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© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)., We investigated the impactof microsatellite instability (MSI) and Epstein-Barr virus (EBV) status in gastric cancer (GC), regarding response to perioperative chemotherapy (POPChT), overall survival (OS), and progression-free survival (PFS). We included 137 cases of operated GC, 51 of which were submitted to POPChT. MSI status was determined by multiplex PCR and EBV status by EBV-encoded RNA in situ hybridization. Thirty-seven (27%) cases presented as MSI-high, and seven (5.1%) were EBV+. Concerning tumor regression after POPChT, no differences were observed between the molecular subtypes, but females were more likely to respond (p = 0.062). No significant differences were found in OS or PFS between different subtypes. In multivariate analysis, age (HR 1.02, IC 95% 1.002-1.056, p = 0.033) and positive lymph nodes (HR 1.82, IC 95% 1.034-3.211, p = 0.038) were the only prognostic factors for OS. However, females with MSI-high tumors treated with POPChT demonstrated a significantly increased OS compared to females with MSS tumors (p = 0.031). In conclusion, we found a high proportion of MSI-high cases. MSI and EBV status did not influence OS or PFS either in patients submitted to POPChT or surgery alone. However, superior survival of females with MSI-high tumors suggests that sex disparities and molecular classification may influence treatment options in GC., This research was partially co-financed by Hospital da Luz Lisboa under the initiative “Luz Investigação” in the context of the Group GENIUS (Reference LH.INV.F2019015).

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/., Objective: Intratumor heterogeneity drives cancer progression and therapy resistance. However, it has yet to be determined whether and how subpopulations of cancer cells interact and how this interaction affects the tumour. Design: We have studied the spontaneous flow of extracellular vesicles (EVs) between subpopulations of cancer cells: cancer stem cells (CSC) and non-stem cancer cells (NSCC). To determine the biological significance of the most frequent communication route, we used pancreatic ductal adenocarcinoma (PDAC) orthotopic models, patient-derived xenografts (PDXs) and genetically engineered mouse models (GEMMs). Results: We demonstrate that PDAC tumours establish an organised communication network between subpopulations of cancer cells using EVs called the EVNet). The EVNet is plastic and reshapes in response to its environment. Communication within the EVNet occurs preferentially from CSC to NSCC. Inhibition of this communication route by impairing Rab27a function in orthotopic xenographs, GEMMs and PDXs is sufficient to hamper tumour growth and phenocopies the inhibition of communication in the whole tumour. Mechanistically, we provide evidence that CSC EVs use agrin protein to promote Yes1 associated transcriptional regulator (YAP) activation via LDL receptor related protein 4 (LRP-4). Ex vivo treatment of PDXs with antiagrin significantly impairs proliferation and decreases the levels of activated YAP.Patients with high levels of agrin and low inactive YAP show worse disease-free survival. In addition, patients with a higher number of circulating agrin+ EVs show a significant increased risk of disease progression. Conclusion: PDAC tumours establish a cooperation network mediated by EVs that is led by CSC and agrin, which allows tumours to adapt and thrive. Targeting agrin could make targeted therapy possible for patients with PDAC and has a significant impact on CSC that feeds the tumour and is at the centre of therapy resistance., The work was supported by NORTE-01–0145-FEDER-000029, Norte Portugal Regional Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund and national funds through FCT—Foundation for Science and Technology POCI-01–0145-FEDER-32189. Programa Operacional Regional do Norte and co-financed by European Regional Development Fund under the project "The Porto Comprehensive Cancer Center" with the reference NORTE-01-0145-FEDER-072678 - Consórcio PORTO.CCC – Porto.Comprehensive Cancer Center. CFR is supported by FCT (SFRH/BD/131461/2017), NB by (SFRH/BD/130801/2017), IB by FCT (SFRH/BD/144854/2019), and BA by FCT (PD/BD/135546/2018). DG’s contribution was supported by the NCI (R21 CA179907). We acknowledge the support of the i3S Scientific Platforms: Translational Cytometry, Animal Facility, Bioimaging and Histology and Electron Microscopy are members of the national infrastructure PPBI - Portuguese Platform of Bioimaging (PPBI-POCI-01–0145-FEDER-022122). Proteomics was performed at the Proteomics Facility of The Spanish National Center for Biotechnology (CNB-CSIC), ProteoRed, PRB3-ISCIII, supported by grant PT17/0019.

Loop ileostomy is performed in rectal cancer surgery to decrease the impact of anastomotic leak but it is associated with a significant complication rate. This study aimed to analyze the morbidity related to diverting ileostomy and to identify factors predictive of complications related to stoma management and reversal, as well as conversion into a permanent ileostomy. A retrospective study was conducted on 112 patients submitted to oncological rectal resection and defunctioning ileostomy in a Portuguese colorectal unit between March 2012 and March 2019. Loop ileostomy was responsible for 13% of index surgery morbidity and 15% of patients’ readmissions due to high output, stoma stenosis and parastomal hernia. Ileostomy was reversed in 89% cases with 7% Clavien-Dindo ≥ IIIb complications. An association was established between diabetes and higher stoma management morbidity (OR: 3.28 [95% CI: 1.039-10.426]. p = 0.041). Likewise, diabetes (OR: 0.17 [95% CI: 0.038; 6.90], p=0.015), oncological disease stage ≥ III (OR: 0.10 [95% CI: 0.005; 0.656], p=0.047) and index rectal surgery morbidity (OR: 0.23 [95% CI: 0.052; 0.955], p=0.041) were associated with less ileostomy closure. Complications of the index surgery also related to higher stoma reversal morbidity (OR: 5.11 [95% CI: 1.665; 16.346], p=0.005). Diabetes and complications of index rectal surgery were identified as predictive of ileostomy morbidity, closure rate and associated complications. It is essential to adjust treatment decisions to patient’s morbidity risk and adopt a more selective approach concerning the use of an ileostomy.

Rectal cancer treatment has evolved with the implementation of new surgical techniques. Transanal total mesorectal excision (TaTME) is the most recent approach developed to facilitate pelvic dissection of mid- and distal rectal tumours. The purpose of this study was to analyse the short- and mid-term oncological outcomes of TaTME. A study was conducted on patients treated with TaTME for rectal cancer at two colorectal units in Portugal between March 2016 and December 2018. Clinical, pathological and oncological data were retrospectively analysed. Primary endpoints were 3-year overall survival, disease-free survival and local recurrence. Secondary endpoints were clinical and pathological outcomes. Fifty patients (31 males, [62%], median age 66 years [range 40–85 years]) underwent TaTME, 49 (98%) for malignant and 1 (2%) for benign disease. There were no cases of conversion, 49 (98%) patients had complete or near-complete mesorectum, all the resections were R0 with adequate distal and circumferential margins. With a median follow-up of 36 months, there were 2 cases (4%) of local recurrence and 3-year estimated overall survival and disease-free survival were 90% and 79%, respectively. TaTME can provide safe mid-term oncological outcomes, similar to what has been published for classic and laparoscopic TME. Our results also show how demanding this novel approach can be and the consequent need for audited data and standardized implementation.

In light of the new legal framework in force in Portugal, which defines the terms for reporting the seismic vulnerability assessment and the need for seismic strengthening of existing buildings, this paper aims at investigating the correlation between two well-known approaches for the seismic risk assessment of stone masonry buildings located within historic centres: the vulnerability index method and nonlinear static seismic analyses. The latter were carried out by using a new three-dimensional macroelement model to numerically represent the considered sample of prototype buildings, together with the application of the N2 Method. In this paper, the original purpose of the vulnerability index method, that of ranking the seismic vulnerability of existing urban cultural heritage (UCH) assets within the same building typology, was numerically validated. However, when reverting the use of the vulnerability index method by replacing the Macroseismic Intensity with a response spectrum, the results were not as interesting as envisaged, since the correlations between the vulnerability index and the main properties of the capacity curves derived from numerical models, presented, in general, a poor fitting. Finally, the possible causes for such poor fitting and future lines of investigation are discussed. Despite these results must be understood with due care and diligence, the authors believe that this exercise might encourage new investigations on this topic that could lead to the development of a new code-oriented methodology for the seismic risk assessment of UCH assets within historic centres. info:eu-repo/semantics/publishedVersion

BackgroundTo assess adherence of gastrointestinal cancer patients to a Combined Exercise and Dietary Intervention (CEDI) during neo-adjuvant chemotherapy.MethodsParallel randomized controlled, open label, pilot trial. A table from a web based randomization system was used to allocate treatments. 46 patients were screened at diagnosis of esophageal, gastric, pancreatic and rectal cancer from June 2018 to November 2019 at a teaching hospital in Loures, 39 were randomized. A planned interim analysis was performed and results are herein presented. Patients were randomized to receive either 8 week individualized CEDI, with moderate aerobic and resistance training, dietary counseling and oral nutritional supplements or standard care. Follow up was conducted after neo-adjuvant treatment. Main outcome measures were adherence to CEDI, change in weight, body composition and functional status. Adherence to CEDI was analyzed with an intention to treat approach, other outcome measures were analyzed with a per protocol approach. Data analysis was conducted with Chi-square test or Fisher exact test and t-test or Mann Whitney U test. Effect size was computed with Cohen’s d for t tests and r for Mann-Whitney U tests. Paired-samples t test or Wilcoxon Signed Rank Test were used to analyze longitudinal data.Results39 patients (CEDI n = 19 or control n = 20) were randomized and included in the intention to treat analysis (29 (74.3%) male, median age 63.5 (Interquartile Range (IQR):11.75)). 32 patients completed follow up. 13/19 (68.4%) were fully adherent to CEDI. CEDI patients maintained weight (Effect size (EF):0.457; 95% Confidence Interval (95%CI): [0.44,0.46]), waist circumference (EF:-0.56, 95%CI: [-1.08, -0.034]), had a lower skeletal muscle loss (EF:-0.79; [-1.77;0.18]) and improved 6 minute walking test distance (EF:-1.51; 95%CI: [-2.57;-0.44]) and quality of life function score (EF:0.45; 95%CI:[0.43,0.45]). There were 4 serious adverse events, 3 in theintervention and 1 in the control arm but none related to the intervention.ConclusionsCEDI is feasible and patients are willing to participate even under neo-adjuvant chemoradiotherapy, resulting in potential nutritional and functional benefits.Trial registrationTrial registry: www.clinicaltrials.gov; Identifier: NCT05237921, 14-2-22, retrospectively registered, https://www.clinicaltrials.gov/ct2/results?cond=&term=NCT05237921&cntry=&state=&city=&dist=

Objectives The purpose of this exploratory study was to identify the main dietary patterns of a Portuguese population of patients with gastrointestinal cancer and to analyze their association with sarcopenia. Methods This was a prospective study with a consecutive sample of 100 patients with gastrointestinal cancer enrolled at diagnosis. Dietary intake was assessed with a semiquantitative Food Frequency Questionnaire, and dietary patterns were obtained with principal component analysis. Nutritional assessment was done using the Patient-Generated Subjective Global Assessment, and body composition was evaluated with anthropometric measures and computed tomography image processing obtained at the third lumbar vertebrae. Sex and body mass index specific cutoffs were used to define sarcopenia. Results Four major patterns were identified: high-fat dairy products, fried snacks, and processed meat diet; legumes, vegetables, and fruit diet; fat and fish diet; and alcohol, cereal, and animal protein diet. On simple logistic regression, the occurrence of sarcopenia in participants in the second tertile (odds ratio [OR] 0.30; 95% confidence interval [CI] 0.10–0.83; P = 0.02) and third tertile (OR 0.24; 95% CI 0.08–0.69; P = 0.01) of adherence to the high-fat and fish diet was reduced compared with the first tertile. On multiple logistic regression, the second tertile (OR 0.38, 95% CI 0.11–1.19; P = 0.10) of the fat and fish dietary pattern maintained a trend toward a reduction of the odds of sarcopenia compared with the first tertile, independently of calorie intake, age, disease location, and stage. Conclusions The fat and fish dietary pattern was associated with lower odds of sarcopenia in this population of patients with gastrointestinal cancer.

The seismic vulnerability assessment of unreinforced masonry buildings within historical centres is a very challenging research subject given the inaccuracy of investigating these buildings as independent structures. Indeed, these buildings are often part of complex structural systems, which may differ in geometry, building materials, construction techniques and maintenance condition, as they result from an urban continued growth phenomenon, in adjacency and continuity with the existing built environment. For this reason, when assessing the seismic vulnerability of buildings enclosed in aggregate, the reciprocal interactions with adjacent structures should be considered. However, even though several studies have been performed in recent years to address this issue, it is not yet clear how to represent these interactions in numerical models, without the need for modelling the entire aggregate. Hence, this study aims at understanding how the “aggregate effect” should be modelled for a more accurate seismic assessment of unreinforced masonry buildings located within historical centres. To this end, an innovative procedure, from now on referred to as “target structural unit approach”, was developed, aiming at identifying the optimal portion of the aggregate that best represents the “aggregate effect” for the investigated structural unit, i.e., the Minimum Unit of Analysis (MUA). This procedure is based on a multi-level analysis of the seismic response of the target structural unit, investigating different modelling configurations in addition to the complete aggregate or the isolated building. The evaluation is preliminarily performed at global– and wall– level; then, the structural unit– level is introduced as additional verification level, with the aim to understand the variability of the seismic response of the case study building in function of different boundary conditions. The procedure herein proposed was employed to a case study located in the “Bairro Ribeirinho” neighbourhood in Faro (Portugal), by performing nonlinear static analyses using a software code based on the macro-elements approach. Although just some first results are shown and further investigations are needed, the proposed approach can be used for the validation of seismic assessment strategies specific for masonry buildings enclosed in aggregate.

Guidelines recommend regional lymphadenectomy with a lymph node yield (LNY) of at least 12 lymph nodes (LN) for adequate colon cancer (CC) staging. LNY ≥22LN may improve survival, especially in right-sided CC [Lee et al., Surg Oncol, 27(3), 2018]. This multicentric retrospective cohort study evaluated the impact of LNY and tumor laterality on CC staging and survival.Patients with stage I-III CC that underwent surgery from 2012 to 2018 were grouped according to LNY:22 and ≥ 22. Primary outcomes were LN positivity (N+ rate) and disease-free survival (DFS). Overall survival (OS) was the secondary outcome. Exploratory analyses were performed for laterality and stage.We included 795 patients (417 22LN, 378 ≥ 22LN); 53% had left-sided CC and 29%/37%/38% had stage I/II/III tumors. There was no association between LNY ≥22LN and N+ rate after adjustment for grade, T stage, lymphovascular invasion (LVI) and perineural invasion; a trend for a higher N+ rate in left-sided CC was identified (interaction p = 0.033). With a median follow-up of 63.6 months for DFS and 73.2 months for OS, 254 patients (31.9%) relapsed and 207 (26.0%) died. In multivariate analysis adjusted for age, ASA score, laparoscopic approach, T/N stage, mucinous histology, LVI and adjuvant chemotherapy, LNY ≥22LN was significantly associated with both DFS (HR 0.75, p = 0.031) and OS (HR 0.71, p = 0.025). Restricted cubic spline analysis showed a more significant benefit for right-sided CC.LNY ≥22LN was associated with longer DFS and OS in patients with operable CC, especially for right-sided CC.

Pancreatic surgery still carries a high morbidity and mortality even in specialized centers. The aim of this study was to evaluate the influence of patients' body composition on postoperative complications and survival after pancreatic surgery.This was a retrospective study on patients undergoing pancreatic surgery between March 2012 and December 2017. Demographics, clinical data, and postoperative complications classified according to Clavien-Dindo were recorded. Body composition was assessed using routine diagnostic or staging computed tomography (CT). Multiple Cox proportional hazards models were adjusted.Ninety patients were included, 55% were male, and the mean age was 68 ± 10.9 years. Of these 90, 92% had a total pancreatectomy or pancreaticoduodenectomy, 7% a distal pancreatectomy, and 1% a pancreaticoduodenectomy with multi-visceral resection; 84% had malignant disease. The incidence of major complications was 27.8% and the 90-day mortality was 8.8%. The ratio of visceral fat area/skeletal muscle area (VFA:SMA) was associated with an increased risk of complications (OR 2.24, 95% CI 1.14-4.87,Body composition is a major determinant of postoperative complications and survival in pancreatic surgery patients.A cirurgia pancreática continua associada a uma elevada morbimortalidade mesmo em centros de referência. O objetivo do presente estudo foi avaliar a influência da composição corporal nas complicações e sobrevivência após cirurgia pancreática.Estudo retrospetivo em doentes submetidos a cirurgia pancreática entre Março 2012 e Dezembro 2017. Foram registadas variáveis demográficas, clínicas, complicações pós-cirúrgicas classificadas de acordo com a classificação de a classificação de Clavien Dindo. A composição corporal foi avaliada utilizando imagens de Tomografia Axial Computorizada (TAC) realizada no diagnóstico. Modelos de riscos porporcionais de Cox foram ajustados.Incluídos 90 doentes, 55% homens e média de idade de 68 ± 10.9 anos; 92% submetidos a pancreatectomia/pancreatoduodenectomia, 7% pancreatectomia distai e 1% pancreatoduodenectomia com ressecção multivisceral; 84% tinham doença maligna. A incidência de complicações major foi de 27.8% e a mortalidade aos 90 dias de 8.8%. O rácio da Área de Gordura Visceral (AGV) / Área de Tecido Muscular Esquelético (ATME) associou-se a um risco acrescido de complicações (OR 2.24, 95% Cl 1.14–4.87,A composição corporal é um determinante major de complicações pós-cirúrgicas e de sobrevivência de doentes submetidos a cirurgia pancreática.

Response to chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (RC) is quite variable and it is urgent to find predictive biomarkers of response. We investigated miR-21 as tissue and plasma biomarker of response to CRT in a prospective cohort of RC patients, The expression of miR-21 was analyzed in pre- and post-CRT rectal tissue and plasma in 37 patients with RC. Two groups were defined: Pathological responders (TRG 0, 1 and 2) and non-responders (TRG 3). The association between miR-21, clinical and oncological outcomes was assessed, miR-21 was upregulated in tumor tissue and we found increased odds of overexpression in pre-CRT tumor tissue (OR: 1.63, 95% CI: 0.40–6.63, p = 0.498) and pre-CRT plasma (OR: 1.79, 95% CI: 0.45–7.19, p = 0.414) of non-responders. The overall recurrence risk increased with miR-21 overexpression in pre-CRT tumor tissue (HR: 2.175, p = 0.37), Significantly higher miR-21 expression is observed in tumor tissue comparing with non-neoplastic. Increased odds of non-response is reported in patients expressing higher miR-21, although without statistical significance. This is one of the first studies on circulating miR-21 as a potential biomarker of response to CRT in RC patients.

Morestin syndrome (MS) is a rare clinical manifestation consequent to an acute compression trauma to the thorax. In such an event, the sudden elevated pressure that happens to the airway and the rapid and retrograde blood flow results in capillary rupture in the head and neck vessel territory. This case reports a car accident victim that was dragged by a truck down a road with closed thoracic trauma resulting in MS. The patient presented with ecchymotic mask, neck and facial cyanosis and petechiae, ocular hemorrhage, otorrhagia, left clavicle fracture and spleen laceration that resolved with conservative measures. In this article, the authors present a specific acute syndrome due to trauma, with potential severe complications that should be recognized early and subject to a multidisciplinary and systemic approach in the emergency setting.

This paper discusses the adoption of Artificial Intelligence-based techniques to estimate seismic damage, not with the goal of replacing existing approaches, but as a mean to improve the precision of empirical methods. For such, damage data collected in the aftermath of the 1998 Azores earthquake (Portugal) is used to develop a comparative analysis between damage grades obtained resorting to a classic damage formulation and an innovative approach based on Artificial Neural Networks (ANNs). The analysis is carried out on the basis of a vulnerability index computed with a hybrid seismic vulnerability assessment methodology, which is subsequently used as input to both approaches. The results obtained are then compared with real post-earthquake damage observation and critically discussed taking into account the level of adjustment achieved by each approach. Finally, a computer routine that uses the ANN as an approximation function is developed and applied to derive a new vulnerability curve expression. In general terms, the ANN developed in this study allowed to obtain much better approximations than those achieved with the original vulnerability approach, which has revealed to be quite non-conservative. Similarly, the proposed vulnerability curve expression was found to provide a more accurate damage prediction than the traditional analytical expressions. Portuguese Foundation for Science and Technology (FCT)Portuguese Foundation for Science and Technology [SFRH/ BPD/122598/2016] Society of Promotion for Housing and Infrastructures Rehabilitation (SPRHI) Regional Secretariat for Housing and Equipment (SRHE) of Faial info:eu-repo/semantics/publishedVersion

This paper aims at providing an insightful comparison between three of the most widely used commercially available macroelement models for assessing the global seismic performance of existing masonry structures: the equivalent frame model of 3Muri®, and the two- and three-dimensional discrete macroelements available in 3D-Macro®. To this aim, a stone masonry building, representative of the Urban Cultural Heritage (UCH) typology of the Azores archipelago (in Portugal), was considered as a case study. Firstly, sensitivity analyses were performed to investigate the impact of a few modelling aspects on the seismic performance of the case study building, and ultimately to define the reference model. Secondly, this reference model was analysed both linearly and nonlinearly. Finally, the seismic performance was evaluated by applying the N2 Method. With this comparative study, the authors aim at discussing, from the user viewpoint, the features that these software codes and corresponding macroelement models have in common and those where they most diverge, as well as their main advantages and drawbacks. Results demonstrate that these models should be applied to UCH assets with due diligence, bearing in mind both the particularities of the case study as well as features and limitations associated with the chosen modelling strategy and software. info:eu-repo/semantics/publishedVersion

This paper aims not only at raising awareness for the preservation of traditional construction techniques and materials when intervening in urban cultural heritage (UCH), but also at demystifying whether or not the integration of traditional seismic strengthening strategies in the renovation process of such assets is economically viable. In Portugal, countless UCH assets have been massively demolished and replaced by modern construction solutions over the last decades. As this phenomenon is contributing both to the mischaracterisation of the existing building stock within the majority of historical centres, and to the gradual loss of knowledge on these construction techniques, it is fundamental to tackle this issue from its very foundations, i.e., by raising the awareness and consciousness of all the involved stakeholders to the need of preserving such techniques and materials as part of the patrimonial value of UCH assets. Hence, in order to investigate the above-mentioned issues, the database created in the framework of the 1998 Azores earthquake by the Regional Secretariat for Housing and Equipment (SRHE) of Faial Island, was herein revisited. By critically handling and analysing this database, it was possible not only to investigate the economic prospects of UCHs assets’ renovation in Portugal, but also to derive new repair cost functions suitable to the Azorean traditional stone masonry building stock, that might be used to support post-disaster emergency plans and the design of risk mitigation strategies.

It is an acknowledged fact that historical centers, given its significance from the cultural and architectural viewpoint, bring further challenges in terms of maintenance planning, survey, and safety assessment. The preparation of an adequate investigation plan and the extent of data to be collected is highly reliant on many aspects, such as the category of the architectonic asset, the importance of the heritage site, or the resources available, for example. In what regards the seismic response assessment of urban cultural heritage assets located in historical centers, the amount and detail of data also depend on this article, scale of assessment, and current state of conservation and occupation. Within this framework, this article provides an overview of the state of the art of investigation techniques currently used in survey operations, which are currently available for improving the knowledge level of urban cultural heritage assets within historical centers, as a supporting tool for the seismi...

This paper aims at providing a comprehensive review on disaster risk mitigation of urban cultural heritage assets located in historical centres, by providing a holistic framework on the features of such a complex system. From all the hazards and threats that can possibly harm cultural heritage assets, particular focus will be given to earthquake risk. The review of the state of science in which the earthquake risk mitigation concerns is considered fundamental to understand the current streams of thought and to identify new research gaps and opportunities to enhance the knowledge level on this particular field of research.

A formação e educação cívica constitui uma das mais importantes e poderosas ferramentas para uma maior consciencialização e perceção dos cidadãos para o risco sísmico, desempenhando um papel fundamental na construção de sociedades mais resilientes. No entanto, por exigir o envolvimento de todos os cidadãos sem exceção, a promoção de uma cultura de risco representa um desafio transversal à nossa sociedade. Reconhecendo a perceção de risco como um aspeto fundamental para o desenvolvimento e implementação de estratégias de informação e comunicação do risco terramoto, este artigo apresenta os resultados de uma campanha de sensibilização realizada no âmbito do projeto de investigação URBSIS que consistiu na recolha e tratamento das respostas a um questionário elaborado com o objetivo de avaliar a perceção dos cidadãos para esta problemática. O questionário teve como público alvo os residentes do Bairro Ribeirinho da cidade de Faro e a comunidade técnica local ligada, direta ou indiretamente, aos setores da construção e do planeamento urbano.

This paper is focused on the calibration of a simplified seismic vulnerability index method for masonry facade walls, through an innovative two-step calibration process based on two complementary approaches. The first one is based on a set of fragility curves constructed from out-of-plane damage limit states obtained from experimental data, which are used to calibrate the weights associated to the parameters of the vulnerability index method that rule the out-of-plane response of the masonry facade walls. The second approach, subsequently used to calibrate the weights of the remaining vulnerability parameters, is based on post-earthquake damage data collected after the seismic event that struck the Azores Archipelago in July 1998. The results obtained from such calibration are then presented and critically discussed taking into account not only the calibration itself, but also their reliability from the methodological point of view. Finally, the addition of three new evaluation parameters is further proposed and analysed. This two-step calibration process represents a valuable contribution for the current state-of-art of the simplified seismic vulnerability assessment methodologies which, up to the present, have been developed and calibrated only on the basis of empirical data.

The prognostic value of body composition analysis in patients with Crohn's disease (CD) is poorly explored. The aims of the present study were to assess fat and skeletal muscle compartments including muscle radiation attenuation (MA) in patients with CD, and to analyze its predictive value to identify complicated phenotypes.Seventy one patients with CD who have had an abdominal CT within one month of clinical, laboratory, and endoscopic evaluation were included. Skeletal muscle area (SMA) and index (SMI), visceral fat area (VFA) and index (VFI), subcutaneous fat area (SFA), and mean MA were measured using appropriate software. Sarcopenia, as defined by Martin's criteria was assessed. Montreal classification was used to characterize disease phenotype.Mean MA was lower in patients40 years (p = 0.001), L2 (p = 0.09) and stricturing/penetrating disease (p = 0.03) whereas SMA and SMI were significantly lower in patients with positive C-reactive protein and previous hospital admissions (p 0.01). On multivariate analysis, higher MA was protective against the complicated disease phenotype (stricturing/penetrating disease and/or previous surgeries) (OR 0.81; p = 0.002) whereas a high visceral fat index increased such risk (OR 26.1; p = 0.02). A ROC curve showed a 82.4% sensibility, 90.3% specificity, 17.6% positive predictive value, 9.7% negative predictive value and an area under the curve (AUC) of 0.91 for body composition analysis to predict complicated disease.A lower muscle attenuation and a high visceral fat index seem to be associated with more severe phenotypes in patients with CD.

The buildings’ capacity to maintain minimum structural safety levels during natural disasters, such as earthquakes, is recognisably one of the aspects that most influence urban resilience. Moreover, the public investment in risk mitigation strategies is fundamental, not only to promote social and urban and resilience, but also to limit consequent material, human and environmental losses. Despite the growing awareness of this issue, there is still a vast number of traditional masonry buildings spread throughout many European old city centres that lacks of adequate seismic resistance, requiring therefore urgent retrofitting interventions in order to both reduce their seismic vulnerability and to cope with the increased seismic requirements of recent code standards. Thus, this paper aims at contributing to mitigate the social and economic impacts of earthquake damage scenarios through the development of vulnerability-based comparative analysis of some of the most popular retrofitting techniques applied after the 1998 Azores earthquake. The influence of each technique individually and globally studied resorting to a seismic vulnerability index methodology integrated into a GIS tool and damage and loss scenarios are constructed and critically discussed. Finally, the economic balance resulting from the implementation of that techniques are also examined.

Walled-off pancreatic necrosis (WOPN) is a rare complication of pancreatitis. We present the case of a woman in her eighties admitted for diffuse abdominal pain. She had a palpable abdominal mass and the CT scan showed necrosis throughout the tail of the pancreas, a peripancreatic and retrogastric hydroaerial collection (19 cm of diameter) and a calculus in the main biliary duct, thus establishing a diagnosis of emphysematous necrotising obstructive pancreatitis. A step-up approach was decided, first with removal of the biliary calculus, followed by a waiting period of 4 weeks in which the patient was under intravenous antibiotics. At re-evaluation, the CT scan showed a smaller and more organised collection, bounded by a wall, defining WOPN. At this stage, transgastric drainage via echoendoscopy was attempted, without success, followed by percutaneous CT-guided drainage, also with little effect. Surgical necrosectomy was then executed, as a final step, with a successful outcome.