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Abstract Dozens of new antiviral systems have been recently characterized in bacteria. Some of these systems are present in eukaryotes and appear to have originated in prokaryotes, but little is known about these defense mechanisms in archaea. Here, we explore the diversity and distribution of defense systems in archaea and identify 2610 complete systems in Asgardarchaeota, a group of archaea related to eukaryotes. The Asgard defense systems comprise 89 unique systems, including argonaute, NLR, Mokosh, viperin, Lassamu, and CBASS. Asgard viperin and argonaute proteins have structural homology to eukaryotic proteins, and phylogenetic analyses suggest that eukaryotic viperin proteins were derived from Asgard viperins. We show that Asgard viperins display anti-phage activity when heterologously expressed in bacteria. Eukaryotic and bacterial argonaute proteins appear to have originated in Asgardarchaeota, and Asgard argonaute proteins have argonaute-PIWI domains, key components of eukaryotic RNA interference systems. Our results support that Asgardarchaeota played important roles in the origin of antiviral defense systems in eukaryotes.

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.

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.

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.

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.

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.

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

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.

Focal segmental glomerulosclerosis (FSGS) is a recognized cause of renal disease worldwide. The collapsing variant is distinct from the others, characterized clinically by a more severe nephrotic syndrome generally resistant to immunosuppressive therapy. It is known that a great number of patients progress to end-stage renal disease. Recognizing this lesion in biopsy is frequently challenging owing to the focal nature of the process which highlights the need for keeping a high index of suspicion for the diagnosis. We report and discuss a case of a non-HIV collapsing FSGS, followed by a complete (unexpected) renal recovery after an oral corticosteroid course.

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.

Abstract Background Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Methods This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. Results A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28–66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4–10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0–1, 22.7% for those who had scores of 2–3, 46.8% for those who had scores of 4–5, and 86.7% for those who have scores of 7–8. Conclusions The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.

Introduction: In Portugal around 20,000 individuals are ostomized, with all the associated changes in patients’ everyday life that can compromise their Quality of Life (QoL). Objectives: Assess and compare QoL of a group of ostomized patients according to sex, age group, type of surgery, primary disease, stoma duration and stoma type. Material and methods: Ostomized patients observed in Stomatherapy department in between January 1st and May 30th 2017 was enrolled. QoL was assessed using the questionnaire Stoma Care QoL Questionnaire). Four domains were evaluated: Self-esteem and Self-image – SeSi Score; relation with Family and Friends – FF Score; relation with Sleep and Fatigue – SF score and ostomy Device Functioning insecurities – DeF score. Results: Urostomy patients had significantly higher Total Scores, SeSi and FF scores than colostomy and ileostomy patients. Regarding SeSi Score, patients aged 70 years old or more and malignant diseases presented significantly higher scores than their younger counterparts and benign causes, respectively. FF Score document that patients with malignant diseases have significantly higher scores than patients with benign diseases. Conclusions: Ileostomy and colostomy patients have a significantly lower QoL than urostomy patients mostly because of its impact on social relations and self-esteem and self-image. Resumo: Introdução: Em Portugal estima-se que cerca de 20.000 indivíduos sejam portadores de estoma, com todas as alterações associadas que podem comprometer a sua Qualidade de Vida (QdV). Objectivos: Avaliar a QdV de doentes ostomizados de acordo com o sexo, idade, tipo de cirurgia, doença primária, duração e tipo de estoma. Materiais e métodos: Foram incluídos todos os avaliados na consulta de Estomatoterapia entre Janeiro e Maio de 2017. A avaliação da QdV foi efetuada com recurso ao Questionário de QdV Stoma care. Avaliaram-se quatro domínios: autoestima e autoimagem (SeSi); relação com família e amigos (FF) relação com sono e cansaço e inseguranças relacionada com funcionamento do dispositivo (DeF). Resultados: Doentes com urostomia apresentaram Scores Total, SeSi e FF, significativamente superior a doentes com colostomia e ileostomia. Relativamente ao score SeSi, os doentes com idade igual ou superior a 70 anos e doença maligna apresentaram scores significativamente maiores que os mais jovens e com doenças benignas, respectivamente. Quanto ao score FF verificou-se que doentes com causas malignas apresentaram scores significativamente superiores aos com causas benignas. Conclusões: Doente ileostomizados e colostomizados apresenta QdV significativamente inferior aos doentes com urostomia, sobretudo devido ao impacto nas relações sociais, auto-estima e auto-imagem. Keywords: Quality of life, Urostomy, Colostomy, Ileostomy, Palavras-chave: Qualidade de vida, Urostomia, Colostomia, Ileostomia

N/a.

Abstract Background Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. Methods This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016–September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. Results A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%. Conclusions The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.

Magnetotactic bacteria are widely represented microorganisms that have the ability to synthesize magnetosomes. The magnetotactic cocci of the order Magnetococcales are the most frequently identified, but their classification remains unclear due to the low number of cultivated representatives. This paper reports the analysis of an uncultivated magnetotactic coccus UR-1 collected from the Uda River (in eastern Siberia). Genome analyses of this bacterium and comparison to the available Magnetococcales genomes identified a novel species called “Ca. Magnetaquicoccus inordinatus,” and a delineated candidate family “Ca. Magnetaquicoccaceae” within the order Magnetococcales is proposed. We used average amino acid identity values

Magnetotactic bacteria biomineralize intracellular magnetic nanocrystals surrounded by a lipid bilayer called magnetosomes. Due to their unique characteristics, magnetite magnetosomes are promising tools in Biomedicine. However, the uptake, persistence, and accumulation of magnetosomes within mammalian cells have not been well studied. Here, the endocytic pathway of magnetite magnetosomes and their effects on human cervix epithelial (HeLa) cells were studied by electron microscopy and high spatial resolution nano-analysis techniques. Transmission electron microscopy of HeLa cells after incubation with purified magnetosomes showed the presence of magnetic nanoparticles inside or outside endosomes within the cell, which suggests different modes of internalization, and that these structures persisted beyond 120 h after internalization. High-resolution transmission electron microscopy and electron energy loss spectra of internalized magnetosome crystals showed no structural or chemical changes in these structures. Although crystal morphology was preserved, iron oxide crystalline particles of approximately 5 nm near internalized magnetosomes suggests that minor degradation of the original mineral structures might occur. Cytotoxicity and microscopy analysis showed that magnetosomes did not result in any apparent effect on HeLa cells viability or morphology. Based on our results, magnetosomes have significant biocompatibility with mammalian cells and thus have great potential in medical, biotechnological applications.

Background: Retinal detachment surgery (RDS) is frequently associated with a high incidence of significant perioperative pain and oculocardiac reflex (OCR) intra-operatively. The peribulbar block has gained wide acceptance in ophthalmic anesthetic practice in the recent times. However, there is little current knowledge regarding its efficacy in RDS. This prospective randomized clinical study evaluated the effect and feasibility of peribulbar block when used in conjunction with general anesthesia on perioperative outcome. Methods: 98 patients, ASA II-III, were randomly allocated to one of two groups to receive either peribulbar block in conjunction with general anesthesia (n = 49) or general anesthesia alone (n = 49). Parameters compared were incidence of OCR, surgical bleeding, duration of surgery, postoperative pain and patient‘s satisfaction. Results and discussion: Patients with PB block had a significantly lower incidence of intraoperative OCR (n = 4 vs. n = 13, p

Abstract Background Magnetotactic bacteria (MTB) are a unique group of prokaryotes that have a potentially high impact on global geochemical cycling of significant primary elements because of their metabolic plasticity and the ability to biomineralize iron-rich magnetic particles called magnetosomes. Understanding the genetic composition of the few cultivated MTB along with the unique morphological features of this group of bacteria may provide an important framework for discerning their potential biogeochemical roles in natural environments. Results Genomic and ultrastructural analyses were combined to characterize the cultivated magnetotactic coccus Magnetofaba australis strain IT-1. Cells of this species synthesize a single chain of elongated, cuboctahedral magnetite (Fe3O4) magnetosomes that cause them to align along magnetic field lines while they swim being propelled by two bundles of flagella at velocities up to 300 μm s−1. High-speed microscopy imaging showed the cells move in a straight line rather than in the helical trajectory described for other magnetotactic cocci. Specific genes within the genome of Mf. australis strain IT-1 suggest the strain is capable of nitrogen fixation, sulfur reduction and oxidation, synthesis of intracellular polyphosphate granules and transporting iron with low and high affinity. Mf. australis strain IT-1 and Magnetococcus marinus strain MC-1 are closely related phylogenetically although similarity values between their homologous proteins are not very high. Conclusion Mf. australis strain IT-1 inhabits a constantly changing environment and its complete genome sequence reveals a great metabolic plasticity to deal with these changes. Aside from its chemoautotrophic and chemoheterotrophic metabolism, genomic data indicate the cells are capable of nitrogen fixation, possess high and low affinity iron transporters, and might be capable of reducing and oxidizing a number of sulfur compounds. The relatively large number of genes encoding transporters as well as chemotaxis receptors in the genome of Mf. australis strain IT-1 combined with its rapid swimming velocities, indicate that cells respond rapidly to environmental changes.

Hierridin B (6), a methylated hydroquinone isolated from the marine picocyanobacterium Cyanobium sp. LEGE 06113, moderately inhibited the growth of colon adenocarcinoma HT-29 cells. Aiming to improve the potential antitumor activity of this natural product, the demethylated analogue, norhierridin B (10), as well as its structurally-related quinone (9), were synthesized and evaluated for their growth inhibitory effect on a panel of human tumor cell lines, including the triple-negative breast cancer (TNBC) cells MDA-MB-231, SKBR3, and MDA-MB-468. Norhierridin B (10) showed a potent growth inhibitory effect on all cancer cell lines. Moreover, the growth inhibitory effect of compound 10 on MDA-MB-231 cells was associated with cell cycle arrest and apoptosis. Norhierridin B (10) interfered with several p53 transcriptional targets, increasing p21, Bax, and MDM2, while decreasing Bcl-2 protein levels, which suggested the potential activation of a p53 pathway. Altogether, these results evidenced a great improvement of the antitumor activity of hydroquinone 10 when compared to 6 and its structurally-related quinone (9). Notably, hydroquinone 10 displayed a prominent growth inhibitory activity against TNBC cells, which are characterized by high therapeutic resistance.

Pseudomyxoma peritonei (PMP) and extragastrointestinal stromal tumors (E-GISTs) are both rare entities. Most of the time, PMP is associated with an appendiceal tumor. An ovarian mucinous tumor can mimic appendiceal metastases. E-GIST is a mesenchymal tumor that can arise from the omentum, retroperitoneum, mesentery, or pleura. We present a case of an 87-year-old woman with mucinous carcinomatosis and acute intestinal occlusion submitted to an emergency laparotomy. She has found to have a borderline mucinous tumor of the ovary from the intestinal type with several lesions of pseudomyxoma peritonei and an E-GIST from the epiploons retrocavity (intermediated risk). In the literature, no relation was found between these two rare tumors. E-GIST was an incidental finding in the context of a mucinous carcinomatosis.

Background: Research over the past decade has focused on the role of Klotho as a cardio protective agent that prevents the effects of aging on the heart and reduces the burden of cardiovascular disease CVD. The role of the interaction between fibroblast growth factor 23-(FGF-23)/Klotho in Klotho-mediated actions is still under debate. The main objective was to ascertain the potential use of plasmatic Klotho and FGF23 as markers for CKD-associated cardiac disease and mortality. Methods: This was a prospective analysis conducted in an outpatient diabetic nephropathy clinic, enrolling 107 diabetic patients with stage 2–3 CKD. Patients were divided into three groups according to their left ventricular mass index and relative wall thickness. Results: Multinomial regression analysis demonstrated that low Klotho and higher FGF-23 levels were linked to a greater risk of concentric hypertrophy. In the generalized linear model (GLM), Klotho, FGF-23 and cardiac geometry groups were statistically significant as independent variables of cardiovascular hospitalization (p = 0.007). According to the Cox regression model, fatal cardiovascular events were associated with the following cardiac geometric classifications; eccentric hypertrophy (p = 0.050); concentric hypertrophy (p = 0.041), and serum phosphate ≥ 3.6 mg/dL (p = 0.025), FGF-23 ≥ 168 (p = 0.0149), α-klotho < 313 (p = 0.044). Conclusions: In our population, Klotho and FGF23 are associated with cardiovascular risk in the early stages of CKD.

Magnetotactic bacteria (MTB) biomineralize magnetosomes, which are defined as intracellular nanocrystals of the magnetic minerals magnetite (Fe3O4) or greigite (Fe3S4) enveloped by a phospholipid bilayer membrane. The synthesis of magnetosomes is controlled by a specific set of genes that encode proteins, some of which are exclusively found in the magnetosome membrane in the cell. Over the past several decades, interest in nanoscale technology (nanotechnology) and biotechnology has increased significantly due to the development and establishment of new commercial, medical and scientific processes and applications that utilize nanomaterials, some of which are biologically derived. One excellent example of a biological nanomaterial that is showing great promise for use in a large number of commercial and medical applications are bacterial magnetite magnetosomes. Unlike chemically-synthesized magnetite nanoparticles, magnetosome magnetite crystals are stable single-magnetic domains and are thus permanently magnetic at ambient temperature, are of high chemical purity, and display a narrow size range and consistent crystal morphology. These physical/chemical features are important in their use in biotechnological and other applications. Applications utilizing magnetite-producing MTB, magnetite magnetosomes and/or magnetosome magnetite crystals include and/or involve bioremediation, cell separation, DNA/antigen recovery or detection, drug delivery, enzyme immobilization, magnetic hyperthermia and contrast enhancement of magnetic resonance imaging. Metric analysis using Scopus and Web of Science databases from 2003 to 2018 showed that applied research involving magnetite from MTB in some form has been focused mainly in biomedical applications, particularly in magnetic hyperthermia and drug delivery.

Prediction in health care is closely related with the decision-making process. On the one hand, accurate survivability prediction can help physicians decide between palliative care or other practice for a patient. On the other hand, the notion of remaining lifetime can be an incentive for patients to live a fuller and more fulfilling life. This work presents a pipeline for the development of survivability prediction models and a system that provides survivability predictions for years one to five after the treatment of patients with colon or rectal cancer. The functionalities of the system are made available through a tool that balances the number of necessary inputs and prediction performance. It is mobile-friendly and facilitates the access of health care professionals to an instrument capable of enriching their practice and improving outcomes. The performance of survivability models was compared with other existing works in the literature and found to be an improvement over the current state of the art. The underlying system is capable of recalculating its prediction models upon the addition of new data, continuously evolving as time passes.

Em virtude das características hidrogeológicas e da ocupação agrícola intensiva, no dia 3 de Setembro de 2004, através da Portaria 1100/2004, o sector norte da zona aluvionar do Tejo foi designado zona vulnerável à poluição difusa de nitratos de origem agrícola (ZVT). Esta região abrangendo os concelhos da Golegã, Alpiarça, Santarém, Chamusca, Vila Nova da Barquinha, Constância e Torres Novas tem uma área aproximada de 19.124ha não estando contudo integrada a área protegida do Paúl de Boquilobo. Actualmente, a ZVT está a ser estudada no âmbito do projecto AGRO 530 intitulado “Plano de Intervenção e Desenvolvimento de um Sistema de Apoio à Decisão para o Norte da Zona Aluvionar do Tejo”. Com início em Julho de 2004, participam neste projecto, o Instituto Superior de Agronomia (ISA), que coordena, o Instituto Superior Técnico (IST) e a Direcção Regional de Agricultura do Ribatejo e Oeste (DRARO). A partir do momento em que se designa uma área como zona vulnerável uma das obrigações processuais é a elaboração de um plano de acção (segundo o Decreto-Lei 235/ 97, artigo 7º). Um dos objectivos deste projecto é contribuir para uma correcta implementação daquele plano de maneira a que nessa zona se pratique uma agricultura sustentável e social-mente aceitável. O trabalho, que agora se apresenta, pretende divulgar as principais linhas de força desse projecto. Os resultados já obtidos sobre a qualidade da água subterrânea naquela zona vulnerável, principalmente no que respeita à contaminação por nitratos e pesticidas, mostram que nas áreas envolventes da Golegã, da Azinhaga e da Chamusca ocorrem teores de nitratos muito acima do valor legal de 50 mg/l de NO3, e que num total de 89 amostras de água subterrânea, colhidas em 2004, em 27% foram detectados pelo menos, um dos pesticidas e/ou metabolitos analisados, sendo que, em 146 amostras de água subterrânea colhidas em 2005, a frequência de detecção de, pelo menos, um pesticida e/ou metabolito, foi de 38% Estes resultados reforçam a necessidade do desenvolvimento de sistemas de apoio à decisão, particularmente para o uso sustentável de fertilizantes azotados e de pesticidas nas principais culturas da ZVT.Taking in account the hydrogeologic characteristics and the intensive agricultural occupation, on 3rd September of 2004, through Portaria 1100/2004, the Northern Tagus alluvium was defined vulnerable zone to diffuse pollution with nitrates from agricultural source (ZVT). This region enclosing Golegã, Alpiarça, Santarém, Chamusca, Vila Nova da Barquinha, Constância and Torres Novas councils, has an approach area of 19124 ha not integrating the Paúl de Boquilobo protection area. Currently, ZVT is to be studied in the scope of the project AGRO 530 entitled “Intervention Plan and Support Decision System Development for the Northern Tagus Alluvium”. With the beginning in July of 2004, the institutions “Instituto Superior de Agronomia” (ISA) (Coordination), “Instituto Superior Técnico” (IST) and “Direcção Regional de Agricultura do Ribatejo e Oeste” (DRARO) participate in this project. From the moment that an area is designed as vulnerable zone, one of the procedural obligations is the elaboration of an action plan (according to the Decree-Law 235/97, article 7º). One of the objectives of this project is to contribute for one correct implementation of the plan towards a sustainable and socially acceptable agriculture. The work, that now is presented, intends to divulge the outlines of this project. The results already obtained on the groundwater quality in the vulnerable zone, mainly concerning nitrates and pesticides contamination, show that in the involving areas of Golegã, Azinhaga and Chamusca occur nitrates levels much higher than parametric value of 50 mg/ l of NO 3-, and that in a total of 89 groundwater samples, collected in 2004, in 27% were detected at least one of the pesticides and/or metabolites, being that, in 146 groundwater samples collected in 2005, the detection frequency of, at least, on pesticide and/or metabolite, it was of 38%. These results reinforce the development need of support decision systems, particularly for the sustainable nitrogen fertilizer and pesticide use in the main cultures of the ZVT.

Introduction. Subcutaneous emphysema is usually benign and self-limited; however, it may be associated with a life-threating situation. Case Report. An elderly woman with progressive malaise with extensive subcutaneous emphysema (cervical to abdominal wall) was observed at the emergency department. Colonic perforation was diagnosed and the patient underwent surgery. Intraoperatively, necrosis and perforation of the sigmoid colon into the retroperitoneum were found and a Hartmann procedure was performed. Conclusion. Cervical and thoracic subcutaneous emphysema may be the first sign of intra-abdominal lesion.

Atherosclerotic cardiovascular disease is the main cause of morbidity and mortality in chronic kidney disease patients. There is a raft of evidence showing that in the general population dyslipidaemia is associated with an increased risk of cardiovascular events, as well as with a greater prevalence of chronic kidney disease. Consequently, the use of statins in the general population with dyslipidaemia is not controversial. Nevertheless, the benefits of statins in patients with chronic kidney disease are more elusive. The authors review the possible effects of statins on the progression of renal disease and cardiovascular events in chronic kidney disease patients.

Obesity represents an important risk factor for the development of chronic kidney disease (CKD), due to its known strong association with diabetes mellitus and hypertension, the two major causes of CKD, but also as an independent renal risk factor. This direct relationship between obesity and kidney injury has been undervalued. The aim of this revisión is to point out the mechanisms of kidney injury induced by obesity, underline the importance of this association and alert for the prevention, education and treatment of the obese patient, as a way to control this heavy modifiable risk factor.

The increased level of plasma total homocysteine (tHcy) in chronic kidney disease patients has been reported as a new and independent risk factor for cardiovascular disease. However, after the description of reverse epidemiology in the renal population, the association of tHcy and nutrition became less clear. We evaluated the association between homocysteine, nutritional status, and inflammation, and their impact on mortality in 95 predialysis patients. High sensitivity C-Reactive Protein (hs-CRP), interleukin 6 (IL-6), Tumor Necrosis Factor 𝛼 (TNF-𝛼)], and tHcy were evaluated, as was the nutritional status by the modified Subjective Global Nutritional Assessment (mSGA). We divided our population in four groups according to their tHcy and mSGA values being above or below the mean level and found the lowest survival in the group with tHcy and mSGA above the mean level, as well as higher levels of IL-6 (𝑃=.03) and TNF-𝛼 (𝑃=.045). Higher levels of homocysteine can be associated with higher mortality in predialysis patients, as long as they are associated with malnutrition and inflammation.

Goodpasture's disease is a rare autoimmune disorder characterised by the development of antiglomerular basement membrane autoantibodies, which typically presents with rapidly progressive crescentic glomerulonephritis and pulmonary haemorrhage. Even with aggressive nonspecific immunosuppression and plasma exchange, mortality remains high. We report a case of life-threatening Goodpasture's disease with relapsing pulmonary haemorrhage refractory to conventional therapy. Second line treatment was based on mycophenolate mofetil 1 g every 12 hours and prednisolone 60 mg/day. In this case, the use of a low-dose mycophenolate mofetil regimen turned out to be insufficient. However, in our opinion higher mycophenolate mofetil doses should be considered an alternative treatment, mainly in relapsing disease, due to its mechanism of action and current insufficient therapeutic weapons.