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Summary: Object recognition is an important ability that relies on distinguishing between similar objects (e.g., deciding which utensil(s) to use at different stages of meal preparation). Recent work describes the fine-grained organization of knowledge about manipulable objects via the study of the constituent dimensions that are most relevant to human behavior, for example, vision, manipulation, and function-based properties. A logical extension of this work concerns whether or not these dimensions are uniquely human, or can be approximated by deep learning. Here, we show that behavioral dimensions are generally well-predicted by CLIP-ViT - a multimodal network trained on a large and diverse set of image-text pairs. Moreover, this model outperforms comparison networks pre-trained on smaller, image-only datasets. These results demonstrate the impressive capacity of CLIP-ViT to approximate fine-grained object knowledge. We discuss the possible sources of this benefit relative to other models (e.g., multimodal vs. image-only pre-training, dataset size, architecture).

A 55-year-old man submitted to emergency surgery due to cardiac perforation by stabbing. One month later, he presented with chest pain, and a transthoracic echocardiogram revealed moderate-severe mitral regurgitation. After 6 months, a new transthoracic echocardiogram showed a left ventricular pseudoaneurysm, being later submitted to pseudoaneurysm exclusion and mitral valvuloplasty.

Abstract Understanding how we recognize objects requires unravelling the variables that govern the way we think about objects and the neural organization of object representations. A tenable hypothesis is that the organization of object knowledge follows key object-related dimensions. Here, we explored, behaviorally and neurally, the multidimensionality of object processing. We focused on within-domain object information as a proxy for the decisions we typically engage in our daily lives – e.g., identifying a hammer in the context of other tools. We extracted object-related dimensions from subjective human judgments on a set of manipulable objects. We show that the extracted dimensions are cognitively interpretable and relevant – i.e., participants are able to consistently label them, and these dimensions can guide object categorization; and are important for the neural organization of knowledge – i.e., they predict neural signals elicited by manipulable objects. This shows that multidimensionality is a hallmark of the organization of manipulable object knowledge.

Reducing carbon dioxide (CO2) emissions is a global priority. The concrete industry has a major role in this reduction since it accounts for about 8% of global CO2 emissions. Despite significant improvements in the sustainability of the production of concrete, one of the best solutions is still to improve the design and construction methods, such that the required quantities of concrete are reduced. Using, as a reference, a real case study, this study compares alternative shaft construction methodologies from engineering and sustainability points of view, highlighting the advantages and drawbacks of each solution. To achieve this purpose, a back analysis is performed to ensure that the numerical model is accurately calibrated and the shaft construction methods can be adequately assessed. The results show that, while the considered methods are applicable and satisfy engineering requirements, the characteristics of the lining of the shaft could have been optimized, resulting in a reduction in CO2 emissions by at least 50% without compromising the safety of the construction.

Eosinophilic colitis and hypereosinophilic syndrome with colic involvement are rare diagnosis that are characterized by wide-ranging gastrointestinal symptoms and idiopathic infiltration of eosinophils in the colon. The diagnostic workup is challenging since there are no standardized criteria. We report a case of a man admitted to the hospital with a history of nonbloody chronic diarrhea. The detailed workup demonstrated blood eosinophilia, and the colonic biopsies revealed extensive eosinophilic infiltration. He was treated with steroids with clinical and analytical improvement. Due to relapsing colitis after therapy withdrawal, he was chronically medicated with 10 mg of prednisolone with ultimate symptom control. This case report describes the diagnostic workup and highlights the most important features of this often underdiagnosed entity.

Perception of risk is known to change throughout the lifespan. Previous studies showed that younger adults are more prone to risk behaviours than older adults. Do these age-related differences influence risk perception during a pandemic crisis? Here, we investigated how age influenced predicted risk during the COVID-19 emergency state in Portugal. We show that time-projected estimations (e.g., appraisals based on ‘now’ vs. ‘in two weeks’ time’, or ‘in four weeks’ time’) of both risk behaviour and importance of transmission prevention decrease over time. Importantly, projected risk decreased more steeply for younger than older adults. Our findings suggest that younger adults have a different perception of epidemic-related risk than older adults. This seems to support the view that public health policy making during epidemics should differentially target younger adults.

Introduction and objectives: Among patients with aortic stenosis (AS), interstitial fibrosis has been associated with progression to heart failure and is a marker of poorer prognosis. We aimed to assess the impact of myocardial fibrosis on clinical events after aortic valve replacement (AVR) in low risk, severe AS. Methods: We prospectively followed 56 severe AS patients with ejection fraction >40%, who underwent AVR with simultaneous myocardial biopsies and collagen volume fraction (CVF) determination. Baseline and follow-up echocardiographic parameters were assessed. Outcomes were all-cause death and the combined endpoint of all-cause death or non-fatal cardiovascular hospitalization. Results: Patients were predominantly women (67.9%) and mean age was 66±12 years. At follow-up, there was a significant decrease in transaortic gradients and wall stress, as well as regression in indexed LV mass. Patients who suffered a fatal event or the combined endpoint had a higher degree of fibrosis (27.1±20.7% vs. 15.4±11.8%, p=0.035; 24.0±18.2% vs. 15.3±12.0%, p=0.038, respectively). Patients with CVF≥15.4% had higher rates of all-cause death (37.5% vs. 97.0%, p=0.001) and lower survival free of the combined endpoint of all-cause death or non-fatal cardiovascular hospitalization (0% vs. 91.2%, p40% submetidos a SVA com biópsia simultânea do miocárdio e determinação da fração de volume de colagénio (FVC). Parâmetros ecocardiográficos no início e no seguimento foram avaliados. Os outcomes estudados foram mortalidade por todas as causas e o evento combinado de mortalidade por todas as causas ou hospitalização cardiovascular não fatal. Resultados: Os doentes eram predominantemente mulheres (67,9%) e a idade média foi 66±12 anos. No follow-up, houve uma diminuição significativa do gradiente transaórtico e do stress da parede, assim como regressão da massa indexada do VE. Os doentes que sofreram um evento fatal ou o evento combinado tinham um maior grau de fibrose (27,1±20,7% versus 15,4±11,8%, p=0,035; 24,0±18,2% versus 15,3±12,0%, p=0,038, respetivamente). Os pacientes com FVC≥15,4% tiveram pior sobrevida (37,5% versus 97,0%, p=0,001) e menor sobrevivência livre do evento combinado (0% versus 91,2%, p

In the last decade (2010–2020), more than half of European countries have improved their health policies within the primary care for type 2 diabetes mellitus. Community pharmacies have been and could continue to be essential actors in this evolution of fighting the disease by providing a set of pharmacotherapeutic follow-up services for the person with diabetes. These services, designated by the Pharmaceutical Group of the European Union as “diabetes management” and “glucose measurement”, have aimed to optimize adherence to therapy and improve health outcomes. However, to follow the European guidelines of Good Pharmacy Practice, providing these services implies having a normative framework or a legal basis. Thus, this study sought to analyze the normative and regulatory framework on which community pharmacies in 28 European countries were based on providing this health care over the last decade.

Pulmonary arterial hypertension (PAH) is an increasingly recognised clinical entity that is associated with connective tissue disease (CTD) in up to one quarter of all diagnoses. Sjögren’s syndrome (SS) is a chronic autoimmune disease characterised by ocular and oral dryness resulting from lacrimal and salivary gland dysfunction. Additionally, SS may involve virtually any organ system and, as a result, the disease is characterised by pleomorphic clinical manifestations. However, SS-PAH reports are scarce, and the area remains insufficiently studied. We present a case of a 75-year-old female with a new diagnosis of PAH and SS.

Vitamin B12 deficiency is a common finding in medical practice. It is easily treated with supplementation and typically has a favourable prognosis. In rare circumstances, it can hide a severe disease that should be promptly addressed. We report the case of an acute myeloid leukaemia presenting as an initially predictable B12 deficiency in a vegetarian patient with chronic gastritis. The supplementation rapidly corrected the deficit and the accompanying cytopenias. However, in the following month the cell counts fell once again, leading to the suspicion that other aetiology could be lying beneath the surface. Maintaining a normal peripheral blood smear, the bone marrow biopsy showed myeloblasts and extensive fibrosis compatible with the diagnosis of acute myeloid leukaemia. The neoplasm justified the vitamin deficit by excessive cellular turnover, a vicious cycle only uncovered after supplementation and that ultimately led to the patient’s death.

Uveo-meningeal syndromes are any disorder characterized by the involvement of the uvea and the meninges. They can have multiple causes, including infectious, autoimmune and malignant diseases. We report the case of a patient with a 10-year-old diagnosis of myelodysplastic syndrome that had been stable. He presented with new onset uveitis, ataxia, diplopia and fluctuating consciousness level, without any obvious cause revealed by brain imaging or blood chemistries. An extensive aetiological search showed no obvious cause. Initially, the patient improved spontaneously and was discharged. However, 2 months later, he deteriorated once again, this time with disperse adenomegalies that were not present previously. The bone marrow biopsy showed a high number of blasts, which affirmed the progression of the previously known myelodysplastic syndrome. The lymph nodes were not biopsied due to very low life expectancy, making the procedure futile. A presumptive diagnosis of uveo-meningitis caused by paraneoplastic syndrome was made. The patient died a few months later.

Abstract Tools are wielded by their handles, but a lot of information about their function comes from their heads (the action-ends). Here we investigated whether eye saccadic movements are primed by tool handles, or whether they are primed by tool heads. We measured human saccadic reaction times while subjects were performing an attentional task. We found that saccades were executed quicker when performed to the side congruent with the tool head, even though “toolness” was irrelevant for the task. Our results show that heads are automatically processed by the visual system to orient eye movements, indicating that eyes are attracted by functional parts of manipulable objects and by the characteristic information these parts convey.

The superior vena cava syndrome refers to a medical emergency resulting from superior vena cava compression, which develops in 2%-4% of non-Hodgkin lymphomas. Primary mediastinal (thymic) large B-cell lymphoma is an unusual and aggressive non-Hodgkin lymphoma that can present with superior vena cava syndrome.We report the case of a Caucasian 21-year-old female, who presented with acute superior vena cava syndrome, having started 2 weeks before. Chest computerized tomography disclosed an anterior mediastinal mass (18 × 14 cm). Thoraco-abdominopelvic magnetic resonance imaging was performed in order to differentiate compression versus mass invasion. A gross anterior mediastinal mass (109 × 60 × 105 mm) occupying the totality of the prevascular space was found, extending from the sternal furcula to the pericardium, fully embedding the superior vena cava. A computerized tomography guided biopsy was performed. Histopathological and immunohistochemical analysis was consistent with Primary mediastinal (thymic) large B-cell lymphoma.Primary mediastinal (thymic) large B-cell lymphoma has unique clinicopathologic aspects and it should be considered in a young patient with Superior vena cava syndrome. Prompt recognition, a timely diagnosis and appropriate treatment are crucial for prognosis.

Serratia marcescens is a rarely implicated agent in endocarditis. We describe a case of a patient that underwent aortic and mitral valve replacement for Streptococcus agalactiae endocarditis. Four months later, he was readmitted with an ischemic stroke and fever. Physical examination and repetitive transthoracic echocardiogram were unremarkable. The initial blood cultures were negative. Due to sustained fever, vancomycin, gentamicin and piperacillin-tazobactam were initiated. On subsequent blood cultures, Serratia marcescens was isolated and antibiotics switched to ertapenem and gentamicin. In addition to cerebral emboli, a splenic embolus was found. The PET/CT revealed an abnormal hypercaptation in the mitral bioprosthesis. The patient was treated for six weeks. There are no current specific recommendations regarding the treatment of Serratia marcescens endocarditis. It is widely accepted that treatment should be prolonged and include a combination of antimicrobial agents. Morbidity and mortality are high, particularly when there’s the need for surgical replacement. In this case, however, the patient ended-up only requiring medical treatment due to the favourable response.

La infección gonocócica diseminada es una enfermedad rara y emergente que debería ser considerada en individuos que presenten poliartralgias agudas, lesiones cutáneas y/o tenosinovitis, incluso en ausencia de síntomas genitourinarios. Presentamos el caso de un joven de 29 años con fiebre, artralgia, lesiones cutáneas y signos de tenosinovitis. El enfoque diagnóstico identificó no sólo una infección gonocócica diseminada pero también una diabetes autoinmune latente, enfermedad subyacente y no diagnosticada previamente Destacamos no solo las particularidades del abordaje diagnóstico y terapéutico necesarias en la actualidad para tratar esta infección emergente, sino también la importancia de investigar factores de riesgo poco comunes asociados a una inmunosupresión subyacente. En casos de diabetes autoinmune latente del adulto, un reconocimiento a tiempo y un tratamiento individualizado son fundamentales para mejorar el pronóstico

Resumo: Nos últimos anos, tem sido crescente o reconhecimento das causas genéticas das doenças cardiovasculares resultado dos significativos progressos das técnicas laboratoriais. Este conhecimento tem permitido a identificação de «novos» fenótipos e a subclassificação das síndromes clínicas, tendo impacto nas decisões terapêuticas e no aconselhamento genético que é facultado às famílias.No presente documento descreve‐se o «estado da arte» relativamente às principais recomendações para testes genéticos nas doenças cardiovasculares, pretendendo‐se providenciar uma ferramenta útil de consulta para cardiologistas e outros profissionais envolvidos na prestação nos cuidados de saúde a doentes com cardiopatias hereditárias e respetivas famílias. Abstract: In recent years, the importance of genetic causes of cardiovascular diseases has been increasingly recognized, as the result of significant advances in molecular diagnosis techniques. This growing knowledge has enabled the identification of new phenotypes and the subclassification of clinical syndromes, impacting the therapeutic approach and genetic counseling offered to affected families.This paper describes the state of the art of genetic testing in the main cardiovascular diseases, aiming to provide a useful tool to help cardiologists and other health professionals involved in the care of individuals with hereditary heart diseases and their families.

Granulomatosis with polyangiitis (GPA) is a necrotizing vasculitis of small and medium vessels with involvement of the upper and lower respiratory tract and necrotizing pauci-immune glomerulonephritis [1]. This vasculitis has a higher incidence in men in the sixth decade of life and more than 80% of patients have positive anti-neutrophil cytoplasm (ANCA) antibodies [1,2].We present the case of a 23-year-old man with two weeks of evolution with polyarthralgia, asthenia, and cough with hemoptoic sputum. He did a chest radiography that showed diffuse bilateral alveolar infiltrates, on the second stage. The patient presented a rapid clinical worsening, with moderate hemoptysis and severe respiratory failure requiring invasive mechanical ventilation.The autoimmune study revealed positivity for ANCA PR3 in titer >200, having started pulses of methylprednisolone, plasmapheresis and later cyclophosphamide, with clinical improvement. His high-resolution chest computed tomography (CT) showed areas of diffuse ground glass densification suggesting capillaritis/alveolar hemorrhage and two subpleural nodular areas suggestive of granulomatous vasculitis. CT of the nasal sinuses showing findings compatible with acute inflammatory changes, with histology of the nasal mucosa inconclusive. Thus, this case shows an exuberant and potentially fatal form of diffuse alveolar hemorrhage that culminated in the initial diagnosis of granulomatous vasculitis in a young adult.

Background: The COVID-19 pandemic has broadly disrupted biomedical treatment and research including non-invasive brain stimulation (NIBS). Moreover, the rapid onset of societal disruption and evolving regulatory restrictions may not have allowed for systematic planning of how clinical and research work may continue throughout the pandemic or be restarted as restrictions are abated. The urgency to provide and develop NIBS as an intervention for diverse neurological and mental health indications, and as a catalyst of fundamental brain research, is not dampened by the parallel efforts to address the most life-threatening aspects of COVID-19; rather in many cases the need for NIBS is heightened including the potential to mitigate mental health consequences related to COVID-19. Objective: To facilitate the re-establishment of access to NIBS clinical services and research operations during the current COVID-19 pandemic and possible future outbreaks, we develop and discuss a framework for balancing the importance of NIBS operations with safety considerations, while addressing the needs of all stakeholders. We focus on Transcranial Magnetic Stimulation (TMS) and low intensity transcranial Electrical Stimulation (tES) - including transcranial Direct Current Stimulation (tDCS) and transcranial Alternating Current Stimulation (tACS). Methods: The present consensus paper provides guidelines and good practices for managing and reopening NIBS clinics and laboratories through the immediate and ongoing stages of COVID-19. The document reflects the analysis of experts with domain-relevant expertise spanning NIBS technology, clinical services, and basic and clinical research – with an international perspective. We outline regulatory aspects, human resources, NIBS optimization, as well as accommodations for specific demographics. Results: A model based on three phases (early COVID-19 impact, current practices, and future preparation) with an 11-step checklist (spanning removing or streamlining in-person protocols, incorporating telemedicine, and addressing COVID-19-associated adverse events) is proposed. Recommendations on implementing social distancing and sterilization of NIBS related equipment, specific considerations of COVID-19 positive populations including mental health comorbidities, as well as considerations regarding regulatory and human resource in the era of COVID-19 are outlined. We discuss COVID-19 considerations specifically for clinical (sub-)populations including pediatric, stroke, addiction, and the elderly. Numerous case-examples across the world are described. Conclusion: There is an evident, and in cases urgent, need to maintain NIBS operations through the COVID-19 pandemic, including anticipating future pandemic waves and addressing effects of COVID-19 on brain and mind. The proposed robust and structured strategy aims to address the current and anticipated future challenges while maintaining scientific rigor and managing risk.

Background: The analysis of the European Union (EU28) health systems’ intervention for type 2 diabetes mellitus (T2DM) reports an insufficient combination of legal support, prevention, and early diagnosis. This fact compromises the patient’s health outcomes. The inclusion of pharmacy services oriented to T2DM (PS-T2DM) in strategic primary care network’s programs could be a solution. However, the different regulatory frameworks that include good pharmaceutical practices and clinical guidelines for T2DM in each EU28 country may be a limitation. Health systems need to know the evolution of these community services and to analyze their operational and regulatory base, both in time and space. Methods: A systematic review was carried out on a qualitative and quantitative approach to the expansion and upgrading of PS-T2DM provided in EU28 pharmacies between 2008 and 2018. Results: The implementation of PS-T2DM in EU28 has increased sharply since 2009 and 2010. Diabetes mellitus (DM) is regulated in 5 countries (Bulgaria, Spain, Italy, Lithuania, and Portugal) and T2DM in 3 (Austria, Latvia, and Romania). Also, in 3 countries (Latvia, Poland, and Spain), pharmacists are involved in implementing guidelines for DM and T2DM, but there is no evidence on the regulation of PS-T2DM. Twenty-two countries showed detailed studies for the PS-T2DM’s provision. The type of PS-T2DM implemented in the highest number of EU28 countries was “promoting the rational use of medicines,” and the specific subtype T2DM-related more commonly reported was the “glucose measurement.” Discussion/Conclusion: Pharmacy disease-oriented services contributed to improving the accessibility, proximity, and equity of primary care for T2DM provided in community pharmacies across the EU28 in recent decades. This promising strategy for improving health outcome sets may be a call to the action of health systems due to its impact consistent with some objectives of universal health coverage for the eradication of DM and T2DM.

Este artículo de investigación se centró en la producción científica del mundo sobre el tema Bosques Tropicales, a partir de los artículos publicados por los 20 principales países que componen la Base de Datos Web of Science, publicados por el Instituto de Información Científica (ISI), que publicó 90 % de la producción total mundial correspondiente al período 1901 y 2012. La evolución de esta producción pasa de 2 artículos en 1901 a 3.554 en el año 2012. Las publicaciones en el período son principalmente de Estados Unidos (14.145 artículos) y Brasil ( 8.324 artículos), correspondiendo la suma de los dos países al 60% del total de publicaciones. La expansión se atribuye a un conjunto de factores, destacando la creciente importancia de los bosques tropicales como área de interés geopolítico; movimientos ecologistas y conservacionistas; la disponibilidad de nuevas tecnologías de imagen y el crecimiento muy gradual de la producción científica mundial en los últimos años. Ciencias ambientales / ecología es el área de conocimiento que registra el mayor número de publicaciones (36,8%), pero otras nueve áreas, entre ellas, ciencias de las plantas (9,8%), agricultura (7,1%), conservación de la biodiversidad 6,6%) y teledetección. (3,4%) también atrajo interés por publicaciones sobre el tema

This paper is an investigation on the interrelationship among some financial performance indicators of the company "Zambrano Loor Naira Narcisa" located in the city of Santo Domingo, Ecuador. The study is conducted because this company presents some difficulties in this regard. In order to guarantee the profundity of the analysis, we apply the technique of dynamic study of Neutrosophic Cognitive Maps, where the cause-effect relationship among the indicators is described and established; in addition it is provided the causal connecting weights between each pair of indicators. Four experts have made the evaluations. The advantage of neutrosophic cognitive maps over fuzzy cognitive maps is that the former maintains the modeling of the uncertainty of the latter, and also offers the possibility of incorporating indetermination, thus constituting a more realistic source to assess cause-effect relationships.

Gastrinomas are neuroendocrine tumors characterized by gastrin overexpression – 80% are sporadic and 20% are associated with multiple endocrine neoplasia type 1. A 75-year-old male patient, surgically treated at the age of 50 years for gastrinoma, followed on an outpatient basis because of chronic non-bloody diarrhea, was admitted to our hospital because of abdominal pain, watery diarrhea, and nonbiliary vomits. He was hypotensive and showed no response to fluids. Blood cultures were positive for Salmonella, and a diagnosis of septic shock due to Salmonella infection was made. The patient’s condition improved, but the history of chronic diarrhea was still not explained. To investigate chronic diarrhea, gastrinoma recurrence was considered. Serum gastrin measurement was five times higher than the upper limit of the normal range (536 pg/mL). A positive somatostatin receptor scintigraphy was diagnostic for neuroendocrine tumor. Metastases were excluded. The patient was proposed to curative surgery, and a diagnosis of a well-differentiated neuroendocrine tumor was made.

We show that, with the exception of the words $a^2ba^2$ and $b^2ab^2$, all (finite or infinite) binary patterns in the Prouhet-Thue-Morse sequence can actually be found in that sequence as segments (up to exchange of letters in the infinite case). This result was previously attributed to unpublished work by D. Guaiana and may also be derived from publications of A. Shur only available in Russian. We also identify the (finitely many) finite binary patterns that appear non trivially, in the sense that they are obtained by applying an endomorphism that does not map the set of all segments of the sequence into itself.

Colon ischaemia is the most frequent type of ischaemia of the digestive tract. It is more common among the elderly, especially patients with haemodynamic disturbance. In young patients, it is associated with particular drugs such as oral contraceptives and ergotamine derivatives. Anaphylaxis is characterized by acute onset and skin and mucosal involvement together with cardiovascular involvement. Gastrointestinal symptoms are common in anaphylaxis, but gastrointestinal bleeding and acute colon ischaemia are rarely described. Here, we present the case of a 52-year-old woman with acute ischaemic colitis associated with an anaphylactic reaction to amoxicillin.

RESUMO: A química é uma das disciplinas considerada difícil de assimilação, pelo fato que seus conteúdos são complexos, principalmente por ser trabalhado de forma tradicional envolvendo conceitos e fórmulas de difícil compreensão, tornado assim uma disciplina desinteressante para os alunos. O presente estudo trata-se de um projeto desenvolvido durante o PIBID/Química, na escola Estadual Governador Plínio Ramos Coelho no município de Humaitá-AM. Tendo como objetivo principal demonstrar a importância da inserção das aulas práticas no processo de ensino e aprendizagem dos alunos. A metodologia utilizada foi baseada em métodos de abordagem qualitativa de campo e laboratorial. A coleta de dados foi feita através de observações realizadas no decorrer das aplicações das aulas práticas, e a análise de acordo com o desempenho dos alunos. O público alvo foi alunos da 1ª fase 1, 2ª fase 2 do EJA e alunos do 2º ano 1, 3º ano 1 e 2º ano 1 do ensino médio período noturno. Diante disso, esse estudo fez-se necessário, pois através do mesmo foi possível observar um bom rendimento dos alunos com relação aos assuntos. Verificou-se que os alunos tiveram maior compreensão dos conteúdos estudados em sala de aula visto que tiveram boas notas nas provas e trabalhos realizados durante os bimestres. Portanto, espera-se que este estudo contribua de forma significativa no processo de ensino-aprendizagem dos alunos do ensino médio por meio do estímulo e da criatividade. PALAVRAS-CHAVE: Contextualização, Ensino-aprendizagem, Laboratório.

Humans and animals rely on accurate object size perception to guide behavior. Object size is judged from visual input, but the relationship between an object's retinal size and its real-world size varies with distance. Humans perceive object sizes to be relatively constant when retinal size changes. Such size constancy compensates for the variable relationship between retinal size and real-world size, using the context of recent retinal sizes of the same object to bias perception towards its likely real-world size. We therefore hypothesized that object size perception may be affected by the range of recently viewed object sizes, attracting perceived object sizes towards recently viewed sizes. We demonstrate two systematic biases: a central tendency attracting perceived size towards the average size across all trials, and a serial dependence attracting perceived size towards the size presented on the previous trial. We recently described topographic object size maps in the human parietal cortex. We therefore hypothesized that neural representations of object size here would be attracted towards recently viewed sizes. We used ultra-high-field (7T) functional MRI and population receptive field modeling to compare object size representations measured with small (0.05–1.4°diameter) and large objects sizes (0.1–2.8°). We found that parietal object size preferences and tuning widths follow this presented range, but change less than presented object sizes. Therefore, perception and neural representation of object size are attracted towards recently viewed sizes. This context-dependent object size representation reveals effects on neural response preferences that may underlie context dependence of object size perception.

Drugs can cause fever of unknown origin. Drug fever is a diagnosis of exclusion and can lead to unnecessary investigations and prolonged hospitalization. Any drug can be responsible. Here, we describe the case of a woman admitted because of acute hepatitis. Pantoprazole was started for stress ulcer prophylaxis when she was admitted to the ICU. Fever developed a few days later and an extensive diagnostic work-up was negative. Fever remitted after pantoprazole discontinuation and the diagnosis of drug fever was established.

Introduction: Papillary fibroelastoma (PFE) is a rare primary benign tumor of cardiac origin that predominantly affects the cardiac valves. Although most patients are asymptomatic, serious complications may result given their propensity for embolization. Advances in imaging technology have enabled earlier detection and more accurate characterization of these tumors. We report a case series, describing clinical presentation, treatment and outcome. Methods: Institutional records of a tertiary center between 1997 and 2015 were reviewed for all patients diagnosed with PFE treated surgically and confirmed histologically. Demographic and clinical characteristics, echocardiography findings and treatment modalities were analyzed and recurrence at follow-up was studied. Results: A total of 26 patients (69% male), aged 54±18 years, had a PFE. Clinically, PFE presented with neurologic deficits in eight cases and was asymptomatic in 65.4%. The mitral valve surface was the predominant tumor location (53.8%), followed by the aortic valve (34.6%). Tumor size ranged between 3 mm and 22 mm, 26.9% had a pedicle and 42.4% were mobile. All patients were treated successfully by complete resection, isolated in 88.5% and with valve repair in three cases. No other cardiac procedure was performed concomitantly and there were no major postoperative complications. Median follow-up was 61±49 months and no tumor recurrence or embolic events were documented. Conclusions: Fibroelastomas are generally small, single and detected by chance during routine imaging exams. Complete surgical resection of the tumor has an excellent prognosis and appears to be a good strategy. Resumo: Introdução: Os fibroelastomas papilares (FP) são tumores benignos primários de origem cardíaca, que afetam predominantemente as válvulas. Embora a maioria dos doentes seja assintomática, podem ocorrer complicações graves por causa de sua propensão para embolizar. A melhoria das técnicas de imagem moderna permitiu a deteção precoce e melhor caracterização desses tumores. É nosso objetivo apresentar a casuística do Serviço, descrever a apresentação clínica, o tratamento e os resultados cirúrgicos. Métodos: Foram revistos os dados institucionais entre 1997 e 2015, de todos os doentes com o diagnóstico de FP tratados cirurgicamente, com confirmação histológica. Foram analisadas as características demográficas, clínicas, ecocardiográficas e cirúrgicas. A recorrência durante o seguimento foi também objeto do estudo. Resultados: Foram identificados 26 doentes (69% homens), de 54±18 anos, com FP. O FP apresentou-se com deficit neurológico em oito doentes, nos restantes casos o diagnóstico foi casual. A superfície valvular mitral foi a localização mais frequente (53,8%), seguida da válvula aórtica (34,6%). A dimensão do tumor variou de 3 a 22 mm, 26,9% eram pediculados e a mobilidade estava presente em 42,4% dos casos. Todos os doentes foram tratados com resseção completa, isolada em 88,5% e com reparação valvular em três casos. Nenhum outro procedimento cardíaco foi feito concomitantemente e não se registaram complicações cardíacas major no pós-operatório. O período mediano de seguimento foi de 61±49 meses, não foi documentada recorrência do tumor nem de eventos embólicos. Conclusões: Os fibroelastomas são geralmente pequenos, isolados e mais frequentemente detetados incidentalmente em exames de rotina. A recessão cirúrgica completa do tumor tem um excelente prognóstico e parece ser uma boa estratégia. Keywords: Cardiac tumor, Fibroelastoma, Cardiovascular event, Palavras-chave: Tumor cardíaco, Fibroelastoma, Evento cardiovascular

Objective: To report the hemodynamic profile and short- and medium-term outcomes of Freedom Solo and Solo Smart stentless aortic valves implanted at our center. Methods: Between 2009 and 2015, all patients undergoing aortic valve replacement using Solo stentless valves at our center were enrolled. Clinical and echocardiographic follow-up was carried out six months postoperatively. Survival and major events, including structural valve deterioration and non-structural valve dysfunction, endocarditis, reoperation and stroke, were assessed through medical records or telephone interview with the referring cardiologist up to November 2015 (mean and maximum follow-up 39±22 and 78 months, respectively). Results: Patients’ (n=345) mean age was 72±8 years, 52% were female and median euroSCORE II was 2.7 (1.5-4.7). There was no intraoperative mortality and in-hospital mortality was 2.6%. Postoperatively, mean transvalvular gradient was 11.9±4.5 mmHg and effective orifice area was 1.9±0.5 cm2. Patient-prosthesis mismatch occurred in 14% but was severe in only one patient. Cumulative survival at six years was 72%. Six patients were reoperated: three due to endocarditis, two for structural prosthesis deterioration and one because of periprosthetic fistula. Five patients suffered stroke, three had medically-treated endocarditis and one had structural valve deterioration but was not considered suitable for reoperation. None of the remainder had structural valve deterioration or non-structural valve dysfunction. Conclusions: Solo stentless aortic valves are safe to implant, with promising clinical outcomes in short- and medium-term assessment. Moreover, they show an excellent hemodynamic performance: low transvalvular gradients, large effective orifice areas and low incidence of patient-prosthesis mismatch. Resumo: Objetivo: Descrever o perfil hemodinâmico e resultados clínicos a curto e médio prazo das biopróteses aórticas stentless Freedom SOLO e SOLO Smart implantadas no nosso Centro. Métodos: Foram incluídos todos os doentes submetidos a substituição valvular aórtica por biopróteses stentless SOLO no nosso Centro, entre 2009 e 2015. O follow-up clínico e ecocardiográfico foi aos seis meses de pós-operatório. A sobrevida e eventos major (deterioração valvular estrutural, disfunção valvular não estrutural, endocardite, reoperação, acidente vascular cerebral) foram aferidos através de registos clínicos e entrevista telefónica com o Cardiologista assistente até novembro de 2015 (follow-up médio 39±22 meses, máximo 78). Resultados: A idade média dos doentes (n=345) foi 72±8 anos, 52% eram do sexo feminino e a mediana de euroSCORE II foi 2,7 (1,5–4,7). A mortalidade hospitalar foi 2,6%, não havendo mortalidade intra-operatória. O gradiente transvalvular médio pós-operatório e a média da área de orifício efetivo foram 11,9 ±4,5 mmHg e 1,9 ±0,5 cm2, respetivamente. O mismatch prótese-doente ocorreu em 14% dos casos, sendo um severo. A sobrevida cumulativa aos seis anos foi 72%. Seis indivíduos foram reoperados: três por endocardite infeciosa, dois por deterioração protésica e um por fístula periprotésica. Registaram-se cinco acidentes vasculares cerebrais, três endocardites tratadas farmacologicamente e um caso de deterioração valvular sem condições clínicas para reoperação. Não se registaram outras deteriorações valvulares estruturais ou disfunções valvulares não estruturais. Conclusões: As biopróteses stentless SOLO apresentaram resultados a curto e médio prazo promissores, revelando um excelente perfil hemodinâmico: baixos gradientes transvalvulares, áreas de orifício efetivo grandes e baixa incidência de mismatch prótese-doente. Keywords: Aortic valve replacement, Stentless aortic bioprosthesis, Cardiac surgery, Palavras-chave: Substituição valvular aórtica, Bioprótese aórtica stentless, Cirurgia cardíaca

Before the development of transfusion medicine, severe anaemia was an important cause of morbidity and mortality. The discovery of haematopoietic mechanisms and essential nutrients made it possible to easily treat and prevent this condition. Nevertheless, it is often fatal in patients presenting with extreme anaemia (haemoglobin levels

Coronavirus disease 2019 (COVID-19) was initially characterized due to its impacts on the respiratory system; however, many recent studies have indicated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) significantly affects the brain. COVID-19 can cause neurological complications, probably caused by the induction of a cytokine storm, since there is no evidence of neurotropism by SARS-CoV-2. In line with this, the COVID-19 outbreak could accelerate the progression or affect the clinical outcomes of neuropsychiatric conditions. Thus, we analyzed differential gene expression datasets for clinical samples of COVID-19 patients and identified 171 genes that are associated with the pathophysiology of the following neuropsychiatric disorders: alcohol dependence, autism, bipolar disorder, depression, panic disorder, schizophrenia, and sleep disorder. Several of the genes identified are associated with causing some of these conditions (classified as elite genes). Among these elite genes, 9 were found for schizophrenia, 6 for autism, 3 for depression/major depressive disorder, and 2 for alcohol dependence. The patients with the neuropsychiatric conditions associated with the genes identified may require special attention as COVID-19 can deteriorate or accelerate neurochemical dysfunctions, thereby aggravating clinical outcomes.

A 70-year-old woman presented to the emergency department with a 3-week history of prolonged fever, asthenia and anorexia, denying other symptoms. Physical examination was unremarkable and the patient admitted for further investigation.Initial laboratory testing showed leucocytosis, elevated C-reactive protein and cholestasis, without hyperbilirubinemia or cytolysis. Abdominal ultrasonography found no abnormalities. Viral serologies, autoimmune tests and blood cultures were collected for further investigation of causes of prolonged fever with hepatic involvement. After two days, Citrobacter koseri was isolated in blood cultures and intravenous (IV) piperacillin–tazobactam initiated. Computed tomography (CT) scan of the abdomen showed a left lobe hepatic abscess with gas and a linear hyperdense image, possibly a foreign body, piercing through the gastric antrum into the abscess. Surgical exploration was done for source control. The abscess was drained and the foreign body, a 3.5 cm long fishbone, was removed. The patient’s condition rapidly improved. Gastrointestinal perforation due to the ingestion of sharp and elongated foreign bodies usually occur in ileal loops, where the intestinal wall is thinner, causing extravasation of fluids and air into the peritoneum and typically presents with an acute abdomen. The uncommon location of perforation masked these symptoms leading to the unusual presentation with prolonged fever.

Primary Sjögren syndrome (SS) is a chronic inflammatory systemic autoimmune disease with a high risk of malignancy development, namely, lymphoproliferative neoplasms. Few studies also reported a high risk of solid cancers; however, the coexistence of primary SS and pancreatic cancer has been rarely described. In this paper, we aim to describe a case of a 59-year-old woman who was an active smoker with sicca symptoms and symmetrical polyarthritis and was diagnosed with primary SS two years before the development of metastatic pancreatic adenocarcinoma. Despite institution of chemotherapy, the patient succumbed to the malignancy. Besides that, we explore the link between primary SS and solid cancers including the main predictors of malignancy and the role of primary SS as a paraneoplastic syndrome. Patients with primary SS should be closely monitored for malignancy, not only for hematological cancer, but also for solid tumors. Further research is necessary to understand which are the predictors of cancer proliferation in primary SS patients.

Phenylketonuria (PKU), the most common inborn error of amino acid metabolism, has been associated with an increased risk of renal impairment, the reason for which is not fully understood. We report the case of a 33-year-old female patient diagnosed with PKU in adulthood after suspicion of the disease in her daughter. The diagnostic approach revealed proteinuria, and minimal change disease (MCD) was identified. Therapeutic measures and follow-up are discussed. The possible link between these two disorders is interesting. Attenuated developmental delay of untreated PKU could be explained by the decreased accumulation of phenylalanine secondary to proteinuria. On the other hand, MCD may be a possible, although as yet unreported, pathophysiological mechanism explaining the renal repercussions that have been found in adult PKU patients, who should be screened for proteinuria.

Este artigo ilustra o desenvolvimento das atividades de pesquisa ao longo dos 48 anos do Hospital de Clínicas de Porto Alegre (HCPA). Fundado em 1971, o HCPA começa a atuar em pesquisa em 1974, data dos primeiros artigos indexados nas bases internacionais. O estudo abrange um período de 44 anos, de 1974 a 2018, para o qual foram levantados os artigos científicos publicados em periódicos indexados na base Web of Science por pesquisadores do próprio hospital, da Faculdade de Medicina e de outras unidades da UFRGS associados aos projetos de pesquisa do HCPA. O artigo resulta de um estudo cientométrico, sendo para tanto realizadas análises de indicadores bibliográficos, como produção total de artigos científicos experimentais, artigos de revisão e artigos completos em eventos (proceedings papers). Para facilidade de informação, os termos utilizados pelas bases foram mantidos em inglês ao longo do texto e nas tabelas e figuras. Um total de 6.383 documentos desses três tipos de artigos foi publicado no período. Mostra-se também a evolução temporal dessa produção. Foram ainda levantadas as principais áreas de pesquisa, as palavras-chave dos artigos, as revistas, a colaboração internacional e menção aos trabalhos mais citados. Ao longo do estudo foi possível verificar que alguns pesquisadores, autores de trabalhos significativos, não indicam nos artigos sua vinculação ao HCPA e recomenda-se uma orientação do GPPG sobre o assunto. Palavras-chave: Produção científica; cientometria; HCPA; análise bibliométrica

Gardner’s syndrome is an autosomal dominant disease caused by a mutation in the APC gene with 20–30% of cases presenting de novo. This entity is a variant of familial adenomatous polyposis, with a prevalence of 3/100,000 habitants. It may present as early as 2 months of age with a variety of both colonic and extracolonic symptoms. We report a case of a 21-year-old man, without any known family history, presenting with microcytic hypochromic anemia and constitutional symptoms for two months. Ultimately, after the etiological study, Gardner syndrome diagnosis was established as an index primary familiar case. Gardner syndrome is a clinical challenge which requires a prompt suspicion in order to reach its diagnosis. Given the malignant evolution of adenomas in 100% of untreated patients, early identification of extraintestinal manifestations (identifiable prior to colonic symptoms) is of the essence. A consequent endoscopic study to confirm gastrointestinal involvement is essential for a more favorable prognosis.

Introduction: The Alzheimer’s Disease Assessment Scale – Cognitive Subscale is a brief battery developed to assess cognitive functioning in Alzheimer’s disease that encompasses the core characteristics of cognitive decline (e.g. memory, language, praxis, constructive ability and orientation). The early detection, as well as the monitoring of cognitive decline along disease progression, is extremely important in clinical care and interventional research. The main goals of the present study were to analyze the psychometric properties of the Portuguese version of the Alzheimer’s Disease Assessment Scale – Cognitive Subscale, and to establish normative values for the Portuguese population. Material and Methods: The Portuguese version of Alzheimer’s Disease Assessment Scale – Cognitive Subscale was administered to 223 cognitively healthy participants according to a standard assessment protocol consisting of the Mini-Mental State Examination, the Montreal Cognitive Assessment and the Adults and Older Adults Functional Assessment Inventory. Normal performance on the assessment protocol was the inclusion criteria for the study. Results: The Alzheimer’s Disease Assessment Scale – Cognitive Subscale revealed good psychometric properties when used in the Portuguese population. Age was the main predictor of the Alzheimer’s Disease Assessment Scale – Cognitive Subscale total score (R2 = 0.123), whereas the influence of education level was lower (R2 = 0.027). These two variables explained 14.4% of the variance on the Alzheimer’s Disease Assessment Scale – Cognitive Subscale scores and were used to stratify the normative values for the Portuguese population presented here. Conclusion: On the total sample, the average total score in the Alzheimer’s Disease Assessment Scale – Cognitive Subscale was 6 points. The normative data were determined according to age and educational level as these were the sociodemographic variables that significantly contributed to the prediction of the Alzheimer’s Disease Assessment Scale – Cognitive Subscale total scores, explaining 14.4% of their variance. The normative data are of the utmost importance to ensure proper use of this battery in Portugal.

Systemic capillary leak syndrome is a rare, underdiagnosed and life-threatening disease characterized by periodic episodes of hypovolaemic shock due to leakage of plasma from the intravascular to the extravascular space. It is associated with haemoconcentration, hypoalbuminaemia and generalized oedema. We report the case of a patient with a history of emergent extensive small and large bowel resection and several episodes of hypovolaemic shock with acute renal injury, who presented with abdominal pain, headache and generalized oedema. Severe systemic capillary leak syndrome was diagnosed after a complex diagnostic approach. This case report describes the acute and prophylactic treatment administered to the patient and the 4-year follow-up. We highlight the importance of timely recognition and prompt treatment, as well as the need for new investigations to prevent the serious and unusual complications seen in this case.

Cardiac angiosarcoma (CA) is the most common primary malignant heart tumour. Its atypical symptoms and rapidly progressive nature contribute to delayed diagnosis and poor outcome. We report the case of a 52-year-old woman admitted with a large pericardial effusion. An extensive study of the aetiology of the pericardial effusion was inconclusive. Two months later the patient returned with ischaemic stroke. An echocardiogram revealed a probable right atrium contained rupture. The patient was submitted to surgical correction but died 9 days later. Histology revealed an angiosarcoma. This case exemplifies the atypical presentation of CA and highlights the importance of a multimodal diagnostic work-up in patients with idiopathic pericardial effusion.

Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome is a rare, unrecognized and chronic inflammatory disorder characterized by distinct cutaneous and osteoarticular manifestations. Renal complications are uncommon. We describe the unusual case of a patient with severe refractory and chronic hidradenitis suppurativa (HS) that progressed to chronic renal failure due to secondary amyloidosis, presenting with mandibular pain and renal failure. The challenging diagnosis of SAPHO syndrome was made. The purpose of this case report is to emphasize the need for vigilance, timely recognition and multidisciplinary treatment. The fundamental management of AA amyloidosis and SAPHO syndrome requires an individualized approach with control of the underlying inflammatory disease.

BACKGROUND:Lonomia obliqua venom is nephrotoxic and acute kidney injury (AKI) is the main cause of death among envenomed victims. Mechanism underlying L. obliqua-induced AKI involves renal hypoperfusion, inflammation, tubular necrosis and loss of glomerular filtration and tubular reabsorption capacities. In the present study, we aimed to investigate the contribution of kallikrein to the hemodynamic instability, inflammation and consequent renal and vascular impairment. METHODOLOGY/PRINCIPAL FINDINGS:Addition of L. obliqua venom to purified prekallikrein and human plasma in vitro or to vascular smooth muscle cells (VSMC) in culture, was able to generate kallikrein in a dose-dependent manner. Injected in rats, the venom induced AKI and increased kallikrein levels in plasma and kidney. Kallikrein inhibition by aprotinin prevented glomerular injury and the decrease in glomerular filtration rate, restoring fluid and electrolyte homeostasis. The mechanism underlying these effects was associated to lowering renal inflammation, with decrease in pro-inflammatory cytokines and matrix metalloproteinase expression, reduced tubular degeneration, and protection against oxidative stress. Supporting the key role of kallikrein, we demonstrated that aprotinin inhibited effects directly associated with vascular injury, such as the generation of intracellular reactive oxygen species (ROS) and migration of VSMC induced by L. obliqua venom or by diluted plasma obtained from envenomed rats. In addition, kallikrein inhibition also ameliorated venom-induced blood incoagulability and decreased kidney tissue factor expression. CONCLUSIONS/SIGNIFICANCE:These data indicated that kallikrein and consequently kinin release have a key role in kidney injury and vascular remodeling. Thus, blocking kallikrein may be a therapeutic alternative to control the progression of venom-induced AKI and vascular disturbances.

BackgroundExtinction-based procedures are often used to inhibit maladaptive fear responses. However, because extinction procedures show efficacy limitations, transcranial direct current stimulation (tDCS) has been suggested as a promising add-on enhancer.ObjectiveIn this study, we tested how cathodal tDCS over the right dorsolateral prefrontal cortex affects extinction and tried to unveil the processes at play that boost the effectiveness of extinction procedures and its translational potential to the treatment of anxiety disorders.MethodsWe implemented a fear conditioning paradigm whereby 41 healthy women (mean age = 20.51 ± 5.0) were assigned to either cathodal tDCS (n = 27) or sham tDCS (n = 16). Fear responses were measured with self-reports, autonomic responses, and implicit avoidance tendencies.ResultsCathodal tDCS shows no statistically significant effect in extinction, according to self-reports, and seems to even negatively affect fear conditioned skin conductance responses. However, one to three months after the tDCS session and extinction, we found a group difference in the action tendencies towards the neutral stimuli (F (1, 41) = 12.04, p = .001, ηp2 = .227), with the cathodal tDCS group (as opposed to the sham group) showing a safety learning (a positive bias towards the CS-), with a moderate effect size. This suggests that cathodal tDCS may foster stimuli discrimination, leading to a decreased generalization effect.DiscussionCathodal tDCS may have enhanced long-term distinctiveness between threatening cues and perceptively similar neutral cues through a disambiguation process of the value of the neutral stimuli-a therapeutic target in anxiety disorders. Future studies should confirm these results and extend the study of cathodal tDCS effect on short term avoidance tendencies.

Renovascular hypertension is an uncommon cause of secondary hypertension. Percutaneous angioplasty is considered in selected patients. Retrospective study of patients undergoing renal artery revascularization, in a tertiary centre, in 2004–2017. Demographic, biometrical, radiological and clinical data were gathered. Sixty-one procedures were performed in 50 patients (42 adults). Most had Atherosclerotic Renal Artery Stenosis (ARAS) (n = 28, 56%), followed by Fibromuscular Dysplasia (FMD) (n = 14, 28%); 8 (16%) presented rare aetiologies. Patients were predominantly female (72%) irrespectively of the aetiology. Compared to FMD, patients with ARAS were older (63 ± 11 vs 35 ± 21 years, p < 0.001), and more often had dyslipidaemia (89.3% vs 42.9%, p = 0.002) and diabetes mellitus (39.3% vs 7.1%, p = 0.04). Most ARAS patients had stent placement (96.4%). Resistant hypertension (53.6%) and deteriorating renal function (32.1%) were the main causes for intervention. Concomitant peripheral artery disease and carotid atherosclerosis were reported in 39.3% and 46.4%, respectively. FMD was predominantly treated with balloon angioplasty (71.4%). Renovascular disease was multifocal in 71.1%. Supra-aortic and other abdominal aortic branches involvement was reported in 14.3% and 21.4%, respectively. Nine early complications (0.0% in ARAS, 25.0% FMD and 33.0% other aetiologies, p = 0.008) and 14 late complications (10.0% in ARAS, 31.3% FMD and 40.0% other aetiologies, p = 0.05) were reported, mainly residual stenosis and restenosis. Cure/improvement of hypertension occurred in 59.2% patients revascularized (66.7% in ARAS, 42.9% FMD and 62.5% other aetiologies, p = 0.33). Our cohort was predominantly female. ARAS patients were older and had higher cardiovascular risk burden. There was a trend to less success in hypertension control improvement in FMD patients.

The T cell receptor (TCR) controls the cellular adaptive immune response to antigens, but our understanding of TCR repertoire diversity and response to challenge is still incomplete. For example, TCR clones shared by different individuals with minimal alteration to germline gene sequences (public clones) are detectable in all vertebrates, but their significance is unknown. Although small in size, the zebrafish TCR repertoire is controlled by processes similar to those operating in mammals. Thus, we studied the zebrafish TCR repertoire and its response to stimulation with self and foreign antigens. We found that cross-reactive public TCRs dominate the T cell response, endowing a limited TCR repertoire with the ability to cope with diverse antigenic challenges. These features of vertebrate public TCRs might provide a mechanism for the rapid generation of protective T cell immunity, allowing a short temporal window for the development of more specific private T cell responses.