Repositório RCAAP

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.

Purpose: This overview focuses on placebo and nocebo effects in clinical trials and routine care. Our goal was to propose strategies to improve outcomes in clinical practice, maximizing placebo effects and reducing nocebo effects, as well as managing these phenomena in clinical trials. Methods: A narrative literature search of PubMed was conducted (January 1980-September 2016). Systematic reviews, randomized controlled trials, observational studies, and case series that had an emphasis on placebo or nocebo effects in clinical practice were included in the qualitative synthesis. Search terms included: placebo, nocebo, clinical, clinical trial, clinical setting, placebo effect, nocebo effect, adverse effects, and treatment outcomes. This search was augmented by a manual search of the references of the key articles and the related literature. Findings: Placebo and nocebo effects are psychobiological events imputable to the therapeutic context. Placebo is defined as an inert substance that provokes perceived benefits, whereas the term nocebo is used when an inert substance causes perceived harm. Their major mechanisms are expectancy and classical conditioning. Placebo is used in several fields of medicine, as a diagnostic tool or to reduce drug dosage. Placebo/nocebo effects are difficult to disentangle from the natural course of illness or the actual effects of a new drug in a clinical trial. There are known strategies to enhance clinical results by manipulating expectations and conditioning. Implications: Placebo and nocebo effects occur frequently and are clinically significant but are underrecognized in clinical practice. Physicians should be able to recognize these phenomena and master tactics on how to manage these effects to enhance the quality of clinical practice.

Objectives: Endarterectomy is the treatment of choice for arterial occlusive disease of the femoral bifurcation. Longitudinal arteriotomy and prosthetic patch angioplasty is the standard technique but, due to the increasing concerns with prosthetic-related infections and multidrug-resistant pathogens our group adopted an alternative approach. We present our experience with eversion femoral endarterectomy. Methods: All patients submitted to eversion femoral endarterectomy in a single institution during 2016-2019 were retrospectively analyzed. Patient demographics, surgical data, and complications were captured from medical records. Results: Nineteen patients, 84.2% male and a median age of 67 years (IQR 62-78) were submitted to eversion femoral endarterectomy with a median follow-up of 180 days (IQR 71-395). Seventeen (89.4%) patients were treated for chronic limb ischemia and the other two were submitted to femoral endarterectomy during endovascular aortic aneurysm repair. Most of the patients had smoking history (84.2%), followed by hypertension (68.4%), dyslipidemia (63.2%), coronary heart disease (29.4%), and diabetes (26.3%). Only 3 patients (15.8%) were submitted exclusively to endarterectomy, 13 (68.4%) were submitted to endarterectomy as an adjuvant for peripheral endovascular treatment, 2 (10.5%) as a concomitant procedure to endovascular repair of aortic aneurysm, and 1 (5.3%) was complemented with thrombectomy of the femoro-popliteal sector. Primary patency rates were 100% and 87.5% (CI (38.7-98.1)) at 6 and 12 months, respectively. Primary-assisted and secondary patency rates were 100%. The 30-day mortality rate was 5.3% (n = 1) and complication rate 10.5% (n = 2). One patient complicated with acute renal disease related to rhabdomyolysis. Another patient developed a wound-related hematoma treated with surgical drainage, but died three days after consequent to ischemia-reperfusion injury. Conclusions: Eversion femoral endarterectomy is a safe and feasible technique, with good patency results and respecting the concept of leaving nothing behind. A careful control of the proximal and distal endpoints is essential for the success of the technique.

Fenestrated stent grafting for endovascular repair (F-EVAR) aims to treat patients with abdominal aortic aneurysms that are unsuitable for standard EVAR because of a short or absent infrarenal neck. F-EVAR has been used initially in patients with higher surgical risk with pararenal abdominal aortic aneurysms, but F-EVAR is now increasingly considered a treatment alternative to open surgery in anatomically suitable patients. F-EVAR has benefitted from ongoing technical refinements and accumulating clinical experience but remains a relatively complex procedure. Correct indication, accurate preoperative planning, and meticulous execution are the key to long-term success. Considering the growing interest in F-EVAR worldwide, including the United States, we discuss current indications and provide advice for planning and technical execution on the basis of the senior authors' 13 years of experience.

The rectus femoris (RF) muscle flap, which is widely used to cover groin infected vascular grafts, is usually harvested through distal tendon division and an extensive muscle elevation and transposition into the groin wound defect. A case of a vascular prosthetic graft infection in the groin was successfully controlled after coverage with an RF flap that was harvested based on proximal portion mobilization instead of the conventional distal one. This case suggests that the RF muscle flap based on proximal insertion mobilization is a feasible, effective, technically simpler, and less invasive alternative to cover infected vascular grafts in the groin.

Introduction: Peritoneal dialysis is the dialytic method of choice in chronic end-stage renal disease in children. This study main purpose was to characterize the long-term survival of a pediatric population who began peritoneal dialysis within the first two years of life. Material and Methods: A descriptive and retrospective study was performed in a portuguese nephrology and renal transplantation pediatric unit, between January 1991 and August 2014. End-stage renal disease etiology, mortality, comorbidities and complications of peritoneal dialysis and end-stage renal disease, growth and psychomotor development were evaluated. Results: Twenty children started peritoneal dialysis within the first two years of life. There were six deaths, but no deaths of children with primary chronic kidney disease were registered over the past decade. The 14 living children were characterized; 13 were males. Congenital abnormalities of the kidney and urinary tract were the leading etiology of chronic kidney disease (45%). The average age start of peritoneal dialysis was 6.1 months; six children started before 30 days of life. Peritonitis was the most frequent cause of hospitalization. Ten children were transplanted at an average age of 5.3 years. All of the children who are still in peritoneal dialysis have short stature, but nine of the transplanted have final height within the expected for their mid-parental height target range. Nine (64%) had some type of neurodevelopmental delay. Discussion: Peritoneal dialysis is a technique possible and feasible since birth, as evidenced in the study, as more than half of children successfully started it before 6 months of life. It allows long-term survival until the possibility of renal transplantation despite the associated morbidity, including peritonitis and complications of chronic renal disease. The ten transplanted children improved their growth, recovered from chronic anemia and improved dyslipidemia, compared with the period of dialysis. However, the average waiting time until the renal transplant was 5.3 years higher than other international centers. Conclusion: These data support the use of peritoneal dialysis from birth, but complications and the worst growth reflect the need to develop strategies to optimize care relating to nutrition, growth and development and to reduce pre-transplant time.

No summary/description provided

No summary/description provided

No summary/description provided

No summary/description provided

Na primeira parte desta tese são identificados e analisados os problemas associados à navegação da carreira da Índia no trajecto entre os Açores e Lisboa, se bem que estando integrados numa problemática mais geral da rota global e das próprias relações políticas e económicas de Portugal com outros reinos europeus. Não esquecendo as debilidades da construção naval, a degradação estrutural das embarcações e a sua sobrecarga com mercadorias, assim como as condicionantes da vida a bordo dos navios, veremos como esses aspectos pesavam fortemente no sucesso das viagens, tornando ainda mais difícil a chegada a Lisboa. Aos perigos ligados ao decurso da navegação e da própria realidade da geografia física, podendo levar a naufrágios e a encalhes, somava-se o risco de encontro com corsários e piratas, cuja presença entre os Açores e a costa portuguesa revelou-se bastante activa. Outros problemas surgiam com o descaminho e o contrabando de mercadorias, não apenas de especiarias mas também de escravos. Por sua vez, na segunda parte estudaremos as medidas adoptadas pela Coroa para tentar combater os problemas atrás indicados. Isso passará pela existência de estruturas de apoio à navegação, de um sistema de defesa e de informação, bem como pela promulgação de legislação. Assim, veremos os Açores como local fundamental de escala da carreira da Índia, mas também Cascais a prestar um apoio final inevitável, inclusive através dos pilotos locais. No plano defensivo as armadas da costa e das ilhas tinham um papel basilar, do mesmo modo que a construção de fortificações ajudou a impedir ataques inimigos e beneficiou a protecção que se pretendia dar aos navios que regressavam a Portugal, marcando a paisagem cultural marítima. Para se estabelecer comunicação entre os Açores e Lisboa e manter actualizado o sistema defensivo, havia um sistema de informação em funcionamento baseado no envio de navios de aviso. Algumas das notícias que circulavam vinham directamente do estrangeiro, onde os espiões ao serviço de Portugal iam recolhendo dados sobre o destino das armadas de corsários ou outras que se preparavam para diferentes territórios ultramarinos. Por fim, veremos a promulgação de legislação como forma de tentar evitar o descaminho e o contrabando de mercadorias, assim como outras medidas tomadas de forma extraordinária.

Objectives: To study the effect of two intravenous maintenance fluids on plasma sodium (Na), and acid---base balance in pediatric intensive care patients during the first 24 h of hospitalization. Methods: A prospective randomized controlled study was performed, which allocated 233 patients to groups: (A) NaCl 0.9% or (B) NaCl 0.45%. Patients were aged 1 day to 18 years, had normal electrolyte concentrations, and suffered an acute insult (medical/surgical). Main outcome measured: change in plasma sodium. Parametric tests: t-tests, ANOVA, X2 statistical significance level was set at ˛ = 0.05. Results: Group A (n = 130): serum Na increased by 2.91 (±3.9) mmol/L at 24 h (p < 0.01); 2% patients had Na higher than 150 mmol/L. Mean urinary Na: 106.6 (±56.8) mmol/L. No change in pH at 0 and 24 h. Group B (n = 103): serum Na did not display statistically significant changes. Fifteen percent of the patients had Na < 135 mmol/L at 24 h. The two fluids had different effects on respiratory and post-operative situations. Conclusions: The use of saline 0.9% was associated with a lower incidence of electrolyte disturbances