Escala de aceitação do teste pré-sintomático: Estudo de validação com uma amostra de pessoas em risco para a doença de Machado-Joseph

Este artigo apresenta um estudo de validação da Escala de Aceitação do Teste Pré-Sintomático, realizado com uma amostra de pessoas em risco para a doença de Machado-Joseph. Este estudo visou testar a estabilidade e a reprodutibilidade da estrutura factorial original da escala e apurar as suas características psicométricas. Avaliámos, ainda, a convergência da escala com um outro instrumento de avaliação psicológica. Os resultados revelaram uma estrutura composta por 18 itens e diferenciada em três factores, que contribuem com 51,6% para a variância total explicada, e cujos coeficientes alfa de Cronbach (Factor 1=0,85; Factor 2=0,76; Factor 3=0,60) atestam a adequada consistência interna do instrumento. A escala não foi influenciada pelas variáveis sexo, idade e grau de instrução e as respostas não foram, aparentemente, determinadas pelo desejo de agradar a terceiros, aspecto que constitui um indicador acrescido da validade de construto da escala. Detectámos, ainda, uma associação estatisticamente significativa entre a adesão ao teste pré-sintomático e as atitudes em relação aos médicos e à medicina. Em suma, a escala apresenta qualidades psicométricas bastante satisfatórias, o que favorece a sua aplicabilidade a amostras de pessoas em risco para doenças neurogenéticas de início tardio e que disponham de teste pré-sintomático. ------ ABSTRACT ------ This paper presents a study on the validation of the Pre-Symptomatic Testing Acceptance Scale, undertaken with a sample of at-risk subjects for Machado- Joseph disease. The present study has aimed to test the stability and reproducibility of the original factorial structure of the scale and to check its psychometric characteristics. We have still evaluated the convergence of the scale with another instrument of psychological evaluation. The results have shown a structure composed of 18 items and differentiated in three factors that have contributed with 51.6% to the total explained variance and its Cronbach alpha coefficient (Factor 1=.85; Factor 2=.76; Factor 3=.60) prove the adequate internal consistency of the instrument. The scale has not been influenced by the variables gender, age, schooling level, and the answers have not apparently been determined by the desire to please other people, which constitutes a further indicator of the scale construct validity. We have also observed a meaningful statistic association between adherence to the presymptomatic testing and attitudes in relation to doctors and medicine. In conclusion, the scale presents fairly satisfactory psychometric qualities, which enables its applicability to samples of at-risk people for other late onset neurogenetic diseases with pre-symptomatic testing

Avaliação Retrospetiva da Reconstrução Oncológica da Cabeça e Pescoço com 114 Retalhos Livres num Centro Oncológico Terciário Português

Introduction: The Portuguese experience in microsurgical reconstruction of the head and neck after oncological surgery is scantly described. The primary aim of this study was to characterize the use of microvascular reconstruction after head and neck tumor resection in a Portuguese tertiary oncological centerMaterial and Methods: The authors retrospectively evaluated 114 microvascular free flap procedures performed for head and neck reconstruction after oncological resection in a department of Head and Neck Surgery of a Portuguese tertiary oncological center. Patients were operated on from January 2012 to May 2018. Data on patient demographic features, tumour characteristics, perioperative complications, postoperative aesthetic and functional results, survival time and time to recurrence were extracted. Results: Most tumours mandating microsurgical reconstruction were mucosal squamous cell carcinomas (85%) and were located in the oral region (95.6%). Around 45% of the patients had a T4a tumour and 30% a T2 tumour. Cervical metastases were present in 45.6% of the cases. The radial forearm flap and the fibular flap were the most commonly used microsurgical reconstructive options (58% and 41%, respectively). More than 80% of patients had no post-operative complications. Partial necrosis of the flap occurred in 6.1% of patients, while total flap necrosis occurred in 3.5% of cases. Aesthetic and functional results were considered at least satisfactory in all patients in which the flaps survived. Discussion: This study is by far the largest series of microsurgical head and neck reconstruction after oncological surgery reported by a single tertiary centre in Portugal. Survival and functional benefits are similar to those reported in other large oncological centres in the world. Conclusion: Microvascular reconstruction seems like a reliable treatment option in head and neck oncological surgery at our institution.info:eu-repo/semantics/publishedVersio

Detection and adsorption of Triclosan on sensors based on PAH/PVS thin-films

Given the vital role of water in life it is paramount to thrive and succeed in areas that look to clean and prevent further contamination in water bodies. Triclosan (TCS) is present in most of our day-to-day products and if left unchecked it can lead to long-term significant problems due to its many inauspicious effects in both human and animal health. Thus arose the need to develop sensors to detect and possibly remove TCS for aqueous solutions. This work was rooted on this premise and sensors based on LbL polyectrolyte thin-films were developed, such as poly(allylamine hydrochloride) (PAH) and poly(vinylsulfonic acid, sodium salt) (PVS), namely (PAH/PVS)(10) and (PAH/PVS)/PAH(10). The goal of this work was to analyze the amount of TCS adsorbed onto reused (PAH/PVS)(10) and (PAH/PVS)/PAH(10) LbL thin-films when immersed in TCS aqueous solutions with decreasing pH. It was demonstrated that sensors with an outer layer of PAH led to a significantly better TCS molecules adsorption (removal). Additionally, sensors composed of (PAH/PVS)(10) presented higher sensibility in discriminating TCS solutions with concentrations between 10(-5) M and 10(-8) M, using impedance spectroscopy.info:eu-repo/semantics/publishedVersio

Changes in bone Pb accumulation: Cause and effect of altered bone turnover

Notice: this is the author’s version of a work that was accepted for publication in Bone. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Bone, [Vol 64 (2014 Jul)] DOI 10.1016/j.bone.2014.04.021"This paper assesses the magnitude of Pb uptake in cortical and trabecular bones in healthy animals and animals with altered balance in bone turnover, and the impact of exposure to Pb on serum markers of bone formation and resorption. The results reported herein provide physiological evidence that Pb distributes differently in central compartments in Pb metabolism, such as cortical and trabecular bone, in healthy animals and animals with altered balance in bone turnover, and that exposure to Pb does have an impact on bone resorption resulting in OC-dependent osteopenia. These findings show that Pb may play a role in the etiology of osteoporosis and that its concentration in bones varies as a result of altered bone turnover characteristic of this disease, a long standing question in the field. In addition, data collected in this study are consistent with previous observations of increased half-life of Pb in bone at higher exposures. This evidence is relevant for the necessary revision of current physiologically based kinetic models for Pb in humans.

Displasia Cimento Óssea Florida: Apresentação Rara de um Problema Comum

Introdução A displasia cimento-óssea (DCO) é a lesão fibro-óssea mais comum. Pensa-se que a DCO tem origem no ligamento periodontal. Outros acreditam que tem origem num defeito da remodelação óssea desencadeada por lesões locais. Com base nas características clínicas e radiográficas, as DCO dividem-se em focal, periapical e florida. A DCO florida caracteriza-se por um envolvimento multifocal não limitado aos segmentos anteriores. Esta forma afecta sobretudo mulheres melanodérmicas com particular incidência nos adultos de meia-idade e idosos. Caracteriza-se por lesões bilaterais e por vezes simétricas. Normalmente estas lesões são assintomáticas podendo tratar-se de achados radiográficos. Noutros casos pode haver dor ligeira, fístulas alveolares e exposição óssea. Raramente pode haver expansão óssea. Radiograficamente, apresentam um padrão semelhante às outras formas de DCO. Inicialmente as lesões são radiotransparentes, adquirindo um padrão misto e posteriormente tornam-se radiopacas com halo radiotransparente. Caso Clínico Mulher, 53 anos, originária da Índia, com Diabetes Mellitus tipo 2. Vai a consulta de Cirurgia de Cabeça e Pescoço no IPO Lisboa enviada pelo médico de família com a informação de ser seguida em Oncologia na Índia por “neoplasia óssea com atingimento a nível de mandíbula e maxilar superior com destruição óssea progressiva”. Clinicamente refere desde há 20 anos parestesias na hemimandíbula esquerda com instalação de dor há 10 anos. Com recente irradiação da dor para a nuca. À observação tem gengivite tartárica, sem outras alterações. Traz consigo duas TC-Cone Beam (2012 e 2017) que mostram a existência e evolução de cinco lesões junto às regiões de 13-14, 23-25, 33, 36 e 46. As múltiplas lesões eram sugestivas do diagnóstico de DCO florida. Pediu-se TC Maxilofacial e manteve-se a sob vigilância medicando-se sintomaticamente. Discussão e Conclusões Nas DCO periapical e florida, os achados clínicos e radiográficos permitem fazer um diagnóstico presuntivo. As características da DCO focal são menos específicas e por isso a biopsia pode ser necessária. A DCO não tem natureza neoplásica e geralmente não requer remoção sendo que para um paciente assintomático a reavaliação periódica e o controlo da doença periodontal estão indicados. Raramente, estas lesões apresentam um crescimento progressivo (displasia óssea expansiva) com necessidade de remoção. Em geral, o prognóstico é bom. O desenvolvimento de sarcomas em áreas de DCO está relatado mas é muito raro.info:eu-repo/semantics/publishedVersio

Technology-Supported Storytelling (TSST) Strategy in Virtual World for Multicultural Education

Learning culture through stories is an effective way for multicultural education, since stories are one of the most powerful and personal ways that we learn about the world. Storytelling, the process of telling stories, is a form of communication and a universal expression of culture. With the development of technology, storytelling emerges out of diverse ways. This study explores the storytelling in virtual worlds for multicultural education, and devises a Technology-Supported storytelling (TSST) strategy by examining and considering the characteristics of virtual worlds which could be incorporated into the storytelling, and then uses this strategy to teach Korean culture to students with different culture background. With this innovative TSST strategy in virtual world, this study expects to provide a guide to practice for teaching multicultural in digital era

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research