Percutaneous Treatment of Pulmonary Atresia with Intact Ventricular Septum: Pulmonary Valve Perforation Using Radiofrequency Energy and Arterial Duct Stenting

A atrésia pulmonar com septo interventricular intacto (AtrP-SI) é uma cardiopatia congénita rara e de prognóstico reservado. Apresenta grande variabilidade anatómica, com diversos graus de hipoplasia do ventrículo direito (VD) o que condiciona a abordagem terapêutica. Idealmente, o objectivo é a reconstituição de uma circulação de tipo biventricular. Para o efeito, dispomos de técnicas cirúrgicas e percutâneas. A perfuração da válvula pulmonar com energia de radiofrequência (RF) é um método válido para doentes com atresia de tipo membranoso, VD sem hipoplasia marcada (bipartido ou tripartido) e circulação coronária não dependente do VD. Por vezes, há necessidade de suplementar a circulação pulmonar implantando um stent no canal arterial. Desta forma é possível tratar alguns doentes com técnicas exclusivamente percutâneas. Relatamos o primeiro caso conhecido em Portugal de um recém-nascido com AtrP-SI submetido a perfuração com radiofrequência e, num segundo tempo, implantação de stent no canal arterial

Fecal Dipeptidyl Peptidase-4: An Emergent Biomarker in Inflammatory Bowel Disease

INTRODUCTION: Dipeptidyl peptidase-4 (DPP-4) is a membrane-bound glycoprotein that acts as a receptor but also exists in a soluble form. It has been recognized as a mediator of inflammation and considered a biomarker in inflammatory bowel disease (IBD). METHODS: We evaluated a prospectively recruited cohort, consisting of 101 patients with IBD, using validated clinical indexes; 22 patients with ulcerative colitis (UC) underwent endoscopic evaluation. Fecal DPP-4 (fDPP-4) levels were analyzed and correlated with clinical scores, Mayo endoscopic score (in UC patients), serum DPP-4, C-reactive protein, and fecal calprotectin. Immunohistochemical staining for DPP-4 in intestinal biopsies was also performed. RESULTS: When compared with remitters, median fDPP-4 levels were higher in patients with ileal Crohn's disease (CD) (7,584 [1,464-7,816] vs 2,104 [630-2,676] ng/mL, P = 0.015) and lower in patients with UC exhibiting clinical activity (1,213 [559-1,682] vs 7,814 [2,555-7,985] ng/mL, P < 0.001). Patients with UC presenting endoscopic activity also had lower levels than remitters (939 [559-1,420] vs 7,544 [4,531-7,940] ng/mL, P = 0.006). Fecal DPP-4 discriminated clinical activity from remission with areas under the curve of 0.76 (95% confidence interval [CI] 0.58-0.94, P = 0.015) and 0.80 (95% CI 0.68-0.93, P < 0.001) in CD and UC, respectively; it allowed to differentiate endoscopic activity in patients with UC, with areas under the curve of 0.84 (95% CI 0.63-1.00, P = 0.009). Immunohistochemical analysis revealed higher DPP-4 apical expression in UC remitters, but no statistically significant differences were revealed between patients with ileal CD. DISCUSSION: Our results suggest that fDPP-4 can be used as a biomarker of IBD activity, particularly in UC. The expression profiles in intestinal tissue might represent a functional compartmentalization of DPP-4 expression

Developing a site-conditions map for seismic hazard Assessment in Portugal

The evaluation of site effects on a broad scale is a critical issue for seismic hazard and risk assessment, land use planning and emergency planning. As characterization of site conditions based on the shear-wave velocity has become increasingly important, several methods have been proposed in the literature to estimate its average over the first thirty meters (Vs30) from more extensively available data. These methods include correlations with geologic-geographic defined units and topographic slope. In this paper we present the first steps towards the development of a site–conditions map for Portugal, based on a regional database of shear-wave velocity data, together with geological, geographic, and lithological information. We computed Vs30 for each database site and classified it according to the corresponding geological-lithological information using maps at the smallest scale available (usually 1:50000). We evaluated the consistency of Vs30 values within generalized-geological classes, and assessed the performance of expedient methodologies proposed in the literature

Optimizing Opponents Selection in Bilateral Contracts Negotiation with Particle Swarm

This paper proposes a model based on particle swarm optimization to aid electricity markets players in the selection of the best player(s) to trade with, to maximize their bilateral contracts outcome. This approach is integrated in a Decision Support System (DSS) for the pre-negotiation of bilateral contracts, which provides a missing feature in the state-of-art, the possible opponents analysis. The DSS determines the best action of all the actions that the supported player can take, by applying a game theory approach. However, the analysis of all actions can easily become very time-consuming in large negotiation scenarios. The proposed approach aims to provide the DSS with an alternative method with the capability of reducing the execution time while keeping the results quality as much as possible. Both approaches are tested in a realistic case study where the supported player could take almost half a million different actions. The results show that the proposed methodology is able to provide optimal and near-optimal solutions with an huge execution time reduction.This work has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 641794 (project DREAM-GO) and grant agreement No 703689 (project ADAPT); from the CONTEST project - SAICT-POL/23575/2016; and from FEDER Funds through COMPETE program and from National Funds through FCT under the project UID/EEA/00760/2013.info:eu-repo/semantics/publishedVersio

ATRÉSIA ESOFÁGICA: 10 ANOS DE EXPERIÊNCIA DE UM SERVIÇO DE CUIDADOS INTENSIVOS PEDIÁTRICOS

Background/Purpose: Oesophageal atresia (OA) is a congenital malformation with a variable prognosis. The aims were to establish OA’s incidence in the central region, to characterize infants with OA admitted and to compare its clinical outcome after surgical repair, according to OA classification. Methods: A retrospective review of infants with OA admitted to a PICU, after surgical repair, between 2002 and 2011. Patient characteristics, OA’s classification, surgery, morbidity and mortality were analyzed. Two groups were compared according to OA classification. Results: Thirty-four infants were admitted, out of which 65% were male, with a median gestational age of 36 weeks and birth weight of 2310g. Nineteen of them presented other malformations, mainly cardiac. Nine cases were classified as long-gap OA. Fistula ligation and primary oesophageal anastomosis was the most common surgical option (n=27). Early complications occurred in 13 infants (38%), mostly anastomotic leak, and were similar according to gap length (p=0.704). PICU stay and mechanical ventilation were longer in long-gap OA patients (p=0.009 and p<0.001 respectively) and in infants with other malformations (p=0.027 and p=0.003 respectively). There was no mortality. Conclusions: The frequency of OA associated malformations implies a systematic screening of these patients. Gap length and presence of associated malformations were the major determinants of length of intensive care stay and ventilation days in OA patients

A model of the reflection distribution in the vacuum ultra violet region

A reflection model with three components, a specular spike, a specular lobe and a diffuse lobe is discussed. This model was successfully applied to describe reflection of xenon scintillation light (175 nm) by PTFE and other fluoropolymers and can be used for Monte Carlo simulation and analysis of scintillation detectors. The measured data favors a Trowbridge-Reitz distribution function of ellipsoidal micro-surfaces. The intensity of the coherent reflection increases with increasing angle of incidence, as expected, since the surface appears smoother at grazing angles. The total reflectance obtained for PTFE is about 70% for VUV light at normal incidence in vacuum and estimated to be up to 100% in contact with liquid xenon

Pharyngolaryngeal Foreign Body as Cause of Disphonia

A ingestão acidental e a impactação de corpos estranhos na via aerodigestiva é uma urgência otorrinolaringológica comum. Nos adultos, as espinhas são os corpos estranhos mais frequentemente impactados. Uma anamnese e uma observação cuidadosas são de extrema importância. Os sintomas incluem odinofagia, disfagia, tosse persistente, alteração da voz, sialorreia e menos frequentemente uma complicação respiratória. As espinhas impactam mais frequentemente numa localização supra-hioideia. Locais menos frequentes de impactação são a hipotaringe, a região cricofaríngea e o esófago, sendo o diagnóstico mais difícil a estes níveis. A migração extra-luminal ocorre raramente, sendo mais frequente na presença de uma espinha. Atendendo a sua forma, este é o corpo estranho que mais facilmente migra e como tal, é o que apresenta maior taxa de complicações. Nesta situação, é necessário um elevado lndice de suspeição, sendo a realização de TC fundamental. Os autores apresentam um caso de migração de uma espinha ao nível da banda ventricular laringea e um algoritmo para o diagnóstico e tratamento de corpos estranhos perfurantes e migrantes.info:eu-repo/semantics/publishedVersio

Synchronization time in a hyperbolic dynamical system with long-range interactions

We show that the threshold of complete synchronization in a lattice of coupled non-smooth chaotic maps is determined by linear stability along the directions transversal to the synchronization subspace. We examine carefully the sychronization time and show that a inadequate observation of the system evolution leads to wrong results. We present both careful numerical experiments and a rigorous mathematical explanation confirming this fact, allowing for a generalization involving hyperbolic coupled map lattices.Comment: 22 pages (preprint format), 4 figures - accepted for publication in Physica A (June 28, 2010

Reflectance of Polytetrafluoroethylene (PTFE) for Xenon Scintillation Light

Gaseous and liquid xenon particle detectors are being used in a number of applications including dark matter search and neutrino-less double beta decay experiments. Polytetrafluoroethylene (PTFE) is often used in these detectors both as electrical insulator and as a light reflector to improve the efficiency of detection of scintillation photons. However, xenon emits in the vacuum ultraviolet wavelength region (175 nm) where the reflecting properties of PTFE are not sufficiently known. In this work we report on measurements of PTFE reflectance, including its angular distribution, for the xenon scintillation light. Various samples of PTFE, manufactured by different processes (extruded, expanded, skived and pressed) have been studied. The data were interpreted with a physical model comprising both specular and diffuse reflections. The reflectance obtained for these samples ranges from about 47% to 66% for VUV light. Fluoropolymers, namely ETFE, FEP and PFA were also measured

Avoidable mortality in acute myocardial infarction at hospital level : where to look for answers?

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017Background: Outcomes assessment is very important for improving health care outcomes and control spending. Acute myocardial infarction (AMI) was chosen for its prevalence, high morbidity and mortality, relevant mortality variability and high treatment costs. Purpose: To study the differences between hospitals in AMI mortality and the associated waste from unjustified variation. Methods: Patients with AMI discharged from public hospitals in our country in 2011–13 were selected and anonymized administrative data was utilized. The relevant variables to explain the differences in mortality were: patient characteristics (demographics, AMI type, comorbidities, and procedures), hospital characteristics (hospital with “coronary green way”, volume, and university hospital), and travel time to hospital. Generalized linear mixed models (1st level: patient, 2nd level: hospital) were used and specifically binary logistic regression was applied. The differences in mortality explained by each group of variables were evaluated with a percentual rate of Pseudo-r2. We considered as waste the number of additional deaths in each hospital compared to patients with the same characteristics, through the hospital random effect variance (difference of each hospital to the global odds). Results: 22.380 patients treated in 17 hospitals were included. Mortality rate was 9.5%. The mortality rate varied between 5.4% (H11) and 14.1% (H3). Our model explained 29.8% of the differences in mortality. Comorbidities explained 23.2% of mortality differences, demographic variables 7.8%, procedures 6.6%, and type of AMI 2.8%. Angioplasty and primary angioplasty procedures were protective factors, since all other procedures showed a comparatively increased risk of death, particularly fibrinolysis without angioplasty (OR 5.9; CI 3.2–10.9). Across all hospitals, there were 137 avoidable deaths, with a variation between -81 deaths (hospital with lower mortality) and +133 deaths (hospital with higher mortality). As shown in Fig. 1, there was a risk of death 3.5 times higher at H8 than at H7. The model showed excellent discrimination (area under the ROC curve: 0.871). Conclusion: We observed significant differences in mortality in acute myocardial infarction between hospitals, therefore indicating variability of practices. The scale of avoidable deaths justifies an investigation of its causes, mainly in the hospitals with worse performance. The hospital characteristics had little impact on the detected differences, so the inefficiencies are probably more related with the internal organization of hospitals and the way care is provided. These results raise relevant concerns at the health system and hospitals levels, in particular about the compliance with AMI guidelines.info:eu-repo/semantics/publishedVersio