Transcatheter aortic valve implantation (TAVI) a reference model in percutaneous cardiovascular intervention

Cardiovascular diseases (CVDs) are the leading causes of death and hospitalization and represent an enormous clinical and public health burden, which disproportionately affects older adults. According to the Instituto Nacional de Estatística (INE), life-expectancy at born and at 65 years has increased, respectively, 9,6% (73,93 to 81,06 years) and 5,1% (80,60 to 84,69 years), between 1990 and 2020. This evolution is observed worldwide and the World Health Organization (WHO) expects octogenarians to quadruple to 396 million by 2050. The 2060 INE estimates for life expectancy at born in Portugal are 84,21 years for men and 89,88 years for women1,2. This has increased the relative importance of heart valve diseases whose prevalence reached more than one in every ten octogenarians. This document summarizes a coherent professional path dedicated to the cardiovascular area, marked by the search for professional excellence, based on solid evidence-based clinical experience, phased research and the constant challenge of technical-scientific evolution. In the following pages, you will find the testimony of the drastic change caused by the structural cardiac intervention model in the aortic valve, with consequences in the organization and training of cath labs, as well as in the entire Cardiology department in terms of care and investigations. Before becoming a cardiologist, I intended already to be an interventional cardiologist and it was with the formulation of this question that I first addressed Prof. Dr. Ricardo Seabra-Gomes, in 1996. His provocative answer has since then placed the responsibility over my shoulders by the success, or not, of this ambition. The endeavor was, and still is, extremely demanding - no more than for everyone - and guided by the critical spirit of the tutored clinical activity in the light of emerging evidence-based medicine. Hospital de Santa Cruz is a pioneer unit in several techniques and percutaneous coronary intervention assumed dominance in 1990, when it surpassed, in number, surgical myocardial revascularization. In 2008 the Cardiology Director, Dr. Aniceto Silva, accepted my proposal for the organization, structuring and development of a program based on the individualized approach of each patient, using all types of percutaneous and other techniques - and all sorts of devices. Thus, it was born the Percutaneous Valves (VaP) program, transversal between Cardiology and Cardiac Surgery, encompassing referral, assessment, patient study, multidisciplinary meetings, discharge and follow-up during the consultation. Parallel and progressively, there was a strong pedagogical and training project to endow the team with a critical mass that allowed the senior operators to achieve autonomy and transversal competence, like that of coronary intervention, unique in the national reality. Finally, several international research consortia were conquered and integrated, in parallel with the international path followed that culminates in the prestigious Board of the European Association of Interventional Cardiology (EAPCI). Safety and efficacy have always been the first requirements for any cardiovascular technique, because mortality and complications are extremely important from a clinical point of view, resulting in prolonged admission and increased hospital costs. Coordinating the structural program is an enormous challenge that intersects all professional groups and colleagues, from resident to the cardiology head, highlighting the importance of building and caring for the referral network. It essentially went through four phases, each requiring an adaptation of the clinical, organizational, research, communication and management strategic plan: I. From 2008 to 2013, the technical and device launch phase, with a concentration of the volume on the three most experienced operators, intensive use of imaging and general anesthesia as default; II. From 2014 to 2016, the strategic innovation and sustained growth phase, with the expansion of the team to other senior operators, with the use of new techniques and devices - including mitral valves - with the cautious introduction of more simplified protocols for TAVI anesthesia and replication of image expertise to non-aortic space. The institution became a national leader and the period includes an official institutional survey that creates waiting lists in 2015 and provides a growth opportunity. The Presidency of Associação Portuguesa de Cardiologia de Intervenção (APIC) poses challenges and provides national and international collaborative opportunities that were distant, until then; III. From 2016 to 2017, the accelerated growth phase to respond to waiting lists and achieve maturation in the entire structural field. The visit of similar institutions is carried out with the adoption of an innovative model of sedation-analgesia with the support of anesthesiology, the teaching of the technique to all senior operators as well as the simplification of intra-hospital processes. The space of transseptal techniques enlarges and with it, all the imaging knowledge. Integration into EAPCI's European Valve For Live project projects APIC into EAPCI. The invitation to join its Board is challenging and allows you to competitively integrate prestigious European and North American research consortia. IV. From 2018 onwards, the consolidation phase, that is based on the daily routine of structural intervention techniques, with underlying administrative coordination and the implementation of a long-distance program that concentrates clinical examinations and evaluations in a single day. There is a growing and unique transversal experience that makes the center the Iberian leader in TAVI and that makes it a hands-on training center for other centers such as Centro Hospitalar do Funchal and Centro Hospitalar da Universidade de Coimbra, in addition to very important care partnerships with the Hospital Garcia de Orta, Hospital Fernando da Fonseca and Centro Hospitalar de Leiria. The biggest current challenge is to provide our network with a simple, expeditious and efficient articulation, expanding the center's narrative to the area of quality from the perspective of the patient and the referrer, based on scientific research within the scope of consortia. Other challenges, such as percutaneous mitral and tricuspid valve intervention, closure of the left atrial appendage and percutaneous closure of valve leaks, arise from this maturity and become a natural evolution in the field of percutaneous structural interventions

Manual or automatic?

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Social Plasticity Relies on Different Neuroplasticity Mechanisms across the Brain Social Decision-Making Network in Zebrafish

Social living animals need to adjust the expression of their behavior to their status within the group and to changes in social context and this ability (social plasticity) has an impact on their Darwinian fitness. At the proximate level social plasticity must rely on neuroplasticity in the brain social decision-making network (SDMN) that underlies the expression of social behavior, such that the same neural circuit may underlie the expression of different behaviors depending on social context. Here we tested this hypothesis in zebrafish by characterizing the gene expression response in the SDMN to changes in social status of a set of genes involved in different types of neural plasticity: bdnf, involved in changes in synaptic strength; npas4, involved in contextual learning and dependent establishment of GABAergic synapses; neuroligins (nlgn1 and nlgn2) as synaptogenesis markers; and genes involved in adult neurogenesis (wnt3 and neurod). Four social phenotypes were experimentally induced: Winners and Losers of a real-opponent interaction; Mirror-fighters, that fight their own image in a mirror and thus do not experience a change in social status despite the expression of aggressive behavior; and non-interacting fish, which were used as a reference group. Our results show that each social phenotype (i.e., Winners, Losers, and Mirror-fighters) present specific patterns of gene expression across the SDMN, and that different neuroplasticity genes are differentially expressed in different nodes of the network (e.g., BDNF in the dorsolateral telencephalon, which is a putative teleost homolog of the mammalian hippocampus). Winners expressed unique patterns of gene co-expression across the SDMN, whereas in Losers and Mirror-fighters the co-expression patterns were similar in the dorsal regions of the telencephalon and in the supracommissural nucleus of the ventral telencephalic area, but differents in the remaining regions of the ventral telencephalon. These results indicate that social plasticity relies on multiple neuroplasticity mechanisms across the SDMN, and that there is not a single neuromolecular module underlying this type of behavioral flexibility.FCT fellowships: (SFRH/BD/44848/2008, SFRH/BD/89072/2012)

Autism-associated gene shank3 is necessary for social contagion in zebrafish

BACKGROUND: Animal models enable targeting autism-associated genes, such as the shank3 gene, to assess their impact on behavioural phenotypes. However, this is often limited to simple behaviours relevant for social interaction. Social contagion is a complex phenotype forming the basis of human empathic behaviour and involves attention to the behaviour of others for recognizing and sharing their emotional or affective state. Thus, it is a form of social communication, which constitutes the most common developmental impairment across autism spectrum disorders (ASD). METHODS: Here we describe the development of a zebrafish model that identifies the neurocognitive mechanisms by which shank3 mutation drives deficits in social contagion. We used a CRISPR-Cas9 technique to generate mutations to the shank3a gene, a zebrafish paralogue found to present greater orthology and functional conservation relative to the human gene. Mutants were first compared to wild types during a two-phase protocol that involves the observation of two conflicting states, distress and neutral, and the later recall and discrimination of others when no longer presenting such differences. Then, the whole-brain expression of different neuroplasticity markers was compared between genotypes and their contribution to cluster-specific phenotypic variation was assessed. RESULTS: The shank3 mutation markedly reduced social contagion via deficits in attention contributing to difficulties in recognising affective states. Also, the mutation changed the expression of neuronal plasticity genes. However, only downregulated neuroligins clustered with shank3a expression under a combined synaptogenesis component that contributed specifically to variation in attention. LIMITATIONS: While zebrafish are extremely useful in identifying the role of shank3 mutations to composite social behaviour, they are unlikely to represent the full complexity of socio-cognitive and communication deficits presented by human ASD pathology. Moreover, zebrafish cannot represent the scaling up of these deficits to higher-order empathic and prosocial phenotypes seen in humans. CONCLUSIONS: We demonstrate a causal link between the zebrafish orthologue of an ASD-associated gene and the attentional control of affect recognition and consequent social contagion. This models autistic affect-communication pathology in zebrafish and reveals a genetic attention-deficit mechanism, addressing the ongoing debate for such mechanisms accounting for emotion recognition difficulties in autistic individuals

The Portuguese version of the RhinoQOL Questionnaire: validation and clinical application

AbstractIntroductionRhinosinusitis constitutes an important health problem, with significant interference in personal, professional, and social functioning. This study presents the validation process of the Portuguese version of the RhinoQOL, to be used as a routine procedure in the assessment of patients with chronic rhinosinusitis.ObjectiveTo demonstrate that the Portuguese version of the RhinoQOL is as valid as the English version to measure symptoms and health-related quality of life in chronic rhinosinusitis.MethodsThe Portuguese version of the RhinoQOL was administered consecutively to 58 patients with chronic rhinosinusitis with and without nasal polyps, assessed for endoscopic sinus surgery. A follow-up survey was completed three months after surgery. Statistical analysis was performed to determine its psychometric properties.ResultsFace and content validity were confirmed by similar internal consistency as the original questionnaire for each sub-scale, and strong correlation between individual items and total score. The questionnaire was easy and quick to administer (5.5min). At three months, there was a significant decrease from baseline for all sub-scale scores, indicating clinical improvement, with an effect size considered as large.ConclusionThis study provides a questionnaire that is equivalent to the original English version, with good responsiveness to change, which can be especially valuable to measure the outcome of surgery

Social zebrafish: Danio rerio as an emerging model in social neuroendocrinology

The fitness benefits of social life depend on the ability of animals to affiliate with others and form groups, on dominance hierarchies within groups that determine resource distribution, and on cognitive capacities for recognition, learning and information transfer. The evolution of these phenotypes is coupled with that of neuroendocrine mechanisms, but the causal link between the two remains underexplored. Growing evidence from our research group and others demonstrates that the tools available in zebrafish, Danio rerio, can markedly facilitate progress in this field. Here, we review this evidence and provide a synthesis of the state-of-the-art in this model system. We discuss the involvement of generalized motivation and cognitive components, neuroplasticity and functional connectivity across social decision-making brain areas, and how these are modulated chiefly by the oxytocin-vasopressin neuroendocrine system, but also by reward-pathway monoamine signaling and the effects of sex-hormones and stress physiology.Fundação para a Ciência e Tecnologia - FCTinfo:eu-repo/semantics/publishedVersio

Brain morphology predicts social intelligence in wild cleaner fish

It is generally agreed that variation in social and/or environmental complexity yields variation in selective pressures on brain anatomy, where more complex brains should yield increased intelligence. While these insights are based on many evolutionary studies, it remains unclear how ecology impacts brain plasticity and subsequently cognitive performance within a species. Here, we show that in wild cleaner fish (Labroides dimidiatus), forebrain size of high-performing individuals tested in an ephemeral reward task covaried positively with cleaner density, while cerebellum size covaried negatively with cleaner density. This unexpected relationship may be explained if we consider that performance in this task reflects the decision rules that individuals use in nature rather than learning abilities: cleaners with relatively larger forebrains used decision-rules that appeared to be locally optimal. Thus, social competence seems to be a suitable proxy of intelligence to understand individual differences under natural conditions.info:eu-repo/semantics/publishedVersio

A methodology for creating greenways through multidisciplinary sustainable landscape planning

This research proposes a methodology for defining greenways via sustainable planning. This approach includes the analysis and discussion of culture and natural processes that occur in the landscape. The proposed methodology is structured in three phases: eco-cultural analysis; synthesis and diagnosis; and proposal. An interdisciplinary approach provides an assessment of the relationships between landscape structure and landscape dynamics, which are essential to any landscape management or land use. The landscape eco-cultural analysis provides a biophysical, dynamic (geomorphologic rate), vegetation (habitats from directive 92/43/EEC) and cultural characterisation. The knowledge obtained by this analysis then supports the definition of priority actions to stabilise the landscape and the management measures for the habitats. After the analysis and diagnosis phases, a proposal for the development of sustainable greenways can be achieved. This methodology was applied to a study area of the Azambuja Municipality in the Lisbon Metropolitan Area (Portugal). The application of the proposed methodology to the study area shows that landscape stability is crucial for greenway users in order to appreciate the landscape and its natural and cultural elements in a sustainable and healthy way, both by cycling or by foot. A balanced landscape will increase the value of greenways and in return, they can develop socio-economic activities with benefits for rural communitiesinfo:eu-repo/semantics/publishedVersio

Block-windowed burst OFDM: A high-efficiency multicarrier technique

A block-windowed burst orthogonal frequency division multiplexing (OFDM) technique which is a multicarrier technique with power spectral density similar to the filtered OFDM approach, since it also employs smoother, non-rectangular windows, is presented. However, it does not need a cyclic prefix, which means the overall power and spectral efficiencies are higher. An appropriate receiver for typical time-dispersive channels, allowing 2 dB of gain relatively conventional OFDM schemes is also presented