Primary Anti-Phospholipid Antibody Syndrome: Real-World Defining Features of Rethrombosis in the Course of Disease

Objective: We aimed to identify features that allow differentiation of primary antiphospholipid syndrome (PAPS) patients that suffer recurrent thrombotic events (RTE) despite anticoagulation, from the other diagnosed PAPS patients. Methods: This was an exploratory study of anticoagulated PAPS patients attending an Autoimmune Diseases Unit (1998-2018). From 2016, anti-phospholipid antibodies and lupus anticoagulant were determined for each patient at consecutive visits, collected together with retrospective clinical characteristics, laboratory, and therapeutic markers and compared according to the occurrence of thrombotic events during follow-up. Results: Overall, two thirds of the patients were female, 93% were Caucasian, with a median age of 40 years at diagnosis, for a median time of 11.5 years in follow-up. Out of 54 patients, 10 were identified with RTE. There were no significant differences among the RTE and non-RTE patients as far as classical risk factors for clotting disorders. The RTE group was characterized by a higher proportion of younger patients, male sex and positivity for all laboratory markers, and initially and over follow-up as well as a sustained high-risk profile based on APS laboratory markers. Anticardiolipin IgG at onset was the only statistically significant marker of the RTE group. At the end of follow-up, consistent reversion to negative status was a rare event, observed in 20% of RTE vs. 25% of non-RTE patients. Conclusions: Despite therapy, we were able to identify features associated to thrombotic events in patients with PAPS. Prospectively regular clinical and laboratory monitoring might be warranted in order to treat APS more assertively.info:eu-repo/semantics/publishedVersio

Indoor environmental quality in households of families with infant twins under 1 year of age living in Porto

Exposure to air pollution in early years can exacerbate the risk of noncommunicable diseases throughout childhood and the entire life course. This study aimed to assess temperature, relative humidity (RH), carbon dioxide (CO2) and monoxide (CO), particulate matter (PM2.5, PM10), ultrafine particles, nitrogen dioxide (NO2), ozone (O3), formaldehyde, acetaldehyde and volatile organic compounds (VOC) levels in the two rooms where infant twins spend more time at home (30 dwellings, Northern Portugal). Findings showed that, in general, the worst indoor environmental quality (IEQ) settings were found in bedrooms. In fact, although most of the bedrooms surveyed presented adequate comfort conditions in terms of temperature and RH, several children are sleeping in a bedroom with improper ventilation and/or with a significant degree of air pollution. In particular, mean concentrations higher than recommended limits were found for CO2, PM2.5, PM10 and total VOC. Additionally, terpenes and decamethylcyclopentasiloxane were identified as main components of emissions from indoor sources. Overall, findings revealed that factors related to behaviors of the occupants, namely related to a conscientious use of cleaning products, tobacco and other consumer products (air-fresheners, incenses/candles and insecticides) and promotion of ventilation are essential for the improvement of air quality in households and for the promotion of children's health.The authors gratefully acknowledge the funding of Project HEALS – ‘Health and Environment-wide Associations based on Large Population Surveys’, through the European Union's Seventh Program for research, technological development and demonstration under grant agreement No info:eu-repo/grantAgreement/EC/FP7/603946/EU. MFG, FF and ZM also gratefully acknowledge the funding of Project NORTE-01-0145-FEDER-000010, Health, Comfort and Energy in the Built Environment (HEBE), cofinanced by Programa Operacional Regional do Norte (NORTE2020), through Fundo Europeu de Desenvolvimento Regional (FEDER). The co-author CR was supported by a PhD Grant PD/BD/135925/2018 funded by the Foundation for Science and Technology (FCT) - Portuguese Ministry of Science, Technology and Higher Education

Multimodality Imaging in Connective Tissue Disease-Related Interstitial Lung Disease

Interstitial lung disease is a well-recognised manifestation and a major cause of morbidity and mortality in patients with connective tissue diseases. Interstitial lung disease may arise in the context of an established connective tissue disease or be the initial manifestation of an otherwise occult autoimmune disorder. Early detection and characterisation are paramount for adequate patient management and require a multidisciplinary approach, in which imaging plays a vital role. Computed tomography is currently the imaging method of choice; however, other imaging techniques have recently been investigated, namely ultrasound, magnetic resonance imaging, and positron-emission tomography, with promising results. The aim of this review is to describe the imaging findings of connective tissue disease-related interstitial lung disease and explain the role of each imaging technique in diagnosis and disease characterisation.info:eu-repo/semantics/publishedVersio

Healthcare Professionals Perception of the Reconciliation Medication Process in a Hospital Context: Case Study

Introdução: O processo de reconciliação terapêutica visa, em momentos de transição entre níveis de prestação de cuidados de saúde, diminuir os incidentes com medicamentos e contribuir para o uso seguro da medicação. Com este estudo pretendeu-se explorar barreiras e fatores que influenciam o processo de reconciliação terapêutica num serviço de Medicina Interna de um hospital de nível distrital e identificar oportunidades de melhoria. Métodos: Estudo de natureza qualitativa, do tipo de estudo de caso único e exploratório, com a realização de entrevistas semiestruturadas a médicos, enfermeiros e farmacêuticos. Resultados: Destacam-se as dificuldades na comunicação com o doente, família, entre os profissionais de saúde, serviços e outras instituições. A nível informático, dificuldades na prescrição em contexto de emergência, alertas de medicação repetidos e o não acesso à plataforma de dados de saúde pelos farmacêuticos. Como oportunidades de melhoria na reconciliação terapêutica, os profissionais de saúde apontaram para a formação, seguimento do doente após alta hospitalar, melhoria da comunicação entre as instituições de saúde e integração entre os sistemas de informação em saúde. Conclusão: Os resultados obtidos demonstram que as barreiras ao processo de reconciliação terapêutica persistem, com consequências expetáveis a nível da qualidade dos cuidados prestados. Este estudo alerta para a necessidade de implementação de medidas que as permitam mitigar.info:eu-repo/semantics/publishedVersio

The Origins and Historical Assembly of the Brazilian Caatinga Seasonally Dry Tropical Forests

This is the final version. Available on open access from Frontiers Media via the DOI in this recordData Availability Statement: The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/Supplementary Material.The Brazilian Caatinga is considered the richest nucleus of the Seasonally Dry Tropical Forests (SDTF) in the Neotropics, also exhibiting high levels of endemism, but the timing of origin and the evolutionary causes of its plant diversification are still poorly understood. In this study, we integrate comprehensive sampled dated molecular phylogenies of multiple flowering plant groups and estimations of ancestral areas to elucidate the forces driving diversification and historical assembly in the Caatinga flowering plants. Our results show a pervasive floristic exchange between Caatinga and other neotropical regions, particularly those adjacent. While some Caatinga lineages arose in the Eocene/Oligocene, most dry-adapted endemic plant lineages found in region emerged from the middle to late Miocene until the Pleistocene, indicating that only during this period the Caatinga started to coalesce into a SDTF like we see today. Our findings are temporally congruent with global and regional aridification events and extensive denudation of thick layers of sediments in Northeast (NE) Brazil. We hypothesize that global aridification processes have played important role in the ancient plant assembly and long-term Caatinga SDTF biome stability, whereas climate-induced vegetation shifts, as well as the newly opened habitats have largely contributed as drivers of in situ diversification in the region. Patterns of phylogenetic relatedness of Caatinga endemic clades revealed that much modern species diversity has originated in situ and likely evolved via recent (Pliocene/Pleistocene) ecological specialization triggered by increased environmental heterogeneity and the exhumation of edaphically disparate substrates. The continuous assembly of dry-adapted flora of the Caatinga has been complex, adding to growing evidence that the origins and historical assembly of the distinct SDTF patches are idiosyncratic across the Neotropics, driven not just by continental-scale processes but also by unique features of regional-scale geological history

Stimulation of endothelial progenitor cells: a new putative effect of several cardiovascular drugs

The role of vascular endothelium in cardiovascular disorders is well recognized. Mature endothelial cells contribute to the repair of endothelial injury, but they only have a limited capacity to do so. This has led to growing interest and further investigation into circulating endothelial progenitor cells (EPCs) and their role in vascular healing, repair, and postnatal neovascularization. The current perception of vascular health is that of a balance between ongoing injury and resultant vascular repair, mediated at least in part by circulating EPCs. Circulating EPCs play an important role in accelerating endothelialization at areas of vascular damage, and EPC enumeration is a viable strategy for assessing reparative capacity. Recent studies have shown that EPCs are affected both in number and function by several cardiovascular risk factors as well as various cardiovascular disease states, such as hypertension, hypercholesterolemia, and coronary artery disease. The present review summarizes the most relevant studies on the effects of cardiovascular drugs on vascular function and EPCs, focusing on their mechanisms of action

Single-atom imaging of fermions in a quantum-gas microscope

Single-atom-resolved detection in optical lattices using quantum-gas microscopes has enabled a new generation of experiments in the field of quantum simulation. Fluorescence imaging of individual atoms has so far been achieved for bosonic species with optical molasses cooling, whereas detection of fermionic alkaline atoms in optical lattices by this method has proven more challenging. Here we demonstrate single-site- and single-atom-resolved fluorescence imaging of fermionic potassium-40 atoms in a quantum-gas microscope setup using electromagnetically-induced-transparency cooling. We detected on average 1000 fluorescence photons from a single atom within 1.5s, while keeping it close to the vibrational ground state of the optical lattice. Our results will enable the study of strongly correlated fermionic quantum systems in optical lattices with resolution at the single-atom level, and give access to observables such as the local entropy distribution and individual defects in fermionic Mott insulators or anti-ferromagnetically ordered phases.Comment: 7 pages, 5 figures; Nature Physics, published online 13 July 201

Annual variation in the levels of transcripts of sex-specific genes in the mantle of the common mussel, Mytilus edulis

Mytilus species are used as sentinels for the assessment of environmental health but sex or stage in the reproduction cycle is rarely considered even though both parameters are likely to influence responses to pollution. We have validated the use of a qPCR assay for sex identification and related the levels of transcripts to the reproductive cycle. A temporal study of mantle of Mytilus edulis found transcripts of male-specific vitelline coat lysin (VCL) and female-specific vitelline envelope receptor for lysin (VERL) could identify sex over a complete year. The levels of VCL/VERL were proportional to the numbers of sperm/ova and are indicative of the stage of the reproductive cycle. Maximal levels of VCL and VERL were found in February 2009 declining to minima between July - August before increasing and re-attaining a peak in February 2010. Water temperature may influence these transitions since they coincide with minimal water temperature in February and maximal temperature in August. An identical pattern of variation was found for a cryptic female-specific transcript (H5) but a very different pattern was observed for oestrogen receptor 2 (ER2). ER2 varied in a sex-specific way with male > female for most of the cycle, with a female maxima in July and a male maxima in December. Using artificially spawned animals, the transcripts for VCL, VERL and H5 were shown to be present in gametes and thus their disappearance from mantle is indicative of spawning. VCL and VERL are present at equivalent levels in February and July-August but during gametogenesis (August to January) and spawning (March to June) VCL is present at lower relative amounts than VERL. This may indicate sex-specific control mechanisms for these processes and highlight a potential pressure point leading to reduced reproductive output if environmental factors cause asynchrony to gamete maturation or release