P-POSSUM - Preditor de mortalidade e morbilidade em cistectomias radicais?

Introdução: A predição do risco pré-operatório pode ser um dado útil na tomada da decisão cirúrgica. O P-POSSUM (Portsmouth POSSUM - Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) é um sistema baseado em variáveis fisiológicas e cirúrgicas, validado para cirurgia geral, que estima a mortalidade e morbilidade de cada doente aos 30 dias após a cirurgia (1). Em grandes séries de doentes submetidos a cistectomia radical estão descritas taxas de 2,5 e 28%, respetivamente (2). Pretendeu-se avaliar a aplicabilidade deste sistema em doentes submetidos a cistectomia radical num hospital central. Métodologia: Foi realizada uma análise retrospetiva, através da consulta dos registos electrónicos, dos parâmetros fisiológicos, cirúrgicos, morbilidade e mortalidade aos 30 dias de todos os doentes submetidos a cistectomia radical eletiva num hospital central, durante um ano. Foi aplicado o sistema P-POSSUM e calculadas as razões observada/prevista para morbilidade e mortalidade aos 30 dias. Resultados: Foram incluídos 28 doentes, com idade média de 70 anos, 78.6% do sexo masculino. Ocorreram 2 mortes (7.1%) e 14 doentes (50%) tiveram pelo menos uma complicação no pós-operatório. As complicações mais frequentes foram hemorragia, deiscência de anastomoses e infeção da ferida cirúrgica. A mortalidade prevista pela aplicação do sistema P-POSSUM foi de 9.2% e a morbilidade média prevista foi de 71.4%. As razões observada/prevista para a mortalidade e a morbilidade foram, respetivamente, 0.77 e 0.7. Discussão e Conclusões: Na amostra populacional estudada, o sistema P-POSSUM revelou-se um excelente preditor da morbilidade e da mortalidade associada a cistectomias radicais. Embora pareça sobrestimar os seus valores, estes resultados coincidem com os apresentados em estudos recentemente publicados. As complicações pós-cirúrgicas mais frequentes estão de acordo com o descrito na literatura até à data. Assim, o sistema P-Possum poderá ser um instrumento útil na predição de risco cirúrgico durante a avaliação individual de doentes propostos para cistectomia radical

Evaluation of patients' discomfort regarding regional anesthesia: 8AP6‐7

Background and Goal of Study: Regional anesthesia may cause physical and psychological discomfort. 50% of patients scheduled for urologic procedures undergo regional anesthesia, and their comfort represents a concern to the anesthesiologist. This study aims to: 1. identify factors related to patients’ discomfort regarding regional anesthesia(position for anesthesia and surgery procedures, puncture site pain, room temperature, audio-visual perception, sensitive/motor blockade); 2. Evaluate patients’ satisfaction with anesthesia. Materials and Methods: Af ter approval from the Hospital Ethics Committee all patients over 18years old, scheduled for urologic surgery, understanding Portuguese and anesthetized with spinal anesthesia were included. Patients in day case surgery or with incomplete medical records were excluded. We performed a questionnaire(with closed ended questions) in the first 24 hours af ter surgery and consulted anesthesia records. We asked yes or no questions, used a 1-10 scale to evaluate pain and a 1-4 scale to evaluate satisfaction. Because there isn’t a valid questionnaire in the literature to evaluate what we aimed to, we created one based on multiple articles1,2. Results and Discussion: 50patients were included; mean age 65 years old (min.32, max.89); 78% males and 70% ASAII. 75%denied discomfort during positioning for back puncture and 58% referred cold during anesthesia or surgery. One person was uncomfortable in the surgical position and no one considered being awake uncomfortable; sensitive/motor blockade was uncomfortable for 22%. Spinal was more painful than the venous puncture for32%; for 50%venous puncture was more painful and for 18%pain was similar. Patients were satisfied or very satisfied with the anesthetic technique and would choose the same technique in the future in 98% of cases. Conclusion: Although this questionnaire is not validated, it allowed us to understand that cold during anesthesia/surgery is a problem for most patients but this is easily solved. It also showed us that most patients are not uncomfortable with positioning during procedures, being awake and not feeling the legs.Interestingly only about one third of the patients thought that the back puncture was more painful than the venous puncture. In general we consider spinal anesthesia a good choice for these patients and we are satisfied that patients don’t find it uncomfortable and are also satisfie

Auditoria à prática profilática e incidência de náuseas e vómitos pós-operatórios (NVPO)

Introdução: As NVPO são uma das principais queixas dos doentes do pós-operatório. Este trabalho teve como objetivo registar a prática farmacológica para profilaxia de NVPO em cirurgia programada e avaliar a sua eficácia. Metodologia: Incluídos todos os doentes submetidos a cirurgia programada das especialidades de Cirurgia Geral, Urologia e Cirurgia Vascular entre 3 e 21 de Dezembro de 2012. Excluídos se alta<24horas(h), pós-operatório no Serviço Cuidados Intensivos/ Intermédios ou impossível acesso aos registos. Tendo como modelos o Score Apfel Simplificado e as recomendações para cirurgia de ambulatório(1) (Tabela 1), a profilaxia instituída foi dividida em adequada, a mais ou a menos; avaliação da ocorrência de NVPO na Unidade Cuidados Pós-Anestésicos e às 24h (registos anestésicos e entrevista). Resultados apresentados em percentagem. Aplicação teste qui quadrado com p<0,05 para significância. Resultados: Avaliados 255 doentes (excluídos 68, incluídos 187). Com 0-1 fator risco (FR) 34%, 2 FR 45%, 3-4 FR 21%. A profilaxia foi adequada em 53% dos doentes, a mais em 16% e a menos em 31%. Incidência total de NVPO - 22% (24% no grupo de doentes que fez profilaxia adequada e 20% no grupo de profilaxia inadequada (p=0.35012)). Neste último grupo 13% realizaram profilaxia a mais e 24% a menos. Resultados da incidência de NVPO por fator de risco na tabela 2. A incidência de NVPO por FR nos doentes com profilaxia adequada foi menor ou igual em todos os grupos em relação ao previsto no Score Apfel simplicado(1,2). No grupo que fez profilaxia inadequada, esta foi a menos principalmente no grupo de 2 FR, com 71% de NVPO; e foi a mais essencialmente no grupo com 1 FR (4 doentes, todos com NVPO). Incidência menor com anestesia locoregional (ALR) vs anestesia geral (AG) (13% vs 27%) (p<0.001). Discussão e Conclusões: A profilaxia foi adequada, segundo as recomendações para cirurgia de ambulatório, em cerca de metade dos doentes. Apesar da profilaxia adequada, nos grupos de FR 1 e 2 não houve redução da incidência de NVPO comparando com a prevista pelo score de Apfel, alertando para a importância de outros fatores de risco não previstos neste score e que estas recomendações poderão ser insuficientes para a profilaxia de NVPO em cirurgia em regime de internamento. A incidência de NVPO foi menor com ALR vs AG, corroborando a ALR como melhor opção em doentes de risco de NVPO (1,2). Estes resultados salientam a importância da adoção de estratégias para redução do risco basal

Legislação e programas de incentivo para a gestão da procura de energia

A energia encontra-se atualmente intrinsecamente ligada ao desenvolvimento tecnológico, sendo a fonte de alimentação da maior parte dos sistemas, não se justificando deste modo um crescimento irracional da sua procura e oferta. Na União Europeia, os edifícios são responsáveis por 40% da energia consumida e 36% das emissões de CO2. Deste modo, a UE tem vindo a desenvolver políticas e regulamentos para a construção sustentável, de forma a mitigar os impactes ambientais e reduzir as necessidades energéticas desde a fase de conceção até à demolição. O ambiente construído sustentado nos princípios da economia circular, com edifícios concebidos modularmente com materiais não tóxicos e produzindo mais energia do que a que necessitam, devem ser parte integrante das infraestruturas existentes. Assim, a gestão da procura de energia consiste na promoção da redução da procura em períodos de pico e da utilização racional da mesma. Ou seja, pretende-se repensar a sua utilização de acordo com a introdução de tarifas dinâmicas que trazem vantagens económicas e ambientais, sendo que, através de baixos preços de produção, se promove o uso eficiente de energia e conservação da mesma durante os períodos de baixa procura para utilização durante os períodos de pico. Contudo, quando as decisões políticas acarretam implicações sociais, estas necessitam de ser bem articuladas com as tecnologias existentes, explorando o conceito da ?internet das coisas? para promoção da mudança de paradigma por parte dos intervenientes. Consequentemente, os edifícios devem correlacionar-se com a rede elétrica de forma a otimizar o conceito das ?redes inteligentes? e interagir com os seus ocupantes para uma gestão de recursos eficiente, minimizando desperdícios, promovendo a gestão e procura sustentável ao longo do ciclo de vida. Este artigo, promove uma análise de todos os fatores e implicações por parte dos intervenientes para um desenvolvimento sustentável da utilização eficiente de recursos e energia.info:eu-repo/semantics/publishedVersio

Prevalence of multimodal species abundance distributions is linked to spatial and taxonomic breadth

We thank the University of St Andrews MHD Cluster and the Bioinformatics Unit (Wellcome Trust ISSF grant 105621/Z/14/Z). L.H.A. was supported by Fundação para a Ciência e Tecnologia, Portugal (POPH/FSE SFRH/BD/90469/2012). A.E.M. acknowledges the ERC (BioTIME 250189). M.D. acknowledges funding from the Marine Alliance for Science and Technology Scotland (MASTS), funded by the Scottish Funding Council (grant reference HR09011) and contributing institutions.Aim. Species abundance distributions (SADs) are a synthetic measure of biodiversity and community structure. Although typically described by unimodal logseries or lognormal distributions, empirical SADs can also exhibit multiple modes. However, we do not know how prevalent multimodality is, nor do we have an understanding of the factors leading to this pattern. Here we quantify the prevalence of multimodality in SADs across a wide range of taxa, habitats and spatial extents. Location. Global. Methods. We used the second-order Akaike information criterion for small sample sizes (AICc) and likelihood ratio tests (LRTs) to test whether models with more than one mode accurately describe the empirical abundance frequency distributions of the underlying communities. We analysed 117 empirical datasets from intensely sampled communities, including taxa ranging from birds, plants, fish and invertebrates, from terrestrial, marine and freshwater habitats. Results. We find evidence for multimodality in 14.5% of the SADs when using AICc and LRT. This is a conservative estimate, as AICc alone estimates a prevalence of multimodality of 22%. We additionally show that the pattern is more common in data encompassing broader spatial scales and greater taxonomic breadth, suggesting that multimodality increases with ecological heterogeneity. Main conclusions. We suggest that higher levels of ecological heterogeneity, underpinned by larger spatial extent and higher taxonomic breadth, can yield multimodal SADs. Our analysis shows that multimodality occurs with a prevalence that warrants its systematic consideration when assessing SAD shape and emphasizes the need for macroecological theories to include multimodality in the range of SADs they predict.PostprintPeer reviewe

Optical and mechanical mode tuning in an optomechanical crystal with light-induced thermal effects

Under the terms of the Creative Commons Attribution (CC BY) license to their work.We report on the modification of the optical and mechanical properties of a silicon 1D optomechanical crystal cavity due to thermo-optic effects in a high phonon/photon population regime. The cavity heats up due to light absorption in a way that shifts the optical modes towards longer wavelengths and the mechanical modes to lower frequencies. By combining the experimental optical results with finite-difference time-domain simulations, we establish a direct relation between the observed wavelength drift and the actual effective temperature increase of the cavity. By assuming that the Young's modulus decreases accordingly to the temperature increase, we find a good agreement between the mechanical mode drift predicted using a finite element method and the experimental one.This work was supported by the EU through the project TAILPHOX (ICT-FP7-233883) and the ERC Advanced Grant SOULMAN (ERC-FP7-321122) and the Spanish projects TAPHOR (MAT2012-31392).Peer Reviewe

Ordering kinetics evaluation of FeAl powders

In this study, time resolved X-ray diffraction experiments using synchrotron X-ray radiation have been performed to get insight on the time and temperature dependent atomic ordering of an intermetallic Fe-40Al (at.%) ball-milled powder. The target of the present study is to gain knowledge on the rapid heating processes occurring during Thermal Spray coating processes. Present results show that in the temperature range 400 °C - 550 °C, the evolution of the order can be followed and modelled by fitting the powder diffraction patterns collected within the first minutes after fast heating. Reasonable refinements have been obtained by assuming the presence of two domains corresponding to the ordered and disordered lattices. The lattice constant changes from 0.29165 nm in the ball-milled powder at room temperature to 0.29281 nm in the ordered phase after 3000 s at 550 °C. The growth of the ordered phase is proposed to be a vacancy-related process with an activation energy of 1.04 eV. Above 550 °C, the ordering kinetics appears too fast to be resolved using the few seconds time scale of the present experiments which is in agreement to thermal spray results conditions.Peer ReviewedPostprint (author's final draft

Influence of protein-phenolic complex on the antioxidant capacity of flaxseed (Linum usitatissimum L.) products

The impact of the naturally present phenolic compounds and/or proteins on the antioxidant capacity of flaxseed products (phenolic fraction, protein concentrates, and hydrolysates) before and after simulated gastrointestinal digestion was studied. For that, whole and phenolic reduced products were assessed. Four glycosylated phenolic compounds (secoisolariciresinol and ferulic, p-coumaric, and caffeic acids) were identified in flaxseed products. Phenolic fraction exerts the highest antioxidant capacity that increased by alkaline hydrolysis and by simulated gastrointestinal digestion. The action of Alcalase and digestive enzymes resulted in an increase of the antioxidant capacity of whole and phenolic reduced products. Principal component analysis showed that proteinaceous samples act as antioxidant is by H transfer, while those samples containing phenolic compounds exert their effects by both electron donation and H transfer mechanisms. Protein/peptide-phenolic complexation, confirmed by fluorescence spectra, exerted a positive effect on the antioxidant capacity, mainly in protein concentrates.This work was supported by FAPESP (2010/52680-7), CNPq and UNICAMP (FAEPEX 607-11) grants, CSIC and Ministry of Economy and Competitiveness (Ramon y Cajal contract).Peer Reviewe

Molecular mechanisms of zinc toxicity in the potworm Enchytraeus crypticus, analysed by high-throughput gene expression profiling

Zinc (Zn) is known to be relatively toxic to some soil-living invertebrates including the ecologically important enchytraeid worms. To reveal the molecular mechanisms of zinc toxicity we assessed the gene expression profile of Enchytraeus crypticus (Enchytraeidae), exposed to the reproduction effect concentrations EC10 and EC50, over 4 consecutive days, using a high-throughput microarray (species customized). Three main mechanisms of toxicity to Zn were observed: 1) Zn trafficking (upregulation of zinc transporters, a defence response to regulate the cellular zinc level), 2) oxidative stress (variety of defence mechanisms, triggered by Reactive Oxygen Species (ROS)), and 3) effects on the nervous system (possibly the primary lesion explaining the avoidance behaviour and also why enchytraeids are relatively susceptible to Zn). The adverse outcome at the organism level (reproduction EC50) could be predicted based on gene expression (male gonad development, oocyte maturation), with Zn at the EC50 affecting processes related to higher stress levels. The gene expression response was time-dependent and reflected the cascade of events taking place over-time. The 1 to 4 days of exposure design was a good strategy as it captured the time for sequence of events towards zinc adverse outcomes in E. crypticus

Giant injection-locking bandwidth of a self-pulsing limit-cycle in an optomechanical cavity

Locking of oscillators to ultra-stable external sources is of paramount importance for improving close-to-carrier phase noise in free running oscillators. In most of them, such as Micro-Electro-Mechanical-Systems or LC circuit-based oscillators, the locking frequency range is limited by the robustness of their natural frequency, which comes explicitly related with intrinsic parameters of the system. In this work we report the synchronization of an optically-driven self-pulsing limit-cycle taking place in a silicon optomechanical crystal cavity to an external harmonic signal that modulates the driving laser. Because of the extreme ductility of the natural self-pulsing frequency (several tens of MHz), the injection-locking mechanism is highly efficient and displays giant relative bandwidths exceeding 60%. The external modulation reveals itself as a knob to explore dynamical attractors that are otherwise elusive and, in particular, as a means to initialize a mechanical resonator into a state of self-sustained oscillations driven by radiation pressure forces. Moreover, we exploit the large anharmonicity of the studied limit-cycle to induce injection-locking to integer multiples and fractions of the frequency of the external reference, which can be used for frequency conversion purposes in nano-electro-opto-mechanical systems