A prospective multicenter portuguese study

Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.This prospective multicentric study aiming to determine the incidence of complications (malignant transformation, torsion or rupture) during conservative management of adnexal masses was performed in two Portuguese tertiary referral hospitals. It included ≥18-year-old, non-pregnant patients with asymptomatic adnexal masses (associated IOTA ADNEX risk of malignancy < 10%) sonographically diagnosed between January 2016 and December 2020. Conservative patient management consisted of serial clinical and ultrasound assessment up to 60 months of follow-up, spontaneous resolution of the formation or surgical excision (median follow-up: 17.8; range 9–48 months). From the 573 masses monitored (328 premenopausal and 245 postmenopausal adnexal masses), no complications were observed in 99.5%. The annual lesion growth rates and increases in morphological complexity were similar in the premenopausal and postmenopausal patients. Spontaneous resolu-tion, evidenced in 16.4% of the patients, was more common in the premenopausal group (p < 0.05). Surgical intervention was performed in 18.4% of the cases; one borderline and one invasive FIGO IA stage cancer were diagnosed. There was an isolated case of ovary torsion (0.17%). These data support conservative management as a safe option for sonographically benign, stable and asymp-tomatic adnexal masses before and after menopause and highlight the need for expedite treatment of symptomatic or increased-morphological-complexity lesions.publishersversionpublishe

Quantitative correlation between transcriptional levels of ER chaperone, peroximal protein and FVIII productivity in human Hek-293 cell line

Hek-293 cell line presents good production platform for recombinant therapeutic proteins, however little is known about the components that contribute to the cellular control of recombinant protein production. In this study, we generated a Hek-293 producing recombinant factor VIII (FVIII) and we evaluated the immunoglobulin-binding protein (BiP) and phytanoil-CoA α-hydroxylase (PAHX) expression levels which are known for diminishing FVIII production. Our analyses showed that the recombinant cell population expresses 3.1 ± 1.4 fold of BIP mRNA (P = 0.0054) and 97.8 ± 0.5 fold of PAHX mRNA (P = 0.0016) compared to nontransduced cells. The amount of these proteins was inversely correlated to the secreted FVIII. In conclusion, BIP and PAHX expression are augmented in human cells producing FVIII and they antagonize the amount of therapeutic factor VIII in the cell culture.This study was supported by the Center for Cell-based Therapy (CTC) and Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP. The authors acknowledge Dr. Garry P. Nolan for contributing with the pBMN-I-GFP vector and David Marco Antonio for statistical support. We thank Fernanda Udinal and Alessandra Almeida for English language support. We also thank Sandra Navarro Bresciani for preparing the figures.This study was supported by the Center for Cellbased Therapy (CTC) and Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP. The authors acknowledge Dr. Garry P. Nolan for contributing with the pBMNIGFP vector and David Marco Antonio for statistical support. We thank Fernanda Udinal and Alessandra Almeida for English language support. We also thank Sandra Navarro Bresciani for preparing the figures

Conservative Management of Asymptomatic Adnexal Masses Classified as Benign by the IOTA ADNEX Model: A Prospective Multicenter Portuguese Study

This prospective multicentric study aiming to determine the incidence of complications (malignant transformation, torsion or rupture) during conservative management of adnexal masses was performed in two Portuguese tertiary referral hospitals. It included ≥18-year-old, non-pregnant patients with asymptomatic adnexal masses (associated IOTA ADNEX risk of malignancy &lt; 10%) sonographically diagnosed between January 2016 and December 2020. Conservative patient management consisted of serial clinical and ultrasound assessment up to 60 months of follow-up, spontaneous resolution of the formation or surgical excision (median follow-up: 17.8; range 9–48 months). From the 573 masses monitored (328 premenopausal and 245 postmenopausal adnexal masses), no complications were observed in 99.5%. The annual lesion growth rates and increases in morphological complexity were similar in the premenopausal and postmenopausal patients. Spontaneous resolution, evidenced in 16.4% of the patients, was more common in the premenopausal group (p &lt; 0.05). Surgical intervention was performed in 18.4% of the cases; one borderline and one invasive FIGO IA stage cancer were diagnosed. There was an isolated case of ovary torsion (0.17%). These data support conservative management as a safe option for sonographically benign, stable and asymptomatic adnexal masses before and after menopause and highlight the need for expedite treatment of symptomatic or increased-morphological-complexity lesions

Curricular Autonomy and flexibility: Leaderships role

Dissertação de Mestrado em Administração Educacional apresentada à Faculdade de Psicologia e de Ciências da EducaçãoWith the decree law nº 55/2018, of july 6, schools and teachers are invited to mobilize competences to manage and decide about curricular decisions, which go towards curricular autonomy and flexibility, for a more inclusive and success promising school. This dissertation focuses on the adaptation of a Mega Group of Schools in the South Zone of Continental Portugal to this decree law, which was the subject of an external evaluation in the third evaluation cycle, which was reflected in the creation of the structuring documents of that Mega Group of Schools and in the implementation of a Curricular Autonomy and Flexibility Project, whose monitoring allows us to attest its evolution along the school year.In fact, in addition to document analysis, monitoring the implementation of the project and carrying out interviews to the school teachers, allowed the mapping of Curricular Autonomy Domains, registering an increase in the number of subjects and teaching levels covered, as well as the diversification of methodologies adopted. This evolution is not unrelated to the role of Leaderships in implementing the project – whether top or intermediate, or even informal leaderships – which end up having a crucial role in the development of the Domains of Curricular Autonomy, and the role of the collaborative cultures experienced in this Mega Group of Schools. The Curricular Autonomy and Flexibility Program it’s a project not doable with a lack of a strong colaboration and strong leaderships.Com o Decreto-Lei n.º55/2018, de 6 de julho, as escolas e os professores são convidados a mobilizarem competências para gerir e tomar decisões curriculares, que vão no sentido da autonomia e flexibilidade curricular, para uma escola que se pretende mais inclusiva e promotora do sucesso escolar.A presente dissertação foca-se na adaptação de um Mega Agrupamento de Escolas da Zona Sul de Portugal Continental a este decreto-lei, que foi alvo de uma avaliação externa no terceiro ciclo avaliativo, que se veio a refletir na elaboração dos documentos estruturantes do mesmo e na implementação de um Projeto de Autonomia e Flexibilidade Curricular, cuja monitorização permite atestar a sua evolução ao longo do ano letivo.Com efeito, para além da análise documental, o acompanhamento da implementação do projeto e a realização de entrevistas a professores permitiram o mapeamento de Domínios de Autonomia Curricular, registando-se o aumento do número de disciplinas e níveis de ensino abrangidos, bem como a diversificação de metodologias adotadas. A esta evolução não é alheio o papel das Lideranças na implementação do projeto – sejam estas de topo ou intermédias, ou até mesmo informais – as quais acabam por ter um papel crucial no desenvolvimento de Domínios de Autonomia Curricular, e o papel das culturas colaborativas vividas neste Mega Agrupamento. O Programa de Autonomia e Flexibilidade Curricular parece ser assim um projeto que não é exequível sem a existência de uma rede de colaboração forte e sem lideranças fortes

Kernicterus e icterícia neonatal : revisão teórica a propósito de um caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014Classical Kernicterus is a clinical triad of abnormal motor control, movements and muscle tone, an auditory processing disturbance with or without hearing loss, and oculomotor impairments, especially impairment of upward vertical gaze. It’s a rare disease with severe neurologic consequences that is due to severe neonatal hyperbilirubinemia. With early identification, prevention and treatment of severe hyperbilirubinemia, kernicterus is a cerebral palsy preventable cause, happening in the neonatal period. Nowadays, newborns are often discharged before 48 hours of life. Once that most of the times, bilirubin peak level happens around 96 hours of life, when many newborns have already been discharged from the hospital, pediatricians often have to predict the risk of developing subsequent severe hyperbilirubinemia. Like this, it’s necessary to improve the diagnosis and to promote the early treatment of neonatal jaundice when necessary.O kernicterus clássico consiste na seguinte tríade: controlo motor anormal dos movimentos e do tónus muscular, distúrbios auditivos com ou sem perda de audição e paralisia ocular, predominantemente no olhar vertical. É uma doença rara com graves consequências neurológicas secundárias a uma hiperbilirrubinemia neonatal. Com a prevenção, detecção precoce e tratamento desta hiperbilirrubinemia o kernicterus é uma das causas evitáveis de PC que ocorre no período neonatal. Actualmente, os RN tem alta muitas vezes antes de perfazerem as 48 horas de vida. Uma vez que o pico de bilirrubina é muitas vezes atingido por volta das 96 horas de vida, altura em que grande parte dos RN já obtiveram alta hospitalar, esta situação força os pediatras a tentar prever o risco de hiperbilirrubinemia grave quando ponderam a alta hospitalar. É necessário conhecer os factores de risco para a ocorrência de kernicterus para saber em que situações o tratamento da icterícia neonatal é necessário