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Abstract Introduction: Foville syndrome (inferior medial pontine syndrome) is a clinical entity that makes part of a subclassification of a broader category of posterior circulation stroke. It is characterized by a blockage of the basilar artery caused by lesions in the pontine tegmentum. This syndrome has a very low incidence worldwide, but its clinical relevance is considerable. Case report: A 41-year-old patient without any medical history was admitted to the emergency department due to signs of focal neurologic deficits. Imaging findings were compatible with an ischemic lesion in the brainstem, and cerebral angiography showed involvement of the basilar artery territory. The patient was diagnosed and followed up in the intensive care unit (ICU) until his recovery. Conclusion: Foville syndrome is a rare disease with high morbidity and mortality. Early recognition and a multidisciplinary approach are decisive to improve the patient's prognosis.

Sugarcane orange rust, caused by Puccinia kuehnii (W. Krüger) EJ Butler, is one of the major diseases impacting sugarcane (Saccharum spp.) production worldwide. The objective of this work was to characterize by histology the development of P. kuehnii in leaves and the response of the cultivars to the disease. Four cultures with different degrees of infection response were inoculated in greenhouse. Microscopy studies were performed in leaf fragments of plants at 5 and 15 days after inoculation. It was shown that the development of fungus structures, prior to foliar tissue penetration, are similar in all cultivars regardless of the type of plant response. It was found that cultivar with grade 1 developed response similar to the hypersensitive response, while grade 2 suggests resistance based on the quantitative contribution of several genes. The results are a contribution towards understanding the genetic basis of orange rust resistance in sugarcane.

La Cruceta es un yacimiento situado en Tauste, en la provincia de Zaragoza. Se trata de un asentamiento rural, que cumplía las funciones de puesto de vigilancia, ocupado entre los siglos XIII y XIV d.C. Durante su excavación, se documentaron estructuras de habitación y de funciones auxiliares, así como cerámica decorada, monedas y elementos metálicos de indumentaria militar. Además, se recuperó una abundante cantidad de restos faunísticos. En este trabajo, se presenta el estudio arqueozoológico de La Cruceta, uno de los primeros para reino de Aragón en época medieval. Los resultados han permitido documentar, además de una funcionalidad estratégica, la existencia de una economía centrada en el ganado ovino y caprino. Los productos explotados son variados (carne, leche, materias primas, etc.), lo que junto a las pautas de procesado parece indicar que La Cruceta, además de puesto de vigilancia, tuvo funciones de producción. ______________________________________________________________________ The Kingdom of Aragon expanded territorially during the 12th and 13th centuries. This expansion was linked to the growth and development of the Aragonese economy, being the agricultural activities the predominant ones. Aragonese husbandry was linked to this territorial and economic expansion of the Kingdom of Aragon, with the increase of the livestock population that took place throughout the 13th century. Studies on this period in the Kingdom of Aragon are practically non-existent, due to the absence of local specialists for this type of study and the scarce interest that has traditionally been given to it. Within this context we find the site of La Cruceta, a Late Medieval settlement located in the municipality of Tauste, in the province of Zaragoza. This settlement was occupied between the beginning of the 13th century and the middle of the 14th century, and it is not clear who promoted this construction. Documentary sources have led to the conclusion that it could have been promoted by the Santa Cristina de Somport Hospital, by the Casa de los Luna or by the municipality of Tauste within a climate of rivalry for the control and exploitation of natural resources. The aims of this work are: 1) to document livestock practices and 2) to show the livestock products exploited by those who occupied La Cruceta, seeking to characterise the economic strategy carried out there. The results have shown how the inhabitants of La Cruceta had a livestock focused on the exploitation of sheep and goats. The dominance of these two species can be observed during most of the Middle Ages in the Iberian Peninsula, but especially from the 13th century onwards, when they formed 50% of the domestic livestock. Furthermore, pigs, cattle, horses and birds also made up the livestock in La Cruceta, although with much lesser quantitative importance. Finally, hunting of species such as red deer also formed part of the economic activities of the site. The results have also shown how the community that occupied La Cruceta exploited a great diversity of animal products (meat, milk, raw materials), highlighting the limited role that wool exploitation could have played. In addition, the presence of perinatal animals led to the conclusion that they were bred at the site. With regard to butchering, the absence of elements such as humerus and femurs from sheep and goats, with a high meat content, stands out. In conclusion, our hypothesis is that in addition to being a strategic settlement for the control of the area, La Cruceta was also a settlement with livestock production for the self-consumption of the community that inhabited the site and perhaps for the supply (mainly of meat) of some settlement near the site. This hypothesis is based on the specialization of production in sheep and goats, the mortality profile of both species and the representation of the anatomical regions, which shows a notable absence of elements with higher meat content in these species.

La pornografía puede definirse como el material audiovisual que presenta de forma explícita actividades sexuales y genitales de manera inocultable, con el objetivo de excitar al espectador. El objetivo de este trabajo es identificar las principales causas y consecuencias de la adicción a la pornografía en hombres y mujeres. Se empleó la metodología de la revisión sistemática de literatura (RSL), tomando como referencia investigaciones previas publicadas en bases de datos científicas y publicaciones web especializadas. Este trabajo concluye que la adicción a la pornografía puede generar problemas físicos, mentales, psicológicos y sociales, que son equiparables con los que genera la adicción al consumo de sustancias psicoactivas. Establecer estrategias de autocontrol, incrementar la actividad física y la participación en actividades sociales son algunas de las alternativas que pueden ayudar a combatir y prevenir la adicción.

This work was carried out to evaluate morph agronomic parameters on field conditions plant populations of grain sorghum [Sorghum bicolor (L.) Moench] variety CIAP 132R-05 regenerated via somatic embryogenesis. Plants regenerated from somatic embryos use as plant material in the present work were compared with plants grown from botanical seeds. Quantitative characteristics of the two populations correspond to those listed in the National Register of Commercial Varieties of Cuba. However the population of plants derived from somatic embryos showed significantly higher values in terms of: plant height, stem diameter, length and width of limbo and panicle, fresh and dry weight of panicle length assertion, grain length, number of spikelets per panicle, number of grains per spike and panicle, fresh and dry mass of 1000 grains and agricultural yields. These assessments allowed determining the phenotypic stability of the regenerated plants via somatic embryogenesis, by assessing morphological characters in field conditions.

Orange rust [Puccinia kuehnii (W. Kruger) E. J. Butler] from sugarcane (Saccharum spp.) is a disease of potential importance for Cuban sugarcane farming. However, under natural conditions, the presence of symptoms has not maintained stability in the foci of infection, which makes it difficult to evaluate the phenotypic resistance response of the cultivars to this disease. The present work was carried out with the objective of establishing a protocol to select sugarcane cultivars for their resistance to orange rust in the greenhouse. Includes, reference cultivars, source of inoculum, morphological and molecular characterization of P. kuehnii uredospores, inoculation conditions and inoculation method, variables to evaluate the response of the inoculated plants and their classification according to the degree of resistance to P. kuehnii. Keywords: inoculation, Puccinia kuehnii, resistance, Saccharum spp.

Sugarcane orange rust, caused by Puccinia kuehnii (Krüguer) Butler, is considered one of the most important diseases, due to losses in agricultural yields in susceptible commercial plantations. The objective of this work was to characterize the response of sugarcane cultivars to orange rust in green house conditions. Sugarcane plants of two months old were inoculated with spore suspension obtained from pustules on sugarcane leaves (‘C01-227’) with orange rust symptoms. Previously to inoculum preparation, P. kuehnii occurrence were confirmed by optical microscopy and polymerase chain reaction techniques. The experimental conditions used allow identify differential response between sugarcane cultivars to P. kuehnii infection. Some cultivars showed to be resistant to the fungus through interactions incompatible with a typical hypersensitive response. In other cultivars, different grades of susceptibility with significant differences in latency period of the disease was observed. Key words: Puccinia kuehnii, resistance, Saccharum spp.

Introducción: en nuestro país, como en el resto del mundo, los sistemas de salud están sometidos a procesos de modernización y reforma con el objetivo de adecuar sus capacidades a las necesidades de la población. En este contexto la estructura y gestión del sistema de salud son vehículos importantes para cumplir el objetivo. A fin de hacer buen uso de esta red, resulta crucial asegurar una buena coordinación entre los diferentes niveles de atención. Un sistema de referencia-contrarreferencia (SRC) constituye una herramienta que pone, a disposición de los médicos, criterios y procedimientos homogéneos que permiten canalizar la demanda para servicios de salud y hacer uso eficiente del sistema de atención. Objetivos: analizar las derivaciones de pacientes al Hospital Pediátrico del Centro Hospitalario Pereira Rossell (HP-CHPR) a través del Departamento de Emergencia (DEP) y de la Policlínica Pediátrica General de Referencia (PPGR). Material y método: se realizó un estudio descriptivo a partir de los registros correspondientes del triage de las interconsultas de las policlínicas de atención primaria a los servicios de neuropediatría, neumología y gastroenterología realizados en la PPGR desde agosto del año 2005 a diciembre de 2006. Se analizaron además los pases realizados al DEP del CHPR desde septiembre a diciembre del año 2006. Se realizaron fichas codificadas tanto para evaluar la interconsula a especialista, así como para evaluar el pase al DEP. Se calcularon porcentajes. Los datos se procesaron mediante Epi Info 6.04. Resultados: evaluación de los niños derivados a especialistas. El 69% de los casos procedía de Montevideo. Luego del triage, 69% del total de interconsultas fueron derivadas a la policlínica de referencia. Neuropediatría fue la especialidad más solicitada en 60% de los pases. Luego de realizado el triage del total de niños con pase a neuropediatría, 30% fue derivado a esta especialidad, a gastroenterología 0,05% y a neumología 0,03%. La calidad de los datos fue buena en 30% de los casos. La derivación fue oportuna en 89% de los casos. Evaluación de los pases al DEP. Del total de consultas en ese período, 24% concurrieron con pase. Se analizó 7,6%. El 73,2% provenía de Montevideo, 20% de Canelones. Los pacientes fueron derivados desde sistemas de emergencia móvil en 39% de casos. El 26% de los pases fue realizado por pediatra y el resto por médico general o de familia. El motivo de la derivación más frecuente fue por requerimiento de especialista, 29,6%. La calidad del pase fue buena en 64%. El 57% de los pacientes fue trasladado en ambulancia con médico; de éstos, 58,5% no requería tercer nivel de atención. Conclusiones: los resultados hallados muestran una ineficiente utilización de los recursos. Se deben establecer medidas para racionalizar el sistema de atención y promover su eficacia. Se proponen medidas para mejorar el funcionamiento del SRC y la derivación oportuna y adecuada a especialista en el HP-CHPR.

Induction of mutations is an alternative for genetic improvement of sugarcane (Saccharum spp. hybrid). It has been used to obtain mutants with resistance to rust (Puccinia melanocephala). Characteristics of pathogen infection process were identified through histopathological studies in a mutant (IBP 8518) of the B4362 variety, with resistance to this disease. Fragments of leaves were inoculated with P. melanocephala . Then, these were stained with lactophenol tripan blue to observe, in the optical microscope, the autofluorescence of the dead cell as hypersensitive response. The essay demonstrated fist that resistance of mutant involves a hypersensitive response at the place of interaction with the fungus. The it does not depend on possible structural changes of the leaf surface. Histological characterization of this incompatible interaction could contribute to the study of molecular processes of resistance to P. melanocephala in sugarcane. Keywords: histology, hypersensitive response, mutant

Partial sequences of sugarcane genes, obtained by means of a subtractive library were identified by BLAST alignment against all sequences available in the databases. During the homology search, five genes were identified as chloroplast or citosol ribosomal proteins. The biggest homology obtained among the identified sequences as ribosomal proteins of sugarcane was with the corn genome. Key words: consensus domain, Saccharum spp., subtractive library

AFLPs (amplified fragment length polymorphism) was carried out from genomic DNA of five rust resistant sugar cane somaclons and their susceptible donor, Saccharum officinarum var B 4362, using three combinations of primers (EcoRI/aca: MseI/acc; EcoRI/aca: MseI/atg and EcoRI/aca: MseI/agg). Six polymorphic bands were obtained, two of these only appeared in the resistant genotypes, which are probably DNA sequences, related to rust resistance locus. These fragments have been cloned to study their nucleotide sequence and to investigate their roll in resistance mechanism develop by these mutants during Puccinia melanocephala infection. Key words: molecular markers, Puccinia. melanocephala, Saccharum

The hypersensitive response is one of the most powerful mechanisms for which the plants resist pathogen attack. Mutations carried out previously on the variety B4362, of sugarcane, originated five mutants that express this mechanism towards the attack of rust (Puccinia melanocephala Syd.). By means of a subtractive hybridization among the cDNA obtained starting from the resistant clone inoculated with rust and a pool of cDNA of the susceptible variety (B4362) inoculated and of the resistant clone not inoculated, it was possible to reduce the number of genes expressed during the infection with the fungus. A subtractive library was carried out where we hope that most of the genes are involved in the hypersensitive response that present these mutants towards the infection of the pathogen. Key words: Subtractive hybridization, hypersensitive response, Puccinia melanocephala Syd.

Septic shock comprise a cascade of metabolic, hemodynamic and clinical changes provoked from the release of toxic bacterial products. Recent advances in understanding the pathophysiology of septic shock have suggested modalities of interrupting the earliest stages in the pathogenic mechanism and afford sorne hope of diminishing high mortality. However, at this time, early diagnosis and institution of appropriate medical and, surgical therapy seem to he the way to manage it.

The enteric nervous system (ENS) is responsible for the genesis of motor patterns ensuring an appropriate intestinal transit. Enteric motor neurons are classified into afferent neurons, interneurons and motorneurons. Motorneurons are excitatory or inhibitory causing smooth muscle contraction and relaxation respectively. Muscle relaxation mechanisms are key for the understanding of physiological processes such as sphincter relaxation, gastric accommodation, or the descending phase of the peristaltic reflex. Nitric oxide (NO) and ATP or a related purine are the primary inhibitory neurotransmitters. Nitrergic neurons synthesize NO through nNOS enzyme activity. NO diffuses across the cell membrane to bind guanylyl cyclase, and then activates a number of intracellular mechanisms that ultimately result in muscle relaxation. ATP is an inhibitory neurotransmitter together with NO. The P2Y1 receptor has been identified as a the purine receptor responsible for smooth muscle relaxation. Although, probably, no clinician doubts about the significance of NO in the pathophysiology of gastrointestinal motility, the relevance of purinergic neurotransmission is apparently much lower, as ATP has not been associated with any specific motor dysfunction yet. The goal of this review is to discuss the function of both relaxation mechanisms in order to establish the physiological grounds of potential motor dysfunctions arising from impaired intestinal relaxation.

Deep knowledge of the relevance of signs and symptoms of acute heart failure (AHF) would lead to better diagnostic and decision-making strategies. The signs and symptoms of congestion are easily assessed bedside. It is interesting to analyze the sensitivity, specificity and the importance of each of them in the diagnosis of AHF. More specific signs (jugular venous pressure) are more difficult to determine, and the agreement among physicians examining the same patient tends to be poor. Both the symptoms and the classic signs of AHF can have a high sensitivity (dyspnea) or specificity (in the case of orthopnea, paroxysmal nocturnal dyspnea), but not both at the same time. Given the limitations of these findings, it is necessary to find support on other studies such as imaging tests and biomarkers for diagnostic confirmation. [ABSTRACT FROM AUTHOR]

Abstract Left ventricular (LV) hypertrophy is a common finding in patients with severe aortic stenosis (AS). Cardiac magnetic resonance (CMR) is the gold-standard technique to evaluate LV remodeling. Our aim was to assess the prevalence and describe the patterns of LV adaptation in AS patients before and after surgical aortic valve replacement (AVR). Prospective study of 130 consecutive patients (71y [IQR 68–77y], 48% men) with severe AS, referred for surgical AVR. Patterns of LV remodeling were assessed by CMR. Besides normal LV ventricular structure, four other patterns were considered: concentric remodeling, concentric hypertrophy, eccentric hypertrophy, and adverse remodeling. At baseline CMR study: mean LV indexed mass: 81.8 ± 26.7 g/m2; mean end-diastolic LV indexed volume: 85.7 ± 23.1 mL/m2 and median geometric remodeling ratio: 0.96 g/mL [IQR 0.82–1.08 g/mL]. LV hypertrophy occurred in 49% of subjects (concentric 44%; eccentric 5%). Both normal LV structure and concentric remodeling had a prevalence of 25% among the cohort; one patient had an adverse remodeling pattern. Asymmetric LV wall thickening was present in 55% of the patients, with predominant septal involvement. AVR was performed in 119 patients. At 3–6 months after AVR, LV remodeling changed to: normal ventricular geometry in 60%, concentric remodeling in 27%, concentric hypertrophy in 10%, eccentric hypertrophy in 3% and adverse remodeling (one patient). Indexes of AS severity, LV systolic and diastolic function and NT-proBNP were significantly different among the distinct patterns of remodeling. Several distinct patterns of LV remodelling beyond concentric hypertrophy occur in patients with classical severe AS. Asymmetric hypertrophy is a common finding and LV response after AVR is diverse.

Introduction and objectives: Current epidemiological data on heart failure (HF) in Portugal derives from studies conducted two decades ago. The main aim of this study is to determine HF prevalence in the Portuguese population. Using current standards, this manuscript aims to describe the methodology and research protocol applied. Methods: The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) is a large, three-stage, population-based, nationwide, cross-sectional study. Community-dwelling citizens aged 50 years and older will be randomly selected via stratified multistage sampling. Eligible participants will be invited to attend a screening visit at a mobile clinic for HF symptom assessment, anthropomorphic assessment, N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, one-lead electrocardiogram (ECG) and a sociodemographic and health-related quality of life questionnaire (EQ-5D). All subjects with NT-proBNP ≥125 pg/mL or with a prior history of HF will undergo a diagnostic confirmatory assessment at the mobile clinic composed of a 12-lead ECG, comprehensive echocardiography, HF questionnaire (KCCQ) and blood sampling. To validate the screening procedure, a control group will undergo the same diagnostic assessment. Echocardiography results will be centrally validated, and HF diagnosis will be established according to the European Society of Cardiology HF guidelines. A random subsample of patients with an equivocal HF with preserved ejection fraction diagnosis based on the application of the Heart Failure Association preserved ejection fraction diagnostic algorithm will be invited to undergo an exercise echocardiography. Conclusions: Through the application of current standards, appropriate methodologies, and a strong research protocol, the PORTHOS study will determine the prevalence of HF in mainland Portugal and enable a comprehensive characterization of HF patients, leading to a better understanding of their clinical profile and health-related quality of life. Resumo: Introdução e objetivos: Os dados epidemiológicos atuais sobre insuficiência cardíaca (IC) em Portugal provêm de estudos realizados há mais de duas décadas. O objetivo principal deste estudo é determinar a prevalência da síndrome de IC na população portuguesa com 50 ou mais anos, sendo, especificamente, objetivo deste artigo descrever as abordagens metodológicas e o protocolo de investigação aplicados. Métodos: O Estudo de Prevalência de Insuficiência Cardíaca em Portugal (PORTHOS) é um estudo observacional transversal de grande dimensão, de base populacional, nacional, constituído por três fases. Serão selecionados aleatoriamente por amostragem estratificada multietapas cidadãos com 50 ou mais anos residentes na comunidade em Portugal. Os participantes elegíveis serão convidados a participar numa visita de triagem, que decorrerá numa clínica móvel, durante a qual serão submetidos a avaliação de sintomas de IC, avaliação antropomórfica, um teste de N-terminal pró-peptídeo natriurético tipo B (NT-proBNP), eletrocardiograma de 1 derivação, questionários sociodemográficos e questionário de qualidade de vida relacionada à saúde (EQ-5D). Todos os participantes com NT-proBNP ≥125 pg/mL ou história prévia de IC serão submetidos a uma avaliação diagnóstica confirmatória composta por eletrocardiograma de 12 derivações, ecocardiografia completa, questionário de IC (KCCQ) e colheita de sangue. Para validar o procedimento de triagem, um grupo controlo passará pela mesma avaliação diagnóstica. Os resultados dos ecocardiogramas realizados serão validados centralmente e o diagnóstico de IC será confirmado de acordo com as recomendações de IC da Sociedade Europeia de Cardiologia. Uma subamostra aleatória de participantes com diagnóstico questionável de IC com fração de ejeção preservada (ICFEp), após a aplicação do algoritmo de diagnóstico de fração de ejeção preservada da Heart Failure Association (HFA-PEFF) será convidada a realizar ecocardiografia de esforço. Conclusão: Através da aplicação das recomendações atuais e abordagens metodológicas adequadas, o estudo PORTHOS irá determinar a prevalência da IC em Portugal Continental e permitir uma caracterização abrangente dos doentes com IC, para melhor compreensão do seu perfil clínico e qualidade de vida relacionada com a saúde.

Abstract Aims Increased collagen content of the myocardium modifies tissue reflectivity and integrated backscatter (IBS) indexes are suggested as markers of myocardial fibrosis (MF). We sought to assess the correlation between calibrated (c) IBS and bidimensional (2D) strain derived IBS with left ventricular (LV) MF in patients with severe aortic stenosis (AS). Methods and results We made a prospective observational cohort study including 157 patients with severe AS referred for surgical aortic valve replacement (AVR), with complete preoperative transthoracic echocardiography, cardiac magnetic resonance (CMR) and endomyocardial biopsy (EMB) obtained from the anterior basal septum at the time of surgery. Two groups of 30 patients were specifically evaluated, with and without late gadolinium enhancement (LGE) at CMR. IBS was obtained at QRS peak from both parasternal long axis (PLAX) and apical-three-chamber (AP3C) views and measured in decibels (dB). Whole-cardiac cycle IBS at basal anterior septum was obtained from 2D longitudinal strain. Correlation analysis of reflectivity indexes was performed with global and segmental (anterior basal septum) values of native T1 and extracellular volume (ECV), and EMB collagen volume fraction (CVF) (Masson´s Trichrome). IBS values were compared in both group of patients (LGE + vs. LGE –). 60 patients (74 [36–74] years, 45% male) with high gradient (mean gradient: 63 ± 20mmHg), normal flow (45 ± 10mL/m2) AS and preserved left ventricular ejection fraction (60 ± 9%) were included. Basal septum cIBS was − 17.45 (–31.2–10.95) and − 9.17 ± 9.45dB from PLAX and A3C views, respectively. No significant correlations were found between IBS and both non-invasive CMR tissue characterization and CVF: median MF of 9.7(2.1–79.9)%. Acoustic indexes were not significantly different according to the presence of pre-operative LGE. Conclusion In this group of patients with classical severe AS, IBS reflectivity indexes are of no added value to discriminate the presence of MF. Graphical Abstract

Acute venous thromboembolism (VTE) is a common worldwide disease admitted to emergency departments (ED), usually presenting as pulmonary embolism or lower limb deep vein thrombosis (DVT). Due to the lack of typical clinical and biomarker diagnostic features of unprovoked VTE, early identification is challenging and has direct consequences on correct treatment delay. Longitudinal, prospective, observational study. Patients admitted to ED with a suspicion of unprovoked acute VTE between October 2020 and January 2021 were included. Clinical and laboratorial variables were compared between VTE positive and negative diagnoses. Red cell distribution width (RDW) cut point was determinate through a receiver operating characteristic analysis. RDW accuracy, sensitivity, and specificity were calculated. Fifty-eight patients were analyzed. And 82.8% of suspected patients with VTE were diagnosed with an acute thrombotic event confirmed by imaging examination. In patients with VTE, RDW at admission in ED was higher than with other diagnosis, respectively, 14.3% (13.2-15.1) and 13.5% (13.0-13.8). Platelet count was the only additional characteristic that revealed difference between the 2 groups (264×10 9 /L for VTE and 209×10 9 /L for non-VTE). Logistic regression models showed good discriminatory values for RDW≥14%, with an area under the curve (AUC) = 0.685 (95% confidence interval, 0.535-0.834). These findings were more pronounced in isolated DVT, with a sensitivity of 76.9%, specificity 100%, and accuracy 85.7%. Our study demonstrated a significant association between an early high RDW and the diagnosis of acute unprovoked DVT. RDW ≥ 14% has an independent predictor of unprovoked VTE in adult patients.

Introduction and Objectives: To characterize patients with atherosclerosis, a disease with a high socioeconomic impact, in the Lisbon and Tagus Valley Health Region. Methods: A cross-sectional observational study was carried out through the Lisbon and Tagus Valley Regional Health Administration primary health care database, extracting data on the clinical and demographic characteristics and resource use of adult primary health care users with atherosclerosis during 2016. Different criteria were used to define atherosclerosis (presence of clinical manifestations, atherothrombotic risk factors and/or consumption of drugs related to atherosclerosis). Comparisons between different subpopulations were performed using parametric tests. Results: A total of 318 692 users were identified, most of whom (n=224 845 users; 71%) had no recorded clinical manifestations. The subpopulation with clinical manifestations were older (72.0±11.5 vs. 71.3±11.0 years), with a higher proportion of men (58.0% vs. 45.9%), recorded hypertension (78.3% vs. 73.5%) and dyslipidemia (55.8% vs. 53.5%), and a lower proportion of recorded obesity (18.2% vs. 20.8%), compared to those without clinical manifestations (p

The United Arab Emirates is currently building and operating four units of the APR-1400 developed by a South Korean vendor, Korea Electric Power Corporation (KEPCO). This paper attempts to perform APR-1400 reactor core analysis by using the well-known two-step method. The two-step method was applied to the APR-1400 first cycle using the open-source nodal diffusion code, KOMODO. In this study, the group constants were generated using CASMO-4 fuel transport lattice code. The simulation was performed in Hot Zero Power (HZP) at steady-state and transient conditions. Some typical parameters necessary for the Nuclear Design Report (NDR) were evaluated in this paper, such as effective neutron multiplication factor, control rod worth, and critical boron concentration for steady-state analysis. Other parameters such as reactivity insertion, power, and fuel temperature changes during the Reactivity Insertion Accident (RIA) simulation were evaluated as well. The results from KOMODO were verified using PARCS and SIMULATE-3 nodal core simulators. It was found that KOMODO gives an excellent agreement.

Resumo: Introdução e objetivos: A Internet é fundamental na divulgação de informação médica. Contudo, a ausência de controlo de qualidade potencia a “desinformação” da população. Pretendemos caraterizar a relevância e qualidade da informação sobre enfarte agudo do miocárdio em língua portuguesa no site YouTube (www.youtube.com). Métodos: Analisaram‐se 1.000 vídeos correspondentes aos primeiros 100 resultados da pesquisa no YouTube dos termos: “ataque + cardíaco”, “ataque + coração”, “enfarte ‐ cerebral”, “infarto ‐ cerebral”, “enfarte + miocárdio”, “enfarte + agudo + miocárdio”, “infarto + miocárdio”, “infarto + agudo + miocárdio”, “trombose + coração” e “trombose + coronária”. Excluíram‐se vídeos irrelevantes (n = 316), duplicados (n = 345), sem áudio (n = 24) e de língua não portuguesa (n = 106). Os vídeos elegíveis foram analisados quanto a origem, tema, público‐alvo e imprecisões científicas. A qualidade foi avaliada com os scores Health on the Net Code (HONCode, de 0‐8) e DISCERN (0‐5) – quanto maior, melhor a qualidade. Resultados: Incluíram‐se 242 vídeos, a maioria de formadores independentes (n = 95, 39%) e destinados à população‐geral (n = 202, 83,5%). Um terço (n = 79) apresentou imprecisões; vídeos de sociedades científicas e instituições de saúde/governamentais não apresentaram quaisquer imprecisões. A qualidade média foi baixa/moderada; apenas um vídeo apresentou boa qualidade, sem imprecisões. Instituições de saúde/governamentais foram a fonte com melhor qualidade (HONCode 4±1, DISCERN 2±1). Conclusões: A informação sobre enfarte agudo do miocárdio em língua portuguesa é irrelevante em um terço dos casos e um terço dos vídeos relevantes é impreciso. A qualidade média da informação é reduzida, sendo importante definir estratégias de controlo de qualidade da informação médica online. Abstract: Introduction and objectives: The Internet is a fundamental aspect of health information. However, the absence of quality control encourages misinformation. We aim to assess the relevance and quality of acute myocardial infarction videos shared on YouTube (www.youtube.com) in Portuguese. Methods: We analyzed 1,000 videos corresponding to the first 100 search results on YouTube using the following terms (in Portuguese): “cardiac + arrest”; “heart + attack”; “heart + thrombosis”; “coronary + thrombosis”; “infarction – brain”, “myocardial + infarction” and “acute + myocardial + infarction”. Irrelevant (n=316), duplicated (n=345), without audio (n=24) or non‐Portuguese (n=106) videos were excluded. Included videos were assessed according to source, topic, target audience and scientific inaccuracies. Quality of information was assessed using The Health on the Net Code (HONCode from 0 to 8) and DISCERN (from 0 to 5) scores – the higher the score, the better the quality. Results: 242 videos were included. The majority were from independent instructors (n=95, 39.0%) and were addressed to the general population (n=202, 83.5%). One third of the videos (n=79) contained inaccuracies while scientific society and governmental/health institution videos had no inaccuracies. The mean video quality was poor or moderate; only one video was good quality without any inaccuracies. Governmental/health institutions were the source with the best quality videos (HONCode 4±1, DISCERN 2±1). Conclusions: One third of the videos had irrelevant information and one third of the relevant ones contained inaccuracies. The average video quality was poor; therefore it is important to define strategies to improve the quality of online health information.

Atrial fibrillation (AF), the most common arrhythmia in the adult population worldwide, represents a significant burden in terms of cardiovascular mortality and morbidity and has repercussions on health economics. Oral anticoagulation (OAC) is key to stroke prevention in AF and, in recent years, results from landmark clinical trials of non-vitamin K oral anticoagulants (NOAC) have triggered a paradigm shift in thrombocardiology. Despite these advances, there is still a significant residual vascular risk associated with silent AF, bleeding, premature sudden death and heart failure.The authors review AF epidemiologic data, the importance of new tools for early AF detection, the current role of catheter ablation for rhythm control in AF, the state-of-the-art in periprocedural OAC, the optimal management of major bleeding, the causes of residual premature death and future strategies for improvements in AF prognosis. Resumo: A arritmia mais comum na população adulta em todo o mundo, a fibrilhação auricular (FA), contribui decisivamente para a elevada mortalidade e morbilidade cardiovascular, com repercussões na economia da saúde. A anticoagulação oral (ACO) é a chave para a prevenção do acidente vascular cerebral na FA. Nos últimos anos, os resultados dos grandes ensaios clínicos com os ACO não antagonista da vitamina K mudaram o paradigma na trombocardiologia. Apesar deste avanço, o risco vascular residual associado à FA silenciosa, hemorragia, morte súbita prematura e insuficiência cardíaca continua a ser significativo.Os autores fazem uma revisão dos dados epidemiológicos da FA, a importância das novas ferramentas para a deteção precoce da FA, o papel atual da ablação por cateter no controlo do ritmo na FA, o estado da arte na ACO periprocedimento, a gestão ideal de hemorragias graves, as causas de morte prematura residual e estratégias futuras para a melhoria do prognóstico da FA.

One of the essential elements to achieving smile esthetics is the phenotype and gingival contour, which with their architecture influence the size of dental crowns. The term “periodontal phenotype” was standardized in the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. However, much has been said about the topic, with other nomenclatures. Evaluating different periodontal phenotypes is essential, as they provide us with information related to the characteristics of periodontal tissues and dental forms. In addition to making the treatment more predictable, it can avoid problems such as trauma, inflammation, and other clinical and surgical complications. The purpose of this literature review is to research the topic, periodontal phenotype, through the most relevant articles between the period 2017 to 2021, showing its classification, prevalence, and forms of diagnosis. There are several ways to diagnose the periodontal phenotype, and the one recommended by the World Workshop is the transparency of the gingival sulcus using the millimeter probe. We can observe a prevalence of the thin phenotype for the female gender, whereas the thick phenotype is prevalent for the male gender. There is still a lack of scientific evidence for the correct relationship of the periodontal phenotype with other factors such as age, smoking, hygiene habits, diet and, malocclusion.

Resumo: Introdução e objetivos: As doenças cardiovasculares são a principal causa de morte em Portugal, sendo a aterosclerose o processo fisiopatológico subjacente mais comum. O objetivo deste estudo foi quantificar o impacto económico da aterosclerose em Portugal através da estimação dos custos associados. Métodos: A estimativa dos custos foi realizada na ótica da prevalência e na perspetiva da sociedade. A prevalência das principais manifestações focais da aterosclerose foi estimada com recurso a três fontes epidemiológicas nacionais. O custo anual da aterosclerose incluiu custos diretos (consumos de recursos) e indiretos (impacto na produtividade da população). Estes custos foram estimados para o ano de 2016 com base nos dados da Base de Dados de Morbilidade Hospitalar, do Sistema de Informação da Administração Regional de Saúde de Lisboa e Vale do Tejo que integra informação da prática clínica real em ambiente de cuidados de saúde primários e do Inquérito Nacional de Saúde de 2014 e na opinião de peritos. Resultados: O custo da aterosclerose em 2016 totalizou cerca de 1,9 mil milhões de euros (58% e 42% correspondendo a custos diretos e indiretos, respetivamente). A maior parte dos custos diretos esteve associada aos cuidados de saúde primários (55%), seguindo‐se o ambulatório hospitalar (27%) e, por último, os episódios de internamento (18%). Os custos indiretos foram principalmente determinados pela não participação no mercado de trabalho (91%). Conclusões: A aterosclerose apresenta um importante impacto económico, correspondendo a uma despesa equivalente a 1% do Produto Interno Bruto nacional e a 11% da despesa corrente em saúde, em 2016. Abstract: Introduction and objectives: Cardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease‐related costs. Methods: Costs were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real‐world data from primary care, the 2014 National Health Interview Survey, and expert opinion. Results: The total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%). Conclusions: Atherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.

Objective: To evaluate the impact of a real-time visual feedback device on CCs rate and depth delivered by healthcare professionals.Methods: In a simulated scenario a sensor was placed on a manikin’s chest and connected to a defibrillator which provided real-time visual feedback on the rate and depth of CCs. Thirty-two healthcare professionals performed sequentially 5 cycles of 30 CCs without (FeedOFF) and with (FeedON) feedback. CCs with a depth between 50 and 60mm and a rate between 100 and 120cpm were considered optimal.Results: Visual feedback resulted in a significant increase in the proportion of CCs with optimal depth (median 8.7 [interquartile range 0.7–55.5]% FeedOFF vs 63.3 [17.6–88.1]% FeedON, p=0.002) and optimal rate (median 51.3 [1.3–81.3]% FeedOFF vs 68.3 [45.3–86.1]% FeedON, p=0.018). Overall, CCs were too shallow and too fast in the FeedOFF cycle. There was also a significant increase in optimal CCs (optimal depth and rate) with the use of the feedback device (from median 0.7 [0–26.9]% FeedOFF to 31.9 [3.6-59.9]% FeedON, p=0.001). Participants’ factors such as age, sex, body mass index, job or time since last CPR training did not have a significant impact on CPR quality.Conclusion: In the absence of visual feedback, there is a tendency towards lower depth and higher rate of CCs. The use of feedback technology significantly improves the quality of CCs.

Resumo: Nos últimos anos, temos assistido a um aumento do número de doentes com necessidade de cuidados cardíacos agudos, com patologia cardiovascular progressivamente mais complexa, muitas vezes complicada por comorbilidades não cardiovasculares agudas ou crónicas, com impacto na abordagem e prognóstico destes doentes. As unidades coronárias têm evoluído para unidades de cuidados intensivos cardíacos, caracterizadas por cuidados de saúde altamente especializados ao doente cardíaco crítico. Tendo em conta que os recursos humanos e técnicos nesta área são limitados, considerámos ser urgente uma reflexão profunda sobre o modelo de organização dos cuidados ao doente cardíaco agudo, incluindo a definição do nível de cuidados, a constituição e formação da equipa e a criação de redes de referenciação.Paralelamente, é fundamental um investimento claro dos serviços nesta área central da cardiologia, de forma a alavancar o desenvolvimento contínuo e sustentado de outras áreas cardiológicas essenciais, nomeadamente a eletrofisiologia e a cardiologia de intervenção, assegurando cuidados de excelência e de elevada diferenciação a todos os doentes cardíacos críticos. Abstract: In recent years, the number of patients requiring acute cardiac care has increased, with progressively more complex cardiovascular conditions, often complicated by acute or chronic non‐cardiovascular comorbidities, which affects the management and prognosis of these patients. Coronary care units have evolved into cardiac intensive care units, which provide highly specialized health care for the critical heart patient. In view of the limited human and technical resources in this area, we consider that there is an urgent need for an in‐depth analysis of the organizational model for acute cardiac care, including the definition of the level of care, the composition and training of the team, and the creation of referral networks. It is also crucial to establish protocols and to adopt safe clinical practices to improve levels of quality and safety in the treatment of patients. Considering that acute cardiac care involves conditions with very different severity and prognosis, it is essential to define the level of care to be provided for each type of acute cardiovascular condition in terms of the team, available techniques and infrastructure. This will lead to improvements in the quality of care and patient prognosis, and will also enable more efficient allocation of resources.

The aim of this study was to present a literature review on the etiology, diagnosis and treatment of dentin hypersensitivity. Dentin hypersensitivity is characterized by short and acute pain, which arises from exposed dentin in response to stimuli, typically thermal, evaporative, tactile, osmotic or chemical and which cannot be attributed to any other dental defect or pathology. The term “Root Hypersensitivity” is used to describe the dentin hypersensitivity normally associated with gingival recessions, abrasions, erosions and abfractions. The etiology is multifactorial and the choice of the ideal treatment depends on a correct diagnosis. Other entities related to hypersensitivity are non-carious cervical lesions (NCCL), which are common conditions in a more distant society with new habits. All treatments presented, such as the use of blocking agents associated with desensitizing toothpaste, restorative procedures, the use of lasers and surgical procedures are effective in reducing dentinal hypersensitivity. An evaluation of the periodontal profile is also important especially when aiming at marginal stability and prevention of possible future NCCL. Thus, it can be concluded that dentin hypersensitivity and non-carious cervical lesions are conditions that require the dentist’s knowledge in relation to their etiology, forms of treatment and long-term maintenance.

Introduction: Coronary artery disease is becoming the leading cause of death in women in Western society. However, the available data shows that women are still underdiagnosed and undertreated with guideline-recommended secondary prevention therapy, leading to a significantly higher rate of in-hospital complications and in-hospital mortality. Objective: The main objective of this work is to assess the approach to acute coronary syndrome (ACS) in Portugal, including form of presentation, in-hospital treatment and in-hospital complications, according to gender and in three different periods. Methods: We performed an observational study with retrospective analysis of all patients included between 2002 and 2019 in the Portuguese Registry of Acute Coronary Syndromes (ProACS), a voluntary, observational, prospective, continuous registry of the Portuguese Society of Cardiology and the National Center for Data Collection in Cardiology. Results: A total of 49 113 patients (34 936 men and 14 177 women) were included. Obesity, hypertension, diabetes (p

Advanced Power Reactor (APR-1400) is a Generation III + Pressurized Water Reactor (PWRs) and has gained popularity among energy mix community. APR-1400 features enhanced safety limits to prevent a “Fukushima-type” accident scenario for a duration up to 8 h. This work proposes a system that enhances APR 1400 passive cooling (Thermosyphon Cooling System, TCS) capabilities to guarantee at least double the coping time before core meltdown. TCS provides enough cooling to the reactor core in the case of loss of offsite power, known as Station Black-Out (SBO) accident. This work invites to use the In-containment Refueling Water Storage Tank (IRWST) to further extend the APR1400 capability to passively cool the reactor core after an SBO accident. This work is designed and tested by 3Keymaster simulator platform developed by Western Service Corporation. Simulation has modified the existing model of APR1400 in the simulator by adding pipes, valves and heat exchanger. Results show the system will cool the reactor core for almost 18 h after the SBO accident. The system works initially in parallel with steam generators then it continues cooling the reactor core for extra 18 h resulting in providing more time for restoring the on-site power sources and preventing core meltdown.

Even with improvements in lifestyle interventions, better control of cardiovascular (CV) risk factors, and improvements in CV outcomes, cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in Portugal and Europe. Atherogenic dyslipidemias, particularly hypercholesterolemia, have a crucial causal role in the development of atherosclerotic CVD. The clinical approach to a patient with dyslipidemia requires an accurate diagnosis, based on harmonized and standardized lipid and lipoprotein laboratory assessments. Results and reports of these tests, together with assessment of total CV risk and the respective therapeutic targets, will help ensure that clinical guidelines and good clinical practices are followed, increasing the reliability of screening for lipid disorders, producing more accurate diagnoses and CV risk stratification, and improving CV prevention. To this end, this consensus aims to provide clinicians with practical guidance for the harmonization and standardization of laboratory lipid tests, focusing on the most recent dyslipidemia management guidelines. Resumo: Apesar da melhor intervenção nos estilos de vida, do melhor controlo dos fatores de risco cardiovascular (CV) e da melhoria dos resultados CV, a doença cardiovascular (DCV) continua a ser a principal causa de morbilidade e mortalidade em Portugal e na Europa. A dislipidemia aterogénica, nomeadamente a hipercolesterolemia, tem um papel causal no desenvolvimento de DCV aterosclerótica. A abordagem clínica de um doente com dislipidemia preceitua um diagnóstico atento, sustentado em procedimentos laboratoriais harmonizados e padronizados. Os resultados e relatórios dos testes de lipídios se ajuntarem o risco CV total e os respetivos alvos terapêuticos garantem que as diretrizes clínicas e as boas práticas clínicas estão a ser seguidas e respeitadas, o que aumenta a segurança no rastreio e no diagnóstico das alterações lipídicas e da estratificação de risco e melhora a prevenção CV. Nesse sentido, este consenso tem como objetivo fornecer aos clínicos orientações práticas para a harmonização e padronização dos testes laboratoriais lipídicos, com foco nas diretrizes mais recentes da abordagem das dislipidemias. Keywords: Dyslipidemia, Cardiovascular risk, Laboratory procedures, Laboratory reports, Harmonization, Standardization, Palavras-chave: Dislipidemia, Risco cardiovascular, Procedimentos laboratoriais, Relatórios laboratoriais, Harmonização, Padronização

Abstract  In this paper, several algorithms for compressing the feedback of channel quality information are presented and analyzed. These algorithms are developed for a proposed adaptive modulation scheme for future multi-carrier 4G mobile systems. These strategies compress the feedback data and, used together with opportunistic scheduling, drastically reduce the feedback data rate. Thus the adaptive modulation schemes become more suitable and efficient to be implemented in future mobile systems, increasing data throughput and overall system performance. [ABSTRACT FROM AUTHOR]

Abstract  In this paper we propose a simple, yet flexible and efficient, channel estimator for the uplink in broadband orthogonal frequency division multiplexing (OFDM) systems. The processing is performed in the time-domain, by extracting the Channel’s Impulse Response (CIR) for each user from a joint training signal. In this OFDM system, the pilot sequence we advocate, where all users share the same pilot sub-carriers, consists of one OFDM-symbol endowed with time-shifted properties per user, which isolates each user’s CIR and is robust against multi-user interference. The feasibility of our approach is substantiated by system simulation results obtained using BRAN-A broadband mobile wireless channel model. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: The role of endothelial dysfunction (ED) in patients with ST-elevation myocardial infarction (STEMI) is poorly understood. Peripheral arterial tonometry (PAT) allows non-invasive evaluation of ED, but has never been used for this purpose early after primary percutaneous coronary intervention (P-PCI). Our purpose was to analyze the relation between ED assessed by PAT and both the presence of microvascular obstruction (MVO) and infarct extension in STEMI patients. Methods: ED was assessed by the reactive hyperemia index (RHI), measured by PAT and defined as RHI

The circular economy model offers great opportunities to companies, as it not only allows them to capture additional value from their products and materials, but also reduce the fluctuations of price-related risks and material supply. These risks are present in all kind of businesses not based on the circular economy. The circular economy also enables economic growth without the need for more resources. This is because each unit has a higher value as a result of recycling and reuse of products and materials after use. Following this circular economics framework, the Polytechnic University of Madrid (Universidad Politécnica de Madrid, UPM) has adopted strategies aimed at improving the circularity of products. In particular, this article provides the result of obtaining recycled PLA filament from waste originating from university 3D FFF (fused filament fabrication) printers and waste generated by “Coronamakers” in the production of visors and parts for PPEs (Personal Protective Equipment) during the lockdown period of COVID-19 in Spain. This filament is used in the production of 3D printed parts that university students use in their classes, so the circular loop is closed. The obtained score of Material Circularity Indicator (MCI) of this material has been calculated, indicating its high level of circularity.

We report a case of sarcoidosis with an unusual presentation, initially manifesting as bilateral pulmonary embolism and then as a cardiac form of the disease with an ominous clinical event consisting of sustained ventricular tachycardia. The diagnosis was established by clinical and magnetic resonance criteria despite normal conventional echocardiographic study. Detailed functional assessment provided by tracking techniques (speckle tracking echocardiography and cardiac magnetic resonance tissue tracking) enabled the detection of regional deformation abnormalities, indicating prominent circumferential strain and epicardial layer alterations, partly matching the structural changes depicted by distribution of delayed enhancement.We find this case notable for various issues it raises concerning diagnosis and management of cardiac sarcoidosis. These are mainly related to recent developments in imaging modalities that enable non-invasive identification of structural and functional abnormalities in this condition early, before overt deterioration in left ventricular ejection fraction. Information from different imaging modalities and tools provide information that could potentially assist preclinical diagnosis, with possible prognostic implications. Resumo: Apresenta-se o caso de um doente de 44 anos com o diagnóstico prévio de sarcoidose pulmonar, admitido consecutivamente no serviço de urgência por embolia pulmonar e taquicardia ventricular sintomática. Embora o estudo ecocardiográfico mostrasse normal fração de ejeção ventricular esquerda, o diagnóstico de sarcoidose cardíaca foi estabelecido por elementos de ordem clínica, em conjugação com os achados de ressonância magnética cardíaca. Quando se efetuou estudo funcional detalhado do ventrículo esquerdo por speckle (ecocardiografia) e tissue tracking (ressonância magnética), detetaram-se alterações regionais da deformação miocárdica, parcialmente coincidentes com a distribuição do realce tardio por ressonância. Para além da apresentação pouco habitual sob a forma de evento embólico, este caso de sarcoidose com subsequente documentação de envolvimento cardíaco, permitiu a aplicação de modalidades de imagem cardiovascular avançadas, colocou em evidência a afeção estrutural e funcional miocárdica, na presença de normal fração de ejeção ventricular esquerda. Keywords: Cardiac sarcoidosis, Pulmonary embolism, Speckle tracking, Tissue tracking, Palavras-chave: Sarcoidose cardíaca, Embolia pulmonary, Speckle tracking, Tissue tracking

An implanted pacemaker is generally considered a contraindication for magnetic resonance imaging (MRI). The increasing number of indications for MRI and the rising prevalence of implanted cardiac pacemakers have prompted the recent development of MRI-conditional pacemaker systems.We present the case of a 68-year-old woman with left ventricular hypertrophy, hypertension, aortic valve stenosis and a family history of cardiac amyloidosis, who developed complete heart block. In view of the foreseeable need for cardiac MRI, an MRI-conditional dual chamber pacemaker was implanted. The MRI scan confirmed moderate left ventricular hypertrophy and aortic valve stenosis, and showed no delayed enhancement suggestive of amyloid heart disease. This case illustrates the feasibility of cardiac MRI in this setting and the usefulness of the recently introduced MRI-conditional pacemaker systems. Resumo: A presença de um pacemaker é habitualmente considerada uma contra-indicação para a realização de ressonância magnética (RM). O número crescente de indicações para RM e de doentes portadores de pacemaker motivaram o desenvolvimento de pacemakers RM-condicionais.Apresentamos o caso de uma mulher de 68 anos com hipertrofia ventricular esquerda, hipertensão arterial, estenose valvular aórtica e história familiar de amiloidose cardíaca, que desenvolveu bloqueio auriculo-ventricular completo. Devido à necessidade previsível de realizar uma RM cardíaca, foi-lhe implantado um pacemaker RM-condicional. A RM cardíaca confirmou a hipertrofia ventricular esquerda moderada e estenose valvular aórtica, não tendo evidenciado realce tardio sugestivo de amiloidose cardíaca. Este caso ilustra a exequibilidade da RM cardíaca neste contexto e a utilidade dos pacemakers RM-condicionais actualmente ao nosso dispor. Keywords: Cardiac magnetic resonance imaging, Pacemaker, MRI-conditional pacemaker, Palavras-chave: Ressonância magnética cardíaca, Pacemaker, Pacemaker RM-condicional

Resumo: O pseudoaneurisma do ventrículo esquerdo é uma complicação rara do enfarte agudo do miocárdio, associada a elevada mortalidade. No entanto, pode manifestar‐se de modo inespecífico, dificultando e atrasando o seu diagnóstico.Os autores apresentam o caso de um doente de 65 anos, hipertenso, sem outros antecedentes relevantes conhecidos, em que toracalgia, tosse e derrame pleural esquerdo, inicialmente atribuídas a um processo pneumológico, foram as manifestações de um pseudoaneurisma do ventrículo esquerdo, após enfarte agudo do miocárdio silencioso. O diagnóstico foi suspeitado por ecocardiografia, confirmado por ressonância magnética cardíaca e o doente foi submetido a cirurgia de reparação do pseudoaneurisma com sucesso.Este caso ilustra uma forma de apresentação atípica de um pseudoaneurisma do ventrículo esquerdo, em que as manifestações resultaram da extensão pericárdico‐pleural do processo inflamatório associada à rotura miocárdica contida. O caso demonstra a necessidade de suspeitar o diagnóstico e o valor dos vários exames de imagem para a confirmação do mesmo, de modo a possibilitar a terapêutica cirúrgica adequada e assim modificar o curso da doença. Abstract: Left ventricular pseudoaneurysm is a rare complication of acute myocardial infarction, associated with high mortality. However, it can present in a non‐specific manner, complicating and delaying the diagnosis.The authors present the case of a 65‐year‐old patient, hypertensive, with no other known relevant medical history, who presented with chest pain, cough and left pleural effusion, initially attributed to a pulmonary process. However, these were in fact the result of a left ventricular pseudoaneurysm following silent acute myocardial infarction. The diagnosis was suspected on echocardiography and confirmed by cardiac magnetic resonance imaging, and the patient underwent successful surgical pseudoaneurysm repair.This case illustrates an atypical presentation of a left ventricular pseudoaneurysm, in which the manifestations resulted from pericardial and pleural extension of the inflammatory process associated with contained myocardial rupture. The case demonstrates the need for a high index of suspicion, and the value of imaging techniques to confirm it, in order to proceed with appropriate surgical treatment, and thus modify the course of the disease. Palavras‐chave: Pseudoaneurisma do ventrículo esquerdo, Ecocardiografia, Ressonância magnética cardíaca, Keywords: Left ventricular pseudoaneurysm, Echocardiography, Cardiac magnetic resonance

Objetivo: Identificar los factores asociados a la aceptación por parte del paciente de la hospitalización a domicilio directamente desde el servicio de urgencias. Pacientes y métodos: Estudio de cohortes prospectivo observacional de pacientes que, una vez visitados en urgencias, reunían criterios de ingreso en sala convencional, podían responder a una entrevista y disponían de un posible cuidador. Se tomó como variable dependiente la predisposición a aceptar o no un ingreso en hospitalización a domicilio. De cada paciente, como variables independientes se recogieron aspectos demográficos, factores de su estado de salud-comorbilidad y de su enfermedad actual, y percepciones psicosociales relacionadas con la hospitalización a domicilio. La relación entre variables se estableció por análisis de regresión logística múltiple. Resultados: Se realizaron 129 entrevistas. La predisposición a aceptar un ingreso en hospitalización a domicilio fue del 71%. Sólo las percepciones psicosociales del paciente, con independencia de sus aspectos demográficos e incluso de su estado de salud actual y comorbilidad, se relacionaron con la predisposición a aceptar un ingreso en hospitalización a domicilio, en concreto las adecuadas condiciones físicas del domicilio (odds ratio [OR]: 4,31; intervalo de confianza del 95% [IC95%]: 1,18-15,78), la ausencia de miedo por tener que manejar el oxígeno (OR: 5,99; IC95%: 2,05-17,52), la ausencia de miedo a una mala evolución clínica (OR: 6,07; IC95%: 1,94-18,96) y la percepción de una mayor libertad de horarios (OR: 12,61; IC95%: 3,31-48,01). Conclusiones: La hospitalización a domicilio tendría una buena aceptación si se ofreciera directamente en el Servicio de Urgencias como alternativa a la hospitalización convencional. Esta aceptación se asocia a percepciones psicosociales, que deberían tenerse en cuenta al ofrecer esta modalidad asistencial.Aim: To identify the factors associated with patients' acceptance of emergency department discharge directly to hospital-at-home care. Patients and methods: We performed a prospective observational cohort study of patients seen at the emergency department who met the following inclusion criteria: need for hospital admission, ability to be interviewed, and availability of an informal caregiver. The dependent variable was defined as the predisposition to accept or refuse hospital-at-home care. For each patient, the following independent variables were recorded: demographic characteristics, health-related factors, comorbidities, current illness and psychosocial perceptions related to hospital-at-home care. The associations among the variables were tested by means of logistic regression analysis. Results: We included 129 patients. Seventy-one percent would have accepted hospital-at-home care. Acceptance of hospital-at-home care was associated with psychosocial perceptions only, independently of demographic characteristics, current illness severity and comorbidities. These psychosocial perceptions included adequate conditions at home (OR: 4.31; 95% CI: 1.18-15.78), not being afraid of oxygen manipulation (OR: 5.99; 95% CI: 2.05-17.52), lack of fear of a poor outcome (OR: 6.07; 95% CI: 1.94-18.96) and the possibility of enjoying a more flexible schedule (OR: 12.61; 95% CI: 3.31-48.01). Conclusions: Hospital-at-home care would be well accepted by patients if offered in the emergency department as an alternative to conventional hospitalization. Acceptance depends on patients' psychosocial perceptions, which should be assessed before this mode of care is proposed.

This article talks about how in the literature history, many authors had shown a profound interest in describing the phenomenon of football soccer, one of the most popular sports on earth. We can see this aspect in pre-Hispanic texts like: Popol Vuh, also in some modern intellectuals like Eduardo Galeano (Uruguayan), in his book: El footboy a sol y sombra. The document also mentioned other literary texts which prominent figures, narrative atmospheres, sail in the aesthetic description of the football

Resumo: Apresentamos o caso de um homem de 21 anos, que foi submetido a apendicectomia sob anestesia geral e que imediatamente após a extubação desencadeou quadro de edema pulmonar agudo. A propósito, faremos uma breve revisão da literatura, enfatizando os mecanismos fisiopatológicos subjacentes e os aspectos mais importantes do diagnóstico e tratamento. Abstract: We report the case of a 21-year-old man who underwent appendectomy under general anesthesia and developed acute pulmonary edema immediately after extubation. We then review the literature, focusing on the pathophysiology and the most important aspects of diagnosis and treatment of post-extubation pulmonary edema. Palavras-chave: Edema pulmonar, Extubação, Pulmão, Keywords: Pulmonary edema, Extubation, Lung

CD5 is a lymphoid-specific transmembrane glycoprotein constitutively expressed on thymocytes and mature T and B1a lymphocytes. Current data support the view that CD5 is a negative regulator of antigen-specific receptor-mediated signaling in these cells, and that this would likely be achieved through interaction with CD5 ligand/s (CD5L) of still undefined nature expressed on immune or accessory cells. To determine the functional consequence of loss of CD5/CD5L interaction in vivo, a new transgenic mouse line was generated (shCD5EμTg), expressing a circulating soluble form of human CD5 (shCD5) as a decoy to impair membrane-bound CD5 function. These shCD5EμTg mice showed an enhanced response to autologous antigens, as deduced from the presentation of more severe forms of experimentally inducible autoimmune disease (collagen-induced arthritis, CIA; and experimental autoimmune encephalitis, EAE), as well as an increased anti-tumoral response in non-orthotopic cancer models (B16 melanoma). This enhancement of the immune response was in agreement with the finding of significantly reduced proportions of spleen and lymph node Treg cells (CD4+CD25+FoxP3+), and of peritoneal IL-10-producing and CD5+ B cells, as well as an increased proportion of spleen NKT cells in shCD5EμTg mice. Similar changes in lymphocyte subpopulations were observed in wild-type mice following repeated administration of exogenous recombinant shCD5 protein. These data reveal the relevant role played by CD5/CD5L interactions on the homeostasis of some functionally relevant lymphocyte subpopulations and the modulation of immune responses to autologous antigens.

Accelerated atherosclerosis represents a major problem in both systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients, and endothelial damage is a key feature of atherogenesis. We aimed to assess early endothelial changes in SLE and RA female patients (127 SLE and 107 RA) without previous CV events. Biomarkers of endothelial cell activation (intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), thrombomodulin (TM), and tissue factor (TF)) were measured and endothelial function was assessed using peripheral artery tonometry. Reactive hyperemia index (RHI), an indicator of microvascular reactivity, and augmentation index (AIx), a measure of arterial stiffness, were obtained. In addition, traditional CV risk factors, disease activity and medication were determined. Women with SLE displayed higher sICAM-1 and TM and lower TF levels than women with RA (p = 0.001, p

Plant regeneration by somatic embryogenesis from cell suspensions is considered the most efficient method for mass production of plants. The objective of this work was to achieve the genetic transformation of Coffea arabica cv. Caturra rojo by electroporation of embryogenic cell suspensions. The effect of different electroporation conditions (capacitance and field strength) on the cell suspensions without the application of plasmid DNA, by analysis of cell vitality at 24, 48 and 72 hours after electroporation was evaluated. The effect of electroporation buffer on cell vitality and transient expression of the gene for beta-glucuronidase was also determined. Besides, the transient expression of GUS gene in em bryogenic cell suspensions electroporated with plasmid PDB-GUS-INT was studied. In the electroporated cell suspensions, under different electroporation conditions, electric shocks significantly affect cell vitality compared to the control group. In the Electroporated cell suspensions with buffer of Dekeyser et al. (1990) and applying a discharge time of 500 msec was obtained the highest percentage of vitality, with a value of 32.14, compared to other treatments. While in the electroporated cell aggregates with a capacitance of 100 and 1200 uF there was a higher transient GUS gene activity (59.37 and 61.01%) compared to electroporated treatment with a capacitance of 490 uF, where values obtained were 50.0%. Keywords: somatic embryogenesis, coffee tree

El artí­culo nos habla de cómo a lo largo de la historia de la literatura, distintos autores han mostrado profundo interés por describir el fenómeno del fútbol, uno de los deportes más populares del planeta. Este aspecto lo podemos notar en textos prehispánicos como: Popol Vuh, hasta intelectuales modernos como Eduardo Galeano (uruguayo), en su libro: El futbol a sol y sombra. El documento hace mención de otras obras literarias cuyos personajes, o atmósferas narrativas, navegan en la descripción estética del balompié