The genetic landscape of mitochondrial diseases in the next-generation sequencing era: a Portuguese cohort study

Introduction: Rare disorders that are genetically and clinically heterogeneous, such as mitochondrial diseases (MDs), have a challenging diagnosis. Nuclear genes codify most proteins involved in mitochondrial biogenesis, despite all mitochondria having their own DNA. The development of next-generation sequencing (NGS) technologies has revolutionized the understanding of many genes involved in the pathogenesis of MDs. In this new genetic era, using the NGS approach, we aimed to identify the genetic etiology for a suspected MD in a cohort of 450 Portuguese patients. Methods: We examined 450 patients using a combined NGS strategy, starting with the analysis of a targeted mitochondrial panel of 213 nuclear genes, and then proceeding to analyze the whole mitochondrial DNA. Results and Discussion: In this study, we identified disease-related variants in 134 (30%) analyzed patients, 88 with nuclear DNA (nDNA) and 46 with mitochondrial DNA (mtDNA) variants, most of them being pediatric patients (66%), of which 77% were identified in nDNA and 23% in mtDNA. The molecular analysis of this cohort revealed 72 already described pathogenic and 20 novel, probably pathogenic, variants, as well as 62 variants of unknown significance. For this cohort of patients with suspected MDs, the use of a customized gene panel provided a molecular diagnosis in a timely and cost-effective manner. Patients who cannot be diagnosed after this initial approach will be further selected for whole-exome sequencing. Conclusion: As a national laboratory for the study and research of MDs, we demonstrated the power of NGS to achieve a molecular etiology, expanding the mutational spectrum and proposing accurate genetic counseling in this group of heterogeneous diseases without therapeutic options.

Are tomato plants co-exposed to heat and salinity able to ensure a proper carbon metabolism? - An insight into the photosynthetic hub

Abiotic stress combinations, such as high temperatures and soil/water salinization, severely threaten crop productivity worldwide. In this work, an integrative insight into the photosynthetic metabolism of tomato plants subjected to salt (100 mM NaCl) and/or heat (42 °C; 4 h/day) was performed. After three weeks, the stress combination led to more severe consequences on growth and photosynthetic pigments than the individual stresses. Regarding the photochemical efficiency, transcript accumulation and protein content of major actors (CP47 and D1) were depleted in all stressed plants, although the overall photochemical yield was not negatively affected under the co-exposure. Gas-exchange studies revealed to be mostly affected by salt (single or combined), which harshly compromised carbon assimilation. Additionally, transcript levels of stress-responsive genes (e.g., HsfA1 and NHX2) were differentially modulated by the single and combined treatments, suggesting the activation of stress-signature responses. Overall, by gathering an insightful overview of the main regulatory hub of photosynthesis, we show that the impacts on the carbon metabolism coming from the combination of heat and salinity, two major conditioners of crop yields, were not harsher than those of single stresses, indicating that the growth impairment might be attributed to a proficient distribution of resources towards defense mechanisms.

Effect of Ferulago lutea (Poir.) Grande Essential Oil on Molecular Hallmarks of Skin Aging

With the increase in global life expectancy, maintaining health into old age becomes a challenge, and research has thus concentrated on various strategies which aimed to mitigate the effects of skin aging. Aromatic plants stand out as promising sources of anti-aging compounds due to their secondary metabolites, particularly essential oils (EOs). The aim of this study was to ascribe to Ferulago lutea EO several biological activities that could be useful in the context of skin aging. The EO was obtained using hydrodistillation and characterized by gas chromatography-mass spectrometry (GC/MS). The anti-inflammatory potential was assessed using lipopolysaccharide (LPS)-stimulated macrophages. The effect on cell migration was disclosed using scratch wound assay. Lipogenesis was induced using T0901317, hyperpigmentation with 3-isobutyl-1-methylxantine (IBMX) and senescence with etoposide. Our results show that the EO was characterized mainly by α-pinene and limonene. The EO was able to decrease nitric oxide (NO) release as well as iNOS and pro-IL-1β protein levels. The EO promoted wound healing while decreasing lipogenesis and having depigmenting effects. The EO also reduced senescence-associated β-galactosidase, p21/p53 protein levels and the nuclear accumulation of γH2AX. Overall, our study highlights the properties of F. lutea EO that make it a compelling candidate for dermocosmetics applications.

Unveiling the efficacy of pre-emergent application of young Eucalyptus globulus leaves as a weed control strategy: Bridging macroscopic effects and cellular responses

Allelopathy, the inhibition of neighbouring plant growth by certain plants, can be particularly useful if applied in a targeted way for weed management. So, this study aimed to assess and characterize the herbicidal activity of fresh and dried leaves from young Eucalyptus globulus Labill. trees applied as a soil amendment. For this, fresh and dried leaves (FL and DL, respectively) were incorporated into the soil at different concentrations (0, 1, 5, and 10% w/w), where Portulaca oleracea L. seeds were sown. After 5 weeks of exposure, results revealed that the soil incorporation of DL at 10% (w/w) presented the strongest herbicidal properties, inhibiting seed germination by 63% and inducing the loss of cell viability. To unravel the possible mode of action and the main targets at both cellular and subcellular levels, an in vitro experiment was performed. Purslane seeds were sown in a nutritive medium containing different dilutions of an aqueous extract prepared with dried eucalyptus leaves. After 5 days of exposure, germinated seedlings were processed for transmission electron microscopy and histological analyses as well as for reactive oxygen species (ROS) in vivo detection by confocal laser scanning microscopy. Results revealed that the allelochemical release from DL induced ROS overproduction, resulting in the loss of cell integrity and organization, which was characterized by damage to several cellular sub-structures, along with enhanced accumulation of lipid droplets. Overall, the incorporation of DL into the soil can represent a sustainable alternative to reduce synthetic herbicide application and subsequent environmental contamination.

Epidural Anesthesia for Cesarean Section in a Pregnant Woman With Acute Pulmonary Edema: A Case Report

Although rare, acute pulmonary edema is the most common cause of death in pregnant women with severe hypertension. The authors report a case involving a pregnant woman at 36 weeks of gestation with preeclampsia, who exhibited pulmonary edema and required immediate cesarean delivery. The patient had type 1 respiratory failure and needed supplemental oxygenation with a Venturi mask. The cesarean section was performed successfully under epidural anesthesia. Women with severe preeclampsia and acute pulmonary edema remain a challenge when presented for cesarean delivery, and the best anesthetic option remains controversial.

First Dark Matter Search Results from the LUX-ZEPLIN (LZ) Experiment

The LUX-ZEPLIN experiment is a dark matter detector centered on a dual-phase xenon time projection chamber operating at the Sanford Underground Research Facility in Lead, South Dakota, USA. This Letter reports results from LUX-ZEPLIN's first search for weakly interacting massive particles (WIMPs) with an exposure of 60 live days using a fiducial mass of 5.5 t. A profile-likelihood ratio analysis shows the data to be consistent with a background-only hypothesis, setting new limits on spin-independent WIMP-nucleon, spin-dependent WIMP-neutron, and spin-dependent WIMP-proton cross sections for WIMP masses above 9  GeV/c^{2}. The most stringent limit is set for spin-independent scattering at 36  GeV/c^{2}, rejecting cross sections above 9.2×10^{-48}  cm at the 90% confidence level.

The journey of cardosin A in young Arabidopsis seedlings leads to evidence of a Golgi-independent pathway to the protein storage vacuole

The aspartic proteinase cardosin A is a vacuolar enzyme found to accumulate in protein storage and lytic vacuoles in the flowers and protein bodies in the seeds of the native plant cardoon. Cardosin A was first isolated several decades ago and has since been extensively characterized, both in terms of tissue distribution and enzyme biochemistry. In the native system, several roles have been attributed to cardosin A, such as reproduction, reserve mobilization, and membrane remodeling. To participate in such diverse events, cardosin A must accumulate and travel to different compartments within the cell: protein storage vacuoles, lytic vacuoles, and the cytoplasmic membrane (and eventually outside the cell). Several studies have approached the expression of cardosin A in Arabidopsis thaliana and Nicotiana tabacum with promising results for the use of these systems to study of cardosin A trafficking. A poly-sorting mechanism has been uncovered for this protein, as two different vacuolar sorting determinants, mediating different vacuolar routes, have been described. The first is a conventional C-terminal domain, which delivers the protein to the vacuole via the Golgi, and the second is a more unconventional signal-the plant-specific insert (PSI)-that mediates a Golgi-independent route. The hypothesis that these two signals are activated according to cell needs and in organs with high metabolic activity is investigated here. An Arabidopsis line expressing cardosin A under an inducible promoter was used to understand the dynamics of cardosin A regarding vacuolar accumulation during seed germination events. Using antibodies against different regions of the protein and combining them with immunofluorescence and immunocytochemistry assays in different young seedling tissues, cardosin A was detected along the secretory pathway to the protein storage vacuole, often associated with the endoplasmic reticulum. More interestingly, upon treatment with the drug Brefeldin A, cardosin A was still detected in protein storage vacuoles, indicating that the intact protein can bypass the Golgi in this system, contrary to what was observed in N. tabacum. This study is a good starting point for further research involving the use of fluorescent fusions and exploring in more detail the relationship between cardosin A trafficking and plant development.

Conceptual framework for management or transmission of knowledge in companies: A systematic review

The literature on knowledge management as a broad area, typically studied under the scope of business management, and on knowledge transmission as a process, often studied under the scope of work psychology and ergonomics, although extensive, lacks a synthesis regarding the dimensions involved in knowledge management or transmission practices in workplaces. Thus, this study aims to systematize the existing programs for management or transmission of knowledge in workplaces and to develop a conceptual framework to support their design and implementation in this context. Thereto, the study resorts to the main scientific approaches that address knowledge management and knowledge transmission (business management and work psychology/ergonomics). The methodology followed a systematic review to identify and analyse the programs concerning the management or transmission of knowledge implemented in professional contexts, nearly from the beginning of the 21st century, considering the two scientific approaches. The analysis of the 28 articles shows what defines the implemented practices, their impact, and the role assumed by HR. The results demonstrate differences and similarities between the two approaches which guided the dimensions included in the conceptual framework. This study makes advances for both the scientific field, bringing different scientific discourses closer together by acknowledging their strengths; and for practitioners, through the possibility of improving the understanding of the application scope of the concepts of knowledge management and knowledge transmission, as well as supporting their action in workplaces.

Metabolic Disruption of Gold Nanospheres, Nanostars and Nanorods in Human Metastatic Prostate Cancer Cells

Nanomaterials offer a broad spectrum of applications in biomedicine. The shapes of gold nanoparticles could modulate tumor cell behavior. Spherical (AuNP_sp), stars (AuNP_st) and rods (AuNP_r) shapes of polyethylene glycol coated-gold nanoparticles (AuNPs-PEG) were synthesized. Metabolic activity, cellular proliferation, and reactive oxygen species (ROS) were measured and the impact of AuNPs-PEG in metabolic enzymes function was evaluated by RT-qPCR in PC3, DU145, and LNCaP prostate cancer cells. All AuNPs were internalized, and the different morphologies of AuNPs showed to be an essential modulator of metabolic activity. For PC3 and DU145, the metabolic activity of AuNPs was found to rank in the following order from lowest to highest: AuNP_sp-PEG, AuNP_st-PEG, and AuNP_r-PEG. Regarding LNCaP cells, the AuNP_st-PEG were less toxic, followed by AuNP_sp-PEG and AuNP_r-PEG, but it seems not to be dose-dependent. The proliferation was lower in AuNP_r-PEG in PC3 and DU145 cells but was stimulated around 10% in most conditions (0.001-0.1 mM) in LNCaP cells (not statistically significant). For 1 mM, LNCaP cells showed a significant decrease in proliferation only for AuNP_r-PEG. The outcomes of the current study demonstrated that different AuNPs conformations influence cell behavior, and the correct size and shape must be chosen considering its final application in the field of nanomedicine.

Profiling cardiac fibroblasts in regenerative hearts after myocardial infarction

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fundação para a Ciência e Tecnologia (FCT)

Introduction

Mouse neonates at postnatal day 1 (P1) are able to regenerate their hearts after myocardial infarction (MI) by reactivating cardiomyocyte proliferation and neovascularization, with little to no fibrosis. However, this process is transient and 7 day-old animals develop a reparative response as observed in adults [1]. After MI, these animals undergo permanent loss of myocardial tissue that is replaced by a rigid fibrotic scar to avoid organ rupture, having devastating consequences for heart function. Although the role of cardiac fibroblasts (CF) - the main orchestrators of fibrosis – in adults is well-documented, no study has unveiled the role of CF during neonatal regeneration. Recent work from our group showed that at least a subset of neonatal CF is able to provide pro-regenerative cues to cardiomyocytes, pointing to a beneficial role of CF in MI resolution.

Purpose

The ultimate goal of our research is to unravel CF-mediated mechanisms that confer regenerative potential to the neonate and re-activate these processes in the adult.

Methods

Mouse ventricles from E16, P1, P3 and P7 mice were subjected to targeted RNA-sequencing. To unveil non-myocyte cell dynamics in the first week after injury in regenerative (P1) hearts, myocardial infarction (MI) was induced by permanent ligation of the left descending coronary artery. To specifically assess the impact of CF in heart regeneration, a Tcf21iCre knock-in mouse line, carrying the diphtheria toxin receptor, was generated, rendering Tcf21+ CF - the majority of CF in the heart - susceptible to diphtheria toxin.

Results

Transcriptional profiling around birth highlighted severe extracellular matrix (ECM) changes from regenerative (P1) to reparative stages (P7). Coherently, from P1 to P7 CF were found to populate the myocardium and undergo a phenotypic shift that explained the transcriptional alterations observed for ECM-encoding genes, indicating a role of CF in the regeneration to repair transition. After MI at P1, CF were found to be readily and transiently recruited to the ischemic site, peaking at day 5 post-MI and returning to basal levels at day 7, a period in which cardiomyocyte proliferation and neovascularization were up-regulated. Of note, no evidence was found of fibrotic tissue or myofibroblasts from 7 days post-MI onwards. Contrarily, MI at P7 resulted permanent loss of cardiomyocytes, impaired neovascularization and formation of aberrant fibrosis as a result from exuberant and persistent fibroblast recruitment and activation. To evaluate the functional impact of fibroblast ablation during the regenerative response, ablation of Tcf21+ CF was performed after MI at P1. CF removal resulted impaired cardiac cell proliferation, indicating that CF recruited after MI are essential for effective neonatal regeneration.

Conclusion

After birth, CF undergo a switch from a regenerative to reparative phenotype that contributes to the loss of regenerative capacity after birth.

New CTX-M Group Conferring β-Lactam Resistance: A Compendium of Phylogenetic Insights from Biochemical, Molecular, and Structural Biology

The production of extended-spectrum β-lactamases (ESBLs) is the main defense mechanism found in Gram negative bacteria. Among all the ESBLs, the CTX-M enzymes appear as the most efficient in terms of dissemination in different epidemiological contexts. CTX-M enzymes exhibit a striking plasticity, with a large number of allelic variants distributed in several sublineages, which can be associated with functional heterogeneity of clinical relevance. This observational analytical study provides an update of this family, currently with more than 200 variants described, from a phylogenetic, molecular, and structural point of view through homology in amino acid sequences. Our data, combined with described literature, provide phylogenetic and structural evidence of a new group. Thus, herein, we propose six groups among CTX-M enzymes: the already stablished CTX-M-1, CTX-M-2, CTX-M-8, CTX-M-9, and CTX-M-25 clusters, as well as CTX-M-151 as the new cluster.

Coping with Abiotic Stress in Plants-An Endomembrane Trafficking Perspective

Plant cells face many changes through their life cycle and develop several mechanisms to cope with adversity. Stress caused by environmental factors is turning out to be more and more relevant as the human population grows and plant cultures start to fail. As eukaryotes, plant cells must coordinate several processes occurring between compartments and combine different pathways for protein transport to several cellular locations. Conventionally, these pathways begin at the ER, or endoplasmic reticulum, move through the Golgi and deliver cargo to the vacuole or to the plasma membrane. However, when under stress, protein trafficking in plants is compromised, usually leading to changes in the endomembrane system that may include protein transport through unconventional routes and alteration of morphology, activity and content of key organelles, as the ER and the vacuole. Such events provide the tools for cells to adapt and overcome the challenges brought on by stress. With this review, we gathered fragmented information on the subject, highlighting how such changes are processed within the endomembrane system and how it responds to an ever-changing environment. Even though the available data on this subject are still sparse, novel information is starting to untangle the complexity and dynamics of protein transport routes and their role in maintaining cell homeostasis under harsh conditions.

Mechanisms of membrane traffic in plant cells

The organelles of the secretory pathway are characterized by specific organization and function but they communicate in different ways with intense functional crosstalk. The best known membrane-bound transport carriers are known as protein-coated vesicles. Other traffic mechanisms, despite the intense investigations, still show incongruences. The review intends to provide a general view of the mechanisms involved in membrane traffic. We evidence that organelles' biogenesis involves mechanisms that actively operate during the entire cell cycle and the persistent interconnections between the Endoplasmic reticulum (ER), Golgi apparatus, trans-Golgi network (TGN) and endosomes, the vacuolar complex and the plasma membrane (PM) may be seen as a very dynamic membrane network in which vesicular traffic is part of a general maturation process.

Elucidating the role of Cavin1 in drug-induced long QT syndrome (diLQTS)

Introduction

Several drugs can induce QT prolongation by altering cardiac ion currents, notably IKr. The cardiotoxic response to a drug is however extremely variable between individuals, ranging from no impact to life-threatening ventricular arrhythmias. The molecular mechanisms underlying this variability remain unclear. Previously, we reported higher expression levels of Cavin1, an essential protein for caveolae formation, in cardiomyocytes (CM) derived from patients with high susceptibility to develop sotalol-induced long QT.

Purpose

We aimed to explore whether Cavin1 could sway the cardiac repolarization response to drugs.

Method

We used induced pluripotent stem cells-derived CM (iPS-CM) from two subjects with the highest sensitivity (HS) to sotalol (ie, those with the highest increase in QTc) and two individuals with the lowest sensitivity to sotalol (LS) to perform molecular and electrophysiological investigations.

Results

At baseline, no differences in terms of repolarization durations, IKr amplitude, and ion channel expression were noted between the HS- and the LS-iPS-CM. However, the HS-iPS-CM displayed significant prolongation in action potential and field potential (FPD) durations after the application of 30 and 50μM of sotalol. They also displayed higher sensitivity to other drugs targeting hERG (E4031, vandetanib, and clarithromycin). Cavin1 mRNA and protein levels were increased by 2 fold in the HS-iPS-CM as compared to the LS-iPS-CM. Overexpressing Cavin1 in the LS-iPS-CM using adenovirus induced a higher sensitivity to sotalol as only 10μM was sufficient to induce 12% longer FPD. Consistently, the infection with Cavin1 increased the sensitivity of LS-CM to the other hERG blockers. In contrast, siRNA against Cavin1 reduced its expression by 60% in HS iPS-CM and switched their phenotype to a lower sensitivity to sotalol and the other hERG blockers. Interestingly, in line with the shortening of the FPD in LS-iPS-CM, overexpressing Cavin1 increased hERG expression in isolated membrane fraction from HEK cells stably expressing KCNH2. This suggests a role of Cavin1 in modulating hERG trafficking/recycling to the membrane and thereby the number of channels that can be blocked by drugs.

Conclusion

Altogether, this work identified Cavin1 as a novel modulator of cardiomyocyte response to hERG blockers and a potential risk factor for diLQT. Further understanding of its contribution may pave the way for personalized drug prescription to avoid undesirable cardiotoxicity.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Leducq

Scarlet fever in an adult patient: A challenging diagnosis in an airway emergency

Scarlet fever is essentially a childhood disease, although it may occur in all ages. Early diagnosis and treatment are essential in preventing the spread of infection and progression to life-threatening complications. The case presented describes the clinical difficulty in the diagnosis of scarlet fever in an adult patient with acute involvement of the airway (oedematous laryngitis) and the need for emergent orotracheal intubation and eventually tracheotomy. A high degree of suspicion related to the airway involvement is of utmost importance in an emergency room setting.

Abiotic Stress Triggers the Expression of Genes Involved in Protein Storage Vacuole and Exocyst-Mediated Routes

Adverse conditions caused by abiotic stress modulate plant development and growth by altering morphological and cellular mechanisms. Plants’ responses/adaptations to stress often involve changes in the distribution and sorting of specific proteins and molecules. Still, little attention has been given to the molecular mechanisms controlling these rearrangements. We tested the hypothesis that plants respond to stress by remodelling their endomembranes and adapting their trafficking pathways. We focused on the molecular machinery behind organelle biogenesis and protein trafficking under abiotic stress conditions, evaluating their effects at the subcellular level, by looking at ultrastructural changes and measuring the expression levels of genes involved in well-known intracellular routes. The results point to a differential response of the endomembrane system, showing that the genes involved in the pathway to the Protein Storage Vacuole and the exocyst-mediated routes are upregulated. In contrast, the ones involved in the route to the Lytic Vacuole are downregulated. These changes are accompanied by morphological alterations of endomembrane compartments. The data obtained demonstrate that plants’ response to abiotic stress involves the differential expression of genes related to protein trafficking machinery, which can be connected to the activation/deactivation of specific intracellular sorting pathways and lead to alterations in the cell ultrastructure.

Chemical characterization and bioactive potential of Artemisia campestris L. subsp. maritima (DC) Arcang. essential oil and hydrodistillation residual water

ETHNOPHARMACOLOGICAL RELEVANCE

Artemisia campestris L. is widely used in traditional medicine for their anti-inflammatory, antirheumatic, antimicrobial and antioxidant properties. A. campestris subsp. maritima Arcang., a halophyte plant ("madorneira" or "erva-lombrigueira" in Portugal), is traditionally used for gastric disorders, rheumatism and hypertension.

AIM OF THE STUDY

The present study aims to characterize the essential oil (EO) and the hydrodistillation residual water (HRW), a by-product of the EO production, of Artemisia campestris subsp. maritima from Portugal and evaluate the antioxidant, antifungal, anti-inflammatory and wound healing activities of both extracts at concentrations without toxicity.

MATERIALS AND METHODS

The phenolic profile of HRW was determined by HPLC-PDA-ESI/MSⁿ and the EO was analyzed by gas chromatography (GC-FID and GC-MS). The antioxidant activity of both extracts were determined by several assays (ABTS, NO FRAP, β-carotene and DPPH). The antifungal activity (MIC and MLC) was evaluated against yeasts, dermatophytes and Aspergillus strains using broth macrodilution methods. The anti-inflammatory potential was determined measuring the nitric oxide (NO) production by stimulated mouse leukemic macrophages (RAW 264.7). Cell viability was evaluated for RAW 264.7 and mouse fibroblasts (NIH/3T3). The wound healing activity was evaluated in mouse fibroblasts (NIH/3T3) by the scratch assay.

RESULTS

The HRW is mainly characterized by hydroxycinnamic acids and the essential oil is characterized by high amounts of β-pinene (54.5%), cadin-4-en-7-ol (9.5%), Z-β-ocimene (6.0%) and Ƴ-terpinene (4.6%). Both extracts showed high antioxidant potential in different assays. Additionally, only the hydrodistillation residual water showed anti-inflammatory activity (IC₅₀ of 330 μg/mL). On the other hand, only the EO showed antifungal activity, particularly against Epidermophyton floccosum (MIC and MLC values of 0.16 μL/mL), and wound healing activity. Bothe extracts were not cytotoxic to macrophages CONCLUSIONS: The by-product HRW contains safe bioactive compounds with antioxidant and anti-inflammatory effect and the EO shows antioxidant properties, antifungal activity against dermatophytes and wound healing effect in skin cells. Overall, our results support the interest and economic value of two extracts obtained from a Portuguese native species and provide scientific validation to some of its traditional uses.

Benefits of two twelve-week multimodal programs on reaction time in community dwellings at risk of falling: preliminary results

Background

A slower reaction time (RT) performance is considered a risk factor for falls. Different approaches as a psychomotor intervention (involving neuromotor exercises) or the whole-body vibration (inducing neurophysiological changes) may reduce the risk of falls. Nevertheless, a combined program may promote greater gains. This study aimed to investigate the acceptability and the effect of two multimodal programs on RT in community-dwelling older adults fallers or balance-impaired.

Methods

A total of 37 participants (74.3 ± 5.2 years) were divided into two groups (3x/week): experimental group 1 (psychomotor intervention); experimental group 2 [EG2] (combined program: psychomotor intervention + whole-body vibration). The Deary-Liewald reaction time task assessed RT. Simple and choice reaction time [CRT] (ms) tasks were recorded under single and dual-task (DT) paradigms. DT cost was also computed.

Results

The attendance rate was 86.3%. Wilcoxon test comparisons revealed significant differences between baseline and post-intervention evaluations in the EG2. The improvement was observed in the variable ‘CRT-DT’, in which participants spent less time to perform the task (1026.0 ± 153.4 vs. 960.4 ± 160.9, P = 0.040). The correspondent effect size was medium (r = 0.33). The DT cost was also decreased in CRT-DT by 3.9%. No significant differences between groups were found.

Conclusions

This study demonstrated that both programs were safe and highly attended. The results suggest that a combined intervention (psychomotor intervention + whole-body vibration) should be privileged to improve RT and reduce the risk of falls. Trial Registration: ClinicalTrials.gov Identifier: NCT03446352. Funding: This study was supported by the ESACA Project (Grant ALT20-03-0145-FEDER-000007) and by FCT (SFRH/BD/147398/2019).

Novel approaches to reduce the risk of falling in community dwellings: effects of two multimodal programs in lower-body strength—a pilot study

Background

Muscle weakness is a key risk factor for falls and strength exercises should be included in fall prevention programs. A psychomotor intervention promoting motor stimulation and the whole-body vibration (WBV) providing muscle contractions may reduce the incidence of falls. Our hypothesis relies on the greater benefits of a combined program. This study aimed to evaluate the effectiveness and the feasibility of two 12-week multimodal programs in lower-body strength in community dwellings fallers or with balance impairment.

Methods

Thirty-seven participants (34 women; mean age 74.3 ± 5.2 years) were allocated into: experimental group 1 [EG1] (psychomotor intervention), or experimental group 2 [EG2] (combined program: psychomotor intervention plus WBV), 3x/week. Maximal strength of knee extensors and flexors was assessed by an isokinetic dynamometer at 60°/s. Wilcoxon and Mann-Whitney tests were performed.

Results

The overall adherence rate was high (86.3%), with a level intensity in the rating of perceived exertion of 12.1 ± 0.3 points, in EG1, and 12.5 ± 0.4 points, in EG2. Significant changes between the pre-post intervention were observed exclusively in EG2, in the variables ‘Peak torque extension’ (71.7 ± 28.6 Nm vs. 79.2 ± 23.5 Nm, P = 0.042) and ‘Agonist/Antagonist ratio’ (60.2 ± 13.0 vs. 53.5 ± 8.6, P = 0.013). The effect size (r) in both variables was medium. No significant changes between groups were detected.

Conclusions

This pilot results indicate that both programs were feasible and well-tolerated. The combined program demonstrates larger effectiveness, since the WBV may positively influence the lower-body strength, reducing the risk of falls. Trial Registration: ClinicalTrials.gov Identifier: NCT03446352. Funding: This pilot was granted by the ESACA Project (Grant ALT20-03-0145-FEDER-000007) and by FCT (SFRH/BD/147398/2019).

Extensive skin necrosis after periprosthetic knee infection: a case that highlights the possibility of complications induced by low-molecular-weight heparin

We describe a case of a patient with atrial fibrillation, anticoagulated with dabigatran, that developed severe knee skin necrosis in the setting of an acute periprosthetic knee infection, after initiating low-molecular-weight heparin. A wide range of etiology hypotheses was discussed within a multidisciplinary team. The complex approach consisted of treating the underlying infection, multiple types of soft-tissue management, and stopping enoxaparin.

Hopelessness in patients with schizophrenia

Introduction

Individuals with schizophrenia have a shortened average life expectancy, with a lifetime risk of suicide around 5%.

Objectives

Here we present a case of a patient diagnosed with schizophrenia who developed depressive symptoms with suicidal ideation, reactive to psychotic symptoms. Considering this specific case, the factors that contribute to the increased risk of suicide in these patients are reviewed.

Methods

Relevant clinical information was extracted from the patient’s clinical process. In addition, we searched Pubmed^R database with the terms “Schizophrenia”, “Hopelessness” and “Suicide”.

Results

A 40-year-old male patient, single and unemployed presents a progressive psychotic condition, with 20 years of evolution, with an impact on social and work behaviour. As a background he has a history of depressive episodes with suicidal ideation at the age of 36, following psychotic symptoms. This is a patient with preserved cognitive functioning combined with a high level of education, who understands the impact of his reality on his functioning. In this context, he develops feelings of hopelessness, that are the risk factor for suicide, most consistently reported in patients with schizophrenia.

Conclusions

This case assesses a patient with schizophrenia who has several factors, that contribute to an increased risk of suicide, focusing on hopelessness. In the future, it may be interesting to study in more detail the individual weight of each factor, so that it is possible to accurately predict the individual risk of each patient and, consequently, it is possible to implement preventive strategies.

Exome sequencing detected an extremely rare case of foetal onset familial haemophagocytic lymphohistiocytosis type 5 presenting with hydrops foetalis

Background

Familial hemophagocytic lymphohistiocytosis (FHL) is a genetically heterogeneous autosomal recessive hyper-inflammatory syndrome which needs early accurate diagnosis and appropriate treatment to prevent complications and early mortality. Recently, it was reported that mutations in STXBP2 gene are linked to FHL type 5 (FHL-5).

Case Presentation

We report a Sri Lankan neonate who presented with low Apgar scores at birth, abdominal distension, and hepatosplenomegaly, followed by lethargy, poor sucking and rapid decompensation with wide spread activation of inflammation within 48 h of birth. Her elder sibling also had a similar presentation during early neonatal period and deceased at two weeks of age with no diagnosis. Unfortunately, the index case deceased at 14 days of age following multi-organ dysfunction and severe metabolic acidosis. Targeted gene panel followed by reflex exome sequencing revealed a novel likely pathogenic homozygous variant in the STXBP2 gene (NM_001272034.1:c.1141-2A > G) which confirmed the diagnosis of autosomal recessive FHL-5.

Conclusion

Early diagnosis of FHL type 5 using genetic analysis and timely treatment are difficult in the absence of family history due to a wide spectrum of clinical manifestations. However both early diagnosis and treatment doesn’t alter the long term prognosis. So genetic counselling would be the better option.

In vitro evaluation of potential benefits of a silica-rich thermal water (Monfortinho Thermal Water) in hyperkeratotic skin conditions

Thermal therapy has gained popularity over the years, and Portugal is one of the richest European countries in mineral therapeutic waters. The interest in the use of these natural mineral waters (NMW) for dermatologic purposes is continuously growing but there is a lack of scientific studies supporting its health benefits. The study aims to investigate the effect of a silica-rich NMW in skin cell homeostasis using two representative cell lines of the epidermis and dermis, keratinocytes and fibroblasts, respectively, in addition to a macrophage cell line. Mouse skin fibroblasts, macrophages and human keratinocytes were exposed to culture medium prepared with NMW. Cell metabolism (MTT or resazurin assays) and cell proliferation (trypan blue exclusion dye assay) were investigated. Migration (scratch-wound assay) and senescence (β-galactosidase activity assay) of fibroblasts were also studied. Exposure to NMW compromised the cell metabolic state of all the cell lines tested. This impairment was more pronounced in skin keratinocytes (60% reduction) relatively to skin fibroblasts (45% reduction) or macrophages (25% reduction). Proliferation of macrophages was reduced threefold upon exposure to thermal water, compared to controls. No differences were observed in migration between fibroblasts exposed to NMW and controls, while a potentiation of senescence of these cells was observed. Our results shed light in the bioactive effects of a silica-rich NMW supporting its therapeutic use. A reduction in both cell metabolism and proliferation of keratinocytes and macrophages supports the empirical clinical benefits of this NMW in hyperkeratotic conditions, such as psoriasis and atopic dermatitis.

Calcium Modulation, Anti-Oxidant and Anti-Inflammatory Effect of Skin Allergens Targeting the Nrf2 Signaling Pathway in Alzheimer's Disease Cellular Models

Experimental evidence highlights nuclear factor (erythroid-derived 2)-like 2 (Nrf2) as a molecular target in Alzheimer's disease (AD). The well-known effect of electrophilic cysteine-reactive skin allergens on Nrf2-activation led to the hypothesis that these compounds could have a therapeutic role in AD. This was further supported by the neuroprotective activity of the skin allergen dimethyl fumarate (DMF), demonstrated in in vivo models of neurodegenerative diseases. We evaluated the effect of the cysteine-reactive allergens 1,4-phenylenediamine (PPD) and methyl heptine carbonate (MHC) on (1) neuronal redox imbalance and calcium dyshomeostasis using N2a wild-type (N2a-wt) and human APP-overexpressing neuronal cells (wild-type, N2a-APPwt) and (2) on neuroinflammation, using microglia BV-2 cells exposed to LPS (lipopolysaccharide). Phthalic anhydride (PA, mainly lysine-reactive), was used as a negative control. DMF, PPD and MHC increased Hmox1 gene and HMOX1 protein levels in N2a-APPwt cells suggesting Nrf2-dependent antioxidant activity. MHC, but also PA, rescued N2a-APPwt mitochondrial membrane potential and calcium levels in a Nrf2-independent pathway. All the chemicals showed anti-inflammatory activity by decreasing iNOS protein in microglia. This work highlights the potential neuroprotective and anti-inflammatory role of the selected skin allergens in in vitro models of AD, and supports further studies envisaging the validation of the results using in vivo AD models.

Validation of a semi-automated surveillance system for surgical site infections: Improving exhaustiveness, representativeness, and efficiency

OBJECTIVES

To assess whether electronic records data could improve the efficiency, exhaustiveness, and representativeness of SSI surveillance by selecting a group of high-risk patients for manual review.

METHODS

Colorectal surgeries (2016-2018) and cholecystectomies (2017-2018) were selected. Post-surgical antibiotic use, positive culture, C-reactive protein (CRP) values, body temperature, leukocyte count, surgical re-intervention, admission to the emergency room, and hospital readmission were retrieved. For representativeness, procedures registered in HAI-Net were compared with non-included procedures, and the validity of each variable (or combination) was tested considering the presence of SSI as the gold standard. The proportion of procedures flagged for manual review by each criterion was estimated.

RESULTS

Little more than 50% of procedures were included in HAI-Net (SSI risk: 10.6% for colorectal and 2.9% for cholecystectomies). Non-included procedures showed higher proportions of infection markers. Antibiotic use and CRP >100 mg/dl presented the highest sensitivity for both surgical groups, while antibiotic use achieved the highest positive predictive value in both groups (22% and 21%, respectively) and flagged fewer colorectal procedures (47.7%).

CONCLUSIONS

Current SSI surveillance has major limitations. Thus, the reported incidence seems unreliable and underestimated. Antibiotic use appears to be the best criterion to select a sub-sample of procedures for manual review, improving the exhaustiveness and efficiency of the system.

Chemical signature and antimicrobial activity of Central Portuguese Natural Mineral Waters against selected skin pathogens

The common therapeutic indications of Portuguese Natural Mineral Waters (NMWs) are primarily for respiratory, rheumatic and musculoskeletal systems. However, these NMWs have been increasingly sought for dermatologic purposes. Opposing to what is observed in the major European Thermal Centres, there are few scientific evidences supporting the use of Portuguese NMWs for clinical applications. The aim of this study was to characterize the antimicrobial profile of individual NMWs from the central region of Portugal and correlate the results with their physicochemical characterization. An extensive multivariate analysis (principal component analysis) was also performed to further investigate this possible correlation. Six collection strains representing skin microbiota, namely Staphylococcus aureus, Escherichia coli, Corynebacterium amycolatum, Candida albicans, Staphylococcus epidermidis and Cutibacterium acnes, were analysed, and their antimicrobial profile was determined using Clinical and Laboratory Standards Institute M07-A10, M45-A2, M11-A6 and M27-A3 microdilution methods. Different NMWs presented different antimicrobial profiles against the strains used; the physicochemical composition of NMWs seemed to be correlated with the different susceptibility profiles. Cutibacterium acnes showed a particularly high susceptibility to all NMWs belonging sulphurous/bicarbonated/sodic ionic profile, exhibiting microbial reductions up to 65%. However, due to the complex physicochemical composition of each water an overall conclusion regarding the effect of a specific ion on the growth of different microorganisms is yet to be known.

Forssman Prevalence in a Portuguese Donor Population

Introduction Discovered in 1911 by Frederick Forssman, the Forssman (Fs) antigen (Ag) expression varies among species, being rarely present on human red blood cells (RBC). In 1987 three unrelated English families were identified with a phenotype designed Apae which was later classified as the 31st blood group: FORS. Since antibodies (Ab) anti-Fs has natural occurrence and the expression of the Ag occurs on the surface of the RBC, body fluids and organs, raises a potential role for this antigen in transfusion and transplantation implications.

Objectives Our main goals were to evaluate the prevalence of anti-Fs Ab and clarify its impact in transfusional medicine by classifying the type of immunoglobulin (Ig) involved.

Methodology 3-5% sheep RBC suspension with positive expression for Fs Ag was used to evaluate the presence of Ab anti-Fs in plasma samples from a Portuguese population of blood donor and classify the immunoglobulin involved. Standard tube technique was used in all the experiments.

Results From a total of 11877 donors, 117 (0,99%) showed weak reactions (between 0 and 1 in a scale from 0 to 4). All these samples would be further studied to evaluate the presence of the Arg296Gln in the GBGT1 gene. Also, from the 192 samples studied to classify the Ab involved, 52% revealed to be only IgM, being the rest a mixture between IgG and IgM.

Conclusion The population studied revealed few samples with negative reaction against the sheep RBC confirm the low-prevalence of this blood group. The majority from the Ab to be IgM was also corroborated although the presence of an IgG portion can be clinically significant once it can cross the placental barrier.

Associations of socioeconomic and health related factors with fall risk on community dwelling older adults from Alentejo

Introduction With the world, population ageing falls become a problem. Portugal follows this tendency, particularly in Alentejo. Ecological models evidence that biological, behaviour and socioeconomic factors explain falls. However, the role of socioeconomic and health-related factors on the risk of falls is not well known.

Objectives To analyse the association of socioeconomic and health-related factors with fall risk on community-dwelling older adults from Alentejo.

Methodology This observational study involved 384 community-dwelling older adults (73.6 ± 6.0 years), the minimal sample size calculated by Open Epi Online program, of whom 40.6% fell at least once in the previous year. Sociodemographic characteristics (age, gender, marital status, schooling, retirement age, living alone and yield) and health-related factors (number of health conditions, cognitive state, fat mass %, physical activity, and depression index) were accessed.

Results Univariate Regression Logistic showed that gender was the only sociodemographic characteristics which significantly explains falls occurrence, in which to be woman increases the likelihood of falling on 96% (OR: 1.96, p < 0.05). As regard health-related factors, results show that for each additional health condition the likelihood of falling increased 17%, for each additional 1% on fat mass this likelihood increased 4%, and for each additional point on depression index this likelihood increased 15.1% (OR: 1.04 to 1.17, p < 0.05).

Conclusion Health-related factors showed to be more preponderant in the occurrence of falls compared to socio-demographic characteristics. Women with more chronic conditions increased fat mass, and high depression index will be the most susceptible to falls. Thus, preventive measures should play particular attention to these persons.

Twelve-week multimodal programs can improve dual-task performance in risk factors for falls in community-dwelling older adults: a pilot study

Introduction Performing a dual-task (DT), mainly while walking and performing another task simultaneously, is seen as determinants factors for falls and injuries in older adults. A psychomotor intervention relying on the prevention of sensorimotor and neurocognitive deterioration may prevent falls. The whole-body vibration (WBV) promotes the increase of agility, reducing the risk of falling. However, an intervention that combines both methods can lead to additional benefits, particularly as regards DT.

Objectives To evaluate the feasibility and the effect of two multimodal programs designed for community-dwelling older adults, fallers or at high risk of falling, on DT performance ability.

Methodology Thirty-seven participants (74.3±5.2 years) were randomly assigned into experimental group 1 [EG1] (psychomotor intervention); or experimental group 2 [EG2] (psychomotor intervention + WBV). DT performance (TUGcog) was assessed by the Timed Up and Go Test (s) performed simultaneously with the counting backward cognitive task.

Results Adherence rate was 86.3%. Wilcoxon test comparisons showed improvements from baseline to post-intervention on EG1 (time (s): 10.1±2.7 vs. 9.0±2.7, p = 0.001; cognitive stops (n): 0.9±1.0 vs. 0.2±0.4, p = 0.012; motor stops (n): 0.3±0.5 vs. 0.0±0.0, p = 0.025), corresponding to an effect size (cohen’s d) ranging from 0.41 (small) to 0.92 (medium) and on EG2 (time (s): 9.9±2.5 vs. 8.5±1.8, p = 0.010; cognitive stops (n): 1.1±0.7 vs. 0.4±0.5, p = 0.004), corresponding to a d ranging from 0.64 (medium) to 1.15 (medium). There were no significant differences between groups.

Conclusion These preliminary results suggested that the multimodal programs were feasible and effective in reducing the risk of falling by improving the determinant risk factor DT performance. Trial Registration: ClinicalTrials.gov Identifier: NCT03446352. Funding: This study was funded by ESACA Project (Grant ALT20-03-0145-FEDER-000007) and by FCT (SFRH/BD/147398/2019).

No man is an island: spatial clustering and access to primary care as possible targets for the development of new community mental health approaches

BACKGROUND

to understand if patients seen at Centro Hospitalar Psiquiátrico de Lisboa (CHPL) live in geographical clusters or randomly throughout the city, as well as determine their access to the psychiatric hospital and primary care facilities (PCF).

METHODS

spatial autocorrelation statistics were performed (queen criterion of contiguity), regarding all patients observed at CHPL in 2017 (at the census subsection level), and considering not only their overall number but also main diagnosis, and admission to the psychiatric ward - voluntary or compulsory. Distance to the hospital and to the closest PCF was measured (for each patient and the variables cited above), and the mean values were compared. Finally, the total number of patients around each PCF was counted, considering specified radius sizes of 656 and 1000 m.

RESULTS

All 5161 patients (509 psychiatric admissions) were geolocated, and statistical significance regarding patient clustering was found for the total number (p-0.0001) and specific group of disorders, namely Schizophrenia and related disorders (p-0.007) and depressive disorders (p-0.0002). Patients who were admitted in a psychiatric ward live farther away from the hospital (p-0.002), with the compulsory admissions (versus voluntary ones) living even farther (p-0.004). Furthermore, defining a radius of 1000 m for each PCF allowed the identification of two PCF with more than 1000 patients, and two others with more than 800.

CONCLUSIONS

as patients seem to live in geographical clusters (and considering PCFs with the highest number of them), possible locations for the development of programs regarding mental health treatment and prevention can now be identified.

Reconfiguração do horário de trabalho para turnos de 12h: que impactos na saúde?

Num contexto normativo que amplia a margem para configuração de horários de trabalho ao abrigo de um “regime de adaptabilidade”, acentua-se o debate sobre os turnos de 12h, em virtude de uma conjuntura que mobiliza mais trabalhadores para tais horários, bem como das evidências de impactos na saúde. A partir da análise da mudança de um horário 3x8h para 2x12h numa empresa portuguesa, este estudo explora os fatores e condições considerados de risco agravado em jornadas de 12h. Os resultados revelam que os trabalhadores, no confronto com os constrangimentos do trabalho nestes horários, constroem estratégias de preservação de si e do coletivo, ainda que estas estratégias comportem custos para a saúde. A ponderação (no imediato e a longo prazo) que cada trabalhador faz sobre a sustentabilidade do trabalho em 12h convoca, simultaneamente, para debate: as especificidades do conteúdo de trabalho, a fase do percurso profissional e as suas exigências concretas, e os imperativos de conciliação com a vida fora do trabalho.

Pru p 3 sublingual immunotherapy ultra-rush protocol is safe and clinically effective

Summary

Introduction. Sublingual immunotherapy (SLIT) with Pru p 3 can prevent severe allergic reactions to LTP-containing foods, but the standard initiation protocol is time-consuming. Objectives. Establish the safety of a novel ultra-rush initiation protocol for SLIT with Pru p 3. Methods. Prospective study comparing the side effects of the standard vs novel ultra-rush initiation protocols of SLIT with Pru p 3 in patients with anaphylaxis to LTP. Results. Fifteen patients were included (standard initiation, 5; ultra-rush initiation, 10), 80% females. All patients had oropharyngeal pruritus during initiation, 80% with spontaneous recovery, but no other gastro-intestinal, respiratory, cutaneous or systemic side effects occurred in any patient of both groups. Conclusion. The novel ultra-rush protocol halved the build-up time without increasing side effects.

N-Linked Glycosylation Modulates Golgi-Independent Vacuolar Sorting Mediated by the Plant Specific Insert

In plant cells, the conventional route to the vacuole involves the endoplasmic reticulum, the Golgi and the prevacuolar compartment. However, over the years, unconventional sorting to the vacuole, bypassing the Golgi, has been described, which is the case of the Plant-Specific Insert (PSI) of the aspartic proteinase cardosin A. Interestingly, this Golgi-bypass ability is not a characteristic shared by all PSIs, since two related PSIs showed to have different sensitivity to ER-to-Golgi blockage. Given the high sequence similarity between the PSI domains, we sought to depict the differences in terms of post-translational modifications. In fact, one feature that draws our attention is that one is N-glycosylated and the other one is not. Using site-directed mutagenesis to obtain mutated versions of the two PSIs, with and without the glycosylation motif, we observed that altering the glycosylation pattern interferes with the trafficking of the protein as the non-glycosylated PSI-B, unlike its native glycosylated form, is able to bypass ER-to-Golgi blockage and accumulate in the vacuole. This is also true when the PSI domain is analyzed in the context of the full-length cardosin. Regardless of opening exciting research gaps, the results obtained so far need a more comprehensive study of the mechanisms behind this unconventional direct sorting to the vacuole.

Fe3O4@Au nanoparticles-based magnetoplatform for the HMGA maize endogenous gene electrochemical genosensing

This work addresses a technological advance applied to the construction of a magnetogenoassay with electrochemical transduction for the maize taxon-specific (HMGA gene) detection using gold-coated magnetic nanoparticles as nanosized platform. Superparamagnetic core-shell Fe₃O₄@Au nanoparticles (10.4 ± 1.7 nm) were used to assemble the genoassay through the covalent immobilization of HMGA DNA probes onto carboxylated self-assembled monolayers at the nanoparticles surface. A hybridization reaction using sandwich format was selected to prevent inefficient hybridization connected with stable secondary DNA structures using also fluorescein isothiocyanate as DNA signaling tag. The labelling of the hybridization reaction with enzymes allowed the chronoamperometric measurement of the peroxidase activity linked to the nanoplatform located on gold surface. Using this electrochemical magnetogenoassay a linear concentration range from 0.5 to 5 nM and a LOD of 90 pM with a RSD <1.2% was calculated. Certified maize was evaluated without further purification after PCR amplification. This work highlights the efficacy of the electrochemical magnetogenoassay for the HMGA detection, showing its potential as alternative procedure for the verification of the compliance of the legislation.

Reconfiguração do horário de trabalho para turnos de 12h: que impactos na saúde?

Num contexto normativo que amplia a margem para configuração dehorários de trabalho ao abrigo de um “regime de adaptabilidade”, acentua-se o debate sobre os turnos de 12h, em virtude de uma conjuntura que mobiliza mais trabalhadores para tais horários, bem como das evidências de impactos na saúde. A partir da análise da mudança de um horário 3x8h para 2x12h numa empresa portuguesa, este estudo explora os fatores e condições considerados de risco agravado em jornadas de 12h. Os resultados revelam que os trabalhadores, no confronto com os constrangimentos do trabalho nestes horários, constroem estratégias de preservação de si e do coletivo, ainda que estas estratégias comportem custos para a saúde. A ponderação (no imediato e a longo prazo) que cada trabalhador faz sobre a sustentabilidade do trabalho em 12h convoca, simultaneamente, para debate: as especificidades do conteúdo de trabalho, a fase do percurso profissional e as suas exigências concretas, e os imperativos de conciliação com a vida fora do trabalho.