Repositório RCAAP

Introduction: Aneurysms of small abdominal vessels are extremely rare; however, even minor aneurysmal accessory arteries can rupture, leading to potentially fatal consequences. The purpose of this paper is to report a case of coil embolisation of an aneurysmal posterior gastric artery. Case presentation: The authors describe the case of a 66 year old female patient with an aneurysm of the posterior gastric artery. Coil embolisation was performed. The six month follow up computed tomography angiogram revealed exclusion of the aneurysm. Discussion: The presented case is exceedingly rare. This type of aneurysm has to be kept in mind as a possible cause of bleeding, despite the limited information regarding their natural history. Conclusion: Owing to the safety and applicability of the endovascular technique, it is nowadays probably the best treatment alternative for this type of aneurysm.

Mediterranean diet has been suggested to explain why coronary heart disease mortality is lower in southern than northern Europe. Dietary habits can be revealed by isotope ratio mass spectrometry (IRMS) measurement of carbon (δ(13)C) and nitrogen (δ(15)N) in biological tissues. To study if diet is associated with human plaque stability, atherosclerotic plaques from carotid endarterectomy on 56 patients (21 Portuguese and 35 Swedish) were analysed by IRMS and histology. Plaque components affecting rupture risk were measured. Swedish plaques had more apoptosis, lipids and larger cores, as well as fewer proliferating cells and SMC than the Portuguese, conferring the Swedish a more rupture-prone phenotype. Portuguese plaques contained higher δ(13)C and δ(15)N than the Swedish, indicating that Portuguese plaques were more often derived from marine food. Plaque δ(13)C correlated with SMC and proliferating cells, and inversely with lipids, core size, apoptosis. Plaque δ(15)N correlated with SMC and inversely with lipids, core size and apoptosis. This is the first observational study showing that diet is reflected in plaque components associated with its vulnerability. The Portuguese plaques composition is consistent with an increased marine food intake and those plaques are more stable than those from Swedish patients. Marine-derived food is associated with plaque stability.

Active carotid plaques are associated with atheroembolism and neurological events; its identification is crucial for stroke prevention. High‐definition ultrasound (HDU) can be used to recognize plaque structure in carotid bifurcation stenosis associated with plaque vulnerability and occurrence of brain ischemic events. A new computer‐assisted HDU method to study the echomorphology of the carotid plaque and to determine a risk score for developing appropriate symptoms is proposed in this study. Plaque echomorphology characteristics such as presence of ulceration at the plaque surface, juxta‐luminal location of echolucent areas, echoheterogeneity were obtained from B‐mode ultrasound scans using several image processing algorithms and were combined with measurement of severity of stenosis to obtain a clinical score—enhanced activity index (EAI)—which was correlated with the presence or absence of ipsilateral appropriate ischemic symptoms. An optimal cutoff value of EAI was determined to obtain the best separation between symptomatic (active) from asymptomatic (inactive) plaques and its diagnostic yield was compared to other 2 reference methods by means of receiver‐operating characteristic (ROC) analysis. Classification performance was evaluated by leave‐one‐patient‐out cross‐validation applied to a cohort of 146 carotid plaques from 99 patients. The proposed method was benchmarked against (a) degree of stenosis criteria and (b) earlier proposed activity index (AI) and demonstrated that EAI yielded the highest accuracy up to an accuracy of 77% to predict asymptomatic plaques that developed symptoms in a prospective cross‐sectional study. Enhanced activity index is a noninvasive, easy to obtain parameter, which provided accurate estimation of neurological risk of carotid plaques.

Objective: Aortic arch aneurysmal disease remains a therapeutic challenge. For patients unsuitable for standard open surgery, hybrid repair with debranching of the supra-aortic arteries followed by thoracic endovascular grafting has been shown to be an effective solution. The aim of this study was to report the clinical outcomes of a single-institution experience using hybrid aortic arch repair. Methods: The cases of all consecutive patients submitted to hybrid aortic arch repair between January 2010 and June 2018 were prospectively collected and retrospectively analyzed. The outcomes of the study were 30-day mortality, perioperative complications, 2-year survival, endoleak, and reintervention rates. Results: A total of 35 patients with a median age of 71 years (interquartile range, 62-77 years) were submitted to hybrid aortic arch repair, with a median follow-up of 26.9 months (interquartile range, 2.4-63.6 months). Ten procedures (28.6%) were performed urgently for contained rupture. The most common etiology was degenerative (n ¼ 14 [40.0%]). The proximal landing zones according to the Ishimaru classification were zone 2 in 20 patients (57.1%), zone 1 in 12 patients (34.3%), and zone 0 in 3 patients (8.6%). Early endoleaks were observed in six patients (17.1%), equally distributed between type I and type II. Late endoleaks were identified in 4 of 24 patients (16.7%; type I, n ¼ 2 [8.3%]; type II, n ¼ 1 [4.2%]; and type III, n ¼ 1 [4.2%]). Thirty-day mortality rate was 14.3% (n ¼ 5) with an early death rate of 8.7% (2/23) in elective cases and 30.0% (3/10) in urgent cases (odds ratio [OR], 4.93; confidence interval [CI], 0.68-35.67; P ¼ .128). Except in one patient, 30-day mortality was associated with landing zone 0 or zone 1 (26.7% vs 5.0%; OR, 6.91; CI, 0.68-69.86; P ¼ .141). Three patients (8.6%) suffered a postoperative stroke, and no episodes of spinal cord ischemia were observed. Two-year survival rate was 67.8% (CI, 49.4%- 80.8%). Survival rates were significantly lower with increasing age (hazard ratio [HR], 1.10; CI, 1.03-1.18; P ¼ .004), urgent procedure (HR, 4.80; CI, 1.56-14.80; P ¼ .003), zone 0 or zone 1 (HR, 6.34; CI, 1.73-23.18; P ¼ .001), presence of arrhythmia (HR, 3.76; CI, 1.22-11.62; P ¼ .013), and cerebrovascular disease (HR, 4.12; CI, 1.38-12.35; P ¼ .006). A multivariate analysis identified age (HR, 1.11; P ¼ .047) and zone 0 or zone 1 (HR, 4.93; P ¼ .033) as the only predictors for overall mortality. Conclusions: Hybrid aortic arch repair seems to be an alternative for higher risk patients not suitable for open repair, but selection of patients is crucial and may benefit from further refinement. In this study, worse outcomes were seen in older patients and those who required more proximal landing zones.

Objective: Seat belt aorta is rare and difficult to manage. The lack of data and follow-up increases the complexity of treating such patients. We aimed to create a decision algorithm by reviewing our current experience and analyzing the presentation and management of our patients. Methods: We performed a descriptive case series based on retrospective analysis of all consecutive patients admitted with the diagnosis of seat belt aorta from 2008 to 2018. Seat belt aorta was defined as any blunt abdominal aortic lesion resulting from a seat belt compression mechanism after a car accident. Results: Nine consecutive patients were admitted with the diagnosis of seat belt aorta, all of whom developed lesions in the infrarenal aorta. Eight patients were assessed in the acute phase and one patient presented with late-onset symptoms. Associated injuries were present in all acute patients, and seat belt sign and small bowel injury were present in 88%. One patient presented with a small intimal tear and was treated conservatively. All other patients diagnosed with large intimal flaps (seven patients) and pseudoaneurysm (one patient) underwent open repair in five cases and endovascular repair in three cases. In-hospital mortality for the acute cases was 38%, with no mortality seen during follow-up. Two patients submitted to endovascular repair required reinterventions. Conclusions: Seat belt aorta is a deadly condition, frequently associated with blunt thoracoabdominal trauma with concomitant injuries; the presence of a seat belt sign or lower limb ischemia must lead to a high diagnostic suspicion. Management must take into account the other concomitant injuries. Follow-up is crucial as most patients are young; they may develop complications and subsequently require further intervention.

Till macrofabric and grain-size analysis of glacial diamictons and landforms present in several valleys of the Serra da Estrela Mountains in central Portugal were used to interpret till types and to reconstruct the glacial paleoprocess history of this mountainous region. Supraglacial melt-out and flow tills are dominant in this range. Supraglacial melt-out tills, representative of periods of glacial stability and stagnation followed by recession, present weaker fabric data and coarser, poorly sorted sediments. Flow tills, mainly representative of glacial stability followed by recession, present crude layering, and soft-sediment deformation structures with moderate fabric data and coarser to fine, poorly sorted sediments. Glacial diamictons affected by post-glacial paraglacial activity in the form of landslides were also observed in three valleys. These present weaker to moderate fabric data and coarser, poorly sorted sediments. These glacial diamictons and landforms are of particular importance in the reconstruction of the glacial dynamics and history of the Serra da Estrela Mountains due to a scarcity of chronological data based on absolute dating methods. These mountains also represent the southernmost Atlantic range in Europe where significant glaciation took place, which makes it an interesting area to investigate mountain glacial dynamics in low elevation humid Atlantic coastal ranges and compare it with other Atlantic ranges.

Carob seedlings were grown at different proportions of nitrate NO3) and ammonium (NH4) supplied at a concentration of 3.5 mM nitrogen (N). The effect of five different combinations of NH4- and NO3-N on growth rates, N and carbon (C) content of the plant and dry matter distribution were studied. The presence of NH4 in the nutrient solution enhanced plant growth rate, although net photosynthesis rates per unit area were lower than in NO3-fed plants. Nitrate –fed plants exbibited the highest rates of carbon dioxide (CO2) assimilation, water use, and N-use efficiency. Nevertheless, plants growing only with NO3 were more fragile and susceptible to fungus infections. The role of cotyledons on the regulation of the supply of photosynthates from leaves to roots in the different combinations of NO3- and NH4-N is described. Results suggest that the growth rates of carob may be improved using suitable combinations of NO3- and NH4-N. Equal concentrations of these two N sources allows good development and adequate allocation of low C and N to different developing sinks of the carob seedlings.

Thermokarst lakes result from the thawing of ice-rich permafrost and are widespread across northern landscapes. These waters are strong emitters of methane, especially in permafrost peatland regions, where they are stained black by high concentrations of dissolved organic matter (DOM). In the present study, we aimed to structurally characterize the DOM from a set of peatland thermokarst lakes that are known to be intense sites of microbial decomposition and methane emission. Samples were collected at different depths from three thermokarst lakes in the Sasapimakwananisikw (SAS) River valley near the eastern Hudson Bay community of Kuujjuarapik–Whapmagoostui (Nunavik, Canada). Samples were analyzed by spectrofluorometry, Fourier-transform infrared spectroscopy (FTIR), nuclear magnetic resonance spectroscopy (NMR), and elemental analysis. Fluorescence analyses indicated considerable amounts of autochthonous DOM in the surface waters of one of SAS 1A, indicating a strong bioavailability of labile DOM, and consequently a greater methanogenic potential. The three lakes differed in their chemical composition and diversity, suggesting various DOM transformations phenomena. The usefulness of complementary analytical approaches to characterize the complex mixture of DOM in permafrost peatland waters cannot be overlooked, representing a first step towards greater comprehension of the organic geochemical properties of these permafrost-derived systems

In the increasingly competitive hotel environment, decision-makers must consider the risks and benefits of remaining independent or affiliating with a brand or consortium. This research sought to understand the level of importance associated with a set of motivating factors considered by Portuguese four- and five-hoteliers as it relates to remaining independent or affiliating. The study results suggest that independent hoteliers rank control over decision making and shorter decision making as most important in remaining independent, and increased sales and more aggressive marketing as most important in the decision to affiliate. Affiliated hoteliers rank shorter decision making and absence of fees as most important in remaining independent, and increased sales, brand value, and more aggressive marketing as most important in the decision to affiliate. Interestingly, independence and freedom were considered less important in the decision to remain independent, by all respondents. We apply Hofstede’s cultural dimensions theory to explain some of the key findings.

Studies have suggested that material deprivation is strongly associated with negative health outcomes, and lower usage of various levels of healthcare. We aim to analyse geographical access to emergency medical services (EMSs) and hospital emergency units by EMS in relation to deprivation in the Lisbon Metropolitan Area (LMA), Portugal.

The book, as a means of artistic expression, has been explored since the beginning of editorial practices. Design, music, theatre, literature, cinema, among other forms of creative expression, are parts of a whole that constitute book art and independent publishing, whose expressivity is directly influenced by the rich mixture of participating areas and techniques. It is necessary to know the particular details of leading work in this area, so that the disruptive role of the artist´s book may be assimilated and understood. The primary forms of graphic communication, such as cave paintings, appeared spontaneously, fulfilling the needs of the prehistoric human being. Over the years, and as the language developed and became more complex, the mediums of inscription were also perfected. The Chinese and Egyptian cultures made the discovery and refinement of paper possible, as they were the first to apply bamboo and papyrus fibers, respectively, in a “leaf” manufacturing process. The "leaf," which is a finite plan is added on to another leaf and yet another until the user decides to finish its compilation. From the need for compilation emerges the codex, an ingenious page storage structure, which two thousand years later remains resilient. When travelling in time, it is possible to verify the potential of the codex as an object of art and expression, which has suffered constant experimentation over the years. Having as a starting point the Middle Ages, and throughout history, it can be concluded that the possibilities for innovation are inexhaustible, both graphically and conceptually. As such, it is estimated that the expedition of book art and author's publication will continue to progress, as the possibilities for exploration seem to multiply over time. The future of the printed culture may be tied to the knowledge of the current available technological means, allied to an innovative and conscious experimentation of tactile supports.

Background: Bipolar disorder is a chronic and often debilitating illness. Current treatment options (both pharmaco- and psychotherapy) have shown efficacy, but for many leave a shortfall in recovery. Advances in the understanding of the pathophysiology of bipolar disorder suggest that interventions that target mitochondrial dysfunction may provide a therapeutic benefit. Methods: This review explores the current and growing theoretical rationale as well as existing preclinical and clinical data for those therapies aiming to target the mitochondrion in bipolar disorder. A Clinicaltrials.gov and ANZCTR search was conducted for complete and ongoing trials on mitochondrial agents used in psychiatric disorders. A PubMed search was also conducted for literature published between January 1981 and July 2017. Systematic reviews, randomized controlled trials, observational studies, case series, and animal studies with an emphasis on agents affecting mitochondrial function and its role in bipolar disorder were included. The search was augmented by manually searching the references of key papers and related literature. The results were presented as a narrative review. Results: Mitochondrial agents offer new horizons in mood disorder treatment. While some negative effects have been reported, most compounds are overall well tolerated and have generally benign side-effect profiles. Conclusions: The study of neuroinflammation, neurodegeneration, and mitochondrial function has contributed the understanding of bipolar disorder's pathophysiology. Agents targeting these pathways could be a potential therapeutic strategy. Future directions include identification of novel candidate mitochondrial modulators as well as rigorous and well-powered clinical trials.

The research Plane Narratives is a plastic and textual investigation propped by personal and public archive images of the city of Brasília. The archives serve as tools and, from the Movements of Memory, give rise to new conversion planes about the territory in question. The plane is seen as an exhumable surface, open to deterritorialization and reterritorialization – where the meeting of words with images generates a theater of disfigurement. How can body narratives disfigure the plane of the archive to create new imagery futures? The methodology used evokes a relationship with the deleuzian philosophy, with time and with the land. The artwork is developed from philosophical notions where memory is a desire that exhumes. The city becomes a kind of archaeological site: it is excavated, twisted and recartographed – reframing visual, gestural, affective and also symbolic processes.

This project-work entitled Worldbuilding Based on Characters, consists of a graphic and theoretical research about the construction of an imaginary world, where he main character is used as the guideline for the methodology. Graphically, this fantasy world will be represented through studies of Concept Art and scenographic illustrations, carried out digitally through a bitmap software. Whereas in theoretical terms, the elements belonging to this world will be shaped attuned to the needs imposed by the characters and the plot in which they exist, while also being cognizant to the preexisting worldbulding methods and traditions. Accordingly, we will present a first chapter of the theoretical framework about this process, which we’ll divide into two parts. In the first part, it’ll be highlighted the definition of the worldbuilding process, emphasizing as an example the construction of the Middle Earth by J. R. R. Tolkien; and in which environments this process will be most frequently applied. Additionally, we will end the first part with an inherent requirement to the construction of an unreal world - the voluntary suspension of disbelief, which is a factor that affects the ability to immerse yourself in a world, since characterized by the voluntary acceptance of elements alien to human reality. In the second part of this theoretical framework, we will inform on the most usually employed methodologies, highlighting the process of George R. R. Martin due to its impact on the methodology of this work. Finally, we will present the practical component of this study in the second chapter, in which we connect the concept art with inside-out worldbuilding, seeing that the theoretical component of the creation of this world is intrinsic to the development of the drawings. As such, we will demonstrate how the world unfolded from the characters and their narrative context, and how these same elements determined previously will be revisited in future illustrations. In parallel, we will also highlight the artistic process in the design of the most important drawings, since there’s a concern for the improvement of the digital drawing technique, associated with the problem arisen from how it might be possible to transmit an imaginary world through this medium.

O projecto do Coletivo Aleph centrou-se na discussão dos quotidianos em espaço urbano de pessoas com diferentes identidades, expressão de género e orientação sexual. Estes quotidianos que têm lugar em áreas públicas abertas (praças, ruas, jardins, parques), em espaços semipúblicos de recreação e lazer (cafés, academias, clubes desportivos, centros comerciais, etc.) e em espaço privado (em casa), são desafiados quando se questiona quem os concebeu e para quem foi projectada a cidade. Com efeito, nem todos esses espaços “socialmente aceites” são inclusivos, garantem segurança, promovem afectos e conforto. Talvez por serem pensados e projectados a partir de lentes heteronormativas, as suas características produzem efeitos diferenciados na mobilidade, permanência, segurança e, não raras vezes, produzem práticas excludentes. Perguntamos, assim, se esses espaços não são, em última análise, aqueles que permitem a presença, a mobilidade e a acção de certos grupos e pessoas, mas inibem o pleno acesso de outras, levando ao debate sobre os direitos humanos, cidadania e direito à cidade. A crítica foi desenvolvida por esta investigação culminou na elaboração de um webdocumentário (ferramenta digital disponível em http://www.ceg.ulisboa.pt/mpps/#3). O instrumento comunicacional então utilizado para apresentar a nossa pesquisa (o webdocumentário) explora conteúdos relacionados com a experiência urbana de jovens estudantes universitários com diferentes identidades, expressão de género e orientação sexual, que narram, discutem e criticam o espaço urbano concebido segundo as lentes heteronormativas. Esta crítica é sustentada através das histórias dos sujeitos envolvidos e voluntários na nossa investigação. A metodologia que o Coletivo Aleph utilizou para a recolha de informação centrou-se nas técnicas qualitativas da narrativa, sob a forma de storytelling, storymapping, e go-along techniques, tendo resultado em mapas, fotos, registos escritos, áudios e infográficos que ilustram a vida urbana dos e das participantes. Além das narrativas obtidas sob os referidos formatos, foi utilizada uma aplicação em que foram registados os pontos-chave dos seus quotidianos urbanos, expressando assim as sensações/atmosferas de acolhimento, repulsa, tranquilidade, liberdade, etc. Este artigo explora os objectivos, metodologia e resultados a que o Coletivo chegou.

This text seeks to provide a historical analysis of Brazilian psychiatry. My purpose here is to emphasize the inherent connection between (un)democratic processes and social understandings of the figure of the “mad.” The structuration of the system of psychiatric care indeed would seem to be inseparable from human rights concerns and the need to consider all individuals as worthy of care. Without a doubt, social acceptance of the “mad” is intrinsically related to concerns for democracy, and de-democratization, for its part, begins by targeting “deviant” figures.

CasaDuna/DuneHouse is a center of art, research and memory created in 2017 by the philosopher Julia Naidin and the visual artist Fernando Codeço. The center is situated at Atafona, a district of the city of São João da Barra, located in the State of Rio de Janeiro, Brazil. Atafona used to be a seaside resort town, but it has been experiencing a very powerful process of erosion in the last decades. As a result of rising sea levels, the landscape has been radically reshaped—as a consequence, part of the coast was swallowed and several buildings slowly became ruins and are now partially submerged. For this reason, the main beach was nicknamed “Apocalypse beach.” The process of erosion taking place in the region is in part a natural one—it is also largely due to the encounter of the Atlantic Ocean with the Paraíba do Sul River—but it seems to have been accelerated by the massive industrial process that took place in the region. The river traverses the three most industrial regions of Brazil, namely, São Paulo, Rio de Janeiro, and Minas Gerais. CasaDuna is a center for art, research, and memory, and is shaped by the physical and psychological processes of erosion that have transformed the landscape and people in the region.

Roots, cotyledons and hypocotyls of Ceratonia siliqua, excised from sterile seedlings produced ed callus on agar with a defined nutrient medium. Callus production takes place in 2-month old ciltures. Percentage callus formation in cotyledons and hypocotyls was greater than in roots. In the cotyledons, callus induction was stimulated in the veins with differentiation of both shoots and roots. Callus growth in the second explant was greatly increased when coconut milk was added to the medium where organogenesis eventually occurred.

This chapter explores the intrinsic relationship between weather/weathering and the imaginary of the sea having as central axis the work of the artist Arthur Bispo do Rosário. Bispo was a black man who spent most of his life in psychiatric institutions. There is an important nexus between his psychotic deliriums and the making of several hundreds of objects, many of them being ships or keeping a relationship to the sea. These objects open the path to a decolonial discussion on the marks left by the history of the transatlantic slave trade.

Depression remains a debilitating condition with an uncertain aetiology. Recently, attention has been given to the renin–angiotensin system. In the central nervous system, angiotensin II may be important in multiple pathways related to neurodevelopment and regulation of the stress response. Studies of drugs targeting the renin–angiotensin system have yielded promising results. Here, we review the potential beneficial effects of angiotensin blockers in depression and their mechanisms of action. Drugs blocking the angiotensin system have efficacy in several animal models of depression. While no randomised clinical trials were found, case reports and observational studies showed that angiotensin-converting enzyme inhibitors or angiotensin receptor blockers had positive effects on depression, whereas other antihypertensive agents did not. Drugs targeting the renin–angiotensin system act on inflammatory pathways implicated in depression. Both preclinical and clinical data suggest that these drugs possess antidepressant properties. In light of these results, angiotensin system-blocking agents offer new horizons in mood disorder treatment.