Salvage Flexor Hallucis Longus Transfer for a Failed Achilles Repair: Endoscopic Technique

Flexor hallucis longus (FHL) transfer is a well-established treatment option in failed Achilles tendon (AT) repair and has been routinely performed as an open procedure. We detail the surgical steps needed to perform an arthroscopic transfer of the FHL for a chronic AT rupture. The FHL tendon is harvested as it enters in its tunnel beneath the sustentaculum tali; a tunnel is then drilled in the calcaneus as near to the AT footprint as possible. By use of a suture-passing device, the free end of the FHL is advanced to the plantar aspect of the foot. After adequate tension is applied to the construct, the tendon is fixed in place with an interference screw in an inside-out fashion. This minimally invasive approach is a safe and valid alternative to classic open procedures with the obvious advantages of preserving the soft-tissue envelope and using a biologically intact tendon

Calibration of transition intensities for a multistate model: Application to long-term care

UID/MAT/00297/2020We consider a non-homogeneous continuous time Markov chain model for Long-Term Care with five states: the autonomous state, three dependent states of light, moderate and severe dependence levels and the death state. For a general approach, we allow for non null intensities for all the returns from higher dependence levels to all lesser dependencies in the multi-state model. Using data from the 2015 Portuguese National Network of Continuous Care database, as the main research contribution of this paper, we propose a method to calibrate transition intensities with the one step transition probabilities estimated from data. This allows us to use non-homogeneous continuous time Markov chains for modeling Long-Term Care. We solve numerically the Kolmogorov forward differential equations in order to obtain continuous time transition probabilities. We assess the quality of the calibration using the Portuguese life expectancies. Based on reasonable monthly costs for each dependence state we compute, by Monte Carlo simulation, trajectories of the Markov chain process and derive relevant information for model validation and premium calculation.publishersversionpublishe

Automatic calibration of the SHETRAN hydrological modelling system using MSCE

Automatic calibration is preferred because it provides an objective and extensive searching in the feasible parameter space. In this study, the Modified Shuffled Complex Evolution (MSCE) optimization algorithm is applied to automatically calibrate the physically-based spatially-distributed hydrological model SHETRAN in the 705-km2 semi-arid Cobres basin in southern Portugal, with a spatial resolution of 2 km and a temporal resolution of 1 h. Twenty-two parameters are calibrated for the main types of land-use and soil. Nash-Sutcliffe Efficiency (NSE) is 0.86 for calibration and 0.74 for validation for basin outlet; NSE is respectively 0.65 and 0.82 for calibration, 0.69 and 0.63 for validation of internal gauging stations Albernoa and Entradas. As for storm events, NSE is 0.87 and 0.64 respectively for Storms No.1 (during the calibration period) and No.4 (during the validation period) at basin outlet; it is 0.69 and 0.65 for Storm No.4 respectively at Albernoa andEntradas. The results are satisfactory not only for basin outlet but also for internal gauging stations

Implementação de um Estudo de Efetividade da Vacina Contra a Gripe no Contexto Hospitalar em Portugal: Projeto EVA Hospital

Introduction: The project ‘Integrated Monitoring of Vaccines in Europe’ aimed to measure seasonal influenza vaccine effectiveness against hospitalised adults, aged 65 years and over, with influenza. We describe the protocol implementation in Portugal. Material and Methods: We implemented a test-negative design, targeting community-dwelling patients aged 65 years old and over hospitalised with severe acute respiratory illness. Patients were reverse transverse-polymerase chain reaction tested for influenza. Cases were those positive for influenza while others were controls. Most variables were collected using hospital medical records. Selection bias was evaluated by comparison with the laboratory influenza test requests database according to demographic characteristics. Crude, season-adjusted influenza vaccine effectiveness was estimated as = 1 – odds ratio, and 95% confidence intervals were obtained by conditional logistical regression, matched with the disease onset month. Results: The recruitment rate was 37.8%. Most participants (n = 368) were female (55.8%) and aged 80 years old and over (55.8%). This was similar to values for potentially eligible severe acute respiratory illness patients (80 years old and over: 56.8%, female: 56.2%). The proportion of missing values was below 2.5% for 20 variables and above 5% (maximum 11.6%) for six variables. Influenza vaccine effectiveness estimates were 62.1% against AH1pdm09 (95% confidence intervals: -28.1 to 88.8), 14.9% against A(H3N2) (95% confidence intervals: -69.6 to 57.3), 43.6% against B/Yam (95% confidence intervals: -66.2 to 80.8). Discussion: Given the non-existence of a coded admission database in either participating hospital the selection of severe acute respiratory illness due to clinical features was the feasible one. These results are only valid for the older adult population residing in the catchment area of the two participating hospitals who were admitted to a public hospital with severe influenza or SARI symptoms. Conclusion: Despite the low participation rate, we observed comparable characteristics of participants and eligible severe acute respiratory illness patients. Data quality was high, and influenza vaccine effectiveness results were in accordance with the results of meta-analyses and European season-specific estimates. The final sample size was low, which inhibited obtaining estimates with good precision.info:eu-repo/semantics/publishedVersio

Legionella: Novas Abordagens, Novas Necessidades

1º Prémio na Jornada Técnica: Prevenção e Controlo da LegionellaINTRODUÇÃO: O CHLC desenvolve, desde há vários anos, procedimentos contra o crescimento e proliferação da Legionella, monitorizando e auditando as estruturas e as práticas. De acordo com as recentes orientações e normas emanadas pela DGS, surge a necessidade de criar novos instrumentos para a avaliação do risco e dar resposta às necessidades do Centro Hospitalar. OBJETIVO Identificar os fatores de risco que determinam os pontos críticos para a monitorização da Legionella. MATERIAIS E MÉTODOS: Foram construídas listas e grelhas de observação, com os fatores de risco que determinam os pontos críticos, a partir das quais se observaram as estruturas e práticas do CHLC. Os instrumentos utilizados tiveram como base os documentos publicados pela DGS, IPQ, ECDC, o procedimento multissectorial do CHLC - AMB.102 e os relatórios das auditorias. RESULTADOS: Para a avaliação das condições microbiológicas, os pontos críticos deverão ser aqueles, mais suscetíveis da ocorrência da proliferação da Legionella. Destes, a literatura salienta: Pontos distais das redes prediais Zonas de estagnação de água Idade e complexidade das redes e sistemas Sistemas e equipamentos geradores de aerossóis Após a análise dos pontos críticos foram determinados os fatores de risco que estão associados, nomeadamente: Presença de nutrientes e de biofilmes Zonas suscetíveis a fenómenos de corrosão e incrustação Origem do abastecimento de água Zonas de estagnação de água da rede predial e da água dos sistemas e equipamentos geradores de aerossóis Ausência de biocida na rede predial Tipos de materiais utilizados nas redes de canalização CONCLUSÕES A avaliação do risco permitiu reorganizar os pontos críticos definidos anteriormente e atualizar o conhecimento das condições favoráveis ao crescimento da Legionella na nossa instituição, promovendo a melhoria e atualização do programa do CHLC. Assim, torna-se evidente de que a existência de um cadastro completo e atualizado das infraestruturas, redes, sistemas e equipamentos, incluindo peças desenhadas e memórias descritivas das redes de água fria e quente, das redes dos circuitos de água de aquecimento e arrefecimento e uso terapêutico, é essencial para que a avaliação do risco seja mais proficiente.info:eu-repo/semantics/publishedVersio

Impacts of climate and land use changes on the hydrological and erosion processes of two contrasting Mediterranean catchments

The impacts of climate and land use changes on streamflow and sediment export were evaluated for a humid (São Lourenço) and a dry (Guadalupe) Mediterranean catchment, using the SWAT model. SWAT was able to produce viable streamflow and sediment export simulations for both catchments, which provided a baseline for investigating climate and land use changes under the A1B and B1 emission scenarios for 2071–2100. Compared to the baseline scenario (1971–2000), climate change scenarios showed a decrease in annual rainfall for both catchments (humid: − 12%; dry: − 8%), together with strong increases in rainfall during winter. Land use changes were derived from a socio-economic storyline in which traditional agriculture is replaced by more profitable land uses (i.e. corn and commercial forestry at the humid site; sunflower at the dry site). Climate change projections showed a decrease in streamflow for both catchments, whereas sediment export decreased only for the São Lourenço catchment. Land use changes resulted in an increase in streamflow, but the erosive response differed between catchments. The combination of climate and land use change scenarios led to a reduction in streamflow for both catchments, suggesting a domain of the climatic response. As for sediments, contrasting results were observed for the humid (A1B: − 29%; B1: − 22%) and dry catchment (A1B: + 222%; B1: + 5%), which is mainly due to differences in the present-day and forecasted vegetation types. The results highlight the importance of climate-induced land-use change impacts, which could be similar to or more severe than the direct impacts of climate change alone

Ruthenium-cyclopentadienyl bipyridine-biotin based compounds: Synthesis and biological effect

Prospective anticancer metallodrugs should consider target-specific components in their design in order to overcome the limitations of the current chemotherapeutics. The inclusion of vitamins, which receptors are overexpressed in many cancer cell lines, has proven to be a valid strategy. Therefore, in this paper we report the synthesis and characterization of a set of new compounds [Ru(eta(5)-C5H5)(P(C6H4R)(3))(4,4'-R'-2,2'-bpy)](+) (R = F and R' = H, 3; R = F and R' = biotin, 4; R = OCH3 and R' = H, 5; R = OCH3 and R' = biotin, 6), inspired by the exceptional good results recently obtained for the analogue bearing a triphenylphosphane ligand. The precursors for these syntheses were also described following modified literature procedures, [Ru(eta(5)-C5H3)(P(C6H4R)(3))(2)Cl], where R is -F (1) or -OCH3 (2). The structure of all compounds is fully supported by spectroscopic and analytical techniques and by X-ray diffraction studies for compounds 2, 3, and 5. All cationic compounds are cytotoxic in the two breast cancer cell lines tested, MCF7 and MDA-MB-231, and much better than cisplatin under the same experimental conditions. The cytotoxicity of the biotinylated compounds seems to be related with the Ru uptake by the cells expressing biotin receptors, indicating a potential mediated uptake. Indeed, a biotin-avidin study confirmed that the attachment of biotin to the organometallic fragment still allows biotin recognition by the protein. Therefore, the biotinylated compounds might be potent anticancer drugs as they show cytotoxic effect in breast cancer cells at low dose dependent on the compounds' uptake, induce cell death by apoptosis and inhibit the colony formation of cancer cells causing also less severe side effects in zebrafish.This work was financed by the Portuguese Foundation for Science and Technology (Fundacao para a Crencia e Tecnologia, FCT) within the scope of Projects UID/QUI/00100/2019 and PTDC/QUI-QIN/28662/2017. This work was supported by the strategic program UID/BIA/04050/2013 (POCI-01-0145-FEDER-007569) funded by national funds through the FCT I.P. and by the ERDF through the COMPETE2020 -Programa Operacional Competitividade e Intemacionalizacao (POCI). A.V. acknowledges the Investigator FCT2013 Initiative for the Project IF/01302/2013 and CEEC-IND/01974/2017 (acknowledging FCT, as well as POPH and FSE, the European Social Fund). L.C.-R, A.R.B. and A.P. thank FCT for their Ph.D. Grants (SFRH/BD/100515/2014, SFRH/BD/139271/2018, and SFRH/BD/139412/2018, respectively). L.C.-R also acknowledges Fulbright Research Grant 2017/2018 with the support of FCT. Brittany Karas acknowledges NJAES-RutgersNJ01201 and NIEHS Training Grant T32-ES 007148 and B.T.B. and C.D. acknowledge NIH-NIEHS P30 ES005022. K.R.C. acknowledges NJAES Project 01202 (W2045) and NIH ES005022

In vitro cytocidal effects of the essential oil from Croton cajucara (red sacaca) and its major constituent 7- hydroxycalamenene against Leishmania chagasi.

Visceral leishmaniasis is the most serious form of leishmaniasis and can be lethal if left untreated. Currently available treatments for these parasitic diseases are frequently associated to severe side effects. The leaves of Croton cajucara are used as an infusion in popular medicine to combat several diseases. Previous studies have demonstrated that the linalool-rich essential oil from C. cajucara (white sacaca) is extremely efficient against the tegumentary specie Leishmania amazonensis. In this study, we investigated the effects of the 7-hydroxycalamenene-rich essential oil from the leaves of C. cajucara (red sacaca) against Leishmania chagasi, as well as on the interaction of these parasites with host cells