64 research outputs found

    Tratamento do varicocelo e impacto na infertilidade masculina

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    Trabalho final de mestrado integrado em Medicina área cientifica de Urologia, apresentado à Faculdade de Medicina da Universidade de CoimbraActualmente, a infertilidade é um problema em crescimento, estimando-se que a sua prevalência nos casais em idade reprodutiva seja de aproximadamente 15 %. Considera-se que o factor masculino está associado a 50% dos casos documentados. O varicocelo é uma patologia benigna e comum que atinge sensivelmente 15% da população masculina, podendo estar presente em 40% dos doentes com infertilidade. Objectivos Este artigo de revisão bibliográfica tem como objectivos expor o tratamento do varicocelo e, observar o seu potencial impacto no tratamento da infertilidade masculina. Material e Métodos O método utilizado para a elaboração deste artigo consistiu numa extensa revisão de artigos científicos originais e de revisão na Pubmed / Medline (até Novembro de 2011) em língua inglesa, usando os seguintes termos: varicocele, male infertility, varicocele treatment, varicocelectomy, percutaneous occlusion, medical treatment, semen parameters, pregnancy rates, assisted reproduction techniques, em várias combinações. Adicionalmente foram consultados livros e sites especializados na área e relevantes para a temática. Desenvolvimento A associação entre varicocelo e infertilidade masculina é conhecida desde a década de 1950, permanecendo a fisiopatologia do processo incerta. Os parâmetros seminais estão habitualmente alterados na presença de varicocelo e a oligoastenoteratozoospermia é a anormalidade mais comum. Num contexto de infertilidade conjugal, o tratamento do varicocelo tem como propósito melhorar a função testicular e os parâmetros seminais com vista ao aumento da probabilidade de concepção. Todavia, o Tratgrau em que o tratamento do varicocelo melhora as taxas de gravidez e o sucesso das técnicas de reprodução assistida, continuam a ser temas controversos. Actualmente, estão descritas duas vertentes para o tratamento do varicocelo: tratamento médico e tratamento cirúrgico, com taxas de complicações e recidiva distintas. A varicocelectomia ou a oclusão percutânea da veia espermática interna afectada, são as terapêuticas mais abordadas na literatura, e as preconizadas na maioria dos casos. Conclusão São necessários mais estudos comparativos, controlados e randomizados para uniformizar a informação dispersa por diferentes publicações, com a finalidade de se poder concluir sobre qual o melhor método para o tratamento do varicocelo e, qual o verdadeiro impacto na fertilidade de cada doente.Introduction Currently, infertility is a growing problem, and it is estimated that its prevalence among couples of reproductive age is approximately 15%. It is considered that the male factor is associated with 50% of documented and stated cases. The varicocele is a common and benign condition that affects about 15% of the men and affects 40% of the patients with infertility. Objective This literature review article aims to expose the treatment of varicocele and note its potential impact on the treatment of male infertility. Materials and Methods The method used for the preparation of this article consisted in an extensive review of original papers and reviewed articles in Pubmed / Medline (to November 2011) in English, using the following terms: varicocele, male infertility, varicocele treatment, varicocelectomy, percutaneous occlusion , medical treatment, semen parameters, pregnancy rates, assisted reproduction techniques, in several combinations. In addition, there were some consultation books and websites specialized in this area and relevant to this topic. Evolvement The association between varicocele and male infertility has been known since the 1950s, the pathophysiology of the process remains uncertain. The semen parameters are usually modified in the presence of varicocele and oligoasthenoteratozoospermia is the most common abnormality. In the context of a couple's infertility, the treatment of varicocele aims to improve testicular function and semen parameters in order to increase the probability of conception. However, the degree to which the treatment of varicocele improves pregnancy rates and the success of assisted reproduction techniques, are still controversial topics. Currently, two aspects are described for the treatment of varicocele: medical treatment and surgical treatment, with dissimilar relapse and complications rates. The varicocelectomy or percutaneous occlusion of the affected internal spermatic vein are the most addressed treatment in the therapeutic drug literature and recommended in most cases. Conclusion In order to be able to conclude about the best method for the treatment of varicocele, and what is the real impact on fertility in each patient, it would take more comparative studies, randomized and controlled to standardize the information scattered in different publication

    The role of astrocytic calcium signaling in the aged prefrontal cortex

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    Aging is a lifelong process characterized by cognitive decline putatively due to structural and functional changes of neural circuits of the brain. Neuron-glial signaling is a fundamental component of structure and function of circuits of the brain, and yet its possible role in aging remains elusive. Significantly, neuron-glial networks of the prefrontal cortex undergo age-related alterations that can affect cognitive function, and disruption of glial calcium signaling has been linked with cognitive performance. Motivated by these observations, we explored the possible role of glia in cognition during aging, considering a mouse model where astrocytes lacked IP3R2-dependent Ca2+ signaling. Contrarily to aged wild-type animals that showed significant impairment in a two-trial place recognition task, aged IP3R2 KO mice did not. Consideration of neuronal and astrocytic cell densities in the prefrontal cortex, revealed that aged IP3R2 KO mice present decreased densities of NeuN+ neurons and increased densities of S100β+ astrocytes. Moreover, aged IP3R2 KO mice display refined dendritic trees in this region. These findings suggest a novel role for astrocytes in the aged brain. Further evaluation of the neuron-glial interactions in the aged brain will disclose novel strategies to handle healthy cognitive aging in humans.The authors acknowledge funding from national funds through Foundation for Science and Technology (FCT) fellowships (SFRH/BPD/97281/2013 to JO, SFRH/BD/101298/2014 to SG, IF/00328/2015 to JO, IF/01079/2014 to LP, and SFRH/BD/133006/2017 to IC); Marie Curie Fellowship FP7-PEOPLE-2010-IEF 273936 and BIAL Foundation Grants 207/14 to JO and 427/14 to LP; Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER) (NORTE-01-0145-FEDER-000013); FEDER Funds, through the Competitiveness Factors Operational Programme (COMPETE), and The National Fund, through the FCT (POCI-01-0145-FEDER-007038)

    The Portuguese National Programme for the Promotion of Healthy Eating: 2012-2015

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    This paper describes the first 4-year period (2012–2015) of implementation of the Portuguese National Programme for the Promotion of Healthy Eating (PNPAS). PNPAS was approved in 2012 and emerged as a preventive programme for noncommunicable diseases, aiming to improve the nutritional status of the population; it represents the first national strategy in Portugal for the promotion of healthy eating. To accomplish its mission, and taking into account its overall principles, PNPAS has five main goals: (i) to increase knowledge about the food intake of the Portuguese population and about its determinants and consequences; (ii) to modify the availability of certain foods (high in sugar, salt and fat), in schools, workplaces and public spaces; (iii) to inform and empower the population for the purchase, preparation and storage of healthy food, especially the most vulnerable groups; (iv) to identify and promote crosssectoral actions that encourage the consumption of foods of good nutritional quality in an articulate and integrated way with other sectors, namely agriculture, sport, environment, education, social security and local authorities; and (v) to improve the qualifications and conduct of the different professionals who, owing to their roles, may influence nutritional knowledge, attitudes and behaviours. The design of PNPAS followed the latest strategic lines suggested by WHO and the European Commission, proposing a crosssectoral mix of interventions to ensure physical and economic access to healthy eating by creating healthy environments and empowering individuals and communities. Several actions were implemented at different levels during the first 4-year period of implementation of PNPAS; two were especially relevant. The first concerned the empowerment of citizens regarding healthy eating, where the most important aspect was introduction of a digital strategy through development of a website and a blog dedicated to healthy eating. The second concerned the development of documents for health care and other professionals, including several guidelines in new areas, such as anthropometric measures and intervention in preobesity. Process and output indicators were defined to monitor and evaluate the programme. Among those considered as output indicators were the evaluation of childhood obesity, salt consumption and intake of breakfast by school-aged children

    Proinflammatory and anti-inflammatory cytokines in the CSF of patients with Alzheimer's disease and their correlation with cognitive decline

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    Cumulative data suggest that neuroinflammation plays a prominent role in Alzheimer's disease (AD) pathogenesis. The purpose of this work was to assess if patients with AD present a specific cerebrospinal fluid (CSF) cytokine profile and if it correlates to disease progression. We determined the levels of 27 cytokines in CSF of patients with AD and compared them with patients with frontotemporal dementia and nondemented controls. In addition, we correlated the cytokine levels with cognitive status and disease progression after 12 months. Patients with AD had higher levels of proinflammatory and anti-inflammatory cytokines (eotaxin, interleukin [IL]-1ra, IL-4, IL-7, IL-8, IL-9, IL-10, IL-15, granulocyte colony-stimulating factor, monocyte chemotactic protein 1, platelet-derived growth factor, tumor necrosis factor alfa) compared to nondemented controls. There was a negative correlation between the disease progression and the levels of several cytokines (IL-1β, IL-4, IL-6, IL-9, IL-17A, basic fibroblast growth factor, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, interferon gamma, macrophage inflammatory proteins-1β). To the best of our knowledge, this is the first study reporting a "protective" role of the upregulation of specific intrathecal cytokine levels in AD. This finding supports that a fine "rebalancing" of the immune system represents a new target in AD therapeutic approach.The work at ICVS/3B's has been developed under the scope of the project NORTE-01-0145-FEDER-000013, supported by the Northern Portugal Regional Operational Program (NORTE, 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER) and funded by FEDER funds through the Competitiveness Factors Operational Program (COMPETE) and by National funds, through the Foundation for Science and Technology (FCT), under the scope of the project POCI-01-0145-FEDER-007038. The work at Centro Hospitalar do Porto (CHP) work was funded by "Bolsa para Investigacao" of Departamento de Ensino Formacao e Investigacao (DEFI) do CHP. S.P. das Neves is a recipient of a PhD fellowship with the reference PD/BD/114120/2015, from POCH through FCT National Funds

    Beyond new neurons in the adult hippocampus: imipramine acts as a pro-astrogliogenic factor and rescues cognitive impairments induced by stress exposure

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    Depression is a prevalent, socially burdensome disease. Different studies have demonstrated the important role of astrocytes in the pathophysiology of depression as modulators of neurotransmission and neurovascular coupling. This is evidenced by astrocyte impairments observed in brains of depressed patients and the appearance of depressive-like behaviors upon astrocytic dysfunctions in animal models. However, little is known about the importance of de novo generated astrocytes in the mammalian brain and in particular its possible involvement in the precipitation of depression and in the therapeutic actions of current antidepressants (ADs). Therefore, we studied the modulation of astrocytes and adult astrogliogenesis in the hippocampal dentate gyrus (DG) of rats exposed to an unpredictable chronic mild stress (uCMS) protocol, untreated and treated for two weeks with antidepressants—fluoxetine and imipramine. Our results show that adult astrogliogenesis in the DG is modulated by stress and imipramine. This study reveals that distinct classes of ADs impact differently in the astrogliogenic process, showing different cellular mechanisms relevant to the recovery from behavioral deficits induced by chronic stress exposure. As such, in addition to those resident, the newborn astrocytes in the hippocampal DG might also be promising therapeutic targets for future therapies in the neuropsychiatric field.ARMS: ELC, NDA, PP, AMP, JSC, MM, AJR, JFO, and L.P. received fellowships from the Portuguese Foundation for Science and Technology (FCT) (IF/00328/2015 to J.F.O.; 2020.02855.CEECIND to LP). This work was funded by FCT (IF/01079/2014, PTDC/MED-NEU/31417/2017 Grant to JFO), BIAL Foundation Grants (037/18 to J.F.O. and 427/14 to L.P.), “la Caixa” Foundation Health Research Grant (LCF/PR/HR21/52410024) and Nature Research Award for Driving Global Impact—2019 Brain Sciences (to L.P.). This was also co-funded by the Life and Health Sciences Research Institute (ICVS), and by FEDER, through the Competitiveness Internationalization Operational Program (POCI), and by National funds, through the Foundation for Science and Technology (FCT)—project UIDB/50026/2020 and UIDP/50026/2020. Moreover, this work has been funded by ICVS Scientific Microscopy Platform, member of the national infrastructure PPBI—Portuguese Platform of Bioimaging (PPBI-POCI-01-0145-FEDER-022122; by National funds, through the Foundation for Science and Technology (FCT)—project UIDB/50026/2020 and UIDP/50026/2020; “la Caixa” Foundation (ID 100010434 to A.J.R.), under the agreement LCF/PR/HR20/52400020; and the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (grant agreement No 101003187 to A.J.R.)

    Transmural remission improves clinical outcomes up to 5 years in Crohn's disease

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    © 2022 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.Introduction: Evidence supporting transmural remission (TR) as a long-term treatment target in Crohn's disease (CD) is still unavailable. Less stringent but more reachable targets such as isolated endoscopic (IER) or radiologic remission (IRR) may also be acceptable options in the long-term. Methods: Multicenter retrospective study including 404 CD patients evaluated by magnetic resonance enterography and colonoscopy. Five-year rates of hospitalization, surgery, use of steroids, and treatment escalation were compared between patients with TR, IER, IRR, and no remission (NR). Results: 20.8% of CD patients presented TR, 23.3% IER, 13.6% IRR and 42.3% NR. TR was associated with lower risk of hospitalization (odds-ratio [OR] 0.244 [0.111-0.538], p < 0.001), surgery (OR 0.132 [0.030-0.585], p = 0.008), steroid use (OR 0.283 [0.159-0.505], p < 0.001), and treatment escalation (OR 0.088 [0.044-0.176], p < 0.001) compared to no NR. IRR resulted in lower risk of hospitalization (OR 0.333 [0.143-0.777], p = 0.011) and treatment escalation (OR 0.260 [0.125-0.540], p < 0.001), while IER reduced the risk of steroid use (OR 0.442 [0.262-0.745], p = 0.002) and treatment escalation (OR 0.490 [0.259-0.925], p = 0.028) compared to NR. Conclusions: TR improved clinical outcomes over 5 years of follow-up in CD patients. Distinct but significant benefits were seen with IER and IRR. This suggests that both endoscopic and radiologic remission should be part of the treatment targets of CD.info:eu-repo/semantics/publishedVersio

    Estratégia Nacional para a Medicina Genómica - PT_MedGen: desafios e prioridades

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    Documento preparado pela Comissão nomeada pelo Despacho n.º 5135/2021, de 20 de maio do SEAS (Diário da República n.º 98/2021, Série II de 2021-05-20, pp 107-108): Fernando de Almeida, Instituto Nacional de Saúde Doutor Ricardo Jorge I.P. – Presidente da Comissão; Astrid Moura Vicente, Instituto Nacional de Saúde Doutor Ricardo Jorge I.P. – Coordenadora da Comissão e responsável pelo GT Doenças Complexas; Patrícia Calado, Agência de Investigação Clínica e Inovação Biomédica – Cocoordenadora da Comissão e responsável pelo GT Comunicação; Manuel Santos, Universidade de Aveiro, GenomePT – Responsável pelo GT Boas práticas de Sequenciação; Ana Sofia Carvalho, ICBAS - Instituto de ciências Biomédicas Abel Salazar, Universidade do Porto - Responsável pelo GT Questões Éticas, Legais e Sociais; Cíntia Águas, Membro do GT Questões Éticas, Legais e Sociais; Cátia Sousa Pinto, Serviços Partilhados do Ministério da Saúde E.P.E. – Responsável pelo GT Dados de Saúde; Mário Jorge Gaspar da Silva, Instituto Superior Técnico, Universidade de Lisboa; BioData.pt – Responsável pelo GT Interoperabilidade de Partilha de Dados; Ana Portugal Melo, BioData.pt - Membro do GT Interoperabilidade de Partilha de Dados; Mónica Duarte Correia de Oliveira, Instituto Superior Técnico, Universidade de Lisboa – Responsável pelo GT Economia da Saúde; Joana Feijó, Health Cluster Portugal – Responsável pelo GT Indústria e Setor Privado; Laura Vilarinho, Instituto Nacional de Saúde Doutor Ricardo Jorge I.P. – Responsável pelo GT Doenças Raras; Carla Oliveira, I3S - Instituto de Investigação e Inovação, Universidade do Porto – Responsável pelo GT Cancro.Com os contributos adicionais de: Ana Berta Sousa, Centro Hospitalar Universitário de Lisboa Norte; Ana Fortuna, Centro Hospitalar Universitário do Porto; Gabriela Sousa, Instituto Português de Oncologia de Coimbra; Guiomar Oliveira, Centro Hospitalar Universitário de Coimbra; João Paulo Oliveira, Centro Hospitalar Universitário de São João; Jorge Pinto Basto, Colégio da Especialidade de Genética Médica da Ordem dos Médicos; Jorge Saraiva, Centro Hospitalar Universitário de Coimbra; Margarida Venâncio, Centro Hospitalar Universitário de Coimbra; Patrícia Dias, Centro Hospitalar Universitário de Lisboa Norte; Sérgio Sousa, Centro Hospitalar Universitário de Coimbra.À Comissão compete a definição de roadmap para o planeamento e implementação da Estratégia Nacional para a Medicina Genómica, que apoiará a contribuição de Portugal na iniciativa 1+MG.O presente documento visa propor o conceito e as linhas de ação prioritárias da Estratégia Nacional para a Medicina Genómica (PT_MedGen). O documento baseia-se na auscultação de alguns dos principais stakeholders nacionais, representados na Comissão nomeada pelo Despacho n.o 5135/2021 coordenada pelo INSA, e ainda na consulta de outras entidades e peritos de relevância. A estratégia PT_MedGen tem a meta global de criar infraestruturas e processos que permitam a adoção de abordagens de medicina personalizada na prática clínica, a par com a contribuição para a iniciativa 1+MG. Esta estratégia promoverá ainda a investigação, a inovação, a competitividade e a internacionalização, permitindo a criação de conhecimento e valor significativos na área da saúde.info:eu-repo/semantics/publishedVersio

    Transmural remission improves clinical outcomes up to 5 years in Crohn's disease

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    IntroductionEvidence supporting transmural remission (TR) as a long-term treatment target in Crohn's disease (CD) is still unavailable. Less stringent but more reachable targets such as isolated endoscopic (IER) or radiologic remission (IRR) may also be acceptable options in the long-term. MethodsMulticenter retrospective study including 404 CD patients evaluated by magnetic resonance enterography and colonoscopy. Five-year rates of hospitalization, surgery, use of steroids, and treatment escalation were compared between patients with TR, IER, IRR, and no remission (NR). Results20.8% of CD patients presented TR, 23.3% IER, 13.6% IRR and 42.3% NR. TR was associated with lower risk of hospitalization (odds-ratio [OR] 0.244 [0.111-0.538], p < 0.001), surgery (OR 0.132 [0.030-0.585], p = 0.008), steroid use (OR 0.283 [0.159-0.505], p < 0.001), and treatment escalation (OR 0.088 [0.044-0.176], p < 0.001) compared to no NR. IRR resulted in lower risk of hospitalization (OR 0.333 [0.143-0.777], p = 0.011) and treatment escalation (OR 0.260 [0.125-0.540], p < 0.001), while IER reduced the risk of steroid use (OR 0.442 [0.262-0.745], p = 0.002) and treatment escalation (OR 0.490 [0.259-0.925], p = 0.028) compared to NR. ConclusionsTR improved clinical outcomes over 5 years of follow-up in CD patients. Distinct but significant benefits were seen with IER and IRR. This suggests that both endoscopic and radiologic remission should be part of the treatment targets of CD.info:eu-repo/semantics/publishedVersio

    Predictors of cardiac involvement in idiopathic inflammatory myopathies

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    Copyright © 2023 Bandeira, Dourado, Melo, Martins, Fraga, Ferraro, Saraiva, Sousa, Parente, Soares, Correia, Almeida, Dinis, Pinto, Oliveira Pinheiro, Rato, Beirão, Samões, Santos, Mazeda, Chícharo, Faria, Neto, Lourenço, Brites, Rodrigues, Silva-Dinis, Dias, Araújo, Martins, Couto, Valido, Santos, Barreira, Fonseca and Campanilho-Marques. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Objectives: Idiopathic inflammatory myopathies (IIM) are a group of rare disorders that can affect the heart. This work aimed to find predictors of cardiac involvement in IIM. Methods: Multicenter, open cohort study, including patients registered in the IIM module of the Rheumatic Diseases Portuguese Register (Reuma.pt/Myositis) until January 2022. Patients without cardiac involvement information were excluded. Myo(peri)carditis, dilated cardiomyopathy, conduction abnormalities, and/or premature coronary artery disease were considered. Results: 230 patients were included, 163 (70.9%) of whom were females. Thirteen patients (5.7%) had cardiac involvement. Compared with IIM patients without cardiac involvement, these patients had a lower bilateral manual muscle testing score (MMT) at the peak of muscle weakness [108.0 ± 55.0 vs 147.5 ± 22.0, p=0.008] and more frequently had oesophageal [6/12 (50.0%) vs 33/207 (15.9%), p=0.009] and lung [10/13 (76.9%) vs 68/216 (31.5%), p=0.001] involvements. Anti-SRP antibodies were more commonly identified in patients with cardiac involvement [3/11 (27.3%) vs 9/174 (5.2%), p=0.026]. In the multivariate analysis, positivity for anti-SRP antibodies (OR 104.3, 95% CI: 2.5-4277.8, p=0.014) was a predictor of cardiac involvement, regardless of sex, ethnicity, age at diagnosis, and lung involvement. Sensitivity analysis confirmed these results. Conclusion: Anti-SRP antibodies were predictors of cardiac involvement in our cohort of IIM patients, irrespective of demographical characteristics and lung involvement. We suggest considering frequent screening for heart involvement in anti-SRP-positive IIM patients.info:eu-repo/semantics/publishedVersio

    Employing an open-source tool to assess astrocyte tridimensional structure

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    Astrocytes display important features that allow them to maintain a close dialog with neurons, ultimately impacting brain function. The complex morphological structure of astrocytes is crucial to the role of astrocytes in brain networks. Therefore, assessing morphologic features of astrocytes will help provide insights into their physiological relevance in healthy and pathological conditions. Currently available tools that allow the tridimensional reconstruction of astrocytes present a number of disadvantages, including the need for advanced computational skills and powerful hardware, and are either time-consuming or costly. In this study, we optimized and validated the FIJI-ImageJ, Simple Neurite Tracer (SNT) plugin, an open-source software that aids in the reconstruction of GFAP-stained structure of astrocytes. We describe (1) the loading of confocal microscopy Z-stacks, (2) the selection criteria, (3) the reconstruction process, and (4) the post-reconstruction analysis of morphological features (process length, number, thickness, and arbor complexity). SNT allows the quantification of astrocyte morphometric parameters in a simple, efficient, and semi-automated manner. While SNT is simple to learn, and does not require advanced computational skills, it provides reproducible results, in different brain regions or pathophysiological states.The authors acknowledge funding from national funds through the FCT—Foundation for Science and Technology—project (PTDC/SAU-NSC/118194/2010) to G.T., V.M.S., S.G.G. and J.F.O., and fellowships (SFRH/BD/89714/2012 to V.M.S., SFRH/BPD/97281/2013 to J.F.O., SFRH/BD/101298/2014 to S.G.G., PD/BD/114120/2015 to S.P.N, and PD/BD/127822/2016 to G.T.); Marie Curie Fellowship FP7-PEOPLE-2010-IEF 273936 and BIAL Foundation Grants and 207/14 to J.F.O.; QREN and FEDER funds through Operational program for competitiveness factors—COMPETE, “ON.2 SR&TD Integrated Program—NORTE-07-0124-FEDER-000021”; National and European funds through FCT, and FEDER through COMPETE (PEst-C/SAU/LA0026/2011 and FCOMP-01-0124-FEDER-022724; PEst-C/SAU/LA0026/2013 and FCOMP-01-0124-FEDER-037298, respectively)info:eu-repo/semantics/publishedVersio
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