Comportamento da taxa fotossintetica do umbuzeiro sob condicoes de campo.

O objetivo deste trabalho foi observar o comportamento fotossintético do umbuzeiro em seu habitat natural

Treatment options beyond immunotherapy in patients with wild-type lung adenocarcinoma: a Delphi consensus

Purpose: Immunotherapy-based approaches are standard first-line treatments for advanced/metastatic lung cancer or for chemoradiotherapy consolidation in locally advanced disease. Uncertainty on how to treat patients at disease progression prompted us to develop a consensus document on post-immunotherapy options in Spain for patients with advanced wild-type lung adenocarcinoma. Methods: After extensive literature review, a 5-member scientific committee generated 33 statements in 4 domains: general aspects (n = 4); post-durvalumab in locally advanced disease (n = 6); post-first-line immunotherapy ± chemotherapy in advanced/metastatic disease (n = 11); and post-first-line platinum-based chemotherapy in advanced/metastatic disease (n = 12). A panel of 26 lung cancer experts completed 2 Delphi iterations through an online platform rating their degree of agreement/disagreement (first-round scale 1–5 and second-round scale 1–4, 1 = strongly disagree, 4/5 = strongly agree) for each statement. Second-round consensus: ≥ 70% of responses were in categories 1/2 (disagreement) or 3/4 (agreement). Results: Consensus was reached for 2/33 statements in the first Delphi round and in 29/31 statements in the second round. Important variables informing treatment at disease progression with an immunotherapy-based treatment include: disease aggressiveness, previous treatment, accumulated toxicity, progression-free interval, PD-L1 expression, and tumour mutational burden. A platinum-based chemotherapy should follow a first-line immunotherapy treatment without chemotherapy. Treatment with docetaxel + nintedanib may be appropriate post-durvalumab in refractory patients or following progression to first-line chemotherapy + immunotherapy, or second-line chemotherapy after first-line immunotherapy, or first-line chemotherapy in some patients with low/negative PD-L1 expression, or second-line immunotherapy after first-line chemotherapy. Conclusions: To support decision making following progression to immunotherapy-based treatment in patients with advanced wild-type lung adenocarcinoma, a consensus document has been developed.The project was funded by Boehringer Ingelheim

Contributos para uma cartografia da investigação em Psicologia em Portugal: uma análise a partir dos trabalhos apresentados no V Simpósio Nacional de Investigação em Psicologia

O presente artigo constitui um balanço do V Simpósio Nacional de Investigação em Psicologia. Procurou-se, em primeiro lugar, analisar a distribuição temática e institucional da investigação apresentada, que se mostrou heterogénea e diversificada e, na sua grande maioria, realizada ou liderada por psicólogos vinculados a instituições universitárias. Foi também analisada a saliência dos diversos temas e a sua estrutura de associação, através da frequência das palavras-chave dos trabalhos apresentados e de uma análise de correspondências múltiplas, a qual permitiu elaborar uma cartografia das tendências de pesquisa em Portugal, mostrando as várias lógicas que organizam as diferentes linhas temáticas e as instituições universitárias a elas mais associadas

Hypotension, acidosis and vasodilation syndrome after heart transplant: incidence, risk factors, and prognosis

[Abstract] Background. HAV syndrome, the combination of hypotension, acidosis and vasodilation (HAV), is a serious postoperative complication after heart transplantation (HT). Its etiology and prognosis are poorly understood. Aim. To determine the incidence and prognosis of post-HT HAV syndrome and examine possible risk factors. Methods. Retrospective examination of the records of 85 consecutive patients who underwent HT between December 1999 and June 2002 sought the HAV criteria: systolic BP <85 mm Hg plus HCO3 <19 mEq/l whole excluding cardiogenic, hypovolemic and septic shock. Donor variables included sex, age, weight, height, cause of death, time in ICU, and ischemic time; while recipient variables, sex, age, weight, height, etiology of cardiopathy, previous cardiopulmonary bypass surgery, preoperative amiodarone, β-blockers, catecholamines, mechanical ventilation or intra aortic balloon pump (IABP), RVP, time on waiting list, pump time, reoperations, polytransfusion, preoperative creatinine, GOT, GPT and GGT, induction with OKT3 or anti-CD25, bypass-to-HAV time, duration of catecholamine treatment, and 1 month survival after HT. Results. The 11 HAV cases (13%) appeared between 1 and 72 h after HT (75% in the first hour). Catecholamines were used for 1 to 6 days; control was achieved within 48 h in 58% of cases. Two HAV patients (18%) died within the first month versus six non-HAV patients (8.1%) (P = .275). Only polytransfusion showed more than a borderline value to predict HAV syndrome. Conclusions. HAV syndrome has an incidence of 13% and a mortality of 18% within 1 month post-HT. The only likely risk factor is polytransfusion

Renal dysfunction after orthotopic heart transplantation: incidence, natural history, and risk factors

[Abstract] Background. Renal dysfunction is a common complication after orthotopic heart transplantation (HT). The importance of factors other than exposure to immunosuppressive drugs is unclear. The purpose of this study was to determine the incidence and natural history of renal dysfunction following heart transplantation, and to evaluate a number of variables as risk factors for this condition. Methods. We examined the creatinine levels at 1, 6, 12, 24, and 60 months in 262 consecutive heart transplant patients who survived at least 1 year. The potential risk factors included pre- and posttransplantation diabetes mellitus, arterial hypertension, and drugs used to control arterial hypertension. Results. 17.2% of patients showed mild renal dysfunction (creatinine 1.5-2.5 mg/dL) and 1.9% moderate dysfunction (creatinine >2.5 mg/dL) at 1 month; 29.8% showed mild and 1.1% moderate dysfunction at 6 months; 33.2% showed mild and 1.9% moderate dysfunction at 1 year; 40% showed mild, 0.9% moderate and 0.4% severe dysfunction (requiring dialysis or renal transplantation) at 2 years; and 43.6% showed mild, 1.7% moderate and 0.9% severe dysfunction at 5 years. None of the conditions analyzed as possible risk factors showed a significant association with renal dysfunction except the use of diuretics. Conclusion. The incidence of renal dysfunction after orthotopic heart transplantation was 33.6% within the first year after transplant and 44% within the first five years, although more than 95% of cases were mild. The incidence increased with time after transplantation. Renal dysfunction seems likely to be multifactorial in origin, but no individual risk factors were identified

Use of archival versus newly collected tumor samples for assessing PD-L1 expression and overall survival : an updated analysis of KEYNOTE-010 trial

Background: In KEYNOTE-010, pembrolizumab versus docetaxel improved overall survival (OS) in patients with programmed death-1 protein (PD)-L1-positive advanced non-small-cell lung cancer (NSCLC). A prespecified exploratory analysis compared outcomes in patients based on PD-L1 expression in archival versus newly collected tumor samples using recently updated survival data. Patients and methods: PD-L1 was assessed centrally by immunohistochemistry (22C3 antibody) in archival or newly collected tumor samples. Patients received pembrolizumab 2 or 10 mg/kg Q3W or docetaxel 75 mg/m2 Q3W for 24 months or until progression/intolerable toxicity/other reason. Response was assessed by RECIST v1.1 every 9 weeks, survival every 2 months. Primary end points were OS and progression-free survival (PFS) in tumor proportion score (TPS) 50% and 1%; pembrolizumab doses were pooled in this analysis. Results: At date cut-off of 24 March 2017, median follow-up was 31 months (range 23-41) representing 18 additional months of follow-up from the primary analysis. Pembrolizumab versus docetaxel continued to improve OS in patients with previously treated, PD-L1-expressing advanced NSCLC; hazard ratio (HR) was 0.66 [95% confidence interval (CI): 0.57, 0.77]. Of 1033 patients analyzed, 455(44%) were enrolled based on archival samples and 578 (56%) on newly collected tumor samples. Approximately 40% of archival samples and 45% of newly collected tumor samples were PD-L1 TPS 50%. For TPS 50%, the OS HRs were 0.64 (95% CI: 0.45, 0.91) and 0.40 (95% CI: 0.28, 0.56) for archival and newly collected samples, respectively. In patients with TPS 1%, OS HRs were 0.74 (95% CI: 0.59, 0.93) and 0.59 (95% CI: 0.48, 0.73) for archival and newly collected samples, respectively. In TPS 50%, PFS HRs were similar across archival [0.63 (95% CI: 0.45, 0.89)] and newly collected samples [0.53 (95% CI: 0.38, 0.72)]. In patients with TPS 1%, PFS HRs were similar across archival [0.82 (95% CI: 0.66, 1.02)] and newly collected samples [0.83 (95% CI: 0.68, 1.02)]. Conclusion: Pembrolizumab continued to improve OS over docetaxel in intention to treat population and in subsets of patients with newly collected and archival samples

Reproduction and respiration of a climate change indicator species: effect of temperature and variable food in the copepod Centropages chierchiae

The abundance of the calanoid copepod Centropages chierchiae has increased at the northern limits of its distribution in recent decades, mainly due to oceanic climate forcing, suggesting this as a key species in monitoring climate change. Laboratory experiments were conducted to study the combined effect of temperature, food type and concentration on the egg production rate (EPR) and hatching success (HS) of C. chierchiae. Females were fed on two monoalgal diets (Gymnodinium sp. and Phaeodactylum tricornutum) at two food concentrations and at three different temperatures (13, 19, 24C). Respiration rates of both genders were measured at four different temperatures (8, 13, 19, 24C). EPR was significantly different between temperatures and food concentrations, the maximum EPR being attained when the copepods were exposed to high food levels and at 19C. Prey type significantly influenced EPR; feeding on P. tricornutum resulted in higher egg production than Gymnodinium sp. HS was significantly lower at 13C than at 19 and 24C and higher with Gymnodinium sp. Respiration rates were sex independent and increased exponentially with temperature. To maintain basal metabolism, the minimum food intake of P. tricornutum ranged between 0.4 and 1.8 g C and for Gymnodinium sp. between 0.03 and 0.13 g C. Food intake was always higher than the metabolic demands, except for the highest temperature tested (24C). The present results confirm the sensitivity of C. chierchiae to temperature variations and may help in understanding the successful expansion of its distribution towards northern latitudes.Portuguese Science and Technology Foundation (FCT) [PTDC/MAR/098643/2008, PTDC/MAR/111304/2009, PTDC/MAR/0908066/2008]; FCT [SFRH/BD/28198/2006]; [SFRH/BPD/38332/2007

Prognostic Value of Treadmill Exercise Echocardiography

[Abstract] Introduction and objectives. Exercise echocardiography (EE) is useful for diagnosing coronary disease, but little is known about its value for risk stratification. We aimed to determine: a) whether data from EE supplemented clinical data and data from exercise testing and resting echocardiography in predicting cardiac events; and b) whether the number and location of abnormal regions and their responses to exercise influenced risk stratification. Patients and method. The 2,436 patients referred for EE were followed up for 2.1 ±1.5 years. Some 120 serious cardiovascular events (i.e., non-fatal myocardial infarction or cardiovascular death) occurred before revascularization. Results. In 1203 patients (49%), EE gave abnormal results. There were 89 events in patients with an abnormal result (7.3%) and 31 in those with a normal result (2.5%; P <.0001). Multivariate analysis of clinical data, and data from exercise testing, resting echocardiography, and EE showed that male sex (RR=1.7; 95% CI, 1.1–2.8; P = .02), metabolic equivalents or METs (RR=0.9; 95% CI, 0.86–0.98; P=.01), peak heart rate × blood pressure (RR= 0.9; 95% CI, 0.9; P=.002), resting wall motion score index (RR=2.5; 95% CI, 1.5–4.1; P <.0001), and number of abnormal regions at peak exercise (RR=1.4; 95% CI, 1.2–1.7; P<.0001) were independently associated with the risk of a serious event (final model χ2, 170; incremental P <.0001). The same variables, excluding sex, were independently associated with cardiovascular death (final model χ2, 169; incremental P = .01). Conclusions. Exercise echocardiography supplements clinical data and data from exercise testing and resting echocardiography in patients with known or suspected coronary artery disease.[Resumen] Introducción y objetivos. Aunque la ecocardiografía de ejercicio es útil para el diagnóstico de la enfermedad coronaria, hay menos datos referentes a su valor pronós-tico. El objetivo de este estudio fue esclarecer: a) si hay un valor incremental de la ecocardiografía en el pico del ejercicio respecto a las variables clínicas, la prueba de esfuerzo y la ecocardiografía en reposo, y b) si el número y la localización de los territorios afectados, así como el tipo de respuesta al ejercicio, influyen en la estratificación. Pacientes y método. En 2.436 pacientes referidos para ecocardiografía de ejercicio se realizó un seguimien-to de 2,1 ± 1,5 años. Hubo 120 eventos (infarto no fatal o muerte cardiovascular) antes de la revascularización. Resultados. La ecocardiografía fue anormal en 1.203 pacientes (49%). Hubo 89 eventos en pacientes con resul-tado anormal (7,3%) frente a 31 con resultado normal (2,5%; p < 0,001). Mediante un análisis multivariable de variables clínicas, de la prueba de esfuerzo y de la ecocardiografía en reposo y ejercicio encontramos que las variables asociadas de manera independiente con el riesgo de eventos eran: ser varón (riesgo relativo [RR] = 1,7; interva-lo de confianza [IC] del 95%, 1,1–2,8; p = 0,02), los equiva-lentes metabólicos o MET (RR = 0,9; IC del 95%, 0,9–1,0; p = 0,01), el producto frecuencia cardíaca × presión arterial (RR = 0,9; IC del 95%, 0,9–1,0; p = 0,02), el índice de moti-lidad segmentaria basal (RR = 2,5; IC del 95%, 1,5–4,1; p < 0,0001) y el número de territorios afectados (RR = 1,4; IC del 95%, 1,2-1,7; p < 0,0001) (χ2 final = 170, valor incremental de la ecocardiografía en el máximo esfuerzo; p < 0,0001). Las mismas variables, excepto el sexo, estaban asociadas con la muerte (χ2 final = 169, valor incremental de la ecocardiografía de ejercicio; p = 0,01). Conclusiones. La ecocardiografía en el máximo ejercicio incrementa el valor pronóstico de las variables clínicas, la prueba de esfuerzo y la ecocardiografía de reposo