Prognostic evaluation of soluble CD40L in acute myocardial infarction: is not fancy, is science!

© Annals of Translational Medicine. All rights reserved.Acute myocardial infarction (AMI) is a critical clinical presentation of coronary artery disease (CAD). As pointed out previously by us, major clinical research efforts have been dedicated to the identification of patients at higher risk and to the diagnosis of CAD and AMI. Although a great pool of information concerning systemic inflammation markers have been so far collected in different cardiovascular conditions, the evolution of AMI is not well depicted.Fundação para a Ciência e Tecnologia contracts: SFRM/BPD/6308/2009 and UID/BIO/04565/2013; Programa Operacional Regional de Lisboa POR2020: LISBOA-01-0145-FEDER-007317info:eu-repo/semantics/publishedVersio

Esperança, transposição e glória : uma abordagem temática à Escatologia de Clive Staples Lewis

A presente dissertação tem como objectivo dar a conhecer alguns temas relacionados com a teologia escatológica presente nas obras de Clive Staples Lewis. Neste sentido são expostos os temas da virtude da Esperança; o conceito lewisiano de Transposição, que descreve a relação entre as realidades naturais e as sobrenaturais; os dotes e qualidades aos quais a Criação é elevada na glória do Céu. A monografia expõe ainda uma biografia do autor e põe em relevo as suas influências literárias, filosóficas e teológicas. Desta forma, pretendemos mostrar a importância do pensamento de Lewis no contexto da antropologia escatológica.This dissertation aims to make known some themes related to the eschatological theology present in the works of Clive Staples Lewis. In this sense, the exposed themes are the virtue of Hope; the lewisian concept of Transposition, which describes the relationship between natural and supernatural realities; the gifts and qualities to which Creation is raised in the glory of Heaven. The monograph also exhibits a biography of the author and highlights his literary, philosophical and theological influences. Therefore, we intend to show the importance of Lewis's thinking in the context of eschatological anthropology

Técnicas de avaliação funcional do controlo da ventilação no homem

Arquivos da Sociedade Portuguesa de Patologia Respiratória. 1992; 9(2):63-72Os autores descrevem a experiência da primeira unidade de exploração funcional do controle da ventilação existente em Portugal, fazendo uma análise das vantagens e limitações de cada uma das técnicas que executam, nomeadamente estimulação com CO2, respitrace (pletismografia por variação de inductância), pressões máximas, pressão de oclusão e escalas analógicas de Borg. (Introdução) A regulação da ventilação processa-se através de um conjunto complexo de controladores, efectores e receptores (mecânicos e químicos), estando a resposta a diferentes estímulos dependente da integridade destes diferentes componentes, ou seja, poderá existir um centro respiratório (CR) íntegro com uma ventilação pulmonar inadequada. Assim, a técnica ideal para a avaliação funcional do controle da ventilação é aquela que permita medir directamente a actividade CR. Poderemos constatar (quadro) que essa técnica ainda não existe. Conseguimos controlar o estímulo (p.ex. CO2), mas não as respostas. Destas, a mais próxima é a medição invasiva da actividade do nervo frénico. Das técnicas não invasivas, mais próxima é a pressão de oclusão. No nosso laboratório iniciámos em 1983 o estudo e padronização da pressão de oclusão, após estágio no Laboratório de Exploração Funcional Respiratória do Hospital Cochin Port Royal de Paris, a que se seguiu a pletismografia por variação de inductância. Posteriormente estandardizaram-se as pressões máximas e a estimulação com CO2, encontrando-se em fase de avaliação os 'loads' respiratórios. A ordem de apresentação das técnicas será da que mede a actividade do centro respiratório com um maior envolvimento de efectores para a que recorre ao menor número destes

Sessão II – Nacionalidade, Economia e Defesa

A Sessão II prende-se com o papel da Educação da Juventude em termos de Nacionalidade, Economia e Defesa. Foram convidados a participar com as suas reflexões Instituições Políticas, Instituições de Defesa Militar e Civil e dos Sistemas Económico, Social e Cultural

Controlo da ventilação

Acta Medica Portuguesa, 1995, 8: 433-440O sistema de controlo da ventilação pode ser considerado como um circuito fechado constituído por dois subsistemas: o sistema controlador e o controlado. Ambos são definidos pelas suas entradas (inputs) e saídas (outputs). O sistema controlador tem como substrato anátomo-fisiológico os centros respiratórios que levam a cabo dois tipos de controlo da ventilação: o automático e o voluntário. A informação de entrada do sistema controlador é um valor de gasometria e tem como saídas parâmetros de ventilação. Estes últimos constituem a informação de entrada do sistema controlado ou efector, o qual terá como saídas valores de gases no sangue. Desta forma a respiração é normalmente regulada por dois tipos de controlo anatomicamente distintos mas funcionalmente integrados, denominados controlo metabólico ou automático e controlo voluntário ou comportamental. O primeiro refere-se à homeostasia dos gases no sangue e o segundo relaciona-se com a coordenação da respiração com actos voluntários como a formação e o canto

Inflammation is associated with the presence and severity of chronic coronary syndrome through soluble CD40 ligand

This study is part of the PhD thesis program of one of the authors (TPdS), supervised (MMC) and co-supervised (PN) by other two, conducted in NOVA Medical School/Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal. TP acknowledges the support of Fundação para a Ciência e Tecnologia, Portugal (Project UID/BIO/04565/ 2020), and Programa Operacional Regional de Lisboa 2020 (Project N. 007317). The authors are grateful to Joana Castro, PhD, from Medinres - Medical Information and Research, for her advice in the statistical analysis.Introduction: Inflammation contributes to the initiation and progression of atherosclerosis, although the underlying inflammatory pathways are not entirely known. Specifically, the role of the proinflammatory soluble CD40 ligand (sCD40L) on the expression of chronic coronary syndrome (CCS) is not completely understood. We evaluated whether sCD40L expression is associated with the presence of CCS and with the clinical and anatomical severity of CCS. Methods: We prospectively recruited 94 participants, assigned to two groups matched by age and sex, without coronary artery disease (n=26) and with CCS (n=68). Clinical, laboratory and anatomical data were prospectively collected, and serum levels of sCD40L were measured. Results: In patients with CCS, classic cardiovascular risk factors were more prevalent, and the sCD40L levels, leukocyte and neutrophil counts, and neutrophil/lymphocyte ratio, but not the C-reactive protein levels, were significantly higher than those in controls. sCD40L was independently associated with the presence of obstructive coronary artery disease in multivariate analysis. Regarding CCS severity, sCD40L levels showed a significant stepwise increase with increasing angina severity (ANOVA P=0.001). In addition, sCD40L was independently associated with the anatomical severity of coronary artery disease, as assessed by the Gensini score. Among patients with CCS, those with previous coronary artery bypass grafting (n=23) had lower sCD40L levels than patients waiting for revascularization (n=45) [4.3 (2.1) ng/mL vs. 6.8 (3.5) ng/mL, P=0.001]. Conclusions: The expression of the proinflammatory sCD40L was associated with the presence of CCS and reflected the clinical and anatomical severity of CCS. In addition, we describe for the first time the association between prior CABG and reduced sCD40L levels in patients with CCS.publishersversionpublishe

The proinflammatory soluble CD40 ligand is associated with the systemic extent of stable atherosclerosis

Funding: T.P. has received research support from Fundação para a Ciência e Tecnologia, Portugal [Project UID/BIO/04565/2020], and Programa Operacional Regional de Lisboa 2020 [Project N. 007317].Background and objectives: Polyvascular atherosclerosis is frequent and associated with a high cardiovascular risk, although the mechanisms regulating the atherosclerosis extent to single or multiple arterial territories are still poorly understood. Inflammation regulates atherogenesis and soluble CD40 ligand (sCD40L) is an inflammatory mediator associated with the presence of single-territorial atherosclerosis. We assessed whether the sCD40L expression is associated with the atherosclerosis extent to single or multiple arterial territories and with the atherosclerosis severity in different territories. Materials and Methods: We prospectively enrolled 94 participants with no atherosclerosis (controls, n = 26); isolated coronary atherosclerosis (group 1, n = 20); coronary and lower extremity (LE) atherosclerosis (group 2, n = 18); coronary and carotid atherosclerosis (group 3, n = 12); and coronary, LE, and carotid atherosclerosis (group 4, n = 18). Serum sCD40L levels were quantified. Results: The sCD40L levels (ng/mL, mean (standard deviation)) were 4.0 (1.5), 5.6 (2.6), 7.2 (4.2), 5.9 (3.7), and 5.1 (2.4) in controls and groups 1 to 4, respectively (ANOVA p = 0.012). In nonrevascularized patients, the sCD40L levels were significantly higher in group 2 than in group 1 and were correlated with the number of LE diseased segments. Prior LE bypass surgery was associated with lower sCD40L levels. Coexistence of coronary and LE atherosclerosis was independently associated with the sCD40L levels. Conclusions: The sCD40L levels were increased in stable atherosclerosis, particularly in polyvascular coronary and LE atherosclerosis. The number of LE diseased segments and prior LE revascularization were associated with sCD40L expression. To our knowledge, these are novel data, which provide insights into the mechanisms underlying multi-territorial atherosclerosis expression. sCD40L may be a promising noninvasive tool for refining the stratification of the systemic atherosclerotic burden.publishersversionpublishe

Prognostic Value of VEGF in Patients Submitted to Percutaneous Coronary Intervention

The authors gratefully acknowledge the assistance of the staff of Servico de Cardiologia, Hospital de Santa Marta, and Ms. Rute Pinheiro for the help with laboratory work. The study was financially supported by Fundacao para a Ciencia e Tecnologia, PIC/IC/82734/2007 Contract and SFRM/BPD/6308/2009 Grant, and by Liga dos Amigos do Hospital de Santa Marta.We examined the longitudinal changes of VEGF levels after percutaneous coronary intervention for predicting major adverse cardiac events (MACE) in coronary artery disease (CAD) patients. VEGF was measured in 94 CAD patients' serum before revascularization, 1-month and 1-year after. Independently of clinical presentation, patients had lower VEGF concentration than a cohort of healthy subjects (median, IQ: 15.9, 9.0-264 pg/mL versus 419, 212-758 pg/mL; P < 0.001) at baseline. VEGF increased to 1-month (median, IQ: 276, 167-498 pg/mL; P < 0.001) and remained steady to 1-year (median, IQ: 320, 173-497 pg/mL; P < 0.001) approaching control levels. Drug eluting stent apposition and previous medication intake produced a less steep VEGF evolution after intervention (P < 0.05). Baseline VEGF concentration <40.8 pg/mL conveyed increased risk for MACE in a 5-year follow-up. Results reflect a positive role of VEGF in recovery and support its importance in CAD prognosis.publishersversionpublishe