post-operative care unite in comparison with patients with hemoglobin within the normal range (average 2.08 days ± 1.12; 1.77 days ± 1.01, respectively) (p

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Introduction: Over the past decade, endovascular treatment (EVT) is taking over visceral arterial aneurysms treatment considering its effectiveness, safety and minimal invasiveness. Methods: We retrospectively evaluated our department experience in visceral arterial aneurysms endovascular approach from 2009 to 2019. Results: From 2009 to 2019, nineteen visceral artery aneurysms were submitted to EVT (mean age 62,5 years, 53% women). The addressed arterial segments were: the splenic artery (52%, n=10) followed by the renal artery (21%, n = 4), the hepatic artery (11%, n = 2), the superior mesenteric artery (11%, n = 2) and the celiac arrtery (5%, n = 1). Average diameter was 26,9 ± 5,4 mm [range 21–39 mm]. The majority were asymptomatic incidental findings (74%). Concomitant aneurysms were found in 3 patients (15,8%). EVT included: stent-graft exclusion (n = 9), aneurysm-sac coil embolization (n = 6), stent-assisted coil embolization (n=2) and segmental artery exclusion (n=2). Median radiological follow-up was 46,8 months [range 1,1–128 months]. Early SMA occlusion was reported in one case after stent-assisted coil embolization, however without ischemic symptoms. End-organ loss was reported in one case (renal artery coil embolization, without overall renal function worsening). Conclusion: Nowadays, endovascular approach is the first-line intervention for most visceral arterial aneurysms. Although still limited, the reported results are favourable and are in line with the current literature.

Treatment of aortic pathologies involving the aortic arch represents a great challenge for vascular surgeons. Endografting techniques, comparing to open surgery, are less invasive approaches. However, an adequate proximal landing zone remains a challenge and, regarding this issue, parallel graft techniques represent a viable endovascular treatment option in patients with challenging aortic arch pathology by extending the proximal landing zone while maintaining aortic side branches perfusion. Parallel graft techniques required a thorough planning and the clinical and imagiological follow-up are mandatory. They appear to be a safe and minimally invasive alternative techniques in selected fragile patients. The authors report three clinical cases that required the use for parallel grafts to treat complex pathology of aortic arch.

Introduction: Endovascular techniques have been revolutionizing the revascularization of patients with chronic limb threatening ischemia (CLTI), showing consistently high limb salvage rates. However, endovascular recanalization of infrapopliteal occlusive disease can be technically demanding and the failure rate for these types of lesions is about 20%. In that case, an alternative vascular access may be required. We report our experience concerning CLTI patients who underwent retrograde access and recanalization of chronic occlusions after failure of anterograde attempts. Methods: Retrospective institutional review of consecutive patients requiring retrograde punctures to obtain endovascular revascularization (2013–2018) – 51 limbs in 50 patients. The primary outcome was to evaluate the technical success and the limb salvage - major-amputation free survival. The secondary outcomes were the rate of major and minor amputation, the global survival of this population and the characterization of the population and the endovascular procedures performed. Results and conclusion: The technical success was achieved in 76,5% of the procedures. The major amputation free-survival rate was 81,4% at 6 months. The femoro-popliteal and distal territories were concomitantly treated in 63,3% of the procedures and isolated distal territory was treated in 32,7%. Femoral approach was always initially performed (90,2% anterograde). Direct revascularization according to the angiosome concept was obtained in 64,6% of the cases. Anterior tibial artery was punctured in 33,3% of cases followed by pedal artery (27,5%), peroneal artery (19,6%), common plantar artery (7,8%), posterial tibial artery above the ankle (3,9%), supra-articular popliteal artery (3,9%), lateral plantar artery (2%) and metatarsal artery (2%). Percutaneous transluminal angioplasty (PTA) was performed in 69,4% of the procedures (2% with Drug Elluting Balloons) and PTA and stenting in 28,6%. During follow-up 19,4% of patients were submitted to major amputation and 29,4% to minor amputation. The rate of healing at 6 months was 43,3%. The results of the retrograde access and recanalization of chronic occlusions are comparable to data reported in the literature, confirming it as a valuable alternative. As so, the retrograde access approach for revascularization of CLTI patients appears to be a safe and effective alternative that expands revascularization options after the failure of a conventional endovascular anterograde approach, allowing the salvaging a greater number of limbs, particularly in patients with significant co-morbidities.

Introduction: Type B aortic intramural hematoma (B-IMH) has a complex and variable natural history: it can remain stable and resolve spontaneously or progress to dissection, aneurysm, ulcer or even rupture. The possibility of disease progression, frequently with mild or no symptomatology, poses a significant treatment dilemma. Clinical Case: We report a case of a 60 year-old-female diagnosed with an acute B-IMH, initially treated medically. However, 1-month control CTA revealed disease progression (increased B-IMH thickness and evolution to an ulcer-like-projection with 20 mm diameter and 11 mm depth). She was submitted to a left carotid-subclavian bypass followed by TEVAR and left-subclavian ostial embolization. During follow-up (5 months) patient remain asymptomatic, demonstrating favorable aortic remodeling. Conclusion: Type B-IMH is a dynamic pathology. From presentation to late follow-up, patients remain at high risk for abrupt catastrophic complications. As reported, TEVAR seems to be a safe and effective approach in the event of unfavorable evolution.

The following study aims to analyze the graduates characteristics in Brazilian non-metropolitan regions. In order to achieve this objective, it was defined as study object, the management distance education course of Federal University of Santa Catarina, in the inner cities of Rio Grande do Sul and Santa Catarina. Regarding the methodological procedures, this research was classified as a survey and used quantitative data. For data gathering, the questionnaire tool was used and the analysis was done with descriptive statistics data. As main results, it was verified that the distance education students have distinct characteristics comparing with classroom academics, being formed by people with more advanced family and occupation conditions. Another issue to be emphasized is that, for most of the students that was the first time in a university. These data give indications that distance education fulfills, in this context, the function to get an audience that, for different reasons, cannot access higher education, and thus, can contribute to the development in the countryside.

Resumo O objetivo deste artigo é refletir sobre os desafios que se colocam perante os novos fluxos de refugiados dirigidos à Europa desde o início da segunda década do século XXI. Com o intuito de explicar a nova crise dos refugiados, revisita-se o modelo de repulsão-atração e confronta-se o desígnio da agência – motivos individuais que induzem à migração – com a interferência da estrutura – fatores económicos, sociais e políticos que explicam o aumento dos fluxos, atendendo também à dinâmica e operacionalidade do enquadramento legal vigente no contexto europeu. Apesar da escassa evidência empírica ainda disponível, conclui-se que os novos movimentos de refugiados colocam profundos desafios à observação e análise teórica, bem como ao enquadramento legal existente, assumindo-se por isso que são necessários estudos mais aprofundados e novos instrumentos de regulação para responder à dimensão e complexidade dos fluxos.

Editorial - Dossiê "Migrações em Países Lusófonos"

O objetivo deste trabalho é conhecer a percepção de alunos, tutores e professores ao longo de um curso de graduação a distância, no que se refere à interação estabelecida entre eles. A coleta de dados foi realizada por meio de entrevistas semiestruturadas com coordenadores (6), tutores presenciais (8), tutores a distância (2) e alunos concluintes (24) do curso de administração a distância ofertado pela Universidade Federal de Santa Catarina através do Sistema Universidade Aberta do Brasil. A análise de dados seguiu os preceitos da análise de conteúdo de Bardin (2004). Os resultados indicam que as interações aconteciam presencialmente e virtualmente e que os alunos consideram a interação entre eles e com os tutores satisfatória. Entretanto, em relação aos professores, a satisfação tende a decrescer. Além disso, há evidências nos discursos dos entrevistados de que a interação pode afetar tanto no desempenho quanto na permanência dos alunos no curso, especialmente nos primeiros semestres.

Background: The UN Replacement Migration report (2000) had a significant impact in academic and civil society. Its approach consisted of estimating the migration volumes required to mitigate the effects of population decline and ageing. The volume of migrants required to prevent population decline and sustain the working-age population was not particularly high, but the vast number of migrants needed to maintain the potential support ratio was highlighted as an unrealistic goal. Objective: In this paper the UN exercise is revisited and updated by deploying the concept of prospective age to overcome a strict chronological definition of the working-age population. The replacement migration approach is developed from a new European perspective, the temporal series is extended for an additional decade, and alternative operative age-group definitions are compared by projecting replacement migration estimations according to both classic (conventional) and dynamic (prospective) age limits. Conclusions: The key conclusions of the original UN publication are reasserted. In many countries the replacement migration volumes needed to sustain the decline in total population and working-age population are of an order of magnitude similar to recent observed migration. However, even under the prospective-age approach the halt of the ageing process - expressed as the maintenance of the current potential support ratio - remains an unrealistic target. Contribution: We propose the deployment of the prospective-age concept to define dynamic age limits in the definition of working-age population. Because the prospective-age concept is flexible it will be possible to explore other dimensions from this perspective in the future, increasing the analytical potential of replacement migration estimations as a valuable contribution to the demographic ageing debate.

Photo-luminescent carbon dots (CD) have become promising nanomaterials and their synthesis from natural products has attracted attention by the possibility of making the most of affordable, sustainable and, readily-available carbon sources. Here, we report on the synthesis, characterization and bioimaging potential of CDs produced from diverse extensively produced fruits: kiwi, avocado and pear. The in vitro cytotoxicity and anticancer potential of those CDs were assessed by comparing human epithelial cells from normal adult kidney and colorectal adenocarcinoma cells. In vivo toxicity was evaluated using zebrafish embryos given their peculiar embryogenesis, with transparent embryos developing ex-utero, allowing a real-time analysis. In vitro and in vivo experiments revealed that the synthesized CD presented toxicity only at concentrations of ≥1.5 mg mL−1. Kiwi CD exhibited the highest toxicity to both cells lines and zebrafish embryos, presenting lower LD50 values. Interestingly, despite inducing lower cytotoxicity in normal cells than the other CDs, black pepper CDs resulted in higher toxicity in vivo. The bio-distribution of CD in zebrafish embryos upon uptake was investigated using fluorescence microscopy. We observed a higher accumulation of CD in the eye and yolk sac, avocado CD being the ones more retained, indicating their potential usefulness in bio-imaging applications. This study shows the action of fruit-based CDs from kiwi, avocado and pear. However the compounds present in these fruit-based CDs and their mechanism of action as a bioimaging agent need to be further explored.

Este texto aprofunda o tema das estratégias de obtenção de emprego entre imigrantes brasileiros em Portugal. Entre os principais objetivos está, em primeiro lugar, compreender a importância das redes sociais na obtenção de emprego no exterior, como mecanismo facilitador do processo de migração. Em segundo, explorar a hipótese de que, entre os migrantes internacionais, os "laços fracos" importam mais para obtenção de emprego do que os "laços fortes". Por fim, identificar as variáveis - sexo, idade, qualificação, inserção socioprofissional e tipo de empregador, entre outras - associadas aos diferentes tipos de estratégias e de redes. A principal base empírica utilizada é uma pesquisa com imigrantes brasileiros em Portugal realizada no ano de 2009.This article addresses the theme of job search strategies among Brazilian immigrants in Portugal. Its main objectives are, first, to understand the importance of social networks in finding employment abroad, as an enabling mechanism of the migration process. Second, to explore the hypothesis that, among international migrants, the "weak ties" matter more than "strong ties" to get a job. Finally, to identify the variables - gender, age, qualification, socio-professional insertion and type of employer, among others - associated with different types of strategies and networks. The main empirical base used for this study is a survey of Brazilian immigrants in Portugal carried out in 2009.

Este artigo visa contribuir para o debate sobre as consequências socioeconómicas do envelhecimento demográfico em Portugal, discutindo as respostas políticas disponíveis para fazer face a este problema, entre as quais a imigração de substituição. Para tal, apresentam-se e discutem-se as dinâmicas de envelhecimento actualmente em curso, bem como as suas potenciais consequências; enunciam-se as alternativas instrumentais disponíveis, assim como as suas vantagens, desvantagens e limitações, e analisa-se a experiência recente ao nível das tendências e políticas migratórias, à luz do potencial contributo da imigração para a mitigação das consequências do envelhecimento demográfico.This article seeks to contribute to the debate on the issues of the socioeconomic consequences of demographic ageing in Portugal, the available policy responses to this problem, and replacement migration as a partial solution. It begins by presenting and discussing the demographic ageing dynamics currently in place, as well as their potential consequences; it then lists the available instrumental alternatives and their respective advantages, disadvantages, and structural limitations; and, finally, it analyses the recent Portuguese experience in terms of migration dynamics and policies, under the light of the potential contribution of immigration to mitigating the consequences of demographic ageing.

Este artículo plantea consideraciones teóricas sobre la relación entre migraciones y cambio social. Se expone que las migraciones combinan características banales y radicales, ya que son al mismo tiempo comunes e inquietantes en términos personales y sociales. Más adelante muestra la experiencia reciente de los países del sur de Europa, en concreto España, Italia y Portugal. Se presentan algunas cifras sobre la inmigración internacional reciente hacia estos países, que muestran los patrones generales de entradas extranjeras. Finalmente, se reflexiona sobre el impacto y los retos derivados de la migración internacional en el sur de Europa. En algunos aspectos las entradas se adaptan y refuerzan estructuras tradicionales ya existentes en esos contextos. En otros sentidos producen características completamente nuevas y anuncian la forma del mundo del futuro. In this paper, some theoretical considerations are made regarding the relationship between migration and social change. It is argued that migration combine a trivial and a radical character, since it is at the same time common and disturbing in personal and societal terms. Next, the recent experience of the Southern European countries, namely Spain, Italy and Portugal, is recalled. Some figures about recent international immigration to these countries are presented, displaying the main patterns of foreign inflows. Finally, some reflections are made about the impacts and challenges deriving from international migration in Southern Europe. In some aspects, inflows adapt and reinforce traditional structures already existing in those contexts. In other aspects, they produce entirely new traits, and announce the shape of the world to come.

Resumo Neste artigo pretendemos fazer uma análise sucinta sobre as dinâmicas migratórias de tipo forçado na África subsaariana que afectam Moçambique, país inserido num contexto regional complexo que o remete para a condição plural de país de emigração, imigração e trânsito. As conclusões da investigação indicam que os fluxos migratórios forçados no país são procedentes sobretudo da África central e do Corno de África, decorrentes da violência trivializada e persistente dos países dessas regiões. Os refugiados que procuram acolhimento ou asilo fazem-no na região centro e norte de Moçambique, em resultado da conjuntura socioeconómica e política relativamente estável que encontram, comparativamente com a de muitos países da região subsaariana.

A crise econômica internacional desencadeada em 2008 produziu enormes efeitos sobre as migrações mundiais. Alguns estudos têm sido dedicados a esta temática. O objetivo deste artigo é refletir e discutir sobre a existência de um possível fluxo de retorno dos imigrantes brasileiros em Portugal ao país de origem. Os resultados desta investigação apontam para uma desaceleração do fluxo de entrada em Portugal, uma propensão significativa ao retorno, mas um volume efetivo de retorno inferior ao que seria teoricamente de esperar.