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INTRODUCTION: Age-related muscle changes, translated into a decrease both in muscle imass and functionality, are determinants of a decrease in strength and resistance to exercise in older adults. OBJECTIVE: To correlate the loss of muscle mass and functionality with the respiratory function in older adults. METHODS: Cross-sectional study including 18 volunteers with age above 65 years (13 women and 5 men) included in the AGA@4life Project. All participants performed functional respiratory tests with an Flowhandy ZAN 100 spirometer, and handgrip strength was assessed with an appropriate dynamometer. Nutritional profile was assessed and body composition was evaluated via bioimpedance. RESULTS: There was a significant association between the percentage of lean mass and several spirometric parameters, namely the FEV1, FVC, PEF25, PEF50, PEF25/75 and PEF. Significant associations were also found with the self-efficacy for exercise and the same respiratory parameters. A significant and positive correlation was observed between the percentage of lean mass and handgrip strength. CONCLUSIONS: The results show an association between respiratory function and functional and clinical parameters characteristic of sarcopenia, suggesting common pathophysiological mechanisms in the limitation observed with the worsening of these parameters.

INTRODUCTION: Aging is associated with changes in heart structure and function, and there are benefits of physical exercise in delaying these changes. OBJECTIVES: To characterize the heart of a geriatric cohort at a structural and functional level, and to evaluate the potential cardiac benefits of a personalized exercise intervention program. METHODS: Non-randomized intervention study, including a group of old adults from the AGA@4life cohort. Two echocardiographic evaluations were performed, at baseline and 3 months after the implementation of a multidisciplinary intervention program, integrating the practice of adapted physical exercise. Participants were divided into 2 groups: group 1 with low adherence to the exercise program (< 20% of sessions); group 2 with high adherence to the exercise program (> 90% of sessions). RESULTS: Characteristic heart changes were observed at baseline, mainly at the valvular level, with 89.2% (n = 33) cases of aortic fibrosis, 73% (n = 27) cases of mitral fibrosis, 51.2% (n = 19) cases of aortic regurgitation, and 68% (n = 25) cases of mitral regurgitation. After the intervention, significant changes were observed in several functional parameters in group 2, namely in the maximum velocity of the E' (p = 0.01) and S' (p = 0.02) mitral valve waves, and maximum velocity of the E' tricuspid valve wave (p = 0.02). Positive structural changes were also observed in group 2, namely a reduction in relative wall thickness (p = 0.03) and left ventricular diastolic diameter (p = 0.04). CONCLUSION: Personalized physical exercise implemented as part of a multidisciplinary intervention program is a useful non-pharmacological tool for maintaining adequate cardiac function and structure in the old adult.

Aging is a complex process inherent to and inevitable in humans. With life expectancy rising, there are concerns about the senior population’s wellbeing, and a hope of preventing certain diseases such as cardiovascular diseases. To achieve it, this study resorts to the implementation of an interventional program based on the comprehensive geriatric assessment model [AGA@4life]. The aim is to evaluate the effect of a new nutritional and exercise regime and evaluate possible changes in nitric oxide (NO) metabolites and endothelin 1 (ET-1). An intervention study was developed with 17 participants with ages of 65 and above. They were evaluated in the beginning [T0] and after eight weeks [T1], where NO metabolites and ET-1 levels were determined by enzymatic assays and the slot blot technique, respectively. There was a significant decrease in ET-1 levels in both the control (p < 0.001) and intervention (p = 0.04) groups from T0 to T1, but there was only a tendency for a decrease in the NO metabolite’s levels in the same conditions [p > 0.05]. Even though the NO metabolite levels did not increase as expected, possibly because of an increase in oxidative stress, the ET-1 levels decreased as expected and the overall results are promising, proving this program could have a beneficial effect on the geriatric population.

Abstract During the past 15 years, new treatment paradigms for neovascular age-related macular degeneration (nvAMD) have evolved due to the advent of intravitreal anti-vascular endothelial growth factor (VEGF) therapy and rapid advances in retinal imaging. Recent publications describe eyes with type 1 macular neovascularization (MNV) as showing more resistance to macular atrophy than eyes with other lesion types. We sought to explore whether the perfusion status of the native choriocapillaris (CC) surrounding type 1 MNV influences its pattern of growth. To evaluate this effect, we analyzed a case series of 22 eyes from 19 nvAMD patients with type 1 MNV exhibiting growth on swept-source optical coherence tomography angiography (SS-OCTA) over a minimum follow-up of 12 months. We observed an overall weak correlation between type 1 MNV growth and CC flow deficits (FDs) average size (τ = 0.17, 95% CI [− 0.20, 0.62]) and a moderate correlation with CC FD % (τ = 0.21, 95% CI [− 0.16, 0.68]). Type 1 MNV was located beneath the fovea in most of the eyes (86%) and median visual acuity was 20/35 Snellen equivalent. Our results support that type 1 MNV recapitulates areas of CC blood flow impairment while serving to preserve foveal function.

Abstract Background Skeletal age (SA) is an estimate of biological maturity status that is commonly used in sport-related medical examinations. This study considered intra-observer reproducibility and inter-observer agreement of SA assessments among male tennis players. Methods SA was assessed with the Fels method in 97 male tennis players with chronological ages (CA) spanning 8.7–16.8 years. Radiographs were evaluated by two independent trained observers. Based on the difference between SA and CA, players were classified as late, average or early maturing; if a player was skeletally mature, he was noted as such as an SA is not assigned. Results The magnitude of intra-individual differences between repeated SA assessments were d = 0.008 year (observer A) and d = 0.001 year (observer B); the respective coefficients of variation were 1.11% and 1.75%. Inter-observer mean differences were negligible (t = 1.252, p = 0.210) and the intra-class correlation coefficient was nearly perfect (ICC = 0.995). Concordance of classifications of players by maturity status between observers was 90%. Conclusion Fels SA assessments were highly reproducible and showed an acceptable level of inter-observer agreement between trained examiners. Classifications of players by skeletal maturity status based on assessments of the two observers were highly concordant, though not 100%. The results highlight the importance of experienced observers in skeletal maturity assessments.

Sodium, although essential for life, is a key factor in changes in vascular function and cardiovascular disease when consumed in excess. Sarcocornia spp., a halophyte plant with many nutritional benefits, presents itself as a promising substitute for the consumption of purified salt. Matrix metalloproteinases (MMPs) 2 and 9 are widely studied due to their action in physiological processes and as biomarkers at the diagnostic level due to their increased expression in inflammatory processes. This study aimed to evaluate whether replacing salt with Sarcocornia perennis (S. perennis) powder in healthy young people leads to an improvement in biochemical profiles and the attenuation of MMP-2 and MMP-9 activity. In the present study, 30 participants were randomized into a control group that consumed salt and an intervention group that replaced salt with powdered S. perennis. The evaluation of the biochemical parameters was carried out by the spectrophotometry method, and the evaluation of MMP activity was carried out by zymography. A significant decrease was observed in the intervention group in total cholesterol, high-density lipoprotein cholesterol (HDL-c), and creatinine (p-value ≤ 0.05), along with lower but not significantly different mean values of triglycerides. Regarding MMP activity after the intervention, a lower mean value was observed for MMP-9 activity, with there being higher mean values for MMP-2 activity, both with p-values ≥ 0.05. The results confirmed that the consumption of S. perennis is a beneficial choice for health regarding the lipid profile. The evaluation of MMP activity indicated the potential of S. perennis in the regulation of MMP-9 activity in healthy individuals, along with the need for the further study of these proteases in individuals with pathologies.

AimThis study aimed to evaluate if physical activity is associated with systemic and cellular immunometabolic responses, in young adults after mild-to-moderate COVID-19 infection.MethodsMild- to- moderate post-COVID-19 patients (70.50 ± 43.10 days of diagnosis; age: 29.4 (21.9– 34.9) years; BMI: 25.5 ± 4.3 kg m2 n = 20) and healthy age-matched controls (age: 29.3 (21.2 – 32.6) years; BMI: 25.4 ± 4.7 kg m2; n = 20) were evaluated. Physical activity levels (PAL), body composition, dietary habits, muscular and pulmonary function, mental health, sleep quality, metabolic parameters, immune phenotypic characterization, stimulated whole blood and PBMC culture (cytokine production), mRNA, and mitochondrial respiration in PBMCs were evaluated. ResultsThe post-COVID-19 group exhibited lower levels of moderate to vigorous physical activity (MVPA) (p = 0.038); therefore, all study comparisons were performed with adjustment for MVPA. Post-COVID-19 impacted the pulmonary function (FEV1, FEV1%pred, FVC, and FVC %pred) compared with the control (p adjusted by MVPA (p adj)

Summary: Background: Arterial stiffening is central to the vascular ageing process and a powerful predictor and cause of diverse vascular pathologies and mortality. We investigated age and sex trajectories, regional differences, and global reference values of arterial stiffness as assessed by pulse wave velocity (PWV). Methods: Measurements of brachial-ankle or carotid-femoral PWV (baPWV or cfPWV) in generally healthy participants published in three electronic databases between database inception and August 24th, 2020 were included, either as individual participant-level or summary data received from collaborators (n = 248,196) or by extraction from published reports (n = 274,629). Quality was appraised using the Joanna Briggs Instrument. Variation in PWV was estimated using mixed-effects meta-regression and Generalized Additive Models for Location, Scale, and Shape. Findings: The search yielded 8920 studies, and 167 studies with 509,743 participants from 34 countries were included. PWV depended on age, sex, and country. Global age-standardised means were 12.5 m/s (95% confidence interval: 12.1–12.8 m/s) for baPWV and 7.45 m/s (95% CI: 7.11–7.79 m/s) for cfPWV. Males had higher global levels than females of 0.77 m/s for baPWV (95% CI: 0.75–0.78 m/s) and 0.35 m/s for cfPWV (95% CI: 0.33–0.37 m/s), but sex differences in baPWV diminished with advancing age. Compared to Europe, baPWV was substantially higher in the Asian region (+1.83 m/s, P = 0.0014), whereas cfPWV was higher in the African region (+0.41 m/s, P

In recent years, the world’s aging population has increased, contributing to the development of age-related pathologies, which have been aggravated by physical inactivity and excessive fat intake. This study aimed to evaluate the effect of implementing a nutritional program (control group—CG) combined with exercise (intervention group—IG) on the inflammatory profile, MMPs, and TIMPs in a group of 34 elderly participants (IG, n = 18; CG, n = 16). Participants underwent a full multidisciplinary diagnostic evaluation (T0), with the gathering of clinical information and biochemical and hematological determinations being re-evaluated eight weeks later (T1). A diet manual was made, which provided a selection of different types of diets resulting from the nutritional needs of the different users at the center. The aerobic exercise consisted of two sessions per week with a total duration of 1 h. The laboratory evaluation was performed by slot blot. Statistical analysis included a paired sample t-test and Spearman’s correlation coefficient. We observed that in the IG, there was a significant increase at T1 of TNF-α (p < 0.05) and MMP-2 (p < 0.05), without changes in IL-6 and MMP-9, showing that the intervention did not cause an exacerbated inflammatory response in exercised elderly people. The intervention program implemented showed potential to contribute to better active aging strategies, taking advantage of the known benefits of exercise without inducing a harmful inflammatory response in elderly participants.

Introdução: O stress oxidativo (SO) resulta da produção excessiva de espécies reativas de oxigénio (ROS), sendo responsável pelo desenvolvimento de inúmeras patologias. O resveratrol (3,5’,4- trihidroxiestilbeno) é um antioxidante de origem natural, produzido por uma grande variedade de espécies, cujas propriedades têm despoletado um interesse crescente. Objetivo: Compreender o papel do resveratrol nas defesas antioxidantes enzimáticas e na função vascular, mas também na redução da inflamação. Material e Métodos: 27 alunos clinicamente saudáveis, com idades entre os 18 - 22 anos foram randomizados em grupo controlo (GC) e experimental (GE), e submetidos à suplementação com placebo e resveratrol, respetivamente, durante 30 dias. Foi realizada a avaliação laboratorial da atividade da glutationa peroxidase (GPx) e redutase (GluRed) por espectrofotometria, e dos níveis séricos de endotelina 1 (ET-1), fator de necrose tumoral-alfa (TNF-α) e interleucina-6 (IL-6) por slot blot, no período basal (T0) e após suplementação (T1). Resultados: No que concerne à atividade da GPx, no momento T1, observaram-se valores superiores no GE (p = 0,005). Relativamente à GluRed, ambos os grupos demonstraram uma tendência de aumento da atividade enzimática em T1. No entanto, apenas o GC revelou resultados estatisticamente significativos (p = 0,004). Nos restantes parâmetros avaliados, não foram observadas diferenças significativas. Conclusões: A suplementação com resveratrol pode ser eficaz na redução do SO, ao aumentar a atividade das enzimas antioxidantes. Ainda assim, não foi possível provar o seu papel como agente cardioprotetor e anti-inflamatório.

Regeneration depends on the ability of mature cells at the injury site to respond to injury, generating tissue-specific progenitors that incorporate the blastema and proliferate to reconstitute the original organ architecture. The metabolic microenvironment has been tightly connected to cell function and identity during development and tumorigenesis. Yet, the link between metabolism and cell identity at the mechanistic level in a regenerative context remains unclear. The adult zebrafish caudal fin, and bone cells specifically, have been crucial for the understanding of mature cell contribution to tissue regeneration. Here, we use this model to explore the relevance of glucose metabolism for the cell fate transitions preceding new osteoblast formation and blastema assembly. We show that injury triggers a modulation in the metabolic profile at early stages of regeneration to enhance glycolysis at the expense of mitochondrial oxidation. This metabolic adaptation mediates transcriptional changes that make mature osteoblast amenable to be reprogramed into pre-osteoblasts and induces cell cycle re-entry and progression. Manipulation of the metabolic profile led to severe reduction of the pre-osteoblast pool, diminishing their capacity to generate new osteoblasts, and to a complete abrogation of blastema formation. Overall, our data indicate that metabolic alterations have a powerful instructive role in regulating genetic programs that dictate fate decisions and stimulate proliferation, thereby providing a deeper understanding on the mechanisms regulating blastema formation and bone regeneration.

Summary: Adequate alternatives to conventional animal testing are needed to study developmental neurotoxicity (DNT). Here, we used kinematic analysis to assess DNT of known (toluene (TOL) and chlorpyrifos (CPS)) and putative (β-N-methylamino-L-alanine (BMAA)) neurotoxic compounds. Drosophila melanogaster was exposed to these compounds during development and evaluated for survival and adult kinematic parameters using the FlyWalker system, a kinematics evaluation method. At concentrations that do not induce general toxicity, the solvent DMSO had a significant effect on kinematic parameters. Moreover, while TOL did not significantly induce lethality or kinematic dysfunction, CPS not only induced developmental lethality but also significantly impaired coordination in comparison to DMSO. Interestingly, BMAA, which was not lethal during development, induced motor decay in young adult animals, phenotypically resembling aged flies, an effect later attenuated upon aging. Furthermore, BMAA induced abnormal development of leg motor neuron projections. Our results suggest that our kinematic approach can assess potential DNT of chemical compounds.

Background and Aims: We evaluated adipose tissue-derived hormones, body composition, serum metabolic profile, levels of brain-derived neurotrophic factor (BDNF), and the association of these parameters with the clinical outcome in patients with COVID-19. We sought to examine whether obesity, sex, and age influence the adipose tissue endocrine response to the disease.Methods: This prospective study investigated 145 hospitalized patients with COVID-19. Patients were categorized based on their body mass index (BMI), sex and age, and were also classified regarding their outcome after hospitalization as: (a) Non-ICU: patients hospitalized who did not receive intensive care; (b) ICU-survivor: patients admitted to the intensive care unit and discharged; (c) ICU-death: patients who died. Blood samples were collected by the hospital staff between the first and third day of hospitalization. Serum leptin, adiponectin and BDNF concentrations, triglycerides, total cholesterol and cholesterol fractions were performed following the manufacturer's guidelines.Results: We demonstrate that BDNF levels predict intensive care (IC) need (p < 0.01). This association was found to be stronger in patients >60y (p = 0.026). Neither leptin nor adiponectin concentration was associated with IC requirement or with patient's outcome, while the BDNF/adiponectin ratio was closely associated with worsened outcomes (p < 0.01). BDNF concentration was similar between sexes, however tended to be lower in male patients (p = 0.023). In older patients, BDNF concentration was lower than that of younger patients (p = 0.020). These age and sex-specific differences should be considered when employing these potential markers for prognosis assessment. While appetite and body composition regulating hormones secreted by the white adipose tissue are not reliable predictors of disease severity, the ratio BDNF/adiponectin was indicative of patient status.Conclusion: Thus, we propose that serum BDNF content and BDNF/adiponectin ratio may serve as tools predicting worsened prognosis in COVID-19, especially for male patients.

Previous studies have shown that excessive salt intake is strongly associated with high blood pressure (HT), vascular dysfunction, and the overall risk of cardiovascular diseases. The aim of this study was to evaluate Sarcocornia effectiveness as a salt substitute, addressing its effect on cardiovascular function in healthy young individuals. Thirty healthy participants, aged 18 to 26 years, were randomized into two groups: the control group (CG) and the intervention group (IG). The IG used Sarcocornia powder as a salt substitute for cooking, and the CG used regular salt, during a period of 1 month. A baseline evaluation was performed before the participants started the intervention phase, and was repeated after a 30-day intervention period. Each evaluation included blood pressure (BP) measurement, carotid-femoral pulse wave velocity (PWV), and carotid pulse wave analysis (PWA), and blood samples were also collected for analysis. Sodium excretion was measured at baseline and after intervention through spot urine collection and analysis, a method suitable for this population but with known limitations. Baseline parameters were similar between groups and were within the normal range. Sodium excretion remained unchanged in the two evaluations in the CG, but significantly decreased after intervention in the IG. The reduction in sodium excretion in the IG was followed by a significant reduction in brachial and aortic systolic (SBP) and diastolic blood pressure (DBP), and also in PWV. No significant changes were observed in the CG in terms of cardiovascular parameters. This preliminary study conveys positive results in favor of Sarcocornia as a dietary substitute for regular salt, providing added evidence of the negative cardiovascular effects of high salt intake in young and healthy adults.

Introduction: This study was aimed at evaluating the changes in the Ventricular-Arterial Coupling (VAC) of old adults after the implementation of a multidisciplinary intervention program comprising a tailored physical exercise component. Methods: A non-randomized pilot study, enrolling 21 old adults with age above 65 years of age (mean 81.08 years). The participants were divided into two groups (Group 1 and 2), both subject to a baseline thorough and multidisciplinary diagnostic evaluation. A tailored intervention program was implemented for a period of 3 months, after which the participants were re-evaluated. The Group 2 included a component of tailored exercise training and physiotherapy intervention. Central and peripheral Blood Pressure (BP) and hemodynamic parameters related to cardiovascular efficiency were evaluated by transthoracic echocardiography and pulse wave analysis. Self-efficacy for exercise scales as well as handgrip strength and nutritional status were also evaluated at baseline and after intervention. Results: Baseline diagnostic information was similar in both groups. After the intervention, significant changes were observed in Group 2, mainly a reduction in BP, in arterial stiffness and a better cardiovascular efficiency was also depicted, with a decrease in the stroke work and an increase in the VAC, as well as in the left ventricle efficiency parameter. Regarding the indicators of frailty, there was an improvement in handgrip strength and self-efficacy for exercise in Group 2. No significant changes were observed in Group 1. Conclusion: The results of this pilot study highlight the positive modulation provided by a tailored physical exercise approach of the old adult, increasing cardiac efficiency and thus constituting a factor for improving overall well-being. Large randomized trials are needed to further validate these findings.

Introduction: This study was aimed at evaluating the effect of a tailored exercise intervention programme in the Arterial Stiffness (AS) of old adults. Methods: Non-randomized intervention study, enrolling 32 community dwelling old adults, aged over 65 years (mean age: 83.28 ± 8.29 years), with no prior history of major cardiovascular events. Participants were divided into two groups (intervention group—Group 2, and control group—Group 1) according to their willingness to participate in the physical training program. The exercise program included aerobic and strength components, prescribed in a personalized approach, and implemented under direct control of two experienced professionals. Aortic Pulse Wave Velocity (PWV), a measure of AS, was evaluated at baseline and 3-months after the intervention period. Clinical evaluation, anthropometric measures and blood samples were also collected in both time-points. Results: The groups had similar clinical and demographic characteristics at baseline. After the intervention program, a significant reduction in PWV was observed only in Group 2 [F(1, 15) = 29.38; p < 0.001; η2 = 0.67]. A readjustment of the PWV age-dependent trajectory was observed, with a reduction of the absolute PWV in all age strata. A significant reduction in systolic brachial blood pressure was also depicted in Group 2 [mean difference: 12.57 mmHg; F(1, 15) = 9.46; p = 0.01; η2 = 0.39]. Parameters related to functional status, such as the handgrip strength, the self-efficacy for exercise and the activity and participation profile, were also significantly improved in Group 2. Conclusion: Physical exercise was shown to be an effective non-pharmacological tool to positively modulate age-related decline in AS in older adults.

The Moens-Korteweg equation predicts changes in pulse wave velocity (PWV) after changes in arterial radius; therefore, an increase in arterial radius, as seen in a reactive hyperemia (RH) condition, should slow PWV over a given arterial segment. If this assumption is true, then the deceleration of PWV over the brachial artery (flow-mediated slowing [FMS]) should be an equivalent signal of endothelial function during a conventional RH flow-mediated dilation (FMD) procedure. Our aim was to compare FMS with FMD after RH in healthy individuals as part of a study that seeks to evaluate the clinical usefulness of FMS as a noninvasive approach to characterize endothelial function. This cross-sectional study included 25 healthy participants (18 women [72%]) with a mean ± SD age of 21.12±0.73 years. The FMD and FMS were simultaneously measured. A significant correlation was observed between both measures of FMS (absolute difference and percentage variation) and echo FMD: R=−0.42 (P=.04) and r=0.46 (P=.02), respectively. The FMS was shown to depend on the baseline brachial diameter, with smaller variations depicted for smaller baseline brachial diameters. It seems to be a promising and feasible method for measuring changes after RH, although further studies are needed to evaluate how this correlation holds in different clinical conditions and to demonstrate its clinical usefulness.

Introdução: O resveratrol é uma fitoalexina natural cujos principais benefícios devem-se às suas propriedades antiinflamatórias e antioxidantes. Os seus efeitos sugerem que este é um suplemento útil para a redução da inflamação, podendo desempenhar um papel fundamental na prevenção das doenças cardiovasculares. Este promove a vasodilatação pela indução da síntese de óxido nítrico (NO), possui atividade antitrombótica e evita a agregação plaquetária. O fator de crescimento endotelial vascular (VEGF) é responsável pela angiogénese, sendo a sua expressão influenciada pelo resveratrol. Objetivos: Avaliar o efeito do resveratrol no perfil vascular pela determinação da pressão arterial e dos biomarcadores interleucina-6 (IL-6), proteína C reativa (PCR), VEGF e NO. Material e Métodos: 27 alunos com idades compreendidas entre os 18 e os 22 anos foram divididos em grupo controlo (GC) e grupo de intervenção (GI), que consumiram placebo e 100 mg de resveratrol por dia, respetivamente, durante 1 mês. A pressão arterial foi medida com aparelho automático validado. Os níveis de PCR foram obtidos por imunoturbidimetria, os de IL-6 e VEGF por slot blot e a quantificação de NO por espectrofotometria. Resultados: Entre os grupos observou-se uma diminuição da pressão arterial braquial e central (??0.05). A variação negativa no NO apresentou-se superior no GC apesar das diferenças não serem significativas (p>0,05). Nos restantes marcadores avaliados não se observaram diferenças significativas. Conclusões: A ingestão regular de resveratrol parece ser uma abordagem preventiva a nível vascular, dado que modula positivamente o perfil vascular, reduzindo a pressão arterial. A variação nos níveis de NO poderá ajudar a explicar os benefícios verificados.

In 2015, several disarticulated human skeletal remains were identified in the top layers of the prehistoric site of Buraca da Moira Rock Shelter (Boa Vista, Leiria), during the archaeological excavation carried out under the scope of the EcoPLis — Human Occupations in the Pleistocene Ecotones of the River Lis project. The recovery of chert, constiquartz and quartzite blanks, a schist plate, as well as adornments in bone and shell indicates a Late Neolithic-Chalcolithic chronology. The disarticulated human assemblage, composed of a total of 129 bone and tooth fragments, allowed the estimation of a minimum number of six individuals. Among the remains recovered, an upper portion of an adult right ulna lacking the coronoid process was identified. Replacing it, a semi-oval groove with smooth contours and exposing some trabecular bone was observed. The location, type of bone change, and the observed signs of bone healing are consistent with an uncommon trauma: a fracture of the coronoid process. In the differential diagnosis, both postmortem changes and developmental disturbances were considered but later excluded. The mechanisms that underlie the bone changes are discussed in light of the clinical and paleopathological literature.

Objective: The ASINPHAR@2action programme aims at raising awareness to early vascular ageing (EVA) through a community-based intervention. This preliminary analysis is focused on the analysis of the proportion of participants with abnormal arterial stiffness (AS) and the definition of its main determinants. Design and method: This preliminary analysis is a cross-sectional, observational, descriptive, non-interventional study of participants enrolled in 11 communal pharmacies in Portugal (HOLON pharmacies), between April and November 2017. Blood pressure (BP) and arterial function parameters were measured with a non-invasive validated device (MOBIL-O-GRAPH, IEM®). Clinical and demographic information was gathered. Results: Participants recruited for the project account for 658, 65.7% women, with a mean age of 57.34 ± 16.26 years (range: 20–96 years). Brachial BP was 126.60 ± 16.43 mmHg and 79.89 ± 11.54 mmHg, and central BP was 115.80 ± 15.35 mmHg and 81.18 ± 11.60 mmHg, respectively for systolic and diastolic BP. Mean pulse wave velocity (PWV) was 8.45 ± 2.28 m/s. The proportion of participants with increased PWV was 19,9%. Participants with increased PWV were significantly older and had higher brachial and central BP and BMI. Multivariate linear regression indicated age, Gender, BP and abdominal fat as independent determinants of PWV. AS trajectories were significantly different as a function of arterial hypertension and cardiovascular risk classification (figure 1). Conclusions: The preliminary results of this pioneering large scale study measuring arterial function in communal pharmacies provides the grounds for the operationalization of subclinical target organ damage screening in pharmacies, as a strategy to improve cardiovascular risk monitoring and to promote adherence to treatment.

Objective: To study the determinants of Arterial Stiffness (AS) in the elderly. Design and method: Cross-sectional, observational study of elderly participants. Blood Pressure (BP) and arterial function parameters were measured with a validated device. Clinical and demographic information was gathered, as well as the estimation of global cardiovascular risk, health related quality of life, dietary profile and cognition. Cholesterol and glycaemia were measured. Results: 54 Participants recruited for the project, with a mean age of 73.0 ± 6.0 years (range: 65–94 years). Central BP was 119.4 ± 16.2 mmHg and 38.3 ± 11.6 mmHg, respectively for aortic systolic and pulse pressures. Mean pulse wave velocity (PWV) was 10.6 ± 1.36 m/s and the augmentation index was 27.0 ± 17.6%. Significant differences were depicted as a function of gender, with males presenting higher BP and PWV. The proportion of participants with increased PWV, according to the available reference values, was 31.6%. Participants with increased PWV had higher brachial and central BP, higher BMI and higher abdominal fat. Functionality was worst in high PWV participants, as well as cognitive function. Multivariate linear regression indicated age (β = 0.172; CI: 0.158;0.185; p < 0.001), and aortic systolic BP (β = 0.033; CI: 0.028;0.038; p < 0.001) as independent determinants of PWV. Also Hypertension (OR = 15.83; IC:8.16–30.7) and Diabetes (OR=2.34;IC: 0.99-5.50) were independently associated with AS. Conclusions: Accelerated AS is a common finding in the elderly and is highly associated with hypertension and diabetes. A strong association of AS with central BP and reflected waves is also of notice in this particular population.

Background: Multiple studies report that stiffness of the elastic arteries has a predictive value independent of cardiovascular (CV) risk. According to the 2016 European Guideline on CV Disease Prevention in Clinical Practice by the European Society of Cardiology, arterial stiffness (AS) may predict future CV events and improve the classification of CV risk. (1–3). Purpose: To evaluate the feasibility of incorporating AS assessment as a point-of-care test in community pharmacies, both as an independent parameter and integrated in a holistic service on CV risk assessment. Methods: Eleven community pharmacies were selected to participate in the pilot project. Community pharmacists were trained to provide the service, and manuals were developed to assist them in the patient care process. Data were collected through GoogleForms®. Results: Since March 2017, over 650 patients were incorporated in the service. 19.9% of participants displayed an increased Pulse Wave Velocity (PWV). Noteworthily, 12.3% of participants without previously known risk factors presented high PWV. 24 patients were referred to the GP. Several referrals to pharmacy services were made (n = 341). Based on feedback from pharmacies (on service pricing, service duration, and communication with patients and other healthcare professionals) modifications to the service were incorporated for the second phase of the study; in particular, the service price was adjusted, since only 33.3% of participants were willing to pay €15 for it. Conclusions: Arterial stiffness is a useful and feasible parameter to be measured in community pharmacies. It allows for a holistic service, adding to other CV risk predictors already available.

Introduction: The PORT-VASPh Cohort was designed to contribute to a better understanding of vascular function in children and adolescents, mostly focusing PWV and other complementary aspects of arterial hemodynamics. Methods: The PORT-VASPh cohort is a prospective and observational study, with 953 children and adolescents enrolled, 40% females, age ranging from 5 to 17 years (mean age: 12.08 ± 2.92 years). The overall health profile for each participant was defined based on three clinical evaluations, in which blood pressure (BP) was measured under standard conditions over the brachial artery with a clinically validated automatic sphygmomanometer (OMRON 705IT) and an appropriately sized cuff. Gender-specific percentiles were used for the definition of the individual BP phenotype. Carotid-femoral PWV was measured to all participants at the third clinical evaluation, with the Complior SP device, complying with the methodological recommendations. All participants were evaluated by the same experienced clinician. Results: Mean PWV was 6.20 ± 0.95 m/s and was higher in males compared with females (6.31 ± 0.97 m/s vs 6.02 ± 0.89, respectively; p < 0.0001). Gender-specific percentile tables, accounting for age, were obtained from the normotensive participants (n = 758), as depicted in Figure 1. The determinants of PWV were assessed through linear regression. In a multivariable model, age, gender, blood pressure and family history of cardiovascular disease were significantly associated with PWV. Conclusion: In children and adolescents, aortic PWV is strongly influenced by age, gender, BP and genetics, in line with the available evidences in adult populations. Further studies are needed towards a thorough understanding of the arterial dynamics at these ages.

Objective: To evaluate and explore the benefits of dark chocolate in young healthy adults. Methods: Randomized study in 30 healthy participants aged 18 to 27 years. Half of the participants ingested a 20 g dose of low cocoa chocolate (LCC:∼55%; 12,61 ± 1,35 mg equivalent of epichatequin/g) and the others ingested a daily dose of 20 g of high cocoa chocolate (HCC:∼90%; 18,19 ± 2,64 mg equivalent of epichatequin/g). A baseline evaluation was performed before the participants started ingesting the assigned chocolate for a 30 days period, after which a final evaluation was performed. Each evaluation included heart ultrasonography, carotid-femoral pulse wave velocity (PWV) and carotid pulse wave analysis (PWA), flow mediated slowing (FMS), an analysis of the ventricular-arterial coupling (VAC), cognitive testing and functional near infra-red spectroscopy (fNIR) of the pre-frontal cortex. Results: A statistically significant improvement was depicted over the brachial and central systolic and pulse pressures in the HCC group, and a trend for improvement in the AiX and the FMS was also observed in the HCC. The VAC parameters showed a significant improvement in the HCC group after intervention, increasing from 0.674 to 0.719 (p=0.004). Improvement in the memory scores (speed and accuracy) was observed in both groups, with a larger improvement in the HCC group, and related with an improvement in the pre-frontal cortex perfusion. Conclusions: The intake of cocoa-rich chocolate improves vascular function and cognitive performance in healthy young adults, by reducing blood pressure, promoting vascular dilation, and improving brain perfusion over the prefrontal cortex.

Objectives: Accurate blood pressure (BP) measurement is critical for appropriate hypertension diagnosis and management. Aortic BP represents pressure loading on vital organs and this can be approximated using upper arm cuff BP. With advancing age, cuff systolic BP (SBP) increases and diastolic BP (DBP) decreases (widening pulse pressure [PP]), but whether age may influence cuff BP compared with invasive BP is unknown and was the aim of this study. Methods: Cuff BP was measured simultaneously, or near-simultaneously, with invasive aortic BP during catheterization in 1696 individuals within the INSPECT consortium (an international collaboration comprising data from 31 studies and 19 different cuff BP devices [17 oscillometric, 2 mercury sphygmomanometry]). Differences in cuff and invasive BP were assessed using mixed models. Results: Subjects were aged 63.3 ± 10.6 years and 32% female. Cuff SBP overestimated invasive aortic SBP in those aged 40–49, but with increasing age there was a progressive increase in the underestimation of aortic SBP (Table). Conversely, cuff DBP systematically overestimated aortic DBP, increasingly with age. Thus, there was a progressively higher error (underestimation) in cuff PP with older age. Adjusting models for sex, mean arterial pressure, heart rate and catheter type did not alter the findings, and no interactions between these parameters and age were found. Conclusion: Cuff BP is progressively more biased with increasing age, exposing older people to greater chance for misdiagnosis of risk related to BP. The findings highlight the need to improve cuff BP methods to ensure all people receive appropriate diagnosis and management of hypertension.

In 2019, a new virus, SARS-CoV-2, responsible for the COVID-19 disease, was discovered. Asymptomatic and mildly symptomatic patients were forced to quarantine and closely monitor their symptoms and vital signs, most of the time at home. This paper describes e-CoVig, a novel mHealth application, developed as an alternative to the current monitoring paradigm, where the patients are followed up by direct phone contact. The e-CoVig provides a set of functionalities for remote reporting of symptoms, vital signs, and other clinical information to the health services taking care of these patients. The application is designed to register and transmit the heart rate, blood oxygen saturation (SpO2), body temperature, respiration, and cough. The system features a mobile application, a web/cloud platform, and a low-cost specific device to acquire the temperature and SpO2. The architecture of the system is flexible and can be configured for different operation conditions. Current commercial devices, such as oximeters and thermometers, can also be used and read using the optical character recognition (OCR) functionality of the system. The data acquired at the mobile application are sent automatically to the web/cloud application and made available in real-time to the medical staff, enabling the follow-up of several users simultaneously without the need for time consuming phone call interactions. The system was already tested for its feasibility and a preliminary deployment was performed on a nursing home showing promising results.

The knowledge of where past human populations collected their raw materials to produce stone-tools is crucial to understand subjects such as their territoriality, mobility, decision-making, range of acquisition, networks and, eventually, to infer their cognitive abilities and the adaptations to new environments, landscapes and territories. Therefore, the creation of lithic reference collections (lithotheque) is of utmost importance. In geological terms, Portugal is a highly complex and diversified region, with a plethora of igneous, sedimentary and metamorphic rocks dated from Proterozoic to present days. Such diversity might have influenced considerably the human decision-making on the choices of raw material and it might be one of the major reasons for the diversity seen throughout the diachrony of its archaeological record. Thus, sampling, cataloguing and mapping the raw material diversity in a territory with such variability allows to enrich the knowledge about it and, consequently to build stronger inferences about past human behaviour with more detail and less bias. In order to help the archaeological and anthropological research to better understand such archaeological record and past human behaviour in this territory, we started a reference collection for this region host in the University of Algarve: the LusoLit. Though in its early stages, this collection has already several hundred chert samples from Central and Southern Portugal. In this early stage, the raw material that we start collecting was chert because it is the least ubiquitous through the landscape and, consequently, that can provide better information.

Plexins are semaphorin receptors and are well known for their roles in neuronal pathfinding. Here the authors describe a role for Plexin A in healing damaged epithelia in Drosophila and zebrafish. In Drosophila, Plexin A inhibits the GTPase Rap1 to allow epithelial remodelling to facilitate wound repair.

This study aimed to compare the dynamics of the prefrontal cortex (PFC), between adult and adolescent chess players, during chess-based problem-solving tasks of increasing level of difficulty, relying on the identification of changes in oxygenated hemoglobin (HbO2) and hemoglobin (HHb) through the functional near-infrared spectroscopy (fNIRS) method. Thirty male federated chess players (mean age: 24.15 ± 12.84 years), divided into adults and adolescents, participated in this cross-sectional study. Participants were asked to solve three chess problems with different difficulties (low, medium, and high) while changes in HbO2 and HHb were measured over the PFC in real-time with an fNIRS system. Results indicated that the left prefrontal cortex (L-PFC) increased its activation with the difficulty of the task in both adolescents and adults. Interestingly, differences in the PFC dynamics but not in the overall performance were found between adults and adolescents. Our findings contributed to a better understanding of the PFC resources mobilized during complex tasks in both adults and adolescents.

A compreensão dos fatores que modulam a saúde e o bem-estar constitui um aspeto crítico para a preservação do bom funcionamento do Homem, nas suas diversas dimensões. Numa época em que o envelhecimento populacional se assume como um desafio estrutural, a adoção de estratégias de preservação da saúde ao longo da vida assumem-se como essenciais, e entre estas, a literacia em saúde é reconhecidamente decisiva. Alguns estudos têm-se debruçado sobre a importância da educação para a saúde na promoção de um sistema cardiovascular mais saudável, debruçando-se, entre outros aspetos, no efeito ecológico de um maior conhecimento em saúde sobre a pressão arterial. Perante esta circunstância, realizamos dois trabalhos com o objetivo de identificar benefícios de um programa de educação para a saúde sobre a pressão arterial em duas populações especiais: crianças/adolescentes e idosos. Para tal, constituíram-se duas coortes de estudo: coorte A – crianças/adolescentes (idades entre os 5 e os 17 anos à data de inclusão); coorte B – idosos (idades entre os 65 e os 90 anos à data de inclusão). A coorte A foi constituída por 3550 famílias e a coorte B por 45 idosos. Em ambas as situações, o desenho experimental implicou uma avaliação cardiovascular basal, seguido de um programa de educação para a saúde estruturado e individualizado (manipulação experimental), centrado nos fatores de promoção de saúde cardiovascular ajustados a cada tipo de população, e reavaliação num contexto de follow-up anual. No follow-up da Coorte A, identificou-se por entrevista um grupo de famílias que referiram ter ajustado os seus comportamentos de vida (grupo ativo: n=1150) contrastando com outro que referiu não ter feito grandes ajustamentos (grupo controlo: n=2400). A análise do comportamento da pressão arterial identificou uma redução de 1.43 mmHg na pressão sistólica e de 0.63 mmHg na pressão diastólica no grupo ativo, mantendo-se diferenças tensionais na ordem dos 1.71 mmHg para a pressão sistólica e de 0.59 mmHg para a pressão diastólica entre o grupo ativo e o grupo de controlo ao fim de 2 anos de seguimento. Na coorte B, a intervenção fez-se também acompanhar de uma redução significativa da pressão arterial, aumentando a percentagem de doentes hipertensos controlados de 51.2% (basal) para 74.4% (pós-intervenção), explicado em grande medida por um aumento significativo na adesão à terapêutica conseguido pelo programa de educação (passando de 11.6% para 79.1%; p

PURPOSE:To characterize quantitative optical coherence tomography angiography (OCT-A) parameters in active neovascular age-related macular degeneration (nAMD) patients under treatment and remission nAMD patients. DESIGN:Retrospective, cross-sectional study. PARTICIPANTS:One hundred and four patients of whom 72 were in Group 1 (active nAMD) and 32 in Group 2 (remission nAMD) based on SD-OCT (Spectral Domain OCT) qualitative morphology. METHODS:This study was conducted at the Centre Ophtalmologique de l'Odeon between June 2016 and December 2017. Eyes were analyzed using SD-OCT and high-speed (100 000 A-scans/second) 1050-nm wavelength swept-source OCT-A. Speckle noise removal and choroidal neovascularization (CNV) blood flow delineation were automatically performed. Quantitative parameters analyzed included blood flow area (Area), vessel density, fractal dimension (FD) and lacunarity. OCT-A image algorithms and graphical user interfaces were built as a unified tool in Matlab coding language. Generalized Additive Models were used to study the association between OCT-A parameters and nAMD remission on structural OCT. The models' performance was assessed by the Akaike Information Criterion (AIC), Brier Score and by the area under the receiver operating characteristic curve (AUC). A p value of ≤ 0.05 was considered as statistically significant. RESULTS:Area, vessel density and FD were different (p

Objective: In the present analysis of the VASOTENS study [1] baseline data, we checked whether organ damage of hypertension (TOD) i) is better associated with 24-hour central than peripheral BP and ii) is related to ambulatory arterial stiffness, estimated by pulse wave velocity (PWV) and augmentation index (AIx). Methods: TOD in 334 hypertensive patients (mean age 53±15, 52% males, 45% treated) was estimated by calculation of left ventricular mass index (LVMI), intima-media thickness (IMT) and creatinine clearance (CC). 24-hour indices were estimated through the Vasotens technology [2]. 24-hour brachial (bSBP) and aortic systolic BP (aSBP), standard deviation of bSBP, PWV and AIx were obtained. Bivariate and multivariate analysis (stepwise linear regression) was used. Results: A significant relation was found for age, bSBP and aSBP vs. LVMI and IMT (see table). IMT was also significantly related to SBP variability and arterial stiffness, whereas age, SBP variability and AIx were significantly associated with СС. In the multivariate analysis, including all ••••variables entered in the bivariate model, adjusted by sex, statistically significant (p < 0.001) association was observed for aSBP and age with LVMI (standardized regression coefficient 0.25 and 0.18, respectively), and for age with IMT (0.56) and CC (−0.53). Correlation coefficients LVMI (g/m2) IMT (mm) CC (ml/min) Age (years) 0.25*** 0.56** −0.53** bSBP (mmHg) 0.23*** 0.24** −0.01 aSBP (mmHg) 0.28*** 0.26** −0.05 SD bSBP (mmHg) 0.01 0.24** −0.19* PWV (m/s) 0.09 0.17* −0.14 AI (%) 0.07 0.22** −0.18* ***p < 0.001 ; **p < 0.01; *p < 0.05. Conclusions: In hypertensive patients age appears to be the major determinant of TOD, with central SBP, and marginally peripheral SBP, PWV and AIx, also playing a significant role. Our results suggest that estimation of 24-hour central hemodynamics and arterial stiffness in ambulatory conditions may help improve the individualized assessment of the BP-associated TOD.

Background: Several studies have been attempting to ascertain the risks of Sleep Apnea Syndrome (SAS) and its morbidity and mortality. Objective: The main objective was to verify whether SAS increases the risk of death; the secondary objective was to evaluate its morbidity in relation to cardiovascular disease and the number of days hospitalized. Methods: A systematic review and a meta-analysis were performed of the published literature. The research focused on studies comparing the number of deaths in patients with untreated SAS and in patients with non-SAS. Results: The meta-analysis was based on 13 articles, corresponding to a total of 13394 participants divided into two groups (non-SAS = 6631; SAS = 6763). The meta-analysis revealed a clear association of SAS with the occurrence of fatal events, where the presence of SAS corresponded to a 61% higher risk of total mortality (OR=1.61; CI: 1.43 - 1.81; p < 0.00001), while the risk of death from cardiac causes was 2.52 times higher in these patients (OR = 2.52; IC: 1.80 - 3.52; p < 0.00001). Similar results were obtained for mortality from other causes (OR = 1.68; CI: 1.08 - 2.61; p = 0.02). Resembling results were obtained in the remaining outcomes: non-fatal cardiovascular events were higher in the SAS group (OR = 2.46; IC: 1.80 - 3.36; p < 0.00001), the average number of days hospitalized was also higher in the SAS group (IV = 18.09; IC: 13.34 - 22.84; p < 0.00001). Conclusion: The results show that untreated SAS significantly increases the risk of death, cardiovascular events and the average number of days hospitalized.

Resumo: Introdução: O objetivo do estudo foi avaliar a eficácia do pacing auricular antitaquicardia (ATP) na conversão de episódios de taquiarritmia auricular e seu impacto na redução da carga arrítmica. Métodos: Estudo retrospetivo que decorreu no laboratório de pacing num hospital distrital, incluindo consecutivamente 57 doentes que implantaram pacemaker dupla câmara, com capacidade de realizar pacing auricular antitaquicardia, entre 2005‐2010. Formaram‐se dois grupos, grupo ATP_ON constituído por 24 doentes e grupo ATP_OFF constituído por 33 doentes. O período de seguimento foi de 15 meses, tendo‐se recolhido os dados das consultas de seguimento de pacing realizadas em três momentos distintos, o primeiro ao 3.° mês após o implante (M1), o segundo ao 9.° mês (M2) e o último ao 15.° mês (M3), incluindo este período, tentativa de tratamento por ATP de 12 428 episódios de taquiarritmias auriculares. Resultados: Apesar de não ocorrerem diferenças estatisticamente significativas, verificou‐se uma tendência favorável ao grupo ATP_ON, visto que, o aumento de carga arrítmica foi menos acentuado neste grupo. Também neste grupo se verificou percentagem média de pacing ventricular apical significativamente inferior, associando‐se este parâmetro a redução marginalmente significativa da carga arrítmica (p = 0,06). Verificou‐se uma relação significativamente positiva entre a evolução da percentagem de pacing ventricular e a evolução da carga arrítmica (R = 0,417, p = 0,02). Conclusões: O pacing auricular antitaquicardia converteu 59,7% dos episódios de arritmia auricular, mas não reduziu significativamente a carga arrítmica. Verificou‐se correlação significativamente positiva entre a evolução da percentagem de pacing ventricular e a evolução da carga arrítmica. Abstract: Introduction: The aim of this study was to assess the effectiveness of atrial antitachycardia pacing (ATP) in the conversion of atrial tachyarrhythmia episodes, and its impact in reducing arrhythmic burden. Methods: We performed a retrospective study in the pacing laboratory of a district hospital of 57 consecutive patients implanted with a dual chamber pacemaker, capable of performing atrial antitachycardia pacing, between 2005 and 2010. The patients were divided into two groups: ATP_ON (n=24) and ATP_OFF (n=33). The follow‐up period was 15 months, with data being collected at three follow‐up consultations: the first at three months after implantation, the second at nine months and the last at 15 months. In this period, there were 12 428 ATP therapies of atrial tachyarrhythmias. Results: Although there were no statistically significant differences, there was a trend in favor of the ATP_ON group, the increase in arrhythmic burden being less marked in this group. The mean percentage of ventricular apical pacing was also significantly lower in this group, which was associated with a marginally significant reduction in arrhythmic burden (p=0.06). There was a significant positive correlation between changes in the percentage of ventricular pacing and changes in arrhythmic burden (r=0.417, p=0.02). Conclusions: Atrial antitachycardia pacing converted 59.7% of episodes of atrial arrhythmia, but did not significantly reduce arrhythmic burden. There was a significant positive correlation between changes in the percentage of ventricular pacing and changes in arrhythmic burden. Palavras‐chave: Fibrilhação auricular, Pacing auricular antitaquicardia, Pacing ventricular, Carga arrítmica, Keywords: Atrial fibrillation, Atrial antitachycardia pacing, Ventricular pacing, Arrhythmic burden

Resumo: Introdução: A distrofia miotónica é uma doença multissistémica, que se associa a alterações cardíacas que são responsáveis por elevada taxa de morbilidade e mortalidade. O atingimento do tecido de condução é frequente, traduzindo‐se em alterações no ritmo cardíaco, que tendem a progredir com a idade. Objetivo: O presente trabalho propõe‐se avaliar o perfil cardiovascular global, bem como o risco de arritmias cardíacas, em indivíduos com distrofia miotónica de Steinert tipo 1 (DMS1), correlacionando os diversos achados com o estudo genético (tamanho da expansão CTG) comparando possíveis diferenças entre géneros. Métodos: Estudo retrospetivo que incluiu 31 pacientes DMS1 referenciados ao serviço de cardiologia do Centro Hospitalar Entre Douro e Vouga pelo serviço de neurologia para rastreio de doença cardíaca. Todos os doentes realizaram uma consulta clínica e foram submetidos a exames complementares de diagnóstico, nomeadamente eletrocardiograma (ECG), eletrocardiograma de alta resolução (ECGAR), variabilidade da frequência cardíaca (VFC), monitorização eletrocardiográfica ambulatória contínua (MEAC‐Holter) e ecocardiograma transtorácico (ETT). Foi ainda consultado o exame genético previamente efetuado. Resultados: Dos 31 doentes estudados, 38% apresentaram BAV 1.° grau e 51% apresentaram perturbação da condução intraventricular no ECG; 62% dos doentes apresentaram potenciais ventriculares tardios; não se verificou doença cardíaca no ETT; as extrassístoles supraventriculares e ventriculares raras foram as arritmias mais frequentes no Holter de 24 h; a amostra apresentou valores diminuídos para a VFC, o que reflete a presença de disfunção vagal. Os doentes com maiores expansões CTG apresentaram maior número de anormalidades cardíacas. Conclusões: Pacientes com DMS1 apresentam alterações cardíacas, embora a gravidade das alterações documentadas esteja aquém do sugerido na literatura. Este aspeto poderá refletir a qualidade do seguimento clínico oferecido aos doentes por um centro com uma consulta especializada. Abstract: Introduction: Myotonic dystrophy is a multisystem disease associated with cardiac abnormalities that are responsible for high morbidity and mortality. It commonly affects conduction tissue, resulting in changes in heart rate that tend to progress with age. Objective: The aim of the study was to assess overall cardiovascular risk and the risk of arrhythmias in patients with myotonic dystrophy type 1 (DM‐1) and to correlate them with genetic study (CTG expansion size). Methods: This retrospective study included 31 DM‐1 patients referred to the cardiology department of Centro Hospitalar Entre Douro e Vouga by the neurology department for screening for heart disease. Patients’ medical records were consulted for the diagnostic tests performed in the diagnostic cardiology consultation: electrocardiogram (ECG), high‐resolution ECG, heart rate variability (HRV), Holter 24‐hour ambulatory ECG and transthoracic echocardiogram (TTE); results of genetic testing were also consulted. Results: Of 31 patients studied, 38% had first‐degree atrioventricular block (AVB) and 51% had intraventricular conduction disturbances (62% had late potentials). TTE revealed no structural heart disease. Rare supraventricular and ventricular ectopic beats were the most common arrhythmias on 24‐hour Holter monitoring. The sample showed lower HRV, reflecting vagal dysfunction. Patients with larger CTG expansions had more cardiac abnormalities. Conclusions: Patients with DM‐1 had arrhythmic events, with AVB and more significantly intraventricular block, although none had malignant arrhythmias or structural heart disease. No patient died. Patients with larger CTG expansions had greater involvement of cardiac conduction tissue. Palavras‐chave: Distrofia muscular miotónica, Miocardiopatia, Disritmias, Keywords: Myotonic dystrophy, Cardiomyopathy, Arrhythmia

Através dos registos geomorfológicos e sedimentares, os rios fornecem relevantes arquivos de mudanças paleoambientais, nomeadamente paleoclimáticas e paleogeográficas. As sucessões sedimentares melhor datadas são as mais importantes, com as idades numéricas dos respetivos dos eventos sedimentares, de fósseis e de materiais arqueológicos, obtidas por uma variedade de técnicas. Os arquivos fluviais do Quaternário fornecidos pelo rio Tejo em Portugal (Baixo Tejo) constituem um importante repositório de dados para estudos da evolução da dinâmica sedimentar e da paisagem, bem como da ocupação humana pré-histórica. O atual estado de conhecimentos resultantes das sucessivas abordagens usando métodos da geomorfologia, litostratigrafia, arqueologia e datação numérica no estudo do Terraço T4 do Baixo Tejo é aqui sintetizado. Este trabalho tem enfoque nos sítios com indústrias do Paleolítico que foram encontradas no Terraço T4, o qual é constituído por uma unidade basal de cascalheiras e uma unidade superior dominada por areias. Os mais antigos artefactos são de rara ocorrência e foram encontrados na unidade de Cascalheiras Inferiores, apresentando formas bifaciais pouco elaboradas que podem ser atribuídas ao Acheulense, com uma idade provável de ca. 340 a 325 ka. Em contraste, os níveis estratigráficos inferiores e médios da unidade de Areias Superiores do T4 apresenta vários sítios arqueológicos que documentam fases sucessivas de um Acheulense evoluído, que foram datados de ca. 325 a 200 ka. Nos níveis estratigráficos dos depósitos do topo do T4 foram encontradas indústrias do Paleolítico Médio e datam, provavelmente, de ca. 165 a 155 ka.

There are multiple hypotheses for human responses to glacial cycling in the Late Pleistocene, including changes in population size, interconnectedness, and mobility. Lithic technological analysis informs us of human responses to environmental change because lithic assemblage characteristics are a reflection of raw material transport, reduction, and discard behaviors that depend on hunter-gatherer social and economic decisions. Pinnacle Point Site 5-6 (PP5-6), Western Cape, South Africa is an ideal locality for examining the influence of glacial cycling on early modern human behaviors because it preserves a long sequence spanning marine isotope stages (MIS) 5, 4, and 3 and is associated with robust records of paleoenvironmental change. The analysis presented here addresses the question, what, if any, lithic assemblage traits at PP5-6 represent changing behavioral responses to the MIS 5-4-3 interglacial-glacial cycle? It statistically evaluates changes in 93 traits with no a priori assumptions about which traits may significantly associate with MIS. In contrast to other studies that claim that there is little relationship between broad-scale patterns of climate change and lithic technology, we identified the following characteristics that are associated with MIS 4: increased use of quartz, increased evidence for outcrop sources of quartzite and silcrete, increased evidence for earlier stages of reduction in silcrete, evidence for increased flaking efficiency in all raw material types, and changes in tool types and function for silcrete. Based on these results, we suggest that foragers responded to MIS 4 glacial environmental conditions at PP5-6 with increased population or group sizes, 'place provisioning', longer and/or more intense site occupations, and decreased residential mobility. Several other traits, including silcrete frequency, do not exhibit an association with MIS. Backed pieces, once they appear in the PP5-6 record during MIS 4, persist through MIS 3. Changing paleoenvironments explain some, but not all temporal technological variability at PP5-6.

Background and Objective: To combine the results of the best scientific evidence in order to compare the effects of cardiac resynchronization therapy (CRT) in heart failure patients with atrial fibrillation (AF) and in sinus rhythm (SR) and to determine the effect of atrioventricular nodal ablation in AF patients. Methods: The electronic databases PubMed, B-On and Cochrane CENTRAL were searched, and manual searches were performed, for randomized controlled trials and cohort studies up to November 2012. The endpoints analyzed were all-cause and cardiovascular mortality and response to CRT. Results: We included 19 studies involving 5324 patients: 1399 in AF and 3925 in SR. All-cause mortality was more likely in patients with AF compared to patients in SR (OR=1.69; 95% CI: 1.20–2.37; p=0.002). There were no statistically significant differences in cardiovascular mortality (OR=1.36; 95% CI: 0.92–2.01; p=0.12). AF was associated with an increased likelihood of lack of response to CRT (OR=1.41; 95% CI: 1.15–1.73; p=0.001). Among subjects with AF, ablation of the atrioventricular node was associated with a reduction in all-cause mortality (OR=0.42; 95% CI: 0.22–0.80; p=0.008), cardiovascular death (OR=0.39; 95% CI: 0.20–0.75; p=0.005) and the number of non-responders to CRT (OR=0.30; 95% CI: 0.10–0.90; p=0.03). Conclusions: The presence of AF is associated with increased likelihood of all-cause death and non-response to CRT, compared to patients in SR. However, many patients with AF benefit from CRT. Atrioventricular nodal ablation appears to increase the benefits of CRT in patients with AF. Resumo: Introdução e objetivos: Combinar os resultados da melhor evidência científica de forma a comparar os efeitos da terapêutica de ressincronização cardíaca (TRC) em doentes com insuficiência cardíaca em fibrilhação auricular (FA) e em ritmo sinusal (RS) e determinar a influência da ablação auriculoventricular (AV) no grupo de doentes em FA. Métodos: A pesquisa realizou-se nas bases de dados eletrónicas da PubMed, B-On e CENTRAL e de forma manual, incluindo ensaios clínicos controlados aleatorizados e estudos de coorte até novembro de 2012. Analisou-se a mortalidade total e cardiovascular e a resposta à TRC. Resultados: Foram incluídos 19 estudos que envolveram 5324 pacientes: 1399 em FA e 3925 em RS. O grupo com doentes em FA apresenta maior risco de mortalidade total, comparativamente ao grupo de doentes em RS (OR=1,69; IC 1,20–2,37, p=0,002). Não foram verificadas diferenças estatisticamente significativas quanto à mortalidade cardiovascular (OR=1,36, IC 0,92–2,01, p=0,12). A não resposta à TRC foi maior no grupo em FA (OR=1,41; IC 1,15–1,73; p=0,001). Entre os indivíduos em FA, a ablação do nódulo auriculoventricular foi associada à redução da mortalidade total (OR=0,42; IC 0,22–0,80; p=0,008), mortalidade cardiovascular (OR=0,39; IC 0,20–0,75; p=0,005) e número de não respondedores à TRC (OR=0,30; IC 0,10–0,90; p=0,03). Conclusões: A presença de FA está associada a maior probabilidade de morte por todas as causas e de não resposta à TRC, comparativamente aos doentes em RS. Contudo, um número significativo de doentes em FA beneficia da TRC. A ablação AV parece aumentar os benefícios da TRC nos doentes com FA. Keywords: Atrial fibrillation, Cardiac resynchronization therapy, Atrioventricular nodal ablation, Meta-analysis, Palavras-chave: Fibrilhação auricular, Terapêutica de ressincronização cardíaca, Ablação auriculoventricular, Metanálise

FUNDAMENTO: Apesar da evolução tecnológica do cardiodesfibrilador implantável, uma das questões que permanece em aberto é sobre o eventual benefício do cardiodesfibrilador implantável de dupla câmara comparativamente ao de câmara única, para diminuir os choques inapropriados. OBJETIVO: Avaliar, em pacientes com cardiodesfibrilador implantável, qual é o tipo de dispositivo que proporciona menor número de choques inapropriados (câmara dupla versus câmara única). MÉTODOS: Meta-análise da literatura publicada, de estudos randomizados, comparando cardiodesfibrilador implantável de câmara dupla ao de câmara única, que tenham, como endpoint avaliado, a ocorrência de choques inapropriados. RESULTADOS: O cardiodesfibrilador implantável de câmara dupla não mostrou benefícios na redução do número de pacientes com choques inapropriados. Pelo contrário, na análise de efeitos fixos, a associação foi tendencialmente favorável ao cardiodesfibrilador implantável de câmara única (OR = 1,53; IC95%: 0,91-2,57), não obstante a ausência de significado estatístico (p = 0,11). Merece destaque a heterogenia observada nos resultados (I2 = 53%), o que motivou a replicação da análise utilizando um modelo de efeitos aleatórios. No entanto, as diferenças significativas permaneceram na ocorrência de choques inapropriados em ambos os grupos (OR = 1,1; IC95%: 0,37-3,31; p = 0,86). Para complementar a análise, procedeu-se à análise de sensibilidade, na qual se verificou que a exclusão de um estudo resultava na mais baixa heterogenia observada (I2=24%) e na associação com os choques inapropriados significativamente favorável ao cardiodesfibrilador de câmara única (OR = 1,91; IC95%: 1,09-3,37; p = 0,27). CONCLUSÕES: Verificou-se a não existência de evidência clara de superioridade de qualquer um dos dispositivos avaliados.

FUNDAMENTO: A doença cardiovascular continua a ser principal causa de morte nos países desenvolvidos e não é inteiramente prevista por fatores de risco clássicos. O aumento da rigidez arterial constitui um importante determinante de morbidade e mortalidade cardiovascular. OBJETIVO: Avaliar se a velocidade da onda de pulso prediz a ocorrência de acidente vascular cerebral (AVC) em pacientes hipertensos. MÉTODOS: Estudo de coorte, observacional, prospetivo, multicêntrico, incluindo 1.133 pacientes hipertensos (586 homens), com uma média de idade de 51,05 ± 12,64 anos. Todos os pacientes foram submetidos à avaliação da VOP pelo método Complior, a uma avaliação clínica pormenorizada e à medição da pressão arterial. RESULTADOS: A incidência cumulativa de risco de AVC nos hipertensos com VOP aumentada foi de 3,25% (IC: 1,97%-5,25%), em comparação com 0,78% (IC: 0,28% - 1,87%) nos hipertensos com VOP normal (risco relativo (RR) = 4,15; IC: 1,53 - 11,26). Numa análise multivariável, ajustando o modelo aos fatores de risco cardiovasculares clássicos, a VOP foi um preditor independente de AVC, com um hazard ratio (HR) = 1,40 (IC: 1,13 - 1,73, p < 0,002), indicando um incremento de 40% no risco de AVC por cada incremento de 1 m/seg na VOP. A adição da VOP a um modelo composto pelos fatores de risco cardiovascular convencionais melhorou significativamente a sua capacidade discriminativa para o risco de AVC (C de Harrel aumentou de 0,68 para 0,71 após inclusão da VOP; p BACKGROUND: Cardiovascular disease remains the leading cause of death in developed countries and is not entirely predicted by classic risk factors. Increased arterial stiffness is an important determinant of cardiovascular morbidity and mortality. OBJECTIVE: To assess whether Aortic Pulse Wave Velocity (PWV) predicts the occurrence of stroke in hypertensive patients METHODS: A cohort, observational and prospective study, including 1133 hypertensive patients (586 men), with a mean age 51.05 ± 12.64 years, was designed. PWV with the Complior method was performed in all patients, as well as a detailed clinical evaluation and blood pressure measurement. RESULTS: The cumulative incidence of stroke in hypertensive patients with increased PWV was 3.25% (CI: 1.97% -5.25%), compared with 0.78% (CI: 0.28% -1.87%) in hypertensive patients with normal PWV (Risk Ratio (RR) =4.15; CI:1.53-11.26). In a multivariate analysis, adjusting the model to classical cardiovascular risk factors, PWV was an independent predictor of stroke, with a Hazard Ratio (HR) = 1.40 (CI:1.13-1.73, p

FUNDAMENTO: Pacientes com Doença Arterial Periférica (DAP) possuem um risco elevado de eventos cardiovasculares existindo uma elevada prevalência dessa patologia em pacientes com doença renal crônica. OBJETIVO: O objetivo deste estudo consiste em verificar se existe uma associação entre a DAP e a função renal em pacientes hipertensos. MÉTODOS: A amostra deste estudo foi constituída por um total de 909 pacientes com hipertensão arterial. Foi avaliada a presença de DAP, com recurso ao índice tornozelo-braço (ITB), e a determinação da função renal com base no cálculo da taxa de filtração glomerular. Os indivíduos foram divididos em grupos de acordo com o ITB anormal (< 0,9) e normal (0,9-1,4). RESULTADOS: A porcentagem de pacientes com um ITB anormal foi de 8%. No grupo de pacientes com ITB anormal a prevalência de doença renal crônica foi de 23,4%, comparativamente a uma prevalência de 11,2% no grupo com ITB normal. Por meio da análise de regressão logística multivariável, ajustando o modelo aos factores de risco cardiovasculares convencionais, identificou-se um efeito estatisticamente significativo e independente da eTFG sobre a probabilidade de desenvolvimento de DAP, com um OR de 0,987 (IC: 0,97-1,00). CONCLUSÃO: Demonstrou-se uma associação independente entre a DAP e a doença renal crônica. Dessa forma, a combinação de um diagnóstico preciso da doença renal e a medida de rotina do ITB poderá constituir um meio mais eficiente de identificação de DAP subclínica, permitindo aos indivíduos se beneficiarem de intervenções precoces com o intuito da diminuição do risco cardiovascular.BACKGROUND: Patients with peripheral arterial disease (PAD) have a high risk of developing cardiovascular events. There is a high prevalence of PAD in individuals with kidney disease and both are important risk factors for cardiovascular events. OBJECTIVE: The aim of this study was to investigate the association between PAD and renal function in hypertensive patients. METHODS: The sample consisted of 909 individuals with arterial hypertension. The presence of PAD was evaluated using the ankle-brachial index (ABI) method and renal function was assessed based on the estimated glomerular filtration rate (eGFR). The subjects were divided into groups, according to abnormal (ABI < 0.9) and normal ABI (ABI 0.9-1.4). RESULTS: The percentage of subjects with abnormal ABI was 8%. In the group of individuals with abnormal ABI, prevalence of CKD was 23.4%, compared to a prevalence of 11.2% in patients with normal ABI. Multivariable logistic regression analysis, after adjusting the model to the conventional cardiovascular risk factors, identified a statistically significant and independent effect of eGFR on the likelihood of developing PAD, with an OR of 0.987 (CI: 0.97-1.00). CONCLUSION: An independent association between PAD and chronic kidney disease was observed in the present study. Therefore, the combination of an accurate diagnosis of kidney disease and routine ABI evaluation could constitute a more efficient means to identify subclinical PAD, allowing individuals to benefit from early interventions, aiming at reducing cardiovascular risk.

O escore de CHADS2 é um método de estratificação do risco de eventos cardiovasculares, sendo útil na decisão terapêutica em doentes de moderado/alto risco. Esta metanálise tem como objectivo averiguar se o escore de CHADS2 é eficaz na predição de eventos cerebrovasculares em doentes com Fibrilação Auricular (FA). Realizou-se uma pesquisa bibliográfica informatizada nos motores de busca PubMed, EMBASE e SciELO, durante o período de março de 2011 a abril de 2012. Os estudos foram seleccionados de acordo com critérios predeterminados. A metanálise incidiu em seis estudos de coorte, observacionais e prospectivos, que avaliaram a capacidade preditiva do escore de CHADS2 para eventos cerebrovasculares e morte. Os endpoints definidos (mortalidade e/ou Acidente Vascular Cerebral [AVC] não fatal) foram comparados entre doentes com CHADS2 < 2 e doentes com CHADS2> 2, e também em função da presença/ausência de FA. No que diz respeito à ocorrência de eventos cardiovasculares combinados, morte e AVC, observou-se um maior risco no grupo com escore de CHADS2 > 2 e com FA crônica, com Odds Ratio (OR) respectivamente de 2.92 (IC:2.08-4.10; p < 0.00001), 2.85 (IC:2.23-3.65; p < 0.00001) e 3.23 (IC:2.11-4.94; p < 0.00001). Demonstrou-se ainda que o risco de ocorrência de eventos cardiovasculares é maior para indivíduos com CHADS2 > 2, independentemente da presença de FA: OR = 2.93 (IC:2.81-3.06; p < 0,00001) nos doentes com FA; OR = 2.94; (IC:2.87-3.01; p < 0,00001) nos doentes sem FA. Os estudos indicam claramente a capacidade discriminativa do escorede CHADS2 para o risco de eventos cerebrovasculares, independentemente da presença ou não de FA, permitindo desta forma identificar doentes de moderado/alto risco e seleccionar estratégias terapêuticas adequadas.

FUNDAMENTO: Os indivíduos com insuficiência renal crônica terminal estão sujeitos a um elevado estresse cardíaco pelo carácter repetitivo e intermitente da terapia dialítica. As alterações na sístole elétrica ventricular induzidas pela necessária terapia dialítica são um contributo importante na predição da ocorrência de morte súbita arrítmica na insuficiência renal crônica terminal. OBJETIVO: O objetivo principal desta investigação é avaliar o comportamento da repolarização ventricular em face da terapia dialítica, mediante o estudo do intervalo QTc e dispersão do QTc. MÉTODOS: A amostra em estudo inclui 47 indivíduos sujeitos a hemodiálise (61,7% do sexo masculino e 38,3% do sexo feminino) com idade média de 66,79 ± 13,16 anos. Todos os indivíduos foram sujeitos a três eletrocardiogramas realizados em três momentos durante a terapia dialítica (pré, durante e após a sessão), sendo posteriormente analisada a sístole elétrica ventricular. RESULTADOS: Ocorreu um aumento do intervalo QTc máximo e da dispersão do QTc associado à terapia dialítica. Aliado ao aumento desses intervalos ocorreu um aumento do número de indivíduos com critérios eletrocardiográficos para hipertrofia ventricular esquerda, registando-se no período pós-diálise uma média superior do intervalo QTc máximo (473 ± 27,63 mseg) e da dispersão do QTc (58,95 ± 18,87 mseg) desses indivíduos, comparativamente aos indivíduos sem HVE, 455,21 ± 26,85 mseg e 44 ± 16,41 mseg, respectivamente. CONCLUSÃO: O presente estudo confirmou um aumento do intervalo QTc e da dispersão do QTc associado à terapia dialítica. Esse aspecto reforça a dependência da repolarização ventricular em relação ao equilíbrio hídrico e eletrolítico e sugere um perfil de maior vulnerabilidade arrítmica associada à terapia dialítica.

El Paleolítico Superior del Suroeste de la Península Ibérica está marcado por la presencia de conjuntos de cantos tallados y lascas en cuarcita. La caracterización detallada a nivel regional y cronológico de estos conjuntos es de la mayor importancia, ya que, en las fases más recientes del Paleolítico, se pueden encontrar sin asociación a fósiles-guía o depósitos datables. En este estudio, hemos utilizado 36 conjuntos de cuarcita de esa región para poner a prueba el carácter diagnóstico de esta materia prima a través de análisis de tributos y remontajes. Los resultados indican que Gravetiense, Solutrense y Magdaleniense se pueden distinguir en sus conjuntos de cuarcita, lo que permite, por sí mismo, la diferenciación de la secuencia clave del Paleolítico Superior. También indican que los conjuntos Gravetiense y Magdaleniense están tecnológicamente más próximos entre sí que respecto al Solutrense, un patrón posiblemente relacionado con la adaptación al Último Máximo Glaciar.

FUNDAMENTO: O diabetes mellitus é uma doença crônica muito comum e ultimamente tem apresentado um considerável aumento da prevalência e incidência. Os diabéticos apresentam uma grande mortalidade cardiovascular na qual as arritmias ventriculares malignas parecem estar implicadas. OBJETIVO: Este trabalho propõe o estudo dos efeitos do diabetes nos parâmetros da repolarização ventricular responsáveis pelo aumento da suscetibilidade a arritmias ventriculares malignas e/ou morte súbita. MÉTODOS: Foi selecionado um grupo de 110 diabéticos e outro de 110 controles com a mesma distribuição de idade, sexo e raça. Avaliaram-se os parâmetros da repolarização ventricular QTmáx, QTméd, QTmín, QTc máx, QTc méd, QTc mín, dispersão de QT e de QTc, intervalo Tpeak-Tend e jTpeak-jTend (D II, V2 e V5), dispersão de Tpeak-Tend e de jTpeak-jTend. A aquisição do eletrocardiograma (ECG) foi efetuada pelo mesmo operador e a avaliação pelos mesmos observadores. Os intervalos QT foram corrigidos segundo a fórmula de Bazzet. RESULTADOS: Foram encontrados em diabéticos valores significativamente superiores aos controles de QTc máx (p < 0,001), QTc méd (p < 0,001), dispersão de QT (p < 0,001), dispersão de QTc (p < 0,001), dispersão de Tpeak-Tend (p < 0,001) e dispersão de jTpeak-jTend (p < 0,001). Em diabéticos verificaram-se valores prolongados do intervalo QTc (5,5%), dispersão de QT (0,9%), dispersão de QTc (0%), intervalo Tpeak-Tend (7,3%), intervalo jTpeak-jTend (6,4%), dispersão de Tpeak-Tend (16,4%) e dispersão de jTpeak-jTend (12,7%). Nos controles não se verificaram valores prolongados de nenhum parâmetro. CONCLUSÃO: Concluímos que o diabetes causa prolongação e dispersão espacial da repolarização, podendo contribuir para maior instabilidade elétrica ventricular da qual as arritmias ventriculares malignas poderão ser a expressão clínica expectável.BACKGROUND: Diabetes mellitus is a chronic and very common condition, and there has been lately a considerable increase in its prevalence and incidence. Diabetic patients have increased cardiovascular mortality, in which malignant ventricular arrhythmias seem to be implicated. OBJECTIVE: To study the effects of diabetes on ventricular repolarization parameters responsible for an increased susceptibility to malignant ventricular arrhythmias and/or sudden death. METHODS: We selected a group of 110 diabetic patients and a group of 110 controls with the same distribution of age, gender and race. We evaluated the following parameters of ventricular repolarization: QTmax, QTmean, QTmin, QTc max, QTc mean, QTc min, QT and QTc dispersions, Tpeak-Tend and jTpeak-jTend intervals (D II, V2 and V5), Tpeak-Tend and jTpeak-jTend dispersions. The electrocardiograms (ECG) were performed by the same operator and reviewed by the same observers. QT intervals were corrected according to Bazzet's formula. RESULTS: We found significantly higher values of QTc max (p < 0.001), QTc mean (p < 0.001), QT dispersion (p < 0.001), QTc dispersion (p < 0.001), Tpeak-Tend dispersion ( p < 0.001), and jTpeak-jTend dispersion (p < 0.001) in diabetic patients than in controls. In diabetic patients, we observed prolonged values of QTc interval (5.5%), QT dispersion (0.9%), QTc dispersion (0%), Tpeak-Tend interval (7.3%), jTpeak-jTend interval (6.4%), Tpeak-Tend dispersion (16.4%), and jTpeak-jTend dispersion (12.7%). In the controls there were no prolonged values of any of the parameters. CONCLUSION: We concluded that diabetes causes prolongation and spatial dispersion of repolarization, and it may contribute to a greater ventricular electrical instability, whose expected clinical expression may be malignant ventricular arrhythmias.

O objetivo deste trabalho foi conhecer os níveis de ansiedade, depressão e burnout em enfermeiros que trabalham por turnos. A recolha de dados foi realizada através de um questionário que engloba dois instrumentos previamente traduzidos e validados para a população portuguesa: Hospital Anxiety and Depression Scale (HADS) e Maslach Burnout Inventory (MBI). Este questionário foi aplicado antes e após o turno da tarde. Em ambos os momentos, os inquiridos obtiveram níveis médios de exaustão emocional e baixos níveis de realização pessoal e de despersonalização (MBI). Relativamente à ansiedade e à depressão, os valores obtidos foram compatíveis com um nível moderado de ansiedade e ligeiro de depressão (HADS). Não se encontraram diferenças estatisticamente significativas (dos níveis de ansiedade, depressão e burnout) do primeiro para o segundo momento de avaliação. É fundamental que o profissional de saúde responsável pela gestão esteja desperto para estas questões, podendo, assim, adotar medidas preventivas.El objetivo de este trabajo se centró en conocer los niveles de ansiedad, depresión y burnout en enfermeras que trabajan por turnos. La recolección de datos se realizó mediante la elaboración de un cuestionario que incluyó dos instrumentos previamente traducidos y validados para la población portuguesa: Hospital Anxiety and Depression Scale (HADS) y Maslach Burnout Inventory (MBI). Este cuestionario fue aplicado antes y después del turno de la tarde. En ambos momentos, los participantes obtuvieron niveles promedio de agotamiento emocional, niveles bajos de realización personal y de despersonalización (MBI). Con respecto a la ansiedad y la depresión, los valores obtenidos concuerdan con un nivel moderado de ansiedad y de depresión leve (HADS). No se observaron diferencias estadísticamente significativas (de niveles de ansiedad, depresión y burnout) entre la primera y segunda etapa de evaluación. Es esencial que el profesional de la salud responsable por la gestión sea consciente de estos asuntos, y que pueda así, tomar medidas preventivas.The objective of this work is to recognize anxiety, depression and burnout levels in nurses working in shifts. Data collection was performed through the development of a questionnaire including two instruments previously translated and validated for the Portuguese population: Hospital Anxiety and Depression Scale (HADS) and Maslach Burnout Inventory (MBI). This questionnaire was administered before and after the afternoon shift. In both stages of evaluation, participants had average levels of emotional exhaustion, low personal accomplishment and depersonalization (MBI). Regarding anxiety and depression, the values obtained were consistent with a moderate level of anxiety and mild level of depression (HADS). No statistically significant differences were found between (levels of anxiety, depression and burnout) at the first and second assessment points. It is crucial that health professionals responsible for management are aware of these issues and can thus take preventive measures.

FUNDAMENTO: O Acidente Vascular Cerebral (AVC) constitui uma das primeiras causas de morte a nível mundial. A importância do espessamento da íntima-média na estratificação de risco cardiovascular tem sido recorrentemente estudada; contudo, essa relação gera ainda alguma controvérsia. OBJETIVOS: Determinar se o espessamento da íntima-média na Artéria Carótida Comum (ACC) pode ser utilizado como um marcador independente de alto risco para a ocorrência do AVC. MÉTODOS: A amostra compreende um grupo de 948 doentes consecutivamente estudados por Triplex Scan Cervical no período compreendido entre janeiro de 2004 e junho de 2009. Esses doentes foram agrupados em razão da presença ou ausência de AVC recente, do que resultou um grupo de doentes com AVC Isquémico (AVC I) (n = 452, 48%), outro com AVC Hemorrágico (AVC H) (n = 22, 2%) e um grupo de doentes Sem Eventos (n = 474, 50%). RESULTADOS: Na análise de regressão logística ajustada para fatores de risco cardiovascular clássicos, o espessamento da íntima-média na ACC associou-se significativamente e de forma aproximadamente linear com o AVC I (Odds Ratio = 1.808, Intervalo de Confiança: 1.291-2.534, p = 0,01), mas não com o AVC H (p = ns). Uma interação significativa com a idade foi também encontrada, demonstrando-se uma capacidade discriminativa do risco de AVC I maior em indivíduos com idade inferior a 50 anos. CONCLUSÕES: O espessamento da íntima-média na ACC revelou-se um preditor de risco independente para o AVC I, mas não para AVC H reforçando assim a utilidade da sua avaliação na prática clínica. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0)BACKGROUND: Stroke is one of the major causes of death worldwide. The importance of increased intima-media thickness in cardiovascular risk stratification has been recurrently studied. The relationship between them, however, is still controversial. OBJECTIVES: To determine whether increased common carotid artery (CCA) intima-media thickness can be used as an independent high-risk marker for the occurrence of stroke. METHODS: This study sample comprised 948 patients consecutively assessed by use of cervical triplex scan from January 2004 to June 2009. Those patients were divided into groups according to the presence or absence of recent stroke as follows: a group of patients with ischemic stroke (n = 452, 48%); a group of patients with hemorrhagic stroke (n = 22, 2%); and a group of patients with no events (n = 474, 50%). RESULTS: On logistic regression analysis adjusted for the classic cardiovascular risk factors, increased CCA intima-media thickness associated significantly and on an approximately linear way with ischemic stroke (Odds Ratio = 1.808, confidence interval: 1.291-2.534, p = 0.01), but not with hemorrhagic stroke (p = ns). A significant interaction with age was also found, showing a greater discriminative capacity for the risk of ischemic stroke in individuals aged less than 50 years. CONCLUSIONS: The increased CCA intima-media thickness was identified as an independent predictor of the risk for ischemic stroke, but not for hemorrhagic stroke, emphasizing the usefulness of its assessment on clinical practice. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0)

Resumo: Introdução: Atualmente, o diagnóstico da Síndrome de Brugada (SB) obriga à documentação do padrão eletrocardiográfico de repolarização característico denominado tipo 1. Em 38% dos casos familiares desta entidade encontra-se uma mutação do gene SCN5A responsável pela síntese do canal de sódio NaV1.5. A disfunção desta corrente de sódio repercute-se no potencial de ação cardíaco de resposta rápida, fundamentalmente nos miócitos auriculares, nas fibras de Purkinje e nos miócitos ventriculares. Objetivos: Detetar portadores de mutação do SCN5A sem recorrer ao padrão de repolarização no ECG. Métodos: A partir de 3 famílias e de um total de 141 elementos, dos quais 55 portadores (P+) de duas mutações non-sense específicas do SCN5A causadoras de SB, foram estudados os maiores de 16 anos (113 elementos/42 P+). Foi medido no ECG o intervalo PR (PR) em DII e dispersão QT (dQT) entre V1 e V3. No ECG de alta resolução (ECGAR) determinado o QRS filtrado (QRSf), root-mean square (RMS40) e low-averaged signal (LAS). Para detetar P+ foi criado: 1) um teste de rastreio (TesteRas) constituído pelo intervalo PS (PR+QRSf) ≥ 250 (250 ms corresponde a 80% do valor teórico máximo deste intervalo em saudáveis) e 2) um teste diagnóstico (TesteDx) que resulta do cumprimento simultâneo de 4 condições: PS ≥ 250 e dQT > 10 e LAS ≥ 26 e RMS40 ≤ 29 (estes 2 últimos valores correspondem aproximadamente a 70% do valor teórico máximo em saudáveis). Resultados: Encontradas diferenças significativas entre os P+ versus não portadores (P-) do PR, da dQT, do QRSf, do LAS e da RMS40. O gene está associado a todas estas variáveis, sendo a associação mais forte com o PR. A 63 elementos (38 P+) foi aplicado o TesteRas e o TesteDx. O TesteRas foi positivo em 38 de 38 P+ com 8 falsos positivos em 27 P- (sensibilidade [S] =100% e especificidade [E] =66,67%). Na curva Roc para este teste o cut-off PS=252,5 tem S=100% e E=76% e o cut-off PS=260 tem S=94,7% e E=84%. O TesteDx foi positivo em 36 de 38 P+ com 3 falsos positivos: S=94,74% e E=88,89%. Por modelo logístico multivariado identifica-se um cut-off através da curva Roc com S=92% e E=92%. A S e E de diagnóstico do ECG espontâneo usando o padrão de repolarização tipo 1 no mesmo grupo de doentes foram de 52,4% e 97,2%, respetivamente (a diferença de S entre o TesteDx e o padrão de repolarização no ECG é estatisticamente significativa). Conclusões: O TesteRas e o TesteDx são uma ferramenta mais eficaz do que o padrão de repolarização típico para distinguir entre P+ e P- destas duas mutações non-sense do SCN5A. Sugerimos a sua utilização em familiares diretos de casos índice com SB, quando o resultado genético (ainda) não está disponível e num score de probabilidade de doença em indivíduos com ECG de Brugada idiopático ou em indivíduos com sintomas relacionados com arritmias e padrão de repolarização tipo 2 ou 3 de Brugada. Abstract: Introduction: Diagnosis of Brugada syndrome (BS) currently requires documentation of a characteristic repolarization pattern (type 1 Brugada ECG). Mutations in the SCN5A gene, which codes for sodium channel NaV 1.5, are found in 38% of familial cases of BS. Sodium current dysfunction negatively affects the cardiac fast response action potential, particularly in atrial and ventricular myocytes and in the fast-conducting Purkinje system. Objectives: To detect carriers of SCN5A mutations without using the characteristic repolarization pattern (type 1 Brugada ECG). Methods: Of a total of 141 members of three different families including 55 carriers of two nonsense SCN5A mutations causing BS, all those aged over 16 (113 individuals, 42 carriers) were studied. The PR interval (PR) and QT dispersion (QTd) between leads V1 and V3 were measured on conventional ECG. Using signal-averaged ECG the total duration of the filtered QRS complex (fQRS), the root-mean-square (RMS40) and the low-amplitude signal (LAS) were measured. The following procedures were developed to detect carriers/To detect carriers the following procedures were developed: (1) a screening test (ScreenTest) with PS (PR+fQRS) ≥250 (250 ms is 80% of the theoretical maximum in healthy individuals); and (2) a diagnostic test (DiagTest) for the simultaneous fulfillment of four conditions: PS ≥250 and QTd ≥10 and LAS >26 and RMS40 ≤29 (the latter two cut-offs are approximately 70% of the theoretical maximum in healthy carriers). Results: Significant differences in PR, QTd, QRSf, RMS40 and LAS were found between carriers and non-carriers. The SCN5A gene was associated with all these variables, the strongest association being with PR. Both tests were applied to 63 family members (38 carriers). The ScreenTest was positive in 38 of 38 carriers, with eight false positives in 27 non-carriers (sensitivity [SE]=100% and specificity [SP]=66.67%). From ROC curve analysis a cut-off of PS=252.5 shows SE=100% and SP=76% and a cut-off of PS=260 shows SE=94.7% and SP=84%. The DiagTest was positive in 36 of 38 carriers, with three false positives: SE=94.74% and SP=88.89%. From ROC curve analysis a multivariate logistic model identifies a cut-off with SE=92% and SP=92%. In the same group the SE and SP of the characteristic spontaneous repolarization pattern (type 1 Brugada ECG) to detect carriers were 52.4% and 97.2%, respectively, and the difference between the SE of the DiagTest and of the typical repolarization pattern is statistically significant. Conclusions: The ScreenTest and DiagTest are more effective tools than the characteristic repolarization pattern to discriminate between carriers and non-carriers of these two nonsense SCN5A mutations. We suggest their use in first-degree relatives of Brugada patients when the results of genetic testing are not available, in a score of disease probability in individuals with idiopathic Brugada ECG, and in patients with arrhythmias or other Brugada-related symptoms presenting type 2 or type 3 Brugada ECG. Palavras-chave: Síndrome de Brugada, Score diagnóstico, SCN5A, Keywords: Brugada syndrome, Diagnostic score, SCN5A gene

Resumo: Introdução: A velocidade da onda de pulso carotideo-femoral (VOP) tem constituído um importante marcador de risco cardiovascular, traduzindo o reflexo arterial subsequente a um conjunto de contextos clínicos em que o impacto cardiovascular é manifesto. Este trabalho visou estabelecer parâmetros de normalidade da VOP para a população portuguesa, com base numa definição estatística. Método: O presente trabalho corresponde a uma sub-análise do Projecto EDIVA, envolvendo 668 indivíduos saudáveis (412 do sexo masculino), com idade média 39,73 ± 15,6 anos, índice de massa corporal 25,56 ± 4,05 kgm2, pressão arterial sistólica e diastólica respectivamente 125,47 ± 11,18 e 75,75 ± 9,27 mmHg. Estes indivíduos foram submetidos a um follow-up médio de 23,3 ± 3,34 meses, com avaliação anual da VOP. A normalidade foi definida em termos da história pessoal e familiar, da avaliação clínica, do ECG de superfície e da realização de exames analíticos de rotina. Resultados: A VOP média na amostra foi de 8,8 ± 1,4 m/s, sendo de 8,7 ± 1,6 m/s e 8,9 ± 1,5 m/s, respectivamente no sexo feminino e masculino (p = ns). A normalidade foi definida a partir do percentil 95 para cada faixa etária, e por género. A avaliação sequencial permitiu ainda avaliar o contributo percentual de agravamento da VOP face ao envelhecimento (5%), definindo-se assim uma variação positiva da VOP (em avaliações sequenciais) inferior a 5% como normal. Conclusão: Os resultados obtidos permitem: por um lado, estabelecer critérios de referência para a VOP tendo em consideração o papel determinante do envelhecimento na deterioração fisiológica da função das grandes artérias; por outro lado, estabelecer uma medida de valorização da variação longitudinal da VOP, aspecto que se reveste de grande importância face à adopção desta metodologia em programas integrados de seguimento de doentes com risco cardiovascular manifesto. Abstract: Introduction: Aortic pulse wave velocity (PWV) has been associated with cardiovascular risk in different clinical subsets. This subanalysis of the EDIVA project aimed to establish criteria for normality of PWV based on a statistical definition that considers the fundamental physiological role of aging in arterial stiffness. Methods: A sample of 668 healthy subjects (412 male) enrolled in the EDIVA Project (a prospective, multicenter, observational study) were studied. Mean age was 40.00 ± 13.42 years, body mass index was 25.90 ± 4.21 kg/m2, and systolic and diastolic blood pressure were respectively 125.47 ± 11.18 and 75.75 ± 9.27 mmHg. PWV was determined annually using a Complior device, and mean follow-up was 23.3 ± 3.34 months. Personal and family history, physical examination, electrocardiogram and biochemical analysis were used to determine individual health. Results: In the overall population PWV was 8.8 ± 1.4 m/sec, 8.7 ± 1.6 m/sec in men and 8.9 ± 1.5 m/sec in women (p = NS). Normal PWV was defined as the 95th percentile adjusted for age and gender, above which PWV was considered abnormal. Serial evaluation of PWV also enabled the annual age-dependent increase in PWV to be estimated at 5%, values above this cut-off being defined as abnormal vascular deterioration. Conclusion: This study establishes criteria for normality based on a statistical definition that takes into account the fundamental physiological role of aging in arterial stiffness. Additionally, it provides a cut-off for the clinical interpretation of serial PWV measurements. Palavras-chave: Velocidade da onda de pulso, Distensibilidade arterial, Normalidade, Risco cardiovascular, Keywords: Pulse wave velocity, Arterial stiffness, Normality, Reference values

Located at the crossroads of two rather different ecological and cultural worlds (Mediterranean Spain and Portuguese Atlantic), the site of Vale Boi is a crucial element in understanding the economic and social traits of the communities that inhabited Southwestern Iberia during the Last Glacial Maximum (LGM). Combining an open-air with a rockshelter component, Vale Boi presents a lengthy Solutrean record starting with a Proto-Solutrean phase followed by a set of occupations in the 25 to 20.3 ka cal BP time-span. The very rich and well preserved assemblages proved that the site was treated, throughout, as a seasonal residential camp and although a striking combination of exogenous cultural traits has been identified, regional adaptive idiosyncrasies are quite evident. This paper focuses on the results of the lithics, fauna, beads and portable art analysis from Vale Boi, and their impact on the comprehension of the LGM ecodynamics in Southwestern Iberia.Localizado en el marco de dos contextos diferentes desde el punto de vista ecológico y cultural (el Mediterráneo español y el Atlántico portugués), el yacimiento de Vale Boi (Algarve, Portugal) es un lugar fundamental para comprender la organización económica y social de las comunidades que habitaron el sudoeste de la Península Ibérica durante el Último Máximo Glacial (LGM). Situado en una zona en la que se combinan ocupaciones al aire libre y en abrigo, Vale Boi presenta un amplio registro solutrense que comienza con el el Proto-Solutrense y a la que le siguen un amplio número de ocupaciones entre el 25 y el 20,3 ka BP. El importante y bien preservado conjunto demuestra que este asentamiento funcionó como un campamento residencia estacional. Aunque han sido identificados diversos caracteres culturales de origen exógeno, son también evidentes los elementos adaptativos idiosincráticos. El presente artículo se centra en los resultados de los análisis del utillaje lítico, la fauna, las cuentas ornamentals y los objetos de arte mueble de Vale Boi y su impacto en la comprensión ecodinámica del LGM en el Sudoeste de la Península Ibérica.