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Background: Airway clearance impairment has a significant impact on self-care and quality of life. Identifying clinical data, nursing diagnoses, and nursing interventions is essential to clinical reasoning and enhancing nursing care. This study aims to map the existing evidence on clinical data, nursing diagnoses, and nursing interventions addressing the nursing focus on “airway clearance”. Methods: Research was conducted based on Joanna Briggs’s Scoping Review Methodology. We searched four databases for published studies until December 2023. Results: From the initial 1854 studies identified, 123 were included in the review. The findings highlighted two areas of nursing attention: one related to signs and symptom management, and the other related to education and coping strategies. The data that led to nursing diagnoses were divided into cognitive and clinical data. The nursing diagnoses were mostly related to secretion retention, excessive mucus production, and airway obstruction. The most commonly identified nursing interventions were educational interventions assembled into predesigned education programs rather than patient-tailored programs. Conclusions: Findings can add substantial value for systematizing the nursing process related to “airway clearance”, improving nursing decision-making and care quality. This study was prospectively registered with the Open Science Framework (OSF) on 02 December 2022, with the registration number wx5ze.

Introduction and objectives: Diabetes, dyslipidemia, older age, gender, urinary tract infections, and recent antibiotic intake have been associated with a decrease in the urobiome richness and other fluctuations in this microbiome. Gut and blood microbiome have been reported to be altered in patients with chronic kidney disease (CKD), and specifically in peritoneal dialysis (PD) patients. Still, there are currently no studies describing the urogenital microbiome in CKD-PD patients. In this study we characterized the urobiome profile in 46 PD patients and analyzed its clinical and inflammatory parameters. Materials and methods: Mid-stream urine, fecal and blood samples were collected from 46 patients undergoing PD at Centro Hospitalar Universitário de São João (CHUSJ) in Porto, Portugal. Exclusion criteria were age under 18 years old, inability to give informed consent, history of infection in the last three months, and antibiotic intake in the last three months. The microbiome communities were analyzed by amplification and sequencing of the V3–V4 region of the bacterial 16S rRNA gene. Correlations with the patients’ clinical data and inflammatory profile were performed. Results: CKD-PD patients presented a unique urobiome profile dominated by Bacillota, Actinomycetota and Pseudomonadota and characterized by a lower Shannon diversity than fecal and blood microbiome. The taxonomic profiles of urogenital samples were organized in multiple subtypes dominated by populations of Lactobacillus, Staphylococcus, Streptococcus, Gardnerella, Prevotella, Escherichia-Shigella, being similar to other non-PD-CKD patients. Gender, sCD14, residual diuresis and history of peritonitis were significantly associated to variations in the urobiome. Although not reaching statistical significance, diabetes and the time on PD also showed association with particular taxonomic groups. Depletion of Gardnerella, Staphylococcus, Corynebacterium, Lactobacillus or Dermabacter populations correlated with CKD-PD patients with history of diabetes, history of peritonitis and altered levels of sCD14. Conclusions: Our results highlight urogenital microbiome as a potential partner and/or marker in the overall health state of CKD-PD patients. Resumen: Introducción y objetivos: Diabetes, dislipemia, edad avanzada, género, infecciones del tracto urinario y toma reciente de antibióticos, entre otras, se han asociado a una disminución en la riqueza del urobioma y a otras fluctuaciones de dicho microbioma.Recientemente, se han descrito alteraciones en losmicrobiomas intestinal y en sangreen pacientes con enfermedad renal crónica (ERC) y, específicamente, en pacientes en diálisis peritoneal (DP).A pesar de ello, aún no existen estudios que describan el microbioma urogenital en pacientes en DP. En el presente trabajo, caracterizamos el urobioma en 46 pacientes en DP. Pacientes y métodos: Se recogieron muestras de orina (micción espontánea), heces y sangre de 46 pacientes en DP del Centro HospitalarUniversitário de São João en Oporto, Portugal. Los criterios de exclusión fueron edad menor a 18 años, incapacidad para entenderel consentimiento informado, e historia de infección y toma de antibióticos en los últimos 3 meses. Las comunidades microbiológicas fueron analizadas por amplificación y secuenciación de las regiones V3-V4 del 16S rRNA bacteriano. Se realizaron correlaciones con los datos clínicos y el perfil inflamatorio de los pacientes. Resultados: Los pacientes en DP presentaron un urobioma único dominado por Bacillota, Actinomycetota yPseudomonadota, y caracterizado por una menor diversidad de Shannon que los microbiomas en sangre e intestinal. Los perfiles taxonómicos de las muestras urogenitales se organizaron en múltiples subtipos dominados por poblaciones de Lactobacillus, Staphylococcus, Streptococcus, Gardnerella, Prevotella, Escherichia-Shigella, siendo similar al descrito para otros pacientes con ERC no en DP.Género, factor sCD14, diuresis residual yantecedentes de peritonitis se asociaron de forma significativa a cambios en el urobioma. Diabetes y tiempo en DP también se asociaron con grupos taxonómicos específicos, aunque no de forma estadísticamente significativa. La deplección de Gardnerella, Staphylococcus, Corynebacterium, Lactobacillus o Dermabacterse correlacionó con antecedentes de diabetes, historia de peritonitis y niveles alterados de sCD14. Conclusiones: Nuestros resultados subrayan la importancia del microbioma urogenital como potencial biomarcadordel estado de salud de nuestros pacientes en DP.

Après un rappel du contexte sociohistorique de l’émergence de l’animation socioculturelle et de sa professionnalisation, soulignant les valeurs qui lui sont liées, c’est à partir d’aspects contemporains de la société portugaise, de l’éventail des formations et des emplois actuels que nous projetons le futur professionnel des animateurs. Les personnes âgées et les enfants seront très certainement les groupes avec lesquels ces professionnels exerceront l’essentiel de leurs activités au sein d’organisations du tiers-secteur, au détriment des domaines culturels, d’occupation de temps libres, d’interventions communautaires ou auprès de groupes vulnérables. Dans tous les cas, la responsabilité des associations professionnelles et des institutions de formation est importante afin d’éviter que l’animation socioculturelle soit engloutie par la logique de marché et la technicisation, afin de garantir que sa spécificité et que les valeurs qui la sous-tendent soient sauvegardées.

Optically pure lactic acid (LA) is needed in PLA (poly-lactic acid) production to build a crystalline structure with a higher melting point of the biopolymer than that of the racemic mixture. Lignocellulosic biomass can be used as raw material for LA production, in a non-food biorefinery concept. In the present study, genetically engineered P. acidilactici ZP26 was cultivated in a simultaneous saccharification and fermentation (SSF) process using steam pretreated softwood solids as a carbon source to produce optically pure D-LA. Given the low concentrations of identifiable inhibitory compounds from sugar and lignin degradation, the fermentation rate was expected to follow the rate of enzymatic hydrolysis. However, added pretreated solids (7% on weight (w/w) of water-insoluble solids [WIS]) significantly and immediately affected the process performance, which resulted in a long lag phase (more than 40 h) before the onset of the exponential phase of the fermentation. This unexpected delay was also observed without the addition of enzymes in the SSF and in a model fermentation with glucose and pretreated solids without added enzymes. Experiments showed that it was possible to overcome the extended lag phase in the presence of pretreated softwood solids by allowing the microorganism to initiate its exponential phase in synthetic medium, and subsequently adding the softwood solids and enzymatic blend to proceed to an SSF with D-LA production.

BackgroundThe NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3) inflammasome has been described in both immune cells and platelets, but its role in the megakaryocyte (MK) lineage remains elusive.ObjectiveThe aim of this study was to explore the role of NLRP3 inflammasome in megakaryocytes and platelets.MethodsWe generated Nlrp3A350V/+/Gp1ba-CreKI/+ mice carrying a mutation genetically similar to the one observed in human Muckle–Wells syndrome, which leads to hyperactivity of NLRP3 specifically in MK and platelets.ResultsPlatelets from the mutant mice expressed elevated levels of both precursor and active form of caspase-1, suggesting hyperactivity of NLRP3 inflammasome. Nlrp3A350V/+/Gp1ba-CreKI/+ mice developed normally and had normal platelet counts. Expression of major platelet receptors, platelet aggregation, platelet deposition on collagen under shear, and deep vein thrombosis were unchanged. Nlrp3A350V/+/Gp1ba-CreKI/+ mice had mild anemia, reduced Ter119+ cells in the bone marrow, and splenomegaly. A mild increase in MK TGF-β1 might be involved in the anemic phenotype. Intraperitoneal injection of zymosan in Nlrp3A350V/+/Gp1ba-CreKI/+ mice induced increased neutrophil egression and elevated levels of a set of proinflammatory cytokines, alongside IL-10 and G-CSF, in the peritoneal fluid as compared with control animals.ConclusionMK/platelet NLRP3 inflammasome promotes the acute inflammatory response and its hyperactivation in mice leads to mild anemia and increased extramedullary erythropoiesis.

The study suggests a link between ICOS-ICOSL signaling and LTa3 induction on T cells. LTa3 subsequently activates fibroblasts in the salivary gland, leading to formation of tertiary lymphoid tissues (TLS).

Lentinula edodes, commonly known as shiitake mushroom, is renowned for its potential health advantages. This research delves into the often-overlooked by-product of shiitake cultivation, namely spent mushroom substrate (SMS), to explore its nutraceutical properties. The SMS samples were collected and subjected to different extraction methods, namely short or long agitation, and ultrasound-assisted extractions using different temperatures and distilled water or a 50% (v/v) ethanol as solvents. The extracts were tested for phenolic content (total phenols, ortho-diphenols, and flavonoids), antioxidant capacity (DPPH, 2,2-diphenyl-1 picrylhydrazyl; ABTS, 2,2’-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid; and FRAP, ferric reducing antioxidant power), and antibacterial activity. The different extraction methods revealed substantial variations (p < 0.05) in phenolic composition and antioxidant capacity. The highest phenolic content and antioxidant capacity were achieved using 24 h extraction, agitation, 50 °C, and ethanol as the solvent. Furthermore, the extracted compounds displayed antibacterial activity in specific tested bacterial strains. This study highlights the nutraceutical potential of L. edodes’ SMS, positioning it as a valuable dietary supplement for animal nutrition, with emphasis on its prebiotic properties. Hence, this research unveils the promising health benefits of SMS in both human and animal nutrition.

The winery industry generates significant amounts of organic waste, such as pruning firewood, stems, and wine lees, which can cause environmental issues and affect the economic sustainability and competitiveness of the industry. Given the known antioxidant and antimicrobial properties of phenolic compounds, we analyzed these by-products to quantify their phenolic composition and evaluate the effectiveness of pruning firewood and stem extracts from six autochthonous varieties of the Dão Region in inhibiting the growth of bacteria from diabetic foot wounds isolated from hospital patients. The study employed colorimetric methods to measure total phenols, ortho-diphenols, and flavonoids in the phenolic composition. The ABTS, DPPH, and FRAP methods were applied to assess the antioxidant capacity, and the disk diffusion method was applied to determine the antimicrobial activity of Gram-positive and Gram-negative bacteria. The results showed that Jaen had the most ortho-diphenols and flavonoids in pruning firewood, and the highest levels of these compounds were located in stem extracts. Jaen also had the highest antioxidant capacity in both pruning firewood and stems across all methods used. Notably, red wine lees displayed the highest biological and antioxidant activities. Moreover, pruning firewood extract displayed great efficacy in inhibiting the growth of Gram-positive bacteria, making it a promising candidate as a natural alternative against antibiotic resistance, which is a global public health concern.

To provide meat safety and consumer protection, appropriate hygiene control measures at an abattoir are required. This study aimed to evaluate the influence of visual fecal contamination level (VFCL) and lairage time (LT) on pig skin (PS) and external (ECS) and internal (ICS) carcass surfaces. The presence of Enterobacteriaceae, Escherichia coli (E. coli) and Salmonella in PS, ECS, and ICS were evaluated. A total of 300 paired samples were collected from 100 pigs. Results underlined the importance of the skin (Enterobacteriaceae: 3.27 ± 0.68 log CFU/cm2; E. coli: 3.15 ± 0.63 log CFU/cm2; Salmonella: 21% of samples) as a direct or indirect source of carcass contamination. Although VFCL revealed no significant effect (p > 0.05), the increase of LT had a significant impact (p < 0.001) on Enterobacteriaceae and E. coli levels across all analysed surfaces, and Salmonella presence on ICS (p < 0.01), demanding attention to LT. Also, the ICS showed a higher level of these bacteria compared to ECS. These results highlight the need of food business operators to consider ICS as an alternative area to sample for Salmonella, as a criterion for process hygiene based on EC Regulation No. 2073/2005, and as a potential contamination source to be integrated in the hazard analysis critical control point (HACCP) plans.

MDM2 and BET inhibitors have shown efficacy in AML treatment. Here, the authors show that the two compounds can synergize through both p53 protein stabilization and inhibition of BRD4-mediated repression of p53 target genes.

Deep vein thrombosis is the clotting of blood in deep veins. Here, a microfluidic device containing flexible valves fabricated in-situ is used to investigate the effects of blood flow conditions and valve elasticity on thrombus formation, revealing the circumstance under which clotting occurs.

Deep vein thrombosis (DVT) is a disease with high prevalence and morbidity. It can lead to pulmonary embolism with severe respiratory insufficiency and risk of death. Mechanisms behind all stages of DVT, such as thrombosis commencement, propagation, and resolution, remain incompletely understood. Animal models represent an invaluable tool to explore these problems and identify new targets for DVT prevention and treatment. In this review, we discuss existing models of venous thrombosis, their advantages and disadvantages, and applicability to studying different aspects of DVT pathophysiology. We also speculate about requirements for an “ideal model” that would best recapitulate features of human DVT and discuss readouts of various models.

Enquadramento: a família é o contexto privilegiado de cuidados de suporte à vida e saúde dos indivíduos. A abordagem sistémica da família tem, conceptualmente vindo a ganhar projeção. A Ontologia de Enfermagem, propõe uma estrutura onde os conceitos da disciplina e as suas relações são especificados, descrevendo uma representação formal do conhecimento de enfermagem. Objetivos: representar o conhecimento em enfermagem sobre a família como cliente dos cuidados, em três classes de itens de informação: dados, diagnósticos e intervenções. Metodologia: estudo qualitativo inferencial; realizada análise documental à parametrização do Sistema de Apoio à Prática de Enfermagem - SAPE®, revisão da literatura e focus group. Resultados: na parametrização nacional constatou-se pouca visibilidade da família como unidade de cuidados bem como a ausência de representação dos modelos concetuais que suportam o conhecimento disciplinar. Na Ontologia de Enfermagem, o processo familiar engloba: organização do funcionamento da casa e edifício residencial; preparação da família para integrar um familiar dependente no autocuidado; preparação da família para a chegada do recém-nascido; e, planeamento familiar. Para cada domínio foram especificadas três classes de informações de enfermagem. Conclusão: Este estudo apresenta-se como um contributo para a formalização do conhecimento de enfermagem no domínio do Processo Familiar.

Staphylococcus aureus is both a human commensal and a pathogen, that causes serious nosocomial and community-acquired infections. Despite nostrils being considered its preferred host habitat, the oral cavity has been demonstrated to be an ideal starting point for auto-infection and transmission. The antibiotic resistance assessment of S. aureus is a priority and is often reported in clinical settings. This study aimed to explore the prevalence and antimicrobial susceptibility of S. aureus in the oral and nasal cavities of healthy individuals. The participants (n = 101) were subjected to a demographic and clinical background survey, a caries evaluation, and to oral and nasal swabbing. Swabs were cultured in differential/selective media and S. aureus isolates were identified (MALDI-TOF MS) and tested for antibiotic susceptibility (EUCAST/CLSI). Similar S. aureus prevalence was found exclusively on nasal (13.9%) or oral (12.0%) habitats, whereas 9.9% of the population were simultaneous nasal and oral carriers. In oro-nasal cavities, similar antibiotic resistance rates (83.3–81.5%), including MDR (20.8–29.6%), were observed. Notably, 60% (6/10) of the simultaneous nasal and oral carriers exhibited different antibiotic resistance profiles between cavities. This study demonstrates the relevance of the oral cavity as an independent colonization site for S. aureus and as a potential source of antimicrobial resistance, a role which has been widely neglected so far.

Large-scale production of microalgae and their bioactive compounds has steadily increased in response to global demand for natural compounds. Spirulina, in particular, has been used due to its high nutritional value, especially its high protein content. Promising biological functions have been associated with Spirulina extracts, mainly related to its high value added blue pigment, phycocyanin. Phycocyanin is used in several industries such as food, cosmetics, and pharmaceuticals, which increases its market value. Due to the worldwide interest and the need to replace synthetic compounds with natural ones, efforts have been made to optimize large-scale production processes and maintain phycocyanin stability, which is a highly unstable protein. The aim of this review is to update the scientific knowledge on phycocyanin applications and to describe the reported production, extraction, and purification methods, including the main physical and chemical parameters that may affect the purity, recovery, and stability of phycocyanin. By implementing different techniques such as complete cell disruption, extraction at temperatures below 45 °C and a pH of 5.5–6.0, purification through ammonium sulfate, and filtration and chromatography, both the purity and stability of phycocyanin have been significantly improved. Moreover, the use of saccharides, crosslinkers, or natural polymers as preservatives has contributed to the increased market value of phycocyanin.

In early life, maternal factors are of the utmost relevance for oral microbiome acquisition and maturation. Therefore, our study explored the impact of maternal factors, such as saliva and breastmilk colonization, cardiovascular risk factors (CRF), type of delivery, oral health, and caregiving habits on the prevalence of potential pathogenic and opportunistic oral bacteria in early life. A total of 26 healthy mothers, 23 mothers with CRF, and their 50 children were included and samples (child’s oral swabs, mother’s saliva, and breastmilk) were collected 4 to 12 weeks after delivery and inoculated in selective and differential media for detection of non-fastidious Gram-negative and Gram-positive bacteria to isolate potential pathogenic and opportunistic bacteria identified by MALDI-TOF MS (414 isolates). Within mother–child dyads, the same species were identified in 86% of the pairs and potential pathogenic microorganisms from the Staphylococcaceae and Enterobacteriaceae families were found to be statistically significantly concordant between mother–child samples, particularly in the healthy group. Staphylococcus saprophyticus and Stenotrophomonas maltophilia oral colonization in mother–child pairs were associated with the presence of CRF. Breastfeeding was related to the early life oral colonization of Staphylococcus epidermidis in children from healthy mothers and C-section was associated with higher diversity of pathogens, independent of cardiovascular status (p = 0.05). This study reveals the presence of potential oral opportunistic and pathogenic bacteria in early life and highlights the importance of maternal factors in its acquisition.

Platelets play a key role in the development, progression and resolution of the inflammatory response during sterile inflammation and infection, although the mechanism is not well understood. Here we show that platelet CLEC-2 reduces tissue inflammation by regulating inflammatory macrophage activation and trafficking from the inflamed tissues. The immune regulatory function of CLEC-2 depends on the expression of its ligand, podoplanin, upregulated on inflammatory macrophages and is independent of platelet activation and secretion. Mechanistically, platelet CLEC-2 and also recombinant CLEC-2-Fc accelerates actin rearrangement and macrophage migration by increasing the expression of podoplanin and CD44, and their interaction with the ERM proteins. During ongoing inflammation, induced by lipopolysaccharide, treatment with rCLEC-2-Fc induces the rapid emigration of peritoneal inflammatory macrophages to mesenteric lymph nodes, thus reducing the accumulation of inflammatory macrophages in the inflamed peritoneum. This is associated with a significant decrease in pro-inflammatory cytokine, TNF-α and an increase in levels of immunosuppressive, IL-10 in the peritoneum. Increased podoplanin expression and actin remodelling favour macrophage migration towards CCL21, a soluble ligand for podoplanin and chemoattractant secreted by lymph node lymphatic endothelial cells. Macrophage efflux to draining lymph nodes induces T cell priming. In conclusion, we show that platelet CLEC-2 reduces the inflammatory phenotype of macrophages and their accumulation, leading to diminished tissue inflammation. These immunomodulatory functions of CLEC-2 are a novel strategy to reduce tissue inflammation and could be therapeutically exploited through rCLEC-2-Fc, to limit the progression to chronic inflammation.

Dès la première version du programme de formation de la licence en animation socioculturelle de l’École Supérieure d’Éducation de Lisbonne en 2006, l’équipe enseignante a jugé bon d’y intégrer une composante de sciences physiques et naturelles. En effet, dans les sociétés contemporaines comprises comme des sociétés du risque, la réflexivité est centrale et la science et les scientifiques deviennent de plus en plus nécessaires, mais sans qu’on les sépare des populations, au contraire. Ce besoin de réflexivité sur les risques apporte des défis supplémentaires à la formation et à l’intervention des professionnels en animation socioculturelle. Une enquête auprès des étudiants nous montre quelles sont leurs représentations de sciences physiques et naturelles et quelle importance ils attribuent à ces connaissances en tant que citoyens et animateurs socioculturels. Une approche transdisciplinaire, incluant les sciences physiques et naturelles, semble offrir des outils utiles pour la difficile tâche des animateurs qui est de trouver des moyens pour faire face à une réalité pleine de complexités et d’ambiguïtés.

C’est à la suite des enseignements découlant de conférences prononcées par Jean-Claude Gillet à Lisbonne que la formation en animation offerte à l’École Supérieure d’Éducation de l’Institut Polytechnique a été recadrée autour, d’une part, de la relation complexe que les animateurs tissent dans leur activité professionnelle avec les décideurs, les élus et les employeurs et, d’autre part, de la centralité de l’agir professionnel permettant à la fois la production de savoirs et le développement de compétences pour décider et agir. Le texte qui suit évoque les origines et la pérennité de ce legs tenace.

Vascular calcification (VC) is a frequent condition in chronic kidney disease (CKD) and a well-established risk factor for the development of cardiovascular disease (CVD). Gut dysbiosis may contribute to CVD and inflammation in CKD patients. Nonetheless, the role of gut and blood microbiomes in CKD-associated VC remains unknown. Therefore, this pilot study aimed to explore the link between gut and blood microbiomes and VC in CKD patients on peritoneal dialysis (CKD-PD). Our results showed relative changes in specific taxa between CKD-PD patients with and without VC, namely Coprobacter, Coprococcus 3, Lactobacillus, and Eubacterium eligens group in the gut, and Cutibacterium, Pajaroellobacter, Devosia, Hyphomicrobium, and Pelomonas in the blood. An association between VC and all-cause mortality risk in CKD-PD patients was also observed, and patients with higher mortality risk corroborate the changes of Eubacterium eligens in the gut and Devosia genus in the blood. Although we did not find differences in uremic toxins, intestinal translocation markers, and inflammatory parameters among CKD-PD patients with and without VC, soluble CD14 (sCD14), a nonspecific marker of monocyte activation, positively correlated with VC severity. Therefore, gut Eubacterium eligens group, blood Devosia, and circulating sCD14 should be further explored as biomarkers for VC, CVD, and mortality risk in CKD.

Introdução: O tromboembolismo pulmonar e trombose venosa profunda ocorrem em idade pediátrica com incidência, morbilidade e mortalidade desconhecidas. O objetivo foi rever epidemiologia, apresentação clínica, exames complementares de diagnóstico e prognóstico de doentes com tromboembolismo pulmonar e trombose venosa profunda. Material e Métodos: Estudo retrospetivo, descritivo e analítico de doentes pediátricos internados num hospital de nível II por tromboembolismo pulmonar e trombose venosa profunda, entre 2000 e 2014. Estudaram-se características demográficas, história clínica, comorbilidades e fatores de risco. Resultados: Foram internados 11 doentes (sete com tromboembolismo pulmonar, cinco com trombose venosa profunda e um com ambos), 64% do género feminino e idade média de 16 anos. Todos os doentes com tromboembolismo pulmonar referiam toracalgia/dispneia, 25% síncope/palpitações e 25% febre. Todos os doentes com trombose venosa profunda referiam dor no local da obstrução, 83% edema/cianose do membro afetado e 17% febre. O estudo da trombofilia positivo foi o fator de risco mais frequente nas duas entidades. O valor médio dos D-dímeros foi 3252 ug/L e 2660 ug/L no tromboembolismo pulmonar e trombose venosa profunda, respetivamente. Todos os doentes iniciaram anticoagulação, três necessitaram de cuidados intensivos, três apresentaram sequelas e houve um óbito. Discussão: Todos os doentes tinham pelo menos um fator de risco associado e as condições de hipercoagulabilidade herdadas foram o fator de risco mais frequentemente encontrado nos nossos adolescentes. Conclusão: O aumento da incidência na população pediátrica descrito na literatura pode ser atribuído à crescente sensibilização para esta patologia, aos avanços médicos e aumento da sobrevida de doenças crónicas. Escasseiam recomendações baseadas na evidência que identifiquem os doentes com risco de trombose, para que as decisões possam ser tomadas de forma cuidadosa, equilibrando o risco e benefício em cada caso.

We describe a hospital-based outbreak caused by multidrug-resistant, Klebsiella pneumoniae carbapenemase 3–producing, mcr-1–positive K. pneumoniae sequence type 45 in Portugal. mcr-1 was located in an IncX4 plasmid. Our data highlight the urgent need for systematic surveillance of mcr-1 to support adequate therapeutic choices in the nosocomial setting.

Inhibitors of the tyrosine kinase Btk have been proposed as novel antiplatelet agents. In this study we show that low concentrations of the Btk inhibitor ibrutinib block CLEC-2-mediated activation and tyrosine phosphorylation including Syk and PLCγ2 in human platelets. Activation is also blocked in patients with X-linked agammaglobulinemia (XLA) caused by a deficiency or absence of Btk. In contrast, the response to GPVI is delayed in the presence of low concentrations of ibrutinib or in patients with XLA, and tyrosine phosphorylation of Syk is preserved. A similar set of results is seen with the second-generation inhibitor, acalabrutinib. The differential effect of Btk inhibition in CLEC-2 relative to GPVI signalling is explained by the positive feedback role involving Btk itself, as well as ADP and thromboxane A2 mediated activation of P2Y12 and TP receptors, respectively. This feedback role is not seen in mouse platelets and, consistent with this, CLEC-2-mediated activation is blocked by high but not by low concentrations of ibrutinib. Nevertheless, thrombosis was absent in 8 out of 13 mice treated with ibrutinib. These results show that Btk inhibitors selectively block activation of human platelets by CLEC-2 relative to GPVI suggesting that they can be used at 'low dose' in patients to target CLEC-2 in thrombo-inflammatory disease.

Intraspecific agonistic interactions are widespread across the animal kingdom, with many individual morphological and physiological characteristics playing important roles in the fate of disputes. Additionally, changes to environmental conditions can influence the outcomes of animal contests. The shore crab (Carcinus maenas) is a globally distributed species, present in numerous coastal and estuarine temperate systems around the world. Although shore crabs are highly tolerant to changes in temperature, this parameter has important physiological effects on the species’ ecology, while its effects on behavior are not fully understood. Our study aims to investigate how different individual characteristics (such as sex, color morphotype, carapace and chela morphology) and temperature conditions affect the dyadic interactions between shore crabs when disputing food resources. In general, the differences in carapace width between opponents, their sexes, color morphotypes and the temperature conditions interacted and were important predictors of the contest fate. We found that the body size and color morphotype of C. maenas determined the fate of dyadic disputes. However, the higher temperatures disrupted the well-established dominance of the larger red color morphotype individuals. Overall, the agonistic contest results suggest higher plasticity than previously acknowledged.

Introdução: As infeções do trato respiratório são das patologias que mais frequentemente motivam a prescrição antibiótica em idade pediátrica. Os objetivos deste estudo foram identificar a frequência e padrão de prescrição de antibacterianos na patologia respiratória. Material e Métodos: Durante dois anos (divididos pela apresentação das normas de orientação clínica), os dados foram obtidos através da consulta de processos clínicos de crianças com patologia respiratória. Utilizaram-se os testes qui-quadrado ou teste exato de Fisher para testar associações entre variáveis, assumindo-se significado estatístico quando p < 0,05. Resultados: Realizaram-se 547 consultas (idade média de seis anos ± 5,3, 55% do género masculino). A pesquisa do antigénio do Streptococcus do grupo A na orofaringe foi realizada mais frequentemente por internos de Pediatria (p = 0,005). A radiografia de tórax foi mais pedida pelo especialista de Medicina Geral e Familiar (p = 0,033). Prescreveu-se antibiótico em 87% pneumonias, 84% otites médias agudas, 68% amigdalites, 25% laringites, 17% infeções respiratórias superiores e 16% bronquiolites agudas. O especialista de Medicina Geral e Familiar prescreveu mais antibiótico que o interno de Pediatria na amigdalite aguda (p = 0,003) e na otite média aguda (p = 0,013). O antibiótico mais prescrito foi amoxicilina (61%). Não houve diferenças entre os dois períodos estudados quanto ao número de prescrições e escolha de antibiótico das patologias estudadas. Discussão: A prescrição de antibióticos foi elevada e numa proporção significativa a antibioterapia poderia ser ajustada. Realça-se que não houve diferenças na prescrição após a apresentação das normas de orientação clínica. Conclusão: Considera-se necessária uma melhoria da prescrição antibiótica pediátrica no ambulatório.

The education and training of the population is n owadays an impo rtant task. Political decision is not made without measuring ed ucational outcomes (Schleicher, 2012). Therefore, the re is an increasing demand in what teacher performance is con cerned (Lanthaum e, 2006 ; Schleicher, 2012). The text is part of a wider study on teache rs in the Portuguese e ducational system. In the analysis made, the available knowledge on the p roc es s of teacher professionalization in Portugal was enhanced. The analysis of teachers’ pr ofessional group h as been d eveloped in conne ct io n with its pr ofessionalization process, in pa rticular the question s around the differentiation pro cesses and internal homogenization, focusing the analysis on the (re)placement of teachers in the cla ssification of professio ns. Methodologically, th e basic sources for the descrip tors of groups of classifications of professions are the ones expr essed in intern ational and national classifications.

Purpose: To report a case of a 56-year-old male with right homonymous hemianopia. Methods: Retrospective descriptive study of a case report based on information from clinical records, patient observation and analysis of complementary diagnostic tests. Results: An asymptomatic 56-year-old male presented to our hospital for a routine ophthalmic examination. The best-corrected visual acuity was 20/20 in the right eye (RE) and in the left eye (LE). Pupillary function, intraocular pressure, external segment examinations and slit-lamp biomicroscopy were normal, bilaterally. Fundoscopy showed a cup-to-disc (C/D) ratio in the RE of 0.3 and of 0.4 in the LE. Retinal nerve fiber layer (RNFL) thickness measured by spectral domain optical coherence tomography revealed thinning of the superior, temporal and nasal RNFL in the RE and thinning of the superior, inferior and temporal RNFL in the LE. Automated static perimetry showed right homonymous hemianopia. Brain computed tomography (CT) showed an open-lip schizencephaly with a significant reduction of the left brain parenchyma. Conclusions: Despite the large visual defect, the patient was unaware of it and had an active professional life. This is an interesting case because despite the extensive morphological abnormalities seen on brain CT there is a relatively small functional repercussion.

Purpose: To report a case of a 20-year-old female with decreased visual acuity (VA) in the left eye (LE). Methods: This is a retrospective and descriptive case report based on data from clinical records, patient observation and analysis of diagnostic tests. Results: A 20-year-old female presented with decreased VA in the LE for 3 days. Best-corrected visual acuity (BCVA) was 20/20 in the right eye (RE) and 20/40 in the LE. Pupillary function, intraocular pressure, results of external segment examinations and slit-lamp biomicroscopy were normal, bilaterally. RE fundoscopy was normal, and in the LE it revealed papillitis and posterior pole exudative retinal detachment. Optical coherence tomography (OCT) confirmed the macular serous retinal detachment and showed thickening of the posterior choroid also revealed by orbital ultrasound and magnetic resonance imaging (MRI). Fluorescein angiography showed angiographic features typical of Vogt-Koyanagi-Harada (VKH) disease: disseminated spotted choroidal hyperfluorescence and choroidal multifocal hypofluorescence, multifocal profuse leakage in the retina with pooling, serous retinal detachment and optic disc hyperfluorescence. Serological testing for the diagnosis of infectious pathologies was negative, and the review of systems was normal. The patient received systemic steroids and cyclosporine. LE BCVA improved up to 20/20 at 18 months after the diagnosis, with complete reabsorption of subretinal fluid and normal retinal and choroidal thickness by OCT. Conclusion: Despite the unilateral involvement, the clinical and angiographic features were typical of VKH disease, and ophthalmologists should be aware to recognize this rare clinical variant of the disease.

Purpose: This study aims to report a case of traumatic maculopathy in a 12-year-old male following blunt trauma in his left eye (LE) who presented 6 months after injury. Methods: Retrospective and descriptive case report based on data from clinical records, patient observation and analysis of diagnostic tests. Results: A previously healthy, 12-year-old male presented for a routine visit with complaints of a 2-month history of decreased visual acuity in his LE. Six months before the initial visit, he suffered blunt trauma to the LE during a struggle and had no medical observation. At the visit, best-corrected visual acuity (BCVA) in the LE was counting fingers and in the right eye, it was 20/20. Fundus examination of the LE showed a central macular lesion of 1 disc diameter with fibrosis, increased retinal thickness and intraretinal hemorrhage. Optical coherence tomography showed disruption of the inner/outer segment (IS/OS) photoreceptor junction, increased reflectivity, cell infiltration of the retinal wall and retinal pigment epithelium detachment. Retinal thickness was 289 μm at the site of the lesion. A fluorescein angiogram revealed early impregnation and late diffusion. High-dose steroid pulse therapy (intravenous methylprednisolone 500 mg for 3 days and oral prednisolone 30 mg, tapering for 10 days) was done. LE BCVA increased to 20/200, and retinal thickness decreased by 71 μm 1 week after treatment. Off-label intravitreal triamcinolone (IVTA; 0.05 ml/2 mg) was administered 2 weeks after oral treatment in an attempt to achieve additional improvement. Three weeks after IVTA, LE BCVA improved to 20/150 and retinal thickness decreased by 10 μm. Three months after the initial visit, LE BCVA was 20/125 and retinal thickness 208 μm. Conclusion: We present a case of commotio retinae caused by an ocular blunt trauma 6 months before, with loss of BCVA. BCVA improved after oral steroids and IVTA. Nevertheless, fibrosis and disruption of the IS/OS junction in the macula limited the gain of BCVA.

Background: Mediterranean spotted fever is a zoonosis endemic in the Mediterranean region. The microorganism Rickettsia conorii is responsible for the disease due to its angiotropism for endothelial cells. It produces host cell necrosis, thrombosis, and organ dysfunction. Ophthalmologic manifestations are rare. Findings: The authors describe the case of a 55-year-old female with Mediterranean spotted fever who developed localized retinal vasculitis with associated macular edema. Treatment with intravitreal triamcinolone allowed a significant recovery of visual acuity. Conclusion: Ophthalmological symptoms in these patients should be emphasized because there can be severe ocular complications with a potentially irreversible loss of visual acuity.

O objetivo deste artigo é apresentar os resultados de uma análise diagnóstica da atuação institucional relativamente às situações de violência infanto-juvenil em três territórios de um conselho da periferia de Lisboa (Portugal). Tendo como pano de fundo as políticas subjacentes à intervenção das instituições nesta problemática, aprofundamos alguns padrões relacionais emergentes numa rede de (meso)atores, na procura de obstáculos e potencialidades de articulação e colaboração. O produto deste trabalho inscreve-se num projeto de escala mais ampla , cujo enfoque é avaliar a contribuição das políticas de segurança escolar na inclusão e igualdade educativa e social em contextos escolares marcados pela diversidade e complexidade social e cultural.

Purpose: To report an uncommon case of a 29-year-old Caucasian male diagnosed with unilateral choroidal neovascularization (CNV) secondary to punctate inner choroidopathy leading to visual impairment. Methods: This is a retrospective and descriptive case report based on data from clinical records, patient observation and analysis of ancillary diagnostic tests. Results: A 29-year-old Caucasian male presented to our emergency department with complaints of decreased central vision in his left eye (LE), detected a few hours before. Best-corrected visual acuity (BCVA) in the LE was counting fingers at 50 cm and BCVA in the right eye was 20/20. Fundoscopy of the LE evidenced multiple round and yellowish lesions in the macula and nasal to the optic nerve, without intraocular inflammation signs. Optical coherence tomography showed increased retinal thickness with detachment of the neuroepithelium and a slight retinal pigment epithelium detachment. Fluorescein angiography revealed hyperfluorescent lesions with blurred borders in the macula. An intravitreal injection of bevacizumab (1.25 mg/0.05 ml) was administered in the LE, which resulted in anatomic and visual improvement. Conclusion: We present a rare case of unilateral CNV secondary to punctate inner choroidopathy in a young, myopic male.

No presente texto procura-se contribuir para a discussão dos processos de supervisão e de construção do conhecimento profissional, a partir da apresentação da análise dos posterspôstereselaborados pelos professores envolvidos no programa de Supervisão, Acompanhamento e Avaliação do Período Probatório de Professores. Na análise retomaram-se os objectivos da formação em supervisão concebida e implementada no âmbito do programa: a relevância do processo supervisivo; a centralidade da reflexão; a relação com o conhecimento e desenvolvimento profissional. Na discussão dos resultados destaca-sea importância atribuída ao processo supervisivo, reforçando a relevância da dimensão relacional neste processo. Menos expressivos são os resultados relativos à centralidade da reflexão no processo em análise. No que diz respeito ao conhecimento profissional destacou-se o uso predominante das dimensões relativas ao conhecimento do conteúdo, do currículo, didático, pedagógico e reflexivo. A dimensão relativa ao conhecimento científico foi a menos comum.El presente texto pretende contribuir con la discusión de los procesos de supervisión y de construcción del conocimiento profesional, a partir de la presentación del análisis de los posters que los profesores participantes produjeron en la primera implementación del período probatorio en Portugal. En dicho análisis se retoman los objetivos de la formación: la importancia del proceso de supervisión, la centralidad de la reflexión y la relación con el conocimiento y desarrollo profesional. En la discusión de los resultados se destaca: la importancia atribuida a la supervisión, subrayando la relevancia de la dimensión relacional. Los resultados relacionados con la centralidad de la reflexión son menos expresivos. Con relación al conocimiento profesional se distingue el uso predominante de las dimensiones relativas al conocimiento del contenido, del currículo, del ámbito didáctico, pedagógico y reflexivo. La dimensión relativa al conocimiento científico ha sido la menos común.This paper aims at contributing for the discussions around the processes of supervision and professional knowledge, through the analysis of posters produced by the teachers involved in the first edition of the Teachers' Probation Period in Portugal. We took as a reference for our analysis the aims of the training program: the relevance of the supervision process; the centrality of reflection and the relation to professional knowledge and development. In the discussion of the findings we highlight: the importance attributed to the supervision process, stressing the relevance of the relational dimension within this process. The findings related to the centrality of reflexivity within the process are less expressive. Concerning professional knowledge we highlight the predominant use of the following dimensions: knowledge about content, curriculum, didactics, pedagogical and reflexive. Scientific knowledge is the least used.

There is often a sort of a protocol associated to each class, stating when and how certain methods should be called. Given that this protocol is, if at all, described in the documentation accompanying the class, current mainstream object-oriented languages cannot provide for the verification of client code adherence against the sought class behaviour. We have defined a class-based concurrent object-oriented language that formalises such protocols in the form of usage types. Usage types are attached to class definitions, allowing for the specification of (1) the available methods, (2) the tests clients must perform on the result of methods, and (3) the object status - linear or shared - all of which depend on the object's state. Our work extends the recent approach on modular session types by eliminating channel operations, and defining the method call as the single communication primitive in both sequential and concurrent settings. In contrast to previous works, we define a single category for objects, instead of distinct categories for linear and for shared objects, and let linear objects evolve into shared ones. We introduce a standard sync qualifier to prevent thread interference in certain operations on shared objects. We formalise the language syntax, the operational semantics, and a type system that enforces by static typing that methods are called only when available, and by a single client if so specified in the usage type. We illustrate the language via a complete example.

Salmonellosis remains one of the most frequent foodborne zoonosis, constituting a worldwide major public health concern. The most frequent sources of human infections are food products of animal origin, being pork meat one of the most relevant. Currently, particular pig food production well-adapted and persistent Salmonella enterica serotypes (e.g., Salmonella Typhimurium, Salmonella 1,4,[5],12:i:-, Salmonella Derby and Salmonella Rissen) are frequently reported associated with human infections in diverse industrialized countries. The dissemination of those clinically-relevant Salmonella serotypes/clones has been related to the intensification of pig production chain and to an increase in the international trade of pigs and pork meat. Those changes that occurred over the years along the food chain may act as food chain drivers leading to new problems and challenges, compromising the successful control of Salmonella. Among those, the emergence of antibiotic resistance in non-typhoidal Salmonella associated with antimicrobials use in the pig production chain is of special concern for public health. The transmission of pig-related multidrug-resistant Salmonella serotypes, clones and/or genetic elements carrying clinically-relevant antibiotic resistance genes, frequently associated with metal tolerance genes, from pigs and pork meat to humans, has been reported and highlights the contribution of different drivers to the antibiotic resistance burden. Gathered data strengthen the need for global mandatory interventions and strategies for effective Salmonella control and surveillance across the pig production chain. The purpose of this review was to provide an overview of the role of pig and pork meat in human salmonellosis at a global scale, highlighting the main factors contributing to the persistence and dissemination of clinically-relevant pig-related Salmonella serotypes and clones.

Anomalous otolith formation has been reported in freshwater and marine fish species. The prevailing anomaly is the deposition of vaterite instead of aragonite, resulting in different otolith shape and transparency. In this study we report high occurrence rates of anomalous otoliths in juvenile flounder collected in the river Minho estuary (NW Portugal). Several pairs of otoliths were randomly selected from juvenile fish collected between 2013 and 2015, in two estuarine areas, and visually inspected on both sides for the presence of anomalies. Most anomalies consisted of depressions, projections or holes in different parts of the otolith. Distribution of irregularities was examined in relation to site of collection and fish total length. At the site with higher salinity, most otolith pairs were normal. In contrast, at the tidal freshwater station, 43% of the pairs examined were abnormal. In general, both otoliths were affected but the left one presented more extreme changes. The occurrence of anomalies seems to be related to fish size since these were only found in fish smaller than 7.5 cm. Preliminary morphometric analyses indicate that abnormal otoliths have the same proportions as normal ones, but the former seem heavier, for the same sized fish. It is presently unclear how these anomalies affect fish growth or survival. Raman microspectroscopy was used to determine the mineral phases (i.e. type of CaCO3 polymorph) in one normal and one abnormal otolith, revealing crystals of aragonitic-type in both cases. SEM-EDS analysis corroborated Raman results and did not reveal differences in chemical composition between abnormal and normal zones but further studies are needed.

Primary Sjögren’s syndrome (pSS) is a complex autoimmune disease characterised by local exocrine glandular involvement and systemic multiorgan manifestations. In this review we will discuss the value of the histological examination of the salivary glands in the classification criteria, and more recently as prognostic tool for patient stratification and monitoring. The limitations of the current tools used to assess salivary gland pathology in pSS will also be reviewed in relation to using salivary gland biopsy analysis as an outcome measure in clinical trials.

The commitment of stem and progenitor cells toward specific hematopoietic lineages is tightly controlled by a number of transcription factors that regulate differentiation programs via the expression of lineage restricting genes. Nuclear factor one (NFI) transcription factors are important in regulating hematopoiesis and here we report an important physiological role of NFIX in B- and myeloid lineage commitment and differentiation. We demonstrate that NFIX acts as a regulator of lineage specification in the haematopoietic system and the expression of Nfix was transcriptionally downregulated as B cells commit and differentiate, whilst maintained in myeloid progenitor cells. Ectopic Nfix expression in vivo blocked early B cell development stage, coincident with the stage of its downregulation. Furthermore, loss of Nfix resulted in the perturbation of myeloid and lymphoid cell differentiation, and a skewing of gene expression involved in lineage fate determination. Nfix was able to promote myeloid differentiation of total bone marrow cells under B cell specific culture conditions but not when expressed in the hematopoietic stem cell (HSPC), consistent with its role in HSPC survival. The lineage choice determined by Nfix correlated with transcriptional changes in a number of genes, such as E2A, C/EBP, and Id genes. These data highlight a novel and critical role for NFIX transcription factor in hematopoiesis and in lineage specification.

Variation in human skin and eye color is substantial and especially apparent in admixed populations, yet the underlying genetic architecture is poorly understood because most genome-wide studies are based on individuals of European ancestry. We study pigmentary variation in 699 individuals from Cape Verde, where extensive West African/European admixture has given rise to a broad range in trait values and genomic ancestry proportions. We develop and apply a new approach for measuring eye color, and identify two major loci (HERC2[OCA2] P = 2.3 × 10(-62), SLC24A5 P = 9.6 × 10(-9)) that account for both blue versus brown eye color and varying intensities of brown eye color. We identify four major loci (SLC24A5 P = 5.4 × 10(-27), TYR P = 1.1 × 10(-9), APBA2[OCA2] P = 1.5 × 10(-8), SLC45A2 P = 6 × 10(-9)) for skin color that together account for 35% of the total variance, but the genetic component with the largest effect (~44%) is average genomic ancestry. Our results suggest that adjacent cis-acting regulatory loci for OCA2 explain the relationship between skin and eye color, and point to an underlying genetic architecture in which several genes of moderate effect act together with many genes of small effect to explain ~70% of the estimated heritability.

This article describes the use of evolutionary psychology to inform the design of a serious computer game aimed at improving 9–12-year-old children's conflict resolution skills. The design of the game will include dynamic narrative generation and emotional tagging, and there is a strong evolutionary rationale for the effect of both of these on conflict resolution. Gender differences will also be taken into consideration in designing the game. In interview research in schools in three countries (Greece, Portugal, and the UK) aimed at formalizing the game requirements, we found that gender differences varied in the extent to which they applied cross-culturally. Across the three countries, girls were less likely to talk about responding to conflict with physical aggression, talked more about feeling sad about conflict and about conflicts over friendship alliances, and talked less about conflicts in the context of sports or games. Predicted gender differences in anger and reconciliation were not found. Results are interpreted in terms of differing underlying models of friendship that are motivated by parental investment theory. This research will inform the design of the themes that we use in game scenarios for both girls and boys.

Type one diabetes mellitus is the second most frequent disease in childhood, presenting with serious complications when inadequately controlled. The most useful measure of metabolic control is hemoglobin A1c (HbA1c), being essential the awareness of the causes of its variability.to evaluate the effect of age and time of disease on HbA1c; to evaluate the relationship between HbA1c and serum lipid and microalbuminuria values.Observational, transversal and analytic study, based on data obtained in the files of all patients that attain the Pediatric Diabetic Consult. The studied variables were: sex, actual age, diagnostic age, metabolic control and chronic complications. Statistical analysis was made with Excel2003® and SPSS 15.0®. A significance level of 5% was adopted. Results: a 96 diabetic population was obtained. Last year HbA1c average was 8,3% and was less than 7,5% in one third of the cases. Adolescent's HbA1c (8,4%) was significantly higher than in children (7,8%) (p=0,03). Diabetics with a disease longer than five years presented higher HbA1c values (9% vs. 7,8%; p

Recently admixed populations offer unique opportunities for studying human history and for elucidating the genetic basis of complex traits that differ in prevalence between human populations. Historical records, classical protein markers, and preliminary genetic data indicate that the Cape Verde islands in West Africa are highly admixed and primarily descended from European males and African females. However, little is known about the variation in admixture levels, admixture dynamics and genetic diversity across the islands, or about the potential of Cape Verde for admixture mapping studies. We have performed a detailed analysis of phenotypic and genetic variation in Cape Verde based on objective skin color measurements, socio-economic status (SES) evaluations and data for 50 autosomal, 34 X-chromosome, and 21 non-recombinant Y-chromosome (NRY) markers in 845 individuals from six islands of the archipelago. We find extensive genetic admixture between European and African ancestral populations (mean West African ancestry = 0.57, sd = 0.08), with individual African ancestry proportions varying considerably among the islands. African ancestry proportions calculated with X and Y-chromosome markers confirm that the pattern of admixture has been sex-biased. The high-resolution NRY-STRs reveal additional patterns of variation among the islands that are most consistent with differentiation after admixture. The differences in the autosomal admixture proportions are clearly evident in the skin color distribution across the islands (Pearson r = 0.54, P-value

O objetivo do presente artigo é realçar o cenário de crítica e questionamento ao poder romano presente numa documentação intitulada pelos seus editores de Acta Alexandrinorum. Através da análise de algumas temáticas comuns dos escritos selecionados, a principal intenção do artigo é investigar a motivação para a escrita dos textos que foram divulgados como uma espécie de resistência literária dos alexandrinos ao Império nos séculos II e III d.C.