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Introduction: Cardiac rehabilitation (CR) has been demonstrated to improve exercise capacity in acute coronary syndrome (ACS), but not all patients derive the same benefit. Careful patient selection is crucial to maximize resources. Objective: To identify in a heterogeneous ACS population which patients would benefit the most with CR, in terms of functional capacity (FC), by using cardiopulmonary exercise testing (CPET). Methods: A retrospective analysis of consecutive ACS patients who underwent CR and CPET was undertaken. CPET was performed at baseline and after 36 sessions of exercise. Peak oxygen uptake (pVO2), percentage of predicted pVO2, minute ventilation/CO2 production (VE/VCO2) slope, VE/VCO2 slope/pVO2 and peak circulatory power (PCP) (pVO2 times peak systolic blood pressure) were assessed in two moments. The differences in pVO2 (ΔpVO2), %pVO2, PCP and exercise test duration were calculated. Patients were classified according to baseline pVO2 (group 1,

The number of patients treated with abdominal aortic aneurysm (AAA) increased considerably in the last decades. Even though open surgery remains the gold standard for AAA treatment, endovascular techniques like Chimney grafts (CGs) showed to be reliable to treat patients with contraindications for conventional surgery and hostile neck aneurysms. CGs are off-the-shelf stents which are accessible and useful for urgent/emergent cases. This work reports a case of a 67 years-old caucasian male with a symptomatic infrarenal aortic aneurysm having a 2.5mm short neck and a maximum diameter of 67 mm. Due to patient comorbidities and after ruling out other causes for the pain, he was treated in urgency with chimney technique to prevent rupture.

Introduction: A number of guidelines for the management of carotid disease are available to help clinicians in therapeutic decision and provide useful guidance for the best care of the patients. They stated that carotid endarterectomy (CEA) has some benefit in symptomatic patients with carotid stenosis of 50-69% and is highly beneficial in stenosis of 70-99%, with mortality/ stroke rate less than 6%. The maximum benefit is observed when surgery is performed within two weeks after the cerebrovascular event. CEA in asymptomatic patients should be offered to patients with life expectancy higher than 5 years, stenosis of >70%, and perioperative complications should be less than 3%. The aim of this study is to analyse our clinical practice, review treated patients and referral times and compare the outcomes of our institutional practice with published guidelines. Material and methods: Retrospective study of patients undergoing carotid endarterectomy at Centro Hospitalar Universitário do Porto between 2010 and 2015. Results: Between 2010 and 2015, 404 patients underwent CEA, 76% men, and mean age 69 years for both sexes. The degree of stenosis was usually evaluated by ultrasound. The use of complementary study with angio-CT was required in 20% and angiography in 2.2% of the cases. The majority of patients (54.2%) were symptomatic (stroke/ TIA

A hemorragia major é uma complicação conhecida da biópsia renal percutânea, com uma taxa aproximada de 2,2%. A embolização arterial selectiva é um procedimento seguro, eficaz e pouco invasivo, com aplicação importante na gestão de hemorragias ativas, como por exemplo nas lesões iatrogénicas após biópsia renal. Caso clínico de doente do sexo feminino, 52 anos. No contexto do diagnóstico imagiológico de neoplasia renal metastizada, submetida a biopsia renal percutânea. Admitida na sala de emergência, 3 horas após a biópsia renal, por choque hemorrágico, com angio-TC a evidenciar volumoso hematoma retroperitoneal com sinais de hemorragia ativa na dependência da neoplasia renal. Por ausência de condições para intervenção cirúrgica, foi realizada angiografia com intenção de controlo da hemorragia. Procedeu-se a embolização selectiva do foco hemorrágico com micropartículas PVA (álcool polivinílico). Após realização do procedimento, a doente evoluiu favoravelmente do ponto de vista hemodinâmico, com resolução do choque hemorrágico.

Introdução: Os resultados a longo prazo do EVAR dependem da fixação proximal da endoprótese de forma a evitar migração da mesma e o desenvolvimento de endoleak tipo Ia. As características anatómicas do colo aneurismático, nomeadamente a presença de trombo, podem influenciar os resultados do EVAR. Objetivos: Estudar a relação entre o trombo do colo aneurismático e o tipo de endoprótese utilizada e o desenvolvimento de endoleak Ia. Materiais/Métodos: Análise retrospetiva da base de dados de doentes com AAA tratados por EVAR na nossa instituição entre dezembro 2001-2013. Procedemos à revisão de todos os angioTACs pré-operatórios disponíveis (total de 164) e dividimos os doentes em dois grupos: com trombo significativo no colo aneurismático (>25% da circunferência do colo) versus sem trombo significativo. Estudamos ainda o tipo de endoprótese (fixação supra versus infra-renal) utilizada. Posteriormente, avaliamos o follow-up e o desenvolvimento de endoleak tipo Ia. Resultados: Dos 164 doentes, 38 doentes apresentavam trombo > 25% da circunferência aórtica (versus 126 com trombo

Insulin receptor substrate (IRS) 2 is a key mediator of insulin signaling and IRS-2 knockout (IRS2−/−) mice are a preclinical model to study the development of diabetes, as they develop peripheral insulin resistance and beta-cell failure. The differential inflammatory profile and insulin signaling in the hypothalamus of non-diabetic (ND) and diabetic (D) IRS2−/− mice might be implicated in the onset of diabetes. Because the lipid profile is related to changes in inflammation and insulin sensitivity, we analyzed whether ND IRS2−/− mice presented a different hypothalamic fatty acid metabolism and lipid pattern than D IRS2−/− mice and the relationship with inflammation and markers of insulin sensitivity. ND IRS2−/− mice showed elevated hypothalamic anti-inflammatory cytokines, while D IRS2−/− mice displayed a proinflammatory profile. The increased activity of enzymes related to the pentose-phosphate route and lipid anabolism and elevated polyunsaturated fatty acid levels were found in the hypothalamus of ND IRS2−/− mice. Conversely, D IRS2−/− mice have no changes in fatty acid composition, but hypothalamic energy balance and markers related to anti-inflammatory and insulin-sensitizing properties were reduced. The data suggest that the concurrence of an anti-inflammatory profile, increased insulin sensitivity and polyunsaturated fatty acids content in the hypothalamus may slow down or delay the onset of diabetes.

Introdução: As características do colo aneurismático, em particular a presença de trombo, podem limitar o tratamento por EVAR. Objetivos: Estudar se a presença de trombo no colo aneurismático e o tipo de endoprótese utilizada (fixação supra ou infra-renal) têm impacto na função renal dos doentes tratados por EVAR na nossa instituição. Materiais/Métodos: Análise retrospectiva da base de dados de doentes com AAA tratados por EVAR na nossa instituição entre dezembro/2001 e dezembro/2013. Para cada doente avaliamos o valor de creatinina e clearence nos pré e pós-operatório. Dos doentes com agravamento da função renal, selecionamos aqueles que tiveram lesão renal aguda (LRA) pelos critérios de RIFLE modificados, e estudamos a relação entre LRA e trombo do colo aneurismático e tipo de endoprótese utilizado. Da base de dados de 241 doentes foram excluídos os doentes IRC em hemodiálise à data do procedimento e aqueles em que não dispúnhamos de análises com função renal no pré e pós-operatório. Relativamente ao estudo da relação endoprótese utilizada e função renal: 127 foram tratados com endopróteses de fixação supra-renal, 74 com endoproteses de fixação infra-renal e 27 foram excluídos da análise por terem sido tratados com endopróteses torácicas ou não dispormos dessa informação. Relativamente ao estudo do trombo do colo aneurismático, conseguimos esse dado para 190 doentes. Resultados: relativamente ao impacto do trombo do colo aneurismático na função renal verificamos que dos 190 doentes estudados, 21 (11%) desenvolveram LRA no pós-operatório e a presença de trombo no colo em >25% e >50% da circunferência do colo, apresentou relação estatisticamente significativa com o desenvolvimento de LRA (p=0,045 e p=0,010, respetivamente). Relativamente ao estudo das endopróteses utilizadas, 14.2% dos doentes tratados com endopróteses de fixação supra-renal e 5.4% dos tratados com endopróteses de fixação infra-renal desenvolveram LRA no pos-operatório, no entanto esta diferença não se mostrou estatisticamente significativa (p=0,052). Discussão/conclusões: Na nossa experiência a presença de trombo do colo aneurismático teve relação com o desenvolvimento de LRA no pós-operatório imediato mas não parece ter impacto na função renal aos 6 e 12 meses. Os doentes tratados com endopróteses de fixação supra-renal desenvolveram mais LRA no pós-operatório mas esta diferença não se mostrou estatisticamente significativa.

Introduction/Aims: Horseshoe kidney (HSK) is a renal malformation that results from the kidney's fusion in midline. It is an unusual entity that rarely coexists with Abdominal Aortic Aneurysm (AAA). Because of the anatomical characteristics (intimate relationship between kidney and aorta, variability in the renal arteries, veins and collecting systems emergency) conventional surgery can be technically difficult. Endovascular treatment has emerged as a therapeutic alternative in some cases of congenital renal malformations. We report a case of endovascular aneurysm repair (EVAR) in a patient with coexistent AAA and HSK. Material / Methods: We review a case of a patient with coexistent AAA and HSK treated by EVAR in our institution with description of diagnosis, treatment, outcome and complications. Results: A 74-year-old man was referred to our center with an assymptomatic AAA. He had medical history of ischemic heart disease, congestive heart failure and smoking. CT angiography revealed an infrarenal AAA, with 57mm diameter and HSK. After studying anatomical features, the patient was proposed for EVAR. Under general anesthesia both femoral arteries were exposed. An Endurant® II endoprosthesis was deployed immediately distal to an accessory renal artery and two iliac extenders were deployed in the left and one in the right side. Control angiography found an image compatible with endoleak type1 so a new dilatation of the proximal colon with Reliant® balloon was performed. In the final control angiography there was still some reflux into the aneurysmal sac which was interpreted as probable endoleak type 2. Postoperatively angioCT revealed endoleak type 1 which led to reintervention with implantation of an aortic extender Endurant®, with good result. In control angioCT there was no evidence of endoleak and all renal arteries were patent. Conclusions: EVAR has clear advantages in cases of coexistent AAA and HSK, anatomically complex for conventional surgery. Although renal vasculature in these patients is very variable, sometimes with accessory arteries responsible for vascularization of considerable percentages of parenchyma. Thus, preoperative planning is essential to assess the need to exclude accessory renal arteries and consider, individually, the risk / benefit ratio.

O objetivo do presente trabalho foi analisar as Atitudes face ao Desporto e os comportamentos agressivos em dois desportos coletivos, comparando andebolistas e basquetebolistas. Utilizámos o Aggression Questionnaire / Questionário de Agressividade (AQ) (de Buss e Perry, 1992, na versão portuguesa de Cunha e Gonçalves, 2012) e o Sports Attitudes Questionnaire / Questionário de Atitudes face ao Desporto (SAQ) (de Lee, 1996, na versão portuguesa de Gonçalves, Silva, Chatzisarantis, Lee e Cruz, 2006). Participaram no estudo 32 atletas (21 masculinos, 11 femininos), 15 andebolistas e 17 basquetebolistas. Os resultados apontam para a inexistência de diferenças significativas na agressividade (entre as duas modalidades e entre o género dos praticantes). No que respeita às atitudes face ao desporto, encontraram-se diferenças no fator ‘Convenção’ em função do género dos atletas. Foram identificadas associações entre alguns factores da agressividade e das atitudes face ao desporto. Palavras-chave: Atitudes; Desporto; Comportamentos Agressivos; Andebol; Basquetebol;

AbstractThe teaching personal-social responsibility (TPSR) model is a well-established approach for developing positive social behaviors. However, today's research community has diagnosed the need to gather greater empirical evidence regarding the consistency of the evaluation tool in measuring personal-social responsibility levels. Thus, this study was geared towards testing the validity and reliability of a two factor model of the Personal and Social Responsibility Questionnaire (PSRQ) among athletes. A questionnaire was administered to 517 athletes, distributed into two representative samples of different competitive levels, sports and regions. Exploratory and confirmatory factor analyses were used to examine the PSRQ's factor structure. The scale showed good psychometric properties and the factor structure was stable in the two samples, providing evidence of cross validity. Implications and research directions of these results are discussed.

ABSTRACT CONTEXT: The aim of the present clinical review was to illustrate the diagnostic difficulty associated with psychotic experiences during adolescence, in the light of the multiplicity of circumstances interplaying during this period. It was also intended to illustrate the observation that not all hallucinations occur in the context of a declared psychotic disorder. CASE REPORT: The patient was a 16-year-old adolescent girl who came to the Emergency Department of Coimbra Pediatric Hospital. On admission, she displayed mood and sensory perception disorders, with a bizarre gait abnormality. A diagnosis of conversion disorder was finally suggested, in accordance with the International Classification of Diseases, 10th edition. CONCLUSIONS: Conversive hallucinations are rare in the psychiatric literature. This diagnostic hypothesis only gained consistency over a long period of follow-up within a child and adolescent psychiatry outpatient service, which was fundamental for appropriate diagnostic clarification. The authors discuss psychotic experiences that can arise from a neurotic setting and share the reasoning that was constructed in relation to the differential diagnosis. The psychogenesis and phenomenology of this young patient’s conversive hallucinations and the therapeutic strategies adopted over the course of the follow-up are also discussed.

Sport psychology literature suggests that understanding engagement levels is pivotal to promote positive sporting experiences among athletes. The purpose of this study was to examine the psychometric properties of the Athlete Engagement Questionnaire among Portuguese sport athletes. Two distinct samples of Portuguese athletes from different competitive levels were collected, and the results of a confirmatory factor analysis demonstrated a good fit of the model to the data. A review of the psychometric properties indicated that all factors showed good composite reliability, convergent validity, and discriminant validity. In addition, a multi-groups analysis showed the invariance of the model in two independent samples providing evidence of cross validity. Implications of these results for scholars and coaches are discussed and guidelines for future studies are suggested.

O priapismo isquémico é uma ereção persistente, sem relação com estímulo sexual, caracterizada pela redução ou ausência de fluxo sanguíneo intracavernoso. Apresenta-se um caso clínico de um homem de 30 anos, com priapismo com 48 horas de evolução. Foi submetido noutra instituição à drenagem dos corpos cavernosos, instilação de efedrina e criação de shunt cavernoso-esponjoso, sem melhoria do quadro. Ao ecoDoppler observou-se ausência de fluxo nas artérias cavernosas, trombose das veias cavernosas e fluxo venoso dorsal normal. Foi submetido a cirurgia de Grayhack, com construção de pontagens cavernoso-femoral bilateral por transposição segmentar da veia grande safena. Apresentou boa evolução clínica e resolução do priapismo. No 7.◦ dia de pós-operatório apresentou trombose das pontagens, com fluxo de baixa resistência nas artérias cavernosas.

Libman-Sacks endocarditis (LSE) is the most characteristic cardiac manifestation of systemic lupus erythematosus (SLE). It is usually clinically silent but heart failure due to valvular dysfunction, secondary infective endocarditis and embolic phenomena can complicate valvular abnormalities. We present a patient with SLE and blindness due to right central retinal artery occlusion. Echocardiographic examination revealed a verrucous vegetation on the posterior mitral valve leaflet consistent with LSE. Anticoagulation therapy was started. Echocardiographic regression of the vegetation was observed and there has been no recurrence of thromboembolic events to date. Resumo: A endocardite de Libman-Sacks é a manifestação cardíaca mais característica do LES. É habitualmente clinicamente silenciosa, mas a insuficiência cardíaca por disfunção valvular, a endocardite infecciosa secundária e os fenómenos embólicos podem complicar as alterações valvulares. Apresentamos um caso clínico de uma doente com LES e amaurose à direita por trombose da artéria central da retina. O ecocardiograma mostrou uma vegetação verrucosa no folheto posterior da válvula mitral, compatível com endocardite de Libman-Sacks. A doente iniciou terapêutica com anticoagulação, verificou-se regressão da vegetação descrita e não teve recorrência de eventos tromboembólicos até à data. Keywords: Systemic lupus erythematosus, Libman-Sacks endocarditis, Embolization, Retinal artery occlusion, Palavras-chave: Lúpus eritematoso sistémico, Endocardite de Libman-Sacks, Embolização, Oclusão da artéria da retina

Investigation from a diversity of theoretical perspectives displays that one of the best predictors of children’s continuing involvement in sports is the development of positive feelings for sport involvement (e.g. Martins, Rosado, Ferreira & Biscaia, 2014). In sport, the concept of engagement reflects the energy in action, the connection between the person and the activity, and it is considered as a form of active involvement between the individual and the task (Russell, Ainley, & Frydenberg, 2005). In sport, the concept of athletes’ engagement reflects a relatively stable and long lasting experience that is generically characterized through positive emotions and cognitions when engaged in the act of practicing the given activity (Lonsdale, Hodge, & Raedeke, 2007). Therefore, the analysis of experiences related to engagement is important in order to understand sport participation, and how its different levels can condition the social involvement. In addition, these studies failed to examine potentially important gender differences in engagement among athletes. Therefore, the study of athletes by evaluating their engagement levels comparing genders, can contribute towards shedding light on decisive aspects pertaining to its social involvement within ethical dimensions as well as personal and social responsibility, on which research is still lacking. Objectives: The purpose of this study was to investigate the impact of gender on engagement in a sport scenario among youth athletes.

The thermal energy found in shower hot wastewater, which is usually dumped, can be recovered through heat exchangers and used to pre-heat shower cold-water, contributing to energy sustainability. The objective and novelty of this work are to present a computational fluid dynamics (CFD) model and a theoretical model based on literature correlations to evaluate the performance of a shower water horizontal heat exchanger with twisted tape inserts. CFD simulations are used to improve the shape of twisted tape in the setting of the turbulator. The findings suggest that the wastewater flow convection heat transfer coefficient is between the flow around a cylinder and the flow around a cylinder in a narrow channel. The results for the turbulator are consistent with theoretical data, except for twist ratios below 3. The most promising twisted tape design has a twist ratio of 4 and a thickness of 1 mm. A conclusion could be drawn that the efficacy of the twisted tape in the heat exchanger is greater at lower flow rates. The performance gain ranges from 18.1 % to 3.0 % for flow rates of 3–10 L/min. Future directions for this research should focus on the improvement of the external convection coefficient because it represents the highest thermal resistance in the shower wastewater horizontal heat exchanger.