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Certain cyanobacteria of the secondary metabolite-rich order Nostocales can establish permanent symbioses with a large number of cycads, by accumulating in their coralloid roots and shifting their metabolism to dinitrogen fixa-tion. Here, we report the discovery of two novel lipoglycopeptides, desmamides A (1) and B (2), together with their aglycone desmamide C (3), from the nostocalean cyanobacterium Desmonostoc muscorum LEGE 12446 isolated from a cycad (Cycas revoluta) coralloid root. The chemical structures of the compounds were elucidated using a combination of 1D and 2D Nuclear Magnetic Resonance (NMR) spectroscopy and Mass Spectrometry (MS). The desmamides are decapeptides, featuring O-glycosylation of tyrosine (in 1 and 2) and an unusual 3,5-dihydroxy-2-methyldecanoic acid residue. The biosynthesis of the desmamides was studied by substrate feeding experiments and bioinformatics. We describe herein the dsm biosynthetic gene cluster (BGC) and propose it to be associated with desmamide production. The discovery of this class of very abundant (>1.5% d.w.) bacterial lipoglycopeptides paves the way for exploration of their potential role in root endosymbiosis.

Dimethylsulfoniopropionate (DMSP) is an abundant marine organosulfur compound[1] with roles in stress protection[2, 3], chemotaxis[4], nutrient and sulfur cycling[5] and, potentially, climate regulation[6, 7]. Marine algae and bacteria are considered significant DMSP producers, but many diverse representatives lack known DMSP synthesis genes/enzymes[8, 9]. Here, new DMSP biosynthesis enzymes were identified that considerably increase the number and diversity of potential DMSP-producing organisms, inferring new and significant global DMSP producers. A novel bifunctional DMSP biosynthesis enzyme, DsyGD, identified in the rhizobacterium Gynuella sunshinyii, produces DMSP at levels higher than any other bacterium from methylthiohydroxybutyrate (MTHB) via an N-terminal MTHB S-methyltransferase domain (termed DsyG) and a C-terminal dimethylsulfoniohydroxybutyrate (DMSHB) decarboxylase domain (termed DsyD, which is the first reported enzyme with this activity). DsyGD is also found in some filamentous cyanobacteria, not previously known to produce DMSP. Regulation of DMSP production and dsyGD transcription was consistent with their role in osmoprotection. Indeed, cloned dsyGD conferred osmotolerance to bacteria deficient in osmolyte production, something not previously demonstrated for any known DMSP synthesis gene, and which could be exploited for biotechnology e.g., engineering salt tolerance. DsyGD characterisation led to identification of phylogenetically distinct DsyG-like proteins, termed DSYE, with MTHB S-methyltransferase activity, in diverse and environmentally abundant Chlorophyta, Chlorachniophyta, Ochraphyta, Haptophyta and Bacillariophyta algae. These algae comprise a mix of low, high and previously unknown DMSP producers[10]. Algae containing DSYE, particularly bloom-forming Pelagophyceae species, which we showed to accumulate medium-high intracellular DMSP levels, were globally more abundant DMSP producers than Haptophyta, Dinophyta and Bacillariophyta with DSYB and/or TpMMT. This highlights the potential importance of Pelagophyceae and other DSYE containing algae in global DMSP production and sulfur cycling.

A cancer patient treated with a molecule found in algae-eating sea hares native to the Indian Ocean. Jet fuel produced by algae in open urban ponds. A tonne-scale synthesis of pharmaceuticals using enzymes from a green biofilm growing in your backyard. The first example is a reality, but the others are not necessarily confined to a utopian future. All these scenarios can be linked to blue-green algae (cyanobacteria). These talented microbial biochemists generate a vast set of unique secondary (specialized) metabolites. Initially infamous for being potent toxins that have resulted in human deaths, some cyanobacterial secondary metabolites have proven useful and are currently used in the clinic. The enzymes that biosynthesize some of these compounds are likewise remarkable and could find future industrial use. Here, I discuss some aspects of past and current secondary metabolite discovery in cyanobacteria, the potential impact of these small molecules for human activities and how the study of their biosynthesis has unearthed exciting new enzymatic reactions.

Purpose Postoperative complications after a colonic and rectal surgery are of significant concern to the surgical community. Although there are different techniques to perform anastomosis (i.e., handsewn, stapled, or compression), there is still no consensus on which technique provides the least number of postoperative problems. The objective of this study is to compare the different anastomotic techniques regarding the occurrence or duration of postoperative outcomes such as anastomotic dehiscence, mortality, reoperation, bleeding and stricture (as primary outcomes), and wound infection, intra-abdominal abscess, duration of surgery, and hospital stay (as secondary outcomes). Methods Clinical trials published between January 1, 2010, and December 31, 2021, reporting anastomotic complications with any of the anastomotic technique were identified using the MEDLINE database. Only articles that clearly defined the anastomotic technique used, and report at least two of the outcomes defined were included. Results This meta-analysis included 16 studies whose differences were related to the need of reoperation (p p = 0.02), while for the anastomotic dehiscence, mortality, bleeding, stricture, wound infection, intra-abdominal abscess, and hospital stay, no significant differences were found. Compression anastomosis reported the lowest reoperation rate (3.64%) and the handsewn anastomosis the highest (9.49%). Despite this, more time to perform the surgery was required in compression anastomosis (183.47 min), with the handsewn being the fastest technique (139.92 min). Conclusions The evidence found was not sufficient to demonstrate which technique is most suitable to perform colonic and rectal anastomosis, since the postoperative complications were similar between the handsewn, stapled, or compression techniques.

Hepatitis C virus (HCV) infection is an important public health problem, especially in areas with a low human development index such as the Amazon region. This study aimed to identify the prevalence and genotypes of HCV among people living with HIV (PLWH), both neglected chronic diseases in the Amazon region. From March 2016 to June 2017, 433 PWLH were attended to at two sexually transmitted infection referral centers in the city of Belém, in the Brazilian state of Pará in the Amazon region. All individuals were submitted to testing via the rapid immunochromatographic assay (RIA) for the qualitative detection of anti-HCV antibodies. Samples with anti-HCV antibodies were evaluated by reverse transcriptase polymerase chain reaction (RT-PCR), and samples with HCV RNA were subjected to nucleotide sequencing and phylogenetic analysis. Three (0.7%) PLWH had anti-HCV antibodies, and only one (0.2%) had HCV RNA (genotype 2); of these, 31 (7.1%) self-declared to have used drugs at least one time, and 12 (2.7%) regularly use injected drugs. One participant was elderly, single, heterosexual, with a history of unprotected sex and multiple sexual partners. This study detected a low prevalence of HCV infection and recorded the presence of HCV genotype 2 for the first time among PLWH in the Brazilian Amazon.

PurposeHaemorrhoids are normal structures in the human body, only seen as pathological when symptomatic. Nowadays, new techniques have surfaced using a diode laser which, after locating the target arteries, blocks the blood flow while hitting and shrinking the local mucosa/submucosa at a depth of 4 mm. Our work aimed to give a broad view over this new technique and its consequences in the post-operative follow-up with a systematic review.MethodsEMBASE and MEDLINE databases were consulted, retrieving clinical trials, which mentioned the use of 980 nm diode laser on the treatment of haemorrhoids.ResultsTen clinical trials analyzing the post-operative effects of laser haemorrhoidectomy were selected, including 2 randomized controlled clinical trials and 1 controlled clinical trial. The overall quality of the trials was low, indicating a high risk of bias.ConclusionThe laser haemorrhoidectomy procedure revealed a high therapeutic potential, considering the reduced number of postoperative complaints (bleeding/pain), the high symptom resolution and the reduced recurrence, albeit the high heterogeneity between the studies in terms of reported results. Future investigations with higher quality and controlled double-blinded studies obtaining better-categorized results should be conducted in order to better evaluate this procedure and compare it to the current paradigm.

Este artículo contiene 16 páginas, 5 figuras, 1 tabla., Aim The influence of niche and neutral mechanisms on the assembly of ecological communities have long been debated. However, we still have a limited knowledge on their relative importance to explain patterns of diversity across latitudinal gradients (LDG). Here, we investigate the extent to which these ecological mechanisms contribute to the LDG of reef fishes. Location Eastern Atlantic Ocean. Taxon Reef-associated ray-finned fishes. Methods We combined abundance data across ~60° of latitude with functional trait data and phylogenetic trees. A null model approach was used to decouple the influence of taxonomic diversity (TD) on functional (FD) and phylogenetic (PD) diversity. Standardized effect sizes (SES FD and SES PD) were used to explore patterns of overdispersion, clustering and randomness. Information theoretic approaches were used to investigate the role of large- (temperature, geographic isolation, nitrate and net primary productivity) and local-scale (human population and depth) drivers. We further assessed the role of demographic stochasticity and its interaction with species trophic identity and dispersal capacity. Results Taxonomic diversity peaked at ~15°–20°N, with a second mode of lower magnitude at ~45°N; a pattern that was predicted by temperature, geographic isolation and productivity. Tropical regions displayed a higher proportion of overdispersed assemblages, whilst clustering increased towards temperate regions. Phylogenetic and functional overdispersion were associated with warmer, productive and isolated regions. Demographic stochasticity also contributed largely to community assembly, independently of ecoregions, although variation was dependent on the trophic identity and body size of species. Main conclusions Niche-based processes linking thermal and resource constraints to local coexistence mechanisms have contributed to the LDG in reef fishes. These processes do not act in isolation, stressing the importance of understanding interactions between deterministic and stochastic factors driving community structure in the face of rapid biodiversity change., This study was partially supported by Portuguese national funds from FCT—Foundation for Science and Technology through project UIDB/04326/2020. C.R. and P.N. were financially supported by the Oceanic Observatory of Madeira Project (M1420-01-0145-FEDER-000001—Observatório Oceânico da Madeira-OOM). D.A.S. was supported by a UKRI Future Leaders Fellowship (MR/S032827/1). P.J.M. was supported by a Marie Curie Career Integration Grant (PCIG10-GA-2011-303685). T.W. received funding from the Australian Research Council (DP170100023).

Magnetosome synthesis in magnetotactic bacteria (MTB) is regarded as a very ancient evolutionary process that dates back to deep-branching phyla. Magnetotactic bacteria belonging to one of such phyla, Nitrospirota, contain the classical genes for the magnetosome synthesis (e.g., mam, mms) and man genes, which were considered to be specific for this group. However, the recent discovery of man genes in MTB from the Thermodesulfobacteriota phylum has raised several questions about the inheritance of these genes in MTB. In this work, three new man genes containing MTB genomes affiliated with Nitrospirota and Thermodesulfobacteriota, were obtained. By applying reconciliation with these and the previously published MTB genomes, we demonstrate that the last common ancestor of all Nitrospirota was most likely not magnetotactic as assumed previously. Instead, our findings suggest that the genes for magnetosome synthesis were transmitted to the phylum Nitrospirota by horizontal gene transfer (HGT), which is the first case of the interphylum transfer of magnetosome genes detected to date. Furthermore, we provide evidence for the HGT of magnetosome genes from the Magnetobacteriaceae to the Dissulfurispiraceae family within Nitrospirota. Thus, our results imply a more significant role of HGT in the MTB evolution than deemed before and challenge the hypothesis of the ancient origin of magnetosome synthesis.

Tubulointerstitial nephritis and uveitis syndrome (TINU) combines tubulointerstitial nephritis and uveitis and is a known cause of kidney failure in children and adults. This is a challenging diagnosis since renal and ocular manifestations may not occur simultaneously and may be present in several alternative diagnosis. The authors report the case of a 28-year-old patient with acute kidney injury (AKI) and biopsy-proven acute tubulointerstitial nephritis. Bilateral symptomatic uveitis presented six months after the initial presentation. Physicians in charge of patients with kidney disease attributed to acute tubulointerstitial nephritis must bear in mind the need for ophthalmologic surveillance for at least one year post-diagnosis. Although a diagnosis of exclusion, its incidence may be higher than described. Kidney disease is believed to be self-limited and prognosis still, most patients will require systemic therapy and relapses are common.

Translational research allowed us to hypothesize that endoscopic surgery performed with new generation 3D systems could improve surgeons’ performance, reducing the learning curve, and the perceived workload. However, there is currently a lack of evidence in randomized clinical trials considering advantages for the surgeon and the patient of using the new 3D systems. This systematic review of literature aims to understand what are the differences when performing an endoscopic surgery with new 3D or 2D systems when it comes to intra-operative, post-operative and surgeons perspective outcomes, and at the same time, understand what were the difficulties encountered when performing research about as different imaging systems for surgeons. A systematic review of literature was conducted through an online search in databases MEDLINE ©/PubMed © to identify articles published in English, from 1st January 2014 to 31st May 2019, that compared clinical results of 2D and 3D third-generation video-assisted surgery. A total of 30 articles were included in the qualitative analyses. Of the 30 articles analyzed, 13 were articles in which patients were randomly selected, of which 7 were considered to be at “Low” risk of bias. From the 7 articles, 2 demonstrated an association between lower blood loss and 3D systems. In this selection of low risk randomized articles, no differences were observed in any of the studies when it comes to conversion to open surgery, intra-operative complications, morbidity, length of stay, and oncological outcomes. In conclusion, this systematic review presents the current knowledge on clinical use of 3D systems for endoscopic surgery. Significant scientific evidence puts 3D technology with advantages in surgeon performance, learning curve, and fatigue.

A pesquisa analisa comparativamente dois conjuntos de imagens: fotografias jornalísticas que retratam mulheres beneficiadas pelo Bolsa-Família, publicadas entre 2003 e 2015, em jornais e revistas de ampla circulação nacional; e imagens oficiais do Farm Security Administration, retiradas de coletâneas e do site photogrammar.yale.edu. Busca-se construir uma abordagem teórico metodológica que suscite um olhar atento aos pequenos detalhes, questionando julgamentos e assertivas morais preexistentes. Para tanto, nos apoiamos sobretudo nas reflexões teóricas de Jacques Rancière e Didi-Huberman, que buscam caracterizar o trabalho das imagens como montagens intervalares capazes de tornar perceptíveis as hierarquias e assimetrias que os discursos dominantes se esforçam em apagar. Objetiva-se questionar as formas de legibilidade e inteligibilidade frequentemente associadas às imagens de sujeitos em situação de vulnerabilidade, em prol de apropriações que nos tornem sensíveis às governamentalidades que distribuem desigualmente os espaços, as falas, os tempos e as exposições e aparições da alteridade.

Introduction Cutaneous manifestations related to chronic kidney disease (CKD) are common and associated with high morbidity. Acquired perforating dermatosis (APD) occurs mostly in diabetic or CKD patients, namely those undergoing hemodialysis. Case report A 58-year-old male with type 2 diabetes, with long-term insulin use, several microvascular and macrovascular complications, and on maintenance hemodialysis for 5 years presented with a 1-week history of painful, pruritic, umbilicated papules and some punctiform necrotic lesions on his left forearm, both hands, and both amputation stumps. There was no evidence of infection or vascular alterations, and the patient was not responsive to an initial course of topical corticosteroid. These lesions rapidly evolved to larger, coalescent necrotic injuries, with aggravated pain, intense left-hand skin peeling, and the appearance of similar lesions in the trunk, requiring hospital admission. Calciphylaxis and APD were suspected. Skin biopsy was performed and directed treatment initiated, including intradialytic sodium thiosulfate. Histology findings were compatible with APD and also excluded findings suggestive of vasculitis or calciphylaxis. Soon after, difficult-to-treat cellulitis of the left hand and forearm progressed to critical ischemia and amputation. Microbiology analysis revealed Serratia marcescens as the causative agent. Discussion To our knowledge, there are no previously described cases of APD-related cellulitis. Its treatment can be particularly challenging, as lesions can persist and relapse, and chronic scars can develop. S. marcescens behaves as an opportunistic and difficult-to-treat pathogen, complicating the prognosis. Conclusion APD can be associated with cellulitis and all of its complications in patients with underlying severe vasculopathy. Awareness of this complication in APD with early referral and aggressive treatment might improve the outcomes and quality of life of such patients.

As editor of scopio Editions it is a great honour to be writing this closing text about the upcoming book which communicates our last Duelo/Dueto session of Architecture, Art and Image (AAI) series that had as invited authors Valerio Olgiati and Bas Princen. I will start by talking about the book as a privileged medium for Architecture, Art and Image and then go on focusing on this book in particular and its authors. This conference series had from the start planned a publication for each session with the contribution of the invited speakers and the organization because we believe that the physical book, without prejudice towards the potential of digital publications, is still a tool of paramount importance for preserving and building knowledge, not just for students and academics, but also for all professionals and non-scholars. The physical book somehow allows the understanding of what was discussed and debated in Duelo/Dueto sessions in a different manner, encouraging and giving the right time to each viewer for a deeper thinking. The reading of these sessions also means that these events of rich exchange of ideas and personal experience between significant authors coming from AAI universe are preserved for future studies. In this way, they can be shared with a larger audience, opening the mind of many to these events and encouraging critical thinking toward a vast horizon of issues related to AAI universe. It is worth referring also that the specific potential of the physical book as a unique medium to communicate Architecture, Art and Image1 was explored in this publication, which adds to its uniqueness and makes it more an author´s book than the customary conference or roundtable publication. It was possible to create a visual narrative where the sum is greater than the parts, which we believe has as a result an innovative reading and a more insightful understanding about the thoughts, work and artistic strategies of both authors. Thus, we believe that this book, the second of this series of four publications focused on each session, will foster a significant critical debate related to Architecture, Art and Image, as already happened with our first published book on this series. [...]

Metronidazole (MTZ) is a drug potentially used for the treatment of intestinal infections, namely, the ones caused by colorectal surgery. The traditional routes of administration decrease its local effectiveness and present off-site effects. To circumvent such limitations, herein a drug delivery system (DDS) based on MTZ-loaded nanoparticles (NPs) immobilized at the surface of electrospun fibrous meshes is proposed. MTZ at different concentrations (1, 2, 5, and 10 mg mLâ 1) was loaded into chitosanâ sodium tripolyphosphate NPs. The MTZ loaded into NPs at the highest concentration showed a quick release in the first 12 h, followed by a gradual release. This DDS was not toxic to human colonic cells. When tested against different bacterial strains, a significant reduction of Escherichia coli and Staphylococcus aureus was observed, but no effect was found against Enterococcus faecalis. Therefore, this DDS offers high potential to locally prevent the occurrence of infections after colorectal anastomosis., The authors thank the Portuguese Foundation for Science and Technology (FCT) and CUF, S.A. for the Ph.D. scholarship of A.O. (PD/BDE/142979/2018). Also, the authors thank the FCT for the financial support of L.C.R. (SFRH/BPD/93697/ 2013). This work was also financially supported by the project Bluebiolab − Transboundary Marine Biotechnology Laboratory (0474_BLUEBIOLAB_1_E) financed by the Interreg programme Spain-Portugal through the European Regional Development Fund (ERDF), and by the FCT projects PTDC/CTM-CTM/29813/2017-(POCI-01-0145-FEDER-029813), UIDB/50026/2020, and UIDP/50026/2020

EnglishThe present work is a record of the reflections of the students of High School, participants of the Philosophy and High School studies group: perspective for the integral formation in light of the Critical Theory, in the Advanced Campus Goioere, of the Federal Institute of Parana (IFPR). The studies are oriented as a formative process, by the research, putting itself as a record of the argumentative expressions of the members themselves. the research aims to stimulate the formation of teachers for the areas of human sciences from the perspective of Critical Theory, especially for the motivation to study philosophy, understanding it as a simple curricular component. It is also sought to provide textual construction of ideas from the theoretical analysis of philosophy. Theoretically the research is based on the Critical Theory of the society, highlighting thinkers like Adorno, Horkheimer and Marcuse. The methodology of work is focused on the orientations on themes and classic authors of philosophy, which shed light on the highlighted problem reality. The work is a collection of ideas from ongoing studies, revealing students' self-reflection. He is expected to contribute as a formative experience to the students, who are a fundamental part of the educational process and who are open to future teaching, especially from the degrees in the humanities. portuguesO presente trabalho e um registro das reflexoes dos estudantes de Ensino Medio, participantes do grupo de estudos Filosofia e Ensino Medio: perspectiva para a formacao integral a luz da Teoria Critica, no Campus Avancado Goioere, do Instituto Federal do Parana (IFPR). Os estudos sao orientados como processo formativo, pela pesquisa, colocando-se como um registro das expressoes argumentativas dos proprios membros. A pesquisa tem por objetivo estimular a formacao de docente para as areas das ciencias humanas a partir da perspectiva da Teoria Critica, especialmente pela motivacao ao estudo da Filosofia, compreendendo-a para alem do conceito de componente curricular. Procura-se tambem proporcionar a construcao textual de ideias a partir da analise teorica da Filosofia. A pesquisa se fundamenta na Teoria Critica da sociedade, destacando pensadores como Adorno, Horkheimer, Marcuse, Habermas e Honneth. A metodologia de trabalho esta voltada para as orientacoes sobre temas e autores classicos da Filosofia, os quais lancam luzes sobre a realidade-problema destacada. O trabalho e uma coletânea de ideias dos estudos em andamento, reveladoras da autorreflexao dos estudantes. Espera-se que ele contribua como experiencia formativa aos estudantes, os quais sao parte fundamental do processo educativo e que se abrem a futura docencia, especialmente a partir das licenciaturas em ciencias humanas

Acknowledging the long history of mutual interference between Architecture and Photography, their complex and ubiquitous relationship, and understanding Photography as a relevant artistic and critical research tool, Inaki Bergera ́s work offers new light over these matters. Photography and Modern Architecture in Spain fosters a renewed under- standing of Spanish architecture from the modern period, compiling and structuring all the information that was somehow scattered or lost, speaking about the photographers that were creating images of those modern buildings and the architects to which they were associated with. New American Topographics is an astonishing photography book reinterpreting the visual discourse of the New Topographic aesthetics and bringing them to contemporary time., Histories of Postwar Architecture, No 4 (2019): Mass Media and the International Spread of Post-War Architecture

Acupuncture is one of the areas among the alternative therapies that arise high curiosity in the biomedical scientific community. It is particularly popular for treatment of chronic diseases and addictions. However, contrasting with its evidence-based effectiveness, the lack of reasonable explanations for its mode of action divides that scientific community. Difficulties also arise to those responsible for providing information for clinicians and professionals who wish to acquire competencies leading to the acupuncture practice and have a background based on biochemistry and physiology. The classic theories of nerve conduction do not fully explain how information is read and transmitted during the acupuncture treatment. Other theories have been proposed, but they are based on concepts such as biophotonic waves and quantum biochemistry that are difficult to read and understand by those who do not have knowledge in physics. It is the main objective of this review to provide a summary of the main theories and explanatory approaches to the signal transduction and conduction in acupuncture and to describe them in terms of their explanatory hypotheses, limitations, and weaknesses.The most of the literature found support theories for neural conduction, including gate control. They explain the effects of acupuncture in pain relief; few studies have been conducted concerning the conduction based on biophotons. The primo vascular system has been referred as a possible anatomic support for conduction of information during an acupuncture treatment, which could be connected to biophoton transmission. Keywords: acupuncture, biophotons, gate control, neural conduction, primo vascular system

Background: Laboratory skills training is an essential step before conducting minimally invasive surgery in clinical practice. Our main aim was to develop an animal model for training in clinically highly challenging laparoscopic duodenal atresia repair that could be useful in establishing a minimum number of repetitions to indicate safe performance of similar interventions on humans. Materials and methods: A rabbit model of laparoscopic duodenum atresia surgery involving a diamond-shaped duodeno-duodenostomy was designed. This approach was tested in two groups of surgeons: in a beginner group without any previous clinical laparoscopic experience (but having undergone previous standardized dry-lab training, n = 8) and in an advanced group comprising pediatric surgery fellows with previous clinical experience of laparoscopy (n = 7). Each participant performed eight interventions. Surgical time, expert assessment using the Global Operative Assessment of Laparoscopic Skills (GOALS) score, anastomosis quality (leakage) and results from participant feedback questionnaires were analyzed. Results: Participants in both groups successfully completed all eight surgeries. The surgical time gradually improved in both groups, but it was typically shorter in the advanced group than in the beginner group. The leakage rate was significantly lower in the advanced group in the first two interventions, and it reached its optimal level after five operations in both groups. The GOALS and participant feedback scores showed gradual increases, evident even after the fifth surgery. Conclusions: Our data confirm the feasibility of this advanced pediatric laparoscopic model. Surgical time, anastomosis quality, GOALS score and self-assessment parameters adequately quantify technical improvement among the participants. Anastomosis quality reaches its optimal value after the fifth operation even in novice, but uniformly trained surgeons. A minimum number of wet-lab operations can be determined before surgery can be safely conducted in a clinical setting, where the development of further non-technical skills is also required. Open access funding provided by University of Szeged. This study has been funded by FEDER funds through the Competitiveness Factors Operational Program (COMPETE) and by national funds through the Foundation for Science and Technology (FCT) within the scope of project No. POCI-01–0145-FEDER-007038, as well as by project No. NORTE-01–0145-FEDER-000013, supported by the Northern Portugal Regional Operational Program (NORTE 2020) under the Portugal 2020 Partnership Agreement through the European Regional Development Fund (FEDER).

Este artigo analisa as relações entre imagens fotojornalísticas e governamentalidade neoliberal a partir de enquadramentos de mulheres e famílias empobrecidas. São analisadas fotografias divulgadas pela Folha de S. Paulo entre 2011 e 2015 (acompanhadas de elementos como legendas e títulos das matérias) que nos parecem emblemáticas dos quadros de sentido mobilizados por esse veículo para caracterizar, sob um viés de apreciação e avaliação moral da conduta dessas mulheres e famílias, os potenciais impactos do Programa sobre os modos como suas existências são tornadas legíveis, inteligíveis e aptas ou não ao reconhecimento social. A análise levou em conta o modo como o enquadramento biopolítico que lhes confere sentido investe e desinveste as mulheres de sua humanidade e de sua autonomia a partir da construção de narrativas cronológicas que adquirem status de documentos usados para condená-las ou absolvê-las a partir da avaliação das escolhas que supostamente tinham à disposição.

The book on screen is the result of a postdoctoral internship carried out by Elza Margarida de Mendonça Peixoto at the School of Physical Education, Physiotherapy and Dance at UFRGS (2019-2020), under the supervision of professor Alberto Reinaldo Reppold Filho. This internship allowed the systematization of research that had been developed for some years, in particular that of his first post-doctorate in Philosophy of Education, held at the University of Lisbon (2014-2015), under the mentorship of the renowned Portuguese Marxist José Barata- Moura, and dedicated to the category of practice and criticism of the different idealistic conceptions of this category – the “idealisms of practice”. The continuity of her investigation allowed her to extend and deepen it, now focused on a problematization of the category of practice in Brazilian critical educational thinking, in general, and in teacher education, in particu El libro en pantalla es el resultado de una pasantía postdoctoral realizada por Elza Margarida de Mendonça Peixoto en la Escuela de Educación Física, Fisioterapia y Danza de la UFRGS (2019-2020), bajo la supervisión del profesor Alberto Reinaldo Reppold Filho. Esta pasantía permitió la sistematización de investigaciones que se venían desarrollando durante algunos años, en particular la de su primer posdoctorado en Filosofía de la Educación, realizado en la Universidad de Lisboa (2014-2015), bajo la tutela del reconocido marxista portugués José Barata-Moura, y dedicado a la categoría de práctica y crítica de las diferentes concepciones idealistas de esta categoría - los “idealismos de práctica”. La continuidad de su investigación permitió ampliarla y profundizarla, ahora centrada en una problematización de la categoría de práctica en el pensamiento crítico educativo brasileño, en general, y en la formación docente, en particular. Le livre à l'écran est le résultat d'un stage postdoctoral réalisé par Elza Margarida de Mendonça Peixoto à l'École d'éducation physique, physiothérapie et danse de l'UFRGS (2019-2020), sous la direction du professeur Alberto Reinaldo Reppold Filho. Ce stage a permis de systématiser des recherches qui s'étaient développées depuis quelques années, notamment celle de son premier post-doctorat en philosophie de l'éducation, tenu à l'Université de Lisbonne (2014-2015), sous le mentorat du célèbre marxiste portugais José Barata-Moura, et consacré à la catégorie de la pratique et à la critique des différentes conceptions idéalistes de cette catégorie – les « idéalismes de la pratique ». La continuité de son enquête a permis de l'étendre et de l'approfondir, désormais centrée sur une problématisation de la catégorie de pratique dans la pensée critique éducative brésilienne, en général, et dans la formation des enseignants, en particulier. Mais sobre o texto originalÉ necessário fornecer o texto original para ver mais informações sobre a traduçãoEnviar feedbackPainéis laterais O livro em tela é resultado do estágio de pós-doutorado realizado por Elza Margarida de Mendonça Peixoto na Escola de Educação Física, Fisioterapia e Dança da UFRGS (2019-2020), sob a supervisão do professor Alberto Reinaldo Reppold Filho. Esse estágio permitiu a sistematização de pesquisas que estavam sendo desenvolvidas há alguns anos, em particular a do seu primeiro pós-doutorado em Filosofia da Educação, realizado na Universidade de Lisboa (2014-2015), sob a tutoria do destacado marxista português José Barata-Moura, e dedicado à categoria da prática e da crítica às diferentes concepções idealistas desta categoria – os “idealismos da prática”. A continuidade da sua investigação permitiu estendê-la e aprofundá-la, agora voltada a uma problematização da categoria da prática no pensamento crítico educacional brasileiro, em geral, e na formação de professores, em particular.

O livro em tela é resultado do estágio de pós-doutorado realizado por Elza Margarida de Mendonça Peixoto na Escola de Educação Física, Fisioterapia e Dança da UFRGS (2019-2020), sob a supervisão do professor Alberto Reinaldo Reppold Filho. Esse estágio permitiu a sistematização de pesquisas que estavam sendo desenvolvidas há alguns anos, em particular a do seu primeiro pós-doutorado em Filosofia da Educação, realizado na Universidade de Lisboa (2014-2015), sob a tutoria do destacado marxista português José Barata-Moura, e dedicado à categoria da prática e da crítica às diferentes concepções idealistas desta categoria – os “idealismos da prática”. A continuidade da sua investigação permitiu estendê-la e aprofundá-la, agora voltada a uma problematização da categoria da prática no pensamento crítico educacional brasileiro, em geral, e na formação de professores, em particular.

Este articulo explora las relaciones entre las dimensiones virtuales de la fotografía y las realidades físicas concretas en el marco del discurso contemporáneo de la Arquitectura, Ciudad y Territorio. Apoyado en las obras de Filip Dujardin, Isabel Brison, Philipp Schaerer, Beate Gütschow, Dionisio Gonzalez, Emilio Pemjean e Thomas Ruff, analizamos distintos enfoques de la manipulación digital de imágenes para la creación de visiones utópicas y distópicas de los paisajes urbanos. A través del análisis de ejemplos concretos del uso de la fotografía como un instrumento para explorar ideas y formas arquitectónicas, la construcción de espacios y construcciones imaginarias es analizada como parte constituyente de los métodos de investigación visual desarrollados por estos autores, pudiendo estos ser incorporados en el debate crítico sobre el entorno urbano. Se analiza un determinado número de relaciones entre las estrategias artísticas desarrolladas por estos autores, con enfoque en los diversos métodos utilizados por ellos para la construcción de narrativas visuales y la construcción de estructuras y espacios imaginarios. La relevancia teórica y el potencial de las obras fotográficas analizadas son destacados identificando aspectos y particularidades clave que hacen de estos autores importantes referencias para la comprensión de la fotografía como un instrumento crítico documental y ficcional para comprender, explorar y comunicar cambios urbanos contemporáneos, con especial enfoque en la arquitectura y espacio público. = This paper explores the relationships between virtual dimensions of photography and concrete physical realities in contemporary discourses on Architecture, City and Territory. Based on the work of Filip Dujardin, Isabel Brison, Philipp Schaerer, Beate Gütschow, Dionisio Gonzalez, Emilio Pemjean and Thomas Ruff, we analyse different approaches to the digital manipulation of images for the creation of utopian and dystopian visions of urban landscapes. By analysing specific examples of the use of photography as an instrument to explore architectural ideas and forms, the construction of imaginary spaces and constructions is examined as constitutive parts of visual research methods developed by these authors, which may be applied for embedding critical debates on the urban environment in the public sphere. A number of relations between the artistic strategies developed by these authors are examined, focusing on the various methods used for the construction of visual narratives in tandem with the creation of fictional structures and imaginary spaces. The theoretical relevance and potential of the photographic works is highlighted pinpointing key aspects and features that make these authors important references for an understanding of photography as a documentary and fictional critical instrument for understanding, exploring and communicating contemporary urban changes with a special focus on architecture and the public space.

Syphilis continues to be a public health problem worldwide and its incidence has increased in people living with HIV/AIDS in recent years. This study determined the prevalence and factors associated with syphilis in people living with HIV/AIDS in the city of Belém, northern Brazil. A cross-sectional study was conducted from June to November 2018. A total of 500 people living with HIV/AIDS attended at a specialized unit of the public health network of the State of Pará were studied. Questionnaires were used to collect socio-demographic data and potential risk factors for syphilis. Blood samples were collected from all subjects and screened for syphilis using VDRL, and the seropositive were confirmed using FTA-abs. Logistic regressions were used to identify the factors associated with syphilis. Most subjects were male (56.8%), had more than 40 years (54.0%), single (63.0%), had finished high school (54.2%), had monthly income ≤1 minimum wage (72.4%), and had been born to the city of Belém (59.8%). Prevalence of syphilis was 6.4%. Eight characteristics/behaviors associated with syphilis: male, young adults, single, studied at least high school, monthly income >1 minimum wage, homosexual/bisexual, does not use or sporadically use condoms during sexual intercourse, and have had more than one sexual partner in the last three months. The prevalence of syphilis in people living with HIV/AIDS in Belém is low when compared to other Brazilian states. However, there is a need for public policies and actions to monitor, control and prevent these two sexually transmitted infections.

Despite its worldwide distribution in sedimentary infralittoral and circalittoral bottoms, rhodolith beds have been the subject of fewer studies than other nearshore communities, like kelp forests and coral reefs. This is also the case in Madeira archipelago (Eastern Atlantic), where until recently our knowledge on rhodolith beds was limited to a few references to its occurrence and species composition. In the course of an ongoing habitat-mapping project developed in Madeira, observations revealed that rhodolith beds are more common and extensive than previously supposed. The habitat maps for these beds in Madeira archipelago here presented are the first ever produced for the region. They reveal a total of 46 rhodolith beds at eleven different locations spread across three islands (Madeira, Desertas and Porto Santo), with areas ranging from 776 to 101,081 m(2) and at depths between 12 and 35 m. Author's observations, as well as the results suggest that more rhodolith beds are likely to exist in the archipelago, particularly at greater depths and unexplored locations. The application of molecular systematic tools for the identification of rhodolith-forming species revealed the occurrence of four species belonging to the genera Lithothamnion and Phymatolithon. This latter genus is represented by a single species which is commonly found in rhodolith beds of the archipelago. Genetically, our results show similarities both with the rhodolith communities from the Canary islands and the Algarve (south of Portugal) and highlight the singularities of the archipelago's marine flora. The new array of data here presented is deemed essential for an effective management and conservation of these important and sensitive habitats. M1420- 01-0145-FEDER-000001 info:eu-repo/semantics/publishedVersion

The most well-recognized magnetoreception behaviour is that of the magnetotactic bacteria (MTB), which synthesize membrane-bounded magnetic nanocrystals called magnetosomes via a biologically controlled process. The magnetic minerals identified in prokaryotic magnetosomes are magnetite (Fe3 O4 ) and greigite (Fe3 S4 ). Magnetosome crystals, regardless of composition, have consistent, species-specific morphologies and single-domain size range. Because of these features, magnetosome magnetite crystals possess specific properties in comparison to abiotic, chemically synthesized magnetite. Despite numerous discoveries regarding MTB phylogeny over the last decades, this diversity is still considered underestimated. Characterization of magnetotactic microorganisms is important as it might provide insights into the origin and establishment of magnetoreception in general, including eukaryotes. Here, we describe the magnetotactic behaviour and characterize the magnetosomes from a flagellated protist using culture-independent methods. Results strongly suggest that, unlike previously described magnetotactic protists, this flagellate is capable of biomineralizing its own anisotropic magnetite magnetosomes, which are aligned in complex aggregations of multiple chains within the cell. This organism has a similar response to magnetic field inversions as MTB. Therefore, this eukaryotic species might represent an early origin of magnetoreception based on magnetite biomineralization. It should add to the definition of parameters and criteria to classify biogenic magnetite in the fossil record.

Acanthamoeba castellanii (Ac) are ubiquitously distributed in nature, and by contaminating medical devices such as heart valves and contact lenses, they cause a broad range of clinical presentations to humans. Although several molecules have been described to play a role in Ac pathogenesis, including parasite host-tissue invasion and escaping of host-defense, little information is available on their mechanisms of secretion. Herein, we describe the molecular components secreted by Ac, under different protein availability conditions to simulate host niches. Ac extracellular vesicles (EVs) were morphologically and biochemically characterized. Dynamic light scattering analysis of Ac EVs identified polydisperse populations, which correlated to electron microscopy measurements. High-performance thin liquid chromatography of Ac EVs identified phospholipids, steryl-esters, sterol and free-fatty acid, the last two also characterized by GC-MS. Secretome composition (EVs and EVs-free supernatants) was also determined and proteins biological functions classified. In peptone-yeast-glucose (PYG) medium, a total of 179 proteins were identified (21 common proteins, 89 exclusive of EVs and 69 in EVs-free supernatant). In glucose alone, 205 proteins were identified (134 in EVs, 14 common and 57 proteins in EVs-free supernatant). From those, stress response, oxidative and protein and amino acid metabolism proteins prevailed. Qualitative differences were observed on carbohydrate metabolism enzymes from Krebs cycle and pentose phosphate shunt. Serine proteases and metalloproteinases predominated. Analysis of the cytotoxicity of Ac EVs (upon uptake) and EVs-free supernatant to epithelial and glioblastoma cells revealed a dose-dependent effect. Therefore, the Ac secretome differs depending on nutrient conditions, and is also likely to vary during infection.

Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been introduced as useful inflammatory markers to predict the outcome of a wide spectrum of diseases, such as malignancies and cardiovascular pathologies. Limited evidence is available for their role in end-stage renal disease and dialysis patients. The aim of this study was to evaluate NLR and PLR as predictors of mortality in peritoneal dialysis (PD) patients. Methods: In this retrospective study 122 incident PD patients between 2004 and 2019 were included. Demographic, clinical and laboratory data were collected. Relationships between NLR, PLR and high-sensitivity C-reactive protein (hs-CRP) were evaluated by Spearman correlation test. Univariable and multivariable Cox regression analysis were performed to determine the association of NLR and PLR with all-cause mortality. Results: Mean levels of NLR and PLR were 3.99±2.6 and 195.5±101.7, respectively. Both NLR and PLR were significantly and positively correlated with serum hs-CRP levels (r=0.340, p

O potencial que a tecnologia informática possui para descrever empreendimentos futuros ao público em geral é enorme. No entanto, a utilização de modelos realistas de computador podem, por si só, ofuscar variáveis importantes do projecto urbano que se prendem mais com a sua lógica de configuração espacial e com as ideias que lhe estão subjacentes. Foram utilizados dois grupos de contraste, compostos por estudantes universitários de cursos diferentes, para analisar as diferenças em relação à avaliação feita por eles sobre a forma e o conteúdo de uma apresentação em vídeo de um projecto urbano em Lisboa. Os resultados obtidos realçam o poder que a tecnologia informática e a modelação realista possuem para esbater as diferenças entre os sujeitos., 12º Encontro Português de Computação Gráfica, Comunicações Curtas, 137, 141, Pedro Leão Neto, Projecto urbano; comunicação; tecnologia informática; modelação realista

The International Conference on the 5th issue of Sophia Journal, which took place at FAUP, opened a new cycle of international forums, henceforth to be held annually, and taking up the theme and topics examined in Sophia for each year. Sophia Journal’s International Conference presented both a live and videoconference program organized by CEAU / FAUP, in partnership with UNIZAR and DECA / ID - U. Aveiro. The event was broadcast live online, encompassing a rich and diverse program: (i) a series of videoconferences; (ii) the roundtable launch and presentation of the 4th issue of the peer reviewed journal Sophia: “Visual Spaces of Change: Unveiling the Publicness of Urban Space through Photography and Image”; (iii) the presentations of articles of the 5th issue of Sophia Journal: “Visual Spaces of Change: Designing Interiority - shelter, shape, place, atmosphere”; (iv) the launch of the open call for papers for the 6th issue of Sophia Journal: “Visual Spaces Of Change: photographic documentation of environmental transformations”; (v) the announcement of the awards of the International Competition of Ideas: Exhibition and Mobile Projector and the Visual Spaces of Change exhibition, developed for this conference and for the spaces of FAUP, where new contemporary photography projects will be communicated, as well as a new exhibition structure that was awarded with the first prize in the International Competition of Ideas: Exhibition and Mobile Projector. The objective of these international forums is to promote the reflection and debate on the universes of Architecture, Art and Image, addressing various issues transversal to the worlds of Photography and Architecture, and exploring how the image can be a means to cross borders and shift boundaries between different disciplines. This event provided the opportunity to visit the exhibition of the Visual Spaces of Change Projects developed for this conference using FAUP’s interior and outdoor spaces, featuring novel projects in the new exhibition modular structure, which awarded the first prize to Sérgio Magalhães representing studium.creative studio. The Visual Spaces of Change research project proposes a visual communication strategy based on the development of contemporary photography projects that reflect upon different dynamics of urban change to open new horizons of public intervention in the public space. Wilfried Wang (UTSOA) O’Neil Ford Centennial Professor in Architecture at the University of Texas at Austin and Guest Editor of Issue #6 of Sophia journal: “Visual Spaces of Change: photographic documentation of environmental transformations” announced the open call for this 6th issue of Sophia journal. This issue will bring together photographers and researchers who make significant contributions to these discussions, including the material processes of creating, managing and interpreting sets of documents. We are interested in material processes where photography is explored as a significant research tool for critical and innovative views on architecture and urban transformation in their expanded fields and contextualized by larger systems: cultural, political, artistic, technical, and historical dimensions. Finally, some words about the published content in Sophia’s other sections besides the peer reviewed articles, with the former having been integrated into the journal’s structure as a way of enrichening the publication with diverse viewpoints from experts in the field and other types of readings apart from the articles from the call. [...]

Monoclonal gammopathies consist of a broad spectrum of diseases, ranging from asymptomatic monoclonal gammopathy of undetermined significance to multiple myeloma (MM). Multiple myeloma is a malignant plasma cell disorder and accounts for 10% of all hematological malignancies and 1% of all malignancies. Differential diagnosis may be challenging, considering the variety of clinical entities with similar behavior. About 15-20% of MM only secretes monoclonal light chains, called light chain MM, which is associated with poorer outcome. Two intermediate concepts were recently introduced, monoclonal gammopathy of renal significance (MGRS) and a wider concept of monoclonal gammopathy of clinical significance (MGCS). The former behaves as a clonal proliferative disorder with associated nephrotoxicity, but does not have the hematological criteria for MM, while MGCS expands this concept to other organs. A subtype of MGCS is monoclonal immunoglobulin deposition disease, a multisystemic disorder characterized by light or heavy chain deposition of monoclonal immunoglobulin in various organs and encompasses three clinical entities: Light-Chain, Light-and Heavy-Chain, and Heavy-Chain Deposition Disease (LCDD, LHCDD and HCDD, respectively). We describe an unusual case of LCDD in which MM was subsequently considered although the proposed criteria are not met. We demonstrate the variability of clinical-pathological presentation of LCDD, requiring a rapid decision-making, particularly in terms of kidney and survival outcomes.

Resumo O artigo investiga o filme A carruagem de ouro (1952), dirigido por Jean Renoir, buscando identificar como as escolhas estilísticas e dramatúrgicas do diretor configuram um artificialismo teatral. A partir da análise da mise-en-scène e da dramaturgia da obra, abordamos como tal artificialismo resulta em uma perspectiva lúdica e incisiva sobre as relações sociais. O aspecto teatral do trabalho é analisado a partir de elementos formais que são mais comuns no teatro (como a frontalidade dos rostos, a desnaturalização e o aprisionamento dos espaços) ou em um cinema considerado “teatral” (como as entradas e saídas laterais), preservados pelo estilo de Renoir. Abstract The article looks into the film The Golden Coach (1952), directed by Jean Renoir, seeking to identify how the director’s stylistic and dramaturgical choices constitute a theatrical artificialism. From the analysis of the mise-en-scène and the dramaturgy of the work, we analyzed how such artificialism results in a playful and incisive perspective on social relations. The theatrical aspect of the work is analyzed from the formal elements that are more common in the theater, such as the frontality of the faces, the denaturalization and the imprisonment of the spaces, or in a cinema considered theatrical, as the lateral entrances and exits, but which are preserved by Renoir’s style.

O presente texto apresenta uma reflexão sobre a educação dos sentidos a partir do estudo das obras “A indústria cultural” de Theodor W. Adorno e “A obra de arte na era de sua reprodutibilidade técnica” de Walter Benjamin. Primeiramente apresentamos uma breve contextualização histórica sobre o período no qual se desenvolveram os referentes textos. Em seguida buscamos demonstrar através do pensamento de Walter Benjamin como a arte passou a educar os sentidos das classes trabalhadoras a partir da sua reprodutibilidade técnica. Nas considerações finais, apontamos a importância da leitura de ambas as obras para possíveis reflexões acerca da formação do discurso nas tomadas de decisão social e cultural na atualidade. Como também buscamos compreender a função política da arte na formação crítica do sujeito. This text presents a reflection on the education of the senses based on the study of the works “The cultural industry” by Theodor W. Adorno and “The work of art in the age of its technical reproducibility” by Walter Benjamin. First, we present a brief historical contextualization about the period in which the related texts were developed. Then we seek to demonstrate through the thought of Walter Benjamin how art began to educate the senses of the working classes from its technical reproducibility. In the final remarks, we point out the importance of reading both works for possible reflections on the formation of discourse in social and cultural decision making today. As we also seek to understand the political function of art in the critical formation of the subject.

Background and Aims Cardiovascular disease (CVD) is the main cause of death in chronic kidney patient. Increase pulse pressure (PP) is associated with adverse cardiovascular outcomes and is an independent risk factor of progression of chronic kidney disease. In this study we aim to identify the risk factors associated with increased PP in a population with severely decreased glomerular filtration rate. Method This was a prospective analysis conducted in an outpatient nephropathy clinic between 2005-2018, enrolling 692 patients with stage 4 CKD. Patients were divided into two groups according to their pulse pressure. Group 1 mean PP< 50 mmHg, Group2 mean PP >50 mmHg. Based on the calcium/magnesium ratio (rCaMg), the subjects were also divided into 4 risk groups according to the following criteria: 75th percentile (rCaMg: > 8.6; n=165) - G4. We used descriptive analysis, Student's t test, Univariate logistics regression analysis and CHAID analysis to determine the relationship between variables and PP. Results Total of 682 patients, with mean age 70 (SD 12.5), female 54%. An independent t-test was conducted to compare groups. There was a significant difference in mean hemoglobin level (p=0.005), calcium (p=0.029), phosphorus (p=0.017), magnesium (p Phosphorus OR 1.906 (CI 1.338-2.715) p After adjusting for confounding variables only sex OR 0.613 (CI 0.420-0.896) p=0.012 and rCa/Mg groups: G1 OR 7.392 (CI 4.362-12.527) p CHAID analysis identified rCa/Mg G2, G3, G4 (82.4%) as the more likely significant predictor to PP> 50 mmHg (p Conclusion These results suggest increased calcium/magnesium rate and male gender were associated with increased pulse pressure in a population with stage 4 CKD. Further studies are needed to understand this relationship.

Background and Aims Survival analysis is a cornerstone in medical research. For this purpose Kaplan-Meier is the most widely used statistical test, but the presence of competing risks violates the fundamental assumption that the censoring mechanism is independent of survival time. This leads to overestimation of the cumulative probability of cause-specific failure. Cumulative incidence estimate and competing risks analysis are preferred. The purpose of this study was to compare different survival analysis methods: Kaplan-Meier and cumulative incidence function estimates in a cohort of Peritoneal Dialysis (PD) patients. Method The survival of 115 incident patients on PD in a university hospital was evaluated after establishing 2 cohorts: patients starting renal replacement therapy with PD (PD first; n=85) and patients switching to PD on the first 6 months of dialysis (PD transfer; n=30). Kaplan-Meier, cumulative incidence function, cause-specific and subdistribution hazards were performed. The event of interest was death and the competing risk events were transfer to hemodialysis and renal transplantation. Results Besides higher residual renal function (RRF) and kt/V in the PD first group, there were no other significant differences between groups. There were 22 deaths. PD first group had a better survival with both Kaplan-Meier (log-rank test, p=0.013) and cumulative incidence function (p=0.021) approaches. The Cox regression model showed, as protecting variables, higher albumin (HR=0.174; CI95% 0.054-0.562), higher RRF (HR=0.785; CI95% 0.666-0.925) and PD first (HR=0.350; CI95% 0.132-0.927). Higher Charlson Index predicted worse outcome (HR=1.459; CI95% 1.159-1.835). PD as first dialysis therapy was associated with 65.0 % lower risk of death comparing with PD transfer. The subdistribution multivariable model found higher Charlson Index (HR=1.389; CI95% 1.118-1.725) and lower RRF (HR=0.798; CI95% 0.680-0.936) were statistically associated with death, but not PD transfer or albumin. This result differs from the obtained using the cause-specific hazard model. Analyzing the competing events, patients submitted to renal transplantation had a lower Charlson Index. Conclusion The probability of death was overestimated by the Kaplan-Meier method. The bias of Kaplan-Meier is especially great when the hazard of the competing risks is large. This study consisted on a statistical critical analysis of a real medical example, broader clinical conclusions related with “PD first initiative” should be cautious in this context. It is primordial to recognize the presence of competing risks in studies with multiple outcomes, as in Peritoneal Dialysis studies, to estimate cumulative incidence and yield more accurate results. This study shows how different conclusions are attained with different statistical methodology and its relevance in clinical context.

Background and Aims Peritoneal protein loss (PPL) in peritoneal effluent is a well-recognised detrimental result of peritoneal dialysis treatment since its inception. Hydrostatic convection is a major drive for peritoneal protein transport; therefore venous congestion may have a role in peritoneal protein loss (Krediet RT et al Perit Dial Int. 2019 ). The aim of this study was to explore the importance of overhydration on the magnitude of peritoneal protein clearance in incident PD patients. Method A total of 97 adult incident PD patients were included. A standard peritoneal equilibration test, 24-hour urine and dialysate collection, and multifrequency bioimpedance analysis were performed. Independent-samples t test and Pearson correlation coefficient were performed to evaluate relevant clinical associations and linear multivariable regression was done. Results Statistically significant univariable relationships for 24h PPL were found for continuous ambulatory PD technique (CAPD) and, with a correlation coefficient >0.20, for age, pulse pressure, 4-hour dialysate/plasma creatinine and extracellular water/total body water. On multivariable analysis, type of PD technique (β=0.327, p=0.011), 4-hour dialysate/plasma creatinine (β=0.247, p=0.037), and extracellular water/total body water (β=0.304, p=0.016) were significant independent predictors of peritoneal protein loss. Conclusion Overhydration revealed the most important connection with peritoneal protein loss. Mortality has been associated with PPL in some studies, but not others. This could be a result of this relationship, as volume overload has been strongly related with lower survival.

Background and Aims Peritoneal Dialysis (PD) is currently the first option as renal replacement therapy to many patients, for several reasons, as personal flexibility, volemic management in cardiorenal patients, poor vascular access to dialysis, among others. Mechanical complications can be a drawback in these patients, which may occur during or after catheter placement. Abdominal wall hernias and dialysate leaks are relatively common and highly related to chronically increased intraperitoneal pressure. In this setting CT peritoneography is the technique of choice as it allows differentiation between a true hernia or a wall leakage. Method We describe a case of a 69-year-old man, with a personal history of polycystic kidney disease, colonic diverticulosis and hypertension, which opted for PD. The patient later developed a mechanical complication for which a proper diagnostic approach, namely through specific imaging, and surgical planning were essential. Results After 15 months without complications, it was detected a bulging in the periumbilical area, exacerbated by orthostatism. Changes in dialytic prescription included lower dialytic volumes during orthostatic period, with some improvements. The limitation of volumes and difficulty of drainage were limiting dialytic prescription and insufficient kt/V. An ultrasound (figure 1) and CT peritoneography (figure 2) were performed, revealing an hernial sac with peritoneal liquid leak, without any intestinal loop, approachable by minimally invasive surgery and local anesthesia. Mini-laparotomy was performed, hernial sac was removed, without peritoneum aperture, with only a 4-day pause on PD technique. Conclusion CT peritoneography allowed the differentiation between this true hernia and a wall leakage, by providing accurate anatomical detail, allowing proper planning of surgical intervention. In this case, the patient had additional predisposing factors, namely polycystic kidney disease. Moreover, only a short pause on PD was necessary. Although some limitations exist, such as the use of iodinated contrast material and ionizating radiations, CT peritoneography is currently the gold standard for the evaluation of mechanical complications in PD; in addition to those mentioned, it is also useful for complications related to the catheter (kinking, entrapment, malposition), intrabdominal adhesions or loculated fluid collections.

Background and Aims Cardiovascular disease (CVD) is the most life-threatening complication in chronic kidney disease (CKD) patients. In addition to traditional risk factors, most patients with CKD display abnormal mineral metabolism with underlying hormonal dysregulation, defined as chronic kidney disease-mineral and bone disorder (CKD-MBD). CKD-MBD involves changes in mineral ion homeostasis, bone quality and turnover, cardiovascular and soft tissue calcifications, which highly contribute for cardiovascular complications. Vascular calcification (VC) is associated with significant morbidity and mortality and a strong predictor of cardiovascular risk in CKD patients. Early preventive measures, including new diagnostic/prognostic tools, are required to reduce the development and progression of VC, left ventricular hypertrophy and arterial stiffness, which are crucial for the prevention of CVD outcomes in CKD patients. Gla-rich protein (GRP) is a vitamin K-dependent protein with a dual capacity to function as an inhibitor of pathological calcification and anti-inflammatory agent in the cardiovascular system, whose clinical utility is unknown. Our aim with this study was to evaluate the potential of GRP as a new marker for CKD-MBD and vascular calcification, in type 2 diabetic patients with chronic kidney disease (CKD) stages 2-4. Method In an observational prospective study including all eligible type 2 diabetic patients with CKD stages 2-4 (n=80) followed in outpatient nephrology consultation from 2010 to 2017, we explored correlations between levels of GRP in serum with mineral metabolism and inflammation markers, CKD developmental stage, vascular calcification and pulse pressure (PP). Vascular calcification score (VCS) was evaluated using the plain x-ray of the hands and pelvis (Adragão score), and increased cardiovascular risk was considered for VCS≥3. Measurements of GRP in serum were performed using a recently developed sandwich ELISA assay. Descriptive statistics, ANOVA and post hoc analysis with Scheffe test were used for analysis. Forward stepwise logistic regression (likelihood ratio) analysis was applied to identify predictive factors for VCS and PP, and ROC curves were used to assess the sensitivity and specificity of GRP in relation to these exposure factors. Results Spearman’s correlation analysis revealed the strong positive correlation between levels of serum GRP and eGFR (r=0.863, p Conclusion Reduced levels of GRP were associated with higher levels of vascular calcification promoters such as P, FGF-23 and CaxP, and with lower levels of the VC inhibitor α-Klotho, indicating a correlation between GRP and the dysregulation of phosphate metabolism characteristic of CKD-MBD. In addition, this pilot cohort study indicates that GRP levels might be a significant clinical predictor of vascular calcifications in diabetic patients with CKD. Funding This research was funded by the Portuguese Society of Nephrology (SPN) through project funding 2016, by the Portuguese national funds from FCT - Foundation for Science and Technology through the transitional provision DL57/2016/CP1361/CT0006 and project UID/Multi/04326/2019. Acknowledgments To SPN by the attribution of the Jacinto Simões award (2018) financed by Fresenius medical care.

Background and Aims The report of peritoneal protein loss should be related with a timely collection (24-hour measurement or 4-hour PET assessment) or concentration. Standardized and reproducible estimation of peritoneal protein transport is obtained during PET. The 24-hour measurements estimate the real amount of PPL, but may be affected by other factors unrelated to the prognosis of PD patients, as inconsistencies in collection and management of the samples. Overall, PET protein loss quantification may be a more specific marker of peritoneal large-pore dysfunction and is seemingly more convenient than 24-hour measurements. The aim of this study was to compare the results of both sampling methods. Method A total of 144 adult incident PD patients were included. A standard peritoneal equilibration test, 24-hour urine and dialysate collection, and multifrequency bioimpedance analysis were performed. Independent-samples t test and Pearson correlation coefficient were performed to evaluate relevant clinical associations. Results Statistically significant univariable relationships for 24h PPL were found for continuous ambulatory PD technique (CAPD) and, with a correlation coefficient >0.20, for pulse pressure, 4-hour dialysate/plasma creatinine and extracellular water/total body water. Studying 240 min PPL, only with 4-hour dialysate/plasma creatinine, creatinine clearance and bicarbonate levels were statistically significant. In both samples there was no significant association with age, gender, type of effluent (biocompatible solutions or lactate plus bicarbonate comparing with bicarbonate), comorbidity Charlson Index, or presence of diabetes. Correlation between 240 min PPL and 24h PPL ensues, but it is not strong (p Conclusion The weak correlation between 24h and 240 minutes show that these two measurements should not be considered equivalent. Measurements of a 24h sample might be more close to patients’ clinical status and prognosis, despite more frequent sampling errors. PET protein loss quantification should be regarded as a marker of peritoneal large-pore dysfunction.

Background and Aims Cardiovascular disease (CVD) is the main cause of death in chronic kidney patient. The interaction between calcium and magnesium and mineral metabolism have been identified as risk markers for CVD. The main objective was to identify the variables associated with cardiovascular and other causes of mortality in a group of patients with stage 4 of chronic kidney disease (CKD). Method This was a prospective analysis conducted in an outpatient nephropathy clinic between 2005-2018, enrolling 692 patients with stage 4 CKD. Based on the calcium/magnesium ratio (rCaMg) the subjects were divided into 4 risk groups according to the following criteria: 75th percentile (rCaMg: > 8.6; n=165) - G4. Descriptive statistics, ANOVA, chi-square and Log Rank test were used for comparison between groups. Bonferroni test was used as a post-hoc test. Kaplan-Meier analysis was used to evaluate mortality. The Kaplan-Meier method for measuring patient survival rate was applied and a comparison between the four percentiles was based on the log rank test The multinomial regression models were used to assess predictive factors for cardiovascular mortality. CHAID analysis was used to assign patients to risk groups. Results The mean age was 70 years, 53.5% women, with an eGFR of 19.9 ml/min (sd 8.1). Differences among groups were evaluated with the use of an analysis of variance (ANOVA) model. Age (p 8.6) were older (p Survival at 84 months was progressively shorter with higher rCaMg (G- 1=81.4%, G-2:70.7, G- 3=60.5%, G- 4=28.4%. log Rank =xxx, p=0.004) Multinomial regression analysis showed that Phosphorus; ORa: 1.946 (CI 1.194-3.169), p=0.007, rCaMg; ORa: 1.106 (CI 1.071-1.261) p=0.031, Age: ORa; 1.032 (CI 1.007-1.058) p=0.013, Pulse pressure: ORa; 1.033 (CI 1.007-1.060) p=0.011 were linked to increased cardiovascular mortality. CHAID analysis identified that in 43.7% of patients with P> 4.1 mg/dl, 15.5% were associated with cardiovascular mortality (p Conclusion The calcium/magnesium ratio was shown to be a strong predictor of cardiovascular mortality in patients with stage 4 chronic kidney disease. After CHAID analysis the phosphorus level was assumed to be strongest predictor of cardiovascular mortality in this group of patients.