Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study

BACKGROUND

Dyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function.

METHODS

Dyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as ≥2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis.

RESULTS

The prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC

CONCLUSION

The prevalence of dyspnoea varies substantially across the world and is strongly associated with lung function impairment. Using the mMRC scale in epidemiological research should be discussed.

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Key Words

• Breathlessness
• Dyspnoea
• Lung function
• Spirometry

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Affiliation(s)

A Müller Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
E F Wouters Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
P Koul Department of Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
T Welte Department of Respiratory Medicine/Infectious Disease, Member of the German Centre for Lung Research, Hannover School of Medicine, Hannover, Germany
I Harrabi Faculté de Médecine, Sousse, Tunisia
A Rashid RCSI and UCD Malaysia Campus, Penang, Malaysia
L C Loh RUMC, Penang, Malaysia
M Al Ghobain King Abdullah International Medical Research Center, King Saud ben Abdulaziz University for Health Science, Riyadh, Saudi Arabia
A Elsony The Epidemiological Laboratory, Khartoum, Sudan
R Ahmed The Epidemiological Laboratory, Khartoum, Sudan
J Potts National Heart and Lung Institute, Imperial College London, London, UK
K Mortimer University of Cambridge, Cambridge, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
F Rodrigues Pulmonology Department, Lisbon North Hospital Centre, Lisbon, Portugal; Institute of Environmental Health, Associate Laboratory TERRA, Lisbon Medical School, Lisbon University, Lisbon, Portugal
S N Paraguas Philippine College of Chest Physicians, Manila, Philippines
S Juvekar KEM Hospital Research Centre, Pune, India
D Agarwal KEM Hospital Research Centre, Pune, India
D Obaseki Department of Medicine, Obafemi Awolowo University, Nigeria; Faculty of Medicine, University of British Columbia, Canada
T Gislason Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
T Seemungal Faculty of Medical Sciences, University of West Indies, St Augustine, Trinidad and Tobago
A A Nafees Aga Khan University, Karachi, Pakistan
C Jenkins Woolcock Institute of Medical Research, Sydney, Australia
H B Dias Escola Superior de Tecnologia da Saúde de Lisboa, Politecnico de Lisboa, Lisbon, Portugal
F M E Franssen Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
M Studnicka Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
C Janson Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
H H Cherkaski Faculty of Medicine, University Badji Mokhtar, Annaba, Algeria
M El Biaze Department of Respiratory Medicine, Faculty of Medicine, Mohammed Ben Abdellah University, Fes, Morocco
P A Mahesh Department of Respiratory Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India
J Cardoso Pulmonology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; NOVA Medical School, Nova University Lisbon, Lisboa, Portugal
P Burney National Heart and Lung Institute, Imperial College London, London, UK
S Hartl Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria
D J A Janssen Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
A F S Amaral National Heart and Lung Institute, Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, London, UK

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The relationships between passions, intentions, habit and exercise frequency

There were three purposes to this research. First, we sought to test the differential role of harmonious and obsessive passion in predicting intention and habit for exercise. The second goal of this research was to test the associations between intention, habit and exercise frequency. Last, the third goal was to assess the mediation role of intention and habit in the relationship between both forms of passion and exercise frequency. The sample consisted of 284 participants (140 males, 144 females) aged 18-60 years old (M age = 29.81, SD = 9.16). Regression paths of the structural model indicated significant associations: a) harmonious passion was significantly associated with intentions and habit; b) obsessive passion was significantly associated with habit; c) intentions and habit were significantly associated with exercise frequency. The mediation model variance explained was 17% (p < .001). The total effect via harmonious and obsessive passion was β = .57 (IC95% = .42, .73) and the total indirect effect was β = .11 (IC95% = .02, .24). Having harmonious passion for a fitness activity appears to have the potential to increase regular physical activity among exercisers. Individuals who recognize the significance of physical exercise and participate in activities they enjoy the most can affirm the positive effects on their health from being active.

Biocatalysis for biorefineries: The case of dye-decolorizing peroxidases

Dye-decolorizing Peroxidases (DyPs) are heme-containing enzymes in fungi and bacteria that catalyze the reduction of hydrogen peroxide to water with concomitant oxidation of various substrates, including anthraquinone dyes, lignin-related phenolic and non-phenolic compounds, and metal ions. Investigation of DyPs has shed new light on peroxidases, one of the most extensively studied families of oxidoreductases; still, details of their microbial physiological role and catalytic mechanisms remain to be fully disclosed. They display a distinctive ferredoxin-like fold encompassing anti-parallel β-sheets and α-helices, and long conserved loops surround the heme pocket with a role in catalysis and stability. A tunnel routes H₂O₂ to the heme pocket, whereas binding sites for the reducing substrates are in cavities near the heme or close to distal aromatic residues at the surface. Variations in reactions, the role of catalytic residues, and mechanisms were observed among different classes of DyP. They were hypothetically related to the presence or absence of distal H₂O molecules in the heme pocket. The engineering of DyPs for improved properties directed their biotechnological applications, primarily centered on treating textile effluents and degradation of other hazardous pollutants, to fields such as biosensors and valorization of lignin, the most abundant renewable aromatic polymer. In this review, we track recent research contributions that furthered our understanding of the activity, stability, and structural properties of DyPs and their biotechnological applications. Overall, the study of DyP-type peroxidases has significant implications for environmental sustainability and the development of new bio-based products and materials with improved end-of-life options via biodegradation and chemical recyclability, fostering the transition to a sustainable bio-based industry in the circular economy realm.

Profile of emergency department overuse in hospitalized patients with pulmonary disease and its impact on mortality

INTRODUCTION AND OBJECTIVES

Portugal is one of the countries with the highest number of visits to the emergency department (ED), 31% classified as "non-urgent" or "avoidable." The objectives of our study were to evaluate the size and characteristics of patients with pulmonary disease who overuse the ED, and identify factors associated with mortality.

MATERIALS AND METHODS

A retrospective cohort study was conducted, based on the medical records of ED frequent users (ED-FU) with pulmonary disease who attended a university hospital center in the northern inner city of Lisbon from January 1 to December 31, 2019. To evaluate mortality, a follow-up until December 31, 2020 was performed.

RESULTS

Over 5,567 (4.3%) patients were identified as ED-FU and 174 (0.14%) had pulmonary disease as the main clinical condition, accounting for 1,030 ED visits. 77.2% of ED visits were categorized as "urgent/very urgent." A high mean age (67.8 years), male gender, social and economic vulnerability, high burden of chronic disease and comorbidities, with a high degree of dependency, characterized the profile of these patients. A high proportion (33.9%) of patients did not have a family physician assigned and this was the most important factor associated with mortality (p<0.001; OR: 24.394; CI 95%: 6.777-87.805). Advanced cancer disease and autonomy deficit were other clinical factors that most determined the prognosis.

CONCLUSIONS

Pulmonary ED-FU are a small group of ED-FU who constitute an aged and heterogeneous group with a high burden of chronic disease and disability. The lack of an assigned family physician was the most important factor associated with mortality, as well as advanced cancer disease and autonomy deficit.

Which effects had the pandemic in migrants’ health and well-being? A mixed-methods approach

Background

The COVID-19 pandemic affected populations’ health, with a disproportionate impact on those most socially vulnerable such as migrants. The way these populations experienced the pandemic lockdowns and its effects on daily life are yet to be known. This study aimed to understand the effects of the pandemic on health and well-being of migrants in Portugal.

Methods

In a mixed-methods approach, a survey was conducted with a community-based sample of 1126 migrants in the Lisbon Metropolitan Area, assessing sociodemographics, migration-related characteristics and the perceived impact of the pandemic on health. In addition, n = 12 migrants purposively recruited were invited to participate in a photovoice study, sharing photographs about their daily life during the lockdowns. Following semi-structured interviews were conducted. Quantitative data were analysed using multivariable analysis and qualitative data were analysed through content analysis.

Results

A fifth of the participants perceived having worse health condition since the pandemic, which was more likely among women (OR = 1.58, CI95% 1.13-2.20), those &gt;45 years old (OR = 1.78, CI95% 1.02-3.16), with lower education (Basic education: OR = 1.57, CI95% 1.01-2.47) and with lower monthly income (&lt;EUR 650: OR = 1.69, CI95% 1.18-2.44). Two themes emerged from the photovoice: effects of the pandemic lockdowns on daily life (routines, social relations, work) and on health and well-being (eating habits, physical exercise, leisure). Strategies to cope with the adverse effects included social activation and changes in lifestyles.

Conclusions

The pandemic had disproportionate effects on some migrant groups, intensifying social and health inequalities, with consequences for their well-being. Participatory methods can contribute to further understand migrants’ experiences while involving and empowering them for health promotion.

Key messages

• The pandemic had adverse effects on migrants’ health and well-being, disproportionately affecting most socially vulnerable migrant groups.

• Participatory research methods as photovoice are valuable to gain access to individual experiences and perspectives, while involving and empowering participants.

The relationship between past exercise behavior and future exercise adherence: A sequential mediation analysis

The present study explored the mediation role of past exercise adherence, self-reported frequency and intentions in the association between past experience and future exercise adherence. In total, 431 exercisers (female = 216; male = 215) aged 18 and 64 years, engaged in fitness activities such as group fitness classes and resistance training, were included in the analysis. Serial mediation procedures were employed to examine the direct, indirect, and total indirect effects among variables. The predictor variable and all mediators displayed a positive and significant association with future six-month adherence. Past six-month exercise adherence displayed the most significant association with future six-month adherence. The sequential indirect path from exercise experience → past six-months adherence → self-reported frequency → intentions future six-months adherence displayed a positive and significant effect (β = .19 [CI95% = .09, .31]), presenting a partial mediation effect. Past behaviour is the most significant predictor of future adherence, and thus interventions should be based on promoting consistent exercise frequency. Professionals working in the fitness centre context can identify possible dropouts based on their past behaviour and intentions to be physically active in the future.

Dissection of the role of microRNAs in cardiac fibrosis through functional genomics screenings

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FCT, Portuguese Foundation for Science and Technology

Cardiac fibrosis is a maladaptive remodelling process of the myocardium, which results from an over-activation of cardiac fibroblasts into myofibroblasts, excessive deposition of ECM proteins (particularly collagen) and scar formation, ultimately leading to stiffening of the heart wall and greatly compromising heart function.

A deeper knowledge of the molecular and cellular fibrogenic processes is crucial to identify novel targets for therapeutic interventions aimed at diminishing cardiac fibrosis and preventing/reversing cardiac remodelling.

Recent studies have shown that microRNAs control several features of cardiovascular diseases, including cardiac fibrosis. To systematically identify microRNAs that modulate cardiac fibrosis, we performed a series of high-content microscopy functional screenings using a genome-wide library of microRNA mimics (2,588 mature microRNAs). We focused on key phenotypes relevant to cardiac fibrosis, specifically human primary cardiac fibroblast proliferation, myofibroblast differentiation, and deposition of fibrillary collagen under unstimulated and stimulated conditions.

Using this approach, we identified 134 microRNAs that strongly modulate myofibroblast differentiation (4-fold change), as well as a high number of microRNAs that completely block cardiac fibroblast proliferation (166 microRNAs) or that strongly modulate collagen deposition (4-fold change; 227 and 96 microRNAs in unstimulated and stimulated conditions, respectively). Of note, we observed that myofibroblast differentiation is not a pre-requisite for collagen deposition, and that specific microRNAs can modulate these phenotypes independently.

Clustering performed on the global analysis of the phenotypes elicited by each microRNA led to the selection of 92 microRNAs. We confirmed that the phenotypes could be reproduced in human cardiac fibroblasts from different donors and that some of the phenotypes were conserved in fibroblasts isolated from different tissues, including aorta, skin, and lung. Additionally, we performed high-throughput qPCR analysis to identify molecular signatures associated with the effects of these microRNAs on 92 genes implicated in fibrosis-related processes. Based on these data, we selected 8 microRNAs for detailed mechanistic characterization. Seven of these microRNAs strongly block collagen deposition in stimulated conditions, while exhibiting differential effects on cardiac fibroblast differentiation and/or tissue-specific activities, and 1 microRNA increases collagen deposition. Mechanistic studies showed that 3 of these microRNAs target the CDS or 3’UTR of collagen (Col1a1), while the others act through alternative mechanisms.

Overall, our work establishes microRNAs as powerful modulators of multiple processes critical to cardiac fibrosis and offers a unique opportunity for testing different anti-fibrotic approaches based on the differential modulation of these processes by microRNAs.

Examining the Coach Motivation Questionnaire in Fitness Professionals (CMQ-FP): Factor Structure, Invariance, and Predictive Analysis

Purpose: To date, most research on the assessment of motivation has been exerciser-focused and has not considered how fitness professionals' motivations impact their behaviors toward exercisers during training sessions. The purpose of this study was to examine the factor structure of the Coach Motivation Questionnaire in a sample of fitness professionals (CMQ-FP) to ascertain its usefulness for this vocational grouping. Measurement invariance analysis was conducted between female and male fitness professionals, and predictive validity was tested considering need-supportive and need-thwarting behaviors as outcomes. Methods: Participants were 799 fitness professionals (female = 412) aged between 20 and 56 years (M = 28.71, SD = 3.24), who completed a multi-section survey assessing their motivation toward work and their interpersonal behaviors when engaging with exercisers. Results: The results of this research supported all three hypotheses. First, the hypothesized 6-factor measurement model showed acceptable fit to the data. Second, the factor structure of the CMQ-FP was invariant across gender (male and female fitness professionals). Third, fitness professionals' (autonomous or controlled) motivation was a valid predictor of need-supportive or need-thwarting behaviors. Conclusion: This study supported the factor structure of the CMQ-FP, presenting as a valid measure of motivation in fitness professionals. Understanding fitness professionals' perceptions of their coaching motivation can inform professional development activities to assist fitness professionals to increase understanding of what motivates these professionals and how they might be more need-supportive and less need-thwarting in their pedagogical behaviors.

Cauda equina syndrome following combined spinal-epidural anesthesia with levobupivacaine for cesarean section

Cauda equina syndrome (CES) is a rare but possible complication of neuroaxial anesthesia. Damage to the nerve roots may occur due to compression, inflammation, stretching, direct trauma, spinal ischemia or neurotoxicity, usually with lidocaine or bupivacaine. We describe a case of a 33-year-old patient that underwent an uneventful cesarean section with a combined spinal-epidural technique anesthesia, with levobupivacaine. 48 h after the procedure, she presented diminished muscular strength and abolished osteotendinous reflexes in the left lower limb, limited flexion of the right hallux, urinary retention and saddle anesthesia. Imaging exams excluded hematoma, thickening or compression of the cauda equina nerve roots. CES was suspected and treatment was initiated. 9-month follow up revealed diminished osteotendinous reflexes on the left lower limb and perianal hypoesthesia. Despite being unusual, neurological complications require prompt recognition and management to avoid permanent damage.

Adaptation and Validation of a Portuguese Version of the Sports Motivation Scale-II (SMS-II-P) Showing Invariance for Gender and Sport Type

In the present cross-sectional study, we adapted and examined the validity of a Portuguese version of the Sport Motivation Scale II (SMS-II-P) within a sample of 1148 Portuguese athletes (women = 546, men = 602) with a mean age of 18.45 years (SD = 5.36), participating in a variety of sports (i.e., football, basketball, swimming, and athletics). We conducted confirmatory factor analysis, convergent and discriminant validity analysis, and multigroup analysis across participants' sport type (team and individual) and gender. We also examined the correlations between the SMS-II-P behavioral regulations and basic psychological needs satisfaction. The results supported that the SMS-II-P had good psychometric properties and was invariant across gender and sport type. The scale demonstrated good convergent and discriminant validity, and the subscales achieved adequate internal consistency. Correlations between the six types of regulation measured in the SMS-II supported the distinction between autonomous and controlled behavioral regulations, and the correlations between these subscales and other measures of autonomy, competence, and relatedness satisfaction provided evidence of the self-determination continuum. Implications of this research for assessing Portuguese athletes and conducting future research are discussed.

Integrated efforts to promote mental health care during the SARS-CoV-2 pandemic: Reflecting on the experience of a university helpline

Introduction

The SARS-CoV-2 pandemic is affecting numerous dimensions of our society since the beginning of the outbreak. A significant increase in emotional distress was expected in the general population, particularly among the high-risk groups such as the oldest, chronic patients, healthcare professionals, and psychopathology vulnerable people. There was an urgent need to adapt and create solutions to promote mental health. Given the recommendations to minimize face-to-face interactions, several helplines were widely developed.

Objectives

In this work, we aim to reflect on the experience of a university helpline, that integrated efforts with the regional mental health care services.

Methods

A University helpline was created to give support to the regional community outside academia. The team was created on an online teamwork platform, to communicate through the chat, carry videoconference meetings, and store useful files. A Manchester screening decision tree was adopted, to define a set of guidelines to provide support to the callers, based mainly on the guidelines defined by the Order of Portuguese Psychologists. Liaison with the mental health care services, including other specific helplines, was established.

Results

Notwithstanding all the efforts, the number of received calls was scarce, similarly to helplines created by other national universities and by other entities.

Conclusions

A new approach to psychological intervention in crisis is needed, maintaining integrated efforts, and taking advantage of the opportunity to foster personalized mental health care in the digital era. It is important to continuously assess the value of integrated efforts in patient care and to the healthcare system.

MRSA/MSSA causing infections: prevalence of mecA gene

Introduction Staphylococcus aureus is part of the human flora, present in the skin and mucous membranes but can become pathogenic, causing a wide spectrum of infections that were initially treated with penicillin. However, were observed some strains with resistance to this antibiotic and, therefore was developed a new antibiotic, the methicillin. After its introduction, arose the first S. aureus with resistance to methicillin (MRSA) due to the presence of a gene known as mecA that encodes an altered penicillin binding protein (PBP2a). In Europe, it is estimated that MRSA are associated to 44% of hospital acquired infections and its mortality rate is around 20%.

Objectives Prevalence of MRSA strains in different types of infection in Coimbra district.

Methodology Were analysed a total of 539 isolates of S. aureus previously characterized to the antibiotic susceptibility profile in the Hospital and University Center of Coimbra. Through the minimum inhibitory concentration (MIC) of oxacillin we classified our strains into MRSA and S. aureus methicillin-sensitive (MSSA); simultaneously, the mecA gene was detected by Polymerase Chain Reaction (PCR).

Results Of the 539 isolates, 49% were considered MRSA and 51% MSSA. All MRSA isolates express the mecA gene, but from the total of 276 MSSA, 191 show this gene but do not express it. MRSA isolates were mostly from respiratory tract samples (48%) and blood cultures (21%) while MSSA were isolated in skin and soft tissue samples (35%).

Conclusion MRSA are considered one of the primary pathogens for the development of pneumonia and septicaemia due to its highly virulent potential and the increasing expression of genetic determinants of antimicrobial resistance. Therefore, infections caused by MRSA continue with highly representability in the clinical context and their dissemination is a public health problem.

Respiratory infections caused by Haemophilus influenzae β-lactamase positive carrying blaTEM gene

Introduction One of the main etiological agents of respiratory infections is H. Influenzae. The group of antibiotics most used to the treatment of H. influenzae infections is β-lactams. The most common β-lactam resistance is to ampicillin, characterized by the production of TEM (95%) and ROB (5%) β-lactamases, designated enzymatic resistance.

Objectives Characterize the susceptibility profile of H. influenzae to β-lactam antibiotics, to evaluate the enzymatic resistance by the β-lactamase production and to correlate the phenotypic profile with the presence of the blaTEM.

Methodology Total of 152 isolates of H. influenzae from respiratory infections were evaluated: 88 from expectorations, 56 from bronchial aspirates and 8 from bronchoalveolar lavage, collected in Clinical Pathology Service of Centro Hospitalar e Universitário de Coimbra. The results of the antimicrobial susceptibility profile and the β-lactamase screening were also provided. In order to investigate the blaTEM, DNA was extracted from the isolates and the detection was performed using the PCR technique.

Results The prevalence of the blaTEM in the isolates was 31.6%, of these 33.3% showed resistance to ampicillin and 57.9% were positive in β-lactamase activity screening and blaTEM carriers. There was a statistically significance between the presence of the gene with ampicillin resistance and β-lactamase activity screening.

Conclusion β-lactamase TEM production was the main mechanism of enzymatic resistance which demonstrates the high spread of the blaTEM among isolates of H. influenzae. The results found suggest that the negative strains for this β-lactamase but that presented β-lactamases with activity and resistance to β-lactams should have other β-lactamases as ROB or others. However strains with β-lactamase negative should have other mechanisms promoting the resistance as PBP3. This study provides important data on the antibiotic therapy, to minimize the expression of resistance mechanisms and problems associated with treatment.

Sex Differences in Relationships Between Perceived Coach-Induced Motivational Climates, Basic Psychological Needs, and Behavior Regulation Among Young Swimmers

This study analyzed independent and codependent effects of task- and ego-involving motivational climates on basic psychological need satisfaction and behavioral regulation (i.e., autonomous and controlled motivation) among young athletes. Participants were young Portuguese female ( n = 114) and male ( n = 324) swimmers, nested within four different clubs. Participants completed a multisection survey, assessing motivational climates, basic psychological needs satisfaction, and behavioral regulation. We used polynomial regression analysis with surface response methodology to analyze the interactions between these constructs. We found that perceived task- and ego-involving motivational climates were not mutually exclusive; rather, their relationship depended on how athletes perceived coaches’ behaviors and how coaches emphasized one or both climates. Coaches who fostered both motivational climates promoted positive outcomes among male (but not female) athletes.

Subcutaneous emphysema as a complication of the use of a laryngeal mask in a child

The use of supraglottic airway devices has been increasing in popularity, mostly due to their high success rate and low complications. However, there is very little information available about the potential and group specific concerns regarding their use in children. We present the first description of a child that developed subcutaneous emphysema after the use of a laryngeal mask. We believe that more awareness to the risk of perioperative adverse events with laryngeal mask insertion in the paediatric population is needed.

Last Interglacial Iberian Neandertals as fisher-hunter-gatherers

Marine food-reliant subsistence systems such as those in the African Middle Stone Age (MSA) were not thought to exist in Europe until the much later Mesolithic. Whether this apparent lag reflects taphonomic biases or behavioral distinctions between archaic and modern humans remains much debated. Figueira Brava cave, in the Arrábida range (Portugal), provides an exceptionally well preserved record of Neandertal coastal resource exploitation on a comparable scale to the MSA and dated to ~86 to 106 thousand years ago. The breadth of the subsistence base-pine nuts, marine invertebrates, fish, marine birds and mammals, tortoises, waterfowl, and hoofed game-exceeds that of regional early Holocene sites. Fisher-hunter-gatherer economies are not the preserve of anatomically modern people; by the Last Interglacial, they were in place across the Old World in the appropriate settings.

Erratum to "Gastroenteropancreatic Neuroendocrine Neoplasia Characterization in Portugal: Results from the NETs Study Group of the Portuguese Society of Endocrinology, Diabetes and Metabolism"

[This corrects the article DOI: 10.1155/2019/4518742.].

Fabrication and characterization of polyimide-based 'smooth' titanium nitride microelectrode arrays for neural stimulation and recording

OBJECTIVE

As electrodes are required to interact with sub-millimeter neural structures, innovative microfabrication processes are required to enable fabrication of microdevices involved in such stimulation and/or recording. This requires the development of highly integrated and miniaturized systems, comprising die-integration-compatible technology and flexible microelectrodes. To elicit selective stimulation and recordings of sub-neural structures, such microfabrication process flow can beneficiate from the integration of titanium nitride (TiN) microelectrodes onto a polyimide substrate. Finally, assembling onto cuffs is required, as well as electrode characterization.

APPROACH

Flexible TiN microelectrode array integration and miniaturization was achieved through microfabrication technology based on microelectromechanical systems (MEMS) and complementary metal-oxide semiconductor processing techniques and materials. They are highly reproducible processes, granting extreme control over the feature size and shape, as well as enabling the integration of on-chip electronics. This design is intended to enhance the integration of future electronic modules, with high gains on device miniaturization.

MAIN RESULTS

(a) Fabrication of two electrode designs, (1) 2 mm long array with 14 TiN square-shaped microelectrodes (80  ×  80 µm²), and (2) an electrode array with 2 mm  ×  80 µm contacts. The average impedances at 1 kHz were 59 and 5.5 kΩ, respectively, for the smaller and larger contacts. Both designs were patterned on a flexible substrate and directly interconnected with a silicon chip. (b) Integration of flexible microelectrode array onto a cuff electrode designed for acute stimulation of the sub-millimeter nerves. (c) The TiN electrodes exhibited capacitive charge transfer, a water window of  -0.6 V to 0.8 V, and a maximum charge injection capacity of 154  ±  16 µC cm^-2.

SIGNIFICANCE

We present the concept, fabrication and characterization of composite and flexible cuff electrodes, compatible with post-processing and MEMS packaging technologies, which allow for compact integration with control, readout and RF electronics. The fabricated TiN microelectrodes were electrochemically characterized and exhibited a comparable performance to other state-of-the-art electrodes for neural stimulation and recording. Therefore, the presented TiN-on-polyimide microelectrodes, released from silicon wafers, are a promising solution for neural interfaces targeted at sub-millimeter nerves, which may benefit from future upgrades with die-electronic modules.

Motivational patterns in persistent swimmers: A serial mediation analysis

Objective: The main objective of the present study was to examine the associations between coach-created task-involving climate and athletes' intentions to continue practicing sport, through a serial mediation analysis that included basic psychological needs satisfaction (BPN), self-determined motivation (SDM) and enjoyment. Methods: Seven-hundred and ninety-nine elite swimmers (450 males, 349 females; aged 12-22 years, M = 16.65, SD = 2.83) participated in the present study. Groups were created according to age, years of experience, and gender. Results: Serial mediation analysis provided support for the proposed model where BPN's and enjoyment represent the most important mediators between task-involving climate and athletes' intentions to continue sport practice. Conclusion: Enjoyment stands out as the most relevant predictor of intention to persist and as a significant mediator in the relation between task-involvement climate, BPN, SDM, and long-term sports practice. The task-involving climate created by coaches appears to set in motion a sequence where the satisfaction of basic needs and SDM lead to more enjoyment and increased persistence among young athletes.

Immunohistochemistry for diagnosis and prognosis of breast cancer: a review

Breast cancer is the most prevalent malignant tumor and main oncologic cause of mortality in women. Although most diagnosis of breast pathology is accomplished using hematoxylin and eosin stained sections, some cases require immunohistochemistry for proper evaluation. We investigated the latter cases including distinctions between ductal and lobular carcinoma, in situ and invasive carcinoma, typical ductal hyperplasia and atypical ductal hyperplasia/ductal carcinoma in situ, papillary and spindle cell lesion assessment, metastasis evaluation, and assessment of prognostic and therapy markers. E-cadherin is used to differentiate ductal and lobular carcinoma; 34βE12, CK8, p120 catenin and β-catenin also produce consistent results. Myoepithelial cell (MEC) stains are used to evaluate in situ and invasive carcinoma; calponin, smooth muscle myosin heavy chain and p63 are sensitive/specific markers. 34βE12 and CK5/6 are positive in ductal hyperplasia, which enables its differentiation from atypical ductal hyperplasia and ductal carcinoma in situ. CK 5/6, ER and MEC markers are consistent options for evaluating papillary lesions. Spindle cell lesions can be assessed using β-catenin, SMA, CD34, p63, CKs and hormone receptors. It is important to differentiate primary carcinomas from metastases; the most commonly used markers to identify breast origin include mammaglobin, GCDFP-15, GATA3 and ER, although none of these is completely sensitive or specific. Immunohistochemistry can be used to evaluate central prognostic and predictive factors including molecular subtypes, HER2, hormone receptors, proliferation markers (Ki-67) and lymph-vascular invasion markers including ERG, CD31, CD34, factor VIII and podoplanin. Owing to the complexity of mammary lesions, diagnosis also depends on each particular situation, evaluation of cytological characteristics revealed by immunochemistry and correlation with histological findings.

Predictors and outcomes of disseminated tuberculosis in an intermediate burden setting

SETTING

University-affiliated hospital located in Porto, North Portugal, an area with a low to intermediate incidence of tuberculosis (TB).

OBJECTIVE

To identify predictors and outcomes of disseminated TB (dTB).

DESIGN

A cohort of patients diagnosed with TB between 2007 and 2013 was retrospectively analysed. Patients with dTB criteria were characterized and compared to single organ TB cases. Factors independently associated with dTB were determined by multivariate logistic regression analysis.

RESULTS

A total of 744 patients were analysed, including 145 with dTB. Independent risk factors for dTB were pharmacological immunosuppression (OR 5.6, 95% CI 2.8-11.3), HIV infection (OR 5.1, 95% CI 3.1-8.3), chronic liver failure or cirrhosis (OR 2.3, 95% CI 1.4-4.1) and duration of symptoms (OR 2.3, 95% CI 1.4-3.8). Compared to single organ TB, the clinical presentation of dTB patients differed by the absence of haemoptysis (OR 3.2, 95% CI 1.3-8.4) and of dyspnoea (OR 1.9, 95% CI 1.2-3.1), presence of weight loss (OR 1.8, 95% CI 1.1-2.9), night sweats (OR 1.7, 95% CI 1.1-2.7) and bilateral lung involvement (OR 4.4, 95% CI 2.8-7.1). Mortality and time until culture conversion were higher for dTB patients, although not reaching statistical significance.

CONCLUSION

Immunosuppressive conditions and chronic liver failure or cirrhosis were associated with increased risk of dTB. The haematogenous spread may be dependent on longer symptomatic disease and usually progresses with bilateral lung involvement.

Abstract P5-09-09: CHEK2: the third susceptibility BReast CAncer (BC) gene?

INTRODUTION:

Considered a medium penetrance gene, CHEK2 codes for a kinase that is a key component of the DNA damage-signaling pathway. CHEK2 pathogenic variants were previously associated with breast and colorectal families and also with Li-Fraumeni phenotypes. Next generation sequencing (NGS) allowed for systematic inclusion of CHEK2 into gene panels. In here, we characterize the growing subgroup of CHECK2 BC families identified through our multidisciplinary program.

METHODS: Identification and review of CHEK2 families identified between 01/2000-06/2018 (until 2014 only the c.1100delC was tested (MLPA, MRC Holland); since 2014 NGS methods used were either,Trusight Cancer sequencing panel (Illumina, San Diego, CA, USA) or BRCA MASTR Dx (Multiplicom, Niel, Belgium). Carriers were included in a prospective follow up program.

RESULTS: 3646 index pts consented on gene testing. Most hereditary families (HF) were BRCA1/2 (374) (92%) but among non-BRCA HF bigger subgroups were 16 CHEK2, 10 Tp53 and 5 PALB2 HF. All CHEK2 index pts were diagnosed with only 3 different pathogenic variants: c.1100delC (9) c.319+2T&gt;A (6) and c.593-1G&gt;T (1 case of the only male BC pt in all CHEK2 pedigrees).

Index pts: mostly (93,8%) to females, with a mean age at first cancer diagnosis of 39 years (yrs) (30-52), 62,5% between 30-39yrs. With the exception of a Non Hodgking's Lymphoma index case, all index pts had BC(93,8%), 68,8% of which were ductal carcinomas and 12,5% of intraductal, all strongly positive for the estrogen receptor. With a mean follow up of 8,26yrs (3-15), secondary cancer cases occurred in 37,5% of index pts (mostly, 12,5%, BC at a mean of 53yrs (41-59).

Family phenotypes: data form 98 relatives (53,5% females) revealed diagnoses of BC (31,6%), prostate (8,1%), colorectal (7,1%) cancers. Only 22,2% of family cancers were diagnosed before 50yrs.

VUS: Among several complex variants of unknown significance, c.1036C&gt;T;p.Arg346Cys co-segregates in a predominantly male family with 3 prostate, 1 male and 1 female BC.

DISCUSSION AND CONCLUSIONS:

In the Portuguese population, emerging recurrent pathogenic variants in the CHEK2 gene, make it the most important non-BRCA BC gene so far. Carriers are included in prospective follow up but non-CHEK2 relatives are a challenge to genetic testing, as well as pedigree review, that questions its classification as a medium penetrance gene (or suggest the role of modifier factors).

Citation Format: Gomes VL, Machado P, Fragoso S, Santos S, Coelho I, Parreira J, Rodrigues P, Rodrigues F, Clara A, Bento S, Luís A, Opinião A, Vaz F. CHEK2: the third susceptibility BReast CAncer (BC) gene? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-09.

Gastroenteropancreatic Neuroendocrine Neoplasia Characterization in Portugal: Results from the NETs Study Group of the Portuguese Society of Endocrinology, Diabetes and Metabolism

BACKGROUND

The incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) has been increasing in the last five decades, but there is no large-scale data regarding these tumours in Portugal. We conducted a cross-sectional, multicentric study in main Portuguese centers to evaluate the clinical, pathological, and therapeutic profile of GEP-NENs.

METHODS

From November, 2012, to July, 2014, data from 293 patients diagnosed with GEP-NENs from 15 centers in Portugal was collected and registered in an online electronic platform.

RESULTS

Median age at diagnosis was 56.5 (range: 15-87) years with a preponderance of females (54.6%). The most frequent primary sites were the pancreas (31.1%), jejunum-ileum (24.2%), stomach (13.7%), and rectum (8.5%). Data regarding hormonal status was not available in most patients (82.3%). Stratified by the tumour grade (WHO 2010 classification), we observed 64.0% of NET G1, 24.7% of NET G2, and 11.3% of NEC. Poorly differentiated tumours occurred mainly in older patients (p = 0.017), were larger (p < 0.001), and presented more vascular (p = 0.004) and lymphatic (p = 0.001) invasion. At the time of diagnosis, 44.4% of GEP-NENs presented metastatic disease. Surgery (79.6%) and somatostatin analogues (30.7%) were the most frequently used therapies of GEP-NENs with reported grading.

CONCLUSION

In general, Portuguese patients with GEP-NENs presented similar characteristics to other populations described in the literature. This cross-sectional study represents the first step to establish a national database of GEP-NENs that may aid in understanding the clinical and epidemiological features of these tumours in Portugal.

Smart Healthy Age-Friendly Environments - Policy Recommendations of the Thematic Network SHAFE

The European Commission (DG SANTE) launched a call for proposals in November 2017 on strategic initiatives for a Joint Statement in 2018. Ten proposals were voted until December 7th in the European Union Health Policy Platform[1]; the proposal under the theme Smart Healthy Age-Friendly Environments (SHAFE)[2] was the most voted and was confirmed by the European Commission in March 2018. In this context, since March 2018, Cáritas Coimbra and AFEdemy Ltd are thus coordinating one of the three Thematic Networks for 2018, SHAFE, in close cooperation with main partners, such as the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), the European Innovation Partnership on Smart Cities and Communities (EIP-SCC), the Reference Sites Collaborative Network, the European Covenant on Demographic Change, Eurocities, the European Health Telematics Association (EHTEL), the European Connected Health Alliance (ECHAlliance), the European Construction, Built Environment and Energy Efficient Building Technology Platform (ECTP) and the European Centre for Social Welfare Policy and Research. SHAFE aims to facilitate the creation of healthy and friendly environments for all ages through the use of new technologies, towards the production of a comprehensive and participatory Joint Statement. This document was presented to the European Commission on 12 November 2018, with five main areas of recommendations to the EC, Member States and other local, regional and national organisations and is open for endorsement and implementation from this date onwards.

[Familial Mediterranean fever]

Familial Mediterranean Fever (FMF) is the most frequent monogenic auto-inflammatory disease. FMF is an autosomal recessive disease, which affects populations from Mediterranean origin and is associated with MEFV gene mutations encoding for the protein pyrin. Pyrin activation enhances the secretion of interleukin 1 by myelo-monocytic cells. Main features of the disease are acute attacks of serositis mainly located on the abdomen, less frequently on chest and joints, accompanied by fever and biological inflammatory markers elevation. Usually attacks last 1 to 3 days and spontaneously stop. A daily oral colchicine intake of 1 to 2mg/day is able to prevent attack's occurrence, frequency, intensity and duration among most patients. Colchicine is also able to prevent the development of inflammatory amyloidosis, the most severe complication of FMF. This state of the art article will focus on the diagnosis of FMF, the treatment and an update on the pathophysiology including the recent described dominant form of MEFV-associated new auto-inflammatory diseases.