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Carrasco D, Guedes-Martins L. Cardiac Axis in Early Gestation and Congenital Heart Disease. Curr Cardiol Rev 2024; 20:CCR-EPUB-137797. [PMID: 38279755 PMCID: PMC11071675 DOI: 10.2174/011573403x264660231210162041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/06/2023] [Accepted: 10/17/2023] [Indexed: 01/28/2024] Open
Abstract
Congenital heart defects represent the most common structural anomalies observed in the fetal population, and they are often associated with significant morbidity and mortality. The fetal cardiac axis, which indicates the orientation of the heart in relation to the chest wall, is formed by the angle between the anteroposterior axis of the chest and the interventricular septum of the heart. Studies conducted during the first trimester have demonstrated promising outcomes with respect to the applicability of cardiac axis measurement in fetuses with congenital heart defects as well as fetuses with extracardiac and chromosomal anomalies, which may result in improved health outcomes and reduced healthcare costs. The main aim of this review article was to highlight the cardiac axis as a reliable and powerful marker for the detection of congenital heart defects during early gestation, including defects that would otherwise remain undetectable through the conventional four-chamber view.
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Affiliation(s)
- D. Carrasco
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto, Serviço de Obstetrícia - Centro Materno Infantil do Norte, Porto 4099-001, Portugal
| | - L. Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto, Serviço de Obstetrícia - Centro Materno Infantil do Norte, Porto 4099-001, Portugal
- Centro Hospitalar Universitário do Porto EPE, Centro Materno Infantil do Norte, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
- Unidade de Investigação e Formação-Centro Materno Infantil do Norte, 4099-001 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, 4200-319, Portugal
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Sofia-Gonçalves A, Guedes-Martins L. Nuchal Translucency and Congenital Heart Defects. Curr Cardiol Rev 2024; 20:1-13. [PMID: 38275068 DOI: 10.2174/011573403x264963231128045500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/18/2023] [Accepted: 10/17/2023] [Indexed: 01/27/2024] Open
Abstract
Nuchal translucency comprises a temporary accumulation of fluid in the subcutaneous tissue on the back of a fetus's neck, which accompanies the crown-rump length and is observed through an ultrasound performed between 11 and 13 weeks + 6 days gestation. Nuchal translucency is considered to be above normal when values are higher than the 95th/99th percentile or equal to or higher than 2.5/3.5 mm. The first connection between increased nuchal translucency and the presence of congenital heart defects is described in the study of Hyett et al., who observed that they are directly proportional. Since that time, several studies have been conducted to understand if nuchal translucency measurements can be used for congenital heart defect screening in euploid fetuses. However, there is great variability in the estimated nuchal translucency cutoff values for congenital heart defect detection. The purpose of this review was to understand how increased nuchal translucency values and congenital heart defects are related and to identify which of these defects are more frequently associated with an increase in these values.
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Affiliation(s)
- A Sofia-Gonçalves
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313, Porto, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto - Centro Materno Infantil do Norte, 4099-001, Porto, Portugal
| | - L Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313, Porto, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto - Centro Materno Infantil do Norte, 4099-001, Porto, Portugal
- Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar Universitário do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
- Unidade de Investigação e Formação - Centro Materno Infantil do Norte, 4099-001, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319, Porto, Portugal
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Portela Dias J, Guedes-Martins L. Fetal Pulmonary Venous Return: From Basic Research to the Clinical Value of Doppler Assessment. Pediatr Cardiol 2023; 44:1419-1437. [PMID: 37505268 PMCID: PMC10435640 DOI: 10.1007/s00246-023-03244-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
The fetal pulmonary circulation represents less than 25% of the fetal cardiac output. In comparison with the pulmonary arteries, studies on pulmonary veins are few and limited, and many questions remain to be answered. The literature reports that pulmonary veins play an important role in regulating vascular flow, forming an active segment of the pulmonary circulation. The development of more sophisticated ultrasonography technology has allowed the investigation of the extraparenchymal pulmonary veins and their waveform. The recognition of the pulmonary vein anatomy in echocardiography is important for the diagnosis of anomalous pulmonary venous connections, with a significant impact on prognosis. On the other hand, the identification of the normal pulmonary vein waveform seems to be a reliable way to study left heart function, with potential applicability in fetal and maternal pathology. Thus, the goal of this narrative review was to provide a clinically oriented perspective of the available literature on this topic.
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Affiliation(s)
- J Portela Dias
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313, Porto, Portugal.
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar e Universitário de Santo António, Largo da Maternidade Júlio Dinis 45, 4050-651, Porto, Portugal.
- Unidade de Investigação e Formação - Centro Materno Infantil do Norte, 4050-651, Porto, Portugal.
| | - L Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313, Porto, Portugal
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar e Universitário de Santo António, Largo da Maternidade Júlio Dinis 45, 4050-651, Porto, Portugal
- Unidade de Investigação e Formação - Centro Materno Infantil do Norte, 4050-651, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal
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Meneses Alves T, Martins M, Cunha A, Costa C, Ferreira L, Carreira L, Guedes-Martins L, Braga J. 128 Termination of pregnancy for fetal abnormality in a portuguese tertiary care hospital: Two-year retrospective study. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Barros T, Soares C, Andrade A, Moreira C, Guedes-Martins L, Braga J. 213 Case report: fetal malformations and 3P22.2P21.2 Deletion. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mendes S, Timóteo-Ferreira F, Soares AI, Rodrigues AR, Silva AMN, Silveira S, Matos L, Saraiva J, Guedes-Martins L, Almeida H, Silva E. Age-related oxidative modifications to uterine albumin impair extravillous trophoblast cells function. Free Radic Biol Med 2020; 152:313-322. [PMID: 32224083 DOI: 10.1016/j.freeradbiomed.2020.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/13/2020] [Accepted: 03/23/2020] [Indexed: 01/05/2023]
Abstract
Advanced maternal age is associated not only with a significant reduction in fertility but also with an additional risk of developing pregnancy-related disorders. Most of these disorders are now believed to be the clinical manifestation of an incorrect placentation, namely deficient transformation of maternal spiral arteries and ineffective trophoblast invasion through uterine stroma. In the present study it was hypothesized that an age-related loss in uterine redox homeostasis interferes with the function of extravillous trophoblasts (EVTs) and placentation. To test this hypothesis, relative levels of oxidatively modified proteins were evaluated in human samples from placenta and placental bed, and the role of specific oxidative modifications to proteins in placentation was studied using a cell culture model of EVTs. In the placental bed, the carbonylation level of a 66 kDa protein (identified as albumin) presented a strong, positive and significant correlation with maternal age. Albumin was immunodetected preferentially in endothelial cells and connective tissue between muscle fascicles. In vitro results showed that carbonylated albumin overload did not alter cell viability, but reduced EVTs motility and triggered cell stress response pathways. Moreover, EVTs presented decreased ability to adhere to and invade a collagen extracellular matrix pre-treated with carbonylated albumin. In conclusion, reproductive ageing is accompanied by an increase in maternal uterine carbonylated albumin, that may have a deleterious role in the modulation of EVTs function.
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Affiliation(s)
- S Mendes
- Ageing and Stress, Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação Em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal; Unidade de Biologia Experimental, Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - F Timóteo-Ferreira
- Ageing and Stress, Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação Em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal; Unidade de Biologia Experimental, Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - A I Soares
- Ageing and Stress, Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação Em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal; Unidade de Biologia Experimental, Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - A R Rodrigues
- Ageing and Stress, Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação Em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal; Unidade de Biologia Experimental, Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - A M N Silva
- REQUIMTE-LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, Rua do Campo Alegre, s/n, 4169-007, Porto, Portugal.
| | - S Silveira
- Unidade de Biologia Experimental, Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - L Matos
- Ageing and Stress, Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação Em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal; Faculdade de Medicina Dentária, Universidade do Porto, Rua Dr. Manuel Pereira da Silva, 4200-393, Porto, Portugal; Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal.
| | - J Saraiva
- Ageing and Stress, Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação Em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal; Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - L Guedes-Martins
- Ageing and Stress, Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação Em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal; Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - H Almeida
- Ageing and Stress, Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação Em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal; Unidade de Biologia Experimental, Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal; Ginecologia-Obstetrícia, Hospital-CUF Porto, Estrada da Circunvalação 14341, 4100-180, Porto, Portugal.
| | - E Silva
- Ageing and Stress, Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação Em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal; Unidade de Biologia Experimental, Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
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Guedes-Martins L, Silva E, Gaio AR, Saraiva J, Soares AI, Afonso J, Macedo F, Almeida H. Fetal-maternal interface impedance parallels local NADPH oxidase related superoxide production. Redox Biol 2015; 5:114-123. [PMID: 25912167 PMCID: PMC4412968 DOI: 10.1016/j.redox.2015.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 12/19/2022] Open
Abstract
Blood flow assessment employing Doppler techniques is a useful procedure in pregnancy evaluation, as it may predict pregnancy disorders coursing with increased uterine vascular impedance, as pre-eclampsia. While the local causes are unknown, emphasis has been put on reactive oxygen species (ROS) excessive production. As NADPH oxidase (NOX) is a ROS generator, it is hypothesized that combining Doppler assessment with NOX activity might provide useful knowledge on placental bed disorders underlying mechanisms. A prospective longitudinal study was performed in 19 normal course, singleton pregnancies. Fetal aortic isthmus (AoI) and maternal uterine arteries (UtA) pulsatility index (PI) were recorded at two time points: 20-22 and 40-41 weeks, just before elective Cesarean section. In addition, placenta and placental bed biopsies were performed immediately after fetal extraction. NOX activity was evaluated using a dihydroethidium-based fluorescence method and associations to PI values were studied with Spearman correlations. A clustering of pregnancies coursing with higher and lower PI values was shown, which correlated strongly with placental bed NOX activity, but less consistently with placental tissue. The study provides evidence favoring that placental bed NOX activity parallels UtA PI enhancement and suggests that an excess in oxidation underlies the development of pregnancy disorders coursing with enhanced UtA impedance.
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Affiliation(s)
- L Guedes-Martins
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Porto, Portugal; Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
| | - E Silva
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Porto, Portugal.
| | - A R Gaio
- Department of Mathematics, Faculty of Sciences, University of Porto, Rua do Campo Alegre, 4169-007 Porto, Portugal; CMUP-Centre of Mathematics of the University of Porto, Rua do Campo Alegre, 4169-007 Porto, Portugal.
| | - J Saraiva
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Porto, Portugal; Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
| | - A I Soares
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Porto, Portugal.
| | - J Afonso
- Department of Pharmacology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
| | - F Macedo
- Department of Cardiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
| | - H Almeida
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Porto, Portugal; Obstetrics-Gynecology, Hospital-CUF Porto, 4100 180 Porto, Portugal.
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Guedes-Martins L, Cunha A, Saraiva J, Gaio R, Macedo F, Almeida H. Internal iliac and uterine arteries Doppler ultrasound in the assessment of normotensive and chronic hypertensive pregnant women. Sci Rep 2014; 4:3785. [PMID: 24445576 PMCID: PMC3896929 DOI: 10.1038/srep03785] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/02/2014] [Indexed: 11/21/2022] Open
Abstract
The objective of this work was to compare Doppler flows pulsatility index (PI) and resistance indexes (RI) of uterine and internal iliac arteries during pregnancy in low risk women and in those with stage-1 essential hypertension. From January 2010 and December 2012, a longitudinal and prospective study was carried out in 103 singleton uneventful pregnancies (72 low-risk pregnancies and 31 with stage 1 essential hypertension)at the 1st, 2nd and 3rd trimesters. Multiple linear regression models, fitted using generalized least squares and whose errors were allowed to be correlated and/or have unequal variances, were employed; a model for the relative differences of both arteries impedance was utilized. In both groups, uterine artery PI and RI exhibited a gestational age related decreasing trend whereas internal iliac artery PI and RI increased. The model testing the hemodynamic adaptation in women with and without hypertension showed similar trend. Irrespective of blood pressure conditions, the internal iliac artery resistance pattern contrasts with the capacitance pattern of its immediate pelvic division, suggesting a pregnancy-related regulatory mechanism in the pelvic circulation.
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Affiliation(s)
- L Guedes-Martins
- 1] Departamento de Biologia Experimental, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal [2] IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal [3] Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - A Cunha
- Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - J Saraiva
- Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - R Gaio
- 1] Department of Mathematics, Faculty of Sciences of the University of Porto, Portugal [2] CMUP-Centre of Mathematics of the University of Porto, Portugal
| | - F Macedo
- 1] Departamento de Medicina, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal [2] Centro Hospitalar S. João, 4200-319 Porto, Portugal
| | - H Almeida
- 1] Departamento de Biologia Experimental, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal [2] IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal [3] Ginecologia-Obstetrícia, Hospital-CUF Porto, 4100 180 Porto, Portugal
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Guedes-Martins L, Matos L, Soares A, Silva E, Almeida H. AGEs, contributors to placental bed vascular changes leading to preeclampsia. Free Radic Res 2013; 47 Suppl 1:70-80. [PMID: 23796030 DOI: 10.3109/10715762.2013.815347] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Glycation of proteins or other biomolecules and their further long-term degradation result in the formation of advanced glycation end products, AGEs. AGEs and other ligands interact with their receptors, RAGEs, localized to a variety of tissues, but mainly in endothelium and vascular wall cells. This interaction triggers diverse signaling pathways that converge on the activation of NF-κB and the initiation of a local inflammatory reaction that, when prolonged, results in dysfunctional features. Preeclampsia is a serious vascular disorder centred at the placenta-uterine interface, the placental bed, but the condition extends to the mother's circulation. RAGEs have notorious expression in the placental bed tissues along pregnancy but, in addition, RAGEs and their ligands are expressed in the fetal membranes and are found in the amniotic fluid and the mother's serum. Disorders complicating pregnancies and having an important vascular involvement, as preeclampsia and diabetes mellitus, have additional enhanced AGE/RAGE expression variation. This indicates that for their assessment, the assay of RAGEs or their ligands may become useful diagnostic or prognostic procedures.
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Affiliation(s)
- L Guedes-Martins
- Departamento de Biologia Experimental, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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